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µoªí¤é´Á 2012-04-16
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ªA°È°|©Ò ´¶·R¾¦ÃEÁB¥¿¤úÂå¶E©Ò 
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¤µ¦~12¤ë16¡B17¤é¦b¥x¥_¶ê¤s¶º©±Á|¦æªº¤¤µØ¥Á°ê¾¦ÃEÁB¥¿¦~·|²±ªpªÅ«e¡AÁ`¦@Áܽаꤺ¥~¤G¤Q¤G¦ìª¾¦W¾ÇªÌ¦@»E¤@°ó¡A¦U¤H±N¥L­Ì²¦¥Í¸gÅ礧ºëµØ¦p¼Æ®a¬Ã¦üªº§e²{¦bÆ[²³·í¤¤¡C


¦³ªº¾ÇªÌ°w¹ï°ª«~½è¡B°ª®Ä²v¡B¨t²Î¤ÆªºÁB¥¿ªvÀø°µ¦UºØ·s¬ì§Þªº¸Ñ»¡¡F¦³ªº«h¬O¦b¤ú¬ì¾ã¦X¤è­±¡A¥H¤Î¦UºØ¯f¨Òªø´Áí©w©Êªº±´°Q¡A¥H¥L­Ì¾Ç¾iªºÂ×´I¤Î¼Æ¤Q¦~°lÂܪºÄ_¶Q¯f¨Ò¡A¨Ï§Ú­Ì±o¨ì«Ü¦hÃø¯à¥i¶Qªº¸ê®Æ¡A²{¦b§Ú´N´X­Ó¾ÇªÌªº¨£¸Ñ´£ºõ«´»âªº¤À¨Éµ¹¤j®a¡C


§Ú­º¥ý´N´¿©ú¶QÂå®vªº±MÃD»P¤j®a±´°Q¤U¦C´X­Ó¤j¶µ¡C


(1) Screw¡G¦b¼É¤úªº¯f¨Ò¤¤¡A¤j¦Ý¾¦¤£¬O«Ü¦nªºanchorage¡A©Ò¥H´¿Âå®v³£¥HA-1 screw·í¤ä¼µ¡A³oºØ°©°vªº§÷®Æ¬ãµo¶V¨Ó¶V¶i¨B¡A¥HÜg¦Xª÷(¤»¾TÜg¥|°v)º¯¤£ù׿û(stainless)¡A«h¦p¤M¤b¤@¼Ë§ó§Q¡C¦P®ÉÁÙ¥i¦b³»ÀY§@¦UºØ¦p¶ê¬}¡B¤è¬}¡Btube¡Bbracketµ¥ªº³]­p¡A¦]¬°¨Ï¥Îªºwire²Ê¨ì¦p2.0mm¤§µw¡A©Ò¥H¥i¥H¨Ï¥Îmultiple force¡A¦P®É©Ô¼u¤O½u(spring)¨ìªù¤ú¤W§ï¥¿¤¤½u¡A¤Î¦P®É©Ô¼u¤O½u¨ìª÷Äݽu¤W§@ªù¤ú«á©Ô¡C
(2) High Pull HG¡G¥ÎJ-hook§@enmass«á©Ô®É¡A¬O«Ü¦nªºbite control¤Îtorque controlªº¤u¨ã¡Aµ´¹ï¤£·|¦³Incisor lingual tippingªº²{¶H¡A¦P®É¥i¥H¸Ñ¨M¤W¤úÅi¥~ÅS¤Ó¦h(gummy smile)¤Î«e¤ú¥~¼Éªº²{¶H¡A¦Ó±Nzygoma°µ­×¹¢(remodeling)¡AÂǵۨϥθû¤j­±¿nªºpadŨ©ó¤W­±¡A«h¤j»æÁy¥i¥H§ï¦¨¥Ê¤lÁy¡C
(3) Bracket¡GÁB¥¿¾¹ªº¿ï¾Ü¤è­±¡A¹ï©ó©Þ¤úªº¯f¨Ò§Ú­Ì¤j³£¿ï¾ÜStraight wire bracket¡A¦ý¹ï§½³¡½Õ¾ã¡A¦p¤Wªù¤ú±ÛÂ઺¯f¨Ò¡A¥i¥H¥Î¼Ð·ÇÁB¥¿¾¹(Standard bracket)¡A¦A¥[¤Wª÷ÄݽuÅsºP(first order bend)¡A ´N¥i°µ§Ö³tª½±µªº±ÛÂà±±¨î¡C
(4) Wire Bending¡G¹ï¤UÃE°¼ªù¤úªñ¤ß¦Þ°¼±ÛÂ઺¯f¨Ò¡A«h¦b¤WÁB¥¿¾¹®É´N¥i±N¥¦ÂH¦b°¼ªù¤úªñ¤ß¤@¨Çªº¦a¤è¡A¦P®É¦b½u¤W¥[°¼ªù¤úªºoff set(first order bend)¡A¦]¬°¤UÃE°¼ªù¤ú¥»¨Ó´N¤ñ¥¿ªù¤ú«p¥B¤j¡A©Ò¥H»Ý­n¸g±`§@¤@¨ÇÅsºP(wire bending)¨Ó§ïµ½¥¦»P¾F¤úÃö«Y¡A·íµM¤ü¤ú©·«×(canine eminence)­n§@¥X¨Ó¡A¤ú¤}¤Wªº¦U±Æ¤ú¾¦¦ì¸m¤~·|¥­¾ã¡C


(5) Torque¡G¥HÅsºP°Æ¥D½u(accessory wire)§@³æÁû¤ú«atorqueªº±±¨î¡A©Î¥HART§@¾ã±Æ«e¤úªº±±¨î¡A©ÎªÌ¥Î¥ÑDr. Tseng³]­pªºHigh torque bracket(T-1)¨Ó½Õ¾ã¤ú¾¦¨¤«×¡C¤WÃE¾¦¦C­n§@¥XLingual crown torque¡A¤UÃEªº¦Þ°¼«rÀY»PÀU°¼«rÀY­n¥­¾ã¡A«h«r¦X¤~·|ºò±K¡C


®J¤Î¶}ùÁB¥¿¬ì±Ð±ÂAbbas R. Zaher¹ï”Finishing: How to Achieve Excellence in Orehodontic Tx”³o­ÓÃD¥Ø¡A¤]«D±`ºë­nªº®Ú¾Ú¥H¤U¦UÂI§@µo´§:




(1) §ïÅÜAxial inclination… contact point(¹Ï¤@)


(2) Gingival margins alignment(¹Ï¤G)


(3) Contouring of the incisal edge(¹Ï¤T)


(4) ¥h°£Black triangle… crown shape(¹Ï¥|)


(5) Timing: before/ during/ after ortho


(6) Restoration of missing and peg lateral


¦Óªü®Ú§Êªº¤j¾Ç¤Î¬ã¨s©Ò©ÒªøJulia F. Harfin¡A«h°w¹ï¦¨¤HÄY­«¤ú©P¯f±wªºÁB¥¿ªvÀø§@¤¶²Ð¡G
(1) ÁB¥¿ªvÀø¹ï¤ú©P¯f¾¦¦C(occlusion)ªºÃ­©w¦³§U¯q
(2) ÁB¥¿ªvÀø¹ï¤ú©P¯f±¡¦³À°§U¡A¦bªvÀøÁB¥¿©Î¨ä¥L¤ú¾¦¤§«e¡A­n¥ý±±¨î¦íinflammation¤Îinfection¤T­Ó¤ë¡A¦bªvÀøÁB¥¿¶¥¬q¤¤ÁÙ¬O­n«ùÄòºÊ±±¤ú©Pª¬ªp¡C


(3) ±µ¤U¨ÓÁB¥¿ªvÀø´Á¶¡¥H.022 pre programmed brackets ¥[¤W low-load deflexion arch wire (NiTi,coil springµ¥) ¥Hcontinuous ligature wire í©w¦í¤ú¤}¡A¦A¥[¤W¹ï«rsplint¡A¥HÁ×§Kpremature contactsªº¶Ë®`¡A¤§«á¥Hfixed retention§@ªø®É¶¡ºû«ù¡A¬Æ¦Ü¥[¤W°²¤úÀ±¸É¯Ê¤ú°Ï¡A§¹¦¨«áÁÙ¬O­n«ùÄò§@¤fµÄ½Ã¥Í«ü¾É¡A¨C¤G­Ó¤ë§@¤ú©Pµû¦ô¤Î±±¨î¡A¥Htetraciclina omega ¤ô©Ê·»¾¯¨Ó¨R¬~¶Ë¤f¡A¥Hºû«ù¤ú©P°·±d¡A¦P®Ép’t¥»¨­­n¤F¸Ñ¤ú©Pª¬ªp¬O¤£Â_¦b§ïÅܪº¡A©Ò¥Hp’t¥»¨­­n­tºû«ùªº³d¥ô¡C


¥t¥~¡A­J¥ü¤¯Âå®vÁ¿ºt¦³Ãö¾¦ÃEÁB¥¿¦b¾ã¦X©ÊªvÀø(Interdisciplinary Dental Therapy, IDT) ¤¤ªº¦a¦ì:
(1) ÁB¥¿¬O©Ò¦³¦U¬ì¤¤°ß¤@¥i¥H¹ï¤ú¾¦§@²¾°Ê¡BÃö³¬©Î»s³yªÅ¶¡ªº¡C
(2) ¤]¥i¥H¨M©w¦óªÌ¥i¥H©Þ°£¡A¦óªÌ¤£¥i¥H©Þ¡C
(3) ¥i¥H­«·s«Ø¥ß«r¦X¡C
(4) ¤]¥i¥H¸g¥Ñ±Æ¦C©Î«á©Ô§ïµ½¥~Æ[¤Î·L¯º½u¡C


©Ò¥HÁB¥¿Âå¥Í»Ý¦Ò¼{¥H¤U¦UÂI
(1) P’t condition , P’t expectation
(2) Diagnosis & Tx plan¥HIdeal/Realisticªº³]­p¥h§@­pµe
(3) Comprehensive(¥þ¤f)/Local Tx(§½³¡)
(4) Non-Extraction/ Extraction/ Surgery
(5) Extraction site selection
(6) Tooth movement(¦óºØ¤è¦V)/ Mechanics(¦óºØappliance)/Anchorage(¦óºØ¸Ë¸m)
(7) Multidisciplinary interaction¡G±N¦UºØ¬ì§O¤¤¶¡ªº»Î±µ°µ¦nÂà¶E·¾³q
(8) Retention&Stability


ÁB¥¿ªº«~½èºÞ¨î¥i¥Ñ¤U¦C±±¨îªº§ó±o·í
(1) ÂǥѦU¬ì¦h¤@ÂIªº¾ã¦X¦Ò¼{¨Ó§@ªvÀø­pµe(interdisciplinary consideration)¡A¬Æ¦Ó¦b¾ã­ÓÁB¥¿ªvÀø«e«á¡AÁÙ¦P®ÉÅU¼{P’tªº¥~Æ[¤Î«r¦X¥\¯à¡A¥H¦U¬ìªº¯à¤O¨Ó³W¹º¤@­Ó§ó¦nªºªvÀø¹Lµ{¤Îµ²ªG¡C
(2) ªvÀø­pµe»Ý»P¨ä¥¦¬ìÂå®v·Ó·|°Q½×¡A¥i¥H§ó¤F¸Ñ¬ÛÃöª`·N¨Æ¶µ¡C
§¹¦¨¶¥¬q®É¡A­nªá¦h¤@¨Ç­@¤ß¡A¨Ò¦p:±NP’tªº§¹¦¨ÁB¥¿«áªºª¬ªp»P°²¤ú»s§@µ¥°ÝÃD¤@¨Ö¦Ò¼{¦n¡A¦b§@¤ú¾¦ÁB¥¿©Ô¾ã®É¡A¤úÅi¡B¤ú§É°©ªº¦ì¸m´N­n¨M©w¦n¡A¥H§K¼vÅT°²¤ú»s§@¡A¦Ó¼vÅT¥~Æ[¡C


±µ¤U¨Ó´N´X¦ìÂå®v¦bÁB¥¿ªvÀøªºªø´Áí©w«×±´°Qªº¤ß±o¤W¡A»P¤j®a¤À¨É:
²Ä¤@¦ì±i¤ß²eÂå®v¹ïFunctional Orthopedic TxªºÃ­©w©Ê§@¤@¦^ÅU¡A¨ä¤¤¦³´X­Ó¯f¨Ò¬Oskeletal Cl ¢», mandible prognethism ¤Îhigh mandibulan planeªº¯f¨Ò¡A¥i¥H¥Î¤U¦C¦UºØ¤èªkªvÀø¡G
(1)Follow upª½¨ìmandible¥Íªø§¹¦¨
(2)chin cap
(3)Facial mask
(4)Others


§Ú°w¹ï±iÂå®vªº¯f¨Ò¥H¨Å¤ú®É´Áªº²Ä¤T´Á«r¦X²§±`¡A±Ä¥ÎBondedªºRPE¥[¤Wfacial mask¡A¸g¥|­Ó¤ëªvÀø¡A¤WÃE¤Ï®É°wÂà¤W¥h¡A¤UÃE¦V«á¤W¤èÂà¦V¡A¿ù«r§ïµ½¦^¨Ó¡A¥~Æ[¤]§ï¦n¡A¸g¹L¤Q¤T¦~¦hªºÆ[¹îµ²ªGÁÙºû«ùªº¤£¿ùªº«r¦X¡A¤ÀªR¤UÃEªº¥Íªø¤è¦V¬O¦V¤U¡B¦V«e¥Íªø¤F¡A¦ý«r¦XÁٺⱱ¨î¦í¤F¡AÁöµM¤UÃE¤@ª½¦b¥Íªø¡A¦ý¤WÃE«e¤ú¬Û¹ïflare out¡A¤UÃE«e¤ú¬Û¹ïLingual tipping¦^¨Ó¡AÁÙ³£compensateªº¤£¿ù¡A¨S¦³¿ù«r¡A¤]µL¶·¦A§@ªvÀø¡C©Ò¥H¦­´ÁªºCl ¢»ªvÀøÁöµMµLªk«O»Ù±N¨Ó¤UÃE¤£¥Íªø¥X¨Ó¡A¦ý¬O¥i¥H¥ý§@¤@¨ÇªvÀø¡A±N¨Ó¦AÆ[¹î¡Aµ¥¤UÃE¥Íªø§¹¦¨®É¦A¬Ý«r¦X¦p¦ó¡C


²Ä¤G¦ìĬ©ú¦`Âå®v³ø§iªºjaw©McondyleÅܤƻPÁB¥¿Ã­©w«×ªºÃö«Y¡A¤£Â_´£¿ô·s¶iÂå®v¡AÁB¥¿ªvÀø§¹¦¨¥H«á·|¦³«Ü¦h¤£Ã­©wªº«r¦XÅܤơA¶·¦³Á{§É¸gÅç¨ÓÁͦNÁ×¥û¡A­ì¦]§Ú­ÌÂkÃþ¬°¥H¤U¼Æ¶µ¡G
(1)Relapse
(2)Maturation
(3)Differential growth of jaws
(4)Aging changes of periodontium dentition and occlusion
(5)Abnormal changes of condyle


¤×¨ä¬O²Ä(5)ÂI¬OĬÂå®vÁ¿ÃDªº­«ÂI¡A¥H¤@­Ó¤K·³¦Ý¾¦²Ä¤@¯Å«r¦X²§±`¡A¥~Æ[¤Î«r¦X³£ÁÙ¦nªº¯f¨Ò¬°¨Ò¡A¤UÃE°©ªºµo¨|±q¤K·³¨ì¤Q¤C·³¡AºCºCÅܦ¨¶}«r¡A¤§«áĬÂå®v¨C­Ó¯f¨Ò³£·ÓTMJ¨¤«×ªºX¥ú¨Ó°lÂÜ¡A¦]¬°¦³«Ü¦h­ì¦]¼vÅT¤UÃEªºµo¨|¡A¦ptrauma¡B²´·úµo¨|¤£¹ïºÙ¡Bosteosclerosis…¡A¦³®É­Ô¨Ã¤£¬O¦]¬°ºû«ù¾¹¨SÀ¹¡A¦]¬°¦a°ò¤w¸gÃa±¼¤F¡A«hµo¨|·|°¾¦V¡A»P°t¦X«×¨SÃö«Yªº¡C


¥t¥~ªº¯f¨Ò¡A¨Ò¦p¤@­Ó¦Ý¾¦²Ä¤G¯Å«r¦X²§±`¡A¤UÃE°¾¦V¤Î°ª¨¤«×ªº¯f¨Ò¡A¥HFour bite extraction¤è¦VªvÀø¡A³Ì«á¤Q¤K·³®É©~µMÅܦ¨²Ä¤T¯Å«r¦X²§±`¡C


ÁÙ¦³¤@­Ó¤E·³concave profile ¤Îlong faceªº¯f¨Ò¡A¦­´Á¥Htwo by four ªvÀø¸Ñ¨M«e¤ú¿ù«r°ÝÃD¡A¤U«e¤ú«D±`uprighting¡A©Ô¦n«á¤@¸ôÆ[¹î¡A¤U¤Ú¶V¨Ó¶V¦y¡A±q¤Q¤T·³¨ì¤Q¤C·³®É«r¦X¤~¶}©lÅܤơA¤UÃE°©¶}©l¬n±×¡A¤U«e¤úÅܾÖÀ½¡A»´·L¿ù«r¡A§@°¼Æ`¤ÀªR¡A¤UÃE°©¥Íªø¤è¦V¬°¦V¤U¥Íªø¡A¤WÃE°©¬°¦V«e¥Íªø¡A¨S¦³©¹¤£¦nªº¤è¦V¥Íªø¡A©Ò¥H§A¥Ã»·¤£ª¾¹Dp’tµo¨|·|¦p¦ó§ïÅÜ¡A¬Ý¦üÄY­«ªº¯f¨Ò¡A«o­Æ§K©óÃø¡C



¥t¥~¦A´£¤@­Ó¯f¨Ò¡AºÙ¬°Idiopathic Condylar Resorption(ICR)¡A¦o±q¦n¦nªº«r¦XÅܦ¨¶}«r¡A³o¨ÇÁ{§É¼x¥ü(symptom)¥i¯à¦³¥i¯à¨S¦³¡A¯gª¬¤]¥i¯àºCºCÁͽw¡A¥D­n»PTMJ¨üÀ£©Î¨ü¤O¦³Ãö¡A©Ò¥H­n¾Ç·|±qX¥ú¤ù§PŪ²§±`condylar¥Íªøªº«¬ºA¡A«h¥­®É¦b¦­´ÁÀˬd±w¯f®É¡A´N·|¯S§Oª`·N¤UÃE°©ªº²§±`µo¨|¡C³oºØ¶}«r¤]ºÙ¬°«á¤Ñ©Ê¶}«r(Acquired Open Bite)¡A­ì¦]¥i¯à¦]¤U¦C¤§¤@³y¦¨¡G
(1) ù®ÃEÃö¸`½L²æ¦ì (Displaces disks)
(2) ù®ÃEÃö¸`ÅÜ©Ê(TMJ degeneration)
(3) ù®ÃEÃö¸`°©©ÊÃö¸`ª¢(TMJ osteo-arthrosis)¡C
 


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ÁÙ¦³¤@­Ó¥ý¤Ñ¶}«r(Congenital Open Bite)¯f¨Ò¡A±q¤Q·³Æ[¹î¨ì¤G¤Q¤­·³¶}«r°ª«×¡A«ùÄò¼W¥[¨ì³s¥|¶ô¤û±Æ©ñ¤J¤f¤º³¡µLªk¤ÁÂ_ªºÄY­«¯f¨Ò¡AĬÂå®v¤£¬Û«H¦³¤£¤â³N¡A¥ú¾aÁB¥¿§Þ³N¥i¥H§ïµ½³oºØª¬ªp¡A©Ò¥Hµ²½×´N¬OÁB¥¿Âå®v¨S¦³¿ìªk¥H²Î­pªº²{¦¨¸ê®Æ©M¼Æ¾Ú¥h¤F¸Ñ­Ó§O¥Íªø®t²§¡A¦pgrowth spurt¦b¦ó®É¡Aduration¦hªø¡A¤UÃE°©¥Íªø¤è¦V(direction)¦p¦ó¡H¥H¤Î·|asymmetry¶Ü¡H³o¨Ç°ÝÃD³£­n¦Ò¼{­Ó§O®t²§©Ê¡AÁٻݭn¾a¦h¤@¨ÇÁ{§É¸gÅç§@§PÂ_¡C
 


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