英国Garstang作品
合作伙伴
第35期
很开心又跟大家见面，正值新春放假期间，希望大家能有更多时间陪伴家人，同时闲暇之余还可以看看牙匠之家的案例分享。后台一直都在反映活动类的作品太少，在这里小编还是要跟大家说声抱歉，在活动版块这类小编确实是个门外汉，受后台大家之托，本期还是硬着头皮上了一期来自Garstang Dental Referral Practice胶托类的作品分享，诠释得不对的地方还请大家多多指正。Garstang Dental Referral Practice是一个牙科临床诊所，名匠录第9期来自普雷斯顿Finlay Sutton老师也是在Garstang就职，当然旗下还有几位老师也是很出名（也希望下次有机会能更新到他们相关擅长的案例）。
今天带来Garstang分享的案例是一个个性化胶托的案例，看过第9期Finlay Sutton老师的作品的朋友应该都大致了解过，Finlay Sutton老师最擅长的就是将一个普通的修复种类做到极致，包括患者的原来的笑容照片都是进行神还原。今期带来是一个70岁老人的一个旧义齿二次修复案例。
首先上一张修复前后的对比图。
Figure1.2.Pre-treatment with existing complete maxillary denture, remaining lower anterior teeth with caries/severe chronic periodontitis and a removable mandibular partial denture.
图1.2.使用现有的上颌全口义齿进行预处理，保留下前牙患龋/严重慢性牙周炎和可摘下颌部分义齿。
Figure 3. Pre- treatment aesthetic appearance with remaining lower anterior teeth having caries/severe chronic periodontitis and a removable mandibular partial denture (RPD).
图3.治疗前美观，残留的下前牙有龋齿/严重慢性牙周炎和可摘下颌部分义齿(RPD)。
Figure 4. Pre-treatment with existing complete maxillary denture, remaining lower anterior teeth having caries/severe chronic periodontitis and a removable mandibular partial denture (RPD).
图4.使用现有的上颌全口义齿进行预处理，剩下的下前牙有龋病/严重慢性牙周炎和可摘下颌部分义齿(RPD)。
Figure 5. Pre- treatment without dentures showing 5 lower anterior teeth with caries/severe chronic periodontitis.We elected to remove these teeth and replace with an immediate complete denture.
图5.前处理无假牙，显示5颗下前牙有龋齿/严重慢性牙周炎，我们选择拔除这些牙齿，并立即更换完整的义齿。
Figure 6. Pre-treatment - maxillary complete denture with worn occlusal surfaces and bleached pink acrylic.
图6.前处理-上颌全口义齿与磨损的咬合面和已经开始发白的胶托。
Figure 7. Pre-treatment - mandibular cobalt chromium based partial denture with worn occlusal surfaces, bleached pink acrylic and an added tooth LR3.
图7.前处理-下颌钴铬钢托部分义齿磨损的咬合面，已发白的胶托和一个添加的牙齿右下颌3牙。
Figure 8. Pre-treatment with existing dentures in occlusion from the right.
图8.用现有义齿对右牙合进行预处理。
Figure 9. Pre-treatment with existing dentures in occlusion from the left.
图9.用现有义齿从左侧咬合的前处理。
Figure 10. Pre-treatment maxillary complete denture - under extended in the potsdam position resulting lack of peripheral seal and lack of retention.
图10.前处理上颌全口义齿-在波茨坦位置延长，造成周围密封不足，缺乏固位。
Figure 11. Pre-treatment - maxillary denture bearing area with shallow sulcus and extremely flabby anterior ridge.
图11.治疗前-上颌义齿承载区浅沟，前嵴极度松弛。
Figure 12. Pre-treatment - mandibular denture bearing area with redundant - mobile mandibular ridge offering little stability and support for a mandibular complete immediate denture. Lower anterior teeth with hopeless prognosis.
图12.前处理-下颌义齿承载区与冗余-移动下颌嵴提供不稳定和支持下颌全口义齿。下前牙预后不佳。
Radiograph of the failing lower anterior teeth showing teeth with cervical/root caries, alveolar bone loss of 60 - 90%. We elected to remove these teeth and replace them with a complete immediate mandibular denture.
失败前牙X线片显示牙有颈、根龋，牙槽骨丢失60~90%。我们选择移除这些牙齿，并用一个完整的下颌义齿代替它们。
Figure 13. Right retromolar pad - it is important to cover the retromolar pads to maximise stability of lower denture.
图13.右磨牙垫-重要的是覆盖后磨牙垫，以最大限度地稳定下义齿。
Figure 14. Left retromolar pad - it is important to cover the retromolar pads to maximise stability of lower denture.
图14.左后磨牙垫-它是重要的覆盖后磨牙垫，以最大限度地稳定下义齿。
Figure 15. Maxillary primary impression made in red cake compound prior to wash in alginate.
图15.用藻酸盐冲洗前，用红饼制成上颌初级印模。
Figure 16. Maxillary primary impression made in red cake compound and alginate wash. The impression is overextended to assist production of an optimally extended special tray.
图16。上颌初级印模用复合红饼和海藻酸钠冲洗。该印象是过度延伸，以协助生产一个最佳扩展的特殊托盘。
Figure 17.18. Mandibular primary impression made in two stages using Accident XD, Ivoclar. This overextends the impression and allows the fabrication of a correctly extended special tray.
图17.18.下颌初级印模，分两个阶段，这超出了印模，但我们可以通过这个模型制做一个正确扩展的特殊托盘。
Figure 19. Maxillary primary cast with heavily distorted shape of flabby ridge.
图19.上颌初级模型，松弛嵴严重变形。（其实这里如果不是临床检查，技师单纯的看这模型是很清晰的，很难想象口中的情况跟模型的误差会这么大的。）
Figure 20.21. Maxillary primary cast with window in the special tray over the flabby area, to allow an undistorted impression of the anterior ridge.
图20.21.上颌初级模型，窗在松弛区的特殊托盘上，使前嵴不受扭曲的印痕。
Figure 22.Maxillary special tray with window over the flabby ridge area, to allow undistorted impression of the soft tissue.
图22.带窗的上颌特殊托盘覆盖松弛的嵴区域，使软组织不受扭曲的印痕。
Figure 23. Maxillary special tray border moulded with greenstick.
图23.上颌特殊托盘边缘与绿色塑造。
Figure 24. Maxillary special tray with definitive impression made in zinc oxide eugenol, the excess over the window is trimmed away with a blade.
图24.上颌骨特殊托盘，用氧化锌丁香酚制成明确的印模，窗户上方的多余部分用刀片修剪掉。
Figure 25. Maxillary special tray with definitive impression made in zinc oxide eugenol, the excess over the window trimmed away with a blade.
图25.上颌骨特殊托盘，用氧化锌丁香酚制成明确的印模，多余的部分用刀片修剪掉。
Figure 26. Maxillary special tray is tried back in the mouth - allowing the flabby ridge to rest in an undistorted position.
图26.上颌特殊托盘被尝试回到口内-允许松弛的脊休息在一个不扭曲的位置。
Figure 27. Silicone adhesive is applied to the outside of the tray, not onto the fitting surface.
图27.硅酮粘合剂适用于托盘的外部，而不是涂在安装表面。
Figure 28. Intaglio surface of finalised maxillary definitive impression. The flabby ridge is recorded in an un-displaced position with light bodied silicone impression material (Doric Flo, Schottlander).
图28.上颌骨最终印模凹凸不平的表面。松弛的山脊记录在一个未被取代的位置与轻体硅印模材料(Doric Flo，Schottlander)。
Figure 29. The occlusal surface of the definitive impression. The flabby ridge is recordeded in an un-displaced position with light bodied silicone impression material (Doric Flo, Schottlander).
图29.确定印模的咬合面。松弛的脊被记录在一个不被取代的位置，用轻质的硅胶印模材料(Doric Flo，Schottlander)。
Figure 30. Mandibular primary cast.
图30.下颌初级模型。
Figure 31. Mandibular primary cast with special tray (first part) on denture bearing area only, not covering the teeth.
图31.下颌初级模型专用托盘(第一部分)仅在义齿承载区，不覆盖牙齿。
Figure 32. Mandibular cast with 2 part special tray system. This is designed to enable accurate impression making of the edentulous area without the natural teeth hindering the impression making process.
图32。下颌骨模型采用2部分特殊托盘系统。这是设计，以使准确的印模区，不妨碍自然牙齿形成过程。
Figure 33. Mandibular 2 part special tray system. This is designed to enable accurate impression making of the edentulous area without the natural teeth hindering the impression making process.
图33.下颌2部专用托盘系统。这是设计，以使准确的印模区，不妨碍自然牙齿形成过程。
冬去春来，年复一年，万年经过长期观察，精心推算，制定出了准确的太阳历，当他把太阳历呈奉给继任的国君时，已是满面银须。
Figure 34. Intaglio of the mandibular special tray border moulded with greenstick compound.
图34.下颌特殊托盘边缘凹凸不平，用绿色化合物模塑而成。
Figure 35.Occlusal surface of the mandibular special tray border moulded with greenstick compound.
图35.下颌特殊托盘边缘的咬合面用绿色化合物模塑。
Figure 36. Occlusal surface of the mandibular special tray border moulded with greenstick compound in the mouth. The natural teeth do not hinder the impression process.
图36.下颌特殊托盘边缘的咬合面，口内用绿色化合物铸成。天然牙齿不妨碍印像过程。
Figure 37. Zinc oxide/eugenol impression material applied to the fitting surface of the special tray prior to making the impression.
图37.氧化锌/丁香酚印模材料应用于特殊托盘的贴合表面，然后再作印模。
Figure 38. Occlusal surface of the mandibular special tray with part 1 of the definitive impression the mouth. The natural teeth do not hinder the impression process.
图38.下颌特殊托盘的咬合面与第1部分的确定印模口。天然牙齿不妨碍印像过程。
Figure 39.40. Second part of the definitive impression made in alginate.
图39.40.第二部分海藻酸钠的明确印模。
Figure 41.42.43. Definitive mandibular impression made in two parts. The denture bearing area recorded in zinc oxide/eugenol and the teeth recorded in alginate. The natural teeth do not hinder the impression process enabling a superb impression of the denture bearing area.
图41.42.43.下颚印模分为两部分。用氧化锌/丁香酚记录义齿的承载面积，用海藻酸钠记录牙齿的承载面积。天然牙齿不妨碍印模过程，使义齿承托区具有极好的印模效果。
Figure 44. Definitive maxillary cast with persevered land area to enable waxing up of the polished surfaces.
图44.固定的上颌模型，去除边角，让模型光整。
Figure 45. Comparison of cross sections of the anterior flabby ridge on the maxillary casts. The undistorted flabby ridge on the definitive cast will enable construction of an optimally fitting base plate that maximises retention and stability of the upper denture.
图45.上颌模型初模松弛嵴横断面的比较。最终模型上未变形的松弛嵴将能够建造一个最合适的基板，最大限度地提高上义齿的固位性和稳定性。
Figure 46. Definitive maxillary cast showing the path of insertion of the denture enabling thin flange under the base of the nose - resulting in optimum lip support under the base of the nose mimicking nature.
图46.确定的上颌铸型显示义齿插入的路径，使薄凸缘在鼻底下形成最佳的唇托，使鼻底更像自然。
Figure 47. Maxillary wax rim fabricated with a definitive denture base, to enable assessment of fit at the jaw registration visit.
图47.用固定义齿基托制作上颌蜡缘，以便在颌骨注册检查时评估合适程度。
Figure 48. Definitive mandibular cast - showing preserved land area, enabling waxing of the polished surfaces.
图48.明确的下颌模型。
Figure 49. Mandibular registration rims on light cured base with wax pivots in the premolar and molar regions.
图49.前磨牙和磨牙区有蜡枢轴的光固化基托上的下颌配准轮缘。
Figure 50. Maxillary rim shaped first - for correct lip support, incisal plane, occlusal plane, buccal corridors and centre line.
图50.上颌边缘首先成形-用于正确的唇支撑，切牙平面，咬合面，颊走廊和中线。
Figure 51. Maxillary and mandibular rims in place at the correct occluding vertical dimension in centric relation.
图51.在正中关系中，上颌骨和下颌缘在正确的封闭垂直尺寸上就位。
Figure 52. Dentate photograph of the patient used to mimic tooth position. This is used as a guide for shaping the wax rims (Finlay) and positioning the teeth (Rowan).
图52.用于模拟牙齿位置的病人的牙齿照片。这是一个指南，用于塑造蜡轮辋(芬利)和定位牙齿(罗文)。
Figure 53. Wax rims shaped using the information offered from the dentate photograph of the patient in figure 52. Rowan uses these photographs to enable production of the wax try ins.
图53.蜡轮辋形状使用提供的信息，从病人的牙齿照片在图52。罗文利用这些照片来制作蜡型。
Figure 54. Maxillary and mandibular casts mounted on Denar Mk 2 articulator.
图54.上颌和下颌模型安装在Dnar Mk 2颌架上。
Figure 55. Wax trial insertion - Schottlander enigmalife teeth.
图55.蜡试插入-Schottlander神秘感牙齿。
Figure 56.57.58.59. Try in checked for correct aesthetics, occluding vertical dimension and centric relation.
图56.57.58.59.尝试检查正确的美学，封闭垂直尺寸和中心关系。
Figure 60. Mandibular anterior teeth removed from model prior to finishing the complete denture.
图60.完成前下颌前牙摘除模型
Figure 61. Mandibular complete denture on the definitive model.
图61.下颌全口义齿的确定模型。
Figure 62. Definitive casts prepared with mandibular teeth removed for the complete dentures.
图62.为全口义齿拔除下颌牙的最终模型。
Figure 63. Complete dentures finished with Schottlander enigma life teeth prior to fitting.
图63.最终修复体。
Figure 64.65.66.67. Mandibular immediate complete denture fitting surface.
图64.65.66.67.下颌即刻全口义齿配件表面。
Figure 68. Maxillary complete denture with Schottlander enigmalife teeth.
图68.上颌全口义齿与Schottlander谜语咬合牙
Figure 69. Mandibular immediate complete denture with Schottlander enigmalife teeth.
图69.下颌即刻全口义齿与Schottlander谜状牙。
Figure 70. Right hand side of the complete mandibular denture showing the soft tissues helping to hold the lower denture stable.
图70.下颌全口义齿的右侧显示软组织，有助于保持下口义齿的稳定。
Figure 71. Left hand side of the complete mandibular denture showing the soft tissues helping to hold the lower denture stable.
图71.下颌全口义齿左侧显示软组织，有助于保持下口义齿稳定。
Figure 72. Complete dentures fitted.
图72.全口义齿已安装。
Figure 73. Complete dentures fitted - full extension of the postdam to maximise retention
图73.已安装的完整义齿.最大限度地保持牙列的完全延伸。
Figure 74. Complete dentures fitted.
图74.全口义齿已安装。
Figure 75.76. Complete dentures fitted - mimicking the natural teeth.
图75.76.全口义齿贴合-模仿天然牙齿。
最终修复体口内照。
下颌戴入口内后吸附状况
下颌取戴状况
编后按
在新的一年里，牙匠之家没有太多华丽的祝福，但愿此技术文章能给大家在新的一年里带来更多新的思路。由于小编的外语渣缘故，所以有很多翻译可能不准确，为了方便有能力的读者，特把原文注释一起放上来，希望解释不到位的地方大家多多包涵。我是郭远，新的一年，祝愿大家身体健康，万事如意！
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