精密附着体修复在牙列缺损伴重度磨耗咬牙合重建中应用体会.docVIP

精密附着体修复在牙列缺损伴重度磨耗咬牙合重建中应用体会[摘要]目的：探讨精密附着体修复在牙列缺损伴重度磨耗患者咬牙合重建中的应用价值。方法：对38例牙列缺损伴重度磨耗的病例，用精密附着体进行牙列修复及咬牙合重建。结果：重建后患者面下1/3高度恢复，牙列形态完整，配戴舒适，咀嚼功能恢复，获得满意疗效。结论：精密附着体修复对于牙列缺损伴重度磨耗患者是一种有效的方法。 [关键词]精密附着体修复；重度磨耗；牙合垫式过渡性修复；咬牙合重建 [中图分类号]R783.5 [文献标识码]A [文章编号]1008-6455（2008）06-0872-03 Experiences of precision attachments prostheses in the reconstraction and restoration of occlusion of dentition defect accompanied with severe dental attrition PAN Dan1,XIONG Xi-zhou2,BAI Huai-yan1 （1.Department of Oral,Zhenghe Hospital of Shaanxi, Xi’an 710054, Shaanxi,China;2.The Stomatological Hospital of Fourth Military Medical University) Abstract:Objective To discuss the treatment of dentition defect accompanied with severe dental attrition with precision attachments prostheses.Methods38 patients were treated with precision attachments prostheses to observe the clinical effects. Results The results showed that the lower of third of the face had been reestablished, the patients’ masticatory efficiency improved and the clinical effect are satisfied with expected results. Conclusion Precision attachments prostheses are effective methods of dentition defect accompanied with severe dental attrition. Key words:precision attachments prostheses; severe dental attrition; transitional bite plate; occlusal reconstraction 牙列缺损伴重度磨耗，在临床中较为常见，患者常因咀嚼无力，牙齿敏感，食物嵌塞，面型改变等原因就诊。这类患者因牙体硬组织大量磨耗，平面位置，曲线及颌位关系均发生改变，往往需要重建咬牙合进行修复，但长期的过度磨耗使剩余基牙的牙周状况较差，牙冠高度不足，给修复造成很多困难。本文阐述了对有牙列缺损伴重度磨耗的患者采用精密附着体进行咬牙合重建的应用体会。 1资料和方法 1.1临床资料：2005～2008年为38例患者利用精密附着体修复进行了牙列缺损伴重度磨耗的咬牙合重建。38例患者按Whittaker牙列磨耗的分级标准均属于III级以上，Kennedy一类15例，Kennedy二类14例，Kennedy三类9例，5例有夜磨牙史[1]，其中男性26例，女性12例，年龄55～71岁，平均63岁。患者主诉为咀嚼无力，牙齿敏感，食物嵌塞，牙间隙，面型异常。检查发现患者牙列缺损，面下1/3明显短于面中1/3距离，颏唇沟深，剩余牙列牙合面重度磨耗，牙合龈距离低，个别牙位甚至牙合龈距离丧失，咬龈，患者对美观及舒适度要求高，无进行性牙周病。 1.2修复前准备 1.2.1口腔检查及模型分析：修复前摄全牙合曲面断层片，关节薜氏位片，观察双侧颞下颌关节有无器质性病变。对有牙体、牙髓、根尖周、牙周病变的患牙行完善治疗，制取研究模型，记录原有颌位关系备用。 1.2.2颌位关系重新确定：结合余留牙牙列磨耗的程度，参考患者面中1/3与面下1/3距离，以牙尖交错位和下颌姿势位的间距减去2～3?作为垂直距离升高的高度来确定暂时性牙合垫的厚