下颌牙周病渐进缺牙致无牙颌的种植方案设计

目的：牙周病致牙列缺失的义齿修复是非常困难的,尤其是下颌骨低平条件较差的下颌牙列缺失修复。患者常抱怨义齿的压疼、固位稳定及咀嚼效率差。虽然牙种植体应用较好地解决了上述问题,但在临床中患者由于下颌后牙区骨高度不足且距下颌神经管较近,医疗风险及手术难度加大,使得种植覆盖义齿修复效果不如预期。本文目的是用种植体最佳分布结果指导临床牙周病渐进性拔牙病例设计种植修复方案。方法：通过分析牙周病致无缺牙行种植覆盖义齿修复的临床效果并对下颌无种植覆盖义齿三维有限元分析。结果：牙周病致无缺牙行种植覆盖义齿常规在两侧颏孔区之间种植2-4枚种植体,由于后牙区没有种植体支撑,从义齿修复受力原则及防止磨牙区及种植体周骨质吸收来讲不是最佳方案,最佳应在后牙区种植种植体。结论：牙周病治疗过程中在下颌缺牙的磨牙区植入1-2枚种植体,即便最后下颌自然牙全部缺失,可以常规在两侧颏孔区之间种植2-4枚种植体,结合前期植入的种植体共有6-8枚,可以考虑种植固定或者套桶冠固位进行下颌牙列缺失的种植修复,使种植修复效果达到最佳。

Conceptual designs of implantation to aclusion induced by progressive loss of teeth for paradentosis in mandible

Objective：It＇s extreme difficult with dentures to restore dentition deficiency resulted from paradentosis,especially in low-lying mandibular alveolar ridge.Denture patients always complain of pressure pain,poor retention,stability and masticatory efficiency.Although the application of dental implants can better solve the above problems,in clinic,patiens with shortage of alveolar bone height and too close distance between alveolar bone and mandibular cannal in mandibular morlars＇area result in medical risk and difficulty of operations incresing,which makes restoration effect of implantation overdenture not as good as expect.The purpose is to guide to design the dental implantation and restoration for cases in-duced by progressive teeth extraction as paradentosis with the best distribution of dental implants.Methods：Through analyzing the clinical effect of restoring aclusion caused by paradentosis with implantation overdenture,we further adopt three-dimensional finite element analysis to analyze the implantation overdeture for mandibular aclusion.Results：Commonly,2-4 implants were inserted into the alveolar bone between two sides mental foramens to use implantation overdenture to restore the aclusion induced by paradentosis,because molars＇ region had not implants support,from dentures＇ mechanical principle and prevention of bone resorption in molars region and peri-implants,which was not the best plan.The best should be that implants are inserted into molars＇region.Conclusions：In the process of periodontal treatment,1-2 implants were inserted into mandibular molars＇ region after missing teeth.Even if all of mandibular teeth would miss,2-4 implants were commonly inserted into the alveolar bone between two sides mental foramens.Thus,plus pre-implanted,this added up to a total of 6-8 implants.To achieve the best effect of the implantation restoration we can consider fixed implant supported denture or telescope denture to restore the mandibular dentition deficiency.