牙周補綴之通盤考量與臨床應用

General consideration and clinical application in periodontal prosthesis-clinical cases report

許朝隆(Chao-Lung Hsu)

指導教授 ： 蔡吉政

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2007年)

https://doi.org/10.6832/KMU.2007.00094

摘要

現今的牙科治療已經走入跨專科治療，亦即講求各專科通力合作的整合性治療。凡是由口腔診斷、牙體復形、牙髓治療、牙周治療、口腔外科到矯正以及補綴治療等，乃至牙科技工上的配合，都應屬於牙周補綴的範疇。『牙周補綴』一詞依1974年Amsterdam所下的定義為:「應用在嚴重牙周疾病的治療當中，不可或缺的復形與補綴」。在重度牙周侵犯的齒列中，因深度牙周囊袋、牙齒搖動及缺牙經常引起牙齒病理性位移，咬合關係位置偏位、後牙咬合塌陷以及顳顎關節症狀。
基本上牙科治療除了要滿足病患對外在美觀的需求外，同時也要兼顧內在牙周環境的穩固，就如同完美的建築物必定要地基的基本厚實，當最終補綴物的開始建置時需建立於牙周的健全。由於牙周疾病致病菌毒素的種類對牙周組織會產生不同程度的破壞，而每個人對罹患牙周病的感受性亦不同，牙醫師必須考量患者的人格特質，經濟能力、治療方法的差異性與患者溝通選擇最合適的治療計畫。
本臨床病例報告十個案例裡，有簡單的單顆牙齒缺失而運用植牙立即負擔的幫忙來完成補綴治療；有複雜的全口牙周治療與咬合重建，配合矯正治療，加上雙重套薄蓋冠系統或彈性活動假牙的補綴物製作；也有運用植牙的幫忙來完成補綴治療。所有案例均為牙周補綴的一部分，經由專業性及整合性的牙周補綴治療才能為患者提供健康的牙周環境，以方便口腔衛生的維護。這些病例包括女性八名，男性二名，年齡分佈介於37至72歲(平均年齡54.3歲)平均療程為15.6個月(6個月至27個月)目前所有案例的病患均能滿足對咀嚼、發音與美觀的要求，然而能夠有多久的使用年限，長期的追蹤，定期複診是必要的。

關鍵字:牙周補綴、後牙咬合塌陷、雙重套冠系統、植牙

關鍵字

牙周補綴 ； 後牙咬合塌陷 ； 雙重套冠系統 ； 植牙

並列摘要

New-aged dental treatment has entered cross many specialties, namely strive for the integratness of giving full cooperative treatments. All answers share, oral diagnostic, operative, endodontic, periodontal treatment, oral surgical , orthodontic, prosthodontics, and support from dental technicians should be included. Dr. Amsterdam (University of Pennsylvania, 1974) shared the same view. He defined periodontal prosthesis as“Those restorative prosthetic endeavors are absolutely essential in the treatment of advanced periodontal disease”.
Periodontal compromised dentitions involved deep pocket depth, tooth mobility, missing teeth, which could lead to the pathological migration, central relation discrepancy, posterior bite collapse and temporomandibular joint dysfunction syndrome.
Basically, the dental therapy is not only to provide the esthetics but also to stabilize the supporting structures. Like a perfect building, it must have a solid base. The final prosthesis should be constructed on a stable periodontal structure.
Since the individual susceptibility of periodontal disease and different disease progression are affected by virulence of infection bacteria, dentist must evaluate the patient’s characteristics, financial capabilities and treatment variabilities to select the most appropriate treatment for the patient.
This clinical thesis included 10 representative periodontal-prosthetic cases,
(case report, literature review, and discussion) including case such as single-tooth implant and immediate loading, cases which involved full-mouth periodontal treatment and occlusal rehabilitation, matching orthodontics treatment, telescopic denture system or flexible removable denture. eight females and two males (aged 37~72 yrs old ; 54.3 y/o on the average).
with treatment course of 6~27 months (15.6 months on the average) were reported. All cases are part of periodontal-prosthesis and can be used as reference for similar treatments. Patients are satisfied in terms of chewing, articulation and esthetics. However, the endurance is yet to be proved and long-term follow-up are indispensable.

Key words: periodontal-prosthetics, posterior bite collapse, telescopic prosthesis, implant

並列關鍵字

periodontal-prosthetics ； posterior bite collapse ； telescopic prosthesis ； implant

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