李小姐因一次意外撞擊，造成上顎前牙斷裂並出現搖晃。
對她而言，這不只是牙齒受傷，更直接影響了笑容、自信與日常社交。她對門牙外觀相當敏感，也很清楚自己在意的是什麼——無論是牙齒的型態、顏色，甚至牙齦線條的高度與左右對稱性，都看得格外仔細。
因此在諮詢過程中，她願意花時間反覆討論每一個細節，而不是只求「快點完成」。
此外，她早年曾因蛀牙接受過根管治療，前牙假牙已使用超過 15 年，近期偶爾出現刺痛感。這也讓她在面對這次治療時，更在意療程是否穩定、假牙材質是否具備正式認證，以及未來能不能長期安心使用。
在完整評估後，確認左上門牙需以植牙方式重建。然而，由於受傷當下局部齒槽骨條件不足，若貿然採取即拔即植，雖然能快速完成，但對前牙美學區而言，可能增加牙齦塌陷與外觀不可預期的風險。
在這樣的條件下，治療團隊並未選擇「最快的方式」，而是由植牙專科江政倫醫師與牙髓病專科劉炯伶醫師共同討論，從「長期穩定與美學可預測性」出發，規劃一套分階段的前牙重建流程。
Ms. Lee suffered a traumatic injury that resulted in fracture and mobility of her upper front tooth.
For her, the impact went far beyond physical damage—it affected her smile, her confidence, and everyday social interactions.
She was highly sensitive to the appearance of her front teeth and very clear about what mattered to her—whether it was tooth shape, shade, or the height and symmetry of the gum line.
During consultation, she chose to spend time discussing each detail carefully rather than seeking a quick fix.
Adding to the complexity, she had undergone root canal treatment years earlier, and the existing crown had been in use for over 15 years, recently causing occasional sharp discomfort.
This made her especially concerned about long-term stability, material certification, and whether the restoration could be relied on comfortably in the years ahead.
After comprehensive evaluation, it was determined that the upper left central incisor required implant reconstruction.
However, due to insufficient local alveolar bone at the time of injury, immediate extraction and implantation—while faster—would have increased the risk of gingival collapse and unpredictable aesthetic outcomes.
Rather than choosing the fastest approach, the treatment team collaborated across specialties to design a phased anterior reconstruction plan, prioritizing long-term stability and aesthetic predictability.
第一步｜齒槽骨保留：為未來的美感留下選擇權
Alveolar Ridge Preservation：Preserving options for future aesthetics
在拔除受損牙齒後，先進行齒槽骨保留術，目的是盡可能維持前牙區的骨量與牙齦支撐，避免骨吸收造成牙齦塌陷。
對前牙美學區來說，牙齦的高度與弧線，往往比牙齒本身更容易被注意到。
一旦牙齦塌陷，就算假牙再漂亮，也很難看起來自然。
因此，這一步其實是在替未來的美觀留下空間。
Following extraction of the damaged tooth, alveolar ridge preservation was performed to maintain bone volume and soft tissue support in the anterior region.
In aesthetic zones, the height and contour of the gingiva often draw more attention than the tooth itself.
Once the gum line collapses, even the most beautifully crafted crown can appear unnatural.
This initial step was therefore not merely preparatory—it preserved the foundation needed for a natural-looking result later on.
第二步｜臨時假牙塑型：在癒合過程中慢慢調整，而不是最後才補救
Provisional Restoration and Soft Tissue Shaping：Guiding healing instead of correcting afterward
癒合期間，使用右上側門牙至左上側門牙區段的臨時假牙進行牙齦塑型。
透過臨時假牙形態的逐步微調，引導牙齦高度、對稱性與牙齦乳突型態，讓軟組織在癒合時就朝理想結果靠近，而不是等到最後才想辦法修正。
對於願意為美觀反覆溝通與調整的李小姐來說，這樣的過程反而讓她更安心——
因為每一次調整，都是在為最後那顆正式假牙鋪路。
簡單說，就是先把「牙齦這個舞台」搭好，最後的全瓷冠才有空間自然演出。
During the healing phase, a provisional restoration spanning from the upper right lateral incisor to the upper left lateral incisor was used to shape the gingiva.
Through gradual adjustments to the provisional crown contours, gingival height, symmetry, and papilla form were guided as healing progressed.
For Ms. Lee, who valued detailed communication and refinement, this approach offered reassurance.
Each adjustment was not a delay, but a step closer to the final restoration.
In simple terms, the gingiva was prepared as a stage—so the final all-ceramic crown would have the space to perform naturally.
第三步｜DSD 全數位規劃：在治療開始前，就先看見結果
Fully Digital Smile Design：Seeing the result before treatment begins
整體流程結合 DSD（Digital Smile Design，全數位微笑設計）進行規劃。
從牙齒比例、對稱性、牙齦高度，到最終假牙型態，皆先在數位環境中反覆模擬與確認。
這樣的方式，特別適合對外觀要求高、又希望每一步都「心裡有底」的患者。
治療不再只是憑想像，而是一開始就知道目標長什麼樣子，並在每個階段逐步靠近。
The entire treatment plan was developed using Digital Smile Design (DSD).
Tooth proportions, symmetry, gingival levels, and final crown form were all simulated and reviewed in a digital environment before clinical execution.
This approach was particularly suitable for a patient with high aesthetic expectations who wanted clarity at every stage.
Rather than relying on imagination, the destination was visible from the outset, and each step of treatment was designed to move steadily toward that goal.
第四步｜四個月後植牙：只放在最適合的位置
Implant Placement After Healing：Placing the implant only when conditions are ideal
經約四個月癒合，待軟硬組織條件穩定後，進行左上門牙植牙。
手術前搭配影像檢查與數位設計，製作專屬手術導板，輔助精準定位，讓植體在規劃位置上準確落點，同時將手術創傷控制在最小範圍。
本案例選用 Straumann® TLX 植體。
TLX 採用 Tissue Level（牙齦水平）設計，將植體與零件的接合位置提升到牙齦高度，並搭配位於牙齦上方的光滑頸部。
這樣的結構，不僅讓臨床操作更穩定，也讓患者日後清潔更容易、細菌較不易堆積，能有效降低牙齦發炎風險，提升長期使用的安心感——
這對曾有根管治療、假牙已使用超過 15 年、偶爾感到刺痛的她來說，尤其重要。
此外，TLX 植體的 SLActive® 親水表面，能在植入初期更快啟動骨整合，有助於縮短不穩定期，讓患者更早回到正常咀嚼生活。
After approximately four months of healing, once both hard and soft tissues had stabilized, implant placement was performed in the upper left central incisor region. Preoperative imaging and digital planning were used to fabricate a customized surgical guide, ensuring precise implant positioning while minimizing surgical trauma.
This case utilized the Straumann® TLX implant. Its Tissue Level design elevates the implant–abutment connection to the gingival level, combined with a smooth collar above the gum line. This structure enhances clinical stability, simplifies oral hygiene, and reduces bacterial accumulation—lowering the risk of peri-implant inflammation and improving long-term comfort.
For a patient with a history of root canal treatment and a long-standing crown that had begun causing discomfort, these factors were particularly important. In addition, the SLActive® hydrophilic surface promotes faster osseointegration during the early healing phase, shortening the period of instability and allowing an earlier return to normal function.
第五步｜牙齦微調與最終修復：讓笑容回到自然的位置
Gingival Refinement and Final Restoration：Returning the smile to its natural position
待植體穩定後，進行細緻的牙齦微調，使牙齦曲線自然流暢，並與鄰牙達到高度協調。
最終完成上顎三顆全瓷冠與一顆植牙修復，在外觀、功能與牙齦穩定性上，皆達到理想狀態。
Once the implant achieved stability, meticulous gingival refinement was carried out to ensure a smooth, harmonious gingival contour aligned with adjacent teeth. The final restoration consisted of three upper all-ceramic crowns and one implant-supported crown, achieving balanced aesthetics, function, and long-term soft tissue stability.
治療總結
Treatment Summary
這不只是一個「前牙植牙」的案例，而是一個為高度重視美感的患者，量身規劃的前牙美學重建流程。
透過分階段治療、軟硬組織管理，以及全數位規劃與精準執行，讓修復不只是補上一顆牙，而是讓笑容回到自然、對稱，並且能長期安心使用的狀態。
那種感覺是——
不用再擔心被看出來，也終於可以放心去笑。
This case was not simply about replacing a missing front tooth. It was a carefully tailored anterior aesthetic reconstruction designed for a patient with high aesthetic sensitivity and long-term expectations.
Through phased treatment, comprehensive soft and hard tissue management, fully digital planning, and precise execution, the restoration became more than a replacement—it allowed the smile to return to a state that felt natural, symmetrical, and reliable over time.
And perhaps most importantly, it brought back a quiet sense of confidence—
the kind where nothing looks “done,” and smiling no longer requires a second thought.
