牙列重度磨耗应用固定修复咬合重建的临床观察

目的观察以固定义齿修复进行咬合重建在治疗牙列重度磨耗中的临床效果。方法选择35例牙列重度磨耗或伴有牙列缺损的患者,制作烤瓷或铸造固定义齿进行全牙列咬合重建修复。1年后比较修复前后美观效果、夜磨牙症状、颞下颌关节症状和咀嚼效率的变化。结果所有患者均获得了满意的美观效果,夜磨牙和关节症状有明显减轻或消失,同时显著提高了咀嚼效率。结论固定义齿修复是一种良好的、有效的咬合重建的方法。在保留息止颌间隙的前提下,临床义齿戴用3周后如无不适症状,可考虑行永久咬合重建。     

老年人牙列重度磨耗的固定义齿咬合重建修复

目的：探讨老年人牙列重度磨耗的固定义齿咬合重建修复的可行性，总结临床经验。方法：回顾性研究7例老年人牙列重度磨耗的固定义齿咬合重建患者临床资料，分析临床表现、诊疗特点，总结诊疗过程中注意事项。由一个典型病例介绍诊疗过程。结果：老年人牙列重度磨耗临床表现、并发症多样，[牙合]垫式活动义齿暂时性修复3个月后，单颌或双颌固定义齿咬合重建，修复12个整牙列，随访2～4年，患者满意度高，未出现再度磨耗，颞下颌关节稳定。结论：老年人牙列重度磨耗的固定义齿咬合重建修复可行，诊疗过程较长，中短期疗效肯定。     

牙列缺损伴重度磨耗的咬合重建及修复

目的探讨牙列缺损伴重度磨耗咬合重建及修复方法。方法本文重点介绍了牙列缺损并伴有严重磨耗,面下1/3高度变短的病例,采用固定义齿与简单或垫式通可摘局部义齿进行联合性修复,以获得永久性咬合重建治疗。结果对牙列缺损伴重度磨耗的病例,可通过暂时性修复进行过渡,固定义齿与简单或垫式可摘局部义齿进行联合性修复以达到满意的疗效。结论合理的咬合重建修复治疗可有效恢复患者正中颌位关系及正常的咀嚼功能、治疗及预防颞下颌关节疾病、改善美观。     

重度磨耗伴末端游离缺失的套筒冠义齿咬合重建修复10例

目的 探讨牙列重度磨耗伴末端游离缺失的套筒冠义齿咬合重建修复的可行性。方法 回顾性研究10例牙列重度磨耗伴末端游离缺失的患者进行套筒冠义齿咬合重建修复后的临床资料,分析临床表现、诊疗特点,总结诊疗过程中的注意事项。结果 牙列重度磨耗临床表现、并发症多样,垫式活动义齿暂时性修复3个月后,行单颌或双颌套筒冠义齿咬合重建,修复12个整牙列,随访2年,患者满意度高,咀嚼功能恢复好,未出现再度磨耗,颞下颌关节稳定。结论 牙列重度磨耗伴末端游离缺失的套筒冠义齿咬合重建修复可行,诊疗过程较长,中短期疗效肯定。     

牙列重度磨耗粘结复合树脂咬合面预增高咬合重建

目的:探讨牙列重度磨耗以粘接复合树脂预增高咬合,后行咬合重建修复的临床治疗新途径。方法:先采用粘接复合树脂直接修复牙列重度磨耗患者的咬合面,增高咬合,恢复垂直距离及正中关系,再以固定修复、固定-可摘局部义齿修复等方式行咬合重建。结果:4例牙列重度磨耗患者以粘接树脂预增高咬合均可有效升高咬合垂直距离,复合树脂粘接可靠,调简捷,患者对粘接复合树脂预增高咬合适应性好,永久性修复体完成后随访半年-1年,患者面部外形改善,咀嚼功能恢复良好。结论:牙列重度磨耗粘接树脂咬合面预增高咬合重建,可较为准确恢复咬合垂直距离,易于患者接受及配合,为固定式咬合重建创造了便利条件,作为咬合重建修复的新途径值得进一步研究。     

中重度牙列磨耗一次性咬合重建修复的疗效观察

目的探讨中、重度牙列磨耗患者一次性咬合重建的临床效果。方法中、重度牙列磨耗患者23例,行一次性固定或活动义齿修复,随访并询问患者的主观感受、咀嚼情况、颞下颌关节区变化,摄X线片,了解义齿、牙根及颞下颌关节结构改变。结果患者普遍认为一次性重建易适应、咀嚼效率显著提高,无颞下颌关节区不适等症状。复查X线片示无明显异常。结论中、重度牙列磨耗患者选择性实施一次性咬合重建的临床效果良好。     

牙列重度磨耗伴缺损的可摘局部义齿重建修复

目的：探讨应用可摘局部义齿一次性咬合重建修复牙列重度磨耗伴缺损的可行性.方法：对17例牙列重度磨耗伴缺损的患者采用（耠）垫式可摘局部义齿行一次性咬合重建,治疗后1个月、3个月和6个月复诊,调查患者主观感觉、咀嚼效果、义齿稳定性;以及是否有颞颌关节不适.结果：患者咬合升高1.5mm-2.5mm.随访6个月,患者无不适,咀嚼功能改善明显,对义齿的美观和功能都满意.结论：对于牙列重度磨耗伴缺损的病例可以尝试应用可摘局部义齿进行一次性咬合重建修复.     

牙列缺损伴重度磨耗的咬合重建序列治疗体会

目的：评价牙列缺损伴重度磨耗的咬合重建序列治疗的效果。方法：选取牙列缺损伴重度磨耗患者36例,采用固定-活动联合修复方法实施咬合重建,通过3年随访,观察临床修复效果。结果：咬合重建后36例患者取得较满意疗效。结论：有序、合理的咬合重建治疗可以恢复患者正常的咀嚼功能,缓解颞下颌关节紊乱病及牙齿敏感,改善美观。     

牙列重度磨耗(牙合)重建中的固定修复治疗

目的 :探讨应用固定修复治疗牙列重度牙合磨耗的疗效。方法 :对 5 8例牙列重度磨耗病例共制作 2 3 5个冠桥牙合重建修复体。结果 :重建后牙列形态与咬合、面下 1/ 3高度获得适度恢复 ,咀嚼功能良好。结论 :固定修复是一种用于牙列重度磨耗 牙合重建的治疗方法。修复中应重视基牙及对颌牙的治疗和调牙合、及暂时修复体的戴用     

牙列重度磨耗老年患者咬合重建的疗效观察

目的评价对牙列重度磨耗导致咬合垂直距离降低的老年患者进行咬合重建的疗效。方法老年牙列重度磨耗患者65例按有无牙列缺损和颞下颌关节紊乱（tempommandihulardisorders,TMD）分为3组。A组42例,牙列重度磨耗伴牙列缺损,不伴TMD。B组15例,牙列重度磨耗伴牙列缺损,且有功能性TMD。C组8例,牙列重度磨耗伴有功能性TMD,但无牙列缺损。A组和B组采用胎垫式可摘义齿,C组采用可摘式验垫重建咬合。65例患者随访45d～9年,根据咀嚼功能和颞下颌关节（temporomandibularjoint,TMJ）功能进行疗效评价。结果咀嚼功能方面,A组42例中40例达到优良,B组15例中14例达到优良,C组8例中7例达到优良。TMJ功能方面,A组仍无TMD病例,B组15例中14例TMJ功能恢复正常,C组8例中7例TMJ功能恢复正常。结论老年患者由于牙列重度磨耗导致的咬合垂直距离降低,有必要进行咬合重建修复,在正中耠位行验重建修复效果满意,可为其后固定修复提供参考。     

牙列重度磨耗伴缺损老年患者两种咬合重建治疗的效果比较

目的:观察牙列重度磨耗伴缺损的老年患者分别采用垫式可摘局部义齿与固定义齿进行咬合重建治疗的效果,并进行对比研究。方法:24例牙列重度磨耗伴缺损的老年男性患者,分别采用垫式可摘局部义齿与固定义齿进行咬合重建治疗,其中垫式可摘局部义齿咬合重建组15例,固定义齿咬合重建组9例,并分别对患者治疗前后的自我感觉(美观、舒适)、临床表现、咀嚼效率、颞下颌关节紊乱病临床症状的变化等指标进行评估及分析。结果:垫式可摘局部义齿与固定义齿咬合重建治疗后,患者均主观感觉良好、临床症状改善、咀嚼效率增加,差异显著(P<0.01)。固定义齿咬合重建组患者较垫式可摘局部义齿咬合重建组患者主观感觉更好,咀嚼效率增加更多(P<0.05)。有颞下颌关节病症状的患者咬合重建后症状均有改善,两种咬合重建方法间未见明显差异。结论:垫式可摘局部义齿与固定义齿咬合重建治疗均能一定程度恢复牙列重度磨耗伴缺损老年患者的口颌功能,改善颞下颌关节病症状。采用固定义齿进行咬合重建治疗更具有美观、舒适、提高咀嚼效率的作用。     

牙列缺损伴重度(牙合)面磨损(牙合)重建修复的临床研究

目的 通过对不同类型牙列缺损并伴重度(牙合)面磨损的患者进行修复治疗,探讨(牙合)重建的有关问题.方法 选取牙列缺损并伴重度(牙合)面磨损患者69例,制取修复前研究模型,根据不同的缺损类型进行(牙合)垫式可摘局部义齿、固定义齿或固定-可摘义齿联合修复,随访3个月～4年,观察修复治疗效果.结果 患者的咀嚼功能明显改善,有颞下颌关节症状者,症状得到了缓解,无颞下颌关节症状者在咬合升高后未出现新的颞下颌关节症状.结论 对于牙列缺损伴重度(牙合)面磨损患者,(牙合)垫式可摘义齿及固定义齿修复均是(牙合)重建修复的有效方法.     

Wear of resin denture teeth in partial removable dental prostheses

PurposeTo investigate occlusal wear of resin denture teeth in partial removable dental prostheses worn by partially edentulous patients.MethodsThirty patients with partial removable dental prostheses were included in the study. Thirty-two patients with complete dentures served as a reference group. Occlusal wear after two years was evaluated indirectly using gypsum casts and a three-dimensional laser-scanner device. Overall wear of complete occlusal surfaces and maximum wear of occlusal contact areas were measured. Patient and prosthesis data were analyzed using univariate and multiple linear mixed models.ResultsOverall wear of denture teeth in partial removable dental prostheses was 91 (SD 85) μm, and maximum wear of occlusal contact areas was 329 (SD 204) μm (means and standard deviations). Average and maximum wear values for teeth in complete dentures were both lower than those for teeth in partial removable dental prostheses. However, differences between wear of different types of denture did not reach statistical significance after adjustment for gender, type of tooth, dental status of the opposing jaw, and antagonist material. Statistical analysis revealed that wear was greater for denture teeth occluding with ceramic crowns and/or fixed partial dentures as antagonists.ConclusionsResin denture teeth in partial removable and complete dental prostheses are subjected to clinically important occlusal wear that might destabilize occlusion and cause further problems. Patient-related factors and dental status affect wear behavior and should be taken into consideration when treating patients with removable dentures.     

Restoration of the Occlusal Vertical Dimension with an Overlay Removable Partial Denture: A Clinical Report

The process of tooth loss throughout life associated with severe occlusal wear may pose a challenge in the rehabilitation of partially edentulous arches. In these cases, many therapeutic procedures are necessary because each tooth must be restored to obtain the correct anatomical contour and recover the occlusal vertical dimension (OVD). A removable partial denture (RPD) with occlusal/incisal coverage, also known as an overlay RPD, is an alternative treatment option with fewer interventions, and, consequently, lower cost. This clinical report reviews the principles involved in the clinical indication for an overlay RPD, as well as the necessary planning and execution, to discuss the feasibility and clinical effectiveness of this treatment, identifying the indications, advantages, and disadvantages of this procedure through the presentation of a clinical case. The overlay RPD can be an alternative treatment for special situations involving partially edentulous arches in patients who need reestablishment of the OVD and/or realignment of the occlusal plane, and it can be used as a temporary or definitive treatment. The main advantages of this type of treatment are its simplicity, reversibility, and relatively low cost; however, further studies are needed to ensure the efficacy of this treatment option.     

Implant‐Supported Prosthetic Rehabilitation of a Patient with Localized Severe Attrition: A Clinical Report

Patients usually adapt to their existing occlusal vertical dimension (OVD). It is essential to resolve each of the problems associated with decreased vertical dimension as a result of attrition. This report describes the multidisciplinary dental treatment of a 40‐year‐old male patient who had severe tooth wear, resulting in reduced vertical dimension. After clinical evaluations, extraoral examination showed a reduction of the lower facial height, drooping, and overclosed commissures. Ten dental implants were placed into the maxillary and mandibular alveolar processes. During the osseointegration period, an interim removable partial denture was made at increased OVD to use in the first stage of rehabilitation. It was used for 3 months as a guide for preparing the definitive restorations. The patient's adaptation to the increased OVD was evaluated. During this period, he was asymptomatic. Following the evaluation period, the provisional fixed restoration was used for 3 months. Then, full‐mouth definitive prostheses supported by a combination of implants and teeth were fabricated to upper and lower jaws. Osseointegration of the implants, peri‐implant mucosa health, prosthesis function, and esthetics were assessed after 1 week and 1, 3, and 6 months. After 3 years of follow‐up, no functional or esthetic difficulties with the implants and restorations were noted.     

Long-term prognosis of extensive polyunit cantilevered fixed partial dentures.

The aim of this retrospective study was to elucidate the long-term prognoses of extensive fixed partial dentures including unilateral or bilateral polyunit cantilevers in patients with healthy but reduced periodontal support. Following periodontal therapy 36 cross-arch fixed partial dentures with two or more cantilever units unilaterally or bilaterally were fitted in 34 patients. In the prosthodontic design, special attention was given to the retention to long parallel preparations, to the dimensions of the framework, and to the occlusal design. After completion of therapy, the patients were enrolled in a regular maintenance care program and followed up for a period of 5 to 12 years. During this follow-up period one abutment tooth was fractured in one patient. One fixed partial denture with extremely reduced periodontal support was lost as a result of complete periodontal breakdown from occlusal trauma. For 33 fixed partial dentures, neither periodontal nor technical complications occurred.     

Functional preprosthetic orthodontics and prosthetic reconstruction with resin-bonded fixed partial dentures

When a resin-bonded fixed partial denture is planned in the maxillary anterior region, special attention must be paid to occlusal diagnosis. Specific instrumental diagnosis is necessary to define the functionally important factors: the anterior teeth, the occlusal plane, the temporomandibular joint, and their three-dimensional relation. The optimal treatment in an anterior-guided occlusion is a complete integration of the retainers in the given tooth form without altering the original inclination of the palatal guiding surfaces of the anterior teeth. In many cases, preprosthetic orthodontics is indicated because of functional and esthetic reasons. The objective is to achieve an anterior tooth position that allows the retainers of a resin-bonded fixed partial denture to be incorporated with the designed inclination of the guiding surfaces, using noninvasive preparation techniques. Preprosthetic orthodontic treatment planning, possible problems, and limiting factors as well as the subsequent prosthetic reconstruction have been described in detail. The interdisciplinary treatment has to be planned individually for each patient, depending on the functional diagnosis and the clinical and anatomic situation.     

咬合重建相关病例回顾及修复流程研究

目的根据咬合异常的不同临床表现，应用不同的修复方法进行咬合重建，评价临床效果，讨论与咬合重建相关疾病的临床诊断及修复设计流程。方法64例咬合异常患者按照修复前检查-诊断-修复设计-咬合重建修复-修复后评价的临床步骤，进行固定修复、固定-可摘局部义齿修复及可摘局部义齿修复咬合重建，于修复前后分别检查颞颌关节健康状况、义齿使用情况与咀嚼效能。结果咬合重建修复1年后，30例颞颌关节紊乱病患者中的25例治愈，对关节区疼痛与关节弹响的疗效差异有统计学意义：全部患者对咬合重建修复的临床效果满意，与可摘局部义齿修复相比较，固定修复、固定-可摘局部义齿修复在义齿舒适度（X^2=5．25，P〈0．05）和对发音影响（X^2=10．86，P〈0．05）等方面的满意度较高，差异有统计学意义；不同种类修复之间及选用不同种类修复咬合重建修复前（F=9．248，P〈0．05）和修复后（F=4．858，P〈0．05），患者咀嚼效能的差异有统计学意义。总结和制定与咬合重建相关疾病的临床诊断流程及修复设计流程。结论运用系统化的临床诊断流程及修复设计流程，能保障获得准确的诊断与针对性的修复设计，保证咬合重建诊疗修复取得成功。     

Combined application of roll flap and combination onlay-interpositional graft to enhance esthetics of maxillary anterior fixed partial denture: A case report

In the maxillary anterior region, reconstruction of the localized alveolar ridge defect is very important in enhancing the esthetics of fixed partial denture. A 40-year-old female patient presented with a chief complaint of the inconvenience and unesthetic problem of 3-unit maxillary anterior prosthesis due to alveolar ridge resorption. After removal of old prosthesis, intraoral examination revealed moderate (buccolingually 4 mm) ridge deficiency in missing tooth region, leading to the diagnosis of Class I alveolar ridge defect. One of the reconstruction techniques to overcome this problem might be a technique that combines two types of soft tissue augmentation techniques. The purpose of this paper was to demonstrate the new combined technique of roll flap and combination onlay-interpositional graft utilized to acquire sufficient dimension of recipient area by one time of operation and to present the esthetic improvement of fixed partial denture by using this procedure in case of maxillary anterior localized ridge defect.