Jul
【牙周醫師看植牙】系列之2
【牙周醫師看植牙】系列之2
轉診醫希望能夠一次拔除3顆無救牙（＃36、＃37、＃38）、再以2顆植牙來重建，這3顆都是嚴重牙周囊袋及搖動度、已經骨吸收到根尖、甚至有極深二級分岔的無救牙，其中唯有＃37垂直移動。因患者有全口牙周疾病，所以建議在拔牙重建之前，先進行非手術的牙周治療來清潔、控制疾病。
治療後＃36、＃38 都有明顯改善，原本就垂直移動的＃37仍維持拔除的建議，患者在表達希望保留＃36、＃38 的意願之後，我們為已死髓的＃36進行根管治療→根尖手術→死胡同隧道成型術。因有保留患部的前後鄰牙＃36、＃38，當患者在＃37植牙時，有極大的幫助！不僅拔牙窩的保存很簡單，拔牙時不需翻瓣，只填入膠原蛋白塞做位點保存即可，極大的減少如果選擇翻瓣後大量補骨再生的拔牙窩保存術給予患者的腫脹、不適與未來的抗拒。
3個月後翻瓣時，只需做微量的垂直和水平骨重建就可以同時植牙，不需再補骨才能植且也不需補角化齦。最後完成的植牙在型態與功能部分，皆與天然鄰牙一致的大小與軟組織的高度；雙贏的結果不僅是重建的植牙和兩顆相鄰無救牙都藉由彼此分擔咬合的力量而達到，患者和二位治療醫師（植牙、假牙醫師）也如此，除非植牙的治療是以利益優先而非醫療優先。
【Implant Reconstruction SEEN by Periodontist】2
3 periodontally hopeless teeth #’s 17-19 were asked to be extracted at the same time for future implant reconstruction by a referring dentist.
Non-surgical periodontal treatment was given to all teeth (including these hopeless teeth) prior to execution of the referral request with the approval of the patient due to generalized moderate to severe periodontitis. 2 out of 3 of the hopeless teeth healed with improved prognosis except for #18 which was present with apical movement (depressibility) initially. The implant reconstruction is thus recommended with 3 phases approach:
extract #18 with socket preservation and implant
placement 3 months later
extract #19 and #17 with socket preservation following restored #18 after 3 months
Restored #19 implant 3 months after
Patient declined the treatment plan for 2nd & 3rd phases due to favorable responses on #’s 19 &17 following non-surgical treatment and express strong desire to retain them. Thus #19 underwent root canal treatment followed by apicoectomy and Cau-de-sac furcation surgery. Simultaneous surgical implantation and hard tissue augmentation for #18 is performed with minor horizontal & vertical GBR.
The result of retaining #’s 19 & 17 is obviously beneficial to implant reconstruction for #18. The implant crown can be restored to its desirable height and size mimicking the adjacent teeth. The reciprocal benefit from the occlusal load of the implant disperses the burden of two adjacent teeth. A win-win situation is accomplished not just in the standpoint of 3 teeth as well as in the standpoint of a patient & two treating dentists. Because implant therapy and any other treatment as well shouldn’t meant for a greater financial reward than the therapeutic one.
n summary, the retention of two adjacent severe periodontally involved teeth makes great differences with the following remarks:
Easier to place implant in between with better maintenance of soft & hard tissue level.
Open socket preservation by collagen plug is sufficient without changing MGJ.
Periodontal treatment rendered for neighboring hopeless teeth is essential.
Sharing occlusal force by implant can help ease off the load for adjacent hopeless teeth.
返回列表