측두하악관절장애(temporomandibular joint disorder)를 동반한 부정교합 환자의 측모 골격 특성

Abstract

[한글]

측두하악관절장애와 하안면 구조의 부조화와의 연관성에 대한 많은 논란이 있어 왔으며, 측두하악관절장애에 의해서 안면의 부조화가 초래될 수 있는지, 반대로 안면의 부조화가 측두하악관절장애를 일으킬 수 있는지는 아직 명확하지 않다. 측두하악관절장애 환자의 안모의 특성을 이해하는 것은 이러한 연관성을 규명하는데 중요하다.

이에 본 연구는 두개안면골격 구조와 측두하악관절장애에 대한 연관성을 알아보기 위해 측모두부규격방사선사진에서의 계측값들을 설정하여 측두하악관절장애의 증상의 여부에 따라 안모의 특성을 살펴보았다.

연세대학교 치과대학병원 교정과에 내원한 18세 이상의 교정치료 전 성인 남녀 111명으로 대상으로, 측두하악관절장애의 증상을 가지는 이들을 실험군(56명), 측두하악관절장애의 증상이 없는 이들을 대조군(55명)으로 설정한 후, 전후방적 골격 관계를 나타내는 ANB 차이에 따라 Class I (평균 : 2.89˚)?Class II (평균 : 6.32˚)?Class III (평균 : -2.02˚)으로 분류하여 두개안면구조의 계측항목들 간의 유의성을 검정하여 다음과 같은 결과를 얻었다.

1.Class I, Class II, Class III의 실험군은 대조군에 비하여 짧은 하악지 를 나타냈다(Class I (p<0.001), Class II (p< 0.01), Class III (p<0.01) ).

2.Class I에서 Mandible plane to SN (p<0.01), Gonial angle (p< 0.01), Class II 에서는 Gonial angle (p<0.05)이 유의성 있는 결과를 나타냈으며, 상악 전치가 더욱 설측 경사된 양상을 보였다(Class I - U1 to SN (p< 0.01), Class II - U1 to SN (p< 0.01)).

3.Class II (p<0.01), Class III (p<0.01)의 실험군은 대조군에 비하여 Effective mandibular length가 짧았으나, Class I에서는 유의한 차이를 나타내지 않았다.

4.Class III에서는 Anterior cranial base Mandibular length가 실험군에서 유의성 있게(p<0.01) 큰 값을 나타냈으며, Occlusal plane이 더욱 급한 경사를 보였다(Occlusal plane to SN(p<0.01), Occlusal plane to Mandibular plane(p<0.01)).

이상의 결과로, 측두하악관절장애를 가진 실험군은 각 군에 따라 hyperdiver-gent한 안모와 설측 경사된 상악 전치, Occlusal plane의 급한 경사를 가지는 특징을 보였다. 측두하악관절장애는 하안면의 구조과 깊은 연관성을 가지고 있으므로, 측두하악관절장애를 가진 환자의 교정 치료 시 환자의 특성을 임상적으로 고려하여, 치료 계획 수립과 치료 중에 참고하여야 할 것이다.

[영문]There have been many controversies about the relationship between the temporomandibular joint disorder and the lower face skeletal structures. It is not certain whether the disharmony of facial skeletal structure is caused by temporomandibular joint disorder or temporo- mandibular joint disorder is caused by the disharmony of facial skeletal structure.

Understanding the face profile of the patients with temporo- mandibular joint disorder symptoms is important in finding the relationship between the temporomandibular joint disorder and the craniofacial structures.

The purpose of this study is to show the relationship between the cranio-facial skeletal structure and the temporomandibular joint disorder by es-tablishing measurements of lateral cephalogram and examining the charact-eristics of the facial profile of patients with temporomandibular joint disorder. Out of 111 male and female patients over 18 years old from the Department of Orthodontics, Dental Hospital, Yonsei University, patients showing symptoms of temporomandibular joint disorder were cho-sen as the experimental group (56 patients), and patients without temporomandibular joint disorder were chosen as the control group (55 patients). Lateral cephalogram was taken and traced to prove the significant difference in craniofacial measurements between the experim

ental group and the control group of Class I (mean : 2.89˚), Class II (mean : 6.32˚), Class III (mean : -2.02˚) patients which were grouped according to ANB difference. The following is the result of this study.

1.The length of the mandible (Co-Me) and the mandibular ramus (Ar-Go) of male and female patients of all the Classes showing symptoms of temporomandibular joint disorder, were shorter compared to those of the control group. This difference was statistically significant (Class I (p<0.001), Class II (p< 0.01), and Class III (p< 0.01)).

2.In Class I, Mandible plane to SN (p<0.01) and Gonial angle (p<0.01) were significantly different. In Class II, Gonial angle (p<0.05)) was different. And in both classes, the maxillary incisors were tilted more lingually.(Class I - U1 to SN (p<0.01), Class II - U1 to SN (p< 0.01)).

3.Experimental groups of Class II (p<0.01) and Class III (p<0.01) showed shorter effective mandibular length compared to the control groups. However, patients grouped as Class I did not show significant difference.

4.The Anterior cranial base Mandibular length of the Class III experimental group was larger than that of the control group. And Class III experimental group showed steeper inclination of the occ-lusal plane compared to the Class III control group (Occlusal plane to SN plane (p<0.01), Occlusal plane to Mandibular plane (p<0.01)).

From the above results, it can be summarized that each experimental group with temporomandibular joint disorder had one or more of the following characteristics: hyperdivergent facial profile, more lingually tilted maxillary incisors, and steeper occlusal plane. There was signifi-cant correlation between the structure of the lower face and the temporo-mandibular disorder. Therefore, when we start orthodontic treatment in patients with temporomandibular joint disorder, the these characteristi-cs should be considered in the clinical aspect. We should also be care-ful in planning orthodontic treatment and during orthodontic treatment.