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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=1739355239-wKjonPaccIWVCJ74G6O6YydI3wvVF6vC-0-0e3af35df5f8fce6877647c4319bd748)
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=1739355239-zjloy63o1v0WAvxi8jXTnQUBIsUhVGGl-0-3362c9c7a61b98ac77b29ec4e96e0c87)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_839_686_861_708.png?sign=1739355239-av8uiVGA5iACTWlQGllaaCp1MB2Uwdne-0-268cc076dabefe1f83de6485dc8d9b69)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_985_686_1007_708.png?sign=1739355239-hJK3IYyOdValYcu2BN9fT9XGN0FzhdFN-0-8b7bb380305fe0e3e95111ef3131e134)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_282_719_304_741.png?sign=1739355239-Clh207ozb2TnOJeFIKX4KMmiteo7OPt2-0-87c79ee3f0047218ef1af5d4786ed325)
(一)简单
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_336_750_357_771.png?sign=1739355239-Hw4uzSpYVd2IPne3JY926Idiygh3vVe3-0-6fd9fcec4e25be09869b07ae3d6bd12f)
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=1739355239-lMvhVySBenYNAP3nqMKFlZ1l6YvHpwJQ-0-21fb146f91b5db43ef26958278b6fe7f)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_479_785_501_807.png?sign=1739355239-BGG1TyGKywbJKBOT81ndQIdEd4NaOneY-0-2cf2a06787c02f4c13f27746fb7ae126)
1.单向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_378_818_400_840.png?sign=1739355239-ea6jYMdFeSBoaFB56G6IZpuLS0HgLEbA-0-8c9429bb3e51529fb316c4ddb35d85f9)
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=1739355239-LCsf5FS5niT7AkULCfnLyAPQId3N48Qn-0-7219708dfbeb1dadbf2dc4ca7013eb34)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_264_883_285_905.png?sign=1739355239-qde0SWB0JFiXneyZkT2EzVwhV1n6guZn-0-bc6179b5d35ffbb95dfc8026f01edfff)
2.多向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_377_949_399_971.png?sign=1739355239-e8Mys9imfeU4Wdrump73HPJbUJMfbBzb-0-29b28220a3e7d0cbec8c1745b40192c7)
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=1739355239-gYzJiWoegkgPAJwEdntJMP3sPB9nxswq-0-1e36931b1d93b6b32c014d4b2329a397)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_743_982_765_1004.png?sign=1739355239-uolpkowUS5Hfvpx4C2Y0mhqtTiwo9p7g-0-db86d163107bd8ade4f2332cc89717b5)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1029_982_1051_1004.png?sign=1739355239-ImrAqVdb5kHwK9gzBjNn4fRv8pvLldyv-0-34b5d914b25108c9c3893f6ca6f0d1c4)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_305_1015_327_1037.png?sign=1739355239-1OKNCSuraufYaEto6KTNIKjAY9Lpgy0K-0-2f93b735e9fe7345f1067c00e978dba1)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_239_1146_261_1168.png?sign=1739355239-kWGPexolBPHF8QMcE0C93anyxQCcSYDE-0-00335198f6208f8612dd38d458d38347)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_830_1146_852_1168.png?sign=1739355239-grzcwuZDqDrxwqOQQ58MZUBebBixpe2I-0-ed78b3d8c6e05ef1c51e13e49758cb3a)
(二)半可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1210_401_1231.png?sign=1739355239-89MTatuVxAlH5x8ITo537ADTzMHUbZ6J-0-9bda80e7b5ddddc25403d0770f463acf)
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=1739355239-6Ekvkr94iXYNxJpITTPGhFvrHuRkVjlq-0-ee39252418691c8a6fe4db18c097acfb)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1007_1245_1029_1266.png?sign=1739355239-oYuRFIcoGbB1lxpvsfqo3W2hDh4U743W-0-a66972c5654d24ea1a83c6c89f5bef59)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1277_598_1299.png?sign=1739355239-eR4awx0WIHdNMiKkHtqCUeiip4KNKJE8-0-f0ceaa642e1ef386222e2514b06797ea)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1310_598_1332.png?sign=1739355239-XsoX4Xs8nrzfBkJkBCcuLiw2flxierx7-0-9bb43c5c06f1b1235444d8e7282f6250)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_976_1343_998_1365.png?sign=1739355239-vE3cZAdJwwn51LEFhXfpsZ2Vtle3dd8s-0-1cd4ae7f50d22c6cc24c4b5964dc004c)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_240_1376_262_1398.png?sign=1739355239-2pCYgOFPkQB4bA3drBlkkZGWIWDm36Uv-0-f559f5fe7c35744ea6faeb535a362516)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_483_1376_505_1398.png?sign=1739355239-K3EKfhVZ9F0cD9jv9CBf5kYwZRKWeKXv-0-7008e41d915612f4e9294341c4da3ba2)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_612_1409_633_1431.png?sign=1739355239-MBy7NtGPmrB7niOMuRnzMg0L7dmljTOP-0-d20d4c76bd9915f2d873c415409b3125)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_896_1409_917_1431.png?sign=1739355239-kmtEHDzWIelsaKVkcs7EUuDqZ88f9tfy-0-fb871fad8d81162233d0c67112ff8b44)
(三)全可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1440_401_1460.png?sign=1739355239-bAHDpjOhogOxn9Csi7pyUH3BTyXKR1N0-0-d4e0b31c5e29bf49613b013741645e3a)
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=1739355239-vI41puwCKdD4NNuZEqgNzK5i18XXTIUh-0-aeef99366fb77641eecea35c5f84ec66)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_665_1474_686_1496.png?sign=1739355239-WpW3YYDBXFuInCtG3TNBO0GTEU6ZIEyn-0-a1fe7a614e761a7bfa99118b0a272e6d)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_940_1474_962_1496.png?sign=1739355239-wzKtl9y9o4FfHdnOO3moz6hPNovwacQs-0-586805eb1402d227cbabfbc68b4b42bd)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_346_260_368_282.png?sign=1739355239-rDdsyHr8gnp5trVft6IrWRXo2lR3y3Uh-0-f8441603332a99298a76b5e0e6f74c37)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_449_260_471_282.png?sign=1739355239-mHjQl9aMEUfmTRgV2qd5fh1I0mVNn2Op-0-c2fe939c29e520f5db7d77de77d39f2c)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1048_260_1070_282.png?sign=1739355239-exzY7JhX6eu2KOLTvHEWB6MUfDZi9KxW-0-8d76595d70901db3ff80262c7f6dc7c6)
二、
架的用途
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_306_340_330_363.png?sign=1739355239-apbZZ1AdXmLDDeti5DBWPkMRfD6LtaJs-0-0aec02b9282fb47e54801d9c59125db3)
(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=1739355239-r08d2qyzTPQRL6q5UsNQ2hQnQoSZhn7E-0-bcc1939342d9386eea9dab563a21a7a0)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_540_424_561_446.png?sign=1739355239-2BTqdTdWCPZBzEW4NVwKVgZNXQEprj2G-0-4423a3000f03596ab0a570475c24141c)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_853_424_875_446.png?sign=1739355239-2UlRH6JvRnlr6GXqxqVM2w9KQrlHhr61-0-f686b5a6ec568986aba23c1dd2d4dc7f)
(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=1739355239-pYMnIf2wLn7eXqPjUNh1C9QOyc3f2bFq-0-5e7f4abd419b698dcda31d4786ee2259)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_944_555_965_577.png?sign=1739355239-JQcSCqvb1iFG5wSF1ruOAQh5dSl7pyyh-0-e3696d781d5cde867abaf35f931a7f1c)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_586_588_608_610.png?sign=1739355239-E8DVxYWB1Ob2TdyOOmOK7Tz8Inrx91du-0-0cf83329c8e0932b472f013c13454c64)
(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=1739355239-sT3hhfva0MvKfKSQxsKneox5FF0Y0eAq-0-2a3ca94875efdd0753d602d1c7d02291)
(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=1739355239-8EuO2euh3nG8yC2qv539ujHSr8w7bt2X-0-94c8d0508ac9fec29f052b01bfc77784)
【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=1739355239-96XXUkAaFIpD6yS8LZcig5FuCAts7Ncu-0-bfd653556908b9f358641710ca84c4f6)
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=1739355239-DF6evr8977aRtpDpGt02dIHUI0zJudOk-0-6f4c6b9f37aaf8e75ff5b31ab6defc90)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_538_1015_560_1037.png?sign=1739355239-aO3WvG68HhDNyWeQuRWu7ew1dRYQqMr7-0-48a06375f78f4e4be808defcd2735487)
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=1739355239-FAk6Z7kFW1iEgmyBWUz0yagMyjeu5Pxq-0-26d7dd90ad4ce7fcbb6d80d129f0e107)
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=1739355239-W7xZs3zC5ogzTcfMjYmx1LDuL7bs4nfC-0-60c111dca9a63ae3c9eca1ec7e99d0e5)
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=1739355239-1UW4WlW15x6Lryltg8VLRT59SnvEfkng-0-a278269fe14873481059e317b62ad952)
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=1739355239-tEUZrMgemDSM7T1wfh6EGl7MU8syyJnS-0-5e67474eecf58a9581d4674e76c26e29)
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=1739355239-hZONqYXVLs1Y7R59nC6TkFNZm9TbHFbj-0-b0fde6fb8ea9cbf9e5155af2c79e1155)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1025_1310_1047_1332.png?sign=1739355239-8ndptmjvU5DE9w6pGDA4pufcx9ewdqcR-0-a14c9ad00b917452faabe96aa326e7df)
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=1739355239-eY2gTOIH16rlluojlX6C6dxK6lIOOX4t-0-971abad4a33f71737a3d48122a26949f)
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=1739355239-wqwGV2mWAS8zQQAIgez9n85qem5YQ4UM-0-fb82ab5fd9334bbf14a9bf2efc35ce18)
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=1739355239-8S4eDbmpgjsLwgdX8iktpDeIZ9f5sKmw-0-72f1946087d68c0bf0971b9d60763509)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_981_1474_1003_1496.png?sign=1739355239-J9icPPFZmH3efEuEbdwMzERFDifBDceS-0-8308058100a3f18002caf4336ac6435c)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_230_227_252_249.png?sign=1739355239-PlajfUNcUtWPsEmBZyZT7AulaKTI5BCZ-0-9c2dd9a21c9aeac5be5f7a26e80c13ca)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_384_227_405_249.png?sign=1739355239-zJYQIW8xSUhZyapJE8l5568kiAEItSns-0-647485cf080c8eb1d19beba424b279f8)
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=1739355239-VPz6MwT70AoOibvnw5pS4BgP3qHLYzkQ-0-a2e4cc15f608c3df354ba135eb14557a)
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=1739355239-HR1q6Ci6aMDtlsYVWqWHQAhmpOKSRUQp-0-e197431ed275ef6255006dc2c993dbba)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_461_391_483_413.png?sign=1739355239-vBOibtQuzlDv6Blsd2UTqkifmgy2fRSA-0-8f26d11fc41fb5766f27041b590b556d)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_852_391_874_413.png?sign=1739355239-o0S4Tm4rAxaRcFwJiI2pmDeqMZhzDwTb-0-ca9415a73e1419fb91941337fab3882b)