A diagnostic method for deep bite in children and adolescents with varying severity of connective tissue disorders

Relevance. Currently, congenital connective tissue disorders (CTDs) are recognized as a complex interdisciplinary clinical problem, presenting with a broad spectrum of systemic and regional phenotypic manifestations. These disorders are frequently associated with malocclusion, as well as various dental and occlusal anomalies related to tooth shape, position, and jaw development. However, data remain limited regarding early diagnosis, as well as the optimization of comprehensive treatment, prevention, and rehabilitation strategies for dentoalveolar anomalies in children and adolescents, especially when considering the severity of congenital connective tissue differentiation abnormalities.

Materials and methods. The study included 717 schoolchildren aged 12 to 18 years, all diagnosed with CTDs, comprising 415 girls and 302 boys. Clinical dental examinations identified deep bite in 173 participants using a diagnostic method developed by the authors. The severity of each participant's CTD was determined based on the classification criteria established by T. Milkovska-Dmitrova and A. Karkashev (1985). Biometric measurements were performed on plaster dental models of children with deep bite using the proposed diagnostic technique.

Results. The analysis revealed statistically significant differences (p < 0.05) in biometric deep bite parameters between groups with different degrees of congenital connective tissue differentiation abnormalities. The data demonstrated a clear trend: the more severe the CTD, the more pronounced the deep bite parameters. These findings underscore the importance of early, comprehensive primary and secondary prevention, alongside individualized medical and social rehabilitation strategies for children with CTDs.

Conclusion. The proposed biometric diagnostic method allows for the identification of deep bite while taking into account the severity of congenital connective tissue differentiation abnormalities. This approach supports the timely detection of vertical malocclusions and facilitates appropriate therapeutic, preventive, and rehabilitative measures for school-aged children with varying degrees of CTDs.

1. Abramova VR, Kuzmina SS, Korkin EV, Kardashevskaya MV, Danilova AI. Assessment of physical development of students in the Far North. Modern problems of science and education. 2019;(6) (In Russ.). Available from: https://science-education.ru/ru/article/view?id=29344

2. Dakuko AN, Krivtsova LA, Nalobina AN, Ivashchenko ON, Plekhanova MA. Influence of connective tissue dysplasia at the formation of adaptive and functional capabilities in children engaging precise technical sports activities. Therapy. 2020;(6):64-70 (In Russ.). doi: 10.18565/therapy.2020.6.64-70

3. Viktorova IA, Ivanova DS, Nechaeva GI, Potapov VV, Tikhonova OV, Goloshubina VV. Rehabilitation of patients with connective tissue dysplasia in outpatient practice. Therapy. 2020;(6):8-17 (In Russ.). doi: 10.18565/therapy.2020.6.8-17.

4. Zakharova IN, Tvorogova TM, Solov’yeva EА, Stepurina LL, Vorob’yeva AS. Connective tissue dysplasia: a risk factor for osteopenia in children and adolescents. Medical Council. 2020;(1):30-40 (In Russ.). doi: 10.21518/2079-701X-2020-1-30-40.

5. Avanisyan V, Al-Harazi G, Harutyunyan Yu. Morphology of facial skeleton in children with undifferentiated connective tissue dysplasia. Archiv EuroMedica. 2020;10(3):130-141. doi: 10/35630/2199-885x/2020/10/3.32

6. Blinov, MS, Borodulina II, Tegza NV. Signs of dysmorphogenesis dentofacial system with undifferentiated connective tissue dysplasia. The Dental Institute. 2018;(3):94-96 (In Russ.). Available from: https://elibrary.ru/item.asp?id=35618914

7. Lopez-Oliva I, de Pablo P, Dietrich T. Gums and joints: is there a connection? Part one: epidemiological and clinical links. Br Dent J. 2019:605-609. doi: 10.1038/s41415-019-0722-8

8. Davydov BN, Domenyuk DA, Dmitrienko SV, Kondratyeva TA, Harutyunyan YuS. Cephalometric features of connective tissue dysplasia manifestation in children and adolescents. Pediatric dentistry and dental prophylaxis. 2020;20(3):174-183 (In Russ.). doi: 10.33925/1683-3031-2020-20-3-174-183

9. Harutyunyan Yu, Domenyuk DA, Dmitrienko SV. Undifferentiated connective tissue dysplasi a as a key factor in pathogenesis of maxillofacial disorders in children and adolesce. Archiv EuroMedica. 2020;10(2):83-94. doi: 10/35630/2199-885x/2020/10/2.24

10. Makedonova YuA, Vorobev AA, Osuko AN, Alexandrov AV, Dyachenko DYu, Pavlova-Adamovich AG. Diagnosis of hypertonicity of the masticatory muscles at a dental appointment. Endodontics Today. 2021;19(3):190- 199 (In Russ.). doi: 10.36377/1683-2981-2021-19-3-190-199

11. Narkevich AN, Vinogradov KA. Methods for determining the minimum required sample size in medical research. Social'nye aspekty zdorov'a naselenia / Social aspects of population health [serial online] 2019; 65(6):10 (In Russ.). doi: 10.21045/2071-5021-2019-65-6-10

12. Smirnova АA, Gavrilova OA, Fedorova KV, Sokolova LN, Bobrov DV. Abnormal wear patterns in different types of malocclusions. Pediatric dentistry and dental prophylaxis. 2022;22(2):111-121 (In Russ.). doi: 10.33925/1683-3031-2022-22-2-111-121

13. Uvarova AA, Glazkova AV, Budina TV, Mamedov AA, Dybov AM, Volkov AG. The impact of masticatory muscles hypertonicity on the bite formation. Stomatology. 2023;102(3):45 49 (In Russ.). doi: 10.17116/stomat202310203145

14. Coles W, Copeman A, Davies K. Hypermobility in children. Pediatrics and child health. 2018;28(2):50-56. doi: 10.1016/j.paed.2017.12.001

15. Haller G, Zabriskie H, Spehar S. Lack of joint hypermobility increases the risk of surgery in adolescent idiopathic scoliosis. Journal of pediatric orthopaedics, part B. 2018;27(2):152-158. doi: 10.1097/BPB.0000000000000489