第四章牙列缺损的固定义齿修复课件.ppt

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1、第十三章第十三章 固定固定桥桥 Chapter four Fixed Partial Chapter four Fixed Partial Denture(Fixed bridge)Denture(Fixed bridge)第一节第一节 概述概述 Section One SummarizeSection One Summarize一、定义一、定义(Definition)Definition)牙列缺损是指牙列中的部分牙齿缺失牙列缺损是指牙列中的部分牙齿缺失(Dental arch deficiency:Dental(Dental arch deficiency:Dental arch with

2、some teeth missing)arch with some teeth missing)Dental arch deficiencytooth defaultTooth defaultDental arch missingDental arch missing二、病因二、病因(PathogenyPathogeny)龋病、根尖周病、牙周病、外伤、龋病、根尖周病、牙周病、外伤、颌骨疾病、发育障碍等。颌骨疾病、发育障碍等。(Caries(Caries、Apical disease Apical disease、PeriodonticalPeriodontical disease diseas

3、e、Trauma Trauma、Maxillary and Maxillary and Mandibular disease Mandibular disease、AnodontiaAnodontia etc.)etc.)CariesApical diseaseApical diseasePeriodonticalPeriodontical disease disease、TraumaTraumaAnodontiaAnodontia三、牙列缺损的影响三、牙列缺损的影响1 1 1 1咀嚼功能减退咀嚼功能减退咀嚼功能减退咀嚼功能减退(MasticatoryMasticatoryMasticator

4、yMasticatory function decrease)function decrease)function decrease)function decrease)2 2 2 2牙周组织病变牙周组织病变牙周组织病变牙周组织病变(PeriodonticalPeriodonticalPeriodonticalPeriodontical disease)disease)disease)disease)3 3 3 3发音功能障碍发音功能障碍发音功能障碍发音功能障碍(Pronunciation obstacle)(Pronunciation obstacle)(Pronunciation obst

5、acle)(Pronunciation obstacle)4 4 4 4影响美观影响美观影响美观影响美观(Esthetic(Esthetic(Esthetic(Esthetic effectioneffectioneffectioneffection)5 5 5 5对颞下颌关节的影响对颞下颌关节的影响对颞下颌关节的影响对颞下颌关节的影响(affect on(affect on(affect on(affect on TemporomandibularTemporomandibularTemporomandibularTemporomandibular joint-joint-joint-joi

6、nt-TMJ)TMJ)TMJ)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-establishing the occlusal plane,an occlusal interference m

7、ay 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四、牙列缺损的修复方式 (Prosthesis tapes)(Prosthesis tapes)1 1固定义齿固定义齿（fixed partial denturefixed partial denture）利用缺牙间隙两端或一端的天然牙为支持，利用缺牙间隙两端或一端的天然牙为支持，通过其

8、上的固位体将义齿粘固于基牙上，患通过其上的固位体将义齿粘固于基牙上，患者不能自行摘戴。者不能自行摘戴。(retainer connect with(retainer connect with ponticpontic and fixed to abutment)and fixed to abutment)因其结构类似工程桥梁结构，故又称固定因其结构类似工程桥梁结构，故又称固定桥桥（fixed bridgefixed bridge）。fixed partial denturefixed partial denture 2 2可摘局部义齿可摘局部义齿removable partial dentur

9、e removable partial denture 3 3固定活动联合修复体固定活动联合修复体 （fixed-removable partial denturefixed-removable partial denture）4 4种植义齿种植义齿 (ImplantalImplantal partial denturepartial denture)五、固定义齿的特点五、固定义齿的特点1 1义齿所受的合力通过基牙全部传义齿所受的合力通过基牙全部传导至牙周支持组织，其传导方式类导至牙周支持组织，其传导方式类似天然牙。似天然牙。（occlusal force-abutment-occlusal

10、force-abutment-periodontal tissueperiodontal tissue）2 2义齿咀嚼效率高。义齿咀嚼效率高。(efficiency mastication)(efficiency mastication)3 3义齿舒适、无异物感。义齿舒适、无异物感。(comfortable.(comfortable.noneyewinkernoneyewinker)4 4 4 4修复后功能活动障碍少。修复后功能活动障碍少。修复后功能活动障碍少。修复后功能活动障碍少。(less function disturb)(less function disturb)(less func

11、tion disturb)(less function disturb)5 5 5 5切割牙体组织较多。切割牙体组织较多。切割牙体组织较多。切割牙体组织较多。(more cut dental tissue)more cut dental tissue)more cut dental tissue)more cut dental tissue)6 6 6 6不易自洁。不易自洁。不易自洁。不易自洁。(not easy to(not easy to(not easy to(not easy to selfcleanselfcleanselfcleanselfclean)7 7 7 7适应范围小。适应

12、范围小。适应范围小。适应范围小。(strict indication)(strict indication)(strict indication)(strict indication)六、固定桥和可摘局部义齿的比较comparison of fixed bridge and removable partial denture1、固定桥的优点（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。修复后

13、功能活动障碍少。(less function disturb)less function disturb)（6 6）美观（美观（aestheticaesthetic）（7 7）使用方便（使用方便（convenientconvenient）2、可摘局部义齿的优点l（1）牙体切割少（）牙体切割少（less cut dental tissue）l（2）制作简单，容易修改（制作简单，容易修改（easy to fabricate and amend）l（3）容易清洁（容易清洁（easy to clean）固定桥的发展历程development history第二节第二节固定义齿的组成和分类固定义齿的组成

14、和分类(Section two:(Section two:Components and Components and Types of FPDTypes of FPD)一、组成一、组成(Components)Components)由固位体、桥体、连接体三部分由固位体、桥体、连接体三部分组成，它支持和固定在基牙上形成一组成，它支持和固定在基牙上形成一个整体行使功能。个整体行使功能。(retainer、pontic、connector、abutmentabutment)The components of a fixed partial denture.（一）固位体（一）固位体（retainerre

15、tainer）是在基牙上制作全冠是在基牙上制作全冠(full crown)(full crown)、部分冠部分冠(partial crown)(partial crown)、桩冠、桩冠(post crown)(post crown)、嵌体、嵌体(inlay or(inlay or onlayonlay)等。与桥体等。与桥体(ponticpontic)相连。相连。（二）桥体（二）桥体（ponticpontic）即人工牙，是固定义齿修复缺失即人工牙，是固定义齿修复缺失牙的形态和功能的部分。牙的形态和功能的部分。（三）连接体（三）连接体（connectorconnector）连接桥体连接桥体(pon

16、ticpontic)与固位体与固位体(retainer)(retainer)的部分称为连接体。的部分称为连接体。1 1固定连接固定连接体体（rigid connectorrigid connectorrigid connectorrigid connector）用焊接用焊接(soldering)(soldering)或整体铸造或整体铸造法法(casting)(casting)形成的连接体。固位形成的连接体。固位体和桥体之间不能活动。体和桥体之间不能活动。2 2活动连接体活动连接体（non-rigid connectornon-rigid connectornon-rigid connector

17、non-rigid connector）固位固位体体(retainer)(retainer)和桥体和桥体(ponticpontic)之间通过一种栓道之间通过一种栓道(attachment)(attachment)或或关关节节(joint)(joint)相连，形成一可活动相连，形成一可活动（non-rigid)的连接体的连接体(connector)(connector)。二、固定义齿的类型二、固定义齿的类型l双端固定桥双端固定桥（rigidly fixed bridgerigidly fixed bridge）（完全固定桥完全固定桥 complete fixed bridgecomplete f

18、ixed bridge；fixed-fixed bridgefixed-fixed bridge）l半固定桥半固定桥（semi-fixed bridgesemi-fixed bridge）（应力中断式桥应力中断式桥 broken-stress fixed bridgebroken-stress fixed bridge）l单端固定桥单端固定桥（free-end fixed bridgefree-end fixed bridge）（悬臂固定桥悬臂固定桥 cantilever bridgecantilever bridge）l复合固定桥复合固定桥（compound fixed bridgecomp

19、ound fixed bridge）l种植固定桥种植固定桥（implant fixed bridgeimplant fixed bridge）l固定可摘联合固定桥固定可摘联合固定桥 （fixed-removable combined bridgefixed-removable combined bridge）l粘结固定桥粘结固定桥（adhesive fixed bridgeadhesive fixed bridge）CAD/CAM固定桥(computer aided design-computer associated manufacture)第三节第三节固定义齿的适应证固定义齿的适应证(In

20、dications)l1.缺牙的数目缺牙的数目(Numberofteethmissing)l2.缺牙的部位缺牙的部位(Areaofteethmissing)l3.基基牙牙的的条条件件(Condition of abutmentteeth)The optimum crown-root ratio for a fixed partial denture 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 simil

21、ar,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 root is essentially circular in cross section.The molar with divergent roots(A)will be a better abutment tooth than one whose roots ar

22、e 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 respective tooth and the root surface area of the smallest tooth in the arch,the lateral incisor(based on data by Jepsen).Comparative root surface

23、 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 area of the smallest tooth in the arch,the central incisor(based on data by Jepsen).第三节第三节固定义齿的适应证固定义齿的适应证(Indications)l4.咬合关系咬合关系(Occlussion)

24、l5.缺缺牙牙区区牙牙槽槽嵴嵴的的条条件件(Condition ofedentulousalveolarridge)l6.年龄年龄(Age)l7.口腔卫生情况口腔卫生情况(Oralhygiene)l8.余余 留留 牙牙 的的 情情 况况(Condition of themaintainedteeth)第三节第三节固定义齿的适应证固定义齿的适应证(Indications)l9.患者的要求和口腔条件的一致性患者的要求和口腔条件的一致性（consistency of patients demand and oral condition）l10.适应症的掌握（适应症的掌握（indication mastery）