安格式二級咬合不正合併後牙錯咬及深咬的牙周病患之矯正治療

Orthodontic Treatment in Periodontal Compromised Patient with Class II Posterior Cross Bite and Deep Overbite

成人矯正治療會面臨的困難是除了咬合不正外，還會同時合併有牙周病及缺牙的問題。如何在符合口腔現有條件及適當生物力學考量下，達成病人在美觀及功能上的期望，常是成人矯正治療的一大挑戰。本病例為牙周病科轉介而來32歲女性病患，主訴為上顎暴牙同時因缺牙而造成齒列中多處有縫隙。矯正常規檢查，診斷為全口牙周炎，安格式二級第一類異常咬合，雙側後牙錯咬及深咬，上顎雙側第一大臼齒及下顎右側第二大臼齒缺失。在牙周健康穩定情況下，藉由矯正植體運用，矯正治療改善暴牙及後牙錯咬並將阻生的下顎第三大臼齒扶正並前拉取代缺失第二大臼齒，對病人的齒列咬合、顏面美觀、咀嚼功能都成功改善。

Orthodontic management in adult patients with advanced periodontitis is complicated and highly technique sensitive because of missing teeth and reduced alveolar attachment.This case report presents a 32-years old female who was referred from periodontal department, complained about maxillary protrusion and anterior spacing. The diagnoses were Class II division 1 malocclusion, combined with bilateral posterior crossbite and deep overbite. After periodontal inflammation was under well controlled, complicated orthodontic teeth movements were achieved with the aid of TADs. The orthodontic treatment includes the retraction of maxillary anterior teeth and intrusion and palatal movement of upper right segment. In the lower arch, the mesial tilted 3rd molar was successfully uprighted and mesially protracted to replace the missed 2nd molar. The facial esthetic was improved and the occlusion was stable after treatment. Her periodontal condition was well maintained.