齒槽骨劈開手術應用於齒顎矯正之方法介紹與病例報告

第一大臼齒因為在孩童六歲左右萌出，以致臨床上常見其早期嚴重蛀牙，及至青少年時期亦常見其早期喪失，導致該處齒槽骨因被吸收而逐漸萎縮，特別是下顎。此類患者求助矯正門診時，常見其第二大臼齒已明顯向近心傾斜，通常會建議拔除第三大臼齒，並將第二大臼齒往遠心扶正後，再進行此缺牙區的人工植牙或傳統的牙橋製作；但此舉並非最理想之處置，最理想乃將第二與第三大臼齒向近心移，以關閉第一大臼齒的缺牙空間。若將下顎第二與第三大臼齒往近心缺牙處移動時，常因此區齒槽骨萎縮後，皮質骨厚度增加，造成牙根容易被吸收，矯正時間拉長；如果患者合併齒槽骨高度與寬度不足，將又可能造成該牙根旁的齒槽骨開裂(dehiscence)，導致該牙搖晃而被拔除。本病例嘗試以超音波骨刀(Piezosurgery)，於缺牙區進行齒槽骨劈開手術(split technique)，其切線盡可能靠近齒槽之舌側，以使齒槽上的皮質骨板(cortical plate)可完整置於頰側；這樣當後牙向前牽引時，才不會因皮質骨板而阻礙前進及牙根被吸收或裂開，同時也能增加齒槽骨之高度與寬度，亦可使矯正後的牙齒更加穩定。其長期效果雖仍在持續觀察中，但這項新突破值得介紹給大家應用於下顎第一大臼齒早期喪失之矯正患者！

關鍵字

齒槽骨劈開手術；超音波骨刀；矯正迷你骨釘

並列摘要

The incidence of dental caries involving the first molar is often very high, because the eruption time of the first molar is about 6 years old. And because the loss rate of the first molar is also very high in adolescents, the alveolar bone will be absorbed, especially in the mandible. When the patient came for help with the obvious mesial tipping of the second molar, we might suggest extracting the third molar and then performing an artificial implant or a traditional bridge after the second molar was moved to the distal end. But the ideal procedure is to moved the second and third molars towards the proximal end to close the missing tooth space of the first molar. Because the thickness of the cortical bone will increase greatly when the alveolar bone is absorbed and shrinks, performing proximal protraction of the second and third molars might cause significant root resorption and the duration of the orthodontic treatment will be very long. If insufficient width of the alveolar bone is also observed in the patient, root dehiscence or fenestration of the tooth might occur and an extraction may be required due to the mobility of the tooth. In this case, we tried to use the alveolar bone splitting technique with the Piezosurgery, and the incison line was put in the alveolar ridge as lingually as possible that the integrity of the cortical plate of the alveolar ridge is reserved in the buccal side. Because the resistance to the mesial movement of the posterior teeth is greatly decreased, the possibility of the root resorption or dehiscence is reduced, and the stability after the orthodontic treatment would be improved while the height and width of the alveolar bone increase. Although the long-term effects still need continuous observation, we believe this will be a major breakthrough in orthodontic space closure treatment for patients with first molar loss.

並列關鍵字

Alveolar bone splitting technique ； Piezosurgery ； Mini-screw

國際替代計量

齒槽骨劈開手術應用於齒顎矯正之方法介紹與病例報告

全文下載

主題瀏覽