应用多学科联合治疗解决前牙美学区复杂病例（附1例5年随访结果）

上前牙美学区的二次修复及相关治疗在日常诊疗过程中备受关注,此类病例常涉及既往修复体形态不佳、基牙医源性过度预备导致侵犯牙周正常解剖结构以及咬合关系紊乱等问题,进而产生前牙区美学缺陷,给再治疗带来挑战,往往需要多学科联合治疗。文章通过展示1例前牙美学区病例的诊疗全过程,包括病情分析、多学科参与治疗设计、具体实施步骤和修复后效果等,以期为临床多学科联合治疗上前牙复杂病例提供经验。     

101例中国东北汉族上颌中切牙几何特征的研究

目的：研究上颌中切牙临床冠近远中径、切龈径与唇面形态,为前牙美学修复提供参考。方法：选取前牙列完整自愿者101例,测量左上中切牙近远中径、切龈径;并按尖圆、方正、卵圆形记录唇面总体形态,按平直、圆突、反圆弧记录切缘形态;以平坦、圆突记录唇面突度。按性别和年龄分组,SPSS 13.0分析研究结果。结果：经两独立样本T检验,壮年组的切龈径较青年组有所增加,但差异无统计学意义;男性切龈径大于女性,性别差异P〈0.05,有统计学意义;近远中径、近远中径/切龈径比值,青年与壮年组、男女两性差异均无统计学意义。经卡方检验,中切牙唇面形态构成比性别差异无统计学意义。结论：男性中切牙切龈径较女性长。中切牙形态与性别没有必然关系。     

数字化技术在酸蚀症伴重度磨耗患者功能美学缺陷修复中的应用1例

牙磨耗、磨损、酸蚀症等多因素导致的非龋性牙体缺损在口腔临床中的发病率呈上升趋势,通常伴随着不同程度的口腔美学缺陷及功能障碍。对其进行全牙列固定修复咬合重建时,不仅要恢复牙列的形态和美观,更要实现咬合关系与整体口颌系统的协调。本文报道1例酸蚀症伴重度磨耗的病例,利用多模态数字化数据（口内扫描、面部扫描、电子面弓、下颌运动轨迹描记等）构建4D虚拟患者,制定全面的修复方案,进行不同牙齿的个性化微创修复,采用唇贴面、颊贴面、贴面、高嵌体、嵌体、全冠等多种修复体,完成数字化全牙列咬合重建治疗,为该疾病的诊治提供可视化、可全程质控的全局观诊疗策略。     

如何规避前牙美学修复的龈边缘暴露

前牙修复后常因修复体龈边缘暴露而影响最终美学效果,如何规避此问题是口腔医生面临的挑战.本文通过牙龈生物型、牙周组织状况、修复体龈边缘位置、排龈技术与排龈线及暂时修复体制作等几个方面,探讨前牙美学修复中如何有效地规避修复体龈边缘暴露,以提高前牙修复的美学效果.     

计算机图像处理技术在前牙美学修复中的应用

目的探讨用计算机图像处理技术为患者制作美观的、符合个性特征的前牙修复体的过程。方法对13例需行前牙美学修复的患者拍摄修复治疗前及治疗中前牙图像，获取患者牙齿与周围软组织的美学信息，包括天然牙的形态、颜色、半透明度、个性特征，以及下颌息止位时和微笑时牙齿的切缘位置、龈缘位置等。分析美学信息资料后行美学修复设计，应用Photoshop 8.0软件制作修复预期效果图，指导技师制作修复体。结果完成13例患者的前牙美学修复，临床美学修复效果良好。结论将计算机图像处理技术应用于前牙美学修复设计，有助于医师和技师为患者制作美观的、符合个性特征的修复体。     

牙周治疗技术和口腔临床美学

4与口腔美学治疗相关的牙周手术 牙龈对前牙美观的影响很重要.改善牙龈形态的方法有很多种,包括龈切、根向复位瓣骨修整、正畸牵出或压入牙龈等.要与患者交流有关牙龈形态改变的预期结果,然后再决定是否采取手术.结合计算机图像模拟技术能给患者提供最终结果的参考,特别是针对一两个牙及剩余邻牙牙龈水平有一个准确的描述,但目前的技术手段还欠缺唇运动评估的综合效果.     

后牙种植患者上前牙牙龈形态与牙槽骨形态相关性的数字化测量分析

目的:通过数字化方法探讨后牙种植患者上前牙唇侧牙龈形态和牙槽骨形态的相关性,为前牙修复设计和美学重建提供参考。方法:前瞻性选取2020年5月至2021年5月于第四军医大学口腔医学院口腔修复科行种植修复的后牙缺失患者64例,其中男性24例,女性40例,年龄（25.6±3.3）岁;按牙周表型分为薄龈型（29例）和厚龈型（3...     

CAD/CAM前牙固定桥修复上颌复杂牙列缺损1例

<正>涉及上颌前牙区的复杂牙列缺损病例的修复效果应兼顾美学与功能。在美学方面要考虑修复体的形状、颜色、牙龈丰满度和笑线位置等,在功能方面要去除修复体的咬合干扰,为患者建立一个长期稳定的平衡牙合。本文报道了1例上颌前牙区伴骨缺损的复杂咬合重建病例,由于首选的种植治疗方案无法实施,在采用传统固定义齿修复治疗过程中,利用数字化CAD/CAM(计算机辅助设计与制造)技术复制临时义齿的舌侧外形,用活动义龈修饰唇侧软硬组织缺损,     

2013 年北京综合医院口腔学术年会论文摘要

牙周病广泛流行,是导致牙齿缺失的主要原因。老年人的患病率在75％以上,且严重程度较重。中重度牙周病治疗中,我科采用口腔多学科协作应用修复学和种植学方法得到了满意疗效。牙周病治疗的总体目标：基本H标是消除炎症、破坏停止;恢复牙周组织的形态;恢复牙龈及骨的生理外形;恢复牙的边缘嵴及邻面接触点,消除食物嵌塞;恢复牙周组织的功能：修复缺牙、调狳、松动牙固定等;维持疗效,防止复发：自我控制菌斑,定期复查。在牙周病治疗中保存牙槽骨骨量至关重要。导致颌骨丧失三因素：炎症、咬合创伤和牙列缺失后废用性颌骨萎缩。中重度牙周病治疗中通过牙周治疗消除炎症,通过牙周夹板消除咬合创伤,不能保留的牙及早拔除并种植义齿修复。牙周病修复治疗的内容：咬合调整,松动牙固定,缺失牙修复。牙周夹板的作用：稳定牙列,预防牙齿移位;改变力的传递方向,避免或减少咬合力对牙周组织的创伤;控制牙齿的异常动度,为受损牙周组织愈合创造有利的条件;形成多根巨牙,分散咀嚼压力,减轻单个牙牙周组织的负担;恢复牙列完整性,改善咀嚼效能和美感。牙周夹板有半永久的粘结式夹板和永久的粘固式夹板两种。牙列缺失后颌骨废用性萎缩应进行种植义齿修复。前牙区牙槽骨解剖学上有倾斜角度且牙槽骨伴有凹陷性缺损,一般需植骨治疗。前牙美学要素多,前牙区种植手术较疑难,因而前牙区牙周病患者在完善的牙周治疗基础上可选择牙周病修复治疗;后牙区要求有咬合功能,美学要求低,中重度牙周病患牙应选择种植义齿修复治疗。     

多学科联合治疗重度牙周炎导致的前牙连续缺失（附1例4年随访报告）

 随着生活水平及口腔治疗技术的提高，上前牙美学区种植修复成为越来越多患者的选择。因重度牙周炎伴有错牙合畸形进而导致前牙美学区连续失牙是临床上十分棘手的难题，若同时存在缺牙区软硬组织缺损，采用种植修复将面临巨大挑战，要解决此类问题往往需要多学科联合治疗。文章展示了1例重度牙周炎病例的诊疗全过程，包括病情分析、多学科参与治疗设计、具体实施步骤和修复后效果等，为临床解决因重度牙周炎导致上前牙美学区连续失牙的种植修复问题提供了经验。     

Biological basis for soft tissue management in implant dentistry

Good aesthetic finish of implant/restorations requires healthy peri-implant soft tissue at the appropriate location. The relevance of the peri-implant soft tissue seal, the biological width, the keratinized gingival zone and the need for effective plaque control in order to maintain peri-implant soft tissue health were discussed. The presence of a soft tissue seal/cuff around dental implants and abutments and its role in defense against infection were convincingly demonstrated in animal studies. In order to achieve long-term stable peri-implant health, it is important to achieve an adequate soft tissue seal around dental implant/restorations. The constant dimension of a biological width (of the soft tissue) often dictates where the final gingival margin will be. It is therefore not surprising that the position and stability of the alveolar bone ridge surrounding dental implants ultimately determines where the gingival margin rests. For dental implant restorations in the aesthetic zone, this is a crucial variable for the clinician to understand and deliver. Available data so far suggest that with good oral hygiene, peri-implant soft tissue health can be maintained irrespective if a keratinized gingival tissue zone surrounding implant/restoration is present. In reality, good oral hygiene is very difficult to achieve around dental restorations without the protection of a band of keratinized gingival tissue. Studies on peri-implantitis and peri-implant mucositis further demonstrated the causal relationship between dental plaque accumulation and peri-implant inflammation. It is therefore imperative that long-term maintenance care of dental implants and implant supported dental restorations should include a strict regime of plaque control and monitoring.     

Minimally invasive use of coloured composite resin in aesthetic restoration of periodontially involved teeth: Case report

Gingival recession causes not only aesthetic problems, but problems with oral hygiene, plaque accumulation, speech, and tooth sensitivity. Replacing the missing gingival tissue with composite resin, when indicated, can be a time- and cost-effective solution. Here we report the case of a 25-year-old female who presented with generalized gingival recession. Black triangles were present between the maxillary and mandibular anterior teeth due to loss of interdental tissues, caused by recent periodontal surgery. She also had slightly malposed maxillary anterior teeth. The patient elected to replace gingival tissue with pink composite resin and to alter the midline with composite resin veneers. The first treatment phase involved placement of pink gingival composite to restore the appearance of interdental papilla to her upper (16, 15, 14, 13, 12, 11, 21, 22, 23, and 24) and lower (34, 33, 32, 31, 41, 42, 43, and 44) teeth. Phase two was to place direct composite resin bonded veneers on her upper (16, 15, 14, 13, 12, 11, 21, 22, 23, and 24) teeth to alter the midline and achieve desired colour. The third treatment phase was to level the lower incisal edge shape by enameloplasty (31, 32, 41, and 42) to produce a more youthful and attractive smile. This case report and brief review attempt to describe the clinical obstacles and the current treatment options along with a suggested protocol. Use of contemporary materials such as gingival coloured composite to restore lost gingival tissue and improve aesthetics can be a simple and cost-effective way to manage patients affected by generalized aggressive periodontitis (AgP).     

Treatment of gingival fibromatosis associated with Zimmermann-Laband syndrome

BACKGROUND: Gingival fibromatosis is a rare condition characterized by a generalized enlargement of the buccal and lingual aspects of the attached and marginal gingiva. METHODS: This case report describes the periodontal management of a 13-year-old female patient with gingival fibromatosis associated with Zimmermann-Laband syndrome. The patient presented with gingival enlargement involving the maxillary and the mandibular arches, anterior open bite, and non-erupted teeth. Periodontal treatment included gingivectomy in all four quadrants. RESULTS: Histopathologic evaluation of the excised tissue supported the diagnosis of gingival fibromatosis. A significant improvement in esthetic appearance and eruption of the non-erupted teeth were obtained. The patient was referred for appropriate orthodontic treatment and has been closely followed for the earliest signs of recurrence of gingival enlargement. CONCLUSIONS: The successful therapy for gingival fibromatosis depends on correctly identifying the etiological factors and improving the impaired function and esthetic appearance through surgical intervention and adjunctive orthodontics. Maintaining treatment results depends on preservation of periodontal health.     

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??The incidence of permanent anterior teeth were highest in dental trauma. Because of its anatomic positi its impact on esthetics?? treatment methods and process are gaining more and more attention from dentists and patients. Three aspects about dental trauma were summarized in this paper ??including important premise of minimally invasive aesthetic treatment?? technology of minimally invasive aesthetic treatment for permanent anterior teeth in oral emergency ??including anesthesia?? protective therapy?? compensatory therapy?? composite resin restoration?? root canal preparation and filling?? broken crown bonding?? tooth root socket displacement?? orthodontic traction?? immediate planting?? teeth bleaching?? capping?? splintage?? veneering ?? and management of anterior trauma complicated periodontal diseases????and characteristics and treatment related to old dental trauma?? in order to provide theoretical and practical guidance for minimally invasive aesthetic treatment for permanent anterior teeth.     

恒前牙牙外伤微创美学治疗技术

前牙创伤发生率占牙外伤的首位,由于所处解剖部位和对美学的影响,其治疗受到医生和患者的高度关注。本文通过对恒前牙牙外伤实施微创美学治疗的重要前提、急诊牙外伤微创美学技术（包括：麻醉、保护性和代偿性治疗、复合树脂修复、根管预备及充填、断冠粘接、牙根牙槽窝移位、正畸牵引、即刻种植、牙齿美白、盖髓术、夹板固定、贴面修复、合并牙周疾病的前牙外伤的处理）以及陈旧性牙外伤的特点和治疗进行综述,为临床施行恒前牙牙外伤的微创美学治疗提供理论和实践依据。     

即刻种植和早期种植对前牙美学区种植体周围软组织的影响分析

目的:分析即刻种植和早期种植对前牙美学区种植体周边软组织的影响。方法:随机抽取我院于2015年8月至2019年8月期间收治的60例单颗前牙缺失患者,其中有30例患者于拔牙后行即刻种植(观察组),30例拔牙后行早期植入(对照组),均予以Astra Tech种植体及种植体植入半年后给予氧化锆全瓷修复,并在半年后复查,对比分析两组患者的红色美学评分(PES)等。结果:两组患者对比PES总分和各节点PES评分无明显差异(P>0.05)而在各节点PES评分中,牙龈生物型和牙槽骨缺损、远中龈乳头,缺失牙位和牙龈高度及缺牙原因和近、远中龈高度存在显著相关性。结论:即刻种植和早期种植对前牙美学区种植体周边软组织之间的影响差异不明显,对前牙美学区种植体修复时软组织美学产生的主要影响包括缺失牙位、牙龈生物型及缺牙原因。     

牙冠延长术改善前牙修复美观效果的临床观察

目的探讨对过短前牙行牙冠延长术的手术方法、术后修复时间、适应证及美学效果。方法对22例患者的148颗过短前牙行牙冠延长术后再行修复治疗，用改良Ryge标准动态评价牙龈、牙周情况，用Kay牙齿美学分类标准评价患牙治疗前后的美观效果。结果牙冠延长术结合修复治疗后，22例患者牙齿的美观效果均达Kay牙齿美学分类ClassⅡ-Ⅰ（化妆）或ClassⅡ-Ⅰ标准。修复后2周复查时约7．4％患牙的牙龈有较明显的炎症。经治疗及口腔卫生保健指导后，98．6％的患牙在修复6个月以上复查时，牙龈、牙周健康状况良好。2例患者随访4年余，其牙龈、牙周均无炎症表现，牙冠比例保持正常。结论通过正确的适应证选择、准确的修复设计、精细的手术操作、术后足够的牙龈恢复期及正规的口腔卫生保健，牙冠延长术结合修复治疗可获得满意的前牙修复美观效果。     

The level of buccal gingival margin around single and two adjacent implant restorations: a preliminary result

STATEMENT OF PROBLEM

Little information is available about the buccal gingival level of multiple implant restorations.

PURPOSE

This study was aimed to evaluate the relationship between width and height of buccal soft tissue around single and 2 adjacent implant restorations.

MATERIAL AND METHODS

Four implant restoration groups (first and second molars, single second molars, posterior single restorations between teeth, and anterior single restorations between teeth) were randomly chosen from one dental institute. Each group comprised of 6 patients. After 6 months of function, silicone impressions were taken and stone models were fabricated for each restoration group. The stone models were cut in bucco-lingual direction at the most apical point of buccal gingival margin. The height and width of buccal supra-implant soft tissue were measured. One way ANOVA and Tukey HSD post hoc tests were performed to analyze the data obtained (P < .05).

RESULTS

The most unfavorable width-height ratio was noted for the group, which was comprised of the second molar in the multiple adjacent (first and second molar) implant-supported restorations. The group also resulted in the shorter height of buccal supra-implant mucosa rather than that of anterior single implant restorations between natural teeth.

CONCLUSION

To achieve a favorable level of buccal gingival margin, greater thickness of buccal supra-implant mucosa is required for the implant restorations without a neighboring natural tooth compared to the implant restorations next to a natural tooth.     

个性化铸瓷复合基台在前牙种植美学修复中的临床应用

目的 评价个性化铸瓷复合基台在前牙区软硬组织缺损病例中种植修复的美学效果。方法 选择因种植区软硬组织不足而存在基台金属色外露、角度偏差太大、义齿牙冠过长和龈乳头缺失等问题,成品基台修复无法达到完善美学效果的上颌前牙区种植义齿修复患者52例,在常规可铸金属基台表面复合铸造陶瓷制作个性化基台并完成铸造全瓷外冠,改善牙颈部透黑现象。种植义齿修复后3、6个月复诊,对美学效果进行评价。结果 52例患者共制作了63件修复体,均改善了牙颈部透黑现象,收到了较理想的美学效果。观察期内牙龈健康,未见牙龈继续退缩与种植体周围炎发生。结论 个性化铸瓷复合基台可有效地改善软硬组织不足患者上颌前牙区种植义齿的美学效果。