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●CNA INTRUSION ARCH装正与装反的差异

2009-09-16 16:08:34| 分类：矫正概念与病例 | 标签： |举报 |字号大中小订阅

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●CNA INTRUSION ARCH装正与装反的差异

(图A) 此一病例为一替牙期的5年级学童,女性,因为门牙成蝴蝶牙(BUTTERFLY TEETH),有外翻的现象,并且有散在性间隙,前来求诊,图A是例行性的回诊已到后期的治疗,运用CNA INTRUSION ARCH WIRE来做前牙的INTRUSION(压入)让咬合变浅一点,但,在就在助手医生协助清洗装妥后正准备照相时发觉,怎么这条INTRUSION ARCH WIRE看起来怪怪的,通常WIRE上会有两处弯折,如今所见的弯折是倒过来的,于是我就先把它给拍下来,然后我心理有谱了,一定是助手医生因为新手的关系,没有仔细瞧清楚,也没问一下就装上了,所以产生如图片上的状况

如图A,上颚若是像图片那样,则会产生上门牙挺出(EXTRUSION)的现象,咬合会变得更深,一个挺出,当然会有一个反作用力给压入,那就是大臼齿,其前端变成tip forward bend,那不仅会产生molar牙根往远心走,牙冠往近心shift,上前牙会更加有把水平覆咬关系给加大,那就不是我们所要的把门牙的关系变浅的咬合

(图B)这是错误的左侧图像,可以看到对称的INTRUSION ARCH WIRE也是反的,

(图C)这是右侧正确的图像,我把弓线给卸下后,重新安装好,并且请助手医生看一遍,顺便敲三下(KNOCK THREE TIMES),让其脑力激荡一下,这样的INTRUSION ARCH WIRE才是我们要的,它才可以产生上颚门牙的INTRUSION,与MOLAR 的TIP BACK BEND,唯有MOLAR直立,咬合才会变浅,overjet & overbite的关系才会变好,

请注意!若是CNA INTRUSION ARCH WIRE未入槽沟前,其位置应会在如图的上颚系带被拉起来的最低点处,经由置入槽沟绑住后,弓线会产生往上的一个力道,把门牙压入

透过简易的2x4 appliance,利用乳牙整前牙,这都是临床上一些小技法,由侧位图像所看,犬齿关系已有class I relationship,molar的关系也是,剩下的就是慢慢等,让各象限的345/345顺利萌出

原本家长担心的萌牙不顺产生日后整体口腔牙列的排列异常,经由简易的操作后,病人的牙列已有大变动,我想家长心中是高兴的,

(图D)这是左侧的正确INTRUSION ARCH WIRE的放法,那您会问?可不可以倒过来放?当然可以,只是放的案例会不一样,若是有前牙开咬的病例,一般会采取让门牙挺出(extrusion),所以就会把intrusion arch wire给倒过来放,形成图A的情形,这样为咬合的变深,开咬的现象就会慢慢的改善,,,

(原稿: http://tw.myblog.yahoo.com/orthodontist-yang/article?mid=6494)

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