Management of Unerupted Maxillary Central Incisors in Early Mixed Dentition-A Case Report

早期混合齒列時期上顎正中門齒阻生的處理－案例報告

謝宛君(Wan-Chun Hsieh) ； 王姻麟(Yin-Lin Wang) ； 張曉華(Hsiao-Hua Chang) ； 黃桂芬(Guay-Fen Huang) ； 郭敏光(Ming-Kuang Guo)

《臺灣兒童牙醫學雜誌》 18卷2期 (2018/06) Pp. 77-82

https://doi.org/10.6319/TJPD.201806_18(2).0006

摘要

Unerupted maxillary central incisor is not a rare problem for pediatric dentist at outpatient department. According to different contributing factors, we have different treatment approaches. Except for the impacted tooth erupts spontaneously after obstacle is removed, advanced treatment like surgical exposure and orthodontic traction are necessary. In early mixed dentition, insufficient anchorage for orthodontic traction and patient's compliance are challenging problems for dentist. This article presents a case of a 6-year-8-month boy having labial inversely unerupted maxillary right central incisor. Because no anchorage from upper anterior teeth, we designed a modified Nance appliance soldered with 3 spurs banded for forced-eruption of the unerupted tooth. After 21 months treatment and maintenance, the impacted incisor was moved to proper position with normal vitality and root formation. However, improper oral hygiene of the patient was noted, reinforcing oral hygiene care is necessary. Further treatments such as second stage orthodontic treatment and labial gingival margin improvement may be needed in permanent dentition.

關鍵字

Surgical Exposure ； Early Mixed Dentition ； Modified Nance Appliance

並列摘要

未萌發的上顎正中門齒對於兒牙醫師在門診不算是少見的問題，不同的成因會用不一樣的治療方式，因此，除了移除障礙物就會自然萌發的阻生齒，進一步的治療如透過手術讓埋伏齒露出及矯正拉出是需要的。在早期混合齒列時期，因不足的錨定而無法提供足夠的矯正拉力以及病人的配合度都是讓牙醫師棘手的問題。本篇案例是一位六歲八個月的男孩上顎右側正中門齒牙冠朝唇側方向阻生，由於前牙無法提供錨定的矯正拉力，我們設計了改良式的南西式裝置焊接三支鐵刺作為提供矯正拉力的錨定，經過21個月的治療和維持，阻生的門齒被移動到適當的位置，且牙髓具有活性，牙根也正常生長，後續治療例如第二階段的矯正，唇側牙齦高度的改善，等進入恆齒齒列時期可以考慮施作。

並列關鍵字

埋伏齒露出 ； 早期混合齒列 ； 改良式南西式裝置