廣泛性中度至重度慢性牙周炎之全口重建

Full Mouth Reconstruction in Moderate to Severe Chronic Periodontitis

周祐任(Yeo-Zen Chou)

指導教授 ： 李惠娥

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2011年)

https://doi.org/10.6832/KMU.2011.00035

摘要

牙周補綴治療概念於1974前由Dr. Amsterdam提出，對於嚴重牙周病治療合併復形與補綴治療的觀念、原則與技術提供後輩們一個典範。牙周補綴病患一般常見的牙周組織破壞，造成牙齦紅腫發炎或嚴重嚴重萎縮，導致咬合不穩定及牙齒位移，不當的咬合受力而造成咬和崩壞，齒槽骨破壞造成牙冠/牙根比例不良產生次發性咬合創傷。因此，降低次發性咬和創傷是牙周補綴治療得首要任務。對於殘存齒分布不佳的狀況使用覆蓋式可撤式義齒提供跨弓式設計式的牙床與牙根受力分佈較平均，可降低齒槽骨吸收速度，能提高義齒穩定性及支持性。隨著植體設計不斷的進步，使的成功率大大提升，臨床運用的普及化在牙周補綴治療上也增添了一大利器。
本論文提出九例病例報告，病患為輕度至重度牙周炎，分別利用植體和覆蓋式可撤式義齒搭配磁性附連體、雙重套冠完成重建，其中病歷一、三、五、六和七利用植體製作固定式義齒，病例二、四和九為覆蓋式可撤式義齒，病例四利用磁性附連體和金屬薄冠蓋，病例二運用雙重冠重建，病例八則是利用傳統式鉤靠式可撤式義齒。治療過程搭配使用的手術方式有牙冠增長術，牙周膜翻瓣手術，牙根切除、切半術等不同設計的重建病例。

關鍵字

牙周補綴 ； 咬合崩塌 ； 覆蓋式義齒 ； 人工植體 ； 磁性附連體

並列摘要

By 1974, the concept of periodontal prosthesis treatment had been proposed by Dr. Amsterdam to treat advanced periodontitis combined the prosthetic and restorative treatment, which provided a standard of concept, principle, and technique in the dentistry.

The common symptom of periodontal prosthetic patients are inflammation、edema and severe gingival recession among the periodontal tissue, which causes unstable occlusion and tooth migration. Improper chewing force can result bite collapse, and alveolar damage can cause poor crown/root ratio , and create the secondary occlusal trauma。
Therefore, to reduce secondary occlusal trauma is the first priority in periodontal prosthetic treatment. Using overdenture can provide cross arch design to make root and residual ridge supportive force distribution more evenly. As the result, this treatment can decrease alveolar ridge resorption rate and enhance the denture support and stability. With the progress of implant design, the successful rates are dramatically increased, and the popularization of clinical application makes periodontal prosthetic treatment as a powerful method.

This thesis provides nine cases report. The patients have chronic to severe periodontitis. The reconstruction treatment has been accomplished by implants、overdenture combined magnet ( Magfit ) and Konus telescope. Among those patients, case 1, 3, 5, 6, and 7 are treated by implant fixed prosthesis. As for case 2, 4, and 9, removable overdanture was applied. Moreover, case 4 used magnet and metal copping; case 2 used konus telescope; and case 8 used the traditional clasp denture. During the treatments, the surgical methods applied crown lenghthening procedure，periodontal flap surgery，root resection and hemisection procedures to complete the reconstruction.

並列關鍵字

Periodontal prosthesis ； bite collapse ； overdenture ； implant ； magnet

參考文獻

1. Amsterdam, M.A., L., ed. Periodontal prosthesis. . 5th ed. Periodontal Therapy, ed. H.M.G.D.W. Cohen. 1973, CV Mosby Co, : St, Louis. 527.

2. Amsterdam, M., ed. Twenty-five years in retrospect. 1974, Alpha Omega. 4.

3. Ramjord, S.P.A., MM, ed. Occlusion. 1966, C.V Mosby Co.: St, louis. 115.

4. Stern, N.B., L., Collapse of the Occlusion_aetiology, Symtomatology and treatment. Journal of Rehabilitaion, 1975. 2: p. 1.

5. Prosthodontics, A.o., The glossary of prosthodontic terms. Journal of Prosthetic Dentistry, 2005. 94(1): p. 63.