颅面部生长发育课件.ppt
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1、下颌骨的生长发育下颌骨的生长发育The Growth and Development of MandibleDepartment of OrthodonticsLiu Yuehua,DDS,PhD,M.Orth.RCS(Edin)下颌骨的发生(下颌骨的发生(SperberSperber,GHGH,19891989)图示下颌骨副软骨的发生部位图示下颌骨副软骨的发生部位At birth:Body is still defined.Alveolar process scarcely present.Rami are proportionally short.Condyles are poorly d
2、efined.Symphyseal growth still occurs increasing widthMandible symphysis closes 1-2 years.Three major parts:body,rami,alveolar processThe mandible is a composite bone with endochondral growth at the condyle and intramembranous bone formation.下颌骨各部分的生长方向下颌骨各部分的生长方向 (EnlowEnlow,DHDH,19901990)Posterior
3、 border of ramus-intramembranous bone formation by periosteal tissues.Simultaneous resorption of bone on the anterior border of ramus.Surface deposition and reposition on complete surface of mandibular-remodelling.Mandibular lingual tuberosity(intramembranous)-appositional growth for horizontal elon
4、gation of the mandibular body on the lingual surface(between most posterior molar and mandibular foramen)The mandible appears to“grow”in a downward and forward manner when visualized on superimposed serial cephalometric tracing registered on cranial base.A:Simultaneous displacement occurs in the opp
5、osite direction,displacing the chin anteriorly and inferiorly.B:Actual growth takes place in a wide variety of regional direction with the predominent growth trend posteriorly and superiorly.下颌骨宽度的增长下颌骨宽度的增长下颌骨外侧面增生新下颌骨外侧面增生新骨,内侧面吸收陈骨;骨,内侧面吸收陈骨;髁突随颞凹向两侧生长,髁突随颞凹向两侧生长,使升支宽度增加;使升支宽度增加;下颌骨前部在乳牙萌出后,下颌骨前部
6、在乳牙萌出后,宽度较少增加,下颌尖牙间宽度较少增加,下颌尖牙间宽度在岁以后几无增加。宽度在岁以后几无增加。下颌骨高度的增长下颌骨高度的增长下颌升支高度的生长主下颌升支高度的生长主要靠下颌髁突新骨的生长;要靠下颌髁突新骨的生长;喙突的同时生长;喙突的同时生长;下颌体的生长,主要是靠下颌体的生长,主要是靠下颌牙齿萌出时牙槽突的增高下颌牙齿萌出时牙槽突的增高及下颌骨下缘少量增生新骨。及下颌骨下缘少量增生新骨。The mandibular condyle-Endochondral growth by interstitual and appositional proliferation of cart
7、ilage Surface deposition and resorption on complete surface of mandibular-remodelling inferior border of mandible coronoid process become fully differentiated Alveolar process(intramembranous)-Grows when teeth begin to erupt -resorbs when teeth are lostThe combination of condylar and ramus growth br
8、ings about:A backward transposition of the ramus,thereby permitting elongation of the body of the mandible.A displacement of the body(and dentition)in an anterior direction.A vertical lengthening of the ramus,providing displacement of the mandible inferiorly and vertical dimension for alveolar growt
9、h.A moveable articulation during various growth changes.Vertical section through the ramus and the coronoid process showing the charateristic pattern of resorption The remodelling mechanism involved in this superior and lateral relocation is basically the expanding“V”principle.As the coronoid termin
10、i become higher,they grow apart at their apicies.髁状突的生长髁状突的生长 (GooseGoose,DHDH,19821982)Severe mandibular deficiency from TMJ infection.四、牙列与合的发育四、牙列与合的发育(一)合的建立(一)合的建立婴儿在无牙齿萌出时,无合关系;婴儿在无牙齿萌出时,无合关系;婴儿第个月乳牙萌出时开始建合;婴儿第个月乳牙萌出时开始建合;成人第三磨牙萌出时才完成建合。成人第三磨牙萌出时才完成建合。向前的动力向前的动力向后的动力向后的动力内外的动力平衡内外的动力平衡垂直向的动力平衡
11、垂直向的动力平衡(二)建合的动力平衡(肌肉)(二)建合的动力平衡(肌肉)萌牙前期的颌间关系萌牙前期的颌间关系乳牙合乳牙合替牙合替牙合恒牙合恒牙合乳牙合期乳牙合期生长间隙:生长间隙:-岁,前牙部分;岁,前牙部分;灵长间隙灵长间隙(primate space):primate space):上颌乳尖牙近中或远中。上颌乳尖牙近中或远中。In the maxillary arch,the primate space is mesial to the canines.In the mandibular arch,the primate space is distal to the canine.Spac
12、ing in the primary incisor region is normally distributed among all the incisors,not just in the“primate space”locations where permanent spaces exist in most mammalian species.垂直型垂直型(flush terminal plane)近中型近中型(mesial step)远中型远中型(distal step)2-42-4岁岁 无间隙、无磨耗、无间隙、无磨耗、E E远中呈直线远中呈直线4-64-6岁岁 有间隙、有磨耗、有间隙
13、、有磨耗、E E 近中移动近中移动前牙合关系:覆盖很浅,覆合较深;前牙合关系:覆盖很浅,覆合较深;前牙部分具有生长间隙及灵长间隙;前牙部分具有生长间隙及灵长间隙;终末平面以垂直型及近中型较多,对恒牙合终末平面以垂直型及近中型较多,对恒牙合的建立意义较大;的建立意义较大;上颌乳尖牙的近中舌侧面与下颌乳尖牙的远上颌乳尖牙的近中舌侧面与下颌乳尖牙的远中唇侧面相接触。中唇侧面相接触。(二)替牙合期二)替牙合期Period when both primary and permanent teeth are present in the mouth.恒牙萌出时间及顺序恒牙萌出时间及顺序Most commo
14、n eruption sequence:Another sequence of eruption fairly common in the mandibular arch is:The sequence of eruption of the permanent teeth is more important than the exact time of eruption.Eruption of the first permanent molarsGives the key to the occlusionThree ways a Class I molar relationship can d
15、evelop:(i)Mesial step terminal plane:permanent molars erupt directly into a Class I relationship.(ii)Straight(Flush)terminal plane:erupting lower first permanent molars may give mesial force moving lower second primary molars forward to allow a Class I molar relation.(iii)Late mesial shift of a stra
16、ight terminal plane.-most common way that a Class I molar relation results.-permanent molars erupt end-to-end.-because of dimensional differences between the primary and permanent 3,4 and 5(Leeway space of Nance),after exfoliation of the primary teeth the lower first permanent molars move mesially i
17、nto a Class I occlusions.替牙间隙(替牙间隙(LeewayLeewayspace)space)=(C+D+EC+D+E)(3+4+53+4+5)上颌单侧约上颌单侧约0.90.9mmmm 下颌单侧约下颌单侧约1.71.7mmmm替牙间隙(替牙间隙(LeewayLeewayspace)space)On the average,the combined width of the mandibular deciduous canine and first and second deciduous molars is 1.7 mm greater than the permane
18、nt successors.The deciduous versus permanent tooth dimension for the comparable maxillary arch segment is only 0.9mm.Mesial drift is consequently greater in the mandibular arch,often compensating for a flush terminal plane.“Leeway space”in maxillary and mandibular arches,as described by Nance.If a c
19、hild has a flush terminal plane molar relationship early in the mixed dentition,about 3.5 mm of movement of the lower molar forward relative to the upper molar is required for a smooth transition to a Class I molar relationship in the permanent dentition.About half of this distance must be supplied
20、by differential growth of the lower jaw,carrying the lower molar with it.the other half can be obtained from the leeway space,which allows greater mesial movement of the mandibular than the maxillary molar.Eruption of the permanent teeth(i)First molars followed almost immediately by lower central in
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