Liu MJ, Lin MH, Chen HL, et al. Robertsson & Mohlin 2000 attachment level maxillary mid-palaltal suture autotransplant Czochrowska et al Czochro

Size: px

Start display at page:

Download "Liu MJ, Lin MH, Chen HL, et al. Robertsson & Mohlin 2000 attachment level maxillary mid-palaltal suture autotransplant Czochrowska et al Czochro"

以史
7 years ago
Views:

1 CASE REPORT 牙齒自體移植術應用於患有嚴重局部牙周病病患的牙周矯正治療上的病例報告 * * * 臨床上患有雙顎齒槽前突合併有嚴重牙周病而喪失上顎若干前牙的病患, 欲尋求理想的整合性復健是相當困難的前牙區缺牙的整治方法包括.. 固定牙橋活動假牙人工植牙自體移植, 或是利用矯正來關閉空間但針對雙顎前突合併有已降低骨高度和狹窄化牙脊的前牙區域, 單獨假牙或人工植牙的復治療, 可能會導致門齒的過度外展, 咬合功能或美觀上不盡理想若利用自體移植來解決缺牙區問題, 因為保留有誘導骨再生能力的牙周膜, 不僅能解決因牙周病而拔除牙齒所產生的骨頭缺損, 同時也提供了矯正時牙齒移動的可行性, 以及齒槽骨的塑形與再塑形經由矯正移動與後退前牙區的牙齒, 將能改善齒槽前突的問題並獲得臉形的大幅改善本病例報告為一因嚴重牙周病而喪失上顎同側正中門齒與側門齒且合併有雙顎齒槽前突的病例首先想到的治療計畫為希望能經由矯正的牙齒移動來關閉此處缺牙空間時, 同時獲得前牙區大量的後退, 進而解決其雙顎齒槽前突的問題, 但針對同側的前牙區大範圍缺牙空間實在是相當困難, 又若想利用對側的牙齒移動來解決同側缺牙的問題, 也會面臨牙齒移動是否能越過上顎正中顎骨縫合的風險因此, 決定先經由牙周治療與追蹤獲致良好口腔衛生習慣後, 拔除左上左下與右下第一小臼齒, 並選擇將左上第一小臼齒移植到右上正中門齒區, 待牙周膜再生完成及根管治療後, 進行齒顎矯正來關閉缺牙空間並獲致大量的前牙後退經由兩年的矯正治療, 同時改善病患的面部外觀與缺牙問題 (J. Taiwan Assoc. Orthod. 20(3): 49-63, 2008) 關鍵詞 : 自體移植前牙區缺牙前言 Millar

. 固定牙橋活動假牙人工植牙自體移植, 或是利用矯正來關閉空間但針對雙顎前突合併有已降低骨高度和狹窄化牙脊的前牙區域, 單獨假牙或人工植牙的復治療, 可能會導致門齒的過度外展, 咬合功能或美觀上不盡理想若利用自體移

2 Liu MJ, Lin MH, Chen HL, et al. Robertsson & Mohlin 2000 attachment level maxillary mid-palaltal suture autotransplant Czochrowska et al Czochrowska et al 2002 病例報告前言 35 X- 1, 1 X- X 臨床檢查 1. mentalis strain 2. convex profile 1. edge-to-edge 2. Angle's class I relationship curve of Spee 3mm 3. U 2mm mm Bleeding on probing 50

3 Autotransplantation in Periodontitis Case X 光檢查 1. X panoramic findings 2 bone loss 2. X cephalometric findings 3 ANB=-1.29 SN-MP=32.82 U1-NA=40.60 &12.71mm L1-NB=45.55 &10.51 mm U1-L1=95.14 診斷 X 1. localized aggressive periodontitis pathologic tooth migration apical lesion 2. mentalis strain 3. Skeletal class III relationship 3 4. Angle's class I with bimaxillary dentoalveolar protrusion 5. labial proclination Dental crowding 1. 術前牙周囊袋探測 1.B(D M):Buccal side,distal to mesial;2. P(D M):Palatal side,distal to mesial; 3. L(D M):Lingual side,distal to mesial;4. L(M D):Lingual side,mesial to distal ;5. Palatal side,distal to mesial #17 #16 #15 #14 #13 #12 #11 B(D M) P(D M) /- 0/- 0/- 0/- 0/- II/+ II/+ #21 #22 #23 #24 #25 #26 #27 B(M D) P(M D) I/- 0/- 0/- 0/- 0/- 0/- 0/- Probing #47 #46 #45 #44 #43 #42 #41 B(D M) L(D M) /- I/- 0/- 0/- 0/- I/- I/- Probing #31 #32 #33 #34 #35 #36 #37 B(M D) L(M D) I/- I/- 0/- 0/- 0/- 0/- 0/- 51

Angle's class I with bimaxillary dentoalveolar protrusion 5. labial proclination Dental crowding 1. 術前牙周囊袋探測 1.B(D M):Buccal side,distal to mesial;2. P(D M):Palatal side,distal to mesial; 3.

4 Liu MJ, Lin MH, Chen HL, et al. 2. 術後牙周囊袋探測,#11 處為原先 #24 的自體移植牙 1.B(D M):Buccal side,distal to mesial;2. P(D M):Palatal side,distal to mesial;3. L(D M):Lingual side,distal to mesial;4. L(M D):Lingual side,mesial to distal ;5. Palatal side, distal to mesial #17 #16 #15 #14 #13 #11 B(D M) P(D M) /- 0/- 0/- 0/- 0/- I/- #21 #22 #23 #25 #26 #27 B(M D) P(M D) /- 0/- 0/- 0/- 0/- 0/- Probing #47 #46 #45 #43 #42 #41 B(D M) L(D M) /- 0/- 0/- 0/- 0/- 0/- Probing #31 #32 #33 #35 #36 #37 B(M D) L(M D) /- 0/- 0/- 0/- 0/- 0/- 3. 矯正前 / 後側頭顱分析值 (Steiner analysis) Skeletal pattern 正常值術前術後 SNA SNB ANB PFH/ AFH UFH/ LFH Dental patten 62~65% / : : U1-NA 22( )/4(cm) 40.60/ /5.53 L1-NB 25( )/4(cm) 45.55/ /6.11 U1-L U1-SN Tweed triangle FMA 20~ IMPA FMIA 65~

Palatal side, distal to mesial #17 #16 #15 #14 #13 #11 B(D M) 322 333 322 312 222 322 P(D M) 333 222 211 111 113 222 0/- 0/- 0/- 0/- 0/- I/- #21 #22 #23 #25 #26 #27 B(M D) 222 333 323 322 222 322 P(M

5 Autotransplantation in Periodontitis Case 圖 1. 初診時右上正門牙區的牙周狀況圖 2. 治療前的環口放射照片圖 3. 治療前的側頭顱放射照片圖 4. 矯正治療前病人照片 53

6 Liu MJ, Lin MH, Chen HL, et al. 治療目標 mentalis strain 治療計畫 banding maximum anchorage 5. Curve of Spee attachment level loop-mechanism step-down 6. #11 #22 loopmechanism 7. 治療流程 a knife edge loopmechanism X- X 治療結果 X 12 3 SNA 1.5 SNB 54

7 Autotransplantation in Periodontitis Case 1.7 ANB 3.3 eruption intrusion group function 1.5mm 1.5mm intercuspation 2 x-ray white line cortical bone 13 (a) (b) (c) (d) (e) (f) (g) (h) 圖 5. 自體移植手術的過程 (a) 移植前的缺牙區 (b) 拔下後欲移植的小臼齒 (c) 先用慢速手機與碳鋼磨針進行初期窩洞定位 (low-speed with carbide bur)(d) 用植牙鑽針進行窩洞擴大與塑形 (e) 移植牙植入事先準備好窩洞 (f) 以鎳子確定移植牙置入後能有良好的穩定度 (g) 用玻璃離子黏著劑進行移植牙與鄰接牙固定 (h) 用縫線緊密縫合齦瓣, 同時增進移植牙的穩定度 55

自體移植手術的過程 (a) 移植前的缺牙區 (b) 拔下後欲移植的小臼齒 (c) 先用慢速手機與碳鋼磨針進行初期窩洞定位 (low-speed with carbide

8 Liu MJ, Lin MH, Chen HL, et al. 圖 6. 移植牙追蹤八週後開始根管治療圖 7. 移植牙根管治療最後完成充填圖 8. 矯正關閉缺牙的空間圖 9. 治療後環口放射照片圖 10. 治療後側頭顱放射照片 56

9 Autotransplantation in Periodontitis Case 圖 11. 治療後病人照片 (a) (b) (c) 圖 12. 術前術後測顱 X 光重疊分析摹寫 :(a) 整體性重疊 (b) 上顎重疊 (c) 下顎重疊 57

10 Liu MJ, Lin MH, Chen HL, et al. 圖 13. 術後移植牙的牙周狀況討論罹患有牙周病的病患, 進行矯正治療時所需要的考量 localized aggressive periodontitis Hart et al mm attachment loss Carranza & Newman 1996 pathologic tooth migration proximal contact abnormal contact point wedge force Brunsvold 2005 light orthodontic force 5 mm intrusion 自體移植運用於牙科的治療與要獲得成功的自體移植所需要的考量事項 Aprel, 1956 periodontal ligament healing Andreasen, 1976, Tsukiboshi new attachment reattachment 58

1991 4 mm attachment loss Carranza & Newman 1996 pathologic tooth migration proximal contact abnormal contact point wedge force

11 Autotransplantation in Periodontitis Case 1 cone shaped Cohen Andreasen 1981a Kim et al % 2. Bone induction bone induction bone graft fibroblast cementoblast osteoblast Clockie 2001 keratinized gingiva gap Paulsen Pulp healing Andreasen et al mm inflammatory resorption Gregoriou et al Azevedo et al Root developing Tsukiboshi mm Kallu et al /2~3/4 expected root length Paulsen

gap Paulsen 2001 3. Pulp healing Andreasen et al. 1990 1 mm inflammatory resorption Gregoriou et al.

12 Liu MJ, Lin MH, Chen HL, et al. 3~9 Bauss et al 2004 extrusion rotation 使用小臼齒來取代正中門牙的優缺點與所需考量的事項 Kallu et al discoloration ankylosis crown/root ratio canine:34.9% molar:22.2% Zachrisson et al scallop form Laureys et al Czochrowska et al 2000 interdental papilla ossteo-induction remodeling Jonsson & Sigurdsson 使用矯正方式關閉前牙區缺牙空間與犬齒來取代側門牙所需考量的事項 Stenvik & Zachrisson general crowding

2005 194 273 discoloration ankylosis crown/root ratio canine:34.9% molar:22.2% Zachrisson et al.

13 Autotransplantation in Periodontitis Case ossteo-induction Proffit et al straight-wire edgewise appliance tipping torque tipping =+8 =+10 torque =0 =+6 torque root proximity 結論參考文獻 1. Aprel H. Autoplasty of enucleated prefunctional third molars. J Oral Surg, 1956;8: Andreasen JO. Histometric study of healing of period- ontal tissues in rats after a surgical injury. I. Design of a standardized surgical procedure. Odontol Revy, 1976; 27:115~ Andreasen JO. Histometric study of healing of periodontal tissues in rats after a surgical injury. II. Healing events of alveolar bone, periodontal ligaments and cementum. Odontol Revy, 1976;27:131~ Andreasen JO. Effect of extra-alveolar period and storage media upon periodontal and pulp healing after replantation of mature permanent incisors in monkeys. Int J Oral Surg, 1981;1: Andreasen JO. Periodontal healing after replantation and autotransplantation of incisors in monkeys. Int J Oral Surg, 1981;10: Andreasen JO, Paulsen HU,Yu Z, BayerT, Schwartz O. A long-term study of 370 autotransplanted premolars. Part III. Tooth survival and pulp healing subsequent to transplantation. EurJOrthod, 1990;12: Azevedo P, Moura C, Zanetta-Barbosa D, and Bernadineli N. Time of endodontic treatment in autogenic transplants of mature teeth: Histological study in dogs. Oral Surg Oral Med Oral Pathol Oral Radiol Oral Endod, 2007;104: Brunsvold MA. Pathologic tooth migration. J Periodontol, 2005;76: Carranza FA, Newman MG. Clinical periodontology 8th edition, W.B. Sauders Company,U.S.A., 1996;322~ Clokie CM, Yau DM, Chano L. Autogenous tooth transplantation: an alternative to dental implant placement? J Can Dent Assoc, 2001;67: Czochrowska EM, Stenvik A, Album B, Zachrisson BU. Autotransplantation of premolars to replace maxillary incisors: A comparison with natural incisors. Am J Orthod Dentofacial Orthop, 2000;118: Czochrowska EM, Stenvik A, Zachrisson BU. The esthetic outcome of autotransplanted premolars replacing maxillary incisors. Dent Traumatol, 2002;18: Gregoriou AP, Jeanaonne BG, Musselman RJ.Timing of calcium hydroxide therapy in the treatment of root 61

Design of a standardized surgical procedure. Odontol Revy, 1976; 27:115~130. 3. Andreasen JO. Histometric study of healing of periodontal tissues in rats after a surgical injury. II.

14 Liu MJ, Lin MH, Chen HL, et al. resorption in replanted teeth in dogs. Dent Traumatol, 1994;10: Hart TC, Marazita ML, Schenkein HA, Gunsolley JG, Diehl SR.No female preponderance in juvenile periodontitis after correction for ascertainment bias. J Periodontol, 1991;62: Jonsson T, Sigurdsson TJ. Autotransplantation of premolars to premolar sites. A long-term follow-up study of 40 consecutive patients. Am J Orthod Dentofacial Orthop, 2004;125: Kallu R, Vinckier F, Politis C, Mwalili S, Williams G. Tooth transplantation: a descriptive retrospective study. Intern J Oral Maxillofac Surg, 2005;34: Kim E, Jung JY, Cha IH, Kum KY, Lee SJ. Evaluation of the prognosis and causes of failure in 182 cases of autogenous tooth transplantation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2005;100: Kristerson L. Autotransplantation of human premolars. A clinical and radiographic studyof 100 teeth. Int JOral Surg, 1985;14: Laureys W, Beele H, Cornelissen R, Dermaut L. Revascularization after cryopreservation and autotransplantation of immature and mature apicoectomized teeth. Am J Orthod Dentofacial Orthop, 2001;119: Martinez-Canut P, Carrasquer A, Magan R, Lorca A. A study on factors associated with pathologic tooth migration. J Clin Periodontol, 1997;24: Millar BJ, Taylor NG. Lateral thinking: the management of missing upper lateral incisors. Br Dent J, 1995;179: Proffit WR, Henry WF, David MS. Contemporary orthodontics 4th edition, Mosby,U.S.A., Robertsson S, Mohlin B. The congenitally missing upper lateral incisor. A retrospective study of orthodontic space closure versus restorative treatment. Eur J Orthod, 2000;22: Stenvik, Zachrisson. Missing anterior teeth: orthodontic closure and transplantation as viable options to conventional replacements, Endodontic Topics, 2006;14, Tsukiboshi M. Autotransplantation of teeth, Wound healing in transplantation and replantation, Quintessence Publishing Co, Inc. Japan. 2001;22~ Tsukiboshi M. Autotransplantation of teeth: requirements for predictable success. Dent Traumatol, 2002;18: Zachrisson BU, Stenvik A, and Haanæs H, Management of missing maxillary anterior teeth with emphasis on autotransplantation. Am J Orthod Dentofacial Orthop, 2004;126:

Autotransplantation of premolars to premolar sites. A long-term follow-up study of 40 consecutive patients. Am J Orthod Dentofacial Orthop, 2004;125:668-675. 16.

15 Autotransplantation with Combining Periodontal and Orthodontic Therapies in a Severe Localized Periodontitis Case Ming-Jung Liu *, Ming-Huei Lin, Hui-Ling Chen *, Sheng-Yang Lee Department of Dentistry, Wan-Fang Hospital, Taipei Madical University * School of Dentistry, Taipei Medical University It is quite difficult for dentist to treat patients with upper anterior teeth lost due to severe periodontitis with bimaxillary dentoalveolar protrusion. Fixed partial denture(fpd), removable partial denture(rpd), implant, autotransplantation, or orthodontic space closure are selections which can be chosen when such problem is encountered. In situations with reduced bone height or narrowed ridge treatment with denture or implant alone will cause imperfection in the aspect of function and esthetics. If we try to restore these edentulous area with auto-transplantation, the preserved potential of ossteoinduction in transplanted tooth will not only resolve the problem of the reduced bone height resulted from periodontical tooth loss, but will also remodel the alveolar process with orthodontic tooth movement. With such bone remodeling while retracting the anterior teeth, the appearance of patient profile and problem of dentoalveolar protrusion will be resolved simultaneously. This is a case report of a patient with dentoalveolar protrusion and central and lateral incisors loss due to severe periodontitis. The primary treatment objectives were to close these edentulous area and to improve facial appearance with orthodontic retraction of anterior teeth. However, the clinician would face a predicament, because the space of two-tooth missing on the same side would be too large to close with orthodontic tooth movement. Meanwhile, if we moved tooth across the midline, it would still be risky whether tooth movement could be performed safely across the mid-palatal suture. Therefore, after periodontical treatment and follow-up, we decided to extract all first premolar, except upper right quadrant area, then we transplanted the upper left first premolar to upper right edentulous area. After waiting period of periodontal reattachement on transplanted tooth and endodontic treatment, we started orthodontic tooth movement to close these edentuluous area and to accomplish extensive retraction of the anterior teeth. After 2 years of orthodontic treatment, we successfully resolved her problems of edentulous area and dentofacial appearance. (J. Taiwan Assoc. Orthod. 20(3): 49-63, 2008) Key words: autotransplantation, upper incisors missing Received: August 18, 2008 Revised: August 26, 2008 Accepted: September 2, 2008 Reprints and correspondence to: Dr. Sheng-Yang Lee, School of Dentistry, Taipei Medical University No.250, Wusing St., Sinyi District, Taipei City 110, Taiwan Tel: ext Fax: 缺 twc @yahoo.com.tw 63

severe periodontitis with bimaxillary dentoalveolar protrusion.

6-1-1極限的概念

6-1-1極限的概念選修數學 (I-4 多項式函數的極限與導數 - 導數與切線斜率定義. f ( 在的導數 : f ( h 對實函數 f ( 若極限存在 h h 則稱 f ( 在點可微分而此極限值稱為 f ( 在的導數以 f ( 表示 f ( f ( 函數 f ( 在的導數也可以表成 f ( 註 : 為了