牙周病整體治療病例報告及文獻回顧

病理性牙齒位移為牙周炎的常見併發症，且時常是患者尋求牙周治療的主訴。造成病理性牙齒位移的因素有很多，以牙周組織破壞及咬合不正為主要原因，通常需要牙周、矯正、贋復合併治療。本病例報告提出一位50歲已戒菸女性罹患全口慢性牙周炎的病例，病患上下顎前牙區呈現多處病理性牙齒位移，下顎前牙區有微血管血管瘤。基本牙周治療期間切除血管瘤，骨內缺損採取之牙周手術包括放置自體移植骨或生物活性玻璃，或合併置入牙釉基質蛋白，左下第一大臼齒之根又分叉處放置自體移植骨，術後一年進行追蹤，全口探測深度降為3毫米以下，手術區域有顯著牙周附連獲得，放射線檢查呈現多處骨充填。病理性牙齒位移未經矯正治療即有明顯改善，下顎前牙區間隙自動完全關閉，血管瘤病灶區癒合良好，且病患恢復整體牙周健康，並維持穩定結果。（臺灣牙周醫誌17: 25-43, 2012）

關鍵字

病理性牙齒位移；骨內缺損；自體移植骨；生物活性玻璃；牙釉基質蛋白；牙周手術

並列摘要

Pathologic tooth migration is a common complication of periodontitis and is often the motivation for patients to seek periodontal therapy. The etiology of pathologic tooth migration is multifactorial and periodontal tissue destruction and malocclusion appear to be the major factors. Most pathologic tooth migration cases require periodontal, orthodontic, and prosthodontic teamwork treatment. This paper reported the periodontal management of a 50-year-old female, a former smoker, who had chronic periodontitis combined with pathologic tooth migration of anterior teeth and had a capillary hemangioma at buccal surface of right lower central incisor area. In addition, conventional periodontal surgeries consisting of autogenous osseous grafting, bioactive glass grafting, and Emdogain treatment were performed for the intrabony and furcation lesion. One-year postoperative examination revealed that full mouth probing depth was less than 3 mm. Significant clinical attachment level gain and bone fill were noted over osseous grafting sites. The pathologic migrated teeth exhibited spontaneous repositioning without orthodontic therapy. Spaces of 13-23 partially closed and that of 31 -43 completely closed. The hemangioma lesion healed well. The overall periodontal health improved and favorable outcomes were achieved. (Taiwan J Periodontol 17: 25-43, 2012)

並列關鍵字

pathologic tooth migration ； intrabony defect ； autogenous bone graft ； bioactive glass ； enamel matrix protein ； periodontal surgery

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牙周病整體治療病例報告及文獻回顧

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