臺灣博碩士論文加值系統

背景：
傳統的牙周補綴治療主要是針對牙周破壞牙齒的治療與復形，並藉由併連牙周組織減少與具搖動度的牙齒，以支撐固定或合併活動補綴物，重建口腔功能。
而隨著牙科植體的進展與接受度，改變了臨床醫師對此類患者的治療觀點與治療計劃的決定，但也因此提高擬定治療計劃時的複雜性。
方法：
本文收集十位在醫學中心牙科就診患者，經臨床及放射線檢查後，分別診斷為全口無牙、嚴重廣泛性慢性牙周炎、慢性菌斑型牙齦炎或廣泛性侵犯型牙周炎等，其平均年齡41.8歲(25至68歲)，3女7男，經過牙周基本治療後，再分別接受牙根分開與切除術、根叉穿通術、保守性牙周手術、根管治療、局部矯正、引導骨再生術、骨嵴軟硬組織手術、植牙手術、傳統補綴物、植牙補綴物與雙重冠義齒等治療方式。共完成2組雙重冠義齒、26根植牙、2組植牙覆蓋式義齒等各種牙周補綴治療。其平均治療與維護時間1.9年。
結果：
十位患者對於治療結果的功能與美觀均十分滿意。臨床牙周指數與放射線檢查明顯改善，咬合狀況穩定，且仍在定期牙菌斑控制、臨床維護與追蹤治療中。依本個案群有限的臨床實驗結果，顯示這跨科際整合性治療，機動性合併自然牙或人工植牙運用在嚴重牙周破壞患者，其結果值得期待。
結論：
本文病例綜合多種不同牙周補綴方法的動態性治療，應用在牙周支持減少齒列與各類缺牙患者的口腔復建，以作為日後臨床治療參考與分析。但仍須更多病例與更長時間追蹤此類個案，來確定這些方法的結果。

Background:
Traditional periodontal prosthesis refers to the treatment and restoration of periodontally involved teeth, with reduced periodontium support or mobility, to support fixed or removable prostheses and the rehabilitation of oral function. However, the advent and general acceptance of dental implants has altered our concepts and treatment planning in these advanced cases , but has also increased the complexity of the final treatment plan.This thesis addresses those issues and the role of dental implants in perio-prosthesis. Materials and Methods: A total of ten patients, using clinical and radiographic examination, either full edentulous, severely generalized chronic periodontitis, chronic plaque-induced gingivitis or generalized aggressive periodontitis was diagnosed. The patients, ranging in ages from 25 to 68 years (mean 41.8 years), three women and seven men, received basic periodontal therapy and either root separation/resection, tunnel preparation,conservative periodontal surgery, endodontic treatment, minor tooth movement, guided bone regeneration,ridge hard/soft tissue surgery,implant surgery,conventional prostheses,implant prostheses or telescopic denture.The time between initial examination and follow-up was 14 to 28 months(mean 1.9 years) Results: Ten patients were satisfied with the functions and esthetics of treatment outcome.The periodontal parameters and radiographic examination revealed improved condition , and all patients,with stable occlusion, are still in individual designed maintenance program.The clinical results, with the small number of individuals under investigation, showed these interdisplinarily collaborative treatments, combing natural teeth or dental implants in periodontal compromised patients, are welcoming and promising. Conclusions: This case series, with dynamic perio-prosthetic treatments, showed the results of occlusal rehabilitation for patients of reduced periodontal support or missing teeth and provided the experiences for futher studies.In addition, more work and longer follow-up time needs to be done on a larger group of individuals to verify the observations of this thesis.

中文摘要 6
英文摘要 7
前言/方法 8
結果 病例報告
病例- 1全口無牙患者(Full Edentulous Patient)，應用上顎傳統全口義齒 (Conventional Complete Denture)，下顎植牙支撐式覆蓋式義齒 (ImplantSupportedOverdenture) 17
病例- 2嚴重廣泛性慢性牙周炎患者(Severely Generalized Chronic Periodontitis)，應用上顎可撤式雙重冠義齒(Removable Telescopic Denture)，與下顎植牙固位式覆蓋式義齒(Implant Retained verdenture) 26
病例- 3嚴重廣泛性慢性牙周炎患者，應用上顎可撤式雙重冠義齒 39
病例- 4嚴重局部慢性牙周炎患者 (Severely Localized Chronic Periodontitis)，應用下顎後臼齒區單顆植牙(Single Implant Replacement For Mandibular Molar) 46
病例- 5慢性菌斑型牙齦炎(Chronic Plaque-induced Gingivitis)，應用上顎局部植牙支撐式固定贗復物(Implant Supported Fixed Partial Denture)與下顎單顆植牙 52
病例- 6嚴重廣泛性慢性牙周炎患者，應用上顎與下顎局部植牙支撐式固定贗復物 59病例- 7嚴重廣泛性慢性牙周炎患者，應用上顎局部與單顆植牙支撐式固定贗復物 (Single Implant Replacement For Maxillary Molar)，與下顎局部植牙支撐式固定贗復物 73
病例- 8嚴重廣泛性慢性牙周炎患者，應用上顎前牙單顆植牙 (Single Implant Replacement For Maxillary Anterior Tooth) 87
病例- 9廣泛性侵犯型牙周炎患者(Generalized Aggressive Periodontitis)，應用傳統固定贗復物(Conventional Fixed Partial Denture) 95
病例-10廣泛性侵犯型牙周炎患者，應用局部復形體(Partial Dental Restoration) 102
綜合討論 109
結論 120
致謝辭 123
參考文 124

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BioOss
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綜合討論
Pocket management
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classification
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Furcation therapy
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Mandibular Molar Furcation/Tunneling
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Telescopic denture
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Implant
Implant in Perio patient
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結論
Furcated Molar
＃Kinsel RP, Lamb RE, Ho D. The treatment dilemma of the furcated molar: root resection versus single-tooth implant restoration. A literature review. Int J Oral Maxillofac Implants 1998 May-Jun;13(3):322-32 (UCSF)
＃Fugazzotto PA. A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years. J Periodontol 2001 Aug;72(8):1113-23
＃Plagmann HC, Holtorf S, Kocher T. A study on the imaging of complex furcation forms in upper and lower molars. J Clin Periodontol 2000 Dec;27(12):926-31
＃Tarnow DP, Fletcher P. Root resection vs. maintenance of furcated molars. The controversy continues. N Y State Dent J 1989 Nov;55(9):34, 36, 39
＃Bjorn AL, Hjort P. Bone loss of furcated mandibular molars. A longitudinal study. J Clin Periodontol 1982 Sep;9(5):402-8
＃Machtei EE, Grossi SG, Dunford R, Zambon JJ, Genco RJ. Long-term stability of Class II furcation defects treated with barrier membranes. J Periodontol 1996 May;67(5):523-7