上頜前牙埋伏阻生伴牙瘤的正畸外科聯(lián)合治療
發(fā)布時(shí)間：2019-03-20 21:08
【摘要】：目的:初步探討運(yùn)用外科手術(shù)與正畸聯(lián)合牽引的方法,矯治上頜前牙埋伏阻生伴牙瘤病例的臨床療效。材料與方法:病例一于2015年8月就醫(yī)的上前牙埋伏阻生并牙瘤患者,女性,18歲。上下齒槽骨發(fā)育良好,骨性I類(lèi),高角。面部對(duì)稱(chēng),上頜中線(xiàn)右偏約4mm。直面型,鼻唇角、頦唇溝正常。前牙覆頜、覆蓋正常,左側(cè)尖牙關(guān)系為近中關(guān)系,上牙列III°擁擠,下牙列II°擁擠,Spee曲線(xiàn)左右皆平直。11、12、13埋伏阻生伴牙瘤,36、46殘根。根據(jù)本病例的模型、曲面斷層片、頭顱側(cè)位片和CT檢查確診為:上頜右側(cè)前牙唇側(cè)埋伏阻生伴牙瘤。采用外科手術(shù)切除牙瘤同時(shí)聯(lián)合正畸閉合式牽引導(dǎo)萌,拔除12埋伏齒,36、46殘根。應(yīng)用直絲弓矯治技術(shù),牽引埋伏齒,排齊整平牙列,維持標(biāo)準(zhǔn)的覆頜、覆蓋,精準(zhǔn)比對(duì)磨牙關(guān)系,矯治結(jié)束佩帶Hawley保持器。通過(guò)比較治療前后影像學(xué)數(shù)據(jù)分析得出軟硬組織的變化。病例二:2016年1月就診,女性,13周歲,安氏I類(lèi),上中下面高基本協(xié)調(diào),左右面部對(duì)稱(chēng),上頜中線(xiàn)左偏約4mm,下頜中線(xiàn)左偏約2mm。前牙覆頜Io、覆蓋正常,上牙列II°擁擠,下牙列I°擁擠,Spee曲線(xiàn)左右約2mm。22、23埋伏阻生伴牙瘤,63滯留,根據(jù)曲面斷層片、CT得出:22、23腭側(cè)阻生伴牙瘤,采用外科手術(shù)切除牙瘤并聯(lián)合正畸閉合式牽引導(dǎo)萌的方法,拔除23、63,直絲弓矯治,牽引埋伏齒,舌側(cè)固定絲保持。結(jié)果:患者一經(jīng)過(guò)18個(gè)月的綜合治療,至目前為止,埋伏齒已牽引至正常牙列,牙齒排列整齊,覆頜覆蓋基本正常,上頜中線(xiàn)欠佳,側(cè)貌良好。牙髓活力正常,牙周組織較好。顳下頜關(guān)節(jié)檢查未見(jiàn)異常,張口度、張口型正常。曲面斷層片顯示11、13周?chē)X槽骨高度略降低,其余牙根及齒槽骨未見(jiàn)異常吸收,牙周組織良好,牙瘤處骨質(zhì)恢復(fù)良好,未見(jiàn)復(fù)發(fā),顳下頜關(guān)節(jié)未見(jiàn)異樣,埋伏牙及鄰近牙齒周?chē)琴|(zhì)正常,牙根無(wú)明顯吸收。治療前后投影測(cè)量數(shù)據(jù)對(duì)比:U1-SN增加13o、U1-NA增加9o、U1-NA增加3mm、IMPA增加5.5o、L1-NB增加6o、L1-NB增加2.5mm、UL-E增加2mm、LL-E增加2mm、ULP增加2mm、LLP增加1.5mm、NLA減小14o、Z角減小7o;治療前后重疊圖顯示:上下頜骨無(wú)明顯變化,上下前牙唇傾。側(cè)面形態(tài)無(wú)較大明顯改變,此時(shí)病人和家屬對(duì)現(xiàn)今的牽引效果療效滿(mǎn)意�；颊叨颊呓�(jīng)過(guò)12個(gè)月治療,埋伏齒已牽引至正常牙列。結(jié)論:對(duì)于多顆埋伏阻生齒的牽引,埋伏齒之間相互干擾,常伴有個(gè)別牙發(fā)育不良,治療時(shí)應(yīng)拔除發(fā)育不良的埋伏齒再進(jìn)行正畸牽引。牙瘤為良性腫瘤,切除后不易復(fù)發(fā),常與埋伏齒伴發(fā),手術(shù)應(yīng)時(shí)避免損傷埋伏齒而導(dǎo)致?tīng)恳�。青少年上頜前牙埋伏阻生患者,多以保留自體牙為主,通過(guò)外科手術(shù)和正畸聯(lián)合治療,避免拔除埋伏齒治療的后期修復(fù),通常能獲得較好的治療效果。
[Abstract]:Objective: to investigate the clinical effect of surgical combined with orthodontic traction in the treatment of impacted maxillary teeth with odontoma. Materials and methods: case 1, 18-year-old female, was admitted to hospital in August 2015. Superior and inferior alveolar bone developed well, bony class I, high angle. The right side of the upper middle line is about 4 mm. Straight type, nose-lip angle, chin-lip groove normal. The anterior teeth were covered with normal jaws, and the left canines were closely related to each other. The upper dentition was crowded with III 擄and the inferior dentition was crowded with II 擄. The Spee curve was straight from left to right. 11, 12, 13 ambush impacted with odontoma, 36, 46 residual roots. According to the model of this case, curved cross-sectional film, lateral cephalography and CT examination, it was diagnosed as impacted odontoma with impacted labial side of the upper right anterior tooth. The 12 buried teeth, 36, 46 residual roots were removed by surgical removal of odontoma and combined with orthodontic closed traction. The technique of straight wire arch was used to fix the buried teeth, align the teeth, maintain the standard overburden, cover, accurately compare the relationship of molars, and wear Hawley retainer at the end of the correction. The changes of soft and hard tissue were obtained by comparing the imaging data before and after treatment. Case 2: in January 2016, female, 13-year-old, class I, basic coordination between upper, middle and lower sides, right and left facial symmetry, left of maxillary midline about 4 mm, left of mandible midline about 2 mm. The Io, coverage of anterior teeth was normal, the upper dentition was crowded with II 擄and the inferior dentition was crowded with I 擄. The Spee curve was about 2 mm. 22, 23 ambushed impacted with odontoma, 63 retention. According to the curved surface slice, CT obtained: 22, 23 palatal impacted with odontoma. The method of surgical removal of odontoma combined with orthodontic closed traction was used to remove 23,63 straight wire arch, traction entrapment teeth and retention of tongue fixed wire. Results: after 18 months of comprehensive treatment, the entrapped teeth had been drawn to normal dentition, the teeth were arranged neatly, the overburden was basically normal, the maxillary midline was not good and the profile was good. Pulp activity is normal, periodontal tissue is better. Temporomandibular joint examination showed no abnormal, open mouth degree, normal mouth type. Curved section showed that the height of alveolar bone around 11, 13 decreased slightly, the rest of the root and alveolar bone did not show abnormal absorption, periodontal tissue was good, osseous recovery was good, no recurrence was seen, and there was no abnormal temporomandibular joint. The bone around the impacted teeth and adjacent teeth is normal, and the root of the teeth has no obvious absorption. Comparison of projection measurements before and after treatment: U1-SN increased by 13o, U1na increased by 9o, U1na increased by 3mm, IMPA increased by 5.5o, L1 / NB increased by 6o, L1 / NB increased by 2.5mm, ULE increased by 2mm, LLE increased by 2mm, ULP increased by 2mm. LLP increased 1.5 mm, NLA decreased by 14 o, Z angle decreased by 7 o; Before and after treatment, there was no significant change in the upper and lower jaws, and the upper and lower anterior teeth were tilted. There was no significant change in lateral morphology, and the patients and family members were satisfied with the current traction effect. Patient 2 after 12 months of treatment, entrapped teeth have been drawn to normal dentition. Conclusion: for the traction of multiple impacted teeth, the entrapment teeth interfere with each other, often accompanied by individual tooth dysplasia, and then orthodontic traction should be carried out with the removal of the developmental buried teeth. Odontoma is a benign tumor, it is not easy to recur after resection, often associated with buried teeth, the operation should avoid injury of buried teeth and lead to traction failure. In adolescent patients with impacted maxillary anterior teeth, most of them retain autogenous teeth. Combined surgical treatment and orthodontic treatment can avoid the late repair of extraction of ambushed teeth, and usually have a good therapeutic effect.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R783.5
本文編號(hào)：2444633
[Abstract]:Objective: to investigate the clinical effect of surgical combined with orthodontic traction in the treatment of impacted maxillary teeth with odontoma. Materials and methods: case 1, 18-year-old female, was admitted to hospital in August 2015. Superior and inferior alveolar bone developed well, bony class I, high angle. The right side of the upper middle line is about 4 mm. Straight type, nose-lip angle, chin-lip groove normal. The anterior teeth were covered with normal jaws, and the left canines were closely related to each other. The upper dentition was crowded with III 擄and the inferior dentition was crowded with II 擄. The Spee curve was straight from left to right. 11, 12, 13 ambush impacted with odontoma, 36, 46 residual roots. According to the model of this case, curved cross-sectional film, lateral cephalography and CT examination, it was diagnosed as impacted odontoma with impacted labial side of the upper right anterior tooth. The 12 buried teeth, 36, 46 residual roots were removed by surgical removal of odontoma and combined with orthodontic closed traction. The technique of straight wire arch was used to fix the buried teeth, align the teeth, maintain the standard overburden, cover, accurately compare the relationship of molars, and wear Hawley retainer at the end of the correction. The changes of soft and hard tissue were obtained by comparing the imaging data before and after treatment. Case 2: in January 2016, female, 13-year-old, class I, basic coordination between upper, middle and lower sides, right and left facial symmetry, left of maxillary midline about 4 mm, left of mandible midline about 2 mm. The Io, coverage of anterior teeth was normal, the upper dentition was crowded with II 擄and the inferior dentition was crowded with I 擄. The Spee curve was about 2 mm. 22, 23 ambushed impacted with odontoma, 63 retention. According to the curved surface slice, CT obtained: 22, 23 palatal impacted with odontoma. The method of surgical removal of odontoma combined with orthodontic closed traction was used to remove 23,63 straight wire arch, traction entrapment teeth and retention of tongue fixed wire. Results: after 18 months of comprehensive treatment, the entrapped teeth had been drawn to normal dentition, the teeth were arranged neatly, the overburden was basically normal, the maxillary midline was not good and the profile was good. Pulp activity is normal, periodontal tissue is better. Temporomandibular joint examination showed no abnormal, open mouth degree, normal mouth type. Curved section showed that the height of alveolar bone around 11, 13 decreased slightly, the rest of the root and alveolar bone did not show abnormal absorption, periodontal tissue was good, osseous recovery was good, no recurrence was seen, and there was no abnormal temporomandibular joint. The bone around the impacted teeth and adjacent teeth is normal, and the root of the teeth has no obvious absorption. Comparison of projection measurements before and after treatment: U1-SN increased by 13o, U1na increased by 9o, U1na increased by 3mm, IMPA increased by 5.5o, L1 / NB increased by 6o, L1 / NB increased by 2.5mm, ULE increased by 2mm, LLE increased by 2mm, ULP increased by 2mm. LLP increased 1.5 mm, NLA decreased by 14 o, Z angle decreased by 7 o; Before and after treatment, there was no significant change in the upper and lower jaws, and the upper and lower anterior teeth were tilted. There was no significant change in lateral morphology, and the patients and family members were satisfied with the current traction effect. Patient 2 after 12 months of treatment, entrapped teeth have been drawn to normal dentition. Conclusion: for the traction of multiple impacted teeth, the entrapment teeth interfere with each other, often accompanied by individual tooth dysplasia, and then orthodontic traction should be carried out with the removal of the developmental buried teeth. Odontoma is a benign tumor, it is not easy to recur after resection, often associated with buried teeth, the operation should avoid injury of buried teeth and lead to traction failure. In adolescent patients with impacted maxillary anterior teeth, most of them retain autogenous teeth. Combined surgical treatment and orthodontic treatment can avoid the late repair of extraction of ambushed teeth, and usually have a good therapeutic effect.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R783.5
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