골격성 III급 부정교합자의 수직적 안면골격형태와 교합평면과의 관계

Interrelationships between occlusal plane angle and vertical skeletal patterns of skeletal Class III malocclusion individuals

  • 정우준 (부산대학교 치과대학 치과교정학교실) ;
  • 손우성 (부산대학교 치과대학 치과교정학교실) ;
  • 김용덕 (부산대학교 치과대학 구강악안면외과교실) ;
  • 김성식 (부산대학교 치과대학 치과교정학교실)
  • Jung, Woo-Joon (Department of Orthodontics, School of Dentistry, Pusan National University) ;
  • Son, Woo-Sung (Department of Orthodontics, School of Dentistry, Pusan National University) ;
  • Kim, Yong-Deok (Department of Oral & Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Kim, Seong-Sik (Department of Orthodontics, School of Dentistry, Pusan National University)
  • 발행 : 2007.08.30

초록

본 연구는 악교정 수술을 필요로 하는 골격성 III급 부정교합자의 두개안면형태와 교합평면이 어떤 관련성을 가지고 있는 지를 알아보기 위하여 악교정 수술을 시행하기로 계획된 골격성 III급 부정교합자 90명의 초진 시 측모 두부 방사선계측사진을 대상으로 연구를 하였다. 전치부 피개량에 따라서 positive overbite (PO) group, edge to edge bite (EO) group, negative overbite (NO) group의 세 군으로 분류를 하였으며, 각 군의 골격관계와 상하악 제1소구치와 제1대구치의 교두의 접촉점을 연결한 기능교합평면과의 관계에 대한 항목을 계측하여 상관관계 분석과 회귀 분석을 시행하였다. 연구 결과, 각 군 간의 분류와 상관없이 전치부 피개 교합의 변화에 대해서 saddle angle, articular angle, Y axis, AFH, SN-FH, SN-Mn, FH-Mn 항목이 유의성 있는 차이를 보였다. 특히, 상악 전치부는 기능교합평면에 대한 각도에서 유의성 있는 차이를 보였으며, 하악 전치부는 FH 평면에 대한 각도에서 각 군 간에 유의성 있는 차이를 보였다. 안면 골격 계측 항목과 상하악골에 대한 기능교합평면의 각도 항목들과의 상관관계에서는, 상하악골의 이개 정도를 나타내는 Mx-Mn 항목이 모든 군에서 유사한 정도로 기능교합평면 각도와 가장 높은 상관관계를 보였다. 이를 이용하여 Mx-Mn 항목의 변화에 따라서 FH-Occ, Mx-Occ, Mn-Occ 항목이 어느 정도의 변화를 일으키는지를 알아보고자 회귀분석을 시행한 결과, 결정계수가 각각 0.714, 0.560, 0.677로 나타났다. 따라서 본 연구를 통해서 골격성 III급 부정교합자의 기능교합평면의 형성은 상하악골의 골격적인 수직이개 정도와 깊은 관련성이 있음을 알 수 있었다.

The purpose of this study was to evaluate the relationships between the occlusal plane angle and craniofacial skeletal pattern in relation to anterior overbite. Methods: Lateral cephalograms of 90 adults with skeletal class III malocclusions were traced and measured to analyze skeletal factors and occlusal plane angles. In terms of anterior overbite, all patients were classified into 3 subgroups of positive overbite, edgebite, and negative overbite groups. All measurements were evaluated statistically by ANOVA and Duncan's Post Hoc, and correlation coefficients were evaluated among measurements. Results: In this study, some skeletal measurements (saddle angle, articular angle, Y axis, AFH, SN-FH, SN-Mn, FH-Mn) showed a significant difference among the 3 groups in relation to overbite changes. Correlation coefficient showed that PFH/AFH, SN-Mn, Mx-Mn, and FH-Mn showed a significant difference with FH-Occ, Mx-Occ, and Mn-Occ. Regression analysis showed that Mx-Mn had a determination coefficient of 0.714, 0.560, and 0.677 in relation to FH-Occ, Mx-Occ, and Mn-Occ, respectively. Conclusion: This study suggests that consideration of the occlusal plane in relation to the maxillomandibular vertical skeletal state enable the establishment of a more predictable orthognathic surgery result.

키워드

참고문헌

  1. Worms FW, Speidel TM, Bevis RR, Waite DE. Posttreatment stability and esthetics of orthognathic surgery. Angle Orthod 1980;50:251-73
  2. Tompach PC, Wheeler JJ, Fridrich KL. Orthodontic considerations in orthognathic surgery. Int J Adult Orthodon Orthognath Surg 1995;10:97-107
  3. Rosen HM. Occlusal plane rotation: aesthetic enhancement in mandibular micrognathia. Plast Reconstr Surg 1993;91:1231-40 https://doi.org/10.1097/00006534-199306000-00007
  4. Wolford LM, Chemello PD, Hilliard FW. Occlusal plane alteration in orthognathic surgery. J Oral Maxillofac Surg 1993;51:730-40 https://doi.org/10.1016/S0278-2391(10)80410-0
  5. Wolford LM, Chemello PD, Hilliard F. Occlusal plane alteration in ortbognathic surgery--Part I: Effects on function and esthetics. Am J Ortbod Dentofacial Ortbop 1994;106:304-16 https://doi.org/10.1016/S0889-5406(94)70051-6
  6. Chemello PD, Wolford LM, Buschang PH. Occlusal plane alteration in orthognathic surgery--Part II: Long-term stability of results. Am J Orthod Dentofacial Ortbop 1994;106:434-40 https://doi.org/10.1016/S0889-5406(94)70066-4
  7. Enlow DH, Kuroda T, Lewis AB. Intrinsic craniofacial compensations. Angle Orthod 1971;41:271-85
  8. Schudy FF. Cant of the occlusal plane and axial inclinations of teeth. Angle Orthod 1963;33:69-82
  9. Schudy FF. The rotation of the mandible resulting from growth: its implications in ortbodontic treatment. Angle Orthod 1965;35:36-50
  10. Thayer TA. Effects of functional versus bisected occlusal planes on the Wits appraisal. Am J Orthod Dentofacial Orthop 1990;97:422-6 https://doi.org/10.1016/0889-5406(90)70114-R
  11. Di Paolo RJ. An individualized approach to locating the occlusal plane. Am J Orthod Dentofacial Orthop 1987;92:41-5 https://doi.org/10.1016/0889-5406(87)90294-0
  12. Subtelny JD, Sakuda M. Open-bite; diagnosis and treatment. Am J Ortbod 1964;50:337-58 https://doi.org/10.1016/0002-9416(64)90175-7
  13. Hyun SW. Individualized reconstruction of the lower occlusal plane according to skeletal pattern. Korean J Ortbod 1995;25:465-85
  14. Hwang CJ, Lim SA. A study of the postoperative stability of occlusal plane in orthognathic patients depending on the difference of occlusal plane. Korean J Orthod 1998;28:237-53
  15. Hwang CJ, Lim SA, Moon JL. A study on the postoperative stability of hard tissue in orthognathic surgery patients depending on the difference of occlusal plane. Korean J Orthod 1999;29:239-49
  16. Kim SS, Park JU, Son WS. A study of morphology of mandibular symphysis and location of lower incisor under the influence of the craniofacial skeleton in skeletal Class III malocclusion. Korean J Orthod 1998;28:763-74
  17. Yang WS. Morphology of mandibular symphysis and positioning of lower incisors in the skeletal Class III malocclusions. Korean J Orthod 1985;15:149-53
  18. Kim SD, Kwon OW, Sung JH. The relationship between the morphology of mandibular symphysis and the craniofacial morphology in Class III malocclusion. Korean J Orthod 1996;26:509-22
  19. Ahn HS, Kim SS, Son WS. A study on the morphological changes of lower incisor and symphysis during surgical-orthodontic treatment in skeletal Class III malocclusion. Korean J Orthod 2002;32:361-73
  20. Dawson PE. Evaluation, Diagnosis, and Treatment of Occlusal Problems, 2nd ed. St Louis: Mosby; 1989. p.85-91
  21. Dawson PE. Evaluation, Diagnosis, and Treatment of Occlusal Problems, 2nd ed. St Louis: Mosby; 1989. p.88
  22. Bjork A, Skieller V. Facial development and tooth eruption. An implant study at the age of puberty. Am J Orthod 1972;62:339-83 https://doi.org/10.1016/S0002-9416(72)90277-1
  23. McNamara JA Jr. A method of cephalometric evaluation. Am J Orthod 1984;86:449-69 https://doi.org/10.1016/S0002-9416(84)90352-X
  24. Shin SJ, Hwang BN, Lee JK, Rhee SH. Postoperative stability and occlusal plane alternation by orthognathic surgery of skeletal Class III malocclusion with anterior open bite. Korean J Orthod 1999;29:113-27
  25. Lee YJ, Sohn BW. A study on the postoperative stability of occlusal plane in Class III orthognathic surgery patients. Korean J Orthod 2000;30:643-55