本文選題：單顆牙缺失 + 臨床效果評(píng)價(jià)��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)鈷鉻合金金屬翼板粘結(jié)固定橋修復(fù)單顆牙缺失的臨床效果進(jìn)行評(píng)價(jià)及脫落失敗原因進(jìn)行分析。方法:選擇2014年11月—2016年12月于大連醫(yī)科大學(xué)附屬第一醫(yī)院口腔科所診治的26例患者,患者均為前牙或者前磨牙缺失,上頜共21例,下頜共5例,其中,基牙有較大面積修復(fù)體;有夜磨牙等口腔副功能者;口腔內(nèi)部環(huán)境復(fù)雜唾液過多不益于粘結(jié)者;患者齲齒易感性高;患者合并精神異常等情況不作為粘結(jié)固定橋修復(fù)的納入標(biāo)準(zhǔn),按照粘結(jié)固定橋預(yù)備的原則進(jìn)行修復(fù)體的預(yù)備、修復(fù)體的加工、修復(fù)體的試戴,并采用Super Bond CB進(jìn)行修復(fù)體的粘結(jié)固位后,完成修復(fù)。在患者戴入后1個(gè)月及1年后進(jìn)行隨訪,依照美國公共健康部門制訂的評(píng)定系統(tǒng)(USPHS標(biāo)準(zhǔn)及Ryge標(biāo)準(zhǔn)一),由2名經(jīng)驗(yàn)豐富的口腔科醫(yī)生進(jìn)行評(píng)估,按等級(jí)分為A、B、C三級(jí),主要檢查患者修復(fù)體的牙體的完整性、繼發(fā)齲、鄰接關(guān)系、鄰邊緣變色、術(shù)后敏感、修復(fù)體情況、邊緣密合性、磨耗情況、顏色滿意度九個(gè)方面,評(píng)價(jià)結(jié)果為A、B級(jí)均視為成功,評(píng)價(jià)為C級(jí)時(shí)被視為失敗。結(jié)果:在進(jìn)行粘結(jié)固定橋修復(fù)后1個(gè)月,檢查牙體的完整性等九個(gè)方面,復(fù)檢情況表明26件修復(fù)體的各項(xiàng)評(píng)估標(biāo)準(zhǔn)均達(dá)到了A級(jí),治療效果滿意。治療后1年,隨訪率達(dá)96.15%,失訪1例,3例修復(fù)體邊緣稍有顏色改變,1例修復(fù)體邊緣與牙體組織之間有裂隙但不松動(dòng),1例患者對(duì)修復(fù)體的顏色匹配度的滿意程度欠佳,此5例患者評(píng)價(jià)效果達(dá)到B級(jí);4例修復(fù)體出現(xiàn)脫落;其余16例患者修復(fù)體各評(píng)價(jià)標(biāo)準(zhǔn)及患者滿意度達(dá)到了 100%。其中4例患者出現(xiàn)修復(fù)體脫落,分別是由于繼發(fā)齲、牙體長軸不一致、粘結(jié)操作問題以及存在咬合高點(diǎn)造成的,在去除了引起脫落的因素后,均進(jìn)行了二次粘結(jié),其3個(gè)月短期觀察效果良好;有一例為牙周病患者,由于缺隙兩側(cè)基牙的松動(dòng)度不同,造成在咀嚼過程中松動(dòng)度較小一側(cè)基牙的翼板發(fā)生脫粘結(jié),而松動(dòng)度較大側(cè)基牙的翼板粘結(jié)仍牢固,未完全發(fā)生脫落,我們將脫粘結(jié)一側(cè)的翼板磨除后進(jìn)行拋光,將雙端粘結(jié)改為單端粘結(jié)繼續(xù)使用,并未納入失敗病例。結(jié)論:鈷鉻合金金屬翼板粘結(jié)固定橋具備對(duì)牙髓損傷小、幾乎無需麻醉、臨床可操作性強(qiáng),制作價(jià)格較低廉,即使初期粘結(jié)失敗也可重新選擇固定橋或者其他修復(fù)方法進(jìn)行二次修復(fù)等優(yōu)點(diǎn),并且在修復(fù)單顆牙缺失時(shí),其短期臨床效果良好,特別是對(duì)頜間距離不足,咬合緊的病例更是一種值得推廣的半永久式、微創(chuàng)的修復(fù)手段。
[Abstract]:Objective: to evaluate the clinical effect of cobalt-chromium alloy metal flange fixed bridge in repairing single tooth loss and to analyze the reasons of failure. Methods: 26 patients were selected from Department of Stomatology, first affiliated Hospital of Dalian Medical University from November 2014 to December 2016. The patients were all anterior teeth or premolars missing, 21 cases were maxillary and 5 cases were mandible. Abutment teeth have a large area of restorations; those with oral accessory function such as night molars; the patients with complex saliva in the internal environment of oral cavity are not beneficial to adhesive; the patients with dental caries are more susceptible to dental caries. Patients with mental disorders are not included in the standard of fixation bridge repair. According to the principle of bonding fixation bridge preparation, repair preparation, prosthesis processing, and prosthesis trial wear are carried out in accordance with the principles of bonding fixation bridge preparation. Super Bond CB was used for the bonding retention of the prosthesis to complete the restoration. The patients were followed up for one month and one year after exposure. According to the assessment system developed by the public health department in the United States, USPHS standard and Ryge standard were evaluated by two experienced stomatologists. The patients were divided into three levels according to their grades. The dental integrity, secondary caries, contiguous relationship, discoloration of adjacent edges, sensitivity after operation, prosthetic condition, edge compactness, abrasion and color satisfaction were examined. A rating of level C is considered a failure. Results: after one month of bond-fixed bridge restoration, the integrity of the teeth was examined. The re-examination results showed that all the 26 prostheses were evaluated according to grade A, and the therapeutic effect was satisfactory. One year after the treatment, the follow-up rate was 96.15%. One case had a slight color change on the edge of the prosthesis in 3 cases, and one case had a crack between the edge of the prosthesis and the tooth tissue, but one case had a poor degree of satisfaction with the color matching degree of the restoration. The evaluation results of these 5 cases reached B grade and 4 cases showed abscission, and the other 16 cases were evaluated according to the criteria and satisfaction degree of 100 cases. Among them, 4 patients had prosthetic exfoliation, which were caused by secondary caries, inconsistent long axis of teeth, adhesive operation problems and occlusal high points. After removing the factors that caused the exfoliation, the secondary bonding was carried out. In one case of periodontal disease, because of the different mobility of abutment teeth on both sides of the gap, the flange of the abutment with lower mobility occurred during mastication. However, the flange of the side abutment with greater mobility is still firm and not completely falling off. We polished the flange on the debonded side after grinding, and changed the double end bond to single end bond to continue to use it, which was not included in the failure case. Conclusion: Co-Cr alloy metal flange bonding fixation bridge has less damage to dental pulp, almost no anesthesia, strong clinical maneuverability and low cost. Even if the bonding failure in the initial stage, the fixed bridge or other restoration methods can be re-selected for secondary restoration, and the short-term clinical effect is good, especially for the lack of intermaxillary distance, when a single tooth is missing. The case of tight occlusion is a semi-permanent, minimally invasive repair method that is worth popularizing.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R783.4
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本文編號(hào)：1787764