• Journal of Oral Medicine and Pain
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• v.37 no.4
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• pp.213-219
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• 2012

Oral appliances are a primary treatment option for snoring and mild to moderate obstructive sleep apnea (OSA) and are considered as an alternative for patients with severe OSA who have failed continuous positive airway pressure (CPAP) or upper airway surgery. But it is true that OAs have varying degrees of effectiveness depending on different oral appliances and the efficacy of OAs are established in some but not all patients. New oral appliance, which is one of Adjustable Anterior Positioners, was developed by Dept of Oral Medicine, Dental School, Dankook University. This is a report for treating severe OSA patient with a failure of previous uvulopalatopharyngoplasty using a new Adjustable Anterior Positioner, followed by significant success of controlling OSA.

• The korean journal of orthodontics
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• v.28 no.4 s.69
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• pp.547-561
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• 1998

Obstructive sleep apnea (OSA) is a disorder characterized by repetitive episode of upper airway collapse during sleep. Recent studies showed that not only the anatomic factors but the physiologic factors of the upper airway also have effcts on the occurrence of apnea and that the genioglossus muscle also plays an important role in the maintenance of the upper airway. A variety of therapies were performed to treat OSA, and among them the use of mandibular repositioning appliances showed reasonable results. But there is still a lack of research on the structural and physiological mechanism upon the use of mandibular repositioning appliances. The author selected 26(male 17, female 9) OSA patients that came to the Yonsei University Dental Hospital, Department of Orthodontics, and 20 normal adults (male 10, female 10) and took cephalometric radiographs of them in a supine position before and after the placement of the mandibular repositioning appliance to see the structural changes of the upper airway and compare the therapeutic effects between the two groups. We also studied the waking genioglossus muscle activity in OSA patients and investigated the difference in the electromyogram of the genioglosssus muscle upon the change in body posture and the use of mandibular repositioning appliance. Following results were obtained. 1. Among the cephalometric measurements of the upper airway structure, the length of the soft palate, maximum thickness of the soft Palate and SPAS, MAS, VAL, H-H1, MP-H showed statistically significant differences between the normal and OSA groups, but the IAS and EAS showed no statistically significant differences between the two groups. 2. In both the normal and OSA groups, as the epiglottis moved forward on wearing the mandibular repositioning appliance, the epiglottis level of the upper airway increased and the maximum thickness of the soft palate changed and the hyoid bone also moved forward, but the IAS in both groups showed various results and the effect of the mandibular repositioning appliance on the structure of the upper airway was different in the two groups. 3. Upon changing the position, the electromyogram of the genioglossus muscle showed a increasing tendency but there was no statistically significant differences, and when the mandibular repositioning appliance were worn there was a statistically significant increase in the electromyogram of the genioglossus muscle in both the upright and supine positions. The mandibular repositioning appliances not only have an effect on the anatomical structure of the upper airway but also on the physiology of the upper airway. There are different responses to the use of mandibular repositioning appliance between the normal and OSA groups therefore it could be considered to have the different physiology of the upper airway between the two groups.

• The korean journal of orthodontics
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• v.25 no.4
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• pp.375-401
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• 1995

Cause of skeletal Class III malocclusion in growing patients can be classified into maxillary deficiency, mandibular overgrowth, and combination of the two. Use of Protraction Head Gear(P.H.G.) has been recommended for treatment of growing Class III malocclusion patients, for it results in forward & downward movement of maxilla and backward & downward rotation of mandible. Numerous animal experiments were performed and clinical study data have been reported ; nevertheless, studies on soft tissue profile change and comparison of treatment effects among the patients who had undergone treatment are considered to be somewhat insufficient. The author selected 93 patients, who had been diagnosed as skeletal Class III malocclusion with maxillary deficiency and then treated with P.H.G. ; the sample group was divided according to sex, treatment beginning age, palatal suture opening(intraoral appliance), and facial growth pattern. For each group, changing patterns of hard and soft tissue profile observed, and comparision with 20 normal group(Angle's Class I) patients of statistical significance in amount of growth and treatment of hard and soft tissue was done. The following results were obtained. 1. Skeletal, dental, and soft tissue measurements indicated that more growth changes was induced in the sample group that used P.H.G. compared to the growth amount of normal group. 2. No statistical significance was observed in the amounts of maxillary forward movement and mandibular backward & downward rotation depending on treatment beginning age in both sex group. 3. R.P.E. showed more significant maxillary forward movement and less protrusion of upper incisor than La-Li. 4. There was no statistical significance in the amount of maxillary forward movement depending on facial growth pattern. On the other hand, measurements indicating mandibular downward & backward rotation indicated greater change in counterclockwise growth pattern group than the clockwise. 5. Changes in upper and lower lip thicknesses showed a close relationship with positional changes in underlying bone tissue and upper and lower teeth, and upper lip height and nasolabial angle increased and mentolabial angle decreased.

• The korean journal of orthodontics
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• v.27 no.3 s.62
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• pp.373-389
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• 1997

The purpose of this stdudy 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 maxillayy protraction, the maxilla and maxillary dentition moved antero-inferiorly, the mandibld and mandibular dentition moved postero-interiorly and palatal plane rotated antero-superiorly by $0.59^{\circ}$. 2. After maxillary protraction, the soft tissue of upper lip moved antero-interiorly 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 mote inferiorly than posttreatment. 5. The correlation coefficients between the postion of upper and lower incisal edge and that position of lips were high, especially in horizontal change.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.488-495
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• 2001

Treatment of class II malocclusions require distalization of maxillary molars into class I relationship. Intraarch distal molar movement techniques have recently assumed an important role in young patients. In this study, the dental and skeletal effects of the pendulum appliance were evaluated by means of cephalometric radiographs. The samples were consisted of 19 patients: 11 females and 8 males, mean age $11.68{\pm}1.52$ years. Measurements were obtained from cephalometric prior to and the day of removal of the pendulum appliance. Treatment changes were analyzed. The following results were obtain. 1. The pendulum appliance produced $2.94{\pm}1.54mm$ distal molar movement with a mean intrusion of $1.17{\pm}0.97mm$, mean period $18.13{\pm}7.95$ weeks. 2. The anchor tooth was $1.34{\pm}1.40mm$ forward movement and $0.48{\pm}0.99mm$ extrusion, and labial tilting of incisors. 3. The angle between palatal plane and mandibular plane increased significantly. 4. There was no significant difference in according to 2nd molar position. 5. Total movement was consisted of 74% distal movement of 1st molar and 26% forward movement of the anchor tooth.

• The korean journal of orthodontics
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• v.39 no.6
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• pp.362-371
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• 2009

Objective: The purpose of this study was to compare the longitudinal treatment effects of facemask with rapid maxillary expansion (FM/RME) and chincup (CC) therapy followed by fixed orthodontic treatment (FOT) in Class III malocclusion (CIII) patients. Methods: The samples consisted of twenty-one CIII patients who had similar skeletal and dental characteristics before FM/RME or CC therapy and good retention results (Class I molar/canine relationship and positive overbite/overjet) after FOT (Group 1, FM/RME, n = 11; Group 2, CC, n = 10). Lateral cephalograms were taken before (T0) and after FM/RME or CC therapy (T1), and after FOT and retention (T2). Skeletal and dental variables were measured. Mann-Whitney U-test and Wilcoxon signed-rank test were used for statistical analysis. Results: During T0-T1, FM/RME therapy induced forward movement of point A, and labioversion of the upper incisors. Both groups showed posterior repositioning of the mandible. FM/RME resulted in increase of the vertical dimension; however, CC caused an increase in articular angle and decrease in gonial angle. During T1-T2, both groups exhibited forward growth of point A. Group 1 showed forward growth and counterclockwise rotation of the mandible and increase of IMPA; however, Group 2, showed increase of ANS-Me/N-Me and decrease of overbite. Conclusions: The key factor for successful FM/RME and CC therapy and good retention results might be a harmonized forward growth of the maxilla that could keep pace with the growth and rotation of the mandible.

• The korean journal of orthodontics
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• v.34 no.2 s.103
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• pp.109-119
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• 2004

This study aimed at investigating the skeletal, dentoalveolar, and soft tissue changes of Class III malocclusion cases treated by second molar extraction. The lateral cephalograms of 15 subjects with moderate Class III malocclusion by average ANB $-1.4^{\circ}\;and\;IMPA\;85^{\circ}$ were traced and the computerized superimposition of average craniofacial change was made. The data was gathered and statistically analyzed. The results were as follows: 1 Lower anterior facial height/anterior facial height increased by 0.6%(P<0.01), mandibular plane increased by $1.5^{\circ}$(P<0.05). 2. There was a slightly downward & backward rotation of the mandible. 3. Lower first molar tipped distally by 4.nm(P<0.001), lower anterior teeth lingually tipped by $3.2^{\circ}$(P<0.05). 4. Retracted lower lip improved facial profile. This study may suggest that second molar extraction could be effective for a moderate Class III malocclusion to make distalization of the lower first molar easier and avoid severe lingual tipping of the lower incisor, if the lower third molar has a normal shape, good direction of eruption and adequate time for lower second molar extraction

• The korean journal of orthodontics
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• v.26 no.5 s.58
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• pp.523-534
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• 1996

This study was to investigate the horizontal & vertical bone change pattern when using cervical headgear in Class II malocclusion of growing children and compared the skeletal features between the group with increased lower facial height and the group without increase in lower facial height. The results are as follows ; 1. Forward growth of maxilla was inhibited, downward tipping of anterior palatal plane could be seen and distal movement of maxillary first molar was observed. 2. There was relative forward movement of Mandible against the Maxillary cranial base, and relative forward movement of mandibular 1st molar against the Maxilla and vertical increase due to alveolar growth of Mandible. 3. There was significant increase in anterior and posterior facial heights but the ratio of facial height showed no significant difference. 4. The group with increased lower facial height has shorter ramus length, than the smaller palatal plane angle, and more distal movement of Maxillary 1st molar than the group without increase Ha-young Hyun

• The korean journal of orthodontics
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• v.28 no.4 s.69
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• pp.533-546
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• 1998

A Skeletal Class III malocclusion may be the result 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, SNA 1 and SNA 2 group, SNB 1 and SNB 2 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 plane 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 mast 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 less 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.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.4
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• pp.652-661
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• 2008

The purpose of this study was to evaluate the skeletal and dental effects obtained by the Frankel functional regulator III in growing children with Class III malocclusions. Cephalometric changes in thirty children at the time of mixed dentition malocclusions (initial mean age, $7.9{\pm}1.1$ years; mean treatment duration, $1.5{\pm}0.8$ years) were analysed. The results were as follows : 1. The skeletal effects on the maxilla showed a significant downward displacement whereas forward displacement was not significant in comparison with the control group. 2. The skeletal effects on the mandible showed statistically significant backward and downward displacement. 3. The dental effects showed statistically significant backward movement in the mandibular incisor tip and increase of overjet The results suggested that forward displacement on the maxilla was insufficient and treatment effects were caused mainly by downward displacement of the maxilla, backward and downward rotation of the mandible, and the increase of overjet during short period.