前牙修复体形状计算机辅助设计的方法学研究

目的 建立前牙冠桥修复体形状的计算机辅助设计系统,增进医、患、技间的信息交流,提高前牙修复体的美学质量。方法 采用数码相机采集图象、采用空间域方法、邻域平均法、图像平均法和图像平衡法等进行图象预处理;建立样本牙形库、通过对样本牙、缺失牙的特征选择、提取和排序、运用计算机基于串－并方式的三层可调隐单元模糊神经网络法,结合医生、患者的意见,进行前牙修复体计算机的形状自动设计和手动个性化设计。结果 在该系统的支持下,对前牙各种不同缺失与缺损临床病例86例进行设计、医生、患者共同参与设计形状,打印制作配方,形状匹配效果满意。结论 实现了修复体形状的计算机自动匹配和个性化设计,促进了人工神经网络技术、信息处理技术在口腔修复领域的应用。     

金属烤瓷修复体色度学研究

目的：研究金属烤瓷修复体色度学特征，为临床金属烤瓷修复的比色、配色提供指导。方法：数码照像计算机色度分析系统分别测定1296件金属烤瓷修复体、792颗活体前牙和Vita比色板色片的色度，分析并比较金属烤瓷修复体、活体前牙和Vita比色板各色片色度值范围，金属烤瓷修复体与Vita比色板匹配情况及色度值差异情况。结果：金属烤瓷修复体、活体前牙和Vita比色板各色片色度值范围不吻合，金属烤瓷修复体的颜色主要分布在Vita比色板的个别色片，金属烤瓷修复体与Vita比色板的色度差为△L＊0．45，△a＊1．14，△b＊0．56，△E＊ab2．58。结论：金属烤瓷修复体的色度与Vita比色板色片相差较大。     

浅谈金瓷修复体的色彩还原

金属—烤瓷修复体以其色泽逼真、美观，能很好地恢复牙齿的形态和功能等优点，被日益广泛应用于临床。然而要达到与天然颜色一致，因目前尚未有一种完善的牙齿颜色的测量系统，也没有一种理想的颜色复制系统［１］，其颜色的匹配一直是国内外口腔修复工作者难以解决的问题...     

多次烧结遮色瓷对金瓷修复体颜色的影响

探讨金属烤瓷修复体颜色匹配和色泽稳定性，提高金瓷修复体质量，一直是临床烤瓷修复面临的重要课题。本实验拟利用光谱扫描色度仪测试多次烧结遮色瓷层后金瓷修复体色相、明度、彩度的变化，探讨烧结变色规律及对金瓷修复体颜色的影响，为临床上金属烤瓷修复体的制作提供实验依据。     

制作过程中影响金瓷修复体颜色的因素

颜色匹配是金瓷修复技术上的一个难点.常常在比色时可从比色板上找出一个较满意的颜色,而修复体制做完成后却不能达到良好的颜色匹配。原因之一是牙体     

不同厚度In-Ceram全瓷修复体的色差分析

目的 :研究不同厚度In Ceram全瓷修复体对整体颜色的影响。方法 :应用MINODACR 3 2 1色差仪测试In Ceram全瓷修复体底核及其上构筑不同厚度的不透明牙本质瓷及体瓷 ,采用国际照明委员会 (CIE) 1976L a b 标准色度系统分析背景颜色对修复体颜色的影响。结果 :随着不透明牙本质瓷及体瓷厚度的增加 ,修复体对背景颜色的遮盖能力增强 ,当不透明牙本质瓷厚 0 .2mm ,修复体在 1.6mm时背景颜色对其颜色无肉眼可见差别 ,当不透明牙本质瓷厚 0 .4mm ,修复体在 1.4mm时背景颜色对其颜色无肉眼可见差别。结论 :临床可根据牙体变色情况酌情选择不透明牙本质瓷及体瓷的厚度 ,以期达到与天然牙颜色最匹配的效果。     

金瓷修复体着色剂色稳定性的研究

使用表面着色剂是改善金瓷修复体表面色的重要手段，但临床应用中，着色剂在烧结前后颜色会有一定改变。为了解着色剂颜色改变的一般规律及特点，我们采用ＣＩＥ１９７６ＬＡＢ色度系统对ＶｉｔａＶＭＫ６８的５种着色剂进行了色稳定性分析。结果表明，５种着色剂烧结后均有明显颜色改变；各着色剂颜色变化的特点不同；几种着色剂中以棕黄着色剂色稳定性最差。以上规律可指导临床医生更有效地使用着色法提高修复体质量。     

金瓷修复体与VITA成品比色板色度差

目的：掌握 Ｖ Ｉ Ｔ Ａ 成品比色板及金瓷修复体的色度规律及二者间色度差异特点,更合理、客观地使用 Ｖ Ｉ Ｔ Ａ 成品比色板。方法：选用 Ｃ Ｉ Ｅ１９７６ Ｌ ａ ｂ系统。用美能达 Ｃ Ｒ－ １００ 色度计,对我院口腔修复专业由同一位技师制作的部分前牙金瓷修复体及所选 Ｖ Ｉ Ｔ Ａ 成品比色板上的比色片颜色进行测试,并对二者色度学规律、色度差异值进行统计分析。结果：金瓷修复体的明度值均高于所选比色片的明度值。二者色相一致,彩度值不同。金瓷修复体较 Ｖ Ｉ Ｔ Ａ 成品比色板上 Ａ 组色片ａ ｂ值高,颜色偏黄红;较 Ｂ、 Ｃ组色片ｂ值高,颜色偏黄;与 Ｄ组色片彩度值相近,匹配性较好。金瓷修复体与 Ｖ Ｉ Ｔ Ａ 成品比色板上深颜色色片匹配性优于浅色片。结论：金瓷修复体与所选 Ｖ Ｉ Ｔ Ａ 成品比色板比色片颜色存在肉眼所见颜色差异。使用 Ｖ Ｉ Ｔ Ａ成品比色板指导临床选色、配色时,应选择较同名牙或相邻牙明亮度低、色彩偏淡的比色片作为指导制作金瓷修复体的色标。     

烧结次数对金属烤瓷修复体颜色三要素的影响

目的：研究烧结次数对金属烤瓷修复体颜色三要素的影响。方法：采用CIE1976L*a*b*色度系统，计算公式：色差△Eab*={(△L*)^2 (△b*)^2}^1/2，彩度Cab*={(a*)^2 (b*)^2}^1/2，色调角hab*=tg^-1b*/a*,L*代表明度。结果：t检验分析：金瓷烧结5次以上，颜色有明显改变，表现为明度增加；体瓷烧结3次变色，表现为明度增加，彩度增加；遮色瓷绕结3次变色，表现为色调角增大。结论：金属烤瓷修复体烧结5次以上变色，变色表现为明度增加，变色主要与体瓷层明度和彩度的增加有关；遮色瓷层烧结变色对金属烧瓷修复体颜色无明显影响。     

天然牙颜色的测量与匹配的研究进展

颜色是影响牙齿及修复体美观的一个重要因素，而修复体颜色与天然牙颜色的完美匹配又是口腔修复学的难点之一，本文就天然牙颜色的分析，测量，以及计算机在活体牙的测色与配色中的应用作一综述。     

前牙冠修复体色差容忍度的初步研究

目的通过研究前牙陶瓷冠修复体的色差容忍度,为提高修复成功率提供有效配色方案。方法选取30名口腔修复科临床患者的单侧上颌中切牙缺损的冠修复体与对侧天然上颌中切牙为实验对象,使用数码相机在标准环境下分别采集单侧天然牙、修复体与天然牙的数码图像,在对图像进行色彩校正后,利用Photoshop识色软件进行色度分析。根据患者和医师对修复体颜色的满意度将修复体分成满意组和不满意组,对2组的色差数据进行Wilcoxon检验。结果颜色满意组修复体与天然牙的总色差△E为2.550 3,颜色不满意组修复体与天然牙的总色差△E为4.077 2,2组总色差的差异具有统计学意义（P＜0.01）。当修复体明度L*、b*、饱和度C*大于天然牙时,颜色满意组与颜色不满意组间△L*、△b*、△C*的差异无统计学意义（P>0.05）;当修复体明度L*、b*、饱和度C*小于天然牙时,颜色满意组与颜色不满意组间△L*、△b*、△C*的差异有统计学意义（P<0.01）。颜色满意组与颜色不满意组间色度差△a*和色相差△H°间的差异均有统计学意义（P<0.05,P<0.01）。结论控制口腔修复体与天然牙间的色差,是配色成功的关键因素;充分利用口腔修复体色差容忍度,将在一定程度上有利于提高修复体的成功率。     

Direct 3D Printing of Flexible Nasal Prosthesis: Optimized Digital Workflow from Scan to Fit

A maxillofacial prosthesis is a successful treatment modality to restore missing facial parts. Digital technologies and 3D printing are employed in constructing facial prostheses such as ears; however, their application is still partial, and final prostheses are usually manufactured conventionally using stone molds. This report aims to introduce a complete digital workflow to construct a nasal prosthesis and compare it to the conventional workflow of a patient requiring a nasal prosthesis. A computer tomography scan showing the defect was exported to specialized software to create 3D reconstructions of the patient's face and underlying bone. The nose was digitally designed restoring facial esthetics, anatomy, shape, and skin color. Different skin tones were digitally matched to skin tissues adjacent to the defect area using the Spectromatch system. The design was 3D printed in flexible and colorful material at 16 μm resolution using a 3D printer. External color pigmentations were applied to the nose for optimum esthetics, and the prosthetic nose was sealed in silicone and left to heat polymerize for 15 minutes. The prosthetic nose was retained in place using biomedical adhesive, and the patient was pleased with it. This report proposes a complete digital workflow to directly design and fabricate a prosthetic nose of acceptable esthetics. Such a workflow can lead to enhanced prosthesis reproducibility and acceptability and may become an effective treatment option for treatment of patients with facial defects.     

Fabrication of a Maxillofacial Prosthesis Using a Computer-Aided Design and Manufacturing System

PURPOSE: Maxillofacial prostheses are usually fabricated on the basis of impressions made with dental-impression material. The extent to which the prosthesis reproduces normal facial morphology depends on the clinical judgment of the individual fabricating the prosthesis. This paper describes a computer-aided design and manufacturing (CAD/CAM) system for the fabrication of maxillofacial prostheses. This system will provide a more consistently accurate reproduction of facial morphology. MATERIALS AND METHODS: Facial measurements were taken using a non-contact three-dimensional laser morphological measurement system. The measurements were sent to a computer numerical controlled (CNC) milling machine to generate a cast of the patient's face for the fabrication of prosthesis. RESULTS: Facial contours were measured using a laser. This method minimizes patient discomfort and avoids soft tissue distortion by impression material. Moreover, the digital data obtained is easy to store and transmit, and mirror-images can be readily generated by computer processing. CONCLUSION: This method offers an objective, quantified approach for fabricating maxillofacial prostheses.     

Skin response to cobalt 60 irradiation and the consequences for matching the color of facial prostheses

A radiotherapy treatment (⁶⁰Co) of cancer in the head and neck region causes side effects in the skin that postpone the facial prosthetic treatment. The increasing and fading erythema and pigmentation of the skin was investigated with the use of a subtractive colorimeter. This method was verified with photographs scored according to the Oxford scoring system. Fourteen patients were investigated during a period of 24 weeks. The mean colorimetric skin response showed a peak 6 weeks after the onset of irradiation. Six to 7 weeks later, there was no significant difference between the skin color before and after irradiation. At this time the dry desquamation of the skin is healed. From this viewpoint, the color matching procedure for a facial prosthesis may start not earlier than 15 weeks from the onset of irradiation. If a nonirradiated control field in the facial region is present, a color match for the facial prosthesis can be started just after the irradiation period.     

BLB种植系统在前牙修复中的美学评价

目的：探讨BLB种植系统在前牙缺失修复中的美学效果。方法：对86例前牙缺失的病人共植入BLB种植体169枚,术后4个月修复,并分别于修复后0,6,12个月由患者与随访医生对修复体的外形、颜色、牙龈形态、色泽、丰满度、龈缘曲线、牙间乳头高度、修复体与邻牙的协调性八个方面进行评价。结果：86例患者,修复后0,6,12个月满意度分别为92．6％、94．9％和95％。结论：BLB种植系统操作简单,基台可调磨,应用于前牙区修复可以获得较好的美学效果。     

前牙种植基台的临床决策——Lights决策树

基台在种植修复系统中连接根方种植体与冠方上部修复体，是承上启下的重要部件。在符合机械及生物学等常规规范下，基台的合理设计选择可一定程度上弥补目标修复体空间（TRS）与种植体空间位置上的偏差，对维系种植体周组织的健康及修复体长期、稳定、有效的预后发挥重要的作用。与后牙基台相比，日常使用的前牙基台种类更加繁杂，如何能够便捷正确选择前牙基台极具挑战性。本决策方案通过虚拟种植设计进行正确种植位点比选，并与上部目标修复体进行术前统筹后，实测选定位点上种植体平面目标修复空间高度（I），预判能否进行种植修复及可选的种植修复体固位方式。术后再根据种植系统（S）、螺钉孔穿出位置和修复体固位方式等初选基台类型；进入术后二期修复时，再结合种植体周水平软组织厚度（T）、穿龈深度（GH）及长轴角度（L）等的实测核查值，完成永久基台的最终选择。同时具体讨论了个性化基台的概念和分类应用。该方案的主控变量L、I、GH、T、S组合成了Lights字样，因此简称为前牙基台Lights决策树。该决策树的决策效能良好，临床可及性高。     

Precise Reproduction of Soft Tissue Structure around the Pontic Area Using Computer‐Aided Design and Manufacturing

Reproducing soft tissue contours around a pontic area is important for the fabrication of an esthetic prosthesis, especially in the anterior area. A gingival model that precisely replicates the soft tissue structure around the pontic area can be easily obtained by taking a pick‐up impression of an interim fixed dental prosthesis. After a working cast is fabricated using the customary technique, the pick‐up model is superimposed onto the working model for the pontic area using computer‐aided design and manufacturing (CAD/CAM). A definitive restoration using this technique would be well adapted to the pontic base, which is formed by the interim prosthesis.     

美学区基牙根尖病变冠桥再修复短期疗效观察

目的    观察上颌前牙区冠桥修复继发根尖周病变患者,进行根尖外科手术同期联合冠延长术后冠桥再修复的短期治疗效果。方法     选择2013年9月至2014年10月广东省口腔医院门诊就诊的上颌前牙区冠桥修复后继发根尖周病患者6例,病灶局部行根尖外科手术（根尖刮治、根尖切除及根尖倒充填）,同期采用冠延长术增加基牙临床冠高度,修整龈缘及牙槽嵴外形,术前术后暂时修复体成型牙龈,术后3个月软硬组织改建稳定,进行纤维桩树脂核、二硅酸锂铸瓷永久冠修复。每一治疗阶段采用锥形束CT（CBCT）评估骨组织愈合情况,红色美学评分（pink esthetics score,PES）评价软组织转归情况。结果    根尖周病灶骨缺损区新骨充填,修复体周龈缘形态稳定,质地色泽协调,修复体正常行使功能。结论    根尖外科手术同期冠延长术治疗冠桥修复继发根尖周病临床可行,每阶段暂时修复体有利于再修复最终修复体的美学效果。     

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??Objective    To evaluate the one stage procedures of apical surgery with crown lengthening and the second restoration for upper anterior teeth with apical diseases and compromised fixed prosthesis in short-term. Methods    Totally 6 patients with severe periapical diseases and compromised prosthesis??from Guangdong Provincial Stomatological Hospital between Sep. 2013 to Oct. 2014??were treated using simultaneous apical surgery with crown lengthening for periapical curettage??resecting apical lesion??retrograding filling trimming gingival margin??shaping alveolar??improving clinical crown height??provisional restorations before and after surgeries??then final restorations by fiber-resin posts and cores and lithium disilicate crowns 3 months after surgeries. Evaluation of modeling and remodeling was made by CBCT??soft tissue re-building by PES. Results    Periapical defect was filled with new bone??and gingival margins and restorations were stable 6 months after surgeries with harmonious color and normal function. Conclusion    Simultaneous apical surgery and crown lengthening is an effective treatment for upper anterior teeth with periapical diseases and compromised prosthesis??final esthetic is facilitated by provisional restorations.