- 期刊
上顎嚴重吸收之一步驟植體治療：病歷報告
One-step Implant Therapy with Severely Atrophic Posterior: Case Report
摘要
二十一世紀牙科治療主要朝向簡單方便、快速與減少侵犯性發展。早期鼻竇骨增生植牙手術多分兩階段進行，建議進行鼻竇骨增生，再植牙。二次手術常常增加治療時間與患者不適。近年來許多臨床研究發現，只要能得到初期穩定，一階段式（one-stage）鼻竇骨增生合併植牙手術與兩階段式（two-stage）植體之成功率並無顯著差異。最近有學者將鼻竇骨增生合併一步驟非埋植（one-step，non-submerged）植牙手術用於剩餘齒槽骨高度僅剩不到三毫米之上顎嚴重吸收患者。雖然一步驟鼻寶骨增生植牙手術之臨床研究較少，然而在適當條件下，是植牙治療時的另類選擇。一般而言，一步驟鼻竇骨增生植牙手術的部位不能有鼻腔感染且需有足夠角化牙齦與骨脊寬度、高度與足夠骨質密度以提供植體初期穩定度。本文將以兩個病例報告說明一步驟鼻竇骨增生植牙手術的臨床適應症與操作時應注意事項。一步驟鼻竇骨增生植牙手術的優點是縮短手術時間、減輕術後不適、無需兩至三次手術、減少術後照顧、與減少耗材與療程：然而一步驟鼻竇骨增生植牙手術的缺點是軟硬組織條件要夠且操作困難度較高。臨床上只要慎選患者，仔細診斷，應是患者接受度較高的術式。一步驟鼻竇骨增生植牙手術之長期療效則仍有待更多臨床研究證實。
並列摘要
The mainstream of periodontal therapy in the 21th century is simple, convenient, and minimum invasive. Early treatment modality for dental implant in severely atrophic maxillary sinus recommended two-stage surgery and performed sinus augmentation before implant placement which increase treatment time and discomfort. Recent studies indicated that as long as one can achieve primary implant stability, the success rate of one-stage implant surgery is similar to that of two-stage one. One-step, non submerged implant placement simultaneously with sinus grafting in severely atrophic maxilla (OISM) with less than 3 mm residual bone height has been documented lately. Although clinical studies in OISM are rare, it may be a treatment alternative under appropriate condition. The advantages of OISM are to reduce surgical time, and post-operative discomfort, eliminate secondary surgery, reduce postsurgical maintenance care and treatment cost. However, soft and hard tissue management for OISM is more difficult to perform. In general, the surgical site should not have sinusitis or other sinus pathology and need adequate keratinzed mucosa and good bone density to provide implant primary stability. Two case reports are presented to demonstrate the indications and treatment procedures of OISM. In case of meticulous patient selection and treatment planning, OISM shall be the treatment modality of high patient acceptance. More clinical studies are required to validate the predictability and long-term stability of OISM.
延伸閱讀
- 童元釔、楊雅慧、郭生興、張心涪、賴向華、姚宗珍、陳羿貞（2006）。嚴重下顎前突症之正顎手術治療－病例報告。中華牙醫學雜誌（中文版），25(4)，271-280。https://doi.org/10.7106/CJD.200612.0271
- Dung, T. S. Z., & Tu, Y. K. (2015). 上顎嚴重吸收之一步驟植體治療：初步報告. 臺灣牙周病醫學會雜誌, 20(2), 79-90. https://doi.org/10.6121/TAP.2015.20.2.02
- （2002）。植體固位之下顎覆蓋式義齒的贋復併發症：前瞻性研究之初步分析。中華民國牙周病醫學會雜誌，7(1)，72-73。https://www.airitilibrary.com/Article/Detail?DocID=10279962-200203-7-1-72-73-o
- Lu, H. K. (2004). Prophylactic apicoectomy involving implant sites with possible retrograde peri-implantitis. 中華民國牙周病醫學會雜誌, 9(), s73-s80. https://www.airitilibrary.com/Article/Detail?DocID=a0000071-200407-9-s-s73-s80-a
- 林弘賓、姚序駒、陳清煌、董曉青、黃慶瑄、吳朝榮（1988）。Surgical Therapy for Accommodative and Convergence Insufficiency-A Case Report。中華民國眼科醫學會雜誌，27(1)，135-138。https://doi.org/10.30048/ACTASOS.198805.0025