ORIGINAL ARTICLE 악교정수술을받은 III급부정교합자의치료전, 후의하악치열궁변화 남형진 a ㆍ손우성 b ㆍ박수병 c 김성식 d 본연구는악교정수술을받은골격성 III 급부정교합자의치료전, 후의하악치열궁변화를관찰하고, 이들이초진시의측모두부방사선규격사진및석고모형과어떠한상관성을가지고있는지를알아보기위해골격성 III 급부정교합자로진단받은 31 명 ( 남자 14 명, 여자 17 명, 평균 21.8 ± 3.3 세 ) 을대상으로치료전, 악교정수술전, 악교정수술후채득한측모두부방사선규격사진과치료전, 후의석고모형을계측하여상관분석과회귀분석을시행하였다. 연구결과 Mn-LMMC, Mn-LIE, Mn-MnOcc 는술전교정치료에의한유의한차이를보이지않았다. 치료전의계측치와치료후변화된계측치와의상관관계에서는치열궁공간부족 (ALD) 은 ICW, IPW1 의변화량과순상관관계 (r = 0.492, 0.615) 를보였으며, 치열궁장경 (arch length) 의변화량과도순상관관계 (r = 0.641) 를보였다. 그러나 Spee 만곡은전치부치축각도변화와치열궁폭경및장경등각각의변화량과는상관관계를보이지않았다. 이를이용하여회귀분석을시행한결과, 술전교정후 Arch length, IPW1 의변화량은치료전의계측치로각각 64.0%, 75.8% 를설명할수있었다. 이상의연구에서골격성 III 급부정교합자의치료전, 후의변화량과치료전측모두부방사선규격사진및석고모형간에관련성이있었고악교정수술을동반한교정치료계획을수립할때술전교정치료의목표설정과악교정수술결과의예측에도움이될것으로판단된다. ( 대치교정지 2008;38(4):283-298) 주요단어 : III 급부정교합의수술교정, 치성보상, 하악치열궁 서론 경제적여건이좋아지고심미에대한요구가증가하면서악교정수술을동반한교정치료는최근더욱증가하는추세이다. 1-3 악교정수술시의교정치료는외과적인수정을제한하는치성보상을제거하거나감소시킨다. 치성보상이란골격적인부조화가존재할때좋은안모와기능교합을유지하고자절치의경사도와수직적위치가변화되는것으로정의된다. 4 악교정수술이필요할정도로심한골격성 III 급부정교합자에서대체적으로상악골열성장과하악골과성장이주된증상인경우가많으며, 하악치열 a 전공의, b 교수, c 교수, d 부교수, 부산대학교치과대학치과교정학교실. 교신저자 : 손우성. 부산시서구구덕로 305 부산대학교병원치과교정과. 051-240-7443; e-mail, wsson@pusan.ac.kr. 원고접수일 : 2008년 1월 3일 / 원고최종수정일 : 2008년 6월 20일 / 원고채택일 : 2008년 6월 23일. * 본논문은부산대학교자유과제학술연구비에의하여연구되었음. 의경우전치부와구치부모두치성보상기전에의해설측으로경사된것을흔히볼수있다. 5 악교정수술시외과의는술전교정완료시의절치의위치를바탕으로치아가서로맞물리도록맞추므로하악절치의수직적인위치가수술후안면의고경을결정하며절치의전후방적인위치는수술시악골간전후방이동량의결정에영향을미친다. 6 교정의로서악교정수술에의한적절한측모와심미성획득을위해서는치료시작전에치료후의절치의위치를정확하게예측하는것이꼭필요하다. 7 Steiner 8 는 NA line 과 NB line 을기준으로상하악절치의이상적위치와경사도를제시하였고, Arnett 등 9 은상하악제 1 대구치교두와상하악절치의절단을연결한각각의평면에대한상하악절치의각도를기준으로상하악절치의이상적인목표치를제시하였으나, 골격과치열의특성에따라서제시하지못하고있다. 악교정수술이필요한골격성 III 급부정교합자의경우치성보상으로하악궁에총생과 Spee 만곡이 283
남형진, 손우성, 박수병, 김성식 대치교정지 38 권 4 호, 2008 년 존재하는경우가많은데, 총생의정도가심한경우가아니면공간의확보, 교합면평탄화, 설측경사된치아의조절을위해비발치확장배열을고려한다. Yang 10 은하악전돌증환자의경우악교정수술을동반한교정치료시하악절치의위치를결정할때하악결합의형태에따른치아이동의한계가존재한다고주장하였고, Handelman 11 과 Wehrbein 등 12 도하악이부에서절치의전후방이동이한계가있으며, 이를고려하지않은치아이동은골소실과치주조직의파괴를유발할수있음을지적하였다. 따라서심미성을획득하고치주조직에위해를가하지않는범위내에서이동하게될하악절치의위치를각환자에맞게예측하고, 이동계획을설정하는것이치료계획측면에서가장중요한부분이라고할수있다. Hwang 과 Kwon 13 은골격성 III 급부정교합자의술전교정의예측치와실측치의비교에서여러가지요소에의해술전교정전예측의정확성이낮다고했다. Kim 등 14 은골격성 III 급부정교합자의악교정수술을동반한교정치료증례에서개개의치아의이동의한계에대해제시하였다. 이와같이지금까지의연구에서는초진시술전교정치료의결과를예측하기위해측모두부방사선규격사진을주로이용하였으나, 석고모형을함께이용하여하악치열궁의변화를예측하는연구는미흡하였다. 본연구는골격성 III 급부정교합자의치료전, 후하악치열궁이어떻게변화하며이들이초진시의측모두부방사선규격사진및석고모형의계측치와어떠한연관성이있는지를알아보고, 어떤항목이하악치열궁의변화에영향을미치는지를평가하여술전교정치료의목표수립및악교정수술결과의예측에참고하기위해시행하였다. 이거나구순, 구개열및기타두개안면증후군의증상이있는경우또는파절이나우식등에의해치관이소실되거나선천적기형치아및결손치아가있는경우, 하악치열에공간과잉이존재하는경우는연구대상에서제외하였다. 치료전, 악교정수술전, 악교정수술후최소 6 개월이경과한시점에채득한측모두부방사선규격사진과치료전, 후의하악석고모형을이용하였다. 연구방법 측모두부방사선규격사진의투사및계측항목의설정모든채득된측모두부방사선규격사진의투사도는아세테이트지상에서작성되었고각도는 0.1 o 까지, 길이는디지털캘리퍼 (Absolute Digimatic, Mitutoyo, Kawasaki, Japan) 를이용하여 0.01 mm 까지계측하였다. 모든투사도의작성과자료입력은판독자의오차를줄이기위해한명의연구자에의해이루어졌다. 본연구에이용한하악과관련된계측점과계측항목은다음과같다. 1) 계측점및계측평면 (Fig 1) 1. S (Sella) 연구방법 연구대상 부산대학교병원치과진료처교정과에내원하여골격성 III 급부정교합자로진단받은후술전교정치료를하고구강악안면외과에서상악골의 Le Fort I 수술과하악지시상분할골절단술혹은하악지시상분할골절단술만을시행한환자 31 명 ( 남자 14 명, 여자 17 명, 평균 21.8 ± 3.3 세 ) 을연구대상으로선정하였으며이중상악소구치발치는 18 명, 상악비발치는 13 명이었다. 안면비대칭이심하여악교정수술시하악골후퇴량이좌우 3 mm 이상의차이를보 Fig 1. Landmarks of lateral cephalometric films. 1, S (sella); 2, Na (nasion); 3, Or (orbitale); 4, Po (porion); 5, A (point A); 6, B (point B); 7, Me (menton); 8, Go (gonion); 9, LIE (lower incisor edge); 10, LIRA (lower incisor root apex); 11, LMMC (lower molar mesio-buccal cusp). 284
Vol. 38, No. 4, 2008. Korean J Orthod 악교정수술을받은 III 급부정교합자의치료전, 후의하악치열궁변화 2. Na (Nasion) 3. Or (Orbitale) 4. Po (Porion) 5. A point 6. B point (supramentale) 7. Me (Menton) 8. Go (Gonion) 9. LIE (Lower incisor edge) 10. LIRA (Lower incisor root apex) 11. LMMC (Lower molar mesio-buccal cusp) 12. SN plane (S 점과 Na 점을연결한평면 ) 13. FH plane (Or 점과 Po 점을연결한평면 ) 14. MnOcc plane ( 하악절치절단연과하악제 1 대구치근심협측교두정을연결한평면 ) 9 15. Mn plane (Me 점과 Go 점을연결한평면 ) 2) 계측항목 (Figs 2 and 3) 골격계측항목 1. SNA (SN plane 과 Na-A point line 사이의각 ) 2. SNB (SN plane 과 Na-B point line 사이의각 ) 3. ANB ( SNA SNB) 4. SN-Mn (SN plane 과 Mn plane 사이의각 ) 5. FH-Mn (FH plane 과 Mn plane 사이의각 ) 6. AFH (Na 점과 Po 점사이의거리 ) 7. PFH (S 점과 Go 점사이의거리 ) 8. PFH/AFH (AFH 에대한 PFH 의비율 ) 치아계측항목 1. IMPA (LIE 와 LIRA 를연결한선과 Mn plane 사이의각중후방에위치한각 ) 2. FH-LI (LIE 와 LIRA 를연결한선과 FH plane 사이의각중후방에위치한각 ) 3. Mn-LMMC (Mn plane 과 LMMC 사이의수직거리 ) 4. Mn-LIE (Mn plane 과 LIE 사이의수직거리 ) 교합평면계측항목 1. SN-MnOcc (SN plane 과 MnOcc plane 사이의각 ) 2. Mn-MnOcc (Mn plane 과 MnOcc plane 사이의각 ) 석고모형계측치료전, 후의하악석고모형을이용하여다음항목을계측하였고모든계측및자료입력은오차를줄이기위해한명의연구자에의해이루어졌다. Fig 2. Angular measurement of lateral cephalometric films. 1, SNA (SN plane to NA plane); 2, SNB (SN plane to NB plane); 3, ANB (NA plane to NB plane); 4, SN-Mn (SN plane to mandibular plane); 5, FH-Mn (FH plane to mandibular plane); 6, IMPA (lower incisor to mandibular plane); 7, FH-LI (FH plane to lower incisor); 8, SN-MnOcc (SN plane to mandibular occlusal plane); 9, Mn-MnOcc (mandibular plane to mandibular occlusal plane). Fig 3. Linear measurement of lateral cephalometric films. 1, AFH (anterior facial height); 2, PFH (posterior facial height); 3, Mn-LMMC (vertical distance between mandibular plane to lower molar mesio-buccal cusp); 4, Mn-LIE (vertical distance between mandibular plane to lower incisal edge). 285
남형진, 손우성, 박수병, 김성식 대치교정지 38 권 4 호, 2008 년 Fig 4. Measurement of curve of Spee. A, Dental surveyor to allow measurement of angulation and inclination of each tooth and curve of Spee. B, surgical-orthodontic model calipers to measure curve of Spee. 1) 치열궁공간부족 (arch length discrepancy, ALD) 0.01 mm 단위의디지털캘리퍼를이용하여제 3 구치를제외한모든하악영구치의근원심폭경을교합면과평행하고치아의장축에직각으로계측한후합하여요구공간 (required space) 으로하고, 구치부는중심구, 전치부는절단연을지나게하여제 2 대구치원심면에서반대측제 2 대구치원심면까지의치열궁길이를계측하여가용공간 (available space) 으로한후그차이를공간부조화의양 (arch length discrepancy) 으로계산하였다. 또한 Little 15 에의해제시된방법으로전치부에서각인접치아간의접촉점사이의 5 개의수평거리를합산하여 Irregularity index 를계산하였다. 2) Curve of Spee 정확한측정을위해 Shannon 과 Nanda 16 의연구에근거하여하악석고모형을치과용서베이어의금속판에좌, 우측제 2 대구치의원심협측교두정과양측하악중절치의절단연의중점이같은평면에오도록장착했다 (Fig 4, A). 0.01 mm 단위의디지털캘리퍼 ( 수술교정모델측정기, 자인메드, 서울, 한국 ) 를이용하여제 2 대구치의원심협측교두에맞춰원점조절을한후교합평면에대한교두의수직높이를측정하였다 (Fig 4, B). 이중가장큰값을 curve of Spee 값으로하였으며좌, 우측의평균치를사용하였다. 3) 치열궁폭경및장경 (Arch width and arch length) 치열궁폭경을측정하기위해하악견치부터제 2 대구치까지교두간거리를측정하였다. 견치와소 Fig 5. Set-up model gauge. 구치는협측교두정, 제 1, 2 대구치는근심협측교두정간거리를측정하였고교두정이교모등으로닳았을경우원래있었을것으로추정되는교두정을사용하였다. 치열궁장경은양측하악중절치절단연의중점에서양측제 2 대구치원심면을연결한선에이르는수직거리로측정하였다. 1. ICW (Inter-canine arch width): 견치간폭경 2. IPW1 (Inter-1st premolar arch width): 제 1 소구치간폭경 3. IPW2 (Inter-2nd premolar arch width): 제 2 소구치간폭경 4. IMW1 (Inter-1st molar width): 제 1 대구치간폭경 5. IMW2 (Inter-2nd molar width): 제 2 대구치간폭경 6. AL (Arch length): 치열궁장경 286
Vol. 38, No. 4, 2008. Korean J Orthod 악교정수술을받은 III 급부정교합자의치료전, 후의하악치열궁변화 Table 1. Mean values and comparison of cephalometric measurements Measurement Group Mean ± SD Significance Skeletal angular ( o ) SNA T0 79.24 a 3.45 T1 79.40 a 3.14 * T2 80.43 b 4.15 SNB T0 83.58 a 3.75 T1 83.47 a 3.50 T2 79.30 b 3.66 ANB T0-3.35 a 3.50 T1-4.07 a 3.55 T2 1.13 b 3.44 SN-Mn T0 39.75 6.52 T1 39.77 6.15 T2 42.52 5.82 FH-Mn T0 32.16 5.86 T1 31.85 5.72 T2 34.54 5.00 Skeletal linear (mm) AFH T0 144.96 10.43 T1 145.33 9.71 T2 142.37 9.25 PFH T0 90.01 7.46 T1 90.79 7.25 T2 87.21 8.76 PFH/AFH T0 0.62 0.04 T1 0.63 0.04 T2 0.61 0.05 Dental angular ( o ) IMPA T0 78.52 a 7.62 T1 89.03 b 8.31 T2 83.45 c 7.22 FH-LI T0 69.60 a 7.18 T1 59.18 b 8.00 * T2 62.26 b 8.05 Dental linear (mm) Mn-LMMC T0 38.09 3.52 T1 38.54 3.61 T2 36.64 3.80 Mn-LIE T0 47.73 4.35 T1 48.90 4.14 T2 49.00 3.86 Table 1. Continued Measurement Group Mean ± SD Significance Occlusal angular ( o ) SN-MnOcc T0 19.28 13.26 T1 18.25 5.12 T2 15.94 4.85 Mn-MnOcc T0 22.91 a 4.62 T1 21.28 a 4.20 T2 26.31 b 4.73 Pretreatment (T0), Presurgical (T1), Postsurgical (T2). SD, standard deviation; Positive values indicate decrease between the groups; negative values, increase; < 0.05; p < 0.001; a,b,c The same superscripts indicate no statistically significant difference between the indicated groups (p > 0.05). 4) 근원심경사 (angulation) 와협설측경사 (inclination) Bae 와 Son 17, Kim 등 14 의연구에근거하여하악중절치부터제 2 대구치의순면에연필로 FACC (facial axis of clinical crown) 와 FA point (facial axis point) 를표시하였다. 좌, 우측중절치와좌, 우측제 1 대구치의 FA point 를연결한 Andrews' plane 이지평면과평행하도록서베이어의모형고정대에장착한후셋업모형측정기 (set-up model gauge, IV-Tech, Seoul, Korea) 를이용하여 Andrews' plane 에대한해당치아의근원심경사 (angulation) 와협설측경사 (inclination) 을측정하였다 (Fig 5). 근원심경사 (angulation) 와협설측경사 (inclination) 의평균변화량에서양 (+) 의부호는치료후수치가감소되었음을나타내므로 angulation 의경우에는임상치관의원심경사, inclination 의경우에는임상치관의설측경사를의미하며, 음 (-) 의부호는그반대를의미한다. 통계분석 이상에서얻은각계측항목을 SPSS for Windows ver 12.0 (SPSS, Chicago, IL, USA) 를이용하여분석하였다. 측모두부방사선규격사진과석고모형의각각의계측항목의측정에대한신뢰성을평가하기위해각각 15 개씩을무작위로추출하여동일인에의해 2 주후에시행되었다. Paired t-test 를통하여검사자내의신뢰성검정을시행하였고 Dahlberg 의함수 18 를 * p 287
남형진, 손우성, 박수병, 김성식 대치교정지 38 권 4 호, 2008 년 이용하여 method error를구했다 (, Se는측정된 method error, D는두계측치간차이, N 은두번계측한개수를뜻한다 ). 그결과각각의계측항목에대해서유의성있는차이가없었다. 치료전, 악교정수술전, 악교정수술후의측모두부방사선규격사진의계측항목의차이를알아보기위해 ANOVA test와사후검정으로 Scheffe 방법을시행하였으며, 치료전과후의석고모형의계측항목의차이를알아보기위해 paired t-test를시행하였고, 치료전과술전교정후측모두부방사선규격사진및석고모형의계측치변화량간의상관관계를측정하기위해 Pearson 이변량상관분석을시행하였다. 또한술전교정에의한각각의계측치변화량간의상관관계를측정하기위해 Pearson 이변량상관분석을시행하였으며, 치료전의측모두부방사선규격사진및석고모형의계측항목에따라술전교정에의한각계측치가어떤변화를보이는지를예측하기위해선형회귀분석을시행하였다. 이때측모두부방사선규격사진중선계측항목을 110% 확대율을적용하여실계측치로변환하였다. 이 (p > 0.05) 를보이지않았다. Mn-LMMC, Mn-LIE, Mn-MnOcc 는술전교정후유의한차이 (p > 0.05) 를보이지않았으나, Mn-MnOcc 는악교정수술후유의한차이 (p < 0.05) 를보였다 (Table 1, Fig 6). 치료전, 후의석고모형의계측항목의비교 ICW, IMW1, #31, #34, #44, #47 치아의근원심경사 (angulation), #36, #47 치아의협설측경사 (inclination) 를제외한모든항목에서유의한차이 (p < 0.05) 를보였다 (Tables 2-4 and Figs 7 and 8). 모든부위에서치열궁폭경이증가하였고, 평균변화량은제 1 소구치에서가장컸으며제 1 대구치에서가장작았다. 또한치열궁장경도증가하였다. 근원심경사 (angulation) 의경우치료후에전치는임상치관의근심경사를, 구치는원심경사를보였으며, 협설측경사 (inclination) 의경우모든치아가순, 협측경사를보였다. 연구성적 치료전, 악교정수술전, 악교정수술후의측모두부방사선규격사진의계측항목의비교 SNB 와 IMPA, FH-LI, Mn-MnOcc 항목에서유의한차이 (p < 0.05) 를보였다. IMPA 는술전교정후증가하였고악교정수술후감소하였다. FH-LI 는술전교정후감소하였으나, 악교정수술후유의한차 Fig 6. Comparison of cephalometric measurements. Pretx, pretreatment; presurg, presurgical; postsurg, postsurgical. Table 2. Mean values and comparison between before treatment model and after treatment model in arch length discrepancy and curve of Spee of mandible (paired t-test) Measurement Group Mean ± SD Difference (before-after) Mean Significance ALD (mm) Before treatment -3.40 2.19-3.35 * After treatment -0.05 0.20 II (mm) Before treatment 5.09 2.90 4.45 * After treatment 0.63 0.85 COS (mm) Before treatment 1.68 0.61 0.86 * After treatment 0.82 0.40 ALD, arch length discrepancy; II, irregularity index; COS, curve of Spee; SD, standard deviation; * p < 0.001. 288
Vol. 38, No. 4, 2008. Korean J Orthod 악교정수술을받은 III 급부정교합자의치료전, 후의하악치열궁변화 Table 3. Mean values and comparison between before treatment model and after treatment model in arch width and arch length of mandible (paired t-test) Measurement Group Mean ± SD Difference (before-after) Mean Rate (%) Significance Arch width (mm) ICW Before treatment 27.22 2.49-0.52-1.90 After treatment 27.73 1.80 IPW1 Before treatment 34.34 3.04-2.69-7.84 After treatment 37.03 1.95 IPW2 Before treatment 41.55 3.45-1.99-4.78 After treatment 43.54 1.75 IMW1 Before treatment 47.87 2.74-0.41-0.86 After treatment 48.28 2.26 IMW2 Before treatment 53.52 3.61-1.46-2.72 * After treatment 54.98 3.52 Arch length (mm) Before treatment 42.79 3.50-2.99-7.00 After treatment 45.79 3.07 ICW, inter-canine arch width; IPW1, inter-1 st premolar arch width; IPW2, inter-2 nd premolar arch width; IMW1, inter-1 st molar arch width; IMW2, inter-2 nd molar arch width; SD, standard deviation; Positive values indicate decrease between the groups; negative values, increase; Rate, (before - after)/before 100; * p < 0.01; p < 0.001. Table 4. Comparison between before treatment model and after treatment model in angulation and inclination of mandibular teeth (paired t-test) Tooth number Difference (before-after) Angulation ( o ) Inclination ( o ) Mean ± SD Significance Mean ± SD Significance 31-2.10 4.00-10.11 7.07 32-4.79 5.51-9.35 6.89 33-3.60 5.15-3.55 5.86 34 1.61 4.65-5.82 7.11 35 3.06 4.83-3.66 7.72 * 36 3.45 5.23 0.42 6.12 37 2.84 4.86-3.21 5.84 41-1.18 3.95-9.45 7.85 42-2.50 4.11-8.79 6.76 43-2.76 6.57 * -4.39 5.94 44 1.53 4.76-9.02 7.74 45 2.48 5.73 * -4.45 8.82 46 2.95 4.24 2.94 7.75 * 47 0.02 5.81-2.48 7.52 SD, standard deviation; Tooth No., tooth number (FDI system); Positive angulation values indicate distal tipping of clinical crown; negative values, mesial tipping; Positive inclination values indicate lingual tipping of the clinical crown; negative values, labial tipping; * p < 0.05; p < 0.01; p < 0.001. 289
남형진, 손우성, 박수병, 김성식 대치교정지 38 권 4 호, 2008 년 치료전과술전교정후계측치변화량간의상관관계 IPW2 의변화량과순상관관계 (p < 0.05) 를보였다 (Tables 6-8). 수평및수직골격계측항목과술전교정에의한각각의계측항목의변화량사이에서는상관관계를보이지않았다 (Table 5). 공간부조화의양인 ALD 은폭경의변화량인 ICW, IPW1 과순상관관계 (r = 0.492, p < 0.01; r = 0.615, p < 0.001) 를보였으며, AL 의변화량과는순상관관계 (r = 0.641, p < 0.001) 가나타났다. COS 는각각의변화량과상관관계를보이지않았다. ICW, IPW1, IPW2 등은 AL 의변화량과순상관관계 (r = 0.537, 0.540, 0.429, p < 0.05) 를보였다. 또한견치간폭경과제 1 대구치간폭경의차이인 ICW-IMW1 은 IMW1 의변화량과역상관관계 (r = -0.576, p < 0.01) 를보였다. 모든하악치아의협설측경사 (inclination) 는 Fig 7. Mean difference between before and after treatment in arch width and arch length. 술전교정에의한각각의계측치변화량간의상관관계 ALD 의변화량은 ICW, IPW1, AL 의변화량과순상관관계 (p < 0.01) 를보였다. AL 의변화량은 ICW, IPW1, IPW2 의변화량과는순상관관계 (p < 0.05) 를보였으나, IMW1, IMW2 의변화량과는상관관계를보이지않았다 (Table 9). 치료전의측모두부방사선사진및석고모형의계측항목과술전교정에의한각각의계측항목의변화량간의회귀분석 다중선형회귀모형에서단계적선택법 (stepwise procedure) 을사용하여각각의계측항목의변화량을예측하기위해반응변수에유의한영향을미치는설명변수를찾아냈다. 각각의계측항목의변화량을종속변수로하고치료전의측모두부방사선사진및석고모형의계측항목을독립변수로하여각각의변화량을설명하도록하였다. 특히술전교정치료목표설정과상관있는 AL, IPW1 의변화량과치료전계측항목간의선형식을얻었는데, AL= -0.770 + 0.465 ALD + 0.131 #31 (Inclination) - 0.074 #32 (Inclination)( 수정결정계수 R 2 = 0.640, p < 0.001), IPW1 = -16.862 + 0.852 IPW1-0.352 AL ( 수정결정계수 R 2 = 0.758, p < 0.001) 로나타났다. Fig 8. (A) Difference in angulation between before and after treatment. Positive angulation values indicate distal tipping of clinical crown; negative values, mesial tipping. (B) Difference in inclination between before and after treatment. Positive inclination values indicate lingual tipping of clinical crown; negative values, labial tipping. 290
Vol. 38, No. 4, 2008. Korean J Orthod 악교정수술을받은 III 급부정교합자의치료전, 후의하악치열궁변화 Table 5. Correlation coefficient analysis between pretreatment cephalometric measurements and each change (pretreatment to presurgical, n = 31) Pretx IMPA FH-LI ALD II COS ICW IPW1 IPW2 IMW1 IMW2 AL SNB 0.063 0.013 0.217-0.284 0.008-0.201 0.117-0.155-0.178-0.005 0.031 SN-Mn -0.033-0.048-0.209 0.203 0.083 0.083-0.212-0.024 0.090-0.036-0.054 FH-Mn -0.023-0.033-0.216 0.211 0.063 0.089-0.271-0.109 0.087-0.011-0.075 AFH 0.184-0.249-0.018 0.022 0.256 0.227-0.055 0.143 0.057-0.172 0.140 PFH 0.129-0.132 0.090-0.053 0.248 0.212 0.165 0.229 0.018-0.101 0.135 PFH/AFH -0.037 0.100 0.123-0.081 0.022 0.013 0.252 0.113-0.039 0.062 0.018 IMPA 0.236-0.199 0.060 0.065 0.107 0.145 0.101 0.346-0.070-0.185 0.328 FH-LI -0.275 0.271 0.072-0.183-0.173-0.211 0.079-0.307 0.027 0.217-0.280 Mn-LMMC 0.073-0.094 0.013 0.143 0.083 0.125-0.038 0.098 0.089 0.090 0.088 Mn-LIE 0.143-0.181 0.084 0.098 0.194 0.128-0.050 0.041-0.209-0.190 0.231 SN-MnOcc 0.258-0.297-0.219 0.035 0.460 * 0.050-0.156 0.333 0.042-0.173 0.007 Mn-MnOcc -0.181 0.152 0.154-0.156 0.250 0.047 0.105 0.016-0.299-0.255-0.041 * p < 0.01. Table 6. Correlation coefficient analysis between pretreatment model measurements and each change (pretreatment to presurgical, n = 31) Pretx ΔPretx- Presurg ΔPretx- Presurg IMPA FH-LI ALD II COS ICW IPW1 IPW2 IMW1 IMW2 AL ALD 0.351-0.329 0.996-0.635-0.198 0.492 0.615 0.287 0.287 0.197 0.641 II -0.312 0.283-0.765 0.958-0.045-0.425 * -0.509-0.347-0.438 * -0.088-0.595 COS 0.009-0.007 0.007-0.241 0.839 0.170-0.067 0.331-0.076-0.351 0.132 Arch width ICW -0.016 0.005 0.387 * -0.171 0.156 0.707 0.212 0.365 * 0.015-0.036 0.537 IPW1 0.241-0.206 0.587-0.413 * 0.015 0.425 * 0.775 0.507 0.170-0.028 0.540 IPW2 0.242-0.217 0.273-0.309 0.450 * 0.471 0.437 * 0.870 0.265-0.234 0.429 * IMW1 0.124-0.103 0.202-0.310 0.271 0.376 * 0.294 0.490 0.571 0.204 0.247 IMW2-0.102 0.118 0.158-0.214 0.230 0.261 0.170 0.276 0.442 * 0.346 0.070 ICW-IMW1-0.144 0.111 0.154 0.160-0.133 0.275-0.104-0.164-0.576-0.245 0.249 Arch length 0.205-0.187 0.116 0.043 0.130 0.110-0.054 0.084-0.253-0.189 0.486 * p < 0.05; p < 0.01; p < 0.001. 고찰 술전교정치료의주된목적은총생과교두간섭의 해소및 Spee 만곡의평탄화를포함하여상하악의치성보상을해소하고상하악치열궁의조화를확립하여술후안정성을높이기위함이다. 1,2,19,20 두개안면골격형태의치성보상 21-25 과경조직의변화에따른 291
남형진, 손우성, 박수병, 김성식 대치교정지 38 권 4 호, 2008 년 Table 7. Correlation coefficient analysis between pretreatment model measurements (angulation) and each change (pretreatment to presurgical, n = 31) Pretx ΔPretx- Presurg ΔPretx- Presurg IMPA FH-LI ALD II COS ICW IPW1 IPW2 IMW1 IMW2 AL Angulation 31 0.134-0.106 0.342-0.283-0.106 0.243 0.358 * 0.262 0.343 0.118 0.283 32 0.306-0.284 0.505-0.359 * 0.143 0.368 * 0.596 0.506 0.198-0.140 0.274 33-0.075 0.050-0.152 0.337-0.017-0.082-0.014-0.131-0.194-0.037-0.099 34-0.137 0.129-0.395 * 0.044 0.421 * -0.029-0.252 0.002-0.117-0.466-0.025 35-0.174 0.177-0.190 0.061 0.233 0.021-0.134 0.009 0.104-0.071-0.052 36-0.076 0.068 0.001-0.173 0.438 * 0.027 0.056 0.157 0.137-0.006 0.048 37 0.476-0.464 0.460-0.445 * 0.068 0.097 0.380 * 0.208 0.186-0.025 0.376 * 41 0.120-0.147 0.303-0.054-0.155 0.064 0.075 0.071 0.125 0.143-0.007 42 0.450 * -0.435 * 0.116-0.076 0.008-0.063 0.329 0.280 0.417 * 0.168 0.125 43-0.235 0.207-0.277 0.437 * -0.021-0.091-0.012-0.012-0.210-0.038-0.155 44-0.256 0.201-0.353 0.482 0.149 0.136-0.408 * -0.091-0.143 0.023-0.292 45-0.109 0.037-0.101 0.254 0.048 0.206-0.150-0.120 0.090 0.125-0.115 46 0.094-0.124 0.125-0.138 0.336 0.210-0.120-0.018 0.041 0.054 0.198 47 0.234-0.221 0.231-0.183 0.233-0.175-0.068-0.233-0.017 0.234 0.105 Tooth number (FDI system). * p < 0.05; p < 0.01; p < 0.001. Table 8. Correlation coefficient analysis between pretreatment model measurements (inclination) and each change (pretreatment to presurgical, n = 31) Pretx IMPA FH-LI ALD II COS ICW IPW1 IPW2 IMW1 IMW2 AL Inclination 31 0.309-0.316 0.119-0.112 0.242 0.280 0.172 0.456 * -0.071-0.344 0.533 32 0.272-0.236 0.356 * -0.282 0.303 0.383 * 0.334 0.599 0.053-0.274 0.374 * 33-0.044 0.031-0.009 0.056 0.304 0.438 * 0.027 0.368 * -0.052-0.308 0.323 34 0.339-0.307 0.357 * -0.279 0.031 0.368 * 0.694 0.530 0.132-0.198 0.433 * 35 0.250-0.204 0.170-0.197 0.412 * 0.313 0.330 0.811 0.461-0.101 0.225 36 0.295-0.252 0.201-0.335 0.192 0.280 0.351 0.518 0.661 0.145 0.183 37 0.099-0.046 0.329-0.289 0.155 0.142 0.380 * 0.459 0.480 0.265 0.173 41 0.258-0.236 0.095-0.043 0.284 0.274 0.219 0.458-0.040-0.263 0.471 42 0.099-0.059 0.236-0.192 0.226 0.373 * 0.214 0.499 0.025-0.262 0.363 * 43 0.169-0.143 0.055-0.032 0.080 0.275 0.250 0.359 * 0.121-0.057 0.343 44 0.176-0.110 0.256-0.289 0.075 0.279 0.591 0.504 0.109-0.189 0.343 45 0.179-0.130 0.107-0.163 0.281 0.395 * 0.334 0.743 0.167-0.345 0.251 46-0.038 0.117 0.185-0.184-0.089 0.385 * 0.302 0.438 * 0.264 0.095 0.252 47 0.009 0.054 0.022-0.157 0.192 0.138 0.175 0.394 * 0.271 0.168-0.004 Tooth number (FDI system). * p < 0.05; p < 0.01; p < 0.001. 292
Vol. 38, No. 4, 2008. Korean J Orthod 악교정수술을받은 III 급부정교합자의치료전, 후의하악치열궁변화 Table 9. Correlation coefficient analysis between each change of measurements (pretreatment to presurgical, n = 31) IMPA FH-LI ALD II COS ICW IPW1 IPW2 IMW1 IMW2 AL IMPA 1.000 FH-LI -0.978 1.000 ALD 0.337-0.317 1.000 II -0.259 0.230-0.664 1.000 COS -0.011 0.020-0.188-0.134 1.000 ICW 0.047-0.110 0.498-0.384 * 0.006 1.000 IPW1 0.273-0.256 0.630-0.492-0.206 0.484 1.000 IPW2 0.217-0.200 0.301-0.363 * 0.333 0.503 0.552 1.000 IMW1 0.169-0.122 0.281-0.402 * -0.070 0.220 0.311 0.424 * 1.000 IMW1-0.119 0.140 0.166 0.057-0.373 * -0.142-0.021-0.220 0.515 1.000 AL 0.486-0.504 0.638-0.511-0.127 0.571 0.466 0.375 * 0.226-0.054 1.000 * p < 0.05; p < 0.01; p < 0.001. 연조직의변화에관한연구 26-28 는많이이루어져술전교정및악교정수술의치료계획수립에많은도움이되고있다. 술전교정치료는이러한치성보상과악교정수술에해당하는경조직변화를연결하여심미적인연조직변화를이루게하는중요한과정이다. 치아의교합을배제한악교정수술은있을수없으므로악교정수술량은술전교정후의치아의배열에의해결정된다고할수있다. Capelozza Filho 등 29 은하악전돌자에서하악골의후방이동량과치성보상의해소사이에상관관계가있음을밝혔으며, Yang 30 은술전교정치료에서전치부의순, 설측치축을부적절하게변동시키게되면수술시부적절한위치로하악이이동되고결과적으로부적절한측모가초래된다고하였다. 최근경제적여건의발전과더불어심미에대한높은관심으로악교정수술을동반한치료는증가하는추세여서초진시에악교정수술이계획된환자의수술후변화를정확하게예측하는것이더욱중요하게되었다. 26 심미성향상을위한치료계획을수립하기위해서는술전교정치료에의한실제적인치아의위치변화의예측과이에대한고려가필수적이다. 이러한예측은초진시의진단자료에근거를두게되므로초진시의측모두부방사선사진및석고모형과술전교정치료후의변화와의상관관계를알아보는것은치아의위치변화를예측하는데도움이된다. 치료전, 후의하악치열의변화에관한기존의연구들을살펴보면치축변경시의기준평면으로측모두부방사선사진상에서 SN plane, FH plane, 구개평면, 하악평면, 교합평면등을사용하였다. Yang 30 은악교정수술을동반한교정치료의경우술전교정치료과정의치축변화는기존의기준평면을사용할수있으나수술이개입되게되면수술에의해기준평면이영향을받으므로교합평면을기준평면으로설정해야절치치축에대한경사도가수술시골절단면의위치에상관없이일정하게된다고하였고, Arnett 등 9 은상하악교합평면을기준평면으로설정하여절치의치축각도를분석하였다. 또한셋업모형측정기를사용하여석고모형에서의개개의치아의근원심경사와협설측경사를측정하고공간부조화양, 치열궁폭경및장경등을측정하여, 절치이외의치아에대해서는적합한정보를제공하지못하는측모두부방사선규격사진의한계를보완하고자하였다. 14,17,31 연구대상으로선정된남녀에서골격의크기에성별의차이가존재할것으로예상되었으나, 본연구에서는남녀의성별에의한측모두부방사선규격사진과석고모형의유의성있는차이는나타나지않았다 (p > 0.05) (Table 10). 치료후하악치열궁폭경과장경은전반적으로증가하였고, 특히제 1 소구치간폭경의변화가가장컸으며견치간폭경과제 1 대구치간폭경의변화는크지않았다. 이결과는악교정수술이필요한 III 급부정교합자에서소구치부에서치성보상이많이일어나고제 1 대구치는치성보상이다른치아보다적게일어난다는 Lee 와 Son 21 의연구결과와일치하였다. 따라서치료전의견치간폭경과제 1 대구치간폭경을참고하여치료후하악치열궁의형태를예측할수있을것으로생각한다. 개개치아의근원심경사 (angulation) 의경우치료 293
남형진, 손우성, 박수병, 김성식 대치교정지 38 권 4 호, 2008 년 Table 10. Sexual differences of pretreatment cephalometric and model measurements Male Female Significance Mean ± SD Mean ± SD Pretreatment cephalometric measurements SNB 83.73 3.47 83.44 4.07 NS SN-Mn 39.14 6.43 40.24 6.74 NS FH-Mn 31.28 6.81 32.88 5.04 NS AFH 149.58 10.39 141.15 9.04 NS PFH 95.36 6.91 85.60 4.46 NS PFH/AFH 0.63 0.04 0.60 0.04 NS IMPA 78.72 8.94 78.34 6.61 NS FH-LI 70.61 8.82 68.75 5.62 NS Mn-LMMC 38.62 3.83 36.83 2.75 NS Mn-LIE 49.22 4.15 46.49 4.22 NS SN-MnOcc 20.69 4.48 18.11 7.00 NS Mn-MnOcc 23.28 4.75 22.60 4.63 NS Pretreatment model measurements ALD -3.58 1.96-3.25 2.40 NS II 5.42 3.09 4.80 2.79 NS COS 1.86 0.57 1.53 0.60 NS ICW 27.07 2.85 27.32 2.22 NS IPW1 35.14 2.89 33.67 3.08 NS IPW2 43.02 3.65 40.34 2.81 NS IMW1 49.10 2.65 46.84 2.42 NS IMW2 55.15 3.95 52.17 2.72 NS Arch length 42.89 3.82 42.71 3.32 NS NS, statistically not significant. 후전치부는임상치관이근심경사되는경향을보였고제 1 소구치후방의구치부는원심경사되는경향을보였다. 협설측경사 (inclination) 의경우모든치아가임상치관의순협측경사를보였다. 이러한평균변화량은전형적으로치성보상이해소되는양상을보였다. 그리고초진시존재하던총생과 Spee 만곡이해소되는과정이모두전치부로집중되는것이아니라하악치열전체로분산됨을의미한다. 또한상악의소구치발치군과비발치군사이에유의성있는차이가없었다. 이러한결과는 Kim 등 14 과 Lee 등 31 의연구결과와일치하였다. 본연구는후향적연구로서술전교정완료시의모형은근원심경사 (angulation) 와협설측경사 (inclination) 를측정하는순협면이브라켓에의해측정할수없었으므로술전교정완료시의모형은연구자료로이용하지못했다. 물론술후교정은치아의배 열을마무리하는단계로서치아의위치를변화시켰을것이라고추측할수있다. 19 그러나 Willmot와 Moss 32 는측모두부방사선사진연구에서골격성 III 급부정교합자의하악수술후하악절치는술전교정후와차이가없었다고하였다. 본연구결과에서도 FH plane에대한절치치축각도가악교정수술후에도술전교정후와유의한차이가없었다. 이러한술후교정에의해유의한변화가없었다는점과술전교정치료의목표에근거하여하악의치료후의모형과술전교정완료시의모형이유사하다고가정하였다. 실제로 Bae와 Son 17 의방법으로측정한결과, 측모두부방사선사진상의하악절치치축의치료전과술전교정후간변화는모형의치료전, 후 #31, 41의 inclination의변화의평균값과비슷하였다. 이를바탕으로초진시의측모두부방사선사진및석고모형과술전교정에의한변화량간상관관계를조사하였다. 공간부조화의양인 ALD은폭경의변화량인 ICW, IPW1과 AL의변화량과순상관관계를보였는데, 이는 ALD의절대값이클수록하악절치의순측경사가많이나타나고치열궁폭경과장경도많이증가함을의미하며치열궁폭경의증감은제2소구치후방보다는제1소구치전방에서더욱많이증가됨을의미한다. 또한견치간폭경과제1대구치간폭경의차이인 ICW-IMW1은 IMW1의변화량과역상관관계를보였는데, 이는치료전의견치간폭경과제1대구치간폭경간의차이가클수록제1대구치의변화량은작음을의미하여하악치열궁의폭경을변화시킬때참고할수있을것으로생각한다. AlQabandi 등 33 은하악절치의전방경사는총생의해소및견치간폭경의감소와관련이있음을설명하였고, Braun과 Hnat 34 은견치간폭경의변화와치열궁장경의변화와관련이있다고하였다. 본연구는이와같은연구와대부분일치하였으나견치간폭경이치열궁장경과역상관관계를이루는것과는일치하지않았다. 오히려 AL의변화량은 ICW, IPW1, IPW2의변화량과순상관관계를보였다. 이것은앞의연구가총생의정도가유사한조건하에서견치간폭경변화에따라기존의악궁형태를변형시킨것에기인하고본연구는총생의정도가달랐기때문으로생각한다. 또한 AL의변화량은제1대구치후방의폭경변화인 IMW1, IMW2와는상관관계를보이지않아서 AL의변화량은후방부보다는제2소구치전방의폭경변화량과관련이큼을의미한다. Hemley 35 에의하면 Spee 만곡은하악구치부가근 294
Vol. 38, No. 4, 2008. Korean J Orthod 악교정수술을받은 III 급부정교합자의치료전, 후의하악치열궁변화 심경사되고하악견치가원심경사되며사이의소구치가하방에위치하는상태를일컫는다. 이러한 Spee 만곡을해소하기위해 Strang 과 Thompson 36 은하악구치부의원심경사와소구치의정출및전치의함입이필요하다고했다. Chung 등 37 과 AlQabandi 등 33 은 Spee 만곡의감소와하악절치의전방경사와관련이없었다고하였으며, 본연구에서도 Spee 만곡과전치부치축각도변화와치열궁폭경및장경등각각의변화량과는상관관계를보이지않아유사한결과를보였다. Spee 만곡이술전교정치료에의해유의성있는변화를보인것으로나타났지만하악절치와하악구치부수직길이변화는유의성있는변화를보이지않아서, 하악교합평면이변하지않고소구치부의정출로 Spee 만곡이평탄화된것으로생각한다. Bae 와 Son 17 은셋업모형측정기를사용하여측모두부방사선사진에서의계측치들을진단용모형에서의계측치와서로연계시켜분석하고임상적으로적용할수있다고하였다. 따라서치료전에측모두부방사선사진뿐만아니라실질적으로간편한셋업모형측정기를사용하여모형을계측함으로써치료시의변화량을더욱정밀하게예측할수있을것이다. 치료전의계측값을바탕으로하악절치의전방경사이동량과장경변화량및폭경확장량을예측하는유의한변수를찾기위해본연구에얻은자료를바탕으로회귀분석을시행하였다. 술전교정치료목표설정과상관있는 AL, IPW1 의변화량과치료전계측항목간의선형식을얻었는데, AL = -0.770 + 0.465 ALD + 0.131 #31 (Inclination) -0.074 #32 (Inclination)( 수정결정계수 R 2 = 0.640, p < 0.001), IPW1 = -16.862 + 0.852 IPW1-0.352 AL ( 수정결정계수 R 2 = 0.758, p < 0.001) 로나타났다. 이두가지선형식은임상적으로적용할수있을것으로판단된다. 이러한판단에근거하여술전교정치료에의한변화를예상하여술전교정치료의목표설정에참고할수있을것이다. 치성보상의해소와하악골수술량사이에관련성이있으므로술전교정에의한치아의변화량을예상하지못하면악교정수술시부족하거나과도한골격이동을하게되어심미성이손상될수있으므로정확한치아의이동예측은심미성향상에중요하다. 29 치료전하악총생의양이적어서회귀식을통하여하악전치의전방경사가적을것으로예상되면 II 급고무줄을사용하거나 13 miniscrew 와 MEAW (multi-loop edgewise archwire) 를사 용하여 38 하악전치의전방경사를도모하여하악전치부치성보상을해소할수있다. Handelman 11 과 Wehrbein 등 12 은하악이부에서절치의전후방이동이한계가있으며이를고려하지않은치아이동은골소실과치주조직의파괴를유발할수있다고하였다. 따라서치료전하악총생의양이과도하여많은양의전방이동이예상되면하악제 2 소구치를발거하는것을고려해야한다. 13 또한많은양의하악절치의전방이동으로정상수평피개에맞춰악교정수술로하악을후방이동할경우하악이부의과도한후방이동으로심미적안모에악영향을미칠수있는데, 이러한경우에하악이부성형술을수술직전이아니라치아배열초기부터예상할수있다. Bailey 등 39 은상하악폭경문제가있어상악의폭경을교정적으로확장할경우재발및안정성의이유로술전교정초기에시행해야한다고하였다. 폭경은상하악을분리하여생각할수있는문제가아니므로하악의폭경또한변화를예상하여상악과조화를이루도록치료초기부터폭경조절에유의해야한다. 악교정수술이필요없는환자의치열궁변화에비해악교정수술이필요한환자의치열궁변화는치료초기골격적부조화의존재라는측면에서차이가있을수있다. 골격적부조화가심할수록하악의치아가설측으로경사되는경향이크며이는치성보상해소시에확장의여력을더욱크게한다. 또한악교정수술을통하여골격적인위치변화를시도할수있으므로폭경의조절이좀더용이하다. 본연구에서는치료전, 후의하악치열궁변화를관찰하고치료전의측모두부방사선규격사진및석고모형의계측치와의관련성이있음을알수있었다. 측모두부방사선규격사진과석고모형을연계하여골격성 III 급부정교합자의하악치열궁변화를더욱정밀하게예측할수있을것으로생각한다. 그러나치아이동이 II 급고무줄의사용유무와다양한브라켓의사용등치료역학에따라다양하게변할수있고하악치열의변화는발치와비발치군간에차이가있을수있으므로치아의변화를정확하게예측하기위해여러가지요소를조절한연구가필요할것이다. 또한이를개개인의골격특성과안모의특징에따라제공할수있다면보다정확히악교정수술의결과를예측하는데도움이될수있을것으로생각한다. 295
남형진, 손우성, 박수병, 김성식 대치교정지 38 권 4 호, 2008 년 결론 본연구는악교정수술을받은골격성 III 급부정교합자의치료전, 후의하악치열궁의변화를관찰하고이들이초진시의측모두부방사선규격사진및석고모형과어떠한상관성을가지고있는지를알아보기위해골격성 III 급부정교합자로진단받은 31 명 ( 남자 14 명, 여자 17 명, 평균 21.8±3.3 세 ) 을대상으로치료전, 악교정수술전, 악교정수술후채득한측모두부방사선규격사진과치료전, 후하악석고모형을분석하여다음과같은결론을얻었다. 1. Mn-LMMC, Mn-LIE, Mn-MnOcc 는술전교정치료에의한유의한차이 (p > 0.05) 를보이지않았다. 2. ALD 은 ICW, IPW1 의변화량과순상관관계 (r = 0.492, p < 0.01; r = 0.615, p < 0.001) 를보였으며 AL 의변화량과도순상관관계 (r = 0.641, p < 0.001) 를보였다. 3. Spee 만곡은전치부치축각도변화와치열궁폭경및장경등각각의변화량과는상관관계를보이지않았다. 4. 술전교정후 Arch length, IPW1 의변화량은치료전의계측치로각각 64.0%, 75.8% 를설명할수있었다. 이상의연구에서골격성 III 급부정교합자의치료전, 후의변화량과치료전측모두부방사선규격사진및석고모형의계측치간에관련성이있었고, 이것을적용하면악교정수술을동반한교정치료계획을수립할때치료전의계측치를이용하여더욱정밀한술전교정치료의목표설정과악교정수술결과의예측에도움이될것으로판단된다. 참고문헌 1. Yang SD. Surgical treatment objectives. J Korean Dent Assoc 2007;45:404-13. 2. Tae GC. Pre- and post-surgical orthodontic treatment. J Korean Dent Assoc 2007;45:413-22. 3. Montini RW, McGorray SP, Wheeler TT, Dolce C. Perceptions of orthognathic surgery patient's change in profile. A five-year follow-up. Angle Orthod 2007;77:5-11. 4. Worms FW, Isaacson RJ, Speidel TM. Surgical orthodontic treatment planning: profile analysis and mandibular surgery. Angle Orthod 1976;46:1-25. 5. Lee SJ, Hong SJ, Kim YH, Baek SH, Suhr CH. Effect of maxillary premolar extraction on transverse arch dimension in Class III surgical-orthodontic treatment. Korean J Orthod 2005;35:23-34. 6. Proffit WR, White RP, Sarver DM. Contemporary treatment of dentofacial deformity. St Louis: Mosby; 2003. p. 245-67. 7. Wolford LM, Hilliard FW, Dugan DJ. Surgical treatment objective. St Louis: Mosby; 1995. p. 11-74. 8. Steiner CC. Cephalometrics in clinical practice. Angle Orthod 1959;29:8-29. 9. Arnett GW, Jelic JS, Kim J, Cummings DR, Beress A, Worley CM Jr, et al. Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity. Am J Orthod Dentofac Orthop 1999;116:239-53. 10. Yang WS. Morphology of mandibular symphysis and positioning of lower incisors in the skeletal class III malocclusions. Korean J Orthod 1985;15:149-62. 11. Handelman CS. The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae. Angle Orthod 1996;66:95-109. 12. Wehrbein H, Bauer W, Diedrich P. Mandibular incisors, alveolar bone, and symphysis after orthodontic treatment. A retrospective study. Am J Orthod Dentofac Orthop 1996;110:239-46. 13. Hwang CJ, Kwon HJ. A study on the preorthodontic prediction values versus the actual postorthodontic values in class III surgery patients. Korean J Orthod 2003;33:1-9. 14. Kim SJ, Park SY, Woo HH, Park EJ, Kim YH, Lee SJ, et al. A study on the limit of orthodontic treatment. Korean J Orthod 2004;34:165-75. 15. Little RM. The irregularity index: a quantitative score of mandibular anterior alignment. Am J Orthod 1975;68:554-63. 16. Shannon KR, Nanda RS. Changes in the curve of Spee with treatment and at 2 years posttreatment. Am J Orthod Dentofacial Orthop 2004;125:589-96. 17. Bae GS, Son WS. Construction of an ideal set-up model for lingual orthodontic treatment. Korean J Orthod 2005;35:459-74. 18. Dahlberg G. Statistical methods for medical and biological students. New York: Interscience Publishers Inc.; 1940. p. 122-32. 19. Bousaba S, Delatte M, Barbarin V, Faes J, De Clerck H. Preand post-surgical orthodontic objectives and orthodontic preparation. Rev Belge Med Dent 2002;57:37-48. 20. Swinnen K, Politis C, Willems G, De Bruyne I, Fieuws S, Heidbuchel K, et al. Skeletal and dento-alveolar stability after surgical-orthodontic treatment of anterior open bite: a retrospective study. Eur J Orthod 2001;23:547-57. 21. Lee HK, Son WS. A study on basal and dental arch width in skeletal Class III malocclusion. Korean J Orthod 2002;32:117-27. 22. Ishikawa H, Nakamura S, Iwasaki H, Kitazawa S, Tsukada H, Chu S. Dentoalveolar compensation in negative overjet cases. Angle Orthod 2000;70:145-8. 23. Jeon YJ, Park SB, Son WS. The correlation between dental compensation and craniofacial morphology in skeletal class III maloccusion. Korean J Orthod 1997;27:209-19. 24. Shim HY, Chang YI. Dentoalveolar compensation according to skeletal discrepancy in Normal occlusion. Korean J Orthod 2004;34:380-93. 25. Park SS, Kim HD, Lee DH, Jeon YM, Kim JG. Dentoalveolar characteristics according to facial types of class III malo- 296
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ORIGINAL ARTICLE Changes of mandibular dental arch during surgical-orthodontic treatment in skeletal class III malocclusion individuals Hyung-Jin Nam, DDS, MSD, a Woo-Sung Son, DDS, MSD, PhD, b Soo-Byung Park, DDS, MSD, PhD, c Seong-Sik Kim, DDS, MSD, PhD d Objective: The purpose of this study was to investigate changes in the mandibular dental arch from presurgical orthodontic treatment and orthognathic surgery, and to evaluate the relationships between the pretreatment records and changes of mandibular dental arch in skeletal Class III malocclusion individuals. Methods: Lateral cephalometric radiographs and mandibular study models of 31 adults with skeletal class III malocclusion were taken and measured. All measurements were evaluated statistically by ANOVA, Scheffe's Post Hoc, and paired t-test, and correlation coefficients were evaluated. Results: No significant difference in Mn-LMMC, Mn-LIE, Mn-MnOcc was detected between pretreatment and presurgical groups. Statistically significant but low correlations were demonstrated between the initial arch length discrepancy (ALD) and change in ICW, IPW1 (r = 0.492, 0.615) and change in arch length (r = 0.641). No association was seen between the initial depth of curve of Spee and change in mandibular incisor angle and arch width or arch length. Regression analysis showed that the amount of change for arch length and IPW1 could be explained by 64.0% and 75.8% of the pretreatment variables respectively. Conclusions: This study suggests that orthognathic surgery results can be predictable by measuring the pretreatment records. (Korean J Orthod 2008;38(4):283-298) Key words: Class III surgical-orthodontics, Dental decompensation, Lower dental arch a Resident, b Professor, c Professor, d Associate Professor, Department of Orthodontics, School of Dentistry, Pusan National University. Corresponding author: Woo-Sung Son. Department of Orthodontics, School of Dentistry, Pusan National University Hospital, 305, Gudeokro, Seo-gu, Busan 623-739, Korea. +82 51 240 7443; e-mail, wsson@pusan.ac.kr. Received January 1, 2008; Last Revision June 20, 2008; Accepted June 23, 2008. 298