骨格性下顎前突症における, 矯正治療単独症例と外科矯正併用症例の比較  [in Japanese] Comparison of Orthodontic Treatment Alone and Combined Orthodontic and Surgical Treatments in Skeletal Mandibular Prognathism Patients  [in Japanese]

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Abstract

骨格性の要素が強い下顎前突症の矯正治療において, 外科手術を併用する方法がしばしば選択される. しかし, 現在外科手術を併用するか否かを判別する明確な基準はなく, また患者の外科手術に対する希望の有無により, 治療法を決定しなくてはならない. そこで今回は骨格形態的所見, 歯列・顎堤の特徴的所見, 顔貌所見の類似する2症例において, 一方は矯正治療単独で, もう一方は外科矯正併用治療を選択した症例について比較検討を行った. 矯正治療単独症例は上下顎両側小臼歯を抜去し, マルチブラケット装置にて動的治療を行った. 外科矯正併用治療症例では術前矯正後, 下顎後退術を施行した. その後, 術後矯正と頤形成術を行い, 保定治療へ移行した. 治療の結果, 矯正治療単独症例では, 主に下顎前歯の舌側傾斜により被蓋は改善したが, 下顎正中矢状断面 (以下Symphysisと称す) に対し過度の舌側傾斜を与えたため下顎前歯唇側に歯肉退縮を認めた.外科矯正併用治療症例では, 初診時若干の歯肉退縮を全体的に認めたが, 矯正治療および外科手術により, 上下顎の前後的不調和が改善し, さらに上下顎前歯の歯軸傾斜を適正に近づけることができたため歯周組織の負担が軽減し, 歯肉退縮が改善した. これらの結果をふまえて, 過去の報告に, 上下顎の大きさや位置の不調和の補正を, Symphysisの形態が自らの厚みや形を変化させることで対応しているという報告よりSymphysisの形態的特徴と, 頭蓋に対する下顎前歯の傾斜の違いに着目し考察を行った. さらに, 両症例の審美的観点, 歯周組織的観点, 咬合機能的観点から加えて考察を行った.

In skeletal mandibular prognathism, we often provide combined treatment involving an orthodontic approach and a surgical technique. However, there is currently no clear basis for whether we apply a surgical operation. We selected two similar cases based on their skeletal morphological characteristics, dentition alveolar characteristics and facial appearances. One patient received treatment by an orthodontic approach alone, while the other patient was treated by combined orthodontic and surgical approaches. In the orthodontic treatment alone, we treated the patient with a multibracket appliance after extraction of the upper and lower premolars on both sides. In the combined orthodontic and surgical treatments, we used a pre-surgical orthodontic, performed a setback operation of the mandible, and used a post-surgical orthodontic treatment with genioplasty. After the orthodontic treatment alone, the patient could take on the proper overbite by lingual inclination of the lower anteriors, but exhibited a gingival recession in his lower labial anteriors owing to excessive lingual inclination out of the symphysis. In contrast, after the combined surgical and orthodontic treatments, the patientʼs inappropriate maxillomandibular relationship was greatly improved. Her gingival recession at the initial visit was improved by liability relief of the periodontal tissue because the proper interincisal angle could be obtained. Based on these results, we investigated the symphysis morphological characteristics and compared the differences in the lower incisive inclinations in the two patients. Furthermore, we considered the differences from the esthetic, periodontal and occlusal functional viewpoints.

Journal

  • Dental Medicine Research

    Dental Medicine Research 30(2), 167-177, 2010-07-31

    Showa University Dental Society

References:  15

Codes

  • NII Article ID (NAID)
    10027973182
  • NII NACSIS-CAT ID (NCID)
    AA12322983
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    18820719
  • NDL Article ID
    10850743
  • NDL Source Classification
    ZS44(科学技術--医学--歯科学・口腔外科学)
  • NDL Call No.
    Z19-1251
  • Data Source
    CJP  NDL  IR  J-STAGE 
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