成年患者之單側下顎大臼齒前移併用牙周輔助加速成骨矯正治療－－病例報告

Corticotomy Assisted Lower Molar Protraction Treatment for A Periodontally Compromised Patient – A Case Report

本病例為51歲女性，求診時右下第一大臼齒牙根斷裂，且具有廣泛性牙周病。主訴要求拔除右下第一大臼齒後，以矯正治療關閉拔牙空隙，以免除假牙製作，患者並不希望外觀或前牙齒列有大幅改變。治療計劃為拔除右下第一大臼齒，以第二與第三大臼齒之前移，完全關閉拔牙空間。然而直到治療第17 個月，治療仍難有進展。因拔牙空間很大，又需全部靠長距離前移動作來治療，因此安排了質皮骨切開術（corticotomy），才得以順利達成目標。術後咬合穩定，外觀也保持不變。質皮骨切開術不但提升了治療效率，也增進且擴張了成人患者的治療範圍。

This is a case of a 51 years old female with skeletal Class I malocclusion, suffered from root fracture of #46 & moderate generalized periodontitis. She asked for molar protraction of #47 #48 to close the extraction space of #46 without any prosthesis or dramatic change of profile. Treatment planning was removal of #46 & protraction of #47 #48 with mini screw. It became difficult to close the residual space of #46 after 17 months of treatment due to narrow edentulous ridge. Therefore corticotomy plus bone grafting was performed. After treatment, her occlusion was stable and profile was satisfied. Selective alveolar corticotomy can be a feasible treatment modality for adults. The procedure not only enhances the efficiency of treatment but also broadens the range of tooth movement.