牙冠延长术用于磨牙冠修复的临床疗效及牙周指标分析

目的　分析牙冠延长术用于磨牙全冠修复的临床疗效及牙周指数变化。方法　选择26颗临床冠长度过小无法满足全冠修复固位要求的磨牙,以及固位不良反复脱落,破坏了生物学宽度造成牙龈炎症的全冠修复失败病例,施以牙冠延长术,术后6周行固定全冠修复。观察不同时段临床冠长度的变化,记录各相关牙周指数并进行分析,评估术后全冠修复的临床效果。结果　术后短期内临床冠长度增加效果确切;试验组术后的各项牙周指数均优于术前(P<0.05),与对照组无明显差异(P>0.05),在1年的观察期内保持相对稳定(P>0.05);全冠修复体的固位良好,边缘密合,龈缘与冠缘的位置关系相对稳定。结论　对于临床冠过短的磨牙,冠延长术是改善全冠修复效果,促进牙周组织健康的有效方法。     

高频电刀在口腔修复临床中的应用及效果评价

目的：本文介绍了高频电刀在烤瓷冠、铸造全冠修复临床中的应用。并初步探讨了高频电刀的临床应用效果。方法：使用高频电刀对需制作烤瓷冠、铸造全冠修复的基牙在牙体预备前或制作修复体后根据牙龈情况分别进行增生牙龈切除术、牙冠延长术、龈沟止血、牙龈成形术等多种牙龈修整手术。结果：对治疗的84例门诊病人84颗牙齿进行评价，医师和患者对牙龈外形、牙功能等满意率高，无不良并发症。结论：对烧瓷冠、铸造全冠修复前或修复后的基牙使用高频电刀行增生牙龈切除术，牙冠延长术，牙龈成形术等牙龈修整手术，可改善由于龈外形线，牙冠较短、龈增生等原因影响牙龈美观、牙周健康疾患的治疗效果。     

远中楔形瓣切除术应用于短龈距第二磨牙冠修复的临床效果观察

目的探讨第二磨牙远中龈距不足的病例应用远中楔形瓣术后冠修复临床效果。方法收集30例第二磨牙远中龈距不足的病例,均排除手术禁忌证,采用远中楔形瓣切除过多牙龈组织,必要时去除少量牙槽骨。术后常规医嘱,术后临时冠修复,1周拆线。术后4-6周永久修复体修复。完成永久修复时、修复后6个月、修复后12个月进行随访,并记录3个时期患牙远中的牙冠高度,以及患牙和对照牙的远中龈沟出血指数（SBI）,采用SPSS 16.0进行分析。结果术后所有病例远中龈距均满足了牙体预备所需要的空间,永久修复体功能形态恢复良好。30例修复体固位效果良好,龈缘位置无明显变化,不同时期远中临床牙冠高度变化不显著（F=1.279,P=0.284）;牙龈无明显红肿,远中SBI与对侧同名牙之间差异均无统计学意义（3个时期的比较分别为t0=2.283,P0=0.534;t6=-0.767,P6=0.722;t12=2.129,P12=0.263）。结论游离端磨牙远中楔形瓣是改善远中临床牙冠短的磨牙冠修复效果的一种有效方法。     

水激光在前牙美容性冠延长术中的应用效果观察

目的对上颌前牙区临床牙冠过短的患牙用水激光行牙冠延长术术后效果观察。方法选择需要前牙美学区延长的20位患者,随机分为2组,各10位30颗患牙,试验组行上颌前牙美学区冠延长,采用水激光行牙龈切除即刻不翻瓣骨修整。对照组行上颌前牙美学区冠延长,采用刀片行牙龈切除即刻翻瓣骨修整。检测术前、术后2周、4周、2个月、6个月龈缘位置,龈沟出血指数,探诊深度。结果试验组龈缘位置、探诊深度的稳定性在4周内与对照组存在显著差异(P<0.05),4周后无明显差异。龈沟出血指数2组无明显差异。结论水激光在美容区牙冠延长术中能较快获得龈缘的稳定性以及正常的牙周附着。     

应用改良冠延长术桩核冠修复上颌磨牙冠根折的临床观察

目的：评价上颌磨牙冠根折采用改良牙冠延长手术后,行桩核冠修复的短期临床效果。方法选取腭尖劈裂至牙龈下3~6mm的上颌磨牙23颗,分为4mm组、5mm组和6mm组,采用改良牙冠延长术即牙根改形结合少量去骨的方法重建牙生物学宽度,术后4周进行金属桩核冠修复。修复后即刻和1年检查牙齿松动度、菌斑指数、出血指数和探诊深度,并测量手术牙和对侧同名牙的力值和患者满意度。结果6mm组术牙中有1例术中出现基牙Ⅰ°松动,术后1周、修复后即刻、修复后1年复查松动度未出现明显变化;5mm组术牙中有1例在修复后9个月根折,其余术牙术后牙龈健康、未出现牙齿松动。修复后即刻和1年时,术牙力值与对侧同名牙差异没有统计学意义(P >0．05);冠缘位置未发生明显变化,患者对冠修复体功能满意。结论牙根改形结合少量去骨的方法作为一种改良的牙冠延长术,扩大了牙冠延长术的适应证,可以应用于临床上颌磨牙劈裂牙的保留。     

口腔修复学：冠桥

前牙临术短冠牙冠延长术后烤瓷修复的临床效果观察；Cercom全瓷在口腔固定修复中的应用初探；镍铬合金烤瓷冠修复上颌切牙对牙周组织的影响；IPS Empress全瓷贴面颜色效果的初步研究；国产乳磨牙金属预成冠的研制和临床应用；金属烤瓷修复体两种牙体预备形式的临床性能比较；非贵金属烤瓷冠修复后牙龈组织和血液中镍铬元素含量分析；上皮下结缔组织移植术治疗烤瓷冠修复后引起的牙龈退缩；不同牙冠高度与全冠固位力关系的实验分析；上前牙薄弱根管重塑后桩核冠修复提前牙齿抗力的实验研究；牙半切除术后全冠修复的疗效观察；以前磨牙形态修复磨牙分离的残根68例报告；利用残根作为固定桥基牙的临床观察；镍铬合金烤瓷冠过敏症：4例报道；全瓷固定桥的研究进展（综述）；套筒冠义齿在牙列重度磨耗伴牙列缺损修复中的应用；IPS-Empress 2 高强度全瓷冠桥的临床应用；空核桩冠一体化修复牙体缺损的方法。     

套筒冠义齿修复牙列重度磨耗的临床评价体会

目的：探讨套筒冠义齿修复重度磨耗[牙合]的临床效果。方法：对9例牙列重度磨耗的患者，进行套筒冠义齿修复（6例患者有颞下颌关节紊乱病），共制作套筒冠义齿12件，观察时间6—48个月，追踪患者主观感觉、咀嚼效果、义齿固位、稳定度及颞下颌关节紊乱病是否缓解；并通过X线片检查基牙牙周膜情况、基牙牙槽骨高度。结果：套筒冠义齿修复重度磨耗[牙合]后，患者自我感觉满意、能提高咀嚼效能，义齿固位稳定性好，颞下颌关节紊乱病疗效好，基牙牙周膜无明显异常，基牙牙槽骨无吸收。结论：采用套筒冠义齿修复牙列重度磨耗导致垂直距离下降的患者，可行而且有效。     

牙冠延长术用于上前牙残根固定修复11例临床观察

目的 观察牙冠延长术应用于上前牙残根固定修复的临床疗效。方法 选取2010—2011年安徽医科大学附属口腔医院牙周黏膜科门诊收治的上前牙残根患者11例（共15颗患牙）,行牙冠延长术并于术后6周进行桩核冠修复,修复后随访1年观察疗效。结果 牙冠延长术后1～2周,11例患者术区牙龈均无出血、溢脓,部分患牙牙龈组织稍红肿;术后6周,所有患牙牙龈组织基本不红肿,患牙无松动。龈缘至断端的距离测量结果显示,术后各时间点与术前比较,差异均有统计学意义（P < 0.05）。在冠修复后1个月,有1颗上侧切牙邻面有黏结剂,牙龈红肿,探诊出血,经过处理去除黏结剂,教会患者正确使用牙线,1个月后炎症消退;其余l4颗患牙经1年观察,龈缘位置正常,修复体与软组织协调,冠边缘密合,稳固无松动,患者对修复效果满意。结论 牙冠延长术是保留上前牙残根的一种有效方法,扩大了桩冠修复的适应证。     

改良内冠式套筒冠在下颌倾斜基牙固定修复中的应用

目的　探讨改良内冠式套筒冠在下颌第一磨牙缺失,第二磨牙倾斜固定修复中的应用效果。方法　通过改良套筒内冠改变倾斜基牙轴向,与另一侧基牙取得共同就位道,固定修复下颌缺失牙。结果　27个固定桥经过0.5~2年临床观察,固位稳定,基牙无继发龋,无牙龈炎症,无松动,咀嚼效果较好。X线片显示,倾斜基牙牙槽骨无明显吸收。结论　改良内冠式套筒冠可用于倾斜基牙的固定修复,扩大了固定修复的适应范围。     

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目的观察牙冠延长术应用于上前牙残根固定修复的临床疗效。方法选取2010—2011年安徽医科大学附属口腔医院牙周黏膜科门诊收治的上前牙残根患者11例（共15颗患牙）,行牙冠延长术并于术后6周进行桩核冠修复,修复后随访1年观察疗效。结果牙冠延长术后1～2周,11例患者术区牙龈均无出血、溢脓,部分患牙牙龈组织稍红肿;术后6周,所有患牙牙龈组织基本不红肿,患牙无松动。龈缘至断端的距离测量结果显示,术后各时间点与术前比较,差异均有统计学意义（P〈0.05）。在冠修复后1个月,有1颗上侧切牙邻面有黏结剂,牙龈红肿,探诊出血,经过处理去除黏结剂,教会患者正确使用牙线,1个月后炎症消退;其余l4颗患牙经1年观察,龈缘位置正常,修复体与软组织协调,冠边缘密合,稳固无松动,患者对修复效果满意。结论牙冠延长术是保留上前牙残根的一种有效方法,扩大了桩冠修复的适应证。     

髓室固位形在短临床冠修复中的应用

目的:探讨髓室固位形在磨牙临床冠较短、固位不足情况下作为全冠主要固位形的修复效果。方法:对28例临床冠短于4mm需要全冠修复或作为全冠固位体的磨牙进行完善的根管治疗后,在髓室制备箱型固位形,利用髓室作为全冠主要固位形完成修复,随访2年,评价修复效果。结果:28例无松动、脱落,除了1例崩瓷外,均能正常行使功能。结论:髓室固位形在短临床冠修复中是一种可行的固位方式,扩大了冠、桥修复的适应症。     

Periodontal and Prosthetic Conditions in Patients Treated with Removable Partial Dentures and Artificial Crowns: A Longitudinal Two-Year Study

In the present longitudinal study the periodontal and prosthetic conditions in 30 patients treated with removable partial dentures and artificial crowns were followed over a period of 2 years. The patients were given individual instructions in oral and denture hygiene and adequate periodontal treatment before the prosthetic therapy was started. The removable partial dentures were carefully planned and designed. The patients were regularly checked, and necessary instructions, scaling and prosthetic corrections were undertaken. The patients cooperated excellently and no significant deterioration was found in the clinical periodontal status of the remaining teeth. Only a few carious lesions were registered. The present study does not support the opinion that a removable partial denture per se will cause periodontal and carious lesions. When teeth with artificial crowns were examined regarding the position of the crown margins it was found that clinically observable gingival inflammations tended to be greatest when the crown margins were subgingivally located. Some deterioration of the removable partial denture occurred during the two-year follow-up concerning preferably occlusion, articulation, stability and clasp retention.     

The use of resin cements in restorative dentistry to overcome retention problems

The use of resin cements in combination with dentin bonding agents can result in superior attachment of prostheses to tooth structure. This paper describes four clinical cases in which dentin-bonded resin cements were used to overcome retention problems. In the first case, a detached fixed partial denture, which was in good condition when separated, was recemented to abutment teeth prepared with less-than-ideal angle of convergence. In the second case, a detached all-porcelain crown was recemented with a dentin-bonded resin cement after appropriate surface treatment. In the third case, a porcelain-fused-to-metal crown made for a molar tooth was cemented to a short clinical crown, avoiding crown-lengthening surgery. In the fourth case, a 3-unit fixed partial denture was recemented to abutments with less-than-ideal supporting features. Dentin-bonded resin cements can help to extend the life of detached prostheses until the patient is financially prepared for replacement or it can help to avoid crown-lengthening surgery.     

A telescopic crown concept for the restoration of the partially edentulous arch: the Marburg double crown system

PURPOSE: This article describes the concept of the Marburg double crown system (MDC system) in the treatment of partially edentulous patients. Long-term success is assessed by a review of patient records. MATERIALS AND METHODS: Double crowns with clearance fit are used to retain tooth-, mucosa-, and implant-supported removable partial dentures (RPD). To achieve retention, an additional attachment, the TC-SNAP system, is used. All metal components are fabricated in a single cobalt-chromium-molybdenum alloy; the framework (including outer crowns) is cast in one piece. Because of the framework's rigidity, the RPD can be constructed without major and minor connectors. The denture base adjacent to the abutments is fabricated using a perioprotective design that is similar to fixed partial dentures. One hundred eleven dentures, of which 49 (44%) were fabricated for patients with intraoral defects, were evaluated by reviewing patient records. RESULTS: The mean age of the patients at the time of insertion was 57.5 years (+/- 12.3). The mean number of double crowns per denture was 3.5 +/- 2.1 (range, 1 to 9). The probability that a patient will have lost all abutment teeth 10 years after insertion of the denture is 4%. The probability that a patient will have kept all teeth that abut the denture 5 years after insertion is 87%; 10 years after insertion the probability is 80%. CONCLUSION: The Marburg double crown system is a versatile and successful means of achieving the long-term restoration of the partially edentulous jaw. Insertion and removal of the denture and routine oral hygiene are easy to perform, even for patients with limited manual dexterity. As a full-arch reconstruction, the MDC system enables easy adjustment, modification, and relining with low follow-up costs.     

Effect of abutment mobility, site, and angle of impact on retention of fixed partial dentures

Fixed partial dentures cemented to dies of adjustable mobility were subjected to repeated impacts at three different sites. Immobile abutments retained their prostheses longer than mobile abutments. Impacts that fell between the centers of rotation of the abutments were withstood longer than impacts that fell nearer the ends of the prostheses. This study failed to show a significant difference between the effect of impacts perpendicular to the occlusal plane and impacts angled 45 degrees toward the lingual plane. The results of this study suggest that (1) crowns that anchor rigid prostheses to mobile teeth require greater retentive ability than crowns on relatively immobile abutments and (2) occlusal impacts are best withstood when they fall on the areas of the fixed partial denture over and between the centers of rotation of the abutment teeth. If a fixed partial denture must withstand loading outside these areas, as is the case with cantilevered pontics and some tilted abutments, the retainer furthermost from the anticipated eccentric load must have exceptionally good retention.     

Clinical complications in fixed prosthodontics

The purpose of this article is to identify the incidence of complications and the most common complications associated with single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores. A Medline and an extensive hand search were performed on English-language publications covering the last 50 years. The searches focused on publications that contained clinical data regarding success/failure/complications. Within each type of prosthesis, raw data were combined from multiple studies and mean values calculated to determine what trends were noted in the studies. The lowest incidence of clinical complications was associated with all-ceramic crowns (8%). Posts and cores (10%) and conventional single crowns (11%) had comparable clinical complications incidences. Resin-bonded prostheses (26%) and conventional fixed partial dentures (27%) were found to have comparable clinical complications incidences. The 3 most common complications encountered with all-ceramic crowns were crown fracture (7%), loss of retention (2%), and need for endodontic treatment (1%). The 3 most common complications associated with posts and cores were post loosening (5%), root fracture (3%), and caries (2%). With single crowns, the 3 most common complications were need for endodontic treatment (3%), porcelain veneer fracture (3%), and loss of retention (2%). When fixed partial denture studies were reviewed, the 3 most commonly reported complications were caries (18% of abutments), need for endodontic treatment (11% of abutments), and loss of retention (7% of prostheses). The 3 most common complications associated with resin-bonded prostheses were prosthesis debonding (21%), tooth discoloration (18%), and caries (7%).     

The use of endodontically treated teeth as abutments for crowns, fixed partial dentures, or removable partial dentures: a literature review.

Endodontically treated teeth are commonly required to serve as abutments for crowns, fixed partial dentures, or removable partial dentures. Many clinicians are of the opinion that endodontically treated teeth do not serve as well as vital teeth. This article reviews the pertinent literature and seeks to reach a consensus for the use of endodontically treated teeth with each type of prosthesis. With appropriate preparation designs, endodontically treated teeth can serve well as abutments for crowns. As restorations become more complex and involve edentulous spans, some reservations apply. In some fixed partial denture designs, the use of endodontically treated teeth may be contraindicated.     

超声洁治和局部用派丽奥治疗人工冠和固定义齿引起的慢性牙周炎

目的：评价采用超声龈上洁治术和20g／L盐酸二甲胺四环素(派丽奥)治疗人工和固定义齿引起的慢性牙周炎的疗效。方法：将30个由人工冠和固定义齿引起的慢性牙周炎患牙随机分为超声龈上洁治组和派丽奥组并在基线和治疗后1周、12周时检查患牙的临床指标。结果：两种治疗方法均可使菌斑指数和牙龈指数等指标改善。结论：超声龈上洁治术和局部用盐酸二甲胺四环素是治疗人工冠和固定义齿引起的慢性牙周炎的安全有效的方法。