不同状况阻生上颌尖牙临床处理策略分析

Analysis of the clinical strategies in managing maxillary impacted canine of different status

目的：探讨阻生上颌尖牙合适的临床处理策略，为其合理治疗提供依据。方法回顾2000-2012年期间在大连市口腔医院正畸科接受治疗的35例阻生上颌尖牙病例的临床资料，总结分析尖牙阻生状况及相应的治疗措施和疗效。临床处理方法包括拔除、助萌和导萌。结果拔除2例；只做正畸治疗的助萌法16例，留出足够间隙后等待阻生尖牙自行萌出，观察时间5～24个月，均取得良好治疗效果，矫治后阻生尖牙牙龈形态及牙根状况良好；正畸附加外科手术牵引的导萌法17例，除1例21岁男性患者外，其余16例均牵引到位，但矫治后部分阻生尖牙牙龈形态不如助萌法矫治后。结论当阻生上颌尖牙牙体严重畸形、根弯曲短小及高位近远中向横位阻生时考虑拔除；阻生上颌尖牙近远中向错位不严重，扩弓或减数拔牙即可为阻生尖牙留出足够萌出间隙，判断其能自然萌出时首选助萌法；阻生上颌尖牙近远中向错位严重或阻生尖牙已伤及邻牙牙根、仅用正畸治疗无法去除阻生尖牙萌出障碍时采用导萌法，导萌术后的牵引需注意控制牵引方向及大小，要避免伤及邻牙牙根，尽量使阻生牙从附着龈萌出，有利于形成良好的牙龈形态。

Objective To investigate the suitable treatment methods of maxillary impacted canine of different status. Methods A retrospective study was done. Treatment records for 35 maxillary canine impacted cases treated of recently 10 years were analyzed .The treatment methods included helping eruption,surgically guided eruption and extraction. Re-sults There were 2 cases extracted and helping eruption in 16 cases. The waiting eruption time was 5-24 months. Good results were obtained in all cases except one 16-year old boy’s upper left canine pulp necrosis while erupting. Surgically guided eruption was done in 17 cases,and in 16 cases the impacted teeth were moved to the dental arch. Only one 21-year old patient,impacted canine was supposed partially ankylosed,the impacted tooth was moved slowly and the pa-tients refused to pull the tooth. Conclusion The teeth should be extracted it they are with severity deformity,curved short root,and are impacted in high position mesiodistally. When orthodontic expansion or extraction can achieve enough space for impacted canine and the canine can erupt spontaneously,helping eruption is preferred.When orthodontic treat-ment alone cannot remove the obstacle in the path of the canine eruption ,or ectopic canine presses to adjacent tooth root ,causing the root desorption,surgically guided eruption methods should be performed as quickly as possible. During surgically guided eruption,the direction and the force should be proper to avoid damage to gingiva.