牙周補綴之病例報告-以植體及牙周補綴支持性療法治療全口牙周炎

Periodontal-prosthetic Rehabilitated Cases Report-Treating Periodontal Patients by Implant and Perio-proshotontic Supportive Treatment

黃雁玲(Yen-Ling Huang)

指導教授 ： 何坤炎

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(2010年)

https://doi.org/10.6832/KMU.2010.00083

摘要

在治療嚴重牙周病患者時，常見有缺牙、牙周附連喪失造成牙齦萎縮伴隨有牙冠牙根比例不良、病理性移位、咬合不協調或不美觀等問題產生。Dr. Amsterdam 提出牙周補綴治療概念，在正確的診斷為前提下，整合牙周病治療、根管治療、口腔外科、矯正和補綴治療，以達到理想的效果。基於此理念運用覆蓋式可撤式義齒的設計，其提供了除傳統鉤靠式可撤式義齒外另一種治療方式，此設計的優點在於提供了跨弓式的固定效應並使咬合力量平均分配，同時利用剩餘自然牙，減輕牙床的過度受力，降低齒槽骨吸收速度，同時亦提高義齒的穩定度、固位性以及支持性。植體日新月異的發展，以及穩定的成功率，讓牙周補綴計畫中可加入支台齒，解決僅用自然牙常有的支台齒位置分配不佳的限制。覆蓋式可撤式義齒運用自然牙或植體，搭配不同的附連體，更可大大提升義齒固位性和穩定性。
本文提出九個案例，分別運用植體和覆蓋式可撤式義齒搭配磁性附連體、套疊式附連體或桿夾式附連體等完成重建。其中病例一、三、七、八和九利用植體製作固定式義齒，病例二、三、四、五和六為覆蓋式可撤式義齒，病例二和病例四利用磁性附連體，病例三和病例五運用套疊式附連體，病例六則是利用桿夾式附連體提升全口無牙固位效果。治療過程中搭配使用的手術方式有齒槽骨嵴保存術、牙周膜翻瓣手術、上顎竇增高術和蒂狀移植。
然而這些複雜的治療能夠有最佳的預後，最重要是正確診斷和補綴物設計以及患者的配合和心態的改變，唯有用心的執行口腔清潔，並且定期回診維護，才能有長遠的成功。

關鍵字

牙周補綴支持性治療 ； 覆蓋式義齒 ； 人工植體 ； 磁性附連體 ； 套疊式附連體

並列摘要

In treating patients with periodontal diseases, there are many problems such as missing teeth, attachment loss, gingival recession, poor crown/root ratio, pathological tooth migration, disharmony occlusion or even unaesthetic appearance. Dr. Amsterdam told us we could only treat successfully basing on correct diagnosis. Periodontal-prosthetics is an integrated dental therapeutic discipline by means of combined periodontal, endodontic, orthodontic, prosthodontic therapy and oral surgery. According to the concept, for instance, the design of overdenture provides another treatment modality besides the traditional removable partial denture with clasps on it. It takes the advantages of cross-arch splinting effect and directs the occlusal force to spread to all abutments evenly. The concept of rigid support can help to relief the overload of the denture bearing area and to decrease the resorption of alveolar ridge. It also improves the stability, support and retention of the denture. As dental implants develop speedily and provide stable success rate, we can add implants as additional abutments. Because the remaining teeth are not always in favor distribution, we can solve this problem with dental implants now. Overdentures could be supported either by roots or by implants. The retention and stability could be enhanced by precision attachments.
This clinical thesis includes 9 periodontal-prosthetic cases rehabilitated by implants or overdentures combined with magnets, telescopic crowns or bar and clips. We restored with implant-supported fixed partial denture including case 1, 3, 7, 8, and 9. And in case 2, 3, 4, 5, and 6, we rehabilitated with overdentures. In case 2 and case 4, we use magnets；in case 3 and case 5, we use telescopic crowns. We use bar and clips combined with overdenture to improve retention of full mouth edentulous patient in case 6. We also treated by surgery including ridge preservation, flap operation, sinus lifting, and pedicle graft.
Hoping good prognosis of all these complicated treatments, it’s prerequisite to have correct diagnosis, proper design of prosthethesis, motivation and to keep good oral hygiene for patients. Only continuing maintenance and good oral hygiene can lead to long-term success.

並列關鍵字

Perio-prosthodontic supportive treatment ； overdenture ； implant ； magnet ； telescopic crown

參考文獻

1. Amsterdam M. Periodontal prosthesis. Twenty-five years in retrospect. Alpha Omegan 1974;67(3):8-52.

2. Loe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol 1967;38(6):Suppl:610-6.

3. Flemmig TF. Periodontitis. Ann Periodontol 1999;4(1):32-8.

4. Miller S. Textbook of Periodontia. Philadelphia: Blackstone; 1950.

5. Hamp SE, Nyman S, Lindhe J. Periodontal treatment of multirooted teeth. Results after 5 years. J Clin Periodontol 1975;2(3):126-35.