치열궁의 성장발육 development of occlusion the three primary correlates of human dental...
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치열궁의 성장발육 Development of Oc-
clusion • The three primary correlates of human dental occlusion1) Dentitional development2) Craniofacial growth3) Neuromuscular maturation
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치열 발육의 단계
• 무치열기
• 유치열기
• 혼합치열기
• 영구치열기
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무치열기
• No tooth
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무치열기
• Natal tooth • Neonatal tooth
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무치열기
• Inclusion cyst
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Gum pad
• Upper ant. gum pad– Wider (intercuspal width)
– 4-5mm protrude (overjet)
– 0.5mm overlap (overbite)
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OCCLUSION OF PRIMARY DENTITION
1. 유치열기는 인간이 갖는 최초의 교합상태
2. 유치열기의 기초가 영구치열기로 이동
3. 유치열기가 부재시에는 영구치열기가 부재 – Ectodermal dysplasia
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Ectodermal dysplasia
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유치열기
• Primary teeth ;
– 태생 6 주에 형성 시작
– Enamel 은 1 세 까지 완성
– 24-36 개월 내에 모두 맹출
– 치근은 3 세까지 완성
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Teething• 치생 , 생치 ( 齒生 , 生齒 )
– 치아의 맹출을 가져오는 전체과정 • Difficult Eruption
– 유치 맹출 시 전신장애• 불안 , 손가락 빨기 , 타액증가 ,
식욕감퇴
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유치열의 특성• Ovoid arch form
• Space – interdental space
– primate space
– leeway space
• Tooth axis (Vertical)
• Terminal plane(Flush)
• Minimal over bite & over jet(1mm)
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유치열의 특성• Interdental space
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유치열의 특성
• Primate space
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유치열의 특성
• Leeway space
Sum of (c-d-e) > (3-4-5) This allows more space for 3-4-5 This "leeway space" aver-ages 1.7 mm. in the mandibu-lar buccal segment; 0.9 in the maxillary buccal segment
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유치열의 특성• Tooth axis(Vertical)
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측두방사선 상에서 중절치 치축의 변화
유치열기 영구치맹출시
맹출1 년 후
9 세 10 세 11 세
상악palatalplane
93.4 109.2 110.7 111.1 114.5 115.6
하악Mdplane
88.4 85.2 93.0 93.7 97.6 98.0
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상하 절치 각도의 변화
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유치열기 교합 분석
• 목적 : 1. 조기진단 2. 영구치열의 교합예측
– Sagittal relationship– Vertical relationship – Transverse relationship
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Sagittal relationship
• Molar occlusion– terminal plane(E)
• Canine occlusion
– CⅠ, CII, CIII
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Primary dentition terminus
• 제 2 유구치의 distal terminal plane – 3 가지 분류
• a) flush terminal plane• b) mesial step
c) distal step– 유치열기에서 장래의 교합 상태를 예측할 수 있는 유일한
진단 형태는 terminal plane 이다
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Flush terminal plane
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Mesial step
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Distal step
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Terminal plane 의 영구치열 이행
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Vertical relationship
• Normal
• open bite
• same plane
• deep bite
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Transverse relationship
• normal
• cross bite
• scissor bite
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유치열의 변화
3y 6m 5y 6m
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혼합 치열기 교합
• Ideal dental arch pattern (7Y)– Tight proximal contact– No rotation– Specific B-L axial inclination– Specific M-D axial inclination– Even marginal ridge vertically– Flat occlusal plane– Excess leeway space
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치아위치를 결정하는 요인
• 유전적 요인• Mesial drifting tendency• 맹출의 intraoral stage
– 주변 근육 등• 교합기 (occlusal stage of eruption)– 교합근
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Occlusal changes in Developing Dentition
• Arch length – 유중절치 incisal edge, 제 2 유구치
원심면• Arch width
– 전치부 intercanine arch width • C 의 tip or cingulum
– 구치부 intermolar arch width • E 의 central pit
• arch perimeter (circumference)
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• arch length - A• arch width - B• arch perimeter - C
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Arch width (Moyer)
상악 하악
유치열 28.8 22.3
중절치 맹출 31.0 24.0
소구치 맹출 32.0 25.5
영구치열 33.6 25.5
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Changes in the Inter-Canine Width
Inter-Canine Width: distance between the crown tips of cuspids
22
24
26
28
30
32
34
36
2 4 6 8 10 12 14 16 18 Years
㎜
Moorrees, ‘59Moorrees, ‘59
I2
C
I1
I1
I2
C
I1
I2
C
C
I1
I2
Maxilla
Mandible
Males Females
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Changes in the Bimolar Width
2 4 6 8 10
12
14
16
18
YEARS
34
36
38
40
42
㎜ Maxilla
Mandible
Males Females
Bimolar Width: distance between the MLC of the 1st Molar
Moorrees, ‘59Moorrees, ‘59
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10-yr-old10-yr-old
Van der Linden, ‘86Van der Linden, ‘86
Maxilla: continue to increase due to midpalatal sutu-ral growth
Mandible: no appreciable increase
Anterior section (between mesial sufaces of perm. canines)
Enlargement of Apical AreaEnlargement of Apical Area
4-yr-old4-yr-old
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Arch Length
상악 하악
유치열 28.5 28.2
중절치 맹출 29.0 25.2
소구치 맹출 29.9 25.3
영구치열 28.5 23.5
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Arch circumference 조절 factor
• Leeway space• Mesial drifting tendency• Interproximal wear• Lingual position of incisior• Change in angulation of the perma-
nent teeth• Growth
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Mechanisms of Occlusal Adjustment
• End to end Class I molar rela-
tionship
– Early mesial shift
– Late mesial shift
– Maxilla 보다 Mandible 의 큰 전방 성장
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Mechanisms of Occlusal Adjust-ment
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Ugly Duckling stage
• 절치와 견치의 맹출 사이의 시기 – 7-12 세
• 측절치는 심하게 flare 되어 중절치 사이에 간격
• 일시적인 것으로 영구 견치가 제 위치로 맹출 함에 따라 간격이 감소