Prognathia (distal bite). Traumatology and reconstructive surgery of the cranio-maxillofacial

In children, the upper prognathia is 50-60% of total number all deformities of the dentoalveolar system.

Causes of upper prognathia (excessive development of the upper jaw)

Among the endogenous etiological factors, first of all, rickets and respiratory dysfunction (for example, due to hypertrophy of the palatine tonsils) should be mentioned. Among the exogenous - sucking fingers, artificial feeding with a horn, etc.

Depending on the etiology, the structure of prognathia may be different. So, the prognathia caused endogenous factors(for example, a violation of nasal breathing), combined with lateral compression of the upper jaw, tight teeth in the anterior region. If it is caused by exogenous factors, then it is noted significant expansion alveolar arch, due to which the teeth in it are located freely, even with intervals (three), i.e. fan-shaped.

A certain role in the development of maxillary prognathia is played by incorrect installation permanent large molars in the process of their eruption. These teeth, during eruption, are set in a single-tubercle closure: the masticatory tubercles of the lower large molars articulate with the same-named tubercles of the upper ones. Only after erasing the chewing surfaces of the milk large molars and the medial shift of the lower jaw, the upper first large molars, with its medial-buccal tubercle, is installed in the intertubercular grooves of the lower ones.

If the physiological erasure of the tubercles of the milk teeth is delayed or does not occur at all, then the first large molars remain in the position in which they erupted. This causes a delay in the development of the lower jaw, which remains in the distal position; superior prognathism develops.

Symptoms of upper prognathia (excessive development of the upper jaw)

It is necessary to distinguish between true prognathia, in which the lower jaw has a normal shape and size, and false (apparent) prognathism, due to underdevelopment of the lower jaw. With false prognathia, the size and shape of the upper jaw do not deviate from the norm.

The main symptom of overdevelopment of the upper jaw is its disfiguring protrusion forward; the upper lip is in a position shifted forward and is not able to cover the frontal section of the dentition, which, when smiling, is exposed along with the gum.

The lower part of the face is elongated by increasing the distance between the base of the nasal septum and the chin. The nasolabial and chin furrows are smoothed out.

The lower lip in the region of the red border is in contact with the palate or the posterior surface of the frontal upper teeth, the cutting edges of which do not contact the lower ones at all, even with increased protrusion of the lower jaw forward.

The lower front teeth with cutting edges abut against the mucous membrane of the palatine surface alveolar process or anterior hard palate, injuring it.

The upper dental arch is narrowed and extended forward; the palatine vault is high, has a Gothic form.

Often, true upper prognathia is combined with underdevelopment of the lower jaw, which aggravates the disfigurement of the face, especially its profile. The face in this case is, as it were, beveled downwards ("bird's face").

Treatment of upper prognathia (excessive development of the upper jaw)

Superior prognathia should be treated in childhood through the use of orthodontic appliances. If such treatment was not carried out in a timely manner or turned out to be ineffective, one has to resort to surgical methods.

At adults people with excessively pronounced prognathia, not amenable to treatment with equipment, good results are obtained by the removal of the front teeth and resection of the alveolar process. However, despite the ease of implementation and a good cosmetic result, the method cannot be called effective, since the functional capacity of the masticatory apparatus after such treatment is significantly reduced. Considering that the resection of the alveolar process ends with the installation of a fixed bridge prosthesis, which excludes the possibility of further growth of the upper jaw, this operation is permissible. only in adults.

Operation A. Ya. Katz

In this sense, it is more sparing, since it provides for the preservation of teeth: after detachment of the mucoperiosteal flap on the lingual surface of the alveolar process within the upper 6-10 teeth, the palatal part of each interdental space is removed with a drill. The mucoperiosteal flap is laid and sutured to its original place.

Due to this intervention, the resistance of the alveolar ridge to the action of the sliding arch, which is installed after the operation, is weakened. The described operation is shown when upper teeth arranged fan-shaped and between them there are certain gaps. Due to these gaps, it is possible to reposition the anterior teeth backward and assemble them in a close row, achieving contact between the proximal surfaces of their crowns.

Symmetrical removal of upper premolars

Symmetrical removal of the upper teeth in combination with compact osteotomy is performed in cases where the reposition of all anterior teeth cannot be carried out by the orthodontic method alone, i.e. when each of them is in contact with two neighboring teeth. In addition, it is indicated for prognathism, combined with lateral narrowing of the upper jaw or with open bite. In such cases, one (usually the first) small molar tooth is removed from each side, and then the operation is performed as in the treatment of an open bite.

14 days after compactosteotomy, orthodontic appliances are installed to gradually move the teeth back.

Other Treatments for Prognathia

Osteotomy and retrotransposition of the frontal part of the upper jaw according to Yu. I. Vernadsky or by P. F. Mazanov is undertaken when it is necessary to quickly (simultaneously) eliminate prognathia, especially in cases of its combination with an open bite, as already mentioned above.

Defects and deformities of the jaws average 4.5%. These are usually manifestations various changes facial and brain skull. These changes can be congenital in nature (as a result of exposure to various pathological factors during the development of the fetus), as well as acquired in nature (after trauma, inflammatory diseases etc.).

Anatomical, functional and aesthetic changes with deformations facial skull sometimes dramatically affect the behavior of the victim in society. Such people become withdrawn, uncommunicative, suspicious, with a constant feeling of inferiority. They have significant violations of the functions of chewing, speech, breathing, facial expressions. Aesthetic flaw may be the cause of the development of a secondary neurotic reaction. Therefore problems medical rehabilitation including surgery, drug therapy, physiotherapy, the use of methods of psychotherapeutic correction, and social rehabilitation people with dentoalveolar deformities should be addressed comprehensively.

There are the following main types of violations that can be observed in various combinations:

1) upper macro- or prognathia (hyperplasia - overdevelopment upper jaw);

2) lower macro- or prognathia (hyperplasia - excessive development of the lower jaw);

3) an increase in both jaws;

4) upper micro- or retrognathia (hypoplasia - underdevelopment of the upper jaw);

5) lower micro- or retrognathia (hypoplasia - underdevelopment of the lower jaw);

6) reduction of both jaws;

7) open and deep bites.

The particles "macro" or "micro" in the above terms denote an increase or decrease in all sizes of the jaw, and the prefixes "pro" or "retro" - a change in the ratio of the dentition in the sagittal direction only in the frontal section, with normal sizes of other sections of the jaws. Prognathia and re-trognathia are considered as anomalies associated with a violation of the position of the jaw relative to the base of the skull.

The tasks of treatment with combined asymmetric deformations of the facial skeleton caused by congenital hyper- or hypoplasia of the tissues of the maxillofacial region in

as a result of the syndrome of I and II gill arches (otocraniostenosis or hemifascial microsomia).

Dental deformities and anomalies are treated with orthodontic and surgical methods.

The possibilities of orthodontic measures in adults are limited to the zone of teeth and alveolar process (X. A. Kalamkarov, L. S. Persia). Various genetic abnormalities are eliminated mainly by surgery.

To determine the indications for orthodontic or surgical treatment, as well as for a possible combination of them, a thorough examination of patients and the joint work of orthodontists and surgeons are necessary. It is necessary to clearly diagnose the form of deformation (combined, isolated), determine the nature of the malocclusion, the degree of displacement of the dentition in various planes, and make calculations on teleroentgenograms and malocclusion models. It is necessary to study the shape and contours of the face, the state of the muscular apparatus, the temporomandibular joints.

After comprehensive examination the patient determine the methods surgical intervention(osteotomy or intercortical splitting), fixation of bone fragments, immobilization of the jaw in postoperative period and other technical details of the operation, as well as orthodontic, orthopedic treatment measures. It is necessary to draw up individual plan ballroom treatment.

Surgery it is advisable to carry out in people not younger than 17-18 years old, since by this period of life the formation of the bones of the facial skeleton and soft tissues is basically over. Besides more of dental deformities in childhood is due to disproportions in the growth and development of the dental system. By the age of 17-18 years, self-regulation of the bite often occurs.

In cases where patients have a well-adapted occlusion with fissure-tubercular contact of many antagonist teeth, operations are performed without changing the basis (basis) of the jaws. Apply replanting materials in the form of contour and supporting plastics. To do this, use cartilage, bone, freely transplanted soft tissues(skin, skin with subcutaneous tissue, fascia, etc.), as well as various foreign explants (implants).

In the surgical treatment of deformities and anomalies in the development of the facial skeleton special meaning have osteoplastic surgery, in which A complex approach to correct dental deformities.

Operational interventions with defects and deformities of the lower jaw. In case of defects and deformities of the lower jaw, operations on the alveolar process, on the body of the lower jaw within the dentition, in the area of ​​the angles and branches of the lower jaw, as well as operations on the condylar processes of the lower jaw, should be distinguished.

Operations on the alveolar process are used in the presence of

adaptation of the occlusion in the area of ​​the chewing group of teeth and the absence of closure in the anterior part of the dentition.

In operations on the body of the lower jaw, various methods osteotomy (vertical, stepped, sliding, etc.) and osteoectomy (wedge-shaped, rectangular, etc.). These methods have some disadvantages: the need to extract teeth; often over-education soft tissues in the buccal areas and, consequently, puffiness of the face; possible damage to the neurovascular bundle of the lower jaw; invariability of the mandibular angle and insufficient conditions for the regeneration of fragments. This place does not always withstand the physiological load during the function of the lower jaw, which is the cause of complications in the form of an open bite.

The most widespread operations in the area of ​​the angle and branch of the lower jaw in the form of vertical or horizontal osteotomy (A. E. Rauer, A. A. Limberg, V. F. Rudko, G. G. Mitrofanov, V. A. Bogatsky, Obwegesser, Dal Font). Currently, most authors prefer planar (intercortical) osteotomies in the area of ​​the angle and branch, which create significant areas of contact (wound) surfaces of bone fragments, maintain the ratio of the temporomandibular joint, reduce the treatment time, observed good result(Fig. 198, a, b). These methods are to some extent universal, as they are used when various pathologies- underdevelopment or excessive development of the lower jaw, open or deep bite and a combination of these forms of malocclusion (Fig. 199, a, b).

Surgical interventions for defects and deformities of the upper jaw. Deformities of the upper jaw can manifest themselves both in the form of a violation of its normal size, and in the form of an incorrect position. With prognathism or excessive development of the upper jaw, apply surgical operations consisting in partial resection of the jaw.

In cases where the anterior teeth do not represent functional and aesthetic value, it is possible to remove them from the corrected protruding area of ​​the alveolar process or to perform a fragmentary osteotomy of the anterior maxilla. After extraction of first premolars with wedge or rectangular resection bone tissue the alveolar process with the frontal teeth located in it is sawn out and moved backwards. good effect gives complex surgical and orthodontic treatment for deformities of the upper jaw, including the method of weakening the bone structure by multiple perforations from the vestibular and palatine sides - compact osteotomy (AT Titova). In this case, orthodontic movement of the teeth of the upper jaw backwards should be carried out according to the principle of A. Ya. Katz. This will move the lower jaw and create more sharp corner lower jaw by excision of the cortical layer of the bone inside and outside - decortication.

To eliminate the upper retro- and micrognathia, operations have been developed to move the entire middle zone of the face anteriorly at the same time (V. M. Bezrukov, V. P. Ippolitov). This makes it possible to eliminate the deformation of the middle zone of the face to a greater extent and, together with the displacement of the bone fragment, synchronously displace the cartilaginous part of the nose anteriorly, avoiding its secondary deformation. To prevent displacement of the upper jaw posteriorly, a bone graft is inserted between the tubercle of the upper jaw and the pterygoid processes of the main bone.

In addition, single-stage surgical interventions on bone skeleton middle and lower zones of the face (V. P. Ippolitov). Applies also contour plastic with jaw deformities, which is mainly indicated to eliminate residual deformities and increase the aesthetic effect of the treatment.

Surgical interventions for ankylosis of the temporomandibular joint and contracture of the lower jaw are discussed in chapters XI and XII.

DENTAL AND MAXILLOFACIAL IMPLANTATION

Implantation according to the previously adopted international classification refers to allotransplantation, according to the new - to explantation. However, foreign literature uses the term "implantation" - especially in relation to dental structures.

AT surgical dentistry It is possible to conditionally distinguish dental and maxillofacial implantation.

Implantation has a long history, and its development in different periods associated with the use of different materials. Physical, chemical and biological properties allograft materials - metals, plastics and others often determined inadequate osseointegration and engraftment in tissues, were the cause of shortcomings in operations and failures. This did not allow for many years to introduce the method of implantation into the practice of surgical dentistry. In the 40s of the XX century, fundamental research on implantation appeared: in our country - on the maxillofacial (creation of implant systems for plastic surgery, trauma), and abroad - on dental structures.

There are dental (endodonto-endoosseous and endosseous), submucosal, subperiosteal, intraosseous, transosseous and combined implants. By function in the dentoalveolar system, facial and cerebral skull implants can be replacement, support, support-replacing, with or without a shock-absorbing system.

According to the properties of biocompatibility, implants can be made of biotolerant (stainless steel, CCS), bioinert (aluminum oxide ceramics, carbon, titanium, titanium niclide) and bioactive materials (tricalcium phosphate, hydroxylapatite, glass ceramics).

Dental implantation is the most widely used in dentistry. In our country, the first studies on dental implantation were carried out by N.N. Znamensky (1989-1991). In the 1940s and 1950s there were interesting work E. Ya. Vares, S. N. Wise and others, but they did not receive their development. However, abroad dental implantation has been widely used for more than 30 years: in the 60s, subperiosteal implants were popular;

in the 70s - flat and cylindrical; since the 80s - bone-integration. In our country, only in the 80s, thanks to the research of A. S. Chernikis, O. N. Surov, M. 3. Mirgazizova, dental implantation was developed. The experience of dental implantation is a little over 15 years.

At present time for increase chewing efficiency with partial and complete loss of teeth use endosseous, subperiosteal and transosseous implants. Of these, endosteal implants are most widely used. Among them two main fundamentally different systems: screw implants R. Bronemark and flat - L. Linkova. Over the years based on them went material improvement for implantation, their types and designs, as round ["Bonefit", "Kor-Vent" (Spec- tra-system), Steri-OSS, Ankylosis,"Contrast" etc.], and flat(systems Linkov "Oratronic""VNIIIMT", "Park-de-ntal", "METEM" etc.) forms (Fig. 200, a). Today known more 100 species and dental systems implants. So, from implants round forms screw, qi-

cylindrical, solid, hollow, cone-shaped, non-porous, superficially porous, having grooves, cuts, holes on the surface.

Indications and contraindications for dental implantation. The main indication for implantation is the inability to create a functional and aesthetic effect traditional methods orthopedic treatment. The choice of an implant of one design or another depends on the conditions in the oral cavity and is determined by its future function. The orthopedic surgeon selects the implant and draws up an orthopedic treatment plan.

Indications for dental implantation are also determined by the general condition of the body and the condition of the oral cavity - teeth and mucous membranes. Immunodeficiency diseases and conditions, namely allergic, autoimmune, immunoproliferative syndromes, hereditary burden are a contraindication to implantation. When examining a patient for implantation and evaluating general condition organism pay attention to age, safety of life support systems. In the presence of an infectious syndrome, a more detailed examination of the patient about infectious disease. With a positive decision on the issue of implantation in these cases, the patient is treated. Stabilization of the immunobiological state of the body is necessary and, according to indications, correction defensive reactions his. Sanitation of odontogenic foci and foci of ENT organs requires special attention. It is not recommended to carry out implantation in patients who use drugs and "malicious" smokers. Special attention should be paid to patients with systemic and age-related bone diseases, to women in the premenopausal and postmenstrual period, when osteoporosis of the bones, including the jaws, is observed. important research mental state patient, knowledge of his motivation for implantation, as well as the possibility of adapting the surgical and orthopedic stages of treatment. The patient must be aware of the percentage of risk and make a choice of treatment with and without implantation, taking into account the functional and aesthetic possibilities.

Diagnosis during implantation. In the examination for implantation, a diagnosis is carried out, consisting of a clinical assessment dental system, x-ray studies and orthopedic models. It is necessary to conduct a clinical study, measure the height and width of the alveolar processes of the jaws, the position of the mandibular canal, the location of the maxillary sinus. Special attention should be addressed to the condition of the teeth (the quality of filling their canals and cavities) and the oral mucosa, occlusion.

Clinical data are supplemented by X-ray examination. Orthopantogram, sighting images, evaluation of computed tomography indicators are required.

Clinical and X-ray diagnostics supplemented by the evaluation of jaw models, including in the occluder. According to

The most common are congenital cleft jaws, which are the result of a violation of the formation of the face in the early stages of embryogenesis. Isolated clefts of only the alveolar process are rare. A cleft of the alveolar process of the upper jaw, as a rule, is combined with a cleft upper lip and the sky. Median cleft of the mandible and lower lip is extremely rare. Treatment of congenital clefts is surgical. Cleft palate is repaired with plastic surgery, one of the stages of which is fissurorophy - sewing up the edges of the crevices.

Violation of the development and growth of the jaws is primarily associated with damage to the growth zones of the bone in children - trauma (including birth), inflammatory processes(osteomyelitis, arthritis, purulent otitis media), the presence of deep scars in the tissues surrounding the jaw, after burns, noma, and also as a result of radiation injury during jaw growth.

Underdevelopment of the lower jaw (microgenia) can be symmetrical (with uniform underdevelopment of both sides of the jaw; Fig. 5, d) and unilateral, or asymmetrical. The latter are more common. With symmetrical (bilateral) microgenia, the lower third of the face is reduced, the chin is displaced posteriorly. With unilateral microgenia, the chin is displaced from the midline of the face towards the jaw lesion, the other side looks flattened and, as it were, sinking (Fig. 5e). Microgenia is most often associated with osteomyelitis, ankylosis of the temporomandibular joint, trauma with damage to the growth zones of the jaw bones.

Excessive development of the lower jaw (Fig. 5, c; macrogeny, or progeny) is characterized by a massively developed jaw with a sharply shifted forward chin. This type of anomaly in the development of the jaws is associated with heredity, since it is often observed in several generations of the same family. The upper jaw is of normal size.

Excessive development (protrusion forward) of the frontal section of the upper jaw with a normal value of the lower - prognathia (Fig. 5, a).

Underdevelopment of the upper jaw - micrognathia (opistognathia; Fig. 5, b) - is associated with impaired growth (trauma, early operation about the cleft palate).

Open bite (Fig. 5, e) is a deformity in which, when the jaws are closed, only the molars are in contact, and a gap remains between the remaining teeth. It is observed after suffering rickets, with improperly fused fractures of the jaws, after surgery for ankylosis of the temporomandibular joint.

Treatment of anomalies of the jaws and dentition is mainly orthodontic (see Orthodontic treatments).

Surgical treatment is carried out at the age of 15-17 years, when the formation of the facial skeleton is basically completed.

Plastic surgeries used to eliminate developmental anomalies and deformities of the jaws can be conditionally divided into two main groups: osteoplastic surgery and contour plastic surgery. Depending on the type of anomalies in the development and deformation of the jaws, various methods of osteoplastic operations are shown (Fig. 6). In some cases, the operation consists only in osteotomy of the body or jaw branch, followed by displacement of the jaw fragment without the use of a free bone graft, in others, in osteotomy using a free bone graft. As a rule, along with the operation, orthodontic appliances are also used to fix the jaws, as well as to correct the bite.

Contour plastic is indicated for a moderate degree of underdevelopment of the jaws and their deformation, if there is no significant malocclusion. The operation consists in changing the outer contour of the jaw and moving the soft tissues to the correct position. The most effective replanting of a simulated plastic implant under the periosteum.

Rice. 6. Surgical treatment of jaw deformities: a - moving back the frontal section of the upper jaw; b - osteotomy c wedge resection bodies of the lower jaw; c - osteotomy with wedge resection of the mandibular branch; d - closed osteotomy of the lower jaw branch according to Kostechka; e - horizontal or oblique osteotomy of the lower jaw branch; f - vertical osteotomy with wedge-shaped resection of the mandibular branch; g - osteotomy of the body of the lower jaw with bone grafting; h - stepped osteotomy of the lower jaw branch; and implantation of plastic in the area of ​​the receding chin.

There are several anomalies in the structure of the jaws, in which it can be said that one of them is smaller than the other. The most common are progenia, when the lower jaw protrudes forward, and prognathia - larger than the upper jaw bone, or both of them are abnormally large. These changes relate to the ratio of the jaws in relation to each other. When talking about a small jaw, then in medicine most often we are talking about micrognathia, which is also called false prognathia. It may be top if undersized upper jaw, or lower - the lower jaw bone is not fully developed.

1. At micrognathia when one of the jaws is not sufficiently developed, and therefore it is small and narrow.

Micrognathia (Micrognathia) consists of the words micros ( Greek. "small") and gnathos ( Greek. "jaw"). This is one of the anomalies that causes distal bite of the teeth, and means underdevelopment of the jawbone. In addition to the upper and lower, complete and incomplete micrognathia are also isolated.
Other names: microgenia, false prognathia.

1. In the case of true progeny or pronatia when one of the jaw bones is overdeveloped, while the small one is mistakenly called the one that is normal in size.

Causes of anomalies

The development of the irregular structure of the jaws is varied. Conventionally, it is customary to distinguish between congenital and acquired anomalies. Congenital changes are laid by the incorrect development of the maxillofacial region, even in utero.

The progenic and prognathic ratio in the embryo changes periodically during its development, as natural process. As a result of endogenous and exogenous factors, failure occurs. This can be negatively affected serious illnesses mothers during pregnancy bad habits or genetic predisposition.

In an adult main reason is the lack of correction of the anomaly in childhood and any trauma to the maxillofacial region.

Small jaw in a child

After the birth of a child, the main reason is artificial feeding. But Negative influence renders the wrong approach to this process. By following all the recommendations of the pediatrician, you can completely avoid negative consequences.

A small lower jaw can be observed with prolonged sucking of a nipple by a child, thumb hands or other object that presses on solid sky. As a result, the upper jaw becomes larger and the lower jaw does not seem to develop.

The same is observed from above. But the reason for the formation of a large lower jaw often lies in the absence of nasal breathing. The child breathes through the mouth, which leads to stretching of the muscular masticatory apparatus. As a result, the jaw begins to move distally.

Other reasons include a violation of chewing, swallowing, speech, changes in the tone of the muscles of the back of the head and neck. Violation of the turgor of the circular muscle of the mouth leads to the displacement of the upper vestibular teeth. A change in their position leads to pathology of bone tissue.

Small jaw in an adult

If you do not correct all the anomalies in childhood, then with age they will become more pronounced. When the lower jaw is smaller than the upper jaw, they speak of prognathism. It can be both false and true.

With a true anomaly, the jaw arch actually undergoes changes. False changes are observed mainly as a result of the displacement of the teeth, in one direction or another.

In an adult, the cause of these anomalies may be the lack of permanent molars(certain teeth). As a result, the lower jaw stops developing and becomes smaller than the upper jaw. To the absence chewing teeth causes trauma, early removal or congenital adentia.

Features of treatment

Features of the therapeutic effect depend on the severity of the problem and are prescribed by the dentist after a thorough examination. With a progenic bite, they achieve a decrease in the growth of the lower jaw and stimulate the development of the upper. Before this, anomalies in the location of the teeth are eliminated.

During the period of milk bite, all activities are aimed at:

• Sanitation of the oral cavity and teeth;
• Restoration of nasal breathing;
• Normalization of language functions;
• Elimination of bad habits;
• Grinding of tubercles of milk teeth.

A good effect is observed from the use of myogymnastics. She is assigned to early age when the bone tissue has not yet completely gone through the process of decalcification. Also during this period, various orthodontic appliances are recommended. They are used long time. During the day, apply for several hours and at night.

Anomalies associated with prognathia are more difficult to treat. Correction is carried out only surgically. Plastic surgery of the lower and upper jaw bones is used.

© zea_lenanet / Fotolia

Anomalies of bite are characterized not only by the presence of a pathological dentition, but also by the abnormal development of the jaw. One of the most common problems of this type is a small lower jaw.

A pronounced discrepancy between the jaw and its normal size leads to the formation of an aesthetic defect and a violation of the basic functions of the dentoalveolar apparatus.

concept

In orthodontics, under the term "small lower jaw" several concepts are considered at once, which are radically different from each other.

Micrognathia and microgenia

Most often, with a small lower jaw, they indicate the development of micrognathia, or, as they call it in another way, microgenia.

Micrognathia of the lower jaw is its incomplete or slow development, inappropriate physiological norms and parameters. Micrognathia can be observed both on the entire jaw and on its part, for example, in the lateral section, only on one side.

Prognathia

Unlike microgenia, prognathia is overgrowth of the upper jaw, against which, the bottom one looks smaller. Because of this, the pathology is often called false progeny.

Causes and manifestations

Prognathia and micrognathia can form from the first months of a child's life or in adulthood, under the influence of certain factors. Depending on age, pathology has certain clinical manifestations, which make it possible to detect deviations in early stages its development.

The child has

main reason wrong growth the jaw of a child is process disruption prenatal development during the period of laying the prognathic and progenic ratio of the jaws. The following are considered as factors provoking such anomalies:

• malnutrition;
• genetic predisposition;
• the occurrence of severe colds and viral diseases;
• smoking and alcohol abuse.

In children, in addition to congenital micrognathia, an acquired type of this pathology is often detected. A number of reasons can lead to its development:

• late removable bite with early loss of milk teeth;
• pathology of the endocrine system;
• premature removal of temporary teeth;
• abnormal development of the bones of the maxillofacial region;
• pronounced violations of nasal breathing;
• the presence of bad habits: constant sucking of a pacifier or a finger, the habit of gnawing pencils and pens;
• absence breastfeeding, given that the artificial was carried out incorrectly.

The relief of these causes at an early age of children, allows you to correct the situation without the use of complex orthodontic appliances.

In children, the anomaly is manifested by the retraction of the lower lip and chin.. In severe cases, this leads to dysfunction of suckling, as a result of which, the child is not able to properly latch on the nipple.

During the growth of milk teeth, their wrong position. Due to the lack of space in the jaw arch, the teeth are often outside the dentition or strongly deviated to the side.

In an adult

As negative factors, provoking misdevelopment jaws in adults, distinguish the following:

• absence orthodontic treatment in childhood, as a result of which, the pathological condition of the jaw worsens over the years, and the signs of the anomaly become more pronounced;
• trauma to the face or jaw, with severe damage to the periodontal or bone tissue;
• hypertonicity of the muscles of the occipital and cervical parts of the body;
• violation of breathing, swallowing and chewing;
• pathological changes in the development of the circular muscle of the oral cavity;
• endocrine disorders: dysfunction metabolic processes, diabetes;
• pathology of bone tissue: rickets,.

In adults, pathology is manifested by a distortion of the patient's facial features. When considering the profile, the recession of the lower lip, which has a stretched appearance, stands out. The cutting part of the front upper teeth, may come into contact with lower lip or come forward.

The lower row of teeth is deformed, as the position of some units that stand out from the general row changes. Severe pathologies are characterized by a violation of the chewing function, as a result of which have trouble biting and chewing solid foods.

Treatment Methods

Features of the methods used to treat an abnormally developed lower jaw primarily depend on the type of anomaly. With insufficient growth of the lower jaw, all manipulations will be aimed at stimulating its development.

If the excessive size of the upper jaw acts as the cause of the pathology, then the therapy will consist in restraining its growth. To solve the problem, all methods are selected in accordance with the severity of the pathology and the age of the patient.

During the period of milk bite

This period is the most optimal for the correction of bite pathologies and allows you to correct the situation with the use of sparing therapeutic methods.

Treatment of micrognathia and prognathia during milk bite will include a number of standard procedures:

1. , with the restoration of destroyed teeth and the removal of damaged roots. In the presence of periodontal tissue diseases, they are treated with the use of drugs of local and general action.
2. . Carried out in case of premature loss of milk units. To fill them, the dentist carries out splinting of the included defects, or sets temporary prostheses. This will preserve the position of the teeth and restore the size of the jaw arch.
3. Normalization of respiratory and language functions. If necessary, the doctor conducts. If the cause of the pathology is a violation of nasal breathing, then the nasal septum is corrected. These manipulations without fail accompanied by special gymnastics.
4. On the early stages development of pathology, to restore the normal size of the jaw, it is enough eliminate bad habits of the child.
5. . Represents an effect on the muscles of the jaw special exercises normalizing their tone. Myogymnastics is used in children 4–7 years old and allows you to completely restore the normal size of the jaw without the use of orthodontic appliances.
6. Grinding bumps chewing surface– fissure. It is used if the cause of the pathology is the absence of normal closing of the teeth.
7. Application of orthodontic appliances. At severe violations jaw growth, the use of special orthodontic nipples, caps, plates is prescribed.

During permanent bite

During the period of removable and permanent dentition, treatment is prescribed depending on the type of anomaly. For the treatment of prognathia in the shift period, the following orthodontic devices are used:

• Herbst apparatus, equipped with intraoral telescopic non-removable elements;
• Frenkel regulator;
• facial bow in combination with non-removable systems.

During the period of permanent occlusion, when the formation of the jaw bones is already completed, removable and non-removable devices are ineffective, therefore, to correct the problem, they resort to surgical intervention. Main surgical method is the removal of some teeth and excision of a section of the alveolar ridge.

Microdentia during mixed dentition is corrected with distractors. These devices are presented various models, each of which is aimed at solving the problem of insufficient jaw growth, taking into account the age and characteristics of the patient's dentition.

Distractors provide stretching of the jaw bone tissue with its gradual replacement with new bone.

In case of their ineffectiveness or during the period of permanent occlusion, the dimensions of the jaw are corrected surgically. The procedure involves the dissection of the bone tissue of the alveolar ridge and the installation of an expanding device on it.

In the course of treatment, the device is regularly activated, pushing the bone apart, and new ones are formed in the resulting gap. bone cells. This operation is considered one of the most sparing, but it involves long-term treatment with constant activation of the expander.

There is another, more radical option. Its essence lies in protrusion of the jaw forward, due to its breaking off from the main bone. The operation begins with exfoliation of the mucosa and dissection of the alveolar ridge.

After that, the correct bite ratio is created, and fixing plates are installed at the dissection site, which prevent the edges of the severed bone from connecting.

A bone-forming material is placed in the resulting gap, which will completely fill the excised cavity within a few months.

How this happens is schematically shown in the following video:

Forecasts and prevention

Treatment of a small lower jaw in the period of milk and mixed dentition has quite favorable prognosis. But if we consider correction with permanent occlusion, then even when using surgical intervention, it is not always possible to achieve the desired result.

In addition, after such operations, possible load on the jaw, decreases.

In order to avoid the development of such an anomaly, it is necessary to adhere to certain preventive measures:

These measures are simple and do not require in large numbers time to complete them. But at the same time, they will avoid a serious problem, which in the future may require a long and complex treatment.

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