変則抜歯により矯正治療単独で治療した骨格性下顎前突症の一例  [in Japanese] A Case of Skeletal Mandibular Protrusion Treated Only by Orthodontic Treatment with Unusual Extraction  [in Japanese]

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Abstract

外科的矯正の適応には数多くの要因が加味されるため, その判定基準は一定ではなく, また矯正治療単独で治療することが可能かの判定基準も曖昧である.本症例はoverjet-5mm, overbite+3.5mmで前歯部の反対咬合が認められる下顎の過成長による骨格性下顎前突症である.また正貌においては下顎の右側への偏位が認められたことから, 外科的矯正の適応症例であると思われた.しかし患者から外科矯正回避の希望があったため, 過剰歯を含む変則的な9本の抜歯を行い, 矯正治療単独で治療を行った.外科的矯正を併用しないことにより, (1) 顔貌の非対称の改善がなされていない (2) 正中線が上下で一致していない (3) overjetに左右差が認められる (4) 左右大臼歯部における頬舌的トルクの左右差が認められるなどの問題点が残された.また保定後も若干不安定な様相が認められた.骨格的な歪みを残したまま咬合の再構築を行う場合は, 顎顔面形態の3次元的把握と口腔周囲機能との関連性についてより多くの情報を解析し治療目標を設定するとともに, 従来の咬頭嵌合を確立するという目的を考え直す必要性が認められた.

The indication criteria for surgical orthodontic treatment have not been established due to various factors, and there are no clear criteria for judging whether treatment only by orthodontic treatment is possible.<BR>This case was skeletal mandibular protrusion due to mandibular overgrowth with anterior cross-bite (overjet-5mm, overbite+3.5 mm). Since the frontal facial view showed mandibular deviation in the right direction, surgical orthodontic treatment was indicated. However, the patient did not consent to surgical orthodontic treatment, unusual extraction of 9 teeth including supernumerary teeth was performed, and treatment was performed only by orthodontic treatment.<BR>Since surgical orthodontic treatment was not performed, the following problems remained : <BR>1. Facila asymmetry was not improved.<BR>2. The maxillary median line was not accordant with the mandibular median line.<BR>3. Differences in overjet between the right and left sides were noted.<BR>4. Bucco-lingual torque in the right molar area differed from that in the left molar area.<BR>Furthermore, slightly unstable morphological conditions were found after retention. In performing occlusal reconstruction in cases with remaining skeletal distortion, it was necessary not only to understand the three-dimensional maxillo-facial morphology and stablish treatment goal analyzing further information regarding the relationship with function around the oral cavity, but also to reconsider conventional goal that is the establishment of intercuspation.

Journal

  • The Journal of Showa University Dental Society

    The Journal of Showa University Dental Society 24(2), 204-214, 2004-06-30

    Showa University Dental Society

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