http://dx.doi.org/10.5933/jkapd.2016.43.1.1 ISSN (print) 1226-8496 ISSN (online) 2288-3819 Evaluation of the Developmental Age of Permanent Teeth by the Nolla Method Minkyung Shin 1, Jeseon Song 1, Jaeho Lee 1, Byungjai Choi 1, Seongoh Kim 1, Hyoseol Lee 2 1 Department of Pediatric Dentistry, College of Dentistry, Yonsei University 2 Department of Pediatric Dentistry, School of Dentistry, Kyunghee University Abstract The developmental age of permanent teeth was evaluated in children and adolescents according to age and gender using the Nolla Method. A retrospective study was performed on panoramic radiographs of 1,200 subjects aged 4-15 years, including 50 children for each age/gender group. Three well-trained examiners estimated the developmental stage of upper and lower permanent teeth using the Nolla Method. The inter-examiner reliability was excellent (intra-class correlation coefficient value = 0.973). The mean developmental age was calculated. In boys, Nolla stage 6, indicated by crown completion, was seen in the central incisor, lateral incisor, canine, first premolar, second premolar, first molar, and second molar at 5.4, 6.4, 6.7, 7.5, 7.8, 4.6, and 8.1 years, respectively, in the maxilla and at 4.8, 5.1, 6.0, 6.5, 7.2, 4.5, and 8.0 years, respectively, in the mandible. In girls, Nolla stage 6 was seen at 5.3, 6.0, 6.3, 7.3, 7.7, 4.8, and 8.1 years, respectively, in the maxilla and at 4.8, 5.1, 5.9, 6.5, 7.2, 5.0, and 7.9 years, respectively, in the mandible. In this study, the developmental age of permanent teeth was evaluated in Korean children and adolescents who visited Yonsei University Dental Hospital. This study may be helpful in diagnosis and treatment planning in the clinic. Key words : Permanent teeth, Developmental age, Nolla method Ⅰ. 서론성장중인어린이를다루는소아치과에서소아의성장과발육에대한지식은필수적이다. 소아치과의사는환아의발육상태를평가하고성장을이용한교정치료및공간유지, 치료계획의수립등에이를응용할수있어야한다. 소아의성장발육상태를평가하는척도로서신장, 체중, 골성숙도그리고치아성숙도등을측정하는방법이있다. 신장과체중을이용하여성장을평가하는방법은침습적인검사나방사선사진촬영없이최소한의비용으로시행할수있는간편한방법으로, 2006년김등 1) 이 2004년의최신한국인인체치수조사자료를토대로 한국인소아의성장지표를제시한바있다. 골성숙도를이용하는방법으로는수완부골성숙도를평가하는 Fishman 2) 의 SMI(Skeletal Maturation Indicators) 방법이이용되고있고, 수완부골성숙도와치아성숙도와의관련성에관하여서도일찍이연구된바있다 3). 치아성숙도는치아의맹출이나석회화정도를측정함으로써평가할수있다. 치아의맹출은주로 Hellman 4) 의단계를통한평가가사용되고있다. 그러나치아의구강내출은은단시간내에이루어지므로맹출시기를정확하게평가하기어렵고공간상실과같은국소적인원인에의해영향을받을수있으며개인차가크다는단점이있다. 따라서치아의석회화정도를이용 Corresponding author : Hyoseol Lee Department of Pediatric Dentistry, School of Dentistry, Kyunghee University, 26, Kyunghee-daero, Dondaemun-gu, Seoul, 02447, Korea Tel: +82-2-958-9371 / Fax: +82-2-965-9247 / E-mail: stberryfield@gmail.com Received March 4, 2015 / Revised July 22, 2015 / Accepted July 7, 2015 1
하는방법이주로사용되고있다. 치아의석회화는교정학분야에서일찍이이용되기시작한성장발육척도로서 Moorrees 5), Nolla 6), Demirjian 7) 에의한방법이치아발육에관한연구에널리적용되고있는데, 각방법은치아의치관석회화, 치근석회화, 치근단공폐쇄에걸친치아의발육과정을세부단계로나누어각단계에점수를부여하고이를합산하여치령을계산하는점에서동일하나, Moorrees 5) 는이를 14단계, Nolla 6) 는 10단계, Demirjian 7) 은 8단계로구분하였다. 이중 Nolla 방법을각단계별로살펴보면, 0단계는치와 (crypt) 의부재, 1단계는치와 (crypt) 의형성, 2단계는초기석회화의개시, 3단계는치관의 1/3 형성, 4단계는치관의 2/3 형성, 5단계는치관의대부분이형성, 6단계는치관형성완료, 7단계는치근의 1/3 형성, 8단계는치근의 2/3 형성, 9단계는근단공이개방된상태로치근대부분이형성, 10단계는근단공의폐쇄를의미한다. 치아발육평가의기준으로삼고있는기존의연구들은대부분 20세기후반에시행된외국의연구들로우리나라어린이의성장발육양상과차이가있을수있다. 국내에서도조 8), 박 9), 최와김 10), 안등 11) 이파노라마사진을이용하여연구하였다. 이중 Nolla 방법을이용하여치아발육을측정한연구는조 8) 와박 9), 안등 11) 에의해보고된바있다. 조 8), 박 9) 의연구는각각 1973년에 2-10세남녀 719명, 1974 년에 4-15세남녀 828명의파노라마사진을대상으로시행한것으로오랜기간이경과하여사회-경제적지표의변화로어린이의영양상태가개선됨에따라신체발육및치아발육이향상되었을것으로생각된다. 한편, 2000년에시행된안등 11) 의연구는표본의수가 258명으로연구대상의수가적어나이와성별에따른측정값이대표성을띠기어려울것으로생각된다. 이에따라본연구의목적은소아청소년환자에서영구치의석회화단계를 Nolla stage에따라평가하여나이와성별에따른영구치의평균발달연령을알아보고자한다. Ⅱ. 연구재료및방법 1. 연구대상본연구는 2008년부터 2012년까지연세대학교치과대학병원에내원하여파노라마방사선사진을촬영한환자중 4세에서 15세까지의남녀 1,200명 ( 각연령별남녀각 50명 ) 을대상으로하였다. 치아발육에영향을미칠수있는전신적요소를배제하기위하여전신질환이있는환자는제외하였고, 국소적영향요인을배제하기위하여과잉치에인접한영구치, 낭종과같은병소에포함된영구치, 치수치료병력이있는유치의계승영구치등은조사대상에서제외하였다. 2. 연구방법파노라마방사선사진을통법에의하여촬영한후 Nolla 6) 방 법에의해제3대구치를제외한좌측상, 하악영구치의치아석회화단계를 0부터 10까지의 11단계로평가하였다. 방사선사진판독은잘교육된 3명의조사자에의하여시행되었다. 3명의조사자간의일치도를계산하기위하여측정값을바탕으로 intra-class correlation coefficient가계산되었다. 조사자 3명의조사자간신뢰도 (ICC) 는 0.973로높은일치도를보였다. 3개의측정값중 2개이상의측정값이같은경우그값을해당치아의석회화단계로결정하였고, 측정값이모두다른경우세측정값중중간값을해당치아의석회화단계로결정하였다. Ⅲ. 연구성적 1. 나이와성별에따른영구치의평균발육단계 Nolla 방법에의하여측정한영구치의치아별평균발육단계는연령과성별에따라상악영구치에서다음과같았고 (Table 1), 하악영구치에서는다음과같이나타났다 (Table 2). 2. Nolla 발육단계에따른영구치의발육연령나이에따른영구치의평균발육단계를 Nolla stage를기준으로환산하여치아발육단계에따른치아의발달연령을계산한결과이다 (Table 3, 4). 치아발육상태가 Nolla stage 10단계에이른후에는방사선사진상관찰되는변화가없어이단계는연령계산에서제외하였다. Ⅳ. 총괄및고찰본연구에서는 4세에서 15세까지의남녀 1,200명의파노라마사진을분석하여소아청소년에서영구치의발육연령을평가하였다. 연구결과, 남아의하악제1소구치, 제2소구치, 제2 대구치, 상악제2대구치의치관석회화시기는 6.5세, 7.2세, 8.0세, 그리고 8.1세로나타났다. Nolla가보고한 7세, 7.7세, 8.2세, 그리고 8.2세와비교하여본연구에서의치관석회화시기가더빠른것으로나타났다. 또한, 남녀의모든치아에서치근의길이가완성되는시기가 Nolla의연구에비하여본연구의결과에서더빠른것으로나타났다 (Table 5). 이전의국내연구들과본연구결과를비교하면, 박 9) 의보고와비교하면모든치아에서본연구에서의치아발육이더빠른것으로나타났다. 안등 11) 의보고와비교시에는일부치아에서본연구의결과에서치아발육이더빠른것으로나타났다. 치관석회화시기는남자의상악제1대구치, 하악제1, 2소구치에서본연구의결과가더빠르게나타났고, 치근석회화시기는남자의상악중절치, 측절치, 제1소구치, 제1대구치, 하악측절치, 견치, 제1소구치, 제1대구치, 여자의상, 하악제1대구치에서본연구결과가더빠른것으로나타났다. 그러나안 11) 의연구에는치아별로누락된결과가있고나이및성별에따른조 2
Table 1. Developmental stage by Nolla Method in maxillary permanent teeth Age Gender Nolla stage (Average±SD) I1 I2 C P1 P2 M1 M2 4 M 5.7±0.6 4.6±0.6 4.3±0.5 3.5±0.7 2.8±0.7 6.1±0.5 2.5±0.6 F 5.6±0.6 4.9±0.7 4.6±0.7 3.5±0.7 2.8±0.8 6.3±0.5 2.4±0.7 5 M 6.2±0.7 5.3±0.7 5.2±0.5 4.6±0.6 4.4±0.8 7.1±0.7 3.8±0.9 F 5.8±0.7 5.2±0.7 5.2±0.6 4.5±0.5 4.1±0.8 6.8±0.6 3.6±0.9 6 M 6.8±0.6 6.0±0.4 5.8±0.5 5.3±0.5 5.2±0.6 7.6±0.7 4.9±0.8 F 6.9±0.7 6.3±0.6 6.1±0.6 5.4±0.6 5.2±0.6 8.0±0.9 5.2±0.8 7 M 7.8±0.6 7.0±0.7 6.6±0.6 6.0±0.4 6.0±0.5 8.8±1.0 5.9±0.3 F 8.1±0.6 7.5±0.7 7.0±0.5 6.4±0.6 6.3±0.6 9.3±1.0 5.7±0.9 8 M 8.7±0.6 8.0±0.9 7.2±0.6 6.7±0.6 6.5±0.5 10.0±0.2 6.4±0.5 F 8.8±0.6 8.4±0.6 7.6±0.6 7.0±0.8 6.5±0.6 9.9±0.4 6.1±0.8 9 M 9.0±0.6 8.7±0.8 7.6±0.6 7.3±0.7 6.9±0.6 9.9±0.4 6.6±0.6 F 9.4±0.5 9.1±0.7 8.1±0.5 7.8±0.8 7.3±0.8 10.0±0.0 6.8±0.6 10 M 9.6±0.5 9.5±0.6 8.1±0.5 8.1±0.7 7.9±0.8 10.0±0.0 7.2±0.8 F 9.6±0.5 9.4±0.5 8.6±0.6 8.4±0.8 8.0±1.0 10.0±0.1 7.2±0.7 11 M 9.9±0.3 9.7±0.5 8.7±0.8 8.7±0.9 8.7±1.1 10.0±0.0 8.0±1.0 F 10.0±0.2 9.9±0.2 9.3±0.6 9.1±1.0 8.8±1.0 10.0±0.1 8.2±1.2 12 M 10.0±0.1 9.9±0.2 9.4±0.6 9.5±0.7 9.4±0.8 10.0±0.0 8.8±1.0 F 10.0±0.0 10.0±0.2 9.7±0.5 9.6±0.6 9.3±0.9 10.0±0.0 9.0±1.1 13 M 10.0±0.0 10.0±0.1 9.7±0.6 9.8±0.5 9.8±0.6 10.0±0.0 9.4±0.8 F 10.0±0.0 10.0±0.1 9.9±0.3 9.9±0.3 9.8±0.5 10.0±0.0 9.5±0.7 14 M 10.0±0.0 10.0±0.0 9.9±0.3 9.9±0.3 9.9±0.4 10.0±0.0 9.6±1.4 F 10.0±0.0 10.0±0.0 10.0±0.2 10.0±0.2 10.0±0.2 10.0±0.0 9.9±0.3 15 M 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 F 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 9.9±0.2 M = male, F = female, SD = standard deviation, I1 = central incisor, I2 = lateral incisor, C = canine, P1 = first premolar, P2 = second premolar, M1 = first molar, M2 = second molar Table 2. Developmental stage by Nolla Method in mandibular permanent teeth Age Gender Nolla stage (Average±SD) I1 I2 C P1 P2 M1 M2 4 M 6.1±0.6 5.5±0.7 4.9±0.5 4.0±0.5 3.0±1.0 6.6±0.6 2.4±0.7 F 6.4±0.6 5.9±0.6 5.1±0.5 4.2±0.6 2.9±1.0 6.8±0.6 2.5±0.7 5 M 6.9±0.7 6.4±0.7 5.7±0.5 5.2±0.7 4.5±0.8 7.2±0.5 3.6±0.9 F 6.9±0.7 6.3±0.6 5.6±0.6 5.2±0.6 4.3±0.9 7.4±0.5 3.6±0.9 6 M 7.7±0.7 7.1±0.6 6.1±0.5 5.8±0.4 5.3±0.7 7.7±0.7 4.9±0.6 F 7.9±0.9 7.2±0.8 6.5±0.6 5.9±0.6 5.4±0.6 8.1±0.9 5.2±0.6 7 M 8.7±0.6 8.2±0.8 7.0±0.5 6.6±0.6 6.1±0.5 8.8±0.7 5.7±0.5 F 8.9±0.7 8.8±0.6 7.2±0.6 6.8±0.6 6.3±0.7 9.1±0.5 6.0±0.5 8 M 9.6±0.5 9.1±0.5 7.7±0.5 7.3±0.6 7.0±0.6 9.3±0.5 6.5±0.5 F 9.6±0.5 9.4±0.5 8.0±0.4 7.4±0.5 7.0±0.6 9.6±0.7 6.4±0.5 9 M 9.7±0.4 9.5±0.5 8.1±0.6 7.9±0.5 7.4±0.6 9.9±0.3 6.9±0.6 F 9.9±0.3 9.8±0.4 8.6±0.6 8.2±0.7 7.6±0.8 9.9±0.3 7.2±0.7 10 M 10.0±0.2 9.9±0.3 8.4±0.7 8.3±0.8 8.0±0.7 10.0±0.0 7.4±0.6 F 10.0±0.0 9.9±0.3 8.9±0.6 8.6±0.7 8.2±0.8 10.0±0.0 7.5±0.8 11 M 10.0±0.0 10.0±0.1 9.0±0.5 8.9±0.7 8.6±0.8 10.0±0.0 8.2±0.9 F 10.0±0.0 10.0±0.1 9.6±0.6 9.4±0.7 9.0±0.8 10.0±0.1 8.3±0.9 12 M 10.0±0.0 10.0±0.0 9.4±0.6 9.4±0.7 9.2±0.7 10.0±0.0 8.8±0.9 F 10.0±0.0 10.0±0.0 9.7±0.5 9.6±0.5 9.3±0.9 10.0±0.0 9.0±0.9 13 M 10.0±0.0 10.0±0.1 9.8±0.5 9.8±0.5 9.8±0.5 10.0±0.0 9.5±0.6 F 10.0±0.0 10.0±0.0 9.9±0.3 9.9±0.4 9.7±0.6 10.0±0.0 9.5±0.7 14 M 10.0±0.0 10.0±0.0 9.9±0.2 9.9±0.2 9.8±0.4 10.0±0.0 9.8±0.5 F 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 9.8±0.4 15 M 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.1 F 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.0 10.0±0.2 10.0±0.0 9.9±0.3 M = male, F = female, SD = standard deviation, I1 = central incisor, I2 = lateral incisor, C = canine, P1 = first premolar, P2 = second premolar, M1 = first molar, M2 = second molar 3
Table 3. Developmental age of permanent teeth in boys Developmental age of teeth (year) Nolla Stage Mx. Mn. I1 I2 C P1 P2 M1 M2 I1 I2 C P1 P2 M1 M2 1 Average SD 2 Average 4.6 4.6 SD 0.3 0.5 3 Average 4.5 4.7 5.3 4.6 5.0 SD 0.3 0.3 1.0 0.6 0.5 4 Average 4.7 4.5 5.0 5.5 5.7 4.7 5.1 5.8 SD 0.4 0.3 0.6 0.6 0.6 0.4 0.5 0.5 5 Average 4.6 5.0 5.5 6.0 6.1 6.3 4.5 4.6 4.9 5.6 6.0 6.5 SD 0.4 0.6 0.7 0.5 0.5 0.5 0.3 0.4 0.6 0.6 0.6 0.6 6 Average 5.4 6.4 6.7 7.5 7.8 4.6 8.1 4.8 5.1 6.0 6.5 7.2 4.5 8.0 SD 0.8 0.7 0.8 0.8 1.0 0.4 0.9 0.6 0.7 0.7 0.7 0.8 0.4 0.8 7 Average 6.4 7.7 8.5 9.0 9.4 5.9 10.2 5.6 6.1 7.7 8.5 9.1 5.4 9.8 SD 0.9 0.7 0.9 0.8 1.1 0.8 1.2 0.7 0.7 0.9 0.9 1.0 0.7 1.1 8 Average 7.8 8.7 10.2 10.7 11.0 6.6 11.6 6.6 7.3 9.5 10.0 10.6 6.5 11.3 SD 0.8 0.9 1.1 1.0 1.0 0.7 1.0 0.7 0.8 1.2 1.2 1.3 0.8 1.1 9 Average 9.3 10.0 12.3 12.1 12.3 7.4 12.7 8.1 8.6 11.5 11.7 12.2 8.0 12.7 SD 1.0 1.1 1.0 1.1 1.0 0.6 1.0 0.9 0.9 1.2 1.1 1.1 0.7 1.1 Mx. = maxilla, Mn. = mandible, SD = standard deviation, I1 = central incisor, I2 = lateral incisor, C = canine, P1 = first premolar, P2 = second premolar, M1 = first molar, M2 = second molar Table 4. Developmental age of permanent teeth in girls Developmental age of teeth (year) Nolla Stage Mx. Mn. I1 I2 C P1 P2 M1 M2 I1 I2 C P1 P2 M1 M2 1 Average SD 2 Average 4.5 4.6 SD 0.4 0.4 3 Average 4.5 4.8 5.0 4.6 5.0 SD 0.3 0.4 0.7 0.3 0.5 4 Average 4.7 5.0 5.3 5.8 4.6 5.2 5.5 SD 0.5 0.5 0.4 1.3 0.4 0.4 0.4 5 Average 4.8 5.0 5.1 6.0 6.1 6.4 4.7 4.9 5.3 6.2 6.5 SD 0.5 0.5 0.5 0.5 0.5 0.5 0.6 0.5 0.5 0.7 0.6 6 Average 5.3 6.0 6.3 7.3 7.7 4.8 8.1 4.8 5.1 5.9 6.5 7.2 5.0 7.9 SD 0.7 0.6 0.7 0.7 0.9 0.7 1.2 0.5 0.6 0.7 0.7 0.8 1.2 0.9 7 Average 6.5 7.2 7.7 8.7 9.3 5.5 10.1 5.4 5.9 7.0 8.0 8.9 5.1 9.7 SD 0.7 0.6 0.8 1.1 1.3 0.7 0.9 0.8 0.7 0.8 0.9 1.2 0.6 1.2 8 Average 7.5 8.1 9.4 10.2 10.8 6.5 11.4 6.5 7.0 8.8 9.6 10.4 6.0 10.9 SD 0.6 0.8 1.1 1.2 1.2 0.7 1.1 0.7 0.5 1.0 1.1 1.4 0.6 1.3 9 Average 9.2 9.6 11.3 11.2 11.5 7.3 12.8 7.6 8.2 10.7 11.2 11.5 7.6 12.6 SD 0.9 1.1 1.1 1.3 1.2 1.1 1.2 0.8 1.0 1.3 1.2 1.2 1.0 1.3 Mx. = maxilla, Mn. = mandible, SD = standard deviation, I1 = central incisor, I2 = lateral incisor, C = canine, P1 = first premolar, P2 = second premolar, M1 = first molar, M2 = second molar 4
Table 5. Developmental age of root length completion of permanent teeth Developmental age (Y M) Tooth Nolla 6) (1960) Park 9) (1974) Ahn 11) (2000) Authors M F M F M F M F Mx. I1 11Y 10Y 10Y 9M 10Y 5M 9Y 5M 8Y 10M 9Y 4M 9Y 2M I2 12Y 11Y 11Y 7M 11Y 4M 10Y 1M 9Y 10Y 9Y 7M C 15Y 12Y 6M 14Y 6M 13Y 7M 11Y 8M 10Y 6M 12Y 3M 11Y 3M P1 14Y 6M 12Y 9M 14Y 2M 13Y 10M 12Y 4M 10Y 7M 12Y 1M 11Y 2M P2 15Y 6M 14Y 14Y 10M 14Y 6M 12Y 3M 11Y 6M M1 11Y 6M 9Y 6M 11Y 6M 10Y 9M 9Y 8Y 5M 7Y 4M 7Y 4M M2 16Y 6M 15Y 6M 12Y 8M 12Y 9M Mn. I1 10Y 8Y 6M 9Y 9M 9Y 10M 8Y 1M 7Y 6M 8Y 1M 7Y 8M I2 10Y 6M 9Y 8M 10Y 7M 10Y 2M 8Y 11M 8Y 1M 8Y 7M 8Y 3M C 13Y 6M 12Y 14Y 13Y 3M 11Y 8M 10Y 1M 11Y 6M 10Y 9M P1 14Y 12Y 6M 13Y 9M 13Y 7M 12Y 4M 10Y 8M 11Y 9M 11Y 3M P2 15Y 14Y 6M 14Y 4M 14Y 12Y 2M 11Y 6M M1 11Y 6M 10Y 10Y 1M 9Y 7M 8Y 4M 7Y 8M 8Y 7Y 7M M2 16Y 6M 15Y 6M 12Y 9M 12Y 7M Y M = year month, M = male, F = female, Mx. = maxilla, Mn. = mandible, I1 = central incisor, I2 = lateral incisor, C = canine, P1 = first premolar, P2 = second premolar, M1 = first molar, M2 = second molar 사대상의수가 4-37명이어서비교하기어려웠다. 방사선사진상에서치아의석회화수준을이용하여치아발육을평가한연구는주로파노라마방사선사진을이용하여이루어진다. 파노라마방사선사진은상, 하악골및안면구조를연속된한장의방사선사진으로보여주며, 전악구내방사선촬영에비하여술식이비교적간편하고촬영시간이짧으며 X선노출량이비교적적은장점이있다. 따라서치아및치아주위의전반적인평가, 치아및악골의발육과정의평가, 특히혼합치열의분석에유용하여보편적으로사용되고있다. 그러나구내표준방사선사진에비하여해상도가좋지못하며상의확대와왜곡이심하고 X선노출시간이길어서환자의움직임에의한선예도저하가발생할수있는단점이있다 12). 각치아의석회화시기에서상악소구치부위의편차가전치부와구치부에비하여큰것으로나타났는데, 이는파노라마방사선사진판독시상악소구치부위에서의상왜곡과해상도저하로정확한판독이가장어렵기때문으로보인다. 영구치의석회화시기에는개인차가존재하며인종, 지역간의차이도존재하는것으로보고된바있으며 13,14), 사회경제적요인도치아발육에영향을미치는것으로보고되었다 15,16). 본연구의결과와이전의연구들과의석회화시기의차이는인종, 지역, 사회경제적요인의차이에기인하는것으로볼수있다. 그러나국내의선행연구들의경우조사대상의수가적어대표성을갖기어려우므로치아발육시기에관하여단순비교를하기에는무리가있다. 치아의발육을평가하는데있어서는한개체에대하여종적으로치아발육을관찰함으로써더정확한연구결과를얻을수있을것이므로이에대한대규모코호트연구가시행되어야한다. Ⅴ. 결론본연구를통하여연세대학교치과대학병원에내원한소아청소년환자에서의영구치의평균발육시기를평가하였다. 성장중인환자의진단과치료계획수립에있어본연구의결과가임상적으로유용하게적용될수있을것으로생각된다. References 1. Kim YJ, Lee SJ, Kim JW, et al. : Evaluation model of growth and development in pediatric dentistry. J Korean Acad Pediatr Dent, 33:173-180, 2006. 2. Fishman LS : Chronological versus skeletal age, an evaluation of craniofacial growth. Angle Orthod, 49:181-189, 1979. 3. Chertkow S, Fatti P : The relationship between tooth mineralization and early radiographic evidence of the ulnar sesamoid. The Angle Orthodontist, 49:282-288, 1979. 4. Hellman M : The phase of development concerned with erupting the permanent teeth. American Journal of Orthodontics and Oral Surgery, 29:507-526, 1943. 5. Moorrees CF, Fanning EA, Hunt EE, Jr. : Age variation of formation stages for ten permanent teeth. J Dent Res, 42:1490-1502, 1963. 6. Nolla CM : The development of the permanent 5
teeth. J Dent Child, 27:254-266, 1960. 7. Demirjian A, Goldstein H, Tanner J : A new system of dental age assessment. Human Biology, 211-227, 1973. 8. Cho SH : A Study on calcification of the roots of the permanent teeth by orthopantomography. J Korean Dent Assoc, 11:789-800, 1973. 9. Park BD : A study on calcification of the roots of the permanent teeth by orthopantomography. J Korean Dent Assoc, 12:395-410, 1974. 10. Choi BJ, Kim EY : A study on the development of permanent teeth using panoramic radiographs. J Korean Acad Pediatr Dent, 23:170-177, 1996. 11. Ahn SH, Yang KH, Choi NK : The calcification timing of the permanent teeth by Nolla stage. J Korean Acad Pediatr Dent, 27:540-548, 2000. 12. Association of Korean Professors of Oral and Maxillofacial Radiology: Oral and Maxillofacial Radiology, 4th ed. Narae Publishing, Seoul, 128, 2008. 13. Garn SM, Lewis AB, Koski K, Polacheck DL : The sex difference in tooth calcification. Journal of Dental Research, 37:561-567, 1958. 14. Garn SM, Lewis AB, Polacheck DL : Variability of tooth formation. Journal of Dental Research, 38: 135-148, 1959. 15. Phillips V, van Wyk Kotze T : Dental age related tables for children of various ethnic groups in South Africa. J Forensic Odontostomatol, 27:29-44, 2009. 16. Mappes MS, Harris EF, Behrents RG : An example of regional variation in the tempos of tooth mineralization and hand-wrist ossification. American Journal of Orthodontics and Dentofacial Orthopedics, 101:145-151, 1992. 6
국문초록 Nolla 방법을이용한영구치의발육연령평가 신민경 1 송제선 1 이제호 1 최병재 1 김성오 1 이효설 2 1 연세대학교치과대학소아치과학교실 2 경희대학교치의학전문대학원소아치과학교실 이연구의목적은 Nolla 방법에근거하여소아청소년에서나이와성별에따른영구치의평균발육연령을평가하기위한것이다. 연세대학교치과대학병원에내원하여파노라마사진을촬영한어린이중 4세에서 15세의남녀각각 50명을대상으로하여 1,200명의파노라마사진을후향적으로조사하였다. 3명의잘훈련된조사자가 Nolla 방법에의하여상, 하악영구치의발육단계를평가하였다. 조사자간신뢰도 (ICC, intra-class correlation coefficient value) 는 0.973으로높은일치도를보였다. 조사결과를바탕으로발육연령의평균값을계산하였다. 치관이완성되는 Nolla 6단계는남아에서는상악중절치부터제2대구치까지각각 5.4, 6.4, 6.7, 7.5, 7.8, 4.6, 8.1세에서나타났고, 하악에서는 4.8, 5.1, 6.0, 6.5, 7.2, 4.5, 8.0세에서나타났다. 여아에서는상악에서 5.3, 6.0, 6.3, 7.3, 7.7, 4.8, 8.1세, 하악에서는 4.8, 5.1, 5.9, 6.5, 7.2, 5.0, 7.9세에치관이완성되었다. 본연구를통하여우리나라소아청소년환자에서의영구치의평균발육연령을평가하였다. 성장중인환자의진단과치료계획수립에있어본연구의결과가임상적으로유용하게적용될수있을것으로생각된다. 주요어 : 영구치, 발육연령, Nolla 방법 7