无牙颌种植固定修复的咬合分析

目的 探讨全口无牙颌患者应用固定种植修复后的咬合特点。方法 选取30例全口无牙颌种植固定修复患者作为试验组,30例天然牙列受试者作为对照组,使用Teetester数字化咬合分析系统分析二者在牙尖交错位、前伸颌位、侧方颌位等不同位的咬合时间及咬合力分布等特点。结果 牙尖交错位时,试验组的咬合接触时间、最大咬合力均小于对照组（P<0.05）,而最大咬合力时左右侧咬合力平衡度则相反;前伸颌位时,试验组的咬合分离时间小于对照组（P<0.05）;侧方颌位时,试验组的咬合接触时间小于对照组（P<0.05）。二者的平均咬合压力、前牙区总受力百分比、侧方颌的颌型均无统计学差异。结论 全口无牙颌种植固定修复患者牙尖交错位时的最大咬合力会降低,但与天然牙列相似的是,前伸颌位时咬合力量均集中在前牙区,侧方颌位时均以组牙功能为主。     

种植义齿修复牙列缺失后嚼肌肌电活动变化及意义

目的：评价种植义齿修复牙列缺失后咀嚼功能的改善程度。方法：应用种植覆盖义齿及固定义齿修复牙列缺失，定量分析嚼肌肌电图，并对照天然牙列及常规全口义齿修复。结果：在ICP位最大紧咬时，种植覆盖义齿的AMP值明显大于常规义齿，对应嚼肌较高肌力水平，在承受50％MVC时，其MPF值与对照组无显著差异，但150s出现明显下降变化。结论：种植覆盖义齿修复较常规全口义齿明显提高咀嚼功能，种植固定义齿的修复优势未能体现是因为患者担心咬合力过大造成种植体及上部结构破坏。     

单侧游离缺失不同修复方法的咬合力学分析

目的分析单侧游离缺失不同修复方法咬合力分布情况与特点及与天然牙列咬合力分布的差异。方法采用T—Sean咬合分析仪进行体内咬合力分布及咬合时间的测定。实验组为单侧游离缺失患者,按照修复方法不同分为种植组（种植固定义齿修复患者,15名）和支架组（铸造支架活动义齿修复患者,13名）。对照组为正常牙列（15名）。比较种植组、支架组与正常组咬合力分布的差异。结果从出现牙尖交错位到最大咬合力的时间：正常组、种植组和支架组的均值分别为：0．39s、0．42s和0．62s,三组间差异无统计学意义。正常组与种植组、支架组左右向位移均无显著性差异;正常组与支架组有显著性差异。正常组、种植组和支架组3组之间前后向位移均有显著性差异。结论种植义齿和活动义齿修复区域均出现咬合力偏低趋势,但种植义齿达到牙弓的左右向咬合平衡,与对侧天然磨牙咬合力较接近,较接近天然牙列的咬合力分布。而活动义齿在牙弓的左右向和前后向都未能达到天然牙列的咬合力平衡。     

咬合支持丧失患者修复前后咀嚼肌表面肌电分析

目的：探讨咬合支持丧失患者修复前后咀嚼肌肌电的变化。方法：对24例咬合支持丧失患者进行常规修复,记录不同时期双侧咬肌和颞肌前束在下颌姿势位及牙尖交错紧咬位时的肌电活动,分析肌电幅值、不对称指数及咬肌/颞肌活动指数的变化。结果：（1）修复前后下颌姿势位肌电变化,咬肌肌电幅值和不对称指数在不同时期无明显变化（P〉0.05）;颞肌肌电幅值和不对称指数在义齿戴用3个月以上后显著小于义齿早期（P〈0.05）;咬肌/颞肌前束活动指数在各时期均小于0。（2）修复后牙尖交错位紧咬时肌电变化,咬肌及颞肌前束肌电幅值在戴牙3个月后显著高于戴牙早期（P〈0.05）;不对称指数与初戴牙时接近（P〉0.05）,较戴牙1周及1个月显著减小（P〈0.05）。咬肌/颞肌前束活动指数值在各时期均接近0。结论：咬合支持丧失患者进行咬合重建过程中,咀嚼肌肌电活动在不同时期有所变化。肌电测量可为咬合重建效果的评价提供参考。     

铸瓷高嵌体修复牙体严重缺损的年轻恒磨牙的效果分析

目的 评价铸瓷高嵌体修复严重缺损的年轻恒磨牙的临床效果。方法 选取牙体严重缺损的第一恒磨牙60颗,随机分为2组,分别进行树脂直接充填（树脂组）和铸瓷高嵌体修复（高嵌体组）。在修复后3、6、12、24个月检查两组患牙的修复体状态及咬合情况。按照改良USPHS/Ryge标准对修复体进行评价,使用T-Scan Ⅲ咬合分析系统进行咬合分析,记录牙龈状况和邻接关系恢复情况。结果 治疗后12个月,两组边缘适合性评分的差异有统计学意义,高嵌体组的A级多于树脂组（P<0.05）。治疗后12和24个月,两组表面光滑度评分的差异有统计学意义,高嵌体组的A级多于树脂组（P<0.05）。树脂组的患牙与对侧同名牙力百分比的差异均有统计学意义,患牙平均力百分比低于对侧同名牙（P<0.05）;而高嵌体组的患牙与对侧同名牙力百分比的差异均无统计学意义（P>0.05）。两组的牙龈状况和食物嵌塞情况均无明显差异（P>0.05）。结论 在本研究条件下,高嵌体组在修复体边缘适合性和表面光滑度方面,成功率较树脂组高,咬合力恢复也较树脂组更佳。在修复牙体严重缺损的年轻恒牙时,铸瓷高嵌体修复可作为推荐方案之一,有较好的修复效果。     

铸瓷高嵌体修复牙体严重缺损的 年轻恒磨牙的效果分析

目的 评价铸瓷高嵌体修复严重缺损的年轻恒磨牙的临床效果。方法 选取牙体严重缺损的第一恒磨牙60颗,随机分为2组,分别进行树脂直接充填（树脂组）和铸瓷高嵌体修复（高嵌体组）。在修复后3、6、12、24个月检查两组患牙的修复体状态及咬合情况。按照改良USPHS/Ryge标准对修复体进行评价,使用T-Scan Ⅲ咬合分析系统进行咬合分析,记录牙龈状况和邻接关系恢复情况。结果 治疗后12个月,两组边缘适合性评分的差异有统计学意义,高嵌体组的A级多于树脂组（P<0.05）。治疗后12和24个月,两组表面光滑度评分的差异有统计学意义,高嵌体组的A级多于树脂组（P<0.05）。树脂组的患牙与对侧同名牙力百分比的差异均有统计学意义,患牙平均力百分比低于对侧同名牙（P<0.05）;而高嵌体组的患牙与对侧同名牙力百分比的差异均无统计学意义（P>0.05）。两组的牙龈状况和食物嵌塞情况均无明显差异（P>0.05）。结论 在本研究条件下,高嵌体组在修复体边缘适合性和表面光滑度方面,成功率较树脂组高,咬合力恢复也较树脂组更佳。在修复牙体严重缺损的年轻恒牙时,铸瓷高嵌体修复可作为推荐方案之一,有较好的修复效果。     

视觉反馈诱导下升颌肌不同水平主动收缩的表面肌电研究

目的:探索持续紧咬、咬合力水平和视觉反馈三因素对正中紧咬时颞肌前束和咬肌的肌电活动水平是否存在协同作用。方法:应用T-Scan III咬合分析仪和BioEMG III肌电图仪同步记录25例健康正常成年人以轻度、中等、最大咬合力做正中紧咬时双侧颞肌前束(TA)和咬肌(MM)的肌电活动,并以多因素方差分析方法分析咬合力水平、力值视觉反馈和维持因素对肌电活动的影响。结果:析因分析结果显示,双侧TA和MM的肌电活动水平均随咬合力增高以及力量维持而增强(P<0.001),而且咬合力水平与维持因素之间存在交互作用(P<0.01),力值视觉反馈下仅一侧肌电(右侧TA和左侧MM)维持在目标水平(P>0.05)。结论:维持一定的咬合力水平将增加咬肌和颞肌前束的肌电活动,维持努力与咬合力水平之间存在交互作用。咬合力水平视觉反馈对降低肌电活动水平有一定的作用。     

肌位咬合板对颅颌功能紊乱者咀嚼肌肌电图的影响

目的：研究肌位咬合板对颅颌功能紊乱（ Ｃ Ｍ Ｄ）患者咀嚼肌肌电的影响,探讨其作用机理。方法：采用美国 Ｅ Ｍ２ 型肌电仪记录１０２ 例患者带咬合板前后的姿势位（ Ｍ Ｐ Ｐ）及牙尖交错位（ Ｉ Ｃ Ｐ）最大紧咬时的肌电变化。结果：（１）即刻戴入咬合板后颞肌前束（ Ｔ Ａ）与嚼肌（ Ｍ Ｍ）的 Ｍ Ｐ Ｐ高电位明显降低（ Ｐ＜ ０．０５）;治疗后不戴咬合板复查, Ｔ Ａ、颞肌后束（ Ｔ Ｐ）和 Ｍ Ｍ 肌紧张缓解。（２）戴咬合板紧咬双侧 Ｔ Ａ、 Ｔ Ｐ 和 Ｍ Ｍ 的肌电活动显著减小（ Ｐ＜ ０．０５）, Ｍ Ｍ 的肌电活动对称性明显提高（ Ｐ＜ ０．０５）,活动指数显著增加（ Ｐ＜０．０５）。结论：肌位咬合板能明显降低升颌肌最大紧咬的肌电活动,提高嚼肌的肌电活动对称性及活动指数。     

通过种植修复进行全口咬合重建:病例报道

目的:对一列上颌无牙颌患者采用Nobel guide种植修复,下颌牙列缺损采用常规种植固定桥修复.评价和探讨种植修复在全口咬合重建中的应用.方法:患者女性,59岁.上颌无牙颌,全口义齿修复.下颌两侧后牙牙列缺损,固定义齿修复.自诉上颌义齿固位不佳,不能咀嚼,下颌固定义齿松动.拔除下颌松动基牙,取上下颌模型,上诊断合架,制作义齿的诊断蜡型.取得上颌骨的CT数据,制作Nobel Guide模板及即刻临时固定种植义齿.术中利用Nobel Guide模板在上颌植入6颗种植体,并带入预成的临时即刻义齿.下颌按常规在左右后牙区各植入2颗种植体.三个月后,上颌制作个性化纯钛固定种植义齿支架+高强度树脂修复.下颌制作氧化锆全瓷修复(Procera系统).结果:获得了理想的上下颌咬合关系及正常的咬舍曲线.患者的咀嚼效率和美观均得到了很大的改善和提高.结论:利用种植修复进行全口咬合修复是可行的.通过制定缜密的治疗方案是可以达到很好的效果.     

过渡性治疗义齿在疑难全口义齿修复前的临床应用初探

目的 探讨治疗义齿在疑难全口义齿修复前的临床应用价值。方法 选择36例疑难全口病例修复困难或失败的患者,针对修复困难或失败的原因,应用治疗义齿改善不利于义齿修复的多种因素,通过治疗义齿复制,完成最终义齿修复。采用颌位关系指数、固位力及稳定性评分、口腔健康影响程度-EDENT量表评价治疗过程的有效性。结果 36例患者中,33例患者获得有效治疗,顺利完成最终义齿修复,且修复效果良好。结论 治疗义齿是一种行之有效的治疗方法,能纠正咬合和黏膜面问题并作为口颌系统神经及肌肉康复训练的工具,有助于最终义齿修复,值得临床推广和应用。     

Modification of denture teeth for improved occlusal stability of a maxillary removable complete denture opposed by a mandibular implant-supported fixed complete denture: A clinical report

Wear of artificial teeth is the most common complication associated with an implant-supported fixed complete denture (ISFCD). This wear alters the occlusal scheme, with loss of eccentric occlusal balance and vertical dimension of occlusion (VDO). This clinical report describes the fabrication of a new maxillary removable complete denture opposing an existing ISFCD with occlusal modifications. Both prostheses received splinted zirconia crowns cemented with composite resin cement.     

In vivo evaluation of occlusalcontact area and maximum bite force in patients with various types of implant-supported prostheses

Abstract

Objective. To determine the effects of various implant retained and/or supported prostheses on number of occlusal contacts (NOC), occlusal contact area (OCA)and maximum bite force (BF). Patients and methods: In total, 56 patients were included in the study; five test groups and two control groups. The patients in the treatment groups received implant-supported/retained prosthesis; over-dentures retained with two individual attachments in occlusion with complete denture, with four individual attachments in occlusion with complete denture, with four individual attachments in occlusion with fixed partial dentures or natural dentition, 6-implant retained fixed bridges in occlusion with natural dentition and 8-implant retained fixed bridges in occlusion with natural dentition. The patients in control group 1 were wearing conventional complete maxillary and mandibular dentures, whereas in control group 2 they had fixed full-arch porcelain-fused to metal restorations prostheses for both arches. Dental Pre-scale was used measure the NOC, BF and OCA. Results. There was no statistically significant difference between the treatment and control groups, among the groups with regards to NOC. OCA demonstrated different results among the removable and fixed reconstruction groups. With regards to BF, removable dentures supported with four implants showed higher bite force values than controls and two implant over-dentures. Also, a fixed reconstruction using eight implants showed higher BF values than a fixed reconstruction using six implants. Conclusion. Use of implants for removable dentures and fixed reconstructions improve occlusal contact area and bite force.     

第一磨牙缺失不同修复方法的咬合接触特征研究

目的 针对单个第一磨牙缺失的病例,研究种植及可摘局部义齿（RPD）种不同修复方法所恢复的牙列咬合接触特征。方法 选择15名单个第一磨牙缺失的患者作为实验组,15名正常牙列人群作为对照组,其中,实验组每位患者同时进行种植及RPD修复,应用TeeTester咬合分析仪,测试对照组和实验组在未修复、RPD修复及种植义齿修复后3种状态下分别做正中咬合及咀嚼运动,分析其咬合接触特征(总咬合力、总接触面积、不平衡指数、单次咀嚼循环时间,OT/DT比值),并进行统计学分析。结果 患者做正中咬合时,在总咬合力、总接触面积、不平衡指数方面,患者未修复时分别为（48.76±12.82）kg,（317.59±58.47）mm2,（24.78±7.40）,行RPD修复时分别为（54.36±10.59）kg,（355.81±77.43）mm2,（18.29±8.42）,行种植修复时分别为（61.94±12.36）kg,（398.17±83.86）mm2,（17.80±6.69）;患者咀嚼运动时在总咬合力、总接触面积、不平衡指数、单次咀嚼循环时间及T0/Td方面,患者行种植修复时分别为（52.14±16.53）kg,（348.08±81.76）mm2,（15.69±9.16）,（0.4072±0.10）s,（1.718±0.26）。统计学分析表明,RPD、种植义齿修复和对照组的部分咬合接触特征结果无显著性差异,但与未修复前结果有显著性差异。单次咀嚼循环时间及T0/Td在各组间均无显著性差异。结论 在恢复咬合力及咬合接触面积方面,种植义齿优于RPD,较接近天然牙列,并明显优于不修复。正中咬合时全牙列的总咬合力及总接触面积明显大于咀嚼运动时,但不平衡指数无明显统计学差异。     

Occlusal contacts of edentulous patients with mandibular hybrid dentures opposing maxillary complete dentures.

The purpose of this study was to evaluate differences between the occlusal contacts of edentulous patients with mandibular implant-supported hybrid dentures opposing maxillary complete dentures and those of patients with conventional maxillary and mandibular complete dentures. Six parameters related to occlusion were measured in the 2 groups (n = 40 for each group) using pressure-sensitive film. The mean values generated by each test group for each parameter were compared using a t test. Pearson's correlation coefficients between occlusal force, age, and time in function were examined. Occlusal force and area in the implant denture wearers were larger than those in the conventional denture wearers. No significant difference was seen in occlusal force balance between the left and right sides. The center of occlusal load in the implant denture wearers was more anterior. The maxillary denture may become more unstable in implant denture wearers. It is suggested that the stability and retention of a maxillary denture be checked and the occlusion be adjusted more frequently in the hybrid denture wearer than in the conventional denture wearer.     

Avoiding osseous grafting in the atrophic posterior mandible for implant-supported fixed partial dentures: a report of 2 cases

Bone atrophy occurs after tooth extraction in the posterior mandible, placing the mandibular canal and its neural, arterial, and venous contents closer to the osseous facial aspect and the coronal crest. This proximity places the structure in danger of damage when dental implants are surgically placed to support fixed or removable prostheses. Several options are available to treat these areas for implant-supported fixed and removable complete or partial dentures. Osseous grafting and ridge expansion are surgical options that enable acceptance of standard sized dental implants but have serious morbidities. Additionally, vertical osseous augmentation is not predictable at this time. Narrow diameter dental implants can be placed to avoid the mandibular canal, but some bone volume situations preclude this. Very wide and very short (6.5 × 5 mm) dental implants may be placed at an angle in atrophic sites to successfully support fixed partial dentures. An anterior guidance occlusal scheme may be used in maxillary dentate patients or group function in maxillary complete denture patients. A 100 micron occlusal relief in fixed partial dentures in dentate patients may be required to account for natural tooth intrusion and to prevent occlusal overload of the implant-supported partial denture.     

A simplified approach to implant-supported metal-ceramic reconstruction

Restoring the edentulous patient with an implant-supported fixed complete denture prosthesis is a challenging procedure. The patient's occlusal vertical dimension, centric relation position, esthetics, and phonetics should be maintained throughout the restorative process, while the patient is traditionally wearing a removable prosthesis. This article presents an alternative treatment philosophy that addresses these concerns and guides the restorative process using a fixed provisional restoration made from the patient's removable complete dentures.