Apr
植體周圍炎再生治療[極限] ! ?
這次的案例是由熟識的轉診醫師轉來的56歲女性患者，欲接受左下牙位34、35、36的三顆拔牙及植牙重建。
一般而言，我會遵照轉診醫的指示來進行，加上這三顆牙誠如轉診醫所訴，有以下情形，可說是明顯無救：
一、牙位34、36的植牙已經骨吸收超過70-90％
二、牙位35的自然牙有近心骨缺損和三級搖動度
但患者卻提出了一個挑戰性極高的請求：「林醫師可以幫我留下牙齒嗎？」
我問哪一顆？他說【三顆都要！】於是我如其所願地保留下三顆無救牙.....
就像我以前習慣留下無救但可用的自然牙一樣，在非手術治療處理之後自然牙上使用GTR、在植牙上使用GBR，同時留下了這兩顆植牙及自然牙，迄今已三年。
我再生生病植牙的方式和自然牙相同，不需要拆牙冠、也不需卸下基台，便利實用少變數, 照著這樣的方法就能夠得到圖中的結果，但在執行前必須要從患者身上取得三個重要前提：
一、可以正常使用這些牙齒
二、患者本身強烈的想留下牙齒
三、患者不希望負擔拔牙後重建所需的時間、金錢以及精力
A referred 56 y/o female patient with the referral notes said “Please extract #’s 19-21 (34-36) and reconstruct the site with implants.”
Generally speaking, I would follow the instruction and obey what was ordered. Because these 3 teeth are so “scientifically and justifiably hopeless” due to severe bone loss over 70-90% for #’s 19 & 21(36 & 34) and grade III mobility for #20 (35). However, this patient seems to have a very challenging and pathetic request “Can you still keep the teeth for me?” I said: “Which one?” She replied: “All of them please!!!”
So I did. Just like the way I would keep hopeless natural teeth in the past, saving these 3 teeth for more than 3 years already after periodontal regeneration surgery (GTR for #21 and GBR for #’s 20 & 19) following non-surgical treatment without removing the crown and abutment on implants .
The key questions that I ask the patient which allow me to go for the treatment were the following 3:
She could still function (chew) with this site without difficulty.
She wanted to keep the tooth and implants more than I do.
She can’t afford the reconstruction time, money and effort if anyone of them was removed.
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