咬合重建相关病例回顾及修复流程研究

目的根据咬合异常的不同临床表现，应用不同的修复方法进行咬合重建，评价临床效果，讨论与咬合重建相关疾病的临床诊断及修复设计流程。方法64例咬合异常患者按照修复前检查-诊断-修复设计-咬合重建修复-修复后评价的临床步骤，进行固定修复、固定-可摘局部义齿修复及可摘局部义齿修复咬合重建，于修复前后分别检查颞颌关节健康状况、义齿使用情况与咀嚼效能。结果咬合重建修复1年后，30例颞颌关节紊乱病患者中的25例治愈，对关节区疼痛与关节弹响的疗效差异有统计学意义：全部患者对咬合重建修复的临床效果满意，与可摘局部义齿修复相比较，固定修复、固定-可摘局部义齿修复在义齿舒适度（X^2=5．25，P〈0．05）和对发音影响（X^2=10．86，P〈0．05）等方面的满意度较高，差异有统计学意义；不同种类修复之间及选用不同种类修复咬合重建修复前（F=9．248，P〈0．05）和修复后（F=4．858，P〈0．05），患者咀嚼效能的差异有统计学意义。总结和制定与咬合重建相关疾病的临床诊断流程及修复设计流程。结论运用系统化的临床诊断流程及修复设计流程，能保障获得准确的诊断与针对性的修复设计，保证咬合重建诊疗修复取得成功。

Clinical study on the systematic diagnosis and prosthetic design of the diseases relating to occlusal reconstruction

Objective To study the principles and practical protocols of diagnosis and prosthtic design of diseases relating to occlusal reconstruction,and evaluate clinical effects of the treatment of occlusal reconstruction. Methods Sixty four patients with abnormal occlusion were included, among whom, thirty with TMJ disorder symtomps. Thepatients were treated with fixed, fixedremovable removable partial denture, and removable partial dentures to reconstruct occlusion according to the procedures as follows： clinical examination, diagnosis, prosthetic design, manufacture, application of. the prosthesis, and post-treatment evaluation. TMJ function, patient＇s self-assessment on the prostheses, and masticatory efficiency before and after treatment were assessed to verify the effects of the treatment of occlusion reconstruction. Results Systematic protocols and charts of clinical diagnosis and prosthetic design of the diseases relating to occlusion reconstruction were developed. Following the protocols and charts strictly, satisfying curative effects were achieved in all the 64 patients. One year after occlusion reconstruction, 25 out of the 30 patients with TMJ disorders were cured completely. All the 64 patients were satisfied with the general function of their prostheses. The satisfaction degree for the comfort and compacts on phonetics of fixed and fixed-removable partial prostheses were significantly higher than that of removable partial dentures. The masticatory efficiency of the three types of prostheses and before/after treatment also showed significant difference. Conclusions All the fixed, fixed-removable and removable prostheses achieve good clinical results in occlusal reconstruction. Proper use of the systematic protocols of the diagnosis and prosthetic design can get precise clinical diagnosis and individual prosthetic design, guaranteeing the success of occlusion reconstruction.