- 期刊
上顎後牙單顆缺牙之植牙治療考量：病例報告及文獻回顧
The Considerations of Implant Treatment of Maxillary Posterior Single Missing Tooth: A Case Report and Literature Review
摘要
上顎後牙的單顆缺牙固定式贋復，可以傳統固定式局部義齒或植牙支撐之牙冠完成，但二者之術式考量和步驟卻大相逕庭。前者步驟較少需時較短，但需有相鄰而足以支撐之支柱牙，且難免有健康齒質之犧牲，長期追蹤也常見因照護欠佳引起繼發性齬齒或牙周問題。後者雖常因齒槽嵴質與量不佳，在植牙前需較繁複的準備，但能保有相鄰自然牙之完整，且在牙齒喪失後之齒槽嵴保存、及贋復完成後的清潔，有較理想之結果。上顎後牙區的缺牙的贋復因其受限的解剖構造，以植牙為考量的治療常被視為極大的挑戰，肇因於較低的骨質密度、缺牙後的齒槽嵴吸收、和上顎竇的氣室化，造成齒槽嵴質與量條件之不足。上顎竇增高術經三十多年的發展以優異的植體存活率成功解決這些問題。本文藉一嚴重齬齒無法保留之上顎大臼齒，拔牙時做齒槽嵴保存，之後側方開窗上顎竇增高術及同時植牙，完成單顆牙冠贋復，為上顎後牙區單顆缺牙之植牙治療考量做討論及文獻回顧。（台灣牙周醫誌17: 65-84, 2012）
並列摘要
Missing of single maxillary posterior tooth could be treated by either conventional three unit fixed partial denture or implant-supported single crown as fixed prosthesis, the considerations of treatment and clinical procedures are quite different. At least two adjacent abutment teeth with adequate periodontal support are required when preparing for conventional fixed partial dentures which needs less clinical procedures and appointments to finish. Bes ides sacrificing healthy natural tooth structure, secondary caries and periodontal problems of abutment teeth following insufficient oral hygiene care are common. On the other hand, implant-supported single crown preserve not only the integrity of healthy structure of the adjacent natural teeth but also the ridge dimension after tooth loss. Maintenance of oral hygiene is easier with implant-supported single crown, though surgical procedures are more complicated especially when the residual ridge is deficient in both quality and quantity. Implant prostheses frequently meet challenges in maxillary posterior areas, which reveal limited anatomic conditions resulting from lower bone density, ridge resorption after tooth loss, and varying degree of pneumatization of maxillary sinus. Implants in grafted sinus were reported with excellent survival rates for over thirty years since maxillary sinus floor elevation procedure was first introduced and solved successfully the problems of atrophic ridge in maxilla. This article reported a case of maxillary single missing molar in severe deficient ridge, treated by ridge preservation, sinus floor elevation, and implant rehabilitation. Clinical considerations involving dimensional change of alveolar ridge after tooth extraction, sinus pneumatization, and residual bone height are discussed and relevant past literature revealed. (J Taiwan Periodontol 17: 65-84, 2012)