应用全瓷冠修复可摘活动义齿基牙

全瓷冠已经用于替代传统的金属烤瓷冠修复单个牙齿。传统用于修复的全瓷冠由于其物理特性的缺陷在许多情况下存在禁忌．以前可摘局部义齿基牙只能用金属冠或金属烤瓷冠修复．然而氧化锆陶瓷冠的强度特点使得在某些特殊情况下全瓷冠用于修复可摘局部义齿基牙（removable partial denture．RPD）成为可能。目前可应用Procera All Zirkon系统制备传统的导平面和支托窝从而修复可摘局部义齿基牙。本文详述了借助ProceraCAD／CAM系统．利用氧化锆全瓷冠修复可摘局部义齿的连接部分基牙的技术方法。     

可摘局部义齿基牙楔状缺损充填修复的疗效评价

目的：比较应用GCFujiIXGP玻璃离子水门汀、Dyract复合材料及银汞合金三种材料对可摘局部义齿基牙颈部楔状缺损的临床修复疗效。方法：79例186颗楔状缺损可摘局部义齿基牙,缺损部位分别用GCFujiIXGP玻璃离子水门汀、Dyract复合材料及银汞合金修复,修复2年后用改良的USPHS系统评价修复体的疗效。结果：银汞合金修复效果好于另外两组。结论：银汞合金适合修复可摘局部义齿基牙的楔状缺损。     

可摘局部义齿修复后龈沟液中白介素-1变化的实验研究

目的：探讨可摘局部义齿对龈沟液中白介素-1（IL-1）表达水平的影响,为临床可摘局部义齿设计和制作提供依据。方法：对牙列缺损患者进行铸造支架式可摘局部义齿修复,修复后6个月,分别采取近缺隙侧基牙区和非基牙区龈沟液,用酶联免疫吸附法测定分析龈沟液中IL-1的表达水平。结果：可摘局部义齿修复后,近缺隙侧基牙区龈沟液中IL-1的表达水平升高,非基牙区无明显改变。结论：对于可摘局部义齿修复者,近缺隙侧基牙龈沟液中IL-1的表达水平升高,且明显高于非基牙区龈沟液IL-1水平。     

糖尿病患者义齿修复后龈沟液中白介素-1变化的实验研究

目的：探讨糖尿病患者戴用可摘局部义齿后龈沟液中白介素-1（IL-1）的变化,从而为临床上糖尿病患者义齿修复方式的选择提供依据。方法：对牙列缺损的糖尿病患者进行钴铬合金铸造支架式可摘局部义齿修复,在修复后六个月时分别采取基牙和非基牙区的龈沟液,用酶联免疫吸附法测定分析IL-1的表达水平。结果：可摘局部义齿修复后,糖尿病患者近缺隙侧基牙区龈沟液中IL-1的表达水平明显升高,而非基牙区则无明显改变。结论：糖尿病患者可摘局部义齿修复对基牙龈沟液中IL-1的表达水平有影响,从而为临床义齿修复提供了一定的理论依据。     

多乐氟预防可摘局部义齿基牙患龋的临床研究

目的 观察多乐氟对可摘局部义齿基牙的防龋效果. 方法 行可摘局部义齿修复的牙列缺损患者100例,采用自身对照的方法,患者修复义齿后,随机选择一侧基牙作为试验侧基牙组涂布多乐氟,半年重复1次,对照侧基牙组做空白对照,3年后复诊检查可摘局部义齿基牙的龋坏情况. 结果 试验侧基牙组患龋率为24. 7%(40/162),低于对照侧基牙组41. 9%(67/160),差异具有统计学意义(χ2 =10. 71,P<0. 01). 结论 可摘局部义齿基牙涂布多乐氟可有效预防龋病的发生.     

可摘局部义齿对Ⅱ型糖尿病患者基牙牙周状况的影响

目的研究可摘局部义齿对Ⅱ型糖尿病患者基牙的影响程度。方法选取口腔门诊就诊的Ⅱ型糖尿病患者60例,牙周非手术治疗后进行可摘局部义齿修复,研究基牙与其对侧同名牙于义齿修复前、修复后2周、3个月、6个月、12个月、24个月的菌斑指数、牙龈指数、探诊出血指数、探诊深度和临床附着丧失5项牙周指标。结果 1)Ⅱ型糖尿病患者戴用可摘局部义齿后基牙的牙周指标明显高于对照牙(P<0.01);2)Ⅱ型糖尿病患者戴用可摘局部义齿后的6个月内,基牙的牙周指标均明显升高(P<0.01);但随着戴用时间继续延长,基牙的牙周状况趋于稳定和缓解。结论戴用可摘局部义齿可引起Ⅱ型糖尿病患者基牙牙周指数的升高。     

老年人可摘局部义齿修复对基牙的影响

目的:分析研究老年人可摘局部义齿修复后对基牙的影响,探讨其原因及预防措施。方法:对95例牙列缺失后的老年人行冷弯卡环固位式可摘局部义齿修复,记录和比较戴可摘局部义齿后基牙和非基牙的龋坏率和缺失率,用χ2检验分析其结果有无差异,并对影响基牙的原因进行分析。结果:戴用可摘局部义齿5a后,基牙的患龋率(17.38%)显著高于非基牙(7.10%);因牙折、牙周病松动及龋坏无法保留而拔除的基牙缺失率(27.01%)也显著高于非基牙(7.79%)(P<0.01)。结论:冷弯卡环固位可摘局部义齿修复后在一定程度上可增加老年人基牙的患龋率和缺失率。     

高钉帽磁性附着体义齿在下颌牙槽嵴低平患者的应用

目的 高钉帽磁性附着体义齿在下颌牙槽嵴低平患者中的临床应用观察。方法 对15例下颌牙槽嵴低平患者采用高钉帽磁性附着体可摘义齿修复并进行2年的随访观察。结果 高钉帽磁性附着体可摘义齿修复患者的基牙牙槽骨吸收少,基牙松动度改变小,满意度高。结论 对于下颌低平牙槽嵴患者且基牙牙周情况良好的患者,高钉帽磁性附着体可摘义齿是一种较好的修复方式。     

波恩式铸造全冠修复原活动义齿基牙对义齿固位力的效果评价

目的:评价波恩式方法制作的金属全冠修复可摘局部义齿基牙的效果.方法:选择48颗基牙残冠,首先恢复牙体解剖形态,然后利用波恩制作方法完成铸造金属全冠,基牙修复完成后,戴入原可摘义齿,定期临床检查,评价修复效果.结果:经过3～6个月的随访观察,48颗患牙经波恩冠修复后获得满意效果,1例患者出现牙龈炎.结论:可摘局部义齿基牙牙体缺损进行全冠修复时,波恩制作方法简单易行,效果好.     

制作适合原有可摘局部义齿的基牙全冠的临床方法

目的：研究制作适合原有可摘局部义齿的基牙全冠的修复方法。方法：采取间接法制作基牙全冠，即在备牙后制取模型，并留下可摘局部义齿在技工室制作全冠。结果：做冠后，可摘局部义齿的支托与全冠紧密贴合，卡环固位良好，患者对修复效果表示满意。结论：对于需要制作基牙全冠的病例，应该依据基牙外形保存情况、牙列缺损部位的不同，选择最佳的修复方法。     

Stress distribution of abutments and base displacement with precision attachment- and telescopic crown-retained removable partial dentures

Five types of removable partial dentures (two attachment dentures, two telescopic dentures and one clasp denture) were designed. The two attachment dentures were retained by the rigid-precision attachments with or without a stabilizing arm, and the two telescope dentures were retained with cone telescope crowns with or without cross-arch stabilization. The stresses acting on abutment teeth and denture bases and the movements of denture bases were investigated, and the influences of denture design were clarified. The stress acting on a terminal abutment tooth retained by a rigid-precision attachment or cone telescopic crown was larger than that acting on a terminal abutment tooth retained by a clasp. The attachment dentures tended to concentrate more stress at the terminal abutment tooth than did the telescopic dentures. The stress of denture base of an attachment denture and a telescopic denture was less than that of a clasp denture. There was no difference between the stresses of attachment and telescopic dentures. The displacement of the denture base tended to be less when the denture was designed with a rigid connection for the retainer and with cross-arch stabilization.     

利用阻生智齿预备钛金属冠改善下颌义齿固位的应用观察

目的:利用阻生智齿增加下颌单颌总义齿固位力。方法:通过手术暴露下颌阻生智齿,在智齿冠上预备牙体,制作钛金属套冠将阻生齿牙冠形态转移至口腔中,从而把固位力不足的下颌单颌总义齿修复,转变成有正常基牙固位的可摘局部义齿修复。结果:通过3例利用埋伏阻生智齿接钛金属套冠,对下颌牙槽嵴严重吸患者的可摘局部义齿修复,经2～3年的临床观察,钛套冠固定良好,无松动,牙龈正常。可摘局部义齿固位良好。结论:利用埋伏阻生智齿接钛金属套冠,加强下颌牙槽嵴严重吸收可摘局部义齿固位力的效果明显。     

老年人牙列缺损可摘局部义齿修复设计回顾性研究

目的:总结老年人多数牙列缺损的临床修复体会,探讨老年患者可摘局部义齿的设计。方法:对276例老年多数牙列缺损患者分别设计牙合垫式、连续卡环式、连续卡环加牙合垫式可摘局部义齿,其中179例余留牙有残根、残冠患者,先作根管治疗,然后按以上形式设计覆盖式可摘义齿。对修复效果作戴修复体时及戴后3月、3年随访,标准分为好、差两个等级。结果:276例复查结果:满意度调查,好均为100%,(P>0.05)。咀嚼功能检查,戴后3月,好为100%,3年好为99.3%,(P>0.05)。基牙牙周情况检查,戴后3月,好为100%,3年好为97.1%,(P>0.05)。结论:对老年人多数牙列缺损患者,应根据患者口腔情况设计最佳个体修复方案,制作适合老年人生理特点的可摘局部义齿。     

北京口腔医院技工中心11年修复体加工情况的统计分析

目的客观评估不同种类修复体的应用情况,为临床应用、资源优化配置和科研课题选择等提供参考信息。方法收集首都医科大学附属北京口腔医院技工中心2002-2012年的工作月报和制作数据,以299953件修复体为研究对象,统计冠桥固定修复体、种植固定修复体、可摘局部义齿、全口义齿等主要修复体类别的数量,分析发展趋势。结果活动类修复体构成比呈逐年下降趋势,固定类修复体逐年成为主要修复类型。全口义齿与胶连活动义齿缓慢减少,4种铸造支架活动义齿均增长。贵金属烤瓷固定义齿的制作量增长速率较快,种植体固定修复体一直呈稳定增长趋势,全瓷固定修复体制作量自开展后加速增长。贵金属全冠修复体制作量呈整体增长,成为铸造全冠修复体主要材料类型,而普通钴铬全冠修复体制作量则持续缓慢降低。结论固定类修复体占主导地位,活动类修复体逐年降低,各种材料修复体均有不同程度的起伏,但都有各自的临床需求,其中贵金属、全瓷、种植类需求量增长最为明显,预示未来修复体发展的方向。     

Provisional restoration for abutment of an existing removable partial denture

The abutment of an existing removable partial denture may require a crown restoration. Fabrication of a provisional restoration to fit the existing clasp assembly requires special consideration. This article presents a simple technique for fabrication of such provisional restorations. An alginate impression is made of the arch with the removable partial denture in place. The abutment tooth is then prepared, providing adequate clearance between the clasp assembly and the tooth preparation. Cold curing acrylic resin of proper shade is mixed and poured in the impression of the abutment tooth. The impression is then seated in the mouth and removed before the acrylic resin is completely polymerized. The provisional restoration is then separated from the partial denture, finished and polished.     

Fabricating Crowns to Fit Existing Removable Partial Dentures: An Illustration of Two Techniques

The prosthetic treatment of a structurally compromised abutment tooth supporting a removable partial denture may present a variety of restorative modalities. Ideally, a surveyed crown is made for the individual tooth, which is later followed by a new removable partial denture fit to the contours of the crown. Frequently, however, the removable partial denture is clinically acceptable, and remaking the prosthesis is not indicated. In these cases, the crown can be made to fit the existing removable partial denture. Fabricating crowns to fit existing removable partial dentures can be accomplished using a direct method, an indirect method, or combinations of these techniques. Direct techniques traditionally use acrylic resin and inlay wax intraorally to develop a custom pattern that captures the contours of the clasp assembly. Indirect techniques use a pick-up impression to allow the crown pattern to be waxed against the denture framework on a cast in the laboratory. Combination methods use either a direct-indirect or indirect-direct approach. The direct-indirect method develops the preliminary resin pattern directly on the tooth and finalizes the contours in wax on a master cast. The indirect-direct technique initiates a crown pattern on a die and completes it either intraorally or on the die after the intraoral refinements. This article reviews the literature for methods of fabricating surveyed crowns under existing removable partial dentures. Additionally, two cases are presented that illustrate an indirect and combination direct-indirect technique for making the restorations.     

Anterior rests for maxillary removable partial dentures.

Positive anterior rests were shown to be an essential element of design when considering stress distribution with a removable partial denture involving anterior teeth. Proximal plates often added stability and reduced stress accumulation in any one region. Distobuccal forces on the extension base adversely affected the primary canine abutment. Forces in the regions of the anterior base and central incisor abutment produced the most widespread transmission of stress throughout the arch. Greater stress throughout the arch was observed when forces were applied to the central incisor rather than to the right canine abutment. There is a need for established criteria of rest form and placement. Guidelines for using the natural crown as opposed to a positive rest seat in a restoration are needed. Continuing studies of other anterior rest forms should increasingly clarify this phase of treatment planning. The dentist should recognize the need for structural integrity in the anterior maxillary segment when designing removable partial dentures. A practical, defensible rationale for the routine use of maxillary anterior teeth as removable partial denture abutments must be established.     

Further aspects of design for distal extension removable partial dentures based on the Kennedy classification

A supplement to the Kennedy classification of partially edentulous arches for restoration with removable partial dentures has been suggested. Factors affecting denture design relating to the position of the abutment teeth, the symmetry of the edentulous distal extensions, the arch form and the cross-sectional shape of the residual ridges have been discussed and classified. An understanding of the movement of the denture bases in relation to the influence of these factors makes for a rational approach to removable partial denture design and the treatment of complications observed clinically in removable partial denture wearers.     

不同设计形式RPD对支持组织应力分布影响的光弹分析

目的:探讨分裂式设计与RPI设计制作的钴铬合金铸造支架RPD修复KennedyⅠ类缺损对支持组织应力分布的影响,为优化义齿设计提供实验依据。方法:分别以分裂式设计和RPI设计两种设计形式的钴铬合金铸造支架RPD修复下颌牙双侧游离缺失,用三维光弹应力冻结切片技术测试义齿加载后对基牙和缺牙区牙槽骨的应力分布,并加以分析比较。结果:钴铬合金分裂式设计的铸造支架RPD承受压力沿基牙牙体长轴传导,基牙远中所受扭力较小。结论:对于KennedyⅠ类牙列缺损,钴铬合金分裂式设计的铸造支架RPD使支持组织受力均匀、合理,减小了基牙受到的扭力,达到基牙保护的目的,是一种值得推广的设计。