种植义齿修复功能性咬合的几点思考

Functional Occlusal Design of Implant Prosthesis

目的:探讨牙种植体冠桥修复设计在牙列形态功能重建中的临床意义。方法:随机抽取本院临床上采取种植单冠或种植体连冠、种植体固定桥、种植体-牙联合固定修复病例20例,追踪比较种植体、相邻牙、对合牙骨嵴顶水平变化及骨吸收方式,修复体结构变化特点、咀嚼主观感受、颞下颌关节症状、T-scan咬合记录等。结果及讨论:临床种植义齿修复治疗中,越来越多的咬合问题出现在就诊病人的不同治疗时期,有的患者经过医师的适当处理:如调改咬合、佩戴咬合垫、引导患者改变咀嚼习惯、不同修复时期选择不同质地的食品等可即刻或短期内恢复正常,骨吸收减缓,或有一定改建。但临床上也有一部分患者,从其牙列排列或咬合形态结构无明显异常,依照传统的治疗手段处理后仍无法解决或缓解咬合不适症状,如持续性咬合痛、异常咬合音、颞下颌关节弹响和颌面部局部酸困不适感甚至疼痛、嚼碎食物困难等。这类患者修复区咬合形态无明显异常。本课题研究结果认为:在目前尚缺乏垂直向咬合接触的正常形态标准情况下,种植修复较之天然牙修复更应该注重以近远中向(一牙对二牙)以及唇(颊)舌向关系正常的咬合形态标准作为咬合治疗的正常标准。过渡义齿修复及定期仔细地调改咬合十分重要。进一步建立满足种植修复体功能需求的、个体化的垂直向咬合接触正常标准,是今后研究的主要内容。

Objective： To investigate the influence of implant - retained prosthetic design on the morphology and function rehabili- tation of denture. Methods ： 20 patients who bad fixed implant - retained prosthesis were selected, the data were analyzed to compare （ 1 ） the difference of crestal bone level and bone resorption style of implants, adjacent teeth and opposite teeth, （2） structural change of prosthesis, （3） patient subjective feeling, （4） symptoms of temporomandibular joint, and （5） T - scan biting record, et al. Results and Conclusion： In recent years, significance of occlusion for dental implant treatment has attracted clinician researchers＇ attention. The problem of occlusion comes at different stages of implant prosthesis. After occlusal adjustment, wearing occlusal pad, teaching patients to change chew habits, and choosing different food at different prosthetic phases, the occlusal problem of some patients could be resolved and bone resorption was slow down and remodeled. However, some patient, which tooth arrangement and occlusal forms were nomal,were still uncomfortable with traditional treatment. Continuous biting pain, abnormal biting sound, temporomandibular joint ring, masticatory muscle pain and chewing difficult happened on these patient. The following conclusions were drawn within the limits of this pilot study. （ 1 ） It must be emphasized that currently there is no evidence - based, implant - specific concept of occlusion, it is more important for implant prosthesis to follow the occlusal morphology standard, which mesio - distal relation （ one tooth opposite two teeth） and buccal -lingual relation were correct. （2） Transition prosthesis and periodic occlusal adjustments were suggested. （3） Future studies in this area are needed to clarify the standard of implant - specific concept of occlusion to induce axial loading.