牙周炎合併夜間磨牙：運用引導組織再生及咬合治療之病例報告

本報告係對有夜間磨牙病史，且有嚴重牙周破壞，患齒經咬合治療及組織導引再生術後，治療成功病例報告。患者為28歲女性，主訴右上犬齒牙齦腫痛約一月；檢查發現牙周附連嚴重喪失，有一放射性陰影延伸至根尖1/3，咬合面明顯磨耗，下顎右側方運動時該牙雖先接觸，但因搖動位移後呈群體功能性咬合。該齒與第一小臼齒間呈開放接觸，但患者描述以前並不存在。且齒頸部有一非齲性第五級窩洞。患者自述有夜間磨牙的習慣，但否認有其他全身性疾病。臨床診斷為嚴重牙周炎並伴有病理性位移，病因可能包括牙菌斑及咬合性傷害。經咬合調整、製作咬合板及施行牙周引導組織再生術及合併使用冷凍脫鈣乾燥骨粉後，追蹤壹年，牙周健康狀況明顯改善。臨床附連組織平均獲得了4.4mm（最多達9mm）、探測深度降為3mm、動搖程度由術前Ⅱ級進步至0級、牙齦萎縮並不明顯。原X光片陰影消失，且根尖齒槽骨板完整及緻密。雖然咬合傷害及炎性反應所造成牙周傷害已有廣泛深入之研究，但臨床上之分析與診斷，卻十分困難及深受限制。文獻中鮮少有夜間磨牙之組織再生病例，因此將該病例之臨床發現、檢查、診斷、治療及追蹤結果詳述報告，以供類似病例治療之參考。

關鍵字

夜間磨牙；咬合板；引導組織再生；咬合性傷害

並列摘要

Purpose of the report was to describe our tasks, the guided tissue regeneration and occlusal therapy, in saving a severely periodontal destructive tooth in a case with bruxism history. A 28 years old female, complained gingival swelling and toothache over upper right canine area for a month. Through detailed examinations, severe periodontal attachment loss around the canine was noted. X-ray showed a radiolucent shadow extended to apical one third of the root. An obvious occlusal attrition and a cervical non-carious class V cavity were found on the lesion tooth. During the lateral movement to right side, the canine initially contacted with opposite tooth, followed by group function occlusion. Open contact between first premolar and the canine was developed. Patient had bruxism history and denied any other systemic disease. The canine was diagnosed as severe periodontitis combined with pathological migration due to plaque retention and the traumatic occlusion. Occlusal bite plate was delivered, after the gross occlusal adjustment. Guided tissue regeneration (GTR) surgery combined with demineralized freeze dried bone allograft was also performed. A year later, obviously improved periodontal conditions: average 4.4mm clinical attachment gain and 3mm probing depth were obtained without obvious gingiva recession. Grade II tooth mobility was also reduced to 0. However, the gingiva recession was not obvious. The radiolucent shadow was disappeared and the lamina dura was integrated. Although the bacterial plaque and occlusal trauma have been contributed to be the etiologies of the progress of periodontal destruction, the accurate methodology in diagnosis is still limited and difficult. Because GTR treatment in the case with bruxism has been seldom well described, we reported a case and discussed the clinical findings, examination, conflicts, diagnosis, treatment, and results in detail in order to be the reference of successful treatment similar case.

並列關鍵字

Bruxism ； Occlusal bite plate ； Guided tissue regeneration ； Occlusal trauma

國際替代計量

牙周炎合併夜間磨牙：運用引導組織再生及咬合治療之病例報告

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