埋伏弯根上颌中切牙序列矫治的研究

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[摘要] 目的 探讨埋伏弯根上颌中切牙有效的正畸牵引治疗方法。方法 选择11例患者共12颗埋伏弯根上颌中切牙为研究对象，常规拍摄定位X线片，配合口内检查、模型分析等，确定埋伏牙的位置及其与邻牙的相互关系，采用封闭式导萌、选择性根管治疗及根尖切除术、修复治疗等方法进行矫治。结果 12颗埋伏牙通过治疗后顺利进入正常牙列，未见牙根吸收粘连，建立了良好的咬合关系。9例唇侧埋伏弯根上颌中切牙患者的临床牙冠唇倾角度较大，4例根尖位于唇侧黏膜下，进行了根管治疗加根尖切除术，其中1例行烤瓷冠改形修复；其余5例未做根管治疗，暂行观察。2例腭侧埋伏弯根上颌中切牙的疗效稳定。结论 埋伏弯根上颌中切牙采用序列矫治可以取得良好的美观和功能效果。

[关键词] 埋伏牙； 上颌中切牙； 弯根牙； 序列矫治； 正畸治疗

[中图分类号] R 783.5 [文献标志码] A [doi] 10.3969/j.issn.1000-1182.2012.03.017

Sequence orthodontic treatment of impacted dilacerated maxillary central incisors Zheng Yi, Pang Xuannai, Nan Lan, Mo Shuixue. （Dept. of Orthodontics, College of Stomatology, Guangxi Medical University, Nanning 530021, China）

[Abstract] Objective To explore an effective orthodontic method for treating impacted dilacerated maxillary cen-tral incisors. Methods 12 impacted teeth of 11 cases were chosen. The position of the impacted teeth and the rela-tions with neighbour tissues were assessed by X-ray images, oral examination and plaster model, etc. The impacted teeth were induced to erupt with the closed-eruption technique and fixed orthodontic appliances, root canal therapy, apicoectomy and prosthetic treatment. Results 12 impacted teeth were moved into arches, and the occlusal relation-ship was normal. There were no root resorption or conglutination in those impacted teeth. The labial impacted teeth of nine cases had bigger labial crown torsion. The root apexes of four impacted teeth were palpable under mucosa of

the labial sulcus and operated by root canal therapy and apicoectomy. One of them received prosthetic treatment. Others（five cases） hadn’t accepted root canal therapy, and were observed temporarily. The effects of two palatal impacted teeth was stable. Conclusion It was a good method to expand indication with sequence orthodontic treatment. The impacted dilacerated maxillary central incisors could be aligned with good esthetical and functional effect.

[Key words] impacted teeth； maxillary central incisors； dilacerated teeth； sequence orthodontic treatment； or-thodontic treatment

上颌埋伏弯根中切牙是临床上矫治难度较大的错畸形。由于埋伏的三维空间位置多变，牙根多出现形态上的变异，以往多以拔除为主，破坏了牙列的自然形态，严重影响患者的外形、功能和心理健康。随着正畸技术的日益提高及与口腔各学科合作治疗的广泛开展，笔者整理出一套较为完整可行的治疗方案，采用开窗后正畸导萌的方法，将埋伏弯根的中切牙牵引至正常牙列得以保存，使其矫治适应证得到进一步的扩展。

1 材料和方法

1.1 研究对象

选择2006年6月—2011年6月在广西医科大学附属口腔医院正畸科进行治疗的11例患者的12颗埋伏弯根中切牙为研究对象。11例患者中，男7例，女4例；年龄8～15岁，平均11.5岁。11例患者中，唇侧倒置埋伏型7例，唇侧前后水平埋伏型2例，腭侧后前埋伏型2例。牙根弯曲部分在根尖1/3～1/2，弯曲度为20°～100°。

1.2 治疗方法

1.2.1 定位方法 常规拍摄全景片、头颅侧位片、体