@到底要拔3/3或是乳c/c?(犬齒異位萌出)~~最近剛接手的high canine ectopic eruption的case－崇愛牙醫診所(資料重建中,歡迎新舊朋友)

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底下4點是出自Orthodontic tooth movement of total buccally blocked-out canine: a case report裡面的文章

First, there is usually severe crowding, at least in the canine

region. To overcome this, space is needed to be created for alignment. Extractions are usually needed. The anchorage situation is usually severe. This problem may be controlled by anchorage reinforcement measures such as a palatal arch or a Nance button.

Second, in some cases one side of the crowding (the side of the blocked out canine) may be more severe than the other side, in these cases the dental midline is usually shifted to the crowded side. This midline correction can be facilitated by delaying extraction on the crowded side during orthodontic midline correction. This also reduces the chance of the crowded canine to drop in place more to the crowded side than it should be which makes subsequent midline correction and to obtain a decent occlusion difficult.

Third, the condition usually requires substantial amount of bodily movement of canine which is difficult to perform because the canine has a long and bulbous root. This morphology makes bodily movement of the canine time-consuming, difficult to control and often results in root resorption.

Even when orthodontic forces are applied in a desired direction, it is difficult to produce the amount of root movement required because a large hyalinised layer will be created [1]. In addition, the canine root is usually close to the cortical bone of the maxilla, an area of reduced vascularisation. This results in delayed bone remodeling and tooth movement. In order to produce efficient canine root movement, very light orthodontic force will be needed. This can be achieved by sectional wire with frictionless mechanic coupled with slight activation during canine retraction stage, and using long span of wire (with increased interbracket width and increased flexibility) by differential bonding of the teeth during alignment stage.

Fourth, the buccal bone covering the buccally placed canine root is usually thin. Therefore, palatal root torque is needed for the canine to increase the buccal bone thickness, decrease the risk of bone dehiscence and decrease the risk of gingival recession [2]. In addition, the canine should be allowed to erupt in place naturally rather than to extrude it as this may lead to gingival recession

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