Konstantin Ronkin, DMD

Periodically B. professional activity We face situations when one or another method of diagnosis or treatment is based on the opinion, previously expressed and repeated for decades, rather than scientifically based facts. Similar opinions over time acquire the status of laws, and sometimes they are difficult to distinguish from the truth. In fact, they are nothing more than myths who flood our specialty.
The other category of myths make up the results are not sufficiently carefully made or not until the end of proven research. For example, not quite a correct study conducted in England in the nineties of the last century showed the negative impact of bleaching procedure on solid tissue of teeth, which led the dentistry of this country 20 years ago on the issue of teeth whitening. A few years later, the study was repeated, the results of the initial tests were not confirmed, but the myth of the dangers of bleaching still twists in dental circles, despite hundreds positive results scientific works conducted in many countries of the world.
Extremely common and survival are myths related to the field of aesthetic and functional dentistry. I must say that they interest me more than any others. Let's try to deal with some of them in this article.

Myth first - bite height

According to this myth, it is impossible to increase the height of the bite is simultaneously more than 2 mm in constructing occlusion during orthopedic, therapeutic or or-todontic treatment. This myth today undergoes some correction. Part of the doctors expanded the framework to 4 and even 6 mm.
However, in general, there is a certain figure, within which we are allowed to raise the bite. Let's figure it out. Movement of the jaw is carried out on a certain trajectory (Fig. 1).

Fig. 1. Movement lower jaw It is carried out by the usual pathological trajectory due to the presence of supercontacts in the field of the upper front teeth, which can cause muscle hypertonus.

The position of this trajectory in the skull space is influenced by many factors. Congenital pathology of the joints and jaws, bite anomalies, dysfunction of the VGC joints, erasing of the teeth as a result of Bruxism or Clancha, ascending problems associated with the violation of the posture, the narrowing of the respiratory tract. The special group contains the factors that we create: incorrectly made composite or ceramic restoration, not conducted by selective sealing after orthodontic treatment, not a manufactured apparatus to prevent the displacement of neighboring teeth with early loss of the molar, an untreated crowded position of the teeth or deformation of the dentition, etc. - All this can lead to the emergence of supercontacts.
Due to proprioceptive transmission, the central nervous system receives a signal about the presence of such premature contact. The CNS sends the impulse back to the muscles, forcing them to change the position of the jaw so that the teeth do not stumble upon these supercontacts during closure. This phenomenon was called the "Assignment Syndrome of a negative impact." Thus, the neuromuscular system, controlling the movement of the lower jaw to bypass the supercontact, moves it by the changed - pathological trajectory (Fig. 2).

Fig. 2. Pathological trajectory of the lower jaw on axiographies. Crossing curves indicates the occlusion causes of the trajectory change.

Why pathological? Because some muscles should constantly work with overvoltage to move the jaw along the modified trajectory (Fig. 1). As a result, their hypertonus arises, over time, spasm and, finally, chronic fatigue. The AMC as a result of such a displacement of the lower jaw with the physiological trajectory, also undergo changes, which can be expressed in the displacement of the articular head from the central position, the joint deformation, the disk offset (Fig. 3).

Fig. 3. The pathology of the joint with the front displacement of the disc and the morphological change.

If such a patient has decreased the height of the bite and the vertical PWM-Bachi index is 3 mm (Fig. 4), the restoration of his bite of "on the eyes" more than 2 mm can cause unpleasant symptoms and exacerbate pathology. And in this case, supporters of the myth of 2 mm will be absolutely right.

Fig. 4. Changing the position of the lower jaw in the patient as a result of pathological washelling and dysfunction of the ENCH: Shimbachi index \u003d 3mm, the planned width of the central incisors \u003d 8 mm, the LVI \u003d 17.75 mm index.

First of all, let us find out how much it is necessary to increase the height of the lower third of the face and, accordingly, the bite (I apologize in advance from those of you who are accustomed to another terminology, but I hope to be understood). According to the aesthetic index of LVI, with the width of central incisors, an 8 mm vertical index should be 17.75 mm. That is, ideally, we need to "reveal" a bite of more than 14 mm. Oh! And I assure you that if such a patient, in which the lower jaw moves along the pathological trajectory, increase the height of 14 mm, you risk obtaining complete symptomatics of the ENCH dysfunction.
Another method of determining the right position of the lower jaw in the restoration of the bite height is the relaxation of the muscles using the J5 Momonitor (Miotronix Company) - Fig. five.

Fig. 5. Electronostimulation using the Momonitor.

As a result of such relaxation, the lower jaw is shifted to the true position of the physiological rest and restores the physiological neuromuscular trajectory of the lower jaw movement (Fig. 6).

Fig. 6. The axiography of the movement of the lower jaw. As a result of the relaxation of the muscles, the lower jaw moves with the usual (blue and green lines) on the neuromuscular trajectory (dotted line), and under the action of electriumplots from the myomonitor
Moves on the position of physiological rest (red dot), to the planned neuromuscular occlusion (black point). The neuromuscular trajectory in this case is located 3.5 mM Kepende from the usual, and the neuromuscular occlusion is located at a point located 3.5 mm on the Sagitaly, 3.6 vertically and 0.5 mm horizontally left on the position of the usual occlusion.

With the help of axiographies and myography, we can determine the individual distance of physiological rest (distance from the position of physiological peace to central occlusion) - Fig. 7.

Fig. 7. Axiography allows you to determine the individual distance of physiological rest.

However, it is possible to use a medium value that is 1.5 - 2 mm. Climbing the neuromusc trajectory for this distance from the position of physiological peace, we will find a point in which the lower jaw in the vertical dimension should be (Fig. 6). As a rule, the LVI index and the method based on the determination of the position of physiological rest coincide. The main thing is that the jaw moves along the neuromuscane trajectory, which may in some cases be a few millimeters from the usual. The movement of the lower jaw on the neuromuscular trajectory is provided by ultra-low-frequency electron-stimulation with the help of a mycomonitor.
In such a situation, we can increase the height of bite by 10 and 15 mm, and it becomes possible to move the lower jaw to the situation in which the muscles will feel comfortable, be in a relaxed, balanced state. The K7 system allows you to observe the muscle condition on the computer screen in any position of the lower jaw in real time (Fig. 7). Therefore, we can see the condition of the muscles at the point we have identified on the neuromuscane trajectory according to the LVI index or relative to the position of physiological peace. And if the muscles are relaxed at easy pricked bite at this point, it confirms the correctness of our choice (Fig. 8).

Fig. 8. Miography of chewing muscles. The left part shows the muscle tone in a relaxed state, the middle part - with easy pricked bite at the point of neuromuscular occlusion, the right side is easy pricing in the usual occlusion. Tonus of muscles when pricked in the usual occlusion is higher than when pricking on the registration position in the position of neuromuscular occlusion.

In addition, we can define an occlusal comfort zone for each patient. This zone looks like a cylinder located along the neuromuscular trajectory. In most patients, the height of the cylinder exceeds its length and averages 5-7 mm, with the exception of a group of patients with Clanch (Fig. 9).

Fig. 9. The comfort zone looks like a cylinder with a large vertical size.

Within the comfort zone, you can find the optimal position of the lower jaw for this patient, corresponding to the tasks of treatment. The position of the jaw determines the muscle tone, and not an average digital value. Of course, the position of the jaw must be confirmed by the radiographically correct position of the articular head.
Thus, the state of the muscles and the neuromuscular trajectory determine how much bite the height can increase, and not the average, and in practice we can see an increase in the height to 15 - 18 mm.

Myth Second - Ceramic Restorations in the Side

The above data allow you to debunk another myth, according to which it is impossible to make ceramic restorations in the field of molars.
First of all, modern extruded ceramics (EMPRESS) for strength is not inferior to the compound of ceramics with metal in metal-based restoration, not to mention restorations from high-strength E-Max material, Ivoclar company. Secondly, if you prostate the patient in optimal occlusion, in which the muscles are in a balanced relaxed state, when the lower jaw operates on the neuromuscane trajectory and created the optimal microcircuit with all the rules of heatology, the load on the restoration in the lateral portions of the dental series makes it possible to use ceramic restorations . The experience of using the restorations from the material in the complete reconstruction of the dental rows in our institute showed the effectiveness of the use of ceramic restorations on lateral teeth. When checking the remote results (8-15 years) in a group of 43 patients after a complete reconstruction of ceramic restorations, 89% of patients did not observe any chips, breakdowns, facets, washes, separation or loss of teeth (Fig. 10).

Fig. 10. Restoration of teeth using crowns, veneers and lining
Empress.

Conclusion

Of course, we must use the achievements of modern science and introduce high technologies in everyday practices in order not to be in captivity of such and many other myths.

The article is provided by the Boston Institute for Aesthetic Dentistry

Raise the height of the bite due to an increase in the height of the coronal part with the help of sealing material. We use modern light composites that effectively fill the shape of the tooth.

To create accurate restorations and designs, we apply facial arc. The device that is fixed on the head to register your jaw in different directions to make a personal cast. Then the latter is transferred to articulator - The device that reproduces the trajectory and helps simulate the appropriate restoration given individual features Back at the planning stage of treatment.

Brequet Systems

We refund you the right relationship of the jaws using braces. In our dentistry, 4 reliable techniques are classic and innovative. They will cope with the most difficult orthodontic task.

What method of treatment will suit you? The choice largely depends on the clinical indications and state of jaw and teeth. Sign up for reception at a convenient time for detailed advice and diagnostics.

Return a harmonious and anatomically correct position of the dental rows possible! We, as Innovative Center for the Dental Association of Russia, We will help you with this thanks to the recognized competence of the doctors and technologies of the new generation. Contact dentistry "Dent-A-Honey" (Cheboksary) for high-quality help on any day of the week.

Coronels made of non-remote ceramics

Reconstruction of bite with the help of crowns from ceramics, which is as close as possible by structure to natural teeth. Designs are created in their own digital laboratory individually for you.

About 90% of bite pathologies - anomalies that are developing in childhood.

Basically, they are laid in infancy, and as agrees are formed in pronounced deviations that require compulsory treatment.

Atypical bite height is one of the most common manifestations of the improper structure of the jaw apparatus.

Basis of construction

The height of the bite is a concept that belongs to the localization of the fragments of the dentition, and its value is considered to be the determining factor in the correct location of the organs.

Absolutely any height is measured by the method of conventional observation, but only a practitioner orthodontist, specializing in bite standards, can conduct a competent measurement, and capable of distinguishing their pathological manifestations.

The magnitude of each dental unit and the height of its state make it possible to calculate the form of any bite.

It should also be taken into account that the ratios of the jaws at the time of the measurement should be completely rest - this will allow the difference as accurately as possible between the height of the lower facial zone and the FBK (fbug-and-tube contact).

In this position, the range of the distance between the organs in the range of 0.2-0.5 cm is considered.

Causes of the development of anomaly

The reasons negatively affecting an occlusal distance may become:

• excessive teeth erase - if the situation is not controlled, the outer surface of the tooth changes its structural content, the solid tissue loses strength and pathology is actively progressing;
• functional overload of separately taken jaw fragments - arises against the background of using bridge prosthetics, disagreeable bite;
• bruxism accompanied by partial dysfunction nervous systemss - Crushing the teeth - the process is uncontrollable.

  During the involuntary compression of the jaws, the pressure of pressure on the frontal units is several times higher than the average permissible, as a result of which the enamel is deformed, the tooth dismisses, the central occlusion decreases;

• failure in the work glands of the internal secretion - disrupts the quality composition of solid tissue, the teeth become movable, crumbling, erased;
• incorrect phosphorus-potassium exchange process in the human body - the lack of these components is extremely negative effect on bone structure The body reduces its strength. Toothbrobe becomes loose, maxillary atrophy, growth direction, and the form of organs change.

Physiological peace

If the height of the bite is determined by the intercessory distance at the time of occlusion, the state of physiological rest is the value between the lower and the upper jaw in full relaxation of muscle tissues.

Normal is the height greater than the sizes of no more than 0.2 - 0.3 cm.

Specialists classify two forms of bite pathology - overstated and understated.

In the first case, the cause of this phenomenon is incorrectly performed prosthetic design. As a rule, this is not sufficiently fitted under the required dimensions, the system, as a result of which an artificial tooth is an order of magnitude higher than the remaining mines of the jaw row.

A visual doctor is able to determine an anomaly at the following basis - the height of the bite below the quiet parameters by 0.1 cm, or is in one dimension with it.

In the second case, the provoking factor in the abnormal development of the process of closure of the jaws is excessive erasing of solid tissue coronal part of the organ.

The bite can be somewhat underestimated and because of the prosthesis incorrectly made, but it happens infrequently. In this case, the difference relative to the height of physiological peace will be tangible and will be at least 0.3 cm.

Methods of calculation

Anatomical calculation method

This method of calculating the height of the central occlusion is based on the measurement of the correct position of the lower area of \u200b\u200bthe front zone. Its main goal is to bring the patient's face to a state as close as possible to the norm.

Practitioners of specialists in this field of dentistry, world-famous scientists - Giz and Keller scientifically allocated a number of specific features of anatomical nature, which should be considered when calculating the central occlusion:

• bottom and upper lips should be in a moving conditionAt the same time, the level of their voltage is the average and below average. For the entire measurement period, lightly in contact with each other, they should not be addressed, and rounded muscle fragments of the oral area - function in normal mode;
• corners of the mouth need to slightly lift So that the nasolabial folds had a clear relief.

According to orthodontists, this method cannot be classified as a reliable and most objective measurement option.

It is for this reason that its main disadvantage is currently the practice of using anatomical methodology for calculating the height of occlusion is limited.

Anatomo-physiological

This measurement method is based on the use of the height of the relative physiological rest of the lower zone of the jaw row in the complex with anatomical specificity and reflex samples in the process of performing a conversational function.

It is scientifically confirmed that from a physiological point of view, under the correct outlines of the lower area of \u200b\u200bthe face, the lips come into contact with each other freely, the muscular voltage at that moment is practically absent. The folds of the lips and the chin are slightly expressed, the corners of the oral cavity slightly lowered down.

The base base of this technique is considered to be the localization of the lower jaw zone relative to its physiological rest.

At the same time, the height of the occlusion is below the height of the lower front part in the relaxed position and the state of the total muscular rest to 0.3 cm. Full physiological peace is a common jaw relaxation, in which the magnitude between the teeth does not exceed this permissible threshold.

In this way, for accurate measurement of bite height The bottom area of \u200b\u200bthe facial apparatus, on the patient's face, the doctor makes two marks. One below the gap of the oral cavity, and the second is slightly higher than this place.

As a rule, one mark is made on the tip of the nose, and the second - in the center of the chin, and measure the distance between them in a fully relaxed physiological muscular state.

This value is transferred to paper or a special plate made of thin wax layer. From the resulting distance take 0.2 - 0.3 cm. It is necessary in order to at the moment of jaws The distance between them was less than height in physiological peace. So you can get the desired height of occlusion.

To understand how the result is trueIt is necessary to determine how much the height of the lower front part coincided with the magnitude of the height of alveolar processes, which in the segment of the frontal dental units is equal to the desired value - 2.5 - 3 cm, and part of the side organs - from 1.5 to 2 cm.

To achieve the most accurate result, the doctor at the time of manipulation is trying to distract the patient, talking to him on third-party themes, or asks several times to make swallowing movements, such as a person who swallows fragments of food. After such actions, jaws come to a state of complete relaxation.

The minus of the method is that in some patients the necessary difference is a threshold of 0.3 mm, and others are about 5 mm. At the same time, it is impossible to calculate the perfectly accurate amount of it. Therefore, a standard figure of 2 - 3 mm is taken as the basis, which is now considered to be the norm.

To understand how much the alveolar height is calculated, a small trick is done. The patient is proposed to pronounce several audible combinations in a certain sequence.

When trying to spell each of them oral cavity Operated for a certain period. If it exceeds the resulting measurement, the indicators, it means that the value is calculated incorrectly.

From the video, find out how the bite checks.

Prosthetics planning

Planning during prosthetics against the background of bite anomalies is somewhat different from the standard procedure for its conduct.

Depending on the type of pathology, the correctional scheme for the preparation of the oral cavity is determined to the upcoming process.

When identifying a reduced occlusion indicator, for full prosthetics Calculate a constructive bite by applying disobedient devices - commercial capppon, fusey plates.

They are made individually on the basis of the cast with the subsequent suction and installation of the device. Thus, artificially due to the reduced occlusion indicator to the state physiological norm. Terms of wearing structures are individual and determined by the degree of development of anomaly.

In a number of clinical situations, with an increased herald of the frontal organs, the correction is carried out using orthodontic therapy without the procedure for the preparation of occlusal surface zones.

The optimal solution is a Dalka device. It is a chromic plate of a non-removable type, which is necessary to create interdimensional occlusion for about 3 months.

One of the options for restoring the normal bite height is artificial elongation of the tooth crowns. The procedure is performed by orthodontic pulling.

In this case the contour of the required organ is adjustedThe remaining elements of the jaw row retain the appearance.

In case the situation is too launched, the procedure is carried out by surgical - The root of the tooth is taken off, and the area of \u200b\u200bthe gums is given the necessary form and relief surface.

Details

Gpuchi (reduced) bite

A deep bite belongs to the group of anomalies of hereditary origin. Its occurrence contributes: the excessive development of the intermitory bone, the early loss of the upper dairy cutters (the lower constant incisors, without encountering antagonists, reach the sky mucosa, and the cutters upper jaw, breaking, set ahead of the lower and deeply overlap them) or dairy and constant indigenous teeth, the prevalence of muscle lifts of the lower jaw over the muscles that put forward her kepenta, and other factors [Yu.L. Oratov, 1991].

There are various clinical variants of a deep bite, which is due to a combination of it with other anomalies (see Table 11).

The occurrence of reduced bite causes various pathology of the chewing apparatus: the pathological washydrability of natural teeth on the background of intact dental rows, defects of dental series in lateral departments, periodontopathy and secondary deformations of dental rows, as well as prosthetics errors, including excessive vast toothbank, articulating among themselves, For prosthetics.

The relationship between dental rows with a deep (reduced) bite is characterized by overlapping by the upper front teeth of the lower more than 1/3 of the height of the crowns of the latter. When specified pathology, the cutting edges of the lower front teeth are often reached the mucous membrane of the sky and is injured, and the cutting edges of the upper incisors are often injured by the mucous membrane of the alveolar leaf of the lower jaw. Occlusive curve has atypich form, and the level of the occlusal plane of the front teeth of the lower jaw above the level of the side teeth. Prevalting are vertical movements The lower jaw, which determines the crushing character of chewing movements and the degree of disruption of grinding food in the oral cavity. With a reduced bite (in the absence of parafunctions and the pathological height of solid teeth, there is a decrease in the compression force of chewing muscles. Often disrupted diction. In articulation, patients complain about fast "fatigue" chewing muscles.

In such patients, a aesthetic face defect occurs due to the shortening of the lower third, the hydrogen and chin rings, the "excess" lips, and the like. The aesthetic center of the jaws is often shifted.

Patients may involuntarily bite the mucous membrane of the cheeks, lips and the language and complain about the decrease in the volume of the oral cavity. When opening your mouth, you can hear a click that occurs when the back of the back of the tongue from the heaven mucosa.

Often there are pain or a sense of discomfort in the field of ENCH, especially in articulation. Such painses are enhanced at the time of complete closure of the dental rows. Capitation, click and crunch and crunch in the ENCH appear, which indicates the presence of in them dystrophic changes. It is possible to join the listed sensations and the so-called "ear" symptoms: noise, worsening hearing, the desire to "venture Evstachiyeva pipes" and others, although during the examination of the hearing body often do not detect pathologies.

Neurological symptoms are often joined: Headache, pain in the ENCH and in the near-wing-chewing area with irradiation in various parts of the head, which is associated with the involvement in the pathological process of the ENCH, due to the violation of the optimal interconnects of the Motor reactions of the ENCH and the change in the position of the joint heads in relation to the articular pits and articular tubercles.

Due to the reduction in the height of the bite and changes in the tone and the volume of the chewing muscles actually, the outflow of saliva from the parotid glands may be violated due to the decrease in the diameter of their output ducts, since the latter are conjugate with the activities of the indicated muscles. Sometimes there is dryness in the oral cavity.

The reduced bite is often complicated by the distal shift of the lower jaw and the protrusion of the upper front teeth. Then in the side areas of the dentition arises clinical picture The false phenomenon of Godon, which requires the appropriate differential diagnosis.

The nature of the patient's age of the patient is influenced by the nature of the expression of the symptoms, its psychosomatic state, the magnitude and topography of defective dental rows, the state of the periodontal of the preserved teeth, morphological changes in the ENCH, the nature of the kinematics of the lower jaw, etc.

Two ways of normalizing the magnitude of the interlimoolar distance are known: simultaneous and two-stage. Clinical practice has shown that in the absence of clear indications for the use of a simultaneous method, its unreasonable use may lead to complications, especially related to the occurrence or exacerbation of the existing pathology of periodontal and the temporomandibular joint. The use of a two-step method based on the restructuring of myostatic reflexes [I.S. Rubinov, 1965], gives a smaller number of complications. However, when it is used to change the magnitude of the intervalolar distance, there are significant differences in tactics, volume and pace of normalization of the height of a reduced bite [A.V. Kazambalists, 1996]. In particular, the distance between the articulating teeth, the knowledge of which is necessary in the anatomy-physiological method of determining the central relations of the jaws, the establishment of the position of physiological rest of the lower jaw. According to various authors, the distance between the articulating teeth is: 1-6 mm (A.Giz), 1-2 mm (B.N. Bethylene), 2 mm (AI.Betelman), 2-4 mm (A.Ya. Katz), 2-5 mm (V.Yu. Kurlyandsky), 4 mm (P.Cantorovich), 4-6 mm (A.K.Nedergin). According to L.M. Perezashkevich (1961), this distance ranges from 1.5 to 9 mm and in 70% is 2-3 mm, 12% - 1.5-2 mm, in 7% - 3-4 mm . At the same time, the author observed the extreme cases when this distance was 7 mm at an orthoganotic bite and 9 mm - with a prenatical bite and the normal development of the coronal parts of the teeth.

Traditionally, in the diagnosis of deep (reduced) bite to rational dental prosthetics, it is necessary to determine the constructive bite and carry out the functional preparation of the oral cavity to dental prosthetics, which ensures the necessary conditions for the latter and it is a test to prepare the correctness of the selection of the height of the bite.

To perform the functional preparation of the oral cavity to dental prosthetic (orthodontic preparation), the disobedright bite of the devices are used (fuseum plates, overview kappa), which are manufactured in three clinical stages:.

1) Preparation of the cast;.

2) definition of a constructive bite;.

3) sucking and overlaying the apparatus.

At the first stage, it is necessary to plan the structural features of the future bubble plate or kappa, on the second - to determine the height of the bite, as well as the width and shape of the scope of the dividing bite of the tire plate. The latter is carried out depending on the specific clinical situation, which is determined by the nature of pathology - the type of deep (reduced) bite (see Table 11).

At the same time, the tacial plates have common design features that contribute to the prevention of other deformations of the chewing apparatus.

When planning a bubble plate should be remembered about the need to include in its design of the retractive arc, which allows you to evenly distribute the chewing pressure on the teeth, keep the fusent plate from the immersion and avoid the displacement of the anterior teeth of the upper jaw on the possible increased pressure on them. According to aesthetic considerations, the retraction arc can be replaced by cobblers in the field of the front teeth. The latter can be combined with occlusive linings, which are advisable to arrange in the mesial fissuras of the first premolars on both sides. Sometimes it is overlapped by the cutting edges of the front tooth of the plastic tire plate, which in the color in this area should be selected according to the color of the enamel of natural teeth. In the protrudal arrangement of the anterior teeth of the upper jaw, the presence of a retractive arc in the structure of the tire plate allows to eliminate the specified pathology.

The dividing platform needs to be located (in width) in the field of the front teeth: from 13 to 23. The question of the size of the scholarship ("bite height") is solved individually. As a rule, try the front teeth of the upper jaw to overlap the coronal part of the lower front teeth for 1/3. The length of the tanker is mainly determined by the maximum distal shift of the lower jaw. This is necessary to prevent the development of a forced progeting. If the normalization is needed, not only the height of the bite, but also the mesiodistal position of the lower jaw shall be simulated in the form of an inclined plane. The magnitude of the angle of the inclined plane is determined by the values \u200b\u200bof the distal shift of the lower jaw (the greater the distal shift, the greater the angle of the inclined plane) and on average is 60 °.

In all cases, the occlusal surface of the tire should be smooth, providing normal lateral movements of the lower jaw and uniform contact with its front teeth. This is finally achieved at the stage of sucking and overlaying the tires by applying a copy paper.

It is important in modeling the separation platform is to combine the aesthetic center of the jaws, which contributes to the holding of the lower jaw in the correct position and has a positive effect on the ENCH function.

The period of wearing patients of fuseum plates is strictly individual and depend on the purpose of their application: the functional preparation of the oral cavity to prosthetics or the correction of the bite anomaly.

The functional method of preparation of the oral cavity to dental prosthetics by I.S. Rubinov is shown in a reduced bite (with a deep bite only in cases where it deepened due to the loss of teeth and other reasons). The essence of this preparation lies in the restructuring of myostatic reflexes, the development of a new, greater length of the muscles of the lifting lower jaw (MM. Masseters, Temporales, Pretygoidei Medialis), which allows you to increase the interlimoolar space and eliminates the possibility of applying it with small overlapping and direct bite to eliminate it . With a deep bite, which takes place in a patient from birth, it is possible a minor increase in bite height, but not to orthognotic, since adult tissue restructuring in the OSD area will not happen, which will lead to pain in the ENCH, other neurological symptoms and recurrence of the anomalies.

With an increase in the bite height in the patient, the patient in the first week there is an increase in the tone of the rest of the chewing muscles of the chewing muscles to 80-100 g (the tone of the physiological rest - 40 g) with a simultaneous decrease in their compression tone to 50-70 g (physiological compression tone - 180-220 g) . In the second week, the stabilization of these indicators is noted, followed by the normalization of the tone of peace and the tone of the compression of the actual chewing muscles, which by the end of the third and fifth week come to the initial data. Thus, as a result of using a tanning plate (disagreeable bite, the apparatus) takes place for static and dynamic reflexes of bite disagreement, which ensures an increase in the interlimavolar space, that is, a new state of functional rest of the lower jaw. Clinically on the completion of the functional preparation of the oral cavity to prosthetics can also be judged by the sensations of the patient: it is convenient to keep the lower jaw in the new position, including in the absence of a tonaker or kappa in the oral cavity, the former position of the lower jaw is uncomfortable for the patient (he is looking for it, but It does not find), the lack of unpleasant sensations in the field of ENCH, the appearance of a mixed type of chewing.

It is believed that it is possible to dissolve a bite of up to 6-10 mm, it is possible simultaneously (if the patient has pronounced diseases of cardiovascular and nervous systems) or achieve the specified disagreement of the bite in stages, by gradually laying plastics in the field of the tire, disagreement of the plate. To judge the completion of functional training follows the above-described clinical data, as well as the indicators of the petonometry of the actual chewing muscles. Functional preparation is complete when the tone of peace and compression of the actual chewing muscles came to the source data and remains at this level for several days.

It is possible to make dentures with one-step reduction of the bite height of the sick, in which there is no sharp reaction in the form of a noticeable increase in the tone of the chewable muscles in approximately 50 g [L.M. Perzashkevich, S.B. Fishchev, 1987].

With bite anomalies, deformities of the dental rows, the wearing plate is longer and is determined by the deadlines to eliminate the anomaly.

After the completion of the functional preparation of the oral cavity and orthodontic treatment, rational dental prosthetics are carried out. In such cases, the wider use of relying dentures with the inclusion of various occlusal linings in their design, as the bite is still disassembled. Important is also restoration optimal form an occlusal curve with multiple occlusive contacts. This ensures the prevention of recurrence of pathology and favorable remote results of dental prosthetics. After a preliminary orthopedic treatment by restructuring the reflexes of bite disagreement, the timing of adaptation to dentures is reduced, as with reuse with the prostheses (L.M. Perzashkevich). In the process of using such dentures, the compression tone of the aggressive muscles actually increases for 12 months. up to 31.3%. This suggests that the normalization of the height of the bite puts the chewing muscles in the optimal conditions of the function (Z.P. Lyti, E.D.Volov).

The study of A.V. Kazimbalist (1996) to develop a functional and physiological approach to the rehabilitation of patients with a secondly reduced bite. The prerequisite for the emergence of these studies was the work of I.S. Rubinova (1965, 1970), L.M. Perzashkevich (1961, 1975), Z. Prati (1967), B.K. Kostur (1970), Wberessmeyer and A. MANYS (1985) and others, which show that the maximum force of compression of the jaws and the bioelectric activity of chewing muscles occurs in the position of central occlusion. The chewing muscle can develop the maximum effort only in the case of the optimal ratio of its attachment points [V.Kopekin, 1993].

In the clinical aspect, the existing difficulties in the treatment of patients with a reduced bite are reduced precisely to the inability to accurately and confidently determine the central relationship of the jaws.

The studies conducted by A.V.Simbalist (1996) on the rehabilitation of patients with a partial or complete loss of teeth and a reduced bite and estimate the integral force of compression of the jaws allowed us to identify three types of distribution of power characteristics depending on the size of the intelvelaolar state. For complete absence The dentive single-sized distribution was found in 51%, duplex - in 26%, unpressed - in 23% of cases. In this case, the maximum force of compression of the jaws with a double-pic distribution was significantly higher than the case of dependence (see Table 9).

Thus, in the process of determining the central relations of the jaws, the functional-physiological method, the use of a device for determining the central relationship of the JOUCO type jaws, equipped with a mechanism for smooth control of the inter-vololar distance, the "Vizir-E" rutodinameter and the electromogram drive allowed A.V. Kazimbalist to construct dentures each Patient, taking into account the maximum compression force of the jaws. A comparative assessment of the use of an anatomo-physiological and functional and physiological method of determining the central relationship of the jaws testified to more efficient adaptation to dentures in cases where more than chewing high level Jaw compression efforts (Fig. 30). It should also be noted that when using the functional-physiological method of determining the central relations of the jaws, the author noted a smaller duration of the correction period and a relatively smaller number of corrections (Fig. 31).

The results of the research of A.V. Kazimbalistov (1996) are fully consistent with the results of previously conducted fundamental studies on the study of the peculiarities of the chewing function, depending on the height of bite in dentures [L.M. Perzashkevich, 1961] and the possibility of restoring the normal bite height from toothless patients with The usual reduced bite [Z.P. Lyti, 1967], in which the reaction of actually chewing muscles was also taken into account depending on the method of increasing bite.

The data of physiological chewing samples indicate that at normal bite height in the process of addictive to complete dentures, chewing efficiency increases from 25% on the day of prostheses up to 90% in a year of use. The increase in bite on 5-8 mm significantly makes it difficult to adapt to dentures, reduces chewing efficiency by 14-19%. A decrease in bite of 3-8 mm is not subjectively reflected in the adaptation process, but weakens the effectiveness of the chewing function by 6-14% compared with the norm [L.M. Perzashkevich, 1961]. That is why among people using complete dentures, the reduced bite height occurs in 35.7% of cases, which is due to a relatively easy adaptation of patients with a reduced bite, atrophic processes in the tissues, the wasraging of plastic teeth, and the errors of doctors that take The usual rapprochement of the toothless jaws for the state of physiological peace [Z. Pilate, 1967].

The use of AV.Simbalist functional-physiological method for determining the central relations of the jaws with a partial loss of teeth and with a secondly reduced bite made it possible to develop an algorithm for conducting such patients with different types of distribution of the chewing machine's power characteristics (Table 10).

These studies acquire special relevance today, when expensive technologies for the manufacture of dentures are becoming more and more widely used in clinical practice. To date, the question of a simultaneous way to restore bite due to the possibility of serious complications of prosthetics did its use in wide clinical practice very problematic. After the fundamental studies of AV.Simbalistov (1996), it is possible to consider a simultaneous method for restoring the bite of an alternative two-stage method of conducting patients with a secondly reduced bite, developed due to partial loss of teeth.

Often, patients with problems not only an aesthetic nature are addressed to the orthopedist dentist, but also with the lack of some teeth. It can be molars on the upper and lower jaws, which often delete early on therapeutic readings. Such patients do not always immediately appeal for orthopedic help, many postpone the implantation and prosthetics for various reasons.

Later, patients come to the orthopedist, but there is no longer enough space for prosthetics in the area of \u200b\u200bremote tooth. The reasons can be a lot: the neighboring teeth could move towards the defect or leaning out that even worse. There are situations when the teeth-antagonists are put forward towards the defect. Usually it clearly shows an X-ray shift when the coronal parts of the teeth on both sides of the defect are practically contact with contact surfaces, and between the roots a lot of distance. Such a position of the teeth is in the future problems with periodontal, with the dental root of the roots and complaints of the patient to jammed food, that is, tangible discomfort. So patients orthoped recommends pre-conducting orthodontic treatmentwithout which prosthetics will be impossible. Orthodontist, in turn, prepare with the movement of teeth into the correct position, and then when the conditions for prosthetics are created, transfers the patient to continue the treatment of the orthopedist.

Why is it important not to tighten with the beginning of treatment?

If the patient has no tooth on the upper jaw, then the bottom teeth antagonists can start extending upwards. If there is no tooth on the lower jaw, then the upper teeth, which are located above this defect, can also move down. And the jaw blocking can occur when the selected tooth does not give chewing correctly, which sometimes becomes the cause of the dysfunction of the temporomandibular joint. It happens that after the removal of sixth and seventh teeth, the eighth, teeth of wisdom are rubbed, then the orthodontist will have to decide on their removal or preservation.

Reducing the depth of bite

Another typical situation is the loss of lateral teeth and an increased erasability of the front teeth. As a consequence of such a situation - decrease in the height of the bite. Such patients, especially with an incorrect, deep bite of orthopedists before prosthetics, are sent to orthodontist to "raise" the height of the bite.

Correction of the smile zone and the absence of front cutters

Aesthetic problem is found in a smile zone associated with the lack of anterior teeth, such as the second incisors. Currently, it is often a situation when there are no robusts. It does not cause complaints while there are dairy teeth on this place, but after their removal, the question arises about the restoration of the defect. In such situations, the orthodontist, orthopedist and an implantologist choose a comprehensive treatment strategy. Options are considered with implantation and prosthetics in this area or orthodontic movement of neighboring teeth with further restoration of veneers to create a harmonious smile.

It is less likely to meet with the absence of one of the front incisors. If the defect exists for quite a long time, there may be problems with implantation in this area due to the deficit bone tissue. Then the orthodontist offers a treatment plan with the movement of the side cutter into the place of the absent central, and the prosthetics on the implant is carried out already in the liberated area where enough bone tissue.

Partial or complete orthodontic treatment?

We offer different variants. Sometimes for aesthetic and functional result, a full orthodontic treatment is necessary. If we are talking about patients who already have enough orthopedic structures on the upper jaw, there are no side teeth, there is a crowding, the close position of the front incisors on the lower jaw, will be sufficient to level the lower cutters, and, as far as possible, lift the bite. In this case, we are talking about partial orthodontic treatment, a duration of not 1.5-2 years old, but much faster.

Local problems, such as the toned eighth teeth, in the absence of seventh or sixth, are resolved by supporting from two minivints without the use of bracket systems or using small systems for the lateral teeth. This will also be partial orthodontic treatment.

Team approach

In solving such clinical situations, a team approach is required, in which an orthopedist is responsible for the overall concept of treatment. It discusses the necessary result with the orthodontist, and the orthodontist analyzes the possibility of its implementation. The orthopedist plans to move the teeth with an accuracy of millimeters and gives specific instructions for orthodontist.

Sequence of treatment

Prosthetics are performed after orthodontic treatment. When in the oral cavity there are already some orthopedic designs (crowns, veneers), the braces are permissible to position them. However, after the end of orthodontic treatment, the design is most likely to be replaced, because the shape of the dentition and bite will be different.

Orthodontic treatment in the presence of restorations

If necessary, the prosthetics of teeth before the start of orthodontic treatment orthopedic plans to formulate special, milling plastic crowns for the period of wearing the bracket system. Such designs are well withstanding the fixation of locks and the movement of the teeth, after the completion of the orthodontist is completed, the temporary crowns should be replaced with permanent, already taking into account the corrected bite.

The retainer is not glued to orthopedic structures, with the exception of veneers - in this case, the inner surface of the tooth and the retailer will be securely fixed. It is almost impossible to glue ceramic crowns to glue the retainer, so there is a retention kap for patients with such structures. The first year after the completion of treatment, it will remove the load from the front teeth and will be a retaining factor guaranteeing the stability of the result.