Orthodontic Traction of Impacted Dilacerated Maxillary Central Incisor

阻生且牙根彎曲之上顎正中門齒之矯正牽引治療

陳昶安(Chang-An Chen) ； 張凱迪(Kai-Ti Chang) ； 蔡恒惠(Hung-Huey Tsai)

《臺灣兒童牙醫學雜誌》 21卷2期 (2021/06) Pp. 57-65

https://doi.org/10.6319/TJPD.202106_21(2).0003

摘要

An impacted maxillary central incisor may cause shifting of the dental midline and esthetic problem. As missing upper incisors are regarded as unattractive this may have an effect on self-esteem and general social interaction, it is important to detect and manage the problem as early as possible. Dilaceration is a cause of unerupted incisor. Treatments of an impacted dilacerated permanent tooth include: 1) surgical exposure combined orthodontic traction and 2) extraction. In consideration of esthetic and periodontal problem, the first choice will be surgical exposure with orthodontic traction, however, it can be challenging because of the tooth morphology and its position. The purpose of this report is to discuss a case of 6 years 5 months old girl with impacted dilacerated maxillary right central incisor treated by surgical exposure with orthodontic traction to achieve better appearance. The surgical exposure was done under propofol target controlled infusion sedation. After surgical exposure, the impacted incisor was pulled out by elastic thread to the wire that tied directly to the hole on the tooth made by bur. After surgery, the dilacerated maxillary right incisor was placed to the ideal position through orthodontic traction and alignment. To confirm to location of dilacerated tooth, besides traditional X-ray films, CBCT is useful to show the exact position and direction of the tooth which can help us diagnose case more precisely. To achieve better outcomes, dilaceration should be treated as soon as possible. In this case, we intervened in the first transitional period thus we got satisfactory outcome.

關鍵字

Dilaceration ； Impacted central incisor

並列摘要

上顎正中門齒阻生會造成中線偏移以及美觀方面的問題。正中門齒缺失造成的不美觀也會影響患者的自信與社交互動，因此及早發現、盡快治療是很重要的。正中門齒會因牙齒型態彎曲而無法正常萌出。治療阻生且牙根彎曲之上顎恆牙正中門齒的方式有兩種：1）手術暴露合併矯正牽引治療；2）拔除。考慮到美觀以及牙周方面的問題，會傾向選擇手術暴露合併矯正牽引治療，但由於牙齒的型態以及它的位置治療難度會較高。本篇目的在於探討六歲五個月女孩利用手術暴露合併矯正牽引治療的方式來治療阻生且牙根彎曲之上顎右側正中門齒以達到較好的外觀。先於異丙酚（propofol）之標靶輸注（target controlled infusion）下完成手術暴露。完成手術暴露後，將埋伏齒用橡皮筋拉出。透過手術暴露合併矯正的治療上顎右側正中門齒將牙齒排到一個理想的位置。為了確認彎曲齒確切的位置，除了傳統的X光片，錐狀射束電腦斷層掃描（CBCT）可以讓我們知道牙齒確切的方向以及位置，幫助我們做更正確的診斷。為了達成較好的治療成果，彎曲齒建議越早治療越好。在此案例中，在患者混合齒列早期就介入了治療因此達到了較好的成果。

並列關鍵字

彎曲齒 ； 阻生正中門齒