可摘局部义齿的基牙健康状况研究

可摘局部义齿的基牙健康状况研究余占海霍绥梅刘斌为了解可摘局部义齿（Ｒｅｍｏｖａｂｌｅｐａｒｔｉａｌｄｅｎｔｕｒｅｓ，简称ＲＰＤｓ）对基牙健康状况的影响，自１９９０年起，先后选择１２８例牙列缺损患者进行了ＲＰＤｓ修复，并定期对他们进行了为期１年的临床...     

可摘局部义齿基牙牙周指数和牙菌斑细菌相对分布

临床研究已经证实[1～3] ,戴用可摘局部义齿 (Ｒｅ ｍｏｖａｂｌｅＰａｒｔｉａｌＤｅｎｔｕｒｅｓ ,ＲＰＤｓ)会破坏口腔微生态平衡 ,进而对基牙牙体、牙周组织健康造成不良影响。为了进一步探讨ＲＰＤｓ对口腔微生态系影响的微观变化及特点 ,作者先后为 2 8例第一磨牙缺失的患者进行ＲＰＤｓ修复 ,并就基牙牙周指数及菌斑细菌相对分布变化进行了为期 4年的动态检测分析。现报道如下 :1　资料和方法1.1　病例选择本组 2 8例患者 ,男 17例 ,女 11例 ,年龄 2 3～ 5 4岁 ,均为第一磨牙缺失 (任何一区 )。从未戴过义齿 ,基牙无龋或充填物 ,牙龈…     

可摘局部义龄基牙健康状况的研究

目的 对比患者不同的口腔卫生习惯,不同的义齿设计,不同的义齿材料等,以分析可摘局部义齿（removable partial dentures,RPDs)对口腔微生态的影响。方法 在患者戴入RPDs3年后,用龋病,牙周病常用指数及口腔卫生指数来检查基牙健康状况,用X^2检验分析它们之间的结果有无差异。结果 患者的口腔卫生习惯,义齿的不同设计均与基牙健康密切相关,而两种不同材料的义齿对基牙的损坏无显著性差异。结论 RPDs基牙的健康与多因素有关,而口腔卫生状况是决定RPDs口腔微生态的重要因素。     

可摘局部义齿基牙健康状况的远期临床观察

为了深入探讨可摘局部义齿（ＲｅｍｏｖａｂｌｅＰａｒｔｉａｌＤｅｎｔｕｒｅｓ，ＲＰＤｓ）对口腔微生态系进而对基牙健康状况的影响，以及影响特点和相关因素［１］，我们先后对１２８例牙列缺损患者进行了ＲＰＤｓ修复，并对患者进行了为期４年的临床追踪观察。现将...     

可摘局部义齿卡环对基牙的影响

目的 研究可摘局部义齿卡环对基牙牙体牙周及义齿的修复效果的影响。方法 采用社会调查和门诊连续随访的形式,对被卡环损伤了的３９７颗基牙（１４６名患者的１７９件义齿）进行了调查分析。结果 基牙损伤与年龄、义齿使用时间、义齿类型及义齿质量有关。结论 戴牙时间越长,基牙发生损伤越重。主要原因是基牙与卡环的摩擦过多或卡环位置不当。     

可摘局部义齿患者口腔内环境变化的动态观察

目的：观察和探讨可摘局部义齿对口腔唾液流率、pH值及变链菌数的影响机制和特点。方法：收集28例患者戴用可摘局部义义齿前及戴用后2周、3月、6月、1年、2年、4年的5min非刺激性全唾液，计算单位时间内唾液分泌总量（流率，ml/min）；用精密pH试纸测定唾液pH值；采用塑料条法测定唾液中变链菌数。结果：①患者戴用可摘除局部义齿后，唾液流率有所降低，唾液pH值有所升高。但随着戴用时间延长，它们又逐渐恢复正常。②患者戴用可摘局部义齿后唾液中变形链球菌数量增加。结论：戴用可摘局部义齿可导致患者唾液分泌减少；酸碱平衡改变及变形链球菌数量增加。     

可摘局部义齿

可摘局部义齿基牙健康状况的实验研究／余占海…∥口腔颌面修复学杂志．快速液压自控牙用树脂聚合器的临床应用研究／赵堂民…∥临床口腔医学杂志，Mini—SG附着体义齿修复双端游离缺失的临床疗效／武华…∥临床口腔医学杂志．     

老年人可摘局部义齿基牙的临床调查

可摘局部义齿修复效果与基牙有直接密切关系。通过临床调查560例次可摘局部义齿确定出基牙的排列顺序及统计出双尖牙、尖牙为老年人常用基牙。由于双尖牙具有有利的解剖形态及解剖位置,所以常首选作为义齿的基牙,实际对尖牙起到了保护作用,是尖牙在口腔中保持较长时间的原因之一。对双尖牙的组织保健、形态完整的维持与修复是很重要的。     

用桩冠作基牙的可摘局部义齿修复

临床上常见一些患者全牙列缺损，但以上、下尖牙多见残留部分较完整的牙根，因而要求进行义齿修复。临床上亦有拔除残根后进行全口或半口义齿修复、根管治疗后覆盖义齿修复、附着体修复等。作者自1996年开始采用保留适合做桩冠、且能承担可摘局部义齿固位力的残根，先完成桩冠修复，再用该桩冠做基牙，进行可摘局部义齿修复，取得了良好效果。现介绍如下：1.选择适宜作可摘局部义齿基牙的残根，牙根需有足够的长度及粗细合适的根管，尖周情况良好，牙龈、牙周无炎症。行完善的根管治疗后进行桩冠修复，要求桩冠钉长度达根长2/3，直径达1/2根…     

老年人可摘局部义齿修复对基牙的影响

目的:分析研究老年人可摘局部义齿修复后对基牙的影响,探讨其原因及预防措施。方法:对95例牙列缺失后的老年人行冷弯卡环固位式可摘局部义齿修复,记录和比较戴可摘局部义齿后基牙和非基牙的龋坏率和缺失率,用χ2检验分析其结果有无差异,并对影响基牙的原因进行分析。结果:戴用可摘局部义齿5a后,基牙的患龋率(17.38%)显著高于非基牙(7.10%);因牙折、牙周病松动及龋坏无法保留而拔除的基牙缺失率(27.01%)也显著高于非基牙(7.79%)(P<0.01)。结论:冷弯卡环固位可摘局部义齿修复后在一定程度上可增加老年人基牙的患龋率和缺失率。     

老年人可摘局部义齿修复后对基牙牙周状况的影响

目的：研究老年人戴用可摘局部义齿对基牙牙周健康状况的影响。方法：对56例牙列缺失后的老年人行可摘局部义齿修复,3个月、12个月后复查并记录基牙与对侧同名牙的菌斑指数、牙龈指数、探诊出血指数、探诊深度等四项牙周指标。结果：患者戴用可摘局部义齿后基牙的四项牙周指标明显高于对照牙（P〈0．01）;老年患者戴用可摘局部义齿后的3个月内,基牙的牙周指数均明显升高（P〈0．01）,12个月时基牙的牙周状况趋于稳定状态。结论：老年人戴用可摘局部义齿可引起基牙的牙周指数增加。     

Failures in the rehabilitation treatment with removable partial dentures

Abstract

Background. Despite being functional and having aesthetic benefits, the acceptance of patients regarding the use of removable partial dentures (RPDs) has been low. In part, this is due to the deleterious effects that causes discomfort to the patient. Success depends not only on the care expended by the patient, including daily care and oral hygiene, but also on common goals set by their professional and clinical staff, aiming beyond aesthetics, to incorporate issues of functionality and the well-being of patients. Methods and results. For rehabilitation treatment with RPDs to reach the desired level of success without damaging the support structure, all the steps (diagnose, cavity preparation, adaptation of the metal structures, functional of distal extension and posterior follow-up) in the rehabilitative treatment should be carefully developed. A literature review was carried out, searching through MEDLINE (PubMed) articles published between 1965 and December 2012 including clinical trials and reviews about the use of RPDs. Conclusions. This study describes factors that lead to failures and complications in oral rehabilitation through the use of RPDs and suggests possible solutions.     

Longitudinal study of the influence of removable partial denture and chemical control on the levels of Streptococcus mutans in saliva

Some studies have evaluated the salivary levels of mutans streptococci (MS) in removable partial denture (RPD) users. Saliva samples (2.0 mL) were obtained from 31 patients in six periods: (T0): immediately before installation of RPD; (T8): 8 days after T0; (T48): 48 days after T0; (T92): 92 days after T0; (T140): 140 days after T0 and (T189): 189 days after T0. The samples were vortexed and serially diluted from 10(-1) to 10(-6) in 0.05 m phosphate buffer (pH 7.4). From each dilution, 0.025 mL was plated on Mitis Salivarius Bacitracin (MSB). The plates were incubated in 5% CO2 at 37 degrees C for 72 h. There was an increase (t-test, P < 0.05) in the number of MS between periods T0 and T48 (mean/s.d., CFU mL(-1) of saliva): T0: 2.26/4.43 x 10(6) and T48: 0.47/1.48 x 10(8). After this, intensive treatment with CHX was accomplished in 29 patients. Saliva samples were obtained after treatment in four periods: (T24 h): 24 h after T0; (T14): 14 days after T24 h; (T28): 28 days after T24 h, and (T63): 63 days after T24 h. The number of MS in saliva did not decrease (t-test, P > 0.05). A new CHX formulation was applied in 15 patients. Saliva samples were obtained in periods: (T0): before new CHX application; (T24 h): 24 h after T0 and (T82): 82 days after T0. The new CHX reduced MS levels in saliva: (mean/s.d., CFU mL(-1) of saliva): T0: 6.64/8.47 x 10(6) and T24 h: 3.2/4.27 x 10(5) (sign rank, P < 0.05). In conclusion, there was a significant increase in the number of MS in saliva after the installation of RPD. The intensive treatment with a properly formulated CHX was effective in the reduction of MS, between 24 h and 82 days after its application.     

口干与可摘局部义齿临床关系的相关研究

目的:观测佩戴两种不同材料可摘局部义齿的患者戴牙前后口腔中静态唾液流率,探讨口干与佩戴可摘局部义齿的相关关系。方法:采用舌下置棉球浸唾称重法,选取符合纳入标准的60例钢托排牙的患者(A组)和60例钢网排牙的患者(B组),测量其戴牙前后不同时间点口腔中静态唾液流率,并进行相关分析。结果:经过重复测量分析得出A,B两组患者戴牙前后唾液流率有差别,静态唾液流率有所减少,经t检验分析,P<0.05。结论:戴用可摘局部义齿可以导致患者口腔中静态唾液流率降低,从而引起口干的症状。     

可摘局部义齿修复1126例临床分析

目的：对1126例可摘局部义齿进行分析，为临床关于可摘局部义齿修复牙列缺损积累经验。方法：随机选取1126件义齿修复病例，分析牙齿缺损位置、数量与性别和年龄的关系及修复体的类型，并对采用新技术进行的特殊设计进行分析。结果：上颌牙缺失多于下颌，不同年龄组缺牙好发部位不同，青年组以前牙缺失为多，其他年龄组以后牙缺失为多。男女两组中平均失牙数随年龄增加而增加，但与性别无关，在各类可摘局部义齿设计中，第5类最多。结论：可摘局部义齿制作简便，适应症广，目前仍然在修复治疗中发挥着重要的作用。     

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本文介绍了可摘局部义齿临床设计的基本要求,强调保护基牙为设计的首要原则,并从支持、固位、稳定、连接等几个方面阐述了义齿的设计要点,供口腔医生在进行临床义齿修复工作中参考。     

Treatment with removable partial dentures: a longitudinal study. Part I

The aim of this study was to evaluate the effectiveness of an oral rehabilitation by removable partial denture (RPD). Between 1983 and 1994, 629 patients were provided with an RPD at the Dental School of the Université catholique de Louvain. All the RPDs were constructed with a cobalt-chromium framework. All the treatments were provided by dental students under the supervision of clinical instructors. At recall time (1998-2000), 269 patients could not be reached neither by telephone nor by mail and 27 had died. Consequently, 333 patients were called for clinical examination and 254 of these (76.3%) actually attended. For a total of 292 RPDs fitted for these 254 patients, 218 (74.7%) were still being worn at the time of the check-up. Seventy-four dentures were considered to be 'failures', either because they were replaced by another RPD or by a complete denture, or because they had actually never been worn. The statistical analysis (Mantel-Haenszel and Kaplan-Meier) shows that the number of failures is significantly higher at the lower jaw compared with the upper jaw. Most of the failures are attributable to RPDs with free-end saddles and, in particular, to class I mandibular dentures. The patients are wearing their denture(s) mostly continuously (63.6%) and award a high degree of satisfaction to their denture. In general, the results recorded may be considered as very satisfactory, all the more so as we have no regular recall procedures established at our school and as check-up asked for spontaneously by the patients in the course of the period of observation are most of the time occasional or non-existent.     

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口腔修复是目标明确的临床技术,其治疗计划的形成具有显著的“逆向设计”特性。制定过程大致为：首先从恢复外观功能的需求确认是否必须进行修复,然后根据患者的主观愿望和客观条件选择修复技术,可摘局部义齿是最常用的选项。从患者年龄和目前的口腔疾患及保健状况可推测剩余组织的预后,患者的经济条件和心理状况也应作为治疗计划的参考依据。下一步是根据患者剩余软、硬组织的条件设计义齿结构,包括基牙数量和布局、固位体、连接体、人工牙排列等。有关的辅助性措施如修复前正畸、拔牙、牙体牙髓治疗等应该针对最后的治疗目标而选择性采用。     

分割式及普通可摘局部义齿缺牙区黏膜的三维有限元分析

目的:研究并比较戴用分割式可摘局部义齿与普通可摘局部义齿在不同载荷下缺牙区黏膜的应力情况。方法:选择上颌第二双尖牙、第一磨牙缺失伴基牙有I度松动的患者1例,通过螺旋CT扫描获得上颌二维断层图像。在Pro/Engineer中进行模型的建立,然后导入ANSYS Workbench软件中,进行网格化分和三维有限元分析。结果:斜向、垂直载荷下,戴用分割式可摘局部义齿与戴用普通可摘局部义齿的缺牙区黏膜Vonmises力的数值范围有明显差异。水平载荷下,二者有一定差异。3种载荷下均为戴用分割式可摘局部义齿较大。3种载荷下二者的Von mises力分布情况相似。结论:从生物力学的角度证明,对基牙有I-II度松动以及牙周健康状况不佳的患者,行分割式可摘局部义齿修复是可行的。可以认为,分割式可摘局部义齿有效地起到了保护基牙的作用。