상악골 전방견인 후 경조직과 연조직의 재발에 관한 연구

양준호,박수병,손우성 대한치과교정학회 1997 대한치과교정학회지 Vol.27 No.3

본 연구는 성장기 아동 중 골격성 III급 부정교합 환자에서 구외력을 이용한 상악골 전방견인시에 발생하는 경조직과 연조직의 변화와 상악골 전방견인 장치의 제거 후 관찰되는 경조직과 연조직의 재발 양상 및 이들의 상관성을 알아보곡자 하였다. 부산대학교병원 치과교정과에 내원하여 상악골 열성장을 동반하는 골격성 III급 부정교합으로 진단받은 아동 중 안면 비대칭과 순구개열이 없고 상악골 전반견인 치료 전이나 후에 상하악에서 고정성 또는 가철성 장치를 사용하지 않은 29명(남자 10명, 여자19명)을 대상으로 상악골 전방견인 전, 후와 장치제거 후 1-3개월 때 채득한 측모두부 방사선 규격사진을 계측, 분석하여 다음과 같은 결과를 얻었다. 1. 상악골 전방견인에 의하여 상순부 연조직은 그 하방 경조직과 함께 전하방 이동되었고 하순부 연조직은 경조직의 변화에도 불구하고 수평적으로는 비교적 안정적이었다. 2. 상악골 전방견인 장치제거 후 상하 전치의 재발양상에도 불구하고 상하순 모두 수평방향으로는 비교적 안정적이었으며 수직방향으로는 전방견인 후보다 더 하방이동 하였다. 3. 상악골 전방견인에 의하여 상악골과 상악치열이 전방 이동되었고 구개평면은 전상방 회전되었으며 하악골과 하악치열은 하후방 회전되었다. 4. 상악골 전방견인 장치제거 후 악골의 위치는 비교적 안정적이었으나 상하 전치의 치축과 전상방 회전되었던 구개평면이 치료 전 위치로 재발되었다. 5. 경조직과 연조직의 상관성 검정에서 입술의 위치는 그 하방 경조직과 밀접한 상관성을 보였다. The purpose of this study was to evaluate the effect of maxillary protraction and the relapse of hard and soft tissue after maxillary protraction. For this study 29 patients who were treated with maxillary protractor and labiolingual archwire were selected. Their mean age was 9 years 4 months and mean treatment period was 8.5 months. Lateral cephalograms were taken at pretreatment, immediately after treatment and one to three months after removal of the maxillary protractor. They were traced on skeletodental and soft tissue structures based on Burstone`s analysis and analyzed by Quick-Ceph Image Digitizing System(ORTHODONTIC PROCESSING). The mean and standard deviation between pretreatment and posttreatment and between posttreatment and retention period for each cephalometric variable were calculated. Student t-test was used to determine the statistical significance of the changes in each variable. Correlation coefficients between hard tissue and soft tissue were used to determine interrelationship. The results were as follows : 1. After maxillary protraction, the maxilla and maxillary dentition moved antero-inferiorly, the mandibld and mandibular dentition moved postero-inferiorly and palatal plane rotated antero-superiorly by 0.59°. 2. After maxillary protraction, the soft tissue of upper lip moved antero-inferiorly with the movement of hard tissue but the antero-posterior position of lower lip was stable in spite of the change of hard tissue. The thickness of upper lip was decreased and that of lower lip was increased after maxillary protraction. 3. During the retention period, the position of jaws was relatively stable but upper and lower anterior teeth and antero-superiorly rotated palatal plane relapsed to original position. 4. During the retention period, the soft tissue of lips was stable antero-posteriorly and moved more inferiorly than posttreatment. 5. The correlation coefficients between the position of upper and lower incisal edge and that position of lips were high, especially in horizontal change.

치료시기에 따른 상악골 전방견인효과 : 사춘기전과 사춘기의 비교 A comparison of prepubertal and pubertal patients

김경호,최광철,백형선,이지현 대한치과교정학회 2002 대한치과교정학회지 Vol.32 No.5

상악골 전방견인 장치를 이용한 골격성 Ⅲ급 부정교합 환자의 악정형적 치료에서 치료시기는 치료효과에 지대한 영향을 미칠 수 있으며 이상적인 치료시기는 연구자에 따라 다소의 차이는 있으나 다른 형태의 부정교합보다는 다소 이른 사춘기 이전의 어린 나이라는 것이 선학들의 공통된 의견이었다. 하지만 통계적 자료들을 바탕으로 한 최근의 논문들은 과거 선학들의 의견을 뒷받침 해주는 논문과 그렇지 않은 논문들로 나뉘고 있어 이상적 치료시기에 대한 정립된 의견이 없는 실정이다. 이에 본 연구에서는 119명의 환자들의 수완부골 방사선 사진을 평가하여 골성숙도에 따라 사춘기전군과 사춘기군으로 분류하고 치료전후 측모두부방사선 사진을 분석하여 상악골 전방견인에 대한 치료효과를 비교하였다. 평균 치료기간은 사춘기전군은 6.5개월, 사춘기군은 6.1개월이었으며 치료전후의 측모두부방사선 사진을 분석한 결과 다음과 같은 결론을 얻었다. 1. 상악골의 전방이동양은 사춘기전군과 사춘기군간에 차이에 없었다. 2. 상악골의 하방이동양은 사춘기전군과 사춘기군간에 차이가 없었다. 3. 하악골의 하방이동양과 후하방회전양은 사춘기전군과 사춘기군간에 차이가 없었다. 4. 치성이동양은 사춘기전군과 사춘기군간에 차이가 없었다. 이상의 결과로 사춘기전 뿐 아니라 사춘기에서도 상악골 전방견인에 의해 상악골 성장촉진과 함께 성공적인 악정형 치료가 가능함을 알 수 있었다. Treatment timing is a very important factor to consider in treating skeletal Class Ⅲ patients by means of maxillary protraction. According to the literature maxillary protraction should be carried out at an early age before puberty. However, no scientific data were presented to support this statement and recent studies supported by statistical data showed disagreement concerning the optimum treatment time of maxillary protraction. Therefore, there is no agreement about the optimum treatment time of maxillary protraction. In this study hand-wrist X-rays were taken from 119 patients and subjects were grouped into prepubertal and pubertal group according to their skeletal maturity . Preagreement and posttreatmrnt lateral cephalometric X-rays were taken and treatment effects were compared. The average treatment time was 6.5 months for the prepubertal group and 6.1 months for the pubertal group. The obtained results were as follows : 1. The amount of maxillary forward movement was the same for prepubertal and pubertal group. 2. The amount of maxillary downward movement was the same for prepubertal and pubertal group. 3. The amount of mandibular downward and backward rotational movement was the same for prepubertal and pubertal group. 4. Dental effects were the same for prepubertal and pubertal group.

A cephalometric study on the velopharyngeal changes after maxillary protraction

Lee, Nam-Ki,Cha, Bong-Kuen 대한치과교정학회 2006 대한치과교정학회지 Vol.36 No.2

이 연구의 목적은 훼이스마스크로 상악 전방견인치료를 받은 성장기 골격성 Ⅲ급 부정교합자 25명(남 10, 여 15, 평균나이 9.9세)에서 단기간의 정적인 구개범인두 변화를 측모두부방사선 계측사진상에서 선 계측, 각도 계측 및 비율 계측을 시행하여 평가하는 것이다. 경구개 평면각의 변화량은 maxillary depth 또는 N perp to A의 변화량과 음의 상관관계를 보였다(p <0.01). 경 연구개 각의 증가는 유의성이 있었으며, 이는 경구개 평면각의 변화보다 연구개 평면각의 변화의 영향을 더 받았다(p <0.001). 연조직 과 경조직 비인두 깊이의 증가는 유의성이 있었으며 (p <0.001), 이들의 변화량과 연구개 평면각의 변화량간에는 양의 상관관계를 보였다(p <0.05). 경구개 길이의 증가는 유의성이 있었으며 (p <0.001), 이는 연조직 비인두 깊이의 증량과 음의 상관관계를 보였다(p <0.05). Need 비율 S (C)의 증가는 유의성이 있었으나 (p <0.001), 이러한 증가는 이전 연구에서 보고된 Need 비율 S (C)의 정상범위 내에 있었다. 이 연구로 상악골의 전방견인 후에 정적인 구개범인두 부위에 변화가 있을지라도 구개범인두의 적격성이 유지됨을 알 수 있었다. The purpose of this study was to investigate cephalometrically the short term static velopharyngeal changes in 25 patients (10 boys and 15 girls, aged from 5 years 9 months to 12 years 10 months in the beginning of treatment) with skeletal Class Ⅲ malocclusions who underwent nonsurgical maxillary protraction therapy with a facemask The linear, angular and ratio measurements were made on lateral cephalograms. Only the change in hard palatal plane angle was negatively correlated with the change in maxillary depth or N-perp to A (p < 0.01). The change in velar angle showed a statistically significant increase (p < 0.001). This change was influenced more by the soft palatal plane angle than by the hard palatal plane angle (p < 0.001). The changes in soft tissue nasopharyngeal depth and hard tissue nasopharyngeal depth showed statistically significant increases (p < 0.001). Correlations between the changes in soft tissue (or hard tissue) nasopharyngeal depth and the change in soft palatal plane angle were significant (p < 0.05). The increase in hard palate length was statistically significant (p < 0.001). The change in hard palate length was negatively correlated with the change in soft tissue nasopharyngeal depth (p < 0.05). The change in need ratio S (C) showed a statistically significant increase (p < 0.001). But this difference was within the normal range reported by previous studies. These findings indicate that the velopharyngeal competence was maintained even if the anatomical condition of the static velopharyngeal area were changed after maxillary protraction.

Does surgically assisted maxillary protraction with skeletal anchorage and Class III elastics affect the pharyngeal airway? A retrospective, long-term study

Elvan Onem Ozbilen,Petros Papaefthymiou,Hanife Nuray Yilmaz,Nazan Küçükkeleş 대한치과교정학회 2023 대한치과교정학회지 Vol.53 No.1

Objective: Surgically assisted maxillary protraction is an alternative protocol in severe Class III cases or after the adolescent growth spurt involving increased maxillary advancement. Correction of the maxillary deficiency has been suggested to improve pharyngeal airway dimensions. Therefore, this retrospective study aimed to analyze the airway changes cephalometrically following surgically assisted maxillary protraction with skeletal anchorage and Class III elastics. Methods: The study population consisted of 15 Class III patients treated with surgically assisted maxillary protraction combined with skeletal anchorage and Class III elastics (mean age: 12.9 ± 1.2 years). Growth changes were initially assessed for a mean of 5.5 ± 1.6 months prior to treatment. Airway and skeletal changes in the control (T0), pre-protraction (T1), post-protraction (T2), and follow-up (T3) periods were monitored and compared using lateral cephalometric radiographs. Statistical significance was set at p < 0.05. Results: The skeletal or airway parameters showed no statistically significant changes during the control period. Sella to nasion angle, N perpendicular to A, Point A to Point B angle, and Frankfort plane to mandibular plane angle increased significantly during the maxillary protraction period (p < 0.05), but no significant changes were observed in airway parameters (p > 0.05). No statistically significant changes were observed in the airway parameters in the follow-up period either. However, Sella to Gonion distance increased significantly (p < 0.05) during the follow-up period. Conclusions: No significant changes in pharyngeal airway parameters were found during the control, maxillary protraction, and follow-up periods. Moreover, the significant increases in the skeletal parameters during maxillary protraction were maintained in the long-term.

Miniplate anchorage를 이용한 골격성 Ⅲ급 부정교합 아동의 상악 전방견인 치료

차봉근,이남기,최동순 대한치과교정학회 2007 대한치과교정학회지 Vol.37 No.1

상악 전방견인 장치는 골격성 Ⅲ급 부정교합 특히 상악골 열성장 치료를 위해 널리 사용되고있다. 이 경우 증례에 따라 치아 치조성 이동을 허용하는 다양한 치료목표가 설정될 수 있으나, 상악골의 순수한 전방이동이 필요한 경우 다양한 구내장치를 이용하여 고정원 보강을 시도함에도 불구하고 고정원의 치아 치조성 이동을 피하기 어려운 경우가 발생된다. 이는 치아를 고정원으로 이용하는 경우 골개조(remodeling)가 상악복합체 뿐만 아니라 치주인대에서도 발생되기 때문이다. 특히 이러한 부작용은 역동적인 치열 교환이 일어나서 치성고정원이 부족한 혼합치열기 또는 비교적 늦은 나이에 악정형 치료가 시행되는 경우에 많이 발생되게 된다. 이와 같은 부작용을 방지하기 위해 임플란트의 사용이나 피질골절단술, 신연골형성술 등의 외과적 방법을 응용하여 전방견인을 시도할 수 있으나 본고에서는 악정형적 효과를 극대화하기 위한 새로운 대안으로 골 고정원 (skeletal anchorage)을 이용한 상악 전방견인 치료의 외과적 교정적 치료 술식을 증례를 통해 소개하고자 한다. The maxillary protraction headgear has been widely used in the treatment of skeletal Class Ⅲ children with maxillary deficiency. A variety of treatment objectives which allow dentoalveolar movements may be established, but when only maxillary protraction without dentoalveolar movement is needed, one of the limitations in maxillary protraction with conventional tooth-borne anchorage is the loss of dental anchorage. This is because a bone remodeling occurs not only at circummaxillary sutures but also within the periodontal tissues. During protraction treatment in the mixed dentition phase, in older children or for the patient with multiple congenitally missing teeth, it is not uncommon to observe undesirable mesial movement of maxillary teeth. Such a side effect can be eliminated or minimized using absolute anchorage such as skeletal anchorage. The purpose of this case report is to introduce a new technique of the maxillary protraction headgear treatment using surgical miniplates.

제 Ⅲ급 부정교합 환자에서 상악골 전방견인이 성장에 미치는 효과에 대한 연구

성상진,백형선 대한치과교정학회 1994 대한치과교정학회지 Vol.24 No.2

The method of treatment in skeletal Class Ⅲ malocclusion must be chosen according to an etiology and timing of the treatment. Maxillry protraction has been used as an effective treatment method in growing children with maxillary deficiency. The efficacy of maxillary protraction has been viewed as a result of downward-backward displacement of mandible and compensatory dental displacement during the treatment rather than forward-downward growth of maxilla itself. In this study, 104 subjects treated with maxllary protraction, and 19 males and 21 females with known annual growth amount have been chosen longitudinally as treated group and normal group, respectively. And changes in position of maxilla, mandible and dentition have been comparatively analyzed on the lateral cephalometric radiographs by age. The results were as follows: 1. Treated group showed more forward movement of maxilla compare to the normal group and the mandible displaced backward compare to the normal group. 2. Downward movement of mandible in treated group was similar to that of normal group with statistical significance in female 12 year old group and downward movement of mandible in treated group was similar to that of normal group. 3. In treated group, maxillary central incisor moved more forward than the normal group with statistical significance in male 8,10 year-old groups and female 8,9,10 year-old groups. In treated group, downward movement of maxillary central incisor was similar to that of the normal group with statistical significance in male and female 7,8 year-old groups. Considering the above results and the duration of the treatment, the forward movement of maxilla due to maxillary protraction was effective compared to normal growth amount of the normal group.

골격성 Ⅲ급 부정교합 환자에서 상악골 전방 견인시 일어나는 골격 변화 양상에 관한 연구

이영지,차경석,이진우 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.4

골격성 Ⅲ급 부정교합은 크게 하악이 과성장인 경우, 상악이 열성장인 경우, 이 두가지의 복합으로 나타나는데 이중 상악의 열성장으로 인한 성장기 골격성 III급 부정교합 환자에서는 상악골에 악정형력을 가하여 상악골을 전방견인함으로써 보다 효과적인 결과를 얻을 수 있다. 이에 상악골 견인장치 중 현재 많이 쓰는 RME 와 Facial mask를 사용하여 치료한 34명(남자 9명, 여자 25명)의 환자를 대상으로 치료결과 FH/palatal plane, SNA, SNB, LFH의 변화량을 기준으로하여 각각의 변화량에 따라 두군으로 분류하여 치료 전, 후 상악골 및 하악골의 변화 양상과 수직적인 고경에 차이가 있는지를 관찰하여 다음과 같은 결론을 얻었다. 1. 상악골 전방견인 장치를 사용한 모든 환자에서 상악골의 전방이동과 하악골의 후하방회전이 일어났으며 대부분의 환자에서 구개평면은 상방경사되는 경향을 보였다. 2. Facial mask 사용결과 구개평면이 상방경사된 군(FH/Pal 1군)은 구개평면이 하방경사된 군(FH/Pal 2군)에 비해 상악골의 전방이동이 많이 일어났다. 3. Facial mask 사용결과 상악골의 전방이동량이 많은 군(SNA 1군)은 상대적으로 하악골의 후방이동량은 적게 나타나고 구개평면이 상방경사되는 경향을 보였다. 4. Facial mask 사용결과 하악골의 후방이동이 많이 일어난 군(SNB 1군)은 상대적으로 상악골의 전방이동은 적게 나타나며 하악골의 후방이동은 하방회전과 함께 나타나서 수직적인 증가 특히 전안면부위의 증가를 일으킨다. 5. LFH 증가량에 의해 분류된 두 군 사이의 비교에서 치료 전 saddle angle이 크고 상악골 및 하악골이 후방에 위치하던 군이 saddle angle이 작고 하악골이 전방위치되어 있는 군에 비해 하안면고경의 큰 증가없이 상악골 전방견인이 이루어졌다. A Skeletal Class Ⅲ malocclusion may be the results of a large mandible, a small maxilla, or combination of the two. Protraction devices for the maxilla are used to promote the growth of a deficient maxilla by applying extraoral force to actively growing patients. This study has been performed to determine whether there are significant differences in skeletal and dental changes between FH/Pal 1 and FH/Pal 2 group, SNA1 and SNA2 group, SNB 1 and SNB2 group, and LFH 1 and LFH 2 group after RME and facial mask therapy. The results of this study can be summarized and concluded as follows ; 1. In all patients after maxillary protraction, the maxilla and maxillary dentitions moved forward, and the mandible rotated backward and downward. In most of them, palatal is tends to have an upward inclination. 2. The FH/Pal group 1, having an upward inclination of the palatal plane as a result of Facial mask, showed statistically significant maxillary forward movement compared to the FH/Pal group 2. 3. The SNA group 1 showed significantly less mandibular backward movement and there was a tendency for the palatal plane to upward inclination compared to SNA group 2. 4. The SNB group 1 showed significantly les maxillary forward movement, but the vertical dimension, especially the lower facial height increased by mandibular downward rotation compared to SNB group 2. 5. LFH group 1, which had large saddle angle and posterior positioned mandible in the pre-treatment stage, showed maxillary protraction effect without significant increase in lower facial height compared to LFH group 2.

New approach of maxillary protraction using modified C-palatal plates in Class III patients

Yoon-Ah Kook,Mohamed Bayome,Jae Hyun Park,Ki Beom Kim,Seong-Hun Kim,Kyu-Rhim Chung 대한치과교정학회 2015 대한치과교정학회지 Vol.45 No.4

Maxillary protraction is the conventional treatment for growing Class Ⅲ patients with maxillary deficiency, but it has undesirable dental effects. The purpose of this report is to introduce an alternative modality of maxillary protraction in patients with dentoskeletal Class Ⅲ malocclusion using a modified C-palatal plate connected with elastics to a face mask. This method improved skeletal measurements, corrected overjet, and slightly improved the profile. The patients may require definitive treatment in adolescence or adulthood. The modified C- palatal plate enables nonsurgical maxillary advancement with maximal skeletal effects and minimal dental side effects.

3차원 얼굴 영상을 이용한 상악 전방견인 치료 후의 연조직 평가

최동순(Dong-Soon Choi),이경훈(Kyoung-Hoon Lee),장인산(Insan Jang),차봉근(Bong-Kuen Cha) 대한치과의사협회 2016 대한치과의사협회지 Vol.54 No.3

Purpose: The aim of this study was to evaluate the soft-tissue change after the maxillary protraction therapy using threedimensional (3D) facial images. Materials and Methods: This study used pretreatment (T1) and posttreatment (T2) 3D facial images from thirteen Class III malocclusion patients (6 boys and 7 girls; mean age, 8.9 2.2 years) who received maxillary protraction therapy. The facial images were taken using the optical scanner (Rexcan III 3D scanner), and T1 and T2 images were superimposed using forehead area as a reference. The soft-tissue changes after the treatment (T2-T1) were three-dimensionally calculated using 15 soft-tissue landmarks and 3 reference planes. Results: Anterior movements of the soft-tissue were observed on the pronasale, subnasale, nasal ala, soft-tissue zygoma, and upper lip area. Posterior movements were observed on the lower lip, soft-tissue B-point, and soft-tissue gnathion area. Vertically, most soft-tissue landmarks moved downward at T2. In transverse direction, bilateral landmarks, i.e. exocanthion, zygomatic point, nasal ala, and cheilion moved more laterally at T2. Conclusion: Facial soft-tissue of Class III malocclusion patients was changed three-dimensionally after maxillary protraction therapy. Especially, the facial profile was improved by forward movement of midface and downward and backward movement of lower face.

The effects of maxillary protraction appliance (MPA) depending on vertical facial patterns

Ryu, Young-Kyu,Lee, Kee-Joon,Oh, Chang-Hun 대한치과교정학회 2002 대한치과교정학회지 Vol.32 No.6

성장기 아동에서 상악골 열성장을 보이는 제Ⅲ급 부정교합은 상악골 전방 견인 장치의 적응증이 된다. 상악골 전방 견인장치의 바람직한 효과는 상악골의 정방 이동이지만, 실제로는 상악 치아의 전방 이동, 하악골의 후하방 회전, 하악 전치의 설측 이동 등의 복합적인 결과는 Ⅲ급 관계가 개선된다고 알려져 있다. 그러나 수직적 안모 유형별로 상악골 전방 견인 장치의 효과에 대한 차이는 잘 알려진 바가 없다. 본 연구는 1998년-2000년 사이에 연세대학교 치과병원 교정과에 내원한 환자들 중 초진시 나이는 6세 6개월에서 13세 3개월 사이의 상악골 열성장을 동반한 제 Ⅲ급 부정교합으로 진단된 67명(남 36, 여 31)을 대상으로, 암모유형별로 SNMP군과 Gonial angle군에서 low, average, high로 세부군을 나누어 치료전 측모 두부방사선 규격사진을 통해 상악골 전방견인 장치의 효과를 비교하여 다음과 같은 결과를 얻었다. ① SNMP군의 low angle에서 B point의 후방이동량이 많았으며, HIgh angle에서는 A point의 전방이동양이 컸다. ② Gonial angle군의 low angle에서 A point의 전방이동양이 가장 적었으며, high angle에서는 A point의 전방이동양이 상대적으로 많았다. ③ A point에 대한 arcTan를 구한 결과 A point의 이동 각도는 장안모 군에서 더 수평적인 이동 양상을 보였고, 단안모 군에서는 수직적 이동양상이 강했다. ④ SNMP군과 Gonial angle의 세부군에서 치료기간별 유의성은 없었다. Preadolescent children with deficient maxillae are suitable candidates for the maxillary protraction appliance(MPA). The theoretical effect of the MPA is protraction or anterior displacement of the maxilla. However, it known that complex effects such as anterior displacement of the maxillary teeth, downward and backward rotation of the mandible, linguoversion of the mandibular anterior incisors, are known to play a role in improving the C1 Ⅲ malocclusion. There have been much studies with regard to maxillary protraction, but the different effects of MPAs depending on the vertical facial pattern are not known precisely. This study was based on 67 patients (31 males, 36 females) aged from 6 years 6 months to 13 years 3months, who visited the Dept. of Orthodontics at Yonsei Univ., Dental Hospital and diagnosed as skeletal Class Ⅲ with maxillary deficiency. They were divided into 3 group (low, average, high angle groups) depending on gonial angle and the SNMP (Go-Gn) angle, respectively. Pretreatment and post-treatment lateral cephalograms were used to compare the effects of MPA and the following conclusions were obtained: ① A significantly large amount of backward movement of the B point was observed in patients with a low SNMP angle. Those with a high SNMP angle had significant forward movement at A point. ②The patients with low gonial angle had the least forward movement at the A point, and those with a high angle and more forward movement. ③In comparing the arcTan of the A point, the high angle group showed more horizontal movement while the low angle group showed more vertical movement. ④ there was no significance between the treatment duration of the SNMP and the Gonial angle groups.