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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=1738881350-IQ3nKUJoXUl7zv9SB9IO25sibtJEsqz3-0-3a0f990faf10f81f4cc3dc43ca160602)
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=1738881350-TwD5Pv19yWhfcKBugDSvfZseOQId3K9G-0-1a9c18ecdfb4356771cc2048e22c649c)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_839_686_861_708.png?sign=1738881350-L8vgjcCAvEJgu60qKqPezrOxAWnTwMLz-0-73a779b26323d210b902452c5bacc40f)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_985_686_1007_708.png?sign=1738881350-qNZjwOc1iPLfGN9Z67KHXwxRgaKg3KUa-0-4d32cb41cc3cc5fb8b9e17bef61bd870)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_282_719_304_741.png?sign=1738881350-ts8w3ajG1CQxUyg7j3LcuxbzTcqpt2QM-0-1d8634875a2a4aa516aba00ff3cbcd69)
(一)简单
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_336_750_357_771.png?sign=1738881350-keA9LFPb1837vuq1OcuQEfAdMrOwkay6-0-9310764865d8f1b575e39a10dd107b99)
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=1738881350-yjgsdndx5uF5li86rVfNjhtwMI4Wenqv-0-7ebe4537ecaaeba0fedd29c6de1f9400)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_479_785_501_807.png?sign=1738881350-tqDgtsTadNmTXEHnaj53rCBoxQInkZlI-0-853241d9f8a32efd5384e0112b6dcb9e)
1.单向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_378_818_400_840.png?sign=1738881350-icYnsDnWyfRxDUFTNlzJpNMs6tBAiu8a-0-a0ded4b90d7b3601a45d2103a44d839d)
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=1738881350-g6v7LLC957QqnssUwzC9iMMpMymtZSiY-0-20dc269b69bb40225fa736392a6cb459)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_264_883_285_905.png?sign=1738881350-sVClq8uHXnF1YsNJ1mEu0uOKvQn6pFel-0-b873b9a5000e043583bef1770cf76930)
2.多向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_377_949_399_971.png?sign=1738881350-I1KzdO6pYa7XLIgJ0KmAZZppUADNm7MM-0-1ad8e640bedd67ad46739fb32840c7f3)
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=1738881350-Qcipc5Pqj7u79wqtoMLJ9U5hLWwt9ZUv-0-43e427f875e96203845a779678637e41)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_743_982_765_1004.png?sign=1738881350-Ekti2jsClku95SvKnoHcebJgSHi0fvX3-0-0395084a4b4ded4f796af18890bd2e71)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1029_982_1051_1004.png?sign=1738881350-nGSXaAgNoFGk81Lhew0DiYYUVDRxQdBz-0-1252e4aee2f03156017841d04ce0ceb3)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_305_1015_327_1037.png?sign=1738881350-5TW5z4HhM9FRv5jRYqgVdhl3FzRu0akt-0-1616a466b478c91005e980745b086615)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_239_1146_261_1168.png?sign=1738881350-tOuNfZRjSBOwAafzEZBjB6LiefQX1loh-0-a09e8eb96b0fee63327a8717020473ba)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_830_1146_852_1168.png?sign=1738881350-a2EPvdhUH0Ol0gw022HlcWQW6POfII5C-0-dde921aa58db1395bedc86ab3bc1e229)
(二)半可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1210_401_1231.png?sign=1738881350-LOvPgueH8X9iy6AP0FhhWDtxKqZVMJyK-0-34e7bab4e14e3b2eb07b206f863e832a)
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=1738881350-VaJLtApSQWW5JOd7FKhcEtd0O2MQYNT0-0-5f036ef2aa9c5e2afaaa07d882d4a312)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1007_1245_1029_1266.png?sign=1738881350-vUTrrY4wTcinSW2blb9naOEsn1mmb6wQ-0-a6160635b86ea413ca054554715130ab)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1277_598_1299.png?sign=1738881350-ZQhzDY0UA2YNgXaJKh8M7jVmvpy7IW60-0-9611ea2d09d4d9ac396e97e2e4502fe7)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1310_598_1332.png?sign=1738881350-BFmcbq4wQnIcTnVliFXww2L3GZ0jhtnk-0-a88f3ca56c8dabe0fee0b8f480a68c2c)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_976_1343_998_1365.png?sign=1738881350-PW7k3O05AhnOomX2zwC80hNInVVR8bV9-0-8b2ebb8c576acf62f4dbe8106e4a760a)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_240_1376_262_1398.png?sign=1738881350-tDcY2g4Pbjsgr7Pxylm0c9MF9Rmzork7-0-b108b6946322f40065016b240df48a7c)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_483_1376_505_1398.png?sign=1738881350-LNipqzLTjAlvN1k4qlHpHWhRnlZRPnyW-0-ff098b224d940fa0b4c85f8f9d53d628)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_612_1409_633_1431.png?sign=1738881350-LNHEtU6hdYskxCTUHIag8ZtdqZwBabko-0-e06a24eab2d2e19bb05782d804f57b27)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_896_1409_917_1431.png?sign=1738881350-Y3rCeO4AtktZcsUV9CxwQSmbd0WTL0n4-0-eb3c9b49192b3a7237738306b60c544d)
(三)全可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1440_401_1460.png?sign=1738881350-uZP5uZlme9YOxg1oQrxKlRPUaGUeHJnS-0-a94e59ce2f40653a2ba68338c050bfa3)
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=1738881350-1iHtEmnqsQrKX6ATfQJDvIQ60YpgRfdr-0-f78e4c76da777c02afa9ffefb1dfdf8b)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_665_1474_686_1496.png?sign=1738881350-lZps4HhXTo1g1kI17DyALzR5qDVrQ5HQ-0-73039cb86593d5f3eb496db61a24ea72)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_940_1474_962_1496.png?sign=1738881350-yMa5TLd0NadKUFLPnZU9Jmqk0TULthjV-0-8f4097193b0863cbe48cdd966471da5d)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_346_260_368_282.png?sign=1738881350-madIapvvNGRFjQOATCFbqJQMbfV7GNys-0-e6ecb68240ac24f5ea04b43d40ceaf02)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_449_260_471_282.png?sign=1738881350-lNDQ8LsYUysaLjBNUPyv1xHxyIzfStqY-0-f346a227e21af81a7af0a166c09440f4)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1048_260_1070_282.png?sign=1738881350-X4YyzFQUX9iR0UYsvT6og29yQh4wGJVM-0-acbe0e9f4a793b0c68c0ad4242711b52)
二、
架的用途
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_306_340_330_363.png?sign=1738881350-egeoK19SxY1hSfkdhpTRzxN5QSYwFpUp-0-3b44e16ac380894f20babb8883e5e094)
(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=1738881350-XKjo7RuNUiYauKGoFvmcnIrKJ9SfDeyY-0-7eb13f912c6745547088c63375a6aa34)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_540_424_561_446.png?sign=1738881350-zIOBCPKKGDVwyEAF4KhL5h3Q9Hj7uRFo-0-3d62ac449b67a2c12ad2c52da4bc21df)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_853_424_875_446.png?sign=1738881350-plbj5hcDZ4edaAr56Duwp5h9GZOzaLxC-0-c869433c23bc1caa39ef1dcb5a0132aa)
(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=1738881350-TB0kKa8oxR6RnGdPlURsiNqByCRaCnBX-0-4c5b5626bcfbb6a00b905fb1d1375197)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_944_555_965_577.png?sign=1738881350-pzEvFdPiNUjs50MOPbz2TJ04qI4192lW-0-3e819ec629cc8c610c42aa9788a6fc62)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_586_588_608_610.png?sign=1738881350-O7fZwOBDUWUXpjeWViwk2Osa2kl5AreV-0-5e03c2c0d03aeef299dbf89956b7d6e8)
(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=1738881350-VbXeHRattNmimjRd7MNjI0E6EttDj7Ch-0-54d8ea6c6c988f38d4b131b648db5dec)
(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=1738881350-4jYCAkOlo5KjbUamDtecFPqjv8sVZ3Tf-0-839ad2a373d8e796a87ff0dd9479ea96)
【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=1738881350-6OHCKXEEhQCEn6bPYWxbZI808hlFvcY7-0-ce247cad891358f98d3eba4ba2492178)
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=1738881350-p6Ai4vtN4ZD2jixRIRvqGJE9Y7zuTsBW-0-dd186d97351f198f5c35552d25a2345b)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_538_1015_560_1037.png?sign=1738881350-0tXBfXwfh9LNmH0VUYm5jf2reTFolp8m-0-58a2a9de5234e00b8af152958251270c)
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=1738881350-T9ujYycVYI4inqQ8hsbANSNUk3nQl5pa-0-9c0f0a80257f489b15daa08057d1392d)
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=1738881350-gEx5cMNFmfSUtjDghshWKaRwv7nJzwPG-0-55b595fa510fafa0f875f0735b9abec1)
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=1738881350-3D0BGIFBUsvm7KXblDX2PR9rsDcGNhsO-0-43871fa0d90c6c15d8bc931074c0eee8)
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=1738881350-iOLS3GsDLIG43snNaV3u0BtmykkBlHCk-0-d63965b45063187e5a8c23f9092a0c43)
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=1738881350-fOafXPwfchyo11xG9jrCNFICokInyOTn-0-7e213bee321bf9f5380ab8990b9c78e7)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1025_1310_1047_1332.png?sign=1738881350-HUnno7FdvVBHnZeN49An28yB2K8hCOMp-0-5f285053b1aacfa87c8014bf71921c00)
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=1738881350-WcDEfIrsc7mbaC36BqidgI8UHyj32a4y-0-f17769b9f7ce488163dbc8b7dff8b4c5)
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=1738881350-oCjYNPAfcZa43hDEZo3vD39ieI6J7qrf-0-f5c8c05c5bb6b49bff317630bb7c23ce)
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=1738881350-8FaiWOPDrNQZaAfaBnlebO0zrFYomAw3-0-0e965465c5d769345ebe7c6d745d7e44)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_981_1474_1003_1496.png?sign=1738881350-TbyI7VRXPFWLcKptav49vyK7dMYOyLFE-0-97751a1d90ac4ff8767d53cad66f8c49)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_230_227_252_249.png?sign=1738881350-oFSy6d7heK1ncOmYp8S8y6tpv2kvdNdC-0-8fe4ad79ed367941efa569badb4830cb)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_384_227_405_249.png?sign=1738881350-jWmesxrOC7NDwrRi0doJV1w0b8wvok32-0-bf3ce3391b48a4751589fbc418e9259e)
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=1738881350-nVxias7bHdLJQLFiNzC4B0a0yCCTXQjb-0-e8fc25cc6dfa2d83c9ce67d0e60b0340)
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=1738881350-OKSeZFI3X6nzY9xuqcZCJcncXcgPGBmT-0-9b59c53cafb26025732767ff1021d761)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_461_391_483_413.png?sign=1738881350-jXrYFUolkWyUmlcQr0PZumJXgSCQL8lk-0-a8cae4aff68d908f52c18d023634c356)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_852_391_874_413.png?sign=1738881350-zXtZuSvAzDfECeHDjfvnRBGXu3KwFj7N-0-3a4154e40d24f22ac7a3c72208b42cc8)