覆蓋義齒與人工植牙在臨床牙周補綴之病例報告與討論

牙周病是台灣中老年人最常見的口腔疾病，嚴重程度會隨著年齡逐漸惡化.由於醫療科技的進步與大眾傳播媒體的宣導，人類愈來愈重視身心保健,因而壽命得以延長，牙周病患者的疾病治療與鑲補義齒的需求亦與日俱增。牙周補綴一詞綜合 Dr. Amsterdam(1974) 與Dr. Rosenberg(1988) 等人所下的定義為﹕應用在嚴重牙周疾病的贋復與補綴治療。在重度牙周侵犯的齒列中，因存在很深的牙周囊袋、牙齒搖動及牙齒缺失,經常引起1.牙齒病理性位移，2.中心關係位置偏位,3.後牙咬合塌陷以及4.顳顎關節症狀。由於每位患者對罹患牙周病的易感性不同，牙周致病菌毒素的種類對不同部位牙周組織會產生不同程度的破壞。牙周補綴治療除了牙周病的防治和補綴物的製作，有時要合併根管治療、輔助性矯正或口腔外科手術,以達到理想的口腔解剖結構。牙醫師必須考量患者的現實需求,人格特質,經濟能力,治療方法的岐異性,與患者進行溝通以選擇最合適的治療計畫。本論文共提出 10 個病例報告,六位女性,四位男性。採用不同的治療模式。牙周治療包括非手術性的潔牙和牙根整平術,至於手術性治療包括牙周翻瓣術、根叉侵犯治療、下顎頦骨塊移植術與種植體置入、引導骨再生手術、牙釉基質蛋白牙周再生手術。最終的補綴設計約略分為兩大項,固定式包括傳統固定式義齒, 植體固位式固定義齒.活動式包括傳統可撤式部份義齒,雙重冠固位部份覆蓋義齒, 冠外半精密附連體義齒,雙重冠支持全顎覆蓋義齒。經由跨科性及整合性的牙周補綴治療,為患者提供健康的牙周環境,以方便口腔衛生的維護,同時滿足患者對咀嚼功能、言語及美觀的要求。

關鍵字

牙周補綴；後牙咬合塌陷；輔助性矯正；牙周翻瓣術；根叉侵犯治療；下顎頦骨塊移植術；種植體置入；引導骨再生手術；牙釉基質蛋白牙周再生手術；植體固位式固定義齒；雙重冠固位部份覆蓋義齒；冠外半精密附連體義齒；雙重冠支持全顎覆蓋義齒

並列摘要

Periodontal disease is the most common oral disease in Taiwan senior people. Due to progressing achievement in medical technology and propaganda of mass media, the society has made much more of psychological and physical health promotions, the rising need for restorations for periodontally compromised patient as well. The definition of periodontal prosthesis from Amsterdam and Rosenberg etc. emphasizes the periodontal-prosthetic therapy is essential in the treatment of advanced periodontal disease. These periodontally compromised dentition involved deep pocket Tooth mobility、missing teeth and lead to pathological migration, central relation discrepancy, posterior bite collapse and TMJ syndrome. Owing to the individual susceptibility of periodontal disease and different disease progression are affected by oral hygiene maintenace capability.To achieve this goal a therapy can best be accomplished by means of combined periodontal and prosthetic therapy, supplemented when required by endodontic, adjunctive orthodontic and oral surgical treatment in order to gain the ideal anatomic structure.Dentist must evaluate patient’s practical need ,personal characteristics, financial capabilities and dental treatment variabilities to select the most appropriate treatment. In this thesis, 10 moderate to advanced periodontal prosthetic treated cases including 6 female 4 male patients were presented. These cases applied with many different prosthetic therapies: periodontal treatment including non-surgical treatment (such as scaling and root planning )and surgical procedure ( open-flap curettage、furcation involvement therapy、 chin graft and implant placement、GBR 、EMD regeneration).The definite prosthesis include conventional fixed prosthesis、conventional removable prosthesis、conventional and telescope overdenture 、and attachment retained prosthesis etc.. By interdisciplinary and integrated approach of treatment, patients have healthy periodontal condition for good oral hygiene control, perform the normal chewing function、speech and satisfy esthetic appearance.

並列關鍵字

periodontal prosthesis ； posterior bite collapse ； adjunctive orthodontic treatment ； chin graft ； open-flap curettage ； furcation involvement therapy ； implant placement ； telescope overdenture ； attachment retained prosthesis.

參考文獻

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

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2.Rosenberg, M. M., Kay, H. B., Keough, B. E., & Holt, R. L. (1988) Periodontal and Prosthetic Mangement for Advanced Cases. Quintessencce Publishing Co., Chicago, London, Berlin, Tokyo, and Hong Kong.

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3.Gottlow J.Guided tissue regeneration using bioresorbable and non-resorbable devices:initial healing and long-term results. J Periodontol 1993;64:1157-1165

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4.Heijl L. Peiodontal regeneration with enamel matrix derivative in one human experimental defect. A case report. J Clin Periodontaol 1997;24:693-696

Google Scholar

5.Hammarstrom L,Heijl, Gestrelius S.Periodontal regeneration in buccal dehiscence model in monkeys after application of enamel matrix proteins.J Clin Periodontol 1997;24:669-677

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覆蓋義齒與人工植牙在臨床牙周補綴之病例報告與討論

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