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。     

各种咬合垂直距离确定方法的研究现状

确定咬合垂直距离是咬合重建的重要内容,目前尚无理想的测量方法。本文就息止牙合间隙法、吞咽法、发音法、患者主观感觉、咬合力测定、肌电图法、面部测量法、参照拔牙前记录、参照旧义齿和面部观察法加以综述,探讨了每种方法的研究现状。     

三维转化头影测量法评估咬合垂直距离的研究

目的 对三维转化头影测量法、发音法及息止间隙法确定的云南省汉族无牙颌患者咬合垂直距离的准确性进行比较和分析。方法 首先建立云南省汉族正常者锥形束CT（CBCT）头颅侧位影像各标志点间相关性数据库,随后选取5名63~78岁云南省汉族无牙颌患者,使用NNT.View软件对由CBCT转化的头颅侧位片的各硬组织标志点进行测量分析,结合正常人群数据库,评估出咬合垂直距离,并对CBCT转化头影测量法、发音法及息止间隙法确定的咬合垂直距离进行分析。结果 本研究以发音法为标准参照组,分析了息止间隙法和6种CBCT转化头影测量法（包括N-ANS/ANS-Me、S-Go/N-Me、ANS-Gn/N-ANS、ANS-FH/Me-FH、ANS-Xi-Pm、CA/LA）与发音法的差值,结果发现：7种测量方法与发音法均有很高的一致性（组内相关系数>0.986）;其中息止间隙法、N-ANS/ANS-Me、S-Go/N-Me法差值的绝对值较其他4组更小,而ANS-FH/Me-FH差值的绝对值最大,差异均有统计学意义（P<0.05）。结论 三维转化头影测量法除ANS-FH/Me-FH外,其余5种方法均可为临床评估无牙颌患者咬合垂直距离提供参考。     

老年人息止合间隙及面部距离的调查分析

本文对３８０例有牙颌老年人及４２例无牙颌老年人（已做总义齿修复）的息止间隙及面部的距离进行了测量分析。结果：有牙颌老年人的息止间隙平均数为２．９４ｍｍ，４２例无牙颌戴有总义齿老年人的息止合间隙平均为３．８６ｍ。面中部距离多数大于垂直距离，占４１．３２％。面中部距离与垂直距离相等者不到三分之一，占３１．３２％，面中部距离小于垂直距离者占２７．３７％。本研究表明，老年人息止间隙大于青年人的息止间隙，面中部距离并不完全等于垂直距离，所有确定患者垂直距离的方法都应该根据不同的患者综合运用。     

无牙颌息止位与总义齿垂直距离的关系

作者认为应该重新评价传统的以息止颌位的垂直距离作为总义齿修复出发点的作法,即以息止颌位的垂直距离减去咬合时的垂直距离等于(牙合)间隙的方法。因为在应用此法时,常遇到的问题是面部测量易出错及息止颌位的不恒定。作者报道了一项关于无牙息止颌位面部高度和戴新的全口义齿咬合位时面部高度关系的研究。     

连续发元音与下颌位置变化的研究

本篇文章的目的是探讨连续发元音［ａ］，［ｅ］，［ｉ］，［ｏ］，［ｕ］时下颌位置的稳定性以及每一位置与息止颌位的关系。用Ｋ５－ＡＲ型下颌运动描记记录１０名正常年青人连续发每一元音时的下颌垂直和前后向距离。研究结果表明，连续发元音［ｉ］时，下颌位置稳定与每一受试者的息止颌位接近，［ｉ］音法比传统语音法更具有可重复性，是确定上下颌垂直距离的一种有效方法。     

息止颌位在托牙修复中的应用

在全口托牙及复杂托牙的修复中 ,正中牙合位对保护口腔软硬组织、下颌关节健康 ,恢复咀嚼功能至关重要。作者利用息止颌位获取垂直距离、正中牙合位 ,并检查修复中及修复后托牙正中牙合是否正确。临床资料年龄与性别 :6 5例中 ,男性 2 4例 ,女性 41例 ;最小 40岁 ,最大 80岁。托牙分类 :全口托牙 45例 ,半口托牙 1 5例 ,复杂托牙 5例。方法如下。垂直距离的确定 :1 利用自凝塑料制作牙合托 ,要求固位好。2 常规制作牙合堤 ,上牙合堤平面与双侧瞳孔水平线平行 ,且在上唇下 2ｍｍ。3 牙合堤戴入口内 ,利用息止颌位时的垂直距离减去息止牙合…     

55例总义齿修复的临床评价

目的 评价拔牙前取模减少确定颌位误差修复总义齿的临床效果。方法 记录55例患者拔牙前咬合关系，以此作为拔牙后总义齿的颌位依据，指导后期制作并评价临床应用效果；在记存模上制作即刻总义齿；常规拔牙；拔牙2个月后试验、采用闭口式印模、完成总义齿修复。结果 53例患者获得满意的效果，成功率达96％。结论 用此方法制作总义齿，减少了确定颌位关系时的麻烦与误差，修复效果良好。     

垂直距离改变对面颌部软组织的影响

目的：应用计算机图象分析技术,探讨垂直距离变化对面颌部软组织的影响。方法：通过模拟四种不同垂直距离,对19名正常He者的33项面颌部软组织测量项目进行分析。结果：下唇方肌,三角肌,颏肌肌纤维随垂直距离变化较明显。结论：唇下部软组织受垂直距离的影响较唇上部明显;在重建垂直距离时,临床医师们应对唇下部软组织形态变化更加以重视和参考。     

息止颌位与嚼肌的肌电活动

本文旨在分析下颌息止颌位与咀嚼肌电活动的关系。比较不同面形的临床息止颌位和肌电图息止颌位。 选择无颞颌关节症状,自然开口度大于40mm,侧向运动大于7mm的40位受检者,年龄为22～34岁,平均年龄26岁。受检者没有一人近期做过正畸治疗,用肌电图记录肌电息止颌位,用下颌运动轨迹图(electromyography,EMG)记录临床息止颌位。同时,每个受检者摄头颅侧位片,用头影测量的方法描出Frankfort横线(Pr-Or)与下颌平面(Go-Me)的角度。正常值为24±4°,小于20度为低角组,大于28度称为高角度组。低     

Effect of denture fabrication and wear on closest speaking space and interocclusal distance during deglutition

STATEMENT OF PROBLEM: The accuracy of assessing maxillomandibular relationships for trial bases and dentures using phonetic and swallowing methods has not been compared to that observed with definitive prostheses. Thus, there is no evidence to prove whether measurements obtained through such methods remain the same after adaptation to dentures. PURPOSE: This study investigated changes in the closest speaking space, interocclusal rest space, and interocclusal distance during deglutition in edentulous patients during and after complete denture treatment. MATERIAL AND METHODS: Eighteen edentulous subjects participated in this study and measurements were performed after 7 intervals of time: (1) with occlusion rims and record bases following creation of the maxillomandibular relationship record, (2) with trial dentures, (3) at insertion of definitive complete dentures, (4) 1 week, (5) 2 weeks, (6) 1 month, and (7) 3 months after insertion. Recordings of interocclusal distances were made with a mandibular kinesiograph. Closest speaking space was measured during the pronunciation of the word 'seis'. The distance between postural rest position and centric occlusion, or interocclusal rest space, was measured using a kinesiograph. Interocclusal distance during deglutition was tested by recording the closest mandibular position recorded during swallowing of 20 mL of water. Data were analyzed using repeated-measure ANOVA, followed by the Student-Newman-Keuls test (alpha=.05). RESULTS: A significant (P<.01) reduction in the mean closest speaking space was found when it was evaluated using occlusion rims and record bases (4.6 mm) compared with other stages (3.0 to 3.4 mm). No significant differences were found in mean interocclusal rest space and interocclusal distance during deglutition among the time periods evaluated. CONCLUSIONS: The presence of occlusion rims can influence mandibular position during pronunciation of the /s/ sound. The arrangement of artificial teeth changes the closest speaking space. However, rest position and deglutition were not affected, either during denture fabrication or short-term use.     

A preliminary investigation into the effect of increased occlusal vertical dimension on mandibular movement during speech.

Current methods of determining whether a patient will accommodate to an increased occlusal vertical dimension rely on a largely subjective assessment of the mandibular rest position and capacity to adapt whilst wearing a temporary appliance. The purpose of this preliminary study was to establish if mandibular movement during speech may provide an objective criterion in the assessment of adaptation to increases in occlusal vertical dimension. The closest speaking space, measured as the vertical distance between an incisor point and centric occlusion, as determined during pronunciation of sibilant speech sounds was chosen to depict mandibular movement. The closest speaking space was determined using a Sirognathograph for six young adult subjects and varied from a mean of 1.0 to 3.3 mm. An acrylic splint covering the entire occlusal surface of the lower arch, designed to increase the occlusal vertical dimension by 4 mm in the incisor region, was then cemented on each subject's mandibular arch. The closest speaking space was again determined after 5 days continuous wear of the splint and the mean values found to have decreased to a range of 0.0-1.0 mm. The differences between the mean values for the closest speaking space for each subject before and after splint wear were statistically significant. It was postulated that this method may lead towards an objective basis for deciding if patients will adapt to an increase in occlusal vertical dimension.     

Variability of closest speaking space compared with interocclusal distance in dentulous subjects

Variability of closest speaking space was compared with that of interocclusal distance in 30 dentulous subjects to the nearest 0.1 mm on the screen of a mandibular kinesiograph. Postural rest position was elicited by the subjects saying /M/ and relaxing the jaw. Closest speaking space was defined as the vertical difference in the position of the mandible from the immediate end of rapid counting from 60 to 66 to centric occlusion. The two variables were measured in random order 20 times each. The subjects were examined for two data collecting sessions. The variance of the closest speaking space was smaller than the variance for interocclusal distance for 26 of 30 subjects. The difference between the mean variances was statistically significant, p greater than 0.1 (t 3 and t 3.41, df 29).     

Reliability of Different Facial Measurements for Determination of Vertical Dimension of Occlusion in Edentulous Using Accepted Facial Dimensions Recorded from Dentulous Subjects

The study was undertaken to evaluate the reliability of different facial measurements for determination of vertical dimension of occlusion in edentulous subjects using accepted facial dimensions recorded from dentulous subjects. The hypothesis was that facial measurements can be used to obtain the vertical dimension of occlusion for edentulous patients where no pre-extraction records exist. A total of 180 subjects were selected in the age groups of 50–60 years, consisting of 75 dentate male and 75 dentate female subjects for whom different facial measurements were recorded including vertical dimension of occlusion and rest, and 15 edentulous male and 15 edentulous female subjects for whom all the facial measurements were recorded including the vertical dimension of rest and occlusion following construction of upper and lower complete dentures. The left outer canthus of eye to angle of mouth distance and the right Ear–Eye distance were found to be as valuable adjuncts in the determination of occlusal vertical dimension. The Glabella–Subnasion distance, the Pupil–Stomion distance, the Pupil–Rima Oris distance and the distance between the two Angles of the Mouth did not have a significant role in the determination of the occlusal vertical dimension. The vertical dimension can be determined with reasonable accuracy by utilizing other facial measurements for patients for whom no pre-extraction records exist.     

Anteroposterior and mediolateral variability of the closest speaking space

The variability of the closest speaking space (CSS) was compared to that of interocclusal distance (IOD) in the anteroposterior and mediolateral planes. Data were obtained from 30 dentulous subjects during two recording sessions using a mandibular kinesiograph set to display the frontal and sagittal planes. The two variables were measured in random order 20 times each. Mean variances were compared using a paired t test. The difference between the mean variances was statistically significant (P less than 0.05), with a greater value for CSS, only on the mediolateral projection. The small numerical value of this difference, however, makes any inference of clinical signifiance questionable.     

A new clinical method for evaluating the closest speaking space in dentulous and edentulous subjects: a pilot study

This study proposes a new clinical procedure for measuring the closest speaking space (CSS) and compares it with an instrumental method. The study population included 15 edentulous and 10 dentulous subjects free of systemic disease, speech defects, or masticatory system dysfunction. For all subjects, the CSS was measured using clinical and instrumental methods. The clinical method utilized polyvinyl siloxane, commonly used for interocclusal records, injected on the occlusal surface of the premolars just before the pronunciation of a word containing the consonant sound "s" 3 times. The instrumental method used a kinesiograph. Statistical analysis was performed using 1-way repeated-measures analysis of variance and the Student t test for paired data. There was no statistical difference between the clinical and instrumental methods of determining CSS. Within the limitations of this study, based on a small sample, the new simpler and less expensive method to record the CSS should be considered and further investigated.     

Vertical dimension: A research and clinical analysis

Vertical dimension has been defined in relation to the clinical rest position of the mandible, the vertical dimension of occlusion, and the interocclusal space between the two. The physiologic rest position has been attributed to three possible mechanisms: postural tonicity of the muscles, myotatic (stretch) reflexes, and gravity-elasticity, and/or a combination of all three. There is general agreement that it varies due to head position and many other extrinsic and intrinsic stimuli.The myotatic (stretch) reflex is produced by stimulation of the stretch receptors in the elevator muscles producing a simple two-neuron reflex arc which causes reflex muscle contraction. Its function is to give proprioceptive information to the central nervous system concerning position and movement. The proprioception of mandibular position is determined for the most part by the joint receptors, muscle spindles, pressoreceptors (in the periodontal membrane), and exteroceptors in the oral mucosa.Minimal EMG activity has been demonstrated at the clinical rest position and slightly beyond, at an increased vertical dimension which eliminates the interocclusal space. However, experimental evidence has been shown with adult monkeys that long-term increases in the vertical dimension of occlusion result in intrusion of the posterior teeth with the return almost to the original vertical dimension of occlusion. Several clinical examples of intrusion of the posterior teeth were shown when long-standing occlusal splints were used. Since both occlusal adjustment and vertical dimension increases can cause a reduction in EMG activity, it is recommended that the treatment of TMJ dysfunction is best accomplished by occlusal correction.A treatment prosthesis is recommended for trismus and/or joint injury but it should be accomplished within the interocclusal space. Most treatment prostheses, except those for condylar repositioning, are utilized for the control of symptoms and do not treat the cause of TMJ dysfunction pain.     

A Technique to Obtain Stable Centric Occlusion Records Using Impression Plaster

Recording the maxillomandibular relationship is often a challenge. In situations where there is vertical support but no horizontal stability, and the space between posterior teeth of opposing jaws is not adequate for an interocclusal record, impression plaster can be used. Despite limited clinical use, impression plaster is known for its stability. With this technique, the interocclusal record is obtained by applying the material to the buccal surfaces of the posterior teeth, resulting in a precise and stable cast relationship.     

A comparison of the accuracy of two methods used by pre-doctoral students to measure vertical dimension

STATEMENT OF PROBLEM: Measuring vertical dimension is a soft-tissue measurement. Therefore, inaccuracy may occur. PURPOSE: The purpose of this study is to compare the accuracy of the Willis gauge method with the caliper method. MATERIALS AND METHODS: The Willis gauge measures the distance between the septum of the nose and the chin. The caliper method measures the distance between reference points on the tip of the nose and the chin. Twenty predoctoral students applied both methods 10 times in measuring the rest vertical dimension (RVD) and the occlusal vertical dimension (OVD) of a single edentulous patient. The measurements obtained from one experienced clinician were selected as controls for the interocclusal distances (IOD) for the Willis and the caliper methods, respectively. One-sided t tests and a 1-sided nonparametric test were used to determine significant differences between the 2 methods (alpha=.05). RESULTS: The variances in the RVD values for the Willis gauge method were higher than for the caliper method for most students. A Wilcoxon signed rank test showed that the accuracy of the OVD measurements for the caliper method was significantly better than for the Willis gauge method (P=.001). This was not the case for the RVD measurements (P=.073).The average IOD for the Willis method was significantly higher than the control IOD (P=.026). The average IOD for the caliper method was not significantly larger than the control (P=.1303). CONCLUSION: This study showed that the use of the caliper method by predoctoral students was a significantly more reliable method of measuring the OVD for the patient evaluated.