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Title: 上下顎に広範な発育を呈した外骨症に対して補綴装置を想定したモデルサージャリーを行った1例
Other Titles: A case of extensive exostoses in the maxilla and mandible managed with model surgery of the postoperative denture spaces
Authors: 馬場, 陽久1 Browse this author
岡田, 和隆2 Browse this author
坂田, 健一郎3 Browse this author
羽藤, 裕之4 Browse this author
松田, 彩5 Browse this author →KAKEN DB
樋田, 京子6 Browse this author →KAKEN DB
北川, 善政7 Browse this author →KAKEN DB
山崎, 裕8 Browse this author →KAKEN DB
Authors(alt): Baba, Haruhisa1
Okada, Kazutaka2
Sakata, Kenichiro3
Hato, Hiroyuki4
Matsuda, Aya5
Hida, Kyoko6
Kitagawa, Yoshimasa7
Yamazaki, Yutaka8
Keywords: 外骨症
model surgery
postoperative denture space
restorative oriented treatment
Issue Date: 15-Sep-2021
Publisher: 北海道歯学会
Journal Title: 北海道歯学雑誌
Volume: 42
Start Page: 63
End Page: 69
Abstract: 骨隆起は補綴治療を行うときに問題となることがあるが,義歯製作時に作業用模型上で骨隆起部をリリーフし,骨隆起を回避した設計とすることで対応するのが一般的である.しかしながら,骨隆起が義歯の着脱に影響を及ぼす場合や,骨隆起によって義歯を装着するための空間が確保できない場合には骨隆起形成術を施行する.比較的小さな骨隆起の場合は術後に通法に従って補綴治療を行うことが可能であるが,広範囲にわたって骨形成を行う場合には補綴装置が装着された状態を想定した治療計画を立案する必要がある.今回,広範囲にわたる骨隆起形成術後の補綴治療の1 例を経験したので報告する.患者は65歳の女性で,2013年に左側下顎歯肉の腫れを自覚して当科を受診した.口腔扁平苔癬と診断されて加療し,2015年まで経過観察を行っていた.2018年,義歯の装着困難を主訴に再受診した.口蓋正中部,上顎臼歯部頬側,下顎舌側に,粘膜表面は正常で,周囲との境界は明瞭な骨様硬の膨隆を認めた.上顎残存歯はすべて著しい挺出が認められ,義歯を装着するために必要な空間が不十分であった.広範囲にわたる顎骨外骨症,義歯装着困難による審美障害と診断した.広範囲にわたる骨隆起形成が必要なことから,外科的処置を行う口腔内科と連携して補綴主導型の治療計画を立案した.上顎残存歯はすべて抜去とし,十分なデンチャースペースを確保できるように研究用模型上でモデルサージャリーを行い,術後の口腔内を想定した.このモデルサージャリーを手術中の口腔内に再現できるように,アクリル製熱可塑性シートを用いてサージカルガイドを製作し,全身麻酔下において上顎抜歯術および骨隆起形成術を施行した.術後,創部の治癒が良好であることを確認し,上顎に全部床義歯,下顎に部分床義歯を装着した.その後,問題なく義歯を使用している.
Exostoses in jaws can be problematic when performing prosthetic treatment. It is common to either remove an exostosis or fabricate a prosthesis that avoids it when making dentures. Osteotomy is performed if exostosis occupies the space of prosthesis or prevents a complete denture from accomplishing tight suction. With local resection, patients may wear dentures as conventional after osteotomy. Wit h extensive resection, however, it is necessary to formulate a treatment plan considering the dentures. We report a case of prosthetic treatment after osteotomy for extensive exostoses in the maxilla and the mandible. A 65-year-old woman complained of swelling of the left mandibular gingiva. The mucosal lesion was diagnosed as oral lichen planus and treated for two years. Five years after her first visit, she returned with a chief complaint of difficulty in wearing dentures. Several distentions of bone-like hardness with normal mucosal surfaces and clear boundaries were observed on the median palate, the buccal side of the maxillary molars and the lingual side of the mandible. The denture spaces in the mandible were narrowed by the protruding molar teeth on the maxilla. The diagnosis was buccal exostosis hindering wearing of denture, associated aesthetic disorder. Preoperative planning for prosthetic treatment was instigated f or extensive osteotomy with Hokkaido University Hospital Department of Oral Diagnosis and Medicine. Study casts were shaved to ensure sufficient denture spaces in planning postoperative jaw ridges. To reproduce planning during surgery, surgical guides were made from an acrylic thermoplastic sheet. All remaining maxillary teeth were extracted and osteotomy was performed under general anesthesia. After wound stability was confirmed, new dentures were fitted.
Type: article
Appears in Collections:北海道歯学雑誌 > 第42巻

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