1、下颌骨的生长发育下颌骨的生长发育The Growth and Development of MandibleDepartment of OrthodonticsLiu Yuehua,DDS,PhD,M.Orth.RCS(Edin)下颌骨的发生（下颌骨的发生（SperberSperber，GHGH，19891989）图示下颌骨副软骨的发生部位图示下颌骨副软骨的发生部位At birth:Body is still defined.Alveolar process scarcely present.Rami are proportionally short.Condyles are poorly d
2、efined.Symphyseal growth still occurs increasing widthMandible symphysis closes 1-2 years.Three major parts:body,rami,alveolar processThe mandible is a composite bone with endochondral growth at the condyle and intramembranous bone formation.下颌骨各部分的生长方向下颌骨各部分的生长方向 （EnlowEnlow，DHDH，19901990）Posterior
3、 border of ramus-intramembranous bone formation by periosteal tissues.Simultaneous resorption of bone on the anterior border of ramus.Surface deposition and reposition on complete surface of mandibular-remodelling.Mandibular lingual tuberosity(intramembranous)-appositional growth for horizontal elon
4、gation of the mandibular body on the lingual surface(between most posterior molar and mandibular foramen)The mandible appears to“grow”in a downward and forward manner when visualized on superimposed serial cephalometric tracing registered on cranial base.A:Simultaneous displacement occurs in the opp
5、osite direction,displacing the chin anteriorly and inferiorly.B:Actual growth takes place in a wide variety of regional direction with the predominent growth trend posteriorly and superiorly.下颌骨宽度的增长下颌骨宽度的增长下颌骨外侧面增生新下颌骨外侧面增生新骨，内侧面吸收陈骨；骨，内侧面吸收陈骨；髁突随颞凹向两侧生长，髁突随颞凹向两侧生长，使升支宽度增加；使升支宽度增加；下颌骨前部在乳牙萌出后，下颌骨前部
6、在乳牙萌出后，宽度较少增加，下颌尖牙间宽度较少增加，下颌尖牙间宽度在岁以后几无增加。宽度在岁以后几无增加。下颌骨高度的增长下颌骨高度的增长下颌升支高度的生长主下颌升支高度的生长主要靠下颌髁突新骨的生长；要靠下颌髁突新骨的生长；喙突的同时生长；喙突的同时生长；下颌体的生长，主要是靠下颌体的生长，主要是靠下颌牙齿萌出时牙槽突的增高下颌牙齿萌出时牙槽突的增高及下颌骨下缘少量增生新骨。及下颌骨下缘少量增生新骨。The mandibular condyle-Endochondral growth by interstitual and appositional proliferation of cart
7、ilage Surface deposition and resorption on complete surface of mandibular-remodelling inferior border of mandible coronoid process become fully differentiated Alveolar process(intramembranous)-Grows when teeth begin to erupt -resorbs when teeth are lostThe combination of condylar and ramus growth br
8、ings about:A backward transposition of the ramus,thereby permitting elongation of the body of the mandible.A displacement of the body(and dentition)in an anterior direction.A vertical lengthening of the ramus,providing displacement of the mandible inferiorly and vertical dimension for alveolar growt
9、h.A moveable articulation during various growth changes.Vertical section through the ramus and the coronoid process showing the charateristic pattern of resorption The remodelling mechanism involved in this superior and lateral relocation is basically the expanding“V”principle.As the coronoid termin
10、i become higher,they grow apart at their apicies.髁状突的生长髁状突的生长 （GooseGoose，DHDH，19821982）Severe mandibular deficiency from TMJ infection.四、牙列与合的发育四、牙列与合的发育（一）合的建立（一）合的建立婴儿在无牙齿萌出时，无合关系；婴儿在无牙齿萌出时，无合关系；婴儿第个月乳牙萌出时开始建合；婴儿第个月乳牙萌出时开始建合；成人第三磨牙萌出时才完成建合。成人第三磨牙萌出时才完成建合。向前的动力向前的动力向后的动力向后的动力内外的动力平衡内外的动力平衡垂直向的动力平衡
11、垂直向的动力平衡（二）建合的动力平衡（肌肉）（二）建合的动力平衡（肌肉）萌牙前期的颌间关系萌牙前期的颌间关系乳牙合乳牙合替牙合替牙合恒牙合恒牙合乳牙合期乳牙合期生长间隙：生长间隙：-岁，前牙部分；岁，前牙部分；灵长间隙灵长间隙(primate space):primate space):上颌乳尖牙近中或远中。上颌乳尖牙近中或远中。In the maxillary arch,the primate space is mesial to the canines.In the mandibular arch,the primate space is distal to the canine.Spac
12、ing in the primary incisor region is normally distributed among all the incisors,not just in the“primate space”locations where permanent spaces exist in most mammalian species.垂直型垂直型(flush terminal plane)近中型近中型(mesial step)远中型远中型(distal step)2-42-4岁岁 无间隙、无磨耗、无间隙、无磨耗、E E远中呈直线远中呈直线4-64-6岁岁 有间隙、有磨耗、有间隙
13、、有磨耗、E E 近中移动近中移动前牙合关系：覆盖很浅，覆合较深；前牙合关系：覆盖很浅，覆合较深；前牙部分具有生长间隙及灵长间隙；前牙部分具有生长间隙及灵长间隙；终末平面以垂直型及近中型较多，对恒牙合终末平面以垂直型及近中型较多，对恒牙合的建立意义较大；的建立意义较大；上颌乳尖牙的近中舌侧面与下颌乳尖牙的远上颌乳尖牙的近中舌侧面与下颌乳尖牙的远中唇侧面相接触。中唇侧面相接触。（二）替牙合期二）替牙合期Period when both primary and permanent teeth are present in the mouth.恒牙萌出时间及顺序恒牙萌出时间及顺序Most commo
14、n eruption sequence:Another sequence of eruption fairly common in the mandibular arch is:The sequence of eruption of the permanent teeth is more important than the exact time of eruption.Eruption of the first permanent molarsGives the key to the occlusionThree ways a Class I molar relationship can d
15、evelop:(i)Mesial step terminal plane:permanent molars erupt directly into a Class I relationship.(ii)Straight(Flush)terminal plane:erupting lower first permanent molars may give mesial force moving lower second primary molars forward to allow a Class I molar relation.(iii)Late mesial shift of a stra
16、ight terminal plane.-most common way that a Class I molar relation results.-permanent molars erupt end-to-end.-because of dimensional differences between the primary and permanent 3,4 and 5(Leeway space of Nance),after exfoliation of the primary teeth the lower first permanent molars move mesially i
17、nto a Class I occlusions.替牙间隙（替牙间隙（LeewayLeewayspace)space)=（C+D+EC+D+E）（3+4+53+4+5）上颌单侧约上颌单侧约0.90.9mmmm 下颌单侧约下颌单侧约1.71.7mmmm替牙间隙（替牙间隙（LeewayLeewayspace)space)On the average,the combined width of the mandibular deciduous canine and first and second deciduous molars is 1.7 mm greater than the permane
18、nt successors.The deciduous versus permanent tooth dimension for the comparable maxillary arch segment is only 0.9mm.Mesial drift is consequently greater in the mandibular arch,often compensating for a flush terminal plane.“Leeway space”in maxillary and mandibular arches,as described by Nance.If a c
19、hild has a flush terminal plane molar relationship early in the mixed dentition,about 3.5 mm of movement of the lower molar forward relative to the upper molar is required for a smooth transition to a Class I molar relationship in the permanent dentition.About half of this distance must be supplied
20、by differential growth of the lower jaw,carrying the lower molar with it.the other half can be obtained from the leeway space,which allows greater mesial movement of the mandibular than the maxillary molar.Eruption of the permanent teeth(i)First molars followed almost immediately by lower central in
21、cisors and thenlateral incisors.(ii)Mandibular incisors development lingual to the resorbing roots ot the primary incisors,the primary incisors being moved labially as they exfoliate.(iii)the permanent incisors find their correct positions by influence of their eruptive pathways and functional force
22、s.(iv)If primary incisors are not resorbing properly,both teeth may be present at the same time.The primary tooth should be removed to alloew the lingually placed permanent incisor to assume its proper position.(v)The eruption of the mandibular lateral incisor pushes the primary cuspid distally and
23、labially so that the primate space is lessenes or closed.(i)Lower permanent incisors erupt without crowding and attain good alignment.Small amounts of crowding may be present during eruption of the lower latral incisors but this may be relieved by significant increases in arch length and width in th
24、is region during their eruption.(ii)Intercanine width increases up to the eruption of the lateral incisors.No great relief of crowding in the incisor segment can be expected after the complete eruption if lateral incisors”.(b)When normal spacing is present(c)if lack of spacing is present(i)Permanent
25、 incisors will be crowded upon eruption.Laterals in lingulversion(ii)Laterals may erupt rotated and not diplace primary cuspids into primate space.(iii)Resorption of roots of primary canine may result in premature exfoliation of the canine.When this happens the permanent incisors may be tipped lingu
26、ally by lip muscles.The permanent canine may then be displaced by the root of the lateral and erupt in severe labioversion.(v)If primary canine ar deflected into traumatic occlusion with maxillary canines,the mandible may be retruded to a wide portion of the maxilla,producing a functional Class II r
27、elationship(relieve by grinding crowns out of traumatic occlusion).(d)Maxillary incisor eruptionMaxillary central incisors:Erupt slightly labial to primary centralsHave slight distal inclinationUsually space(diastema)between the centrals.Maxillary lateral incisors:Erupt slightly lingual to permanent
28、 centrals.With distal inclination.(e)The“ugly duckling”stage of development(i)Pattern formed by the 4 maxillary incisors.(ii)As the laterals erupt,the canines higher up are also erupting,being guided down by the roots of the lateral incisors.(iii)This canin position tends to move the roots of the la
29、teral mesially and the crowns flare distally.(iv)As the canines erupt,the laterals upright and the spacs between the incisors close.(v)Orthodontic movement of lateral incisors before th canines come close to eruption is dangerous because the apices of the lateral incisors may be damaged or the perma
30、nent canines may be deflected.(f)Mandibular canine and premolar eruption(i)Favorable sequenc:3,4,5(ii)As should precede the second molar.(iii)Canine eruption should be first to:Maintain proper arch length.Prevent lingual tipping of lower incisors(iv)First premolar eruption is uneventful.(v)second pr
31、emolar is tooth most susceptible to malposition or impaction in the mandibular arch.It suffers the problems of inadequate space since it is the last tooth to be fitted in.(f)Mandibular canine and premolar eruptionIf the second molar erupts before it,the first permanent molar may move mesially and bl
32、ock out the second premolar.If the second primary molar is lost prematurely,the first permanent molar moves mesially blocking out the second premolar.If leeway space is small,the first permanent molar should not be allowed to move mesially until the second premolar in in occlusion.Second premolars a
33、re often congenitally absent.Be careful!(g)Maxillary canine and premolar eruption(i)Favorable sequenc:4,5,3(ii)Maxillary incisor segment is supported by the lower anterios thus is not prone to lingual collapse.(h)First premolar erupts uneventually(i)Second premolar(i)Usually erupts easily duo to lar
34、ger size of primary second molar(ii)Beware of early loss of maxillary second primary molarsthe permanent molars will move mesially,blocking out the second premolars(j)canine eruption is the most critical situation in the maxillary arch.Situation necessary for good canine position:(i)Excessive space
35、when the second premolar erupts.(ii)Canine eruption immediately after second premolar eruption.(iii)No mesial tipping of first permanent molar.(iv)Second permanet molar should not erupt before the second peremolar and the canine.(v)Eruption of maxillary canine closes spaces between the incisors.If m
36、axillary arch length is deficient and sequence is normal,the canine will erupt malposed(most often to labial).(k)Second molar eruption(i)Lower should erupt before upper molar to prevent over-eruption of the upper molar.(ii)Second molars should erupt after all teeth mesial to them.替牙过程中的间隙补偿机制替牙过程中的间
37、隙补偿机制乳牙间适当的间隙乳牙间适当的间隙恒切牙偏唇侧萌出恒切牙偏唇侧萌出尖牙间牙弓宽度增加尖牙间牙弓宽度增加双尖牙偏颊侧萌出双尖牙偏颊侧萌出乳恒牙大小比例协调乳恒牙大小比例协调替牙间隙的调节作用替牙间隙的调节作用 Proper space among deciduous teeth.Slight labial positioning of central and lateral incisors.A Slight increase in arch width across the canines.Slight buccal positioning of premolars.Proportio
38、nal permanent teeth.“Leeway space”adjustment of occlusal relationship.上颌中切牙萌出早期，出现间上颌中切牙萌出早期，出现间隙；隙；上颌侧切牙初萌时，牙冠向远上颌侧切牙初萌时，牙冠向远中倾斜；中倾斜；恒切牙萌出时，轻度拥挤；恒切牙萌出时，轻度拥挤；上下第一恒磨牙建合初期，可上下第一恒磨牙建合初期，可能为尖对尖关系；能为尖对尖关系；上下恒切牙萌出早期，出现前上下恒切牙萌出早期，出现前牙暂时性深覆合牙暂时性深覆合。暂时性错合的表现暂时性错合的表现 The maxillary incisors flare laterally and
39、 are spaced when they first erupt.The spaced incisors teed to improve when the permanent canines erupt.Mild irregularity of the mandibular incisors is normal at age 7 to 8,when the permanent incisors and first molars have erupted but the primary canines and molars are retained.The flush terminal pla
40、ne relationship,which produces an end-to-end relationship of th permanent molars when they first erupt,can change to Class I in the permanent dentition.前牙覆合、覆盖前牙覆合、覆盖尖牙、磨牙关系尖牙、磨牙关系牙弓大小的变化牙弓大小的变化牙龄与骨龄牙龄与骨龄HellmanHellman牙齿发育进度牙齿发育进度I 乳牙合完成前期乳牙合完成前期IIA 乳牙合完成期乳牙合完成期IIC 第一恒磨牙开始萌出期第一恒磨牙开始萌出期IIIA 第一恒磨牙及前牙萌出完成期第一恒磨牙及前牙萌出完成期IIIB 乳磨牙脱落、后继前磨牙开始萌出期乳磨牙脱落、后继前磨牙开始萌出期IIIC 第二恒磨牙开始萌出期第二恒磨牙开始萌出期IVA 第二恒磨牙萌出完成期第二恒磨牙萌出完成期IVC 第三恒磨牙开始萌出期第三恒磨牙开始萌出期VA 第三恒磨牙萌出完成期第三恒磨牙萌出完成期提问与解答互动时间提问与解答互动时间
