Journal of Dental Rehabilitation and Applied Science (구강회복응용과학지)

Korean Academy of Stomatognathic Function and Occlusion (대한턱관절교합학회)
권호 표지

Full mouth Rehabilitation with Orthognathic Surgery in Facial Asymmetry Patient : Case Report

안면 비대칭환자의 악교정 수술을 동반한 완전구강회복

  • Im, So-Min (Department of Prosthodontics and Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University) ;
  • Shin, Hyoung-Joo (Department of Prosthodontics and Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University) ;
  • Kim, Dae-Gon (Department of Prosthodontics and Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University) ;
  • Park, Chan-Jin (Department of Prosthodontics and Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University) ;
  • Cho, Lee-Ra (Department of Prosthodontics and Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University)
  • 임소민 (강릉원주대학교 치과대학 보철학교실 및 구강과학연구소) ;
  • 신형주 (강릉원주대학교 치과대학 보철학교실 및 구강과학연구소) ;
  • 김대곤 (강릉원주대학교 치과대학 보철학교실 및 구강과학연구소) ;
  • 박찬진 (강릉원주대학교 치과대학 보철학교실 및 구강과학연구소) ;
  • 조리라 (강릉원주대학교 치과대학 보철학교실 및 구강과학연구소)
  • Received : 2010.07.15
  • Accepted : 2010.09.25
  • Published : 2010.09.30
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Abstract

Facial asymmetry has been found with a higher frequency (70~84%) in skeletal class III malocclusion patients. Anticipating the poor prognosis of prosthesis due to malocclusion, occlusal stability must be obtained by orthodontic treatment. Moreover, orthodontic surgery would be needed in some severe cases for better functional and esthetic results. The orthognathic surgery is performed on one jaw or two jaw depending on the results of facial diagnosis. Genioplasty may change the vertical, horizontal, sagittal position of chin by osteotomy or augmentation using implants, also. This case is about a 24 year-old male patient who visited our clinic to solve the facial asymmetry and mandibular prognathism. Skeletal class III malocclusion, maxillary canting and menton deviation to left by 13 mm were detected. Multiple ill-fitting prostheses, unesthetic maxillary anterior prostheses, and several dental caries were found. After pre-operative orthodontic treatment, Le-Fort I osteotomy, sagittal split ramus osteotomy, genioplasty, right mandibular angle augmentation were done for the correction of jaw relation and asymmetry. By diagnostic wax-up after post-operative orthodontic treatment, maxillary full mouth rehabilitation and mandibular posterior restorations were planned out. For better result, clinical crown lengthening procedure was done on #11, 12 and implant was placed on left mandibular first molar area. The patient was satisfied with the final prostheses. Because of his high caries risk, long-term prognosis will depend on the consistent maintenance of oral hygiene and periodic follow-up.

안면 비대칭 중 가장 흔히 나타나는 하악 비대칭은 성장 중 골격성장의 비대칭을 유발하는 다양한 원인에 의해 발생한다. 안면 비대칭이 있을 경우 외모 뿐 아니라 저작과 기능에 지장을 줄 수 있다. 심한 골격성 악간관계 부조화가 있는 경우 보철치료만으로는 이상적인 교합관계를 형성하기 어려우며, 힘의 분산이 적절히 이루어지지 않아 자연치와 수복물의 수명이 단축될 수 있다. 악간관계 부조화로 인한 부정교합이 존재하여 치아의 수복 시 예후가 불량할 것으로 예상되는 경우 먼저 교정치료를 통한 악간관계의 개선을 위한 교합안정이 우선되어야 한다. 부조화가 심한 경우 기능적 및 심미적인 치료 결과를 위해 악교정 수술이 필요하며, 진단결과에 따라 편악 또는 양악수술이 시행된다. 상 하악 또는 안면 비대칭증의 악교정 수술시 이부 성형술이 동반될 수 있으며, 이는 하악골의 이부의 수직적, 횡적, 전후방적 위치를 외과적으로 변화시킴으로써 더욱 심미적인 안모개선을 얻기 위해 시행된다. 본 증례의 환자는 안모의 비대칭과 돌출된 하악 및 불량 보철물을 개선하고자 술전 교정을 시행한 뒤 상악 Le-Fort I 골절단술, 하악 시상분할골절단술, 이부 성형술(전방 4 mm), 우측 하악각 증대술을 시행하였다. 술후 교정치료를 진행하고 치관연장술 및 완전구강회복을 진행하였다. 보철 수복 완료 후, 환자의 평가와 객관적 결과로 만족할만한 결과를 얻었기에 이를 보고하고자 한다.

Keywords

References

  1. Cheon OJ, Suhr CH. A posteroanterior roentgenocephalometric study of skeletal craniofacial asymmetric patients. Korean J Orthodo. 1990;20:565-81.
  2. Yanez-Vico RM, Iglesias-Linares A, Torres-Lagares D, Gutierrez-Perez JL, Solano-Reina E. Diagnostic of craniofacial asymmetry. Literature review. Med Oral Patol Oral Cir Bucal. 2010;15:e494-8.
  3. Kim MK, Kang JS, Kim JR, Son WS. A cephalometric study on facial morphology in angle's class III malocclusion patients with facial asymmetry. Korean J Orthod. 1994;24:787-98.
  4. Choi YS, Son WS. A comparative study on the postsurgical changes between one jaw surgery and two-jaw surgery in skeletal class III patients. Korean J Orthod. 1997;27:297-313.
  5. Kim KS, Kim YJ, Lee KH, Kim YH, Kook YA. Level of perception of changed lip protrusion and asymmetry of the lower facial height. Korean J Orthod. 2006;36:434-41.
  6. Chang YI. Facial asymmetry. Korean J Orthod. 1991;21:251-8.
  7. Saka O, Beily M, Marsan G. Combined prosthodontic and orthodontic treatment of a patient with a class III skseletal malocclusion: A clinical report. J Prosthet Dent 2004;92:224-8. https://doi.org/10.1016/j.prosdent.2004.06.002
  8. Janson M, Janson G, Sant'Ana E, Tibola D, Martins DR. Orthognathic treatment for a patient with Class III malocclusion and surgically restricted mandible. Am J Orthod Dentofacial Orthop. 2009;136:290-8. https://doi.org/10.1016/j.ajodo.2007.01.039
  9. Lee KM, Lee SM, Yang BH, Yun MS, Lee JH. The treatment strategies of non-surgical approach for dentofacial asymmetry patient. J Oral Rehabil and Appl Science 2010;26:77-87.
  10. Bailey et al. Trends in surgical treatment of class III skeletal relationships. Int J Adult Orthod Orthognath Surg. 1995;10:108-119.
  11. Kim M, Lee D, Lim Y. Baek S. Three-dimensional evaluation of soft tissue changes after mandibular setback surgery in class III malocclusion patients according to extent of mandibular setback, vertical skeletal pattern, and genioplasty. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e20-e32.
  12. Lee EJ, Son WS, Park SB, Kim SS. The differences of STO between before and after presurgical orthodontics in skeletal Class III malocclusions. Korean J Orthod 2008;38:175-86. https://doi.org/10.4041/kjod.2008.38.3.175
  13. Nahm DS, Suhr CH, Yang WS, Chang YI. Submentovertex cephalometrics in korean adults. Korean J Orthod. 2000;30:1-7.
  14. Amano K, Yagi T, Iida S, Aikawa T, Yamashiro T, Takada K, Kogo M. Facial frontal morphological changes related to mandibular setback osteotomy using cephalograms. J Craniomaxillofac Surg. 2009; 37:412-6. https://doi.org/10.1016/j.jcms.2009.04.012
  15. Ishizaki K, Suzuki K, Mito T, Tanaka EM, Sato S. Morphologic, functional, and occlusal characterization of mandibular lateral displacement malocclusion. Am J Orthod Dentofacial Orthop. 2010;37:454.e1-9.
  16. Matsumoto R, Ioi H, Goto TK, Hara A, Nakata S, Nakasima A, Counts AL. Relationship between the unilateral TMJ osteoarthritis/osteoarthrosis, mandibular asymmetry and the EMG activity of the masticatory muscles: a retrospective study. J Oral Rehabil. 2010;37:85-92. https://doi.org/10.1111/j.1365-2842.2009.02026.x