使用牙周補綴咬合療法治療嚴重根叉侵犯大臼齒在牙齒搖動度與咬合傷害的研究

A Clinical Study of Molars with Advanced Furcation Involvements Using Periodontal, Prosthetic and Occlusal Therapy-Tooth Mobility and Trauma from Occlusion

黃志成(Chich-Cheng Huang) ； 洪純正(Chuan-Cheng Hung) ； 陳正慧(Jen-Huey Chen) ； 洪怡育(Yi-Yuh Hong) ； 李珮瑜(Pei-Yu Li) ； 歐陽玲(Ling Auyeung) ； 蔡吉政(Chi-Cheng Tsai) ； 候桂林(Guey-Lin Hou)

《中華民國牙周病醫學會雜誌》 9卷4期 (2004/12) Pp. 269-281

摘要

本研究主要目的是以治療性過渡補綴物(therapeutic provisional prosthesis，TPP)、牙根分離或切除術(root separation and/or resection，RSR)合併的牙周補綴咬合療法(periodontal，prosthetic and occlusal therapy)，應用在重症牙周炎(severely advanced periodontitis，SAP)患者併有咬合創傷(trauma from occlusion，TFO)之大臼齒區牙周、補綴與咬合治療的方式，以評估治療嚴重牙周炎之大臼牙齒齒搖動與咬合傷害的臨床效果。實驗樣本均取材自2001年8月至2003年4月間，在教學醫院牙科門診部牙周病科就診之患者中，經過全口牙周參數評估後，依本院之診斷方式，診斷出有嚴重第二、三級根叉侵犯(Classes Ⅱ，Ⅲ)之大臼齒之患者經牙周病第一階段治療後仍維持有第二級以上根叉侵犯的患齒，在31名病患中，共50顆大臼齒（上顎37顆，下顎13顆），有17顆大臼齒未接受牙根分離∕分開術，僅完成牙周第一階段治療且定期回診則歸類爲對照組。而之中有33顆大臼齒接受牙根分離∕切開術，並製做25副治療性過渡補綴物（上顎18副，下顎7副）則歸類爲實驗組，平均治療時間14.8±2.0月（從12到18個月）。二組患者均記錄其牙菌斑指數，牙齦指數，牙周囊袋探測深度，牙周附連水平，動搖度及有無咬合傷害。本研究的結果顯示實驗組根叉侵犯區牙齒動搖度與咬合傷害有明顯改善。實驗組在根叉侵犯區的牙齒動搖及咬合傷害部分的改善效果顯顯優於對照組。可見在嚴重牙周炎患者合併有第二級根叉侵犯以上大臼齒以牙根分開或切除術治療合併治療性過渡補綴物在臨床上治療牙齒搖動與咬合傷害可獲得良好之改善效果。

關鍵字

根叉病變 ； 牙根分離∕切除術 ； 治療性過渡補綴物 ； 非手術牙周治療

並列摘要

The purpose of this study was to investigate the differences in teeth mobility and trauma from occlusion of molar abutment with or without molar roots separation and/or resection (RSR) before and after periodontal and prosthetic therapy in severely advanced periodontitis (SAP) combined with trauma from occlusion (TFO), using a removable therapeutic provisional prosthesis (TPP).
Samples were pooled from patients with advanced Class Ⅱ or Class Ⅲ molar furcation involvement treated at the Department of Periodontics of teaching Hospital. A total of 50 abutments consisted of 37 maxillary and 13 mandibular molars, were treated in 31 individuals. There were 17 abutments without root separation/resection and 33 abutments with RSR. Twenty-five TPPs were placed, 18 in the maxillary arch and 7 in the mandibular arch. The mean observation period was 14.8±2.0 months (ranged from, 12 to 18 months). The clinical parameters including plaque index (PII), gingival index (GI), probing pocket depth (PPD), probing attachment level (PAL), and tooh mobility (M) were recorded. The differences in these parameters before and after periodontal and prosthetic therapy in the advanced furcation-involved molars with and without RSR were evaluated. The results revealed a remarked significant improvement in the associated with teeth mobility as trauma from occlusion in advanced Class Ⅱ and Class Ⅲ FI molars with RSR combined with TPP as compared to those without RSR and NSPT in conjunction with a specifically designed TPP provide a significant improvement in teeth mobility and trauma from occlusion.

並列關鍵字

molar furcation involvement ； roots separation and/or resection (RSR) ； non-surgical periodontal therapy (NSPT) ； therapeutic provisional prosthesis (TPP)