安格氏三級異常咬合伴隨門牙缺失之病例使用前拉面罩治療之病例報告

Treatment of Angle Class III Malocclusion with Lateral Incisor Congenital Missing with Facemask–Case Report

混合齒列至青少年時期使用前拉面罩來治療上顎發育不足是常用且有效的方法之一。本病例十歲女童為骨性上顎後縮、前牙錯咬合併上顎右側錐狀側門齒、上顎左側側門齒缺失及上顎齒列中線偏移的安格氏三級不正咬合病例，以前拉面罩合併快速上顎擴張器治療，並且拔除右側錐狀側門齒，關閉空間及犬齒替代。但隨著生長的變化及拔除上顎右側側門牙的空間關閉後，發現水平覆蓋變小、及上顎中線偏左及左右側臼齒不對稱的情況，故在上顎右側植入暫時性錨定裝置，再同時繼續配合前拉面罩，將上顎齒列前拉，直到兩側大臼齒均達到安格氏二級咬合關係。由於病患的合作，治療的結果齒列及外觀均得到大幅的改善。

Protraction facemask is one of the common effective methods to treat the patient with maxillary deficiency in mixed dentition and adolescent patients. In this case report, we present the treatment of a 10-year-old female patient with skeletal class III with maxillary retrognathism, anterior crossbite, left lateral incisor congenital missing, right peg lateral incisor and midline discrepancy with class III malocclusion. Treatment plan included protraction facemask with rapid maxillary expansion therapy, extraction of right peg lateral incisor and canine substitution. We also used temporary anchorage device (TAD) for molar asymmetry and midline correction while using facemask protraction to reach the bilateral Class II molar relationship. The final result was midline on and bilateral Class II molar relationship and facial profile was improved.