成人骨性二級異常咬合合併上顎第一大臼齒缺失之病例報告

Treatment of Severe Class II Division 1 Malocclusion with Maxillary First Molar Missing — Case Report

本篇提出一骨性二級與安格氏二級一類異常咬合之22歲女性患者，主訴為上顎門齒突出。臨床檢查發現患者側面為凸臉形、下顎後縮、上下門齒前突且水平覆蓋約11mm，併有上顎左側第一大臼齒缺失、下顎前牙齒列些微擁擠、上下牙弓呈尖形。經矯正分析並與病患溝通後，治療計畫採取掩飾性矯正治療：上顎拔除雙側第一小臼齒，將左上第二與第三大臼齒往近心移動，右上則以第二小臼齒至第二大臼齒作為錨定；下顎則為不拔牙治療，將尖型牙弓改善為卵圓型解決擁擠問題。此左右不同的錨定方式使上顎中線對齊，也成功維持錨定，並改善患者外觀與咬合型態。

This case report describes a 22-year-old female with skeletal Class II and dental Class II division 1 malocclusion. The chief complaint is her protrusive upper front teeth. Clinical examination revealed a convex facial profile, retrognathic mandible, proclined upper and lower incisors with 11mm overjet, missing of upper left first molar, mild crowding in the lower anterior region and V-shaped arch forms. After orthodontic analysis and communication with the patient, the treatment plan was decided to orthodontic camouflage treatment by extracting the upper first premolars, moving upper second and third molars mesially at left side and maintaining upper second premolar to second molars at right side. In the lower arch, we corrected the taped arch form to ovoid without extraction. The different anchorage methods not only corrected the midline, but also maintained the anchorage and improved the patient's profile and occlusion.