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重度牙列磨耗在中老年人群中有较高的发生率,不同的调查表明其发生率在17%-33.59%间,严重影响患者的容貌、发音功能、咀嚼功能,因此有学者指出重度牙齿磨耗已成为继龋齿、牙周病之后的又一高发口腔疾病。咬合重建是一个序列治疗过程,一般要经过颌位调整阶段、过渡义齿及临时冠桥阶段、永久性义齿完成阶段。咬合板等传统方法在颌位调整及过渡阶段有诸多的不足:如异物感不便于患者接受,不利于后期分区法行固定方式咬合重建,此外有研究表明咬合板等修复体本身可加重牙列磨耗。近年来随着树脂粘接技术及复合树脂性能的改进,为牙列重度磨耗患者以复合树脂粘接咬合面过渡性地恢复垂直距离,进而完成咬合重建提供了有效手段。树脂粘接技术操作步骤不断简化,大大减少了临床操作时间,复合树脂粘结强度也极大提高。同时复合树脂材料性能显著改进,近年来应用于后牙牙合面修复的复合树脂其抗磨、耐压等综合性能不断得到提高,国内外临床应用证明其远期随访均有满意表现。本研究中以复合树脂粘结再造严重磨损的牙列咬合面;分次或一次粘结树脂恢复合适的垂直距离,重新建立正常的咬合关系,进而完成永久性修复。一次或分次升高咬合在3-6个月后,患者无不适主诉及不良体征即可开始永久性修复。本研究中采用分区法进行固定修复:如顺序为右后牙(上)→右后牙(下)→左后牙(上)→左后牙(下)→上前牙→下前牙。粘结树脂预增高咬合,然后行咬合重建修复,经临床应用表明树脂粘结可靠,其抗力及耐磨性能完全可满足在过渡修复期的要求。同时与传统方法比较,具有以下优点:无明显异物感,患者均较快适应及接受;符合生理状态,相比较临时冠桥便于口腔卫生的维护;便于颌平面及、颌位的确定;易于在口内调整树脂修复后的上下前牙切缘高度与上下唇的位置关系,恢复正常的笑线,为将来的永久性修复提供了参考和依据;利于分区法行固定方式咬合重建,重建的咬合关系更为准确。
Severe dentition wear in the elderly population have a higher incidence, different surveys show that the incidence of 17% -33.59%, seriously affecting the patient’s appearance, pronunciation, masticatory function, so some scholars have pointed out that severe dental wear Has become a caries, periodontal disease after another high incidence of oral diseases. Occlusal reconstruction is a sequence of treatment, generally go through the stage of jaw position adjustment, temporary denture and temporary crown bridge stage, permanent denture completion stage. Bite plate and other traditional methods in the jaw position adjustment and transition have many deficiencies: such as foreign body sensation is not easy for patients to accept, is not conducive to the late partition method of fixation occlusal reconstruction, in addition studies have shown that bite plates and other prostheses can aggravate dentition Wear. In recent years, with the improvement of the resin bonding technology and the composite resin performance, it is an effective way to restore the vertical distance to the composite resin bonding occlusal surface and to complete the occlusal reconstruction for patients with severe dentition wear. Resin bonding technology operation steps continue to simplify, greatly reducing the clinical operation time, composite resin bond strength is also greatly improved. At the same time, the properties of composite resin have been significantly improved. In recent years, the composite resin applied to the restoration of posterior teeth occlusal surface has been continuously improved in its wear resistance and pressure resistance. Clinical application at home and abroad has proved satisfactory in long-term follow-up. In this study, composite resin bonded to rebuild severely worn dentition occlusal surface; graded or a bond resin to restore the appropriate vertical distance, to re-establish the normal occlusal relationship, and then to complete a permanent repair. One or several times to raise the occlusion in 3-6 months, the patient without complaints and adverse physical symptoms can begin a permanent repair. In this study, the partition method for fixed repair: If the order of the right posterior teeth (upper) → right posterior teeth (lower) → left posterior teeth (upper) → left posterior teeth (lower) → upper anterior teeth → lower anterior teeth. Bonding resin pre-high bite, and then bite reconstruction repair, the clinical application of resin bonding reliable, its resistance and wear resistance can fully meet the requirements of the transitional rehabilitation period. Compared with the traditional method, it has the following advantages: no obvious foreign body sensation, patients are quickly adapted and accepted; in line with the physiological state, compared with the temporary crown bridge for oral hygiene to facilitate maintenance of jaw plane and jaw position determination; In the mouth, the relationship between the height of the upper and lower incisors and the position of the upper and lower lip after the resin restoration is restored, and the normal smile line is restored, which provides a reference and basis for the permanent repair in the future. It is beneficial to the occlusal reconstruction More accurate.