- 學位論文
牙周補綴於慢性牙周炎的臨床案例討論
Perio-prosthodontic treatment in patients with chronic periodontitis – cases report
摘要
在面對治療嚴重牙周病的病患，往往他們的問題都是相當複雜的，或有喪失咬合高度，殘缺齒列，齒列不整，牙周支持不足等等的問題。在現在的臨床牙醫學裡很重要的因素是，如何依據正確的診斷來訂定一個全面性的治療計畫。而治療計畫越是嚴謹，病人將來的預後越是能夠可預期，進而維持長期而穩定的成果。正因為如此，不論我們是在做單一牙齒的替換或是全口重建的治療，我們都必須以這個觀念為基礎，來做為治療計劃決定的關鍵。雖然這是我們訂定理想治療方針的重要元素，但是實際上影響病人是否能接受治療的主要因素為，治療時間的長短、費用的高低、病人的恐懼、以及身體健康的狀況。因此論文中提供了病人不同治療計畫的選擇，來讓病人依照自身的條件來決定最終的治療選項。 本論文所討論雙重套冠可撤式義齒的設計，可提供除傳統鉤靠式可撤式義齒外另一種合理的治療方式，其優點除提供跨弓式的固定效應並使咬合力量平均分配外，其強支持的特性，能減輕牙床的過度受力，降低齒槽骨吸收速度，同時亦提高義齒的穩定度、固持力以及支持性。雙重套冠可撤式義齒的概念搭配人工植體，可改善支台齒分配不佳的問題，利用人工植體支持的支台齒，不但可提供長缺牙區的咬合支撐，並與其他支台齒共同形成一分散且均衡的力量分配。當然，對於缺牙更多的病患，我們可以選擇戰略地位重要的位置來植入人工植體，利用ERA或是Locator等附連體來做為全口可撤式義齒的支台齒，這樣對於上、下顎全口可撤式義齒的穩定性幫助甚大。 本論文所討論之病例，其牙周狀況雖有不同，但經由縝密的治療計畫及評估，不論是以固定義齒或可撤式義齒之形式完成治療，皆能提供病患滿意的成果。
並列摘要
There are some complicated problems found in patients with severe periodontitis in full-mouth reconstruction. Such as, loss of vertical dimension, missing teeth, malocclusion , loss of periodontal support ,etc. The correct diagnosis followed by the development of a comprehenice treatment plan is the absolute essence of clinical dentistry. The most critical aspect of treatment planning is to provide the patient with the most predictable, stable, long-term prognosis. It is this philosophy that creates the foundation for every decision made in the course of treatment planning, whether it is the replacement of a single tooth or a complete reconstruction. Athough it is essential for the clinician to present the optimal course of therapy, practical issues often interfere with the patient’s ability to accept ideal treatment options. Times constraints, financial limitations, fear, and medical issues are factors that commonly influence the actual course of treatment. Thereofore, we made many different treatment options for patients and finally got an ideal treatment plan which can fit patients’ conditions. The design of telescopic crown system will provide another treatment other than the traditional removable partial denture with a number of clasps on it. It has the advantages of cross-arch splinting effect and can evenily directs the occlusal force to all abutments. The concept of rigid support could help to relief the overload of the denture bearing area and help to decrese the resorption of alveolar ridge. It also increases the stability, support, and retention of the denture. The telescopic crown system combined with implantation could evenily and widely direct the occlusal force to all the denture abutments. Of course, we could select the strategicly important position to place few implants with ERA or Locator attachments to connect the overdenture when we treat edentulous patients. This will have a great advantage for the stability of the overdenture. All these cases in this article, no matter what treatmet used, can all be satisfied with the final results by the thorough evaluation and the careful treatment planning .