华西口腔医学杂志 ›› 2021, Vol. 39 ›› Issue (2): 233-237.doi: 10.7518/hxkq.2021.02.018

• 临床技术改进 • 上一篇    下一篇

颌间距离还是目标修复空间值——实测数值引导的无牙颌种植修复的临床决策

张煜强(), 于海洋()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院修复科,成都 610041
  • 收稿日期:2020-01-24 修回日期:2020-09-13 出版日期:2021-04-01 发布日期:2021-04-09
  • 通讯作者: 于海洋 E-mail:772486569@qq.com;yhyang6812@scu.edu.cn
  • 作者简介:张煜强,硕士,E-mail:772486569@qq.com
  • 基金资助:
    十三五国家重点研发计划项目(2016YFC1102704);国家自然科学基金(81771113)

Interarch distance is a target restorative space value: clinical decisionmaking of implant restoration guided by measured value

Zhang Yuqiang(), Yu Haiyang()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2020-01-24 Revised:2020-09-13 Online:2021-04-01 Published:2021-04-09
  • Contact: Yu Haiyang E-mail:772486569@qq.com;yhyang6812@scu.edu.cn
  • Supported by:
    National Key Research and Development Program of China(2016YFC1102704);The National Natural Science Foundation of China(81771113)

摘要:

无牙颌患者选择种植修复方案时,不少医生忽视了应该在建后研判患者的颌间距离(垂直距离)或水平距离是否足够容纳种植上部结构及修复体等,再进行种植方案设计。而临床上常用的颌间距离(垂直距离)、水平距离的实测内涵和方法还有待明确,常用的术后目测估计除不准确外还易导致种植修复决策路径倒置,导致不少病例植入成功后出现了无法合理修复的尴尬,这种“想到没做到”的主要原因是缺乏关键参数的规范路径和实用工具及方法。本文推荐先建立新的或天然牙、旧义齿保留的正确颌位关系,然后采用更容易把握的目标修复空间的高度和水平距离或夹角作为实测指标,植入术前在架或口内用实测工具采集各植入位点的骨面或龈面到拟定咬合平面的最小垂直距离(包括龈面高度和骨面高度)和水平距离或夹角,根据实测值大小建立了以修复空间的各项数值为引导的无牙颌修复方案决策树,理顺了临床决策路径;同时规范了测量方案(起止点、测量平面等),为合理制定数字化种植修复方案提供了可靠的数量关系依据。

关键词: 目标修复空间高度, 无牙颌修复, 种植修复, 种植覆盖义齿, 临床决策

Abstract:

When design an implant restoration for edentulous patients, many doctors ignore the sufficiency of the interarch distance (vertical distance) or horizontal distance of the patient to accommodate the superstructure and restoration before designing the implant plan. However, the connotation of measuring the interarch distance or horizontal distance has not been clarified in clinical practice. It is often based on visual estimation after operation, and the decision-making path of implant restoration is inverted, resulting in many mistakes regarding the restoration after implantation. The main reason is the lack of standardized paths and practical methods to use before surgery. This article recommended initially establishing a maxillo-mandibular relationship based on natural teeth, old dentures, or new ones and then using the height and horizontal distance or angle of the target restorative space, which was easier to grasp as the measured index. The minimum vertical distance (including the height of the gingival surface and the bone surface) and the horizontal distance (or the angle from the bone or gingival surface to the proposed occlusal plane) should be measured before operation. A decision tree of edentulous jaw restoration guided by the values of the repair space was established based on the measured values. This article clarified the measuring points and planes and thus provided a quantitative relationship basis for the design of implant restoration.

Key words: vertical-height target restorative space, restoration of edentulous jaw, implant restoration, implant overdenture, clinical decision

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