Articles

Revolution in orthodontics – the growth of the jaws without age restrictions

1 Anomalies of the dentognathic system cause severe functional disorders of the maxillofacial region.
Cosmetic deviations caused by them have a negative effect on human psyche, constitute an obstacle to lead a full-fledged life, limit the choice of profession. In many cases, the problems of the dentognathic system become a reason for development of periodontium and temporomandibular joints diseases.

2 The correction of malocclusion up to average statistical norms is often restricted by deficiency of jaws’ bone tissue that dictates a necessity to find difficult and occasionally unstable compromises. With the aim to overcome the bone deficiency of jaws, dentoalveolar compensation, the orthodontic treatment is often carried out with the extraction of teeth. The dentoalveolar compensation frequently leads to setting of teeth in an unnatural position in the jaw with the controversial aesthetic and functional result. Тhe given tactics of correction of anomalies along with improving indices of occlusion may lead to deterioration of the facial proportions.
The combined method of correction of anomalies (orofacial surgery) is a complicated, multistage and expensive treatment procedure.

3 In planning a treatment, there is unfounded viewpoint among the orthodontists that with the end of active growth of the human skeletal system an opportunity to influence on the growth of jaws disappears, so the opportunities for correct positioning of teeth due to lack of bone tissue of alveolar processes of jaws are considered limited. The lack of jaws’ bone tissue often leads to a relapse of anomalies after orthodontic treatment.
Experience has shown that the discrepancy of dental and alveolar arches is one of the main reasons for the relapses of orthodontic treatment. The biomechanics of chewing brings teeth to the optimum position in the alveolar bone, whereby a reduction in the width of the dental arches, and in consequence a relapse of orthodontic treatment occur.

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4 Various fixed and removable intraoral and extraoral constructions of orthodontic appliances and their various combinations are applied in the treatment of malocclusion. However, the designed constructions of the appliances do not provide the intensive correction of the alveolar process form and require a lengthy and multistage treatment. The experience in the treatment of severe anomalies of a dentomaxillofacial system led us to the need to develop fundamentally new appliances.

5 During the 24 years we have created more than 120 constructions of appliances providing new methods of treatment. In the process of accumulation of experience we have abandoned many of our developed constructions. Many previously patented constructions are improved.

6 The new constructions of orthodontic appliances constitute fastening elements disposed on separate teeth and/or their groups made in the form of support-retaining metal wireframes interconnected by lingual (arches) and/or vestibular springs.
Application of the wireframe-spring appliances with new fastening elements, with details dispersedly mounted along the height of crowns of teeth, allows to carry out a corpus (bodily) shifting and correction of the axial position of the teeth,
combined with the achievement of growth and correction of the form of the alveolar process of both jaws.

7 Increasing of the alveolar processes stimulates the growth of both jaws. The growth of jaws has achieved by new means of orthodontic treatment – wireframe-spring orthodontic appliances of three generations (1990-1991, 1994-1996, 2004 – 2005).

8 A previously unknown phenomenon of the growth of jaws’ bone tissue by their irritation from the inside (by interstitial way) was revealed, which is achieved by
separation displacement of teeth with the highest torque on the roots of teeth in the vestibular (buccal) sides and purposeful alteration (by strengthening and slackening ) of tension arised in the tissues.

9 The elasticity of the bone tissue is increased at the intensive growth of the alveolar process, therefore capabilities of correction of the form of alveolar arch are significantly increased and a teeth moving process is accelerated in all directions.

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Application of the wireframe-spring appliances allows to obtain the following advantages:

• – Growth of tissues of the alveolar process of patients of all age groups.

• – Correction of the form of dental alveolar arches.

• – Intensification of sagittal-transversal movements of both individual segments (sequence of movements) and simultaneously several segments of dentition.

• – Reduction of indications for orofacial surgery, and practically exclusion of teeth extraction.

• – Easy control of hygiene of an oral cavity.

• – Improvement of the condition of soft and hard tissues of the oral cavity.

• – Considerable decrease of orthodontic treatment terms and prevention of relapses.

TO WHAT CARDINAL CHANGES OF ORTHODONTIC TREATMENT WILL LEAD THE PROPOSED NEW METHODS AND MEANS?

We have developed orthodontic appliances for accelerated opening of medial palatal suture, the main advantage of which is the prevention of buccal inclination of lateral teeth (see patents of the Republic of Armenia- RA511, 514, USA patent US7357633, rationalization proposal 233, see also “Biomechanics – a combined method of the corpus (bodily) shifting of teeth”), in the last 6 years we have refused to open the medial palatal suture.
At any age (from 3 to 71 years) an increase in the size of the upper jaw we carry out without opening the medial palatal suture. Transversal increase of alveolar processes promotes the growth of both jaws.

The advantages of the increasing of the upper jaw without opening the medial palatal suture are:

- Impact on the dentition by small and changeable forces.
- Increasing of the maxillary sinuses volume, which leads to normalization of respiratory function.
- No age restrictions and aftereffects.

Correction of the alveolar process geometry combined with the growth of the jaws, a significant reduction of the indications for surgical correction of the jaws.
The main indications for orofacial surgery may remain a large mandible, a macrogenia (a large chin) and a macroglossia (unusually large tongue).
New possibilities in the treatment of temporomandibular joint dysfunction of patients with reduced dimensions of the alveolar process of the mandible.
Increasing of the alveolar process leads to the three-dimensional increase of the bone tissue of the lower jaw, including articular head, owing to which a dysfunction of the temporomandibular joint is eliminated.

Conclusion

The new diagnostics and the treatment planning of orthodontic patients are required, taking into account a capability to achieve a growth of the jaws without age restrictions.

Mailyan’s appliances allow to successfully carry out an orthodontic treatment of many severe anomalies of the dentognathofacial system, including congenital and acquired malformations, which in the world practice is accepted to carry out in a complex – Apparatus treatment + orofacial surgery.

For an objective analysis of the growth of jaws it is necessary to study the spatial (three-dimensional) changes occurring in the maxillofacial region, and particularly in patients with a completed growth.
A new trend of dentognathofacial anomalies treatment with innovative methods and means is created, which significantly enhances а scope and efficiency of the orthodontic treatment. This is achieved by an augmentation of jaws tissues in all age groups. A variety of the appliances’ designs increases the capabilities of choice of treatment methods and means practically for all dentognathic anomalies.

Orthodontist-stomatologist: PAVEL D. MAYILYAN
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