合併骨牽引術及齒顎矯正治療早期植入之上顎前牙植體之病例報告

Treatment of Early Implanted Upper Anterior Teeth by Modified Distraction Osteogenesis and Orthodontic Treatment

利用牙科植體來取代缺失的牙齒通常會選擇在顱顏面生長發育完成後才開始進行。對於兒童及青少年，早期植體的植入會造成一些潛在不良的影響，包括：對於牙胚創傷、造成牙齒萌出時的障礙以及對於齒槽骨和顱顏面骨的多層面的生長限制。臨床和影像學的研究結果清楚表示，植體如同黏連齒（ankylosed teeth），不像正常發育齒列中的牙齒會隨著鄰牙一起萌發移動。此病例是一位年輕女性，在她13歲的時候發生車禍，導致3顆上顎前牙喪失，隨之以牙科植體取代。利用根尖下截骨術合併骨牽引術結合矯正治療，以3維方向重新定位局部的植體-骨頭區塊至一個較為美觀以及生物力學的位置。藉由增加局部的植體-骨頭區塊不足的高度，以達到改善與鄰牙牙齦不齊平的情形。

The replacement of teeth by osseointegrated implants is usually restricted to patients with completed craniofacial growth. Implant insertions in children, adolescents and young adults who we refer to as young patients are circumvented due to several unfavorable potential effects including trauma to tooth germs, tooth eruption disorders, and multidimensional restrictions of dental alveolus and skeletal craniofacial growth. The clinical and radiographic findings have clearly shown that the implants do not behave like normal erupting teeth during the development of the dentition. Neither does the fixtures move together with the adjacent teeth, but behaves more like ankylosed teeth. This was a case of a young patient suffered from car accident when she was 13y/o, and which resulted in missing of three upper anterior teeth followed by replacement with osseointegrated dental implants. This case presentation demonstrates a surgical technique that allows the use of subapical osteotomy and distraction osteogenesis in combination with conventional orthodontic treatment to three-dimensionally reposition an implant-bony segment into a more favorable aesthetic and biomechanical position, thus improving the vertical dental alveolus deficiency and leveling the gingival contours with those of the adjacent teeth.