State Autonomous health institution

“Children's clinical dental polyclinic №2”

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Orthodontics

Orthodontics — is a branch of dentistry that deals with the prevention, diagnosis and treatment of dental anomalies, studies the development of bite in humans and the state of the dentition as a whole.

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How to choose an orthodontist?

Unfortunately, there is no one hundred percent method. The most correct way is to see the results of the doctor's work. This may be Your friends who have been treated by a doctor. If You like their smile, feel free to follow these recommendations. Look at the examples of treatment on the website or photos shown at the consultation. Pay attention when choosing a doctor to his qualification. A good orthodontist should constantly improve their skills at training seminars, as our specialty is developing very quickly. Experience is also important, but experience is indicative only with good education and competent work with modern technology. In the patient-child, already at the first contact, positive emotions are caused by the attractive appearance of the orthodontist, a friendly smile.

So, You've come for a consultation. What should I pay attention to when talking with the doctor? Good doctor:

  • explains the crux of the problems is logical, consistently, understandable.
  • offers ways and methods to solve Your problem.
  • clearly and clearly answers your questions.
  • does not exert psychological pressure, justifying the need for treatment.
  • offers the most advanced methods of orthodontic treatment, high-quality and reliable bracket systems of well-known and world manufacturers, modern functional devices.
  • he openly speaks not only about the advantages, but also about the shortcomings of the proposed treatment options.
  • shows the consultation photos of their patients before and after treatment with good results.
  • talks with You politely and correctly.

It should be noted that there is no Doctor good for everyone. A good doctor for You is not only the one who will perform orthodontic treatment qualitatively, but also the one that You liked as a person. Orthodontic treatment is a long process, and the result of treatment depends on how comfortable the relationship between the doctor and the patient will be. If you have a feeling of trust in the doctor, and You are ready to go for a beautiful smile with him, then this is the right choice.
 

Good Luck and we are waiting for You in our clinic!

Orthodontist, child and his parents - the way to success

With the beginning of orthodontic treatment in the patient – a child, a teenager or an adult – a new way of life is formed, where discipline is important, as the patient must responsibly approach the implementation of all doctor's instructions. Orthodontic treatment requires long-term and daily work from the patient. The patient independently uses orthodontic equipment, regularly performs the tasks of the doctor, monitors the hygiene of the oral cavity.

According to the recommendations of L. S. Persin, the child should be involved in the treatment process, giving him the opportunity to choose the color of the plastic orthodontic apparatus, the color of the rubber rings, as well as the color and shape of the container for the orthodontic apparatus. Another option for constant stimulation of the child may be to receive a gift after each visit to the orthodontist or participate in the game to get points and earn a prize.

Modern methods of treatment and the use of the latest materials allow you to visit the orthodontist 1 every 1-2 months. Therefore, for a long time all the responsibility for the implementation of the doctor's recommendations and proper hygiene lies on the shoulders of parents. The parent is a kind of doctor's guide in the home environment. Therefore, it is absolutely necessary that parents are fully informed, properly informed about the process of orthodontic treatment and monitor the implementation of the doctor's recommendations.

To achieve a good result, the parent who spends more time with the child and can monitor the implementation of all doctor's instructions should go to the reception with the child. In the psychological preparation of children, special attention should be paid to explaining to children and their parents the importance of cooperation with the doctor, the essence of the stages of treatment, the influence of bad habits (sucking fingers, biting lips, etc.) and impaired functions of the dentition on the state of the body.

"The success of orthodontic treatment of children depends on the cooperation of the triad doctor-patient-parents." 

 

Children under 18 must be accompanied by a legal representative!!!

Diagnostic methods in orthodontics

Orthopantomography

Orthopantomography (optg) is a method of x-ray examination that allows to obtain a flat one-stage image of the entire dentition system as a single functional complex.

On a correctly performed orthopantomogram, both jaws, the coronal and condyle processes of the lower jaw, the temporomandibular joint (right and left), the paranasal sinuses and part of the nasal cavity are displayed. The image of the teeth is clear, not distorted in shape. Dental cavities, periodontal cracks (especially in the premolars and molars) are clearly visible. You can distinguish a layer of enamel covering the crowns of the teeth, carious, traumatic and other defects in the tissues of the teeth.

Orthopantomography is a mandatory method of examination of the patient before orthodontic treatment.

Teleroentgenography

Telerentgenography (TRG) is the most informative method of studying the dentition, which allows you to determine the morphological changes in the facial and cerebral parts of the skull, to justify the diagnosis and treatment plan.

Analysis of teleroentgenogram allows to solve the following tasks:

  • to determine the facial profile of the patient;
  • determine the size of the jaws and their apical bases;
  • determine the position of the jaws relative to the base of the skull;
  • determine the relative position of the jaws;
  • determine the type of growth of the facial skeleton;
  • to assess the position of the teeth and the development of alveolar processes;
  • to conduct a differential diagnosis of clinical varieties of malocclusion;
  • make a final diagnosis;
  • justify the plan of treatment of the patient.

 

Radiography of TMJ

The method allows the state of the closed dentition and the maximum opening of the mouth. It is an Express method for the diagnosis of TMJ. For a detailed examination of the shape, position, condition of the heads of the lower jaw, articular fossa, disc and ligamentous apparatus of the joint, a computer tomography is necessary to visualize the position of the heads of the temporomandibular joint in or magnetic resonance imaging.

 

Cone-beam computed tomography

Конусно-лучевая компьютерная томография

Cone beam computed tomography (CBCT) is a modern x-ray examination method, which is a kind of 3D computed tomography. The method has a very high informative and significantly expands diagnostic capabilities in such areas of medicine as dentistry, otorhinolaryngology and maxillofacial surgery.

With the help of the CBCT method, unlike the optg and TRG, the visualization of the area of interest in the volume takes place. This allows to obtain a three-dimensional model, to build any cross-section, to carry out very accurate measurements. Other advantages of CBCT are lower radiation load and the absence of overlays of anatomical structures and distortions of their size.

 

Electromyography

Electromyography (EMG) is an objective method of studying the neuro-muscular system by registering the electrical potentials of the masticatory muscles, which allows to assess the functional state of the dentoalveolar system. The electrical activity of the masticatory muscles is recorded simultaneously on both sides. Surface electrodes are used to remove biopotentials. The electrodes are fixed in the area of the motor points of the masticatory and temporal muscles (areas of the greatest muscle tension, which are determined by palpation). Recording of EMG is performed at rest and when performing functional tests (with jaw compression in the right, left, in the usual occlusion, opening/closing of the mouth, movements of the lower jaw forward/backward. Normally, there is a coordinated function of muscle synergists and antagonists, a clear rhythmic change of phases of bioelectric activity and bioelectric rest. Chewing and temporal muscles during chewing show synchronous activity. Interpretation of the obtained EMG data is possible in a comprehensive study of the dentoalveolar system, since the same changes in the EMG pattern occur in various pathological conditions (loss of teeth, malocclusion, decrease in occlusive height, bruxism).

  

 

Occlusion analysis using T-scan

To determine the occlusive effort, the patient is invited to bite the individual thin sensor. On the computer monitor there is an image in the form of a video showing all the movements of the teeth from the first to multiple contact. The obtained data are displayed on two-dimensional and three-dimensional active diagrams, according to which the specialist can not only quickly and accurately see the problem points (premature contact, too strong contact), but also clearly show the patient the cause of the pathology.

Использование Т-скан для выявления преждевременных и травматических окклюзионных контактов, направления ветора смыкания зубных рядов, симметричности окклюзии  Сенсор для Т-скан

  Результаты обследования до после коррекции окклюзионных контактов

Bracket systems and retainers

Bracket system is an orthodontic device that is used by a doctor to correct any cosmetic or functional disorders, such as malocclusion, incorrect position of the teeth and so on. It consists of several elements (locks, rings, etc.), which are attached to the teeth, thereby combining them into a single system and helping to achieve the desired result.

Types of bracket systems

Vestibular braces

The most popular and affordable type of bracket systems. There is an opportunity to use your imagination — vestibular braces are made of different materials of different colors and shapes.

In addition to the standard metal braces, there are sapphire, ceramic and plastic. The latter are diverse in shape and color. Sapphire braces are less noticeable than metal and plastic. Carved from the crystal of artificially grown sapphire and cut like diamonds, sapphire braces are very beautiful. But we should not forget that each bracket system ortodonta chosen by the doctor individually, depending on the state of your teeth.

Lingual braces

From the point of view of aesthetics, the leader is the lingual bracket system, which is installed on the inside of the tooth. Despite the fact that it is made of ordinary metal, this bracket system is the most expensive. This is due to the complexity of the installation. After all, in this case, the so-called "indirect method" is used (not in the oral cavity), which requires special training of the doctor and passes in several stages. First, the bracket is glued to the plaster model, taking into account all the individual characteristics of the patient, then the device is specially transferred to the oral cavity, where it is finally installed. Installing lingual braces will cost more, but it is a great way for those who categorically refuse to wear vestibular.

Retention devices are invisible fixing structures that are made on the day of removal of the bracket system.

 

Non-removable retainers are fixed to the upper and lower teeth (if the braces were on both jaws) and should remain on the teeth for 3-4 years — twice as long as the treatment itself on the braces. They are a piece of metal wire glued to a special material on the six front teeth on the side of the tongue. This design is imperceptible, strong, and so comfortable that you quickly get used to it. It is important not to break them, following the usual recommendations for limiting solid food, as overload can deform both the wire and the material. If the retainer is damaged, it is necessary to come to repair it within 1-2 weeks. It is important that non-removable retainers do not affect diction.

Removable retainers include vestibular plates, mouthguards and some types of functional devices. The most often practiced night use of such devices. The type and duration of use of retention devices is determined individually in each case and depends on the age of the patient, the type of anomaly, the duration of treatment. The choice of the design of retention devices is always up to the attending physician, as no one else can know and feel all the nuances of treatment.

Orthodontic appliance
     
 4

1 - LM-activator

2 - orthodontic plate

3 - trainer for a child 2-5 years

4 - removable plate with screw on the lower jaw

5 - trainer T4K for a child 6-8 years 

6 - fixed device for the expansion of the upper dentition

Dysfunction of the temporomandibular joint

The temporomandibular joint is one of the most complex joints in the human body. Any violation of the system of muscles, ligaments, discs and bones responsible for the movement of the lower jaw, called dysfunction of the temporomandibular joint.

Today you can often find the term TMD – temporomandibular dysfunction. Symptoms of TMJ disorder:

  • headaches, ear pain, pressure and eye pain
  • "clicks" and "noise" when opening or closing the mouth
  • pain syndromes during chewing, wide mouth opening (yawning)
  • the displacement of the jaw, limitation of movements of the mandible.
  • pain in muscles
  • change of bite
     

It should be said that the dysfunction of the temporomandibular joint in most cases is secondary. The starting point for the development of TMJ dysfunction is changes in the functional state of the masticatory muscles, behind which lies a combination of dental and neurological problems that require detailed examination and adequate treatment of the patient.

Some diseases, such as bruxism and oromandibular dystonia, prolonged activity of the masticatory muscles, are accompanied by hypertrophy of the masticatory muscles and violation of the aesthetics of the face (facial asymmetry, increase in the angles of the lower jaw).

Hypertonicity of masticatory muscles can be suspected if You have:

  • increased sensitivity of teeth
  • enamel cracks, chipped ceramic crowns, fillings
  • pathological abrasion
  • periodontal disease
  • temporomandibular joint (TMJ) dysfunction)
  • hypertrophy of masticatory muscles
  • compensatory hypertrophy of the periosteum in the corners of the lower jaw.

An interdisciplinary approach is important for the correct diagnosis. This means that the treatment should be carried out by a team of doctors of different directions.  Orthodontist, orthopedist, therapist, surgeon, neurologist, psychologist will conduct a comprehensive diagnosis (clinical, x-ray, functional) and will make an individual comprehensive step-by-step treatment plan.

Result of treatment

 

Description of clinical cases

The case of the first

Age at the time of treatment : 20 years. 
Before treatment: crowding of teeth, anomalies of the position of the lateral incisors on the upper jaw. 
Treatment: bracket system. 
Duration of treatment: 18 months.

before after
 

 

The second

Age at the time of treatment : 30 years. 
Before treatment: anomalies of closing of teeth in the frontal part. 
Treatment: bracket system. 
Duration of treatment: 16 months.

before after

 

The third

Age at the time of treatment : 12 years. 
To treat malocclusions in the anterior region, delayed eruption of the canine in the upper jaw. 
Treatment: stage 1 - removable orthodontic plates, stage 2 - bracket system. 
Duration of treatment: 48 months.

before during treatment after

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