應用骨性錨定治療三級異常咬合合併前牙開咬病例

Treatment of Skeletal Class Ⅲ Malocclusion with Anterior Openbite with Skeletal Anchorage System

徐儷芳(Li-Fang Hsu) ； 劉怡敏(Yi-Min Liu) ； 詹鳳蘭(Fong-Lan Chan) ； 姚宗珍(Chung-Chen Jane Yao) ； 陳羿貞(Yi-Jane Chen)

《中華民國齒顎矯正學雜誌》 23卷3期 (2011/09) Pp. 45-53

https://doi.org/10.30036/TJO.201109.0005

摘要

骨性三級異常咬合合併前牙開咬的成人患者是臨床上較棘手的案例，由於我們常用在前牙開咬的治療策略如壓入上下顎臼齒，使下顎骨逆時針旋轉以增加前牙垂直覆蓋的方法，在此類患者較不適用，故其矯正治療策略常需要配合手術，將上顎骨進行順時針旋轉，同時讓下顎骨後退及逆時針旋轉，以達到良好的治療結果。成人前牙開咬的治療，必須仔細衡量患者的顏面美觀是否能夠與牙齒咬合同步改善，以及治療後的咬合關係是否能維持穩定。對於臨床上較常見的二級咬合異常合併前牙開咬，利用骨釘與骨板等迷你植體錨定使上下顎後牙內縮(intrusion)，可降低後齒槽高度使下顎骨逆時針旋轉及改善前牙開咬；然而，上述效應對於原已具有下巴前突特徵的三級咬合異常未必適合。本篇案例為下顎輕微偏斜且具有高下顎骨角的骨性三級咬合不正合併前牙開咬患者，主訴為前牙開咬及暴牙。患者在放鬆持有閉唇不全，側面觀有上下唇突出的問題，且患者有吐舌癖(ton gue thrust)。口內檢查齒列為右側安格氏第三級咬合異常、左側安格氏第二級咬合異常。治療過程中患者拔除下顎雙側第二大臼齒，並利用迷你植體錨定進行上下顎臼齒的垂直壓入與後退，同時有效率地關閉下顎拔牙空間。歷經28個月的治療後，雙側達到安格氏一級咬合關係，改正了前牙開咬及暴牙問題，同時也增加患者的自信與美觀，經過適當的指導與訓練，患者的吐舌癖以已於治療中逐漸改善。在治療完畢後半年的回診發現維持情況良好，前牙開咬並沒有復發狀況，顯示出臨床上利用迷你骨釘與骨板治療合併軟組織功能訓練來治療骨性三級咬合不正合併前牙開咬，可達到穩定的成效。

關鍵字

迷你骨釘 ； 迷你骨板 ； 前牙開咬 ； 吐舌癖

並列摘要

Skeletal Class Ⅲ with anterior open bite is one of the most challenging problems that orthodontists may encounter. Treatment modalities for skeletal openbite malocclusion include growth modification and surgical-orthodontic therapy; which treatment is chosen depends on the patient's age and growth potential. Treatment considerations should focus on the patient's facial profile, skeletal pattern, growth potential, and severity of dental malocclusion. Here, we present the nonsurgical orthodontic treatment of an adult patient with anterior openbite and high-angle skeletal Class Ⅲ facial pattern. The soft tissue problems associated with anterior openbite included lip incompetency and tongue thrusting habit. We corrected the dental protrusion and closed the openbite by retracting both upper and lower anterior teeth. Temporary anchorage devices including miniplate on maxilla and miniscrews on mandible were used for anterior retraction, prevention of posterior teeth extrusion, and establishment of bilateral Class Ⅰ occlusion. The total treatment time was 28 months. Before the end of treatment, the tongue-thrusting habit was eliminated by tongue habit training. In addition to the improvement of facial profile, the posttreatment occlusion was significantly improved, both functionally and esthetically, with stable interincisal contacts.

並列關鍵字

temporary anchorage devices ； anterior openbite ； tongue thrust