- 學位論文
牙周補綴於嚴重侵犯性牙周炎之廣泛考量與臨床應用
General consideration and clinical application of severe aggressive periodontitis in periodontal prosthesis
摘要
牙周補綴一詞字義涵蓋極廣，而其最主要是應用在嚴重牙周病及上下顎多顆缺牙引起牙齒移位、外暴、傾倒、咬合高度喪失而導致咬合創傷、無法舉咀嚼、顳顎關節障礙及臉形左右不對稱等問題，所做全方位有系統的治療。 本論文提出9個中、重度牙周補綴病例報告，並作相關的討論。第一、二、三病例為廣泛侵犯性牙周炎。病例一右邊第Ⅰ、Ⅳ象限做牙周翻瓣及引導骨再生術，左邊第Ⅱ、Ⅲ象限則以法國LOKKI Laser治療，左、右邊皆癒後良好。病例二、三則以LOKKI Laser做全口牙周炎治療，在補綴上均設計為局部混合薄蓋冠磁鐵套疊式活動義齒。病例四則植入15顆人工牙根合併上顎前牙齒槽脊增寬，引導骨再生及游離牙齦移植術，做全口固定贋復物。病例五上顎植牙磁鐵裝置，做全口混合薄蓋冠磁鐵覆蓋式活動義齒。病例六、七、八、九均為不良贋復物引起侵犯性牙周炎，均經人工植牙、牙冠增長、引導骨再生、游離牙齦移植術及前庭再造術等，做全口固定贋復物。 於牙周補綴整體治療過程中，醫病間之良善溝通與配合是長久維持與成功的重要因素；有計劃、有效率、有系統的全方位全口復健則是牙周補綴的科學依據，醫療科技日新月異，只要能防患於未然，有效控制病況、減少療程痛苦、時間與花費且恢復咬合、發音、咀嚼及美觀等功能，將是芸芸眾生為牙周病或無牙所苦者之福音。
並列摘要
Periodontal prosthesis is a term that describes broad range of applications .It’s main application can be found in severe periodontitis. Symptoms such as gingival recession, alveolar bone resorption, teeth migration, labial flaring out, bite collapse and losing of vertical dimension, can be result of multiple missing teeth in upper and lower arch due to severe periodontitis. Such case will further lead to occlusal trauma, lost of chewing function, and TMJ syndrome. There are primary applications for periodontal prosthesis. This thesis presented 9 moderate to advanced periodontal prosthetic treated cases with related literature review and discussion. Cases 1,2,3, were generalized aggressive periodontitis. In case 1 was treated with flap operation combined with guided bone regeneration (GBR) on the right side I, IV quadrant and treated with LOKKI Laser on the left side II, III quadrant. Both of the right and left side have good prognosis. In cases 2,3 were treated with LOKKI Laser for full mouth advanced periodontitis. All of the above three cases were restored with crown and sleeve-coping combined magnet retained telescopic denture. In cases 4, fifteen implant-supported fixed prosthesis combined ridge augmentation on upper anterior teeth buccal side, GBR and free gingival graft was used to resconstruct his lost dentition. In cases 5, the full mouth was restored with magnetic overdenture and the maxillary was supported by dental implants. In cases 6~9 were caused by nonfitness prosthesis result to aggressive periodontitis, all of these cases were treated with dental implants, crown lengthening, GBR, free gingival graft , vestibuloplasty and then full mouth fixed prosthesis rehabilitation. During the periodontal prosthesis treatment, communication of patient and doctor is vital to the success of the therapy. A well planned, effective, and comprehensive treatment plan is the key points of succerful periodontal prosthesis. Even though, medical technology advances rapidly, only by effective preventive measures, efficient control of existing conditions, reducing chair side time, reducing cost, at same time restoring occlusal function, restoring verbal function, restoring chewing and esthetic function, can the patients of advance periodontitis enjoy full benefit of periodontal prosthesis.