改善宽长比提高前牙美学修复效果临床病例报告分析

发布时间：2018-08-18 15:19

【摘要】：目的:对于前牙牙冠宽长比失调的患者,通过美学分析设计来改善牙冠的宽长比,从而达到理想的美学修复效果。方法:本文选取2014年11月至2016年11月之间,大连市口腔医院修复科及综合二科收治的因前牙宽长比失调影响美观而要求进行前牙美学修复的6名患者,其中男性3例,女性3例,年龄在28～49岁之间。其中因原修复体松动脱落来诊的患者2例,因原修复体破坏生物学宽度导致牙龈增生肿胀出血来诊的患者1例,因外伤造成的前牙缺损的患者1例,因前牙扭转外翻要求改善美观的患者1例,因前牙散在间隙要求关闭间隙的患者1例。修复治疗前与患者说明患牙的缺损情况,可选择的修复方法、治疗过程、治疗周期、所需费用以及愈后效果等。如患者本身有高血压、心脏病、糖尿病等系统疾病,对治疗过程有影响者,则需嘱其控制病情后再进行修复治疗。应用数码相机采集患者影像资料,导入电脑,应用DSD软件对术前患牙进行美学分析,设计出理想的前牙宽长比,并设计制作美学诊断蜡型。与患者进行沟通,通过动态模拟演示和诊断蜡型向患者展示预期的美学修复效果,了解患者期望值,评估患者对美的心理需求,综合参考患者需求,制定出适合患者的个性化美学设计。确定修复治疗计划后,根据具体情况进行系统完善的牙体牙周治疗。如牙体治疗不完善的患牙应考虑进行再治疗,涉及红色美学不良的患者,应根据诊断蜡型制作牙周手术导板,在导板指导下进行牙冠延长术。牙冠延长术后应制作暂时冠,对患者进行口腔卫生宣教,把握好术后修复时机。对于牙冠延长术中未去除骨组织的患者,最终修复可开始于术后6～8周;对于牙冠延长术中去除部分骨组织的患者,最终修复可开始于术后3～6个月。根据患牙缺损情况、美学设计以及患者的经济状况等具体情况选择适合患者的修复材料及修复方式。最终修复完成后,嘱患者认真维护口腔卫生,交代修复体使用方法以及注意事项。采集影像资料进行术前术后对比,并进行临床观察及疗效评价。修复后1个月对修复体进行复查,检查修复体边缘密合情况、邻接关系、修复体局部牙周状况、颜色满意度以及是否有继发龋坏等问题。结果:6例患者最终修复后进行美学评价,均通过改善前牙的宽长比达到较理想的美学效果,患者满意。要求患者1个月后复查回访,其中1例因身体原因未能及时复诊,其余5例复诊,患者对修复体颜色满意,口腔卫生维持较好,修复体边缘密合,牙龈健康无红肿出血,边缘龈无变色,未出现咬合不适。结论:通过改善前牙的宽长比,能够不同程度的提高美学修复效果。结合DSD软件进行前牙区美学修复设计,实现了医患以及医技之间更加有效的交流与沟通,为临床美学修复设计提供可靠的方法。
[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.
【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
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本文编号：2189872