前牙美学区再次修复病例报告

发布时间：2018-04-24 14:28

本文选题：全瓷冠 + 美学修复　；参考：《大连医科大学》2016年硕士论文

【摘要】：目的:前牙美学区的修复越来越受到患者和修复医师的关注。原有的前牙修复体存在着问题、甚至失败的患者,对此有着迫切的修复要求和更高的美学需求。本文针对临床中遇到的前牙美学区再次修复病例进行报告,分析原有修复体失败的原因及再次修复时需要考虑的美学因素,探索规范的美学修复流程。方法:选取5例2014年6月~2015年5月于大连市口腔医院修复科就诊要求再次修复病例。其中,修复体要求拆除重新制作的原因为:烤瓷冠修复后出现牙龈红肿出血影响美观;烤瓷联冠修复后有异味、脱落;烤瓷修复体边缘不密合,牙龈退缩,冠边缘外露;一例为根管治疗后未及时修复,出现冠折,影响美观,要求修复;一例为烤瓷冠脱落,牙龈红肿明显,要求重新修复。出现这些症状的主要原因是:在修复前未进行彻底的牙体牙髓治疗;修复体咬合问题;医生临床操作失误;患者口腔卫生维护较差以及修复体边缘破坏生物学宽度等。美学区的再次修复是在保证口颌系统功能及口腔健康的基础上更加注重美学修复的相关因素。基本的操作流程是:就诊后通过全面口腔检查,明确修复失败的原因及重新修复如何解决并避免再次出现这些问题。美学修复流程:修复前进行美学设计、美学分析、必要的牙周及牙体牙髓治疗、制作诊断蜡型、口内诊断饰面,让患者可以直观感受预期的修复效果,便于医患交流;并对诊断蜡型、诊断饰面进行调改,待达到医患均满意后,制作硅橡胶导板指导临床牙体预备;规范临床操作、精细牙体预备、获得清晰准确的印模、利用诊断蜡型制作精美的临时修复体恢复美观、保护基牙、维持修复体的修复空间、维持咬合关系;修复体的颜色再现与邻牙及对颌牙相协调,并且注意个性化的条纹及色素斑块的恢复。在获得良好的美学效果时,注重修复体的咬合功能恢复,使修复体获得正中合平衡、前伸与侧方组牙功能合。对术前、术后数码照片进行美学分析、测量美学参数的改变。结果:再次修复后,修复体美学参数符合患者的生理要求。患者对修复体的形态,功能及颜色均较为满意。治疗过程中以及术后回访注重修复体的咬合功能以及口腔卫生维护,确保长期稳定的临床效果。结论:1.前牙美学区再次修复应充分分析患者的修复失败原因,利用诊断蜡型,诊断饰面,牙龈成形术、冠延长术等方法,规范美学诊疗流程以确保最终的美学效果。2.美学修复是通过对牙周与牙体形态的改变,在恢复功能与形态的基础上,追求美观与功能之间的平衡状态,从而获得最佳的修复效果。
[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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783

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