Prosthodontics Tribune China No. 1, 2019
高效制定固定修复治疗计划的关键
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[1] =>
修 复 论 坛
——之西雅图读书会专刊病例分析
香港，2019年4月28日出版
PROSTHODONTICS TRIBUNE · 中 文 版
会 员 资 料
高效制定固定修复治疗计划的关键
专刊导读：
包括几个关键原则：
西雅图读书会的“核心与灵魂”
――“多学科治疗计划”与多学科思维
于大光医生 西雅图读书会·中国总负责人
全球最富盛名的学习型牙医组织——Seattle Study Club
（西雅图读书会），其创始人Dr. Michael Cohen，不仅在
华盛顿大学牙科学院任教期间，出版了《Interdisciplinary
Treatment Planning（多学科治疗计划）》著作，更因越
来越多地帮助了许多牙医，掌握到被称为“SSC核心与
灵魂”的“多学科治疗计划制定”的学术思路与理念，
而备受尊敬。
我本人学习与领悟到的SSC多学科治疗计划的思路，
第19卷第4期
· Grant Maier
1.在做治疗计划之前，首先从多学科的角度，充分收
集患者信息与临床发现；
2.根据生物学（biological）-结构（structural）-功能
（functional）- 美学（esthetic）的顺序，来分类并排序，
以便帮助明确诊断；
3.在制定一种或多种治疗计划时，则需要按照美学功能-结构-生物学的顺序来进行。
这种多学科治疗计划的思路，在美国不同牙科院校教
育体系下会有不同叫法，异曲同工的是对牙科疾病的系统
性全面分析，并始终以多学科多专业角度解决问题。相信
这种思维训练及临床工作方法，对很多牙医，尤其是开业
牙医，会带来巨大启发与帮助！
清晰、简明、有效的医技沟通一
直是固定或活动修复治疗过程的关
键部分。过去的几十年中，患者群体
的知识水平和期望都有所提高，对修
复方法、技术和材料出现更多要求。
随着这些要求的提出和替代方案的
增加，修复团队之间也就需要进行更
加全面的交流。
以下归纳了当与技工室交流时需
要考虑的问题。我们着重介绍固定修
复的案例，但是很多的细节也同样适
用于绝大多数的其他情况。
▲ 带有咬合记录的术前模型
▲ 带有咬合记录的预备体模型
▲ 烤瓷前
w w w. d e n t i s t x . c o m
[2] =>
16 修复论坛
▲ 术前曲面体层片
DENTAL TRIBUNE 中文版
▲ 使用Bone blocs技术植骨后曲面体层片
整体信息
需要修复什么？患者的期望是什
么？采用何种方法或何种治疗计划来
满足这些期望？
当前口腔健康状况
现有牙列是否有松动牙，患者是
否有牙列缺失、骨丧失或者更严重的
牙周牙体缺陷，如龋损等？
期望的结果
对于软硬组织的临床预期是什
么？患者的期望是什么？例如，患者是
否认为微笑时有过多的牙龈暴露？种
植牙是解决问题的一部分吗？
垂直距离
当前的垂直距离是多少？预期的
垂直距离是多少？
作为一个团队，医生
和技师都应该明确这一点。
·本质上讲，对于患者而言，什么
是临床、功能最适合的位置？作为临
床医生，你使用哪种咬合原则实施治
疗？首要关注及主要目标是咬合的建
立—从临床角度或功能角度，重建后
的下颌骨体的垂直向位置在哪？
w w w. d e n t i s t x . c o m
[3] =>
DENTAL TRIBUNE 中文版
▲ 术后曲面体层片
修复论坛
17
▲ 上前牙的美学重建
·是否需要进行咬合重建？患者是否
需要先行去极化矫正目前的紧咬合？如
果需要，在最终确定修复体位置前，肌
肉的去极化是否能保持？有哪些过渡性
修复装置（例如牙周夹板、可摘解剖式正
畸装置、固定正畸装置、固定且有一定功
能的诊断饰面）可以通过技工室制作，并
能达到这个目的？
微笑设计
微笑设计的信息是下一个关键步
骤。患者到底需要一个怎样的微笑呢？
在习惯性咬合位下进行咬合设计可以
让我们直接进行诊断蜡型的制作。如果
希望一个病例恢复后的下颌位置更合
适，则技工室可以直接制作一个固定的
诊断饰面。在维持新的垂直距离下，可
以通过这种方法得到一个初始的，期望
的微笑设计。
印模
一直以来，印模是牙科医生与技师
沟通的基础。如果你没有进行数字化扫
描，那么一定要根据说明书制取全牙弓
的印模。在把印模送至技工室前，记得
在患者还未离开时花一些时间仔细检查
印模。
如果你自己灌制石膏模型，一定确
保它们精确地展示出患者口内的情况。
w w w. d e n t i s t x . c o m
[4] =>
18
DENTAL TRIBUNE 中文版
修复论坛
全面的美学细节
当我们在设计修复替代方案时，我们获得再
多的信息也不嫌多。因为没有信息，我们就只能
凭空猜测，以下的关键细节对于技工人员来说非
常重要。
▲ 模型上测量上中切牙
– regular e-news delivered
to your inbox
– individualized content according
to your specialty & region
– latest industry developments
– event specials
– exclusive interviews
with key opinion leaders
– product information
– clinical cases
– job adverts
中切牙的期望长度是多少？
·一张照片胜过千言万语。常规
提供的照片应包括牙列照片、最终比
色照、术前照片和临时修复照片，通
过这些照片，技工可以了解最终修复
体的大致效果。一定要给技工多提供
照片，它们有助于颜色、对称及个性
化设计，以满足患者的个性化需求。
·术前模型和临时修复模型
·X线片、CT/CAT扫描数据、曲面
体层片
材料选择
Sign up
to the finest e-read
in dentistry
www.dental-tribune.com
w w w. d e n t i s t x . c o m
明确说明修复所用的材料。基础
的修复材料包括金属烤瓷、全瓷及混
合树脂。
在这些广泛的类别项下，还有许
多选择。技师了解这些材料应用于各
种各样临床情况中的效果，并且可以
成为评估各种产品在个案中优缺点
的宝贵资源。
[5] =>
DENTAL TRIBUNE 中文版
▲ 兼容全瓷的解决方案现在可以在全口中使用
修复论坛
19
▲ 患者个性化、数字化、精确研磨的全牙弓修复
SUBSCRIBE NOW!
沟通
DTI—international magazine subscriptions
考虑一下如何共享关键的病例细
节。
目前，
牙科杂志和网站上充斥着未
能保护患者隐私信息产生巨大影响的
文章。患者的具体信息必须被安全地
在牙医、技师及患者间传递。
总结
当你按照上面的步骤获得并传递
信息时，技工便几乎不需根据猜测来
制作修复体了。这些细节能够使修复
体根据你具体的要求得到最好地制
作，并能得到一个试戴顺利、
美学与功
能兼顾，满足患者所有要求的修复体。
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DENTAL TRIBUNE 中文版
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[title] => 高效制定固定修复治疗计划的关键
[page] => 01
)
)
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Table of contents
[toc_titles] => 高效制定固定修复治疗计划的关键
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)