• 대한치과의사협회지
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• 제50권2호
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• pp.64-71
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• 2012

Recently, the presurgical orthodontic duration tends to be shortened by virtue of the advancement of surgical and orthodontic techniques in class III orthognathic surgery cases. But the predictability of the surgical results should be secured by removing several uncertain factors in presurgical orthodontic treatment. The purpose of this study is to investigate the influence of immediate postsurgical occlusal stability on postsurgical mandibular change. The study includes 40 patients who underwent orthognathic surgery to correct skeletal class III malocclusion. The patients were divided into two groups based on the numbers of occlusal contact in surgical setup occlusion: group 1 (stable surgical occlusion, n=24) and group 2(unstable surgical occlusion, n=16). Changes of horizontal and vertical mandibular measurements during postsurgical follow up period(from 1 week postsurgery to 12month after debonding) were compared to examine the differences between two groups. The stability of surgical occlusion is one of the factors influencing postsurgical mandibular changes in class III malocclusion. The various class III malocclusion cases have specific prerequisites for the orthognathic surgery according to the skeletal patterns. The prerequisites should be obtained by minimum presurgical orthodontics to increase the predictability of the surgical results.

• 대한치과교정학회지
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• 제35권1호
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• pp.23-34
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• 2005

본 연구에서는 III급 수술-교정 치료 방법에 영향을 미치는 치열 상의 요소를 파악함으로써 술전 교정시 상악 소구치 발치와 비발치의 판단에 필요한 임상적 정보를 얻고자 골격성 III급 부정교합 환자의 수술-교정 치료시 흔히 선택되는 상악 제1소구치 발치로 치료된 군과 비발치로 치료된 군 간의 치료전/후 상/하악 개별 치아 이동 양상과 치열궁 폭경의 변화 양상을 비교 분석하였다 이를 위하여 비발치로 III급 수술-교정 치료를 마친 환자 (24명) 와 술전교정 치료시 상악 제1소구치가 발치된 환자 (31 명)의 치료 전/후 모형 상에서 개개 치아의 근원심/협설측 각도 변화와 상/하 치열궁 폭경의 변화를 측정한 후, 두 군 사이의 교정적 치아 이동 양상을 비교 분석한 후 상/하 치열궁의 조화를 이루는데 필요한 치열궁 폭경의 변화와 이에 기여하는 치아 변위와의 관계를 분석하기 위하여 상관 분석과 회귀 분석을 시행한 결과 발치 군은 비발치 군에 비하여 상악 치열궁 폭경의 감소가 컸으며 이는 상악 구치의 inclination 감소에 크게 영향 받은 것으로 관찰되었다. 하악 치열에서는 inclination의 증가와 폭경의 증가가 있었으나, 비발치/발치군간의 차이는 유의하지 않았다 본 연구의 결과 결론적으로 III급 수술-교정 치료시 술전 상악 소구치 발치는 상악 구치부 치열궁 폭경의 감소에 크게 영향을 미치므로, 상악 소구치 발치에 대한 판단은 상/하악 치열궁의 폭경 및 구치부 경사도 문제와 연계하여 고려해야 할 사항으로 생각되었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권2호
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• pp.174-183
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• 2000

This study was performed to investigate the characteristics of soft tissue profile of the class III malocclusion and to test the yardstick far differential diagnosis between surgical and orthodontic patients. Initial lateral cephalograms of orthodontic group(30 patients) that have acceptable occlusion and profile by orthodontic treatment alone and surgical group(30 patients) that have favorable occlusion and profile by combined surgical-orthodontic treatment were selected in Ajou university hospital. Powell and Burstone II analysis were made on the tracing. Descriptive, comparative, factor, cluster, and discriminant analysis were carried out with computer program. The results were as followings : 1. Patients who received surgery had a more concave profile and a longer lower facial height than patients who received orthodontic treatment alone. 2. Nasolabial angle, ratio of vertical height, and mentolabial sulcus were significantly different at the 5% level. And facial protuberance, upper lip protuberance, mentocervical angle, nasofrontal angle, nasomental angle, mandibular vertical height, angle between cervix and lower face, ratio of mandibular vertical height divided by cervical depth, ratio of vertical height between upper and lower lip, and maxillary protuberance were significantly different at the 1% level. 3. 8 factors were extracted and factor 2, 3, and 8 showed significant differences by factor analysis. 4. Orthodontic group (25) and surgical group (35) were classified by cluster analysis. 5. Discriminant function was D = 0.079Nasomental angle + 0.081Sn-Gn + 3.343Sn-Gn/C-Gn + 1.734Sn-St/St-Me' -26.460, and cutting score was 0, so we can discriminate that orthodontic group has the score above 0, and surgery group below 0. And 91.7% of original grouped cases were correctly classified.

• 대한치과교정학회지
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• 제38권1호
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• pp.60-67
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• 2008

성인에서의 골격성 III급 부정교합의 치료의 원칙은 하악골의 후방이동을 동반한 수술적 교정치료이나, 다양한 문제로 인해 수술적 방법을 선택하기 어렵고 부조화의 정도가 심하지 않은 환자의 경우 비수술적 절충 치료를 선택할 수 있다. 비수술적 절충치료를 시행하는 경우 교정치료의 한계와 치주적인 부분에 대한 주의가 필요하다. 본 교실에서는 간접 골성 고정원을 이용하여 성인에서의 골격성 III급 부정교합을 비수술적으로 절충 치료 하였기에 보고하고자 한다.

• 구강회복응용과학지
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• 제26권3호
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• pp.349-357
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• 2010

골격성 III급 부정교합을 가진 환자에서의 보철 치료는 환자의 전신적요인과 기타 구강내, 외적인 요인을 고려하여 정확한 치료 계획하에 시행되어야 한다. 성인에 있어서 III급 악골관계는 외과적 수술과 교정치료가 선행된 후 보철수복이 진행되도록 계획하는 경우가 일반적이지만 환자의 전신적 요인 등으로 인하여 수술이 불가능한 경우가 있을 수 있다. 이러한 경우에서는 보철로 인한 저작기능의 회복시 좀 더 안정적으로 교합을 유지, 지속할 수 있는 치료가 필요하다. 본 증례에서는 전신질환으로 인하여 수술이 불가한 III급 악골관계를 가진 환자에서 고정성 보철 수복을 통하여 경제적, 시간적으로 효율적이고 기능과 심미를 충족시키는 임상적 결과를 얻었기에 보고하고자 한다.

• 대한치과교정학회지
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• 제28권3호
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• pp.479-486
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• 1998

양악 전돌은 흔히 접하는 부정교합 증례로서, 대부분 상하순의 전돌에 의한 안모 심미성의 손상을 주소로 내원한다. 이러한 증례는 제 1소구치를 발거하고 그 공간을 이용하여 전치부를 견인하여 치료하는 경우가 많으며, 성공적인 치료 결과를 얻을 수 있다. 그러나, 성인 환자의 경우에는 환자의 협조도 불량으로 인한 악외 고정원 사용의 불량, 치료기간의 장기화, 치조골이 충분하지 못한 경우등에 있어서의 치근 흡수량의 증가, 구외 장치 사용으로 인한 환자의 사회심리적 부담감등의 부작용이 있다. 이의 해결방안의 하나인 근첨하 분절 골절단술은 고정원의 절대 보존, 치료기간의 단축, 구외 고정원 사용 필요성 제거 및 이를 통한 환자의 협조도 증가 등의 장점을 가지고 있다. 이에, 제 1소구치 발거 및 이 부위를 이용한 근첨하 분절 골절단술을 병행하여 치료한 치아치조 전돌의 증례를 치료 전후의 두부 방사선 계측 사진및 연구 모형을 통해 비교분석하여 변화를 살펴보고, 이의 장단점을 고찰해 보도록 하고자 한다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권6호
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• pp.559-565
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• 2006

The aim of this study was to evaluate the amount and interrelationship of the soft and hard tissue changes after simultaneous maxillary clockwise rotation and mandibular setback surgery in skeletal class III malocclusion. The sample comprised of 16 adult patients who had anteroposterior skeletal discrepancy. These patients had received presurgical orthodontic treatment and surgical treatment which consisted of Le fort I Osteotomy and bilateral saggital split ramus osteotomy. The presurgical (T1) and postsurgical (T2) lateral cephalograms were evaluated. The computerized statistical analysis was carried out with SPSS/PC program. The results demonstrated a decrease in the vertical dimension in the soft and hard tissue. The nasolabial angle was increased and the mentolabial angle was decreased. The results showed also many statistically significant correlations(p<0.05). The lower lip closely followed the skeletal movement of the B- point in the horizontal plane. The double jaw rotation surgery can afford a good solution to solve the problems of class III malocclusion cases.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.407-412
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• 2011

Purpose: The purpose of the present study was to evaluate the postoperative skeletal stability of two-jaw surgery (Le Fort I osteotomy and bilateral sagittal split ramus osteotomy) via surgery first orthodontic treatment (SFOT) in class III malocclusion. Methods: Thirty-two patients who had two-jaw surgery via SFOT were included in this study. Serial lateral cephalograms were obtained before (T0), immediately after (T1), and six months after (T2) surgery. Twelve variables were measured for horizontal and vertical skeletal stability as well as for dental change. All measurements were evaluated statistically by a paired t-test ($P$ <0.05). Results: The mean skeletal changes were $0.1{\pm}2.5$ mm at point A and $-12.0{\pm}7.4$ mm at the pogonion. The mean horizontal relapse was 11.6% at the pogonion, and the mean vertical surgical changes included an upward displacement of $2.1{\pm}7.1$ mm and a forward displacement of $1.4{\pm}4.6$ mm at the pogonion. Upper incisor inclination decreased after surgery and was maintained at T2, and lower incisors were proclined from T1 to T2 by postsurgical orthodontic treatment. Conclusion: Postoperative skeletal stability of two-jaw surgery via surgery first orthodontic treatment in class III malocclusion was clinically acceptable.

• 대한치과교정학회지
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• 제46권1호
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• pp.42-54
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• 2016

The aim of this clinical report is to describe the complex treatment of an adult Class III malocclusion patient who was disappointed with the outcome of a previous oral rehabilitation. Interdisciplinary treatment planning was performed with a primary indication for implant removal because of marginal bone loss and gingival recession, followed by orthodontic and surgical procedures to correct the esthetics and skeletal malocclusion. The comprehensive treatment approach included: (1) implant removal in the area of the central incisors; (2) combined orthodontic decompensation with mesial displacement and forced extrusion of the lateral incisors; (3) extraction of the lateral incisors and placement of new implants corresponding to the central incisors, which received provisional crowns; (4) orthognathic surgery for maxillary advancement to improve occlusal and facial relationships; and finally, (5) orthodontic refinement followed by definitive prosthetic rehabilitation of the maxillary central incisors and reshaping of the adjacent teeth. At the three-year follow-up, clinical and radiographic examinations showed successful replacement of the central incisors and improved skeletal and esthetic appearances. Moreover, a Class II molar relationship was obtained with an ideal overbite, overjet, and intercuspation. In conclusion, we report the successful esthetic anterior rehabilitation of a complex case in which interdisciplinary treatment planning improved facial harmony, provided gingival architecture with sufficient width and thickness, and improved smile esthetics, resulting in enhanced patient comfort and satisfaction. This clinical case report might be useful to improve facial esthetics and occlusion in patients with dentoalveolar and skeletal defects.

• 대한치과교정학회지
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• 제50권5호
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• pp.304-313
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• 2020

Objective: The aim of this study was to evaluate the stability of bimaxillary surgery involving bilateral intraoral vertical ramus osteotomy performed with or without presurgical miniscrew-assisted rapid palatal expansion (MARPE) in adult patients with skeletal Class III malocclusion. Methods: A total of 40 adult patients with skeletal Class III malocclusion were retrospectively divided into two groups (n = 20 each) according to the use of MARPE for the correction of transverse maxillomandibular discrepancy during presurgical orthodontic treatment. Serial lateral cephalograms and dental casts were analyzed until 6 months after surgery. Results: Before presurgical orthodontic treatment, there was no significant differences in terms of sex and age between groups. However, the difference of approximately 3.1 mm in the maxillomandibular intermolar width was statistically significant (p < 0.001). Two days after surgery, the mandible had moved backward and upward without any significant intergroup difference. Six months after surgery, the maxillary intercanine (2.7 ± 2.1 mm), interpremolar (3.6 ± 2.4 mm), and intermolar (2.0 ± 1.3 mm) arch widths were significantly increased (p < 0.001) relative to the values before presurgical orthodontic treatment in the MARPE group; these widths were maintained or decreased in the control group. However, there was no significant difference in surgical changes and the postsurgical stability between the two groups. No significant correlations existed between the amount of maxillary expansion and postsurgical mandibular movement. Conclusions: MARPE is useful for stable and nonsurgical expansion of the maxilla in adult patients with skeletal Class III malocclusion who are scheduled for bimaxillary surgery.