臺灣博碩士論文加值系統

中文摘要
所謂牙周補綴，可追溯到1974年美國賓州大學阿姆斯特丹教授(1)提出所謂牙周補綴的定義，一探究竟。其定義說: 「牙周補綴即在嚴重牙周病治療當中，提供所需的復形與補綴」。必須結合贗復原則與正確牙周組織處理，才能預測補綴沕的長期成功(Levine et al. 1999)(2)。
要治療牙周惡化的牙齒，對臨床牙醫師而言是一項嚴峻的挑戰。其方法可從簡單的拔牙到整個自然齒列的復健。而治療計劃須考慮病人許多因素，包括年齡、健康、心理狀態、潔牙能力、經濟狀況(Pruthi et al. 1987)(3)。文獻証明只要能適當的治療，持續的牙周維持照護，在家口腔衛生徹底施行，即使是嚴重骨喪失與根叉侵犯，牙齒也能保持健康功能狀態(Nordland et al. 1987)(4)。因此，牙醫師應盡一切努力，拯救惡化的牙齒。
本論文所提出九個患有中度至重度牙周炎病例，五位女性，四位男性，年齡從46 至68 歲。其牙周治療的方法包括非手術性治療與手術治療如翻瓣刮除術、強迫萌出術、牙根分離/切除術、游離牙齦移植術、上皮下結締組織移植術、引導組織再生術與種植體手術。而最終補綴物設計，依齒列狀況、病人經濟考量、牙醫師治療理念，而包含固定義齒、牙鉤式部份活動義齒、CSC雙重冠可撤式義齒、磁性附連體合併CSC雙重冠可撤式義齒、種植體支持式固定義齒。
最後，病患定期回診加強口腔衛生指導與牙結石刮除。能有效控制牙菌斑，才能維持牙周健康。有長期的支持性牙周治療，才有牙周手術治療的長期成效(Wilson et al. 1984, Westfelt et al. 1985 ) (5,6) 。若無良好維持，則牙周治療毫無意義(Becker et al.1984) (7)。

Abstract
So called “periodontal prosthesis”, Dr Amsterdam( University of Pennsylvania, 1974) shared his view with us. He defined periodontal prostheses as “Those restoration prosthetic endeavors that are absolutely essential in the treatment of advanced periodontal disease”. Predictable long-term restorative success requires a combination of restorative principles with the correct management of periodontal tissues.
The treatment of periodontally compromised and weakened teeth poses a serious challenge to clinicians. Approaches to treatment can vary from extraction to rehabilitation of the natural dentition. The treatment plan depends on many factors including age, health, psychologic status, the patient’s ability to improve and maintain adequate plaque control, and economics. There is convincing evidence that teeth with severe bone loss and furcation involvement can be maintained in a state of health and function with the appropriate treatment, continuing periodontal maintenance care, and oral-hygiene measures performed at home. Therefore, every effort should be made by the dentist to save compromised teeth.
This paper presents 9 cases with moderate to advanced periodontitis, including 3 males and 6 females, aged from 46 to 68 years old . The periodontal treatments of these cases include non-surgical and surgical procedures, such as open-flap curettage, forced eruption, root separation/resection, free gingival graft, subepithelial connective tissue graft, guided tissue regeneration, and implantation. The final prosthesis design depends on dentition situation, patient’s economic consideration and dentist treatment philosophy, from fixed partial denture, clasp-retained removable partial denture, detachable crown sleeve coping telescopic denture, magnetic attachment with detachable crown sleeve coping telescopic denture, implant-supported fixed partial denture.
Finally, the patients were periodiac recalled to reinforce oral hygiene instruction and perform root scaling and planning. Only the plaque was controlled effectively, the periodontal health can be maintained. The frequency of supportive periodontal therapy (SPT) and the patient’s cooperation determine long-term success or failure following periodontal therapy. Periodontal therapy without maintenance is of little value in terms of restoring periodontal health.

目錄
誌謝 ---------------------------------------------- 003
中文摘要 ---------------------------------------------- 005
英文摘要 ---------------------------------------------- 008
前言 ---------------------------------------------- 010
病例摘要表 ---------------------------------------------- 011
材料與方法 ---------------------------------------------- 012

病例報告
病例一：以強迫萌出與CSC雙重冠義齒恢復咬合功能之應用----- 014
病例二: 以CSC雙重冠義齒恢復咬合功能三年追蹤病例報告----- 046
病例三: 以牙根切開術合併CSC雙重冠義齒恢復咬合功能二年追蹤 081
病例四: 以強迫萌出與CSC雙重冠義齒贗復牙根過短前牙案例---- 114
病例五: 不良飲食習慣之牙周病人以固定義齒贗復三年追蹤------ 145
病例六: 以大臼齒強迫萌出與活動義齒恢復咬合功能一年半追蹤--- 183
病例七: 以強迫萌出、磁性附連體CSC雙重冠義齒重新處理失敗案例207
病例八: 以牙周再生膜手術恢復咬合功能一年半追蹤------------- 240
病例九: 在上顎以游離牙齦移植與種植體恢復咬合功能病例------- 277

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