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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=1739133447-xDiSWZE4ywCuoR1NJkgLbR2PDP4HXuHY-0-3da326c9d393c5a29c6d76e8d0f28998)
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=1739133447-k91tGlGPRDdDhIgd26bhc9hIipzzA9t6-0-146b75e05e734b63af945b75f0b8e6e0)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_839_686_861_708.png?sign=1739133447-24RdY2Ip3Sl8SKkv0DB4MfUDvPQEB2Gp-0-7ffcadd5c8faf01b82c787b624a6c366)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_985_686_1007_708.png?sign=1739133447-BBD1HHumQergSHSQx51Ou64p420DCFRV-0-37b3c01dbf531bb2eaf6c5dd67b9e579)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_282_719_304_741.png?sign=1739133447-S5aL52ztxlz9MAY47rpKk9IZ6wCney00-0-64821b7ffab7af038862bcc1b6dc63ba)
(一)简单
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_336_750_357_771.png?sign=1739133447-5wutJngHJiUREM6prlx03WJNRKVrpPdz-0-659937e3daf4013b0535ef7003df9614)
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=1739133447-2Qin3bOqO3aqt01Jfg90jQPPdG87hd1y-0-503bbe2a4dfe97decc0b873698375cae)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_479_785_501_807.png?sign=1739133447-F3tv5fVz9Elq9uW4Iyk8abbAtjMi3LPL-0-0083ed835a18166c32a1264bde340485)
1.单向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_378_818_400_840.png?sign=1739133447-33ytdVXINYY0mszcePuk16YCisHAGCVu-0-28ac90a389204b54080d5ae63b27bacc)
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=1739133447-vLhZa7C2fIvs4ZIzKEV0TLbbsA1D1X6T-0-016eb5b2116b78f1391795c8c344968b)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_264_883_285_905.png?sign=1739133447-ypYyDa98cxxmImbVMe0HZJm6eos4sCEP-0-83e734eb2606f51661e98806998e8984)
2.多向运动式
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_377_949_399_971.png?sign=1739133447-C6ql1gw0eNzNJUR3X70TSGORYev8HQUi-0-a3c43f1b25576b19f898c4287acc428d)
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=1739133447-2vgGw87pu2fwO5BgdLiqaao4rVJtPo1v-0-4baacb2c5975518de9872c3426f2c4ea)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_743_982_765_1004.png?sign=1739133447-KBA6eDsm12HymEl7fzp3alXVJwmu8seD-0-6e3122faffb2333249343d9f35c67f98)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1029_982_1051_1004.png?sign=1739133447-3iRgm4CmcBniWRVSPz9gMUKHHTCsgfvr-0-7a18fbf662c92b8ffb2e68bd30cc14a7)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_305_1015_327_1037.png?sign=1739133447-SPCtyTT4Dvmc8R5B6lSvoDogvhPEXQab-0-2aaf5b7ddd93c489aa56387664811932)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_239_1146_261_1168.png?sign=1739133447-vv19kFDLgGHPZF2RKmDTPIKhl7QdWlE7-0-68519c7b08ed0940d244d949ec9dd934)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_830_1146_852_1168.png?sign=1739133447-ovwfye24OXPFSzXI6DqypgaT2Caw1mEx-0-274ef5b7f08c2d79a549843bf2b51cd3)
(二)半可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1210_401_1231.png?sign=1739133447-C3yvTPFqoZcVAOCw7U4QRR5hXGhlsN0a-0-363ed5a9cdeaa364be4603a34fbb073f)
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=1739133447-d5iyzAQpCWLhC5BEMVQicrB0YbbK2yUf-0-51ad2443a3c1019607c54d137aa8f297)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_1007_1245_1029_1266.png?sign=1739133447-zAu2F6djqbTzkUcAiy0M1RZu4YAlZPc8-0-e745f656d9a79c3b6c04c20641d82d24)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1277_598_1299.png?sign=1739133447-p4PECMjuI1vhUp8yDCv01u0XLL3Usfvj-0-b380bc99c8c89e677ceb7e5152c428f8)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_576_1310_598_1332.png?sign=1739133447-4BcN25xW4W0Ud2G8iFvsjPk3CHvavcDF-0-dd2cc198a4fab6abdc174db935946dfb)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_976_1343_998_1365.png?sign=1739133447-nsTO5sMDa4jOiH7ke85PrnSvX2NE0rBz-0-13cbd00499dc60adf125e106178c52ff)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_240_1376_262_1398.png?sign=1739133447-ncDBxjF4TjeuLzLNME6Azz1a1avoGWho-0-df5c88db94714bdd866c13fd9bbd4e3c)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_483_1376_505_1398.png?sign=1739133447-ziyRl3IGsU7jUidSFDt97e1Zqeld9Mrp-0-f12e9616fb3fe4ea6a87f39665662eb0)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_612_1409_633_1431.png?sign=1739133447-mqBJ6RPqhd6M6CJ84lXTZziDpvqmxmuL-0-2d64fce40aeb0a2a25290c1cb7393ad3)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_896_1409_917_1431.png?sign=1739133447-lnfQ1rxI8Pr2GJXs1YyNR7J1G1VbLEts-0-0240273c89e1d6a4e140726881d1e1ce)
(三)全可调节
架
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_380_1440_401_1460.png?sign=1739133447-7qxgCjYuuLs2yfWvWkBiqwC2qnGDxmlu-0-df7a5f394207699312b17ffb90d6f4d7)
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=1739133447-7lmZlpHqNKDyZ0kXKDtPQuaJKO2tlTwh-0-f4a36579a7f250b007a17e30d7ddf7b0)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_665_1474_686_1496.png?sign=1739133447-bGcboaxjWBCEDvJnFvjAuGrI2C50KDrj-0-a9dc6e46ea47119a07d69b377afadd7a)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_57_940_1474_962_1496.png?sign=1739133447-e3f13zzjja93KU6GumgExnSmy4Td2jZr-0-562f92d8e72d7c517f60b92c84ea9940)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_346_260_368_282.png?sign=1739133447-PpobmMyqlglLdPWwc38ZNIvysY20nvp3-0-fc65b1badcdc04201d5ca288ad126898)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_449_260_471_282.png?sign=1739133447-2pEBE7ik6aiolmbBlMrTAnzpmV3gkcV8-0-52aeab6c11f4233f1025b21b031ad2be)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1048_260_1070_282.png?sign=1739133447-Na8WESznwbNWVPftdhWqxstrRkiN6MRw-0-999f3aef0a3b012ac671aedfc86c4553)
二、
架的用途
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_306_340_330_363.png?sign=1739133447-SPkwtN8Klvy25sqFMtugQuerPy7vR3Wt-0-71560b997d71c17ef160a39b8db647bc)
(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=1739133447-RLYZdK6LBFa89S0u9q9jBkRFGrAiMm5v-0-004c0006216b1c9ee46a0b045d3ff846)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_540_424_561_446.png?sign=1739133447-tEtJzqrGdlI7hCpRDgCfHAqPU0QK7FzS-0-4a05b725d2335898ea0d1dcf0ed82ea3)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_853_424_875_446.png?sign=1739133447-neSY7PNclYWcbP5NBqxx4b1eBVnNojaN-0-b4b8082204bc5295abcce62602be87ee)
(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=1739133447-85UPrPtdFBqdIBsfw7VRcsluxQUUoTuX-0-a853472057d7a61a4e4f8620f12681c4)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_944_555_965_577.png?sign=1739133447-aUcFFbKvqB6k7FvwI655oHQwAyfo1qC3-0-0bcacba2bbd069c60856014562efac78)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_586_588_608_610.png?sign=1739133447-ORyk4AcPwqYPe4Kf2176zppWxCkOCjvV-0-83aa79becd2a7c19c155b4af05ae5d21)
(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=1739133447-dPl6XgIFF0KGUmA1qnV4mlAGBIdnBDo5-0-2c9643ffe1addc726f4fc32ba7f2f0c7)
(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=1739133447-VnLlF4QlfbUb3fTVUpjHhrEJNJ64oFho-0-b73811c43d59e71037e398d96892e491)
【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=1739133447-zYgReUjNGPk3T4jJ3AEvezkcQ0hqfzge-0-858cb56142f020eddc0bb9518aa30c1d)
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=1739133447-tbVVP5b1JILWzIpf2WmYpJEUJeqIJYDl-0-6dc523f627e69f1e185045caf8f2689d)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_538_1015_560_1037.png?sign=1739133447-xbt37JUloGo7Go7JiunCBgTWzF9x3fNo-0-589b3deaa26142a4384f0588ccd9cd69)
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=1739133447-nwTtwUKwVZV9vbbquWH6ccpuoovmMu3i-0-65cb8925324fb5ddcdbe19b45c29ab58)
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=1739133447-92cWQz7PqzyNevlUnse5xOzU7P51Repi-0-93c190e913b0b780ddcbecacf46bf818)
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=1739133447-6SgZwlYLMfPu74ZvlRVnpaQrslFinOJH-0-76d92b7f2ec885e397a3b4bacfa47e5a)
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=1739133447-yhNGm9TQ761sWscGQpQeHp9qPjWr0hv6-0-a33d6c31aace549ffaf7094dbdfd95cb)
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=1739133447-1sHgHwlOGJLPyWBo9xy4vxTxnw87mnSQ-0-a215755d03ea5e3c8cb47cbbb728aa26)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_1025_1310_1047_1332.png?sign=1739133447-mhcf16GpndExao2dSwEnMWVKj3RsWevj-0-5b57bbe1cbc6b6a6fec13f8cc79bf8e6)
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=1739133447-izSO5NAyzZxxbp91dNYsT7AJv5WGT3XA-0-88310781c3df4110b1f0135c74cdec32)
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=1739133447-9odpjfpfEl2FnB5EpiZri0ZjUAtjF7ez-0-b6413fa1808ee0bc736cfc6e29ddb9db)
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=1739133447-zrpjiQd2QV1jggYK7fYpL8p1O76gwzj1-0-adb008c90153b083e012e17cb01671e2)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_58_981_1474_1003_1496.png?sign=1739133447-JainFFap1bcX3ogNNATtsrh1kjFA1kpq-0-0ddbbc4b784383325246830a414879f2)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_230_227_252_249.png?sign=1739133447-a3SOKZ1mUrOcJLhpUPgLg87pPzGKf0Yp-0-ff4f34067482e36545db514f3ada0add)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_384_227_405_249.png?sign=1739133447-vWB4J6YrWHRJrTPiWIBPwmDo3D5in93H-0-f1c7c0b002e23aba9b611b3dc52e82ec)
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=1739133447-Bw69Anns9XeMSCHlgH6S5i483ut4bM7k-0-0ae98e9c95e298760cd796f2bac43763)
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=1739133447-tD8WBup3W53E2zeMFCu06ms2Uv8vWHD8-0-fdd0b8c6c87f35e4f6afd44362b369dd)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_461_391_483_413.png?sign=1739133447-dpOL2HISl438Jd8IyV9H95tKpytyw2Cu-0-26b7b30545ddc83f56cdb2e3ab1803d6)
![](https://epubservercos.yuewen.com/B5FBF1/21846776701646506/epubprivate/OEBPS/Images/BZ_59_852_391_874_413.png?sign=1739133447-eHNZMeuHSyeOjdtS5WnsfgotFIcskwfy-0-809c52ec724d87e633a15df332417f81)