牙周補綴學臨床病例報告

Dr. Amsterdam對「牙周補綴」(Periodontal prosthesis)所下的定義為”那些在嚴重牙周疾病的治療中絕對必要的復形與補綴上的努力。”〝它是特別針對遭受牙周病多重破壞的齒列的治療，但其觀念、原則及技術也可引用在自然正常齒列的復形補綴治療上。〞前段話說明了在嚴重破壞的牙周環境中必須要達成的復形補綴治療，就好比在地基不穩固的一塊土地上必須要興建一座建築物，其所牽涉的人、地、事、時、物必須是要多方考量的，這些問題與在脆弱的牙周組織上做復形補綴物的情形並沒有兩樣。所以牙周補綴是一種多方面專業性的(Multidisciplinary),整合性(Integrated)的工程。至於後段話，筆者認為其引申的意義為－牙周補綴治療亦可當作一種預防性(Preventive)的治療，預防不好的情況發生，至少讓已經較差的環境不會變得更壞。本論文所提出之九個臨床病例，五位女性，四位男性，年齡從35至76歲，其病歷資料的收集包括患者歷史、臨床檢查、放射線檢查與研究模型四部份。臨床診斷大多為廣泛性或局部性慢性牙周炎，還有進行性牙周炎與局部牙齦增生。治療的方法大致分成緊急治療、初期治療(包括發炎疾病的治療與咬合治療)與再評估、第二期手術治療與再評估、第三期補綴治療及維護期。包括非手術性的牙周基本治療、根管治療、矯正治療與咬合治療；第二期手術治療包括牙周翻瓣手術、骨修整術、骨移植術或併用牙釉基質衍生物、牙冠增長術、牙根分離/切除術、根尖切除術、游離結締組織移植術與人工植體手術；第三期補綴治療則包含牙齒支持式固定義齒、粘著性牙橋、人工植體支持式固定義齒、傳統式部份活動義齒、磁性附連體合併薄蓋冠覆蓋義齒以及雙重冠合併薄蓋冠覆蓋\義齒。經過一系列的治療步驟，在各項牙周指數，囊袋探測深度與牙齒動搖度上皆有明顯的改善，對於補綴物的美觀、功能及舒適感也都感到滿意，惟大部份病例完成後之維護追蹤期尚不及半年，因此實際的成效尚待進一步的追蹤與評估。任何牙周補綴病例的治療都是要多方考量的，包括患者的特性，社會的環境，各專業醫師的訓練背景及思維模式，以及技工方面的配合，因此透過這種多方面專業性的，整合性的，以及預防性的治療方式才能夠帶給患者健康的牙周支持組織，穩定舒適的咬合和滿意的美觀與功能，更能增進其生活的品質與生命的意義(The quality of life)。

關鍵字

人工植體；牙釉基質衍生物；多方面專業治療；牙周補綴；雙重冠覆蓋義齒

並列摘要

Periodontal prosthesis, as the definition from Dr. Amsterdam, emphasizes the necessity of restorative prosthesis for the dentition with advanced periodontal disease. It seems to make a building on the land without strong foundation. We should have multidirectional consideration about the involvement of persons, places, affairs, time, and materials. It’s the same as we make a restorative prosthesis on a weak periodontal supporting tissue. That’s why we call the periodontal prosthesis a multidisciplinary approach. Also, from my view point in the inclusion of the definition, periodontal prosthesis can be used to prevent the periodontal tissue from becoming bad or, at least, no worse than bad. There are nine clinical cases in this study, including 5 females and 4 males, aged from 35 to 76. The data collection consists of patient history, clinical examination, radiographic examination and study cast. The clinical diagnosis includes generalized or localized chronic periodontitis in most cases, aggressive periodontitis and localized gingival enlargement. The treatment course consists of (1) preliminary therapy, (2) initial therapy including nonsurgical periodontal basic therapy and occlusal therapy, (3) reevaluation, (4) surgical therapy including periodontal flap surgery, bone grafting, application of enamel matrix derivative, crown lengthening, apicoectomy, free connective tissue graft and dental implant surgery, (5) reevaluation, (6) restorative therapy including tooth-supported fixed denture, adhesive bridge, implant-supported fixed denture, conventional removable partial denture and telescopic crown retained or magnetic attachment retained over- denture , and (7) maintenance phase . By the completion of treatment plan, the patients have marked improvements in the periodontal indices, probing pocked depth, and tooth mobility. They also satisfied with the esthetics, comfort, and function of their prostheses. Because most of these cases have been finished and followed for less than 6 months, the realistic effect of treatment should be monitored and evaluated for much longer. In the treatment for any periodontal prosthetic case, we have to consider multidirectionally about the patient’s characteristics, social environments, dentist’s training background and treatment philosophy, and the technician’s cooperation. By the multidisciplinary, integrated, and preventive approach of treatment, the patient may have healthy periodontal supporting tissue, stable occlusion, and satisfied esthetics and functions. Moreover, they may have improvement in the quality of life.