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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 of
2、ten 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,
3、 but 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 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 c
4、ases, diagnosis, 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( vertic
5、al excessive ) 为主, 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 conc
6、epts there is a difference, 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 as
7、 high-angle and low angle, should not be confuse with the mandibular 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 t
8、rue mandibular rotation and direction of the vertical growth.The correct diagnosis should be combined with other 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
9、) 后面高与前面高比值anterior to the posterior facial 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-angle or low angle cases with a high level of growth and developme
10、nt before and after facial disorders 后面部高度生长不足( 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 poster
11、ior teeth) is responsible for a high-angle case. 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
12、 maxillary posterior teeth) is resposible for low-angle case.,8,二、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,A face:
13、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 a square, nasion is wide, lip closure is normal,10
14、,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 low
15、er 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
16、 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,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。 Low angle cases:- broad upper arch with shallow hard palate, the incisor position is more uprig
