@malposition of maxillary left central incisor(左上中門齒異位)門牙倒長(逆長)案例的處理

Impacted Maxillary Central Incisor With Dilaceration(正確的臨床病名)
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此案例為2005年8月的一例左上中門齒倒長的案例,病童為小學5年級,由家長帶來診治,經口內環口全景x光片的檢查,發現左上中門牙產生倒長的情形,家長的希望是把它給拉出來排齊即可,案例採用022系統的edgewise bracket,經由初步的leveling & aligning的過程

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全景x光片所見,可以看到左側中門牙倒著長,與右邊的中門牙產生反方向的情況,

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利用牙科根尖x光面再次確認其生長的位置,牙根疑似彎曲捲起,牙科裡有一名詞形容它~dilaceration ,在字典裡對它的意義解釋為
dilaceration
/di·lac·er·a·tion/ (di-las″er-a´shun) a tearing apart, as of a cataract. In dentistry, an abnormal angulation or curve in the root or crown of a formed tooth

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再次以根尖片確認它,牙根捲曲應是朝頰側面,看似牙根被吸收掉

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經由two force technique慢慢把它給牽引下來,當然術前經由開窗術,把牙體先曝露出來,黏上矯正器,以供弓線來作用

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經由牽引,牙體已逐漸翻轉過來

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已經看到牙冠完全擺入牙列當中,但注意到牙根的部位好像有一點鼓鼓的突出現象,這就是牙根捲曲(dilaceration)的情形,做到此,家長問我說,楊醫生:『可不可以把牙根也給整平一下!』,眾人聽了差點昏倒,這是先天已經長成的樣子,它是硬體組織,想把它扳正是不行的,

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注意看兩顆門牙的高度,有一點不等長,若您曾經到過DR. VINCENT KOKICH的網站看過,他提到過,這類型的案例,牙齒要讓其稍拉咬合面一點,將來去除矯正器後,組織的拉力會把牙體往上提升,也就是要預先做補償,不然,未來移除後,牙齒會呈現往上縮,自然兩顆門牙會不一樣長,,,

此案例做到此, 家長已經滿意,因為小孩欲回老家去,遂建議其讓目前的狀況再穩定一點,就近在3個月後在老家的人民醫院拆除,,,,,,

●Tooth impaction may result from a number of local causes. Causes of non-eruption and impactions are:
1>. Arch length discrepancy

2>. Presence of supernumerary teeth

3>. Mucosal or bony barrier

4>. Retained deciduous teeth.

● Treatment alternatives for an impacted central incisor includes.

1. Extraction of the impacted central incisor and restoration with a bridge or an implant later when growth had
ceased.(拔掉然後做假牙修復)

2. Extraction of the impacted central incisor and closure of the space substituting the lateral incisor for the central incisor with subsequent prosthetic restoration.(拔掉,然後移側門牙替代再以假牙修復外形)

3. Surgical exposure, orthodontic space opening and traction of the impacted central incisor into proper position(手術露出,以矯正的方法拉到正常位置)

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