自主行为能力减弱的老年无牙颌患者应用义齿稳固剂临床效果分析

目的：探讨自主行为能力减弱的老年无牙颌患者应用义齿稳固剂的临床效果.方法：选择23例患有脑血管疾病后遗症、帕金森病或阿尔茨海默病的无牙颌患者,为其重衬原义齿基托并为部分患者更换新人工牙.教授患者的固定看护人使用义齿稳固剂的方法,以帮助患者日常使用全口义齿,随访观察6个月,评价使用义齿稳固剂前、后义齿固位效果并记分,记录患者体重指数（BMI）变化,对结果行配对t检验.结果：患者使用义齿稳固剂后义齿脱位次数记分值大于使用前记分值,差异有显著性（P＜0.05）;使用义齿稳固剂后6个月患者BMI高于使用前及使用后3个月,差异有显著性（P＜0.05）,使用前和使用后3月BMI差异无显著性（胗0.05）.结论：义齿稳固剂可以增强自主行为能力减弱的老年无牙颌患者全口义齿的固位和稳定.     

金属翼板树脂粘接固定义齿的临床应用

金属翼板树脂粘接固定义齿是以铸造金属为支架,金属翼板为固位体,烤瓷熔附金属为桥体的粘接固定桥,是目前应用最多的一种粘接桥修复方法。其主要缺点是远期留存率较低,最常见的失败原因是脱胶,具体表现为脱落或松动,脱落率高成为限制发展的主要因素。影响其成功率的因素众多,本文就病例选择、固位体设计和连接体三个方面对粘接桥的影响作一综述,以供临床参考。     

三种金属修复体磁共振成像伪影范围的研究

目的：研究3种合金单颌固定义齿磁共振成像伪影大小。方法：制取志愿者上颌牙列模型,在模型上分别用钴铬、镍铬、钛合金制作做3套大小形状相同的铸造7—7联冠。将3套联冠按材料不同分成3组。将志愿者不戴义齿在phi1ips1．5T下进行磁共振头颈部扫描作为对照纽,志愿者分别戴3种义齿重复上述检查作为实验组,将实验组与对照组进行对比,观察伪影大小及影响范围,测量伪影影响的宽度、高度,进行单因素方差分析。结果：3种义齿均形成了与义齿形状相近的伪影,并对邻近组织观察产生了一定的影响,但影响范围局限,均未影响到脑部及颈椎的影像。结论：钛合金伪影最小,3种金属义齿均不影响脑部等重要部位的观察。     

不同清洁方式处理义齿树脂基托后的SEM观察

目的:采用扫描电子显微镜对不同清洁方式处理后的义齿树脂基托表面进行观察以分析不同清洁方式对义齿树脂基托的影响。方法:制作圆形树脂基托样本(14mm×14mm×3mm)16个,随机分为4组,A组为对照组置于清水中,B、C、D组为实验组,其处理方式及时间分别为:牙刷+清水组/30s、牙刷+牙膏组/30s、义齿清洁片溶液浸泡组/5min,重复该处理过程1080次。结果:结果显示B、C组树脂基托表面呈现条纹状摩擦沟及划痕结构改变,C组变化尤为明显,A组及D组无明显改变。结论:牙刷+牙膏清洁方式对义齿基托表面形态改变较为明显,义齿清洁片溶液浸泡对基托表面影响较小,几乎不会对其表面造成明显裂纹及划痕。     

The first-choice standard of care for an edentulous mandible: A Delphi method survey of academic prosthodontists in the United States

BackgroundIn 2002 and 2009, two consensus statements—one from a symposium in Canada and one from England—were issued that recommended that the first-choice standard of care for an edentulous mandible should be the two implant–retained mandibular overdenture (IRMOD). The authors conducted a survey to determine if, in 2011, U.S. academic prosthodontic experts’ opinions were aligned with those in the two consensus statements.MethodsThe authors administered a Delphi method survey to an expert panel of 16 nationally representative academic prosthodontists to determine if there is consensus on the first-choice standard of care for an edentulous mandible between the IRMOD and a conventional mandibular complete denture (CD). Consensus agreement was defined as a 70 percent agreement level among the panelists.ResultsThe panel attained consensus favoring the IRMOD for nine of the 10 parameters assessed—retention, stability, speech, masticatory efficiency, comfort while eating soft foods and hard foods, confidence in intimate situations, satisfaction and self-esteem. The exception was esthetics for which only a majority (51–69 percent) favored the IRMOD.ConclusionsThe panelists reached consensus that they would recommend an IRMOD instead of a CD as the first-choice standard of care for patients who are healthy or have mild systemic disease, but not for patients with severe systemic disease.Clinical ImplicationsSurveyed academic prosthodontists recommend an IRMOD as the first choice standard of care when restoring an edentulous mandible of a healthy patient or a patient with mild systemic disease.     

Immediate loading of mandibular overdentures supported by unsplinted direct laser metal-forming implants: results from a 1-year prospective study

Background: At present, only some studies have dealt with immediate loading of unsplinted implants supporting mandibular overdentures. The aim of this prospective study is to evaluate treatment outcomes of mandibular overdentures supported by four one‐piece, unsplinted, immediately loaded, direct laser metal‐forming (DLMF) implants by assessing implant survival rate, implant success, marginal bone loss, and prosthetic complications. Methods: A total of 96 one‐piece DLMF implants were inserted in the edentulous mandible of 24 patients. Four implants were placed in each edentulous mandible. Immediately after implant placement, a mandibular overdenture was connected to the implants. At 1‐year follow‐up, clinical, radiographic, and prosthetic parameters were assessed. Success criteria included absence of pain, suppuration, and implant mobility; absence of continuous peri‐implant radiolucency; and distance between the implant shoulder and the first visible bone contact <1.5 mm. Results: After a 1‐year loading time, the overall implant survival rate was 98.9%, with only one implant lost. Among the surviving 95 implants, two did not fulfill the success criteria; therefore, the implant success rate was 97.8%. The mean distance between the implant shoulder and the first visible bone contact was 0.28 ± 0.30 mm (95% confidence interval, 0.24 to 0.32). Some prosthetic complications were reported. Conclusion: Based on the present results and within the limits of this study, the immediate loading of four unsplinted DLMF implants by means of ball attachment–supported mandibular overdentures seems to represent a safe and successful procedure.     

A cross-over randomised clinical trial of eccentric occlusion in complete dentures

The objective of this study is to compare the effects of canine guidance (CG) and bilateral balanced occlusion (BBO) on denture satisfaction and kinesiographic parameters of complete denture wearers, by means of a cross-over trial. Fifty edentulous patients received new maxillary and mandibular complete dentures. After the intra-oral adjustments and adaptation period, 44 participants were enrolled in the trial and randomly received a sequence of occlusal schemes: BBO followed by CG, or CG followed by BBO. Outcomes were assessed after 30 days of each occlusal scheme. Participants answered a denture satisfaction questionnaire and a kinesiograph instrument recorded mandibular physiologic movements and pattern of maxillary denture movement during chewing. Wilcoxon test and paired sample t-test were used to compare satisfaction levels and kinesiographic data for each occlusal scheme, respectively (α=0.05). The results showed no differences between occlusal schemes on participant's satisfaction and in any of the kinesiographic parameters studied, except for the vertical intrusion of the maxillary complete denture during chewing, which was lower with CG. It can be concluded that the occlusal scheme did not influence on satisfaction and kinesiographic parameters evaluated, as long as volume and resilience of residual edentulous ridges of the participants were normal. Clinical Trial Registration Identifier: NC.T01420536.     

Residual ridge resorption, lower denture stability and subjective complaints among edentulous individuals

Residual ridge resorption in the mandible after tooth loss may lead to worsening of complete denture stability and to various subjective complaints. The aim was to evaluate the association between radiologically assessed residual ridge resorption in the mandible, clinically assessed stability of lower complete denture and subjective complaints among elderly denture wearers. The study population consisted of 326 (115 men and 211 women) edentulous subjects aged 60-78years, all of whom were wearing complete dentures in the mandible. Data on subjective complaints were obtained from questionnaires and interviews. Denture stability was assessed clinically. Residual ridge resorption was analysed from panoramic radiographs. The results showed that women were significantly more often satisfied with their lower dentures and reported fewer problems with eating than men. They also had significantly more often residual ridge resorption than men. Among women, residual ridge resorption was significantly associated with poor chewing ability, low satisfaction with dentures and poor denture stability. Among men, residual ridge resorption did not associate with subjective complaints or denture stability. Poor satisfaction with dentures associated significantly with poor denture stability in both genders. In conclusion, these results highlight the importance of denture maintenance treatment. As the extent of residual ridge resorption in the mandible was the most important factor that increased dissatisfaction with lower complete dentures, it is also important to inhibit the progression of resorption by preventing tooth loss or by using implant-retained dentures.     

附着体可摘局部义齿修复后患者满意度的调查

目的:比较游离端牙列缺损患者行附着体可摘局部义齿和传统可摘局部义齿修复的主观感受。方法:为46例游离端牙列缺损患者制作19件附着体可摘局部义齿(每件义齿设计1￣2副附着体)和27件传统可摘局部义齿,戴用义齿经1￣2次修改,于修复后1个月行满意度问卷调查。结果:附着体可摘局部义齿在外观、舒适性、稳固性、咀嚼功能、语音功能5个单项满意度及均满意度方面高于传统可摘局部义齿,差异有非常显著性(P<0.01),在易清洁单项的满意度上低于传统可摘局部义齿,差异有非常显著性(P<0.01)。结论:游离端牙列缺损患者行附着体可摘局部义齿修复,较传统可摘局部义齿能更好地满足患者需求,达到良好的修复效果。     

临床路径在可摘局部义齿修复游离端牙列缺失患者中的应用价值

摘要:目的 研究临床路径在可摘局部义齿修复游离端牙列缺失患者中的应用价值。方法 选择 130 例肯氏 Ⅰ、 Ⅱ类牙列缺损患者, 按口腔内余留牙和牙槽嵴黏膜条件相近、 肯氏分类及亚类相同的 2 例为一对, 分为 65 对, 均分为临床路径组和传统修复组。比较 2 组的适应期调改次数, 适应期结束后咀嚼是否有力, 咀嚼时游离端基托是否存在肉眼可见活动度、 基牙龋坏、 基齿松动和食物嵌塞情况。结果 临床路径组在适应期调改次数低于传统方法组［1.0 （1.0, 2.0） 次 vs. 3.0 （2.0, 4.0） 次］; 适应期结束后调改后咀嚼有力的比例 （93.85% vs. 76.96%） 高于传统方法组, 出现肉眼可见动度 （0 vs. 15.38%）、 基牙龋坏 （1.54% vs. 13.85%）、 基牙松动 （0 vs. 12.31%） 及食物嵌塞 （1.54% vs. 15.38%）比例均低于传统方法组 （均 P＜0.05）。结论 临床路径可以提高可摘局部义齿的固位和稳定, 遵循临床路径方法制作可摘局部义齿能够减小功能状态下义齿的不稳定性, 具有良好的推广前景。