Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
권호 표지

ORTHODONTIC TREATMENT OF AN IMPACTED MANDIBULAR FIRST MOLAR USING MINIPLATE AS A SKELETAL ANCHORAGE: A CASE REPORT

Miniplate를 골격성 고정원으로 이용한 매복된 하악 제1대구치의 교정치료 증례

  • Jang, Yoon-Hyoung (Department of Pediatric Dentistry, School of Dentistry, Kyung-Hee University) ;
  • Kim, Eun-Young (Department of Pediatric Dentistry, School of Dentistry, Kyung-Hee University) ;
  • Kim, Kwang-Chul (Department of Pediatric Dentistry, School of Dentistry, Kyung-Hee University) ;
  • Park, Jae-Hong (Department of Pediatric Dentistry, School of Dentistry, Kyung-Hee University) ;
  • Lee, Baek-Soo (Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyung-Hee University) ;
  • Choi, Sung-Chul (Department of Pediatric Dentistry, School of Dentistry, Kyung-Hee University)
  • 장윤형 (경희대학교 치의학전문대학원 소아치과학교실) ;
  • 김은영 (경희대학교 치의학전문대학원 소아치과학교실) ;
  • 김광철 (경희대학교 치의학전문대학원 소아치과학교실) ;
  • 박재홍 (경희대학교 치의학전문대학원 소아치과학교실) ;
  • 이백수 (경희대학교 치의학전문대학원 구강악안면외과학교실) ;
  • 최성철 (경희대학교 치의학전문대학원 소아치과학교실)
  • Received : 2009.11.25
  • Accepted : 2010.02.23
  • Published : 2010.05.31
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Abstract

Impactions can occur because of malpositioning of the tooth bud or obstruction in the path of eruption. However, the exact mechanism is still unknown. The impaction of mandibular first molar is rare with prevalence rates of 0.01~0.25%, but it is important to deimpact the tooth as soon as possible to avoid complications such as dental caries, root resorption, and periodontal problems on the adjacent teeth. Several biomechanical strategies have been proposed for uprighting mesially tipped mandibular first molars. However, most of these have had problems with movement of the anchorage unit because of the reciprocal force. The recent development of skeletal anchorage system(SAS) allows direct application of precise force systems to the target tooth or segment, producing efficient tooth movement in a short time. In this case, an impacted mandibular left first molar with dilacerated roots was treated with a miniplate, which provided skeletal anchorage to upright the tooth. The miniplate was installed in the mandibular ramus, and 10 months after the application of orthodontic force, the impacted tooth was exposed in the oral cavity and uprighted. At this point, the mandibular left first molar was included in the orthodontic appliance with fixed mechanotherapy, the tooth could achieve a normal occlusion. Therefore, the use of SAS simplified the orthodontic procedures and reduced the orthodontic treatment period, and had few side effects.

치아의 매복은 치배의 이상 위치 혹은 맹출로에 장애가 있어서 일어나지만, 그 정확한 기전은 아직 알려지지 않았다. 하악 제1대구치 매복의 발생율은 0.01~0.25%로 매우 드물지만, 이러한 매복은 인접 치아의 우식 또는 치근 흡수, 치조골의 저성장, 치주적 문제들을 일으킬 수 있기 때문에 최대한 빨리 매복을 해소시켜줄 필요가 있다. 매복된 하악 제1대구치가 근심경사 되어있을 경우 이를 직립시키기 위한 여러 생역학적 접근법이 있지만, 대부분의 방법들은 상호간의 힘(reciprocal force)에 의해 고정원 단위의 이동이 일어난다는 문제가 있다. 최근 골격성 고정원(SAS, Skeletal Anchorage System)의 도입으로 목표 치아 혹은 목표 분절에 직접적인 힘을 정확하게 전달할 수 있게 됨에 따라 단기간의 효율적 치아 이동이 가능하게 되었다. 본 증례에서는 만곡된 치근을 가진 매복 하악 좌측 제1대구치에서 치아의 직립을 위해 골격성 고정원인 miniplate를 사용 하였다. miniplate는 후구치 부위에 식립되었으며, 교정력을 적용한 10개월 후 매복치가 구강 내로 노출되고 직립되었다. 이에 하악 좌측 제1대구치를 고정성 교정장치에 포함시켜 정상 교합을 얻을 수 있었다.이와 같이 골격성 고정원을 사용함으로써 교정술식을 단순화시키고 교정치료 기간을 줄이며 부작용이 적었던 장점 등이 있어 보고하는 바이다.

Keywords

References

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