高角和低角病例的诊断、临床特征及正畸治疗特点.ppt

1,高角和低角病例的诊断、临床特征及正畸治疗特点 High angle and low angle cases, diagnosis, clinical features and orthodontic treatment,扒突私赏柜炳干出颧扼巍捎炸磅梗躁瞪谣蓉盟李女谊妻欠佳折蘑未沮荤钩高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,2,由于以往的诊断是以安氏分类为主, 正畸医生常常只注意到矢状向错牙合而忽略了垂直向不调。 近年来, 学者们逐渐认识到垂直面型在错畸形诊断和治疗中的重要性: 它不仅为颅面复合体的生长方向提供了线索, 而且直接影响治疗的成功与否。,Previous diagnosis was based on Angle's classification so orthodontists often only noticed the sagittal malocclusion while ignoring the vertical dimension.,In recent years, scholars have come to realize the importance of the vertical dimensions in the diagnosis and treatment of malocclusion it not only provides clues to the direction of growth of the craniofacial complex, but also directly affects the success of treatment.,展谊匹虎沏蛮孪十怕弧糖蜒责蝗刽多抢岗臻吃纸斩蹲坪诺躇炼糜懒毅悟相高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,3,垂直向异常有高角和低角两种类型, 在类安氏错牙合中约有50%左右的患者存在不同程度的垂直向异常。 Vertical anomaly are of two types of high-angle and low angle, about 50%of patients with angle class III malocclusion have varying degrees of abnormal vertical dimension high-angle and low angle cases, diagnosis, clinical features, and orthodontic treatment,囊邮询宇备誓钻典霍民谜还利藕遇蓄澎吼绿疾琴璃沏堡软谨黎蝴观濒溶宅高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,4,一、高角病例和低角病例的诊断和形成机制 High angle and low angle cases diagnosis and form,文献中用来描述垂直向异常的说法很多,常用的有开张面型( hyperdivergent ) 、向后旋转型( backward rotation ) 、垂直生长型(vertical type) 、长面型( dolichocephalic ) 、高角型( high -angle face ) , 均指垂直向异常以发育过度( vertical excessive ) 为主, 而聚合面型( hypodivergent ) 、向前旋转型( forward rotation) 、水平生长型( horizontal type) 、短面型( brachypechalic) 、低角型( low -angle face) 则是指垂直发育不足( vertical deficiency ) 。 由于诊断标准和侧重点不同, 从严格意义上讲, 这些概念之间是有差异的, 但在临床中描述垂直面型时经常通用。Diagnostic criteria and a different focus, in the strict sense, these concepts there is a difference, but often common in the clinical description of vertical type.,齐粳沪哥虹鼻纶纠弧遥写嘎燕纷阅烯墓四股滋袄蒜法察仔黎卒伊掐黑臆阳高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,5,高角病例和低角病例的诊断和形成机制High angle and low angle cases diagnosis and form,本文中统称为高角和低角, 但不能误解为下颌平面角大者即为高角型、小者即为低角型, 这是因为下颌角和下颌下缘在生长改建过程中变化较大, 所以单纯以下颌平面角作为诊断标准可能掩盖了下颌真实的旋转方向,对垂直面型的正确诊断还应结合其他指标。 Referred to article as high-angle and low angle, should not be confuse with the mandibular plane angle, if it is high, called high angle case, and if small than low angle case. Because the mandibular angle and mandibular margin changes with growth,so simple mandibular plane angle as the diagnostic criteria may mask the true mandibular rotation and direction of the vertical growth.The correct diagnosis should be combined with other indicators,柏纠朋薪噬颜聘墓享炙瑶检毅瞒妊镍城友淤揪彪舟惨匿踪劝蘸拧赫骂瘤水高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,6,目前常用的诊断标准是: The commonly used diagnostic criteria are:,( 1) 下颌平面角Mandibular plane angle: 高角病例前颅底下颌平面角( SN - MP) 大于40°,FH 平面下颌平面角( FH- MP) 大于32°低角病例SN- MP 小于29°,FH- MP 小于22°。 ( 2) 后面高与前面高比值anterior to the posterior facial height ratio ( S- Go/ N- Me) : 高角病例大于68%; 低角病例小于62% 。 ( 3) 下前面高与前面高比值lower to the upper facial height ratio( ANS- Me/ N - Me) : 高角病例大于58% ; 低角病例小于55%。,蛀映拯打迸巴乓堕绕悄症宠坷卸睹让秒偷夫尧猎唾颓啸研疤彼赠噎匈厄锑高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,7,高角病例或低角病例的形成主要与前后面部高度的生长发育失调有关。 high-angle or low angle cases with a high level of growth and development before and after facial disorders 后面部高度生长不足( 升支短小、关节窝靠前靠上) 和/ 或前面部高度生长过度( 髁突向后生长、上颌骨垂直发育过度、后牙垂直萌出过度) 形成了高角型。Lack of posterior facial growth ( ascending branch of the glenoid fossa small ) and/or anterior facial height overgrowth(condylar backward growth, excessive eruption of the maxillary posterior teeth) is responsible for a high-angle case. 后面部高度生长过度( 升支较长、关节窝靠后靠下) 和/ 或前面部高度生长不足( 髁突向上向前生长、上颌骨垂直发育不足、后牙萌出不足) 形成了低角型。 posterior height overgrowth (the ascending branch of a glenoid fossa long) and/or in lack of posterior facial growth (upward and forward rotation of condyle,lack of eruption of maxillary posterior teeth) is resposible for low-angle case.,无宙销擎胖涨幌褒盆擂警饯译兢补颜薛雪璃后曰胀难誓搭城楼假鉴隐钦撕高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,8,二、高角病例和低角病例的临床特征 The case of high-angle and low angle of the clinical features,1、面型: 正面观 高角病例多为窄长脸型,两侧下颌角不明显, 鼻根部较窄, 常伴有唇功能不足、开唇露齿;,低角病例则多为宽短脸型, 两侧下颌角呈方形, 鼻根部 较宽, 唇闭合十分自然。,团品束铺挠围柜怕迭远肥畴头涡饭毫绒同涨筒慧峪桓客垦役墒臣婚娜顶悍高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,9,9,clinical features of high-angle and low angle cases,A face: front view: High-angle: long and narrow face, both sides of the mandibular angle is not distinct, the nasion is narrow, often accompanied with incompetent lip.,Low-angle cases are much more wide and short face. Both sides of the mandibular angle was a square, nasion is wide, lip closure is normal,割买镭粥嚼渍熏塞秩怕靛蚜兹霸期柄骨辜庆剂裸樊垃郎集渣衫肺撰欲乔村高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,10,侧面观Lateral view : 高角病例呈开张面型, 面下1/ 3 长,凹面型多见, 上唇较厚, 颏部和颏唇沟均不明显, 头位略前伸; High angle cases, length of the lower 1/3 of the face is long, the concave type profile more common, thick upper lip, chin and chin lip groove are not prominent. 低角病例呈聚合面型, 面下1/ 3 段短, 凸面型多见, 上唇较薄,颏部和颏唇沟明显。 low-angle cases the lower 1/3 of the face generally shorter convex facial profile, thin upper lip, chin and chin lip groove are prominent.,增卯尽境螺捆扁土峰拯悦办因沽笛赢踌摊蹦君呵嘶椅种蝎赦奏乖脏幌危铲高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,11,二、高角病例和低角病例的临床特征 The case of high-angle and low angle of the clinical features,2、牙Tooth : 高角病例常见上牙弓狭窄、腭盖高拱, 由于切牙多唇向倾斜前牙拥挤较少见, 前牙覆浅甚至呈现开或开倾向, 后牙的临床冠高度较大, 曲线平坦甚或反向, 上下颌之间的息止间隙较小; High angle cases:- narrow upper arch with deeper hard palate, anterior proclination is rarely seen. the height of clinical crown larger, the curve of spee is flat and the angle between the facial axis of upper and lower incisor is less.,浩轮辞厘瑰终虐孟壹脆擂摊扑驯跃岸巨术雾君喘旷糜铜虎乞兆掩丝稗欠续高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,12,clinical features of high-angle and low angle cases,Teeth: 低角病例上牙弓较宽阔, 切牙位置较直立故前牙拥挤多见, 前牙覆较深甚至呈闭锁, 后牙的临床冠较短, Spee 曲线深、曲度较大, 息止间隙较大。伴有吐舌习惯的高度病例根尖片常可见恒中切牙牙根明显变短。 Low angle cases:- broad upper arch with shallow hard palate, the incisor position is more upright so anterior teeth crowding is common.clinical crown is smaller. Curve of spee is deep.angle between long axis of upper and lower incisor is high,12,鞋森靡释彝吹譬度绢维胖其败滴弦航吴苏锣檬跌退触抒丈恳缕谈碰打坎死高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,13,牙弓狭窄、腭盖高拱,高角病例,低角病例,上牙弓较宽阔,汤诡恰雪甭磨萍划秘元挛阻惟侯犯痊闯刊盯瘤抿糙叫桩脱为募朔缴残汀蚤高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,14,二、高角病例和低角病例的临床特征 The case of high-angle and low angle of the clinical features,3、硬组织颅面形态: 高角病例的腭平面、牙合平面和下颌平面向下倾斜, 下颌角钝, 下颌下缘弯曲, 磨牙与平面角度倾斜, 上下前牙唇向倾斜, 上下中切牙角较小 high-angle case:- the palatal plane, occlusal plane and mandibular plane is low, angle of mandible is large, curved mandibular lower margin, slightly proclined upper and lower anterior teeth. Angle beteen long axis of upper and lower incisor is small.,体隔觅踏宅腔喉剩题吁童婚效杆秀框际烽津舍谎疹罢津数蒸诀氛辽踩抗沟高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,15,低角病例腭平面、牙合平面和下颌平面接近平行, 下颌角呈直角, 下颌下缘平缓, 下颌管弯曲, 前牙直立, 上下中切牙角较大 the palatal plane, occlusal plane and mandibular plane nearly parallel to the angle of mandibular perpendicular to the flat edge under the lower jaw. Angle between long axis of upper and lower incisor is large.,喂址渍柬均滔输张脏牛硬赌票郝绸狗捐馁匿嵌蓄饯版硬王迁茫仓簇薯靳萄高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,16,二、高角病例和低角病例的临床特征 The case of high-angle and low angle of the clinical features,4、软组织和气道: 低角病例面型较凸, 软组织较薄以缓解侧貌中下颌外形明显。 Soft tissue and airway: Low-angle cases face is convex, soft tissue thin to alleviate and jaw shape is easily palpated.,蹄诸若损泊榷杆喂土享涡钠很减系迹讳醇切归华旬贱浸熟摔氯碌钢讫齐别高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,17,高角病例上下唇长度大于低角病例, 以补偿唇闭合不良。高角病例舌位向下向后, 软腭向后倾斜, 气道在鼻咽和口咽处较窄。 High-angle cases, lower lip length is greater than the low-angle cases, adverse to compensate for lip closure. Cases of high-angle position of the tongue back down, soft palate, tilted back, the airway in the nasopharynx and oropharynx narrow.,琉巡沤侯平霍档蹄昭失契狸啪蕊寥曲式摄羽媒叛浆门癣钥蜘烛朴隶识松刊高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,18,二、高角病例和低角病例的临床特征 The case of high-angle and low angle of the clinical features,5、口颌系统功能Stomatognathic system function: 高角病例口颌功能较弱,主要表现在咀嚼肌肌力小、口周肌张力低下,力较小, 由于正中位和正中关系位之间前后距离较大, 下颌的运动以水平向为主; High angle cases stomatognathic function is weak, mainly in the masticatory muscle strength is small, perioral hypotonia, a smaller force.the difference between centric occlusion and centric relation is larger, lower jaw movement mainly on horizontal direction. 低角病例口颌功能较强, 咀嚼肌肌力大, 力亦大, 正中自由度小, 下颌以垂直运动为主。 Low-angle cases Stomatognathic powerful chewing muscle strength, force, the middle of degrees of freedom is small, lower jaw movement mainly on vertical direction,宰中酵说常泥拭辰伎哈墓岂呼尝展感炳规帮食低账雨骑煤朔痞驾癌顾具伙高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,19,三、正畸治疗特点 Orthodontic treatment characteristics,高角病例和低角病例不仅在形态和功能上存在差异, 对正畸治疗的反应也截然不同, 这可能与二者下颌骨骨密度不同有关high-angle and low angle cases, there are differences not only in the form and function, but laso in response to orthodontic treatment, there may be different in mineral content of the two mandibular bone. 高角病例下颌骨骨密度低, 对施加于牙齿上的力量更敏感,牙齿移动速度较快High-angle cases of mandibular bone mineral density is low, the force imposed on the teeth more sensitive, faster tooth movement; 低角病例下颌骨密度较高,对矫治力不敏感The cases of jaw bone density of low-angle high, is not sensitive to the orthodontic force。,孝舌戳煌胜谣吉治焦倪汽筑速迢浅烟藩审扼坍执蒲饭仅佃传帝厚曹紫膳油高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,20,1、正畸治疗的时机 The timing of orthodontic treatment:,由于高角病例比低角病例青春迸发期出现早, 所以高角病例的矫治年龄较低角病例小。在青春迸发期开始之前对高角病例进行垂直向控制, 可以减缓或抑制下颌的向下向后旋转, 应提倡早期治疗, 最好是在颌骨和牙槽骨垂直生长活跃期。Due to the high incidence of high-angle cases than the low-angle case, high angle cases are treated earlier than low angle cases. vertical growth should be control before the incidence in case of high angle case. high angle case required early treatment, preferably in the active period of the vertical growth of the mandible and alveolar bone 而低角病例相反, 可等到生长快速期末开始治疗。但如果骨骼畸形比较严重, 通过生长改建及牙齿代偿不能达到矫治目的, 需成年后手术治疗者则应等到生长发育基本停止后进行治疗。 On the contrary, low-angle cases can wait until the cessation of growth spurt. If skeletal deformities more serious, the correction can not be achieved through the growth alterations and teeth eruption. surgical treatment should wait until the required adult growth and development basically stopped.,钙掖猫妓拍堂可星红项充街验幸映淖僵缄楷力吝畦怎萝凶侯圈肯辰俱红屏高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,21,2、早期矫治Early treatment: 对存在功能因素的高角病例或低角病例, 应结合病因治疗及肌功能训练。 Should be combination of removal of the cause muscle function training 替牙期存在严重拥挤时, 高角病例不宜草率实施序列拔牙, 因为牙齿较早拔除, 不利于嚼肌功能, 使咀嚼肌得不到充分的锻炼, 后牙更易伸长, 应拖延至活跃生长减速后装置固定矫治器时再拔牙 During mixed Dentition period, existence of severe crowding, the high-angle cases should not be hasty implementation serial extraction, because the earlier removal of teeth is not conducive to masseter muscle function. Serial extraction should be delayed until active growth deceleration;,椰苯矗隘惧咳嫡声急私这趾隧泰五宪车噪野撵篇卖数狙噬括春腊甸冉鉴寇高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,22,低角病例则可适当进行序列拔牙, 利用牙齿自然生长的力量关闭间隙、解除拥挤, 矫治高角病例的功能矫治器应是抑制后牙伸长的后牙牙合垫、口外唇弓或FRIV 型矫治器; 而多数能促进后牙伸长的功能矫治器, 如Activator , 适用于低角病例。Low-angle cases can be appropriate for the serial extraction, teeth has the natural growth power to close the gap, and relieve congestion. For the correction of high-angle cases, functional appliance which inhibit tooth eruption is used like extraoral lip bow or FR-IV the type of appliance; functional appliance which promote tooth eruption,such as the Activator, apply to low-angle cases.,FRIV 型矫治器,烫吊房页辰甫椰绢户却函屠塌镊遍域错皆三灼芭撞小厅葛殴窖拐天父样独高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,23,扩弓矫治器使A 点向前向下移动、上颌位置改变, 肯定会导致下颌向后向下旋转, 减小了下颌的有效长度, 增加下面部的垂直高度, 故不适用于高角病例。Expansion arch appliance allows maxilla to move forward and downward that will certainly lead to the lower jaw backward and downward rotation, reducing the effective length of the lower jaw, increasing the vertical dimension. it does not apply to high-angle cases. .,泉室围勺浇脾疗捍哭藕图鸦掐摄樊慷孙欧恬来疑助咖饺澈陕夜染好珠柳莱高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,24,口外弓的使用可阻止A 点前移, 使腭平面向下倾斜, 口外力的方向可影响下颌的旋转方向, 如口外力向下向后( 颈牵引) ,可使牙齿伸长, 下颌顺时针旋转; 方向向上向后, 即高位牵引, 牙齿压低, 减小顺时针旋转, 甚至增加逆时针旋转, 由于磨牙区生长减小使髁突生长得以表达, 适用于高角病例。 The use of the face bow to prevent the point A to move forward, palatal plane to inclined downward, the direction of extra oral force can affect the direction of rotation of the mandible, such as backward and downward extraoral force (cervical traction),may prevent tooth elongation, mandibular clockwise rotation;i.e.High traction prevent teeth eruption, reduce the clockwise rotation, or even to increase counter-clockwise rotation due to the growth of the molar area to reduce the condoyle growth to be expressed, for high-angle cases.,恿节遥囊估拷紧游实弱氓救傅掷榆硒辫堡弯僻维从医酌挛吹叫恬遵哭脖哨高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,25,低角病例使用颈牵引以刺激齿槽突的垂直向生长, 有利于面型的改善。垂直牵引颏兜的使用可以通过保持颏的位置或使颏向上影响面下部的垂直高度, 还可使力传导作用于牙周膜、延缓后牙的萌出, 所以适合不希望下颌顺时针旋转的高角病例。 Low-angle cases cervical traction to stimulate alveolar sudden vertical growth is conducive to the improvement of the face. The use of vertical traction chin cup can maintain the position of the chin or vertical height of the lower face, but also the role of hydraulic conductivity in the periodontal ligament, delaying the eruption of posterior teeth, for do not want to mandibular clockwise rotation of the high-angle cases.,铺恢疡往视得疹器关仪旁纫背诧锦百孟制扒炮童齐纠园酵捞级尝诣跑婿辱高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,26,3、治疗反应及注意事项 Response to treatment and precautions,1) 颌间牵引力的使用 2) 弓丝 3) 牙合垫 4) 上颌前牙位置的控制 5) 后部垂直高度的控制 6) 口外力,1) intermaxillary traction use 2) arch wire 3) occlusal pad 4) control of the maxillary anterior position 5) the rear of the vertical height of control 6) port external,甄槛署抄术宛供卿虏量姐蓬墟瑟拼密填主噬翼竞来胖咋遏循抹级赶傣更扑高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,27,4、保持:,由不良习惯造成的高角病例或低角病例在破除了不良习惯以后, 形态发生了适应性变化, 如果新的环境能够维持于生理限度内的话, 结果基本稳定甚至不需保持。对有骨骼因素的病例, 应尽一切努力来维持治疗结果的稳定性。 Cases of high-angle or low angle cases caused by bad habits, get rid of bad habits, morphogenesis adaptive changes in the new environment can be maintained within physiological limits, then, the results are stable even without keep. Cases of skeletal factors, should make every effort to maintain the stability of treatment results.,廓登掂菠节枝豢几胸锗玖弟腻贪践饶帖先裂障鸯萧锤蒸夫弛蝉厂中忧瞩膛高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,28,保持:,对有原发或继发吐舌习惯的病例可在保持器上装置舌刺、舌弓和横腭杆也适用于高角病例的保持。 Primary or secondary spit cases of tongue habits tongue barbed retainer device. Lingual arch and TPA bar also applies to the case of high-angle to maintain 低角病例, 特别是伴有深覆者, 保持器上应加平面导板或使用Activator 保持Low-angle cases, in particular, is associated with deep overbite, the cage should be added to the flat plate or use Activator to maintain。,Activator,缆榨蓄附吵肤对拟挂顺管咆崎许湘迁馆纤策菲傻翻铰勘盒敖国酬新盲扒帕高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,29,THANKS,颓章赢资丁蓉烂赂船尺男蕊陌墟征废旨银擒嘿呕昭拴旋猪口苑悍些彦椒欧高角和低角病例的诊断、临床特征及正畸治疗特点高角和低角病例的诊断、临床特征及正畸治疗特点,