第四章 牙列缺损的固定局部义齿修复.ppt

* 华西朱智敏教授 20例单端固定桥567，追踪10年，效果良好。 建议： 桥体减径至2/3 改良鞍式 高度3mm 全颌种植义齿 游离端15mm 华西文献 单端桥桥体14mm Cantilever arm 10~20mm 复合固定桥/Compound fixed bridge 将两种或以上的简单固定桥组合在一起而构成。 多用于两个间隙的共同基牙时。 一般多为四个以上单位，有两个以上基牙，就位道比较困难时，其中一部分可设计为半固定桥。 Implant-supported fixed bridge Removable fixed bridge (套筒冠义齿/牙周夹板) Bonding fixed bridge （Maryland bridge） 诊断与治疗计划 检查诊断 一 病史 二 口腔检查 1. 口外检查 2. 口内检查： 一般检查，缺牙区情况，缺牙两侧余留牙情况，牙合 关系情况，其他牙情况 3. 研究模型 4.X-ray 检查 治疗计划 Dignosis and treatment planning Treatment planning should consider most of the following: 1. Diagnosis 2. Radiographs Caries-Interproximal Recurrent Periapical Lesions? Quality of Previous Endodontics Periodontal Health Alveolar Bone Levels Crown/Root Ratio 3. Diagnostic models/photographs, if necessary 4. Periodontal considerations should include: a. Minimal pocket depth b. Oral hygiene instructions c. Generalized good periodontal health d. Areas to be treated should be scaled thoroughly prior to bonding and veneering e. Any periodontal treatment anticipated should be completed prior to bonding and veneering 5. Caries incidence considerations: a. High caries – contraindication for veneers due to possibility of secondary caries b. Low caries – acceptable for treatment with veneers 6. Occlusion: Possible contraindications include bruxism, clenching, wear facets, fractured teeth,tooth mobility, temporomandibular joint dysfunction. If these contraindications are considered and acceptable treatment is applied, then the degree of contraindication is diminished. 7. Orthodontic considerations: It is to be understood that bonding and veneers are esthetic enhancements and not orthodontic treatment. Malocclusions remain malocclusion, but can be made more esthetic. The treatment of malocclusions should involve orthodontic therapy as indicated. 8. Treatment must be incorporated into the treatment plan in the appropriate sequence in relation to endodontic, periodontic, orth