Method for restoring an individual's vertical dimension of occlusion (embodiments)

Abstract

The invention relates to dental medicine. A method for restoring an individual's vertical dimension of occlusion taking into account their facial proportions consists in obtaining, from a frontal view of the patient's face, an image of the patient's temporomandibular region and of the outline of the face, and determining from the image of the temporomandibular region the presence of condylar displacement in the joint space and the direction of the displacement in relation to the centric position. The same image is used to determine the patient's vertical dimension of occlusion and to ascertain the angular deviation from the Ricketts angle of normal vertical dimension of occlusion. The lower jaw is then relocated by the amount of the ascertained deviation and in the direction of said deviation to the SNA-Pm line of an SNA-Xi-Pm intermaxillary angle. The current Gl-Sn-Pog facial convexity angle is then determined for subsequent adjustment of the relocation of the lower jaw, and a digital graphical model is obtained of the lower jaw with the condyles in the normalized position in the joint space and in relation to the normalized intermaxillary angle and facial convexity angle.

Description

[0001] METHOD OF RESTORING INDIVIDUAL BITE HEIGHT (OPTIONS)

[0002] Field of technology

[0003] The invention relates to dental medicine, in particular, it considers a combined method for diagnosing various types of dental occlusion disorders that lead to changes in the parameters and asymmetries of a person's face. In this case, a method for combined analysis of dental arch destruction, disorders of the location and relationship of the upper and lower jaws and the influence of these components on the configuration of the face is considered.

[0004] During life, human dental arches are subject to daily loads. Various factors (enamel abrasion, caries, trauma) can disrupt the integrity of teeth and lead to deformations of dental arches. This in turn leads to incorrect load distribution during the functioning of dental arches and increased wear of the teeth themselves, their premature destruction. Destruction of dental arches leads to changes in closure, a decrease in the height of closure (bite), which in turn leads to deformations of the face.

[0005] In most cases, changes in the bite height lead to changes in the shape of the skull and external changes in the skin, namely, facial folds become more pronounced (nasolabial folds, fold under the lower lip), and changes in the pupil line are possible.

[0006] In the process of destruction or deformation of the dental arches, the bite decreases (the lower third of the face decreases), which leads to a decrease in the height of the face. Thus, with any violations of the configuration of the dental arches, the normal value of the height of the face changes. The dental arches and temporomandibular joints are components of the dental system, which experience increased stress during functioning (chewing, biting off food). With unsatisfactory dynamic observation, the dental arches can be destroyed and deformed, leading to overload of the joints. Disturbances of the dental arches in turn can lead to the development of facial asymmetries, that is, the listed components are in mutual connection with each other, as shown in Fig. 1

[0007] Violations of the aesthetic parameters of the face for the patient are the fundamental reason for the restoration of the dental arches. That is, the aesthetic parameters of the face must be taken into account in the calculations for the reconstruction of the dental arches.

[0008] Prior art

[0009] RU2354300 describes a method for determining the bite height in individuals with dentoalveolar anomalies and deformations of the maxillofacial region, in which the nosological form of the dentoalveolar anomaly and / or deformation of the maxillofacial region is determined, the parameters characterizing the functional state of the patient's masticatory apparatus in the position of the dental arches in occlusion are assessed by tomographic examination of the temporomandibular joint (TMJ) area in the position of the dental arches in central occlusion, and the optimal bite height.

[0010] RU2753798 discloses a method for treating patients with generalized decompensated pathological abrasion of teeth of grades II-III, according to which the height of the lower third of the face is measured in a state of relative physiological rest and in a state of habitual occlusion with the calculation of the height of the lower third of the face, the interalveolar height is restored under radiological control of the temporomandibular joints.

[0011] RU2445043 describes a method for correcting TMJ dysfunctions detected by early diagnostics, according to which facial anthropometry is performed to determine the displacement of the lower jaw and the change in the height of the lower third of the face, the displacement of the lower jaw in the sagittal, transverse and distal directions is determined, orthopantomography is performed and the size of the joint spaces is determined. The lower jaw is set in a neutral position in central occlusion, a mouth guard with bite pads is made to fix the lower jaw in this position. Repeated occlusography is performed in central occlusion together with the mouth guard, the difference in the initial and blocking contacts is determined and, if the contact is ahead, selective grinding is performed. The elimination of the dysfunction is judged by the patient's subjective sensations, anthropometric data and maintaining the lower jaw in a position without displacement in the sagittal and transverse planes.

[0012] CN109069097 describes a method for processing three-dimensional data for dentistry, comprising the steps of: obtaining scan data generated by a dental scanner, data on facial bones including tooth shapes measured using computed tomography or magnetic resonance imaging;

[0013] - input of graphic data about a person’s face;

[0014] - combining any scan data and facial skeleton data with image data and alignment to create alignment data;

[0015] - analysis of tooth or temporomandibular joint movement based on the mentioned image data to generate trajectory data;

[0016] - applying the specified trajectory data to the specified alignment data to simulate tooth or temporomandibular joint movement,

[0017] In the alignment data generation step, any scan data and facial skeletal data are matched and aligned with the teeth included in the image data to generate three-dimensional alignment data. US1 1030741 discloses a method for processing three-dimensional dental data, comprising:

[0018] - obtaining at least one of scanning data using a dental scanner and data on facial bones having the shape of teeth measured using CT or MRI;

[0019] - receiving data from a human face image;

[0020] - generating registration data by combining and merging any scan data, facial bone data and image data;

[0021] - generating trajectory data by analyzing tooth or temporomandibular joint movement from image data; and

[0022] - modeling tooth or temporomandibular joint movement by applying trajectory data to alignment data.

[0023] US5951498 describes a method for cephalometric analysis of soft tissues for aesthetic correction of facial imbalance in a patient, comprising: performing a cephalometric analysis of soft tissues comprising the steps of:

[0024] - creation of a database of sizes and angular measurements of key facial landmarks and facial harmony values, compiled from a group of aesthetically balanced faces;

[0025] - assessing the patient's facial features by placing the patient's face in a natural head position, placing markers on the facial structures, obtaining an image on film of the head, and measuring the sizes and angles of key landmarks of the patient's face;

[0026] - determination of the true vertical line on the image on the film;

[0027] - measuring the values ​​of absolute landmarks and angle measurements relative to the true vertical line and determining the harmony values ​​of the patient's face; and comparing the measured values ​​of absolute landmarks, angle measurements and harmony values ​​of the patient with a database of measurements of the sizes and angles of key landmarks of the face and harmony values ​​of the face. Also known is a method for diagnosing disturbances in the configuration of a human face during dental work, characterized in that on a photograph of a face in the frontal position or a scan of a human face in the frontal position, a primary facial frame is formed that corresponds to the individual proportions of the human face and consists of a lower base, which is a horizontal line tangent to a point on the lower edge of the lower jaw, an upper base in the form of a horizontal line tangent to the highest point on the skull, and lateral borders in the form of vertical lines,passing tangentially to the most protruding points on the zygomatic bone and perpendicular to the lines of the upper and lower bases, then using computed tomography, an image of the face is obtained in a frontal position and the obtained image is aligned in size with a photograph or scan of the person's face by matching the location points along the outer border of the right eye and the outer border of the left eye, the most protruding point on the edge of the nose and the lowest point on the chin, after which a secondary facial frame is formed on the photograph or scan of the person's face, corresponding to the original proportions of the person's face and in which the bases and lateral borders make up 62% and 38% of the corresponding dimensions of the primary facial frame, which is superimposed on the image obtained using computed tomography, and if there is a difference in the heights of the frames, the need for correction of the height of the dental arches is established (RU 2713149, A61 C7 / 00, A61 B8 / 13, G06T7 / 00, publ. 03.02.2020).,

[0028] This decision was adopted as a prototype.

[0029] The disadvantage of this method is that the fundamental principle is the use of aesthetic analysis by points on the outer surface of the patient's face, and not by the structure of the bone system, the points on which do not change their position. Disclosure of the invention

[0030] The present invention is aimed at achieving a technical result consisting of increasing the accuracy of bite restoration individually for the patient by using calculations based on anthropometric points on bone structures that do not depend on the number of teeth in a person.

[0031] The specified technical result for the first variant is achieved in that the method for restoring an individual bite height taking into account facial proportions is characterized by the fact that in the frontal position of the patient's face, an image of the patient's temporomandibular region and his frontal profile is obtained, according to the image of the temporomandibular region, the presence of displacements of the temporomandibular joint heads in the joint space and their direction relative to the centered position are established, in which the distance from the surface of the joint head in the anterior and posterior sections is equal to 2-3 mm, and in the upper section 3-4 mm, according to the same image, the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height according to Recketts is established, equal to 45 ± 2 ° and measured according to anthropometric points on the bone structures of the lower and upper jaws according to the value of the intermaxillary angle SNA-Xi-Pm, or according to deviations from the ratio between the width of the lateral and central incisor equal to 1: 1.618,and the ratio between the width of the lateral incisor and canine equal to 1:0.618, in which the central incisor is 60% wider than the lateral incisor and 60% wider than the part of the canine visible from the front, then the lower jaw is shifted by the established deviation and in the direction of this deviation to the line SNA-Pm of the intermaxillary angle SNA-Xi-Pm, at the position of which the intermaxillary angle is equal to 45 ± 2 °, then the current angular value of the facial profile Gl-Sn-Pog is determined for subsequent correction of the lower jaw displacement to the angular value of the facial profile equal to 165-175 °, and a digital pictorial model of the lower jaw is obtained in the normalized position of the joint head in the joint space and in relation to the normalized intermaxillary angle and the angular value of the facial profile, after which, based on the digital pictorial model, prosthetic structures are modeled for installation on the patient's dentition or implants, ensuring the preservation of the new bite height due to a change in the position of the lower jaw relative to the upper jaw,and fix them on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

[0032] For this embodiment, when establishing from the image of the temporomandibular region the presence of a displacement of the temporomandibular joint heads in the joint space in the direction of a relatively centered position, in which the distance from the surface of the joint head to the wall of the joint space is at least twice the standardized distances in the anterior and posterior sections of this gap, based on the digital image model, prosthetic structures are first modeled for installation on the patient's dentition or implants, ensuring the elimination of the displacement of the joint heads of the lower jaw by half of the detected displacements, and fixed on the patient's dentition of the lower jaw for adaptation of the patient's lower jaw, and after the end of the adaptation period lasting at least three months, based on a repeated digital image model, prosthetic structures are modeled that ensure the final elimination of the displacement of the joint heads of the lower jaw,and fix them on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

[0033] The specified technical result for the second variant is achieved in that the method for restoring an individual bite height taking into account facial proportions is characterized by the fact that in the frontal position of the patient's face, an image of the temporomandibular region of the patient and his frontal profile are obtained, according to the image of the temporomandibular region, the absence of displacements of the temporomandibular joint heads in the joint space relative to the centered position is established, in which the distance from the surface of the joint head in the anterior and posterior sections is equal to 2-3 mm, and in the upper section 3-4 mm, according to the same image, the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height no Recketts is established, equal to 45 ± 2 ° and measured according to anthropometric points on the bone structures of the lower and upper jaws according to the value of the intermaxillary angle SNA-Xi-Pm, or according to deviations from the ratio between the width of the lateral and central incisor equal to 1: 1.618,and the ratio between the width of the lateral incisor and canine equal to 1:0.618, in which the central incisor is 60% wider than the lateral incisor and 60% wider than the part of the canine visible from the front, then the lower jaw is shifted in the direction of this deviation to the SNA-Pm line of the intermaxillary angle SNA-Xi-Pm, at the position of which the intermaxillary angle is equal to 45 ± 2°, then the current angular value of the facial profile Gl-Sn-Pog is determined for the subsequent correction of the lower jaw shift to the angular value of the facial profile equal to 165-175°, and a digital pictorial model of the lower jaw is obtained with the normalized position of the joint head in the joint space and in relation to the normalized intermaxillary angle and the angular value of the facial profile, after which, based on the digital pictorial model, prosthetic structures are modeled for installation on the patient's dentition or implants, ensuring the preservation of the new bite height due to a change in the position of the lower jaw relative to the upper jaw,and fix them on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

[0034] The specified technical result for the third variant is achieved in that the method for restoring an individual bite height taking into account facial proportions is characterized by the fact that in the frontal position of the patient's face, an image of the temporomandibular region of the patient and his frontal profile is obtained, the floor of which determines the proportions of the face in the vertical direction and, when establishing the deviations of the lower part in the area from the lower part of the nose to the lower point of the chin by its height from the height of the middle part of the face, in the area from the lower part of the nose to the eyebrows, the deviation of the current angular value of the face profile Gl-Sn-Pog from the angular value of the face profile equal to 165-175° is determined, then the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height according to Recketts is established, equal to 45 ± 2° and measured by anthropometric points on the bone structures of the lower and upper jaws by the value of the intermaxillary angle SNA-Xi-Pm,or by deviations from the ratio between the width of the lateral and central incisor equal to 1:1.618, and the ratio between the width of the lateral incisor and canine equal to 1:0.618, in which the central incisor is 60% wider than the lateral incisor and 60% wider than the part of the canine visible from the front, then, based on the image of the temporomandibular region, the presence of displacements of the temporomandibular joint heads in the joint space and their direction relative to the centered position are established, in which the distance from the surface of the joint head in the anterior and posterior sections is 2-3 mm, and in the upper section 3-4 mm, then the lower jaw is shifted by the established deviation and in the direction of this deviation to the line with points SNA-Pm of the intermaxillary angle SNA-Xi-Pm, in the position of which the intermaxillary angle is 45 ± 2 °, after which, based on the digital image model, prosthetic structures are modeled for installation on the dental arches patient or implants,ensuring the maintenance of the new bite height by changing the position of the lower jaw relative to the upper jaw, and fixing them on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

[0035] For all variants of the method, the intermaxillary angle SNA-Xi-Pm according to Recketts is considered to be the angle between two lines emanating from a common point, which is the geometric center of the Xi branches of the lower jaw, one of which is directed to the forward-protruding point SNA of the nasal bone, and the other is directed to the point Pm on the anterior contour of the chin, located in the middle between the anterior point Rod of the chin protrusion in medial section when the head is oriented along the Frankfurt horizontal and the subspinal point B, located posteriorly on the anterior contour of the apical base of the lower jaw.

[0036] For all variants of the method, the angular value of the facial profile GI-Sn-Pog is understood to be the angle formed by two lines emanating from the common point Sn, located at the transition of the nasal septum to the upper lip, one of which is directed towards the forehead and passes through the most protruding point GI on the soft tissue contour of the forehead, and the other is directed along the chin and passes through the most protruding point Rod on the soft tissue contour of the chin.

[0037] The specified features are essential and are interconnected with the formation of a stable set of essential features sufficient to obtain the required technical result.

[0038] The present invention is explained by a specific example of implementation, which, however, is not the only possible one, but clearly demonstrates the possibility of achieving the required technical result.

[0039] Description of drawing figures

[0040] In Fig. 1 - the general algorithm of interrelations of three types of studies; Fig. 2 - the color coding of the distances of the joint head from the walls of the joint space is shown; Fig. 3 - the normalized distances from the joint head to the walls of the joint space; Fig. 4 - the diagram of the intermaxillary angle according to Ricketts; Fig. 5 - the Gl-Sn-Pog facial profile angle is shown; Fig. 6 - the diagram of facial proportions by the height of the face from the front; Fig. 7 - the ratios between the width and height of the face are shown, normalized equal to 1:1,618; Fig. 8 - the block diagram of the algorithm for implementing the method according to the first embodiment; Fig. 9 - the block diagram of the algorithms for implementing the method according to the second embodiment and the extended algorithm for implementing the method according to the first embodiment; Fig. 10 - the block diagram of the algorithm for implementing the method according to the third embodiment; Fig. 11 - an example of an image of the temporomandibular joint on one side of the head with a demonstration of the distances from the head of the joint to the walls of the joint space. Fig. 12 - the same as in Fig.10, view from the other side of the head; Fig. 13 - diagram of the intermaxillary angle according to Ricketts for the joints in Figs. 11 and 12; Fig. 14 - model of the lower jaw with habitual occlusion of the teeth; Fig. 15 - model of the lower jaw with corrected occlusion of the teeth with a new bite height; Fig. 16 - profile view of patient A. with habitual occlusion of the teeth according to Fig. 14; Fig. 17 - profile view of patient A. with corrected occlusion of the teeth with a new bite height according to Fig. 15; Fig. 18 - frontal view of patient B. with habitual occlusion of the teeth; Fig. 19 - digital model of the jaws of patient B. with habitual occlusion of the teeth; Fig. 20 - models of the jaws of patient B. in the habitual and corrected positions; Fig. 21 - frontal views of patient B. with the usual and corrected positions of the jaws; Fig. 22 - diagram of the intermaxillary angle with the usual and new closure of the jaws; Fig. 23 - images of the models of the lower and upper jaws of patient C obtained as a result of scanning; Fig.24 - X-ray images of the temporomandibular joint of patient C; Fig. 25 - image of the calculation of the bite height of the lower and upper jaws of the patient with the usual closure; Fig. 26 - diagram of the intermaxillary angle with the usual and new closure of the jaws of patient C for assessing the bite height; Fig. 27 - profile view of patient C. with the usual closure of the teeth and with the corrected closure of the teeth with the new bite height;

[0041] The best options for implementing the invention

[0042] According to the present invention, a new method is considered, which, when conducting diagnostics and prescribing treatment, takes into account the use of necessary combined calculations: analysis of the position of the temporomandibular joints, the structure of the dental arches, aesthetic anthropometric parameters of the face, since these are interconnected structures. By restoring one structure during the treatment, we change the balance of the above-described complex.

[0043] The claimed method is based on the following premises.

[0044] The SdiMatriX Studio software is used to analyze the position of the articular heads. This program is used to scan the area of ​​the articular space and interpret the main parameters of the position of the head of the mandible joint in color gradation in terms of indicating the distances from the surface of the head to the walls of the articular space (Fig. 2). Within the color gradation, green is the normal range, blue shows that the thickness / distance is more than 3 mm, yellow is the thickness of the articular space of 1-2 mm, and red shows that the thickness is less than 1 mm. The gradation of the color coding of the articular space is based on known data, according to which the distance from the surface of the head of the joint to the walls of the articular space in the anterior, upper and posterior sections should be 2-3 mm (Fig. 3).

[0045] The use of such a program is an advanced method, but does not limit other possibilities for obtaining images in the frontal and profile positions, for example, using computed tomography or other modern and widely used in dentistry means. Within the framework of this application, such means are not specified. It is essential to obtain structural images that show the location of the joint elements and it is possible to calculate distances when bringing the image to dimensional accuracy with the patient in a similarity of 1:1. The use of modern computerized means allows you to model situations, for example, by shifting a part of the image (fragment) for a prognostic assessment of the mutual arrangement of the elements of the lower jaw in relation to the estimated parameters. This allows you to virtually predict the consequences of the changes made and obtain a virtual model of a new jaw or a new position of the dental arches without involving the patient in this process.When restoring damaged teeth, in most clinical cases the bite height (closure of the dental arches) is overestimated. There are many calculations for restoring the normal bite height. But it is necessary to take into account the parameters of the joint position and the aesthetic and anthropometric parameters of the face when performing such restorations. Since it is not enough to rely only on the data of one component (dental arches).

[0046] When restoring the bite height, it is necessary to use calculations based on the ratio of bone structures (since there may be a small number of teeth, which makes calculations based on teeth unacceptable) and calculations that take into account the proportions of the teeth. The most convenient calculation based on bone structures is the Ricketts calculation - calculation of the bite height using the intermaxillary angle SNA-Xi-Pm (Fig. 4). This is a convenient universal analysis that does not depend on the number of teeth in a person, since all anthropometric points are placed on bone structures.

[0047] According to Recketts, the intermaxillary angle SNA-Xi-Pm is the angle between two lines emanating from a common point, which is the geometric center of the Xi branches of the lower jaw, one of which is directed to the forward-protruding point SNA of the nasal bone, and the other is directed to the point Pm on the anterior contour of the chin, located in the middle between the anterior point Rod of the mental protrusion in medial section when the head is oriented along the Frankfurt horizontal and the subspinal point B, located posteriorly on the anterior contour of the apical basis of the lower jaw.

[0048] Another fairly simple and universal calculation that takes into account the proportions of the tooth. In such calculations, the front teeth are mainly analyzed. Because when the front teeth are destroyed or worn out, the smile parameters are disrupted. When the lateral group of dentition is destroyed or worn out, the height of the occlusion and the position of the lower jaw and, consequently, the temporomandibular joints change. The concept of the "golden proportion" means that the ratio between the width of the lateral and central incisors should be 1:1.618, and the optimal ratio between the width of the lateral incisor and canine is 1:0.618. Thus, the central incisor should be 60% wider than the lateral incisor, which, in turn, is approximately 60% wider than the part of the canine visible from the front.

[0049] The third necessary component included in the combined calculation is the analysis of facial proportions. It is necessary to consider not only the proportions of the height and width of the face, but also the angle of the facial profile (Fig. 5 and 6). Since when the height of closure decreases, not only the height of the face changes, but also the lower jaw may shift, which will lead to a change in the facial profile. The angular values ​​of the facial profile (GI- Sn-Pog) indicate the correct positioning of the lower jaw, taking into account aesthetic parameters. Normally, this angle is 165-175 degrees.

[0050] The angular value of the facial profile Gl-Sn-Pog is understood as the angle formed by two lines emanating from the common point Sn, located at the junction of the nasal septum and the upper lip, one of which is directed toward the forehead and passes through the most protruding point GI on the soft tissue contour of the forehead, and the other is directed along the chin and passes through the most protruding point Rod on the soft tissue contour of the chin.

[0051] The vertical component of the face can be divided into 3 approximately equal segments in height for analyzing the proportion of the face. The lower section in the theory of facial proportion in the vertical direction is located from the lower part of the nose to the lower point of the chin along its height, the middle section is located from the lower part of the nose to the eyebrows. In most cases, the lower segment changes. Therefore, for restoration taking into account the aesthetic proportions according to the face scan data, it is possible to take the upper and middle segments as a basis. For analyzing the height and width of the face, the "golden proportion" algorithm is also applicable (Fig. 7). The ratio between the width and height of the face should correspond to 1: 1.618.

[0052] This is a convenient universal analysis, independent of the number of teeth in a person, since all anthropometric points are placed on bone structures. This allows to avoid errors associated with the use of points on soft tissue surfaces and to perform an accurate calculation of the position of the lower jaw not only in relation to the location of the head of the joint in the joint space, but also taking into account the individual proportions of the face, approaching the rules of the "golden proportion".

[0053] To restore the individual bite height, taking into account the functional and aesthetic parameters, it is necessary to take into account the sequence of the following actions (Fig. 8):

[0054] 1 . For the first variant of the method (Fig. 9):

[0055] - conducting an analysis of the location of the joints of the lower jaw;

[0056] - conducting an analysis of the bite height (the height of the closure of the dental arches);

[0057] - restoration of bite height;

[0058] - conducting an analysis of facial proportions or

[0059] 2. For the second variant of the method (Fig. 10):

[0060] - conducting an analysis of facial proportions

[0061] - conducting an analysis of the location of the joints of the lower jaw;

[0062] - conducting an analysis of the bite height (the height of the closure of the dental arches);

[0063] - restoration of bite height

[0064] 3. For the third variant of the method (Fig. 9):

[0065] - conducting an analysis of the location of the joints of the lower jaw and establishing their location in accordance with the norm;

[0066] - conducting an analysis of the bite height (the height of the closure of the dental arches);

[0067] - restoration of bite height;

[0068] - conducting an analysis of facial proportions.

[0069] According to the claimed invention, the method for restoring individual bite height taking into account facial proportions according to the first variant (Figs. 8 and 9) consists in the fact that:

[0070] - in the frontal position of the patient's face, an image of the patient's temporomandibular region is obtained (Figs. 11 and 12) and his frontal profile; - based on the image of the temporomandibular region, the presence of displacements of the temporomandibular joint heads in the joint space and their direction relative to the centered position are established (Figs. 11 and 12), in which the distance from the surface of the joint head in the anterior and posterior sections is 2-3 mm, and in the upper section 3-4 mm (Fig. 3);

[0071] - using this image, the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height according to Recketts, equal to 45 ± 2° and measured according to anthropometric points on the bone structures of the lower and upper jaws according to the value of the intermaxillary angle SNA-Xi-Pm (Fig. 13), or according to deviations from the ratio between the width of the lateral and central incisor equal to 1:1.618, and the ratio between the width of the lateral incisor and canine equal to 1:0.618, in which the central incisor is 60% wider than the lateral incisor and 60% wider than the part of the canine visible from the front, is established;

[0072] - model the lower jaw in the usual occlusion of the dental arches (Fig. 14);

[0073] - the lower jaw is shifted by the established deviation and in the direction of this deviation to the line SNAA-Pm_intermaxillary angle SNA-Xi-Pm, at the position of which the intermaxillary angle is equal to 45 ± 2°;

[0074] - determine the current angular value of the Gl-Sn-Pog facial profile for subsequent correction of the displacement of the lower jaw to an angular value of the facial profile equal to 165-175° (Fig. 5), and obtain a digital pictorial model of the lower jaw in the normalized position of the joint head (Fig. 15) in the joint space and in relation to the normalized intermaxillary angle and the angular value of the facial profile;

[0075] - after that, based on the digital image model, prosthetic structures are modeled for installation on the patient's dental arches or implants, ensuring the preservation of the new bite height by changing the position of the lower jaw relative to the upper jaw, and fixed on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height. In this version of the method, the analysis of the location of the joints is fundamental. That is, the initial task is to correct the position of the articular heads in the joint space. It provides for the presence of displacements of the lower jaw. If the joints are in an uncentered position, this can lead to their overload and the progression of various diseases. Analysis of the bite height - this factor indicates abrasion or destruction of the dental arches. It must be taken into account when restoring teeth in order to assess the degree of restoration of the crown of the tooth.Aesthetic analysis (analysis of facial proportions) is the final operation and is necessary for the previous calculations to be aesthetically acceptable to the person, because any restoration must take into account the facial proportions, otherwise facial asymmetries may appear. Fig. 16 and 17 show this case, where the correction of the bite height practically does not change the facial proportions, but improves the facial aesthetics.

[0076] To correct the bite height, the normal parameters for the joint arrangement and the normal parameters for calculating the bite height are used. The joint space is normally 2-3 mm in the anterior and posterior sections, and 3-4 mm in the upper section. This allows you to adjust the position in accordance with the bite height. The bite height according to Recketts is 45 ± 2° (from 43° to 47°). Thus, the correction of the bite height allows you to select the optimal aesthetic parameters of the face. In most cases, secondary correction is not required.

[0077] Due to the variability of the parameters of the norms, in almost all cases it is possible to select optimal values ​​that do not contradict the aesthetic parameters. In some cases, when there is a contradiction in the parameters of the height of the bite and the aesthetic proportions of the face, the dominant factor is the aesthetic component.

[0078] An example of application of this method according to the first variant. Images of the joint area were obtained (Fig. 11 and 12), which established the presence of displacements of the joint head in the joint space. At the first stage, the location of the joint heads is analyzed using calculations of the width of the joint space. In this case, a forced position of the joints is noted, since the anterior section of the joint space is widened, the posterior section is greatly narrowed, which is clearly visible in Fig. 11 and 12. This suggests that the lower jaw must be shifted forward to align the position of the joint mechanisms. When aligning the position of the joints, it is necessary to take into account the bite height (Fig. 13). Analysis of the bite height helps to set the vertical proportion. In this case, as can be seen in Fig. 13, a decrease in the height is noted, based on the previously described calculations. Therefore, when shifting the lower jaw forward, we will also take into account the restoration of the vertical proportion, i.e. increase the bite height.Thus, we obtain a new calculated position for the lower jaw (Fig. 14 and 15).

[0079] This position should certainly not contradict the aesthetic parameters of the face. Therefore, it is necessary to analyze the proportions of the face in the usual closure and in the new ratio of the lower jaw. In this case, there was a one-time increase in the bite height with control of the aesthetic parameters.

[0080] Complex clinical cases are possible, in which it is necessary to change the sequence of actions. The sequence of actions in cases where visible facial asymmetries (visible aesthetic disturbances of facial proportions) are observed consists of analyzing facial proportions with clearly visible signs of aesthetic disturbances, performing an aesthetic calculation to restore the symmetry of facial parameters, after which an analysis of the bite (the height of the closure of the dental arches) is carried out taking into account the restored aesthetic proportions, and then an analysis of the location of the joints of the lower jaw is carried out.

[0081] In case of severe symmetry violations, the fundamental criterion will be the restoration of facial proportions. For this, there are previously described formulas. When restoring proportions, it is also necessary to conduct an analysis of where the lower jaw and joints will be located in order to correct further possible functional overloads.

[0082] In this case, the analysis of facial proportions comes to the fundamental level. In the frontal position of the patient's face, an image of the patient's temporomandibular region and his frontal profile is obtained, according to which the proportions of the face in the vertical direction are determined. The presence of deviations of the lower part of the face in the area from the lower part of the nose to the lower point of the chin is established by its height from the height of the middle part of the face in the area from the lower part of the nose to the eyebrows or from the height of the upper part of the face. Then the deviation of the current angular value of the Gl-Sn-Pog facial profile from the angular value of the facial profile equal to 165-175° is determined.

[0083] Then the patient's bite height is determined using the methods described in relation to the previously considered method, and the deviation value is established. After this, using the image of the temporomandibular region, the presence of displacements of the temporomandibular joint heads in the joint space and their direction relative to the centered position are established, in which the distance from the surface of the joint head in the anterior and posterior sections is 2-3 mm, and in the upper section 3-4 mm. Then, on the image, the lower jaw is shifted by the established deviation and in the direction of this deviation to the line with the SNA-Pm points of the intermaxillary angle SNA-Xi-Pm, at the position of which the intermaxillary angle is 45 ± 2°.

[0084] After this, based on the digital image model, prosthetic structures are modeled for installation on the patient's dental arches or implants, ensuring the preservation of the new bite height by changing the position of the lower jaw relative to the upper jaw, and they are fixed on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

[0085] Example. Patient A. complained of aesthetic problems associated with a rightward displacement of the chin, which is visually reflected in the photographs of the face (Fig. 18). For a detailed analysis of the presence of a lower jaw displacement, jaw models are used. The models revealed a discrepancy in the interincisal lines, which may also indicate a rightward displacement of the lower jaw (Fig. 19). To restore the aesthetic proportions of the face, it is necessary to shift the lower jaw to the left, taking into account the restoration of symmetry (Fig. 20). At the same time, obtaining a new aligned position of the lower jaw, this position should not contradict the aesthetic parameters of the face (Fig. 21). Further, these aesthetic corrections are confirmed by the data of the bite height calculation. The bite height data in the usual closure and in the new ratio remain within the normal range. In the usual closure 44.8 °, in the new ratio 45.3 ° (Fig. 22).

[0086] There are also clinical cases in which, with long-term destruction of the dental arches, the bite height is significantly reduced. In such cases, it is necessary to work in stages.

[0087] When it is established from the image of the temporomandibular region that there is a displacement of the temporomandibular joint heads in the joint space in the direction of a relatively centered position, in which the distance from the surface of the joint head to the wall of the joint space is at least twice the standardized distances in the anterior and posterior sections of this space, based on the digital image model, prosthetic structures are first modeled for installation on the patient's dentition or implants, ensuring the elimination of the displacement of the joint heads of the lower jaw by half of the detected displacements, and they are fixed on the patient's dentition of the lower jaw to adapt the patient's lower jaw, and after the end of the adaptation period lasting at least three months, based on a repeated digital image model, prosthetic structures are modeled that ensure the final elimination of the displacement of the joint heads of the lower jaw,and fix them on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

[0088] Example. Patient B. has a decrease in the bite height within 5 mm. A one-time increase may lead to severe discomfort, and the patient may not adapt to the new height. Then the bite height is increased in stages, on average, in 2 corrections. The first stage is an increase in the bite by 2.5 mm, an analysis of facial features, while the proportions may not be restored to normal during the first correction. This is followed by the second correction with an increase and taking into account the aesthetic parameters. It is also possible that the image of the temporomandibular region establishes the absence of displacements of the temporomandibular joint heads in the joint space relative to the centered position. Then, using the same image, the patient's bite height is determined and, if deviations are found, the lower jaw is shifted to the SNA-Pm line of the SNA-Xi- Pm intermaxillary angle, at the position of which the intermaxillary angle is 45 ± 2 °.Then, the current angular value of the Gl-Sn-Pog facial profile is determined for subsequent correction of the lower jaw displacement to an angular value of the facial profile equal to 165-175°, and a digital pictorial model of the lower jaw is obtained with a normalized position of the joint head in the joint space and in relation to the normalized intermaxillary angle and angular value of the facial profile. After that, based on the digital pictorial model, prosthetic structures are modeled for installation on the patient's dental arches or implants, ensuring the preservation of the new bite height due to a change in the position of the lower jaw relative to the upper jaw, and they are fixed on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

[0089] Example. During the diagnostics, patient S. was found to have dental arch deformations (Fig. 23), which may lead to impaired lower jaw movement and overload of the temporomandibular joint area. A detailed examination revealed normal joint arrangement. No structural (bone) disorders of the articular heads were found (Fig. 24). According to the bite height calculation data, a decrease in the height within 3 mm is noted. The calculated parameters for the patient are 41.3° (normal 45±2°) (Fig. 25). Based on the combined data of dental arch deformations and decreased bite height, it is necessary to increase the occlusion height. To do this, using the software, the ratio of the dental arches is restored (Fig. 26). When restoring the height, an additional aesthetic analysis of the facial proportions was performed (Fig. 27). The main calculations for the bite height, joint position and aesthetic parameters of the face are made using the SDiMatriX studio software.In this program, after calculating the new bite height, the scans of the jaws (digital models of the jaws) are positioned in the new position, according to all the calculations described above. These digital models in the new ratio are exported to the equipment that models future structures on the dental arches or implants. Then the structures are fixed on the dental arches and the patient adapts to the new bite height. The average adaptation time is about 3 months. Then it is necessary to check whether everything is functioning normally. For this purpose, a repeated face scan is made for anthropometric calculations and a CT scan is made to calculate the bite height and joint position. All this data is analyzed again in the SDiMatriX program.

Claims

Invention formula 1. A method for restoring an individual bite height taking into account facial proportions, characterized by the fact that in the frontal position of the patient's face, an image of the patient's temporomandibular region and his frontal profile is obtained, according to the image of the temporomandibular region, the presence of displacements of the temporomandibular joint heads in the joint space and their direction relative to the centered position are established, in which the distance from the surface of the joint head in the anterior and posterior sections is 2-3 mm, and in the upper section 3-4 mm, according to the same image, the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height according to Recketts, equal to 45 ± 2 ° and measured by anthropometric points on the bone structures of the lower and upper jaws according to the value of the intermaxillary angle SNA-Xi-Pm, or according to deviations from the ratio between the width of the lateral and central incisor equal to 1: 1,618, and the ratio between the width of the lateral incisor and a fang equal to 1:0.618,in which the central incisor is 60% wider than the lateral incisor and 60% wider than the part of the canine visible from the front, then the lower jaw is shifted by the established deviation and in the direction of this deviation to the SNA-Pm line of the intermaxillary angle SNA-Xi-Pm, at the position of which the intermaxillary angle is equal to 45 ± 2°, then the current angular value of the facial profile Gl-Sn-Pog is determined for the subsequent correction of the lower jaw displacement to the angular value of the facial profile equal to 165-175°, and a digital pictorial model of the lower jaw is obtained in the normalized position of the joint head in the joint space and in relation to the normalized intermaxillary angle and the angular value of the facial profile, after which, based on the digital pictorial model, prosthetic structures are modeled for installation on the patient's dentition or implants, ensuring the preservation of the new bite height due to a change in the position of the lower jaw relative to the upper jaw,and fix them on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

2. The method according to claim 1, characterized in that the intermaxillary angle SNA-Xi-Pm according to Recketts is considered to be the angle between two lines emanating from a common point, which is the geometric center of the Xi branches of the lower jaw, one of which is directed toward the forward-protruding point SNA of the nasal bone, and the other is directed toward the point Pm on the anterior contour of the chin, located in the middle between the anterior point Rod of the mental protrusion in medial section when the head is oriented along the Frankfurt horizontal and the subspinal point B, located posteriorly on the anterior contour of the apical base of the lower jaw.

3. The method according to paragraph 1, characterized in that the angular value of the facial profile Gl-Sn-Pog is understood to be the angle formed by two lines emanating from the common point Sn, located at the place where the nasal septum passes into the upper lip, one of which is directed toward the forehead and passes through the most protruding point GI on the soft tissue contour of the forehead, and the other is directed along the chin and passes through the most protruding point Rod on the soft tissue contour of the chin.

4. The method according to claim 1, characterized in that when it is established from the image of the temporomandibular region that there is a displacement of the temporomandibular joint heads in the joint space in the direction of a relatively centered position in which the distance from the surface of the joint head to the wall of the joint space is at least twice the standardized distances in the anterior and posterior sections of this space, based on the digital image model, prosthetic structures are first modeled for installation on the patient's dentition or implants, ensuring the elimination of the displacement of the joint heads of the lower jaw by half of the detected displacements, and they are fixed on the patient's dentition of the lower jaw to adapt the patient's lower jaw, and after the end of the adaptation period lasting at least three months, based on a repeated digital image model, prosthetic structures are modeled that ensure the final elimination of the displacement of the joint heads of the lower jaw,and fix them on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

5. A method for restoring an individual bite height taking into account facial proportions, characterized in that in the frontal position of the patient's face, an image of the patient's temporomandibular region and his frontal profile is obtained, based on the image of the temporomandibular region, the absence of displacements of the temporomandibular joint heads in the joint space relative to the centered position is established, in which the distance from the surface of the joint head in the anterior and posterior sections is 2-3 mm, and in the upper section 3-4 mm, based on the same image, the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height according to Recketts, equal to 45 ± 2 ° and measured by anthropometric points on the bone structures of the lower and upper jaws by the value of the intermaxillary angle SNA-Xi-Pm, or by deviations from the ratio between the width of the lateral and central incisor equal to 1: 1,618, and the ratio between the width of the lateral incisor and fang equal to 1:0.618,in which the central incisor is 60% wider than the lateral incisor and 60% wider than the part of the canine visible from the front, then the lower jaw is shifted in the direction of this deviation to the SNA-Pm line of the SNA-Xi-Pm intermaxillary angle, at the position of which the intermaxillary angle is equal to 45 ± 2°, then the current angular value of the facial profile Gl-Sn-Pog is determined for the subsequent correction of the lower jaw shift to the angular value of the facial profile equal to 165-175°, and a digital pictorial model of the lower jaw is obtained with the normalized position of the joint head in the joint space and in relation to the normalized intermaxillary angle and angular value of the facial profile, after which, based on the digital pictorial model, prosthetic structures are modeled for installation on the patient's dentition or implants, ensuring the preservation of the new bite height due to a change in the position of the lower jaw relative to the upper jaw,and fix them on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

6. The method according to item 5, characterized in that the intermaxillary angle SNA-Xi-Pm according to Recketts is considered to be the angle between two lines emanating from a common point, which is the geometric center of the Xi branches of the lower jaws, one of which is directed to the forward protruding point SNA of the nasal bone, and the other is directed to the point Pm on the anterior contour of the chin, located midway between the anterior point Rod of the mental protrusion in medial section when the head is oriented along the Frankfurt horizontal and the subspinal point B, located posteriorly on the anterior contour of the apical basis of the lower jaw.

7. The method according to paragraph 5, characterized in that the angular value of the face profile Gl-Sn-Pog is understood to be the angle formed by two lines emanating from the common point Sn, located at the place where the nasal septum passes into the upper lip, one of which is directed toward the forehead and passes through the most protruding point GI on the soft tissue contour of the forehead, and the other is directed along the chin and passes through the most protruding point Rod on the soft tissue contour of the chin.

8. A method for restoring an individual bite height taking into account facial proportions, characterized in that in the frontal position of the patient's face, an image of the patient's temporomandibular region and his frontal profile is obtained, according to which the proportions of the face in the vertical direction are determined and, when establishing the deviations of the lower part in the area from the lower part of the nose to the lower point of the chin by its height from the height of the middle part of the face in the area from the lower part of the nose to the eyebrows or from the height of the upper part of the face, the deviation of the current angular value of the face profile Gl-Sn-Pog from the angular value of the face profile equal to 165-175° is determined, then the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height according to Recketts is established, equal to 45 ± 2° and measured by anthropometric points on the bone structures of the lower and upper jaws by the value of the intermaxillary angle SNA-Xi-Pm, or by deviations from the ratio between the width of the lateral and central incisor equal to 1:1 ,618,and the ratio between the width of the lateral incisor and canine equal to 1:0.618, in which the central incisor is 60% wider than the lateral incisor and 60% wider than the part of the canine visible from the front, then, based on the image of the temporomandibular region, the presence of displacements of the temporomandibular joint heads in the joint space and their direction relative to the centered one are established, T1 position, in which the distance from the surface of the head of the joint in the anterior and posterior sections is equal to 2-3 mm, and in the upper section 3-4 mm, then the lower jaw is shifted by the established deviation and in the direction of this deviation to the line with the SNA-Pm points of the intermaxillary angle SNA-Xi-Pm, in the position of which the intermaxillary angle is equal to 45 ± 2°, after which, based on the digital image model, prosthetic structures are modeled for installation on the patient's dental arches or implants, ensuring the preservation of the new bite height due to a change in the position of the lower jaw relative to the upper jaw, and they are fixed on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.

9. The method according to claim 8, characterized in that the intermaxillary angle SNA-Xi-Pm according to Recketts is considered to be the angle between two lines emanating from a common point, which is the geometric center of the Xi branches of the lower jaw, one of which is directed toward the forward-protruding point SNA of the nasal bone, and the other is directed toward the point Pm on the anterior contour of the chin, located in the middle between the anterior point Rod of the mental protrusion in medial section when the head is oriented along the Frankfurt horizontal and the subspinal point B, located posteriorly on the anterior contour of the apical base of the lower jaw.

10. The method according to paragraph 8, characterized in that the angular value of the facial profile Gl-Sn-Pog is understood to be the angle formed by two lines emanating from the common point Sn, located at the place where the nasal septum passes into the upper lip, one of which is directed toward the forehead and passes through the most protruding point GI on the soft tissue contour of the forehead, and the other is directed along the chin and passes through the most protruding point Rod on the soft tissue contour of the chin.

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