牙周補綴於廣泛慢性牙周炎之考量與臨床應用

Consideration and clinical application of generalized chronic periodontitis in periodontal prosthesis- cases report

顧長順(Chang-Shun Ku)

指導教授 ： 李惠娥

高雄醫學大學/口腔醫學院/牙醫學研究所碩士在職專班/碩士(2007年)

https://doi.org/10.6832/KMU.2007.00102

摘要

美國賓州大學阿姆斯特丹教授於一九七四年提出 “牙周補綴” 的觀念。其定義為：牙周補綴係在嚴重牙周病治療中，所必須的復形與補綴；所應用的醫療觀念與技術，亦適用於正常齒列。牙周補綴的病患通常喪失了牙周組織，因而導致牙齦萎縮、搖動、病理性移位、前牙外展、後咬塌陷、空隙及牙齒延長等現象。所以需要協同各相關科，因此二十一世紀牙周補綴的治療，講究的是各專科合作的整合性治療，內容包涵：口腔診斷、牙體復形、根管治療、口外、矯正、補綴等的配合。

本文共收集九個病例，病患為中度至重度牙周炎，經過階段性完備的治療，再功能重建、恢復咬合、咀嚼及美觀。其中有簡單的，例如：結石刮除術、牙齦下刮除術及牙冠增長術；亦有較複雜的，例如：覆蓋式全口義齒併用磁性附連體、薄蓋冠之全口重建及處理植牙後遺症等。這些病例均屬牙周補綴的範疇，在治療前可先擬出數個治療計畫，與病患討論過後再依病情及實際需要選擇其一，接著進行系列的根管、牙周病、矯正及補綴等治療。

在作任何復形和補綴之前，應先控制好牙周炎及去除創傷性咬合。牙周炎的控制包括：手術式及非手術式。非手術式主要以超音波洗牙治療。就療效而言，Kaldahl於 1990年認為手術式在短期內雖可降低較多的囊袋深度；但長期看來，囊袋深度及臨床附著不管是手術式或非手術式並無太大差異。創傷性咬合之治療包括許多項目，例如：咬合調整、咬合板及splinting 等。

所收集的九個病例中，患者對於咀嚼、美觀均表滿意，發音則需一段時間適應，但都感覺值得。因此這可作為類似病例治療時之參考模式。進一步的追蹤、回診、定期檢查牙周組織及復形體之狀況是必要的，以維持良好的預後。

關鍵字

病理性移位 ； 外展 ； 咬合塌陷 ； 磁性附連體 ； 覆蓋式義齒併用薄蓋冠 ； 植牙 ； 超音波洗牙 ； 創傷性咬合

並列摘要

Dr. Amsterdam (U. Penn., 1974) defined periodontal prosthesis as “Those restorative prosthetic endeavors that are absolutely essential in the treatment of advanced periodontal disease. Whereas specifically it refers to the treatment of the dentition mutilated by the ravages of periodontal disease, in general, its concepts, principles and techniques may be employed in any restorative or tooth replacement service involving the nature dentition”. Periodontal prosthesis patients are usually described as loss of periodontim that results in gingival recession, mobility, pathologic migration, anterior teeth flare out, posterior bite collapse, spacing and elongation. It is necessary to establish multidisciplinay treatment modalities to manage these patients. Therefore twenty first century treatment is an integrated treatment which emphasizes on cooperation of different fields.
This report contains 9 cases with moderate to advanced periodontitis, treated with phased-in comprehensive care treatment plans, and restored articulation, chewing and esthetics. There are some simple cases like subgingival curettage and crown lengthening. There are also complicated cases such as full mouth periodontal treatment, occlusal rehabilitation, matching magnetic attachment with CSCTD or removable partial denture and how to manage problem due to implant. Making a good treatment plan is important. Various treatment plans offer the option of sequential therapy of endodontics, periodontics, orthodontics and prosthodontics.
It is important to control periodontitis and eliminate occlusal trauma before practice of any resoration and prosthesis. The control of periodontitis included surgical and nonsurgical therapy. Nonsurgical therapy primarily accompanied with ultrasonic scaling. According to the report of Kaldahl WB, Kalkwarf et al. in 1990, the short-term result of surgical therapy may reduce more probing depth than nonsurgical therapy; but there was no significant statistic difference for both probing depth and clinical attachment level in the long-term result. The therapy of occlusal trauma included many items such as occlusal adjustment, occlusal plate and splintitng.
All treatments done in these cases are effective so far in terms of satisfying patients’ needs for chewing, articulation and esthetics. Therefore all cases can be used as reference or similar treatments. Frequent hygiene recalls and prosthetic maintained are necessary to achieve a long-term prognosis.

並列關鍵字

pathologic migration ； flare out ； bite collapse ； magnetic attachment ； CSCTD ； implant ； ultrasonic scaling ； traumatic occlusion

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