牙周補綴之病例報告 ─以牙周補綴支持療法、Könus雙重套冠系統重建重症牙周炎合併咬合崩壞為代表─

Periodontal Prosthesis： Report of 9 cases

鍾漢程(Han-Cheng Chung)

指導教授 ： 何坤炎

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(2019年)

https://doi.org/10.6832/KMU.2008.00133

摘要

美國賓州大學阿姆斯特丹教授於1974年首先定義＂牙周補綴＂一詞為“牙周補綴即是在嚴重牙周病治療當中，提供所需的復形與補綴，其所應用的醫療觀念、原則與技術，亦適用於自然齒列的補綴或牙齒的替換”1。然而牙周補綴患者常因牙周組織的破壞而造成咬合不穩定及牙齒的病理性傾斜、移位，造成其齒列狀況與正常齒列有所不同，例如：牙齒的病理性移位、咬合不協調、牙齦萎縮、多處缺牙、咬合性創傷引起牙齒過度動搖…等症狀，因而更提升義齒贋復的難度性2。所以＂牙周補綴＂是一門結合牙周病治療、牙體復形、根管治療、齒顎矯正、口腔外科及義齒贋復等統合各科的全方位治療。
本文提出十例病例報告，患者由牙齦炎至重度牙周炎，而經過各階段治療及評估，在手術方面包含了牙周手術、牙根分割術、牙冠增長術、游離牙齦移植術、引導組織再生術、局部齒列矯正、人工植牙…等，且配合患者實際需求，考量了病人的個別因素，包括經濟及人格特質，基於牙周補綴的觀念，而制定各種不同的治療計劃。補綴的方式，從簡單的固定義齒、可撤式有鉤靠式活動義齒、覆蓋式義齒到複雜的雙重冠義齒，甚至人工植牙，這都是依患者的不同而有所改變，最後還要加上患者良好的維護及定期回診，才能確保牙周補綴的良好預後。由於筆者的知識與經驗都還不足，而所有的病例之治療過程及方式都仍有許多值得討論與改進空間，且追蹤時間並不長久，這些病例的穩定性應仍待進一步的觀察。

關鍵字

牙周補綴支持性治療 ； 雙重冠補綴物 ； 咬合崩壞 ； 根叉病變

並列摘要

In 1974, Dr. Amsterdam(the professor of Pennsylvania University) pointed out “periodontal prosthesis＂ and defined it 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.＂However, periodontal prosthesis patients are characterized by loss of periodontium that usually results in unstable occlusion, and pathologic tilting, migration, occlusal discrepancy, gingival recession, multiple missing oh the teeth, tooth mobility caused by occlusal trauma...etc. It is such different from normal dentition, therefore, it is complicated to reconstruct the edentulous area in patients with severe destruction of periodontal apparatus. Therefore, periodontal prosthesis covers a wide spectrum of techniques from periodontal treatment, operative dentistry, endodontic therapy, orthodontics to oral surgery and prosthodontics.
This paper presents 10 cases with gingivitis to advanced periodontitis. The periodontal treatments of these cases include various periodontal surgeries, such as flap operation, root resection, crown lengthening procedure, gingival augmentation , GTR and implants. The final prosthesis design depends on individual situation including economic condition and personality, from simple fixed bridge, clasp retained RPD to complex removable prosthesis, such as Könus telescopic denture, tooth supported overdenture and implant. And the most important things for patients would be keeping good oral hygiene and periodontal recall visit by doctors after prosthesis delivery to make sure the prognosis.
Owing to limitation knowledge and experience, the longterm results must be observed.

並列關鍵字

periodontal–prosthodontic supportive treatment ； telescopic prosthesis ； bite collapse ； furcation involvement ； crown lengthening procedure

參考文獻

1. Amsterdam M. Periodontal prosthesis: Twenty-five years inretrospect. Alpha Omegan 1974; 12-13.

2. Stahl SS. Marginal lesion. In: Goldman HM, Cohen DW., ed: Periodontal Therapy, 4 ed. St. Louis: Mosby; 1968: 120-121.

3. Flemmig TF. Periodontitis. Ann Periodontol 1999; 4(1): 32-38.

4. Nyman S, Lindhe J. Examination of patients with periodontal disease. In: Lindhe J, Lang NP, Karring T (eds). Clinical Periodontal and Implant Dentistry. 4th Ed. Munksgaard: Blackwell Publishing Co.,2003: 403-413.

5. Hamp SE.,Nyman,S.,Lindhe J. Periodontal treatment of multirooted teeth. Result after 5 years. J Clin Periodontol 1975; 2: 126-135.