牙周補綴臨床病例報告-以自然牙合併植體支持之Konus雙重套冠義齒為代表

Periodontal-prosthetic cases report-Represented by a case of teeth and implant supported Konus denture

蔡劼良(Chieh-Liang Tsai)

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(2013年)

https://doi.org/10.6832/KMU.2013.00114

摘要

根據賓州大學Dr. Amsterdam對「牙周補綴」所下的定義：『牙周補綴即在重症牙周病的治療當中，提供必要的復形與補綴。它是針對遭受牙周病嚴重破壞齒列的治療，然而它的基本概念、原理與技術同樣也適用在自然齒列的復形治療上』。牙周補綴學是跨學科整合性的牙科協同治療，它涵蓋了牙周病治療、復形補綴學、植體學、口腔外科、根管治療以及矯正治療等領域。牙周補綴學的治療對象主要是中重度牙周炎的患者，這類患者通常伴隨有缺牙、牙齒動搖、病理性移位、咬合創傷、咬合崩壞等問題。牙周補綴學的治療目標乃是在正確的診斷及嚴謹的治療計畫下，經由跨學科的協同治療，希望恢復牙齒及其周圍支持組織的生理外形及功能，進而改善患者的咀嚼、發音及美觀等長期的需求，以期達到全方位的治療目標。
本論文共提出九個牙周補綴的病例，其中男性三例，女性六例，分布年齡從35歲到60歲，平均年齡為49歲。治療時間由9個月至26個月，平均療程為16.1個月。總計完成全口重建六例，單顎重建一例，局部重建二例。治療方式乃依據病患之主訴，並衡量其牙周狀況、預後情形、經濟能力、人格特質等因素，制定牙周補綴治療計畫。治療內容除了基本牙周治療外，並配合各種牙周手術的進行，包括人工植牙手術、游離牙齦移植手術、牙根切除術、牙冠增長術等術式。而補綴物的設計方面，則應朝向減少牙菌斑堆積、降低咬合干擾、建立穩定的咬合關係、穩定動搖的牙齒、將咬合力平均分擔至各個支台齒減少咬合傷害為目標。補綴物的設計方面包括了雙重套冠可撤式義齒、磁性附連體覆蓋式義齒、精密附連體覆蓋式義齒、活動義齒合併精密附連體、植體支持之固定義齒、傳統固定式義齒等不同之補綴物的運用，希望能幫助患者恢復口腔健康，達到美觀與功能兼備的目標。

關鍵字

牙周補綴 ； 植牙 ； 全口重建 ； 咬合崩壞 ； 雙重套冠可撤式義齒

並列摘要

According to Dr. Amsterdam (1974), periodontal prosthesis is defined as『those restorative and prosthetic endeavors that are absolutely essential in the treatment of advanced periodontal disease. Whereas this specifically referred to the treatment of the dentition mutilated by the ravages of periodontal disease, in general, its basic concepts, principles and techniques may be effectively employed in the restoration of any tooth or teeth in the natural dentition.』Periodontal prosthetics is an interdisciplinary and integrated dental perspective treatment. It includes periodontal therapy, restorative-prosthodontics, implantology, oral surgery, endodontics and orthodontics. The treatment of periodontal prosthetics aim at patients with moderate to severe periodontitis. These patients’ symptoms commonly combined with missing tooth, tooth mobility, pathological migration, trauma from occlusion and bite collapse. Under proper diagnosis and strict treatment plan, the priority goal of periodontal prosthetics treatment is to reestablish the physiological form, function, and supporting structure of dentition ; furthermore, to fulfill the long-term satisfaction of chewing function, phonetics and esthetic demands of periodontal patients. In this thesis, there are 9 periodontal prosthetic treated cases were discussed, including 3 males and 6 females whose age ranging from 35 to 60 years old (mean 49 years old). The average therapeutic course consumed 16.1 months. In total, 6 patients had full mouth rehabilitation, 1 patient had full arch prosthetic reconstruction and the rest of 2 had partial reconstruction. Multidisciplinary treatment modalities were proposed to meet the patients need according to the chief complains, personality and financial capability. Besides the basic periodontal therapy, a variety of periodontal surgeries were performed which including dental implants, free gingival graft, root resection and crown lengthening. The treatment goal of prosthetic design should be able to decrease plaque accumulation, reduce occlusal interference, provide stable occlusion, stabilize mobile teeth and distribute occlusal force to all remaining abutment teeth. Different type of prosthetic designs including telescopic removable denture, magnet attachment retained overdenture, precision attachment retained denture, implant supported fixed partial denture and traditional fixed partial denture were proposed to achieve the oral health of the patient.

並列關鍵字

periodontal prosthesis ； dental implants ； full mouth reconstruction ； bite collapse ； telescopic denture

參考文獻

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