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所在平台: Udemy |
课程主页: https://www.udemy.com/course/orthodontic-diagnosis-treatment-of-open-bite-malocclusion/
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课程名称：开放性咬合的正畸诊断与治疗 课程概述：开放性咬合是指前牙或后牙之间没有接触，其复杂性源于骨骼、牙齿及习惯等多重因素的共同作用。开放咬合的病因可归因于遗传因素、解剖因素及环境因素。然而，传统或外科正畸治疗后的复发倾向表明，开放咬合被认为是最具挑战性的颌面畸形之一。本课程旨在强调案例讨论，并关注诊断和管理工具。成功的技术干预需要对病因的早期诊断、面部形态及分类进行深入了解。舌位适应失败可能是开放咬合复发的主要原因。在大多数开放咬合治疗情况下，建议并必要进行长时间的固定或可拆卸保持治疗。开放性咬合的治疗仍然是临床医生面临的巨大挑战；通过细致的诊断、及时的干预及适当的治疗模式与器械选择，可以改善治疗效果及长期稳定性。 开放咬合的分类包括： - 简单开放咬合：犬齿至犬齿间有4毫米或以上的开放。 - 复合开放咬合：前磨牙至前磨牙的开放。 - 婴幼儿开放咬合：从磨牙到磨牙的开放。 开放咬合的类型： - 假性或牙性开放咬合：牙齿前倾，但骨性基础未有改变，且不超过犬齿，面部形态正常。 - 真性或骨性开放咬合：涉及或变形的牙槽骨，与高面部生长特征相关。 根据开放咬合的位置，分为： - 前牙开放咬合：可分为牙性和骨性。 - 后牙开放咬合：即使切牙接触，仍有问题的后牙接触。 - 完全开放咬合。 本课程还将探讨开放咬合的病因，包括遗传和非遗传因素，以及如何通过早期识别和处理相应的病理状况来提高治疗效果。
The term open bite is referred as no contact between anterior or posterior teeth. The complexity of open bite is attributed to a combination of skeletal, dental and habitual factors. Etiology of open bite can be attributed to genetics, anatomic and environmental factors. However, the tendency toward relapse after conventional or surgical orthodontic treatment has been indicated. Therefore, open bite is considered one of the most challenging dentofacial deformities to treat. The aim of this course is to emphasize on case discussion and focus of diagnosis and management tools. Early etiological diagnosis, dentofacial morphology and classification are essential to the successful outcome of the technical intervention. Failure of tongue posture adaptation subsequent to orthodontic and/or surgical treatment might be the primary reason for relapse of open bite. Prolonged retention with fixed or removable retainers is advisable and necessary in most cases of open bite treatment. The treatment of open bite remains a tough challenge to the clinician; careful diagnosis and timely intervention with proper treatment modalities and appliance selection will improve the treatment outcomes and long-term stability.ClassificationClassification of open bite by Worms, Meskin, and Isaacson (1971):• Simple open bite - From canine to canine, with 4mm or more in centric relation.• Compound open bite - From premolar to premolar.• Infantile open bite - From molar to molar.Types of open biteFalse or Dental open bite: In this bite the teeth are proclined as there is no alteration of the osseous bases but it does not extend beyond the canine. This patient has normal facial morphology, a correct bone relation, a pesudo-bite and dento-alveolar problem.True or Skeletal open bite: In this type of open bite the alveolar processes are involved or deformed and dolichofacial characteristics are also seen. This patient present's hyper-divergency in maxilla, with their lower facial third and vertical dimensions increased.According to the zone where open bite is located, they are divided into:Anterior open bite: Anterior open bite from its etiological point of view are divided into two categories:o Dentalo SkeletalThe dental anterior open bite results from dental eruption impediment.The skeletal open bite is due to posterior facial growth.• Posterior open bite: Posterior open bite is characterized by failure of number of teeth in either or both opposing buccal segments to reach occlusion although there is incisor contact.It is seen rarely and can be because ofο Tongue interpositionο Disturbances in eruption (eg. ankylosis)ο Primary failure of eruption• Complete open bite.Andrew richardson classified anterior open bite as:• Transitional open bite:-This type of open bite occurs when the permanent teeth are erupting. Due to incomplete growth of dento alveolar region results in anterior open bite. Spontaneous corrections occur due to continued alveolar growth and average growth increment in lower anterior facial height.• Digit sucking open bite:-Eruption of incisor teeth is impeded by digit sucking thus creating anterior open bite. Such open bites get corrected by retrieving the habit.These open bites are rare in pubertal growth stages, but rarely persist in adult life.Growth of dento alveolar process and up-righting of incisors tends to the spontaneous closure of anterior open bite.• Anterior open bite due to local pathology:-Local pathological conditions leading to anterior open bite includes cyst, dilacerations, and ankylosis.Dento alveolar growth is facilitated by appropriate surgical treatment for removal of local pathology.• Open bite due to skeletal pathology:-Anterior open bite due to skeletal pathology or abnormality becomes apparent towards the end of the growth period.Some of these conditions are cleft palate, craniofacial dyostosis, cleidocranialdyostosis, and achondroplasia.• Non pathological skeletal open bite:-Non pathological skeletal group consists of three sub groups;o Open bite in primary dentition stage but in the pre-pubertal and pubertal growth period closure is brought about by dento alveolar growth compensation. Thus, the incidence of open bite tends to decrease with advancing age.o Open bite is apparent in pre-pubertal stage, but closes in pubertal stage and reappears in the post pubertal stage.This is due to interplay between vertical facial growth and compensating dento alveolar growth which is sufficient to close the open bite. But in post pubertal stage vertical facial growth dominates and causes open bite.o Third group presents most difficult clinical orthodontic problem, where facial growth dominates leading to gross anterior open bite as age advances.According to Moyer's:• Simple open bite:-This type of open bite is confined to the teeth and alveolar process. The main problem regarding this type of open bite is failure of some of the teeth to meet the line of occlusion.• Complex open bite:-This type of open bite is caused by primary vertical dysplasia. Complex open bite is frequently associated with Class-I and Class-II malocclusions and occasionally associated with Class III malocclusionAetiologyAnterior open bite like any other malocclusion is the result of certain causes either of the hereditary origin, that act prenatally or post-natally on the tissues of the oro-facial region.Hereditary factorsThe open-bite anomaly is most often associated with inherited facial growth. Horizontal skeletal dysplasias appear to be inherited thus dysplasias in the vertical plane may also be inherited.Three major in the recent years have attempted to explain determinants of craniofacial growth.• Bone, like other tissues, is the primary determinant of its own growth.• The determinant of skeletal growth is cartilage while bone respond secondarily and passively.• The primary determinant of growth is the soft tissue matrix in which skeletal elements are embedded and both bone and cartilage are secondary follower's.Non-hereditary factors• Subtelny and Sakuda (1964) and Tulley, (1969), have stressed the abnormal functional patterns of the tongue, pernicious oral habits abnormal swallowing patterns and speech problems, all contributing to, and being part of, the open-bite phenomenon. A malfunction of the tongue can be a contributing cause or the result of an abnormal swallowing behaviour.
