臺灣博碩士論文加值系統

臨床上遇到許多牙周病患者，因牙周病、齲齒…等因素失去牙齒，而造成後牙咬合崩塌(posterior bite collapse)，也有因補綴物(restoration)不夠，造成牙周與咬合病變、美觀不佳、缺乏穩定的咬合、咀嚼(mastication)困難，甚至顳顎關節(TMJ)病變。
相信「尋求一個實用的準則及治療順序，獲得一個可預期且穩定的治療成果」是每位治療者所祈求的。牙周患者的治療，基本上可分為五個階段：初期的牙周治療階段(initial therapy phase)、暫時性補綴物與治療階段(provisional restoration and stabilization)、最後的牙周治療階段(definitive therapy management phase)、補綴治療階段(Prosthetic phase)、回診與維持階段(recall and maintenance phase) (Rosenberg, Kay, Keough, & Holt，1988)。
本論文有九個臨床常見的病例(男性六位、女性三位)，平均年齡約52歲(48歲至78歲)，所遇到的牙周問題有骨上囊袋(suprabony pocket)、骨內囊袋(intrabony pocket)、牙根分叉侵犯(furcation Involvement)等。根據每位患者的牙周特性，參考上述五個治療階段，設計適合每位患者的治療計畫。所採取的治療方式，則包括了非手術治療與手術治療，例如囊袋去除術、牙周翻瓣清創術、牙齒分割、牙根切除術等。而最終補綴物的設計有切除牙根製作固定牙冠牙橋(案例一)、薄蓋冠合併覆蓋式義齒(案例二、三)、可撤式活動假牙(案例三、四、五、六)、人工植牙(案例七、八、九)、全口假牙(案例七)等。

On clinical we have met many patients lost their teeth due to peridontitis, caries…etc, even worse posterior bite collapse, also because of inadequate restoration, induce periodontal and occlusal pathosis, esthetic impairment, absence of stable occlusion, difficulty in mastication, temporomandibular joint (TMJ) dysfunction.
We want to find a practical guideline and sequence for the periodontal therapy. The treatment results should be predictable and long-lasting. A typical sequence of therapy in the management of the periodontal-prosthetic case is as follows:Initial therapy phase; Provisional restoration and stabilization; Definitive periodontal management phase; Prosthetic phase; Recall and maintenance phase (Rosenberg, Kay, Keough, & Hol, 1988).
The thesis includes 9 clinical cases that often met in clinics (male 6, female 3), average age of the cases is 52 years old (48 years old to 78 years old), the periodontal problem were suprabony pocket , intrabony pocket, furcation involvement. According to every case’s periodontal characteristics follow the five sequence described above, to design treatment plane suit for every case indivally. The periodontal treatment includes nonsurgical treatment and surgical treatment (pocket reduction surgery, open debridement, tooth separation, root amputation). The final prosthesis design including root amputation with fixed crown bridge (case 1), capping with overdenture (case 2, 3), removeable partial denture (case 3, 4, 5, 6), implant (case 7, 8, 9), and complete denture (case 7).

前言 1
案例一 4
案例二 25
案例三 39
案例四 56
案例五 72
案例六 90
案例七 109
案例八 126
案例九 143
綜合討論 158
參考文獻 165

Adell, R., & Branemark (1981) A 15-year study of osseointegrated implant in the treatment of the edentulous jaw. Int. J. Oral Surg, 10: 387-416.
Albrektsson, T. et al. (1986) The long term efficacy of currently wed dental implants. A review and proposed critenia of success. Int. J. Oral Maxillofac Implant, 1: 11-25.
Amen, C. R. (1966) Hemisection and root amputation. Periodontics, 4: 197-204.
Amen, C. R. (1966) Hemisection and root amputation. Periodontics, 4: 197-204.
Bidez, M. et al. (1990) FEA Investigations in Plate-form Dental Implant Design Proceedings of the First Word Congress of Biomechanics, San Diego, Carol.
Bidez, M. et al. (1992) Force transfer in implant dentistry: Baxic concepts and principles. Oral Implantol, 18: 264-274.
Bystrom, A., Happonen, R.-P., Sjogren, U. & Sundqvist, G. (1987) Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis. Endodontics and Dental Traumatology, 3: 58-63.
Eriksson, A. R. et al. (1983) Temperature threshold levels for heat induced bone tissue injury: a vital microscopic study in the rabbit. J. Prosthet Det, 50: 101-107.
Haapasalo, M., Ranta, K. & Ranta, H. (1987) Mixed anaerobic periapical infection with sinus tract. Endodontic and Dental Traumatology, 3: 83-85.
Klavan, B. (1975) Clinical observations following root amputation in maxillary molar teeth. Journal of Periodontol, 46: 1-5.
Klavan, B. (1975) Clinical observations following root amputation in maxillary molar teeth. Journal of Periodontol, 46: 1-5.
Langer, B., Stein, S. D., & Wagenberg, B. (1981) An eveluation of root resections: a 10 year study. Journal of Periodontol, 52: 719-722.
Langer, B., Stein, S. D., & Wagenberg, B. (1981) An eveluation of root resections: a 10 year study. Journal of Periodontol, 52: 719-722.
Lindhe, J. (1989) Interrelationships between Periodontics and Endodontics. Texbook of Clinical Periodontology, p259. Copenhagen: Munksgaard.
Nair, P. N. R. & Schroeder, H. E. (1984) Periapical actinomycosis. Journal of Endodontics, 10: 567-570.
Rosenberg, M. M., Kay, H. B., Keough, B. E., & Holt, R. L. (1988) Periodontal and Prosthetic Mangement for Advanced Cases. Quintessencce Publishing Co., Chicago, London, Berlin, Tokyo, and Hong Kong.
Rubach, W. C., & Mitchell, D. F. (1965) Periodontal disease, accessory canals, and pulp pathosis. Journal of Periodontol, 36: 34-38.
Seltzer, S., Bender, I. B., & Zonti, M. (1963) The interrelationship of pulp and periodontal disease. O. S., O. M., and O. P., 16: 1474-1490.
Simon, J. H., Glick, D. H., & Frank, A. L. Predictable Endodontic and peridontic failures as a result of radicular anomalies, O. S., O. M., and O. P., 31: 823-826.
Stahl, S. S. (1966) Pathogenesis, of inflammatory lesions in pulp and periodontal tissues. Periodontics, 4: 190-196.
Sugarman, M. M., & Surgarman, E. F. (1969) The differential diagnosis of periodontic-endodontic problems. Journal of Alabama Dent. Assoc., 53: 16-24.
Sundqvist, G. & Reuterving, C-O. (1980) Isolation of Actinomyces israeli from periapical infection. Journal of Endodontics, 6: 602-606.
Tronstad,L., Barnett, F., Riso, K. & Slots, J. (1987) Extraradicular endodontic infections. Endodontics and Dental Traumatology, 3: 86-90.
Von Recum A. (1986) Handbook of Biomatenial Evaluation, New York, Macmillan.
Walter T., & McFall, Jr. (1982) Tooth Loss in 100 Treated Patients With Periodontal Disease. Journal of Periodontol, 53(9): 539-549.
Walter, T., & McFall, J. R. (1982) Tooth loss in 100 treated patients with periodontal disease. Journal of Periodontol, 53(9): 539-549.
Wilderman et al. (1970) Histogenesis of repair following osseous surgery. J. Periodontol, 41: 551-565.
Wood, W. R., Greto, G. W., & McFall, W. T. (1989) Tooth loss in patients with moderate periodontitis after treatment and long-term maintenance care. Journal of Periodontol, 60: 516-520.
Yacker, U. J. et al. (1996) The effect of irrigation on osteotomy depth and bur diameter. Int. J. Oral Maxillo Implant, 11(5): 634-638.