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하악골 후방 이동술 후 초기 교합안정과 회귀성향에 대한 변형된 상부자의 효과

Effects of Modified Splint Modification on Early Relapse Tendency and Occlusal Stability after Mandibular Setback Procedure

구강과학- 전남대학교 2002년 14권 2호 p.114 ~ 126
류정호, 김현진, 김선헌, 이은주,
소속 상세정보
류정호 (  ) - 전남대학교 치의학연구소, 치과대학
김현진 (  ) - 전남대학교 치의학연구소, 치과대학
김선헌 (  ) - 전남대학교 치의학연구소, 치과대학
이은주 (  ) - 전남대학교 치의학연구소, 치과대학

Abstract


Many surgeons have tried to reduce the skeletal relapse and temporomandibular discomfort resulted from inproper postoperative condyle position when has been known as a major complication of orthognathic surgery of mandibular prognathism, especially sagittal split ramus osteotomy. In the case of early anterior openbite, it has been known that postoperative condyle position is the most important factor concerned with relapse. Many studies to reduce these complications have been reported by reproducing the preoperative condylar position. Generally, if the condyle is fixed at the antero-inferior position, the early anterior openbite might be resulted from the lever action on the most posterior tooth by movement of condyle to physiologically stable position when the intermaxillary fixation is released. This study was carried out to elucidate whether the condyle could be positioned in the physiologically stable position by using the modified splint. Surgical wafer splint was manufactured in the condition that condyle of articulator was first moved anteriorly 1.73mm, inferiorly 1mm, and then occluded. The effects of the modified splint to early occusal stability and relapse was evaluated by physical examination and radiographic landmarks of cephalometrics.
The results were as follows:
1. The usage of the modified splint helped the occlusal stability and reduced the rate of early anterior openbite.
2. It was acceptable for clinical application in aspects of temporomandibular discomfort.
3. Posterior openbite has rapidly compensated by the usage of the modified splint, and it was advantage to the prevention of early relapse.
4. The usage of the modified split resulted in the tendency of slightly anterior rotation of proximal segment, but it helped the repositioning of condyle into preoperative position.
5. It contributed to the occlusal stability by reducing anterior tooth movement, which was derived from compensational action of postoperative relapse.
6. The degree of inadvertent anteroposterior rotation of the proximal segment at surgery was correlated with the early skeletal relapse.
These results suggest that the proximal segment fixation technique by using the modified splint have advantages to reduce the early skeletal relapse. This technique could be effectively used to the patients who had no facial asymmetry and do not need maxillary movement.

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