성인의 악궁확장, 새로운 방법이 있습니다!

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작성자 최고관리자 댓글 1건 조회 21,428회

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안녕하세요? 바른내일 교정치과 정우영 원장입니다. 

오늘은 성인의 새롭게 제시되고 있는 성인의 악궁확장에 대해 말씀드리려고 합니다. 


이전 포스팅에서 성장기 아동의 악궁확장에 대해 말씀드린 적이 있습니다.  



▼ 이를 안 뽑기 위한 악궁 확장 치료? 악궁 확장의 허와 실 

http://www.smilewithbn.com/bbs/board.php?bo_table=column&wr_id=9&page=2 






 성장기의 아동은 아직 좌우의 상악골이 완전히 붙지 않은 상태이기 때문에 단순한 악궁확장 장치로도 치아의 각도 뿐만 아니라 어느정도 상악골을 확장하는 것이 가능했습니다.  





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아동에서는 좌측의 고정성 확장장치 또는 우측의 가철성 확장장치와 같이 단순한 장치로도

치아 뿐만 아니라 입천장의 상악골을 좌우로 벌려줄 수 있습니다.




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성인에서는 화살표와 같이 좌우의 상아골이 가운데에 만나 결합을 형성하고

나이가 들수록 이러한 결합이 더 견고해져서 교정치료로 상악골을 넓히는 것이 어려웠습니다.



하지만 성인에서는 좌우의 상악골이 가운데에서 만나 이미 강하게 맞물려있기 때문에 이러한 확정이 어렵습니다. 그렇기에 단순히 치아의 각도를 바깥쪽으로 밀어 간신히 하악과의 교합관계만을 형성해주는 치료를 대부분 시행해왔습니다. 




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왼쪽과 같이 좁은 상악골이 확장되지 않는 성인에서는 

오른쪽 처럼 치아를 바깥쪽으로 뻐드러트려서 교합관계를 형성하는 치료가 일반적이었습니다. 



그리고 정말로 많은 양의 상악골 확장이 필요한 환자는 수술을 통해서 좌우의 상악골을 절제해주는 방법으로 치료를 해왔습니다.  



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수술을 동반한 악궁확장의 모식도 



이렇게 전신마취롤 동반하는 수술을 해야한다면 환자입장에서는 상당히 부담스러웠겠지요. 비용도 상당하고, 수술 후에 감내해야하는 통증도 상당했을 것입니다. 


그래서 수 년 전부터 수술을 하지 않고 미니스크류를 사용하여 성인에서도 악궁을 확장하는 방법이 개발되어 그 동안 몇몇 선구적인 임상가들이 이를 시행해 왔습니다.


기존의 악궁확장장치는 치아를 잡고 양쪽으로 밀어서 상악골을 좌우로 미는 방식이기 때문에 실제로 상악골에 전달되는 힘이 부족하였고, 또 치아가 먼저 바깥쪽으로 뻐드러지는 문제가 있었습니다. 


하지만 양측 상악골에 미니스크류를 식립하고 이를 이용해서 직접 뼈를 좌우로 밀 수 있다면 훨씬 직접적으로 상악골을 확장하는 힘을 가할 수 있고, 치아의 뻐드러짐도 최소화할 수 있습니다. 


이를 골격성 고정원을 이용한 악궁확장 (Miniscrew assisted rapid palatal expansion; MARPE)이라고 합니다. 




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MSE 장치는 입천장에 적용하며 4개의 미니스크류 (흰색 화살표)가 사용됩니다.



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UCLA 치과대학 문원(Moon Won) 교수, MSE 개발자



저희 바른내일 교정치과에서도 이러한 악궁확장이 필요한 성인 환자에서 적용한 결과 획기적일 정도로 효과적이고 만족스러운 결과를 얻을 수 있었습니다. 



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동일한 환자에서 좌측, 확장 전에 비해 우측, 확장 후에 상악골의 폭이 상당히 넓어진 것을 관찰할 수 있습니다.  



MSE 장치를 사용한 악궁확장은 일반적인 방법으로 확장이 어려워지는 12세 이상의 아동에서 성인까지 적용이 가능하며, 기존의 확장장치와는 다르게 상악골, 즉 뼈를 확장할 수 있습니다. 그리고 이렇게 얻어진 확장은 치아를 바깥쪽으로 뻐드러트리는 방식이 아니라 치아의 각도는 정상적으로 유지할 수 있어 저작하는 힘을 효과적으로 흡수하고 전달할 수 있습니다. 


미니스크류의 사용으로 불편할거라고 생각하시지만 실제로 경험한 환자들은 상당한 만족도를 보이고 있으며 불편함도 일시적이라고 말씀하시곤 하십니다. 


MSE 장치는 어금니가 반대로 물리고, 윗턱이 좁아서, 그리고 주걱턱 경향을 동반하는 청소년과 성인 환자에서 사용하게 됩니다. 




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