• 대한치과교정학회지
• /
• 제39권2호
• /
• pp.72-82
• /
• 2009

본 연구는 골격성 III급 개방교합자의 악교정 수술 전, 후 설골과 상기도의 변화를 3D-CT를 이용하여 관찰하고 이를 정상교합자와 비교하기 위하여 시행하였다. 전치부 개방교합을 동반한 골격성 III급 부정교합으로 진단되어 악교정 수술을 받은 환자 중 12명을 선정 후, 3D-CT를 통해 설골과 상기도의 3차원 입체영상을 분석하여, 악교정 수술 전, 후의 설골의 위치 변화 및 상기도의 부피 변화를 살펴보고, 이의 결과를 정상교합자 10명과 비교하였다. 설골은 골격성 III급 개방교합군에서 악교정 수술 전에 정상교합군의 설골에 비해 전방에 위치하고 있었고 악교정 수술 후 설골은 후, 상방으로 변화하였으나 유의성은 관찰되지 않았다. Hyoid plane과 mandibular plane이 이루는 각은 악교정 수술전의 골격성 III급 개방교합군이 정상교합군보다 큰 값을 나타내었고, 악교정 수술 후에는 그 차이가 더욱 증가하였다. 골격성 III급 개방교합군의 상기도 부피는 정상교합자보다 작으며 이는, 악교정수술 후에 더욱 감소하였다. 3차원 영상 분석 결과, 골격성 III급 개방교합자의 상기도는 정상교합자에 비해 좁으며, 하악골 후퇴술 이후 더욱 감소하기 때문에 이는 수술적 개선의 안정성에 영향을 줄 수 있음을 알 수 있었다.

• 대한치과교정학회지
• /
• 제19권3호
• /
• pp.147-160
• /
• 1989

Long face patients are characterized by excessive anterior facial height, lip incompetence at rest, anterior open bite, and gummy smile. A major problem is an inferior rotation of the posterior maxilla and upper molars. Long face patients have been the most difficult for orthodontist to treat successfully. In growing patients, the methods for impeding excessive vertical growth have been used high pull head gear, functional appliance, and combined type of two. One significant improvement comes from using a full arch splint to deliver force to the maxilla more vertically. In adult patients, orthodontic camouflage treatment is biomechanically difficult and doesn't work when the problem is primarilly vertical. Surgical maxillary impaction provides a means for successfully treating most of problems. Also, superior reposition of the chin via a mandibular inferior border osteotomy is effective in decrease of lower anterior facial height and correction of the poor chin-lip balance. Post-surgical stability and the physiologic response are good. The coordinated orthodontic and surgical treatment is necessary for solution the difficult skeletal deformity.

• Journal of Oral Medicine and Pain
• /
• 제31권3호
• /
• pp.255-263
• /
• 2006

임상적으로 비정복성 관절원판전위로 진단된 3명의 환자에서 이들은 모두 물리치료, 약물치료만이 행해진 환자로 내원 중에 갑작스런 교합변화 및 전치부 개교합을 나타내었다. 종래에 알려진 개교합의 발생은 류마티즘 관절염이나 양측과두의 심한 퇴행성 변화가 있는 경우에 상당한 과두지지의 상실로 후방지지를 잃게 되어 구치들이 과도하게 접촉하고 전치 개교합이 발생될 수 있는 것은 이미 잘 알려진 사실이나, 과두지지의 상실이 없는 비정복성 관절원판전위만으로 특정 환자에서는 개교합의 발생이 가능하며 이는 구치부 치아의 증출에 의한 전치부 개교합이라 볼 수 없으며, 하악의 후하방 회전의 결과로 볼 수 있다. 이들 3환자들의 전체적인 골격적 특징은(1)구치부 앵글씨 1급 교합관계와 천피개 교합,(2)높은 하악하연각,(3)높은 하악각 등으로 봐서 상하악의 골격적 형태가 II급과 III급에 관계없이 수직적 성장이 강한 안모형태에서 갑작스런 개교합이 발생될 수 있으리라 생각된다. 앞으로 개교합이 발생되는 관절원판전위 환자에서 하악의 후하방 회전의 원인을 밝히고, 이러한 골격적인 특징이 측두하악장애의 원인 인자가 될 수 있는 지 더 많은 연구가 필요하리라 생각된다.

• 대한치과교정학회지
• /
• 제34권4호
• /
• pp.289-301
• /
• 2004

It is the purpose of this study to characterize oral symptoms and to comprehend the cause and the relapse possibility of patients with open bite. This case study examines the orthodontic treatment of a group of female patients with open bite and Angle's Class I malocclusion. A cephalograph of the patient was taken and tracing of the radiograph was completed. In addition to Bjork and Ricketts analysis, additional measurements of specific areas were taken. The occlusal plane was determined by drawing a line connecting the mesiobuccal cusp tip of the maxillary first molar and the incisal edge of the maxillary central incisors. Patients were divided into two groups depending on the relationship between the marginal ridge of the maxillayy first premolar and the drawn line. Those patients with marginal ridges above the occlusal plane were placed into Group 1, while Group 2 subjects exhibited marginal ridges lower than the occlusal plane. The common characteristics within each group and the characteristic differences between each group both prior to and after orthodontic treatment were examined, and finally, the functional oral volume of each patient was analyzed. The results of the case study were as follows: 1. An examination of the skeletal relationship and anatomical form for both Group 1 and 2 showed that all subjects exhibited hyperdivergent skeletal forms, but Group 2 subjects generally demonstrated underdevelopment of the mandible and a smaller articular angle, resulting in an anterior positioning tendency of the mandible. 2. An analysis of the maxillary arches of Group 1 subjects prior to and after orthodontic treatment showed that the antero-inferior direction had changed to an antero-superior directional tendency, while the maxillary arches of the Group 2 patients showed a trend from an antero-superior direction to an antero-inferior relationship. The mandibular arches in both groups showed a change to an antero-superior direction. 3. Functional space analysis showed that Group 2 patients exhibited a greater tendency of haying palatal planes that drop in a postero-inferior direction, resulting in a more severe open bite than their Group 1 counterparts. The results of this case study show that although patients belonging to either Group 1 or 2 exhibited few external differences in the appearance of open bite, an examination of the dental and skeletal relationships by analyzing patient cephalographs showed that patients presenting with flat maxillary occlusal planes exhibited more severe open bite relationships than patients with curved occlusal planes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제29권2호
• /
• pp.95-101
• /
• 2003

The purpose of this study was to evaluate the patterns of skeletal changes of proximal and distal segments after one jaw surgery and two jaw surgery with posterior impaction using SSRO on mandible in order to determine the skeletal origin of relapse and compare the stability of surgical methods in anterior open bite. The points and lines from lateral cephalometrics were measured before, after surgery, and at least 6-month follow up period. And then, the positional change of the proximal and distal segment were evaluated respectively. The results obtained were as follows; In cases of two jaw surgery, the results were stabler because they had less relapse factors. In cases of one jaw surgery, the value of APD were increased but it didn't relapse to the original value. Both of proximal and distal segments were responsible for the relapse tendency. But in one jaw surgery, the rotation of proximal segment was more responsible, and in two jaw surgery, the rotation of distal segment was.

• 대한치과교정학회지
• /
• 제42권3호
• /
• pp.144-154
• /
• 2012

This article reports the orthodontic treatment of a patient with skeletal mandibular retrusion and an anterior open bite due to temporomandibular joint osteoarthritis (TMJ-OA) using miniscrew anchorage. A 46-year-old woman had a Class II malocclusion with a retropositioned mandible. Her overjet and overbite were 7.0 mm and -1.6 mm, respectively. She had limited mouth opening, TMJ sounds, and pain. Condylar resorption was observed in both TMJs. Her TMJ pain was reduced by splint therapy, and then orthodontic treatment was initiated. Titanium miniscrews were placed at the posterior maxilla to intrude the molars. After 2 years and 7 months of orthodontic treatment, an acceptable occlusion was achieved without any recurrence of TMJ symptoms. The retropositioned mandible was considerably improved, and the lips showed less tension upon lip closure. The maxillary molars were intruded by 1.5 mm, and the mandible was subsequently rotated counterclockwise. Magnetic resonance imaging of both condyles after treatment showed avascular necrosis-like structures. During a 2-year retention period, an acceptable occlusion was maintained without recurrence of the open bite. In conclusion, correction of open bite and clockwise-rotated mandible through molar intrusion using titanium miniscrews is effective for the management of TMJ-OA with jaw deformity.

• 대한치과교정학회지
• /
• 제21권3호
• /
• pp.685-699
• /
• 1991

The purpose of this report is to review vertical dysplasia such as openbite or deep bite in skeletal Class III malocclusion and their treatment modality and to present two cases treated with MEAW. The results obtained were as follows A. Open bite case 1. The treatment time was 3 year 8 months. 2. Upper and lower incisors showed extrusion and especially lower anterior alveolar process showed remodelling. 3. The mesially inclined upper and lower molars were uprighted and especially lower first molars showed extrusion that means remodelling of alveolar bone. 4. Normal overbite and overjet were established. 5. Mandible showed slight clockwise rotation. 6. Maxilla showed slight downward bending of ANS part. 7. Upper lip showed downward drop and lower lip showed retraction and touch between upper and lower lip was established. 8. Tongue posture of post-treatment was more raised than pretreatment. B. Deep bite case 1. The treatment time was 1 year 8 months. 2. Upper incisors showed intrusion and labioversion and lower incisors showed slight intrusion and linguoversion. 3. The lower molars showed distal uprighting and intrusion and upper molars showed mesial movement and extrusion. 4. Normal overbite and overjet were established. 5. Maxilla did not show downward movement. 6. Mandible showed slight clockwise rotation. 7. Lower lip showed retraction and downward drop and upper lip showed downward drop.

• 대한소아치과학회지
• /
• 제32권2호
• /
• pp.229-235
• /
• 2005

흡지벽, 수직적인 골격 발육부전 등 여러 원인을 갖는 개방교합은 치아와 치조돌기에 국한되어 있는 단순 개방교합, 수직골격 발육부전에 의한 골격성 개방교합인 복잡 개방교합으로 나눌 수 있다. 단순 개방교합은 흡지벽, 농설벽 등 국소적 원인에 의하며 치조돌기의 수직적 발육결여와 상하악 잔치의 맹출 장애 등의 특징을 보인다. 농설벽은 혀가 상하악 전치 사이에 위치하고 혀의 주변부위가 구치부 교합면 사이에 놓이지 못하게 됨으로써 구치부 과맹출에 의한 전치부의 개방교합과 상악전치의 전돌을 가속화하게 된다. 악습관에 의한 개방교합을 가진 어린이에서는 습관을 없애주는 것이 개방교합을 치료하는 가장 좋은 방법일 것이다. 그리고 Hawley type 장치에 crib을 첨가하거나 oral screen을 장착시켜 농설벽을 치료할 수 있다 그리고 근기능요법은 동기유발과 혀의 기능을 조절하고 입술운동을 통해 새로운 연하운동을 발전시키도록 훈련하여 부정교합을 교정하거나 개방교합의 재발을 방지한다. 본 증례는 농설벽에 의한 개방교합을 가진 8세 여자 환자에서 탄성고무, 빨대를 이용한 연하연습과 발음연습을 포함한 근 기능요법과 습관제거장치를 이용해 습관의 중지 및 개방교합의 개선을 얻었기에 보고하는 바이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제30권1호
• /
• pp.25-33
• /
• 2004

The purpose of this study was to evaluate the postoperative stability of the severe open bite or mandibular prognathic patients after mandibular set back surgery by Obwegeser II method. There were 19 patients who had been undergone Obwegeser II method. The horizontal and vertical position of the cephalometric points were measured preoperation and immediate postoperation, postoperative 1 month, postoperative 6 months ; were analyzed by linear measurement to evaluate changes in skeletal landmark and the relapse was compared between open bite group and prognathism group. By the operation, horizontal change of B was $6.84{\pm}4.35mm$ and vertical change of B was $6.28{\pm}3.25mm$ in open bite group and horizontal change of B was $14.20{\pm}4.81mm$ and vertical change of B was $1.99{\pm}2.66mm$ in prognathism group, horizontal change of Pog was $3.82{\pm}5.71mm$ and vertical change of Pog was $5.38{\pm}2.11mm$ in open bite group and horizontal change of Pog was $13.24{\pm}5.99mm$ and vertical change of Pog was $1.91{\pm}0.94mm$ in prognathism group. Between immediate postoperation and postoperative 1 month, all skeletal landmarks change was no statistical difference (p>0.05) and there were no statistical difference between open bite group and prognathism group except x-Me landmark (p>0.05). Between postoperative 1 month and 6 months, horizontal change of B was $0.12{\pm}1.35mm$ and vertical change of B was $1.47{\pm}1.48mm$ in open bite group and horizontal change of B was $1.43{\pm}1.35mm$ and vertical change of B was $0.82{\pm}1.99mm$ in prognathism group, horizontal change of Pog was $0.13{\pm}1.40mm$ and vertical change of Pog was $0.88{\pm}1.71mm$ in open bite group and horizontal change of Pog was $1.08{\pm}1.74mm$ and vertical change of Pog was $0.47{\pm}1.57mm$ in prognathism group (p>0.05) and there were no statistical difference between open bite group and prognathism group (p>0.05). Between immediate postoperation and postoperative 6months, horizontal change of B was $0.24{\pm}1.17mm$ and vertical change of B was $1.87{\pm}1.63mm$ in open bite group and horizontal change of B was $1.54{\pm}1.55mm$ and vertical change of B was $1.04{\pm}1.96mm$ in prognathism group, horizontal change of Pog was $0.91{\pm}1.46mm$ and vertical change of Pog was $1.18{\pm}2.05mm$ in open bite group and horizontal change of Pog was $0.96{\pm}1.62mm$ and vertical change of Pog was $1.23{\pm}2.35mm$ in prognathism group (p>0.05) and there were statistical difference between open bite group and prognathism group in x-B, x-Pog, x-Gn, x-Me (p<0.05). Obwegeser II method is considered as one of the best operation when surgical correction of severe open bite or severe mandibular prognathism is needed.

• 대한치과교정학회지
• /
• 제46권4호
• /
• pp.199-211
• /
• 2016

Objective: Given the considerable disagreement between the Peer Assessment Rating (PAR) index and the American Board of Orthodontics Cast-Radiograph Evaluation, we aimed to develop a novel assessment system-the Improvement and Completion of Outcome (ICO) index-to evaluate the outcome of orthodontic treatment. Methods: Sixteen criteria from 4 major categories were established to represent the pretreatment malocclusion status, as well as the degree of improvement and level of completion of outcome during/after treatment: dental relationship (arch length discrepancy, irregularity, U1-SN, and IMPA); anteroposterior relationship (overjet, right and left molar position, ANB); vertical relationship (anterior overbite, anterior open-bite, lateral open-bite, SN-MP); and transverse relationship (dental midline discrepancy, chin point deviation, posterior cross-bite, occlusal plane cant). The score for each criterion was defined from 0 or -1 (worst) to 5 (ideal value or normal occlusion) in gradations of 1. The sum of the scores in each category indicates the area and extent of the problems. Improvement and completion percentages were estimated based on the pre- and post-treatment total scores and the maximum total score. If the completion percentage exceeded 80%, treatment outcome was considered successful. Results: Two cases, Class I malocclusion and skeletal Class III malocclusion, are presented to represent the assessment procedure using the ICO index. The difference in the level of improvement and completion of treatment outcome can be clearly explained by using 2 percentage values. Conclusions: Thus, the ICO index enables the evaluation of the quality of orthodontic treatment objectively and consecutively throughout the entire treatment process.