口腔组织病理学咬合治疗二正畸和正颌治疗中的牙合学问题双语.ppt

正畸和正颌治疗中的牙合学问题Occlusion study in orthodontics and orthognathic treatment 　CASE 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. 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. 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. 与TMD的发生有明显关系的特征性错牙合Characteristic malocclusions 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 深覆牙合Deep Overbite 　深覆盖　Deep Overjet 反牙合 Crossbite 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. b.关闭前牙间隙 Closing space at anterior region 上切牙内收Upper incisors moving palatally 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. 颌间牵引Intermaxillary traction 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。