全口义齿固位及稳定不良的临床分析
摘要
近年来，随着我国逐渐步入老年社会,无牙颌患者逐年增加，因为严重影响患者咀嚼功能，并影响面部外形，给患者带来了极大的痛苦，因此患者迫切要求修复。临床上我们常采用全口义齿来对无牙颌患者进行修复，良好的固位和稳定是获得全口义齿良好修复效果的关键，是修复的重点和难点，同时也是近年来人们所研究的方向。固位稳定不良可使患者在进食过程中咀嚼效率下降，失去了全口义齿修复的意义，给患者带来了极大的痛苦。要提高全口义齿的固位和稳定，除了患者需要耐心适应、练习以外，最主要需要医师仔细检查，尽量找出影响固位稳定的因素。
本文通过对全口义齿固位及稳定不良现象的临床分析，探讨提高全口义齿固位及稳定的方法。在我院2002.3～2004.3间行全口义齿修复，并出现固位及稳定不良现象的患者53例，其中初戴全口义齿32例，旧义齿21例，对其义齿固位稳定不良现象及检查结果进行回顾性分析，寻找出相应的改进方法。结果显示，初戴全口义齿出现固位及稳定不良的原因有患者自身
因素8例，占25.0%，咬合关系不平衡18例，占56.3%，技工室制作过程中的误差6例，占18.7%。旧全口义齿出现固位及稳定不良的原因主要是牙槽嵴进行性吸收，与义齿基托之间不密合。初戴全口义齿经过修改后临床效果得到了显著的改善，旧义齿修改前后临床效果提高不明显，必须重新制作或通过外科手术方法来改善。
从中我们可以得出结论，全口义齿的固位和稳定不良是临床上的一种常见现象，受多种因素的影响。
患者的心理因素和不良习惯对义齿的固位稳定影响很大，在修复之前要与患者进行沟通交流，帮助患者纠正不良的咬合习惯，尽快适应义齿。一些患者口腔解剖条件不好，给修复带来了极大困难，在修复之前要详细检查口腔情况，将骨突、骨刺以及较大的骨隆突手术去除，将增生的牙龈组织切除，作好准备工作。
全口义齿取模的要求较高，必须是口腔功能状态时的状况，以保证义齿在行使功能时仍保持良好的稳定性。牙槽嵴低平的患者采用二次印模法可取得较准确的印模。
全口义齿做正中、前伸、侧方咬合时必须多点接触，符合平衡牙合的要求。有早接触点时进行调磨，以建立较大的牙合型宽
容度。调牙合时要慎重，严格按照要求调磨，不要盲目操作，防止形成新的咬合不平衡。
旧义齿由于牙槽骨进行性吸收以及牙合面的磨耗，基托与粘膜之间不密合，患者面下1/3变短，通过软衬材料重衬可以使基托与粘膜之间密合，恢复垂直距离，固位有一定提高，但效果不显著。
由于所观察的临床病例有限，有些问题的看法可能有局限性，有些方面可能有所遗漏，仍需以后长期大量的临床观察。
Recently, along with our country come in the old age society gradually,the edentulous jaws patients are increasing year by year . Because it influentes the masticate function seriously、affects the face shape and brings tremendous of sufferings, the patients request to be repaired urgently. In the clinical,we often use complete dentures to repair the edentulous jaws.A better retension and stability is the key of getting a better repairing result of complete dentures, and also is the direction of people studying in recent years. In order to improve the retension and stability of complete dentures, it need the patients adapting and practicing apart from, mostly it need the doctor's careful check.Doctors should find out the factor of affecting the retension and the stability as far as possible.
In this paper, we analyze the phenomenon that the
complete dentures' retension and stability are bad, in order to study a method to improve the retension and stability of complete denture. In 2002.3～2004.3,we observed 53 patients who repaired the complete dentures in our hospital, and the dentures' retension and stability are bad,include 23 new dentures and 21 old dentures.We analyz the phenomenon that the complete dentures' retension and stability are bad,and look for the improved methods.
The result show, the reasons for complte dentures' retension and stability are bad include that the patients themselves factor 8 cases, occupy 25.0%,the occlude relations are unbalance 18 cases, occupy 56.3%，the manufacture error 6 cases，occupy 18.7%.In the old complete dentures,it mainly is the alveolar ridge are absorbing,there is a space in the alveolar ridge and the base plate.Through the repair,the new dentures’ clinical result have improved, the old dentures’ clinical result haven’t a obviously improvement,it must make a new one
or have a surgical operation.
From the paper,we can get a conclusion, the bad retension and stability of complete dentures is a familiar phenomenon in the clinic,it is influence by various factors.
The patients’ mental state factor and bad habit influence the retension and stability of complete dentures greatly.Before the repairing proceed,the doctors must communicate with patients, correct the patients’bad occlude habit,help patients adapt to the dentures as soon as. Some patients’oral anatomy is not good, and bring difficult to repair.Before the repair,doctors shoule examine the patients’oral circumstance detailly,do away with the apophysis ,torus and hyperplasia gingival, make the good preparation work.
In the complete dentures,taking impression has a higher request,it must be the condition of oral function to ensure the denture still keep the good stability when make a function.If the alveolar ridge is low and even,we
can take impression two times to get a accurate impression.
When complete denture make occlude,it must contect several spots,accord with the balance occlusion.The premature contact spots are grinded to establish the bigger occlusal latitude.The occlusal adjustment should be careful,accord to the request and prevent the new imbalance occlusion.
Because of the alveolar ridge are absorbing and the occlisal surface’ attrition,there is a space in the alveolar ridge and the old complete dentures’ base plate,the vertical dimension become shorter.We use the soft liner to reline the base plate to make it contact with alveolar ridge,and recovery the vertical dimension.The retension and stability have some improvement,but the effect is not notable.
Because of the clinical cases that we observe are limited,some viewpoints may be localization, some aspect may have the lapse, still need long-term and large quantity of clinical observational.
本文通过对全口义齿固位及稳定不良现象的临床分析，探讨提高全口义齿固位及稳定的方法。在我院2002.3～2004.3间行全口义齿修复，并出现固位及稳定不良现象的患者53例，其中初戴全口义齿32例，旧义齿21例，对其义齿固位稳定不良现象及检查结果进行回顾性分析，寻找出相应的改进方法。结果显示，初戴全口义齿出现固位及稳定不良的原因有患者自身
因素8例，占25.0%，咬合关系不平衡18例，占56.3%，技工室制作过程中的误差6例，占18.7%。旧全口义齿出现固位及稳定不良的原因主要是牙槽嵴进行性吸收，与义齿基托之间不密合。初戴全口义齿经过修改后临床效果得到了显著的改善，旧义齿修改前后临床效果提高不明显，必须重新制作或通过外科手术方法来改善。
从中我们可以得出结论，全口义齿的固位和稳定不良是临床上的一种常见现象，受多种因素的影响。
患者的心理因素和不良习惯对义齿的固位稳定影响很大，在修复之前要与患者进行沟通交流，帮助患者纠正不良的咬合习惯，尽快适应义齿。一些患者口腔解剖条件不好，给修复带来了极大困难，在修复之前要详细检查口腔情况，将骨突、骨刺以及较大的骨隆突手术去除，将增生的牙龈组织切除，作好准备工作。
全口义齿取模的要求较高，必须是口腔功能状态时的状况，以保证义齿在行使功能时仍保持良好的稳定性。牙槽嵴低平的患者采用二次印模法可取得较准确的印模。
全口义齿做正中、前伸、侧方咬合时必须多点接触，符合平衡牙合的要求。有早接触点时进行调磨，以建立较大的牙合型宽
容度。调牙合时要慎重，严格按照要求调磨，不要盲目操作，防止形成新的咬合不平衡。
旧义齿由于牙槽骨进行性吸收以及牙合面的磨耗，基托与粘膜之间不密合，患者面下1/3变短，通过软衬材料重衬可以使基托与粘膜之间密合，恢复垂直距离，固位有一定提高，但效果不显著。
由于所观察的临床病例有限，有些问题的看法可能有局限性，有些方面可能有所遗漏，仍需以后长期大量的临床观察。
Recently, along with our country come in the old age society gradually,the edentulous jaws patients are increasing year by year . Because it influentes the masticate function seriously、affects the face shape and brings tremendous of sufferings, the patients request to be repaired urgently. In the clinical,we often use complete dentures to repair the edentulous jaws.A better retension and stability is the key of getting a better repairing result of complete dentures, and also is the direction of people studying in recent years. In order to improve the retension and stability of complete dentures, it need the patients adapting and practicing apart from, mostly it need the doctor's careful check.Doctors should find out the factor of affecting the retension and the stability as far as possible.
In this paper, we analyze the phenomenon that the
complete dentures' retension and stability are bad, in order to study a method to improve the retension and stability of complete denture. In 2002.3～2004.3,we observed 53 patients who repaired the complete dentures in our hospital, and the dentures' retension and stability are bad,include 23 new dentures and 21 old dentures.We analyz the phenomenon that the complete dentures' retension and stability are bad,and look for the improved methods.
The result show, the reasons for complte dentures' retension and stability are bad include that the patients themselves factor 8 cases, occupy 25.0%,the occlude relations are unbalance 18 cases, occupy 56.3%，the manufacture error 6 cases，occupy 18.7%.In the old complete dentures,it mainly is the alveolar ridge are absorbing,there is a space in the alveolar ridge and the base plate.Through the repair,the new dentures’ clinical result have improved, the old dentures’ clinical result haven’t a obviously improvement,it must make a new one
or have a surgical operation.
From the paper,we can get a conclusion, the bad retension and stability of complete dentures is a familiar phenomenon in the clinic,it is influence by various factors.
The patients’ mental state factor and bad habit influence the retension and stability of complete dentures greatly.Before the repairing proceed,the doctors must communicate with patients, correct the patients’bad occlude habit,help patients adapt to the dentures as soon as. Some patients’oral anatomy is not good, and bring difficult to repair.Before the repair,doctors shoule examine the patients’oral circumstance detailly,do away with the apophysis ,torus and hyperplasia gingival, make the good preparation work.
In the complete dentures,taking impression has a higher request,it must be the condition of oral function to ensure the denture still keep the good stability when make a function.If the alveolar ridge is low and even,we
can take impression two times to get a accurate impression.
When complete denture make occlude,it must contect several spots,accord with the balance occlusion.The premature contact spots are grinded to establish the bigger occlusal latitude.The occlusal adjustment should be careful,accord to the request and prevent the new imbalance occlusion.
Because of the alveolar ridge are absorbing and the occlisal surface’ attrition,there is a space in the alveolar ridge and the old complete dentures’ base plate,the vertical dimension become shorter.We use the soft liner to reline the base plate to make it contact with alveolar ridge,and recovery the vertical dimension.The retension and stability have some improvement,but the effect is not notable.
Because of the clinical cases that we observe are limited,some viewpoints may be localization, some aspect may have the lapse, still need long-term and large quantity of clinical observational.
引文
徐君伍，主编.口腔修复学.第4版.人民卫生出版社，2001.147
胡燕萍.无牙颌粘膜的特性.国外医学口腔医学分册，1993；20：159
Atwool DA. Reduction of residual ridge: a major oral disease entity. J Prosthet Dent, 1971,26:266～279
Cawood JI, Howell RH. A classification of the edentulous jaws. Int J Oral Maxillofac Surg, 1988,17:232～236
Macgregor AR, Watt ME, Brown J. Vertical dimension in edentulous patients J Dent,1984;12(4):287
Van Willigen JD, Rashbass C, Melchior H J.“Byteryte”, an apparatus for the determination of the preferred vertical dimension of occlusion required for the construction of complete denture prosthesis. J oral Rehabil,1985;12:23
Munakata Y, Kasal S. Determination of occlusal Vertical dimension by means of controlled pressure against tissues supporting a complete denture. J Oral Rehabil, 1990;17:145
Gamon JA, Wright SM. Perception of vertical dimension. J Oral Rehabil,1982;9:307
徐君伍，主编.口腔修复理论与临床.第1版.北京：人民卫生出版社，1999.173
10.Geering All, Kundert M, Kelsey CC. Complete denture and overdenture prosthetics. Stuttgart: Georg Thiem Verlag, 1993.90～98
11.徐军.疑难总义齿修复的牙合学要点.中华口腔医学杂志，2002；37（1）：72～74
12.Frush JP.Lineal occlusion.Ill Dent J,1966,35:788～794
13.Jones PM. The monoplane occlusion for complete dentures.J Am Dent Assoc,1972,85:94～100
14.Geering AH,Kundert M,Kelsey CC.Complete denture and overdenture prosthetics.Stuttgart:Georg Thiem Verlag,1993.90～98
15.程祥荣，黄洪章，等.磁附着体种植全口义齿的初步临床应用.口腔医学纵横杂志，1994；10（2）：70～72
16.董研，骆小平，王雅北，等.人工牙排列对下颌全口义齿固位及支持组织的影响.华西口腔医学杂志，1997；15（4）：308～311
17.孙杰，乔瑞科，王丽，等.对不同磨光面外形的全口义齿咀嚼效能的测定和分析.临床口腔医学杂志，2001；17（1）：24
18.Hatijigiorgis GG, Grisius RJ, Fenster RK, et al. J Prosthet Dent 1987;57(3):354～358
19.肖平.分段取蜡牙合记录确定全口义齿正中关系位.口腔颌面修复学杂志，2001；2（1）：29
20.Heartwell CM and Rahn AO. Syllabus of complete dentures. 3rd ed. Philadelphia: Lea and Febiger,1980:351
21.王雅北，郭天文，等.总义齿排牙的有关问题.无牙颌修复学术会议论文集，西安：第四军医大学口腔系，1987：35
22.徐军.疑难总义齿修复的牙合学要点.中华口腔医学杂志，2002；37（1）：72～74
胡燕萍.无牙颌粘膜的特性.国外医学口腔医学分册，1993；20：159
Atwool DA. Reduction of residual ridge: a major oral disease entity. J Prosthet Dent, 1971,26:266～279
Cawood JI, Howell RH. A classification of the edentulous jaws. Int J Oral Maxillofac Surg, 1988,17:232～236
Macgregor AR, Watt ME, Brown J. Vertical dimension in edentulous patients J Dent,1984;12(4):287
Van Willigen JD, Rashbass C, Melchior H J.“Byteryte”, an apparatus for the determination of the preferred vertical dimension of occlusion required for the construction of complete denture prosthesis. J oral Rehabil,1985;12:23
Munakata Y, Kasal S. Determination of occlusal Vertical dimension by means of controlled pressure against tissues supporting a complete denture. J Oral Rehabil, 1990;17:145
Gamon JA, Wright SM. Perception of vertical dimension. J Oral Rehabil,1982;9:307
徐君伍，主编.口腔修复理论与临床.第1版.北京：人民卫生出版社，1999.173
10.Geering All, Kundert M, Kelsey CC. Complete denture and overdenture prosthetics. Stuttgart: Georg Thiem Verlag, 1993.90～98
11.徐军.疑难总义齿修复的牙合学要点.中华口腔医学杂志，2002；37（1）：72～74
12.Frush JP.Lineal occlusion.Ill Dent J,1966,35:788～794
13.Jones PM. The monoplane occlusion for complete dentures.J Am Dent Assoc,1972,85:94～100
14.Geering AH,Kundert M,Kelsey CC.Complete denture and overdenture prosthetics.Stuttgart:Georg Thiem Verlag,1993.90～98
15.程祥荣，黄洪章，等.磁附着体种植全口义齿的初步临床应用.口腔医学纵横杂志，1994；10（2）：70～72
16.董研，骆小平，王雅北，等.人工牙排列对下颌全口义齿固位及支持组织的影响.华西口腔医学杂志，1997；15（4）：308～311
17.孙杰，乔瑞科，王丽，等.对不同磨光面外形的全口义齿咀嚼效能的测定和分析.临床口腔医学杂志，2001；17（1）：24
18.Hatijigiorgis GG, Grisius RJ, Fenster RK, et al. J Prosthet Dent 1987;57(3):354～358
19.肖平.分段取蜡牙合记录确定全口义齿正中关系位.口腔颌面修复学杂志，2001；2（1）：29
20.Heartwell CM and Rahn AO. Syllabus of complete dentures. 3rd ed. Philadelphia: Lea and Febiger,1980:351
21.王雅北，郭天文，等.总义齿排牙的有关问题.无牙颌修复学术会议论文集，西安：第四军医大学口腔系，1987：35
22.徐军.疑难总义齿修复的牙合学要点.中华口腔医学杂志，2002；37（1）：72～74