The purpose of the study was to increase the effectiveness of orthopedic and orthodontic treatment of children with dentition defects during the period of mixed occlusion to prevent secondary dento-maxillaire deformities. Material and methods. 47 patients aged from 6 to 11 years with dentition defects in the frontal and lateral areas were examined and treated to conduct comparative evaluation of the effectiveness of using removable and non-removable prostheses appliances in patients with dentition defects during the period of mixed occlusion. All the patients were divided into two clinical groups by the design type of a prosthesis appliance, the choice of which depended on the results of a complete clinical research taking into account the location and the length of dentition defects. For group I patients (n=29), we used removable orthodontic prostheses appliances (standard mechanically-operated appliances with artificial teeth), in areas with missing teeth, to regulate the size of upper and lower dentition and replace dentition defects. For group II patients (n=18), we used non-removable orthodontic prostheses appliances (bands with a spacer and a non-removable prosthesis appliance of our own design). At the beginning of treatment and after 3 and 6 months, the assessment of oral hygiene was conducted using Yu. A. Fedorov and V. V. Volodkina indices. Follow-up examinations of patients in both groups were conducted once a month. However, every 3 and 6 months, patients of group I (with removable prosthesis appliances) received repetitive jaw impressions and made control diagnostic models, which measured the size of a dentition defect area to monitor the treatment. The data on control measurements was compared with data obtained at the beginning of the treatment. The criteria for completion of orthodontic treatment were considered to be the regulation of the size of upper and lower dentition and the position of individual teeth, as well as the preservation of the place in the dental arch until the physiological change of prematurely lost teeth. Results and discussion. The main causes of dentition defects occurrence in patients of both groups were the following: premature removal of temporary and permanent teeth due to complications of caries – 39 patients (83.0%), the loss of teeth due to a trauma – 5 patients (10.5%). Dentition defect was caused by adentia – in 2 people (4.3%), by retention – in 1 person (2.1%). We determined that 30 people (63.8%) had defects of the upper jaw, which was the most prevailing dentition defects. Dentition defects in the lateral areas were recorded in 32 people (68.1%). The largest number of dentition defects was of short size – 29 (61.7%). To restore the integrity of the dentition, we made 29 removable prostheses appliances with artificial teeth for group I patients, 9 (31.0%) of them served to replace dentition defects of the frontal area and 20 (69.0%) replaces dentition defects of the lateral area. In order to replace the dentition defect and preserve the place in the dental arch, we made 18 non-removable prostheses appliances for group II patients, 6 (33.3%) of them were of our own design to replace the dentition defect in the frontal area, and 12 (66.7%) replaced teeth gap bands with a spacer for the lateral one. Based on the analysis of these indicators in people with dentition defects who used removable and non-removable appliances, we can conclude, that there is a clear connection between the impact of orthodontic appliances on oral hygiene, depending on its type. The negative dynamics of changes in the hygiene index according to Fedorov-Volodkina in patients with non-removable prostheses appliances can be explained by the deterioration of oral hygiene conditions due to the design features of the appliances and the inability to remove the appliance yourself. Therefore, the use of non-removable appliances requires additional hygienic measures. Removable appliances had almost no effect on the state of oral hygiene, but worked less predictably by reducing the time of their active action in the oral cavity. If children refused to wear removable prostheses and prosthesis appliances, there quickly developed secondary dento-maxillaire deformities, which over time became more stable, and pathological changes were more significant. In group I patients, 6 months after the start of treatment with removable prostheses appliances, the shortening of dentition defects was detected in the frontal area by 1.3±1.1 mm and in the lateral area by 1.2±0.9 mm. Negative changes in the length of the dentition defect in patients of group I before treatment and after 6 months are specifically connected with irresponsible attitude to treatment. Not all patients in this group fully wore removable prostheses appliances, and some of them did not wear at all. Conclusion. Our research showed that removable orthodontic appliances for replacement of dentition defects and prevention of secondary dento-maxillaire deformities could be used in patients of different ages, their special effectiveness was observed in pediatric-age patients, however, only in those who responsibly followed the recommendations of an orthodontist. The use of non-removable orthodontic appliances for replacement of dentition defects and prevention of secondary dento-maxillaire deformities is a more rational choice of dental prosthesis. The prosthesis appliance for the upper jaw developed by us doesn’t inhibit the growth of the jaw, meets all the esthetic and functional requirements applied to these appliances. During treatment with non-removable appliances patients cannot control the time when the appliance “works”, which leads to a more predictable result of treatment
Keywords: dentition defects in children. secondary dento-maxillaire deformities in children, removable prosthesis appliances, non-removable prosthesis appliances
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