간접골성 고정원을 이용한 상악 구치부 원심이동 장치 종류에 따른 치아 이동 양상 평가 = Three dimensional analysis of tooth movement using different types of maxillary molar distalization appliances

국문 초록 (Abstract)

본 연구의 목적은 pendulum 장치, 미니임플란트를 동반한 pendulum장치(펜듈럼), 오픈코일 스프링 및 미니임플란트를 동반한 오픈코일 스프링 이용 시 각각의 치아이동 양상을 3차원적으로 분석하는 데 있었다. 상악 좌측 치조골 및 치아 모형을 제작하고, Calorific machine을 이용하여 모형상에서 대구치를 3 mm 원심이동시켰다. 실험은 5회씩반복 실시하였다. 모델을 전산화 단층 촬영한 후 V-Works를 이용하여 3차원 모델을 제작하였다. Rapidform상에서 3차원적으로 이동방향과 이동량을 계측하였고, 각각의 장치에 관한 통계적 유의성을 검정하였다. 교정용 미니임플란트를 간접 골성 고정원으로 이용하여 오픈코일 스프링으로 구치부를 원심으로 이동시켰을 때가 치체이동에 가장 가까운 이동양상을 보였고, 고정원 소실도 적게 나타났다 (p ＜ 0.05). 오픈코일 스프링, 펜듈럼 장치 모두 미니임플란트를 부가적으로 이용했을 때 고정원 소실량이 적었다 (p ＜ 0.05). 미니임플란트를 이용하지 않은 경우에는 두 장치의 고정원 소실량이 비슷하였다. 미니임플란트의 이용 여부와 관계없이 펜듈럼 장치로 상악 구치 원심 이동 시 오픈코일 스프링에 비해 제1대구치가 조절성 경사이동 양상으로 이동되었고 (p ＜ 0.05), 제2대구치는 비조절성 경사이동 양상을 보였으며, 치관의 협측경사이동이 일어났다 (p ＜ 0.05). 이와 같은 결과를 근거로 간접 골성 고정원을 이용한 오픈코일 스프링이 상악 구치의 원심 치체이동에 가장 효과적인 장치였으며, 펜듈럼 장치를 이용한 구치부 원심이동 시에는 추가적인 조절이 필요하다고 할 수 있다.

다국어 초록 (Multilingual Abstract)

Objective: The purpose of this study was to compare the three dimensional changes of tooth movement using four different types of maxillary molar distalization appliances; pendulum appliance (PD), mini-implant supported pendulum appliance (MPD), stainless steel open coil spring (SP) and mini-implant supported stainless steel open coil spring (MSP). Methods: These experiments were performed using the Calorific machine which can simulate dynamic tooth movement. Computed tomography (CT) images of the experimental model were taken before and after tooth movement in 1 mm thicknesses and reconstructed into a three dimensional model using V-works 4.0. These reconstructed images were superimposed using Rapidform 2004 and the direction and amount of tooth movement were measured. Results: The mean reciprocal anchor loss ratio at the first premolar was 17 - 19% for the PD and SP groups. The appliances using mini-implants (MPD or MSP) resulted in less anchorage loss (7 - 8%). On application of a pendulum appliance or MPD, distalization was obtained by tipping rather than by bodily movement. Furthermore, the maxillary second molar tipped distally and bucally. But on application of MSP, distalization was achieved almost by bodily movement. Conclusions: Regarding tooth movement patterns during molar distalization, stainless steel open coil spring with indirect skeletal anchorage was relatively superior to other methods.

참고문헌 (Reference)

1 Wehrbein H, "implant anchorage reinforcement of posterior teeth: a prospective study" 116 : 678-686, 1999

2 Wilson WL, "Variations of labiolingual therapy in Class II cases" 41 : 852-871, 1955

3 Deguchi T, "The use of small titanium screws for orthodontic anchorage" 82 : 377-381, 2003

4 Gianelly AA, "The use of magnets to move molars distally" 96 : 161-167, 1989

5 Hilgers JJ, "The pendulum appliance for Class II non-compliance therapy" 26 : 706-714, 1992

6 Carano A, "The distal jet for upper molar distalization" 30 : 374-380, 1996

7 Weijs WA, "Strain in mandibular alveolar bone during mastication in the rabbit" 22 : 667-675, 1977

8 Bondemark L, "Repelling magnets versus superelastic nickel-titanium coils in simultaneous distal movement of maxillary first and second molars" 64 : 189-198, 1994

9 Jones RD, "Rapid Class II molar correction with an open-coil jig" 26 : 661-664, 1992

10 Caputo AA, "Photoelastic visualization of orthodontic forces during canine retraction" 65 : 250-259, 1974

11 Chaconas SJ, "Orthodontic force characteristics of open coil springs" 85 : 494-497, 1984

12 Yun SW, "Molar control using indirect miniscrew anchorage" 39 : 661-664, 2005

13 Chang YJ, "Microscrew anchorage for molar intrusion" 38 : 325-30, 2004

14 Kircelli BH, "Maxillary molar distalization with a bone-anchored pendulum appliance" 76 : 650-659, 2006

15 Gianelly AA, "Japanese NiTi coils used to move molars distally" 99 : 564-566, 1991

16 Karlsson I, "Intraoral maxillary molar distalization" 76 : 923-929, 2006

17 Burstone CJ, "Holographic determination of centers of rotation produced by orthodontic forces" 77 : 396-409, 1980

18 Moss ML, "Finite element method modeling of craniofacial growth" 87 : 453-472, 1985

19 Ghosh J, "Evaluation of an intraoral maxillary molar distalization technique" 110 : 639-646, 1996

20 Pieringer M, "Distalization with a Nance appliance and coil springs" 31 : 321-326, 1997

21 Gianelly AA, "Distalization of molars with repelling magnets" 22 : 40-44, 1988

22 Sugawara J, "Distal movement of maxillary molars in nongrowing patients with the skeletal anchorage system" 129 : 723-733, 2006

23 Byloff FK, "Distal molar movement using the pendulum appliance. Part 1: clinical and radiological evaluation" 67 : 249-260, 1997

24 Ogura M, "Comparison of tooth movements using Friction-Free and preadjusted edgewise bracket systems" 30 : 325-330, 1996

25 Carano A, "Clinical applications of the Miniscrew Anchorage System" 39 : 9-24, 2005

26 Bondemark L, "Class II correction with magnets and superelastic coils followed by straight-wire mechanotherapy. Occlusal changes during and after dental therapy" 59 : 127-138, 1998

27 Baeten LR, "Canine retraction: a photoelastic study" 67 : 11-23, 1975

28 Chang HN, "Bone-screw anchorage for pendulum appliances and other fixed mechanics applications" 12 : 284-289, 2006

29 Keleş A, "Bodily distalization of molars with absolute anchorage" 73 : 471-482, 2003

30 Drescher D, "Application of the orthodontic measurement and simulation system (OMSS) in orthodontics" 13 : 169-178, 1991

31 Chun YS, "An experimental study on the dynamic tooth moving effects of two precision lingual archs (Pla) for correction posterior scissor bite by the calorific machine" 28 : 29-41, 1998

32 Rhee JN, "A comparison between friction and frictionless mechanics with a new typodont simulation system" 119 : 292-299, 2001