牙周病患者二級異常咬合之矯正治療－病例報告

Orthodontic Treatment for a Periodontally Compromised Class Ⅱ Malocclusion-A Case Report

林俊豪(Jiun-Hao Lin) ； 巫冠誼(Kuan-Yi Wu) ； 洪義玲(I-Ling Hong) ； 陳羿貞(Yi-Jane Chen)

《中華民國齒顎矯正學雜誌》 24卷2期 (2012/06) Pp. 53-63

https://doi.org/10.30036/TJO.201206.0006

摘要

成人齒列矯正患者尋求矯正治療最常見的主訴是顏面牙齒的美觀問題，牙周病造成牙周組織破壞容易導致咬合異常愈形嚴重，尤其是上下顎門齒病理性位移的必然結果就是門齒排列逐漸凌亂，改善門齒美觀往往是此類患者就診最大的訴求，所需的臨床處置包括牙周與矯正的跨科協同治療，在治療計畫擬定、達成治療目標，及維護治療成果等長期療程中的各個階段，患者自身配合意願與治療動機都十分重要。本病例報告所提出之33歲女性患者，因牙齒不適至牙周病科求診，診斷為成年型牙周病。經牙周病科醫師完成第一及第二階段牙周治療後，患者被安排至齒顎矯正科進行會診，主訴是希望能改善牙齒排列及上顎門齒前突。矯正常規檢查後診斷其齒列為安格式二級咬合異常，但上下後牙區的咬合接觸尚稱穩定。於定期監測牙周健康的前提下，我們為患者進行局部矯正裝置治療，並將治療目標侷限於改善上顎門齒排列。在達成上述目標後，患者對矯正治療的信心與意願顯著增加，而主動要求擴大治療範圍，於是我們繼續以全口矯正裝置及上顎兩側後牙區迷你骨釘，進行上顎全齒列遠心移動，完成上下齒列調整並改善咬合關係至安格式一級咬合。患者在歷經1年11個月的治療，無論是齒列咬合、顏面美觀、咀嚼功能各方面都有顯著改善，治療後2年9個月追蹤至今仍維持穩定結果。

關鍵字

迷你骨釘 ； 牙周病 ； 成人齒列矯正

並列摘要

Adult orthodontic treatment has become increasingly popular. The primary motivating factor for seeking orthodontic treatment in adults is facial and dental esthetics, especially the alignment of their anterior teeth. Pathologic migration of anterior teeth is a common cause of esthetic concern among adult patients. The anchorage control is very important in the orthodontic treatment for the dentition with compromised periodontal support. Mini-implant anchorage provides a good solution to this situation. However, the force level should be light and consistent. Here in we report a 33-year-old female patient who presented a Class Ⅱ division 1 malocclusion with maxillary anterior crowding, protrusion, and compromised periodontal support. After periodontal phase I and phase II treatment, she was arranged to consult orthodontic department for correcting the malalignment and protrusion of her upper incisors. The orthodontic treatment was facilitated with 2 miniscrews as temporary anchorage devices for anterior retraction. Active orthodontic treatment was conducted only for upper dentition in the first 6 months, and followed by full -mouth fixed appliance therapy. Active orthodontic treatment was completed in 1 year and 11 months. The orthodontic treatment outcomes and the periodontal conditions were stable 2 years and 9 months after active treatment. An interdisciplinary approach is required to achieve a good treatment outcome in the treatment of periodontally compromised patients.

並列關鍵字

Miniscrew ； periodontitis ； adult orthodontics