- 期刊
牙周保守性治療合併齒顎矯正以改善病理性移位前牙區之外觀：一病例報告
Combined Periodontal Conservative and Orthodontic Treatment to Improve the Esthetics of Pathologically Migrated Anterior Teeth: A Case Report
摘要
牙周炎患者需要接受矯正治療，來解決牙齒病理性移位所造成之美觀主訴時，常因為牙周支持骨的嚴重破壞，過大牙齒動搖程度和急性牙周發炎症狀，導致牙醫師必須面臨選擇把牙齒拔除，或留下繼續矯正治療之兩難困境，此外，矯正治療期間的口腔衛生維護，和避免矯正後牙齒再度移位，亦是另一項挑戰。本病例為一位42歲女性病患，因為近年來上顎門牙有病理性移位，逐漸往外暴出影響美觀，且上下門齒深咬造成齒齦創傷問題來尋求治療，其診斷為全口慢性牙周炎及上顎門牙區牙周膿腫，在僅採用牙周保守性治療合併矯正治療處理，不但獲得牙周囊袋減少、臨床附連增加、病患美觀大幅改善，並使其重拾自信，治療經三年之追蹤檢查，發現牙周狀況維持穩定，且牙齒也沒有發生移位的情形，治療結果相當良好，因此在前牙美觀區，某些牙周預後欠佳牙齒，只要經審慎評估，即使僅採用保守性牙周處置，配合良好口腔衛生，及適當之矯正治療，仍然可達到不錯之治療效果。
並列摘要
Pathologic migration is a common finding associated with periodontal involved teeth. Combined periodontic-orthodontic therapy is usually required in order to reestablish the function and the esthetics of upper anterior teeth. However, orthodontic treatment on advanced periodontal involved teeth is more challenging. The case report illustrates a 42-year-old female patient who suffered from the esthetic problem due to the pathologic flaring-out of upper anterior teeth. Severe bone destruction, hypermobility and direct impinging of the palatal gingiva due to overeruption of lower anterior teeth with the presence of periodontal abscess of lateral incisors were noted. The prognoses of the upper anterior teeth were poor to questionable. The patient received only non-surgical periodontal therapy combined with orthodontic treatment with regular maintenance every 3 months. Decreases of the probing depth, gain of clinical attachment of the compromised anterior teeth were noted. The esthetics was improved and the patient was cheerful and expressed self-confidence. Three year followed-up revealed neither recurrence of the periodontal disease nor tooth migration. In conclusion, esthetic result can be achieved even in periodontal compromised dentition using only conservative periodontal therapy combined with good oral hygiene and orthodontic treatment.