应用T-scan III系统对楔状缺损患者牙合接触的研究

目的 测量楔状缺损患牙的接触,探究因素与楔状缺损形成的关系。方法 从32例受检者中选取32颗口内单象限内单颗楔状缺损患牙和34颗同名未患楔状缺损牙分别作为实验组和对照组。应用直接接触测量法及T-scan Ⅲ系统分析受检牙干扰的分布,并应用T-scan Ⅲ系统对受检牙在正中、侧方及前伸运动中的接触进行动态、定量测量。结果实验组中单侧组与双侧组患牙的工作侧干扰牙数百分比（75.0%、70.0%）均高于各自对照牙（17.7%、18.2%）,差异有统计学意义（P＜0.05）;在侧方工作侧运动中,实验组患牙所分担的力及其咬合高点上接触强度,均高于对照牙,差异有统计学意义（P＜0.05）。结论 口内单象限内单颗牙楔状缺损的发生与干扰及力负担过重有关。     

模型分析和调法治疗运动型食物嵌塞的临床研究

目的:探究模型分析和调法治疗运动型食物嵌塞的效果.方法:对符合纳入标准的96名食物嵌塞老年患者进行口腔检查并取模.根据解剖变异、力方向失调、力大小失调对运动型食物嵌塞进行分类并制定调方案.治疗后按照"完全不塞"、"改善明显"、"轻微改善"、"完全没变化"记录患者主观感受评分,并在一年内进行随访.结果:上颌第一与...     

金属面与应力中断设计在龈距不足游离端牙齿缺失修复中的应用

目的 探讨金属面与应力中断设计修复龈距不足患者游离端牙齿缺失的效果。方法 对利用vitallium2000plus结合金属面、应力中断设计与压力印模技术修复龈距不足游离端牙齿缺失的病例1例进行回顾性分析,并复习相关文献。结果 该金属面及应力中断设计有效解决了患者龈距不足、咬合力大、义齿易折裂的难题。应力中断设计可有效保护基牙,但应力中断设计与应力传导现象在患者口内是如何表现的,尚未见报道。本研究T-scan检测结果显示,戴牙前、后,患者力分配比由左侧77.5%、右侧22.5%变为左侧61.3%、右侧38.7%,右侧牙列力占总力分配比提高了16.2%,口内咬合力分布更加均匀。进一步分析,初始咬合阶段,左右侧咬合力基本接近,随着咬合力进一步增加,在中间咬合阶段,右侧咬合力占比有所下降,并在终末咬合阶段进一步下降并达到一个动态平衡。以上T-scan检测及文献复习结果提示咬合力的动态平衡现象与应力中断设计和应力传导有关。结论 金属面复合应力中断设计能够实现对于龈距不足患者游离端牙齿缺失的微创修复。     

有限元法分析多用唇弓和摇椅弓在矫治深覆时的应力效应

目的：研究多用唇弓和摇椅弓作用下各牙位所受应力情况。方法：建立下颌骨、下牙列、下颌牙方丝弓托槽及弓丝的有限元模型,通过 ANSYS 分析多用唇弓和摇椅弓不同应用方法下各牙位的受力情况。结果：多用唇弓入槽后,切牙受龈向力,磨牙受向力;并随着多用唇弓丝给尖牙施以龈向力,切牙所受龈向力减小,第一磨牙所受向力增加。摇椅弓随着入槽牙位的增加,切牙受龈向力继续增加,尖牙受向力并逐渐增加,第二前磨牙受向力,第一磨牙受力方向由向转为龈向。结论：多用唇弓对尖牙施加龈向力时,侧切牙受力显著减小,应在切牙压低完成后,单独完成尖牙的压低过程。摇椅弓入槽方式不同对各牙位所产生的应力大小和方向都有所不同,并且随着入槽牙位的增加,侧切牙和磨牙受力改变最为明显。     

昆明市乳牙列错畸形发病率的调查研究

目的 了解云南省昆明市市区乳牙列错情况,为乳牙期错畸形的预防性和阻断性矫治提供依据.方法 对昆明市市区3所幼儿园的乳牙全萌出且达到接触的2 116名乳牙列儿童进行调查,计算其错畸形发病率.结果 在2116名乳牙列儿童中,错1 516名,错率72％.排列在错前6位的依次是:深覆、牙列拥挤、前牙反、切、乳牙早失、开.结论 昆明市市区乳牙列错率的数据报告显示其发病率较高,需加强乳牙列错畸形的防治.     

创伤的诊断

创伤是引起咬合创伤的咬合状态。咬合异常不一定就是创伤,看上去咬合无异常也不一定不是创伤。由于缺乏明确的诊断标准,创伤是临床认识的一个难题。本文将解读咬合概念并提出咬合创伤症候群的概念用于创伤的诊断。     

微调适应证探讨

微调是精细的咬合治疗技术,在口腔临床已有较为广泛的应用.微调要达到有效的治疗效果,既要掌握其基本技能,更要准确掌握其适应证.本文结合作者应用微调咬合治疗的临床经验,重点探讨微调的适应证.微调技术主要适用于咬合创伤、咬合干扰等咬合病、咬合的相关疾病、咬合创伤口颌面痛、龋病及牙体缺损窝洞充填术后的咬合调整、牙周病的辅助治疗、固定义齿及可摘义齿修复后的咬合精细调整、人工种植牙修复完成后以及错颌畸形正畸后的精确咬合调整等.文章对每一类适应证的特点做了介绍,对颞下颌紊乱及颞下颌关节紊乱病能否应用微调治疗也做了分析,特别强调了规范化微调的重要性.     

楔状缺损的病因探讨

目的 了解楔状缺损的病因。方法 对有侧方Ｈｅ早接触的牙进行４年观察。结果 侧方Ｈｅ早接触牙在４年内能楔状缺损。结论 楔状缺损的病因与侧方Ｈｅ早接触有关,综能引起创伤Ｈｅ,由于应力集中在牙颈部形成楔状缺损。     

伴扁桃体肥大Ⅲ类错畸形儿童早期矫治的临床诊疗策略

腺样体/扁桃体肥大是儿童上气道阻塞相关牙颌面畸形的常见病因,由此引起的睡眠打鼾、张口呼吸、睡眠不宁等临床症状已日益为患儿家长所重视.由于腺样体/扁桃体肥大不仅可能导致患儿出现突面或凹面畸形,还可能造成儿童阻塞性睡眠呼吸暂停,因此临床诊疗往往需要多学科协作.目前,国内外研究对儿童腺样体肥大相关的Ⅱ类错畸形关注度较高,而...     

楔状缺损与唾液和pH值的关系

楔状缺损是一种常见的非龋性牙体缺损性疾病,是牙体硬组织的慢性损伤,好发于中老年人,其病因复杂。近年来,随着研究方向的进一步拓展,唾液和pH值在楔状缺损形成中的作用逐步显现,本文就唾液和pH值对楔状缺损的影响进行回顾和总结。     

F—l型数字力仪的研制与应用

作者运用电阻应变传感技术,结合大规模集成电路和液晶数字显示系统,成功研制了牙合力测定仪,其可在口腔中直接准确地测定牙齿的咬合力,为定量研究牙体牙周健康状况及修复治疗效果,提供较为准确的客观依据.本文介绍了一种新研制的数字式(牙合)力仪,并用此(牙合)力仪对正常50名青年男女进行(牙合)力测定,以供参考.     

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目的评价调对楔状缺损患者中、远期治疗效果的影响。方法对2005年10月至2006年7月河南大学第一附属医院口腔科门诊及同济大学口腔医院口腔内科就诊的楔状缺损患者73例251颗楔状缺损患牙用单组分光固化复合体充填,随机对118颗患牙进行调(调组)。充填后6、12、18、24个月对充填体脱落情况和颈部新楔状缺损形成情况进行评价。结果4例患者失访,调组为113颗牙,未调组127颗牙。24个月复查时调组充填体脱落率显著低于未调组(6.2%对14.2%,P<0.05)。结论楔状缺损充填体脱落率受患牙承受咬合力的影响。     

255例牙冠折裂的临床分析

目的分析长期咀嚼过程中牙冠折裂的发生情况,并初步探讨冠折发生的相关因素。方法以2005年12月-2007年12月在兰州市第一人民医院口腔科就诊的255颗冠折牙为研究对象,对折裂牙的患者性别、年龄、牙位、折裂位置及形态等进行分析。结果255颗冠折牙中,1）上颌第一磨牙76颗（29.8%）,下颌第一磨牙45颗（17.6%）,上颌第二磨牙41颗（16.1%）,下颌第二磨牙37颗（14.5%）,上颌第二前磨牙32颗（12.5%）,上颌第一前磨牙15颗（5.9%）,下颌第二前磨牙9颗（3.5%）;2）折裂位置与窝沟重叠者158颗（62.0%）,发生于牙尖斜面者97颗（38.0%）。3）正常者85颗（33.3%）,面形态异常者55颗（21.6%）,型异常者115颗（45.1%）。结论牙位及形态等与牙冠折裂的发生具有一定的关系。力是牙冠折裂的基本因素,但不是唯一因素。     

Nitric oxide synthase expression is increased by occlusal force in rat periodontal ligament

OBJECTIVES: The goal of this study was to investigate the role of nitric oxide synthase (NOS) in occlusal force-induced signal transduction in rat periodontal ligament (PDL). DESIGN: Rats were fitted with a bite plate and a metal cap to the maxillary and mandibular incisors, respectively, to eliminate the occlusal forces on rat molars. One group was sacrificed at 7 days (exclusion group), while the remaining rats had their appliances removed to reestablish molar occlusal contact (reload group) and were sacrificed 7 days thereafter. Another group of rats (normal group) were left completely untreated. Frozen cross sections of the upper first molars were stained with NADPH-diaphorase to quantify NOS activity. The distal sides of the disto-palatal roots of the upper first molars were examined, and the number and the area of stained cells in the PDL were measured. RESULTS: In the normal group, NOS expression was detected in blood vessels, monocyte-macrophages, fibroblastic cells and osteoclastic cells. NOS expression was lower in the exclusion group when compared with the normal group or the reload group (p < 0.05), and the exclusion group exhibited occluded blood vessels and a narrowing of PDL. In contrast, in the reload group the PDL and blood vessel structure had recovered and NOS expression was increased to the level of the controls. CONCLUSION: Occlusal force resulted in increased NOS expression. NO may mediate changes in PDL structure in response to occlusal force.     

Relation between clenching strength and occlusal force distribution in primary dentition

The aim of this study was to investigate the relation between clenching strength and occlusal force distribution in primary dentition. Twenty healthy children with normal occlusions: 11 boys and 9 girls, ages 3.2-5.8 years (avg. 4.5 years) were selected. Setting the bilateral masseter muscular activity at maximum clenching in full intercuspation as 100%, the occluding forces at 20, 40, 60, 80 and 100% clenching were recorded with pressure-sensitive sheets (Dental Prescale 50H, type R, Fuji Photo Film Co.), and the force of each primary tooth was analysed by computer (Occluzer FPD703). Occlusal force distribution was expressed as a percentage of the total occlusal force of each tooth and was compared between each clenching. There were no significant differences between various clenching strengths in the occlusal force distribution in primary dentition [one-way repeated-measures analysis of variance (ANOVA)]. Thus, the results of the present study suggest that the distribution of occluding forces on a primary dental arch had its own pattern and that the clenching strength had no effect on that pattern. These patterns may be useful in determining occlusal function in children.     

牙周炎基础治疗对咬合力和牙周状况影响的观察

目的 探讨牙周基础治疗对慢性牙周炎(CP)牙周状况和最大咬合力的影响。方法 重度CP病例27例,每病例双侧磨牙各选择一患牙(初诊患牙牙周袋≥5mm,牙松动度≤Ⅱ度),随机分为龈上洁治组(S组)和根面平整组(P组)。S组患牙给予龈上洁治、碘氧液冲洗疗法;P组患牙予以龈上洁治、根面平整和碘氧液冲洗疗法。分别在治疗前和治疗后1、3、6个月测定息牙的咬合力值、龈炎指数(GI)、牙周袋深度(PD)。结果 ①P组治疗后1、3、6个月,最大咬合力值较治疗前有显著性提高(P<0.05);S组与治疗前无显著性差异(P>0.10)。②治疗后1个月,两组的咬合力值无显著性差异(P>0.05);治疗后3、6个月,P组的咬合力显著高于S组(P<0.01);③治疗后3、6个月,P组的GI值、PD值显著低于S组(P<0.001)。结论 洁治、根面平整治疗对于CP患牙的最大咬合力、GI、PD的改善是持续性的,较龈上洁治有显著性差异。     

Occlusal pressure, contact area, force and the correlation with the morphology of the jaw-closing muscles in patients with skeletal mandibular asymmetry

Summary  The purpose of this study was to investigate the difference in the occlusal force between deviated and non-deviated sides of the mandible in adult patients with skeletal mandibular asymmetry, and then also compare the findings to those obtained from controls. The absolute and balance data of the occlusal pressure, occlusal contact area and occlusal force of 23 patients and the controls were examined. Correlations between the occlusal force and the morphology of the jaw-closing muscles were also analysed. The occlusal pressure of patients was not smaller than controls, however, the occlusal contact area and occlusal force in patients were significantly lower than those in the controls. There was no significant difference in the balance of the occlusal contact area and the occlusal force between the right and left sides in the controls, while the balance was shifted to the deviated side in the patients. Interestingly, the balance of the occlusal pressure was very similar between the patients and the controls. Most parameters of the morphology of the jaw-closing muscles did not show a linear correlation with either the occlusal pressure or force. In conclusion, the occlusal contact area and occlusal force in patients were significantly lower than those in the controls, and also the balance was shifted to the deviated side in patients with skeletal mandibular asymmetry. It is assumed that the morphology and orientation of jaw-closing muscles may have not linear but complex correlation to the weaker and unbalanced occlusal force in patients.     

伴有颞下颌关节紊乱病的女性开患者的咬合力分析研究

目的探讨咬合因素对女性开!患者中颞下颌关节紊乱病（ TMD）发病的影响。方法选取女性开!患者102名,根据TMD的有无分为两组,伴有TMD的试验组有59名患者;不伴有TMD的对照组有43名患者。采用咬合力测试仪对两组患者进行咬合力、咬合接触面积、每一咬合接触点上的平均咬合压强和咬合重心的测试,并通过SPSS 11.0软件进行统计学分析。结果试验组的咬合力和咬合接触面积均小于对照组,两组间每一咬合接触点上的平均咬合压强和咬合重心的偏移无统计学差异。结论咬合力不足与开!女性TMD的发病有关。     

第一磨牙缺失不同修复方法的咬合接触特征研究

目的 针对单个第一磨牙缺失的病例,研究种植及可摘局部义齿（RPD）种不同修复方法所恢复的牙列咬合接触特征。方法 选择15名单个第一磨牙缺失的患者作为实验组,15名正常牙列人群作为对照组,其中,实验组每位患者同时进行种植及RPD修复,应用TeeTester咬合分析仪,测试对照组和实验组在未修复、RPD修复及种植义齿修复后3种状态下分别做正中咬合及咀嚼运动,分析其咬合接触特征(总咬合力、总接触面积、不平衡指数、单次咀嚼循环时间,OT/DT比值),并进行统计学分析。结果 患者做正中咬合时,在总咬合力、总接触面积、不平衡指数方面,患者未修复时分别为（48.76±12.82）kg,（317.59±58.47）mm2,（24.78±7.40）,行RPD修复时分别为（54.36±10.59）kg,（355.81±77.43）mm2,（18.29±8.42）,行种植修复时分别为（61.94±12.36）kg,（398.17±83.86）mm2,（17.80±6.69）;患者咀嚼运动时在总咬合力、总接触面积、不平衡指数、单次咀嚼循环时间及T0/Td方面,患者行种植修复时分别为（52.14±16.53）kg,（348.08±81.76）mm2,（15.69±9.16）,（0.4072±0.10）s,（1.718±0.26）。统计学分析表明,RPD、种植义齿修复和对照组的部分咬合接触特征结果无显著性差异,但与未修复前结果有显著性差异。单次咀嚼循环时间及T0/Td在各组间均无显著性差异。结论 在恢复咬合力及咬合接触面积方面,种植义齿优于RPD,较接近天然牙列,并明显优于不修复。正中咬合时全牙列的总咬合力及总接触面积明显大于咀嚼运动时,但不平衡指数无明显统计学差异。     

Clinical and instrumental treatment of a patient with dysfunction of the stomatognathic system: a case report

This article details a case report of a subject chosen from among patients treated in the author's clinic in the Posturology and Gnathology Section of the University Milano-Bicocca.It shows how the indispensable clinical analysis of the stomatognathic system and the connections between posture can be supported by instrumental analysis, such as the computerized occlusal analysis system and the force platform, to diagnose and treat dysfunctional patients.