臺灣博碩士論文加值系統

21世紀的牙醫醫學進步神速，不管矯正、植牙、根管治療、補綴、牙周病治療…都是材料不斷的改進，而使治療的過程及結果變的更簡單、可預期。對患者而言，可減低治療中的痛苦與縮短療程；對牙醫師來說，也可以在相同的時間服務更多的患者，醫療品質也同時提高。
由於整合牙醫學有其需要性，牙周補綴觀念應運而生，尤其是單人診所醫師要花更多時間來了解各次專科之間的關係以提供患者更好的服務及醫療品質。
從牙周病治療開始到補綴重建完成，其過程因病情複雜程度、患者要求、醫師能力，短者幾個月，長則甚至兩、三年以上才能完成。
本臨床九個病例報告裡，治療過程中除了一例有open window做sinus lift外，儘量以簡單的方法完成療程。最終補綴有五例有CSCDT(crown and sleeve-coping telescopic denture)，三例有植牙，八例有固定牙橋，一例傳統有鈎式活動假牙；其中五例有追蹤報告。
　本臨床病例報告之重症牙周病例的牙周補綴重建，是以CSCTD、矯正、牙根切開或分離術(根叉病變之病例)與植牙完成全部治療。治療過程中結合牙周、矯正、咬合、補綴與植牙的技術，使得患者的治療結果，非但兼顧牙周病的治療與維護，同時也改善牙齒排列美觀、咬合傷害、牙齒之long-axis之改善以應付重建後牙齒之咀嚼力之合理分配，最後並達成全方位的治療。
　在最終補綴治療完成後，我們要把口腔照護當作治療的延續，患者如果無法在家做好口腔清潔工作，之前的努力會大打折扣。因此，如何教導患者能持續有恆心的做好口腔衛生工作，並固定時間做口腔檢查是全口重建成功與否的關鍵所在。

Owing to the improvements in the materials, the orthodontic, implant, and endodontic treatment processes and outcomes have become much easier and predictable. For patients, disconfort during the treatment could be reduced, and the course of the treatment could also be shortened. Meanwhile, dentists have more sufficient time to treat patients. Also, the quality of dental treatment can be exalted.
The integration of different dental disciplines is necessary for advanced periodontal diseased patients. Clinic with only one dentist especially needs to understand the relationships among the other specialists in order to provide patients with better service and treatment.
From the beginning of the treatment of periodontal disease to the accomplishment of prosthodontal therapy, the whole process might take a long time due to the complexity of the disease, the requests from patients, and the ability of the dentist. Some dental treatment even took two or three years in order to achieve the goal.
In these nine clinical case report of nine clinical cases, one case received sinus lift during the treatment coures, the other eight cases were finished in an easier way during their treatments. There are 5 CSCDT cases, 3 cases of implant, 8 cases of fixed crown-bridge, 1 case of traditional clasp-retained removable partial dentures. Five of the cases have reports in the follow-up period.
The results presented in this report showed that the periodontal prosthodontic treatment for the severe periodontal disease could be completed by CSCTD, orthodontics, and combination of periodontal, orthodontic, occlusal, prosthodontic and implant techniques . By doing so, the periodontal disease could be controlled, the teeth could be properly arranged and occlusal damage could be reduced. The long-axis of occlusal force of the traumatized teeth could be improved by a well-distributed chewing force of the teeth after the reconstruction.
After the prosthodontal treatment is completed, patients should take good care of their oral health. Otherwisw, the treatment results shall be compromized. Therefore, the key to the success of the perio-prosthodontal rehabilitation is to guide the patients to maintain good oral hygiene, and have a regular time schedule for re-examination.

目錄-001
中文摘要-002
英文摘要-003
前言-004
致謝詞-005
材料與方法-006
病歷摘要表-007
病例報告一：牙周補綴應用於成人牙周炎與齒列不正之全口重建-008
病例報告二：以固定假牙及有勾式活動假牙重建成人缺牙及中度以上牙周炎患者-035
病例報告三：上顎以CSCTD，下顎以固定牙橋重建中重度牙周炎之患者-051
病例報告四：以CSCTD、植牙、固定牙橋對重症牙周炎患者全口重建-074
病例報告五：以CSCTD(Crown & Sleeve - Coping Telescopic Denture )及牙根分
開術 (Root Separation)解決上下顎後牙根叉侵犯-095
病例報告六：前牙錯咬合併上下顎局部缺牙之全口重建-119
病例報告七：用矯正方式及固定牙橋解決單側後牙咬合塌陷之全口重建-134
病例報告八：重度牙周炎合併下顎兩側游離端缺牙之全口重建-149
病例報告九：局部重度牙周炎及游離端缺牙之全口重建-176
總討論-192
結論-193
參考文獻書目-194

1.Wise RJ, Kramer GM. Predetermination of osseous changes changes associated with uprighting tipped molars by probing. Int J Periodont Rest Dent 1983;3:69-81
2.Ericsson, I., Thilander, B., Lindhe, J. & Okamoto, H.(1977). The effect of orthodontic tilting movements on the periodontal tissues of infected and non-infected dentitions in the dog. Journal of Clinical Periodontology 4, 78-293.
3.Lundgren, D., Kurol, J., Thorstensson, B. & Hugoson, A.(1992). Periodontal conditions around tipped and upright molars in adults. An intra-individual retrospective study. European Journal of Orthodontics 14, 449-455.
4.Tarnow, D.P., Magner, A.w. & Fletcher, P. (1992). The effect of the distance from the contact point to the crest of bone on of Periodontology 63, 995-996
5.Melsen B, Agerbaek N, Mardenstam G. Intrusion of incisors in adult patients with marginal bone loss. Am J Orthod Dentofac Orthop 1989;96:232-241.
6.Wehrbein H, Fuhrmann RAW , Deidrich PR. Periodontal conditions Orthod Dentofac Orthop 1994;106:455-462.
7.Nevins M, Wise RJ. The use of orthodontic therapy to alter infrabony pockers. Part II. Int J Periodont Rest Dent 1990;10:199-207.
8.Harpenau, L.A. & Boyd, R.L. (2000). Long-term follow-up of successful orthodontic-periodontal treatment of localized aggressive periodontitis: a case report. Clinical orthodontics and Research 3,220-229.
9.Melsen B, Agerback N. Orthodontics s as an adjunct to rehabilitation. Periodontology 2000 1994;4:148
10.Rosling, B., Nyman, S. & Lindhe, J. (1976). The effect of systematic plaque control on bone regeneration in infrabony pockets. Journal of Clinical Periodontology 3, 38-53.
11.Lindhe J, Nyman S.Role of occlusion in periodontal disease and biologic rationale for splinting in treatment of periodontitis. Oral Sci Rev 1977;10:11.
12.Galler C, Selipsky H, Philips C, Ammons W. The Effect of splinting on tooth mobility. II. After osseous surgery. J Clin Periodontol 1979;6:317.
13.Perrier M, polson A. The effect of progressive and increasing tooth hypermobility on reduced but healthy supporting tissues. J periodontal 1982;53:152.
14.Williams WN, Low SB, Cooyser WR, Cornell CF. The effect of periodontal bone loss on bite force discrimination. J periodontol 1987;58:236.
15.Hou GL, Tsai CC, Weisgold AS. Treat-ment of molar furcation involvement using root separation and a crown and sleeve coping telescopic denture. Alongitudinal study J Periodontol 1999,70:1098-1109.
16.Artun J, Urbye KS. The Eggect of orthodontic treatment on periodontal bone support in patients with advanced loss of marginal periodontium. Am J Orthod Dentofac Orthop 1988;93:143-148.
17.Ong, M.A., Wang, H-L. & Smith, F.N.(1998). Interrelationship between periodontics and adult orthodontics. Journal of Clinical Periodontology 25, 271-277.
18.Abrams L. Augmentation of the deformed residual edentulous ridge for fixed prosthesis. Compend Cont Educ Dent 1980;1:205
19.Genco RJ, Goldman HM, Cohen DW. Contemporary periodontics. St. Louis: Mosby; 1990. P. 643.
20.Sato N. Periodontal surgery: a clinical atlas. Tokyo: Quintessence Publishing; 2000. P. 422.
21.Schluger S et al. Periodontal diseases. 2nd ed. Philadelphia: Lea & Febiger; 1990. P. 632.
22.Seibert J. Reconstruction of the deformed partially edentulous ridges using full-thickness overlay grafts. Parts 1 and 2. Compend Cont Educ Dent 1983;4:437.
23.Bergman B, Hugoson A, Olsson C-O. A 25 year longitudinal study of patients treated with removable partial dentures. JOral Rehabil 1995;22:595-599.
24.Bergman B. Prognosis for prosthodontic treatment of partially edentulous patients . In Owall B, Kayser A F, Carlsson G E.Prosthodontics:principles and management strategies. Lon-don; Mosby-Wolfe.1996.24.
25.Carranza FA. Glickman’s clinical periodontology. 7th ed. Philadelphia : WB Saunders;
1990.p.945.
26.Gomes BC, Renner RP. Periodontal considerations of the removable partial Overdenture.
Dent Clin North Am 1990;34;653.
27.Renner RP, Boucher IJ. Removable partial dentures. Chicago: Quintessence Publishing;
1987.p.53.
28.Basker R M. Clinical evaluation of partial denture retainers. In Bates J F,Neill D J, Preiskel H W (ed). Restoration of the Par-tially Dentate Mouth, pp 211-223. Chicago: Quintessence, 1984.
29.Bates J F. Retention fo partial dentures. Br Dent J 1980;149:171-174.
30.Abelson D C. Denture plaque and denture cleansers:a revicw of the literature. TGerodontics 1985;5:202-206.
31.Bates J E Plaue accumulation and partial denture design. In Bates J F,Neill D J, Preiskel H W (ed).restoration of the Par-tially Dentate Mouth, pp 225-236. Chicago: Quingtessence,1984.
32.Berg E. Periodontal problems associated with use of distal exten=sion removable partial dentures-a matter of construction? J Oral Rehabil 1985;12:369-379.
33.Blinkhorn A S. Dental health education: what lessons have we ignored? Br Dent J 1998;184:58-59
34.Wagg B J. Root surface caries: a review. Comm Dent Health 1984;1: 11-20.
35.Pontoriero, R., Lindhe, J., Nyman, S., Karring, T., Rosenberg, E. & Sanavi, F. (1988). Guided tissue regeneration in degree II
36.Lekovic, V., Kenney, E.B., Kovacevic, K. & Carranza, F.A. Jr. (1989). Evaluation of guided tissue regeneration in class II furcation defects. A clinical re-entry study. Journal of Periodon-tology 60,694-698.
37.Caffesse, R., Smith, B., Duff, B., Morrison, E., Merril, D. & Becker, W. (1990). Class II Furcations treated by guided tissue regen-eration in humans: case reports. Journal of Perwdontology 61,510-514.
38.Camevale, G., Pontoriero, R. & Di Febo, G. (1998). Long-term effects of root-resective therapy in furcation-involved molars. A 10-year longitudinal study. Journal of Clinical Periodontology 25,209-214.
39.Camevale, G., Di Febo, G., Tonelli, M.P., Marin, C. & Fuzzi, M. (1991). A retrospective analysis of the periodontal-prosthetic treatment of molars with interradicular lesions. International Journal of Periodontics and Restorative Dentistry II, 189-205.
40.Serio FG. Clinical rationale for tooth stabilization and splinting. Dent Clin North Am, 43(1): 1-6, 1999.
41.Kinane, D.f. & Chestnutt, I. (2000). Smoking and Periodontal Disease. Critical Reviews Oral Biological Medicine 11, 356-365.
42.Glickman, I. (1965). Clinical significance of trauma from occlusion. Journal of the American Dental Association 70, 607-618.
43.Glickman, I & Smulow J.B. (1968). Adaptive alteration in the periodontium of the Rhesus monkey in chronic trauma from occlusion. Journal of Periodontology 39, 101-105.
44.Lindhe, J. & Svanberg, G. (1974). Influences of trauma from occlusion on progression of experimental periodontitis in the Beagle dog. Journal of Clinical Periodontology 1, 3-14.
45.Lovdahl, A., Schei, O., Waerhaug, J. & Arno, A. (1959). Tooth mobility and alveolar bone resorption as a function of occlusal stress and oral hygiene. Acta Odontologica Scandinavica 17, 61-77.
46.Besimo, C. and Graber, G. A new concept of overdentures with telescope crown on osseointegrated implant. The International Journal of Periodontics & Restorative Dentistry 14(6), 487~495, 1994.
47.Weischer, T. and Mohr, C. Implant-supported mandibular telescopic prosthesis in oral cancer patients: An up to 9-year retrospective study. Journal of Periodontology 14, 329~334, 2001.
48.Wenz H J, Lehmann K M, A telcscopic crown concept for the restoration of the partially edentulous arch the Marburg double crown system. Int J Pros 1998;11:541-550.
49.Melsen, B. (1986). Tissue reaction following application of extrusive and intrusive forces to teeth in adult monkeys. American Journal of Orthodontics 3. 21-38.
50.Melsen, B., Agerbaek, N. & Markenstam, G. (1989). Intrusion of incisors in adult patients with marginal bone loss. American Journal of Orthodontics and Dentifacial Orthopedics 96, 232-241.
51.Murakami, T., Yokota, S., & Takahama, *. (1989). Periodontal changes after experimentally induced intrusion of the upper incisors in Macaca fuscata monkeys. American Journal of Orthodontics and Dentofacial Orthopedics 95, 115-126.
52.Nelson, P.A. & Artun, J. (1997). Alveolar bone loss of maxillary anterior teeth in adult orthopedics. American Journal of Orthodontics and Dentofacial Orthopedics 111, 328-334.
53.Melsen, B. (1991). Limitations in adult orthodontics. In: Melsen, B., ed. Current Controversies in Orthodontics. Chicago: Quintessence, pp. 147-180.
54. Stepovich, M.L. (1979). A clinical study on closing edentulous spaces in the mandible. The Angle Orthodontist 49, 227-233.
55.Goldberg, D. & Turley, P. (1989). Orthodontic space closure of edentulous maxillary first molar area in adults. International Journal of Orthodontics and Orthognathic Surgery 4, 255-266.
56.Hom , B.M. & Turley, P.K. (1984). The effects of space closure on the mandibular first molar area in adults. American Journal of Orthodontics 85, 457-469.
57.Lindskog-Stokland, B., Wennstrom, J.L., Nyman, S. & Thilander, B. (1993). Orthodontic tooth movement into edentulous areas with reduced bone height. An experimental study in the dog. Eutopean Journal of Orthodontics 15, 89-96.
58.Edwards, J.G. (1971). The reduction of relapse in extraction cases. American Journal of Orthodontics 60, 128-141.
59.Kokich V. Esthetics: The ortho-perio-restorative connection. Semin Orthod 1996;2:21-30.
60.Kokich V, Nappen D, Shapiro P. Gingival contour and clinical crown length: Their effects on the esthetic appearance of maxillary anterior teeth. Am J Orthod 1984;86:89-94.
61.Kokich V. Anterior dental esthetics: An orthodontic perspective II. Vertical relationships. J Esthet Dent 1993;5:174-178.
62.Kokich V. Anterior dental esthetics: An orthodohtic perspective III. Mediolateral relationships. J Esthet Dent 1993;5:200-207.
63.Cronin, R.J. and Wardle, W.L. Loss of anterior inter-dental tissue: Periodontal and prosthodontics solutions. The Journal of Prosthetic Dentistry 50, 505~509, 1983.
64.Tarnow, D.P., Magner, A.W., and Fletcher, P. The effect of the distance from the contact point to the crest of bone presence or absence of the interproximal dental papilla. Journal of Periodontology 63, 995~996, 1992.
65.Saadoun, A.P. Management of furcation involvement. Journal of Western Society of Periodontology 33(3), 91~125, 1985.
66.Sanctis, M.D. and Prato, G.P. Root resection and root amputation. Current Opinion of Periodontology, 105~110, 1993.
67.Bergonholtz, A. Radectomy of multirooted teeth. Journal of American Dental Association 85, 870~875, 1972.
68.Iloyd, R.S. and Bear, P.N. Periodontal therapy by root resection. The Journal of Prosthetic Dentistry 19(2), 362~365, 1960.
69.Smith, S.M. and Brown, F.H. The hemisected mandibular molar: A strategic abutment. The Journal of Prosthetic Dentistry 9(1), 140~147, 1987.
70.黃啟洲，利用牙冠加長術合併半切斷術來處理臼齒牙齦下齲齒。鼎友，11(7)1,51~58, 1996.
71.Basten, CH. J., Ammons, W.F., and Persson, R. Long-term evaluation of root-resected molar: A retrospective study. The International Journal of Periodontics & Restorative Dentistry 16(3), 207~219, 1996.
72.Langer, B., Stein, S.D., and Wangenberg, B. An evaluation of root resections. A ten-years study. Journal of Periodontology 52, 719~722, 1981.
73.Blomlöf, L. Jannson, L., Appelgren, R., Ehnevid, H., and Lindskog, S. Prognosis and mortality of root-resected molars. The International Journal of Periodontics & Restorative Dentistry 17(2), 191~201, 1997.
74.Eastman, J.R. and Backmeyer, J. A review of periodontal, endodontic, and prosthetic consideration in odontogenous resection procedures. The International Journal of Periodontics & Restorative Dentistry 2,35~51, 1986.
75.Wenz, H.J., Lehmann, K.M., and Hertrampf, K. Clinical longevity of removable partial dentures retained by telescopic crowns: Outcome of the double crown with clearance fit. The international Journal of Periodontology 14(3), 207~213, 2001.
76.Hou, G. L., Liou, M.D., Lin, C.C., and Tsai, C.C. The clinical application of C-S-C telescope prosthesis. Journal of Formosa Dental Association 10, 251~262. 1987.
77.Weaver, J.D. Telescopic copings in restorative dentistry. The Journal of Prosthetic Dentistry 61(4), 429~433, 1989.
78.Yalisove, I.L. Crown and Sleeve-coping retainers for removable partial dentures. The Journal of Prosthetic Dentistry 16, 1069~1085, 1966.
79.Yalisove, I.L. Telescopic prosthetic therapy. Compendium: The continuing education in dentistry 11(10), 584~592, 1989.
80.Langer, A. Combination of diverse retainers in removable partial dentures. The Journal of Prosthetic Dentistry 40(4), 378~384, 1978.
81.Axelsson P, Lindhe J. The significance of maintenance care in the treatment of periodontal disease. J Clin Periodontol 1981;8:281.