effects of maxillary lateral incisor agenesis on skeletodental … · 2019. 8. 3. · effects of...

https://doi.org/10.5933/JKAPD.2019.46.2.147 JKoreanAcadPediatrDent46(2)2019ISSN(print)1226-8496ISSN(online)2288-3819

Effects of Maxillary Lateral Incisor Agenesis on Skeletodental Characteristics in Mixed Dentition

Siyeon Nam, Jonghyun Shin, Jiyeon Kim, Taesung Jeong, Shin Kim

Department of Pediatric Dentistry, College of Dentistry, Pusan National University

Thisstudyaimedtoevaluateskeletodentalcharacteristicsofpatientwithmaxillarylateral incisoragenesis(MLIA)in

mixed dentition.

It involved the children in early mixed dentition who visited Pusan National University dental hospital for orthodontic

purposedandhadintactprimarycanines.38childrenwithMLIAand38controlswiththesamechronologicalage

satisfying the inclusion criteria were selected. The craniofacial structures and dental arch dimensions of the MLIA were

evaluatedusingmodel&cephalometricanalysisandcomparedtocontrols.

The rate of unilateral MLIA was high in male and the rate of bilateral MLIA was high in female. In model analysis, the

width / length ratio of maxillary anterior portion of the MLIA group were higher and arch perimeter of the maxilla of the

MLIAgroupweresmallerthanthoseofthecontrolgroup(p=0.003,0.04).Cephalometricanalysisshowedthattherewere no significant differences in terms of skeletal, dental analysis. In soft tissue profile, nasolabial angle was larger in

MLIAsthanincontrols(p=0.039).Considering these skeletodental characteristics of MLIA, early diagnosis and proper management is highly

recommended to minimize the possibility of functional defect.

Key words : Lateral incisor, Congenital missing, Early mixed dentition

Abstract

147

Corresponding author : Shin KimDepartmentofPediatricDentistry,CollegeofDentistry,PusanNationalUniversity,49,Busandaehakro,Mulgeum-eup,Yangsan,Gyeongsangnam-do,50612,RepublicofKoreaTel:+82-55-360-5180/Fax:+82-55-360-5174/E-mail:[email protected],2018/RevisedNovember8,2018/AcceptedOctober29,2018※Thisworkwassupportedby2018ResearchGrantofPusanNationalUniversityDentalHospital.

Ⅰ.서론

치아결손은가장흔한치아발육이상중하나이다[1,2].치아

결손이있는경우두개안면골격및악궁형태는유전,환경적상

호작용,성장등여러가지요인의조합에의해영향을받는다[3].

그중상악측절치는전방부에위치하여결손될경우심미적문

제가발생될수있고,초기혼합치열기에맹출하므로결손시부

정교합이나치조골발육저하와같은기능적문제가발생할수

있어조기진단및관리가매우중요하다[4].

상악측절치결손환자들은다분야접근법으로치료를받아야

하는데,소아치과의사,교정과의사,보철과의사등이그들의치

료계획에있어중요한역할을한다.진단및치료계획에있어상,

하악악궁의크기및형태뿐만아니라상,하악골의전후방및수

직적관계,성장방향등골격적특성이중요한요소가된다[5].

치아결손이있는경우전반적인교합과두개안면형태에영

향을미치게되는데,악궁내해당부위치조융선이위축되고치

조골발육저하로인한악골의열성장이나타날수있다고보고

되었다[6,7].이전의연구에서Buyuk등[8]은상악측절치결손

J Korean Acad Pediatr Dent 46(2) 2019

148

환자들의상악치아치조폭경이대조군에비해좁게나타났다

고보고하였고,Bassiouny등[9]은상악측절치의결손을보이는

성인의골격을분석한결과상악열성장에의한골격성3급경향

을나타냈다고보고하였다.

그러나이전의상악측절치결손환자들의특징을보고한연구

들은성장이완료된성인을대상으로골격및악궁의특성에관

해보고하였고,성장기아동을대상으로한연구는없었다.초기

혼합치열기는상악측절치가맹출되는시기로상악측절치결손

을보이는아동에서이시기에결손으로인한골격및악궁의변

화가나타나는지여부에대해확인해볼필요가있다.

따라서이연구의목적은선천적상악측절치결손을보이는

초기혼합치열기아동의골격및치아치조적특징에대해평가

하는것이다.

Ⅱ.연구대상및방법

이연구는부산대학교치과병원임상연구윤리위원회(Institu-

tionalReviewBoard,IRB)의심의를통과후시행되었다(승인번

호PNUDH-2018-007).

1.연구대상

이번연구의대상자는2008-2017년사이부산대학교치과

병원소아치과에교정진단및치료를목적으로내원하여교정

검사를시행한2793명중,초기혼합치열기(Hellmandentalage

IIIA)에해당하며상,하악유견치가잔존하는아동을대상으로

시행하였다.선천적두개안면기형(cleft liporpalate,Down’s

syndrome,ectodermaldysplasia등)이나과거악안면외상및

수술의병력이있거나,이전에보철또는교정적치료를받은환

자는제외하였다.

실험군은한국인으로제3대구치를제외한다른치아의결손

없이상악측절치선천결손(maxillary lateral incisoragenesis,

MLIA)을보이는아동을선정하였고총38명이었다.대조군은실

험군과동일하게38명을선정하였고그기준은다음과같다.

1)치령이실험군과일치하는아동

2)치관의파절이나손상,형태이상이없고치열의변형을초

래할수있는구강영역의악습관이존재하지않는아동

3)치아결손,매복,심한총생(crowding)이나간극(spacing)이

없는아동

4)인접면의수복또는기성금속관수복치료를받은치아가

없는아동

2.연구방법

각군모두에서교정진단을위해제작한초기진단모형을이

용하여상,하악에서각각8가지항목이측정되었다(Fig.1).기

준점5개를이용하여상,하악전후방의폭경과길이,전후방의

폭경대장경의비,전폭경대후폭경의비,총악궁길이를측정

하였다(Table1).각측정치는0.01mm의정밀도를가진digital

calipers(AbsoluteDigimaticCaliperSeries500,MitutoyoCor-

poration,Japan)를사용하여측정되었다.

측모두부계측방사선분석을위해두부방사선규격사진촬영

장치(PM2002CC,Planmeca,Finland)를이용하여78KVp의관

전압,11mA의관전류,1.5초의노출시간으로촬영한측모두

부계측방사선사진을이용하였다.촬영된사진은투사도를작

성하여컴퓨터프로그램(VCephTM5.5,OSSTEMIMPLANTINC.,

Korea)에입력하여분석하였다.대상아동의악골의전후방적,

수직적관계및치아,연조직분석을위하여Rickettsanalysis,

Downs analysis, Steiner analysis, McNamara analysis, Jarabak

analysis,Burstoneanalysis의분석법일부항목을재편집하여분

석하였다.사용된계측점및계측항목은다음과같다(Fig.2).

1)계측점

(1)Skeletallandmarks

①Nasion(Na):V’notchoffrontalandnasalbone

②Sella(S):centerofsellaturcica

③Porion(Po):mostsuperiorpointoftheoccipitalbone

④Orbitale(Or):mostinferiorpointoftheorbitalcontour

⑤Basion(Ba):mostinferiorpointoftheoccipitalbone

⑥HingeAxis:centerofrotationofthecondyle

⑦ANS:tipoftheanteriornasalspine

⑧PNS:tipoftheposteriornasalspine

⑨Apoint:deepestpointbetweenANSandtheupperin-

cisal alveolus

⑩Bpoint:deepestpointbetweenpogonionandthelower

incisal alveolus

⑪Pogonion(Pog):mostanteriorpointofthesymphysis

⑫Menton(Me):mostinferiorpointofthesymphysealout

line

⑬Corpusleft:leftpointofatangentoftheinferiorborder

of the corpus

⑭Ramusdown:lowerpointofatangentofthePosterior

border of the ramus


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Fig. 1. Dental cast indicating reference points and measurements of dental arch.A.Pointsandmeasurmentsofarchwidthandlengthindentalcast(Mx.,Mn.) -AAW:Anteriorarchwidth,WidthbetweentwosidesoftheD3 -TAW:Totalarchwidth,WidthbetweentwosidesoftheP6 -AAL:Anteriorarchlength,LengthfromthepointMPtotheLineconnectingbothsidesD3 -TAL:Totalarchlength,LengthfromthepointMPtotheLineconnectingbothsidesP6B.Pointsandmeasurmentsofarchperimeterindentalcast(Mx.,Mn.) -AP:Archperimeter,SumofdistancesbetweenMPandeachP6 - MP : The midpoint of the gingival tissue between the lingual sides of the central incisor -D3:Thepointofcontactwiththeboundaryofsoftpalateoflowestcervicalpartofprimarycanine -P6:Mesiolingualsidewherethelingualtissuestouchthecrownofthetooth

A B

Table 1. Definition of dental points and measurements used in model analysis

Name Definition

Point MP The midpoint of the gingival tissue between the lingual sides of the central incisor

D3 The point of contact with the boundary of soft palate of lowest cervical part of primary canine

P6The point of the first permanent molar in the the mesiolingual side where the lingual tissues touch the crown of the tooth

Arch dimensions AAW Anteriorarchwidth,WidthbetweentwosidesoftheD3

TAW Totalarchwidth,WidthbetweentwosidesoftheP6

AAL Anteriorarchlength,LengthfromthepointMPtotheLineconnectingbothsidesD3

TAL Totalarchlength,LengthfromthepointMPtotheLineconnectingbothsidesP6

AP Archperimeter,SumofdistancesbetweenMPandeachP6

Ratios AWLR Anteriorwidthtolengthratio,AAW/AALX100

TWLR Totalwidthtolengthratio,TAW/TALX100

WR Widthratio,AAW/TAWX100


150

⑮Gnathion (Gn) : the lowestpointof themidlineof the

lower jaw

⑯ Articulare (Ar) : intersectionof inferiorcranialbasesur-

face and posterior border of the condyle

(2)Softtissuelandmarks

①Glabella (G) :mostprominentpoint in themidsagittal

plane of the forehead

②Softtissuenasion(Na’):themidpointonthesofttissue

contour of the base of the nasal root at the level of the

frontonasal suture

③Dorsumofnose:theexternalridgeofthenose

④Pronasale(PRN):mostanteriorpointofthenose

⑤Columella(Cm):mostanteriorpointonthecolumellaof

the nose

⑥Subnasale (Sn) : thepointatwhich thenasal septum

merges with the upper cutaneous lip in the midsagittal

plane

⑦Soft tissueApoint (Apoint’) :mostconcavepointbe-

tween subnasale and the anterior point of the upper lip

⑧Labralesuperius(Ls):apointindicatingthemucocutane-

ous border of the upper lip

⑨Stomionsuperious(Stms): lowermostpointinthever-

milion of the upper lip

⑩Stomioninferious(Stmi):uppermostpointinthevermil-

ion of the lower lip

⑪Labraleinferious(Li):apointindicatingthemucocutane-

ous border of the lower lip

⑫Mentolabialsulcus(Si):thepointofgreatestconcavityin

themidlinebetweenthelowerlip(Li)andchin(Pg’)

⑬Soft tissueBpoint (Bpoint’) :mostconcavepointbe-

tween the lower lip and the soft-tissue chin

⑭Softtissuepogonion(Pog’):mostanteriorpointonsoft

tissue chin

⑮Softtissuegnathion(Gn’):theconstructedgnathion,the

constructed midpoint between soft tissue pogonion and

soft tissue menton

⑯ Softtissuementon(Me’):lowestpointonthecontourof

the soft tissue chin

⑰ Cervicalpoint (C) : innermostpointbetween thesub-

mental area and the neck located at the intersection of

lines drawn angent to the neck and submental area

(3)Dentallandmarks

①Mx1crown:tipofthecrownoftheuppercentralincisor

②Mx1root:tipoftherootoftheuppercentralincisor

③Mn1crown:tipofthecrownofthelowercentralincisor

④Mn1root:tipoftherootofthelowercentralincisor

⑤Mx6distal:distalcontactpointofmaxillaryfirstmolar

(seconddeciduousmolar)2mmaboveocclusion

⑥Mx6 root :distalbuccal rootofmaxillary firstmolar

(seconddeciduousmolar)

⑦Mn6distal:distalcontactpointofthemandibularfirst

molar(seconddeciduousmolar)2mmaboveocclusion

⑧Mn6root:distalrootofmandibularfirstmolar(second

deciduousmolar)

2)계측항목

(1)Horizontalskeletalpattern

①SNA:angleofS-N-A

②SNB:angleofS-N-B

③ANB:①-②

④Wits:thedistancebetweenthepointstoseeoffrepairs

Fig. 2. Cephalometric landmarks used in this study.


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to the functional occlusal plane from point A to point B

⑤Apoint-NPerpend :distancefromApointtonasion

perpendicular line

⑥Pog-NPerpend :distance frompogonion tonasion

perpendicular line

⑦Facialconvexity:angleofNA-APog

⑧Midfaciallength:distancefromCondyliontoANS

⑨Mandibularlength:distancefromCondyliontopognion

⑩Maxillomand.Diff.(Maxillomandibulardifference):⑨-⑧

(2)Verticalskeletalpattern

①Y-axis:linepassingthesellaandbasionincrosssection

②Sum:Saddleangle+Gonialangle+Articularangle

③Saddleangle:angleofN-S-Ar

④Articularangle:angleofS-Ar-Go

⑤Gonialangle:angleofAr-CGo-Me

⑥Mn.Planeangle(toSN) : theanteriorangleformedby

the intersection of SN and Go-Gn is mesured

⑦FacialHeightRatio:PFH/AFHX100

⑧Ant.FacialHeight(AFH):distancefromNatoMe

⑨Post.FacialHeight(PFH):distancefromStoGo

⑩LowAnt.FacialHt.:distancefromANStoMe

⑪ANS-Me./Nasion-Me:⑧/⑩

⑫ABtoMand.Plane:angleformedattheintersectionof

point A-point B line to nasion-progonion line

⑬ODI(theoverbitedepthindicator):sumoftheangleof

the A-B plane to the mandibular plane and the angle of

the Palatal plane to Frankfort horizontal plane

(3)Dentalpattern

①U1toNA(angular):theanglebetweenthelongaxisof

upper central incisor and the NA line

②U1 toNA (linear) :distance from incisal tipofupper

central incisor to NA line

③L1toNB(angular):theanglebetweenthelongaxisof

the lower central incisor and the NA line

④L1toNB(linear) :distancefromincisaltipofthelower

central incisor to NA line

⑤U1 toSN : theanglebetween the longaxisofupper

central incisor and the SN line

⑥U1 to A-Pog : distance fromUpper incisor tip to

A-Pogonion

⑦L1 toA-Pog :distance from incisor tipof the lower

central incisor to A-Pog line

⑧Interincisalangle : theanglebetweenthe longaxisof

upper central incisor and the long axis of the lower

central incisor

⑨IMPA : theanglebetween the longaxisof the lower

central incisor and the mandibular plane

(4)Softtissueprofile

①UpperLipE-plane(Estheticplane):distancefromEsthetic

line(Prn-Pg‘)toupperlip

②LowerLipE-plane(Estheticplane):distancefromEsthetic

line(Prn-Pg‘)tolowerlip

③Nasolabialangle:angleofCm-Sn-Ls

④U-liptoA’B’:distancefromUpperliptosofttissueA-B

plane

⑤L-liptoA’B’ :distancefromLowerliptosofttissueA-B

plane

⑥FA’B’A:angleofSN-Bpoint’planeandOr-Poplane

대조군이정상초기혼합치열기아동을대변하는지여부를확

인하기위해,대조군의측정값을정상초기혼합치열기아동의

기준치와비교한결과유사한값을나타냄을확인하였다[10,11].

MLIA군과대조군선정의적합도에대한타당성을조사하기

위해동의비율(thepercentageofagreement)을조사하였다.초

기조사2주후MLIA의유무에관계없이20명의대상자를무작

위로선정하여동일한연구자와다른한명의연구자가평가하

였다.연구대상의MLIA유무및대상기준을만족시키는지여

부의확인에서두연구자간의100%동의가얻어졌다.

모형분석및측모두부계측방사선분석계측값은재현성을

보장하기위해한연구자가분석을시행하였다.측정된계측값

의신뢰도를평가하기위해MLIA의유무에관계없이모형분석

및측모두부계측방사선분석계측값중20개를선정하여초기

조사2주후에동일한연구자가재측정하였다.신뢰도평가기

법은계급간상관계수(intraclasscorrelationcoefficient, ICC)를

사용하였고,신뢰도계수는0.93에서0.97사이로확인되었다.

3)통계분석

MLIA군과대조군의모형분석및측모두부계측방사선분석

값을비교하기위하여독립표본t-검정을수행하였으며,Shap-

iro-Wilk test에서정규성을만족하지않은변수들에대해서는


152

비모수적방법인Mann-WhitneyUtest를수행하여비교하였다.

모든통계분석은SPSS24.0을사용하여수행되었다.

Ⅲ.연구성적

MLIA군의성별분포는남아25명(평균8.6±1.4세),여아13

명(평균8.0±1.0세)으로남아의수가더많았다.남,여모두편

측결손이양측결손에비해많았다.또한편측결손에서는남아

의비율(72.7%)이높았고양측결손에서는여아(80%)의비율이

높게나타났다(Table2).

Model분석결과,상악은MLIA군이대조군에비해전악궁폭

(anteriorarchwidth,AAW),전악궁장(anteriorarchlength,AAL),

총악궁장(totalarchlength,TAL)이통계적으로유의하게작았고

(p =0.012,0.00,0.038),MLIA군이대조군에비해전악궁장폭

지수(anteriorwidthtolengthratio,AWLR)가큰것으로나타나

전방부의폭보다장경의감소량이더큰것으로나타났다(p =

0.003).또한총악궁길이(archperimeter,AP)는MLIA군이대조군

에비해작은값을보였다(p=0.04).하악은MLIA군이대조군에

비해AAL이큰값을나타냈다(Table3,p=0.004).

측모두부계측방사선분석결과,전후방적측면에서MLIA

Table 2. Distribution of patients with maxillary lateral incisor agenesis

Gender UnilateralMLIA(n/%) BilateralMLIA(n/%) Age(Mean±SD)

Males(n=25) 24(72.7) 1(20.0) 8.6±1.4

Females(n=13) 9(27.3) 4(80.0) 8.0±1.0

Total(n=38) 33 5

MLIA : maxillary lateral incisor agenesis

Table 3. Comparison of arch dimensions and ratios between MLIA and Controls

Arch dimensions and RatiosGroupI(n=38) GroupII(n=38)

p valueMean±SD Mean±SD

Maxilla Arch dimensions AAW 25.61±2.77 27.00±1.80 .012

TAW† 39.10±3.92 40.23±2.16 .140

AAL 7.46±1.36 8.62±1.26 .000

TAL 25.51±2.21 26.45±1.62 .038

AP 65.79±3.80 67.46±3.14 .040

Ratios AWLR† 350.71±54.16 319.37±47.49 .003

TWLR† 154.48±20.94 152.54±10.41 .568

WR† 66.28±12.07 67.14±3.17 .057

Mandible Arch dimensions AAW 21.67±1.72 22.11±1.79 .276

TAW 37.49±2.42 37.70±2.07 .680

AAL† 5.37±6.09 5.34±1.30 .004

TAL 23.07±1.99 23.60±1.75 .215

AP† 61.60±4.00 68.38±39.57 .294

Ratios AWLR† 505.88±142.33 439.89±124.06 .002

TWLR† 163.46±14.93 160.45±13.24 .424

WR 57.90±4.26 58.66±3.76 .409

Group I : MLIA, Group II : ControlAAW : Anterior arch width, TAW : Total arch width, AAL : Anterior arch length, TAL : Total arch length, AP : Arch perimeter, AWLR : Anterior width to length ratio,AAW/AALX100;TWLR:Totalwidthtolengthratio,TAW/TALX100,WR:Widthratio,AAW/TAWX100Independentt-testwereperformedandMann-WhitneyUtest (nonparametricmethod)wereusedforvariablesthatdidnotsatisfythenormality intheShapiro-Wilk test respectively.†:Mann-WhitneyU-test


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군이대조군에비해midfacial length,mandibular length가큰

값을보였으나(p =0.007,0.012)maxillomandibulardifference

는유의한차이를보이지않았고(p =0.634),수직적측면에

서anteriorfacialheight(AFH)와posteriorfacialheight(PFH),

lowanteriarfacialheight가큰값을보였으나(p=0.001,0.021,

0.001),facialheightratio(PFH/AFH),ANS-Me(AFH)/Na-Me

(Lowanterior facialheight)에서유의한차이를보이지않았다

(p=0.573,0.592).연조직외형에서는MLIA군이대조군에비해

nasolabialangle이큰값을보였다(Table4,p=0.039).MLIA군

과대조군의측모두부계측방사선분석값을비교한결과중유

의한결과를나타내거나결과해석에중요한항목위주로Table

4에표기하였다.

Ⅳ.총괄및고찰

상악측절치선천결손의유병률은0.8-4.25%로인종에따

라다르게보고되고있다[12-15].Caucasian계는제3대구치를제

외하고하악제2소구치나상악측절치가가장많은빈도의결손

을보이는반면,Asian계는하악전치가가장흔한결손을보이

는것으로나타났다[6,10,13,16-20].최근한국인을대상으로한

연구에따르면하악제2소구치와하악측절치가가장빈도가높

았고다음이상악제2소구치,상악측절치순이었다[4].이처럼

인종에따라다소차이는있지만상악측절치는비교적높은치

아결손률을보인다.치아결손의성별에따른차이로는대부분

의경우여성이남성에비해결손률이높았고,그비율은인종에

Table 4. Cephalometric comparisons between MLIAs and controls

VariablesGroupI(n=38) GroupII(n=38)

p valueMean±SD Mean±SD

Horizontal Skeletal Pattern

SNA 80.99±3.26 81.20±1.85 .726

SNB 77.34±3.41 77.54±1.55 .742

ANB 3.65±3.01 3.67±1.55 .982

Wits -2.82±3.50 -3.49±1.78 .299

Midfacial Length 82.42±5.36 78.72±5.48 .007†

Mandibular Length 105.08±6.46 101.01±7.35 .012†

Maxillomand. Diff 22.67±4.01 22.26±3.44 .634

Vertical Skeletal Pattern

Facial Height Ratio 0.60±0.04 0.61±0.02 .573

Ant.FacialHeight(AFH) 113.97±7.54 107.84±7.75 .001†

Post.FacialHeight(PFH) 68.46±5.18 65.36±6.10 .021†

Low Ant. Facial Ht. 64.57±4.85 60.56±4.99 .001†

ANS-Me. / Nasion-Me 0.54±0.02 0.54±0.02 .592

AB to Mand. Plane 68.98±5.59 68.95±3.09 .979

Dental Pattern

U1toSN 105.13±5.56 105.51±4.09 .732

U1toA-Pog 6.14±2.82 6.42±1.57 .599

L1toA-Pog 3.88±2.21 3.09±1.54 .075

Interincisal angle 125.71±7.80 125.74±5.00 .984

IMPA 90.86±5.15 90.55±3.29 .752

Soft Tissue Profile

Upper Lip E-plane 1.95±2.39 1.91±2.34 .950

Lower Lip E-plane 2.11±2.29 1.45±2.42 .224

Nasolabial angle 102.47±9.29 98.44±8.36 .039†

Group I : MLIA, Group II : ControlIndependentt-testwereperformedandMann-WhitneyUtest (nonparametricmethod)wereusedforvariablesthatdidnotsatisfythenormality intheShapiro-Wilk test respectively.†:Mann-WhitneyU-test


154

따라다르게보고되었다[21,22].이번연구결과상악측절치편

측결손의비율이양측결손에비해높았는데이는Chung등[4]

과Rølling[23]의연구와동일하지만,Bassiouny등[9]과Altug-

Atac등[24]의연구와는상이한결과를나타내었다.또한이번

연구에서는남아가여아에비해상악측절치결손률이높게나

타나기존의대부분의연구와상이한결과를나타내었다.이번

연구는상악측절치결손으로인해초래되는골격의변화여부

를확인하기위함이므로,연구대상을제3대구치를제외한다른

치아의결손이없는환자로선정하였다.또한,악궁내폭경,장

경,총악궁길이등에서상악측절치결손의영향만을평가하기

위해상,하악유견치가조기탈락되거나결손된환자는제외하

였다.이처럼연구대상의선정기준이제한적이기때문에,일반

적인상악측절치결손환자의분포와차이가있을수있다고생

각된다.

치열궁의성장및형태의변화에대한연구는다양하게진행

되어왔다[25,26].치열궁의고경,장경,폭경중치열궁의고경

은성장이가장오래지속되는데안면고경의성장및치아맹

출을통해일생동안계속성장이일어나고,장경과폭경의성장

은치아맹출시기별로다르지만치열궁의전방부는일찍안정된

다[27].특히,치열궁의폭경은전신골격성장시기를따르지않

고오히려치아맹출및배열에따른변화와밀접한관계가있

다[28].이번연구에서모형분석결과MLIA군이대조군에비해

상악의전악궁폭(AAW)과전악궁장(AAL),총악궁장(TAL),총악궁

길이(AP)에서유의할만큼작은값을나타냈다(p=0.012,0.00,

0.038).폭경의감소는LeBot과Salmon[29]이성인에서상악측

절치의결손,쐐기형태의치아,왜소치형태의치아가나타날

경우악궁의폭이감소한다고하였고,Buyuk등[8]이상악측절

치결손은악궁의폭경뿐만아니라상악기저골의폭경도감소

시킨다고보고한내용과유사한결과를보였다.초기혼합치열

기에MLIA군이대조군에비해작은폭경을나타낸것은측절치

맹출시유견치간폭경의증가가원활하게일어나지않은것으

로추측되며,성장이완료된영구치열에서는상악측절치결손

으로인해영구견치의근심측맹출에기인한것으로추측된다.

한편상대적수치비교를위해측정하였던상악전폭경대장경

의비(AWLR)는MLIA군이대조군에비해통계적으로유의할만

큼큰값을보여(p=0.003),상악측절치결손시상악전방부에

서폭경에비해장경의감소량이더큰것을확인하였다.이러한

장경의감소는상악측절치결손으로인해상악중절치가충분

히순측으로맹출하지못한현상으로해석할수있다.

측모두부계측방사선분석결과,연조직분석에서MLIA군

이대조군에비해nasolabialangle이유의할만큼크게나타났

는데(p =0.039),이는기존의연구결과에서상악측절치결손

을보인성인의골격을분석한결과nasolabialangle이크고

상,하순의E-line이후퇴된경향을보인것과유사하다[9].그밖

에도MLIA군이대조군에비해midfacial length와mandibular

length가유의할만큼큰값을보였으나(p=0.007,0.012)max-

illomandibulardifference값에서유의성을나타내지않았고(p=

0.634),수직적측면에서AFH,PFH,lowanteriorfacialheight에

서유의할만큼큰값을보였으나(p=0.001,0.021,0.001)facial

heightratio(PFH/AFH),ANS-Me(AFH)/Na-Me(Lowanterior

facial height)의값이유의성을나타내지않았다(p =0.573,

0.592).즉각항목의절대값은크지만항목간의비율에서는유

의한차이가없는것으로보아,상악측절치결손에의해서나

타난골격적변화라고해석하기보다는MLIA군이대조군에비

해상대적으로큰골격을가졌다고해석할수있다.이전연구

에서Bassiouny등[9]은성인대상으로상악측절치결손환자

들의골격을분석한결과straight또는concave한안모를보이

고상악이후퇴된골격성3급부정교합의경향을나타냈다고보

고하였고,Woodworth등[30]에의하면양측성상악측절치결

손환자들의골격을분석한결과두개안면의부조화에의한3

급부정교합의경향을나타냈다고보고하였다.또한치아결손증

(hypodontia)이있는경우상악후퇴경향이나타나고,치아결

손의정도가더심할수록상,하악의골격이3급부정교합경향

을나타낸다고보고하였다[31,32].이는이번연구에서MLIA군

이대조군에비해nasolabialangle이상대적으로큰값을보였

으나(p=0.039)다른골격적변화를보이지않은결과와차이를

보였다.이번연구대상자의치령은초기혼합치열기로상,하악

골격의뚜렷한성장이발현되기전이므로기존의성인대상으로

시행한연구결과와차이를보였을수있다고생각된다.

상악측절치결손의처치는크게공간폐쇄,공간확보두가

지로나눌수있다.치료방향은각환자의나이,치료협조도뿐

만아니라상악견치의치은연형태,치아형태와크기,악궁형

태,골격유형등을고려하여결정해야한다[33].Robertsson과

Mohlin[34]은상악측절치결손환자들에서공간폐쇄혹은공

간확보의치료를받은후치주건강,교합,기능적인면을평가

하였는데,공간폐쇄치료를받은경우공간확보치료에비해

치주건강에유리하였고,환자의술후만족도도높았다고보고

하였다.이처럼교정적치료를통해공간을폐쇄할경우치주건

강,심미,기능적인면에서우수하다는여러연구결과들이보고

되었지만,공간을확보하여추후implant식립등보철치료를

시행할경우하악의측방운동시견치보호교합을유지할수있

다는장점이있으므로각증례에따라적절한선택이필요하다

[35,36].

이번연구를통해상악측절치선천결손을가진초기혼합치


155

열기아동의골격및치아치조특성에대해확인할수있었다.

정상교합의아동과비교시,상악전방부폭경및장경,상악총

악궁길이가감소되었고,골격적으로는nasolabialangle의증가

로인한연조직의변화를제외하고는유의한차이가없었다.상

악측절치는초기혼합치열기에맹출하며이시기는상악측절

치의결손이존재하더라도뚜렷한안모및기능이상이나타나

기이전이다.그러나아직성장이완료되지않았고추후두개안

면골격의성장에상악측절치결손이외에도많은요소들이작

용할수있어초기혼합치열기시기에공간폐쇄,공간확보등

의치료방향을결정하는것은어려울수있다.

이번연구결과를토대로초기혼합치열기에상악측절치결

손으로인해발생될수있는문제점으로는정중선변위와전치

부반대교합등이있다.상악측절치결손으로인해정중선변위

가발생했거나발생가능성이있을경우,개선후인공치를포함

한가철성공간유지장치등으로정중선을유지시켜심미,기능

적인면을충족시켜줄수있다.전치부반대교합을보이거나추

후상악열성장에의한반대교합의가능성이있을경우,상악측

절치결손으로인해부정적인영향이더해질수있으므로상악

악궁확대,상악골견인등으로전치부의정상피개를형성해주

는것이필요할수있다.또한조기치료를시행하지않을경우,

정중선변위및상악열성장등이발생할수있는가능성에대해

파악하고있는것이필요하다.이처럼임상가는상악측절치결

손이있을경우조기에결손에대한진단을하는것이중요하며

필요시적절한치료를통해추후상악측절치결손으로인해발

생할수있는문제를감소시켜주는것을추천한다.

이번연구의한계점으로는앞서언급했듯이연구대상의선

정기준이제한적이기때문에일반적인상악측절치결손환자

의분포와차이가있을수있다.그리고부산대학교치과병원소

아치과에교정치료를목적으로내원한아동을대상으로하였고,

모집장소가한기관에한정된점등으로인해일반적인상악측

절치결손아동의특징을대변하지못할수있다.또한이번연

구의MLIA군이성장완료후실제기존연구들의결과와동일한

양상의골격변화를보이는지여부에대해아직확인할수없다

는한계가존재한다.향후다기관및폭넓은대상자를상대로한

연구가필요하고,상악측절치가결손된아동의성장을장기간

추적하여두개안면발달및변화에관한종적인연구가필요할

것으로보인다.

Ⅴ.결론

상악측절치선천결손을동반한초기혼합치열기아동들의악

궁및골격수치를정상아동과비교한결과,모형분석에서는

상악의전방부폭경과장경에서작은값을나타냈고상악폭경

대장경비에서큰값을보였고상악의총악궁길이가작은값을

나타냈다.측모두부계측방사선분석에서는nasolabialangle이

큰값을보인것을제외하고는뚜렷한골격차이를나타내지않

았다.상악측절치결손이있을경우,뚜렷한안모및기능이상

이나타나기이전에진단하여발생할수있는이상교합에대해

사전에파악하고예방하는것이중요하다.또한결손으로인해

이미발생된문제점을초기에해소하여심각한문제로발전되는

것을방지하는것이필요하다.

References

1.Ben-BassatY,Brin I :Skeletalanddentalpatterns inpa-

tients with severe congenital absence of teeth. Am J Or-

thod Dentofacial Orthop,135:349-356,2009.

2.Ben-BassatY,BrinI:Skeletodentalpatternsinpatientswith

multiple congenitally missing teeth. Am J Orthod Dentofa-

cial Orthop,124:521-525,2003.

3.CobourneMT :Familialhumanhypodontia-is itall inthe

genes? Br Dent J ,203:203-208,2007.

4.ChungCJ,HanJH,KimKH:Thepatternandprevalenceof

hypodontia in Koreans. Oral Dis,14:620-625,2008.

5.LeeRT:Archwidthandform:areview.Am J Orthod Den-

tofacial Orthop,115:305-313,1999.

6.EndoT,OzoeR,YoshinoS,ShimookaS:Hypodontiapat-

terns and variations in craniofacial morphology in Japanese

orthodontic patients. Angle Orthod ,76:996-1003,2006.

7.OpHeijDG,OpdebeeckH,vanSteenbergheD,Quirynen

M : Age as compromising factor for implant insertion. Peri-

odontol2000,33:172-184,2003.

8. Buyuk SK, Ozkan S, Celik E, et al . : Evaluation of the skeletal

and dental effects in orthodontic patients with maxillary

lateral incisor agenesis. J Esthet Restor Dent, 29:284-290,

2017.

9.BassiounyDS,AfifyAR,ZawawiKH,et al . : Prevalence of

maxillary lateral incisor agenesis and associated skeletal

characteristics in an orthodontic patient population. Acta

Odontol Scand ,74:456-459,2016.

10.AasheimB,OgaardB :Hypodontia in9-year-oldNorwe-

gians related to need of orthodontic treatment. Scand J

Dent Res ,101:257-260,1993.

11.SungJH,KwonOW,KyungHM,ParkKD :A longitudinal

cephalometric study of the craniofacial growth changes of

Koreansagedfrom8to16years.Korean J Orthod ,22:491-


156

507,1992.

12.AlvesaloL,PortinP :The inheritancepatternofmissing,

peg-shaped, and strongly mesio-distally reduced upper

lateral incisors. Acta Odontol Scand,27:563-575,1969.

13.MullerTP,Hill IN,PetersenAC,Blayney JR :Asurveyof

congenitally missing permanent teeth. J Am Dent Assoc ,

81:101-107,1970.

14.Tavajohi-KermaniH,KapurR,ScioteJJ:Toothagenesisand

craniofacial morphology in an orthodontic population. Am

J Orthod Dentofacial Orthop,122:39-47,2002.

15.PolderBJ,Van’tHofMA,Vander LindenFP,Kuijpers-

Jagtman AM : A meta-analysis of the prevalence of dental

agenesis of permanent teeth. Community Dent Oral Epide-

miol ,32:217-226,2004.

16.HunstadbratenK:Hypodontiainthepermanentdentition.

ASDC J Dent Child,40:115-117,1973.

17.WertherR,RothenbergF:Anodontia:areviewofitsetiol-

ogy with presentation of a case. Am J Orthod Dentofacial

Orthop ,25:61-81,1939.

18.BrekhusPJ,OliverCP,MonteliusG:Astudyofthepattern

and combinations of congenitally missing teeth in man. J

Dent Res ,23:117-131,1944.

19.ShapiroSD,FarringtonFH:Apotpourriofsyndromeswith

anomalies of dentition. Birth Defects Orig Artic Ser ,19:129-

140,1983.

20.ZhuJF,MarcushamerM,KingDL,HenryRJ:Supernumer-

ary and congenitally absent teeth: a literature review. J Clin

Pediatr Dent ,20:87-95,1996.

21.PinhoT,TavaresP,MacielP,PollmannC :Developmental

absence of maxillary lateral incisors in the Portuguese

population. Eur J Orthod ,27:443-449,2005.

22.RøllingS,PoulsenS:OligodontiainDanishschoolchildren.

Acta Odontol Scand, 59:111-112,2001.

23.RøllingS :Hypodontiaofpermanent teeth inDanish

schoolchildren. Scand J Dent Res ,88:365-369,1980.

24.Altug-AtacAT,ErdemD :Prevalenceanddistributionof

dental anomalies in orthodontic patients. Am J Orthod

Dentofacial Orthop,131:510-514,2007.

25.GoldsteinMS,StantonFL :Changes indimensionsand

form of the dental arches with age. Int J Orthod Dent

Child ,21:357-380,1935.

26.CohenJT:Growthanddevelopmentofthedentalarchin

children. J Am Dent Assoc ,27:1250-1260,1940.

27.Sillman JH :Dimensional changesof thedentalarches:

longitudinalstudy frombirth to25years.Am J Orthod,

50:824-842,1964.

28.YangYM,BaikBJ,KimJG :Astudyonthevolumesand

forms of the palate for deciduous and permanent denti-

tion. J Korean Acad Pediatr Dent ,30:696-706,2003.

29.LeBotP,SalmonD:Congenitaldefectsoftheupperlater-

alincisors(ULI):conditionandmeasurementsoftheother

teeth, measurements of the superior arch, head and face.

Am J Phys Anthropol ,46:231-243,1977.

30.WoodworthDA,SinclairPM,AlexanderRG:Bilateralcon-

genital absence of maxillary lateral incisors: a craniofacial

and dental cast analysis. Am J Orthod ,87:280-293,1985.

31.WisthP,ThunoldK,BöeOE:Frequencyofhypodontia in

relation to tooth size and dental arch width. Acta Odontol

Scand ,32:201-206,1974.

32.FekonjaA:Hypodontiainorthodonticallytreatedchildren.

Eur J Orthod ,27:457-460,2005.

33.Al-AneziSA :Orthodontic treatment forapatientwith

hypodontia involving the maxillary lateral incisors. Am J

Orthod Dentofacial Orthop,139:690-697,2011.

34.RobertssonS,MohlinB :Thecongenitallymissingupper

lateral incisor. A retrospective study of orthodontic space

closure versus restorative treatment. Eur J Orthod ,22:697-

710,2000.

35.StuartCE,StallardH:Diagnosisandtreatmentofocclusal

relations of the teeth. Texas Dent J ,75:430-435,1957.

36.ShawWC:Orthodontics&occlusalmanagement.Br Dent J ,

177:120-121,1994.

JKoreanAcadPediatrDent46(2)2019

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국문초록

상악측절치결손이어린이안면골격과치열궁형태에미치는영향

남시연ㆍ신종현ㆍ김지연ㆍ정태성ㆍ김신

부산대학교치의학전문대학원소아치과학교실

이연구는상악측절치선천결손을보이는초기혼합치열기아동의골격및치아치조특성을평가하고자하였다.부산대학교치과

병원소아치과에교정진단및치료를목적으로내원한초기혼합치열기의상,하악유견치가모두존재하는아동중,상악측절치를

제외한나머지치아결손이없는38명의상악측절치결손군과대상기준을만족시키는동일한치령의대조군38명을선정하였다.각

군의측모두부계측방사선분석과모형분석의측정값을비교하여상악측절치결손군의골격및치아치조특성을평가하였다.

성별에따른결손의총비율은남아가더높았고편측결손군에서는남아의비율이더높았지만양측결손군에서는여아의비율이

더높았다.모형분석에서결손군은대조군에비해상악전방부폭경대장경비가크게나타났고(p=0.003),총악궁둘레는작게나타

났다(p=0.04).측모두부계측방사선분석결과,골격및치아적측면에서는유의한차이가없었고,연조직외형에서결손군이대조군

에비해nasolabialangle이큰값을나타냈다(p=0.039).

상악측절치결손아동의골격및치아치조특징에유념하여뚜렷한안모및기능이상을보이기이전에조기진단후적절한관리

를통해기능적결함의가능성을최소화시키는것이추천된다.

effects of maxillary lateral incisor agenesis on skeletodental … · 2019. 8. 3. · effects of...

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