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??Occlusal analysis and occlusal management are important in periodontal therapy. In order to provide reference for the clinicians??we made a literature review to summarize the development and changes of the connection between occlusal trauma and periodontitis??the methods of occlusal examination and occlusal management of occlusal trauma??timing??method selection??effect evaluation and long-term follow-up??in periodontal treatment.     

Clinical protocol for occlusal adjustment: Rationale and application

Background: Occlusal adjustment can optimize the result of orthodontics, orthognathic surgery, and comprehensive restoration, and resolve adverse forces to the dentition that affect the entire masticatory system. Mounted diagnostic casts and computerized occlusal analysis offer complementary advantages for evaluating occlusal problems. Predictable occlusal adjustment is facilitated by precise, measured documentation of occlusal force by computerized occlusal analysis.

Clinical presentation: A conservative, structural correction of a pronounced, chronic occlusal problem by additive and subtractive occlusal adjustment was performed after a previous failed occlusal adjustment. The patient’s chief concerns were significant anterior teeth fremitus in maximum intercuspation and “pain in the teeth and a poor bite” after 30+ adjustments over 2.5 years.

Clinical Relevance: Confirmation of specific criteria for a therapeutic occlusion resolved the anterior teeth fremitus and uneven bite. Traumatic occlusal contact on posterior teeth may elicit protective mandibular repositioning affecting anterior teeth relationships and should be considered during comprehensive diagnosis.     

牙周治疗中的咬合分析

在牙周治疗中,咬合分析和咬合治疗是不可忽视的一个环节。文章通过文献回顾,阐述了咬合创伤与牙周炎之间联系的发展变化,总结了牙周治疗中咬合检查的方法,对牙周治疗中咬合创伤的治疗时机、方法选择、效果评价及长期随访等进行了归纳,以期对临床医生提供参考。     

Clinical and instrumental treatment of a patient with dysfunction of the stomatognathic system: a case report

This article details a case report of a subject chosen from among patients treated in the author's clinic in the Posturology and Gnathology Section of the University Milano-Bicocca.It shows how the indispensable clinical analysis of the stomatognathic system and the connections between posture can be supported by instrumental analysis, such as the computerized occlusal analysis system and the force platform, to diagnose and treat dysfunctional patients.     

Force Finishing and Centering to Balance a Removable Complete Denture Prosthesis Using the T-Scan III Computerized Occlusal Analysis System

Obtaining bilateral balance of removable complete denture prostheses is the occlusal goal of the restorative dentist or prosthodontist. Despite our best clinical efforts, and the using of advanced mechanical devices like semi-adjustable articulators and face bow transfer mounting of dental casts, it is a struggle to provide accurate occlusal force balance. Some of the advocated reasons for the clinical difficulty of obtaining reliable occlusal balance are that stone casts lack soft tissue resiliency, and articulators only approximate human occlusal functional movements. However, modern technology offers clinicians a digital answer to this clinical force balance problem. It is known as computerized occlusal analysis. The T-Scan III system can be employed with complete removable denture prostheses to perform computer-guided occlusal force-finishing corrective adjustments that measurably improve the installed prosthetic occlusal balance.     

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目的比较Ⅰ、Ⅱ、Ⅲ类错验及正畸治疗后患者与个别正常验的咬合力差异,为正畸临床诊断和术后稳定性评价提供参考。方法于2006年1月至2008年12月选择来大连大学附属口腔医院正畸科就诊的无正畸治疗史的Ⅰ、Ⅱ、Ⅲ类错铪患者110例及正畸治疗后患者42例,另选择个别正常矜志愿者28名。采用T-ScanⅡ咬合力分析系统,对其[牙合]力总值进行比较分析。结果Ⅰ、Ⅱ、Ⅲ类错[牙合]的验力总值均低于个别正常[牙合]（P〈0．05）;正畸治疗后患者虽获得良好的咬合关系,[牙合]力总值增加,但与个别正常[牙合]比较,差异仍有统计学意义（P〈0．05）。结论正畸治疗可改善咬合关系,增加[牙合]力总值,但与个别正常[牙合]的[牙合]力总值仍有差异,推断牙齿在建立良好的咬合关系后,仍需要一定时间的咬合面磨合、神经肌肉的改建,才能更好地发挥咬合功能。     

患者主观感受和T-Scan咬合分析在牙列重度磨耗修复功能性评价中的作用

目的比较患者主观感受和T-Scan咬合分析在牙列重度磨耗修复中功能性评价的相关性及功能性比较,以期为临床工作提供客观参考依据。方法按受试者入选标准,选择2012～2013年于首都医科大学附属北京口腔医院修复科就诊,牙列重度磨耗患者14例。制作不同高度(2、4、6mm)的过渡义齿,患者戴用不同垂直距离增高值的过渡义齿各1周。在患者初始状态、3副过渡义齿初戴、戴用1周,共7个时间点,分别依据主观量化表评价患者主观感受,运用T-Scan咬合分析仪检测咬合分布状态。采用Spearman相关分析对主观感受和T-Scan咬合分析在牙列重度磨耗修复功能性评价中的相关性以及功能性进行比较。结果经Spearman相关分析,患者主观评分与咬合力不对称比、咬合时间之间存在显著相关性(P<0.05),与咬合力量间无显著相关性。结论在咬合重度磨耗患者垂直距离恢复的修复治疗中,除依赖于医生个人经验和患者主观感受外,提示我们治疗过程中也可将T-Scan咬合分析中的咬合时间、咬合不对称比作为临床的客观参考依据。     

A Method for Occlusal Reshaping

A method for occlusal reshaping is described using a step-by-step analysis starting from the articulation of models to the completion of the clinical procedures. Several newly introduced definitions are provided to help the reader understand the procedures. This article is divided into three parts: (1) the preliminary procedures, (2) the occlusal reshaping of the study casts, and (3) the clinical occlusal reshaping. The advantages of this particular method include establishment of anterior guidance before initiating posterior reshaping procedures, maintenance of maximum cusp height and fossae depth, the placement of forces along the mid vertical axis of the teeth, and the establishment of simultaneous even contact of the posterior teeth, while providing the desirable anterior guidance.     

种植义齿的牙尖斜度与支持骨受力关系的研究

目的 :比较模拟咀嚼力通过不同牙尖斜度的种植义齿传递到种植体周围支持骨后产生的应力大小。方法 :制作种植义齿及支持骨模型 ,冠修复体设计成0、20、30不同牙尖斜度。记录模拟咀嚼运动所需的载荷及所产生的应变。测量方法采用电测法。结果 :牙尖斜度越大 ,所需要的载荷以及种植体周支持骨产生的应变越大。结论 :种植义齿的咬合形态对支持骨的受力有影响 ,较小的牙尖斜度对种植义齿的骨界面应力变化小     

复合(牙合)切垫的改进及其临床应用效果观察

目的:本文观察用改进的复合(牙合)切垫对老年人作可摘式(牙合)重建的临床效果.方法:评定疗效标准,分别观察牙列重度磨耗组及牙体治疗后重度牙周病组各20例,随诊2～5年的临床效果.结果;磨耗组优15例(75%),良5例(25%).牙周病组优良18例(90%).结论:复合(牙合)切垫在技术上弥补了一般金属及塑胶(牙合)垫的不足,改进后操作更为方便,舒适美观,是用作老年可摘式(牙合)重建的一种较好方法.     

Influence of different narrative instructions to record the occlusal contact with silicone registration materials

This study examined the influence of narrative instructions on the occlusal contact area, occlusal contact point and masticatory muscle activities in normal subjects. Twelve healthy men and 12 healthy women with no more than one missing tooth per quadrant participated. Surface EMG was recorded from the masseter and temporal muscle. As a control measurement, intercuspal position was maintained to produce a habitual clenching record (NCR) while the occlusal contact area and occlusal contact point was recorded by means of silicone material. Subsequently, the occlusal contact area was recorded with the narrative instruction for minimum clenching record (MCR), light clenching record (LCR) and strong clenching record (HCR). While the EMG activity (%MVC) increased modestly from MCR to LCR (from 9·3 ± 2·0% to 11·5 ± 1·5%), the occlusal contact area increased rapidly (from 17·2 ± 11·3 mm² to 26·8 ± 15·6 mm²) (P < 0·05). Both EMG activity and occlusal contact area increased gradually from LCR to NCR (to 17·7 ± 2·0% and to 31·4 ± 14·2 mm², respectively). Finally, EMG activity still increased from NCR to HCR (to 44·5 ± 3·7%) (P < 0·05), but the occlusal contact area remained stable (to 36·8 ± 16·6 mm²). Occlusal contact points at left posterior, right posterior, anterior and total area were not significantly different between each task. This study showed that narrative instructions while recording the bite can result in largely stable occlusal contact area. An adequate narrative instruction may therefore contribute to taking a stable occlusal recording in natural dentition.     

开张式双垫与塑料垫治疗磨牙症的对比研究

目的：比较开张式双垫在治疗磨牙症中与塑料垫的临床疗效。方法：分别用自制的开张式双垫与塑料垫对48位磨牙症患者进行治疗,随访9个月。分别统计治疗结束1个月和9个时的停止磨牙列数和平均减少的磨牙时间。结果：戴用1个月停止磨牙数比为6∶12,戴用9个月停止磨牙数比为10∶21。其差异具有显著性（P〈0.01）。结论：开张式双垫治疗磨牙症优于塑料垫。     

Influence of the thickness of silicone registration material as a means for occlusal contact examination – an explorative study with different tooth clenching intensities

This study explored the influence of the thickness of silicone registration material on evaluation of the occlusal contact area and number of occlusal contact points, during increasing tooth clenching conditions in normal subjects. Twenty‐four subjects with no more than one missing tooth per quadrant participated. Surface electro‐myography was recorded from the masseter muscle. As a baseline measurement, intercuspal position was maintained with minimal force, and occlusal contact was recorded using blue silicone material. Occlusal contact was also recorded at 20% maximum voluntary contraction (MVC) and 40% MVC using visual feedback. The occlusal contact area and number of occlusal contact points were analysed using five levels of thickness of silicone registration material: Level 1 (0–149 μm); Level 2 (0–89 μm); Level 3 (0–49 μm); Level 4 (0–29 μm); and Level 5 (0–4 μm). The anterior part and the left and right posterior regions of the dental arch were analysed separately. At all detection levels, the occlusal contact area significantly increased from baseline to 20% MVC and to 40% MVC in the molar area (P < 0·05). In the anterior part, the occlusal contact area significantly increased from baseline to 20% MVC and to 40% MVC only when using Level 5. The number of occlusal contact points significantly increased from baseline to 20% MVC and to 40% MVC only when using Level 5 in the molar area (P < 0·05). It suggested that occlusal contacts may be different at low tooth clenching intensity with potential effects on the teeth or periodontal tissues.     

根管治疗后(牙合)面单面缺损双尖牙修复方式的生物力学研究

目的：从生物力学角度比较不同方法修复根管治疗后双尖牙的效果，并探询最佳方案。方法：实验通过收集对称的双尖牙，对照组为完整离体牙，试验组制备根管治疗及殆面单面缺损模型，试验一采用银汞充填；试验二采用高强度粘结性材料FX-Ⅱ充填；试验三为银汞充填后再加冠修复；1mm／min加载于与牙体长轴成45。烦尖舌斜面巾点测试破坏载荷，用SPSS10．0软件包进行配对分析。结果：试验一、试验二P〈0．05，充填组破坏载荷低于对照组；试验三P〈O．05全冠组破坏载荷高于对照组。结论：可认为从生物力学角度来讲，骀面单面缺损的最佳修复方法是全冠修复。     

力因素引起楔状缺损的研究进展

楔状缺损是一种常见的牙体硬组织非龋性疾病,刷牙、酸的作用、牙颈部结构及力作用是其常见的病因。近20年来,临床研究中根据该病的一些特殊表现,研究了力对楔状缺损形成的影响,本文就引起楔状缺损的力因素这个病因作一综述。     

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目的评价调对楔状缺损患者中、远期治疗效果的影响。方法对2005年10月至2006年7月河南大学第一附属医院口腔科门诊及同济大学口腔医院口腔内科就诊的楔状缺损患者73例251颗楔状缺损患牙用单组分光固化复合体充填,随机对118颗患牙进行调(调组)。充填后6、12、18、24个月对充填体脱落情况和颈部新楔状缺损形成情况进行评价。结果4例患者失访,调组为113颗牙,未调组127颗牙。24个月复查时调组充填体脱落率显著低于未调组(6.2%对14.2%,P<0.05)。结论楔状缺损充填体脱落率受患牙承受咬合力的影响。     

255例牙冠折裂的临床分析

目的分析长期咀嚼过程中牙冠折裂的发生情况,并初步探讨冠折发生的相关因素。方法以2005年12月-2007年12月在兰州市第一人民医院口腔科就诊的255颗冠折牙为研究对象,对折裂牙的患者性别、年龄、牙位、折裂位置及形态等进行分析。结果255颗冠折牙中,1）上颌第一磨牙76颗（29.8%）,下颌第一磨牙45颗（17.6%）,上颌第二磨牙41颗（16.1%）,下颌第二磨牙37颗（14.5%）,上颌第二前磨牙32颗（12.5%）,上颌第一前磨牙15颗（5.9%）,下颌第二前磨牙9颗（3.5%）;2）折裂位置与窝沟重叠者158颗（62.0%）,发生于牙尖斜面者97颗（38.0%）。3）正常者85颗（33.3%）,面形态异常者55颗（21.6%）,型异常者115颗（45.1%）。结论牙位及形态等与牙冠折裂的发生具有一定的关系。力是牙冠折裂的基本因素,但不是唯一因素。     

Occlusal pressure, contact area, force and the correlation with the morphology of the jaw-closing muscles in patients with skeletal mandibular asymmetry

Summary  The purpose of this study was to investigate the difference in the occlusal force between deviated and non-deviated sides of the mandible in adult patients with skeletal mandibular asymmetry, and then also compare the findings to those obtained from controls. The absolute and balance data of the occlusal pressure, occlusal contact area and occlusal force of 23 patients and the controls were examined. Correlations between the occlusal force and the morphology of the jaw-closing muscles were also analysed. The occlusal pressure of patients was not smaller than controls, however, the occlusal contact area and occlusal force in patients were significantly lower than those in the controls. There was no significant difference in the balance of the occlusal contact area and the occlusal force between the right and left sides in the controls, while the balance was shifted to the deviated side in the patients. Interestingly, the balance of the occlusal pressure was very similar between the patients and the controls. Most parameters of the morphology of the jaw-closing muscles did not show a linear correlation with either the occlusal pressure or force. In conclusion, the occlusal contact area and occlusal force in patients were significantly lower than those in the controls, and also the balance was shifted to the deviated side in patients with skeletal mandibular asymmetry. It is assumed that the morphology and orientation of jaw-closing muscles may have not linear but complex correlation to the weaker and unbalanced occlusal force in patients.     

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正畸治疗后是否应该进行调[牙合]是一个颇具争议的问题,其主要原因之一是目前对正常[牙合]的标准尚未达成共识,因此,正畸后调[牙合]治疗的目标尚不明确。本文根据笔者的临床工作体会,阐述了正畸结束时进行调[牙合]治疗的必要性以及调[牙合]治疗的指征、时机和注意事项。