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2012. February
中華民國贋復牙科學會 會訊
小編輯的話
龍年到了!在此恭祝各位新年愉快,龍馬精神!聽說這次的會
訊有可能是紙本會訊的最後一次,所以顯得格外珍貴喔! 不過,本著
傳遞訊息交流情感的宗旨,本期會刊一樣希望讓您在新春滿足口腹
之慾之外,也能有滿滿的精神糧食補充!內容除了中國中榮的病例
討論會精華外還有精采扎實的學術文章。 一百年下半年的學會活動
沸沸揚揚,上海亞太口腔 復學會的熱烈參與,儘管因為主辦國在
內地而有些名稱上的爭議,但本學會三十多人的參訪亦宣示了台灣
參與國際學術活動的決心與毅力;第六十六次學術研討會暨年會於
十一月十九、二十日舉辦,大會花絮更是讓人目不暇給,秘書長與
學術委員賣力鼓吹招攬,並集合台美精銳加上各位的熱情參加才能
促成這次年會的成功!新的一年學會總部也換了個全新風貌,歡迎
會員都來坐坐。在此筆者許個願望希望大家都有更美好的展望與躍
進,心想事成!大家一起加油囉!
小編輯 鄭鈞仁
中華民國贋復牙科學會/ The Academy of Prosthetic Dentistry, Republic of China2
病例討論專欄
█術前口外照片
█病例特色:正顎手術後全口假牙重建
█口外檢查
TMJ and mandibular range of motion
● MMO = 60mm(from upper edentulous ridge around 11 to lower edentulous ridge around 41)
● 31,41 Extracted & socket preservation and pontic-relined at 31,41 region
● 15,13,12,11,21,22,23-27,35-37,32-42 full ceramic crowns/FPDs
● � e patient rejected the implant surgery, so dental implant option was excluded.
Removal of old provisional restorations and Extraction of 31,41
The Academy of Prosthetic Dentistry, Republic of China/中華民國贋復牙科學會 27
病例討論專欄
Fabrication of new provisional crown /FPDs:#15,13,12,11,21,22,23-25,27,35-37,32-42 after removal of marginal and internal caries of 13,12,21,22,23,25 and Extraction of 31,41
Smiling view with new provisional FPDs
Occlusion adjustment until she felt comfortable and no interference
中華民國贋復牙科學會/ The Academy of Prosthetic Dentistry, Republic of China28
病例討論專欄
Incisal, midline adjustment
Adjustment stage
After the occlusion was satisfied and the soft tissue became stable without bleeding on probing. . . Ready for final impression taken.
Re-check the space for crown/FPDs
The Academy of Prosthetic Dentistry, Republic of China/中華民國贋復牙科學會 29
病例討論專欄
Final impression for master casts
Final impression for master casts
Full wax-up with resin-wax coping
Wax-up copings try-in and adjustment
中華民國贋復牙科學會/ The Academy of Prosthetic Dentistry, Republic of China30
病例討論專欄
Duplicate the morphology of wax pattern and transfer to new provisional FPDs
Try in the new provisional FPD/crowns and adjustment
The Academy of Prosthetic Dentistry, Republic of China/中華民國贋復牙科學會 31
病例討論專欄
Centric occlusion
Right excursion
Protrusion
Duplicate the anterior guidance to fabricated the customized incisal table
Left excursion
中華民國贋復牙科學會/ The Academy of Prosthetic Dentistry, Republic of China32
病例討論專欄
Color matching
Fabrication of zirconia copings
The Academy of Prosthetic Dentistry, Republic of China/中華民國贋復牙科學會 33
病例討論專欄
Zirconia copings try-in and check bite
Completion of FM all-ceramic FPDs
中華民國贋復牙科學會/ The Academy of Prosthetic Dentistry, Republic of China34
病例討論專欄
Delivery of FM All-ceramic FPDs
Right excursion
Left excursion
Protrusion
The Academy of Prosthetic Dentistry, Republic of China/中華民國贋復牙科學會 35
病例討論專欄
█完成後口外觀
Follow up 8 Ms later
Follow up 8 Ms later
中華民國贋復牙科學會/ The Academy of Prosthetic Dentistry, Republic of China36
病例討論專欄
Follow up 15 Ms later
Follow up 8 Ms later
The Academy of Prosthetic Dentistry, Republic of China/中華民國贋復牙科學會 37
病例討論專欄
Follow up 17 Ms later
█術前術後比較
中華民國贋復牙科學會/ The Academy of Prosthetic Dentistry, Republic of China38
病例討論專欄
Q
Q
Q
Q
A
A
A
A
#21至#23 gingival line 較高位,有考慮解
決方式?
#21牙齒是歪斜的,以臨時義齒改變牙齒型
態並求中線對正。前牙gingival line右低左
高,曾考慮牙周手術解決,但評估後因為
periodontal root coverage 效果不好故而沒有
考慮手術。
有無考慮請病人配戴咬合板?
基於保護 復物立場應該製作,但病人說有戴了會失眠經驗所以沒有
意願做,不過會密切追蹤回診。
#25,#27為何要splinting?不splinting會怎樣?
第一組臨時義齒是兩顆牙齒分開,但因為兩者之occlusal table會加長
而增加受力時的offset,牙齒因而產生mobility; 之後將兩者splinting,
mobility 減少故而最後選擇splinting。
主模送去scanning & milling時die是切開狀態與否?會有何影響?
是切開的,不過每個die起碼有兩支pins。再則,另外將製作好的全瓷
牙冠copings 再置放回未切成die 的master cast上做recheck的動作。因
為矯正過後的牙齒仍會有位移的情況,這也可能是造成過程中#23-25-27牙橋重做的原因。
The Academy of Prosthetic Dentistry, Republic of China/中華民國贋復牙科學會 39
2. Torricel li P, Verne E, et al . Biological glass coating on ceramic mater ial s: in v itro evaluat ion using pr imar y osteoblast cultures from health and osteopenic rat bone. Biomaterials,22:2535-43,2001.
3. Rimondini L, Cerroni L, et al. Bacterial colonization of zirconia ceramic surfaces: an in vitro and in vivo study. Int J Oral Maxillofac Implants,17:793-8,2002.
4. Scotti R Kantorski KZ, et al. SEM evaluation of in situ early bacterial colonization on a Y-TZP ceramic: A pilot study. In J Prosthodont, 20:419-22,2007.
5. Denry I, Kelly R. State of art of Zirconia for dental applications. Dent Mater,24:299-307,2008.
6. Guazz ato M , A l bakr y M , et a l . Inf luence of g r iding , sandblasting , polishing and heat treatment on the flexural strength of a glass-in�ltrated alumina-reinforced dental ceramic. Biomaterials,25:2153-60,2004.
7. Guazzato M, Albakry M, et al. Strength, fracture toughness and microstructure of a selection of all-ceramic.Part II.Zirconia-based dentalceramic. Dent Mater,20:449-56,2004.
8. Sundh A, Sjogren G. Fracture resistance of all ceramic zirconia bridges with di�ering phase stabilizers and quality of sintering. Dent Mater,22:778-84,2006.
9. Hisbergues M, Venderville S. et al. Zirconia: established facts and perspectives for a biomaterial in dental implantology. J Biomed Mater Res B Appl Biomater,88:519-29,2009.
10. Heuer AH, Claussen N. et al. Stability of tetragonal ZrO2 particles in ceramic matrices. J Am Ceram Soc,65:642-50,1982.
11. Kosmac T, Oblak G. et al. Strength and reliability of surface treated Y-TZP dental ceramics. J Biomed Mater Res,53:304-13,2000.
12. Sundh A, Molin M, Sjogren G. Fracture resistance of yttrium oxide partially-stabilized zirconia all ceramic bridges after veneering and mechanical fatigue testing. Dent Mater, 21:476-82,2005.
13. Lughi V, Sergo V. Low temperature degradation-aging-of zirconia: a critical review of the relevant aspects in dentistry. Dent Mater,26:807-20,2010.
14. Kelly JR, Denry I. Stabilized zirconia as a structural ceramic: an overview. Dent Mater,24:289-98,2008.
15. A� W, Grigoriadou M, Strub JR. ZrO2 three-unit �xed partial dentures: comparison of failure load before and a�er exposure to a mastication stimulator. J Oral Rehabil,34:282-90,2007.
16. Kosmac K , Oblak C. et al. The effect of surface grinding and sandblasting on flexural strength and reliability of Y-TZP zirconia ceramic. Dent Mater.15:426-433,1999.
17. Luthardt RG, Holzhuter M. et al. Reliability and properties of ground Y-TZP-zirconia ceramics. J Dent Res,81:487-91,2002.
18. Zhang Y, Law n B. Long-term strength of ceramic for biomedical applications. J Biomed Mater Res B A ppl Biomater.69:166-72,2004.
19. Zhang Y, Lawn B.et al. E�ect of sandblasting on the long term performance of dental ceramic. J Biomed Mater Res B Appl Biomater.7:381-6,2004.
20. Sailor I, Feher A. et al. Five-year clinical results of zirconia frameworks for posterior f i xed partial dentures. Int J Prosthodont.20:383-388,2007.
21. Reich S. Kappe K . et al. Clinical f it of four-unit zirconia posterior fixed dental prostheses. Eur J Oral Sci.116:579-584,2008.
22. McLean JW, von Fraunhofer JA. �e estimation of cement �lm thickness by an in vivo technique. Br Dent J.131:107-111,1971.
23. Guess PC, Kulis A, Witkowski S, Wolkewitz M, Zhang Y and Strub JR : Shear bond strengths between different zirconia cores and veneering ceramics and their susceptibility to thermocycling. Dent Mater. 24(11):1556-67,2008.
24. Vult von Steyern P, Carlson P and Nilner K : All-ceramic fixed partial dentures designed according to the DC-Zirkon technique. A 2-year clinical study. J Oral Rehabil 32: 180-7,2005.
25. Raigrodski AJ, Chiche GJ and Potiket N: The efficacy of posterior three-unit zirconium-oxide based ceramic �xed partial dental prosthesis: a prospective clinicalpilot study. J Prosthet Dent 96:237-44,2006.
26. Va l d er haug J. A 1 5 -year c l i n i ca l e v a l u at i o n o f f i x e d prosthodontics. Acta Odontol Scand 49:35-40,1991.
27. Guess P, Schultheis S. et al. All-ceramic systems: Laboratory and clinical performance. Dent Clin N Am 55:333-352,2011.
Materials Modulus (GPa)
Hardness (GPa)
Toughness (MPa m½)
Strength(MPa)
CTE(x10-6℃)
Firing(℃)
Cercon 210 12 9 1300 10.5 1350
IPS e.max Zir CAD 210 13 5.5 900 10.8 1500
Lava 210 14 5.9 1048 10.5 1480
In-ceram YZ 210 12 5.9 >900 10.5 2760 melting point
Procera Zirconia 210 14 6 1200 10.4 1550
表一:不同廠牌氧化鋯全瓷冠的物理性質27
中華民國贋復牙科學會/The Academy of Prosthetic Dentistry, Republic of China56
The Academy of Prosthetic Dentistry, Republic of China/中華民國贋復牙科學會 57
課後筆記
Spread 在1:1.5以內、⑶謹慎使用在Class III患者
上...等,均有助於降低側方力對植體的威脅。此
外,想理上,Hybrid需要13mm左右的 復空間。
太少則可能須考慮使用FPD來治療,較為適當。
傳統的治療流程,最令人頭痛的地方,主
要在於⑴繁瑣而重複的治療步驟、⑵鑄造大金
屬支架所產生的miss fit,需要(數次)section and
solder以達到Passive fit。在本次報告中,作者使用
了特製的Custom tray,運用Close tray impression的方
法(類似reline)把植體的位置、角度,軟組織,
咬合高度,上下顎關係,Lip support,Esthetics 同
時紀錄在一個impression;並應用brush and bead
technique 作支架鑄造的 veri�cation jig ;如此可以避
免臨床上因支架miss �t 而需要的section and solder,
並把整個流程簡化,從接上Abutments 起,大概
只需要三次門診(步驟)(1.取模,作 verification
jig,上咬合器;2. 蜡型試戴;3. 完成裝置),即
可完成。
同時,在北醫盧威佐醫師的幫助及陳玫秀主
任的指導下,我們亦嚐試把Hybrid的組織面,由
傳統的金屬或樹脂,改為粉紅瓷,如此一來,不
但改善了美觀,並著減少牙菌斑及結石的堆積。
雖然,新的治療流程與 復體的設計,均達
到作者原先的預期效果,並有令人滿意的治療
結果;但仍需要更多的臨床資料,以確認其穩定
性,以取代傳統Hybrid洽療方式。
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