全口义齿印模技术的进展介绍

采取印模是制作全口义齿的第一步,是成功修复全口义齿的关键。准确的全口印模要精确地反映无牙颌患者剩余牙槽嵴的解剖形态和周围组织生理功能活动范围,以便使义齿基托与口腔黏膜高度密合,获得良好的边缘封闭,从而取得全口义齿良好的固位,并能在功能运动时保持稳定。越来越多的研究表明,传统的印模方法已不能满足临床要求。近年来各种改良式印模方法层出不穷,如：开窗托盘印模法、动态压力式印模法、后缘截断框架式托盘印模法及中性区技术等,这些方法在取组织面、磨光面或黏膜转折处的印模上各有优势或侧重。针对不同的患者,应根据其剩余牙槽嵴条件、全身情况或修复需求等情况而选择相应的印模方法。本文就无牙颌取模技术的不同侧重角度、技术要点、适应证等方面作一综述。     

全口义齿印模技术的发展现状

全口义齿修复前,需通过可塑性印模材料来复制无牙颌牙槽嵴和周围软硬组织的解剖形态,清晰准确的口腔印模不仅为后续技工制作义齿提供了良好的结构基础,而且是保证最终修复体固位、稳定及功能的关键.现有研究表明,除印模材料、印模托盘、印模操作和印模消毒外,印模技术也是无牙颌印模制取精度的重要影响因素之一.近年来,随着各类牙科材料的...     

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目的比较硅橡胶闭口式印模法和开口式印模法在无牙颌义齿修复中的临床疗效。方法收集2008年3月至2011年9月福建医科大学附属第一医院口腔科收治的无牙颌修复患者30例,按初诊时间顺序随机分为闭口式印模组和对照组,分别使用闭口式和开口式印模法制作全口义齿,3个月后复查其吸附力和压痛修改情况。结果用闭口式印模法制作的全口义齿,吸附力好于开口式印模法,其压痛修改次数也明显减少。结论对于无牙颌全口义齿的制作,硅橡胶闭口式印模法优于开口式印模法。     

试牙后闭口式印模方法制作全口义齿的效果评价

目的:通过采用试牙后闭口式印模法制作全口义齿,并对其效果进行评估。方法:选取52例无牙颌患者,随机分为两组,分别采用传统方法和试牙后闭口式印模法取模和制作全口义齿。调查患者对不同义齿的满意度。结果:通过该方法制作的全口义齿的患者满意度明显提高。结论:试牙后闭口式印模法有助于提高全口义齿的固位功能、咀嚼功能、语音功能、封闭性和舒适性。     

Current concepts and techniques in complete denture final impression procedures

PURPOSE: In 2001, a survey of U.S. dental schools was conducted to determine which concepts, techniques and materials are currently prevalent in the teaching of final impression procedures for complete dentures in the predoctoral clinical curriculum. MATERIALS AND METHODS: The questionnaire was mailed to the chairperson of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 44 schools returned the completed survey resulting in a response rate of 82%. RESULTS: Results from this survey show that the majority of schools (71%) teach the selective-pressure technique for final impression making; the majority of the schools (64%) use modeling plastic impression compound for border molding the final impression tray; 39% of the schools do not place vent holes in the final impression tray, 30% of schools place more than one hole and 27% place one hole only; the majority of the schools (98%) are using custom trays for final impressions. Ninety-eight percent of the schools are border molding the custom tray and 70% of schools are using a visible light-cured (VLC) composite resin material to make the trays. Thirty-six percent of the schools are teaching the Boucher impression technique and 34% are teaching the modified Boucher impression technique. CONCLUSIONS: Predoctoral clinical complete denture educational programs agree on many aspects of final impression making, however, there is variability in their teachings regarding the impression philosophy and the materials used.     

A randomised trial of a simplified method for complete denture fabrication: patient perception and quality

Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lesser use of time and resources, without disadvantage for the patient. This study compared a simplified method for complete denture fabrication to a conventional protocol in terms of oral health‐related quality of life (OHRQoL), patient satisfaction and denture quality. Forty‐two edentulous patients requesting treatment with complete dentures were randomly allocated into two study groups. Group S received dentures fabricated by a simplified method and Group C received conventionally fabricated dentures. Before interventions and after three and 6 months following insertion, OHRQoL and patient satisfaction were analysed by specific instruments. A prosthodontist assessed denture quality 3 months after delivery. Groups presented no difference for OHRQoL, denture quality and general satisfaction. Differences regarding patient satisfaction with some aspects of the dentures were found after 3 months (S > C), but were insignificant at 6 months. It was concluded that the simplified method is able to produce dentures of a quality comparable to those produced by the conventional method, influencing OHRQoL and patient satisfaction similarly.     

Functional impression and jaw registration: a single session procedure for the construction of complete dentures

The conventional fabrication of complete dentures involves two separate clinical sessions for functional impression making and jaw registration. The presented method combines both procedures in one session. The aim of this study was to survey the three-dimensional tooth positions in complete dentures with reference to the ridges to establish arbitrary guideline values that could be used for the manufacturing of tooth-position analogue plastic rims on functional impression trays. New complete dentures were fabricated by supervised undergraduate students in the conventional manner for 104 edentulous patients. The position of the maxillary teeth was surveyed in the horizontal plane using the Schmuth 'vizor-measuring plate'. The vertical dimension of occlusion, represented as the distance between opposing ridge areas of the dentures in maximum intercuspation, was measured at different sites by means of a Gutowski gauge. The tooth positions on the dentures varied widely, e.g. the horizontal distances between the incisive papilla and the maxillary incisors was 7.1 +/- 2.3 (3-14) mm. The vertical dimension of occlusion, which is most important in the jaw registration, varied equally with an anterior inter-alveolar distance between 12 and 33 (20.4 +/- 4.0) mm. Arbitrary moulding of the tooth position-analogue plastic rims does not seems to be an ideal method of pre-shaping functional impression trays, because the individual anatomical variation is considerable. Alternatively, the horizontal and vertical tooth positions of functionally and aesthetically pleasing dentures should be measured to pre-shape the rims of functional impression trays in the maxillary and the mandibular jaw. Such trays are a valuable tool for functional impressions and an immediate preliminary jaw registration in the fabrication of new complete dentures. This method allows a first try-in of the full set-up in the third clinical visit without loosing precision.     

Hyposalivation, xerostomia and the complete denture: a systematic review

BACKGROUND: To determine the treatment effects of hyposalivation on denture retention, the authors conducted a systematic review of the literature. TYPES OF STUDIES REVIEWED: The authors reviewed clinical investigations that assessed the treatment effects of hyposalivation on denture retention. They searched six electronic databases for works from 1950 to the second week of September 2007 by using the key words "denture," "hyposalivation," "xerostomia," "dry mouth," "elderly" and "aged." They limited the citation search to articles written in English and describing studies that involved human subjects. RESULTS: The authors identified 11 articles in the search; none was a report of a randomized controlled clinical trial. CLINICAL IMPLICATIONS: The few clinical research studies published on the topic of hyposalivation and denture retention represent a low level of evidence for establishing clinical practice guidelines. The authors found that they could make no conclusions regarding the treatment effects of hyposalivation on denture retention. The article provides a literature review regarding the etiologies and clinical presentation of salivary disorders and xerostomia in elderly people, the role of saliva in denture retention, the effect of dry mouth on denture use and the treatment of dry mouth problems in denture wearers. Prospective clinical trials are needed to establish a framework for evidence-based treatment of denture-wearing patients experiencing dry mouth.     

Face‐bow transfer in prosthodontics: a systematic review of the literature

An extensive search for randomised controlled clinical trials was accomplished to compare dental prostheses and occlusal splints constructed with or without face‐bow transfer, and question whether face‐bow transfer may present better clinical results than simpler approaches. Studies were identified by searching electronic databases (PubMed/MEDLINE, Latin American and Caribbean Literature on the Health Science, and Brazilian Bibliography of Dentistry). The keywords ‘dental articulator’, ‘semi‐adjustable articulator’, ‘face‐bow’, ‘jaw relation record’ and ‘occlusal splint therapy’ were used. The minimum inclusion requirements were (i) randomised controlled trials with patients of any age, (ii) comparison between dental prostheses or occlusal splints constructed with or without face‐bow transfer and (iii) assessment of clinician's time, number of occlusal contacts, patient satisfaction or masticatory function. The search resulted in the identification of 8779 articles. Subsequently, 8763 articles were excluded on the basis of title and abstract. By the end of the search phase, eight randomised controlled trials were considered eligible. Current scientific evidence suggests that face‐bow transfer is not imperative to achieve better clinical results in prosthodontics. Randomised clinical trials suggest that simpler approaches for the construction of complete dentures and occlusal splints may present acceptable results, while no clinical study has investigated its use in fixed and removable partial dentures.     

Use of Resin‐Based Provisional Material to Create the Posterior Palatal Seal in Complete Denture Definitive Impressions

The purpose of this article was to present an alternative procedure using resin‐based provisional material to create the posterior palatal seal (PPS). This method offers more practicality in clinical routine and increased control for addition of material to create the PPS when compared to traditional techniques such as the use of impression wax.     

Mandibular complete denture versus single‐implant overdenture: a systematic review of patient‐reported outcomes

The single‐implant mandibular overdenture (SIMO) has been proposed as an alternative for edentulous patients who are poorly adapted to their dentures due to low retention and stability of the conventional mandibular complete denture (CD). However, there is a lack of evidence regarding the effectiveness of SIMO, which can be measured by examining patient perception of treatment effects. The aim of this systematic review was to assess the comparative results of CD and SIMO treatments using patient‐reported outcome measures. A literature search was carried out in PubMed, Scopus and Cochrane Central databases. The search included studies published up to July 2017. The focus question was: ‘Do single‐implant mandibular overdentures improve patient‐reported outcomes compared to conventional complete dentures in edentulous patients?’ Eligible studies were randomised clinical trials (RCT) and prospective studies. After initial screening for eligibility and full‐text analysis, 11 studies were included for data extraction and quality assessment (five parallel‐group RCTs, two crossover RCTs and four prospective studies). All studies reported marked improvement in satisfaction with the dentures and quality of life measures after SIMO treatment, irrespective of variations in implant treatment protocols and retention systems. Methodological considerations revealed a lack of evidence from RCTs on the comparative effectiveness of the two treatment strategies. Hence, although available evidence suggests considerable improvement in patient‐reported outcomes following the insertion of a single implant to retain a mandibular denture, further well‐designed comparative studies between SIMO and CD are required to improve the level of evidence and to support the indication of SIMO treatment in routine practice.     

Bilateral balanced occlusion compared to other occlusal schemes in complete dentures: A systematic review

No consensus has been reached regarding the best occlusal scheme for making complete dentures. Thus, the purpose of this systematic review was to compare bilateral balanced occlusion (BBO ) with other occlusal schemes (canine guidance, lingualised occlusion and zero degree) in complete dentures. The schemes were compared in terms of quality of life/satisfaction and masticatory performance. Two independent reviewers performed a comprehensive search of studies published in or before October 2017 using the PubMed/MEDLINE , Scopus and Cochrane Library databases. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA ) statement. The focused question was: “In conventional complete denture, is BBO better than lingualised occlusion, canine guidance and zero degree in terms of quality of life, patient satisfaction and masticatory performance/muscle activity?” Seventeen studies were selected for analysis. In total, there were 492 patients with a mean age of 64.78 years and a mean follow‐up duration of 2.96 months (range: 1‐6 months). All studies compared BBO with the other occlusal schemes. Eleven studies evaluated the influence of the occlusal scheme designs on quality of life and satisfaction, and 8 studies evaluated masticatory performance and muscle activity between BBO and the other occlusion schemes. The present systematic review indicated that BBO does not confer better quality of life/satisfaction or masticatory performance and muscle activity. Thus, lingualised occlusion can be considered a predictable occlusal scheme for complete dentures in terms of quality of life/satisfaction and masticatory performance, while canine guidance can be used to reduce muscular activity.     

口内扫描数字化印模对固定修复临床应用效果的Meta分析

目的 系统评价口内扫描数字化印模(IDI)技术对固定修复的临床应用效果.方法 计算机检索Medline(Ovid)、EMBASE、Cochrane Central Register of Controlled Trials以及中国知网(CNKI)数据库关于IDI对口腔固定修复治疗临床效果的随机对照试验(RCT),各数据...     

改良式印模法促进下颌全口义齿固位的临床探讨

目的:探讨下颌全口义齿改良式印模法的临床应用。方法:5例下颌牙槽嵴低平的无牙颌患者,口角炎反复发作,其旧义齿牙列磨损严重,戴用时稳定性差。本文根据日本学者阿部二郎提出的下颌吸附性义齿理论与临床操作新要求,来介绍改良印模法制作下颌全口义齿的过程。结果:下颌全口义齿可通过改良式印模法实现义齿边缘的完整封闭,增加义齿固位,提高患者咀嚼效率与生活质量。患者评价较满意。结论:改良印模法应用于下颌牙槽嵴低平无牙颌患者,可明显增加义齿固位力。     

Reliability of a two‐colour chewing gum test to assess masticatory performance in complete denture wearers

The aim of this study was to test the reliability of a method to measure the masticatory performance of complete denture wearers employing a colour‐mixing ability test and assessment by visual and electronic colourimetric analysis. A sample of 75 subjects was selected from patients who received new conventional complete dentures. Masticatory tests were performed using a two‐colour chewing gum that was masticated for 5, 10, 20, 30 and 50 chewing cycles, performed in a random order. The mixing level of the two colours of the chewed gum was assessed visually by two independent raters based on a 5‐point ordinal scale. The specimens were flattened into a 1‐mm‐width wafer, scanned and saved as a two‐sided digital image. Each pair of images was submitted to an electronic colourimetric analysis to assess the level of colour mixture, measured by the circular variance of hue (VOH ). Overall inter‐ and intra‐rater agreements in visual analysis were 64% and 68%, respectively (almost 99% of scores ranged within ±1 point), whilst overall weighted kappa was >0.80. A proportional increase in the level of mixture occurred with increased number of chewing cycles (P  < .001). Similarly, VOH and the visual analysis were highly correlated (r = ?.89; P  < .001). Bland‐Altman plots revealed excellent agreement and extremely low systematic error between duplicated VOH measures. It was concluded that the two‐colour chewing gum test is a reliable method to assess the masticatory performance in complete denture wearers using both visual and electronic colourimetric analyses.     

Attachment‐Retained Gingival Prosthesis for Implant‐Supported Fixed Dental Prosthesis in the Maxilla: A Clinical Report

The rehabilitation of edentulous maxillae is a complex procedure due to the involvement of esthetic and functional requirements. A trial maxillary denture can be used to identify the need for adequate upper lip support when replacing removable complete dentures by implant‐fixed dental prostheses. This clinical report describes the outcome of the rehabilitation of an edentulous atrophic maxilla with unfavorable maxillomandibular relationship and deficient upper lip support. A trial denture was fabricated and used to diagnose the need for a prosthesis capable of restoring the upper lip support. The reduced upper lip support was also confirmed by a lateral cephalogram. The patient was rehabilitated by an implant‐fixed dental prosthesis associated with an attachment‐retained gingival prosthesis. The case presented shows that when loss of upper lip support is detected and the patient does not wish to undergo further surgical reconstruction procedure, the retention of a gingival prosthesis using a ball attachment is a satisfactory treatment option.