外胚叶发育不全患者义齿修复1例

外胚叶发育不全综合征(HED)是起源于外胚层结构发育不良的一类罕见的先天性遗传疾病,80%的HED患者有部分或全部缺牙,无牙区牙槽嵴严重萎缩,颌间关系异常等[1]。与普通牙列缺损的患者相比,其修复治疗有自己的特点。本文通过对1例成年HED患者的义齿修复,以病案形式探讨HED患者的修复治疗方法。     

遗传性外胚层发育不良儿童和青少年植入骨内种植体的观察

遗传性外胚层发育不良(hereditaryectodermal dyspla-sia,HED)患者常有面部和牙齿发育畸形,采用义齿修复技术恢复口腔功能至关重要。由于HED患者存在圆锥形牙齿,刃状牙槽嵴等,采用传统修复体固位困难,不稳定,并随年龄增长常需重作义齿。而骨内种植体支持式修复技术可克服以上缺点。本文目的是评价骨内种植体能否成功地用于HED者,以及生长发育对     

牙列重度磨损咬合重建修复治疗方法的探讨

目的 探讨牙列重度磨耗患者行固定义齿咬合重建修复的可行性.方法 结合1例牙列重度磨耗患者,咬合垫佩戴3个月后,制作过渡性修复体,口内观察1年,然后行上下颌固定义齿最终修复,经过这一序列诊疗过程完成咬合重建.结果 患者使用最终修复体2年,美观满意,咀嚼效率良好,无咀嚼系统肌肉及颞下颌关节不适症状.结论 牙列重度磨耗的固定义齿咬合重建修复是一个复杂的序列治疗过程,治疗效果是满意的.     

咬合支持恢复前后海马内代谢物质变化的临床初步研究

目的探讨咬合支持丧失和重建对脑内神经生化代谢的影响。方法选取7例咬合支持长期丧失的患者,进行义齿修复以恢复咬合支持。于义齿修复前和义齿修复正常戴用6周后,应用质子磁共振波谱分析技术,检测患者海马内神经物质代谢的变化情况。结果恢复咬合支持6周后,7例患者胆碱复合物与肌酸的比值较义齿修复前平均下降11.9%(P<0.05);肌醇与肌酸的比值较义齿修复前平均下降28.8%(P<0.05);氮乙酰天门冬氨酸与肌酸的比值较义齿修复前上升4.8%(P>0.05)。结论恢复咬合支持6周后,患者脑内神经物质的变化趋势提示,恢复咬合支持可能有助于改善神经元功能。     

咬合重建相关病例回顾及修复流程研究

目的根据咬合异常的不同临床表现，应用不同的修复方法进行咬合重建，评价临床效果，讨论与咬合重建相关疾病的临床诊断及修复设计流程。方法64例咬合异常患者按照修复前检查-诊断-修复设计-咬合重建修复-修复后评价的临床步骤，进行固定修复、固定-可摘局部义齿修复及可摘局部义齿修复咬合重建，于修复前后分别检查颞颌关节健康状况、义齿使用情况与咀嚼效能。结果咬合重建修复1年后，30例颞颌关节紊乱病患者中的25例治愈，对关节区疼痛与关节弹响的疗效差异有统计学意义：全部患者对咬合重建修复的临床效果满意，与可摘局部义齿修复相比较，固定修复、固定-可摘局部义齿修复在义齿舒适度（X^2=5．25，P〈0．05）和对发音影响（X^2=10．86，P〈0．05）等方面的满意度较高，差异有统计学意义；不同种类修复之间及选用不同种类修复咬合重建修复前（F=9．248，P〈0．05）和修复后（F=4．858，P〈0．05），患者咀嚼效能的差异有统计学意义。总结和制定与咬合重建相关疾病的临床诊断流程及修复设计流程。结论运用系统化的临床诊断流程及修复设计流程，能保障获得准确的诊断与针对性的修复设计，保证咬合重建诊疗修复取得成功。     

牙列重度磨耗应用固定修复咬合重建的临床观察

目的观察以固定义齿修复进行咬合重建在治疗牙列重度磨耗中的临床效果。方法选择35例牙列重度磨耗或伴有牙列缺损的患者,制作烤瓷或铸造固定义齿进行全牙列咬合重建修复。1年后比较修复前后美观效果、夜磨牙症状、颞下颌关节症状和咀嚼效率的变化。结果所有患者均获得了满意的美观效果,夜磨牙和关节症状有明显减轻或消失,同时显著提高了咀嚼效率。结论固定义齿修复是一种良好的、有效的咬合重建的方法。在保留息止颌间隙的前提下,临床义齿戴用3周后如无不适症状,可考虑行永久咬合重建。     

锁骨颅骨发育不全综合征患者的咬合重建修复

目的 对锁骨颅骨发育不全综合征(CCD)患者进行咬合重建修复,观察疗效并总结修复要点.方法 对1例CCD成年患者抬高垂直距离,上颌行垫式可摘局部义齿修复,下颌行可摘局部义齿修复,过渡性咬合重建修复6个月,随访观察疗效.结果 修复6个月后,患者主观感受和临床检查均显示美观及咀嚼功能得到明显改善,建议以此时的垂直距离为最佳距离行永久性修复.结论 对CCD患者采用垫式可摘局部义齿修复是一种有效的咬合重建的方法,但随着年轻患者的颅颌骨发育,颌间距离还需定期调整.     

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观察(牙合)垫式义齿修复牙列缺损伴咬合垂直距离过低的修复效果.方法 2002-2010年在南京医科大学附属南京第一医院口腔科,对17例牙列缺损伴咬合垂直距离过低患者采用(牙合)垫式可摘局部义齿修复,观察修复效果.结果 随访12～24个月,15例患者咀嚼功能、颜面美观等得到明显改善.结论 (牙合)垫式可摘局部义齿可以用于牙列缺损伴咬合垂直距离过低患者的义齿修复.     

牙列重度磨耗伴缺损的可摘局部义齿重建修复

目的：探讨应用可摘局部义齿一次性咬合重建修复牙列重度磨耗伴缺损的可行性.方法：对17例牙列重度磨耗伴缺损的患者采用（耠）垫式可摘局部义齿行一次性咬合重建,治疗后1个月、3个月和6个月复诊,调查患者主观感觉、咀嚼效果、义齿稳定性;以及是否有颞颌关节不适.结果：患者咬合升高1.5mm-2.5mm.随访6个月,患者无不适,咀嚼功能改善明显,对义齿的美观和功能都满意.结论：对于牙列重度磨耗伴缺损的病例可以尝试应用可摘局部义齿进行一次性咬合重建修复.     

上颌舌尖咬合总义齿用于下颌齿槽嵴过低病例

自1990年来,笔者采用后牙舌尖咬合对7名无牙颌疑难病例进行义齿修复,取得了较满意的较果。 临床资料 1 一般情况:采用上颌舌尖咬合总义齿修复无牙颌患者7人,其中下颌牙槽骨严重吸收萎缩的4人,下颌呈刃状牙槽嵴的1人,有可移动牙槽嵴组织的2人。患者年龄64～78岁,平均年龄71岁。有可移动牙槽嵴组织的2人有总义齿修复史,其余人均未做过义齿修复。     

种植义齿修复功能性咬合的几点思考

目的:探讨牙种植体冠桥修复设计在牙列形态功能重建中的临床意义。方法:随机抽取本院临床上采取种植单冠或种植体连冠、种植体固定桥、种植体-牙联合固定修复病例20例,追踪比较种植体、相邻牙、对合牙骨嵴顶水平变化及骨吸收方式,修复体结构变化特点、咀嚼主观感受、颞下颌关节症状、T-scan咬合记录等。结果及讨论:临床种植义齿修复治疗中,越来越多的咬合问题出现在就诊病人的不同治疗时期,有的患者经过医师的适当处理:如调改咬合、佩戴咬合垫、引导患者改变咀嚼习惯、不同修复时期选择不同质地的食品等可即刻或短期内恢复正常,骨吸收减缓,或有一定改建。但临床上也有一部分患者,从其牙列排列或咬合形态结构无明显异常,依照传统的治疗手段处理后仍无法解决或缓解咬合不适症状,如持续性咬合痛、异常咬合音、颞下颌关节弹响和颌面部局部酸困不适感甚至疼痛、嚼碎食物困难等。这类患者修复区咬合形态无明显异常。本课题研究结果认为:在目前尚缺乏垂直向咬合接触的正常形态标准情况下,种植修复较之天然牙修复更应该注重以近远中向(一牙对二牙)以及唇(颊)舌向关系正常的咬合形态标准作为咬合治疗的正常标准。过渡义齿修复及定期仔细地调改咬合十分重要。进一步建立满足种植修复体功能需求的、个体化的垂直向咬合接触正常标准,是今后研究的主要内容。     

Restoration of occlusal vertical dimension by means of a silica-coated onlay removable partial denture in conjunction with dentin bonding: a clinical report.

The prosthesis described in this article allowed restoration of occlusal height by means of an onlay removable partial denture and composite resin bonded veneers. Reasons for its selection are: 1. It is a reversible procedure. 2. The patient can easily clean any plaque accumulation due to supragingival margins. 3. The cost to the patient was much lower than that of a fixed prostheses. 4. Chair time is less than with a fixed prosthesis. 5. Tooth structure remains relatively unaltered except for recontouring prior to onlay construction. 6. Repairs are easily done. 7. The onlays of the removable partial denture transfer the occlusal load on the abutment teeth along their long axes. 8. The procedure is less stressful and fatiguing to the patient than that involving a fixed prosthesis.     

Clinical assessment of chewing function of obturator prosthesis wearers by objective measurement of masticatory performance and maximum occlusal force

PURPOSE: Eating, which includes chewing and swallowing, is an oral function that influences quality of life. Though the swallowing ability of maxillectomy patients was reported in our previous study, the chewing function has not been fully reported to date. Thus, the purpose of this study was to evaluate the chewing function of obturator prosthesis wearers by measurement of masticatory performance and occlusal force. The relationship of these 2 measurements was also investigated. MATERIALS AND METHODS: Twenty maxillofacial obturator prosthesis wearers undergoing periodic checkup at the maxillofacial rehabilitation clinic in Kyushu University Hospital were recruited for this study. Additionally, 20 young, healthy individuals were recruited as controls. Data on masticatory performance, which was measured by a sieve method using hydrocolloid material, and maximum occlusal force, which was measured by the Dental Prescale System (Fuji Film), were obtained for each participant. RESULTS: The mean of masticatory performance was 2.6 (SD 1.2) on a 1.40-mm mesh. There was no significant difference in masticatory performance between the patient group and the controls. The mean maximum occlusal force of the patient group was 625.9 N (SD 299.1 N), which was significantly lower than that of the control group. There was no significant correlation between masticatory performance and maximum occlusal force for the patient group in this study (P = .3726). CONCLUSION: Masticatory performance of obturator prosthesis wearers with dentate or partially edentulous maxillae was not different from that of young, healthy individuals, though maximum occlusal force of these patients was lower than that of controls.     

固定修复重建咬合5年临床观察

目的 临床分析咬合失调患者的病因，采用固定修复术重建咬合，测定治疗前后的咀嚼效能及观察颞下颌关节紊乱病的临床变化。方法 65例经临床诊断为咬合失调病例，采用固定修复的方法施行咬合重建，并分别于修复前，修复后3个月和5年，采用过筛法进行咀嚼效率的测试，检查颞下颌关节紊乱病临床症状的变化。结果 统计学分析显示固定修复前后咀嚼效率有显著性差异（P＜0．01）；颞下颌关节紊乱病的临床症状得到缓解。结论 固定修复方法对恢复咬合关系是有效的，重建咬合后颞下颌关节紊乱病得到缓解，这种不可逆性咬合重建尚需长期的，大量的临床观察。     

Reliable and Repeatable Centric Relation Adjustment of the Maxillary Occlusal Device

This technique article describes a quantifiable, repeatable, and reliable method for occlusal device adjustment in centric relation using a leaf gauge. In addition, specific suggestions for occlusal device design are provided to enhance patient comfort with the prosthesis in place.     

Replacement of a mandibular implant-fixed prosthesis with an implant-supported overdenture to improve maintenance and care

PatientsA 69-year-old woman presented to the Osaka University Dental Hospital. She had two chief complaints, (a) food accumulation under the lower teeth and (b) poor maxillary denture retention while eating. On clinical examination the patient presented with a maxillary complete denture and fixed mandibular implant prosthesis. For preventing food accumulation under the fixed implant prosthesis and to keep the maxillary denture stable by providing posterior occlusal contact for bilaterally balanced occlusion, the use of a mandibular implant-supported overdenture with self-adjusting magnetic attachments provided a prosthetic solution for this patient. After provided the new dentures, the patient was pleased and was comfortable with the aesthetic, stability and retention of the dentures. There were no discernable clinical or radiographic changes after 1 year of use.DiscussionTo prevent food accumulation beneath the fixed implant prosthesis and maintain the stability of the maxillary denture by providing posterior occlusal contact for bilaterally balanced occlusion, a mandibular implant-retained overdenture with magnetic attachments was used to provide a prosthetic solution for this patient.ConclusionIn this clinical case, an implant-fixed prosthesis in the edentulous mandibular region was replaced into an implant-supported overdenture with considerations for (a) preventing the food accumulation beneath the lower prosthesis, (b) achieving the proper occlusion in the posterior part for maxillary denture stability and (c) ease of maintenance and care for the prostheses.     

Custom metal occlusal surfaces for acrylic resin denture teeth

A simple step-by-step procedure has been presented for the fabrication of custom metal occlusal surfaces for acrylic resin denture teeth. This technique works equally well with complete or removable partial dentures and provides the patient with a long-lasting prosthesis and minimal postinsertion problems due to occlusal changes and wear.     

多模态数据融合的可视化技术在咬合重建中的应用

目的　通过多模态医学数据融合,实现数字化升高咬合垂直距离并进行咬合重建,应用于临床诊断及修复。方法　利用软件手段,将口内扫描（IOS）、口外面部扫描（EOS）、锥形束计算机断层扫描（CBCT）、动态咬合运动轨迹进行多模态医学数据融合,创建可视化、可操作的四维虚拟牙科患者,对虚拟患者咬合及颞下颌关节进行系统性评估,在兼顾前牙美学及后牙修复空间的基础上,进行数字化升高咬合垂直距离,建立新的颌位并对接计算机辅助设计和计算机辅助制造（CAD/CAM）设备,实现咬合重建的固定修复。结果　通过多模态医学数据融合及CAD/CAM设备的对接,得到了可视化、可操控的四维虚拟牙科患者,使咬合重建的固定修复技术更加便捷与安全。结论　多模态数据融合创建四维虚拟患者创新地实现了同一患者各种数据在同时间、同空间的结合,方便、直观地展示了患者口颌系统解剖结构及功能状态,能够为临床医生提供有效的诊断与修复手段。     

An EMG study on TMJ disorders

The Authors have described a clinical case involving a patient with a classical TMJ syndrome and a full range of typical symptoms, both dental and non-dental. The patient underwent a set of EMG tests before his occlusal plane was restored using a special material, immediately following reconstruction and, lastly, three months following the application of a prosthesis. The findings of these EMG tests have shown that the complex symptoms reported by the patient could be traced back to his occlusal plane. Once it was reconstructed, all the typical dental and non-dental symptoms of TMJ disorders subsided.     

A Comparative Evaluation of the Effect of Double Casting Technique Using Functionally Generated Path and Conventional Single Casting with Respect to Functional Articulation,Patient Satisfaction and Chair Side Time,in Single Unit Molar Teeth: An In Vivo Study

A stable centric occlusal position that shows no evidence of occlusal disease should not be altered. Confirmative restorative dentistry deals with making restorations that are in harmony with existing jaw relations. Conventional techniques for construction have been unsuccessful in producing a prosthesis that can be inserted without minor intraoral occlusal adjustment. This study was conducted to evaluate the benefits of the double casting technique with FGP over the conventional casting technique. Ten patients with root canal treated maxillary molar were selected for the fabrication of metal crown. Two techniques, one involving the conventional fabrication and other using functionally generated path with double casting were used to fabricate the prosthesis. A comparison based on various parameters which was done between the two techniques. The change in the height of castings for the double casting group was less compared to the conventional group and was highly statistically significant (P < 0.001). The time taken for occlusal correction was significantly lower in double casting group than the conventional group (P < 0.001). The patient satisfaction (before occlusal correction) indicated better satisfaction for double casting group compared to conventional (P < 0.01). The functionally generated path with double casting technique resulted in castings which had better dimensional accuracy, less occlusal correction and better patient satisfaction compared to the conventional castings.