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【牙周醫師看植牙】系列之1

牙周醫師的植牙跟一般科及口腔外科醫師的植牙會有何不同？我的觀察有以下5點：

1、 不會只相信CT，因為如果CT切太薄會高估問題、低估潛力

2、 一定要照小片（PA片），且最好有2個不同的角度，要相信有看到的，而不是猜測看不到的

3、 一定要依照患者臨床上牙周囊袋及搖動的情形來判斷是否拔除患部牙或鄰牙？或是保留？

      而不是搖牙＝拔牙

4、 一定要同時治療鄰牙的牙周病來縮小區域，而不是以連帶拔牙的方式反而擴大患部

5、重視軟硬組織的重建高度，最理想的重建是植牙跟鄰牙相接的齦緣線及骨線的高低落差越少越好

【Implant Reconstruction SEEN by Periodontist】1

Implant reconstructed dentition is becoming more and more popular not just for full edentulism but also for partial edentulism. While co-existed in a periodontally compromised dentition with natural teeth remains a big challenge, the implant assisted rehabilitation so called “perio-prosthesis” is difficult to balance between teeth with reduced periodontium & implants with augmented ridges.

As a periodontist, I found it easier to reconstruct a ridge for implant while retained a neighboring tooth even with reduced periodontium. With the help of the neighboring periodontium regardless how reduced it is, one can narrows the surgical site at the same time augment the ridge. On the other side, with the help of the implant to share the occlusal load, the periodontally compromised tooth was further reconciled . As a matter of fact, this serves as a mutually beneficial act.

The key though is to have the faith to regenerate both ridges and periodontium at the same time. The importance to distinguish hopeless to be removed and to be rescued can not be judged by X ray only. One should exercise the overall clinical evaluation.