Andreyishchev Andrey Ruslanovich
For 3 years I went with the bracket system installed by Adreishchev, in which he forgot/forgot or simply decided not to install the system to separate the teeth. As a result, without disconnection, the braces on the lower teeth erased the upper teeth... How could the attending physician not pay attention to this for several years?!?!?!? How's that?! The damage was so serious that colleagues at work began to notice it and diligently recommend changing the doctor. But Andreishchev didn’t worry at all. To all my requests and statements that my teeth were wearing away, I received the answer - “everything is fine. This is how it should be - the teeth are moving, grinding in, be patient. This is normal.” At this moment, as usual, he was practicing his wit more with one of his assistants, not really paying attention to my problem. He paid attention to me only after I started complaining about him to all the doctors who worked with me in the same clinic - BK-dent. Apparently his ego was hurt.
I came to the clinic unscheduled 5-7 times because the back side of the upper front teeth was knocking off the braces on the lower teeth (they just fell off. I brought these sapphire stickers in my hands), they glued them back and said that everything was fine :) Happened days when they fell off on the way to the metro and I had to return to the clinic. then they advised me to eat calcium) because... cement does not set well. No, can you imagine such a doctor?! I still cringe when I remember! (I even have a witness about calcium. - My mother, in tears and not understanding what was happening to her beloved son, called Andreishchev - he told her that everything was fine, you just need to eat calcium and the braces will stay on your teeth well) And I ate for 2 months calcium. Unfortunately, without a photo of worn-out teeth, it is impossible to convey the full irony of his letters. (when he writes, the quote is “We have finished communicating. I wish you health and good mood” to my request for compensation and to correct the mistake. Therefore, I am attaching photos before and after. There are clearly visible dents in the teeth in the shape of braces. And ours with him correspondence where he sends me.
At that time I was still determined to apologize and correct mistakes together... I needed results. Now I need justice and to punish the culprit. By the way, general dental treatment cost me about 600,000. I wonder why he doesn’t like my way of communicating? Should I detract from correcting his own mistakes? or grovel before him? I noticed that when there are no complaints about him, he is positive and cheerful. As soon as you show him that he is wrong, you begin to communicate as if with another person. This is how you go for 3 years. you suffer, and then he says, “Come on, goodbye.”
Attached photos: Photos before and after this doctor's work. (I focus on the front 2 teeth, but the situation with those closest to them is not much better, they are simply covered with veneers.
Our correspondence with him. Where he shows his essence and complete confidence in his impunity.
https://drive.google.com/open?id=1VU83QtO_9ef69ee_2Inat8-ya6gus7Xy
The best plastic surgeons
Plastic surgeon
Education
— St. Petersburg State Medical University named after. acad. I.P. Pavlova. Faculty of Dentistry (with honors) (specialty - dentistry. Diploma BVS 0175829 dated 06/18/1999).
— Internship in surgical dentistry at the St. Petersburg State Medical University. acad. I.P. Pavlova.
— Specialization in the specialty “Orthodontics” in the Department of Orthodontics of the Central Research Institute of Dentistry.
— Clinical residency in maxillofacial surgery at the St. Petersburg State Medical University. acad. I.P. Pavlova.
— Primary specialization in the specialty “Orthodontics” at the Department of Pediatric Dentistry of the St. Petersburg Medical Academy of Postgraduate Education (MAPO).
— Specialization in plastic surgery on the basis of the Military Medical Academy named after. CM. Kirov.
— Postgraduate studies at the Department of Surgical Dentistry and Maxillofacial Surgery of the St. Petersburg State Medical University named after. acad. I.P. Pavlova.
— State Educational Institution of Higher Professional Education of the Russian State Medical University of Roszdrav. (specialty - plastic surgery. Diploma PP - I No. 491163 dated 03/26/2011)
Advanced training: courses, symposiums and seminars on plastic surgery
·Course on the use of compression-distraction devices at the Moscow Center for Pediatric Maxillofacial Surgery (St. Vladimir Children's Hospital) (Moscow, June 2001)
Seminar on augmentation mammoplasty (Istanbul, 2007)
·Congress of the European Association of Lingual Orthodontists (Cannes, July 2008)
·Congress of Plastic Surgeons (Ekaterinburg, 2009)
·Internship in orthodontic practice (Berlin, December 2009)
·Internship at a plastic surgery clinic (Paris, July 2009)
·I Baltic Congress of Orthognotic Surgeons and Orthodontists (Vilnius, September 2009)
·Annual Congress of Orthognotic Surgeons and Orthodontists (Santa Barbara, January 2010)
·Annual Course in Orthognotic Surgery and Orthodontics (Santa Barbara, October 2010)
Internship at the clinic of Dr. P. Server (Birbingham (Alabama), 2010)
In 2014, he successfully defended his dissertation on the topic “Rehabilitation of patients with combined dentofacial anomalies using various combination treatment regimens” for the scientific degree of Doctor of Medical Sciences.
Author of more than 50 published works and over 20 speeches at various scientific forums.
experience
Since 2000 – surgeon at the Department of Plastic Surgery at the SPIK Beauty Institute, St. Petersburg.
Since 2016 - Aesthetic plastic surgeon at the SPIKA Beauty Institute
Types of bites are discussed in detail in the previous material . This is about the effect of orthodontic treatment on the signs of facial aging.
Narrated by Andrey Ruslanovich Andreishchev (plastic and maxillofacial surgeon, orthodontist, MD)
Very often patients come to me after orthodontic treatment who are dissatisfied with the changes in the new position of the upper lip, or the fact that the marionette folds have not disappeared. The teeth have become straight, there seem to be no complaints about the orthodontist, but the face has changed, and the patient does not like the changes.
Orthodontists most often avoid this topic. Many issues are within the competence of the orthognathic surgeon. For example, an orthodontist cannot significantly move the lower jaw forward and orthodontically influence the “puppet” folds (jowls). Therefore, when a patient begins to ask questions about the effects of age-related changes, the orthodontist is very limited in what he can do, and in most cases the conversation ends very quickly. The patient agrees to the proposed treatment plan, not knowing what changes will occur in the face.
The orthodontist does not know how to perform operations to advance the lower jaw, and if he does not have experience working with a surgeon, he himself has the question of what to do with such a patient. As a surgeon, I can answer these questions.
Aging with mesial occlusion
With a mesial bite, the profile is concave (the middle zone of the face is usually recessed), there is an emphasis on the nasolabial folds, the upper lip is small and not very pronounced (recessed, flattened) in combination with a protruding chin and lower lip. In this case, the contour of the lower jaw and chin is usually very clear.
Age-related bone resorption most severely affects the upper jaw, which leads to deepening of the nasolabial folds and retraction of the upper lip. Mesial occlusion exacerbates this tendency.
A mesial malocclusion often results in a drooping tip of the nose, the position of which is determined by two factors: the shape and direction of the nasal bones, and the anterior nasal spine (the bony protrusion that sits above the upper lip at the base of the columella). When the upper jaw is recessed, most often the anterior nasal spine looks down and, accordingly, the tip of the nose also looks down.
Mesial bite
What to do?
When correcting mesial occlusion, in the vast majority of cases, an osteotomy of the upper jaw is performed (either independently or in combination with a large-scale intervention to reconstruct the facial skeleton).
The advancement of the upper jaw changes the proportions of the face: the concavity of the profile, the retraction of the upper lip are eliminated, the increase in bone support leads to the spreading of the nasolabial folds.
In cases where the patient has significant flattening of the infraorbital areas, it is customary to cut the bone closer to the level of the infraorbital margin in order to create support for the advanced tissues of the infraorbital area. In some cases, the operation is complemented by osteotomy of the zygomatic bones (malarplasty), which further increases the support for soft tissues, enhancing the rejuvenating effect.
A very important nuance: a mesial bite is often combined with an extension of the anterior height (the distance from the point between the eyebrows to the bottom of the chin) of the midface. In this case, the tissues of the infraorbital and paranasal areas look flat, the relief is not pronounced. During surgery, the upper jaw, as a rule, not only moves forward, but also lifts. In this case, the soft tissues, having received support, are gathered “into a fold.” This creates volume and relief in the midface area.
When the upper jaw moves forward, the anterior nasal spine also moves forward, creating the prerequisites for raising the tip of the nose. If this effect is undesirable, resection of the spine and expansion of the bone base of the nasal cavity is performed. Accordingly, the nose changes minimally.
Surgeries on the lower jaw significantly affect the proportions of the face and the shape of the profile. But as for age-related changes, the posterior displacement of the chin creates excess soft tissue, exacerbating age-related changes. What to do? Plan an expanded operation in which the effect of concomitant interventions offsets the negative effect of moving the lower jaw. For example, by extending the chin, we have the opportunity to correct excess soft tissue that occurs when the lower jaw is retracted or the chin is shortened.
Orthognathic surgery is a powerful and effective tool in the fight against age-related facial changes. An alternative method of treating mesial occlusion is orthodontic – dento-alveolar compensation. In this case, the upper teeth deviate anteriorly, the lower ones - posteriorly, for which they often resort to removing teeth in the lower jaw. From the point of view of influencing the closure of teeth (bite), this is effective, but such treatment is not suitable for correcting the contours of soft tissues. Therefore, you need to initially determine what exactly worries the patient. If among the complaints there are aesthetic wishes, then the issue of surgical correction should be discussed and appropriate orthodontic preparation should be carried out.
The photo shows a clinical example of irrational planning: with a mesial occlusion, two teeth in the lower jaw were removed, a course of orthodontic treatment was carried out to close the gaps from the extracted teeth. The bite has been corrected, but the face has not changed. A few years later, braces were installed, post-extraction gaps were opened, which in the future will be replaced with prosthetics, and the bite was decompensated. A bimaxillary osteotomy was performed. As a result, the bite was normalized, facial features were corrected, but the patient lost two healthy teeth.
This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.
Aging in distal occlusion
When the face ages, a very important parameter is the ratio of bone and soft tissue. A patient with underdevelopment of the lower jaw has an excess of soft tissue in this area, because while the bones were developing slowly, the soft tissues were developing as expected. With a distal bite, there are not enough supporting structures and bone contours, so facial puffiness is already present from childhood. Throughout life, such a person will not have clear contours of the corners of the jaw, chin, lower edge of the lower jaw, or a clear contour of the neck. And with age, the tissues of the lower third of the face will sag faster than in people without such problems.
Distal bite
What to do?
When enlarging the chin, it is possible to move the bone structure forward, lengthen the body of the lower jaw and thereby redistribute excess soft tissue along this elongated contour: the contour is emphasized, the face looks younger.
Orthodontically, we can move the entire lower jaw forward, but the orthodontist cannot influence the chin itself. In children, extension occurs easily, in adults there are certain restrictions, but almost everyone can extend it a little. This can be done if the depth of the incisal overlap allows: the cutting edge of the lower incisor should rest against the palatal surface of the upper incisor. The depth of overlap can normally be from half the height of the crown to direct butt contact.
If you want to extend the chin and get a certain visual effect, surgical intervention is performed in the chin area: the lower edge of the chin of the jaw is mobilized with a horizontal cut and moved forward. This stretches the soft tissues under the chin as they attach to the bone being moved from the inside, creating a clear contour. This effect cannot be achieved with a chin implant: the muscles will not stretch and the tissues under the chin have sagged and will continue to sag.
Genioplasty is not a malocclusion correction method. This is a variant of camouflage of facial manifestations of the anomaly. Genioplasty can be included in a complex of orthognathic intervention, or can be performed in isolation, for example, to obtain an aesthetic effect in patients with previously performed orthodontic compensation.
The woman had a distal bite, which was corrected by introducing the upper jaw (raising) and advancing the lower jaw.
This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.
If, with severe underdevelopment of the lower jaw, surgery is indicated, and, as a rule, double-jaw surgery, then in a patient with slight underdevelopment, there are fundamentally two ways to solve this issue:
1) 2 teeth on the upper jaw are removed, the upper front teeth are tilted back and we achieve contact between the upper incisors and the lower incisors. Closure and cutting-tubercle contact appear, and the person can bite off food normally.
In principle, the bite becomes compensated, there is closure of the teeth along the entire perimeter of the dentition. This is good for the joint; it is relieved, since all teeth participate in the function. This is a compromise, but not the norm: by adjusting the normal upper jaw to the small lower jaw, we compensated for the bite, but, if we talk about anatomy, we reduced the size of the upper jaw. If the patient's decision is esthetically satisfactory, then it is acceptable.
2) The correct treatment option for such a patient is not to remove the teeth, straighten them, and then, with the help of surgery, push the lower jaw forward.
The top row is before the operation, the bottom row is after. Implementation of the upper jaw (raising) and extension of the lower jaw were carried out
This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.
Bite and chin position
Chin relocation is the goal of an independent branch of aesthetic maxillofacial surgery - genioplasty. During the operation, it is possible to influence not only the shape and size of the chin, but also the aesthetics of the entire lower area of the face, its proportions and age characteristics.
A two-jaw osteotomy with advancement and reduction of the lower jaw + genioplasty with advancement and reduction of a fragment of the lower jaw was performed
With a distal bite, patients often want to have a more pronounced chin, and, having this complex, they train themselves to push the lower jaw forward. Whereas people with a mesial bite, on the contrary, open their mouths slightly so that the lower lip protrudes less forward and is in normal relationship with the upper. From the outside it seems to be working out well. But this occurs due to tension in the jaw muscles, constant training of which leads to hypertonicity. Chronic spasm can lead to TMJ dysfunction. And what this entails - look at the first section of the material.
The capabilities of the orthodontist are limited to the glenoid cavity. Using a CT scan, x-ray of the joint or MRI, the position of the articular head in the glenoid cavity is determined. The articular head in the articular cavity has a fairly free position and can be varied within a certain range. If the picture shows that a person has trained the muscles so that the articular head is located in the posterior position, then it can be adjusted so that it moves to the central position or even slightly to the front, and at the same time the chin and lower jaw move forward. If the articular head is already in the anterior position, then it can no longer be moved forward, since it may come out of the articular cavity.
The orthodontist cannot influence the chin itself. The chin is a fragment of the lower jaw. Orthodontically, we can move the entire lower jaw forward. For a child this happens easily, for an adult there are certain limitations, but almost everyone can push it a little. This can be done if the depth of the incisal overlap allows: the cutting edge of the lower incisor should rest against the palatal surface of the upper incisor. The depth of overlap can normally be from half the height of the crown to direct butt contact.
If you want to extend the chin and get a certain visual effect, surgical intervention is performed in the chin area: the lower edge of the chin of the jaw is mobilized with a horizontal cut and moved forward. This stretches the soft tissues under the chin as they attach to the bone being moved from the inside, creating a clear contour. This effect cannot be achieved with a chin implant: the muscles will not stretch and the tissues under the chin have sagged and will continue to sag.
In case of significant violations of the jaw relationship, orthognathic surgery is required.
For example, in a patient with a distal bite and slight underdevelopment of the lower jaw, there are fundamentally two ways to solve this issue:
1) Two teeth on the upper jaw are removed, the upper front teeth are moved back, and we achieve contact between the upper incisors and the lower incisors. Closure and cutting-tubercle contact appear, and the person can bite off food normally.
In principle, the bite becomes compensated, there is closure of the teeth along the entire perimeter of the dentition. This is good for the joint; it is relieved, since all teeth participate in the function. This is an acceptable solution, a compromise. But not the norm: by adjusting the normal upper jaw to the small lower jaw, we compensated for the bite, but, if we talk about anatomy, we reduced the size of the upper jaw. If the patient's decision is esthetically satisfactory, then it is acceptable.
2) The correct treatment option for such a patient is not to remove the teeth, straighten them, and then use surgery to lengthen and push the lower jaw forward:
This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.
Children or adolescents have the opportunity to stimulate the advancement of the lower jaw using orthodontic appliances. During the period of growth, when the lower jaw moves forward, newly formed bone will grow in the joint area, and thus the position of the advanced dentition will be stable, that is, we will grow bone.
For adults, only surgery is available. In the area of the angle of the jaw, a cut is made in the bone in the anteroposterior direction at an angle of about 30°, and then these two fragments of the jaw are moved forward relative to each other. At the site of the cut, the bone becomes thinner, but lengthens. Bone growth to normal thickness occurs after six months. We achieve the main thing - increasing the distance from the chin to the joint.
With an open bite, as with a mesial bite, aging occurs more slowly in the lower third of the face, since initially the soft tissues are greatly stretched and have less tendency to sag. An open bite is characterized by excessive development of the upper jaw, but the peculiarity is that with this type of bite the lower jaw has a more vertical orientation. That is, a widened angle of the lower jaw is obtained (normally, the body of the lower jaw and its branch form an angle of more than 123°, an increase in the height of the lower zone of the face, non-occlusion of the front teeth.
The contour of the neck is determined by the concept of the cervical angle. This is the angle between the submental area and the front surface of the neck below the Adam's apple. Normally, this angle for a young person should be about 120° (standing straight in front of the mirror, relaxed, looking at the level of the reflection’s eyes). In case of pronounced violations of facial proportions, this angle may change. For example, in a person with the facial proportions of Vincent Cassel (a sharply elongated face, an elongated lower part of the face and a lowered chin), this angle will be sharp and clear, since the Adam's apple is located high and the chin is strongly lowered. This is not considered the norm (although, of course, he is very good-looking!).
In the opposite situation, with pronounced underdevelopment of the lower jaw, the chin is very high, and despite the fact that the angle seems to be 120°, soft tissues collect under the chin, there is no clear line, and with age this area drops even more. Therefore, the position of the chin as one of the points of the cervical angle is of great importance from the point of view of assessing age-related changes in the neck.
If, during orthodontic treatment, the lower jaw moves forward or lowers, or the upper jaw moves forward, the soft tissues are stretched and a rejuvenation effect is obtained. If the jaws move back, there is an excess of soft tissue and, accordingly, we aggravate age-related changes.
The starting point of treatment should be the patient's wishes. If you tell the doctor: “I have crooked teeth, I want straight teeth,” the orthodontist will tell you how to fix it. And if you don't like marionette folds, you need to ask if they will go away. Questions you can ask the orthodontist: “How will the face change as a result of treatment? What will happen to the position of the lips? What will happen to the position of the chin? What will happen to the height of the lower third of the face? This is what primarily affects aesthetics. Ideally, the doctor should explain how the face will change after treatment and show examples of such cases in photographs.
To communicate with patients, come to our forum, section Aesthetic dentistry and dental health or Plastic surgery of cheekbones, jaws and chin
Education
- St. Petersburg State Medical University named after. acad. I.P. Pavlova. Faculty of Dentistry (with honors).
- Internship in surgical dentistry at St. Petersburg State Medical University. acad. I.P. Pavlova.
- Specialization in the specialty "Orthodontics" in the Department of Orthodontics of the Central Research Institute of Dentistry.
- Clinical residency in maxillofacial surgery at St. Petersburg State Medical University named after. acad. I.P. Pavlova.
- Primary specialization in the specialty "Orthodontics" at the Department of Pediatric Dentistry of the St. Petersburg Medical Academy of Postgraduate Education (MAPO).
- Specialization in plastic surgery on the basis of the Military Medical Academy named after. CM. Kirov.
- Postgraduate studies at the Department of Surgical Dentistry and Maxillofacial Surgery of the St. Petersburg State Medical University named after. acad. I.P. Pavlova.
- In 2014, he successfully defended his dissertation on the topic “Rehabilitation of patients with combined dentofacial anomalies using various combination treatment regimens” for the scientific degree of Doctor of Medical Sciences.
Refresher courses
- Course on the use of compression-distraction devices at the Moscow Center for Pediatric Maxillofacial Surgery (St. Vladimir Children's Hospital) (Moscow, June 2001)
- Seminar on augmentation mammoplasty (Istanbul, 2007)
- Meeting of the European Association of Lingual Orthodontists (Cannes, July 2008)
- Congress of Plastic Surgeons (Ekaterinburg, 2009)
- Internship in orthodontic practice (Berlin, December 2009)
- Internship at a plastic surgery clinic (Paris, July 2009)
- I Baltic Congress of Orthognotic Surgeons and Orthodontists (Vilnius, September 2009)
- Annual Meeting of Orthognotic Surgeons and Orthodontists (Santa Barbara, January 2010)
- Annual Course in Orthognotic Surgery and Orthodontics (Santa Barbara, October 2010)
- Internship at the clinic of Dr. P. Server (Birbingham (Alabama), 2010)
