牙周補綴全口重建之病例報告 -以合併自然牙與戰略植體應用於Könus 雙重套冠義齒病例為代表

臨床牙科的領域中，牙周病學與補綴學息息相關，齒列受到牙周病侵犯的病人，常有附連喪失、牙齒病理性位移、咬合塌陷的棘手情況，重建的治療過程包含移除造成組織發炎的病因、提供理想咬合支持外，有時亦需要矯正學的介入，更改牙齒排列，便於維持清潔，同時改善骨缺損、咬合創傷。另一項優點為調整支台齒間平行度、建立理想咬合平面及前牙導引，緩解擁擠或外展的前牙，提供理想的周邊環境，以贋復物恢復美觀及功能，此即跨科性治療。人工植牙的發展對於牙科治療計畫的訂定有舉足輕重的影響，精確的放射線檢查對於植牙術前的解剖構造及病理破壞評估很重要，如果手術部位能有完整的3D影像，可以讓手術安全性更高、植體位置更理想。電腦斷層掃瞄不失為一利器，其中較新的cone-beam CT (CB)，輻射劑量低，設備便宜，對於牙科而言為經濟、方便的診斷工具，針對不同難度的植牙病例，應考慮不同的術前檢查方式、所需檢查花費及暴露的輻射劑量，原則如同放射學的宗旨，即合理抑低。本病例報告中，共有四位病患因人工植牙的需求而接受電腦斷層掃瞄，雖然整體治療費用略微提高，但是對於術前掌握患者殘存齒槽骨的質、量都有很大幫助，病患對於術前審慎的檢查亦表示肯定及安心。本報告中提出九個病例，依照跨科性治療原則，分別以手術、非手術的方式改善牙周健康，便於病患維持清潔，並以人工植牙增加支持，矯正強逼萌出術改善牙齦缺損及增加冠部齒質，再依病患情況，設計各式義齒達成全口重建目標。考量到不同病患其訴求、經濟能力、社會地位、配合度、維持口腔清潔之能力皆不盡相同，身為牙醫師應有因地制宜，提供不同治療計畫的能力，配合患者的需求與能力，提供恢復功能、美觀、發音的贋復物。預防勝於治療，病患的動機及定期回診維護，才是確保贋復物長期成功率的不二法門。

關鍵字

咬合塌陷；人工植牙；雙重套冠

並列摘要

Periodontal and restorative dentistry are mutually important of clinical dentistry. Patients with a compromised periodontal condition would encounter great difficulties such as decreased attachment level, pathologic tooth migration and lost of occlusal support. Periodontal and prosthodontic treatment in conjunction with orthodontic intervention is required. Treatment procedure would involve removal of inflammation and occlusal interference . Correction of tooth position or mal-alignment using orthodontic methods can significantly decrease periodontal breakdown. These treatments will improve oral hygiene, modify osseous defects, and cease occlusal trauma. Orthodontic tooth movement can also provide environments for prosthodontic rehabilitation such as paralleling abutment teeth and reestablishing occlusal plane as well as anterior guidance. Realigning crowded or migrated incisors is helpful for improving esthetics. This is so-called “interdisciplinary treatment concept”. The development of dental implants has a great effect on treatment planning. Accurate presurgical assessment requires precise radiographic visualization of anatomic structures and pathologic conditions. Three-dimensional (3D) visualization reveals more anatomic details and potentially includes all radiographic information necessary for maximal surgical safety and implant positioning improvement. Computerized tomography (CT) technology nowadays comprises a broad band of different technologies. Cone-beam (CB) CT imaging cost less and the radiation dose is lower than the others. The option of radiographic method should be choosened by the complexity of the implant case, the availability of technology and expertise, the costs for examination and the device. The radiation exposure which should be as low as possible. This report contains 4 cases arranged cone-beam computerized tomography examinations for presurgical implantation evaluation. Although total charge increase, patients are glad to have further examination for better understanding of the bone quality and quantity. Cases with different treatment modality are present in this report. According to interdisciplinary treatment concepts, we combine periodontology, implantology, orthodontics (forced eruption) and prosthodontics for full mouth reconstruction. Every patient has his own consideration about treatment planning due to different claim, economic ability, social status and ability to cooperate and maintain oral health. It’s our duty to satisfy patient’s need of esthetics, function and articulation. An ounce of prevention is worth a pound of cure. Motivation and periodic maintenance are the key to long-term success.

並列關鍵字

bite collapse ； dental implants ； Könus telescopic denture

參考文獻

Atwood DA. Some clinical factors related to rate of resorption of residual ridges. 1962. J Prosthet Dent 2001;86(2):119-25.

Google Scholar

2. Mitrani R, Brudvik JS, Phillips KM. Posterior implants for distal extension removable prostheses: a retrospective study. Int J Periodontics Restorative Dent 2003;23(4):353-9.

Google Scholar

3. Hug S, Mantokoudis D, Mericske-Stern R. Clinical evaluation of 3 overdenture concepts with tooth roots and implants: 2-year results. Int J Prosthodont 2006;19(3):236-43.

Google Scholar

4. Mericske EA, Mericske-Stern R. Overdenture abutments and reduced periodontium in elderly patients. A retrospective study. Schweiz Monatsschr Zahnmed 1993;103(10):1245-51.