数字化全颌固定咬合重建（一）：有牙颌的“5-19N”重建临床技术方案

doi:10.7518/hxkq.2025.2025003

华西口腔医学杂志 ›› 2025, Vol. 43 ›› Issue (3): 325-335.doi: 10.7518/hxkq.2025.2025003

数字化全颌固定咬合重建（一）：有牙颌的“5-19N”重建临床技术方案

于海洋(), 吴嘉诚, 税钰森, 颜哲彬, 裴亚鹏

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:2025-01-03 修回日期:2025-03-18 出版日期:2025-06-01 发布日期:2025-06-10
通讯作者: 于海洋 E-mail:yhyang6812@scu.edu.cn
作者简介:于海洋，四川大学华西口腔医院二级教授、博士研究生导师、一级临床专家。擅长显微美容修复、数字种植修复和数字化可摘局部义齿修复等。现任中华口腔医学会修复专业委员会主任委员、中国口腔医学技术联盟理事长、国家口腔医学中心修复分中心副主任、国家口腔医学质控中心口腔修复专业副组长、口腔修复国家临床重点专科负责人，主编出版规划教材《口腔固定修复学》《口腔医学美学》及专著《数字引导式显微修复学》《引导式精准植入术》《口腔微距摄影速成》等30余部。提出口腔TRS数论、美学修复形—色—心三要素四维辩证论，发明“TRS可测量种植导板”“备牙定深孔导板”等多项临床技术方案；研发的多项软件及医疗器械产品已经成功转化临床。|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(82071145);四川大学华西口腔医院资助临床研究项目(LCYJ2022-BZ-2)

Digital full-mouth fixed occlusal reconstruction (partⅠ): the “5-19N” clinical technical solution for dentulous situation

Yu Haiyang(), Wu Jiacheng, Shui Yusen, Yan Zhebin, Pei Yapeng

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:2025-01-03 Revised:2025-03-18 Online:2025-06-01 Published:2025-06-10
Contact: Yu Haiyang E-mail:yhyang6812@scu.edu.cn
Supported by:
National Natural Science Foundation of China(82071145);Clinical Research Project of West China Hospital of Stomatology, Sichuan University(LCYJ2022-BZ-2)

摘要/Abstract

摘要：

咬合重建也叫重建，是指采用修复手段，在正确的颌位关系下重新建立全牙列或多数牙的咬合接触关系的治疗方法，是矫正牙齿严重磨损和牙列缺损等的重要治疗手段。其中，全颌固定咬合重建可有效恢复美观及功能，但其临床技术方案复杂、技术敏感性高，各种并发症高发，一直以来被业界关注。随着数字化技术在重建中的应用和发展，数字化重建的临床程序相较于传统方案面貌一新。然而，数字化技术种类众多，其效能高低不一，如何构建高效规范的数字化临床技术方案仍然是当前的临床难点。为此，本文首先着墨于高发的有牙颌重建，系统整理了数字化全颌固定咬合重建的临床程序，从重建“从大到小”贯穿几何量依次进行空间转移的底层逻辑入手，指出了重建时应关注的最小几何量（最小咬合感知厚度）和最大几何量（正中关系），最后提出了有牙颌重建的5阶段19步（或加N步）的临床技术方案，简称有牙颌“5-19N”重建临床技术方案，该方案对今后采用数字化技术方案处理有牙颌复杂全颌固定咬合重建病例有一定的指导价值。

关键词: 数字化, 咬合重建, 固定修复, 临床方案, 精度

Abstract:

Occlusal rehabilitation is an effective means of treating tooth wear, edentulous jaws and other oral diseases. Among them, full-mouth fixed occlusal reconstruction can effectively restore aesthetics and function, but the complexity of the clinical process, the high sensitivity of the technique, and the high incidence of various complications have always drawn much attention. With the application and development of digital technology in occlusal rehabilitation, the treatment outcome has been improved compared with traditional treatment. However, there are many kinds of digital technology with different efficacy, how to build an efficiently standardized digital clinical technical solution is a current difficulty. Therefore, combined with the long-term work of the department of prosthodontics in our hospital, in this paper, the minimum (occlusal perception of thickness) and maximum (centric relation) geometric quantities which should be paid attention to during reconstruction are put forward. We systematically organized the clinical procedure of digital full-mouth fixed occlusal rehabilitation used in our department for a long time. In conclusion, a 5-stage 19-step or n-step solution (5-19N for short) characterized by “from large to small” restorative space splitting logic is proposed. It has a certain reference value for the future use of digital technology to deal with complex occlusal rehabilitation cases.

Key words: digital, occlusal rehabilitation, fixed restoration, clinical solution, accuracy

中图分类号:

R783.4

于海洋, 吴嘉诚, 税钰森, 颜哲彬, 裴亚鹏. 数字化全颌固定咬合重建（一）：有牙颌的“5-19N”重建临床技术方案[J]. 华西口腔医学杂志, 2025, 43(3): 325-335.

Yu Haiyang, Wu Jiacheng, Shui Yusen, Yan Zhebin, Pei Yapeng. Digital full-mouth fixed occlusal reconstruction (partⅠ): the “5-19N” clinical technical solution for dentulous situation[J]. West China Journal of Stomatology, 2025, 43(3): 325-335.

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数字化全颌固定咬合重建（一）：有牙颌的“5-19N”重建临床技术方案

Digital full-mouth fixed occlusal reconstruction (partⅠ): the “5-19N” clinical technical solution for dentulous situation

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