全口义齿与美学

作者在门诊为４０例牙列缺失患者制作全口义齿时，将数学上占有重要地位的“黄金分割”方法用来确定前牙定位Ｈｅ堤平面及尖牙的排列位置，同时采用美国正畸学家Ｒｉｃｈｅｔｔｓ设计的“审美平面”确定上下唇的丰满度。并将用该方法排列的全口义齿与常规方法排列的全口义齿进行了自身的比较研究，４０例患者中有３５例选择了前一种方法排列的全口义齿，２例认为两副义齿均可，２例选择常规方法排列的义齿，１例对两种方法的排牙均不     

长正中牙合全口义齿修复无牙颌再诊患者咀嚼效能研究

目的评价长正中牙合全口义齿修复无牙颌再诊患者的咀嚼效能。方法选择2011年1月—2013年8月口腔科全口义齿修复无牙颌再诊患者20例,为每位患者制作1副长正中牙合全口义齿,以该义齿为模板,采用义齿复制技术再制作1副解剖牙合全口义齿,每例患者交替戴用长正中牙合全口义齿和解剖牙合全口义齿3个月以上,采用UV-2450型分光光度计,集中进行咀嚼效能测定。结果 2种牙合型30 s咀嚼效率吸光度值:长正中牙合全口义齿(0.898)明显高于解剖牙合全口义齿(0.657),t=8.581,P<0.001,2种牙合型咀嚼效率有高度显著性差异。结论 20例长正中牙合全口义齿修复无牙颌再诊患者的咀嚼效能高于解剖牙合全口义齿。     

真空成型树脂暂基托的临床应用

目的：评价真空成型树脂暂基托在全口义齿制作中的临床效果。方法：随机选择门诊制作全口义齿的患者60例，每例患者均在同一垂直距离下分别用蜡制暂基托、自凝塑料暂基托和透明树脂暂基托确定正中关系位，完成3副义齿的制作，进行自身对照研究。结果：利用自凝塑料和透明树脂暂基托完成的全口义齿，咀嚼效率优于利用传统的蜡制暂基托完成的全口义齿。前两者与后者统计学上差异有显著性，而利用自凝塑料暂基托和透明树脂暂基托完成的全口义齿之间咀嚼效率差异无统计学意义。结论：真空成型树脂暂基托在全口义齿制作中可以推广。     

全口义齿实验教学中2种教学方法的应用比较

目的:比较全口义齿工艺技术实验教学过程中2种不同的义齿制作方法—精细步骤制作法和常规制作法,探讨在全口义齿实验教学中应如何合理应用2种方法来提高教学效果。方法:将46名学生随机分为常规制作组(n=23)和精细步骤制作组(n=23)。在3个实验教学阶段(初学时、11个月时、临床实训)中,针对3个重要的义齿制作环节,即托制作、上架、排列人工牙等,对2种义齿制作方法的效果进行比较。应用SPSS 18统计软件包对数据进行处理,统计方法包括独立样本t检验和单因素方差分析。结果:3个不同的实验教学阶段中,托制作和上架两个环节精细步骤制作法组成绩较常规制作法组高(P<0.05),平均高4.3%～7.3%;而在学习难度相对大一点的排列人工牙实验教学中,精细步骤制作法组实验成绩则低于常规制作法组(P<0.05),平均低5.6%。结论:在全口义齿工艺技术实验教学中,针对不同的学习环节和阶段,科学选择合理的教学方法,使学生在一定的实践训练时间内较快地提高自己的义齿制作技能,达到更好的教学效果,是完全可能的。     

舌向集中与半解剖式全口义齿的满意度及咀嚼效能比较

目的比较牙槽嵴重度吸收无牙颌患者对舌向集中牙合和半解剖式牙合2种牙合型全口义齿的满意度和咀嚼效能差异。方法选择18例牙槽嵴吸收严重的无牙颌患者,为每位患者分别制作舌向集中牙合和半解剖式牙合全口义齿各1副,随机选择其中1副义齿使用3个月后更换另1副义齿。记录每副义齿的疼痛修改次数,并于使用1、3个月后分别进行满意度问卷调查,测定咀嚼效能。结果患者对舌向集中牙合全口义齿的固位稳定和咀嚼功能评价显著优于半解剖式牙合(P<0.01)。2种牙合型义齿的咀嚼效能无显著差异(P>0.05)。舌向集中牙合全口义齿因疼痛调改的次数明显少于半解剖式。结论对于牙槽嵴吸收严重的无牙颌患者,应用舌向集中牙合型可以提高全口义齿的固位稳定和舒适程度。     

老年人全口义齿再修复疑难病例的临床研究

目的:观察充分利用旧义齿信息在老人全口义齿再修复疑难病例中的应用效果。方法:选择132例戴用旧义齿10年以上的老年无牙颌患者,按照旧义齿使用年限分两组,实验组:旧义齿使用15年以上66例,利用超硬石膏翻制重衬后的旧义齿组织面模型,利用聚醚橡胶翻制修整后的旧义齿蜡型,将蜡型放在石膏模型上按照咬合关系上牙合架,再制作新义齿;对照组:旧义齿使用10~15年66例,按照常规方法制作新义齿。结果:与常规方法比较,充分利用旧义齿信息制作的全口义齿患者适应较快,满意度高。戴用新义齿后3 d,分别做咀嚼效率、舒适度满意度调查,均P<0.05,差异有统计学意义;2周做总体满意度比较(P<0.05),差异有统计学意义。结论:老年人全口义齿再修复的疑难病例,需要充分利用旧义齿信息制作新义齿才能提高满意度。     

不同排牙方法对全口义齿修复影响的临床研究

目的 探讨不同的排牙方法对无牙颌患者满意度和全口义齿咀嚼效能的影响.方法 采用上颌排牙法、下颌排牙法和综合排牙法为10例无牙颌患者分别制作3副全口义齿.戴用3个月后,测试无牙颌患者对3种全口义齿的满意度,同时通过吸光度法测定咀嚼效率及咀嚼次数,比较三种排牙方法的全口义齿咀嚼效能的异同.结果 无牙颌患者在戴用3个月后对下颌排牙法和综合排牙法全口义齿的满意度均好于上颌排牙法义齿.本实验3组全口义齿中下颌排牙法和综合排牙法全口义齿的咀嚼次数和咀嚼效能无显著差异,但均好于上颌排牙法义齿.结论 下颌排牙法和综合排牙法的全口义齿排列的人工牙有利于无牙颌患者在咀嚼过程中稳定地使用义齿,提高咀嚼效能,而且无牙颌患者对下颌排牙法和综合排牙法的全口义齿也更满意.     

义齿黏附剂与线性殆在牙槽嵴重度吸收无牙颌患者中的应用

目的：评价义齿黏附剂和线性胎在牙槽嵴吸收严重的无牙颌患者全口义齿修复中的应用效果。方法：选择15例牙槽嵴吸收严重的无牙颌患者,为每位患者制作解剖式骀和线性胎2副全口义齿,3个月后更换使用。每副义齿于戴用3个月时检测其使用义齿黏附剂前后的咀嚼效率,并采用满意度问卷调查获取患者的主观评价。结果：使用义齿黏附剂后,线性胎和解剖式胎全口义齿的咀嚼效率均较使用前得到改善（P〈0．05,P〈0．01）。义齿黏附剂使用前后,两种骀型全口义齿的咀嚼效率间差异无统计学意义（P〉0．05）。义齿黏附剂使用前,线性骀全口义齿的固位稳定和舒适程度满意度高于解剖式骀全口义齿（P〈0．05,P〈0．01）;使用义齿黏附剂后,两种胎型全口义齿的固位稳定、咀嚼功能和舒适程度满意度均有显著性提高（P〈0.01）。结论：对牙槽嵴吸收严重的无牙颌患者,应用线性骀全口义齿和义齿黏附剂均可改善义齿的治疗效果。     

上颌钛制腭托全口义齿临床应用的回顾性研究

目的：探讨纯钛作为全口义齿上颌腭托材料在口腔内长期应用后的临床效果。方法：选择由同一全口义齿专家多次镶配全口义齿的患者11例，最后一副义齿为钛制上颌腭托，进行满意度问卷调查及义齿检查。结果：采用传统PMMA制作的全口义齿的重做原因，主要是上颌基托折裂(72．7％)，其次为不舒适(27．3％)和固位差(27．3％)，改用钛制腭托义齿后，平均戴用2．95年未出现折裂；72．8％的患者认为钛制腭托义齿优于PMMA腭托义齿，主要表现在异物感小，固位好，舒适，质轻，可以改善口干症状，18．2％的患者认为两种义齿使用效果不存在明显差别。钛制义齿磨光面45．4％出现色素沉着，27．2％颜色变暗。腭部粘膜未见明显炎症。在咀嚼功能、发苦、冷热刺激的敏感性及味觉方面两种材料义齿没有明显差别。结论：全口义齿上颌腭托采用纯钛制作，其抗折性能、舒适性优于传统PMMA，但长期应用后，部分腭托磨光面出现色素沉着及颜色变暗，对固位及适合性的影响因受个人因素、义齿制作质量的影响，有待进一步研究。     

宣教与指导对初戴全口义齿固位作用的研究

目的：观察宣教与指导对初戴全口义齿固位及适应性的疗效。方法：选择第一次戴用全口活动义齿患者80例，随机分两组。对照组按常规制作全口义齿及医嘱，实验组实施修复前宣教及初戴后指导。观察两组病例对全口义齿固位的满意度及适应情况。结果：戴义齿3个月后，实验组对义齿的适应性及固位满意度明显好于对照组。结论：宣教与指导对全口义齿初戴者尽快适应全口活动义齿功能有着重要意义。     

正畸治疗前后患者颜面美的感知变化及相关因素研究

目的探讨接受正畸治疗的患者对颜面美的感知变化及相关影响因素,用于指导临床治疗提高患者的满意度。方法选取12例矫治完成的病例图像制作调查问卷。随机选择于山东大学口腔医院接受正畸治疗的患者100例,分别在其正畸治疗前(对照组)及治疗一年半后(治疗组),评价问卷中病例颜面美的改变,并进行统计学分析。结果接受正畸治疗的患者对颜面美的感知度显著提高。其中文化水平较高的中年女性患者对颜面美的感知度提高最为显著,而高中以下的少年男性患者对颜面美的感知度提高不明显。拔牙及不拔牙患者对颜面美的感知度均提高,但提高的程度无显著差异。结论患者对颜面美的感知会随着正畸治疗的进行而提高,正畸治疗中要注重患者的审美心理及行为的变化,适时调整矫治方案,加强同患者的沟通,提高患者的满意度。     

减轻义齿压痛方法的探讨

目的为减少初戴可摘义齿患者的修改次数甚至达到不复诊修改，使义齿能尽早地行使功能。方法作者对76例患者，采用①在石膏模型缓冲硬区；②作精细的选磨调，使义齿力均匀地分布在每个后牙上，同时达到正中及非上中的咬合平衡；③基托边缘适度伸展，稳定义齿。结果31例全口义齿中19例，45例局部义齿中31例．均未进行修改。结论采用上述方法可达到上述目的。     

Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study

OBJECTIVES: Complete root coverage is the primary objective to be accomplished when treating gingival recessions in patients with aesthetic demands. Furthermore, in order to satisfy patient demands fully, root coverage should be accomplished by soft tissue, the thickness and colour of which should not be distinguishable from those of adjacent soft tissue. The aim of the present split-mouth study was to compare the treatment outcome of two surgical approaches of the bilaminar procedure in terms of (i) root coverage and (ii) aesthetic appearance of the surgically treated sites. MATERIAL AND METHODS: Fifteen young systemically and periodontally healthy subjects with two recession-type defects of similar depth affecting contralateral teeth in the aesthetic zone of the maxilla were enrolled in the study. All recessions fall into Miller class I or II. Randomization for test and control treatment was performed by coin toss immediately prior to surgery. All defects were treated with a bilaminar surgical technique: differences between test and control sites resided in the size, thickness and positioning of the connective tissue graft. The clinical re-evaluation was made 1 year after surgery. RESULTS: The two bilaminar techniques resulted in a high percentage of root coverage (97.3% in the test and 94.7% in the control group) and complete root coverage (gingival margin at the cemento-enamel junction (CEJ)) (86.7% in the test and 80% in the control teeth), with no statistically significant difference between them. Conversely, better aesthetic outcome and post-operative course were indicated by the patients for test compared to control sites. CONCLUSIONS: The proposed modification of the bilaminar technique improved the aesthetic outcome. The reduced size and minimal thickness of connective tissue graft, together with its positioning apical to the CEJ, facilitated graft coverage by means of the coronally advanced flap.     

Dental implant treatment for two adjacent missing teeth in the maxillary aesthetic zone: a comparative pilot study and test of principle

Aim: The aim of this prospective comparative pilot study was to evaluate hard and soft peri‐implant tissues in patients with a missing adjacent central and lateral upper incisor treated with either one implant and an implant crown with a cantilever or two implants with solitary implant crowns up to 1 year after functional loading. Material and methods: In the “Implant–cantilever group”, five patients were treated with one dental implant in the region of the central incisor (NobelReplace Groovy Regular Platform). In the “Implant–implant group”, five patients were treated with two adjacent dental implants: at the position of the central incisor (NobelReplace Groovy Regular Platform) and at the position of the lateral incisor (NobelReplace Groovy Narrow Platform). Implant survival, pocket probing depth, papilla index, marginal bone level and patient satisfaction were assessed during a 1‐year follow‐up period. Results: No implants were lost during the 1‐year follow‐up. Mean pocket probing values of the implants were comparable between the two groups. Papilla index scores in both groups were relatively low, pointing towards a compromised papilla. Marginal bone loss was minimal and comparable between the groups. Patient satisfaction was very high in both groups. Conclusion: In this 1‐year prospective comparative study, no large differences in hard‐ and soft‐tissue levels could be shown between patients with a missing central and lateral upper incisor treated with either one implant and an implant crown with a cantilever or two implants with solitary implant crowns. To cite this article:
Tymstra N, Raghoebar GM, Vissink A, Meijer HJA. Dental implant treatment for two adjacent missing teeth in the maxillary aesthetic zone: a comparative pilot study and test of principle.
Clin. Oral Impl. Res. 22 , 2011; 207–213.
doi: 10.1111/j.1600‐0501.2010.02017.x     

无托槽隐形矫治联合修复治疗在前牙美学修复中应用的临床效果研究

 目的　通过比较无托槽隐形矫治联合修复治疗与常规修复治疗在前牙美学修复中应用的临床效果,探讨无托槽隐形矫治在修复治疗中的临床应用价值。方法　选取2018年11月至2019年12月于中国医科大学附属口腔医院拟行前牙美学修复患者36例,随机分为研究组和对照组,每组18例。研究组患者先采用无托槽隐形矫治器对牙齿进行空间管理后,再进行修复治疗;对照组患者直接进行常规修复治疗。根据Kay牙齿美学分类标准,分别对治疗前后两组牙齿美学效果进行评价;根据Ryge评价标准改编的评分系统,对两组修复体美观性进行评分;由患者本人采用视觉模拟评分法对最终的修复效果进行满意度评分。结果　（1）治疗前两组患者牙齿美学分类主要为Ⅱ类和Ⅲ类,其差异无统计学意义（Z = -0.163,P > 0.05）。治疗后两组患者牙齿美学分类的分布不同,研究组牙齿美学效果优于对照组,差异有统计学意义（Z = -3.670,P < 0.05）。（2）研究组修复体美观性评分为（1.278 ± 0.286）分,低于对照组［（2.340 ± 0.808）分］,其差异有统计学意义（t = -5.223,P < 0.05）。（3）在修复体形态、与邻牙协调程度方面,研究组患者满意度高于对照组,差异有统计学意义（均P < 0.05）;在修复体颜色方面,两组患者满意度评分比较,差异无统计学意义（P > 0.05）。结论　无托槽隐形矫治联合修复治疗在前牙美学修复中应用,可达到更理想的美学效果。无托槽矫治在前牙美学修复治疗中具有较高的应用价值。     

无托槽隐形矫治联合修复治疗在前牙美学修复中应用的临床效果研究

目的　通过比较无托槽隐形矫治联合修复治疗与常规修复治疗在前牙美学修复中应用的临床效果,探讨无托槽隐形矫治在修复治疗中的临床应用价值。方法　选取2018年11月至2019年12月于中国医科大学附属口腔医院拟行前牙美学修复患者36例,随机分为研究组和对照组,每组18例。研究组患者先采用无托槽隐形矫治器对牙齿进行空间管理后,再进行修复治疗;对照组患者直接进行常规修复治疗。根据Kay牙齿美学分类标准,分别对治疗前后两组牙齿美学效果进行评价;根据Ryge评价标准改编的评分系统,对两组修复体美观性进行评分;由患者本人采用视觉模拟评分法对最终的修复效果进行满意度评分。结果　（1）治疗前两组患者牙齿美学分类主要为Ⅱ类和Ⅲ类,其差异无统计学意义（Z = -0.163,P > 0.05）。治疗后两组患者牙齿美学分类的分布不同,研究组牙齿美学效果优于对照组,差异有统计学意义（Z = -3.670,P < 0.05）。（2）研究组修复体美观性评分为（1.278 ± 0.286）分,低于对照组［（2.340 ± 0.808）分］,其差异有统计学意义（t = -5.223,P < 0.05）。（3）在修复体形态、与邻牙协调程度方面,研究组患者满意度高于对照组,差异有统计学意义（均P < 0.05）;在修复体颜色方面,两组患者满意度评分比较,差异无统计学意义（P > 0.05）。结论　无托槽隐形矫治联合修复治疗在前牙美学修复中应用,可达到更理想的美学效果。无托槽矫治在前牙美学修复治疗中具有较高的应用价值。     

Single‐Tooth Implants with Different Neck Designs: A Randomized Clinical Trial Evaluating the Aesthetic Outcome

Aim: To evaluate the aesthetic outcome of single‐tooth implants in the aesthetic zone with different neck designs from a professional's and patient's perception. Materials and Methods: Ninety‐three patients with a missing anterior tooth in the maxilla were randomly assigned to be treated with an implant with a smooth neck, a rough neck with grooves or a scalloped rough neck with grooves. Implants were installed in healed sites. One year after definitive crown placement (18 months post‐implant placement), photographs were taken and the aesthetic outcome was assessed according to two objective aesthetic indexes: pink esthetic score/white esthetic score (PES/WES) and implant crown aesthetic index (ICAI). A questionnaire was used to assess the aesthetic outcome and general satisfaction from a patient's perception. Standardized radiographs were taken to measure marginal bone level changes. Results: One implant was lost. Although there was a significant difference in marginal bone loss between the different implant neck designs (smooth neck 1.19 ± 0.82 mm, rough neck 0.90 ± 0.57 mm, scalloped neck 2.01 ± 0.77 mm), there were no differences in aesthetic outcome. According to the professional's assessments using PES/WES and ICAI, 79.3% and 62% of the cases showed acceptable crown aesthetics, and 59.8% and 56.5% of the cases showed acceptable mucosa aesthetics. Overall, patients were satisfied about the aesthetics of the mucosa (81.5%) and crown (93.3%), and general patient satisfaction was high (9.0 ± 1.0 out of a maximum of 10). According to the professional's assessment, a pre‐implant augmentation procedure was associated with less favorable aesthetics of the mucosa. Conclusion: This study shows that the aesthetics of single‐tooth implants in the maxillary aesthetic zone appears to be independent of the implant neck designs applied but dependent on the need for pre‐implant surgery.     

Autotransplantation of teeth to the anterior maxilla: A systematic review of survival and success,aesthetic presentation and patient‐reported outcome

Background/Aim

Autotransplantation of teeth to the anterior maxilla may be indicated after trauma or in patients with congenitally missing teeth. The aim of this systematic review was to report the current evidence concerning survival and success rate, aesthetic outcome, and patient‐reported outcome of autotransplanted teeth to the anterior maxilla.

Materials and Methods

A MEDLINE search followed by an additional hand search was performed to identify relevant literature. All levels of evidence except case reports were considered. Any publication reporting on 10 or more autotransplanted teeth to the anterior maxilla, and written in English were eligible for this systematic review.

Results

The systematic search identified 95 abstracts. Thirty‐seven full‐text articles were evaluated of which 17 could finally be included. Data on survival and success rate of the transplants could be extracted from 11 studies. Survival rates ranged between 93% and 100% (weighted mean: 96.7%, median: 100%) after 9 months to 22 years of observation (median: 8.75 years). No consensus regarding definition of success criteria of the transplants could be found in the literature. Two and four studies contained data on aesthetic and patient‐reported outcomes, respectively. In general, they reported favourable aesthetic results and high patient satisfaction.

Conclusion

The current available evidence suggests a high survival rate after autotransplantation of teeth to the anterior maxilla. However, the level of evidence is low. Limited data on aesthetic and patient‐reported outcomes warrant additional research in this field.     

Orthognathic surgery for juvenile idiopathic arthritis of the temporomandibular joint: a critical reappraisal based on surgical experience

Juvenile idiopathic arthritis (JIA) involving the temporomandibular joint (TMJ) can result in significant dentofacial deformities that may require orthognathic surgical correction. The aim of this study was to assess the functional and aesthetic results relative to stability after bimaxillary surgery with counterclockwise rotation of the occlusal plane in patients with JIA. A retrospective chart review was conducted of all patients affected by JIA who underwent orthognathic surgery between January 2000 and December 2019 at the Face Surgery Centre (Parma, Italy). Patient records were evaluated for surgical indications, complications, and outcomes. The final study sample included 13 patients (12 female, one male). The mean age of the patients was 18.6 years (range 17–26 years) at the time of surgery; 12 patients had bilateral TMJ disease. At the 1-year follow-up, all patients except one had a stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible. The 1-year postoperative cone beam computed tomography (CBCT) scan revealed complete ossification at all osteotomy sites. Bilateral sagittal split osteotomy with mandibular advancement is an effective procedure with a low rate of complications for patients with JIA with stable disease confirmed by preoperative CBCT or magnetic resonance imaging.     

The aesthetics of all-ceramic veneered and monolithic CAD/CAM crowns

The aim of this study was to examine whether crowns fabricated from machinable blocks would achieve acceptable aesthetics and whether these could compete with the aesthetics of restorations obtained by individual layering technique. Fourteen patients, who were to receive single anterior crown restorations, participated in this study. For each person two kinds of crowns were provided: one crown was made with the Cergogold system. The second one was produced in a Cerec machine and was additionally stained. Three independent examiners assessed the aesthetic appearance of crowns fabricated to match each subject's anterior shade. A scale of 1-6 was used to assess the aesthetic adaptation of each crown, with 1 representing excellent characteristics and 3.5 marking the threshold for clinical acceptability. The examiners' scores were averaged, and the mean values were analysed with the Wilcoxon signed rank test (P相似文献