铜丝结扎法治疗下颌第二恒磨牙异位萌出1例

doi:10.7518/hxkq.2024.2023418

华西口腔医学杂志 ›› 2024, Vol. 42 ›› Issue (4): 531-537.doi: 10.7518/hxkq.2024.2023418

铜丝结扎法治疗下颌第二恒磨牙异位萌出1例

吕丽华¹(), 陈文瑨²(), 韦日霞², 黄华²()

^1.浙江大学医学院附属儿童医院口腔科国家儿童健康与疾病临床医学研究中心，杭州 310052
^2.广西医科大学附属口腔医院儿童口腔科，南宁 530021

收稿日期:2023-12-02 修回日期:2024-03-03 出版日期:2024-08-01 发布日期:2024-07-17
通讯作者: 黄华 E-mail:6517057@zju.du.cn;chenwenjin90@163.com;huanghua58430@126.com
作者简介:吕丽华，主治医师，硕士，E-mail：6517057@zju.du.cn|陈文瑨，主治医师，博士，E-mail：chenwenjin90@163.com
基金资助:
广西高校口腔医学装备研发与应用重点实验室开发课题(KQZBKF202203)

Brass wire ligation for treatment of the ectopic eruption of the mandibular second molar: a case report

Lihua Lü¹(), Chen Wenjin²(), Wei Rixia², Huang Hua²()

^1.Dept. of Stomatology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
^2.Dept. of Pediatric Dentistry, Guangxi Medical University College of Stomatology, Nanning 530021, China

Received:2023-12-02 Revised:2024-03-03 Online:2024-08-01 Published:2024-07-17
Contact: Huang Hua E-mail:6517057@zju.du.cn;chenwenjin90@163.com;huanghua58430@126.com
Supported by:
Guangxi University and College of Stomatology Equipment Research & Development and Application Key Laboratory Open Project(KQZBKF202203)

摘要/Abstract

摘要：

第二恒磨牙异位萌出若未得到及时治疗，会导致相邻的第一磨牙牙体组织吸收、牙齿早失、咀嚼效率下降及其他严重的错𬌗畸形。及时发现和处理第二恒磨牙异位萌出，对预防青少年错𬌗畸形、建立正常咬合关系具有重要的意义。然而，目前针对下颌第二恒磨牙异位萌出的病例报告比较少见，大多治疗方法主要为手术及正畸的方式，且缺乏长期的随访。本文报道1例采用铜丝结扎法治疗下颌第二恒磨牙异位萌出，使恒牙顺利萌出并建立正常咬合。术后观察5年，咬合稳定，牙根发育、牙髓活力及牙周状况正常。本文为近中倾斜度不大且已经部分萌出的阻生年轻下颌第二恒磨牙提供一种治疗周期短、简便及微创的临床思路。

关键词: 铜丝结扎, 下颌第二恒磨牙, 异位萌出

Abstract:

Ectopic eruption of the second permanent molar is a tooth replacement disorder during adolescence. If not treated in time, it can cause hard tissue of the adjacent first molar resorption, early tooth loss, decreased chewing efficiency, and other serious malocclusions. Timely detection and treatment of ectopic eruption of the second permanent molar are of great significance in preventing malocclusions in adolescents and establishing normal occlusion relationships. However, current case reports on the ectopic eruption of the mandibular second molar are relatively rare and are mostly concentrated on surgical and orthodontic treatments, and long-term follow-up is lacking. This paper reports a case in which brass wire ligation was used to treat ectopic eruption of the mandibular second permanent molar, allowing the permanent teeth to erupt smoothly and establish a normal occlusion. The patient was observed for five years after the operation. The occlusion was stable, and the tooth root development, pulp vitality, and periodontal conditions were normal. This paper provides a clinical approach that is short in treatment duration, simple, and minimally invasive for young mandibular second permanent molars with moderate mesial inclination and partial eruption. This method is of importance in helping children establish physiological occlusion.

Key words: brass wire ligation, mandibular second molar, ectopic eruption

中图分类号:

R783.5

吕丽华, 陈文瑨, 韦日霞, 黄华. 铜丝结扎法治疗下颌第二恒磨牙异位萌出1例[J]. 华西口腔医学杂志, 2024, 42(4): 531-537.

Lihua Lü, Chen Wenjin, Wei Rixia, Huang Hua. Brass wire ligation for treatment of the ectopic eruption of the mandibular second molar: a case report[J]. West China Journal of Stomatology, 2024, 42(4): 531-537.

图/表 8

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表 1

下颌第二恒磨牙异位萌出的治疗方法

方法	适应证	操作要点	优点	缺点
分牙法	下颌第二磨牙不可逆性异位萌出，轻度近中倾斜，伴有牙本质或牙骨质吸收但未累及牙髓	常用分牙簧、分牙圈、0.5~0.7 mm铜丝等，将分牙装置置于第一恒磨牙与第二恒磨牙邻面接触点下方	简便、创伤小	易因放置时间过长导致其松动脱落或滑入牙周软组织内造成局部牙龈、牙周组织炎症以及牙槽骨吸收^[22]
正畸法	第二磨牙部分萌出或未萌出，轻至中度倾斜和/或低位阻生	在托槽粘接后应用特殊装置的设计（如推簧、悬臂等）进行第二恒磨牙的直立	可以灵活地控制牵引力量及施力方向	正畸法存在周期较长，操作较复杂及口腔卫生情况较难保持等问题^[23]
正畸法	第二磨牙部分萌出或未萌出，轻至中度倾斜和/或低位阻生	使用微种植钉直立近中倾斜的第二磨牙，选择磨牙后区与微种植钉相连的弹性牵引在磨牙的远中产生一个拉力	直接作用于目标牙且不需要取模及技工制作矫治器，减少患者等待时间，降低支抗丢失的风险	不适用于儿童，对于青少年患者除非将第三磨牙拔除，否则由于第三磨牙的生长很难在第二磨牙后区放置微种植钉^[24]
手术直立法	第二恒磨牙萌出位置较低，第二恒磨牙牙长轴与第一恒磨牙牙长轴相交的角度较大。满足以下条件成功率会较高：1）第二恒磨牙牙根形成1/3~1/2；2）牙列内有足够空间和骨量；3）第二恒磨牙旋转直立不超过90°^[25]	暴露第二恒磨牙，然后对第二恒磨牙施加远中和??向力，直到第二磨牙的近中边缘嵴与相邻第一磨牙的远中边缘嵴处于同一水平后固定^[26]	缩短了治疗时间，可以立即重新定位	带来比较大的创伤和不良反应，如牙髓坏死、牙固连、根吸收，甚至在术中容易造成牙根折断等^[27]
第三磨牙代替萌出	下颌第二磨牙存在以下一种及以上情况时采用：1）严重阻生难以通过牵引直立到正常位置；2）难以完整拔除进行再植；3）第三恒磨牙牙冠完全形成而牙根尚未开始钙化时；4）第二、三恒磨牙只有一颗萌出位置^[28]	拔除第二恒磨牙，让第三磨牙萌出代替第二磨牙的位置	第三磨牙自行萌出，发生牙髓坏死、牙根吸收或骨性粘连的概率较低	由于第二磨牙拔除与第三磨牙萌出存在3~4年的时间间隔，在此期间第三磨牙越来越近中倾斜，因此无法预计其正常萌出道，常需后续的正畸治疗，在拔除阻生第二磨牙、不干预第三磨牙的情况下，顺利萌出建??的成功率低^[29]
第二恒磨牙拔除第三磨牙再植法	无法采用上述方法，且存在第三磨牙牙胚	拔除严重阻生的下颌第二磨牙，同时拔除相邻下颌第三磨牙将其植入第二磨牙的牙槽窝内固定	可以简化治疗，第三磨牙无须后期再进行正畸移动到位	该方法可能预后不佳，移植牙可能发生牙根吸收、骨性粘连或并发感染而导致移植失败^[30]

表 1

参考文献 31

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铜丝结扎法治疗下颌第二恒磨牙异位萌出1例

Brass wire ligation for treatment of the ectopic eruption of the mandibular second molar: a case report

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