고령의 한국인에서 상악 구치부와 상악동의 근접도 및 피질판 두께에 대한 CBCT 평가

김성은,김난아,김선호,김정희,김미연 대한통합치과학회 2022 대한통합치과학회지 Vol.11 No.3

Cone-beam computed tomography (CBCT) can provide high resolution images and three-dimensional (3D) volumetric data. It can be used as a reliable diagnostic tool to evaluate tooth morphology and relationship of teeth with surrounding anatomical structures. Many previous studies indicate that the age of the subject had a significant effect on alveolar bone resorption. Alveolar bone resorption can cause severe dental problems to patients, especially to the elderly population. The aim of this study is to evaluate the anatomical relationships of maxillary posterior roots to the maxillary sinus and cortical plates in elderly Korean population using cone-beam computed tomographic (CBCT) images. CBCT images of 1906 patients who visited the VHS medical center dental hospital from January 2020 to August 2020 were retrospectively analyzed in this study. A total of 3909 teeth (2355 maxillary second premolars, 1554 maxillary first molars) were examined. Anatomical relationships of maxillary second premolars and first molars were studied by measuring the distance from each root apex to the sinus floor and to cortical plates using CBCT images in both sagittal and coronal planes. The variables were expressed as mean values±standard deviation. The independent samples were analyzed using the t-test (p<0.05). The majority of maxillary second premolars had single root (95%), and the remaining 5% of second premolars had two separate roots. There was one maxillary second premolar presented an accessory root. Similarly, 99% of maxillary first molars had three separate roots, and only 1% of first molars presented an accessory root. The mean distances from root apex to the sinus floor were shorter in maxillary first molars (3.74 to 4.43 mm) than second premolars (4.60 to 5.07 mm). The frequency of a root protrusion into the maxillary sinus was high in palatal roots of maxillary first molars than other roots. In terms of cortical plate thickness, maxillary second premolars had thicker cortical plates than maxillary first molars. The mean distances from root apex to the sinus floor were shorter in maxillary first molars than second premolars. The frequency of a root protrusion into the maxillary sinus was high in palatal roots of maxillary first molars than other roots. In terms of cortical plate thickness, maxillary second premolars had thicker cortical plates than maxillary first molars. Knowledge of approximate values of cortical bone thickness and distance to the sinus floor could help clinicians to avoid iatrogenic damage during conventional and surgical endodontic treatments.

이소맹출 한 상악 제1대구치의 맹출 유도

윤효진,박호원,이주현,서현우 大韓小兒齒科學會 2010 大韓小兒齒科學會誌 Vol.37 No.4

Ectopic eruption means the eruption of the tooth in an abnormal position due to multiple factors, which found most frequently in maxillary fist permanent molars, mandibular lateral incisors and maxillary permanent canines. Ectopic eruption of the maxillary first permanent molar occurs when the molar erupts with a more mesial angulation than normal, and locks itself in an atypical resorption on the distobuccal root of the second primary molar. The maxillary first permanent molar plays important roles for mastication and occlusion, so ectopically erupted maxillary first permanent molars should be relocated into proper position. Treatment options are separation by insertion of the brass wire or elastic rings, preparation of distal aspect of the maxillary second primary molar, using fixed or removable appliance with finger spring, and placement of space maintainer or space regainer after extraction of the maxillary second primary molar. We report three cases treated of ectopically erupted maxillary first permanent molar by re-setting of stainless steel crowns, placement of brass wire and using active plate. We could find out distal movement of maxillary first permanent molars into proper position and normal occlusion. 이소맹출(ectopic eruption)은 여러 가지 원인들에 의해 치아가 비정상적 위치로 맹출하는 경우를 말하며, 주로 상악 제1 대구치, 하악 측절치 그리고 상악 견치에서 발생된다. 이소맹출 한 상악 제1대구치는 정상보다 근심방향으로 맹출하여, 동측 상악 제2유구치의 원심협측 치근을 흡수시키며, 결국 상악 제1대구치는 상악 제2유구치 하방에 걸리게 된다. 상악 제1대구치는 저작기능 및 교합에 중요한 역할을 하고 있으므로, 이소맹출 한 상악 제1대구치는 적절한 위치로 이동이 필요하다. 상악 제1대구치를 적절한 위치로 이동하기 위한 치료방법으로는 brass wire 또는 elastic ring을 이용한 separation, 상악 제2유구치의 원심면 삭제, finger spring을 포함한 고정성 또는 가철성 장치, 상악 제2유구치를 발치한 후 공간유 지장치 또는 공간회복장치의 이용 등이 있다. 본 증례들은 강릉대학교 치과병원에 내원한 환자들에서 이소맹출 한 상악 제1대구치를 기성금관의 재시적, brass wire의 적용, active plate를 이용하여 적절한 위치로 이동시켜 양호한 교합을 이루었기에 이를 보고하는 바이다.

Cone beam형 전산화단층영상을 이용한 상악동저와 상악제1대구치 치근단과의 위치관계

김경아,고광준 대한구강악안면방사선학회 2008 Imaging Science in Dentistry Vol.38 No.2

Purpose : To assess the positional relationship between the maxillary sinus floor and the apex of the maxillary first molar using cone beam computed tomograph (CBCT). Materials and Methods : CBCTs from 127 subjects were analysed. A total of 134 maxillary first molars were classified according to their vertical and horizontal positional relationship to the maxillary sinus floor and measured according to the distance between the maxillary sinus floor and the maxillary first molar. Results : Type III (The root projected laterally on the sinus cavity but its apex is outside the sinus boundaries) was dominated between 10 and 19 years and type I (The root apex was not in contact with the cortical borders of the sinus) was dominated (P<0.05) between 20 and 72 years on the vertical relationship between the maxillary sinus floor and the apex of the maxillary first molar. The maxillary sinus floor was located more at the apex (78.2%) than at the furcation (21.3%) for the palatal root. The distance from the root apex to the maxillary sinus floor confined to type I was increased according to the ages (P<0.05). Type M (The maxillary sinus floor was located between the buccal and the palatal root) was most common (72.4%) on the horizontal relationship between the maxillary sinus floor and the apex of the maxillary first molar. Conclusion : CBCT can provide highly qualified images for the maxillary sinus floor and the root apex of the maxillary first molar.

Inter-radicular distance between the maxillary second premolar and the first molar

( Seo-rin Jeong ),( Sun-kyoung Yu ),( Min-su Kim ),( Sung-hoon Lim ) 조선대학교 구강생물학연구소 2018 Oral Biology Research (Oral Biol Res) Vol.42 No.2

The aim of this study was to evaluate the effect of the curvature of mesiobuccal root of the maxillary first molar in the space between the maxillary second premolar and the first molar, which is the preferred site for mini-implant placement. In this study, cone-beam computed tomography (CBCT) data of 85 patients (36 male, 49 female; 14-38 years old) were used to measure the mesiobuccal root length of the maxillary first molar and the distance from the cementoenamel junction (CEJ) to the most curved point of the mesiobuccal root of the maxillary first molar. The interradicular distance between the maxillary second premolar and the first molar, and the buccolingual width of alveolar bone and cortical bone thickness at the plane 4-, 6-, and 8-mm apical to the CEJ were also measured. The length of the mesiobuccal root of the maxillary first molar was 11.2 ± 1.1 mm, and the distance from CEJ to the most curved point was 6.4 ± 0.7 mm, which was about 57.4% of the root length. The interradicular distances were almost same at the 4- and 6-mm planes, but increased significantly between the 6- and 8-mm planes. Although the buccolingual widths of the alveolar bone was increased apically, cortical bone thicknesses were not different among the 4-, 6-, and 8-mm planes. The interradicular distance does not increase between the 4-mm and 6-mm planes from CEJ because of the presence of the curvature of the mesiobuccal root of maxillary first molar.

국군 상악 제1대구치와 제2대구치의 치근 및 근관 형태에 대한 콘빔전산화단층촬영 연구

전보경 ( Bokyung Jeon ),홍진선 ( Jinson Hong ),최성환 ( Sunghwan Choi ),최용석 ( Yongseok Choi ),임정민 ( Jeongmin Lim ),이찬현 ( Chan-hyun Lee ) 국군의무사령부 2021 대한군진의학학술지 Vol.52 No.1

Objective; The aim of this study is to investigate the root and canal morphology of maxillary first and second permanent molars using a cone-beam computed tomography (CBCT) in Korean Military. Method; A total 928 CBCT images of bilateral maxillary first and second molar from 232 patients were selected. Patients visited Armed Forces Capital Dental Hospital for surgical extraction, root canal treatment, and implant surgery. The following data were analyzed and recorded: number of roots, types of root canal, presence of MB2 canal, MB1 and MB2 canal. Result; Number of roots of all maxillary first molars was three. There were various numbers of roots of maxillary second molars (1~3roots). There were various types in MB canal in both maxillary first and second molars, However, there was only one type in DB and P canal. The MB2 canal of maxillary first and second molars was present in 38.1% and 9.8% respectively. The mean distance of maxillary first and second molars were 2.24mm and 1.93mm respectively. Conclusion; As a result of observing through CBCT, there were differences in the number of roots, the type of root, and the average distance to the entrance of the MB1 and MB2 root canals in the maxillary first and second molars. There were various canal types of MB canals of maxillary molars in Korean military. These data can help successful endodontic treatment.

근심이동된 상악 대구치에서 Open Coil Jig 장치를 이용한 치험례

김진태,김병창 大韓小兒齒科學會 1994 大韓小兒齒科學會誌 Vol.21 No.2

Maxillary first molar is the key in normal occlusion. Mesial drifting of maxillary first molar result form early loss of second deciduous molar. Mesial drifted maxillary first molar was treated by headgear, Hawley appliance with screw, brasswire, etc. But, these appliance should be necessary for patients cooperation. Recently, several appliance for molar distalizing without patients cooperation has been introduced. We are reporting in this paper about distalizing of mesial drifted maxillary first molar because of early loss of deciduous second molar by open coil jig. Distalization of molar by open coil jig is predictable, rapid, painless method without mecesscity of patient cooperation.

악안면 형태에 대한 상악 제1대구치 발육장애의 영향

박소영,정태성,김지연,김신 대한소아치과학회 2019 大韓小兒齒科學會誌 Vol.46 No.2

This study was aimed to evaluate orofacial morphologies on the cases of developmental disorders of maxillary first molars. Panoramic radiographs, lateral cephalographs, and clinical photos of 2983 children who attended the Pediatric Dental Clinic of Pusan National University Dental Hospital from 2006 to August 2017 were assessed retrospectively. 34 patients were selected whose maxillary first molars were missed or developmentally delayed unilaterally or bilaterally. Demirjian’ s method was used for estimating dental age, then which was compared to chronologic age of children. Parameters expressing skeletal and dentoalveolar disharmony were checked and compared with control. Additionally, occlusion relationship was evaluated. Maxillary dental age was significantly delayed compared to chronologic age. Several parameters which show skeletal open-bite tendency and skeletal class III malocclusion with maxillary retrusion were statistically significant. Anterior crossbite and edge-bite were expected in most of these cases, but compensation by occlusion and soft tissue was also verified which might mask skeletal class III tendency. Congenital missed or developmentally delayed maxillary first molars might be related with declined growth of maxilla. If developmental disorders of maxillary first molars were verified during clinical examination, careful monitoring of orofacial growth was necessary during puberty and timed orthopedic and orthodontic intervention were considered. 이 연구의 목적은 상악 제1대구치의 결손 또는 발육 지연을 보이는 증례에서 나타나는 악안면 형태를 평가하는 것이다. 2006년부터 2017년 8월까지 부산대학교치과병원 소아치과에 내원한 어린이 2983명의 교정 진단자료를 후향적으로 평가하여 상악제1대구치가 편측 또는 양측으로 결손되거나 발육지연을 보이는 34명을 선정하였다. Demirjian 법을 응용하여 상하악 치령을 추정하고 역령과 비교하였다. 측방두부규격방사선사진 계측을 통해 골격 및 치아치조적 부조화를 반영하는 지표들을 평가하였고, 전치부 교합관계를 확인하였다. 상악 치령은 역령과 비교할 때 유의하게 낮았다. 골격성 개방교합 경향 및 상악 열성장형 골격성 III급 부정교합을 나타내는 지표가통계적으로 유의하였다. 전치부 피개는 반대교합과 절단교합이 주로 나타났지만, 보상에 의해 정상 피개를 보이는 증례도 있었다. 상악 제1대구치의 선천결손 및 발육지연은 상악골의 성장에 영향을 줄 가능성이 있다고 판단되었다. 따라서 제1대구치의 발육장애가 확인될 경우 사춘기 동안의 악안면 성장을 주의 깊게 관찰해야 하며 적절한 시기에 교정치료를 고려하는 것이 필요하다고 사료되었다.

비가역성 이소맹출로 분류된 상악 제1대구치의 맹출 특성에 관한 방사선학적 연구

임엘,이상호,이난영 大韓小兒齒科學會 2009 大韓小兒齒科學會誌 Vol.36 No.4

Ectopic eruption of the maxillary first permanent molar means that the molar erupts out of the normal position and is arrested in its eruption by the second primary molar. This local eruption disturbance results in a premature atypical resorption on the distal part of the second primary molar. In most irreversible cases, the second primary molar is lost prematurely, either by spontaneous exfoliation or by extraction, In cases of doubt as to whether the eruption is of the irreversible type or not, careful radiographic observation period for a few months would be valuable in evaluating the possibilities of the tooth's freeing itself. The purpose of this study was to determine the characteristics and occurrence of the ectopic eruption of the maxillary first permanent molar. A descriptive, observational, retrospective study was done using the radiographs of 25 conseutive patients, who were in the first phase of mixed dentition. A method was designed to evaluate the amount of pathologic resorption of the second maxillary primary molar and the mesial angulation of the first permanent molar. The study showed that the most important etiologic factor was the eruption path or mesial angulation of the first permanent molars relative the chosen reference lines. 이소맹출은 유전적 요인 혹은 여러 가지 국소적 요인에 의해 치아가 비정상적인 위치로 맹출하는 경우를 말한다. 이소맹출이 가장 빈번히 발생하는 치아는 상악 제1대구치로 이를 방치할 경우 인접치의 치근흡수 및 이에 따른 조기탈락으로 영구치 맹출공간 부족을 야기하며, 결과적으로 부정교합을 유발하는 중요한 요인으로 작용한다. 그러나, 치료에 앞서 이소맹출중인 치아가 자발적으로 맹출하기를 기다려볼 것인지 혹은 조기에 치료를 하여 제2유구치의 치근흡수나 탈락을 예방해야 할 것인지에 대한 결정이 선행되어야 한다. 현재 이를 위한 몇몇 진단학적 기준이 제시되고 있으나 학자간 이견이 존재한다. 본 연구에서는 방사선학적 검사를 통해 상악 제1대구치의 이소맹출이 조기 발견된 증례들 중 전방에 위치한 제2유구치의 치근이 흡수되어 비가역적 특징을 보인다고 판단되는 증례에 대해 특별한 처치 없이 주기적인 검진을 통해 자발적으로 해소된 결과를 관찰하였다. 이와 함께 상악 제2유구치 치근흡수의 정도와 상악 제1대구치의 맹출 기울기에 따른 후향적 분석을 통해 상악 제1대구치 이소맹출의 유형을 예측하고자 하였다. 상악 제2유구치의 치근 흡수 정도에 따라 grade I에서 IV로 분류하였고, 파노라마 방사선 사진 상에서 양측 안와의 최하방점을 연결한 수평선과 상악 제1대구치의 근심면을 따라 연결한 수직선을 기준으로 하여 근심각(mesial angle)을 측정하였다. 결과적으로는 상악 제2유구치의 치근 흡수 정도보다 상악 제1대구치의 맹출 기울기가 이소맹출의 유형을 진단하는 데에 있어 더 신뢰할만한 기준이라고 판단할 수 있었다.

상악 제일대구치의 저항중심에 관한 유한요소법적 분석

조정현,이기수,박영국 대한치과교정학회 1993 대한치과교정학회지 Vol.23 No.2

The purpose of this study was to analyse the center of resistance of the maxillary fitst molar using the 3-dimension finite element method. An extracted maxillary first molar of normal shape and average root length was selected and sectioned every 1.5mm parallel to the cementoenamel junction. Each section was traced and digitized to construct 3-D finite element model of the maxillary first molar. After a certain magnitude of counterbalancing moment(M) was applied to the tooth, a varying single force(F) of distomesial direction was applied to a certain point of th tooth until the tooth was translated. The force producing translation(Ft) was substituted to the equation △d=M/Ft to calculate the center of resistance of the maxillary first molar. And reducing the alveolar bone level 1.68mm, and 3.36mm below to the cementoenamel junction, the tooth movement was analysed to see the effect of reducing the alveolar bone level to the location of the center of resistance. The results were as follows ; 1. The center of resistance of the maxillary first molar was 3.72mm apical, 1.10mm buccal, and 0.71mm mesial to the geometric center of the horizontally sectioned surface at the cementoenamel junction. This point was 0.36mm apical, 1.20mm buccal, and 0.71mm mesial to the trifurcation point, indicating that it was not on the tooth root. 2. As the alveolar bone level was reduced, the center of resistance of the maxillary first molar was moved to the apical direction.

Anesthetic efficacies of buccal with palatal injection versus buccal with intra-septal injection in permanent maxillary first molars of pediatric patients

Peecharat Areenoo,Chanika Manmontri,Nattakan Chaipattanawan,Papimon Chompu-inwai,Manop Khanijou,Thongnard Kumchai,Natthamet Wongsirichat 대한치과마취과학회 2022 Journal of Dental Anesthesia and Pain Medicine Vol.22 No.4

The high success rate of dental treatment is dependent on the cooperation of pediatric patients during procedures. Dental treatment often causes pain, particularly in children. The factors in providing treatment to pediatric patients include the characteristics and location of the tooth, profoundness of the anesthesia including the type of local anesthetic, and cooperation of the patient. Previous studies have examined several techniques to successfully achieve profound pulpal anesthesia in maxillary permanent teeth. The dentist should select the injection technique to be used based on patient needs. In children, either buccal with palatal injections or buccal with intra-septal injections may be used to anesthetize the permanent maxillary first molar. Buccal with palatal injections are commonly used prior to routine maxillary dental procedures. Currently, there are only a few studies on the employment of buccal with intra-septal injections to anesthetize permanent maxillary first molars in pediatric patients. This review will focus on efficacy of buccal with palatal versus buccal with intra-septal pulpal anesthesia of the permanent maxillary first molars in pediatric patients and aim to determine which technique should be used during routine dental procedures.