国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (1): 1-9.doi: 10.7518/gjkq.2024001

• 专家笔谈 •    下一篇

无牙颌患者种植治疗修复空间与修复方式的选择策略

汤春波()   

  1. 南京医科大学附属口腔医院种植科 江苏省口腔疾病研究重点实验室江苏省口腔转化医学工程研究中心 南京 210029
  • 收稿日期:2023-08-23 修回日期:2023-10-12 出版日期:2024-01-01 发布日期:2024-01-10
  • 通讯作者: 汤春波
  • 作者简介:汤春波，教授，博士，Email：<email>cbtang@njmu.edu.cn</email>
  • 基金资助:
    国家自然科学基金面上项目(82170993)

Restorative space in edentulous patients and the clinical decision of implant restoration

Tang Chunbo()   

  1. Dept. of Oral Implantology, Affiliated Stomatological Hospital of Nanjing Medical University, Jiangsu Province Key La-boratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China
  • Received:2023-08-23 Revised:2023-10-12 Online:2024-01-01 Published:2024-01-10
  • Contact: Chunbo Tang
  • Supported by:
    National Natural Science Foundation of China(82170993)

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摘要：

无牙颌患者在种植修复的设计过程中，应充分考虑患者建𬌗后的修复空间能否足够容纳种植义齿上部结构和修复体，根据修复空间选择合适的修复方式。目前存在的困难在于临床上对修复空间的评估尚无统一的标准。当口内的修复空间与修复体设计不匹配时，会出现种植义齿的机械或生物学并发症。本文综述并明确了无牙颌患者垂直高度和水平关系的评估方法，介绍了相应的无牙颌种植修复方式的临床决策。本文推荐：在无牙颌患者种植治疗之前，记录天然牙或旧义齿保留的正确的颌位关系；使用数字化技术，获得患者口腔颌面部完整的数字化信息，从而构建出三维虚拟牙科患者模型；根据测量得出的垂直修复空间和水平关系，设计以功能和美学为导向的种植修复方案。

关键词: 无牙颌, 种植修复, 垂直空间, 水平关系

Abstract:

The restoration space should be fully considered in designing the implant restoration for edentulous patients to accommodate the superstructure of implant dentures and prostheses and select the appropriate restoration method. However, no unified standard exists for the evaluation of restoration space in clinical practice. Mechanical or biological complications of implant dentures occur when the restorative space in the mouth does not match the prosthesis design. This study recommends recording the correct jaw relation retained by natural teeth or old dentures before implant treatment in edentulous patients. The complete digital information of the patient’s oral and maxillofacial region can be obtained using digital technology, and a three-dimensional virtual dental patient model can be constructed. A functional and aesthetically oriented implant restoration plan can be designed according to the measured vertical restoration space and horizontal relationship.

Key words: edentulous, implant restoration, vertical space, horizontal relation

中图分类号: 

  • R783.4

图 1

种植上部修复体的机械并发症A：无牙颌固定义齿桥架折断；B：纯钛支架烤塑桥树脂崩裂。"

表 1

选择无牙颌种植固定义齿或覆盖义齿时考虑因素"

考虑因素种植固定义齿种植覆盖义齿
牙槽嵴形状垂直/凸颊侧倾斜/凹
颌间距离较小或正常较大
水平颌位关系Ⅰ/Ⅱ类Ⅲ类
黏膜厚的，角化的薄的，可移动的
笑线低高
面部/唇部支撑无需支撑需要支撑

图 2

垂直修复空间（箭头示）的测量"

图 3

为避免暴露种植体-基台连接处，高笑线患者进行上颌牙槽嵴修整术A：患者术前口内照；B：患者截骨前口内照；C：患者截骨6 mm后的口内照；D：患者终修复完成后微笑照。"

图 4

上颌前突患者的种植修复治疗A、B：患者术前面相照；C：患者术前口内照；D、E：患者修复完成后面相照；F：患者修复完成后口内照。"

图 5

下颌前突患者的种植修复治疗A：患者术前面相照；B：患者术前口内照；C：患者修复完成后面相照；D：患者修复完成后口内照。"

图 6

HTRS的测量"

图 7

上颌第一磨牙位点的牙槽嵴顶连线与??平面的夹角"

图 8

上颌无牙颌的修复方式A：不带粉色修复体的种植固定义齿；B：带粉色修复体的种植固定义齿；C：种植覆盖义齿。"

图 9

使用固定义齿和覆盖义齿恢复面部丰满度情况A、B：第Ⅳ类患者使用固定义齿修复时的口内照和面相照；C、D：第Ⅳ类患者使用覆盖义齿修复时的口内照和面相照，面部的丰满度相比于固定义齿修复时恢复更好。"

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