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하악전돌증환자의악교정수술시경조직변화에 따른연조직변화에대한 3D 스캐너를이용한분석 위원장황순정 ( 인 ) 부위원장김명진 ( 인 ) 위원이종호 ( 인 )
prognathism, 3-dimensional scan, soft tissue analysis, surgery simulation
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1. Soncul M, Bamber MA: Evaluation of facial soft tissue changes with optical surface scan after surgical correction of Class III deformities. J Oral Maxillofac Surg 62:1331e1340, 2004 2. Rustemeyer J, Gregersen J: Quality of Life in orthognathic surgery patients: Postsurgical improvements in aesthetics and self-confidence. J Craniomaxillofac Surg 40: 400e404, 2012 3. Ackerman JL, Proffit WR, Sarver DM: The emerging soft tissue paradigm in orthodontic diagnosis and treatment planning. Clin Orthod Res 2: 49e52, 1999 4. Phillips C, Greer J, Vig P, Matteson S: Photocephalometry: errors of projection and landmark location. Am J Orthod 86: 233e243, 1984 5. Tsuchiya M, Takasugi H, Kakiuchi K, Yoshida K, Sakuda M: Symmetry analysis of the human face based on Moire topography. J Osaka Univ Dent Sch 28: 17e25, 1988 6. Shen YH, Shieh TY: The application of Moire topography in analysis of face among Taiwanese adults. Gaoxiong Yi Xue Ke Xue Za Zhi 11: 339e352, 1995 7. O.E. Becker, R.L. Avelar, A. do N Dolzan, O.L. Hass Jr., N. Scolari, R.B. de Oliveira. Soft and hard tissue changes in skeletal Class III patients treated with double-jaw orthognathic surgery-maxillary advancement and mandibular setback. Int J Oral Maxillofac Surg 2014;43:204 212-11 -
8. Ingervall B, Thuer U, Vuillemin T. Stability and effect on the soft tissue profile of mandibular setback with sagittal split osteotomy and rigid internal fixation. Int J Adult Orthod Orthognath Surg. 1995;10:15 25 9. Alan C. Jensen, Peter M. Sinclair, Larry M. Wolford. Soft jaw tissue changes associated with double surgery. Am J Ortho Dentofac 1992;101:266-275. 10. Ming Tak Chew. Soft and hard tissue changes after bimaxillary surgery in chinese class III patients. Angle Orthod 2005;75:959-963 11. Karim A. Mobarak, Olaf Krogstad, Lisen Espeland, and Torstein Lyberg. Factors influencing the predictability of soft tissue profile changes following mandibualr setback surgery. Angle Orthod 2001;71:216-227 12. Minji Kim, Dong-Yul Lee, Yong-Kyu Lim, Seung-Hak Baek. Three-dimensional evaluation of soft tissue changes after mandibular setback surgery in class III malocclusion patients according to extent of mandibular setback. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:20-32 13. Ayse Tuba Altug-Atac, Halise Bolatoglu, and Ufuk Toygar Memikoglu. Facial soft tissue profile following bimaxillary orthognathic surgery. Angle Orthod 2008; 78:50-57 14. Hee-Yeon Suh, Shin-Jae Lee, Yun-Sik Lee, Richard E. Donatelli, Timothy T. Wheeler, Soo-Hwan Kim, Soo-Heang Eo, Byoung-Moo Seo. - 12 -
A More Accurate Method of Predicting Soft Tissue Changes After Mandibular Setback Surgery. J Oral Maxillofac Surg 2012;70:553-562 15. Joo-Young Park, Myung Jin Kim, Soon Jung Hwang. Soft tissue changes after setback genioplasty in orthognathic surgery patients. Journal of Cranio Maxillo Facial Surgery 2013;41:657-664 - 13 -
Landmark Horizontal reference line (HRL) Vertical reference line (VRL) Nasion (N) Sella (S) point A Incisor superius (Is) Incisor inferius (Ii) point B Pogonion (Pog) Soft tissue point A (point A') Labrale Superius (Ls) Labrale Inferius (Li) Soft tissue point B (point B') Soft tissue pogonion (Pog') Definition 7 degrees from sella-nasion line Line perpendicular to horizontal reference line intersecting sella The junction of the frontonasal suture at the most posterior point on the curve at the bridge of the nose. The center of the pituitary fossa of the sphenoid bone determined by inspection. The most posterior on the curve of the maxilla between the anterior nasal spine and supradentale. The midpoint of incisal edge of maxillary central incisor The midpoint of incisal edge of mandibular central incisor The point most posterior to ad line from infradentale to pogonion on the anterior surface of the symphysial outline of the mandible. The most anterior point on the contour of the bony chin Greatest concavity between Subnasale and labrale superius The most anterior point of the upper lip The most anterior point of the lower lip The most posterior on the curve of the maxilla between the anterior nasal spine and supradentale. Greatest concavity between labrale inferius and soft tissue pogonion - 14 -
Variables Definition Distance distance A distance Is distance Ii distance B distance Pog distance A distance Ls distance Li distance B' distancepog' Angle U1 to FH plane L1 to FH plane ANS-PNS to FH plane Me-Go to FH plane distance from point A to vertical reference line distance from Incisor superius to vertical reference line distance from Incisor inferius to vertical reference line distance from point B to vertical reference line distance from Pogonion to vertical reference line distance from soft tissue point A to vertical reference line distance from Labrale superius to vertical reference line distance from Labrale inferius to vertical reference line distance from soft tissue point B to vertical reference line distance from soft tissue Pogonion to vertical reference line angle between upper incisor and FHplane angle between lower incisor and FH plane angle between hard palate and FH plane angle between Mandible border extension and FH plane - 15 -
Advanceme nt Setback Superior Inferior Maxilla Pronasale 30 0 20 0 Subnasale 30 30 20 20 soft. A point 30 30 20 20 LabraleSuperius 50 60 30 15 StomionSuperiu s 50 60 30 15 Mandible LabraleSuperius 0 20 0 0 LabraleInferius 85 90 100 100 Soft. B point 100 90 100 100 Soft. Pogonion 100 90 100 100 Soft. Gnathion 100 90 100 100 Soft. Menton 100 90 100 100 Symphysis LabraleInferius 60 75 100 100 Soft. Pogonion 10 10 10 10 Chin Soft. Pogonion 80 90 60 60 Soft. Menton 100 100 90 100-16 -
Sugery results(t1) Simulation results(t2) Mean Stdev Mean Stdev A'_H/A_H 0.83 0.22 0.68 0.42 Ls_H/Is_H 0.85 0.31 0.41 0.29 Li_H/Ii_H 0.93 0.25 1.01 0.41 B'_H/B_H 1.01 0.22 0.77 0.42 Pog'_H/Pog_H 0.91 0.22 0.83 0.24 Pearson correlation coefficient p-value A'_H/A_H 0.607.007 Ls_H/Is_H 0.495.037 Li_H/Ii_H 0.590.010 B'_H/B_H 0.554.017 Pog'_H/Pog_H 0.544.019 SPSS ver.22 software (SPSS, Chicago, Il, USA) 프로그램을통해 - 17 -
* N A /A Ul/Is LL/Ii B /B Pog /Pog Becker(2014) 58 0.66 0.88 0.87 0.69 0.74 Ingervall(1995) 29 - - 1.07 0.88 1.06 Jensen(1992) 17 0.83 0.98 1.00 0.89 1.26 Chew(2005) 34 0.60 0.73 0.84 1.01 0.85 Morabak(2001) 80 - - 1.02 1.08 1.04 Kim(2010) 33 - - 0.81 0.89 0.88 My research (Surgery results) 20 0.83 0.85 0.92 1.01 0.91 My research (Simulated results) 20 0.68 0.41 1.01 0.77 0.83 *: Included the papers subjected to mandibular prognathism patient underwent bimaxillary surgery. -: not measured N: Number of patients - 18 -
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Analysis of soft tissue changes following hard tissue changes of prognathism patients after orthognathic surgery using 3-dimensional scanning system Semin Park Department of Dentistry School of Dentistry Seoul National University Introduction: Recently, 3-dimensional computer imaging has received considerable attention as a means of predicting results of orthognathic surgery. With 3-dimensional scanner, taking patient's 3-dimensional facial profile made possible. Along with technology development, accuracy and reliability of 3-D scanner became acceptable. Also, with 3-dimensional facial profile, maxillofacial surgeons can easily simulate orthognatic surgery and predict prognosis of patient. However, it has been controversial to the accuracy and reliability between surgery simulation and actual surgery results. The purpose of this study is to assess the soft tissue change to hard tissue movement after mandibular setback surgery in prognathic patients and to assess real surgery results and simulated surgery results. Materials and Methods: Twenty patients with mandibular prognathism treated since May, 2015 were studied. All undergone pre-surgical orthodontic treatment and orthognathic surgery with Le Fort I osteotomy, - 22 -
bilateral sagittal split ramus osteotomy. 3-dimensional facial profile, lateral cephalograph and PA cephalograph was taken before the orthognathic surgery(t0) and 6 month after the orthognathic surgery(t1). In order to calculate soft tissue change to hard tissue movement, Point A, Incisor superius(is), Incisor inferius(ii), Point B and Pogonion(Pog) was chosen as hard tissue landmark. Soft tissue landmark is chosen to correspond hard tissue landmark; Soft tissue point A(point A ), Labrale superius(ls), Labrale inferius(li), Soft tissue point B(point B ) and Soft tissue pogonion(pog ). According to actual hard tissue change, Surgery simulation is done in Morpheus 3D dental solution(morpheus3d Co., Seoul, Korea). Statistic analysis was done in SPSS ver.22 software (SPSS, Chicago, Il, USA). Results: Cephalometric measurements show that the soft tissue change to hard tissue movement ratio was 0.83 at point A /point A, 0.85 at Ls/Is, 0.92 at Li/Ii, 1.01 at point B /point B, and 0.91 at Pog /Pog. At surgery simulation, soft tissue change to hard tissue movement ratio was 0.68 at point A /point A, 0.41 at Ls/Is, 1.01 at Li/Ii, 0.77 at point B /point B, and 0.83 at Pog /Pog. Pearson coefficient between surgery results and simulated results was range to 0.50 to 0.61. conclusion: Further research is needed for accurate prediction. However, predicting prognosis of 3-dimensional facial prognosis can be acceptable. In the future, accurate surgery simulation can be done with software development. The result can be used for basic data with 3-dimensional facial diagnosis and treatment plan for orthognathic surgery. Key words: prognathism, 3-dimensional scan, soft tissue analysis, surgery simulation Student number: 2013-22111 - 23 -