The Journal of Korean Academy of Prosthodontics (대한치과보철학회지)

The Korean Academy of Prosthodonitics (대한치과보철학회)
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Rehabilitation with orthognathic surgery and orthodontic treatment in patient with severe occlusal disharmony: A case report

심한 교합 부조화를 보이는 환자에서 악교정수술 및 교정치료를 동반한 구강회복: 증례 보고

  • Jung-Jin Lee (Department of Prosthodontics, School of Dentistry, Jeonbuk National University) ;
  • Kwang-Yeob Song (Department of Prosthodontics, School of Dentistry, Jeonbuk National University) ;
  • Seung-Geun Ahn (Department of Prosthodontics, School of Dentistry, Jeonbuk National University) ;
  • Ju-Mi Park (Department of Prosthodontics, School of Dentistry, Jeonbuk National University) ;
  • Jae-Min Seo (Department of Prosthodontics, School of Dentistry, Jeonbuk National University)
  • 이정진 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소) ;
  • 송광엽 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소) ;
  • 안승근 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소) ;
  • 박주미 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소) ;
  • 서재민 (전북대학교 치과대학 치과보철학교실 및 구강생체과학연구소)
  • Received : 2023.04.11
  • Accepted : 2023.07.05
  • Published : 2023.07.31
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Abstract

The occlusal treatment including prosthetic treatment should be considered when the pathologic symptom was observed with the excessive discrepancy between the centric relation occlusion (CRO) and the maximum intercuspal position (MIP). Through careful diagnosis, the malocclusion and interarch relationship can be analyzed, and occlusal adjustment, restorative treatment, orthodontic therapy, or orthognathic surgery can be performed depending on the degree of disharmony. The patient in this case report complained the unstable occlusion and loss of masticatory function that had been occurring for several years. At the time of the visit, the patient showed severe occlusal disharmony, with only the upper right second molar contacting the lower jaw at the maximum intercuspal position. Based on the analysis of the occlusion, it was difficult to solve the problem with just occlusal adjustment or restorative treatment. In addition, the patient had the skeletal class II malocclusion between the upper and lower jaws. Therefore, for resolving the severe skeletal class II malocclusion, pre- and post-orthodontic treatment, bilateral sagittal split ramus osteotomy (BSSRO) was performed. After that, the occlusal adjustment was performed for stable occlusion, and the missing teeth area was restored with dental implants. During the follow-up period, a periodic follow-up visits and additional occlusal adjustments were performed to achieve a stable centric occlusion and harmonious anterior and lateral guidance. As a result, the final prosthodontic treatment was completed, and the patient's masticatory function was restored.

교합의 부조화가 있고 중심위와 최대 교두간 접촉위의 불일치가 과도하며 이와 관련된 병적인 징후가 관찰되는 경우, 반복 재현이 가능한 안정된 교합을 얻고 상실된 저작기능을 회복하기 위해 교합치료를 고려해야 한다. 면밀한 진단을 통하여 중심위를 기준으로 한 악간 및 교합관계를 분석하여 그 부조화의 정도에 따라 교합조정이나 보철수복, 교정치료, 악교정 수술 등을 시행할 수 있다. 본 증례의 환자는 수 년 전부터 발생한 교합 불안정 및 저작기능 상실을 주소로 본원에 내원하였으며 내원 당시 최대 교두간 접촉위에서 상악 우측 제2대구치만 접촉이 이루어지는 심한 교합부조화를 보였다. 중심위를 기준으로 한 교합분석 결과, 교합조정이나 보철수복을 통한 치료만으로는 문제를 해결하기 힘든 상,하악간 골격성 2급의 심도가 매우 깊었다. 따라서 임시의치수복을 통한 중심위를 확보하고 심한 골격성 2급을 해결하기 위한 술 전,후 교정치료를 동반한 양측 하악골 상행지 시상분할 골절단술(bilateral sagittal split ramus osteotomy, BSSRO)을 시행하였다. 이후, 전악에 걸친 세밀한 교합조정을 시행하여 교합을 더욱 안정화시켰으며, 무치악 부위는 임플란트를 식립하고 임시수복 하였다. 경과관찰 동안, 주기적인 교합평가 및 추가적인 교합조정을 통하여 안정적인 중심위와 조화로운 전방 및 측방유도를 얻었다. 이에 최종 보철수복을 완료하여 환자의 저작기능을 회복하였기에 이를 보고하는 바이다.

Keywords

References

  1. 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
  2. Lee KM, Lee SM, Yang BH, Yun MS, Lee JH. The treatment strategies of non-surgical approach for dentofacial asymmetry patient. J Oral Rehabil Appl Sci 2010;26:77-87.
  3. Kim M, Lee DY, Lim YK, Baek SH. 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:e20-32. https://doi.org/10.1016/j.tripleo.2010.01.002
  4. Ishihara Y, Kuroda S, Sugawara Y, Kurosaka H, Takano-Yamamoto T, Yamashiro T. Long-term stability of implant-anchored orthodontics in an adult patient with a Class II Division 2 malocclusion and a unilateral molar scissors-bite. Am J Orthod Dentofacial Orthop 2014;145(4 Suppl):S100-13. https://doi.org/10.1016/j.ajodo.2013.07.016
  5. Hwang JH, Jung BY, Lim CS, Cha IH, Park W. Posterior maxillary segmental osteotomy concomitant with sinus lift using a piezoelectric device. J Oral Maxillofac Surg 2011;69:2339-44. https://doi.org/10.1016/j.joms.2011.04.023
  6. Lownie JF, Cleaton-Jones PE, Coleman H, Forbes M. Long-term histologic changes in the dental pulp after posterior segmental osteotomies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:299-304. https://doi.org/10.1016/S1079-2104(99)70212-X
  7. The glossary of prosthodontic terms: Ninth edition. J Prosthet Dent 2017;117(5S):e1-105. https://doi.org/10.1016/j.prosdent.2016.12.001
  8. Hodge LC Jr, Mahan PE. A study of mandibular movement from centric occlusion to maximum intercuspation. J Prosthet Dent 1967;18:19-30. https://doi.org/10.1016/0022-3913(67)90107-2
  9. Rieder CE. The prevalence and magnitude of mandibular displacement in a survey population. J Prosthet Dent 1978;39:324-9. https://doi.org/10.1016/S0022-3913(78)80105-X
  10. Crawford SD. Condylar axis position, as determined by the occlusion and measured by the CPI instrument, and signs and symptoms of temporomandibular dysfunction. Angle Orthod 1999;69:103-15; discussion 115-6.
  11. Harrel SK, Nunn ME. The association of occlusal contacts with the presence of increased periodontal probing depth. J Clin Periodontol 2009;36:1035-42. https://doi.org/10.1111/j.1600-051X.2009.01486.x
  12. Brandini DA, Trevisan CL, Panzarini SR, Pedrini D. Clinical evaluation of the association between non-carious cervical lesions and occlusal forces. J Prosthet Dent 2012;108:298-303. https://doi.org/10.1016/S0022-3913(12)60180-2
  13. Choo SS, Heo YH, Cho LR, Park CJ. Prosthetic rehabilitation for a patient with CO-MI discrepancy. J Dent Rehabil Appl Sci 2015;31:273-82. https://doi.org/10.14368/jdras.2015.31.3.273
  14. Kobayashi Y, Shibuya H, Nagano T, Yanagita S. Treatment of the temporomandibular joint dysfunction patient by full mouth occlusal reconstruction (author's transl). Shigaku Odontology J Nihon Dent Coll 1975;63:79-93.
  15. Wassell RW, Steele JG, Welsh G. Considerations when planning occlusal rehabilitation: a review of the literature. Int Dent J 1998;48:571-81. https://doi.org/10.1111/j.1875-595X.1998.tb00494.x