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研究生:張觀英
研究生(外文):Kuan-Ying Chang
論文名稱:牙周補綴暨種植體之全方位考量與臨床應用-病例報告論文集
論文名稱(外文):General consideration and clinical application in periodontal prosthesis and implant-cases report
指導教授:蔡吉政蔡吉政引用關係
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:牙醫學研究所碩士在職專班
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:281
中文關鍵詞:種植體引導骨再生手術桿狀球狀式附連體覆蓋式義齒牙周補綴手骨鑽上顎竇撐高術
外文關鍵詞:bar-clip type .ball type overdentureOSFE (osteotome sinus floor elevation) techniqueImplantsPeriodontal prosthesis
相關次數:
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  • 收藏至我的研究室書目清單書目收藏:1
牙周補綴的定義就是〝在治療牙周疾病時所必要的復形與補綴治療〞;雖然它特別指的是被牙周病多方破壞牙齒的治療,但治療的觀念原理和計畫適用於一般正常牙齒的復形與補綴.長久以來,牙周病是民眾口腔健康的重大威脅,在牙周病完整治療過程中,首先要利用各種方法來控制牙周病炎症,去除致病原,不論是非手術性或手術性治療,切除性或再生性的治療。而後輔以適當的補綴重建治療以恢復患者美觀,和咀嚼功能。因此牙周補綴不單是簡單區分為牙周與補綴治療,而是跨越多科整合性的全方位治療,必要時輔以根管治療,植體矯正,咬合治療等等。
本臨床病例論文集,係作者於門診診治的牙周補綴與人工植體贋復臨床病
例中,整理出來的12個牙周補綴與人工植體贋復病例報告,主要以全口多顆缺牙併局部慢性牙周炎–以種植體、手骨鑽上顎竇撐高術配合固定贋復物重建病例為代表(參閱病例十二之附圖A.B.C.D乃本人治療另一病例,其上顎骨高度在2~3mm以下時,用手骨鑽做上顎竇撐高術之效果較不穩定,於是使用開窗法來做上顎竇撐高術)
病例內容包括牙科主訴.現今牙科概況.全身病史.過去牙科病史.個人習慣.口內檢查.診斷.問題條列.治療計劃.治療過程, 合併引導骨再生手術之應用,可解決骨骼寬度不足或骨骼解剖形態不佳時而產生的骨缺損包括裂開型或開窗型等,使牙科植體種植在理想的位置上.
從完整的牙周治療到各種牙周補綴齒列全口重建或局部重建,補綴物包括各種組合配套固定義齒,可撤性活動義齒(鉤式活動義齒),桿狀.球狀式附連體覆蓋式義齒(病例二、病例三),雙層套冠(病例八)及種植體,這些補綴物是依牙周情況,缺牙部位,缺牙數量及病患經濟能力與實際需求作為考量而製作的,其目的是為了達到舒適美觀與耐用。至於這些補綴物是否可以維持長久健康與功能,需要進一步追蹤觀察,為了達到此目的,定期回診檢查與患者口腔衛生的維護是必須徹底實行,如此才能確保牙周補綴長期良好的預後和維持更久的使用年限。
Dr. Amsterdam(Univ. Pen,1974) defined periodontal prosthesis as “Those restorative prosthetic endeavors that are absolutely essential in the treatment of advanced periodontal disease. Whereas specifically it refers to the treatment of the dentition that has been devastated by peridontitis,but the underlying principle and treatment planning is suitable for the restoration of normal dentition as well. Periodontal disease has long been a major threat to the oral health of public.

In a comprehensive periodontal treatment, the first priority is to control periodontal inflammation by removing etiology, via surgical, reductive or regenerative treatment, followed by appropriate restorative and/or prosthetic treatment to restore the patients esthetic and occlusal function. The discipline of periodontal prosthesis is not simply classified as periodontal treatment and prosthetic treatment; it`s comprehensive multidiscipline management that may endodontic and orthodontic treatment as needed.An interdisciplinary perspective treatment is to solving full mouth problems.

The objectives of dental restoration are rebuild occlusion function, maintain perio- dontal health and enhance esthetics.

There are twelve comprehensive periodontal prothesis cases in this dissertation.

The case reports are derived from comprehensive periodontal treatment and periodontal prosthesis utilized in the rehabilitation of occlusion. Appliances that periodontal prosthesis can utilize include fix prosthetics, removable prosthetics (clasp design or precision attachment), overdenture(magnet type. ball type. bar-clip type.), telescopic crowns and implants. Consideration for these treatment are based on periodontal condition, location of the lost dentition, amount of lost dentition, patient`s financial and practical desires. The report contains 12 cases studies. There is moderate case such as single-tooth, implant coordinating crown lengthening procedure and visually disguising prostheses for better visual effect.. Treatment objectives in anterior aesthetic site are (1) main emphasis:reestablishment and long term stability from an aesthetic and functional point of view. (2) demanding reliable surgical and prosthetic procedure. (3) predictable and succesful tissue integration.

There are also complicated cases like full-mouth periodontal treatment and occlu- sal rehabilitation, matching the use of osteotome technique for sinus augmentation at thetime of implant placement
.
A non-invasive method for implant insertion in areas with insufficient bone height in the maxilla using osteotomes was developed.

The osteotome sinus floor elevation was proposed for implant sites with at least 5-6mm of bone between the alveolar crest and the max-illary sinus floor. For this purpose, a set of osteotomes with increasing taper and concave tips was applied to prepare the implant site up to 1-2mm within the sinus floor boundary. After widening of the access cavity and application of a grafting material, the osteotome was to be
advanced into the site with light malleting, thereby pushing the sinus floor towards the sinus cavity. After the insertion of press-fit implants as ‘the final osteotomes’, the ‘tented’ grafting area resulted in an elevation of the sinus floor for several millimeters.Using a midcrestal incision, the implants were inserted through the alveolar crest by means of the Summers Osteotome Kit ® according to the OSFE technique as described by Summers plus GBR(guided bone regeneration)
[case 1.case 8, OSFE (osteotome sinus floor elevation) technique.]

All cases are part of periodontal-prosthesis and can be used as reference for simi- lar treatments.

Following the treatment cycle 1. diagnosis(diagnostic wax up) 2. case / treatment plan 3. surgical procedure 4. re-entry (healing cap) 5. impression and provisional prosthesis. 6. final restoration, these case reports set out the treatment plans to make the treatment outcome more efficient and accountable by means of the prosthetically driven and soft tissue and bone driven implant dentistry according to professor Tsai’s
and teacher’s instruction.

The aim of dentition prosthesis is to achieve a level of comfort, esthetic, and longevity of dentition that the patient can accept. Although all prothesis function well ,the further follow-up and studies are imperative for the long-term results.In order to achieve this purpose,patients should be educated to recognize the importance of regular checkup and maintenance of the oral hygiene, to ensure a good prognosis and endurance of periodontal prosthesis. (Case 12, Fig A.B.C.D lateral wall open
window technique for maxillary sinus elevation)
中文摘要 1
英文摘要 3
材料與方法 5
病例摘要總表 6
前言 8
病例報告.
病例報告一:全口多顆缺牙併局部慢性牙周炎-以種植體、手骨鑽上顎竇撐高術配合
固定贋復物重建 11
病例報告二:牙科植體於下顎缺牙區的臨床應用Implant retained and tissue
supported overdenture 43
病例報告三:牙科植體於下顎缺牙區的臨床應用及全口重建Implant retained and
tissue supported overdenture 60
病例報告四:全口多顆缺牙併局部慢性牙周炎-以種植體、手骨鑽骨嵴撐開手術配合
固定贋復物重建 85
病例報告五:全口多顆缺牙併局部慢性牙周炎–以種植體配合固定贋復物重建 124
病例報告六:不良贋復物引起之慢性牙周炎-以種植體及固定贋復物之全口重建 144
病例報告七:全口多顆缺牙併局部慢性牙周炎–以種植體配合固定贋復物重建 162
病例報告八:全口多顆缺牙併局部慢性牙周炎-以種植體、手骨鑽上顎竇撐高術配合固
定贋復物重建 179
病例報告九:種植體與固定贋復物在局部缺牙區的使用 202
病例報告十:上顎前牙缺牙併局部慢性牙周炎–以種植體、手骨鑽骨嵴撐開術
配合固定贋復物重建 219
病例報告十一:上顎前牙缺牙併局部慢性牙周炎–以種植體、引導骨再生術配合
固定贋復物重建 235

病例報告十二:全口多顆缺牙及廣泛嚴重性牙周炎-以開窗式上顎竇增高術合併下頦
骨移植骨手術配合固定贋復物重建 252
病例報告十三:牙科植體於上顎缺牙區的臨床應用及全口重建-以桿狀附連體支撐
覆蓋式義齒 256
總討論 261

結論 268

致謝辭 270

參考文獻與書目 272
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