성숙가토의 관절원판후조직 절단 후 하악골의 위치변화가 악관절에 미치는 영향에 관한 연구

Abstract

[한글]

악관절장애는 점차 증가추세에 있어 교정치료시 악관절에 대한 이해 및 고려가 필요불가피한 실정이다.

교정치료시 교정치료 목적상 하악골의 위치를 변화시켜야 할 경우가 종종 있으며, 이러한 치료가 악관절조직에 미치는 영향에 대해 많은 선학들의 연구가 있어 왔다. 그러나 이들 모두는 정상 악관절에서의 연구이었으며 악관절장애가 있는 악관절을 대상으로 시행한 연구는 국내를 막론하여 미미한 실정이다.

저자는 악관절내장증에서 하악골의 위치변화가 악관절에 미치는 영향에 대하여 알아보기 위하여, 성숙가토를 실험대상으로 하여, 외과적으로 관절원판후조직을 절단하여 관절원판을 전방변위시킨 후 하악골을 전방위치시키거나 후방력을 적용하여 악관절조직의 변화를 분석한 결과 다음과 같은 결론을 얻었다.

1. 가토에서 판절원판후조직을 절단함으로써 관절원판의 전방변위가 초래되어 악관절내장증과 유사한 조직소견이 관찰되었다.

2. 관절원판을 전방변위시킨 후 방치한 가토의 관절융기와 과두관절면에서는관절 운동에 의한 침식과 변형이 나타났으며, 전하방으로 변위된 관절원판에서는 모양의 변형과 내부구조의 변성이 초래되었다.

3. 관절원판을 전방변위시킨 후 하악골을 전방위치시킨 가토에서는, 관절융기와 과두 전방부위의 침식이 다소 심하게 관찰되었으나, 과두 후상방부위와 관절와에서의 활발한 연골중식으로 인한 순행성재형성 (progressive remodeling) 소견이 관찰되었다.

4. 관절원판을 전방변위시킨 후 하악골에 투방력을 적용한 가토에서는 관절운동에 의한 관절면의 침식은 관찰되지 않았으나, 관절면의 연골증식이 대조군에 비하여 저조하게 나타나 역행성재형성 (regressive remodeling)소견을 보였으며 특히 하악과두가 환절원판후

조직을 압박하는 소견이 현저하게 나타났다.

THE EFFECTS OF CHANGES OF MANDIBULAR POSIT10N ON TEMPOROMANDIBULAR JOINT IN ADULT

RABBITS WHOSE RETRODISCAL TISSUES WERE INCISED

Hyeon-Shik Hwang

Department of Dental Science, Graduate School, Yonsei University

(Directed by Professor Byung-Wha Sohn, D.D.S., M.S.D., Ph.D.)

The purpose of this experiment was to study the effects of changes of mandibular

position on temporomandibular joint in internal derangement patients Twenty-four

female New Zealand White Rabbits, weighing over 3.5kg, were utilized in this study

. Bilateral temporomandibular joint surgery was performed in twenty-one of the

rabbits to displace disc anteriorly through incising the retrodiscal tissue 1-2mm

posterior to the disc, thus inducing internal derangement. They were divided into

three groups : nine were left untreated after surgery, six were fitted with

functional protrusive appliances 4 weeks after surgery, and six wore collar

appliances to apply 4 ounces of mandibular retractive force per side 4 weeks after

surgery. The remaining three served as the control group. Histologic examinations

were performed after sacrificing them by threes at 4-week intervals.

The results were as follows :

1. Histologic findings similar to internal derangement were observed in the

rabbits whose retrodiscal tissues had been incised.

2. In the rabbits untreated after surgery, articular surface on condylar process

and articular eminence showed severe erosion and deformation, and displaced disc

manifested changes in both shape and internal architecture.

3. Functional protrusion after surgery resulted in progressive remodeling on

posterosuperior portion of condyle and glenoid fossa, while it also brought about

erosion on articular eminence and anterior portion of condyle.

4. Mandibular retraction after surgery resulted in compression of retrodiscal

tissue and regressive remodeling of posterior portion of condyle.

[영문]

The purpose of this experiment was to study the effects of changes of mandibular position on temporomandibular joint in internal derangement patients Twenty-four female New Zealand White Rabbits, weighing over 3.5kg, were utilized in this study

. Bilateral temporomandibular joint surgery was performed in twenty-one of the rabbits to displace disc anteriorly through incising the retrodiscal tissue 1-2mm posterior to the disc, thus inducing internal derangement. They were divided into three groups : nine were left untreated after surgery, six were fitted with functional protrusive appliances 4 weeks after surgery, and six wore collar appliances to apply 4 ounces of mandibular retractive force per side 4 weeks after surgery. The remaining three served as the control group. Histologic examinations

were performed after sacrificing them by threes at 4-week intervals.

The results were as follows :

1. Histologic findings similar to internal derangement were observed in the rabbits whose retrodiscal tissues had been incised.

2. In the rabbits untreated after surgery, articular surface on condylar process and articular eminence showed severe erosion and deformation, and displaced disc manifested changes in both shape and internal architecture.

3. Functional protrusion after surgery resulted in progressive remodeling on posterosuperior portion of condyle and glenoid fossa, while it also brought about erosion on articular eminence and anterior portion of condyle.

4. Mandibular retraction after surgery resulted in compression of retrodiscal tissue and regressive remodeling of posterior portion of condyle.