長期追蹤兩階段治療骨性二級異常咬合－－病例報告

Long-term Follow up of Two-stage Treatment of Skeletal Class II Malocclusion – Case Report

骨性二級異常咬合於混合齒列期的兩階段治療：第一階段配戴功能性矯正裝置，期待增加下顎水平生長量，待進入永久齒列期再次評估後進行第二階段的固定矯正治療。本次報告二病例皆是外觀呈現下顎骨後縮的骨性二級顎間關係、嚴重水平覆咬，齒列為完全二級安格氏異常咬合，治療計劃皆為兩階段治療：配戴功能性矯正裝置後水平覆咬減少，臼齒皆達一級咬合關係；進入第二階段的固定矯正治療，治療計劃皆為不拔牙，擴張上顎以後退上顎前牙繼續減少水平覆咬，治療完成皆達到一級犬齒及臼齒咬合關係。本次報告將比較兩病例治療過程及長期追蹤的結果，同時討論功能性矯正裝置對下顎骨生長的影響、矯正治療與顳顎關節障礙的相關性及兩階段治療是否有其必要性。

The common treatment protocol for skeletal Class II malocclusion during mixed dentition is a two-stage treatment, namely functional appliance followed by fixed appliance. The goal of the functional appliance is to enhance the horizontal growth of mandible. After reevaluation, the second stage of fixed appliance is implemented. This is a 2-case report of skeletal Class II malocclusion. Both clinical examinations showed mandible retrognathia, large overjets and full Class II Angle's molar relationships. Two-stage treatments were undertaken. After functional appliances, overjets were reduced and Class I molar relationships were achieved. Following that , fixed appliances were carried out without extraction of teeth while maxilla was expanded, and upper anterior teeth were retracted to reduce the residual overjet. The aim of this case report was to compare the outcomes of the 2 cases. In addition, the effects of functional appliance on mandible growth, the relationships between orthodontic treatment and temporomandibular disorder and the necessity of 2-stage treatment for skeletal Class II malocclusion will be discussed.