正中关系位记录方法

正中关系位对全口义齿的修复、咬合重建、牙合关系紊乱的检查与治疗、牙体修复、正畸矫治及颞颌关节功能紊乱综合征的检查与治疗等都有重要意义。传统正中关系位的记录方法包括哥特式弓描记法、吞咽咬合法、卷舌后舔法、功能反射法、颏区诱导法、双侧扶持下颌法、下颌运动轨迹描记法、肌监测仪法等,这些方法均需要患者的极大配合,而且灵活性较大,可重复性较差,初学者不易掌握。文章在概述了传统正中关系位记录方法之后,介绍了一种新的记录方法——Leaf Gauge（正中关系咬合片）法,该方法的使用无需太多临床经验,初学者容易掌握,且重复性强、精确度高。     

吸光度法对30例全口义齿咀嚼效能的比较研究

目的：比较不同方法制作全口义齿的咀嚼效能。方法：应用吸光度法测量30例无牙颌患者分别采用直接咬合法和哥特氏弓描记法确定正中关系制作完成的全口义齿的咀嚼效能。结果：经统计学分析,哥特式弓描记法优于直接咬合法制作的全口义齿。结论：哥特式弓描记法是可推广的确定正中颌位关系的方法。     

不同颌位关系记录法对全口义齿再修复患者义齿调胎量影响的研究

目的通过研究3种方法记录颌位关系的全口义齿再修复患者义齿调胎量的差异,为此类患者探寻最佳颌位记录方法,并为临床提供参考。方法随机选择20名全口义齿再修复患者,采用自身对照的研究,对患者分别采用直接咬合法、哥特式弓描记法、哥特式弓联合面弓转移颌位关系法制作3副全口义齿,并比较不同方法在调殆前后覆殆、覆盖的差异。结果用哥特式弓联合面弓转移颌位关系法制作的全口义齿调验前后覆殆、覆盖的变量差异大于直接咬合法及哥特式弓描记法,其差异具有统计学意义（P〈0.05）。直接咬合法与哥特式弓描记法转移颌位关系法之间无明显差异（P〉O.05）。结论使用哥特式弓描记法与哥特式弓联合面弓转移颌位关系法确定的颌位更符合生理功能,为全口义齿再修复患者提供更可靠的颌位记录方法,提高医生的工作效率和患者的满意度。     

不同颌位记录方法对全口义齿再修复患者咀嚼效率的影响

目的比较3种记录颌位关系方法对全口义齿再修复患者不同时期咀嚼效率的影响。方法随机选择20名全口义齿再修复患者采取自身对照的方法,每位患者分别采用直接咬合法、哥特式弓描记法、哥特式弓联合面弓转移颌位关系法制作3副全口义齿,并比较不同方法下制作的义齿在患者即刻佩戴义齿时、佩戴义齿3个月后的咀嚼效率的差异。结果患者即刻佩戴义齿时咀嚼效率测定结果显示,使用哥特式弓联合面弓转移颌位关系法制作全口义齿的患者咀嚼效率明显高于使用其他2种方法制作全口义齿的患者（P〈0．05）,而使用直接咬合法与哥特式弓描记法制作全口义齿的患者咀嚼效率没有差异;佩戴义齿3个月后,3组患者的咀嚼效率无明显差异。结论使用哥特式弓联合面弓转移颌位关系法可为患者提供更可靠的颌位记录方法,可以提高患者的即刻咀嚼效率,提高患者的满意度和医生的工作效率。     

自主后退法和双手引导法确定正中关系位的比较研究

目的 比较自主后退法和双手引导法确定正中关系位时髁突位置的异同,以期为临床确定正中关系位提供参考.方法 选择15名年轻健康志愿者,分别以自主后退法和双手引导法确定正中关系位,超声波电子下颌运动轨迹描记仪记录双侧髁点运动轨迹,观察正中关系位时髁点相对牙尖交错位时髁点的移动方向,测量两种方法获取的正中关系位髁点相对牙尖交错位髁点间距离,使用配对t检验比较两种方法的差异.结果 除1名志愿者外,14名志愿者正中关系位时髁点位置均比牙尖交错位时偏向上后方,自主后退法、双手引导法确定的正中关系位髁点与牙尖交错位髁点间距离分别为(0.67±0.22)和(0.73±0.25) mm,差异无统计学意义(P＞0.05).结论 自主后退法与双手引导法确定的正中关系位髁突位置基本一致.     

哥特式弓描记法判断无牙颌患者偏侧咀嚼的初步研究

目的:探讨无牙颌患者偏侧咀嚼的临床判定方法,为今后进一步研究患者的义齿修复提供参考.方法:对30例无牙颌患者进行哥特式弓描记及叩齿点的测量,使用三维精密平移台测量哥特式弓描记图像顶点、边缘运动各终点及叩齿点坐标,建立坐标系,计算肌力闭合道终点(MCP)相对于正中关系位(CRP)水平方向上的偏移量d、不对称指数AI(角度)、AI(幅度)以及AI(偏离),所得数据利用SPSS13.0进行统计分析.结果:30例无牙颌患者中2例(6.67％)MCP与CRP为同一位置,8例(26.67％)MCP与CRP在水平方向上协调,20例(66.67％)MCP与CRP在水平方向上存在不协调,最小偏离量为0.340 mm,最大偏离量可达到2.640 mm.20例MCP与CRP不协调的无牙颌患者中,14例患者的d值方向至少与AI(角度)、AI(幅度)、AI(偏离)中的1个指标方向相一致.结论:哥特式弓描记法作为判断无牙颌患者有无偏侧咀嚼的方法,有一定可信度,但其具体判定指标还需进一步研究,必要时应结合患者病史、心理状态等因素综合分析.     

无牙颌颌位记录的临床方法

无牙颌颌位关系记录的目的是正确确定患者的正中关系位,以期在此位置上通过全口义齿重新建立良好的咬合关系。颌位关系记录内容包括垂直关系与水平关系2部分。对于垂直关系,临床上一般通过记录患者面下1/3垂直距离来确定。当患者下颌位于息止颌位时,髁突位于关节窝中央略向前下,咀嚼肌处于均衡放松状态,临床上一般通过测量息止颌位垂直距离来确定正中关系位垂直距离。在临床上医师通常在记录垂直关系的同时进行水平颌位关系的记录。本文通过图文并茂方式详细描述了颌位关系记录的几种临床常用方法。     

对功能性反患者X线头影测量的1种修正方法

本文介绍一种对功能性反牙合患者头颅侧位描记片的修正方法,获得患者正中关系位时的X线头影测量,用以正确评价功能性反牙合患者真实的颌骨前后向位置关系。1资料与方法患儿,男,8岁。替牙牙合,两侧磨牙关系均为中性,前牙覆牙合-3.0 mm,覆盖-1.5 mm,下颌可以自由后退至前牙对刃关系。首先拍摄患者在下颌后退位时的头颅侧位片。(在下颌后退位时,前牙对刃,后牙无咬合接触)。用硫酸纸直接描记下颌后退位(MR)头颅侧位片的头影图。注意头影图必须包括上下颌尖牙以及后牙牙冠的轮廓线。用第2张硫酸纸将先前所绘头影图中下颌部分描记下来。注意必须…     

用吞咽位记录正中关系

在评价上下颌关系,检查咬合和作修复时,常以正中关系作为参考位。作者认为“正中关系”位包括:后退接触位(RCP),肌位(MP)和牙尖交错位(IP)。病人缺牙后因失去牙周本体感受的调节,只有后退接触位的记录是可靠的。临床上常用吞咽位     

下颌功能性正中偏移与上颌第一磨牙牙龈萎缩的关系

目的 观察中线偏移与第一磨牙牙龈萎缩的关联性.方法 选取32例无缺牙、无颞下颌关节功能紊乱,第一磨牙位于牙弓的正确位置上且没有偏向颊侧或腭侧的患者,制取上下颌印模,上颌模型以面弓转移至第三类(牙合)胎架上,并以正中关系记录将模型固定于(牙合)架上.观察下颌从正中关系位到牙尖交错位之间的运动途径,检测是否有下颌中线偏移,...     

Comparison of the replicability of routinely used centric relation registration techniques

PURPOSE: This study was conducted to determine statistically the most repeatable mandibular position of 3 centric relation methods. MATERIALS AND METHODS: Three centric relation recording methods commonly reported in the literature were selected: bimanual mandibular manipulation with a jig, chin point guidance with a jig, and Gothic arch tracing. Fourteen healthy adult volunteers (7 males and 7 females), with an average age of 26.61 +/- 4.20 years and no history of extractions, temporomandibular joint dysfunction, or orthodontic treatment, were selected for the study. Accurate casts were mounted on an articulator (Denar D4A) by means of a facebow and maximum intercuspation silicone registration record. A mechanical 3-dimensional mandibular position indicator was constructed and mounted on the articulator enabling the operator to analyze the mandibular positions in 3 spatial axes (x, anteroposterior; y, superoinferior; z, mediolateral shift). Each centric relation method was recorded four times on each subject (at baseline, 1 hour, 1 day, and 1 week at approximately the same time of day). Records were transferred to the articulator, and data were extracted using a stereomicroscope modified to accept the mandibular position indicator. RESULTS: Variability within subjects ranged from 0.03 mm (left-side z axis for the bimanual method) to 1.6 mm (left-side y axis for the Gothic arch method). To indicate the least variable (most repeatable) method a comparison was made using the F test. The bimanual method was the most consistent, showing between 10.11 (p = 1) and 0.438 (p = 0.005) times less variation than the Gothic arch method (the least consistent). The repeatability of the chin point guidance method was somewhere between the other 2 methods. CONCLUSIONS: The results of this study showed that of the 3 centric relation methods evaluated, the bimanual manipulation method positioned the condyles in the temporomandibular joint with a more consistent repeatability than the other 2 methods, whereas the Gothic arch was the least consistent method.     

Intraoral gothic arch tracing

In order to create optimum esthetics, function and phonetics in complete denture fabrication, it is necessary to record accurate maxillo-mandibular determinants of occlusion. This requires clinical skill to establish an accurate, verifiable and reproducible vertical dimension of occlusion (VDO) and centric relation (CR). Correct vertical relation depends upon a consideration of several factors, including muscle tone, inter-dental arch space and parallelism of the ridges. Any errors made while taking maxillo-mandibular jaw relation records will result in dentures that are uncomfortable and, possibly, unwearable. The application of a tracing mechanism such as the Gothic arch tracer (a central bearing device) is a demonstrable method of determining centric relation. Intraoral Gothic arch tracers provide the advantage of capturing VDO and CR in an easy-to-use technique for practitioners. Intraoral tracing (Gothic arch tracing) is a preferred method of obtaining consistent positions of the mandible in motion (retrusive, protrusive and lateral) at a comfortable VDO.     

Influence of the inclination of the plate of an intra-oral tracing device on the condylar position registered by tapping movement

The object of this study was to determine the best inclination of the intra-oral tracing device to get optimum condylar position with the registration of tapping movement. Three appliances with different tracing plate inclinations were used in five healthy subjects. The tracing plates were set at 0 degrees to occlusal plane (horizontal); at the angle formed by drawing a line from condylar point to the stylus position at occlusal plane (inclined); then at the angle half to inclined (half-inclined). Subjects made Gothic arch and tapping movements (n = 30) at a 30 mm interincisal distance with the head Camper plane horizontal. The incisal and condylar points were tracked with a 6-degree-of-freedom jaw movement tracking system. The location of gothic arch apex, the distribution and mean position of 30 tapping points from intercuspal position were analyzed in incisal and condylar point between the appliances. Data were analyzed with repeated measures one-way anova. Results showed that mean position of tapping points were significantly different among the appliances. Half-inclined appliance recorded tapping points in a convergent area nearer to intercuspal position (IP) than other appliances. In all appliances, the contact points of the tapping movement were anterior to Gothic arch apex.     

A Comparative Evaluation of Static and Functional Methods for Recording Centric Relation and Condylar Guidance: A Clinical Study

To evaluate and compare the centric relation and horizontal condylar guidance using interocclusal wax and extra oral Gothic arch methods and subjective evaluation of dentures thus fabricated. Centric relation and horizontal condylar guidance was recorded by using interocclusal wax and gothic arch tracing in 28 completely edentulous patients. These records were transferred to the articulator and difference in both values was recorded. After that patients were divided in two groups according to the centric relation and horizontal condylar guidance recording method used to achieve balanced occlusion. Response of the dentures was subjectively evaluated using “Woelfel subjective evaluation criteria”. Centric relation recorded by both the methods did coincide in 7.14 % of patients. Centric relation recorded by interocclusal wax was posterior to Gothic centric relation in 21.43 % of patients, and anterior to Gothic centric relation in 71.42 % patients. Gothic arch tracings gave higher mean guidance values on both the sides as compared to protrusive wax record in all the subjects, although the difference was statistically insignificant (P > 0.05). Subjective evaluation showed statistical insignificance for all the parameters in both groups. Gothic arch method records the centric relation at a more posterior position than the Static method, but it does not make any difference in clinical performance of the complete denture. Horizontal condylar guidance angle was approximately similar by both the methods.     

154例无牙颌患者哥特式弓口内描记法描记图形分析与分类

目的：根据口内哥特式弓描记轨迹图形的特点，对哥特式弓描记轨迹进行分类，并探讨每种分类的判读方法和影响因素。方法：随机选取154例无牙颌患者，运用美国Geneva Dental公司生产的口内哥特式弓描记仪描记运动轨迹，并记录患者是否存在偏侧咀嚼习惯、旧义齿的咬合情况以及是否患有瘫痪帕金森综合征等全身疾病，运用spss的ordin regression分析这些因素与轨迹分型的关系。结果：根据哥特式弓描记图形大致分为5种类型：尖顶型、圆顶型、多顶点型、偏侧型和单点型。偏侧咀嚼，旧义齿的咬合情况，以及是否患有瘫痪等全身疾病对分型存在影响，并具有统计学意义。结论：尖顶型描记轨迹颌位关系位于尖顶的顶端，易于判断，圆顶型多位于圆顶两边延长线所组成的角的角分线与圆顶的交界附近，多顶点型需要对每个顶点进行验证，偏侧型位于偏侧方的顶点附近单点型就是这一点的位置。偏侧咀嚼，旧义齿的咬合情况，以及是否患有瘫痪等全身疾病对分型存在影响，影响的作用依次减小。     

A Technique to Stabilize Record Bases for Gothic Arch Tracings in Patients with Implant-Retained Complete Dentures

Clinicians have long expressed concern about the accuracy of the Gothic arch tracing for recording centric relation in edentulous patients. With the use of dental implants to assist in retaining complete dentures, the problem of inaccurate recordings, made for patients without natural teeth, can be significantly reduced. This article presents a technique that uses healing abutments to stabilize the record bases so that an accurate Gothic arch tracing can be made.     

半坡博物馆馆藏六千年前人类牙弓形态研究

目的：通过对西安半坡出土6000年前新石器时期人颌骨的相关研究,了解该时期人的牙弓特征.方法：选取保存较完整的上颌骨94个,下颌骨98个.对牙弓进行三维测量,并对牙弓形态进行观测.结果：报告了该批次标本上下颌牙弓形态的各项测量数据及非测量性状的观测结果.牙弓形态主要以椭圆形为主,Terra牙列指数分析上下牙弓均大于现代人,上颌牙弓宽度变化更为明显.结论：为进一步研究人类颌骨演化积累数据资料.     

少牙畸形患者牙弓长度和宽度的临床研究

目的研究少牙畸形患者牙弓的长度和宽度,为临床诊治提供参考。方法选取少牙畸形与正常的牙模型各50副,用游标卡尺测量并计算牙弓长度和宽度的各项参数,采用ANOVA法进行统计分析。结果少牙畸形患者较正常的上、下牙弓长度分别少4.40mm和2.80mm,上、下颌尖牙宽度分别少2.82mm和2.70mm,上、下颌磨牙宽度分别少3.40mm和1.80mm。两组测量项目的差异均有统计学意义(P<0.01)。结论正畸治疗时,应当考虑到少牙畸形患者的牙弓长度和宽度均较正常小。