日本補綴歯科学会雑誌
Online ISSN : 1883-177X
Print ISSN : 0389-5386
最新号
選択された号の論文の25件中1~25を表示しています
原著論文
  • 佐藤 裕二, 北川 昇, 服部 佳功, 山下 秀一郎, 玉置 勝司, 中村 隆志
    2008 年 52 巻 4 号 p. 457-464
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    目的 : (社) 日本補綴歯科学会は, 補綴治療の対象である, 歯質欠損, 部分歯列欠損, 無歯顎に対する症型分類を提示した. 症型分類は2つの主要セクションと4つの小項目から成り立っている. さらに, 4つのレベル (Level I : 難易度が低い症例, Level II : 難易度が中等度の症例, Level III : 難易度が高い症例, Level IV : 難易度が著しく高い症例) が, 治療の難易度として定義される. 本研究の目的は, 全部床義歯治療時間に関する歯科医師の意識調査を行うことにより, 歯科医師の熟練度と症例の難易度 (症型分類) が治療時間におよぼす影響を明らかにすることである.
    方法 : 14大学, 311名からアンケート結果を得た. 臨床経験 (認定医・専門医資格の有無) と全部床義歯治療時の各ステップのチェアータイムを調査した.
    結果 : 調査用紙より無歯顎者に関する症型分類のLevelが高くなるにつれて, 全部床義歯の治療に必要な時間はかなり長くなるが, 単位時間の診療報酬は低くなることが示された. 日本補綴歯科学会の認定する認定医・専門医の資格取得者は全体に治療に要する時間は短いものの, やはり症型分類の高いLevelには長時間を要することが示された.
    結論 : 日本補綴歯科学会の認定する認定医・専門医の資格取得者では難易度にかかわらず, 資格未取得者と比較して全部床義歯の治療時間が短く, 治療回数も少ない傾向を示した. しかし, Level III, Level IVに分類される難症例では認定医・専門医の資格取得者においても, 時間を要することが示された.
  • 高橋 睦, 高橋 史, 森田 修己
    2008 年 52 巻 4 号 p. 465-472
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    目的 : スポーツ時の顎口腔領域の外傷予防には, マウスガードの装着が有効である. 本研究では, 厚さの異なる2種類のシートの成形後の厚みについて比較検討を行うことを目的とした.
    方法 : マウスガードシートに10mm四方の格子を印記し, 各格子の厚さをメジャリングディバイス®を用いて測定した. マウスガードシートは2mmおよび4mmの厚さのものを用い, 2種類の厚さのマウスガードシートの成形後のシート各部の厚みの違いをWilcoxon符号付順位和検定およびt 検定を用いて分析した. さらに, 成形後のシート各部の延びと厚みの関係を回帰分析により検討した.
    結果 : シートの模型圧接部は, すべての部位で厚みが減少した. シート各部の厚さの変化は2mmシートと4mmシートで同様であった. 前歯部および口蓋部では, 2mmシートのほうが4mmシートに比較して厚みの変化率が大きかった (p < 0.01). 臼歯部の厚みの変化率は, 2mmシートと4mmシートで違いは認められなかった. 延びと厚みの関係は, 二次関数で表された.
    結論 : 本研究の結果, 前歯部および口蓋部の厚みの減少率は2mmシートのほうが4mmシートよりも大きくなり, 臼歯部の厚みの減少率はシートの厚さによる違いがないことが明らかとなった.
  • 竹内 聡史, 河野 正司, 小林 博, 桜井 直樹, 細貝 暁子, 金城 篤史, 甲斐 朝子
    2008 年 52 巻 4 号 p. 473-481
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    目的 : 下顎タッピング運動に随伴する体幹動揺が, 座位において観察できるのか, また立位と座位でどのような差を示すか追求することを目的とした.
    方法 : 被験者は顎口腔系に異常を認めない男性6名 (25-29歳, 平均年齢27.0歳) で, 姿勢は立位, 座位の2種類として, 10秒間の咬頭嵌合位保持, 3Hzの20秒間タッピング, その後10秒間咬頭嵌合位保持を1測定単位として測定を行った. 下顎運動はTRIMETII (東京歯材社製) により上顎座標系にて下顎切歯点を, 頭部は大地座標系で上顎切歯点, 下顎頭点, 頭頂点, 後頭点を, また体幹動揺はProreflex (Qualisys社製) により大地座標系で胸骨点の矢状面内運動を分析した.
    結果 : 座位において, 下顎タッピング運動に随伴する体幹動揺が認められた. 開口量に対する体幹動揺量を立位と座位でWilcoxonの符号付検定をしたところ, 有意に立位の方が大きくなった. また体幹動揺の周波数分析におけるパワーの平均値を立位と座位でWilcoxonの符号付検定をしたところ, 有意に立位の方が大きくなった. しかし, 原波形解析による検出率をWilcoxonの符号付検定をしたところ, 立位と座位で有意差は認められなかった.
    結論 : 体幹動揺量は立位の方が大きいが, 原波形による検出率では差がなく, 咀嚼動作として自然な座位での分析も可能であることが明らかとなった.
Original Articles
  • Akinori Tasaka, Yasuaki Tahara, Tetsuya Sugiyama, Kaoru Sakurai
    2008 年 52 巻 4 号 p. 482-487
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: The purpose of this study was to clarify the effect of different chewing rates on salivary cortisol levels as a stress indicator.
    Methods: The subject group consisted of 16 healthy males. They were required to rest for 30 min, and then given arithmetic calculations to perform for 30 min as stress loading. Immediately after, the first set of saliva specimens (S1) was collected over a period of 1 min to measure cortisol levels. Next, they were asked to chew a tasteless gum base for 10 min, and the second set of saliva specimens (S2) was collected in the same manner. They were then required to rest for 10 min, after which the third set of saliva specimens (S3) was collected. Chewing rates were set to slow, habitual, and fast in time with a metronome. Salivary cortisol levels were analyzed by radioimmunoassay. Changes in salivary cortisol levels comparing S1 with S2, and S1 with S3 were determined.
    Results: Changes in salivary cortisol levels between S1 and S2 showed a reduction of 4.7%, 14.6%, and 16.2% with slow, habitual, and fast chewing, respectively. A significant difference was observed between slow and fast chewing. Changes in salivary cortisol levels between S1 and S3 showed a reduction of 14.4%, 22.2%, and 25.8% with slow, habitual, and fast chewing, respectively. A significant difference was observed between slow and fast chewing.
    Conclusion: This study showed that differences in chewing rate affected salivary cortisol levels as a stress indicator, and suggested that the effect on stress release with fast chewing is greater than that with slow chewing.
  • Hisashi Koshino, Toshihiro Hirai, Yuichi Yokoyama, Maki Tanaka, Yoshif ...
    2008 年 52 巻 4 号 p. 488-493
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: The purpose of this study was to investigate the influence of mandibular residual ridge shape on the masticatory ability in complete denture wearers.
    Methods: The subject group consisted of 199 complete denture wearers. The mandibular residual ridge of each subject was evaluated using a replica of the ridge which was obtained with heavy-body silicone impression material. The basal area of each replica was measured with a digitizer. The volume and the height of each replica were also calculated. The masticatory ability of each subject was evaluated using a-25-item food intake questionnaire method by authors. The masticatory score of each subject was calculated to represent the masticatory ability. Furthermore, all subjects were divided into three groups (S, M, L group) according to the value of the basal area.
    Results: There were statistically significant correlations between the basal area of the residual ridge and the masticatory score (r = 0.366, p < 0.01), and also the volume of the residual ridge and the masticatory score (r = 0.314, p < 0.01). The basal area of the residual ridge, the volume of the residual ridge, and the masticatory score of the L group (29 persons) were statistically larger than those of the M group (136 persons) and the S group (34 persons) (p < 0.05), and those values in the M group were statistically larger than those of the S group (p < 0.05).
    Conclusion: It was confirmed that the basal area of denture foundation of the mandible had an influence on the masticatory ability in complete denture wearers.
  • Naoya Uemura, Masahiro Tanaka, Takayoshi Kawazoe
    2008 年 52 巻 4 号 p. 494-500
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: Neck pain is one of the main symptoms of temporomandibular disorder. Muscle activity of the sternocleidomastoid muscle during occlusion has been clarified in recent years. We reported that when healthy individuals were instructed to chew rapidly, the activity of the sternocleidomastoid muscle responded to activity of the masseter muscle, however, during voluntary jaw opening, activity of the sternocleidomastoid muscle did not respond, but worked actively due to motor programming. The objective of the present study was to investigate the learning effects of repetitive training, that is, changes in activity mode of the neuromuscular system.
    Materials and Methods: The sternocleidomastoid and the anterior belly of digastric muscles in 8 healthy male adults were analyzed. In response to acoustic stimulation, each subject was instructed to open their mouth as quickly and widely as possible a total of 30 times with a break between measurements. EMG-reaction times (RT) of the sternocleidomastoid and anterior belly of digastric muscles were measured, and the length of time from the start of EMG activity of agonist to the start of actual movement was measured.
    Results: In all subjects, at first measurement, EMG-RT of the sternocleidomastoid muscle did not precede that of the anterior belly of digastric muscle. With each measurement, the difference in EMG-RT between the sternocleidomastoid and the anterior belly of digastric muscles decreased, and in 6 of the 8 subjects, EMG-RT of the sternocleidomastoid muscle preceded that of the anterior belly of digastric muscle.
    Conclusion: Repetitive task movement alters the start times of muscular activities, and from the perspective of EMG kinesiology, motor learning effects were confirmed with maximum ballistic voluntary jaw opening.
  • Teruhisa Hirayama, Marie Koike, Tadafumi Kurogi, Akiko Shibata, Shiger ...
    2008 年 52 巻 4 号 p. 501-506
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: The purpose of this study was to investigate the ion release from titanium casts in solutions of mixed organic acids and to reconsider the possibility of allergic reactions to titanium.
    Methods: Cast specimens were made from commercially pure titanium. For the immersion solutions, we prepared two types of organic acid solutions, one mixed with organic acids contained in whole stimulated saliva at two different dilutions, and the other, a lactic acid solution. Following immersion, the amounts of dissolved titanium ions, weight loss of the casts, and micrographs of the specimen surfaces were examined.
    Results: There were significantly larger amounts of dissolved titanium ions in the mixed organic acid solutions than in the lactic acid solution. There was also a significant difference in the weight loss values between the immersion solutions (p < 0.0001), but the significance level was different from that of the difference in the quantity of ion elution.
    Conclusion: The results suggested that a much larger quantity of ions is released from titanium casts attached in the oral cavity than has been reported previously, and that it is necessary to consider the possibility of allergic reactions to titanium casts.
  • Chaivut Prunkngarmpun, Yuka I. Sumita, Hisashi Taniguchi
    2008 年 52 巻 4 号 p. 507-512
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: The purpose of this study was to establish an evaluation method using a Nasometer, with several monosyllabic test words, to reveal the level of air leakage in maxillectomy patients without limitations due to language or ability to read.
    Methods: 20 normal Japanese (Group 1) and 20 international adults (Group 2), were asked to read 7 monosyllables, (5 vowels and 2 combined vowels, /a/, /i/, /u/, /e/, /o/, /am/, /aj/), 6 times each and 12 Japanese maxillectomy patients (Group 3) were asked to read only 3 monosyllables (/a/, /am/, /aj/) 6 times each. The “Nasalance Score” was calculated using a Nasometer (Nasometer II, model 6400 KayPentax, Lincoln Park, NJ, USA).
    Results: Coefficient of variations (CVs) of three monosyllables /a/, /am/, /aj/ of Group 1 and Group 2 showed less than 0.33. There is significant difference in all pairs of three monosyllables between Group 1 and Group 3 (p < 0.05).
    Conclusion: Using a Nasometer, these three monosyllables, /a/, /am/ and /aj/, could be used as standard test words and could reveal the level of air leakage in maxillectomy patients.
  • Mutsumi Takahashi, Fumi Takahashi, Osami Morita
    2008 年 52 巻 4 号 p. 513-520
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: This study evaluated the masticatory side as well as which side was the habitual chewing side by the use of wax cubes and a bite force measuring system in normal dentate subjects (ND) and complete denture wearers (CD).
    Methods: Forty two ND subjects (29 males, 13 females; mean age, 24.8 ± 2.4 years), and 11 CD subjects (4 males, 7 females; mean age, 72.8 ± 7.0 years) participated in the study. The test food used in this study was wax cubes to determine the masticatory side. The difference in the occlusal contact area and occlusal force between the masticatory side and the opposite side was investigated using Dental Prescale®. ND was classified into 2 groups: those whose agreement on the masticatory part was high (ND-H) or low (ND-L). The distribution of the center of the occlusal balance was analyzed by Dental Prescale® in ND-H, ND-L, and CD.
    Results: The occlusal contact area and occlusal force of the masticatory side was greater than the opposite one, and the center of the occlusal balance was wide in ND-H. In ND-L and CD, the occlusal contact area and occlusal force did not differ between the masticatory side and the opposite one, and the center of the occlusal balance developed a tendency to gather in the center.
    Conclusion: The results of this study suggested that the evaluation of the masticatory side and the use of Dental Prescale were helpful in determining the habitual chewing side.
  • Akio Izumida, Masanobu Yoda, Ryoichi Inagaki, Joji Toyoda, Minoru Ishi ...
    2008 年 52 巻 4 号 p. 521-528
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: Hard resins for crowns and bridges are widely used for esthetic restorations. The objective of this study was to evaluate the mechanical properties of new commercial hard resins and to compare the results with those of the other hard resins previously investigated.
    Methods: Dentin and enamel made with two new hard resins (Epricord®: EP, Kuraray, Co., Ltd., Osaka, Japan and Prossimo®: PR, GC, Co., Ltd., Tokyo, Japan) were used in this study. Regarding the fundamental characteristics, the thermal expansion/shrinkage coefficient, the filler content, the polymerization shrinkage, and the wear were examined. Regarding the strength of resin, the bending strength, hardness, compression strength, elastic modulus, and fracture strength of a jacket crown were measured.
    Results: These resins showed comparatively lower levels than the other hard resins regarding the bending strength, hardness, compression strength, and fracture strength of the jacket crown. The total filler content rate and wear amount of these resins exhibited similar values to those of the other resins. The thermal expansion/shrinkage coefficients of these resins exhibited higher values than those of the other resins. EP showed a different tendency from PR about the compression strength, elastic modulus, and polymerization shrinkage.
    Conclusions: PR and EP did not show dramatically better physical properties. However, the results of each examination in this study may be acceptable clinically. The results of each investigation changed according to the products used, and proper use for each case and application was suggested.
  • Akiko Hosogai, Toyohiko Hayashi, Shoji Kohno, Kazuhiro Yamada, Tomoaki ...
    2008 年 52 巻 4 号 p. 529-536
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: The aim of this study was to develop a means of coordinating helical computed tomography (CT)—based morphological data in 3 dimensions (3-D) with that pertaining to jaw movement as recorded by a device that measures jaw movement in six-degrees-of-freedom (6-DOF), thus producing multi-point movement analysis of the condyle.
    Methods: The study sample was two volunteers. One of the subjects had erosive bony changes in both condyles, while the other had healthy condyles. We employed a customized facebow, which enabled us to coordinate jaw movement data and morphological volume data from CT. Total uncertainty of the coordination was computed, according to International Organization for Standardization (ISO). In order to demonstrate the effects of multi-point analysis for complex condylar movement, we tried to visualize the trajectory of the working condyle in lateral excursion.
    Results: The overall uncertainty at a condylar center chosen as an example to illustrate the method was 0.38 mm, 0.19 mm, and 0.50 mm in antero-posterior, latero-medial, and supero-inferior directions, respectively, in terms of 95% coverage as defined by the ISO.
    Conclusion: We developed facebow-based X-ray markers with high clinical operability, which could correlate the helical CT's coordinate system with our 6-DOF jaw movement measuring system for precise analysis of 3-D condylar movements. In motion analysis of rotational condyle, even a small amount of measurement error cannot necessarily be neglected. Then, a multi-point approach such as that realized by our system presents the best option.
  • Fumi Takahashi, Mutsumi Takahashi, Shuji Toya, Osami Morita
    2008 年 52 巻 4 号 p. 537-542
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: The aim of this study was to investigate the relationship between medicine and stimulated saliva and oral moisture.
    Methods: Fourteen patients with subjective oral dryness and 13 healthy adults were enrolled in this study. Disease, medicine, and medicines that had a side effect of oral dryness were investigated. The Saxon test was performed by chewing a piece of gauze sponge for 2 min. Oral moisture was measured at the lingual and buccal mucosa using an oral moisture checking device. Statistical analysis was performed by the Mann-Whitney U-test and Student t-test.
    Results: Stimulated saliva and oral moisture did not differ according to the number of diseases. Oral moisture at lingual mucosa was different between a minor medicine group (0-2 types of medicine) (31.3 ± 1.9%) and a major medicine group (≥3 types of medicine) (29.5 ± 2.2%) (p = 0.05). Oral moisture differed between a group not taking any medicine that had a side effect of oral dryness (31.2 ± 1.8% at lingual mucosa and 33.8 ± 1.4% at buccal mucosa) and a group taking such medicine (29.3 ± 2.3% at lingual mucosa and 32.4 ± 1.8% at buccal mucosa) (p < 0.05).
    Conclusion: The results of this study showed that oral moisture tended to decrease in the subjects who took many types of medicine or who took medicine that had a side effect of oral dryness. The medicine did not influence the amount of stimulated saliva. Therefore, it was suggested that medicine could influence the moisture of the oral mucosa.
  • Ayako Hagino, Ken Inohara, Yuka I. Sumita, Hisashi Taniguchi
    2008 年 52 巻 4 号 p. 543-549
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: The aim of this study was to investigate the factors influencing the outcome of prostheses on speech rehabilitation of mandibulectomy patients.
    Methods: Eleven patients (6 males and 5 females) who underwent mandibulectomy without glossectomy because of a tumor participated in the study. A Speech Intelligibility (SI) test was applied without and with a prosthesis to evaluate their speech ability. The type of resection, whether soft tissue grafting was undertaken or not, the continuity of mandibular bone, and the number of remaining teeth related to the stability of the prosthesis were determined from the medical records. The some of acoustic features, Formant 1 and Formant 2 range, were investigated to evaluate objectively the limitation of tongue movement. Five questionnaires were sent out to evaluate subjectively the difference in sense of discomfort while speaking with and without the prosthesis. These eleven items were entered into stepwise multiple regression models to determine the predictors of the differences in SI score without and with a prosthesis.
    Results: Three variables, the ease of tongue movements, whether soft tissue grafting was undertaken or not, and whether the mandibular bone was continuous or not, contributed to the recovery of speech ability with prosthodontic treatment.
    Conclusion: The ease of tongue movement, no soft tissue grafting, and the continuity of mandibular bone contribute to the recovery of speech ability with prosthodontic treatment.
Technical Procedure
  • Koh-ichi Suginaka
    2008 年 52 巻 4 号 p. 550-554
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Purpose: The riegel and swing-lock® attachments are excellent retainers in terms of secure retention, but the former requires a great volume of abutment tooth reduction and the latter has problems with aesthetics and abrasion. In contrast, the RPI and RPA clasps have been highly appreciated as excellent retainers for abutment tooth protection, but any retentive forces are needed. Thus, the purpose of the study is to design a retainer that made the use of these merits.
    Methods: The form of the retainer (named Suginaka Riegel® lock retainer) for this purpose is based on the RPPA, for which a lingual arm is provided. In applying this technique, the buccal arm corresponding to the Akers-type buccal arm in the RPPA utilizes the undercut area below the survey line, ranging from the distal to the mesial corner. This buccal arm extends from the metal tooth that turns the hinge placed in the buccal denture border. The Suginaka Riegel® device placed in the denture base locks the metal tooth in place.
    Results: Utilizing the deeper undercut below the survey line provides secure retention while eliminating the risk of adverse forces being exerted on the abutment tooth during denture function or insertion and removal.
    Conclusion: This new, additional form of the Suginaka Riegel® lock denture allows the abutment tooth to provide latch effect-derived retention solely by preparation of the rest seat and guide plane. This allows use on a healthy tooth and on a tooth for which prosthodontic treatment has already been completed.
Case Reports
  • Ani Ratnasari, Koichi Hasegawa, Kumiko Yoshihara, Noriyuki Nagaoka, Su ...
    2008 年 52 巻 4 号 p. 555-558
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Patient: An 83-year-old woman visited the hospital for new complete dentures. A mesh type stainless palatal plate (Trutissu plate) was selected, because it enables the patient to experience the taste and temperature of food. Twenty one months after insertion, the patient returned complaining of pain on mucosa under the mandibular denture base. On clinical examination, a small swollen area was observed on the palatine rugae region of the mesh plate. By making a small hole in the swollen part, a creamy mass of dark brown color was discharged from the swollen space between the laminated structure of the Trutissu plate. Three months after the first deformation was corrected, further deformation of the Trutissu plate was observed. The patient admitted that she had not used the ultrasonic cleansing apparatus. A candidiasis-like lesion was observed on the palatal mucosa.
    Discussion: The formation of Candida biofilms on dentures may assist survival of fungal cells and contribute to the disease process in patients with denture stomatitis. In this case, the patient did not use ultrasonic cleaner, thus resulting in microbial accumulation and morphological change of the laminated mesh plate. However, this is rare in the clinical use of the Trutissu mesh plate, and the only case reported in 20 years. Ultrasonic cleansing was effective in removing microorganisms from the denture.
    Conclusion: Routine ultrasonic cleansing should be performed to avoid the possible accumulation of microorganisms in the laminated mesh structure.
  • Fujio Tsuchida, Yuko Suminaga, Norio Takishin, Toshio Hosoi, Yoshihiro ...
    2008 年 52 巻 4 号 p. 559-561
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    Patient: A 58-year-old man with a complaint of masticatory disturbance presented. His mandibular left premolars and molars were missing, and the mandibular left canine, which was neighboring to the missing part, showed marked labial tipping. A cobalt-chromium removable partial denture was fabricated using a new magnetic attachment retainer because it seemed difficult to apply a conventional clasp for this case. This retainer is constructed from the buccal hook arm sliding bucco-lingually and the magnetic attachment which works to lock the movable part when it was closed. Six years after the delivery of this denture, both the abutment tooth and the periodontal tissue are healthy, and the denture is functioning well.
    Discussion: As this retainer does not use the elasticity of clasp arms, block out area can be minimized, and the maximum area of the contacting surface of the hook arm brings about very positive retention and bracing. The function of attractive force is to resist the splitting force and not to become directly involved in the retention of the denture. Therefore, the attractive force for this system does not need to be very strong. This system also provides the advantages of a sectional denture, allowing protection of the abutment tooth and the use of the abutment tooth in its original form.
    Conclusion: The retainer described in this report has many advantages including, no hazardous lateral force, adequate retentive force, and application to natural teeth or tipped teeth.
認定医症例報告
  • 村井 健二
    2008 年 52 巻 4 号 p. 562-565
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    症例の概要 : 患者は71歳の女性, 不適切な唇舌的位置に埋入された上下顎前歯部インプラントの違和感および審美性の改善を希望して来院した. 上顎にはテレスコープクラウンを, 下顎には磁性アタッチメントを応用したインプラント支台オーバーデンチャーを作製した. 以後5年以上経過しているが, 良好な状態を維持している.
    考察 : テレスコープクラウンを用いた場合, 作用する応力が過大になりやすいが, 咬合や適合の修正を細かく行うことによって対応しており, 今のところ問題は起こっていない.
    結論 : 埋入位置が不良なインプラントに対し, オーバーデンチャーによりインプラントの撤去や再埋入することなく違和感や審美性を改善することができた.
  • 山内 英嗣
    2008 年 52 巻 4 号 p. 566-569
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    症例の概要 : 患者は46歳の女性. 両側遊離端欠損部にインプラント治療を希望していたが, 外科手術の恐怖感から, 治療計画を部分床義歯による治療に変更した. その後, 即時義歯の維持・安定や審美的な不満などからコーヌステレスコープ義歯による治療を行った.
    考察 : 本症例では長期的に良好な経過を得た. これは, 適確な診査・診断をもとに, rigid supportを有するコーヌステレスコープ義歯を選択したことによると考えられる.
    結論 : 患者は十分満足しており, コーヌステレスコープ義歯は最適な補綴治療であったと思われる. 今後も良好な口腔内の状態を維持するために, 義歯の動態と歯周組織の状態について定期的な観察が必要である.
  • 小平 順可
    2008 年 52 巻 4 号 p. 570-573
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    症例の概要 : 71歳の男性で, 上下顎総義歯の維持不良による発音障害を主訴に来院した. 顎堤は, 上下顎ともに高度な吸収を認めた. 義歯は床縁が短く維持も不良で, 機能時に離脱が認められた. 装着していた義歯を治療用義歯として, 義歯の維持と顎位の改善を図ることとし, これらが得られたことを確認した上で新義歯を作製した.
    考察 : 治療前後の評価より, 発音機能の回復が得られたと考える. 患者が新義歯に順応し舌の運動範囲が拡大したことが推測される. これは, 新義歯に適切な舌房形態を与えることができたためと考える.
    結論 : 維持・安定が図られ, 発音機能の改善を考慮した新義歯は, 機能時に離脱を認めず, 発音が明瞭となった.
  • 水口 一
    2008 年 52 巻 4 号 p. 574-577
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    症例の概要 : 患者は初診時50歳の女性で, 起床時の左側顎関節部疼痛, 開口障害を訴え本院を受診した. 画像診査ならびに臨床診査より両側変形性顎関節症と診断した. スタビリゼーションアプライアンスにて均等な咬合接触を付与し症状の緩解を得たが, 左側臼歯部の咬合接触が消失し咀嚼障害を訴えた. 右側臼歯部の削合ならびに暫間接着アンレーを装着し経過観察を行った後, ポーセレンアンレーを装着し左側臼歯部の咬合接触を回復した.
    考察 : 6年後に経過観察を行ったが, 顎関節症症状の再発, 歯科補綴装置の破損, 咬合関係の変化は認められなかった.
    結論 : 補綴学的処置により変形性顎関節症による臼歯部開咬の治療のみならずQOL向上に貢献できた.
専門医症例報告
  • 中島 厚
    2008 年 52 巻 4 号 p. 578-581
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    症例の概要 : 患者は62歳の男性で, 下顎左側臼歯部咬合痛による咀嚼障害を主訴に来院した. 主訴改善のため, 歯根破折した⌈5を抜歯した. 治療は, 下顎両側遊離端欠損部にインプラント支持による固定性補綴装置を用いた. 咬合力バランスを確認しながら全顎的にプロビジョナルレストレーションに置き換え, 2002年5月に最終補綴装置へ移行した.
    考察 : 咬合力バランスを確認しながら咬合再構築を行ったことが成功した一因と推察する.
    結論 : 悪習癖や破折の既往がある場合でも, 注意深く調整を行えば, 咬合支持の回復と残存歯保護の観点から, 両側遊離端欠損に対するインプラント治療は有用であることが示唆された.
  • 神庭 光司
    2008 年 52 巻 4 号 p. 582-585
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    症例の概要 : 74歳女性. 上顎左側臼歯部の義歯破損と上下顎義歯維持の不良による咀嚼障害を主訴として来院した. 義歯破損の原因はクリアランス不足の状態において, 強度の劣る義歯が装着されていることと診断した. また, 義歯不安定の原因は, 上顎では片側性の設計, 下顎では間接支台装置の破損によるものと診断した. 治療方針は義歯の強度の確保と両側性設計による把持力の発揮においた.
    考察 : 両側性の設計にすることで義歯の安定が増し, クリアランスを確保した後に, 上顎義歯を装着することで, 強度の確保もできたと考える.
    結論 : 新義歯では咀嚼機能が回復し, また強度的にも経過観察中に大きな義歯の破損は生じていないことから, 妥当性のある補綴処置が行えたと考える.
  • 鮎川 保則
    2008 年 52 巻 4 号 p. 586-589
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    症例の概要 : 患者は58歳の女性. 下顎右側大臼歯欠損と上顎右側臼歯部ブリッジ脱離による咀嚼障害の治療を希望して来院した. 下顎大臼歯部はインプラントを支台としたハイブリッドセラミックス前装鋳造冠を用いた補綴治療を行った. 同時に7⌋歯肉縁下の二次う触や, 同歯挺出によるクリアランス狭小化に配慮しつつ75⌋を支台歯としたブリッジによる補綴を行った. 4年以上経過したが, その間5⌉遠心に歯間離開を生じたため, 同歯の補綴装置再作製にて対応した.
    考察 : 離開は天然歯の生理的移動により生じたと考えられた. 今後さらに観察していく必要がある.
    結論 : 片側遊離端欠損症例に対し, インプラントを用いて咬合支持を再建することができた.
  • 池田 浩子
    2008 年 52 巻 4 号 p. 590-593
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    症例の概要 : 患者は上顎左側歯肉癌により上顎骨切除術を施行された75歳の女性. 治療用顎義歯を製作し, 創部の状態に合わせ調整を繰り返した後, 組織の安定を待ってから最終顎義歯へ移行した.
    考察 : 治療用顎義歯の栓塞子の形態として開口量が少なかったこと, 装着時および装着後の調整のしやすさを考慮し, 治療用顎義歯の栓塞子部は天蓋開放型を選択した. その後患者の訴えを考慮しながら栓塞子の形態を調整し, 最終顎義歯では, 中空型で天蓋閉鎖型栓塞子にしたところ, 患者の満足を得られることができた.
    結論 : 栓塞子の形態は術後の創部の状態や開口量などの条件に左右され, それらの条件に合わせた形態の選択が重要と考えられた.
  • 川本 善和
    2008 年 52 巻 4 号 p. 594-597
    発行日: 2008/10/10
    公開日: 2009/02/20
    ジャーナル フリー
    症例の概要 : 63歳男性で, 咀嚼障害を訴え来院した. 咬合再構築および歯周治療を行い, 上顎は全部床義歯, 下顎は臼歯部に間接歯冠修復用コンポジットレジン前装固定性ブリッジによる補綴治療を行った.
    考察 : 間接歯冠修復用コンポジットの着色や変色を認めずに経過しているのは, 定期的なメインテナンスによるものと考えられる.
    結論 : 間接歯冠修復用コンポジットレジンは歯間部やポンティック部にプラークが付着しやすい傾向を示したが, 歯ブラシ指導に加え, 音波ブラシの指導を併用することで, 口腔内の清掃状態の改善が認められた. 機能的にも審美的にも良好な結果を得られた.
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