全口义齿人工牙的选择与排列

选牙与排牙是全口义齿制作的关键步骤之一。前牙选择的要素包括人工牙的形态、大小和颜色。后牙则主要考虑型,一般包括三种类型:解剖式牙、半解剖式牙、非解剖式牙(例如舌向集中型牙)。排列前牙对于恢复患者唇部正常外形以及改善发音都有重要影响,应尽量避免左右牙齿过于对称而引起的"假牙面容"。后牙排列则侧重恢复咬合功能。全口义齿完成选牙和排牙后应进行临床试戴,目的是检查前牙美观是否满意、基托边缘是否合适、咬合是否良好等。     

计算机辅助全口义齿人工牙排列的研究

目的　研究开发一套计算机辅助全口义齿设计 (computeraidedcompletedenturedesign ,CACDD)系统。方法　经过对无牙颌模型、人工牙及具有正中关系位的上下托的三维 (3D)测量、数据处理与建模等环节后 ,根据全口义齿人工牙排列的原则和要求进行排牙。运用仿射和投影变换技术调整牙关系。结果　①生成了具有正中关系位的上、下颌虚拟基托 ,其数学模型为双 3次B样条曲面。②实现了全口义齿人工牙的计算机辅助排列和全口义齿的 3D显示。结论　该系统为计算机辅助全口义齿设计和教学提供了可行的工具     

Occlusal schemes of complete dentures--a review of the literature

Occlusal scheme is defined as the form and the arrangement of the occlusal contacts in natural and artificial dentition. The choice of an occlusal scheme will determine the pattern of occlusal contacts between opposing teeth during centric relation and functional movement of the mandible. With dentures, the quantity and the intensity of these contacts determine the amount and the direction of the forces that are transmitted through the bases of the denture to the residual ridges. That is why the occlusal scheme is an important factor in the design of complete dentures. Three occlusal schemes are viewed in this review: bilateral balanced occlusion, monplane occlusion, and linear occlusion scheme. Each scheme represents a different concept of occlusion. Comparisons between these schemes are also reviewed and analyzed. The reasoning underlying the bilateral balanced occlusion scheme is that stability of the dentures is attained when bilateral contacts exist throughout all dynamic and static states of the denture during function. Anatomic teeth are used: the upper anterior teeth are set to satisfy aesthetics, and the posterior teeth are arranged in a compensatory curve and a medial curve. This scheme is adequate for well developed residual ridges, with skeletal class I relation. With highly resorbed residual ridges, the vectors of force that are transmitted through anatomic cusps will dislodge the lower denture and thus impair the comfort and efficiency of mastication experienced by the patient. In order to accommodate to the special needs posed by highly resorbed residual ridges and skeletal relations that are not class I, the monoplane scheme of occlusion was designed. This scheme consists of non anatomic (cuspless) teeth, which are set so that the anterior teeth provide the aesthetics, the premolars and the first molars are used for chewing, and the second molars do not occlude (although sometimes they are specifically used to establish bilateral contacts in lateral movements). Linear occlusion scheme occludes cuspless teeth with anatomic teeth that have been modified (bladed teeth) in order to achieve linear occlusal contacts. Linear contacts are the pin-point contacts of the tips of the cusps of the bladed teeth against cuspless teeth that create a plane. The specific design of positioning upper modified teeth on the upper denture and non anatomic teeth on the lower one is called lingualized occlusion. It is characterized by contacts of only the lingual (palatinal, to be more accurate) cusps of the upper teeth with the lower teeth. The lingualized occlusal scheme provides better aesthetics than the monoplane occlusion scheme, and better stability (in the case of resorbed residual ridges) than bilateral occlusion scheme of anatomic teeth. The results of studies that compared different occlusal schemes may well be summarized as inconclusive. However, it does seem that patients preferred anatomic or semi-anatomic (modified) teeth, and that chewing efficiency with anatomic and modified teeth was better than with non anatomic teeth. Similar results were found in studies of occlusal schemes of implant-supported lower dentures opposed by complete upper dentures. Conclusion: There isn't one occlusal scheme that fits all patients in need of complete dentures, in fact, in many cases more than one occlusal scheme might be adequate. Selection of an occlusal scheme for a patient should include correlation of the characteristics of the patient with those of the various occlusal schemes. The characteristics of the patient include: height and width of the residual ridge, aesthetic demands of the patient, skeletal relations (class I/II/III), neuromuscular control, and tendency for para-functional activity. The multiple characteristics of the occlusal schemes were reviewed in this article. Considering all of those factors in relation to a specific patient, the dentist should be able to decide on the most suitable occlusal scheme for the case.     

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目的 评价舌侧集中（牙合）与解剖式双侧平衡（牙合）全口义齿修复低平牙槽嵴无牙颌患者的咀嚼效率及咬合力。方法 选择2012年6月至2013年4月到中国医科大学口腔医学院修复科就诊的牙槽嵴吸收较严重的无牙颌患者20例作为研究对象,采用闭口式印模法在同一垂直距离和正中关系咬合记录下为同一患者制作舌侧集中（牙合）与解剖式双侧平衡（牙合）2种不同（牙合）型全口义齿,每例患者随机先后接受2副义齿盲戴使用。每副义齿分别在戴用1周、3个月时采用吸光度法测量咀嚼效率以及用Tee-Tester咬合压力测试仪测量2种（牙合）型的最大咬合力,并在每副义齿使用3个月时进行问卷调查。结果 舌侧集中（牙合）全口义齿的咀嚼效率略高于解剖式双侧平衡（牙合）,但差异无统计学意义（P 〉 0.05）;其咬合力小于解剖式双侧平衡牙合,差异有统计学意义（P 〈 0.05）。在主观满意度调查问卷中,患者对舌侧集中（牙合）全口义齿的舒适性、稳定性、咀嚼能力等评价更高。结论 与解剖式双侧平衡（牙合）全口义齿相比,舌侧集中牙合全口义齿修复低平牙槽嵴无牙颌患者具有更高的稳定性;其具有与解剖式双侧平衡（牙合）相当的咀嚼效能,且咬合力小于解剖式双侧平衡（牙合）,从而延缓了牙槽嵴的吸收。     

Complete denture occlusion considered from occlusal contacts during mastication

Few reports describe the functional superiority of full balanced occlusion to that of lingualized occlusion. Recently, a bilateral balanced scheme has been much more generally applied than a unilateral balanced scheme in lingualized occlusion as well as in full balanced occlusion. Occlusal contacts on the non-chewing side occur earlier than on the chewing side;in the order of second molar, first molar, and then premolars. The contact on the balancing side contributes to the prevention of denture dislocation and guidance from eccentric positions to the centric occlusal position during mastication. Therefore, bilateral balanced occlusion was shown to be effective for denture stability during mastication with complete dentures. Today's typical edentulous patients have greater mean age than in the past, and thus are seen with severe alveolar bone resorption, thin mucosa and sometimes abnormalities of the maxillomandibular relation. Their occlusal positions are often unstable and changeable after insertion of complete dentures. Because lingualized occlusion allows for easier accommodation and correction, lingualized occlusion is more suitable for such cases than full balanced occlusion, which requires a strict occlusal relationship. In light of the standard Japanese diet, there is some doubt about why lingualized occlusion might be suitable for Japanese edentulous patients in terms of the sense of mastication. A method of evaluating the sense of mastication needs to be established.     

全口义齿的二次上架与三次上架

二次上架与三次上架是对全口义齿进行必要的咬合调改,目的是确保义齿能够与患者口腔结构良好适合并具有良好的咬合关系。二次上架一般在技工室由技工完成,内容是将基托成型后的义齿连同无牙颌模型一起复位至原先架上。通过原有颌位关系记录指导消除因义齿制作过程造成的咬合问题。与二次上架不同的是,三次上架则是由医师在临床完成。医师在进行全口义齿初戴时,重新记录患者上下颌的颌位关系,并将其与新义齿转移至架上进行最终的咬合调整。经过二次与三次上架的操作,全口义齿能够在患者口内具有良好的咬合关系。     

Regaining pleasure and success with complete denture services

The techniques used by Earl Pound for denture construction are stated, and their application to contemporary denture construction and implant-based prosthodontics is discussed. Positioning the anterior teeth using the mandibular movements of speech, the use of lingualized occlusion, and the fabrication of diagnostic provisional removable complete dentures--all hallmarks of the Pound technique--are described. It is the author's experience that many patients are content with properly fabricated conventional dentures and do not require dental implants for retention, comfort, and stability of their prostheses.     

Pre-extraction records for complete denture fabrication: a literature review

Dentists use arbitrary methods in determining the vertical dimension of occlusion, and arranging the maxillary anterior teeth. Some dentists have difficulty in making maxillomandibular records for completely edentulous patients. Therefore the use of pre-extraction records has been recommended. This article reviews the pre-extraction records proposed for determining the vertical dimension of occlusion, recording centric relation, and arranging the maxillary anterior teeth. A MEDLINE search, from 1966-2002, for the key words "pre-extraction records" was supplemented with a hand search to identify relevant peer-reviewed English articles published in dental journals. On the basis of the review, it appeared that pre-extraction records proposed for determining the original vertical dimension of occlusion and arranging the maxillary anterior teeth for a completely edentulous patient were useful and preferred to arbitrary methods, whereas pre-extraction records proposed for recording centric relation may not be necessary.     

Checking the occlusal relationships of complete dentures via a remount procedure

Correct occlusal relationships are part of the successful prosthetic treatment of edentulous patients. Occlusal checking should be performed via a remount procedure because denture base materials and fabrication procedures cannot provide dimensionally accurate complete dentures. Occlusal errors caused by the adjustment of denture bases to the denture foundation after a certain period of wearing can also be corrected by means of remounting. The following remount procedures for complete dentures are described: fabrication of transfer casts, transfer of a maxillary denture with a facebow, centric relation record, and mounting of dentures with transfer casts in an articulator with a dental stone. Deflective occlusal contacts of denture teeth in centric occlusion can be eliminated by selective grinding and by tooth-guided excursive movements. In complete denture treatment, priority is given to anterior/canine-guided occlusion.     

104例佩戴全口义齿患者满意度与义齿质量间关系的研究

目的 研究患者对全口义齿满意度与义齿质量间是否存在联系.方法 对104例佩戴全口义齿3-10个月的患者进行满意度问卷调查,同时进行义齿质量相关检查,包括义齿基托边缘伸展、人工牙排列、义齿稳定状况、义齿的固位、咬合关系和息止(牙合)间隙.结果 影响全口义齿患者满意度的主要因素为义齿基托边缘伸展、人工牙排列、咬合关系和息止(牙合)间隙.结论 患者对全口义齿外观、咀嚼能力、义齿稳固性、舒适性方面的满意度受义齿质量临床评价相关参数的影响.     

Using the term "centric"

“Centric” is an old term that would be almost impossible to eliminate from dental terminology. It seems prudent, then, that the term be used correctly and that simple, usable definitions of centric relation and centric occlusion be employed. The word “centric” is an adjective that should not be made to function as a noun. Centric relation is a bone-to-bone (mandible to maxillae) relation. Centric occlusion is a tooth-to-tooth relation (mandibular teeth to maxillary teeth). Therefore, centric relation and centric occlusion are not the same by definition; however, often they both can exist at the same time.     

A simplified approach to optimizing denture stability with lingualized occlusion

Occlusal prematurities are destructive and destabilizing influences in complete dentures. Unless denture bases are adequately and evenly stabilized, it is virtually impossible to properly equilibrate the occlusion. One reason is that all artificial teeth in a denture unit are physically bound into a single denture base and literally act as a single tooth. Therefore, a single point of occlusal prematurity disrupts the entire denture occlusion and negatively affects the denture base stability and retention, preventing proper equilibration. This article describes a step-by-step approach using an intraoral central bearing point tracing device and lingualized occlusion to achieve an effective and simplified equilibration.     

Occlusal considerations for partially or completely edentulous skeletal Class II patients. Part II: Treatment concepts

Four basic concepts must be considered when developing the prosthetic occlusion for skeletal class II patients: (1) Centric relation must be used as a reference position to relate the mandible to the maxillae; (2) the posterior denture teeth must be positioned close to their former positions; (3) freedom of movement must be created in eccentric movements; and (4) multiple occlusal contacts must be provided in centric and eccentric positions. We have described a method that incorporates these basic concepts and provides a harmonious occlusal arrangement for both edentulous and partially edentulous class II patients.     

The Development of Lingualized Occlusion

This article is a historical review of the development of the lingualized occlusion concept over the past century. It focuses on the pioneers of lingualized occlusion and their designs rather than on techniques for achieving a lingualized complete denture occlusion.     

Comparison of the occlusal vertical dimension after processing complete dentures made with lingualized balanced occlusion and conventional balanced occlusion

STATEMENT OF PROBLEM: An increase in occlusal vertical dimension (OVD) may occur after processing complete dentures. Although many factors that generate this change are known, no information is available in the dental literature regarding the effect that the occlusal scheme may have on the change in OVD. PURPOSE: This in vitro study compared the increase in OVD, after processing, between complete dentures with teeth arranged in lingualized balanced occlusion and conventional balanced occlusion. MATERIAL AND METHODS: Thirty sets of complete dentures were evaluated as follows: 15 sets of complete dentures were arranged in conventional balanced occlusion (control) and 15 sets of complete dentures were arranged in lingualized balanced occlusion. All dentures were compression molded with a long polymerization cycle. The occlusal vertical dimension was measured with a micrometer (mm) before and after processing each set of dentures. Data were analyzed using an independent t test (alpha=.05). RESULTS: The mean increase in the OVD, after processing, was 0.87 +/- 0.21 mm for the control group and 0.90 +/- 0.27 mm for the experimental group. There was no significant difference between the groups. CONCLUSION: After processing, dentures set in lingualized balanced occlusion showed an increase in OVD similar to those set in conventional balanced occlusion. CLINICAL IMPLICATIONS: Although the 2 occlusal concepts resulted in similar increases in the OVD after processing, the lingualized balanced occlusion may result in easier occlusal adjustments, as the less complicated occlusal scheme uses a smaller number of centric occlusion contact points.     

Lingualized occlusion revisited

Lingualized occlusion represents an established method for the development of functional and esthetic complete denture articulation. Since its introduction, the lingualized technique has undergone many changes. This article provides an overview of the history and development of lingualized occlusion, and addresses common misconceptions associated with the lingualized technique. In addition, a practical method for the development of lingualized denture occlusion is presented.     

Lingualized occlusion for removable prosthodontics

Lingualized occlusion provides a useful combination of several occlusal concepts. Many advantages of anatomic and nonanatomic occlusions are retained. Adjustment to compensate for minor changes in vertical and centric relation is readily accomplished. Satisfactory occlusion is easily obtained, and balanced occlusion can be accomplished. The lingualized occlusal concept is not a panacea, and all other procedures still must be carefully executed.     

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。     

The lingualized occlusion of complete denture

This article reviews the literatures dealing with the lingualized occlusion of complete denture including the origin,development and research.Lingualized occlusion is a valuable concept because many advantages of anatomic and nonanatomic occlusions are retained,satisfactory occlusion is easily obtained,balanced occlusion can be accomplished.     

Selection of occlusal scheme on the basis of pressure distribution on supporting structures under complete dentures

In case of making complete dentures, we have to consider not only denture stability but also the restoration of aesthetics and function such as mastication and speech. However these are contradictory theoretically from the point of view of denture stability, and it is very difficult to satisfy both requirements in the case of a patient who has poor upper and lower alveolar ridges. We investigated the effect of artificial posterior teeth form and occlusal scheme on the distribution of pressure on supporting structures under complete dentures during mastication with upper and lower edentulous simulators. In this report, a guideline for the selection of occlusal scheme for complete dentures, based on our previous investigations, is described. The occlusal scheme remarkably affected the distribution of pressure under simulated complete dentures, as shown by comparing the distribution of pressure using two different occlusal schemes:fully balanced occlusion and lingualized occlusion. However other factors such as posterior teeth form and position affect the distribution of pressure as well, and are related to each other. Therefore, not only occlusal scheme but also posterior artificial teeth form has to be considered, and the form of posterior teeth should be carefully and comprehensively decided when making complete dentures.