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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=1738892935-IVAbT5ttRUB2thScBBox0uUXqdgIcI7H-0-13eb20f5d10a651b4dafc9feec1c1bc9)
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=1738892935-pHE9jd2uxrzZzRXbZS6ZkoJ8rJkKiAUN-0-1886dc75df4e5764d8b3d6a4496c4220)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_839_686_861_708.png?sign=1738892935-I2Z8PsC2KXQoyOgr5mwUxmZeP7Ru6TPS-0-8c98fb951ba74a2b2a70c882b443ee40)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_985_686_1007_708.png?sign=1738892935-zS4hZTjYvh4sBmr76gNNskNeULGNpbEp-0-759df01271474171c3ad3435f841a4ee)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_282_719_304_741.png?sign=1738892935-8x86fl5KLOugrnAl72zxkwymMiRzwluo-0-5719b3242a8e36cb846af7411d45eaa0)
(一)简单
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_336_750_357_771.png?sign=1738892935-u3OBjD1dLaclJjDB2jDkkWLuFjRaK4iS-0-106aaa4fe42fa03d3af7d2fa0a8b7bdc)
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=1738892935-8HxHtEXU13ayKAy3dRKn6CtLqqeAjXmv-0-7e7ce48da8542be8dfa119f358e0c883)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_479_785_501_807.png?sign=1738892935-UfgZCmUeiVVgB6LuZuQfpjOtc0v1LL5E-0-fad0c0a7924238e6f0ee0148b5b78b6e)
1.单向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_378_818_400_840.png?sign=1738892935-4YAryglpzdKo7pTRy0eTyeBdANjU2tzB-0-64d1af789edef375b33beda9eb66d996)
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=1738892935-T5KKPl9E7LkxC9CftFcwpTxW0oj6djBG-0-7eeedc535f829064055306232a916164)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_264_883_285_905.png?sign=1738892935-jK5L5y1YWtuHDP3vhSR8lip2IxLRMGOo-0-c23f723f74797780477d92c6f5f96e94)
2.多向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_377_949_399_971.png?sign=1738892935-Fs3uwqojP5K1g9RlIWqsxNokYuHAog88-0-641925fe6d9ec79acacdb4c26154ffdd)
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=1738892935-6v634Jwsl51mANY17e9xuOZtUecTCkzA-0-d91fae5007c3f1e7f0c7b17182fadcba)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_743_982_765_1004.png?sign=1738892935-B5YAbNvB1dZe05Qu3VUM3hC4efVkDK4M-0-f99620b83622909e9b16e7043c2bd657)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1029_982_1051_1004.png?sign=1738892935-PUbaDimZP604Hr23kmZIefQw4bU6K7Vv-0-a00b30498a0af53fd763deb8eb6db8df)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_305_1015_327_1037.png?sign=1738892935-UTwfV9lwiEvebCvDG8p6VWTiUGVoOruW-0-6cda568b425453ddc7f0068455938b9d)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_239_1146_261_1168.png?sign=1738892935-tAntLGuTUYhy1K87USXhJBoVSpYpm1jx-0-3979bbf52b0430a67f62746c9516c108)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_830_1146_852_1168.png?sign=1738892935-6pQLklbT3yQhnZ2xBGMCOjecdHv3YKlf-0-0355a2c131eeaa935b553ee6ad1ffba5)
(二)半可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1210_401_1231.png?sign=1738892935-TyLAbkZhcW9DBaIncfUDd0UQuxKLlhqu-0-e10b3b65eb6d5364b85b373a7f3abf61)
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=1738892935-34y2t6ZU2LzmVjhY8A9Zw7FFK5yf0DfR-0-82d5333a77eea881fbd8f1954516517a)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1007_1245_1029_1266.png?sign=1738892935-joFi9JUCTxNQgFcMsWMSlMkrHiOmiczb-0-77d646a48b571af11de0ced7cd25fd2e)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1277_598_1299.png?sign=1738892935-zA4uemMSsMJUpLlKmzKTYgeIjbaZIIpm-0-b3a25439fd107edf9e0e0ab742d8e724)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1310_598_1332.png?sign=1738892935-Co3aJLNi5eW1xR8sO3y9bSzmOqZ7VHA5-0-baf85d70cb3e10b0c14ac321604b8a46)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_976_1343_998_1365.png?sign=1738892935-uSdso6rLKeQjl7Pb91QMKjv7zfMF3ZAl-0-41cf8a532dc4587643637c34024fb111)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_240_1376_262_1398.png?sign=1738892935-hSkKeiq56uQWG8fjRKTOFeShqVFQxWWG-0-3e70f99fffde78472914f04f690a9822)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_483_1376_505_1398.png?sign=1738892935-NzT3rUeZJq6IoCOkc7diOHAA8t4E8IJO-0-89c2064c798b387889caf7a7dc8a34b4)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_612_1409_633_1431.png?sign=1738892935-KApFBr95zbjENP03x4Aff0q7ZuLBjTfv-0-21b2d6ae93d968875dc6c0bc0a9a2e8f)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_896_1409_917_1431.png?sign=1738892935-Z9Tu3el8DJmNoTRAmA77yWz8zipEksCE-0-f36601e864beecf162824fbedd08df0c)
(三)全可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1440_401_1460.png?sign=1738892935-QIVD3bp6k3aWP6XdcAGmdNfJcpOB59Tx-0-34dbc98399887dcd951ce2ca35cccde8)
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=1738892935-J4asEyVNoyT36oK96ENh7MNP4YiZXeKO-0-7498a1d819f7d360399b40b9d4e90e26)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_665_1474_686_1496.png?sign=1738892935-8ZDIzvTrzl1TJAHvPtGIYgmnLM1ScyiD-0-6ecd0a881f65325bc92738948fd82b0e)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_940_1474_962_1496.png?sign=1738892935-c6WOJLv1aABNvoyjNdssbgF6xfCDBFMW-0-beab6448b1bb32f28765ade99cee0ec3)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_346_260_368_282.png?sign=1738892935-DGtxUtcIWgUq2TiZ4V31Rv7mwpoXC8ew-0-09960c02b1cee278ba50b83e2005a4b7)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_449_260_471_282.png?sign=1738892935-8Xhj1VQgZr0CbM1RORgQPVHFbgWD6P24-0-b2df63ccfdce587ad589a9c1a7aa0dfe)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1048_260_1070_282.png?sign=1738892935-8TPBEHqp8V7yvOCY3iEJFwlPybJpK3IT-0-d9e7d630478700056338fe63025dbba4)
二、
架的用途
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_306_340_330_363.png?sign=1738892935-IxjLnuLP5u2whbP9E07wAIhOI7TGCyxd-0-16bac95c26a61e905de9d49131012a23)
(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=1738892935-0rvWveTsBQTNFhcOWRV1R8TMUnLjkynJ-0-40325aa1e24142ce19a80529ca5bd091)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_540_424_561_446.png?sign=1738892935-doejtyEbc2WZBwNVwViHve7ZIoyuLFj6-0-a2668324120ea3998db3e6f5c2895c97)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_853_424_875_446.png?sign=1738892935-qoONIQJvbXb4uMBBnTJ8b0dkpWfQJjMR-0-e54de31f1c124326c7dac1af723724fb)
(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=1738892935-ddQnwtopCwEVATatpi6ivaB7XR5CEJeB-0-c5cc7ca754176938cad28409367256d4)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_944_555_965_577.png?sign=1738892935-VMBfixp2wLN58a9TDdKUScfvvrqnr0s6-0-0532b63909559632657f41fe158c5577)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_586_588_608_610.png?sign=1738892935-SqYrJDquk5behubGHvvjWTUczgDLPhtX-0-7184ffcb06ef3c14a296c99ce1db149c)
(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=1738892935-WhDilglrM5b7jpegrK8s8DKtSu4Ya6go-0-7170acdf81c3156358637e996c238261)
(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=1738892935-u0Ywm568up6N5vSlYLAFjkg73Co87T8N-0-5dc63bf78dd102fb70bd2542dcbcf66f)
【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=1738892935-dJ4ZTDoa4t1H3uEaneQsTaH6rOfzcMrg-0-9d199501986efa460894da7a3eae07c5)
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=1738892935-XAS7s9qBkgVIyh5GXHYDYPJbRb8IUiyi-0-9a2cae9960ab924b4864cea49ff16c66)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_538_1015_560_1037.png?sign=1738892935-1b7GOjUrrk7TGuQupfWDViaz0Fs0pehi-0-ee0266c71b0a99c28507b4b0a1140e6f)
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=1738892935-n78Wq4iW50hfuH4rv3eUxnn5a1gSPI3C-0-360d9ccd481b02b8e1169645e0c8a78e)
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=1738892935-MaKDTIBMQYrEIUmQtO844E9TPEnV8EU9-0-5f13899d77784d128bb317a9668c4250)
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=1738892935-Kl1wpNSTvMnJKFayUybz2z1PbJgCncNS-0-353607b69d3d83a6a4463f2b3f8a1dbd)
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=1738892935-sPtmDy3a4ZHhcQAtuCvBrThuT5T1o58i-0-910dc692bcc1d40cf2690d95d61fedf0)
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=1738892935-fdLRw1CCjQNVXFKAlePzypNA8V29S2Ho-0-2d826b9d8ba13d1871772f27648501d9)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1025_1310_1047_1332.png?sign=1738892935-trtZxXBtlFSusBB5afHylqyMm48DwIil-0-e817223f72f0201247d233975712a11e)
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=1738892935-Zwx2VLUsRbaVFVfOspGPDiYNLCAYDrbh-0-fa26c03d97d87bd2dee477e76c30f24d)
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=1738892935-9IJKhe7Jf6SlZJ7auHYjD4vEAK0NrcDA-0-e757cf6e5721ecbc435c4544f0e4d59e)
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=1738892935-vWGyjuAtB21u4O4JFtOPu62a2Npi6TUJ-0-93e3d06a982ae61b8cefc46c593840ee)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_981_1474_1003_1496.png?sign=1738892935-Sx1d1rQgU0AtDZDL0HtFByvUc4tjSmb3-0-70b513ce61446f6a3f7c79d8a7b61e69)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_230_227_252_249.png?sign=1738892935-BAYjl5SJxWZlB1brJHk4nGZa5Qm7jy8z-0-17b9b5558b9faece0ad3b4695b63d009)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_384_227_405_249.png?sign=1738892935-gELT1NoZ5hOFMRWBhi0v2f3tWZVE4wN3-0-bb91ac05ee1bf7e06c0a2e39a4516331)
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=1738892935-S8yIMZJrkDr4fGa0xeOGdJy7WgUXHK5o-0-d248bcc0096955cc3690eab4f4be5839)
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=1738892935-quq7MHS143KWOL2XevxZM9L4I0wW5y8g-0-3014ff57811fa49875fb3987f01e9ac7)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_461_391_483_413.png?sign=1738892935-Y6OMCsmeJB5AvFfwhROOMuayt3verxX8-0-39048a23a0a8953c3426385cb6bbe9cc)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_852_391_874_413.png?sign=1738892935-e2TEqPieXrjXfK4W1IKlH2NfzOdHpZIH-0-f34764a82360d9f819d438b709d3d727)