口腔医学 ›› 2025, Vol. 45 ›› Issue (12): 932-939.doi: 10.13591/j.cnki.kqyx.2025.12.010

• 病案分析 • 上一篇    下一篇

基于目标修复体空间理论的固定-可摘同期修复策略构建及高龄患者临床随访研究

王中熠1,2, 吴嘉诚2, 于海洋2()   

  1. 1 南京医科大学附属口腔医院修复科,口腔疾病研究与防治国家级重点实验室培育建设点(南京医科大学),江苏省口腔转化医学工程研究中心,江苏南京(210029)
    2 口腔疾病研究国家重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院修复Ⅱ科,四川成都(610041)
  • 收稿日期:2025-06-30 出版日期:2025-12-28 发布日期:2025-12-16
  • 通讯作者: 于海洋 E-mail:yhyang6812@scu.edu.cn
  • 基金资助:
    国家自然科学基金青年科学基金项目(82401166);江苏省自然科学基金青年基金项目(BK20240515);江苏省卓越博士后计划(2024JSBSH034);江苏省科教能力提升工程——江苏省研究型医院(YJXYYJSDW4);江苏省医学创新中心(CXZX202227)

Fixed-removable simultaneous prosthetic strategy based on target restoration space theory and its application in senior patients: A clinical study

WANG Zhongyi1,2, WU Jiacheng2, YU Haiyang2()   

  1. Department of Prothodontics, The Affiliated Stomatological Hospital of Nanjing Medical University; State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases(Nanjing Medical University); Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China
  • Received:2025-06-30 Online:2025-12-28 Published:2025-12-16
  • Contact: YU Haiyang E-mail:yhyang6812@scu.edu.cn

摘要:

目的 基于目标修复体空间理论,构建一种针对Kennedy一、二类复杂牙列缺损的高效的固定义齿与可摘式种植义齿同期修复策略,评估其临床应用价值。 方法 通过多模态数字化技术(口内和模型扫描、CBCT及三维面部扫描等)构建虚拟患者,用于同步设计氧化锆全冠、可摘式种植义齿和义齿支持式种植导板,确保全冠、种植体、可摘修复体轴向协调;通过CAD/CAM技术实现数字几何量向实体修复体的高精度转移。对1例82岁患者实施该方案,进行3年随访,评估牙周情况、修复体适配性、口颌功能恢复及并发症发生情况。 结果 构建固定-可摘同期修复策略,该策略将复诊次数减少至7次,总疗程缩短至7.25个月,即使未遵医嘱及时拔牙,亦有宽裕的治疗容错空间。临床应用中,固定义齿边缘贴合良好,Locator种植覆盖义齿固位稳定性佳,实现了可靠的咬合重建。3年随访显示:患者口腔健康影响程度量表-14(OHIP-14)评分由31降至6;满意度视觉模拟评分达96;种植体骨结合良好,无机械并发症。 结论 固定-可摘同期修复策略显著提升了Kennedy一、二类牙列缺损的治疗效率,也优化了治疗流程的容错机制。3年随访初步证实该方案的可靠性,可作为复杂牙列缺损咬合重建的优选方案。

关键词: 目标修复体空间, 牙列缺损, 聚醚醚酮, 固定-可摘同期修复, 高龄患者

Abstract:

Objective To develop and evaluate a fixed-removable simultaneous prosthetic strategy for Kennedy Class Ⅰ and Ⅱ dentition defect based on the target restoration space (TRS) concept. Methods A virtual patient was created using intraoral scans, CBCT, and facial scans. Under TRS guidance, zirconia crowns, removable implant overdentures, and surgical guides were simultaneously designed. CAD/CAM technology enabled precise fabrication. The proposed treatment was applied to an 82-year-old patient, with a three-year follow-up to evaluate the periodontal condition, prosthesis adaptation, recovery of oral and maxillofacial function, and occurrence of complications. Results A fixed-removable simultaneous prosthetic strategy has been constructed. The protocol reduced follow-up visits to 7 and shortened treatment time to 7.25 months. Despite the delayed tooth extraction against medical advice, the treatment showed a favorable tolerance range. Clinically, the prosthesis had precise marginal fit, and the Locator implant overdenture provided stable retention, resulting in reliable occlusal restoration. At 3 years, OHIP-14 score dropped from 31 to 6, VAS satisfaction was 96, and no complications occurred. Conclusion This TRS-based strategy improves efficiency, reduces clinical burden, and offers a reliable solution for complex edentulous cases in senior patients.

Key words: target restorative space, dentition defect, polyether-etherketone, fixed-removable simultaneous prosthetic strategy, senior patients

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