牙周補綴於牙周病之考量與臨床應用

牙周病重症的患者常有嚴重的牙周組織破壞，牙齦萎縮，缺牙，牙齒搖動，病理性移位以及疼痛等等的問題。伴隨牙周重症常見的咬合問題有不良咬合平面、牙齒往缺牙區傾斜及伸長、以及咬合干擾造成的繼發性咬合創傷。這些病理性的變化使病人喪失口腔及社交功能、美觀、親密性甚至對自我失去信心等等。當今牙周病治療不再只是牙結石刮除及翻瓣清創手術而已。近幾年手術技術及材料的進步滋養了許多新的術式像是引導組織再生術、引導骨再生術、牙周整形手術以及最近幾年常見的生長激素的使用。新的治療方式為未來的補綴物打造更穩固的基礎。但往往還要與其他專科像是口腔外科、矯正科、根管治療科的密切配合才能達到治療的目的。牙周重症的患者無法光靠牙周病治療解決。咬合方面的疾病也需要一並處理才會有理想的結果但常常是被忽略的一環。只有詳細有系統性的檢查才能達到正確的診斷並提供最佳的預後。補綴物的完成是治療的最終目的，臨床醫師需將病人的需求，治療動機及經濟狀況充分的了解並與病患討論才能決定對病人最適合的治療計畫。本論文舉出10個牙周補綴病例報告。經過詳細的檢查及診斷後給予病患合適的治療計畫。治療過程遵守實證醫學及保守治療的原則,避免診斷不足,過度治療的問題發生。人工植牙的應用，使治療計畫變的簡單但卻又不失治療品質。牙周治療包括嚴謹的口腔清潔衛教、確實的牙齦下牙根整平術、組織再生手術、游離牙齦移植術及牙冠增長術。其他手術包括引導骨再生術、立即性植牙、鼻竇增高術及植體周圍炎的處理。最終的補綴設計包括傳統固定式義齒、雙重冠覆蓋式義齒、植體植入固定式義齒。經由專業性及整合性的牙周補綴治療，才能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、發音及美觀的要求。

關鍵字

人工植體；雙重冠覆蓋式義齒；鼻竇增高術；牙冠增長術

並列摘要

Severe periodontal destruction is characterized by severe bone loss, gingival recession, tooth loss, tooth mobility, pathological migration and pain. It is often accompanied by occlusal diseases such as altered plane of occlusion, tipping and elongation of teeth into edentulous areas and occlusal disturbances which lead to secondary trauma from occlusion. These pathological changes lead to loss of oral and social functions, esthetics, intimacy and even self esteem. Contemporary periodontal therapy is no longer just root planing and open flap surgery. Advances in surgical techniques and dental materials nourished guided tissue regeneration, guided bone regeneration, periodontal plastic surgery and lately the use of growth facors. New treatment protocols build a better foundation for future prosthetic rehabilitation. However interdisplinary collaboration with oral surgeons, orthodontists and endodontists may be required to achieve the final goal. Patients who suffered from severe periodontal destruction cannot be treated successfully with periodontal therapy alone. Occlusal diseases that accomplish tooth lost in periodontally compromised patients must be addressed however it is often overlooked. Thorough examination in an orderly manner assures accurate diagnoses and provide best treatment prognosis. Giving the patient an esthetic long lasting final prosthesis is the final goal of treatment. However the clinician need to understand the patient’s needs, desires, motivation, economic condition and discuss thoroughly each treatment modality before reaching the final treatment plan that best fit the patient. This thesis presents 10 patients with complex treatment needs. Thorough examinations were carried out to determine the diagnoses. Treatment plans were discussed extensively with patients to suit their needs. Treamtnets were carried out following the concept of “evidence based dentistry” and “conservative dentistry”to prevent under-diagnoses and over treatments. The use of dental implants simplified the treatment planning process yet did not lower the standard of care. Periodontal therapy includes meticulous oral hygiene instruction, thorough root planning, periodontal regeneration with resorbable membranes and growth factors, gingival grafting and crown lengthening. Other surgical treatments includes guided bone regeneration , immediate implants, sinus augmentation and periimplantitis managements. Final prostheses designs include conventional removable partial denture, double crown overdenture, implant supported fixed prostheses. Through integrated periodontal-prosthetic treatments providing the patient a healty, easily maintained oral condition. At the same time satisfy patient’s oral function including mastication, phonetics and esthetics.