1、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,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 Angles classification so orthodontists ofte
2、n 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, b
3、ut also directly affects the success of treatment.,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 typesofhigh-angle andlowangle,about50%ofpatients with angle class III malocclusion havevarying degrees of abnormalvertical dimensionhigh-angleandlowangle cases,diagnosis,
4、clinical features,and orthodontic treatment,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,
5、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 diff
6、erence, but often common in the clinical description of vertical type.,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 ashigh-angleand lowang
7、le, should not be confuse with the mandibularplane angle, if it is high, calledhigh angle case, and if small than low angle case. Becausethe mandibular angle and mandibular margin changes with growth,so simplemandibular plane angleasthediagnostic criteriamay mask thetruemandibularrotation and direct
8、ion of theverticalgrowth.The correctdiagnosisshould becombined withother indicators,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 faci
9、al 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%。,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-angleorlowanglecaseswitha high level ofgrowth and development before and after facial disorders后面部高度生长不足( 升支
10、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 facialgrowth ( ascending branch oftheglenoid fossa small) and/oranterior 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
11、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 heightovergrowth (the ascending branch ofaglenoid fossalong)and/orin lack of posteriorfacial growth(upward and forward rotation of condyle,lack of eruption of maxillary posterior teeth) is resposible for low-angle case.,8,
12、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。,9,9,clinical features of high-angle and low angle cases,Aface:front view: High-angle:long and narrowface, both sides ofthe mandibul
13、ar angleis not distinct,thenasion isnarrow,often accompanied with incompetent lip.,Low-angle casesare much morewideandshortface.Both sides of themandibular anglewas a square,nasionis 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
14、, 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 ch
15、in 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 archwith deeper hard palate,anterior proclination is rarely
16、seen.the height of clinical crown larger,the curve of speeisflatand the angle between the facial axis of upper and lower incisor is less.,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。
17、 Low angle cases:- broad upper arch with shallow hard palate, theincisorpositionismore uprightso anterior teethcrowding is common.clinical 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The case o
18、f 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
19、 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, 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. Angl
20、e 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.,17,高
21、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.
22、,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, perior
23、al 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 freedo
24、m is small, lower jaw movement mainly on vertical direction,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,
25、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 hig
26、h, is not sensitive to the orthodontic force。,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 treat
27、ed 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
28、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
29、 development basically stopped.,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 s
30、evere 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;,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
31、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 u
32、sed 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,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
33、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.,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
34、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 (cervic
35、al 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.,25
36、,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
37、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.,26,3、治疗反应及注意事项Response to treatment and precautions,1) 颌间牵引力的
38、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 use2) arch wire3) occlusal pad4) control of the maxillary anterior position5) the rear of the vertical height of control6) port external,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
39、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 ev
40、ery effort to maintain the stability of treatment results.,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,29,THANKS,
