软衬式赝复体在一侧上颌骨缺损修复中的应用

目的 评价软衬材料在一侧上颌骨缺损修复中的应用及临床效果.方法 6例一侧上颌骨缺损患者,每例患者同时制作软衬式阻塞器修复体和传统硬质树脂阻塞器修复体各1副,分别作为试验组和对照组.比较两组在修复体的固位稳定性、口鼻腔封闭作用及语音清晰度等方面有无差别.结果 试验组修复体在固位稳定性、口鼻腔封闭作用方面均优于对照组修复体,试验组和对照组的语音清晰度分别为(90.4±6.7)%和(84.2±5.1)%,差异有统计学意义(P＜0.01).结论 软衬材料应用于一侧上颌骨缺损早期修复,能在术后早期恢复患者的生理功能,增加修复体的固位稳定性,改善语音清晰程度.     

软衬式赝复体修复单侧上颌骨缺损的疗效分析

目的探讨应用软衬式赝复体修复单侧上颌骨缺损的临床效果。 方法以2010年9月至2014年9月北京大学深圳医院口腔科收治的16例单侧上颌骨缺损的患者为研究对象,制作软衬式赝复体修复上颌骨缺损部分。分别测量患者术后戴入赝复体前和戴入赝复体1个月后的咀嚼效率和语音清晰度值。 结果单侧上颌骨缺损应用赝复体修复1个月后,咀嚼效率与语音清晰度值差异有统计学意义(t_咀嚼效率=-2.33,P_咀嚼效率=0.034;t_{语音清晰度}=-2.49,P_{语音清晰度}=0.029)。 结论软衬式赝复体修复单侧上颌骨缺损可以取得良好的修复效果。     

用CT资料构建上颌骨缺损区实体模型的研究

目的：探讨采用螺旋CT资料构建上颌骨缺损区三维实体模型,及在上颌骨缺损伴张口受限患者赝复体修复中的应用。方法：采用螺旋CT扫描数据三维重建和快速成型技术制作上颌骨缺损区三维实体模型,应用于上颌骨缺损伴张口受限患者赝复体修复。结果：6例上颌骨缺损伴中度以上张口受限患者,利用构建的缺损区三维实体模型进行赝复体修复,患者的赝复体固位良好,面部外形、语音和咀嚼功能恢复良好。结论：采用螺旋CT数据能构建准确的上颌骨缺损区三维实体模型,能解决上颌骨缺损伴中度以上张口受限患者赝复体修复的取模难题。     

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目的    探讨一侧上颌骨缺损应用赝复体修复的临床效果。方法    以2007年9月至2009年9月中国医科大学口腔医学院修复科收治的10例一侧上颌骨缺损患者为研究对象，制作上颌赝复体修复缺损部分。分别于修复前与修复后1个月，采用宋兆峻法测定咀嚼效率、主观语音清晰度测试法测试语音清晰度值，并进行患者的自我临床效果评价。结果    一侧上颌骨缺损应用赝复体修复1个月后，咀嚼效率与语音清晰度值均得到明显的提高，患者自我临床效果评价良好。结论    赝复体修复一侧上颌骨缺损可以得到良好的修复效果。     

充气式硅橡胶赝复体修复单侧上颌骨缺损的研究

目的：建立充气式硅橡胶赝复体的制备方法,探讨其在单侧上颌骨缺损修复中的应用。方法：单侧上颌骨缺损且张口不受限患者,采用分层法获取缺损区模型,对单侧上颌骨缺损伴张口受限的患者,采用螺旋CT扫描数据三维重建和快速成型技术制作上颌骨缺损区三维实体模型,再采用高温硫化法制备医用硅橡胶赝复体外囊,改良软组织扩张器为内囊,采用磁性固位体连接赝复体与义齿。结果：14例上颌骨缺损修复,其中8例为单侧上颌骨缺损且张口不受限患者,6例为单侧上颌骨缺损伴中度张口受限患者,4例张口不受限患者采用甲基丙烯酸甲酯赝复体修复,其余均采用充气式硅橡胶赝复体修复,戴用赝复体1个月后进行临床效果评价,并随访1-3年,硅橡胶赝复体均固位良好,面部外形、语音和咀嚼功能均恢复良好,取戴方便,软硬组织面均无红肿糜烂。结论：充气式硅橡胶赝复体是修复上颌骨缺损的一种比较好的方法,能较好地解决单侧上颌骨缺损伴中度张口受限患者常规赝复体固位不良及取戴不便的问题。     

无牙颌上颌骨缺损修复的体会

目的：探讨单纯修复的方法修复无牙颌上颌骨缺损的效果。方法：对无牙颌上颌骨缺损患者进行分类和不同的修复方法,对疑难的单侧和双侧颌骨缺损采用改良的修复方法。结果：修复后6个月复查,小面积的无牙颌上颌骨缺损,通过常规方法可以获得较好的修复效果;半侧、双侧的无牙颌上颌骨缺损,通过改良的修复法可以提高修复效果。结论：单纯修复方法可以解决一部分无牙颌上颌骨缺损的修复;如果有条件,应该增加其他固位和承力方法;患者自身对赝复体的适应能力在无牙颌上颌骨缺损的修复中很重要。     

套筒冠在齿槽突裂及前牙区颌骨缺损修复中的应用

目的：探索应用套筒冠固位技术修复齿槽突槽突裂及前牙区颌骨缺损的可行性。方法：应用4－5只套筒冠做为齿槽突裂及前牙区颌骨缺损修复体的固体位,采用金属网做为缺损区牙齿和软修复体的连接体,应用烤瓷冠或金属一树脂冠修复葙列缺损,应用树脂材料修复齿槽突及腭部缺损区,形成套筒冠固位的齿槽突裂及腭部缺损修复体,并采用主,客观指标评价其修复效果,结果：经6例患者26－28个月的位的齿槽突裂及腭部缺损修复,并采用主,客观指标评价其修复效果。结果：经6例患者26－28个月的随访证明,套筒冠式修复体固位稳定良好,取戴方便,舒适耐用,能满意地修齿槽突裂,前牙区颌骨缺损以及腭部缺损,结论：套筒冠式修复体是一种齿槽突裂及前牙颌骨缺损的良好修复方式,值得推广。     

自体富血小板血浆在颌骨缺损修复中作用的临床研究

目的　评价自体富血小板血浆在颌骨缺损修复中的作用。方法　40例颌骨缺损患者随机分成实验组和对照组。实验组：20例颌骨缺损骨腔用自体富血小板血浆加可溶止血纱布充填;对照组：术后骨腔放置可溶止血纱布。比较2组术后6个月骨缺损区骨密度的变化。结果　 术后6个月骨缺损区骨密度的变化,实验组优于对照组。结论　 富血小板血浆应用于颌骨缺损患者,能促进骨组织的生长。     

硅橡胶软衬材料对全口义齿牙槽骨吸收的影响研究

目的：研究长效硅橡胶软衬材料对全口义齿牙槽骨吸收变化的影响。方法：选择2010～2012年我科修复牙列缺失患者29例,牙槽骨条件在二级以上,随机分为两组,研究组应用长效硅橡胶软衬技术,对照组不应用软衬材料。修复后利用曲面断层和线性体层摄影技术,定点测量前牙区和后牙区牙槽骨高度,一年后复查牙槽骨高度,进行配对t检验统计分析。结果：牙槽骨吸收变化值,后牙区高于前牙区;两种测量技术均显示软衬材料组牙槽骨吸收低于对照组。结论：牙槽骨的吸收变化,前牙区低于后牙区,软衬材料的应用可以减缓牙槽骨的吸收。     

上颌骨缺损赝复体修复后咀嚼功能评价

上颌骨缺损严重影响患者的咀嚼、语言、吞咽等生理功能和美观,使患者生存质量下降,给患者带来很大的生理和心理负担。赝复体修复方法在上颌骨缺损的修复中占有重要地位,能够在一定程度上改善患者的面部外形,重建语言、咀嚼等生理功能,是早期上颌骨肿瘤切除术后主要的修复方法。本文就上颌骨缺损患者赝复体修复后咀嚼功能的恢复作一综述。     

Evaluation of speech in patients with partial surgically acquired defects: pre and post prosthetic obturation

AIM: Maxillectomy often results in a high level of morbidity with significant psychological and functional implications for the patient. Such disabilities include inability to masticate, deglutition, and speech disturbance. Unfortunately, little is known about the nature of the speech disturbance and the influence of the class of surgical defects in this group of patients. The aims of the present study were to assess the effectiveness of the maxillary obturator as a speech rehabilitation aid and to examine the influence of the classes of surgical defects on speech intelligibility (SI). MATERIALS AND METHODS: Twelve patients aged between 18 and 60 years with surgically acquired partial maxillary defects were included in this study. The patients were given immediate surgical obturators six to ten days after surgery, which were then converted to interim obturators by relining with tissue conditioner. Interim prostheses were used for two to three months until healing and resorption were found satisfactory after which the definitive obturators were fabricated. The SI test described by Plank et al. and Wheeler et al. was employed in this study. There were significant improvements in the mean SI score from 59.8% without prosthetic obturation, to 89.2% following interim obturation, and 94.7% following definitive obturation (p<0.005). Nine patients (75%) had class I surgical defects, two patients (16.67%) had class II defects, while only one patient (8.33%) had a class VI surgical defect. None of the patients had class III, IV, or class V surgical defects. There was an improvement in the SI score from class I to class VI without obturation, after insertion of interim obturator, and after insertion of the definitive obturator. CONCLUSION: Results support the widely held view that the maxillary obturator is a useful speech rehabilitation aid. It also shows immediate, interim, and definitive obturators are all important in the speech rehabilitation of patients with surgically acquired maxillary defects. Moreover SI is affected by the class of defect.     

Replacement of an obturator section of an existing two-piece implant-retained edentulous obturator

There is an increasing number of people in the community who have postablative surgery for tumors of the maxilla. Postsurgical defects these individuals have are usually restored by means of a complete or partial denture obturator with various materials, including resilient silicone extensions. These patients require long-term maintenance of their obturator prostheses, which must be considered in the context of their general health and ongoing medical care. When a resilient silicone bulb is used to obturate the defect, the silicone sometimes deteriorates, whereas the denture base remains functional. This article describes a simple procedure to construct a replacement, resilient silicone bulb obturator while retaining the original complete or partial denture base.     

应用赝复体修复上颌牙列缺损伴上颌骨缺损临床效果评价

目的　评价应用赝复体修复上颌牙列缺损伴上颌骨缺损的临床效果。方法　选取2017年10月至2019年12月于中国医科大学附属口腔医院口腔颌面外科因口腔颌面部肿瘤切除单侧上颌骨并需赝复体修复患者16例。比较患者赝复体修复前和赝复体修复后2个月的咀嚼效率,并采用华盛顿大学生存质量问卷（University of Washington quality of life questionnaire,UW-QOL）评价患者赝复体修复后2个月的生存质量。结果　赝复体修复前和赝复体修复后2个月患者的咀嚼效率分别为（52.5 ± 10.5）%和（69.8 ± 11.1）%,其差异有统计学意义（t = 11.31,P < 0.05）。经UW-QOL评价发现,患者对各项评分均较高,其中疼痛为（89.1 ± 12.8）分,吞咽为（87.5 ± 15.8）分,咀嚼为（84.4 ± 18.0）分,这三项的患者主观感受更好。结论　应用赝复体修复上颌牙列缺损伴上颌骨缺损的临床效果较好,可提高患者的生存质量。     

应用赝复体修复上颌牙列缺损伴上颌骨缺损临床效果评价

 目的　评价应用赝复体修复上颌牙列缺损伴上颌骨缺损的临床效果。方法　选取2017年10月至2019年12月于中国医科大学附属口腔医院口腔颌面外科因口腔颌面部肿瘤切除单侧上颌骨并需赝复体修复患者16例。比较患者赝复体修复前和赝复体修复后2个月的咀嚼效率,并采用华盛顿大学生存质量问卷（University of Washington quality of life questionnaire,UW-QOL）评价患者赝复体修复后2个月的生存质量。结果　赝复体修复前和赝复体修复后2个月患者的咀嚼效率分别为（52.5 ± 10.5）%和（69.8 ± 11.1）%,其差异有统计学意义（t = 11.31,P < 0.05）。经UW-QOL评价发现,患者对各项评分均较高,其中疼痛为（89.1 ± 12.8）分,吞咽为（87.5 ± 15.8）分,咀嚼为（84.4 ± 18.0）分,这三项的患者主观感受更好。结论　应用赝复体修复上颌牙列缺损伴上颌骨缺损的临床效果较好,可提高患者的生存质量。     

Rehabilitation of Hemimaxillectomy with Foldable Obturator in Restricted Mouth Opening: A Case Report

Acquired defects of the head and neck region as in case of hemimaxillectomy can be devastating to the patients and presents considerable reconstructive challenge for the Prosthodontists. The defects created by the surgery results in damaging effects on functional, cosmetic, and psychological aspects of the patient. The purpose of this clinical report is to discuss the method of fabricating a foldable obturator for rehabilitation of a patient of hemimaxillectomy with restricted mouth opening.     

Light-cured combination obturator prosthesis.

A technique for the fabrication of an open combination (hard-resilient) obturator prosthesis with VLC materials for patients undergoing partially edentulous maxillectomy is described. VLC denture resins and resilient liners are an exciting innovation in prosthodontic treatment and offer the maxillofacial prosthodontist a wider choice of treatment modalities. The technique and the resultant obturator prosthesis have the following advantages: 1. The ease and rapidity of the technique saves time for both the patient and the maxillofacial prosthodontist by introducing the open obturator prosthesis at the earliest opportunity. 2. The combination open obturator prosthesis provides a stable record base for securing jaw relation records. 3. The thickness and resiliency of the obturator prosthesis can be managed more easily. Flexibility and resiliency can be modified by the thickness of the resilient liner or by adding a rigid scaffolding according to the clinical requirements. 4. Prostheses are easy to repair or modify by using increments of VLC hard or resilient materials. 5. The combination VLC obturator prosthesis provides stability, retention, and decreased weight and obduration of residual palatal defects. 6. The technique can be used for partially edentulous or edentulous patients after maxillary resection.     

Treatment Outcome with Delayed Maxillary Obturator Prosthesis: Case Series of Four Patients

A series of four patients is presented to indicate the possibility of success with delayed prosthodontic rehabilitation of acquired maxillary defects. Four patients with a history of hemi‐maxillectomy in the past 3 to 5 years were rehabilitated with definitive obturator prostheses. All had partial maxillectomy on the right side. Because of delayed referral to the prosthodontic facility, immediate surgical and interim obturation was not planned. Definitive obturator prostheses were fabricated following the necessary steps and delivered to the patients. Prosthesis function was subsequently reassessed in these patients every fortnight for the first 3 months then once every quarter for the next 3 years, followed by once a year. Individual patient responses were evaluated at regular intervals. Components of prosthesis function assessed were esthetics, speech, mastication, and salivary control, all of which were restored to satisfactory levels by the definitive obturators. Thus, optimal restoration of esthetics and function is achievable despite a time lag in prosthodontic therapy after surgery.     

Mushroom-shaped resilient retainer for maxillary obturator prostheses.

A new type of highly resilient retainer for maxillary obturator prostheses is described. The obturator component is composed of an acrylic resin connector and a round resilient wing, with the combined shape resembling a mushroom. The retainer is designed to absorb mechanical stresses, which are transmitted from the denture portion to nasal soft tissues through the obturator extension, and to use tissue undercuts more effectively than do conventional hollow extension prostheses. Renewability of the retainer part is another advantage of this retainer. From these properties, the retainer seems to have many indications for the prosthodontic treatment of maxillary defects.     

Orofacial functions in patients with congenital and acquired maxillary defects: a fluoroscopic study

By means of videofluoroscopic recordings, chewing, swallowing and speech were monitored in nine patients with congenital and acquired maxillary defects. All of them were rehabilitated with a maxillary obturator prosthesis. The defective region was seldom used for chewing. No leakage between the obturator and surrounding tissue was observed, either for solids or for liquids. All of the prosthetic reconstructions were surprisingly stable during function. In the phonetic analysis, speech production was judged to be restored almost to normal. Videofluoroscopy may be valuable as a complement to other functional diagnostic procedures, and for the evaluation and improvement of rehabilitation with an obturator prosthesis.     

The fate of resorbable poly-L-lactic/polyglycolic acid (LactoSorb) bone fixation devices in orthognathic surgery.

PURPOSE: The aim of this study was to evaluate the long-term outcome of resorbable poly-L-lactic/polyglycolic acid (PLLA-PGA) bone fixation devices used for fixation of maxillary and mandibular osteotomies. MATERIALS AND METHODS: Twelve patients were postoperatively evaluated. Eight patients who had undergone bilateral sagittal split mandibular osteotomies that had been fixed with PLLA-PGA screws were followed-up for up to 2 years postoperatively with radiographs. One of these patients underwent a bone biopsy for detailed histologic evaluation of the screw fixation sites. Two patients who had undergone mandibular symphyseal osteotomies were also radiographically evaluated at 18 months to 2 years postoperatively. Two patients who had Le Fort I osteotomies fixed with PLLA-PGA plates and screws underwent open exploration of the operated sites for visual examination. RESULTS: All 8 mandibular osteotomy patients showed radiographic screw hole lucency immediately after surgery that remained unchanged in the first year after surgery. By 18 months postoperatively, all 48 screw holes showed near or complete trabecular bone fill. The bone biopsy of one screw hole at 2 years postoperatively showed complete fill with normal trabecular bone. No residual polymer material or fibrous scar was seen. The mandibular symphyseal sites showed complete elimination of all screw holes by 2 years postoperatively, with only faint evidence of intraosseous tunnels. The maxillary sites showed complete bone healing along the osteotomies and no evidence of residual fixation material or bone defects in the screw holes. No communication with the maxillary sinus was seen in the fixation sites. CONCLUSION: This orthognathic patient series showed complete resorption of the PLLA-PGA fixation devices without osteolysis in maxillary and mandibular bone sites by 18 to 24 months after surgery.