- 學位論文
牙周補綴於牙周炎病例全口重建之病例報告
Case reports-full mouth rehabilitation with perio-prosho concept in patients with periodontitis
摘要
面對牙周炎的患者，常有附連喪失、牙齒病理性位移、咬合塌陷、多處牙齒喪失、甚至合併咬合不正、齲齒等複雜情況，造成臨床治療的困難。重建的治療過程包含牙周控制、牙周補綴支持治療外，也需與根管、牙體復形、矯正等多科合作跨科治療、並視情況加入人工植牙增加支持，恢復患者咀嚼功能、美觀、發音。 在一些案例中，以人工植牙的介入，提供理想的支持，依義齒設計、患者缺牙的分佈、對咬牙的狀況、骨頭條件等決定人工植牙的位置顆數。搭配 cone-beam (CB)CT，手術導板增進植牙精準度。贋復重建除了使用傳統印模方式，也嘗試以數位口內掃描、模型掃描、數位CADCAM牙冠、數位活動金屬支架等等方式，來增進贋復物的精密度、減少患者療程間印模的不適。 本報告中提出十個病例，考量到不同患者的訴求、經濟能力、配合度、維持口腔清潔之能力等等，設計不同治療計畫，先以非手術或手術的方式改善牙周健康，並經由一步步取模、置位、面弓轉移，得到診斷蠟型，來預測我們希望未來達到的理想狀況。再將診斷蠟型複製到口內來驗證是否可行，並在臨時義齒階段調整修正，最終完成兼具美觀功能的義齒。很重要的是，即時我們做了很多努力延緩牙齒破壞，但我們仍阻止不了生理性的老化， 未來仍會有牙齒逐漸的喪失，牙床萎縮等等，故設計時，需一併考量維修方便性， 同時也要培養患者好的清潔習慣及定期回診，讓患者了解，治療不單是醫師的責任，病人須共承擔，才能使贗復物用得長久。
並列摘要
There are complicated situation in treating patients with periodontitis, such as attachment loss, pathologic migration, multiple teeth missing, or even combining with malocclusion, caries which result in the difficulties of clinical treatment. Rehabilitation procedure would involve periodontal control, prosthodontic treatment, operative/ endodontic and orthodontic treatment which is so-called “interdisciplinary treatment concept”. Depend on the situation, implants should be taken into consideration to restore patients’ masticatory function, esthetic, and phonetics. In some cases, implants provide ideal support. Base on the design of prosthesis, distribution of abutment teeth, the opposed teeth, and bone quality, it could be determined the number and position of implants. With cone-beam computerized tomography examinations for presurgical implantation evaluation and surgical stents, the precision of implant surgery could be increased. The prosthetic rehabilitation processes use various means, including traditional way /digital technique. Ten cases with different treatment modality depends on patients’ claim , economic ability, and ability to cooperate are present in this report. Following the standard procedure, the diagnosis wax-up was made, and then transferred to intral-oral to work. After adaptation and adjustment, we could duplicate the appearance of provisional prosthesis to final prosthesis. Dentist could not prevent the biological aging. Patients would lose teeth progressively, so the repairability of restoration should be considered. Routine follow up and oral hygiene maintenance are very important. Patients, as well as dentist, should take the responsibility of whole treatment.