Impacted Maxillary Canine: Case Series of Patients Received VISTA Technique and Full Mouth Orthodontic Treatment

Maxillary canines have the strongest root and the longest formation time in the whole mouth, so they are easily to become impacted if there were obstacles during their growth. Management of maxillary canine impaction is one of the most challenging situations in orthodontic treatments. After clinical and radiographic examination, we can locate the impacted canine and evaluate its prognosis to decide whether surgical approach is promising or not. However, we meet a lot of complications when using the traditional ways of surgical exposure and forced eruption to expose highly and mesially positioned impacted maxillary canine. We introduced 2 cases that used vertical incision subperiosteal tunnel access (VISTA) technique for surgically exposing the impacted canines. Case 1 was a 9-year-old boy with tooth 13 impaction. He was treated with VISTA technique and a Nance appliance with a lever arm as an anchorage. He had been under full mouth orthodontic treatment for 2 years and 10 months since then. The gingival appearance and root torque of tooth 13 were fair. Case 2 was a 12-year-old girl with tooth 13 impaction. She received VISTA technique and a miniscrew implanted over right infra-zygomatic crest as an anchorage. The location and gingival health of the canine were good after further orthodontic treatment and follow-ups. VISTA technique is a minimally invasive option for exposing the maxillary impacted canine. It can also help us to avoid the problems such as root resorption of adjacent teeth, and questionable gingival status when using traditional surgical approach.

關鍵字

Maxillary canine impaction ； vestibular incision subperiosteal tunnel access

並列摘要

上顎犬齒為全口牙根最強壯及發育時間最長的牙齒，過程中受到阻礙容易造成阻生。而阻生犬齒為矯正問題中最難處理的狀況之一。經過臨床及放射線學檢查定位及評估預後進而決定是否要手術露出，但傳統的手術露出方式若遇到高位、近心異位顯著的頰側阻生犬齒常有許多問題。這裡介紹兩個使用前庭切線骨膜下穿道手術（veritcal incision subperiosteal tunnel access, VISTA）的案例。案例一男童於九歲時接受VISTA手術露出上顎右側阻生犬齒配合南斯氏裝置及槓桿臂拉動牙齒，手術配合矯正治療至今經過兩年十個月，牙齦外觀及牙齒軸向良好。案例二為十二歲女性，接受VISTA手術配合位於打在顴骨下骨嵴的迷你骨釘解決上顎右側阻生犬齒的問題，亦改善很多且無不良副作用。VISTA手術侵犯性小，且可以避免鄰近牙根吸收，術後牙齦健康、美觀無虞，是一個很適合用來解決頰側阻生犬齒的術式。

並列關鍵字

上顎頰側阻生犬齒；前庭切線骨膜下穿道手術

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