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[无牙颌患者传统治疗与使用面弓和快速全功能架治疗的对比分析]

[Comparative analysis of edentulous patients treated traditionally and with the use of a face-bow and Quick Master articulator].

作者信息

Kubrak J

机构信息

Zakładu Protetyki Stomatologicznej Pomorskiej Akademii Medycznej w Szczecinie.

出版信息

Ann Acad Med Stetin. 1998;44:237-49.

PMID:9857542
Abstract

Correct determination of the occlusal plane is one of the most difficult stages of treatment. After determining the correct occlusal plane its reproduction is possible thanks to the use of articulators. These instruments simulate movements of the jaw in three planes. One of the most optimal articulators is a semi-adjustable type. These instruments are not complicated and give good treatment results. A modern semiadjustable type of articulator is Quick Master. The face-bow which comes together with this instrument is used for recording and transferring the occlusal relation to the articulator. This allows to mount models in an adequate three dimensional position in relation to the temporo-mandibular joint. The use of these instruments leads to many questions and doubts due to difficulties in their use. Therefore the aim of my study was to elaborate a simple method of occlusal recording. I have also compared the treatment results of edentulous patients treated with the use of an articulator and the use of a traditional method. Prosthetic restorations were prepared among 60 patients. The study material was divided into two groups of 30 patients each. In the control group for preparing complete dentures the Gysi method was employed as the most common. In the study group a face-bow and articulator were used. After preparing complete dentures detailed clinical control examinations were carried out and were repeated 24-48 hours after fitting the dentures and also after 3 and 6 months of their use. Working with the face-bow I have employed my own modification of recording the occlusion. The upper wax rim was placed on a slightly warmed bite fork and drawing pins were placed in the recording block to act as a type of key. The lower rim was warmed and brought to occlusal contact a couple of times. Next the face-bow was inserted. The recorded occlusion was transferred and mounted in the articulator. Teeth in both cases were set up similarly to the Gysi method. Lower teeth were set up on the top of the ridge, the upper teeth could be set slightly out of the top line but in the area marked afore between the lines. After preparing and fitting the dentures a clinical examination was carried out and a survey concerning the dentures in use was filled out by the patients. In the study group QM the adaptation period lasted 5 to 30 days, an average of 10.5 days. Full adaptation was achieved in 24 patients during 3 to 14 days. In the control group adaptation period lasted 3 to 42 days, an average of 18.4 days (Tab. 1). A significant difference was obtained. An analysis of the number of reviews with need of occlusal adjustment (Tab. 2) in the QM group showed that most patients needed 1 adjustment or such procedure was not necessary. In the control group 2 or 3 adjustments were necessary (79%). Presented data show that dentures prepared with the use of an articulator are more physiologic and ensure a balanced occlusion. In the method with the use of an articulator a shorter adaptation period is necessary. A subjective patient estimation of the dentures was also positive for the articulator method. The introduced modification of recording the occlusion ensures an efficient and fast mounting and demounting of the face-bow and its use becomes very advantageous. Semiadjustable articulators should be essential instruments in rehabilitation of edentulous patients. The elaborated procedure is a simple and not time-consuming method. It ensures positive treatment results of edentulous patients assuring all basic aims of masticatory organ rehabilitation.

摘要

确定咬合平面是治疗过程中最困难的阶段之一。确定正确的咬合平面后,借助牙合架就可以重现该平面。这些器械可模拟下颌在三个平面上的运动。最理想的牙合架类型之一是半可调式。这类器械并不复杂,且能带来良好的治疗效果。一种现代的半可调式牙合架是Quick Master。随该器械配备的面弓用于记录咬合关系并将其转移至牙合架。这使得模型能够相对于颞下颌关节在合适的三维位置上进行上架。由于这些器械使用起来存在困难,因此引发了诸多问题和疑虑。所以我的研究目的是精心设计一种简单的咬合记录方法。我还比较了使用牙合架治疗无牙颌患者与使用传统方法治疗的效果。为60例患者制作了修复体。研究材料分为两组,每组30例患者。在对照组中,制作全口义齿时采用最常用的吉西(Gysi)方法。在研究组中,使用了面弓和牙合架。制作完全口义齿后,进行了详细的临床对照检查,并在义齿试戴后24 - 48小时以及使用3个月和6个月后再次进行检查。在使用面弓时,我采用了自己改良的咬合记录方法。将上蜡基托置于稍微温热的咬叉上,并在记录块中插入图钉作为一种定位标记。将下蜡基托温热,使其咬合接触几次。接下来插入面弓。将记录的咬合关系转移并上架到牙合架上。两种情况下排牙均类似吉西方法。下牙排在牙槽嵴顶上,上牙可稍超出顶线,但在之前标记的线之间的区域内。制作并试戴义齿后,进行了临床检查,患者填写了关于所使用义齿的调查问卷。在研究组QM中,适应期为5至30天,平均10.5天。24例患者在3至14天内实现了完全适应。在对照组中,适应期为3至42天。平均18.4天(表1)。得到了显著差异。对QM组中需要进行咬合调整的复查次数分析(表2)表明,大多数患者需要1次调整或无需此类操作。在对照组中,需要2次或3次调整(79%)。所呈现的数据表明,使用牙合架制作的义齿更符合生理要求,并能确保平衡的咬合。使用牙合架的方法需要更短的适应期。患者对使用牙合架方法制作的义齿主观评价也呈阳性。所引入的咬合记录改良方法确保了面弓的高效快速装卸,其使用变得非常有利。半可调式牙合架应成为无牙颌患者修复治疗中的必备器械。所精心设计的程序是一种简单且不耗时的方法。它确保了无牙颌患者的积极治疗效果,实现了咀嚼器官修复的所有基本目标。

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