Підходи в лікуванні пацієнтівіз ретенованими центральними різцями верхньої щелепи, обумовленими надкомплектними зубами

Abstract

Ретенція верхніх центральних різців – це особлива проблема, яка пов’язана із естетичними, морфологічними та функціональними порушеннями прикусу. У статті описано п’ять клінічних випадків ретенованих центральних різців верхньої щелепи, обумовлених надкомплектними зубами після хірургічно-ортодонтичного лікування. В однієї пацієнтки спостерігалось самостійне прорізування центрального різця через місяць після видалення надкомплектного зуба. В чотирьох пацієнтів затримані центральні різці відкривали за допомогою метода «віконця». За відсутності у зубній дузі центральних різців після терміну їх фізіологічного прорізування необхідно зробити ортопантомограму, яка підтвердить або спростує ретенцію зуба, а потім 3D комп’ютерну томографію для чіткого уявлення про позицію зуба і тільки потім обирати варіант лікування. Пацієнтам із ретенованими центральними різцями верхньої щелепи, обумовленими надкомплектними зубами, необхідно провести ортодонтичне лікування у кілька етапів, а термін виведення ретенованих зубів у зубну дугу значно менший у пацієнтів, лікування яких здійснювали у ранній період змінного прикусу. Ретенция верхних центральных резцов – это особая проблема, которая связана с эстетическими, морфологическими и функциональными нарушениями прикуса. В статье описаны пять клинических случаев ретенированных центральных резцов верхней челюсти, обусловленных сверхкомплектными зубами, после хирургическо-ортодонтического лечения. У одной пациентки наблюдалось самостоятельное прорезывание центрального резца через месяц после удаления сверхкомплектного зуба. У четырех пациентов ретенированные центральные резцы открывали с помощью метода "окошка". Из-за отсутствия в зубной дуге центральных резцов после срока их физиологического прорезывания необходимо сделать ортопантомограмму, которая подтвердит или опровергнет ретенцию зуба, а потом 3D компьютерную томографию для четкого представления о позиции зуба и только потом выбирать вариант лечения. Пациентам с ретенированными центральными резцами верхней челюсти, обусловленными сверхкомплектными зубами, необходимо провести ортодонтичне лечение в несколько этапов, а срок перемещения ретенированных зубов в зубную дугу значительно меньше у пациентов, лечение которых осуществляли в ранний период сменного прикуса. Impaction of maxillary central incisors is a special problem associated with aesthetic, morphological and functional aspects of malocclusion. Provision of complex orthodontic correction involves a combination of surgical, instrumental, functional and prosthetic methods. That is why searching for ways to reduce timing of orthodontic treatment in order to eliminate this pathology is an urgent problem of orthodontics. The aim of the study was to increase the effectiveness of complex treatment of patients with impaction of permanent maxillary central incisors caused by supernumerary teeth during periods of mixed and permanent dentition by developing our own approaches to the correction. The treatment results of five patients (aged 7, 8, 9, 10 and 15 years) with delayed eruption of maxillary central incisors were analyzed. According to the findings obtained during clinical examination and additional investigations (photometric facial analysis, study of diagnostic models of jaws and orthopantomograms, 3D computer tomography), impacted central incisors, supernumerary teeth, which blocked their eruption, were diagnosed. Orthodontic treatment was carried out with various designs of orthodontic devices including prosthetic devices with screws, vestibular arches with hooks, clasps, artificial central incisors. Additionally, four patients (8, 9, 10 and 15 year old) underwent surgical exposure of crowns of the impacted teeth, brackets were attached onto their surface and process of orthodontic correction with elastic bands was initiated. In all cases, access to the central incisors was made from vestibular side of the alveolar process. On the second stage of the treatment, removable orthodontic appliances were used during mixed dentition to place central incisors into the correct position in the dental arch and dental braces were used in permanent dentition. Results. The results of complex treatment are positive. The impacted tooth (tooth 11) was erupted independently in a 7-year-old patient in a month after the treatment with removable orthodontic appliance. The period of orthodontic relocation to the dental arch of impacted central incisors in an 8-year girl lasted 3 months (tooth 21), in a 9-year boy - 3 months (tooth 21), in a 10-year boy - 9 months (teeth 11, 21) and in a 15-year boy - 14 months (tooth 11). Conclusion. Firstly, orthopantomogram is a modality to confirm or to refute the tooth impaction, if there are no central incisors in the dental arch after the period of their physiological eruption. Secondly, 3D computer tomography is strongly recommended to be carried out to determine accurate position of the tooth and only after these stages it is possible to choose a proper method of the treatment. Early diagnosis and removal of supernumerary teeth, which cause the impaction of maxillary central incisors enables to avoid complications and significantly shortens the duration of surgical and orthodontic treatment. Impaction of maxillary central incisors is a special problem associated with aesthetic, morphological and functional aspects of malocclusion. Provision of complex orthodontic correction involves a combination of surgical, instrumental, functional and prosthetic methods. That is why searching for ways to reduce timing of orthodontic treatment in order to eliminate this pathology is an urgent problem of orthodontics. The aim of the study was to increase the effectiveness of complex treatment of patients with impaction of permanent maxillary central incisors caused by supernumerary teeth during periods of mixed and permanent dentition by developing our own approaches to the correction. The treatment results of five patients (aged 7, 8, 9, 10 and 15 years) with delayed eruption of maxillary central incisors were analyzed. According to the findings obtained during clinical examination and additional investigations (photometric facial analysis, study of diagnostic models of jaws and orthopantomograms, 3D computer tomography), impacted central incisors, supernumerary teeth, which blocked their eruption, were diagnosed. Orthodontic treatment was carried out with various designs of orthodontic devices including prosthetic devices with screws, vestibular arches with hooks, clasps, artificial central incisors. Additionally, four patients (8, 9, 10 and 15 year old) underwent surgical exposure of crowns of the impacted teeth, brackets were attached onto their surface and process of orthodontic correction with elastic bands was initiated. In all cases, access to the central incisors was made from vestibular side of the alveolar process. On the second stage of the treatment, removable orthodontic appliances were used during mixed dentition to place central incisors into the correct position in the dental arch and dental braces were used in permanent dentition. Results. The results of complex treatment are positive. The impacted tooth (tooth 11) was erupted independently in a 7-year-old patient in a month after the treatment with removable orthodontic appliance. The period of orthodontic relocation to the dental arch of impacted central incisors in an 8-year girl lasted 3 months (tooth 21), in a 9-year boy - 3 months (tooth 21), in a 10-year boy - 9 months (teeth 11, 21) and in a 15-year boy - 14 months (tooth 11). Conclusion. Firstly, orthopantomogramis a modality to confirm or to refute the tooth impaction, if there are no central incisors in the dental arch after the period of their physiological eruption. Secondly, 3D computer tomography is strongly recommended to be carried out to determine accurate position of the tooth and only after these stages it is possible to choose a proper method of the treatment. Early diagnosis and removal of supernumerary teeth, which cause the impaction of maxillary central incisors enables to avoid complications and significantly shortens the duration of surgical and orthodontic treatment.