【摘要】：目的:對(duì)于前牙牙冠寬長(zhǎng)比失調(diào)的患者,通過美學(xué)分析設(shè)計(jì)來改善牙冠的寬長(zhǎng)比,從而達(dá)到理想的美學(xué)修復(fù)效果。方法:本文選取2014年11月至2016年11月之間,大連市口腔醫(yī)院修復(fù)科及綜合二科收治的因前牙寬長(zhǎng)比失調(diào)影響美觀而要求進(jìn)行前牙美學(xué)修復(fù)的6名患者,其中男性3例,女性3例,年齡在28～49歲之間。其中因原修復(fù)體松動(dòng)脫落來診的患者2例,因原修復(fù)體破壞生物學(xué)寬度導(dǎo)致牙齦增生腫脹出血來診的患者1例,因外傷造成的前牙缺損的患者1例,因前牙扭轉(zhuǎn)外翻要求改善美觀的患者1例,因前牙散在間隙要求關(guān)閉間隙的患者1例。修復(fù)治療前與患者說明患牙的缺損情況,可選擇的修復(fù)方法、治療過程、治療周期、所需費(fèi)用以及愈后效果等。如患者本身有高血壓、心臟病、糖尿病等系統(tǒng)疾病,對(duì)治療過程有影響者,則需囑其控制病情后再進(jìn)行修復(fù)治療。應(yīng)用數(shù)碼相機(jī)采集患者影像資料,導(dǎo)入電腦,應(yīng)用DSD軟件對(duì)術(shù)前患牙進(jìn)行美學(xué)分析,設(shè)計(jì)出理想的前牙寬長(zhǎng)比,并設(shè)計(jì)制作美學(xué)診斷蠟型。與患者進(jìn)行溝通,通過動(dòng)態(tài)模擬演示和診斷蠟型向患者展示預(yù)期的美學(xué)修復(fù)效果,了解患者期望值,評(píng)估患者對(duì)美的心理需求,綜合參考患者需求,制定出適合患者的個(gè)性化美學(xué)設(shè)計(jì)。確定修復(fù)治療計(jì)劃后,根據(jù)具體情況進(jìn)行系統(tǒng)完善的牙體牙周治療。如牙體治療不完善的患牙應(yīng)考慮進(jìn)行再治療,涉及紅色美學(xué)不良的患者,應(yīng)根據(jù)診斷蠟型制作牙周手術(shù)導(dǎo)板,在導(dǎo)板指導(dǎo)下進(jìn)行牙冠延長(zhǎng)術(shù)。牙冠延長(zhǎng)術(shù)后應(yīng)制作暫時(shí)冠,對(duì)患者進(jìn)行口腔衛(wèi)生宣教,把握好術(shù)后修復(fù)時(shí)機(jī)。對(duì)于牙冠延長(zhǎng)術(shù)中未去除骨組織的患者,最終修復(fù)可開始于術(shù)后6～8周;對(duì)于牙冠延長(zhǎng)術(shù)中去除部分骨組織的患者,最終修復(fù)可開始于術(shù)后3～6個(gè)月。根據(jù)患牙缺損情況、美學(xué)設(shè)計(jì)以及患者的經(jīng)濟(jì)狀況等具體情況選擇適合患者的修復(fù)材料及修復(fù)方式。最終修復(fù)完成后,囑患者認(rèn)真維護(hù)口腔衛(wèi)生,交代修復(fù)體使用方法以及注意事項(xiàng)。采集影像資料進(jìn)行術(shù)前術(shù)后對(duì)比,并進(jìn)行臨床觀察及療效評(píng)價(jià)。修復(fù)后1個(gè)月對(duì)修復(fù)體進(jìn)行復(fù)查,檢查修復(fù)體邊緣密合情況、鄰接關(guān)系、修復(fù)體局部牙周狀況、顏色滿意度以及是否有繼發(fā)齲壞等問題。結(jié)果:6例患者最終修復(fù)后進(jìn)行美學(xué)評(píng)價(jià),均通過改善前牙的寬長(zhǎng)比達(dá)到較理想的美學(xué)效果,患者滿意。要求患者1個(gè)月后復(fù)查回訪,其中1例因身體原因未能及時(shí)復(fù)診,其余5例復(fù)診,患者對(duì)修復(fù)體顏色滿意,口腔衛(wèi)生維持較好,修復(fù)體邊緣密合,牙齦健康無紅腫出血,邊緣齦無變色,未出現(xiàn)咬合不適。結(jié)論:通過改善前牙的寬長(zhǎng)比,能夠不同程度的提高美學(xué)修復(fù)效果。結(jié)合DSD軟件進(jìn)行前牙區(qū)美學(xué)修復(fù)設(shè)計(jì),實(shí)現(xiàn)了醫(yī)患以及醫(yī)技之間更加有效的交流與溝通,為臨床美學(xué)修復(fù)設(shè)計(jì)提供可靠的方法。
[Abstract]:Objective: to improve the ratio of crown width to crown length through aesthetic analysis in patients with anterior tooth crown width ratio disorder, so as to achieve an ideal aesthetic effect. Methods: from November 2014 to November 2016, 6 patients, including 3 males, were selected from Department of Restoration and Comprehensive Department of Department of Stomatology, Dalian Stomatology Hospital, who required aesthetic restoration of anterior teeth due to the aesthetic effect of ratio of width to length of anterior teeth. Three cases were female, aged between 28 and 49 years. Among them, 2 cases were diagnosed by loosening and shedding of the original prosthesis, 1 case by swelling and bleeding of gingival hyperplasia caused by the destruction of biological width of the original prosthesis, and 1 case by trauma of anterior tooth defect. One patient with anterior torsional valgus and one with closed space because of anterior teeth scattered in the space. Explain the defect of the affected teeth with the patient before the treatment, the alternative repair method, the course of treatment, the treatment cycle, the cost and the effect of the recovery and so on. If the patient has hypertension, heart disease, diabetes and other systemic diseases, the treatment process will be affected, it should be ordered to control the disease and then repair treatment. The digital camera was used to collect the image data of the patients and the computer was introduced. The aesthetic analysis of the affected teeth before operation was carried out by DSD software. The ideal ratio of width to length of the anterior teeth was designed and the wax shape of aesthetic diagnosis was designed and made. To communicate with patients, demonstrate and diagnose waxy shape to show patients the expected aesthetic restoration effect, understand patients' expectations, assess patients' psychological needs for beauty, and comprehensively refer to patients' needs. To develop a personalized aesthetic design suitable for patients. After the restoration treatment plan was determined, systematic periodontal treatment was carried out according to the specific situation. If the teeth with incomplete tooth treatment should be retreated, the patients with bad red aesthetics should make the guide plate of periodontal surgery according to the diagnosis of wax type, and the crown lengthening should be carried out under the guidance of the guide plate. Temporary crown should be made after crown lengthening and oral hygiene education should be carried out. For the patients who did not remove bone tissue in crown lengthening, the final repair could begin at 6 ~ 8 weeks after operation, and for the patients with partial bone tissue removal during crown lengthening, the final repair could begin 3 ~ 6 months after operation. According to the situation of tooth defect, aesthetic design and economic condition of the patients, the materials and methods are selected. After the final repair, the patient is advised to maintain oral hygiene, explain the use of prosthesis and precautions. The imaging data were collected and compared before and after operation, and the clinical observation and evaluation of curative effect were carried out. One month after restoration, the restoration was reviewed to check the edge of the restoration, the relationship between the edges, the local periodontal condition, the color satisfaction and the secondary caries. Results the aesthetic evaluation was carried out in 6 patients after the final restoration, and the patients were satisfied by improving the ratio of width to length of the anterior teeth. One patient was asked to return to the hospital after one month. One patient failed to return to the hospital in time for physical reasons. The remaining 5 patients were satisfied with the color of the prosthesis, the oral hygiene was maintained well, the edges of the prosthesis were close together, and the gingival health had no redness and bleeding. The edge of the gingiva has no discoloration and no occlusal discomfort. Conclusion: the effect of aesthetic restoration can be improved in different degree by improving the ratio of width to length of anterior teeth. In combination with DSD software, the design of aesthetic restoration of anterior tooth region can realize more effective communication and communication between doctors and patients as well as medical skills, and provide a reliable method for the design of clinical aesthetic restoration.
【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
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本文編號(hào)：2189872