- 學位論文
臨床牙周補綴病例報告與討論 — 十個病例報告
Clinical periodontal prosthetic report:10 cases
摘要
由於老年人口的增加及公眾對於牙周病認知的覺醒，更由於希望藉由保留一口自然的齒列或滿意的假牙來維持美觀、功能、及身體的健康，導致牙科治療中整合牙周及補綴甚至矯正的需求已逐漸增加，這對牙科醫師而言，當然是一個提昇專業水準機會，但更是一份艱難的挑戰。 而一個成功的牙周補綴治療計劃，可能包括了牙周病、補綴、矯正、根管治療，甚至口腔顎面外科的多學科範圍。而在實施補綴之前的牙周治療可能包括了手術性或非手術性，切除性或再生性，化學性或機械性，甚至全身性疾病的治療。這主要的目的是為了先消除牙周炎性反應；而另一個重點是利用適當的咬合治療去清除咬合的創傷，也是非常重要的。牙周及咬合治療完畢之後，如何將僅有的、支持性不佳的、分佈不利的、數目較少的牙齒去相互整合，去建立一個穩定的咬合，與極易於清潔的環境，是長期成功的重要因素。至於補綴的方式，可能包括了固定假牙、有鉤活動假牙、套疊式活動假牙、覆蓋式義齒，甚至人工植牙，這都是依病患的不同而有所應改變。 在本份論文中提出了十個病例，皆是根據上述原則來處理，這其中當然考量了病人的個別因素，包括經濟及人格特質。在手術方面，包含了一般常見的牙周及植牙手術, 如病例三及病例十利用了牙冠增長術改善了前牙牙齦不對稱， 牙齦下齲齒及生物寬度受侵犯的問題；病例五的糖尿病病人在謹慎的內科監控下實施了較大範圍的前庭加深術, 改善了活動假牙的穩定性；病例二、七、八有一些不是很好的殘留牙根卻有保留價值(垂直支持及牙脊保留)但不適合牙冠增長術者運用了方便的手術性萌出；病例三及病例八皆有頰繫帶過長及固著性角化牙齦的問題，皆以游離牙齦移植解決；病例六在拔除前牙後因牙脊保存術失敗而實施了兩次軟組織增高術，改善了因牙脊嚴重萎縮所成之不美觀；病例四因中央牙尖(central cusp)斷裂長期所造成的牙周-根管合併病變則利用了目前盛行的牙釉基質蛋白去嚐試引導牙周再生；而植牙方面則使用在病例九的局部缺牙區。在補綴方面，則運用了各種不同的假牙設計，從簡單的固定假牙, 有鉤活動假牙、全口假牙到複雜的支持型覆蓋性義齒、Konuskrone denture、CSC套疊式義齒及植牙。由於筆者的知識與經驗都還不足，而所有的病例追蹤時間並不長久，這些病例的穩定應仍待進一步的觀察。
並列摘要
Because of increasing numbers of older patients with periodontal and occlusal pathosis, public awareness of periodontal disease, a growing wide-spread desire to preserve our natural or restored dentitions in good health, function, and esthetics, there is an increasing demand for dentist to integrate periodontal and prosthetic therapy. A successful periodontal prosthetic treatment plan may be involved in the integration of multidisciplinary regimen that includes periodontal, prosthetic, orthodontic, endodontic, even oral surgical concepts. Before performing prosthetic treatment , proper occlusal treatment to reduce occlual trauma and stabilize occlusion are very important. Besides dentists try their best to control the periodontal inflammation, it may need surgical or non-surgical : resection or regeneration；chemical or physical treatment and ,sometimes, treatment of general systemic disease, if necessary. After periodontal and occlusal treatments , it is a key factor how we can combine proper prosthetics with minimal bony support and the distribution number of remaining teeth to establish stable occlusion and cleanable oral environment. These prosthetic managements consist of various treatment by means of fixed partial denture, removable partial denture , telescopic denture , overdenture with attachment and implant prosthesis to deal with different periodontal conditions in my report. Of course , the consideration for patient’s economic condition and individual personality is also important. The thesis includes 10 cases following the above treatment principles , as if possible. The periodontal treatments of these cases include nonsurgeries and various periodontal surgeries .The final prosthesis design depends on individual situation, from simple fixed bridge , clasp-retained RPD, single denture to complex removable prosthesis, such as Konuskrone deuture, CSC telescopic deuture, tooth-supported overdenture and implant. Owing to limitation knowledge and experience, the long-term results must be observed .