INTERDISCIPLINARY APPROACH IN TREATMENT OF PATIENTS WITH DENTAL ANOMALIES
Authors: Smahlyuk L.V. , Kulish N.V. , Nesterenko O. M. 
Published: June 2022

The article presents data on the treatment of patients with TMJ and concomitant deformities. The most important connection between the dental system and the musculoskeletal system is the temporomandibular joint, which in the presence of dental anomalies and in the period of temporary occlusion undergoes increased loads, which leads to its dysfunction. The concept of the interaction of posture and occlusion was first put forward in the early 20th century, which noted that children with glossoptosis have X-shaped legs, crooked posture and typical signs of distal occlusion. It has been theorized that occlusal disorders can alter posture in the frontal and sagittal planes and ultimately alter body weight distribution. Postural curvature causes a violation of the position of the head of the temporomandibular joint, which in turn leads to pain and joint dysfunction. Any postural disorders lead to compensatory changes throughout the body, not excluding the maxillofacial area. This is especially true for the formation of mesial occlusion (III class according to Angle). Mesial occlusion in the structure of dental anomalies is determined in 12% of cases, but the severity of the anomaly and aesthetic disorders that occur often force orthodontists to use a combination.

Therefore, further improvement of methods of diagnosis and treatment of occlusions of occlusion of the third class according to Angle will allow most patients to get a positive treatment result and the opportunity to adapt in society. An example of coordination of specialists in the planning and implementation of treatment is the clinical case of patient K. 16 years old, who went to the clinic where on the basis of examination and special research methods diagnosed: Angle class III (skeletal form) true progeny, macroglossia. Also at inspection of a posture sharp curvature of a backbone, with signs of scoliosis is defined. From the back there is a clear asymmetry of the shoulders within 4 centimeters. Asymmetrical location of the shoulder blade and even significant hypertrophy of the right shoulder blade (in this direction the patient is determined by the displacement of the mandible).

Asymmetry was noted in the general study of the face. Displacement of the chin to the right was noted. The asymmetry of facial structures begins with the upper third. Asymmetry of superciliary arches, orbits, wings of the nose, nostrils, and corners of the mouth was also observed. Deepened nasolabial folds were noted. The lower lip overlaps the upper one. But the profile of the face remains almost straight. Based on the data obtained, the patient was offered the following treatment plan: consultation with an orthopedist traumatologist about scoliosis, consultation with a dentist surgeon about skeletal surgery, consultation with a speech therapist. Orthodontic treatment is concerned with a brace system. The patient’s brace system was fixed on the upper jaw (“straight arch” technique was used). 38 and 48 teeth were removed. Bilateral planar osteotomy of the mandible and resection of the tip of the tongue were performed. The lower jaw brace system was fixed using oblique intermaxillary traction, which the patient used for 6 months. A course of therapy with a speech therapist was conducted to restore speech function. The total duration of the active treatment period contained 4 years. After creating the maximum occlusal contact, the patient regained chewing function. Thus, the treatment of mesial occlusion and its prognosis largely depends on etiological factors and the possibility of their elimination, as well as the severity of morphological and functional disorders, the difficulty of eliminating them during permanent occlusion. Therefore, the sacred rule of medicine "better to prevent than to cure" in relation to skeletal forms of mesial occlusion is the most relevant.