数字化微笑设计在前牙美学修复中的临床应用效果研究
发布时间：2018-02-28 19:41
本文关键词： 数字微笑设计 前牙美学修复 诊断蜡型 诊断饰面 出处：《安徽医科大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的探讨DSD在前牙美学修复中对提高修复后患者满意度和临床效果以及远期效果中所起的作用。方法选取2014年9月至2016年9月期间,在安徽省蚌埠医学院第一附属医院口腔医学中心修复科接受前牙美学修复的患者64例,其中男30例、女34例。年龄18-47岁。共修复牙数172颗。应用简单随机分组原则分为两组:观察组(数字微笑设计组)、对照组(单纯修复组),每组32人。对照组在用单反数码相机拍摄比色照片后常规修复;观察组对常规美学修复进行改良,由同一人用单反数码相机采集术前颌面部及口内包含所需的美学信息的照片。将术前照片导入keynote软件处理,进行微笑分析,并模拟出术后的效果,得到患者的认可后将分析的数据结果、模拟的术后效果、原始照片及模型一并交于技师,用于诊断蜡型的制作。然后在诊断蜡型的基础上制作硅橡胶导板及诊断饰面,使患者更直观的观察美学效果,患者满意后用硅橡胶导板在牙备时精确指导和控制牙备量,最终完成工作模型制作,后连同诊断蜡型一并交于技师处。两组患者的修复体的制作均交于同一技师制作,且材料均选择义获嘉公司生产的IPS-e.max press铸瓷。修复体完成后,行试戴,根据情况进行适当磨改后抛光,粘接。嘱患者半年后、一年后复诊,便于对长期修复效果进行观察。1两组患者在美学修复后即从修复体的外形、颜色匹配度、舒适度三个方面进行满意度评价,用直观模拟量表表示,0代表完全不能接受,100代表完全满意,数值越大,满意度越高。2由一位未参与修复体设计和制作的修复医师对两组患者的修复后临床效果进行评价。从修复体的形态、颜色、龈缘形态、前牙切缘弧度、表面个性特征五个方面进行优、良、中、差的分级。3两组患者修复后6个月后,参照改良Ryge标准及USPHS评价标准,由同一位医师对修复体形态、完整度、边缘密合度、牙龈健康状况、舒适度进行检查后按照A、B、C、D进行分级评价。将上述结果进行统计学分析。结果对照组32例患者初戴时有2例患者对修复体形态提出异议;观察组32例患者初戴时无一返工。1患者满意度评价:在修复体的外形、舒适度方面,观察组高于对照组(P0.01);而在颜色匹配度方面,两组间的无明显差异(P0.05)。2临床效果观察:两组患者在修复体形态、前牙切缘弧度、龈缘形态观察组临床效果高于对照组(P0.05);而在颜色和表面个性特征方面临床效果差异无统计学意义(P0.05)。3 6个月后临床效果观察:6个月复诊观察组4例、对照组5例患者失访。观察组28例患者(75颗)及对照组27例患者(71颗),均无修复体脱落发生;观察组在修复体形态、患者舒适度方面A级评分明显高于对照组(P0.05);在修复体完整性、边缘密合度、牙龈健康状况方面A级评分与对照组无明显差异(P0.05)。结论1数字微笑设计有助于医患沟通,术前能够较直观的模拟修复后效果,有利于提高患者临床操作上的配合度;术后能明显提高其对修复体外形及舒适度的满意度。2将数字微笑设计运用到前牙美学修复中有助于医技沟通、医医沟通,有助于做出在外形、切缘弧度、龈缘形态方面更符合临床美学要求的修复体。3从6个月后的效果观察,数字微笑设计后修复体,外形更加符合美学标准,让患者自觉更加舒适。总之,数字化微笑设计是口腔前牙美学修复中最有效、便捷的一种技术手段。
[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. 瀛楀井绗戣璁℃湁鍔╀簬鍖绘偅娌熼，
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