牙周補綴病例報告¬咬合崩壞之全口重建(代表病例)

Case Reports of Periodontal Prosthesis--Full Mouth Reconstruction to Bite Collapse, Represented

陳玉甄(Yu-Chen Chen)

指導教授 ： 吳逸民

高雄醫學大學/口腔醫學院/口腔衛生學系碩士在職專班/碩士(2014年)

https://doi.org/10.6832/KMU.2014.00065

摘要

牙周病的患者，常因牙周附連組織喪失、牙齒動搖而被拔除，由於剩餘牙齒病理性移位、牙冠牙根比例不佳、牙齒過度萌發，進而導致咬合崩塌等種種問題。因此必需跨科整合牙周病科、根管治療科、矯正科、口腔外科、與補綴科的意見，同時還需考慮病人臨床上的主訴、評估其身體健康狀況、經濟能力、甚至人格特質，以及生活習慣和口腔衛生狀況，最後才能訂立最適合病人需求的治療計畫。
本文提出十個牙周補綴病例，利用各種不同的設計與方法，如矯正、牙根切除(RSR,root resection)、游離牙齦移植術(FGG,free gingival graft)、結締組織移植術(CTG, connective tissue graft)、牙冠增長術 (CLP,crown lengthening procedure)、齒槽骨整形術(alveoplasty)、引導骨再生(GBR,guide bone regeneration)、人工植牙手術(implant surgery)、鼻竇增高術(sinus lifting)、側窗開孔鼻竇增高術(open window sinus lifting)、根尖置位翻瓣手術(APF,apically positioned flap)、撐骨手術、雙重套冠可撤式義齒(CSC telescope denture， Konus telescope denture)、固定式牙冠牙橋、定位器(kerator)輔助全口覆蓋式義齒。其中七例以人工植體來進行重建，其中三例配合使用不同的再生膜來進行引導骨再生。
人工植體因為表面處理的進步，使得骨整合時間大幅縮短。新式鼻竇增高器械的發明也改進鼻竇增高術之術式，減少傷口範圍及術中出血、術後腫痛，配合植體plateform加大0.2mm的設計，可以同時完成鼻竇增高與植牙手術，以往分二次手術至少需要等6-9個月，現在甚至可立即受力。另外植體周圍炎也是近來熱門的課題，其處理方法也在文中一併討論。

關鍵字

牙周補綴 ； 咬合崩塌 ； 植牙 ； 鼻竇增高術 ； 全口重建

並列摘要

Patients with periodontal disease, tooth is unplugged most often due to loss of periodontal tissue attachment and severe mobility, furthermore, the pathological migration of remaining teeth, the poor crown/ root ratio, and supra-eruption of teeth, even leading to bite collapse and other problems. Except for the necessity of the opinions integration between Periodontology, Endodontics, Orthodontics, Oral Surgery, and Prosthodontics interdisciplinary, the patient’s chief complaints, clinically assess of the physical health, economic capacity, living habits, oral health status and even personality traits are need to be considered to provide the most suitable treatment plan to fit the needs of the patient.
This paper presents ten perio-prosthodontic cases, using a variety of different designs and methods, such as correction, root resection (RSR), free gingival graft (FGG), crown lengthening procedure (CLP), alveolar bone plastic surgery, guided bone regeneration (GBR), dental implant surgery, sinus augmentation, open window sinus lifting, apically positioned flap( APF), supporting bone surgery, telescope denture (CSC telescope denture, Konus telescope denture), fixed crowns and bridges, locators (kerator) auxiliary overdenture. Of which seven cases with dental implants for reconstruction (case1,2,6,7,8,9,10) Three cases (case 1,2,7) using different regeneration membrane for guided bone regeneration GBR.
Because the progress of surface treatment of dental implant such that the
osseointegration time is considerably reduced. The invention of new instruments improves the procedure of sinus augmentation, reduce the scope and bleeding wounds, postoperative pain. When combined with the implant plateform increase 0.2mm design, dental implant can be done simultaneously with sinus augmentation which in the past the two surgery need to wait at least 6-9 months in between, and now even immediately loading could be performed. Since inflammation around the implant is also hot topic recently, treatment methods are also discussed in the paper.

並列關鍵字

periodontal prosthesis ； bite collapse ； implant ； sinus lifting ； full mouth reconstruction

參考文獻

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