病例討論專欄春季病例討論會病例二病例特色 : 上顎 kennedy class II 之雙重冠義齒復 59 歲蘇女士主訴醫療病史牙科病史 OD, RCT, scaling, extraction, single crown 口外檢查 Ovoid to square shape face f

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泱风谢
5 years ago
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slightly convex upper dental midline VS.

nasolabial angle: 88 口內檢查 38 中華民國贋復牙科學會 /

1 春季病例討論會病例二病例特色 : 上顎 kennedy class II 之雙重冠義齒復 59 歲蘇女士主訴醫療病史牙科病史 OD, RCT, scaling, extraction, single crown 口外檢查 Ovoid to square shape face facial profile: slightly convex upper dental midline VS. facial midline: on upper lip/e-line: on nasolabial angle: 88 口內檢查 38 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China,Taiwan

Maxilla: Arch form: ovoid Missing : 14, 27 Spacing : 11-21 15, 24 rotation 16, 17 mesial tilting Mandible: Arch form: ovoid Metal crown:36

上顎牙周檢查結果 maxilla others BOP BOP BOP BOP BOP BOP BOP FI I II TM 3 3 1 1 2 1 3 1 PD buccal 778 10910 323 336 245 322 323 423 778 845 979 655

7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 PD lingual 756 646 323 653 433 333 223 333 322 322 334 334 735 7910 buccal 535 335 334 533 223 424 323 344 233

2 Maxilla: Arch form: ovoid Missing : 14, 27 Spacing : , 24 rotation 16, 17 mesial tilting Mandible: Arch form: ovoid Metal crown:36 Crowding: , 45 rotation 37, 47 lingual tilting Tooth mobility: Grade 1:11,12, 25, 28,37 Grade 2:14,47 Grade 3:17,16,15,26 X 光片及牙周檢查上顎牙周檢查結果 maxilla others BOP BOP BOP BOP BOP BOP BOP FI I II TM PD buccal palatal maxilla 下顎牙周檢查結果 Mandbible mm mandible mandible PD lingual buccal FI I I I TM 2 1 others BOP BOP BOP BOP BOP BOP BOP BOP The Academy of Prosthetic Dentistry, Republic of China,Taiwan/ 中華民國贋復牙科學會 39

H H H G F F G G G H F H F 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42

Adeqate remaining bone Possibilities to control etiologic factors Maintainable dentition

furcationinvolvement Adequate maintenance possible Patient cooperation Moderate to advanced

patient compliance Advanced bone loss Degree II~III furcationinvolvement Tooth mobility

: 如上圖 Stduy cast analysis R't lateral view Canine & molar relation: class 1 Missing: 14 16, 17

overlap: 2mm (21-31) 11-21 spacing 11, 12 supra-eruption L't lateral view Canine & molar

3 H H H G F F G G G H F H F P F G G G G G G G G G G F P Good Fair Poor Questionable Hopeless Adeqate remaining bone Possibilities to control etiologic factors Maintainable dentition Patient cooperation Less than adequate remaining bone support Some tooth mobility Degree I furcationinvolvement Adequate maintenance possible Patient cooperation Moderate to advanced bone loss Tooth mobility Degree I~II furcationinvolvement Difficult to maintain rreas Doubtful patient compliance Advanced bone loss Degree II~III furcationinvolvement Tooth mobility Inaccessible area Advanced bone loss Nonmaintainable area Extraction indicated 整體預後 :Fair 個別預後 : 如上圖 Stduy cast analysis R't lateral view Canine & molar relation: class 1 Missing: 14 16, 17 mesial tilting 46 supra-eruption Frontal view Horizontal overlap: 2mm (21-31) Vertical overlap: 2mm (21-31) spacing 11, 12 supra-eruption L't lateral view Canine & molar relation: class 1 Missing: supra-eruption 40 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China,Taiwan

Problem list Diagnosis Generalized horizontal bony destruction Missing teeth: 14,27 Mobility Grade 111, 12, 14, 28, 37 Grade 223, 47 Grade 3: 15, 16, 17, 26 Furcation involvement G r ad e I : 1 7 (

4 Problem list Diagnosis Generalized horizontal bony destruction Missing teeth: 14,27 Mobility Grade 111, 12, 14, 28, 37 Grade 223, 47 Grade 3: 15, 16, 17, 26 Furcation involvement G r ad e I : 1 7 ( B), 2 7 (M, D), 3 7 (B, L), 36(B),46(B,L), 47(B) Grade II: 27(B) Supra-eruption: 11, 12, 28, 46 Spacing : Crowding: Treatment goals Prevent periodontium destruction Function Restore arch integrity Ideal occlusal plane Proper occlusal scheme Esthetics Generalized chronic periodontitis Missing teeth: 14,27 Multiple teeth malalignment Restore upper and lower missing teeth & establish harmony looks Tentative treatment plan Phase I Full mouth scaling Extract hopeless teeth 24,26,15,16,17 Provisional prosthesis to restore stable occlusion Phase II Flap op and ridge augmentation if necessary Implantation Phase III Prosthetic treatment option Final prosthesis fabrication Phase IV Periodic follow up Oral hygiene maintenance Denture adjustment if needed Prosthetic treatment options Treatment option 1: implant supported FPD Advantages Disadvantages Best funcation Long-term prognosis Comfortable High-cost Surgery Time-consuming Esthetic concern The Academy of Prosthetic Dentistry, Republic of China,Taiwan/ 中華民國贋復牙科學會 41

Treatment option 2A: implant-tooth-supported telescopic denture

Good founction No surgery Lonf-term prognosis Relative

traditional clasp retained RPD Advantages Disadvantages No

Moderate function Patient's choice Treatment option2b:

5 Treatment option 2A: implant-tooth-supported telescopic denture Treatment option2b: telescopic denture Advantages Disadvantages Good founction No surgery Lonf-term prognosis Relative high-cost Relative discomfortable Treatment option3: traditional clasp retained RPD Advantages Disadvantages No surgery Less cost Time saving Bone resorption Uncomfortable Moderate function Patient's choice Treatment option2b: telescopic denture 42 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China,Taiwan

6 Treatment course Provisional restoration 46 metal crown fabrication after intentional endo treatment Tooth preparation for inner crown fabrication Impression for inner crown fabrication The Academy of Prosthetic Dentistry, Republic of China,Taiwan/ 中華民國贋復牙科學會 43

7 Inner crown try-in and pick-up Occlusal rim Facebow transfer and bite registration 44 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China,Taiwan

8 Outer crown and framework try-in Wax denture try-in The Academy of Prosthetic Dentistry, Republic of China,Taiwan/ 中華民國贋復牙科學會 45

9 Denture after packing Delivery Protrusion 46 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China,Taiwan

10 Right side working Left side working Full mouth periapical X-rays after delivery The Academy of Prosthetic Dentistry, Republic of China,Taiwan/ 中華民國贋復牙科學會 47

11 One year follow up Q Telescope denture cantileverdistal free end (long axis) A major connectorposterior strap posterior strap strap denturestabilitybridge type (rigidity) Q A (stability loss) (PDL widening) (retention) abutment retention Q retentionretention A 48 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China,Taiwan

12 Q A (taper) Q (fitness) (ridge resorption) A (fitness) reline Q A (rest)13 splinting(attachment) (retention) Q case23, 25, 28telescope28 (preparation)28telescope(rest) A telescope abutmentretention7 28telescope abutmentretention(support) splinting28 Q telescope denture(survival rate) A Q 46crownenameloplasty A X4645 intentional endodontic treatment Q abutment A Q 3728telescope abutment A 28survival rate Konus telescoperigid support Konuscantileversupport rigid supportmucosa free end28restrestkonus telescope retentionkonus telescope retentionrest 28secondary splinting The Academy of Prosthetic Dentistry, Republic of China,Taiwan/ 中華民國贋復牙科學會 49

1. Generalized chronic periodontitis. 2. Occlusal attrition. 3. Posterior bite collapse 4. Chronic apical periodontitis of 15, 44 Periodontal treatmen

1. Generalized chronic periodontitis. 2. Occlusal attrition. 3. Posterior bite collapse 4. Chronic apical periodontitis of 15, 44 Periodontal treatmen 1 1. 2. 3. addition silicone agar functional impression wax 56 Missing teeth of 11,12,14,18,21,22,24,25,26,27,28,34,37,38,46,47,48 Uneven occlusal plane and loss of vertical dimension Multiple occlusal

病例討論專欄 春季病例討論會病例二 病例特色 : 上顎 kennedy class II 之雙重冠義齒 復 59 歲蘇女士主訴 醫療病史 牙科病史 OD, RCT, scaling, extraction, single crown 口外檢查 Ovoid to square shape face f

病例討論專欄春季病例討論會病例二病例特色 : 上顎 kennedy class II 之雙重冠義齒復 59 歲蘇女士主訴醫療病史牙科病史 OD, RCT, scaling, extraction, single crown 口外檢查 Ovoid to square shape face f