J Korean Academy of Advanced General Dentistry 2015;4:27-32 Need of Orthodontic Treatment and Considering Factors from Interdisciplinary Point of View

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1 J Korean Academy of Advanced General Dentistry 2015;4:27-32 Need of Orthodontic Treatment and Considering Factors from Interdisciplinary Point of View : Focused on Case 전상민, 김민선, 이강희, 박원서, 정복영, 김기덕, 방난심 연세대학교치과대학통합진료학과 Sangmin Jeon, Minseun Kim, Kang-Hee Lee, Wonse Park, Bock-Young Jung, Kee-Deog Kim, Nan-Sim Pang Department of Advanced General Dentistry, College of Dentistry, Yonsei University ABSTRACT In general, most cases for interdisciplinary treatment often demonstrate a poor periodontal health, moderate dental caries requiring multiple extractions, or a missing tooth status. Missing teeth or a poor periodontal heath can cause tooth movement over time, which leads to the collapse of teeth alignment and therefore requires a space redistribution when establishing a treatment plan. In case when the existing periodontal health is poor, however, one should be careful for initiating orthodontic treatment, which should be applied to a proper case only. Once a treatment initiation is decided, the periodontal inflammation control - the most crucial factor - should be considered with caution over three stages: pre-treatment, mid-treatment, and post-treatment stage. Key words : Interdisciplinary treatment, Orthodontic treatment, Periodontal inflammation 서 최근중년여성이나남성환자들이앞니가점점삐뚤어 진다며, 전치부의총생을주소로내원하는경우가많다. 내 원시치료를안할경우총생의정도가더심해지는지, 총 생이심해질경우향후무슨문제가발생할수있는지에대해많은문의를한다. 질문의내용으로보면심미적인목적도있지만치아의기능또는예후가교정치료여부의중요요인으로작용하고있음을알수있다. 휴지기또는연하시입술, 볼, 혀에의해발생하는힘의불균형은치주막대사활동에의해치아는특정위치에존재하게된다. 그러나어떠한요소에의해그힘의균형이 Correspondence : Prof. Nan-Sim Pang Department of Advanced General Dentistry, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul , Korea Tel: , fax: pangns@yuhs.ac Received: March 8, 2015; Revised: March 21, 2015; Accepted: March 26, 2015 론 깨어지게되면치아는이동하게되는데, 그대표적인예가치주의파괴로인한치근막대사활동의이상이다 1. 따라서치아의이동이있는사람은치아의위치를유지하는힘의균형이깨졌다고판단할수있으며, 더이동할가능성은크다고볼수있다. 그렇게이동한치아는총생의원인이되며, 이로인해 brushing이어려워지며 2, 이는 plaque 침착을기여하는요소가된다 3. 또한얇아진 interdental bone은약한자극에도 bone loss를초래하게되고 4 교합의변화로인해 TFO의발생가능성또한높아지게된다 5. 이러한요소들이맞물려치주질환의악화를초래할수있고, 이러한치주질환의악화는치아의이동을야기할수있으며, 이는총생을심화시키게되는악순환이발생할수있다 6. 이러한구조속에서교정치료는그목적을찾을수있다. 그러나통합적관점에서의치과치료가필요한경우교정치료는또다른성격을갖게된다. 상기한내용이외에도이상적인치료를위한붕괴된공간의회복또는공간의재 27

2 JOURNAL OF KOREAN ACADEMY OF ADVANCED GENERAL DENTISTRY Figure 1. 다수의치아상실과치아우식증으로인한공간의붕괴가관찰된다. Figure 2. #18, 17, 13, 22, 23, 28, 45 치아에대한발치진행하였으며, periodontal inflammation 이호전된것을관찰할수있다. 분배를위해필요하게된다. 증례보고 40세남환이전반적인치과치료를받고싶다는주소로내원하였다. 특별한 PMH는없었으나, 치과치료에대한공 포심에서내원을미룬경우에해당했다. 다수의치아우식이발견되며, 상하악전치부위 crowding과 spacing이관찰되며, #14, 24, 25 소구치의 rotation, 상악전치부의좌측 deviation이관찰된다. 또한 #45 치아발치시 #44, 45 두개의임플란트식립을위한공간이부족함을알수있는등전반적인공간의재분배가필요함을판단할수있다 (Fig 1). 교정전 hopeless tooth에대한발치를진행하였고 4주에 28

평가하였다 (Fig 2). 가능하면작은힘을가하는것이좋으므로 012 Ni-Ti로 #36 band 적용하에교정치료시작하였다 (Fig 3).

3 Jeon et al. Orthodontic Treatment for Interdisciplinary Approach 걸쳐진행중인 periodontal inflammation control 시행하였으며매번내원시 TBI 시행하고 tooth brushing ability 평가하였다 (Fig 2). 가능하면작은힘을가하는것이좋으므로 012 Ni-Ti로 #36 band 적용하에교정치료시작하였다 (Fig 3). 2주간격으로내원하며 plaque control 및 minocycline application 동반하에 alignment 진행하였으며, 다소치아의이동이빠른것을관찰할수있다. Figure 3. Bracket Bonding (012 Ni-Ti). Figure 4. POD 14 weeks : Lower space control with open coil (Mx. : 012 Ni-Ti / Mn. : 016 S-S). Figure 5. POD 18 weeks : Lower spce control with open coil (Mx. : 016 Ni-Ti / Mn. : 016 S-S). 29

JOURNAL OF KOREAN ACADEMY OF ADVANCED GENERAL DENTISTRY Figure 6. POD 52 weeks : Rotation control (Mx. and Mn. : 16 S-S). Figure 7. Implant place on #22, 44, 45.

4 JOURNAL OF KOREAN ACADEMY OF ADVANCED GENERAL DENTISTRY Figure 6. POD 52 weeks : Rotation control (Mx. and Mn. : 16 S-S). Figure 7. Implant place on #22, 44, 주후하악 #44, 45 임플란트식립위한공간확보위해 open coil spring 적용하였다 (Fig 4). 18주후 #33, 34 간의 space가많이닫힌것을관찰할수있으며, #44, 45 임플란트식립위한공간또한형성되고있는것을볼수있다 (Fig 5). 20주후상악 space control 시작하였다. #22, 23 missing 부위공간부족및상악전치부 midline correction 을위해 #12, 11, 21 치아를우측으로이동시키기로하였으 며, 최종적으로 #22, 23 공간평가후임플란트를한개심을지두개심을지결정하기로하였다. 환자분의개인적인사정으로 5개월 follow up loss 되었으나다행히잘유지되고있었으며, #24, 25, 34, 35 rotation control 시행하였다 (Fig 6). 그후 #44, 45 임플란트식립하였으며 #22, 23 부위는 2개의임플란트를식립하기에는충분한 space가확보되지않아 #22 부위에임플란트를한개만식립하였다 (Fig 30

5 Jeon et al. Orthodontic Treatment for Interdisciplinary Approach Figure 8. Implant crown delivery on #44, 45. 7). #44, 45 implant crown delivery 시행하였으며, 상악 #22, 23 부위의 implant crown 제작예정이다 (Fig 8). 고찰성인의경우치주염을가지고있는경우가 75% 에이른다고하며 7, 그중 destructive periodontal disease가 7~15% 에이른다 8 고보고한다. 그런경우교정치료는일종의 trauma로일시적또는영구적인해를미친다는의견도있으며 9, 일시적으로치주변화는발생하나, 장기적으로볼때는전혀해롭지않다는의견 10, 오히려치주건강상태는더좋아지는결과를낳는다 11 등의상반되는케이스들이보고되고있다. 하지만공통적으로교정치료의성패는 inflammation control에달려있다고말하고있다. Inflammation control 은교정전, 교정중, 교정후 3단계에걸쳐세심히이루어지며, 교정전에는 mucogingival correction, tooth brushing ability 향상을위해 TBI 시행, 진행중인치주염의치료를포함하며, 교정중에는 band의적용시반드시치은연상에위치시킬것, 과잉의 cement를제거할것, simple design 의교정장치를사용할것, 적어도 3개월간격으로 professional periodontal inflammation control 시행할것등을추천하며, 교정후에도 periodontal surgical retention procedure 시행하며, jiggling 등의 TFO가발생하지않도록 occlusal adjustment 시행할것, 정기적인치주건강상태 check up 할것등을 guideline으로제시하고있다 12. 그무엇보다중요한것은교정치료가개입되어도되는지에대한적당한 case selection이다. 환자의나이, general condition, 협조도, 현증에대한정확한평가, rotation, intrusion, bodily movement 등을포함한치아의이동양상과필요한정도, 교정치료의 simplicity, 또는필요한기간등을포함한교정치료의난이도를고려하여 case를선택해야한다. 또한이러한분석을통해교정치료를통해얻을수있는 benefit, 그리고교정치료로인해발생할수있는합병증에대한 risk에대해평가가이루어져야한다. 또한합병증발생시대안적치료가전제되어야한다. 참고문헌 1. Proffit WR. Equilibrium Theory Revisited: Factors Influencing Position of the Teeth. The Angle Orthodontist: July 1978;48(3): Alexander AG, Tipnis AK. The effect of irregularity of teeth and the degree of overbite and overjet on the gingival health; A study of 400 subjects, Brit Dent J 1970;128: Löe H, Anerud A, Boysen H, Morrison E. Natural history of peri- 31

6 JOURNAL OF KOREAN ACADEMY OF ADVANCED GENERAL DENTISTRY odontal disease in man Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age. J clinic Periodontol 1986;13: Polson AM. Long term periodontal status after orthodontic treatment, Am J Orhod 1988;93: Pritchard JF. The effect of bicuspid extraction orthodontics on the periodontium, J Peiodontol 1975;46: Sadowsky C, BeGole EA. Long-term effects of orthodontic treatment on periodontal health, Am J Orhtod 1981;80: Frazier M, Southard TE, Doster PM. Prevention of eamel demineralization during orthodontic treatment : an in vitro study using pit and fissure sealants, Am J orthod Dentofacial Orthop 1996;109: Ericsson I, Thilander BU. Orthodontic relapse in dentitions with reduced periodontal support : An experimental study in dogs. Eur J Orthod 1980;2: Alstard S, Zachrisson BU. Longitudinal study of periodontal condition associated with orthodontic treatment in adolescent. Am J Ortho 1979;76: Kloehn JS, Pfeifer JS. The effect of orthodontic treatment on the periodontium. Angle Orthod 1974;44: Kessler M. Interrelationships between orthodontics and periodontics. Am J Orthod 1976;70: 황현식, 박영철. 교정치료시치주조직변화에대한임상적고찰 (1), 치과임상 1990;10(6):

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상악측절치(dh) J Korean Academy of Advanced General Dentistry 2014;3:29-33 ABSTRACT Endodontic Treatment of 2 Maxillary Lateral Incisors with Dens Invaginatus; 2 Case Reports Jaemin Lee, Kee-Deog Kim, Bock-Young Jung,