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三、颌位关系记录与转移
颌位关系记录与转移包括记录上、下颌在垂直和水平向位置关系,采用面弓记录上颌与颞下颌关节的关系,并将记录的上、下颌及颞下颌关节的三者位置关系转移并固定到
架上。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_971_588_993_610.png?sign=1739673934-Wb2TZTLBe5UXwQfsGNGsJEi0ilv1Y5Gv-0-5dd5a66df64fa91ba2dad41fccf4859e)
(一)颌位关系记录
颌位关系记录是指用
托来确定并记录在患者面部下1/3的适宜高度,以及两侧髁突在下颌关节凹生理后位时的上下颌位置关系,即确定并记录垂直距离和正中关系。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_439_654_461_675.png?sign=1739673934-cj85r3540rvXl9BZFqW1IjNRHA9X22Zf-0-e8d0aacb3ab7aaa70e0efb621dbf91ff)
1.确定垂直距离
垂直距离为自然牙列呈正中
时,鼻底至颏底的距离,也就是面部下1/3的距离。牙列缺失和牙周组织吸收后,上下无牙颌牙槽嵴顶形成的间隙称为颌间距离。确定垂直距离临床最常用的方法为利用息止
间隙法,此外还有面部外形观察法、发音法、面部比例测定法以及利用拔牙前记录或以旧义齿作参考。上面几种方法可以相互印证,用蜡
堤记录垂直距离。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_690_719_711_741.png?sign=1739673934-rQyJQ8OIh0sVbTP10ycXtiJ5STYFnZPN-0-07458f88159d002c63f71b12b45dbc63)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_665_785_687_807.png?sign=1739673934-CLbR1LhpxPWgS4upO2SgCCd041YmxuNe-0-c402f509aa10f09fb4dc311271ae79c4)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_275_851_297_872.png?sign=1739673934-T7V2Fl9D8hYBVKTF822W9Zbk64b6LVHj-0-b4d0713410b0c5bc94d4d7da12e61b4c)
2.确定正中关系
临床常用的方法有哥特式弓描记法、卷舌后舔法、吞咽咬合法、后牙咬合法以及医生手法辅助法。在确认患者能够咬合在正中关系位时,就可在原先已经确定好垂直距离的上下蜡
堤之间放置记录材料(咬合记录硅橡胶或蜡)来记录正中关系。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_393_949_415_971.png?sign=1739673934-D2kRCTDzUddPkdKp4fRBwvJsvryHZaMT-0-869b5d93c9c0122dc4c127ceaf39d3dd)
3.蜡堤记录形态学信息 (1)前牙丰满度:
医生修整蜡
堤前部的前后位置和弯曲弧度,技师参考曲度排列人工牙。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_517_1015_539_1037.png?sign=1739673934-1ZiCXFbZ5d1vx8g7lR9tONr8xVfxWjbh-0-dc44315aa03cc14878c8e626106f9041)
(2)平面位置:
修整上下蜡
堤的分界面,在前部注意美观、协调,在后部注意平分颌间距离,与下颌运动协调,并符合横
曲线和补偿曲线曲度。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_517_1080_539_1102.png?sign=1739673934-fH07JQM4Wjf24wkJ9irAuAMue27aSO86-0-14340011583314d1c192517264946e19)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_550_1113_572_1135.png?sign=1739673934-28C10sxkI0M3Jqe8N7rA3cYPG8EHMLIh-0-baa373661d818e14ac7eb9c87f709c6a)
(3)记录口腔中性区:
一般将印模材料置于消减后的蜡
堤唇颊舌面,记录唇、颊、舌肌肉作用的平衡区,供技师排牙参考。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_763_1146_785_1168.png?sign=1739673934-2VAhQe4UX0LL02NleLNyEZswf2XZiqk0-0-2654ad3a4cf8744887e97d01c9392af6)
4.在堤唇面画标志线
上下
托形成后,将上下
托就位于口中。以蜡刀刻画一些标志线于
托唇面。标志线可用来选择人工牙的长度、宽度和指示人工牙排列的位置。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_531_1212_553_1234.png?sign=1739673934-aLZWMkcbrgzJn5YvdzBTfyuTRuFJltPU-0-4dafc57396506daf3630b656c171192c)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_721_1212_743_1234.png?sign=1739673934-2E0tuTRwLktOgC7Bc9m85jwCKHJEo3JF-0-ac37143fe1bbeb8e95397e3cc9f892db)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_282_1245_304_1266.png?sign=1739673934-PqqIFrGI49VtWfqUkioXpofecXkjcAM4-0-e90dcb1c8e6c8dad3c31fb7ad367ff13)
(1)中线:
参照整个面形确定中线,并画在
堤前部唇面,代表面部正中矢状面所在的位置,作为两个上中切牙交界的标志线。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_639_1277_660_1299.png?sign=1739673934-g6DLP6gSnr17KgUM4zK2X8L98NF2QQlM-0-a4f352a7c2090d924fb11cfa509255a6)
(2)口角线:
当上下唇轻轻闭拢时,画出口角在
托上的位置,口角线也是垂直于
平面的直线。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_683_1343_705_1365.png?sign=1739673934-UlMDhH68xfs9yCmVaR43cB5Tvae4moHv-0-988519afbecb8e4f7f8a9ae998e11079)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_1007_1343_1029_1365.png?sign=1739673934-gwYfTt2DymmDvIixSw9dWA6CKfsNdWP7-0-dd933735c7b152571cf50fcf2450c610)
(3)唇高线和唇低线:
上下
托在口中就位,嘱患者微笑,以蜡刀画出微笑时上唇下缘和下唇上缘的位置线,上唇下缘在上
托唇面上形成凸向上的弧线和下唇上缘在下
托唇面上形成凸向下的弧线。唇高线、唇低线也叫笑线。笑线又分微笑和大笑两种笑线。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_491_1409_513_1431.png?sign=1739673934-Ak49TIZ0NC2nQ2aC7jE07MDOUNIZhRY7-0-70abd471967977308c1cdbe82526dc41)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_541_1442_563_1463.png?sign=1739673934-Ss5vFNXksW8ELwcOEM118MtpE4y8XYFV-0-576d485e7bbd7aece3469babc72150ec)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_75_985_1442_1007_1463.png?sign=1739673934-iofruWwqF8DeaSYXNECX93pDqT5TEgrk-0-cd345d255c24295546f253148b45c427)
(二)颌位关系转移
颌位关系转移,又称上
架,就是将带有上下
托的上下模型用石膏固定在
架上,以便保持上下模型间的高度和颌位关系。
架是一种固定上下
托和模型的仪器,它具备与人体咀嚼器官相当的部件和关节,能在一定程度上模拟下颌的运动。上
架需借助于面弓将患者上颌对髁突的固有位置关系,通过上
托转移至
架上。这样,上颌模型固定在
架的位置就与患者上颌对颞下颌关节的固有位置关系相当,
架就可在口外模拟患者的口内情况,以便进行排牙及排牙后的调
,使在
架上完成的全口义齿戴入口中,能更符合或更接近患者的实际情况。根据
架模拟下颌运动的程度不同,可将
架分为:不可调
架、半可调
架及全可调
架。具体上
架方法见后面操作部分。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_468_260_490_282.png?sign=1739673934-7tLmd8gNOb44UsDvdTtJsUotzTzGF2G0-0-e9b976be94c06468bbec93e98918842f)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_680_260_702_282.png?sign=1739673934-W7dzjgfm5OLGLk5DCc4SdeRNhgzqmGns-0-b125d0daaca147f4b5361a88df36e005)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_967_260_989_282.png?sign=1739673934-bmHw2Xkq1oNE6PMEf1sss0qI8LtoAb0T-0-09d03e0b30d523cc83eacb345bd1563f)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_589_292_611_314.png?sign=1739673934-WHiPlG1QtdWmsa9MzR1k4gzOIXfa39Vf-0-805e3c92b805703686f230fb621b2759)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_789_292_811_314.png?sign=1739673934-ZoXj9yjH1CQgxLd3J0uSeRkQUsTcNpPJ-0-6c2cd0a25768d96eebf6be0c4437b140)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_892_325_914_347.png?sign=1739673934-rUKNpN9WhgVA7S92GX9k5IIErTxGfCNu-0-d5685f42770203c26559b9478bb10894)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_630_358_652_380.png?sign=1739673934-SBeQqtUoQlD8uPzOAijJHTcMYoAIZh8P-0-36a846f9e6bb0d9081e6adf3327e28cf)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_742_358_764_380.png?sign=1739673934-hn3eSL1PcEGYwjXxYOUOKjmxidOHzyVh-0-6afdddc114c8dc3d407499011318c167)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_1048_358_1070_380.png?sign=1739673934-yB5aHXQjIPoz0pL67w7h8O49oVzyhrKk-0-a763258b72b33e4d7b972a27a5a8c5f4)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_782_391_804_413.png?sign=1739673934-TU3sw51blUuJtErgxKhlQAgfHEo9ifWM-0-8a2f87bd38529e424c11f08817feb28e)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_558_424_580_446.png?sign=1739673934-lq79x0B3iVpUQ4klB3GyvRNE2Q0onAJ2-0-f9461dccd3180d5b5bedf6280ea3cbc6)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_638_424_659_446.png?sign=1739673934-8iMqfwGA4kL1QsvtOGY0f9ZbCPFKRa6f-0-520afcdbd723b9b71c3eb8aa9fe02a82)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_500_457_522_479.png?sign=1739673934-bnfLoDTj9fgRsFcFUUAJfFJdYAxJ9LiL-0-daaeb2f786b5bdde0e007e93edd38f12)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_845_457_867_479.png?sign=1739673934-66cqEkXExJFGNnrcAN3Nd2N6VYAsBv55-0-76b5e459436893dbec23be546bd7475e)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_1014_457_1036_479.png?sign=1739673934-nTEUUL2jn7JQZMumzVXzLSKQVlXOO8oh-0-6aa9ee9bd51fc6135b5369ecfce95c4b)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_279_489_301_511.png?sign=1739673934-dQVvog42mjvubAKN3ZWIOaeG53YUfZab-0-837a249e65d78cd82cd6ccd4fc3a471f)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_410_489_432_511.png?sign=1739673934-5ZLE4FLrIkleI5McKKJX8bZ3aZ78M7cB-0-5dbd7562fe1f1f34fe53936817ccebca)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_541_489_563_511.png?sign=1739673934-WgdqZa5MAnKgv1TA72KC9g6hD1fP0kDO-0-1dcf24cf90c312815eab3898f4b2869e)
(三)颌位关系检查
制作无误的全口义齿戴在患者口中作正中咬合时,上下颌牙列应有良好的咬合关系,也可能会出现下颌后退、下颌偏斜或前牙开
的现象。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_620_588_642_610.png?sign=1739673934-rRLrq4dboFleSmfFsgCTk1TgUWsTgyg2-0-f417bcad24e2941aab1ab27eb492423a)
1.下颌后退
确定颌位关系时,如果患者作了前伸动作,而又未被及时发现,戴义齿时下颌回到正中咬合位置,就会出现下颌义齿后退现象。表现为上下前牙水平开
,垂直距离增高。如果仅有很小范围的后退,可重新上
架适当调改有关的牙尖即可。若后退的范围较大,必须返工或重做。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_966_654_988_676.png?sign=1739673934-iZHA2dEr5cndhqWCvI4ovnBfAWOULPQQ-0-3ff67d75c1df619829923e9901e8d47b)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_649_686_671_708.png?sign=1739673934-TCBYb5LUNsZuT98XmFDRqlKRZSzTQM8o-0-bca03b514618d6fb8e1502c0170a867a)
2.下颌偏向一侧
确定颌位关系时,如果患者下颌偏向左侧,戴义齿时下颌会出现偏向右侧的现象。表现为上下义齿中线不一致。应重新制作上颌或下颌义齿,有时需重做上、下颌义齿。下颌义齿偏斜也有假象,常因某处有疼痛所致,消除疼痛原因后,偏斜也随之消失。
3.前牙开
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_352_883_374_905.png?sign=1739673934-xzxUmiBgiirZFjBYxETXk1FmSEmqLQSJ-0-6de11d43b336041c50102d8180bbee67)
义齿前牙不接触,后牙接触为开
。轻度开
者,可重新上
架磨改后牙牙尖,严重者应返工,重排后牙。但应鉴别有无假性开
,如外斜嵴处黏膜过薄而形成硬区、磨牙后垫区取印模时受压致使相应的义齿组织面局部突起均可形成假性开
。经检查修改后,开
即可纠正。
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_700_883_722_905.png?sign=1739673934-GTXHIWfDOzec4WwBcmFCfqs9SabufK5m-0-c865ef23e15a413b51c67cd72ae317f3)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_811_883_833_905.png?sign=1739673934-03xjU6qGJw705G3uFP5pUVEwjyjY8JiO-0-c769eb9006fc154bf2ddb4aa64770b5a)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_959_883_981_905.png?sign=1739673934-lkABdChkyomZHK0jDc0T939AoBrsT2ZC-0-75500309c4ae6e2dac8e8a74a85ff657)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_748_916_770_938.png?sign=1739673934-ByCuo50y3st1cTFwg9VR0UdDaa4m8OBL-0-d8883aad3b1371a391f830c474c1eeea)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_959_949_981_971.png?sign=1739673934-hOYPv0p2RKbGnl4sPSPES8dCZnwGfnKZ-0-3dcda7dd8914719bb2ab9c11e17638b7)
![](https://epubservercos.yuewen.com/36C289/19400086508719006/epubprivate/OEBPS/Images/BZ_76_315_982_337_1004.png?sign=1739673934-GANcYX1aQCoJZBD5lBMRMDKeNuUfU3t9-0-b2cb62eb92ca7e8986ba277b38400de8)
(张少锋 田 敏)