本文選題：牙周炎　切入點：牙齒松動度　出處：《大連醫(yī)科大學》2016年碩士論文

【摘要】：目的:牙周炎患者牙周支持組織受損,患牙受力后產生移位、松動;經牙周基礎治療、調鄈以及牙周手術后,牙齒的松動度會有所減輕,若患牙的松動度仍為患者所不能接受,則需行牙周夾板進行固定。本文選擇改良式鑄造可摘牙周夾板進行松牙固定,最后對固定療效進行分析,為可摘牙周夾板的臨床應用提供依據。方法:選擇2014年3月到2016年1月于我院就診的10例牙周炎患者。病例納入標準:1、牙周炎確診,伴有或不伴有牙列缺損;2、患者拒絕拔牙或身體狀況不允許拔牙或拒絕大量磨牙;3、已行完善的牙周基礎治療及手術治療,炎癥得到有效控制,但患者對咀嚼功能仍不滿意;4、有牙髓癥狀或牙周牙髓聯(lián)合病變者已行完善的牙髓治療;5、患者同意行可摘牙周夾板修復,能夠在美學上接受可見的金屬支架;6、術后能保持良好的口腔衛(wèi)生。檢查口腔內情況并拍X線片全面評定牙周及牙髓病變程度;拔除無保留價值的Ⅲ°松動牙,若患者不愿意拔除或者身體狀況不允許拔除,可行姑息治療,將該牙在夾板上所對應的舌板做成網狀,便于日后增添樹脂牙;對有齲壞及牙體缺損的患牙行牙體充填;對于有牙髓癥狀或者牙周牙髓聯(lián)合病變者行完善的RCT治療;口腔衛(wèi)生宣傳教育,超聲齦上潔治、齦下刮治、根面平整、局部涂藥。6—8周后復診檢查口內菌斑、牙石控制情況,牙周袋探診深度,牙齒松動度等。炎癥得到控制后,進行必要的咬合調整,建立平衡的咬合關系。若經基礎治療后口腔衛(wèi)生良好,但牙周袋仍≥5mm,探診后有出血或溢膿者;后牙的根分叉病變達Ⅱ°或Ⅲ°,需手術暴露根分叉者,應行手術治療。待牙周情況穩(wěn)定后,行改良式鑄造可摘夾板固定患牙。選擇無松動或者Ⅰ°松動牙做固位基牙,固位基牙盡量分散;設計長臂卡、聯(lián)合卡固定松動牙,義齒舌側設計為舌板,與健康鄰牙上的鄈支托連用時對余留松動牙具有明顯的固定作用。固位基牙頰側固位臂位于導線之下,余牙卡環(huán)均在導線之上,僅起支持和穩(wěn)定作用,無固位力;對于Ⅱ°-Ⅲ°松動以及經根管治療后的患牙我們改良設計了大“鄈支托”,其面積為鄈面的1/2-2/3,“鄈支托”與對頜牙只形成尖窩接觸,而該大“鄈支托”只行使窩的功能,患牙的功能尖不與對頜接觸,減輕了患牙所受鄈力,防止患牙劈裂,如果日后患牙脫落,可以直接增添樹脂義齒,存在的大“鄈支托”可以有效的將鄈力分散至大連接體上,進而傳至牙周支持組織;設計改良式聯(lián)合卡,其固位基牙側的卡環(huán)臂位于導線之下,起固位作用,而松動患牙側的卡環(huán)臂位于導線之上,只起卡抱作用,若固位基牙的同一側有兩個松動患牙,可將該側卡環(huán)臂設計成長臂卡環(huán),即聯(lián)合卡與長臂卡的結合體;基托伸展范圍和局部可摘義齒基本相同,基托與牙接觸區(qū)應位于牙冠外形高點線處并接觸密合,在齦乳突處的基托組織面則要有足夠的緩沖。預備鄈支托窩、隙卡溝(盡量利用自然間隙)以及舌側導平面,制備共同就位道;取印模前可將Ⅲ°松動牙通過樹脂粘接劑與鄰牙固定到一起,以防止印模材的擠壓造成其移位;取印模后送義齒加工廠制作可摘夾板,一并修復缺失牙。囑患者半年、1年、2年定期復查,復查時對患者進行診斷性監(jiān)測,強化與患者的溝通和菌斑控制,輔以口腔衛(wèi)生指導,行全口的潔治及相應的治療。結果:評價標準:從患者的主觀感覺、口腔臨床檢查以及X線檢查三個方面進行評價。經過一年到兩年復診,行改良式可摘牙周夾板修復的10例患者均表示疼痛消失,咀嚼功能恢復良好,松動牙得到固定;臨床檢查牙周袋變淺,無溢膿,患牙松動減輕或無進一步發(fā)展;X線片示牙槽骨新生或無進一步吸收。結論:改良式鑄造可摘夾板對牙周病松動牙固定效果顯著,我們改良設計的大“鄈支托”以及聯(lián)合卡尤其適用于經根管治療的患牙以及重度松動患牙,可以有效防止牙劈裂及牙脫落,更好的恢復患者的咀嚼功能,并可同時修復牙列缺損,消除食物嵌塞;又由于其操作簡單,費用較低,在臨床上得到廣泛應用。
[Abstract]:Objective: periodontal support tissue damage, the tooth force resulting from displacement, loosening; after periodontal treatment, adjusting Kui and periodontal surgery, loose teeth will be reduced, if the acceptance of tooth mobility is not required for patients, periodontal splint for fixing. This paper chooses improved casting of loose teeth fixed removable periodontal splint fixation, finally the curative effect analysis, provide the basis for clinical application of removable periodontal splint. Methods: 10 cases of periodontitis patients selected from March 2014 to January 2016 in our hospital. The inclusion criteria: 1, diagnosed with or without periodontitis. Dentition defect; 2 patients refused extraction or physical condition does not allow extraction or refusal of a large number of 3 molar; has basic treatment and periodontal treatment to improve the inflammation has been effectively controlled, but the patients on the masticatory function is still not satisfied; 4, there are symptoms or dental pulp The periodontal lesions have been combined with pulp pulp treatment improved; 5 patients agreed for removable periodontal splint, can accept metal stents visible in aesthetics; 6, after surgery can maintain good oral hygiene and oral examination. X-ray comprehensive assessment of periodontal and dental pulp disease degree; pull out without reservation value of third degree loose teeth, if patients are not willing to pull out or physical condition does not allow removal of palliative treatment, the tongue plate of the teeth in the splint made of mesh, easy to add after resin teeth on the affected teeth; dental filling with caries and tooth defect; for RCT treatment of dental pulp disease or periodontal endodontic lesions for improvement; oral hygiene education, ultrasonic supragingival scaling, subgingival scaling and root planing, topical drug.6 8 Zhou Houfu examination in plaque, tartar control, periodontal probing depth, loose teeth Degree. The inflammation was controlled after occlusal adjustment is necessary, the establishment of occlusal balance. If the basic treatment of oral health is good, but the periodontal pocket is still more than 5mm, after the detection of bleeding or pus overflow; the molar furcation involvement of second degree or third degree, requiring surgical exposure of the furcation. Should undergo surgical treatment. For periodontal stability, for improved casting removable splint teeth. No loosening or 1 degree tooth solid abutments, solid abutments to disperse; design of arm joint card card, fixation of loose teeth, denture design for lingual tongue plate, and Kui a healthy dentition on support for the remaining loose teeth with fixed effect. Solid abutments buccal retentive arm wire positioned under the remaining tooth ring card in the wire, only support and stability, no retention; for the second degree and third degree - Loosening after root canal after treatment, the teeth we changed 鑹璁′簡澶р，

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