知识中心
FRED F. SCHUDY, DDS FREED F. SCHUDY, DDS
As we grow older, we become less and less sure of many things. So when we come to the end of a professional career, as I have, and still feel strongly about certain concepts, there is a good possibility that we may be right in these convictions. Here are the seven concepts I feel most sure of after 50 years in orthodontic practice.
随着年龄的增长，我们对很多事情越来越不确定。因此，当我们的职业生涯即将结束时，就像我一样，仍然对某些概念有强烈的感觉，我们很有可能在这些信念上是正确的。以下是我在从事正畸工作 50 年后*确信的七个概念。
1. Molars do not intrude. A common misconception is that when we move molars occlusally, the muscles of mastication will intrude the molars and close the bite. This is patently wrong. Of course, molars will intrude like all teeth if you apply a continuous force to them, but they do not intrude from function.
1. 磨牙不会下沉。一个常见的误解是，当我们将磨牙向咬合方向移动时，咀嚼肌会使磨牙下沉并闭合咬合。这显然是错误的。当然，如果你对磨牙施加持续的力量，它们会像所有牙齿一样下沉，但它们并不会因功能而下沉。
2. Management of the vertical growth of the alveolar processes is the primary function of the orthodontist. We aren't sure at present whether condylar growth can be stimulated. Vertical growth of the posterior portion of the maxilla cannot be stimulated or inhibited. That leaves only the alveolar processes, which can be affected vertically more than laterally or sagittally. The lower molars seem to have latent growth potential that does not fully express itself unless they are completely uprighted.
2. 牙槽突的垂直生长管理是正畸医生的主要职能。 我们目前不确定下颌骨的生长是否可以被刺激。上颌后部的垂直生长无法被刺激或抑制。那只剩下牙槽突，它们的垂直生长受到的影响大于横向或矢状面方向的影响。下磨牙似乎具有潜在的生长潜力，除非它们完全直立，否则这种潜力不会完全表现出来。
When there is a danger of producing too much vertical growth of the jaws, we should not use long Class II elastics for an extended period, even if anchorage has been prepared. Short Class II elastics, from the distal of the lower cuspid to the mesial of the upper cuspid, can be worn indefinitely without producing any vertical development of the molars, because they are attached anterior to the center of resistance of the lower arch.
如果存在导致下颌垂直生长过快的危险，我们就不应该长期使用长的二类矫治器，即使已经准备好了锚定装置。从下颌尖牙远端到上颌尖牙中端的短 II 类矫治器可以无限期地使用，而不会导致臼齿的垂直发育，因为它们连接在下牙弓阻力中心的前方。
3. Growth prediction is based on average growth, and average growth needs no prediction. As treatment progresses, the orthodontist needs to know whether to stimulate or inhibit the vertical growth of the molars. It is far more important to know whether an increment of growth comes from the condyles, the body of the maxilla, the maxillary alveolar process, or the mandibular process than to know that the chin moves downward and forward on a certain trajectory at a certain rate.
3.生长预测基于平均生长，而平均生长无需预测。随着治疗的进展，正畸医生需要知道是刺激还是抑制磨牙的垂直生长。知道生长的增量是来自髁突、上颌骨体、上颌骨牙槽突还是下颌骨牙槽突，远比知道下巴以一定的速度按一定的轨迹向下和向前移动要重要得多。
4. Lower incisors should not be intruded to level the arch in growing patients. This limits vertical development of the lower face and tends to result in a closed bite. The first bicuspid is at the lowest point in the curve and therefore is its weakest link. If the bicuspids and molars can be moved occlusally to the level of the incisors, the occlusal plane will nearly always be stable. Of course, other important relationships--sagittal harmony of the jaws, overbite correction, correct torque of the upper anterior teeth, and any necessary intrusion of the upper anteriors--must already have been established. All this will allow the maximum possible vertical development.
4.对于生长期的患者，下切牙不应该侵入牙弓使其变平。这限制了下颌面的垂直发育，容易导致闭合咬合。第一双尖牙位于曲线的*低点，因此是*薄弱的环节。如果双尖牙和臼齿能够在咬合面上移动到切牙的水平，那么咬合面几乎总是稳定的。当然，其他重要的关系--颌骨的矢状协调、咬合过大的矫正、上前牙的正确扭力以及上前牙的必要内收--必须已经建立。所有这些都将使垂直发育达到*大可能。
Leveling with round archwires is inadvisable because the apices of the incisors usually move lingually, and it then becomes difficult to torque them back to their previous positions. For the last 20 years, I have used .016" brackets on the anterior teeth and .018" brackets on the posterior teeth. This provides incisor control, molar control, and intrabracket space around the wire in the bicuspid region, making it possible to level with rectangular archwires.
使用圆形弓丝进行矫治是不可取的，因为门牙的尖部通常会向舌侧移动，这样就很难将它们扭回到原来的位置。在过去的 20 年里，我在前牙上使用 0.016 英寸的托槽，在后牙上使用 0.018 英寸的托槽。这样可以控制切牙、臼齿，并在双尖牙区域的钢丝周围提供托槽内空间，从而可以使用矩形弓丝进行矫治。
5. There are good reasons for extracting second bicuspids rather than first bicuspids. The treated lower arch is more stable, because the cuspids require less movement and less manipulation, and unwanted cuspid expansion can be avoided. The upper second bicuspid is usually more narrow mesiodistally than the upper first bicuspid, so when it is extracted the molar is positioned farther distally, improving interdigitation with the lower first molar. The lower second bicuspid is wider than the lower first bicuspid, so its removal further improves molar occlusion.
5.拔除第二尖牙而不是第一尖牙是有充分理由的。治疗后的下牙弓更稳定，因为尖牙需要的移动和操作更少，而且可以避免不必要的尖牙扩大。上第二双尖牙通常比上第一双尖牙的中线更窄，因此拔除时前磨牙的远端位置更远，改善了与下第一磨牙的相互咬合。下第二双尖牙比下第一双尖牙宽，因此拔除它可以进一步改善磨牙的咬合。
The upper first bicuspid usually has longer, wider roots than the upper second bicuspid, making it much more resistant to lateral forces. The first bicuspid's long buccal cusp helps disocclude the molars in lateral movement, produce good permanent interdigitation, and make the finished result resemble a full complement of teeth. If the lower first bicuspid is extracted and the cuspid is tipped or retracted bodily into the extraction space, the cuspid apex tends to move into the labial bone. Since it is difficult to torque the apex back into the center of the bony ridge, the tip of the upper cuspid is often left contacting the labial surface of the lower cuspid, producing poor function.
上第一双尖牙的牙根通常比上第二双尖牙的牙根更长、更宽，使其更能抵抗侧向力。第一双尖牙的长颊尖有助于阻挡磨牙的侧向移动，产生良好的恒牙间隙，并使*终结果类似于完整的牙齿。如果拔除下第一双尖牙，并且尖牙向拔牙间隙内倾斜或后缩，尖牙顶就会向唇骨移动。由于很难将尖顶扭转回骨嵴的中心，上尖牙的顶端通常会与下尖牙的唇面接触，从而导致功能不良。
Finally, treatment is much easier. If the lower first bicuspids are retracted with sectional arches from first molar to first bicuspid, the cuspids will usually correct themselves. When spaces appear distal to the cuspids, I stop adjusting the sectional arches and apply weak Class II elastics to the closing loops on the archwires. If the elastics were applied to the molar hooks, they would tip the molars forward. A common practice is to pit the anterior teeth against the posterior teeth and let them meet in the center. This can result in the incisors being positioned too far lingually. We can make them meet precisely where we want them by using sectional arches correctly.
*后，治疗就容易多了。如果用从第一磨牙到第一尖牙的分段弓来牵引下第一尖牙，尖牙通常会自行矫正。当尖牙远端出现空隙时，我就会停止调整分段牙弓，并在弓丝的闭合环上使用弱的二级弹力线。如果在磨牙颊面管钩上使用弹力线，就会使磨牙前倾。一种常见的做法是将前牙对着后牙，让它们在中间相遇。这可能会导致门牙的位置过于偏向舌侧。我们可以通过正确使用切面牙弓，使它们精确地相遇。
6. Differential anchorage is nature's way of harmonizing the temporomandibular joint and the teeth. In natural growth, lower molars seldom move forward appreciably in relation to the symphysis; often they move distally. These teeth offer resistance to forward movement, while the upper molars move forward much more readily. In the first phase of treatment, the upper incisors should be intruded or maintained as the overbite is reduced. If this is done before retraction of the anterior teeth, the upper and lower incisors never occlude with one another, and the condyles cannot possibly be forced posteriorly into the fossae. Such evidence, which can be documented cephalometrically, is what the profession needs to counteract the charge that TMJ dysfunction can be caused by orthodontic tooth movement.
6.不同的固定方式是大自然协调颞下颌关节和牙齿的一种方式。在自然生长过程中，下磨牙很少相对于骨骺明显向前移动；它们经常向远端移动。这些牙齿在向前移动时会受到阻力，而上磨牙则更容易向前移动。在治疗的第一阶段，随着咬合过度的缩小，上切牙应该内收或保持。如果在前牙后缩之前就这样做，上下切牙永远不会相互咬合，髁突也不可能被逼向后方的窝沟。这些证据都可以通过头颅测量记录下来，这也正是专业人士所需要的，以反驳颞下颌关节功能障碍可能由正畸牙齿移动引起的指控。
7. The most important part of orthodontic treatment is the management of the six upper anterior teeth. The smile is our acid test. In general, the upper incisors should be held at their original vertical level or intruded, but there are many exceptions. A "gummy smile" or excessive overbite will require incisor intrusion. In any case, if the finished upper model is placed on a table teeth down, the cuspids, bicuspids, and molars should contact the table and the incisors should be ½mm from the table.
7. 正畸治疗中*重要的部分是对六颗上前牙的管理。微笑是我们的试金石。一般来说，上切牙应保持在其原始的垂直水平或进行内陷，但也有许多例外。“牙龈微笑”或过度咬合将需要切牙内陷。无论如何，如果将完成的上颌模型放在桌子上，牙齿朝下，犬牙、前磨牙和磨牙应接触桌面，而切牙应离桌面½毫米。
The anterior teeth must not only be properly positioned anteroposterioraly, but properly angulated and torqued. You can torque adequately with .018" or .022" single or twin brackets, but it requires many archwire changes. An .016" bracket can be filled with wire much earlier, and you can accomplish all necessary torquing and intrusion of the upper incisors in the eight to 12 months prior debonding、
前牙不仅必须在前后方向上正确定位，还必须正确倾斜和扭转。使用 0.018 英寸或 0.022 英寸的单支或双支托槽可以充分扭转，但这需要多次更换弓丝。0.016 英寸的托槽可以更早地填充弓丝，并且您可以在去除粘接前的八到十二个月内完成上前牙所需的所有扭转和压入。
I am so sure of the concepts I have outlined here that ido not hesitate to boldly affirm them. I will trust in posterity to further confirm them.
我非常确信我在这里概述的概念，因此我毫不犹豫地大胆肯定它们。我相信后人会进一步证实它们
联系我们