崇愛牙醫診所(資料重建中,歡迎新舊朋友)

         
下顎後牙的長期缺失，會產生上顎對咬牙的過度萌發(over elongation)和鄰接牙向缺牙區傾斜或不當位移，往往在製作補綴物時會遇到後牙區顎間空間不足的問題，需要矯正治療的幫助，可利用臨時微植體(TAD)來解決傳統錨定裝置的缺點及限制。利用骨釘治療顎間空間不足及後牙錯咬，可以獲得良好的結果。

  
臨床上常會碰到大臼齒因為對咬側的牙齒長期缺失,形成另一側的牙齒伸長(elongation)的現象,造成在補綴假牙製作上產生困擾,於是會要求矯正的醫師來做壓入的動作,通常這種情形出現在後牙大臼齒居多,且有些案例出現對咬牙已伸長碰到另一側的牙床,產生咬合的干擾或是崩壞(occlusal
collapse),此情形在操作上較困擾,但有賴骨釘(MIA)與骨板(MINIPLATE)的發明,使得這項煩人的工作變得較簡便多了。

   
對於因失去對咬牙而過度萌發的上顎大臼齒可能造成牙周、咬合干擾(occlusal
interfenrence)等問題。要壓入過度萌發的牙齒需要充分的錨定(anchorage)的支持，包括口內多顆牙的連綁、口外裝置如頭套的配戴、以及新發展的微植體(MIA)作為骨性錨定運用等方式

         
上顎第一大臼齒平均壓入量為3~4mm，最大值可達8mm。與上顎第一大臼齒相鄰近之其他牙齒，包括上顎第二大臼齒，以及上顎第一、第二小臼齒，平均壓入量為l~2mm。各個牙齒的頰側和顎側壓入量並沒有明顯差異。因此，固定矯正裝置配合微植體如鈦金屬骨釘與骨板的運用，對於過度萌發的上顎臼齒可獲得確實有效的壓入治療結果。

大臼齒壓入,所使用的是骨釘的雙側聯合壓入,也就是頰側(BUCCAL SIDE)與顎側(PALATAL
SIDE)一起來,這樣臼齒的牙根才能平穩的壓入,做整體移動(bodily movement)

至於操作上, 必需注意的是除了雙側平穩的壓入外,使用的力值不宜過大,別忘了,上顎上方還有一個天花板在上頭(上顎竇,maxillary
sinus),一定要check x光,監控壓入的深度,因為sinus是一個球形物,它的外邊有一個類似capsule(膠囊)的樣子包住,所以大臼齒牙根被壓入的力值一定要小心監控,不然力一加大,很可能來個刺破氣球,那就糟啦!!

    至於下顎方面,也別忘了,下顎下齒槽神經束(inferior alveolar nerves
bundle)也在後牙段的下方通過神經管裡頭,所以在操作上也需特別的留意,以免壓傷啦!

Ancor Pro® Orthodontic Anchorage System(看一下動畫演示)

 CR=CENTER OF
RESISTANCE(抗力中心)

Maxillary
Molar Intrusion with the Molar Intrusion Arch (使用壓入弓)

以微型骨釘壓入大臼齒的案例報告
(點入有圖可看)

以骨釘做uprighting(朴孝尚)(非常經典,圖文並茂,值得一看再看)

 intrusion of overerupted
maxillary Molars with Miniscrew Anchorage (drs. lin/liu/yeh)

Modified Transpalatal Arch (M-TPA) For Intrusion Of Maxillary 2nd
molars

Molar intrusion of extruded molars

solution
in MIA(景熙文)

CASE REPORT How would you treat this malocclusion?

CASE REPORT How would you treat this
malocclusion?~1

handbook of dentos absoanchor MIA (absoanchor臨床操作手冊)

the Dentaurum Illustrated Atlas of Skeletal Anchorage,
2006

上顎臼齒對咬牙過度萌出的治療            
molar
intrusion臨床病例

molar
intrusion臨床案例

aarhus MIA使用的操作臨床步驟(精彩絕倫,無與倫比)

採用skeletal anchorage system來壓入大臼齒的案例(請看圖即可)

spider MIA
system的臨床案例 (spider
screw:skeletal anchorage system)

Simple Method of Molar Intrusion with Micro-implant Anchorage; Case
reports

mia壓入的臨床案例

Skeletal Anchorage in Orthodontics(C palatal plate/C
tube)

(from:www.scielo.br/scielo.
php?script=sci_arttext&p...)

Maxillary Molar Intrusion with Fixed Appliances and
Mini-implant Anchorage Studied in Three Dimensions(Chung-Chen Jane Yao, DDS,
PhD;a Jang-Jaer Lee, DDS, MSD;b Hsing-Yu Chen, DDS;c Zwei-Chieng Jenny Chang,
DDS, MSD;d Hsin-Fu Chang, DDS, MSD;e Yi-Jane Chen, DDS,
MSDf)(台大矯正科在angle的文獻)

Reduction of Gingival Display with
Maxillary Intrusion Using Endosseous Dental Implants(JCO)

 The use of temporary anchorage devices for molar intrusion (J
Am Dent Assoc, Vol 138, No 1, 56-64) (裡面有molar
intrusion的量與時間表格數據)

Treatment of Skeletal Open Bite with a Device for Rapid
Molar Intrusion:A Preliminary Report

Transalveolar screw: A new concept for orthodontic
anchorage

Feature Micro Implants in Orthodontics(By A. Korrodi Ritto, DDS,
PhD)

The Ortho Implant Using the Cope PlacementProtocol™: Big
Results From a Tiny Implant (by Jason Bryan Cope, D.D.S., Ph.D)

壓低後牙

Clinical Experience on a Case of Skeletal Openbite Treated
with lingual bracket and skeletal anchorage system without OGS

Mini-screw Application For Gummy Smile Correction

An Adult Case of Skeletal Open Bite with a Large
LowerAnterior Facial Height

Maxillary molar intrusion with fixed orthodonticappliances
and bony anchorage—A preliminary reportwith a 3-D analysis

Clinical use of Dual Top micro-screws for orthodontic
anchorage(值得看!)

Treatment and posttreatment dentoalveolarchanges following
intrusion of mandibularmolars with application of a skeletalanchorage system
(SAS) for open bite correction(Junji Sugawara, DDS, PhD)

 Molar Rotation and Beyond

Current Products and Practice Bone anchorage devices in
orthodontics

nonextraction treatment of anopen bite with microscrew
implant anchorage

Intrusive Effects of the Connecticut Intrusion Arch and the
Utility Intrusion Arch

Intrusion of the Overerupted Upper Left First and SecondMolars by
Mini-implants with Partial-Fixed OrthodonticAppliances: A Case
Report(張心涪等)

The influences of molar intrusion on the inferior alveolar
neurovascular bundle and root using the skeletal anchorage system in
dogs