金属翼板粘结固定桥修复单颗牙缺失的临床疗效观察

发布时间：2018-04-22 15:13

  本文选题：单颗牙缺失 + 临床效果评价　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:对钴铬合金金属翼板粘结固定桥修复单颗牙缺失的临床效果进行评价及脱落失败原因进行分析。方法:选择2014年11月—2016年12月于大连医科大学附属第一医院口腔科所诊治的26例患者,患者均为前牙或者前磨牙缺失,上颌共21例,下颌共5例,其中,基牙有较大面积修复体;有夜磨牙等口腔副功能者;口腔内部环境复杂唾液过多不益于粘结者;患者龋齿易感性高;患者合并精神异常等情况不作为粘结固定桥修复的纳入标准,按照粘结固定桥预备的原则进行修复体的预备、修复体的加工、修复体的试戴,并采用Super Bond CB进行修复体的粘结固位后,完成修复。在患者戴入后1个月及1年后进行随访,依照美国公共健康部门制订的评定系统(USPHS标准及Ryge标准一),由2名经验丰富的口腔科医生进行评估,按等级分为A、B、C三级,主要检查患者修复体的牙体的完整性、继发龋、邻接关系、邻边缘变色、术后敏感、修复体情况、边缘密合性、磨耗情况、颜色满意度九个方面,评价结果为A、B级均视为成功,评价为C级时被视为失败。结果:在进行粘结固定桥修复后1个月,检查牙体的完整性等九个方面,复检情况表明26件修复体的各项评估标准均达到了A级,治疗效果满意。治疗后1年,随访率达96.15%,失访1例,3例修复体边缘稍有颜色改变,1例修复体边缘与牙体组织之间有裂隙但不松动,1例患者对修复体的颜色匹配度的满意程度欠佳,此5例患者评价效果达到B级;4例修复体出现脱落;其余16例患者修复体各评价标准及患者满意度达到了 100%。其中4例患者出现修复体脱落,分别是由于继发龋、牙体长轴不一致、粘结操作问题以及存在咬合高点造成的,在去除了引起脱落的因素后,均进行了二次粘结,其3个月短期观察效果良好;有一例为牙周病患者,由于缺隙两侧基牙的松动度不同,造成在咀嚼过程中松动度较小一侧基牙的翼板发生脱粘结,而松动度较大侧基牙的翼板粘结仍牢固,未完全发生脱落,我们将脱粘结一侧的翼板磨除后进行抛光,将双端粘结改为单端粘结继续使用,并未纳入失败病例。结论:钴铬合金金属翼板粘结固定桥具备对牙髓损伤小、几乎无需麻醉、临床可操作性强,制作价格较低廉,即使初期粘结失败也可重新选择固定桥或者其他修复方法进行二次修复等优点,并且在修复单颗牙缺失时,其短期临床效果良好,特别是对颌间距离不足,咬合紧的病例更是一种值得推广的半永久式、微创的修复手段。
[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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.4
，

本文编号：1787764