Preparing teeth for implantation and raising the bite. What is dental implantation? What is the dentition and why deviations occur

Often, patients turn to the orthopedic dentist with problems not only of an aesthetic nature, but also with the absence of some teeth. These can be molars on the top and mandible, which are often removed early therapeutic indications. Such patients do not always immediately seek orthopedic care, many postpone implantation and prosthetics for various reasons.

Later, patients come to the orthopedist, but the places for prosthetics in the area extracted tooth is no longer enough. There can be many reasons: adjacent teeth could move towards the defect or lean, which is even worse. There are also situations when antagonist teeth move towards the defect. It usually shows clearly X-ray when the crown parts of the teeth on both sides of the defect practically touch the contact surfaces, and there is a large distance between the roots. This position of the teeth causes further problems with the periodontium, with the exposure of the roots of the teeth and the patient's complaints about food getting stuck, that is, tangible discomfort. For such patients, the orthopedist recommends preliminary orthodontic treatment, without which prosthetics will be impossible. The orthodontist, in turn, prepares by moving the teeth to the correct position, and then, when the conditions for prosthetics are created, he transfers the patient to continue treatment with an orthopedist.

Why is it important not to delay the start of treatment?

If the patient does not have a tooth upper jaw, then lower teeth-antagonists may begin to move up. If there is no tooth in the lower jaw, then upper teeth, which are located above this defect, can also move down. And blocking of the jaw can occur when a displaced tooth does not allow chewing properly, which sometimes causes dysfunction of the temporomandibular joint. It happens that after the removal of the sixth and seventh teeth, the eighth, wisdom teeth, erupt, then the orthodontist will have to make a decision about their removal or preservation.

Decreased bite depth

Another typical situation is the loss of lateral teeth and increased abrasion anterior teeth. As a consequence of this situation - a decrease in the height of the bite. Such patients, especially those with an incorrect, deep bite, are referred by orthopedists to an orthodontist before prosthetics in order to "raise" the height of the bite.

Correction of the smile zone and the absence of anterior incisors

Meets aesthetic problem in the smile zone, associated with the absence of front teeth, for example, second incisors. At present, it is not uncommon for a situation where even their rudiments are absent. It does not cause complaints while milk teeth are in this place, but after their removal, the question arises of restoring the defect. In such situations, the orthodontist, orthopedist and implantologist choose a comprehensive treatment strategy. Options are being considered with implantation and prosthetics in this area or orthodontic movement of neighboring teeth with their further restoration with veneers to create a harmonious smile.

Less common is the situation with the absence of one of the front incisors. If the defect exists for a long time, then there may be problems with implantation in this area due to a shortage of bone tissue. Then the orthodontist proposes a treatment plan with moving the lateral incisor to the place of the missing central incisor, and prosthetics on the implant is carried out in the vacant area, where there is enough bone tissue.

Partial or full orthodontic treatment?

We offer different variants. Sometimes a complete orthodontic treatment is necessary for an aesthetic and functional result. If a we are talking about patients who already have a lot of orthopedic structures in the upper jaw, missing lateral teeth, crowding, tight position of the anterior incisors on the lower jaw, then it will be sufficient to align the lower incisors, and, as far as possible, raise the bite. In this case, we are talking about partial orthodontic treatment, lasting not 1.5-2 years, but much faster.

Localized problems such as tilted eighths and missing sevenths or sixths are treated with two mini-screws without brackets or small posterior systems. This will also be a partial orthodontic treatment.

Team approach

In dealing with such clinical situations, a team approach is needed, in which the orthopedist is responsible for the overall concept of treatment. He discusses the desired result with the orthodontist, and the orthodontist analyzes the possibility of its implementation. The orthopedist in such a situation plans the movement of the teeth with an accuracy of millimeters and gives specific instructions to the orthodontist.

Sequence of treatment

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

Orthodontic treatment with restorations

If it is necessary to prosthetic teeth before starting orthodontic treatment, the orthopedist plans to install special, milled plastic crowns for the period of wearing the braces. Such structures withstand the fixation of locks and the movement of teeth well, after the completion of the work of the orthodontist it will be necessary to replace temporary crowns on permanent ones, already taking into account the corrected bite.

The retainer does not stick to orthopedic structures, with the exception of veneers - in this case it is not affected inner surface teeth and the retainer will be securely fixed. It is almost impossible to stick a retainer on ceramic crowns, therefore, a retention cap is provided for patients with such constructions. The first year after the completion of the treatment, it will take the load off the front teeth and will be a deterrent to guarantee the stability of the result.

Dental implants

Implantation - The best way reconstruction of the missing elements of the dentition. After a series of procedures, the bite looks aesthetically flawless, the functions of the chewing apparatus are fully restored. Unfortunately, the installation of implants is not for everyone. Let's take a closer look: How is implantation carried out? Who can't do it?

There are a number pathological conditions organisms that make dental implantation impossible. Doctors of the clinic "My Orthodontist" carefully study the anamnesis of each patient. What conditions should be excluded?

• Violation of hemocoagulation (the process of blood clotting). Implantation is always accompanied slight bleeding- this is normal. If you ignore the pathology of blood clotting, there will be serious complications.
• Diabetes mellitus (today it is not an unconditional contraindication, but the operation can be performed only in patients with compensated type II diabetes. With type I diabetes, implantation is not indicated).
• Autoimmune and inflammatory pathologies connective tissue. These conditions will interfere with the healing of periodontal tissues.
• Any malignant neoplasm.
• HIV and venereal diseases.
• Open form of tuberculosis.
• Immune disorders (they will interfere with tissue healing and bone regeneration).
• Osteoporosis.
• Mental and nervous diseases, addiction. Implantation requires a restrained behavior from the patient, compliance with all medical recommendations. People with neuroses, mental and behavioral disorders may not be able to cope with this task.
• hypertonicity facial muscles(chewing muscle).

There is relative contraindications which hinder immediate implantation. They can be eliminated surgical methods, cured therapeutically or resolved naturally. These "temporary" bans include:

• carious teeth, tartar;
• inflammation of the gums, temporomandibular joint;
• malocclusion and jaw defects;
• infections and inflammation of the oral mucosa;
• partial resorption of the bone tissue of the gums (for correction, bone grafting, sinus lifting is performed);
• smoking, alcoholism;
• pregnancy.

There are a number general contraindications health related. Implantation should not be carried out when the patient is exhausted, weakened by long-term illnesses, or has anemia. In case of intolerance local anesthetics procedures will also fail. Dental implants can lead to deterioration in the condition of "cores", rheumatic patients, people with CFS and chronic stress. Taking immunosuppressants and some other medicines may prevent postoperative healing fabrics.

Implant placement is a complex procedure, but it can be made as easy as possible by following simple guidelines.

• Don't worry. Before the procedure, you can take a vegetable sedative drug: valerian extract, motherwort tincture or decoction.
• Do not go to the procedure on an empty stomach, be sure to eat.
• Check again if your teeth and mouth are healthy. Tell your doctor about any suspicions - infection at the time of surgery is unacceptable.
• Do not smoke, do not drink alcohol even the day before.
• Strictly follow medical prescriptions throughout all stages of implantation.

It is better to make an appointment with an implantologist at the beginning of the day: human psyche in the first half of the day it is easier to cope with stress.

After studying your history and eliminating contraindications, you can proceed with the operation. If no preliminary surgical procedures are required for implantation, the procedure will consist of three successive stages.

First stage. Under local anesthesia a recess is made in the jaw where the implant is inserted. From all sides, the intraosseous element is covered with mucous. For its complete integration into bone tissue jaw is required up to six months. The control of ingrowth is carried out by X-ray.

Second phase. Under local anesthesia put a gum shaper to give the tissues a natural anatomically shaped. After a few days, if there are no complications and the patient does not notice discomfort in oral cavity, the shaper is replaced with a titanium abutment - a cylindrical screw that acts as a transition element between the implant and artificial tooth. Prosthetics are appointed in one to two weeks.

Third stage. An orthopedic dentist takes a cast of the jaws, which serves as a model for creating a prosthesis. A dental technician makes a crown. You will be tried on the manufactured design several times; The prosthodontist will adjust the crown to a perfect match with the adjacent natural teeth.

The result of a series of procedures will be a completely restored dentition. High-quality implanted teeth cannot be visually distinguished from real ones.

The risk of complications or bad result during implantation is possible - usually this outcome is associated with the mistakes of implantologists. Sign up for the procedure only in a trusted clinic with a good name, study patient reviews, do not be afraid to inquire about licenses medical institution and qualifications of physicians.

Implantation is considered a low-traumatic intervention. The intraosseous element takes root in 97-98% of cases. A successfully placed implant completely fuses with the surrounding jaw tissues. Specialists of the clinic "My Orthodontist", observing the treated patients, note the durability of "new" teeth and normal condition surrounding tissues.

The success of the operation depends on the coordinated work of the team of specialists and the behavior of the patient. Before the operation, the doctor will consult you on oral hygiene, tell you what pastes, brushes, flosses you need to buy. Regular care of implanted teeth is easy.

At the end of the main procedures, a schedule of inspections is drawn up. You will visit the doctor once every six months (in some cases - every 3 months). On the preventive examination the specialist will evaluate the quality of oral hygiene and the condition of the jaw tissues.

Dental implantation is a progressive method of restoring the chewing apparatus and a beautiful smile. This is a complex multi-stage process, but the result is worth it!

Bite is the relationship between the teeth of the upper and lower jaws when they are closed. Correction of bite - achieving the correct relationship of the dentition, is one of the main tasks of any dental treatment, along with proper occlusion (correct tooth contact). That is, a competent physician integrated approach to treatment initially sets the goal of achieving correct bite, correct occlusion, and all subsequent treatment builds on this independently or with the involvement of relevant specialists, the main place among which is occupied by orthodontists.

Contrary to the popular belief among patients that it is necessary to correct the bite mainly from an aesthetic point of view, even small bite pathologies lead both to a deterioration in the condition of the teeth and to an overload of the temporomandibular joint, and hence to headaches and others. backfire. Our country is only on the way to realizing the need to correct the bite in most adolescents, in contrast to Western countries, where the installation of braces is often included in medical insurance, because. treatment of the consequences of malocclusion is much more difficult, longer and more expensive.

Fortunately, currently bite correction in adulthood is an absolutely normal practice, many patients older than 50-60 successfully correct their bite.

Why it is necessary to correct an overbite

Speaking about the need to correct malocclusion, one could enumerate many indirect consequences, such as the effect on the digestive system, etc. But despite their importance, ordinary person they seem distant and intangible, therefore, let us dwell on the specific consequences of malocclusion and the lack of proper contact of the teeth:

• In the absence of contact, teeth tend to opposing teeth; with supercontact or incorrect closure teeth are destroyed, there is abrasion of teeth. Both cases lead to a gradual loss of teeth, and the process occurs over the years, and not to old age, as many believe. There is sensitivity in the teeth. The installation of one high-quality implant costs from 70-100 thousand rubles, and on the front teeth (which often suffer due to malocclusion), it is necessary to install metal-free crowns, which are even more expensive, but they will not replace healthy teeth. This is not counting the fact that bone grafting is often necessary before implant placement. Thus, bite correction, the prices for which are much more affordable than subsequent orthopedic treatment, has a very specific economic justification.
• Incorrect closure of the teeth leads to an overload of the temporomandibular joint. Previously, this point was given insufficient attention, but modern concepts proceed from the need to create conditions correct operation joint during dental treatment. The consequences of improper operation of the joint appear quickly enough: a crunch, clicks or discomfort appears. Often, headaches are added to them.
• It is impossible not to mention social consequences malocclusion: with medical point vision, they are not so important, but for patients they are usually the decisive factor. AT modern world straight teeth are part of the image of a healthy, successful person. In addition, malocclusion leads to incorrect, unnatural facial proportions. A beautiful smile helps to arrange a personal life, get a higher income, make it easier to find contact with people - all this is difficult to measure in monetary terms.

When is an overbite corrected?

A normal (orthognathic) bite is when the upper teeth slightly overlap the lower ones. There are many other signs - the relationship, location, inclinations of specific teeth, their turn, closure, etc., therefore, only an orthodontist can accurately determine whether a person has a normal bite.

Unfortunately, the bite is not ideal for most of the world's population. However, this is not always a direct indication for bite correction (from a medical, not an aesthetic point of view).

There are cases when it is obvious to the patient that his bite is wrong, the lower jaw is too forward or backward, the teeth do not close, etc. However most of borderline situations.

Thus, in view of the large percentage of cases of detection of malocclusion, the importance of its correction and the impossibility of determining the need for treatment by the patient on their own, we recommend that everyone, without exception, visit an orthodontist to determine the correct bite, occlusion (tooth closure) and determine the need for treatment, or lack thereof.

It is correct to visit the orthodontist in the following periods of life:

• During the formation of a temporary bite, when the child is 4-6 years old. The doctor will determine whether the bite is formed correctly, give recommendations on the use of children's orthodontic appliances that prevent the formation of bad habits.
• From 6 to 11 years old, the doctor may prescribe treatment with plates or other devices, which later will help simplify the treatment on braces (kappa), or avoid it altogether.
• During the formation of a permanent bite from 11-12 years old (or later, when the doctor prescribes) - the most correct period to control and correct an already permanent bite with braces, mouthguards or other orthodontic appliances.
• At any older age. At the same time, it is not necessary to visit the orthodontist in each of these periods: at the first visit, the doctor will determine how the dentoalveolar system is developing and will give recommendations on the need and time of the next visit.

Contraindications for bite correction

It's hard to talk about absolute contraindications to correction of the bite: there are situations when the doctor together with the patient decides whether it is possible and necessary to correct the bite in each particular case, or how to eliminate obstacles.

What can interfere with orthodontic treatment:

• Serious periodontal disease (gums and everything that holds the tooth in the jaw). When correcting an overbite, the teeth move, therefore, it is necessary that they be fixed in a new place. This can be difficult to do with severe periodontitis - in this case, prior periodontal treatment or abandonment of orthodontic treatment is required.
• Mental illness can interfere with the correction of the bite, because. bite correction is a long process, it is necessary to follow the doctor's recommendations, etc.
• Carious and other lesions of the teeth, poor hygiene- these are overcome obstacles: before starting treatment, the orthodontist necessarily sends the patient for examination to the therapist in order to carry out a complete sanitation.
• Pregnancy is not a direct contraindication. However, it should be borne in mind that the process of bite correction is lengthy, requires visits to the doctor (usually once a month or once every 2 months, depending on the case and the equipment chosen for treatment), which can be difficult during pregnancy. In addition, orthodontic treatment often does not require anesthesia or x-rays, but they may be required if other manipulations are needed - dental treatment or extractions, which sometimes accompany bite correction. And we should not forget that a lot of calcium, resources, energy goes into the development of the child, which can affect the treatment. Although there are many cases in practice when, for example, braces are used during pregnancy, it is better to plan for the correction of the bite for the period after the birth of the child. But if pregnancy occurs during the period of orthodontic treatment, there is nothing to worry about, mouthguards: braces during pregnancy are a completely normal situation.
• Other situations where it is difficult to visit a doctor. For example, long-distance business trips can interfere normal treatment, although many of our patients arrive for appointments from abroad and successfully undergo treatment.
• Allergy to metal and mature age are not contraindications, as it was before: treatment is performed at any age, and other materials can be used instead of metal.
• No matter how strange it may sound, the reluctance to correct the bite is the main contraindication. After all, the process takes enough long time, you must follow all the doctor's recommendations, carefully monitor hygiene, etc. Therefore, in the absence of desire, including in a teenager, when he is forced (and does not explain the need for treatment), it is extremely difficult to achieve a good result.

Types of malocclusion

Normal, healthy is orthognathic bite. When determining one or another type of malocclusion, Angle's classification is most often used, who identified several classes of occlusion. The basis, among other things, is the ratio of the location of the sixth teeth of the upper and lower jaws:

• Class 1 - neutral bite, when the ratio of the teeth of the lower and upper jaw is normal, however, there may be crowding or gaps and other deviations from the normal position of the teeth.
• Grade 2 - distal occlusion when the lower jaw is pushed too far back. If in childhood a distal occlusion is detected, its correction takes place by limiting the growth of the upper jaw, and stimulating the growth of the lower. In adulthood, special equipment is used to push the lower jaw forward.
• Grade 3 - mesial bite, when the lower jaw is too advanced forward. Correction of the underbite, especially when the dimensions of the lower jaw are too large, is a rather complicated and lengthy process with the use of additional functional apparatus.

These types of bite can be combined with the following anomalies in the location of the teeth:

• Deep bite - the upper incisors overlap the lower teeth too much, the lower teeth do not rest on the tubercles of the upper incisors, biting food is difficult, and therefore it is very important to start correcting a deep bite as soon as possible. Often combined with a distal bite.
• Open bite - the incisors of the upper and lower jaws do not close due to the presence of a gap between them; the upper teeth are often tilted and project forward.
• Cross bite - when the teeth of the upper and lower jaw intersect; also there may be no intersection in the anterior region, but due to the displacement of the lower jaw laterally, the lower teeth may overlap the upper ones; there is no normal contact; a person usually chews food on one side. Correction crossbite very important, because missing normal function chewing food.
• Crowding - Teeth are misaligned due to lack of space. This is one of the most common pathologies. Often the result of macrodentia (large teeth), and can also occur after the eruption of the last, eighth teeth (wisdom teeth).
• The gaps between the teeth are the opposite of crowding anomaly. Including, diastema - the gap between the first incisors.
• Displacement of the center is a common anomaly, and sometimes the result of incorrect orthodontic treatment, when there is no symmetry: the center of the upper and lower jaws (which is located between the front incisors) should be in line with the nose.
• Progenia is a more general concept than underbite, when the anterior teeth of the lower jaw are in front of the anterior teeth of the upper jaw. In this case, the bite can be neutral.

bite correction methods

Correction of bite is a complex task, which involves doctors of various specialties, and the orthodontist plays a leading role in planning and treatment. Based on the age of the patient, the type and degree of pathology, as well as the wishes of the patient, one of the following methods to correct an overbite:

• Plates are removable orthodontic appliances, usually installed in childhood (up to 11-12 years old). They are made individually for the patient from plastic mass.
• Braces - most commonly used in correcting an overbite over the age of 11–12 years.
• Mouthguards are a modern alternative to braces. They are removable and made of transparent plastic individually for the patient.
• Trainers are removable orthodontic appliances, usually made of silicone. As a rule, the purpose of their application is to solve a specific problem within the framework of complex treatment(muscle relaxation, getting rid of thumb sucking habits, etc.).
• Functional devices such as Herbst apparatus, Twin Force Bite Corrector, TwinBlock, etc. also help to solve a specific problem within the framework of complex treatment - to expand the jaw, move the jaw, etc. In addition, there are many other devices that are used in conjunction with braces or mouth guards to solve specific problems when correcting an overbite.
• Orthognathic surgery - it is resorted to in rare cases. it surgery to correct bite by changing the shape of the jaw. It is usually also accompanied by orthodontic treatment.
• Installation of crowns, veneers - strictly speaking, bite - the ratio of the location of the teeth, but also when correcting the bite, they achieve the correct occlusion (correct closing of the teeth). Both tasks can be solved without moving the teeth, but by installing dentures or changing the shape of the teeth with the help of veneers. I must say that this method should be used strictly according to indications (i.e., healthy teeth should not be turned to install crowns if orthodontic treatment is possible). Also orthopedic treatment can be used in combination with orthodontic, when the correct occlusion cannot be achieved by one movement of the teeth.

Stages of bite correction in orthodontic treatment

Correction of the bite is divided into several important stages: the neglect of each of them will make the entire treatment in vain, or even harmful to health.

Diagnostics, planning, preparation

Any quality treatment should be based on correct diagnosis correctly diagnosed. Diagnosis in orthodontic treatment includes the following procedures:

• Examination of the patient, determination of the correct bite, occlusion. Determination of the need and possibility of treatment.
• Panoramic X-ray of teeth (OPTG, Orthopantomogram) is an X-ray examination. The picture shows all the teeth of both jaws at once. This image is obligatory in our clinic for all patients: it can be used to evaluate general state teeth, the condition and location of the roots, which is important when moving them, as well as to see unerupted teeth, the existence of which patients sometimes do not even know.
• A teleroentgenogram (TRG) is also an X-ray study made from a certain distance, which allows you to most accurately convey the dimensions and proportions of the jaws. Usually a lateral x-ray is taken, according to which the orthodontist can make the necessary calculations. This study It is not always carried out, as directed by a doctor.
• Taking casts and making plaster models - an exact copy of the patient's teeth - allows the orthodontist to see the picture most fully and make calculations for treatment planning.
• Computed tomography (CT) - appointed in recent times more and more often doctors of all specialties, tk. it allows to reveal the smallest, hidden defects of bone tissue in a three-dimensional form.
• Photographing is a possible, but not obligatory element of diagnostics during treatment with braces. Usually required in the treatment of mouthguards, because. aligners are modeled remotely and photographs of the patient are required.

Based on a complete set diagnostic procedures, the orthodontist plans treatment:

• Calculations are made on the basis of plaster models and TRG: an orthodontist cannot simply estimate by eye how the teeth will stand as a result of treatment. Accurate calculations are needed to understand whether there is enough space for the teeth (or vice versa, there is too much of it), how the teeth will stand as a result of the treatment.
• Based on the calculations, examination, a treatment plan is drawn up. The need for separation (grinding the teeth from the sides) or extraction of teeth in case of insufficient space is determined. The tactics of treatment, the need to expand the jaw, the need to use rods to move the jaw, other functional devices, etc. are determined.
• Orthodontic equipment is selected for bite correction, treatment methods: braces, mouthguards or other instruments, including based on the wishes of the patient, aesthetic considerations and how much it costs to correct the bite on this equipment.

Preparation for treatment includes:

• Sanitation of the oral cavity. Before correcting the bite, it is necessary. put all the teeth in order, cure caries, remove tartar and plaque.
• Gum treatment if necessary.
• Sometimes, according to the doctor's prescription, it may be necessary to wear removable trainers before starting treatment.

Orthodontic treatment

First stage

If occlusion correction with braces was chosen, first of all, they are installed. Often braces are placed first on one jaw, and in next move to another. Installation consists in gluing the actual braces (small metal locks) on each tooth and fixing the arc on them. It is the arc that pulls the teeth in a given direction. There is direct and indirect installation of braces: with direct braces, they are glued directly to the teeth one at a time; with indirect, the brackets are fixed on the model of the teeth in the right places and then glued to the teeth all at the same time.

Contrary to the wishes of patients, even when the teeth are crooked in only one jaw, most often, braces must be installed in both, because. after moving the teeth in only one of the jaws, there will be no proper closure of the teeth.

During treatment with mouthguards (transparent plastic aligners), if necessary, the doctor glues attachments to the teeth - small tubercles that help the mouthguards to better adhere to the teeth and, accordingly, move them more efficiently. Then the doctor simply gives the patient several sets of mouthguards (which will last until the next visit). Because Mouthguards are removable, the patient independently changes them.

Continuation of treatment, scheduled visits to the doctor

Treatment depends on the diagnosis different stages, such as:

• Expansion of the jaw, freeing up space in order to place exactly all the teeth.
• Body movement of teeth (i.e., movement of the entire tooth).
• Correction of the inclination, reversal of the tooth.
• Moving the lower jaw back or forward (actual bite correction), etc.

In the case of treatment on braces, the doctor sets different archwires at different intervals - soft, hard, applies traction, elastics - each of these tools performs its function.

When treating with mouth guards, it is also possible to use additional accessories to correct the bite.

The frequency of visits to the doctor depends on the selected equipment:

• Ligature braces - about 1 time per month.
• Self-ligating braces - about 1 time in 1.5-2 months.
• Kappa - depends on the stage of treatment and the doctor's recommendations - perhaps 1 time per month or 1 time in 2 months.

End of treatment

After achieving the planned result, the doctor, in agreement with the patient, decides to end the treatment. During treatment with braces, they are removed and the remaining glue is removed from the teeth.

retention period

Highly milestone, which comes immediately after orthodontic treatment - the retention period. It fixes achieved result. It is neglect that often leads to negative reviews patients, such as "after the treatment, all the teeth returned to their place, the treatment did not make sense." The fact is that the teeth need to be fixed in the position in which they stood after the treatment. Therefore, immediately at the end of treatment, usually:

• Wire retainers are placed on 4 front teeth. This is a thin wire that is attached to inside teeth and fix them.
• For a certain period of time (for example, 6 months), a mouthguard is put on at night, which also allows you to hold your teeth, or a retention plate.

Timing for bite correction

Each stage of treatment takes certain time:

• Diagnosis, planning, preparation - can take from one day to several weeks, in the case when the patient's teeth are in bad condition and their preliminary long-term treatment in several doses is required, or extraction of teeth is required. The first consultation itself takes about one hour.
• When treating with mouth guards or individual braces, for example Incognito, a certain time is required for their manufacture and delivery - from one to two months, because. they are made individually for each patient, often abroad - a lot of time is spent on their delivery and customs clearance.
• The installation of braces usually takes place at the next appointment after diagnosis and preparation and takes about one hour. Approximately the same amount is needed for the installation of attachments in the treatment of mouthguards.
• The timing of wearing braces is highly dependent on the diagnosis. It can be generally said that in a large percentage of cases, this period is 1-1.5 years with medium degree crooked teeth and malocclusion. In more simple cases it takes about 6 months for treatment on braces, and in difficult times it can be 2 years or more. Usually teeth move 0.5-1 mm per month.
• The removal of braces (or attachments for mouthguards) takes approximately one hour.

The retention period always lasts differently and is set by the doctor: the younger the patient, the shorter the retention period. Of course, other factors also play a role. Approximately, we can say that the wire retainer should be worn 2 times longer than the patient wore braces or mouthguards. However, the retainer does not cause inconvenience to the patient, a visit to the doctor is extremely rare, therefore, it is justified prolonged wear to fix the result.

The most important problem with malocclusion is the inability to fully chew and swallow food, and therefore, problems begin with gastrointestinal tract and teeth. In addition, malocclusion causes asymmetry of the face oval, speech is disturbed, pains appear both in the teeth and in the area of ​​​​the ears and jaw, sometimes the temporomandibular joint is damaged.

Surgical correction of malocclusion is possible for people different ages, but there are limitations here: it is highly undesirable to carry out this kind of operation for children under the age of 18 due to the incomplete formation of their teeth and bite. In adults, this type of surgery is usually performed before the age of 60 due to health problems.

Surgical correction of dentoalveolar pathologies is called osteotomy. This type operations involves various kinds manipulations by surgical intervention in bone tissue: bone augmentation, changing the shape of the chin, lengthening or shortening of the jaw, extraction of teeth, etc. All operations to correct bite anomalies are carried out strictly according to medical indications, since any surgical intervention is a great stress for the whole organism and requires a long recovery.

When are maxillofacial surgeries performed?

Contraindications for dental surgery

As you can see, the list of dentoalveolar anomalies and bite defects is quite large, but not in all cases it is possible to perform surgical intervention for a number of reasons, which include:

• blood diseases and diabetes;
• oncological diseases, HIV, tuberculosis;
• cardiovascular disease and nervous system;
• disease thyroid gland;
• poor oral hygiene;
• age up to 18 years;
• any infectious disease.

Preparation and conduct of the operation.

Before the operation, it is required to fully examine the patient in order to pass all necessary analyzes, identifying the causes of deformations and the presence possible diseases, in which the operation should not be performed, as well as to simulate a future face using a computer correct form. Based on the simulation, the doctor draws up a treatment plan and draws up a plan for further manipulations.

Surgical correction of the bite and abnormal structure of the jaw is performed using general anesthesia.

Types of surgery

Depending on the type and how pronounced the pathology is, various manipulations are carried out, which are divided into four main types:

• Osteotomy in the lower jaw.
• Osteotomy in the upper jaw.
• Genioplasty
• Segmental osteotomy

Osteotomy in the lower jaw

This operation is performed by surgical incisions in the bone, which is located behind chewing group teeth. Thus, the jaw is set in the correct position, while the bone fragments are connected using plates made of titanium until the bone tissue grows.

Osteotomy in the upper jaw

In this case, the incisions are made above the teeth, just below the edge of the eye sockets. In this case, the maxillofacial surgeon can freely move the bone, while simultaneously moving the palate and upper teeth of the jaw. To fix the correct position, the bone fragments are fastened with screws, splints, or titanium plates. Read more.

Genioplasty

Mentoplasty of the chin (correction of the shape of the chin). During the operation, a part of the bone tissue is cut off, which is then installed in the correct position.

Segmental osteotomy

With this surgical intervention, the jawbone is dissected into segments, which are then compared in the desired position along with the teeth and fixed.

Features of osteotomy in various pathologies of the jaw and occlusion.

Deep bite treatment. Before surgery, a deep bite is first treated with braces to straighten the teeth. As a rule, in this case, braces are worn from six months to 1.5 years. After reaching the alignment of the dentition, the operation itself is performed. Sometimes you have to remove the incisors to correct the bite. During the operation, the doctor dissects the bone tissue, after which he places the resulting fragments in correct location, fixing them together with screws, screws or plates.

Surgical treatment of open anterior bite. During this operation, cut soft tissues on the upper jaw, located in the area of ​​the nasal septum, after which the bone is exposed, while moving the cut tissues away. Part of the bone is amputated, and the jaw is moved to the desired position, which is fixed with a plate with screws.

Treatment of lateral open bite. To correct this malocclusion, distraction osteogenesis is used, in which the structure is restored and the bone lengthens. The operation is carried out as follows: the bone is opened, in the place of its deformation it breaks symmetrically to the arch of the jaw, then distractors are installed that create the necessary pressure on bone elements, thereby correcting their position up to the complete closure of the jaws and at the same time stimulating the growth of new bone tissue.

Surgical correction of the chin (elimination of dysplasia). During the operation, the following manipulations are performed: the soft tissues of the chin are dissected to access the bone and give it mobility, then the chin is set in the correct position, after which it is fixed with a titanium plate.

Recovery period.

Since maxillofacial operations are considered quite complex, then recovery period takes quite a long time, as a rule, it lasts from 5-6 months.

Immediately after surgery, a splint is applied to the patient's cheeks and chin, then a course of antibiotics is prescribed to reduce the risk possible complications and infections.

After the effect of anesthesia wears off, the following symptoms appear:

• speech problems;
• numbness in places where surgery was performed;
• stuffy nose;
• bouts of nausea, and sometimes vomiting;
• microtrauma in the form of edema, as well as bruises around the lips and cheeks;
• pain and discomfort when moving the jaws;
• pain, as well as sore throat as a result of the use of an endotracheal tube during the operation.

Usually, all these symptoms disappear within the first month, at the same time you need to follow a diet in the form of eating soft pureed food. If the patient has braces, then rubber bands are put on them, and constant supervision of the attending physician is required.

In view of the difficulty of carrying out hygiene procedures it is recommended to rinse the mouth with antiseptic solutions in the first weeks after the operation.

After two weeks, the sutures and the splint are removed, and the fixing elements - plates and screws are removed after 4 months.

Thus, surgery is often the only way to effective elimination congenital or acquired defects of the jaw and bite. At the same time, a person receives not only a beautiful smile, but also returns to a normal one. full life thanks to the restored chewing function and correct speech.

Surgical correction of the bite

Malocclusion is a problem that orthopedists should not ignore when planning dental implants. It is important to find the source of the deformity (congenital adentia, childhood anomalies in the development of the occlusion, skeletal forms of occlusion deformity, etc.). This requires high-quality diagnostics and experienced orthodontists. Some of the bite disorders are treated orthodontically - by wearing braces or special equipment, in other cases, doctors may resort to the help of a surgeon (for skeletal bite deformities). In any case, implantation of teeth in patients with malocclusion is not the first step in treatment.

If you put implants without correcting the bite

Unfortunately, in many Moscow clinics, the work of an implantologist is still practiced in isolation from the orthodontist and orthopedist. The patient comes, complains about the lack of teeth and after a while they install an implant, referring him to an orthopedist for prosthetics. This tactic is wrong.

1. Due to malocclusion, the following problems may appear: gum recession, increased tooth wear, selective tooth decay due to uneven chewing load.
2. Decrease in the life of a dental implant due to uneven load on it. Premature loosening of the implant and the development of inflammation around the implant (peri-implantitis).
3. Incorrect bite negatively affects work digestive system and temporomandibular joints. The joints wear out prematurely, there are clicks, crunch, pain in the TMJ.
4. The health of the neck muscles and posture depend on the correct bite. Incorrect bite can provoke chronic headaches due to muscle spasm and nerve compression.
5. Psychological discomfort persists. Having installed a dental implant, the patient does not get a beautiful smile, a partial solution to the problem leaves the patient with internal dissatisfaction.

Dental implantation in "Dial-Dent"

In "Dial-Dent" any treatment is carried out comprehensively. If the patient has a malocclusion, then first it is necessary to correct it, then to carry out dental implantation, prosthetics on implants and, if necessary, aesthetic prosthetics. Only such a tactic guarantees the correct load on the dental implant and long term services. All stages are discussed with the patient before the start of treatment.

In a situation where the doctor sees that it is impossible to carry out implantation of teeth and prosthetics on implants without correcting the bite, since the orthodontic situation may worsen and it is impossible to guarantee the service life of the crown on the implant, and the patient refuses orthodontic preparation- the patient may be denied implantation.

At regular inter-medical discussions (round tables) that take place in Dial-Dent, doctors analyze difficult cases, and the final decision is made taking into account the opinions of all necessary specialists. Below are photos from the next round table of Dial-Dent specialists.