本文選題：全瓷冠 + 美學(xué)修復(fù)��； 參考：《大連醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:前牙美學(xué)區(qū)的修復(fù)越來(lái)越受到患者和修復(fù)醫(yī)師的關(guān)注。原有的前牙修復(fù)體存在著問(wèn)題、甚至失敗的患者,對(duì)此有著迫切的修復(fù)要求和更高的美學(xué)需求。本文針對(duì)臨床中遇到的前牙美學(xué)區(qū)再次修復(fù)病例進(jìn)行報(bào)告,分析原有修復(fù)體失敗的原因及再次修復(fù)時(shí)需要考慮的美學(xué)因素,探索規(guī)范的美學(xué)修復(fù)流程。方法:選取5例2014年6月~2015年5月于大連市口腔醫(yī)院修復(fù)科就診要求再次修復(fù)病例。其中,修復(fù)體要求拆除重新制作的原因?yàn)?烤瓷冠修復(fù)后出現(xiàn)牙齦紅腫出血影響美觀(guān);烤瓷聯(lián)冠修復(fù)后有異味、脫落;烤瓷修復(fù)體邊緣不密合,牙齦退縮,冠邊緣外露;一例為根管治療后未及時(shí)修復(fù),出現(xiàn)冠折,影響美觀(guān),要求修復(fù);一例為烤瓷冠脫落,牙齦紅腫明顯,要求重新修復(fù)。出現(xiàn)這些癥狀的主要原因是:在修復(fù)前未進(jìn)行徹底的牙體牙髓治療;修復(fù)體咬合問(wèn)題;醫(yī)生臨床操作失誤;患者口腔衛(wèi)生維護(hù)較差以及修復(fù)體邊緣破壞生物學(xué)寬度等。美學(xué)區(qū)的再次修復(fù)是在保證口頜系統(tǒng)功能及口腔健康的基礎(chǔ)上更加注重美學(xué)修復(fù)的相關(guān)因素�；镜牟僮髁鞒淌�:就診后通過(guò)全面口腔檢查,明確修復(fù)失敗的原因及重新修復(fù)如何解決并避免再次出現(xiàn)這些問(wèn)題。美學(xué)修復(fù)流程:修復(fù)前進(jìn)行美學(xué)設(shè)計(jì)、美學(xué)分析、必要的牙周及牙體牙髓治療、制作診斷蠟型、口內(nèi)診斷飾面,讓患者可以直觀(guān)感受預(yù)期的修復(fù)效果,便于醫(yī)患交流;并對(duì)診斷蠟型、診斷飾面進(jìn)行調(diào)改,待達(dá)到醫(yī)患均滿(mǎn)意后,制作硅橡膠導(dǎo)板指導(dǎo)臨床牙體預(yù)備;規(guī)范臨床操作、精細(xì)牙體預(yù)備、獲得清晰準(zhǔn)確的印模、利用診斷蠟型制作精美的臨時(shí)修復(fù)體恢復(fù)美觀(guān)、保護(hù)基牙、維持修復(fù)體的修復(fù)空間、維持咬合關(guān)系;修復(fù)體的顏色再現(xiàn)與鄰牙及對(duì)頜牙相協(xié)調(diào),并且注意個(gè)性化的條紋及色素斑塊的恢復(fù)。在獲得良好的美學(xué)效果時(shí),注重修復(fù)體的咬合功能恢復(fù),使修復(fù)體獲得正中合平衡、前伸與側(cè)方組牙功能合。對(duì)術(shù)前、術(shù)后數(shù)碼照片進(jìn)行美學(xué)分析、測(cè)量美學(xué)參數(shù)的改變。結(jié)果:再次修復(fù)后,修復(fù)體美學(xué)參數(shù)符合患者的生理要求�；颊邔�(duì)修復(fù)體的形態(tài),功能及顏色均較為滿(mǎn)意。治療過(guò)程中以及術(shù)后回訪(fǎng)注重修復(fù)體的咬合功能以及口腔衛(wèi)生維護(hù),確保長(zhǎng)期穩(wěn)定的臨床效果。結(jié)論:1.前牙美學(xué)區(qū)再次修復(fù)應(yīng)充分分析患者的修復(fù)失敗原因,利用診斷蠟型,診斷飾面,牙齦成形術(shù)、冠延長(zhǎng)術(shù)等方法,規(guī)范美學(xué)診療流程以確保最終的美學(xué)效果。2.美學(xué)修復(fù)是通過(guò)對(duì)牙周與牙體形態(tài)的改變,在恢復(fù)功能與形態(tài)的基礎(chǔ)上,追求美觀(guān)與功能之間的平衡狀態(tài),從而獲得最佳的修復(fù)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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R783

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