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prothodontic treatment (approach (force distribution
防止骨吸收 (Cantilever…
prothodontic treatment
種類
complete denture全口假牙
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假牙+ implant restoration植體
沒有本體受器, 小心受力過大(側方 垂直力)group function
approach
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jaw relation(pure rotation, reproducible)
CR: 無後牙, 改變咬合高度, 全口重建 (關節相關)(缺牙多 全口假牙)
MI: 單顆少數牙重建, 垂直高度咬合狀況不變(牙齒相關)(FPD, 缺牙數少)
jaw movement
anterior guidance 下顎運動接觸點都在前牙, 後牙分開 優先選擇
mutual protection(protect condyle reduce tension側方運動前牙支撐, 上下顎咬緊後牙支撐)
easy fabrication, ant teeth presence, custom inccisal table
group function 前牙接觸不到(無犬齒, 暴牙 戽斗)減少後牙承受的側方力
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occlusal anatomy
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immediate side shift groove width 設定適當 groove width
若沒有設定好 cement loss, fremitus , heavy contact, 牙齒鬆動PDL變寬 TMJ問題
force distribution
防止骨吸收
Cantilever effect 懸臂式牙橋, 粗短受到壓力小 避免 後牙 strong anterior 懸臂牙橋
減輕單顆牙承受壓力 reduced direct impaction on isolated tooth
cross-arch, Ante's law(支撐牙面積>失去牙面積), equal distributed occlusal contact, 好的guidance, 減少occlusal table size, 不要有懸臂現象
減少植體所受垂直壓力 reduce verticcal overload on implant
減少 咬合接觸咬合面積 不要懸臂, 周圍有自然牙
減輕植體受的側向力 reduce lateral force on implant
讓咬點咬在植體垂直柱內, 防止側方力(真的有用多棵植體一起承受)
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clinical procedure
mounting study cast in CR-Lucia Jig tenique
test odf raised VDO(applying occlusion splint)
diagnostic wax up and making provisionals
toot preparation and making final impression
facebow transfer and making CR bite record
framework try-in and confirm CR bite record
final delivery
有牙病患全口重建最難
因為單牙齦能忍受誤差大, 若有牙齒其咬合不對, 只能透過關節位置去製作假牙以及正確咬合
步驟:
establishong a new VDO
plot border movement of jaw
find true Hinge axis
kinetic facebow transfer
CR record
用pano tracing 把病患下顎運動轉移到fully adjustable articulator上