@the clinical assessment & treatment planning for orthodontics－崇愛牙醫診所(資料重建中,歡迎新舊朋友)

這個topic是去參加多場系列矯正演講的一個主題,,當日的主要上課內容摘要如下:

1)facial midline是做為矯正治療的一個final treatment goal(目標),病人的facial midline不會表現在dental midline上

2)crossbite通常是有functional shift 與mandibular displacement所產生的

3)ideal treatment要有病人的motivation強,與morphology good

4)normal occlusion + an event(events)>physiologic tolerance會導致TMD syptoms

5)orthodontics→orthopedics stability

6)源自英國的IOTN →IOTN

7)age & sex distribution of TMD patients~~有TMD的病人年齡層約在女性34.2歲,男性 33.8歲,,,有85.4%的病人必須尋求治療~JA HOWARD

8)有戴用frankel或是twinblock appliance的病人,必須注意要修掉側方的resin部份,以免將來lateral segment產生open bite太多,而產生joint的疼痛問題(TMJ clicking)

9)Helkimo scores(下方有專文)

10)RED( Rigid External Distraction )→→RED

IOTN Grade 3 - Moderate treatment need

Increased overjet greater than 3.5mm but less than or equal to 6mm with incompetent lips.
Reverse overjet greater than 1mm but less than or equal to 3.5mm.
Anterior or posterior crossbites with greater than 1mm but less than or equal to 2mm discrepancy between retruded contact position and intercuspal position.
Displacement of teeth greater than 2mm but less than or equal to 4mm.
Lateral or anterior open bite greater than 2mm but less than or equal to 4mm.
Increased or complete overbite without gingival or palatal trauma.

Increased overjet greater than 6mm but less than or equal to 9mm.
Reverse overjet greater than 3.5mm with no masticatory or speech difficulties.
Severe displacements of teeth greater than 4mm.
Extreme lateral or anterior openbites greater than 4mm.
Increased and complete overbite with gingival or palatal trauma.
Less extensive hypodontia requiring pre-restorative orthodontics or orthodontic space closure.
Posterior lingual crossbite with no functional occlusal contact in one or both buccal segments.
Reverse overjet greater than 1mm but less than 5mm with recorded masticatory and speech difficulties.
Partially erupted teeth, tipped and impacted against other teeth.

Increased overjet greater than 9mm.
Extensive hypodontia with restorative implications.
Impeded eruption of teeth due to crowding, displacement, the presence of supernumerary teeth, retained deciduous teeth and any pathological cause.
Reverse overjet greater than 5mm with reported masticatory and speech difficulties.
Defects of cleft lip and palate.
Submerged deciduous teeth.