| Summary: | 碩士 === 高雄醫學大學 === 牙醫學研究所碩士在職專班 === 97 === Severe periodontal destruction is characterized by severe bone loss, gingival recession, tooth loss, tooth mobility, pathological migration and pain. It is often accompanied by occlusal diseases such as altered plane of occlusion, tipping and elongation of teeth into edentulous areas and occlusal disturbances which lead to secondary trauma from occlusion. These pathological changes lead to loss of oral and social functions, esthetics, intimacy and even self esteem.
Contemporary periodontal therapy is no longer just root planing and open flap surgery. Advances in surgical techniques and dental materials nourished guided tissue regeneration, guided bone regeneration, periodontal plastic surgery and lately the use of growth facors. New treatment protocols build a better foundation for future prosthetic rehabilitation. However interdisplinary collaboration with oral surgeons, orthodontists and endodontists may be required to achieve the final goal.
Patients who suffered from severe periodontal destruction cannot be treated successfully with periodontal therapy alone. Occlusal diseases that accomplish tooth lost in periodontally compromised patients must be addressed however it is often overlooked. Thorough examination in an orderly manner assures accurate diagnoses and provide best treatment prognosis.
Giving the patient an esthetic long lasting final prosthesis is the final goal of treatment. However the clinician need to understand the patient’s needs, desires, motivation, economic condition and discuss thoroughly each treatment modality before reaching the final treatment plan that best fit the patient.
This thesis presents 10 patients with complex treatment needs. Thorough examinations were carried out to determine the diagnoses. Treatment plans were discussed extensively with patients to suit their needs. Treamtnets were carried out following the concept of “evidence based dentistry” and “conservative dentistry”to prevent under-diagnoses and over treatments. The use of dental implants simplified the treatment planning process yet did not lower the standard of care. Periodontal therapy includes meticulous oral hygiene instruction, thorough root planning, periodontal regeneration with resorbable membranes and growth factors, gingival grafting and crown lengthening. Other surgical treatments includes guided bone regeneration , immediate implants, sinus augmentation and periimplantitis managements. Final prostheses designs include conventional removable partial denture, double crown overdenture, implant supported fixed prostheses. Through integrated periodontal-prosthetic treatments providing the patient a healty, easily maintained oral condition. At the same time satisfy patient’s oral function including mastication, phonetics and esthetics.
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