Tortoocclusion of teeth (rotation)

Tortoocclusion of teeth (syn. – tortoanomaly, tooth rotation around the axis) is observed, more often in permanent occlusion and less often in temporary occlusion. More often than other teeth, the incisors of the upper and lower jaws rotate along the axis, less often – canines, premolars and molars. The rotation of the tooth can be insignificant (from 14ᵒ to 45ᵒ) and significant (from 90ᵒ to 180ᵒ). Tortoocclusion of a tooth can be combined with other pathological occlusions of the same tooth.

Pic.20. Tortoocclusion of teeth 11 and 21.

Etiology, pathogenesis:

- heredity;

- harmful habits of biting cheeks, lips;

- impaired breathing, speech, closing of lips, which leads to underdevelopment of the jaws;

- impaired formation of the tooth root or alveolar process;

- the presence of impacted teeth;

- disorder of the tooth germ position;

- sports (when the patient uses the wrong breathing technique);

- ENT diseases;

- discrepancy in the size of the teeth and jaws;

- delayed physiological change of temporary teeth;

- trauma to the teeth, alveolar process, jaws;

- macrodentia (absolute or individual);

- presence of supernumerary tooth;

- disorder of the tooth formation;

- micrognathia of the jaw;

- premature extraction of temporary molars without preventive measures;

- narrowing and shortening of the dentition and apical base of varying degrees;

- discrepancy in the width of the dentition and apical base;

- violation of calcium-phosphorus metabolism;

- vitamin D deficiency states.

Functional disorders:

- breathing;

- speech;

- chewing;

- impaired lip closure;

- chronic trauma to the mucous membrane of the lip;

- dysfunction of the temporomandibular joint;

- periodontal tissue diseases (localized, generalized).

Aesthetic changes:

- half-open mouth;

- visualization of anomalous tooth during talking and smiling;

- deep supramental fold;

- smoothed nasolabial folds;

- disorder of facial proportions;

- disorder of facial symmetry.

Forms of anomaly:

- with space in the dentition;

Pic.21. Tortoocclusion of tooth 43 with space in the dental arch.

- without space in the dentition;

- with concomitant anomalies of the dentition and bite;

Pic.22. Tortoocclusion of teeth 11 and 21, open bite.

Pic.23. Tortoocclusion of teeth 11 and 21, prognathic, cross bite.

- with compensated deficiency of space in the dentition;

- with decompensated or complete deficiency of space in the dentition.

Research methods:

1. Clinical.

2. Paraclinical.

X-ray:

- orthopantomography;

- computer tomography.

Biometric:

- dental examination by methods:

Tonn

Bolton

Pont and H. Linder, G. Hart

Korkhaus

Snagina

Little

Nance

Schwarz

Fuss

Schmuth

Facial photometry.

Reopardodontography.

Principles of treatment:

Preparatory period

- psychotherapeutic preparation;

- elimination of the risk factor (if possible);

- elimination of the etiological factor (if possible);

- oral cavity sanitation;

- checking the state of oral hygiene, if necessary - training;

- prosthetic preparation (according to indications);

- surgical preparation (according to indications).

Active period of orthodontic treatment in temporary and mixed occlusion:

- functional treatment methods (myogymnastics, massage, etc.);

- appliances treatment method taking into account the clinical manifestation of the pathology (creation of space in the dental arch for an abnormally located tooth: expansion of the dentition, lengthening of the dentition, distalization of the teeth, etc.);

- normalization of functions (aesthetic, speech, chewing);

- normalization of the bite height (if necessary);

- surgical treatment methods (serial sequential extraction of teeth according to Hotz; extraction of individual teeth; extraction of supernumerary tooth, etc.);

- separation of the bite by using a bite plate, occlusal overlays;

- stripping.

Active period of orthodontic treatment in permanent occlusion:

- normalization of functions (aesthetic, speech, chewing).

- surgical treatment methods (extraction of individual teeth; supernumerary tooth, compact osteotomy, insert of orthodontic implants, etc.).

- stripping;

- prosthetic treatment;

- separation of the bite by using a bite plate, occlusal overlays;

- functional treatment methods (myogymnastics, massage, etc.);

- physiotherapeutic treatment method: vacuum therapy, low-frequency therapeutic vibration, MRI-magnetic resonance reflexotherapy, ultraphonophoresis, ultrasound, electrophoresis, etc.

Retention period of orthodontic treatment:

- preservation of the achieved result and prevention of relapse with the help of special equipment - retainers (fixed, removable);

- functional adaptation to the newly created occlusion;

- extraction of the rudiments of third molars (if necessary).