后牙咬合对前牙修复的影响

The Influence of Posterior Occlusion When Restoring Anterior Teeth

后牙咬合对前牙修复的影响

abstract When any type of esthetic restorative procedure is being considered or performed, a comprehensive diagnosis and treatment plan is required. Attention to the diagnostic signs of the loss of posterior support (LPS) and their influence on the anterior dentition will guarantee a more predictable outcome. Historical solutions and their inadequacies are addressed. Patient presentations are utilized to demonstrate contemporary treatment of patients requiring esthetic rehabilitations who are lacking posterior support.

摘要：当任何一种美容修复计划被制订或是执行的时候，一个全面的诊断和治疗计划是必须的。在修复过程中，对后牙支持丧失的体征和其对前牙牙列产生的影响加以考虑，将确保产生一个可以预见的结果。从前治疗方法及其不足在这里被提出。这里我们利用的病例耐心地向大家展示了对后牙支持丧失但需要美观重建的患者进行治疗的最新的治疗方法。

there is a general consensus that tooth retention amongst the aging population pays credence to preventive dentistry and patient education. Appearance is a common concern for this group of patients. A comprehensive examination allows the clinician to diagnose risk factors that are responsible for the deterioration of oral health and function. These patients often request restorative treatment with indirect restorations to enhance their appearance(figure 1). During the diagnostic phase,critical elements of posterior occlusion are overlooked at the expense of longevity of the proposed treatment (figures 2 and 3). Health, function, and esthetics should be the ultimate aim of any medical or dental comprehensive treatment plan.

在关注预防口腔医学和老年教育的老年人中对保留牙齿的态度是一致的。这些患者中对美观都很重视。全面的检查将使临床医生能够对会引起口腔健康和功能造成损害的原因作出诊断。这些患者常会要求用间接修复体进行修复以加强他们的美观。在诊断阶段，后牙咬合关系的因素常会被忽略将导致修复体不能被长期使用。健康，功能和美观都应是牙科综合治疗计划的最终目的。figure 1. Maxillary anterior teeth restored with porcelain laminate veneers for patient with adequate posterior support and occlusal stability.

图1.后牙有良好的支撑和咬合稳定的患者通过瓷贴面修复的上颌前牙.

figure 2a. Maxillary anterior teeth previously restored but failed due to posterior bite collapse.图2a,因为后牙咬合崩溃所致上前牙修复失败

figure 2b. Posterior support needs to be established before anterior teeth are restored.

图2b,在前牙修复之前,后牙咬合支持需要被建立.

figure 2c. Cardinal signs for LPS are present clinically

图2C,后牙支持丧失的主要临床症状

figure 2d. Cardinal signs for LPS are present radiographically.

在放射检查中显示的后牙支持丧失的主要症状

figure 3a. Patient presented with LPS.后牙支撑丧失的患者

figure 3b. Mucosal-supported RPD failed to provide posterior support.粘膜支持的可摘局部义齿不能提供足够的后牙支持

figure 3c. Cardinal signs of LPS are present.后牙支撑丧失的主要体征

Diagnosis诊断

Diagnosis and treatment planning cannot be based on esthetic desires alone. A number of factors need to be evaluated prior to decision making:诊断和治疗计划不能仅以美观为基础。在作结论之前，许多因素都应该被考虑。

1.Occlusal stability 咬合的稳定性

2.Status of periodontal and dental disease 牙周和牙齿疾病的情况

3. Anatomical limitations 解剖的限制

4.Space management 空间的管理。

Posterior support is an important factor to consider in order to achieve occlusal stability. The loss of posterior support is defined as the loss of occluding vertical dimension as a result of the loss or drifting of posterior teeth. Secondary occlusal trauma has been defined as the effects induced by occlusal force (normal or abnormal) acting on teeth with decreased periodontal support. Hence, it is possible for a patient with an almost intact dentition, but with a reduced periodontium to present with the signs of LPS (figure 4).

为提高咬合的稳定性，后牙的支持是一个必须要考虑的重要因素。丧失的后牙支持一般定义为因为后牙缺失或是移位而导致咬合垂直距离的丧失。其次，咬合创伤也被定义为因为咬合力（正常的或是不正常的）作用于牙周支持丧失的牙上引起的。因此对于拥有完整牙列的患者，但也会因为不良的牙周情况而出现后牙支持丧失的症状

figure 4. Radiographs of patient with almost intact dentition but with reduced periodontium with the signs of LPS.

牙列较完整但牙周状况较差的并带有后牙支撑丧失的患者的放射影像