JUSTIFICATION OF THE CHOICE OF THE METHOD OF TREATMENT OF ORTHODONTIC PATIENTS WITH LINGUAL FRENULUM SHORTENING І – ІІІ TYPES

Golovko N. V., Iyad N. A. Najib

CONTENTS

Scentific article

The paper presents the results of the clinical and teleroentgenography examination of 259 orthodon-tic patients with lingual frenulum shortening aged from 6 to 27. The examined patients were divided into groups according to the age and the form of lingual frenulum shorten-ing (group I – 91 patients with early mixed occlusion; group II – 76 patients with late mixed occlusion; group III – 92 patients with permanent occlusion). The size measurements of frenulum and tongue were determined according to G. A. Zolotukhina (1999). The comparison group consisted of 45 individuals with the physiological bite and without clinical signs of anomalies of size and frenulum attachment, 13 of them – with early mixed occlusion, 15 – with late mixed occlusion and 17 – with permanent occlusion. The type of frenulum shortening was diagnosed according to F. Ya. Khoroshilkina (2004). The study of the tongue location was performed with the use of 81 lateral teleroentgenograms of the head. Barium suspension was used for contrast study; it was administered in a thin layer on the tongue from the tip to the root. The measurement of free space was performed according to T. Racosi (1966) in the modification of L. P. Barinova (1970). The study showed that types I and II of lingual frenulum shortening was diagnosed in almost equal number of cases – 41,31% and 39,38%, respectively; type III was observed more than 2 times less frequently – in 19,30% of patients. With the increase of shortening degree, the decrease in the length and height of the tongue, as well as the in-crease in its width was determined. The length of lingual frenulum by type I shortening was by 2,46 mm less than by normal frenulum, by type II – 9,46 mm, by type III – 15,43 mm. In all 259 patients, the disorders of different functions were observed, with predominating difficulty of moving the tongue upwards (in 93,44% of patients). Change in sizes and difficulty of moving the tongue upwards suggest its inappropriate location in the mouth. Lateral teleroentgenogram with contrast study showed the change in the position of its back and tip with the forma-tion of free space between the back of the tongue and hard palate up to 51,79%. Thus, the obtained data show an increase in the degree of morphological (size of tongue and frenulum, change in its position) and functional disorders (decrease in the range of motions) by the decrease of the length of frenulum. Therefore, for orthodontic patients with the type I lingual frenulum shortening, it is indicted to apply instrumental and functional treatment (myogymnastic exercises for extending the frenulum, increasing the range of motions and change of position. If necessary, the lessons are held with a speech therapist. By the type II – the combined method with a large amount of activities: instrumental, surgical (single-stage frenuloplastics) and functional (myogymnastic exercises prior to frenuloplastics and in 7-10 days after the surgery in order to increase the range of motions and change of position; the prescription of individually manufactured devices for performing the myogymnastic exercises. If necessary, the lessons are held with a speech therapist. Orthodontic patients with type III frenulum shortening require the most complex and long-term care: instrumental, surgical (with the approval of oral surgeon – two-stage frenuloplastics) and functional (myogymnastic exercises prior to frenuloplastics and in 7-10 days after the surgery in order to increase the range of motions and change of position; the prescription of individually manufactured devices to perform myogymnastic exercises). If necessary, the lessons are held with a speech therapist.

orthodontic patients, shortened lingual frenulum, the size of the tongue, the size of frenulum, teleroentgenography

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