chinh nha theo co che sinh hoc ricketts

8/6/2019 Chinh Nha Theo Co Che Sinh Hoc Ricketts

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I U TR CH NH NHA THEO C CH SINH H C C A

RICKETTSRICKETTSRICKETTSRICKETTS

Khi nim iu tr chnh hnh rng-mt v chnh rng theo Rickettsc ph bin Php bt u t nm 1966 bi bc s Carl F.Gugino ri sau lan sang Chu u nh s gip ca Dr. Ruel, W.Bench. PhpJ.Phillippe v cng s ca ng ta cng nh M. Langlade v M.Picaud ng gp vo nhiu hiu bit cho phng php ny.

Ricketts nh ngha nhng nguyn tc m trong c mt s iutri ngc li vi nhng kin thng thng c cng nhn M cch my nm. T cc nguyn tc ng ta a ra mt k thut iu trtheo quan nim ca ng. K thut c ngun gc t k thut Edgewise,trong k thut ny ng gi li nguyn tc kim sot cc rng theo 3 chiutrong khng gian bng nhng ng bracket v nhng dy vung hoc ch nht, tuy vy lc p dng cng nh cch dng cc dy khc nhau nhiu. Mc

ch l t c kt qu tt nht c th trong mt thi gian ti thiu v s nnh ti a. Cc kt qu l t c thng bng ngha l lm thng phhp hai cung rng theo 1 khp cn l tng, mt thng bng chc nng vmt thng bng thm m. Chng ta cho thm vo yu t cui cng l yut thi gian.Tht vy cc giai on iu tr khc nhau phi t c kt qutrong mt thi gian ti thiu.

A. Nhng nguyn tcA. Nhng nguyn tcA. Nhng nguyn tcA. Nhng nguyn tc

1. S dng mt h thng chn on v iu tr vi s gip ca mtm hnh trn phim Cefalo cho php chng ta nhn thy c nhngmc tiu t c .

2. Lm ch vn ng xon trong lc iu tr.

3. C c s mc gi nh cc c hoc bn xng (dy, c)

4. Di chuyn rng trong bt c hng no vi mt lc ph hp.


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5. Thay i xng

6. iu tr cn su trc khi iu tr cn cha

7. Chia on

8. iu chnh qu mc

9. iu tr cc sai khp cn theo trnh t dn dn ti lp hoc phchi chc nng bnh thng hn.

10. S dng cc dng c a c trc.

I. Nguyn tc 1I. Nguyn tc 1I. Nguyn tc 1I. Nguyn tc 1: S dng mt h thng chn on v iu tr vi s gip S dng mt h thng chn on v iu tr vi s gip S dng mt h thng chn on v iu tr vi s gip S dng mt h thng chn on v iu tr vi s gip ca mt m hnh trn phim Cefalo cho php chng ta nhn thy c nhngca mt m hnh trn phim Cefalo cho php chng ta nhn thy c nhngca mt m hnh trn phim Cefalo cho php chng ta nhn thy c nhngca mt m hnh trn phim Cefalo cho php chng ta nhn thy c nhngmc tiu mc tiu mc tiu mc tiu t c .t c .t c .t c .

Khm chc nng bnh nhn, xem cc ti liu (mu, phim ton cnh,phim chp trong ming, phim chp t xa thng v nghing, phim chp s vphn tch phim c tay) th khng chn on v ln k hoch iu tr.Cn phi c thm mt m hnh cphalometrique ging nh set-up bng

thch cao ca cc nh lm rng gi hiu c nhng kt qu s c csau iu tr.

Holdaway gi kiu sp xp l VTO (Visual treatment objective).Mt s tc gi dng thut ng ct mu c tnh s pht trin v iutr.Trn phim cephalo nghing ngi ta c lng s pht trin trin v iutr c mc ch l c 1 ng v s ln hn t ci th nht, ch n cc

gii thit pht trin v kt qu ca c ch c hc p dng. Mt s tc gi cns dng thut ng d phng s pht trin, thut ng ny ch bao ph mtphn cc cng vic trn. V vn ny cn c mt vi s phn bit sau:

- D kin s pht trin trong thi gian ngn 2-3 nm cho php nhn thytrong thi gian ngn nhng lch lc no c th thy sau mt thi gianngn nu khng can thip.


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- Mt VTO ngn hn 2-3 nm c mc tiu iu tr v cn thit. i viVTO ny chng ta phi ch n mt phn pht trin 20 30% vmt phn thay i do iu tr (70 80%). Kiu ny khng th giring l d phng s pht trin. cch ny cng c th p dng chonhng ngi kt thc s pht trin.

- Mt VTO di hn 8 10 nm c gi l d phng s pht trin theothi gian di cho thy r phn pht trin cn li v nhng thay i doiu tr sa cha cc sai lch. Nh vy ta c mt mu ca 1 ca no

sau khi ht pht trin v sau iu tr. Thc hin k thut nybngtay th phc tp, n nn c lm bng my tnh.

VTO n gin ngn hn (h.2) phi c thc hin mt cch c hthng v hp logc. N cho bit khng nhng cc yu t d dng hin ti mcn tin lng s pht trin, kt qu ko di iu tr v bit c kt qu iutr chnh hnh v chnh rng. S dng nguyn tc 5 vng sp xp chng v 7vng nh gi cho php a ra cc giai on iu tr v t chng trnh.Chn on tnh tr thnh chn on ng. Nhng mun to VTO khng chcn bit hin tng pht trin v s thay i kiu mt m cng cn phi hiutht r c ch v tc dng cc b my chnh nha m nha s ang dng. Phinh gi nhng thay i d kin trn mi vng nh gi v kt qu m ccthay i c th c vng khc. V d khi cm c t th mi, xng hmtrn v di c t th mi th rng ca di, rng hm di, rng ca trn ,

rng hm trn, mt nghing s nh th no.u im ca VTO l do c s tng quan gia nhng thay i ca

cc vng cho php hiu r hn nhng vn v chnh xng, chnh rng vmc gi . K thut ny s c m t chi tit hn.

II. Nguyn tc 2: Lm ch vn ng xon trong lc iu tr.II. Nguyn tc 2: Lm ch vn ng xon trong lc iu tr.II. Nguyn tc 2: Lm ch vn ng xon trong lc iu tr.II. Nguyn tc 2: Lm ch vn ng xon trong lc iu tr.


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xng t chn rng ta vo v xng v gi n gim di chuyn.c bit hn l trng hp rng hm di m ngi ta t chn rng ta vov xng ngoi bng cch to vt xon bng lc xon chn rng- tin nh vnong rng. Khi to mt lc ngoi ming ln rng hm trn th hm rng c1 cm trn cnh trong cho php rng hm ta ln v xng ngoi (tuy nhin tchu lc xng hm di). Trng hp ngc li nu mun c di chuynhoc mt mc gi th ngi ta t chn rng xng xp giu mch mu, ni mu c th lm tiu xng v lm rng di chuyn. Nu ngi ta mun

l rng hm di di gn th phi t chn rng xa bn xng v loi b lcxon chn rng tin nh. Trong 1 s trng hp m ngi ta mun nhln rng ca di m cung rng li st bn trong ( nhn thy trn phim) thphi bt u bng ng tc lm xa cc chn rng nh cc lc xon chnrng-tin nh

IV. Nguyn tc 4: di chuyn cc rng theo bt c hng no vi lc canIV. Nguyn tc 4: di chuyn cc rng theo bt c hng no vi lc canIV. Nguyn tc 4: di chuyn cc rng theo bt c hng no vi lc canIV. Nguyn tc 4: di chuyn cc rng theo bt c hng no vi lc canthip thch hpthip thch hpthip thch hpthip thch hp

Nhng kch thch to nn do nn hay ko trn rng lm thay i sinh l m xng do c nhng t bo ti lm tiu hoc bi xng. Cc lc phi mc ti thiu gy nn cc kch thch nhng khng c mnh qu v cth nn mnh cc mao mch v gy nhi mu. Kt qu rng di chuyn chmli. Cc lc nn rng cn phi nh nhng n tu thuc ch yu vo b mtchn rng yu t i khng vi s di chuyn. B mt ny c gi l b mt

trn v n tu thuc vo kch c chn rng v hng di chuyn rngNgi ta c th nh ln rng ca di xung vi 1 lc nh lin tc

70-80gr tng ng 100gr F/cm2 b mt trn ca chn rng . Phi c mt lckhong 160-200gr nh ln rng ca trn, b mt chn rng pha trn carng ca trn th gp i rng ca di. Cc rng nanh trn c th b y livi lc khong 100gr.


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l l do ti sao lm gim cc lc mnh qu ca dy k thut sinhhc dn dn pht trin h thng cc ng cong vng v cc l xo

V. Nguyn tc 5: thay i xngV. Nguyn tc 5: thay i xngV. Nguyn tc 5: thay i xngV. Nguyn tc 5: thay i xng

Trong giai on pht trin c th to s thay i xng hm trn vdi bi nhng lc v dng c ph hp. hm trn lc ngoi mt tao cbng hoc hn 500 mg c th chuyn im A ra pha sau, nhng trng hpngoi l c th t n 8 mm. Cc lc cho phi hp hay lc dc c th yli hoc chuyn mt phng khu ci ln pha trn v ra sau. Cc lc ngoi

ming theo hng sau-trc (mt n chnh hnh ca Delaire) c th a imA ra pha trc vi mm t bit l khi phi hp vi dng c tch xng hmtrn.

Ngi ta thy theo thng k h l cc b activateur (b hot ng)c th lm thay i nhng cu trc su ca hm di v hm trn.

Theo chiu ng ngang ta c th tch ng gia ca xng hm trn

hoc bng 1 b c nong nhanh hoc vi 1 b quadrelix hoc bng 1 lcngoi ming .

VI. Nguyn tc 6: iu tr khp cn su ca rng ca trc khi iu tr VI. Nguyn tc 6: iu tr khp cn su ca rng ca trc khi iu tr VI. Nguyn tc 6: iu tr khp cn su ca rng ca trc khi iu tr VI. Nguyn tc 6: iu tr khp cn su ca rng ca trc khi iu tr cn chacn chacn chacn cha

Khp cn su thng gp trong cc trng hp khp cn sai. Ngi tahay gp trong loi II nhm 1 v thng xuyn gp loi II nhm 2.

iu tr khp cn sai ny cn phi iu tr cn su trc risau y li rng ca hoc a rng ca hoc c xng hm di ra trc. lm u ny c 2 cch:

- Lm tri rng pha sau.

- nh ln rng ca trn hoc rng ca di hoc c 2.


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* Lm tri rng pha sau* Lm tri rng pha sau* Lm tri rng pha sau* Lm tri rng pha sau: Kt qu rng pha sau tri l lm tng chiucao ca tng mt di v lm xng hm di xoay ra pha sau. iu ny ikhi c mong c ngi mt ngn (vn ng ny thng b cn tr do hthng c cn v chn rng hm nm trong xng c). Ngc li lm trirng hm pha sau khng nn c ngi mt di v chiu cao tng di ln ri.(trong trng hp ny th lm tri rng pha sau li rt thun li)

nh lnh lnh lnh ln rng can rng can rng can rng ca

L cch c la chn iu tr khp cn su vi hi vng l sau ny

s n nh hn so vi phng php lm tri rng hm trong trng hp thngbng c thng bng.

Nu chng ta khng iu chnh c khp cn su rng ca trc lcy li rng ca trn th s c chm sm rng ca vi phn x cm th bnth cc rng hm khng chm nhau tri ln. Vn ng ny c tng nhanhnu c hiu lc ngoi ming hoc ko chun lin hm. Kch thc dc b

thay i , nguy c ti pht ln v tnh trng khp cn su li tr li ngay saukhi iu tr

t c mc ch ny Rickette pht trin khi nim cung c bn nh ln rng ca v cung on lm n nh cc rng pha sau.

VII. Nguyn tc 7: Chia on cc cungVII. Nguyn tc 7: Chia on cc cungVII. Nguyn tc 7: Chia on cc cungVII. Nguyn tc 7: Chia on cc cung

y l im c bn ca k thut, chia on cung c nhiu thun li.N m bo c th kim sot tt hn cc mt phng cn do to s c lpcc rng trc v cc rng sau, ta trn chnh cc rng sau lm tri, lmln a ra trc hoc li ra sau. Do vy c th dng cc lc nh v lin tccho cc cung c bn v nhng thay i ca n, nhng im ta rng hm xa rng ca. Kim sot cc vn ng xon v dng trc th c kt qu hn:trong giai on u ngi ta dng ngay dy vung, chia on cung gipBracket trnh c st ln dy khi Bracket trt (v d khi y li rng nanh).


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Chia on lm cho cc rng pha bn pht trin t do hn di s kim sotca cung c bn. Cui cng u im ca on cung to ra mt lc chnhxng tt hn hm trn.

VIII. Nguyn tc 8: iu chnh qu mcVIII. Nguyn tc 8: iu chnh qu mcVIII. Nguyn tc 8: iu chnh qu mcVIII. Nguyn tc 8: iu chnh qu mc

Phn ln cc ti pht xy ra sau khi iu tr th nhn chung khngthun li. Do vy cn c d kin trc v hiu n s cha trc. V dkhp cn loi II tiu loi 1 c khp cn su rng ca phi c kt thc vicc tng quan rng hm, tin hm v rng nanh trong t th iu chnh qu

mc, c ngha l a v loi I qu mc, cc rng ca phi trong t th uchm u trong khi lu gi. Trong chnh xng hay chnh nha u nn iuchnh qu mc

IX. Nguyn tc 9: loi b khp cn sai theo mt qui trIX. Nguyn tc 9: loi b khp cn sai theo mt qui trIX. Nguyn tc 9: loi b khp cn sai theo mt qui trIX. Nguyn tc 9: loi b khp cn sai theo mt qui trnh iu tr dn dn nh iu tr dn dn nh iu tr dn dn nh iu tr dn dn ti lp hoc phc hi chc nng bnh thng hnti lp hoc phc hi chc nng bnh thng hnti lp hoc phc hi chc nng bnh thng hnti lp hoc phc hi chc nng bnh thng hn

Nhiu bin dng lin quan n vn ri lon chc nng. Bng cch

iu tr dn dn v loi b cc khp cn sai cc ri lon chc nng cng cth c iu chnh hn, tnh trng cung rng bnh thng hn v s n nhkt qu cng s c ci thin hn.

X. Nguyn tc 10: sn sut trcX. Nguyn tc 10: sn sut trcX. Nguyn tc 10: sn sut trcX. Nguyn tc 10: sn sut trc

C th lm sn nhiu b chnh nha trong phng php sinh hc dndn ca Rickett. Kh nng ny cho php nh thc hnh dnh nhiu thi gianhn n vn chn on, k hoch iu tr , ng vin ngi bnh v hiur hn cc chi tit ca b hm nn. Nhng thy thuc cn phi bit r ccchi tit cc b hm nn lm sn v c ch s dng n.

B. Phn tch trn phimB. Phn tch trn phimB. Phn tch trn phimB. Phn tch trn phim

Phn tch phim s mt y bao gm 32 yu t phim chp nghingv 18 yu t phim chp thng. Thng ngi ta dng my tnh phntch. Phn tch tm tt gm c 10 yu t (h.1) chia ra lm 4 phn nh sau:


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- Xc nh v tr cm trong khng gian.

- Xc nh xng hm trn bi cong ca mt.

- Xc nh cung rng trong mt.

- nh gi mt nghing (bng 2).

Yu t Trung bnh chnhlch

thay i

1 trc mt 900 3 0

2 Gc mt 870 3 10 /3 nm

3 Mt phng hmdi

260 4 10 /3 nm

4 Chiu cao tng mtdi

470 4 0

5 Cung hm di 260 4 1/20 /nm

6 li + 2mm 2 1mm/3 nm

7 Protrusion i_ / AP 0 +1mm 2 0

8 inclination i_ / AP 0 220 4 0

9 _6 n PtV tui+ 3mm 2 1mm/nm

Hnh 1: Phn tch tmtt 10 yu t caRicketts


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10 mi di/mtphng E

- 2 mm 2 t li vi tui

Bng II: Phn tch tm tt 10 yu t. Nhng gi tr ny c a ra chotr em 9 tui.

T phn tch tm tt ngi ta c th ly ra 5 yu t miu t typemt v a vo 1 trong 3 type chnh.

Bng 3: Yu t m t mt.

Yu t Trungbnh

mtdi

trungbnh

mtngn

1 Trc mt 900 3

2 Gc mt 870 3

3 Mt phng hm di 260 4

4 Chiu cao mt di 470 4

5 Cung hm di 260 4

- Mt di: tng ng vi s pht trin theo hng ng.

- Mt trung bnh: tng ng vi pht trin theo hng trung bnh.

- Mt ngn: tng ng vi pht trin theo hng ngang

70% rng lch phi iu tr l nhng ngi mt va, 12,5% ngi mt

ngn, 12,5% ngi mt di theo lch tiu chun trung bnh.Vic nh r type ca mt rt quan trng v n lin quan n nhiu yu

t trong iu tr: p ng mc gi, p ng vi lc nn xng hay nn rng,thi gian v dng ca lu gi

C. Nhn c mc tiu ca iu tr (VTO)C. Nhn c mc tiu ca iu tr (VTO)C. Nhn c mc tiu ca iu tr (VTO)C. Nhn c mc tiu ca iu tr (VTO)


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Hin nay chng ta dng ch yu l VTO n gin v lm nhanh hnVTO c in v n c nhng xu hng hng ti nhng mc tiu iu tr cnt c. D kin lu di rt kh lm bng tay v nn lm bng my tnh .

I. K thut VTO n gin (h.2)

* Trn ng v trn phim u tin (en ) ngi ta t mt t giyaxetat c th di chuyn d dng. Dng bt mu v thc c vch mm.

Nn sNn sNn sNn s v trc mt (h.2a): v trc mt (h.2a): v trc mt (h.2a): v trc mt (h.2a): ngi ta k ng Na- mi bng cch tngthm 1 mm vng Nasion v Basion. nh du im Cc hnh c. V trc

mt t im Cc trc c bng cch tng mi nm 3 mm v pha di.

Cm v mt phng di (h.2b):Cm v mt phng di (h.2b):Cm v mt phng di (h.2b):Cm v mt phng di (h.2b): ngi ta trt trc mt mi ln caotrn trc c cho n khi u pha di ca 2 trc trng nhau. Mt phng Ba-c v mi song song vi nhau. Ngi ta v cm v mt phng hm di mibng cch in li trn hnh c.

Mt phng mt (h.2c):Mt phng mt (h.2c):Mt phng mt (h.2c):Mt phng mt (h.2c): bi v giai on ny ngi ta c im Nasion

mi v cm mi nn c th v mt phng mt mii. Chng mt phng c trnmt phng mi da vo im Nasion. Ngi ta chia ra lm 3 phn bng nhautrn on gia im cm c v mi ri nh du 3 phn .

Hm trn v mt phng AHm trn v mt phng AHm trn v mt phng AHm trn v mt phng A----Po (h.2d v e)Po (h.2d v e)Po (h.2d v e)Po (h.2d v e): trt ln pha trn 1/3 th nht mt phng mt mi trn ci c v t du u tin im cm c. Vhm trn tr im A. Gim im A v pha sau 1 mm/1nm (tc dng ca s pht trin + tc dng c hc).V mt phng A-Po mi

Mt phng cn (h.2f):Mt phng cn (h.2f):Mt phng cn (h.2f):Mt phng cn (h.2f): trt ln pha trn 1/3 th 2 im mt phngmt mi trn ci c v nh du th 2 trn im cm c. V mt phng cnbng cch t theo ng v u tin.

Rng ca hm di (h.2g v h):Rng ca hm di (h.2g v h):Rng ca hm di (h.2g v h):Rng ca hm di (h.2g v h): t ra cn rng ca di +1mmtrc mt phng A-Po v trn mt phng cn, trc ln ca rng ca to 1 gc


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220 vi mt phng A-Po. a rng ca ra pha trc hoc y li v pha sautu theo mc ch iu tr.


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Rng hm hm di (h.2i,j):Rng hm hm di (h.2i,j):Rng hm hm di (h.2i,j):Rng hm hm di (h.2i,j): Phn tch cung rng di bit rng cadi nguyn ch hoc phi dng v pha xa hay pha gn. Sau chng haimt phng hm di v ghi im cm. V 1 ng vung gc vi mtphng cn chy qua im pha xa nht ca rng hm di ri nh du trnmt phng cn mi. Ngi ta t rng hm vi mt cn ca n trn mtphng cn mi sao cho ra xa ch nh du hoc 1mm v pha sau hoccch t v pha trc tu theo kt qu phn tch cung rng.

Rng hm hm trn (h.2k):Rng hm hm trn (h.2k):Rng hm hm trn (h.2k):Rng hm hm trn (h.2k): t rng hm trn trong quan h loi I so

vi rng hm di.Rng ca hm trn (h.2 l):Rng ca hm trn (h.2 l):Rng ca hm trn (h.2 l):Rng ca hm trn (h.2 l): t rng hm trn theo tng quan cn cha

v cn ph 2-3mm v t trc ln song song vi trc mt.

h.2: Nhn cc mc tiu iu tr n gin theo Guging

* Mt nghing ngoi da

Ngi ta c th cho thm vo VTO n gin ng v da. i vi

vng lm mi ngi ta chng mt phng mt im Nasion v t ling lm ca mi. i vi nh mi, chng phn trn ca xng hm trncng vi ENA ghi v chuyn VTO v pha sau 1mm mi nm dc theo vmhu. T v u mi cho ti rnh mi mi. i vi im A v mi trn, chngdc theo mt phng mt sao cho 2 mt phng cn trng nhau.

Ngi ta chia lm thnh 3 phn theo chiu ngang khong cch giacc im rng ca trn ( t lc bt u v VTO). Chng im A xng vghi im A da trn ci c. Gi mt phng cn song song, chng im ghi sautrn im rng ca trn (tc l a ra pha trc h.v 2/3) .V mi trn bngcch ni vi im A mi da. i vi mi di ngi ta nh du 1 im gia cn cha v su trn hnh v u tin v trn VTO. Ngi ta xptrng 2 im m vn gi mt phng cn song song. T v mi di.Nhng m mm xung quanh im B bo tn cc tng quan cng nh trn


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phim c. Ngi ta ni mt cch hi ho mi di n vng im B v ngvin cm sao cho loi b sc cng v co c mi-cm c c ng vinu n v hi ho.

II. S dng VTO, cc vng xp chng ln nhau.II. S dng VTO, cc vng xp chng ln nhau.II. S dng VTO, cc vng xp chng ln nhau.II. S dng VTO, cc vng xp chng ln nhau.

VTO n gin l 1 phng tin lm vic c dng cng vi v trnphim u tin nh nguyn tc chng phim. Ngi ta xp chng VTO trnng v u tin bng cch dng 5 vng xp chng vi 7 vng nh gi(h.3). Cc vng tng ng vi cc giai on sau ny ca k hoc iu tr.

+ Vn chc nng (hm di)

+ Vn chnh xng ( li: im A)

+ Rng ca di (phn tch cung rng + im neo chn)

+ Rng hm di (phn tch cung rng + im neo chn)

+ Rng ca trn

+ Rng hm trn

* Vng sp xp th nht:* Vng sp xp th nht:* Vng sp xp th nht:* Vng sp xp th nht: ng Basion - Nasion c ghi trn im Ccl vng nh gi 1 cho thy ton b s pht trin ca cm, trc mt nghoc m, ngha l cho thy hm di xoay do iu tr v di chuyn ca rnghm trn. Khi pht trin bnh thng trong 1 thi gian (2-3nm) cm di

Hnh 3: 5vng chngphim theoGugino


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chuyn dc trc mt, trc ny khng quay, rng hm cng di chuyn dctrc mt v gi cc tng quan ca n.

- Trc mt m 10 th c 5mm li

- Trc mt m 10 th iu chnh tng quan rng hm c 3mm

- Trc mt m 10 th iu tr c rng ca su 4mm

- Trc mt m rng t 1 1,50 th iu tr c khp cn ngc, sau khp li 1/2.

- Trc mt m 10 cho xu hng mt di i vi lch

- Trc mt m hoc ng tu theo type lc ngoi ming s dng

- Trc mt ng khi nh rng pha sau:

Vng xp chng th 2Vng xp chng th 2Vng xp chng th 2Vng xp chng th 2: ng Basion-Nasion vi im Nasion tovng nh gi 2 cho thy cc thay i ca xng hm trn. Khngc iu tr, gc Basion- Nasion- im A khng thay i khi tr phttrin. Tt c thay i im A do iu tr, cc lc c hc khc nhauc th lm thay i ti a theo bng IV

C ch Thay i ti a

Lc ngoi mt chnh xng

Chun loi II

Activateur

Xon chn rng-khu ciChun loi III

Cung mt

Xon chn rng-tin nh

-8mm

-3mm

-2mm

-1mm n 2mm+ 2mm n+3mm

+2 n +4mm

+1 n + 2mm


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Vng xp chng th 3Vng xp chng th 3Vng xp chng th 3Vng xp chng th 3: trc ca thn xng bm di vi im Pmto nn vng nh gi 3 i vi rng ca di v vng 4 i virng hm di. Nu khng iu tr hm di s gi quan h vimt phng A-P 0. Khi xp chng phim th ch thy r nhng dichuyn ca rng khi phim c chng rng ca v rng hmdi. Ngi ta cn a rng ca di ra trc, ra sau, lm tri haylm ln? Bo tn t th rng hm, dng li hay di v pha gn?

Loi neo chn no th cn thit Vng xp chng th 4Vng xp chng th 4Vng xp chng th 4Vng xp chng th 4: Phn trn ca hm trn vi gai mi trc

cho php nghin cu vng nh gi th 5 i vi rng hm trn vvng th 6 i vi rng ca trn. Ngi ta cn gi, di gn, di xa,lm tri hay lm ln cc rng hm v rng ca? Phi lm xon cino? Cn s dng loi lc ngoi mt no v cung no?

Vng nh gi th 5:Vng nh gi th 5:Vng nh gi th 5:Vng nh gi th 5: V phng din thm m ghi mc mtphng cn gip cho nghin cu vng nh gi th 7, tc vng datrng nghing.

Nh vy s dng mt cch c h thng VTO nh nhng vng xpchng ln nhau v nhng vng nh gi cho php lc no cng t chc ck hoch iu tr theo mt trnh t logic: Hm di, li, rng ca di,phn tch cung rng v rng hm di, rng hm v rng ca trn.

D. Cc cungD. Cc cungD. Cc cungD. Cc cung

Phn ln cc trng hp l s dng cung chia on. Ngi ta nhngcung lin tc v cung l tng vo giai on iu tr cui cng. Ngi ta phinghin cu 4 im sau:

- Lm cung


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- iu tr qu mc to thun li cho s n nh trong giai on lugi.

- Ngn chn khp cn sai hm rng hn hp.

*Tin hot ng*Tin hot ng*Tin hot ng*Tin hot ng: on rng ca c lm c hoc khng c lc xon nhthn rng- li gi rng ca theo trc ca n hoc y n ra pha ngoi.Phn sau gm: nghing v pha trong khong 300 (to-in), gp v pha di30 45 0 (tip back), xon thn rng- li khong 450 v nong 1 cm mi bnhm c c s mc gi ti a.

* t trong ming* t trong ming* t trong ming* t trong ming. y l mt cng vic cn cn thn trnh ph bnhng yu t tin hot ng lm trn cung. Ngi ta khuyn nn lmnng 2 phn cui trnh bin dng.

* Hot ng trong ming* Hot ng trong ming* Hot ng trong ming* Hot ng trong ming: Dng km ca Tweed c th lm nhiu loi

hot ng trong ming hoc vng rng hm hoc vng rng nanh nhngphi rt cn thn v khng ngn ngi tho cung ra kim tra tc dng cacc hot ng .

Cung hm trn cng s dng nhng nguyn tc nh vy tr xonrng hm. Ta hay dng dy c tit din ch nht 0,41 mm x 0,56 mm(.016 X .022).

Hnh 5: cung s dng a ra trc hmdi theo Gugino

6: Cung ko co hm ditheo Gugino7: Cung ko co hm trntheo Gugino


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* Nhng thay i:* Nhng thay i:* Nhng thay i:* Nhng thay i:

- Cung a ra pha trc (h5):Cung a ra pha trc (h5):Cung a ra pha trc (h5):Cung a ra pha trc (h5): l 1 cung c bn vng trn phatrong v lm hi di hn cung rng, ta vo ng rng hm y rng ca ratrc.

- Cung dng co li (h6,7)Cung dng co li (h6,7)Cung dng co li (h6,7)Cung dng co li (h6,7): l cung c 4 vng trn pha ngoi,nhng vng trn sau phi trc ng rng hm c th ko li rng ca.Cung c lm cng ra sau nhng ng rng hm t 1,5 2,0 mm mi lnlm hot ng.

---- Cung lm phngCung lm phngCung lm phngCung lm phng: Sp xp rng ca th c m bo bng cchthm cc ch T vng rng ca.

---- Cung dng ko lin hmCung dng ko lin hmCung dng ko lin hmCung dng ko lin hm: l mt cung hm trn gm 2 vngtrc trc chn thng ng trc, n c dng mc dy chun linhm loi II.

II. on cungII. on cungII. on cungII. on cung

l nhng cung ch yu dng bn, lm bng dy tit din vungElgiloy xanh l.

1. Cung ko ra sau:1. Cung ko ra sau:1. Cung ko ra sau:1. Cung ko ra sau:

l cung c dng trong trng hp nh rng v c 1 h thngvng to 1 lc khong 100 150 gr khi ta cng 3mm. Ngi ta phn bitloi ko rng nanh trn (hoc rng 4 nu nh 5 )(h8,9) v loi ko

rng nanh di.8: Ko rng nanh hmtrn theo Langlade9: Ko rng nanh ti chtheo Langlade


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2. Cung lm thng2. Cung lm thng2. Cung lm thng2. Cung lm thng

l h thng cung c cc nt ch T gia mi rng cn phi lm

thng (hnh 10)

3. Cung dng trc:3. Cung dng trc:3. Cung dng trc:3. Cung dng trc:

Dng ch yu trong trng hp nh rng, sau khi y li rng nanhhoc rng tin hm, n c mt vng dng li rng nanh trong trng hprng nanh b v pha xachn .

4. Cung ko chun lin hm.4. Cung ko chun lin hm.4. Cung ko chun lin hm.4. Cung ko chun lin hm.

C 1 vng trn nm ngang pha ngoi trc rng hm vi 1 to inquan trng pha sau v 1 vng trn thng ng sau rng nanh c b gcv pha trn vng rng nanh. Cung ny chu lc ko chun lin hm loi II.

5. Cung l tng v lm n nh.5. Cung l tng v lm n nh.5. Cung l tng v lm n nh.5. Cung l tng v lm n nh.

l nhng on cung l tng lin tc theo dng cung rng l tng vng bn. N gm nhng to in vng rng hm v 1 mc hnh li l

trc rng hm v mt mc khc yu hn gia rng nanh v rng hm nh.C th lm bng dy tit din hnh ch nht (h11)

6. on cung l6. on cung l6. on cung l6. on cung lm tri R nanh trn ca Langladem tri R nanh trn ca Langladem tri R nanh trn ca Langladem tri R nanh trn ca Langlade.

7. L xo nng trc v lm cc chn rng song song vi nhau7. L xo nng trc v lm cc chn rng song song vi nhau7. L xo nng trc v lm cc chn rng song song vi nhau7. L xo nng trc v lm cc chn rng song song vi nhau.

N u lm bng dy trn K: 0,35 mm v c x l nhit.

III. Cung lin tc.III. Cung lin tc.III. Cung lin tc.III. Cung lin tc.

10: Cung on lm thng vdng trc theo langlade11: Cung on l tng theoLanglade


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l nhng cung lm bng dy tit din vung Elgiloy xanh l nong hoc lm ko co cung rng li hoc sp xp rng cho u. N t cdng hn so vi on cung (h12)

IV. Cung l tng.IV. Cung l tng.IV. Cung l tng.IV. Cung l tng.

Nhng cung l tng u tin c lm bng dy c tit din hnhvung. Sau l cung c tit din hnh ch nht c sc co ko nng hn.

C cung l tng hm trn v hm di. 2 cung phi ph hpvi nhau v hp vi cung l tng.

Cung l tng trnCung l tng trnCung l tng trnCung l tng trn theo dng cung l tng ca hm trn mt cch un v cn xng. N c to in vng rng hm, mt ng cong hnh li ltrc rng hm v 1 ng cong khc nh hn gia rng nanh v rng hmnh,1 b gp rt nh gia rng ca bn v rng nanh.

Cung l tng diCung l tng diCung l tng diCung l tng di cng ging nh trn nhng c thm 1 xon dndn thn rng- li t tin hm u tin n rng hm. Trong trng hp m

R7 mang khu th cng c 1 mc hnh li l gia 2 rng hm ln v 1 to in R7 (h13). ng cong nh gia rng ca bn v rng nanh l to raim chm rng ca bn-rng nanh, hi ra pha ngoi mt gn nanh lugi tt hn.

E. Cc b phn khcE. Cc b phn khcE. Cc b phn khcE. Cc b phn khc

Ngoi nhng cung ring ca k thut sinh hc dn dn Ricketts cndng nhiu b phn khc trong cc k thut khc v thng c ci tin.

12: Cung lin tc koco li theo Gugino13: cung l tng hmdi theo Gugino


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1. Quadhelix1. Quadhelix1. Quadhelix1. Quadhelix.

l mt cung khu ci nong, lm bng dy trn 9/10 mmElgiloy xanh l vi 4 vng trn gn vi khu cc rng hm (h14) bng cchhn hoc c th tho ra c bi nhng ci cht kho khu ci. Cung c tin hot ng trc khi t vo ming v cho php rng hm quay xa-trong, nong rng hm hoc rng nanh hoc song song vi nhau. C th tcng trong ming, pha trc c th c nhng b phn chng mt ngntay v chng a li ra khi nut v nhng l xo ph nh hn (0,6mm) c

tc dng trn rng ca. Cung c lm sn vi nhiu c.2. Bihelix:2. Bihelix:2. Bihelix:2. Bihelix:

l cung li gn ging quadhelix nhng ch c 2 nt trn vngrng hm, c tc dng nong rng hm v rng hm nh hm di.

3. B tch hm ca Hass:3. B tch hm ca Hass:3. B tch hm ca Hass:3. B tch hm ca Hass:

N gm 1 c nong ni vi 1 khung cng dnh vo 2 khu rng hm v

2 khu rng hm nh, c nong c tc ng 1 2 ln/ ngy do lm tchng ni gia 2 xng hm trn.

4. Cung vm ming Nance ngc.4. Cung vm ming Nance ngc.4. Cung vm ming Nance ngc.4. Cung vm ming Nance ngc. l cung Nance 9/10es mm ci tin bi 1 vng rng sau rng hm.

Pha trc c mt nt nha acrylic c th ct b lc ko li rng ca ra sau.Cung dng quay xa- khu ci rng hm v dng neo chn (h15).

5. Bumper.5. Bumper.5. Bumper.5. Bumper.

14: Quadhelix nonghm15: Cung Nance


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l 1 chn choc, dng ch yu hm di, n gm mt cung phangoi 11/10es mm hn vo mt ngoi rng hm di vi 1 nt b tr mibn v pha trc bng nha Acylic hoc mng n hi to nn 1 mng giami v rng ca Bumper c th tho ra lp vo bng dng cc ng mtngoi hn vo rng hm Bumper gip cho rng hm neo chn tt hn, dngln v lm quay xa- li rng hm, chng cc rng ny khi rng hm sa th 2 rng mt v xa b sc p ca c mi ln rng ca.

6. Cc lc ngoi ming6. Cc lc ngoi ming6. Cc lc ngoi ming6. Cc lc ngoi ming.

Cc dng c ny cn c dng nhng t hn trc y, trc y cv ngi ta hi lm dng n. Ngi ta chia ra thnh cc lc: lc chnh xng>500 gr v chnh rng


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Richetts hay dng chun lin hm loi II, c khi loi I hm trn, himkhi loi III.

Theo c in chun loi II chy t rng hm di n vng pha trctrn. Li ch ca k thut chia on l c th kim sot c mt phng cnvng rng ca trn trong khi ko. Trong trng hp khp cn h pha trcngi ta t cc chun rng ca qua nhng mc hay vng trn cung s dng c ci tin. Trong trng hp khp cn su ngi ta t chun rngnanh v c th lm ln rng ca trong cng mt th. Chun c th t theo

hnh tam gic hoc hnh vung hoc theo nhiu cch. Lc ko bao gi cngphi c kim sot bng thc o. Cn phi eo thng xuyn v thay isng, ti. Cng nh tt c cc lc ngoi ming khc tc dng ca n tuthuc vo s phi hp ca ngi bnh. N thng c dng sa v saqu i quan h loi 2 khp cn h hoc ng khe.

chinh nha theo co che sinh hoc ricketts

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