高角和低角病例的诊断临床特征及正畸治疗特点

1、.1 高角和低角病例的诊断、临床特征及高角和低角病例的诊断、临床特征及 正畸治疗特点正畸治疗特点 High angle and low angle cases, diagnosis, clinical features and orthodontic treatment .2 由于以往的诊断是以安氏由于以往的诊断是以安氏 分类为主分类为主, 正畸医生常常正畸医生常常 只注意到矢状向错牙合而只注意到矢状向错牙合而 忽略了垂直向不调。忽略了垂直向不调。 近年来近年来, 学者们逐渐认识学者们逐渐认识 到垂直面型在错畸形诊断到垂直面型在错畸形诊断 和治疗中的重要性和治疗中的重要性: 它不它不 仅为颅面

2、复合体的生长方仅为颅面复合体的生长方 向提供了线索向提供了线索, 而且直接而且直接 影响治疗的成功与否。影响治疗的成功与否。 Previous diagnosis was based on Angles 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 dime

3、nsions 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. .3 垂直向异常有高角和低角两种类型垂直向异常有高角和低角两种类型, 在在类类 安氏错牙合中约有安氏错牙合中约有50%左右的患者存在不同程度左右的患者存在不同程度 的垂直向异常。的垂直向异常。 Vertical anoma

4、ly 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 .4 一、一、高角病例和低角病例的诊断和形成机制高角病例和低角病例的诊断和形成机制 High angle and

5、 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)

6、、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.

7、.5 高角病例和低角病例的诊断和形成机制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 mandibula

8、r 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 co

9、rrect diagnosis should be combined with other indicators .6 目前常用的诊断标准是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

10、 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%。 .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

11、( 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 ca

12、se. 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 fo

13、r low-angle case. .8 二、高角病例和低角病例的临床特征二、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、面型: 正面观正面观 高角病例多为窄长脸高角病例多为窄长脸 型型,两侧下颌角不明显两侧下颌角不明显, 鼻鼻 根部较窄根部较窄, 常伴有唇功能常伴有唇功能 不足、开唇露齿不足、开唇露齿; 低角病例则多为宽短脸型低角病例则多为宽短脸型, 两侧下颌角呈方形两侧下颌角呈方形, 鼻根部鼻根部 较宽较宽, 唇闭合十分自然。唇闭合十分自然。 .9 9 clinical

14、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

15、 a square, nasion is wide, lip closure is normal .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

16、 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. .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

17、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. .12 cl

18、inical 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.clini

19、cal crown is smaller. Curve of spee is deep.angle between long axis of upper and lower incisor is high 12 .13 牙弓狭窄、腭盖高拱 高角病例低角病例 上牙弓较宽阔 .14 二、高角病例和低角病例的临床特征二、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

20、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. .15 低角病例腭平面、牙 合平面和下颌平面接 近平行,

21、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. .16 二、高角病例和低角病例的临床特征二、高角病例和低角病例的临床特征 The case of

22、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. .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, lo

23、wer 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. .18 二、高角病例和低角病例的临床特征二、高角病例和低角病例的临床特征 The case of high-angle and low angle o

24、f 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 cen

25、tric 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 direc

26、tion .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 tw

27、o 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。 .20

28、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 gr

29、owth 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 co

30、ntrary, 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. .21 2、早期

31、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

32、 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; .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

33、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

34、-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 .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 certa

35、inly 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. . .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

36、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 pre

37、vent 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. .25 低角病例使用颈牵 引以刺激齿槽突的

38、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 t