KennedyⅠ-Ⅳ类牙列缺损

Kennedy -类牙列缺损的设计,研究生 潘领战 孟波 林川 指导老师 肖茂春教授,Kennedy -类牙列缺损的设计,活动义齿临床设计的思路Kennedy -类牙列缺损的修复设计,Considerations for removable prostheses,Decide which of the missing teeth are to be replaced and which saddles are to be restoredDeciding on the nature of the supportDeciding on the form of the major connectorDeciding on how the prosthesis will be retainedPlanning for stabilityReview of design with hygiene and maintenance in mind,Deciding which of themissing teeth are to be replaced and which saddlesare to be restored,plan holistically“formulate a tentative denture design concurrent with the formulation of the treatment plan.”,Deciding on the nature of thesupport, Class I: Denture supported by mucosa and underlying bone Result in Displace mucosa further loss of alveolar bone Class II: Denture supported by teeth Help to maintain alveolar bone means Class III: Denture supported by a combination of mucosa and tooth-borne means. instability Class IV: Denture supported by implants,Cingulum rests,occlusal rests,Incisor rests,Over denture,Deciding on the form of the majorconnector,Maxillary common major connectors,Palatal plate,Palatal strap,Anterior or posteriorpalatal bar,Skeletal design,Horseshoe design,Labial bar,Deciding on the form of the majorconnector,Mandibular common major connectors,Lingual plate,Lingual bar,Kennedy bar.,Sublingual bar,Labial bar,Deciding on how the prosthesis willbe retained,Direct retainers,Occlusally approaching claspGingivally approaching clasp,thimble crown,tooth-coloured polymeric material,clasp,Deciding on how the prosthesis willbe retained,Direct retainers,use of undercuts not on buccal or lingual of teeth,Use of bony undercuts, e.g labial undercuts in teeth anterior bounded saddles,Rotational path of insertion.,Guide planes,Deciding on how the prosthesis willbe retained,Direct retainers,Precision attachments,Use of resilient materialsSoft liner,Denture adhesives,Planning for stability,indirect retention,Review of design with hygiene andmaintenance in mind,Kennedy牙列缺损分类法,第一类:双侧游离缺牙第二类:单侧游离缺牙第三类:一侧或两侧后牙缺失,鞍基前后都有基牙第四类:前部缺牙,Kennedy-类设计的基本原则,保护口腔组织健康良好的固位良好的稳定性良好的支持作用达到一定的美观要求坚固耐用、方便取戴,Kennedy第一类牙列缺损,特点 1.双侧后牙游离端缺失 2.多设计为混合支持式义齿 3.多采用大连接体连接两侧远中游离端鞍基,Kennedy第一类牙列缺损,设计要点1.双侧单个后牙游离端缺失(1)基牙选择(2)支托设计(3)间隙卡环位置(4)人工牙设计,Kennedy第一类牙列缺损,设计要点2.双侧多个后牙游离端缺失(1)基牙选择(2)支托和卡环的设置(3)间接固位体(4)人工牙排列,Kennedy第一类牙列缺损,设计要点3.双侧后牙全部缺失,余留前牙条件差 采用粘膜支持式 尖牙上设计低位卡环,Kennedy第一类牙列缺损,设计举例,Kennedy第一类牙列缺损,设计举例,Kennedy第一类牙列缺,设计举例,Kennedy第二类牙列缺损,特点(1)单侧后牙游离端缺失(2)多设计为混合支持式义齿(3)多设计为与牙弓对侧相连,Kennedy第二类牙列缺损,设计要点(1)单侧一个后牙游离缺失 常规选择两个基牙,单侧设计,Kennedy第二类牙列缺损,设计要点(2)两个以上后牙游离缺失 牙弓对侧设计直接固位体 两侧用大连接体相连 按固位,稳定,美学原则加设间接固位体,Kennedy第二类牙列缺损,设计要点(3)牙弓一侧全部牙齿缺失 尽量利用牙弓对侧基牙 余留牙条件差时,尽量用塑料基托相连,提高义齿固位,稳定功能 口内仅留个别后牙时, 可不设合支托,Kennedy第二类牙列缺损,设计举例,Kennedy第二类牙列缺损,设计举例,Kennedy第二类牙列缺损,设计举例,Kennedy第二类牙列缺损,设计举例,Kennedy第三类牙列缺损,特点(1)牙弓一侧或两侧有缺失牙(2)缺牙间隙两侧均有天然牙存在(3)多设计为牙支持式义齿,Kennedy第三类牙列缺损,设计要点(1)缺牙间隙较小，而两端基牙条件较好时，在基牙上设计直接固位体即可。,Kennedy第三类牙列缺损,设计要点(2)缺牙间隙大，缺隙在牙弓一侧，前方基牙又较弱者，可用大连接体，利用两侧牙弓支持，并在对侧使用有间接固位作用的卡环,Kennedy第三类牙列缺损,设计举例,Kennedy第四类牙列缺损,特点(1)前牙缺失(2)多设计为混合支持式义齿,Kennedy第四类牙列缺损,设计要点(1)1个或2个前牙缺失,常选择两个基牙,基牙常为第一前磨牙(2)人工牙排列要避免深覆合,要与相邻的天然牙协调,与牙弓对侧同名天然牙对称,颜色尽量与天然牙一致,Kennedy第四类牙列缺损,设计要点(3)尖牙缺失,间隙小,合力不大的情况下,可在缺隙远中设置两个固位体,单侧设计义齿,使基托面积减小,便于发音(4)前牙缺失较多者,要增加基牙数,防止义齿发生唇舌