• 대한치과의사협회지
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• 제57권12호
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• pp.758-767
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• 2019

The classification of periodontal disease in 1999 has been widely used for determining a diagnosis, establishing a treatment plan, and evaluating the prognosis of the patient with periodontal disease. However, scientific evidence from many studies indicates the need for a new classification system for periodontal and peri-implant disease. Summary at 2017 world workshop as follows: 1) Periodontal health and peri-implant health was defined; 2) Chronic periodontitis and aggressive periodontitis were unified as periodontitis; 3) Periodontitis was further classified by staging and grading to reflect disease severity and management complexity, rate of disease progression, respectively; 4) Periodontal disease as manifestation of systemic disease is based on the International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) code; 5) Periodontal biotype and biologic width was replaced to periodontal phenotype and supracrestal tissue attachment, respectively; 6) The excessive occlusal force was replaced by a traumatic occlusal force; 7) ≥3 mm of radiographic bone loss, ≥6 mm of pocket probing depth and bleeding on probing indicates peri-implantitis in the absence of radiograph at final prosthesis delivery.

• 구강회복응용과학지
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• 제16권2호
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• pp.149-159
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• 2000

Occlusal disease is comparable to periodontitis in that it is generally not reversible. Occlusal disease, however, like periodontitis, often maintainable. It does itself to treatment and when restorative dentistry is utilized it becomes, in that sense, reversible. Moreover, a systematized and integrated approach will lead to a prognosis that is favorable and predictable. This approach facilitates development of optimum oral function, comfort, and esthetics, resulting in a satisfied patient. Such a systematized approach consists of four logical phase : (1) patient evaluation, (2) comprehensive analysis and treatment planning, (3) integrated and systematic reconstruction, and (4) postoperative maintenance. An integrated treatment plan is first developed on one set of diagnostic casts, properly mounted on a semiadjustable articulator using jaw relationship records. This is accomplished by using wax to make reconstructive modifications to the casts. These modified casts become the blueprint for planned occlusal changes and the fabrication of provisional restorations. The treatment goals are : (1) comfortably functioning temporomandibular joints and stomatognathic musculature, (2) adherence to the basic principle of occlusion advocated by Schuyler, (3) anterior guidance that is in harmony with the envelope of function, (4) restorations that will not violate the patient's neutral zone. This report shows the treatment procedures for a patient whose mandibular position has been altered due to posterior bite collapse. Migration of the maxillary anterior teeth had occurred, and the posterior occlusal contacts showed pathologic interference. Precise diagnosis using mounted casts was executed and prosthodontic reconstruction by the aid of an unconventional orthodontic correction on maxillary flaring was planned. An unconventional orthodontic correction can be accomplished by using preexisting natural teeth, which can be modified for use in active tooth movement or splinted together for orthodontic anchorage. This technique has an advantage over conventional fixed appliance orthodontic therapy because it can accomplish tooth movement concurrently with restorative and periodontal therapy. On occasion, minor tooth movement can be necessary to achieve the optimum occlusal scheme, crown form, and tooth position for the forces of occlusion to be displaced down the long axis of the periodontally compromised teeth. Once the occlusion, periodontal health, and crown contours for the provisional splinted restoration are acceptable, the final splinted restoration can be similarly fabricated, and it becomes an excellent orthodontic retainer.

• 대한치과의사협회지
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• 제53권11호
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• pp.844-854
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• 2015

This clinical report describes an orthodontic-prosthodontic interdisciplinary treatment for a patient with multiple missing teeth and unilateral scissors bite. A 47-year-old female presented with multiple missing posterior teeth, anterior large overjet, deep bite, and posterior scissors bite on the right premolar area. Periodontal therapy was performed and followed by orthodontic treatment. The maxillary anterior teeth were initially aligned, then two implants were placed for the left mandibular molars to increase occlusal vertical dimension. The scissors bite between the right maxillary and mandibular premolars were corrected using the miniscrews as an anchorage. Other implants were placed for the right maxillary and mandibular molars after the occlusal planes and occlusal relationship were harmonized. The patient adapted well to altered vertical dimension without any specific problems including peri-implant marginal bone loss. Interdisciplinary approach resolve the complex orthodontic-prosthodontic problems and concluded in successful results.

• 대한치과의사협회지
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• 제50권1호
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• pp.22-30
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• 2012

The methods for the occlusal force measurement have long been developed. The occlusal analyzing equipment utilizing the pressure-sensitive film (Prescale) is useful for the assessment and comparison among large group of patients. On the other hand, the apparatus which uses the grid-based sensor sheet (T-scan) can be a useful assistant for acquiring the well-balanced occlusion. The device that can process the electrical input from the strain gauge which is attached to the tooth surface can collect the dynamic data of actual masticatory force. This device has been developed for the measurement of actual mastication with the food bolus and it can be a useful method for the comparison before and after the restorative treatment. Occlusal force measurement can be applied for the analysis of therapeutic action, diagnosis of crack- tooth syndrome, temporomandibul ar disease, and idiopathic implant loosening.

• 대한소아치과학회지
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• 제31권3호
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• pp.448-452
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• 2004

외상성 교합은 교합력의 결과로서 치주조직에 가해지는 손상이다. 주된 증상은 치아의 동요도이고, 통증, 타진에 민감, 열에 민감한 증상이 동반될 수 있으며 교합력에 의해 치아가 이동을 할 수도 있다. 만성으로 진행시 치아의 과도한 교모가 나타나며 방사선학적으로 치근막 공간의 비후, 치조백선의 비후, 치조골의 방사선 투과성 치근흡수 등이 나타날 수 있다. 외상성 교합은 치주질환의 원인과 관련되어 있다. 증가된 치아동요도를 야기하며 외상성 교합 자체는 치은염과 치주낭을 발생시키지 않으나 국소적 치태와 염증이 존재하고 있는 하에서 골소실, 치주낭이 발생할 수 있다. 치은퇴축은 외상성 반월, 맥콜스 팽윤, 스틸만 균열의 형태로 나타난다. 본 증례는 하악 유견치 부위의 치주질환을 주소로 내원한 5세 남아로서 상하악 유견치의 조기 접촉에 의해 하악 좌우측 유견치의 중증도의 동요도, 교합마모, 치은 퇴축, 치조골 파괴의 증상이 나타났기에 보고하는 바이다.

• Journal of Oral Medicine and Pain
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• 제21권1호
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• pp.67-78
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• 1996

This study was performed to compare the TMJ sounds by means of vibration-related items by Sonopak such as integral, high integral, above 300/(0-300) ratio, peak amplitude, peak frequency and median frequency before and after occlusa1 splint therapy as well as counselling, physical modalities. For this study 22 patients with craniomandibular disorders (CMDs) were selected and examined by routine diagnostic procedure for CMDs including Transcranial and Panoramic radiographs and were classified into 3 CMDs subgroups : disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Visual analogue scale (VAS) about joint sound was recorded during treatment period and VAS treatment index (VAS Ti) was calculated from the VAS data and treatment duration. The author evaluated and compared treatment results by several parmeters such as symptom duration, timing of joint sound, parafunctional habits, trauma, and diagnostic classification. The obtained results were as follows : 1. Before the treatment, the highest value of peak amplitude was observed in disc displacement with reduction group and value of median frequency was highest in degenerative joint disease group. In addition the highest values of peak frequency and ratio ware observed in degenerative joint disease group, though they were not significant. Furthermore the lowest value of high integral was observed in disc displacement without reduction group and though it was not significant, value of integral was lowest in that group. 2. Among 3CMDs subgroups disc displacement with reduction group showed the significantly decreased value of high integral and degenerative joint disease group had the significantly decreased value of integral after conservative treatment including occlusal splint therapy. Conclusively conservative treatment including occlusal splint therapy vay be effective in the treatment of CMDs including TMJ sound. 3. Fair prognosis for conservative treatment was observed in acute group under 6 months than chronic group, 6 months over in symptom duration but there was no statistical difference. The result for conservative treatment was observed slightly poor in subjects with bruxism, clenching, unilateral chewing habit and trauma history but there were no statistical differences.

• 구강회복응용과학지
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• 제17권3호
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• pp.145-154
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• 2001

In the past, many dentist were interested mainly in the mechanical aspects such as tooth preparation and retainer types for making dental restoration. But, these days, the concept of restorative treatment emphasizes the importarce of gnatic system and masticatory muscles in addition to oral cavity. So, the current considerations for the fixed prosthodontic treatment include the stabilization of temporomandibular joint and neuromuscualr system and the relationship of periodontal ligament and occlusion. To achieve the above objectives, occlusal splint has been used as one of the mouth preparations for restorative treatment. The objectives of occlusal splint are as follows; 1. To use as preliminary application for periodontal-occlusal treatment 2. To provide proper vertical dimension 3. To control abnormal habits and parafunction 4. To treat the temporomandibular disease and myofascial pain 5. To establish the new therapeutic position In some cases, the patients had improper vertical dimension and occlusal interferences caused by prostheses reconstucted using centric relation recorded without considering the health of TMJ and manticatory muscle. And these prosthesis act as primary source that cause pathologic phenomenon in periodontal ligament, muscles and TMJ. Physiologically, in order to make the treatment occlusion guided by proper centric relation method, the method should be guided after the use of occlusal splint for some period. The main objective of prosthetic treatment is to maintain the function and health of stomatognathic system. So, one of the most important things that have to be performed by clinicians is a clinical ability to do the correct diagnosis and treatment planning based on the stomatognatic function and occlusion.

• Journal of Korean Dental Science
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• 제10권1호
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• pp.35-44
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• 2017

In case of loss of many teeth due to dental caries or periodontal disease, improvement of masticatory function and aesthetics can be obtained through implant treatment. However, if the patient does not have a normal intercondylar relationship, it is difficult to achieve an ideal occlusal relationship with only prosthetic treatment. In particular, oral reconstruction with orthodontic treatment or orthognathic surgery is necessary for patients with mandibular prognathism. However, if the posterior occlusion collapses due to severe caries or periodontal disease, orthognathic surgery may be difficult. The occlusal vertical stop is very important for the stability of the mandibular position during occlusal reconstruction through orthognathic surgery. The patient in this case had posterior occlusion collapsed due to the caries of a large number of posterior teeth, and showed mandibular prognathism and long face. We planned a full arch restoration with orthognathic surgery and extracted the hopeless teeth. To secure the vertical stop required for orthognathic surgery, the implant was placed before surgery. After the orthognathic surgery and the final prosthesis application, the results were satisfactory for the improvement of the aesthetics and the restoration of the masticatory function.

• 구강회복응용과학지
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• 제29권1호
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• pp.45-58
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• 2013

교합접촉 분석에 이용되는 T-Scan $III^{(R)}$ (Tekscan, South Boston, MA, USA)의 정확도 및 신뢰도를 Add picture 방법을 통해 평가하였다. 두 방법에서 공통적인 교합접촉점의 분포 및 교합접촉면적을 비교하여 교합진단 및 조정 술식에서 T-Scan 방법의 적용 시 고려점을 밝히고자 하였다. Angle I급 교합관계, 정상치열자 한 사람의 구강을 대상으로 부가중합형 실리콘인상재를 이용하여 상하악치열궁을 10회 인상채득하였으며, 10쌍의 초경석고 모형을 제작하였다. 자체제작한 하중장치에 모형을 자석과 경석고를 이용하여 부착한 후 최대감합위와 최대교합력을 재현하기 위해 78.9kg의 하중을 가하였다. T-Scan 측정 시에는 상하악 모형과 T-Scan 센서의 위치가 변하지 않는 상태에서 2번 반복 측정하였다. Add Picture의 경우 상하악모형을 동일한 하중을 가하여 최대감합위에서 폴리이써 교합인기재를 이용하여 교합을 인기하였다. 교합접촉 양상은 접촉점 수와 총 교합면적에 대한 접촉면적 백분율을 측정하여 비교하였다. T-Scan 방법은 포토샵 프로그램 상에서 픽셀수를 계산하여 색상에 따른 면적을, Add picture 방법은 빛 투과 정도에 따라 인상재 두께를 $0{\sim}10{\mu}m$, $0{\sim}30{\mu}m$, $0{\sim}60{\mu}m$의 3가지로 나누고, 이에 따른 면적을 실측하여 계산하였다. 총 교합면면적은 접촉면을 표시한 모형의 촬영상에서 픽셀수를 계산하여 함께 촬영된 격자를 기준으로 제곱미터값으로 변환하였다. 대응표본 t-검정을 이용하여 통계분석하였다. T-Scan 방법에서 분홍색상 및 붉은 색상으로 표시된 면적의 일부가 Add picture 방법에서 $0{\sim}10{\mu}m$, $0{\sim}30{\mu}m$, $0{\sim}60{\mu}m$의 상하악 치아 간 거리에 해당하는 면적에 상응하였다. 교합접촉점 분포 비교 시 T-Scan 방법과 Add picture 방법은 유사하였다. 교합접촉면적 비교 시 T-Scan 방법에서 확대된 결과가 관찰되었으며, 전체교합면적에 대한 접촉면적 백분율 비교에서도 T-Scan 방법과 Add picture 방법의 백분율값은 유의한 차이를 보였다(P<.05). T-Scan에서 분홍색상 및 붉은 색상으로 표시된 부위의 면적값은 Add picture의 $0{\sim}10{\mu}m$, $0{\sim}30{\mu}m$ 부위의 면적값보다 크고(P<.05), $0{\sim}60{\mu}m$ 부위와는 유사한 값을 보였다(P>.05). T-Scan에서의 교합접촉상은 실제보다 확대되어 나타났으며, 따라서 교합접촉에 대한 진단 및 조정 술식에서 보조적인 수단으로 활용하는 것이 추천된다.

• Journal of Oral Medicine and Pain
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• 제32권4호
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• pp.375-381
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• 2007

교합안정장치는 턱관절장애의 관리를 위해 가장 많이 선택되어지는 치료방법이다. 교합안정장치는 치료목적을 달성하기 위해 구강 내에서 매일 수 시간씩 착용하며, 전체적인 치료기간은 적게는 6개월에서 길게는 2년 가량이 소요된다. 구강 내에서 교합안정장치는 틀니나 고정식 교정장치의 경우처럼 의도하지 않게 타액이나 산소로부터 세균을 보호하고, 세균의 저장고로서 역할을 수행할 수 있는 가능성이 있다. 이런 조건은 일반적으로 치주질환과 구취를 유발하는 주요 원인균인 혐기성 세균과 치아우식에 중요한 역할을 하는 S. mutans의 서식에 용이한 환경을 제공하게 되어 교합안정장치을 사용하게 되면서 발생되는 나쁜 맛이나 치주질환, 치태 형성 및 치아우식의 원인요소가 될 수 있다. 이 실험에서는 교합안정장치 사용 전후 구강 내 특정 치아에서 혐기성 세균과 S. mutans 수의 변화를 비교함으로써 교합 안정장치가 이들 세균 수 증가에 어떠한 영향을 끼치며, 그것이 임상적으로 어떤 의미를 가지는지에 대해 알아보고자 하였다. 총 4명의 남성(평균나이 27.5 세)이 참여하였고, 하루 9시간씩 상악교합안정장치를 취침시간 동안에만 사용하였으며, 총 5일 간 진행하였다. 5일 후 교합안정장치를 제거한 구강에서 상악좌측제2대구치, 상악좌측중절치, 하악좌측제2대구치를 각각 선택하여 치태와 타액이 혼재된 샘플을 정해진 규격으로 채취하였다. 각각의 샘플은 혐기성 세균 배양을 위한 혈액한 천배지와 S. mutans 선택배지에 각각 $100{\mu}{\ell}$씩 도말하여 $37^{\circ}C$ 10% $CO_2$ 조건으로 3일간 혐기 배양하였다. 각각의 배지에서 배양된 세균을 집락형성단위(CFU) 기준으로 육안으로 세어 최종적으로 CFU/ml로 환산해 기록하였다. 얻어진 자료를 통해 다음과 같은 결론을 내렸다. 1. 교합안정장치 사용에 따라 구강 내 혐기성 세균 수와 S. mutans 수의 변화가 생겼다. 2. 혐기성 세균의 경우 교합안정장치 사용에 따라 상악제2대구치(P=0.003)와 상악중절치(P=0.020)에서 모두 그 수가 유의하게 증가하였다. 3. 교합안정장치의 장착은 직접 피개되지 않은 대합치아의 혐기성 세균 수 증가에도 간접적인 영향을 끼쳤다. 4. S. mutans의 경우 교합안정장치 사용에 따라 상악제2대구치(P=0.043)와 상악중절치(P=0.049)에서 모두 그 수가 유의하게 증가하였다. 5. 교합안정장치의 장착은 직접 피개되지 않은 대합치아의 S. mutans 수에 어떤 영향도 끼치지 않았다.