本文選題：全瓷冠 + 美學修復�。� 參考：《大連醫(yī)科大學》2016年碩士論文

【摘要】：目的:前牙美學區(qū)的修復越來越受到患者和修復醫(yī)師的關(guān)注。原有的前牙修復體存在著問題、甚至失敗的患者,對此有著迫切的修復要求和更高的美學需求。本文針對臨床中遇到的前牙美學區(qū)再次修復病例進行報告,分析原有修復體失敗的原因及再次修復時需要考慮的美學因素,探索規(guī)范的美學修復流程。方法:選取5例2014年6月~2015年5月于大連市口腔醫(yī)院修復科就診要求再次修復病例。其中,修復體要求拆除重新制作的原因為:烤瓷冠修復后出現(xiàn)牙齦紅腫出血影響美觀;烤瓷聯(lián)冠修復后有異味、脫落;烤瓷修復體邊緣不密合,牙齦退縮,冠邊緣外露;一例為根管治療后未及時修復,出現(xiàn)冠折,影響美觀,要求修復;一例為烤瓷冠脫落,牙齦紅腫明顯,要求重新修復。出現(xiàn)這些癥狀的主要原因是:在修復前未進行徹底的牙體牙髓治療;修復體咬合問題;醫(yī)生臨床操作失誤;患者口腔衛(wèi)生維護較差以及修復體邊緣破壞生物學寬度等。美學區(qū)的再次修復是在保證口頜系統(tǒng)功能及口腔健康的基礎(chǔ)上更加注重美學修復的相關(guān)因素�；镜牟僮髁鞒淌�:就診后通過全面口腔檢查,明確修復失敗的原因及重新修復如何解決并避免再次出現(xiàn)這些問題。美學修復流程:修復前進行美學設(shè)計、美學分析、必要的牙周及牙體牙髓治療、制作診斷蠟型、口內(nèi)診斷飾面,讓患者可以直觀感受預期的修復效果,便于醫(yī)患交流;并對診斷蠟型、診斷飾面進行調(diào)改,待達到醫(yī)患均滿意后,制作硅橡膠導板指導臨床牙體預備;規(guī)范臨床操作、精細牙體預備、獲得清晰準確的印模、利用診斷蠟型制作精美的臨時修復體恢復美觀、保護基牙、維持修復體的修復空間、維持咬合關(guān)系;修復體的顏色再現(xiàn)與鄰牙及對頜牙相協(xié)調(diào),并且注意個性化的條紋及色素斑塊的恢復。在獲得良好的美學效果時,注重修復體的咬合功能恢復,使修復體獲得正中合平衡、前伸與側(cè)方組牙功能合。對術(shù)前、術(shù)后數(shù)碼照片進行美學分析、測量美學參數(shù)的改變。結(jié)果:再次修復后,修復體美學參數(shù)符合患者的生理要求�；颊邔π迯腕w的形態(tài),功能及顏色均較為滿意。治療過程中以及術(shù)后回訪注重修復體的咬合功能以及口腔衛(wèi)生維護,確保長期穩(wěn)定的臨床效果。結(jié)論:1.前牙美學區(qū)再次修復應(yīng)充分分析患者的修復失敗原因,利用診斷蠟型,診斷飾面,牙齦成形術(shù)、冠延長術(shù)等方法,規(guī)范美學診療流程以確保最終的美學效果。2.美學修復是通過對牙周與牙體形態(tài)的改變,在恢復功能與形態(tài)的基礎(chǔ)上,追求美觀與功能之間的平衡狀態(tài),從而獲得最佳的修復效果。
[Abstract]:Objective: the restoration of anterior teeth aesthetic area has been paid more and more attention by patients and prosthesiologists. There are some problems or even failures in the original anterior tooth prosthesis, which has an urgent need for restoration and a higher aesthetic demand. In this paper, we report the cases of rerepair in the aesthetic region of anterior teeth, analyze the causes of failure of the original restoration and the aesthetic factors that need to be considered in the process of rerepair, and explore the standard procedure of aesthetic restoration. Methods: five cases were selected from June 2014 to May 2015 in the Department of Restoration of Dalian Stomatological Hospital. Among them, the reasons why the restoration needs to be removed and remade are as follows: gingival redness and bleeding after restoration of porcelain fused porcelain crown have bad smell and fall off, the edge of porcelain restoration is not close, gingival retreat, crown edge is exposed; One case was not repaired in time after root canal treatment, and the crown fold appeared, which affected the beauty and required restoration; the other case was porcelain crown loss, gingival redness was obvious, and the restoration was required. The main causes of these symptoms are: incomplete dental pulp treatment before restoration; occlusal problems of prostheses; doctors' failure in clinical operation; poor oral hygiene maintenance of patients and destruction of biological width at the edge of restoration. The rerepair of American school district is a relative factor of aesthetic restoration on the basis of ensuring the function of oral and maxillary system and oral health. The basic procedure is to make clear the causes of failure and how to solve these problems and avoid recurrence. Aesthetic restoration process: aesthetic design, aesthetic analysis, necessary periodontal and dental pulp treatment, making diagnostic wax type, oral diagnosis surface, so that patients can directly feel the expected effect of repair, so as to facilitate the communication between doctors and patients. After making silicone rubber guide plate to guide clinical tooth preparation, standardize clinical operation, fine tooth preparation, obtain clear and accurate impression. The delicate temporary restoration made of diagnostic wax type was used to restore beauty, protect abutment teeth, maintain restoration space and maintain occlusal relationship, and the color reproduction of restoration was in harmony with adjacent teeth and maxillary teeth. And pay attention to personalized stripes and pigmented plaque recovery. In order to achieve good aesthetic effect, attention should be paid to the restoration of occlusal function of the prosthesis, so that the prosthesis could achieve the balance of the midline and the function of the forward and lateral teeth. The changes of aesthetic parameters were measured by aesthetic analysis of digital photographs before and after operation. Results: after rerepair, the aesthetic parameters of the prosthesis met the physiological requirements of the patients. The patients were satisfied with the shape, function and color of the prosthesis. During the course of treatment and after operation, attention should be paid to the occlusal function of prosthesis and the maintenance of oral hygiene to ensure long-term and stable clinical effect. Conclusion 1. In order to ensure the final aesthetic effect, we should fully analyze the causes of failure in the restoration of anterior tooth aesthetic area, and standardize the process of aesthetic diagnosis and treatment by using the methods of diagnosis wax type, diagnostic facade, gingival plasty, crown lengthening and so on. Aesthetic restoration is based on the change of periodontal and dental morphology and the pursuit of balance between beauty and function on the basis of restoration of function and form in order to obtain the best restoration effect.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R783

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