华西口腔医学杂志 ›› 2024, Vol. 42 ›› Issue (3): 277-285.doi: 10.7518/hxkq.2024.2023460

• 临床决策 •    下一篇

关闭前牙牙间隙的口腔门诊多科室合作临床决策

于海洋(), 税钰森, 蒋青松   

  1. 口腔疾病防治全国重点实验室 国家口腔医学中心 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:2023-12-29 修回日期:2024-02-20 出版日期:2024-06-01 发布日期:2024-05-24
  • 通讯作者: 于海洋 E-mail:yhyang6812@scu.edu.cn
  • 作者简介:于海洋,教授,博士,E-mail:yhyang6812@scu.edu.cn
  • 基金资助:
    国家自然科学基金(82271020)

Multidisciplinary clinical decision-making of anterior diastema closure

Yu Haiyang(), Shui Yusen, Jiang Qingsong   

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2023-12-29 Revised:2024-02-20 Online:2024-06-01 Published:2024-05-24
  • Contact: Yu Haiyang E-mail:yhyang6812@scu.edu.cn
  • Supported by:
    The National Natural Science Foundation of China(82271020)

摘要:

前牙牙间隙是一种常见的牙齿缺陷。临床常用关闭前牙牙间隙方案包括正畸治疗、直接修复以及间接修复等,是一项可能同时涉及正畸科、牙体牙髓科、修复科、全科以及牙周科等口腔门诊多科室合作的诊疗项目。由于当前我国口腔门诊普遍存在的分科过细、跨科室合作效率低,以及牙间隙的病因繁杂,使得临床跨科室合作关闭牙间隙时如何选择最佳治疗时机与合理方案尚缺乏清晰的诊疗思路,最终将影响关闭前牙牙间隙的疾病诊治效能和疗效。为此,本文推荐了一套基于病因诊断与牙间隙几何量实测值进行分类分级来关闭前牙牙间隙的三个序列临床决策树。该套决策树通过患者病史和临床检查结果进行病因归类,并判断牙间隙的稳定性,再进一步依据牙间隙几何量实测值、患者的求美心理评估、诊疗费用与时间成本等,合理选择相应的口腔门诊跨科室联合治疗方案,实现牙间隙的精准分类诊疗。本决策树针对前牙牙间隙跨科室合作难点,提供了客观高效的决策拐点,有助于进一步提高工作效率,提升关闭前牙牙间隙的疗效。

关键词: 前牙牙间隙, 病因诊断, 临床决策, 跨科室联合诊疗, 实测, 邻贴面

Abstract:

Anterior diastema is a common esthetic defect in China. The general treatment for a patient with diastemata, including orthodontics and direct and indirect restorations, is a multidisciplinary clinical procedure covering the orthodontics, operative dentistry, general dentistry, and prosthodontics department. Given the diversity of departments and the complex etiology of this defect, decision-making regarding the closing methods and time selection is undefined and unintegrated, which makes the long-term stability of closure unpredictable. This article proposed an etiology-based decision tree with actual measurement of diastemata width for diastemata closure. The decisional steps include classifying the etiological factors based on patients' medical history and clinical manifestation to evaluate the stability of diastemata. After maintaining the stability of diastemata, contemporary and multidisciplinary treatment plans were selected in accordance with the measured width of diastemata and patients' cosmetic psychology, economics, and available time. These decision trees focus on the challenges of collaboration among dental departments, propose an objective and efficient ways for connections, and promote efficient and effective diastemata closure.

Key words: anterior diastema, etiological diagnosis, clinical decision, multidisciplinary clinical procedure, actual measurement, adjacent laminate veneer

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