以人工植牙重建缺牙區咬合病例報告及討論

臨床上應用人工植牙做缺牙區的贋復。始於1964年Brane mark 的下顎植體支持性活動全口義齒。隨著人工植牙技術的推廣，逐步在1990年後推廣到局部缺牙與單顆缺牙的贋復。本文以十一個病例探討植牙的限制因素。從患者的全身性狀況談起，包括年齡太高或年紀太小，或有全身性疾病者，如：糖尿病、高血壓等，對於植牙的成功率是否有影響。繼而談到植牙區骨頭的質與量，是否會影響植牙的成敗。舉放射線治療過的植牙患者為例，說明骨質可能變化時，植牙的狀況。另外也舉，欲植牙而骨量不足時為例，說明配合鼻竇腔側開窗術及DFDBA人工骨粉移植等引導骨(組織)再生技術，來解決植牙區骨量不足時的問題，做為探討。最後強調人工植牙必須在牙周病治療穩定後，有術前完整的檢查診斷，術中小心慎行，配合術後定期回診追蹤診察，始能有效提高植牙的成功率與存活率。

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並列摘要

Clinical application with dental implants for lost teeth originated from Dr. Branemark in 1964. He restored an edentulous lower jaw case with a removable complete denture supported by dental implants. Today, due to the progress in technique and materials we are able to restore partial edentulous case and full edentulous case with fixed restorations. This thesis presented 11 cases and discussed the limiting factors in clinical application of dental implants. Systemic conditions such as diabetes mellitus and hypertension are frequently encountered in clinical application, we presented the management of such cases. The quality and quantity of bone over implant site may affect the success rate of implant integration. This thesis also included a case of implant placement in a patient who had a malignant mixed tumor of parotid gland surgically removed and underwent full term radiation therapy 1 year prior to implantation. Fixtures were placed in patient’s upper and lower jaws, we have the one and half year follow up report on the 5 implants. To treat insufficient bone level in posterior maxilla is challenging. A case was treated by sinus lifting through lateral window technique and placing DFDBA in the sinus. Interestingly enough, the case showed both success and failure as one of the three placed implants failed integration and dropped out. Final restoration was still achieved as the remaining 2 implants were successfully integrated. It is also important of to have proper diagnosis and through treatment of periodontal conditions prior to implant placement. Only with the comprehensive diagnosis and treatment plan, meticulous operation techniques, and close follow- up post implant loading can insure high success rate for implants.