근첨하 분절 골절단술을 병행한 Ⅲ급 야악 전돌증의 교정치료 증례

정미향(Mi-Hyang Jeong),남동석(Dong-Seok Nahm) 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.3

Bimaxiilary protrusion can be treated effectively in growing patients and in adults with conventional orthodontic therapy. However, In the adult patient, combined surgical and orthodontic treatment modalities may offer distinct advantages over such conventional therapy. In those cases complicate by vertical jaw dysplasia, sagittal dysplasia, or transverse skeletal discrepancy in addition to bimaxillary protrusion, the possibilities of obtaining successful results through orthodontic treatment alone greatly diminish. Surgical retraction of both maxillary and mandibular anterior segments with subapical osteotomies and ostectomies in the extraction site may be a good treatment alternative. Treatment time and possible adverse effects of lengthy orthodontic therapy may be reduced and optimum esthetic improvement may be facilitated. On the following cases, patient who had bimaxillary protrusion with Angle class III malocclusion was treated with combined orthodontic - surgical therapy by anterior subapical segmental osteotomies. 양악 전돌은 흔히 접하는 부정교합 증례로서, 대부분 상하순의 전동에 의한 안모 심미성의 손상을 주소로 내원한다. 이러한 증례는 제 1 소구치를 발거하고 그 공간을 이요아여 전치부를 견인하여 치료하는 경우가 많으며, 성공적인 치료 결과를 얻을 수 있다. 그러나, 성인 환자의 경우에는 환자의 협조도 불량으로 인한 악외 고정원 사용의 불량, 치료기간의 장기화, 치조골이 충분하지 못한 경우등에 있어서의 치근 흡수량의 증가, 구외 장치 사용으로 인한 환자의 사회심리적 부담감등의 부작용이 있다. 이의 해결방안의 하나인 근첨하 분절 골절단술은 고정원의 절대 보존, 치료기간의 단축, 구외 고정원 사용 필요성제거 및 이를 통한 환자의 협조도 증가 등의 장점을 가지고 있다. 이에 제 1 소구치 발거 및 이 부위를 이용한 근첨하분절 골절단술을 병행하여 치료한 치아치조 전돌의 증례를 치료 전후의 두부 방사선 계측 사진 및 연구 모형을 통해 비교분석하여 변화를 살펴보고, 이의 장단점을 고찰해 보도록 하고자 한다.

양악전돌증 치료에서 피질골절단술의 효율성에 관한 연구

서영준,정성우,강학수,임재중,허영성,우순섭,심광섭,황경균,Seo, Young-Jun,Jung, Sung-Woo,Kang, Hag-Soo,Im, Jae-Jung,Huh, Young-Sung,Woo, Soon-Seop,Shim, Kwang-Sup,Hwang, Kyung-Gyun 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.4

In esthetic treatment of bimaxillary protrusion, it is important to move backward the anterior teeth segment. For the backward movement of the anterior teeth segment, orthodontic force and segmental osteotomy have been applied on the clinical treatment until recently. These methods caused long treatment time, anchorage loss, the possibility of root resorption and the complication followed by segmental osteotomy. Therefore, corticotomy has become a major concern lately. This research has been conducted to study the efficiency of corticotomy in the treatment of bimaxillary protrusion comparing the profile change, canine retraction velocity and space closing time. The research compared and analyzed space closing time, canine retraction velocity and profile change in two groups of patients. Both groups were formed out of patients over 18 years old who visited the department of dentistry in Hanyang University for treatments. The experimental group who was treated by corticotomy and Skeletal Anchorage System(SAS). The control group who received orthodontic treatment using SAS. The following results are produced after analyzing both groups. The significant statistic difference in space closing time has been observed in the experimental group as compared with the control group(p<0.05). In the experimental group, the significant statistic increase in canine retraction velocity was also observed(p<0.05). There was no significant difference in profile change between the control group and the experimental group(p<0.05). As a result, orthodontic treatment using corticotomy has a reasonable efficiency in space closing time as compared with the existing orthodontic treatment. Therefore, it is concluded that corticotomy with orthodontic treatment can be reasonably applied to dentofacial abnormality.

근첨하 분절 골절단술을 병행한 Ⅲ급 양악 전돌증의 교정치료 증례

정미향,남동석 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.3

양악 전돌은 흔히 접하는 부정교합 증례로서, 대부분 상하순의 전돌에 의한 안모 심미성의 손상을 주소로 내원한다. 이러한 증례는 제1소구치를 발거하고 그 공간을 이용하여 전치부를 견인하여 치료하는 경우가 많으며, 성공적인 치료결과를 얻을 수 있다. 그러나, 성인 환자의 경우에는 환자의 협조도 불량으로 인한 악외 고정원 사용의 불량, 치료기간의 장기화, 치조골이 충분하지 못한 경우등에 있어서의 치근 흡수량의 증가, 구외 장치 사용으로 인한 환자의 사회심리적 부담감등의 부작용이 있다. 이의 해결방안의 하나인 근첨하 분절 골절단술은 고정원의 절대 보존, 치료기간의 단축, 구외 고정원 사용 필요성 제거 및 이를 통한 환자의 협조도 증가 등의 장점을 가지고 있다. 이에, 제 1소구치 발거 및 이 부위를 이용한 근첨하분절 골절단술을 병행하여 치료한 치아치조 전돌의 증례를 치료 전후의 두부 방사선 계측 사진 및 연구 모형을 통해 비교분석하여 변화를 살펴보고. 이의 장단점을 고찰해 보도록 하고자 한다. Bimaxillary protrusion can be treated effectively in growing patients and in adults with conventional orthodontic therapy. However, In the adult patient, combined surgical and orthodontic treatment modalities may offer distinct advantages over such conventional therapy. In those cases complicate by vertical jaw dysplasia, sagittal dysplasia, or transverse skeletal discrepancy in addition to bimaxillary protrusion, the possibilities of obtaining successful results through orthodontic treatment alone greatly diminish. Surgical retraction of both maxillary and mandibular anterior segments with subapical osteotomies and ostectomies in the extraction site may be a good treatment alternative. Treatment time and possible adverse effects of lengthy orthodontic therapy may be reduced and optimum esthetic improvement may be facilitated. On the following cases, patient who had bimaxillary protrusion with Angle Class III malocclusion was treated with combined orthodontic - surgical therapy by anterior subapical segmental osteotomies.

양악전돌증 환자에서 하악 6전치 후방 이동 시 치료 방법에 따른 하악 경조직과 연조직의 변화: 하악 전방분절골절단술과 발치 교정 치료

김영주,김경아,유용재,유경선,유정민,오주영,김수정,김성훈,이백수,Kim, Young-Joo,Kim, Kyung-A,Yu, Yong-Jae,Ryu, Kyung-Sun,Ryu, Jeong-Min,Ohe, Joo-Young,Kim, Su-Jung,Kim, Seoung-Hun,Lee, Baek-Soo 대한악안면성형재건외과학회 2012 Maxillofacial Plastic Reconstructive Surgery Vol.34 No.4

Purpose: The purpose of the study is to evaluate the effectiveness of anterior segmental osteotomy (ASO) in bimaxillary protrusion (BP) patients by comparison between the mandibular soft and hard tissue changes from orthodontic treatment and ASO. Methods: All 44 patients were diagnosed with BP in Kyung-Hee Medical Center. Orthodontic treatment with teeth extractions were underwent by 23 patients (Group A) and 21 patients underwent ASO (Group B). Mandibular soft and hard tissue changes were measured and evaluated, which were based on the vertical and horizontal reference line in lateral cephalometric radiographs. Statistical significance between the changes and correlation between each measurement were analyzed. Results: The amount of B point movement was lesser than that of the lower incisal tip (LIT) retraction, and LIT was tilted lingually in group A. The posterior movement discrepancy between LIT and B point was insignificant, and the inclination of lower incisor was not changed in group B. The soft tissues, including the lower lip, showed a posterior movement and reduction in the depth of mento-labial groove. According to the correlation analysis, the movement of the lower incisor was significantly related to the movement of the lower lip in group A, and the movement of the lower incisor was significantly related to that of the movement of lower lip, B point and Pog in group B. Conclusion: The orthodontic treatment in BP patients results in posterior tilting movement of the lower incisor, but ASO results in the bodily movement of the lower incisor. Consequently, ASO is more effective in BP cases because it ensures the controlled movement of the lower incisors.

Effect of extraction treatment on upper airway dimensions in patients with bimaxillary skeletal protrusion relative to their vertical skeletal pattern

Ha-Nul Cho,Hyun Joo Yoon,Jae Hyun Park,Young-Guk Park,Su-Jung Kim 대한치과교정학회 2021 대한치과교정학회지 Vol.51 No.3

Objective: To investigate dimensional changes in regional pharyngeal airway spaces after premolar extraction in bimaxillary skeletal protrusion (BSP) patients according to vertical skeletal pattern, and to further identify dentoskeletal risk factors to predict posttreatment pharyngeal changes. Methods: Fiftyfive adults showing BSP treated with microimplant anchorage after four premolar extractions were included in this retrospective study. The subjects were divided into two groups according to the mandibular plane steepness: hyperdivergent (Frankfort horizontal plane to mandibular plane [FH-MP] ≥ 30) and nonhyperdivergent groups (FH-MP < 30). The control group consisted of 20 untreated adults with skeletal Class I normodivergent pattern and favorable profile. Treatment changes in cephalometric variables were evaluated and compared. The association between posttreatment changes in the dentoskeletal and upper airway variables were analyzed using linear regression analysis. Results: The BSP patients showed no significant decrease in the pharyngeal dimensions to the lower level in comparison with controls, except for middle airway space (MAS, p < 0.01). The upper airway variable representing greater decrease in the hyperdivergent group than in the nonhyperdivergent group was the MAS (p < 0.01). Posttreatment changes in FH-MP had negative correlation with changes in MAS (β = –0.42, p < 0.01) and inferior airway space (β = –0.52, p < 0.01) as a result of multivariable regression analysis adjusted for sagittal skeletal relationship. Conclusions: Decreased pharyngeal dimensions after treatment in BSP patients showed no significant difference from the normal range of pharyngeal dimensions. However, the glossopharyngeal airway space may be susceptible to treatment when vertical dimension increased in hyperdivergent BSP patients.

Hard and soft tissue profile changes folloeing anterior subapical osteotomy in bimaxillary dentoalveolar protrusion patients

Han, Un-Ae,Kim, Jeong-Hwan,Yoon, Tae-Ho,Park, Je-Uk,Kook, Yoon-Ah 대한치과교정학회 2003 대한치과교정학회지 Vol.33 No.6

본 연구는 입술 및 치아 돌출을 주소로 내원한 교정 환자를 소구치 발치와 근첨하 분절 골절단술로 전치부의 최대 후방 이동을 도모한 증례들에서 이로 인한 수술 전후의 측모 변화를 알아보고자 시행하였다. 양악 전돌증을 동반한 골격성 제Ⅰ급 부정 교합 환자 20명의 수술 전과 후 측모 두부X-선 사진을 중첩하여 경조직 및 연조직의 변화를 평가하여 다음과 같은 결론을 얻었다. 1. 상악 전치부는 후방으로 치체 이동하였고, 하악 전치부는 후방으로 약간의 경사 이동하였다. 2. 수평 방향의 연조직 변화는 Nt와 Sn를 제외하고는 모든 항목이 유의성 있게 변화하였고, 수직 방향으로는 Ls는 하방으로, Li는 상방으로 유의성 있게 변화하였다. 3. 경조직변화에 대한 연조직변화의 상관 관계는 ΔHId/ ΔHLi, ΔHId/ ΔLL-Eline, ΔHPt.B/ ΔHILS와 ΔUI-FH/ ΔNL에서 높게 나타났다. 4. Ricketts' E-line에 대해 상순변화에 비해 하순의 더 많은 후방 이동을 보였다. 상악 전치 변위에 대한 상순 변위 비율은 50%였고, 하악 전치 변위에 대한 하순 변위 비율은 60%였다. 위에서 언급된 결과로서, 근첨하 분절 골절단술은 심한 치조 전돌 환자에게 효율적인 치료법으로서 빠른 외모 개선의 결과를 가져오는 수술적 접근 방법이다. The purpose of this study is to evaluate hard and soft tissue changes following the first four premolar extractions and anterior subapical osteotomy in bimaxillary dentoalveolar protrusion patients requiring maximal retraction of anterior segments. A sample of 20 adult female patients was selected. Surgical procedures were performed by the same surgeon, and modified segmental osteotomy and anterior subapical osteotomy techniques were employed on the maxilla and mandible respectively. Pre-surgical and post-surgical lateral cephalometric radiograms were traced and superimposed using the best-fit method and two reference planes. The results were as follows 1. The bodily movement of the maxillary anterior segment was achieved in a posterior direction. The mandibular anterior segment was moved posteriorly with a slight correction of the lower incisors. 2. The horizontal soft tissue measurements changed significantly after treatment, but Nt and Sn landmarks remained unchanged. The vertical soft tissue measurements indicated that Ls moved inferiorly and Li superiorly. 3. The correlation between hard and soft tissue changes indicated that ΔHId/ ΔHLi, ΔHId/ ΔLL-Eline, ΔHPt.B/ ΔHILS, and ΔUI-FH/ ΔNL were significant. 4. More lower lip relative to upper lip retraction was demonstrated in relation to Rickett's E-line. The ratio between upper incisor and upper lip displacement was 50%, and between the lower incisor and lower lip displacement was 60%. We conclude from the results that the anterior subapical osteotomy is an efficient treatment option for adult patients who have severe dentoalveolar protrusion and desire rapid results.

Cone-beam computed tomography-based diagnosis and treatment simulation for a patient with a protrusive profile and a gummy smile

Shunsuke Uesugi,Toshihiro Imamura,Satoshi Kokai,Takashi Ono 대한치과교정학회 2018 대한치과교정학회지 Vol.48 No.3

For patients with bimaxillary protrusion, significant retraction and intrusion of the anterior teeth are sometimes essential to improve the facial profile. However, severe root resorption of the maxillary incisors occasionally occurs after treatment because of various factors. For instance, it has been reported that approximation or invasion of the incisive canal by the anterior tooth roots during retraction may cause apical root damage. Thus, determination of the position of the maxillary incisors is key for orthodontic diagnosis and treatment planning in such cases. Cone-beam computed tomography (CBCT) may be useful for simulating the post-treatment position of the maxillary incisors and surrounding structures in order to ensure safe teeth movement. Here, we present a case of Class II malocclusion with bimaxillary protrusion, wherein apical root damage due to treatment was minimized by pretreatment evaluation of the anatomical structures and simulation of the maxillary central incisor movement using CBCT. Considerable retraction and intrusion of the maxillary incisors, which resulted in a significant improvement in the facial profile and smile, were achieved without severe root resorption. Our findings suggest that CBCT-based diagnosis and treatment simulation may facilitate safe and dynamic orthodontic tooth movement, particularly in patients requiring maximum anterior tooth retraction.

상하악 치조전돌증의 양악 분절골절단 수술후 경, 연조직 변화에 관한 연구

송재철,진병로 大韓顎顔面成形再建外科學會 1997 Maxillofacial Plastic Reconstructive Surgery Vol.19 No.3

The purpose of this study was to evaluate the interrelationship of the soft and hard tissue changes after both maxillary and mandibular anterior segmental surgery in bimaxillary protrusion patients, 11 patients had received both maxillary and mandibular anterior segmental surgery and were investigated radiologically with lateral cephalogram. The results were as follows : 1. The correlation of maxillary hard and soft tissue horizontal changes were relative high. : Coefficient between UIE and Stms was 0.89 (p<0.001). 2. The correlation of mandibular hard and soft tissue horizontal changes were very high, especially at the chin. : Coefficients were over 0.90 (p<0.001) 3. All points were moved superiorly except SLS, LS, Stms. 4. Upper and lower lip convexity to the E-Line were decreased (p<0.001) and postsurgical facial profiles were changed very esthetically.