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Neutral zone and alveolar relation consideration for fabricating complete denture in a patient with severe alveolar bone resorption: a case report

치조제 흡수가 심한 환자에서 중립대 및 치조제 관계를 고려한 총의치 수복 증례

  • Hyung-Jun Kim (Department of Prosthodontics, School of Dentistry, Chonnam National University) ;
  • Woo-hyung Jang (Department of Prosthodontics, School of Dentistry, Chonnam National University) ;
  • Chan Park (Department of Prosthodontics, School of Dentistry, Chonnam National University) ;
  • Kwi-dug Yun (Department of Prosthodontics, School of Dentistry, Chonnam National University) ;
  • Hyun-Pil Lim (Department of Prosthodontics, School of Dentistry, Chonnam National University) ;
  • Sang-Won Park (Department of Prosthodontics, School of Dentistry, Chonnam National University)
  • 김형준 (전남대학교 치의학전문대학원 보철학교실) ;
  • 장우형 (전남대학교 치의학전문대학원 보철학교실) ;
  • 박찬 (전남대학교 치의학전문대학원 보철학교실) ;
  • 윤귀덕 (전남대학교 치의학전문대학원 보철학교실) ;
  • 임현필 (전남대학교 치의학전문대학원 보철학교실) ;
  • 박상원 (전남대학교 치의학전문대학원 보철학교실)
  • Received : 2023.09.05
  • Accepted : 2023.10.23
  • Published : 2023.12.31

Abstract

In order to fabricate stable dentures in patients with severe resorption of residual ridges, various factors must be considered. One of them is the neutral zone, which is defined as the potential region in which the pressure of the tongue outward in the oral cavity and the pressure of the cheeks and lips directed inward from the outside of the oral cavity equalize during functioning. In patients with severe ridge resorption, if the teeth are usually arranged above the residual ridge, the teeth are located on the lingual side rather than the original position. Therefore, the functional space of the tongue is invaded, the tongue is positioned backward, and the sealing of the lingual border is broken, which acts as a factor reducing the maintenance of denture. In addition, it is also important for the stability of dentures to assume an interalveolar crest line connecting the maxillary and mandibular ridge crests, and to arrange the maxillary and mandibular artificial teeth to match the masticatory force to the interalveolar crest line. Therefore, good clinical results were obtained by fabricating dentures for the patient with poor alveolar residual ridge using neutral zone impression and ridge relationship analysis.

잔존 치조제의 흡수가 심하게 진행된 환자에서 안정된 의치를 제작하기 위해서는 여러가지 요소를 고려해야 한다. 그 중 하나는 중립대(Neutral zone)로, 기능하는 동안 구강 안에서 밖으로 향하는 혀의 압력과 밖에서 안으로 향하는 볼과 입술의 압력이 평형을 이루는 잠재적인 영역으로 정의된다. 만약 치조제의 흡수가 심한 경우에 통상적으로 잔존 치조제 상방에 치아를 배열한다면 치아는 기존 위치보다 설측에 위치하게 된다. 따라서 혀의 기능공간을 침범하게 되어 혀가 후방으로 위치하게 되고, 설측 변연의 봉쇄가 깨져 의치를 탈락시키는 요인으로 작용하게 된다. 또한 상·하악의 치조제를 잇는 치조정간선을 상정하고 저작력을 치조정간선에 일치시키도록 상·하악 인공치를 배열하는 것 또한 의치의 안정에 중요하다. 따라서 불량한 잔존 치조제를 지닌 환자에게 중립대 인상 및 치조제 관계 분석을 이용해 의치를 제작하여 좋은 임상 결과를 얻었기에 보고하는 바이다.

Keywords

References

  1. Basker RM, Harrison A, Ralph JP. A survey of patients referred to restorative dentistry clinics. Br Dent J 1988;164:105-8. https://doi.org/10.1038/sj.bdj.4806372
  2. Atwood DA. Postextraction changes in the adult mandible as illustrated by microradiographs of midsagittal sections and serial cephalometric roentgenograms. J Prosthet Dent 1963;13:810-24. https://doi.org/10.1016/0022-3913(63)90225-7
  3. Fish EW. An analysis of the stabilising factors in full denture construction. Br Dent J 1931;52:559-70.
  4. Aidsman IK. Glossary of prosthodontic terms. J Prosthet Dent 1977;38:66-109. https://doi.org/10.1016/0022-3913(77)90268-2
  5. Beresin VE, Schiesser FJ. The neutral zone in complete dentures. J Prosthet Dent 1976;36:356-67. https://doi.org/10.1016/0022-3913(76)90155-4
  6. Massad JJ, Cagna DR, Goodacre CJ, Wicks RA, Ahuja SA. Application of the neutral zone in prosthodontics. 1st ed. New Jersey; Wiley Blackwell; 2017.
  7. Atwood DA, Coy WA. Clinical, cephalometric, and densitometric study of reduction of residual ridges. J Prosthet Dent 1971;26:280-95. https://doi.org/10.1016/0022-3913(71)90070-9
  8. Sanghvi SJ, Bhatt NA, Bhargava K. An evaluation of cross-bite ridge relationships. A study of articulated jaw records of 150 edentulous patients. J Prosthet Dent 1981;45:24-9. https://doi.org/10.1016/0022-3913(81)90007-X
  9. Bilhan H, Geckili O, Ergin S, Erdogan O, Ates G. Evaluation of satisfaction and complications in patients with existing complete dentures. J Oral Sci 2013;55:29-37. https://doi.org/10.2334/josnusd.55.29
  10. LaVere AM, Freda AL. Artificial tooth arrangement for prognathic patients. J Prosthet Dent 1972;28:650-4. https://doi.org/10.1016/0022-3913(72)90117-5
  11. Weinberg LA. Tooth position in relation to the denture base foundation. J Prosthet Dent 1958;8:398-405. https://doi.org/10.1016/0022-3913(58)90065-9
  12. Kawahata N, Kamada Y, Ohtsuka A, Kamashita Y, Nishi Y, Hamano T, Nagaoka E. A visual method for analysing bucco-lingual position of artificial posterior teeth. Part 1: use of theridge crest. J Oral Rehabil 1998;25:914-20.
  13. Porwal A, Sasaki K. Current status of the neutral zone: a literature review. J Prosthet Dent 2013;109:129-34. https://doi.org/10.1016/S0022-3913(13)60030-X
  14. Fahmi FM. The position of the neutral zone in relation to the alveolar ridge. J Prosthet Dent 1992;67:805-9. https://doi.org/10.1016/0022-3913(92)90588-2