- 學位論文
嚴重牙周病患者之跨科整合治療
The interdisciplinary treatment of the compromised patients with advanced periodontitis
摘要
在治療牙周補綴病患者時，常見有齒質缺損、根管治療不全、咬合崩塌、缺牙、牙周附連喪失、根叉侵犯，牙齦萎縮、牙冠/牙根比例不良、病理性移位、不良習慣、咬合不協調、及軟硬組織缺失等問題。在正確的診斷為前提之下，整合牙周病治療、根管治療、口腔外科、矯正和補綴治療，以達到整合治療效果。 本文提出九個案例，根據患者的主訴、身體狀況、經濟能力，採用符合病患需求的整合治療方式。再根據牙周補綴的設計，利用各種治療方式，包括有局部或全口齒列矯正、牙根切除術、游離牙齦移植術、牙冠增長術、齒槽骨整型術、植牙手術、蓄意自體牙再植術、鼻竇增高術、骨嵴劈開術、血小板凝膠(platelet rich fibrin;PRF)等術式來克服病人的問題。而補綴設計目標是希望能達到減少牙菌斑堆積，減少咬合干擾，提供穩定咬合，均勻分散咬合力於支台齒上減少傷害。包括薄蓋冠全顎覆蓋式義齒、析量固定式牙冠牙橋、冠外附連體、無鉤式可撤局部義齒等不同設計予以全口重建。然而這些複雜的治療能夠有最佳的預後，最重要是正確診斷和補綴物設計以及患者的配合和心態的改變。唯有用心的執行口腔清潔，並且定期回診維護，才能有長遠的成功。
並列摘要
There are many clinical findings in common when the periodontally- compromised patients ask for prosthesis therapy. Such as tooth structure deficiency, incomplete endodontic treatment, bite collapse, missing teeth, periodontal attachment loss, furcation involved periodontitis, gingival recession, poor crown/root ratio, pathological tooth migration, oral parafunction, occlusal disharmony and soft and hard tissue defect. Periodontal-prosthetic treatment calls for integration of periodontal,endodontic, orthodontic, prosthodontic therapy and oral surgery. The treatment outcome is satisfied on basis of accurate diagnosis. 9 periodontally- compromised patients seeking for prosthetic reconstruction are collected in this clinical thesis. Multidisciplinary treatment modalities were selected to meet what the patients need according to their chief complains, physical conditions and financial capability. Based on the principle of periodontal-prosthesis reconstruction, a variety of treatment procedures were chose to solve different clinical situation, such as local or full mouth orthodontic treatment, root resection, free gingival graft, crown- lengthening procedure, alveoloplasty, dental implants, intentional tooth replantation, sinus lifting, alveolar crestal splitting and PRF. The prosthesis design such as over denture with dental copings, survey crowns and bridges, extracoronal attachment and removable partial dentures without clasp features decreasing plaque retention, reduce occlusal interferences, provide stable occlusion, and balanced distribution of occlusal force to keep the remaining abutment teeth from trauma. The long term success calls for the cooperation between the patients and the dentists.