本文關(guān)鍵詞： 數(shù)字微笑設(shè)計(jì) 前牙美學(xué)修復(fù) 診斷蠟型 診斷飾面　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討DSD在前牙美學(xué)修復(fù)中對(duì)提高修復(fù)后患者滿意度和臨床效果以及遠(yuǎn)期效果中所起的作用。方法選取2014年9月至2016年9月期間,在安徽省蚌埠醫(yī)學(xué)院第一附屬醫(yī)院口腔醫(yī)學(xué)中心修復(fù)科接受前牙美學(xué)修復(fù)的患者64例,其中男30例、女34例。年齡18-47歲。共修復(fù)牙數(shù)172顆。應(yīng)用簡(jiǎn)單隨機(jī)分組原則分為兩組:觀察組(數(shù)字微笑設(shè)計(jì)組)、對(duì)照組(單純修復(fù)組),每組32人。對(duì)照組在用單反數(shù)碼相機(jī)拍攝比色照片后常規(guī)修復(fù);觀察組對(duì)常規(guī)美學(xué)修復(fù)進(jìn)行改良,由同一人用單反數(shù)碼相機(jī)采集術(shù)前頜面部及口內(nèi)包含所需的美學(xué)信息的照片。將術(shù)前照片導(dǎo)入keynote軟件處理,進(jìn)行微笑分析,并模擬出術(shù)后的效果,得到患者的認(rèn)可后將分析的數(shù)據(jù)結(jié)果、模擬的術(shù)后效果、原始照片及模型一并交于技師,用于診斷蠟型的制作。然后在診斷蠟型的基礎(chǔ)上制作硅橡膠導(dǎo)板及診斷飾面,使患者更直觀的觀察美學(xué)效果,患者滿意后用硅橡膠導(dǎo)板在牙備時(shí)精確指導(dǎo)和控制牙備量,最終完成工作模型制作,后連同診斷蠟型一并交于技師處。兩組患者的修復(fù)體的制作均交于同一技師制作,且材料均選擇義獲嘉公司生產(chǎn)的IPS-e.max press鑄瓷。修復(fù)體完成后,行試戴,根據(jù)情況進(jìn)行適當(dāng)磨改后拋光,粘接。囑患者半年后、一年后復(fù)診,便于對(duì)長(zhǎng)期修復(fù)效果進(jìn)行觀察。1兩組患者在美學(xué)修復(fù)后即從修復(fù)體的外形、顏色匹配度、舒適度三個(gè)方面進(jìn)行滿意度評(píng)價(jià),用直觀模擬量表表示,0代表完全不能接受,100代表完全滿意,數(shù)值越大,滿意度越高。2由一位未參與修復(fù)體設(shè)計(jì)和制作的修復(fù)醫(yī)師對(duì)兩組患者的修復(fù)后臨床效果進(jìn)行評(píng)價(jià)。從修復(fù)體的形態(tài)、顏色、齦緣形態(tài)、前牙切緣弧度、表面?zhèn)�性特征五個(gè)方面進(jìn)行優(yōu)、良、中、差的分級(jí)。3兩組患者修復(fù)后6個(gè)月后,參照改良Ryge標(biāo)準(zhǔn)及USPHS評(píng)價(jià)標(biāo)準(zhǔn),由同一位醫(yī)師對(duì)修復(fù)體形態(tài)、完整度、邊緣密合度、牙齦健康狀況、舒適度進(jìn)行檢查后按照A、B、C、D進(jìn)行分級(jí)評(píng)價(jià)。將上述結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果對(duì)照組32例患者初戴時(shí)有2例患者對(duì)修復(fù)體形態(tài)提出異議;觀察組32例患者初戴時(shí)無一返工。1患者滿意度評(píng)價(jià):在修復(fù)體的外形、舒適度方面,觀察組高于對(duì)照組(P0.01);而在顏色匹配度方面,兩組間的無明顯差異(P0.05)。2臨床效果觀察:兩組患者在修復(fù)體形態(tài)、前牙切緣弧度、齦緣形態(tài)觀察組臨床效果高于對(duì)照組(P0.05);而在顏色和表面?zhèn)�性特征方面臨床效果差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3 6個(gè)月后臨床效果觀察:6個(gè)月復(fù)診觀察組4例、對(duì)照組5例患者失訪。觀察組28例患者(75顆)及對(duì)照組27例患者(71顆),均無修復(fù)體脫落發(fā)生;觀察組在修復(fù)體形態(tài)、患者舒適度方面A級(jí)評(píng)分明顯高于對(duì)照組(P0.05);在修復(fù)體完整性、邊緣密合度、牙齦健康狀況方面A級(jí)評(píng)分與對(duì)照組無明顯差異(P0.05)。結(jié)論1數(shù)字微笑設(shè)計(jì)有助于醫(yī)患溝通,術(shù)前能夠較直觀的模擬修復(fù)后效果,有利于提高患者臨床操作上的配合度;術(shù)后能明顯提高其對(duì)修復(fù)體外形及舒適度的滿意度。2將數(shù)字微笑設(shè)計(jì)運(yùn)用到前牙美學(xué)修復(fù)中有助于醫(yī)技溝通、醫(yī)醫(yī)溝通,有助于做出在外形、切緣弧度、齦緣形態(tài)方面更符合臨床美學(xué)要求的修復(fù)體。3從6個(gè)月后的效果觀察,數(shù)字微笑設(shè)計(jì)后修復(fù)體,外形更加符合美學(xué)標(biāo)準(zhǔn),讓患者自覺更加舒適�？傊�,數(shù)字化微笑設(shè)計(jì)是口腔前牙美學(xué)修復(fù)中最有效、便捷的一種技術(shù)手段。
[Abstract]:Objective to investigate the DSD in the repair of front teeth aesthetic to improve patient satisfaction after repair and the clinical effect and long-term effect in vitro. Methods from September 2014 to September 2016, 64 cases of anterior teeth restoration aesthetic patients undergoing in stomatology medical center of the First Affiliated Hospital of Bengbu Medical College of Anhui Province, of which 30 cases were male, 34 were female at age 18-47. A total of 172 teeth. Teeth repair simple application were randomly divided into two groups: observation group (Digital smile design group) control group, (simple repair group), each group of 32 people. The control group in shooting the color photos after routine repair of a digital SLR camera; the observation group of conventional aesthetic restoration improved aesthetic information by the same person with digital SLR camera collection of preoperative maxillofacial and mouth contains the photos. Photos will be imported to keynote software before operation, smile analysis, and to simulate the postoperative effect. Fruit, be accepted by patients after the analysis of the data, simulation of the postoperative effect, the original photos and submit to the model for the production technicians, diagnostic wax. Then making a silicone rubber plate and diagnosis based on facing diagnostic wax type, make patients more intuitive to observe the learning effect, patient satisfaction after the silicone rubber plate and preparation of precise guidance control of teeth in the tooth preparation, the final completion of work model making, together with the diagnostic wax together. Restoration technician in two groups of patients were given to the same material selection and production technicians, Yi Huojia production company IPS-e.max press porcelain restoration. The body is completed, for trials, appropriate grinding after polishing, according to the situation of bonding. The patients after half a year, one year after the visit, it is convenient to observe the.1 patients in the two groups after repair from the shape of aesthetic restorations on the long-term repair effect, color matching The degree of satisfaction and comfort evaluation of three aspects, using the visual analogue scale that represents 0 totally unacceptable, 100 representative completely satisfied, the greater the value, higher satisfaction of.2 by a restoration did not participate in the design and production of repair physicians on clinical effect of two groups of patients after repair of color from the evaluation. The restoration, morphology, gingival morphology, incisal margin arc, the five aspects of the surface personality of excellent, good, poor, grade.3 repair of two groups of patients after 6 months, according to Ryge standard and improved USPHS evaluation standard, by the same physician to repair the body morphology, integrity, edge density, gingival health, comfort after the inspection in accordance with A, B, C, D were evaluated. The results were statistically analyzed. The results of the 32 patients in the control group with 2 cases of patients with early objection on the restoration form; observation group of 32 patients without a primary wear Evaluation of patient satisfaction.1 rework: in repairing the body appearance, comfort, the observation group than the control group (P0.01); while in color matching, no significant difference between the two groups (P0.05) to observe the clinical effects of.2: two groups of patients in the restoration of anterior teeth morphology, margin arc, gingival morphology the clinical effect of observation group is higher than that of control group (P0.05); while there was no significant difference in the clinical effect of color and surface characteristics (P0.05) to observe the clinical effect after 6 months.3 6 months of follow-up of 4 cases in the observation group, the control group of 5 patients were lost. The observation group of 28 patients (75 teeth) and a control group of 27 patients (71 teeth), no prosthesis shedding occurred in the observation group; repair body form, patients comfort a score significantly higher than the control group (P0.05); the complete restoration, edge density, gingival health grade score and control group had no significant difference (P0.05) conclusion the number of 1. 瀛楀井絎戣璁℃湁鍔╀簬鍖繪偅娌熼，

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