中等度認知症の患者にデジタルコピーデンチャーを用いた総義歯作製を行った

Complete Denture Fabrication Using Digitally Fabricated Copy Dentures for a Patient with Moderate Dementia.

抄録

91歳の女性が，総義歯の装着感の悪さと痛みを主訴に当院を受診した．中等度の認知症で，コミュニケーションが困難であった（Mini-Mental State Examination, 16; Barthel Index, 15）．デジタルで作製したコピーデンチャーを用いて，以下の手順で閉塞印象と顎の記録を行った。まず，ティッシュコンディショナーを用いて古い義歯の適合不良を修正し，その後，咬合の微調整を行った。次に、修正した旧義歯の形態を3Dスキャナーでコピーしたコピーデンチャーを3Dプリンターで作製した。その後、従来の方法で以下のように新義歯を作製した。印象採得と咬合を行い，その後，義歯を加工した。この症例報告では、以下の結果が得られた。まず、新しい義歯は、慣れ親しんだ義歯の形態をデジタルで再現しているため、受け入れられやすいようである。さらに、義歯の3Dデータは、義歯の破折や紛失の際に、すぐに義歯を作製するために使用することができる。また、印象採得と総入れ歯の納品に必要な通院回数は、わずか2回で済んだ。また、患者さんの古い入れ歯は、患者さんの夕食後に患者さんのご家族が当歯科医院に持参し、入れ歯の形態をコピーした後、すぐに患者さんのご家族に返却することで、患者さんの食事に支障をきたすことがありませんでした。これにより、患者さんとそのご家族の負担を軽減することができました。

A 91-year-old woman was referred to our hospital with a chief complaint of unsatisfactory fit and pain associated with her complete dentures. She had moderate dementia with difficulty in communication (Mini-Mental State Examination, 16; Barthel Index, 15). The closed impressions and jaw record were taken with the digitally fabricated copy dentures as follows. First, the tissue conditioner was used to correct the poor fit of the old dentures, following which minor occlusal alterations were made. Second, the copy dentures that copied the morphology of the corrected old dentures using three-dimensional (3D) scanner were fabricated with a 3D printer. The new dentures were then fabricated using conventional methods as follows. The impressions were cast and articulated, and the dentures were subsequently processed. This case report documented the following results. First, the acceptance of new dentures appeared to be easier since the new dentures copied the morphology of the familiar dentures digitally. Moreover, the 3D data of the dentures could be used for immediate denture fabrication in case of fracture or loss of the dentures. Second, only two visits were required for taking an impression and delivering the complete dentures. In addition, her old dentures were brought to our dental office by the patient's family after the patient's dinner; immediately after copying the dentures' morphology, the dentures were returned to the patient's family, thus avoiding any disturbance to the patient's eating routine. These reduced the burden on the patient and her family.