三种全口义齿重衬材料临床应用的比较

背景：对于无牙颌患者而言,由于牙槽嵴的吸收,全口义齿戴用一段时间后,口腔黏膜与基托不密合,出现义齿固位不良,临床上常采取基托重衬解决义齿固位问题。 目的：观察Sofreliner MS软衬材料、自凝树脂和热凝树脂3种材料在不同牙槽嵴和黏膜条件患者中全口义齿重衬后的临床效果。 方法：选择2009-09/2011-09期间就诊于内蒙古医学院附属医院口腔修复科中为牙槽嵴、牙龈条件优和劣组患者各30例,将牙槽嵴、牙龈条件优和劣组各随机等分为3个亚组分别采用Sofreliner MS软衬材料、自凝树脂、热凝树脂进行全口义齿重衬,衬垫1年后复查,比较3种材料重衬后的义齿固位、舒适度、咀嚼功能恢复的满意度及清洁情况。 结果与结论：牙槽嵴、牙龈条件劣组患者中采用Sofreliner MS软衬材料重衬义齿的修复效果明显优于自凝树脂、热凝树脂(P < 0.05);而牙槽嵴、牙龈条件优组中3种材料的修复效果差异无显著性意义(P > 0.05)。提示对于牙槽嵴、牙龈条件差的患者,应用Sofreliner MS软衬材料重衬义齿可使义齿稳固、舒适、并有效提高咀嚼功能。 关键词：软衬材料;全口义齿;义齿重衬;牙槽嵴;固位 doi:10.3969/j.issn.1673-8225.2012.12.042     

部分后牙缺失修复前后下颌牙根尖应力分布的光弹实验研究

目的：探对部分后牙缺必修复前后对下领牙根尖应力分布规律的影响。材料和方法：以环氧树脂制作正常[牙合]及单侧、双侧后牙缺尖的下颌光弹模型，并在翻制好的模型上进行常规活动义齿修复。2．0kg垂直加载后，在光弹仪上对牙根尖及牙槽嵴中相应观测点的主应力大小和方向进行观测。结果：单侧磨牙缺失时，缺牙对侧和缺牙侧余留牙的根尖主应力水平升高、缺牙侧余留牙根尖主应力的远中偏向角度减小，从而使余留牙的负担明显增大；和义齿修复后缺牙对侧牙和缺牙侧余留牙的根尖主应力水平明显回落至正常，但义齿修复区域牙槽嵴所承受的远中颊侧的力明显增大，而且缺牙对侧余留牙的应力水平明显高于义齿修复侧相应的牙槽嵴观测点。当双侧下颌磨牙同时缺失时，余留牙的根尖主应力明显比正常更偏向近中舌侧，而且其上的应力水平电异常增高；活动义齿修复后，余留牙上的应力水平回落至正常水平．义齿修复区的应力水平更低，而且余留牙及义齿修复区的牙槽嵴承力向远中颊侧的分量更大。结论：单侧或双侧磨牙缺失会对下颌牙余留牙根尖主应力的大小及方向造成显著影响，而活动义齿修复后这种影响可以部分消除，但牙槽嵴对咬合力沿下颌骨向后方的传导特征也会随之发生改变。     

舌侧集中牙合与解剖式双侧平衡牙合应用于全口义齿修复的系统评价

背景：牙合型是制作全口义齿成功的关键,临床上如何选择合适的牙合型一直是困扰修复科医师的问题。 目的：系统评价舌侧集中牙合和解剖式双侧平衡牙合应用于全口义齿修复的临床效果。 方法：用关键词“complete denture” ,“edentulous”,“occlusion” ,“balanced”,“lingualized,” “anatomic”,计算机检索Cochrane图书馆临床对照试验库、Pubmed/Medline数据库、EMBASE数据库、万方数据库、CNKI中国知网数据库及中国生物医学文献库,语言设置为中文和英文,年限设置均从创刊到2013年10月,检索相关文献,此外用手工检索11种口腔医学杂志和相关文献的参考文献。由两位评价员独立进行文献筛选、资料提取和质量评价,共检索出628篇文献。 结果与结论：按照纳入和排除标准,纳入5篇文献。其中1篇文献研究证明舌侧集中牙合在患者固位力满意度上高于双侧平衡牙合(P < 0.05)。其中1篇研究证明舌侧集中牙合在患者对“进食有问题”、“需要避免特殊食物”的评比分数上低于完全双侧平衡牙合(P < 0.05),在“不舒适假牙”的评比分数上高于完全双侧平衡牙合(P < 0.05)。其中1篇文献证明舌侧集中牙合应用于重度牙槽骨吸收患者具有更好的咀嚼效率和能较好保护牙槽骨(P < 0.05)。其他2篇文献研究中舌侧集中牙合与双侧平衡牙合在患者总体满意度等研究的比较结果上差异无显著性意义。结果证实,舌侧集中牙合具有与解剖式双侧平衡牙合相似的患者满意度、咀嚼效率、美观和发音,对严重牙槽骨吸收患者有更好的咀嚼效率和保护牙槽骨的作用。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

全口义齿修复后造成松软牙槽嵴和／或牙槽嵴粘膜增生的原因初探

目的：研究松软牙槽嵴和／或牙槽嵴粘膜增生形成的原因，探讨预防和治疗措施。方法：对180例戴用全口义齿一年以上的患者进行临床调查研究。研究内容包括缺牙原因，义齿戴用的时间，牙槽嵴粘膜情况，松软牙槽嵴和／或牙槽嵴粘膜增生发生的部位，人工牙的类型等。结果：①180例全口义齿病例中，有松软牙槽嵴者20例，占22％，男：女＝6∶4，其中下牙槽嵴占60％，上牙槽嵴占20％，上下牙槽嵴均有者占20％。患牙槽嵴粘膜增生者共8例，占4．4％，最多发生在下舌侧，其次为下唇沟。同时患有松软牙槽嵴和牙槽嵴粘膜增生的有4例，占患牙槽嵴粘膜增生病例的一半。②在患松软牙槽嵴的病例中，人工牙为塑料牙和瓷牙各占50％。缺牙原因为牙周病者共12例，占60％，龋病2例，占10％，龋病-牙周病者8例，占30％。③在患松软牙槽嵴的病例中，下颌牙槽嵴条件均为差，上颌牙槽嵴条件均为中或差。在患增生的粘膜组织的病例中，75％病例义齿固位为中或差，25％义齿固位为较好。结论：发病原因与患者缺牙原因，牙槽嵴部位，牙槽嵴条件，人工牙类型等有关。因此可以认为，牙槽嵴粘膜松软是戴用全口义齿后出现的不可忽视的问题，而牙槽嵴粘膜松软和／或增生的粘膜组织是相辅相成的。所以一副全口义齿不是一劳永逸的，使用一定的时间后需要更换，特别对牙槽嵴条件较差的患者而言更是如此。     

常规与新型网孔羟基磷灰石修复唇腭裂的比较

背景：尽管常规网孔羟基磷灰石具有一定的生物相容性和成骨诱导性,但在移植后不能被人体吸收,用于牙槽突裂的骨缺损充填时会影响上颌骨和尖牙的发育与萌出。 目的：对比常规网孔羟基磷灰石与新型网孔羟基磷灰石复合骨修复牙槽突裂的效果。 方法：将46例唇腭裂患者随机分为试验组与对照组,均按唇腭裂序列治疗安排,在行鼻部软组织缺损修复后,试验组采用新型网孔羟基磷灰石复合骨材料(羟基磷灰石与骨形态发生蛋白复合物)修复牙槽突裂,对照组采用常规网孔羟基磷灰石材料修复牙槽突裂。修复后6个月内,观察新形成骨组织平面至牙槽嵴顶端的垂直距离,从并发症情况、牙槽突裂形态大小、骨痂形成及材料吸收综合评定临床修复效果。 结果与结论：试验组修复2,4,8,12,24周的新形成骨组织平面至牙槽嵴顶端的垂直距离均高于对照组      (P < 0.05),临床修复显效率和总有效率均高于对照组(P < 0.05)。表明新型网孔羟基磷灰石复合骨材料修复牙槽突裂具有良好的成骨诱导性及生物相容性,并发症少且骨痂形成迅速。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

活性短肽修饰纳米晶胶原基骨修复拔牙后剩余牙槽嵴

背景：各种原因导致的牙齿拔除后都会造成剩余牙槽嵴的吸收,导致颌骨骨量不足,不利于患者后期接受义齿和种植牙的修复治疗。 目的：通过建立大鼠拔牙后剩余牙槽嵴模型,观察纳米晶胶原基骨/活性肽P17-骨形态发生蛋白2对拔牙窝修复及牙槽嵴吸收的影响。 方法：将36只健康SD大鼠随机分为实验组、对照组和单纯材料组,均拔除右侧下颌中切牙,实验组在拔牙窝内即刻植入纳米晶胶原基骨/活性肽P17-骨形态发生蛋白2材料,对照组在拔牙窝内植入纳米晶胶原基骨/骨形态发生蛋白2材料,单纯材料组在拔牙窝内植入纳米晶胶原基骨材料。 结果与结论：①牙槽嵴的相对长度：术后2,4,8周,实验组与对照组均大于单纯材料组(P < 0.05),实验组与对照组比较差异无显著性意义(P > 0.05)。②组织学观察结果：术后2,4,8周,实验组与对照组新生血管和新骨形成的速度和质量均优于单纯材料组。③新生骨面积占骨缺损面积的百分比：术后2,4,8周,各组随时间增长不断增加,实验组与对照组大于单纯材料组(P < 0.05),对照组大于实验组。表明纳米晶胶原基骨/活性肽P17-骨形态发生蛋白2具有良好的骨诱导能力,拔牙后即刻植入可促进拔牙创的愈合,延缓剩余牙槽嵴的吸收。     

前方牵引与Frankel矫治替牙期反(牙合)的临床疗效对比

目的比较前方牵引与Frankel矫治儿童替牙期反(牙合)的临床疗效。方法选取本院于2015年3月至2019年3月收治的76例替牙期牙(反合)患者作为研究对象,根据随机法分为前方牵引组和Frankel组,每组各38位。通过分析头影测量结果和患者舌位置情况,比较两种方法的临床疗效。结果治疗后两组患者的SNA角、ANB角、U1-SN角、U1-NA角、U1-L1角的角度明显增大,两组患者角度比较,差异无统计学意义(P0.05);Frankel组患者舌长改变情况明显优于前方牵引组,差异有统计学意义(P0.05)。结论前方牵引与Frankel矫治儿童替牙期反(牙合)效果均佳,但Frankel治疗改善舌长效果更优。     

面部形态与无牙颌牙槽嵴萎缩关系的初步探讨

研究选用正常牙合成年人６０个进行侧位头影测量，并将头影测量值的均数进行了统计学分析，结果表明：上面高、下面高、全面高及下凳七牙区牙槽骨的高度男女比较差异有非常显著性；上颌后牙区牙槽骨的高度及翼上颌裂至上颌前牙区的距离男女比较差异有显著性。据此认为女性短面形多于男性。因此，研究结果支持面部形态对无牙颌牙槽嵴的吸收有一定影响的结论。     

舌侧金属加强杆种植覆盖义齿的三维有限元分析

目的 通过三维有限元分析方法探讨舌侧金属加强结构义齿基托设计对无牙下颌种植修复义齿的生物力学影响,为无牙颌修复治疗提供参考。方法 构建舌侧金属加强结构与无加强结构两种义齿基托设计的2颗种植体支持locator式覆盖义齿三维有限元模型,分别对后牙中央窝垂直施加150 N载荷、斜向施加150 N载荷以及对前牙垂直施加150 N载荷,模拟正中咬合、左右侧方咀嚼以及前牙切割食物时两种模型各组织的受力情况。结果 后牙及前牙垂直向加载时,两种义齿基托设计模型各组织受到的应力分布较为接近,所受最大应力差别在0~0.16 MPa之间;偏侧咀嚼时,未添加金属加强杆的义齿基托、种植体和黏骨膜应力集中范围,以及种植体、种植体周围骨最大受力明显大于添加金属加强杆模型,所受最大应力差别在0.59~2.99 MPa之间。结论 在义齿基托舌侧添加金属加强杆,可以起到应力分散的作用,或可在一定程度上减小骨吸收及基托折断的风险。     

两种不同附着体固位全口义齿：修复下颌牙列缺失的生物相容性

背景：精密附着体能提供恒定持久的固位力,提高咀嚼效率,防止牙槽骨吸收,近年已在全口义齿修复牙列缺失患者中使用,而磁性附着体和球帽附着体在下颌牙列缺失中应用较多。目的：比较磁性附着体和球帽附着体固位全口义齿修复下颌牙列缺失的临床效果。方法：纳入牙列缺失患者50例,其中男28例,女22例,年龄40-82岁,随机均分为2组,分别行磁性附着体固位的下颌可摘义齿修复和球帽附着体固位的下颌可摘义齿修复。戴入义齿6个月后进行咀嚼功能检查;戴入义齿2年后,进行患者满意度问卷调查及牙周健康检查。结果与结论：戴入义齿6个月后,两组均获得了较高的咀嚼效率,组间比较差异无显著性意义。戴入义齿2年后,磁性附着体组患者对固位情况和舒适性的满意度高于球帽附着体组(P < 0.05);磁性附着体组的牙龈指数、龈沟出血指数、基牙松动度低于球帽附着体组(P < 0.05),牙槽骨高度高于球帽附着体组(P < 0.05)。表明磁性附着体固位全口义齿修复下颌牙列缺失在临床疗效上较球帽附着体具有一定的优越性,能够提供合适的固位力,更好地保护基牙牙周组织健康。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Functional magnetic resonance imaging of brain activity during chewing and occlusion by natural teeth and occlusal splints

Brain imaging based on functional magnetic resonance (fMRI) is a useful tool for examination of neuronal networks and cerebral structures subserving visiospatial function. The purpose of this study was to compare the brain activity during chewing and occlusal function in centric occlusion on natural teeth or on occlusal splints. Four tasks were performed by 13 healthy, fully dentate subjects (21-32 years old, 6 female and 7 male): occlusal tap-tap movements in centric occlusion by natural teeth, after application of a maxillary occlusal splint and chewing movements on left and right sided rubberdam strips. In order to reveal which areas of the brain were more strongly activated, conjunction analyses between the different tasks were performed for each subject and for the average values of brain signal activity of all subjects. Whilst several known foci of activity were subtracted, differences of significant activity rested in areas of the sensorimotor cortex. Mainly ipsitaterality of hemispheres concerned the left and right sided chewing, whereas the conjunction between tap-tap movements on natural teeth and splint occlusion indicated only one weak, but significant activation foci. The study confirms fMRT as one of the most useful developing methods to clear up neuro-cortical effectiveness of occlusion and occlusal therapy.     

Integrated actions of masticatory muscles: Simultaneous EMG from eight intramuscular electrodes

In 29 normal persons with complete dental arches, the muscular activity of the temporalis, masseter, medial pterygoid, anterior belly of the digastric, mylohyoid and geniohyoid muscles was studied electromyographically with bipolar fine wire electrodes during various mandibular movements – both resisted and unresisted. Action potentials were recorded on FM magnetic tape and each experiment was also videotaped. Temporalis muscle was active during centric closing of the jaw with either contact of the teeth, or against resistance; during free lateral movements to the ipsilateral side, either against resistance or occlusal contact; during incisor gum chewing, molar gum chewing on ipsilateral or contralateral sides, during normal mastication; and during forceful centric occlusion. Activity occurred in the masseter and medial pterygoid muscles during the following movements: closing the jaw slowly either without occlusal contact or with occlusal contact and against resistance; free lateral movement to contralateral side, either against resistance or with occlusal contact; protraction of the jaw either without occlusal contact or with occlusal contact; swallowing either saliva or water; incisor gum chewing with either the ipsilateral or contralateral molars; normal mastication; and during forceful centric occlusion. Activity occurred in the digastric, mylohyoid and geniohyoid muscles during the following movements; opening of the jaw either slowly or maximally against resistance; closing the jaw against resistance; free lateral movement to ipsilateral and contralateral sides, either against resistance or with occlusal contact; protraction against resistance of the jaw either without or with occlusal contact; swallowing saliva and water; and protraction of the tongue. They work in antagonism (reciprocally) during gum chewing and normal mastication.     

Analysis of stresses in complete upper dentures with flat teeth at differing inclinations

This study measures the effect of the inclination of the occlusal surfaces of flat teeth, on the magnitude of exerted stresses in a model of the complete upper denture (CUD), in order to estimate which inclination could be more beneficial for the stressed denture. Three groups of dentures were produced, with three different inclinations of their posterior flat teeth on the buccolingual direction: group 1 with an inward inclination of flat posterior teeth on the buccolingual direction (anti-Monson arrangement), group 2 with flat occlusion (no inclination) and group 3 with outward inclination (Monson arrangement). Using commercial edentulous molds and standardized procedures, six identical CUDs were produced for each group. Two rosette strain gauges were cemented onto the midline of each denture specimen, for measuring the stress magnitudes. The use of flat teeth with outward inclination may prolong the lifetime of the denture, by reducing the detrimental stresses (tensile principal and maximum shear stress). When flat posterior teeth with inward inclination are used, the reinforcement of CUD is necessary, to withstand the significant increase of the developed stresses (p<0.05).     

Using occlusal wear information and finite element analysis to investigate stress distributions in human molars

Simulations based on finite element analysis (FEA) have attracted increasing interest in dentistry and dental anthropology for evaluating the stress and strain distribution in teeth under occlusal loading conditions. Nonetheless, FEA is usually applied without considering changes in contacts between antagonistic teeth during the occlusal power stroke. In this contribution we show how occlusal information can be used to investigate the stress distribution with 3D FEA in lower first molars (M(1)). The antagonistic crowns M(1) and P(2)-M(1) of two dried modern human skulls were scanned by μCT in maximum intercuspation (centric occlusion) contact. A virtual analysis of the occlusal power stroke between M(1) and P(2)-M(1) was carried out in the Occlusal Fingerprint Analyser (OFA) software, and the occlusal trajectory path was recorded, while contact areas per time-step were visualized and quantified. Stress distribution of the M(1) in selected occlusal stages were analyzed in strand7, considering occlusal information taken from OFA results for individual loading direction and loading area. Our FEA results show that the stress pattern changes considerably during the power stroke, suggesting that wear facets have a crucial influence on the distribution of stress on the whole tooth. Grooves and fissures on the occlusal surface are seen as critical locations, as tensile stresses are concentrated at these features. Properly accounting for the power stroke kinematics of occluding teeth results in quite different results (less tensile stresses in the crown) than usual loading scenarios based on parallel forces to the long axis of the tooth. This leads to the conclusion that functional studies considering kinematics of teeth are important to understand biomechanics and interpret morphological adaptation of teeth.     

基于三维数字化建模的全口义齿咬合接触的计算机仿真

针对目前在口腔颌面修复领域对全口义齿咬合接触的研究中存在的问题,本文应用空间机构理论中的方向余弦矩阵法,建立Hanau(牙合)架的下颌运动位移矩阵,以Matlab6.5、VC6.0 及VTK为开发平台,通过应用激光扫描测量法,采用计算机图形学及数据库技术,重建人工牙列的三维数字模型,并测量标志点三维几何坐标数据,然后在此基础上,开发了运行于PC机上的全口义齿咬合接触计算机仿真软件系统.该系统能从任何需要的角度和位置清晰地全面观察Hanau(牙合)架上下颌咬合接触的全过程,并对咬合接触的位置和区域进行检测.该系统的实现将有助于深入分析全口义齿动态咬合接触的情况,并辅助医生作全口义齿修复工作的临床诊断.     

可摘局部义齿卡环对口腔微生态系的影响

背景：可摘局部义齿卡环可对口腔微生态系造成一定影响。 目的：从卡环材料、形态、与基牙接触面积等方面阐述可摘局部义齿卡环对口腔微生态系的影响。 方法：应用计算机检索1980至2011年 PubMed 数据库、万方数据库、维普数据库、CNKI数据库、OVID数据库中与卡环对硬组织,软组织及唾液微生物影响的研究密切相关的文章。 结果与结论：可摘局部义齿由人工牙,基托,牙合支托,固位体和连接体组成,它的戴入可对口腔微生态系造成一定影响。卡环是可摘局部义齿最直接的固位体,它主要与基牙的颊舌面相接触,影响其所在基牙颊舌面的生理性自洁作用,促进菌斑在卡环与基牙接触区周围的聚集,还可改变菌斑和龈沟中细菌的数量和种类,影响其所在基牙颊舌面和牙周微生态系,在一定条件下可导致龋病,牙龈炎,牙周病的发生。     

角度基台修复后牙种植义齿的短期评价

背景：随着口腔种植修复技术的快速发展与适应证的不断扩大,角度基台的应用逐渐增多,后牙区作为口腔咬合的负重区,种植体承载的颌力大,对后牙区角度基台的评价具有更现实的临床指导意义。 目的：评价角度基台在后牙区种植义齿的短期临床效果。 方法：选择2008年1月至2013年1月来诊接受后牙区种植的114例患者,共植入175颗ITI种植体并完成单冠修复。根据基台的应用分为角度基台组与直基台组。测量两组修复后6个月、2年种植义齿牙周探诊深度、改良菌斑指数、改良龈沟出血指数与种植体周围年均骨吸收量,采用寿命表法计算两组种植义齿的5年累积存留率。 结果与结论：直基台与角度基台的种植义齿在牙周探诊深度、改良菌斑指数、改良龈沟出血指数方面比较差异均无显著性意义(P > 0.05)。种植体周围年均骨吸收量差异也均无显著性意义(P > 0.05)。15°与20°角度基台的5年累积存留率为95.6%,直基台的5年累积存留率为96.4%。结果显示种植义齿的基台角度与种植体周围软组织健康及骨吸收程度无相关性,15°与20°的角度基台在后牙区种植义齿可以取得较好的临床修复效果,长期效果有待于进一步观察。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：