RU2779362C1 - Method for diagnosing a person's health when planning and conducting osteopathic functional dental treatment by doctor datsenko's method - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be used for performing a comprehensive examination of the patient when planning and conducting osteopathic functional dental treatment. History is collected, dental examination is conducted, impressions are made, plantography of the feet is performed in the standing position of the patient. 3D cephalometry is performed on the basis of cone-beam computed tomography (CBCT), as well as multispiral computed tomography (MSCT) of the head and neck, magnetic resonance imaging (MRI) of the closed and open temporomandibular joint (TMJ), MRI of the spine, orthopantomogram (OPTG), the gait is recorded on video. Height, weight, and body mass index are taken as the anthropometric data. Spirometry is performed, muscle strength in the arms, HR, and BP are determined. Bioelectrical impedance analysis of body composition is conducted, determining the level of water, protein, visceral fat, and bone mass, the basal metabolic rate, and the biological age. The blood oxygen saturation, the levels of glucose, cholesterol, vitamin D, and B group vitamins are determined. The general physical fitness is evaluated: running, jumping rope, squats, push-ups, pull-ups, abdominal crunches, the balance and a handwriting sample are assessed. A Lüscher test is taken. After all the information is collected, it is compared with the reference values.

EFFECT: method raises the accuracy of examination of the patient when planning and conducting osteopathic functional dental treatment due to the comprehensive assessment of the most significant indicators.

1 cl, 23 dwg, 1 ex

Description

The invention relates to medicine, namely to the diagnosis of human health with a holistic approach to planning and treating a patient from the point of view of osteopathic dentistry.

From the prior art, a method is known for diagnosing the musculoskeletal system when planning and conducting dental treatment (RF patent No. system with compressed and relaxed jaws, determination of the physiological position of the lower jaw after muscle relaxation. Then, an optical topography of the spine is performed in 3 positions: the jaws are in a relaxed state, the jaws are closed and the jaws are closed with a bite template located between the teeth, at the beginning between the back teeth on both sides, then between the front teeth. The feet are scanned in the patient's standing position using the DIERS Pedoscan scanner in 3 positions: the jaws are in a relaxed state, the jaws are closed and the jaws are closed with the bite template located between the teeth, first between the back teeth on the right, then between the back teeth on the left, then between the front teeth teeth. If violations in the cranio-mandibular system are detected, therapy is carried out, including osteopathic correction, muscle relaxation, exercise therapy, acupuncture and physiotherapy, as well as impressions are taken and an occlusal cap is made for positioning and centering the lower jaw. After that, the above sequence of actions is repeated, while the optical topography of the spine and scanning of the feet in the patient's standing position using the DIERSPedoscan scanner is carried out in 3 positions: the jaws are in a relaxed state, the jaws are closed without an occlusal cap and the jaws are closed with an occlusal cap. Dental treatment is then performed to create stable interdental contacts that hold the lower jaw in its new position. Once every 6 months, the results of treatment are monitored. EFFECT: method provides diagnostics of disorders in the cranio-mandibular system, which allows subsequently to carry out effective dental treatment due to the achievement, due to the subsequent correction of the identified disorders, of the physiological position of the lower jaw. It is used in dentistry, and can be used before and / or during dental intervention.

The method according to patent No. 2657195 does not provide high accuracy in diagnosing human health, since it considers diagnosing the health of the body only by examining the musculoskeletal system, without examining other vital systems of the human body.

Meanwhile, health is the first and most important human need, which is difficult to give an exhaustive definition. In 1948 the WHO defined health. It is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This definition is not exhaustive enough, in connection with this, the work of Pavel Iosifovich Kalyu attracts attention [Nalyu P.I. The essential characteristic of the concept of "health" and some issues of restructuring healthcare: an overview. - M., 1988.]. The author considers 79 definitions of human health formulated by representatives of various scientific disciplines at different times in different countries of the world. The above list is far from complete, but even he, the author writes, is already striking in both the variety of interpretations and the heterogeneity of the features used in defining this concept.

It follows from this work that human health is a normal function of the body at all levels of its organization: the body; organs; histological, cellular and genetic structures; the normal course of physiological and biochemical processes that promote individual survival and reproduction. And also human health is a dynamic balance of the body and its functions with the environment.

Thus, human health consists of the relationship of different organs and functions through which they are carried out. For example, the respiratory function is carried out with the help of the respiratory system, which includes the nasal cavity, pharynx, larynx, trachea, bronchi and bronchioles. The function of swallowing is carried out with the help of the tongue, hyoid bone, other structures of the oral cavity, pharynx, larynx, esophagus. In addition, all functions are controlled by different parts of the brain. In this regard, it is worth considering them together in order to give an accurate assessment of the state of health of the human body.

The method of diagnosing human health perfectly copes with this task when planning and conducting osteopathic functional dental treatment according to the method of Dr. Datsenko.

With this approach, the normal functioning of the body as a whole is one of the main elements of the concept of "health". For all characteristics of the human body (anatomical, physiological, biochemical), average statistical indicators of the norm are calculated. An organism is healthy if the indicators of its functions do not deviate from their known average (normal) state. Fluctuations within the upper and lower limits of the norm are regarded as acceptable.

Accordingly, a deviation from the norm that disrupts the structure of an organ or weakens its functioning can be considered as the development of a disease. For the normal harmonious functioning of the human body, it is necessary to be within the normal range, i.e. in a state of equilibrium (balance), which is the main criterion for evaluating treatment according to the method of Dr. Datsenko and fixing the treatment using the diagnostics of this author.

It should be noted that the prototype also assesses the state of balance of the musculoskeletal system, but this is not enough for a comprehensive analysis of the state of the entire human body, and therefore the result of treatment is not stable and requires constant correction. Due to the insufficient set of all the characteristics of the human body (anatomical, physiological, biochemical), as well as neurohumoral, psycho-emotional, mental processes, social adaptation processes for assessing the state of human health, the prototype cannot be considered integral.

The author is a functional dentist working in holistic dentistry, the purpose of which is to create a psycho-emotional balance, a balance of body functions for active longevity of a person through osteopathic (changing the work of certain organs through changes in the musculoskeletal structure) and dental effects, namely the creation of a balance of cavity organs mouth, skull, spine, feet and psycho-emotional balance.

The objective of the invention is to develop a comprehensive method for diagnosing human health when planning and conducting osteopathic functional dental treatment.

A new technical result of the method developed by Datsenko S.O. is to increase the accuracy of diagnosing human health due to a more complete involvement in the analysis of the health characteristics of the body, not only the data of the musculoskeletal system, but also the assessment of all functions (breathing, swallowing, chewing, speaking, vision, hearing, endocrine regulation, neuro-humoral, psycho-emotional, upright posture, coordination, orientation, speed of thinking, social adaptation) of the body and systems to ensure human life, establishing the relationship of different organs and functions with which they are carried out, as well as comparison of the obtained indicators of diagnostics of human internal organs with the norm to obtain comprehensive information for diagnosis and treatment.

A new technical result is achieved due to the fact that in the method for diagnosing human health when planning and conducting osteopathic functional dental treatment, including the collection of anamnesis, diagnostics of the musculoskeletal system, a comprehensive analysis of the musculoskeletal system, dental examination and impression taking, osteopathic examination, scanning feet in the patient's standing position, if violations in the cranio-mandibular system are detected, therapy is carried out, including osteopathic correction, physiotherapy exercises, impressions are taken and an occlusal splint is made for positioning and centering the lower jaw, in addition, 3D cephalometry is included in the diagnosis of the musculoskeletal system based on CBCT 15*21, MSCT of the head and neck, MRI of the TMJ in closed and open form, MRI of the spine, photo protocol, photometry, video analysis of gait, kinesiological and osteopathic tests, and a comprehensive analysis of the musculoskeletal system up to additionally include anthropometric data, blood and hair tests for microelements, hormones, vitamins, toxic substances, bacteria, helminths, additionally carry out a Luscher color test, a handwriting sample, speech therapy and phonetic tests, which are used to judge the presence of pathology and dysfunction in bones and organs skull, sphenobasilar symphysis, spine, lungs, internal organs, feet, cranio-mandibular disorders, the presence of disorders in the maxillofacial region and their relationship with functional disorders: sucking, swallowing, chewing, speaking, breathing, hearing, vision, upright posture , coordination, speech production, salivation, digestion, endocrine regulation, orientation, neurovegetative regulation, psycho-emotional state, speed of thinking, social adaptation.

Completeness of data collection, their interpretation, the use of a holistic medical approach based on the osteopathic impact on the upper jaw, lower jaw, skull bones, sphenobasilar symphysis (SBS), bones of the spine, feet, internal organs, followed by the use of orthodontic correction based on bone - muscle stimulation with the help of elastopositioners, namely Sodis APF activators (staminolene) and the use of alignment and expansion (enlargement) of the vertical, transverse and sagittal planes in the oral cavity through the reconstruction of the dentition using a composite protocol or (and) neuro-occlusive rehabilitation (NOCR), and also with the use of Planas plates made it possible to identify by the proposed method not the pathology of the teeth, but the pathology of the functions of the internal organs of a person, i.e. improve the accuracy of diagnosing human health.

According to the degree of deviation from osteopathic norms and indicators, the method for diagnosing human health when planning and conducting osteopathic functional dental treatment according to the method of Dr. Datsenko is more complete, because. evaluates all systems, organs, functions of the body and their interrelations, allows for a complete complex treatment, the result of which is stable over time, and also allows you to restore the normal functioning of the human body, according to generally accepted physiological, psychological, osteopathic norms by influencing the dentoalveolar apparatus.

Carrying out diagnostics of human health with a holistic approach to treating a patient from the point of view of osteopathic functional dentistry according to the method of Dr. Datsenko takes place in stages in accordance with a clear protocol for diagnostic manipulations. This diagnosis is carried out based on the concept of a holistic approach. The holistic approach to human health is based on the assertion that teeth are an external reflection of overall health, and any problem in the mouth is a reflection of what is happening in our body. According to holistic medicine proponents, every problem has a cause that lies in how we perceive our lives and affects various systems of the body, including teeth. Holistic doctors claim that each person can mobilize their own inner reserves for healing; to mobilize the free man that exists in him and the power of faith that he is able to heal himself on his own. When the spiritual aspect is balanced and strong, the immune system is also strengthened. Since the belief of holistic doctors is based on the fact that the lack of balance and the problem that exists in a certain part of the body will lead to disease of the whole organism, the goal of holistic dentistry is to preserve the active longevity of the human body by creating a balance of the organs of the mouth, skull, spine, feet, achieving psycho-emotional, functional and structural balance.

The method for diagnosing human health when planning and conducting osteopathic functional dental treatment according to the method of Dr. Datsenko occurs according to the following scheme:

1. collection of anamnesis;

The appearance of the patient, his psycho-emotional stress, his posture, muscle tone, gait, coordination of movements are assessed. From the patient's words, the doctor collects information about what complaints are of concern at the moment, using an extended list of complaints. When filling out the patient's medical history, harmful working and living conditions, bad habits (smoking, alcohol consumption), hereditary factors (hormonal diseases (diabetes mellitus, disorders in the field of sex hormones, thyroid disease, metabolic diseases (obesity, anorexia, etc.) ), previous diseases (diseases of the gastrointestinal tract, neurosis and other diseases of the nervous system), radiation therapy, trauma, duration of the disease, frequency of exacerbation, provoking factors, allergic history (intolerance to drugs, vaccines, food products, previously installed prostheses, orthodontic appliances), and also - the nature of nutrition (regime, regularity, nature of food), whether it is on dispensary records in general, in particular, a dentist (since what time and for what disease).To assess the psychosomatic state, genetic factor, violations of other body functions (chewing , swallowing, breathing, speaking, vision, balance, etc.) before taking p the patient is questioned.

2. diagnostics of the musculoskeletal system;

3D cephalometry based on CBCT (cone beam computed tomography) 15*21

MSCT (multispiral computed tomography) of the head and neck

MRI (magnetic resonance imaging) TMJ in closed and open form

MRI (magnetic resonance imaging) of the spine

Photograph, which consists of two parts. Dental (assessment of the organs of the oral cavity) and postural (assessment of the positions of the body, face).

Photometry is performed in two stages. First, the functional chewing angles of Planas (AFMP angle) on the right and left are determined to determine the side of chewing and balancing sides in laterotrusion. After that, photometry of the eyes is performed.

Video gait analysis

Kinesiology and osteopathic tests

3. complex analysis of the musculoskeletal system;

Anthropometric data is collected (height, weight, body mass index, spirometry, glucose level, cholesterol level, muscle strength in the arms, blood oxygen saturation, heart rate, blood pressure, water, protein, visceral fat, bone mass, basal metabolic rate, determination body age using appropriate instruments Structural components are determined using the MI Body Composition Scale 2 model XMTZC05HM General physical fitness is assessed (running, jump rope, squats, push-ups, pull-ups, abs, back muscles, lower back, balance assessment).

Blood and hair tests are collected for trace elements, hormones, vitamins, toxic substances, bacteria, and helminths.

Additionally, the Luscher color test is carried out, which is a projective technique and is used to measure the psychophysiological state of a person, his stress resistance, activity and communication skills. The idea is based on the fact that color perception is not subjective, but universal, while color preferences are, on the contrary, subjective and able to diagnose the current state of a person. This test is very easy and fast to pass, and at the same time is considered "deep", created for specialists, psychiatrists, psychologists and doctors. Each color carries a certain energy charge, which causes both physiological and psychological effects in a person. The test is easy to perform and reflects the focus of a person on a certain kind of activity, on meeting needs, reflects his functional and psycho-emotional state.

A sample of the patient's handwriting is taken. Handwriting is a characteristic of the neuropsychological status of a person, reflecting many aspects for the study of personality. Handwriting changes indicate changes in the nervous system. In the process of writing text with a pen on paper, many systems of the human body are involved. This process requires the relationship of muscular actions with cognitive abilities and sensory organs responsible for vision and touch. In addition, the correct setting of the brush when writing plays a role. And also noted is the literacy of written speech, the correctness of reading and writing off information by the brain and is part of speech therapy diagnostics. All these parameters change during functional treatment.

During a conversation, teeth, jaws, lips, tongue and neuromuscular system are in constant interaction. Interaction patterns are iterative and measurable. At this moment, speech therapy and phonetic tests are carried out, which are used to judge the presence of pathology and dysfunction in the bones and organs of the skull, sphenobasilar symphysis, spine, lungs, internal organs, feet, cranio-mandibular disorders, the presence of disorders in the maxillofacial region and their relationship with functional disorders: swallowing, chewing, speaking, breathing, hearing, vision, bipedalism, coordination, neurovegetative regulation, psycho-emotional state. Phonetic interactions are determined using phonetic tests - pronouncing the sounds "F" or "V" and "S". The "F"/"V"-test gives an idea of the phonetic incisal ratio (the ratio of the upper central incisors to the lower lip), and the "S"-test shows the protrusion phonetic ratio (the ratio of the upper front teeth to the lower ones).

Functional tests are carried out by video recording of the swallowing process; range of motion in the cervical spine by slowly turning the head to the right, left, forward, backward. Assessment of coordination of movements through squats with open and closed eyes; lifting legs from 90 degrees with arms extended forward with open and closed eyes, followed by video recording. Carrying out kinesiological tests to determine the influence of the dentoalveolar system on the structure and function by means of video recording of movements with an open and closed mouth, arms extended forward with legs raised at the knees 90 degrees (Unterberger (Fukuda) test)

4. dental examination and impression taking;

During a dental examination, the general dental formula is determined. It is found out how regularly, with what and with what frequency the patient performs oral hygiene, whether professional oral hygiene was performed earlier (by what), whether dental treatment (therapeutic, orthopedic, orthodontic, periodontal, implantation) was previously performed, what treatment was carried out, what was achieved effect, what recommendations were given by the doctor earlier; whether the patient followed these recommendations and for how long, if not, then for what reason; whether a general somatic correction was carried out, if so, which doctor, what drugs, what effect was achieved.

Determine if there is pain when opening the mouth and palpation of the temporomandibular joint, analyze articular noise at various periods of mouth opening and closing (at the end of opening and beginning of closing or at the beginning of opening and the end of closing), and whether there is a crunch, clicking, crepitus, sounds of friction of the articular surfaces during the movement of the lower jaw. To determine how freely and to what extent the patient can open his mouth, whether there are deviations of the lower jaw, and also to determine the nature of the movement and displacement of the lower jaw when opening and closing the mouth. To palpate the masticatory muscles (external pterygoid, masticatory proper, temporal muscle): soreness, tightness of the muscles. Conduct a study of pain sensitivity of the skin of the face and oral mucosa in the area of the joint: increased, decreased, unchanged. Are there any pathological processes, with which the patient associates this, the nature of pain, if any, their regularity and frequency.

The patient's dental status is assessed.

Determination of the index of oral hygiene.

Recording the dental formula, examination and description of the mucosa, tongue.

The next step is to take diagnostic impressions. with A-silicone or C-silicone impression materials to obtain maximum accuracy of the oral organs, namely the frenulum, periodontal tissues, gingival sulcus, teeth and dental anatomy, i.e. chewing surfaces of the cutting edges. When casting models, attention is paid to ensure that the entire dental arch of the upper and lower jaw, together with the maxillary tubercle, is presented on diagnostic casts, all frenulums (upper lip, lower lip, tongue) and the architectonics of the palate, palatine suture, palatine folds are displayed as accurately as possible.

5. osteopathic examination;

Osteopathic examination with the identification of disorders in the craniomandibular system (KMC) caused by occlusion, with clenched and relaxed jaws:

- four lines test

- leg length analysis

- stop rotators test

- standing flexion test

- seated flexion test

- oculomotor test

- analysis of the state of the atlanto-occipital joint (COC1)

- diagnosis of the upper cervical spine (С2С3)

- manual diagnosis of the presence of pathological patterns in the skull

- manual diagnosis of the presence of cranial suture dysfunctions

6. scanning of the feet in the standing position of the patient (plantography);

Plantography is performed strictly vertically with closed jaws with the eyes positioned strictly in the horizon (look straight ahead), arms strictly along the body. The position of the body is free (the patient stands as much as possible as convenient for him).

After receiving all the information, they are processed and analyzed by a specialist, by comparison with existing standards. The conclusion is made about the presence of pathology of organs and functions.

After the diagnosis, it may turn out that functional treatment is contraindicated.

Contraindications for starting functional treatment may include:

1. Acute injuries

2. Acute post-stroke and post-infarction conditions

3. Acute postoperative condition

4. The fact of detection of malignant tumors requiring other treatment tactics

5. Exacerbation of psychiatric conditions and diseases

6. Severe status epilepticus

7. Bronchial status in a state of exacerbation

8. Any condition with impaired consciousness (for example, coma, etc.)

During dispensary observation by relevant specialists (neurologists, cardiologists, psychiatrists, oncologists, pulmonologists), a conclusion of specialists is required with a note that there are no contraindications to treatment by a functional dentist.

If functional treatment is not contraindicated, then complex therapy is carried out:

1. Osteopathic, myofunctional, biomechanical, psychological, neuropsychological correction.

2. Consultations of related specialists (if necessary)

3. Professional oral hygiene. Training in cavity hygiene. Selection of hygiene products.

4. Restoration of the integrity of the dentition. Preliminary prosthetics.

5. Functional orthodontic treatment.

Monitoring the implementation of doctor's prescriptions, wearing equipment, performing exercises in accordance with the treatment plan, etc. every 8 weeks.

Taking impressions with assessment of occlusal movement every 8 weeks

Carrying out a photo protocol with an assessment of the skeletal relationships of the maxillary bone, maxillary dentition, HIP-plane and base of the skull, changes in posture, parallelism of skeletal structures every 12 weeks

Carrying out functional tests with an assessment of the functions of the cranio-mandibular system every 24 weeks.

Control of the movement of the occlusal plane every 4 weeks and its correction according to indications.

Interim diagnostics of human health in the process of osteopathic functional dental treatment according to the method of Dr. Datsenko (after about 72 weeks).

6. Final restoration of occlusion. Final prosthetics (if necessary).

7. Carrying out the final diagnosis of human health in the process of osteopathic functional dental treatment according to the method of Dr. Datsenko (after about 144 weeks).

After fixing the final result, a regular visit to the dentist is required for the purpose of a professional examination at intervals of 1 time in 6 months to control the general hygiene of the oral cavity. After achieving balance in the oral cavity, skull, spine, feet, psycho-emotional balance, balance of all functions, as well as normalization of the interconnections of all functions and organs of the human body, it is only necessary to maintain oral hygiene.

As a result of using this technique, the dentist:

1. In addition to dental diagnostics, it also performs diagnostics of the entire musculoskeletal structure, and diagnostics of the most important functions of the human body such as chewing, swallowing, speaking, breathing, walking upright, coordination, vision, hearing, endocrine regulation, neuro-humoral, psycho-emotional, orientation, speed of thinking, social adaptation,

2. Allows assessing the general physical fitness of the patient, assessing the neurological status, endocrine, psycho-emotional status, conducting vitamin and mineral diagnostics of the composition in the body and diagnosing parasites in the patient's body.

3. All the data obtained as a result of this diagnosis allow us to further maintain the general health of the patient, and not separately of any organ, and to carry out treatment and rehabilitation as efficiently as possible for the patient.

4. Avoids errors in determining the central position of the lower jaw, achieving a harmonious position and interaction between the cranio-mandibular structures and the structures of the entire spine as a whole, including the cervical region, which in turn prevents the development of neurological disorders that often occur after dental interventions.

5. Properly defined position of the lower jaw and determination of the correct height of the dentition, alignment of the chewing angles of Planas will allow the dentist to avoid recurrence of the disease, complications in the form of dysfunction of the TMJ, to carry out a complete rehabilitation of the TMJ, chipped crowns, periodontal disease, changing the position of the teeth after orthodontic treatment and also it is an indispensable condition for the prevention of aging, the basis for the cosmetic rehabilitation of all patients by non-surgical and non-infectious methods.

Further, the decision on the presence of pathology is explained by reference to the figures, which show the following:

Fig. 1 - Postural signs of craniomandibular dysfunction

Fig. 2 - Clinical picture with distal occlusion

Fig. 3 - Effect of ascending and descending dysfunction on posture

Fig. 4 - Polygon of forces acting on the spine according to Littlejohn

Fig. 5 - Front unbalance

Fig. 6 - Mobility of the spine

Fig. 7 - The condition of the arch of the foot

Fig. 8 - Definition of tonic asymmetry

Fig. 9 - Classification of the upper respiratory tract according to Mallampati

Fig. 10 - Planas Functional Masticatory Angle (AFMP)

Fig. 11 - The norm of the shape of the dental arch

Fig. 12 - The norm of the location of bone landmarks and the main planes of the skull

Fig. 13 - The norm of the maxillary arch

Fig. 14 - Ideal plane of occlusion

Fig. 15 - Linear position of the upper jaw relative to cranial landmarks

Fig. 16 - HIP plane

Fig. 17 - Parallelism of skeletal structures

Fig. 18 - Occlusal plane

Fig. 19 - Skeletal relationships of the maxillary bone, maxillary dentition, HIP plane and base of the skull

Fig. 20 - Center of convergence of axial loads of teeth

Fig. 21 - Transversal cut of the skull

Fig. 22 - Ideal location of the center of occlusal forces

Fig. 23 - The norm of the location of the occlusal plane

Below is a summary of the relationships between the structure of organs and functions of the human body with the functions and structure of the temporal mandibular joint (TMJ).

On FIG. 1 shows postural signs of craniomandibular dysfunction.

- abnormal ratio of teeth with neutral occlusion - class 1,

- distal occlusion - class 2,

- medial occlusion - class 3.

Easily noticeable signs can be different raising of the eyebrows, curvature of the position of the head, unilaterally raised collarbones.

1. In case of distal occlusion, the line of gravity, especially in the head, cervical-thoracic zone, the head is shifted forward, lumbar lordosis, change in the position of the lumbar vertebrae.

2. In the case of medial occlusion, the line of gravity is in the head, cervical chest area and shoulders, the head is displaced back, the cervical and lumbar sections are in extension.

3. In all cases, limited mobility of the hyoid bone.

4. There is a latent scoliosis.

5. Imbalance of the pelvic region.

6. In case of crossbite, facial asymmetry and scoliosis.

7. In case of open bite, axial dysfunction of the atlas.

Thus, cranio-mandibular dysfunction will always be visible externally on the human body and is associated with the person's posture.

There is a close relationship between the occipito-cervical region, neck muscle tone and TMJ function. The head in the joint occupies a position that guarantees the best occlusion of the teeth.

Banneman demonstrated a change in the position of the spine with an incorrect position of the lower jaw.

Before starting dental treatment, it is important to stabilize the masticatory muscles in order to stabilize the head. In the case of prognathia, with an abnormal position of the body, the bite is too open, the lowered position of the atlas is found in 30% of cases.

In FIG. 2 shows the clinical picture in distal occlusion.

The result of a violation of the position of the teeth is a violation of the functions of speaking, swallowing, digestion, patients experience frequent dizziness, headaches,

neurovegetative symptoms (unreasonable fears, susceptibility to stress, a feeling of tension, a sharp change in pressure, rapid heartbeat, etc.).

In FIG. 3 shows the effect of ascending and descending dysfunction on human posture.

Using the Barr vertical alignment test in the photo protocol, one can judge the presence of TMJ pathology.

1. In the case of ascending dysfunction (pelvis tilted to the side), there is a short leg, lower back pain, dysfunction of the foot, knee, hip joint or pelvis.

2. In the case of downward dysfunction (deviation towards the head, neck), pain in the neck, dysfunction of the collarbone, shoulder, lower jaw, old craniocervical injury, eye and vision disorders are observed.

3. In the case of simultaneous ascending and descending dysfunction, the head and neck are displaced in one direction, the pelvis in the opposite direction.

4. In the case of a compensatory state, any intervention is associated with the risk of decompensation.

5. In the case of fixation of unilateral hypertonicity (the head, upper body and pelvis deviate in the same direction), it can be argued that there are disorders of the central nervous system or disorders of the vestibular apparatus.

On FIG. four shows the polygon of forces acting on the spine according to Littlejohn.

A line runs from the anterior border of the foramen magnum to the coccyx. It is balanced by two lines from the posterior border of the foramen magnum to the acetabulum, and crossing it at T4, creating one triangle above and one below the third rib and T4 (centre of gravity). The functional line connects the symphysis of the lower jaw and the pubic fusion. Triangles create support for the spine and internal organs.

Superior Triangle - Consists of articular structures associated with the foramen magnum and providing a base for the skull, having a point of balance at Th4.

Any imbalance of the hyoid bone and its muscles affects its function, and as a result, the normal functioning of all structures of this triangle is disrupted.

The lower triangle is the maintenance of the function of the abdominal organs by transmitting the rhythmic activity of the chest. To maintain normal tension in the abdominal cavity, the normal position of the pelvis (the base of the triangle) is necessary.

Thus, for the balanced functioning of the body as a whole, the normal functioning of the hyoid bone is necessary. Hyoid bone dysfunction occurs due to disorders in the TMJ.

If viewed from above, then normally the projection of the TMJ on the pelvic bones will form an anterior imbalance according to Busquet Fig. 5

According to Busquet, if the body is strictly vertical, then it will be unstable and risk constantly falling back. Therefore, nature has created anterior destabilization as the most comfortable position that "gives" the body forward movement.

According to Slavichek, the TMJ, the hyoid bone, the clavicular-sternal joint are on the same vertical line - this is the norm (large joints of the body are on the same line).

On FIG. 6 shows normal spinal mobility.

The angle of rotation of the head in the same direction (down-up back (6), right-left (7) and the usual three-dimensional twisting of the entire spine (8) depends on the movements of the lower jaw.

Normally, the tilt of the head to the side (lateral flexion) is 45 ° from the axis of the spine, given that the inclination of the scalene and upper portion of the trapezius muscle is limited.

Turning the head (rotation to the side) - an angle of 90 degrees.

The head should tilt to the right at 70-80 degrees, to the left about 60-70 degrees.

Safe flexion angle (forward tilt) at an angle of 45 degrees, the norm of reaching the collarbone with the chin, a safe extension angle (up to the back) of 90 degrees.

A significant number of fitness club clients complain of pain and discomfort in the area of the thoracic spine. They complain of tightness between the shoulder blades, aching pain in the neck and back, a crunch in the thoracic region. All these complaints indicate insufficient mobility of the thoracic region in 3 planes: horizontal, frontal and sagittal. Normally, according to Kalanji, the thoracic spine should perform the largest amount of rotational movements (approximately 60%), lateral tilts (~30%) and flexion/extension (~10%). If the volume of these movements is insufficient, then the unevenly distributed load goes to the more mobile lower back and neck. And this is directly related to occlusion, so functional dentists must consider the relationship of occlusion with the cervical spine.

- the ratio of the upper and lower jaws is always associated with the static of the neck,

- the occlusal plane (the plane in which the occlusal contacts of the teeth of the upper and lower jaws are located) is parallel to the C2C3 plane (the plane in which the articular surfaces of the 2nd and 3rd cervical vertebrae pass),

- violation of occlusion is always accompanied by changes in the cervical spine.

If we consider a person from the point of view of various theories, then from the point of view of the articular theory, the facets of the teeth interact with each other as articular surfaces. Canines determine the position and freedom of movement of the lower jaw, and the position of the articular process of the lower jaw in the temporomandibular joint determines changes in the atlanto-occipital articulation. If there is no canine guidance or the canines are dystopic, then problems in the cervical spine are predictable. When the position of the bone structures changes, the muscles also change their state and structure, and without work with the muscles, the bone structures cannot independently return to their normal position.

Dysfunction of the cervical vertebrae affects the TMJ through the cervical fascia or the hyoid bone.

Breathing through the mouth, according to Lawrence and Razook, causes the head to extend to create the best passage through the mouth.

The shortening of the muscles of the occiput, resulting from the extension of the head, causes its adaptive protrusion to maintain a horizontal gaze. As a result, hypertension of the occipital muscles and muscles of the back of the neck occurs.

The combination of tilting the head, neck, shoulder girdle also leads to the displacement of the lower jaw back and down due to the tension of the hyoid muscles. This causes compression of the condylar process in the articular cavity of the ANS and an increase in the tone of the masticatory muscles. Lateral flexion with contralateral rotation of the head causes a mandibular shift resembling congenital torticollis.

Dynamic signs of cranio-mandibular dysfunction:

- restriction of rotation of the head from the side of the raised scapula,

- the atlas and the axial vertebra are usually in a position of rotation directed to the side occupying a lower position of the scapula,

- lateral redistribution of weight leads to instability of the lower limb.

Any change in the position of the lower jaw leads to a change in the position of the head on the spine. The articular process of the TMJ and the condyle of the atlantooccipital junction are congruent.

When diagnosing, it is important to assess the condition of the arch of the foot.

On FIG. 7 shows the stop state:

9 - Normal foot

10 - Foot with a high arch (hollow foot)

11 - Hyperpronated (valgus) foot

12 - Flattened foot

13 - Flat-valgus foot

Patients with anomalies of occlusion have a forward tilted head position, retraction of the chest, a change in the angle of the ribs, protrusion of the shoulder blades, protrusion of the abdomen, curvature of the shins, and flat feet.

The reverse trend is also observed: the functional state of the musculoskeletal system determines posture and affects the formation of the musculoskeletal-ligamentous apparatus.

In this case, fixed postural reflexes, caused by bad habits, lead to an incorrect posture of a person and, in turn, contribute to the development of dentoalveolar anomalies.

Anomalies of occlusion (occlusion) can be both a cause and a consequence of disorders of the musculoskeletal system.

Therefore, for the successful correction of malocclusion, it is important not only to return the teeth to the correct position, but also to get rid of problems with the spine, to strengthen the muscles of the whole body.

On FIG. 8 shows the performance of a marching test (Fukuda-Unterberger test). The method of conducting a march test is as follows: the patient closes his eyes, stretches his arms forward and begins to walk in place, raising his knees high. It is enough to take 50 steps. The test is evaluated by the angle of deviation of the patient from the initial position, which normally should not exceed 30-45°. With a unilateral peripheral lesion of the vestibular system, the patient turns towards the affected labyrinth.

With a central lesion of the vestibular system, there will be a pronounced ataxia during marching, deviation in different directions, sometimes a fall or turn in the direction of the pathological process with damage to the cerebellum.

Lack of or backward movement, especially in combination with wide swing, is considered a gross violation. The direction of displacement may indicate lateralization of a peripheral lesion.

It is advisable to supplement the Fukuda-Unterberger test with repeated tests with head turns to the right and left. Under the influence of the occipital reflex in a healthy person, when the head is turned to the right, the tone of his extensor muscles of the right lower limb increases, and the left one decreases. In the test with the head turned to the right, the patient turns around his axis to the left. When the head is turned to the left, the tone of the extensor muscles of the left lower limb increases and the tone of the right lower limb decreases. In the Fukuda test with the head turned to the left, the body turns to the right.

With initially disturbed muscle tone of the postural system, the rotation of the body revealed in the usual Fukuda test is modified accordingly when performing the test with head turns. For example, when a patient performs a head-turn test to the right, they turn more to the left than when their head was in a neutral position.

The difference between the angles of rotation around the axis (or back) observed at the end of the test with the head in a neutral position and when the head is turned expresses the integral “gain” of the occipital reflex (right or left). Comparison of these two "wins" reveals the advantage of "winning" to the right or to the left.

In FIG. 9 shows the classification of the upper respiratory tract, carried out according to the method of Mallampati. The test is based on visualization of the pharyngeal structures with the patient's mouth fully open. The person sits opposite the doctor so that his mouth is at eye level with the doctor. The patient opens the mouth as wide as possible while sticking out the tongue as much as possible. By visualizing the visible structures, a class is determined. All four classes are the norm, everything that deviates from the norm is a pathology. This can be the disposition of the uvula (tilt to the right or left), changes in the soft and (or) hard palate, etc. In the course of treatment, due to functional treatment, the patient achieves one of the types of visualization, according to the Mallampati classification.

Normally, a healthy person should chew evenly on both sides of the dentition, i.e. give the same load on the left and right side. According to Professor Vincenzo de Cicco, if chewing occurs only on one side, then only one hemisphere of the brain is active, which contributes to the formation of an imbalance. Chewing uniformity is measured using Planas Functional Chewing Angles (AFMP) of FIG. ten

This is the angle in the horizontal plane, formed during the lateral displacement of the lower jaw (to the right, to the left), occurs during interdental contact 31-41.

Normally, the free movement of the lower jaw in the horizontal plane is fixed; achievement of bilateral equivalence of the functional chewing angle of Planas; achieving maximum contact during horizontal jaw movements.

The Planas angle is 15-20° with the growth of milk teeth; decreases until the age of 6 years; increases during the appearance of permanent teeth; decreases to 0° by 65-70 years; the equivalence of the angle on both sides means a two-sided chewing process; in case of unequal angle, chewing occurs on the side with a smaller angle.

In FIG. 11 shows the shape and location of the upper dental arch relative to the base of the skull. They also affect how the occlusal forces are directed. The direction of forces affects the areas of attachment of the dura mater, the circulation of cerebrospinal fluid, the articulatory movements of the bones of the skull, the craniosacral mechanism, the brain and other structures of the central nervous system, and symmetrically balanced force vectors. If the maxillary dental arch is well developed and has the correct symmetrical shape, the vectors of forces developed by the teeth as a result of the contraction of the masticatory muscles are symmetrically and balancedly directed to the center of the skull (the region of the base of the skull). This ensures that the bones of the skull support the cranial respiratory mechanism. A balanced load enhances the movement of the bones of the skull, thereby creating harmony in all structures of the central nervous system, including the brain and the craniosacral mechanism. If the maxillary arch is narrowed and has an irregular shape, the occlusal force vectors are not symmetrical and pass by the region of the base of the skull. This leads to incorrect transfer of the load through the cranial sutures, which slows down the cranial movements, thereby negatively affecting the brain, the craniosacral mechanism and other parts of the central nervous system. Incorrect occlusal contacts develop abnormal forces, causing a kind of blockage of the cranial sutures, which is expressed in a decrease or restriction of the normal cranial respiratory mechanism. If the dental arch has an asymmetric shape, then the forces applied to the dura mater are also asymmetric. This causes sheath stress. Disturbance of articulation of the bones of the skull leads to distortion, or twisting of the dura mater. Since the dura mater is a continuation of the spinal cord, the twisting of the membrane is observed along the entire length of the spinal cord. As a result, compensatory mechanisms and/or neurological disorders develop in other parts of the body.

The ideal result of the treatment of dentoalveolar deformities is the formation of such jaw arches, which in size and shape would resemble those of a “primitive” person. However, true expansion cannot be achieved if the bones of the skull are already formed. Orthodontists, however, are trying to change the size and shape of the dental arches in order to even come close to "perfect symmetry".

Normally, the jaw arches should be wide, symmetrical, should provide adequate positioning of all teeth, normal position of the tongue, adequate lip closure, and physiological cranial movement. The shape of the dental arch, determined by the shape of the jaw arch, should correspond to the shape of the skull.

Factors preventing the formation of a normal jaw arch:

- Incorrect tongue position (e.g. tongue pressure)

- Incorrect habitual position during sleep (on one side or with a hand under the cheek)

- Narrowed airway volume (obstruction, mouth breathing)

- Bad habits (thumb sucking)

- Birth trauma (use of forceps during childbirth)

- Impaired cranial movement (with deformities of the upper jaw)

- Congenital anomalies (cleft palate)

- Injuries

- Diseases

- Incorrect location of the maxillary complex in relation to the base of the skull and the horizontal relative plane.

In FIG. 12 shows the norm of the location of bone landmarks and the main planes of the skull. The main horizontal plane of the skull is the HIP-plane (Hamulus - Incisive Papilla / uncinate process - interincisive papilla), the reference points of which are the incisal foramen and pterygomaxillary notches (bone landmarks of the base of the skull). There is a close relationship between the occlusal plane, the horizontal plane and the HIP plane. The HIP plane is the most reliable reference among the horizontal planes. This is the most accurate landmark because it is tied to bony structures (maxilla, palatine, and sphenoid bones) rather than soft tissue structures of the face (such as the ala of the nose or tragus). The figure shows the main planes - landmarks and their relationship with the bones of the base of the skull.

These soft tissue landmarks are strongly associated with bone landmarks (incisal foramen and bone pterygomaxillary notches). The ideal plane of occlusion should be parallel to the plane through the pterygomandibular notches and incisal foramen, as well as the plane through the Porion points and the anterior nasal spine.

Orthocranial occlusion can be said if the occlusal plane is orthogonal to the masticatory forces. The nature of the occlusion is determined by the size, shape and location of the articular fossae, the upper and lower jaws, the movements of the masticatory muscles, the work of the TMJ, as well as the location of the teeth in the dentition of Fig. 13 In orthocranial occlusion, the occlusal plane is parallel to the HIP plane, occlusal forces are balanced along the entire occlusal plane, as well as in the space of the skull; the right and left sides of the upper and lower jaws and the articular fossae are symmetrical and are located on the same level; the work of masticatory muscles and TMJ is coordinated. Cranial means "pertaining to the skull or cranial". Ortho means "straight or regular, perpendicular or at right angles, correcting irregularities and deformities" 2S The approach to dental treatment has for many years been based on the axiomatic assertion that the lower jaw is a more important bone than the upper and that it forms the basis of occlusion. For a long time, the generally accepted standard was the use of the Camper, Frankfurt and hinge-orbital planes as reference points (the facial arch was installed parallel to the latter), as well as the transversal hinge axis passing through the centers of the articular heads. Some dentists, however, have come to the conclusion that the maxilla is fundamental and that the generally accepted horizontal planes of reference are not horizontal; that the lower jaw does not rotate around the hinge axis; and that aligning the facebow with the AOA is pointless. The theory of orthocranial occlusion is based on the following principles: The maxillary arch is the basis of the stomatognathic system. The base of the skull (sphenoid-occipital or sphenobasilar synchondrosis) is the most important anatomical landmark of the skull. This is the junction of the sphenoid and occipital bones. Through the pterygoid processes of the sphenoid bone, by means of a suture, the base of the skull is connected with the palatine bones, and through them with the upper jaw.

The dental arch of the upper jaw and articular fossae form the basis of occlusion. The maxillary dental arch (Fig. 13), together with the articular fossae, are fixed structures, while the lower jaw is a mobile component of the stomatognathic system. The upper jaw is a reliable reference point for the analysis and preparation of a treatment plan for disorders in the system. In order to achieve the best results of treatment, reliable guidelines are needed at the diagnostic stage and during the treatment process. As the main component of the dentition, the upper jaw has a great influence on the spatial arrangement, shape and function of the bones of the skull, in particular, the bones of the base of the skull. It, in turn, is influenced by adjacent structures, such as the sphenoid bone. Curvature or any other deformities of the maxillary arch affect the functioning of the craniosacral mechanism.

The ideal location of the occlusal plane and maxillary structures is shown in Fig. 14. The concept of the occlusal plane is associated with the maxillary bone. On the undeformed skull in the lateral projection, it can be seen that the occlusal plane is parallel to the plane passing through the pterygomaxillary notches and the incisive foramen, i.e. HIP plane. The pterygomaxillary notches are located in the area of the connection of the plates of the pterygoid processes of the sphenoid bone with the palatine bones. The incisal opening is located in the anterior part of the maxillary arch along the midsagittal line. Note that the Porion - ANS plane can also be used as a reference when analyzing the location of the occlusal plane and maxillary bone structures.

The ideal plane of occlusion should be even and symmetrical. If you look at the undeformed skull from behind, you can see that the line passing through the tops of the articular tubercles of the temporal bones, as well as the line passing through the pterygomaxillary notches, and the occlusal plane are straight lines parallel to each other. The ideal plane of occlusion should be parallel to the indicated planes on either side of the midsagittal line. If you look at the undeformed skull from below, you can note the symmetry of the occlusal plane with respect to the line passing through the pterygomandibular notches, the line passing through the articular fossae, and the median line of the upper jaw.

If we consider the upper jaw as a 3D object, then its spatial location relative to other 3D objects or bone landmarks can be described, firstly, as a linear distance to the object / landmark, and, secondly, as an axial displacement or reversal relative to it. The linear position of the maxilla relative to cranial landmarks - for example, the sphenoid bone (Hp), the base of the skull (SO) and the temporal bone (Po) - is described in 3 planes: midsagittal, transversal and horizontal Fig. 15. Linear distances include: vertical (14), anterior-posterior (15), medio-lateral (16).

The upper jaw is also in a certain axial position relative to these planes. The axial/rotational positions include: anterior-posterior axial (turn in the transverse axis) (17); medio-lateral axial (turn in the longitudinal axis) (18); latero-rotational (turn in the vertical axis) (19).

To maintain homeostasis in the stomatognathic system, it is necessary that the ratio of the jaws to each other and their location relative to the rest of the bones of the skull favor the harmonious functioning of the neuromuscular system and the craniosacral mechanism. Sphenobasilar synchondrosis is considered the base of the skull. This is the junction of the sphenoid and occipital bones. This is a key landmark of the skull. The skull is stable. The micromovement of the bones of the skull does not count, since the amplitude of movements in this case is negligible 8 '. Since the maxilla is connected to the sphenoid bone, its location relative to the sphenoid bone is reasonable to use as a basis for functional diagnosis and analysis. Just as the sphenobasilar synchondrosis is the main cranial landmark, the maxilla is the basis of the stomatognathic system. Dentists should consider the upper dentition as the basis of occlusion, since its location relative to all bone landmarks is strictly constant.

The main reference point for determining the position of the maxillary bone is the HIP plane (Fig. 16). The HIP plane corresponds to the base of the skull in 6 projections.

Parallelism of skeletal structures (Fig. 17) is the key to the harmony of the neuromuscular system. The harmony and homeostasis of the neuromuscular system is due to symmetry. Paired parts of the body must be symmetrical and located at the same level relative to the horizontal plane, which is perpendicular to the gravitational force. If the skeleton frame is parallel to the gravitational force, then the system is balanced. Incorrect arrangement of a particular structure leads to tension, with the help of which the neuromuscular system seeks to maintain the body in a straight position. In a healthy body, the lines connecting the symmetrical points of the skeleton should be parallel to each other at all levels, such as: base of the skull, occlusal plane, cervical spine, shoulder girdle, thoracic region, lumbar region, pelvic girdle, knee joints, ankles and foot bones. If the lines connecting the symmetrical parts of the body are parallel, then they are simultaneously perpendicular to the direction of the gravitational force. In the absence of symmetry, functional disharmony and overstrain of the neuromuscular system are observed. It must be realized that chronic structural disharmony of symmetrical areas of the body can lead to disharmony in the stomatognathic system, and vice versa. In a healthy body, the planes connecting the symmetrical parts of the body are parallel to each other (or close to them) and perpendicular to the direction of the gravitational force.

The main part of the chewing load is created by the reduction of M. Masseter, M. Pterygoideus medialis and M. Temporalis. For a balanced functioning of the stomatognathic system, the occlusal plane, defined by the HIP plane, must be perpendicular to the occlusal load vector (Fig. 18). Occlusal forces are balanced along the occlusal plane if they are perpendicular to it. They affect teeth, periodontium, mucosa, TMJ, cranio-sacral mechanism and head and neck muscle function. I believe that they also have an effect on the neuromuscular system of the whole organism. Axiom: “If a mass acts on a surface perpendicular to the plane of motion, the counteraction vector is equal to the force of the impact, and vice versa. If the surface is not perpendicular to the plane of the direction of movement, then the angle of incidence is equal to the angle of reflection" at a right angle to the occlusal forces. If the first part of this axiom is applied to the dentition and the occlusal plane, then under the described conditions, the masticatory efficiency will be maximum, and the detrimental angular occlusal load affecting the teeth and periodontium will be minimal.

The skeletal relationships of the maxillary bone, maxillary dentition, HIP plane, and skull base are shown in FIG. 19 The interincisal papilla covering the incisal foramen, which is located on the lower surface of the palatine process of the maxillary bone along the midline, is the anterior point of the HIP plane. The posterior points are the pterygomaxillary notches located upward from the palatine bones in the area of the connection of the anterior lower parts of the plates of the pterygoid processes of the sphenoid bone with the palatine bones. The sphenoid bone is also connected to the occipital bone, forming a sphenobasilar synchondrosis and thus forming. base of skull. The occlusal plane, which is for the most part parallel to the HIP plane, and with it the maxilla is connected to the base of the skull by pterygomandibular notches. The base of the skull is the most important structure used as a key landmark in the AccuLiner system. The pterygomandibular notches and the interincisal papilla are precise landmarks that can be easily found by both the dentist and the dental technician. Using them, you can accurately transfer the spatial arrangement of the upper jaw to the articulator. The sphenoid bone, which is the main bone of the skull, together with the AccuLiner articulator, constitutes a kind of basis for navigation in the stomatognathic system. (See Methodological recommendations for the AccuLiner system for more details). Thus, clinicians now have a reliable tool for a scientifically based and validated approach to the diagnosis and treatment of occlusal disorders, TMJ pathology and muscular dysfunctions of the stomatognathic system.

The line formed by the intersection of the transversal and midsagittal planes is called the structural axis of the maxillary complex. On this axis - at a distance of about 10 cm from the plane of occlusion - there is a glabella. This is the structural center of convergence of axial loads of the teeth of the upper and lower jaws (Fig. 20). The inclination of the upper teeth and lower chewing teeth is such that their central axes converge in the structural center. The structural center of convergence of axial loads (the structural center of "dental masses") is geometrically the top of the cone, the base of which is the occlusal plane and is called dental.

To assess the location of the occlusal plane, a transversal cut of the skull can be used (Fig. 21). With an orthogonal position of the occlusal plane relative to the occlusal forces, the load is evenly transferred along the maxillary and temporal bones to the rest of the bones of the skull.

The occlusal forces developed during chewing, swallowing, clenching of teeth, etc., are transmitted from the lower jaw to the temporal bones, and through the maxillary and palatine bones to the rest of the bones of the skull. Ideally (Fig. 22) the occlusal forces are at an angle of 8°-10° to the HIP plane. Zicher notes that occlusal forces come from the alveolar process along the canine, zygomatic and pterygoid buttresses to the base of the skull. Their trajectories go around the maxillary sinuses, nasal cavity and eye sockets. “The swallowing reflex causes the dentition to close and the tongue to rise towards the hard palate. The vertical pressure of the tongue on the hard palate is transmitted through the maxillary and palatine bones, as well as through the vomer to the sphenoid bone. This force vector takes part in spheno-basilar flexion, providing an adequate range of motion.” On a normal, undeformed skull, the center of occlusal forces is located on the occlusal plane at the projection point of the contact points between the second premolars and first molars on the midsagittal axis.

In a healthy body, the occlusal plane should be perpendicular to the gravitational force and parallel to the lines connecting the symmetrical parts of the body (Fig. 23). The biomechanics of the head, neck, and craniomandibular system play an important role in maintaining perfect structural symmetry in the body. There is an interdependence between the location of the maxilla and mandible, the plane of occlusion, and the general arrangement of symmetrical body structures. If the occlusal plane, maxilla and mandible are in the correct position, there is a high probability of maintaining the correct position of the head in space. In a healthy body, the planes connecting the symmetrical parts of the skeleton should be parallel to each other and perpendicular to the direction of the gravitational force. If so, then the skeletal system is in a state of balance. The bony framework is most stable when the vertical axis passes through the external auditory meatus, the head of the humerus, the head of the femur, and the lateral malleolus. In this case, the external occipital protrusion is in line with the second sacral vertebra. On this vertical line is the center of mass of the body. In a generalized version, the center of mass of an upright person is located in the upper sacral part of the pelvis - just above the middle of the distance from the soles of the feet to the top of the head. Optimal stability of the sacroiliac joint occurs when the gravity axis of the body is located slightly posterior to the acetabulum (the articular fossa in which the head of the femur is located), as already discussed when considering the anterior imbalance according to Busque (Fig. 5). This turns the acetabulum into the center of rotation of the ilium. Structurally, the pelvis is the basis of the skeleton, providing movement of the body. The sacroiliac joint bears the greatest load in the entire body. The pelvis consists of the sacrum and 2 iliac bones. The muscles of the lower torso (legs and feet) and the upper torso (torso, neck and head) either attach to the pelvis or indirectly affect its stability. Travell described the "paraspinal muscles" as a group of muscles running from the mastoid process of the temporal bone and cervical vertebrae to the sacrum and ilium of the pelvis. Body platform, i.e. feet and ankles - one of the 3 main elements of the body frame. The other two are the sacrum and, surprisingly, the mouth (upper and lower jaws and the occlusal plane). Not so long ago, the craniosacral system was introduced into the rank of the physiological systems of the body. It has its own physiological rhythm. Functionally, it is closely related to the central nervous system, autonomic nervous, neuromuscular-skeletal and endocrine systems. Its boundaries are formed by the membranes of the brain, mainly by the dura mater. The dura mater and its attachments determine the functional abilities of the craniosacral mechanism. The dura mater is attached to the bones of the skull. When leaving the foramen magnum, the dura becomes the sheath of the spinal cord. Here it is attached to the first cervical vertebra, sacrum and coccyx. During cranial breathing, the sphenoid and occipital bones interact with each other in the area of synchondrosis, creating a pumping motion. This occurs in parallel with the movements of the sacrum, which promote the movement of cerebrospinal fluid along the spinal cord and brain. This movement is a vital mechanism. Any deformation at the level of the sacrum will adversely affect the work of the sphenobasilar mechanism. Accordingly, disturbances in the sphenobasilar mechanism will affect the location of the sacrum and hence the pelvis. Fonder, Makofsky, Rokabado and other researchers came to the conclusion that the position of the jaw affects the spatial position of the head, and this, in turn, affects the location of other body structures. Liley proved that the body is constantly adapting, changing the position of structures in such a way that the head always finds itself in the correct position relative to the true horizontal. It is because of this relationship of structures that the location of the upper and lower dental arches, as well as the occlusal plane, is so important for the optimal functioning of the body. It affects the structural arrangement of sphenobasilar synchondrosis, the bones of the skull, the dura mater, the cervical vertebrae, and the pelvis, which largely determines the location and symmetry of the lower extremities: legs, knees, ankles, and feet.

Thus, it becomes clear that the location of the maxilla and mandible and the occlusal plane has a direct impact on the neuro-musculoskeletal system, the craniosacral mechanism, the central nervous system and the autonomic nervous system.

The following is a clinical example demonstrating the results of diagnosing human health when planning and conducting osteopathic functional dental treatment, according to the proposed method.

Example #1. Patient D., 9 years old.

1. collection of anamnesis;

The patient looks distracted, his gaze is dispersed, his mouth is half open, muscle tone is reduced, his eyes are half closed with an overhanging upper eyelid, the gait is lethargic, uncoordinated (with a bias to the right side), coordination is preserved.

Expresses complaints about a constantly open mouth, uneven teeth, chewing disorder, restless sleep, white-blue skin tone, bruises under the eyes, the child intercepts air with his mouth, takes deep breaths, but not exhaling enough, feeling that he is suffocating, does not breathe through his nose, has a restless sleep, kyphoscoliosis, flat feet, allergic reactions, including flowering, nocturnal enuresis, emotional excitability, mood swings.

Previously, he was examined by a pediatrician and an endocrinologist for cyanosis under the eyes, poor performance at school, no problems were identified, except for a violation of posture. The food is full, varied, the appetite is selective, he chews badly, swallows in pieces, he is under dispensary registration for rehabilitation by an orthopedist-traumatologist in the center of Dikul 3 times a week (about 2 years). Swimming 2 times a week. There are no dynamics, the child is limping on the right side, the blockage of the body on the right side. Kinesiology correction (about 1 year). It is noted, despite classes with a private speech therapist and a speech therapist at school, the non-pronunciation of the letter R. The speech therapist makes a diagnosis of burr.

Functional dental treatment has not been previously carried out, they applied to correct scoliosis, flat feet, allergies, restore breathing and chewing function.

Information was taken from the patient's questionnaire that the pregnancy proceeded without complications (at 7 months, the mother was on preservation, the diagnosis was that the uterus was in good shape, she was in the hospital for 10 days), during pregnancy, the mother regularly went in for swimming, often walked, was born at term, breastfeeding up to 15 months, impaired type of swallowing, difficulty in nasal breathing, incorrect orientation of the head and body in space, a pronounced tilt to the right. The infantile type of swallowing, oral type of breathing predominates, there are signs of a violation of the function of speaking (burr, dyslexia), the child's body collapses to the left.

He is under dispensary observation by a neurologist for neurosis-like enuresis, atopic dermatitis from the age of 3, a diet is prescribed, food allergies to eggs, milk, soy. He is under dispensary observation by an orthopedist, the diagnosis is S-shaped kyphoscoliosis of the thoracolumbar region. She regularly goes in for swimming, due to a violation of posture in the center of Dikul. There are no speakers. Phimosis, surgical intervention was performed.

2. diagnostics of the musculoskeletal system

A native high-resolution MSCT study of the brain, cerebral skull with a primary collimation of 64 × 0.6 mm, a thickness of reformatted sections of 1.0-5.0 mm was performed, followed by a three-dimensional analysis of images in MPR and VRT reconstructions. Rough bone pathology of the brain and facial skull was not revealed. The structure of the supra- and infratentorial parts of the brain corresponds to age. Differentiation into gray and white matter is distinct. Densitometric indicators of gray and white matter are within normal limits. The lateral ventricles are symmetrical, not dilated (up to 4.5 mm wide), the third ventricle is up to 3.5 mm wide, the fourth is not deformed, of normal size. Basal cisterns are not changed. Sylviian fissures can be traced on both sides. Subarachnoid spaces are clearly visualized, not expanded. No pathological densitometry zones were found in the region of the cerebellopontine angles and internal auditory canals. The craniovertebral transition is not changed. The cerebellar tonsils are located at the level of the margin of the foramen magnum.

A native high-resolution MSCT study of the cervical spine was performed with a primary collimation of 64 × 0.6 mm, a thickness of reformatted sections of 1.0-5.0 mm, and subsequent three-dimensional image analysis in MPR and VRT reconstructions. Cervical lordosis in the supine position is preserved. No pronounced deviation of the axis of the spinal column to the coronal plane was detected. The ratio of anatomical structures in the atlanto-occipital joints is not disturbed. There is a moderate asymmetry of the lateral atlantoaxial joints: the width on the right is 6 mm, on the left is 2.5 mm (probably, styling features). The lateral atlanto-axial articulations are moderately sclerotic. The vertebral bodies are of regular shape, with wavy contours. The bone structure of the vertebrae is homogeneous, osteolytic, osteoblastic changes are not determined. The endplates of the vertebrae are uneven, their integrity is not changed. Articular gaps of facet joints of uniform width, endplates with even contours. Uncovertebral articulations of the usual structure. The intervertebral foramina are clearly visualized, not narrowed on both sides. The openings of the canals of the vertebral arteries can be traced on both sides, without gross deformation and narrowing. Intervertebral discs of uniform height. Paravertebral soft tissues of a homogeneous structure, not thickened, do not contain pathological densitometry fields. Focal pathology of the brain, brain skull, cervical spine was not revealed.

Airway volume based on 3D cephalometry is insufficient. There is a pronounced narrowing of the airway lumen (at a rate of 250-600 mm2. in a patient 250-150 mm2).

A study of cone-beam computed tomography of the temporomandibular joints in the position of habitual bite (closed mouth) was carried out.

On the visible extent of the bone-traumatic, destructive changes were not detected.

The dimensions of the articular heads of the lower jaw, the articular fossae of the temporal bones are symmetrical on both sides.

Right temporomandibular joint:

The articular head of the lower jaw is of normal shape and size, structurally unchanged. The cortical layer is even, clear; marginal osteophytes are not visualized.

In the articular fossa of the temporal bone, the head of the lower jaw is displaced anteriorly (mesially). The width of the joint space in the anterior section is narrowed and is 1.9 mm (the average age norm is 2.7+-0.3 mm). In the upper section, the joint space is 3.0 mm (the average age norm is 3.2+-0.5 mm). In the posterior section, the width of the joint space is within the normal range of 2.4 mm (the average is 2.7+-0.3 mm). The width of the joint space in the frontal plane is uniform, no displacement of the articular head in the transverse direction was detected.

Articular fossa of the temporal bone of the usual shape and size. The cortical layer of the articular surface of the temporal bone is even, clear, of normal thickness.

Left temporomandibular joint:

The articular head of the mandible is moderately flattened in the anterior section, there is a sharpening of the anterior lower contour of the articular surface. The dimensions and structure of the articular head are not changed. The cortical layer is even, clear, of normal thickness.

In the articular fossa of the temporal bone, the head of the lower jaw is displaced anteriorly. The width of the joint space in the anterior section is 1.7 mm (normal average is 2.7+-0.3 mm). In the upper section, the width of the joint space is 3.4 mm (the norm is on average 3.2 + -0.5 mm). In the posterior section, the width of the joint space is slightly narrowed and is 2.2 mm (normal average 2.7+-0.3 mm). The width of the joint space in the frontal plane is uniform, no displacement of the articular head in the transverse direction was detected.

Articular fossa of the temporal bone of the usual shape and size. The cortical layer of the articular surface is even, clear.

The functional chewing angles of Planas (AFMP angle) are uniform on the right and left, the chewing side is right and the balancing side is right with laterotrusion.

According to the ORTHPG image, the bite is interchangeable. All rudiments of permanent teeth are present. Crowding of teeth in the upper and lower jaws. Inflammatory, infectious processes on the teeth and bones were not found. The Spee curve is slightly pronounced. The width of the branches on the right is 37 mm, on the left 37 mm, which indicates the absence of obvious dominants in structure and function.

According to Sassouni TWG. Tendency towards skeletal class 2. An increase in the vertical proportions of the lower third of the face (skeletal open bite). Retrusion of the upper incisors. Retrusion of the upper incisors. Trend towards vertical type of growth. Indication for extrusion mechanics. Clockwise rotation of the HF (retroinclination of the HF). HF long back. Underdevelopment of the chin. Retroposition of the LF with a normal chin size. The bass is long at the back with a normal chin size.

TRG on other authors.

Conclusion according to Steiner: Angle ANB=6/84° (distal occlusion). Retrusion of the upper incisors relative to the NA line by 8.61°. Protrusion of the lower incisors relative to the NB line by 3.17°. The interincisal angle is reduced by 6.36° (biprotrusion). Increased inclination of the occlusal plane (clockwise rotation) relative to the anterior cranial fossa by 6.56°.

Conclusion according to Schwarz: Decreased the slope of the NSn line relative to the Frankfurt horizontal by 12.25°. The slope of the NSn line relative to the base of the upper jaw is reduced by 9.51°. Convex type of face profile. On the left, the length of the body of the lower jaw is reduced by 2.16 mm; on the right, it is reduced by 6.03 mm. The length of the body of the upper jaw was increased by 2.44 mm. On the left, the length of the lower jaw branch is reduced by 6.65 mm, on the right, by 8.7 mm. The inclination of the upper incisors relative to the body of the upper jaw was reduced by 3.02°. The interincisal angle is reduced by 7.34° (biprotrusion). Retroposition of the lower jaw relative to the upper (ANS-PNS - A-B) at 14.56°.

Conclusion according to McNamara: Convex type of face profile. Reducing the inclination of the occlusal plane relative to the body of the lower jaw by 3.8° (horizontal type of growth). Reduction of the facial axis (vertical type of growth) by 3.55°. The posterior position of the chin relative to the vector N by 6.1 mm. Retrusion of the lower incisors relative to the A-Pog line by 11.04 mm. Retrusion of the upper incisors relative to vector A by 6.83 mm.

Conclusion according to Ricketts: Reducing the length of the anterior cranial fossa by 5.92 mm. Reducing the length of the posterior face height by 13.87 mm. The anterior position of the external auditory canals relative to the PTV line is 2.07 mm. Decreasing the face depth angle (N-Pog - to the Frankfurt horizontal) by 4.13°. Reduction of the facial axis (horizontal type of growth) by 3.18°. Increasing the inclination of the body of the lower jaw (rotation clockwise) relative to the Frankfurt horizontal by 2.25°. Reducing the length of the lower jaw (Xi-Pm) by 4.45 mm. Retrusion of the upper incisors relative to the Frankfurt horizontal at 17.18°. Retrusion of the lower incisors relative to the A-Pog line by 2.29° Overjet 3.52 mm. Overbite 0.52mm. The distance between the upper lip to the E-line is -1.1 mm, the lower lip +2.42 mm (positive lip).

Kim conclusion: Combination Factor increased by 18.84°. (APDI increased by 16.24° mesial(?) occlusion). The distance between the upper lip to the E-line is -1.1 mm, the lower lip +2.42 mm (positive lip).

Conclusion according to Jarabak: Reducing the length of the anterior cranial fossa by 4.92 mm. Shortening of the body of the lower jaw by 11.9 mm. Retroposition of the lower jaw at 2.59°. Angle ANB=6.77°. Reducing the depth of the face by 10.93 mm. Posterior position of the chin at 8.21° relative to the base of the skull. Shortening of the posterior and anterior face height. Index PFH / AFH 64% - the norm. Posterior position of the chin relative to the upper jaw (Pog-A - A-N) at 4.81°.

Conclusion according to Downs: Increasing the inclination of the body of the mandible (rotation clockwise) relative to the Frankfurt horizontal by 2.25°. Posterior position of the chin, relative to the anterior cranial fossa at 4.51°.

Conclusion according to Slavicek: Increase in the facial axis by 4.18°. Decreased facial depth by 3.73°. Mandibular arch reduction (Xi-PM - Xi-DC) by 3.15°. The anteposition of the upper jaw relative to the N-Pog line is 5.16 mm. Lower face height increased by 3.67°. Protrusion of the lower incisors relative to the A-Pog line by 3.0 mm, and 1.71°. The anterior position of the upper molars relative to the RTU line is 16.58 mm. Occlusial plane-Axis orbital plane (Slavicek) 25.6°. Idealized Occlusial plane-Axis orbital plane 19.99°. The distance from the center of rotation of the joint to the occlusal plane is reduced by 18.91 mm.

A dental and postural photo protocol was carried out.

Video recording of the gait revealed a blockage on the right side. There is a large roll, balance is not maintained, the patient falls to the right side.

3. comprehensive analysis of the musculoskeletal system

The following data were collected: height, weight, body mass index, spirometry, glucose level, cholesterol level, arm muscle strength, blood oxygen saturation, heart rate, blood pressure, water level, protein, visceral fat, bone mass, basal metabolic rate, age determination body) with appropriate instruments. Structural components were determined using the MI Body Composition Scale 2, model XMTZC05HM. An assessment of general physical fitness (running, jump rope, squats, push-ups, pull-ups, abs, back muscles, lower back, balance assessment) was carried out.

The weight of the child at a norm of 25.6-31.5 is 5.5 kg higher than the upper norm. Growth is also ahead of the norm from 125-136 by 5 cm. In this connection, the child experiences spinal pressure with overweight. Moreover, the data obtained using weights showed the division into structural elements as follows: water, protein metabolism is normal, fat mass is much lower than normal, only 6.8%, basal metabolism is normal and amounts to 1295 Kcal per day, visceral fat and bone mass normal, Lung volume is slightly above normal, while oxygen saturation is at the lower limit of the normal limit. The strength of the muscles in the arms is not enough. General physical development is average and below the norm. Running at the norm when running 30 meters in 6.8 seconds. at the lower limit of the norm 6.2 sec. Rope 70 jumps, corresponds to the lower norm. Squats 41 times per minute at the lower rate of 40, the upper 44 times. Push-up 6, with a lower limit of 10, which confirms the lack of strength in the hands. Press 25, at a rate of 23-28, which indicates the average development of the muscles of the back and lower back. Balance test failed, child leans body to the right. In addition, after the delivery of KLA, OAM, vitamins of group B. Vitamin D, a deficiency of vitamin D was detected.

Based on the Luscher test, increased anxiety, variability in actions, behaviors, interpretations, psycho-emotional instability, tearfulness, capriciousness were revealed.

The handwriting does not have a pronounced slope. There are no connecting lines between vowels at the junctions of vowels with consonants. The letters do not have a distinct form, the letters are not on the same level, they are either above or below the line, the outlined line of the letter. The handwriting is not stable. There are shifts from left to right.

4. dental examination and impression taking;

On the basis of a dental examination, the face is relatively symmetrical and proportional, the chin is shifted to the right relative to the midline of the face, the nasal passages are collapsed, there is significant cyanosis under the eyes on the right and left, a pronounced tilt of the head to the left, the profile is convex, hidden open bite.

The general dental formula is determined. Professional oral hygiene was not carried out, no one taught hygiene, the level of hygiene is low. She has been visiting the dentist regularly since early childhood. Multiple caries, decompensated form. Previously sanitized.

Pain when opening the mouth is not observed, palpation of the temporomandibular joint is painless. The mouth opens freely, the height of the mouth opening is 48.7 mm. There is a zigzag movement of the jaw and deviation of the lower jaw with a shift to the left, as well as hypertonicity of the lower jaw on the right when opening and closing the mouth. On palpation of the masticatory muscles (external pterygoid, actually chewing, temporal muscles), pain, muscle compaction is not observed. Pain sensitivity of the skin of the face and oral mucosa in the area of the joint is not changed. Pathological processes, with which the patient associates this, the nature of pain, if any, their regularity and frequency.

The index of oral hygiene according to the formula Fedorov Yu.A. - Volodkina V.V. KPU+kp=13, IG satisfactory.

Based on the impressions taken, the patient has a hidden open bite, a deflection in the premolars on the left and right, more pronounced on the left, roll-tilt of the upper jaw to the left. The level of the necks of the lower jaw on the left is much lower than on the right. The sublingual space is uniform on the right and left with a tilt to the left, a tendency to the Gothic palate, the premaxilla is not developed, the effect of a stool in the anterior part of the upper jaw.

The width of the left half of the jaw is greater than the width of the right half by 1.5 mm. Mismatch of perpendicular lines from 6 teeth and the middle seam. The tooth is located closer to the premaxilla in relation to tooth 2.6, which indicates temporoparietal pressure on the right. The shape of the arc is trapezoidal on the upper jaw and on the lower jaw. There is a reversal of the premolars by the palatine tubercles medially.

5. an osteopathic examination was performed;

6. scanning of the feet in the standing position of the patient (plantography);

Streeter's highly arched foot. The left leg participates in point support, the area of support of the left leg is much smaller compared to the right leg.

Using the data of questionnaires, photometry, photo protocol, kinesiology tests, osteopathic studies and conclusions, we make a diagnosis.

Diagnosis:

Underdevelopment of the upper and lower jaw. Axial displacement of the atlas. Kyphoscoliosis. Omission of the diaphragm of the body (hyoid, sternoabdominal, pelvic). Hidden open bite, high arched foot. Tendency towards skeletal class 2. An increase in the vertical proportions of the lower third of the face (skeletal open bite). Retrusion of the upper incisors. Retrusion of the upper incisors. Trend towards vertical type of growth. Indication for extrusion mechanics. Clockwise rotation of the HF (retroinclination of the HF). HF long back. Underdevelopment of the chin. Retroposition of the LF with a normal chin size. The bass is long at the back with a normal chin size. Signs of dysfunction of the temporomandibular joints - decentration of the articular heads of the lower jaw, anterior (mesial) displacement, symmetrical on both sides. Deformation of the articular head of the lower jaw on the left - may be a sign of juvenile arthritis of the temporomandibular joint. Violation of the functions of breathing, swallowing, chewing, speaking, vision, hearing, endocrine regulation, neuro-humoral, psycho-emotional, bipedal locomotion, coordination, orientation, speed of thinking, social adaptation. Psycho-emotional imbalance. Significant vitamin D deficiency, rickets.

There are no contraindications to treatment by a functional dentist.

Drawing up a functional treatment plan

8. Functional, digital, instrumental diagnostics of the face, body, occlusion and structure. Treatment planning.

9. Osteopathic, myofunctional, biomechanical, psychological, neuropsychological correction. Consultations of related specialists (if necessary)

10. Previously sanitized. Professional oral hygiene. Training in cavity hygiene. Selection of hygiene products.

11. Restoration of the integrity of the dentition. Preliminary prosthetics.

12. Beginning of functional orthodontic treatment. Equipment selection.

13. Creating a releasing height with composite crowns (semi-crowns) (upper and lower jaw)

14. Use of orthodontic equipment according to Planac (according to indications)

15. Selection of intermediate functional equipment (according to indications)

16. Correction of occlusal relationships. Occlusal-structural planning and balancing on the posterior teeth.

17. Assessment of the patient's condition according to 7 principles of balance (according to OSB)

18. Final restoration of occlusion. Final prosthetics (if necessary).

19. Regular visits to the dentist for the purpose of a professional examination (1 time in 6 months)

DIARY OF VISITS

After the start of functional treatment, the T0 activator was selected, exercises in the activator were prescribed, regular monitoring of the implementation of the recommendations was carried out, intermediate casts were taken every 8 weeks, and the releasing height was assessed. After that, according to individual measurements (from impressions), Planas plates were made, in which the patient was constantly, taking off for the duration of the exercises in the activator. In addition, articulatory gymnastics was prescribed to develop diction and speaking function in new occlusal conditions of the oral cavity.

After that, an intermediate diagnosis of the patient was carried out, during which it was revealed:

- Improving the general well-being of the child;

- Normalization of the digestive function (the child began to chew, chew food, in connection with this he began to saturate faster, stopped swallowing unchewed food, eats according to the regimen, there is no uncontrolled food intake)

- The child has an interest in the taste of food, he began to cook for the family;

- Behavior has become more balanced, the child has become more lively, open;

- Relations with parents, which were quite tense, smoothed out a little, the child began to make contact with adults and willingly plays with his younger brother;

- The child has become more mobile, notes the absence of pain in the spine while in the activator;

- Nocturnal enuresis stopped bothering, sleep returned to normal, the child stopped waking up in a dream.

In general, there is a tendency to normalize the state of the body.

An additional daily physical activity was prescribed. The development of articulation functions, exercises in the activator continues. The activator is selected in accordance with changes in the width of the upper and lower jaws.

Conclusions:

To assess the functional development of the patient, the dentist needs to consider not only the function of chewing, but also all functions related to it: breathing, swallowing, speaking, vision, hearing, endocrine regulation, neuro-humoral, psycho-emotional, bipedal locomotion, coordination, orientation, speed of thinking , social adaptation.

To evaluate them, a more extended detailed approach is required, which will make it possible to exclude errors in diagnosis. Classical visual examination, history taking does not give a complete picture, and in order to minimize the human factor, the use of modern technologies is required, such as CT, MRI, 3D cephalometry, which provide maximum detail of the hard and soft tissues of the head and neck areas, TMJ, which are fundamental for the implementation of basic functions organism, such as breathing, swallowing, chewing, speaking, vision, hearing, endocrine regulation, neuro-humoral, psycho-emotional, upright posture, coordination, orientation, speed of thinking, social adaptation, as well as allowing for the most accurate digital calculation for objective examination and diagnosis.

After all, according to holistic medicine, within which this diagnostic was created, each person can mobilize his own internal reserves for healing; to mobilize the free man that exists in him and the power of faith that he is able to heal himself on his own. Diagnostics of the health of the body, collected comprehensively, will allow a person to realize his full potential.

Claims (1)

A method for a comprehensive study of a patient when planning and conducting osteopathic functional dental treatment, including taking an anamnesis, dental examination, taking impressions, plantography of the feet in the patient's standing position, characterized in that 3D cephalometry is also performed based on cone beam computed tomography (CBCT), multislice computed tomography (MSCT) of the head and neck, magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) in closed and open form, MRI of the spine, orthopantomogram (OPTG), video recording of gait, as anthropometric data determine height, weight, body mass index, also perform spirometry, determine muscle strength in the arms, heart rate, blood pressure, conduct a bioimpedance analysis of body composition, determining the level of water, protein, visceral fat, bone mass, basal metabolic rate, biological age, in addition, determine blood oxygen saturation determine blood levels of glucose, cholesterol, vitamin amine D, vitamins of group B, they evaluate general physical fitness - running, jump rope, squats, push-ups, pull-ups, press, assess balance and handwriting sample, conduct the Luscher test, after receiving all the information, they are compared with standard values.

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