'Elastic tie back'을 이용한 발치공간 폐쇄에 관한 임상적 고려

CLINICAL CONSIDERATION ON USING THE ELASTIC 'TIE BACKS' DURING SPACE CLOSURE

치아이동시 생역학을 고려한 frictionless system이 공간폐쇄를 위해 이상적이지만, 이는 숙달된 wire bending이 필요하며 잘못 계산된 교정장치를 사용하였을때 부작용이 매우 클 수 있다. 최근 Straight Wire Appliance가 도입 됨에 따라 복잡한 wire bending없이 "Elastic tie back"을 이용한 공간폐쇄가 가능하지만 alignment와 leveling을 위한 치료기간이 길고 friction과 binding으로 인해 이상적인 교정력을 적용시키는데 어려움이 있다. 그러나 교정환자 수가 많아지고 짧은 치료 기간이 요구되어지는 요즈음에 선택적으로 "Elastic tie back"을 이용하는 공간폐쇄는 부작용을 최소화 하면서 손쉽게 이용할 수 있는 교정장치라고 사료된다.

Preadjusted appliance, following the original concept of the Andrews Straight-Wire appliance, became increasingly common in the 1980s. In six phases of treatment, anchorage control, leveling and aligning, overbite control, overjet reduction, space closure, and finishing are very effective with using the preadjusted appliances. Space closure is the phase of treatment in which the difference between standard edgewise and preadjusted mechanics is most noticeable. Orthodontists have been able to reduce the use of closing loops and, because of the level slot lineup, enjoy the advantages of sliding mechanics. In 1990, Dr. John C. Bennett and Richard P. McLaughlin introduced the new space closure system, namely, elastic 'tiebacks'. They found an $.019'\times.025'$ working archwire most effective in an .022'-slot system. Hooks of .024' stainless steel or .028' brass wire are soldered to the upper and lower archwires. The force required for space closure is delivered by elastic 'tiebacks'. An elastic modulo stretched by 2-3mm(to twice its normal length) usually delivers 0.5-1.5mm of space closure per month. Group movement and sliding mechanics are combined for gentle, controlled space closure, so that about 0.5mm of incisor retraction and 0.5mm of mesial molar movement can be seen each month. The tiebacks are replaced every four to six weeks. By using the elastic 'tiebacks', the next two cases were treated during space closure. Even though we found some clinical problems of this mechanics, long treatment time, hard to control of vertical dimension and anchorage, the application method of this system is so simple that orthodontists can manage many patients during short chair time. But we must apply this mechanics after perfect understanding of the biomechanics in tooth movement.