CLY Orthodontics Studio | 齊杏歯顎矯正專科

極難的開咬與歪斜矯正治療

    矯正醫師對於歪斜與開咬，一直視為非常困難的案例之ㄧ。通常在台灣，這些案例也伴隨上下唇的外突。

    尤其本文案例，更已經缺少了左上第一大臼齒，筆者決定在矯正治療過程中利用其空間來後移，而避免後續的植牙問題。

    拔除其他的第一小臼齒以用來改善外突，讓臉型更對稱與平衡，共18個月的矯正治療，並使用迷你骨釘來做錨定作用。

    Asymmetrical smile is one of the mist difficult cases in the daily orthodontic clinic. In Taiwan, lots of this kind of patients also have the protrusive upper and lower lips. 

    In the following case, missing of the left upper first molar was noted in the beginning. I decided to close this space orthodontically, which mean no need of dental implant for this missing space.

    Due to the facial profile problem, I need to extract the premolars to make the face more balance and symmetrical. The total treatment time is 18 months with miniscrews as the anchorage.

 這是一位有歪斜、暴牙、開咬與下顎後縮，綜合非單一顏面美觀問題的患者。初次看到這位患者，也許會優先想到拔牙，以取得空間來把牙齒排好。然而，優美和諧與對稱的顏面外觀，是我覺得最大的挑戰。

    The following patient actually has combined facial asymmetry, bimaxillary protrusion and small chin problems. Most doctors will think of extraction to align the teeth perfectly. However, the harmonized, balanced, and symmetrical facial profile is what I'm looking for in the first sight. Also, it's very challenge. 

    說到矯正設計，其實就是尋找最佳的鼻唇與下顎之間最好的相對位置。拔除小臼齒事實上是讓中線能對齊，然後將上下牙齒後移、上推。然而，改正咬合平面，與下顎骨的逆時針旋轉。更能讓上下牙齒後移量的情況改變，因為當更為協調的下巴曲線形成與更為立體的鼻唇角形成時，才是決定上下牙齒位置的主要因素。

    Talking abou the design of biomechanism, I'd say simply. It is how to find the best position to place the upper and lower dentition to the right position in terms of nose, lips and the chin. 

    Extraction is just making the space more usable for retraction and correct the midline. More importantly, is how to correct the occlusal plane and auto-rotate the mandible to make the bite differently. Also, the amount of retraction will also be different.  The reason is when the more prominent nasolabial angle and more beautiful lip-mental curve are developed; the perfect anterior teeth relationship then can be decided.