치조 및 구개파열 환자에서 골이식에 대한 임상적 고찰

이창곤(Chang Kon Lee),박재현(Jae Hyun Park),이명진(Myung Jin Lee),김종섭(Jong Sup Kim),진병로(Byung Rho Chin),이희경(Hee Kyung Lee) 대한구강악안면외과학회 1993 대한구강악안면외과학회지 Vol.19 No.4

Dentofacial deformity patients combined with cleft lip and palate are usually encountered at dental clinic and they require a rehabilitation for better esthetics and improvement of function. Rehabilitation of the patient combined with cleft lip and palate requires a consideration of the appearance, speech, occlusion, mastication, hearing an deglutition as well as emotional and social well-being of the patients. This study is aimed for helping better understanding for ideal materials as bone graft and proper time of bone graft. The material used in this study consists of the 14 cases of dentoalveolar cleft patients at the department of dentistry, medical college of young nam university, for the period of March 1990 to Jenuary 1993 The obtained results were as follows: 1. All patients were arranged from 11 years to 36 years, their average age was 30.3 years at male and 15 years at female. Male to female ratio was about 10 : 4. 2. the bone graft materials were obtained from iliac bone in 10 cases, the chin bone in 1 case, alveolar bone of extraction socket in 1 case, and parietal bone 2 cases. 3. There was no presurgical-orthodontic treatment in 3 cases. And others were performed with presurgical-orthodontic treatment. And the period of presurgical-orthodontic treatment were arranged from 3 months to 19 months. 3. Recipient sites showed successful ossification with the exception of 1 case. 5. There was no complication such as infection or necrosis in 13 cases. But we showed a complication with wound dehescence and resorption of graft materiaal caused to poor mucosal flap coverage in 1 case 6. As bone graft of dentoalveolar cleft patients, we found that presurgical-orthodontic treatment was needed for improvement of anterior-posterior discrepancy and security of sufficient intercanine width.

교정적 절충 치료를 받은 III급 부정교합 성인 환자의 악교정 수술을 동반한 재교정 치료

이윤정(Yoonjung Lee) 대한치과교정학회 2023 대한치과교정학회 임상저널 Vol.13 No.3

In order to improve the incisal angle and occlusal plane of the maxilla without tooth extraction, maxillary rotation, which makes the maxillary occlusal surface move forward and downward, can be applied to increase mandibular set-back and de-crease the vertical dimension of the skeletal Class III. Therefore, if an appropriate surgical occlusion is formed through min-imal pre-surgical orthodontic treatment, there will be an advantage of quick operation and short treatment period. A female patient who had a history of growth modification and orthodontic treatment decided to have orthodontic retreatment with orthognathic surgery due to aesthetic problems and open bite relapse. For 6 months of presurgical orthodontic treatment, the inclination of the maxillary molars was adjusted using a full-size stainless-steel wire, and the intermolar width problem was corrected by adjusting the lingual inclination of the mandibular molars using Schwarz’s appliance with a posterior bite block. Additionally, adjustment for occlusal interferences of the maxillary palatal cusps was continuously performed. The patient had LeFort I osteotomy with PNS impaction, mandibular setback, and additional genioplasty. As a result, the overall length of the face was reduced and asymmetry was corrected, resulting in a stable Class I occlusion relationship. In order to shorten the presurgical orthodontic period, minimal presurgical orthodontic treatment was done without extraction, and appropri-ate mandibular set-back results were obtained by adjusting the maxillary incisor angle and occlusal plane through maxillary rotation.

상악 양측 제2대구치의 정출을 동반한 골격성 Ⅲ급 부정교합 환자의 최소 술전 교정을 이용한 악교정 수술 치험례

안윤수,김진규,정영수,유형석,최성환 대한치과교정학회 2019 대한치과교정학회 임상저널 Vol.9 No.2

This case report describes a successful orthognathic treatment with minimal presurgical orthodontics and bilateral extraction of maxillary second molars. A 21-year-old man had mandibular prognathism. His maxillary second molars were bilaterally extruded because there were no opposing teeth. After minimal presurgical orthodontic treatment with bilateral extraction of maxillary second molars to prevent immediate premature contact after surgery, we performed Le Fort I and bilateral intraoral vertical ramus osteotomy to correct the patient’s mandibular prognathism. During the postoperative orthodontic treatment, maxillary third molars were aligned to replace the bilaterally extracted maxillary second molars. The total treatment period was 14 months. As a result of these treatments, the patient’s facial appearance was rapidly improved. The minimal presurgical orthodontic treatment can guarantee immediate stable occlusion after surgery and achieve a rapid aesthetic improvement in skeletal Class Ⅲ patients.

골격성 III급 부정교합 환자의 수술-교정 치료: Corticision을 동반한 최소술전교정치료

김성훈,유지아,김윤지,안지수,박재억 대한통합치과학회 2013 대한통합치과학회지 Vol.2 No.1

Patients’ demand for shorter treatment time before surgery is increasing due to social pressure. Minimal pre‐surgical orthodontic treatment might result in early facial improvement and shorter treatment time. A case of skeletal Class III patient (18yrs, F) who underwent orthognathic surgery after minimum presurgical orthodontic treatment with corticision is presented in this report. The results showed a good facial profile and correct occlusion. The presurgical treatment time was 7 weeks. The total Treatment time was 11 months.

최소술전교정

김병호(Byoung-Ho Kim) 대한치과의사협회 2012 대한치과의사협회지 Vol.50 No.2

Recently, the presurgical orthodontic duration tends to be shortened by virtue of the advancement of surgical and orthodontic techniques in class III orthognathic surgery cases. But the predictability of the surgical results should be secured by removing several uncertain factors in presurgical orthodontic treatment. The purpose of this study is to investigate the influence of immediate postsurgical occlusal stability on postsurgical mandibular change. The study includes 40 patients who underwent orthognathic surgery to correct skeletal class III malocclusion. The patients were divided into two groups based on the numbers of occlusal contact in surgical setup occlusion: group1(stable surgical occlusion, n=24) and group 2(unstable surgical occlusion, n=16). Changes of horizontal and vertical mandibular measurements during postsurgical follow up period(from 1 week postsurgery to 12month after debonding) were compared to examine the differences between two groups. The stability of surgical occlusion is one of the factors influencing postsurgical mandibular changes in class III malocclusion. The various class III malocclusion cases have specific prerequisites for the orthognathic surgery according to the skeletal patterns. The prerequisites should be obtained by minimum presurgical orthodontics to increase the predictability of the surgical results.

골격성 III급 부정교합자에서 술 전 교정치료 전과 후의 수술계획의 차이

이은주,손우성,박수병,김성식 대한치과교정학회 2008 대한치과교정학회지 Vol.38 No.3

본 연구는 술 전 교정치료 전 치아 이동 예측치(initial STO)와 술 전 교정치료 후 실측치에 바탕을 둔 STO (finalSTO)를 비교하고자 시행되었다. 부산대학교병원 치과교정과에 내원하여 교정 및 악교정수술 복합치료를 시행 받은 환자 중 하악만 수술한 환자 40명을 선정하여 상악 제1소구치 발치 여부에 따라 두 그룹(발치 그룹 20명, 비발치그룹 20명)으로 분류하였다. 술 전 교정치료 전의 initial STO, 술 전 교정치료 후의 final STO를 작성하여 각 계측치를 수평, 수직 기준선에 대해 거리를 측정하여 비교하였다. 발치 그룹의 두 STO 비교 시 수직적으로 상악 중절치절단연과 치근단, 상악 제1대구치 협측교두에서, 수평적으로 상악 중절치 절단연, 상악 제1대구치 근심협측교두, 하악 중절치 치근단, 하악 제1대구치 근심면과 근심협측교두에서 차이를 보였으며 비발치 그룹의 경우는 수직적으로 하악 중절치 치근단, 수평적으로 상악 중절치 절단연, 하악 중절치 절단연과 치근단, 하악 제1대구치 근심면에서 차이를 보였다. 두 STO의 차이와 initial STO 수립에 영향을 미칠 수 있는 여러 진단 요소와의 상관성 평가 시 상악 치열궁 공간 부족량이 상악 전치의 수평, 수직 및 제1대구치의 수평 위치 예측에 유의한 상관성을 가졌으며 두 그룹 모두 하악 전치 치축 각도와 하악 치열궁 공간 부족량이 하악 전치의 수평 위치 예측에 유의한 상관성을 보였다. InitialSTO 작성과 술 전 교정 단계에서 이를 고려하여 진행한다면 좀 더 효율적인 치료 계획 수립 및 전체적인 치료 기간을 줄이는 것에도 도움이 될 것이라 생각한다. and final STO in Class III malocclusions and to find which factors are related to the discrepancies. Methods: Twenty patients were selected for the extraction group and 20 patients for the non-extraction group. They were diagnosed as skeletal Class III and received presurgical orthodontic treatment and mandibular set-back surgery at Pusan National University Hospital. The lateral cephalograms were analyzed for initial STO (T1s) at pretreatment and final STO (T2s) after presurgical orthodontic treatment, and specified the landmarks as coordinates of the X and Y axes. Results: Differences in hard tissue points (T1s-T2s) in the X coordinates of upper central incisor edge, upper first molar mesial end surface, lower central incisor apex, lower first molar mesial end surface and mesio-buccal cusp and Y coordinates of upper central incisor edge, upper central incisor apex, upper first molar mesio-buccal cusp were statistically significant in the extraction group. Differences in hard tissue points (T1s-T2s) in the X coordinates of upper central incisor edge, lower central incisor apex, lower first molar mesial end surface and Y coordinates of lower central incisor apex were statistically significant in the non-extraction group. In the extraction group, the upper arch length discrepancy (UALD) had a statistically significant effect on maxillary incisor and first molar estimation. Lower arch length discrepancy and IMPA had statistically significant effects on mandibular incisor estimation in both groups. Conclusions: Discrepancies between initial STO and final STO and factors contributing to the accuracy of initial STO must be considered in treatment planning of Class III surgical patients to increase the accuracy of prediction.

상악 좌측 측절치 결손을 동반한 골격성 III급 부정교합 환자의 선수술 치험례

임희진,이윤진,국윤아,김윤지 대한치과교정학회 2020 대한치과교정학회 임상저널 Vol.10 No.1

This case report describes a surgery-first orthognathic treatment of a skeletal Class III patient with congenital missing of a maxillary lateral incisor. A 24-year-old male presented with a chief complaint of mandibular prognathism. Clinical examination showed concave facial profile with moderate crowding. Intraorally, he exhibited both Class III molar relationship, mild crowding in both arches, and 3.0 mm negative overjet. The maxillary dental midline was deviated 3.0 mm to the left, caused by congenital missing of the maxillary left lateral incisor. The cephalometric analysis showed skeletal Class III malocclusion with a hyperdivergent pattern. For skeletal overcorrection of mandibular prognathism and asymmtery, bilateral sagittal split ramus osteotomy was performed with surgery-first approach. To correct the maxillary midline deviation, maxillary right second premolar was extracted. Maxillary left lateral incisor was substituted with the canine by orthodontic space closure. With careful pre-operative orthodontic planning, surgery-first orthognathic treatment was successfully treated with satisfying esthetics.

Cone-beam CT를 이용한 안면비대칭자에서 이부편위에 따른 치성보상의 양상분석

박수병,박정희,정연화,조봉혜,김용일 대한치과교정학회 2009 대한치과교정학회지 Vol.39 No.5

Objective: The purpose of this study was to evaluate the correlation between menton deviation and dental compensation in facial asymmetry. Methods: Tooth axis and distance of first molar and canine to the reference plane were investigated by cone-beam computerized tomography. The subjects consisted of 50 patients with asymmetric mandibles (male 21, female 29, mean age 24.3 years). Control groups were also assessed (male 11, female 9, mean age 25.6 years). Nine measurements (5 linear measurements and 4 angular measurements) were measured in order to evaluate the correlation between menton deviation and the linear and angular difference of first molar and canine in the deviated and none-deviated sides using the defined MPR images. The differences between deviated and non-deviated side, according to menton deviation, were statistically analyzed using stepwise multiple regression analysis. Results: From the result, Menton deviation was negatively correlated with mandibular first molar's angular measurement (Δ∠LM6-Mn plane (dev.-ndev.)) and positively with maxillary fist molar's angular measurement (Δ∠UM6-FH plane (dev.-ndev.)) (p < 0.01). Two angular measurements (Δ∠ LM6-Mn plane (dev.-ndev.), Δ∠UM6-FH plane (dev.-ndev.)) explained the variability in menton deviation with a significant r² value of 0.589. Conclusions: This study suggests that the tooth axis of upper and lower first molars leans towards the deviated side of Menton when there is mandibular asymmetry with Menton deviation. 본 연구는 Cone-beam CT의 MPR이미지상에서 하악골 평면에 대한 하악 제1대구치와 견치의 편위측과 비편위측의 높이와 각도차이 그리고 FH 평면에 대한 상악 제1대구치와 견치의 편위측과 비편위측의 높이와 각도차이를 계측함으로써 안면비대칭자에서 이부편위에 따른 편위측과 비편위측의 제1대구치와 견치의 높이와 협설측 경사도를 CBCT를 이용하여 분석하고 그 관련성을 알아보는 데 있다. 연구대상은 하악골의 이부편위를 동반한 안면비대칭 환자 50명(여자 29명, 남자 21명, 평균나이 24세 4개월)으로 하였다. 대조군으로 평균나이 25세 7개월인 20명(남자 11명, 여자 9명)을 분석하였다. 결과는 이부편위에 대해 FH 평면에 대한 상악 제1대구치의 편위측과 비편위측의 길이 및 각도 차이(편위측 - 비편위측)는 대조군에 대해 통계적으로 유의한 차이가 존재하였다 (p < 0.01). 비대칭군에서 상악 제1대구치 각도는 편위측이 비편위측보다 평균 8.62 ± 5.95˚ 컸다 (p < 0.01). 상악 견치의 경우에도 편위측과 비편위측의 각도차이가 평균 4.48 ± 5.05˚로 통계적으로 유의한 차이가 존재하였다 (p < 0.01). 하악골 평면에 대한 하악 제1대구치의 수직 길이와 각도는 편위측과 비편위측에서 통계적으로 유의할 만한 차이가 존재하였다 (p < 0.01). 각도의 차이는 평균 -11.92 ± 5.79˚로 나타났다. 이부편위에 대한 상하악 제1대구치와 견치의 수직거리 및 각도의 Pearson 상관분석 및 회귀분석 결과, FH 평면에 대한 상악 제1대구치의 편위측과 비편위측의 각도차이(Δ∠ UM6-FH plane (dev.-ndev.))는 통계적으로 유의한 양의 상관관계를 나타내었고, 하악골 평면에 대한 하악 제1대구치의 편위측과 비편위측의 각도차이(Δ∠LM6-Mn plane (dev.-ndev.))는 통계적으로 유의한 음의 상관관계를 나타내었다. 이상의 결과에서 이부편위를 동반한 하악골 비대칭이 존재하는 경우, 이부가 편위되는 방향으로 상하악 제1대구치의 치아장축의 각도가 변화되는 것으로 나타났다.