Indirect palatal skeletal anchorage (PSA) for treatment of skeletal Class I bialveolar protrusion

Indirect palatal skeletal anchorage (PSA)를 이용한 골격성 I급 양악 치성 전돌 환자의 치험례

  • Chae, Jong-Moon (Department of Orthodontics & Dentistry, Daegu Fatima Hospital, The Korean Orthodontic Research Institute Inc.)
  • 채종문 (대구파티마병원 치과 교정과, 사단법인 한국치과교정연구회)
  • Published : 2004.10.01

Abstract

Anchorage plays an important role in orthodontic treatment especially in the maxillary arch. In spite of many efforts for anchorage control. it was difficult for clinicians to predict the result of treatment because most of the treatment necessitated an absolute compliance of patients, But recently, skeletal anchorage has been used widely because it does not necessitate patient compliance but produces absolute anchorage. In addition titanium miniscrews have several advantages such as ease of insertion and removal. possible immediate leading and use in limited implantation spaces. In this case, a skeletal Class I bialveolar protrusion Patient was treated with standard edgewise mechanics using indirect active P.S.A. (palatal skeletal anchorage). The miniscrews in the paramedian area of the hard palate provided anchorage for retraction of the upper anterior teeth and remained firm and stable throughout treatment This indicates that the PSA can be used to reinforce anchorage for orthodontic treatment in the maxillary arch Consequently, this new approach can help effective tooth movement without patient compliance, when used with various transpalatal arch systems.

교정치료에 있어서 고정원의 조절은 매우 중요한 요소이며, 상악에서 특히 그러하다. 이를 얻기 위해 많은 노력을 해 왔으나 대부분이 환자의 협조에 대한 의존이 필수적이었기 때문에 고정원 보강에 대하여 확신할 수 없었다. 하지만 최근 skeletal anchorage를 이용하여 환자의 협조를 최소화하면서도 보다 효과적으로 고정원 보강을 할 수 있는 방법이 시행되고 있다. 또한 과거의 골 융합성 임프란트와 달리 미니 스크류는 구강 내의 어느 부위에나 식립할 수 있을 정도로 식립 부위의 제한성이 적다는 장점이 있다. 저자는 titanium miniscrew를 구개 정중부의 약간 측방에 식립하고, indirect active P.S.A.(Palatal skeletal anchorage)를 이용하여 치료한 결과 상악 구치부에서의 고정원 보강을 얻을 수가 있었다. 이 치료 결과로 보아 PSA는 상악 구치부의 고정원 보강 역할을 할 수 있을 것으로 생각되며. 또한 transpalatal arch system의 다양한 design을 응용한다면 효율적인 치아 이동을 하는데 많은 도움이 될 것으로 생각된다.

Keywords

References

  1. Roberts WE, Nelson CL, Goodacre CJ. Rigid Implant Anchorage to Close a Mandibular First Molar Extrdction Site. J Clin Orthod 1994;28:693-704
  2. Shapiro PA, Kokich VG. Uses of Implants in Orthodontics. Dent Clin North Am 1988;32:539-50
  3. Block MS, Hoffman DR. A new device for absolute anchorage for orthodontics. Am J Orthod Dentofacial Orthop 1995;107:251-8 https://doi.org/10.1016/S0889-5406(95)70140-0
  4. Janssens F, Swennen G, Dujardin T, Glineur R, Malevez C. Use of an onplant as orthodontic anchorage. Am J Orthod Dentofacial Orthop 2002;122:566-70 https://doi.org/10.1067/mod.2002.126404
  5. Umemori M, Sugawara J, Mitani H, Nagasaka H, Kawamura H. Ske-letal anchorage system for open-bite correction. Am J Orthod Dento-facial Orthop 1999;115:166-74 https://doi.org/10.1016/S0889-5406(99)70345-8
  6. Sherwood KH, Burch JG, Thompson WJ. Closing anterior open bites by intruding molars with titanium miniplate anchorage, Am J Orthod Dentofacial Orthop 2002; 122:593-600 https://doi.org/10.1067/mod.2002.128641
  7. Costa A, Raffini M, Melsen B, Miniscrews as Orthodontic Anchorage A preliminary report, Int J Adult Orthod Orthogn Surg 1998;13: 201-9
  8. Kanomi R. Mini-implant for Orthodontic Anchorage. J Clin Orthod 1997;31:763-7
  9. Park HS, Bae SM, Kyung HM, Sung JH. Micro-implant anchorage for treatment of skeletal Class I bialveolar protrusion. J Clin Orthod 2001;35:417-22
  10. 박효상. Micro-implant를 이용한 교정치료, 서울:나래출판사 2001:23-33
  11. Wehrbein H, Feifel H, Diedrich P. Palatal implant anchorage reinfor-cement of posterior teeth:A prospective study. Am J Orthod Dento-facial Orthop 1999;116:678-86. https://doi.org/10.1016/S0889-5406(99)70204-0
  12. Wehrbein H, Merz BR, Diedrich P, Glatzmaier J. The Use of palatal implants for orthodontic anchorage. Design and clinical application of the orthosystem. Clin Oral Implants Res 1996;7:410-6 https://doi.org/10.1034/j.1600-0501.1996.070416.x
  13. Wehrbcin H, Glatzmaier J, Yildirim M. Orthodontic anchorage capacity of short titanium screw implants in the maxilla. Clin Oral Implants Res 1997;8:131-41 https://doi.org/10.1034/j.1600-0501.1997.080208.x
  14. Wehrbein H, Merz BR. Aspects of the use of endosseous palatal imp-lants in orthodontic therapy. J Esthet Dent 1998;10:315-24 https://doi.org/10.1111/j.1708-8240.1998.tb00510.x
  15. Wehrbein H, Merz BR, Hammerle CH, Lang NP. Bone-to-implant co-ntact of orthodontic implants in humans subjected to horizontal loading. Clin Oral Implants Res 1998;9:348-53 https://doi.org/10.1034/j.1600-0501.1998.090509.x
  16. Wehrbein H, Merz BR, Diedrich P, Palatal P. bone support for orthodon-tic implant anchorage-a clinical and radiological study. Eur J Orthod 1999;21:65-70 https://doi.org/10.1093/ejo/21.1.65
  17. Mannchen R A new supraconstruction for palatal orthodontic impl-ants. J Clin Orthod 1999;33:373-82
  18. Abels N, Schiel HJ, Hery-Langer G, Neugebauer J, Engel M. Bone condensing in the placement of endosteal palatal implants: a case report. Int J Oral Maxillofac Implants 1999;14:849-52
  19. 경승현, 임중기, 박영철. Miniscrew를 고정원으로 이용한 교정치료. 대치교정지 2001;31:415-24
  20. Bernhart T, Vollgruber A, GahJeitner A, Dortbudak O, Haas R. Alter-native to the median region of the palate for placement of an ortho-dontic implant. Clin Oral Implants Res 2000;11:595-601 https://doi.org/10.1034/j.1600-0501.2000.011006595.x
  21. Schlegel KA, Kinner F, Schlegel KD. The anatomic basis for palatal implants in orthodontics. Int J Adult Orthodon Orthognath Surg 2002;17:133-9
  22. 임용규, 권종진. 교정 영역에서 Implant의 이용. 임플란트연구 2000;51-61
  23. Laino A, Boscaino F, Galeota G, Terzoni AM. Differential anchorage in orthodontics: problems and clinical implications. Arch Stomatol(Napoli) 1990;31:849-58
  24. Hoederath H, Bourauel C, Drescher D. Differences between two trans-palatal arch systems upon first-, second-, and third-order bending activation. J Orofac Orthop 2001;62:58-73 https://doi.org/10.1007/PL00001919
  25. Scuzzo G, Pisani F, Takemoto K. Maxillary molar distalization with a modified pendulum appliance. J Clin Orthod 1999;33:645-50
  26. Kinzinger G, Fuhrmann R, Gross U, Diedrich P. Modified pendulum appliance including distal screw and uprighting acrivation for non-compliance therapy of Class II malocclusion in children and adole-scents. J Orofac Orthop 2000;61:175-90 https://doi.org/10.1007/s000560050003
  27. Kinzinger G, Fritz U, Diedrich P. Bipendulum and quad pendulum for non-compliance molar distalization in adult patients. J Orofac Orthop 2002;63:154-62 https://doi.org/10.1007/s00056-002-0121-6