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第五章 上
架、排牙和雕牙
第一节 上
架
【相关知识】
一、
架的种类
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_289_636_312_659.png?sign=1738851327-jcJfwKm8wXcdQaHQ9RlOfPxJV7o44p5S-0-2d4ff336748802dd901052c402085a21)
根据其关节结构、模拟下颌运动的程度不同,可将
架分为简单
架、半可调节
架和全可调节
架三大类。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_707_686_729_708.png?sign=1738851327-jchsBSNY8quyOyPj1EKxy7Gc3Zb89Mv4-0-e8f05f4f767e7ca16882b05b94339041)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_839_686_861_708.png?sign=1738851327-1DWFoa2ceFsvC9gz7HEW8OA7rQ0RtFOX-0-8bed4f53891bba7b70cb2628d3b0800f)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_985_686_1007_708.png?sign=1738851327-CpGEbWHE6sNT4JBtxZF5majV5MDBms73-0-5a3978dce2e8b76f247784327ac6c6fd)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_282_719_304_741.png?sign=1738851327-4GLI0Lit2KiKCK2YGuV2DIZYshVQIWVQ-0-8caadc87a5f7454ca2067d7cbea5eab0)
(一)简单
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_336_750_357_771.png?sign=1738851327-hQiLLQGPXfWjKlThf1jzhiFsxIBuuwAn-0-7863c97889ccffc05c1895655e93f42f)
简单
架又称为不可调节
架,分为单向运动式与多向运动式两种。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_282_785_304_807.png?sign=1738851327-A4apMznOAkSuqJNUHxTzqBctmGZ6Hxe9-0-c08c49bb11f0e56a35b44aeb0f047285)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_479_785_501_807.png?sign=1738851327-syxFufzJb0AeFBXVd2eCWw2E1gxlFXjX-0-ffa311df8e23738c95ad0d007ae234d5)
1.单向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_378_818_400_840.png?sign=1738851327-52uX4Eg8mUVOVnoxn41mXSs9V5MOF5s7-0-fec55459d534e28f55bfecc1d46c1c80)
结构最简单,上下颌体之间为铰链轴,仅可模拟下颌的上下开闭口运动。可保持上下颌模型的位置关系及上下牙列的正中咬合接触关系,不能模拟前伸
及侧方
的咬合关系。一般用于牙体缺损的修复,不宜用于牙列缺损及牙列缺失的义齿修复。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1030_851_1052_872.png?sign=1738851327-I0DFlZiBECecolnt4gfyUor5aDPIkTq2-0-6bb69dbe567ef2eebb5d885ac72387c6)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_264_883_285_905.png?sign=1738851327-jgrnGnxuas1UMGn7LIuW2Dfnk9vZcrdd-0-29812f8cfc02824c2dc4e978ab37337c)
2.多向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_377_949_399_971.png?sign=1738851327-BRamuLH99RaBpUs0oMjeCCcR1BCeOcJm-0-584cde24bc2c8d01596ea405911a6bc8)
又称为平均值
架,通过对大样本人群口颌系统个体运动参数进行测量和分析,取得平均值,以此值作为设定多向运动式
架参数的依据,又称平均值
架。平均值
架两髁突间的正常值范围为(105±5)mm,前伸髁导平均值为25°~30°,侧方髁导依Hanau提出的L=H/8+12经验公式,约为15°。切导平均约为10°。铰链轴采用经验铰链轴,一般取从耳屏中点至外眦连线上,由耳屏向前13mm处。由于未能转移患者的铰链轴位置,其设定的髁导和切导与患者实际的髁道和切道之间也存在差异,采用这些平均值的
架,在模拟下颌运动方面自然会出现一定程度的误差。该类
架可用于较短的固定桥、可摘局部义齿修复病例。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_575_949_597_971.png?sign=1738851327-oHgUWRUaq66D70bleYvsnfJZIKUrOsE8-0-02b4bac6bf21d9f1b6a781c311c2ae09)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_743_982_765_1004.png?sign=1738851327-vt0zXKkZWb6g7U69mP6UoC0gvomjjnvt-0-e10330cbe9174a1d6349e6aa9769cdc6)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1029_982_1051_1004.png?sign=1738851327-5O0W5aqGm3MfxrclB2LzEj8vxqLWR5bx-0-9a68ac25dbbd6204e0feb47dd2a32014)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_305_1015_327_1037.png?sign=1738851327-iTfUNnCctqpbQc0SeX2P0GVxMs4DnOdz-0-f6874cb1d1b4a61c97af8cfa82e0c415)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_239_1146_261_1168.png?sign=1738851327-RPZkFmpXkCIDhEO1zG7Of83LZEvA2nll-0-a7ee69bd9b9ca7bba63e5db1944491ee)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_830_1146_852_1168.png?sign=1738851327-95b6j7vyzIbD4hllFwfvmqCFI9GGL3KH-0-5376c0ab7a758350ead35e25b0e9e5ff)
(二)半可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1210_401_1231.png?sign=1738851327-VmRSjBqtPBNo7xcNFd2gKgOG05qkyilJ-0-aec758768d9b9833189ab6cfe7749c7b)
该类
架均配有面弓,能通过面弓将上颌与颞下颌关节的位置关系准确地转移到
架上。在模拟下颌运动程度上优于平均值
架,其髁导和切导斜度均可调节,通过面弓转移将患者铰链轴与上颌之间的关系转移到
架上,与每位患者的实际情况相对应,极大减少了垂直距离少量改变带来的整体咬合误差,可在很大程度上模拟下颌的前伸及侧方
运动。这种
架模拟下颌前伸和侧方
运动准确,操作简便,适用于牙列缺损较严重的固定义齿、可摘局部义齿和全口义齿的修复。半可调式
架的典型代表是Hanau H型
架。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_283_1245_305_1266.png?sign=1738851327-2cE8rT92uIk7GHaIMwarJho91axz7WKW-0-f642d9b2298a9058e0ddbf75d45377a3)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1007_1245_1029_1266.png?sign=1738851327-Ltgj4TJECxGyuD553YqaUm9ob6Go7Tbs-0-5c5ce34a48d3172de044c665d7a7954d)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1277_598_1299.png?sign=1738851327-PesXpJ0SreRE5D7NvNKPGk8DLRvaqaGJ-0-ff0d658da9386accf41829e2c35119c7)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1310_598_1332.png?sign=1738851327-XSikw6PvgjctJ7OqVuD6nRVPo3XBp5qX-0-3c6f5389fd0b34d9644f8dfc4dc8fab0)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_976_1343_998_1365.png?sign=1738851327-wLX73ntTyuVsBgN1G6kSlPiQB1Tl2ELP-0-cc5c1669dbd9dfc13f73fd0faeb2b962)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_240_1376_262_1398.png?sign=1738851327-rhzW6XWMV5Dv3yq9m5xcwgEBzQBSrLdU-0-e265ce31ebab62c1b9da8bbd9553874e)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_483_1376_505_1398.png?sign=1738851327-WMwPSBEOrq06E2VRV0TDx5RGZDevGv0u-0-92cb0b3bbffc44c05d543c029487dbc8)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_612_1409_633_1431.png?sign=1738851327-6C6V2URYDwIRc0saEXoVlw2KA2pujxwR-0-184f0e34115c798541199563bfa824b3)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_896_1409_917_1431.png?sign=1738851327-0Pvdoib4wuIA0du0Mrm0K6jKgVHq510F-0-83de6a1e1a0406a7c616bd3889f6e4dc)
(三)全可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1440_401_1460.png?sign=1738851327-vgwWtWGIOcTRwZaZrxKmGZikbBgBdooh-0-c781f07d715a30a89387e284b79384b2)
全可调节
架模拟下颌运动程度比半可调节
架更精确,除髁导斜度外,
架的髁球间距亦可调节,也可模拟迅即侧移等下颌运动特征,还可利用运动面弓将患者下颌三维运动特征转移至
架上,在
架上建立可准确模拟患者髁道特征的个体化髁导。由于此种
架结构和操作均复杂,多用于全口咬合重建治疗或科研工作。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_328_1474_350_1496.png?sign=1738851327-5fcgYrhAaIbAiZo8burc9gHnNEuttK1y-0-64683a7ec3733bf3eedcee54f24a5011)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_665_1474_686_1496.png?sign=1738851327-tlkUuDnIw28e8Ifrrh1PgkKeNmZ7ZaAP-0-ed1a82c97f7123e602a4a1368550e7a2)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_940_1474_962_1496.png?sign=1738851327-O2xhzjNpeyyDMhb5HOCnrfKdIfl2WXSA-0-bc0668708aa64eaa077353732c702714)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_346_260_368_282.png?sign=1738851327-jodNheGbZGi4b8dcSXUzpTZ72gX8RzzY-0-ad7d3bbd505db5f9ce4990e8553c2308)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_449_260_471_282.png?sign=1738851327-rWP6Jm2iXQoEbVGRU8wQpN6xNwkt7hQM-0-397d86cb2c76ababb4cb3a8d28ff677f)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1048_260_1070_282.png?sign=1738851327-yY80ecNPskRDFGXBCDMylqVggCaelN3t-0-abac3d6b9b33f4abe2e37b754a6e5432)
二、
架的用途
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_306_340_330_363.png?sign=1738851327-6H231gZkg05jGOJo1rkq5ku9zWKCkpIc-0-e800981184772d699862907bcce65ae2)
(一)能稳定、准确、可靠地重现个体的下颌正中关系位或正中颌位
这是
架最基本的功能,任何
架都必须满足。但是对于简单
架,仅正中关系位或者正中颌位是准确的,任何垂直距离改变、任何脱离开正中关系位或者正中颌位的咬合关系都是不准确的。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_301_424_323_446.png?sign=1738851327-rXGiFHq3yQMycYdZJvEXgMeH2chKbZu4-0-ba5a648c3b2236ae06ace8e3a23315f5)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_540_424_561_446.png?sign=1738851327-jvAX1ksWZjNDEj3eFAb4suCXBicsQ8WT-0-4224c3197c141a402656e34511b04823)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_853_424_875_446.png?sign=1738851327-sNdSRzVe38zUBqO3K28B2w0sBq1bjQF9-0-ddac46978b9b01a8199e9bf4b584c9b3)
(二)能转移、重现个体的铰链轴与上颌牙弓的位置关系
具有此项功能的
架,通过面弓转移将患者上颌体与铰链轴位置转移到
架上,重现了个体铰链轴与上颌的位置关系,这样
架的闭合弧与患者一致,当垂直距离在一定范围内改变时,依然能够与患者实际情况相符合。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_414_555_436_577.png?sign=1738851327-EAtfm8DzDu29UQa45jQIaiXXaP6pHEmI-0-21bd23c37a1de03cf58c0d59a7d9f7ec)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_944_555_965_577.png?sign=1738851327-bhHR7NRI41Bq4cyqG3A6A4GBu3AYMYdX-0-28ec25af69953d4dbaefad117738fc52)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_586_588_608_610.png?sign=1738851327-LRjgTkbkAArBuKAixOSXRETm1BIv7VGq-0-fe571dc8ba864ac61cf7c2fb6628785a)
(三)能重现个体的各种非正中颌位关系
能够将前伸髁导斜度、侧向髁导斜度(侧方髁导斜度)转移到
架上,模拟患者的非正中颌位关系。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_833_686_855_708.png?sign=1738851327-bcoj8aee2pS5oO5jJY6s8Y0EQOAF5tet-0-9408e6973db070b17045709f64a3b132)
(四)能模拟个体化的下颌运动特征
可以模拟迅即侧移等下颌运动特征,并将髁间间距、个性化髁导转移到
架上,更好地模拟患者下颌运动。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_924_785_946_807.png?sign=1738851327-N1bDucElaumrGym5VhNEpoKTIqq3zQuY-0-aab45782a0cb2c449ce6f5bff7cbbf6a)
【技能要求】
一、上简单
架的方法步骤
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_381_931_405_954.png?sign=1738851327-Fj5rsG2uCx9F8ugOZxINWDjGEuQfU8z1-0-8cdd7d0911a538985604bb9749b7a128)
1.将上下颌模型浸泡、浸湿。
2.将
架放在操作台上,打开
架。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_306_1015_327_1037.png?sign=1738851327-xdQ6rbqFR8vmeoTuoLymOihEAwaiMeSo-0-6aed41a831e8ee73af87b66876cd686f)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_538_1015_560_1037.png?sign=1738851327-DsZrKbGJgmWxRtytt3SA4vo4SyPjLdh8-0-9d421a1b5b7879a155fecf672bc025a1)
3.以适宜的水粉比例调拌石膏,放在
架下颌体上。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_604_1047_625_1069.png?sign=1738851327-1z3XHQ7BzYQU9CxPEdwz9pTd1bEfNCj1-0-d4a72dfea0a1da68b13db3f6d9dd52b6)
4.把浸湿的下颌模型固定在下颌体上。
5.按照正确的咬合关系,将上颌模型和蜡
记录放在下颌模型上。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_647_1113_669_1135.png?sign=1738851327-GHLM0liK8kBg5KVfvZbQOxIFj8CAz3sf-0-579edf75bb25d6cd6ee604944d528c9e)
6.闭合
架,用石膏将上颌模型固定在上颌体上。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_327_1146_349_1168.png?sign=1738851327-DIu7IGxuuDkVjDbVbB2k8JQeRpNNHwX4-0-62932d9bd6dd89b7590e8dc5a941514d)
7.用调拌刀刮去模型周围多余的石膏,并将石膏表面涂抹光滑。
8.用橡皮筋加压固定。
二、上简单
架的注意事项
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_381_1259_405_1282.png?sign=1738851327-a64iPIqLilZi5D3cBjcP8QVYjpmhIr8u-0-ba1218497c27913ec7f86844f15c12fc)
1.在上
架前,模型底部要刻出固位沟,然后在模型底部涂分离剂,同时模型在上
架前一定要浸湿。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_327_1310_349_1332.png?sign=1738851327-4k9AXUQye2oGIaTZxG4a9Wp8kzm3Lt1p-0-524c1a8a2b56837d0bf635ec5f572275)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1025_1310_1047_1332.png?sign=1738851327-qxYIi0w21DPnJpMNfMbo8H20XZCeDXI2-0-9164c30094e9026aea0d98e25bd32afc)
2.检查
架上的各个螺丝是否拧紧,以免造成咬合关系的错位。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_328_1376_350_1398.png?sign=1738851327-Safx0fdDBcr9Xa0lsDxlZix3dGVhYVP4-0-fd3dda9e380d39e46cc943d2211f36b6)
3.用简单
架上上颌模型时,一定要使上颌体与调节升降螺丝的顶部接触,以免咬合升高。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_352_1409_373_1430.png?sign=1738851327-68aqPi9a4HUDC6dGb2mHzEt6xbnMCW3U-0-368de8f0eb6d4f5b259452984e157300)
4.上平均值
架时,用石膏固定模型时不能移动已定位的模型,模型应位于
架的中心,
托的中线应与
架的中线一致。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_374_1474_396_1496.png?sign=1738851327-hekBunj0e3WyeQ38VfJnDO8d9usGYZoi-0-6c7ed289947e41cb4f51ec31742317c0)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_981_1474_1003_1496.png?sign=1738851327-ekHYWQpmtgwVM2mga7JfcFdv4oONmqLA-0-0929225a1cbb40135eb30d956c1bd9ca)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_230_227_252_249.png?sign=1738851327-p0DyXGC7qqxHP8UxjovEMD84DRmH9eCC-0-7b2355a2cc8e050945df9d79338bc366)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_384_227_405_249.png?sign=1738851327-6bNysrpg8mshVNT45OaGWw2VpVFYfQph-0-e9449e74121a0d855e84e4f259dd046d)
5.上平均值
架时,随时注意切导针与切导盘是否接触。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_353_260_375_282.png?sign=1738851327-xu1caM94IHhR7Vo10CtBaEoUEEYmSGgi-0-8d1230d3102eeeb2e1878aca6bade1b5)
6.为了防止切导针上浮,可使用加速剂(减少石膏的膨胀率)、适当加大水的比例、分两次上石膏的方法等。
7.在上
架完成后,为了防止由于石膏膨胀引起垂直高度改变,用皮筋加压固定,直至石膏完全固化。同时洗干净
架上多余的石膏,避免因石膏残渣影响
架各部位的固位和运动。
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_310_358_332_380.png?sign=1738851327-XuOO5fWuTLKDHbWJpQp3y71NCiYbygV6-0-cb64ef6bf3506e167f3fbf2c1f51018b)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_461_391_483_413.png?sign=1738851327-8zw64cMxdvavlRwTjBbiytwjnU20HaA7-0-9053e2a8c18f9b48bc02a0fbbcc58616)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_852_391_874_413.png?sign=1738851327-WY1eWEzjl5R2W0Es9w6ptCoumYyJGS4i-0-01c5d2d412cb302c33d00089ff8f7cf8)