牙科学修复：Introduction to Complete denture（简版）

1、Introduction to Complete Denture1Complete Denture A full denture is designed to replace the entire dentition and associated structures of the maxillae or mandible. Partial Denture A partial denture is used to replace one or more removed teeth in an arch.Definition2Definition It is a removable applia

2、nce usually composed of artificial teeth set in an acrylic base. 34 Who will wear the complete dentures? Age 50y Incidence 6.81%（65y-74y） Caries & Periapical diseases Periodontitis Trauma Reasons for dentition loss Congenital & developmental problems Tumor（肿瘤）5 Complete denture Implants supported de

3、nture Tooth Tissue Engineering Restoration methods6 Appearance changes （面容改变） Eating problems （进食困难） Pronunciation troubles （发音障碍） Influence of psychological status （心理影响） Problems after dentition loss78Changes of oral tissues after dentition loss Jaw bones Soft tissues Temporomandibular joint (TMJ)

4、Bone resorption of the residual ridgesChanges of oral tissues after dentition loss9Characteristics of resorption on residual ridges A chronic, irreversible, and progressive process Changes of loading distribution and atrophy of disuse Speed of bone resorption Faster in the first 6 months after teeth

5、 extraction Stable after 2 years Direction of resorption Maxillae upward & inward Upper arch diminution Mandible forward & outward Lower arch enlargemnt Jaw bonesChanges of oral tissues after dentition loss11Influences of resorption on residual ridgesJaw bonesChanges of oral tissues after dentition

6、loss Reasons for dentition loss esp. Periodontitis Time after dentition missing the longer, the worse Bone density spongy bone compact bone Force bearing Mandible Maxilla 3-4 times General health and bone metabolism12Residual ridge form1. Favorable form with satisfied height and width （有足够高度和宽度，形态丰满

7、）2. Knife-edge form （刃状牙槽嵴，高度足够但宽度不足）3. Lower or flat form （低平牙槽嵴，高度宽度均不足）4. Serious alveolar-bone-absorption （牙槽骨吸收达基骨） Decreased vertical dimension （垂直距离降低） Atrophy of masticatory muscles （咀嚼肌萎缩） Lips and cheek retraction, increasing facial wrinkles （唇颊内陷，皱纹增多） Tongue expansion （舌扩张） Changes of or

8、al mucosa （粘膜改变）Soft tissuesChanges of oral tissues after dentition loss13 Lips and cheek retraction Increasing facial wrinkles Ptosis of labial angle Changes of oral tissues after dentition loss14 Tongue expansionSoft tissuesChanges of oral tissues after dentition loss15 Changes of oral mucosa Mout

9、h floor and vestibular grooves are shallowing.Attachment of frena are becoming relatively higher.The oral mucosa are getting thinner with increased sensitivity. Temporomandibular jointProtraction of mandibleTMJ disordersPain / Joint clickingLong timeChanges of oral tissues after dentition loss16Anat

10、omic landmarks of edentulous patients 无牙颌解剖标志17 Alveolar ridge 牙槽嵴 Oral vestibule 口腔前庭 Oral cavity proper 口腔本部/固有口腔 Oral Anatomy18Edentulous ridgeAttached mucosa 高度角化复层鳞状上皮Stress-bearing area 19Hard palate覆盖高度角化附着黏膜 Maxillary labial frenum （上唇系带） 上颌唇侧正中位置，牙槽嵴唇侧粘膜到上唇粘膜之间的粘膜皱襞，是口轮匝肌在上颌骨的附着处。20Maxilla

11、取印模时患者作唇的自主运动，并行肌功能修整 基托在此区应形成相应切迹，予以缓冲。 Maxillary buccal frenum （上颊系带） 位于上颌前磨牙牙根附近，呈扇形，能固定口角，协 助颊肌将食物移向后方。 区分前弓区和后弓区 基托在此区应缓冲，形成相应的切迹。21Maxilla Zygomatic process （颧突） 颧突是颧骨下缘的延长，上颌第一磨牙颊侧根方的骨性隆起。22Maxilla 它把加在磨牙上的咀嚼压力分散到眶外侧缘和颧弓。予以缓冲，避免压痛排列人工牙时，应把第一磨牙排列在该处 Maxillary tuberosity （上颌结节） 上颌牙槽嵴两侧远端的圆形骨突。2

12、3Maxilla 形成明显倒凹时，需要考虑外科修整 义齿基托应覆盖结节颊面并尽量伸展，以增强固位。 Pterygomaxillary notch （翼上颌切迹） 上颌结节后缘和蝶骨翼突之间的间隙，表面有粘膜覆盖， 形成凹陷切迹状。 是上颌全口义齿两侧后缘的界限，发挥封闭作用。Maxilla Incisive papilla（切牙乳头） 位于上颌腭中缝前端的梨形软组织小突起，是上颌重要的、稳定的标志。25Maxilla 其下为切牙孔，有鼻腭神经和血管通过，不能受压，故基托组织面需适当缓冲。切牙乳突是上颌全口义齿排牙的重要标志！ Palatal rugae （腭皱） 上颌正中线前端硬腭上，左右侧各

13、有34条前后横行排列的波浪形凸起粘膜。 有辅助发音的作用。 26Maxilla 义齿基托组织面应贴合，但不能压迫；磨光面可仿造腭皱形态。8. Torus palatinus（腭隆突） 20% 形成骨性隆突 多数人 较平坦 Maxilla位于硬腭中央部分。 其上粘膜薄且缺乏弹性。义齿基托应缓冲。 个别腭隆突过大，需行外科手术切除。9. Palatal fovea （腭小凹） 位于软硬腭结合处稍后方中线的两侧，左右各一，为口内粘液腺导管的开口。28Maxilla 它是前颤动线的定位标志。上颌全口义齿的后缘应在腭小凹后2mm处。 Vibrating line （颤动线） 位于软腭与硬腭的交界部位。发

14、“阿”音时软腭升高，发音结束后又复归原位，故又称“阿”线(后颤动线)。Maxilla 前后颤动线之间的弓形区域为上颌全口义齿基托的后缘封闭区，义齿基托组织面在此区域向粘膜突起形成后堤。30 Mandibular labial frenum（下唇系带） 下颌正中唇侧粘膜从牙龈交界处到下唇粘膜之间的粘膜皱襞，是口轮匝肌在下颌骨的附着处。Mandible 它随唇肌的运动而活动，活动度小于上颌，基托在此区应形成相应的切迹。 Mandibular buccal frenum （下颊系带） 刃状结缔组织，起于下颌前磨牙牙龈交界线下，呈扇形，其活动度大，抗力强。31Mandible义齿基托在此区应形成相应的

15、切迹。 Buccal shelf area（颊棚区） 又称颊侧翼缘，位于下颌后弓区，在下颌颊系带至咬肌下段前缘之间。Mandible义齿基托可较大范围伸展，利于固位和承受咬合力。4. Distal buccal angles area（远中颊角区） 颊棚区后方，磨牙后垫的颊侧。咬肌前缘相对应的部位。Mandible 由于咬肌活动的影响，义齿基托在此区不能过多伸展。5. Retromolar pad （磨牙后垫） 位于下颌最后磨牙牙槽嵴远端的粘膜软垫，覆盖在磨牙后三角上，由疏松的结缔组织构成，含黏液腺。Mandible 下颌全口义齿后缘应盖过磨牙后垫1/2或2/3，起封闭作用。 磨牙后垫的形态和

16、位置比较稳定，作为排人工牙时的解剖标志 垂直向：下颌第一磨牙的He平面与磨牙后垫的1/2处等高；前后向：下颌第二磨牙应位于磨牙后垫前缘；颊舌向：磨牙后垫颊面、舌面向前与下颌尖牙的近中 面形成一个三角形，下颌后牙的舌尖应位于 此三角形内。6. Lingual frenum（舌系带） 连接口底与舌腹的粘膜皱襞，位于口底中线部，活动度较大。 Mandible义齿基托应形成相应切迹。7. Sublingual glands（舌下腺） 位于舌系带两侧，在下颌骨舌面的舌下腺凹内。可随下颌舌骨肌的运动上升或下降。Mandible 与此区相应的义齿舌侧基托边缘不应过长，否则舌运动时易将下颌全口义齿推起。8.

17、Torus mandibularis （下颌隆突） 位于下颌两侧前磨牙根部的舌侧，向舌侧隆起，表面覆盖的粘膜较薄。Mandible 与之相应的组织面应适当缓冲，过分突出时，其下方形成显著的倒凹，需手术铲除。9. Mylohyoid ridges（下颌舌骨嵴） 位于下颌骨后部的舌面，从第三磨牙斜向前磨牙区，由宽变窄。38Mandible 表面覆盖粘膜较薄，下方有不同程度的倒凹，基托组织面应缓冲。10. Retromylohyoid fossa （下颌舌骨后窝） 下颌舌骨后间隙，是下颌总义齿舌侧后缘的边界。39Mandible 义齿舌侧基托为S型，进入舌骨后窝的基托部分可抵抗义齿向前脱位。义齿舌侧

18、边缘应尽量向下向后延长。11. Lingual flange area（舌侧翼缘区） 是与下颌全口义齿舌侧基托接触部位的解剖标志，从前向后包括舌系带、舌下腺、下颌舌骨肌、舌腭肌、翼内肌、咽上缩肌。Mandible 舌侧翼缘区后部是下颌全口义齿固位的重要部位，此区基托应有足够的伸展。41Structures of Complete DentureArtificial teethGenerally, acrylic artificial teeth!Denture baseAcrylic baseAcrylic-metal frame base42Surfaces of Complete Dent

19、ure Tissue surface Polishing surface Occlusal surface 与牙槽嵴、上腭等组织密切接触 与唇、颊、舌侧软组织和肌肉接触 形成适当的斜面 切割、碾碎食物 咬合接触广泛且平衡43Divisions of Complete Denture Primary stress-bearing area （主承托区） Secondary stress-bearing area （副承托区） Border seal area （边缘封闭区） Relief area （缓冲区）Maxilla 唇颊侧止于唇颊粘膜与牙槽嵴粘膜的反折线，避让开唇颊系带；上颌后缘止于腭小

20、凹后2mm至两侧翼上颌切迹的连线。Border seal 唇颊侧止于唇颊粘膜与牙槽嵴粘膜的反折线，避让开唇颊系带；下颌舌侧止于口底粘膜与牙槽嵴舌侧粘膜的反折线，避让开舌系带；下颌后缘止于磨牙后垫的中1/2或前2/3。Mandible45Neutral zone指导人工牙排列与磨光面塑形Retention and Stability of complete denture Retention of Prosthesis1. Removable partial dentureEmbrace force of claspsLock function of abutmentsAdsorption ca

21、pacity472. Fixed prosthesisFrictional forceAdhesion3. Implant supported dentureOsseointegration（骨整合） 1. Adsorption capacity The attractive force between two objects, including adhesion and cohesion. Contact area between denture base and oral mucosa Adaptation Quality and quantity of salivaRetention

22、of complete denture4849Retention of complete denture2. Interfacial reaction Interfacial surface tension （界面的表面张力） Interfacial viscous tension （界面的黏张力） 3. Atmospheric pressure4. Balance of muscles Anatomic morphology of jaws Characteristics of denture bearing mucosa Quality and quantity of saliva Bor

23、der extension of denture base Border sealInfluence factorsRetention of complete denture50 Anatomic morphology of jaws Position of dental arches Characteristics of denture bearing mucosa Arrangement of artificial teeth and occlusion Maxillomandibular relationship Suitable shape of denture polishing s

24、urfaceStability of complete denture5152Complete DentureFabrication processes Examination，diagnosis and preparing treatment Impression and Cast Maxillomandibular relationship recording Mounting the casts on articulator by face bow transfer Selection and Arrangement of Artificial teeth Try in Final fa

25、brication Insertion and adjustment5354Examination, diagnosis and preparing treatment检查、诊断和修复前准备55InquiryExamination Patients demands History of dental treatment Physical condition (Age, gender, and generalhealth) Character traits and mental status Social backgroundExtra-oral examination (颌面部检查)Exami

26、nation and DiagnosisExamination Facial characteristics Lip TMJ & muscles5657Examination and DiagnosisExaminationOral examination (口内检查) Morphology and consistency of the residual ridges Oral mucosa Attachment of frena and muscles Palatal Vault Maxillomandibular relationships Tongue Saliva Existing d

27、entures58拔牙创松软牙槽嵴2. 黏膜1. 牙槽嵴缝龈瘤骨突、骨刺溃疡3.系带和肌肉附着4.腭穹窿5.骨突和倒凹6.上下颌弓的位置关系7.舌的大小和位置8.旧义齿59 颌弓前后位置关系正常颌弓关系上颌前突轻度下颌前突严重下颌前突60正 常上颌弓宽于下颌弓下颌弓宽于上颌弓舌腭部 颌弓左右位置关系61有天然牙时的垂直距离垂直距离过大垂直距离过小垂直距离适中 颌弓垂直位置关系Diagnosis and treatment plan Implants supported dentureComplete denture VS.63Preparing treatmentSurgery拔除残根牙槽嵴低

28、平的手术手术修整牙槽骨突手术修整过高的附丽系带手术修整增生粘膜下的软组织 （缝龈瘤、松软牙槽嵴）前庭沟加深术骨移植人工材料植入单侧牙槽嵴的倒凹，义齿通过旋转方式就位，可很好的增加义齿的固位。双侧存在倒凹时需通过外科手术修整。64Relining 义齿支持组织的修整（重衬）Occlusion adjustment 旧义齿的咬合调整Maxillofacial muscle training 颌面部肌肉训练Preparing treatmentNon-Surgery treatment652. Impression and Cast for theedentulous ridges印模和模型Maki

29、ng accurate impression(1) Anatomic landmarks well be recorded(2) Appropriate border extension (3) Good border molding (4) No voids and wrinklesRequirements67Making accurate impressionBorder extension68印模材料非弹性材料弹性材料水胶体琼脂藻酸盐不含水的弹性体聚硫橡胶硅橡胶印模膏氧化锌丁香酚聚醚橡胶Classification of all impression materialsMaking ac

30、curate impression69(1) Alginate （藻酸盐） for prelimiary and final impression(2) Rubber based elastic material: silicon （硅橡胶） for preliminary, final impression for border molding(3) Impression compound （印模膏） for preliminary impression and border moldingImpression Materials for edentulous jawMaking accur

31、ate impression Should correspond to denture-bearing tissues Must fit tuberosities and profile of ridge Making accurate impressionEvaluating the Tray71Stock TrayCustom Tray72Making accurate impressionImpression techniques(1) 一次印模法 Poor accuracy!(2) 二次印模法 Technique of secondary impression Anatomic imp

32、ression （解剖式印模） - Static，no pressure Functional impression （功能性印模） - With pressure 1. Preliminary impression 2. Custom tray 3. Border molding 4. Final impressionMaking accurate impressionSecondary impression by using custom tray731. Preliminary Impression An impression made for the purpose of making

33、 a preliminary cast which is used for diagnosis and/or fabrication of a custom impression tray. 74Important first step Should as accurate as possible Select an impression material that has a relatively high viscosity. (alginate , compound)751. Preliminary ImpressionCover all the necessary landmarks

34、of edentulous alveolar ridge2-3 mm of clearance should exist between the tray and ridge to allow space for the impression material. Modified the tray with soft boxing wax if necessarySelection of Stock Tray1. Preliminary ImpressionMaxillary Impressiona. incisive papillab. palatal rugaec. median pala

35、tine raphed. maxillary tuberositye. pterygomaxillary notchf. fovea palatini and vibrating line areag. buccal spaceh. zygomatic processi. residual alveolar ridgej. buccal frenumk. labial frenum 1. Preliminary Impression77Mandible Impression a. labial frenumb. residual alveolar ridgec. retromolar padd

36、. lingual frenume. mylohyoid (interior oblique line)f. external oblique lineg. buccal frenumh. masseteric notch 1. Preliminary Impression78(1) Mark the border with indelible pen(2) Pour artificial stone to get preliminary cast2. Preliminary Cast3. Custom Tray Made from preliminary cast Advantageadap

37、ts to the contours of alveolar ridge with borders approximating the outline of the complete denture 80Step 1. Outline the boarder of the preliminary castStep 2. Block out undercuts3. Custom Tray81Step 3. Apply separating medium to the castStep 4. Adapt custom tray material on the castStep 5. Trim of

38、f excess materialStep 6. Add tray handleStep 7. Self-cure or light-cure Step 8. Adjust and polish4. Border Molding The technique for correctly extending the flanges of a custom impression tray using a soft but slightly viscous impression material that becomes at least semi-rigid as it cools, or polymerizes. Definition To determine the contours, height and width of the borders of the completed dentureObjective5. Final impressionMaking accurate impressionSecondary impression by using compound83Checklist for Final Impression(1) All necessary anatomic landmarks