【作者】 张倩；

【导师】 周益；

【作者基本信息】 浙江大学 ， 口腔医学（专业学位）， 2019， 硕士

【摘要】 目的:探究倾斜与轴向植入种植体在上颌骨中重度吸收无牙领病例中的应用,并评价该义齿修复技术的初期临床效果。方法:回顾性收集2015年至2018年在浙江大学医学院附属口腔医院种植中心,因上颌全牙列缺失需要进行种植固定义齿修复的病例5例,其中上颌““ALL-ON-4””共2例、ALL-ON-6轴向植入种植体病例共3例。根据术前口腔专科检查及CBCT影像学检查,制定个性化种植修复方案。术中选择轴向或倾斜植入4-6颗Nobel Active系列种植体,3-7个月后行CAD/CAM(计算机辅助设计/计算机辅助制造(Computer Aided Design/Computer Aided Manufacturing)切削纯钛支架结合聚合瓷修复体或烤瓷熔附金属冠桥修复体的种植体支持式固定义齿永久修复。术后半年至2年,随访了解义齿修复治疗效果。结果:①5人行上颌无牙颌种植固定修复,共26枚种植体,无种植体折断或植入失败。(2)临床随访2年显示倾斜角度植入种植体颈部牙槽骨吸收小于2mm,轴向植入种植体颈部牙槽骨吸收同样小于2mm,两者临床修复效果无明显差异,种植体效果临床评价均为成功。当悬臂梁长度控制在6-14mm时,临床初期观察未发生机械及生物并发症。③ 临时修复体4副,未出现临时义齿折断等并发症。永久修复体5副(其中CAD/CAM切削纯钛支架结合聚合瓷4副,烤瓷熔附金属冠桥1副),术后无修复体脱落、折断或失败。结论:①对于颌位关系正常,美观及咀嚼功能要求较高的上颌牙槽骨中重度吸收的无牙颌患者,采用“ALL-ON-4”和轴向植入6颗种植体的种植修复方案可以获得较为满意的临床效果。② 在上颌牙列缺失的种植固定修复中,牙槽骨后部倾斜种植体的植入角度和义齿悬臂梁长度的控制是影响治疗效果的关键因素。③CAD/CAM切削纯钛支架结合聚合瓷修复体或烤瓷熔附金属冠桥修复体的种植体支持式固定义齿初期临床效果良好,发生机械与生物并发症风险低。更多还原

【Abstract】 Objective:To investigate the application of oblique and axial implants in the treatment of edentulous jaws with severe maxillary distraction and to evaluate the initial clinical outcome of the denture restoration technique.Methods:A retrospective collection of 5 cases of implanted fixed dentures was performed in the Affiliated Stomatological Center of Zhejiang University School of Medicine from 2015 to 2018,including 2 cases of "ALL-ON-4",3 cases of 6 anxial implants.According to the preoperative dental specialist examination and CBCT imaging examination,a personalized implant restoration program was developed.Intraoperative selection of 4-6 Nobel Active implants in axial or oblique orientation,CAD/CAM after 3-7 months(Computer Aided Design/Computer Aided Manufacturing)Permanent fixation of implant-supported fixed dentures with pure titanium stents combined with polymeric porcelain restorations or porcelain-fused metal crown bridge restorations.After six months to two years,follow-up was performed to evaluate the effect of denture restoration.Result:① A total of 26 implants were fixed in 5 maxillary edentulous jaws,with no implants broken or implant failure.② The clinical follow-up of 2 years showed that the alveolar bone resorption of the implanted neck was less than 2 mm,and the alveolar bone resorption of the axial implanted implant was also less than 2 mm.There was no significant difference in the clinical repair effect between the two.The evaluation was all successful.When the length of the cantilever beam was controlled at 6-14 mm,no mechanical and biological complications occurred in the early clinical observation.③ Temporary prosthesis 4,no complications such as temporary denture fracture.5 pairs of permanent prosthesis(including 4 pieces of CAD/CAM cutting pure titanium scaffold and polymerized porcelain,1 set of porcelain fused metal crown bridge),no prosthesis shedding,breaking or failure after operation.Conclusion:① For edentulous patients with severe maxillary relationship,aesthetics and chewing function,which are severely absorbed in the maxillary alveolar bone,the“ALL-ON-4”and axial implants of 6 restoration program can obtain satisfactory clinical results② In the fixed fixation of the maxillary dentition,the implantation angle of the oblique implant at the back of the alveolar bone and the control of the length of the cantilever beam are the key factors affecting the therapeutic effect.③ The implantable fixed denture with CAD/CAM cutting pure titanium stent combined with polymerized porcelain restoration or porcelain fused metal crown bridge prosthesis has good initial clinical effect and low risk of mechanical and biological complications.更多还原