第四章牙列缺损的固定义齿修复课件.ppt

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1、第十三章 固定桥 Chapter four Fixed Partial Denture(Fixed bridge),第一节 概述 Section One Summarize,一、定义(Definition),牙列缺损是指牙列中的部分牙齿缺失(Dental arch deficiency:Dental arch with some teeth missing),Dental arch deficiency,tooth default,Tooth default,Dental arch missing,Dental arch missing,二、病因(Pathogeny),龋病、根尖周病、牙周病、

2、外伤、颌骨疾病、发育障碍等。(Caries 、Apical disease 、 Periodontical disease 、Trauma 、Maxillary and Mandibular disease 、Anodontia etc.),Caries,Apical disease,Periodontical disease 、,Trauma,Anodontia,三、牙列缺损的影响,1咀嚼功能减退(Masticatory function decrease)2牙周组织病变(Periodontical disease)3发音功能障碍(Pronunciation obstacle)4影响美观(E

3、sthetic effection)5对颞下颌关节的影响(affect on Temporomandibular joint-TMJ),Tooth position and alignment are maintained, in part, by interaction between teeth(arrows).,When a tooth is removed, adjacent teeth often migrate into the vacated space.,If a fixed partial denture is fabricated without first re-esta

4、blishing the occlusal plane, an occlusal interference may be created(arrow).,Occlusion is properly restored by correction of the occlusal plane in conjunction with placement of a fixed partial denture.,四、牙列缺损的修复方式 (Prosthesis tapes),1固定义齿（fixed partial denture） 利用缺牙间隙两端或一端的天然牙为支持，通过其上的固位体将义齿粘固于基牙上，患

5、者不能自行摘戴。(retainer connect with pontic and fixed to abutment ) 因其结构类似工程桥梁结构，故又称固定桥（fixed bridge） 。,fixed partial denture,2可摘局部义齿removable partial denture,3固定活动联合修复体 （fixed -removable partial denture）,4种植义齿 (Implantal partial denture),五、固定义齿的特点,1义齿所受的合力通过基牙全部传导至牙周支持组织，其传导方式类似天然牙。 （occlusal force-abutm

6、ent-periodontal tissue）2义齿咀嚼效率高。 (efficiency mastication)3义齿舒适、无异物感。 (comfortable.noneyewinker),4修复后功能活动障碍少。 (less function disturb)5切割牙体组织较多。 (more cut dental tissue)6不易自洁。 (not easy to selfclean)7适应范围小。 (strict indication),六、固定桥和可摘局部义齿的比较comparison of fixed bridge and removable partial denture,1、固

7、定桥的优点,（1）固位作用好（good retention）（2）支持作用好（good sustenance）（3）稳定作用好（good stability）（4）义齿舒适、无异物感。 (comfortable.noneyewinker)（5）修复后功能活动障碍少。 (less function disturb)（6）美观（aesthetic）（7）使用方便（convenient）,2、可摘局部义齿的优点,（1）牙体切割少（less cut dental tissue）（2）制作简单，容易修改（easy to fabricate and amend ）（3）容易清洁（easy to clean

8、）,固定桥的发展历程development history,第二节固定义齿的组成和分类(Section two :Components and Types of FPD ),一、组成(Components),由固位体、桥体、连接体三部分组成，它支持和固定在基牙上形成一个整体行使功能。(retainer、pontic、connector 、abutment ),The components of a fixed partial denture.,（一）固位体（retainer）,是在基牙上制作全冠(full crown)、部分冠(partial crown)、桩冠(post crown)、嵌体(

9、inlay or onlay)等。与桥体(pontic)相连。,（二）桥体（pontic）,即人工牙，是固定义齿修复缺失牙的形态和功能的部分。,（三）连接体（connector）,连接桥体(pontic)与固位体(retainer)的部分称为连接体。,1固定连接体（rigid connector）,用焊接(soldering)或整体铸造法(casting)形成的连接体。固位体和桥体之间不能活动。,2活动连接体（non-rigid connector）,固位体(retainer)和桥体(pontic)之间通过一种栓道(attachment)或关节(joint)相连，形成一可活动（non-rigi

10、d)的连接体(connector)。,二、固定义齿的类型,双端固定桥（rigidly fixed bridge） （完全固定桥 complete fixed bridge； fixed-fixed bridge）,半固定桥（semi-fixed bridge） （应力中断式桥 broken-stress fixed bridge）,单端固定桥（free-end fixed bridge） （悬臂固定桥 cantilever bridge）,复合固定桥（compound fixed bridge）,种植固定桥（implant fixed bridge）,固定可摘联合固定桥 （fixed-remo

11、vable combined bridge）,粘结固定桥（adhesive fixed bridge）,CAD/CAM固定桥(computer aided design-computer associated manufacture),第三节 固定义齿的适应证(Indications),1. 缺牙的数目(Number of teeth missing)2. 缺牙的部位(Area of teeth missing)3. 基牙的条件(Condition of abutment teeth),The optimum crown-root ratio for a fixed partial dentu

12、re abutment is 2:3(A). A ratio of 1:1(B) is the minimum that is acceptable.,Although the root surface area of these teeth is similar, the root configuration of the maxillary premolar(A),with its greater faciolingual dimension, makes it a superior abutment to the maxillary central incisor(B), whose r

13、oot is essentially circular in cross section.,The molar with divergent roots(A) will be a better abutment tooth than one whose roots are fused(B).,Comparative root surface areas of maxillary teeth. The figure in parentheses above each tooth is the ratio between the root surface area of the respectiv

14、e tooth and the root surface area of the smallest tooth in the arch, the lateral incisor (based on data by Jepsen).,Comparative root surface areas of mandibular teeth. The figure in parentheses above each tooth is the ratio between the root surface area of the respective tooth and the root surface a

15、rea of the smallest tooth in the arch, the central incisor (based on data by Jepsen).,第三节 固定义齿的适应证(Indications),4. 咬合关系(Occlussion)5. 缺牙区牙槽嵴的条件(Condition of edentulous alveolar ridge)6. 年龄(Age)7. 口腔卫生情况(Oral hygiene)8. 余留牙的情况(Condition of the maintained teeth ),第三节 固定义齿的适应证(Indications),9. 患者的要求和口腔条件的一致性（consistency of patients demand and oral condition）10. 适应症的掌握（indication mastery）,