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固定義齒學概論Introduction to Fixed Prosthodontics

固定義齒學概論Introduction to Fixed Prosthodontics

台北醫學大學台北醫學大學牙醫學系兼任臨床助理教授王茂生醫師王茂生醫師m8704001@tmu.edu.tw

學習目標

1. KEY TERMS2. Introduction to Fixed Prosthodontics3. Presentation

KEY TERMS• ABUTMENT 支柱牙–Tooth, root, or implant used for

retention of a fixed or removable

prosthesis.

• ALUMINUM CROWN 鋁牙冠–Provisional coverage of thin

aluminum used for posterior teeth.

• ARTICULATOR 咬合器–Dental laboratory device that

simulates the movements of the mandible and

temporomandibular joint.

• BEVEL 斜面- enamel margin of a tooth preparation

• CAST POST 鑄造(柱)–metal support fitted into the root canal

of an endodontically treated tooth to improve the

retention of a cast restoration.

• CHAMFER 弧形(緣)–Tapered finish line of the margin at the

cervical area of a tooth preparation.

ABUTMENT–Tooth, root, or implant used forretention of a fixed or removable

prosthesis.

•DIE–Replica of the preparedportion of a tooth used in thelaboratory during the making of acast restoration

implant ABUTMENT

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ABUTMENT 支柱牙–Tooth, root, or implantused for retention of a fixed or

removable prosthesis.

DIE 單齒膜–Replica of the prepared portion of a tooth used in thelaboratory during the making of a cast restoration

Cast–鑄造物模型 Restoration修復體

ABUTMENT –Tooth, root, or implantused for retention of a fixed or removableprosthesis.

ABUTMENT–Tooth, root, or implant used for retention of afixed or removable prosthesis.

resistance抵抗力ARTICULATOR–Dental laboratory device that simulates

the movements of the mandible andtemporomandibular joint

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Dentatus Modulus

Dentatus Modulus

Panadan

BEVEL - enamel margin of a tooth preparationCHAMFER–Tapered finish line of the margin at the cervical area of atooth preparation.

SHOULDER 肩台–margins of a toothpreparation for a cast restoration

CAST POST–metal support fitted into the root canal of an

endodontically treated tooth to improve the retention of a cast restoration

•CORE - Portion of

a post and core that

extends above the

tooth structure

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CAST POST–metal support fitted into the root canal of anendodontically treated tooth to improve the retention of a cast restoration

•CORE 冠心- Portion of a post and core that extends above thetooth structure.

•CUSTOM–Referring to provisional coverage that is designedfrom a preliminary impression or thermoplastic trayresembling the tooth being prepared.

•DIE 單齒膜–Replica of the prepared portion of a tooth usedin the laboratory during the making of a cast restoration.

•FIXED BRIDGE 固定牙橋–Dental Prosthesis with artificialteeth fixed in place and supported by attachment to the naturalteeth.

CUSTOM –Referring to provisional coverage that is designed from apreliminary impression or thermoplastic tray resembling the tooth beingprepared

CUSTOM –Referring to provisional coverage that is designed from apreliminary impression or thermoplastic tray resembling the tooth beingprepared

•CROWN 牙冠–Cast Restoration that covers the entire anatomiccrown of the tooth.

•GINGIVAL RETARACTION 牙齦排開–

Displacement of gingival tissues away from the tooth.

•HYPERTROPHIED 肥大–referring to overgrown oral tissues.

• INFUSER–Syringe that applies hemostatic solution on thegingival retraction cord.

• INLAY 嵌體–Cast restoration designed for class II cavity

• INVESTMENT MATERIAL 包埋材–Special gypsum productable to withstand extreme heat.

enamel

cementoenamel

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CROWN–Cast Restoration that covers theentire anatomic crown of the tooth

•Anatomic Crown–the portion of the natural teeththat extends from its cementoenamel junction to theocclusal surface or incisal edge

•Clinical Crown–the portion of a tooth extends fromthe occlusal table or incisal edge to the freegingival margin

GINGIVAL RETARACTION–Displacement of

gingival tissues away from the tooth.

INLAY–Cast restoration designed for class II cavity

INVESTMENT MATERIAL–Special gypsum product able to withstand

extreme heat. •MASTER CAST 主模型–Cast created from a final impression usedto construct baseplate, bite rims, wax setups and finished prosthesis.

•ONLAY 冠蓋體–Cast restoration designed for occlusal crown andproximal surfaces of posterior teeth.

•OPAQUER 不透光–Resin material placed under a porcelainrestoration to mask discoloration.

•POLYCARBONATE CROWN–Provisional crown of tooth-

colored material used for anterior teeth.

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MASTER CAST–Cast created from a final impressionused to construct baseplate, biterims, wax setups and finished

prosthesis.

CAST: v 鑄造 n 模型

MASTER CAST–Cast created from a final impressionused to construct baseplate,bite rims, wax setups and

finishe prosthesis.

MASTER CAST–Cast created from a final impression used to constructbaseplate, bite rims, wax setups and finish prosthesis

Baseplate bite rims,

wax setups finish prosthesis

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MASTER CAST–Cast created from a final impression used to constructbaseplate, bite rims, wax setups and finish prosthesis

Balance Occlusion ONLAY–Cast restoration designed for occlusal crown and

proximal surfaces of posterior teeth.

OPAQUER–Resin material placed under a porcelain restoration to maskdiscoloration

OPAQUER–Resin material placed under a porcelain restoration to masktooth discoloration

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POLYCARBONATE CROWN–Provisional crown of tooth-coloredmaterial used for anterior teeth.PRE-FORMED–Referring to provisional coverage that is already shapedin the appearance needed

PONTIC 橋體–artificial tooth that replaces a missingnatural tooth.

•PORCELAIN-FUSED-TO-METAL(PFM) CROWN 陶瓷金屬融合冠–

Indirect restoration in which a thin porcelain material isfused to the facial portion of a gold crown.

•PROSTHESIS 贗復體–Fabricated replacement for amissing tooth.

PONTIC–artificial tooth that replaces a missing natural tooth.

PORCELAIN-FUSED-TO-METAL CROWN–Indirect restoration in which a thin porcelain material isfused to the facial portion of a gold crown.

• PROVISIONAL–Referring to temporary coverage made for crown orbridge preparations and worn during cast preparation.

• RESIN-BONDED BRIDGE–Fixed dental prosthesis with wings that arebonded to the lingual surfaces of adjacent

teeth; also known as

Maryland Bridge.

•SHADE GUIDE 比色板–Accessory dental item that

• contains

• different shades of teeth and is used to match

• the color of a patient’s teeth for the laboratory

technician.

•SHOULDER 肩台–margins of a tooth preparation for a

• cast restoration.

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PROVISIONAL–Referring to temporary coveragemade for crown or bridge preparations and worn

during cast preparation.RESIN-BONDED BRIDGE–Fixed dental

prosthesis with wings that are bonded tothe lingual surfaces of adjacent teeth;

also known as Maryland Bridge

Adhesive Bridge Etched Cast restoration

SHADE GUIDE–Accessory dental item that contains different shades ofteeth and is used to match the color of a patient’s teeth for the laboratory technician.

• SOLDER JOINT 焊接點–Point or junction where two metal objects arefused, such as on a bridge.

• THREE-QUARTER CROWN–

Cast restorations that covers the anatomic crown of a tooth except forthe facial or buccal portion.

• UNIT–Each component of the fixed bridge.

VENEER 嵌面–Thin layer of tooth-colored material bonded or cemented toprepared facial surface of a tooth.

THREE-QUARTER CROWN–Cast restorationsthat covers the anatomic crown of a

tooth except for the facial or buccal portion.

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VENEER–Thin layer of tooth-colored material bonded or

cemented to prepared facial surface of a tooth.

ALUMINUM CROWN–Provisional coverageof thin aluminum used for posterior teeth.

Fixed Prosthodontics固定義齒學 牙冠牙橋學

A bridge is a non-removable prosthesis, or fixed partial denture(FPD), rigidly attached to one or more abutment teeth, replacingone or more lost or missing teeth.

牙橋不是一個活動假牙,是一個假牙牢固粘著在一個或二個支台齒同時取代一個或多個缺牙

一、齒列缺損(dentition defect)之原因。

齲齒、根尖周病、牙周病、外傷、頜骨疾病、先天牙胚缺失等是原因

固定假牙 活動假牙

二、固定假牙與活動假牙的區別

支持方式 支台齒, 黏膜或牙-黏膜固定形式 牙套+黏著劑 固位體.+連接體+基底適應範圍 較窄,缺牙數目較少, 適應範圍廣闊,

適應症嚴格 缺牙數及組織缺損量不受限制支台齒條件 要求高.位置正常 可有輕度鬆動.傾斜舒適度 無異物感 有異物感發音 不影響 初期有影響咀嚼效能 好 稍差齒磨耗量 量多 量少製作 複雜 樹脂類較簡單.鑄造支架較複雜摘戴方式 固定.不能自行取戴 能自行摘戴清潔衛生 自潔作用,口內刷洗 口外刷洗修理方式 拆除重作 可以修補.添加

三、Reason for replacing lost tooth

為什麼做假牙

1.Esthetic美觀 恢復面容美觀

2.Function功能 提高咀嚼功能

3.Speech發音 改善發音

4.Occlusion and TMJ dysfunction prevention

避免咬合及顳顎關節障礙

5.Maintenance of dental health維持牙齒健康

剩餘牙、牙周健康

6.Provide a good mental and physical health

有益患者的身心健康，

四、Consequences without replacement

不作假牙的後果

1.Supraoclusion of the opposing teeth or tooth牙齒往對咬長長

2.Tilting of the adjacent teeth鄰齒傾斜

3.Loss of proximal contact接觸點喪失

4.Food impaction, caries, periodontitis, alveolar boneloss, occlusal trauma, TMJproblem,extraction,…………

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五、Treatment for tooth loss缺牙之治療

1.Fixed partial denture固定假牙

2.Implant-supported prostheses植體支持

3.Removable partial denture活動假牙

4.Complete denture全口假牙

Whenever possible, it is advisable to restore edentulous spaceswith fixed rather than removal partial denture

六、Component of bridge 牙橋的組合

1.The abutment支台齒

2.The retainer牙套

3.The pontic橋體

4.The connector or the joint連接部

七、Ante’slaw

The root surface area of the abutment teeth should be equal orgreater than that of the tooth being replaced. 支台齒牙根表面積的總和大於或等於缺牙區牙根表面積的總合

八、Clinical Procedures臨床操作過程

1.Tooth preparation牙修形

2.Tissue Management 排齦

3.Impression印模

4.Provisional restoration臨時假牙

5.Try-in試戴

6.Cementation固定

九、Laboratory Procedure技工室的過程

1.Master cast and die 工作模型及支台齒

2.Wax pattern臘型

3.Investing and casting包埋鑄造

4.Polish磨光

•十、Types of Occlusion• 1. Balanced Occlusion/Bilateral balanced occlusion

平衡咬合/雙側平衡咬合• 2. Canine Protected Occlusion/Mutually Protected Occlusion

犬齒咬合/前後相互保護咬合• 3. Group Functional Occlusion/Unilateral Balanced Occlusion

群功能咬合/單側平咬合十ㄧ、印模材料

1.Agar(reversible)2.Alginate(irreversible)3.Rubber Base:

(a)polysulfide(b)polyether(c)silicone–1. Condensation Silicon

2. Addition Silicon

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•~~百分之百的生產力~~A B C D E F G H I J K L M01 02 03 04 05 06 07 08 09 10 11 12 13N O P Q R S T U V W X Y Z14 15 16 17 18 19 20 21 22 23 24 25 26

只有必要的知識(Knowledge)是不夠的，那僅能達到百分之九十六：K N O W L E D G E11 + 14 + 15 + 23 + 12 + 5 + 4 + 7 + 5 = 96

還需要埋頭苦幹（Hardwork），能才達到百分之九十八：H A R D W O R K8 + 1 + 18 + 4 + 23 + 15 + 18 +11 = 98

需要再加上競競業業的工作態度（Attitude）就可以達到百分百：A T T I T U D E1 + 20 + 20 + 9 + 20 + 21 + 4 + 5 = 100

態度

•影響一生的關鍵: 個性 態度 智慧

每個人之所以成功或失敗完全取決於他對別人和自己的態度

THEN, look how far the love ofGod will take you :

L-O-V-E-O-F-G-O-D

12+15+22+5+15+6+7+15+4=101%

贏家-要合群、要謙遜、要肯學習，才能與工作夥伴有好的交流，激發出更好的工作成果。

小聰明只能贏在一時，好的品格與正確的價值觀才是永恆立世之本。

要懂得感恩

Summary

資料來源Modern Dental AssistingDONIL. BIRD and DEBBIES. ROBINSONSEVENTH EDITIONFundamentals of Fixed ProsthodonticsThird editionHerbert T. Shillingburg Jr, DDSSumiya Hobo, DDS, MSD, PhDLowell D. Whitsett, DDSRichard Jacobi,DDSSusan E. Brackett, DDS,MSContemporary Fixed ProsthodonticsThird EditionRosenetiel‧Land‧Fujimoto