prosthodontics

口腔修复
  • 文章类型: Journal Article
    牙髓治疗牙齿的修复(ETT)仍然是现代牙科的重大挑战。由于牙髓手术的原始病理学和侵入性,这些牙齿通常会遭受严重的结构损伤。因此,与活牙相比,ETT更容易骨折,需要恢复性策略,可以有效地恢复功能和美学,同时最大程度地减少失败的风险。近年来,粘合剂牙科的进步和高强度陶瓷的发展进一步扩大了ETT的修复选择。由于结合修复体保留了更多的牙齿结构并增强了牙齿修复体的整体强度,因此受到了欢迎。修复材料和技术的选择受多种因素的影响,包括剩余牙齿结构的数量,牙齿的功能要求,和病人的审美要求。尽管有大量可用的材料和技术,恢复ETT的最佳方法仍然是一个正在进行的研究和辩论的话题。在这次全面审查中,探讨了修复经牙髓治疗的受损牙齿的现状和最新进展。存在许多治疗选择,涉及广泛的材料。本文旨在介绍过去十年的生物材料进展及其应用,提供治疗受损ETT的替代方法,目的是延长其在牙弓上的保留时间,并为每天面临此问题的牙科医生提供宝贵的资源。
    The restoration of endodontically treated teeth (ETT) remains a significant challenge in modern dentistry. These teeth often suffer from substantial structural damage due to both the original pathology and the invasive nature of endodontic procedures. Consequently, ETT are more susceptible to fractures compared to vital teeth, necessitating restorative strategies that can effectively restore both function and aesthetics while minimizing the risk of failure. In recent years, advances in adhesive dentistry and the development of high-strength ceramics have further expanded the restorative options for ETT. Bonded restorations have gained popularity as they preserve more tooth structure and enhance the overall strenght of the tooth-restoration complex. The choice of restorative material and technique is influenced by numerous factors, including the amount of remaining tooth structure, the functional requirements of the tooth, and the aesthetic demands of the patient. Despite the plethora of available materials and techniques, the optimal approach to restoring ETT remains a topic of ongoing research and debate. In this comprehensive review, the current state of and recent advances in restoring damaged endodontically treated teeth are explored. Numerous therapeutic options exist, involving a wide range of materials. This article aims to present the biomaterial advancements of the past decade and their applications, offering alternative approaches to treating damaged ETT with the goal of prolonging their retention on the dental arch and serving as a valuable resource for dental practitioners who face this issue daily.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    背景:残余牙脊吸收在修复治疗中存在障碍,影响义齿稳定性和牙种植体的成功。遗传因子,特别是缺氧诱导因子1亚基α(HIF-1α)基因内的单核苷酸多态性(SNP)1772C>T变异,被假设为有助于残余脊吸收进展。然而,其影响仍未得到充分调查,特别是在南印度人口的背景下。我们试图调查SNP1772C>T与完全无牙个体中残余脊吸收(RRR)之间的联系,考虑到人口因素,基因分型方法,和统计评估。
    方法:在一项前瞻性病例对照研究中,我们从印度南部招募了100名完全无牙的参与者.参与者根据牙槽脊高度进行分类。非侵入性收集唾液样本进行DNA提取,和聚合酶链反应限制性片段长度多态性(PCR-RFLP)分析用于确定使用HphI限制性内切酶的基因型分布。统计评价包括卡方检验和Fisher精确检验。
    结果:我们观察到病例组和对照组之间基因型分布没有显著差异(CT:p=0.24;CC:p=0.65;TT:p=0.30)。杂合基因型CT在两组中普遍存在。
    结论:尽管我们没有观察到SNP1772C>T和RRR之间的显著关联,我们的发现暗示了残余脊吸收的遗传易感性,值得进一步探索。不同种族的遗传易感性变化以及其他遗传变异对残留脊吸收的影响需要进一步研究。这项研究通过强调遗传分析在常规牙科实践中改善治疗策略的潜力,为个性化修复护理奠定了基础。
    BACKGROUND: Residual ridge resorption presents obstacles in prosthodontic treatment, affecting denture stability and the success of dental implants. Genetic elements, specifically the single nucleotide polymorphism (SNP) 1772C>T variant within the hypoxia-inducible factor 1 subunit alpha (HIF-1α) gene, are hypothesized to contribute to residual ridge resorption progression. Nevertheless, its impact remains insufficiently investigated, especially within the context of South Indian populations. We sought to investigate the connection between SNP 1772C>T and residual ridge resorption (RRR) among fully edentulous individuals, considering demographic factors, genotyping methodologies, and statistical evaluations.
    METHODS: In a prospective case-control study, we recruited 100 completely edentulous participants from South India. Participants were categorized based on alveolar ridge height. Saliva samples were non-invasively collected for DNA extraction, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was employed to determine genotype distribution using the HphI restriction enzyme. The statistical evaluations comprised the utilization of chi-square and Fisher\'s exact tests.
    RESULTS: We observed no significant variations in genotype distributions between the case and control cohorts (CT: p=0.24; CC: p=0.65; TT: p=0.30). The heterozygous genotype CT was prevalent in both groups.
    CONCLUSIONS: Although we did not observe significant associations between SNP 1772C>T and RRR, our findings imply a genetic predisposition to residual ridge resorption that warrants further exploration. Variations in genetic susceptibility across ethnicities and the influence of other genetic variants on residual ridge resorption require additional investigation. This study lays the groundwork for personalized prosthodontic care by highlighting the potential of genetic analysis in routine dental practice to improve treatment strategies.
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  • 文章类型: Journal Article
    目的:评估上颌切牙的2D和3D自然对称性。
    方法:对59名年轻的成年志愿者进行上颌藻酸盐印模。性别,正畸治疗史,并收集了优势手。对于2D分析,使用数字卡尺测量上颌铸模。对于3D分析,使用实验室扫描仪扫描铸件,并评价对侧切牙唇面对称性。进行了曼-惠特尼测验和学生t检验,α=0.05。
    结果:结果表明对侧中切牙或侧切牙之间缺乏相同的长度,具有最小的相同宽度测量值。68%的中切牙和73%的侧切牙显示长度差异超过0.2毫米。中切牙在宽度上比侧切牙表现出更多的相似性,61%的中切牙和47%的侧切牙在0.2毫米以下有差异。高度不对称的对侧牙齿之间的差异位于过渡线上。性二态的影响,正畸因素,而主手在门牙对称性上无统计学意义。
    结论:天然上颌切牙的2D和3D对称性很少见。3D对称性在正畸治疗状态中保持一致,性别,和支配的手,表明它独立于这些参数。
    结论:为了实现自然和美观的微笑康复,必须很好地理解上颌切牙的对称性。在我们的研究中,上颌切牙的2D和3D对称很少发生,但是中切牙在宽度上比侧切牙更相似,在0.2毫米的差异。另一方面,高度不对称的对侧牙齿之间的差异位于过渡线。这些结论应包含在进一步的计算机辅助三维微笑设计中。
    OBJECTIVE: To assess the 2D and 3D natural symmetry of the maxillary incisors.
    METHODS: Maxillary alginate impressions were taken of 59 young adult volunteers. Gender, orthodontic treatment history, and dominant hand were collected. For 2D analysis, a digital caliper was used for measurements on maxillary casts. For 3D analysis, the casts were scanned using a lab scanner, and the labial surface symmetry of contralateral incisors was evaluated. Mann-Whitney tests and Student\'s t-test were performed, α = 0.05.
    RESULTS: Results indicated a lack of identical lengths among contralateral central or lateral incisors, with minimal occurrences of identical width measurements. 68% of central incisors and 73% of lateral incisors showed differences in length exceeding 0.2 mm. Central incisors showed more similarities than lateral incisors in width, with 61% central incisors and 47% lateral incisors having differences under 0.2 mm. The differences between highly asymmetrical contralateral teeth are situated at the transitional lines. The influence of sexual dimorphism, orthodontic factors, and the dominant hand on incisors\' symmetry was not statistically significant.
    CONCLUSIONS: 2D and 3D symmetry of the natural maxillary incisors are rare. 3D symmetry remains consistent across orthodontic treatment status, gender, and dominant hand, suggesting its independence from such parameters.
    CONCLUSIONS: To achieve a natural and aesthetic smile rehabilitation, the symmetry of the maxillary incisors must be well understood. In our study, 2D and 3D symmetry of the maxillary incisors occurred rarely, but central incisors showed more similarities than lateral incisors in width, with differences under 0.2 mm. On the other hand, differences between highly asymmetrical contralateral teeth are situated at the transitional lines. These conclusions should be included in further computer-assisted three-dimensional smile designs.
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  • DOI:
    文章类型: Journal Article
    目的:本研究的目的是描述一种完全引导的骨植入手术和假体复位的内部方案。
    方法:在1例患者中放置了4个腋外颧牙种植体(ZIs)。术前阶段包括数字计划,通过它设计和创建了一个手术指南。通过CBCT将数字计划与最终的术后植入物定位叠加,对引导手术和引导假体重新定位的准确性进行了分析。放射学评估包括植入物角度偏差,入口和出口偏差,平台偏差,和先端顶冠状和近端偏斜。假体评估在三个方向上进行:颊部,顶冠状,和远端。
    结果:所有ZIs在3个月的愈合后都成功骨整合,没有并发症。植入物的平均轴向角度偏差为0.52±0.36度,平均植入深度偏差为0.47±0.28mm。植入物的入口和出口偏差为0.74±0.42mm和0.7±0.43mm,分别。将虚拟假体叠加,并与第一磨牙和中切牙水平的临时聚甲基丙烯酸甲酯假体的标准镶嵌语言文件进行比较;平均颊侧偏差为0.6±0.035mm,平均顶冠部偏差为0.65±0.11mm,平均近端偏离为0.3±0.07mm。
    结论:根据本病例系列的第一个病例获得的结果,根据正确的假体参数进行细致细致的数字规划,可以安全地指导手术的执行。
    The present study aims to describe an in-house protocol for fully guided zygomatic implant surgery and prosthesis repositioning.
    Four extramaxillary zygomatic dental implants (ZIs) were placed in one patient. The preoperative phase included digital planning, through which a surgical guide was designed and created. The analysis of the accuracy of guided surgery and the guided prosthesis repositioning was carried out by superimposing the digital planning with the final postsurgical implant positioning through CBCT. The radiologic evaluation included implant angular deviation, entrance and exit deviation, platform deviation, and apex apicocoronal and mesiodistal deviation. The prosthetic evaluation was performed in three directions: buccopalatal, apicocoronal, and mesiodistal.
    All the ZIs successfully osseointegrated after 3 months of healing, with no complications. The mean axial angular implant deviation was 0.52 ± 0.36 degrees, and the mean implant depth deviation was 0.47 ± 0.28 mm. The entrance and exit deviation of the implants was 0.74 ± 0.42 mm and 0.7 ± 0.43 mm, respectively. The virtual prosthesis was superimposed and compared with the standard tessellation language file of the provisional polymethyl methacrylate prosthesis at the level of the first molars and central incisors; the mean buccopalatal deviation was 0.6 ± 0.035 mm, the mean apicocoronal deviation was 0.65 ± 0.11 mm, and the mean mesiodistal deviation was 0.3 ± 0.07 mm.
    According to the results obtained in this first case of the present case series, careful and meticulous digital planning based on the correct prosthetic parameters can safely guide the performance of surgery.
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  • DOI:
    文章类型: Journal Article
    数字技术在牙科领域逐渐普及。特别是,用口内扫描仪进行印象变得越来越常规;然而,即使在这之前也必须经常使用收缩绳。本文提出了一种创新的技术,可以使用印模材料代替收缩绳的临时修复物记录自然牙基牙的数字印象。在实验室里,使用计算机辅助设计,技术人员可以分割临时修复体的内表面,并用它来替换口内扫描的基台,从而获得准确的应对方法,从而获得有关制剂的牙龈上和血管内表面的更详细信息。
    Digital technologies are gradually gaining ground in dentistry. In particular, taking impressions with intraoral scanners is becoming routine; however, even this must often be preceded by the use of retraction cords. This article presents an innovative technique to record digital impressions of natural tooth abutments using interim restorations relined with impression material instead of retraction cords. In the laboratory, using computer-aided design, the technician can segment the internal surface of the interim restoration and use it to replace the abutment of the intraoral scan, thus obtaining an accurate coping that yields more detailed information about the supragingival and intrasulcular surface of the preparation.
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  • 文章类型: Journal Article
    生物标志物可以帮助确定全口义齿的成功。较少研究评估无牙患者的生物标志物。这可以帮助为无牙患者规划更好的定性护理。这项研究比较了一氧化氮(NO)的含量,全口义齿患者义齿插入前后的唾液α淀粉酶(SAA)和硫代巴比妥酸反应性物质(TBARS)。
    该研究涉及25名无牙患者。唾液样本是从患者之前获得的,1h,和插入义齿后1周。样品管理遵循标准化程序,运输和储存。研究因生物标志物而异。SAA通过酶测定来估计。通过Griess反应评估脂质过氧化和NO的TBARS。将获得的数据列表并进行统计分析。
    结果显示义齿插入前后标记水平的变化。插入义齿后,SAA的平均水平从8.26±1.32nm/ml降至3.44±1.25nm/ml。插入义齿后TBARS和NO的平均值增加至14.33±4.72nm/ml和NO22.92±5.79ng/ml。结果具有统计学意义,p<0.05。
    该研究得出结论,义齿插入降低了心理应激标记(SAA)的水平,并增加了氧化应激标记(TBARS,NO).
    UNASSIGNED: Biomarkers can aid in determining the success of complete denture. Fewer studies evaluated the biomarkers in edentulous patients. This can aid in planning of better qualitative care for edentulous patients. The study compared the quantities of nitric oxide (NO), salivary alpha amylase (SAA) and thiobarbituric acid reactive substances (TBARS) before and after denture insertion in complete denture patients.
    UNASSIGNED: The study involved 25 edentulous patients. The saliva samples were obtained from patients prior, 1 h, and 1 week after denture insertion. Standardized procedure was followed in sample management, transportation and storing. The investigations varied with the biomarkers. SAA was estimated by enzymatic assay. TBARS by lipid peroxidation and NO was assessed by Griess reaction. The obtained data were tabled and statistically analyzed.
    UNASSIGNED: The results displayed variation in the level of markers between before and after denture insertion. The mean levels of SAA decreased from 8.26 ± 1.32 nm/ml to 3.44 ± 1.25 nm/ml in following denture insertion. The mean of TBARS and NO increased after denture insertion to 14.33 ± 4.72 nm/ml and NO 22.92 ± 5.79 ng/ml. The results were statistically significant with p < 0.05.
    UNASSIGNED: The study concluded that denture insertion decreased the levels of psychological stress marker (SAA) and increased the Oxidative stress marker (TBARS, NO).
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  • 文章类型: Journal Article
    三维(3D)打印技术已导致口腔修复的转变。这篇综述总结了这一演变,加工技术,材料,数字计划的整合,挑战,3D打印在口腔修复中的临床应用及未来发展方向。从3D打印的推出到其在口腔修复中的当前应用,它进行了评估。印刷技术与数字牙科的融合促进了准确,定制假肢,重新定义治疗计划,设计,和制造工艺。该技术的发展是从生成模型到类似假体的固定假牙(FDP),植入物,和夹板。此外,它表现出更广泛的能力。3D打印材料的探索提供了各种选择,如聚合物,陶瓷,金属,和杂种,每种都具有适用于不同临床情况的独特特性。3D打印技术和数字工作流程的结合简化了数据传输的过程,计算机辅助设计(CAD)设计制造,减少错误和坐在椅子上的时间。临床益处包括提高准确性,comfort,保守的实验室程序,和经济学。该技术的挑战涉及诸如初始投资之类的重要方面,材料可用性,和技能要求。未来趋势强调对改进材料的研究,生物打印整合,人工智能(AI)应用,正规化努力,以确保该技术的安全和通用使用。3D打印为口腔修复提供了希望,通过研究应对挑战。材料的改进将促进其更广泛的采用,并彻底改变牙科康复的未来。
    The three-dimensional (3D) printing technology has led to transformative shift in prosthodontics. This review summarizes the evolution, processing techniques, materials, integration of digital plan, challenges, clinical applications and future directions of 3D printing in prosthodontics. It appraises from the launch of 3D printing to its current applications in prosthodontics. The convergence of printing technology with digital dentistry has facilitated the creation of accurate, customized prostheses, redefining treatment planning, design, and manufacturing processes. The progression of this technology is from generating models to prosthesis like-fixed dental prosthesis (FDP), implants, and splints. Additionally, it exhibits more wide capabilities. The exploration of materials for 3D printing provides various options like polymers, ceramics, metals, and hybrids, each with distinctive properties that are applicable to different clinical scenarios. The combination of 3D-printing technology and digital workflow simplifies the processes of data transfer, computer-aided design (CAD) design to fabrication, decreasing errors and chairside time. The clinical benefits include enhanced accuracy, comfort, conservative lab procedures, and economics. Challenges in the technology involve significant aspects like initial investment, material availability, and skill requirements. Future trends emphasize on research for improved materials, bioprinting integration, artificial intelligence (AI) application, regularization efforts to ensure safe and common use of the technology. 3D printing offers promise in prosthodontics, addressing challenges through research. The material improvements will promote its broader adoption and revolutionize the future of dental rehabilitation.
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  • 文章类型: Journal Article
    目的:这项为期2年的前瞻性研究报告了使用四个微型种植体保留的下颌覆盖义齿治疗后修复并发症和维护事件的发生率。
    方法:种植体干预包括无瓣或拍打手术,同时立即或延迟负重,作为随机临床试验的一部分。插入四个一体式钛锆微型植入物(Straumann微型植入物系统),并使用椅旁程序将保留性PEEK元素(Optiloc)结合到覆盖义齿中。在2年的随访中记录了口腔修复并发症和维护事件,根据标准化标准定义最终结局.数据分析包括描述性统计,发病率和发病率密度率,和Kaplan-Meier的生存.
    结果:74例患者中有73例(64.9%为女性),平均年龄64岁(SD=8.2),完成了研究随访(其中一个在9个月后退出).植入物存活率为100%。共发生163例口腔修复事件53例(72.6%),20例患者无临床主诉或维持需求.最常见的手术是调整/修复覆盖义齿基托(47.0%),保留插入件的更换(19.8%),和实验室换层(12.9%)。达到了较高的修复成功率(93.2%),所有患者都提供了可使用的覆盖义齿,并在修复并发症解决后继续使用。第一年基质置换和实验室反应的发生率很低,虽然义齿基托调整在第一年很常见,尤其是前6个月。
    结论:微型种植体系统显示出较高的修复成功率。初始随访期间的小调整/修理是常见的。在使用覆盖义齿一年后,往往会发生换牙和基质置换,由于需要重新衬砌,可能会发生矩阵替换。
    OBJECTIVE: This 2-year prospective study reports the incidence of prosthetic complications and maintenance events after treatment with mandibular overdenture retained by four mini implants opposed to a maxillary denture.
    METHODS: Implant intervention included flapless or flapped surgery combined with immediate or delayed loading, as part of a randomized clinical trial. Four one-piece titanium-zirconium mini-implants (Straumann Mini Implant System) were inserted, and the retentive PEEK elements (Optiloc) were incorporated into the overdenture using chairside procedures. Prosthodontic complications and maintenance events were recorded over a 2-year follow-up, and the final outcome was defined according to standardized criteria. Data analysis included descriptive statistics, incidence and incidence density rates, and Kaplan-Meier survival.
    RESULTS: 73 out of 74 patients (64.9 % female), mean age of 64 (SD=8.2) years, completed the study follow-up (one withdrew after 9 months). Implant survival was 100 %. A total of 163 prosthodontic events occurred in 53 patients (72.6 %), and 20 patients had no clinical complaints or maintenance needs. The most common procedures were adjustment/repair of the overdenture base (47.0 %), replacement of retentive inserts (19.8 %), and laboratory relining (12.9 %). A high prosthodontic success rate was achieved (93.2 %), and all patients presented serviceable overdentures and continuous use after the resolution of prosthodontic complications. The incidences of matrix replacement and laboratory relines were low in the first year, while denture base adjustments were common within the first year, especially in the first 6 months.
    CONCLUSIONS: The mini implant system showed high prosthodontic success rates. Minor adjustments/repairs during the initial follow-up were common. Relines and matrix replacements tend to occur after one year of overdenture use, and matrix replacements may occur as a consequence of the need for relining.
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  • 文章类型: Journal Article
    背景:由于牙科实践的快速变化,近年来,数字技术在德国大学的本科牙科教育中变得突出。这种转变促使对内容和教学方法进行重新评估,特别是在学生为患者治疗做好准备的课程中。使用树脂牙齿的标准化模型的传统训练无法涵盖患者情况下遇到的单个牙弓配置的复杂性。这项研究探讨了使用3D打印技术来创建用于假肢治疗模拟的个性化模型,旨在评估学生对他们在此培训环境中的体验的反馈。
    方法:首先,该研究描述了基于口内扫描的可交换牙齿的个性化模型的设计和制造,安装在连接板的距离持有人,可以固定到标准的幻影头。第二,学生通过问卷提供反馈,评估各个方面,例如3D打印模型与传统frasaco模型相比的有效性,以进行准备练习。
    结果:结果表明,实现的模型的设计对于准备训练是可行的(问题号4:93%的积极评价),并显示出对3D打印模型的积极看法,学生发现它们对准备练习有效,并有利于弥合模拟和真实患者情况之间的差距(问题号6:69%的正面评价)。
    结论:研究表明,3D打印技术为牙科教育提供了一个有价值的工具,为学生提供现实和患者特定的场景,以提高他们的技能和临床实践的准备。通过具有成本效益的方法进一步改善材料性能对于广泛实施至关重要。
    BACKGROUND: Due to rapid changes in dental practice, digital technologies have become prominent in undergraduate dental education at German universities in recent years. This shift has prompted a re-evaluation of content as well as teaching methods, particularly in courses where students are prepared for patient treatment. Traditional training on standardized models with resin teeth cannot cover the complexity of individual dental arch configuration encountered in patient situations. This study explores the use of 3D printing technology to create individualized models for prosthetic treatment simulations, aiming to evaluate students\' feedback towards their experience with this training setting.
    METHODS: First, the study describes the design and fabrication of individualized models with exchangeable teeth based on intraoral scans, mounted on connected plates with distance holders that can be fixed to standard phantom heads. Second, students provided feedback through a questionnaire, assessing various aspects such as the effectiveness of the 3D-printed models compared to traditional frasaco models for preparation exercises.
    RESULTS: The results indicated that the design of the realized models was feasible for preparation training (question no. 4: 93% positive rating) and showed positive perceptions of the 3D-printed models, with students finding them effective for preparation exercises and beneficial in bridging the gap between simulation and real patient situations (question no. 6: 69% positive rating).
    CONCLUSIONS: The study suggests that 3D printing technology offers a valuable tool in dental education, providing realistic and patient-specific scenarios for students to enhance their skills and readiness for clinical practice. Further improvements in material properties in hand with cost-effective approaches are essential for widespread implementation.
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