METHOD OF EARLY ORTHODONTIC TREATING PATIENTS WITH COMPLETE UNILATERAL CONGENITAL CLEFTS OF THE UPPER LIP, ALVEOLAR PROCESS AND PALATE BEFORE PRIMARY CHEILORINOPLASTY

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely pediatric orthodontics, and is applicable in treating patients with complete unilateral congenital clefts of the upper lip, alveolar process and palate. Cast of an upper jaw with a congenital defect and a cast of the lower jaw is produced with subsequent digital 3-dimensional laser scanning of the obtained impressions. Digital model of an upper jaw with a congenital defect and a digital model of the lower jaw are obtained. Digital calculations and virtual simulation of stages of treatment on larger and smaller fragments of digital models of the upper jaw with a congenital defect are performed, a reference for this is a continuous alveolar arc of the lower jaw. At the stage of virtual simulation of stages of treatment position of maxillary fragments is changed so that become identical: height of maxillary arc in cutter region on larger fragment of upper jaw defined by distance from point located at intersection of line passing along vertex of alveolar ridge and line leading from frenulum of upper lip to cuticular papilla of point to constructed horizontal plane passing through transient fold in area upper lip bridles front, and then through transient folds at the base of upper jaw fragments of right and left sides (height E), height of maxillary arch in canine of healthy half on larger fragment of upper jaw defined by distance from point located at intersection of apex of alveolar ridge and line passing in area of transitional fold of mucosa of vestibule of oral cavity in place of location of frontal bridles of upper lip to constructed horizontal plane, passing through transient fold in upper lip frenulum region from front, and then through transient folds at the base of maxilla fragments of right and left sides (height F), and the height of the maxillary arc in the canine region on the side of the cleft on the small fragment of the upper jaw, defined by the distance from the canine to the constructed horizontal plane passing through the transitional fold in the area of the upper lip frenulum from the front, and then through the transverse folds at the base of the maxillary fragments of the right and left sides (height F'). After that, the orthopedic apparatus is virtually constructed taking into account the virtual simulation of the stages of the treatment, constructing the sections in the orthopedic apparatus ahead of the small fragment and along the anterior surface of the larger fragment of the upper jaw. Sections in the orthopedic apparatus corresponding to the inner surface of larger and smaller fragments of the upper jaw are also constructed in virtual fashion. Orthopedic apparatus is manufactured by means of 3-axis milling machine with numerical programmed control by a digital model of an orthopedic apparatus from a solid mass of a plastic standardized billet. In the process of treating sections of the finished orthopedic apparatus, located anterior to the small fragment and along the anterior surface of the larger fragment of the upper jaw, as well as areas of inner surface of larger and smaller fragments of upper jaw are subject to selective grinding by successive removal of plastic at least 1 mm per month for small fragment and at least 2 mm – for larger fragment. Each time after grinding, an orthopedic apparatus with a ground portion is used. Volume of all parts of the orthopedic apparatus for grinding at each stage is recorded in a process map for each stage of early orthodontic treatment. Early orthodontic treatment involves an extraoral pressured dressing having a non-uniform thickening in the form of a pillow.;EFFECT: method enables providing direct exposure of a larger fragment of the upper jaw and creating the most favorable topographic and anatomical conditions for the subsequent cheilorinoplasty in the patients with complete unilateral congenital clefts of the upper lip, alveolar process and palate.;1 cl, 3 tbl, 10 dwg, 2 ex