使用咬合、牙周與補綴綜合療法治療重症牙周炎 ∼ 長期追蹤之研究

A longitudinal study on the severely advanced periodontitis using the combined techniques of occlusal, periodontal and prosthetic therapy

黃上芳(Shang-Fang Huang)

指導教授 ： 蔡吉政 ； 侯桂林

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2004年)

摘要

摘 要
許多研究顯示單根牙的治療較為單純，手術或非手術的效果亦較佳，而有嚴重根叉病變的臼齒在長期的研究結果發現，因為其複雜的解剖形態且臨床上常沒有合適的器械進入根叉區域，故不論用手術或非手術性的牙周治療，長期追蹤治療的結果均未有良好的可預測性。
本研究主要目的是探討本院使用的咬合、牙周與補綴綜合療法(特稱為三明治療法)，用於治療重症牙周炎患者，以回溯性調查研究使用治療性過渡補綴物(therapeutic provisional prosthesis, TPP)以及CSC雙重冠假牙(crown and sleeve-coping telescopic denture, CSCTD)做為牙周治療中及治療後的補綴物時，長期觀察支台齒放射線齒槽骨高度變化情形與支台齒的成功率。
研究樣本取材自1980年至2003年間，在高雄醫學大學附設中和紀念醫院牙科門診牙周病科就診接受三明治療法的患者，有完整的標準平行法全口X光片攝影紀錄者26位，其中男、女性各13名，年齡分佈於38~78歲，平均54.77(±10.19)歲，以放大鏡將X光影像放大3.5倍，使用數位式電子游標測微尺(electronic digimatic caliper)測量支台齒近遠心的放射線齒槽骨高度(radiographic alveolar bone level, RABL)，並計算支台齒的成功率。
本研究結果如下：(1) 放射線齒槽骨高度經治療後有明顯改善。
(2) 垂直破壞型齒槽骨高度累計變化量及每年的變化量皆與原始齒槽骨高度有關，原始RABL越低者，治療後所獲得的改善越多；垂直破壞型齒槽骨高度累計變化量與每年變化量與治療期間長短無關，而每年的改變量在第一年時最多。 (3) 支台齒的成功率以下顎非臼齒最佳，其次是上顎非臼齒，再其次為下顎臼齒，成功率最差的是上顎臼齒。

關鍵字

CSC雙重冠假牙 ； 牙周炎 ； 數位式電子游標測微尺

並列摘要

Abstract
Many studies indicated that periodontal therapy for single-rooted teeth is simpler and had better prognosis. Long-term study reported that molar with furcation involvement didn’t have good predictability caused by complicated tooth morphology and poor access.
This study evaluated the effects of the combined techniques of occlusal, periodontal and prosthetic therapy which called as “Sandwich therapy” to treat the severely advanced periodontitis. This retrospective study investigated the change of radiographic alveolar bone level and successful rate of abutments.
Samples were pooled from patients accepted the sandwich therapy at the Department of Periodontitis, Kaohsiung Medical University Memorial Hospital. A total of 215 abutments consisted with 140 non-molar teeth and 75 molar teeth were treated by a well-trained senior periodontist. The mean age of patients is 54.77(±10.19) years old, ranged from38 to 78 years old. The mean observation period was 9.23(±3.75) years. We use the magnifier to incease the image 3.5 times and measured the radiographic alveolar bone level of abutments with electronic digimatic caliper. Besides, we calculated the successful rate of abutments.
The results revealed significant improved radiographic alveolar bone level after treatment. Cumulative and annual radiographic alveolar bone level changes of angular bony defects were related with initial radiographic alveolar bone levels but there were no relationship between cumulative and annual radiographic alveolar bone level changes and the treatment periods. The highest successful rate of abutments was the mandibular non-molar teeth (98.39%) followed by the maxillary non-molar teeth (95.00%), and the mandibular molars (93.33%); and was the lowest in the maxillary molars (79.07%).

並列關鍵字

electronic digimatic caliper ； periodontitis ； Crown and sleeve-coping telescopic denture

參考文獻

參考資料

Albandar JM., Rise J., Gjermo P., Johansen JR. (1986). Radiographic quantification of alveolar bone level changes. J Clin Periodontol. 13: 195-200.

Basten CH., Ammons WF., Jr., Persson R. (1996). Long-term evaluation of root-resected molars: a retrospective study. Int J Periodontics Restorative Dent. 16: 206-19.

Becker W., Becker BE., Berg L., et al. (1988). New attachment after treatment with root isolation procedures: report for treated Class III and Class II furcations and vertical osseous defects. Int J Periodontics Restorative Dent. 8: 9-23.

Becker W., Becker BE. (1990). Guided tissue regeneration for implants placed into extraction sockets and for implant dehiscences: surgical techniques and case report. Int J Periodontics Restorative Dent. 10: 376-91.