Pathological abrasion of teeth. How to deal with malocclusion: little tricks

Ph.D., CEREC-trainer, dentist

Today, CEREC debunks the myth that increasing height lower third the face and, accordingly, the bite is a labor-intensive task, feasible only in collaboration with the laboratory. With CEREC equipment, total dental reconstruction with increased bite height can be performed in one visit.

This is possible thanks to the latest software. Options such as smile design, a virtual articulator and the ability to virtually mark tooth contacts make total bite reconstruction an easy and fun task. In the presented clinical case describes a technique for increasing the patient’s bite height in one visit with occlusal wear facets. The technique described below, I am sure, is not new, and although not described in the literature, it is used by many clinics equipped with CEREC technology. In particular, in the author’s clinic of Tamara Prilutskaya this technique has been successfully used for several years.

It should be understood that dental reconstruction should be carried out in the absence or subsidence of clinical manifestations dysfunction of the temporomandibular joint. And after reinstallation lower jaw to the new correct position, if necessary, relative to the initial one with the help of, for example, an orthotic, later - with the help of CEREC Omnicam, a new bite can be simulated in one visit.

Materials and methods

CEREC Omnicam, Trilux Forte Vita ceramic blocks, Duo Cement Kit.

Clinical case

Smile design, a virtual articulator and the ability to virtually mark tooth contacts make total bite reconstruction an exciting task

The patient complained of abrasion of the teeth of the upper jaw and, accordingly, a decrease in height upper incisors to such an extent that they are no longer visible when smiling. As a result clinical examination maxillofacial area no muscular-fascial tension was detected, the movements of the lower jaw were full, symmetrical, pathological changes from the side of the TMJ joint was not detected. The bite is straight (Fig. 1). On the frontal teeth of the upper jaw 13-23, occlusal abrasion facets are determined, wedge-shaped defects in the area of 24 and 25 teeth (Fig. 1, 2). It was not planned to change the height of the lower teeth, although they also had occlusal abrasion facets, but with a slight loss of tissue (Fig. 3, 15), so the bite increased without transversal and sagittal movements of the lower jaw, namely, in the usual occlusion only due to an increase heights upper teeth.

Treatment plan

Total prosthetics and increased bite by increasing the height of the teeth in the upper jaw. On the first visit - manufacturing and fixation of ceramic restorations for 9 teeth of the upper jaw. In subsequent appointments, it was planned to complete the prosthetics of the remaining teeth, and in fact it took the following two visits: on the second visit - 11 teeth, 3 teeth of the upper jaw: 15, 16, 27 - and 7 teeth of the lower jaw: 44-31 and 34-36. On the third visit - the remaining two teeth of the lower jaw, 32 and 33.

Treatment

On the first visit, a minimally invasive preparation of 9 teeth of the upper jaw was carried out, which took no more than 60 minutes, that is, about 7 minutes per tooth, which, in our opinion, is a lot, since the preparation was minimally invasive (Fig. 4). The bite is fixed in the usual occlusion with the first layer of silicone impression material. In the frontal region, the impression mass is removed before it hardens, which allows for visual control of the position of the lower jaw in relation to the upper jaw and subsequent optical registration of the bite (Fig. 4).

A light-curing composite was used to directly restore the lost tissue of the two central maxillary teeth, after which the patient was asked to close his mouth. The lower jaw teeth were inserted into the grooves of the impression material until the composite contacted the lower teeth, and the new position of the jaws was registered virtually. Thus, the position of the lower jaw in relation to the upper remained stable, without deviation from the usual occlusion, and the height increased by the size of the temporary restorations (Fig. 5).

Virtual dental modeling is a simple procedure, since everything happens in automatic mode and only in some cases does medical intervention be required. In this case, modeling of 9 teeth took no more than an hour, milling of 9 restorations took just over two hours, glaze firing took two times for 15 minutes, fixation, occlusal correction and polishing of the occlusal surface took just over two hours: total time- six and a half hours, if you add one hour for preparation. But the patient’s appointment time is reduced due to the fact that all stages, except preparation, occur not sequentially, but in parallel; The fact that the dentist has two well-trained assistants further reduces the appointment time.

For example, the 26th tooth is virtually modeled, a ceramic block of the required size and color is inserted into the milling machine, and the milling process begins. And at this time, teeth 25 and 24 are modeled (Fig. 6), after milling the 26th tooth, its fitting is carried out, the approximal and distal contacts are checked, and the restoration of the 25th tooth is milled in parallel.

When 3-4 restorations are ready, with verified approximal contacts, glaze is applied, and these restorations are sent for glaze firing. At the same time, the stages of virtual modeling, milling, fitting and fixation of the remaining restorations continue (Fig. 7).

After the glaze firing, the restorations are cemented with DUO CEMENT VITA. After fixing all restorations, teeth are ground according to occlusion and polished areas to be corrected.

Thus, in this clinical case, the total time of the first appointment was 4 hours 45 minutes (Fig. 8). To control the parallelism of the line of occlusion - the line of the pupils, the “smile design” option was used (Fig. 9, 10).

VITABLOCS TriLuxe forte 2M 2 was chosen for the restoration. These blocks consist of four layers that differ in color intensity. In this clinical case, this made it possible to create natural color shades, as in the structure of a natural tooth, due to a subtle color transition from the enamel to the cervical layer with a more emphasized color in the lower part of the dentin and neck (Fig. 11, 12).

At the second visit, it was planned to complete the prosthetics, but when the appointment time exceeded 5 hours, it was decided to move the restoration of the two remaining teeth, 32 and 33, to next appointment. The preparation was also minimally invasive (Fig. 13-15). On the third visit, the work was completed (Fig. 16, 17).

Conclusion

Rapid patient recovery is not the primary criterion for the CEREC technique. The precision quality of the fit of the restorations, minimally invasiveness and information content still remain in the foreground: the dentist constantly sees a virtual model of the tooth being restored with high magnification and can prevent his mistakes in a timely manner, because the patient is sitting in a chair. Dentistry today is aggressive, often the patient is offered to remove all teeth or completely dissect the remaining ones. In my opinion, dentistry more often harms than helps, the patient loses money, but does not gain health. The CEREC technique changes the main thing: the patient still loses money, but gains health for many years.

Closing teeth, diastemas, correcting crowded teeth

Restoration is one of the gentlest methods of correction. various pathologies related to bite. The procedure is not complicated and can be completed in one visit.

It is worth remembering the rule of the golden proportion, which implies maintaining certain proportions between teeth. If we take one of the teeth as one, then the size of the adjacent teeth will be 1.618 and 0.618 of the size of the first tooth. Knowing the size of one tooth, you can find out the proportional sizes of all other teeth.

The formula can be successfully used to close teeth and diastemas, improving the aesthetic perception of the patient’s smile by skillfully creating the illusion of an ideal row of teeth.

The illustrations show various ways creating such an illusion.

It is important to take into account the characteristics of light reflection by tooth enamel.

Knowledge of such techniques allows you to achieve a clear visual effect.

The distance between the teeth does not change, but the visual effect radically changes the overall perception of the smile. To make a tooth visually shorter or longer vertically, similar techniques are required.

It is important when working in the horizontal plane to remember the “golden ratio” formula.

Understand and evaluate opportunities this method using a complex clinical example.

The patient's age is over 40 years, but there were chances to correct the neglect.

Helped again " golden ratio"and the concept of moving the zenith of the crowns.
By moving the zenith (the maximum height of the tooth neck), the doctor also moves the axis of the tooth. Next, you can significantly change the visual arrangement of the teeth by applying the composite to different parts of the tooth.

The method also proves its effectiveness in eliminating interdental gaps.

But it is worth considering that when applying a composite, the width of the tooth will become much greater than the height. To visually align the size of the tooth, you can perform a gingivotomy (cut the gum) using metal burs without a diamond coating (for example, from the IQDent brand). The length becomes acceptable to create the desired effect.
There are two types of gingivotomy:

1. without osteotomy (surgicaland bite management-better surgical intervention ), if the height of the gum allows you to trim the gum and increase the area of the tooth;

2. with under sharp th - decrease bone by 1-2 mm to form a new position of the gums.

To clearly demonstrate to the client the expected result, it is convenient to use computer modeling.
Next clinical example shows the features of eliminating crowding of teeth.

Wax modeling is appropriate here, allowing you to evaluate the degree of preparation and the final version. In addition, it provides material for the restoration of teeth and gums.

Photo of the patient before and after treatment.

Correction caseinternal slope -deformation dentition to the external one - remove (from prognathia to orthognathia) using a composite restoration.

First, a gingivotomy was performed to visually raise the dentition. The teeth had to be ground down before applying the composite material to the palatal and buccal surfaces.
After restoration, it is recommended to use special therapeutic and prophylactic agents.

Another case where surgery was avoided due to the use of restoration.

At first lower teeth were filed - sanded for alignment.

Turning - the depth of tooth preparation is much less than for veneers and other products.
Adhesive structures

The patient was satisfied with the result.
An example of correcting crowded teeth.

The uniqueness of the example is in the noticeable removal of the fangs from the internal position to the normal one -
external. All the work was done in one day.

Composite materials allow you to emerge with honor even from very difficult situations.

The stump inlay was ground and covered with composite, restoring the “live” appearance.

Normal on the jaws forms physiological bite, allowing a person to eat and talk without problems. However, in some cases, the masticatory organs are displaced and form a pathological closure. The consequences of dental malocclusion occur at any age, causing a person to worry about appearance and digestive difficulties.

Malocclusion in an adult

What is malocclusion?

In the classical denture literature, several types of occlusion are distinguished. Physiological closure of the masticatory organs - orthognathic - is considered to be one in which the lower ones are ⅓ of the height, and the masticatory tubercles fall into the desired depressions of the antagonists. In the twentieth century, some other types of jaw relationships were also considered normal, but modern research found that only orthognathic contact is normal, and the other types are pathological.

Violation occurs in early age, and the consequences are observed throughout a person’s life. In this regard, doctors divide into several categories:

The lower jaw is pushed forward - progeny.
Frontal upper teeth strongly pushed forward (without contact with the lower ones) - prognathia.
The frontal upper and lower teeth stick out, but close together - biprognathia.
The upper teeth overlap the lower teeth by more than half - deep bite.
All chewing organs close without overlap - straight.
The teeth are partially or completely out of contact – open.
underdeveloped - cross.

Causes of anomalies

Clinical statistics show that only 30% of people have a normal jaw relationship, therefore this problem has undergone extensive study. Malocclusion in children can form even inside the mother’s womb, and the baby is sometimes born with already formed disorders. However, doctors also name other reasons for the development of pathology:

genetic predisposition;
lack of vitamins, micro- and macroelements in the body;
excessive pacifier use;
early tooth extraction;
metabolic disorder;
breathing problems;
various jaw injuries.

Possible consequences

Many people don’t even think about the dangers of malocclusion, preferring to simply not notice the problem. However, the consequences of pathology affect not only the function digestive system, but also on appearance person and his self-esteem. Facial asymmetry due to malocclusion is often observed in cross-bite and open forms illness, and a strongly protruding chin is formed during progeny. In addition, all types of pathologies can disrupt chewing process and provoke excessive wear of the enamel of tooth crowns, chips and microcracks.

Changes in bite also affect correct formation speech, because all organs of the oral cavity take part in the formation of sounds. In dentistry, there is even a test word “psychophasotron”, the pronunciation of which is much more difficult when the front teeth are open. In addition, a violation of the chewing load provokes pressure on soft fabrics, resulting in the development of periodontal disease and other diseases. The consequences of malocclusion also affect the attachment point of the lower jaw to the skull – the temporomandibular joint. Its deformation contributes to the appearance of characteristic clicking sounds when opening the mouth both during chewing and speech.

A deep bite is especially noticeable when speaking: it seems as if the upper teeth completely overlap the lower ones. Although this is extreme form pathology, but even its partial manifestation does not allow a person to eat normally. The consequences of a deep bite are also reflected in the reduction of the oral cavity, which leads to difficulty breathing and the development of lung diseases.

Dentists note the influence of the defect on the rapid progression of caries. This violation is associated with excessive load on certain groups of masticatory organs in which food debris accumulates at an increased rate.

Development of caries

It becomes clear why in children, sometimes with hygiene and the absence of other factors.

Elderly people, as is known, are often installed removable structures complete loss due to malocclusion is associated with a number of difficulties:

Position artificial teeth According to all technical rules, it can be problematic.
Sometimes you have to raise the bite by 2-3 mm, which increases the load on the joint.
Dentures often become dislodged and break.

An abnormal jaw relationship also provokes a disease such as, in which the muscles contract so strongly that in quiet room Grinding can be clearly heard. If you do not fight the disease, then over time you will experience increased abrasion the occlusal surface of the teeth, and people increasingly wake up in the morning with pain in the head and jaw joint.

How to cope with pathology?

The methods are not diverse, and they are used in dentistry only after thorough examination oral cavity.

Deviations from the norm in children under 6 years of age can be eliminated without problems: the body is just forming, and plates with springs will allow bone growth to be turned in the right direction.

For teenagers and adults it is a little more difficult, but modern methods cope with this task too. With the help of braces, the dentition is aligned and creates the basis for the proper growth of the chewing organs, but this process requires constant monitoring see a doctor and lasts 2-3 years. In addition, American scientists have developed a method for eliminating pathology using special mouth guards:

An impression of the jaw is taken.
Modeled on a computer current situation in the oral cavity and desired.
Mouthguards are created for all periods of the course of treatment.
They are dressed in accordance with the doctor's instructions.

After 1 year of using aligners, each person will notice changes, and after another couple of years, the dentition will become completely normal. Treatment of deep bite is also carried out in this way, but the patient should prepare for prolonged load on the joint and discomfort.

Statistics show that about 70% of the population of our country has some kind of bite problem. And often people do not strive to correct them, citing the fact that only public and wealthy people should take care of the beauty of their teeth. But, unfortunately, the aesthetic component is just the tip of the iceberg, and the main danger of malocclusion lies beyond the visible problems.

It is worth starting with the origin of this defect. Like most problems relating to bone tissue, malocclusion can be a consequence of:

a genetic pattern, because heredity has a primary influence on the formation of a child’s jaw;
diseases respiratory tract, for example, when forced mouth breathing the growth of the facial part of the skull is disrupted, which causes the development of deformation;
injuries received during the development of the dentition;
bad habits in infancy, such as constant thumb sucking.

It is worth noting that even poor posture can cause malocclusion in a child. Banal scoliosis, due to improper functioning of the spinal muscles, can also affect the functioning of the jaws.

Types of malocclusion

The location of the jaws relative to each other is a determining factor in the process of diagnosing occlusion:

distal, during the development of which upper jaw more developed relative to the lower one. With such a deviation, the pressure is distributed unevenly, as a result of which the back teeth take on the load of the front teeth, which is favorable ground for the development of caries on them. Main feature distal occlusion– disproportionately small chin. Over the years it leads to premature development periodontal disease and periodontitis;
mesial, characterized by excessive protrusion of the lower jaw. A clear sign of this deformity is the patient’s protruding chin. This change contributes to dysfunction of chewing and early development inflammatory diseases teeth and gums;
deep, diagnosed when the upper teeth overlap the lower teeth at a distance exceeding the length of their crown. Often, with this type of bite, the face has insufficient height, and the lip is constantly in an inverted position due to insufficient space. Over time, the first consequence may be periodontal disease, that is, loosening of the teeth, as well as permanent damage to the oral mucosa by the teeth.
open, representing the impossibility of closing the jaws with each other. This pathology can be observed both in the front part of the jaw and in the side. An invariably slightly open mouth, or general asymmetry of the face - here obvious signs open bite;
cross observed when one side of the jaw is underdeveloped. Such a deformation primarily impairs chewing function, since patients are forced to chew predominantly on one side of the jaw. Main goal treatment is the alignment of both sides of the jaw relative to each other.
dystopia, affecting the location of the teeth in their “own” place. Mostly it is a consequence of violation of the timing and sequence of teething. Teeth that have changed their location can injure the mucous membranes of the oral tissues and also lead to the development of erosions.

If a bite defect is detected on its early stage, then the treatment can be gentle, and the elimination of the problem is quite quick and inexpensive. That is why it is so important to conduct systematic preventive examinations.

The insidiousness of malocclusion

An incorrect bite entails a whole series of unpleasant consequences, some of which are very difficult to eliminate:

increased load on individual teeth, leading to accelerated abrasion of the enamel and, as a result, increased sensitivity;
work disorders articulatory apparatus. Often, malocclusion becomes the root cause of a lisp and other diction disorders due to the forced unnatural position of the tongue;
accumulation of plaque in places where teeth overlap, which leads to the development of caries, periodontitis and other diseases of the teeth and gums;
deformations in the area of the temporomandibular joint, which is quite difficult to correct due to its three-dimensional structure;
in severe cases, difficulties with eating and breathing may also occur.

A bad bite can also result in headaches and even pain when chewing food.

Detection of malocclusion

There are several of the most obvious signs of a defective bite, allowing you to identify it yourself:

protruding lower jaw;
retracted upper lip;
unnaturally closing dentition;
unevenly growing teeth.

These are only the most obvious signs of existing deviations. Put more accurate diagnosis and only an orthodontist can prescribe appropriate treatment.

Prosthetics for malocclusion

If you have an advanced bite problem, the only way out What remains is prosthetics, which can restore the proper row of teeth. There are several methods of prosthetics to combat bite problems:

Mouthguard

It is a removable overlay on teeth made of transparent polymer that combats tooth curvature using pressure. Allows you to achieve results without noticeable discomfort and painful sensations. There are several types of mouthguards for correcting bites:

standard, made without taking into account personal characteristics. It has a low cost, but is not able to deal with complex cases of curvature;
thermoplastic, following the contours of the teeth thanks to custom production from a special polymer. Have short term manufacturing and wide possibilities for use, but have a slightly higher cost;
Invisalign, manufactured using plaster model and using 3D modeling. The most expensive and effective type of cap. Able to cope with minor deformities without undue discomfort.

Braces

Thanks to their design, they are able to correct almost any dental deformation, with the exception of extreme complex cases requiring surgical intervention. There are 2 main types of braces:

vestibular, attached to the front part of the tooth;
lingual, placed on inner surface teeth, which makes them invisible to others.

They can be made from a variety of materials: metal, ceramics and even semi-precious stones.

Removable denture

Used in cases of almost complete absence of a number of teeth. It is made mainly from hypoallergenic acrylic and can be of the following types:

full, used in case complete absence teeth on the jaw, fixed to the gum directly;
partial, used in the absence of several teeth in a row and is attached both to the problematic jaw and to the remaining adjacent teeth.

They are distinguished by durability and relatively low cost, as well as the possibility of individual selection due to the extremely wide color scheme products.

Bridge

This type is a series of interconnected dental crowns on a metal base. Rigidly attached to neighboring natural teeth fixing elements. The chewing efficiency of the jaw is restored 100% and does not interfere with tactile, taste and temperature sensations. The use of metal in the structure can significantly increase its service life, but increases the final cost of the product.

This is how they put a “bridge” on the teeth

Implants

Most modern way prosthetics for malocclusion. Implanted directly into bone tissue followed by fixation of the denture on it. The most durable method of all presented, with an almost lifetime guarantee. Aesthetic component this method also beyond any competition, because even upon closer examination it is impossible to distinguish the implanted structure from a natural tooth.

It is important to remember that up to approximately 7 years of age, malocclusion can be corrected by massaging problem areas and special gymnastics. It is necessary to wean the child from bad habits so that you don’t have to resort to complex, lengthy and expensive treatment methods later.

Video - Malocclusion: how to fix it

Methods of insurance against malocclusions

It is worth remembering that the main causes of deviations are born in early childhood, so, for the most part, the responsibility for the crooked jaws of children lies with their parents. And if obvious genetic abnormality missing, you just need to adhere to the following simple rules:

Recommendation	Reasons for the development of deviations	What to do
Monitor your health during pregnancy	Mineralization of teeth begins in the 20th week of pregnancy	Control the amount of calcium and fluorine-containing elements consumed
Feeding a newborn correctly	Uneven muscle development due to improper sucking	Pay attention proper operation facial muscles when sucking
Monitor your child's nasal breathing	The habit of breathing through the mouth causes an open bite	Make sure your child breathes predominantly through their nose
Wean off bad habits	Sucking fingers and pacifiers during the first teething may cause them to become crooked later.	Monitor the occurrence of these habits and stop them as quickly as possible

It is worth remembering that each patient’s teeth are unique and require individual selection of treatment methods. There are no universal ways to get rid of the problem. Only a thorough diagnostic examination by a specialist will make it possible to make an accurate diagnosis based on photographs and casts.