話說上回還記得向各位報告過的兩篇文章裡的小女孩,可以先進入文章重新review一下
在逐次的回診當中,我一直觀察右上乳c的變化,怎麼她的牙老是不換?於是再次要求家長照下全口x光全景片,謎底終於揭曉,原來牙齒迷走了,可以從下面這一張panorex film看到,右上3竟然橫躺在右上456的底部,也就是上顎顎側的底,在上顎竇下方,
為了確保一下,再照一張根尖片,底下的根尖片,可以看到右上3的根部
病人的全景x光片
這是根尖x光片
這是上顎鏡像所見
在與家長溝通後,委請去拍3D 螺旋CT,進一步將三維空間做一下釐清,以便請口腔外科醫師,做右上3的拔除手術,
(p/s:
螺旋CT：牙體螺旋CT三維重建技術(three dimensional reconstruction technology of spiral CT，3DSCT)是利用專用牙體成像軟體和表面遮蓋法(shaded surface display，SSD)後處理軟體對螺旋CT容積掃描所得的三維資料做回顧性的重建，以獲得牙體表面立體圖像，如進行即時多層面重建(multiplanar reformation，MPR)，還可顯示任意方向多個平面包括冠狀、矢狀、斜面、曲面等斷面圖像)
這一病例在先前PO文中,我曾提過她不是一個挺配合的患者,所有過程能做到這一步,至少我們盡力了,乳C一直是不敢黏上矯正器,主因是它會被迫吸收,牙齒將來會越來越鬆動,甚至被拔除,保留它或許可以對外觀起到一點作用
下面文獻雖然可以提供參考,但務必是牙齒可以保留完整才可以做,若是無法完全而必須分批分段拔除則又另當別論
Autotransplantation of Transmigrated Mandibular Canine
| Transmigrant impacted mandibular canines A retrospective study of 15 cases | ||||||
|
TREATMENT OPTIONS FOR IMPACTED TEETH
Unusual Cases of the Transmigrated Mandibular Canines: Report of 4 Cases
Transmigration 大部分是單側性的，只有16 cases是雙側性 (both)。左側 犬牙發生率也較右側高 (both)。女性發生率也較男性高 (both)。 |
*埋伏阻生牙還可能會導致中線的偏斜、牙弓不對稱及咬合錯亂，影響咀嚼功能和顳下頜關節的健康
*埋伏阻生牙自身在頜骨內也可發生牙根的外吸收、骨質粘連、牙槽骨吸收，在外傷時該區易發生牙槽骨骨折；另外，埋伏阻生牙可壓迫神經引起相應的神經症狀，還可能成為感染的病灶，繼發炎症、囊腫。位於上前牙區的埋伏阻生牙對顏面美觀、語言發音以及患者的心理帶來不良影響
*上顎犬齒是除第三大臼齒外最易發生埋伏阻生的牙齒 ,
上頜犬齒顎側埋伏阻生的患病率為 2.4％
Mupparapu used five criteria to classify the transmigrated canines. These are summarized as:(Mupparapu 提出以下五個分類：
Type 1: The canine is impacted mesioangularly across the midline, labial, or lingual to the anterior teeth with the crown portion of the tooth crossing the midline.(Type1~近心傾斜，牙冠跨越中線)
Type 2: The canine is horizontally impacted near the inferior border of the mandible below the apices of the incisors.(Type2~水平阻生，在門牙根尖之下。)
Type 3: The canine has erupted either mesial or distal to the opposite canine.(Type3~跑到對侧犬齒區附近。)
Type 4: The canine is horizontally impacted near the inferior border of the mandible below the apices of eitherpremolars or molars on the opposite side.( Type4~水平阻生，在對侧小臼齒根尖之下。)
Type 5: The canine is positioned vertically in the midline with the long axis of the tooth crossing the midline. (Type5~垂直阻生，長軸跨越中線。)
IMPACTED MAXILLARY CANINE
Classification of impacted maxillary canine:
ARCHER'S CLASSIFICATION
Class I
Palatally Impacted canine
a) Horizontal
b) Vertical
c) semivertical
Class II
Buccally impacted canine
a) Horizontal
b) Vertical
c) Semivertical
Class III
Impacted canine located in both the palatal and labial surfaces.
Class IV
Impacted canine located in the alveolar process.
Class V
Impacted canine located in an edentulous maxilla.
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