【作者】 郭英；

【导师】 王伟；

【作者基本信息】 吉林大学 ， 口腔临床医学， 2004， 硕士

【摘要】 游离端缺失在临床上较为常见，也是修复的重点和难点，多采用可摘局部义齿修复。一付合格的游离端可摘局部义齿要配戴舒适，恢复患者的面部美观、发音，还要获得良好的咀嚼功能。由于其缺牙的部位位于后牙，应承担绝大部分的咀嚼压力，远中缺少可支持义齿的天然牙，其义齿支持形式应为余留健康基牙和剩余牙槽嵴粘膜共同支持。而两者组织差异大，基牙提供了相对稳定的支持，而牙槽嵴粘膜具有较大的可让性，在口腔功能状态下受力后，二者产生的移动性大小不一。这使义齿在行使功能时容易发生旋转、下沉等不稳定现象，易对基牙产生不利的扭力，牙槽嵴所受应力分布不均，引起基牙松动，牙槽嵴不均匀吸收，或二者互相促进形成恶性循环，导致基牙松动脱落，修复失败。可摘局部义齿（The removable partial denture ,RPD）是一种价格低廉，形式灵活的可逆的治疗方法，适用于任何年龄的失牙病人。RPD的目的在于恢复患者的咀嚼功能，改善美观，保存余留牙及牙周组织。游离端缺失可摘局部义齿修复是临床较常见和较复杂的牙列缺损修复类型，与基牙支持式RPD相比，游离<WP=43>端缺失RPD存在着一些特殊的问题，如作用于基牙的扭力矩，义齿基托与基牙负重的差异等，临床常见戴牙后远中基牙创伤及牙槽嵴粘膜压痛。因此如何保证患者戴用的义齿在行使功能中舒适稳定、固位良好、有利于周围软硬组织的健康，一直为国内外口腔修复工作者研究探讨的重要课题之一。 在游离端可摘局部义齿初戴及使用中经常出现疼痛现象，严重影响了义齿的使用。要减少疼痛现象的产生，需在修复前检查到义齿完成的每一个环节力求科学、准确。游离端缺失的可摘局部义齿的设计具有高度的科学性，应该充分考虑义齿功能状态时，牙合力的大小及口腔内组织的承受能力。尽量使牙合力在软硬组织上均匀分布，使基牙免受扭力作用。义齿固位良好也是避免戴用后出现疼痛的必要条件。 为了探讨游离端可摘局部义齿初戴及使用中出现疼痛的部位特点及原因，分析总结规律，以减少、避免临床中游离端可摘局部义齿使用后疼痛现象的产生。本临床回顾性研究收集82例行游离端可摘局部义齿修复的病例，其中40例为旧义齿出现疼痛而无法继续使用，检查分析其疼痛产生的部位及原因。42例患者为初诊要求修复。经过修复前的常规检查和处理，针对不同患者的口腔状况及牙列缺损情<WP=44>况，设计制作义齿，试戴82例新制作的游离端可摘局部义齿。统计试戴及使用中出现疼痛的部位特点，分析原因，经过调磨、调牙合及缓冲等处理，使义齿配戴舒适并可以正常行使功能。　　发现40例因旧义齿出现疼痛而无法继续使用的游离端缺失的患者中，弯制的活动义齿占90%。因义齿固位稳定不良造成的疼痛约占总数的67.5%，个别基牙出现松动、疼痛的约占22.5%。试戴82例新制游离端可摘局部义齿，其中74例出现试戴过程中的不同部位，不同程度的疼痛症状。义齿基托边缘前庭沟出现疼痛占总数的38.2%，咬合功能时牙槽嵴区处出现疼痛占总数的25.8%，牙槽嵴区骨尖骨突处及骨性硬区处出现疼痛占总数的15.7%，放置固位体的基牙有疼痛现象的占总数的17.9%，其他部位约占2.2%。 经统计学分析得出结论，游离端可摘局部义齿试戴及戴用中出现疼痛的现象比较多见，疼痛部位较多。在义齿修复前的口腔检查和修复前的预备工作非常重要，应在口腔软硬组织状况良好，不存在影响义齿修复的情况时进行修复工作。游离端缺失的可摘局部义齿的设计具有高度的科学性，应该充分考虑义齿功能状态时，牙合力的大小及口腔内组织的承受能力。尽量使牙合力在软硬组织上均匀分布，使基牙免受扭力作用。义齿固位良好也是<WP=45>避免戴用后出现疼痛的必要条件。游离端可摘局部义齿修复时取模，必须是患者口腔功能状态时的情况。以保证咀嚼时义齿基托始终与口腔粘膜密合，义齿稳定性良好。义齿技工室制作的每一步都需精确无误，否则制作的义齿戴用时调改的部位次数增加。要减少疼痛现象的产生，需在修复前检查到义齿完成的每一个环节力求科学、准确。更多还原

【Abstract】 Deletion of the free end is common in clinic, and it is the focal point and hard point. It may be restored by removable partial denture. A pair of qualified removable partial denture must be comfort, can recover the facial beautiful outlook and vocalization, and obtain the satisfactory mastication function.The removable partial denture must be supported by the surplus base teeth and alveolar ridge mucous membrane, because the distal locus lack the nature teeth and shoulder the big partial of mastication pressure.However, the surplus base teeth and alveolar ridge mucous membrane are different,the base teeth provide the relative resistant support; the alveolar ridge mucous membrane posses the fairly big alienability; when they suffer the power in oral cavity functional status. Their movement are different. The denture will happen the conbolution and the sink, and they will yield the torsion. <WP=47>Because the alveolar ridge mucous membrane support unequal power, it will cause the basis teeth loose and the alveolar ridge absorption, and the two accelerate each other to yield the vicious cycle, and they will cause the basis teeth loose and shedding. The removable partial denture is a excellent cure method with price cheap, the style active and removable, and it serve for the lose teeth patient with any age. The removable partial denture can recover the facial beautiful outlook and vocalization, obtain the satisfactory mastication function, and preserve the lose teeth and periodontal tissues. However the removable partial denture suffer the power in oral cavity functional status, Their movement are different. The denture will happen the buckling and the sink, and they will yield the torsion. In the clinic the distal basis teeth trauma and the alveolar ridge mucous membrane tenderness is common. So The question that the denture is comfort and stable,and the profitable the soft and hard tissue’s health , is the important topic in the <WP=48>prosthodontic field.The pain phenomenon is common in the period of the denture initial ware and usage, they effect the use of the denture. For decreasing the pain phenomena, every link must science and accurate in the period of the denture restore.The removable partial denture of the free and design posses the high science. We must think about the jaw force and the bear ability of the oral cavity tissue when the denture exercise the function.The jaw force should distribution well-distributed on the soft and hard tissue, the basis teeth will avoid the mis-storsion. The excellent retention of the denture is the necessary condition to avoid the pain.To investigate the characteristic and reason of the pain locus when the denture exercise the function, and avoid the production the pain phenomena after the removable partial denture is used. In our clinical retrospective study, we collect 82 cases that are restored by the removable partial denture of the <WP=49>free end. 40 patients’ old denture can’t use again. 42 patients is preliminary diagnosis. By the routine examination and treatment, to aim directly at the oral cavity status and the condition of the dentition defect. We design and fabricate the removable partial denture of the 82 cases, then try-in. We statistics the locus characteristic of the pain,and analysis the reason. By adjust and milling , amortization and so on, they make the denture comfort and exercise the normal function.In 40 cases that the denture can’t continue to use because of the ache, The curvature removable partial denture occupy to 90%. Because of the retention stabilizing. The patients with the ache occupy to 67.5 %. Because of the basis teeth mobility, the patients with the ache occupy to 22.5 %. The new removable partial of denture 82 cases is tried on, 74 cases patients present on the different locus and degree ache in the period of the try-in. The ache patients in the vestibular groove of the margin of the denture’s base occupy to 38.2%. The ache patients in the <WP=50>alveolar ridge crest when they bite occupy to 25.8%.更多还原