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Be,lJ,yrcSi HenpepblBHO VI nepe>KVlBalOT SBOlllOLtVlOHHble Vl3MeHeHVlSI. lt1MeHHo B
STOM KOHTeKCTe KHVlra. 6eHHeTTa, P. MaKllaIIV1Ha VI X. T peBVl3V1
«CVlCTeMaTVl3V1pOBaHHaSi MexaHVlKa OpTO,lJ,OHTVlYeCKoro lIeyeHVlSI» SlBJlSleTCSI
KBVlHTSCCeHLtVle npaKTVlYeCKO OpTO,lJ,OHTVlVI. 3Ta HaCTOlIbHaSi KHVlra
«OpTO,lJ,OHTVlYeCKVlX peLtemOB» ,lJ,aeT B03MO>KHOCTb BpaYy war 3a waroM
ocyw.eCTBVlTb He06xo,lJ,VlMOe nepeMew.eHVle 3y60B, VlcnpaBVlTb VlIIVi
CKoppVlrVlpOBaTb OKKlII03V11O B pa3HbiX nIlOCKOCTSIX. lt1 TOlIbKO B TaKOM CJlYLJae
MO>KHO roBOpVlTb 0 rapaHTVIVI cTa6V1l1bHOCTVI pe3YllbTaTOB lIeYeHVlSI.
YMeHVle YBVI,lJ,eTb, OC03HaTb VI BocnpoVl3BeCTVI - BOT, Ha Haw B3rIlSl,lJ"
KayeCTBa, KOTopble He06xo,lJ,VlMO pa3BVlBaTb nOCTOSlHHO, eCJlVl Bbl 3aHVlMae-
TeCb OpTO,lJ,OHTVle.
npe,lJ,llaraeMaSi KHVlra CHVlCKaJJa orpOMHYIO nonYIlSipHOCTb cpe,lJ,VI OpTO,lJ,OH-
TOB MHorViX CTpaH MVlpa, VI Mbl Ha,lJ,eeMCSI, YTO OHa 6y,lJ,eT no ,lJ,OCTOVlHCTBY
OLteHeHa VI BOCTpe60BaHa CneLtVlaJJVlCTaMVI VI y Hac.
B ,lJ,06pbl nyrb!
M. C.llporoMl1peqKaR
BI1l/e-npe311p,eHT Accol/l1al/1111 Oprop,OHroB YKpal1Hbl,
maBHblii Oprop,OHT M03 YKpal1Hbl,
K. M. H., p,Ol/eHT Kacpep,pbl croMaroflOrl111 p,eTcKoro B03paCTa
flbBOBCKOro Hal/110HMbHOro Mep,I1l/I1HcKOro YHI1BepCI1Tera
11M. /l,aHl1fla rMI1l/KOro (r. flbBOB)

BCTynnEHiliE

B 1972 ro,lJ,Y Andrews ony611V1KoBaJJ CBOIO oCHoBonollaralOw.yiO CTaTblO 1 ,
VI BnOClIe,lJ,CTBVIVI Ha OCHOBaHVIVI nOllyyeHHblX ,lJ,aHHbIX pa3pa60TaJJ annapaT.
O,lJ,HaKO BCKope noclIe BHe,lJ,peHVlSI annapaTa C VlHTerpVlpOBaHHblMVI
B 6peKeTbi 0603HayeHVlSlMVI nOIlO>KeHVlSI 3y60B CTaJJO OyeBVI,lJ,HO, YTO ,lJ,lISi
peanVl3aLtVlVl ero nOTeHLtVlaJJa Ha npaKTVlKe Tpe6yeTcSI HOBaSi nporpaMMa
MexaHVlKVI lIeyeHVlSI VI YPOBHe npVlMeHSIeMbix CVlII. T.e., HOBaSi MexaHVlKa
JleyeHVlSI VI YPOBHVI CVlII Bbl3BaJJVI He06xo,lJ,VlMOCTb MO,lJ,VlcpVlKaLtVlVl CVlCTeMbl
6peKeTOB. B KOHeYHOM VlTOre, l1MeHHO MexaHVlKa VI YPOBHVI CVlII CblfpaJJVI
pewalOw.ylO pOllb B on pe,lJ,elleH VI VI KOHCTPYKLtVlVl annapaTa, a He Ha060pOT.
B ,lJ,aHHOM pa3,lJ,elle npe,lJ,CTaBIleH 0630P pa3BVlTVlSI MexaHVlKVI OpTO,lJ,OHTVlYeC-
KOro lIeyeHVlSI C HaYaJJa 70-x ro,lJ,OB XX BeKa, KOTOpble 03HaMeHOBaJJVI
HaYaJJO COBpeMeHHoro STana pa3BVlTVlSI B ,lJ,aHHO 06I1aCTVI, a TaK>Ke
paCCMaTpVlBalOTCSI npVlHLtVlnbl npVlMeHSleMO HblHe MeTO,lJ,VlKVI.
KOHCTPYKLtVlSl annapaTa VI MexaHVlKa lIeyeHVlSI TeCHO B3aVlMOCBSl3aHbi. B
KaKO- TO CTeneHVI KOHCTPYKLtVlSl 6peKeTOB MO>KeT OCHOBblBaTbCSI Ha HaYYHblX
,lJ,OCTVI>KeHVlSlX VI pe3YlIbTaTax VlCClIe,lJ,OBaHVI, VI ee MO>KHO pa3pa60TaTb
6YKBaJJbHO B TeyeHVle HeCKOllbKVlX MeCSILteB. LITO KacaeTCSI COOTBeTCTBYIOw.e
MexaHVlKVI lIeYeHVlSI, Ha ee pa3pa60TKY VI YCOBepweHCTBOBaHVle Tpe6YIOTCSI
ro,lJ,bl, npVl STOM OHa ,lJ,OIl>KHa npOTVI VlCnblTaHVle B KlIVlHVlyeCKl1X YCIIOBVlSlX
VI nO,lJ,TBep>KAaTbCSI pe3YlIbTaTaMVI lIeyeHVlSI MHoroYVlClIeHHblX naLtVleHTOB.
CJle,lJ,OBaTellbHO, ,lJ,aHHble no VlcnOllb30BaHVlIO MexaHVlKVI lIeyeHl1S1 ,lJ,OIl>KHbI
nO,lJ,TBep>K,lJ,aTbCSI KOHKpeTHblMVI clIyyaSlMVI Vl3 KlIVlHVlYeCKO npaKTVlKVI
VI OCHOBblBaTbCSI Ha peKOMeH,lJ,aLtVlSlX onblTHblX OpTO,lJ,OHTOB. Aa>Ke XopOWO
nO,lJ,roTOBJleHHble VlCClIe,lJ,OBaHVlSI no S<pcpeKTVlBHOCTVI lIeyeHVlSI He BCer,lJ,a
n03BOllSilOT C,lJ,ellaTb COOTBeTCTBYIOw.Vle BbIBO,lJ,bI 2 , 3.
OCHOBHEnonOEHiII
MEXAHiIIKili nE"'EHiII
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.
MexaHVlKa OpTO,lJ,OHTVlYeCKoro lIeyeHVlSI Onpe,lJ,ellSleTCSI YeTblpbMSI OCHOBHblMVI
<paKTOpaMVI - Bbl60p 6peKeTOB, n03V1LtVlOHVlpOBaHVle, lIeye6Hbie ,lJ,yrVl
VI YPOBeHb CVlII (pl1c. 1.1). cnollb3YSI c6aJJaHcVlpoBaHHoe COyeTaHVle STVIX
SlIeMeHTOB, MO>KHO ,lJ,06V1TbCSI s<p<peKTVlBHbIX VI ycnewHblx pe3YllbTaTOB
lIeyeHVlSI. O,lJ,HaKO, KaKVle-IIV160 Vl3MeHeHVlSI O,lJ,HOro Vl3 HViX (HanpVlMep, ,lJ,yrVl)
MOryT B 3HaYVITellbHO CTeneHVI nOBIIVlSlTb Ha Bce ,lJ,pyrVle SlIeMeHTbl
VI s<pcpeKTVlBHOCTb MeTO,lJ,a lIeyeHVlSI.
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PMC. 1.1. MeXaHi-1KY OPTOAOHTi-1lJeCKoro llelJeHi-1S1 onpeAellSlIOT lJeTblpe
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3

iIIccnEAOBAHiIIANDREWS
Andrews no npaBY CYVlTaeTCSI OTLtOM TeXHVlKVI npSlMO ,lJ,yr
VI npe,lJ,CTaBIISleTCSI VlHTepeCHblM paCCMOTpeTb ero BKlIa,lJ, B CBeTe OnblTa,
HaKonlleHHoro B TeyeHVle 25 lIeT KlIVlHVlyeCKoro VlcnOllb30BaHVlSI ,lJ,aHHO
CVlCTeMbl.
nOSlBVlBWVICSI BnepBble B 1972 ro,lJ,Y annapaT, oCHoBaHHbl Ha npVlMe-
HeHVIVI TeXHVlKVI npSlMo ,lJ,yrVl (straight-wire appliance@ - SWA), 6a3V1poBaJJCSI
Ha HaYYHblX VlCCJle,lJ,OBaHVlSlX, HO BKlIIOYaJJ VI PM TnVlYHbIX xapaKTepVlCTK,
npcyw.Vlx 6peKeTaM, npVlMeHSlBwVlMCSI B S,lJ,)Kya3- TeXHVI Ke.
B pa60Te Andrews npVlBe,lJ,eHbl ,lJ,aHHble 06ClIe,lJ,OBaHVlSI 120 MO,lJ,elle
naLtVleHTOB C HOpMaJJbHO OKKlII03V1e, He npOXO,lJ,VlBWVlX OpTO,lJ,OHTVlYecKOro
JleyeHVlSI. nOllyyeHHble pe3YllbTaTbi CTaJJVI OCHOBO ,lJ,lISi pa3pa60TKVI CVlCTeMbl
6peKeTOB.
Bem-1LJIt1Ha aHrynmJ,1t11t1
annapaTa Andrews
2° 2°
11 °
5°
go
2° 2°
5°
2°
2°
Benlt1LJIt1Ha aHrymuJ,1t11t1
annapaTa Andrews
HeCMOTpSl Ha TO, YTO CVlCTeMa npSlMO ,lJ,yrVl OCHOBblBaJJaCb Ha
COBepweHHO HOBO KOHLtenLtVlVl, B He Tpa,lJ,VlLtVlOHHO VlcnOllb30BaJJVlCb
60llbWVle CVllIbl, CBOCTBeHHble S,lJ,)Kya3- TeXHVlKe. KpOMe TOro, He
npe,lJ,YCMaTpVlBaJJVlCb SlIeMeHTbl KOHTpOIlSi <pVlKCaLtVlVl, TaKe KaK Vl3rVl6b1
,lJ,yrVl BTOpOro nOpSl,lJ,Ka. 3TO MorllO 06YClIaBlIViBaTbCSI TeM, YTO KlIVlHVlYeCKVI
onblT Andrews B 06l1aCTVI OpTO,lJ,OHTVIVI 6blll CBSl3aH C npVlMeHeHVleM
S,lJ,)Kya3- TeXHVI KVI VI YPOBHSlMVI CVlII, Vlcnollb3yeMbix npVl lIeYeHVI. OH TaK>Ke
nO,lJ,YepKVlBaJJ BIIVlSlHVle «s<p<peKTa OT,lJ,aYVI», no,lJ, B03,lJ,eCTBVleM KOTOpOro npVl
BBe,lJ,eHVIVI TOpKa TepSleTcSI aHryllSlLtVlSl 3y6a. nOSTOMY Andrews pewVlII BBeCTVI
,lJ,OnOIlHVlTellbHYIO aHryllSlLtVlIO B 6peKeTbi ,lJ,lISi nepe,lJ,HVlX 3y60B (pVlC. 1.2).
n03V1LtVlSl 6peKeTa COBna,lJ,aJJa C Cepe,lJ,VlHO KlIVlHVlYeCKO KOpOHKVI. noc-
KOllbKY npVl npVlMeHeHVIVI HOBOro annapaTa YMeHbwaJJacb He06xo,lJ,VlMOCTb
Benlt1LJIt1Hbl aHrynm.l,lt1lt1, nonYLJeHHble
B It1CCneAOBaHIt151X
2,8° 2,7° 8,4° 8,0° 3,6°
1,5° 1,3° 2,5° 0,4° 0,5°
BenIt1LJIt1HblaHryn5l1t11t1,
nonYLJeHHble B It1CCneAOBaHIt151X
PMC. 1.2. nepBOHalJaIlbHaSl KOHCTPYKi-1S1 annapaTa TeXHi-1Ki-1 npSlMo Ayri-1 OCHOBaHa Ha 3aMepax cooTBeTcTBYIOI..Lli-1X napaMeTpoB Ha 120 MOAeIlSlX nai-1eHTOB
C HopMaIlbHblM npi-1KYCOM, He npOXOAi-1BWi-1X OPTOAOHTi-1lJeCKoro llelJeHi-1S1

B BblnOIlHeHVIVI Vl3rVl60B Ha ,lJ,yre, HaMeTVllIaCb TaK>Ke TeH,lJ,eHLtVlSl K CTaH,lJ,ap-
TVl3aLtVlVl ct>OpMbl ,lJ,yrVl. nO,lJ, BIIVlSlHVleM pa60T Roth OpTO,lJ,OHTbl Bce yaw.e
CTaJJVI npVlMeHSlTb WVlpOKYIO VlIIVi KBa,lJ,paTHYIO ct>OPMY ,lJ,yrVl, XOTSI Andrews
npo,lJ,oll>KaJJ VlcnOllb30BaTb 6a3aJJbHYlO KOCTb HVI>KHe yelllOCTVI B KayeCTBe
opVleHTVlpa npVl onpe,lJ,eJleHL-1V1 ct>OpMbl ,lJ,yrVl. Ha npaKTL-1Ke npVlMeHSIIIVi Pa3JlVlY-
Hble ct>OpMbl ,lJ,yr, nOCKOllbKY He 6blll0 yeTKVlX opVleHTVlpOB no VlX npVlMeHeHVlIO.
B nepBble ro,lJ,bl npVlMeHeHL-1S1 annapaTa B MexaHVlKe lIeyeHL-1S1 B03HVlKaJJVI
TPY,lJ,HOCTVI, CBSl3aHHbie C B03,lJ,eCTBVleM 3HaYVITellbHbiX CVlII, L-1, B03MO>KHO,
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3HalJi-1TellbHble Ci-111bl, YTO npi-1BOAi-1IlO K yrIly611eHi-11O npi-1Kyca Ha nepeAHeM
YlJaCTKe i-1 <!>OpMi-1pOBaHi-11O OTKpblTOro llaTepaIlbHoro npi-1Kyca. 3TO SlBlleHi-1e
nOIlYlJi-1110 Ha3BaHi-1e «3<!><!>eKTa OTAayw> (<<roller coaster»).
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PMC. 1.4-1.6. nOclleAoBaTeIlbHocTb IleyeHi-1S1, npeACTaBlleHHaSl Ha pi-1cYHKax, AeMOHCTpi-1pyeT pa3Bi-1Ti-1e «3<!><!>eKTa OTAaYi-1» Ha paHHi-1X 3Tanax lleyeHi-1S1 TeXHi-1Ki-1
npSlMo Ayri-1. He>KellaTeIlbHoe yrlly6IleHi-1e npi-1Kyca 06ycllaBIli-1BallOCb B03AeCTBi-1eM lJpe3MepHbix Ci-1Il i-1 npi-1MeHeHi-1eM 311aCTi-1YHbIX peTpaKi-10HHbIX Ci-1Il.
B CBSl3V1 YBellVlyeHVleM aHryllSlLtVlVl nepe,lJ,HL-1X 3y60B. ClIe,lJ,OBaTellbHO, BO
MHorViX clIyyaSix Ha6111O,lJ,aJJOCb yrlly6l1eHVle nepe,lJ,Hero npVlKYca C ct>OpML-1-
pOBaHVleM IlaTepaJJbHoro OTKpblTOro npL-1KYca, SlBlIeHVle, KOTOpoe CTaJJO
Vl3BeCTHbiM no,lJ, Ha3BaHVleM «sct>ct>eKTa OT,lJ,aYVI» (roller coaster) (pVlC. 1.3-1.6).
PaHHVle KlIVlHVlyeCKVle L-1CCJle,lJ,OBaHVlSI n06Y,lJ,L-1I1V1 Andrews BBeCTVI pSl,lJ,
MO,lJ,Vlct>VlKaLtVl B KOHCTPYKLtVlIO annapaTa, VI noclIe npVlMeHeHVlSI B TeyeHVle
HeKoTOporo BpeMeHVI opVlrVlHaJJbHo «CTaH,lJ,apTHo» TeXHVlKVI npSlMo ,lJ,yrVl
OH peKOMeH,lJ,OBaJJ npVlMeHSlTb WVlpOKVI aCCOpTL-1MeHT 6peKeTOB. HanpVlMep,
OH npVlwell K BbIBO,lJ,y, YTO npVl sKCTpaKLtVlOHHOM lIeyeHVIVI ,lJ,lISi KlIblKOB He06-
XO,lJ,VlMbl 6peKeTbl, 06eCneYL-1BalOw.L-1e npOTVlBO,lJ,eCTBVle HaKllOHY, pOTaLtVlVl,
C cooTBeTcTBYIOW.VlM nlleYOM CVlII (pVlC. 1.7). OH TaK>Ke peKOMeH,lJ,OBaJJ
VlcnOllb30BaTb TpVl pa3IlVlYHbiX KOMnlleKTa 6peKeTOB ,lJ,lISi pe3LtOB C pa3HblMVI
3HayeHVlSlMVI TopKa, B 3aBVlCVlMOCTVI OT Tpe60BaHVI KOHKpeTHo KlIVlHVI-
YeCKO cVI-ryaLtVlVl.
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n03I11L1,II1f1 6peKeToB
nOCepeAII1He
KnIl1HlI1yeCKII1X
KOpOHOK 3y6oB
3HaYII1TenbHbie
YPOBHII1 clI1n
Pa3Hbie
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PMC. 1.7. MeXaHi-1Ka OPTOAOHTi-1lJeCKoro llelJeHi-1S1 TeXHi-1KO npSlMo Ayri-1 B
nepBble roAbl npi-1MeHeHi-1S1
5

iIIccnEAOBAHiliSi ROTH
B pe3YlIb TaTe CBOVIX paHHX VlCClIe,lJ,OBaHVI opVlrHaJJbHO TeXHKVI npSlMO
,lJ,yrVl Roth npeA1lo>K1I Mepbl no npeO,lJ,OlleHVlIO np06l1eM, xapaKTepHblX ,lJ,lISi
nOBCe,lJ,HeBHoro KlIVlHVlyeCKoro npVlMeHeHVlSI. B TO BpeMSI KaK Andrews
B XO,lJ,e pa60Tbi C nepBblM nOKOlleHVleM 6peKeTOB peKOMeH,lJ,OBaJJ npVlMeHSlTb
VlX WVlpOKVI accopTVlMeHT, Roth cTpeMVllIcSi Vl36e>KaTb He06xo,lJ,VlMOCTVI
HaJJVlYVISI 3HaYVITellbHoro KOIlVlyeCTBa pa3Hbix CVlCTeM 6peKeTOB. nOSTOMY
OH peKOMeH,lJ,OBaJJ VlcnOllb30BaTb YHVI<»VlLtVlpOBaHHYIO cVlcTeMY, COCTOSlW.YIO
Vl3 MVlHVlMaJJbHOro KOIlVlyeCTBa 6peKeTOB, npVlMeHSlIOw.VlxCSI B clIyyae
Y,lJ,aIleHVlSI 3y60B (sKcTpaKLtVlOHHbIX 6peKeTOB), KOTOpble, no ero MHeHVlIO,
MO>KHO npVlMeHSlTb npVl lIeyeHVIVI KaK B clIyyaSix C Y,lJ,aJJeHVleM 3y60B
(sKcTpaKLtVlOHHbIX), TaK VI B clIyyaSix 6e3 y,lJ,aJJeHVlSI (HesKCTpaKLtVlOHHbIX).
TaKO no,lJ,XO,lJ, 03HaMeHOBaJJ BBe,lJ,eHVle 6peKeTOB BTOpOro nOKOlleHVlSI
A1lSl TeXHKVI npSlMo ,lJ,yr, VI peKOMeH,lJ,aLtVlVl Roth nOIlYYVlIlVi wVlpoKOe
pacnpocTpaHeHVle B npaKTVlKe OpTO,lJ,OHTOB, KOTOpble CTaJJKVlBaJJVlCb
C aHaJJorVlYHblMVI TPY,lJ,HOCTSlMVI B MexaHVlKe lIeYeHVlSI, Vl3-3a WVlpOKOro
accopTVlMeHTa 6peKeTOB. AnnapaT, pa3pa60TaHHbl Andrews VI Roth,
6a3V1poBaJJCSI Ha 06w.Vlx npHLtVlnax MexaHVlKVI lIeYeHSI, KOTOpble OHVI
npVlMeHSIIIVi B cBoe npaKTKe.
B KOHLten-ryaJJbHoM nO,lJ,XO,lJ,e K lIeyeHVlIO Roth nO,lJ,YepKVlBaJJ 3HayeHVle
apTVlKYIISiTOpOB ,lJ,IlSi ,lJ,VlarHOCTVlYeCKO perVlCTpaLtVI ,lJ,aHHbIX npVl cBoeBpe-
MeHHOM HaJJO>KeHVIVI WVlH Ha paHHeM STane lIeyeHVlSI VI npVlMeHeHVlSI rHaTO-
1I0rVlyeCKVlX n03V1LtVlOHepOB Ha 3aBepwalOw.eM STane lIeyeHVlSI (pVlC. 1.8).
T aKO no,lJ,XO,lJ, o6eCneYVlBaJJ npaBVllIbHoe nOIlO>KeHVle Mblw.eIlKOBbIX OTPOCT-
KOB. npVl pa3Mew.eHVIVI 6peKeToB Roth opVleHTVlpoBaJJCSI Ha Cepe,lJ,VlHY
KlIVlHVlYeCKO KOpOHKVI B COOTBeTCTBVIVI C peKOMeH,lJ,aLtVlSlMVI Andrews.
KaK OTMeYaJJOCb Bblwe, OH npVlMeHSIII 60llee WVlpOKYIO <»OPMY ,lJ,yrVl, yeM
Andrews, BO Vl36e>KaHVle HapyweHVlSI n03V1LtVlVl KlIblKOB B npOLteCce lIeyeHVlSI
VI 06eCneyeHVlSI omVlMaJJbHo npOTpY3V1V1.
6peKeTbi
Roth
n03U.s:I 6peKeToB
nocepeAHe
KnHW1eCKX
KOpOHOK 3y6oB
CTaHAapTHble
wpoKe Ayr
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PMC. 1 .8. Roth Bbl6paIl Ci-1CTeMY 6peKeTOB AIlS! C03AaHi-1S! HOBO Ci-1CTeMbl
annapaTa

iIIccnEAOBAHiliSi MCLAUGHLIN,
BENNETT ill TREVISI 1975-1993
HeCMOTpSl Ha TO, YTO Mclaughlin VI Bennett VlCClIe,lJ,OBaJJVI pSl,lJ, aJJbTepHaTVlB-
HblX CVlCTeM 6peKeTOB, BKlIlOyaSi «nepeXO,lJ,HYIO» cepVlIO 6peKeTOB Andrews,
B nepVlo,lJ, C 1975 no 1993 ro,lJ, OHVI npe,lJ,nOYVlTaJJVI pa60TaTb rllaBHblM
06pa30M co CTaH,lJ,apTHO CVlCTeMO 6peKeTOB TeXHVlKVI npSlMo ,lJ,yrVl.
BMeCTO TOro, YT06bl Vl3HaYaJJbHO MO,lJ,VI<I>VlLtVlpOBaTb OCHOBHYIO KOHCTPYKLtVlIO
6peKeTOB, Ha npOTSI>KeHVIVI 60llee 15 lIeT OHVI 3aHVlMaJJVlCb pa3pa60TKo
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CKOllb>KeHVlSI VI npVlMeHeHVlSI nOCTOSlHHblX He3HaYVITellbHbiX CVlII, B OCHOBHOM
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Mclaughlin, Bennett i-1 Trevisi AO 1997 roAa
11

iIIccnEAOBAHiliSi MCLAUGHLIN
ill BENNETT 1997-2001
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AnSI 3aBepweHVlSI COBpeMeHHO CVlCTeMan13aLtVlVl MeTO,lJ,VlKVI MexaHVlKVI
lIeyeHVlSI B03HVlKlIa He06xo,lJ,VlMOCTb 06paTVlTbCSI K BonpocaM Bbl60pa <l>OpMbl
,lJ,yrVl VI YPOBHe CVlII.
HeCMOTpSl Ha TO, YTO HaYaJJbHaSi OBaJJbHaSi <l>opMa ,lJ,yrVl OKa3aJJaCb
3<p<peKTVlBHO B nepBble ro,lJ,bl ee npVlMeHeHVlSI, B CBSl3V1 C npe,lJ,bl,lJ,yw.VlMVI
VI HacTOSlw.VlMVI VlCCJle,lJ,OBaHVlSlMVI <l>OpMbl ,lJ,yrVl 6blll0 peKOMeH,lJ,OBaHO
(pVlC. 1.20) npVlMeHSlTb TpVl OCHOBHblX ee <pOpMbl - cY>KeHHYIO, npSlMoyrollb-
HYIO VI OBaJJbHYIO. npVl HaJJO>KeHVIVI OHVI OTIIVlyalOTCSI flJaBHblM 06pa30M
no paccToSlHVlIO Me>K,lJ,y KlIblKaMVI VI Me>K,lJ,y npeMollSlpaMVI, cocTaBIISlIOw.eMY
npVlMepHO 6 MM. Me>KMOIlSipHoe paCCTOOHVle B Tpex <pOpMax ,lJ,yr npaKTVI-
yeCKVI VI,lJ,eHTVlYHO, O,lJ,HaKO MOIlSlpHble yyaCTKVI ,lJ,yr MO>KHO YBellVlYVIBaTb
VlIIVi YMeHbwaTb no Mepe He06xo,lJ,VlMOCTVI nOCpe,lJ,CTBOM He3HaYVITellbHoro
Vl3rVl6a ,lJ,yr.
6blllVi ony611VI KOBaHbl peKOMeH,lJ,aLtVlVl OTHOCVlTellbHO <POpMbl 3y6HO ,lJ,yrVl
VI Bbl60pa ,lJ,yrVl 13 .
B HacTOSlw.e TpeTbe KHVlre onVlcaHbl Bce OCHOBHble YeTblpe npVlHLtVlna
MexaHVlKVI lIeyeHVlSI: KOHCTPYKLtVlSl 6peKeTOB, n03V1LtVlOHVlpOBaHVle 6peKeTOB
VI Bbl60p ,lJ,yrVl, a TaK>Ke ,lJ,aeTCSI HOBaSi OLteHKa YPOBHe CVlII (HanpVlMep,
A1lSl 06be,lJ,VlHeHVlSI peKOMeH,lJ,aLtVl no VlcnOllb30BaHVlIO TepMOaKTVlBVlpyeMbix
HViKelleBO- TViTaHOBblX ,lJ,yr), 3aHOBO <l>OPMYIlVipyeTcSI 06w.aSl KOHLtenLtVlSl
lIeyeHVlSI. B KHVlre npe,lJ,CTaBlIeHa anp06V1pOBaHHaSi VI 3<P<I>eKTVlBHaSi
MexaHVlKa lIeyeHVlSI TeXHVlKO npSlMO ,lJ,yrVl.
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Mclaughlin, Bennett i-1 Trevisi AO 2001 roAa

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C nOMow.blO CiliCTEMbl MBT™
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. 6peKeTbi 0,022 VI 0,018 ,lJ,1OMa
. KOHTpOllb <pVlKCaLtVlVl Ha paHHVlX STanax lIeyeHVlSI
. nepeMew.eHVle rpynn 3y60B
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. E.n.VlHbl pa3Mep CTaJJbHO ,lJ,yri<1 npSlMoyrollbHoro CeyeHVlSI
. AyrVl C KplOYKaMVI
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HaSi CVlCTeMa 6peKeToB. OHa npe,lJ,CTaBlIeHa CTaH,lJ,apTHbIMVI MeTaJJlIi<1yeCKVlMi<1
6peKeTaMVI, 6peKeTaMVI Cpe,lJ,HVlX pa3MepOB VI np03paYHblMVI 6peKeTaMVI.
60JlbWOe 3HayeHVle VlMelOT TOYHble xapaKTepVlCTVlKVI 6peKeTOB, nOSTOMY
nonblTKVI VlcnOllb30BaTb «HeYTO nO,lJ,06Hoe» MOryr OTpVlLt3TellbHO CKa3aTbCSI
Ha COOTHoweHVIVI CVlII MeXaHVlKi<1 lIeyeHVlSI, B pe3YllbTaTe yero HeB03MO>KHO
6Y,lJ,eT ,lJ,OCTVlYb >KellaeMblX pe3YllbTaTOB lIeyeHVlSI.
B OpTO,lJ,OHTVlYeCKO npaKTi<1Ke BpeMSI Bpaya npe,lJ,CTaBIISieT HaVl60llbwylO
LteHHOCTb. nOSTOMY y OpTO,lJ,OHTa ,lJ,OIl>KHa 6blTb nOIlHaSi YBepeHHOCTb B
Ha,lJ,e)l(HOCTVI CVlCTeMbl 6peKeTOB, KOTOpaSi 06eCneYi<1BaeT nOClIe,lJ,OBaTellbHoe
npOBe,lJ,eHVle lIeYeHVlSI, i<1 MO>KeT CSKOHOMi<1Tb BpeMSI BpaYa, npOBe,lJ,eHHOe
y KpeClIa naLtVleHTa, Ha 3aKlllOYVlTellbHbiX sTanax lIeyeHVlSI.
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nOIlHoe Ha3BaHVle CVlCTeMbl - MBTTM Versatile+, VI KaK CJle,lJ,yeT i<13
Ha3BaHi<1S1, OHa npe,lJ,Ha3HaYeHa,lJ,IlSi YHVlBepCaJJbHoro npVlMeHeHVlSI B caMblX
pa3Ho06pa3HbiX clIyyaSiX OpTO,lJ,OHTVlYeCKoro lIeyeHVlSI. TaKaSi YHi<1BepCaJJb-
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B WVlpOKOM accopTVlMeHTe 6peKeTOB), a TaK>Ke YCTpaHeHVlSI He06xo,lJ,i<1MOCTVI
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6peKeTOB ClIe,lJ,yeT npe,lJ,npi<1HSlTb Bce B03MO>KHble YCVlIIVlSI, nOCKOllbKY B
COOTBeTCTBVIVI C MeTO,lJ,VlKO lIeyeHVlSI npe,lJ,YCMaTpVlBaeTCSI pen03V1LtVlOHVI-
pOBaHVle (nepeKlleViBaHi<1e) 6peKeTOB B clIyyae B03HVlKHOBeHVlSI TaKO
He06xo,lJ,VlMOCTVI B XO,lJ,e lIeyeHVlSI. PeKOMeH,lJ,yeTcSI npVlMeHeHi<1e VlHCTpYMeH-
TOB VI VlH,lJ,VlBVI,lJ,YaJJbHble cxeMbl A1lSl YCTaHOBKVI 6peKeTOB. L-1HTepecHO
OTMeTi<1Tb, YTO CTpeMlIeHVle K ,lJ,OCTVI>KeHVlIO TOYHOCTVI npVl YCTaHOBKe
6peKeTOB npi<1BellO K B0306HOBJleHVlIO i<1HTepeCa K npi<1MeHeHVlIO HenpSlMO
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He3HaLlMTenbHbie nOCTOSlHHble CMnbl
AaHHaSi TeXHVlKa Tpe6yeT npVlMeHeHVlSI He3HaYVITellbHbiX nOCTOOHHblX CVlII.
ABTOpbl nOllaralOT, YTO STO caMbl s<p<peKTVlBHbl cnoc06 nepeMew.eHVlSI
3y60B, KOTOpbl 06eCneYi<1BaeT KOM<I>OPT naLtVleH-ry i<1 MVlHVlMVl3i<1pyeT
Tpe60BaHVlSI K <pi<1KCaLti<1V1. He3HaYVITellbHbie CVllIbl oc06eHHO Ba>KHbl Ha
HaYaJJbHblX STanax lIeyeHVlSI, KOr,lJ,a aHryllSlLtVlSl 6peKeTOB Tpe6yeT <pVlKCaLti<1V1
B camTTaJJbHO nIlOCKOCTVI, VI B Tex clIyYaSlX, Kor,lJ,a Ba>KHO 06eCneYVlTb
KOM<I>OPT naLtVleHTa.
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Tpa,lJ,VlLtVlOHHO Ci<1l1bl B ,lJ,Vlana30He 200 r CYi<1TaJJVlCb He3HaYVITellbHbIMVI,
a CVllIbl, npeBblwalOw.Vle 3HayeHVle 600 r, - Ype3MepHb1MVI. B OCHOBHOM,
OpTO,lJ,OHT ,lJ,OIl>KeH VlcnOllb30BaTb TOHKVle, rVl6KVle ,lJ,yrVl Ha HaYaJJbHblX sTanax
lIeyeHi<1S1 C MVlHVlMaJJbHblM OTKlIOHeHVleM, VI Vl36eraTb CJlVlWKOM YaCTO
VlX 3aMeHbl. Bpay TaK>Ke ,lJ,OIl>KeH pacn03HaBaTb npVl3HaKi<1 npVlMeHeHVlSI
pe3MepHblx Ci<1I1, TaKVlX KaK n06l1e,lJ,HeHVle ,lJ,eCHbl, ,lJ,VlCKOM<POpT naLtVleHTa
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VI npe,lJ,npVlHVlMaTb Mepbl, YT06bl Vl36e>KaTb VlX.
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Ha 3aKllIOYi<1TellbHbIX sTanax lIeyeHVlSI Vlcnollb3YlOT TOHKVle ,lJ,yrVl, TaKi<1e KaK
CTaJJbHble ,lJ,VlaMeTpoM 0,014 ,lJ,1OMa VlIIi<1 TepMOaKTVlBVlpyeMbie HVlKeJleBO-
TViTaHOBble ,lJ,VlaMeTpoM 0,016 ,lJ,1OMa ,lJ,IlSi yrOYHeHVlSI VI CTa6V111V13aLtVlVl
n03V1LtVlVl 3y60B.
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i<111i<1 Vl3MepVlTb KOIli<1yeCTBeHHO, ClIe,lJ,yeT Ha,lJ,eSlTbCSI Ha TO, YTO npVl BHVlMa-
TellbHOM Vl3yyeHVIVI ,lJ,aHHO pa60Tbi VI pa3JlVlYHbiX KlIVlHVlyeCKi<1X clIyyaeB
y YViTaTelle B03HVlKHeT YeTKoe npe,lJ,CTaBlIeHVle 0 TOM, KaK npi<1MeHSlTb VlX
B Onpe,lJ,elleHHblX KlIVlHVlyeCKi<1X Ci<1-ryaLti<1S1x.
13

6peKeTbi 0,022 M 0,018 AIOMMa
nOllaralOT, YTO annapaT TeXHVlKVI npSlMO ,lJ,YrVI HaVl60llee s<I><I>eKTVlBeH C
na30M 6peKeTa 0,022 ,lJ,1OMa. na3 60llbwero pa3Mepa 06eCneYVlBaeT 60llee
cB060,lJ,HOe nepeMew.eHVle HaYaJJbHblX ,lJ,yr VI y,lJ,ep>KVlBaHVle He3HaYVITellbHbiX
CVlII (pVlC. 1.21). Ha n03,lJ,HVlX sTanax lIeyeHVlSI xopowo <l>YHKLtVlOHVlPYIOT
CTaJJbHble npSlMoyrollbHble ,lJ,yrVl CeyeHVleM 0,019/0,025 ,lJ,1OMa (pVlC. 1.22).
npVl pa3Mepe na3a 0,018 ,lJ,1OMa OCHOBHO SlBIISleTCSI ,lJ,yra CeYeHVIM
0,016/0,022 VlIIVi 0,017/0,025 ,lJ,1OMa. STVI ,lJ,yrl1 60llee rVl6KVle VI nOSTOMY
06eCneYVlBalOT 601lbWVl npor116 VI 3arVl6aHVle ,lJ,yrVl npVl 3aKpblTVIVI npOMe-
>KYTKO B 14 C nOMow.blO MeXaHVlKl1 CKOllb>KeHVlSI.
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Ha HaYaJJbHblX sTanax lIeyeHVlSI OCHOBHYIO yrp03Y <t>VlKCaLtVlVl npe,lJ,CTaBIISieT
aHryllSlLtVlSl 6peKeTOB A1lSl nepeAHVlX 3y60B. 6peKeTbi MBTTM VlMelOT MeHbWVle
BeJlVlYVlHbl aHryllSlLtVlVl no cpaBHeHVlIO C npe,lJ,bl,lJ,yw.VlMVI nOKOlleHVlSlMVI
6peKeTOB TeXHVlKVI npSlMO ,lJ,yrVl. YMeHbweHVle aHryllSlLtVlVl B COyeTaHVIVI
C npVlMeHeHVleM TOHKVlX 0PTO,lJ,OHTVlyeCKVlX ,lJ,yr CHVI>KaeT He06xo,lJ,VlMOCTb
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BnepBble HaYVlHalOw.VlX npVlMeHSlTb s-ry HOBYIO MeTO,lJ,VlKY lIeyeHVlSI, 3ayac-ry1O
y,lJ,VlBJlSleT, HaCKOllbKO YMeHbwalOTCSI Tpe60BaHVlSI K <t>VlKCaLtVlVl,  OHVI nOCTe-
neHHO CTaJJKVlBalOTCSI co Bce MeHbwe He06xo,lJ,VlMOCTblO npVlMeHeHVlSI
Tp3,lJ,VlLtVlOHHO BHepOTOBO TSlrVl VlIIVi He6HbiX VI Sl3blYHbiX ,lJ,yr.
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CSH3KM TMna laceback (pVlC. 1.23) 06blYHO npVlMeHSIIOT ,lJ,IlSi KOHTpOJlSl
n03V1LtVlVl KOpOHOK KlIblKOB npVl y,lJ,aJJeHVIVI MOIlSipOB, VI B HeKOTOpblX
HesKCTpaKLtVlOHHblX clIyyaSix.
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CKlIlOyeHVleM Tex clIyyaeB, KOr,lJ,a cyw.ecTByeT He06xo,lJ,VlMOCTb YBellVlyeHVlSI
,lJ,lIVlHbl 3y6HO ,lJ,yrVl. AHCTaJJbHble 3arVl6bl 06eCneYVlBalOT y,lJ,06HOe 3arVl6a-
HVie ,lJ,VlCTaJJbHbIX KOHLIOB ,lJ,yrVl n033,lJ,VI MOIlSipOB VI nOMoralOT npe,lJ,OTBpaTVlTb
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HeKoTopblX clIyyaSix III KlIacca. AViCTaJJbHble 3arVl6bl VI CBSl3KVI TVina laceback
npVlMeHSIIOT Ha STane BblpaBHVlBaHVlSI  nepeMew.eHSI 3y60B ,lJ,0 STana
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Ha YlJaCTKaX MOIlSlpOB
15

nepeMew.eHMe .-pynn 3y60B
B TeX CJlyYaSlX, KOr,lJ,a STO B03MO>KHO, 3y6bl 06be,lJ,HSlIOT B rpynnbl (pVlC. 1.25).
B npoLtecce nO,lJ,roToBKVI 3y6HO ,lJ,yrVl K rpynnoBblM nepeMew.eHVlSlM, npVl
y,lJ,aIleHVIVI npeMollSipoB, cnOllb3YIOT CBSl3KVI TVina laceback, KOHTpOIlVl-
pYIOw.Vle n03V1LtVlIO KlIblKOB VI VlX peTpaKLtVlIO c LtellblO nepeMew.eHVlSI pe3L\OB.
Ha HVI>KHe ,lJ,yre KlIblKVI ,lJ,VlCTaJJVl3V1PYIOT CBSl3KaM ,lJ,0 TeX nop, nOKa He
6y,lJ,eT YCTpaHeHa CKyYeHHOCTb nepe,lJ,HVlX 3y60B. 3aTeM 3y6bl HVI>KHero
nepe,lJ,Hero CerMeHTa nepeMew,aIOT BMeCTe KaK rpynny Vl3 weCTVI VlIIVi
BOCbMVI 3y60B. Ha BepXHe ,lJ,yre KlIblKVI 06blYHO He OTO,lJ,BraIOT OT 60KOBbiX
pe3LtOB. O,lJ,HaKO npVl STOM Ba>KHO coxpaHVlTb nOIlO>KeHVle KlIblKOB B I KlIacce.
nOSTOMY CBSl3KVI TVina laceback Ha BepXHe yelllOCTVI ClIe,lJ,yeT VlcnOllb30BaTb
,lJ,0 MOMeHTa ,lJ,OCTVI>KeHSI I KlIacca Ha KlIbiKax, ,l],a>Ke eCIIVi STO 03HayaeT
OT,lJ,aJJeHVle KlIblKOB OT 60KOBbiX pe3LtOB (naL\VleHT J.N., c. 123). He06xo,lJ,VlMO
TaK>Ke OTO,lJ,BVlraTb KlIblK OT 60KOBOro pe3Lt3, eCIlVi 60KOBO pe3eLt VlMeeT
MaJJYIO BeJlVlYVlHY, VI B 6Y,lJ,yw.eM MO>KeT nOTpe60BaTbcSI ero Hapaw.VlBaHVle,
a B HeKoTopblX clIyyaSix ,lJ,a>Ke co cMew.eHVleM cpeAVlHHo IIV1HVlVI.
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iIIcnonb30BaHMe TpeX <l>OPM AY'-
Ao Cepe,lJ,VlHbl 90-x ro,lJ,OB aBTOpbl KHVlr B 60llbwVlHcTBe CJlYLJaeB OT,lJ,aBaJJ
npe,lJ,nOYTeHVle npVlMeHeHVlIO ,lJ,yrVl OBaJJbHO <t>OpMbl (c. 76). OHVI CYVlTaJJVI
TaKYIO <t>OPMY Ha,lJ,e)l(HO npVl lIeyeHVIVI 3HaYVITellbHOro KOIlVlyeCTBa naLtVleHTOB
TexHVlKo npSlMo ,lJ,yrVl.
B KOHLte 90-x ro,lJ,OB XX BeKa aBTopbl npVlWIIVi K BbIBO,lJ,y, YTO BO MHomx
cJlyyaSix xopowVle pe3YllbTaTbi ,lJ,aeT VlCnOIlb30BaHe CY>KeHHO ,lJ,yrVl,
a VlHOr,lJ,a - KBa,lJ,paTHo. CY>KeHHaSi <t>opMa ,lJ,yrVl VlMeeT MHVlMaJJbHoe
Me>KKlIbIKOBoe paccTOSlHVle,  ee npVlMeHeHVle, OYeBVI,lJ,HO, MO>KeT 6blTb
nOKa3aHO,lJ,IlSi naLteHTOB C Y3KVlMVI, KOHYeCKVlMVI <t>opMaMVI 3y6HbiX ,lJ,yr.
npVlMeHeHVle ,lJ,yrlr1 KBa,lJ,paTHO <pOpMbl nOKa3aHO naLtVleHTaM C WVlpOKO
<t>OpMO 3y6HO ,lJ,yrVl, VI B cllyyaSlX, Tpe6ylOw.x 6YKKaJJbHO npoTpY3V1V1
3y60B 60KOBbiX cerMeHTOB HVI>KHero pSl,lJ,a VI pacwVlpeHVlSI BepxHe ,lJ,yrVl.
B HacTOSlw.ee BpeMSI peKOMeH,lJ,yeTcSI TeXHVlKa VlH,lJ,VlBVI,lJ,YaJJbHOro nO,lJ,60pa
,lJ,yrVl ,lJ,IlSi KIDK,lJ,Oro naLtVleHTa Ha OCHOBe OBaJJbHO, CY>KeHHO VI KBa,lJ,paTHO
,lJ,yr (c. 78-79).


PMC. 1.25. B Tex cIlYlJaSlX, KorAa 3TO B03MO>KHO, BblnOllHSlIOT rpynnoBoe nepeMel..LleHi-1e 3y60B: KOHTpOllb 3a nepeAHi-1Mi-1 CerMeHTaMi-1 BepxHero i-1 Hi-1>KHero PSIAOB
ocyllteCTBllSlIOT B eIlOM KaK 3a rpynno, cocTOSIe i-13 WeCTi-1 i-1Ili-1 BOCbMi-1 3y60B. B ci-1TYai-1i-1 A npOMe>KyroK 3aKpblT nocpeAcTBoM Me3i-1aIlbHoro nepeMel..LleHi-1S1
MOllSlpOB i-1 npeMoIlSlpoB B xOAe IleyeHi-1S1, nOTpe60BaBwero Mi-1Hi-1MaIlbHO <I>i-1KCai-1i-1. B Ci-1Tyai-1i-1 6 pe3bl i-1 KIlbIKi-1 CMellteHbl B i-1MelOllti-1CSI npOMe>KyroK -
nOTpe60BaIlacb MaKCi-1MaIlbHaSl <I>i-1KCai-1S1, KaK npi-111eyeHi-1i-1 aHOMalli-1 III KIlacca i-111i-1 B cIlYlJae 6i-1MaKCi-1IlllSlpHO npoTpY3i-1i-1.
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16blYHO B XO,lJ,e lIeyeHVlSI VlCnOllb3YlOT CTaJJbHYIO ,lJ,yry npSlMoyrollbHOro
eyeHVlSI O,lJ,HOro pa3Mepa - 0,019/0,025 ,lJ,1OMa. PaccMaTpVlBaJJoCb npVlMe-
eHVle ,lJ,yr 60llbwero pa3Mepa, HO, HecMoTpSl Ha lIyYwee 06eCneyeHVle
DHTpOIlSl, VlX npVlMeHeHVle MeHee s<l><I>eKTVlBHO ,lJ,IlSi MexaHVlKVI CKOllb>KeHVlSI.
 HeKoTOpblX cJlyyaSix npVlMeHeHLt1e CTaJJbHblX ,lJ,yr CeyeHVleM 0,019/0,025
,1OMa VlIIVi TepMOaKTLt1BVlpyeMblx HLt1KelleBO- TViTaHOBblX ,lJ,yr MO>KeT 6blTb
elleco06pa3HblM Ha 60llee n03,lJ,HLt1X sTanax lIeyeHVlSI ,lJ,IlSi nOIlHoro VlcnOllb-
OBaHVlSI napaMeTpoB, BBe,lJ,eHHbIX B cVlcTeMY 6peKeTOB. AaHHaSi TeXHLt1Ka
ICHOBaHa Ha KOHLtenLtVlVl «noIlHo ,lJ,yrLt1» Lt1 ,lJ,IlSi ee BblnOIlHeHLt1S1 pe,lJ,KO
IpVlMeHSIIOTcSI 3aKpbIBalOw.Lt1e neTIIVi (c. 252) VlIIVi CeKLJ,VlOHHble ,lJ,yrLt1.
TeOpeTVlyeCKVI npVl ,lJ,yre 0,019/0,025 ,lJ,1OMa VI pa3Mepe na3a 0,022
llOMa cyw.ecTByeT 3a30p npVlMepHo B 10 0 (pVlC. 1.26). O,lJ,HaKO B KlIVlHLt1-
lecKo npaKTVlKe ,lJ,yra <l>YHKLtLt10HVlpyeT lIyywe, yeM npe,lJ,nOllaraJJocb,
I, no Bce BepoSiTHoCTVI, STO npOVlCXO,lJ,VlT 6l1aro,lJ,apSi OCTaTOYHOMY HaKllOHY,
leoTKoppVlrVlpoBaHHoMY BO BpeMSI BBe,lJ,eHVlSI npSlMoyrollbHo ,lJ,yrVl, VI cox-
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AyrM C KplOLlKaMM
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36-38 MM Ha BepxHe ,lJ,yre VI 26 MM - Ha HVI>KHe (pVlC. 1.31). Ha BepxHe
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C KplOlJKaMi-1 Ha Tpy6Kax AIlSl MOllSlpOB i-1Ili-1 Tpy6Kax AIlSl Hi-1>KHi-1X BTOpblX npeMoIlSlpoB AIlSl 06eCnelJeHi-1S1 YHi-1BepCaIlbHOCTi-1 MeXaHi-1Ki-1 IlelJeHi-1S1. TaKaSl YHi-1BepCaIlb-
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MeTOAbl HanO>KeHMSI nMraTYPbl Ha AyrM
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npOBe,lJ,eHVlSI. B nOClIe,lJ,HVle ro,lJ,bl ropa3,lJ,0 60llbwe BHVlMaHVlSI CTaJJVI
y,lJ,ellSlTb pa311V1YVlSlM BeIlVlYlt1Hbl 3y60B, nOCKOllbKY BO MHorViX clIyyaSiX OHVI
MOryr BocnpenSITCTBOBaTb ,lJ,OCTlt1>KeHlt11O VI,lJ,eaJJbHoro pe3YllbTaTa lIeyeHVlSI.
HanpVlMep, OpTO,lJ,OHTbl nplt1WIIVi K BbIBO,lJ,y, YTO yaCTO 6blBaeT He06xo,lJ,lt1MO
COWIIVI<poBbIBaTb SMaJJb Ha HVI>KHlt1X pe3Lt3X A1lSl nOllyyeHVlSI omVlMaJJbHO
OKKlII03V1V1 Ha 3aKlllOYVlTellbHOM STane lIeyeHVlSI, KaK onVicaHO B pa3,lJ,elle 10.
flll1TEPATYPA
1 Andrews L. F. 1972. The six keys to normal occlusion. American Journal of
Orthodontics 62:296-307.
2 Reukers E. 1997. Straight Wire Appliance versus conventional full edgewise,
prospective clinical trial. University of Nijmegen, Nijmegen.
3 Reukers H. A. J., Kuijpers-Jagtman A. M. 1996. Effectiveness of orthodontic
treatment: a prospective clinical trial. European Journal of Orthodontics 18:424
(abstract).
4 Mclaughlin R. P., Bennett J. C. 1989. The transition from standard edgewise to
preadjusted appliance systems. Journal of Clinical Orthodontics 23: 142- 153.
5 Bennett J. C., Mclaughlin R. P. 1990. Controlled space closure with a
preadjusted appliance system. Journal of Clinical Orthodontics 24: 251-260.
6 Mclaughlin R. P., Bennett J. C. 1991. Finishing and detailing with a preadjusted
appliance system. Journal of Clinical Orthodontics 25:251-264.
7 Bennett J., Mclaughlin R. P. 1993. Orthodontic treatment mechanics and the
preadjusted appliance. Mosby-Wolfe, London (ISBN 07235 1906X).
8 Sebata E. 1980. An orthodontic study of teeth and dental arch form on the
Japanese normal occlusions. The Shikwa Gakuho 80(7):945-969.
nocneAOBaTenbHblM nOAXOA K
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BpeMeHVI, YTO oTpa3V1TcSI Ha KayeCTBe pe3YllbTaTOB lIeyeHVlSI.
9 Watanabe K., Koga M., Yatabe K., Motegi E., Isshiki Y. A. 1996. A morphometric
study on setup models of Japanese malocclusions. The Shikwa Gakuho.
10 Roth R. H. 1987. The Straight Wire Appliance 17 years later. Journal of Clinical
Orthodontics 21 :632-642.
11 Mclaughlin R. P., Bennett J. C. 1995. Bracket placement with the preadjusted
appliance. Journal of Clinical Orthodontics 29:302-311.
12 Bennett J., Mclaughlin R. P. 1997. Orthodontic management of the dentition with
the preadjusted appliance. Isis Medical Media, Oxford (ISBN 1 89906691 8).
Republished in 2002 by Mosby, Edinburgh (lSBN-07234 32651).
13 Mclaughlin R. P., Bennett J. C. 1999. Arch form considerations for stability and
esthetics, Revista Espana Ortodontica 29(2):46-63.
14 Ouchi K., Koga M., Watanabe K., Issiki Y., Kawada E. 2001. The effects of
retraction forces applied to the anterior segment on orthodontic arch wires -
changes in wire deflection with wire size. Presented to southern California
component of Edward H Angle Society. In press.
21

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peaIli-13YIOTCSI npi-1 i-1CnOIlb30BaHi-1i-1 npSlMoyrollbHo Ayri-1 CeyeHi-1eM
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npaKTVlyeCKVI nOIlHOCTblO. npl1MeHeHVle ,lJ,yrVl CeyeHVleM 0,019/0,025 ,lJ,1OMa
B 6peKeTe Ha BepxHeM KlIblKe 06eCneYVlT nOIlHYIO peaJJVl3aLtVllO aHryllSlLtVlVl
8 0 . AHryllSlLtVlSl 60llbwe 7 0 Vl3 8 0 6y,lJ,eT nOIlHOCTblO peaJJVl30BaHa (pVlC. 2.13).
npVl npVlMeHeHVIVI MeXaHl1KVI He3HaYVITellbHbiX VI nOCTOSlHHblX CVlII
aHryllSlLtVlSl xopowo KOHTpOlll1pyeTcSI, VI ee BellVlYVlHbl nOIlHOCTblO VI 6blCTpO
peaJJVl3YlOTCSI B KlIVlHVlYeCKO npaKTVlKe. BellVlYVlHbl aHryJlSlLtVlVl, nOllyyeHHble
B pe3YllbTaTe VlCClIe,lJ,OBaHVI, npVl611V1>KaIOTCSI K BeJlVlYVlHaM aHryllSlLtVlVl
6peKeTOB CVlCTeMbl MBTTM, XOTSI 06S13aTellbHbl 6blllVi He3HaYVITellbHbie
Vl3MeHeHVlSI aHryllSlLtVlVl Tpy60K AIlSi MOIlSipOB 11 BepXHVlX npeMollSipoB.
AnSI Bcex MOIlSipOB peKOMeH,lJ,yeTcSI npVlMeHSlTb 6peKeTbi C aHryIlSlLtVle
0 0 . ECIIVi 6peKeT C aHryIlSlLtVle 0 0 YCTaHoBVlTb napaJJlIellbHo w.eYHbIM
6yropKaM MOIlSipOB, OH 06eCneYVlT aHryllSlLtVlIO 50 BepXHVlX MOIlSipOB VI aHry-
IIS1LtVlIO 2 0 HVI>KHVlX MOIlSipOB (pVlC. 2.14). 3TOT Bonpoc ,lJ,OCTaTOYHO WVlpOKO
06cY>K,lJ,aJJcSI B ,lJ,pyrl1x VlCTOYHVlKax4.
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C aHryIlSlLtVle 0 0 B OTlIl1YVle OT aHryllSlLtVll1 2 0 B opVlrVlHaJJbHoM annapaTe
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BepTl1KaJJbHoe nOIlO>KeHVle, nepeMew,aSlcb B Han paBJleH VI VI I KlIacca.
B HeKOTOpblX clIyyaSix npl1 STOM TaK>Ke CHVI>KaIOTCSI Tpe60BaHVlSI K <!>VlKCaLtVlVl.
BellVlYl1Ha 2 0 MO>KeT nOKa3aTbCSI He3HaYVITellbHo, HO cYMMapHoe 3HayeHVle
8 0 B CJlyYae yeTblpex BepXHVlX npeMOIlSipOB CTaHOBVlTCSI 3HaYVlTeJlbHbiM C TOYKVI
3peHVlSI aHryIlSlLtVlVl. B clIyyae HVI>KHVlX npeMollSipoB BellVlYVlHa Me3V1aJJbHoro
HaKllOHa KOpOHOK 2° B opVlrVlHaJJbHblX 6pcKeTax TeXHVlKVI npSlMO ,lJ,yrVl
OnpaB,lJ,bIBaeTCSI, nO,lJ,Aep>KVlBaSi HaKllOH KOpOHOK Knepe,lJ,VI, B HanpaBlIeHVIVI
I KlIacca, VI MO>KHO peKOMeH,lJ,OBaTb ee ,lJ,aJJbHewee npVlMeHeHVle.
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npi-1 HaIlO>KeHi-1i-1 Ha MOIlSlpbl napaIlIleIlbHo 6YKKaIlbHbiM 6yropKaM aHrYllSli-1S1
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PeanM3au.MSI TOpKa
KaK YKa3blBaJJOCb paHee, BellVlYVlHbl in-out  aHryIlSlLt 3<1><I>eKTBHO
VlcnOllb30BaHbi B TeXHKe npSlMo ,lJ,yr. TOpK >Ke, HanpoTB, Vlcnollb3yeTcSI
He,lJ,OCTaTOYHO, BB,lJ,y ,lJ,BYX MeXaHVI'.leCKX npVlYH:
. nllOUJ.a,lJ,b npVlIlO>KeHSI TOpKa MaJJa  3aBVlCVlT OT KpyrSlw.ero 3<1><I>eKTa
,lJ,yrVl, OTHOCVlTellbHO TOHKO no cpaBHeH1O C BeIlVlYVlHO 3y6a (pVlC. 2.16).
PMC. 2. 16. BBeAeHHbl B OCHOBaHi-1e TOpK HeAOCTaTOYHO a<t><t>eKTi-1BHO
peaIllr13yeTcSI B TeXHi-1Ke npSlMo Ayrlr1 lJaCTIr1YHO BCIleACTBIr1e MaIlo nIlOU\aAi-1
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VlcnOllb30BaHVle ,lJ,yrVl 60llbwe TOIIW.VlHbl npenSlTcTByeT CKOllb)l(eHVlIO.
3TVI ,lJ,yr VlMelOT 3a30p npVlMepHo 10 0 B 3aBCVlMOCTVI OT ,lJ,OnycKoB npVl
Vl3roToBlIeHL1V1 6peKeTOB VI npeLtVl3OHHOCT Vl3roTOBlIeHVlSI ,lJ,yr, a TaK>Ke
CTeneHVI VlX cKpyrlleHVlSI (pVlC. 2.17).
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PMc.2.17. Me>KAY npSlMoyrollbHo CTaIlbHO AYro CeyeHi-1eM 0,019/0,025
AIOMa i-1 na30M 0,022 AIOMa 3a30p COCTaBIlSleT npi-1MepHO 10 0 . TOlJHOCTb
yrIla 3aBi-1Ci-1T OT npei-13i-10HHOCTi-1 i-13roTOBIleHi-1S1 Ayri-1 i-1 na3a 6peKeTa,
a TaK>Ke OT CTeneHi-1 cKpyrlleHi-1S1 i-111i-1 3aOCTpeHi-1S1 KpaeB Ayri-1.
33

YYVlTblBaSi OTHOCVlTellbHYIO HeS<t><t>eKTVlBHOCTb 6peKeTOB TeXHVlKVI
npSlMO ,lJ,yrVl ,lJ,lISi nOllyyeHVlSI TOpKa, B03HVlKlIa He06xo,lJ,VlMOCTb BBe,lJ,eHVlSI
,lJ,OnOIlHVlTellbHoro TOpKa B 6peKeTbi ,lJ,JISi pe3LtOB, MOIlSipOB VI HVI>KHVlX
npeMOIlSipOB ,lJ,JISi 06eCneyeHVlSI O>KVI,lJ,aeMbIX Ltelle lIeyeHVlSI npVl
TOpK pe3u.OB
B KlIVlHVlYeCKO npaKTVlKe Ltelleco06pa3eH TOpK (pVlC. 2.18-2.21), no,lJ,
B03,lJ,eCTBVleM KOTOpOro KOpHVI BepXHVlX pe3LtOB nepeMew.alOTcSI He6Ho,
a KOpHVI HVI>KHVlX pe3LtOB - BecTVl6YIlSipHO. TaKOe Tpe60BaHVle Bbl,lJ,BVlraeTCSI
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npVlBeCTVI K nOTepe TopKa BepXHVlX pe3LtOB, VI KOr,lJ,a HVI>KHVle pe3Ltbi
VlMelOT TeH,lJ,eHLtVlIO K Bbl,lJ,BVI>KeHVlIO Knepe,lJ,VI, B npOLteCce BblpaBHVlBaHVlSI,
no,lJ, B03,lJ,eCTBVleM SlIaCTVlYHblX TSir II KlIacca.
· AHOMaJJVIVI I KlIacca, npVl KOTOpblX npaBVllIbHbl TOpK pe3LtOB nOMoraeT
06eCneYVlTb OnTVlMaJJbHYIO OKKlII03V11O Ha nepe,lJ,HeM yYaCTKe.
· AHOMaJJVIVI III KlIacca, npVl KOTOpblX Ha.n.ne>Kaw.VI TOpK MO>KeT nOMOYb
KOMneHcVlpoBaTb He3HaYVITellbHbie CKelleTHbie HapyweHVlSlll1 KlIacca.
MVlHVlMaJJbHblX Vl3rVl6ax Ha ,lJ,yre. cJ:>aKTOpbl <t>OpMbl 3y6HO ,lJ,yrVl, BblnYKllOCTVI
KlIblKOB VI ,lJ,pyrVle oc06eHHocTVI 06YClIOBVIlIVi He06xo,lJ,VlMOCTb HaJJVlYVISI
6peKeTOB Tpex onLtVl A1lSl TOpKa KlIbIKOB, KaK YKa3aHO Ha c. 44-48.
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TOpK KnblKOB
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3KCTpaKLtVlVl 3y60B. O,lJ,HaKO, nmVlYHaSi rpynna 0PTO,lJ,OHU1yeCKVlX naLtVleHTOB
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aBTOpbl VlcnOllb3YlOT TOpK -14 0 , KOTOpbl 06eCneYVlBaeT IIYYWVI KOHTpOllb
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n03BOllSieT YMeHbwVlTb <l>YHKLtVlOHaJJbHble nOMexVI, npenSlTcTBYSI YAJlVlHeHVlIO
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37

TOpK HM>KHMX npeMonSipOB M MonSipOB
Bo MHorViX CJlyyaSiX y naLtVleHTOB Ha6111O,lJ,aIOTCSI Y3KVle 3y6Hbie ,lJ,yrVl Ha
BepXHe yeJlIOCTVI, YTO COnpOBO>K,lJ,aeTCSI KOMneHCaLtVlOHHblM CY>KeHVleM
HVI>KHVlX 3y6HbiX ,lJ,yr. B TaKVlX CJlyyaSiX 06blYHO 6blBaeT He06xo,lJ,VlM
w.eYHbl TOpK (BepTVlKaJJbHoe BblpaBHVlBaHe) KOpOHOK HVI>KHVlX MOIlSipOB
VI npeMOIlSipOB. TOpK A1lSl nepBoro MOIlSipa -30 0 VI BTOpOro MOIlSipa -35 0
PMC. 2.30. ABTOpbl 3HalJi-1TeIlbHO i-13MeHi-111i-1 BeIli-1lJi-1Hbl TOpKa AIlSl Hi-1>KHi-1X
60KOBbiX 3y6oB no cpaBHeHi-11O C xapaKTepi-1CTi-1KaMi-1 Opi-1ri-1HaIlbHoro annapaTa
straight-wire. 8TO cnoco6cTByeT YMeHbWeHi-11O HaKIlOHa Hi-1>KHi-1X MOIlSlpOB,
a TaK>Ke paCWi-1peHi-11O Hi-1>KHe 3y6HO Ayri-1.
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B opVlrVlHaJJbHoM annapaTe TeXHVlKVI npSlMo ,lJ,yrVl npVlBO,lJ,VlT K HaKlloHY
KOpOHOK HVI>KHVlX MOIlSipOB n03TOMY aBTOpbl npVlHSlIIVi Ba>KHOe peweHVle
Vl3MeHVlTb TOpK HVI>KHVlX npeMollSipoB Ha 50, nepBblX MOIlSipOB - Ha 1 0 0
VI BTOpblX MOIlSipOB - Ha 25 0 (pVlC. 2.30).
-35 0
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PMC. 2.34. Tpy6Ka AIlSl BTOpOro Hi-1>KHero MOIlSlpa

YHiliBEPCAnbHOCTb
CiliCTEMbl6PEKETOB
6peKeTbi VI HanpaBJlSlIOw.Vle w.eYHble TPy6KVI nepBoro VI BTOpOro nOKOlIeHVI
(C. 6) VlMellVi e,lJ,VlHCTBeHHYIO onLtVlIO ,lJ,lISi Ka>K,lJ,Oro 3y6a C peKOMeH,lJ,aLtVle
OTHOCVlTellbHO ,lJ,aJJbHewe KOMneHCaLtVlVl aHryIlSlLtVlVl, TOpKa VI Bell W'I VI Hbl
in-out. OHVI He 06eCneYVlBaJJVI YHVlBepCaJJbHOCTVI CVlCTeMbl. B CVlCTeMY
6peKeTOB MBTT M Versatile+ BHeceHbl 3HaYVITellbHbie KOHCTPYKTVlBHble
YCOBepweHCTBOBaHVlSI no cpaBHeHVlIO C npe,lJ,bl,lJ,yw.VlMVI annapaTaMVI. OHVI
BKlIlOyalOT Vl3MeHeHVlSI aHryllSlLtVlVl VI TopKa, a TaK>Ke KOHCTPYKTVlBHble napa-
MeTpbl, KOTopble 06eCneYVlBalOT YHVlBepCaJJbHOCTb TeXHVlK npSlMO ,lJ,yr.
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HVI>Ke npVlBe,lJ,eHbl ceMb OCHOBHblX aCneKTOB YHVlBepCaJJbHOCTVI annapaTa:
HVI>Ke onVicaHO, YTO VlHHOBaLtVlSl CVlCTeMbi 06be,lJ,VlHSleT ceMb pa3HbiX
BapVlaHTOB 6peKeTOB VI w.eYHbIX TPy60K, B 3aBVlCVlMOCT OT nOTpe6HocTe.
3m C03,lJ,aeT B03MO>KHOCTVI VlH,lJ,VlBVI,lJ,YaJJbHOro nO,lJ,XO,lJ,a npVl npVlMeHeHVIVI ,lJ,yr
VI 6peKeToB VI cBepxKOppeKLtVlVl B Onpe,lJ,elleHHblx cVI-ryaLtVlSlx lIeyeHVlSI. 3TVlM
npeVlMyw.ecTBoM MO>KHO BocnOllb30BaTbCSI ,lJ,lISi lIeyeHVlSI OT,lJ,ellbHbiX 3y60B
VlIIVi rpynnbl 3y60B. npVl 3TOM YCTpaHSleTcSI He06xo,lJ,VlMOCTb B BblnOIlHeHVIVI
Ha ,lJ,yre Vl3rVl60B nepBoro, BTOpOro VI TpeTbero nOpSl,lJ,KOB Ha 3aBepwalOLlIVIx
3Tanax lIeyeHVlSI VI nOBblwaeTCSI 3<p<peKTBHOCTb annapaTa.
1. OnLtVlSl,lJ,IlSi He6Ho paCnOIlO>KeHHbIX 60KOBbiX pe3LtOB (-10 0 ).
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6. cnOllb30BaHVle Tpy60K,lJ,IlSi BTOpblX BepXHVlX MOIlSipOB Ha nepBblX MOIlSipax B clIyyaSlX, He Tpe6ylOw.Vlx npVlMeHeHVlSI BHepOTOBO TSlrVl.
7 . cnollb30BaHVle Tpy60K ,lJ,IlSi BTOpblX HVI>KHVlX MOIlSipOB Ha nepBblx  BTOpblX BepxHx MOIlSipax npoTVlBOnOIlO>KHO CTOpOHbl Ha 3aBepwalOw.eM 3Tane
lIeyeHVlSI npVl YCTaHoBlIeHVIVI COOTHoweHHSI MOIlSipOB no II KlIaccy.
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BepXHVlX 60KOBbiX pe3LtOB. Y naLtVleHTOB co CKYyeHHOCTblO BepXHVlX nepe,lJ,HVlX
3y60B I VlIIVi III KlIacca CKelleTHblX aHOMaJJVI BepXHVle 60KOBbie pe3Ltbi VlMelOT
TeH,lJ,eHLtIt1IO K nepeKpeCTHOMY npVlKYCY, YTO 3aTpY,lJ,HSleT npaBVllIbHYIO KoppeK-
l\VlIO nOIlO>KeHVlSI VlX KopHe. B npoLtecce lIeyeHVlSI cyw.eCTByeT pVlCK nepeMe-
w.eHVlSI KOpOHKVI BeCTVl6YIlSiPHO, npl1 3TOM KOpHVI MOryT OCTaBaTbCSI B He6HO
n03V1LtVlVl. B TaKO cVI-ryaLtVlVl B03HVlKaeT He06xo,lJ,VlMOCTb B BbinOIlHeHVIVI
,lJ,OnOIlHVlTellbHbIX Vl3rVl60B Ha ,lJ,yre, YTO 3aTSlfVlBaeT npOLteCC lIeyeHVlSI.
PMC. 2.35. nepeA nepeMew,eHi-1eM He6Ho cMew,eHHbiX pe3oB clleAyeT
C03AaTb AIlSl Hi-1X AOCTaTOlJHO MeCTa B 3y6HO Ayre. ,lJ,IlSl YBeIli-1lJeHi-1S1 Ayri-1
Ai-1CTaIlbHble 3ari-16bl BblnOllHSlIOT 2 MM Ai-1CTaIlbHO n038Ai-1 Tpy60K Ha MOllSlpax.
AIlSi cBoeBpeMeHHoro ,lJ,OCTVI>KeHVlSI Ltelle lIeyeHVlSI peKOMeH,lJ,YIOTcSI
clIe,lJ,YIOw.Vle Mepbl:
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npocTpaHcTBo ,lJ,IlSi cMew.eHHoro 3y6a. 3TOro MO>KHO ,lJ,OCTVlYb C nOMOL1tblO
cnVlpaJJbHo npY>KVlHbl. 6peKeTbi Ha COCe,lJ,HVlX 3y6ax nO,lJ,BSl3bIBaIOT
npOBOIlOYHO MeTaJJIIVlYeCKO IIVira-rypo BO Vl36e>KaHVle pOTaLtVl 3TVlX
3y60B (pVlC. 2.35 VI 2.36).
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i-1CnOllb30BaTb Ayry i-13 cKpyYeHHO npOBOIlOKi-1 Ai-1aMeTpOM 0,015 AIOMa i-1Ili-1
TepMOaKTi-1Bi-1pyeMYIO Hi-1KeIleBO-Ti-1TaHoBYIO Ayry Ai-1aMeTpOM 0,016 AIOMa
AIlSl He3HalJi-1TeIlbHoro BeCTi-16YIlSlpHoro nepeMew,eHi-1S1 60KOBbiX pe3oB

. Ha He6HO paCnOIlO>KeHHbl 60KOBO pe3eLt YCTaHaBIIViBalOT 06b1YHbl
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yero 3HayeHVle TopKa MeHSleTCSI C + 1 0 0 Ha - 10 0 . 3TO cnoc06cTByeT
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Ha 180 0 TOpK i-13MeHSleTCSI C + 1 0 0 Ha - 10 0
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B npoLtecce lIeyeHVlSI npVlMeHSleTCSl CnVlpaJJbHaSi npY>KVlHa KaK MeTO,lJ,
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CpeAi-1HHO Ili-1Hi-1i-1 BnpaBO npi-1HSlTO peWeHi-1e YAaIli-1Tb nepBble BepXHi-1e
npeMOIlSlpbl i-1 BTOpble Hi-1>KHi-1e npeMOIlSlpbl. nOCIle HayaIlbHoro BblpaBHi-1BaHi-1S1
i-1 nepeMel..LleHi-1S1 YCTaHOBIleHa Cni-1paIlbHaSl npY>Ki-1Ha AIlSl 06eCneyeHi-1S1 MeCTa
AIlSl 60KOBOro pe3a. Ha aTOM aTane He YCTaHaBlli-1BaIli-1 6peKeTbi Ha Hi-1>KHi-1e
3y6b1, nOCKOIlbKY n03AHee B XOAe IlelJeHIr1S1 06S13aTellbHO YCTaHaBlli-1BaIli-1
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cllyyae cIleAyeT npOBOAi-1Tb C i-1CnOIlb30BaHi-1eM Kpyrllo CTaIlbHO Ayri-1
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yeJlOBeKa OHVI VlMelOT caMble ,lJ,lIVlHHble KOpHVI. Bbl60p cooTBeTcTBYIOw.ero
TOpKa Vl3 Tpex VlMelOw.VlxcSI OnLt11 CHVI>KaeT He06xo,lJ,VlMOCTb B ,lJ,OnOIlHVI-
TeJlbHblX Vl3rVl6ax Ha ,lJ,yre.
KOHLtenLt11S1 CVlCTeMbl MB"fTM npe,lJ,ycMaTpVlBaeT np11MeHeHVle ,lJ,BYX T11nOB
6peKeTOB A1lSl BepxH11x KlIblKOB (p11C. 2.41) C LtellblO 06eCneyeHVlSI Tpex
onLtVl TOpKa (_7°, 0°, +7°).
TOpK _7°
TOpK 0°
TOpK +7°
PMC. 2.41. Ci-1CTeMa MB"fTM npeAycMaTpi-1BaeT Tpi-1 oni-1i-1 TOpKa AIlSl BepXHi-1X
KIlblKOB
TpM onu.MM TopKa AnSI HM>KHMX KnblKOB
(-6°, 0°, +6°)
T OpK - 11 ° B opVlrVlHaJJbHOM annapaTe TeXHVlKVI npSlMO ,lJ,yrVl 4 6blll
HeY,lJ,OBJleTBOpVlTellbHbIM, nOCKOllbKY B HeKOTOpblX CJlyyaSiX KOpHVI HVI>KHVlX
KJlblKOB npO,lJ,OIl>KaJJVI C11l1bHO Bblc-rynaTb Knepe,lJ,VI. ABTOpbl npe,lJ,nOYVlTalOT
npVlMeHSlTb TOpK _6° AIlSi HVI>KHVlX KlIbIKOB, O,lJ,HaKO VlHOr,lJ,a MO>KHO TaK>Ke
VlcnOllb30BaTb TOpK 0° VlIIVi ,lJ,a>Ke +6°. OHVI OT,lJ,aIOT npe11Myw.eCTBO MeHbwe
BeJlVlYVlHe TOpKa no cpaBHeHVlIO C pe3YllbTaTaMVI VlCClIe,lJ,OBaHVI, nOCKOllbKY
y KopHe H11>KH11X KlIblKOB VlHOr,lJ,a npOVlCXO,lJ,VlT peLteCCVlSI ,lJ,eCHbl, n03TOMY
VlX JlYLJwe nepeMew.aTb B KOCTHO TKaHVI aJJbBeOIlSipHoro OTpocTKa. TaK>Ke,
B clIYLJaSiX rlly60Koro np11KYCa He06xo,lJ,VlMO nO,lJ,aBaTb KOpOHKY KlIblKa
BecTVl6YllSiPHO npVl O,lJ,HOBpeMeHHOM y,lJ,ep>KVlBaHVIVI KOpHSI B aJJbBeollSlpHo
KOCTVI. TOpK _6° XopOWO COflJacyeTcSI C Vl3MeHeHVlSlM11 Bell11Y11Hbl TopKa Ha
5° Ha HVI>KHVlX npeMollSipax. B CVlCTeMe MBTTM npe,lJ,ycMOTpeHo npVlMeHeHVle
,lJ,BYX T11nOB 6peKeToB AIlSi H11>KHVlX KlIblKOB (p11C. 2.42) ,lJ,lISi 06eCneyeHVlSI
Tpex onLtVl TOpKa (_6°, 0°, +6°).
TOpK _6°
TOpK 0°
TOpK +6°
Pi-1C. 2.42. Ci-1CTeMa MB"fTM npeAycMaTpi-1BaeT Tpi-1 oni-1i-1 TOpKa AIlSl Hi-1>KHi-1X
KIlblKOB
KorAa cneAyeT MCnOnb30BaTb TPM onu.MM TopKa AnSI KnbIKOB?
Cyw.eCTByeT weCTb OCHOBHblX <l>aKTOpOB, BJlVlSlIOW.VlX Ha Bbl60p 6peKeTOB AIlSi KlIbIKOB:
1. <t>opMa ,lJ,yrVl
2. Bblc-rynaHVle KlIblKOB
3. PeweHVle OTHOC11TellbHO 3KCTpaKLtVl11 3y60B (KOHTpOllb aHryIlSlLtVlVl)
4. r Jly60KVI npVlKYc
5. 6blcTpoe pacwVlpeHVle He6Horo WBa
6. AreHe3V1S1 BepXHVlX 60KOBbiX pe3LtOB, 3aKpblTVle npOMe>KyrKoB
, -
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CPOPM8 ,n,yr1l1
ECJlVl Y naLtVleHTa XOPOWO pa3BVlTbie 3y6Hbie ,lJ,yrVl VI He Tpe6yeTcSI 3HaYVITellb-
HOro nepeMew.eHVlSI 3y60B, 06blYHO AIlSi 6peKeTOB Ha BepXHVlX KlIblKax BbI6V1-
palOT TOpK _7 0 , Ha HVI>KHVlX KlIblKax _6 0 . npVl HeCKOllbKO 60llee OBaJJbHO VlIIVi
CY>KeHHO <t>opMe 3y6HO ,lJ,yrit1 MO>KHO VlcnOllb30BaTb 6peKeTbi C TOpKOM 0 0
A1lSl BepXHVlX VI HVI>KHVlX KlIbIKOB. npVl OyeHb Y3KVlX 3y6HbiX ,lJ,yrax (naLtVleHTKa
A.L., c. 86) BO MHorViX clIyyaSiX Ltelleco06pa3Ho npVlMeHSlTb 6peKeTbi c
TOpKOM +7 0 AIlSi BepxHVlx KlIblKOB VI +6 0 - ,lJ,lISi HVI>KHit1X (pVlC. 2.43 VI 2.44).
BepXHSISI Ayra
TOpK _7°
TOpK 0°
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KsaApaTHas:ll/lnll1
OSanbHas:l cpopMa
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PMC. 2.43 M 2.44. Cl>opMa 3y6HO Ayri-1 i-1MeeT 6oIlbwoe 3HayeHi-1e npi-1 Bbl60pe 6peKeToB AIlSl BepXHi-1X i-1 Hi-1>KHi-1X KIlblKOB
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BblcTynaH//1e KflblKOB
ECJlVl Y naLtVleHTa KlIbIK BbiC-rynalOT KnepeAVI IIVi Ha 3TVlX yyaCTKax
Ha6111O,lJ,aeTCSI peLteCCVlSI ,lJ,eCHbl, Ha HaYaJJbHOM 3Tane lIeyeHVlSI 06blYHO He
CJleAyeT npVlMeHSlTb 6peKeTbi C TOpKOM _7 0 ,lJ,lISi BepxHVlx KlIblKOB VI _6 0 ,lJ,lISi
HVI>KHVlX KlIbIKOB. Llelleco06pa3Hee Bbl6paTb 6peKeTbi C TOpKOM 0 0 IIVi +7 0
A1lSl BepxHVlx KlIblKOB VI +6 0 - ,lJ,lISi HVI>KHVlX (pVlC. 2.45).
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PMC. 2.45. BblcTynalOl..Lli-1e KOpHi-1 KIlblKOB B HalJaIle IleyeHi-1S1, Tpe6YIOL4ero
peTpaKi-1i-1 KllbiKOB. cnoIlb30BaHbl 6peKeTbi C TOpKOM 0 0 AIlSl BepXHi-1X i-1
Hi-1>KHi-1X KIlbiKOB AIlSl o6eCnelJeHi-1S1 MeXaHi-1Ki-1 IleyeHi-1S1.
PeWeH//1e OTHOC//1TeflbHO 3KCTpaKL.l,//1//1
3y6oB(KOHTpOflbaHrYflL.l,//1//1)
MHorVie BpayVi nOllaralOT, YTO npVlMeHeHVle 6peKeTOB C TOpKOM _7 0
A1lSl BepxHVlx KlIblKOB VI _6 0 ,lJ,lISi HVI>KHVlX - 3TO He omVlMaJJbHbl Bbl60p
A1lSl clIyYaeB, Tpe6ylOw.Vlx y,lJ,aJJeHVlSI npeMOIlSipOB, VlIIVi npVl HaJJVlYVIVI
3HaYVlTeJlbHO aHryllSlLtVlVl KlIbIKOB, KOTOPYIO HY>KHO OTKoppVlrpOBaTb B XO,lJ,e
lIeyeHVlSI. AnSI 06eCneyeHVlSI MexaHVlKVI peTpaKLtVlVl KlIblKOB B KIDK,lJ,OM clIyyae,
Kor.n.a He06xo,lJ,VlMO 3HaYVITellbHO Vl3MeHVlTb aHryIlSlLtVlIO, OHVI npe,lJ,nOYVlTaIOT
6peKeTbi C TOpKOM 0 0 . BpayVi CYVlTaIOT, YTO 6peKeTbi C TOpKOM 0 0 VlMelOT
TeH,lJ,eHLtVlIO K y,lJ,ep>KaH1O KopHe KlIblKOB B ry6YaTO KOCTHO TKaHVI,
06l1eryaSi TaKVlM 06pa30M KOHTpOllb VlX aHryIlSlLtVl. Ha 6peKeTe C TOpKOM 0 0
VlMeeTCSI KpIOYOK, nOCKOllbKY ero yaCTO npVlMeHSIIOT ,lJ,lISi peTpaKLtVlVl KlIblKa
(pVlC. 2.45) VlII MexaHVlKVI II KlIacca.
ifly60K//1M np//1KYC
B clIyyaSix aHoMaJJ npVlKYca 11/2 KlIacca VI APyrVlx aHoMaJJVI rlly60Koro
npKYca yaCTO B03HVlKaeT He06xo,lJ,VlMOCTb nepeMecTVlTb KOpOHKVI KlIblKOB
BecTVl6YIlSiPHO, HO npVl 3TOM YAep>KaTb VlX KOpHVI B LteHTpaJJbHOM nOIlO>KeHVIVI
B KOCTVI. 3TOro Jlerye ,lJ,06V1TbCSI, Vlcnollb3YSl 6peKeTbi C TOpKOM 0° VlIIVi +6 0
,lJ,lISi HVI>KHVlX KlIblKOB (pVlC. 2.46).
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PMC. 2.46. npi-1MeHeHi-1e 6peKeToB C TOpKOM 0 0 i-111i-1 +6 0 AIlSl Hi-1>KHi-1X KIlblKOB
0611eryaeT BeCTi-16YIlSlpHoe nepeMew.eHi-1e KOpOHOK 3y6oB, OAHOBpeMeHHO
YAep>Ki-1BaSl eHTpallbHoe nOllO>KeHi-1e i-1X KopHe B KOCTHO TKaHi-1. B
HeKOTopblX cllyyaSlX TaKO nOAXOA nOMoraeT npi-1 IlelJeHi-1i-1 aHOMaIli-1
rlly6oKoro npi-1Kyca.
OblCTpoe paCW//1peH//1e
He6HOrO WBa
nOclIe 6blCTpOro pacwVlpeHVlSI He6Horo WBa pacwVlpeHVle BepxHe 3y6HO
,lJ,yrVl c03AaeT BTOpVlYHOe pacwVlpeHVle HVI>KHe ,lJ,yrVl. Ha HVI>KHVlX 3y6ax 5
Ha6111O,lJ,aIOTCSI Vl3MeHeHVlSI TOpKa (BepTVlKaJJbHoe BblpaBHVlBaHVle), VI A1lSl
nOMep>KK 3TVlX nOIlO>KVlTellbHbIX Vl3MeHeHVI peKOMeH,lJ,yeTcSI VlcnOllb30BaTb
6peKeTbi C TOpKOM 0 0 VlIIVi +6 0 Ha HVI>KHVlX KlIbiKax.

AreHe3Mfl BepXHMX 60KOBbiX pe3L.l,OB,
38KpblTMe npOMe>Kj'TKOB
B cJlyyae OTCyrCTBVlSI OAHOro VlIIVi 060Vlx BepXHX 60KOBbiX pe3LtOB MO>KHO
npVlHSlTb peWeHVle 3aKpblTb 3T npOMe>KyrKVI  06eCneYVlTb X Me3V1aJJbHbl
KOHTaKT C LteHTpaJJbHblMVI pe3Lt3M. B TaKO c-ryaLtVlVl Ltelleco06pa3HO
nepeBepHyrb Ha 180 0 6peKeT C TOpKOM _7 0 ,lJ,lISi BepxHero KlIbiKa. npVl 3TOM
3HayeHVle TOpKa Vl3MeHVlTCSI Ha +7 0 , a aHryllSlLtVlSl OCTaHeTCSI TaKO >Ke - 8 0 .
neBOcTOpoHHVI 6peKeT YCTaHaBJlVlBalOT Ha lIeBbl KlIbIK, a npaBocTOpoHHVI -
Ha npaBbl KlIbIK. He ClIe,lJ,yeT pa3Mew,aTb 6peKeT ,lJ,lISi lIeBoro KlIblKa Ha
npaBoM KlIblKe VI Ha060poT.
nepeBepHyrbl 6peKeT Ha KlIblKe xopowo a.n.amVlpyeTcSI K nOBepxHocT
3y6a VI 6YAeT KoppVlrVlpoBaTb n03LtVlIO in-out 3y6a. Ha 3Tane npSlMoyrollb-
HO ,lJ,yrVl 3TO nOMO>KeT pa3BepHyrb KopeHb KlIblKa He6Ho npVl MVlHVlMaJJbHblX
Vl3rVl6ax Ha ,lJ,yre (pVlC. 2.47).
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PMC. 2.47. AreHe3i-1S1 npaBoro BepxHero 60KOBOro pe3a. AnSI o6eCnelJeHi-1S1
MeXaHi-1Ki-1 IleyeHi-1S1 i-1CnOllb3yeTcSI YHi-1BepCaIlbHocTb Ci-1CTeMbl MB'fTM. 6peKeT
AIlSl npaBoro BepxHero KIlblKa nepeBOpaYi-1BalOT Ha 180°. Ha npaBbl BepXHi-1
nepBbl nocTOSlHHbl MOIlSlp npi-1KIleeHa Tpy6Ka IleBoro Hi-1>KHero BTOpOro
MOllSlpa C pOTai-1e 0° AIlSl AOCTi-1>KeHi-1S1 COOTHOWeHi-1S1 MOllSlpOB no II KIlaccy
B KOHe llelJeHi-1S1 (pi-1c. 2.58, c. 51).
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B3aMM03aMeHSIeMbie 6peKeTbi
AnSI HM>KHMX pe3u.oB
B 6peKeTax A1lSl HVI>KHX pe3LtOB VlcnOIlb3yercSi aHryllSlLtVlSl 0 0 , YTO COOTBeTCT-
ByeT ,lJ,aHHbIM VlCClIeAOBaHVI, VI npe,lJ,bSlBIISieT MeHbwe Tpe60BaHVI K onope
Ha HVI>KHe ,lJ,yre. AonOIlHVlTellbHoe npeVlMyw.eCTBO 3aKlllOyaeTCSI B TOM, YTO
aHryJlSlLtVlSl O°,lJ,llSi Bcex yeTblpex pe3LtOB YMeHbwaeT accopTMeHT 06S13a-
TellbHblX A1lSl VlcnOllb30BaHSI 6peKeTOB (pVlC. 2.48-2.50).
83all1M03aMeHs:leMble
PMC. 2.48. AHryllSli-1S1 0 0 6peKeToB AIlSl Hi-1>KHi-1X pe3oB o6eCneYi-1BaeT i-1X B3ai-1M03aMeHSleMOCTb
. .
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PMc.2.49. 6peKeTbi AIlSl Hi-1>KHi-1X pe3oB C aHrYIlSli-1e 0 0 , YTO o6eCneYi-1BaeT
i-1X B3ai-1M03aMeHSleMOCTb
PMC. 2.50. Ha peHTreHoBcKoM CHi-1MKe nOKa3aHbi napaIlIleIlbHO pa3Mel..LleHHbie
KOpHi-1 Hi-1>KHi-1X pe3oB Y TOro >Ke nai-1eHTa, lJTO i-1 Ha coceAHeM CHi-1MKe

B3aMM03aMeHSIeMbie 6peKeTbi
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AHaJJorVlYHbie xapaKTepCTVlKVI npcyw.VI 6peKeTaM ,lJ,lISi BepXHVlX
npeMOIlSipOB. CVlCTeMa 6peKeTOB VlMeeT aHryllSlLtVlIO 0 0 ,lJ,lISi Bcex BepxHVlX
npeMOIlSipOB, YTO CH>KaeT Tpe60BaHVlSI K onope  06l1eryaeT ,lJ,OCT>KeHVle
I KlIacca. AHryllSlLtVlSl 0 0 06eCneYBaeT B3aVlM03aMeHSIeMocTb 6peKeTOB
(pc. 2.51-2.54), YTO YMeHbwaeT x Heo6xo,lJ,VlMbl accopTVlMeHT.
IL ..,...-r
B3aM03aMeHeMe
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PMC. 2.51. AHrYllSli-1S1 0° 6peKeTOB AIlSl BepXHi-1X npeMoIlSlpoB o6eCnelJi-1B8eT i-1X B38i-1M038MeHSleMOCTb i-1 B03MO>KHOCTb i-1CnoIlb30B8Hi-1S1 cnp8B8 i-1 CIleB8, 8 T810Ke
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PMC. 2.52-2.54. 6peKeTbi AIlSl BepXHi-1X npeMollSlpoB i-1MeIOT 8HrYIlSli-11O 0°,
lJTO o6eCneYi-1B8eT i-1X B38i-1M038MeHSleMOCTb i-1 B03MO>KHOCTb i-1CnOllb30B8Hi-1S1
H8 nepBblx i-1 BTOpblX npeMoIlSlp8X i-1 cnp8B8, i-1 ClleB8. KOpHi-1 KIlblKOB
OnTi-1M8IlbHO p83MeeHbl C np8Bi-1IlbHO 8HrYIlSli-1e.
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PMC. 2.52
PMC. 2.54
49

iIIcnonb30BaHMe Tpy60K AnSI BTOpblX
BepxHMx MonSipoB Ha nepBblx MonSipax
B cnYLlaSlX, He Tpe6YIOUJ.MX npMMeHeHMSI
BHepOTOBOM TSirM
PeKOMeH,lJ,OBaHHble CneLtVl<J>VlKaLtVlVl Tpy60K ,lJ,lISi nepBblX &IJ BTOpblX MOIlSipOB:
TOpK -14°, aHryllSlLtVlSl 0° &IJ aHT&lJpOTaLt&IJSl10°. TaKVlM 06pa30M, Tpy6KY
,lJ,lISi BTOpOro BepxHero MOIlSipa MO>KHO VlcnOllb30BaTb Ha nepBblx BepxHVlx
MOIlSipax B clIyyaSlX, He Tpe6ylOw.Vlx npVlMeHeHVlSI BHepOTOBO TSlrVl
(pVlC. 2.55 &IJ 2.56).
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flMTEPATYPA
1 Andrews L. F. 1972. The six keys to normal occlusion. American Journal of
Orthodontics 62:296-307.
2 Sebata E. 1980. An orthodontic study of teeth and dental arch form on the
Japanese normal occlusions. The Shikwa Gakuho 80(7):945-969.
3 Watanabe K., Koga M., Yatabe K., Motegi E., Isshiki Y. A. 1996. A morphometric
study on setup models of Japanese malocclusions. The Shikwa Gakuho.
4 Bennett J., Mclaughlin R. P. 1997. Orthodontic management of the dentition with
the preadjusted appliance. Isis Medical Media, Oxford (ISBN 1 89906691 8)
pp. 283-288. Republished in 2002 by Mosby, Edinburgh (ISBN 0723432651).
5 Sandstrom R. A., Klapper L., Papaconstantinou S. 1988. Expansion of the lower
arch concurrent with rapid maxillary expansion. American Journal of Orthodontics
94:296-302.

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6peKeTOB AOJl)f(eH Bbln011Hs:lTb caM BpaLJ-OpTOAOHT, He nepenopYLJas:l 3TO
CBOM aCCCTeHTaM, AIls:l 06eCneLJeHs:I TOLJHOCT <J>KCaLJ, annapaTa.
TO"lHOCTb n03MLl.MM 6peKeTOB
T OLJHOCTb n03LJ, 6peKeTOB MeeT nepBOCTeneHHoe 3HaLJeHe AIls:l
06eCneLJeHs:I nOJlHOVI  3<J><peKTBHOVI peaJI3aLJ, Be11LJH, BBeAeHHblX
B CCTeMY 6peKeTOB. 3TO cnoc06cTByer ycnexy MexaHK 11eLJeHs:I 
YJlYLJwaeT CTa6JlbHOCTb AOCTrHYTbIX pe3Y11bTaTOB.
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CnOKOVlHoe, HeTOpOnJlBOe nOBeAeHe BpaLJa np <J>KCaLJ, annapaTa
nOMoraeT MHM3poBaTb LJYBCTBO ACKOM<J>OpTa  paCCes:lTb onaCeHs:I
naLJ,eHTa, LJTO cnoc06cTByeT C03AaH1O AOBepTe11bHblx oTHoweHVI.
YTKVI nOAXOA BpaLJa cnoc06cTByeT TaK)f(e <J>OpMpoBaH1O aTMoc<J>epbl
COTpYAHLJeCTBa C naLJ,eHTOM, MelOLltero 60JlbWOe 3HaLJeHe Ha
AaJlbHeVlW14X 3Tanax JleLJeHs:l1 .
nOCJle <pKCaLJ, annapaTa naLJ,eHry TaK)f(e CJleAyeT A3Tb COOTBeTCT-
BYIOLlte peKOMeHAaLJ,, KaK OTMeLJeHO B pa3Ae11e 5 (c. 112).
np npKJleBaH 6peKeTOB  <pKCaLJ, K011eLJ, LJ,eMeHTOM nOJle3HO
CnOJlb30BaTb cBeTOOTBep)f(AaeMble CCTeMbl, npMeHeHe KOTOpblX
3KOHOMT BpeMs:I OPTOAOHTa np pa60Te C HeCbeMHOVI rexHKOVI. Bs:ILlte
MaTepaJlbl CJleAyeT cn011b30BaTb B CTpOroM COOTBeTCTB C HCTPYKLJ,eVl
3roToBTeJls:l, CnOJlb3Y51 CTOLJHK CBeTa AIls:l 06eCneLJeHs:I Cl1bl
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--
B 60JlbWHCTBe CJlYLJaeB B03MO)f(Ha OAHOBpeMeHHas:l <J>KCaLJ,s:I Bcex
6peKeTOB  KOJleLJ, C TeM, LJT06bl OrpaHLJTb OLltYLlteHe ACKOM<J>OpTa
naLJ,eHTa paMKaM OAHOro nOCeLlteHs:I,  06eCneLJTb OAHOBpeMeHHYIO
KOppeKLJ,1O n0110)f(eHs:I Bcex 3y60B C caMoro HaLJaJla JleLJeHs:I. OAHaKO
B HeKOTOpblX cryaLJ,s:lX, paCCMaTpBaeMbiX AaJlee, LJ,eJleC006pa3HO pac-
CMOTpeTb Bonpoc 0 <J>KCaLJ, LJaCTLJHoro annapaTa, OCTaBJls:ls:l OTAe11bHble
3y6bl Jl rpynnbl 3y60B 6e3 6peKeTOB.
50nbwoilt ,n,eQJII1L.J,II1T MeCT8
ECJl OTAeJlbHble 3y6bl nepeMeLltalOT B BepTKaJlbHOM 11 rop30HTaJlbHOM
HanpaBJleHs:lX B npeAe11ax 3y6HOVI p;yr (pc. 3.1), 3aLJacrylO 11YLJWe OT110-
)I(Tb npKJleBaHe 6peKeTOB Ha Hee AO Tex nop, nOKa He nepeMeCT5ITCs:I
APyre 3y6bl  He 6YAeT nOJlYLJeH AOCTaTOLJHblVi npOMeOK.
CnYl./8l11rny6oKoro npll1KYC8
MeTOAbl HaLJaJla JleLJeHs:I rlly60KOro npKYca npeACTaBJleHbl B pa3AeJle 6.
B HeKOTOpblX CJlYLJa5lX, KorA3 He n11aHpyeTcs:I cn011b30BaHe HaKYCOLJHOVI
nJlaCTHK Jl nOBblweHe OKKJlI03, 11eLJeHe CJleAyeT HaLJHaTb C BepXHeVi
3y6HOVI Ayr. n03AHee, nOCJle LJaCTLJHOVI KOppeKLJ, npKYca no BepT-
K3Jl, nOs:lBJls:leTCs:I B03MO)f(HOCTb <pKCaLJ, 6peKeTOB Ha H)f(He pe3LJ,bl, He
npLJHs:Is:I np 3TOM ACKOM<popTa naLJ,eHry  pCKa nOBpe)f(AeHs:I 3MaJI
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KllblK B HaLJaIle IleLJeHiI1S! He npil1KIleil1Ilil1 6peKeT, nOCKOIlbKY 6blIlO He06xOAiI1MO
C03AaTb MecTO, npe)f(Ae LJeM nonblTaTbCS! nepeMeCTiI1Tb ero B Ilil1HiI1lO 3y6HO
Ayril1
CnYl./8111 COWnll1QJOBblB8HII1fl SM8nll1
B Tex CJlYLJas:lX, KorAa pe3LJ,bl MeIOT TpeyroJlbHYIO <J>OPMY (pc. 3.2),
06blLJHO B03HKaeT He06xoAMOCTb B MOAe11pOBaH x <J>OPMbl COWJl-
<J>oBbIBaHeM 3MaJI. LJ,eJleC006pa3Ho OT110)f(Tb <J>KCaLJ,1O 6peKeToB Ha
pe3LJ,ax, oc06eHHo H)f(Hero 3y6HOro ps:lAa. ECJl YCTaHOBTb 6peKeTbi
Ha H)f(He pe3LJ,bl B caMOM HaLJaJle JleLJeHs:I, OH He36e)f(HO CJlerKa
BbIABHYTCs:I KnepeA Ha 3Tane nepeMeLlteHs:I 3y60B, oc06eHHo B
He3KCTpaKLJ,OHHbIX CJlYLJas:lx. nOCJleAYIOLltee COWJl<J>oBbIBaHe 3MaJI 
HaKJlOH 3TX 3y60B K3ap, npOAIleBaeT BpeMs:I JleLJeHs:I. 3TOro He)f(eJlaTeJlb-
HOro 3<J><J>eKTa MO)f(HO 36e)f(aTb, eCJl B HaLJaJle JleLJeHs:I He YCTaHaBJlBaTb
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LJT06bl iI136e)f(aTb 06pa30BaHiI1S! He3CTeTiI1LJHbiX LJepHblX TpeyroIlbHiI1KOB.
LleIleco06pa3Ho OTIlO)f(iI1Tb (j>iI1KCaLl.iI1lO 6peKeTOB Ha HiI1)f(HiI1X pe3L1.aX, LJT06b1
iI13MeHiI1Tb iI1X He)f(eIlaTeIlbHoe BblABiI1)f(eHiI1e KnepeAiI1 Ha HaLJaIlbHOM 3Tane
IleLJeHiI1S!. MeXaHiI1Ka IleLJeHiI1S! ynpow,aeTcS!, eCIlil1 HiI1)f(HiI1e pe3L1.bl TpeyroIlbHo
(j>OpMbl 06pa60TaTb nepeA pa3Mew,eHiI1eM 6peKeTOB.
CnYl./8111 npll1MeHeHlI1fl CKonb3flUJ,II1X no ,n,yre
KplOl./KOB (sliding jig) B nepll1o,n, CMeHHoro
npll1Kyc8
B HaLJaJle 11eLJeHs:I Ha BepXHe npeM011s:lpbl, a HorAa  Ha BepXHe KJlbIK
06blLJHO He npKJleBaIOT 6peKeTbl, eC11 npeAnOJlaraeTCs:I CnOJlb30BaHe
CKOJlb3s:1LltX KplOLJKOB (naLJ,eHT T.S., c. 195) AIls:l KOHTp011s:l Jl ACTaJI-
3aLJ, BepXHX MOJls:lpOB.
Bo MHorx cJlYLJas:lx JleLJeHs:I np CMeHHOM npKYce B annapaT BBOA5IT
TOJlbKO nOCTOs:lHHble 3y6bl. B HeKoTopblX cJlYLJas:lx B annapaT MO)f(HO BBeCT
TaK)f(e MOJlOLJHble 3y6bl AIls:l YJlYLJWeHs:I npOLJHOCT  CTa6JlbHOCT
annapaTa, 11 )f(e OKa3aTb B03AeVlcTBe Ha n03LJ,1O M0110LJHbIX 3y60B.

KOHu.Enu.s:I PA3MEW.EHs:I
5PEKETOB - 35E>KAHE OW50K
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He06xOAMO npeAnpHs:lTb BCe Mepbl AIls:l TOLJHOro n03L.J,OHpOBaHs:I
6peKeTOB, nOCKOJlbKY OHO s:lBJls:leTCs:I 3aJ10roM ycnewHoro JleLJeHs:I.
OmMaJlbHOe n03L.J,OHpOBaHe 6peKeTOB cnOc06cTByeT AOCT)f(eH1O
OmMaJlbHOVI OKKJlI03 MHMaJlbHbIM YCJls:lM  0611erLJaeT lleLJeHe
Ha 3aKJlIOLJTeJlbHbIX 3Tanax, nOBblWas:l, TaKM 06pa30M, 3<P<J>eKTBHOCTb
KpynHoVi OPTOAOHTLJeCKOVI npaKTK.
B OprHaJlbHOVI TeXHKe nps:lMOVI Ayr 6peKeTbi YCTaHaBJlBaJI
06blLJHO C cnOllb30BaHeM HCTpYMeHTOB  CTaHAapTHblX 3MepeHVI
B MJlllV!MeTpax OT peLltero Kpas:l Jl OKKJlI03OHHOVI nOBepXHOCT
Ka)f(AOro 3y6a He3aBCMO OT ero BeJlLJHbl. B TO )f(e BpeMs:I y naL.J,eHTOB
C KpynHblM pe3L.J,aM 6peKeTbi YCTaHaBJlBaJI CJlWKOM OKKJlI03OHHO,
LJeM naL.J,eHTaM C MaJlblM 3y6aM. 6peKeTbi n03L.J,OHpOBaJI Ha 3y6ax
pa3HOVI KpB3Hbl, LJTO 06YCJlaBJlBaJlO pa3JlLJs:I 3MeHeHVI TOpKa 
BeJlLJH in-out. TeM He MeHee, 3Ta CCTeMa 6bllla npeMJleMa, nOCKOllbKY
AOnOJlHTeJlbHOe 3m6aHe Aym Tpe60BaJlOCb B ll1060M cJlYLJae.
Andrews BBeJl nOHs:lTe «cepeAHa KJlHLJeCKOVI KOpOHK 3y6a» B
KaLJeCTBe TeOpeTLJeCK 6011ee Hap,e)f(HOVI ompaBHoVi TOLJK, cnollb3yeMoVi
B TeXHKe SWA, B KOTOpOVI KPblllbs:l 6peKeTa pacnoJlaraJICb napaJIllellbHO
Henpas/IInbHbl1ll paKYPC
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paKYPC
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AJlHHOVI oc KJlHLJeCKOVI KOpOHK 3y6a. 2 3TO n03BOllJlO 36e)f(aTb
HeAOCTaTKOB OprHaJlbHOVI 3A)f(yaVl3- TeXHK B OTHoweH TOpKa
 BeJlLJH in-out, nOJlYLJaeMblX 6peKeTOM. OAHaKo, KaK OTMeLJaeTCs:I
Ha c. 63, 6blJlO 3aTpYAHTellbHo A06TbCs:I TOLJHOro BepTKaJlbHoro
n03L.J,OHpOBaHs:I 6peKeTa, CnOllb3Y51 TOllbKO cepeAHY KJlHLJeCKOVI
KOpOHK. np 3TOM B03HKaJlO MHOro OW60K C BepTKaJlbHbiM pa3Me-
LlteHeM, n03TOMY B HaCTOs:lLltee BpeMs:I aBTopbl nOAAep)f(BaIOT npMeHeHe
HCTpYMeHTOB COBMeCTHO C HABAYaJIbHbIM cxeMaM pa3MeLlteH51
6peKeToB. 3TO COOTBeTcTByeT npHL.J,ny Andrews 0 cepeAHe KJlHLJeCKOVI
KOpOHK, HO 06eCneLJBaeT 6011ee BblCOKYIO TOLJHOCTb BepTKaJlbHoro
pa3MeLlteHs:I, TeM caMblM YCTpaHs:Is:I He06xoAMOCTb AOnOJlHTeJlbHoro
3r6aHs:I Aym.
np npKJleBaH 6peKeTOB nps:lMOVI TexHKoVi CJleAyeT 36eraTb
paccMOTpeHs:I 3y60B co CTOpOHbl, cBepxy Jl CH3Y. Ans:l H3AJle)f(aLltero
0630pa 3y60B BO BpeMs:I <J>KCaL.J, annapaTa He06xoAMO, LJT06bl naL.J,eHT
nOBepHYll roJlOBY, a BpaLJ-OpTOAOHT BpeMs:I OT BpeMeH MeHs:lJl nOJlmKeHe
OTHOCTellbHO Hero (pc. 3.3).
npaS/IInbHbl1ll
paKYPc HenpaslllnbHbl1ll paKYPC
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TO"lHOCTbropM30HTanbHoro
paaMew.eHMSI 6peKeTOB
Ans:l pe3LJ,OB  MOJls:lpOB XapaKTepHbl OTHOCTeJlbHO nJlOCKe BeCT6Ylls:lpHble
 LlteLJHbie nOBepXHOCT, n03TOMY He3HaLJTellbHble OW6K He OKa3blBalOT
BJl51Hs:I Ha n03LJ,1O 3TX 3y60B (pc. 3.4). Y KJlblKOB  npeMOJls:lpOB
BecT6Ylls:lpHble nOBepxHocT 6011ee BblnYKJlble, n03TOMY TOLJHOCTb n03LJ,
6peKeTOB OLJeHb B3)f(Ha, TaK KaK OW6K rop30HTaJlbHOro pa3MeLlteHs:I
6peKeTOB Bbl3blBalOT pOTaLJ,1O 3TX 3y60B. OLJ,eHKa KJlblKOB, npeMOJls:lpOB,
MOJls:lpOB  pOTpOBaHHbIX pe3LJ,OB C OKKJlI03OHHOVI CTOpOHbl C nOMOLltblO
CTOMaTOJlOrLJeCKoro 3epKaJla (pc. 3.6) nOMoraeT npaBJlbHO OLJ,eHTb
n03LJ,1O 6peKeTa OTHOCTeJlbHO BepTKaJlbHOVI AIlHHOVI oc KJlHLJeCKOVI
KOpOHK. 6peKeTbi Ha H)f(HX KJlblKax CJleAyeT pa3MeTb no AIlHHOVI OC,
Jl He3HaLJTeJlbHO Me3aJlbHO OT Hee, AIls:l 06eCneLJeHs:I OmMaJlbHoro
KOHTaKTa C 60KOBbIM pe3u,aM (pc. 3.7).
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ACTaIlbHO OTHOCiI1TeIlbHO BepTiI1KaIlbHOVI CpeAiI1HHO llil1HiI1i11. B pe3YIlbTaTe
KOHTaKTHbie nYHKTbl Me)f(AY KllbiKaMiI1 ill 60KOBblMiI1 pe3L1.aMiI1 TPYAHO Ha3BaTb
AeaIlbHblMiI1, oc06eHHo C IleBo CTOpOHbl.
PMC. 3.4. OWiI16KiI1 ropil130HTaIlbHoro pa3Mew,eHiI1S1 6peKeTa Bbl3blBalOT
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npeMoIlSlpax ill MOIlSlpax cIleAyeT npoBepSlTb C nOMow,blO CTOMaTOIlOril1LJeCKoro
3epKaIla

POTII1pOB8HHbie pe3l.l,bl
He3HaLJTellbHoe nepeMeLlteHe B Me3aJlbHOM Jl ACTaJlbHOM HanpaBJle-
Hs:lX LJ,eJleC006pa3HO B CllYLJae pOTpOBaHHbIX pe3LJ,OB. Ha pOTpOBaHHOM
3y6e 6peKeT MO)f(HO npKJleTb 60Jlee Me3aJlbHO Jl ACTaJlbHO, HOrAa
C 36bITKOM KOMn03THoro MaTepaJla co CTOpOHbl Me3aJlbHOVI ll
ACTaJlbHOVI OCHOBbl 6peKeTa. nOA06HbiM 06pa30M MO)f(HO A06TbCs:I nOJlHOVI
KOppeKLJ, pOTaLJ, 3y6a 6e3 npMeHeHs:I KaKX-Jl60 AOnOJlHTellbHbIX
Mep (pc. 3.8).
TO"lHOCTb oceBoro pa3Mew.eHMSI
6peKeTOB
He06xOAMa TOLJHaSi B3YaJI3aLJ,s:I AJlHHOVI BepTKaJlbHOVI oc KJlHLJeCKOVI
KOpOHK K3)f(AOro 3y6a (pc. 3.9), nOCKOllbKY OW6K n03LJ, 6peKeTOB
MOryr Bbl3BaTb HenpaBllbHYIO aHrylls:lLJ,1O 3y60B. Kpblllbs:l 6peKeTa AOll)f(Hbl
6blTb pacnOJlO)f(eHbl napaJIJlellbHO AJlHHOVI oc  KaK 6bl OXBaTblBaTb ee. B
3TOM CJlYLJae He clleAyeT npHMaTb B paCLJeT HanpaBlleHe peLltX KpaeB
pe3LJ,OB.
To "I HOCTb BepTMKanbHoro
pa3Mew.eHMSI 6peKeTOB
3TO caMblVi CJlO)f(HbIVi acneKT (pc. 3.10) pa3MeLlteHs:I 6peKeTa. TOLJHOCTb
ero n03LJ, MO)f(HO YBeJlLJTb np cnOllb30BaH HcTpYMeHToB 
HABAYaJIbHbIX cxeM pa3MeLlteHs:I 6peKeTOB. np 3TOM B03HKaIOT
TPYAHOCT TaKOro POA3, KaK HeCOOTBeTCTBe AJlHbl 3y60B, BecT6YJls:lpHO
 OpaJIbHO nepeMeLlteHHble KOpH, LJaCTLJHO npope3aBWeCs:I 3y6bl 
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iI1Ilil1 AiI1CTaIlbHee. TaKiI1M 06pa30M MO)f(HO A06i11TbCSI nOIlHo KOppeKLl.iI1i11
pOTaLl.iI1i11 3y6a.
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BiI13yaIlil13aLl.iI1S1 BepTiI1KaIlbHO AIlil1HHO OCiI1 KIlil1HiI1LJeCKO KOpOHKiI1 Ka)l(p,oro
3y6a
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PMC. 3.10. TOLJHOCTb BepTiI1KaIlbHO OCiI1 npeAcTaBIlSleT c060 caMbI
CIlO)f(Hbl acneKT pa3Mew,eHiI1S1 6peKeTOB
6'

BEPTKA.nbHOE PA3MEW.EHE
5PEKETOB C nOMow.blO
HCTPYMEHTOB  CXEM
KnMHM"IeCKOe npMMeHeHMe
MHcTpYMeHToB AnSI onpeAeneHMSI
n03MLl.MM 6peKeTOB
npMeHeHe HCTpYMeHTOB AIls:l pa3MeLlteHs:I 6peKeTOB MeeT pa3JlLJHble
HlOaHCbl B 3aBCMOCT OT TOro, Ha KaKX YLJaCTKax 3y6HOro ps:lAa OH
PMC. 3.11. Ha YLJaCTKe pe3L1.0B iI1HCTpYMeHT pacnoIlaralOT nOA yrIloM 90 0 K
BeCTiI16YIlSlPHO nOBepXHOCTiI1
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PMC. 3.13. Ha YLJaCTKaX KIlblKOB ill npeMoIlSlpoB iI1HcTpYMeHT pacnoIlaralOT
napaIlIleIlbHo OKKIlI03i110HHO nIlOCKOCTiI1
cnOllb3YIOTCs:I. B 06JlaCT pe3L.J,OB HcTpYMeHT pa3MeIOT nOA yrJlOM 90 0
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pe>Kyw,ero Kpafl
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cnOllb30BaTb HcTpYMeHTbl ll CTaHAapTHble cxeMbl pa3MeLlteHs:I
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6peKeT Ha BepxHeM npaBoM Ll.eHTpaIlbHOM pe3L1.e npil1KJleeH Ha 0,5 MM 6Ilil1)f(e
K AecHeBoMY KpalO C YLJeTOM He06xOAiI1MOCTiI1 6YAyw,e 06pa60TKiI1 pe)f(yw,ero
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cIlYLJae 6peKeT cIleAyeT npil1KIleil1Tb Ha 0,5 MM 6Ilil1)f(e K AecHeBoMY KpalO
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He06xOAiI1MO 06pa60TaTb nepeA HaLJaIlOM OPTOAOHTiI1LJeCKoro IleLJeHiI1S!, B iI1HOM
cIlYLJae 6peKeT cIleAyeT npil1KIleil1Tb Ha 0,5 MM 6Ilil1)f(e K AecHeBoMY KpalO
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65

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BOCnOJlb30BaTbCs:I MeTaJlllLJeCKM cenapaTOpaM (TP 353-020)
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KOpOHK 3y6a,  3TO CJleAyeT npOBepTb, B3YaJlbHO KOHTPOllPY5I
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1 Gross A. M. 1990. Increasing compliance with orthodontic treatment. Child and
Family Behavioural Therapy 12(2).
2 Andrews L. F. 1989, Straight-Wire - the concept and the appliance. Wells Co, LA.
3 Bennett J., Mclaughlin R. P. 1997. Orthodontic management of the dentition with
the preadjusted appliance. Isis Medical Media, Oxford (ISBN 1 89906691 8)
pp. 28-40. Republished in 2002 by Mosby, Edinburgh (ISBN 0723432651).
4 Mclaughlin R. P., Bennett J. C. 1995. Bracket placement with the preadjusted
appliance. Journal of Clinical Orthodontics 29:302-311.
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......
5 Sondhi A. 1999. Efficient and effective indirect bonding. American Journal of
Orthodontics and Dentofacial Orthopedics 115:352-359.
6 Kalange J. T. 1999. Ideal appliance placement with APC brackets and indirect
bonding. Journal of Clinical Orthodontics 33:516-526.
7 Roberts G. J., Lucas V. S., Omar J. 2000. Bacterial endocarditis and orthodontics.
Journal of the Royal College of Surgeons, Edinburgh 45: 141- 145.
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Ha H)f(HeVlLJeJlIOCT. OH npWJl K BbIBOAY, LJTO «He3aBCMO OT
AarH03a, nOCTaBJleHHoro naLJ,eHry,  B03MO)f(HOCTeVilleLJeHs:I, Me)f(KJlbl-
KOBoe paCCTOs:lHe Ha H)f(HeVlLJeJlIOCT MeeT TeHAeHLJ,1O YBeJlLJBaTbCs:I B
XOAe JleLJeHs:I npMepHO Ha 1-2 MM  3aTeM YMeHbwaTbc5I np6Jl3TeJlbHO
Ha TaKYIO )f(e BeJlLJHY B nocTpeTeHLJ,OHHOM nepoAe».
CCJleAOBaHs:I Burke  coaBTOpoB nOATBepAll HaKOnJleHHble 3HaHs:I,
oncaHHble B OpTOAOHTLJeCKOVI JlTeparype, OTHOCTeJlbHO TOro, LJTO, eCJl
<J>OPMY 3y6HOVI Ayr 3MeHs:lIOT B npOLJ,eCce OPTOAOHTLJeCKoro lleLJeHs:I,
BO MHorx cJlYLJas:lx 6YAeT Ha6JllOAaTbCs:I TeHAeHLJ,s:I ee B03BpaLlteHs:I
K CXOAHbIM AaHHbIM. 3TO oc06eHHo xapaKTepHO AIls:l Me)f(KJlbIKoBOro
npoMeKa. 3MeHeHe paCCTOs:lHs:I Me)f(AY MOlls:lpaM npeACTaBJls:leTCs:I
6011ee cTa6JlbHbIM.
CTa6MnbHbie pe3ynbTaTbi CnY"laeB
paCWMpeHMSI Me>KKnbIKOBOrO
paCCTOSlHMSI Ha HM>KHeM Ayre
B 6011bwHcTBe CJlYl.JaeB paCCTOs:lHe Me)f(AY KJlbIKaM Ha H)f(HeVlLJeJlIOCT
He CJleAyeT YBellLJBaTb B XOAe lleLJeHs:I, BBAY pCKa B03BpaLlteHs:I B
CXOAHoe nOllO)f(eHe. Felton  coaBTOpbl B OTMeLJaJI, LJTO np LlteLJHOM
BepTKaJlbHOM BblpaBHBaH 3y60B B03BpaLlteHe nepeAHx 3y60B
H)f(Hero ps:lAa B CXOAHoe nOllO)f(eHe OTMeLJaeTCs:I B 70% CJlYl.JaeB. OAHaKo
B OCTaJlbHblX 30% CllYLJaeB 3TO, BepOs:lTHO, MOryr 6blTb CJleAYIOLlte CTa6Jlb-
Hble 3MeHeHs:I:

CnY'-IaM rny6oKoro npMKyca (TaKMe,
KaK aHOManMM 11/2 Knacca), npM KOTOpblX
HaKnOH HM>KHMX KnblKOB npOM30wen B
fl3bl'-lHOM HanpaBneHMM KaK OTBeT
Ha pa3Mew,eHMe BepXHMX KnblKOB
OAHOBpeMeHHO C npnOAHs:lTeM npKYca 6YAeT npoCXOATb BepTKaJlb-
Hoe BblpaBHBaHe H)f(HX KJlbIKOB. Ans:l 06eCneLJeHs:I cTa6llbHOCT 3TOro
nepeMeLlteHs:I CJleAyeT coxpaHTb KOppeKLJ,1O rlly60KOro npKYca. B 1974
roAY Shapiro 9 oncaJI 3MeHeHs:I AIlHbl 3y6HOVI Ayr  Me)f(MOJls:lpHoro
paCCTOs:lHs:I y 22 naLJ,eHTOB, lleLJeHHblX 6e3 YAaJleHs:I 3y60B,  Y 58
naLJ,eHTOB C 3KCTpaKLJ,eVl 3y60B nOClle lleLJeHs:I  B nocTpeTeHLJ,OHHbIVi
nepOA. OH npweJl K BbIBOAY, LJTO Me)f(KJlbIKOBOe paCCTOs:lHe Ha H)f(HeVi
LJeJlIOCT MeeT Bblp3)f(eHHYIO TeHAeHLJ,1O K B03BpaLlteH1O K CXOAHbIM
pa3MepaM AO lleLJeHs:I, BO Bcex rpynnax aHOMaJIVl3a CKJlIOLJeHeM
CJlYLJaeB 11/2 KJlacca. PacwpeHe Me)f(KJlbIKoBOro npoMeKa y naLJ,eHTOB,
JleLJeHHblX no nOBOAY aHoMaJIVlII/2 KJlaCca, Bbls:lBJlO 3HaLJTeJlbHO 6011bWYIO
cTa6JlbHOCTb cpaBHTeJlbHO C aHOMaJIs:lM I Jl 11/1 KJlaCCOB. MeHee
3HaLJTeJlbHOe nocTpeTeHLJ,OHHOe YMeHbweHe AIlHbl Ayr Ha611IOAaIlOCb
TaK)f(e B rpynne aHoMaJIVl11/2 KJlacca. npeACTaBJls:llOT HTepec AaHHbie
Shapiro, KOTOpble MO)f(HO 06bs:lCHTb TeM <J>aKTOM, LJTO naLJ,eHTbl C aHOMa-
Jls:lM 11/2 KJlacca 06blLJHO MeIOT rlly60KVI npKYc  H)f(He KJlbIK HaKJlO-
HeHbl s:l3bILJHO no OTHoweH1O K He6HoVi nOBepxHocT BepxHx KJlbIKOB. np
OTKpbIT npKYca peLlte Kpas:l H)f(HX KJlblKOB MOryr nepeMeTbCs:I B
BecT6YJls:lpHOM HanpaBJleH (pc. 2.46, c. 46), a BepXYWK KopHeVi 3TX
3y60B - s:l3bILJHO, np 3TOM 3y6 OCTaeTCs:I Ha TOM )f(e MeCTe.
CnY'-IaM, B KOTOpblX nOKa3aHO 6blcTpoe
pacWMpeHMe Ha BepxHel11 ,n,yre,
coxpaHfllOw,eeCfl nocne ne'-leHMfl
Ladner  MuhPo oncaJI 6blcTpoe pacwpeHe Ha BepxHeVi Ayre, BJleKYLltee
3a c060Vl pacwpeHe Ha H)f(HeVi 3y6HOVI Ayre, KOTOpoe MO)f(eT OCTaTbCs:I
cTa6JlbHbIM. CTeneHb TaKOVI oTBeTHoVi peaKLJ, 6bllla CCJleAOBaHa
Sandstrom  coaBTopaM 11, Ha611IOAeHs:I KOTOpblX nOKa3aJ1, LJTO nOllO-
)f(eHe H)f(HX KJlblKOB BblpaBHBaeTCs:I no BepTKaJI,  paCCTOs:lHe Me)f(AY
KJlbIKaM YBeJlLJBaeTC5I B cpeAHeM Ha 1,1 MM, a paCCTOs:lHe Ha MOlls:lpax
B03pacTaeT B cpeAHeM Ha 2,9 MM. nOA06HblVi pe3YJlbTaT He 06eCneLJBaeT
B AOCTaTOLJHOVI Mepe C03AaHe AonOllHTellbHoro MeCTa Ha H)f(HeVi Ayre.
Haas 12 oncaJI HTeHCBHoe pacwpeHe BepXHeVi Ayr  nOATBepAll, LJTO
YBeJlLJeHe Me)f(KJlbIKoBOro paCCTOs:lHs:I Ha 3-4 MM MellO MecTO TOllbKO B
HeCKOJlbKX cllYLJas:lx.
HecMoTps:l Ha nOAaBJls:llOLltee 6011bWHCTBO AaHHbIX, cBAeTeJlbCTBYIOLltX
o HecTa6llbHoCT pacWpeHs:I Ha H)f(HeVi Ayre, Braun  coaBTOpbl 13 ,14
nOKa3aJ1, LJTO 60JlbWHCTBO HKelleBO-TTaHOBbIX Ayr, nOCTaBJls:leMblX
OCHOBHbIM OPTOAOHTLJeCKM KOMnaHs:lM, 06eCneLJBa1OT pacwpeHe
Me)f(KJlbIKoBOro npoMeKa Ha H)f(HeVi Ayre Ha 5,9 MM, aHa BepXHeVi Ayre -
8,2 MM.

.
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0606w.eHMe npo6neM
B KnMHM"IeCKOM npaKTMKe
- HaYLJHble CCJleAOBaHs:I  KJlHLJeCKe Ha611IOAeHs:I nOATBep)Kp,3IOT,
LJTO:
. <t:>OpMbl 3y6HOVI Ayr y LJeJlOBeKa xapaKTep3YIOTCs:I 3HaLJTeJlbHbIM
pa3Ho06pa3eM.
. B pe3YJlb TaTe TaKOro MHoro06pa3s:I BPs:lA Jl MO)f(eT cyLlteCTBOBaTb
eAHas:l <J>opMa Ayr, KOTOPYIO MO)f(HO 6blllO 6bl CnOJlb30BaTb np
OPTOAOHTLJeCKOM JleLJeH Bcex naLJ,eHTOB.
..

. ECJl B XOAe JleLJeHs:I 3MeHs:lIOT <POp MY nepBLJHOVI 3y6HOVI
Ayr naLJ,eHTa, TO nOCJle CHs:lTs:I OPTOAOHTLJeCKX annapaTOB
B 70% CJlYLJaeB MeeTCs:I 60JlbWas:l BepOs:lTHOCTb B03BpaLlteHs:I K
nepBOHaLJaJlbHOVI <popMe.
KaKOe BJls:lHe npBeAeHHble BblBOAbl OKa3blBalOT Ha OPTOAOH-
TLJeCKOe lleLJeHe? 3HaLJT ll 3TO, LJTO Ayr CJleAyeT HABAYaJIbHO
nOAroHs:lTb AIls:l Ka)f(AOro naLJ,eHTa? Jl )f(e MO)f(HO CnOJlb30BaTb
onpeAelleHHYIO <J>OPMY npeABapTellbHo C<J>OpMpoBaHHblx Ayr,
0611erLJaIOLltx pa60ry OPTOAOHTa, A3)f(e eCll B HeKoTOpblX cJlYl.Jas:lx
6YAYT He06xoAMbl MOA<pKaLJ,?
Aanee npBOATC5I peKoMeHAyeMblVi B KHre CCTeMaT3-
pOBaHHblVi nOAXOA K Bbl60py <J>OPMbl 3y6HbiX AYr.
Pa3nM"IHble BMAbl
3y6HbiX Ayr y "IenOBeKa
6011bWHCTBO aBTOpoB np3HalOT 3MeHeHe BeJlLJHbl  <J>OpMbl 3y6HbiX
Ayr y LJellOBeKa. HanpMep, B 1987 roAY Felton  coaBTOpbl 8 ony6JlKOB3Jl
CClleAOBaHe, B KOTOpOM paccMaTpBaJlCs:I Bonpoc 0 B03MO)f(HOCT
onpeAelleHs:I AeaJIbHOVI 3y6HOVI Ayr. OH CCJleAOBaJI 30 MOAeJleVi
HelleLJeHHblX naLJ,eHTOB C HOpMaJlbHblM npKYCOM (3 Bb160pK Andrews,
BKJlIOLJaBWeVi 120 naLJ,eHTOB), 30 naLJ,eHTOB C aHOMaJIs:lM I KJlaCca,
lleLJeHHblX 6e3 YAaIleHs:I 3y60B  30 He3KCTpaKLJ,OHHbIX CJlYLJaeB C aHOMa-
lls:lM II KJlacca. OH nOATBepAll, LJTO H B OAHOVI 3 3TX rpynn He
AOMHpOBaJla KaKas:l- TO onpeAeJleHHaSi <J>opMa Ayr  LJTO ClAamaLJ,s:I
<J>OPMbl Ayr OKa3bIBaeTC5I He06xOAMOVI BO MHorx CllYLJas:lX AIls:l AOCT)I(eH51
OmMaJlbHOVI AOllroBpeMeHHOVI CTa6llbHOCT, MeHHO BBAY 60JlbWOro
pa3Ho06pa3s:I <J>OPM Ayr, paCCMaTpBaeMbiX B CCJleAOBaHs:lX.
06Llte3BeCTHO, LJTO 3HaLJaJlbHO <popMa 3y6HOVI Ayr 3aBCT OT <J>OPMbl
KOCT, a nOClle npope3blBaHs:I 3y60B Ha ee <POPMY AeVlCTByeT OKpalOllte
MblWLJ,bl nOllOCT pTa. Pa3JlLJHble reHeTLJeCKe  3KOllOrLJeCKe <J>aKTOpbl
TaK)f(e onpeAells:llOT 3HaLJTeJlbHOe pa3Ho06pa3e <J>OPM Ayr, 0 LJeM
CBAeTeJlbCTBYIOT nOBceAHeBHbie KJlHLJeCKe Ha611IOAeHs:I.
73

nPAKT'"IECKE PEWEHS1
npMMeHeHMe TpeX 4>OpM Ayr
BnepBble KJlaCc<J>KaL.J,1O <J>OPM 3y6HbiX Ayr npeACTaBJl Chuck 15 B 1932
roAY, pa3AeJls:ls:l X Ha ceHHble, KBClApaTHble  OBaJlbHble. MHore aBTopbl
 KJlHL.J,CTbl nOJlb30BaJICb AaHHOVI KJlaCc<J>KaL.J,eVl B TeLJeHe ps:lAa
JleT, a npO3BOATell OPTOAOHTLJeCKX annapaTOB HaLJaJI 3roTaBJlBaTb
JleLJe6Hbie Ayr, OCHOBblBas:lCb Ha A3HHOVI KJlaCc<J>KaL.J, (onCbIBaSi
X KaK Y3Ke, HOpMaJlbHble  wpOKe). TaKoVi noAXOJJ" OCHOBaHHblVi Ha
npMeHeH Tpex <J>OPM Ayr, OTKpblBaeT 60JlbWe B03MO)f(HOCT AIls:l
HABAYaJI3aL.J, lleLJeHs:I no cpaBHeH1O C KOHL.J,enL.J,eVl OJJ,HOVI <pOPMbl
Ayr, oc06eHHO Ha HaLJaJlbHOM 3Tane. ECll <POpMbl Ayr, npBeAeHHblx B
CCJleAOBaH Felton  coaBTOpoB 8 , KJlacc<J>L.J,pOBaTb KaK ceHHble,
KBClApaTHble  OBaJlbHble, TO KOllLJeCTBO 3TX <POpM B rpynne Andrews
aHoMaJIVlI  II KJlaCCOB MO)f(HO npeACTaBTb B Ta6JlL.J,e 4.1.
B Heony6JlKOBaHHoM cclleJJ,oBaH, npoBeAeHHoM OAHM 3 aBTOpoB,
C nOMOLltblO np03paLJHblX wa611oHoB npOaHaJI3pOBaHbl 200 cllYLJaeB
(npeMyLlteCTBeHHo llu,a 6eJloVi pacbl) C AelleHeM Ayr Ha ceHHble,
KBap,paTHble  OBaJlbHble. COrllaCHO nOJlYLJeHHblM pe3YllbTaTaM (pc. 4.1)
AyrM: cpeHHble{%) KBaApaTHble(%) oBanbHble(%)
MOAeIlil1 Andrews 27 20 53
AHoMaIlMM I Knacca 60 3 37
AHoMaIlMM II KIlacca 53 7 40
Ta6nMqa 4. 1
npMepHO 50% H)f(HX Ayr MeJl ceHHYIO <J>OPMY, 8% - KBClApaTHYIO
 42% - OBaJlbHYIO. npBeAeHHble A3HHble cOrllacYIOTcs:I C pe3YllbTaTaM,
nOJlYLJeHHbIM Felton.
Nojima  coaBTOpbl 16 CnOJlb30BaJI ceHHble, KBClApaTHble  OBaJlbHble
Wa6JlOHbi B cJlYLJae aHOMaJIVlI, II  III KJlaCCOB KaK B rpynne JlL.J, 6eJloVl, TaK
 )f(emoVi pac (pc. 4.2  4.3). no pe3YJlbTaTaM aHaJI3a rpynnbl JlL.J, 6elloVi
pacbl OKa3aJ10Cb, LJTO 44% 3 HX MeJl ceHHYIO <POPMY Ayr, 18%-
KBClApaTHYIO  38% - OBaJlbHYIO. OAHaKo Nojima  coaBTOpbl BKJlIOLJll B
06e rpynnbl paBHoe KOJlLJeCTBO naL.J,eHTOB C aHOMaJIs:lM III KJlacca (3
KOTOpblX 44% MeJl KBClApaTHble Ayr), a TnLJHbIVi COCTaB naL.J,eHTOB
6eJloVi paCbl MeJl MeHbwee KOllLJeCTBO aHoMaJIVlIII KJlacca. n03TOMY
COOTHoweHe: 50% ceHHbIX, 8% - KBClApaTHblX  42% - OBaJlbHblX <J>OPM
3y6HbiX Ayr 6011ee nOKa3aTeJlbHO AIls:l 6eJloVi paCbl. B XOAe aHaJI3a s:lBHO
npOCJle)f(BaIOTC5I pa3JlLJSI, 06YCJlOBJleHHbie pacoBoVi npH3AJle)f(HOCTblO,
np 3TOM HTepeCHO OTMeTTb, LJTO B rpynne 1lL.J, )f(emoVi pacbl COOTHowe-
He COCTaBllO: 12% - ceHHblx, 46% - KBClApaTHblx  42% - OBaJlbHblX
<J>OpM 3y6HbiX Ayr, LJTO cBAeTellbcTByeT 06 06paTHoM COOTHoweH Me>KJI.Y
KBap,paTHoVi  ceHHoVi <J>opMaM Ayr no cpaBHeH1O C rpynnoVi 6elloVi
paCbl.
 C\f)KeHHble Ayrl1 - 50%
 QBanbHble Ayrl1 - 42%
 KBaApaTHbie Ayrl1 - 8%
np/llMepbl 1113 npaKTII1K/II
PMC. 4.1. naLl.iI1eHTbl npaKH1KM OAHOro M3 aBTOpoB
 CY>KeHHble Ayrl1 - 12%
 QBanbHble Ayrl1 - 42%
 KBaApaTHbie Ayrl1 -46 0
s:lnoHcKafl nonynflLl,II1f1
PMC. 4.2. it1ccIleAoBaHMS! Nojima. npil1Mepbl iI13 npaKTiI1KiI1
PMC. 4.3. it1ccIleAOBaHiI1S! Nojima
 CY>KeHHble Ayrl1 - 44%
 QBanbHble Ayrl1 - 38%
 KBaApaTHbie Ayrl1 -18 0 0
6enafl paca

PeKoMeHAyeMoe npOLl.eHTHOe
KOnM"IeCTBO Ayr pa3HbiX 4>OpM
06HapeHO, YTO ABa Tna aHOMaJIVI OTJlyaIOTCs:I Cra6JlbHOCTblO pe3Yllb-
raTOB nOCJle JleYeHs:I, npOBeAeHHoro C LJ,ellblO He3HaYTeJlbHoro LlteYHoro
BepTKaJlbHOro BblpaBHBaHs:I 3y60B Ha H)f(HeVi Ayre. 3TO CJlyYa He6Horo
paCWpeHs:I  rlly60KOro npKYca. TaKM 06pa30M, peKoMeHAyeMble
COOTHOWeHs:I (pc. 4.4): 45% - ceHHblx, 10% - KBap,paTHblx  45%-
OBaJlbHblX Ayr npeACTaBJls:llOTCs:I peaJIbHblM AIls:l npaKTK naLJ,eHTOB
npeMyLlteCTBeHHo 6eJloVi pacbl.
H)f(e npeACTaBJleHbl Tp <J>OpMbl Ayr, a MeHHO CeHHa5l, KBap,paTHas:l
 OBaJlbHa5l, npMeHs:leMble aBTopaM Ha paHHx 3Tanax lleyeHs:I (pc.
4.5-7). Ha 60Jlee n03AHX 3Tanax JleYeHs:I AIls:l K3)f(AOro naLJ,eHra CnOJlb-
3YlOTCs:I HABAYaJIbHble <POpMbl Ayr (IAF - individual arch form) (c. 78).
,I::r.
.
c=J C}')KeHHble Ayn1 - 45%
c=J GBanbHble Ayn1 - 45%
c=J KBaApaTHble AyrVl -10 0
a-
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PMC. 4.4
PMC. 4.5. CY)f(eHHble Ayril1
PMC. 4.6. KBaApaTHbie Ayril1
PeKoMeHAyeMble
COOTHOWeHIt1f1
/IIcnonb3yeMbix Ayr
PMC. 4.7. OBaIlbHbie Ayril1
75

. '-.--
CY>KeHHaSi ne"le6HaSi Ayra
AaHHas:l <J>OpMa lleLJe6HOVI Ayr MeeT YMeHbWeHHOe Me)f(KJlbIKOBOe
paCCTOs:lHe; ee npMeHeHe LJ,elleco06pa3HO Ha paHHX 3Tanax lleLJeHs:I
naLJ,eHTOB C Y3KM AyraM B BAe 6YKBbi «V» (naLJ,eHTKa A.L., c. 86).
Oc06eHHo B3)f(HO cnOllb30BaTb TaKYIO <J>OPMY JleLJe6HOVI Ayr AIls:l
naLJ,eHTOB C Y3KM 3y6Hb1M AyraM, B LJaCTHOCT, B CJlYLJas:lX peLJ,eCC
AeCHbl Ha YLJaCTKax KJlblKOB  npeMOlls:lpOB (LJaLlte Bcero y B3pOCJlbiX naLJ,eH-
TOB). Ans:l 3TX naLJ,eHTOB Y3Ke Ayr LJaCTO cnOllb3YIOT B KOM6HaLJ,
C npKJleeHHbIM B nepeBepHYTOM BAe 6peKeTaM Ha KJlbiKax.
B CJlYl.Jae JleLJeHs:I TOJlbKO BepXHeVlLJellIOCT LJaCTO Tpe6yeTcs:I npMeHe-
He Y3KX lleLJe6HbiX AYr. np 3TOM HeT He06xoAMOCT paCWpeHs:I
JleLJe6HOVI Ayr no OTHoweH1O K HelleLJeHHOVI Ayre. 60KOBbie YLJaCTK TaKX
Ayr MO)f(HO JlerKO ap,ampOBaTb K Me)f(MOJls:lpHOMY npOMeKY A3HHOro
naLJ,eHTa.
KBaApaTHaSi ne"le6HaSi Ayra
npMeHeHe AaHHoVi <pOpMbl Ayr nOKa3aHO Ha paHHX 3Tanax lleLJeHs:I
y naLJ,eHTOB C WpOKM 3y6Hb1M AyraM (naLJ,eHTKa C.W., c. 152).
OH CnOJlb3YIOTCs:I no KpaVlHeVi Mepe Ha nepBblx 3Tanax JleLJeHs:I, B
cJlYl.Ja5lx, Tpe6YIOLltx BepTKaJlbHoro BblpaBHBaHs:I 60KOBbiX cerMeHTOB
H)f(HeVlLJeJlIOCT  pacWpeHs:I BepxHeVl3y6HoVi Ayr. np LJpe3MepHoM
pacwpeH LJ,elleco06pa3Ha 3aMeHa Ha OBaJlbHYIO AYry Ha 6011ee n03AHX
3Tanax JleLJeHs:I. KBap,paTHble Ayr npMeHs:lIOTCs:I AIls:l YAep)f(aHs:I pacwpe-
Hs:I BepxHx Ayr nOCJle 6blCTpOro pacWpeHs:I BepXHeVlLJellIOCT (c. 80).
OBanbHaSi ne"le6HaSi Ayra
60Jlee 15 JleT aBTOpbl OTAalOT npeAnOLJTeHe npMeHeH1O AaHHoVi <J>OPMbl
JleLJe6HOVI Ayr B 6011bwHcTBe CJlYLJaeB. 17 B KaLJeCTBe npMepa MO)f(HO
paccMoTpeTb KJlHLJeCKVI cllYLJaVi naLJ,eHTa J.N., c. 120. KOM6HpOBaH-
Hoe npMeHeHe TaKX Ayr B COLJeTaH C COOTBeTCTBYIOLltM KOHeLJHbIM
MepOnps:lTs:lM  peTeHLJ,eVl (c. 289) n03BOJls:leT nOllYLJTb xopowe
pe3YJlb TaTbl cTa6llbHoCT B 60JlbWHCTBe CJlYLJaeB  MHMaJlbHOe
KOJlLJeCTBO CJlYLJaeB B03BpaTa K CXOAHOVI <J>opMe Aym nOCJle lleLJeHs:I.
OAHaKo nOCJleAHee BblwenpBeAeHHoe CCJleAOBaHe YKa3blBaeT Ha TO,
LJTO CJleAyeT CnOJlb30BaTb 60JlbWee KOJlLJeCTBO ceHHbiX Ayr. np
HaJlO)f(eH APyr Ha APyra Tp <t>OpMbl Ayr pa3JlLJa1OTCs:I rJlaBHblM 06pa30M
paCCTOs:lHeM Me)f(AY KJlbIKaM  nepBblM npeMOJls:lpaM, COCTaBJls:lIOLltM
npMepHO 6 MM (pc. 4.8  4.9).

CCTEMAT3POBAHHbl nOAxOA
K CbOPME AYr
CpaBHeHMeCTaHAapTHX
M MHAMBMAyanbHblX Ayr
B COBpeMeHHOVI OPTOAOHTLJeCKOVI npaKTKe HepaLJ,OHaJlbHO BbInOJlHs:lTb
AOnOJlHTeJlbHble 336bl lleLJe6HOVI Ayr AIls:l K3)f(AOro naLJ,eHTa;
He06s:13aTeJlbHO CnOJlb30BaTb 3ry CCTeMY, eCJl 36paTb H)f(eOncaHHYIO.
CKPYLJeHHas:l Ayra CeLJeHeM 0,015 AIOVIMa  TepMOaKTBpyeMble KpYrllble
HKelleBO-TTaHOBble Ayr (HANT) CeLJeHeM 0,016 AIOVIMa CnOJlb3YIOT Ha
paHHx 3Tanax JleLJeHs:I B KaLJeCTBe HBeJlpYIOLltX Jl BblpaBHBaIOLltX,
pa3BBaIOLltX He3HaLJTellbHble Cllbl. X <popMa 3aLJacrylO Ae<popMpyeTcs:I,
BCJleACTBe nOABs:l3bIBaHs:I K HenpaBJlbHO paCnOllO)f(eHHbiM 3y6aM. He CJle-
AyeT O)f(A3Tb, LJTO OH OK 3HaLJTeJlbHOe B03AeVlcTBe Ha <POPMY 3y6HOVI
Ayr B TeLJeHe KOpOTKOro nepoA3 x npMeHeHs:I. n03TOMY Ha paHHx 3Ta-
nax JleLJeHs:I LJ,elleco06pa3Ho cnOllb30BaTb cTaHAapTHble OBaJlbHble Ayr.
nOcJle nepeMeLlteHs:I 3y60B  nepexoAa K 6011ee npOLJHblM TepMOaKT-
BpyeMblM HKeJleBO-TTaHOBbIM AyraM, a nOTOM CTaJlbHblM AyraM,
JleLJe6Hbie Ayr OKa3blBalOT Bce 60JlbWee B03AeVlcTBe Ha <POPMY 3y6HOVI
Ayr. 3TO 06bs:lCHs:leTCs:I x 60Jlee BblCOKOVI npOLJHOCTblO Ha paCTs:I)f(eHe
 60Jlee AIlTeJlbHbIM CpOKOM nOllb30BaHs:I. n03TOMY Ha nOCJleAYIOLltX
3Tanax lleLJeHs:I LJ,eJleC006pa3Ho BbInOJlHTb AOnOJlHTeJlbHbIVi 3r6 Ayr
B COOTBeTCTB C <pOpMOVI 3y6HbiX Ayr K3)f(AOro naLJ,eHTa.
cnonb30BaHMe np03pa"lHblX
Wa6nOHOB B Ha"lane ne"leHMSI
np03paLJHbie wa6110Hbl MO)f(HO CnOllb30BaTb AIls:l OLJ,eHK <J>OpMbl 3y6HOVI Ayr
naLJ,eHTa B HaLJaJle lleLJeHs:I AIls:l onpeAeJleHs:I <POpMbl H)f(HeVi Ayr: ceH-
Ha5l, KBap,paTHas:l ll OBaJlbHas:l (pc. 4.10). LJacTO Ha AaHHOM 3Tane 3TO
eAHCTBeHHas:l np6113TeJlbHas:l OLJ,eHKa, KOTOpaSi AaeT nOlle3Hbie YKa3aHs:I.
CY)I(eHHafl Ayra

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PMC. 4.8. COBMew.eHiI1e BepXHiI1X Ayr PMC. 4.9. COBMew,eHiI1e HiI1)f(HiI1X Ayr
KOHTponb 4>OpMbl 3y6HOM AyrM
B Ha"lane ne"leHMSI
PeKoMeHAyeTcs:I pacnOJlaraTb accopTMeHTOM Kpymblx Ayr CKJlIOLJreJlbHO
OBaJlbHOVI <J>OpMbl (c. 84). 3TO n03BOJls:leT OrpaHLJTb accopTMeHT Ayr. KaK
npaBllo, nepBble Ayr - 3TO cKpYLJeHHbie Ayr CeLJeHeM 0,015  0,0175
AIOVlMa, TepMOaKTBpyeMble HKeJleBO- TTaHOBble Ayr CeLJeHeM 0,016
AIOVIMa ll B HeKoTopblX cJlYLJas:lx CTaJlbHble Ayr CeLJeHeM 0,014 AIOVIMa.
Bce OH MOryr MeTb OBaJlbHYIO <J>OPMY  He Tpe6YlOT AOnOJlHTeJlbHOVI
ap,amaLJ,.
no Mepe nepexoAa OT 3Tana BblpaBHBaHs:I  nepeMeLlteHs:I K 3Tany
cnOllb30BaHs:I KPYrllblX Ayr 6011bwero CeLJeHs:I (C. 111, 112) B03HKaeT
He06xoAMOCTb ap,amaLJ, HeKoTOpblX 3 HX. B CBOIO OLJepeAb, CTaJlbHble
Ayr CeLJeHeM 0,016, 0,018  0,020 AIOVIMa no Mepe He06xoAMOCT
AOJl)f(Hbl MeTb ceHHYIO Jl KBap,paTHYIO <J>OPMY, onpeAeJls:leMYIO nepeA
JleLJeHeM np nOMOLlt np03paLJHoro wa611oHa. OLJeBAHO, Ha 3TOM 3rane
He nOHap,06TCs:I ap,amaLJ,s:I lleLJe6HOVI Ayr AIls:l naLJ,eHTOB C OBaJlbHbIM
3y6Hb1M AyraM.
GBanbHafl Ayra
KBaApaTHafl Ayra
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PMC. 4.10. np03paLJHble wa6IloHbi MO)f(HO iI1CnOIlb30BaTb B HaLJaIle IleLJeHiI1S! AIlS! onpeAeIleHiI1S! <1>OpMbl HiI1)f(He Ayril1 y naLl.iI1eHTa - ceHHO, KB8ApaTHO iI1Ilil1
OBaIlbHo
77

KOHTponb 4>OpMbl 3y6HOM AyrM
C nOMOl.U,blO npSlMoyronbHblX
TepMOaKTMBMpyeMblx HMKeneBO-
TMTaHOBblX Ayr
nps:lMoyrollbHble TepMOaKTBpyeMble HKelleBO- TTaHOBble Ayr
3aBoAcKoro 3roTOBlleHs:I 3A3mpOBaTb HeB03MO)f(HO. n03TOMY CJleAyeT
MeTb B 3anaCe Ayr CeHHOVl, KBap,paTHOVI  OBaJlbHOVI <J>OPM, nOCKOllbKY
X (KaK  CTaJlbHble Ayr 6011bwero CeLJeHs:I) CnOJlb3YIOT B KaLJeCTBe Ayr,
6Jl3KOVI no <J>opMe K 3y6HOVI Ayre naLJ,eHTa, onpeAells:leMOVI C nOMOLltblO
np03paLJHbiX wa6110HOB B HaLJaJle JleLJeHs:I.
nps:lMoyrollbHble TepMOaKTBpyeMble HKelleBO- TTaHOBble Ayr MO)f(HO
CnOJlb30BaTb B TeLJeHe HeCKOllbKX MeCs:lLJ,eB; OH B03AeVlCTBYlOT Ha
3MeHeHe <J>OpMbl 3y6HOVI Ayr naLJ,eHTa, oc06eHHO Ha YLJaCTKe KJlbIKOB.
B cJlyyae x npMeHeHs:I 6e3 YLJeTa ceHHOVl, KBap,paTHOVI ll OBaJlbHOVI
<J>OPM B03MO)f(Hbl He)KellaTellbHble 3MeHeHs:I HaLJaJlbHOVI <POpMbl 3y6HOVI
Ayr naLJ,eHTa.
KOHTponb 4>OpMbl 3y6HOM AyrM
C nOMOl.U,blO CTanbHblX
npSlMoyronbHblX Ayr
CTaJlbHble nps:lMoyroJlbHble Ayr CeLJeHeM 0,019/0,025 AIOVIMa MaKC-
MaJlbHO B03AeVlCTBYlOT Ha <POPMY 3y6HOVI Ayr. n03TOMY x CJleAyeT
ap,ampoBaTb K HABAYaJIbHOVI <popMe Ayr Ka)f(AOro naLJ,eHTa. npoLJ,ecc
ap,amaLJ, pa60LJx Ayr K HABAYaJIbHOVI <J>opMe Ayr npocT  He
Bbl3blBaeT 3aTpYAHeHVI, n03TOMY ero MO)f(eT BblnOllHTb aCCCTeHT, a
OKOHLJaTeJlbHO npOKOHTpOllpOBaTb BpaLJ-OpTOAOHT. LJTO KaCaeTCs:I xpaHeHs:I
accopTMeHTa CTaJlbHblX nps:lMoyroJlbHblX Ayr CeLJeHeM 0,019/0,025 AIOVIMa
(c. 84), TO 3AeCb MeIOTCs:I Tp B03MO)f(HOCT:
1. MeTb B 3anace CKJlIOLJTeJlbHO OBaJlbHble Ayr  np He06xoAMOCT
ap,ampoBaTb x.
2. PacnOJlaraTb AOCTaTOLJHblM KOllLJeCTBOM ceHHblx  OBaJlbHblX Ayr,
LJTO cOKpaeT 06beM He06xoAMb1X MOA<pKaLJ,VI. 3TO OmMaJlbHblVi
BapaHT AeTCKX OPTOAOHTOB, TaK KaK AIls:llleLJeHs:I AeTeVi KBap,paTHas:l
Ayra CnOJlb3yeTcs:I peAKo.
3. MeTb 3anac ceHHblX, KBap,paTHbIX, OBaJlbHblX Ayr, LJTO n03BOlls:leT
MHM3pOBaTb 06beM MOA<J>KaLJ,VI, HO np 3TOM Tpe6yeTcs:I
x WPOKVI accopTMeHT. Arot<e np HaJILJ Bcex Tpex <J>OPM Ayr
CJleAyeT YLJTbIBaTb He06xoAMOCTb 3A3maLJ, HeKOTOpblX 3 HX,
nOCKOllbKY HABAYaJIbHas:l <J>opMa Ayr MHorx naLJ,eHTOB He BcerAa
TOLJHO COBn3A3eT C roTOBbIM AyraM ceHHOVl, KBap,paTHOVI Jl
OBaJlbHOVI <pOpM.
Ap.anTaLl.MSI
CTanbHblX Ayr -
onpeAeneHMe MHAMBMAyanbHoM
4>OpMbl AnSI Ka>KAOrO naLl.MeHTa
nOCJle TOro, KaK nps:lMoyrollbHble TepMOaKTBpyeMble HKelleBO- TTaHOBble
Ayr BblnOllHll CBOIO <PYHKLJ,IO, JleLJe6Hbie Ayr 3 Hep)f(aBelOLlteVi
CTaJI CeLJeHeM 0,019/0,025 AIOVIMa MO)f(HO ap,ampoBaTb AIls:l Ka)f(AOro
naLJ,eHTa, opeHTpYs:lCb Ha <POPMY ero H)f(HeVl3y6HoVi Ayr. 3aTeM MO)f(HO
npcrynaTb K C03AaH1O <J>OpMbl BepXHeVilleLJe6HOVI Ayr, KOOPAHPY51 ee
C H)f(HeVl, HO wpe Ha 3 MM Ha Ka)f(AOM YLJaCTKe. Ans:l 3TOro BblnOJlHs:lIOT
CJleAYIOLltee (pc. 4.11 A-E):
· nOcJle CHs:lTs:I nps:lMoyrollbHOVI TepMOaKTBpyeMoVi HKeJleBO- TTaHO-
BOVI Ayr (pc. 4.11A) Ha H)f(HIOIO AYry HaKJlap,bIBaIOT nllaCTLJeCKVI
BOCKOBblVi BaJIK npKYCHoro wa6110Ha AIls:l CHs:lTs:I OTTCKa n03LJ,11
6peKeTOB (pc. 4.116).
· Ha JleLJe6HOVI Ayre 3 Hep)f(aBelOLlteVi CTaJI CeLJeHeM 0,019/0,025
AIOVIMa AonOllHTeJlbHO BblnOJlHs:lIOT 3r6bl B COOTBeTCTB C OTTCKaM
n03LJ, 6peKeTOB (pc. 4.11 f).
· 3aTeM <J>OPMY Ayr cpaBHBalOT C CXOAHOVI MOAeJlblO ll ee Kcepo-
KoneVl, LJT06bl y6eATbcs:I B ee COOTBeTCTB C <J>OPMOVl3y6HOVI Ayr AO
lleLJeHs:I.
· 3areM npOBeps:llOT cMMeTp1O Ayr nOCJle BblnOllHeHs:I AOnOJlHTeJlb-
HblX 3r60B, cpaBHBas:l ee C wa611oHoM.
· ,HaKOHeLJ" AeJlalOT KcepoKon1O Ayr nOCJle BbInOJlHeHs:I AonOllH-
TeJlbHblX 3r60B  3aHOCs:lT ee B KapTOLJKY naLJ,eHTa. OHa COAep)f(T
HABAYaJIbHYIO <POPMY Ayr A3HHOro naLJ,eHTa. B TaKOVI <J>opMe
YCTaHaBJlBaIOT H)f(He nps:lMoyrollbHble CTaJlbHble Ayr, a BepXHe
paCWps:llOT Ha 3 MM. KOOPAHaLJ,s:llleLJe6HbIX Ayr BeCbMa B3)f(Ha,
oc06eHHO np CnOJlb30BaH Kpyrllblx CTaJlbHblX Ayr 6011bwero CeLJeHs:I
 nps:lMoyroJlbHblX CTaJlbHblX Ayr CeLJeHeM 0,019/0,025 AIOVIMa. np
COBMeLlteH BepXHs:Is:I Ayra AOll)f(Ha BblcrynaTb npMepHo Ha 3 MM 3a
npeAeJlbl H)f(HeVi Ayr. 3TO CBAeTeJlbCTByeT 0 nepeKpbIT H)KHX
3y60B BepXHM  B 6011bwHcTBe CllYLJaeB 06eCneLJBaeT npaBJlbHYIO
ap,amaLJ,1O JleLJe6HbiX Ayr (pc. 4.11 E).

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PMC. 4.11A. CiI1MMeTpil1lO npSlMoyroIlbHo cTaIlbHo Ayril1 nOCIle AonOIlHiI1-
TeIlbHoro 3ril16aHSI npoBepSlIOT Ha wa6IlOHe, 3aTeM MO)f(HO 3roTOBiI1Tb
KcepOKOnil1lO, iI1cnoIlb3YSl ee KaK iI1AeaIlbHYIO <l>OPMY HiI1}1(He 3y6HO Ayril1
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PMC. 4. 115. BocKoBbl BaIlil1K pa3MSlrLJalOT B TenIlo BOAe ill HaKIlaAblBalOT
Ha HiI1)f(HIOIO 3y6HYlO Ayry AIlSl CHSlTiI1S1 OTTiI1CKOB n03i11L1.iI1 6peKeTOB
PMC. 4.11 r. Ha IleLJe6HO cTaIlbHo Ayre CeLJeHiI1eM 0,01 9/0,025 AIOMa
BblnOIlHSlIOT AOnOIlHiI1TeIlbHble iI13ril16bl B COOTBeTCTBiI1i11 C OTTCKaMiI1 n03i11L1.iI1i11
6peKeToB
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PMC. 4.11 E. nOcIle onpeAeIleHiI1S1 iI1AeaIlbHo <l>OpMbI HiI1)f(He Ayril1 <l>OPMY
BepxHe Ayril1 MO}l(HO nOIlYLJiI1Tb nYTeM paCWiI1peHiI1S1 <l>OpMbl HiI1)f(He Ayril1
npMepHo Ha 3 MM
79

MOACbKAU. CbOPMbl AYr
 KOOPAHAU.SI
nE....E5HbIX Ayr
B HeKOTOpblX CJlYl.Jas:lX He06xOAMO MOA<PL.J,pOBaTb TnLJHYIO HAB-
AYaJlbHYIO AYry , KaK npaBllO, COOTHOWeHs:I BepXHeVi  H)f(Heii1 Ayr.
MOAM4>MKaLl.MSI,06ycnoBneHHaSi
TOpKOM Ha 60KOBbiX Y"laCTKaX
AOnOJlHTeJlbHbIVi LlteLJHblVi TOpK KOpHs:I Ha TPy6Kax AIls:l BepXHX MOlls:lpOB
MeeT TeHAeHL.J,1O K CeH1O BepXHeVi Ayr, a nporpeCCBHblVi LlteLJHblVi
TOpK KOpOHOK H)f(HX MOlls:lpOB - K BepTKaJlbHOMY BblpaBHBaH1O H)f(HX
MOJls:lpOB  pacwpeH1O H)f(HeVl3y6HoVi Ayr (pc. 4.12).
B HeKoTOpblX cJlYl.Jas:lx KOM6HaL.J,s:I CnOJlb30BaHs:I TaKX annapaTOB
MO)f(eT 06YCJlOBTb TeHAeHL.J,1O K nepeKpecTHoMY npKYcy Ha YLJaCTKe
MOJls:lpOB. ECll 3TO MeeT MecTO, TO 60KOBbie cerMeHTbl BepXHeVilleLJe6HOVI
Ayr MO)f(HO pacwpTb Ha 5 MM no cpaBHeH1O C H)f(HeVi AYroVi Ha YLJaCTKe
MOJls:lpOB.
MOAM4>MKaLl.MSI nocne paCWMpeHMSI
BepXHeM "IenIOCTM
nOCJle pacWpeHs:I BepxHeVi Ayr C nOMOLltblO 3KcnaHAepoB AIls:l
6blCTpOro pacWpeHs:I ll Ayr quadhelix (pc. 4. 13A) B03MO)f(Hbl ABe
cTYaL.J,. Bo-nepBblx, 3y6bl H)f(HeVi Ayr MOryr npOs:lBTb TeHAeHL.J,1O
K BepTKaJlbHOMY BblpaBHBaH1O B LlteLJHOM HanpaBJleH, , BO-BTOPbIX,
B BepxHeVi 3y6HOVI Ayre MeeTCs:I CKJlOHHOCTb K B03BpaLlteH1O K CXOAHOVI
<J>opMe (pc. 4.136). Ans:l ynpaBJleHs:I 3TM npOL.J,eCCaM H)f(HIOIO AYry
... 
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MO)f(HO pacwpTb C nOMOLltblO 60Jlee WPOKOVI JleLJe6HOVI Ayr (06bILJHO
60JlbWe Ha OAH pa3Mep - HanpMep, ceHHYIO 3aMeHTb Ha OBaJlbHYIO),
a pacwpeHe BepxHeVi 3y6HOVI Ayr MO)f(HO YAep)f(aTb COOTBeTCTBeHHO C
nOMOLltblO 6011ee WpOKX JleLJe6HbiX AYr.
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Ao KOppeKLI,/II/II TopKa MonflpOB np/ll KOppeKLI,/II/II TopKa MonflpOB
PMC. 4.12. B npoLl.ecce KOppeKLl.iI1i11 TOpKa MOIlSlpOB MO)f(eT B03HiI1KHYTb
TeHAeHLl.iI1S1 K pa3BiI1TiI11O nepeKpecTHoro npil1Kyca. B TaKOM cIlYLJae cIleAyeT
paCWiI1pil1Tb 60KOBO cerMeHT BepxHe IleLJe6HO Ayril1.
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PMC. 4.13. nOcIle paCWiI1peHiI1S1 BepxHe Ayril1 (A) LJaCTO B03HiI1KaeT He06xOAiI1MOCTb paCWiI1peHiI1S1 <j>OPMbl BepxHe IleLJe6HO Ayril1 ill cY)f(eHiI1S1 <j>OpMbl HiI1)f(He
Ayril1 (6) C Ll.eIlblO npeAOTBpaw,eHiI1S1 He)f(eIlaTeIlbHblX iI13MeHeHiI1 Ha YLJaCTKe MOIlSlpOB

PaCWMpeHMe BepXHeM 3y6HOM AyrM
C nOMOUJ.blO ne"le6HblX Ayr
B HeKOTOpblX CJlYLJaSiX KOOPAHaLJ,s:I <J>OPM JleLJe6HbiX Ayr Tpe6yeT oc060ro
BHMaHs:I, nOCKOllbKY OAHa 3y6Has:l Ayra (06bILJHO BepXHs:ls:I) HeCKOJlbKO
MeHbWe, LJeM APyras:l. npMeHeHe CTaJlbHblX nps:lMoyrollbHblX Ayr CeLJeHeM
0,019/0,025 AIOVIMa MO)f(eT cnoc06cTBoBaTb KOppeKLJ, TaKOro nOllO)f(eHs:I 
onpeAelleHHoMY pacwpeH1O Ayr (c. 1 08), ll YAep)f(aH1O paCWpeHs:I,
nOllYLJeHHoro B pe3YJlb TaTe cnOllb30BaHs:I Ayr quadhelix ll 3a CLJeT
6blCTpOro paCWpeHs:I BepXHeVlLJeJlIOCT. HABAYaJIbHYIO <POPMY Ayr
MO)f(HO pacwpTb Ha YLJaCTKe MOJls:lpOB ll cnOllb30BaTb KBap,paTHYIO
JleLJe6HYlO AYry B TeLJeHe OrpaHLJeHHoro nepOAa lleLJeHs:I.
It1AeanbHafl
OBanbHafl Ayra
PaCW/IIpeHHafl
neLJe6Hafl Ayra
PMC. 4.14. Ba)f(Ho iI1CnOIlb30BaTb npaBiI1IlbHYIO TeXHiI1KY paCWiI1peHiI1S!
IleLJe6HblX Ayr
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3TO KOppeKTHas:l TeXHKa paCWpeHs:I OPTOAOHTLJeCKX Ayr (pc. 4.14),
B3)f(HO He AonYCTTb LJpe3MepHoro paCWpeHs:I, LJTO MO)f(eT npBeCT K
CK3)f(eH1O <pOpMbl 3y6HOVI Ayr. np YAep)f(aH KOHLJ,OB pacwpeHHOVI
lleLJe6HOVI Ayr B 3anJlaHpOBaHHOVI HABAYaJIbHOVI n03LJ, OHa AomKHa
coxpaHTb 3TY <J>OPMY (pc. 4.15). B cJlYLJae LJpe3MepHoro Jl HenpaBJlb-
HOro pacWpeHs:I (pc. 4.16  4.17) <J>opMa lleLJe6HOVI Ayr He COBnap,eT
C HABAYaJIbHOVI <J>OpMOVI Ayr np AO)f(aT X KOHLJ,OB, a 3TO MO)f(eT
npBeCT K ceH1O ll pacwpeH1O Me)f(KJlbIKoBOro paCCTOs:lHs:I.
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PMC. 4.15. B pe3YIlb TaTe npaBiI1IlbHO BbinOIlHeHHoro paCWiI1peHiI1S! ill AO)l(aTiI1S1
KOHLl.OB IleLJe6HO Ayril1 OHa npil1HiI1MaeT npaBiI1IlbHYIO <t>OPMY
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PMC. 4.17. HenpaBiI1IlbHOe paCWiI1peHiI1e IleLJe6HO Ayril1
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PaCWMpeHMe BepXHeM 3y6HOM AyrM
C nOMOUJ.blO AyrM jockey
B XOAe 06blLJHOro JleLJeHs:I MO)f(HO nOJlYLJTb OrpaHLJeHHble pacwps:lIOLlte
CJlbl, KOTOpble 06eCneLJBaeT nps:lMoyrollbHas:l Ayra CeLJeHeM 0,019/0,025
AIOVIMa. B cJlYLJae He06xoAMOCT, oc06eHHo Ha 3aBepWalOLltx 3Tanax
JleLJeHs:I, AOnOllHTellbHble 60Jlee BbICOKe pacwps:lIOLlte Cllbl MO)f(HO
06eCneLJTb C nOMOLltblO cnOllb30BaHs:I Ayr jockey (naLJ,eHT M.S.,
c. 238-239). OHa npeACTaBJls:leT c060Vl npocTO BTOPYIO, TaK)f(e pacwpeHHYIO
AYry, nOABs:l3aHHYIO JlOKaJlbHO K OCHOBHOVI Ayre (pc. 4.18). 3TO MO)f(eT
6blTb nps:lMoyroJlbHas:l CTaJlbHas:l Ayra CeLJeHeM 0,019/0,025 AIOVIMa ll
)f(e KpyrJlaSi CTaJlbHas:l Ayra 6011bwero CeLJeHs:I. ECJl Ha nepBblx BepxHx
MOJls:lpax pa3MeLlteHbi Tpy6K AIls:l BHYTPPOTOBOVI Ts:lr, TO LJ,eJleC006pa3Ho
KOHLJ,bl Ayr jockey BBeCT B 3T Tpy6K.
3<J><J>eKTBHO AOnOJlHTellbHoe 3r6aHe LlteLJHoro TopKa KOpHs:I AIls:l
MOJl5lpOB Ha OCHOBHOVI Ayre CeLJeHeM 0,019/0,025 AIOVIMa (pc. 5.30,
c. 108), KOTopoe MO)f(eT 06eCneLJTb oceBoe AB)f(eHe MOJls:lpOB  npeAoT-
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wa6noHY

flJ.1 TEPA TYPA
1 Hawley C. A. 1905. Determination of the normal arch and its application to
orthodontia. Dental Cosmos 47:541-552.
2 Scott J. H. 1957. The shape of the dental arches. Journal of Dental Research
36:996- 1003.
3 Brader A. C. 1972. Dental arch form related to intra-oral forces. American Journal
of Orthodontics 61 :541-561.
4 Mclaughlin R. P., Bennett J. C. 1999, Arch form considerations for stability and
esthetics. Revista Espana Ortodontica 29(2):46-63.
5 Riedel R. A. 1969. In: Graber T M (ed) Current orthodontic concepts and
techniques. Saunders, Philadelphia.
6 De La Cruz A. R., Sampson P., Uttle R. M., Artun J., Shapiro P. A. 1995. Long-
term changes in arch form after orthodontic treatment and retention. American
Journal of Orthodontics 107:518-530.
7 Burke S. P., Silveira A. M., Goldsmith L. J., Yancey J. M., Van Stewart A.,
Scarfe W. C. 1998. A meta-analysis of mandibular intercanine width in treatment
and post retention. Angle Orthodontist 68(1 ):53-60.
8 Felton M. J., Sinclair P. M., Jones D. L., Alexander R. G. 1987. A computerized
analysis of the shape and stability of mandibular arch form. American Journal of
Orthodontics 92:478-483.
9 Shapiro P. A. 1974. Mandibular arch form and dimension. American Journal of
Orthodontics 66:58-70.
/"
..
10 Ladner P. T., Muhl Z. F. 1995. Changes concurrent with orthodontic treatment
when maxillary expansion is a primary goal. American Journal of Orthodontics and
Dentofacial Orthopedics 108: 184- 193.
11 Sandstrom R. A., Klapper L., Papaconstantinou S. 1988. Expansion of the lower
arch concurrent with rapid maxillary expansion. American Journal of Orthodontics
94:296-302.
12 Haas A. J. 1980 Long-term posttreatment evaluation of rapid palatal expansion.
Angle Orthodontist 50:189-217.
13 Braun S. , Hnat W. P., Fender D. E., Legan H. L. 1998. The form of the human
dental arch. Angle Orthodontist 68( 1 ):29-36.
14 Braun S., Hnat W. P., Leschinksy R., Legan H. L. 1999. An evaluation of the
shape of some popular nickel titanium alloy preformed arch wires. American
Journal of Orthodontics and Dentofacial Orthopedics 116: 1- 12.
15 Chuck G. C. 1934. Ideal arch form. Angle Orthodontist 4:312-327.
16 Nojima K., Mclaughlin R. P., Isshiki Y., Sinclair P. M. 2001. A comparative study
on Caucasian and Japanese mandibular clinical arch forms. Angle Orthodontist
71 :195-200.
17 Bennett J., Mclaughlin R. P. 1993. Orthodontic treatment mechanics and the
preadjusted appliance. Mosby-Wolfe, London (ISBN 0 7235 1906X).

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B BAe He6Hbix Jl s:l3bILJHbIX Ayr AIls:l 06eCneLJeHs:I KOHTpOJls:l n03LJ,
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ill npeABapil1TeIlbHO 3KCTpaKLl.iI1e nepBblX npeMoIlSlpoB. npaBbl BepXHiI1
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,lI,oCTiI1)f(eHiI1lO Omil1MaIlbHO OKKIl103i11i11 cnoc06cTBoBaIl 60IlbWO pa3Mep
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6blTb AOCTrHYTa Ha 3aKJlIOLJTeJlbHOM 3Tane lleLJeHs:I. OnpeAelleHe TaKOVI
«3anJlaHpOBaHHOVI n03LJ, pe3LJ,OB» (3np ll aHrll. PIP) npBOATCs:I Ha
c. 166-169. 3anllaHpoBaHHYIO n03LJ,1O MOJls:lpOB  KJlblKOB onpeAells:llOT Ha
OCHOBe PyKOBoAcTBa no OPTOAOHTLJeCKoMY nepeMeLlteH1O 3y60B - vr0 1 .
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Ha HaLJaJlbHOM 3Tane lleLJeHs:I MO)f(HO onpeAeJlTb, cpaBHBas:l HaLJaJlbHYIO
n03LJ,1O BepXHX  H)f(HX pe3LJ,OB C 3np B KOHLJ,e lleLJeHs:I. Ha 3Tane
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Jls:lTbCs:I B HanpaBJleH, npeAYCMOTpeHHOM 3np, Ha npOTs:I)f(eH Bcero
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npMMep aHOManMM III KnaCCa
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B03MO)f(HOCTb HeOrpaHLJeHHoro nepeMeLlteHs:I B Me3aJlbHOM HanpaBJleH
nOA B03AeVlCTBeM OTKpbIBaIOLltX AYr. n03TOMY MO)f(HO He npMeHs:lTb
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06eCneLJTb YBeJlLJeHe BeJlLJH, 3aJ10)f(eHHb1X B 6peKeTbi.
np HapyweH OKKJlI03 B HaLJaJlbHOVI CTap, KJlbIK 06blLJHO HaKJlO-
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nepBOHaLJaJlbHO BOCbM06pa3Hble CBs:l3K cnOllb30BaJICb AIls:l
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LJTO B cJlYLJaSix He06xOAMOCT x npMeHeHs:I OH 06eCneLJBaJI 3<p<J>eK-
TBHYIO ACTaJI3aLJ,1O KJlbIKOB, He Bbl3blBas:l np 3TOM He)f(eJlaTellbHoro
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MOCT peTpaKLJ, KJlblKOB (pc. 5.15), ll )f(e HeKoTopble cTYaLJ,, KorAa
HHO nOAAep)f(BaTb COOTHoweHe KJlblKOB B I KJlacce (naLJ,eHT J.N.,
c. 122). CooTBeTcTBeHHo, B 60JlbWHCTBe CJlYLJaeB BOCbM06pa3HYIO CBs:l3KY
CHMaIOT, eCJl Me)f(AY KOpOHKOVI KJlblKa  CMe)f(HbIM 60KOBbiM pe3LJ,OM
06pa30BaJlcs:I npoMeoK.
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3ar60B s:lBJls:leTC5I OCHOBHblM MeTOAOM YClleHs:I )f(eCTKOVI <J>KCaLJ,
Ha nepeAHeM YLJaCTKe Ha 3Tane BblpaBHBaHs:I  nepeMeLlteHs:I 3y60B.
BOCbM06pa3Hble CBs:l3K MHM3PYIOT HaKJlOH KOpOHOK KJlblKOB KnepeA
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He OTOABiI1raTb iI1X OT 60KOBbiX pe3L1.0B. OAHaKO B CIlYLJae MaIleHbKiI1X 60KOBbiX
pe3L1.0B, HeCOOTBeTCTBiI1S! CpeAiI1HHO Ilil1HiI1i11 iI1Ilil1 He06xOAiI1MOCTiI1 YCTaHOBiI1Tb
COOTHOWeHiI1e KIlblKOB no I KIlaccy, AiI1CTaIlil13aLl.iI1S! KllblKa OT IlaTepallbHoro
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le60JlbWX KOJleLJ, n03ap, Tpy60K (pc. 5.17).
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npil1 KOHTpOIlbHblX nocew.eHiI1S1X.

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Ha MOIlSlpax, <l>OpMiI1PYSl He60IlbWiI1e KOIlbLl.a, 06pa3YIOw,iI1e AiI1CTaIlbHbl 3aril16
nepeA BBeAeHeM KOHLJ,bl TepMOaKTBpyeMoVi HKelleBO- TTaHOBOVI
Ayr AaMeTpoM 0,016 AIOVIMa  KPYrllOVI CTaJlbHOVI Ayr CJleAyeT HarpeTb
Hap, nllaMeHeM  OXJlap,Tb B BOAe, AIls:l 06eCneLJeHs:I BblCOKOVI TOLJHOCT
np BblnOllHeH ACTaJlbHbIX 3ar60B (pc. 5.18  5.19).
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Ayr MO)f(HO CY3Tb Ha YLJaCTKax AIlHOVI 3 MM, nepeA HarpeBaHeM
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nOA06HO BOCbM06pa3HbIM CBs:l3KaM ACTaJlbHble 3ar6bl 06blLJHO
OCTaBJls:llOT Ha BeCb nepoA BblpaBHBaHs:I  nepeMeLlteHs:I 3y60B 
AO 3Tana npMeHeHs:I nps:lMoyroJlbHOVI TepMOaKTBpyeMoVi HKeJleBO-
TTaHoBoVi Ayr BKJlIOLJTeJlbHO BO Bcex CllYLJas:lX, KOTopble Tpe6YlOT carT-
TaJlbHOro KOHTpOJls:l pe3LJ,OB. n03AHee, Ha 3Tane CTaJlbHOVI nps:lMoyroJlbHOVI
Ayr, CarTTaJlbHblVi KOHTpOJlb ocyLlteCTBlls:llOT C CnOJlb30BaHeM naCCBHbIX
CBs:l30Ktiebacks (pc. 9.17, c. 255  pc. 7.59, c. 186).
8 Tex cJlYLJas:lx, KorAa He06xoAMO YBeJlLJTb AIlHY 3y6HOVI Ayr Ha
3Tane BblpaBHBaHs:I  nepeMeLlteHs:I 3y60B (c. 40)  He Tpe6yeTcs:I carT-
TaJlbHblVi KOHTpOllb pe3LJ,OB, ACTaJlbHble 3ar6bl CJleAyeT BbInOllHs:lTb Ha pac-
CT05IH 1-2 MM ACTaJlbHO n03ap, Tpy60K Ha MOJls:lpax (pc. 7.168, c. 171).
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PMC. 5.18. AiI1CTaIlbHble 3aril16bl MO)f(HO TaK)i(e BblnoIlHSlTb iI13 TepMOaKTiI1BiI1-
pyeMo HiI1KeIleBO-TiI1TaHOBO Ayril1 AiI1aMeTpOM 0,016 AIOMa, npil1 3TOM
KOHLl.bl (3 MM) npOBOIlOKiI1 cIleAyeT HarpeTb HaA nIlaMeHeM ill OXIlaAiI1Tb B BOAe
nepeA ee BBeAeHiI1eM
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PMc.5.19. UeIleco06pa3Ho HarpeTb KOHLl.bl Bcex Ayr, KpoMe CTaIlbHblX
npSlMoyroIlbHblx ill cKpYLJeHHbIX, 3aTeM OXIlaAiI1Tb iI1X B BOAe nepeA YCTaHoBKo.
TaKaSl 06pa60TKa n03BOIlSleT c<I>opMiI1pOBaTb TOLJHble AiI1CTaIlbHbie 3ar6bl.
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PMC. 5.20. npSlMoyroIlbHble TepMOaKTiI1BiI1pyeMble HiI1KeIleBO-TiI1TaHOBble Ayril1
MO)f(HO CY3i11Tb Ha KOHLl.aX Ha paCCTOSlHiI1i11 3 MM, LJT06bl BbmOIlHiI1Tb AiI1CTaIlbHbie
3aril16bl nOCIle HarpeBaHiI1S1 ill OXIla)f(AeHiI1S1 Ayril1
10:

KOHTponb 4>MKCaLl.MM HM>KHMX
MOnSipOB - Sl3bl"lHaSi Ayra
na5lHHbie s:l3blLJHble Ayr MO)f(HO CnOllb30BaTb B CllYLJas:lX He3HaLJTeJlbHOVI
CKYl.JeHHOCT 3y60B H)f(HeVlLJellIOCT Ha n03AHX 3Tanax cMeHHoro npKYCa.
nepBble H)f(He MOlls:lpbl 06blLJHO CMeIOTCs:I Me3aJlbHO B npOMeOK,
06pa30BaBWVlC5I nOCJle Bblnap,eHs:I MOJlOLJHblX BTOpblX H)f(HX MOlls:lpOB
(pc. 5.21  5.22). TaKOe CMeLlteHe MO)f(HO OrpaHLJTb C nOMOLltblO
cBoeBpeMeHHoVi YCTaHOBK s:l3bILJHOVI Ayr, CnOJlb30BaB 3TOT npoMeoK
AnSI BblpaBHBaHs:I  nepeMeLlteHs:I nepeAHx 3y60B.
CnOJlb30BaHe s:l3bILJHbIX Ayr TaK)f(e LJ,eJleC006pa3Ho AIls:l 06eCneLJeHs:I
MaKCMaJlbHOVI <J>KCaLJ, B CllYLJas:lX 3KCTpaKLJ, MOlls:lpOB, KOTOpble
BKJlIOLJalOT B ce6s:1 Ps:lA aHOMaJIVI, CBs:l3aHHbIX C 6MaKCJlJls:lpHbIM HaKJlOHOM
3y60B KnepeA, a TaK)f(e cJlYLJa LJpe3MepHoVi cKYLJeHHOCT nepeAHx 3y60B
H)I(HeVlLJeJlIOCT. B 06ex CTYaLJ,s:lX CJleAyeT paccMoTpeTb BapaHT
CnOJlb30BaHs:I s:l3bIYHOVI Ayr Ha HaLJaJlbHOM 3Tane BblpaBHBaHs:I 
nepeMeLlteHs:I 3y60B. 3TO nOMO)f(eT OrpaHLJTb Me3aJlbHOe nepeMeLlteHe
H)I(HX MOJls:lpOB, a B cJlYl.Jae 6MaKC1l1ls:lpHoro HaKJlOHa 3y60B KnepeA
06eCneLJT CnOJlb30BaHe npoMeKa, 06pa30BaBwerocs:I nOCJle YAaJleHs:I
npeMOJls:lpOB AIls:l peTpaKLJ, 3y60B nepeAHero YLJaCTKa. B cllYLJae 3HaLJTeJlb-
HOVI CKYl.JeHHOCT 3y60B npMeHeHe s:l3bILJHOVI Ayr 06eCneLJBaeT cnOllb30-
BaHe npoMeKa, 06pa30BaBwerocs:I nOCJle YAaJleHs:I npeMOlls:lpOB, AIls:l
YCTpaHeH51 CKYl.JeHHOCT nepeAHX 3y60B (naLJ,eHT J.N., c. 120).
KOHTponb 4>MKCaLl.MM HM>KHMX
MOnSipOB - 3naCTM"IHble TSirM
III KnaCCa M BHepOTOBaSi TSira
B cJlYl.Jae 3HaLJTellbHOVI cKYLJeHHOCT 3y60B H)f(Hero Ps:lA3, KorA3 Tpe6yeTcs:I
YCJleHHaSi <J>KCaLJ,, KOTOPYIO He MO)f(eT 06eCneLJTb npMeHeHe TOllbKO
OAHOVI s:l3bILJHOVI Ayr, B03MO)f(HO cnOllb30BaHe KplOLJKOB K06as:lw
(Kobayashi) Ha Yl.JaCTKe H)f(HX KJlblKOB oAHoBpeMeHHo C BHepoTOBoVi Ts:lroVi
(pc. 5.23). ABTOpbl npeAnOLJTaIOT OTKJlap,bIBaTb npMeHeHe 311aCTLJHbIX
TSir III KJlacca AO 3Tana KPYrllOVI Ayr AaMeTpoM 0,016 AIOVIMa AIls:l npeA-
OTBpaLlteHs:I 3KCTPY3 pe3LJ,OB. K CLJaCTblO, TaKas:l YClleHHas:l <J>KCaLJ,s:I Ha
H)I(HeVi 3y6HOVI Ayre Tpe6yeTcs:I TOllbKO B OLJeHb HeMHorx cllYLJas:lx.
-
+ 2,5 MM
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PMC. 5.21. HiI1)f(HiI1e Sl3b1LJHble Ayril1 MO)f(HO npil1MeHSlTb AIlSl npeAoTBpaw,eHiI1S1
Me3i11aIlbHoro nepeMew,eHiI1S1 nepBblx MOIlSlpOB B 06pa30BaBwil1cSI nOCIle
BblnaAeHiI1S1 MOIlOLJHblX HiI1)f(HiI1X BTOpblX MOIlSlpOB npOMe)f(YTOK, KOTOpbl
B cpeAHeM COCTaBIlSleT 2,5 MM
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PMC. 5.22. naSlHHble Sl3b1LJHble Ayril1 Ll.eIleco06pa3Ho iI1CnOIlb30BaTb AIlSl
MaKCiI1MaIlbHO <l>iI1KCaLl.iI1i11 B cIlYLJae YAaIleHiI1S1 npeMoIlSlpoB Ha 3Tane
BblpaBHiI1BaHiI1S1 ill nepeMel1\eHiI1S1 3y60B. x 06blLJHO HY)f(HO CHiI1MaTb AO
3aKpbfTiI1S1 npOMe)f(YTKa. X npil1MeHeHiI1e TaK)i(e nOIle3HO AIlSl 3aw,iI1Tbl
oCB060AiI1BwerocSI npOMe)f(YTKa, KaK nOKa3aHO Ha CHiI1MKe npil1 IleLJeHiI1i11
6e3 YAaIleHiI1S1 3y60B.
Headgear
PMC. 5.23. 3IlaCTiI1LJHbie TSlril1 III KIlacca MO)f(HO npil1MeHSlTb B COLJeTaHiI1i11 C
BHepoTOBo TSlro AIlSl MaKCiI1MaIlbHO <l>iI1KCaLl.iI1i11 B nepeAHeM YLJaCTKe Ha
HiI1)f(He LJeIlIOCTiI1

YCMneHMe 4>MKCaLl.MM B CarMTTanbHOM
nnOCKOCTM M KOHTpOnb BepXHMX
MOnSipOB - BHepOTOBaSi TSira
B HeKOTOpblX CJlYLJas:lX MO)f(eT B03HKHYTb He06xOAMOCTb B OrpaHLJeH
nepeMeLlteHs:I 60KOBbiX BepXHX cerMeHTOB B Me3aJlbHOM HanpaBJleH,
coxpaHeH X n03LJ, ll A3)f(e ACTaJI3aLJ,, AIls:l 06eCneLJeHs:I
H3AJle)f(aLlteVi n03LJ, nepeAHX 3y60B B rapMOH C npo<J>JleM Jlu,a.
Tpe60BaHs:I, npeAbs:lBJls:leMble K KOHTpOJlIO <J>KCaLJ, 60KOBbiX 3y60B,
06blLJHO Bblwe AIls:l BepXHeVi 3y6HOVI Aym, LJeM H)f(HeVi. 3TO 06YCJlaBJl-
BaeTCs:I ns:lTblO OCHOBHbIM <J>aKTOpaM:
1. BepxHe MOJls:lpbl nepeMeLltalOTCs:I B Me3aJlbHOM HanpaBJleH C
60JlbWeVi JlerKOCTblO, LJeM H)f(He.
2. nepeAHe 3y6bl BepXHeVlLJellIOCT 60JlbWe, LJeM H)f(HeVi.
,
3. B 6peKeTbi AIls:l BepXHX nepeAH14X 3y60B BBeAeHa 6011bwas:l aHrylls:lLJ,s:I,
LJeM B 6peKeTbi AIls:l H)f(HX nepeAHX 3y60B.
4. Ans:l pe3LJ,OB BepXHeVlLJeJlIOCT He06xoAM 60JlbWVI KOHTpOJlb TOpKa 
KopnycHoro nepeMeLlteHs:I, LJeM AIls:l H)f(HX pe3LJ,OB, Tpe6YIOLltx TOllbKO
ACTaJlbHOro HaKJlOHa Jl BepTKaJlbHoro BblpaBHBaHs:I.
5. Bo MHorx OPTOAOHTLJeCKX npaKTKax AMepK  EBponbl y naLJ,eHTOB
LJaLlte Ha611IOAaIOTCs:I aHOMaJI II KJlaCca, LJeM III KJlacca.
BBAY BblWenepeLJClleHHblx <J>aKTOpOB, BHepoTOBble CJlbl 06blLJHO
CLJTaIOTCs:I Ha60Jlee 3<P<J>eKTBHbIM MeTOAOM KOHTpOJls:l <pKCaLJ, 60KOBbiX
3y60B BepxHeVi Ayr, np YCJlOB AOCTaTOLJHOVI CTeneH COTpYAHLJeCTBa
C naLJ,eHTOM. Ha pcYHKe nOKa3aHbI Tp OCHOBHblX Tna BHepoTOBoVi T5Ir
 HanpaBJleHs:I AeVlcTBs:I Cll (pc. 5.24).
B 60JlbWHCTBe cllYLJaeB aBTOpbl OTA3IOT npeAnOLJTeHe KOM6HpoBaH-
HOVI BHepoTOBoVi Ayre (3aTbIllOLJHOVI  weVlHoVi Ts:lraM). YpOBH CJl, CnOJlb-
3yeMbix BO BHepoTOBoVi Ayre, COCTaBJls:llOT 150-250 r AIls:l 3aTblllOLJHOVI
 100-150 r AIls:l weVlHoVi Ts:lr. AaHHble BeJlLJHbl CJl n03BOlls:llOT
06eCneLJTb HeKoTOpoe YClleHe AeVlcTBs:I 3aTblllOLJHOVI T5Ir BHepoTOBoVi
Ayr, 06pa3Y51 BeKTOp Cllbl, npOXOAs:lLltVI HeCKOJlbKO Bblwe OKKJlI03OHHOVI
nllOCKOCT,  oCJla6Jls:llOT TeHAeHLJ,1O K BepTKaJlbHOVI 3KCTPY3 60KOBbiX
3y60B BepXHeVlLJellIOCT, oAHoBpeMeHHo 06eCneLJBas:l 3<J><peKTBHYIO
ACTaJI3aLJ,1O MOJls:lpOB.
AnHa nJleLJeVi BHewHeVi Aym BHepoTOBoVi Ts:lr MeeT 60JlbWOe
3HaLJeHe AIls:l npeAOTBpaLlteHs:I He)f(eJlaTeJlbHoro HaKJlOHa MOJls:lpOB. OH
AOJl)f(Hbl 3aKaHLJBaTbCs:I Ha YLJaCTKe nepBoro BepxHero MOlls:lpa (pc. 5.25).
CJlWKOM AIlHHble ll 30rHYTble KH3Y nlleLJ YCllBaIOT TeHAeHLJ,1O K
ACTaJlbHOMY HaKJlOHY KOpOHOK nepBblX MOlls:lpOB. 60Jlee KOpOTKe Jl
3arHYTbie BBepx nJleLJ YCJlBaIOT TeHAeHLJ,1O K ACTaJI3aLJ, KopHeVi
60JlbWe, LJeM KOpOHK, KaK nOKa3aHO Ha pcYHKe. Y naLJ,eHTOB C YBellLJeH-
HblM yrJlOM OCHOBaHs:lLJellIOCT, rAe He06xoAMa He3HaLJTeJlbHas:l ACTaJI-
3aLJ,s:I MOJls:lpOB, MO)f(HO cnOllb30BaTb TOJlbKO BblCOKYIO 3aTblllOLJHYlO Ts:lry.
B CJlYLJas:lX )f(e BeCbMa MaJlOro Me)f(LJeJlIOCTHoro yrJla, KorA3 MYCKYllaTYpa
AOCTaTOLJHO CJlbHa, LJT06bl MHM3poBaTb BepTKaJlbHYIO 3KCTPY31O
60KOBbiX 3y60B, LJ,eJleC006pa3Ho paccMoTpeTb B03MO)f(HOCTb cnOllb30BaHs:I
TOJlbKO weVlHoVi Ts:lr.
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PMC. 5.25. Ha pil1cYHKe CXeMaTiI1LJHO nOKa3aHO BIlil1S1HiI1e Allil1Hbl BHewHero
nIleLJa BHepoTOBo TSlril1
105

YCMneHMe 4>MKCaLl.MM B CarMTTanbHOM
nnOCKOCTM M KOHTpOnb BepXHMX
MOnSipOB - He6HaSi Ayra
BTOpOVI MeTOA YCJleHs:I <J>KCaLJ, Ha 60KOBbiX YLJaCTKax BepXHeVlLJellIOCT
npeAnOJlaraeT CnOJlb30BaHe He6HOVI Ayr. 06blLJHO ee YCTaHaBJlBaIOT
nOCJle pOTaLJ, BepXHX MOJls:lpOB  06eCneLJeHs:I X n03LJ, no I KJlaccy
OTHOCTeJlbHO H)f(HX MOJls:lpOB.
He6HYIO AYry MO)f(HO 3roTOBTb 3 KpymoVi npOBOllOK 60JlbWOro
AaMeTpa 0,045 Jl 0,051 AIOVIMa (1, 1 ll 1,3 MM), KOTOPYIO pa3MeLltalOT
Me>KAY MOJls:lpaM, <J>OpMPYs:I neTlllO nocpeAHe He6a, a TaK)f(e npoBolloK
AaMeTpoM npMepHo 2 MM, npOlleralOLlteVi OT CBOAa He6a (pc. 5.26
 5.29). He6HYIO AYry npnaBaIOT K KOJlbLJ,aM Ha MOlls:lpax.
BEPTKA.nbHbl KOHTPOnb
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AJl51 OrpaHLJeHs:I TeHAeHLJ, K BpeMeHHoMY Yr1ly6JleH1O npKYca
no BepTKaJI (pc. 5.27), oc06eHHo B cJlYLJas:lx rJly60Koro npKYca.
B03AeVlCTBe aHrylls:lLJ, 6peKeTOB CIlbHee npOs:lBJls:leTCs:I Ha BepxHeVi Ayre,
nOSTOMY Tpe6yeTcs:I oc060 TLltaTellbHbl KOHTpOllb, eCJl KJlbIK HaKJlOHeHbl
B ACTaJlbHOM HanpaBlleH B HaLJaJlbHOVI CTap, JleLJeHs:I. B TaKX CllYLJas:lX
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OrpaHiI1LJeHiI1S1 Me3i11aIlbHoro nepeMew,eHiI1S1 BepXHiI1X MOIlSlpOB Ha 3Tane
BblpaBHiI1BaHiI1S1 ill nepeMew,eHiI1S1 3y60B
3TO MO)f(eT npBecT K x 3KCTPY3, LJTO B 6011bwHcTBe CJlYLJaeB
He)f(eJlaTellbHO.
3TOro MO)f(HO 36e)f(aTb, eCJl He YCTaHaBJlBaTb 6peKeTbi Ha pe3LJ,bl B
HaLJaJle lleLJeHs:I, ll )f(e He BBOATb AYry B na3bl 6peKeTOB Ha pe3u,ax, a npo-
BeCT ee 6011ee OKKJlI03OHHO AO Tex nop, nOKa KOpH KJlblKOB He BblpOBHs:I-
IOTCs:I no BepTKaJI,  He nepeMeCTs:lTCs:I B ACTaJlbHOM HanpaBJleH C
nOMOLltblO BOCbM06pa3HbIX CBs:l30K. B TaKOM CllYLJae pe3LJ,bl MO)f(HO 6YAeT
BKJlIOLJTb B AYry, He onaCas:lCb B03HKHOBeHs:I He)f(eJlaTeJlbHOVI 3KCTPY3.
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PMC. 5.27. AHrYIlSlLl.iI1S1, BBeAeHHaSl B 6peKeTbi TeXHiI1KiI1 npSlMo Ayril1 All)! nepeAHiI1x 3y60B, 06YCIlaBIlil1BaeT TeHAeHLl.iI1lO K BpeMeHHOMY yrIly6IleHiI11O npil1Kyca
Ha HaLJaIlbHblX 3Tanax IleLJeHiI1S1. ,lJ,iI1CTaIlbHbl HaK1l0H KIlblKOB npil1 HaLJaIlbHO CTaAiI1i11 HapyweHiI1S1 OKKIl103i11i11 cnoc06cTByeT yrIly6IleHiI11O npil1Kyca.

BepTMKanbHblM KOHTpOnb KnblKOB
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B BecT6Ylls:lpHOM HanpaBJleH KJlbIK (naLJ,eHT J.N., c. 121), TaK KaK
3TO MO)f(eT npBecT K He)f(ellaTeJlbHoMY BepTKaJlbHOMY nepeMeLlteH1O
60KOBbiX pe3LJ,OB  npeMOlls:lpOB (pc. 5.28).
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TiI1TaHOBO Ayre AiI1aMeTpOM 0,016 AIOMa Ha HaLJaIlbHblX 3TanaX IleLJeHiI1S1. ECIlil1 HaLJaIlbHYIO Ayry nOIlHOCTblO BBeCTiI1 B na3bl 6peKeTOB Ha KIl bl Kax, 3TO MO)f(eT
Bbl3BaTb He)f(eIlaTeIlbHble nepeMew,eHiI1S1 3y60B Ha CMe)f(HbIX YLJaCTKaX 60KOBbiX pe3L1.0B ill npeMOIlSlpOB.
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BepTMKanbHblM KOHTpOnb MOnSipOB
B cnY"laSix 60nbWOrO Me>K"IenIOCTHOrO
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cnOJlb30BaTb CJleAYIOLlte MeTOAbl BepTKaJlbHoro KOHTpOJls:l MOJls:lpOB:
.
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6peKeTbi Ha BTopble MOJls:lpbl, LJT06bl CBeCT K MHMYMY 3KCTPY31O
3TX 3y60B. ECll Bce- TaK Tpe6yeTCs:I HaJlO)f(eHe KOJleLJ" Ha Ayre
n03ap, nepBoro MOJls:lpa BblnOJlHs:lIOT YCTYn AIls:l npeAOTBpaLlteHs:I
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nepeMeLlteHe 3TX 3y60B, a He X HaKJlOH, LJT06bl 36e)f(aTb 3KCTPY3
He6HbiX 6yroPKOB. JlYLJwe Bcero 3TO AellaTb C nOMOLltblO HeCbeMHblX
SKcnaHAepOB, HorAa B COLJeTaH C BblCOKOVI BHepOTOBOVI Ts:lroVi.
PMC. 5.29. npil1 <!>iI1KCaLl.iI1i11 He6Ho Ayril1 Ha paCCTOSlHiI1i11 2 MM OT He6a,
Sl3blLJHbie CiI1Ilbl cnoc06cTBYlOT BepTiI1KaIlbHoMY KOHTpOIlIO n03i11L1.iI1i11 MOIlSIpOB
. B cJlYl.Jae cnOllb30BaHs:I He6Hbix Ayr x CJleAyeT YCTaHaBJlBaTb
Ha paCCTOs:lH OKOllO 2 MM OT He6a, LJT06bl s:l3b1K Mor OKa3blBaTb
BepTKaJlbHOe HTPY3oHHoe B03AeVlcTBe (pc. 5.29).
. np CnOJlb30BaH BHepoTOBoVi Ts:lr AIls:l naLJ,eHTOB C 60JlbWM
Me)f(LJeJlIOCTHbIM YrllOM CJleAyeT npMeHs:lTb KOM6HpoBaHHYIO Jl
BblCOKYIO Ts:lry. HeLJ,elleCo06pa3Ho CnOJlb30BaHe weVlHoVi T5Ir.
. B HeKoTOpblX cJlYLJaSix AIls:l YMeHbweHs:I 3KCTPY3 MOJls:lpOB 3<J><J>eKTBHO
npMeHeHe HaKYcOLJHblX nllaCTHOK Ha YLJaCTKe MOlls:lpOB BepxHeVi
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6b8Ma KOCTHOVI TKaH Ha BepXHeVlLJeJlIOCT LJ,elleco06pa3HO CnOllb30BaTb
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blpaBHBaHs:I  nepeMeLlteHs:I 3y60B C nOMOLltblO nps:lMoyrollbHblX Ayr,
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B 60JlbWHCTBe CJlYLJaeB peKoMeHAyeTCs:I YCTaHOBKa 6peKeTOB Jl KOJleLJ, Ha
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cTa61l3aLJ,1O <pOpMbl 3y6HOVI Ayr  KOHTpOllb n03LJ, KJlbIKOB. OAHaKO
cyLlteCTBYIOT cTYaLJ,, np KOTOpblX HaJlO)f(eHe BCeX 6peKeTOB He
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(naLl.iI1eHT L.B., c. 116) ill BepxHero KIlblKa (naLl.iI1eHTT.C., c. 192).
MEPOnps:lTs:I no nOBTOPHOMY
BbIPABHBAHtO 3Y50B
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He06xOAMOCTb B nOBTOpHoM BblpaBHBaH  nepeMeLlteH 3y60B.
nOBTOpHoe BblpaBHBaHe 3y60B CJleAyeT npoBoATb np BKJlIOLJeH B AYry
BHOBb npope3aBWXCs:I 3y60B, np nepeKJleBaH 6peKeTOB ll nOBTOp-
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LJae Tpe6yeTcs:I B03BpaT K 60Jlee TOHKM AyraM AIls:l BKJlIOLJeHs:I B AYry 3TX
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SA)f(yaVl3-annapaTe  B nepBble roAbl npMeHeHs:I TeXHK nps:lMOVI Ayr.
npMeH5IJlCb Kpyrllble CTaJlbHble Aym AaMeTpoM 0,014, 0,016, 0,018 
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CeLJeHe nps:lMoyroJlbHblX CTaJlbHblX Ayr COCTaBJls:lJlO 0,018/0,025,
0,019/0,025 AIOVlMa, np 3TOM LJaLlte Bcero CnOJlb30BaJICb Ayr CeLJeHeM
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OTA3IOT npeAnOLJTeHe 6peKeTaM C na30M 0,022 AIOVIMa no cpaBHeH1O
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npoMeKoB C npMeHeHeM MexaHK CKOJlb)f(eHs:I He06xoAMa
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ABTOpbl BBOAll Ayr B CJleAYIOLlteVi nOClleAOBaTellbHOCT: KpYrllble
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Hble CTaJlbHble Ayr CeLJeHeM 0,019/0,025 AIOVIMa (pc. 5.32). TaKas:l
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60Jlee r6Kx Ayr CeLJeHeM 0,018/0,025 AIOVIMa.
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AJl51 LJero CKPYLJBaJICb BMeCTe CTaJlbHble npOBOJlOK OLJeHb MaJlOro
AaMeTpa (pc. 5.33). B pe3YJlbTaTe nOllYLJllaCb npOBOJlOKa, KOTOPYIO
Ha3blBalOT cKpYLJeHHOVI ll MHOro)f(llbHOVI-. Ayr 3 TaKOVI npOBOllOK
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AO STana npMeHeHs:I KPYrllblX CTaJlbHblX Ayr AaMeTpoM 0,014 AIOVIMa B
cJlYl.Jae 3HaLJTeJlbHbIX aHOMaJIVI nOJlO)f(eHs:I 3y60B B 3y6HOM Ps:lAY.
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CT3JlbHbIX Ayr Ha 3Tane BblpaBHBaHs:I  nepeMeLlteHs:I 3y60B. OAH pa3Mep
HKeJleBO- TTaHOBOVI Ayr MO)f(HO CnOJlb30BaTb BMeCTO ABYX pa3MepoB
CTaJlbHblX nps:lMoyroJlbHblX AYr. OAHaKo MHome OPTOAOHTbl CLJTaJI x np-
MeHeHe np06JleMaTLJHbIM, BBAY x BblCOKOVI CTOMOCT. X CTaJI He-
YMecTHo npMeHs:lTb B cJlYLJas:lx, KorAa Tpe60BaJlaCb )f(eCTKOCTb, xapaKTepHas:l
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Ayr, KOHTpOJlb npKYca, 3aKpblTe npoMeKa  YMeHbweHe rlly60KOro
npKYca C nOMOLltblO Me)f(LJeJlIOCTHbIX 3JlaCTLJHbIX Ts:lr.
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Ha3blBalOT «TepMOaKTBpyeMas:l Ayra», 3HaLJTeJlbHO nOBblClla x r6KocTb.
B pe3YJlbTaTe TaKe Ayr MO)f(HO cnOllb30BaTb B KaLJeCTBe 3aMeHbi Tpex
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KOTOpble B HaCTOSlUJ,ee BpeMSI npil1MeHSlIOTcSI B KaLJeCTBe HaLJaIlbHblX npil1
3HaLJiI1TeIlbHbiX HapyweHiI1S1x nOIlO)f(eHiI1S1 3y60B B 3y6HbiX pSlAax
BMecTO nepeCTaHOBK Ayr np K3)f(AOM nOCeLlteH Ha 3Tane BblpaB-
HBaHs:I  nepeMeLlteHs:I 3y60B MO)f(HO HaHOCTb oXJl3)f(A3IOLltee cpeAcTBo
Ha TepMOaKTBpyeMYIO HKeJleBO- TTaHoBYIO AYry Ha Tex YLJaCTKax, rAe
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aKTBaL.J, Ayr  06eCneLJBaeT 3<J><peKTBHOe nepeMeLlteHe 3y60B.
KaK H YABTellbHo, HO naL.J,eHTbl He )f(aJlYIOTCs:I Ha OLltyLlteHe AonOllH-
TeJlbHoro ACKOM<pOpTa, npeAnOJlO)f(TellbHO nOTOMY, LJTO 06pa3YIOTC5I
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nOCJleAOBaTellbHOCTb BBeAeHs:I Ayr, KOTOPYIO npMeHs:lIOT aBTOpbl,
npeACTaBJleHa Ha pc. 5.34. TaKOVI nOAXOA 3HaLJTeJlbHO cOKpaTJl BpeMs:I
y KpeCJla naL.J,eHTa  nOBbICJl 3<P<J>eKTBHOCTb nepeMeLlteHs:I 3y60B
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TEPMOAKTBPYEMbIE HKEnEBO-
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TepMOaKTBpyeMblx HKeJleBO- TTaHOBbIX Ayr He nOKa3aHO 3-3a X
BbICOKOVl3JlaCTLJHOCT, TOrAa peKOMeH'AOBaHbl CTaJlbHble Ayr. K HM
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fll/lTEPATYPA
1 Mclaughlin R. P., Bennett J. C. 1999. An analysis of orthodontic tooth movement-
the VTO. Revista Espana Ortodontica 29(2): 1 0-29.
2 Mclaughlin R. P., Bennett J. C. 1989. The transition from standard edgewise to
preadjusted appliance systems. Journal of Clinical Orthodontics 23: 142-153.
3 Robinson S. N. 1989. An evaluation of the changes in lower incisor position
during the initial stages of clinical treatment using a preadjusted edgewise
appliance. University of London MSc thesis.
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PMC. 5.99
PMC. 5.102
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PMc.5.109
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MM L 28°
.1KA-Po 4 MM
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J.N. AO
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1

PA3AEn 6
BblpaBHMBaHMe AyrM M KOHTpOnb
npMKYca no BepTMKanM
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3KCTpaKLJ,1I1111 3y6oB 138
ne"leHMe C 3KCTpaKIJ,MeM 3y6oB 138
npll1MeHeHlI1e He3HaLJII1TenbHbiX clI1n Ha 3Tane
BblpaBHII1BaHII1f1 111 nepeMew,eHII1f1 3y6oB 139
npll1MeHeHlI1e He3HaLJII1TenbHbiX clI1n Ha 3Tane
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npMKyca 142
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BCTYnnEHE
...
B npeAblAYLlteVi KHre aBTOpbl paCCMaTpBaJI BonpOCbl KOHTpOJls:l npKYca
no BepTKaJI B OTAeJlbHOM pa3AeJle nOCJle 06Cy)f(AeHs:I np0611eMbl
BblpaBHBaHs:I  nepeMeLlteHs:I 3y6oB. OAHaKO, KaK Bbls:lCHllOCb, oc06eHHO
np npMeHeH TepMOaKTBpyeMblx HKelleBO-TTaHOBbIX Ayr, KOHTpOllb
npKYca no BepTKaJI 60Jlee TeCHO CBs:l3aH C npOLJ,eCCOM BblpaBHBaHs:I
3y60B  06blLJHO ero BblnOJlHs:lIOT nOClle BblpaBHBaHs:I  nepeMeLlteHs:I
OTAeJlbHblX 3y60B. HanpMep, BO MHorx CJlYLJas:lX Ha paHHX 3Tanax lleLJeHs:I
Ha611IOAaeTCs:I OmMaJlbHOe nepeMeLlteHe 3y6oB, OAHaKO B nOCJleAYIOLlteM
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JleLJeHs:I, a TaK)f(e 06Llte npHLJ,nbl, npMeHs:lIOLlteCs:I np lleLJeH
nepeAHero OTKpblTOro npKYca.
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KOHTaKTa C BepXHiI1MiI1 nepeAHiI1MiI1 3y6aMiI1
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LJpe3MepHYIO 3KCTPY3i111O HiI1)f(HiI1X pe3L1.0B
CbOPMPOBAHE
rnY50KOrO npKYCA
3KCTPY3s:I  pOCT nepeAHx 3y60B npOAOll)f(aeTCs:I AO B03HKHOBeH5I
KOHTaKTa C 3y6aM-aHTaroHcTaM (pc. 6.1), Ms:lrKM TKaH5IM He6a
(pc. 6.2), Jl nOKa s:l3b1K He 6YAeT npens:lTCTBOBaTb X 3KCTPY3
(pc. 6.3). n03AHee HeOrpaHLJeHHOe npope3blBaHe BTOpblX H)I(HX
nOCTOs:lHHbIX MOJls:lpOB 06ycllaBJlBaeT <J>OpMpoBaHe 60KOBOro Yl.JaCTKa
KpBOVI Wnee B CllYLJas:lX aHoMaJIVlII KJlacca (pc. 6.4).
ECJl nepeAHe 3y6bl npope3blBalOTCs:I np HopMOrHaTLJeCKOM npKYce
(3-4 MM), B pe3YllbTaTe o6eCneLJBaeTCs:I AeaJIbHOe COOTHoweHe B
nepeAHeM YLJaCTKe (3-4 MM). OAHaKo np aHOMaJIs:lX II  III KJlacca, KorAa
Ha611IOA3eTCs:I LJpe3MepHoe Jl HeAOCTaTOLJHOe rop30HTaJlbHOe nepeKpblTe
nepeAHX 3y60B, MO)f(eT npo30VlT 3JlWHee YAJlHeHe 3TX 3y60B.
T aKOro pOAa 3MeHeHs:I HaKJlOHa KpBOVI Wnee Ha6111OA3IOTC5I 06bll.JHO Ha
YLJaCTKe Me)f(AY KJlbIKaM  nepBblM npeMOlls:lpaM, nOCKOllbKY npeMOJl5lpbl
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LJpe3MepHoMY npope3bIBaHIO.
PMC. 6.2. npil1 n03i11L1.iI1i11 MOIlS!pOB II KIlacca HiI1)f(HiI1e pe3L1.bl MorYT paCTI-1 AO
MOMeHTa KOHTaKTa C He6oM. 3TO MO)f(eT npil1BeCTiI1 K cJ>OpM ill pOBaH ill 10 KPYTO
Kpil1BO Wnee Ha nepeAHeM YLJaCTKe.
PMC. 6.4. HeOrpaHiI1LJeHHaS! 3KCTPY3i11S! BTOpblX HiI1)f(HiI1X MOIlSlpOB npil1
aHOMaIlil1S!X II KIlacca cnoco6cTByeT pa3BiI1TiI11O 60KOBOro YLJaCTKa Kpil1BOVI Wnee
1

nEPEMEw.EHE 3Y50B
np OTKPbIT npKYCA
KOppeKLJ,s:I my60Koro npKYca npeAnOllaraeT 06paLlteHe YKa3aHHoro
npOLJ,eCCa BCns:lTb  ocyLlteCTBJls:leTCs:I C nOMOLltblO pa3JlLJHbIX nepeMeLlteHVI
3y60B, BKJlIOLJaIOLltX CJleAYIOLltee:
· npope3bIBaHe/3KCTpY31O 60KOBbiX 3y60B (pc. 6.5)
· ACT3JlbHbIVi HaKJlOH 60KOBbiX 3y60B (pc. 6.6)
· YBeJlLJeHe HaKJlOHa pe3LJ,OB KnepeA (pc. 6.7)
. HTPY31O pe3LJ,OB (pc. 6.8)
· COl.JeTaHe ABYX Jl 6011ee nepeMeLlteHVI 3y6oB, YKa3aHHbiX Bblwe.
_I!IPIII
n pope3bIBaHMe/3KCTPY3MSI
60KOBbiX 3y6oB
npope3blBaHe 60KOBbiX 3y60B npeACTaBlls:leT c060Vl 06blLJHblVi BepTKaJlb-
HblVi pOCT MOJls:lpOB B paCTYLlteM opraH3Me. 3TO CTa6JlbHbIVi npOLJ,eCC,
cOnpOBO)f(AaIOLltVI pa3BTe JlLJ,a B BepTKaJlbHOVI nJlOCKOCT.
HopMaJlbHoe npope3blBaHe 60KOBbiX 3y60B cnoc06CTByeT OTKpbIT1O
npKYca Y naLJ,tt'leHTOB C my60KM npKYCOM (pc. 6.5). BepTKaJlbHblVi pOCT
llu,a Y paCTYLltX naLJ,eHTOB TaK)f(e o6eCneLJBaeT npOCTpaHCTBO AIls:l
3KCTPY3 60KOBbiX 3y60B, KOTOpas:l MO)f(eT MeTb MecTO np OpTOAOHT-
LJeCKOM JleLJeH B npOLJ,eCce BblpaBHBaHs:I KpBOVI Wnee  CnOJlb30Ba-
Hs:I Me)f(LJeJlIOCTHbIX 3JlaCTLJHbIX Ts:lr Ha BepXHeVlLJellIOCT (II, III KJlacca
 BepTKaJlbHbIX).
OAHaKo AIls:l npOLJ,eCca 3KCTPY3 60KOBbiX 3y60B Y B3pOCJlbiX naLJ,eHTOB
co cpeAHeVi Jl MaJlOVI BeJlLJHOVI Me)f(LJelllOcTHoro yma xapaKTepHa
HecTa6llbHOCTb. 06blLJHO Clla MbIWLJ, npoTBoAeVlcTByeT raKoVl3KcTPY3,
 K KOHLJ,y JleLJeHs:I Jl )f(e BCKope nOCJle Hero MOlls:lpbl nepeMeLltalOTCs:I
B CBOIO CXOAHYIO BepTKaJlbHYIO n03LJ,IO, a BeJlLJHa Me)f(LJeJlIOCTHoro
yma - K HaLJaJlbHblM 3HaLJeHs:lM. 3TO MO)f(eT CTaTb npLJHOVI peLJ,ABa 
B0306HOBJleHs:I my60Koro npKYca. y B3pOCllbiX naLJ,eHTOB C 60JlbWM
ymoM OCHOBaHVlLJeJlIOCTeVl, y KOTOpblX MblWeLJHble TKaH oClla6JleHbl,
OPTOAOHTLJeCKas:l 3KCTPY3s:I 60KOBbiX 3y60B MO)f(eT CTa6Jl3pOBaTbCs:I B
KOHLJ,e lleLJeHs:I  06eCneLJTb nOCTOOHHoe OTKpbITe npKYca. Ans:l 60Jlb-
WHCTBa naLJ,eHTOB C 6011bWM Me)f(LJellIOCTHbIM yrlloM 3TO He)f(ellaTeJlbHO.
PMC. 6.5. npope3bIBaHiI1e/3KcTPY3i11S! 60KOBbiX 3y6oB

AMCTanbHblM HaKnOH 60KOBbiX 3y6oB
B OCHOBHOM 3TO CTa6JlbHOe 3MeHeHe y pacTYLltero naLJ,eHTa, nOCKOJlbKY
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ACTaJlbHbIVi HaKJlOH 60KOBbiX 3y60B He OTllLJaeTCs:I cTa6llbHOCTblO,
nOCKOJlbKY HaLJHaeTCs:I HTPY3s:I 3TX 3y60B K CXOAHbIM BepTKaJlbHbiM
n03LJ,s:lM. 3TO MO)f(eT npO30VlT He B npOLJ,eCce OpTOAOHTLJeCKoro
,
lleLJeHs:I, HO 06blLJHO CJleAyeT BCKope nOCJle ero 3aBepWeHs:I  MO)f(eT
npBeCT K nOCTOpTOAOHTLJeCKOMY peLJ,ABY my60KOro npKYca.
y B3pOCJlbiX naLJ,eHTOB C 6011bWM Me)f(LJeJlIOCTHbIM yrlloM ACTaJlbHblVi
HaKJlOH 60KOBbiX 3y60B MO)f(eT npBeCT K nOCTOs:lHHOMY OTKpblTOMY
npKYcy, n03TOMY ero CJleAyeT 36eraTb. B HeKOTOpblX CJlYLJax y B3pOCllbiX
naLJ,eHTOB C 6011bWM ymoM OCHOBaHs:I LJelllOCTeVi BblpaBHBaHe 60KOBbiX
3y60B nOCJle X HaKJlOHa 611aronps:lTHOe (pc. 6.6).
HaKnOH pe3L1.0B KnepeAM
Bo MHorx CJlYLJas:lX y naLJ,eHTOB C rJly60KM npKYCOM  HaKJlOHeHHbIM
K3ClA pe3u,aM HaKJlOH 3TX 3y60B KnepeA cnoco6cTByeT OTKpbIT1O
npKYca Ha YLJaCTKe nepeAHX 3y6oB. Ha H)f(HX 3y6ax lleLJeHe COCTOT
B o6eCneLJeH HaKJlOHa KOpOHOK H)f(HX pe3LJ,OB KnepeA. B BepxHeVi
3y6HOVI Ayre 06blLJHO Ha611IOAaeTCs:I COLJeTaHe HaKJlOHa KOpOHOK KnepeA
 KOHTpOJls:l TOpKa KopHeVl, KOTOpble ACTaJlbHO nepeMeLltalOTCs:I B KOCTHOVI
TKaH (pc. 6.7).
HTPY3MS1 nepeAHMX 3y6oB
B 6011bwHcTBe CJlYLJaeB lleLJeHs:I paCTYLltX naLJ,eHTOB 06blLJHO He
Tpe6yeTcs:I ocyLlteCTBlls:lTb HTPY31O nepeAHX 3y60B. no Mepe pOCTa llLJ,a
no BepTKaJI npeAOTBpaLlteHe Jl A3)f(e OrpaHLJeHe HOpMaJlbHOro
npope3blBaHs:I 3TX 3y60B 06eCneLJT «YBellLJeHe» OTKpblTs:I npKYca
maBHblM 06pa30M 3a CLJeT npope3blBaHs:I, 3KCTPY3 /ll ACTaJlbHOro
HaKJlOHa 60KOBbiX 3y60B.
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PMC. 6.7. HaKIloH pe3L1.0B KnepeAiI1
PMC. 6.8. HTPY3i11S! nepeAHiI1x 3y6oB

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H5IIOT C LJ,el1blO YMeHbWeHH5I npOTpY3HVI nepeAHVlX 3y60B Hl1Vl YCTpaHeHVlfI VlX
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npOH30W110 AVlCTaIlbHOro HaKllOHa pe3LJ,OB, nOCKOl1bKY STO npHBeAeT K SKCT-
PY3HH pe3LJ,OB VI AaIlbHe
weMY yrl1y611eHHIO npHKYca (pVlC. 6.20). nOSTOMY
aBTOpbl npeAn04HTalOT Bbln011H5ITb rpynnOBYIO peTpaKLJ,HIO weCTVI nepeAHVlX
3y60B C nOMOUJ,blO np5lMoyrol1bHO
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3y60B VI KOHTp0l151 npHKYca no BepTVlKaIlH.
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paKLJ,VlIO KllbIKOB, 4T06bl 06ecne4HTb AOCTaT04HO MeCTa AIl51 nepeMeUJ,eHH5I
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I Kllacca. nOSTOMY B HeKOTOpblX Cl1Y4a5lX KllblKH MO)l{HO nepeMeCTHTb Ha
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STOM Me3
aIlbHO OT KllblKOB MOryr 06pa30BaTbC5I HeKOTOpble npOMe>KYTKH
(naLJ,HeHT J.N., c. 123). Bo MHorVlX Cl1Y4a5lX OTMe4aIlOCb, 4TO OKKllI03HOHHbl

KOHTaKT Me)I{AY HVI)I{HHM H BepXHHM KllblKaMH cnoc06cTByeT AHCTaIlH3aLJ,HH
BepxHero KllbiKa. TaKO
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BeCbMa n0l1e3HbiM npH 06UJ,eM nepeMeUJ,eHVlH BepXHHX nepeAHHX 3y60B.
3aTeM MO)l{HO nepeXOAHTb K peTpaKLJ,HH 3y60B BepxHe
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C npHMeHeHHeM np5lMoyrol1bHbiX CTaIlbHblX AYr.
nOCl1e BBeAeHVl5I Ha4aIlbHbiX l1e4e6Hbix Ayr y pe3LJ,OB H KllblKOB Ha611IOAaeT-
C5I TeHAeHLJ,H5I K Me3V1aIlbHOMY HaKllOHY, B CB5I3H C BBeAeHHo
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HaKllOHa Ha KllblKax Cl1eAyeT HCn0l1b30BaTb BOCbMH06pa3Hbie CB5I3KH (Iace-
back) (c. 15). He Cl1eAyeT npHMeHflTb Sl1aCTVl4Hbie CHl1bl, nOCKOl1bKY OHH
MOryr Bbl3BaTb 4pe3MepHbl
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CB5I3KY C AHCTaIlbHO CTOpOHbl KllblKa, Bbl3blBa51 ero He3Ha4V1Tel1bHbl
HaKJlOH. 3a 3THM ClleAyeT COOTBeTCTBYIOW.VI nepVloA ero BepTVlKaIlbHOro
BblpaBHHBaHH5I nOA HHBel1VlpYIOUJ,VlM B03AeCTBVleM l1e4e6HO AyrH. TaKoe
BepTHKaIlbHOe BblpaBHHBaHVle Ha611IOAaeTC5I B Cl1Y4ae npVlMeHeHH5I BOCbMVI-
06pa3HbiX CB5I30K, HO OHO He OTMe4aeTC5I npVl npVlMeHeHHVI 311aCTVl4HbiX
LJ,en04eK, nOCKOl1bKY OHVI OKa3blBalOT nOCT05IHHOe B03AeCTBVle, VlcKll104alOw.ee
B03HHKHOBeHHe «3Q>Q>eKTa OTM4H».
Ha ceroAH5IUJHH AeHb Cl1eAyeT C4HTaTb, 4TO 611aronpH5ITHa51 Ha4aIlbHa51
n03HLJ,H5I KJlblKOB npeAnOl1araeT He3Ha4V1Tel1bHbl Vll1Vl YMepeHHbl HaKllOH
KOpOHOK KnepeAH. OAHaKO, eCl1Vl Ha611IOAaeTC5I He611aronpVlfITHa51 aHry115lLJ,VlfI
KJlblKOB B Ha4aIle l1e4eHH5I (pHC. 6.21), TO KOppeKLJ,VlVlfI rl1y60KOro npVlKYca
Tpe6yeT ropa3Ao 6011bWe YCVll1H. Ha pHC. 6.22 nOKa3aHO, KaK 6peKeTbi
TeXHHKH np5lMO AyrVl, YCTaHOBl1eHHble Ha KllblKax C He611aronpVlflTHo
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HaBl1HBaTb 6peKeTbi Ha pe3LJ,bl H BKll104aTb VlX B Ha4aIlbHbie AyrH C LJ,el1blO
IUiIB 1IaIJ..
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KllblKOB MO)l{eT OKa3aTbC5I HeLJ,el1eco06pa3HblM Q>HKcHpoBaTb 6peKeTbi Ha
pe3LJ,bl AO peTpaKLJ,HH KopHe KllbIKOB, 4TO Yl1Y4waeT aHry115lLJ,HIO na30B
6peKeTOB Ha KllbiKax. TaKO nOAXOA CHVI)I{aeT TeHAeHLJ,HIO K yrl1y611eHHIO
npVlKYCa, HeVl36e)l{HYlO B TaKVlX Cl1Y4a5lX. Mb TepHaTVlBHa51 TeXHHKa npeAJla-
raeT BblnOl1HeHVle Vl3rVl6a Ha Ayre Me3V1aIlbHO OT KllblKOB AIl51 npeAOTBpa-
UJ,eHH5I AeCTBVlfI He3Ha4V1Tel1bHblX VlHTPY3V10HHbiX CHl1 Ha pe3LJ,bl npH
AVlCTaIlbHOM nepeMeUJ,eHVIVI KopHe KllbIKOB.
B 3aKll104eHVle MO)l{HO OTMeTHTb, 4TO CYUJ,eCTByeT LJ,el1bl P5lA Q>aKTOpOB,
KOTopble MOryr npHBeCTH K yrny611eHHIO npVlKYca Ha Ha4aIlbHOM 3Tane
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VI COOTBeTCTBYIOUJ,VlM nepVlOAOM «3Q>Q>eKTa OTM4W>. Cn0l1b30BaHVle
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HaVl6011ee 3<t>Q>eKTVlBHbl cnoc06 KOHTp0l151 n0110)l{eHVl5I H nepeMeUJ,eHH5I
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MexaHVlKa CKOl1b)l{eHVl5I Tep51er CBOIO SQ><!:>eKTVlBHOCTb VI npOVlCXOAVlT
yrny611eHHe npVlKYca.
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npHKYCa, Ha STane 3aKpb1TH5I Ayr BBOAVlTC5I AOnOl1HHTel1bHbl He3Ha4HTellbHbl
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ABTOpbl nblTaIlVlCb npHMeH5ITb CHl1bl pa3HbiX YPOBHe npH 3aKpblTHH
npOMeKOB VI npVlWl1H K BbIBOAY, 4TO AVlana30H CVll1 150-200 r 5IB115leTC5I
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06YC110Bl1eHHOe Cl1eAYIOUJ,VlMH Q>aKTOpaMVI:
· Ype3MepHbie CVll1bl npHBOA5IT K nOTepe TOpKa pe3LJ,OB Ha np5lMoyrol1bHO
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H yrl1y611eHVle npHKYCa.
PMC. 6.23. npMeHeHe "Ipe3MepHblx Cll Ha 3Tane 3aKpbIT npOMe)l(YTKoB
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reHeTH4eCKHX H/Hl1Vl BHeWHHX Q>aKTOpOB. K aKTOpaM BHewHero B03AeCT-
BH5I OTHOC5ITC5I npHBbl4Ka COCaTb naIlbLJ,bl (pVlC. 6.24), napaQ>YHKLJ,H5I fl3blKa
B n0110CTH pra H np0611eMbi C r1l0TaHVleM, HapyweHVlfI AblXaTel1bHblX nYTe,
06YC110Bl1eHHbie TaKHMH 3a6011eBaHIII5IMIII, KaK aIll1eprVlfl, aAeHOVlAHT VI
TOH3Hl1HT, a raK)l{e AblxaHHe 4epe3 pOT.
reHeTH4ecKHe Q>aKTOpbl MOryr B03AeCTBOBaTb Ha OpMHpoBaHVle
OTKpblTOro nepeAHero npVlKYca Cl1eAYIOUJ,HM 06pa30M: naLJ,HeHTbl, y
KOTOpblX Ha611IOAaeTC5I 4pe3MepHbl BepTHKaIlbHbl pOCT nepeAHe 4aCTH
l1HLJ,a no cpaBHeHHIO C BepTVlKaIlbHblM pOCTOM 60KOBO 4aCTVll1HLJ,a, 6011ee
npeApacn0110)l{eHbi K Q>OpMVlpOBaHHIO OTKpblTOro nepeAHero npHKYca. Y
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KPYTO yrol1 MaHAVl6Y115lpHO n110CKOCTVI H YAIlHHeHHe HH)I{He 4aCTH l1HLJ,a.
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06bl4HO Tpe6yeTc5I 3Ha4HTel1bHa51 SKCTPY3V151 VI TOpK pe3LJ,OB.
C APYro CTOpOHbl, eCl1H y naLJ,HeHTOB cpeAH5I5I Hl1H KOpOTKa51 HH)I{H5I5I
4aCTb l1VlLJ,a (cpeAHVI Vll1H MaIlbl Me)l{4el1IOCTHO yrol1) (pVlC. 6.25), He-
CMOTpfl Ha TO, 4TO BHeWHHe Q>aKTOpbl MOryr 06YC110BHTb Q>OpMHpOBaHHe
OTKpblTOro nepeAHero npVlKYCa, l1e4V1Tb TaKO npVlKYc 06bl4HO ropa3Ao
l1er4e. YCTpaHeHHe npVl4V1HHbIX Q>aKTOpOB n03B0115leT 6blCTpO 3aKpblTb
npVlKYC, nOCKOl1bKY B STOM Cl1Y4ae HeT He06xOAVlMOCTH B 3Ha4HTel1bHO
SKCTPY3HH H TOpKe pe3LJ,OB. T aKa51 aHOMaIlH5I Ha3b1BaeTC5I 3y60aIlbBe0115lp-
HblM OTKpblTblM npVlKYCOM, ee HeTpYAHO OTKOppeKTVlpOBaTb nocpeACTBOM
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naJlbLJ,eB. nepeAH OTKpblTbl npKYc TaKoro Tna 06blYHO nOMaeTCSI
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<t>OpMpoBaHe OTKpblTOro npKyca CB5I3aHO C napa<t>YHKLJ,e Sl3b1Ka, nporH03
nOJlHoro ycnexa JleYeHSI COMHTeJleH.

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SQ>Q>eKTHBHee 6YAyr ero pe3Yl1bTaTbl. B HaCT05IUJ,ee BpeMfI npeAJlO)l{eH
LJ,el1bl P5lA BapHaHTOB paHHero l1e4eHH5I. Aanee paCCMaTpVlBaIOTC5I MeTOAbl
l1e4eHH5I B nOp5lAKe l1erKOCTH VlX npVlMeHeHH5I:
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nyrH H CTVlMYl1VlpOBaTb AblxaHHe 4epe3 HOC, 06ecne4V1Bafl 6011bWe
npOCTpaHCTBa AJl51 fl3blKa.
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AyrVl, KOTOpble orpaHH4HBalOT BepTHKaIlbHOe npope3blBaHHe M0115lpOB.
· HaKYC04Hbie nl1aCTHHKH MO)l{HO YCTaHOBHTb Ha BepXHHX Hl1H HVI)I{HVIX
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pOTaLJ,HIO H OTKpblBaHHe HH)I{He 4el1lOCTVI (oc06eHHO B Cl1Y4ae 6011bWOro
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OHVI OKa3blBalOT He3Ha4HTel1bHOe AaBl1eHVle Ha 3y6Hbie p5lAbi.
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npaUJ,e npH A06poCOBeCTHOM HoweHHVI MO)l{eT orpaHH4HTb BepTHKa1lb-
HYIO SKCTPY3HIO VI BepXHVlX, H HVI)I{HVIX M0115lpOB, COOTBeTCTBeHHO. OAHaKO
Q>aKTOp COTPYAHH4eCTBa naLJ,VleHTa, KaK npaBVl110, orpaHH4HBaeT npVlMe-
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· YAaIleHVle M01104HbiX KllblKOB VI HHOrAa npeM0115lpOB B Cl1Y4ae 3Ha4HTel1b-
HO CKY4eHHOCTH 3y60B H/Hl1H npOTpY3HH cnOC06CTByeT SKCTPY3HH
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l1e4eHVlfI OTKpblTOro npVlKYca Ha611IOAaeTC5I Yl1Y4weHHe, no Mepe TOro
KaK AblXaTel1bHble nyrVl paCWHpflIOTC5I B npOLJ,eCce OPTOAOHTH4ecKoro
l1e4eHVl5I. nOSTOMY AaHHbl MeTOA npVlMeH5IeTC5I y He6011bworo
K0l1Vl4eCTBa naLJ,VleHTOB.
· ECl1H npVl4V1HO nepeAHero OTKpblTOro npHKYCa 5IB115lIOTC5I aAeHOH,lJ,bl
H TOH3Hl1VlT, HX YCTpaHeHVle MO)l{eT cnOC06CTBOBaTb 3aKpblTHIO npHKYCa.
B TaKHX Cl1Y4a5lX naLJ,VleHTOB Cl1eAyeT HanpaBHTb Ha KOHCYl1bTaLJ,HIO K
Bpa4Y-OTOl1apHHrol1ory .
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4eHHIO nepeAHero OTKpblTOro npHKYCa B xOAe OPTOAOHTH4ecKoro l1e4eHVlfI
nOl1HblM nOCT05lHHbiM annapaTOM. B TO BpeM5I KaK B OpTOAOHTHH npeAn04-
TeHHe OTAaeTC5I HeSKCTpaKLJ,HOHHOMY l1e4eHHIO, B HeKOTOpblX Cl1Y4a5lX
OTKpblTOro npHKYCa SKCTpaKLJ,VlfI 3y60B MO)l{eT OKa3aTbC5I 6011ee s<I>Q>eKTVlB-
HO, npe>K.D,e Bcero AIlfl 06ecne4eHVlfI SKCTPY3V1V1 pe3LJ,OB VI HX HaKllOHa
K38P,H. Aanee npVlBOA5ITC5I HeKOTopble B03MO)l{Hbie BapVlaHTbll1e4eHVl5I:
. ECllH B BepXHe H HVI)I{He 3y6HbiX Ayrax Ha611IOAaeTC5I CKY4eHHOCTb
3y60B H/Hl1H npOTpY3V151, MO)l{eT 6blTb nOKa3aHO YAaIleHHe BepXHVlX
H HH>KHHX npeM0115lpOB.
. ECl1H pacn0110)l{eHVle 3y60B Ha HVI>KHe Ayre He Tpe6yeT SKCTPY3V1V1 3y60B
AIl51 06ecne4eHVl5I HaKllOHa HH)I{HHX pe3LJ,OB K3aAH, VI pa3Mep M0115lpOB
6011ee 4eM Ha 3-4 MM npeBblwaeT pa3Mep MOl1flpOB no II Kllaccy, MO)l{eT
6blTb nOKa3aHO TOl1bKO YAaIleHVle BepxHVlx npeM0115lpOB (naLJ,VleHT L.J.,
c. 184). 3ro n03B0l1HT oCYUJ,ecTBVlTb peTpaKLJ,VlIO VI HaKllOH BepxHVlx
pe3LJ,OB K3aAH.
. ECl1H pacn0110)l{eHHe 3y60B Ha HVI)I{He Ayre He Tpe6yeT SKCTpaKLJ,HH
3y60B AIl51 06ecne4eHH5I HaKllOHa pe3LJ,OB K3aAH VI Bel1Vl4V1Ha M0115lpOB
COCTaB115leT MeHee 3 MM II Kllacca, YAaIleHHe BepXHVlX npeMOl1flpOB
Bbl3blBaeT COMHeHHe. Ype3Bbl4aHo TPYAHO nepeMeCTVlTb BepXHVle
M0115lpbl KnepeAVI Ha 4-7 MM, COXpaH5I5I npVl STOM BepTVlKaIlbHOe
n0110)l{eHHe VlX KopHe. A STO He06xoAHMO AIl51 HaAJle)l{aw.e OKKll103HVI
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npKyca II KllaCca. B AaHHOM CllY4ae 31laCT4Hble TSlr II KllaCCa nOABSl3aHbi K
KplOLJKY Ha Tpy6Ke Ha BTOpOM H>KHeM npeM01l5lpe.
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VI HVI)I{He 4el1lOCTe MO)l{HO HaKlleVlBaTb Ha 0,5 MM 611Vl)l{e K AecHeBoMY
KpalO, 4eM 06bl4HO (c. 65). 3ra npocra51 npOLJ,eAypa n03B0115leT 3aKpblTb
npVlKYC B XOAe l1e4eHVl5I.
. B Cl1Y4a5lx OTKpblTOro npVlKYca He peKoMeHAyeTc5I craBVlTb KOl1bl..\8.
Ha BTopble M0115lpbJ Ha Ha4aIlbHblX VI npOMe04Hb1X sTanax l1e4eHH5I,
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H 6.27) Vll1H III Kllacca, VlX Cl1eAyeT YCTaHaBl1HBaTb OT npeM0115lpOB,
a He MOl1flpOB. TaKlt1e «KopOTKHe» Sl1aCT4Hble T5IrH MVlHVlMVl3HPYlOT
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B n0110CTVI pra. Ha STane peTeHLJ,VIVI MO)l{HO paCCMOTpeTb npHMeHeHHe
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nAUVI
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PMc.7.1. B AaHHOM CJlY4ae paCCMaTpBaIOTCSI TOJlbKO ceMb TOlIeK aMepeH LlAMT. TopK BepXHX peaLlOB aMepSiIOT OTHOCTeJlbHO OKKJllOaOHHO nJlOCKOCT
BepXHe lIeJlIOCT, a TOpK H)I(HX peaLloB - OTHOCTeJlbHO OKKJllOaOHHo nJlOCKOCT H)I(He lIeJlIOCT. Ha AaHHo cxeMe Ha lVL (CTHHO BepTKaJlbHO
JlH) npoeLlPYIOTCSI CJleAYIOI.l.te TOlIK: T04Ka A MSlrKX TKaHe, nepeAHSISI TOllKa BepxHe ry6bl, nepeAH5ISI TOlIKa H)I(He ry6bl, TOlIKa B MSlrKX TKaHe
 pogonion MSlrKX TKaHe. 060aHalleHi-lbie lIepHblM LI<I>Pbl cooTBeTcTBYIOT OTAeJlbHblM cTaHAapTHblM OTKJlOHeHSlM.
163

BblSlBneHMe TSI>KenbiX CnYLIaeB aHOManMM II KnaCCa
npHMeHeHHe OpTOAOHTH4eCKVlX MeTOAOB MO)l{eT 06eCne4HTb AOCTH)I{eHVle XOPOWVlX KOHe4HbiX pe3YllbTaTOB npH lle4eHHVI 601lbWVlHCTBa naLJ,VleHTOB co
CKelleTHblMH aHOMaIlVl5lMVI I KllaCCa H He3Ha4V1TellbHb1MH aHOMaIlVl5lMH II KllaCCa. OAHaKO, 04eHb Ba)I{HO HAeHTVI<j>HLJ,HpOBaTb Ha 3Tane OLJ,eHKVI Te aHOMaIlHH
" K1laCCa, B OCHOBe KOTOpblX lle)l{aT 3Ha4V1TellbHble CKelleTHble AVlCnpOnOpLJ,VlH. B TaKHX CllY4a5lX LJ,elleC006pa3HO paCCMOTpeTb B03MO)l{HOCTb xVlpyprH4ecKO-
OpTOAOHTH4ecKoro lle4eHH5I (pHC. 7.2). OT VlCKll104V1TellbHO OPTOAoHTH4ecKoro lle4eHH5I ClleAyeT OTKa3aTbC5I, eCllVl TOllbKO He CYUJ,eCTByeT peaIlbHO nepcneK-
THBbl A06HTbC5I 61laronpH5ITHblX CKelleTHblX Vl3MeHeHVI y pacryUJ,ero naLJ,HeHTa B pe3YllbTaTe lle4eHH5I Q>YHKLJ,VlOHaIlbHbIMVI annapaTaMH.
TeopeTH4eCKHe CllY4aVllle4eHVlfI aHOMaIlVl 11/1 (A, B H C) Kllacca npeACTaB1l5llOT HeKoTopble Vl3 B03MO)l{HbiX TPYAHocTe, C KOTOpblMH MO)l{eT CTOllKHyrbC5I
Bpa4-opTOAOHT.
TVL
TVL
TVL
o
4
o
'4
-12
\
5
-8
o
4
)
i

-5
2
-6
\
5
-5
-11
-3
PMc.7.2. Ha BblwenpBeAeHHo cxeMe pa3J14Hble LtBeTOBble 0603HalfeHSI, npMeHSleMble B aHaJl3e no Arnett, nOMoralOT 06HapY)KTb Y4acTK  CTeneHb
AcnpOnoPLt JILta. Ha npaBo cxeMe npeACTaBJleHO COCTOSlHe, cooTBeTcTBYIOw.ee HopMe. CpeAHSISI cxeMa AeMoHcTpPyeT YMepeHHYIO aHOMaJl1O 11/1 KJlaCCa,
AJISI JlelfeHSI KOTOPO npMeHSlIOTcSl TOJlbKO OPTOAoHT4ecKe MeTOAbl. CxeMa CJleBa cBAeTeJlbCTByeT 0 TOM, lfTO CTeneHb aHOMaJl MO)KeT nOTpe60BaTb
KOM6HpoBaHHoro OPTOAOHT4eCKo-xPyprlfecKoro JlelfeHSI,  lfTO OT CKlllOlfTeJlbHO OPTOAOHT4eCKx MeTOAOB JlelfeHSI npAeTCSI OTKa3aTbCSI, eCll TOllbKO
npMeHeHe <l>YHKLtOHallbHblx annapaTOB He 06ecne4T 3HalfTeJlbHb1X CKeJleTHblX 3MeHeH Y paCTYllIero naLteHTa (naLteHT T.S., c. 198-205).
CMTYaI4MS1 A - OPTOAOHTM'IeCKOe MacKMpoBaHMe He3Ha'lMTenbHoM aHOManMM II macca. ECllH HMelOw,eeC5I CKelleTHOe HapyweHHe He3Ha-
4HTellbHO, MO)l{HO npHHflTb peweHVle 06 VlCKll104HTellbHO OPTOAOHTH4eCKOM lle4eHVlH. OPTOAOHT nocpeACTBOM «MaCKHpOBaHVlfI» MO)l{eT OTKoppHrHpOBaTb
aHOMaIlHIO KOCTH II Kllacca B pe3YllbTaTe 3y60aIlbBeOllflpHO KOMneHCaLJ,HVI, BKllI04alOUJ,e He3Ha4HTellbHbl HaKllOH BepXHVlX pe3LJ,OB K3aAH H/HllH HaKllOH
HH)I{HHX pe3LJ,OB KnepeAH. npH TaKOM lle4eHVlH 06bJ4HO Tpe6yeTc5I npVllle}l(HOe COTpYAHVl4eCTBO naLJ,HeHTa npVl npHMeHeHHVI 31laCTVl4HbiX T5Ir II Kllacca H/HllH
BHepoTOBo T5IrH. ne4eHHe 06bl4HO AOll)l{HO npVlBOAVlTb K AOCTH)I{eHVlIO XOPOWVlX 3y60aIlbBe01l5lpHbiX COOTHoweHVI H npVleMlleMoro npoQ>HllflllVlI..\8.
(pHC. 7.3).
ITVL
TVL

o
4
o
3
LlBeTOBas:J MapKpOBKa. CnOJlb-
30BaHHas:J B 4e<paJlOMeTp'JeCKOM
aHaJl3e TKaHei1 no Arnett:
'-IepHbli1- B npeAeJlax 1 (1 c.o.) _
3eJleHbli1 - B npeAeJlax 2 (2 c.o.) _
CHi1 - B npeAeJlax 3 (3 c.o.)
KpacHbli1- 60Jlee 3 (3 c.o,) _
c.o. - CTaHAapTHoe OTKJlOHeHe
-8
. \
-5
-6
PMC. 7.3. B TeopeTlfeCKO cTyaLt A KOppeKLtSI
AOCTrHYTa 3a ClfeT 3y60allbBeOllSlpHO KOMneHCaLt,
KOTOPO cnoc06CTBOBaJl B HeKOTOpo CTeneH 611aro-
npSlTHble 3MeHeHSI pOCTa. MHore He3HalfTellbHble
aHOMall II Kllacca Y paCTYllIx naLteHTOB ycnewHo
nOAAalOTCSI nOA06HOMY JlelfeHIO.
-6
I

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.
a
C1
c.u
a
""U
=:.
m
...r:.
m
I
:s:
::c
»
I
a


S
Sc
CMTYaIJ"MS1 B - nonblTKa OPTOAOHTM'IeCKOrO MaCKMpOBaHMS1 60nee 3Ha'lMTenbHb1X CKeneTHblX aHOManMM II KJ1acca. ECllH CKelleTHa51
aHOMaIlVl51 II Kllacca HaxOAVlTC5I B AVlana30He OT YMepeHHO AO TfI)I{e1l0, TO npVlMeHeHHe TOllbKO OPTOAOHTH4eCKVlX MeTOAOB pHCKOBaHO. ECllH Bpa4-
OPTOAOHT npHHHMaeT peweHVle KoppVlrVlpOBaTb npVlKYC nocpeACTBOM 3y60aIlbBe01l5lpHoro «MaCKHpOBaHH5I» CKelleTHO aHOMaIlHH II Kllacca, He HCKJlIO-
4eHa B03MO)l{HOCTb 4pe3MepHO peTpaKLJ,HVI BepXHHX pe3LJ,OB K3aAVI H BeCbMa He61laronpH5ITHOe Vl3MeHeHe npOQ>H1l5l1lHI..\8. (pVlC. 7.4). KpoMe TOro,
BepxHHe H HVI)I{HHe pe3LJ,bl YCTaHaBllVlBaIOTC5I B n03V1, LJ,Vl5IX He61laronpVlflTHbiX AIl51 B03MO)l{HO AaIlbHeWe xVlPyprVl4ecKo KOppeKLJ,VlH. An51 nOllYLJeHH5I
OnTVlMaIlbHblX pe3Yllb TaTOB xVlpyprH4ecKoro BMeWaTellbCTBa He06xoAVlMO AaIlbHeWee OPTOAoHTVl4ecKOe lle4eHVle AIlfl AeKOMneHCaLJ,HVI n03HLJ,HH
nepeAHVlx 3y60B.
TVL
TVL
0 -2 ...
3 -1 ...
-5 -3
-9
-9
PMC. 7.4. B TeOpeTw.lecKoVi cTyaLt B npeAnpHSlTa
nonblTKa npoBecT KOppeKLt1O TSI)KeI10Vl aHOMal1 II
Kl1acca C nOMOlltblO TOl1bKO 0PTOAOHTW'IeCKOro l1eeHSI,
B pe3Y11bTaTe ero npo30wl1 He611aronpSlTHble 3Me-
HeHSI npo<j)I1S1 I1Lta. OTO OTeTI1BO npOCl1e)KBaeTCSI
Ha npaBoVi cxeMe no B03pocweMY KOI1ecTBY 3MepeHVI
no Arnett, 0603Ha4eHHbix KpacHblM LtBeTOM. npO30W110
ynl10llteHe BepxHeVi ry6bl  YMeHbweHe BblnYKl1ocT
I1Lta, B pe3Y11bTaTe ero Y naLteHTa C<j)OpMpoBal1cSI
TaK Ha3blBaeMblVi «OPTOAoHTecKVI BA», KOTOpblVi
nOABepral1cSI pe3KoVi KpTKe B npowl1oM, TO Harl1S1AHO
nOATBep>KJJ,aIOT pe3Y11bTaTbi UAMT.
S
:t>
()
()
»
CMTYaIJ"MS1 C - KOM6HHMpOBaHHoe OPTOAoHTM'IecKo-xMpyprM'IecKoe ne'leHMe 3Ha'lMTenbHb1X aHoManMM 11/1 KJ1acca. naLJ,HeHTbl cTapa-
IOTC5I no B03MO)l{HOCTH Vl36e)l{aTb xHpyprH4ecKoro BMeWaTellbCTBa, OAHaKO BO MHorVlX cepbe3Hbix CllY4a5lx y naLJ,HeHTOB C 3aBepweHHbiM pOCTOM OHO
06ecne4HBaeT MaKCHMaIlbHO B03MO)l{Hbl 61laronpH5ITHbl HCXOA lle4eHVl5I OTHOCHTellbHO n03HLJ,VlH 3y60B H npoQ>VlllflllHI..\8. (pHC. 7.5). ECll He06xoAHMO
XVlpyprH4ecKoe BMeWarellbCTBO no nOBoAY BbIABH)I{eHH5I HVI>KHe 4ellIOCTH, xHpypr MO>KeT OT1l0)l{VlTb OnepaLJ,HIO AO Tex nop, nOKa naLJ,HeHry He HCnOll-
HHTC5I 16 lleT HllVl Ha 601lee n03AHVI CpOK, AO 3aBepweHVlfI pa3BVlTVlfI BVlC04HO-HVI>KHe4ellIOCTHbIX CYCTaBOB, cnoc06HbiX YAep)l{aTb OTKoppHrHpOBaHHYIO
n03HLJ,HIO HH)I{He 4ellIOCTH.
TVL
TVL
0 0
3 4
2
-5
-3
PMC. 7 .5. TeopeTecKaSi cTyaLtSI C aHal1orHa cTYa-
Lt B B Ha4a11e l1e4eHSI. OAHaKo KOppeKLtSI TSI)KeI10Vl
aHOMal1 II Kl1acca BblnOI1HeHa B pe3Y11bTaTe OPTOAOHT-
ecKo-xpyprecKoro l1eeHSI. Ha npaBoVi cxeMe oTeT-
I1BO BAHbl 611aronpSlTHble 3MeHeHSI npo<j)I1S1 I1Lta, B
BAe 3MepeHVI no Arnett, 0603Ha4eHHbix epHblM LtBeTOM.
XOTSI naLteHTbl cTapalOTcSl 36e)KaTb xpyprecKoro
BMewaTel1bcTBa, TO np Hal1 TSI)Kel1blX aHOMal1VI OHO
MO)KeT 06ecne4Tb MaKCMal1bHO B03MO)KHbIVi ycnewHblVi
CXOA l1e4eHSI OTHOCTel1bHO n03Lt 3y6oB  npo<j)I1S1
I1Lta, 0 4eM Lte11eco06pa3HO H<j)OpMpOBaTb naLteHTa.
165

ETbIPE 3TAnA npou.ECCA
nnAHLIIPOBAHLIIS1 nEEHLIIS1

B npoLJ,ecce nllaHHpOBaHH5Ille4eHH5I pa31lH4alOT 4eTbipe STana lle4eHH5I:
3Tan 1 - onpeAeneHMe
3annaHMpoBaHHoM n03MLI,MM
BepxHMx pe3L1,OB
4TO 0603Ha4aeT HAeaIlbHa51 n03HLJ,H5I BepXHHX pe3LJ,OB B KOMnlleKCe llHLJ,a
C T04KH 3peHH5I CarHTTaIlbHO n03HLJ,HVI, TopKa VI BepTHKaIlbHO n03V1LJ,HVI?
B03MO)l{HO llH A06HTbC5I HAeaIlbHO n03HLJ,VIVI BepXHHX pe3LJ,OB? ECllVl HeT, TO
MO)l{HO llH 06eCne4HTb npHeMlleMYIO n03V1LJ,HIO TOllbKO C nOMOUJ,blO OPTOAOH-
TH4ecKoro lle4eHH5I, VlllH )l{e He06xOAHMO paCCMOTpeTb BapVlaHT OpTOrHa-
TH4ecKoro xVlpyprH4ecKOro BMeWaTellbCTBa? T aKHM 06pa30M OnpeAellfllOT
3anllaHHpOBaHHYlO n03HLJ,HIO pe3LJ,OB B Ka)l{AOM OTAellbHOM CllY4ae.
3Tan 2 - HM>KHMe peaLl,bl
B03MO)l{Ha llH YCTaHOBKa HVI)I{HHX pe3LJ,OB B HClA11e)l{aUJ,VI KOHTaKT
C 3anllaHHpOBaHHO n03HLJ,Vle BepXHHX pe3LJ,OB? MO)l{HO llH TaKYIO n03V1LJ,HIO
HH)I{HHX pe3LJ,OB nOllY4HTb B pe3YllbTaTe TOllbKO OpTOAOHTH4ecKoro lle4eHVlfI?
ECllH HeT, HHO llVl MOAHQ>HLJ,HpOBaTb 3anllaHVlpOBaHHYlO n03V1LJ,HIO BepXHVlX
pe3LJ,OB (KOTOpa51 MO)l{eT OKa3aTbC5I HeAOCTH)I{VlMO), OCTaHOBHTbC5I Ha
HeHAeaIlbHOM BapHaHTe COOTHOWeHH5I pe3.LJ,OB HllVl )l{e paCCMOTpeTb BapVlaHT
xHpyprH4ecKoro BMeWaTellbCTBa Ha HVI)I{He 4ellIOCTVI?
n
It
- -
+
PMc.7.6. Ha Ha...anbHOM STane nnaHpoBaHSI ne4eHSI He06xoAMO
onpeAenTb 3annaHpoBaHHYIO n03LJ.1O BepXHX pe3LJ.OB. B HeKOTopblX
cny...a5lx AeanbHaSi n03LJ.SI pe3LJ.OB peanbHo AOCT)I(Ma  ee MO)l(HO
cnonb30BaTb KaK 3annaHpoBaHHYIO n03LJ.1O pe3LJ.OB. B HbIX cny...aSlx
MO)l(HO npHSlTb 3annaHpoBaHHYIO n03LJ.1O pe3LJ.OB, KOTOpaSi He 5IBnSleTCSI
AeanbHO, OAHaKO npeMneMO AnSI AaHHoro cnY4aSl.
n
\\
?
PMC. 7.7. BTOpO STan nnaHpOBaHSI ne...eHSI KacaeTCSI H)I(HX pe3LtOB
 X COOTHoweHSI C 3annaHpOBaHHO n03LJ.e BepXHX pe3LtOB. Ecn STO
HeAOCT)I(MO B pe3ynbTaTe TOnbKO OPTOAoHT4ecKoro ne4eHSI, TO He06xoAMa
MOA<I>KaLJ.SI 3annaHpoBaHHo n03LJ. BepxHx pe3LJ.OB n )l(e paccMoT-
peHe B03MO)l(HOCT xpypr...ecKoro BMewaTenbCTBa Ha H)I(He 4enIOCT.

3Tan 3 - OCTanbHble HM>KHMe 3y6bl
KaKHM 06pa30M ClleAyeT YCTaHOBHTb HVI)I{HHe 3y6bl, aAamVlPYfI VlX K
3anllaHVlpOBaHHO n03HLJ,HH HVI)I{HHX pe3LJ,OB? KaK llVlKBHAVlpOBaTb npOMe-
KVI B HVI)I{He Ayre? He06xOAVlMO llVl YAaJlfITb 3y6bl B CllY4ae CKY4eHHOCTVI
HH)I{HHX 3y60B? Ha AaHHOM srane lle4eHVl5I MO)l{HO VlCnOllb30BaTb BVl3YaIlVl-
3aLJ,HIO LJ,elle lle4eHVl5I VTO (c. 227) AIl51 npVlH5ITVl5I npaBHllbHoro peweHVlfI
no nOBoAY sKCTpaKLJ,HH 3y60B. K OCHOBHblM Q>aKTOpaM OTHOC5ITC5I CKY4eH-
HOCTb 3y60B, KpVlBa51 Wnee H n03V1LJ,H5I cpeAHHHblX llVlHH. BTOpVl4Hbie
Q>aKTOpbl BKll104alOT B ce651 pacwVlpeHVle, AVlCTaIlVl3aLJ,VlIO MOllflpOB,
BepTHKaIlbHOe COWllVl<poBbIBaHVle SMaIl VI VI HaIlVl4V1e npOMeKa E. MHeHVlfI
OPTOAOHTOB OTHOCVlTellbHO paCWHpeHVlfI AyrH H npVleMlleMO CTeneHH
HaKllOHa HH)I{HVIX pe3LJ,OB 4acTO OTllVl4aIOTC5I.
3Tan 4 - OCTanbHble BepXHMe 3y6bl
KaKHM 06pa30M ClleAyeT YCTaHOBHTb OCTaIlbHbie BepXHVle 3y6bl OTHOCVI-
TellbHO 3anllaHHpOBaHHO n03HLJ,VlH BepXHVlX pe3LJ,OB? KaKHM 06pa30M
YCTpaHHTb CKY4eHHOCTb BepXHHX 3y60B HllVl npOMeKVI Me)I{AY HHMVI
H KaKYIO MexaHHKY lle4eHVl5I VlCnOllb30BaTb AIl51 npaBVlllbHO ycraHoBKH
BepXHHX M01l5lpOB VI npeM01l5lpOB? 3y6Hafl BVl3YaIlH3aLJ,HfI LJ,elle lle4eHVl5I
(VTO) n03BOllVlT OLJ,eHHTb He06xOAVlMOCTb nepeMew.eHVl5I BepXHVlX KllblKOB
H M01l5lpOB.
-..I
c
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C
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n
rr
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rr
:I
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2:
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.
:s
:s
=
PMC. 7.8. Ha TpeTbeM :nane nIlaHpoBaHS! Ile4eHS! paccMaTpBalOT
cKY4eHHocTb 3y60B Il HaIl4e npOMe)l(YTKoB Me>KAY HM B H)I(He Ayre 
npHMaIOT peweHe 0 He06xoAMOCT 3KCTpaKI.t. KaKM o6pa30M cIleAyeT
YCTaHOBTb OCTaIlbHble H)I(He 3y6bl OTHOCTeIlbHO 3anIlaHpoBaHHo
n031.t H)I(HX pe31.t0B  nOHaA06TcS! Il AIlS! 3TOro YAaIleHe 3y60B?
c
j;
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.

PMC. 7.9. Ha 3aKIlI04TeIlbHOM 3Tane nIlaHpoBaHS! Ile4eHS! cIleAyeT
npH5ITb peweHe 0 npaBIlbHo n031.t OCTaIlbHblX nepeAHx 3y60B.
KaKM 06pa30M YCTpaHTb cKy...eHHocTb 3y60B Il npoMe)l(YTK Me>KAY HM
 KaKYIO MexaHKY Ile...eHS! cnoIlb30BaTb?
16

COCTABnSlIOUJ.LIIE 3AnnAHLilPOBAH-
HOM n03L11L1.LIILII PE3L1.0B nPLil
nE"'IEHLIILII AHOMAnLilM II KnACCA
---
B KIDKAOM OTAellbHOM CllY4ae ClleAyeT OnpeAellHTb 3np KaK LJ,ellb lle4eHVl5I,
KOTOpOe 06eCne4HT VlX npaBVlllbHYIO CarVlTTaIlbHYIO VI BepTHKaIlbHYIO n03H-
LJ,IO npH COOTBeTCTBYIOUJ,eM TOpKe. Ka)l{Abl Bpa4-0pTOAOHT AOll)l{eH VlMeTb
C06CTBeHHOe npeACTaBlleHHe 0 TOM, KaKVle KOHKpeTHble LJ,ellH npeClleAyeT
n03HLJ,H5I BepXHHX pe3LJ,OB B KOHKpeTHOM CllY4ae, XOT5I CYUJ,eCTByeT 06UJ,ee
MHeHHe 06 opVleHTHpoB04HO LJ,ellH lle4eHH5I. ABTOpbl He CTaBflT CBoe
3aAa4e B paMKax AaHHO KHHrH nOAP06HO paCCMaTpHBaTb STVI LJ,ellH,
OAHaKO C4HTalOT HHbIM npHBeCTH KOMMeHTapVlH 06w.ero xapaKTepa
no 3TOMY nOBOAY, OTHOC5IUJ,VleC5I K 06bl4HbiM LJ,ect>aIlOMeTpVl4eCKVlM napa-
MeTpaM, a TaK)l{e aHaIlH3Y no Arnett. 2-4
CarMTTanbHaSi COCTasnSlIOw.aSl
3annaHMpOSaHHOM noaMu.MM peau.os
npM ne"leHMM aHOManMM II KnaCCa
T PaAHLJ,HOHHO B OPTOAOHTHH carVlTTaIlbHa51 n03HLJ,H5I BepXHHX pe3LJ,OB onpe-
Ae1l5leTCSI OTHOCHTellbHO llVlHVIVI APo, a npaBHllbHOe LJ,eQ>aIlOMeTpVl4eCKOe
3Ha4eHHe COCTaB1l5leT +6 MM (pVlC. 7.10). B aHaIlVl3e no Arnett n03HLJ,VlfI
BepxHHx pe3LJ,OB COOTHOCVlTC5I C HCTVlHHO BepTHKaIlbHO llVlHHe VI VlCnOllb-
3yeTC5I TepMHH MXI-NL, 0603Ha4alOUJ,VI llVlHeHOe H3MepeHVle OT BepwVlHbl
BepxHero pe31..\8. AO VlCTHHHO BepTVlKaIlbHO llHHVlH (pVlC. 7.11).
TVL
MY>KLJL-1Hbl
-12 MM
APo +6 MM
PMC. 7.1 O. np TpaALtOHHOM nOAXOAe K nnaHpoBaH1O OPTOAOHTW-leCKOro
neLJeHSI n03Lt BepxHx pe3LtOB onpeAenSiIOT OTHOCTenbHO nH APo 6e3
A<I><I>epeHLtaLt cTaHAapTHblx 3HaLJeH AnSI MY}I(LJH  )l(eHll.tH
TVL
)f(eHw.L-1Hbl
-9MM
PMC. 7.11. AHan3 no Arnett onpeAenSieT n03Lt1O BepxHx pe3LtOB OTHOCTenbHO TVL (CTHHO BepTKanbHo nH)  pa3nLJaeT HOPMY AJlSl MY}I(LJH
 }l(eHll.tH

COCTaBnsllow.aSl TOpKa
3annaHMpOBaHHOM n03MLJ.MM pe3LJ.OB
npM ne'feHMM aHOManMM II KnaCCa
T PMVlLJ,HOHHO B OPTOAOHTVlH TOpK BepXHVlX pe3LJ,OB OTHOCHTC5I K n1l0CKOCTH
BepXHe 4elllOCTH, npVllle4eHHVI 06bl4HO CTaBVlllaCb LJ,ellb AOCTH)I{eHVl5I
LJ,eQ>aIlOMeTpH4eCKO BellVl4HHbi 110-115° (pVlC. 7.12). AHaIlVl3 no Arnett
onpeAe1l5leT TOpK BepxHHx pe3LJ,OB OTHOCHTellbHO OKKllI03V10HHO n1l0CKOCTH
BepxHe 4elllOCTH, a TOpK HVI}I(HVIX pe3LJ,OB - K OKKllI03V10HHO n1l0CKOCTVI
HH)I{He 4ellIOCTVI. TOpK BepxHero LJ,eHTpaIlbHoro pe31..\8. COCTaBllfleT 58°
Y M4V1H VI 57° - Y )f(eHUJ,VlH (pVlC. 7.13). 601lee nOAP06Hafl VlH<popMaLJ,Vl5I
no TOPKY BepXHHX pe3LJ,OB npeACTaBlleHa Ha c. 174-176.
11 00 AO 115 0
PMC. 7 .12. TpaALI.OHHO B OPTOAOHT TOpK BepXHX pe3L1.0B OTHOCTCSl
K nIlOCKOCT BepxHe 4eIlIOCT
BepTMKanbHaSi COCTaBnSlIOw.aSl
3annaHMpOBaHHOM n03MLJ.MM pe3LJ.OB
npM ne'feHMM aHOManMM II KnaCCa
AHaIlVl3 no Arnett KOllVl4eCTBeHHO onpeAe1l5leT BepTVlKaIlbHYIO n03V1LJ,HIO
BepxHHx pe3LJ,OB, comaCHO KOTOpO npVlKYc no BepTVlKaIlVl AOll)l{eH COCTaB-
1l5lTb 3 MM C 06HeHVleM 4 MM HVI)I{e BepxHe ry6bl B pacClla61leHHOM
COCT05lHVlH Y M4V1H VI 5 MM - Y )l{eHUJ,HH (pVlC. 7.14).
OpTOAoHTVl4ecKa51 LJ,eQ>aIlOMeTpVlfl He AaeT 4eTKoro onpeAelleHVl5I
BepTHKaJlbHO n03HLJ,HVI BepXHHX pe3LJ,OB. <DaKTOpOM, cnoc06CTBYIOUJ,VlM
B03HVlKHOBeHVlIO aHOMaIlVlVl 11/1 Kllacca, 5IB1l5leTC5I BbICOKa51 llHHVlfI Yllbl6KVI
VI B raKVlX CllY4a5lX B03HVlKaeT He06xoAHMOCTb HaKllOHa BepxHHx pe3LJ,OB
KnepeAVI H VlX YKop04eHVle AIl51 06ecne4eHVlfI Cra6V1llbHOCTVI pe3YllbTaTOB.

M'-IIt1Hbl 58 0
)l(eHUJ,It1Hbl 57 0
PMC. 7. 13. AHaIl3 no Arnett onpeAeIlSIeT TOpK BepxHx pe3L1.0B
OTHOCTeIlbHO OKKIlI03OHHO nIlOCKOCT BepxHe l.jeIlIOCT  YI.jTbIBaeT
He3Hal.jTeIlbHble pa3Il4SI 3Ha4eH AIlSI MY)I(4H  )l(eHIlIH
nplt1KYC -
3MM
06Ha>KeHlt1e
KOpOHOK 3y6oB
M'-IIt1Hbl 4 MM
)l(eHUJ,It1Hbl 5 MM
PMC. 7. 14. OpTOAoHT4ecKaSi Ll.ecl>aIloMeTpSI He AaeT l.jeTKoro onpeAeIleHSI
BepTKaIlbHO n03LI. BepXHX pe3L1.0B. B npOTBOnOIlO)l(HOCTb STOMY aHaJl3
no Arnett KOIl4eCTBeHHO onpeAeIlSIeT BeIlI.jHY npKYca no BepTKaJl
 06HIDKeHe BepXHX pe3L1.0B np nOIlO)l(eH ry6 B COCTOSlH101 nOKOSI.

nEPEMEw.EHE BEPXHX PE3LJ.OB
np nE'-IEH AHOMAn II KnACCA
nOClle OnpeAelleHH5I 3np He06xOAHMO npOBeCTH KOHTpOllb HX nepeMeUJ,e-
HH5I. npH nllaHHpOBaHHH MeXaHHKH lle4eHHfI LJ,elleC006pa3HO paCCMOTpeTb
OTAellbHO BepXHlO1O 3y6HYIO AYry AIl51 YCTaHOBlleHVl5I BepXHHX pe3LJ,OB B
3anllaHHpOBaHHO n03V1LJ,HH. CHa4aIla ClleAyeT cnllaHVlpOBaTb KOppeKLJ,VlIO
n03HLJ,HH BepXHHX, a 3aTeM HVI>KHHX pe3LJ,OB. 3TO n03BOllVlT Bblpa60TaTb
4eTKYIO CHCTeMaTH3pOBaHHYIO opraHH3aLJ,HIO MexaHHKH lle4eHH5I.
npH nllaHHpOBaHHVI ABH)I{eHH5I BepXHHX 3y60B HVI)I{HIOIO AYry MO)l{HO
HCnOllb30BaTb KaK B03MO)l{Hbl VlCT04HHK Q>HKCaLJ,HH, eCllVl Tpe6yeTC5I
MexaHHKa II Kllacca. He06xOAHMO TaK)l{e 06ecne4V1Tb HaA11e)l{aw.H KOHTpOllb
npHKYCa no BepTVlKaIlH (pa3Aell 6), AIlfl TOro 4T06bl n03V1LJ,H5I HVI)I{HVIX pe3LJ,OB
He npen5lTCTBOBaIla nepeMeUJ,eHVlIO BepXHVlX pe3LJ,OB. He3aBVlCVlMO OT STVIX
co06peHH, nepeMeUJ,eHVle BepXHVlX pe3LJ,OB MO)l{HO H HHO nllaHVlpOBaTb
6e3 YLJeTa MepOnpH5ITVI, npOBOAVlMblX Ha HVI)I{He 3y6HO Ayre.
HVI)I{e paCCMaTpHBaIOTC5I THnH4Hbie cVlryaLJ,HVI C nOAP06HbiM onHcaHHeM
peKoMeHAyeMo MeXaHVlKVllle4eHH5I MBTTM AIl51 Ka)l{AOro BHAa ABH)I{eHH
3y60B:
· Me3V1aIlbHOe nepeMeUJ,eHHe BepXHVlX pe3LJ,OB
. AVlCTaIlbHOe nepeMeUJ,eHVle BepXHHX pe3LJ,OB npH HaIlH4V1V1 npOMe>KYTKOB
Me)I{AY HHMH
. AHCTaIlbHOe nepeMeUJ,eHVle BepXHVlX pe3LJ,OB nOClle YAaIleHH5I BepXHHX
npeM01l5lpOB
. AHCTaIlbHOe nepeMeUJ,eHHe BepXHVlX pe3LJ,OB npH OTCyrCTBHH npOMe-
>KYTKOB H 6e3 YAaIleHH5I 3y60B.
Me3ManbHoe nepeMew.eHMe
BepXHMX pe3u.OB npM nel.feHMM
aHOManMM II KnaCCa
npH aHOMaIlH5IX 11/2 Kllacca BepXHHe pe3LJ,bl pacn01l0)l{eHbi 06bl4HO CllHWKOM
K3aAH B KOMnlleKCe llHLJ,a.
COrllaCHO COBpeMeHHblM KOHLJ,enLJ,H5IM, KacalOUJ,VlMC5I n03V1LJ,HVI pe3LJ,OB
B KOMnlleKCe llHLJ,a, YCTaHOBKa M01l5lpOB no II Kllaccy (no Angle) 5IB1l5leTC5I
BTOpH4HbiM no OTHoweHHIO K HaKllOHeHHblM K3aAH BepxHHM H HVI)I{HVIM
pe3LJ,aM. B npoLJ,ecce BbipaBHVlBaHVl5I H nepeMeUJ,eHVlfI 3y60B BepxHe AyrVl
pe3LJ,bl nepeMeUJ,aIOTC5I KnepeAH, npVl61lH)I{a5lCb K 3anllaHVlpOBaHHo
n03HLJ,HH H TaKHM 06pa30M, comaCHO KllaCCVI<t>HKaLJ,HVI, nepeXOA5IT B KaTero-
pHIO aHOMaIlHH 11/1 Kllacca no Angle. npH lle4eHHVI naLJ,VleHTOB nOAPocTKO-
Bom B03paCTa 11/1 Kllacc 06bl4HO MO)l{HO nOllY4HTb B pe3Yllb TaTe 06bl4HOro
OPTOAOHTH4ecKoro lle4eHH5I, OAHaKO y OTAellbHblX B3pOCllbiX naLJ,VleHTOB
MO)f(eT nOTpe60BaTbC5I xHpyprH4ecKoe BMeWaTellbCTBO Ha HVI)I{He 4ellIOCTH.
T pe6yeMoe nepeMeUJ,eHVle KnepeAVI BepXHHX pe3LJ,OB nOllY4alOT maBHblM
06pa30M B pe3Yllb TaTe 3y60aIlbBeOllflpHbiX Vl3MeHeHVI. B OpTOAOHTH4eCKO
u.eQ>aIlOMeTpHH yroll SNA HCnOllb3yeTc5I AIlfl onpeAelleHVl5I n03HLJ,HVI CKelleTa,
n03TOMY MO)l{HO npeAn01l0)l{HTb, 4TO Me3HaIlbHOe ABVI)I{eHHe BepxHe 4elllOCTH
cnoc06CTByeT YllY4weHVlIO CarHTTaIlbHO n03HLJ,HH BepxHVlx pe3LJ,OB. 3TO
Bbl3BaHO TeM, 4TO T04Ka A, KOTOPYIO TPYAHO 06HapHTb Ha CHHMKe, HMeeT
TeHAeHLJ,HIO Vl3MeH5ITbC5I BMeCTe C n03V1LJ,Vle KopHe BepxHVlx pe3LJ,OB Ha
3Tane BbipaBHVlBaHH5I npVl aHOMaIlH5IX 11/2 Kllacca (naLJ,HeHTKa D.O., c. 212).
Ha61llOAaeMOe H3MeHeHHe n01l0)l{eHH5I T04KVI A 4acTO npHBoAVlT K 601lbWeMY
CKelleTHoMY HapyweHHIO npH nepexoAe aHOMaIlHVI B 11/1 Kllacc, 4eM STO
Ha61lIOAaeTC5I B Ha4aIle aHOMaIlHH, KllaccHQ>HLJ,VlpyeMo KaK 11/2 Kllacc.
-
PMC. 7.15. CIlO>KHO TOliHO onpeAeIlTb T04KY A. OHa MeeT TeHAeH1O
K 3MeHeH1O BCIleA 3a 3MeHeHeM n03 KopHe BepXHX pe3OB Ha
3Tane nepeMell.l.eHSI 3y60B BepXHe Ayr np IlelleH aHoMaIl 11/2 KIlacca

Ha npaKTVlKe nepBbl STan lle4eHVlfI aHOMaIlH 11/2 Kllacca MO)l{HO
npOBOAHTb ABYM5I cnoc06aMVI:
1. B Ha4aIle lle4eHH5I 3aQ>HKcVlpoBaTb annapaT TOllbKO Ha BepXHVle 3y6bl
(HllH TOllbKO KOllbLJ,a Ha HVI)I{HHe M01l5lpbl) (pVlC. 7.16A). npH nepeXOAe K
HCnOllb30BaHHIO CTaIlbHO np5lMoyrollbHO AyrVl Ha BepxHe 3y6HO Ayre
MO)l{HO 3aQ>HKcHpoBaTb annapaT Ha HVI)I{HHe 3y6bl H npVlcrynHTb K VlX
BblpaBHHBaHHIO.
2. HeCbeMHbl annapaT MO)l{HO YCTaHOBVlTb Ha BepXHlO1O VlllVl HVI)I{HIOIO
AyrVl C caMoro Ha4aIla lle4eHVlfI; HO npVl STOM naLJ,VleHT AOll)l{eH HOCHTb
HaKYC04HYlO nllaCTVlHKY B Te4eHHe nepBblX HeCKOllbKLilX MeCflLJ,eB lle4eHH5I
(pHC. 7.166) AIl51 pa306UJ,eHVlfI npHKYCa H npeAoTBpaeHH5I nOBpee-
HVlfI 6peKeTOB Ha HVI)I{HVIX 3y6ax (naLJ,VleHTKa D.O., c. 209). no Mepe
BbipaBHVlBaHH5I BepxHe AyrVl CbeMHa51 HaKYC04Ha51 nllaCTVlHKa nOCTe-
neHHO Tep5leT T04HOCTb npVllleraHH5I H ee CHVlMaIOT.
BblpaBHVlBaHVle H nepeMeUJ,eHHe BepXHHX 3y60B npOXOAVlT B pe3YllbTaTe
npHMeHeHVlfI THnVl4HO 04epeAHocTH lle4e6Hbix Ayr. nepBble AyrH 06bl4HO
CKpY4eHHbie npOB01l04Hble, nOCKOllbKY B Ha4aIle lle4eHH5I 4acro B03HVlKaeT
He06xoAHMOCTb BblnOllHeHVlfI AOnOllHVlTellbHblX Vl3rVl60B Ha nepeAHHX 3y6ax
BO H36e)l{aHHe 06pa30BaHVlfI 4pe3MepHbix CHll, AecTBYIOUJ,VlX Ha nepeAHVle
pe3LJ,bl. AnHHa BepxHe AyrVl YBellH4HBaeTC5I B Te4eHVle nepBblX HeCKOllbKVlX
MeC5ILJ,eB lle4eHH5I, nOSTOMY AVlCTaIlbHble 3arVl6bl ClleAyeT BblnOllH5ITb Ha
1 MM n03aAH Tpy60K Ha M01l5lpax, 4T06bl cnoc06cTBoBaTb STOMY npoLJ,eccy
(pHC. 7.16B). THnH4Hbie Vl3MeHeHVl5I Ha Ha4aIlbHOM STane lle4eHVl5I MO)l{HO
npOClleAHTb Ha npVlMepe naLJ,VleHTKH 0.0, c. 208 VI 209.
PMC. 7.166. B nepBble MeCSILlbl llelleHSI aHoMallVI 11/2 KJlaCCa naLleHT
MO>KeT HOCTb HaKycollHYIO nllacTHKY Ha BepxHeVi lIellIOCT. (A11bTepHaTBHble
MeTOAbl KOHTpOllSi npKyca no BepTKall paccMaTpBalOTcSI B pa3Aelle 6,
c. 134).
PMC. 7. 16A. llelleHe aHoMallVI 11/2 KJlaCCa MO>KHO HallaTb C HaJlO>KeHSI
annapaTa CKJllOlITellbHO Ha BepxHe 3y6bl
PMC. 7.168. Ha inane BblpaBHBaHSI  nepeMel1teHSI 3y60B ACTaJlbHble
3ar6b1 clleAyeT BblnOllHSlTb Ha paccTOSlH 1 MM n03aA Tpy60K Ha MOJlSlpaX
AJlSl YAJlHeHSI Ayr

AMCTanbHoe nepeMew.eHMe
BepXHMX pe3u.OB npM HanMLlMM
npOMe>KYTKOB Me>KAY HMMM
B HeKOTOpblX CllY4a5lX aHOMaIlH 11/1 Kllacca OTMe4aeTC5I 4pe3MepHoe
BblABH)I{eHHe BepxHHx pe3LJ,OB KnepeAH. ECllVl STO CB5I3aHO C HaIlH4HeM
npoMe>KYTKoB B nepeAHeM OTAelle, TO He COCTaBllfleT oc060ro TPYAa
06beAHHHTb BepXHVle pe3LJ,bl VI nepeMeCTVlTb HX Ha HMelOUJ,eeC5I MecTO.
(MexaHHKY npOLJ,eCca MO)l{HO cpaBHVlTb C VlCnOllb30BaHVleM KYCKa BepeBKVI,
4T06bl c06paTb wapHKH Ha CTOlle!)
MeXaHHKY CKOllb)l{eHVl5I MO)l{HO VlCnOllb30BaTb Ha 06b14HO CTaIlbHO
np5lMoyrollbHO Ayre. CnOllb30BaHVle aKTVlBHblX CB5I30K tieback 06ecne4V1-
BaeT He06xoAHMYlO peTpaKLJ,HIO L-1 3aKpblTVle npoMeKoB. HorAa HX
AecTBHe YCVlllHBalOT clla60 SllaCTH4Ho LJ,en04KO Vl3 4eTbipex 3BeHbeB
Ha nepeAHHx 3y6ax. nepeA Ha4aIlOM peTpaKLJ,HVI pe3LJ,OB ClleAyeT y6eAVlTbc5I
B TOM, 4TO HH)I{HHe 3y6bl n03B01l5lT OCYUJ,eCTBVlTb nOA06Hoe ABVI)I{eHVle.
MO)l(eT nOHaA06HTbC5I COOTBeTCTBYIOw.ee YCVllleHVle <pVlKCaLJ,VIVI C nOMOUJ,blO
BepXHe He6HO AyrH, HaIlO)l{eHHe BHepOTOBO T5IrH B H04Hoe BpeMfI VlllVl
31laCTH4HbIX T5Ir II Kllacca. T VlnH4Ha51 MexaHVlKa lle4eHH5I cxeMaTVl4eCKVI npeA-
craBlleHa Ha pHC. 7.17 VI 7.18, a TaK)l{e Ha npVlMepe naLJ,HeHTKH D.O., c. 209.
+
+
PMc.7.17
.--
PMc.7.18
PMC. 7.17 M 7. 18. np Hall4 npOMe)l(YTKoB Me>KAY nepeAHM BepxHM 3y6aM All51 peTpaKI.\ pe31.\0B  3aKpbIT5I npOMe)l(}'TKoB MO)l(HO CnOllb30BaTb
MexaHKY CKOllb)l(eH5I Ha CTallbHOVI np5lMoyrollbHOVI Ayre ceeHeM 0,019/0,025 AIOVIMa. KPIOK Ha Ayre AOll)l(Hbl 6b1Tb pacn01l0)l(eHbI HenocpeAcTBeHHo B031le
6peKeTOB Ha BepxHx 60KOBbiX pe3l.\aX, T06bl CKlllOTb CTOllKHOBeHe C 6peKeTaM Ha KllblKaX no Mepe 3aKpbIT5I npOMe)l(yrKa. <t>KCal.\1O MO)l(HO 06ecneTb
C nOMOlllblO He6HoVi Ayr, BHepoTOBoVi T5Ir 1l allaCTHbIX T5Ir II KllaCca.
---+-
.--
A
.--
6
PMC. 7 .19. BA co llIe4HoVi CTOpOHbl cxeMbi MexaHK CKOllb)l(eH5I nOClle YAalleH5I nepBblx BepXHX npeM01l5lpoB. 6e3 YClleH5I <I>KCal.\ (A) 06blHO
npocxoAT ABYCTopoHHee 3aKpblTe Ayr. np CnOllb30BaH YClleH5I <I>KCal.\ (B) B03MO)l(Ha peTpY35I weCT nepeAHx 3y60B B AocrynHoe npocTpaHcTBo
 YAep)l(aHL-1e CarTTallbHOVI n031.\ M01l5lpOB.

AI>1CTanbHoe nepeMeLLl.eHl>1e
BepXHI>1X pe3u.OB nocne YAaneHI>1S1
BepXHI>1X npeMOnSipOB
no B03MO)l{HOCTVI 06bl4HO ClleAyeT Vl36eraTb YAaIleHVl5I HH)I{HVIX npeM01l5lpOB
npH lle4eHVlH aHOMaIlVl 11/1 Kllacca, BBHAY He06xoAVlMOCTH YAep)l{aHHfI
Me3HaIlbHO n03HLJ,HVI HH)I{HVIX pe3LJ,OB. nOSTOMY TOllbKO HeKoTOpble CllY4aVl
II Kllacca lle4aT C sKCTpaKLJ,Vle 4eTbipex npeM01l5lpoB. ECllVl Bce )l{e Tpe6yeT-
C5I HX YAaIleHVle, TO 4acTO LJ,elleC006pa3Ha SKCTpaKLJ,H5I nepBblX BepXHVlX
npeM01l5lpOB VI BTOpblX HVI)I{HVIX npeMOllflpOB, 4TO cnoc06cTByeT MexaHVlKe
lle4eHVl5I. HeKoTopble Vl3 nOA06HbiX aHOMaIlH MO)l{HO TaK)l{e lle4V1Tb nOClle
YAaIleHVl5I ABYX BepxHVlx npeM01l5lpOB (naLJ,HeHTKa L.J., c. 184), OKOH4a-
TellbHO YCTaHaBllHBafl M01l5lpbl BO II Kllacce 5 .
AnSI peTpaKLJ,HH BepxHVlx pe3LJ,OB nOClle sKCTpaKLJ,VlH npeM01l5lpOB
npVlMeH5IeTC5I MexaHVlKa CKOllb)l{eHVl5I Ha THnVl4Ho CTaIlbHO npflMoyrollbHO
Ayre. AecTBVle peTpaKLJ,HOHHbIX CVlll 06ecne4V1BaeTc5I 3a C4eT npVlMeHeHVl5I
aKTHBHblX CBSl30K tieback. MO)l{eT nOHaA06V1TbC5I BBeAeHVle He601lbworo
AOnOllHHTellbHoro TOpKa Ha CTaIlbHO np5lMoyrollbHO Ayre Ha nepeAHeM
Y4acTKe, npVl STOM ClleAyeT Vl36eraTb npVlMeHeHVl5I 4pe3MepHbiX peTpaK-
LJ,HOHHbIX CHll. TaKVlM 06pa30M MO)l(HO nOAASp)l(HBaTb KOHTpOllb TopKa
BepXHVlX pe3LJ,OB BO BpeMfI YMeHbweHVlfI ropH30HTaIlbHOro npVlKYca.
MO)l{eT nOHaA06V1TbC5I COOTBeTCTBYIOw.ee YCVllleHVle Q>VlKCaLJ,VlH
C nOMOUJ,blO VlllH BepXHe He6HO AyrVl VI BHepOTOBO TflrVl, HCnOllb3yeMo B
H04Hoe BpeM5I, VlllVl )l{e SllaCTVl4HbiX Tflr II Kllacca (pVlC. 8.12, c. 225) VlllVl VlX
KOM6V1HaLJ,HVI. npeABapVlTellbHO He06xoAVlMO 06ecne4V1Tb BblpaBHHBaHVle
HVI)I{HVIX 3y6oB, 4T06bl nepeKpblTHe B nepeAHeM Y4acTKe 6bl1l0 MVlHVlMaIlbHbIM,
a HVI)I{HVle pe3LJ,bl He npenflTCTBOBaIlVl peTpaKLJ,HVI. TVlnVl4Ha51 MexaHVlKa
lle4eHHfI cxeMaTH4eCKH npeACTaBlleHa Ha pVlC. 7.19 VI 7.20, a TaK)l{e
nOKa3aHa Ha npVlMepe naLJ,VleHTKVI L.J., c. 184.
. .
PMC. 7.20. BA C OKKJlI03OHHOVI CTOpOHbl MexaHK CKOJlb)l(eH5I,
npMeHSleMoVi AJlSl peTpaKl.\ BepxHx pe3l.\OB nOCJle YAaJleHSI npeMOJlSlpoB.
BBAY YCJleHSI ct>KCal.\ BHepoToBoVi TSlroVl, He6HoVi AYroVi Jl 3JlaCT4-
HbIM TSlraM II KJlaCCa B03MO)l(HO YAep)l(aHe n03l.\ BepxHx MOJlSlpOB
 peTpY3SI B AocTynHoe npocTpaHcTBo weCT nepeAHx 3y60B.
AI>1CTanbHoe nepeMeLLl.eHl>1e
BepXHI>1X pe3u.OB npl>1 OTCYTCTBI>1I>1
npOMe>KYTKOB 1>1 6e3 YAaneHI>1S1 3y6oB
B HeKOTOpblx CllY4a5lx aHOMaIlHVI 11/1 Kllacca MO)l{HO npHH5ITb peweHHe
o HesKCTpaKLJ,VlOHHOM lle4eHVlH 3y60B, a BepxHHe 60KoBbie 3y6bl He06xo-
AVIMO nepeMecTHTb B AHCTaIlbHOM HanpaBlleHHH AIl51 06ecne4eHH5I nOClle-
AYIOUJ,e peTpaKLJ,HVI BepxHHx pe3LJ,OB B 3anllaHHpOBaHHo n03HLJ,HH. npH
MVlHVlMaIlbHOM ABVI)I{eHHH (1-3 MM) pOTaLJ,Vl5I nepBblX M01l5lpOB B OCHOBHOM
pewaeT np061leMY (pVlC. 7.21). B AaHHo cVlryaLJ,VIVI LJ,elleC006pa3Ho npHMe-
HeHVle BHepOToBo T5IrVl H CKOllb351UJ,HX KpI04KOB. OAHaKo, eCllH Tpe6yeTc5I
ABVI)I{eHVle Ha paCCT05IHVle 601lee 3 MM, TO cVlryaLJ,H5I OC1l0)l{H5IeTC5I KaK
AIlfl Bpa4a, TaK VI AIlSl naLJ,VleHTa, He3aBVlCHMO OT HCnOllb3yeMo MexaHHKH
lle4eHVl5I.
B STOM CllY4ae He06xoAHMa 601lee C1l0)l{Ha51 MexaHHKa lle4eHH5I BepXHHX
M01l5lpOB, n03BOllfllOw,a51 npOBeCTH AVlCTaIlbHOe nepeMeUJ,eHHe npeM01l5lpOB
npVl nOMow.H OAHOro Vl3 MeTOAOB, npeAHa3Ha4eHHbix AIl5lSTO LJ,ellH, 06bl4HO
C oAHoBpeMeHHo nOAAep)l{KO BHepoTOBo T5Iro. B llHTeparype npHBOA51TC5I
npVlMepbl 6 , 4TO STOT sQ><I>eKT MO)l{HO nOllYllVlTb, VI TOllbKO B CllY4ae C caMblMH
AHCLJ,HnllVlHVlpOBaHHbIMH naLJ,HeHTaMVI YAaeTC5I A06HTbC5I 3anllaHHpOBaHHoro
nepeMew.eHVl5I 3y60B. T VlnVl4Ha51 MexaHVlKa lle4eHVl5I nOKa3aHa Ha c. 194 H 195.
AaHHa51 MeTOAVlKa lle4eHHfI 06bl4HO YBellH4HBaeT BpeM5Ille4eHH5I, npH
STOM He BcerAa YAaeTC5I A06V1TbC5I 3anllaHHpOBaHHbiX LJ,elle. nOSTOMY B He-
KOTOpblX CllY4a5lX aBTOpbl OTKa3bIBaIOTC5I OT KOHLJ,enLJ,VIVI HeSKCTpaKLJ,HOHHOro
lle4eHH5I H paCCMaTpHBalOT Bonpoc 06 YAaIleHHH BTOpblX sePXHHX M01l5lPOB.7- 9
TaKO nOAXOA B 3Ha4HTellbHO CTeneHH 061ler4aeT MexaHHKY lle4eHH5I, H
cyw.eCTBYIOT nOATBep)I{AeHVl5I 10 TOMY, 4TO BnOClleACTBHH TpeTbH BepXHHe
M01l5lpbl 3aHHMalOT npaBVlllbHYIO n03V1LJ,VlIO npH npope3blBaHHH B 601lee, 4eM
80% nOA06HbiX CllY4aeB (naLJ,VleHTKa D.O., c. 215). ECllVl )l{e TpeTbH M01l5lpbl
OTCyrCTBYIOT HllVl HenpaBVlllbHO YCTaHOBlleHbl, LJ,elleC006pa3Ho YAa1leHHe
BepXHVlX npeM01l5lpoB.
PMC. 7 .21. KOppeKl.\SI pOTal.\ nepBoro BepxHero MOJlSlpa n03BOJlSleT
nOJlY'"ITb 6JlaronpSlTHoe nepeMel1\eHe K3aA ero e4HoVi nOBepxHocT Ha
1-3 MM, cnoc06cTBYSI ycraHOBJleH1O B I KJlaCce. ACTaJlbHble 3ar6bl AOJl)l(Hbl
OTCTOSlTb Ha 2-3 MM OT Tpy60K Ha MOJlSlpaX BO 36e)l(aHe orpaHwleHSI
pOTal.\ 3y60B.
1

KOHTponb TOpKa SepXHMX pe3u.OS
B HIOHe 2000 roAa Fastlight 11 npeACTaBVlll Ha paCCMOTpeHVle KOHLJ,enLJ,VlIO
llHLJ,eBoro 4eTbipexyrollbHHKa, COCTOflUJ,ero H3 ClleAYIOUJ,HX 4eTbipeX Yr1l0B:
· Yroll Me>KAY BepXHHMH pe31..\8.MH H He6HO n1l0CKOCTbIO
· Yroll Me>KAY HH)I{HHMH pe3LJ,aMVI VI MaHAVl6Y1l5lpHO n1l0CKOCTbIO
· Me)l{pe3LJ,OBbl yroll
· Yroll Me>KAY He6HO H MaHAVl6Y1l5lPHO n1l0CKOCTflMVI (pHC. 7.22)
npH AelleHHH 4eTbipexyrollbHHKa nOnOllaM nOllY4alOTCfI ABa
TpeyrollbHHKa. BepXHVI TpeyrollbHHK HMeeT ClleAYIOUJ,He Yr1lbl:
· Yroll Me>KAY He6HO VI OKK1l103HOHHO n1l0CKOCT5IMH
· Yroll Me>KAY BepXHHMVI pe3LJ,aMVI VI He6HO n1l0CKOCTbIO
· Yroll Me>KAY BepXHVlMH pe3LJ,aMVI VI OKK1l103HOHHO n1l0CKOCTbIO
n
PMC. 7.22. LJeTblpexyrollbHK Fastlight
n
PMC. 7 .23. BepxH TpeyrollbHK 4eTblpexyrollbHKa Fastlight

HH)I{HH TpeyrollbHHK HMeeT ClleAYIOUJ,Vle Yr1lbl:
. Yroll Me)I{,AY MaHAVl6Y1l5lpHO H OKKllI03V10HHO n1l0CKOCT5IMH
. Yroll Me)I{,AY HH)I{HVlMVI pe3LJ,aMH H OKKllI03V10HHO n1l0CKOCTbIO
. Yroll Me)I{,AY HVI)I{HVlMH pe31..\8.MH VI MaHAVl6Y1l5lpHO n1l0CKOCTbIO
(pHC. 7.24).
TaKa51 OLJ,eHKa 3y60aIlbBe01l5lpHoro KOMnlleKCa 5IBllfleTC5I nOlle3HO
VlHQ>opMaLJ,He OTHOCVlTellbHO TOpKa pe3LJ,OB H cBHAeTellbCTByeT 0 TOM, 4TO
B 3aBHCVlMOCTVI OT CKelleTHblX CTPYKTYP ClleAyeT HCnOllb30BaTb pa31lVl4Hbie
HOpMaTVlBHble 3Ha4eHH5I (pVlC. 7.25).
KOMneHCaLJ,Vl5I TOpKa nepeAHVlx 3y60B, KaK npaBVl1l0, He06xoAVlMa npVl
lle4eHHH aHOMaIlH I Kllacca Y naLJ,VleHTOB C 601lbWVlM Me)l{4elllOCTHbiM yr1l0M
VI naLJ,VleHTOB co CKelleTHblMH aHOMaIlVlSlMVI II H III Kllacca, eCllVl B paMKax
lle4eHH5I He nllaHLt1pyeTc5I xVlpyprH4ecKOe BMeWaTellbCTBO AIl51 KOppeKLJ,VlH
CKelleTHblX COOTHoweHVI.
npH nllaHHpOBaHVlH lle4eHVlSI aHOMaIlVl II Kllacca Bpa4 AOll)l{eH YMeTb
npaBHllbHO OLJ,eHVlTb cVlryaLJ,HIO VI nOCTaBVlTb Ha 4aWH BeCOB, C OAHO
CTOpOHbl, )l{ellaHVle Vl36e)l{aTb xHpyprVl4ecKOro BMeWaTellbCTBa, H, C APYro
PMC. 7.24. H>KH TpeyronbHK 4eTblpexyronbHKa Fastlight
CTOpOHbl, Te He61laronpVl5lTHbie H3MeHeHH5I npOQ>H1l5l1lHLJ,a, KOTopble MOryT
B03HVlKHyTb B pe3YllbTaTe KOMneHCaLJ,VlH TOpKa pe3LJ,OB. KaKa51 CTeneHb
KOMneHCaLJ,VlH TOpKa MO)l{eT C4HTaTbC5I npHeMlleMO, 4T06bllle4eHHe He
nOTpe60BaIlO xHpyprH4ecKoro BMeWaTellbCTBa?
T OpK pe3LJ,OB KOHTpOllHPYIOT C nOMOUJ,blO np5lMoyrollbHbiX Ayr ce4eHHeM
0,019/0,025 AIOMa B na3ax 6peKeTOB 0,022/0,028 AIOMa. CHCTeMa MBF
pa3pa60TaHa C LJ,ellblO COKpaUJ,eHHfI KOllVl4eCTBa He06xoAHMbiX H3rH60B AyrH.
HecMoTp51 Ha STO npeVlMYUJ,eCTBO KOHCTPYKLJ,HH 6peKeTOB, Bpa4 AOll>KeH nOHH-
MaTb, 4TO B CllY4ae He06xoAVlMOCTH ClleAyeT BblnOllH5ITb AOnOllHHTellbHbie
H3rH6bl Ha CTaIlbHO np5lMoyrollbHO Ayre AIl51 YBellH4eHH5I HllH YMeHbweHH5I
TopKa pe3LJ,OB B COOTBeTCTBVIVI C Tpe60BaHH5IMH y AaHHoro naLJ,HeHTa
(naLJ,HeHT D.O., c. 210).

AHOManll1s:1 I KJlacca
naLJ,lI1eHTbl, 06CneAOBaHHbie
B MW-IlI1raHe
6°
16°
AHOManll1s:1 I KJlacca
C ManblM yrnoM
60°
AHOManll1s:1 II KJlacca
100°
PMC. 7 .25. OeHK8 3y60aJlbBeOJlSlpHoro KOMnJleKCa B BAe
lJeTbipexyroJlbHKa, pa3AeJleHHoro Ha ABa TpeyroJlbHKa,
npeACTaBJlSleT CKJlI04TeJlbHYIO H<I>opMa1O 0 TOpKe
pe3OB. B 3aBCMOCT OT CKelleTHbiX YCJlOBiiI CJleAyeT
CnOJlb30BaTb pa3JllJHble HOpMbl  eJl JlelJeHSI.
BepxHelJeJllOcTHoiil  H)I(HelJeJlIOCTHOiil TpeyroJlbHK
BblSlBJlSlIOT TnlJHbliil TOpK nepeAHX 3y60B B pa3JllJHblX
KJlHlJeCKX cTYaSlx. CCblJlK8 Ha HX npBeAeHa AaJlee
(C. 179) np 06cY}I(AeH TOpKa H)I(HX pe3oB. Ba)l(Ho
OTMeTTb, lJTO A8HHbie BeJli>1lJHbl TOpKa npBeAeHbl AJlSI
AJlHHblX oceiil pe3oB, TaK )l(e KaK  B e<l>aJlOMeTplJeCKX
3MepeHSlx. OH OTJllJaIOTCSI OT BeJllJH TopKa B
6peKeT8x, ynoMHaeMblx B APyrx pa3AeJlaX AaHHoiil KHr
(c. 33), KOTOpble OTHOCSlTCSI K BecT6YJlSlpHOiil nOBepXHOCT
KJlHlJeCKOiil KOpOHK 3y6a.
6°
18°
rpynna
naLJ,lI1eHTOB
A-pa Arnett
()t(eH UJ,1I1 H bl/MY)l(LJII1Hbl)
26°
AHOManll1s:1l KJlacca
c 60nbWII1M yrnoM
60°
70°
84°
8°
20°
AHoManll1s:1l11 Knacca

BepTMKanbHblM KOHTpOnb pe3u.OB
B OPTOAOHTH4eCKO npaKTVlKe 4aCTO B03HHKaeT He06xOAVlMOCTb B OTKpblTHVI
rlly60KOro npVlKYca VlllVl )l{e 3aKpblTVIVI OTKpblTOro npVlKYCa. MeXaHVlKa
lle4eHH5I AIl5l STVIX CllY4aeB 6bllla Vl31l0>KeHa B npeAblAYUJ,eM pa3Aelle. npH
nOnblTKe A06HTbC5I HOpMaIlbHOro npVlKYca no BepTVlKaIlVl OPTOAOHT AOll)l{eH
C03AaTb 06pa3 nllaHVlpyeMblx pe3Yllb TaTOB lle4eHVl5I OTHOCVlTellbHO CTeneHH
06HeHH5I pe3LJ,OB K BepXHe ry6e, KaK npeAIlO)l{Vlll Arnett. OAHaKo, 4TO
KaCaeTC5I STO n03V1LJ,HVI 3y60B, TO Y xHpypra 601lbWe B03MO)l{HOCTe,
4eM y OpTOAOHTa.
Ha Ha4aIlbHOM STane lle4eHH5I aHOMaIlVl 11/2 Kllacca B npOLJ,eCce BblpaB-
HHBaHH5I 3y60B npOVlCXOAVlT 3Ha4V1TellbHa51 VlHTPY3V1f1 BepXHVlX pe3LJ,OB no
Mepe npHMeHeHH5I Ayr Bce 601lbwero Ce4eHVl5I. n03AHee, Ha srane npflMO-
yrollbHO AyrVl npVllle4eHVIVI aHOMaIlVl 11/2 Kllacca VI APyrVlx, BepXHVle
pe3LJ,bl MO)l{HO He3Ha4V1TellbHO YKOPOTVlTb, BblnOllHfIfI AOnOllHVlTellbHbl Vl3rVl6
Ha Ayre, VlllH C nOMow.blO BHepoTOBo T5IrH C J-KpI04KaMVI VlllVl HX KOM6V1Ha-
LJ,HVI. BepxHVle pe3LJ,bl MO)l{HO YKOPOTVlTb OTHOCVlTellbHO llHHVIVI YllbI6KVI, eCllH
naLJ,VleHT roTOB HOCVlTb BHepOTOBYIO Tflry C J-KpI04KaMVI (naLJ,VleHT M.P.,
c. 146), npVlKpenlleHHblMVI K CneLJ,HaIlbHO npVlna5lHHbiM KplO4KaM Ha CTaIlbHO
np5lMoyrollbHO Ayre (pVlC. 7.26 H 7.27). MexaHHKa YCVlllHBaeTC5I, eCllVl Ha
BepxHe Ayre AOnOllHVlTellbHO BblnOllHVlTb Vl3rVl6 KpHBO Wnee Ha 2-3 MM.
MO>KHO TaK)l{e nOnbiTaTbC5I YAIlVlHHTb BepXHHe pe3LJ,bl OTHOCVlTellbHO
llHHHVI Yllbl6KVI ClleAYIOUJ,HM 06pa30M. CTaIlbHYIO npflMoyrollbHYIO AYry
ce4eHHeM 0,019/0,025 AIOMa C KpVlBO aHTH-Wnee BellVl4V1HO 2-3 MM
nOABfl3blBalOT K HVI)I{He Ayre. Ha BepXHlO1O 3y6HYlO AYry HaKllaAblBalOT
CTaIlbHYIO AYry ce4eHVleM 0,014 AIOMa c KpVlBO Wnee BellVl4HHO 3 MM.
3aTeM MO)l{HO HCnOllb30BaTb nepeAHVle BepTVlKaIlbHble SllaCTH4Hbie T5IrVl
(50 r) AIl5l YAIlVlHeHH5I BepXHVlX pe3LJ,OB.
.",
.,
\
"
-.
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,
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, ,'.:'" -,' ,.
,,' .,' '" " j ,
. 1,' '-s:'.,;y-" "'. ..
. ': ... \.  , 1 \, 
', , ,:' , ,/ _ "It... l
.' '- . -, ..
_ _ ::.'-i....:.::T ._-:  - . 9' ,...,.:..
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,-of'.. ... ;-
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PMC. 7.26 M 7.27. BepxHe pe3L1,bl MO)l(HO YKOPOTTb OTHOCTeJlbHO JlH
YJlbI6K B TOM CJlY4ae, eCJl naLl,eHT COrJlaCeH HOCTb BHepOTOBYIO TSiry
C J-KpI04KaM. np aTOM He06xOAMO OCTOpO)l(HO npOBeCT AOnOJlHTeJlbHblVi
3r6 KplO4KOB, aAamPYSI X K JlH ll.IeK.

YCTAHOBnEHiliE HiII>KHiliX PE3LJ.OB
nPM AHOMAnillSiX II KnACCA
-
AeCTBHe C HH)I{HHMH pe3LJ,aMH 06bl4HO Bbl3blBaeT 601lbWe np061leM, 4eM
C BepXHHMH. 3a4acrylO 6blBaeT BeCbMa C1l0)l{HO pa3pa60TaTb MeXaHHKY
lle4eHH5I, KOTOpa51 06eCne4V1lla 6bl OmHMaIlbHYIO n03HLJ,HIO HH)I{HHX pe3LJ,OB
OTHOCHTellbHO 3anllaHHpOBaHHO n03HLJ,VlH BepXHHX pe3LJ,OB. B CllY4ae naLJ,H-
eHTOB, Y KOTOpblX npOAOll)l{aeTCfI npOLJ,eCC pOCTa, TaK)l{e BeCbMa 3aTpYAHH-
TellbHO nporH03HpOBaTb 6YAYUJ,He H3MeHeHHfI C AOCTaT04HO T04HOCTbIO
BBHAY H3MeHeHH5I HanpaBlleHVl5I H CTeneHH pOCTa HH)I{He 4ellIOCTVI. HeCMOT-
p51 Ha 3TO, B03MO)l{HO HCnOllb30BaTb 1l0rH4eCKVI VI CVlCTeMaTH3HpOBaHHbl
cnoc06 AJl51 nOllY4eHH5I nllaHVlPyeMo n03V1LJ,HH HVI)I{HVIX pe3LJ,OB, KaK YKa3aHO
BO BTOpOM STane nllaHHpOBaHH5Ille4eHVl5I (C. 166).
KOHTponb CarMTTanbHOM n03MLI,MM
HM>KHMX pe3L1,OB
npH lle4eHHH aHOMaIlVl II Kllacca 3aAa4a 06bl4HO 3aKll104aeTC5I B nepeMe-
llteHHH HH)I{HHX pe3LJ,OB KnepeAH C LJ,ellblO aAamaLJ,VIVI VlX K 3anllaHHpOBaHHO
n03HLJ,HH BepXHHX pe3LJ,OB, YKa3aHHO B nepBOM STane nllaHVlpOBaHVlfI
lle4eHH5I. 3TO KaCaeTC5I KaK lle4eHVl5I aHOMaIlVl 11/1 Kllacca, TaK H BTOporo
3Tana lle4eHH5I aHOMaIlH 11/2 Kllacca, nOClle Ha4aIlbHoro BbipaBHVlBaHH5I
BepxHe AyrH npVl ee nepeXOAe B aHOMaIlVlIO 11/1 Kllacca.
B MexaHHKe OPTOAoHTVl4ecKoro lle4eHVl5I CarVlTTaIlbHYIO n03V1LJ,HIO HVI)I{HVIX
pe3LJ,OB OTHOCHTellbHO BepXHVlX pe3LJ,OB MO)l{HO H3MeHHTb TpeMfI cnoc06aMVI:
n
1. nepeMeUJ,eHVle HH)I{HHX pe3LJ,OB B KOCTH HH)I{He 4elllOCTVI (pHC. 7.28).
2. 1I13MeHeHHe AllVlHbl HH)I{He 4elllOCTH (pVlC. 7.29).
3. 1I13MeHeHHe CarVlTTaIlbHO n03HLJ,HH HH)I{He 4elllOCTVI B pe3YllbTaTe
H3MeHeHH5I n03HLJ,HVI MblUJ,ellKOBbiX OTpOCTKOB HVI)I{He 4elllOCTH B
CYCTaBHblX 5IMKax (pHC. 7.30).
PMc.7.28
n
  .."'.'...
-,' "
\...'\ \\"",
....
.plf"
I
PMc.7.29
PMc.7.30

--
nepeMew.eHMe HM>KHMX pe3u.OB B KOCTM
HM>KHeM LfenlOCTM
AHana30H OPTOAOHTH4ecKOro ABH)I{eHVl5I HH)I{HVIX pe3LJ,OB B npeAellax KOCTVI
HVI)I{He 4elllOCTVI BeCbMa OrpaHVl4eH. Me3V1aIlbHOe KOpnYCHOe nepeMew.e-
HVle 3THX 3y60B 06bl4HO HeB03MO)l{HO BClleACTBVle aHaTOMVl4ecKoro
CTpOeHH5I KOCTH Ha Y4aCTKe HVI)I{HVIX pe3LJ,OB (pVlC. 7.31). nOSTOMY 1l1060e
Me3V1aIlbHOe ABVI)I{eHVle HH)I{HVIX pe3LJ,OB flB1l5leTC5I, rllaBHblM 06pa30M,
pe3YllbTaTOM Vl3MeHeHVl5I TopKa (pHC. 7.32). npeAell AaHHoro HaKllOHa
KnepeAVI COCTaB1l5leT 100° no OTHoweHVlIO K MaHAH6Y1l5lpHO n1l0CKOCTVI,
KaK B HH)I{He4elllOCTHOM TpeyrollbHVlKe aHOMaIlVlH II Kllacca (c. 176). B CllY4ae
npeBblWeHH5I 3TOro YCTaHOBlleHHoro npeAella B03HVlKaeT pVlCK Hecra6Hllb-
HOCTH nOllY4eHHbiX pe3Yllb TaTOB, YXYAweHVl5I SCTeTVl4ecKOro BVlAa VlllVl
3a601leBaHH AeceH.
HaKllOH HH)I{HVIX pe3LJ,OB KnepeAH C VlX HCXOAHO n03V1LJ,HVI 06bl4HO
He06xoAVlMO BblnOllHVlTb npVl lle4eHVlH aHOMaIlVl 11/2 Kllacca VI MHorVlX
aHOMaIlH 11/1 Kllacca, CBfl3aHHbiX C npVlBbI4KO cocaTb YKa3aTellbHbl
naIleLJ" KorAa, KaK npaBH1l0, HH)I{HHe pe3LJ,bl THnVl4HO HaKllOHeHbl K3aAVI.
B raKHX CllY4a5lx 06w.enpVlHflTO nepeMeUJ,aTb HVI)I{HVle pe3LJ,bl B Me3HaIlbHOM
HanpaBlleHVlH. npVllle4eHHH aHOMaIlH 11/1 Kllacca H CKelleTHblX aHOMaIlVl
II Kllacca Bce 4aUJ,e CTaIlH npVlMeHflTb HaKllOH HVI)I{HVIX pe3LJ,OB nOA ymoM,
npeBblwalOUJ,HM 95° K MaHAH6Y1l5lpHO n1l0CKOCTVI H Ha paCCT05lHVlH +2 MM
AO llHHVlH APo. CTOpOHHHKH TPaAHLJ,VlOHHOro nOAXOAa K AaHHo np061leMe
B03paIlH npOTVlB TaKO MeTOAVlKVI Vl3-3a pHcKa peLJ,HAHBOB aHOMaIlVl
H peLJ,eCCHVI AeCHbl. OAHaKo Ha npaKTVlKe He Ha61llOAaIlOCb HVI peLJ,eCCVIVI
PMC. 7.31. J],ana30H OPTOAoHT4ecKoro AB>KeHSI H>KHX pe3oB Ha
Y4acTKe KOCT H>KHeVi 4ell1OCT orpaHw.leH
AeCHbl, HH nopeHH napOAOHTa 12 . 13 , a B03MO)l{Hbie peLJ,HABbl aHOMaIlHH
MO)l{HO orpaHH4V1Tb, HCnOllb3Y51 nOCT05IHHble peTeHLJ,HOHHble annapaTbl.
nOSTOMY YMepeHHbl HaKllOH HVI)I{HHX pe3LJ,OB KnepeAH MO)l{HO HCnOllb-
30BaTb AIl51 nOllY4eHVl5I VlX YAOBlleTBOpHTellbHoro KOHTaKTa C 3anllaHHpOBaH-
HO n03HLJ,Vle BepxHHx pe3LJ,OB. He3Ha4HTellbHbl HaKllOH HH)I{HHX pe3LJ,OB
KnepeAVI MO)l{eT 6blTb npVleMlleMblM npVllle4eHVI aHOMaIlH 11/1 K1lacca
C YMepeHHo CKelleTHO aHOMaIlVle II Kllacca. TaKHM 06pa30M, MO)l(HO
Vl36e)l{aTb 4pe3MepHo peTpaKLJ,HVI BepXHVlX pe3LJ,OB C nOClleAYIOUJ,e
nOTepe BOrHyrOCTVI BepxHe ry6bl (BbI3bIBalOUJ,e YXYAweHHe 3CTeTHKH
npoQ>H1l5l1lHLJ,a).
npVllle4eHVIVI aHOMaIlH II Kllacca B 601lbWHHCTBe CllY4aeB pa3YMHbl
npeAell HaKllOHa HVI)I{HVIX pe3LJ,OB K MaHAH6Y1l5lpHO n1l0CKOCTH COCTaB1l5leT
1 00°. Bo MHorHX CllY4aflx aHOMaIlVlVl II Kllacca HH)I{HVle pe3LJ,bl MO)l(HO
HaKllOHVlTb KnepeAH.
reoMeTpVl4ecKVI, Kble 2,5° HaKllOHa KnepeAVI nepeMew,aIOT pe>KYUJ,He
Kpa51 HVI)I{HHX pe3LJ,OB Ha 1 MM (c03AaBa51 2 MM Mecra Ha KCDKp,ble 2,5°
HaKllOHa KnepeAVI). ClleAOBaTellbHO, 61laroAap51 nOllY4eHHIO MeCTa npH
lle4eHVlH aHOMaIlVl II Kllacca, 06bl4HO OTnaAaeT He06xoAHMOCTb B YAa1leHHH
HVI)I{HHX npeM01l5lpoB.
TOpK _6° AIl51 HVI)I{HHX pe3LJ,OB B CVlCTeMe MB"f™ nOMoraeT npeAoTBpaTHTb
4pe3MepHbl HaKllOH HVI)I{HHX pe3LJ,OB KnepeAH. nOSTOMY npH HCWle)l(allteM
BblpaBHVlBaHVIVI HH)I{He 3y6HO AyrH CTaIlbHYIO np5lMoyrollbHYlO AYry
ce4eHHeM 0,019/0,025 AIOMa MO)l{HO 4acTO HCnOllb30BaTb AIl51 YCHlleHH5I
SllaCTH4HbiX T5Ir II Kllacca npVl peTpaKLJ,HVI BepXHHX pe3LJ,OB, eCllH 3TO
He06xoAHMO no nOKa3aHH5IM.
n
PMC. 7 .32. Me3allbHoe AB>KeHe H>KHX pe3OB B pe3Yllb TaTe X HaKIlOHa
KnepeA C 3MeHeHeM TopKa

5naronpMSlTHbie M3MeHeHMSI AnMHbl
MnM n03Mu.MM HM>KHeM ....enIOCTM
Me3HaIlbHOe ABH)I{eHHe HVI)I{HHX pe3LJ,OB OTHOCVlTellbHO 3anllaHVlpOBaHHO
n03HLJ,HH BepXHHX pe3LJ,OB MO)l{HO YBellH4V1Tb, eCllVl npOVl30AYT 61laronpVl-
5ITHble H3MeHeHH5I AJlVlHbl HH)I{He 4elllOCTVI, H Me3V1aIlbHOe nepeMeUJ,eHVle
T04KH B. 3TO B 3Ha4V1TellbHO CreneHVI cnOc06cTByeT MeXaHVlKe lle4eHVl5I,
YllY4Wa51 B 601lbWHCTBe CllY4aeB SCTeTVlKY npOQ>VlllflllVlI..\8.. KpOMe TOro,
eCllH T04Ka B B xOAe lle4eHH5I nepeMeCTVlTC5I KnepeAVI, nOTpe6yeTc5I
MeHbWH HaKllOH HH)I{HVIX pe3LJ,OB KnepeAH.
nOSTOMY YBellH4eHVle AJlHHbl HVI)I{He 4elllOCTH Tpe6yeTc5I npVllle4eHVIVI
601lbWHHCTBa CllY4aeB II KllaCCa, OAHaKO VI AaIlbWe COMHVlTellbHO, cyw,eCT-
BYIOT llH KaKHe-llH60 MeTOAVlKVI, KOTOpble MO)f(eT VlCnOllb30BaTb Bpa4-0pTO-
AOHT AJl51 AOCTVI)I{eHVl5I STOro. BBVlAY TOro, 4TO TeMa BeCbMa 06WHpHa5l, ee
MO)l(HO BKpaTLJ,e Vl31l0)l{HTb B HVI)I{enpVlBeAeHHblX nYHKTax.
POCT HM>KHeM ....enIOCTM
Ha STane nllaHHpOBaHVl5I lle4eHH5I y pacryw,Vlx naLJ,VleHTOB He06xOAVlMO
nOCTaBHTb 060CHOBaHHbl nporH03 BellVl4V1Hbl VI HanpaBlleHVlfI pOCTa HVI)f(He
4elllOCTH, H KaK ClleACTBVle - Vl3MeHeHVle n03HLJ,VlH T04KVI B. B LJ,e1l0M, y na-
LJ,HeHTOB C MaIlblM yr1l0M Ha61lIOAaIOTC5I 601lee 61laronpH5ITHble Vl3MeHeHVl5I
n03HLJ,HH T04KH B, 4eM y naLJ,HeHTOB CO cpeAHVlM VlllVl 601lbWVlM yrnoM (pVlC.
7.33). 601lee 61laronpVl5lTHbie H3MeHeHVl5I pOCTa Ha61lIOAaIOTC5I Ha n03AHVlX
aTanax pa3BHT5I y pacryUJ,Vlx MaIlb4V1KOB cpaBHTellbHO C AeB04KaMVI. 14

60J1bWOVI Me)l('-IeJ1IOCTHOVI
yroJ1
MaJ1blVi Me)l(ljeJ1IOCTHOVI yroJ1

PMC. 7.33. Ha :nane nnaHMpoBaHSI ne4eHSI paCTYl.l.Iero naL.teHTa He06xoAMO nOCTaBTb 060cHoBaHHbl nporH03 BenW.IHbI  HanpaBneHSI pocra H)I(He
...e1ll0CT

BniJIHHiJle Ha iJl3MeHeHiJle n03iJ1u.iJIiJI
HiJI>KHeM LlenlOCTiJI C nOMow.blO
cl>YHKu.iJlOHanbHbIX annapaTOB
npHMeHeHHe Q>YHKLJ,VlOHaIlbHbIX annapaTOB B nepHOA cMeHHoro npVlKYCa Y
naLJ,HeHTOB nOAPOcTKOBOro B03paCTa 4aCTO AaeT nOllmKVlTellbHble pe3Yllb-
TaTbl npH lle4eHVlH aHOMaIlH II KllaCCa C nOClleAYIOw.VlM YllY4WeHVleM
SCTeTVlKH npOQ>VlllflllHI..\8.. npVl4V1Ha TaKVlX 61laronpVl5lTHbiX Vl3MeHeHVI 3aK-
1l104aeTC5I B TOM, 4TO Q>YHKLJ,VlOHaIlbHble annapaTbl CnOC06Hbi Bbl3BaTb 3y6Hbie
VI CKelleTHble H3MeHeHH5I. C HX nOMow.blO MO)l{HO ocyw.eCTBVlTb HaKllOH
HH)I{HHX pe3LJ,OB KnepeAH, BepXHHX pe3LJ,OB - K3MH, 61laronpVl5lTHO MOAVlQ>H-
LJ,HpOBaTb pOCT HVI)I{He 4elllOCTVI VI orpaHVl4V1BaTb pOCT BepXHe 4ellIOCTVI.
B Te4eHVle npOWllblX AeC5ITVllleTVI npOBOAVlllVlCb AVICKYCCVIVI VI HaY4Hbie
VlCClleAOBaHHfI, HanpaBlleHHble Ha Bbl5lCHeHVle TOro, cnOC06HblllVl Q>YHKLJ,VlO-
HaIlbHble annapaTbl YBellH4V1BaTb OKOH4aTellbHYIO AIlVlHY HVI)I{He 4elllOCTVI
no cpaBHeHHIO C ee AIlVlHO npVl eCTeCTBeHHOM pOCTe 6e3 npVlMeHeHVlfI
annapaToB. CClleAOBaTb sry np061leMY BeCbMa C1l0)l{HO, VI B HacToow.ee
BpeM5I AaHHbie HaY4Hbix VlCClleAOBaHVI He nOATBep)I{AaIOT B03MO>KHOCTVI
MOAHQ>VlKaLJ,HVI CTeneHVI pocra HVI)I{He 4elllOCTVI npVl HCnOllb30BaHVlH STVIX
annapaTOB.
HeCMOTp51 Ha STO, MHorVle OPTOAOHTbl nOllaralOT, 4TO npVlMeHeHVle
Q>YHKLJ,VlOHaIlbHbIX annapaTOB LJ,elleC006pa3HO npVllle4eHVIVI aHOMaIlVl
11/1 Kllacca, nOCKOllbKY OHH Bbl3blBalOT 3Ha4V1TellbHble, 6blcTpble VI nOlle3-
Hble Vl3MeHeHVlfI (naLJ,HeHTKa T.S., c. 198), VI MOryr COKpaTVlTb STan
nOClleAYIOUJ,ero lle4eHVl5I HeCbeMHblM annapaTOM.
B 1998 roAY Pancherz VI coaBTOpbl 15 npOaHaIlVl3V1pOBaIlVl 98 KllVlHVl4ec-
KHX CllY4aeB 11/1 Kllacca, lle4eHHbix C nOMow.blO annapaTa Herbst, C LJ,ellblO
OLJ,eHKVI «sQ>Q>eKTVlBHoro pOCTa MblUJ,ellKOBbiX OTpOCTKOB». AaHHbl TepMVlH
HCnOllb30BaIlH AIl51 onVlcaHVlfI CYMMapHoro s<j>Q>eKTa peMOAellVlpOBaHVlfI
MblUJ,ellKOBbiX OTpOCTKOB, CYCTaBHblX 5IMOK H Vl3MeHeHVI n03V1LJ,V1V1 Mblw.ell-
KOBblX OTpOCTKOB. Y naLJ,VleHTOB C aBTOpOTaLJ,He HVI>KHe 4elllOCTVI KnepeAH
OHH 06HapVlllVl OTHOCVlTellbHO 601lbWOe H3MeHeHVle n03V1LJ,VIVI nOA60pOAKa
KnepeAH, a Y naLJ,VleHTOB C aBTOpOTaLJ,Vle HVI)I{He 4elllOCTVI K3MVI - OTHOCVI-
TellbHO 601lbWOe H3MeHeHVle STO n03V1LJ,VIVI K3MVI.
ECllH AIl51 lle4eHVlfI naLJ,VleHTa Tpe6yeTC5I npVlMeHeHVle Q>YHKLJ,VlOHaIlbHOro
annapaTa B npaKTVlKe, TO ero LJ,elleC006pa3HO npVlMeHflTb Ha n03AHeM srane
cMeHHoro npVlKYca. B STO BpeM5I B03MO)l{eH VlHTeHCVlBHbl pOCT, 4TO n03BO-
1l5leT HenocpeACTBeHHO nepeViTH K srany npVlMeHeHVl5I HeCMHbIX annapaTOB
cpa3Y )l{e nOClle 3aBepweHVlfI STana HCnOllb30BaHVl5I <j>YHKLJ,VlOHaIlbHOro
annapaTa. npVl npVlMeHeHVlH <j>YHKLJ,VlOHaIlbHOro annapaTa Ha paHHeM STane
cMeHHoro npHKYca MOryr B03HHKaTb TPYAHOCTVI Ha ::nane peTeHLJ,VIVI nepeA
YCTaHOBKO HecbeMHoro annapaTa.
HeKOTOpble SQ>Q>eKTbl <j>YHKLJ,VlOHaIlbHblX annapaTOB MOryr B03paCTaTb npVl
npVlMeHeHVlH SllaCTVl4HbiX T5Ir II Kllacca B CllY4ae npVlMeHeHVl5I HeCbeMHblX
annapaTOB Ha 06eHX 4ell1OCTflX. HanpVlMep, «Q>YHKLJ,VlOHaIlbHbl sQ>Q>eKT»
MO)l{HO 4acTO Ha61llOAaTb npVl VlCnOllb30BaHVIVI SllaCTVl4HbiX Tflr II Kllacca Ha
BTOpOM STane lle4eHVl5I aHOMaIlVl 11/2 Kllacca Y pacryw.HX naLJ,VleHTOB.
6narOnpiJIHTHOe iJl3MeHeHiJle
n03iJ1u.iJIiJI Mblw.enKOBbiX OTpOCTKOB
HiJI>KHeM LlenlOCTiJI
B HeMHorHX CllY4aflX, KorAa HVI>KH5I5I 4elllOCTb HaxOAHTC5I B AHCTa1lbHO
n03V1LJ,HVI B Ha4aIle lle4eHH5I, MO)l{HO O)l{HAaTb, 4TO MblUJ,ellKOBble OTpOCTKH
B XOAe lle4eHVlfI nepeMeCT5ITC5I Me3HaIlbHO B LJ,eHTpaIlbHYIO n03HLJ,HIO.
HanpVlMep, npVllle4eHVlH HeKOTopblX aHOMaIlH 11/2 Kllacca VlMeeTC5I
B03MO)l{HOCTb He3Ha4V1TellbHoro Me3V1aIlbHoro nepeMeUJ,eHH5I T04KH B nOClle
nepeXOAa AaHHo aHOMaIlVlH B 11/1 Kllacc (pVlC. 7.34), XOT5I 3TO TPYAHO
nOATBepAHTb AaHHblMH VlCClleAOBaHH (naLJ,VleHT D.O., c. 212).
PMC. 7.34. Ha HallaJlbHblX 3Tanax JlelleHSI HeKoTOpblX aHOMaJl II Kllacca
MeeTCSl B03MO>KHOCTb 6JlaronpSlTHoro Me3aJlbHoro nepeMeLl.leHSI TO"'K B
OpTOneAiJlLleCKiJlM BepTiJlKanbHblM
KOHTpOnb BepXHeM LlenlOCTiJI
XOTfI TaKO KOHTpOllb paccMaTpHBaeTC5I KaK MeTOA AOCTVI)I{eHH5I
Me3V1aIlbHoro nepeMew.eHH5I T04KH B, HMeeTC5I HeMHoro nOATBep>KAeHHVI
SQ>Q>eKTVlBHOCTVI STO OPTOAOHTVl4eCKO npOLJ,eAypbl. BecbMa TPYAHO
A06V1TbC5I BepTVlKaIlbHoro KOHTpOll51 BepxHe 4elllOCTVI C nOMoUJ,blO
OpTOAoHTVl4ecKVlx MeToAoB.

He6naronpIIISITHbie 1113MeHeHIIISI
n03111LJ.1II1II MblUJ.enKOBbiX OTpOCTKOB
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YMeHbWeHllle ee AnlllHbl
B HeKOTOpblX CllY4a5lX MO)l{eT npOHCxOAVlTb 3Ha4V1TellbHOe YKOp04eHVle
HH)I{He 4elllOCTH BClleACTBHe Vl3MeHeHH Ha Y4acTKax ee MblUJ,ellKOBbiX
OTpOCTKOB (pHC. 7.35). lt1HorAa STO npoVlcxoAHT B pe3YllbTaTe VlAVlonaTH-
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BCTpe4aIOTC5I He 4acTO, HO OHH MOryT npVlBeCTH K He61laronpVl5lTHOMY
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Ha Y4aCTKe MblUJ,ellKOBbiX OTpOCTKOB. TaKVle aHOMaIlHH Ha61lIOAaIOTC5I
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HO OHO BCTpeLJaeTCSI He LJacTO. Pe30p6L1,SI MO>KeT 6blTb OAHOCTOpOHHeVi. OHa Bbl3blBaeT YKopOLJeHe AIlHbl H>KHeVi 4eIlIOCT, LJTO, B CBOIO OLJepeAb,
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nepeMeL4eH1O TOLJK B KH3Y  K3aA B XOAe OPTOAOHH14ecKoro IleLJeHSI Il nOCIle ero 3aBepweHSI.

He6naronpMSlTHoe M3MeHeHMe
n03Mu.MM Mblw.enKOBbiX OTpOCTKOB
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Ha Ha4aIlbHOM STane BbipaBHVlBaHVl5I VI nepeMew.eHHfI 3y60B npVllle4eHVlH
HeKOTOpblX aHOMaIlH 11/1 Kllacca MblUJ,ellKOBble OTpOCTKVI MOryT nepeMec-
THTbC5I B AHCTaIlbHOM HanpaBlleHVlVI, npHBOA5I K 3Ha4HTellbHbiM VI He61laro-
npH5ITHbIM H3MeHeHVlflM n03HLJ,VlH T04KVI B. 3m npOHCXOAVlT B Tex CllY4a5lX,
KorAa LJ,eHTpaIlbHa51 OKKllI03V1f1 VI LJ,eHTpaIlbHOe COOTHoweHHe He COBnaAalOT
B Ha4aIle lle4eHH5I (pHC. 7.37). Roth 17 npeA11araIl paHHee VlCnOllb30BaHVle
aKpVl1l0BbiX WHH AIl51 VlAeHTHQ>VlKaLJ,HVI TaKVlX naLJ,VleHTOB VI onpeAelleHHe
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PMC. 7.37. Ecn eHTpanbHa OKKm03  eHTpanbHoe CooTHoweHe He cOBnaAalOT B HaLlane neLleH, TO MbllJ..tenKOBble OTpOCTK 06blLlHO nepeMell.\alOTC
B AcTanbHoM HanpaBneH Ha :nane BblpaBHBaH  nepeMelJ..teH 3y60B. B pe3ynbTare npocxoAT 3Ha4renbHble  He6naronpTHble 3MeHeH n03
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1 Tweed C. H. 1966. Clinical orthodontics. Mosby, St Louis.
2 Arnett G. W., Jalic J. S., Kim J. et al. 1999. Soft tissue cephalometric analysis:
diagnosis and treatment planning of dentofacial deformity. American Journal of
Orthodontics and Dentofacial Orthopedics 116:239-253.
3 Arnett G. W., Bergman R. T. 1993. Facial keys to orthodontic diagnosis and
treatment planning - part I. American Journal of Orthodontics and Dentofacial
Orthopedics 103:299-312.
4 Arnett G. W., Bergman R. T. 1993. Facial keys to orthodontic diagnosis and
treatment planning - part II. American Journal of Orthodontics and Dentofacial
Orthopedics 103:395-411.
5 Bennett J. t Mclaughlin R. P. 1997. Orthodontic management of the dentition with
the preadjusted appliance. Isis Medical Media, Oxford (ISBN 1 89906691 8)
pp. 233-250. Republished in 2002 by Mosby, Edinburgh (ISBN 0723432651).
6 Gianelly A.A. 1998. Distal movement of the maxillary molars. American Journal of
Orthodontics and Dentofacial Orthopedics 114:66-72.
7 Graber T. M. 1969. Maxillary second molar extraction in Class II malocclusion.
American Journal of Orthodontics 56:331-353.
8 Bishara S. E., Ortho D., Burkey P. S. 1986. Second molar extractions: a review.
American Journal of Orthodontics and Dentofacial Orthopedics 89:415-424.
9 Wilson W. L., Wilson R. C. 1981. Modular orthodontics manual. Denver: Rocky
Mountain Orthodontics.
.. :tr
'W  .
. -or
10 Basdra E. K., Stellzig A., Komposch G. 1996. Extraction of maxillary second
molars in the treatment of Class II malocclusion. Angle Orthodontist
66(4):287-292.
11 Fastlght J. 2000. Tetragon: a visual cephalometric analysis. Journal of Clinical
Orthodontics 34(6):353-360.
12 Artun J. t Osterberg S. K., Kokich V. G. 1986. Long-term effect of thin interdental
alveolar bone on periodontal health after orthodontic treatment. Journal of
Periodontology 57:341-346.
13 Ruf S., Hansen K., Pancherz H. 1998. Does orthodontic proclination of lower
incisors in children and adolescents cause gingival recession? American Journal of
Orthodontics and Dentofacial Orthopedics 114: 1 00- 106.
14 Riolo M. et a11974. Atlas of craniofacial growth. Center for Human Growth and
Development, University of Michigan.
15 Pancherz H., Ruf S., Kohlas P. 1998. 'Effective condylar growth' and chin position
changes in Herbst treatment: a cephalometric roentgenographic long-term study.
American Journal of Orthodontics and Dentofacial Orthopedics 114:437-446.
16 Wolford L. M., Cardenas K. 1999. Idiopathic condylar resorption: diagnosis,
treatment protocol and outcomes. American Journal of Orthodontics and
Dentofacial Orthopedics 116:667-677.
17 Roth R. 1972. Gnathological concepts and orthodontic treatment goals. In:
Jarabak J R, Fizzell, J A (eds) Technique and treatment with light wire appliances,
2nd edn. Mosby, St Louis pp. 1160-1223.

nAUV1EHTKA L.J.
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flll1TEPATYPA
*Clark W. J. 1988 The twin block technique: a functional orthopedic appliance system.
American Journal of Orthodontics 93: 1-18.
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Clark W.J. 1995, Twin block functional
therapy: applikations in dentofacial
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(ISBN 0723 42120X), 1995.
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BA C OKKJlI03OHHO CTOpOHbl Yepe3 MeCSlLI nOCIle CHSlTSI annapaTOB.
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3HaYTeIlbHble, HO 6IlaronpSlTHble 3MeHeHSI npo<pIlSl. B xOAe IleYeHSI
yroIl SNA YBeIlYIlCSI C 83 0 AO 84 0 (c. 170), a yroIl SNB YBeIlYIlCSI
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BHYTppOTOBble CHMK, BblnOIlHeHHble Yepe3 19 MeCSlLleB nOCIle 3aBep-
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ABa nepBble H)I(He MOIlSlpbl 06beAHeHbl HaIlO)l(eHHO Sl3bIYHO AYro.
AnSI YIlY'-IWeHSI BepTKaIlbHoro BblpaBHBaHSI IleBoro TpeTbero H)I(Hero
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BHYTppOTOBble CHMK nOCIle KoppeKLI n03LI IleBoro TpeTbero
H)I(Hero MOIlSlpa.
BA C OKKJlI03OHHO CTOpOHbl nOCIle 3aBepweHSI OpTOAOHTYeCKoro
IleYeHSI. BepxHe TpeTb MOIlSlpbl YCTaHoBIlCb B YAoBIleTBopTeIlbHblx
n03LISlX (c. 173).
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PA3AEn 8
 -
0630P neLleHMSI aHOManMM
IIIKnacca
BCTynneHMe 219
T OLJ HOCTb Bbl nOll HeH lI1S1 Ll,e<t:>alloMeTpll1LJeCKOrO
aHallll13a 219
HlI1)J(HeLJellJOcTHaS1 npOrHaTlI1S1 lI1llll1
BepXHeLJellJOcTHaS1 peTpOrHaTlI1S1? 220
rpa<t:>lI1K lleLJeHlI1S1 aHoMallll1V1111 Kllacca 220
npll1HS1TlI1e peWeHlI1S1 0 xlI1pyprll1LJeCKoM/
HexlI1pyprll1LJeCKOM neLJeHlI1l11 aHOMallll1V1
III Kllacca 222
3<t:><t:>eKT «BbITeCHeHlI1S1» 60KOBbiX 3y6oB
npll1 CKYLJeHHOCTlI1 MOllS1pOB 224
3llaCTlI1LJHbie TS1rll1 AJlS1 lleLJeHlI1S1 aHOManll1V1
III Kllacca 225
Me3l11anbHOe nepeMew,eHlI1e BepXHlI1X pe3L1,OB
B KOCTHOVI TKaHlI1 230
OrpaHlI1LJeHlI1S1 nepeMew,eHlI1S1 BepXHlI1X pe3L1,OB
B Me3l11allbHOM HanpaBlleHlI1l11 230
Me3l11allbHOe nepeMew,eHlI1e BepXHeLJellJOcTHoVi
KOCTlI1, 06yclloBlleHHoe npOLl,eCCOM pOCTa 231
Me3l11allbHOe nepeMew,eHlI1e BepXHeLJellJOcTHoVi
KOCTlI1 B XOAe OPTOAOHTlI1LJeCKOrO lleLJeHlI1S1 231
OnpeAelleHlI1e 3annaHlI1pOBaHHoVl n03l11L1,lI1l11
BepXHlI1X pe3L1,OB 226
HlI1)J(HlI1e pe3L1,bl 226
OCTallbHble BepXHlI1e 3y6bl
OCTallbHble HlI1)J(HlI1e 3y6bl
nepeMew,eHMe HM>KHMX pe3u.OB npM ne"leHMM
aHOManMM III Knacca 232
AlI1CTallbHoe nepeMew,eHlI1e lI1 peTpaKLI,lI1S1
HlI1)J(HlI1X pe3L1,OB B npeAellax KOCTlI1 HlI1)J(HeVi
LJellJOCTlI1 232
I
AlI1CTallbHoe nepeMeeHlI1e HlI1)J(HeVi LJellJOCTlI1 -
AlI1CTallbHoe pen03l11L1,lI10HlI1pOBaHlI1e 233
AlI1CTallbHoe nepeMew,eHlI1e HlI1)J(HeVi LJellJOCTlI1 -
OrpaHlI1LJeHlI1e pa3BlI1TlI1S1? 233
Me3l11allbHOe nepeMew,eHlI1e HlI1)J(HeVl LJellJOCTIII -
pa3BlI1TlI1e no III Kllaccy 234
'ieTblpe 3Tana nnaHMpoBaHMSI npM ne"leHMM
aHoManMM III Knacca 226
227
227
nau.MeHT M .5. He3KcTpaKu.MoHHoe ne"leHMe
aHOManMM III Knacca co CKY"IeHHOCTblO
3y6oB 236
KOMnOHeHTbl 3annaHMpoBaHHoM n03Mu.MM
pe3u.oBnpMne"leHMMaHoManMM
III Knacca 228
nepeMew,eHMe BepXHMxpe3u.OB npMne"leHMM
aHOManMM III Knacca 229
nau.MeHTKa K. B. ne"leHMe aHOManMM
III Knacca c YAaneHMeM
BTOpblX MonSipOB 242
217

BCTYnnEHE
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nOIlO)l(eHSI, KacalOw,ecSI cpaBHeHSI OpTOAOHT «nepeMew,eHSI 3y60B»
C OPTOAOHTe «pa3Mew,eHSI Bcex 3y60B», npBeAeHHble BO BCTYnTeIlbHO
YaCT pa3AeIla 7 (c. 162), OTHOCSlTCSI TaK)l(e  K IleYeH1O aHOMaIl
III KJlacca. np IleYeH 60IlbwHcTBa naLleHTOB c aHOMaIlSlM III KJlacca
CHaYaIla He06xoAMO n03LIoHpoBaHe 3y60B, a 3aTeM YCTaHOBIleHe
npaBIlbHoro COOTHoweHSI pe3L10B AIlSl AOCT)I(eHSI rapMOH IlLla.
B paMKax AaHHoro pa3AeIla aBTOpbl He 3aAaBaIlCb LleIlblO nOAP06HO
paCCMaTpBaTb npOLlecc nIlaHpOBaHSI IleYeHSI aHOMaIl III KJlacca,
OAHaKO CYTaIl LleIleco06pa3HbiM npBecT co06peHSI 06w,ero
xapaKTepa  BKpaTLle OCBeTTb KJllOyeBble MOMeHTbl MexaHK IleYeH5I.
Ycnex IleYeHSI aHOMaIl III KJlacca 3aBCT OT AarHocTK CTHHO
nppOAbl aHOMaIl  TOYHOCT OLleHK B03MO)l(HbiX 3MeHeH B npOLlecce
pocTa. np IleYeH TaKX aHOMaIl cIleAyeT YYTbIBaTb cIleAYIOw,e
<paKTOpbl:
. TOYHOCTb BbmOIlHeHSI Lle<paIlOMeTpYeCKoro aHaIl3a
. H)I(HeYeIlIOCTHaSl nporHaTSI Il BepXHeyeIlIOCTHaSl peTporHaTSI?
. r pa<pK IleYeHSI aHOMaIl III KJlacca
. npHSlTe npaBIlbHoro peweHSI 0 xpyprYeCKOM/HexpyprYeCKOM
IleYeH aHOMaIl III KJlacca
. 3<p<peKT «BbITecHeHSI» 60KOBbiX 3y60B np CKYYeHHOCT MOIlSlpOB
. MexaHKa IleYeHSI aHOMaIl III KJlacca
PMC. 8.1. npi-1 aHOMaJli-1S1X III KJlaCCa lIacTO Ha6Jl10AalOTCSI CMell.teHi-1S1 Hi-1}1(He
lIeJlIOCTi-1, KOTopble Heo6xOAi-1MO pacn03HaTb i-1 TOlIHO 3aperi-1CTpi-1pOBaTb
TOLIHOCTb BblnOnHeHMSI
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HeM (LJ,C)  LleHTpaIlbHO OKKJlI03e (LJ,O) ero cIleAyeT AarHocTpOBaTb
 nOAP06HO 3apercTppOBaTb np nepBOM nocew,eH naLleHTa. y HeKO-
TOpblX naLleHTOB HaIlYe cMew,eH H)I(He YeIlIOCT (pc. 8.1) MO}l(eT
6blTb OCHOBHblM <paKTOpOM, 06ycIlaBIlBalOw,M npHSlTe peweHSI
o He06xoAMOCT xpyprYecKOro Il HexpyprYecKOro BMewaTeIlbCTBa.
n03TOMY OyeHb BHO 3aperCTppoBaTb LleHTpaIlbHOe nOIlO)l(eHe
Mblw,eIlKOBbIX OTpOCTKOB B CYCTaBHblX SlMKax, C TeM, ym6bl nIlaHpoBaHe
IleYeHSI MorIlO 6a3poBaTbcSI Ha LJ,c H)I(He YeIlIOCT. 3m npeAnOIlaraeT
BbInOIlHeHe BOCKOBOro npKYCHoro wa6IloHa (pc. 8.2) AIlSl npOLlecca
perCTpaLl  AarHOCTK, BKJllOyalOw,ero B ce6S1 C03AaHe pa60Yx MO-
AeIle, BbInOIlHeHe CHMKOB IlLla, Lle<paIlOMeTpYeCKX peHTreHorpaMM,
a B HeKOTOpblX cIlyyaSlX  TOMorpaMM. 3aTeM He06xoAMO OTperyIlpoBaTb
He3HaYTeIlbHoe OTKpbITe H)I(He YeIlIOCT B npOLlecce IlLleBoro  Lle<pa-
IlOMeTpYecKOro aHaIl3a. T aKM cnoc060M cIleAyeT TOYHO 3aperCTppO-
BaTb CTHHoe CarTTaIlbHOe nOIlO)l(eHe H)I(He YeIlIOCT C paCnOIlO)l(eH-
HbIM no LleHTpy Mblw,eIlKOBbIM OTpOCTKaM  B3S1Tb ero 3a OCHOBY AIlSl
nIlaHpOBaHSI IleYeHSI.
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PMC. 8.2. AnSI TOlIHO peri-1CTpal\i-1i-1 Cari-1TTaJlbHoro nOJlO}l(eHi-1S1 Hi-1}1(He
lIeJlIOCTi-1 Heo6xOAi-1M BOCKOBbl npi-1KycHbl Wa6JlOH B n03i-1l\i-1i-1 C LteHTpaJlb-
HblM nOIlO}l(eHi-1eM Mblll.teJlKOBblX OTpOCTKOB. TaKi-1M o6pa30M o6eCnelli-1BaeTCSI
B03MO}l(HOCTb TOlIHoro nJlaHi-1pOBaHi-1S1 JlelleHi-1S1, OCHoBaHHoro Ha peri-1CTpaLt-H-1
Hi-1}1(He lIeJlIOCTi-1 B nOJlO}l(eHi-1i-1 LteHTpaJlbHoro COOTHOWeHi-1S1.
219

HM>KHe'fenIOCTHaSi npOrHaTMSI
MnM BepXHe'fenIOCTHaSi peTpOrHaTMSI?
Ha HaYaIlbHOM 3Tane nIlaHpOBaHSI IleYeHSI aHOMaIl KJlaCCa III He06-
XOAMO BbISlCHTb, YTO npeACTaBIlSleT c060 aHOMaIlSI - npOrHaT1O
H)I(He yeIlIOCT Il peTpOrHaT1O BepXHe yeIllOCH1, Il )l(e COYeTaHe
3TX ABYX OTKJlOHeH. B 60IlbWHCTBe cIlyyaeB 3TO CTaHOBTCSI OYeBAHbIM
np KJlHYeCKOM OCMOTpe naLleHTa  Ha OCHOBaH peHUeHOrpaMM.
cyw,eCTByeT HeCKOIlbKO MeTOAOB 06blYHOro Lle<paIlOMeTpYeCKoro
aHaIl3a AIlSl OLleHK CarTTaIlbHblX HapyweH CKeIleTHblX COOTHOWeH.
HanpMep, 3HaYeHSI yrIloB SNA, SNB  ANB MO)l(HO CpaBHTb C HopMaM
Michigan 1 AIlSl MYH  )l(eHw,H OAHaKoBoro B03paCTa. B 3TO MeTOAKe
eCTb HeAOCTaTK, HO B TeYeHe MHorx IleT OHa CIlIla rIlaBHblM opeH-
H1pOM AIlSl onpeAeIleHSI CKeIleTHblX HapyweH. McNamara 2 npeAIlaraIl
npOBoATb nepneHAKYIlSlp OT TOYK nasion K C1)paHK<pYPTCKO nIlOCKOCT
AIlS! OLleHK nOIlO)l(eHSI TOyeK A  6 B KayeCTBe 3<p<peKTBHoro nOKa3aTeIlSl
CKeJleTHblX HapyweH (pc. 8.3).
B aHaIl3e Arnett (c. 163) cnoIlb3yeTcSllVL (cTHHaSl BepTKaIlbHaSl
IlHSI) B KayeCTBe KOHTpOIlbHOro opeHTpa,  ee peKoMeHAYIOT npMeHSlTb
(pc. 8.4) KaK 60Ilee TOYHbl MeTOA onpeAeIleHSI  OLleHK xapaKTepa
aHOMaIl  peKoMeHAaLl no x YCTpaHeH1O (pc. 8.5).
+1
PMC. 8.3. McNamara npeAJlO)l(Jl aHaJl3 Ha OCHOBe npoBeAeHSI
nepneHAKYJlSlpa 3 TOK nasion
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PMC. 8.4. B aHaJl3e Arnett CnOJlb3yeTcSI TVL (cTHHaSi BepTKaJlbHaSi
JlHSI)
rpacl>MK ne'feHMSI aHOManMM III KnaCCa
CBOeBpeMeHH8fl KOppeKLI,lAfl CMeUJ,eHlAilI
HIA>KHeilI 4enlOCTIA
cMew,eHe H)I(He YeIlIOCT cIleAyeT AarHoCTpoBaTb y naLleHToB
B B03pacTe 8-9 IleT, cpa3Y )l(e nOCIle npope3blBaHSI nOCTOSlHHblX pe3L10B.
cooTHoweHe n03LI pe3L10B MO)l(eT OrpaHYBaTb pa3BTe BepxHe
yeIlIOCT  CTMYIl1-1pOBaTb pOCT H)I(He YeIlIOCT, YCyry6IlSlSl aHOMaIl1O
III KJlacca. AHaIlOrYHbl 3<p<peKT MeeT npMeHeHe <l>YHKLIOHaIlbHbIX
annapaTOB np IleYeH HapyweH III KJlacca.
KaK npaBIlO, TaKOro pOAa cMew,eHSI MO)l(HO OTKopprpOBaTb
nocpeACTBoM npocTOro nepeMew,eHSI 3y60B, n03TOMY BHO, YT06b1
IleYeHe 6blIlO HayaTO B paHHeM B03pacTe. BnocIleAcTB HeOrpaHYeHHOe
pa3BTe BepxHe yeIlIOCT MO)l(eT B0306HOBTbCSI,  eCIl Mblw,eIlKoBble
OTpOCTK 3aHSlIl LleHTpaIlbHOe nOIlO)l(eHe B CYCTaBHblX SlMKax, 3TO orpaH-
YT nOTeHLIaIlbHbl 3<p<peKT «<PYHKLIOHaIlbHOro annapaTa» Ha nepBoHa-
YaIlbHOe cMew,eHe H)I(He yeIlIOCT.
PeTpOrH8TlAfl BepXHeilI 4enlOCTIA
PaCTYw,M naLleHTaM C peTporHaTe BepxHe YeIlIOCT cIleAyeT
cBoeBpeMeHHo npoBoATb IleYeHe, HanpaBIleHHoe Ha ee pacwpeHe 
pa3BTe. AnSI 3TOro MO)l(eT npMeHSlTbCSI MeTOAKa 6b1CTpOro pacwpeHSI
BepxHe YeIlIOCT  06paTHaSl BHepoTOBaSl TSlra. Ha AaIlbHeWx 3Tanax
MO)l(HO cnOIlb30BaTb He6HYlO AYry AIlSl CTa6Il3aLl CKeIleTHblX
3MeHeH, a 3aTeM npMepHo B B03pacTe 12 IleT npoBoATb IleYeHe
nOIlHblM HeCbeMHblM annapaTOM.
Heo6xo,D,IAMOCTb xlApyprlA4ecKOrO
BMeW8TenbCTB8
B HeKoTOpblX cIlyyaSlX np 36bITOYHOM pa3BT H)I(He YeIlIOCT
BpaY AOIl)l(eH npeAnOIlO)l(Tb, YTO MO)l(eT nOHaA06TbCSI xpyprYeCKOe
BMewaTeIlbCTBO. B TaKX cIlyyaSlX OPTOAOHTYeCKOe IleYeHe cIleAyeT
no B03MO)l(HOCT OTIlO)l(Tb. 3TO AaCT B03MO)l(HOCTb npOCIleATb 3a
AHaMKo pOCTa  BbISlBTb TeHAeHLI pa3BTSI C nOMow,blO peryIlSlpHblX
Lle<paIlOMeTpYeCKX peHTreHorpaMM C TeM, YT06bl MeTb 60Ilee nOIlHYIO
H<popMaLl1O 0 He06xoAMOCT xpyprYeCKoro/HexpyprYeCKoro
BMewaTeIlbCTBa.
AHOM8nIAIA III Kn8CC8; Tpe6YIOUJ,lAe
xlApyprlA4ecKOrO BMeW8TenbCTB8
np HeKoTOpblX aHOMaIlSlX III KJlacca nepBOHaYaIlbHO OyeB1-1AHO, YTO
nOTpe6yeTcSI xpyprYeCKOe BMewaTeIlbCTBO, n03TOMY IleYeHe He cIleAyeT
HaYHaTb AO OKOHyaTeIlbHoro 3aBepweHSI pOCTa. Bbl60p BpeMeH HaYaIla
IleYeHSI cIleAyeT COrIlaCOBaTb C XpyproM. Y MYH 3TO MO)l(eT 6b1Tb
nOCIle 20 IleT, a y )l(eHw,H HeMHoro paHbwe.

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WBeTOBas:l MapKlI1pOBKa, II1CnOnb-
30BaHHas:l B ue<j:>anOMeTpll1'-1eCKOM
aHanll13e TKaHe no Arnett:
LjepHbl - B npeAenax 1 (1 c.o.) _
3eneHbl - B npeAenax 2 (2 c,o,)
CIl1HII1 - B npeAenax 3 (3 c,o.)
KpacHbl - 60nee 3 (3 c.o,) _
c.o. - CTaHAapTHoe OTKllOHeHlI1e
16
2 3
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D
PMC. 8.5. AHaIWI3 Arnett npwMeHSleTcSI C ceHTSl6pSl 1999 roAa. OH npeAIlaraeT ycoBepweHcTBoBaHHblVi nOAXOA, o6eCneLJWBalOUJ,wVI nOMOUJ,b OpTOAOHTaM
W xwpypraM npw AwarHOCTWKe W nIlaHwpOBaHWW IleLJeHWSI. OH nOALJepKWBaeT 3HaLJeHWe npOBeAeHWSI 3aMepOB MSlrKWX TKaHeVi Ilwu.a. OTAeIlbHble W3MepeHWSI
0603HaLJalOT onpeAeIleHHblMw u.BeTaMW.
B aHaIlW3e wcnoIlb3yeTcSI TVL (wcTwHHaSi BepTwKaIlbHaSi IlWHWSI), npeAYCMOTpeHbI pa3Hble HOpMbl AIlSI MY)l(LJWH W )l(eHUJ,WH. Y nau.weHTa Ha CHWMKe, npeAOCTaBIleH-
HOM AOKTOpOM Arnett, BbinOIlHeHa xwpyprWyeCKaSi onepau.wSI Ha o6ewx cTopoHax BepxHeVi LJeIlIOCTW C u.eIlblO BblABW)I(eHWSI KnepeAw BepxHeVi LJeIlIOCTW W OTBeAeHWSI
K38AW HW)I(HeVi LJeIlIOCTW. B o6IlacTw rIla3Hwu. rWAPoKcwIlanaTwTOBble WMnIlaHTaTbl.
221

npMHSlTMe peWeHMSI 0 xMpyprM...eCKOM/HexMpyprM...eCKOM ne...eHMM
aHOManMMll1 Kl1aCCa
KaK  np IleYeH aHOMaIl II KJlaCCa, BHO paCn03HaTb cIlyYa aHOMa-
Il III KJlaCCa C OCHOBHbIM CKeIleTHbIM HapyweHSlM e BO BpeMSI
AarHOCTK, Il )l(e C B03MO)l(HOCTbIO He6IlaronpSlTHoro pa3BTSI.
B CIlYLlae TaKX aHOMaIl cIleAyeT paCCMOTpeTb B03MO)l(HOCT KOM6HpO-
BaHHoro OPTOAOHTYecKOro/XpyprYeCKoro IleYeHSI. neYeHe TOIlbKO
OPTOAOHTYeCKM MeTOAaM cIleAyeT OTIlO)l(Tb Il CKJlIOYTb.
lle<paIloMeTpYecK aHaIl3 MSlrKX TKaHe (STcA), npeAIlO)l(eHHbl
Arnett  coaBTOpaM, 06caIlcSI B pa3AeIle 7 (c. 163). B paMKax nOCIle-
AYIOw,ero TeOpeTYeCKoro paccMOTpeHSI HeKOTOpblX aCneKTOB IleYeHSI
aHOMaIl III KJlacca 6YAYT cnOIlb30BaTbCSI Te )l(e ceMb 3MepeH AIlSl
cIlyyaeB, KorAa npeAnoIlaraeTcSI, YTO BepxHSISI  cpeAH5ISI TpeT npo<pIle
Ill!a 6Il3K K AeaIlbHblM,  BepXHe pe3L1bl paCnOIlO)l(eHbl HOpMaIlbHO.
B TeOpeTYeCKX npMepax A, B  C npeAcTaBIleHbl HeKOTOpble TPYA-
HOCT, C KOTOpbIM BpaY-OpTOAOHT MO)l(eT CTOIlKHYTbCSI B XOAe IleYeHSI:
CHTYal4HH A - xHpyprH'IecKaHjopToAoHTH'IecKaH KOppeKI4HH aHOManHH C l4enblO AOCTH>KeHHH HAeanbHoro pe3ynbTaTa. ECIl np
AarHOCTKe npHSlTO peweHe 0 xPyprYeCKOM BMeWaTeIlbCTBe Ha H)I(He YeIllOCT, TO OHO 06blYHO OTKJlaAblBaeTCSI AO 3aBepweHSI npoLlecca pOCTa,
y MYH 3TO MO)l(eT 6blTb B B03paCTe 22 IleT. nepeA BMewaTeIlbCTBOM He06xoAMO BblnOIlHTb AeKOMneHcaLl1O pe3L10B. KoppeKLI1O BblnOIlHSlIOT noc-
peACTBOM CarTTaIlbHOro BblpaBHBaHSI H)I(He YeIlIOCT /Il BepxHe YeIlIOCT C TpaHCBep3aIlbHO KoppeKLIe BepxHe YeIlIOCT B cIlyyae He06xo-
AMOCT. TaKO nOAXOA AOIl)l(eH 06eCneYTb OmMaIlbHble pe3YIlbTaTbi B rapMoH3aLl 3CTeTK Ill!a  3y60aIlbBeOIlSlpHoro COOTHoweHSI (pc. 8.6).
TVL
TVL
0 0
4 4
LlBeToBa51 MapKLo1poBKa, Lo1CnOJlb-
30B::\HHa51 B L\ecl>aJlOMeTpw'JecKOM
7 2 aHaJlLo13e TKaHei1 no Arnett:
'-IepHbli1 - B npeAeJlaX 1 (1 c,o,) -
1 -5 3eJleHbli1 - B npeAeJlax 2 (2 c,o,) -
CLo1HLo1i1 - B npeAeJlaX 3 (3 c,o,)
KpacHbli1 - 60Jlee 3 (3 c.o,) -
3 -3 c,o, - CTaHAapTHoe OTKJlOHeHLo1e
PMc.8.6. ECJU.1 npi-1 /lelJeHi-1i-1 AaHHOVI aHOMa/li-1i-1 i-1CnO/lb3YIOT COlJeTaHi-1e OPTOAOHTi-1lJeCKoro i-1 Xi-1pypri-1lJeCKoro /lelJeHi-1S1, B03MO>KHO nO/lYlJeHi-1e pe3Y/lbTaTOB
6I1i-13Ki-1X K i-1Aea/lbHbIM no AOCTi-1>KeHi-11O aCTeTi-1lJHoro npo<t>i-1/lSi /li-1a i-1 OnTi-1Ma/lbHoro 3y6oa/lbBeO/lSipHoro COOTHOWeHi-1S1. PeTpY3i-1S1 Hi-1>KHeVllJe/lIOCTi-1 Ha
6 MM OTHOCi-1Te/lbHO TVL (i-1CTi-1HHOVI BepTi-1Ka/lbHOVI /li-1Hi-1i-1) nOTOM 6YAeT HaXOAi-1TbCSI B npeAe/laX 1 OTK/lOHeHi-1S1 OT HOpMbl (1 SD) OTHOCi-1Te/lbHO i-1Aea/lbHoro
Bapi-1aHTa.

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MO)l(HO npoBoATb TOIlbKO OpTOAOHTYeCKOe IleyeHe np He3HaYTeIlbHOM CKeIleTHOM HapyweH. 3TO n03BOIlT npCTYnTb K KoppeKLI 3HaY-
TeIlbHO paHbwe, HO naLleHTa cIleAyeT npeAynpeATb 0 B03MO)l(HOCT 60Ilee n03AHero pOCTa H)I(He yeIlIOCT. AHOMaIl1O MO)l(HO OTKopprpoBaTb
nocpeAcTBoM «MaCKpOBaHSI» CKeIleTHoro HapyweHSlIII KJlacca C nOMow,blO 3y60aIlbBeOIlSlpHo KOMneHcaLl, BKJlIOYalOw,e HaKJlOH BepxHx pe3L10B
KnepeA /Il HaKJlOH H)I(HX pe3L10B K3aA. np IleYeH 06blYHO Tpe6yeTcSI HaMe)l(aw,ee COTpYAHYeCTBO naLleHTa np npMeHeH 3IlaCTYHbIX
TSlr III KJlacca /Il cnOIlb30BaH IlLleBo MaCK. AOIl)l(eH 06eCneYBaTbCSI npeMIleMbl pe3YIlbTaT OTHOCTeIlbHO 3CTeTK npo<pIlSl Il\.,\a  3y60-
aIlbBeOIlSlpHblX CooTHoweH, YCTpaHSISI He06xoAMOCTb B xpyprYeCKOM BMewaTeIlbCTBe, KOTOpOro naLleHTbl npeAnOYTalOT 36eraTb (pc. B.7).
1
2
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3eneHblC1- B npeAenax 2 (2 c,o,) _
CI-1HI-1C1 - B npeAenax 3 (3 c,o,)
KpacHblC1- 60nee 3 (3 c,o,) _
c.o. - cTaHAapTHoe OTKJlOHeHl-1e
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PMC. 8.7. np He3HaLJTellbHb1X aHOMallSlX III KllaCCa nllaH IleLJeHSI MO)l(eT 6a3pOBaTbCSI Ha OPTOAOHTLJeCKOM nepeMeeH 3y6oB C ellblO MaCKpOBK
He3HaLJTellbHoro CKe1leTHoro HapyweHSI. np aTOM B03MO)l(HO AOCT)I(eHe HaAlle)l(aw.ero 3y6oa1lbBe01lSlpHoro COOTHoweHSI  HeKoToporo YIlYLJWeHSI
nponop npo<t>IlSlIla. B AaHHOM TeOpeTLJeCKOM npMepe HaK1l0H BepXHX pe3OB KnepeA COCTaBIlSleT 2 0 , a HaK1l0H H)I(HX pe3oB K3aA - 8 0 .
CMTYaMSI C - n03AHMM pOCT HM>KHeM "IemOCTM. nOCIle «MaCKpOBKW He3HaYTeIlbHoro HapyweHSI OKKJlI03 III KJlaCca C nOMow,blO
OPTOAOHTYeCKX MeTOAOB MO)l(eT Ha6IllOAaTbCSI n03AH pOCT H)I(He YeIlIOCT, oc06eHHO y MYH. TaKaSl CTYaLlSI Bbl3blBaeT OCIlO)l(HeHSI. it1HorAa
3MeHeHSI 3y60aIlbBeOIlSlpHbiX COOTHoweH  npo<l>IlSl IlLla Ha n03AHeM 3Tane pa3BTSI KCSI naLleHTY npeMIleMbIM,  OH He CTpeMTCSI
npOAOIl)l(Tb IleYeHe. OAHaKO, eCIl xpyprYeCKOe BMewaTeIlbCTBO Ha H)I(He YeIlIOCT He06xOAMO, pe3YIlbTaTbi TOIlbKO xpypmYeCKoro IleYeHSI
He MOryT 6blTb YAOBIleTBopTeIlbHbIM BCIleACTBe 3y60aIlbBeOIlSlpHO KOMneHcaLl aHOMaIl (pc. B.B). Ao xpyprYeCKoro BMewaTeIlbCTBa cIleAyeT
BblnOIlHTb OpTOAOHTYeCKYIO AeKOMneHcaLl1O pe3L10B C LleIlblO nOIlyYeHSI OmMaIlbHbiX pe3YIlbTaTOB no YIlYYWeH1O npo<pIlSl IlLla nOCIle onepaLl.
TVL
TVL
0 0 '-IepHblC1 - B npeAenax 1 (1 c,o,) -
3 3 3eneHblC1 - B npeAenax 2 (2 c,o,)
CI-1HI-1C1 - B npeAenax 3 (3 c,o.) -
KpacHblC1- 60nee 3 (3 c,o,) -
2 . c,o, - CTaHAapTHoe OTKnOHeHl-1e
2
1 3
PMC. 8.8. B HeKOTOpblX CIlYLJaSlX nOClle IleLJeHSI, oncaHHoro B npMepe B, MO)l(eT Ha6IllOAaTbCSI pOCT LJeIlIOCT Ha n03AHeM amne pa3BTSI. 3TO C1l0)l(HaSl
cTyaSI. ECIl npHMaeTCSI peweHe npOBOATb xpyprLJeCKOe BMewaTeIlbCTBO Ha H)I(He LJeIlIOCT, eMY, KaK npaBIlO, AOIl)l(HO npeAweCTBOBaTb
OPTOAOHTLJeCKOe lleLJeHe, HanpaBlleHHOe Ha AeKOMneHca1O pe3OB.
223

3c1>cI>eKT «BbITeCHeHMSI» 60KOBbiX 3y6oB
npM CKY"IeHHOCTM MOnSipOB
B IlTepaTYpe 06CaIlaCb CKYyeHHOCTb 60KOBbiX 3y60B KaK <paKTOp pa3B-
TSI HapyweH OKKJlI03 III KJlaCca 3 . comaCHO TeOpeTYeCKM nOIlO)l(e-
HSlM, 3<p<peKT «BbITeCHeHSI» MO)l(eT 6blTb 06YCIlOBIleH CKYyeHHOCTblO MOIlSl-
pOB, KOTOpaSl MO)l(eT npBeCT K HapyweH1O OKKJlI03 nepeAHX 3y60B 
<pOpMpOBaH1O OTKpblTOro npKYca B H)I(He YeIlIOCT C HeAOCTaTOYHblM
BepTKaIlbHbiM pa3BTeM BeTBe (pc. 8.9). AnbTepHaTBHo, 3HaYTeIlbHoe
pa3BTe BeTBe YeIlIOCT MO)l(eT npBeCT K HapyweHSlM OKKJlI03
III KJlacca.
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CCIleAOBaHa. OAHaKO HeKOTOpble, Tw,aTeIlbHO nOA06paHHbie cIlyYa
aHOMaIl III KJlaCca 4 (CM. naLleHTKa K.B., c. 242)  HeKoTOpble npMepbl
OTKpblTOro npKYca5 XOPOWO nOJ]JJ.aIOTCSI IleYeH1O C YAaIleHeM BTOpblX
MOIlSlpOB. T aKe Ha6IlIOAeHSI npAaIOT 060cHoBaHHocTb Teop 3<p<peKTa
«BbITeCHeHSI», KOTOpaSl B HeKoTopblX cIlyyaSlX MO)l(eT 6blTb BHbIM
3TOIlOrYeCKM <paKTOpoM.
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npKYca. B HeKOTOpblX CllY"IaSiX a<l><I>eKT «BbITeCHeHSI» 60KOBbiX 3y6oB MO}l(HO oClla6Tb nocpeACTBOM YAalleHSI nOCTOSlHHblX BTOpblX npeMollSipoB, "ITO 0611er"laeT
MexaHKY lle"leHSI.

3naCTM"IHble TSlI"'M AnSI ne"leHMSI
aHoManMM III Kl1aCca
Me)l(yeIlIOCTHble 3IlaCTYHble TSlr III KJlacca (pc. 8.1 0) BbICoK03<P<I>eKTBHbl
AIlSl OPTOAOHTYeCKO (HexpyprYeCKo) KoppeKLI aHOMaIl III KJlacca.
np x npMeHeH npOCIle)l(BaeTCSl TeHAeHLISI K HaKJlOHY H)I(HX pe3L10B
K3aA, HaKJlOHY BepXHX pe3L10B KnepeA  Can1TTaIlbHO KoppeKLI COOT-
HoweHSI MOIlSlpOB (pc. 8.11). n03TOMY npMeHeHe Bcex KOMnOHeHTOB
3IlaCTYHbIX CIl III KJlacca MO)l(eT 6blTb LleIleco06pa3Ho AIlSl AOCT)I(eHSI
LleIle IleyeHSI B cIlyyaSlX cpeAHero Il MaIlOro Me)l(yeIllOcTHoro yrIla.
np npMeHeH 3IlaCTYHbIX TSlr II KJlacca (pc. 8.12) BepTKaIlbHble
KOMnOHeHTbl CIlbl MOryT 6blTb He6IlaronpSlTHbIM np 60IlbWOM Me)l(ye-
IlIOCTHOM YrIle.
MM 34°
MM 22°
PMC. 8.11. nOKa3aHbI BeKTOpbl CMIl, 3aAeCTBOBaHHblX npM Mcnonb30BaHMM
snaCTMlIHblX TSlr III Knacca. B CIlYlIae rny6oKoro npMKyca npM ManOM Me)l(lIe-
nlOCTHOM yrne s<!><!>eKTMBHO AeCTBMe Bcex lIeTblpex BeKTOpOB. OAHaKO npM
60nbWOM Me)l(lIenlOCTHOM yrIle III Knacca C TeHAeHMe K OTKpblTOMY npMKYCY
YAaneHMe BepXHMX MonSlpOB npOTMBonOKa3aHO. B STOM cnYllae B03MO)l(HO
npMMeHeHMe He6HO AyrM (pMC. 5.29, C. 107).
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PMC. 8.12. Vl306pa)l(eHbI BeKTOpbl CMIl, 33AecTBoBaHHblx npM Mcnonb30Ba-
HMM SIlaCTMlIHblX TSlr II Knacca. B cnYllae Manoro Me)l(lIenlOcTHoro yrna
II KJlacca s<!><!>eKTMBHo AecTBMe Bcex lIeTblpex BeKTOpOB (BepTMKaJlbHbI
KOMnOHeHT Ha YllacTKe BepxHMx pe3oB ypaBHoBewMBaeTcSI KpMBO Wnee
Ha BepxHe Ilelle6Ho Ayre, M nOSTOMY He cnoco6cTByeT He)l(enaTenbHOMY
yrny6neHMIO npMKyca). B cnYllaSlx 6onbworo Me)l(lIeIllOcTHoro yrna II KJlaCCa
cIleAyeT M36eraTb SKCTPY3MM BepXHMX MonSlpOB. B TaKMX cnYllaSlx MO)l(HO
nOAYMaTb 0 npMMeHeHMM KOpOTKMX snaCTMlIHblX TSlr II KJlaCca.
225

'iETbIPE 3TAnA nnAHVlPOBAHVlSI
npVI nE'iEHVIVI AHOMAnVl III KnACCA
:
nOCIleAOBaTeIlbHOCTb nIlaHpOBaHSI IleYeHSI aHaIlOrYHa nIlaHpOBaH1O
np IleYeH aHOMaIl II KJlaCca,  YTaTeIlb MO)l(eT 06paTTbCSI K pa3AeIlY
7, c. 166-167. H)I(e npBoATCSI oncaHe yeTblpex 3TanOB nIlaHpoBaHSI:
3Tan 1 - OnpeAeneHMe
3annaHMpoBaHHo noaMu.MM
BepxHMx peau.OB
Ha AaHHOM 3Tane cIleAyeT peWTb, KaKM MO)l(eT 6blTb AeaIlbHaSl n03LISI
BepXHX pe3L10B. AOCT)I(Ma Il OHa? ECIl HeT, TO MO)l(HO Il np nOMow,
OpTOAOHTYecKOro nepeMew,eHSI 3y60B 06eCneYTb He AeaIlbHOe, HO
npeMIleMoe nOIlO)l(eHe 3y60B? l-1Il )l(e AIlSl AOCT)I(eHSI 3TOro npeM-
IleMoro paCnOIlO)l(eHSI BepxHx pe3L10B nOHaA06TCSI xpyprYeCKOe
BMewaTeIlbCTBO Ha BepXHe YeIlIOCT? T aKM 06pa30M MO)l(HO onpeAeIlTb
3anIlaHpOBaHHYIO n03LI1O BepxHx pe3L10B (pc. 8.13).
3Tan 2 - HM>KHMe peau.bl
cYl1teCTByeT Il B03MO)l(HOCTb 06eCneYTb OnTMaIlbHYIO n03LI1O H)I(HX
pe3L10B B COOTBeTCTB C 3anIlaHpOBaHHO n03LIe BepXHX pe3L10B?
MO)l(HO Il BbInOIlHTb TaKoe nepeMew,eHe H)I(HX pe3L10B C nOMow,blO
TOIlbKO OpTOAOHTYeCKX MeTOAOB? np IleYeH aHOMaIl III KJlacca C
Ype3MepHbiM pa3BTeM H)I(He YeIlIOCT 3TOT Bonpoc 06blYHO SlBIlSleTCSI
KlllOyeBblM, oc06eHHO B cIlyyae pacTYw,x naLleHTOB (pc. 8.14). 3ayacTYIO
OTBeT Ha 3TOT Bonpoc 6YAeT «BepoSlTHo, np YCIlOB, YTO pa3BTe
H)I(He YeIlIOCT He 6YAeT He6IlaronpSlTHbIM». Anb TepHaTBHbl OTBeT:
«B03MO)l(HO, HO cyw,eCTBYIOT onaceHSI no nOBOAY 6YAyw,ero pa3BTSI,
 npeAnOYTTeIlbHO nOAO)I(AaTb, nOKa nOIlHOCTblO He npOSlBSlTCSI ero
TeHAeHLI»(C. 234)
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+-
PMC. 8.13. Ha nepBoM :nane nIlaHpoBaHSI Ile4eHSI aHoMall III Kllacca
clleAyeT onpeAellTb n03lt1O BepXHX pe3ltOB  pewTb, AOCT)I(Ma ll
oHa? ECll HeT, TO B03MO)l(HO paCCMOTpeTb MOA<t>ltpOBaHHYIO n03ltIO, He
AeallbHYIO, HO npeMIleMYIO. TaKM 06pa30M onpeAellSiIOT 3anllaHpOBaHHYIO
n03lt1O pe3ltOB.
PMC. 8. 14. BTOPO :nan nllaHpoBaHSI lle4eHSI npeAnollaraeT peweHe
OTHOCTellbHO n03ltOHpOBaHSI H)I(HX pe3ltOB. 06bl4HO 3TO rllaBHaSi
np0611eMa np ,fJe4eH aHoMall III Kllacca np rnepTpo<t> H)I(He
4ellIOCT.

3Tan 3 - OCTanbHble BepxHMe 3y6bl
np 06Cy)l(AeH nIlaHpOBaHSI IleYeHSI aHOMaIl \I KJlacca (C. 167) 3Tan 3
KaCaIlCSI 60KOBbiX 3y60B H)I(He YeIlIOCT, 3a KOTOpblM CIleAOBaIl 3Tan 4,
rAe paccMaTpBaIlOCb IleYeHe OCTaIlbHblX BepxHx 3y60B. np nIlaHpo-
BaH IleYeHSI aHOMaIl 1\1 KJlacca MeeT MecTO 06paTHbl nopSlAoK. Ha
3Tane 3 LleIleco06pa3Ho OLleHTb n03LI1O 60KOBbiX BepXHX 3y60B. ECIl
He06xoAMO YAaIleHe BepXHX npeMoIlSlpoB (06bIYHO BTOpblX npeMOIlSlpOB),
TO B cIlyyae aHOMaIl 1\1 KJlaCca IlOrYHee YAaIlSlTb nepBble H)I(Hl-1e npeMO-
IlSlpbl. OAHaKO eCIl B03MO)l(HO 060TCb 6e3 YAaIleHSI 3y60B Ha BepXHe
Ayre, TO cIleAyeT paCCMOTpeTb PSIA aIlbTepHaTBHblX peweH OTHOCTeIlbHO
H)I(He Ayr.
cIleAOBaTeIlbHO, Ha TpeTbeM 3Tane npeACTOT pewTb, KaKM 06pa30M
pacnoIlO)l(Tb OCTaIlbHble nepeAHe 3y6bl B COOTBeTCTB C 3anIlaHpOBaH-
HO n03LIe BepXHX pe3L10B. 06blYHO AIlSl MexaHK IleyeHSI aHOMaIl
1\1 KJlaCca npeAnOYTTeIlbHee 06XOATbCSI 6e3 YAaIleHSI 3y60B B BepXHe
YeIlIOCT. 06paw,eHe K VTO (B3YaIl3aLl LleIle) nOMO)l(eT Bbl6paTb
He06xOAMble AaHHble no nepeMew,eH1O MOIlSlpOB  KJlblKOB (pc. 8.15).
3Tan 4 - OCTanbHble HM>KHMe 3y6bl
KaKM 06pa30M pa3MeCTTb OCTaIlbHbie H)I(He 3y6bl AIlSl 06eCneYeHSI x
HOpMaIlbHO OKKJlI03 C 3anIlaHpOBaHHO n03LIe H)I(HX pe3L10B (pl-1C.
8.16)? Tpe6yeTcSI Il AIlSl 3TOro YAaIleHe H)I(HX 3y60B AIlSl YCTpaHeHSI
CKYYeHHOCT 3y60B Il AIlSl 06eCneYeHSI AOCTaTOYHO peTpaKLI H)I(HX
pe3L10B? YAaIleHe H)I(HX npeMOIlSlpOB 06eCneYBaeT peTpaKLI1O H)I(HX
pe3L10B  yaCTO cnOC06CTByeT MexaHKe IleYeHSI aHOMaIl 1\1 KJlacca.
AnSI npHSlTSI npaBIlbHoro peweHSI cIleAyeT 06paTTbCSI K PyKOBOACTBY
no OPTOAOHTYeCKOMY nepeMew,eH1O 3y60B VT06. B HeKOTopblX cIlyyaSlX,
Tpe6ylOw,x 3KCTpaKLI 3y60B, MO)l(eT 6blTb paCCMOTpeH BapaHT YAaIleHSI
BTOpblX MOIlSlpOB (naLleHTKa K.B., c. 242).
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PMC. 8.15. Ha TpeTbeM STane nllaHL1pOBaHL1S1 lle'-leHL1S1 aHOMallL1 1\1 KllaCCa
ClleAyeT Bbl6paTb MeXaHL1KY AllS1 AOCTL1)1(eHL1S1 npaBL1llbHO n03L1L1L1 OCTallbHblX
BepXHL1X 3y6oB, cooTBeTcTBYIOe 3anllaHL1pOBaHHo n03L1L1L1 BepXHL1X
pe3oB
S
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»
?
.
PMC. 8. 16. 3aKlllO'-IL1TellbHbl STan nllaHL1pOBaHL1S1 lle'-leHL1S1 aHOMallL1
III KllaCca. ClleAyeT OeHL1Tb cKY'-leHHocTb L11lL1 HallL1'-1L1e npoMe)l(YTKoB
B HL1)1(He Ayre L1 onpeAellL1Tb n03L1L11O OCTallbHblX HL1)1(HL1X 3y6oB, '-IT06bl
o6eCne'-lL1Tb COOTBeTCTBL1e C 3anllaHL1pOBaHHo n03L1L1e HL1)1(HL1X pe3oB.
227

KOMnOHEHTbI3AnnAHPOBAHHO
n03LJ. PE3LJ.OB np nE'iEH
AHOMAn III KnACCA
np IleYeH KO aHOMaIl III KJlaCCa He06xOAMO OnpeAeIlTb
KOHeYHYIO LleIlb B OTHOWeH 3anIlaHpOBaHHO n03LI pe3L10B, YTO
nOMO)l(eT 06eCneYTb npaBIlbHYIO CarTTaIlbHYIO  BepTKaIlbHYIO n03LI1O
BepXHX pe3L10B np npMeHeH COOTBeTCTBYIOw,ero TOpKa (pc. 8.17).
B paMKax AaHHO KHr aBTOpbl He nIlaHPYIOT 06caTb  onpeAeIlSlTb
KOHKpeTHble LleIl. OAHaKO Y KOro BpaYa-OpTOAOHTa MeeTCSI npeACTaB-
IleHe 0 TOM, KaK AOIl)l(Hbl 6blTb paCnOIlO)l(eHbl BepXHe pe3L1bl,  B
60IlbWHCTBe cIlyyaeB 3T MHeHSI COBnaAaIOT. KaK  B cIlyyae IleYeHSI
aHOMaIl II KJlaCca, npe)I(Ae yeM npHSlTb peweHe 0 AOCT)I(eH KOHK-
peTHO LleIl, He06xOAMO npOaHaIl3pOBaTb cyw,eCTBYIOw,ylO n03LI1O
pe3L10B C nOMow,blO 06blYHbiX Lle<paIlOMeTpYeCKX 3MepeH Il aHaIl3a
no Arnett. cOCTaBIlSlIOw,e 3IleMeHTbi aHaIlOrYHbl aHOMaIlSlM II KJlaCca
(c. 168). nOA06Hbl nOAXOA  aHaIlOrYHble 3HaYeHSI cIleAyeT cnOIlb-
30BaTb np aHaIl3e CXOAHO n03LI BepXHX pe3L10B np IleYeH14
aHOMaIl III KJlacca.
n
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t
\ -.
+
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PMC. 8. 17. npH IleeHHH Ka>K,lJ,O aHOMaIlHH III KIlacca B HaaIle nIlaHHpoBa-
HH5I IleeHH5I Heo6xoAHMO YCTaHoBHTb 3anIlaHHpoBaHHYIO n03H I,tH 10 , o6ecneH-
BalOll,ty1O npaBHIlbHYIO carHTTaIlbHYIO H BepTHKaIlbHYIO n03HI,tHIO BepxHHx
pe31,tOB c cooTBeTcTBYlOllI.HM TOpKOM

nEPEMEUJ,EHiliE BEPXHiliX PE3LJ.OB
nPili nE'-IEHiIIiII AHOMAnillVi
III KnACCA
 ---_'":- -.. .--=: -:--"':---=--.;_.- . -_....::: .,:'.,._-..:...
nOCIle onpeAeIleHSI 3anIlaHpOBaHHO n03LI pe3L10B B KOHKpeTHOM CIlY-
yae AIlSl AOCT)I(eHSI LleIl IleYeHSI nOTpe6yeTcSI KOHTpoIlPyeMoe nepeMe-
w,eHe BepXHX pe3L10B. nepeMeW,eHe BepXHX pe3L10B LleIleco06pa3HO
nIlaHpOBaTb OTAeIlbHO, a 3aTeM paCCMaTpBaTb nepeMew,eHe H)I(HX
pe3L10B. Ha AaHHOM 3Tane nOKa He cIleAyeT paCCMaTpBaTb npOBeAeHe
MeponpSlT Ha H)I(He Ayre, cnOIlb3YSl ee IlWb B KayeCTBe B03MO)l(HOro
CTOYHKa <pKcaLl B cIlyyae npMeHeHSI 3IlaCTYHbIX TSlr III KJlacca.
Aanee 6YAeT paCCMOTpeHa peKoMeHAyeMaSl MexaHKa C npMeHeHeM
6peKeTOB MBTTM AIlSl nepeMew,eHSI BepXHX pe3L10B B npOLlecce IleYeHSI
aHOMaIl III KJlacca.
B cIlyyae He3HaYTeIlbHbIX aHOMaIl III KJlacca np HOpMaIlbHO BepXHe
YeIlIOCT, HO rnepTpo<p H)I(He YeIlIOCT, n03LISI BepXHX pe3L10B
nepeA IleYeHeM MO)l(eT 6blTb 6Il3KO K 3anIlaHpOBaHHO n03LI
pe3L10B. B TaKO CTYaLl nOHaA06TCSI OTHOCTeIlbHO He3HaYTeIlbHoe
nepeMew,eHe BepXHX pe3L10B. OAHaKO BO MHorx cIlyyaSlX III KJlaCca
BepXHe pe3L1bl HHO nepeMew,aTb B Me3aIlbHOM HanpaBIleH. np
HeKOTOpblX Ae<peKTax III KJlaCca C HeAOCTaTOYHO pa3BTO BepXHe yeIlIOC-
o
PMC. 8.18. Me311a11bHOe nepeMew,eHl1e KOpOHOK BepXHl1X pe3L10B
nOCpe,ll,CTBOM HaKllOHa Knepe,ll,l1
TblO A06TbCSI HHOro Me3aIlbHoro nepeMew,eHSI 6e3 Ype3MepHoro
HaKJlOHa KnepeA 6blBaeT Ype3BbIYaHO TPYAHO. ECIl np IleYeH aHOMa-
Il III KJlaCca He06xoAMO Me3aIlbHOe nepeMew,eHe BepxHx pe3L10B, ero
MO)l(HO BblnOIlHTb ABYMSI cnoc06aM:
1. nOCpeACTBOM Me3aIlbHoro nepeMew,eHSI  HaKJlOHa BepxHx pe3L10B
KnepeA B npeAeIlax MelOw,ecSI KOCTHO TKaH (pc. 8.18). Bo MHorx
cIlyyaSlX HapyweH III KJlacca Tpe6yeTcSI Me3aIlbHOe nepeMew,eHe
BepXHX pe3L10B AIlSl 06eCneYeHSI x npaBIlbHo n03LI no Mepe
pa3BTSI H)I(He yeIlIOCT. np HaKJlOHe BepxHx pe3L10B KnepeA
Ka)l(Able 2,5 0 HaKJlOHa C03AalOT npMepHo 1 MM npocTpaHcTBa C KIDK,lJ,O
CTOpOHbl Il B LleIlOM 2 MM. n03TOMY BO MHomx cIlyyaSlX III KJlaCca
3KCTpaKLI1O BepXHX npeMOIlSlpOB BblnOIlHSlTb He peKOMeHAYIOT. ECIl
BepXHe npeMOIlSlpbl YAaIleHbl, 6YAeT OyeHb CIlO)l(HO Il e HeB03-
MO)l(HO A06TbCSI HaKJlOHa BepxHx pe3L10B KnepeA.
2. nOCpeACTBOM nepeMew,eHSI BepXHeYeIlIOCTHo KOCT B Me3aIlbHOM
HanpaBIleH (pc. 8.19) B pe3YIlbTare HOpMaIlbHOro pa3BTSI Il
OPTOAOHTYecKOro IleYeHSI.
o
PMC. 8.19. Me311a11bHOe nepeMew,eHl1e KOpOHOK BepXHl1X pe3L10B
nOCpe,ll,CTBOM Me311a11bHoro nepeMew,eHl1S1 BepXHelJemOCTHoM KOCTl1
B pe3Y11bTaTe HopMa11bHoro pa3Bl1Tl1S1 111111 OpTO,lI,OHTl1lJeCKoro 11eLJeHl1S1
en
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229

Me3ManbHoe nepeMew.eHMe
BepXHMX pe3u.OB B KOCTHOM TKaHM
KaK OTMeYaIlOCb paHee, B npoLlecce BblpaBHBaHSI n03LI 3y60B C nOMO-
W,blO HaYaIlbHblX Ileye6HbiX Ayr Ha6IllOAaeTCSI TeHAeHLISI K nepeMew,eH1O
BepXHX pe3L10B B Me3aIlbHOM HanpaBIleH, B CBSl3 C aHryIlSlLle 6peKe-
TOB. np IleYeH aHOMaIl III KJlaCca 3TO 06blYHO 6IlaronpSlTHO  cno-
co6cTByeT nepeMew,eH1O B 3anIlaHpOBaHHYIO n03LI1O BepXHX pe3L10B.
Ha 3Tane npMeHeHSI npSlMoyroIlbHblX TepMOaKTBpyeMblx
HKeIleBO- TTaHOBbIX Ayr  npSlMoyroIlbHblX CTaIlbHblX Ayr CarTTaIlbHOe
pacwpeHe  3MeHeHe TopKa TaK)l(e 6IlaronpSlTHO AIlSl 60IlbWHCTBa
CJlYlJaeB III KJlacca. 3TO BIlSlHe MO)l(HO YCIlTb, cnOIlb3YSl 3IlaCTYHble
TSlr III KJlaCca Ha 60Ilee n03AHX 3Tanax. 6IlaroAapSl TaKM CnOHTaHHblM
nepeMew,eHSlM 3y60B Ha 3Tane BblpaBHBaHSI  nepeMew,eHSI 3y60B
HalJaIlbHaSl KoppeKLISI BepXHe Ayr np He3HaYTeIlbHbIX Ae<1>eKTax III
KJlaCca ocyw,eCTBIlSleTCSI AOBOIlbHO npOCTO.
OrpaHM"IeHMSI nepeMew.eHMSI BepXHMX
peau.OB B Me3ManbHOM HanpaBneHMM
np nepeMew,eH BepXHX pe3L10B B Me3aIlbHOM HanpaBIleH cyw,eCT-
BYIOT YeTKe KJlHyeCKe OrpaHYeHSI. np 3TOM np06IleMbi MOryT
B03HKHYTb B npOCTblX Ha nepBbl B3rIlSlA cTYaLlSlx IleYeHSI, pCK
nOSlBIleHSI KOTOpblX 06YCIlOBIleH CIleAYIOw,M <paKTOpaM:
1. Llpe3MepHbiM HaKl10H KnepeAM. He06xoAMO 36eraTb Ype3MepHoro
HaKJlOHa BepxHx pe3L10B KnepeA, nocKoIlbKY 3TO MO)l(eT npBecT
K YXYAweH1O 3CTeTK IlLla  <1>YHKLIOHaIlbHbIM HapyweHSlM. KaK
npaBIlo, yroIl HaKJlOHa BepxHx pe3L10B KnepeA OTHOCTeIlbHO
nIlOCKOCT BepxHe YeIlIOCT He AOIl)l(eH npeBblwaTb 120 0 , XOTSI
B03MO)l(Hbi CKJlIOYeHSI (pc. 8.20). B HeKOTopblX cIlyyaSlX MO)l(eT 6blTb
YMeCTeH HaKJlOH MeHee 120 0 . LJpe3MepHbl HaKJlOH pe3L10B MO)l(eT
npBecT K peLlecc AeCHbl  YAIlHeH1O x KJlHYeCKX KOpOHOK.
2. HeS03MO>KHOCTb nonHOCTblO o6ecneMTb nepeKPblTMe Ha
nepeAHeM Y'laCTKe. 3TO MO)l(eT 6blTb 06ycIloBIleHo n03LIe H)I(HX
pe3L10B KnepeA Il APyrM npYHaM, BCIleACTBe yero C<pOpMpO-
BaBwcSI npKYC nIlOXO nO,lJJJ,aeTCSI KoppeKLI (pc. 8.21). ECIl ero He
OTKopprpOBaTb, B03HKaeT pCK nOBpe)I(AeHSI 3MaIl Ha 3y6ax /Il
pe30p6L1 KOpHSI. n03TOMY HepaLlOHaIlbHO nblTaTbCSI oTKOppeKTpo-
BaTb COOTHoweHe pe3L10B III KJlaCca TOIlbKO OPTOAOHTYeCKM
MeToAaM IleYeHSI, eCIl TOIlbKO AarHOCTYeCKe CCIleAOBaHSI
He nOATBep)I(AaIOT, YTO MO)l(HO ocyw,eCTBTb nOIlHYIO KoppeKLI1O
 A06TbCSI npaKTYeCK HOpMaIlbHOro nepeKpblTSI B CarTTaIlbHO
nIlOCKOCT.
..../
20 0
CnY'-Iatll III Knacca
80 0
PMC. 8.20. KaK npaB/lO, C/leAyeT 36eraTb lJpe3MepHoro HaK/lOHa BepxHx
pe31..tOB KnepeA nOA yr/lOM 6o/lee 120 0 K n/lOCKOCT BepxHe lJe/llOCT,
OAHaKO B03MO>KHbl HABAya/lbHble OTK/lOHeHSI
PMC. 8.21. Hel..te/lecoo6pa3Ho npeAnpHMaTb nonblTK HOpMa/l30BaTb
COOTHoweHe pe31..tOB III K/laCCa TO/lbKO OPTOAOHTlJeCKM MeTOAaM,
pa3Be lJTO AarHOCTYeCKe CC/leAOBaHSI nOATBep>KAaIOT B03MO>KHOCTb
o6eCnelJeHSI nO/lHO KOppeKI..t  AOCT>KeHSI HOpMa/lbHoro npKyca.
nOCTOSlHHbl npSlMo npKYc MO>KeT npBeCT K pe30p61..t KopHe //l
CTpaH1O 3MaJl.
/
'-

Me3ManbHoe nepeMew,eHMe
BepXHe"lenIOCTHOM KOCTM,
o6ycnoBneHHoe npou.eCCOM pOCTa
Ha pa3BTe BepxHe YeIlIOCT He cIleAyeT nOIlaraTbCSI KaK Ha 3<p<peKTB-
Hbl <paKTOp KoppeKLI aHOMaIl III KJlacca. 06blYHO B TaKX cIlyyaSlX
pa3BTe BepXHe YeIlIOCT He OKa3blBaeT oc060 6IlaronpSlTHoro B03-
AecTBSI  He cnoc06cTByeT nepeMew,eH1O B 3anIlaHpOBaHHYIO n03LI1O
BepXHX pe3L10B.
Me3ManbHoe nepeMew,eHMe
BepXHe"lenIOCTHOM KOCTM B XOAe
OPTOAOHTM"IeCKOrO ne"leHMSI
B cIlyyae HeAOCTaTOYHOro pa3BTSI BepXHe YeIlIOCT y pacTYw,x naLleH-
TOB cIleAyeT paCCMOTpeTb BapaHTbl IleYeHSI C nOMow,blO opTOneAYeCKX
MeTOAOB, CTMYIlPYIOW,X 3MeHeHSI B BepXHeYeIlIOCTHO KOCT (pc. 8.22).
OH MOryT BKJllOyaTb 6blcTpoe pacwpeHe BepxHe YeIlIOCT  npMeHe-
He IlLleBo MaCK, OAHaKO OTHOCTeIlbHO 3<p<peKTa  cTa6IlbHoCT
TaKOro IleYeHSI cyw,eCTBYIOT HeSlCHOCT  npOTBOpeYBble MHeH5I. TeM He
MeHee, B IlTepaTYpe7 MeIOTCSI HeKOTOpble AaHHble, CBAeTeIlbCTBYIOw,e
o B03MO)l(HOCT AOCT)I(eHS1 6IlaronpSlTHoro pa3BTSI BepXHe YeIlIOCT,
cnoc06CTBYIOw,ero Me3aIlbHOMY nepeMew,eH1O BepXHX pe3L10B
B 3anIlaHpOBaHHYIO n03LIIO.
en
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PMC. 8.22. OpTOneAi-1lJeCKi-1e MeTOAbl nelJeHi-1S1 o6eCnelJi-1BalOT 6naronpi-1S1THble
i-13MeHeHi-1S1 B BepxHe lJenIOCTi-1, cnoco6cTBYlOllti-1e Me3i-1anbHoMY nepeMe-
llteHi-11O BepXHi-1X pe3l\OB B 3annaHi-1pOBaHHYIO n03i-1l\i-11O
231

nEPEMELlI.EHiliE HiII>KHiliX PE3LJ.OB
nPili nE'iEHiIIiII AHOMAnillillll1 KnACCA
- - - --- - - -
- __ ___ s
---------- -- ----- -
..,..'.
B CIlYlJae 06paTHoro nepeKpblTSI H)I(He pe3L1bl MO)l(HO nepeMeCTTb
B ACTaIlbHOM HanpaBIleH 3a CyeT X ACTaIlbHOro nepeMew,eHSI B
H)I(HeYeIlIOCTHO KOCT, Il )l(e 3a CYeT ACTaIlbHOro nepeMew,eHSI
caMO H)I(He YeIlIOCT. He6IlaronpSlTHaSl Me3aIlbHaSl n03LISI H)I(HX
pe3L10B MO)l(eT Ha6IllOAaTbCSI B pe3YIlbTaTe Ype3MepHoro pOCTa H)I(He
yeIlIOCT. 3T B03MO)l(HOCT nOOyepeAHO paCCMaTpBaIOTCSI AaIlee, a TaK)l(e
npBOA5ITCSI peKOMeHAaLl no npMeHeH1O MexaHK IleYeHSI 6peKeTaM
CCTeMbl MBfTM AIlSl nepeMew,eHSI H)I(HX pe3L10B np IleYeH aHOMaIl
III KJlacca.
AMCTanbHoe nepeMew.eHMe
M peTpaKu.MSI HM>KHMX pe3u.OB
B npeAenaX KOCTM HM>KHeM ...enIOCTM
B 60IlbWHCTBe HexpypmYeCKX aHOMaIl III KJlaCca LleIleco06pa3HO
BblnOIlHSlTb peTpaKLI1O  HaKJlOH H)I(HX pe3L10B K3aA (pc. 8.23). 3TO
nOMoraeT KOMneHcpOBaTb He3HaYTeIlbHYIO nporHaT1O H)I(He YeIlIOCT
Il He3HaYTeIlbHYIO peTporHaT1O BepxHe YeIlIOCT,  TaKM 06pa30M
MaCKpOBaTb Ile)l(aw,e B OCHOBe naTOIlor CKeIleTHble HapyweH5I. OAHaKo
aHaTOMSI H)I(HeYeIlIOCTHO KOCT Ha yyaCTKe H)I(HX pe3L10B 06ycIlaBIl-
BaeT onpeAeIleHHble OrpaHYeHSI. PeTpaKLISI  HaKJlOH H)I(HX pe3L10B
K3a.n. nOA yrIloM npMepHO 80° K MaHA6YIlSlPHO nIlOCKOCT (pc. 8.24)
He)l(eIlaTeIlbHbl, B CBSl3 C pCKOM AerCLleHLI  HeAOCTaTOYHO onopbl
KOCT AIlSl Ype3MepHo HaKJlOHeHHblX K3aA pe3L10B. TaK)l(e YXYAwaeTcSI

PMC. 8.23. B 6011bwlIIHcTBe CllYliaeB Hexlllpyprlll4ecKoro lle4eHIIISI aHOMalllll
III KIlacca Ll,eIlecoo6pa3Ho BblnOllHSlTb peTpaKLI,lII1O III HaKllOH Hl-1>KHIIIX pe3L1,OB
K3aAIII
3y60aIlbBeOIlSlpHaSl 3CTeTKa  <PYHKLIOHaIlbHOCTb. 3HaYeHe 80° cpaBHMO
co 3HaYeHSlM CTaHAapTHblX HOpM no AaHHblM MYraHcKoro YHBepCTeTa
(Michigan)1, COCTaBIlSlIOW,M npMepHO 95°. HecMoTpSl Ha TO, YTO BeIlYHa
80° MO)l(eT ycnewHo npMeHSlTbCSI Ha npaKTKe, B HeKOTOpblX CIlYlJaSlX 60Ilee
COOTBeTcTByeT 3HaYeHe 85°, np 3TOM peKoMeHAyeTcSI OLleHBaTb Ka)l(Abl
cIlYlJa HABAYaIlbHO.
He06xoAMble peTpaKLI1O  HaKJlOH K3aA 06eCneYBa1OT 06blYHO C
nOMow,blO 3IlaCTYHbIX TSlr III KJlaCca, a MexaHKa IleYeHSI OKa3blBaeTCSI
npow,e B cIlyyaSlX YAaIleHSI H)I(HX 3y60B. 3KcTpaKLISI nepBblX MOIlSlpOB
Ha60Ilee 3<J><peKTBHa AIlSl ACTaIlbHOro nepeMew,eHSI H)I(HX pe3L10B,
MO)l(HO TaK)l(e paCCMOTpeTb BapaHT YAaIleHSI BTOpblX H)I(HX MOIlSlpOB
(naLleHTKa K.B., c. 242).
ECIl IleYeHe npoBoATCSI 6e3 YAaIleHSI H)I(HX 3y60B, AIlSl peTpaKLI
 HaKJlOHa H)I(HX pe3L10B K3aA MO)l(HO cnOIlb30BaTb MexaHKY IleYeHSI
III KJlacca. B AaHHOM cIlyyae B03MO)l(eH ACTaIlbHbl HaKJlOH H)I(HX
npeMoIlSlpoB  MOIlSlpOB, YTO B CBOIO OyepeAb YMeHbwT MelOw,cSI
npoMeoK AIlSl pacTYw,x TpeTbx MOIlSlpOB (naLleHT M.S., c. 241).
B HeKoTOpblX cIlyyaSlX MO)l(HO YAaIlTb TpeTb MOIlSlpbl Ha paHHeM 3Tane.
np He3KcTpaKLIoHHOM IleYeH aHOMaIl III KJlaCca He BCerAa MO)l(HO
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KoppeKLISI HapyweHSI OKKJlI03, HO He CBepXKOppeKLISI. TaKM 06pa30M,
np06IleMaTYeH nporH03 06eCneYeHSI cTa6IlbHOCT 3MeHeH, KOTopble
Ha6IllOAalOTCSI cpaBHTeIlbHO yaCTO Ha n03AHx 3Tanax B cIlyyaSlX aHOMaIl
III KJlaCca, oc06eHHO y MYH.
52°
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PMC. 8.24. KaK npaBlIIllo, peTpaKLI,IIISI III HaKllOH HIII>KHIIIX pe3L1,OB K3aAIII nOA
yrIloM OKOIlO 80° K MaHAIII6YIlSlPHO nllOCKOCTIII He>KellaTeIleH

AMCTanbHoe nepeMew.eHMe
HM>KHeM 'IenIOCTM - AMCTanbHOe
pen03MMOHMpOBaHMe
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Me3aIlbHOe cMew,eHe H)I(He YeIlIOCT. no Mepe IleYeHSI H)I(HSISI
yeIlIOCTb nepeMew,aeTCSI B ACTaIlbHOM HanpaBIleH, np 3TOM Mblw,eIlKO-
Bble OTpOCTK 3aHMaIOT B CYCTaBHblX SlMKax LleHTpaIlbHOe nOIlO)l(eHe.
T aKoe 6IlaronpSlTHoe 3MeHeHe, conyrCTBYIOw,ee ACTaIl3aLl H)I(HX
pe3L10B B KOMnIleKce Ill!a, MO)l(HO nporH03pOBaTb Ha 3Tane nIlaHpOBaHSI
IleYeHSI (pc. 8.25).
AMCTanbHoe nepeMew.eHMe HM>KHeM
'IenIOCTM - OrpaHM'IeHMe pa3BMTMSI?
B npOWIlOM 60Ilbwoe BHMaHe YAeIlSlIl 14CnOIlb30BaH1O opTOneAYeCKX
annapaTOB  YCTPOCTB, TaKX KaK nOA60pOAOYHaSl npaw,a (pc. 8.26),
AIlSl CAep)l(BaHSI pOCTa H)I(He yeIlIOCT np aHOMaIlSlX III KJlacca.
comaCHO AaHHblM KJlHYeCKO npaKTK  HaYYHblX CCIleAOBaH8,
npMeHeHe opTOneAYeCKX annapaTOB AIlSl OrpaHYeHSI AIlHbl H)I(He
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HVI)I(H lJelllOCTb nepeMell.laeTC B AViCTallbHOM HanpaBlleHVIVI B XOAe JlelJeHVI,
VI Mblw,ellKOBble OTpOCTKVI 3aHVlMalOT Ll,eHTpallbHYIO n03V1L1,VlIO B cycTaBHblx
MKax, n03V1L1,VI HVI)I(HVIX pe3L1,OB AVicTallVl3V1pyeTc B KOMnlleKce llVlLl,a.
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Me3ManbHoe nepeMew.eHMe HM>KHev.
"IenIOCTM - pa3BMTMe no III Knaccy
3TO BHew <paKTOp np IleYeH  nOCIleAYIOw,e peTeHLI y
naLleHTOB C aHOMaIlSlM III KJlaCca, oc06eHHO Y MYH. KaK OTMeYaIlOCb
paHee (c. 226), eCIl y naLleHTa npoSlBIlSlIOTCSI He6IlaronpSlTHble TeHAeHLI
pa3BTSI H)I(He YeIlIOCT, cIleAyeT npoKoHTpoIlpoBaTb AHaMKY ee pa3-
BTSI, npe)I(Ae yeM npHMaTb peweHe 0 KoppeKLI aHOMaIl TOIlbKO
OpTOAOHTYeCKM IleYeHeM. nepeA HaYaIlOM TOIlbKO OPTOAOHTYeCKoro
IleljeHSI naLleHTa cIleAyeT 06S13aTeIlbHo npeAynpeATb 0 HenpeAcKa3yeMoM
xapaKTepe pOCTa np aHOMaIlSlX III KJlacca  nOCIleACTBSlX TaKoro pOCTa.
KaK OTMeYaIlOCb Ha c. 226, y naLleHTOB nOCIle OPTOAOHTYeCKoro IleYeHSI
Ype3BbIYaHO TPYAHO KOHTpoIlpoBaTb  KOppeKTpOBaTb CTYaLl1O B cIlyYae
He6IlaronpSlTHoro pa3BTSI H)I(He YeIlIOCT. n03TOMY OyeHb BHO
BbISlBTb cIlYlja, Tpe6YIOw,e xpyprYecKOro BMewaTeIlbCTBa, C caMoro
HaYaIla. B YaCTHOCT, He cIleAyeT npe)I(AeBpeMeHHO npHMaTb He06paT-
Moe peweHe 06 YAaIleH 3y60B.
flll1TEPATYPA
1 Riolo M. et al. 1974. Atlas of craniofacial growth. Center for Human Growth and
Development, University of Michigan.
2 McNamara J. A. 1984. A method of cephalometric evaluation. American Journal of
Orthodontics 86:449-469.
3 Sato S., Suzuki Y. 1988. Relationship between the development of skeletal mesio-
occlusion and posterior tooth-to-denture base discrepancy. Its significance in the
orthodontic correction of skeletal Class III malocclusion. Journal of the Japanese
Orthodontic Society 48:796-810.
4 Bennett J., Mclaughlin R. P. 1997. Orthodontic management of the dentition with
the preadjusted appliance. Isis Medical Media, Oxford (ISBN 1 89906691 8)
pp. 344-350. Republished in 2002 by Mosby, Edinburgh (ISBN 0723432651).
PMC. 8.27. np He6Ilaronp5ITHO AHaMKe pa3BT5I H>KHe 4en1OCT
III Knacca 04eHb CnO>KHO KOHTponpoBaTb cTyal.t1O y nal.teHTa nocne
OPTOAoHT4ecKoro ne4eH5I
5 Bennett J., Mclaughlin R. P. 1997. Orthodontic management of the dentition with
the preadjusted appliance. Isis Medical Media, Oxford (ISBN 1 89906691 8)
pp. 338-343. Republished in 2002 by Mosby, Edinburgh (ISBN 0723432651).
6 Mclaughlin R. P., Bennett J. 1999. An analysis of orthodontic tooth
movement - the dental VTO. Revista Espanola de Ortodoncia 29:2 10-29.
7 Pangrazio-Kulbersh V., Berger J., Kersten G. 1998. Effects of protraction
mechanics on the midface. American Journal of Orthodontics and Dentofacial
Orthopedics 114:484-491.
8 Ishikawa H. et al. 1998. Individual growth in Class III malocclusion and its
relationship to the chin cap effects. American Journal of Orthodontics and
Dentofacial Orthopedics 114:337-346.

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K nnOCKOCTM HM>KHeM 'IenIOCTM. He3Ha'lMTenbHble AMcnponopMM
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TeIlbHOCTb aKTBHoro IleYeHSI 26 MeCSlLleB.
nOIlYljeHbl xopowe pe3YIlbTaTbi 3y60aIlbBeOIlSlpHoro COOTHoweHSI,
OAHaKO naHopaMHbl CHMOK YKa3blBaeT Ha peTeHLI1O TpeTbX H)I(HX
MOIlSlpOB. naLleHTa HanpaBIl Ha KOHCYIlb TaLl1O K xPypry no nOBOAY
YAaIleHSI TpeTbX MOIlSlpOB. t.1x MO)l(HO YAaIlTb Ha paHHX 3Tanax IleYeHSI.
3TO nOMomo 6bl npMeHTb MexaHKY IleYeHSI III KJlacca  36e)l(aTb
xpyprYeCKoro YAaIleHSI 3TX 3y60B.
r apMOHYHbl npo<pIlb C He3HaYTeIlbHbIM OTKJlOHeHSlM III KJlacca.
3a nepOA IleYeHSI npO30WeJl He3HaYTeIlbHbl pOCT. Cyw,eCTByeT
HeKOTOpbl pCK peLlABa, 06YCIlOBIleHHoro n03AHM pa3BTeM H)I(He
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np06IleMbi n03AHero pOCTa  36e)l(aTb YAaIleHSI TpeTbX MOIlSlpOB.
PMC. 8.52
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Pl1C. 8.61
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PMC. 8.54
PMC. 8.57
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10/29/98
PMC. 8.60
PMC. 8.63
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SNA L 86°
SNB L 88°
ANB L _2°
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FM L 20°
MM L 27°
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CKeneTHblM HapyweHMeM III Knacca (ANB 1°). npocl>Mnb nMa
nponopMoHaneH M rapMOHM'ieH.
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III KJlacca C 3aH)I(eHHbIM npKYcoM no BepTKaIl. H)I(He pe3L1bl CKYyeHbl
 HaKJlOHeHbl K3aA, OTMeyaeTCSI He3HaYTeIlbHaSl cKYyeHHOCTb 3y60B
B BepxHe Ayre.
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CIleAYIOw,x <paKTOpoB:
. r apMOHYHbl Il CIlerKa ynIlow,eHHbl npo<j)Ilb
. HecKoIlbKO 3aBblweHHbl Me)l(YeIlIOCTHO yroIl
. T eHAeHLISI K nepeAHeMY OTKpblTOMY npKYcy
. He3HaYTeIlbHaSl AO YMepeHHo CKYYeHHOCTb nepeAHX 3y60B.
CKYLleHHOCTb 3y60B He HaCTOIlbKO 3HaYTeIlbHa, YT06bl npH5ITb peweHe
06 YAaIleH npeMOIlSlpOB 6e3 pCKa He)l(eIlaTeIlbHoro 3MeHeHSI npo<j)IlSl
Il. C APYro CTOpOHbl, He3KCTpaKLIOHHoe IleyeHe Momo npBeCT
K <POpMpoBaH1O nepeAHero OTKpblTOro npKYca.
naHOpaMHbl CHMOK nOATBepeT, YTO Bce 3y6bl, BKJllOyaSl TpeTb
npeMOIlSlpbl HOpMaIlbHO BeIlYHbl, HaxOASlTCSI B HOpMaIlbHO n03LI.
BAHO, YTO TOpK BepXHX pe3L10B cIleAyeT YBeIlYTb C 107 0 AO npMepHo
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pTeIlbHo. TaKM 06pa30M, 3anIlaHpoBaHHaSl n03LISI BepxHx  H)I(HX
pe3L10B Moma 6bl 6blTb 6Il3KO K CXOAHO np HeKoTopoM 3MeHeH
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peAcTBoM 3KcTpaKLI BTOpblX H)I(HX MOIlSlpOB  cnOIlb30BaTb 3IlaCTYHble
TSlr III KJlacca AIlSl BblpaBHBaHSI  peTpaKLI nepBblx H)I(HX MOIlSlpOB 
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Po-N..l FH -11 MM
WITS -2 MM
GoGnSN L 38°
FM L 29°
MM L 31°
.1KA-Po 5 MM
1KA-Po 2 MM
.1 - K n110CKOCTM
BepxHeM e11l0CTM L113°
1 - K n110CKOCTM
HM>KHeM e11l0CTM L 91°
K.B. AO
ne'leHMH
K.B. nocne
ne'leHMH
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PA3AE 9
3aKpblTMe npOMe>KyTKOB
III MeXaHMKa CKOnb>KeHMSI
BCTynneHMe - Heo6xOAMMOCTb
3<1><I>eKTMBHoro 3aKpblTMSI npOMe>KyrKoB 250
MeTOAbl 3aKpblTMSI npOMe>KYTKoB
Ayrtl1 C 3aKpblBaJOlLI.tI1MtI1 neTnflMtI1
252
252
6anaHC <j>MKCaLtMM npM 3aKpblTMM
npOMe>KyrKoB 260
B3atl1M03aKpblTtI1e npOMe)l(YTKOB 260
3aKpblTtI1e npOMe)l(YTKoB nptl1 MaKCtI1MaJlbHOVI
cptl1KCaLl,tI1t11 - CKYl./eHHOCTb 3y6oB 260
3aKpblTtI1e npOMe)l(YTKoB nptl1 MaKCtI1MaJlbHOVI
cptl1KCaLl,tI1t11 - npoTpY3t11f1 261
3aKpblTtI1e npOMe)l(YTKoB nptl1 MtI1HtI1MaJlbHOVI
cptl1KCaLl,tI1t11 - «C)I(tI1raHtI1e cptl1KCaLl,tI1t11» 262
MeXaHtI1Ka CKOnb)l(eHtI1f1 npll1 3Hal./tI1TenbHblX
ctI1nax (ex-edgewise) 252
3JlaCTtI1l./Hble Ll,enOl./KtI1 254
MeXaHtI1Ka CKOJlb)l(eHtI1f1 nptl1 He3Hal./tI1TeJlbHb1X
C tI1Jl ax 254
AllbTepHaTtI1BHafl MeXaHII1Ka AJlfl nnoxo
nOAQaJOlLI.tI1xcfI 3aKpblTtI1JO npOMe)l(YTKoB 258
npo6neMbi nptl1 3aKpblTtI1t11 npOMe)l(YTKoB 259
naLtMeHT N. H. neLleHMe B3pocnoro naLtMeHTa
C He3HaLlMTenbHbiM CKeneTHblM HapyweHMeM
III KnaCca C YAaneHMeM nepBoro
npeMonSipa 264
naLtMeHTKa M.O'T. neLleHMe C YAaneHMeM
nepBoro npeMonSipa 272
249

BCTynnEHIf1E - HE06XOAIf1MOCTb
3CbCbEKTIf1BHOrO 3AKPbITIf1S1
npOME>KYTKOB
. .. ...
HeCMOTpSl Ha TO, YTO 3aKpblTe npOMeKOB HOrAa He06xOAMO np
6e33KCTpaKLIOHHOM IleYeH, AaHHaSl np06IleMa 06blYHO 06CaeTCSI
B KOHTeKCTe YAaIleHSI npeMOIlSlpOB. 3aKpblTe npOMeKOB BblnOIlHSlIOT
aHaIlOrYHO B 060x CIlaSlX,  XOTSI OTHOWeHe K 3KCTpaKLI np OPTOAOH-
TW.leCKOM IleYeH B npOWIlOM 6blIl0 npOTBOpeYBbIM, B HacTOSlw,ee
BpeMSI CYTaeTCSI, YTO B HeKOTOpblX cIlyyaSlX 3KCTpaKLISI yeTblpeX MOIlSlpOB
LleIleCoo6pa3Ha. npoMeOK BeIlYHO 7 MM, nOIlYlJaeMbl B KOM
KBMpaHTe, MO)l(HO 3<p<peKTBHO cnOIlb30BaTb B cIleAYIOw,x LleIlSlX:
. YCTpaHeHe CKYlJeHHOCT AIlSl AOCT)I(eHSI CTa6IlbHOro nepMew,eHSI
3y60B
. PeTpaKLISI nepeAHx BepxHx 3y60B AIlSl KoppeKLI npKYca np
IlelJeH aHOMaIl 11/1 KJlacca
. PeTpaKLISI H)I(HX pe3L10B AIlSl KoppeKLI HapyweH OKKJlI03
III KJlacca
· PeTpaKLISI BepxHx  H)I(HX pe3L10B AIlSl YIlYYWeHSI npo<t>IlSl IlLla
Il KoppeKLI OKKJlI03 B cIlYlJaSlX 6MaKcIlIlSlpHoro HaKJlOHa 3y60B
KnepeA
· Me3aIlbHOe nepeMew,eHe MOIlSlpOB C LleIlblO YBeIlYeHSI npoMeKa
AIlSl npope3blBaHSI TpeTbx MOIlSlpOB.
PMC. 9.4. 83aMMo3aKpblTMe npOMe>KYTKoB
.... ....-
B cIlyyaSlX MaKCMaIlbHO <pKcaLl 60IlbwaSl yaCTb npocTpaHcTBa
cnoIlb3yeTcSI AIlSl YCTpaHeHSI CKYYeHHOCT 3y60B (pc. 9.1) Il peTpaK-
LI pe3L10B (pc. 9.2).
OAHaKo B CIlaSlX MHMaIlbHO <t>KcaLl, KOrAa CKYlJeHHOCTb Il
npOTpY3SI He3HaYTeIlbHbl, AIlSl YCTpaHeHSI CKYYeHHOCT Il peTpaKLI
pe3L10B nOHaA06TCSI npOCTpaHCTBO MeHee 7 MM B KOM KBaApaHTe.
B TaKX cIlyyaSlX B03HKaeT He06xoAMOCTb B 3aKpbIT OCTaBWXCSI
npoMeKoB 3a CyeT Me3aIlbHoro nepeMew,eHSI nepBblx  BTOpblX
MOIlSlpOB C 06eCneYeHeM 60Ilbwero npoMeKa AIlSl npope3blBaHSI
TpeTbx MOIlSlpOB (pc. 9.3).
Bo MHorx CIlYlJaSlX LleIleco06pa3Ho B3aM03aKpbITe npOMeKOB Ha
yyaCTKe npeMOIlSlpOB (pc. 9.4), oc06eHHo eCIl OCTaBWeCSI npOMeK
He3HaYTeIlbHbl. OAHaKo B APyrx cIlyyaSlX He06xoAMO BHOCTb 3MeHeHSI
B MexaHKY IleYeHSI  KOHTpoIlpoBaTb <t>KcaLl1O C LleIlblO peTpaKLI
pe3L10B (pc. 9.5) Il Me3aIlbHoro nepeMew,eHSI MOIlSlpOB (pc. 9.6).
CIleAoBaTeIlbHo, B 3<t><peKTBHO OPTOAOHTYeCKO npaKTKe
cyw,eCTByeT He06xoAMOCTb B HaAe)l(HOM MeTOAe 3aKpb1TSI npOMeKOB,
06eCneYBalOw,eM KOHTpOIlb <pKcaLl.
,oS
PMC. 9.5. PeTpaKLJ.MSI pe3LJ.OB
PMC. 9.6. Me3MaJlbHOe nepeMew,eHMe
MOIlSlpOB

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PMC. 9.1. npOMe}l()'TKi-1 nOCIle YAaIleHi-1S1 npeMoIlSIpoB MO>KHO i-1CnOIlb30BaTb AIlSI YCTpaHeHi-1S1 cKyeHHOCTi-1 3y6oB i-1 AOCTi-1>KeHi-1S1 cTa6i-1IlbHoro BblpaBHi-1BaHi-1S1
3y6HOro pSlAa
-.
APo
PMC. 9.2. B nocT3KCTpaKi-10HHble npOMe>KYTKi-1 MO>KHO npOBeCTi-1 peTpaKi-11O pe3oB i-1 KllblKOB Ha yacTKe npeMoIlSIpoB, YIlywaSi TaKi-1M o6pa30M rapMOHi-1Hble
nponopi-1i-1 npo<t>i-1IlSI Ili-1a npi-1 pe3MepHo npOTpY3i-1i-1
-.
APo
PMC. 9.3. B cIlyaSlx Mi-1Hi-1MaIlbHO <t>i-1KCai-1i-1 AIlSi 3aKpbITi-1S1 OCTaTOHbIX npOMe>KYTKOB MO>KeT 6blTb Heo6xOAi-1MbIM nepeMeLl.leHi-1e MOIlSIpOB B Me3i-1aIlbHOM
HanpaBIleHi-1i-1, TO o6eCnei-1T 60Ilbwe MeCTa AIlSI npope3bIBalOUJ.i-1XCSI TpeTbi-1X MOIlSIpOB
251

//\
//\
npaBL-1nbHOe 3aKpblTL-1e npOMe>KYTKa
CnL-1WKOM 6blCTpOe 3aKpblTL-1e npOMe>KYTKa
PMC. 9.9. CIWIWKOM 6b1CTpOe 3aKpblTMe npOMe}l(YTKa TalOKe OTpMLl.aTeIlbHO
B03AecTByeT Ha TOpK BepXHMX M HM>KHMX MOJ1S1pOB. TaKMe nepeMew.eHMSI
He6J1aronpMSlTHbi AJ1S1 <l>YHKLl.MOHaJ1bHblX }I(eBaTeJ1bHblX ABM>KeHM, a MOJ1S1paM
Heo6xoAMMbI AOnOIlHMTeIlbHble M3MeHeHMSI TOpKa AJlSI AOCTM}I(eHMSI npaBMIlbHo
n03MLl.MM.
'\. \ J
PMC. 9.11. He>KeJ1aTeJ1bHble 3ct>ct>eKTbI CIlMWKOM 6blCTpOro 3aKpblTMSI
npOMe>KYTKoB BKllIOLJalOT HaKllOH HM>KHMX MOIlSIpOB C 3KcTPY3Me AMCTaIlbHblX
6yrpoB, oco6eHHo B cJ1YLJaSix 60J1bwOro Me>KLJeJ1IOCTHoro yrJ1a. MO}l(eT TalOKe
Ha6J1IOAaTbCSI M36blTOLJHOe pa3pacTaHMe MSlrKMX TKaHe, KOTopoe MHorAa
npenSlTcTByeT HaAJIe>Kaw.eMY 3aKpblTMIO npOMe>KyrKa, MJ1M Bbl3blBaeT nOBTOp-
Hoe OTKpblTMe 3KCTpaKLl.MOHHOro npOMe>KYTKa.
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PMC. 9.10. npM CJ1MWKOM 6b1CTPOM 3aKpblTMM npOMe>KYTKoB B03HMKaeT
TeHAeHLl.MSI K pOTaLl.MM Y 3y6oB, CMe>KHbIX C nocT3KCTpaKLl.MOHHbIMM YLJaCTKaMM
...
IF
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PMC. 9.12. naLl.MeHT, J1eLJeHHbl C npMMeHeHMeM 6peKeTOB Ha BepxHMx
KJ1bIKaX C aHrYIlSlLl.Me 11 0 , KOpHM BepxHMx KJ1bIKOB OCTaJ1MCb B HenocpeAcT-
BeHHo 6IlM30CTM K KOpHSIM npeMoIlSIpoB
253

METOAbI3AKPbITSI npOME>KYTKOB
. Ayr C 3aKpbIBalOw,M neTIlSlM
. MeXaHKa CKOIlb)l(eHSI np 3HaYTeIlbHbIX CIlax (ex-edgewise)
. 3IlaCTYHble LlenOYK
. MexaHKa CKOIlb)l(eHSI np He3HaYTeIlbHbIX CIlax (peKoMeHAyeMaSl)
AyrM c aaKpblBalOUJ.MMM neTnSlMM
Edward Angle OTAaBaIl npeAnOYTeHe He3KCTpaKLIOHHbIM MeTOAaM
IleYeHSI BO Bcex cIlyyaSlX, n03TOMY He06xoAMOCT B MexaHKe 3aKpb1TSI
npoMeKoB np TaKOM nOAXOAe 06blYHO He 6bIIlO. n03AHee, OAHaKO,
Ayr C 3aKpbIBalOw,M neTIlSlM CTaIl yaCTblO TPaALIOHHO MexaHK
3roKYa3, KaK 06 3TOM nCaIl Tweed. 1 Ha KIDI(AO CTaIlbHO npSlMoyroIlbHO
Ayre 6blIl0 06blYHO YeTblpe neTIl - ABe neTIl OMera  ABe 3aKpbIBalOw,e
(KanIleBAHble) neTIl, KOTOpble 06blYHO BbInOIlHSlIl HABAYaIlbHO AIlSl
KIDKAOro naLleHTa. OH OKa3b1BaIl BeCbMa OrpaHYeHHOe B03AeCTBe AO
MOMeHTa BXO>K,lJ,eHSI neTIl OMera B KOHTaKT C Tpy6KO Ha MOIlSlpe.
Ayr C 3aKpbIBalOw,M neTIlSlM 6b1Il r6KM B CBSl3 C HaIlYeM
neTeIlb Ha HX, HO OKa3b1BaIl 3HaYTeIlbHoe CIlOBoe B03AeCTBe Ha
3aKpblTe npOMeKOB Ha 3KCTpaKLIOHHbIX yYaCTKax. n03TOMY np npMe-
HeH TaKO MexaHK IleYeHSI Tpe60BaIlaCb AonOIlHTeIlbHaSl aHryIlSlLlSI,
KOHTpOIlb POTaLl  TOpKa, YTO 06eCneYBaIlOCb nocpeACTBOM BblnOIlHeHSI
HABAYaIlbHbIX 3r60B Ha Ayre AIlSl KIDI(AOro 3y6a. T aKe 3r6bl MO)l(HO
nOCTeneHHO YCTpaHSlTb Il YMeHbwaTb B npOLlecce IleYeH5I.
AaHHbl MeTOA 3aKpb1TSI npOMeKOB MeIl HeAOCTaTK. Tpe60BaIlOCb
MHOro BpeMeH Ha BblnOIlHeHe 3r60B, CIlbl 6b1Il 3HaYTeIlbHble; Mexa-
HKa CKOIlb)l(eHSI HeYAOBIleTBopTeIlbHO,  MexaH3M 06eCneYBaIl
KOpOTK nepOA aKTBaLl. n03TOMY npMeHeHe Ayr C 3aKpbIBalOw,M
neTIlSlM (pc. 9.7) He peKoMeHAyeTcSI AIlSl 06blYHOro 3aKpb1TSI npOMe-
KOB TexHKO npSlMO Ayr. B HeKOTOpblX cIlyyaSlX OH MOryT 6blTb nOIle3Hbi
np 3aKpbJT He60IlbwX OCTaTOYHblX npOMeKOB, oc06eHHO y B3pOCIlbiX
naLleHTOB.
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PMC. 9.7. 3aKpblBalO11te neTm1 6b1Il lJaCTblO TP3AOHHO MexaHK
IlelJeHSI 3,1J,)Kya3-TexHKo. x 06bllJHO BblnOIlHSlIl HABAyaIlbHo AIlSI
Ka)I(Aoro naeHTa. )J,IlSi HX xapaKTepeH OrpaHlJeHHbl Aana30H aKTBa
AO MOMeHTa AOCT)I(eHSI KOHTaKTa neTeIlb OMera C Tpy6KO Ha MOIlSIpe.
-. -
MexaHMKa CKOnb>KeHMSI npM
3Ha"'lMTenbHbiX CMnax (ex-edgewise)
B 70-e roAbl xx BeKa, Ha HaYaIlbHOM 3Tane cnOIlb30BaHSI TeXHK
npSlMO Ayr, CCIleAOBaIlCSI  OLleHBaIlCSI LleIlbl PSIA MexaHK IleYeHSI.
npeAnpHMaIlCb nonblTK npMeHTb TPaALIOHHble YPOBH CIl
3A)1(ya3- TeXHK (500-600 r) np cnOIlb30BaH HOBblX 6peKeTOB.
06HapeHO, YTO Ype3MepHO 60Ilbwe CIlbl, npMeHSlBwecSI AIlSl
3aKpb1TSI npOMeKOB (HanpMep, CTaIlbHble npHbl Pletcher Ha
CTaIlbHblX Ayrax CeYeHeM 0,018/0,025 AIOMa) BbJ3b1BaIl He)l(eIlaTeIlbHble
3MeHeHSI HaKJlOHa, POTaLl  TOpKa (pc. 9.8-9.11).
n03TOMY np npMeHeH TaKX 3HaYTeIlbHbIX CIl AIlSl 3aKpb1TSI
npoMeKoB B03HKaIla He06xoAMOCTb B AonOIlHTeIlbHaSl aHryIlSlLlSI,
KOHTpOIle POTaLl  KOHTpoIle TOpKa. TaKo AonoIlHTeIlbHbl KOHTpOIlb
MO)l(HO 6blIl0 06eCneYTb 3a CyeT BBeAeHSI AonOIlHTeIlbHoro HaKJlOHa,
POTaLl  TOpKa B 6peKeTbl. 3TO SlBIlOCb npeAnocblIlKo AIlSl pa3pa60TK
Andrews 2 «3KCTpaKLIOHHO» Il «TpaHCIlSlLlOHHO» CCTeMbl 6peKeTOB.
OAHaKo, TaKe 6peKeTbi coxpaHSlIl AonOIlHTeIlbHO BBeAeHHble napaMeTpbl
AO KOHLla IleYeHSI (B OTIlYe OT CTaHAaPTHblX 6peKeToB CCTeMbl 3A)1(ya3,
B KOTOpblX, HanpMep, <j)KCpYIOw,e 3r6bl MO)l(HO 6blIlO peryIlpoBaTb
Ha 3aKJlIOYTeIlbHbIX 3Tanax). n03TOMY IleYeHe C nOMow,blO 3KcTpaKLIoH-
HblX 6peKeTOB  npMeHeHeM 3HaYTeIlbHbIX CIl BbIABraIlO 60Ilee
)l(eCTKe Tpe60BaHSI K KOHTpOIlIO <pKcaLl Ha paHHx 3Tanax IleYeHSI,
a TaK)l(e npBoAIlO K cBepxKoppeKLI n03LI 3y60B B KOHLle IleYeHSI
(pc. 9.12).
D npaBIIIJlbHOe 3aKpblTllle npOMe>KYTKa
. CJlIIIWKOM 6blcTpoe 3aKpblTllle npOMe>KYTKa
PMC. 9.8. CIlWKOM 6blcTpaSi peTpaKSI pe3t.\OB MO)l(eT npBeCT
K HenpaBIlbHOMY TOPKY 3TX 3y6oB

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npaBlllnbHoe 3aKpblTllle npOMe>KYTKa
CnlllWKOM 6blCTpOe 3aKpblTllle npOMe>KYTKa
PMc.9.9. Cm1wKoM 6b1CTpOe 3aKpbIH1e npOMe)l(YTKa TalOKe oTpu,aTeIlbHO
B03,lJ,eVlcTByeT Ha TOpK BepxHx  H)I(HX MOllSipOB. TaKe nepeMew.eHSI
He6IlaronpSlTHbl ,lJ,llSi <j>YHKu,oHallbHblx )l(eBaTeIlbHblX ,lJ,B)I(eHVI, a MOIlSIpaM
Heo6xo,lJ,Mbl ,lJ,OnOllHTeIlbHble 3MeHeHSI TOpKa ,lJ,JlSl ,lJ,OCT)I(eHSI npaBllbHoVi
n03u,.
" \ I
PMC. 9.11. He)l(ellaTellbHble 3<j><j>eKTbl CllWKOM 6blCTpOro 3aKpblTSI
npOMe)l(}'TKOB BKmOalOT HaKllOH H)I(HX MOIlSIpOB C 3KcTPY3eVl ,lJ,CTallbHbIX
6yrpoB, oco6eHHo B cllyaSlx 6011bWOro Me)l(yeIllOcTHoro yrIla. MO)l(eT TalOKe
Ha611IO,lJ,aTbCSI 36bIToHoe pa3pacTaHe MSlrKX TKaHeVl, KOTopoe HOr,lJ,a
npenSlTcTByeT Ha,lJ,Jle)l(aw.eMY 3aKpblT1O npOMe)l(YTKa, Il Bb13b1BaeT nOBTOp-
Hoe OTKpblTe 3KcTpaKu,OHHOro npOMe)l(YTKa.
. CnlllWKOM 6blCTpoe 3aKpbITllle npOMe>KYTKa
PMC. 9.1 O. np CllWKOM 6b1CTpOM 3aKpbIT npoMe)l(YTKoB B03HKaeT
TeH,lJ,eHu,SI K pOTau, y 3y6oB, CMe)l(HblX C nocT3KcTpaKu,oHHblM yaCTKaM

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PMC. 9.12. nau,eHT, lleeHHblVi C npMeHeHeM 6peKeTOB Ha BepXHX
KllblKax C aHrYllSlu,eVl 11 0, KOpH BepxHx KJ1b1KOB OCTallCb B HenOCpe,lJ,CT-
BeHHoVi 61130CT K KOpHSIM npeMollSipoB
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3naCTM...Hble u,enO"'KM
3IlaCTYHble LlenOYK He peKOMeHAYIOT npMeHSlTb AIlSl 3aKpb1TSI 3HaYTeIlb-
HblX npOMeKOB 3 co06peH ypOBHSI npMeHSleMbiX CIl. HanpMep,
LlenOYK «C-1 », HaTSlHyrbie Me)I(AY nepBblM MOIlSlpaM, nepBOHaYaIlbHO
reHepPYIOT CIlY 400 r Ha BepxHe Ayre  CIlY 350 r - Ha H)I(He Ayre.
no ypOBHIO CIlbl OH CIleAYIOT 3a 3aKpbIBalOw,M neTIlSlM  CTaIlbHbIM
npHaM Pletcher. B cIlyyae YAaIleHSI nepBblx npeMoIlSlpoB Ype3MepHo
pacTSlHyraSl LlenOYKa Ha 3KcTpaKLIoHHbIX Y4acTKax (pc. 9.13) Bbl30BeT
pOTaLl1O CMe)l(HblX 3y60B. HeAOCTaTOYHO pacTSlHyrble 3BeHbSl LlenOYK
Ha 3KCTpaKLIOHHbIX yyacTKax (pc. 9.14) Bo06w,e He CMOryT 06eCneYTb
3aKpblTe npOMeKOB.
npMeHeHe 3IlaCTYHbIX LlenOyeK LleIleco06pa3HO AIlSl 3aKpb1TSI
OAHOro Il ABYX He3HaYTeIlbHbIX npOMeKOB Ha KOHeYHOM 3Tane IleYeHSI
(pa3AeIl 10), a cIla6ble LlenOYK MO)l(HO cnOIlb30BaTb AIlSl npeAoTBpaw,eHSI
pacKpblTSI npoMeKoB Ha n03AHX 3Tanax IleyeHSI np HaIlY
B nOIlOCT pTa <pHWHbIX Ayr AaMeTpoM 0,014 AIOMa.
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lit "
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PMC. 9.13. LJpe3MepHoe paCTfI)f(eHMe 3IlacTwmo enOI.jKM MO)f(eT Bbl3BaTb
He)f(eJlaTeJlbHYIO pOTaMIO 3y6oB
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PMC. 9.14. He,ll,OCTaTOI.jHO paCTflHYTbie 3JlaCTMI.jHbie enOI.jKM He 06eCnel.jM-
BalOT 3aKpblTMfI npOMe)f(YTKa
MexaHMKa CKOnb>KeHMSI
npM He3Ha...MTenbHb1X CMnaX
B 1990 roAY npeAIlO)l(eH MeTOA KOHTpoIlpyeMoro 3aKpb1TSI npOMeKOB3
C cnOIlb30BaHeM MexaHK CKOIlb)l(eHSI. 3TOT MeTOA OKa3aIlCSI 3<p<peK-
TBHbIM  HaAe)l(HblM Ha npaKTKe  nOIlYYIl wpoKOe pacnpOCTpaHeHe.
ABTOpbl peKoMeHAYIOT cIleAYIOw,ylO TeXHKY:
· ne'le6Hble AyrM. PeKOMeHAYIOT npMeHSlTb npSlMoyroIlbHble CTaIlbHble
Ayr CeYeHeM 0,019/0,025 AIOMa (TaK Ha3blBaeMbie pa60Ye Ayr)
(pc. 9.15) AIlSl 6peKeToB C na30M 0,022, nOCKOIlbKY AaHHbl pa3Mep
Ayr 06eCneYBaeT OmMaIlbHbl KOHTpOIlb no BepTKaIl  cB060AHoe
CKOIlb)l(eHe Ayr B na3ax 6peKeTOB Ha w,eYHbIX cerMeHTax. Ayr
MeHbwero CeYeHSI 06eCneYBa1OT MeHbw KOHTpOIlb npKYca  TOpKa.
Ayr 60Ilbwero CeYeHSI HorAa OrpaHYBaIOT cB060AHoe CKOIlb)l(eHe
6peKeTOB Ha yYacTKe MOIlSlpOB  npeMoIlSlpoB.
· npMnaRHHble KplO'IKM. ABTOpbl no-npe)l(HeMY OTAalOT npeAnOYTeHe
npnaSlHHblM IlaTYHHblM KplOYKaM 0,7 AIOMa. MO)l(HO TaK)l(e cnOIlb30-
BaTb npnaSlHHble KpIOYK 3 MSlrKo Hep)l(aBelOw,e CTaIl 0,6 AIOMa,
nOCKOIlbKY OH IlYYWe B3YaIlbHO BocnpHMaIOTCSI HeKOTOpbIM
B3pOCIlbIM naLleHTaM. KaK npaBIlO, paCCTOSlHe Me)I(AY KpIOYKaM,
paCnOIlO)l(eHHbIM no 06e CTOpOHbl BepxHe Ayr, COCTaBIlSleT 36 Il
38 MM, a Ha H)I(He Ayre - 26 MM (pc. 9.16). ABTOpbl nOIlaralOT,
YTO paCCTOSlHe 26 MM Me)I(AY KpIOYKaM Ha H)I(He Ayre nOAXOAT
60IlbWHCTBY naLleHTOB, OAHaKO paCCTOSlHe Me)I(AY KpIOYKaM Ha
BepxHe Ayre OTIlYaeTCSI 60IlbWM pa3Ho06pa3eM, BBAY pa3IlYHbIX
BeIlYH BepXHX 60KOBbiX pe3L10B y pa3HbiX naLleHTOB. n03TOMY BpaY
AOIl)l(eH MeTb 60IlbWO accopTMeHT BepXHX Ayr C pa3J1YHbIM
paCCTOSlHSlM Me)I(AY KpIOYKaM.

. naCCMBHble CBSl3KM tieback. npee yeM npCTYnaTb K 3aKpblT1O
npoMeKoB, LleIleco06pa3Ho npMeHSlTb npSlMoyroIlbHble CTaIlbHble
Ayr CeyeHeM 0,019/0,025 AIOMa C naCCBHbIM CBSl3KaM tieback
He MeHee 1 MeCSlLla (pc. 9.17). 3TO AaeT BpeMSI AIlSl 3MeHeH TopKa
KOro OTAeIlbHoro 3y6a  OKOHyaTeIlbHoro BblpaBHBaHSI 3y6HbiX
Ayr AIlSl 6ecnpenSlTcTBeHHoro AecTBSI MexaHK CKOIlb)l(eHSI np
YCTaHoBKe aKTBHbIX CBSl30K tieback.
. AKTMBHble CBSl3KM tiebackc 3naCTM'IHbIMM MOAynSiMM. B
nOBceAHeBHo KJlHYeCKO npaKTKe x npMeHeHe 3<p<peKTBHO,
HaAe)l(HO  npocTo. X BBeAeHe He Bbl3blBaeT TPYAHOCTe  MO)l(eT
6blTb nopY'-leHO aCCCTeHTaM. npMeHeHe aKTBHbIX CBSl30K tieback
C 3IlaCTYHbIM MOAYIlSlM npeAnOYTTeIlbHee BO MHorx cIlyYaSlx,
HecMoTpSl Ha TO, YTO cnOIlb30BaHe HKeIleBO- TTaHOBbIX npH
60Ilee HaAe)l(HO  3<p<peKTBH04, KaK oncaHO AaIlee.
0,019/0,025 AIOVIMa
PMC. 9.15. PeKoMeHAyeTcSI npMeHeHe npSlMoyrollbHblx CTallbHblX
«pa6oLjx» fJ,yr CeLjeHeM 0,019/0,025 fJ,1OMa
co
.
. YpOBHM CMn. nepBOHaYaIlbHO 3IlaCTYHble IlraTYPbl tiebaci?' 6b1Il
npeAcTaBIleHbl KaK CBSl3K C cnOIlb30BaHeM 3IlaCTYHbIX MOAYIle,
YAep)l(BalOw,x Ayr Ha 6peKeTax,  pacTSlHyrblx BABoe no cpaBHeH1O
C x CXOAHO AIlHO. np 3TOM ypoBeHb CIl COCTaBIlSleT 50-100 r,
eCIl MOAYIlb npeABapTeIlbHo pacTSlHyr Il «pa3pa60TaH» nepeA
cnOIlb30BaHeM. ECIl )l(e OH npMeHSleTcSI 6e3 npeABapTeIlbHoro
paCTSI)I(eHSI, B nepBOHaYaIlbHOM COCTOSlH, B KOTOpOM ero nOCTaBIlSlIOT
3roTOBTeIl, YPOBeHb CIl MO)l(eT 6blTb Ha 200-300 r 60Ilbwe. 5 CIla
B03AecTBSI 3IlaCTYHoro MOAYIlSl 3aBCT OT Tna cnoIlb3yeMoro
MOAYIlSl  CTeneH ero paCTSI)I(eHSI np YCTaHOBKe. Co06U.J,aIl, YTO
BpaY ycnewHo npMeHSlIl pa3IlYHble Tnbl 3IlaCTYHbIX MOAYIle C
pa3IlYHbIM CTeneHSlM npeABapTeIlbHoro paCTSI)I(eHSI  paCTSI)I(eHSI
B nOIlOCT pm. 6 HeCMOTpSl Ha 3T pa3IlYSI B TeXHKe  YPOBHSlX
CIl, npMeHeHe 3IlaCTYHbIX CBSl30K tieback06w,enp3HaHHO
AIlSl 3<p<peKTBHoro 3aKpblTSI npOMeKOB. n03TOMY npeACTaBIlSleTCSI,
YTO TOYHble 3HaYeHSI YPOBHSI CIl He MeIOT pewalOw,ero 3HayeHSI
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 36-38 MM 
PMC. 9. 16. Ha6011ee LjaCTO cnollb3YIOll.teeCSI paccTOSlHe Me>K,lJ,y KpIOLjKaM
Ha fJ,yrax
PMC. 9.17. naccBHble CBSl3K tieback peKOMeHfJ,yeTcSI npMeHSlTb np YCTaHoBKe npSlMoyrollbHblx CTallbHblX fJ,yr CeLjeHeM 0,019/0,025 fJ,1OMa. AnSI
o6eCneLjeHSI 3MeHeHSI TOpKa Ka>K,lJ,oro OTfJ,ellbHoro 3y6a OH fJ,OmKHbl cnOIlb30BaTbCSI He MeHee 1 MeCSlLl.a. n03fJ,Hee JJ.llSi 3aKpb1TSI npOMe>KYTKoB npMeHSIIOT
aKTBHble CBSl3K tieback.
255

AIlSl nOBCeAHeBHoro ycnexa npMeHeHSI,  YTO B 60IlbWHCTBe
cIlyyaeB Ha6IllOAaeTCSI COOTBeTCTBYIOw,ee 3aKpblTe npOMeKOB, eCIl
C06IllOAalOTCSI OCHOBHble nOIlO)l(eHSI npMeHeHSI TeXHK.
. 3ct>ct>eKT TpaMnnMHa. KIlHYeCK OnblT CBAeTeIlbcTByeT 0 TOM,
YTO npOLleCC 3aKpb1TSI npOMeKOB MO)l(eT npOAOIl)l(aTbCSI B TeYeHe
HeCKOIlbKX MeCSlLleB y rex naLleHTOB, KOTOpble He SlBIlSlIlCb Ha
KOHTpOIlbHble nocew,eHSI, Ae eCIl 3IlaCTYHble MOAYIl HaxOASlTCSI B
nIlOXOM COCTOSlH  BepOOTHO OKa3blBalOT He3HaYTeIlbHoe CIlOBoe
B03AeCTBe. LleM MO)l(HO 06bSlCHTb TaKe KJlHYeCKe 3MeHeHSI?
nOIlaralOT, YTO MO)l(eT MeTb MecTO «3<1><peKT TpaMnIlHa», B03HKalO-
w, np )l(eBaH, KOTOpbl MO)l(eT 06YCIlaBIlBaTb nepOAYeCKYIO
aKTBaLlIO.
. AKTMBHble CBSl3KM tiebacknepBoro TMna (AMcTanbHbiM MOAynb).
BBOASIT npSlMoyroIlbHYIO CTaIlbHYIO AYry CeYeHeM 0,019/0,025 AIOMa C
3IlaCTYHbIM MOAYIlSlM Il npOBOIlOYHO IlraTYPO Ha Bcex 6peKeTax
(pc. 9.18). 3IlaCTYHbl MOAYIlb <PKCPYIOT Ha KplOYKe nepBoro Il
BTOpOro MOIlSlpa. cnoIlb3YIOT MeTaIlIlYecKYIO IlraTYPY AaMeTpoM
0,01 0 AIOMa, OAHO nIleyO KOTOPO npoIleraeT nOA OCHOBHO AYro
(pc. 9.19). 3TO nOBblwaeT cTa6IlbHoCTb aKTBHO CBSl3K tieback
 YAep)l(BaeT ee n03LI1O Ha HeKoTopoM paccTooH OT AeCHeBblX
TKaHe.
. AKTMBHble CBSl3KM tiebackBToporo TMna (Me3ManbHblM MOAynb).
npMeHeHe AaHHblX CBSl30K aHaIlOrYHO npMeHeH1O CBSl30K nepBoro
Tna, HO 3IlaCTYHbl MOAYIlb <PKCPYIOT Ha KplOYKe, npnaSlHHoM K
 
- ...." -'\ ,
\!,  \..:...-...J L j
- - 't...J -I'"
PMC. 9.18. nepe,o, YCTaHoBKo aKTVlBHo CBSl3KVI tieback nepBoro TVina BBO,o,SlT npSlMoyroIlbHYIO cTaIlbHYIO ,o,yry CelJeHVleM 0,019/0,025 ,o,1OMa C ::l1laCTVllJHbIMVI VlIlVI
npOBOIlOlJHblMVI IlViraTypaMVI Ha Bcex 6peKeTax
PMC. 9.19. nOIlHaSi aKTVlBHaSi CBSl3Ka tieback nepBoro TVina. CIle,o,yeT 3aBeCTVI O,o,HO nIleyO IlVirarypHo npoBoIloKVI (i) no,o, OCHOBHYIO ,o,yry. 3IlaCTVllJHbl MO,o,YIlb
pacTSlrVlBalOT B,o,Boe OTHOCVlTeIlbHO nepBOHalJaIlbHoro pa3Mepa (ii).
(.'
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PMC. 9.20. AKTVlBHaSi CBSl3Ka tieback nepBoro TVina Henocpe,o,cTBeHHo nepe,o,
ycraHoBKo
#f"' .,
..,
....
..;... - .;,!,
','Sj ,,:...
.,,-
1'6 '
;',.'" ,
,
,Q,''
, '.  
. - ,.. 
c..-

",'
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..........
PMC. 9.21. AKTVlBHaSi CBSl3KVI tieback nepBoro TVina Ha HVI>KHe ,o,yre.
nOKa3aHa MVlHVlMaIlbHaSi aKTVlBaltVlSl 8IlaCTVllJHoro MO,o,YIlSl, KOTOpbl MO>KHO
6blIlO pacTSlHYTb B 3HaYVITeIlbHO 6oIlbwe Mepe.

Ayre. npSlMoyroIlbHYIO CTaIlbHYIO AYry CeYeHeM 0,019/0,025 AIOMa
YCTaHaBIlBaIOT C 3IlaCTYHbIM MOAYIlSlM Il&4 npOBOIlOYHblM IlraTY-
paM Ha Bcex 6peKeTax, 3a CKJlIOYeHeM 6peKeToB Ha npeMoIlSlpax
(pc. 9.22). npOBOIlOYHYIO IlraTYPY AaMeTpoM 0,010 AIOMa nOABSl3bl-
BalOT K KplOYKY Ha nepBoM Il BTOpOM npeMoIlSlpe, 3aTeM HeCKOIlbKO
pa3 nepeKPYYBaIOT  BTOpblM KOHLIOM <t>KCPYIOT Ha KplOYKe OCHOBHO
Ayr. , HaKOHeLl, YCTaHaBIlBaIOT 06blYHbie IlraTYpbl Ha npeMoIlSlpbl,
OXBaTbIBalOw.e CBSl3KY tieback  OCHOBHYIO AYry (pc. 9.23  9.24). np
cnOIlb30BaH CBSl30K tieback nepBoro  BTOpOro TnOB 3IlaCTYHbl
MOAYIlb 06blYHO pacTSlrBalOT BABoe OTHOCTeIlbHO nepBOHaYaIlbHoro
pa3Mepa AIlSl aKTBaLl. np HaAJle)l(aw.e rreHe nOIlOCT pTa
KOHTpoIlbHble nocew.eHSI naLleHTY Ha3HayalOT He TaK yaCTO, CBSl3K
tieback MO)l(HO peaKTBpOBaTb Yepe3 4-6 HeAeIlb, a 3aMeHSlTb
nOCIle ABYX KOHTpOIlbHblX nocew.eH. ECIl rreHa nOIlOCT pTa
HeYAoBIleTBopTeIlbHaSl, COCTOSlHe MOAYIle MO)l(eT YXYAWTbCSI, 
x cIleAyeT 3aMeHSlTb np KOM nocew.eH. B HeKoTopblX cIlyyaSlX
Ha 3aKJlIOYTeIlbHbIX 3Tanax 3aKpb1TSI npoMeKOB LleIleco06pa3Ho
npMeHeHe ABYX 3IlaCTYHbIX MOAYIle, Il )l(e YCIleHe CBSl30K
tieback 3IlaCTYHO LlenOYKO 3 1 0 Il 12 3BeHbeB, npoIleralOw.e
OT MOIlSlpa AO MOIlSlpa npoTBOnOIlO)l(HO CTOpOHbl.
. AKrMBHble CBH3KM tiebackc HMKeneBO-TMTaHOBbIMM npy>KMHaMM.
BMecTO 3IlaCTYHoro MOAYIlSl MO)l(HO cnoIlb30BaTb HKeIleBO- TTaHOBble
npHbl, eCIl Tpe6yeTcSI 3aKpblTb 06wpHble npoMeK, Il
j)MC. 9.22. nepe,ll, YCTaHoBKoVi aKH1BHoVi CBSl3K tieback BTOpOro Tna Clle,ll,yeT BBeCT npSlMoyroIlbHYIO cTallbHYIO ,lI,yry celleHeM 0,019/0,025 ,lI,IOVIMa
 311aCTlIHbIM ll npoBoIlollHblM llraTypaM Ha Bcex 6peKeTax, 3a CKJllOlIeHeM 6peKeToB Ha npeMollSipax
PMC. 9.23. nOllHble aKTBHble CBSl3K tieback BTOpOro Tna. x <t>KCPYIOT TaKM >Ke o6pa30M, KaK  aKTBHble CBSl3K nepBoro Tna, HO 311acTlIHblVi MO,ll,Yllb
paCnOllO>KeH cnepe,ll,. nOClle,ll,HIOIO 311acTlIHYIO llraTYPY (e) BBO,ll,SlT nOClle YCTaHoBK ,lI,yr  CBSl3K tieback. OHa cTa61l3pyeT nllell CBSl3K tieback
 OTMe>KeBbIBaeT ee OT MSlrKX TKaHeVi.
-
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...\ ' ii...
.... "'.ot 
.... .;--,
1
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. .... 
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..":.,...., : - ....'.,. ---  ",, ,--.-'
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"'.it._ '\ -- Ji. : \
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-.i' " . . ?o- '" , .>." '....
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- ' I'-::':' ..
....,,<.i..
.,  -- .>«>
. '4fi'
--......
..,
, . '., ....
-
11
...- 
. .
PMC. 9.24. AKTBHble CBSl3K tieback BTOpOro Tna (Me3allbHble MO,ll,Yll)
Ha BepxHeVi  H>KHeVi ,lI,yrax. Ha ,lI,aHHOM CHMKe 3IlaCTlIHble MO,ll,YIl pacTSI-
HYTbl MaKCMallbHO - B 6011bwHcTBe cllYllaeB u.ellecoo6pa3Ho MeHbwee
paCTSI>KeHe. Ha nOClle,ll,HeM 3Tane 3aKpblTSI npOMe>KyrKoB HOr,ll,a 3<t><t>eKTB-
HO BBO,ll,Tb ,lI,BOVlHble 311aCTlIHble MO,ll,Yll. CM. TalOKe pc. 9.98, c. 275.
PMC. 9.25. HeCMOTpSl Ha TO, liTO HKelleBO-TTaHOBble npY>KHbl o6ecne-
lIBalOT 6011ee nOClle,ll,OBaTellbHoe 3aKpblTe npOMe>KYTKOB, lIeM 311aCTlIHble
MO,ll,Yll, aBTOpbl nOllaralOT, liTO llerKOCTb  npOCTOTa npMeHeHSI MO,ll,YlleVi
,lI,ellaeT x cnOllb30BaHe npe,ll,nOYTTellbHbIM B 6011bWHCTBe CllYlIaeB.
npMeHeHe HKelleBO-TTaHOBbIX npY>KH MO>KeT 6blTb u.ellecoo6pa3HblM
B Tex cllyyaSlX, KOr,ll,a Tpe6yeTcSI 3aKpblTe 60IlbWX npOMe>KYTKOB, ll KOr,ll,a
orpaHlIeHbl B03MO>KHOCT KOHTpOIlbHblX nOCell.teHVI.
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OrpaHYeHO KOIlYeCTBO KOHTpOIlbHblX nocew,eH (pc. 9.25). B
nOCIleAHX pa60Tax Samuels  coaBTOpbl 7 peKoMeHAYIOT cnOIlb30BaTb
AIlSl 3aKpb1TSI npoMeKoB OmMaIlbHble CIlbl, COCTaBIlSlIOw,e
150 r. 06HapeHo, YTO npHbl C ypoBHeM CIlbl 150 r AeCTBYIOT
3<p<peKTBHee, yeM npHbl C YPoBHeM CIlbl 100 r, OAHaKO He 60Ilee
3<p<peKTBHO, yeM npHbl C YPOBHeM CIlbl 200 r. AaHHaSl pa60Ta
nOATBepAIla x 60Ilee paHHe AaHHble 4 , cBAeTeIlbcTBYIOw,e 0 TOM,
YTO HKeIleBO- TTaHOBble npHbl 06eCneYBa1OT 60Ilee HaAe)l(HOe
3aKpblTe npOMeKOB, yeM 3IlaCTYHble MOAYIl. nOIlaralOT, YTO
cnOIlb30BaHe cIla6blX HKeIleBO- TTaHOBbIX npH (344-150  346-
150 3M Unitek) 06eCneYBaeT YPoBeHb CIl 150 r. npHbl He cIleAyeT
paCTSlrBaTb CIlbHee, yeM 3TO peKOMeHAOBaHO 3roToBTeIleM (22 MM
AIlSl npH 9 MM  36 MM AIlSl npH 12 MM).
Nattrass  coaBTOpbl 6 nOATBepAIl, YTO oCIla6IleHe YCIl np
npMeHeH 3IlaCTYHbIX LlenOyeK npocxoAT 6blCTpO B nepBble
24 yaca nOA B03AeCTBeM OKpalOw,e cpeAbl  TeMneparypbl. B
cIlyyae C HKeIleBO- TTaHOBbIM npHaM TaKoro 6blCTpOro yracaHSI
CIlbl He Ha6IlIOAaeTCSI. HeCMOTpSl Ha TO, YTO AaHHbie CCIleAOBaH
CBAeTeIlbCTBYIOT 0 npeAnOYTTeIlbHOM npMeHeH HKeIleBO- TTaHOBbIX
npH AIlSl 60Ilee 6blCTpOro 3aKpb1TSI npOMeKOB, aBTOpbl npOAOIl)l(alOT
npMeHSlTb 3IlaCTYHble MOAYIl B 60IlbWHCTBe cIlyyaeB IleYeHSI. np
CIlWKOM 6blCTPOM 3aKpbIT npOMeKOB MO)l(eT YTpaYBaTbCSI TOpK
pe3L10B, AIlSl B0306HOBIleHSI KOTOpOro He06xOAMO HeCKOIlbKO MeCSlLleB
Ha 3aKJlIOYTeIlbHOM 3Tane 3aKpb1TSI npOMeKOB. 3IlaCTYHble MOAYIl
npOCTbl B npMeHeH, 3KOHOMYHbl  onpaBAblBalOT ce6S1 B 60IlbWHCTBe
KJlHYeCKX cryau.. HeCMOTpSl Ha TO, YTO npHbl MOryT 3aKpblTb
Bce npOMeK 6e3 He06xOAMOCT 3MeHeH Ha KOM nocew,eH,
3TO B OCHOBHOM TeOpeTYeCKOe npeMyw,eCTBO, nOCKOIlbKY Ha npaKTKe
npeAnOYTTeIlbHO CHMaTb X, AIlSl TOro YT06bl npOBepSlTb  YKOpaYBaTb
Yepe3 Kble 1 Il 2 MeCSll!a B nepoA 3aKpb1TSI npoMeKOB.
AnbTepHaTMBHaSi MexaHMKa
AnSI nnoxo nOAAalOUJ.MxcSI 3aKpblTMIO
npOMe>KYTKoB
B HeKOTOpblX cIlyyaSlX npOMeK C TPYAOM nOAAaIOTCSI 3aKpblT1O Il
3aKpblBalOTCSI CIlWKOM MeAIleHHO np npMeHeH 06bIYHO MexaHK.
ECIl He cyw,eCTByeT OYeBAHbIX npenSlTCTB AIlSl 3aKpb1TSI npOMeKOB
(CM. H)I(e), MO)l(HO paCCMOTpeTb npMeHeHe aIlb TepHaTBHbIX MexaHK
IleyeHSI. B03MO)l(HO npMeHeHe CBSl30K tieback C ABYMSI MOAYIlSlM Il
Ayr C 3aKpbIBalOw,M neTIlSlM. B cIlyyaSlX nIlOXO nOMalOw,XC5I 3aKpblT1O
npoMeKoB B KayeCTBe aIlbTepHaTBHoro MeTOAa IleYeHSI B03MO)l(HO
npMeHeHe annapaTa Hycon@ (<<Edenta»), KOTOpblM ycnewHo nOIlb30BaIlC5I
OAH 3 aBTopoB KHr B TeYeHe 4 IleT np IleYeH OTAeIlbHblX
naLleHTOB.
AnnapaT COCTOT 3 cerMeHTa npSlMoyroIlbHo npoBoIloK AIlHO
1 CM  CeyeHeM 21/25, K KOTOPOMY npnaSlH BHT 7 MM. npSlMoyroIlbHbl
cerMeHT BBOASIT B ABOHYIO Il TPOHYIO Tpy6KY Ha MOIlSlpe  3ar6alOT
B ACTaIlbHOM HanpaBIleH. BHT MeeT 60IlbWYlO roIlOBKY, Ha KOTOpO
MO)l(HO CB060AHO 3a<pKcpOBaTb npOBOIlOYHYIO Ilrarypy. 3aTeM IlraTYPY
npOTSlrBaIOT KnepeA  nOABSl3blBalOT K KplOYKY Ha OCHOBHO Ayre. AnnapaT
Hycon@ pa3pa60TaIl AOKTOP Winfried SchUtz, HeMeLlK BpaY-OpTOAOHT,
KOTOpbl npeAIlO)l(Il ABbl B HeAeIlIO nOATSlrBaTb BHT Ha OAH nOIlHbl
060POT (1/8 MM) C nOMow,blO MaIleHbKO OTBepTK B HanpaBIleH no
YaCOBO cTpeIlKe. TaKM 06pa30M, npoMeoK 3aKpblBaeTcSI npMepHo
Ha 1 MM B MeCSlLI (naLleHT N.H., c. 268). AnnapaT 06eCneYBaeT AeCTBe
BeCbMa KpaTKOBpeMeHHo, HO 3HaYTeIlbHO CIlbl, KOTOpaSl B OCHOBHOM
YCTpaHSleT Bce np06IleMbi C TpeHeM. ECIl annapaT Ype3MepHO aKTBpO-
BaH, 3TO MO)l(eT npBeCT K 3HaYTeIlbHO Ae<popMaLl IleYe6HO Ayr,
yero He cIleAyeT AonYCKaTb. AnnapaT Hycon@, KaK  He6Hbie 3KcnaHAepbl,
ACTpaKLIOHHble BHTbl Il HeKOTopble APyre annapaTbl AIlSl ACTaIl-
3aLl MOIlSlpOB, Tpe6yeT Hwe)l(aw,ero COTpYAHYeCTBa naLleHTa.

npo6neMbi npM 3aKpblTMM
npOMe>KYTKOB
npaKTYeCK BO Bcex cIlyyaSlX 3aKpbIH1e npOMeKOB He Bbl3blBaeT OC06blX
np06IleM  BblnOIlHSleTCSI npOCTO. TOIlbKO B peAKli1X cIlyyaSlX MOryT B03Hli1K-
Hyrb np06IleMbi. ECIl npOMeK He 3aKpblBalOTCSI AOIl)l(HblM 06pa30M,
T.e. 06blYHO Ha 1 MM B MeCSlLI, cIleAyeT Tw,aTeIlbHO 3aMepSlTb x BO BpeMSI
KOHTpOIlbHblX nocew,eH. ECIl OH He YMeHbwalOTCSI, Il eCIl Ayra
nOCTOSlHHO He BbIXOAT ACTaIlbHO 3a Tpy6KaM Ha MOIlSlpax, cIleAyeT
npOaHaIl3pOBaTb B03MO)l(Hbie nOMex, npe)I(Ae yeM np6eraTb K npMe-
HeH1O APyrx MexaHK IleyeHSI.
. HeAOCTaTO'lHOe BblpaBHMBaHMe 3y6oB. Pa60Ye npSlMoyroIlbHble
Ayr YCTaHaBIlBaIOT no MeHbwe Mepe Ha 1 MeCSlLI C naCCBHbIM
CBSl3KaM tieback (c. 255) AIlSl 06eCneYeHSI HaAIle)l(aw,ero BblpaBH-
BaHSI 3y60B  YCTpaHeHSI TOpKa Ha 60KOBbiX 3y6ax. T aK)l(e He cIleAyeT
nblTaTbCSI OTKOppeKTpOBaTb npKYc no BepTKaIl C nOMow,blO peBep-
CBHbIX 3r60B Ha H)I(He Ayre, OAHOBpeMeHHO HaYHaSl 3aKpblBaHe
npOMeKOB. KOHTpOIlb npKYca no BepTKaIl BblnOIlHSlIOT nepeA
3aKpblTeM npOMeKOB.
. nOBpe>KAeHMe 6peKeTOB. 6peKeTbi Ha nepBblx H)I(HX MOIlSlpax
MOryT nOBpe)l(AaTbCSI  yaCTYHO Ae<popMpOBaTbCSI nOA AeVlCTBeM
)l(eBaTeIlbHbiX HarpY30K. B KayeCTBe KpaTKOBpeMeHHO Mepbl MO)l(HO
YMeHbwTb TOIlW,HY Ayr Ha 3TOM yyaCTKe, HO IlYYWe 3aMeHTb n03-
LIIO 3aLlenOB Ha MOIlSlpe. PeKoMeHAyeTcSI npMeHeHe HeTpaHc<popM-
pyeMblx Tpy60K Ha nepBblx MOIlSlpax, nOCKOIlbKY OH He nOABep)l(eHbl
TaKM nOBpe)I(AeHSlM, KaK TpaHc<popMpyeMble Tpy6K Ha nepBblX
MOIlSlpax  06IlaAalOT APyrM npeMyw,eCTBaM (c. 53  54).
. HenpaBMnbHble YPOBHM CMn. 3HaYeHSI CIl, npeBblwalOw,e peKo-
MeHAOBaHHble ypOBH, MOryT Bbl3BaTb HaKJlOH  TpeHe, npenSlTcTBYSl
TaKM 06pa30M 3aKpblT1O npoMeKoB. HeAOCTaTOYHble CIlbl MOryT
HorAa 3aMeAIlSlTb 3aKpblTe npoMeKoB Il BOBce He AaBaTb HKa-
KX pe3YIlb TaTOB y B3pOCIlbiX naLleHTOB. YpOBH CIl AOIl)l(Hbl COOTBeT-
CTBOBaTb pa3Mepy Ayr  x )l(eCTKOCT. np HapyweH COOTBeTCTBSI
MO)l(eT B03HKaTb OTKJlOHeHe Il npor6aHe Ayr, a TaK)l(e He)l(eIla-
TeIlbHoe TpeHe. OnpeAeIleHO, YTO npor6aHe Ayr Bbl3blBaeT TpeHe8,9.
B npOBeAeHHblx HeAaBHO B S1nOH 10 CCIleAOBaHSlX 3aMep51Il CTeneHb
npor6a Ayr B 3aBCMOCT OT 06blYHO npMeHSleMbiX CIl AIlSl 3aKpb1TSI
npoMeKOB. OKa3aIlOCb, YTO B cpeAHeM npoCXOAT Ha 47% 60Ilbwe
npor60B B cIlyyae npMeHeHSI Ayr CeYeHeM 0,016/0,022 AIOMa no
cpaBHeH1O C AyraM CeYeHeM 0,019/0,025 AIOMa (pc. 9.26).
. nOMeXM co CTOpOHbl 3y6oB-aHTaroHMcToB (pc. 9.27). B03MO)l(Hbl
npenSlTcTBSI np 3aKpbIT npoMeKoB Ha H)I(He Ayre, n03TOMY
cIleAyeT Tw,aTeIlbHO npoBepSlTb OKKJlI031O. B npowIloM 3TO yaCTO
CBSl3bIBaIl C ow6KaM BepTKaIlbHoro n03LIoHpoBaHSI 6peKeToB
Ha BepXHX 3y6ax. C npMeHeHeM cxeM np nOCTaHOBKe 6peKeTOB
OW60K CTaIlO MeHbwe,  nOMex 3y60B-aHTaroHcTOB nepeCTaIl 6blTb
np06IleMO.
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PMC. 9.26. npVl 3aKpbIHu1 npOMe)l(YTKoB VI npVlMeHeHVIVI MexaHVlKVI CKOJlb-
)l(eHVlSI CJleAyeT ypaBHoBewVlBaTb npVlJlaraeMble YCVlJlVlSl. PeKoMeHAyeTcSI
npVlMeHeHVle Ayr ce4eHVleM 0,019/0,025 AIOVIMa VI 6peKeTOB C na30M 0,022
AIOVIMa.
II '
PMC. 9.27. 3aKpblTVlIO npoMe)l(YTKoB MorYT npenSlTcTBoBaTb npVlKycHble
nOMexVl co CTOpOHbl 3y6oB-aHTaroHVlcTOB. Ha AaHHOM pVlcYHKe 6peKeT
Ha BepxHeM npeMOJlSlpe npVlKlleeH CJlVlWKOM 6JlVl3KO K AeCHe VI 3KCTPY3V1S1
KOpOHKVI npenSlTcTByeT nOJlHoMY 3aKpblTVlIO npoMe)l(YTKa Ha HVI)I(HeVi Ayre.
. ConpOTMBneHMe co CTOpOHbl MSlrKMX TKaHeM. Pa3paCTaHe
AecHeBblx TKaHe Ha nocT3KcTpaLloHHblX yyacTKax MO)l(eT npenmCTBO-
BaTb 3aKpblT1O npOMe)l(yrKoB  npBoATb K nOBTopHOMY OTKpbIT1O
npOMeKOB nOCIle CHSlTSI annapaTa (pc. 9.11, c. 253). 3TO TaK)l(e
MO)l(eT Bbl3blBaTb np06IleMbi np 3aKpbIT AaCTeMbl. CIleAyeT
nOAAep)l(BaTb BbICOK YPoBeHb rreHbl nOIlOCT pTa  He AonYCKaTb
CIlWKOM 6blCTpOro 3aKpb1TSI npOMe)l(Y1KOB, nOCKOIlbKY 3TO MO)l(eT
npBeCT K IlOKaIlbHO rnepTpo<p AeCHeBblX TKaHe. B HeMHorx
CIlYlJaSlX MO)l(eT 6blTb nOKa3aHO IlOKaIlbHOe CCeYeHe AeCHbl xpypr-
YeCKM cnoc060M.
259

5AnAHC C!)iIIKCALl.iIIiII nPili 3AKPblTiIIiII
npOME>KYTKOB
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ECIl <pKCaLlSI npaBIlbHO 3anIlaHpOBaHa  KOHTpOIlpOBaIlaCb Ha paHHX
3Tanax IleYeHSI, BO MHOrX cIlyyaSlX B3aM03aKpbITe npOMeKOB MO)l(eT
CTaTb MeTOAOM Bbl60pa. T eOpeTYeCK OHO 06eCneYBaeT COOTHoweHe
50:50 B nepeMew.eH pe3L10B  MOIlSlpOB (pc. 9.28), KOTOpoe BO MHorx
CIlyYaSlX KJlHYeCK npeMIleMO, B oc06eHHocT, eCIl npoMeK
He3HaYTeIlbHble.
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3aKpblTMe npOMe>KYTKOB
npM MaKCMManbHOM c!>MKcau,MM -
cKyeHHocTb3y6oB
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npeMoIlSlpoB cnoIlb3yeTcSI AIlSl YCTpaHeHSI cKYYeHHOCT 3y60B. AnSI 3TOro
He06xoAM Tw,aTeIlbHbl KOHTpOIlb <pKcaLl Ha paHHeM 3Tane IleYeHSI
(naLleHT N.H., c. 266), HO 3aTeM 3Tan 3aKpb1TSI npoMeKoB 06blYHO
CBOATCSI K MHMYMY, nocKoIlbKY MelOw.eecSI MecTO B 3y6HOM PSIAY
B OCHOBHOM cnoIlb3yeTcSI AIlSl YCTpaHeHSI CKYYeHHOCT 3y60B.
PMC. 9.28. 80 MHOn-1X cnYLJaSix B3aM03aKpbln1e npOMe>KyrKoB SlBIlSIercSi MerO.lJ,OM Bbl60pa

3aKpblTMe npOMe>KYTKOB
npM MaKCMManbHOM cl>MKCaLl,MM -
npOTPY3MSI
B TaKX CIlYLJaSlX 3aKpblTe npOMeKOB np06peTaeT 60IlbWOe 3HaYeHe.
Ha 3TOM 3Tane He06xOAM Hwe)l(aw, KOHTpOIlb <t>KCaLl AIlSl peTpaK-
LI pe3L10B B MelOw,CSI nOCT3KCTpaKLIOHHbl npOMeOK. AnSI
3KCTpaKLI 06blYHO Bbl6palOT nepBble npeMOIlSlpbl. BTOpble MOIlSlpbl
np 3TOM no B03MO)l(HOCT TaK)l(e BKJllOyalOT B AYry. TaKM 06pa30M,
06eCneYBaeTCSI C6aIlaHCpOBaHHOCTb weCT nepeAHX 3y60B  weCT
60Ilee KpynHblx 60KOBbiX 3y60B, KOTOpaSl 06eCneYBaeT TeOpeTYeCK
IlYYW KOHTpOIlb <pKcaLl (pc. 9.29). Ha 3Tane nepeMew,eHSI MO)l(HO
cnOIlb30BaTb He6Hbie  Sl3blYHbie Ayr AIlSl OrpaHYeHSI Me3aIlbHoro
nepeMew,eHSI MOIlSlpOB, a He6HYIO AYry -  Ha 3Tane 3aKpb1TSI npOMe-
KOB. MO)l(HO TaK)l(e paCCMOTpeTb npMeHeHe BHepoTOBo TSlr, HorAa
C 3IlaCTYHbIM TSlraM III KJlaCca, B cIlyyae Hwe)l(aw,ero COTpYAHYeCTBa
naLleHTa (pc. 9.30).
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MO>KHO nO,ll"D,ep>KaTb 3naCTI.JHbIM TS1raM III Kflacca np OAHOBpeMeHHOM
npMeHeH BHepoTOBoVi TS1r
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261

3aKpblTMe npOMe>KYTKOB
npM MMHMManbHOM c!>MKcau.MM -
«C>KMraHMe c!>MKcau.MM»
AaHHaSl KaTeropSI OXBaTblBaeT cIly'-ta He3HaYTeIlbHO CKYYeHHOCT 3y60B
 npOTpY3, np KOTOpblX AIlSl AOCT)I(eHSI LleIle IleYeHSI He06xOAMa
3KCTpaKLISI MOIlSlpOB. T orAa He06xOAMO 3aKpblTe OCTaIlbHblX npOMeKOB
rnaBHblM 06pa30M nocpeACTBOM Me3aIlbHoro nepeMew.eHSI MOIlSlpOB, YBe-
IlYBaSl TaKM 06pa30M npOCTpaHCTBO AIlSl TpeTbX MOIlSlpOB  coxpaHSISI
npo<pIlb Ill!a. 8 TaKX cIlyyaSlX MO)l(HO YAaIlTb BTOpble npeMoIlSlpbl, np
3TOM He <pKcpOBaTb KOIlbl!a Il 6peKeTbi Ha BTOpble MOIlSlpbl. 060CHOBa-
He TaKOro nOAXOAa 6a3pyeTcSI Ha MaTeMaTYeCKOM 6aIlaHCe ABYX MOIlSlpOB
 BOCbM nepeAHx 3y60B np MexaHKe CKOIlb)l(eHSI. np 3TOM IlOrYHO
O)l(AaTb npeMyw.eCTBeHHO Me3aIlbHoro nepeMew.eHSI MOIlSlpOB (pc. 9.31
 9.32).
8 AaHHOM cIlyyae LleIleco06pa3Ho HayaTb IleYeHe BCKope nOCIle
YAaIleHSI BTOpblX npeMoIlSlpoB, YT06bl 36e)l(aTb ceHSI aIlbBeOIlSlpHo
KOCT Ha 3TX y'-tacTKax. CIla6ble 3IlaCTYHble TSlr II KJlacca (100 r) BO

BpeMSI CHa MOryT nO,lJJJ,ep)l(aTb Me3aIlbHOe nepeMew.eHe H)I(HX MOIlSlpOB
np MexaHKe CKOIlb)l(eHSI. TOpK +17 0 AIlSl BepxHx LleHTpaIlbHblX pe3L10B
 + 1 0 0 - AIlSl BepxHx 60KOBbiX pe3L10B, npeACTaBIlSlIOTCSI 3<p<peKTBHbIM
C KJlHYeCKO TOYK 3peHSI AIlSl nO,lJJJ,ep)l(aHSI CarTTaIlbHO n03LI
3TX 3y60B np B03AeCTB 3IlaCTYHO TSlr II KJlacca B TeYeHe 12
YaCOB. MOIlSlpbl B TeYeHe CyrOK HaxOASlTCSI nOA B03AecTBeM CIlbl,
AecTBYIOw.e B Me3aIlbHOM HanpaBIleH, KOTOpaSl 60Ilbwe Ha H)I(He
Ayre B CIlY npMeHeHSI cIla6blx 3IlaCTYHbIX TSlr II KJlacca.
ECIl nOCIle 3KCTpaKLI BTOpblX npeMoIlSlpoB npMeHSleTcSI MexaHKa
CKOIlb)l(eHSI, B03MO)l(HO 3aKpblTe npoMeKoB BCIleACTBe Me3aIlbHoro
nepeMew.eHSI nepBblX  BTOpblX MOIlSlpOB. np 3TOM YBeIlYBaeTCSI
npocTpaHcTBo AIlSl TpeTbX MOIlSlpOB,  nO,lJJJ,ep)l(BaeTCSI n03LISI H)I(HX
pe3L10B B npo<pIle IlLla.
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C03AaH npOMe}l(YTOK AJlSl BTOpblX iii TpeTblilx HIiI}I(HIiIX MOJlSlpOB.

flMTEPATYPA
'-
1 Tweed C. H. 1966. Clinical orthodontics. Mosby, St Louis.
2 The 'A' Company Straight-Wire Appliance. An eight page descriptive brochure.
'A' Company, San Diego, CA, USA.
3 Bennett J. C., Mclaughlin R. P. 1990. Controlled space closure with a
preadjusted appliance system. Journal of Clinical Orthodontics 24:251-260.
4 Samuels R. H., Rudge S. J., Mair L. H. 1993. A comparison of the rate of space
closure using a nickel-titanium spring and an elastic module: a clinical study.
American Journal of Orthodontics and Dentofacial Orthopedics 103:464-467.
5 Nattrass C., Ireland A. J., Sherriff M. 1997. An investigation into the placement
of force delivery systems and the initial forces applied by clinicians during space
closure. British Journal of Orthodontics 24:127-131.
6 Nattrass C., Ireland A. J., Sherriff M. 1998. The effect of environmental factors
on elastomeric chain and nickel titanium coil springs. European Journal of
Orthodontics 20: 169- 176.
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7 Samuels R. H., Rudge S. J., Mair L. H. 1998. A clinical study of space closure
with nickel-titanium closed coil springs and an elastic module. American Journal
of Orthodontics and Dentofacial Orthopedics 114:73-79.
8 Pizzoni L., Ravnholt G., Melsen B. 1998. Frictional forces related to self-ligating
brackets. European Journal of Orthodontics 20:283-291.
9 O'Reilly D., Dowling P. A., Lagerstrom L., Swartz M. L. 1999. An ex vivo
Investigation into the effect of bracket displacement on the resistance to sliding.
British Journal of Orthodontics 26:219-227.
10 Ouchi K., Koga M., Watanabe K., Issiki Y., Kawada E. 2001. The effects of
retraction forces applied to the anterior segment on orthodontic arch wires -
changes in wire deflection with wire size. Presented to southern California
component of Edward H. Angle Society. In press.
263

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nal.l.MeHT 30 neT C '1pe3MepHOM CK}"IeHHOCTblO nepeAHMX 3y6oB
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W.e'lHble cerMeHTbl B I Kl1aCce, TpeTbM MonSlpbl YAaneHbl paHee.
60IlbWO Me)l(YeIlIOCTHO yroIl (MM 35°). <1>OPMY H)I(He 3y6HO Ayr
onpeAeIlIl C nOMow,blO np03paYHoro wa6IloHa KaK OBaIlbHYIO.
BepxH npaBbl LleHTpaIlbHbl pe3eLl paCnOIlO)l(eH Ha pacCToSlH 12 MM
AO IlH APo, a IleBbl H)I(H LleHTpaIlbHbl pe3eLl - Ha paccTOSlH 5 MM
AO IlH APo. UeIlb IleYeHSI 3aKJllOYaIlaCb B peTpaKLI  nepeMew,eH
pe3L10B B 3anIlaHpoBaHHYIO n03LI1O pe3L10B npMepHO Ha paccTOSlHe 7 MM
AO IlH APo Ha BepxHe Ayre,  Ha 3 MM AO IlH APo Ha H)I(He Ayre.
MexaHKa IleYeHSI 6blIla He06xoAMa AIlSl nepeMew,eHSI BepXHX pe3L10B
npMepHO B CXOAHYIO n03LI1O IleBoro BepxHero LleHTpaIlbHOro pe3L1a Il
60Ilee ACTaIlbHO. UeIlblO IleYeHSI Ha H)I(He Ayre 6blIl0 nepeMew,eHe
H)I(HX pe3L10B B CXOAHYIO n03LI1O H)I(Hero npaBoro LleHTpaIlbHOro
pe3l!a. HecMoTpSl Ha TO, YTO np IleYeH 60IlbwHcTBa naLleHTOB cIleAyeT
36eraTb 3KCTpaKLI, B AaHHOM cIlyyae B03HKJla He06xoAMOCTb B C03Aa-
H npOMeKa AIlSl nepeMew,eHSI H)I(HX pe3L10B. np nOMow, pacw-
peHSI Ayr Il 3a CyeT COWIl<poBbIBaHSI 3MaIl BOCC03AaTb AOCTaTOYHbl
npOMeOK 6blIlO HeB03MO)l(HO. n03TOMY npHSlIl peweHe YAaIlTb Bce
nepBble npeMOIlSlpbl  npOBOATb IleYeHe naLleHTa C 60IlbWM Me)l(yeIlIOCT-
HblM YrIlOM np C03AaH MaKCMaIlbHO <pKcaLl, cnOIlb3YSl BepXHlO1O
He6HYlO AYry  H)I(HIOIO Sl3blYHYIO AYry AIlSl YCIleHSI nepeMew,eHSI 3y60B
Ha 3Tane BblpaBHBaHSI  nepeMew,eHSI 3y60B.
ACTaIlbHble 3ar6bl BblnOIlHSlIl AIlSl 06eCneYeHSI KOM<popTa Ha yyaCT-
Ke MOIlSlpOB  06eCneYeHSI KOHTpOIlSl Me3aIlbHoro AB)I(eHSI nepeAHX
3y60B. (B 60IlbwHcTBe cIlyyaeB ACTaIlbHble 3ar6bl  CBSl3K Tna lace-
back 06blYHO npMeHSlIOT Ha npOTSI)I(eH 3Tana BblpaBHBaHSI  nepeMe-
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0,016 AIOMa OBaIlbHO <l>OPMbl. CTaHAaPTHble MeTaIlIlYeCKe 6peKeTbi
CCTeMbl 0,022 AIOMa cnOIlb30BaIl AIlSl OmMaIlbHOro KOHTpOIlSl, aHa
MOIlSlpbl  npeMOIlSlpbl YCTaHOBIl KOIlbl!a. Ha AaHHOM 3Tane 6peKeTbi Ha
3a6IlOKpOBaHHble BHe Ayr H)I(He pe3L1bl He npKJleBaIl, nOCKOIlbKY He
6blIl0 AOCTaTOYHoro npOCTpaHCTBa AIlSl X pa3Mew,eHSI B 3y6HO Ayre.
AnSI KOM<pOPTa naLleHTa Ha Ayr HaAeBaIl pe3HOBble Tpy60YK.
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OCTaIOTCSI B He3HalJli1TeJ1bHOM li1J1li1 YMepeHHOM II KJlacce.
. B cJ1YlJaSlx, KorAa 3aTpYAHeHo nOJ1HOe 3aKpblTli1e npoMe)l(YfKoB B
BepxHeM nepeAHeM YlJaCTKe, npli1 oAHoBpeMeHHoVi nonblTKe 06eCnelJli1Tb
npaBli1J1bHbIVi ropli130HTaIlbHblVi npli1KYc.
npli1MepHO B 20% CJ1YlJaeB (pli1c. 10.4) aBTOpbl 06Hapy)l(li1J1li1li136bITOlJHOe
KOJ1li1lJeCTBO 3y6HbiX TKaHeVi Ha BepXHli1X nepeAHli1X 3y6ax no cpaBHeHli110 C
Hli1)1(Hli1Mli1. B TaKli1X Cli1ryaLJ,li1S1X KOpOHKli1 BepXHli1X nepeAHli1X 3y60B OKa3bIBaIOT-
CSI HenpOnOpLl,li10HaIlbHO 60J1bWe, lJeM KOpOHKli1 Hli1)1(Hli1X 3y60B, li1 Y naLl,li1eHTa
Ha6J1IOAaeTCSI Carli1TTaIlbHaSl w,eJ1b, a 60KoBbie cerMeHTbl npli1 3TOM HaxO-
A5ITCSI B I KJlacce. 3TO MO)l(eT 6blTb B CJ1eAYIOw,li1X Cli1ryaLl,li1S1x:
. Y naLl,li1eHTOB C KpynHblMli1 BepXHli1Mli1 pe3L1,aMli1
. B HeKoTOpblX cJ1YlJaSlx aHOMaIlli1V1111 KJlaCca, KorAa BepXHli1e pe3L1,bl
HaKJ10HeHbl KnepeAli1, a Hli1)1(Hli1e pe3L1,bl - K3aAli1.
TaKli1e Ae<t>eKTbl MO)l(HO J1erKO YCTpaHli1Tb Ha 3aKJ1lOlJli1TeJ1bHOM 3Tane
J1elJeHli1S1 COWJ1li1<t>oBbIBaHli1eM 3MaIlli1 Ha BepXHli1X nepeAHli1X 3y6ax C nOCJ1e-
AYIOUJ,li1M 3aKpblTli1eM OCTaTOlJHblX npOMe)l(YfKoB.
OCHoBHaSl np06J1eMa B03Hli1KaeT npli1 J1elJeHli1li1 Tex 60% naLl,li1eHTOB,
y KOTOpblX Ha6J1IOAaeTCSI HeAOCTaTOK TKaHe Ha BepXHli1X nepeAHli1X 3y6ax
B Carli1TTaIlbHOVI nJ10CKOCTli1 3Ta TPYAHOCTb HenocpeACTBeHHO CBSl3aHa C TaKli1-
Mli1 <t>aKTOpaMli1 KaK aHryJ1S1L1,li1S1 nepeAHli1X 3y60B, TOpK pe3L1,OB li1 BeJ1li1lJli1Ha
3y60B (pli1c. 10.5). KbIVlli13 3Tli1X <J>aKTOpOB 6YAeT paccMoTpeH AaIlee.
c=J '-Ipe3MepHO 60nbWlIIe 3y6bl
HIII>KHeiii LJemOCTIII 60%
c=J '-Ipe3MepHo 60nbwlIIe 3y6bl
BepXHeiii LJemOCTIII 20%
c=J OnTIIIManbHoe COLJeTaHlIIe 20%
KOOPAII1HaLl,II151 BeJ1I11LJII1Hbl 3y6oB
PMC. 10.4. KOOPAVlHau.VlSI Bem1'-1li1Hbl 3y60B
Paao6LLleHue
npuK}'Ca BepXHUX
U HU)I(HUX ay60B
PMC. 10.5
/ AHrynIL.\s:I
· TOpK
 Ben14Ha
3y6oB

06eCne"leHMe npaBMnbHOv. aHrynSlu.MM
nepeAHMX M 60KOBbiX 3y6oB
AHryJ1S1L1,li1S1 SlBJ1S1eTCSI OAHli1M li13 AOCTOli1HCTB 6peKeTOB TeXHli1Kli1 npSlMOVI
Ayrli1, B oc06eHHOCTli1 npli1 npli1MeHeHli1li1 ABOVlHblX 6peKeTOB AOCTaTOlJHOVI
Wli1pli1Hbl. AaHHaSl xapaKTepli1CTli1Ka, BBeAeHHaSl B 6peKeTbl, npaKTli1lJeCKli1
nOJ1HOCTblO peaIlli13yeTcSI npli1 npli1MeHeHli1li1 OTHOCli1TeJ1bHO He3HalJli1TeJ1bHbIX
Cli1J1, npli1 3TOM 06bllJHO OTnaAaeT He06xOAli1MOCTb B Bbln0J1HeHli1li1li13rli160B
AIlSl 06eCnelJeHli1S1 HaKJ10Ha.
npli1 npli1MeHeHli1li1 CTaHAapTHoro 3A)1(yaVl3-annapaTa li13rli16bl BTOpOro
nopSlAKa (AIlSl 06eCnelJeHli1S1 aHryJ1S1L1,li1li1) BblnOJ1HSlJ1li1 Ha Ayrax no ABYM
npli1lJli1HaM. Bo-nepBblX, C L1,eJ1blO npaBli1J1bHoro nepeMew,eHli1S1 3y60B npli1
aHryJ1S1LJ,li1li1 0 0 B 6peKeTe, li1, BO-BTOPbIX, AIlSl KOMneHCaLl,li1li1 3HalJli1TeJ1bHbIX
Cli1J1, npli1MeHSleMbiX AIlSl nepeMew,eHli1S1 3y60B. n03TOMY, eCJ1li1 npli1 J1elJeHli1li1
annapaTOM npSlMOVI Ayrli1 He li1Cn0J1b3YIOTCSllJpe3MepHble Cli1J1bl, OTnaAaeT He-
06XOAli1MOCTb B MOAli1<t>li1KaLl,li1li1 BeJ1li1lJli1Hbl aHryJ1S1L1,li1li1, nOJ1YlJeHHOVI Andrews B
li1CCJ1eAOBaHli1li1 MOAeJ1e C HOpMaIlbHOVI OKKJ1103li1eVl, KOTopble He npOXOAli1J1li1
OPTOAOHTli1lJeCKOe J1elJeHli1e. ABTOpbl B3S1J1li1 TaKOVI nOAXoA 3a OCHOBY, li1 npli1
pa3pa60TKe annapaTa MBTTM BHeCJ1li1 J1li1Wb He3HalJli1TeJ1bHble MOAli1<J>li1KaLl,li1li1
aHryJ1S1L1,li1li1 OTHOCli1TeJ1bHO napaMeTpoB, npli1BeAeHHblx B li1CCJ1eAOBaHli1li1.
AHryJ1S1L1,li1S1 6peKeTOB - OAli1H li13 KJllOlJeBblX <t>aKTOpOB, B03AeVlCTBYIOw,li1V1
Ha 06M npocTpaHCTBa, 3aHli1MaeMoro KbIM 3y60M. 3TO, B CBOIO OlJe-
peAb, BJ1li1S1eT Ha xapaKTep CMbIKaHli1S1 BepXHli1X 3y60B C Hli1)1(Hli1Mli1. npli1
li1Cn0J1b30BaHli1li1 6peKeTOB Ha nepeAHli1X 3y6ax C aHaIlOrli1lJHbIMli1 napaMeTpaMli1
aHryJ1S1L1,li1li1, KOTOpble nepBOHalJaIlbHO li1CCJ1eAOBaIl Andrews, 06w,aSl BeJ1li1lJli1Ha
aHryJ1S1L1,li1li1 COCTaBJ1S1eT 40° AIlSl BepXHli1X nepeAHli1X 3y60B, li1 TOJ1bKO 6° -
AIlSl Hli1)1(Hli1X nepeAHli1X 3y60B (pli1c. 10.6). 06pa3YIOw,aSlcSI pa3Hli1LJ,a 34°
nOMoraeT YBeJ1li1lJli1Tb pa3Mepbl BepxHero nepeAHero YlfaCTKa li1 YMeHbWli1Tb
pa3Mepbl Hli1)1(Hero nepeAHero YlJaCTKa. A 3TO cnoc06CTByeT YJ1YlJWeHli11O OK-
KJlI03li1li1 rpynnbl naLl,li1eHTOB, COCTaBJ1S1IOw,li1X 60%, 0 KOTOpOVI WJ1a pelJb Bblwe.
ct>OPMY KOpOHOK pe3L1,OB CJ1eAyeT OLl,eHli1BaTb Ha 3Tane KOHelJHblX Mepo-
npli1S1Tli1V1 OPTOAOHTli1lJecKOro J1elJeHli1S1. AHryJ1S1L1,li1S1 KOpOHOK pe3L1,OB 60lJKOBli1A-
HOVlli1J1li1 TpeyroJ1bHOVI <t>OpMbl eABa J1li1 CMO)l(eT nOBJ1li1S1Tb Ha li13MeHeHli1e
AIlli1Hbl YlJaCTKa Ayrli1, 3aHli1MaeMOVlli1Mli1 (pli1c. 10.7). K ClJaCTblO, KOpOHKli1
60lJKOBli1AHOVI <t>OpMbl BCTpelJalOTCSI He lJacTO. KOpOHKli1 TpeyroJ1bHOVI
<t>OpMbl BpalJ-OpTOAOHT MO)l(eT CMOAeJ1li1pOBaTb, npli1AaBaSlli1M 60J1ee
npSlMoyroJ1bHYIO <t>OPMY li13 3CTeTli1lJeCKli1X c006peHli1V1. Bonpoc 0 <t>opMe
KOpOHKli1 rnaBHblM 06pa30M pewaeTCSI Ha 3Tane nJ1aHli1pOBaHli1S1 J1elJeHli1S1 li1
peAKO B03Hli1KaeT npli1 ero 3aBepWeHli1li1.
npli1 pa3pa60TKe Cli1CTeMbl 6peKeTOB MBTTM AIlSl BepXHli1X npeMOJ1S1pOB
aHryJ1S1L1,li1S1 He3HalJli1TeJ1bHO MOAli1<Pli1L1,li1pOBaHa no cpaBHeHli110 C AaHHbIMli1
li1CCJ1eAOBaHli1V1. BMecTO aHryJ1S1L1,li1li1 2° Bbl6paHa aHryJ1S1L1,li1S1 0° AIlSl YJ1Ylfwe-
Hli1S1 OKKJ1103li1li1, BepTli1KaIlbHoro BblpaBHli1BaHli1S1 KOpOHOK BepXHli1X npeMOJ1S1-
pOB li1 nepeBoAa HalJaIlbHoro HapyweHli1S1 OKKJ1103li1li1 II KJlacca B I KJlacc.
AHryJ1S1L1,li1S1 6peKeTOB MBTTM Hli1)1(Hli1X npeMOJ1S1pOB 2 0 COBnaAaeT C AaHHbIMli1
li1CCJ1eAOBaHli1V1, lJTO 06eCnelJli1BaeT li1X aHryJ1S1L1,li11O li1 nepeBoA li13 KaTeropli1li1
HalJaIlbHoro COOTHOWeHli1S1 II KJlacca B COOTHOWeHli1e I KJlacca.
AHryJ1S1L1,li1S1 BepXHli1X MOJ1S1pOB AOJ1)1(Ha COCTaBJ1S1Tb 5°, a Hli1)1(Hli1X - 2°.
TaKli1e 3HalJeHli1S1 aHryJ1S1L1,li1li1 06eCnelJli1BalOT pacn0J10)l(eHli1e 6yroPKOB MOJ1S1-
pOB napaIlJ1eJ1bHO OKKJ1103li10HHO nJ10CKOCTli1, KOTopoe ClJli1TaeTCSI npaBli1J1b-
HbIM. TaKYIO aHryJ1S1L1,li11O 06eCnelJli1BalOT 6peKeTbi MBTTM C aHryJ1S1L1,li1eVl 0°
AIlSl Bcex MOJ1S1pOB, li1 pa3Mew,eHli1e KOJ1eLl, napaIlJ1eJ1bHO BepxywKaM
6yroPKOB (c. 66-67). TaKli1M 06pa30M 06eCnelJli1BaeTCSI YCTaHOBKa MOJ1S1pOB
B li1AeaIlbHOM I KJlacce.
nonHa
aHrynLI,It1 40 0 8 0 8 0 4 0 4 0 8 0 8 0
nonHa 30 00 00 00 00 30
aHrynLI,It1 6 0
PMC. 1 0.6. A<I><I>epeHu,au,SI aHrYllSlu, 6peKeTOB ,lJ,llSl BepxHx  H)I(HX
nepe,lJ,HVlX 3y60B n03BOllSleT YllYYWTb OKKllI031O Y 60% nau,VleHTOB, Y KOTOpblX
KOpOHK BepXHVlX nepe,lJ,HVlX 3y60B 3aHMaIOT MeHbwe MeCTa no cpaBHeH1O
C KopOHKaM H)I(HX nepe,lJ,HVlX 3y60B
PMC. 10.7. <t>OPMY KOpOHOK pe3u,OB Clle,lJ,yeT ou,eHVlBaTb Ha 3aBepwalOw,eM
aTane lleyeHSI  arane cra6llVl3au,VI
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283

06eCne"leHMe COOTBeTCTBYIOw.erO
TOpKa pe3u.OB
KOHTpOJ1b TOpKa SlBJ1S1eTCSI CJ1a6b1M MeCTOM TeXHli1Kli1 npSlMOVI Ayrli1li1 J11060Vl
APYroVi Cli1CTeMbl, OCHOBaHHOVI Ha 3WKYaVl3-TeXHli1Ke. HaIlli1lJli1e CJ1eAYIOw,li1X
TpeX <t>aKTOpOB He n03B0J1S1eT Bblpa60TaTb eAli1HYIO Cli1CTeMY 3HalJeHli1V1 TOpKa,
KOTOpaSl 6bl Morna npli1MeHSlTbCSI AIlSl J1elJeHli1S1 Bcex naLl,li1eHTOB:
1. OK0J10 1 MM npSlMoyroJ1bHOVI CTaIlbHOVI Ayrli1 BBOASIT B 6peKeT npli1MepHO
TaKoro)l(e pa3Mepa AIlSl TOro, lJT06bl ocyw,ecTBli1Tb BeCbMa CJ10)l(HOe
nepeMew,eHli1e 3y6a, npli1 KOTOpOM npoli1CXOAli1T ABli1)1(eHli1e Bcero YlJacTKa
KOpHSI B aIlbBeOJ1S1pHO KOCTli1 (pli1c. 10.8).
2. ,lJ,yrli1 nOJ1Horo pa3Mepa, cOOTBeTcTBYIOw,ero pa3Mepy na3a, 06bllJHO
He li1Cn0J1b3YIOT, nOCKOJ1bKY OHli1 He 06eCnelJli1BalOT 3<t><J>eKTli1BHoro
CKOJ1b)l(eHli1S1 B na3ax 6peKeTOB Ha 60KOBbiX 3y6ax. AnSI 06eCnelJeHli1S1
3<t><t>eKTli1BHOCTli1 MexaHli1Kli1 CKOJ1b)l(eHli1S1 aBTOpbl npli1MeHSlIOT Ayrli1
CelJeHli1eM 0,019/0,025 AIOVIMa B 6peKeTax 0,022 AIOVIMa. 3TO CHli1)1(aeT
3<t><t>eKTli1BHOCTb npli1MeHeHli1S1 npSlMoyroJ1bHblX Ayr AIlSl KOHTpOJ1S1 TOpKa
(pli1c.10.8).
3. Tpe60BaHli1S1 TOpKa BepXHli1X li1 Hli1)1(Hli1X nepeAHli1X 3y60B OTJ1li1lJaIOTCSI y
pa3HbiX naLl,li1eHTOB.
Y 60J1bWli1HCTBa naLl,li1eHTOB C aHOMaIlli1S1Mli1 1li1 II KJlaCCOB npOCJ1e)l(li1BaeTCSI
TeHAeHLI,li1S1 K HaKJ10HY BepXHli1X pe3L1,OB K3aAli1, a Hli1)1(Hli1X pe3L1,OB - KnepeAli1.
npli1 aHOMaIlli1S1X III KJlacca Ha6J1IOAaeTCSI npOTli1BOn0J10)l(HaSl TeHAeHLI,li1S1.
B 60J1bWli1HCTBe OPTOAOHTli1lJeCKli1X npaKTli1K 3HalJli1TeJ1bHaSl rpynna
naLl,li1eHTOB npeACTaBJ1eHa aHOMaIlli1S1Mli1Ili1J1li111 KJlaCCOB, n03TOMY 06w,aSl
TeHAeHLI,li1S1 npli1 li1Cn0J1b30BaHli1li1 OPTOAOHTli1lJeCKli1X annapaTOB 3aKJ1lOlJaeTCSI B
BBeAeHli1li1 AOnOJ1Hli1TeJ1bHoro He6Horo TOpKa KOpHSI B 6peKeTax AIlSl BepXHli1X
pe3L1,OB li1 AOnOJ1Hli1TeJ1bHoro BeCTli16YJ1S1pHoro TOpKa KOpHSI B 6peKeTax AIlSl
Hli1)1(Hli1X pe3L1,OB.
npli1 pa3pa60TKe 6peKeToB Cli1CTeMbl MBTTM aBTOpbl A06aBli1J1li1 10 0 He6-
HOro TOpKa AIlSl KOpHSI L1,eHTpaIlbHblX BepXHli1X pe3L1,OB, 7° He6Horo TOpKa AIlSl
KOpHSI 60KOBbiX BepXHli1X pe3L1,OB li1 5° BeCTli16YJ1S1pHoro TOpKa AIlSl KOpHSI
Hli1)t(Hli1X pe3L1,OB. BBeAeHli1e AOnOJ1Hli1TeJ1bHoro TOpKa no cpaBHeHli110 C
HalJaIlbHblMli1 AaHHbIMli1 OKa3aIlOCb BeCbMa n0J1e3HbIM. TeM He MeHee, lJaCTO
He06xOAli1Mbl AOnOJ1Hli1TeJ1bHble li13rli16bl Ha npSlMoyroJ1bHOVI Ayre AIlSl 06ec-
nelJeHli1S1 COOTBeTCTBYIOw,ero TOpKa Ha YlJaCTKe pe3L1,OB. B 60J1bWli1HCTBe CJ1Y-
lJaeB HapyweHli1V1 OKKJ1103li1li1 II KJlaCca li1 MHOrli1X aHOMaIlli1V1 C 6li1MaKCli1J1J1S1pHOVI
npOTpY3li1eVlI KJlaCca L1,eJ1eC006pa3HO BBOAli1Tb AOnOJ1Hli1TeJ1bHbIVi He6HblVi
TOpK KOpHSI Ha BepXHeVi Ayre (AO 20°) li1 AOnOJ1Hli1TeJ1bHbIVi BeCTli16YJ1S1pHbIVi
TOpK KOpHSI 10-15° Ha Hli1)1(HeVi Ayre (pli1c. 10.9). BeJ1li1lJli1Hbl TOpKa 6peKeTOB
MB"fTM li1 cooTBeTcTBYIOw,li1e li13rli16bl, BblnOJ1HSleMble B cJ1YlJae He06xOAli1-
MOCTli1 Ha Ayrax, cnoc06cTBYlOT YBeJ1li1lJeHli11O BepxHero nepeAHero YlJaCTKa
li1 YMeHbWeHli110 Hli1)1(Hero nepeAHero YlJacTKa, YJ1YlJwaSl, TaKli1M 06pa30M
OKKJ1103li11O B rpynne naLl,li1eHTOB, COCTaBJ1S1IOW,li1X 60% (naLl,li1eHT T. K., c. 194).
10°
.
npfiMoyroflbHafi Ayra CeLJeHlI1eM
0,019/0,025 AIOVIMa o6pa3yeT 3a30p
10° B na3Y 6peKeTa 0,022 AIOVIMa

60flee 20°


10-15°
PMC. 10.8. TexHVlKa nps:!Mo AyrVl Hes<j><j>eKTVlBHa AJls:! KOHTpOJls:! TOpKa, BBVlAY
MaJloro pa3Mepa cerMeHTa nps:!MoyroJlbHO CTaJlbHO AyrVl, a TalOKe Vl3-3a
3a30pa Me)l()J,Y AYro VI na30M 6peKeTa. 3aLlacTYIO B03HVlKaeT He06xoAVIMOCTb
B BblnOJlHeHVIVI AOnOJlHVlTeJlbHblX Vl3rVl60B AJls:! 06ecneLleHVls:! TOpKa Ha nps:!Mo-
yroJlbHO CTaJlbHO Ayre Ha YLlacTKe pe3ltOB.

YCTpaHeHMe HeCOOTBeTCTBMSI
BenM"IMHb13y6oB
BeJ1li1lJli1Ha 3y60B <t>aKTli1lJeCKli1 SlBJ1S1eTCSI ceAbMblM KJllOlJOM HOpMaIlbHOVI
OKKJ1103li1li1. OlJeBli1AHO, lJTO B li1CCJ1eAOBaHli1li1 Andrews y «HeopTOAOHTli1lJeCKli1x»
naLl,li1eHTOB 6blJ1a C6aIlaHCli1pOBaHHaSl BeJ1li1lJli1Ha 3y60B. B npOTli1BHOM cJ1YlJae
y Hli1X 6bl Ha6J1IOAaJ1li1Cb npOMeKli1 Ha OAHOVI Ayre, li1J1li1 CKYlJeHHOCTb -
Ha npOTli1BOn0J10)l(HoVi.
KaK OTMelJaJ10Cb Bblwe, BeCbMa lJaCTO BCTpelJalOTCSI He60J1bWli1e YlJaCTKli1
3y60B BepXHeVllJeJ1IOCTli1 no cpaBHeHli110 C Hli1)1(Hli1M. TaKaSl Cli1ryaLl,li1S1lJaCTO
06YCJ1aBJ1li1BaeTCSI pa3J1li1lJli1S1Mli1 BeJ1li1lJli1Hbl 3y60B. Hali160J1ee lJaCTO BCTpelJalO-
w,aSlCSI Ali1CnpOnopLl,li1S1 BblpaeTcSI B MaIlOVI BeJ1li1lJli1He 60KOBbiX pe3L1,OB
BepxHeVi Ayrli1li1/li1J1li1 KpynHblx 60KOBbiX pe3LJ,ax Hli1)1(HeVi. B 60KOBbiX OTAeJ1ax
MeJ1Kli1e BTopble BepXHli1e npeMOJ1S1pbllJaCTO cnoc06cTBYlOT <J>OpMli1pOBaHli11O
HeCOOTBeTCTBli1S1 Me>KJJ,y BeJ1li1lJli1HOVI 3y60B.
OLl,eHKY Ali1CnpOnopLl,li1li1 BeJ1li1lJli1Hbl 3y60B MO)l(HO BblnOJ1Hli1Tb C nOMow,blO
aHaIlli13a bOJ1TOHa (Bolton)1. Pa3J1li1lJli1S1 BeJ1li1lJli1Hbl 3y60B YCTpaHSlIOTcSI
COWJ1li1<t>oBbIBaHli1eM 3MaIlli1 B Me)l(npOKCli1MaIlbHbIX npoMeKax (06bllJHO
Ha Hli1)1(Hli1X pe3L1,ax) li1/li1J1li1 BOCC03AaHli1eM KOHrypOB 3y60B C nOMow,blO
peCTaBpaLl,li10HHb1X MaTepli1aIlOB Ha npOTli1BOn0J10)l(HOVI Ayre (06bllJHO Ha
BepXHli1X J1aTepaIlbHblX pe3LJ,ax). LJaw,e li136b1TOK 3y6HbiX TKaHeVi BCTpelJaeTCSI
Ha Hli1)1(HeVi Ayre. ECJ1li1 pe3YJ1bTaTbl aHaIlli13a no Bolton nOATBep>KJJ,aIOT 3TO,
TO B 60J1bWli1HCTBe CJ1YlJaeB peKoMeHAyeTcSI BbInOJ1Hli1Tb COWJ1li1<t>oBbIBaHli1e
3MaIlli1 Ha Me)l(npOKCli1MaIlbHbIX YljacTKax nepeAHeVi Hli1)1(HeVi rpynnbl 3y60B
Ha HalJaIlbHblX 3Tanax J1elJeHli1S1 (naLl,li1eHT M.S., c. 236). B HalJaIle J1elJeHli1S1
MO)l(HO TOJ1bKO Mli1Hli1MaJ1bHO YMeHbWli1Tb nepeAHli1e BepXHli1e 3y6bl. no Mepe
npli16J1li1)1(eHli1S1 K 3aKJ1lOlJli1TeJlbHOMY 3Tany J1elJeHli1S1 nOBTOpHO OLl,eHli1BaIOT
06beM TKaHeVi Ha nepeAHli1X 3y6ax BepXHeVllJeJ1IOCTli1. ECJ1li1 OTMelJaeTCSlli1X
li136b1TOK B pe3YJ1b TaTe YAaIleHli1S1 TBepAblX TKaHeVi Ha Hli1)1(Hli1X 3y6ax, TO CJ1e-
AyeT COWJ1li1<t>OBaTb 3MaIlb Ha BepXHli1X nepeAHli1X 3y6ax. npe>KJJ,eBpeMeHHoe
COWJ1li1<t>oBbIBaHli1e 3MaIlli1 Ha HalJaIlbHblX 3Tanax J1elJeHli1S1 Ha 3y6ax BepxHeVi
lJeJ1IOCTli1 BeAeT K 06pa30BaHli11O npoMeKoB, KOTOpble MO)l(HO oTKOppeKTli1-
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COlJeTaHli1li1 C li1X TOlJHblM n03li1L1,li10Hli1pOBaHli1eM. Hali160J1ee HarIlSlAHblM npli1Me-
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Me3li1aIlbHO. 3TO 06eCnelJli1BaeT Ali1CTaIlbHYIO pOTaLl,li11O elJHblX 6yroPKOB
BepXHli1X npeMOJ1S1pOB B n03li1L1,li1li11 KJlaCca, npli1 3TOM npOXOAli1T He6HaSl
pOTaLl,li1S1 6yroPKOB 3Tli1X 3y60B B Me3li1aIlbHOM HanpaBJ1eHli1li1 TaKli1M 06pa30M,
lJTO OHli1 CMblKalOTCSI 60J1ee TOlJHO C 60p03AaMli1 Hli1)1(Hli1X 3y60B. ECJ1li1 nepeA-
Hli1e 3y6bl npOSlBJ1S1IOT npli13HaKli1 pOTaLl,li1li1 B HalJaIle J1eyeHli1S1 (pli1c. 10.9),
L1,eJ1eC006pa3Ho HaKJ1eli1Tb 6peKeTbi CJ1erKa B HanpaBJ1eHli1li1 pOTaLl,Vlli1, lJTO cno-
c06cTByeT KOppeKLI,li1li1li1X n03li1L1,li1li1 (c. 61). TaK)l(e li1MeeT CMbICJ1 YCTaHOBli1Tb
6peKeTbi Ha Hli1)1(Hli1X KJlblKax CJ1erKa Me3li1aIlbHO, lJTO 06eCnelJli1T pOTaLJ,li11O
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3Tane J1elJeHli1S1, OC06eHHO B 3KCTpaKLI,li10HHbIX CJ1YlJaSlx. AnSI 3TOro MO)l(HO
li1Cn0J1b30BaTb naCCli1BHble CBSl3Kli1 tieback (pli1c. 10.10) C YCTaHOBJ1eHHbIMli1
npfiMoyroJ1bHbIMli1 AyraMli1 li1 BOCbMli106pa3Hble J1li1rarypbl Ha YlJacTKax OT
MOJ1f1pOB AO KJlblKOB npli1 npli1MeHeHli1li1 cJ1a60Vl J1li1rarypbl. npli1 J1elJeHli1li1
C YAaJ1eHli1eM 3y60B B nepli10A CTa6li1J1li13aLl,li1li1 BOCbMli106pa3Hble CBSl3Kli1
laceback (pli1c. 10.11) HaKJ1aAblBalOT Ha 3KCTpaKLI,li10HHble npoMe)l(YfKli1 AIlSl
nO,lJ.D,ep)l(aHli1S1li1X 3aKpbITbIMli1. TaK)l(e Ha APyrli1x YlJaCTKax, rAe 3aKpblTli1e
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np06J1eMY OTKpbITli1S1 npoMe)l(YfKOB Ha KOHelJHOM 3Tane J1elJeHli1S1.
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nocT3KCTpaKLtVlOHHbie Y'"IaCTKVI Ha 3Tane cTa6MnVl3aLtMM cneAyeT YCTaHaBnMBaTb
BOCbMM06pa3Hbie nMraTYPHbie CBSl3KVI (pMC. 10.11) AnSI npeAoTBpaw,eHVlSI
nOBTOpHOro OTKpblTMSI npOMe)KYTKOB
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B CJ1YlJaSlX aHoMaIlli1V1I1li1111 KJlaCCOB lJaCTO B03Hli1KaeT He06xOAli1MOCTb
B paCCMOTpeHli1li1 B03MO)l(HOVI CBepXKOppeKLI,li1li1. Ha 3aKJ1lOlJli1TeJ1bHbIX 3Tanax
J1elJeHli1S1 BHO nOJ1HOCTblO OTKOppeKTli1pOBaTb Carli1TTaIlbHOe n0J10)l(eHli1e
3y6HbiX PSIAOB C nOMow,blO, Hanpli1Mep, 3J1aCTli1lJHbIX TSlr 1lli1 III KJlaCCOB li1J1li1
BHepOTOBblX Tflr. nOCJ1e 3aBepWeHli1S1 KOppeKLI,li1li1 OT AaHHblX MeTOAOB MO)l(HO
OTKa3aTbCSlli1J1li1 npli1MeHSlTb nepli10Ali1lJeCKli1. AanbHeVlwee Ha6J1IOAeHli1e
3a naLl,li1eHTOM ocyw,eCTBJ1S1eTCSI B TelJeHli1e 6-8 HeAeJ1b. ECJ1li1 nOJ1YlJeHHble
pe3YllbTaTbi AOCTaTOlJHO cTa6li1J1bHbl, annapaT MO)l(HO CHSlTb. B npOTli1BHOM
CJ1YlJae MO)l(HO BblnOJ1Hli1Tb Carli1TTaIlbHYIO CBepXKOppeKLJ,li1IO.
npli1 aHOMaIlli1li1 II KJlacca pe3L1,bl MO)l(HO nepeMeCTli1Tb B n03li1L1,li11O npSl-
MOro npli1KYca li1 3a<t>li1KCli1pOBaTb li1X npli1MepHO Ha 6-8 HeAeJ1b (pli1c.1 0.12).
nOcJ1e 3TOro OT 3J1aCTli1lJHbIX TSlr MO)l(HO OTKa3aTbCSlli1J1li1 peKoMeHAoBaTb
li1X HOWeHli1e B HOlJHOe BpeMSI, Ha6J1IOAaSl npli1 3TOM, KaK npOXOAli1T cra6li1-
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li1J1li1 BeCTli1 Ha6J1IOAeHli1e aHaIlOrli1lJHO CJ1YlJalO aHOMaJ1li1li1 II KJlacca.
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He AOCTli1rHyro Ha YKa3aHHOM 3Tane, TO KOppeKLI,li1li1 CJ1eAyeT BblnOJ1HSlTb Ha
:nane KOHelJHblX MepOnpli1S1Tli1V1, He3aA0J1ro AO CHSlTli1S1 6peKeTOB, lJTO He
06eCnelJli1BaeT cTa6li1J1bHOCTli1 BepTli1KaIlbHOVI n03li1L1,li1li1 KOpOHOK 3y60B. AnSI
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npaBli1J1bHOVI BepTli1KaIlbHOVI n03li1L1,li1li1 6peKeToB. CxeMbl, 06eCnelJli1BalOw,li1e
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npli1MepHO Ha 50%, li1 YBeJ1li1lJli1J1o 3<t><J>eKTli1BHOCTb J1elJeHli1S1 li1 CTa6li1J1bHOCTb
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li1J1li1 C aHOMaIlbHbIMli1 Maprli1HaIlbHbIMli1 Kpa5lMli1, n03li1L1,li11O 6peKeTOB CJ1eAyeT
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3aKpblTb TaKOVI nepeAHli1V1 OTKpblTblVi npli1KYc 6blBaeT TPYAHO li1J1li1 HeB03MO)l(HO.
PMC. 10.13. npaBlllnbHa51 BepTIIIKanbHaSi n03111LtlllSi 6peKeTa MIIIHIIIMIII3111pyeT
He06xoAVIMOCTb BbinonHeHVlSI Vl3rVl60B Ha KOHelJHOM 3Tane neLJeHVlSI

BepTMKanbHaSlCBepXKoppeKu.MSI
cnY"laM rny6oKoro M OTKpblToro
npMKYCOB
B cJ1YlJaSlx rny60Koro li1 OTKpblTOro npli1KYCOB L1,eJ1eC006pa3HO BblnOJ1HSlTb
HeKOTOpylO CBepXKOppeKLI,li1IO. AaHHblVi npOLl,eCC HalJli1HaeTCSI C HalJaIlbHoro
pa3Mew,eHli1S1 6peKeTOB. 6peKeTbi Ha nepeAHli1X 3y6ax MO)l(HO npli1KJ1eli1BaTb
Ha 0,5 MM 6J1li1)1(e K AecHeBoVi rpaHli1L1,e B CJ1YlJaSlX OTKpblTOro npli1KYca, li1 Ha
0,5 MM 6J1li1)1(e K pew,eMY KpalO B cJ1YlJaSlx rny60KOro npli1KYca (c. 65).
3TO B 3HalJli1TeJ1bHOVI CTeneHli1 cnoc06CTByeT npOLl,eccy cBepXKOppeKLI,li1li1.
B CJ1YlJaSlX rny60KOro npli1KYca BblpaBHli1BaHli1e Kpli1BOVI Wnee C nOMow,blO
nJ10CKli1X CTaIlbHblX npSlMoyroJ1bHblX Ayr 06bllJHO npli1BOAli1T K 3<J><t>eKTli1BHoMY
OTKpbITli11O npli1KYca npli1 YCJ10Bli1li1 BKJ1lOlJeHli1S1 BTOpblX MOJ1S1pOB. ECJ1li1li1CnOJ1b-
30BaHli1e nJ10CKli1X npSlMoyroJ1bHblX CTaIlbHblX Ayr He 06eCnelJli1BaeT OTKpbITli1S1
npli1KYca, MO)l(HO BblnOJ1Hli1Tb li13rli16bl AIlSl OTKpbITli1S1 npli1Kyca. 3TO MO)l(HO
CAeJ1aTb Ae Ha 3aBepwalOw,eM 3Tane J1elJeHli1S1, HO 06bllJHO 3TO BblnOJ1HSlIOT
paHbwe. npli1 HaIlli1lJli1li1 rny60Koro npli1KYca K MOMeHry 3aBepWeHli1S1 J1elJeHli1S1
y naLl,li1eHTOB MO)l(eT Ha6J1IOAaTbCSI 1-2 MM nepeKpbITli1S1 B nepeAHeM
YlJaCTKe. OAHaKo, nOCJ1e cTa6li1J1li13aLl,li1li1 nepeKpblTli1e MO)l(eT YBeJ1li1lJli1BaTbCSI
AO 3-4 MM. AnSI npeAoTBpaw,eHli1S1 nOCJ1eAYIOw,ero lJpe3MepHoro yrny6J1eHli1S1
npli1KYca L1,eJ1eC006pa3Ho npli1MeHeHli1e peTeVlHepOB B Bli1Ae HaKYcOlJHblX
nJ1aCTli1HOK.
ne4eHli1e naLl,li1eHTOB C OTKpblTblM npli1KYCOM npeACTaBJ1S1eT 3HalJli1TeJ1bHYIO
TPYAHOCTb AIlSl BpalJa-OpTOAOHTa. Ha 3aKJ1lOlJli1TeJ1bHbIX 3Tanax J1elJeHli1S1
BHO OLl,eHli1Tb n0J10)l(eHli1e Sl3blKa li1 npli1BbllJKli1, 06YCJ1aBJ1li1BalOw,li1e ero
napa<t>YHKLI,li1IO. AaHHYIO np06J1eMY 06bllJHO BbISlBJ1S1IOT Ha npeAbIAyw,li1X
3Tanax li1 HalJli1HalOT Mli10<t>YHKLI,li10HaIlbHOe J1elJeHli1e, eCJ1li1 npli1BbllJKa He
nOMaeTCSI KOppeKLI,li1li1. B AaHHblX CJ1YlJaSlX npli1MeHeHli1e n03li1L1,li10HepOB
06bllJHO AaeT XopOWli1e pe3YJ1b TaTbl AIlSl 06eCnelJeHli1S1 3aKpbITli1S1 npli1KYca.
npli1 npli1MeHeHli1li1 06bllJHOro peTeVlHepa Ha BepXHeVi Ayre MO)l(HO BblnOJ1Hli1Tb
He60J1bWOe OTBepCTli1e Ha He6HOVI nOBepXHOCTli1 nJ1aCTli1HKli1 AIlSl pa3Mew,eHli1S1
5I3bIKa. TaKli1M 06pa30M HeKOTopble naLl,li1eHTbl MOryT HaYlJli1TbCSlli13MeHSlTb
n0J10)l(eHli1e li1 aKTli1BHOCTb Sl3blKa, YAep)l(li1BaSl KOHlJli1K Sl3blKa y CBOAa He6a
B npOLl,eCce rnOTaHli1S1 li1J1li1 APyrli1X <t>YHKLI,li1S1X. OAHaKO B HeKOTOpblX CJ1YlJaSlX
3aKpenli1BWli1eCSI napa<t>YHKLI,li10HaIlbHble npli1BbllJKli1, CBSl3aHHbie C pa3Mew,e-
Hli1eM Sl3blKa B n0J10CTli1 pTa, li1CnpaBli1Tb He YAaeTCSI, HeCMOTpSl Ha Bce
YCli1J1li1S1 naLl,li1eHTa li1 BpalJa. naLl,li1eHTa CJ1eAyeT npeAynpeAli1Tb 0 TaKOVI
B03MO)l(HOCTli1 ew,e AO HalJaIla J1elJeHli1S1.
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OU.EHKA TPAHCBEP3AnbHbiX
COOTHOWEHiII
CbopMa AyrM
lt1cn0J1b30BaHli1e OAHOVI <J>OPMbl Ayrli1 AIlSl J1elJeHli1S1 pa3HbiX naLl,li1eHTOB
ynpow,aeT 3aAalJY OpTOAOHTa. OAHaKO npli1 TaKOM nOAXOAe HeB03MO)l(HO
06eCnelJli1Tb TOlJHOCTb li1 cTa6li1J1bHOCTb pe3YJ1bTaTOB J1elJeHli1S1. OCHOBOVI
OnTli1MaIlbHOro ynpaBJ1eHli1S1 <t>OpMOVI Ayrli1 SlBJ1S1eTCSI rapMOHli1lJHblVi
6aIlaHC Me)I(AY 3<J><t>eKTli1BHOCTblO li1 TOlJHOCTblO. Cli1CTeMa <t>OpM Ayr,
npeACTaBJ1eHHaSl B pa3AeJ1e 4, COCTOli1T li13 CJ1eAYIOw,li1x 3J1eMeHTOB:
· Tpli1 CTaHAaPTHblX Wa6J10Ha Ayrli1 (KBaApaTHoVl, ceHHOVlli1 OBaIlbHOVI
<t>OpMbl) AIlSl onpeAeJ1eHli1S1 <J>OpMbl 3y6HOVI Ayrli1 naLl,li1eHTa Ha 3Tane
npli1MeHeHli1S1 Kpyrnblx li1 npSlMoyroJ1bHblX TepMOaKTli1Bli1pyeMblx Hli1KeJ1eBO-
Tli1TaHOBbIX Ayr, 06eCnelJli1BalOw,li1X B03MO)l(HOCTb 3<t><t>eKTli1BHoro KOHT-
pOJ1S1 <J>OPMbl Ayrli1 Ha paHHli1X 3Tanax J1elJeHli1S1.
· npli1MeHeHli1e BOCKOBblX Wa6J10HOB, HaKJ1aAblBaeMblX Ha 6peKeTbi Hli1)1(HeVi
Ayrli1 nepeA BBeAeHli1eM CTaIlbHOVI npSlMoyroJ1bHOVI Ayrli1, <t>opMa KOTOpOVI
onpeAeJ1S1eTCSI 3aTeM no BOCKOBOMY Wa6J10HY. <t>OPMY Ayrli1 yrOlJH5IIOT
li1 CpaBHli1BaIOT C pa60lJeVi MOAeJ1blO Hli1)1(HeVllJeJ1IOCTli1 naLl,li1eHTa. nOJ1Y-
lJeHHaSl <t>opMa CTaHOBli1TCSI li1HAli1Bli1AYaIlbHOVI <t>OPMOVI Ayrli1 naLl,li1eHTa.
3Ta npocTaSl TeXHli1Ka 06eCnelJli1BaeT TOlJHOCTb Cli1CTeMbl <t>OpM Ayr.
· CTa6li1J1li13aLl,li1S1 C nOMow,blO cJ1a60Vl Ayrli1 (B OTJ1li1lJli1e OT CTaIlbHOVI
npSlMoyroJ1bHOVI Ayrli1) B KalJeCTBe 3aKJ1lOlJli1TeJ1bHOVI <t>a3bl J1elJeHli151.
AaHHaSl TeXHli1Ka paccMOTpeHa B KOHLI,e HacTOSlw,ero pa3AeJ1a.
KooPAMHau.MSI OPTOAOHTM"IeCKMX Ayr
He3aBli1Cli1MO OT pa3Mepa npli1MeHSleMoVi Ayrli1, <J>OPMY BepxHeVi Ayrli1 HHO
cornaCOBblBaTb C <t>OpMOVI Hli1)1(HeVi Ayrli1 nOCJ1e ee onpeAeJ1eHli1S1. <t>OPMY
BepxHeVi Ayrli1 npli1naCOBblBalOT TaKli1M 06pa30M, lJT06bl OHa 6blJ1a Ha 3 MM
Wli1pe Hli1)1(HeVi Ayrli1 Ha nepeAHeM li1 60KOBOM YlJaCTKax. TaKli1M 06pa30M
MO)l(HO 06eCnelJli1Tb npaBli1J1bHOe nepeKpblTli1e Ha 3 MM Ha nepeAHli1X
li1 60KOBbiX oTpe3Kax Ayrli1. lt1CXOASlli13 co06peHli1V1 06eCnelJeHli1S1 60KOBOro
TOpKa (CM. AaIlee), BO MHOrli1X CJ1YlJaSlX 6blBaeT L1,eJ1eC006pa3Ho YBeJ1li1lJli1Tb
Wli1pli1HY BepxHeVi Ayrli1 Ha 60KOBbiX YlJaCTKax npli1MepHO AO 5 MM. ECJ1li1 B
XOAe J1elJeHli1S1 CJ1eAOBaTb 3Tli1M n0J10)l(eHli1S1M, TO 06bllJHO OTnaAaeT He06-
XOAli1MOCTb B KOOPAli1HaLl,li1li1 Ayr Ha 3aKJ1lOlJli1TeJ1bHbIX 3Tanax J1elJeHli1S1.
B HeKoTopblX cJ1YlJa5lx, KorAa Ha6J1IOAaeTCSI He3HalJli1TeJ1bHOe CeHli1e
Ayrli1 Ha 60KOBbiX cerMeHTax K KOHLI,y J1elJeHli1S1, K BepxHeVi Ayre MO)l(HO
nOABSl3aTb BcnoMOraTeJ1bHYIO AYry li13 npOB0J10Kli1 Ali1aMeTpOM 0,045, 06ec-
nelJli1BalOw,ylO ee paCWli1peHli1e npli1MepHO Ha 6 MM C 06eli1x CTOpOH. 3aTeM
ee MO)l(HO 3aKpenli1Tb Ha BepxHeVi Ayre B Tpy6Kax BHepoTOBoVi TSlrli1 (c. 82).
npli1MeHeHli1e TaKOVI AOnOJ1Hli1TeJ1bHOVI Ayrli1 Tli1na jockey 3<t><t>eKTli1BHO npli1
KOppeKLI,li1li1 He3HalJli1TeJ1bHoro CeHli1S1 BepXHeVllJeJ1IOCTli1 Ha 3aBepWalOl.ltli1X
3Tanax J1elJeHli1S1.
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BBeAeHMeTopKaHa6oKoBx3y6ax
nporpeCCli1BHblVi w,elJHblVi TOpK KOpOHOK pa3pa60TaH B Cli1CTeMe annapaTa
AIlSl Hli1)1(Hli1X 60KOBbiX 3y60B, KaK OTMelJaIlOCb B pa3AeJ1e 2 (c. 33), lJTO
cnoc06CTBOBaIlO ero 3HalJli1TeJ1bHOMY YCOBepweHCTBOBaHli1IO. npli1 BBeAeHli1li1
CTaIlbHOVI npSlMoyroJ1bHOVI Ayrli1 B 6peKeTbi Hli1)1(Hli1e 60KoBbie 3y6bl nepeMe-
LltalOTCSI B BepTli1KaIlbHOe n0J10)l(eHli1e, <!>OPMli1PYSI OTHOCli1TeJ1bHO nJ10cKYIO
Kpli1BYIO Bli1J1bCOHa (Wilson curve) (pli1c. 10.14). npli1 3TOM B03Hli1KaeT cJ1a6aSl
TeHAeHLI,li151 K paCWli1peHli11O Hli1)1(HeVi Ayrli1. OAHaKo, eCJ1li1 <!>OPMY Ayrli1 YCTaHaB-
J1li1BaIOT OTHOCli1TeJ1bHO 6a3aIlbHOVI KOCTli1 Hli1)1(HeVllJeJ1IOCTli1, 3TO B03AeVlCTBli1e
CTaHOBli1TCSI Mli1Hli1MaIlbHbIM. 06bllJHO KOpHli1 Hli1)1(Hli1X 60KOBbiX 3y60B
nepeMew,aIOTc51 B 513bllJHOM HanpaBJ1eHli1li1 OT KOpTli1KaIlbHOVI nJ1aCTli1HKli1, B
OTJ1li1lJli1e OT KOpOHOK, KOTOpble nepeMew,alOTcSI B w,elJHOM HanpaBJ1eHli1li1.
6peKeTbi AIlSl BepXHli1X KJlblKOB li1 npeMOJ1S1pOB li1MeIOT w,elJHblVi TOpK
KopHeVi -7°, lJTO cnoc06CTByeT li1X nepeMew,eHli11O B li1AeaIlbHOe n0J10)l(eHli1e
OTHOCli1TeJ1bHO Hli1)1(HeVi Ayrli1. B 6peKeTbi Ha BepXHli1e MOJ1S1pbl BBeAeH AOnOJ1-
Hli1TeJ1bHbIVi w,elJHblVi TOpK KopHeVi no cpaBHeHli110 C BeJ1li1lJli1HaMli1, npli1BeAeH-
HbIMli1 B li1CCJ1eAOBaHli1li1, lJTO nOMoraeT nepeMeCTli1Tb li1X B HHYIO n03li1L1,li1IO.
OAHaKo cyLlteCTByeT PSIA CJ1YlJaeB, KorAa HHO BBOAli1Tb AOnOJ1Hli1TeJ1bHbIVi
LltelJHblVi TOpK KopHeVi Ha 60KOBbiX YlJacTKax BepxHeVi Ayrli1. BBli1AyaHaTOMli1-
lJeCKli1X oc06eHHocTeVi KopHeVi BepXHli1X MOJ1S1pOB, BHO li1MeTb AOCTaTOlJHYIO
Wli1pli1HY BepXHelJeJ1IOCTHOVI KOCTli1, lJT06bl w,elJHble KOpHli1 He ynli1paIlli1Cb B
KOpTli1KaIlbHYIO nJ1aCTli1HKY (pli1c. 10.15). ECJ1li1 )l(e 3TO CJ1YlJli1TCSI, BP51A J1li1
MO)l(HO 6YAeT YCTaHOBli1Tb npaBli1J1bHbIVi w,elJHblVi TOpK KopHeVi Ha BepXHli1X
60KOBbiX YlJacTKax.
VI, HaKOHeLl" CJ1eAyeT OTMeTli1Tb, lJTO BO MHOrli1X cJ1YlJaSlx 3<t><t>eKTli1BHbIM
OKa3blBaeTCSI BBeAeHli1e BepxHeVi Ayrli1 Tli1na jockey Ali1aMeTpOM 0,045
AIOVIMa B Tpy6Kli1 BHepoToBoVi HIrli1 (c. 82). nOCJ1e AOCTli1)1(eHli151 3<t><t>eKTa
paCWli1peHli1s:1 ee MO)l(HO CHSlTb li1 BBeCTli1 AOnOJ1Hli1TeJ1bHbIVi w,elJHblVi TOpK
KopHeVi B CTaIlbHYIO npSlMoyroJ1bHYIO AYry. 3TO n03B0J1li1T nepeMeCTli1Tb
60KoBbie 3y6bl B HHYIO n03li1L1,li1IO. 3aTeM, Ha 3aKJ1lOlJli1TeJ1bHOM 3Tane
cTa6li1J1li13aLl,li1li1 B KOHLI,e J1elJeHli1S1 BepXHli1e 60KoBbie 3y6bl 06bllJHO YCTaHaB-
J1li1BaIOTCSI B HOpMaIlbHYIO n03li1L1,li11O OTHOCli1TeJ1bHO Hli1)1(Hli1X 60KOBbiX 3y60B.
PMC. 10.14. B npo,-,ecce KoppeK'-'VIVI TOpKa KOpHVI HVI)KHVlX 60KOBbiX 3y60B
nepeMelltalOTCSI B Sl3blllHOM HanpaBlleHVIVI OT KopTVlKallbHoVi nllaCTVlHKVI,
a KOpOHKVI - He3HallViTellbHO B w.ellHoM HanpaBlleHVlVI, eCllVi 4>opMa ,lJ,yrVl
cooTBeTcTByeT 6a3allbHoVi KOCTVI HVI)KHeVi lIelllOCTVI
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PMC. 10.15. ,lJ,llSl npaBVlllbHoro lltellHoro TOpKa KopHeVi Ha YllacTKe BepxHVlx MOllSlpOB Ba)KHO HallVlllVie ,lJ,OCTaTOlIHOro 06beMa BepxHellelllOcTHoVi KOCTVI

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B cJ1YlJaSlx Cy)I(eHli1S1 BepXHeVllJeJ1IOCTli1 CJ1eAyeT 06eCnelJli1Tb ee MaKCli1MaIlb-
HOe paCWli1peHli1e li1 nOAAep)l(li1BaTb ee B TaKOM COCTOSlHli1li1 B TelJeHli1e
npOAOJ1)1(li1TeJ1bHoro nepli10Aa. BepXHlO1O lJeJ1IOCTb MO)l(HO paCWli1pSlTb AO Tex
nop, nOKa He6Hbie 6yropKli1 3y60B BepxHeVi Ayrli1 HaxOASlTCSI B KOHTaKTe CO
w,elJHbIMli1 6yropKaMli1 Hli1)1(Hli1X 3y60B Ha 60KOBbiX YlJaCTKax (pli1c. 10.16A).
PaCWli1peHli1e J1YlJwe npOBOAli1Tb 3a 1 li1J1li1 2 roAa AO nOJ1Horo OPTOAOHTli1-
lJeCKoro J1elJeHli151 C npli1MeHeHli1eM He6HoVi Ayrli1. B TaKOM cJ1YlJae 06bllJHO
06eCnelJli1BaeTCSI cTa6li1J1bHOCTb.
ECJ1li1 paCWli1peHli1e CpeAli1HHoro He6Horo WBa BbIn0J1H51IOT B HalJaIle
OPTOAOHTli1lJeCKoro J1elJeHli1S1, nOCJ1e MepOnpli1S1Tli1V1 no paCWli1peHli11O CJ1eAyeT
YCTaHOBli1Tb He6HYlO AYry. OHa MO)l(eT OCTaBaTbCSI B n0J10CTli1 pTa AO BBeAe-
Hli1S1 np51MoyroJ1bHOVI CTaIlbHOVI Ayrli1, KOTOpaSl 06eCnelJli1BaeT AOCTaTOlJHYIO
)l(eCTKOCTb AIl51 YAep)l(aHli151 AOCTli1rHyroro paCWli1peHli151. B 3TO BpeMSI AIlSl
Hwe)l(aw,eVl CTa6li1J1li13aLl,li1li1 60KOBbiX cerMeHTOB 6J1aronpli1S1THO B03AeVlcT-
Bli1e TOpKa 60KOBbiX 6peKeTOB Ha BepxHeVi Ayre, a TaK)l(e HeKOTopblVi AOnOJ1-
Hli1TeJ1bHbIVi w,elJHblVi TOpK KopHeVi Ha Ayre.
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6blCTpOro paCWVlpeHL-1S1 He6a B CMeHHOM npVlKyce. TaKoe paCWL-1peHL-1e MO>KHO
nOMep>KVlBaTb C nOMOlJ..tblO He6HoVi AyrVl, npL-1MeHeHVle KOTOPOVI cnoc06cTByeT
AOCTL-1>KeHVlIO cooTBeTcTBYlOlJ..tero w,ellHoro TOpKa KopHeVi BepXHL-1X 60KOBbiX
3y60B.
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cl>YHKu.MOHanbHbIX ABM>KeHMM
eHTpaJ1bHOe COOTHOWeHli1e BHO OLl,eHli1Tb B caMOM HalJaIle J1elJeHli1S1.
B npOTli1BHOM cJ1YlJae B03MO)l(Hbi cepbe3Hbie OWli16Kli1 npli1 Ali1arHOCTli1Ke.
AaHHoe COOTHOWeHli1e CJ1eAyeT KOHTpOJ1li1pOBaTb Ha npOTSI)I(eHli1li1 Bcero
npOLl,ecca J1elJeHli151, npli1 3TOM oc06eHHO BHO npOBeCTli1 nOBTopHYIO
OLl,eHKY n03li1L1,li1li1 Hli1)1(HeVllJeJ1IOCTli1 B HalJaIle 3aKJ1lOlJli1TeJ1bHoro 3Tana
J1elJeHli1S1 (pli1c. 10.166). Ao 3aBepWeHli1S1 J1elJeHli1S1 MO)l(eT B03Hli1KHyrb
He06xOAli1MOCTb B AOnOJ1Hli1TeJ1bHOVI KOppeKLI,li1li1, Hanpli1Mep, C nOMow,blO
Me)l(lJeJ1IOCTHbIX 3J1aCTli1lJHbIX TSlr. Y naLl,li1eHTOB C OKKJ1103li1eVlI KJlacca li1
L1,eHTpaIlbHblM COOTHOWeHli1eM Mblw,eJ1KOBbIX OTpOCTKOB CJ1eAyeT npOBepli1Tb,
He Ha6J1IOAaIOTCSI J1li1 nOMeXli1 npli1 60KOBbiX ABli1)1(eHli151X li1 BbIABli1)1(eHli1li1
lJeJ1IOCTli1 KnepeAli1. npli1 BbIABli1)1(eHli1li1lJeJ1IOCTli1 KnepeAli1 BHO, lJT06bl
8 Hli1)1(Hli1X nepeAHli1X 3y60B CMbIKaIlli1Cb C weCTblO BepXHli1Mli1 nepeAHli1Mli1
3y6aMli1 npli1 OTCyrCTBli1li1 60KOBbiX KOHTaKTOB. npli1 60KOBbiX ABli1)1(eHli1S1X
lJeJ1IOCTli1 y naLl,li1eHTa BeAyw,li1M AOJ1)1(eH 6blTb KJlblK npli1 He3HalJli1TeJ1bHOM
KOHTaKTe nepeAHli1X 3y60B li1 pa30MKHyrbiX 60KOBbiX 3y6ax KaK C pa60lJeVl,
TaK li1 C 6aIlaHCli1pYIOw,eVl CTOpOHbl. 2
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PMC. 10.165. YCTaHOBJleHHble B apVlTKYJlSlTOpe MOAeJlL-1 MO>KHO VlCnOJlb30BaTb
A1lSl nOBTOpHoVi OLteHKL-1 n03L-1LtL-1L-1 HVI>KHeVilleJlIOCTVI VI <!>YHKLtL-10Ha1lbHblX
ABL-1>KeHVlVI B Halla1le 3aBepwalOIJ..tero 3Tana 1lelleHL-1S1
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Ou.eHKa AMCcI>YHKU.MM BMCO"lHO-
HM>KHeenIOCTHbIX CYCTaBOB
CJ1eAyeT AOKYMeHTaIlbHO 3aperli1CTpli1pOBaTb Bce npli13HaKli1 HapyweHli1V1
co CTOpOHbl Bli1COlJHO-Hli1)1(HelJeJ1IOCTHbIX CYCTaBOB Y naLl,li1eHTa AO J1elJeHli1S1
li1 C006ll.1li1Tb eMY 06 3TOM. 6eCCli1MnTOMHOe nOTpeCKli1BaHli1e li1J1li1 XPYCT
06bllJHO He Tpe6YIOT npli1HSlTli1S1 npeABapli1TeJ1bHbIX Mep no li1X YCTpaHeHli1IO,
HO li1X CJ1eAyeT KOHTpOJ1li1pOBaTb B XOAe OPTOAOHTli1lJeCKoro J1elJeHli1S1. ECJ1li1
Ha6J1IOAaeTCSI MblWelJHblVi Ali1c6aIlaHC li1/li1J1li1 naLl,li1eHT li1CnblTblBaeT 60J1b,
a L1,eHTpaIlbHOe COOTHOWeHli1e HeB03MO)l(HO TOlJHO 3aperli1CTpli1pOBaTb, TO AO
npOBeAeHli1S1 OPTOAOHTli1lJecKOro J1elJeHli1S1 nOKa3aH 3Tan J1elJeHli1S1 C nOMow,blO
Wli1H li1 <t>li13li10Tepanli1li1. nOCJ1e CTa6li1J1li13aLl,li1li1 COCTOSIHli1S1 naLl,li1eHTa MO)l(HO
npli1crynaTb K OPTOAOHTli1lJeCKOMY J1elJeHli1IO.
B xOAe OPTOAOHTli1lJeCKoro J1elJeHli1S1 CJ1eAyeT KOHTpOJ1li1pOBaTb COCTOSlHli1e
naLJ,li1eHTa B CJ1YlJae npOSlBJ1eHli1S1 Cli1MnTOMOB HapyweHli1V1 B <t>YHKLI,li10Hli1pOBa-
Hli1li1 Bli1COlJHO-Hli1)1(HelJeJ1IOCTHbIX CYCTaBOB. ECJ1li1 Ha 3Tli1 Cli1MnTOMbl 06paTli1Tb
BHli1MaHli1e npli1li1x nepBOM npOSlBJ1eHli1li1, AO <l>opMli1pOBaHli1S1 BHyrpli1CYCTaBHblx
li13MeHeHli1V1, TO B 60J1bWli1HCTBe CJ1YlJaeB MO)l(HO BOCCTaHOBli1Tb HOpMaIlbHYIO
<t>YHKLI,li11O CYCTaBOB li1li136e)l(aTb B03Hli1KHOBeHli1S1 He06paTli1Mb1X li13MeHeHli1V1.
ECJ1li1 Cli1MnTOMbl npOAOJ1)1(aIOT pa3Bli1BaTbCSI, TO npe)I(Ae Bcero CJ1eAyeT
npeKpaTli1Tb npli1MeHeHli1e Bcex annapaTOB li1 YCTPOVlCTB C li1Cn0J1b30BaHli1eM
Cli1J1, TaKli1X KaK BHepOTOBble TSlrli1li1J1li1 3J1aCTli1lJHble TSlrli1, Ha nepli10A YCTpa-
HeHli1S1 np06J1eMbl C Bli1COlJHO-Hli1)1(HelJeJ1IOCTHbIMli1 CYCTaBaMli1. naLl,li1eHry
peKOMeHAYIOT npli1Aep)l(li1BaTbCSI onpeAeJ1eHHOVI Ali1eTbl li1 li1Cn0J1b30BaTb
KOHCepBaTli1BHble MeTOAbl J1elJeHli1S1 Ali1C<t>YHKLI,li1li1.
ECJ1li1 Cli1MnTOMbl He YCTpaHSlIOTCSI, MO)l(HO npli16erHyrb K li1Cn0J1b30BaHli11O
Wli1Hblli1 <t>li13li10TepaneBTli1lJeCKli1M npOLl,eAypaM, a OPTOAOHTli1lJeCKOe J1elJeHli1e
Ha BpeMSI OTJ10)l(li1Tb. B 60J1bWli1HCTBe CJ1YlJaeB OPTOAOHTli1lJeCKOe J1elJeHli1e
naLl,eHTOB BCKope MO)l(HO 6YAeT npOAOJ1)1(li1Tb B 06bllJHOM nopSlAKe. 06w,e-
npli13HaHHO, lJTO OnTli1MaIlbHOVI n03li1L1,li1eVl Mblw,eJ1KOBbIX OTpOCTKOB SlBJ1S1eTCSI
li1X YCTaHOBli1BWaSlCSI AOCTaTOlJHO L1,eHTpaIlbHaSl n03li1L1,li1S1 B CYCTaBHblX SlMKax,
r?V:
PMC. 10.17. ECIU1 Y naLJ,VleHTa Ha6moAaeTcSI CKOl1b}l(eHVle "IemOCTVI KnepeAVI
C cooTBeTcTBYlOllIeVi n03V1LJ,VleVi Mbllllel1KOBblX OTpOCTKOB, LJ,el1eC006pa3Ho
npOAOl1}1(aTb VlCn0l1b30BaHe BHepoTOBoVi TSlrVl 11V1 TSir II Kl1aCCa AJlSI 06ec-
ne"leHSI nepeMellleHVlSI OTpOCTKOB B cycTaBHble SlMK
KOTOPY5I CTpeMSlTcSI 06eCnelJli1Tb B xOAe OPTOAOHTli1lJecKOro J1elJeHli1S1.
n03li1L1,li11O Mblw,eJ1KOBbIX OTpOCTKOB MO)l(HO OLl,eHli1Tb KJlli1Hli1lJeCKli1 C nOMOll.lblO
TeXHli1K n03li1L1,li10Hli1pOBaHli1S1 Hli1)1(HeVllJeJ1IOCTli1 li1 peHTreHOrpa<t>li1lJeCKli1
C nOMow,blO TOMorpa<t>li1li1. MHOrli1e BpalJli1 nOJ1aralOT, lJTO TaKli1e peHTreHO-
rpaMMbl HHbl BO Bcex CJ1YlJaSlX, aBTOpbl ClJli1TaIOT, lJTO li1X CJ1eAyeT AeJ1aTb
TOJ1bKO B CJ1YlJae B03Hli1KHOBeHli1S1 Ali1C<t>YHKLI,li1V1 CYCTaBOB.
B 60J1bWli1HCTBe CJ1YlJaeB He3HalJli1TeJ1bHYIO KOppeKLI,li11O n03li1L1,li1li1 Mblll.leJ1-
KOBblX OTpOCTKOB li1 Hli1)1(HeVllJeJ1IOCTli1 MO)l(HO BblnOJ1Hli1Tb Ha 3aKJllOlJli1TeJ1bHOVI
CTaAli1li1 J1elJeHli1S1. Hanpli1Mep, eCJ1li1 Y naLl,li1eHTa 06HapeHO CKOJ1b)l(eHli1e lJe-
J1IOCTli1 KnepeAli1 C cOOTBeTCTBYIOw,li1M cMew,eHli1eM Mblll.leJ10K KnepeAli1, L1,eJ1e-
co06pa3HO npOAOJ1)1(aTb li1Cn0J1b30BaHli1e BHepOTOBOVI TSlrli1li1J1li1 TSlr II KJlaCca
B TelJeHli1e AOnOJ1Hli1TeJ1bHoro nepli10Aa, lJT06bl li1CKJ1lOlJli1Tb CKOJ1b)l(eHli1e Kne-
peAli1li1 06eCnelJli1Tb nepeMew,eHli1e OTpOCTKOB B cycTaBHble SlMKli1 (pli1c. 10.17).
HanpoTli1B, eCJ1li1 Y naLl,li1eHTa Ha6J1IOAaeTCSI lJeTKoe n0J10)l(eHli1e Mblw,eJ10K
K3aAli1 6e3 npli13HaKOB CKOJ1b)l(eHli1S1 KnepeAli1, L1,eJ1eC006pa3Ho Bbl3BaTb
He3HalJli1TeJ1bHOe CKOJ1b)l(eHli1e KnepeAli1 - TaK, lJT06bl Mblw,eJ1Kli1 npli1HSlJ1li1
60J1ee L1,eHTpaIlbHYIO n03li1L1,li11O B CYCTaBHblX SlMKax. AnSI 3TOro HHO
CHSlTb 3J1aCTli1lJHble TSlrli1 II KJlacca li1J1li1 BHepOTOBYIO T5Iry, li1J1li1 YCTaHOBli1Tb
3J1aCTli1lJHble TSlrli1 III KJlaCca, lJTO oc06eHHo BHO B cJ1YlJaSlx C npOSlBJ1eHli1eM
TeHAeHLI,li1li1 K pocry no III KJlaccy (pli1c. 10.18).
ECJ1li1 Mblw,eJ1Kli1 3aHSlJ1li1 npli1eMJ1eMYIO L1,eHTpaIlbHYIO n03li1L1,li11O B SlMKax B I
KJlaCce, annapaT MO)l(HO CHSlTb. 3TO AOJ1)1(HO 06eCnelJli1Tb npaBli1J1bHOe pa3Bli1-
Tli1e Bli1COlJHO-Hli1)1(HelJeJ1IOCTHbIX cycTaBoB li1 HaAne)l(aw,ee <t>YHKLI,li10Hli1pOBaHli1e
nOCJ1e OPTOAOHTli1lJeCKoro J1elJeHli151. CJ1eAyeT Ha6J11oAaTb 3a COCTOSlHli1eM
naLl,li1eHTOB Ha 3Tane peTeHLI,li1li1 C L1,eJ1blO BbISlBJ1eHli1S1 Cli1MnTOMOB HapyweHli1S1
<t>YHKLI,li1V1 Bli1COlJHO-Hli1)1(HelJeJ1IOCTHbIX cycTaooB. HecMOTpSl Ha TO, lJTO OPTOAOH-
Tbl He MOryT npeABli1AeTb <t>li13li1lJeCKli1e li1 3MOLl,li10HaIlbHble CTpeCCbl naLl,li1eH-
TOB, OHli1 MOryT C03AaTb 6J1aronpli1S1THYIO 06CTaHOBKY AIlSlli1X npeOAOJ1eHli1S1.
.c:, 
PMC. 10.18. ECl1V1 Y naLJ,VleHTa Ha61110AaeTCSI 3Ha"lVlTel1bHOe CMellleHe
n03V1LJ,VIVI Mblllle110K K3aA, Cl1eAyeT npOAOl1}1(Tb l1e"leHe C TeM, "IT06bl OHVI
3aHSll1V1 6011ee LJ,eHTpal1bHYIO n03V1LJ,VlIO

AHA.n3 U.ECbA.nOMETP'-IECKX
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, '" ..mm m m..'.."..,..'.
B pSlAe CJ1YlJaeB L1,eJ1eC006pa3HO BblnOJ1HeHli1e KOHTpOJ1bHbIX peHTreHOrpaMM
npli1MepHO B CepeAli1He npOLl,eCCa J1elJeHli1S1 AIlSl TOro, lJT06bl OnpeAeJ1li1Tb, KaK
CKeJ1eTHble li1 3y60aIlbBe0J1S1pHble CTPYKTYpbl, a TaK)l(e MSlrKli1e TKaHli1 pearli1-
PYIOT Ha J1elJeHli1e. TaKli1e CHli1MKli1 AalOT B03MO)l(HOCTb npOBeCTli1 nOBTopHYIO
OLl,eHKY 3J1eMeHTOB onopbl, a TaK)l(e nepeCMOTpeTb nepBOHalJaIlbHblVi nJ1aH
J1elJeHli1S1 B xOAe ero npOBeAeHli1S1. Y HeKOTopblX naLl,li1eHTOB He06xOAli1Mbl
CHli1MKli1 B KOHLI,e J1elJeHli1S1. Vlx CJ1eAyeT AeJ1aTb npli1MepHO 3a 3-4 MeCSlLI,a AO
CHSlTli1S1 annapaTa, a He nOCJ1e. BbInOJ1HeHli1e peHTreHorpaMM nOCJ1e 3aBepwe-
Hli1S1 J1elJeHli1S1 L1,eHHO C n03HaBaTeJ1bHOVI TOlJKli1 3peHli1S1 li1 n0J1e3HO AIlSl J1elJe-
Hli1S1 nOCJ1eAYIOw,li1X naLl,li1eHTOB, a TaK)l(e AIlSl OLl,eHKli1 ycnexoB li1 OWli160K
J1elJeHli1S1, HO He npli1HOCli1T KOHKpeTHblX npeli1Myw,eCTB AaHHOMY naLl,li1eHry.
n03TOMY li1X npeAnOlJTli1TeJ1bHee BblnOJ1HSlTb AO CHSlTli1S1 an napaTa , lJT06bl B
CJ1YlJae He06xOAli1MOCTli1 MO)l(HO 6blJ10 oTKOppeKTli1pOBaTb n03li1L1,li11O 3y60B B
COOTBeTCTBli1li1 C 3np li1 APyrli1Mli1 nOCTaBJ1eHHbIMli1 L1,eJ1S1Mli1 J1elJeHli1S1 (c. 166).
K Hali160J1ee BHbIM nOKa3aTeJ1S1M, nOAIle)l(aw,li1M OLl,eHKe C nOMow,blO
KOHTpOJ1bHbIX li1 KOHelJHblX L1,e<t>aIlOMeTpli1lJeCKli1X peHTreHorpaMM OTHOCSlTCSI
npo<t>li1J1b MSlrKli1X TKaHeVl, Carli1TTaIlbHaSl n03li1L1,li1S1 pe3L1,OB, TOpK pe3L1,OB,
li13MeHeHli1S1 nJ10CKOCTli1 Hli1)1(HeVllJeJ1IOCTli1 naLl,li1eHTa, CTeneHb BepTli1KaIlbHoro
pOCTa lJeJ1IOCTli1 naLl,li1eHTa li1J1li1 ero OrpaHli1lJeHli1e, a TaK)l(e ycnewHocTb
pe3YJ1b TaTOB KOppeKLI,li1li1 ropli130HTaIlbHblX, CKeJ1eTHbIX li1 3y60aIlbBe0J1S1pHbIX
3J1eMeHTOB. npli1 OLl,eHKe li1Cn0J1b3yeTcSI MeTOA HaIlO)l(eHli1S1 KOHTpOJ1bHbIX li1
KOHelJHblX CHli1MKOB Ha HalJaIlbHble L1,e<t>aIlOMeTpli1lJeCKli1e peHTreHorpaMMbl
AIlSl TOlJHOro onpeAeJ1eHli1S1li13MeHeHli1V1, np0li130WeAWli1X B pe3YJ1bTaTe
OPTOAOHTli1lJeCKoro J1elJeHli1S1.
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ECJ1li1 nJ1aHli1pOBaHli1e J1elJeHli1S1 ocyw,eCTBJ1S1J10Cb Ha OCHOBe aHaIlli13a no
Arnett3 (c. 163), np0<!>li1J1b J1li1LJ,a li1 nSlTb 3y60aIlbBe0J1S1pHbIX li1 CKeJ1eTHbIX
CTPYKTYP MO)l(HO OLl,eHli1Tb Ha 3aKJ1lOlJli1TeJ1bHbIX 3Tanax J1elJeHli1S1 AO CHSlTli1S1
annapaTa (pli1c. 10.19). B OCHOBe aHaIlli13a no Arnett3 J1e)l(aT CJ1eAYIOw,li1e
CTaHAaPTHble HOpMbl 3y60aIlbBe0J1S1pHbIX li1 CKeJ1eTHbIX CTPYKTYP:
>KeHLllMHbl MY>K"IMHbl
95,6:t1,8
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· Mx1 - MxOP
· Md1 - MdOP
· rOpVl30HTaIlbHbli4 npKYC
· BepTKaIlbHbli4 npVlKYc
3,2
TVL
95
PMC. 10.19. Ha 3aKIlIOTeIlbHblX :3Tanax IleeHVlSI MO)l(HO VlcnOIlb30BaTb aHaIl3 no Arnett AIlSl Ol\eHKVI npo<pVlIlSl Ill\a, 3y60aIlbBeoIlSlpHbiX  CKeIleTHblX CTPYKTYP.
06blHO Bpa B cIlyae He06xoAMOCT MO)l(eT AOCTaTOHO 3<p<peKTBHo oTKoppeKTpoBaTb TOpK pe3l\OB  rop30HTaIlbHb!i4/BepTVlKaIlbHbli4 npVlKYc HO eMY eABa
Il YAacTcSI B03Aei4cTBoBaTb Ha n03l\1O MaKcIlIlSlpHoi4 OKKIlI03OHH0i4 nIlOCKOCTVI OTHOCVlTeIlbHO TVL (CTHHOi4 BepTKaJibHoi4 IlHVI). 293

3AKnIO'-ITEnbHblili 3TAn nE'-IEHS1
CTA6Mn3Au.S1 AOCTrHYTbIX
PE3ynbTATOB
npSlMoyroJ1bHble CTaIlbHble pa60lJli1e Ayrli1 Tpe6YlOTCSI AIlSl KOppeKLI,li1li1
npli1KYca no BepTli1KaIlli1, Carli1TTaIlbHOVI KOppeKLI,li1li1li1 3aKpbITli1S1 npOMeKOB,
OAHaKO nOKa3aHli1S1 K li1X npli1MeHeHli11O AIlSl cTa6li1J1li13aLl,li1li1 n03li1L1,li1li1 3y60B
Ha 3aKJ1lOlJli1TeJ1bHbIX 3Tanax J1elJeHli1S1 OrpaHli1lJeHbl. n03TOMY Ha AaHHOM
3Tane li1Cn0J1b3YIOT ropa3Ao 60J1ee CJ1a6ble Ayrli1. 06bllJHO Kpyrnble TepMO-
aKTli1Bli1pyeMble Hli1KelleBO-Tli1TaHOBble Ayrli1 Ali1aMeTpOM O,014li1J1li1 0,016
AIOVIMa li1cnOJ1b3YIOT Ha Hli1)1(HeVi 3y6HOVI Ayre, cornacoBaHHoVi C ct>A
naLJ,li1eHTa. Ha BepxHeVi Ayre, Ha YlJaCTKe Me)l(,D,y 60KOBbIMli1 pe3LJ,aMli1, MO)l(HO
BBeCTli1 KpyrnylO CeKLI,li10HHYIO AYry Ali1aMeTpOM 0,014 AIOVIMa. 3Tli1 Ayrli1
MO)f(HO npli1MeHSlTb napaIlJ1eJ1bHO C li1Cn0J1b30BaHli1eM BepTli1KaIlbHbiX Tpe-
yroJ1bHblX 3J1aCTli1lJHbIX TSlr Ha YlJaCTKax, Tpe6YIOw,li1x cTa6li1J1li13aLl,li1li1. eM
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npli1MeHeHli1li1 3J1aCTli1lJHbIX TSlr B TaKOM CJ1YlJae. Ha 3Tane CTa6li1J1li13aLJ,li1li1
L1,eJ1eC006pa3HO OCTaBJ1S1Tb Bce KOJ1bLl,a li1 6peKeTbi C TeM, lJT06bl MO)l(HO
6blJ10 OTKOppli1rli1pOBaTb He)l(eJ1aTeJ1bHble li13MeHeHli1S1. TaKOVI nOAXOA K
OpraHli13aLl,li1li1 J1elJeHli1S1 n03B0J1S1eT ocyw,eCTBli1Tb nepeMew,eHli1e OTAeJ1bHbIX
3y60B B li1X KOHelJHYIO n03li1L1,li11O AO CHSlTli1S1 annapaTa. Ha 3Tane cra6li1J1li1-
3aLl,li1li1 Ha6J1IOAeHli1e 3a naLl,li1eHTaMli1 ocyw,eCTBJ1S1eTCSI C li1HTepBaIlOM
npli16J1li13li1TeJ1bHO B 2 HeAeJ1li1. B nepBble ABe HeAeJ1li1 3J1aCTli1lJHble TSlrli1
peKoMeHAyeTcSI HOCli1Tb nOCTOSlHHO, B nOCJ1eAYIOw,li1e 2 HeAeJ1li1 - TOJ1bKO
B HOlJHOe BpeMSI, eCJ1li1 npoLl,ecc cTa6li1J1li13aLl,li1li1 npoTeKaeT HOpMaIlbHO.
3aTeM MO)l(HO nJ1aHli1pOBaTb CHSlTli1e annapaTa.
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PMC. 10.20. Ha yacTKax, Tpe6ylOI..l.tVlx cTa6I11IlVl3aVlVI, MO)l(HO npVlMeHSlTb cIla6ble BepTVlKaIlbHbie TpeyroIlbHble 3IlaCTIIIlble AyrVl. YeM TOHee npVlKIleeHbl
6peKeTbl, TeM Kopoe nepVloA VlcnOIlb30BaHVlSI TSir.

npli1 BblnOJ1HeHli1li1 06w,li1x MepOnpli1S1Tli1V1 B TeXHli1KY CTa6li1J1li13aLl,li1li1 MO)l(HO
BHOCli1Tb HeKOTOpble li13MeHeHli1S1 CJ1eAYIOw,ero pOAa:
. ECJ1li1 B BepXHe Ayre npeMOJ1S1pbl cMew,eHbl BeCTli16YJ1S1pHO, CeKLI,li10HHYIO
AYry Ha BepXHeM nepeAHeM YljaCTKe MO)l(HO npOAIlli1Tb AO KJlblKOB, lJT06bl
YAep)l(aTb li1X n03li1L1,li1IO.
. ECJ1li1 B BepXHeVlli1 Hli1)1(HeVi Ayre li1MeIOTCSI Ali1aCTeMbl, TO 3Tli1 YlJaCTKli1
CJ1eAyeT 06BSl3aTb BMeCTe cJ1a60Vl 3J1aCTli1lJHOVI Hli1TblO li1J1li1 J1li1rarypHbIMli1
npOB0J10KaMli1 (pli1c. 10.21).
. B cJ1YlJae YAaIleHli1S1 3y60B Ha nocT3KCTpaKLI,li10HHble YlJacTKli1 CJ1eAyeT
HaIlO)l(li1Tb BOCbMli106pa3Hble J1li1rarypHble CBSl3Kli1 AIlSl YAep)l(aHli1S1li1X
3aKpbITbIMli1.
. B cJ1YlJae BblnOJ1HeHli1S1 paCWli1peHli1S1 He6a AIlSl YAep)l(li1BaHli1S1 pacwli1pe-
Hli1S1 Ha 3Tane cTa6li1J1li13aLl,li1li1 MO)l(HO li1Cn0J1b30BaTb He60J1bwylO cbeMHYIO
He6HYIO nJ1aCTli1HKY C AyraMli1 Ali1aMeTpOM 0,018 AIOVlMa, BBeAeHHbIMli1
Me)l(npOKCli1MaIlbHO Ha AeCHeBbie YlJaCTKli1 (pli1c. 10.22).
. npli1 3aBepWeHli1li1 J1elJeHli1S1 HapyweHli1V1 npli1KYca 11/1 KJlacca (OT YMepeH-
HOVI AO TSI)I(eJ10 CTeneHli1) HeLl,eJ1eco06pa3Ho npli1MeHSlTb KOpOTKYIO
CeKLI,li10HHYIO AYry Ha nepeAHeM YlJaCTKe BepXHeVllJeJ1IOCTli1, nOCKOJ1bKY
MO)l(HO O)l(li1AaTb peLl,li1Ali1Ba Carli1TTaIlbHoro npli1KYca. B AaHHoVi cli1ryaLl,li1li1
Ha 3Tane cTa6li1J1li13aLl,li1li1 MO)l(HO li1Cn0J1b30BaTb nOJ1HYIO BepxHlO1O AYry
Ali1aMeTpOM 0,014 AIOVIMa (naLl,li1eHTKa D.O., c. 210), C Ali1CTaIlbHbIMli1
3arli16aMli1 3a nOCJ1eAHli1Mli1 MOJ1S1paMli1. 3TO 06eCnelJli1BaeT KOHTpOJ1b
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OF ORTHODONTICS)
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n03li1L1,li10Hli1pOBaHli1S1 6peKeTOB (c. 62-65), oc060e BHli1MaHli1e CJ1eAyeT
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flM TEPA TYPA
1 Bennett J., Mclaughlin R. P. 1997. Orthodontic management of the dentition with
the preadjusted appliance. Isis Medical Media, Oxford (ISBN 1 89906691 8)
pp. 50-51. Republished in 2002 by Mosby, Edinburgh (ISBN 0723432651).
2 Bennett J., Mclaughlin R. P. 1997. Orthodontic management of the dentition with
the preadjusted appliance. Isis Medical Media, Oxford (ISBN 1 89906691 8)
pp. 200-205. Republished in 2002 by Mosby, Edinburgh (ISBN 0723432651).
· OKKJ1103li10HHble COOTHOWeHli1S1. Carli1TTaIlbHOe COOTHOWeHli1e MOJ1S1pOB,
npeMOJ1S1pOB li1 KJlblKOB OLl,eHli1BaIOT no KJlaCCli1<t>li1KaLl,li1li1 3HrIlSl (Angle).
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peKLI,li1eVl B cJ1YlJae He06xOAli1MOCTli1) (c. 282) AIlSl AOCTli1)1(eHli1S1 OKKJ1103li1li1
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MO)l(HO 06eCnelJli1Tb C nOMow,blO BepTli1KaIlbHbiX 3J1aCTli1lJHbIX TSlr (c. 294).
KpoMe TOro, XopOWO BblnOJ1HeHHble n03li1L1,li10Hepbl cnoc06cTBYlOT cTa6li1-
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aHryJ1S1L1,li1IO, TOpK li1 BeJ1li1lJli1HY 3y60B (c. 282).
· Me)l(npOKCli1MaIlbHble KOHTaKTbl. On li1CaHbl TeXHli1Kli1 3aKpbITli1S1 npOMe>KYT-
KOB (c. 254) li1 YAep)l(aHli1S1li1X 3aKpblTblMli1 Ha 3aKJ1lOlJli1TeJ1bHbIX 3Tanax
(c. 286). Oc060ro BHli1MaHli1S1 Tpe6YlOT B3pOCJ1ble naLl,li1eHTbI B CJ1YlJae
YAaIleHli1S1 3y60B (c. 268).
!t1, HaKOHeLl" CJ1eAyeT OTMeTli1Tb, lJTO naHopaMHble peHTreHorpaMMbl,
BblnOJ1HSleMble C L1,eJ1blO OLl,eHKli1 aHryJ1S1L1,li1li1 KopHeVl, nOCTOSlHHO nOATBep)K-
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KopHeVi OTBelJalOT Tpe60BaHli1S1M ABO, oc06eHHo, B CJ1YlJae KopHeVi KJlbIKOB.
>>.",,g
3 Arnett G. W., Jalic J. S., Kim J. et al. 1999. Soft tissue cephalometric analysis:
diagnosis and treatment planning of dentofacial deformity. American Journal of
Orthodontics and Dentofacial Orthopedics 116:239-253.
4 The American Board of Orthodontics Calibration Kit. July, 2000.

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PMC. 10.40
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PMC. 10.43
301
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PMC. 10.46

npli1MeHSlJ1li1Cb 06bllJHbie MeTOAbl cTa6li1J1li13aLl,li1li1 C li1Cn0J1b30BaHli1eM
npli1KJ1eli1BaeMoro Hli1)1(Hero li1 cbeMHoro BepxHero peTeVlHepOB.
Bli1A nOCJ1e CHSlTli1S1 annapara. nepli10A aKTli1BHoro J1elJeHli1S1 COCTaBli1J1 15
MeCSlLI,eB.
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PMC. 10.47
PMC. 10.50
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PMC. 10.53
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PMC. 10.48
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PMC. 10.58
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SNA L 73°
SNB L 70°
ANB L 3°
A-N.l FH -7 MM
Po-N.l FH -21 MM
WITS -1 MM
GoGnSN L 50°
FM L 40°
MM L 38°
1.KA-Po 8 MM
1KA-Po 4 MM
1 - K nnOCKOCTM
BepxHeM '1enIOCTM L105°
1" - K nnOCKOCTM
HM>KHeM '1enIOCTM L 90°
303

A3
CHSITMe annapaTa
M peTeHu.MOHHble MepOnpMSlTMSI
BCTynneHMe 307
HeCbeMHble peTeMHepbl 312
3bl4Hble HecbeMHble peTeVlHepbl 312
He6Hbie HeCbeMHble peTeVlHepbl 312
BecTLII6YJlflpHbie HecbeMHble peTeVlHepbl 313
nOArOTOBKa K CHSITMIO annapaTa - nocneAHee
noceU4eHMe 308
CHflTLlle annapaTa B OAHO nocew,eHLlle 308
n03TanHoe CHflTLlle annapaTa 308
HCTpYMeHTbl AnSI CHSlTMSI annapaTa 309
YAaJleHLlle MeTaJlJlLll4eCKLllX 6peKeToB 309
YAaJleHLlle KepaMLII4eCKLIIX 6peKeToB 309
CHflTLlle KOJleLl, 310
YAaJleHLlle OCTaTKOB Ll,eMeHTa LII 6oHALIIHroBbix
MaTepLllaJlOB 310
CJleAbl OT 6oHALIIHroBbix MaTepLllanoB 310
6eJlbie nfiTHa 310
CbeMHble peTeMHepbl 314
06bl4Hbie peTeVlHepbl L113 npOBOJlOKLII
LII nnaCTMaCCbl 314
PeTeVlHepbl, L113rOTOBJleHHble BaKYYMHblM
MeTOAOM 315
nOcTne"le6Hbie MeponpMSlTMSI 316
KOHcYJlbTaLl,LIILII nOCJle 3aBepweHLllfi
Jle4eHLllfi 316
nLIICbMa naLl,LlleHTaM 316
n03MMOHepbl 311
KOHCTPYKLI,Lllfi n03L11L1,LIIOHepOB 311
OeHKa AonroBpeMeHHoM peTeHMM 317
BepxHfIfi Ayra 317
HLII)I(Hfifi Ayra 317
305

BCTYnnEHE
no Mepe B03MO)l(HOCTli1 B OpTOAOHTli1lJeCKOVI npaKTli1Ke CJ1eAyeT npli1MeHSlTb
oTpa60TaHHbie li1 CTaHAapTHble nOAXOAbl. 6J1aroAapSl Cli1CTeMaTli13li1pOBaH-
HOMY xapaKTepy OHli1 YCTpaHSlIOT He06xOAli1MOCTb B npli1HSlTli1li1 e)l(eAHeBHblX
peWeHli1 li1 nOBblwalOT 3<t><t>eKTli1BHOCTb J1elJeHli1S1. 3TO n0J10)l(eHli1e OTHO-
Cli1TCSI KO BceM aCneKTaM li1 3TanaM OPTOAOHTli1lJecKOro J1elJeHli1S1, BKJ1lOlJaSl
peTeHLI,li10HHbIVi nepli10A, AIlSl KOTOpOro OlJeHb BHO Bblpa60TaTb
Omli1MaIlbHbl nOAXoA.
ABTOpbl KHli1rli1 06bllJHO npli1KJ1eli1BaIOT Sl3bllJHblVi peTeVlHep Ha Hli1)1(HeVi
Ayre 60J1bWli1HCTBY CBOli1X naLl,li1eHTOB (pli1c. 11.1), XOTSI OHli1li1 AonycKalOT,
lJTO He Bce naLl,li1eHTbl HaIOTCSI B 3TOM. B HeKOTOpblX CJ1YlJaSlX Hli1)1(Hli1e
BeCTli16YJ1S1pHble cerMeHTbl MOryT li1 TaK OCTaBaTbCSI BbmpSlMJ1eHHbIMli1 6e3
li1Cn0J1b30BaHli1S1 peTeVlHepOB, OAHaKO HeB03MO)l(HO npeAyraAaTb, KaKli1e
CJ1YlJali1 OTHOCSlTCSI K 3TOVI KaTeropli1li1.
HeAOCTaTOK AaHHoro nOAXOAa COCTOli1T B TOM, lJTO HeKOTOpblM naLl,li1eH-
TaM npli1XOAli1TCSI HOCli1Tb peTeVlHepbl 6e3 Hbl. OAHaKO TaKaSl CTpaTerli1S1
nOMoraeT, no KpaVlHeVi Mepe, li136e)l(aTb CKYlJeHHOCTli1 Hli1)1(Hli1X pe3L1,OB li1
peLl,li1Ali1BOB B n03AHeM IOHOM nepli10Ae. TaKli1e n03AHli1e li13MeHeHli1S1 BeCbMa
paCCTpali1BalOT naLl,li1eHTOB li1 npOSlBJ1S1IOTCSI B TO BpeMSI, KorAa OHli1 e He
TaK BOCnpli1li1MlJli1Bbl K AaIlbHeVlweMY J1elJeHli11O (pli1c.11.2). Ha n03AHli1X
3Tanax pa3Bli1Tli1S1 3Tli1 li13MeHeHli1S1 OCJ10)l(HSlIOT npOLl,eCC J1elJeHli1S1 li1 CHli1)1(aIOT
ero 3<t><t>eKTli1BHOcTb.
Reitan 1 npOAeMOHCTpli1pOBaIl, lJTO nepli10AOHTaIlbHb1M CBSl3KaM Tpe6yeTcSI,
no KpaVlHeVi Mepe, 232 AHSI AIlSl nepeCTpOVlKli1 nOCJ1e nepeMew,eHli1S1 3y60B, a
3J1aCTli1lJHbIM cynpaaIlbBeOJ1S1pHbIM B0J10KHaM - OK0J10 1 roAa. Cyw,eCTByeT
He06xOAli1MOCTb B peTeHLI,li1li1, lJT06bl npeAynpeAli1Tb OPTOAOHTli1lJeCKli1e
peLl,li1Ali1Bbl li1 li13MeHeHli1S1, Bbl3bIBaeMbie He6J1aronpli1S1THbIM n03AHli1M pa3Bli1-
Tli1eM. npOTOKOJ1 peTeHLI,li1li1 MO)l(eT 6blTb li1HAli1Bli1AYaIlbHbIM Y KOro BpalJa-
OPTOAOHTa, HO MOryT cyw,eCTBOBaTb pa3J1li1lJHble MHeHli1S1 OTHOCli1TeJ1bHO
)l(eCTKOCTli1 peTeHLI,li10HHoro annapaTa. OAHaKO CJ1eAyeT Bblpa60TaTb cTpaTe-
rli110 npli1MeHeHli1S1 peTeHLJ,li10HHoro annapaTa, KOTOpOVI CJ1eAyeT npli1Aep)l(li1-
BaTbCSI Ha npaKTli1Ke.
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PMC. 11.1. HecbeMHblVi peTeVlHep Vl3 cKPYlJeHHOVI npoBoIloK ,lJ,aMeTpoM
0,015 ,lJ,IOVIMa BbinoIlHeHHblVi Y naLl,eHTa 6e3 3KCTpaKLI, 3y60B. ABTOpbl
06bllJHO YCTaHaBIlBaIOT Sl3bllJHbie peTeVlHepbl 60IlbWHCTBY CBOX naLl,eHTOB.
I . !
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7
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PMC. 11.2. Y naLl,eHTa, IlelJeHHoro C 3KCTpaKLI,eVl nepBblx npeMoIlSIpoB,
Ha6IlIO,lJ,aeTCSI nepeMell.teHe H)I(Hero pe3L1,a B CXO,lJ,HOe nOIlO)l(eHe
B B03pacTe 18 IleT, Tpe6YIOIl.tee ,lJ,aIlbHeVlwero IlelJeHSI ,lJ,IlSI nOBTOpHoro
BblpaBHBaHSI H)I(HX pe3L1,OB. YCTaHoBKa Sl3bllJHOro peTeVlHepa MorIla 6bl
npe,lJ,OTBpaTVlTb peLl,,lJ,B.
,
I.
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307

nOArOTOBKA K CHS1T1O AnnAPATA -
nOCnEAHEEnOCEEHE
nepeA CH5ITli1eM annapaTa He06xOAli1MO y6eAli1TbCSI B TOM, lJTO J1elJeHli1e
3aBepWeHO. Bo BpeMSI nOCJ1eAHero KOHTpOJ1bHOro nocew,eHli1S1 CJ1eAyeT
BblnOJ1Hli1Tb BCe npOBepKli1, peKoMeHAyeMble Ha 3aKJ1lOlJli1TeJ1bHOM 3Tane
J1elJeHli1S1 (pa3AeJ1 10, c. 279).
lt1HorAa Ha n03AHli1X 3Tanax J1elJeHli1S1 MOryT nOSlBli1TbCSI npOMeKli1
Me>KAY 3y6aMli1. Bo BpeMSI nOCJ1eAHero KOHTpOJ1bHOro nocew,eHli1S1 CJ1eAyeT
06BSl3aTb 3y6bl MeTaIlJ1li1lJeCKOVlli1J1li1 3J1aCTli1lJHOVI J1li1rarypoVi (c. 286) AIlSl
06eCnelJeHli1S1 nJ10THbIX KOHTaKTHblX nYHKTOB. 3TO li136aBli1T naLl,li1eHTa OT
pa30lJapOBaHli1S1li1 06eCnelJli1T ero CJ1eAYIOw,ee nJ1aHli1pOBaHHoe nocew,eHli1e
AIlSl CHSlTli1S1 annapaTa. lt1cn0J1b30BaHli1e BO BpeMSI nOCJ1eAHero KOHTpOJ1bHOro
nOCeLlteHli1S1 BMecTO 3J1aCTli1lJHbIX MeTaIlJ1li1lJeCKli1X J1li1raryp AIlSl KpenJ1eHli1S1
K OCHOBHblM AyraM MO)l(eT 06J1erlJli1Tb YAaIleHli1e 6peKeTOB BO BpeMSI
CJ1eAYIOw,ero nocew,eHli1S1 (c. 309).
naLl,li1eHTa CJ1eAyeT npOli1H<t>opMli1pOBaTb 0 npeAcToSlw,eM CHSlTli1li1 anna-
para li1 nOA60APli1Tb ero nepeA nocew,eHli1eM. nOCKOJ1bKY CHSlTli1e annapaTa
3aHli1MaeT AOCTaTOlJHO MHOro BpeMeHli1 li1 CBSl3aHO TaK)l(e C J1a60paTOpHblM
BpeMeHeM, naLl,li1eHTOB CJ1eAyeT nOnpOCli1Tb 0 TOM, lJT06bl OHli1 He OTKJ1aAbl-
BaIlli1 ero. naLJ,li1eHTa TaK)l(e CJ1eAyeT npeAynpeAli1Tb 0 TOM, lJT06bl OH 3anli1-
CaIlCSI Ha npli1eM K CBoeMY CTOMaTOJ1ory AIlSl KOHTpOJ1bHOro OCMOTpa, HO
He paHbwe, lJeM lJepe3 4-6 HeAeJ1b nOCJ1e CHSlTli1S1 HecbeMHoro annapaTa.
B TelJeHli1e 3TOro nepli10Aa AOJ1)1(Ha 3aBepWli1TbCSI CTa6li1J1li13aLl,li1S1 li1 HopMa-
J1li13aLl,li1S1 COCTOSlHli1S1 AeCHeBblX TKaHeVi.
Bo BpeMSI 3TOro nocew,eHli1S1 CJ1eAyeT CHSlTb OTTli1CK Hli1)1(Hli1X nepeAHli1X
3y60B, lJT06bl B J1a60paTOpli1li1 MOrIlli1 li13roTOBli1Tb AYry li13 cKpYlJeHHOVI npoBo-
J10Kli1. ECJ1li1 Ha Sl3bllJHbiX nOBepxHocTSlX Hli1)1(Hli1X pe3L1,OB li1MeIOTCSI OTJ10)l(eHli1S1,
BO BpeMSI 3TOro nocew,eHli1S1 CJ1eAyeT npOBeCTli1 OlJli1CTKY li1 nOJ1li1pOBaHli1e 3Y-
60B, lJTO AaCT B03MO)l(HOCTb nOJ1YlJli1Tb 60J1ee TOlJHYIO J1a60paTOpHYIO MOAeJ1b.
3TO TaK)l(e YMeHbWli1T 06beM He06xOAli1MOVllJli1CTKli1 npli1 CHSlTli1li1 annapaTa.
B HeKOTOpblX cJ1YlJaSlx no PSIAY npli1lJli1H OPTOAOHT MO)l(eT COrJlaCli1TbCSI Ha
CHSlTli1e annapara AO 3aBepWeHli1S1 nepeMew,eHli1S1 3y60B. B TaKli1X cJ1YlJaSlx
MO)l(eT npOSlBli1TbCSI 60J1b1WaSl BepOSlTHOCTb peLl,li1Ali1BOB, li1 MHOrli1e BpalJli1
npOC51T naLl,li1eHTOB Hanli1CaTb pacnli1cKY 0 TOM, lJTO OHli1 npeAynpe)I(AeHbl 0
pli1CKe BCJ1eACTBli1e npe)I(AeBpeMeHHoro CHSlTli1S1 annapaTa. AaHHblVi AOKYMeHT
nOATBep)I(AaeT, lJTO naLl,li1eHTa npeAynpeAli1J1li1 0 TOM, lJTO J1elJeHli1e He 6blJ10
3aBepweHO, li1lJTO npli1 ero npOAOJ1)1(eHli1li1 MOrIlli1 6blTb AOCTli1rHYTbl
AaIlbHeVlWli1e YJ1YlJWeHli1S1.
CHSITMe annapaTa B OAHO nocew.eHMe
06bllJHO npeAnOlJTli1TeJ1bHO CHli1MaTb Bce OpTOAOHTli1lJeCKli1e annapaTbl
B OAHO nocew,eHli1e. 3TO 60J1ee YA06HO AIlSl naLl,li1eHTa li1 3<t><t>eKTli1BHee
B CMbICJ1e nJ1aHli1pOBaHli1S1 pa60Tbi npaKTli1Kli1, nOCKOJ1bKY B TaKOM cJ1YlJae
Tpe6yeTcSI oAHopa30Boe li1Cn0J1b30BaHli1e li1HCTpYMeHToB AIlSl CHSlTli1S1 anna-
paTa li1 nOJ1li1pOBKli1 3y60B. TaK)l(e oPTOAOHry He06xOAli1MO KOHTpOJ1li1pOBaTb
06e Ayrli1 AO 3aBepWeHli1S1 nepeMew,eHli1S1 3y60B. npli1 n03TanHOM CHSlTli1li1
annapaTa HeKOTopble 3y6bl MOryT OCTaBaTbCSI 6e3 peTeHLI,li1li1 li1 nOABepraTbCSI
He)l(eJ1aTeJ1bHoMY nepeMew,eHli1IO.
AaHHoe nocew,eHli1e AOJ1)1(HO CTaTb ano<t>e030M OpTOAOHTli1lJeCKoro
J1elJeHli1S1 AIlSl naLl,li1eHTa. nJ1aHli1pOBaHli1e npoAOJ1)1(li1TeJ1bHOro YTpeHHero
nocew,eHli1S1 n03B0J1li1T HecneWHO CHSlTb annapaT. CJ1eAyeT npeAycMoTpeTb
BpeMSI AIlSl 06CeHli1S1li1 peKOMeHAaLl,li1V1, KacalOw,li1XCSI 3Tana peTeHLI,li1li1,
a TaK)l(e AIlSl BblpeHli1S1 3MOLl,li1V1 BpalJa li1 naLl,li1eHTa no nOBOAY ycnewHoro
3aBepWeHli1S1 J1elJeHli1S1.
n03TanHoe CHSITMe annapaTa
B HeKOTOpblX Cli1ryaLl,li1S1X MO)l(eT 6blTb npli1HSlTO peWeHli1e 0 n03TanHOM
CHSlTli1li1 annapaTa B TelJeHli1e ABYX li1J1li1 60J1ee nocew,eHli1V1. ECJ1li1, Hanpli1Mep,
AIlSl J1elJeHli1S1 OAHOVI Ayrli1 Tpe6yeTcSI ropa3Ao MeHbwe BpeMeHli1, lJeM AIlSl
APYroVl, TO BnOJ1He J10rli1lJHO paCCMOTpeTb 60J1ee paHHee CHSlTli1e annapaTa
C 3TOVI Ayrli1. B HeKOTOpblx cJ1YlJaSlx AOBOJ1bHO npOAOJ1)1(li1TeJ1bHoro J1elJeHli1S1
naLl,li1eHT 6YAeT PaA npeAIlO)l(eHli11O paHbwe CHSlTb annapaT C BepxHeVi Ayrli1,
eCJ1li1 OH COrJ1aCli1TCSI HOCli1Tb AYry Ha Hli1)1(HeVllJeJ1IOCTli1 ew,e HeCKOJ1bKO
MeCSlLI,eB.
nOcTeneHHoe CHSlTli1e annapaTa peKoMeHAoBaHo B cJ1YlJaSlx J1elJeHli1S1
B3pOCJ1bIX naLl,li1eHTOB npli1 li1Cn0J1b30BaHli1li1 KOJ1eLl, li1J1li1 npli1 YAaIleHli1li1 3y60B.
MO)l(HO OCTaBli1Tb KOHelJHbie KOJ1bLl,a Ha MOJ1S1pax li1 li1Cn0J1b30BaTb 3J1aCTli1lJHble
L1,enOlJKli1 li1J1li1 aKTli1BHble CBSl3Kli1 tieback AIlSl 3aKpbITli1S1 npoMeKoB OT
KOJ1eLl, B APymx MecTax.

!.t!RI _
MHCTPYMEHTbl AnS1 CHS1TS1
AnnAPATA
- . _............-..
-_ _.__.....- ... :- - -< -_ ......----uu_
YAaneHMe MeTannM"IeCKMX 6peKeTOB
AnSI YAaneHli1S1 MeTaIlJ1li1lJeCKli1X 6peKeTOB li1Cn0J1b3YIOT li1HCTpYMeHT AIl51
CHSlTli1S1 6peKeTOB (3M Unitek 444-761) li1J1li1 paHee npli1MeHSlBWli1eCSI w,li1nLl,bl
(pli1c. 11.3). npli1li1Cn0J1b30BaHli1li1li1HCTPYMeHToB B cJ1YlJae, eCJ1li1 Ayrli1
<t>li1KCli1PYIOTCSI Ha MeCTe C nOMow,blO J1li1rarypHoVi npOB0J10Kli1, 6peKeTbi
MO)l(HO CHli1MaTb C nOBepXHOCTli1 3y60B 6e3 npeABapli1TeJ1bHoro BbIBeAeHli1S1
AYr. OCHOBHYIO AYry 3aTeM MO)l(HO CHSlTb BMeCTe C 6peKeTaMli1 (pli1c. 11.4),
lJT06bl CHSlTble 6peKeTbi He OCTaBaIlli1Cb B n0J10CTli1 pTa. npli1li1Cn0J1b30BaHli1li1
Ll.\li1nLl,OB AIlSl YAaIleHli1S1 MeTaIlJ1li1lJeCKli1X 6peKeTOB CTaPOVI KOHCTPYKLI,li1li1 Ayrli1
MO)l(HO CHli1MaTb BMeCTe C 3aKpenJ1eHHbIMli1 Ha Hli1X 6peKeTaMli1, eCJ1li1 Ha Hli1X
YCTaHOBJ1eHbl MeTaIlJ1li1lJeCKli1e li1 3J1aCTli1lJHble J1li1rarypbl.
'0


......
f
(
PMC. 11.3. AnSI YAaIleHIr1S1 MeTaIlllwmCKVlX 6peKeToB MO}l(HO Ir1CnOIlb30BaTb
CneLtlr1aIlbHbl VlHcTpYMeHT VlIlVI cTapble UJ,VlnLtbl AIlSI 06pe3aHVlSI IlViraTYP
;
. ..
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I:.

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..
.,
'C ',,,.;Ii
PMC. 11.4. nplr1 CHSlTIr1V1 AyrVl C 6peKeTaMVI, 3aKpenIleHHblMVI K He,
VlCKJ1IOllaeTCSI B03MO}l(HOCTb TOro, LITO 6peKeTbi oCTaHYTcSI B nOIlOCTVI pTa
to
YAaneHMe KepaMM"IeCKMX 6peKeTOB
KepaMli1lJeCKli1e 6peKeTbi ClarityTM CHli1MaIOT C nOMow,blO APYroVi TeXHli1Kli1.
CHalJaIla CJ1eAyeT CHSlTb OCHOBHble Ayrli1 li1 li13J1li1WeK 60HAli1HroBOro
MaTepli1aIla BOKpyr 6peKeTOB BblCOKOCKOpOCTHblM nJ1aMeBli1AHbIM <t>li1Hli1WHbIM
60pOM (pli1C. 11.5). KbIVi 6peKeT 3aTeM MO)l(HO CHSlTb, 3axBaTli1B ero
C Me3li1aIlbHOVlli1 Ali1CTaIlbHOVI CTOpOHblli1 3aB w,li1nLJ,aMli1 AIlSl YCTaHOBKli1
KOJ1eLl, (pli1c. 11.6). ECJ1li1 naLl,li1eHTbl HeMHoro HepBHli1lJalOT li1J1li1 y Hli1X Hec-
KOJ1bKO nOABli1)1(Hble 3y6bl, AIlSl YCTpaHeHli1S1 Ali1CKoM<t>opTa MO)l(HO nOOlJe-
peAHO nOAKJ1aAblBaTb BaTHbie BaJlli1Kli1 nOA nepeAHli1e 3y6bl AIlSl 06eCnelJeHli1S!
TBepAoro npli1KYca npli1 CHSlTli1li1 6peKeTOB.
B peAKli1X cJ1YlJaSlx, KorAa KepaMli1lJeCKli1V1 6peKeT He nOJ1HOCTblO OTAe-
J1S1eTCSI OT nOBepXHOCTli1 3y6a, CJ1eAyeT YAaIlli1Tb ero OCTaTKli1 C nOMow,blO
BblCOKOCKOpOCTHblX aIlMa3HbiX 60POB npli1 OXJ1eHli1li1 BOAOVl C li1CnOJ1b-
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pOHbl TaKIr1M 06pa30M, LITO OHIr1 3aKpblBalOTCSI KaK KHlr1ra. UJ.lr1nLtbl HaKllaAblBalOT
Ha paCCTOSlHVIVI npVlMepHo 1 MM OT nOBepXHOCTIr1 3y6a.
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3axBaT KOJ1bLl,a C Ali1CTaIlbHO-rli1Hrli1BaIlbHOVI CTOpOHbl. TOJ1bKO B peAKli1X
CJ1YlJaSlX Tpe6yeTcSI npli1MeHeHli1e BblCOKOCKOpOCTHOro 60pa AIlSl pa3pe3aHli1S1
MeTaIlJ1li1lJeCKli1X KOJ1eLJ,.
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M 60HAMHrOBbiX MaTepManOB
nOCIle CHSlTli1S1 KOJ1eLl, li1 6peKeTOB OCTaTKli1 L1,eMeHTa MO)l(HO YAaIlli1Tb C nOMO-
blO CKeVlJ1epa li1J1li1 w,li1nLl,OB AIlSl CHSlTli1S1 KOJ1eLl" a 3aTeM BblCOKOCKOpOCTHblX
nJ1aMeBli1AHbIX <t>li1Hli1WHbIX 60pOB 6e3 BOAHOro cnpeSl. 3y6bl MO)l(HO
omOJ1li1pOBaTb 06bllJHblMli1 pe3li1HOBbIMli1 lJaWKaMli1 C neM30Vlli1J1li1 APyrli1Mli1
COOTBeTCTBYIOw,li1Mli1 nOJ1li1pOBaIlbHbIMli1 cpeACTBaMli1. B Tex CJ1YlJaSlX, KorAa
Ha6J1IOAaeTCSI 3HalJli1TeJ1bHaSl rli1nepTpo<t>li1S1 AeCHbl B npOLl,eCce npli1MeHeHli1S1
annapaTa, OCTaTKli1 L1,eMeHTa li1 KJleSl MO)l(HO BpeMeHHO OCTaBli1Tb Ha 3y6ax.
LJepe3 MeCSlLI, HaAIle)l(aw,eVl rli1rli1eHbl COCTOSlHli1e AeCHbl 06bllJHO YJ1YlJWaeTCSI,
n03B0J1S1S1 npOBeCTli1 OKOHlJaTeJ1bHYIO OlJli1CTKY li1 nOJ1li1pOBaHli1e 3y60B.
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CneAbl OT 60HAMHrOBbiX MaTepManOB
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Bo BpeMSI YCTaHOBKli1 annapaTa npOTpaBJ1li1BalOw,ee Bew,ecTBo 06bllJHO HaHO-
CSIT TOJ1bKO Ha YlJaCTOK npli1KJ1eli1BaHli1S1 6peKeTa. B KOHLI,e J1elJeHli1S1, nOCJ1e
CHSlTli1S1 annapaTa, OCTaTKli1 CMOJ1bl MOryT OCTaBaTbCSI Ha npeABapli1TeJ1bHO
npOTpaBJ1eHHOM YlJaCTKe 3MaIlli1, KOTopaSl KOHTpaCTli1pyeT C 4>J1100P03li1pOBaH-
HOVl3MaIlblO. 3TOT «YlJaCTOK OCHOBaHli1S1 6peKeTa» MO)l(eT BblrJ1S1AeTb J1YlJwe,
lJeM He06pa60TaHHaSl 3MaIlb. no 3TOVI npli1lJli1He y HeKoTOpblX naLl,li1eHTOB
6blJ10 6bl J10rli1lJHO npOTpaBJ1li1BaTb BCIO BeCTli16YJ1S1PHYIO nOBepxHocTb 3y6a
C <t>J1100P03li1pOBaHHOVI 3MaIlblO BO BpeMSI YCTaHOBKli1 6peKeTOB. AaHHblVi
Bonpoc B HacTOSlw,ee BpeMSI HaxoAli1TCSI Ha CTaAli1li1 li1CCJ1eAOBaHli151.
6enble nSiTHa
AeKaIlbLl,li1Hli1pOBaHHble nSlTHa Ha nOBepXHOCTli1 3y60B Bbl3blBalOT pa30lJapO-
BaHli1e y BpalJa, naLl,li1eHTa, ero pOAli1TeJ1eVlli1 CTOMaTOJ10ra, HanpaBli1Bwero
naLl,li1eHTa Ha J1elJeHli1e (pli1c. 11.7). LJacTO Bli1HY 3a 3TO B03J1aralOT Ha BpalJa-
OpTOAoHTa. OAHaKo 3alJacrylO 3TO He TaK, oc06eHHO eCJ1li1 y naLl,li1eHTa
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3Tanax J1elJeHli1S1, n03TOMY BeCbMa BHO YCTpaHli1Tb 3ry np06J1eMY. CJ1eAyeT
npeAIlO)l(li1Tb naLJ,li1eHry npOTOKOJ1 rli1rli1eHli1lJecKOro YXOAa li1li13J10)l(li1Tb ero
B nli1CbMeHHOVI <t>opMe ew,e AO HalJaIla J1elJeHli1S1.
. Bo BpeMSI nepBoro nocew,eHli1S1 B CJ1Yllae 06HapeHli1S1 HeYAOBJ1eTBOpli1-
TeJ1bHOVI rli1rli1eHbl n0J10CTli1 pTa naLl,li1eHTa li1H<t>OpMli1PYIOT 06 3TOM li1
npeAynpe)I(AalOT, lJTO eCJ1li1 AO CJ1eAYIOw,ero nocew,eHli1S1 He 6YAeT
OTMelJeHO YJ1YlJWeHli1V1, Ayrli1 npli1AeTCSI CHSlTb.
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OTMelJeHO YJ1YlJWeHli1e, KOTOpoe, KaK npaBli1J10, HacrynaeT.
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YJ1YlJWeHli1S1. OAHaKo B 3TOM peAKO B03Hli1KaeT He06xOAli1MOCTb, eCJ1li1
oroBopeHbl onpeAeJ1eHHble YCJ10Bli1S1.
. ECJ1li1)1(e li1 nOCJ1e 3TOro naLl,li1eHT He npli1Hli1MaeT Mep no YJ1YlJWeHli11O
rli1rli1eHli1lJeCKoro yxoAa 3a n0J10CTblO pTa, peKoMeHAyeTcSI CHSlTb annapaT
li1J1li1 HanpaBli1Tb naLl,li1eHTa Ha J1elJeHli1e K APyroMY BpalJY. OAHaKo TaKoe
CJ1YlJaeTCSI AOBOJ1bHO peAKo.
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AYaIlbHble pa3J1li1lJli1S1 B Tli1ne HaIleTa li1 ero COCTaBe. Y HeKOTOpblX naLJ,li1eHTOB
OTMelJaeTCSI nOBblweHHblVi pli1CK J10KaIlbHb1X li13MeHeHli1V1 B 3K0J10rli1lJeCKOM
paBHOBeCli1li1, KOTOpble MOryT Bbl3BaTb AeKaIlbLl,li1HaLl,li1IO.
BbISlBli1Tb naLl,li1eHTOB, KOTOpble npeApacn0J10)l(eHbl K B03Hli1KHOBeHli11O
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lJTO He60J1bWaSl rpynna naLl,li1eHTOB caMa OTBeTCTBeHHa 3a BbICOKli1 npOLJ,eHT
nopeHHblX 3y60B. HeKOTOpblM naLl,li1eHTaM MO)l(HO peKOMeHAOBaTb
n0J10CKaHli1S1 paCTBOpOM 0,2% XJl0preKCli1Ali1Ha B COOTBeTCTBli1li1 C li1HCTPYKLI,li1-
SlMli1 li13roTOBli1TeJ1eVl B TelJeHli1e 1-2 HeAeJ1b. 3TO MO)l(eT nOMO% B BOCCTa-
HOBJ1eHli1li1 6J1aronpli1S1THOVI 6aKTepli1aIlbHOVI <t>J10pbl li1 3K0J10rli1lJeCKoro
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mpax. OAHaKO li1X npli1MeHeHli1e MO)l(eT 6blTb 3<t><t>eKTli1BHO B CJ1eAYIOw,li1X
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J1elJeHli1S1 li1 CTpeMSlTCSI K li1AeaIlbHOMY pacn0J10)l(eHli11O 3y60B C nOJ1YlJe-
Hli1eM MaKCli1MaIlbHO B03MO)l(HbiX pe3YJ1bTaTOB. MHOrli1e naLl,li1eHTbl
YCTaIOT K KOHLI,Y J1elJeHli1S1 li1 He MOryT COTpYAHli1lJaTb B nOJ1HOVI Mepe npli1
ocyw,eCTBJ1eHli1li1 KOHelJHblX MepOnpli1S1Tli1V1.
. ECJ1li1 Y naLl,li1eHTOB OTMelJalOTCSI YCTOVllJli1Bble npli1BbllJKli1, CBSl3aHHbie C
60KOBbiM li1J1li1 nepeAHli1M pacn0J10)l(eHli1eM Sl3blKa B n0J10CTli1 pTa.
AOJ1)1(HbIM 06pa30M CKOHCTPYli1pOBaHHbIVi n03li1L1,li10Hep MO)l(eT COAeVlCT-
BOBaTb 3aKpblTli11O npli1KYca.
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npe)KAeBpeMeHHOM CHSlTli1li1 annapaTa no PSIAY npli1lJli1H. B TaKOM CJ1YlJae
B03MO)l(HO A06li1TbCSI YJ1YlJWeHli1S1, eCJ1li1 OHli1 6YAYT HOCli1Tb n03li1L1,li10Hep,
HO, KaK npaBli1J10, B 3Tli1X CJ1YlJaSlX peAKO MO)l(HO O)l(li1AaTb AOCTaTOlJHOrO
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HaKJ10H li1 pOTaLl,li11O npli1 YCJ10Bli1li1 AOCTaTOlJHOro COTpYAHli1lJeCTBa co CTOpOHbl
naLl,li1eHTa.
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Tbl lJaCTO YCTaIOT K KOHLI,Y J1elJeHli1S1 li1 e He XOTSIT TpaTli1Tb AOnOJ1Hli1TeJ1bHOe
BpeMSlli1 YCli1J1li1S1 Ha HOWeHli1e n03li1L1,li10HepOB. ECJ1li1 npli1 J1elJeHli1li1 nJ1aHli1-
PyeTcSI li1Cn0J1b30BaHli1e n03li1L1,li10Hepa, TO J1YlJwe npeAynpeAli1Tb 06 3TOM
naLJ,li1eHTa B HalJaIle J1elJeHli1S1. n03TOMY OPTOAOHTbl, KOTOpble lJaCTO li1cnOJ1b-
3YIOT n03li1L1,li10Hepbl, npeAynpe)KAalOT 06 3TOM naLl,li1eHTOB AO HalJaIla
J1elJeHli1S1, lJTO nOBblwaeT YPOBeHb COTpYAHli1lJeCTBa, B OTJ1li1lJli1e OT Tex
npaKTli1K, rAe naLl,li1eHTaM npeAIlaralOT HOCli1Tb n03li1L1,li10Hepbl e B caMOM
KOHLI,e J1elJeHli1S1.

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C 3TanOM CTa6li1J1li13aLl,li1li1.
. CHSlTb ABa KOMnJ1eKTa OTTli1CKOB BepXHeVlli1 Hli1)1(HeVllJeJ1IOCTeVi
C 6peKeTaMli1 Ha 3y6ax. OAli1H KOMnJ1eKT li1Cn0J1b3yeTcSI KaK 3TaIlOH,
a BTOPOVI - AIlSl li13roTOBJ1eHli1S1 n03li1L1,li10Hepa.
. 3aperli1CTpli1pOBaTb J1li1L1,eBYIO AYry li1 L1,eHTpaIlbHOe COOTHOWeHli1e
C nOMow,blO BOCKOBOro npli1KYCHoro Wa6J10Ha li1 YCTaHOBli1Tb MOAeJ1b
B apTli1KYJ1S1TOp. 3TO KpaVlHe BHO AIlSl TOro, lJT06bl OCb OTKpbITli1S1
6blJ1a npaBli1J1bHOVl, KaK li1 TOJ1w,li1Ha n03li1L1,li10Hepa Me)KAY nepeAHli1Mli1
li1 60KOBbIMli1 3y6aMli1.
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n03li1L1,li10Hepa B J1a60paTOpli1li1.
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KOTOpblX HHO YJ1YlJWli1Tb. 06bllJHO n03li1L1,li10Hepblli13roTaBJ1li1BaIOT li13
AOCTaTOlJHO MSlrKOVI 6eJ1oVl pe3li1Hbl, MSlrKoro np03palJHoro MaTepli1aIla
li1J1li1 MaTepli1aIla, KOTOpblVi pa3MSlrlJaeTCSI nOA B03AeVlCTBli1eM TenJ1a
li1 3aTBepAeBaeT npli1 TeMneparype n0J10CTli1 pTa.
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annapaTbi MO)l(HO CHSlTb li1 YCTaHOBli1Tb n03li1L1,li10Hep. Cyw,eCTByeT,
B OCHOBHOM, ABa cnoc06a li1Cn0J1b30BaHli1S1 n03li1L1,li10Hepa:
MaKCli1MaIlbHO B03MO)l(HOe HOWeHli1e n03li1L1,li10Hepa B TelJeHli1e 2
HeAeJ1b, a 3aTeM - TOJ1bKO B HOlJHOe BpeMSI B TelJeHli1e MeCSlLI,a
C nOCJ1eAYIOw,eVl YCTaHOBKOVI peTeVlHepoB
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CTBYIOT 3aKpblTli11O npli1KYca. OHli1 TaK)l(e 3aw,li1w,aIOT 3y6bl OT nepeMew,eHli1S1,
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npli1MeHSlTb npli1 HaIlli1lJli1li1 li1CXOAHOro my60KOro npli1KYca, B 3TOM CJ1YlJae
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HECbEMHblE PETEiliHEPbl
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TOB. B cJ1YlJaSlx YAaIleHli1S1 nepBblX npeMOJ1S1pOB ero 06bllJHO npOAIlSlIOT
AO Me3li1aIlbHblX 60P03A BTOpblX npeMOJ1S1pOB. CKPYlJeHHaSl npOB0J10Ka
AIlSl peTeVlHepa MO)l(eT li1MeTb Ali1aMeTp 0,015 li1J1li1 0,0195 AIOVlMa, ee
TU.taTeJ1bHO npli1KJ1eli1BaIOT K 3y6aM MaTepli1aIlOM T ransbond LRTM. AYry
MO)l(HO li13roTOBli1Tb Y KpeCJ1a naLl,li1eHTa, OAHaKO 60J1ee BblCOKaSl TOlJHOCTb
li1 J1yttwaSl aAamaLl,li1S1 06eCnelJli1Ba1OTCSI npli1 ee li13roTOBJ1eHli1li1 Ha MOAeJ1li1 B
J1a60paTOpli1li1.
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06eCnelJli1BalOw,eVl a6C0J1IOTHYIO CYXOCTb pa60lJero nOJ1S1. B KalJeCTBe
aIlb TepHaTli1Bbl 06bllJHOVlli130J1S1L1,li1li1 C nOMow,blO BaTHblX BaIlli1KOB MO)l(HO
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-
1 Reitan K. 1959. Tissue rearrangement during retention of orthodontically rotated
teeth. Angle Orthodontist 29:105-113.
2 Van Waveren Hogervorst W. L., Feilzer A. J. et al. 2000. The air abrasion
technique versus the conventional acid-etching technique: a quantification of
surface enamel loss and a comparison of shear bond strength. American Journal
of Orthodontics and Dentofacial Orthopedics 117:20-26.
3 Mitchell L. 1992. Decalcification during orthodontic treatment with fixed
appliances - an overview. British Journal of Orthodontics 19:199-205.
4 Twetman S., Hallgren A., Peterson L.G. 1995. Effect of an antibacterial varnish on
mutans streptococci in plaque from enamel adjacent to orthodontic appliances.
Caries Research 29: 188-91.
5 Bishop J. E. 1991. Technology and medicine; doctors get results by sending
letters after treatments. Wall Street Journal October 11: 134.
BepXHSISI Ayra
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B 3aBli1Cli1MOCTli1 OT KOHKpeTHblx o6CTOSlTeJ1bCTB B KOM cJ1YlJae.
6 Boese L. R. 1980. Fiberotomy and reproximation without lower retention,
nine years in retrospect: part 1. Angle Orthodontist 50:88-97.
7 Boese L. R. 1980. Fiberotomy and reproximation without lower retention,
nine years in retrospect: part 2. Angle Orthodontist 50: 159-178.
8 Little R. M., Reidel R. A., Artun J. 1988. An evaluation of changes in mandibular
anterior alignment from 10 years to 20 years postretention. American Journal
of Orthodontics and Dentofacial Orthopedics 93:423-428.
9 Little R. M., Wallen T. R., Reidel R. A. 1981. Stability and relapse of mandibular
anterior alignment - first premolar cases treated by traditional edgewise
orthodontics. American Journal of Orthodontics 80:349-365.
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ISBN 966-7337-16-2
8",,a08H'" L/ T80