雙重冠應用於牙周患齒之跨弓固定贋復－一病例報告

Telescope Crowns Applied in Cross-arch Splinting of Periodontally Compromised Dentition- a Case Report

林文明(Wen-Ming Lin) ； 沈裕福(Yu-Fu Shen) ； 陳朝寶(Chiu-Po Chan)

《中華民國牙周病醫學會雜誌》 2卷1期 (1997/03) Pp. 17-22

https://doi.org/10.6121/CJP.199703_2(1).0003

摘要

近二十年來，牙周贗復的觀念已漸被重視，利用跨弓固定法（cross arch splinting）可使牙周病患齒得以減低動搖度並增進咀嚼能力。然而牙周病患齒之跨弓固定，臨床上有潛在的問題：任何固定式之固位體（retainer），於固定多顆不同動搖度之牙周病患齒時，可能發生部份固位體與支台齒間黏著劑崩解，造成繼發性齲齒。雙重冠技術提供了內外冠間所需之固持，內冠亦可保護支台齒，免於黏著劑崩解（cement failure）。一37歲男性患者主訴上顎固定假牙斷裂鬆脫，欲重做義齒。臨床發現上顎僅剩5顆支台齒，下顎則尚有小臼齒前之10顆牙齒，就診時咬合關係已不可知。由於患者因故無法適應活動義齒，故決定以跨弓固定法加上雙重冠技術予以贗復。初期治療以暫用牙橋試戴半年，待取得可接受之咬合關係後，製作支台當上之內冠，再以外冠併固定牙橋予以贗復。經過16個月使用期間，病患使用情形良好。此方法或可做為另一種牙周患齒固定贗復之選擇。

關鍵字

雙重冠 ； 跨弓固定

並列摘要

Periodontal-prosthodontic rehabilitation has been given more attention in these two decades. It has been reported that patients with advanced periodontitis treated by cross-arch splinting may have decrease of tooth mobility and enhance-ment of chewing ability. Long-term follow-up has supported the statement. However, there is a problem: when fixed retainer which connects several abutments with different mobility is cemented permently, cement failure and secondary caries may occur in one or more abutments. Inner coppings of telescope crowns protect abutments from cement failure in cemented fixed prosthesis. This case report presents a 37 year-old male patient who visited our dental clinic for fixed bridge reconstruction. He had broken and lost his upper old bridge. Clinical examination and radiographic findings revealed only five teeth in upper arch. These abutments had been invaded by moderate periodontitis. There were ten healthy teeth over lower arch with all molars missing. After general dental treatment, a provisional upper cross-arch bridge was inserted for about six months. During this initial treatment, ocdusal adjustment and plaque control were performed. Accepted occlusal relationship were then recorded and transfered to permanent prosthesis. Finally, machine-milled inner crowns were cemented permanently on five upper abutments and cross-arch bridge was set temporarily with zinc-oxide eugenol cement. Sixteen months follow-up showed good retention of prosthesis, well maintained periodontal conditions, and satisfied chewing ability.

並列關鍵字

Telescope crown ； cross-arch splint