无牙颌患者正中颌关系与前伸颌关系肌电研究

正中颌关系(CJR)是已确定垂直距离条件下的下颌对上颌的位置关系。前伸颌关系(PJR)是因下颌前伸而形成的下颌对上颌的位置关系。文献中关于无牙颌患者建立全口义齿正中(牙合)的颌位有分歧。本研究记录和分析无牙颌患者在控制验力条件下于CJR以及PJR咬合时的两侧嚼肌,颞肌的肌电活动,     

肌监控仪在确定无牙颌水平颌位关系中的应用

肌监控仪在确定无牙颌水平颌位关系中的应用暨南大学医学院口腔系（５１０６３０）袁洁自肌监控仪问世以来，主要应用于科研工作及颞颌关节紊乱综合症的诊断和治疗。在修复临床中，如何使下颌位于正确的位置，是修复能否成功的关键。无牙颌患者因失去牙列的支撑和牙间的锁...     

全口义齿修复与颞下颌关节

全口义齿修复与颞下颌关节有天然的联系, 全口义齿功能的发挥依赖于颞下颌关节的正常运动。本文简要介绍全口义齿咬合设计的原则、不同型的特点, 以及如何在全口义齿修复的步骤中注意颌位关系的确定和咬合调整。强调正确进行全口义齿修复对保持颞下颌关节的健康有重要意义。     

治疗性全口义齿矫正不良颌位的研究

目的　评价一种治疗性全口义齿矫正全口义齿患者不正确颌位关系的效果。方法　让11例有不良颌位的无牙颌患者戴用笔者制作的一种上颌后牙为瓷人工牙,下颌后牙区似导板的治疗性全口义齿。采用下颌运动轨迹描记仪,记录患者戴用治疗性全口义齿矫正前后颌位的改变情况。结果　矫正后闭口轨迹末端位的集中性明显提高;下颌运动轨迹的对称显著改善;CRO-ICO三维滑动幅度减少,滑动中牙齿能均匀稳定的接触。结论　治疗性临时全口义齿,对矫正前伸、偏斜等无牙颌患者具有一定的作用。     

两种(牙合)型全口义齿对老年无牙颌患者颞下颌关节紊乱病影响的比较

目的 观察舌侧集中(牙合)型与解剖验型全口义齿对牙槽嵴低平的老年无牙颌患者颞下颌关节紊乱病(tempromadibular joint disorders,TMD)的疗效,以期为临床全口义齿修复的(牙合)型选择提供依据.方法 采用随机数字表法随机选取剩余牙槽嵴低平的老年无牙颌TMD患者中拟行舌侧集中(牙合)型(A组)与解剖(牙合)型(B组)全口义齿修复的患者各35例.检查并记录患者修复前和修复后3、6个月的TMD情况,采用Fricton颞下颌关节功能临床检查表评价TMD改善效果,选用t检验和秩和检验分析修复前后的差异.结果 全口义齿修复3个月后,A组患者颞下颌关节指数(craniomandibular index,CMI)下降值(0.064±0.022)显著高于B组(0.043±0.018) (P＜0.01)；修复6个月后,A组CMI下降值(0.084±0.020)显著高于B组(0.070±0.021) (P =0.011 ＜0.05).结论 对于伴有TMD症状的牙槽嵴低平的老年无牙颌患者,采用舌侧集中(牙合)型全口义齿修复更有利于关节症状的缓解.     

改良记录基托在疑难全口义齿修复中的临床应用

目的探讨疑难无牙颌患者使用改良颌位记录基托行全口义齿修复的修复效果。方法选择20例牙槽嵴重度吸收的无牙颌患者,用光固化树脂基托材料制作记录基托,在基托组织面内衬硅橡胶印模材料形成具有良好稳定性和固位力的改良记录基托,以确保取得精确的上下颌关系及良好后堤封闭的闭口终印模。结果采用改良颌位记录基托制作疑难全口义齿20例,其中18例患者感义齿稳固,咀嚼功能好,无压痛。2例患者感黏膜稍有疼痛,通过调改后均取得满意效果。结论对牙槽嵴重度吸收的无牙颌患者,采用改良颌位记录基托可以获得精确稳定的颌位关系及具有良好后堤封闭的闭口终印模,最终拥有一副理想的全口义齿。     

使用切点针在蜡(牙合)堤上记录全口义齿的水平颌位关系

确定无牙颌患者的水平颌位，是全口义齿修复中关键步骤之一。在临床中可以使用的方法很多，如卷舌法，吞咽法，后牙咬合法，自然开闭口运动，肌监控仪，下颌运动轨迹描记仪，以及美国最新推出Biopark系统，都能帮助无牙颌患者的下颌回到他们的生理性最适位，建立正确的下颌对上颌的位置关系。但     

无牙颌患者全口义齿修复后最大(牙合)力测定

<正> 全口义齿的修复是恢复患者的咀嚼功能。(牙合)力是口腔生理功能检测的指标之一,是上下颌牙齿在咬(牙合)时所发挥的力量,可作为口腔修复治疗疗效评定的客观指标。牙列缺失给患者造成主要后果是咀嚼功能的丧失。而颞颌关节、咀嚼肌肉、牙及牙周组织参与了咀嚼活动。本文采用压电膜式(牙合)力测定仪,对无牙颌患者全口义齿修复后最大(牙合)力进行测定,以评定戴用全口义齿后,患者咀嚼效能的恢复情况。     

用塑料托架记录无牙颌正中颌位关系

无牙颌正中颌位关系是排列人造牙的基础,精确记颌录位关系是提高全口义齿修复质量的重要步骤。在制作全口义齿时,常借助(牙合)托记录患者的颌骨关系位置,采用蜡(牙合)托因受口腔温度影响容易变形。采用树脂(牙合)托虽可取     

上颌磨牙区平面加蜡确定颌位关系173例报告

颌位记录是制作全口义齿的关键步骤之一。笔者认为,采用上颌磨牙区(牙合)平面加蜡确定颌关系,有制止下颌前伸习惯,引导下颌回到正中(牙合)位的作用。笔者自1982年2月至1987年12月,对173例无牙颌患者应用上     

A structural equation model relating oral condition,denture quality,chewing ability,satisfaction, and oral health-related quality of life in complete denture wearers

ObjectivesTo investigate the relationship between mandibular ridge form, stability and retention of mandibular complete denture, accuracy of jaw relation recording, patients’ perception of chewing ability, satisfaction with dentures and oral health-related quality of life (OHRQoL) in complete denture wearers.MethodsA total of 183 edentulous patients, who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures, were recruited. Oral examination was performed. Cawood and Howell's method was used to grade the mandibular ridge form. The stability and retention of the mandibular complete denture were assessed using Kapur method. Accuracy of jaw relation recording was evaluated using a newly developed jaw relation index. Patients’ perception of chewing ability was rated using a food intake questionnaire. Patients’ satisfaction with complete dentures was assessed on a 100-mm visual analogue scale. OHRQoL was measured using the Japanese version of the Oral Health Impact Profile for edentulous subjects. A structural equation model was constructed based on the hypothesis that oral condition and denture quality would be related to chewing ability, satisfaction and OHRQoL.ResultsSignificant relationships were found between mandibular ridge form, stability of mandibular complete denture, accuracy of jaw relation recording, perceived chewing ability, satisfaction and OHRQoL. Various fit indices were within acceptable limits.ConclusionsOral condition and denture quality were related to patients’ perception of chewing ability, satisfaction with dentures and OHRQoL in complete denture wearers.Clinical significanceA favourable oral condition and denture quality are important for successful complete denture therapy.     

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目的    探讨吞咽法所获得的全口义齿水平颌位关系的临床效果。方法    选择2008年5月至2009年9月在承德市口腔医院进行全口义齿修复的无牙颌患者80例,随机分为2组,每组40例。分别用吞咽法和卷舌法确定水平颌位关系,并完成全口义齿的制作。观察两组全口义齿在口内的咬合关系与模型的一致性。结果    用吞咽法所确定水平颌位关系的全口义齿在口内的咬合关系与模型一致性Ⅰ、Ⅱ、Ⅲ类者分别为39、1、0例,而对照组分别为29、7、4例,两组比较差异具有统计学意义（χ2 =7.382,P = 0.023 ）。结论    利用吞咽法所获得的全口义齿水平颌位关系准确性较高,可以做为确定全口义齿水平颌位关系的有效方法。     

A Comparison of the Change in Mandibular Condyle/Fossa Relationship with the Use of Anatomic Teeth and Semi-anatomic Teeth in Complete Denture Prosthesis

The association between dental occlusion and mandibular condyle/fossa relation has long been debated and still remains one of the most controversial issues in Prosthodontics. The aim of the study was to evaluate the effect of two different tooth forms on the condyle/fossa relation recorded during jaw relation process. Twenty edentulous patients were selected with good neuromuscular control. For each patient two pairs of dentures were fabricated with anatomic teeth and semi-anatomic teeth. Condylar position was recorded using a digital volume tomography (DVT) following the process of jaw relation (following extra oral tracing). Subsequent laboratory remounting, the denture insertion was done and DVTs were taken again for both the dentures separately. Two methods were used to evaluate the condyle/fossa relation viz. (1) Zhang’s method (2) Brewka’s method. The obtained values were then subjected to statistical analysis. The statistical significance was set as at 0.05 %. The mandibular concentricity were analysed during the process of jaw relation and after the insertion of dentures with the two different tooth forms. Statistical analysis indicated that no statistically significant difference of the influence of different posterior tooth forms on the condyle/fossa relation recorded during jaw relation (p < 0.05). Thus within limitations of this study it was concluded that the condyle/fossa relation established during jaw relation does not change with the change in posterior tooth form used.     

三种品牌人工牙在全口义齿修复中的性能比较

目的 观察三种品牌人工牙制作全口义齿修复7－8年后的磨耗及He关系变化。方法 选择103例全口义齿修复患者，让其自选三种品牌人工牙之一作全口义齿修复，7－8年后复查人工牙He面磨耗程度，颌位和He关系的变化，义齿固位情况及咀嚼效能的自我评价。结果 三种品牌人工牙所作全口义齿7－8年后的He磨耗，义齿固位经秩和统计分析，Ivoclar牌人工牙与ODI和Bayer两种品牌相比差异有显著性（P＜0.05)，ODI与Bayer比较差异无显著性（P＞0.05)。结论 使用 优质的塑脂人工牙作全口义齿修复，能延长全口义齿发挥最佳咀嚼效能时间。     

应用数字化X线头影测量法对无牙颌颌位关系的初步研究

目的 研究无牙颌面部结构特点，探讨临床应用吞咽法确定颌位关系的理论依据。方法 57～70岁的无牙颌患者43例，新全口义齿戴用舒适后，使用德国SIRONA数字化X线口腔医疗系统，拍头颅定位侧位片，戴义齿正中He位与不戴义齿吞咽位各1张。结果 无牙颌患者男性垂直向面部高度比女性大，前下面高／前上面高比值在男女性均约为6／5，S-N-Po角约为78～80度。在垂直向和前后向，戴义齿正中He位与不戴义齿吞咽位2组数据的差异无显著性。可认为戴义齿正中He位与不戴义齿吞咽位是同一个位置。结论 用SIRONA数字化X线口腔医疗系统进行头影测量，方法便捷，有自身特点。证实吞咽咬合法是确定无牙颌颌位关系的准确可靠的方法之一。     

口腔治疗中不同颌位与髁突位置

在口颌系统中,与颌位稳定相关的因素分别是、颞下颌关节和神经肌肉的稳定,其中髁突在关节窝中的位置与获得一个稳定的颌位密切相关。但口腔治疗中涉及到颌位的选择时,不同学者持不同的观点,对于髁突在关节窝中应处的位置也一直处于争议之中。本文对口腔修复和正畸治疗中颌位选择及“髁突前上位”、“髁突前下位”、“治疗性颌位”的适应证、理论基础及临床应用作一综述。文献复习结果提示,当关节无器质性改变或髁凹关系稳定时,髁突前上位即正中关系为传统建的理想颌位。当关节盘增生、变形、盘突关系紊乱无法寻找理想的髁突前上位时,可选择髁突前下位,缓解关节症状的同时促进骨质改建获得良好的稳定性;甚至对于部分安氏Ⅱ类高角或者轻度骨性错的病例,亦可以尝试利用髁突改建的潜力,前下定位髁突,通过掩饰性矫治简化正畸正颌手术方案;而“治疗性颌位”是针对颅下颌功能紊乱症导致的最大牙尖交错位异常或偏斜、肌肉症状和关节功能异常、颌位不稳定等,通过改变原有咬合或关节的异常引导,在有咬合支持和新的引导的基础上,建立并且稳定一个新的牙尖交错位。它摆脱了髁突定位的争论,但此颌位下髁突具体位置未见报道。不同颌位及髁突位置有不同的适用范围,临床选择时应根据患者关节是否有器质性改变及颌位的稳定性进行综合判断。但对于采用不同颌位和髁突位置进行口腔治疗的远期效果未来还需临床对照试验进一步验证。     

无牙颌位至最大开口位下颌运动规律的初步探讨

目的：探讨从无牙颌位至最大开口位时下颌颏部及髁突顶部的运动轨迹的规律，分析在无牙颌患者牙尖交错位建He与此运动轨迹的关系。方法：分别对22例无牙颌患者行无牙颌位、牙尖交错位和最大开口位时的头颅侧位X线片拍摄，测定在二三个位置时颏前点、髁突顶点以及相应的面角的改变。结果：颏前部从无牙颌位至牙尖交错位及最大开口位发生向下向后的移位，髁突顶发生向下向前的移位，SNPg角逐渐减小。结论：颏部及髁突从无牙颌位到最大开口位下颌的位置出现旋转性的位移，颏前部及髁突顶部可出现不同的旋转曲线，在此轨迹上有助于帮助确定牙尖交错位建He点。     

无牙颌颌位记录的临床方法

无牙颌颌位关系记录的目的是正确确定患者的正中关系位,以期在此位置上通过全口义齿重新建立良好的咬合关系。颌位关系记录内容包括垂直关系与水平关系2部分。对于垂直关系,临床上一般通过记录患者面下1/3垂直距离来确定。当患者下颌位于息止颌位时,髁突位于关节窝中央略向前下,咀嚼肌处于均衡放松状态,临床上一般通过测量息止颌位垂直距离来确定正中关系位垂直距离。在临床上医师通常在记录垂直关系的同时进行水平颌位关系的记录。本文通过图文并茂方式详细描述了颌位关系记录的几种临床常用方法。     

上半口活动义齿与下半口固定义齿修复的临床应用

目的 采用睦半口活动义民下半口固定义齿修复的方法来解决中老年患者因拔牙后牙嵴吸收导致下半口活动义齿固位差,咀嚼功能下降所带来的问题。方法 在临床上分别对１０倍中老年患者采用方法：１：先做上半口活动义齿再做下半口固定义齿修复。方法２：上半口活动义齿与下半口固定义齿同时做。方法３：在保留患者生理Ｈｅ位的情况下,先做下半口固定义睡复再做上半口活动义民方法２都需重建;Ｈｅ。保留生理Ｈｅ位的方法３,避免Ｈ３     

Evaluation of functional suitable digital complete denture system based on 3D printing technology

PURPOSETo improve the clinical effects of complete denture use and simplify its clinical application, a digital complete denture restoration workflow (Functional Suitable Digital Complete Denture System, FSD) was proposed and preliminary clinical evaluation was done.MATERIALS AND METHODSForty edentulous patients were enrolled, of which half were treated by a prosthodontic chief physician, and the others were treated by a postgraduate student. Based on the primary impression and jaw relation obtained at the first visit, diagnostic denture was designed and printed to create a definitive impression, jaw relation, and esthetic confirmation at the second visit. A redesigned complete denture was printed as a mold to fabricate final denture that was delivered at the third visit. To evaluate accuracy of impression made by diagnostic denture, the final denture was used as a tray to make impression, and 3D comparison was used to analyze their difference. To evaluate the clinical effect of FSD, visual analogue scores (VAS) were determined by both dentists and patients.RESULTSTwo visits were reduced before denture delivery. The RMS values of 3D comparison between the impression made via diagnostic dentures and the final dentures were 0.165 ± 0.033 mm in the upper jaw and 0.139 ± 0.031 mm in the lower jaw. VAS ratings were between 8.5 and 9.6 in the chief physician group, while 7.7 and 9.5 in the student group; there was no statistical difference between the two groups.CONCLUSIONFSD can simplify the complete denture restoration process and reduce the number of visits. The accuracy of impressions made by diagnostic dentures was acceptable in clinic. The VASs of both dentists and patients were satisfied.