上颌前牙埋伏阻生伴牙瘤的正畸外科联合治疗

发布时间：2019-03-20 21:08

【摘要】：目的:初步探讨运用外科手术与正畸联合牵引的方法,矫治上颌前牙埋伏阻生伴牙瘤病例的临床疗效。材料与方法:病例一于2015年8月就医的上前牙埋伏阻生并牙瘤患者,女性,18岁。上下齿槽骨发育良好,骨性I类,高角。面部对称,上颌中线右偏约4mm。直面型,鼻唇角、颏唇沟正常。前牙覆颌、覆盖正常,左侧尖牙关系为近中关系,上牙列III°拥挤,下牙列II°拥挤,Spee曲线左右皆平直。11、12、13埋伏阻生伴牙瘤,36、46残根。根据本病例的模型、曲面断层片、头颅侧位片和CT检查确诊为:上颌右侧前牙唇侧埋伏阻生伴牙瘤。采用外科手术切除牙瘤同时联合正畸闭合式牵引导萌,拔除12埋伏齿,36、46残根。应用直丝弓矫治技术,牵引埋伏齿,排齐整平牙列,维持标准的覆颌、覆盖,精准比对磨牙关系,矫治结束佩带Hawley保持器。通过比较治疗前后影像学数据分析得出软硬组织的变化。病例二:2016年1月就诊,女性,13周岁,安氏I类,上中下面高基本协调,左右面部对称,上颌中线左偏约4mm,下颌中线左偏约2mm。前牙覆颌Io、覆盖正常,上牙列II°拥挤,下牙列I°拥挤,Spee曲线左右约2mm。22、23埋伏阻生伴牙瘤,63滞留,根据曲面断层片、CT得出:22、23腭侧阻生伴牙瘤,采用外科手术切除牙瘤并联合正畸闭合式牵引导萌的方法,拔除23、63,直丝弓矫治,牵引埋伏齿,舌侧固定丝保持。结果:患者一经过18个月的综合治疗,至目前为止,埋伏齿已牵引至正常牙列,牙齿排列整齐,覆颌覆盖基本正常,上颌中线欠佳,侧貌良好。牙髓活力正常,牙周组织较好。颞下颌关节检查未见异常,张口度、张口型正常。曲面断层片显示11、13周围齿槽骨高度略降低,其余牙根及齿槽骨未见异常吸收,牙周组织良好,牙瘤处骨质恢复良好,未见复发,颞下颌关节未见异样,埋伏牙及邻近牙齿周围骨质正常,牙根无明显吸收。治疗前后投影测量数据对比: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减小14o、Z角减小7o;治疗前后重叠图显示:上下颌骨无明显变化,上下前牙唇倾。侧面形态无较大明显改变,此时病人和家属对现今的牵引效果疗效满意。患者二患者经过12个月治疗,埋伏齿已牵引至正常牙列。结论:对于多颗埋伏阻生齿的牵引,埋伏齿之间相互干扰,常伴有个别牙发育不良,治疗时应拔除发育不良的埋伏齿再进行正畸牵引。牙瘤为良性肿瘤,切除后不易复发,常与埋伏齿伴发,手术应时避免损伤埋伏齿而导致牵引失败。青少年上颌前牙埋伏阻生患者,多以保留自体牙为主,通过外科手术和正畸联合治疗,避免拔除埋伏齿治疗的后期修复,通常能获得较好的治疗效果。
[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 掳and the inferior dentition was crowded with II 掳. 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 掳and the inferior dentition was crowded with I 掳. 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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.5

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