● 資深牙醫的良心告白：能做假牙就不要植牙

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資深牙醫的良心告白：能做假牙就不要植牙！
康健雜誌   作者／鄭光顯   – 2013年2月11日下午4:27
    《康健》在2012年9月推出「牙醫沒說的植牙三大陷阱」後，陸續有多位牙醫來信說明臨床經驗是能做假牙就不要做植牙。選其中一篇供讀者參考。
     我詳細研讀《康健》「牙醫沒說的植牙三大陷阱」之後，同意這篇文章大致所言真實，很少有刊物談論如此詳盡。但還有其他陷阱需要補充，畢竟許多人對於該不該做植牙或假牙仍霧煞煞，且對這部份的醫療品質存著許多迷思，決定寫下多年來的臨床心得，跟大家分享。
Q1 植牙較優於復假牙治療？
     任何醫療的最大目標應該是：治療者願意提供較省時、省錢、簡單不複雜、安全的診斷及治療方法，且以病人利益為首要考量。
     可惜，醫療在資本主義影響下傾向商業化，植牙已不是「林來瘋」而是「植牙瘋」，成為最夯的醫療方法，這是因為多數民眾及牙醫師被誤導的結果。
     植牙是缺牙時的治療方式之一，但非首選，是沒有辦法的最終選擇。在許多狀況下，傳統假牙不管是固定或活動假牙，仍能有不錯的效果。大部份情況都不是非用植牙醫療不可（殺雞不必用牛刀）。但是想在傳統假牙醫療模式中得到高水準的醫療，並不容易，許多醫療者趁機鼓吹植牙有多棒。
      執業牙醫30年來，我常接獲假牙不舒適、到處求醫都沒辦法得到滿意解決的病人說：「不知道，也無從選擇何者有較高明醫術的治療者，而困擾不已。」
       因為許多病人及醫療提供者不太清楚成功療法的標準，就算病人「感覺還算不錯」，但在達人的檢視下，離成功標準還遠呢！因為病人往往使用植牙一段時間後，不良狀況才會慢慢浮現。
     傳統假牙的治療模式比植牙悠久。一項大規模文獻研究發現，傳統固定式假牙10年的生物性併發症，如再度蛀牙、牙周病變、牙髓病變及生物機械性併發症例如假牙鬆脫、斷裂等，約一成左右；但植牙後五年，植體周圍炎（牙床骨、牙齦發炎）、植體零件鬆脫、斷裂、人工牙根及復假牙鬆脫、斷裂、失敗等約二～五成。
Q2 植牙屬侵入性醫療，比傳統假牙風險高？
      植牙除了傷口有感染的風險，其他像是傷口出血、傷口疼痛、傷口腫脹或癒合不良、局部麻醉風險、因併發症或手術效果不如預期，必要時仍需再度手術及其他治療。
       特殊性症狀者如：骨髓炎、蜂窩組織炎、鼻竇炎、敗血症、皮下氣腫、臉部皮膚瘀血腫脹，顏面嘴唇、下頷、牙齒或舌頭暫時或永久性麻痺感，開口困難，口內疤痕形成，需要附加額外的手術材料，包括軟或硬組織，植牙失敗再度手術取出，在第二度手術前，人工牙根可能提早外露而看得見。
       根據一項研究指出，比較嚴重的還有傷到下頷神經，造成嘴唇、牙齒、舌頭永久性麻痺的約有5～15％。至於其他少見併發症像是傷及舌下血管出血，造成呼吸窘迫而成植物人，或上顎鼻竇手術發炎而致死。
Q3 傳統假牙的缺點？
       傳統假牙也有缺點，例如會損傷兩邊要固定的自然牙、牙齒有時要抽神經等，不過，多跟治療品質有關，並不是常態。我有個患者上顎、下顎接受植牙，上顎幾年後植體從鼻孔穿出，失敗，做了四、五副全口活動假牙，陸陸續續都出現狀況，令他很不滿意，直到重做全口假牙，才說從此不用假牙黏著劑，吃飯、說話可以比較穩，不會脫落，可以吃比較硬的花生，吃東西也較有味道，體重也慢慢增加。

資深牙醫的良心告白：能做假牙就不要植牙

A Straumann-brand root-form endosseous dental implant placed in the site of the maxillary left permanent first molar with bone graft used to elevate the sinus floor

牙齒構造

Straumann guide pin in place to visualize positioning, angulation and depth prior to implant placement. Implant is being placed as a flapless procedure because it was clinically and radiographically evident that there is adequate bone in all dimensions.

Dental Implant
A dental implant is a "root" device, usually made of titanium, used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth.
     Virtually all dental implants placed today are root-form endosseous implants, i.e., they appear similar to an actual tooth root (and thus possess a "root-form") and are placed within the bone (endo- being the Greek prefix for "in" and osseous referring to "bone"). The bone of the jaw accepts and osseointegrates with the titanium post. Osseointegration refers to the fusion of the implant surface with the surrounding bone. Dental implants will fuse with bone; however, they lack the periodontal ligament, so they will feel slightly different from natural teeth during chewing.
     Prior to the advent of root-form endosseous implants, most implants were either blade endosseous implants, in that the shape of the metal piece placed within the bone resembled a flat blade, or subperiosteal implants, in which a framework was constructed to lie upon and was attached with screws to the exposed bone of the jaws.
      Dental implants can be used to support a number of dental prostheses, including crowns, implant-supported bridges or dentures. They can also be used as anchorage for orthodontic tooth movement. The use of dental implants permits undirectional tooth movement without reciprocal action.

Dental Implants

Denatl implant, before and after. -- Oak Brook, IL Dental Implants

假牙、植牙PK戰，哪種比較好？
【元氣周報／記者莊琇閔／報導】   2009-03-16
      很多人會問「我缺的這幾顆牙，做假牙好還是植牙好？」
     一般來說，如果缺牙太多，可能無法採取固定牙橋作義齒，只能選擇活動假牙或人工植牙。
     活動假牙優點是價格便宜，全口約2至4萬元，但咬合較差，且無法咬硬物，且會因有異物感而覺得不舒服。
     人工植牙價格較貴，不過咬合力較佳，可達正常牙齒的8成，日常生活、咀嚼一般食物都沒有問題但美觀且實用，可說是人類的第三套牙。選擇何種假牙？端看經濟與需求的考量。
      植牙技術的興起，雖彌補了以往假牙不美觀及咬合力不佳的缺點。不過植牙畢竟是侵入性手術，且價格不便宜，最好當然莫過於保留自己原有的牙齒，植牙是不得不的選項之一。
牙齒出問題多從蛀牙起
    一般人的牙齒出問題通常從蛀牙開始，這時可以先補牙，將牙齒蛀掉的洞補起來，避免繼續惡化。若是未及時補牙，細菌則會往下侵蝕牙髓神經，這時就必須進行所謂的「根管治療」，將壞死的神經拔除，再製作牙冠將壞牙套住，如果沒有製作牙冠，由於牙齒已經變得脆弱，很容易因為一不小心就裂開，這時就只好把整顆牙拔掉。
只缺一顆牙做固定假牙
      桃園京采牙醫黃籌永醫師說，如果只缺一顆牙，可以裝置固定假牙，將缺牙兩邊的牙齒磨掉一些當作橋墩，再做成牙橋，療程大約一至兩星期，缺點是必須磨掉原來健康的牙齒，而且被當作橋墩的牙齒間常因縫隙不好清理，導致蛀牙或牙周病。
      缺牙較多者戴活動假牙
若是缺牙較多，可戴活動假牙，但固定性不佳，有人會覺得咀嚼功能不佳且有異物感，因此在經濟許可狀況下，常轉而植牙。
黃籌永醫師說，植牙若是能在術前妥善評估，醫師植牙技術夠好，咬合力幾乎等同於健康的牙齒。由於植體與骨頭緊密結合，咀嚼功能也比假牙好，更可免除磨掉健康牙齒的顧慮，缺點則是花費不貲，治療期達3至6個月。
  植牙的壽命關鍵在保健
        植牙成功後等於是擁有人生的第3副牙齒，不過黃籌永醫師特別提醒，術後的保健工作是影響植牙維持時間的重要關鍵，如果口腔衛生沒有做好，不但細菌容易附著造成植體周圍炎，也會導致骨頭破壞，植體因骨質不佳無法支撐而鬆脫，導致植牙的使用壽命減少，因此做好日常清潔及定期回診，是延長植牙壽命的不二法門。

假牙、植牙PK戰哪種比較好？

公視有話好說 (2011-5-25)

從乳牙到假牙牙齒問題真多！ (2011-5-25)

Disadvantages and Problems of Dental Implants
      One of the main disadvantages of a dental implant is the cost. As compared to other alternatives for replacing a missing tooth or teeth, cost can be quite high. With the average cost of a dental implant being about $3600, dental implants can be a costly alternative for replacing a single tooth. Included in the price is the surgical placement of the dental implant and its restoration with a crown. Learn how spending more on a dental implant initially can save you money in the future.
      Another disadvantage of a dental implant is the length of time required from initial dental implant placement to implant restoration. The treatment time can vary from approximately three months to six months. This depends on the area where the implant is placed, the necessity for adjunct procedures like bone grafting, the quality and quantity of healthy bone and overall health of the dental implant recipient. As compared to other options, this may be a considerable difference.
      The need for a minimally invasive surgical procedure could also be considered a disadvantage. With apprehension to dental treatment being quite common, many potential dental implant patients choose less invasive treatment to replace their missing teeth. Dental implant placement is a simple surgery completed at the dental office and can be compared to extraction of a tooth.
       One minor disadvantage for a patient with a dental implant supported denture as opposed to a conventional denture is the need for good oral hygiene around the implant. Excellent oral hygiene is critical for dental implant long-term success.   Dexterity issues or other oral hygiene inadequacies over time can lead to loss of supporting bone, infection, and eventual loss of the dental implant.
What Problems Can You Encounter With Dental Implants:
      One of the most common problems that occur with dental implants is failure of the implant to integrate with surrounding bone.   This is usually indicated by a loose implant a few weeks after surgery. The integration of the implant can be affected by factors, some of which include an infection in the dental implant recipient site, overheating of the surrounding bone, compromised blood supply, limited bone available to stabilize the dental implant, pressure being applied on the dental implant before complete healing or poor stabilization of the dental implant.
       Another problem is a structural failure of a dental implant. After the dental implant has fully integrated with bone and complete healing has occurred, a dental implant can fracture partially or completely if there is excessive pressure exerted on it. This can occur during a traumatic episode such as a blow to the face or excessive forces exerted on the dental implant over a period of time. A crown that is not properly calibrated or teeth grinding can cause excessive and destructive forces. These forces can be detrimental to implants as well as natural teeth.
       Prolonged pain in the area of dental implant placement can also be encountered. After a dental implant is surgically placed in the bone the surrounding area can be tender for a few days. This is mainly due to post surgical inflammation of the surrounding tissue. On occasion, the pain can persist for a longer period of time or even indefinitely. The pain can be caused by chronic localized inflammation, close proximity of the dental implant to a major or even a minor nerve branch or a more severe foreign body reaction. In these situations there are different methods of intervention. One of the most common ones is to have the implant removed and replaced at a later date.
      As with any surgery there are potential complications of placing dental implants. Parasthesia, or numbness of a portion of a tissue can occur. This can include the lip, tongue, cheek and teeth. This is typically a result of over-preparation of the implant site. However, in some cases this can occur due to unknown causes. If this does occur talk to your dentist about your prognosis.
      Most dental implant used today are made out of titanium alloy. Titanium is a non-toxic substance, which can trigger an allergic or inflammatory reaction in certain people. As a result of a production process, titanium alloy contain traces of nickel. This can potentially cause health problems, including hypersensitivity reaction, which can be falsely attributed to titanium. Only about 4 percent of individuals tested will show signs of an allergic reaction to titanium. The hypersensitivity reaction may show a range of symptoms, from red and itchy affected area to Chronic Fatigue Syndrome. The MELISA® test is the only scientifically-proven test which can objectively diagnose titanium allergy. If you are planning to have a hypersensitivity test before having a titanium dental implant placed, it is advised to find out the exact composition of the implant.
      Decementation of a dental implant supported crown, although very rare, can also be encountered. The main reason for a dental crown displacement is improper positioning of a dental implant in the bone. Biting forces or occlusal forces place pressure on the crown in areas that do not have proper support. This causes the crown to eventually come off. If the implant crown is displaced, a new one will need to be fabricated. This can be quite expensive since an average cost of a dental implant crown is about 1800 dollars.
(Source: 2014 DentalImplant411.com)