贋 June 第 19 卷第 1 期 p.59 p.65 p.72 Malo clinic in Lisbon 參訪感想 2014 年之西班牙亂亂走台北榮總贋復專科受訓心得 Contents 小編的話何易 1 中華民國贋復牙科學會理事長上任感言懷抱不變的價值迎向巨變的年代彭玉秋

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2 贋 June 第 19 卷第 1 期 p.59 p.65 p.72 Malo clinic in Lisbon 參訪感想 2014 年之西班牙亂亂走台北榮總贋復專科受訓心得 Contents 小編的話何易 1 中華民國贋復牙科學會理事長上任感言懷抱不變的價值迎向巨變的年代彭玉秋 2 病例討論專欄臨床病例報告一報告 / 張薰方 June 第 19 卷第 1 期臨床病例報告二報告 / 黃曼琦 18 臨床病例報告三報告 / 蘇意翔 34 學者專訪 Paulo Malo 演講及訪問心得何易 48 病例討論專欄臨床病例報告學者專訪 Paulo Malo 演講及訪問心得 Malo clinic in Lisbon 參訪感想旅遊遊記西班牙酒莊巡禮訓練機構花絮台北榮總贋復專科受訓心得 Malo clinic in Lisbon 參訪感想王東美 56 旅遊遊記 2014 年之西班牙亂亂走曾琬瑜 62 訓練機構花絮台北榮總贋復專科受訓心得蘇意翔 72 活動花絮 75 封面照片提供 : 鄭鈞仁醫師 / / / / / / / / / (02) /(02) / / 台灣郵政北台字第 3844 號執照登記為雜誌交寄行政院新聞局局版台誌第 8091 號 /

3 line Paulo Malo Malo Malo Clinic Malo Clinic Malo Malo 何易贋 1

4 懷抱不變的價值迎向巨變的年代 2 贋

5 贋 3 彭玉秋

6 臨床病例報告一 2015/04/11 4 贋

7 贋 5 Basic Information Name: Age: 44 y/o Gender: Female Occupation: Marital status: Married Education status: college Financial condition: fair Attitude: cooperative but very scared Chief Complaint PMH Denied any systemic disease Delivery by caesarean section Drug allergy: Penicillin (Amoxicillin: skin rash) PDH Sporadic dental care at LDC 15-23, 4445 crowns 15 yrs ago (caries) 4647 removable denture Cellulitis over 2223 region s/p antibiotic treatment in Aug , 24, 28, 35 residual root extraction in VGHTPE in Sep. and Oct Extraoral Examination Frontal view: Facial asymmetry: ( ) Facial proportion: 1.0: 1.0: 1.0 Mentalis strain: (-) Lip incompetence: (-) Smile analysis: Gummy smile: (-) Upper incisor show: x Upper midline to facial midline: on Lateral view: Facial profile: convex Labiomental fold: average Upper lip to E line: protrude Lower lip to E line: protrude

8 Intraoral Examination Dental midline Upper: shift to left 1.5 mm Lower: shift to right 1 mm Arch form Upper: ovoid Lower: ovoid Radiographic Examination 6 贋

9 贋 7 Probing Data Mobility GM-BP(I) B GM-BP(I) P Mobility GM-BP(I) B GM-BP(I) P Mobility GM-BP(I) B GM-BP(I) P Mobility GM-BP(I) B GM-BP(I) P Problem list Multiple missing teeth: 16,24,26,28,35,37,38,46,47,48 Multiple ill-fitting prostheses: 15-23,34,36,4445 Caries: 18,17,25,27,43 Dentophobia: weep during treatment Anterior esthetics Endodontic problems: 15,14,13,21,22,23 Diagnosis Multiple missing teeth Chronic gingivitis Caries Residual root Pulp necrosis Chronic apical periodontitis Panoramic film

10 Definitive Treatment Plan options Treatment Option - 1 Upper crown lengthening - 14, 13, 12, 11, 21, 22, 27 single crown - 15x17, 23x25 bridge Lower - 34x36, 4445x bridge Treatment Option - 2 Upper crown lengthening - 15, 14, 13, 12, 11, 21, 27 single crown x25 bridge Lower - 44, 45 single crown - 34x36 bridge OBP Upper Treatment Option , 14, 13, 12, 11, 25, 27 single crown - Class III mod I RPD Lower - 44, 45 single crown - 34x36 bridge Tentative treatment plan Full mouth ultrasonic scaling Remove crowns, provide provisional restorations OD filling RCT / re-treatment Definitive Treatment Course 8 贋

11 1st provisional crowns 贋 9

12 2nd provisional crowns crown lengthening Provisional crown adjustment 10 贋

13 21 22 crown lengthening 贋 11

14 Cross-mounting Fully wax up Cut back 12 贋

15 Metal coping 贋 13

16 Delivery 14 贋

17 Extraoral Examination 贋 15

18 16 贋

19 贋 17 Q1 VD VD defi nitive restoration VD A1 VD CR mounting diagnostic wax up VD master cast mounting Duralay jig VD VD VD Q long-span bridge key and keyway connector A2 abutment teeth 25 pulp vitality key and keyway Q forced eruption crown lengthening A3 forced eruption crown lengthening crown-root ratio 23 24

20 臨床病例報告二 2013/04/11 18 贋

21 贋 19 Basic Information Name: X Age: 48 y/o Gender: male Occupation: nil Marital status: single Education status: Financial condition: fair Attitude: cooperative but anxious Chief Complaint PMH Mental retardation Hypertension(-), DM(-), drug allergy(-) Gastric ulcer PDH Sporadic dental care at LDC 4647 implant in LDC? yrs ago 13, 3536 implant in LDC 1.5 yrs ago VGHTPE 27, 45 extracted in , 44 RCT in Extraoral Examination Smile analysis: Gummy smile: ( ) Upper incisor show: x Upper midline to facial midline: x Asymmetric smile

22 Intraoral Examination Missing teeth: 1816, , , 4548 Ill- fitting splinting crowns and bridge: 23x25, 3338, 4647 Caries: , 2122, 38 Porcelain fracture: 4647 Residual root: 12, 11 Implant: 13,46, 47 Arch form Upper: ovoid Lower: ovoid Radiographic Examination 20 贋

23 贋 21 Probing Data Mobility I I I I I GM-BP(I) B GM-BP(I) P GM-BP(II) B GM-BP(II) P Mobility GM-BP(I) B GM-BP(I) P GM-BP(II) B GM-BP(II) P Mobility I II GM-BP(I) B GM-BP(I) L GM-BP(II) B GM-BP(II) L Mobility I I I GM-BP(I) B GM-BP(I) L GM-BP(II) B GM-BP(II) L

24 Panoramic Radiograph Problem list Loss of teeth Generalized mild, localized moderate chronic periodontitis Residual roots Diagnosis Generalized mild and localized moderate chronic periodontitis Periimplant-mucositis: 13, 4647 Multiple teeth missing: 1816, , , 4548 Ill-fitted prostheses: 23x25, 38, 4647 Caries: , 2122, 38 Residual roots: 1211 Root fracture: 11 Caries: , 2122, 38 Attrition: 33~42 Residual ridge resorption: 3rd quarter Mental retardation Tentative treatment plan Department Region Treatment Perio FM OHI, infection control Crown lengthening evaluation Endo Re-treatment OS 11 Extraction Prostho FM Temporary RPD in therapautic position 38 Crown removal 17x15, 14, 23x25, 33, 43, 44 Temporary crowns and bridges 22 贋

25 贋 23 Diagnostic Wax-up Definitive Treatment Course

26 Definitive Treatment plan-1: Fixed Upper crowns & bridges: 17x15, 14, 13, 12x21, 22, 23x25 Lower crowns & bridges: 33, 43, 44 Implant: 45, 4647 在原本的 implant 上重新做 crown 病例討論專欄 Definitive Treatment plan-2: Removable Upper crowns & bridges: 17x15, 14, 23x25 Overdenture abutments: 13, 12, 21, 22 Kennedy Class II RPD Lower crowns & bridges: 33, 43, 44, 46, 47 Temporary RPD Try-in 24 中華民國贋復牙科學會會訊

27 Diagnostic set up of permanent RPD 贋 25

28 Final impression of 33, 43, 44 Overdenture abutment: Fully Wax up and denture tooth set up Bite registration: Record base Duralay Occlusion rim Bite material Surveyed crown 33, 43: cingulum rest 44: mesial occlusal rest Buccal undercut 33, 44: mesio-buccal 26 贋

29 贋 27 Surveying and Cutback Bisque try in Impression of upper arch

30 Fully Wax up and denture tooth set up Surveyed crown 1516, 2425: embrasure rest Surveying and Cutback Bisque try in 28 贋

31 贋 29 Delivery Impression of RPD

32 Try in Bite record Esthetic try in 30 贋

33 贋 31 Surveying and Cutback Implant impression Fully wax up

34 Coping try in Delivery 3 mouths follow up 32 贋

35 贋 33 Q1 12, 11, 22 overdenture abutment ( ) A1 overdenture abutment skeletal Class II caries (2) overdenture abutment caries, periodontitis overdenture abutment Q2 RPD 46(implant) ( ) A2 46,47 implant 45 distal extension rest seat Q3 22 denture tooth bridge gingival line ( ) A3 Skeletal Class II overdenture abutment denture teeth acrylic resin mechanical retention denture teeth( root form ) Q4 ( ) A4

36 臨床病例報告三 2013/04/11 34 贋

37 贋 35 Basic Information Name: Chief Complaint Age: 47 Gender: Female Occupation: Marital status: Single Education status: Financial condition: fair Attitude: Cooperativ PMH Denied other systemic disease PDH Sporadic dental care in LDC Missing teeth : 16,38,48 loss > 10 yrs 11,46,47 : ext. 4~5 ys at LDC 31 : ext. at LDC, : loss, ,37 : ext. at hospital, : loss, GBR over upper ant. at LDC 4 ys ago 46 implant+gbr at LDC 5 yrs ago Crown #22 : about 6 years Extraoral Examination Frontal view: Facial asymmetry: (+) Facial proportion: 1.0: 1.0: 1.0 Mentalis strain: (-) Lip incompetence: (-) Lateral view: Facial profile: straight Labiomental fold: average Upper lip to E line: retrude Lower lip to E line: retrude Smile analysis: Gummy smile: (-) Upper incisor show: x Upper midline to facial midline: R't 2mm Lower midline to facial midline: X

38 Intraoral Examination Missing teeth : 11,21,16 Gingival recession Previous restoration : 15,17,25,26,27,28 PFM : 22 Temporary prosthesis : 11 Dental caries : 14,15,25,26,27 Radiographic Examination 36 贋

39 贋 37 Probing Data Mobility II I II GM- BP(I) B GM- BP(I) P Mobility III I I I I GM- BP(I) B GM- BP(I) P Mobility I II GM- BP(I) L GM- BP(I) B Mobility III I I II II GM- BP(I) L GM- BP(I) B Problem list Generalized severe chronic periodontitis Dental caries 14,25,26,27 Chronic apical periodontitis 15, 22 Peri-implantitis 46 Multiple teeth loss 16,36,37,38,46,47,48 Diagnosis Generalized severe chronic periodontitis Multiple teeth loss 16,36,37,38,46,47,48 Dental caries 14,15,25,26,27 Chronic apical periodontitis 15, 22 Peri-implantitis 46 Panoramic Radiograph Patient's Expectation

40 Tentative treatment planning Infection control OHI & Periodontal treatment Remove caries and restoration 14,15,25,26,27 Root canal treatment 15 Removal of 46 Implant Extraction of questionable tooth 17,12,22 Delivery of upper & lower interim denture Evaluation Cast preparation and survey Treatment options Interim denture delivery 38 贋

41 贋 39 Check bony defect Diagnostic wax up Treatment Option - 1 Upper - Ext. 12,17,22 - PFM : 15 - Class III mod 1 RPD Lower - Ext. 35,45,46 (4142 if needed) - Class I mod 1 RPD Treatment Option - 2 Upper - Ext. 12,17,22 - PFM : 15 - Class III mod 1 RPD Lower - Ext. 35,41,42,45,46-33,34,43,44 splinted survey crown - Bar attachment between Class I mod 1 RPD Treatment Option - 3 Upper - Ext. 12,17,22 - PFM : 13xxxx23 - Class III RPD Lower - Ext. 35,41,42,45,46 - PFM : 43xxxx33 - Class I RPD Definitive Treatment Plan Upper - Ext. 12,17,22 - Soft tissue augmentation over anterior area - PFM : 13xxxx23 Lower - Ext. 41,42,46 - Soft tissue augmentation over anterior area - PFM : 43xxxx33 Modified Treatment Plan Upper - Ext. 12,17,22 - PFM : 13xxxx23 Lower - Ext. 41,42,46 - Soft tissue augmentation over anterior area - PFM : 43xxxx33

42 1st provisional FPD area Free gingival graft area 40 贋

43 贋 41 2nd provisional FPD 1st prov. 2nd prov. Abutment condition

44 Final impression Color match Fully wax up 42 贋

45 贋 43 Cut back Framework try in

46 Bisque try in and glaze Delivery 44 贋

47 贋 45 2 months follow up 6 months F/U

48 Q1 A1 Q2 A2 Q3 (splinting) A3 46 贋

49 學會活動快報 2015/09/06 秋季繼續教育台北場 - 如何在口內蓋房子, 做個稱職的義齒建築師全面攻略二 : 執行與維護 2015/09/12 新光醫院病例討論會 2015/09/20 秋季繼續教育高雄場 - 如何在口內蓋房子, 做個稱職的義齒建築師全面攻略二 : 執行與維護 2015/11/21-22 第十四屆第一次會員大會暨學術研討會 2015/12/05 台北醫學大學病例討論會奇美博物館半日遊 ( 門票限量 ) 贋復新秀專題報告特別演講 : 闕玲惠醫師外賓演講 : 劉朋儒醫師會員大會及餐敘奇美博物館台南小白宮 - 彭玉秋理事長提供贋 47

50 Paulo Malo 演講及訪問心得 48 贋

51 贋 Dr. Malo All-on-4 Allon-4 Malo Clinic Malo Clinic Dr. Malo Malo Malo 35 Christian Dior All-on-4 Malo All-on surgical protocol All-on-4 bridge All-on-4 All-on-4 bridge what bridge Malo bridge Malo The Malo Clinic Protocol All-on-4 procedure Malo Bridge/ Malo Clinic Bridge

52 Malo Clinic Bridge 1. All-acrylic bridge 2. Acrylic with titanium structure 3. Ceramic bridge with All ceramic crowns and titanium structure All-on-4 Malo immediate loading 1989 push implants to the limit Straumann anchorage NobleBiocare immediate loading immediate loading case immediate loading immediate loading immediate loading protocol 1993 All-on-4 All-on-4 surgical protocol Malo All-on-4 guide All-on-4 guide NobelBiocare Malo Clinic Guide NobelBiocare 99% extraction socket 70% risk factors retrospective prospective JPD 50 贋

53 贋 51 prosthesis failure implants implant prosthesis failure Malo prosthesis failure prosthesis failure Malo initial stability bone quality bone quality Nobel Speedy Malo Nobel Speedy Malo bicortical stabilization bicortical stabilization Nobel Speedy bicortical stabilization Nobel Speedy Branemark MK III engage outer cortex sinus floor speedy implant 2mm engage sinus floor bicortical stabilization Nobel Speedy Malo immediate function Malo immediate loading Malo immediate loading Malo Malo If you are ahead of the crowd for 15 years The crowd will kill you Professor Per-Ingvar Brånemark Malo Malo

54 Malo Malo All-on-4 All-on-the floor All-on-4 super All-on-4 extra All-on-4 plus All-on Malo impact factor JDR JPD 2004 Allon-4 hybrid zygomatic anchorage double zygoma implants Malo case protocol protocol indication All-on-4 Malo All-on-4 surgical protocol 1. 4 implants for full-arch reconstruction 2. Angulation between implants <45 3. Implant anchorage on jaw bone or zygoma 4. Use of cantilever if needed 5. Immediate function with all-acrylic bridge 6. Bone reduction if needed All-on-4 surgical protocol 1. Avoid bone grafting 2. High Success rate 3. High hygiene maintenance capability 4. Immediate load 52 贋

55 贋 53 Malo Malo Clinic bridge 1. All-acrylic bridge denture resin flexibility biomechanic property cantilever 2. Acrylic bridge titanium structure Kulzer A2 3. Ceramic bridge The Rolls-Royce titanium structure All ceramic crowns Malo Malo bridge all-acrylic bridge interim prosthesis acrylic bridge ceramic bridge hybrid denture Malo traditional fixed bridge papilla Lower smile line traditional protocol cantilever pontic cantilever pontic Malo case Malo X acrylic bridge with titanium structure ceramic bridge all-acrylic bridge ceramic bridge with titanium structure all-acrylic bridge denture resin Tempron PMMA resin provisional crown provisional all-acrylic bridge final prosthesis Malo clinic bridge false papilla pink esthetics cantilever pontics smile line

56 Malo 1. over-denture 6, 4, 2, 2, 4, 6 (#16#14#12#22#24#26) cross-arch fixed bridge All-on-4 standard 2. 6, 3, 3, , 2, 2, , 1, 1, 4 bone graft 5. 2, 2 + 5, 5 Zygoma implants All-on-4 hybrid 6. 5, 3, 3, 5 double zygoma implants All- on-4 double zygoma 7. bone grafting Malo extra-maxilla surgical protocol maxilla bone grafting maxilla Malo CT Malo zygoma zygoma Malo Zygoma implants Malo extramaxilla surgical protocol zygoma 5~10mm anchorage implant neck osseointegration cantilever zygoma implant rescue kit zygoma implant trephine zygoma implant tip implant Malo zygoma implants All-on-4 hybrid All-on-4 double zygoma 54 贋

57 贋 55 Barbara Alves Barbara Alves BBC Barbara Malo All-on-4 double zygoma Obturator All-on-4 standard All-on-4 double zygoma indication Barbara Alves Perder um Rosto, Ganhar uma Vida Losing a face, winning a life + ACTIVA Barbara Alves zygoma Malo All-on-4 extreme All-on-4 maxilla zygoma implant implant platform abutment X abutment screw impression coping pin abutment zygoma implant 45 Malo cantilever zygoma implants zygoma 10mm Malo slide Barbara Alves+Malo YouTube CT zygoma implant CT titanium strcture Malo Malo Malo Malo Clinic Malo All-on-4 case All-on-4

58 Malo clinic in Lisbon 參訪感想 56 贋

59 贋 All-on-4 Dr. Malo's clinic Zygoma implant 2009 maxillectomy case case abutment obturator retention zygoma implant All-on-4 case Malo Malo clinic Malo dental clinic

60 Tray polo All on 4 Zygoma surgery Malo lecture all-on-4 1~2 record base VD & bite registration mounting cast & try-in fabrication delivery 22 Dr. Malo Malo clinic All-on-4 case All-On-4 case PS PS case 58 贋

61 贋 59 zygoma Zygoma Dr. Malo Surgery vertical dimension Flap Dr. Malo implant zygoma implant surgery case implant handpiece zygoma orbial rim drill handpiece Flap Dr. Malo zygoma sinus implant zygoma bone maxilla bone surface zygoma implant implant buccal mucosa implant sinus elevation buccal palatal side zygoma All-On-4 multiunit angular abutment PS metal wire & pattern resin open tray impression coping PVS putty Tray resin loop PVS putty rigidity white healing cap record base Bite registration implant healing cap record base wax rim bite try-in delivery lecture delivery schedule lecture prosthesis hands-on Zygoma implant Surgery & Lecture Dr. Malo Malo bridge indication restoration space soft tissue prosthesis smile lip line 2mm upper arch case

62 restoration space acrylic resin interim fixed bridge 4 implant cantilever cantilever part 4~6 3-3 occlusal contact bridge fracture restoration space implant length initial stability immediate loading Dr. Malo (Cabo da Roca) 60 贋

63 贋 61 Porto Sintra Malo clinic!

64 2014 年之西班牙亂亂走 62 贋

65 贋 63 ( ) Yeeyu Demi Yeeyu Demi Demi ( ) 8 ceph lateral profile 5! -Toledo (Toledo)

66 Coke cola 8 What a wonderful day! ( 64 贋

67 贋 65. Mazapán Streptococcus mutans Santa Rita

68 Santa Rita??? ( )? 66 贋

69 贋 67

70 Haro Haro Haro kimogi! 20 Tempranillo Garnacha Monastrell Albariño( Galicia ) Palomino Airen Macabeo Rioja Tempranillo 61, Rioja Alta 43% Rioja Alavesa 20% Rioja Baja 37% Haro( ) Rioja Alta Rioja Haro Barrio de la Estación Haro? 68 贋

71 贋 69 M Muga Muga Bodegas Muga ( ).. Isaac Muga Martínez 1932 M Muga Muga Rioja Alta CVNE López de Heredia 18, Allier Trançais 2 Green harvest Muga

72 .. Veraison?? ( )?!? Streptococcus mutans Muga Muga 70 贋

73 贋 71 La Rioja Alta S.A. La Rioja Alta S.A. Muga La Rioja Alta S.A. Muga!...

74 台北榮總贋復專科受訓心得贋 72 贋

75 贋 73 贋 2~

76 8 - 贋 lab 74 贋

77 贋 75 The 9 th Biennial Congress of Asian Academy of Prosthodontics (AAP) The 27 th Annual Scientific Meeting & General Assembly of the Academy of Prosthetic Dentistry, R.O.C. Taiwan (APD-ROC Taiwan) Prof. Dr. Urs BELSER

78 The 9 th Biennial Congress of Asian Academy of Prosthodontics (AAP) The 27 th Annual Scientific Meeting & General Assembly of the Academy of Prosthetic Dentistry, R.O.C. Taiwan (APD-ROC Taiwan) Dr. Urs BELSER 76 贋

79 贋 77 Dr. Urs BELSER Prof. Dr. Urs BELSER

贋 All-on-4 Dr. Malo's clinic Zygoma implant 2009 maxillectomy case case abutment obturator retention zygoma implant All-on-4 case Malo Malo cl

贋 All-on-4 Dr. Malo's clinic Zygoma implant 2009 maxillectomy case case abutment obturator retention zygoma implant All-on-4 case Malo Malo cl Malo clinic in Lisbon 參訪感想 56 贋贋 57 2014 All-on-4 Dr. Malo's clinic Zygoma implant 2009 maxillectomy case case abutment obturator retention zygoma implant All-on-4 case Malo Malo clinic Malo dental clinic

贋 June 第 19 卷第 1 期 p.59 p.65 p.72 Malo clinic in Lisbon 參訪感想 2014 年之西班牙亂亂走 台北榮總贋復專科受訓心得 Contents 小編的話何易 1 中華民國贋復牙科學會 理事長上任感言 懷抱不變的價值迎向巨變的年代 彭玉秋

贋 June 第 19 卷第 1 期 p.59 p.65 p.72 Malo clinic in Lisbon 參訪感想 2014 年之西班牙亂亂走台北榮總贋復專科受訓心得 Contents 小編的話何易 1 中華民國贋復牙科學會理事長上任感言懷抱不變的價值迎向巨變的年代彭玉秋