牙周補綴應用於咬合崩壞之全口重建 --- 病例報告與討論

Oral Rehabilitation Using Periodontal Prostheses in Patients with Bite Collapse - Cases Report and Discussion

賴麗收(Li-Shou Lai)

指導教授 ： 王震乾

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(2010年)

https://doi.org/10.6832/KMU.2010.00163

摘要

牙周補綴病患常因牙周組織的破壞，而造成有咬合不穩定及牙齒的病理性傾斜、移位的特徵，更因多處缺牙，失去咬合支持後，常造成咬合崩壞，因此需全口重建以恢復功能。但是因為殘存牙齒可能已因牙周破壞而齒槽骨支持不足，牙冠/牙根比不良，或是牙位分布不佳，因此牙周補綴不同於一般補綴，且相當困難。牙周補綴物若設計不當，很可能造成支台齒進一步破壞，或是補綴效果不佳。因此在咬合崩壞之患者利用牙周補綴全口重建，相當複雜而困難，必需結合牙周病治療、牙體復形、根管治療、齒顎矯正、口腔外科及義齒贋復等統合各科的全方位治療。
本論文提出十例病例報告，病患為中度至重度牙周炎，殘存齒數少，牙位分布不佳，均為交錯咬合且咬合崩壞的案例，依病患個別全身性身體狀況、口腔衛生維持能力、殘存牙齒狀況、經濟能力、時間配合度、患者意願等因素考量，除了牙周基本治療外，分別以各種不同手術治療方式，包括牙根切除術、游離牙齦移植術、牙冠增長術、齒槽骨成形術、牙科植體種植手術等。而補綴設計目標是希望能達到減少牙菌斑堆積，減少咬合干擾，提供穩定咬合，均勻分散咬合力於支台齒上減少傷害。包括雙重套冠式可撤義齒、植體輔助雙重套冠式可撤義齒、全顎覆蓋式義齒、析量固定式牙冠牙橋、鉤靠式可撤局部義齒等不同設計予以全口重建，以建立適當穩定的咬合，提供咀嚼功能，避免繼續傷害殘存組織，並利於長期牙周維護，長期定期追蹤維護很重要，以保持口腔衛生並得到長期的成功。

關鍵字

牙周補綴 ； 咬合崩壞 ； 雙重套冠義齒 ； 牙科種植體 ； 可撤式義齒

並列摘要

Periodontal prostheses patients are characterized by unstable occlusion, pathologic tilting, migration , and occlusal discrepancy that usually results in loss of periodontal supporting tissue. Caused by multiple missing of the teeth and loss of occlusal support, bite collapse were usually found in periodontal compromised patients, and needed to full mouth reconstruction. It is such different and difficult than normal dentition, caused by insufficient alveolar bone support, unfavorable crown/root ratio and abutments distribution. If the design of prostheses were unfavorable, it may be caused to damage abutment teeth and uncomfortable restoration. Therefore, it is complicated to reconstruct the edentulous areas with severe destruction of periodontal apparatus or bite collapse patients. The periodontal prostheses treatment must be combined with periodontal treatment, operative dentistry, endodontic therapy, orthodontics to oral surgery and prosthodontics. In this thesis presents 10 cases with moderate to advanced periodontitis, a few teeth were remained and bite collapse due to loss of occlusal vertical stop. Used different operations to treat these patients according to patient’s systemic condition, oral hygiene ability, remain teeth situation, economic consideration, treatment course and patient’s motivation, such as root resection, free gingival graft, crown- lengthening procedure, alveoloplasty, and dental implants. Based to the concepts of periodontal prosthesis, the treatment goals of the prosthesis design should be decreased plaque deposition, improved occlusal interferences, provided stable occlusion, and distribution occlusal force to all abutment teeth. Included different type design of prostheses to full mouth reconstruction these patients, such as telescopic removable dentures, implants assisted telescopic removable dentures, full arch overdentures, surveying crown and bridges, conventional clasps removable partial dentures. To provide stable occlusion, chewing function, prevent continuity traumatized to remain structure and ease to periodontal maintenance. Long-term follow-up and maintenance to are important to keep good oral hygiene and provide long term success.

並列關鍵字

periodontal prostheses ； bite collapse ； telescopic dentures ； dental implants ； removable dentures

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