Anatomical characteristics of the midpalatal suture area for miniscrew implantation using CT image

정중구개봉합부의 해부학적 구조에 관한 전산화 단층촬영을 이용한 연구

  • Park, Young-Chel (Department of Orthodontics, Craniofacial Research Institute, Oral Science Research Center, College of Dentistry, Yonsei University) ;
  • Lee, Jong-Suk (Department of Orthodontics, College of Dentistry, Yonsei University) ;
  • Kim, Doo-Hyung (Department of Orthodontics, College of Dentistry, Yonsei University)
  • 박영철 (연세대학교 치과대학 교정학교실, 두개안면기형연구소, 구강과학연구소) ;
  • 이종석 (연세대학교 치과대학 교정학교실) ;
  • 김두형 (연세대학교 치과대학 교정학교실)
  • Published : 2005.02.01

Abstract

There is lack of data for the amount of vertical bone in the midpalatal region for miniscrew implantation. The purpose of this study was to measure the structure of the midpalatal suture area using CT image and V-works 4.0 program (Cybermed Inc, Seoul, Korea). CT images of 14 male and 14 female adults were reconstructed. In detail, it was 1) to measure the length of maxilla on the midsagittal plane 2) to measure vertical bone height in the midpalatal area 3) to establish the zone of safety for miniscrew implantation. The following results were obtained. The mean length of ANS-PNS was 51.08mm in males and 47.34mm in females. There was a statistically significant difference between males and females (p<0.05). The vertical bone height of the midpalatal suture area was above 0mm except for 6mm posterior from the central Point of ANS-PNS in males The zone of safety was located 19.43mm posterior from the ANS in males while it was 17.62mm in females along the palatal plane. These results support that the safety zone of the midpalatal area is suitable for screw implantation. Midpalatal miniscrew implantation is a powerful tool in modern orthodontics Through many applications. it can expand the modern orthodontic field.

교정용 임플란트 사용에 있어서 정중구개봉합부위의 골조직의 높이에 대한 구체적인 해부학적 자료가 없어서 임상에 적용시 이론적 근거가 부족한 것이 사실이었다. 이에 본 연구는 전산화단층촬영과 재구성 프로그램인 V works 40 (Cybermed Inc. Seoul. Korea)을 이용하여 임플란트 식립을 위한 해부학적 근거를 얻고자 하였다. 성인 남자 14명, 성인 여자 14명의 보철용 임플란트를 위한 CT 자료를 통해 정중 시상면에서 상악골의 길이를 계측하고 정중구개봉합 부위에서 골조직 두께를 측정하며 교정용 임플란트를 안전하게 식립할 수 있는 구체적 부위를 설정하고자 하여 다음과 같은 결과를 얻었다. ANS에서 PNS까지의 상악골의 길이를 계측한 결과 남자에서는 평균 51.08mm, 여자에서는 평균 47.34mm였다 남녀 사이에는 통계적으로 유의한 차이가 있었다 (p<005). 정중구개봉합부위의 골조직 두께를 측정한 결과 남자의 ANS-PNS길이의 중점에서 구개평면을 따라 PNS쪽으로 15 mm지점을 제외하고는 남녀 모두에서 5mm이상의 골조직이 존재하였다. 정중구개봉합부위에 교정용 임플란트를 적응할 때 안정적인 식립부위는 구개평면을 따라서 ANS로부터 남자는 19.43mm 후방부위, 여자는 17.62mm 후방부위에 해당하였다. 이상의 결과로 정중구개봉합부위의 안정적인 식립부위에서는 교정용 임플란트 식립이 적합하다고 판단되며 이를 바탕으로 정중구개봉합부위의 교정용 임플란트를 활용하여 교정치료 영역을 넓힐 수 있을 것이다.

Keywords

References

  1. Roberts WE, Smith RK, Zilberman Y, mozsary PG, Smith RS. Osseous adaption to continuous loading of rigid endosseous implants. Am J Orthod 1984;86:95-111 https://doi.org/10.1016/0002-9416(84)90301-4
  2. Roberts WE, Nelson CL, Goodacre CJ. Rigid implant anchorage to close a mandibular first molar extraction site. J Clin Qrthod 1994;28:693-704
  3. Bae SM, Park HS, Kyung HM, Kwon OW, Sung JH. Clinical application of micro-implant anchorage. J Clin Orthod 2002;36:298-302
  4. Park HS, Kyung HM, Sung JH. A simple method of molar uprighting with micro-implant anchorage. J Clin Orthod 2002;36:592-6
  5. Misch CE. Contemporary lmplant Dentistry, St Louis: Mosby 1999, Chapter 8
  6. Block MS, Hoffman DR. A new device for absolute anchorage for orthodontics. Am J Orthod Dentofacial Orthop 1995;107:251-8 https://doi.org/10.1016/S0889-5406(95)70140-0
  7. Wehrbein H, Merz BR, Diedrich P, Glatzmaier J. The use of palatal implants for orthodontic anchorage. Design and clinical application of the orthosystem. Clin Oral lmplants Res 1996;7:410-16 https://doi.org/10.1034/j.1600-0501.1996.070416.x
  8. Wehrbein H, Merz BR. Aspects of the use of endosseous palatal implants in orthodontic therapy. J Esthet Dent 1998;10:315-24 https://doi.org/10.1111/j.1708-8240.1998.tb00510.x
  9. Wehrbein H, Merz BR, Diedrich P. Palatal bone support for orthodontic implant anchorage-a clinical and radiological study. Eur J Orthod 1999;21:65-70 https://doi.org/10.1093/ejo/21.1.65
  10. Wehrbein H, Feifel H, Diedrich P. Palatal implant anchorage reinforcement of posterior teeth: A prospective study. Am J Orthod Dentofacial Orthop 1999;116:678-86 https://doi.org/10.1016/S0889-5406(99)70204-0
  11. 윤희선. 교정용 고정나사 삽입 위치에 따른 위턱 물렁조직 및 치밀뼈 두께. 석사학위 논문, 연세대학교 대학원, 서울, 2002
  12. Bernhart T, Vollgruber A, Gahleitner A, Dortbudak O, Haas R. Alternative to the median region of the palate for placement of an orthodontic implant. Clin Oral lmplants Res 2000;11:595-601 https://doi.org/10.1034/j.1600-0501.2000.011006595.x
  13. Byloff FK, Karcher H, Clar E, Stoff F. An implant to eliminate anchorage loss during molar distalization: a case report involving the Graz implant-supported pendulum. Int J Adult Orthodon Orthognath Surg 2000;15:129-37
  14. Diedrich PR, Fuhrmann RA, Wehrbein H, Erpenstein H. Distal movement of premolars to provide posterior abutments for missing molars. Am J Orthod Dentofacial Orthop 1996;109:355-60 https://doi.org/10.1016/S0889-5406(96)70116-6
  15. Karaman AI, Basciftci FA, Polat O. Unilateral distal molar movement with an implant-supported distal jet appliance. Angle Orthod 2002;72:167-74
  16. Wehrbein H, Yildizhan F. The mid-palatal suture in young adultsA radiological-histological investigation. Eur J Orthod 2001;23:105-14 https://doi.org/10.1093/ejo/23.2.105
  17. Schlegel KA, Kinner F, Schlegel KD. The anatomic basis for palatal implants in orthodontics. Int J Adult Orthodon Orthognath Surg 2002;17:133-9
  18. Herman GT. Three-dimensional imaging on a CT or MR scanner. J Comput Assist Tomogr 1988;12:450-8 https://doi.org/10.1097/00004728-198805010-00019
  19. Lee JS, Kim DH, Park YC, Kyung SA, Kim TK. The efficient use of midpalatal miniscrew implants. Angle Orthod 2004;74:711-4