上海口腔医学 ›› 2021, Vol. 30 ›› Issue (1): 1-6.doi: 10.19439/j.sjos.2021.01.001

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偏颌与颜面不对称畸形的诊断、分类及临床意义

沈刚   

  1. 上海泰康拜博口腔医院,上海 200001
  • 收稿日期:2020-07-03 修回日期:2020-09-27 出版日期:2021-02-25 发布日期:2021-04-02
  • 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

Classification for mandibular deviation and facial asymmetry and its clinical significance

SHEN Gang   

  1. Shanghai Tai Kang ByBo Dental Hospital. Shanghai 200001, China
  • Received:2020-07-03 Revised:2020-09-27 Online:2021-02-25 Published:2021-04-02

摘要: 依据临床特征、病理机制及颌骨结构,偏颌与颜面不对称畸形可分为单纯颌位性、关节源性与颌骨发育性3大类。单纯颌位性偏颌包括咬合阻碍、咬合代偿及咬合习惯亚型,关节源性偏颌包括髁突不对称吸收与不对称增生亚型,颌骨发育性偏颌包括上颌源与下颌源亚型。正畸治疗偏颌与颜面不对称畸形的重要原则是最大限度地纠正形成下颌偏斜的功能性颌位因素,在颌位重建的基础上再进行咬合重建。在正畸临床上,颌位重建模拟与蜡垫记录是达到精准颌位重建的重要环节。对于单纯颌位性及关节源性偏颌,颌位重建的矫正方法包括解剖式垫与平导、SGTB与SGHB技术等;对于颌骨发育性偏颌,治疗手段则主要依赖于手术。

关键词: 偏颌畸形, 诊断分类, 颌位重建, 矫形治疗

Abstract: Judged from the clinical manifestations, etiological mechanisms and jaw morphological structures, malocclusions with mandibular deviation and facial asymmetry are classified into three main categories, i.e., those with mandibular positioning factors, those with mandibular condyle defects, and those with jaw congenital deformities. In the first category, three subtypes, including mandibular rotation caused by dentitional irregularities, by dental compensation and by habitual posturing, are further defined. In the second category, mandibular deviation caused by condylar asymmetrical resorption or hyperplasia are defined as the two subtypes. The third category is further divided into two subtypes, i.e., jaw and facial asymmetry resulting from maxillary or mandibular structural deformities. The prime goal of orthodontic therapy is to displace and restore the deviated mandible to its right position, followed by correction of occlusal intercuspation. As an important procedure of the whole treatment protocol, It is critical to detect and localize the correct mandibular position by manipulation and then register it by wax pattern and articulator transferring. For the cases with mandibular functional elements and condylar asymmetrical length, the treatment modalities include orthopedic repositioning of the mandible by using occlusal and bite plane, SGTB and SGHB therapies; for cases with growth and developmental anomalies, orthognathic intervention should be an optimal solution.

Key words: Facial asymmetry, Diagnostic classification, Mandibular repositioning, Orthopedic therapies

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