1 / 84

正畸和正颌治疗中的 牙合 学问题 Occlusion study in orthodontics and orthognathic treatment

咬合治疗 ( 二 ). 正畸和正颌治疗中的 牙合 学问题 Occlusion study in orthodontics and orthognathic treatment. Two upper first premolars were extracted to correct open bite , but after the treatment TMD appeared. 患者为年轻女性，开牙合伴有吐舌习惯。 拔除上颌两个第一双尖牙后，术后良好 矫正结束后，外科拔除了下颌第三磨牙，之后出现关节症状，保持期后，症状加重 。.

chick
Download Presentation

正畸和正颌治疗中的 牙合 学问题 Occlusion study in orthodontics and orthognathic treatment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 咬合治疗(二) 正畸和正颌治疗中的牙合学问题Occlusion study in orthodontics and orthognathic treatment

  2. Two upper first premolars were extracted to correct open bite , but after the treatment TMD appeared.

  3. 患者为年轻女性，开牙合伴有吐舌习惯。 拔除上颌两个第一双尖牙后，术后良好 矫正结束后，外科拔除了下颌第三磨牙，之后出现关节症状，保持期后，症状加重。 A young female with open bite+ tongue thrust. Extracted two upper first premolars to correct her open bite ,and after the treatment, the patient’s occlusal relationship became normal. After the treatment, the patient’s lower third molars were pulled out by a surgeon, then she presented with TMD, and the symptom was aggravated after retainment. CASE

  4. 病人起诉外科医生，要求赔偿2500美元。 法官最终认为是正畸医生内收上前牙迫使下颌后退造成关节病，判决赔偿一百万美元。 The patient prosecuted the surgeon to compensate for $2500 . The judge finally considered that TMD was caused by the orthodontist , who moved anterior teeth palatally and then led to the retrognathism of mandible , and sentenced him to pay $1,000,000.

  5. 错牙合畸形的致病机制 • 牙合的稳定依赖于肌肉，关节，牙齿三者的平衡，任何打破这一平衡，都有可能导致咀嚼系统问题的发生。 • The occlusion depends on the muscle,joint and teeth, anyone in wrong will lead to the system broken.

  6. 1. 个别牙错位 2. 深覆牙合，深覆盖 3. 前牙反牙合 4. 单侧后牙反牙合 Malposition in individual teeth Deep overjet and overbite Anterior teeth crossbite Unilateral crossbite 与TMD的发生有明显关系的特征性错牙合Characteristic malocclusions

  7. 深覆牙合Deep Overbite

  8. 深覆盖　DeepOverjet

  9. 反牙合Crossbite

  10. 正畸中的牙合学The occlusion during orthodontic treatment正畸治疗是牙位置的改变，也是咀嚼系统的重建过程，因此，需注意任何可能的诱因。Orthodontic treatment is tooth movement, as you know, is also a rebuilding progress of mastication systemtherefore, pay attention to any possible reaseson.

  11. 初诊First visit

  12. 牙列拥挤 前牙对刃 Dentition crowding Anterior teeth edge to edge

  13. 通过X线检查颞下颌关节 Examining TMJ through X-ray

  14. 排齐和整平Alignment and leveling

  15. a.拉尖牙向远中 Pulling canine distally

  16. b.关闭前牙间隙 Closing space at anterior region

  17. 若上下前牙成比例后移，基本可以维持正常的盘突关系。若上下前牙成比例后移，基本可以维持正常的盘突关系。 但若上切牙内收过度 下颌强迫后退, 髁突相对的后退, 疼痛、弹响。 If upper and lower anterior teeth move posteriorly proportioned, the normal TMJ will be maintained. If upper anterior teeth moving too palatally forcing mandibular setback, the relative setback of condyle, pain and TMJ sounds. 上切牙内收Upper incisors moving palatally

  18. II类牵引: 髁突向前下方 关节盘随之移位。 III类牵引: 髁突向后上方 压迫盘后区。 医生对颌间牵引的患者，在每次复查时应当检查关节，不应只关注牙齿。 Class II traction condyle moving forward displacement of disk. Class III traction condyle moving backward putting pressure on posterior region of disk. Orthodontist should examine not only the teeth but also the TMJ during further consultations. 颌间牵引Intermaxillary traction

  19. 下颌向前向后旋转都会引起盘突关系的相对改变。下颌向前向后旋转都会引起盘突关系的相对改变。 颌间高度减小 下颌逆时针旋转 髁突相对关节盘后移, 弹响。 Mandibular rotation, backward or forward, will lead to the relative alteration of TMJ. Intermaxillary height reducing madibular counterclockwise rotation condyle moving backward TMJ sounds. 颌间高度的控制Control of intermaxillary height

  20. 3.精细调整fine adjustment

  21. 治疗后 Post-treatment

  22. 牙合的六项标准 Six keys to normal occlusion

  23. Occlusal curve Adduction of the upper incisors Intermaxillary traction Control of the intermaxillary height Occlusal trauma 治疗中以下情况需注意Following situations should be paid attention during treatment 1. 牙合平面 2.上切牙内收 3. 颌间牵引 4 .颌间高度的控制 5. 牙合创伤

  24. 牙合干扰 　处理：调牙合 ＴＭＤ症状 处理：暂停治疗、消除症状 Occlusal interferences Management: adjusting occlusion TMD symptoms Management: postponing or discontinuing treatment, eliminating symptoms 治疗中处理Managements

  25. 矫治时机 施加力量 牙合的改变 后牙咬合 Treatment time Force Occlusal changes Posterior occlusion 对咀嚼系统功能影响较大的正畸治疗因素Major factors

  26. 1. 矫治时机 • 上下颌骨存在骨性不调,希望进行功能矫形治疗时,一定要检测患者的生长发育情况。 • If skeletal discrepancy is shown and the functional treatment is wanted, making sure to examine the patient’s growth and development.

  27. 2. 施加力量 III类颌间牵引力过大 下颌后移过多 关节区疼痛。 II类颌间牵引力过大 继发下颌髁突后移位 关节症状。 局部牙齿用力不当 牙合创伤。 Force ClassIII Intermaxillary traction force is too heavy mandible move posteriorly too much , pain of the joint. ClassII intermaxillary traction force is too heavy secondary posterior displacement of condyle joint symptoms. Force of partial teeth is inappropriate occlusal trauma.

  28. 3. 牙合的改变： • 正畸治疗牙移动过程中可能有早接触。 • 病人配合不好。 • 长期使用过高合垫 髁突发生代偿性前移。 • 重度错位牙，严重的牙合干扰。 • 矫治不当，形成早接触。 Occlusal changes: • There maybe premature contacts when moving teeth during treatment. • Patients don’t follow the doctor’s advice. • Utilizing overhigh occlusal splint for a long time anterior condyle displacement with compensatory. • Severe malposed tooth, severe occlusal interference. • Premature contacts by inappropriate treatment.

  29. 4. 后牙咬合Posterior occlusion • 只重前牙美观，忽略后牙咬合，可能会出现后牙区合创伤或干扰。 • Posterior occlusal trauma or occlusal interference may appear if only paying attention to anterior aesthetic but ignoring posterior occlusion.

  30. 5. 治疗目标 • 和谐的功能统一。 • 不但是正中，还有侧位和前伸。 The best target is harmony in three situation.

  31. 6. 调牙合 • 调牙合是最后的抉择。 The adjusting of occlusion is final step.

  32. 常见问题

  33. 大量研究趋向于：接受正畸治疗与未接受群体比较，TMD症状与体征无明显差别。大量研究趋向于：接受正畸治疗与未接受群体比较，TMD症状与体征无明显差别。 青春期的正畸治疗不会增加或减少日后产生TMD的机率。 Lots of studies incline to accept that there is no significant differences in TMD symptom between the treatment group and tne non-treatment one. The adolescent orthodontic treatment will not increase or decrease the possibility of TMD. 一、正畸治疗与TMD的关系Post-Treatment and TMD

  34. 焦点：担心前磨牙拔除后，前牙内收过度，造成下颌后移，以致髁突后移。焦点：担心前磨牙拔除后，前牙内收过度，造成下颌后移，以致髁突后移。 调查研究：拔牙组与不拔牙组，弹响发生率均下降。 认为：弹响的发生与拔牙发生与否无关。 Focus: After premolars are extracted, anterior teeth will move too palatally, which consequently causing the setback of mandible and the post-displacement of condyle. Investigations: the prevalence rates of TMD sounds both declined in extracted group and non-extracted one. Conclusion: TMD sounds have nothing to do with teeth-extracted or not. 二、拔牙治疗与TMD的关系Teeth-extracted and TMD

  35. 正畸治疗后髁突的位置有一定改变，但不一定会导致TMD。正畸治疗后髁突的位置有一定改变，但不一定会导致TMD。 The position of condyle will change to some extent after treatment, but whether TMD will appear is not for sure. 三、正畸治疗对髁突位置的影响Treatment and position of condyle

  36. 多数人认为矫治技术的类型与TMD的发生无明显关系。多数人认为矫治技术的类型与TMD的发生无明显关系。 Most experts suggest that there is no significant relationship between the techniques and the incidence of TMD. 四、不同矫治技术的影响Influence of different techniques

  37. 正颌外科治疗错牙合畸形Orthognatic surgery treat malocclusion

  38. 正颌手术基本步骤： Basic procedures in orthognathic surgery （一）术前正畸 （二）手术 （三）术后正畸与康复治疗 Orthodontic treatment before surgery Operation Orthodontic treatment after surgery, recovering treatment

  39. 初诊 First visit 三类错牙合、开牙合 Class III open bite

  40. 骨性三类 Skeletal Class III 8976

More Related