Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

EVALUATING OF THE EFFECTIVE USAGE OF THE REMOVABLE ORTHODONTIC APPLIANCE WITH A MOVABLE RAMP IN THE TREATMENT OF MESIAL OCCLUSION ACCORDING TO THE ANTHROPOMETRICAL RESEARCH IN MIXED OCCLUSION

Introduction. In mixed occlusion all methods are based on the existence of sizes relationships patterns of teeth on the one side and the length of the dental arch and jaws apical base on the other. The difference between the diagnostic models analysis in permanent and mixed periods – the necessity to provide mesiodistal size for the teeth that did not erupt yet (premolars and canines). The aim of the research. Evaluation of the effective usage of the proposed construction of removable orthodontic appliance with a movable ramp in the treatment of mesial occlusion in a mixed occlusion period compared to the standard equipment by using anthropometric studies of jaws models. Materials and Methods. There were for the treatment 68 patients with mesial bite in mixed occlusion period between the ages of 5 yea rs, 7 months and 10 years, 3 months. They were divided into two groups – main and secondary group. The main group (37) was treated by mentioned removable orthodontic appliance with a movable ramp, and the secondary group (31) – with a standard orthodontic equipment. We analyzed the results of diagnostic jaws models by anthropometric studies before and after orthodontic treatment. In a mixed period of occlusion was performed by using Nance’s and Huckaba’s methods. Length measurements of the dental arch anterior region of the upper and lower jaw was performed by Mirhazizov. Results and Discussion. In the surveyed patients with normal upper frontal teeth torque, the length of the upper dental arch in both groups almost didn't change after the treatment. Patients with retrusion of upper frontal teeth, the length of the upper dental arch increased by two factors: growth stimulation in the area of incisor bone and teeth torque increasing in the main group to 9,00±0,08 mm and in a secondary group to 7,21 ±0,09 mm. Patients with the presence of diastema and diaeresis in the lower frontal teeth area, the length of the lower dental arch decreased, due to the action of activated vestibular arc, in the main group to 4,70±0,13 mm and in a secondary group to 3,90±0,06 mm. In both groups of patients tight contacts between the lower frontal teeth, the length of the lower dental arch did not change since vestibular arc played only a fixing role in this case. Patients with normal upper frontal teeth torque, the length of the frontal segment of the upper dental arch changed insignificantly. Studied patients with upper frontal teeth retrusion, the length of the frontal segment of the upper dental arch increased in the main group to 4,63±0,12 mm and in a comparison group to 4.06±0,11 mm. Patients with the presence of diastema and diaeresis in the lower frontal teeth area, the length of the frontal segment of the lower dental arch decreased in the main group to 3,38±0,17 mm and in a secondary group to 2,73±0,04 mm. In both groups of patients with tight contacts between the lower frontal teeth, the length of the frontal segment of the lower dental arch almost didn’t change. Conclusion. Each patient has an individual clinical situation. Common treatment prognosis for everyone does not exist. Individual prognosis is possible and it's based on the diagnostics results. Therefore, conclusions of the studies also must be differentiated according to the initial clinical picture. In this case – if there was necessity to change teeth torque or not, that affects the sagittal plane measurements studies results

DIFFERENTIAL DIAGNOSIS OF PROGENIC FORMS OF BITE AND ITS IMPORTANCE IN PREDICTING THE RESULTS OF ORTHODONTIC TREATMENT

Increased requirements of patients to the results of orthodontic treatment are forcing orthodontists to have a deep knowledge of the anatomy of the face, to know the structure and constituent elements of facial harmony, guided in species proportions and variations of structure of the facial skull. Growth, according to S. Williams (2006), is an important criterion for differential diagnosis and treatment of the pathology of occlusion. Because most patients are growing in the treatment process, orthodontists become vital to know the principles of growth, as well as the biological essence of the occlusion. Therefore, the definition of individual genetic profile and growth type of the jaws is a key point in diagnosis, predicting the results of orthodontic treatment and the preparation of a rational treatment plan. In the literature these issues are still insufficiently lit, which was the subject of our studies. The purpose of the study: to improve the differential diagnosis of progenic forms of bite and predicting the results of orthodontic treatment for patients of all ages. Materials and methods. We transcribed lateral cephalograms of 53 patients with progenic forms of bite aged from 12 to 35 years. Analysis of cephalograms was conducted by the method of A.M. Schwarz and J. Jarabak with measurement data comparison. Cephalometric analysis by A.M. Schwarz included determination of craniometry, gnathometry and profile analyzing data. Particular attention was paid to the determination of individual genetic profile of face in every patient with progenic bite. To determine the type of growth we used a method proposed by J. Jarabak (Fig.2). Special attention was paid to determination growth type such as: horizontal, vertical and neutral. Depending on the magnitude of the sum angle, the patients were divided into three groups: the first group included 25 patients with a horizontal type of growth, the second one 18 patients with a vertical type of growth and the third group 10 patients – with neutral type of growth. Comparative analysis of cephalograms by A. M. Schwarz and J. Jarabak allowed conducting more detailed differential diagnosis of progenics forms of bite and creating an algorithm of its implementation, which can help diagnose and make a rational treatment plan and predict its result. Conclusions • Differential diagnosis of progenic forms of bite according to our developed algorithm allows making diagnose more objectively, choosing a rational method of orthodontic treatment and predicting its result. • Crucial importance in predicting the results of orthodontic treatment is the determination of individual genetic profile of face and the type of growth of the facial skull, especially in patients with progenic forms of bite. • The most unfavorable individual genetic profile of face in terms of prediction of orthodontic treatment is retroface with forward sloping chin. • The size of the jaws and the position in the skull plays an important role in the preparation of a rational plan of orthodontic treatment. • Analysis of the lateral cephalograms allows providing differentiated approach for the diagnosis of progenic forms of bite

FREQUENCY AND PREVALANCE OF ANOMALIES AND DEFORMATIONS OF DENTOMAXILLARY (DENTOGNATHIC) APPARATUS IN THE TRANSITIONAL PERIOD OF BITE

Relevance of research. Studies of frequency and prevalence of teeth anomalies and deformities are required to develop the organizational principles of prevention and provide timely specialized medical care. Violations not only harm the child's health, but also adversely affect their adaptation to the social environment. The aim of the research. To set frequency of dental apparatus abnormalities and deformities in children with transitional period of bite at school of northern region of Ukraine. Materials and methods. To achieve this purpose the clinical and statistical methods are used. Clinical examination of patients was performed by the standard scheme. During examination of the oral cavity was evaluated placing of lips and tongue frenulums, palate configuration, teeth, dentition, alveolar process and bite. Also shape and position of individual teeth, the amount of space for them in the dental arch were being checked. Results and discussion. Among 724 children, dental apparatus anomalies and deformations were installed in 641 cases, which is 88.54%. Pathology was not found among 83 children (11.46%). According to our data, dental apparatus anomalies and deformations are often complex. Among children, who had teeth and jaws abnormalities (641), in 624 (97.35%) a multiple pathology was established, only in 17 (2.65%) – single pathology. We found that distal occlusion - the most common bite pathology, which was found in 376 (51.93%) children of the total number of surveyed children (724), mesial – 53 (7.32%), open – 22 (3.04%), deep – 282 (38.95%), cross – 32 (4.42%). Anomalies of the teeth were set in 541 people (74.72%). Other pathologies were found in 12 people (1.66%). Conclusion. Due to results of the examination of 6 – 12 years old children, the prevalence of dental abnor- malities and deformities of dental apparatus reaches 88.6%. The high frequency and prevalence of teeth anomalies and deformities largely depend on the level of treatment and preventive care, which needs the development of new, sustainable and available methods of treatment and prevention

CEPHALOMETRIC SASSOUNI PLUS ANALYSIS USAGE FOR EVALUATING THE EFFECTIVENSS OF DISTAL BITE TREATMENT WITH AN ORTHODONTIC APPLIANCE WITH A MOVALE RAMP

Introduction. The effectiveness assessment of the removable orthodontic appliance with a movable ramp in the treatment of distal bite in a mixed occlusion period was carried out by cephalometry. Materials and methods. For the cephalometrical analysis of patients with distal bite in a mixed occlusion period of main and comparison groups Sassouni plus method was used. This method has certain anatomical landmarks and includes investigation of linear, angular and radius parameters with a high level of results individualization. The main group (9 patients) was with the new removable orthodontic appliance, which includes a plastic base on the upper jaw, vestibular arc, retaining clasps and movable ramp. The basis of the appliance and ramp are connected by the two club-shaped springs (torsion springs). They allow us to provide a prolonged contact with the ramp and lingual surfaces of the lower frontal teeth at rest and reduce the rigidity of the appliance. Comparison group (7 patients) was treated with the Schwarz' appliance with a ramp. Duration of treatment was approximately 10-12 months. The data of cephalometric analysis was hold by a number of parameters that were most informative in the study. Next parameters was evaluated: Skeletal A-P, Skeletal Vertical, Upper Incisor, Upper Incisor to PP, Lower Incisor, Effective Length of Premaxilla, Maxilla Position, Maxilla body size, Mandible Position, Mandible body size, Gonial Angle, NSAr angle (Saddle angle), H angle, Upper Lip angle. Results. Analysis was made before and after treatment. The data table with investigation results was made to see clean picture of anatomical structures changes. Superimposition of cephalometric images before and after treatment with the structural landmarks of skull base (supraorbital plane Cl-RO and Si) was made. Cephalometrical study results showed that most of patients (75.0%) had a skeletal distal tendency as point B was placed behind the A arc by -2,22 ± 0,04 mm in the main group and -2,76 ± 0,04 mm in the comparison group. After treatment skeletal sagittal ratio was improved in both groups. The angle of the upper incisors decreased by 0,78 ± 0,36° in the main group and by 1,02 ± 0,04° in the comparison group. In patients with protrusion of the angle of the upper incisors decreased by 3,08 ± 0,12° in the main group and by 2,81 ± 0,05° in the comparison group. The angle of the lower incisors slightly increased in the main group by 0,56 ± 0,04° and in the comparison group by 1,02 ± 0,06°. Despite the fact that the ramp of the appliance influences the position of the lower jaw in general and promotes its movement forward while masticatory muscles action, but in place of appliance's force vector application, still the forward tipping effect of lower incisors is observed. It should be noted that in the main group this effect was slightly lower. This, in our opinion, may be associated with reduced stiffness of the new appliance. After the treatment Mandible Position parameter increased by 2,26 ± 0,06 mm in the main group and by 3,11 ± 0,17 mm in the comparison group. Conclusions. The removable orthodontic appliance with a movable inclined plane allows us to improve the over jet ratio on the dental alveolar level by changing the torque of the upper frontal teeth and allows to move forward the lower jaw. The stability and degree of this displacement depends on the duration of treatment and the patient's ability to follow recommended time of usage. Reducing the stiffness of the appliance by springs had a positive effect on the lower incisors torque control during the treatment

ABOUT ORTHODONTIC FORCES IN APPLIANCES FOR TREATING MESIAL OCCLUSION (CLASS III)

Mesial occlusion is characterized by excessive development of the mandible and its displacement forward (anteriorly) on a background of underdevelopment of the maxilla or it’s retopologize. Orthodontic appliances equipped intermaxillary tractions are using to move the mandible back and maxilla anteriorly in the treatment of patients with this disease [1, 2]. Difficulty of treatment mesial occlusion using orthodontic appliances such causes the need for mechanical-mathematical modeling of their work. This work devoted to a solution issues associated with definition the magnitude and direction of the orthodontic efforts generated by devices with intermaxillary tractions in the treatment of mesial occlusion. The purpose and research problems. The aim of this study is to improve the methods of orthodontic treatment of patients with mesial bite through structural design of orthodontic appliances on the basis of mechanical-mathematical modeling of their work. Results of the study. Conducted the mechanical-mathematical modeling of the orthodontic appliance work, equipped with intermaxillary tractions. Analyzed the orthodontic efforts produced by intermaxillary tractions, depending on the angle of inclination relative to the occlusal plane. Recommendations for the manufacture of structural elements of orthodontic appliances are given. Conclusions. Mechanical-mathematical modeling has shown that orthodontic efforts are required to move the mandible in the desired position depends not only on the magnitude of the tension of the intermaxillary tractions, but also on the angle of inclination to the occlusal plane. At a positive angle of inclination intermaxillary tractions vertical component of the tension of the intermaxillary tractions performs mutual pressing of plates arranged on the upper and lower jaws of the appliance and generates friction force, which prevents mutual displacement of the jaws. If you increase the length of hooks, which attached to the traction the angle of inclination of the intermaxillary tractions to occlusal plane becomes negative. The mutual effort of pressing plates and the frictional force between the plates becomes equal to zero, which contributes to the increase of orthodontic force with the same effort of intermaxillary tractions. However, we must take into account that increasing the length of the hooks may cause inconvenience to the patient. If intermaxillary tractions parallel to the occlusal plane the tension of tractions will be equal to the orthodontic. This arrangement of intermaxillary tractions in the appliance for the treatment of mesial occlusion can be considered optimal, since the tensile force of tractions will be fully used for the correction of malocclusion of the patient

ALGORITHM OF PATIENT’S TREATMENT WITH THE PRESENCE ANOMALIES OF BITE AND SPEECH DISORDERS

Relevance of research. Under complex correction of speech disorders in existing orthodontic pathology, it is important to establish the causative factor, because incorrect tongue articulation, infantile type of swallowing and other bad habits can be the cause of dental and maxillary pathologies and, at the same time, speech disorders. The cause-and-effect relationship between dentoalveolar and speech disorders has been proved. Anomalies and deformations of the dentoalveolar apparatus prevent the sounds from being pronounced normally, contribute to strengthening the habits of improper articulation and complicate logopedic correction. The problem of logopedic correction of sound pronunciation should be addressed comprehensively in collaboration with an orthodontist. The purpose of the research. To treat patients with anomalies of bite and speech disorders according to the proposed algorithm. Materials and methods. To achieve study objectives, 82 patients with severe orthodontic pathology and speech disorders, with normal hearing and intellect, were accepted for treatment. Clinical examination according to the generally accepted scheme, extraoral and intraoral photographs, anthropometry, myography, cephalometry, and logopedic diagnostics of all aspects of speech were conducted. After establishing the diagnosis, determining the treatment plan, orthodontic treatment was performed simultaneously with speech therapy correction. Results and discussion. The first step in the algorithm of successful treatment (correction) of speech disorders and dentoalveolar anomalies was the explanation of its necessity. The second stage of the algorithm was a clinical examination, which included medical history taking and objective methods of examination. The speech therapy part of the algorithm provided for speech therapy diagnosis of all aspects of speech: sound pronunciation, vocabulary, grammar, phonetics. Additional methods of examination were performed for the preparation of the plan, the choice of method and tactics of treatment: extraoral and intraoral photographs, anthropometry, myography, cephalometry, which is an integral part of the second stage of the treatment algorithm for patients with abnormalities and deformations of the dentoalveolar device in conjunction with correction of speech disorders. The third stage of the algorithm was direct orthodontic treatment and speech correction. The retention period is the final stage of the algorithm for treating patients with abnormalities and deformations of the dental apparatus in combination with the correction of speech disorders. Conclusion. The algorithm for treating patients with anomalies of bite and speech disorders consists of the following blocks: motivation, detailed diagnosis, treatment planning and tactics, the active period of orthodontic treatment simultaneously with speech correction and patient management in the retention period

STUDY OF THE STATE OF ENT-ORGANS IN CHILDREN WITH ANOMALIES AND DEFORMATIONS OF DENTOALVEOLAR APPARATUS AND SPEECH DISORDERS

The relevance of research. When examining patients with dentoalveolar anomalies, children with speech disorders can often be observed. For orthodontists, it is important to diagnose the etiologic component of these disorders, namely, whether they are the cause of diseases of the ENT-organs and whether they are directly related to orthodontic pathology. In order to study the impact of the pathology of the ENT-organs on the formation of speech disorders, clinical and additional examination methods were carried out. In case of respiratory tract narrowing due to the deviated septum, hypertrophic or allergic rhinitis, adenoid vegetations, hypertrophy of the tonsils, speech pathology may be observed. Specified pathologies are subject to treatment before the logopedic and orthodontic correction. According to our clinical study in children of the main group and of the comparison group, the apparent pathology of the nose and oropharynx was not detected. Subjective and objective methods of hearing examination also did not reveal deviations from the norm. For a more detailed study of the condition of the upper respiratory tract, it is advisable to use computer tomography of the skull and magnetic resonance therapy of the head. The purpose of research is to eliminate the influence of otorhinolaryngologic pathologies on the formation of speech disorders. Materials and methods. We examined 124 patients. Patients were divided into two groups: control and comparison. The control group consisted of 82 patients with anomalies and deformations of dentognathic apparatus and speech disorders. The comparison group consisted of 42 patients without orthodontic pathology who applied to otolaryngologists for a diagnostic examination. The examination did not show the expressed pathology of ENT-organs in the presence of speech impairment and 5 children (aged from 6 to 12 years) with ENT pathology and speech impairment were not included in the main comparison groups. To make clinical and additional diagnosis such methods as rhinoscopy, pharyngoscopy, otoscopy were used. Results and discussion. During the rhinoscopy of all the examined patients of control and comparison groups, it was found: the nasal passages were free, the nasal shells were of the usual size, the nasal membrane was in the medial position, pathological contents in the nasal cavity were not detected. During pharyngoscopy, attention was mainly paid to the size of palatine tonsils. Thus, 62 children (50%) had the 1st and 2nd stage of development, 42 (33.87%) - 2nd stage and 20 (16.13%) - II-III degree. Adenoids (nasopharyngeal tonsil) of the 1st and 2nd degree were established in 86 children (69.35%), 28 children (22.58%) - second degree and 10 (8.06%) - II-III degree, but in all children of the main and comparison groups, nasal breathing function was not noted. In 124 subjects (100%), there was no adenoid type of facial skeleton. Conclusion. With the narrowing of the respiratory tract due to a curvature of the nasal septum, hypertrophic or allergic rhinitis, adenoid vegetation, hypertrophy of the palatine tonsils, speech impairments can be observed. The specified pathologies are subject to treatment before the logopedic and orthodontic correction. According to our clinical examination of children of the main group and the groups of comparison, evident pathology of the nose and oropharynx was not detected. Subjective and objective methods of hearing examination also did not reveal deviations from the norm. For a more detailed study of the condition of the upper respiratory tract, it is advisable to use computer tomography of the skull and magnetic resonance therapy of the head

STATIC OF ORTHODONTIC APPLIANCES WITH MOVABLE INCLINED PLANE FOR MESIAL BATE TREATMENT

Urgency of an issue. An orthodontic appliance with a movable inclined plane, which consists of a plastic base, vestibular arc, retaining clasps and inclined plane, connected with the base via two clubshaped springs (torsion springs) was proposed. Creation and introduction of new treatment technologies into medical practice requires its mechanics and mathematical background. The aim of the research. Mechanics and mathematical modeling of functionally directing appliance with a movable inclined plane static work for improving sagittal dentoalveolar anomalies and deformations treatment methods. Materials and methods. Maxillodental patient’s static was modeled by the methods of theoretical mechanics during the treatment of mesial occlusion with the appliance with a movable inclined plane. The study used parameters: the angle of the inclined plane of the appliance, the size of the facial skeleton, axial angle of the anterior teeth inclination, the coefficient of friction between the inclined plane and the patient's teeth. Two types of clubshaped springs (torsion springs) was studied: 1 – the one, which create a cushioning effect of the inclined plane action, but do not change its angle of inclination (passive); 2 – one, that seek to increase the angle of the plane inclination due to the disclosure of the curl (active). Results and discussion. Orthodontic forces occurring in the dentoalveolar complex while using orthodontic appliances can be decomposed into two components: the force acting along the axis of the tooth Q, and the force directed perpendicular to this axis direction P. The force Q progressively moves the frontal teeth in the axial direction, and the force P translational-rotationally in the vestibular direction. By setting different angles of inclined plane inclination β, the forces P and Q can be changed, changing the position of the frontal teeth and the alveolar process. The angle of the tooth axis inclination at the beginning of treatment α is determined by the anatomical characteristics of the patient and can take on values in the range 45-75°. Since the orthodontic force vector is in vestibular direction, the angle β is in the range from -30° to α. Minimum orthodontic force will occur in the case where the angle between the inclined plane and a line connecting a point that represents the center of the articular head of the temporomandibular joint, and the incisors contact point will be equal to the arctangent of the coefficient of friction between the patient's teeth and the inclined plane. Based on the orthodontic forces calculations results, the force P increases and Q force decreases with increasing of angle β. The angle between the inclined plane and the axis of the frontal teeth (α - β) influences the ratio between P and Q. If (α - β) 45° the forces P will be less then forces Q. Ratio P < Q is not eligible, since the inclination of the tooth must prevail over its intrusion. About 30° is the most preferred angle between the inclined plane and the axis of the frontal teeth. Conclusion. The presence of elastic joints in functional-directing appliences with an inclined plane, which is used as clubshaped spring, allows us to change vehicles rigidity and to provide more stable support of orthodontic force during the treatment. The movable inclined plane with active springs acts on the teeth not only during the act of swallowing, but in a state of physiological dormancy also

THE QUADRILATERAL ANALYSIS OF CEPHALOGRAM FOR THE TREATMENT OF GNATHIC FORMS OF MESIAL BITE

Relevance of research. Enhancing the quality of diagnosis and planning of orthodontic treatment is an issue of great importance. Cephalometry is the most informative diagnostic method that allows assessing structural features of the skull base and facial skeleton of patients with bite anomalies. Prediction of dominated growth type of facial skeleton is important for selecting the optimal period of early orthodontic treatment, determining the treatment plan and forecasting results. The aim of the research. Increasing efficiency of mesial bite treatment by improving clinical and radiological diagnosis and the development of orthodontic appliances with rational design and indications for usage. Materials and methods. We examined 254 patients with mesial bite aged from 9 to 15 years. 74 patients with gnathic form of mesial bite without recommendations (evidence) to surgery on the jaws were accepted for treatment. 6 patients, who were recommended a comprehensive treatment, refused surgery and limited to orthodontic treatment only. For diagnosis, clinical and additional methods were used. We conducted lateral cephalometric analysis for 254 patients with mesial bite. Analysis was carried out using method of A. Schwarz and methods of Di Paolo, A. Bjork, R. Ricketts. Based on quadrilateral analysis by Di Paolo in determining dentoalveolar and gnathic form, we used the appropriate options for their differential diagnosis, using the formula (A'-B '+ M'-J') / 2; determined the required lengths A'- B '= M'-J' and compared the values with the actual length of the respective segments A'-B 'and M'-J'. According to Di Paolo, value M'-J 'and A'-B' reflects the height of the lower part of the facial skeleton. Its average value at neutral growth type is 65-67%. Reducing the value indicates the vertical growth type, increase – the horizontal one. Patients were divided into two groups: control and basic. The control group was treated with standard orthodontic appliances. The main group was treated with the proposed “Appliance for mesial bite treatment”, consisting of a removable appliance for the treatment of mesial bite and facial mask. Results and discussion. The result achieved during the proposed method of treatment is not only lengthening the upper dental arch and curbing the mandible growth, but also the simultaneous expansion of the upper and lower dental arches. Mandible basis (B'J') barely increased in both groups due to usage of orthodontic appliance. Comparing treatment results in control and basic groups of patients with horizontal growth type, we observed that increasing the size of the maxillary base (A'M') was most active in the main group (difference – 4.1 mm). In patients with vertical and neutral growth type, we also observed that increase of the maxillary base size (A'M') was more active in the main group (differences 1.2 mm and 1.4 mm respectively). Conclusion. Using the proposed method of treatment with orthodontic appliance, one can increase efficiency and decrease active treatment period for patients with gnathic form of mesial bite and upper jaw micrognathia with any growth type of facial skeleton during active growth of dentognathic apparatus. The horizontal growth type has better results, as evidenced by the increase in the maxillary base size for 4.1 mm, comparing with vertical growth type – 1.2 mm, for neutral growth type – 1.4 mm