• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.21.1-21.8
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• 2015

Computer Assisted Simulation Surgery (CASS) is a reliable method that permits oral and maxillofacial surgeons to visualize the position of the maxilla and the mandible as observed in the patient. The purpose of this report was to introduce a newly developed strategy for proximal segment management according to Balanced Orthognathic Surgery (BOS) protocol which is a type of CASS, and to establish the clinical feasibility of the BOS protocol in the treatment of complex maxillo-facial deformities. The BOS protocol consists of the following 4 phases: 1) Planning and simulation phase, 2) Modeling phase, 3) Surgical phase, and 4) Evaluation phase. The surgical interventions in 80 consecutive patients were planned and executed by the BOS protocol. The BOS protocol ensures accuracy during surgery, thereby facilitating the completion of procedures without any complications. The BOS protocol may be a complete solution that enables an orthognatic surgeon to perform accurate surgery based on a surgical plan, making real outcomes as close to pre-planned outcomes as possible.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.11.1-11.5
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• 2015

Rapid palatal expansion(RPE) with the tooth-born appliance is not sufficient to apply to the patients with periodontal problem or insufficient tooth anchorage, and it leads to tipping of the anchorage teeth and increasing teeth mobility and root resorption. To avoid these disadvantages, we present the case using palatal screws and custommade palatal expander. A 23-year-old patient underwent surgically assisted rapid maxillary expansion with the Hyrax expansion using 4 tent screws. The study models were used to measure the pre-/-post surgical width of the anterior and posterior dental arches with a digital sliding caliper. In the result, the custom-made palatal expander with 4 tent screws is suitable for delivering a force to the mid-palatal suture expansion. And it is low cost, small sized and simply applied. The results indicated that maxillary expansion with the custom-made palatal anchorage device is predictable and stable technique without significant complications in patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권2호
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• pp.115-119
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• 2017

Maxillofacial images must be examined to find pathologies not identified during clinical examination. Unicystic ameloblastoma (UA) extending to the mandibular body and ramus was neglected on initial panoramic radiographic examination. After orthodontic therapy, a huge lesion was observed clinically and through imaging exams. After the conservative surgery, no recurrence was observed during five years of follow-up. This case emphasized the need for careful evaluation of patient images focusing on the oral diagnosis before any dental treatment planning, including orthodontic therapy.

• 대한구순구개열학회지
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• 제10권1호
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• pp.57-65
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• 2007

It is well known that the main factor which contributes to the relapse of orthognathic surgery for Cleft Lip and Palate (CLP) patients is post-operative scar on hard and soft palate of maxilla. Therefore, to compensate the amount of relapse, though it cannot be the perfect way to prevent orthodontic, orthopedic relapse, the Le-fort I osteotomy of maxilla and set-back osteotomy of mandible are generally carried-out simultaneously. We are to review the factors contribute to the relapse of CLP patients after orthognathic surgery through this clinical case : The relapse of Skeletal Class III tendency immediately after orthognathic surgery for grown up CLP patients.

• 대한치과교정학회지
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• 제26권1호
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• pp.53-63
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• 1996

경희대학교 부속 치과병원 교정과에 내원한 환자들 중 초진시 2도 이상의 측두하악장애증상을 보이는 환자 73명과 교정치료로 내원한 환자들중 부정교합을 보이나 측두하악장애가 0도인 환자 30명으로 총 103명의 상하악모형과 정모두부방사선사진을 대상으로 수평피개, 수직피개, 개방교합, 반대교합, Curve of Spee의 깊이, 정중선 편위, 안모비대칭, 치면마모, 치료지수, 연령 및 성별분포 등을 분석한 결과 다음과 같은 결론을 얻었다. 1. 측두하악장애군의 연령분포는 20대, 10대, 9세 이전의 순으로, 여성의 비율이 더 많았으며 두 군간에 유의한 차이가 있었다(p<0.001). 2. 수평피개와 수직피개는 두 군간에 유의한 차이를 보이지 않았으며 (p<0.05) 수평피개와 수직피개를 함께 고려한 6가지 분류는 두 군간에 유의한 차이를 보였다(p<0.01). 3. 전치부개방교합은 장애군에서 더 많았으나, 두 군간에 유의한 차이는 없었다. 4. 전치부 반대교합은 정상군에서 더 많았으나, 구치부 반대교합은 장애군에서 더 많았으며 유의한 차이를 보였다 (p<0.05). 5. Curve of Spee의 깊이는 측두하악장애군이 더 깊었으며, 두 군간에 유의한 차이를 보였다(p<0.01). 6. 정중선편위는 두 군간에 유의한 차이가 없었으나, 안모비대칭은 장애군에서 더 많았으며 두 군간에 유의한 차이를 보였다(p<0.01). 7. 치면마모는 측두하악장애군이 정상군보다 많았으며 유의한 차이를 보였다(p=0.001). 8. 치료지수는 두 군간에 유의한 차이를 보이지 않았다. 이상의 결과로 볼 때, 측두하악장애를 보이는 군은 전치부 개방교합, 구치부 반대교합, 깊은 Curve of Spee, 치면마모 및 안모 비대칭 등의 여러가지 부정교합 양상을 보이는 경우가 많았다. 고로 이러한 부정교합의 양상들 보이는 환자들은 측두하악장애의 가능성이 많으므로 치료계획 수립시나 치료기간 동안 주의를 기울이는 것이 바람직할 것으로 사료된다.

• 구강회복응용과학지
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• 제16권2호
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• pp.133-147
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• 2000

A well-planned, precise occlusal adjustment of natural teeth has some distinct advantages over other forms of occlusal therapy. It should be emphasized, however, that an occlusal adjustment is an irreversible procedure and has definite contraindications in some mouths. Generally, the treatment methods for the patients that has open-bite will be following as below. : (1) Use of removable orthopedic repositioning appliance, (2) Orthodontics, (3) Full or partial reconstruction of the dentition, (4) Orthognathic surgical procedure, (5) Occlusal adjustment of the existing natural teeth, (6) Any combination of the above. Above all, the advantages of occlusal adjustment of natural teeth are : (1) the patient is more able to adapt to the changes in jaw position and posture; (2) the phonetic or speaking ability of the patient is not significantly changed and usually is improved; (3) the esthetics of the natural teeth is not altered and often is better; (4) the hygiene of the individual teeth is easily maintained; and (5) the functional usage of the teeth as cutting and chewing devices is markedly improved. The objective of an occlusal adjustment, as with any form of occlusal therapy, is to correct or remove the occlusal interferences, or premature contacts, on the occluding parts of the teeth which prevent a centric relation closure of the mandible. A systematic, disciplined approach can be followed in treatment, the objectives should be listed. They are : (1) Centric relation occlusion of the posterior teeth. (2) Proper "coupling" of the anterior teeth. (3) An acceptable disclusive angle of the anterior teeth in harmony with the condylar movement patterns. (4) Stability of the corrected occlusion. (5) Resolution of the related symptoms. For the patient with open-bite on anterior and posterior teeth, this case report shows the treatment methods in combination the fixed prosthesis with the selective cutting of the natural teeth. Occlusal adjustment is no longer an elective procedure but a mandatory one for patients requiring restorations and those in treatment for TMD dysfunctions or those whose dentitions show signs of occlusal trauma. Occlusal adjustment is essential for all who do not display the above lists.

• 대한치과교정학회지
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• 제34권4호
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• pp.325-332
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• 2004

본 연구의 목적은 산부식과 전처리 과정을 결합하여 접착 단계를 단순화시킨 self-etching primer의 임상적인 유용성 을 판단하고자, self-etching primer로 브라켓을 접착하는 방법과 기존의 $37\%$ 인산으로 부식하여 접착하는 방법을 사용하여, 광중합시 사용되는 광원 및 브라켓 종류에 따른 전단결합강도와 접착파절양상에 관하여 비교 연구하는 것이다. 사람의 상하악 소구치를 포매하여 만든 시편을 부식 및 전처리 방법에 따라 각각 $37\%$ 인산으로 산부식 후 Transbond XT primer를 사용하여 접착한 군과 Transbond Plus self-etching primer를 사용하여 접착한 군으로, 광원 종류에 따라 가시광선과 plasma arc light을 이용하여 중합한 군으로 나누었고, 브라켓 종류에 따라 금속브라켓과 세라믹 브라켓을 사용하여 접착한 군으로 분류하여 각 군간의 전단결합강도와 접착파절양상을 관찰하여 다음과 같은 결과를 얻었다. 1. 광원과 브라켓 종류가 동일한 조건일 때, self-etching primer를 사용하여 접착한 군과 XT primer를 사용하여 접착한 군간의 전단결합강도는 통계적으로 유의한 차가 없었다. 2. 금속브라켓을 접착한 경우, 광원과 부식 및 전처리 방법에 따른 전단결합강도는 통계적으로 유의한 차가 없었다. 3. Self-etching primer와 XT primer를 사용하여 접착한 군 모두에서 세라믹 브라켓을 사용하여 접착한 군의 전단결합 강도는 금속브라켓을 사용하여 접착한 군보다 통계적으로 유의하게 컸다(p<0.001). 4. 접착제 잔류지수는 self-etching primer를 사용하여 접착한 군과 XT primer를 사용하여 접착한 군에서 통계적인 유의한 차가 없었으며, 세라믹 브라켓을 사용하여 접착한 군에서 금속브라켓을 사용하여 접착한 군보다 유의하게 커서, 법랑질-레진 접착 계면 부위의 파절이 더 많은 것으로 나타났다. 이상의 결과로 미루어 보아 Transbond Plus self-etching primer를 사용하여 브라켓을 접착하는 것은 적절한 결합강도를 얻으면서도 사용이 간편하고 시술 시간을 단축시킬 수 있으므로 임상적으로 유용할 것으로 판단된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.413-419
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• 2011

Purpose: Reposition of the maxilla is a common technique for correction of midfacial deformities. To achieve the goal of the surgery, the maxilla should be repositioned based on the precisely planned position during surgery. The internal reference points (IRPs) and the external reference points (ERPs) are usually used to determine vertical dimension of maxilla, which is an important factor for confirming maxillary position. However, the IRPs are known to be inaccurate in determining the vertical dimension. In this study, we investigated the correlation of positional change of the modified IRPs with repositioned maxilla. Methods: The study group consisted of 26 patients with dentofacial deformities. For the simulation of the surgery, patient maxillary CT data and 3-D virtual surgery programs (V-$Works^{(R)}$ and V-$Surgery^{(R)}$) were used. IRPs of this study were set on both the lateral wall of piriform aperture, inferior margin of both infraorbital foramen, and the labial surfaces of the canine and first molar. The distance from the point on lateral wall of the piriform aperture to the point on the buccal surface of the canine was defined as IRP-C, and the distance from the point on the inferior margin of the infraorbital foramen to the point on the buccal surface of the $1^{st}$ molar was defined as IRP-M. After the virtual simulation of Le Fort I osteotomy, the changes in IRP-C and IRP-M were compared with the maxillary movement. All measures were analyzed statistically. Results: With respect to vertical movements, the IRP-C (approximately 98%) and the IRP-M (approximately 96%) represented the movement of the canine and the $1^{st}$ molar. Regarding rotating movement, the IRPs changed according to the movement of the canine and the $1^{st}$ molar. In particular, the IRP-C was changed in accordance with the canine. Conclusion: IRPs could be good indicators for predicting vertical movements of the maxilla during surgery.

• 대한치과교정학회지
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• 제22권3호
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• pp.509-529
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• 1992

Skeletal Class III malocclusion is one of the most difficult type to treat and stabilize. For a child with developing skeletal Class III malocclusion, the treatment objective would be to stimulate maxillary growth, particulary one who has markedly deficient maxilla, and to restrain excessive mandibular growth. In order to stimulate the maxillary growth, maxillary protraction appliance is the one of the effective orthopedic appliances in skeletal Class III. The purposes of this study were as follows ; evaluation of the skeletal and dental changes of the maxillary protraction in children with Class III Maxillary deficiency , comparison of the clinical effects between the group with RPE and labiolingual intraoral appliances , comparison of the clinical effects and stability related to the ages of the patients : stability of the maxillary protraction about 1 year after retention. The subjects consisted of 60 children between the ages of 8 and 13.4 who were diagnosed as Class III with maxillary deficiency and were treated with Face Mask (Delaire Type) from the Dept. of Orthodontics Yong Dong Severance Hospital, Yonsei University. 48 children wore the RPE and 12 children wore Labiolingual Appliance. Lateral Cephalograms were taken for each patient at before and after correction of anterior cross-bite in 60 children, and after an observation period of 10 to 14 months in 19 children. X and Y coordinate of 10 landmarks were analyzed using a horizontal line through sella and rotated $6^{\circ}$ down anteriorly as the horizontal reference axis, and a perpendicular verticual line through sella as the vertical reference axis. Each of the 31 measurents (10 verticals, 10 horizontals, 2 angles and 9 others) was statistically analyzed using SPSS/PC statistics. The results are as follows; 1. After maxillary protraction the maxilla and maxillary teeth moved downward and forward, while the mandible and mandibular incisor rotated downward and backward. 2. Maxillary protraction with rapid palatal expansion appliance was more effective than with labiolingual appliance. 3. More downward movement of the posterior palatal plane obserbed with maxillary protraction doing the midpalatal suture opening than with protraction after finishing the palatal expansion 4. The clinical effects of protraction and changes of the retention periods were not statistically significant among the age groups. 5. During the retention period, maxilla and maxillary teeth, and mandible and mandibular teeth moved downward and forward, however the mandibular changes were larger than the maxillary changes.

• 대한치과교정학회지
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• 제34권1호
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• pp.63-70
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• 2004

상악에 미니스크류를 적용할 때 사용되는 정중 구개봉합부는 특별한 해부학적인 구조물이 존재하지 않으며 두꺼운 치밀뼈로 구성되고 각화치은으로 덮여 있는 장점이 있어서 미니스크류를 식립하기에 유리하다. 그러나 측모 두부 방사선 사진 상에서 보이는 정중 구개봉합부는 그 두께가 얇아 통상적으로 사용되는 미니스크류 식립시 골 천공의 위험과 안정성 에 문제가 있을 것으로 생각되기 쉽다. 본 연구는 미니스크류 식 립을 위 한 정중 구개봉합부의 수직골의 두께를 알아보기 위해 총 25명 (남 : 13, 여 : 12)의 20대 환자 전산화 단층촬영 상을 이용하였다. 전산화 단층촬영상의 횡단면으로부터 정중구개봉합부의 수직골 두께를 계측하였고 각 부위의 유의성을 조사하여 다음과 같은 결론을 얻었다. 1. 정중 구개 봉합부 골의 두께는 남녀간의 유의할 만한 차이를 보이지 않았다. 2. 관상단면에서 보았을 때 정중 구개 봉합부를 중심으로 좌우로 갈수록 두께가 감소하는 양상을 보였고 시상단면에서 보았을 때 절치공에서 후비극쪽으로 갈수록 두께가 감소하는 양상을 보였다. 3. 수평적으로 정중 구개 봉합부 좌우 3mm 이내, 전후방적으로 절치공 후방 25mm 까지는 골의 두께가 3-4mm이상으로 미니스크류 식립을 위한 수직적골 골의 두께가 충분하였다.