义颌再制

上颌骨因外伤、肿瘤切除等造成的单侧或双侧缺损,一般都采用中空式或开顶式义颌修复。我科从1980年起开展的颧颊翼义颌、颧颊翼咽鼻突义颌,在义颌上增加了新的固位和承力装置,可提高义颌的功能。但制作方法较复杂,要经过多次工序反复修改才能完成。且为防止手术区收缩变形,要求术后尽快镶上义颌,义颌经戴一段时间后多数仍需修改或重作。鉴于上述情况,作者用再制的方法,较为省时省力,     

上颌义颌修复(附一病例报告)

全上颌骨缺失的病例在临床上比较少见。当患者上颌骨大部摘除,只保留了额突、眶下缘和颧突时,难以承托修复体和提供足够的固位力。本文应用双侧弹簧固位作义颌修复,取得了比较好的固位效果,报告如下,并就上颌义颌的固位和支持问题作一讨论。     

用力学原理分析义颌用颧区承力及颧区口内种植的作用

目的用力学原理分析义颌用颧区承力及从口腔内在颧区植入种植体对上颌骨大型缺损义颌恢复咀嚼功能的作用.方法用杠杆原理及转动力矩公式M=F×L,对比分析缺损侧有无颧区承力义颌以及从缺损腔内和从口腔内在颧区植入种植体的义颌受力后的情况.结果(1)缺损侧无颧区承力义颌因缺损侧无骨支持面,受力时杠杆作用使义颌翘动.(2)缺损侧有颧区承力的义颌,受力时无杠杆作用使义颌稳定.(3)从缺损腔内向颧骨种植的义颌,种植体长轴方向与力方向呈大角度.种植体受侧向力,具有转动力矩.(4)从口腔内在颧区上种植,种植体长轴方向与力方向一致,种植体受垂直力.结论通过力学原理对上颌骨大型缺损用不同义颌修复方法分析得出(1)颧区承力义颌受力时稳定;口内颧区种植体,只受垂直力,无损伤,故均能有长期恢复咀嚼生理功能的疗效.(2)缺损侧无颧区承力义颌受力时翘动,从缺损腔内斜行向颧骨种植义颌,种植体受到侧向力均会造成损伤,不会有远期疗效.     

螺旋CT分析颧颊翼种植体义颌颧区种植方向和部位

目的为上颌骨大型缺损后行颧颊翼种植体义颌修复时,颧区种植的植入部位及方向提供客观依据。方法通过50例有牙列的单侧正常颧骨的螺旋CT影像三维重建,在矢状位截面影像上测量颧骨的前后倾斜角度;在冠状位截面影像上观察颧骨的形态并测量上颌牙槽嵴最颊侧点到上颌窦最外侧点的水平距离。结果颧骨的前后倾斜角度平均为80.03°,即颧骨前倾9.97°;48例颧骨冠状位影像形态较直,2例明显弯曲;上颌牙槽嵴最颊侧点到上颌窦最外侧点的水平距离为6.77mm。结论一般情况下,种植体前倾10°左右植入能最充分地利用颧骨的上部骨量。但由于个体差异,建议修复前先行螺旋CT影像学检查,评估颧骨的形态和骨量,以提高种植的安全性和有效性。     

颧颊翼咽鼻突义颌修复双侧上颌骨缺损七例

双侧上颌骨缺损后,许多整复手术常难以成功,尤其在肿瘤切除后又接受放射治疗者,而利用颧颊翼咽鼻突义颌进行修复是一种有效的治疗手段。作者对７例双侧上颌骨缺损患者进行义颌修复治疗,６例系肿瘤切除后的缺损,１例为创伤所致缺损。其中１例术后经放射治疗发生放射性...     

颧区垂直骨内种植和斜向骨内种植的生物力学三维有限元法对比研究

目的:比较上颌骨大型缺损后,行颧区成形术,在颧骨体底部垂直于牙合平面方向植入的种植体,与直接往颧骨体斜向30°植入的种植体在垂直牙合力作用下表现的生物力学行为差异。方法:按照两个不同种植体义颌的设计特点建立两个一侧上颌骨大型缺损种植体复合体的三维有限元模型,在相同的垂直于牙合平面加载100N,比较两者的受力情况。结果:斜向植入种植体颈部最大等效应力约是垂直植入种植体的4倍;最大拉应力约是垂直植入种植体的10倍;最大压应力约是垂直植入种植体的5倍;最大剪应力约是垂直植入种植体的4倍。虽然两者在颧骨体以外其余部位的应力分布均类似于颧突支柱的应力传导路径,但斜向种植体受侧向力后在主要传导路径上的最大应力值都要明显高于垂直种植体的轴向受力情况。结论:无论是颧骨体研究区的应力分布,还是颧骨体以外其余颅骨骨质的应力情况,垂直植入都要明显优于斜向植入。提示采用在颧区垂直种植的颧颊翼种植体义颌,比颧骨体斜向种植的常规种植体义颌具有优越的生物力学表现。     

组合式修复体在修复一侧上颌骨摘除后的研究和应用

由各种原因所致的上颌骨部分摘除后,大多数患者需要作义颌修复,以最大限度恢复咀嚼、发音功能和改善面部外貌等。上颌骨部分摘除后,义颌的固位和承力与一般义齿有较大的区别。从制取印模到修复体完成戴入口内部不同于一般义齿。上颌骨一侧缺损的修复,一般多采用中空     

上颌骨严重萎缩或缺损患者的种植技术探讨

颧骨是颌面部骨质比较致密的部位,颧区承力的应用为上颌骨严重萎缩和上颌骨缺损患者的修复开辟了一条新的途径.本文着力探讨颧种植体在上颌后牙区严重萎缩患者和上颌骨缺损患者中的植入方法及其辅助定位.     

磁性附着体加带弹性的翼式基托在覆盖总义齿中的应用

磁性固位体现已成为改善口腔颌面修复体固位的重要手段。作者采用磁性附着体加带弹性的翼式基托覆盖总义齿,对上颌前牙区牙槽嵴明显前突,而双侧口角附近区域均仅有少数条件欠佳的牙齿存留的患者进行修复,既避免了拔牙,缩短了修复时间,又能达到良好的固位、咀嚼、美观等效果。1.材料和方法1.1 材料 Z-1型闭合磁路磁性附着体(第四军医大学口腔医学院研制),规格为4.5mm×4mm×3mm,固位力约950g;直径为1.0mm牙用不锈钢丝;常规制作全口义齿所需的材料等。1.2 病例选择 上颌前牙区牙槽嵴明显前突,单颌双侧均仅有1颗或1颗以上存留牙(包括残冠残根…     

颊翼义颌的临床应用

因各种原因造成的上颌骨及其周围软骨组织缺损,目前多采用矫形的治疗方法。上颌骨切除术后及早地配合修复治疗,对于恢复患者的语言、吞咽、咀嚼、面容以及对患者心理上的安慰都起积极作用。作者从1985年开始,先后为20例上颌骨术后患者采用颊翼义颌进行修复,效果满意。     

前臂皮瓣联合钛网和颊脂垫修复口腔癌术后的上颌骨缺损

目的观察前臂皮瓣联合钛网和颊脂垫修复上颌骨缺损的临床效果。方法对3例上颌牙龈癌和1例腭部腺样囊性癌分别行上颌骨次全切除或全切除术,遗留的缺损用4 cm×5 cm~5 cm×7 cm大小的前臂皮瓣联合钛网和颊脂垫修复。其中钛网用于恢复上颌骨前外侧面、牙槽突和腭部形态,前臂皮瓣用于修复腭部口腔面黏膜缺损,颊脂垫用于修复腭部鼻腔面黏膜缺损。术后通过临床检查及CT和鼻内窥镜检查评价其效果。结果随访1~3年,肿瘤无复发,移植皮瓣全部成活,面部外形及牙槽突和腭部形态恢复良好,鼻腔面钛网被软组织覆盖,佩戴可摘局部义齿修复缺牙后,语言和进食功能恢复良好。结论前臂皮瓣联合钛网和颊脂垫修复上颌骨缺损效果理想。     

Prosthetic rehabilitation of cleft palate patients with fixed partial dentures

Treatment of cleft palate patients demands a well coordinated work of medical and dental specialists. In spite of the surgical and orthodontic therapy a prosthetic rehabilitation is often necessary because of missing teeth, maxillary hypoplasia, malocclusion and palatal defects. The prosthetic phase begins immediately after the orthodontic treatment. In this way the fixed partial denture replaces the retention appliance and stabilizes the achieved status. The aim of the prosthetic treatment is to improve the function of the masticatory apparatus, speech and aesthetic appearance of the patient. An important task of the prostheses is to support and lift up the upper lip and the base of the nose. There are several factors, which make the treatment difficult, like underdeveloped and collapsed maxillary arch, retrognath position of the maxilla, missing alveolar ridge, defects of the bone and mucosa, scars and stiffness of the upper lip. The maintenance of the oral hygiene with the fixed restorations is often difficult because of the stiffness of the upper lip, therefore the design of the pontic is very important especially in the cases, when the missing processus alveolaris has to be replaced in order to improve the harmony of the face.     

The modified “Wunderer” osteotomy for stabilization of the cleft-premaxilla – A new operative technique

The operative closure of bilateral cleft lip and palate is a difficult procedure that requires in most cases secondary corrections. Besides aesthetic improvements of lip and nose also the rehabilitation of the teeth, in particular of the maxillary arch is important for the improvement of the chewing function and also for the well being of the patient. One of the most disturbing factors for the construction of any type of prosthetic devices, like removable denture, fixed bridge or dental implants is the mobility and often also malposition of the premaxilla. This problem can only be solved by the insertion of bone grafts into the bilateral gaps of the anterior maxillary arch. This procedure however, is difficult due to the narrowness and poor overview that complicates the closure of the nasal mucosa, which is the precondition for the success. For facilitating the operation the premaxilla is osteotomized and reflected anteriorly according to the method of Wunderer (1962). Then, after the much easier closure of the nasal mucosa the bony defects can be filled with autogenous cancellous bone and finally the oral mucosa can be closed. A preoperatively prepared palatal acrylic plate helps to protect the palatal tissue and also stabilizes the position of the premaxilla. The blood supply to the osteotomized premaxilla is secured by a sound soft tissue pedicle of the buccal muco-periosteum. The effectiveness of the blood supply of the premaxilla was examined in experimental studies by several authors. Also investigations of the growth impediments of the premaxilla and the midface revealed that early osteotomies will interfere with the development of this region. Therefore it is advisable to carry out this procedure not before the patient has reached the age of 12–14 years, which is also depending on the race and the gender of the patient.     

Obturator prostheses for hemimaxillectomy patients

Maxillary defects are created by surgical treatment of benign or malignant neoplasms, congenital malformation and by trauma. The size and location of the defects influence the degree of impairment and difficulty in prosthetic rehabilitation. Lack of support, retention, and stability are common prosthodontic treatment problems for patients who have had a maxillectomy. A prosthesis used to close a palatal defect in a dentate or edentulous mouth is referred to as an obturator. The obturator prosthesis is used to restore masticatory function and improve speech, deglutition and cosmetics for maxillary defect patients.     

Orthopedic protraction with skeletal anchorage in a patient with maxillary hypoplasia and hypodontia

Multipurpose titanium miniplates were placed on the lateral nasal wall of the maxilla as anchorage for face mask protraction in an 11-year-old girl presenting with severe maxillary hypoplasia and hypodontia. Applying orthopedic forces directly to the maxilla resulted in an eight mm maxillary advancement. Intraosseous titanium screws were also placed on the palatal bone, near the alveolar crests, to provide anchorage for the expansion appliance. The maxilla was expanded from the median palatal suture, and seven mm of expansion was achieved across the buccal segments. No other tooth support was used for the expansion or the protraction of the maxilla.     

仅行唇颊侧浸润麻醉拔除上颌牙镇痛效果分析

目的讨论拔除上颌恒牙时不给予腭侧麻醉的可行性。方法拔除双侧上颌恒牙的患者63例,进行双侧对照试验,试验组予4%盐酸阿替卡因（含1∶100000肾上腺素）1.7mL唇颊侧前庭沟浸润麻醉,5min后拔牙;对照组颊侧注射同前,同时腭侧追加上述局麻药0.4mL浸润麻醉,5min后拔牙。所有患者麻醉后和拔牙后分别完成注射及拔牙疼痛视觉模拟量表（visual analogue scale,VAS）和语言评价量表（verbal response scale,VRS）测试。结果注射疼痛评价VAS值试验组为（26.3±8.1）mm,对照组为（37.9±6.7）mm,二者差异有统计学意义（P〈0.05）;拔牙疼痛评价VAS值试验组为（15.3±6.9）mm,对照组为（13.3±5.7）mm,两组差异无统计学意义（P〉0.05）,所有患者认为拔牙为“可接受”。结论上颌恒牙拔除行腭侧浸润麻醉给患者带来更多不适,仅行4%盐酸阿替卡因唇颊侧浸润麻醉拔牙的方法可行。     

Treatment of nasopharyngeal stenosis by prosthetic hollow stents: Clinical experience in eight patients.

OBJECTIVE: A series of nasopharyngeal appliance designs is presented that represents our evolving experience over a 20-year period in the adjunctive use of prosthetic stents in the surgical correction of nasopharyngeal stenosis. DESIGN: Retrospective assessment of effectiveness of two nasopharyngeal stenosis hollow stent designs in a consecutive series of patients for relief of nasal obstructive symptoms. SETTING: Tertiary academic medical center, Craniofacial Program at Children's Hospital. PATIENTS: Four patients with nasopharyngeal stenosis were treated with a preoperatively fabricated stent made from a clasped palatal appliance onto which hollow acrylic conduits were extended through surgically re-created pharyngeal ports. A subsequent set of four patients with nasopharyngeal stenosis were treated with intraoperatively-fashioned silastic grommets, as opposed to palatal appliances. INTERVENTIONS: Postoperative intraoral stenting of nasopharyngeal ports. MAIN OUTCOME MEASURES: Maintenance of pharyngeal port opening after 1 year, improvement in nasal airway obstructive symptoms. RESULTS: The palatal appliance stents were less well tolerated and had a lower maintenance of port patency after device removal (4 of 8, 50%). The silastic grommets provided better retention into the ports and increased patient tolerance, as well as better 1-year port maintenance (6 of 8, 75%). CONCLUSIONS: The grommet stent appliance offers numerous advantages over a conventional dental-clasped appliance for prosthetic nasopharyngeal stenting, including obviation of extensive preoperative preparation, ease of insertion and removal, and exchange of air during the stenting period. Improved nasopharyngeal patency with this device may be due to greater patient tolerance and subsequent longer use.     

Interim palatal lift prosthesis as a constituent of multidisciplinary approach in the treatment of velopharyngeal incompetence

The velopharynx is a tridimensional muscular valve located between the oral and nasal cavities, consisting of the lateral and posterior pharyngeal walls and the soft palate, and controls the passage of air. Velopharyngeal insufficiency may take place when the velopharyngeal valve is unable to perform its own closing, due to a lack of tissue or lack of proper movement. Treatment options include surgical correction, prosthetic rehabilitation, and speech therapy; though optimal results often require a multidisciplinary approach for the restoration of both anatomical and physiological defect. We report a case of 56 year old male patient presenting with hypernasal speech pattern and velopharyngeal insufficiency secondary to cleft palate which had been surgically corrected 18 years ago. The patient was treated with a combination of speech therapy and palatal lift prosthesis employing interim prostheses in various phases before the insertion of definitive appliance. This phase-wise treatment plan helped to improve patient''s compliance and final outcome.     

A double buccal fat pad flap for middle palate defect closure--a new technique for palate closure

In this article a new method of closing palatal defects by means of buccal fat pad flaps is reported. A double buccal fat pad flap in association with Le Fort I osteotomy approach was adopted to remove tumours of the palate and nasal fossae. The technique is described in a case of adenocarcinoma arising from the nasal septum and its indications and advantages are discussed.     

Stress distribution produced by correction of the maxillary second molar in buccal crossbite

The purpose of this study was to evaluate the stress distribution produced in the dentoalveolar system by a maxillary posterior crossbite appliance used for the correction of maxillary second molars in buccal crossbite. A photoelastic model was fabricated using a photoelastic material (PL-3) to simulate alveolar bone and ivory-colored resin teeth. The model was anteriorly and posteriorly observed with a circular polariscope and photographically recorded before and after activation of the maxillary posterior crossbite appliance. An uncontrolled palatal tipping and a rotating force were generated when the traction force was applied on the palatal surface of the maxillary second molar. A controlled tipping and an intrusive force were generated when the traction force was applied on the buccal surface of the maxillary second molar.