• Journal of Oral Medicine and Pain
• /
• v.14 no.1
• /
• pp.57-66
• /
• 1989

66 patients with temporomandibular disorders were selected for experimental group, and 45 normal subjects who were Dental students were selected for control group. Average age of experimental group was 30.5 years, Male to Female ratio was 2 : 3, and their age distribution were teen-ages to seventh decades. Transcranial radiography (TR) with Denar Accurad 100 was used for each group to get the values of width in joint spaces and to investigate the bony changes of articular surfaces and relative condylar position to articular fossa. In addition to TR, clinical interview and routine charting about amount of mandibular movements and occlusal variations were carried out in experimental group. The obtained results were as follows : 1. The mean values of joint space with in control group were 2.15mm to anterior, 2.98mm to superior and 2.29mm to posterior and the value of relative condylar position to the deepest portion of articular fossa was 0.21mm to anterior. In experimental group, those values were 2.01mm, 2.14mm 2.22mm and 0.12mm to posterior in sequence, respectively. Joint spaces in experimental group, therefore, were inclined to decreased, and relative condylar position was inclined to retrude. Joint space in control group showed symmetric condylar position, but in experimental group showed asymmetry. 2. Non-affected joints with no bony changes in experimental group showed the narrowest joint spaces which were thought to manifest the abnormal stress to non-affected side to dysfunctional state of contralateral affected joints. 3. Amount of mandibular movements in experimental group were within normal values in lateral movements and in protrusive movement but in opening movement with or without passive stretch, those were lower than normal values. Frequency of occlusal variation, for example, protrusive posterior contacts, open bite, median line shift to lateral side were inclined to increase with bony changes and with crepitus.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.26 no.2
• /
• pp.115-131
• /
• 2000

In the study of craniofacial deformity, it is very important that identifying the factor which can affect the morphology and which is closely related to the morphology, because it can not only improve the comprehension of growth and developmental process but also be applied in growth prediction and treatment modality. Several investigators have already mentioned the characterstics of head posture and airway space in relations to morphologic difference. But it is very meaningful work in clarifying the correlation between morphology, head posture and airway space that observing the change of head posture after morplologic change caused by operation and the change of airway space after same procedure. To investigate above correlation, I selected normal group which is consisted of 43 adults and mandibular prognathism group which is consisted of 47 adults who had been operated by sagittal split ramus osteotomy and were followed up more than 1 year. With their lateral skull radiograghs, reference lines which can evaluate each measuring points and areas without effect of postural change were first determined. And using above reference lines, change of airway space, positional change of tongue and hyoid, change of cranial and cervical angulations were measured. The results obtained from the study were as follows 1. In the change of head posture, the position of tongue and hyoid neighboring to pharynx is more closely related to the reference line of cervical column than to reference line of cranium. 2. After mandibular setback operation, the airway dimension was decreased to 81.6% of preoperative state at 1 month postoperatively and was slightly increased to 89.7% at 1 year postoperatively. 3. Posterior movement of tongue plays important role in decrease of airway dimension and inferior movement of hyoid was closely correlated with posterior movement of tongue. 4. Postoperative anterior movement of mandible, namely, morphologic relapse had correlation with relapse phenomenon of airway dimension. 5. Craniocervical angulation increased postoperatively. Especially in the postoperative early state, there was increased foreward inclination of cervical angulation rather than increase of cranial angulation. But at postoperative 1 year it was observed that cervical inclination was returned to preoperative state and cranial angulation was increased gradually. 6. Increase rate of airway dimension was correlated with the increase of cranial angulation from postoperative 1 month to 1 year. In conclusion, relapse tendency of airway dimension following increase of cranial angulation was found after mandibular setback operation and it is considered that increase of cranial angulation is one of compensatory mechanism in airway maintenance.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.12 no.2
• /
• pp.9-20
• /
• 1990

A series of 19 cases with maxillary hyperplasia and mandibular retrognathia were operated on by simultaneous superior repositioning of the maxilla after Le Fort I osteotomy and anterior repositioning of the mandible after bilateral sagittal split ramus osteotomies with or without osteotomy of the inferior border of the mandible. These were evaluated by retrospective cephalometric and computer analysis for the longitudinal skeletal and dental changes for an average of 17.1 months after surgery. For stabilization of the osteotomized segments, the authors used wire osteosynthesis by means of bilateral infraorbital and zygomatic buttress suspension wire at the maxilla, and direct interosseous wire at the split segments of the mandibular rami. Results show generally good stability after simultaneous maxillary and mandibular surgery with wire osteosynthesis, and a minimal to moderate tendency toward skeletal and dental relapse. This article is a preliminary study to defy the efficiency of the wire osteosynthesis (wo)compared with rigid internal fixation (RIF) for simultaneous maxillary and mandibular surgery. 1. The vertical relapse rate of the A point after superior repositioning of the maxilla is 2.2%. 2. The horizontal relapse rate of the B point after advancement of the mandible is 18.3%. 3. The condyle is distracted inferiorly and slightly posteriorly at the immediate postoperative period. 4. At the long term follow up examination, the condyle presents tendency of return to the preoperative position. 5. Condylar segment angle is decreased at the immediate postoperative period, and at the long term follow up evaluation, the angle is increased. 6. Gonial angle is increased at the immediate postoperative period, and then is decreased at the long term follow up evaluation. 7. The dentition is satisfactory with acceptable movement at the long term follow up evaluation. 8. At the mandibular free body analysis, genioplasty shows good stability. 9. Wire osteosynthesis provides excellent stabilization for the simultaneous maxillary and mandibular surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.26 no.2
• /
• pp.164-171
• /
• 2000

Purpose : This study was aimed at measuring the changes in the hyoid bone position, tongue position, and pharyngeal airway space in subjects with mandibular setback osteotomies. Methods : Twenty patients were evaluated retrospectively for their changes in pharyngeal airway space, tongue and hyoid bone positions. All patients underwent surgical mandibular setback using bilateral sagittal split osteotomies. The cephalometric analysis was performed preoperatively, and 1 week, 3-6 months, and 1 year postoperatively. Result : The hyoid bone moved inferiorly and posteriorly immediately after surgery, and it returned to the preoperative position during follow-up period. The nasopharyngeal airway space was not significantly changed after surgery. A considerable decrease in the oropharyngeal and hypopharyngeal airway spaces following mandibular setback surgery was found. The upper and lower tongue was posteriorly repositioned immediately after surgery. During follow-up period, the hypopharyngeal airway space and lower tongue posture returned to the preoperative positions, but the oropharyngeal airway space and upper tongue posture were not significantly changed. The position of pogonion remarkably changed to backward immediately after surgery, but slightly anterior advancement was found during follow-up period. Conclusion : Immediately after mandibular setback surgery, the oropharyngeal and hypopharyngeal airway spaces obviously decreased due to posterior and inferior repositions of the tongue and hyoid bone. During follow-up period, lower tongue and hyoid bone returned to the preoperative positions, it was related to advancement of the pogonion in this period. The narrowing of the oropharyngeal airway space and posterior movement of the upper tongue posture were relatively permanent after mandibular setback surgery. We suspected this phenomenon had an influence on maintaining the total volume of oral cavity against mandibular setback.

• The korean journal of orthodontics
• /
• v.30 no.4 s.81
• /
• pp.387-398
• /
• 2000

This study was aimed to observe the effect of Anterior J hook headgear on the craniofacial structures in mixed dentition with Class II malocclusion. The laterial cephalograms of 20 children treated by Anterior J hook headgear were traced, digitized and statistically analyzed. The results were as follows : 1. Forward growth of maxilla was inhibited. 2. Rotational effect of maxilla was not observed. 3. There was distal movement of maxillary dentition. 4. Maxillarly_dentoalveolar growth changes were more effective in anterior portion than posterior portion. 5. Mandible maintained a normal growth and mandibular plane angle was maintained during treatment period. 6. The ratio of anterior facial height to posterior facial height was almostly not changed.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.17 no.2
• /
• pp.171-179
• /
• 1995

The conservative treatment of the condylar fracture has been used for a long time because of its simplicity, good prognosis and less complication. Traditionally the conservative treatment has been carried out by maxillomandibular fixation using arch bar and wire. But a simplified technique of maxillomandibular fixation introduced here is a procedure that 4 bone screws are placed above the apecies of the maxillary and mandibular canines and then ipsilaterally placed maxillary and mandibular bone screws are linked by a loop of wire each other. This procedure has several advantages compared with the traditional maxillomandibular fixation method. 1) it provides simplicity for the operators. 2) it sustains maxillomandibular fixation more rigidly compared with arch bar technique. 3) it keeps stable maxillomandibular fixation in the region of the anterior teeth so that anterior open bite tendency can be remarkably minimized. 4) it does not injure the periodontal tissue because the teeth are not engaged and causes less discomfort to the patient. 5) it decreases the possibility of operator's AIDS infection through inadvertent skin puncture. 6) it is highly recommended for the patients whose teeth are available for maxillomandibular fixation. The two male patients were diagnosed as bilateral condylar and symphyseal fracture of the mandible. They restored stable occlusion and functional mandibular movement only by a simplified technique of maxillomandibular fixation.

• The Journal of Korean Academy of Prosthodontics
• /
• v.18 no.1
• /
• pp.73-86
• /
• 1980

Recently, the controversy continues as to whether maximum intercuspation of teeth should occur at the terminal hinge position(the condylar theory) or at the myo-co(the neuromuscular theory). There is also much controversy regarding the antero-posterior position of myo-co. The object of this study was to measure and compare with the positional relations of centric relation, centric occlusion and myo-co, and free-way space using Mandibular Kinesiograph and Myo-monitor in the 40 subjects without stomatognathic problems. Mandibular Kinesiograph(M.K.G.) was originally conceived as a research instrument to track mandibular movement and position. As its use in research progressed, its great diagnostic value became apparent in case by case. And Myo-monitor was developed as a means of applying the neuromuscular approach to occlusion. Thus the Myo-monitor technique is an intra-systemic approach to occlusal positioning using patient's own musculature, and Myo-monitor is used to relax the musculature by a light myopulse induced electronically. From this experiment, the following results were obtained. 1. The adaptive free-way space before muscle relaxation was an average of $1.6{\pm}60mm$, and the true free-way space after muscle relaxation using Myo-monitor was an average of $2.4{\pm}0.74mm$. 2. It took an average of $25{\pm}3.11$ minutes to relax the mandibular musculature by Myo-monitor and administration of 5mg. Diazepam and an average of $38{\pm}4.73$ minutes by Myo-monitor without administration of Diazepam. 3. Myo-co existed anterior to centric occlusion, with an average of $0.53{\pm}0.31$ mm, and centric relation existed posterior to centric occlusion, with an average of $0.57{\pm}0.58mm$ before muscle relaxation and with an average of $0.57{\pm}0.43mm$ after muscle relaxation. 4. Centric relation coincided with centric occlusion in 5 of 40 subjects(12.5%), and posterior to centric occlusion in the rest of cases (87.5%). 5. Myo-co existed anterior to centric occlusion in 38 of 40 subjects(95%), except 1 subject that coincided with centric occlusion and 1 subject that existed posterior to centric occlusion. 6. Myo-co and centric relation existed inferior to centric occlusion and the lateral displacement was various with individual difference. 7. The total displacement from centric occlusion to centric relation was an average of $0.74{\pm}0.64mm$ before muscle relaxation, and an average of $0.68{\pm}0.53mm$ after muscle relaxation, and the total displacement from centric occlusion to myo-co was an average of $1.07{\pm}0.58mm$.

• The korean journal of orthodontics
• /
• v.32 no.6 s.95
• /
• pp.413-424
• /
• 2002

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 is 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 Cl 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 groups (low, average, high angle groups) depending on genial 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. 2) The patients with low genial angle had the least forward movement at the A point, and those with a high angle had more forward movement. 3) In 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 Genial angle groups.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.36 no.4
• /
• pp.154-160
• /
• 2014

Purpose: The efficiency of an anchor plate placed during orthognathic surgery via minimal presurgical orthodontic treatment was evaluated by analyzing the mandibular relapse rate and dental changes. Methods: The subjects included nine patients with Class III malocclusion who had bilateral sagittal split osteotomy at the Division of Oral and Maxillofacial Surgery, Department of Dentistry in Ajou University Hospital, after minimal presurgical orthodontic treatment. During orthognathic surgery, anchor plates were placed at both maxillary buttresses. The anchor plates were used to move maxillary teeth backward and for maximum anchorage of Class III elastics to minimize mandibular relapse during the postoperative orthodontic treatment. The lateral cephalometric X-ray was taken preoperatively (T0), postoperatively (T1), and one year after the surgery (T2). Seven measurements (distance from Pogonion to line Nasion-Nasion perpendicular [Pog-N Per.], angle of line B point-Nasion and Nasion-Sella [SNB], angle of line maxilla 1 root-maxilla 1 crown and Nasion-Sella [U1 to SN], distance from maxilla 1 crown to line A point-Nasion [U1 to NA], overbite, overjet, and interincisal angle) were taken. Measurements at T0 to T1 and T1 to T2 were compared and differences tested by standard statistical methods. Results: The mean skeletal change was posterior movement by $13.87{\pm}4.95mm$ based on pogonion from T0 to T1, and anterior movement by $1.54{\pm}2.18mm$ from T1 to T2, showing relapse of about 10.2%. There were significant changes from T0 to T1 for both Pog-N Per. and SNB (P<0.05). However, there were no statistically significant changes from T1 to T2 for both Pog-N Per. and SNB. U1 to NA that represents the anterior-posterior changes of maxillary incisor did not differ from T0 to T1, yet there was a significant change from T1 to T2 (P<0.05). Conclusion: This study found that the anchor plate minimizes mandibular relapse and moves the maxillary teeth backward during the postoperative orthodontic treatment. Thus, we conclude that the anchor plate is clinically very useful.

• The Journal of Korean Academy of Prosthodontics
• /
• v.27 no.2
• /
• pp.11-36
• /
• 1989

Mandibular movements are guided mainly by three determinants, namely the two posterior controls (the Temporomandibular joints) and the anterior control (the incisal guidance). The aim of this study was to evaluate the incisal guide angle in effort to reconcile a patient's condylar guide angle and incisu guide angle, to develop criteria for incisal guidance in clinical practice. 48 subjects (male 33, female 15) with intact intercuspation, without past history and symptoms of stomatognathic system, were selected for this study. All of the subjects had not anterior prostheses. The sagittal condylar guide angles and incisal guide angles were measured and estimated statistically by cephalogram and articulator (Whip-Mix 8500A). The results of this study were as follows: 1. Average of condylar guide angle was 43.33 degree by cephalogram, and was 35.18 degree by articulator. 95% confidence interval was from 40.43 to 46.23 degrees in cephalogram and was from 32.98 to 37.38 degrees in articulator. 2. Average of incisal guide angle was 51.51 degree by cephalogram, and was 44.11 degree by articulator. 95% confidence interval was from 49.12 to 54.95 degrees in cephalogram and was from 40.67 to 47.56 douses in articulator. 3. Difference between condylar and incisal guide angle was 8.18 degree by cephalogram, and was 8.94 degree by articulator. 95% confidence interval was from 4.61 to 11.74 degrees in cephalogram and was from 4.90 to 12.98 degrees in articulator. 4. In case of the incisal guide angle steeper than condylar guide angle, subjects were 69% (33 of 48) in cephatogram and 75% (36 of 48) in articulator. 5. By the multiple regression equation, condylar guide angle was more influenced by the anterior teeth. 6. When the mandible protrudes from the intercuspal position to the edge to edge position the incisal linear movement was 4.18mm (S.D.:1.30mm) and the condylar linear movement was 4.38mm (S.D.:1.26mm).