牙周補綴之病例報告：以Konus，CSC雙重套冠系統可撤式義齒在牙周補綴之應用為代表

Perio-prosthodontic cases reports: The clinical application of Konus, CSC telescopic system.

蔡正文(Cheng-Wen Tsai)

指導教授 ： 蔡吉政

高雄醫學大學/口腔醫學院/牙醫學研究所碩士在職專班/碩士(2003年)

摘要

新世紀的牙科治療，是講求各次專科通力合作的『整合性治療』。舉凡由口腔診斷、牙體復形、牙髓治療、牙周治療、口腔外科到矯正以及補綴治療等，甚至牙科技工上的配合，都應屬於牙周補綴的範疇。這點可由1974年美國賓州大學阿姆斯特丹教授提出所謂『牙周補綴』的定義，一窺端倪。其定義如是說：「牙周補綴即在嚴重牙周病治療當中，不可或缺的復形與補綴之謂也」，又說：「其所應用醫療的觀念、原則與技術，亦適用於一般正常齒列」。從後面這句話不難看出所有應用在正常齒列的醫療資源，均為牙周補綴所用，這也就是『整合性治療』的具體闡述。
當代牙科治療除了要滿足病患對外在美觀的需要外，同時也要兼顧內在牙周環境的穩定。傳統的牙科治療，只要在復形、補綴上花些功夫，就能滿足病患對牙齒硬組織有所謂『白色的美觀』的要求；然而更進一步，吾等還要考慮到牙齦軟組織與牙齒間的整體感，於是乎演繹出如游離牙齦瓣膜手術、牙間乳頭重建術、牙周美容手術等手術，來追求所謂的『紅色的協調』；經由長期的臨床實踐，吾等又發現唯有骨頭的存在，才是確保軟組織穩定的基礎，因此又研發出如引導組織再生手術、引導骨再生手術，甚至進入胚胎學的層級而使用特定的生長因子，希望能重建失去的牙周與骨組織，也就是追求所謂『黃色的支持』。
牙周病係由細菌引發的『炎症』反應是不爭的事實，但免疫以及遺傳在局部或全口牙周病應當扮演何種角色，至今仍有許多爭議的地方。一般病患的期待都是相信醫師能『終結』他目前的牙周病問題，也能提供他『永遠堪用』的假牙。牙周補綴就是在這種諸多『未知』與『高期待』的環境裡做重建的工作，是充滿風險性與挑戰性。吾等應不斷的充實新知、研發更新的醫療技術，不妄下診斷、不輕言保證，運用現有有限的知識與醫療技術，審慎從事，為追求更高醫療品質的治療而倍加努力。
本臨床病例報告十一個案例裡，有簡單的單顆牙齒矯正強迫性萌牙，配合牙冠增長術，加上視覺上偽裝性的補綴物製作；有複雜的全口牙周治療與咬合重建，配合矯正治療，加上雙重套冠系統或彈性活動假牙的補綴物製作；也有運用植牙的幫忙來完成補綴治療。所有案例均為牙周補綴的一部分，也可作為類似治療模式的參考。目前所有案例均能滿足病患對咀嚼、發音與美觀的要求，然而有多久的使用年限，長期的追蹤回診是必要的。

關鍵字

雙重套冠 ； 牙周補綴

並列摘要

New-century dental treatment is “integrated treatment” which emphasizes on collaboration of different specialized fields. In a broader sense, periodontal prosthesis covers a wide spectrum of techniques from oral diagnosis, operative dentistry, endodontic therapy, periodontal treatment, oral surgery to orthodontics and prosthodontics, even support from dental technicians should also be included. Dr. Amsterdam (Univ. Pen, 1974) shared the same view. He defined periodontal prosthesis as “Those restorative prosthetic endeavors that are absolutely essential in the treatment of advanced periodontal disease. Whereas specifically it refers to the treatment of the dentition mutilated by the ravages of periodontal disease, in general, its concepts, principles, and techniques may be employed in any restorative or tooth replacement service involving the nature dentition.” The later comment manifested that all treatment resources utilized in normal dentition can be shared by periodontal prosthesis, substantiating the concept of “integrated treatment”.
In addition to satisfying patients’ needs for better appearance, contemporary dental treatment should take care of the stability of internal periodontal environment as well. Traditional treatment puts efforts on operative dentistry and prosthodontics, aimed at satisfying patients’ anticipation of “white beauty” for dentition only. However, it is not less important to pay attention also to the wholeness between soft tissue and teeth. Techniques such as “free gingival graft operation, “interdental papilla reconstruction”, “periodontal plastic surgery” are thus developed to search for “red harmony”. It is only after long term experiments when bone is discovered the foundation of soft tissue stability. As such, “guided tissue regeneration procedure, GTR”, “guided bone regeneration procedure, GBR”, and even utilization of specific “growing factors”, which has entered into the area of embryology, are developed in hope of reconstructing the lost of bone, the so-called “yellow support”.
It has been proved that periodontal disease is inflammation caused by bacteria. However, what roles “immunity” and “heritage” play in partial or whole periodontal disease is still controversial. Patients generally expect dentists to terminate their periodontal problems and provide them with dentures that last for lifetime. Periodontal Prosthesis is to proceed reconstruction in an environment filled with “unknown” and “high anticipation”. It is therefore very risky and challenging. As professional dentists, we should keep learning new knowledge, doing research for new treatment techniques. Never make diagnosis or guarantee before detailed and prudent examinations are done. In other words, it is our responsibility to seek continuously for better treatment quality, given the limitation on knowledge and skills.
The report contains 11 cases studies. There is simple case such as single-tooth orthodontic forced eruption, coordinating crown lengthening procedure and visually disguising prostheses for better visual effect. There are also complicated cases like full-mouth periodontal treatment and occlusal rehabilitation, matching orthodontics treatment plus telescopic denture system or flexible removable denture. In some cases, implant is also involved. All cases are part of periodontal-prosthesis and can be used as reference for similar treatments. For the time being, all treatments done in the cases are effective in terms of satisfying patients’ needs for chewing, articulation and esthetics. However, the endurance is yet to be proved and long-term tracking and follow-up checks are indispensable.

並列關鍵字

Telescopic system ； Perio-prosthodontics

參考文獻

參考書籍與文獻

1. Amsterdam, M. Periodontal prosthesis: Twenty-five years in retrospect. Alpha Omega , 11-52. 1974.

2. Cohen, L. A. Integrating treatment procedures in occlusal rehabilitation. The Journal of Prosthetic Dentistry 7(4), 511-528. 1957.

3. Clama, L., Alfaro, M. A., and Mercado, A. An interdisciplinary approach for improved estheic results in the anterior maxilla. The Journal of Prosthetic Dentistry 89(1), 1-5. 2003.

4. Blatz, M. B., H?zeler, M. B., and Strub J.R. Reconstruction of the lost interproximal papilla_Presentation of surgical and nonsurgical approaches. The International Journal of Periodontics & Restorative Dentistry 19(4), 395-406. 1999.