KennedyⅠ-Ⅳ類牙列缺損

1、Kennedy -類牙列缺損的設(shè)計研究生 潘領(lǐng)戰(zhàn) 孟波 林川 指導(dǎo)老師 肖茂春教授Kennedy -類牙列缺損的設(shè)計活動義齒臨床設(shè)計的思路Kennedy -類牙列缺損的修復(fù)設(shè)計Considerations for removable prosthesesDecide which of the missing teeth are to be replaced and which saddles are to be restoredDeciding on the nature of the supportDeciding on the form of the major connectorDeci

2、ding on how the prosthesis will be retainedPlanning for stabilityReview of design with hygiene and maintenance in mindDeciding which of themissing teeth are to be replaced and which saddlesare to be restoredplan holistically“formulate a tentative denture design concurrent with the formulation of the

3、 treatment plan.”Deciding on the nature of thesupport Class I: Denture supported by mucosa and underlying bone Result in Displace mucosa further loss of alveolar bone Class II: Denture supported by teeth Help to maintain alveolar bone means Class III: Denture supported by a combination of mucosa and

4、 tooth-borne means. instability Class IV: Denture supported by implantsCingulum restsocclusal restsIncisor restsOver dentureDeciding on the form of the majorconnectorMaxillary common major connectorsPalatal platePalatal strapAnterior or posteriorpalatal barSkeletal designHorseshoe designLabial barDe

5、ciding on the form of the majorconnectorMandibular common major connectorsLingual plateLingual barKennedy bar.Sublingual barLabial barDeciding on how the prosthesis willbe retainedDirect retainersOcclusally approaching claspGingivally approaching claspthimble crowntooth-coloured polymeric materialcl

6、aspDeciding on how the prosthesis willbe retainedDirect retainersuse of undercuts not on buccal or lingual of teeth Use of bony undercuts, e.g labial undercuts in teeth anterior bounded saddlesRotational path of insertion.Guide planesDeciding on how the prosthesis willbe retainedDirect retainersPrec

7、ision attachmentsUse of resilient materialsSoft linerDenture adhesivesPlanning for stabilityindirect retentionReview of design with hygiene andmaintenance in mindKennedy牙列缺損分類法第一類:雙側(cè)游離缺牙第二類:單側(cè)游離缺牙第三類:一側(cè)或兩側(cè)后牙缺失,鞍基前后都有基牙第四類:前部缺牙Kennedy-類設(shè)計的基本原則保護(hù)口腔組織健康良好的固位良好的穩(wěn)定性良好的支持作用達(dá)到一定的美觀要求堅固耐用、方便取戴Kennedy第一類牙列缺損

8、特點 1.雙側(cè)后牙游離端缺失 2.多設(shè)計為混合支持式義齒 3.多采用大連接體連接兩側(cè)遠(yuǎn)中游離端鞍基Kennedy第一類牙列缺損設(shè)計要點1.雙側(cè)單個后牙游離端缺失(1)基牙選擇(2)支托設(shè)計(3)間隙卡環(huán)位置(4)人工牙設(shè)計Kennedy第一類牙列缺損設(shè)計要點2.雙側(cè)多個后牙游離端缺失(1)基牙選擇(2)支托和卡環(huán)的設(shè)置(3)間接固位體(4)人工牙排列Kennedy第一類牙列缺損設(shè)計要點3.雙側(cè)后牙全部缺失,余留前牙條件差 采用粘膜支持式 尖牙上設(shè)計低位卡環(huán)Kennedy第一類牙列缺損設(shè)計舉例Kennedy第一類牙列缺損設(shè)計舉例Kennedy第一類牙列缺設(shè)計舉例Kennedy第二類牙列缺損特點(

9、1)單側(cè)后牙游離端缺失(2)多設(shè)計為混合支持式義齒(3)多設(shè)計為與牙弓對側(cè)相連Kennedy第二類牙列缺損設(shè)計要點(1)單側(cè)一個后牙游離缺失 常規(guī)選擇兩個基牙,單側(cè)設(shè)計Kennedy第二類牙列缺損設(shè)計要點(2)兩個以上后牙游離缺失 牙弓對側(cè)設(shè)計直接固位體 兩側(cè)用大連接體相連 按固位,穩(wěn)定,美學(xué)原則加設(shè)間接固位體Kennedy第二類牙列缺損設(shè)計要點(3)牙弓一側(cè)全部牙齒缺失 盡量利用牙弓對側(cè)基牙 余留牙條件差時,盡量用塑料基托相連,提高義齒固位,穩(wěn)定功能 口內(nèi)僅留個別后牙時, 可不設(shè)合支托Kennedy第二類牙列缺損設(shè)計舉例Kennedy第二類牙列缺損設(shè)計舉例Kennedy第二類牙列缺損設(shè)計舉例

10、Kennedy第二類牙列缺損設(shè)計舉例Kennedy第三類牙列缺損特點(1)牙弓一側(cè)或兩側(cè)有缺失牙(2)缺牙間隙兩側(cè)均有天然牙存在(3)多設(shè)計為牙支持式義齒Kennedy第三類牙列缺損設(shè)計要點(1)缺牙間隙較小，而兩端基牙條件較好時，在基牙上設(shè)計直接固位體即可。Kennedy第三類牙列缺損設(shè)計要點(2)缺牙間隙大，缺隙在牙弓一側(cè)，前方基牙又較弱者，可用大連接體，利用兩側(cè)牙弓支持，并在對側(cè)使用有間接固位作用的卡環(huán)Kennedy第三類牙列缺損設(shè)計舉例Kennedy第四類牙列缺損特點(1)前牙缺失(2)多設(shè)計為混合支持式義齒Kennedy第四類牙列缺損設(shè)計要點(1)1個或2個前牙缺失,常選擇兩個基牙,基牙常為第一前磨牙(2)人工牙排列要避免深覆合,要與相鄰的天然牙協(xié)調(diào),與牙弓對側(cè)同名天然牙對稱,顏色盡量與天然牙一致Kennedy第四類牙列缺損設(shè)計要點(3)尖牙缺失,間隙小,合力不大的情況下,可在缺隙遠(yuǎn)中設(shè)置兩個固位體,單側(cè)設(shè)計義齒,使基托面積減小,便于發(fā)音(4)前牙缺失較多者,要增加基牙數(shù),防止義齒發(fā)生唇