Maxillary denture flange and occlusal discrepancies of Vertex ThermoSens in comparison with conventional heat-cured denture base materials

This study was conducted to investigate the maxillary denture bases and occlusal discrepancies using the Vertex Thermosens in comparison with the conventional polymethyl-methacrylate materials. Twenty maxillary denture bases were prepared from the Vertex ThermoSens and a conventional heat-cured denture base materials. Acrylic maxillary second molars were arranged in their respective positions on the ridge. After curing of both types of denture bases, they were deflasked with their respective master casts. Reference points were prepared for measurements of the antero-posterior and cross-arch dimensions at the denture borders using caliper device. Furthermore, the teeth discrepancies were measured between reference points in the ligual aspect of the second maxillary molars. The recorded data was analyzed using SPSS statistical software version 20. The results showed initial shrinkage of both denture bases in the antero-posterior and cross-arch dimensions immediately after decasting. This contraction was compensated gradually during storage in water up to 2 weeks. Regarding the variable time, there was a significant difference between the tested materials. Moreover, the results revealed occlusal discrepancies and shifting of teeth inward immediately after decasting, followed by outward movement after storage in water for 2 weeks. Regarding the variables time and materials, there were significant differences. Both materials exhibited inward shrinkage in the antero-posterior and cross-arch dimensions immediately after decasting. Both denture bases showed inward shifting of teeth immediately after decasting, followed by outward movement after storage in water up to 2 weeks.

The lingualized occlusion of complete denture

This article reviews the literatures dealing with the lingualized occlusion of complete denture including the origin,development and research.Lingualized occlusion is a valuable concept because many advantages of anatomic and nonanatomic occlusions are retained,satisfactory occlusion is easily obtained,balanced occlusion can be accomplished.

Class III Reversion with Immediate Complete Denture and Immediate Implant-Retained Overdenture: Case Report

With the increased life expectancy, complete dentures have been used in the treatment of edentulism progressively. It restores stomatognathic system functions, providing improvements in chewing, aesthetics, and phonetics. The aim was to report an oral rehabilitation of a patient with severe aesthetic and functional impairment, with Angle’s class III malocclusion. The patient sought the extension project of the School of Dentistry of the Federal University of Minas Gerais with aesthetic complaints. After clinical and radiographic evaluation, the proposed planning was immediate complete denture maxilla and immediate implant-retained overdenture in mandible. During clinical evaluation it was observed that the patient was Angle’s III. The rehabilitation was performed as proposed and at the end of the treatment, it was possible to revert the class III occlusal pattern to Angle’s I. The excellent maxillomandibular relationship was achieved, which ensured optimal facial aesthetics and functional condition. It was concluded that the immediate complete dentures and immediate implant-retained overdenture might be beneficial for restoring the aesthetics and function of patients with Angle’s class III malocclusion.

Treatment of Elderly Bedridden Patients with Removable Dentures to Promote Their Daily Physical Activities: A Case-Control Study

Bedridden patients remain in bed for various reasons, such as chronic illness, old age, and disability, and they cannot perform self-care activities completely or partially. The provision of care for bedridden patients is a major issue in the aging population. Effective rehabilitation is associated with several factors such as cooperation between the patient and the medical staff, selection of effective facilities, and the financial burden. The objective of this study was to evaluate the effect on the activities of daily living (ADL) of occlusion restoration using removable dentures in bedridden older people. This case-control study comprised 32 bedridden older patients who were divided into two groups as follows: denture (n = 18) and no-denture (n = 14). No rehabilitation was provided to any of the patients. The patients were evaluated 3 months after placing the denture, and the ADLs were compared between the two groups. Of the 18 bedridden patients who received removable dentures, 55.6% demonstrated improvements in the ADLs, and the effects persisted for at least 3 months. No improvement in the ADL was observed in the no-denture group. The results of this study suggested that adequate occlusal support can improve the ADL of the elderly. Thus, it is important to take care of oral health early in life in order to maintain oral health, which could help prevent the decrease in the ADL during the later stages of life.

正中关系的临床决策

正中关系(CR)最初应用于无牙颌的全口义齿修复,后来逐渐应用于有牙颌的临床诊疗。关于CR在有牙颌中的应用,一方面对其合理性有不少质疑,如在颞下颌关节紊乱病治疗中,CR是否应作为诊疗核心?咬合重建修复治疗中,CR是否应作为建颌位?正畸治疗中,CR是否应作为目标颌位?但另一方面,CR的各种临床运用却是客观存在的。根据现有认知,本文汇总整理了争议不大的几种主要临床场景的适用条件,初步提出了CR临床应用时的决策树,供临床参考。

分体式颌位关系记录托盘的设计与应用

现有的颌位关系记录托盘为上下一体式设计,在临床使用过程中无法准确获取上颌平面、上唇下约1 mm的位置、上唇支撑度等重要信息。从而使得数字化颌托(或诊断义齿)准确性欠佳,为后继进行准确边缘整塑印模及最终颌位关系记录与转移带来困难。该文介绍了一种分体式颌位关系记录托盘的设计、临床使用方法及要点。其能够准确获取上颌平面、上唇下约1 mm的位置、上唇支撑度等重要信息,为后继进行准确的颌位关系记录与转移提供参考,也为利用口内扫描获取数字化印模后,基于采用分体式颌位关系记录托盘获取的平面、上唇下约1 mm的位置、上唇支撑度等信息直接制作全口义齿奠定基础。

老年可摘义齿佩戴者口腔健康相关生活质量的影响因素分析

目的分析老年可摘义齿佩戴者口腔健康相关生活质量(oral health-related quality of life,OHRQoL)的影响因素及相互关系。方法选取牙列缺损/牙列缺失患者86名作为义齿佩戴组,行可摘义齿修复且义齿远端至少延伸到第一磨牙。选择天然牙列保留至第一磨牙的无可摘义齿患者72名作为对照组。采用Eichner分类法记录上下颌之间的咬合单位和咬合支持数量,口腔健康影响程度量表(Oral Health Impact Profile,OHIP)评价OHRQoL,接触定位法确定主要咬合区,双侧第一磨牙作为测量部位评估最大咬合力,粘性凝胶法评估咀嚼效率,食物接受度问卷评估咀嚼能力。结果义齿佩戴组的OHIP评分以及心理不适和生理能力受限两个分量表的评分高于对照组(P<0.05)。OHIP评分与余留牙数、咬合支持数量、最大咬合力和咀嚼能力呈显著负相关。下颌余留牙数、咬合支持数量、下颌主要咬合区是否为天然牙以及咀嚼能力是OHIP评分的显著影响因素。结论老年可摘义齿佩戴者口腔健康相关生活质量与余留牙咬合关系和主要咬合区存在相关性,其中保留下颌第一磨牙是一个关键影响因素。

义齿咬合板联合综合物理疗法对颞下颌关节盘不可复性前移位的疗效评价

目的:探讨义齿咬合板联合综合物理疗法治疗颞下颌关节盘不可复性前移位(anterior disc displacement without reduction,ADDwoR)的疗效。方法:选择2019年1月—2020年12月衡水市人民医院口腔正畸修复科就诊的牙列缺损或牙重度磨耗并诊断为ADDwoR患者60例,根据治疗方法不同,随机分为义齿咬合板组(A组)和义齿咬合板+综合物理疗法组(B组)。治疗前、治疗时每3周记录患者最大主动开口度(maximum mouth opening,MMO)、视觉模拟量表疼痛评分(visual analog pain score,VAS)。治疗前及治疗后3个月拍摄锥形束CT(CBCT),分析2组患者治疗前、后临床疗效指标变化及颞下颌关节CBCT三维数据差异。采用SPSS 26.0软件包对数据进行统计学分析。结果:治疗后3周,2组VAS和治疗前相比差异有统计学意义(P<0.05)且B组VAS降低较多;治疗后3周起,B组MMO、VAS和治疗前相比差异有统计学意义(P<0.05)。治疗后9周起,A组MMO与治疗前相比差异有统计学意义(P<0.05),但A组与B组MMO、VAS无统计学差异(P>0.05)。CBCT显示,治疗后关节前间隙变窄,关节后间隙增宽,关节上间隙增大,髁突水平角减小,关节结节斜度、髁突高度增大(P<0.05);关节窝深度、髁突前后径、内外径相比差异无统计学意义(P>0.05)。与A组相比,B组治疗后关节前、上、后间隙,髁突水平角,关节结节斜度差异有统计学意义(P<0.05)。结论:义齿咬合板可有效改善ADDwoR症状,义齿咬合板联合综合物理疗法能迅速改善患者开口度,减轻患者关节区疼痛。

过渡性治疗义齿对牙列缺失患者全口义齿修复后咬合能力及美观程度的影响

目的:探讨过渡性治疗义齿对牙列缺失患者全口义齿修复后咬合能力及美观程度的影响。方法:选取2019年3月-2022年3月笔者医院收治的115例牙列缺失患者为观察对象,采用随机数字表法分为观察组(n=58)和对照组(n=57),对照组施以常规全口义齿修复,观察组施以过渡性治疗义齿修复,比较两组戴牙3个月后的咬合能力、固位力与稳定性评分、压痛点总个数,观察两组的发音情况、咀嚼效率与口腔健康状况、美观程度及临床疗效。结果:戴牙3个月后,两组颌位关系指数评分与咬合力均显著升高,且观察组显著高于对照组(均P<0.05);两组固位力与稳定性评分显著升高,且观察组显著高于对照组(均P<0.05);两组压痛点总个数均显著减少,发音情况评分均显著升高,且两组差异有统计学意义(均P<0.05);两组咀嚼效率均显著升高,口腔健康评分均显著降低,且两组差异有统计学意义(均P<0.05);观察组美观程度总满意度94.83%,显著高于对照组的80.70%(χ^(2)=5.365,P=0.021);观察组总有效率为91.38%,高于对照组77.19%(χ^(2)=4.382,P=0.036)。结论:牙列缺失患者全口义齿修复采用过渡性治疗义齿疗效显著,可有效提高患者义齿咬合能力、固位力、稳定性及咀嚼效率,并减轻义齿佩戴后黏膜疼痛及改善患者口腔健康状况,有助于提高语音功能和美观程度,可临床推广应用。

咬合重建固定义齿修复术与可摘局部义齿修复治疗牙周病合并牙列缺损的疗效对比

目的分析对比咬合重建固定义齿修复术与可摘局部义齿修复在牙周病合并牙列缺损患者中的效果。方法回顾性分析2018年2月-2023年2月淮安市口腔医院收治的70例牙周病合并牙列缺损患者的临床资料,按治疗方式的不同将其分为两组。其中行可摘局部义齿修复的36例患者纳入对照组,行咬合重建固定义齿修复术的34例患者纳入观察组,术后观察3个月。对比两组修复效果、咀嚼功能、颞下颌功能、满意度、并发症。结果观察组修复总有效率、满意度为高于对照组,有统计学差异(P<0.05);术后,观察组咀嚼效率、咬合力高于对照组,肌肉压痛指数、颞下颌关节功能障碍指数、颞下颌关节紊乱指数低于对照组,有统计学差异(P<0.05);两组并发症相当,无统计学差异(P>0.05)。结论与可摘局部义齿修复治疗相比,咬合重建固定义齿修复术治疗牙周病合并牙列缺损患者效果显著,能够提升修复效果,改善患者的咀嚼功能与颞下颌功能,提高满意度,且无严重并发症。

固定义齿联合活动义齿修复在女性低位咬合重建治疗中的效果

目的探讨固定义齿联合活动义齿修复在女性低位咬合重建治疗中的效果。方法选取2021年3月至2023年3月于临沂市兰山区人民医院接受低位咬合重建治疗的96例女性患者作为研究对象,按照随机抽签法分为参照组与观察组,每组各48例。参照组予以活动义齿修复,观察组予以固定义齿联合活动义齿修复。比较两组咀嚼率、咬合功能及并发症发生情况。结果治疗后,观察组咀嚼率高于参照组(P<0.05)。治疗后,观察组咬合功能均优于参照组(P<0.05)。观察组并发症总发生率低于参照组(P<0.05)。结论固定义齿联合活动义齿修复在女性低位咬合重建治疗中的效果确切,可提高患者的咀嚼率及咬合功能,减少并发症发生风险,值得临床推广应用。

Stress area of the mandibular alveolar mucosa under complete denture with linear occlusion at lateral excursion

Background The rocking and instability of a loaded complete denture （CD） during lateral excursion reduce the bearing area under the denture base, causing localized high stress concentrations. This can lead to mucosal tenderness, ulceration, and alveolar bone resorption, and the linear occlusion design was to decrease the lateral force exerted on the denture and to ensure denture stability. But it is not known how the bearing areas of linear occlusal CDs （LOCDs） and anatomic occlusal CDs （AOCDs） differ. The purpose of this study was to analyze and compare the distributions of the high and low vertical stress-bearing areas in the mandibular alveolar mucosa under LOCDs and AOCDs at lateral excursion.Methods Computerized tomography （CT） and finite element analysis were used to establish three-dimensional models of an edentulous maxilla and mandible with severe residual ridge resorption. These models were composed of maxillary and mandibular bone structure, mucosa, and the LOCD or AOCD. Lateral excursion movements of the mandible were simulated and the vertical stress-bearing areas in the mucosa under both mandibular CDs were analyzed using ANSYS 7.0.Results On the working side, the high stress-bearing （-0.07 to -0.1 Mpa） area under the LOCD during lateral excursion was smaller than that under the AOCD, while the medium stress-bearing （-0.03 to -0.07 Mpa） area under the LOCD was 1.33-fold that under the AOCD. The medium stress-bearing area on the non-working side under the LOCD was 2.4-fold that under the AOCD. Therefore, the overall medium vertical stress-bearing area under the LOCD was 20% larger than that under the AOCD.Conclusions During lateral excursion, the medium vertical stress-bearing area under a mandibular LOCD was larger and the high vertical stress-bearing area was smaller than that under an AOCD. Thus, the vertical stress under the LOCD was distributed more evenly and over a wider area than that under the AOCD, thereby improving denture stability.

舌侧集中[牙合]与解剖[牙合]全口义齿修复效果比较研究

目的:比较舌侧集中[牙合]全口义齿与解剖[牙合]全口义齿在下颌牙槽嵴中、重度吸收牙列缺失患者的临床修复效果。方法:将符合纳入标准的牙列缺失患者按就诊顺序随机化分为3组,分别制作全口义齿。A组:Excellence IPN舌侧集中[牙合],B组:Surpass G舌侧集中(牙合),C组:Endura解剖[牙合]。在戴用义齿2周、3个月和12个月后,采用称重法测量义齿咀嚼效率。在3个月和12个月时,使用口腔健康影响程度量表(OHIP-20)评估患者的口腔健康相关生存质量。测量数据使用SPSS软件进行统计分析。结果:本研究共纳入30位牙列缺失患者,其中A组11例,B组10例,C组9例。三组患者在戴用义齿12个月时,咀嚼30秒的咀嚼效率组间具有显著差异(P<0.05),在其他时间点测定的咀嚼效率组间无显著性差异(P>0.05)。20项口腔健康影响程度总得分显示,3个月和12个月时A组和B组得分显著低于C组(P<0.05)。结论:舌侧集中(牙合)全口义齿可以保持较高的咀嚼效率,改善患者的生存质量,对下颌牙槽嵴中、重度吸收的牙列缺失患者具有良好的临床效果。

电子面弓应用于恢复后牙固定修复体咬合功能的临床研究

目的研究电子面弓辅助固定修复义齿制作对恢复后牙咬合功能的作用。方法本研究选取单侧2个牙位以上的末端咬合游离的固定修复患者16例,共39颗基牙。比较采用传统技术与数字化口内扫描、电子面弓、虚拟[牙合]架CAD/CAM技术制作固定义齿的修复效果差异。并通过口内咬合纸印迹法、调[牙合]时间和T-Scan Ⅲ数字化咬合分析仪,比较两组修复体的咬合功能。结果(1)两种方法制作的修复体在咬合面早接触点、调[牙合]时间上均有明显统计学差异(P<0.01);(2)两组修复体调[牙合]后,两侧后牙咬合均匀,均未发现明显早接触点。结论采用电子面弓辅助制作的固定修复体可以更加精确地恢复患者咬合功能,减少临床调[牙合]时间,有利于降低医疗成本,从而为精准地恢复后牙固定修复体的咬合功能提供理论和数据参考。

数字化咬合分析系统指导咬合调整在固定局部义齿修复中的疗效评价

目的评价固定局部义齿修复在T-Scan Ⅲ数字化咬合分析系统指导下进行咬合调整的临床疗效。方法选择2018年10月至2020年9月就诊的88例单颗后牙缺失需固定局部义齿修复患者,随机分为咬合纸法组和T-Scan Ⅲ法组,每组44例。口内试戴时,分别采用传统咬合纸法和T-Scan Ⅲ指导法对修复体进行咬合调整,经抛光、粘接后完成修复,于3、12个月时复诊,采用改良的美国公共卫生署(United States Public Health Service,USPHS)评价系统和患者满意度调查表对修复效果进行评价。结果固定局部义齿修复后3个月时,咬合纸法组和T-Scan Ⅲ法组成功率分别为95.45%和97.73%;修复后12个月时,两组成功率分别为90.91%和95.45%,两个时间点两组成功率差异均无统计学意义(P均>0.05);在修复体咬合接触类型评价中,T-Scan Ⅲ法组Ⅰ类占93.18%,高于咬合纸法组(P<0.05);在对修复后咬合感受满意度调查中,两组分别有68.18%和86.36%的患者表示非常满意,后者较前者高(P<0.05)。结论T-ScanⅢ指导下咬合调整能够获得较好的临床效果,固定局部义齿修复中可以将T-ScanⅢ指导下咬合调整作为一种选择。

舌侧集中牙合全口义齿修复治疗重度牙槽嵴吸收患者的效果

目的:观察舌侧集中牙合全口义齿修复治疗重度牙槽嵴吸收患者的效果。方法:选取2019年1月至2022年1月该院收治的100例重度牙槽嵴吸收患者进行前瞻性研究,按照随机数字表法将其分为研究组与对照组各50例。对照组采取解剖式牙合型全口义齿修复治疗,研究组采取舌侧集中牙合全口义齿修复治疗,比较两组治疗后咀嚼效率、咬合力、满意度和生命质量[口腔健康影响程度量表(OHIP-14)中文版]评分。结果:研究组佩戴1、3个月的咀嚼效率和咬合力均高于对照组,差异有统计学意义(P<0.05);研究组美观程度、咀嚼功能、固位功能、语音功能和舒适性等满意度评分均高于对照组,差异有统计学意义(P<0.05);佩戴3个月后,两组功能限制、疼痛与不适、能力受限和身心缺陷等OHIP-14评分均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。结论:舌侧集中牙合全口义齿修复治疗重度牙槽嵴吸收患者可提高咀嚼效率、咬合力和满意度,改善生命质量,效果优于解剖式牙合型全口义齿修复治疗。

舌向集中全口义齿应力分布的光弹性研究(常规全口义齿加载)

目的研究舌向集中与解剖全口义齿在正中及侧向应力加载时其支持组织的应力分布情况。方法采用三维光弹实验的方法,在CawoodⅤ类无牙颌环氧树脂光弹模型上分别制作解剖和舌向集中全口义齿,并于正中及侧向状态下加载冻结,分析和比较支持组织的应力分布情况。结果常规全口义齿正中及侧向加载时,舌向集中较解剖传递更多应力至舌侧,力分配较为均匀。结论对于牙槽嵴重度吸收的无牙颌患者,在选用常规全口义齿修复时,可首先考虑舌向集中以辅助增强义齿的稳定性。

长正中型总义齿的咀嚼效率和满意度的初步评价

目的:测试分析长正中牙合型全口义齿的咀嚼效率和义齿满意度。方法:本研究为自身对照研究,采用置换牙列技术为10例重度牙槽嵴吸收的无牙颌患者同时制作长正中牙合型全口义齿和解剖牙合型全口义齿,并按照随机原则决定每种牙合型全口义齿的戴用顺序,分别于每种牙合型全口义齿戴牙后2、4、6、8、10、12周采用光密度法检测全口义齿的咀嚼效率。每种牙合型全口义齿戴用3个月后,采用问卷调查评估患者对这种牙合型全口义齿修复的总体满意度,并由患者随意愿选择最终戴用义齿的牙合型。结果:长正中牙合型全口义齿的咀嚼效率在数值上高于解剖牙合型全口义齿,但差异并无统计学意义(P=0.062);长正中牙合型全口义齿的患者满意度明显高于解剖牙合型全口义齿(P<0.05)。10名患者全部将长正中牙合型全口义齿作为最终的选择。结论:对牙槽嵴吸收严重的无牙颌患者,长正中牙合型全口义齿可以获得良好的临床治疗效果。

舌向集中全口义齿应力分布的光弹性研究(下颌种植覆盖义齿加载)

目的研究舌向集中与解剖下颌种植覆盖义齿在正中、侧向及前伸应力加载时其支持组织的应力分布情况。方法应用三维光弹实验的方法,在CawoodⅤ类无牙颌模型双侧侧切牙至尖牙区域内各植入1枚种植体后制作环氧树脂光弹模型,分别进行正中、侧向及前伸垂直应力(1 kg)加载;应力冻结后,分析和比较舌向集中与解剖种植覆盖义齿周围支持组织的应力分布情况。结果侧向加载时,舌向集中种植覆盖义齿工作侧与平衡侧的应力差小于解剖种植覆盖义齿;侧向及前伸加载时,舌向集中种植覆盖义齿工作侧和平衡侧支持组织承受应力均小于解剖种植覆盖义齿。结论在使用2个种植体的球帽种植覆盖义齿时,舌向集中对种植体周围骨质有一定保护作用,且在侧向运动时更稳定,可作为种植全口覆盖义齿的首选人工牙。

2种(牙合)型全口义齿咀嚼功能的自体对照研究

目的对舌侧集中[牙合]和解剖式[牙合]全口义齿修复后的功能性进行评价。方法为10例牙槽嵴中重度吸收的无牙颌患者制作可置换舌侧集中[牙合]型和解剖式[牙合]型牙列的全口义齿,随机佩戴每副牙列义齿3个月后评价咀嚼效率、咬合力、肌电图、下颌运动轨迹及患者满意度。结果 2种[牙合]型的咀嚼效率差异无统计学意义;舌侧集中[牙合]的最大咬合力、肌电幅值小于解剖式[牙合],下颌运动的垂直位移和水平位移大于解剖式[牙合],差异有统计学意义;2种[牙合]型在咀嚼面包时的满意度差异无统计学意义,但舌侧集中[牙合]的咀嚼生胡萝卜满意度以及总体满意度均较高,差异有统计学意义。结论对牙槽嵴中重度吸收的无牙颌患者,舌侧集中[牙合]全口义齿能较好地恢复其口颌系统功能。