1例正畸术后迟发性多生牙30个月追踪报告并文献复习

Tardive Supernumerary Teeth after Orthodontic Treatment:A Case Report with 30 Months of Follow-up and Review of the Literature

目的报告1例正畸术后3年右下颌前磨牙区新增1颗多生牙并对其进行30个月追踪的病例,总结迟发性多生牙的诊断及治疗的经验。方法患儿,男,11岁,经17个月正畸治疗后3年发现迟发性多生牙。采用X线全景片联合锥形束CT对迟发型多生牙发生的时间、部位、形态及其生长发育进行跟踪。结果该迟发性多生牙为单发性结节型下颌前磨牙区多生牙,因其邻近邻牙牙根,暂予保守观察。1年后复查全景X线片多生牙呈继续生长趋势,与口腔颌面外科会诊后,从舌侧实施多生牙拔除术。拔除术后1年半全景X线片复查示:多生牙拔除区域骨质愈合良好,未见多生牙及牙囊复发迹象。结论迟发性多生牙对临近牙齿健康及正畸术后牙齿的稳定均有不同程度的影响,其治疗方案有即刻拔除或保留观察,临床应对正畸、牙周、口腔颌面外科及影像学进行综合考量,以衡量两种治疗方法的利弊。提示正畸患者术后2~5年间应定期复查,及时对迟发性多生牙进行诊断与筛查,是术前矫治方案的顺利实施与术后疗效保持的有效保障。

Objective To summarize the experience with diagnosis and treatment of tardive supernumerary teeth through reporting a case of subsequent formation of supernumerary tooth in the right mandibular premolar region 3 years after orthodontic treatment and performing 30 months of follow-up.Methods A tardive supernumerary tooth was found in an 11-year-old boy after 17 months of orthodontic treatment.Panoramic X-ray and cone-beam CT were used to study the appearance,position,morphology and development of the delayed supernumerary tooth.Results The supernumerary tooth was a solitary nodular tooth in the mandibular premolar region.The boy was given temporary conservative observation because the tooth was close to the root of adjacent teeth.After 1 year of observation,panoramic X-ray imaging showed a trend of continued growth in the supernumerary tooth.After consultation with oral and maxillofacial surgeons,the supernumerary tooth was extracted from the side of tongue.At 1 year after extraction,panoramic X-ray examination showed a good bone healing in the extractive area without signs of recurrence of the supernumerary tooth and dental follicle.Conclusion Tardive supernumerary teeth have negative effect on health of adjacent teeth and stability of teeth after orthodontic treatment.There are usually two ways to treat tardive supernumerary teeth:immediate extraction or conservative observation.Orthodontists should comprehensively consider the results of orthodontic,periodontal,oral and maxillofacial surgery and imaging manifestations to analyze the advantages and disadvantages of the two methods.Regular review should be conducted within 2-5 years after surgery.Timely diagnosis and screening provide an effective guarantee for successful implementation of preoperative orthodontics and postoperative maintenance of curative efficacy.