侵犯型牙周炎之治療病例報告及文獻回顧

Aggressive Periodontitis: Full Treatment Case Report and Literature Review

胡桂華(Guei-Hua Hu) ； 周瀅芬(Ying-Fen Chou) ； 江正陽(Cheng-Yang Chiang) ； 邱賢忠(Hsien-Chung Chiu)

《臺灣牙周病醫學會雜誌》 18卷2期 (2013/06) Pp. 151-167

https://doi.org/10.6121/TAP.2013.18.2.08

摘要

本文提出一位29歲廣泛性重度侵犯型牙周炎的男性病患接受牙周整體治療的病例報告，患者在牙周治療前於右上後牙區有深達13毫米的牙周囊袋探測深度，#14頰側牙齦近三年不時有膿腫發作，放射線檢查呈現嚴重骨缺損及根叉侵犯，此外上顎前牙區、左上後牙區、右下後牙區亦有顯著牙周破壞，#45伴有牙周牙髓合併病灶，上顎前牙區並呈現病理性位移現象。經過牙周第一階段的初期治療，第二階段於病灶處施行牙周翻瓣合併骨再生手術，治療後一年追蹤全口的牙周囊袋深度皆在4毫米以內，97%的區域囊袋深度在3毫米以內；牙周探測出血指數由原始的68%降至5%，74%的牙周部位有附連獲得，放射線檢查多處手術部位皆有骨充填，上顎門齒之病理性遷移現象亦自動改善。病患口腔衛生保持良好，整體牙周健康狀況十分穩定。

關鍵字

侵犯型牙周炎 ； 牙周再生手術 ； 牙釉基質蛋白 ； 牙周牙髓合併病灶 ； 病理性牙齒位移

並列摘要

This article is a case report of a 29 year-old man who suffered from generalized severe aggressive periodontitis. He had a probing depth of 13mm over upper right posterior region before periodontal treatment. His upper right first premolar gum area had been suffering from swelling and abscesses off and on for the last 3 years; radiography showed severe periodontal bony destruction and furcation involvement. Other sites also showed severe periodontal destruction, including #45, which had combined endodontic-periodontal lesions, and the upper anterior region, which presented with pathological tooth migration. He received periodontal initial therapy together with surgical therapy that included flap curettage and periodontal regeneration surgery. One year after treatment, his full mouth probing depth has been reduced to below 4mm. An initial 68% bleeding on probing had improved to 5% and 74% of sites had achieved attachment level gains. Radiography also showed apparent bone fill affecting multiple bony defect sites. The diastema of the maxillary pathologically migrated incisors also showed spontaneous correction. The overall periodontal health of the patient had improved significantly and was stable.

並列關鍵字

aggressive periodontitis ； periodontal regenerative surgery ； enamel matrix protein ； perioendo combined lesion ； pathological tooth migration