植牙 VS 杜牙根 (三) Implant vs root canal treatment part 3

今次會講解一下一些臨牀上的考慮因素會影響到植牙還是杜牙根的選擇。





杜牙根
杜牙根能夠保留牙齒，但有些時候未必是一個好的選擇。

1) 沒有保留的價值:
    如果發覺牙齒崩壞得很嚴重，有嚴重裂痕或者嚴重牙周病等，就會考慮不保留。

          嚴重崩壞的牙齒

    
                 有嚴重裂痕的牙齒


     
      嚴重牙周病的牙齒( 從X光片看見嚴重骨收縮)

 
2)  個別牙齒根管的複雜性:
     如發覺牙齒根管複雜，如鈣化，異常彎曲等，就會考慮轉介到專科或者不保留。

     
         圖中看不到牙齒中心的根管

 
            非常彎曲牙腳





植牙考慮的因素:


1. 是否有足夠牙骨:
    因為植牙需要有牙骨包圍支撑來達到承受使用時的咀嚼力，所以需要有足夠的牙骨(高度和闊度)。醫生會照兩張X 光片來評估牙骨是否足夠。


 
                                   嚴重牙骨不足(長度)
 


                     嚴重牙骨不足(長度和闊度)



遇到牙骨的時候，可以怎樣做?  如想做植牙，可以考慮是否進行補骨。

其他因素:
美觀:
- 植牙可以提供幾可亂真的假牙，但更多時候在美觀上亦有不同程度的缺失。


                                                      美觀上與真牙相約




 缺失了軟組織，需要用粉紅色的陶瓷來模仿牙肉

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This time I will explain some of the clinical considerations that will affect the choice of dental implant or root canal treatment

Root canal treatment

Root canal treatment can retain teeth, but sometimes it may not be a good choice.



1) No reserved value:

    If you find that your teeth are badly broken, have severe cracks, or have severe periodontal disease, you may consider not retaining them.





          Badly broken teeth





                 Severely cracked teeth





      Teeth with severe periodontal disease (severe bone contraction seen on X-rays)





2) Complexity of individual tooth root canals:

     If you are told by dentist that the tooth root canal is complicated, such as calcification, abnormal curvature, etc., you may consider get a referral to a specialist or not retaining it.



 

  Cannot see root canal in center of tooth



curved root canal image search results



            Very curved teeth





Implant considerations:


1. Is there enough bone:

   Since dental implants need to be surrounded by bones in order to support the chewing force during use, sufficient bones (in terms of height and width) are required. The doctor will take two X-rays films to assess whether the bones are adequate.







                                   Severe underbone (length)







                     Severe underbone (length and width)


What can I do when I don't have enough bone ? If you want to do dental implants, you can consider whether or not to  fill the bones.

Other factors:

Aesthetics:

-Implant tooth can mimic a real tooth, but more often it is  missing some aesthetics elements.




                                                      Aesthetically similar to real teeth






 Missing soft tissue, pink ceramics are needed to mimic the gum