前牙冠桥修复计算机辅助设计系统的满意度评价

计算机辅助设计 (ＣＡＤ)是信息技术与设计技术密切结合而产生的一门高新技术 ,而人工神经网络又是当代信息科技的竞争热点。传统口腔修复中 ,前牙修复体的形状设计、技师的制作仅靠医生的设计卡 ,未见患者修复前牙齿牙列、牙根、唇形等情况 ,制作有很大的盲目性 ,而且患者在修复前无法预知修复后效果 ,缺乏治疗信心。将ＣＡＤ及人工神经网络技术引入口腔前牙冠桥修复设计 ,不但优化设计 ,突破旧有模式 ,同时也增进了患者、医生、技师间的信息交流和处理。基于神经网络的前牙冠桥修复体计算机辅助设计系统原理与实现的研究 ,是一种处于边缘…     

上颌前牙形态修复效果计算机模拟系统的建立

目的 将三维重建技术、计算机图像处理技术及三维动画设计软件与口腔修复学相结合运用于前牙修复体外形的模拟设计。方法 利用锥形束CT扫描重建标准的上颌前牙模型,建立标准牙齿外形数据库。在Windows XP 环境下,以3Ds Max三维动画设计软件为核心,MS SQL SERVER2000数据库为后台,前端应用程序使用Microsoft Visual C++6.0编写,建立上颌前牙形态修复效果计算机模拟系统,并应用于临床进行模拟修复。结果建立的上颌前牙形态修复效果计算机模拟系统操控方便,模拟修复的效果真实可靠。结论上颌前牙形态修复效果计算机模拟系统有助于患者对修复效果获得相对准确的理解和期望,为制作美观并符合患者期望的前牙修复体提供了一种有效的途径。     

数码摄影在瓷修复比色中的应用评价

目的 评价数码摄影在个别前牙美学修复中对提高美学效果所起的作用及存在的问题.方法 90例分别采用常规比色、常规比色加数码影像、技师直接比色的个别前牙瓷修复体病例,分别由患者本人和医师对修复体进行美观效果评价,同时测量修复体与同名天然牙的色差,分析3种不同方法得到修复体的美学效果的差异.结果 在患者满意度和修复体表面结构、颜色分布、切端半透明感、表面个性特征方面,常规比色加数码影像组与技师比色组相近,明显好于常规比色组,卡方检验差异有统计学意义;但在整体轮廓和整体色调方面,以及修复体与同名牙的总色差,3组间无显著差异.结论 数码摄影在个别前牙美学修复中可以明显提高患者满意度,提高修复体的颜色分布、表面形态结构、切端半透明性及表面个性特征等仿真美学效果,但仍需要其他手段协助准确的捕捉、描述基础颜色信息.     

暂时冠桥在前牙美容修复中形态信息传递作用

目的 解决前牙美容修复中形态信息在医患、医枝之间传递困难的问题。方法 为了美观需求对多个前牙同时修复的患者７４例，３１８颗牙取研究模型作诊断蜡型，并在临床制作暂时冠桥，医患共同观察暂时冠桥的修复效果，达到对前牙形态美观的共识并将戴用暂时冠桥时的模型提从给牙技师供复制形态。结果 修复体的形态能使医患满意。结论 通过暂时冠桥，牙形态信息能有效地在医患之间进行交流与传递。     

数码摄影辅助前牙全瓷修复比色和目测比色的对比研究

目的 前牙全瓷修复中分别应用数码摄影比色与目测比色后,比较分析患者对修复体整体形态、整体色调和个性特征的满意度。方法 76个上前牙单个二氧化锆全瓷修复病例随机分为2组,1组运用常规目测比色,1组运用单反数码相机口腔摄影,记录比色板与天然牙的色差和捕捉天然牙的各种特征(整体轮廓、整体色调、表面个体特征等),后把影像信息传递给技师仿真制作,对比2组患者对修复体的满意度。结果 数码摄影比色和目测比色在整体色调和个性特征的满意度有统计学差异(P<0.05),而整体形态的满意度无统计学差异(P>0.05),数码摄影比色优于目测比色。结论 在前牙美学修复中,利用数码摄影辅助比色,可以明显提高修复体的美学效果和患者的满意度。     

Photoshop用于前牙美学修复前的设计

目的：探讨将数码摄影和Photoshop用于前牙美学修复前设计的临床效果和指导意义。方法：选取100例要求前牙美学修复的患者,分为实验组和对照组,每组各50例。实验组为利用Photoshop进行修复设计组,对照组为常规修复设计组。实验组于修复前拍摄数码照片,并用Photoshop软件制作出预期效果图,经与患者沟通和调整后将二者传递给技师指导最终修复体的完成;对照组常规修复设计完成最终修复体。利用满意度评分表进行包括修复体形态、颜色、切端半透明性、表面结构和个性特征在内的满意度比较,并进行统计学分析。结果：两组患者对修复体形态和表面结构的满意度比较差异无统计学意义(P＞0.05),而对修复体颜色、切端半透明性和个性特征的满意度比较差异具有统计学意义(P＜0.01)。结论： Photoshop预期效果图可快速、直观地增进患者对修复后效果的理解,提高医患沟通的有效性,并能指导技师制作出更完美的修复体。     

二氧化锆全瓷冠修复成人前牙轻度错牙合的临床体会

目的运用二氧化锆全瓷修复技术,通过短期治疗,快速改善成人轻度错牙合并达到临床美学修复的效果。方法选取22例不愿或不适合进行长期正畸治疗的个别前牙错牙合成人病例,进行二氧化锆全瓷美学修复。修复后进行疗效评估,随访观察1年。结果修复后19例患者对修复效果满意,牙列恢复整齐美观,与邻牙、对颌牙及患者面部关系协调。结论成人前牙轻度错牙合用全瓷冠进行美学修复过程中,适应证的选择、前牙美学修复前的准备、标准化的基牙预备、过渡性修复体的制作、全瓷材料的选择等均为关键性因素。     

用复合树月旨重建天然的前牙切端

前牙需要修复的患者希望修复后的前牙与组成微笑的其他牙齿一样美观。因此，临床医生不仅要具有恢复牙齿生物学及功能的专业技术，还需要具有能够指导他们重现牙齿颜色及解剖的细微特征的审美观，使人们感觉不到修复体的存在。我们介绍了具有更好机械性能及光学特性的新型复合树脂，因对牙齿组织光学特性更深的理解，能使复合树脂直接粘结修复达到更加美观的效果。利用加入与牙体晶格一致的复合树脂的方法和作用，在适当的部位正确使用一定厚度的复合树脂，能够体现出色度的变化．从而使修复体表现出正常的光学特性。本文通过一病例描述复合树脂选择及选色的方法，同时介绍的复合树脂临床操作顺序可以在前牙切端修复体处重建天然牙的光泽。利用这项技术，可使树脂修复达到可预计的满意修复美学效果。     

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。     

无托槽隐形矫治联合修复治疗在前牙美学修复中应用的临床效果研究

目的　通过比较无托槽隐形矫治联合修复治疗与常规修复治疗在前牙美学修复中应用的临床效果,探讨无托槽隐形矫治在修复治疗中的临床应用价值。方法　选取2018年11月至2019年12月于中国医科大学附属口腔医院拟行前牙美学修复患者36例,随机分为研究组和对照组,每组18例。研究组患者先采用无托槽隐形矫治器对牙齿进行空间管理后,再进行修复治疗;对照组患者直接进行常规修复治疗。根据Kay牙齿美学分类标准,分别对治疗前后两组牙齿美学效果进行评价;根据Ryge评价标准改编的评分系统,对两组修复体美观性进行评分;由患者本人采用视觉模拟评分法对最终的修复效果进行满意度评分。结果　（1）治疗前两组患者牙齿美学分类主要为Ⅱ类和Ⅲ类,其差异无统计学意义（Z = -0.163,P > 0.05）。治疗后两组患者牙齿美学分类的分布不同,研究组牙齿美学效果优于对照组,差异有统计学意义（Z = -3.670,P < 0.05）。（2）研究组修复体美观性评分为（1.278 ± 0.286）分,低于对照组［（2.340 ± 0.808）分］,其差异有统计学意义（t = -5.223,P < 0.05）。（3）在修复体形态、与邻牙协调程度方面,研究组患者满意度高于对照组,差异有统计学意义（均P < 0.05）;在修复体颜色方面,两组患者满意度评分比较,差异无统计学意义（P > 0.05）。结论　无托槽隐形矫治联合修复治疗在前牙美学修复中应用,可达到更理想的美学效果。无托槽矫治在前牙美学修复治疗中具有较高的应用价值。     

Predictable esthetics through functional design: the role of harmonious disclusion

The goal of this clinical report is to describe and illustrate the principles for achieving a predictable esthetic result for patients with worn incisal edges by creating a harmonious angle of disclusion. Patients can create an esthetic problem from altered tooth form and tooth migration, caused by worn incisal edges resulting from parafunctional activity. This presents substantial challenges to the restorative dentist, paramount among them, achieving longevity of porcelain or composite bonded restorations used in an esthetic reconstruction. Although a number of therapies are available to provide esthetic improvement, the predictability in the continuing presence of the parafunction that caused the esthetic problem is in doubt. Altering the incisal edge position for esthetics and achieving a harmonious angle of disclusion, though, is a clinical approach that may substantially reduce this risk. CLINICAL SIGNIFICANCE: An angle of disclusion in harmony with a patient's envelope of parafunction reduces load on the anterior teeth and therefore may help reduce failure on the restored anterior teeth.     

牙齿个性化美学修复颜色信息的获取与传递

牙齿的微观美学指标包括形态、颜色、半透性、乳光性和荧光性、表面质感及光泽度、个性化染色着色特征等。只有进行系统全面的颜色信息获取和医技传递,才能实现修复体的个性化美学制作。牙齿的基本颜色按照颜色复杂程度准确进行分区确定,对切端颜色和半透明性信息进行个性化采集,同时定位获取牙体内部和表面的分区、分层个性化颜色信息,结合牙齿的形态学、表面质地和光泽度信息,采用口内数码影像向技师进行沟通和传递,这也成为当今牙齿个性化美学修复信息的系统化采集及传递的主要技术。本文就牙齿个性化美学修复颜色信息的获取与传递进行分析和阐述,以期为临床提供一定的指导。     

The Dahl principle: creating space and improving the biomechanical prognosis of anterior crowns.

There is an increased demand for restoration of anterior teeth based on esthetic requirements. Oftentimes, the teeth restored are compromised and have minimal remaining dentin after undergoing root canal treatment. Reduction of nonaxial forces by controlling incisal guidance is essential in improving the long-term prognosis of such situations. Another common complication when crowning anterior teeth is the lack of palatal space for restorative material. This is often evident in patients with anterior tooth wear and deep overbite. This article describes the Dahl principle, a conservative method for controlling incisal guidance and gaining palatal space for restorative material. A case presentation is used to illustrate the concepts discussed.     

Correlation between facial measurements and the mesiodistal width of the maxillary anterior teeth

One of the most difficult aspects during the selection of maxillary anterior teeth for a removable prosthesis is determining the appropriate mesiodistal width of the six maxillary anterior teeth. Many attempts have been made to establish methods of estimating the combined width of these anterior teeth, and improving the esthetic outcome. The proportion of facial structures and the relationship between facial measurements and natural teeth could be used as a guide in selecting denture teeth. The aim of this study was to verify the relation between the combined mesiodistal width of the six maxillary anterior teeth and the facial segments: the width of the eyes, the inner canthal distance (ICD), the interpupillary distance (IPD), the interalar width, and the intercommissural width (ICm). Standardized digital images of 81 dentate Brazilian subjects were used to measure both facial and oral segments when viewed from the frontal aspect through an image processing program. To measure the distance between the upper canines on a curve, accurate casts were made from the upper right first premolar to the upper left first premolar. The Spearman rank correlation coefficient was conducted to measure the strength of the associations between the variables (alpha = 0.05). The results showed a significant correlation between all facial elements and the combined mesiodistal width of the six teeth, when observed from the frontal aspect. The ICD, IPD, and ICm showed the highest probability of being correlated to the mesiodistal width of the teeth (p = 0.000). CLINICAL SIGNIFICANCE: This article considers facial analysis with digital photography as a practical and efficient application to select the mesiodistal width of artificial anterior teeth in an esthetically pleasing and natural appearance during an oral rehabilitation treatment.     

下前牙根管再治疗的临床研究

目的:经切缘开髓路径对下颌前牙根管治疗失败的病例进行再治疗,探讨下颌前牙开髓路径提高根管治疗的成功率。方法:临床收集79例下前牙因根管治疗失败后需要再治疗的患牙共计94颗,去除原根充材料,探查是否遗漏根管,采用经切缘开髓路径对患牙进行根管再治疗,治疗前后拍摄X线片,观察对比治疗前后根管的充填情况及下颌前牙根尖病变的愈合情况。结果:94颗患牙中共发现72例下前牙为双根管,其中下颌中切牙为双根管33例,下颌侧切牙为双根管19例,下颌尖牙双根管20例。所有患牙经根管再治疗后根管充填结果满意,患牙根尖病变明显好转。结论:下颌前牙切缘开髓根管路径趋于直线不仅视野良好,且能有效提高复杂根管的发现率及治疗成功率。     

The variability of the curvature of the labial surface of the upper anterior teeth along the facial axis of the clinical crown

OBJECTIVE: To mathematically assess the curvature of upper anterior teeth along the facial axis of the clinical crown (FACC) line to provide information valuable for assessment of enamel growth. METHODS: Forty upper study models were chosen from the Orthodontic clinic at the Charles Clifford Dental Hospital, Sheffield, UK. The study model incisors and canines were sectioned longitudinally down the FACC line, using a Microslice II cutting machine. Images were captured that showed the proximal view of the tooth curvature from incisal edge/cusp tip to the gingival margin. The images were converted into silhouettes and saved as bitmap files. These were vectorised and converted to an outline of xy data points. The forty xy files were mathematically adjusted so the distance between incisal edge and gingival margin were of equal length. Non Rotational Principal Component Analysis (PCA) was then applied at 20 equal intervals along the curve of each xy file to describe the shape of the teeth. RESULTS: Intra class correlation coefficient for intra-operator repeatability ranged from 0.821-0.998 showing good or excellent levels of reliability. PCA showed variation between tooth types. CONCLUSIONS: The method proved reliable. All tooth types showed that the mid-point region had the greatest rise variable, indicating that the most-prominent point was central or incisal for central and lateral incisors. All were skewed towards the incisal end and had kurtosis at both ends. Central incisors showed least variability. Greater variability was seen within the incisal third than within the gingival third for all tooth types.     

修复后前牙美学临床评价与患者满意度关系的初探

目的试分析修复后前牙美学的临床评价与患者满意度之间的关系，为进一步提高患者满意度提供依据。方法选取个别前牙全瓷修复患者90例，修复后由患者本人评价患者满意度。由医师根据修复体的整体轮廓、表面形态质地、整体色调、颜色分布、切端半透明度、表面个体特征与邻牙的相似程度，对修复体进行分级。采用独立样本t检验或方差分析，分析各美学评价指标不同级别间患者满意度的差异。测量修复体与同名天然牙间的色差，分析其与患者满意度的相关关系。结果除整体色调“良”、“中”两个级别问患者满意度的差异无统计学意义外（P=0．553），其他美学评价指标不同级别间患者满意度的差异均有统计学意义（P〈0．05）。修复体与同名牙间的总色差、明度差的绝对值及△a的绝对值与患者满意度相关，Spearman相关系数分别为-0．434、-0．371、-0．406（P〈0．05）。结论修复后前牙各项美学特征的临床评价与患者满意度均相关，其中表面形态质地、颜色分布、表面个体特征与患者满意度的关系更密切。修复体与同名牙的总色差及明度差与患者满意度有一定的相关性。     

Biomimetic approach to extensive fracture of anterior teeth--a case report

The fracture of anterior teeth in children and adolescents is a common injury. When most tooth structure is compromised and the broken fragment is not recovered, its restoration can become rather complex to both dentist and dental technician. Restoration of single anterior elements is one of the most demanding challenges in fixed prosthodontics. This article describes a clinical case of a 13-year-old patient with an extensive fractured central incisor and contra lateral incisor. Endodontic treatment was performed on both teeth, and a temporary removable appliance was made for esthetics. One month later, an indirect esthetic post and core was made for each tooth, and provisionals were placed. After a 6-month period of soft tissue stabilization, two pressed all-ceramic crowns were fabricated and bonded to the preparations. The authors believe this to be a stable long-term option relative to the reminiscent tooth structure, esthetic demand, and occlusal features of the case.     

Simulated shape design. Helping patients decide their esthetic ideal

BACKGROUND: Esthetic care is changing dentistry from a need-based to a want-based practice. Patients are asking for esthetic treatment, and clinicians are retooling their practices to satisfy this need. One important part of providing esthetic dentistry is ensuring that the patient is as well-informed as possible about treatment outcomes. DESCRIPTION OF TECHNIQUE: This article describes a tool dentists can use to show patients potential tooth sizes, shapes and arrangements before carrying out treatment. Simulated shape design, or SSD, is a reversible method of demonstrating potential esthetic outcomes that involves creating trial restoration shapes and placing them over a patient's teeth. SSD is a simple technique that any dentist can perform. In essence, the technician makes new tooth shapes in wax, the dentist places these in the patient's mouth and the patient evaluates them. The dentist then makes modifications in the SSD, which he or she reports to the technician. CLINICAL IMPLICATIONS: With the decisions of shape, arrangement and size made at chairside, the whole flow of esthetic treatment can be handled smoothly. Preparations can be cut more accurately to better support the restorative material; decisions can be made to open or not open the contacts; and shapes can be agreed on in the earliest stage of evaluation, then duplicated faithfully in the provisional and final restorations. There are no surprises for the patient, the dentist or the technician. Both the esthetic (smile design) and functional elements (anterior guidance) of the restoration can be checked with SSD. SSD could become the standard in determining whether or not to proceed with esthetic treatment.