无牙颌牙槽嵴严重萎缩总义齿修复体会

无牙颌牙槽嵴严重萎缩总义齿修复体会四川省自贡市第四人民医院（６４３０００）张杰无牙颌牙槽嵴严重萎缩进行总义齿修复是目前口腔修复中经常遇见的情况。总义齿修复效果较差，固位不好。笔者对２９例无牙颌牙槽嵴严重萎缩的病人进行了总义齿修复，据临床应用，效果满意...     

液体支持式义齿

一、概述无牙颌或牙齿缺失较多的患者,经过全口义齿或复杂的可摘局部义齿修复后,由于缺牙区牙槽嵴要承受义齿咀嚼时的压力,而牙槽嵴本身又缺少生理性的刺激,导致牙槽骨的萎缩吸收。使义齿基托的组织面与承托区之间存在间隙,影响义齿的固位和稳定;有时出现口腔软组织的创伤炎症,导致修复失败。     

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全口义齿是一种传统的修复方式,因口内无牙,义齿的固位困难,牙槽嵴低平患者的义齿固位更加困难;低平的牙槽嵴表面的黏膜薄,很容易产生压痛.固位不良、咬合疼痛就无法发挥咀嚼功能,更谈不上美观,这些问题一直是牙槽嵴低平患者全口义齿修复的难点.近年来从固位原理、临床制作技术、义齿粘附制剂、基托软衬材料、种植技术等方面都有了一定的进步.     

牙槽嵴增高术

无牙颌病人牙槽嵴广泛吸收,使牙槽嵴变低变窄、凹陷或呈刀刃状,义齿基托与牙槽嵴附着面缩小,影响义齿固位,不能达到恢复咀嚼功能的目的。当下颌骨严重萎缩时,下颌骨下缘厚度可少于1 cm,甚至经不起正常咀嚼压力,而出现自发性骨折。这些病人需要用手术的方法使牙槽嵴加高,才能获得满意的义齿修复效果。近年来,对口腔硬、软组织的各种矫正方法的发展,为病人提供了镶牙一手术联合修复的方法,为支持义齿行使功能提供一个合适的硬、软组织结构。本文将近年来前庭沟成形术和牙槽嵴加高术的发展和外科手术方法作一介绍。一、牙槽骨萎缩的原因无牙颌病人牙槽骨吸收的速度,与失牙原因、失牙时间、骨质致密程度以及全身健     

用人工骨重建牙槽嵴后的全口义齿咀嚼效能测定

近几年来,对牙槽嵴严重萎缩,牙槽嵴变得极度浅平,狭窄或呈刀刃状的无牙颌病人,为使义齿获得良好的固位及稳定,发挥其咀嚼功能,已采用人工骨来重建严重萎缩的牙槽嵴。本文对1987年10月以来用人土骨(颗粒型生物活性玻璃陶瓷)重建牙槽嵴后修复的6例全口义齿病人,比较测定了其咀嚼效能,现报道如下:     

舌侧集中[牙合]全口义齿修复低矮牙槽嵴的临床体会

目的:观察分析舌侧集中[牙合]义齿修复低矮牙槽嵴的临床效果。方法:选取2017年8月~2019年10月我院口腔科门诊诊治的14例无牙[牙合]患者,予以舌侧集中[牙合]义齿修复。统计患者对修复效果的主观满意度及随访3个月后的修复效果。结果:14例患者中,3例经过1周、11例经过2~4周练习后,义齿固位良好,咀嚼功能得到了较好的恢复;随访3个月后,10例满意,4例基本满意,主观满意率为100%。随访过程中,14例患者在第3周对修复外观和心理状况方面满意;在第4周对发音和咀嚼效率方面满意;3个月后对义齿固位和舒适性满意。结论:舌侧集中牙合全口义齿修复方式可有效改善低矮牙槽嵴无牙[牙合]患者的咀嚼效能,具有制作简便、固位稳定、舒适、美观的优势,值得临床推广应用。     

牙槽嵴条件对全口义齿修复影响的临床研究

探讨无牙颌牙槽嵴条件，特别是下颌牙槽嵴条件对全口义齿修复效果的影响。方法无牙颌患者６２人，条件好组３０人，条件差组３２人，测试上下总义齿和固位力，咀嚼效率，和第一月，第三月的全口义齿满意度。结果不同牙槽嵴条件两组间的固位力，咀嚼效率，和第一月，第三月的总满意度及各单项满意虽略有差别。     

老年人牙槽嵴萎缩缺损骨移植术的应用体会

各种原因导致的牙列缺失,往往引起牙槽嵴萎缩缺损和骨量丧失,从而造成义齿修复固位不理想,特别是下颁牙列缺失全口义齿修复。因此,寻求合理的牙槽嵴修复重建方法具有重要的临床意义。我院口腔科近年来采用自体髂骨移植术修复下颔牙槽嵴萎缩缺损患者13例,而后进行活动义齿修复,取得了较好的效果。     

活性玻璃陶瓷植入牙槽窝预防牙槽嵴萎缩的临床效果观察

牙齿摘除以后,牙槽骨逐渐萎缩,使牙槽嵴变低、变窄,甚至呈刀刃状,这是临床上常见的现象,尤以无牙颌患者最为常见。牙槽嵴的这种变化,直接影响了义齿的固位与功能恢复。以往为了解决这类患者义齿修复中的困难,通常是先行外科手术——前庭沟形成术、牙槽嵴植骨加高术等,而后才行义齿修复。但由于适应症的限制和材     

球帽附着体种植覆盖义齿在萎缩下颌无牙颌的应用

目的 探讨球帽附着体种植覆盖义齿在牙槽骨萎缩的下颌无牙颌病例中的应用。方法 用Endo—pore Dental Implant System种植体，球形基台和弹性橡皮帽，为15例牙槽嵴萎缩下颌无牙颌病人作球帽附着体种植覆盖义齿，观察义齿的固位力、稳定性和咀嚼功能，随访0．5—3年。结果 球帽附着体种植覆盖义齿能显著提高下颌全口义齿的固位力和稳定性，改善咀嚼功能，病人满意。结论 球帽附着体种植覆盖义齿修复能显著改善牙槽嵴萎缩的下颌全口义齿的功能。     

按扣型附着体下颌种植覆盖义齿咀嚼效率比较

目的：观察不同支持形式的下颌按扣型附着体种植体覆盖义齿的咀嚼效率。方法：8名患者下颌两侧颏孔之间各植入6个种植体。种植体骨结合后,制作下颌覆盖义齿,分阶段安装太极扣附着体阳性部件。测试2种植体覆盖义齿,4种植体覆盖义齿和6种植体覆盖义齿的咀嚼效率。并进行比较分析。结果：对于采用具有垂直运动的万向绞链按扣型附着体作为连接装置的种植体覆盖义齿,4种植体和6种植体覆盖义齿的咀嚼效率高于2种植体覆盖义齿。6种植体覆盖义齿咀嚼效率与4种植体覆盖义齿咀嚼效率比较无差别。结论：采用上述连接装置,4个以上种植体用于固位、支持和稳定覆盖义齿,可以提高患者的咀嚼效率。     

双种植体支持的下颌覆盖义齿的临床应用

目的:评价双种植体支持的覆盖义齿的临床应用及其效果。方法:2003年11月至2010年10月间,选择下颌无牙患者52例,其中男性39例,女性13例,年龄46-72岁,在下颌两侧尖牙区植入2枚种植体,共104枚种植体,制作覆盖义齿,其中球帽式附着体30例,磁性附着体11例,Locator附着体11例。采用临床检查和x线检查评估。结果:所有种植体在观察期内未出现松动脱落,均保持稳定的骨结合,未见种植体周围炎发生。覆盖义齿的固位、稳定及咀嚼效果的满意度良好。3例球帽附着体2年后出现固位力下降、松动,经调整后固位力增强。4例磁性附着体患者磁体脱落,重新粘固后使用正常。4例患者义齿基托出现折断,折断部位均位于植体-附着体处。未出现基台的松动、折断或变形。结论:双种植体支持的下颌覆盖义齿临床效果可靠,制作方法简单,尤其适合牙槽骨吸收严重的无牙患者。     

下颌无牙颌种植修复设计体会

目的:探讨下颌无牙颌种植体植入位置、数目与修复设计的关系。方法:采用Frialit-2种植体36枚和Endo-pore种植体6枚对8例下颌无牙颌患者进行了种植修复,其中2例进行了杆卡覆盖义齿修复,2例球帽覆盖义齿修复,4例种植固定义齿修复。结果:二期手术时,42枚种植体均形成了良好的骨性结合。经6~24个月的临床修复观察,种植体负重6个月时骨吸收平均0.5mm±0.02mm,戴义齿12个月后骨吸收平均0.1mm±0.03mm。修复的种植义齿能较好地行使咀嚼功能,收到了满意的临床效果。结论:对于下颌无牙颌的种植患者,合理的治疗计划,对于保障种植义齿的修复效果及维持种植体的长期成功率是重要的。     

Patients' evaluation of two occlusal schemes for implant overdentures

Background: There is an absence of conclusive evidence for occlusal schemes in implant overdentures. Purpose: To investigate the consequences of two different occlusal schemes on levels of satisfaction for patients wearing implant overdentures. Materials and Methods: Within an existing randomized controlled clinical trial, a physiologic occlusal scheme was compared with a lingualized occlusal scheme for 18 selected participants all with implant overdentures. Nine participants had conventional maxillary complete dentures opposing mandibular 2‐implant overdentures; a further nine participants had maxillary 3‐implant overdentures opposing mandibular 2‐implant overdentures. All participants recruited had been wearing their original prostheses for 3 years with a bilateral balance occlusal scheme. The participants' existing satisfaction levels, as a baseline, were determined using visual analogue scale questionnaires. They were followed by similar assessments of two further occlusal schemes using 2‐month assessment periods. On completion of the study, the participants selected their preferred occlusal scheme and semiformal interviews were conducted to assess the rationale for their choices. Results: Baseline data showed all the participants had pre‐existing high satisfaction levels. Thereafter, of those participants that received lingualized occlusion first, 55.6% reported that the physiologic occlusion was better than lingualized occlusion. For those participants who received the physiologic occlusion first, 85.7% reported that physiologic occlusion was better than lingualized occlusion. On completion of the study, 64.7% of the participants preferred the physiologic occlusion, 35.3% preferred the lingualized occlusion. However, when the two groups' satisfaction scores were modeled using the three main key indicator questions (general satisfaction, general ability to chew, or general function), there were no significant differences between them. Conclusions: Within the limitations of a small number of participants, the majority of them still indicated a preference for a physiologic occlusion for implant overdentures. Improved function was given as the main indicator for that preference. Having implant overdentures in one or both jaws is not a formative factor in patient's opinions on occlusal schemes.     

无牙颌患者种植义齿修复

目的:无牙颌患者采用种植义齿修复可有效的增强义齿的固位,提高义齿的修复效果。方法:从1999年至2007年,对22例无牙颌患者,年龄45-82岁,行种植义齿修复,其中,有2例采用种植固定义齿修复,7例采用杆-卡式种植覆盖义齿修复,11例采用球-帽式种植覆盖义齿修复,1例采用双套筒冠种植覆盖义齿修复,1例采用磁性固位种植覆盖义齿修复。患者种植体植入2-9颗,共植入种植体97枚,种植体采用Frialit-2,Fri-alit-xive系统,观察时间108个月,采用临床检查、X线观察和患者主观评价等来评价种植体与骨组织结合状态,评价其义齿的修复效果。结果:观察期内发现1枚种植体脱(球-帽式固位种植体),1枚种植体未作修复,仍埋入在粘膜下的颌骨内。种植义齿修复后固位稳定作用良好,患者咀嚼有力,对义齿修复效果满意。结论:无牙颌患者种植义齿修复效果良好,患者满意度高。     

杆卡和球帽附着体下颌种植覆盖总义齿的短期放射学分析

目的：通过放射学观察了解杆卡和球帽附着体下颌种植覆盖总义齿的临床应用效果.方法：共完成2枚种植体支持杆卡下颌种植覆盖总义齿19例,球帽式下颌覆盖总义齿23例,对其定期进行放射学检查.结果：修复体完成1年时,两组病例种植体周围骨吸收之差异无显著意义.结论：杆卡和球帽附着体下颌种植覆盖总义齿修复1年后,其放射学评价结果无差异.     

One-stage operative procedure using two different implant systems: a prospective study on implant overdentures in the edentulous mandible

Background: Evidence‐based reports are needed to support the application of a one‐stage surgical protocol for unsplinted implants supporting mandibular overdentures. Purpose: To examine the feasibility and success of using two different dental implant systems (originally designed for two‐stage operative technique) using a one‐stage operative procedure in patients being rehabilitated with implant mandibular overdentures. Materials and Methods: The study sample involved 24 edentulous subjects (aged 55–80 yr) randomly allocated to two different implant systems, one with a machined titanium implant surface (Steri‐Oss, Nobel Biocare, Göteborg, Sweden) and the other with a roughened titanium surface (Southern Implants, Ltd., Irene, South Africa). Two unsplinted implants to support implant overdentures were placed in the anterior mandible of all patients, using a standardized one‐stage surgical and prosthodontic procedure. Primary stability and bicortical anchorage of the implants was mandatory before healing abutments were connected at the time of implant placement. Implant overdentures and their respective matrices were inserted following a standard 12‐week healing period. Data relating to mobility tests, radiographs, and peri‐implant parameters were documented at 12, 16, and 52 weeks after surgery. Results: A success rate of 95.8% for the Steri‐Oss and 100% for the Southern Implants was found, without any statistically significant differences in the marginal bone loss. Significant changes in Periotest values were observed for both types between 12 and 52 weeks (p <.001). Minor changes were observed in the peri‐implant parameters evaluated. Conclusions: These preliminary findings show a successful application of this one‐stage approach for unsplinted implants supporting mandibular overdentures with Steri‐Oss and Southern Implant Systems.     

杆卡和球帽附着体下颌种植覆盖义齿放射学对比研究

目的：了解杆卡和球帽附着体下颌种植覆盖义齿修复后种植体周齿槽骨的变化。方法：同顾性分析42例全颌牙缺失病例在下颌区各植入2颗种植体,行种植体支持覆盖义齿修复的病例,其中杆卡下颌种植覆盖总义齿19例,球帽式下颌覆盖总义齿23例。对其定期进行随访及放射学检查获得的数据进行总结。结果：杆卡和球帽附着体下颌种植覆盖义齿修复后2年,种植基牙周齿槽骨吸收情况经统计学处理没有差别。结论：杆卡和球帽附着体下颌种植覆盖义齿修复后,短期对种植体基牙周齿槽骨影响没有明显差别。     

种植体支持球帽附着体固位下颌覆盖全口义齿的临床应用

目的:评价种植体支持球帽附着体固位的下颌覆盖全口义齿临床应用效果.方法:随机选择15例下颌无牙颌患者,每例植入2枚种植体,共植入30枚,随访观察1-12个月,从患者满意度、临床检查及种植体X线片观察修复效果.结果:种植体支持覆盖全口义齿修复下颌无牙颌,义齿固位和咀嚼功能满意率分别为100％和93.3％,义齿稳固,咀嚼功...     

种植体支持球帽附着体固位下颌覆盖总义齿的临床应用

目的：探讨球帽附着体固位的下颌种植覆盖总义齿的临床效果。方法：随机选择18例下颌牙列缺失的患者,植入2颗种植体,利用球帽附着体固位制作的覆盖义齿,随访6个月—4年,从患者主观感受和X射线检查两方面观察修复效果。结果：覆盖义齿的美观、舒适、固位稳定性好,咀嚼效率高。结论：种植体支持球帽附着体固位的下颌覆盖义齿修复下颌牙列缺失患者临床效果好。