跨科整合性治療於嚴重牙周疾病患者之臨床運用

The Clinical Application of Interdisciplinary Treatment for Patients with Severe Periodontal Disease

陳俊榮(Chun-Jung Chen)

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(2012年)

摘要

中文摘要
牙周疾病為國人常見的疾病之一，儘管全民健保已提供定期全口洗牙及檢查的服務，然而大多數的人由於衛生習慣不正確加上害怕看牙醫的心態，以至於到門診求助時，往往齒列已經造成嚴重的破壞，而需牙周病學與補綴學的整合性治療。因為不同程度的牙周破壞，會影響到牙齒的動搖度、殘餘的牙周支持組織以及長期的預後情況，而這些都會影響到重要支台齒的選擇及義齒的設計，一旦設計不良，儘管牙周治療成功，對義齒長期而言可能還是會失敗，所以兩者之間有著密不可分的關係。
近年來由於人工植體學的快速發展，使得治療牙周補綴病患時有更多及更理想的治療計畫可以選擇，然而針對手術區域的術前評估與診斷卻也更顯得重要，因為不只齒槽骨的解剖構造，周邊的神經與血管組織的分布，會影響到植牙區可提供種植的骨質與骨量，而咬合的關係、牙齒的排列、相鄰牙齒的根尖病變等，更會關係到未來贋復物的成功率。
本論文提出九個案例，依據患者不同的牙周疾病嚴重程度、需求、經濟能力及身體狀況，訂定出合適的治療計畫之後，利用跨科整合性治療，包括牙周手術、矯正治療、鼻竇增高術、齒槽嵴增長術、植牙手術、牙冠增長術、根尖切除手術等，來達到回復美觀及發音、重建穩定的咬合功能及容易維持清潔的治療目標，再加上定期的回診維護，才能確保贋復物能獲得長期的成功。

關鍵字

牙周補綴 ； 人工植牙 ； 跨科整合性治療

並列摘要

Periodontal disease is one of the most common diseases in our country. Although the National Health Insurance provides full mouth scaling and oral examination services, most people still have a serious problem when they visit dentist mainly due to fear of dental treatment. Periodontal prosthesis will be needed at this time. Periodontal destruction will influence the mobility, remaining supporting tissue, and the long-term prognosis of a tooth. And these are the key factors for determining the key abutments. If the design of the prosthesis is not proper, the long-term prognosis of the restoration may fail even with a successful periodontal treatment. Therefore, the relationship between periodontics and prosthetics is very important.
Nowadays, treatment with dental implants is increasing dramatically. This trend offers more and better treatment options for patients who need periodontal prostheses. However, it is very important to have a precise pre-surgical evaluation and diagnosis. The anatomic structure of the jaw bone and the surrounding vital structures will influence the available bone quality and quantity. Furthermore, the occlusal relationship, the alignment of the dentition and the apical lesions of the neighboring teeth will also influence the outcome of the prosthesis.
Nine patients who need periodontal prostheses were included in the present clinical thesis. Treatment plan was decided according to the severity of the periodontal disease, the demands, the financial ability and the physical condition of the patients. The principle of multidisciplinary treatment planning was utilized in each case. Different treatment or operations were used, including orthodontic treatment, sinus floor elevation, ridge augmentation, implant surgery and apicoectomy to achieve the following goals: to restore the esthetics and phonetics, to re-establish a stable occlusal plane and to design prosthesis that is easy to keep oral hygiene. Also, with the periodic maintenance, the long-term success of the prosthesis can be accomplished.

並列關鍵字

periodontal prostheses ； dental implant ； multidisciplinary treatment planning

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