WO2015132649A1

WO2015132649A1 - Orthodontic orthopaedic functional appliance

Info

Publication number: WO2015132649A1
Application number: PCT/IB2015/000277
Authority: WO
Inventors: Clelia LETTIERI
Original assignee: Lettieri Clelia
Priority date: 2014-03-04
Filing date: 2015-03-04
Publication date: 2015-09-11
Also published as: ITNA20140006U1; WO2015132649A4

Abstract

The orthodontic orthopaedic functional appliance for a treatment of facial asymmetries (even the hemifacial microsomia Ml) it should be used during the age of growth. It is constituted by a resin plate (bite plate) with an occlusal insertion to the upper dental arch. ( in this bite it is possible to apply a common expansion trasversal screw in the middle of palatal zone ). This device has horizontal and vertical different occlusal design of plate which contacts lower teeth. In particular in the horizontal view of the contact area of plate corresponding to a not pathological side of patient, lower teeth have multiple contact of stabilization with the bite, On the pathological side of patient the bite plate design has only partial contact of buccal cusps of the lower teeth as the occlusal surface of the device is slightly inclined. In the vertical view of the bite plate corresponding to a pathological side of patient, the device opens on that side arches higher than the part of bite plate corresponding to the healthy side of patient. In the pathological side of patient the height of the bite plate is derived from the graphical correction of the asymmetry of patient (it is calculated on cephalometric tracing of the x- ray of skull of patient in the front projection and reported on the device). It is possible to apply a removable shield from the pathological side of patient (see figure of the accompanying drawing) in which it is possible to apply an expanding screw to increase the height of shield, if necessary.

Description

DESCRIPTION OF THE ORTHODONTIC ORTHOPAEDIC FUNCTIONAL APPLIANCE

DESCRIPTION TEXT

The proposed orthodontic orthopaedic functional appliance (fig. 1) is used in orthopedics maxillo facial treatment of facial asymmetry in children. In particular it is used for mandibular asymmetries as the hemifacial microsomia (Ml) in cases where there are no additional changes in other district of the skull (as eye, ear, soil tissue and nerves) and there are not extracranial Forms, This device is constituted by a bite plate inserted on the upper teeth of patient (fig. 1 ; parts a - b). It is constructed from acrylic resin on a plaster model developed by an impression in alginate of the dental arches of the patient, The plate fits over the upper teeth (it can be totally in resin or supported by hooks ball fig. 1 part f). The plate can also be a vacuum formed template. The bite plate presents a plan for occlusal contacts with the lower teeth (fig. I) which is different between right and left sides. In particular in the occlusal plane corresponding to the healthy side of the patient (fig. 1 part b) the contact is widespread ,multiple and not - geared (bite plate smooth) with the opposing arch and the device does not have a strong occlusal thickness (the thickness is only 1,5 mm). This design of bite plate ensures a stability of occlusal contacts on this side of mandible and leaves freedom of movement disengaging the growing jaw. From the side where there is the deformation of the jaw (microsomal side), occlusal contacts are not continuous but partial and only the buccal cusps of the lower dental arch contacts against the occlusal base of the orthopedic device (fig. 1 part a), Then, there is a tilt on occlusal plane of device so that the lingual cusps of the lower teeth have no contact but are free (the goal is to deprogram the pathological temporomandibular joint which has an altered functional path in all three directions of space). On the same side, the thickness of the occlusal area is different respect to thickness present on the healthy side. In particular it is larger, This different thickness opens asymmetrically dental arches in the frontal plane. Moreover partial contacts on pathological side and multiple - spread not geared contacts on the healthy side, allows to correct the asymmetrical jaw position on the space with a rotation. During swallowing in fact the patient searchs more stable contacts and performs a rototraslation with mandibular advancement and this movement stimulates the growing of pathological side of mandible. The entity of this asymmetrical thickness is the result of a mathematical calculation carried out on the cephalometric tracing of x - ray of skull of patient in frontal projection and closed mouth . So it can calculate the degrees of the amount of asymmetry of patient refers to the position of anatomical chin relative to the axis of facial symmetry (degree of deviation of the jaw). This angle of asymmetry is entered as tilting of the bite plate in occlusal contact on pathological side of patient (compared to the occlusal plane of the upper dental arch of patient the device presents an occlusal bite plate inclined outwardly towards the cheek of patient in the side of pathological jaw). Entering this angle in this position on the plate on the pathological side , the device get a thickness on the plate which will vary from patient to patient. In the central / median part of the device which contact the palate of patien, it can be applied an expansion symmetrical screw which can be activated if necessary (fig. 1 part c). In the area of the bite plate in the pathological side an expansion screw with vertical direction can be insert and can be activated if necessary ( this is a safety device in the case in which the use can reduce the height of this thickness ) ( fig. 1 part d). On buccal part of this device (in the fornix of the pathological side of the patient and in contact with his cheek) it possible to place a vertical removable buccal shield (fig. 1 part h). This shield has thin metal wires (fig. 1 part g) that allow its insertion in this part of the device. In particular these thin wires are inserted into the special guides that are positioned in the resin of the appliance. This shield has the following characteristics: respectful of the soft tissues in order to avoid any kind of decubitus in its vertical length and in its sagittal length it is long from the back teeth to canines. Also it has an inclination in the frontal plane. The shield moves away from the teeth increasing its inclination from the bottom to the top of teeth and it tilts outward in the cheek of patient. This angle is in absolute value equal to the angle that the pathological condyle, generally inclined medially, forms with the sagittal axis of symmetry of the patient. But the shield is tilted buccally (inclination opposite to pathological condyle) ( the inclination of pathological condyle is calculated respect the axis of symmetry of the patient on the x- ray of skull of patient in frontal projection where it has made a cephalometric tracing). In the shield it is possible to insert a vertical expanding screw in order to increase the height of the shield if necessary. (fig. 1 part e). The device in its design of the occlusal plate ensures the bone growth of mandible deformed at birth and therefore allows to increase the vertical length of the pathological branch of the mandible and the result is the correction of the degree of asymmetry of patients. The buccal shield allows to stimulate the deformed condyle and it thus develops the normal shape and function. The shield also determines the proper orientation in the space of deformed condyle ( in the upper and back direction) and finally it develops cranial anatomical structures of the temporomandibular microsomal joint , as the glenoid cavity and the articular tubercle absent in these patients at birth.

In addition to the strong therapeutic impact this device, in his idea, is designed to be easy to use for both the patient and the orthodontist.

Also it requires a smaller number of hour of daily application (after dinner and all night) with a reduced demand for collaboration to the patient , thereby permitting the use even in patients younger and less - cooperating and therefore a more early use that corrects this pathology very early in an auxologic optimal moment when patients have not yet stabilized the abnormal facial functions related to the altered shape of the bony structures and temporomandibular joint ( we speak then of a very early use around the fourth - fifth year of post - natal life).

Claims

1) IT CLAIMS THE INSERTING ON THE UPPER ARCH, ALSO THROUGH HOOKS

Compared to the previous existing functional appliances for the treatment of facial asymmetries in particular of hemifacial microsomia type M1 growin patients , this device differs in better by them for easier use as it is applied stably to the teeth of the upper arch and the patient is free to be able to have the mouth open and he can also speak during the use. (Unlike other types of functional appliances which are applied on the upper arch not stably but are "to fall" for which the patient is obliged to have the mouth closed in order to activate the function of the appliance itself— or there are other devices inserted to the lower arch and also in this case the patient is obliged to always have the mouth closed in order to to allow its activation). All devices until now in use must be worn all day unlike the orthodontic orthopaedic functional appliance need only a few hours in the evening and the night

2) IT CLAIMS THE ASYMMETRICAL OCCLUSAL BITE PLATE

IN THE FRONTAL PLANE AND DIFFERENCES BETWEEN THE

TWO SIDES OF THIS DEVICE

This device abandons the concept that hemifacial microsomia is to be corrected with an upper dental extrusion on the side affected in order to compensate the mandibular asymmetry, and it introduces the idea of direct repositioning of pathological mandible in the space in order to stimulate the missing part of jaw by asymmetrical occlusal features of this bite plate ( different heights between two sides of the upper plate) The appliance increases in a few months the length of the vertical ramus of deformed jaw and it results in an early correction of the asymmetry of the patient in the frontal plane. 3) IT CLAIMS THE CONTACT OF ONLY BUCCAL CUSPS OF THE LOWER TEETH ON THE UPPER BITE PLATE ON AFFECTED SIDE OF PATIENT

There is a different occlusal contacts on the horizontal plane between the two sides of this device and the lower teeth This device is different from the other existing appliances, for the treatment of hemifacial microsomia in the growing age, in particular for the innovative characteristics of the occlusal bite plate. In the pathological side of patient the plate has an inclination that allows the contact of the only buccal cusps of the lower teeth while the lingual cusps are free from any contact. This partial contact has the purpose of deprogramming the temporomandibular joint and the muscles of the pathological side which have an altered functional path. 4) IT CLAIMS THE MULTIPLE AND SPREAD CONTACT OF THE LOWER TEETH ON THE UPPER PLATE ON THE HEALTHY SIDE OF PATIENT

The contact of lower teeth on plate of the healthy side of patient is different from that in the pathological side. The tower teeth have a multiple, widespread not geared contact on the upper occlusal plate of device,. That contact helps to give greater stability during the occlusal contact . This innovative idea wants to oppose contacts uncomfortable and unstable from the pathological side with contacts more stable and comfortable on the healthy side. The patient during swallowing is induced spontaneously to correct the position of the mandible on the space making a rototraslation with mandibular advancement. Thus he stimulates a vertical growth of pathological side that is stretched to the healty side 5) IT CLAIMS THE APPLICATION OF A REMOVABLE SHIELD ON

BUCCAL FORNIX TN THE AFFECTED SIDE OF PATIENT

A buccal shield can be removable and applied only at a later time when the first phase of correction has been completed. In this way :

a - we avoid: to take a new impression of arches in the young patient for the shield construction and so it can reduce the working time for the orthodontist

b- we use first only the occlusal bite and in a second moment also the shield so the first impact for young patient will not be very complicated The shield will be added later when needed and especially when the patient is already accustomed to an orthodontic appliance (it will also be grown in age and thus more cooperative).

6) IT CLAIMS THE TILT OF THE REMOVABLE SHIELD TOWARD THE CHEEK OF PATIENT IN THE PATOLOGIC AL SIDE

The buccal shield has a lateral inclination studied on teleradiography of x - ray of the skull of patient in a frontal projection. The shields has a tilt customized in order to develop both the mandibular condyle and the cranial structures (the shield is not parallel to the alveolar process but is drew tilted from the bottom to top with an open angle upward and outward). The shield has an expanding vertical screw to be activated if necessary.