套筒冠可摘活动义齿修复后出现的问题及处理

目的探讨套筒冠可摘活动义齿修复后出现的问题与对策。方法分析28例套筒冠可摘活动义齿修复后出现的问题,并根据不同的原因采取相应措施处理。结果修复后出现的问题包括内冠脱落、基牙折断、基牙牙龈炎或牙周炎复发、义齿固位力不够。内冠脱落是修复后出现的最常见问题。结论为了减少套筒冠可摘活动义齿修复后的并发症,应严格遵循套筒冠可摘活动义齿的设计原则、临床操作要点和制作要求。     

圆锥型套筒冠义齿修复牙列缺损的疗效观察

对29件圆锥型套筒冠义齿(108颗基牙)修复牙列缺损后6、12、18个月的基牙牙体牙周状况、义齿固位力情况、咀嚼效能进行检查。1颗基牙折断,3颗基牙内冠脱落,10颗基牙出现牙龈炎,其余义齿使用固位及咀嚼效能良好,牙周无异常。因此,圆锥型套筒冠义齿是修复牙列游离端缺损较理想的方法,但制作中应严格掌握适应证,严格按照制作要求进行加工,才能取得良好的疗效。     

套筒冠覆盖义齿的临床应用

覆盖义齿是指义齿基托的组织面覆盖并支持在已做过治疗的牙根或牙冠上的一种全口义齿或可摘局部义齿。套筒冠是指内冠固定在口腔内，外冠与可摘义齿相连，利用高度密合的内外冠之间的摩擦力用以固位的一种修复方法。套筒冠可摘局部义齿兼有固定义齿和局部可摘义齿的特点，现就我科1999年10月～2002年12月开展的45例利用83颗基牙修复的情况进行探讨。     

圆锥型套筒冠义齿修复老年下颌牙列缺损1例

对单颌牙列仅余留3-5颗天然牙的老年牙列缺损病例用黏膜支持式或混合支持式可摘局部义齿修复,常会引起基牙的负荷过大,或黏膜支持式可摘义齿基托下软组织受力时被压缩,出现基托下软硬组织的萎缩和吸收,义齿下沉,基牙形成早接触,增加基牙和余留牙的负担,造成牙周支持组织损伤。用套筒冠义齿修复能将牙合力合理分配到基牙、牙槽骨和黏膜,减轻基牙的负担,减缓牙槽骨的吸收,义齿戴入后稳定性好、美观舒适、咀嚼效率高、修复后的远期疗效好。本文报道1例下颌仅余留3颗天然牙用圆锥型套筒冠义齿修复后随诊观察4年的临床效果。     

摩擦型套筒冠应用于重度牙列缺损：5年临床疗效观察

对于每个牙弓只余留1～3颗牙的重度牙列缺损患者．摩擦型套筒冠可摘局部义齿的临床疗效尚未被充分证明。现有74位重度牙列缺损患者接受82件套筒冠可摘局部义齿修复．共由173个摩擦型套筒冠所支持。根据记录。套筒冠基牙60个月以上存留率为80．6％．其中性别、基牙活力及基牙松动度显著影响基牙存留率（Kaplan—Meier法）。而套筒冠丢失风险则明显与患者性别、套筒冠所在牙弓、基牙活力和基牙分布有关（COX回归分析）。本研究纳入的患者群体中．套筒冠可摘局部义齿被证实为重度牙列缺损的良好治疗方法。     

圆锥型套筒冠义齿在牙列缺损修复中的应用研究

目的评价圆锥型套筒冠义齿应用于口腔修复的临床效果。方法 38例牙周炎伴牙列缺损患者,制作圆锥型套筒冠义齿47件,上颌27件,下颌20件,共159颗基牙,随访观察6～48个月。结果 38例患者共47件圆锥形套筒冠义齿在修复后均能正常使用。患者均感觉义齿稳定舒适,咀嚼功能恢复良好。159颗基牙中,基牙保存、内冠脱落分别占94.3%（150/159）、9.4%（15/159）,26颗基牙牙龈炎经治疗后炎症消退。结论圆锥形套筒冠义齿修复牙周炎伴牙列缺损能获得较好的效果。     

套筒冠义齿修复Ⅰ.套筒冠义齿的组成与固位

套筒冠义齿(telescope denture)是指以套筒冠为固位体的可摘义齿。套筒冠固位体于1924年由口腔修复学创始人Peeso F．A．首先提出，当时又称为二重冠固位体、套叠冠固位体。自上世纪20年代末至30年代起，在牙列缺损可摘局部义齿修复设计中采用套筒冠作为义齿的固位体。随着该固位体临床应用及口腔修复技术工艺的不断发展，Steiger A．、Bottger H．、Gaermy A．、Koerber K．H．等对套筒冠固位体的设计进行改良，推出了多种结构与形态的套筒冠固位体，如圆柱状套筒冠、缓冲型套筒冠、圆锥型套筒冠等。各种类型套筒冠固位体的形态与设计有一定差异，但基本结构相似，都由内冠与外冠组成。内冠覆盖在基牙的牙冠组织表面，与基牙紧密粘固。外冠覆盖在内冠表面，与内冠之间贴合。外冠作为固位体，与义齿其他部分连接成整体。当义齿戴入后，套筒冠固位体的内外冠之间贴合，即产生固位力。     

黏接式套筒冠可摘义齿的制作

目的 介绍黏接式套筒冠可摘义齿的制作方法.制作方法 用钴铬钼合金、瓷聚合体和金属黏接剂制作具有多个基牙的套筒冠可摘义齿,先按常规方法完成金属内冠,送门诊试戴合适后戴内冠取模、研磨抛光内冠.制作环状外冠,然后采用黏接方法将环状外冠和金属支架黏接成一整体.结论 黏接式套筒冠可摘义齿可提高其适合性及固位能力.     

浅谈铸造金属内冠临床应用后出现的问题

铸造金属内冠是圆锥型套筒冠固位体的组成部分，被粘固在基牙上与双套冠固位体的外冠嵌合，共同组成可摘义齿的固位体。它可以应用于覆盖义齿，保护覆盖义齿基牙牙体组织免遭龋齿破坏，维护残根残冠牙体缺损修复后牙体组织的完整，增强基牙抗力，它还可以形成牙周夹板固定松动牙。笔者在可摘局部义齿修复，残根残冠的保留和牙周病松动牙的治疗中制作并使用了它，本文初步分析临床应用时出现的问题。     

不同材质套筒冠义齿修复轻中度牙周病伴牙列缺损的临床观察

目的：比较三种不同修复材料套筒冠义齿修复轻中度牙周病伴牙列缺损病例的临床疗效.方法：15例轻中度牙周病伴牙列缺损患者,进行完善根管治疗及牙周基础治疗后设计制作21副圆锥型套筒冠义齿,其中11副使用钴铬合金内外冠固位,6副使用金沉积内外冠固位,4副使用氧化锆内冠及金沉积外冠固位.基牙共105颗,其中Ⅰ度及Ⅱ度松动牙85颗.随访3年比较修复前后基牙牙周探诊深度（PD）,基牙松动度,患者满意度.结果：15例患者共21副圆锥型套冠义齿使用良好,牙齿松动度及牙周探诊深度变小（P＜0.05）,患者满意度明显高于卡环式可摘局部义齿.义齿使用2年后3例钴铬合金套筒冠义齿和1例金沉积套筒冠义齿固位力下降,而4例氧化锆内冠及金沉积外冠套筒冠义齿固位良好,无下降趋势.结论：不同材料的套筒冠义齿对轻中度牙周病伴牙列缺损病例具有良好的临床疗效.利用氧化锆内冠和金沉积外冠固位的套筒冠义齿持久固位力优于金沉积套筒冠义齿,更明显优于钻铬合金套筒冠义齿.     

“O”RING附着体固位型活动义齿的临床应用

目的 :介绍“O”RING附着体固位型活动义齿的设计原则、制作方法 ,评价其临床效果。方法 :采用“O”RING附着体为 2 5名患者设计制作 30件义齿。结果 :最长者经 5年零 6个月观察 ,临床效果良好。结论 :患者戴用该义齿后 ,咀嚼功能良好 ,摘戴方便、美观舒适 ,基牙无病变     

利用阻生智齿预备钛金属冠改善下颌义齿固位的应用观察

目的:利用阻生智齿增加下颌单颌总义齿固位力。方法:通过手术暴露下颌阻生智齿,在智齿冠上预备牙体,制作钛金属套冠将阻生齿牙冠形态转移至口腔中,从而把固位力不足的下颌单颌总义齿修复,转变成有正常基牙固位的可摘局部义齿修复。结果:通过3例利用埋伏阻生智齿接钛金属套冠,对下颌牙槽嵴严重吸患者的可摘局部义齿修复,经2～3年的临床观察,钛套冠固定良好,无松动,牙龈正常。可摘局部义齿固位良好。结论:利用埋伏阻生智齿接钛金属套冠,加强下颌牙槽嵴严重吸收可摘局部义齿固位力的效果明显。     

Stress distribution of abutments and base displacement with precision attachment- and telescopic crown-retained removable partial dentures

Five types of removable partial dentures (two attachment dentures, two telescopic dentures and one clasp denture) were designed. The two attachment dentures were retained by the rigid-precision attachments with or without a stabilizing arm, and the two telescope dentures were retained with cone telescope crowns with or without cross-arch stabilization. The stresses acting on abutment teeth and denture bases and the movements of denture bases were investigated, and the influences of denture design were clarified. The stress acting on a terminal abutment tooth retained by a rigid-precision attachment or cone telescopic crown was larger than that acting on a terminal abutment tooth retained by a clasp. The attachment dentures tended to concentrate more stress at the terminal abutment tooth than did the telescopic dentures. The stress of denture base of an attachment denture and a telescopic denture was less than that of a clasp denture. There was no difference between the stresses of attachment and telescopic dentures. The displacement of the denture base tended to be less when the denture was designed with a rigid connection for the retainer and with cross-arch stabilization.     

Fabrication of a New Crown and Provisional to an Existing Removable Partial Denture

A method of fabricating a new crown to an existing removable partial denture is described. A press-form plastic shell made from the diagnostic cast provides the outer contours for the abutment tooth, while an acrylic resin coping is fabricated on a die to provide accurate internal adaptation. The acrylic resin coping is seated on the prepared abutment. Autopolymerizing acrylic resin is mixed and placed in the plastic shell that is then placed in the mouth over the coping, forming the acrylic resin crown pattern. The removable partial prosthesis is fitted over the crown pattern intraorally. The pattern is transferred back to the die, the margins are refined, and the casting is completed and finished, avoiding reduction of the established contours. The same plastic shell is used with tooth-shaded acrylic resin to construct a provisional crown directly in the mouth. This technique allows the patient to wear the removable partial denture while the laboratory procedures are completed.     

Stress distribution and abutment tooth mobility of distal-extension removable partial dentures with different retainers: an in vivo study

Three types of retainers (wrought wire clasp, Aker's cast clasp, and conical crown telescopic retainer) designed for distal-extension removable partial dentures (RPDs) were assessed in two Kennedy class I patients' mouths. The assessment, included the ratio of denture base shearing load and mobility of the terminal abutments when loaded on a free-end RPD occlusal surface. The mean values of denture base shearing ratios of wrought wire clasp, Aker's clasp and conical crown telescope were 60, 42 and 20%, respectively. The abutment mobility of the three types of retainers were all within the 'mobile ability area' except the wrought wire clasp for patient A's right side. The greatest tooth mobility was observed with the wrought wire clasps, followed by Aker's clasp and the conical crown telescopic retainer. From the analysis the following was concluded: (i) different retainers do influence the occlusal load distribution; (ii) the occlusal load distributed to the free-end saddle is closely related to the connecting rigidity of the retainer; (iii) mucosal support has an indispensable role in sharing the occlusal load with various retainers, even the rigid telescopic retainer.     

New telescopic crown design for removable partial dentures

STATEMENT OF PROBLEM: Special technical skills and experiences are required to fabricate a telescopic crown to provide adequate retention with precise frictional retention ("conus friction force") between coping and telescope. It is also difficult to control clinically alterations of retentive forces after prolonged usage. PURPOSE: This study examined an innovative telescopic crown system for removable partial dentures that can be fabricated without special technical skill or experience and readily adjusted retentive forces. The retention of telescopic crowns was investigated after repeated insertion/separation tests. MATERIAL AND METHODS: Ten telescopic crowns were constructed to evaluate retentive forces. Each telescopic crown was adjusted to provide a retentive force of approximately 9.8 N. Each telescopic crown was then subjected to 10,000 insertion/separation cycles, and retentive force of each telescopic crown was recorded initially and after every 1,000 cycles. The retentive force of each telescopic crown was re-adjusted after these measurements to provide a retentive force of approximately 9.8 N. The retentive force was recorded a second time after each 1,000 insertion/separation cycles up to 10,000 cycles. RESULTS: Retention of the telescopic crowns gradually diminished, depending on the number of insertion/separation cycles. The mean retentive force after 10,000 insertion/separation cycles was over 2 N. All 10 telescopic crowns were re-adjusted to exert a retentive force of 9.8 N after the initial 10,000 cycles, and the retentive force also diminished on the second 10,000 cycles. CONCLUSIONS: Reduction of retention was dependent on insertion/separation cycles. This new telescopic crown with reduced retention could be easily readjusted. Readjusted retentive forces were at least equivalent to the initial retention.     

套筒冠义齿修复轻中度牙周炎伴多数牙缺失的疗效观察

目的:探讨多数牙缺失伴牙周病的牙列缺损患者应用套筒冠修复的临床效果。方法:选择多数牙缺失并有可摘局部义齿修复史的轻中度牙周炎患者36例,行牙周基础治疗和根管治疗后设计、制作套筒冠义齿,比较分析修复前和修复后6、12、24个月菌斑指数(PLI)、牙龈指数(GI)、探诊深度(PD)、龈沟出血指数(SBI)、牙齿松动度,并进行问卷调查。结果:36例患者在修复后3次复查时牙齿松动度和牙周袋深度(PD)逐渐变小(P<0.05),与修复前相比有明显改善,差异有统计学意义;菌斑指数(PLI)、牙龈指数(GI)、龈沟出血指数(SBI)无明显的变化(P>0.05);随访问卷调查结果显示,患者对套筒冠义齿满意度明显高于活动义齿。结论:套筒冠义齿修复轻中度牙周炎伴多数牙缺失的牙列缺损具有较好的临床效果。     

老年人磁性附着体可摘局部覆盖义齿修复

目的：观察老年人牙列缺损患采用磁性附着体可局部覆盖义齿的修复效果。方法：采用Magfit磁性附着体固位修复60岁以上的老年人牙列缺损20例,对义齿的固位,使用及肚牙健康等情况进行为期两年的随访观察,对出现的问题及对策进行初步探讨。结：果20例采用磁性附着体可局部覆盖义齿固位较佳,使用效果好,基牙无龋坏,3例龈缘炎症,其中2例基牙牙槽骨较修复前略有吸收,但牙齿松动度未见明显改变。1例上颁义齿因金属支架断裂而致磁体脱落,经对症处理后,问题均得以解除。结论：Magfit磁性附着体可局部覆盖义齿对老年人牙列缺损患有较好的修复效果。     

简易套筒冠覆盖义齿用于外胚层发育不全患者咬合重建——附病例报告

目的：探讨套筒冠覆盖义齿在修复外胚层发育不全患者中的临床应用。方法：1例先天性外胚层发育不良患者,利用余留畸形牙作为基牙,设计套筒冠内外冠,外冠与活动义齿连成整体,制作简易套筒冠覆盖义齿。结果：简易套筒冠覆盖义齿在固位、美观、咀嚼等功能上优于传统的活动义齿,患者对修复效果满意。结论：简易套筒冠覆盖义齿在修复先天性牙列缺损的病例中具有明显的临床优越性。