위축된 상악골을 가진 부분무치증 환자의 보철수복
Prosthetic rehabilitation of an oligodontia patient with atrophic maxilla
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선천성 치아결손은 가장 흔한 치아의 발육장애인데, 이 중 제3대구치를 제외한 6개 이상의 치아가 상실된 경우를 부분무치증(oligodontia)이라 한다. 이러한 치아결손은 부정교합, 치조제 위축, 심미적인 문제 및 사회심리적인 문제 등을 초래한다. 14개의 영구치 결손과 상악궁의 치조제 위축, 하악의 전돌 등이 관찰되는 부분무치증 환자에서 다학제 치료계획을 수립하였다. 만기잔존유치의 발거와 교정치료를 선행하여 보철수복공간을 확보하고 불량한 치축을 개선하였으나, 구치부 절단교합과 상악 치조제의 위축으로 인한 악궁 간 크기 차이가 잔존하였다. 치아결손 부위에 임플란트 식립을 이용한 고정성 보철수복을 계획하여 심미성과 기능성을 회복하고자 하였다. 골이식을 최소화하도록 임플란트의 식립 부위와 개수를 결정하였고, 보철물의 형태를 고려하였으며, 임시수복물에서 심미성과 교합안정성을 평가하였다. 점진적인 임시수복물 조정과정을 통해 적절한 중심교합과 측방운동 시 균형적인 교합을 형성하였으며, 이를 반영한 최종보철물을 제작하여 수복하였다. 현재 안정적으로 기능하고 있으나 전 생애에 걸친 유지관리 치료가 필요하다.
Abstract
Congenital tooth agenesis is the most common developmental dental anomaly, of which oligodontia is defined as the absence of six or more permanent teeth, except the third molars. Tooth agenesis causes malocclusion, alveolar atrophy, aesthetic and psychosocial problems. This clinical report describes a multidisciplinary treatment for a patient diagnosed as oligodontia, who exhibited absence of 14 permanent teeth, atrophy of maxillary alveolar bone, and mandibular protrusion. Restoration space was secured and tooth axis was improved by the extraction of deciduous teeth and orthodontic treatment. However, edge-to-edge bite of posterior teeth and arch dimension discrepancy due to atrophic maxilla was remained. To restore the aesthetics and functionality, implant retained prosthesis was planned. Considering minimal bone grafts, location and number of dental implants and prostheses design were determined. Through the gradual adjustment of provisional restoration, the appropriate centric and eccentric occlusion was reflected into a definitive prosthesis. Currently, stable functional results were attained, however, regular follow up and maintenance care over lifetimes should be performed.
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