Renault P
Cah Prothese. 1990 Mar(69):60-71.
Cases of multiple agenesia present some difficulties in the treatment planing. Three situations may be encountered: limited agenesia, restored by a fixed, bonded or cemented prosthesis, multiple uni- or bimaxillary agenesia without remaining of deciduous teeth, restored by a fixed, bonded or cemented prosthesis or the partial adjacent prosthesis, multiple uni- or bimaxillary agenesia with remaining of deciduous teeth, restored by means of a supra-dental prosthesis. The first two situations have been described in dental literature and are relatively easy to treat. The same is not true for the third situation, where the decision to keep the temporary teeth considerably increases the difficulty of prosthetic restoration. This subject will be illustrated by the presentation of a clinical case of multiple bi-maxillary agenesia. The patient has: on the maxilla: an absence of 9 permanent teeth (18, 15, 14, 12, 22, 23, 24, 25, 28) and the presence of 4 deciduous teeth (62, 63, 64, 65), on the mandible: an absence of all permanent teeth, with the exception of 36 and 46, and the remaining of 4 deciduous teeth (75, 73, 83, 84). The remaining of deciduous teeth and the presence of a very high inter-arch space led to opting for dental coverage so as to keep the deciduous teeth and a proper vertical dimension. The patient wished to solve his "problem" in the maxilla first, and is not wanting to undergo the extraction of his deciduous teeth. The following therapeutic proposal was adapted: On the maxilla, a three-step procedure: first step: building of metal copings on 13, 16 and 26 and metal-ceramic crowns on 11 and 21, second step: building of telescop crowns on 16 and 26 and clasps on 13, 11 and 21, third step: casting of the removable partial denture framework and soldering to the telescop crowns and clasps. On the mandible, a provisional restoration using a supra-dental resin removable partial denture with ceramic occlusal surfaces was adopted. The aesthetic and functional improvement, as well as the comfort provided to the patient due to this kind of mixed prosthesis, appeared to be satisfactory.
多牙缺失病例在治疗方案制定方面存在一些困难。可能会遇到三种情况：局限性牙缺失，可通过固定、粘结或黏固修复体进行修复；上颌或下颌多牙缺失且乳牙已脱落，可通过固定、粘结或黏固修复体或部分邻牙修复体进行修复；上颌或下颌多牙缺失且乳牙仍留存，需通过覆盖义齿进行修复。前两种情况在牙科文献中已有描述，相对容易治疗。而第三种情况则不然，保留乳牙的决定会显著增加修复的难度。本文将通过一个双侧上颌多牙缺失的临床病例进行说明。该患者上颌情况为：缺失9颗恒牙（18、15、14、12、22、23、24、25、28），留存4颗乳牙（62、63、64、65）；下颌情况为：除36和46外所有恒牙缺失，留存4颗乳牙（75、73、83、84）。乳牙的留存以及较大的颌间距离使得选择覆盖义齿以保留乳牙并维持合适的垂直距离成为必要。患者希望先解决上颌的“问题”，且不想拔除乳牙。因此制定了以下治疗方案：上颌采用三步法：第一步：在13、16和26上制作金属基底冠，在11和21上制作金属烤瓷冠；第二步：在16和26上制作套筒冠，在13、11和21上制作卡环；第三步：铸造可摘局部义齿支架并焊接到套筒冠和卡环上。下颌采用临时修复，使用带有陶瓷咬合面的覆盖义齿树脂可摘局部义齿。这种混合修复体在美观、功能改善以及为患者提供的舒适度方面似乎都令人满意。
