3-Dimensional scanning analysis of soft tissue remodeling after BSSRO in mandibular prognathism patient

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치의학대학원 치의학과
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서울대학교 치의학대학원
BSSROdistal cutting3-dimensional scanning analysissoft tissue
학위논문 (석사)-- 서울대학교 치의학대학원 : 치의학대학원 치의학과, 2016. 2. 김명진.
악교정 수술 후의 연조직 변화에 대한 예측 및 이를 기반으로 한 연조직 예측 소프트웨어의 개발은 지난 몇 년 간 논문에서 많이 다루어지고 있는 주제이다. 하지만, 연조직 변화량의 정도는 연구에 따라 다양한 차이를 보이고 있다. 이 논문에서는 회귀현상을 방지하고 유의미한 위치적 안정성을 가진 것으로 보고된 의도적인 원심골편 후방골절제술을 포함한 SSRO 술식을 시행한 환자들을 대상으로 안모의 3차원적 스캔분석 방식을 이용하여 악교정 수술 후의 경조직 변화량에 대한 연조직 변화량을 분석하였다.
2014년 5월부터 서울대학교 치과병원 구강악안면외과에서 제 3급 부정교합을 주소로 악교정수술을 진행한 환자 22명을 대상으로 하였다. 각 환자들은 수술 전과 수술 후 6개월에 측모 두부규격방사선사진, 정모 두부규격방사선사진 및 3차원적 안모 사진(Morpheus3D scanner, Morpheus3D, Seoul, Korea)을 촬영하였고, 이렇게 촬영된 데이터는 Morpheus 3D dental solution(Morpheus3D, Seoul, Korea)을 이용하여 경조직에 대한 연조직의 변화량을 시기별로 측정하였다.
평균적으로 point A'/point A, Ls/Is, Li/Ii, point B'/point B, Pog'/Pog의 변화량 비는 각각 0.89:1, 0.81:1, 0.98:1, 0.97:1, 0.93:1로 나타났다.
본 논문은 안모의 3차원적인 스캔 분석을 통해서 경조직의 변화량 및 연조직 변화량을 측정하였다는 것에 그 의의가 있다. 위와 같은 결과는 악교정 수술에 있어 더 나은 심미적 안모를 얻기 위한 정확한 예측에 도움을 줄 것으로 기대되며, 향후 악교정수술 시 안모의 3차원적 진단 및 수술계획에 도움을 줄 수 있는 기초자료로 사용될 수 있을 것으로 사료된다.
Introduction: The satisfaction of orthognathic surgery is under the control of soft tissue, not the hard tissue. But the response of a patients facial soft tissue does not reflect the exact movements of the underlying skeletal structures in a 1:1 ratio. Recently, 3-dimensional computer imaging has received considerable attention as a means of predicting results of orthognathic surgery. The purpose of this study is to assess the soft tissue change to hard tissue movement after mandibular setback surgery in prognathic patients with 3-dimensional scanning analysis by Morpheus software(Morpheus3D Co., Seoul, Korea), and to use the result for basic data for 3-dimensional facial diagnosis and treatment plan for orthognathic surgery.

Materials and Methods: Twenty-two patients with mandibular prognathism treated since May, 2014 were studied. All undergone pre-surgical orthodontic treatment and orthognathic surgery with Le Fort I osteotomy, bilateral sagittal split ramus osteotomy with distal ostectomy. 3-dimensional facial profile, lateral cephalograph and PA cephalograph was taken before the orthognathic surgery(T1) and 6 month after the orthognathic surgery(T2). Reference line and cephalometric landmarks from Cephalometric analysis method for OrthoGnathic Surgery(COGS) developed by Burstone and Legan was used in this study. Horizontal reference line was drawn 7 degrees from Sella-Nasion line. Vertical reference line was defined perpendicular to horizontal reference line with intersecting Sella. In order to calculate soft tissue change to hard tissue movement, Point A, Incisor superius(Is), Incisor inferius(Ii), Point B and Pogonion(Pog) was chosen as hard tissue landmark. Soft tissue landmark is chosen to correspond hard tissue landmark
Soft tissue point A(point A), Labrale superius(Ls), Labrale inferius(Li), Soft tissue point B(point B) and Soft tissue pogonion(Pog). Superimposition, tracing and data calculating was done in Morpheus software(Morpheus3D Co., Seoul, Korea). Statistic analysis was done in SPSS ver.22 software (SPSS, Chicago, Il, USA).

Results: Cephalometric measurements show that the soft tissue change to hard tissue movement ratio was 0.89 at point A/point A, 0.81 at Ls/Is, 0.98 at Li/Ii, 0.97 at point B/point B, and 0.93 at Pog/Pog. Pearson coefficient is shown that the movement of point A is dependent only on the change of point A, whereas Labrale superius is dependent on Is, Ii and point B. The movement of Li, point B and Pog are dependent not only corresponding hard tissue movement but other mandibular hard landmarks.

Conclusions: With the use of 3-dimensional sanning analysis, soft tissue change was calculated and predicted by hard tissue movements in mandible prognathism patients. The result can be used for basic data with 3-dimensional facial diagnosis and treatment plan for orthognathic surgery.
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College of Dentistry/School of Dentistry (치과대학/치의학대학원)Dept. of Dentistry (치의학과)Theses (Master's Degree_치의학과)
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