临时冠虽称之为临时,但其在牙齿美学修复中的作用远远大于其字面所传达的含义。临时修复是牙齿美学修复中一个非常重要的过程,它不仅是牙齿美学修复中的美学表达和功能表达的重要手段,同时对于软组织美学塑造有着独特和不可替代的作用。
很多复杂的美学和功能重建的病例临时冠会在口内使用数月或更长的时间,因此对临时冠的边缘密合度要求很高,否则会导致牙周的炎症。
▽
本文用一个病例介绍临床上如何获得完美的临时冠边缘密合度。
这是一个牙列重度磨耗,需要全牙列功能美学重建的病例。
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01
制作诊断蜡型
首先按照美学引导的功能重建原则进行美学设计和咬合设计,按照功能美学设计在转面弓、上he架的研究模型上完成诊断蜡型的制作。
02
制作成型阴模
翻制诊断蜡型的硬石膏模型,制作热塑透明压模成型阴模。也可以直接在模型上制取诊断蜡型的油泥型硅橡胶印模,作为临时修复体的成型阴模。
03
制作临时冠
临床上最常使用双丙烯酸树脂临时修复体材料制作临时冠等临时修复体。
牙体预备完成后,调和丙烯酸树脂临时修复体材料,在其工作时间内注满牙体预备牙的成型阴模内以及牙体预备体的周围。将成型阴模完全就位,稳定约2至3分钟,在材料初步凝固呈硬橡胶状时取出阴模。如果牙体预备体为树脂类材料,需使用凡士林等分离剂。
04
临时冠修形
等待数分钟,双丙烯酸树脂临时修复体材料完全聚合凝固,从成型阴膜内取出临时修复体。使用70%酒精清洗去除临时冠表面粘性的氧化阻聚层,磨除多余临时冠材料,修整外形,口内试戴临时冠。
05
临时冠边缘重衬
使用金刚石钻针将临时冠组织面龈1/3部位少量缓冲,涂布牙本质粘接剂,光照固化。将流动树脂注射在牙体预备体边缘,将临时冠就位,小毛刷去除溢出的流动树脂,光照聚合。取下临时冠,修整边缘。
06
临时冠粘接
临时冠最后抛光,表面涂布表面上光剂,光照聚合。完成临时冠制作。使用不含丁香油的临时粘接水门汀完成临时冠粘接。
使用以上技术就可以获得一个具有完美的边缘密合度的临时修复体,可以长期在口内戴用,不会对周围牙周组织产生任何不良刺激。
注:以上临床秘技中所使用的临时修复系列材料,请参考齿美教育微信公号-齿美优选栏目相关文章。
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