覆盖义齿和全口义齿咀嚼功能的比较研究

目的：对比研究全口覆盖义齿和全口义齿的咀嚼功能。方法：选择13例全口覆盖义齿修复患者，14例全口义齿修复患者，测试咀嚼杏仁和小枣时的咀嚼效率，记录下颌运动轨迹；记录左右侧嚼肌，颞肌前束，颞肌后束在息止颌位，大力咬合和咀嚼小枣和杏仁时的肌电图。结果：覆盖义齿组咀嚼杏仁和小枣的效率显著高于常规总义齿组，下颌运动轨迹的规则性和末端集中性优于常规总义齿组，咀嚼运动中，覆盖义齿组颞肌前后束的肌电活动显著强于常规总义齿组，且肌电活动中提颌肌群的协同作用更加明显，结论：全口覆盖义齿对无牙颌患者咀嚼功能的恢复显著优于全口义齿，是一种良好的修复方式。     

CDIC种植体联合磁性附着体在种植覆盖义齿修复中的临床应用

目的：探讨CDIC种植体联合磁性附着体制作种植覆盖义齿修复牙列缺失的临床效果。方法：选取12例牙槽嵴萎缩或全口义齿固位不良的牙列缺失患者,在CDIC组合式骨内结合种植体支持的基础上,行磁性附着体覆盖义齿修复,对义齿的固位、咀嚼功能和使用情况进行2年的随访观察。结果：31枚种植体修复前均达到骨结合,平均愈合周期5个月;磁性附着体覆盖义齿修复后,义齿稳定,咀嚼功能、容貌改善明显,达到患者对美观和功能的要求。结论：CDIC种植体联合磁性附着体制作的种植覆盖义齿是修复牙列缺失的一种行之有效的方法,其性价比高,更宜临床推广应用。     

变异套筒冠全口覆盖义齿修复的临床观察

覆盖义齿是指义齿的基托覆盖并支持在牙根或牙冠上的一种全口义齿或可摘局部义齿。它常用于牙列缺损和缺失患者的修复治疗。变异套筒冠全口覆盖义齿就是基牙上只制作金属内冠,在其上制作的一种全口义齿。牙列缺损或牙列缺失后,患者的咀嚼功能降低,影响全身健康。传统总义齿修复     

下颌种植覆盖义齿修复后满意度的调查分析

目的 比较牙列缺失患者行下颌半口义齿和下颌种植覆盖义齿修复的主观感受。方法 对16例戴用下颌半口义齿后又行下颌种植义齿修复的患者，采用自拟修复前初诊问卷和种植修复后问卷调查，由患者本人就诊时填写。结果 种植固定义齿与下颌半口义齿在舒适、功能、固位等方面存在明显差异。结论 牙列缺失患者行下颌杆卡式种植覆盖义齿，较下颌半口活动义齿修复能更好地满足患者需求，获得高质量的义齿。     

下颌牙周病渐进缺牙致无牙颌的种植方案设计

目的：牙周病致牙列缺失的义齿修复是非常困难的,尤其是下颌骨低平条件较差的下颌牙列缺失修复。患者常抱怨义齿的压疼、固位稳定及咀嚼效率差。虽然牙种植体应用较好地解决了上述问题,但在临床中患者由于下颌后牙区骨高度不足且距下颌神经管较近,医疗风险及手术难度加大,使得种植覆盖义齿修复效果不如预期。本文目的是用种植体最佳分布结果指导临床牙周病渐进性拔牙病例设计种植修复方案。方法：通过分析牙周病致无缺牙行种植覆盖义齿修复的临床效果并对下颌无种植覆盖义齿三维有限元分析。结果：牙周病致无缺牙行种植覆盖义齿常规在两侧颏孔区之间种植2-4枚种植体,由于后牙区没有种植体支撑,从义齿修复受力原则及防止磨牙区及种植体周骨质吸收来讲不是最佳方案,最佳应在后牙区种植种植体。结论：牙周病治疗过程中在下颌缺牙的磨牙区植入1-2枚种植体,即便最后下颌自然牙全部缺失,可以常规在两侧颏孔区之间种植2-4枚种植体,结合前期植入的种植体共有6-8枚,可以考虑种植固定或者套桶冠固位进行下颌牙列缺失的种植修复,使种植修复效果达到最佳。     

种植义齿修复的咀嚼效能评价

咀嚼效能的测定可以客观反映咀嚼能力的大小,它是检测口腔修复效果的重要方法之一。新近的研究表明种植义齿修复后咀嚼效能明显改善,但不同的上部结构形式对种植覆盖义齿功能有一定影响;单侧后牙缺失患者经柱状种植体支持固定义齿修复后咀嚼效能与正常牙列人群咀嚼效能相似。     

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。     

基于口内扫描仪和种植模板的数字化全口覆盖义齿的临床应用

目的:探讨基于口内扫描仪和种植模板的数字化全口覆盖义齿的临床应用.方法:将2017年1月～2019年12月在我院口腔修复科进行治疗的牙列缺失患者64例随机分为对照组和实验组.对照组采用传统全口义齿修复法,实验组采用基于口内扫描仪和种植模板的数字化全口覆盖义齿修复.比较两组患者种植体成功率、种植体周围边缘骨吸收、种植体位置偏移以及义齿满意度的差异.结果:实验组患者种植成功率显著高于对照组,种植体周围边缘骨吸收低于对照组,实验组患者种植体肩部偏移、根部偏移、角度偏移、深度偏移均低于对照组,患者咀嚼功能、固定功能、舒适程度满意度均高于对照组,差异均具有统计学意义(P<0.05).结论:基于口内扫描仪和种植模板的数字化全口覆盖义齿应用于牙列缺失患者,能够提高患者种植成功率,降低种植体周围边缘骨吸收、种植体位置偏移,改善患者义齿满意度,具有较高的临床应用价值.     

全颌固定式种植义齿

目的：牙列缺失的种植义齿修复多采用覆盖义齿方式，但某些患者仍希望得到固定修复。Branemark的可拆卸固定全颌种植义齿技术复杂，美观清洁卫生等也不理想。本研究要建立一种牙列缺失的固定种植我齿修复模式。方法：11例有条件的无牙颌患者，在CDIC种植体支持基础上，用常规烤瓷溶附冠桥技术完全成颌固定式种植义齿修复。结果：1至5年的观察表明，该修复模式在咀嚼功能，美观性，舒适感及清洁卫生维护均获得满意结果。     

三种总义齿修复方式咀嚼效率对比研究

目的研究全口义齿、普通覆盖义齿、附着体式覆盖义齿3种义齿修复后的咀嚼效率。方法全口义齿组19例、普通覆盖义齿组15组、附着体式覆盖义齿组9例,每组各分男女2小组。采用吸光光度法对3种修复方式的咀嚼效率进行测试,将得出数据进行统计学分析。结果附着体式覆盖义齿组的咀嚼效率最高,全口义齿组最低。3组差异有统计学意义。结论附着体式覆盖义齿有较高的咀嚼效率,可作为临床上重度牙列缺损首选的总义齿修复方式。     

Neuromuscular coordination of masticatory muscles in subjects with two types of implant-supported prostheses

OBJECTIVES: To compare the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant-supported prostheses and implant overdentures. MATERIAL AND METHODS: Nineteen subjects aged 45-79 years were examined. Fourteen were edentulous and had been successfully rehabilitated with (a) maxillary and mandibular implant-supported fixed prostheses (seven patients); (b) mandibular implant overdentures and maxillary complete dentures (seven patients). Five control subjects had natural dentition or single/partial (no more than two teeth) tooth or implant fixed dentures. Surface EMG of the masseter and temporal muscles was performed during unilateral gum chewing and during maximum teeth clenching. To reduce biological and instrumental noise, all values were standardized as percentage of a maximum clenching on cotton rolls. RESULTS: During clenching, temporal muscle symmetry was larger in control subjects and fixed implant-supported prosthesis patients than in overdenture patients (analysis of variance, P=0.005). No differences were found in masseter muscle symmetry or in muscular torque. Muscle activities (integrated areas of the EMG potentials over time) were significantly larger in control subjects than in implant-supported prosthesis patients (P=0.014). In both patient groups, a poor neuromuscular coordination during chewing, with altered muscular patterns, and a smaller left-right symmetry than in control subjects were found (P=0.05). No differences in masticatory frequency were found. CONCLUSION: Surface EMG analysis of clenching and chewing showed that fixed implant-supported prostheses and implant overdentures were functionally equivalent. Neuromuscular coordination during chewing was inferior to that found in subjects with natural dentition.     

Effect of osseointegrated implants on the coordination of masticatory muscles: a pilot study

STATEMENT OF PROBLEM: The neuromuscular network of masticatory function is, in part, coordinated with afferent information provided by the periodontal ligament (PDL). Osseointegrated implant-supported prostheses lack this PDL-derived proprioceptive feedback mechanism. PURPOSE: This pilot study was designed to address the hypothesis that implant patients acquire different patterns of functional coordination. Patients with implant-supported prostheses were characterized in regard to masticatory muscle tenderness and fatigue as well as changes in the coordinated activities of masticatory muscles during chewing and maximal occluding force. Results were compared with those of patients with natural teeth and interpreted to assess the functional outcome of implant therapy. MATERIAL AND METHODS: Fifty-seven volunteers (25 partially edentulous patients restored with implantsupported fixed prostheses; 32 control patients) were evaluated. A comprehensive set of clinical examinations was performed, including occlusal analysis and examination of masticatory muscle and TMJ. EMG recordings of 5 volunteers from each group were further evaluated. EMG activities of the masseter and anterior temporalis were recorded during habitual chewing and voluntary maximal occluding force. RESULTS: There were essentially no differences in the clinical evaluations between volunteers in the implant and control groups and no significant alterations in the masticatory muscle coordination for habitual chewing. During the maximal occluding force measurement, EMG recordings revealed a unique masticatory muscle coordination pattern in the implant group with a tendency to activate the working and nonworking side muscles simultaneously. CONCLUSION: Patients with implant-supported prostheses appeared to be well adapted to perform habitual masticatory functions. However, during a nonhabitual function such as maximal occluding force, our pilot data revealed a less coordinated masticatory muscle activity in the implant patients.     

Maintenance of Implant Hybrid Prostheses: Clinical and Laboratory Procedures

Fixed implant hybrid prostheses have been used for the last 40+ years in the treatment of edentulous patients. These prostheses have provided long‐term masticatory function for thousands of patients. The original treatment protocol included fabrication of cast metal frameworks that fit accurately on the restorative platforms or abutments and/or endosseous implants. Frameworks were designed to splint implants together; they also provided retention and support for the functional and esthetic portions of the fixed hybrid prostheses. Initially, edentulous patients were treated with maxillary complete dentures and mandibular fixed, hybrid prostheses. Denture teeth were used in both prostheses. Over the span of many years, occlusal surfaces of the denture teeth in the mandibular prostheses exhibited signs of occlusal abrasion and wear, sometimes completely abrading the teeth and denture bases, resulting in framework exposures. Ultimately, this resulted in decreased chewing efficiency and loss of vertical facial height. Patients would then return to clinicians and ask for retreatment. In certain instances, the underlying frameworks would have to be remade. This involved replicating the original series of appointments and significant additional expense to patients and clinicians alike. The protocol presented in this article avoids having to remake the most expensive portion of fixed implant prostheses—the frameworks. The protocol identifies the clinical and laboratory procedures involved in using existing frameworks and replacing preexisting denture bases and denture teeth, with minimal inconvenience to patients.     

Electromyographic assessment of jaw muscles in patients with All‐on‐Four fixed implant‐supported prostheses

This study evaluated the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant‐supported prostheses according to All‐on‐Four^® principles and in control healthy dentate subjects. Twenty‐six subjects aged 50–74 years were examined. Eighteen were edentulous and had been successfully rehabilitated with (i) mandibular All‐on‐Four^® implant‐supported fixed prostheses and maxillary complete dentures (10 patients) and (ii) mandibular and maxillary All‐on‐Four^® implant‐supported fixed prostheses (eight patients). Eight reference subjects had natural dentition. Surface EMG recordings of the masseter and temporalis muscles were performed during maximum voluntary teeth clenching and during unilateral gum chewing. All values were standardised as percentage of a maximum clenching on cotton rolls. During clenching, a good global neuromuscular equilibrium was found in all participants. During chewing, all groups had similar values of working‐side muscle activities and of chewing frequency. No significant differences in the analysed EMG parameters were found between the patients with mandibular and maxillary All‐on‐Four^® implant‐supported prostheses and the reference subjects. In contrast, standardised pooled muscle activities and standardised muscular activities per cycle were larger in patients with a maxillary removable prosthesis than in control subjects (Kruskal–Wallis test, P < 0·01). Also, patients wearing a complete maxillary denture showed a poor neuromuscular coordination with altered muscular pattern and lower values of the index of masticatory symmetry than dentate control subjects (P < 0·01). EMG outcomes suggest that All‐on‐Four^® implant‐supported prostheses may be considered a functionally efficient treatment option for the rehabilitation of edentulous patients with reduced residual bone volume.     

种植义齿修复牙列缺损的咀嚼功能评价

目的　评价种植义齿修复牙列缺损的咀嚼功能。方法　以非种植义齿侧作为对照,采用吸光度法测定22 例患者种植义齿侧的咀嚼效能,同时对患者种植义齿修复后咀嚼功能的满意度进行问卷调查,分析患者种植义齿 侧的咀嚼效能与其咀嚼功能问卷调查得分的相关性。结果　局部固定种植义齿的咀嚼效能与非种植义齿(天然牙 及金属烤瓷固定义齿)无统计学差异(P>0·05),患者对种植义齿的咀嚼功能作出了肯定的回答,但咀嚼效能的测 试与患者的主观评分并不相关。结论　局部固定种植义齿能满足正常咀嚼功能的要求,绝大多数患者对种植义齿 的咀嚼功能表示满意,但患者对咀嚼功能的主观满意度可能受到诸多因素的影响。     

种植体磁性固位下颌覆盖总义齿的应用

目的：探讨种植体磁性固位下颌覆盖总义齿的临床应用。方法：在下颌全口缺牙且伴有牙槽骨重度吸收患的前牙区选择性植入2－4颗BLBC种植体，4－5个月后全口义齿修复，藏牙3周后，在种植体上旋转磁固位的上部结构并安装永磁体在相对应的义齿组织面内。分别测量患使用种植体一磁固位系统前后的固位力、咀嚼效率。结果：下颌总义齿的固位力、咀嚼效率在使用磁性固位体前、后均存在显性差异。结论：种植体支持的磁固位覆盖总义齿，对于改善下颌全口缺牙且伴有牙槽骨重度吸收患的咀嚼功能有一定作用。     

Electromyographic analysis of masticatory and neck muscles in subjects with natural dentition, teeth-supported and implant-supported prostheses

Objectives: To compare the electromyographic (EMG) characteristics of masticatory and neck muscles in patients with natural dentition, teeth‐supported prostheses and implant‐supported prostheses. Materials and methods: Twenty‐five subjects aged 40–80 years were examined. Five patients had maxillary and mandibular implant‐supported fixed prostheses; five patients had mandibular implant‐supported fixed prosthesis and maxillary removable complete denture; seven patients had implant‐supported fixed prosthesis (one arch) and natural dentition or full‐arch tooth‐fixed prosthesis (one arch); and eight control subjects had natural dentition or single tooth‐fixed prostheses. Surface EMG of masseter, temporal and sternocleidomastoid muscles was performed during maximum teeth clenching and unilateral gum chewing. Interarch dental contacts were assessed with shim stocks. Results: All groups had similar interarch dental contacts (P>0.05). During clenching, patients with maxillary and mandibular implant‐supported fixed prostheses had unbalanced standardized masseter and temporalis anterior activities (74%), with significantly larger values found in the other patients and control subjects (all mean values larger than 86%, P=0.017). All patients chewed with significantly larger muscular potentials than control subjects (on average, 1434–2100 μV s vs. 980 μV s, P=0.04), and had altered muscular patterns (left side, P=0.021). The patients with one arch with natural dentition/tooth fixed prostheses had chewing muscular patterns similar to the control subjects. Conclusions: Clenching with the analyzed prostheses was performed with a relative increment of temporalis activity. Neuromuscular coordination during chewing was larger in patients who maintained their teeth or dental roots, independently from the number of dental contacts.     

Changes in the masticatory function of complete denture wearers after relining the mandibular denture with a soft denture liner

PURPOSE: The purpose of this study was to examine changes in the masticatory function of complete denture wearers after relining the mandibular denture with a soft liner. MATERIALS AND METHODS: Conventional complete dentures were fabricated for 6 completely edentulous patients. One month after completing adjustments of the dentures, maximum biting force, masticatory performance, and electromyography of the masseter muscle during mastication were recorded. Chewing strokes, chewing time, muscular activity, and masticatory rhythm were calculated using the recorded electromyography. The mandibular dentures were then relined with a soft liner. One month after finishing adjustments of the relined dentures, the same tests were performed. These values were compared using a paired t test (alpha = 0.05). RESULTS: When using the soft liner, masticatory performance and maximum biting force were significantly greater (P = 0.019 and P = 0.023, respectively). In addition, the number of chewing strokes was significantly lower (P = 0.020), and chewing time was reduced (P = 0.010). A more stable masticatory rhythm was also found in the initial chewing stage. The muscular activity tended to decrease after the insertion of the lined denture, but no significant difference was found between before and after relining. CONCLUSION: It was shown that applying a soft lining material to the mandibular dentures of 6 edentulous patients improved masticatory function with no adverse effect on the muscular task.     

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。