Teeth can be repaired, teeth can be installed, teeth can be corrected when they are crooked, these seem to be not difficult. However, the dentures that have just been installed are broken in less than a year, the newly made porcelain tooth piers have begun to loosen, and the dentures are crumbling; the dentures look good, but the bite is uncomfortable...
Wei Bin, deputy director and chief physician of the First Department of Stomatology of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, said that dental problems are not only tooth defects and absences, but also have a close relationship with tooth decay, periodontitis, occlusal interference, temporomandibular joint disorders, and bad habits. If the comprehensive consideration and evaluation of these conditions are ignored when filling and filling teeth, and the "top-level design" is not done, the effect of repair treatment will not be maintained for a long time, and the above problems will occur. Especially if the oral disease is serious, a mouthful of rotten teeth, it is very important to do a good job of "top-level design", which directly determines the effect of treatment.
Dragged out of the "rotten teeth"
We often use "a mouthful of rotten teeth" to describe bad and serious tooth decay, lack of teeth problems, when the first tooth decay is not treated, the loss of one or two teeth is not taken seriously, and eventually it will lead to "a mouthful of rotten teeth".
Wei Bin said that many patients in China do not pay enough attention to oral health problems, teeth are broken often endured, dragged, miss early treatment, the condition is getting more and more serious, and when the stomatology department is treated, there are often several tooth decay, missing teeth, loose teeth, etc., or the pain is unbearable, or obviously affect the meal.
The situation of "a mouthful of rotten teeth" is "dragged" out in this way. Wei Bin said: "Even if it is tooth decay, it is gradually expanded from a small area to a large area, under normal circumstances, the development of tooth decay is very slow, as long as you insist on doing oral examination every six months, normal 'maintenance', you can find it in time when a small area of tooth decay first appears, and it will not develop to the point where severe tooth decay needs to be extracted." The condition of occlusal trauma is also similar to tooth decay, and it also takes a long time to accumulate irreversible damage, and regular examination can completely solve these problems. ”
Don't ignore the problems behind missing teeth
There are many methods of dental restoration, such as fillings, inlays, veneers, porcelain all-porcelain crown bridges, dentures, implants, etc., these technologies are now very mature. For simple tooth defects and missing problems, as long as the equipment is complete and the technology is passed, the conventional repair method can be solved, the treatment difficulty is not high, and the effect is ideal.
However, some difficult injuries cannot be solved by such a simple repair. "The so-called difficulty is that in addition to missing teeth in a patient's mouth, there are many other interrelated problems, such as tooth decay, periodontal disease, occlusal trauma, occlusal relationship disorder, dentition and so on." Wei Bin pointed out that there are two kinds of difficult teeth: one is that the patient's oral condition is poor, and it is difficult for conventional methods to achieve satisfactory results; the other is that there are still more complex related problems in the mouth that need to be considered and solved at the same time.
For conventional dental diseases, it is enough to treat them according to the standards of diagnosis and treatment. However, difficult teeth are different. For example, Wei Bin said, such as the common phenomenon of "pulling out one tooth after another", the patient has a missing tooth and wants to implant a tooth, but in fact, the teeth on both sides of the missing tooth are also loose, if it is not found or not designed a good restoration method, after being implanted according to the convention, after a few months, the teeth next to it may fall out again, and the teeth need to be implanted. Many people may think that this is a normal phenomenon, but in fact it is unreasonable from the design level. The design should take into account the "long-term stability" of the area, and the health of the natural teeth (adjacent, conjunctive and gums) in the area should be considered at the same time as the restoration of missing teeth.
"We can't ignore the problems behind missing teeth." Wei Bin said, "When examining the mouth, if you find that the teeth around the missing teeth are also loose, you should first treat the underlying oral disease, save the loose teeth in time, and then implant the teeth; if it is expected that several teeth around may fall in a short period of time, when designing the treatment plan, you should take these problems into account to ensure that the designed treatment plan can be maintained for 10 years, 20 years or even longer, without the need for repeated implants." "We must first treat periodontal disease well, adjust the occlusal relationship, and reasonably distribute the occlusal force." The final step is to repair and plant teeth, rather than passively missing one by one.
It's like building a building, the foundation is compacted, and the building will not fall. Regardless of blindly building a building, it may become a "tofu slag" project.
Top-level design takes into account long-term effects
Wei Bin stressed that the top-level design of difficult teeth is very important. The same patient, different doctors may give different treatment plans, "tooth preservation" and "tooth extraction" can solve the current problem, but the long-term effect and outcome will be different. "The success of treatment is also an indicator of time, if it can be maintained for eight or ten years without major changes, it is a successful treatment." If a pair of dentures is installed, the result is broken and broken in two or three years, which may be caused by various problems such as bite and force direction not well designed, that is, the original treatment plan is not designed reasonably enough. "For example, some patients did not choose implantation to choose fixed bridge repair, need to be fixed on the two teeth next to it, if the two teeth next to it originally have periodontitis, itself is not strong enough, and then bear the weight of a denture, it may exceed the range of affordability, then the life of the denture will not be long, and even the teeth on both sides will be loose and fall." If the periodontal disease of both teeth is treated before the denture is installed, the teeth are stable enough to withstand 3 teeth, and the life of the dentures is long, and the design scheme of such a fixed bridge is also successful.
"Some people feel uncomfortable after installing dentures, or it may be that the occlusal relationship is not adjusted, or a tooth is under the wrong force." Wei Bin said frankly, "Many details are not handled well, which will bring about various problems. ”
Therefore, before designing the plan, it is necessary to do a comprehensive examination of the oral cavity, including auxiliary examinations such as dental tablets, fully understand the problems of periodontitis, caries and occlusal relationships, integrate all aspects of data and information for comprehensive analysis, and then make a scientific design after full communication with patients.
Wei Bin also believes that in addition to considering the scientific and technical nature of the design program itself, it is also necessary to consider the feasibility of the patient's side, including culture, occupation and economic ability, etc., and design a variety of treatment plans according to the needs of patients to communicate with patients, truly reflecting the humanistic care of medical treatment.
Difficult cases require teamwork
Difficult teeth need a team cooperation, because it will involve the knowledge and operation technology of various oral professions, and teamwork is particularly important! According to the specific situation of each difficult case, often led by a professional expert to develop a "general design plan", multiple experts have carried out different treatment projects successively or at the same time, and cooperate with each other to seize the right time to achieve the best treatment effect.
Take the difficult repair cases, the design will be based on clinical examination, auxiliary examination, consultation to get the basic condition assessment, the most common specialized treatment includes periodontal disease treatment, by the periodontal specialist to clean treatment, subgingival scraping and various periodontal surgery; by the endodontic expert through root canal treatment to solve tooth decay, tooth defects, elongation, torsion, adjustment of crown root ratio and preventive treatment, etc.; by the prosthetic expert using porcelain teeth, porcelain bridge, veneer, inlay, implants, movable dentures and other methods of reconstruction, Among them, in order to take into account the needs of aesthetics and eating, it may also be necessary to install 1 to several pairs of temporary transitional dentures; some difficult cases also need the participation of orthodontic doctors, by moving the position of the teeth to create better repair conditions to obtain a more ideal repair effect, such as missing teeth for a long time adjacent to the oblique gap reduction, you can fight for the loss of the gap through orthodontic methods to win back the lost space.
All of this requires tacit cooperation between various specialists to capture the best time for treatment.
Difficult repair should pay attention to case management
Wei Bin believes that compared with the model of general practitioners "one doctor to see the end", teamwork in the treatment of difficult diseases can make better use of technical strength and be more professional. However, difficult cases require the tacit cooperation of so many experts, and experts are so busy, in fact, it is difficult to operate specifically.
There is also a very important link in the treatment of difficult dental diseases is that each difficult case is always responsible for following up the entire treatment process, so that the treatment process can be divided and combined, which not only saves time but also improves the treatment effect, which is actually the concept of patient management, especially in the design and treatment of difficult cases, patient management is particularly important. The team needs to be done by an experienced doctor or assistant who can coordinate, know the plan from start to finish, understand the progress, have the ability to understand the method and communicate with the doctor, communicate with the patient, and organize regular consultations. "Similar to the organizational structure of the first outpatient clinic of the Ninth Hospital, experts of different specialties are concentrated in the same outpatient clinic, which facilitates the collaboration between each other, avoids the rush of patients between different subdivisions, provides convenience for patients to seek treatment, saves the time of referral, and improves efficiency." Professor Wei Bin said, "Patients do not have to travel between various sub-specialties, which is also conducive to case management and the treatment and advancement of intractable diseases." ”
"The top-level design needs to take into account all sub-specialties in order to develop the most scientific and reasonable personalized treatment plan, an expert cannot be proficient in each profession, and at the same time, difficult dental diseases also need meticulous case management." Finally, Wei Bin also stressed that patients should cultivate a stronger awareness of tooth love, the determination and perseverance to insist on seeing teeth, and the good habit of regular follow-up.
Author Jiang Meiqin
Originally published in Healthy Wealth
Experts interviewed
Wei Bin
Deputy Director, Doctor, Chief Physician, Master Supervisor of the First Stomatological Department of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
Medical Expertise:
He has rich clinical experience in dentistry, and is good at combining the use of a variety of clinical means to diagnose and treat difficult dental cases, including joint design of implants and restorations of difficult diseases, dental implants for difficult periodontal diseases, joint treatment of orthodontics and restorations, cosmetic dental restoration, difficult occlusal reconstruction, etc.
Specialist clinic hours: Tuesday afternoon
Special outpatient clinic hours: Tuesday morning, Wednesday morning