同次進行牙冠增長、根尖切除及牙脊增高手術治療上顎前牙：病例報告

Combined Therapy of Surgical Crown Lengthening, Apicoectomy, and Ridge Augmentation in the Treatment of Maxillary Anterior Teeth: A Case Report

陳智龍(Chih-Long Chen) ； 林世榮(Shih-Jung Lin)

《臺灣牙周病醫學會雜誌》 13卷1期 (2008/03) Pp. 23-32

摘要

本報告提出－上顎前牙牙橋贋復前同時施以牙冠增長、根尖切除及牙脊增高手術。患者為40歲女性，經診所轉診主訴為右上正中門齒至左上側門齒暫時牙橋牙齦腫脹，並已於診所完成右上正中門齒與左上側門齒二支台齒之根管治療及冠心柱贋復。臨床檢查發現二支台齒牙周探測正常但合併探測流血，牙齦上健康齒質不足2公釐，根間周圍觸診有疼痛情形，橋體缺牙區牙脊缺損屬Seibert第一類水平缺損。放射線檢查發現支台齒之根管治療充填品質尚可，惟根尖周圍皆有明顯之放射線透射病變。治療時先進行翻辦手術，移除牙齦及根尖周圍肉芽組織後，先進行牙冠增長術，在脊骨上暴露出5公釐之健康齒質，並進行根尖切除術。二支台齒之根尖骨缺損利用異質移植骨合併膠原蛋白再生膜修復，橋體缺牙區取自體結締組織進行牙脊增高術，並以初級縫合覆蓋植入組織。術後六個月完成右上正中門齒至左上側門齒瓷金屬融合牙橋贋復，持續觀察一年後美觀及功能皆獲患者滿意且無任何不適。

關鍵字

牙冠增長術 ； 根尖切除術 ； 牙脊增高術

並列摘要

This article is a case report of a 40-year-old women received combined therapy of surgical crown lengthening, apicoectomy, and ridge augmentation. The chief complaint of the patient was gingival swelling at her upper fake teeth from right central incisor to left lateral incisor. The offending teeth had received endodontic treatment, post-core fabrication, and temporary bridge restoration in a dental practice. Clinical examination of the two abutment teeth including maxillary right central incisor and left lateral incisor revealed shallow probing depth, bleeding upon probing, less than 2 mm height of intact tooth structure above gingival margin, and palpation tenderness around both of the apexes. The edentulous ridge between these two abutment teeth was diagnosed as Seiber's class I horizontal deficiency. Proper root canal filling and distinct apical radiolucency of both teeth were observed in periapical radiography. After appropriate incision and flap reflection, marginal gingiva and granulation tissue around apexes were removed. Surgical crown lengthening was performed to expose at least 5 mm supra-crestal tooth structure followed by apicoectomy of the two roots. Both apical defects were filled with freeze-dried bone allograft (FDBA) and covered by collagen membrane (PeriAid(superscript ®)) for regeneration. Subepithelial connective tissue harvested from left side of palate was grafting into edentulous ridge for augmentation of the pontic site. Healing by primary intention was secured at the end of the surgery. 3-unit porcelain fused to metal bridge was fabricated about 6 months later, and there were no symptom and sign in the following one year. The patient was quite satisfied with the final results.

並列關鍵字

surgical crown lengthening ； apicoectomy ； ridge augmentation