牙齒自體移植術應用於患有嚴重局部牙周病病患的牙周矯正治療上的病例報告

It is suite difficult for dentist to treat patients with upper anterior teeth lost due to severe periodontitis with bimaxillary dentoalveolar protrusion. Fixed partial denture (FPD), removable partial denture (RPD), implant, autotransplantation, or orthodontic space closure are selections which can be chosen when such problem is encountered. In situations with reduced bone height or narrowed ridge treatment with denture or implant alone will cause imperfection in the aspect of function and esthetics. If we try to restore these edentulous area with auto-transplantation, the preserved potential of ossteoinduction in transplanted tooth will not only resolve the problem of the reduced bone height resulted from periodontical tooth loss, but will also remodel the alveolar process with orthodontic tooth movement. With such bone remodeling while retracting the anterior teeth, the appearance of patient profile and problem of dentoalveolar protrusion will be resolved simultaneously. This is a case report of a patient with dentoalveolar protrusion and central and lateral incisors loss due to severe periodontitis. The primary treatment objectives were to close these edentulous area and to improve facial appearance with orthodontic retraction of anterior teeth. However, the clinician would face a predicament, because the space of two-tooth missing on the same side would be too large to close with orthodontic tooth movement. Meanwhile, if we moved tooth across the midline, it would still be risky whether tooth movement could be performed safely across the mid-palatal suture. Therefore, after periodontical treatment and follow-up, we decided to extract all first premolar, except upper right quadrant area, then we transplanted the upper left first premolar to upper right edentulous area. After waiting period of periodontal reallachement on transplanted tooth and endodontic treatment, we started orthodontic tooth movement to close these edentuluous area and to accomplish extensive retraction of the anterior teeth. After 2 years of orthodontic treatment, we successfully resolved her problems of edentulous area and dentofacial appearance.