口腔植體在牙周補綴治療的應用和考量---病例報告與討論

Clinical periodontal prosthetic report: 9 cases

馬光和(Kwong-Wo Ma)

指導教授 ： 王震乾

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(2007年)

https://doi.org/10.6832/KMU.2007.00020

摘要

自美國賓州大學阿姆斯特丹教授於1974年首先定義出”牙周補綴”一詞後，牙周補綴在這三十年間已經廣泛地在世界各地傳播出去，尤其是老年人口比例的逐漸增加，生活水平的逐步提升以至牙周病治療的科技日新月異，使得很多受牙周病侵犯的牙齒都會主觀和客觀地得以保存下來，但是要重建這些因牙周組織破壞而導致（1）病理性移位（2）咬合不協調（3）牙冠、牙根比例不良（4）牙齦萎縮（5）牙根、牙冠部分缺失等症狀的牙齒時。便必須結合牙周病治療、牙體復形、根管治療、齒顎矯正、口腔外科及義齒補綴等各科，才可以達到”牙周補綴”的最高境界。而自80年代開始具有骨整合的口腔植體在北美市場的出現，顛覆了傳統牙醫學治療的觀念，尤其是它的高成功率和日新月異的表面處裡方法，更使得口腔植體等待可受力的時間大為縮短，甚至可以立即受力。另外如引導骨再生術、鼻竇抬高術的成熟，更大大提高了口腔植體的適應症，所以它便成為”牙周補綴”治療的新利器，甚至在一定程度上改變了牙周補綴的傳統觀念。本文提出了九個案例，而每個案例均有口腔植體的應用，從單顆到全口十八顆均有，口腔植體在這些牙周補綴的案例中所擔綱的角色，有（1）立即恢復咬合能力（2）立即恢復美觀功能（3）作為矯正的錨定（4）避免活動性義齒的應用（5）降低義齒補綴在設計上的複雜性（6）作為全口覆蓋式義齒的支柱等，而最重要的一點是提升病患對治療計畫的接受度，降低牙周補綴治療計畫的一些長期不確定性。當然口腔植體並不能代表一切，案例中亦會使用一些牙周手術、牙根分割術、自體骨移植等技術去治療牙周炎的牙齒，而口腔植體只是在缺牙區提供新的支柱，降低自然牙在牙周補綴治療中的負擔和簡化補綴物的複雜性。

關鍵字

牙周補綴 ； 口腔植體 ； 立即受力口腔植體

並列摘要

Since the introduction of the treatment concept on “periodontal prosthesis” by Dr Amsterdam in 1974 at the University of Pennsylvania, it has been in widespread use all over the world. Meanwhile, due to the increasing aging population, upgrading of living standard and improving techniques of periodontal therapy, most of the periodontal compromised tooth with unpredictable prognosis can be saved. However, rehabilitation of the dentition suffered from periodontal disease always has the following problems :(1) pathological migration.(2) unstable occlusion.(3) unfavorable crown-root ratio.(4) gingival recession.(5) crown or root resected. To accomplish an ideal periodontal prosthetic treatment, a number of techniques, such as periodontal treatment, operative dentistry, endodontic therapy, orthodontics, oral surgery and prosthodontics are needed to be used cooperatively.Since the introduction of osseointegrated implant to North America district in 1980s with the high survival rate, the traditional dental therapy philosophy has been challenged. The improving techniques of the surface treatment on the oral implant has dramatically shorten the healing period.Under certain circumstances, the oral implant could be loaded immediately after surgical installation. Meanwhile, the guided bone regeneration and sinus lift technique can replenish the bony defect around the oral implant, therefore the limitation of the oral implant is decreased. The osseointegrated implant has become a new approach of the periodontal prosthesis treatment.This has changed the treatment concept as well.This paper presents 9 cases with moderate to advance periodontitis, localized to generalized condition. An osseointegrated implant was used in every case, from single to eighteen fixtures repetitive. The roles of the osseointegrated implants in these periodontal prosthesis cases play from : (1) recover occlusal function immediately.(2) recover esthetic demand immediately.(3) orthodontic anchorage.(4) avoidance of removable interim prosthesis.(5)simplify the prosthetic design.(6)abutment for the overdenture,the overriding factor is to enhance the treatment acceptance of the patient.Besides the oral implant, we also use periodontal surgery, root resection, autogenous bone graft and connective tissue graft to treat the periodontal compromised tooth.An oral implant can provide the new abutment , share the loading of the periodontal compromised natural tooth and simplify the sophisticated design of the periodontal prosthesis.

並列關鍵字

periodontal prosthesis ； oral implant ； immediate loading implant

參考文獻

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