Lim Geeyoung, Kim Kee-Deog, Park Wonse, Jung Bock-Young, Pang Nan-Sim
Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea.
J Endod. 2013 Aug;39(8):1073-7. doi: 10.1016/j.joen.2013.04.037. Epub 2013 May 29.
Miniscrews are being increasingly used for anchorage control in orthodontics. Despite the concern over root damage caused by miniscrews, there are few reports of precise clinical evaluations and appropriate management of that damage. In the case presented herein, the root damage caused by the placement of miniscrews was repaired by root canal treatment and surgical intervention.
A 44-year-old man received orthodontic treatment for intrusion of the left maxillary first molar with a miniscrew anchorage system. During that treatment, the miniscrews had fallen out and had to be reinserted more than 6 times in the same area. Two years later, the patient complained of a spontaneous pain in the maxillary left molar region. Although the patient received root canal treatment, intraoral sinus tracts could still be detected, and the patient's discomfort persisted. Periradicular surgery revealed that the persistent infection was related to root surface damage caused by orthodontic miniscrew placement. Healing was achieved by a combination of root canal treatment and surgical intervention.
Scanning electron microscopy of the damaged distobuccal root apex revealed a mature biofilm consisting of a network of matrix that contained mostly rod-like and spherical bacteria. At a 12-month recall checkup, the patient was free of pain. A repeat periapical radiograph revealed reduction of the pretreatment radiolucent lesion.
More careful planning of miniscrew placement is necessary to lessen the danger of root damage. Furthermore, a precise evaluation of both root and pulpal damage and careful consideration of the choice of optimal treatment modality are needed.
微型螺钉在正畸治疗中越来越多地用于支抗控制。尽管人们担心微型螺钉会导致牙根损伤，但关于这种损伤的精确临床评估和适当处理的报道却很少。在本文所述的病例中，微型螺钉植入引起的牙根损伤通过根管治疗和手术干预得以修复。
一名44岁男性接受了使用微型螺钉支抗系统压低左上第一磨牙的正畸治疗。在治疗过程中，微型螺钉脱落，不得不在同一区域重新植入6次以上。两年后，患者主诉左上磨牙区自发疼痛。尽管患者接受了根管治疗，但仍可检测到口腔内的窦道，患者的不适感持续存在。根尖周手术显示，持续感染与正畸微型螺钉植入导致的牙根表面损伤有关。通过根管治疗和手术干预相结合实现了愈合。
受损远中颊根尖的扫描电子显微镜检查显示，成熟生物膜由基质网络组成，其中主要包含杆状和球状细菌。在12个月的复查中，患者无疼痛。再次拍摄的根尖片显示，治疗前的透射性病变有所减轻。
为降低牙根损伤的风险，有必要更仔细地规划微型螺钉的植入位置。此外，需要对牙根和牙髓损伤进行精确评估，并仔细考虑选择最佳治疗方式。
