Treatment Considerations of Complicated Crown-Root Fracture of Young Permanent Teeth-Case Report

年輕恆牙複雜性牙冠牙根斷裂的治療考量－病例報告

張靖唯(Ching-Wei Chang) ； 蕭思郁(Szu-Yu Hsiao) ； 沈明萱(Ming-Hsuan Sheen)

《臺灣兒童牙醫學雜誌》 19卷4期 (2019/12) Pp. 163-168

https://doi.org/10.6319/TJPD.201912_19(4).0005

摘要

The anterior maxilla is the most traumatized region in the mouth during childhood. The peak age for these injuries is 9 to 10 years. For untreatable anterior maxillary teeth, the need for future implants should be considered. A waiting period of 8-10 years is neces-sary before growth and development are completed. So it is essential to preserve the di-mension of the edentulous ridge for future implants in a long waiting time. This is a case about a 9 y/o boy who had trauma due to a ball hit over upper central incisors came to clinic after 4 days, with tooth 11 complicated transverse crown-root fracture over CEJ un-der gingiva 3 mm. Additionally, tooth 11 is an immature permanent teeth without fully erup-tion. There are some treatment options for complicated crown-root fracture teeth, including orthodontic extrusion, autotransplantation and decoronation. In teeth with incomplete root formation, pulp capping or pulpotomy may be performed before orthodontic extrusion. It is recommended that orthodontic movement of the injured immature teeth is postponed until root development is seen to resume. Autotransplantation was declined either which is indi-cated in crowding case. This option is suitable for selected patients when a first mandibular premolar can be spared. Decoronation is a simple and safe surgical procedure to preserve alveolar bone before implant placement. At follow-up at 3, 6, 9 months, tooth 11 was as-ymptomatic and had no obvious peri-apical finding. And we used the original tooth 11 crown to buildup the esthetic area to regain natural appearance. It is important to avoid the effect of mental, function and esthetic due to the missing tooth. To conclude, the age of the patient at the time of trauma and gender, are important factors in treatment planning.

關鍵字

young permanent teeth ； complicated crown-root fracture ； decoronation

並列摘要

兒童常常因為外傷而造成上顎前牙區受傷，發生的年齡高峰特別在九到十歲的時期。如果因外傷而造成無法治療的狀況，常常需要等待八到十年才能考慮永久贗復裝置或者是植牙。如何在這個漫長的等待期維持牙脊就變得相當重要。本篇案例是一位九歲的小男孩因為打球導致右上正中門齒在齒頸部水平方向斷裂，裂痕位於牙齦下3 mm，再加上未成熟牙根且牙齒尚未完全萌出的情況下，有三個治療計畫可以考慮，包括矯正外拉牙齒，自體牙再植手術及牙冠去除術。如果使用矯正外拉牙齒，必須等待牙根成熟後方可完成牙髓治療再將牙齒拉出，但考慮到防滲漏不易便不予考慮。而自體牙再植手術必須病患本身有因為擁擠得排列而有多餘的小臼齒或多生齒，否則不考慮。相較來說，牙冠去除術是相對簡單安全保守的手術在植牙手術前去保留齒槽脊。在手術後三個月至九個月的追蹤，右上正中門齒在臨床上皆無症狀，在放射影像上也無明顯病灶，牙根的齒壁有慢慢變薄的跡象。而缺牙的美觀區則是利用病患本身斷裂的牙冠來做假牙的復型，取得較自然的外觀，幫助孩童不因缺牙而有心理上，功能上及美觀上的影響。最後，對於無法治療的年輕恆牙，還是要根據病患的外傷年紀性別去做整體的考量，再做個別的治療計畫。

並列關鍵字

年輕恆牙 ； 複雜性牙冠牙根斷裂 ； 牙冠去除術