口腔修復(fù)學(xué)課件：第四章 牙列缺損的固定局部義齒修復(fù)

1、第四章 牙列缺損的固定局部義齒修復(fù)Fixed Partial Dentures for Replacing the Missing Teeth前言牙列缺損Partially edentulous arches 牙列中從缺一個(gè)牙到只剩一個(gè)牙。前言牙列缺損可能引起的問(wèn)題咀嚼功能減退牙周組織改變發(fā)音功能改變影 響 美 觀顳頜關(guān)節(jié)病變前言牙列缺損的修復(fù)方法固定義齒可摘局部義齒固定活動(dòng)聯(lián)合修復(fù)前言固定義齒/固定橋Fixed partial dentures (FPDs)第一節(jié) 固定義齒的組成與類型Components and Classification of FPDs固定義齒的組成固位體/Retain

2、er橋體/Pontic連接體/Connector基牙/Abutment ？固位體是固定橋粘固于基牙上的那部分構(gòu)造。全冠、樁冠、部分冠、嵌體、翼板。固位體應(yīng)有足夠的固位力和抗力。橋體固定橋的人造牙部分。用以恢復(fù)缺失牙的形態(tài)與功能。生物學(xué)原則、機(jī)械學(xué)原則、美學(xué)原則、自潔性、生理性、功能性。連接體是橋體與固位體的連接部分。按連接方式不同，分為固定連接與非固定連接。Rigid connector：橋體與固位體成一整體。Non-rigid connector：栓體-栓道。固定義齒的類型雙端固定橋半固定橋 簡(jiǎn)單固定橋單端固定橋復(fù)合固定橋種植體固定橋可摘固定橋粘結(jié)橋雙端固定橋/ Rigid fixed br

3、idge 又稱完全固定橋。兩端都有固位體，與橋體之間為固定連接。特點(diǎn)：能承受的牙合力大，患者感覺(jué)舒適，預(yù)后最佳，應(yīng)用最廣。半固定橋/Semi- fixed bridge又稱應(yīng)力中斷式固定橋。兩端都有固位體，一端為固定連接體，另一端為非固定連接。多用于間隔缺失中間基牙的遠(yuǎn)中部分，或當(dāng)某基牙傾斜過(guò)大，難以取得共同就位道時(shí)?？蓜?dòng)連接上的栓道與另一基牙預(yù)備體的就位道一致。單端固定橋/ Cantilever fixed bridge又稱懸臂梁?jiǎn)味藰?。橋體只有一端有固位體，且為固定連接。單端固定橋粘固在一端基牙上。特點(diǎn)：增大了扭力矩、基牙極易傾斜、扭轉(zhuǎn)而引起牙周組織創(chuàng)傷。一般不單獨(dú)使用，尤其不可用于后牙。

4、只在缺牙間隙小時(shí)使用，或復(fù)合固定橋的個(gè)別小間隙。Cantilever Fixed Partial Denture 華西朱智敏教授 20例單端固定橋567，追蹤10年，效果良好。 建議： 橋體減徑至2/3 改良鞍式 高度3mm全頜種植義齒 游離端15mm華西文獻(xiàn) 單端橋橋體14mm Cantilever arm better than the round root. Multiple root better than single-rooted tooth Divergent roots better than conical roots Periodontal ligament area Ro

5、ot surface area Relative value are used to assess the periodontal support of prospective FPD abutments. Antes Law The root surface area of FPD abutments should be at least equal or surpass that of the teeth being replaced with pontics. Periodontium area and Alveolar boneThe stages in the clinical pr

6、ocedure involved in an indirect restoration are usually as follows: 1. Decision as to restoration type (full or partial coverage; intracoronal or extracoronal), materials and method of luting (conventional cementation or bonding with a resin-based luting material)2. Discussion with patient before to

7、oth preparation stage as to type of restoration and aesthetic implications 3. Tooth preparation (this may require prior occlusal adjustment or diagnostic wax-up to facilitate production of provisional restoration) 4. Fabrication of temporary/provisional restoration 5. Impressions and occlusal record

8、s 6. Shade selection 7. Try-in 8. Cementation or bonding. Special Problems Double abutments Arch form Pier abutment Tilted molar abutment FPD replacing canine Cantilever FPD Pier abutmentThe nonrigid connector is a broken-stress mechanical union of retainer and pontic.The mostly commonly used nonrig

9、id design consists of a T-shaped key that is attached to the pontic, and a dovetail keyway placed within a retainer.The keyway of the connector should be placed within the normal distal contours of the pier abutment and the key should be placed on the mesial side of the distal pontic.Tiled molor abu

10、tmentFixed partial denture using a proximal half crown as a retainer on a tilted molar abutment. Fixed partial denture using a telescope crown and coping as a retainer on a tilted molor abutment.A nonrigid connector on the distal aspect of the premor retainer compensates for the inclination of the tilted molor.Cantilever fixed patial dentureProspective abutment teeth for cantilever fixed partial dentures should be evaluated with an eye toward lengthy roots with a favorable configuration, long