上海口腔医学 ›› 2022, Vol. 31 ›› Issue (6): 561-568.doi: 10.19439/j.sjos.2022.06.001

• 述评 • 上一篇    下一篇

含颌位因素错畸形与颌位重建基本原理

沈刚   

  1. 上海泰康拜博口腔医院,上海 200001
  • 收稿日期:2021-08-10 修回日期:2022-06-24 发布日期:2022-12-29
  • 通讯作者: 沈刚,E-mail: shengang03@bybo.com.cn
  • 作者简介:沈刚(1964-),男,博士,教授,博士研究生导师

Malocclusions with mandibular positional deviation: etiological factors, therapeutic restorations and clinical fundamentals

SHEN Gang   

  1. Shanghai Tai Kang ByBo Dental Hospital. Shanghai 200001, China
  • Received:2021-08-10 Revised:2022-06-24 Published:2022-12-29

摘要: 正畸意义上的正常颌位是指上下牙列咬合时达最大接触面积、上下磨牙为中性尖窝关系、颞下颌关节(temporomandibular joint,TMJ)盘-突-窝呈协调关系时的下颌位置。下颌在矢状向、水平向及垂直向游离于正常颌位的状态称颌位偏离,是造成咬合异常及错畸形的重要因素。颌位偏离发生机制涵盖生理性与病理性两大范畴。矢状向生理性颌位偏离的发生机制是为了协调上下牙弓的宽度,下颌位置出现后退或前徙:下颌后退常见于颌位性、混合l型及混合ll型突面畸形,而下颌前徙常见于颌位性凹面畸形。水平向生理性颌位偏离的发生机制是为了跨越局域性咬合障碍,下颌位置出现侧偏,常见于直面错畸形单纯颌位性偏颌。矢状向病理性颌位偏离的发生机制是髁突病理性对称吸收,下颌位置出现后退,常见于骨源性突面畸形,简称突吸退。水平向病理性颌位偏离的发生机制,一是髁突病理性不对称吸收,下颌位置出现侧偏,常见于骨源性突面畸形,简称突吸偏;二是髁突病理性不对称增生,下颌位置出现侧偏,常见于骨源性凹面畸形,简称凹增偏。正畸意义上的颌位重建就是将偏离正常位置的下颌纠正到正常位置上来,在此基础上改善因颌位偏离而造成的咬合紊乱。颌位重建模拟与咬蜡记录是取得临床疗效的关键环节,而GS隐形矫形技术,包括S8-SGTB、S8-SGHB、S9平导及S10垫是主要临床治疗手段。相比传统固定矫形技术,GS隐形技术具有矫形矫治完全融合、颌位改变与牙移动精准实现等优势。牙周改建、骨缝改建,尤其是颌位改变引发的髁突适应性改建及其盘-突-窝关系调整,不仅是颌位重建重要的组织学生物学基础,同时在一定程度上缓解甚至阻止颞下颌关节病(temporomandibular disorder,TMD)的进一步发展。

关键词: 颌位偏离, 髁突改建, 颌位重建, GS矫形技术

Abstract: The definition for a normal mandibular position in orthodontic regime includes two perspectives: an occlusion with maximum contacts with Class I inter-digitation, and an integrated relation between the components within temporomandibular joint (TMJ). Any displacement or deviation of the mandible from its normal position may result in anomalies in occlusion. Mandibular displacement can occur due to either physiological or pathological factors. The physiological deviation of the mandible at sagittal dimension is often caused by the phenomenon where the mandible moves forward or backward to coordinate and match the transverse width with the upper dentition. The physiological deviation of the mandible at transverse dimension, on the other hand, is mainly generated by the scenario where the mandible relocates its position to avoid some regional occlusal irregularities. The pathological deviation of the mandible at sagittal dimension is often taking place when condylar resorption progresses, leading the mandible to retrude backwards. Nevertheless, if the pathological degrading or hyperplasia of the condyles between two sides are unparalleled and asymmetrical, mandibular shift at transverse dimension would occur. The therapeutic restoration of the malpostioned mandible aims to relocate the deviated lower jaw into its relatively normal position, enabling a subsequent correction of the malocclusion. Bite registration and recording based on mandibular re-localization remain the vital and critical procedures in clinical practice. With the advent of clear aligner orthodontics, the clear versions of orthopedic modalities, namely, S8, S9 and S10, are specifically designed to alleviate mandibular displacement, therefore escalating the treatment efficacy by repositioning the mandible and correcting the individual teeth simultaneously. Condylar endochondral ossification triggered by mandibular repositioning not only consolidates the restorative posture of the mandible, but more importantly, repairs the deteriorating condyles and subsequently relieves temporomandibular disorder (TMD) conditions.

Key words: Mandibular displacement, Condylar remodeling, Mandibular relocation, GS orthopedics

中图分类号: