上海口腔医学 ›› 2018, Vol. 27 ›› Issue (6): 561-566.doi: 10.19439/j.sjos.2018.06.001

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突面畸形分类与下颌形态分析

沈刚   

  1. 上海拜博口腔医院,拜博口腔医疗集团口腔正畸学科联合体,上海 200001
  • 收稿日期:2018-08-28 出版日期:2018-12-25 发布日期:2019-01-11
  • 通讯作者: 沈刚,E-mail:gangshen@orthosh.com
  • 作者简介:沈刚(1964-),男,博士,教授,博士研究生导师

Diagnostic classification for malocclusions with facial prognathism and its incorporation into mandibular morphological analysis

SHEN Gang   

  1. Shanghai ByBo Dental Hospital; United Orthodontic Institutions, ByBo Dental Group. Shanghai 200001, China
  • Received:2018-08-28 Online:2018-12-25 Published:2019-01-11

摘要: 突面畸形的诊断分类自提出以来,在正畸临床上逐步得到推广应用。该分类方法以颜面形态作为考察入口,结合咬合关系、牙槽突度、颌骨位置及下颌形态等多个因素作为系统完整的观测项目,将突面畸形分为牙槽性、骨源性、颌位性及混合性(包括混合Ⅰ型及Ⅱ型)4类。本文对突面畸形各分类的病理机制及相应治疗方案作深入探讨,并以诊断分类为指导,重新审视突面畸形的拔牙适应证。本文首次提出“下颌形态分析”这一重要诊断学概念,将头颅定位侧位片下颌骨体部总体形态与正中联合凹势的程度作为主要考察指标,得出了下颌2种主要形态(扁平长方形与厚重三角形)在突面畸形各分类中的分布规律:牙槽性及含有颌位后退因素的突面畸形下颌骨均呈扁平长方形,正中联合凹势较深,颏部前挺较明显。对于骨源性突面畸形,部分病例下颌骨呈扁平长方形,但正中联合凹势较浅,颏部前挺欠佳;而另一部分病例下颌骨呈厚重三角形,正中联合凹势浅,颏部无前挺而呈后缩。

关键词: 突面畸形, 诊断分类, 下颌形态, SGTB矫形

Abstract: Since its introduction, the diagnostic classification for malocclusions with facial prognathism has been well recognized and practically applied in orthodontic specialty. According to this classification, the malocclusions with a prognathic facial profile can be categorized into 4 classes: dento-alveolar originated, skeletally originated, mandibular positioning and combined skeletal and mandibular positioning, i.e, combined subtype I and subtype II. Among the new developments of this innovative malocclusion classification, the morphological assessment of mandibular body highlights a new impetus. Other than measuring the angular and linear perimeters only, this new dogma focuses on evaluating the physical contours of the mandible through cephalometric images. It includes the determination of geometric morphology of the mandible and the depth of symphysis curvature. Two types of mandibular morphology are common in patients with facial prognathism: a favorable flat and horizontally rectangular body with a prominent chin; and a unfavorable thick and vertically triangular body with a retrusive chin. The depth of the symphysis, on the other hand, is shown to be shallow or deep. It is noted that the prognathism with mandibular retruded positioning has a flat mandible and unfavorable triangle-shaped mandible exists only in skeletal prognathism. This new classification restricts the extraction indications for malocclusions with a prognathic facial profile: extraction should be refrained in cases with increased overjet, overbite and deep curve of Spee, and SGTB orthopedic therapy, instead, is recommended.[key words]

Key words: Prognathism, Diagnostic classification, Mandibular morphology, SGTB orthopedics

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