1、Kennedy -类牙列缺损的设计1Kennedy -类牙列缺损的设计活动义齿临床设计的思路Kennedy -类牙列缺损的修复设计2Considerations for removable prostheses1.Decide which of the missing teeth are to be replaced and which saddles are to be restored2.Deciding on the nature of the support3.Deciding on the form of the major connector4.Deciding on how th
2、e prosthesis will be retained5.Planning for stability6.Review of design with hygiene and maintenance in mind3Deciding 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 treatmen
3、t plan.”4Deciding 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 tooth-b
4、orne means. instability Class IV: Denture supported by implants5Cingulum restsocclusal restsIncisor restsOver denture6Deciding on the form of the majorconnectorMaxillary common major connectorsPalatal platePalatal strapAnterior or posteriorpalatal barSkeletal designHorseshoe designLabial bar7Decidin
5、g on the form of the majorconnectorMandibular common major connectorsLingual plateLingual barKennedy bar.Sublingual barLabial bar8Deciding on how the prosthesis willbe retainedDirect retainersOcclusally approaching claspGingivally approaching claspthimble crowntooth-coloured polymeric materialclasp9
6、Deciding 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 planes10Deciding on how the prosthesis willbe retainedDirect retainersPreci
7、sion attachmentsUse of resilient materialsSoft linerDenture adhesives11Planning for stabilityindirect retention12Review of design with hygiene andmaintenance in mind13Kennedy牙列缺损分类法第一类:双侧游离缺牙第二类:单侧游离缺牙第三类:一侧或两侧后牙缺失,鞍基前后都有基牙第四类:前部缺牙14Kennedy-类设计的基本原则保护口腔组织健康良好的固位良好的稳定性良好的支持作用达到一定的美观要求坚固耐用、方便取戴15Kenne
8、dy第一类牙列缺损特点 1.双侧后牙游离端缺失 2.多设计为混合支持式义齿 3.多采用大连接体连接两侧远中游离端鞍基16Kennedy第一类牙列缺损设计要点1.双侧单个后牙游离端缺失(1)基牙选择(2)支托设计(3)间隙卡环位置(4)人工牙设计17Kennedy第一类牙列缺损设计要点2.双侧多个后牙游离端缺失(1)基牙选择(2)支托和卡环的设置(3)间接固位体(4)人工牙排列18Kennedy第一类牙列缺损设计要点3.双侧后牙全部缺失,余留前牙条件差 采用粘膜支持式 尖牙上设计低位卡环19Kennedy第一类牙列缺损设计举例20Kennedy第一类牙列缺损设计举例21Kennedy第一类牙列缺
9、设计举例22Kennedy第二类牙列缺损特点(1)单侧后牙游离端缺失(2)多设计为混合支持式义齿(3)多设计为与牙弓对侧相连23Kennedy第二类牙列缺损设计要点(1)单侧一个后牙游离缺失 常规选择两个基牙,单侧设计24Kennedy第二类牙列缺损设计要点(2)两个以上后牙游离缺失 牙弓对侧设计直接固位体 两侧用大连接体相连 按固位,稳定,美学原则加设间接固位体25Kennedy第二类牙列缺损设计要点(3)牙弓一侧全部牙齿缺失 尽量利用牙弓对侧基牙 余留牙条件差时,尽量用塑料基托相连,提高义齿固位,稳定功能 口内仅留个别后牙时, 可不设合支托26Kennedy第二类牙列缺损设计举例27Ken
10、nedy第二类牙列缺损设计举例28Kennedy第二类牙列缺损设计举例29Kennedy第二类牙列缺损设计举例30Kennedy第三类牙列缺损特点(1)牙弓一侧或两侧有缺失牙(2)缺牙间隙两侧均有天然牙存在(3)多设计为牙支持式义齿31Kennedy第三类牙列缺损设计要点(1)缺牙间隙较小，而两端基牙条件较好时，在基牙上设计直接固位体即可。32Kennedy第三类牙列缺损设计要点(2)缺牙间隙大，缺隙在牙弓一侧，前方基牙又较弱者，可用大连接体，利用两侧牙弓支持，并在对侧使用有间接固位作用的卡环33Kennedy第三类牙列缺损设计举例34Kennedy第四类牙列缺损特点(1)前牙缺失(2)多设计
11、为混合支持式义齿35Kennedy第四类牙列缺损设计要点(1)1个或2个前牙缺失,常选择两个基牙,基牙常为第一前磨牙(2)人工牙排列要避免深覆合,要与相邻的天然牙协调,与牙弓对侧同名天然牙对称,颜色尽量与天然牙一致36Kennedy第四类牙列缺损设计要点(3)尖牙缺失,间隙小,合力不大的情况下,可在缺隙远中设置两个固位体,单侧设计义齿,使基托面积减小,便于发音(4)前牙缺失较多者,要增加基牙数,防止义齿发生唇舌向转动37Kennedy第四类牙列缺损设计要点(5)唇侧牙槽嵴丰满者,可考虑不放唇侧基托,以利美观(6)采用前斜方就位,使人工牙与天然牙间空隙减小,利于人工牙排列与美观(7)深覆合的设计 轻度深覆合,可调磨下前牙,增加切龈距离 中,重度深覆合,腭侧采用铸造基托 下前牙咬及腭粘膜者,可作矫治性修复,但要注意进食时摘下义齿,并且定期复查3839
