種植體支持的修復(fù)體

Implant-supportedprosthesis種植體支持的修復(fù)體

Implant-supported種植體及修復(fù)理解

(UnderstandingtheImplantandProsthesis)

一體式基臺(tái)One-pieceAbutment分體式基臺(tái)Two-pieceAbutment內(nèi)部：六角Theinterior:HEX-shapedCombiDual種植體及修復(fù)理解

(Understandingthe種植修復(fù)體制備順序

(Sequenceofimplantprosthesis)臨床圖片(Clinicside)技工室圖片(Lab.Side)二期手術(shù)(Secondsurgery)取印模(Impression)制備工作模型，選擇基臺(tái)(ManufacturingmodelsChooseAbutment)咬合記錄(Bonnet

forjawRelationrecord)定位輔件(PositioningJig)種植修復(fù)體制備順序

(Sequenceofimpl咬合記錄(Jawrelationrecord)最終修復(fù)體(Deliveryofprosthesis)Mounting制作修復(fù)體(Fabricationofprosthesis)種植修復(fù)體制備順序

(Sequenceofimplantprosthesis)臨床圖片(Clinicside)技工室圖片(Lab.Side)種植修復(fù)體制備順序

(Sequenceofimpla基臺(tái)種類(TypesofAbutment)

一體式基臺(tái)(CombiAb.)分體式基臺(tái)(DualAb.)分體式可研磨基臺(tái)(DualmillingAb.)直接可鑄造基臺(tái)(DereactcasingAb.)角度基臺(tái)(AngledAb.)螺栓固位型基臺(tái)(ScrewAb.)臨時(shí)基臺(tái)(TemporaryAb.)基底(Cylinder)基臺(tái)種類(TypesofAbutment)

一一體式(Combi)分體式(Dual)植入位置理想時(shí)(Whenthepositionofimplantisideal)可在椅旁選擇基臺(tái)(ChoosingabutmentfromChairside)基臺(tái)水平取模(Abutmentlevelimpression)口內(nèi)需要的準(zhǔn)備視情況而定(Preparationrequiredinsidethemouthdependingonthesituation)螺絲不易松動(dòng)(Littlebitofscrewlooseningduetocoldwelding)重新修復(fù)困難(Difficultretrieval)診療時(shí)間長(zhǎng)

(Longchairtime)基臺(tái)水平及種植體水平取模均適用(Abutment

&fixturelevelimpressionallpossible)一般選用種植體水平取模方式(Generallyoperate

fixturelevelimpression)可在模型上選擇基臺(tái)

(Choosingabutmentfrommastermodel)需要定位輔件(PositioningJigrequired)據(jù)患者情況選擇六角或非六角基臺(tái)(DecideonHexedorNon-Hexedaccordingtothepatient’spreference)容易修補(bǔ)

(Easytoprostheticrepair,forretrievalisallowed)診療時(shí)間短

(ShortChairtime!!!)一體式(Combi)分體式(Dual)植入位置理想時(shí)(取模方式：基臺(tái)水平

(Impression

:Abutmentlevel)取模方式：基臺(tái)水平

(Impression:Abu

封閉式(Transfertype)開(kāi)窗式(Pick-uptype)Impressionmaterials:Elasticsiliconerubber(Regularbody)取模方式：種植體水平

(Impression

:Fixturelevel)封閉式(Transfertype)美學(xué)需求(Estheticrequirement)種植角度(Implantangulation)種植位置(Implantlocation)植入深度(穿齦高度)(Fixtureinstallationdepth(GingivalHeight))牙弓間距離(Interarchdistance)修復(fù)類型(Prosthesistype)牙醫(yī)和技工的喜好(Dentist&Dentaltechnician'spreference)DirectcastingAb.+porcelainDualAb.DualmillingAb.AngledAb.

DirectcastingAb.ScrewAb.CombiAb.analogAngled,DualAb基臺(tái)選擇注意事項(xiàng)

(PointstoconsiderinAbutmentSelection)美學(xué)需求(Estheticrequirement)一體式基臺(tái)(Combiabutment)ComportcapLab.analogImpressioncoping☆也可用于即刻負(fù)重或者臨時(shí)冠(Immediate

loadingorprovisionalcrown,alsoallowedwhenmanufacturing)一體式基臺(tái)(Combiabutment)Compo一體式基臺(tái)：病例(Combiabutment:Clinicalcase)☆

ConventionalTechnique:Putcordandimpressionpossible1.去除愈合基臺(tái)(RemoveHealingAb)2.據(jù)牙齦高度及牙齒間

距選擇適當(dāng)型號(hào)的一

體式基臺(tái)(Condsideringgingivaldepth

andthewidthofthetooth,chooseandequipCombiAb)3.據(jù)頜間距離適當(dāng)切削

使用(ConsiderInterarch

spaceandremoveAb.)取印模，安插方式(ImpressionSnaponTechnique)一體式基臺(tái)：病例(Combiabutment:1.選擇基臺(tái)替代體(ChooseLab.Analog)2.將基臺(tái)替代體連接在轉(zhuǎn)移帽上

(CombinewithImpressioncoping)3.制備工作模型(Manufacturemastermodel)4.制備牙冠(Manufacturecrown)☆

ReductionJigrequiredtoremoveAb.Inthemouth一體式基臺(tái)：病例(Combiabutment:Clinicalcase)1.選擇基臺(tái)替代體(ChooseLab.Analo分體式基臺(tái)(Dualabutment)HexedNon-HexedDing(2003):六角和非六角與螺絲松動(dòng)無(wú)直接關(guān)聯(lián)(HexedandNon-Hexeddon’taffectscrewlooseningmuch)六角僅作為基臺(tái)就位的參考(HexisjustusedasIndexofAbutmentpositioning)分體式基臺(tái)(Dualabutment)Hexed分體式基臺(tái)：病例(Dualabutment:Clinicalcase)分體式基臺(tái)：病例(Dualabutment:Cl分體式基臺(tái)：病例(Dualabutment:Clinicalcase)分體式基臺(tái)：病例(Dualabutment:Cl說(shuō)明(Recommendation)簡(jiǎn)單&容易(Simple&Easy)椅旁時(shí)間少，和傳統(tǒng)治療相似(OnlyasmallamountofChairtimeused,andmustbesimilartoConventionaltreatment)可在技工室選擇和調(diào)整基臺(tái)，對(duì)患者來(lái)說(shuō)比較方便(ChoosingandadjustingAbutmentintheLabisconvenientforthepatient.)REC)

種植體水平封閉式取模(Fixturelevelimpressionbytransfertype)

分體式非六角基臺(tái)(Non-HexedDualAbutment)可修補(bǔ)性(Retrievability)選擇粘接材料(Choosingcementmaterials)對(duì)頰舌粘膜無(wú)刺激(Leaveanotchwithintherangethat’snotstimulatedonthetongueorcheekforhookorejection)ZPC或聚羧酸水門汀(ZPCor

Polycarboxylatecement)結(jié)合粘接固位和螺絲固位的修復(fù)方法(Combinethemethodofcementationandscrewing(SCRC))REC)分體式基臺(tái)：修復(fù)體合面?zhèn)涠?，方便取下并修補(bǔ)修復(fù)體(DualAbutment:Withmakingaholeonocclusionafterrestoration,removeandrepairprosthesis.)說(shuō)明(Recommendation)簡(jiǎn)單&容易(S操作說(shuō)明(Recommendationprocedure)☆UsePositioningJigtotransfertheAbutmentModeltotheoralcavitythentightenit(25~30N.cm).Re-tightenafter15minutes.

☆Whenequippedinthemouthandwhenreboundingbygingivaltissue,holdfor10~15minutes操作說(shuō)明(Recommendationprocedur分體式可研磨/角度/臨時(shí)/直接可鑄造基臺(tái)

(DualMilling/Angled/Temporary/DirectCastingAbutment)

分體式可研磨基臺(tái)(DualmillingAb.)SimilartoDualAb.CreatePathmodificationandoptionalmarginbymilling角度基臺(tái)(AngledAb.(15°))

When

installedpathisunfavorable臨時(shí)基臺(tái)(TemporaryAb.)WhenimmediateloadingAfterprovisionalcrownismanufacturedwhengingival

contouring直接可鑄造基臺(tái)(DirectcastingAb.)ManufactureofIndividualizedabutmentpossible

*螺栓固位型基臺(tái)(Screw

Abutment)分體式可研磨/角度/臨時(shí)/直接可鑄造基臺(tái)

(DualMil臨床病例：直接可鑄造基臺(tái)

(Clinicalcase:DirectcastingAb.)臨床病例：直接可鑄造基臺(tái)

(Clinicalcase臨床病例：分體式可研磨基臺(tái)

(Clinicalcase:DualmillingAb.)臨床病例：分體式可研磨基臺(tái)

(Clinicalcase粘接固位&螺栓固位型修復(fù)

(Cement-retainedVsScrew-retainedprosthesis)粘接固位&螺栓固位型修復(fù)

(Cement-retained軸向負(fù)重(Axialload)

通過(guò)誘導(dǎo)應(yīng)力沿種植體長(zhǎng)軸傳導(dǎo)，粘接固位修復(fù)體可以減少作用在牙槽嵴上的應(yīng)力(Cement-retainedprosthesisreducesstressonalveolarcrestbyinducingittoalongaxisofimplant.)適當(dāng)?shù)拇怪焙狭ψ饔迷谛迯?fù)體上時(shí)，螺栓固位型修復(fù)體力量作用在螺絲孔合方。(Screw-retainedprosthesisisgivenforceonocclusalscrewholeforproperverticalocclusalloadingonprosthesis.)螺絲孔的直徑約為3mm，占后牙咬合面的30%，功能區(qū)的50%，因?yàn)楣δ軈^(qū)占整個(gè)咬合面的2/3(Screwholediameterisabout3mm;itoccupies30%ofocclusalsurfaceonposteriorareaor50%offunctionalareabecauseitisfunctionalareaon2/3ofentireocclusalsurface.)幾乎所有的咬合面螺絲孔都位于長(zhǎng)軸上，即咬合接觸區(qū)上(Almostallpositionofocclusalscrewholeislocatedonlongaxis,whereocclusalcontactoccurs.)螺絲孔須用樹(shù)脂覆蓋并適當(dāng)進(jìn)行調(diào)合(Andthenocclusaladjustmentisachievedonscrewholecoveredwithcompositeresin.)軸向負(fù)重(Axialload)

通過(guò)誘導(dǎo)應(yīng)力沿種植體螺栓固位型修復(fù)體的缺點(diǎn)(Drawbacksofscrew-retainedprosthesis)咬合面材料折斷(Fractureofocclusalmaterial)應(yīng)力集中在螺絲孔上(concentratestressonscrewhole)

修復(fù)體就位困難(Access)患者開(kāi)口度有限，螺絲難于就位，且容易誤咽(Itisdifficulttoaccesswithalimitedmouthopeningpatient.Andonecaneasilyswallowscrewwhilehandlinginstrument.)疲勞(Fatigue)

應(yīng)力作用在修復(fù)體支持結(jié)構(gòu)上，甚至?xí)鸱N植體斷裂

(weightingstressonprostheticsupportingstructureevenbringsaboutfractureofimplant.)螺絲松動(dòng)(Screwloosening)Accordingtoseveralreport,50%ofscrewsofprosthesisonupperdentitionisloosenedatleast1timewithin1yearafterloading.

Dependingonsingleimplantstudy,65%ofscrewslooseningoccurswithin3yearsafterloading.☆Rec)cement-retainedprosthesis螺栓固位型修復(fù)體的缺點(diǎn)(Drawbacksofsc種植修復(fù)注意事項(xiàng)

(Considerationofimplantprosthesis)后牙區(qū)咬合面材料(Occlusalmaterialofposteriorarea)烤瓷？樹(shù)脂？→

金屬(Porcelain?,Resin?→Metalocclusion)樹(shù)脂和烤瓷容易碎裂(Fibrousandhardfood;easilyporcelainandresinchippingorfracture.)須考慮功能紊亂(夜磨牙，緊咬牙)

(parafunction(Bruxism,Clenching)mustconsidered)*Zirconiumcore+porcelain咬合面形態(tài)(Occlusalform)側(cè)方不能有剪切力(Shearstrengthmustnotbeoccurredbylateralforce

)大小和天然牙相似或者略小(Similartonaturalsizeoralittlesmallerthannaturaltooth.)種植修復(fù)注意事項(xiàng)

(Considerationofim生理性的近中移位

(Physiologicmesialdrifting)增齡性咬合面和鄰面磨損，將使天然牙向近中移位(Naturalteethmovetomesialsidebecauseofabrasionofocclusalandinterproximalsurfaceinaging.)

由于骨整合，種植體不會(huì)發(fā)生移位。因此，在鄰接區(qū)容易引起食物嵌塞。為了修補(bǔ)鄰接面，修復(fù)體需要具備可修補(bǔ)性。(Implantcannotbemoved

byosseointegration.Therefore,thereeasilyoccursfoodimpactiononinterproximalarea.

Soretrievabilityofprosthesishastobeeasyinordertorepaircontactsurface.）

生理性的近中移位

(PhysiologicmesialOcclusionofimplant-supportedprosthesis理想合(Idealocclusion)交錯(cuò)保護(hù)合(Mutuallyprotectedocclusion)尖牙保護(hù)合(Canineprotectedocclusion)組牙功能合(Groupfunctionocclusion)平衡合(全口義齒)(

Balancedocclusion(fulldenture))種植體保護(hù)合(Implantprotectedocclusion)避免讓種植修復(fù)體過(guò)載(AvoidaddupoverforceonImplantprosthesis.)Occlusionofimplant-support生物機(jī)械原則

(Biomechanicalprinciples)植入前(Whenshouldimplantbeinstalled)確定種植體數(shù)目、直徑和長(zhǎng)度(Confirmthesufficientnumberofimplant,andconsideritsdiameterandlength.)最理想的種植位點(diǎn)和種植體散布于牙弓上(Optimalimplantpositioninganddistributionindentalarch.)適當(dāng)?shù)慕嵌纫员惴稚⒑狭?Favorableangulationofinstalledimplant

fordistributionofocclusalforce.)修復(fù)前(Whenshouldprosthesisberestorated)正中接觸位于牙冠中心附近(Centric

contactshouldbeneartheadjacentcenterofcrown.)

比天然牙的正中接觸要輕(Slightercontactatcentricthannaturaltooth.)減少種植體牙冠咬合面積，降低牙尖斜度(Reduceocclusalsurfaceofimplantcrownandinclinationofcusp.)去除非正中接觸，減小側(cè)方力(Removeeccentriccontact;Reducelateralforce.)生物機(jī)械原則

(BiomechanicalprinciGeneralocclusionofimplantprosthesis全口缺牙(Fullyedentulous)全骨固定修復(fù)(Fullyboneanchoredprosthesis)交互保護(hù)或組牙功能合(Mutuallyprotectedorgroupfunctionocclusion)覆蓋義齒修復(fù)(Overdentureprosthesis)平衡合(Balancedocclusion)部分缺牙(Partiallyedentulous)前牙固定修復(fù)(Anteriorfixedprosthesis)尖牙保護(hù)或組牙功能(Canineprotectedorgroupfunction)后牙固定修復(fù)(Posteriorfixedprosthesis)尖牙保護(hù)合(Canineprotectedocclusion)含尖牙的固定修復(fù)(Fixedprosthesisisincludedcanine)組牙功能(Groupfunction)Generalocclusionofimpla患者主訴(Complaintofpatient)臨時(shí)修復(fù)體容易脫落(Easilydislodgementattemporarysetting)固位力不足→基臺(tái)選擇？(Insufficient

retention→Abutment

selection

?)功能異常?(Parafunction?)食物嵌塞(Foodimpaction)

牙齦楔狀間隙→控制間隙(Gingivalembrasure→space

control.)

選擇適合牙齦線的基臺(tái)(Abutmentselectionmatchwithgingivalline.)

對(duì)頜牙伸長(zhǎng)(Extrusionofopposingtooth)牙冠過(guò)小(Smallcrown)

Abutmentselectionmatchwith

emergencyprofile.定制基臺(tái)(Customizedabutment(UCLAabutment

orUsemillingabutment))對(duì)頜牙疼痛(Painonanopposingtooth.)無(wú)咀嚼感覺(jué)(Cannotfeelchewingsensation.)容易咬頰、咬舌(Easilybitetongueandcheek.)患者主訴(Complaintofpatient)臨時(shí)修Simpleline:SolidabutmentSimpleline:SolidabutmentSimpleline:MultiPurposeabutment(MPA)Simpleline:MultiPurpose種植體支持的修復(fù)體

Implant-supportedprosthesis種植體支持的修復(fù)體

Implant-supported種植體及修復(fù)理解

(UnderstandingtheImplantandProsthesis)

一體式基臺(tái)One-pieceAbutment分體式基臺(tái)Two-pieceAbutment內(nèi)部：六角Theinterior:HEX-shapedCombiDual種植體及修復(fù)理解

(Understandingthe種植修復(fù)體制備順序

(Sequenceofimplantprosthesis)臨床圖片(Clinicside)技工室圖片(Lab.Side)二期手術(shù)(Secondsurgery)取印模(Impression)制備工作模型，選擇基臺(tái)(ManufacturingmodelsChooseAbutment)咬合記錄(Bonnet

forjawRelationrecord)定位輔件(PositioningJig)種植修復(fù)體制備順序

(Sequenceofimpl咬合記錄(Jawrelationrecord)最終修復(fù)體(Deliveryofprosthesis)Mounting制作修復(fù)體(Fabricationofprosthesis)種植修復(fù)體制備順序

(Sequenceofimplantprosthesis)臨床圖片(Clinicside)技工室圖片(Lab.Side)種植修復(fù)體制備順序

(Sequenceofimpla基臺(tái)種類(TypesofAbutment)

一體式基臺(tái)(CombiAb.)分體式基臺(tái)(DualAb.)分體式可研磨基臺(tái)(DualmillingAb.)直接可鑄造基臺(tái)(DereactcasingAb.)角度基臺(tái)(AngledAb.)螺栓固位型基臺(tái)(ScrewAb.)臨時(shí)基臺(tái)(TemporaryAb.)基底(Cylinder)基臺(tái)種類(TypesofAbutment)

一一體式(Combi)分體式(Dual)植入位置理想時(shí)(Whenthepositionofimplantisideal)可在椅旁選擇基臺(tái)(ChoosingabutmentfromChairside)基臺(tái)水平取模(Abutmentlevelimpression)口內(nèi)需要的準(zhǔn)備視情況而定(Preparationrequiredinsidethemouthdependingonthesituation)螺絲不易松動(dòng)(Littlebitofscrewlooseningduetocoldwelding)重新修復(fù)困難(Difficultretrieval)診療時(shí)間長(zhǎng)

(Longchairtime)基臺(tái)水平及種植體水平取模均適用(Abutment

&fixturelevelimpressionallpossible)一般選用種植體水平取模方式(Generallyoperate

fixturelevelimpression)可在模型上選擇基臺(tái)

(Choosingabutmentfrommastermodel)需要定位輔件(PositioningJigrequired)據(jù)患者情況選擇六角或非六角基臺(tái)(DecideonHexedorNon-Hexedaccordingtothepatient’spreference)容易修補(bǔ)

(Easytoprostheticrepair,forretrievalisallowed)診療時(shí)間短

(ShortChairtime!!!)一體式(Combi)分體式(Dual)植入位置理想時(shí)(取模方式：基臺(tái)水平

(Impression

:Abutmentlevel)取模方式：基臺(tái)水平

(Impression:Abu

封閉式(Transfertype)開(kāi)窗式(Pick-uptype)Impressionmaterials:Elasticsiliconerubber(Regularbody)取模方式：種植體水平

(Impression

:Fixturelevel)封閉式(Transfertype)美學(xué)需求(Estheticrequirement)種植角度(Implantangulation)種植位置(Implantlocation)植入深度(穿齦高度)(Fixtureinstallationdepth(GingivalHeight))牙弓間距離(Interarchdistance)修復(fù)類型(Prosthesistype)牙醫(yī)和技工的喜好(Dentist&Dentaltechnician'spreference)DirectcastingAb.+porcelainDualAb.DualmillingAb.AngledAb.

DirectcastingAb.ScrewAb.CombiAb.analogAngled,DualAb基臺(tái)選擇注意事項(xiàng)

(PointstoconsiderinAbutmentSelection)美學(xué)需求(Estheticrequirement)一體式基臺(tái)(Combiabutment)ComportcapLab.analogImpressioncoping☆也可用于即刻負(fù)重或者臨時(shí)冠(Immediate

loadingorprovisionalcrown,alsoallowedwhenmanufacturing)一體式基臺(tái)(Combiabutment)Compo一體式基臺(tái)：病例(Combiabutment:Clinicalcase)☆

ConventionalTechnique:Putcordandimpressionpossible1.去除愈合基臺(tái)(RemoveHealingAb)2.據(jù)牙齦高度及牙齒間

距選擇適當(dāng)型號(hào)的一

體式基臺(tái)(Condsideringgingivaldepth

andthewidthofthetooth,chooseandequipCombiAb)3.據(jù)頜間距離適當(dāng)切削

使用(ConsiderInterarch

spaceandremoveAb.)取印模，安插方式(ImpressionSnaponTechnique)一體式基臺(tái)：病例(Combiabutment:1.選擇基臺(tái)替代體(ChooseLab.Analog)2.將基臺(tái)替代體連接在轉(zhuǎn)移帽上

(CombinewithImpressioncoping)3.制備工作模型(Manufacturemastermodel)4.制備牙冠(Manufacturecrown)☆

ReductionJigrequiredtoremoveAb.Inthemouth一體式基臺(tái)：病例(Combiabutment:Clinicalcase)1.選擇基臺(tái)替代體(ChooseLab.Analo分體式基臺(tái)(Dualabutment)HexedNon-HexedDing(2003):六角和非六角與螺絲松動(dòng)無(wú)直接關(guān)聯(lián)(HexedandNon-Hexeddon’taffectscrewlooseningmuch)六角僅作為基臺(tái)就位的參考(HexisjustusedasIndexofAbutmentpositioning)分體式基臺(tái)(Dualabutment)Hexed分體式基臺(tái)：病例(Dualabutment:Clinicalcase)分體式基臺(tái)：病例(Dualabutment:Cl分體式基臺(tái)：病例(Dualabutment:Clinicalcase)分體式基臺(tái)：病例(Dualabutment:Cl說(shuō)明(Recommendation)簡(jiǎn)單&容易(Simple&Easy)椅旁時(shí)間少，和傳統(tǒng)治療相似(OnlyasmallamountofChairtimeused,andmustbesimilartoConventionaltreatment)可在技工室選擇和調(diào)整基臺(tái)，對(duì)患者來(lái)說(shuō)比較方便(ChoosingandadjustingAbutmentintheLabisconvenientforthepatient.)REC)

種植體水平封閉式取模(Fixturelevelimpressionbytransfertype)

分體式非六角基臺(tái)(Non-HexedDualAbutment)可修補(bǔ)性(Retrievability)選擇粘接材料(Choosingcementmaterials)對(duì)頰舌粘膜無(wú)刺激(Leaveanotchwithintherangethat’snotstimulatedonthetongueorcheekforhookorejection)ZPC或聚羧酸水門汀(ZPCor

Polycarboxylatecement)結(jié)合粘接固位和螺絲固位的修復(fù)方法(Combinethemethodofcementationandscrewing(SCRC))REC)分體式基臺(tái)：修復(fù)體合面?zhèn)涠?，方便取下并修補(bǔ)修復(fù)體(DualAbutment:Withmakingaholeonocclusionafterrestoration,removeandrepairprosthesis.)說(shuō)明(Recommendation)簡(jiǎn)單&容易(S操作說(shuō)明(Recommendationprocedure)☆UsePositioningJigtotransfertheAbutmentModeltotheoralcavitythentightenit(25~30N.cm).Re-tightenafter15minutes.

☆Whenequippedinthemouthandwhenreboundingbygingivaltissue,holdfor10~15minutes操作說(shuō)明(Recommendationprocedur分體式可研磨/角度/臨時(shí)/直接可鑄造基臺(tái)

(DualMilling/Angled/Temporary/DirectCastingAbutment)

分體式可研磨基臺(tái)(DualmillingAb.)SimilartoDualAb.CreatePathmodificationandoptionalmarginbymilling角度基臺(tái)(AngledAb.(15°))

When

installedpathisunfavorable臨時(shí)基臺(tái)(TemporaryAb.)WhenimmediateloadingAfterprovisionalcrownismanufacturedwhengingival

contouring直接可鑄造基臺(tái)(DirectcastingAb.)ManufactureofIndividualizedabutmentpossible

*螺栓固位型基臺(tái)(Screw

Abutment)分體式可研磨/角度/臨時(shí)/直接可鑄造基臺(tái)

(DualMil臨床病例：直接可鑄造基臺(tái)

(Clinicalcase:DirectcastingAb.)臨床病例：直接可鑄造基臺(tái)

(Clinicalcase臨床病例：分體式可研磨基臺(tái)

(Clinicalcase:DualmillingAb.)臨床病例：分體式可研磨基臺(tái)

(Clinicalcase粘接固位&螺栓固位型修復(fù)

(Cement-retainedVsScrew-retainedprosthesis)粘接固位&螺栓固位型修復(fù)

(Cement-retained軸向負(fù)重(Axialload)

通過(guò)誘導(dǎo)應(yīng)力沿種植體長(zhǎng)軸傳導(dǎo)，粘接固位修復(fù)體可以減少作用在牙槽嵴上的應(yīng)力(Cement-retainedprosthesisreducesstressonalveolarcrestbyinducingittoalongaxisofimplant.)適當(dāng)?shù)拇怪焙狭ψ饔迷谛迯?fù)體上時(shí)，螺栓固位型修復(fù)體力量作用在螺絲孔合方。(Screw-retainedprosthesisisgivenforceonocclusalscrewholeforproperverticalocclusalloadingonprosthesis.)螺絲孔的直徑約為3mm，占后牙咬合面的30%，功能區(qū)的50%，因?yàn)楣δ軈^(qū)占整個(gè)咬合面的2/3(Screwholediameterisabout3mm;itoccupies30%ofocclusalsurfaceonposteriorareaor50%offunctionalareabecauseitisfunctionalareaon2/3ofentireocclusalsurface.)幾乎所有的咬合面螺絲孔都位于長(zhǎng)軸上，即咬合接觸區(qū)上(Almostallpositionofocclusalscrewholeislocatedonlongaxis,whereocclusalcontactoccurs.)螺絲孔須用樹(shù)脂覆蓋并適當(dāng)進(jìn)行調(diào)合(Andthenocclusaladjustmentisachievedonscrewholecoveredwithcompositeresin.)軸向負(fù)重(Axialload)

通過(guò)誘導(dǎo)應(yīng)力沿種植體螺栓固位型修復(fù)體的缺點(diǎn)(Drawbacksofscrew-retainedprosthesis)咬合面材料折斷(Fractureofocclusalmaterial)應(yīng)力集中在螺絲孔上(concentratestressonscrewhole)

修復(fù)體就位困難(Access)患者開(kāi)口度有限，螺絲難于就位，且容易誤咽(Itisdifficulttoaccesswithalimitedmouthopeningpatient.Andonecaneasilyswallowscrewwhilehandlinginstrument.)疲勞(Fatigue)

應(yīng)力作用在修復(fù)體支持結(jié)構(gòu)上，甚至?xí)鸱N植體斷裂

(weightingstressonprostheticsupportingstructureevenbringsaboutfractureofimplant.)螺絲松動(dòng)(Screwloosening)Accordingtoseveralreport,50%ofscrewsofprosthesisonupperdentitionisloosenedatleast1timewithin1yearafterloading.

Dependingonsingleimplantstudy,65%ofscrewslooseningoccurswithin3yearsafterloading.☆Rec)cement-retainedprosthesis螺栓固位型修復(fù)體的缺點(diǎn)(Drawbacksofsc種植修復(fù)注意事項(xiàng)

(Considerationofimplantprosthesis)后牙區(qū)咬合面材料(Occlusalmaterialofposteriorarea)烤瓷？樹(shù)脂？→

金屬(Porcelain?,Resin?→Metalocclusion)樹(shù)脂和烤瓷容易碎裂(Fibrousandhardfood;easilyporcelainandresinchippingorfracture.)須考慮功能紊亂(夜磨牙，緊咬牙)

(parafunction(Bruxism,Clenching)mustconsidered)*Zirconiumcore+porcelain咬合面形態(tài)(Occlusalform)側(cè)方不能有剪切力(Shearstrengthmustnotbeoccurredbylateralforce

)大小和天然牙相似或者略小(Similartonaturalsizeoralittlesmallerthannaturaltooth.)種植修復(fù)注意事項(xiàng)

(Considerationofim生理性的近中移位

(Physiologicmesialdrifting)增齡性咬合面和鄰面磨損，將使天然牙向近中移位(Naturalteethmovetomesialsidebecauseofabrasionofocclusalandinterproximalsurfaceinaging.)

由于骨整合，種植體不會(huì)發(fā)生移位。因此，在鄰接區(qū)容易引起食物嵌塞。為了修補(bǔ)鄰接面，修復(fù)體需要具備可修補(bǔ)性。(Implantcannotbemoved

byosseointegration.Therefore,thereeasilyoccursfoodimpactiononinterproximalarea.

Soretrievabilityofprosthesishastobeeasyinordertorepaircontactsurface.）

生理性的近中移位

(PhysiologicmesialOcclusionofimplant-supportedprosthesis理想合(Idealocclusion)交錯(cuò)保護(hù)合(Mutuallyprotectedocclusion)尖牙保護(hù)合(Canineprotectedocclusion)組牙功能合(Groupfunctionocclusion)平衡合(全口義齒)(

Balancedocclusion(fulldenture))種植體保護(hù)合(