하악 유견치 조기탈락은 무엇을 의미할까?
Clinical Implications of the Premature Loss of the Mandibular Primary Canine
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하악 유견치의 조기탈락은 임상에서 흔히 관찰되는 현상으로 후에 영구치열에서 총생의 징후라 할 수 있으며 향후 영구 전치의 배열상의 문제점이나 부정교합을 유발할 수 있다. 영구 측절치가 맹출될 때 맹출 공간이 부족할 경우 인접해 있는 유견치 치근을 흡수시키면서 맹출하게 되고 그 결과 유견치가 조기에 탈락하게 되는데, 이 경우 영구 하악 영구 절치들이 설측으로 경사지게 되면 상악 절치들과 교합 접촉이 상실되어 상악 절치들이 과맹출됨으로써 수직피개교합 및 수평피개교합이 깊어지며 악궁둘레길이는 감소된다. 유견치가 편측으로 상실된 경우는 상기 현상 이외에, 영구 절치들이 조기 상실된 부위의 공간으로 경사지게 되어 정중선이 틀어지게 된다. 보통 4 mm 이하의 공간부족은 순차적인 유치의 disking과 passive lingual arch를 사용하여 leeway space를 보호하는것만으로도 해결이 가능하며 4~6 mm 공간부족은 상기 술식과 함께 악궁의 전후방 및 측방확장으로 어느정도 해소할 수있다.
Abstract
The premature loss of the mandibular primary canine is relatively frequent and a sign of the upcoming spaceproblems in the transitional period. This situation is caused by the permanent lateral incisor resorbing the rootof the primary canine during its eruption. Bilateral loss of primary canines in a crowded arch leads to the lingual tipping of the permanent incisors, withthe consequent reduction in the arch perimeter and increase in overbite. When the loss of a primary canine isunilateral, tipping of the adjacent incisors occurs toward the space, resulting in midline deviation. In thesesituations, treatment possibilities, such as extraction of the antimeric tooth or placement of a passive lingualarch, can be applied; although there are some controversies concerning this. Most space problems with less than 4 mm can be resolved through preservation of the leeway space usingsequential disking of the primary teeth and a passive lingual arch, regaining space or limited arch expansion inthe late mixed dentition. In cases with 4~6 mm of space problems, arch expansion (A-P or transverse) can beapplied. Space problems with more than 6 mm should be treated through diagnosis and treatment planning. Most of these cases will require extraction of permanent teeth including serial extraction (guidance of eruption).
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