DISTAL OCCLUSION AND DENTAL CROWDING: TREATMENT STRATEGY

Dental anomalies are the leading ones among dental diseases in the period of mixed (79,96%) and permanent (84,33%) dentition. According to the results of our studies, frequency of distal occlusion (up to 40%) and dental crowding (up to 65%) are the largest in structure of orthodontic pathology. The aim of the study is to analyze and summarize knowledge about ways of enhancement of treatment and prophylaxis efficiency in patients with distal occlusion and dental crowding. Genetic predisposition, early childhood diseases (including upper respiratory tract infections), children's bad habits, pathological state of teeth (adentia, impaction, micro-, macrodentia), micro-, macrognathia, functional disorders of maxillofacial area contribute a high percentage in structure of "risk factors" which lead to formation of distal occlusion with dental crowding. For each particular patient distal occlusion, complicated by dental crowding, is formed under the influence of combination of several "risk factors", where the first place belongs to disturbances of dental area: breathing, closing of lips, swallowing, chewing, speech. Today it is well known that the first step in correction of distal occlusion of dentitions is to evaluate the patient's potential growth. Treatment in the period of mixed dentition is important with relation to protection of palate from trauma by mandibular incisors with a large sagittal gap, prophylaxis of dysfunction of temporomandibular joint, psychological rehabilitation of children during speech formation, as well as to improve the prognosis of treatment in older age. The best period of treatment is a peak of growth and development. Growth is the most important factor in planning treatment of distal occlusion, since dramatic changes in correction are related to growth rather than teeth movement. Orthodontists forbear from recommendations for teeth extraction in growing patients, as they believe that it leads to worsening of face profile and does not allow to achieve optimal relationships of jaw and occlusion. In adult patients, complete conservative correction of distal occlusion is possible only in the absence of skeletal disorders. Combined method, namely combination of orthodontic treatment and orthognathic surgery, is an alternative for adults treatment. Adequate individual approach to orthodontic treatment in patients with distal occlusion complicated by dental crowding is based on a comprehensive clinical examination, scientific analysis and results interpretation of additional examination methods. Full functional occlusion is possible if all elements of dentition: occlusion, periodontal tissues, temporomandibular joints, muscles and nervous system, are considered. Stable results and positive prognosis are provided by normalization of physiological state of masticatory and mimic muscles.