牙周補綴病例報告
以人工植體與磁性附連體應用於慢性牙周炎之全口重建

中文摘要牙周補綴是1955被Dr.Amsterdam M.發展於重症牙周疾病患者，經由牙周治療後，使用全口固定的贋復技術以保留剩餘牙齒,達到口腔咀嚼、發音、及美觀的功能，並且免除配戴活動假牙的命運。其基礎理念是利用跨弓式固定技術達成固定的效果，減少了前後左右的槓桿作用，此設計具強支持性，因而創造了穩定的咬合，而確定了牙周補綴的基本概念。演化至今，隨著再生醫學的發展及生科產品的演進，在牙周補綴基本理念的建構上延伸發展出更多樣化的設計，若有需求可加入牙科植體，輔助硬組織的不足；結合矯正治療，可以提高牙周與補綴處理的成果，得到更好的預後；為了強化牙周組織，除了基本的牙周治療外，必要時需施以牙周翻瓣手術、牙根切除術、游離牙齦移植術，齒槽骨成形術；為了強化齒質的結構，可配合使用玻璃纖維柱心加上樹脂或鑄造式的冠心根柱來贋復殘缺的齒質，必要時需施以牙冠增長術或強迫萌出術，以達到圍箍效應。若支台齒齒數不足，可設計雙重套冠可撤式活動義齒，利用基底板及主連接體提供跨弓式的固定效應，平均分散咬合力。除此之外，尚可依據支台齒的牙周支持、剰餘殘存齒齒數及在顎弓間幾何分布的狀況，使用各種類型的附連體當作輔助性固持功能的設計，使贋復體能獲得較佳的穩定性、支持性及美觀發音的效果。若有壓力與受壓分配不當時可在重要部位植入植體，彌補支台齒之不足。有異功能咬合現象者，需加以控制，才能建立健全及穩定的口顎系統。牙周補綴連結了各科的統合治療，既可符合健康的口腔生物機械原理，並且可滿足病患的需求。

關鍵字

牙周補綴；雙重套冠可撤式義齒；牙科植體；磁性附連體

並列摘要

Abstract Periodontal prostheses,a treatment for periodontal compromised patients who suffer from advanced periodontitis and are treated using full mouth splinting method,was developed by Dr. Amsterdam M. in 1955.The method can help prevent residual teeth and little-bone-supporting teeth from extraction and retain functions of chewing,phonetics and esthetics. Cross-arch fixed prostheses is a splinting concept that can decrease lever action effect on the dental arch.This design has a strong supportive feature and makes stable occlusion.This cross-arch splinting concept established the determining principle of periodontal prostheses treatment. Today, the developement of regenerative medicine and biotechnology contributes to more treatment planning and more selections.The combination of periodontal treatment,operative dentistry,endodontic therapy,orthodontics ,oral surgery and prosthodontics is necessary.In addition to implant dentistry, the telescopic removable dentures are preferable for the patients who have few teeth on the arch. It is important to use major connector and denture base to get cross-arch effect and to provide stable occlusion and distribution of occlusal force to all abutments and non-tooth supporting area .In addition , the root-retained or implant-retained overdentures which may have many methods of design can be combined with magnetic appliances or other type of attachments in order to have more supporting and retention.Dental implant may assist in getting function of all kinds of removable denture and long span zone of missing teeth. Parafunction is another problem.Oral rehabilitation needs interdisciplinary treatment planning including periodontal,occlusal,and prosthodontic treatments.The key to success is long-term follow-up and maintenance.