使用牙根分離/切除術在嚴重根叉侵犯大臼齒之臨床評估

Clinical evaluation of molars with advanced

洪怡育(Yi-Yuh Hong)

指導教授 ： 侯桂林

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2003年)

摘要

大臼齒區根叉病變在牙周及補綴的治療上一直有很高的不確定性。因其複雜的解剖形態構造及臨床上常沒有合適的器械進入此區域做牙根面的清創術即使經手術或非手術治療，殘留的死角，使得患者與牙醫師無法做牙菌斑個人與專業上的控制。尤其在治療嚴重第二、三級根叉侵犯中 (Class II, Class III furcation involvements )，回溯其治療過程與術式，長期追蹤治療結果，均未有良好可預測性。本研究主要目的是探討本院研發的三合一的牙周補綴治療法 (three in one periodontal-prosthetic therapy)，以治療性過渡補綴物 (therapeutic provisional prosthesis, TPP)， 合併牙根分離或切除術 (root separation and/or resection, RSR) 應用在重症牙周炎 (severely advanced periodontitis, SAP) 患者合併有咬合創傷 (trauma from occlusuion, TFO) 之大臼齒區牙周補綴治療 (periodontal prosthetic therapy) 的方式，以評估以牙根分離或切除術合併過渡性治療用之補綴物在嚴重牙周炎之大臼齒治療上的臨床效果。
實驗樣本均取材自2001年8月至2003年4月間，在高雄醫學大學附設中和紀念醫院牙科門診部牙周病科就診之患者中，經過全口牙周參數評估後，依本院之診斷方式，診斷出有嚴重第二、三級根叉侵犯 (Classes II, III) 之大臼齒之患者經牙周病第一階段治療後仍維持有第二級以上根叉侵犯的患齒，在31名病患中，共50顆大臼齒 (上顎37顆，下顎13顆)，有17顆大臼齒未接受牙根分離/分開術，僅完成牙周第一階段治療且定期回診則歸類為對照組。而之中有33顆大臼齒接受牙根分離/切開術，並製做25副治療性過渡補綴物 (上顎18副，下顎7副)則歸類為實驗組， 平均治療時間14.8 ±2.0月 (從12到18個月) 。二組患者均記錄其牙菌斑指數，牙齦指數，牙周囊袋探測深度，牙周附連水平，動搖度及有無咬合傷害。
本研究的結果如下：（1）對照組與實驗組均可在牙菌斑指數，牙齦指數，及非根叉侵犯區的牙周囊袋探測深度上有明顯的改善，（2）實驗組在根叉區牙周囊袋探測深度，根叉侵犯區、非根叉侵犯區牙周附連水平及牙齒動搖度有明顯改善，（3）實驗組在咬合傷害部分前後有明顯改善，（4）實驗組在根叉侵犯區的牙周附連水平，牙周囊袋探測深度，牙齒動搖度，及咬合傷害部分明顯優於對照組。可見在嚴重牙周炎患者合併有第二級根叉侵犯以上之大臼齒以牙根分開或切除術治療合併治療性過渡補綴物在臨床上可獲得良好之效果。

關鍵字

根叉病變 ； 牙根分離/切開術 ； 治療性過渡補綴物

並列摘要

Because of the inconsistent results of periodontal and prosthetic therapy, periodontists usually could not choose adequate instruments to treat molars furcation involvements (FI) with poor root morphology. In addition, poor root morphology of the remaining root following surgical or non-surgical treatment is usually considered a high risk factor for long-term periodontal personal and professional plaque control. The purpose of this study was to investigate the differences in the clinical periodontal parameters of molar abutment with or without molar roots separation and/or resection (RSR) before and after periodontal and prosthetic therapy in severely advanced periodontitis (SAP) combined with trauma from occlusion (TFO), using a removable therapeutic provisional prosthesis (TPP).
Samples were pooled from patients with advanced Class II or Class III molar furcation involvement treated at the Department of Periodontics, Kaohsiung Medical University Memorial Hospital, Taiwan. A total of 50 abutments consisted of 37 maxillary and 13 mandibular molars, were treated in 31 individuals. There were 17 abutment without root separation/resection and 33 abutments with RSR. Twenty-five TPPs were placed, 18 in the maxillary arch and 7 in the mandibular arch. The mean observation period was 14.8 ± 2.0 months (ranged from, 12 to 18 months). The clinical parameters including plaque index (PlI), gingival index (GI), probing pocket depth (PPD), probing attachment level (PAL), and tooth mobility (M) were recorded. The differences in these parameters before and after periodontal and prosthetic therapy in the advanced furcation-involved molars with and without RSR were evaluated. The results revealed a remarked significant improvement in the associated periodontal parameters (PlI: p <0.001, GI: p <0.001, PAL-NFI: p <0.01, PAL-FI: p <0.001, PD-FI: p <0.001, M: p <0.001) in advanced Class II and Class III FI molars with RSR combined with TPP as compared to those without RSR. It was, therefore, concluded that molar abutments with RSR in conjunction with a specifically designed TPP provide a modified approach for treating molars with advanced Class II and III FI.

並列關鍵字

molar furcation ； roots separation and/or resection (RSR) ； therapeutic provisional prosthesis

參考文獻

參考文獻:

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