以隧道穿通術治療下顎第一大臼齒之第三級根叉侵犯：12年追蹤病例報告

The Treatment of a Mandibular First Molar with Degree III Furcation Involvement Using Tunnel Preparation: A 12-Year Follow-Up

蔡凰慈(Huang-Tzu Tsai) ； 江正陽(Cheng-Yang Chiang) ； 傅鍔(Earl Fu) ； 沈一慶(E-Chin Shen) ； 邱賢忠(Hsien-Chung Chiu)

《臺灣牙周病醫學會雜誌》 19卷3期 (2014/09) Pp. 261-270

https://doi.org/10.6121/TAP.2014.19.3.08

摘要

牙根分叉處因清潔與維護不易，且因牙根表面無法提供血液循環，常導致手術效果不如預期理想與穩定，故一直是牙周病治療上最為棘手困擾的問題；其預後則主要和根叉解剖形態、根叉處齒槽骨缺損範圍、與病患是否可以做到徹底清潔而定。本病例為一30歲（2001年）慢性牙周病男性患者，其左下第一大臼齒因第三級根叉侵犯而進行隧道穿通術；患者十年後因有牙周病復發的現象而再次接受二度手術，並以骨移植術治療其骨內缺損；術後兩年的牙周探測檢查數據均有明顯改善，放射線檢查亦有骨充填。臨床上根叉侵犯第三級的牙齒雖然長期預後可能不見得理想，但只要做好基本治療與定期維護，在牙菌斑控制良好的情況下，延長其使用年限、維持至少十年是可以做到的事。

關鍵字

下顎大臼齒 ； 根叉侵犯 ； 隧道穿通術 ； 長期追蹤

並列摘要

Furcation involvement is quite clearly one of the most difficult problems when treating periodontal disease. A great deal is available in the literature on guidelines for the treatment of furcation involvement in the posterior teeth. Most of these recommendations involve treatment of furcation involvement classifications I or II. However, the literature available on the treatment of classification III is limited and therefore no superior treatment choice for a stable outcome is available. Degree III furcation involvement often leads to a significant deterioration in the patient's long-term prognosis; however, when there is good plaque control with regular maintenance, the teeth are able to be maintained and their useful life is prolonged. This case report presents a patient with chronic periodontitis who, about 12 years ago, had completed periodontal treatment, including tunnel preparation, on his mandibular first molar. Due to a periodontitis relapse, the patient needed to undergo repeat surgery and bone grafting for 36 intrabony defects. Based on clinical periodontal examination and radiographs, after further periodontal treatment, the 36 intrabony defects showed significant improvement with bone fill in the intrabony defect areas. Overall the periodontal therapy resulted in a good prognosis. The tunnel preparation procedure is a treatment alternative and is suitable for furcation III molars. It has a considerably better prognosis than has been previously reported and should be considered as a valid treatment alternative. The indications and long-term prognosis for tunnel preparations are also outlined in this case report.

並列關鍵字

mandibular molar ； furcation involvement ； tunnel preparation ； long-term follow-up