ISSN : 0376-4672
소아치과의 환자 분포와 진료 현황은 끊임없이 변화하고 있다. 이 연구는 소아치과의 환자 분포 및 진료 현황의 변화 추세를 분석하기 위해 시행되었다. 2011년부터 2020년까지 전남대학교 치과병원 소아치과에 내원한 모든 환자의 분포와 진료 현황에 대한 정보를 분석하였다. 전체 내원 환자 수는 2019년까지 증가하는 경향을 보였으나, 2020년 COVID-19의 영향으로 다소 감소하였다. 초진 환자의 비율은 2011년 12.18%에서 2020년 8.98%로 감소하였다. 2011년에는 수복치료, 예방치료, 외과적 치료, 치수치료, 교정치료 순으로 시행되었다. 2012년 이후에는 예방치료의 비율이 증가하여 가장 높게 나타났으며, 2020년에는 예방치료, 수복치료, 외과적 치료, 교정치료, 치수치료 순이었다. 진정법의 시행 빈도와 급여 진료의 비율은 10년에 걸쳐 증가하는 경향을 보였다.
Objective : The objective of this study was to suggest the diagnostic reference levels for intraoral and panoramic radiography through the nationwide survey at regular intervals in South Korea. Study Design : One hundred twenty-six dental institutions from all regions of South Korea were visited. Information on radiographic equipment and clinical exposure parameter was recorded at 118 intraoral and 125 panoramic equipment. Patient entrance dose (PED) and dose-area product (DAP) in intraoral radiography and DAP in panoramic radiography were measured using a DAP meter. Results : Third quartile PED and DAP of intraoral radiography in adults were 1.5 mGy and 46.0 mGy cm2 , those in 12-year-old children 1.2 mGy and 37.1 mGy cm2 and those in 6-year-old children 1.0 mGy and 29.9 mGy cm2 . Third quartile DAP of panoramic radiography in adults, 12, and 6-year-old children were 227 mGy cm2 , 175 mGy cm2 , 163 mGy cm2 , respectively. The median exposure parameters of intraoral radiography in adults were 60kV, 6mA, and 0.23 seconds and those in 12-year-old children 60kV, 6mA, and 0.16 seconds and those in 6-year-old children 60kV, 6mA, and 0.15 seconds. The median exposure parameters of panoramic radiography in adults were 74kV, 10mA, and 13.6 seconds and those in 12-yearold children 67kV, 10mA, and 13.2 seconds and those in 6-year-old children 67kV, 8mA, and 12.0 seconds. Conclusion : As the national DRLs for intraoral radiography and panoramic radiography in Korea, we recommended 1.5 mGy and 227 mGy cm2 for adults, 1.2 mGy and 175 mGy cm2 for 12-year-old children, and 1.0 mGy and 163 mGy cm2 for 6-year-old children, respectively
목적 : 이 연구의 목적은 네비게이션 가이드 시스템(navigation guide system)을 이용한 치조정 접근 상악동 거상술(crestal approach sinus augmentation)을 제안하고 이러한 새로운 술식을 사용한 증례를 보고하고자 함이다. 연구 방법 : 상악동 거상술이 요구되는 임플란트 환자중 잔존골 4mm이상이며 치조정접근 상악동거상술이 필요한 환자 5명을 선정하였다. 이 환자들의 구강내 인상채득과 CBCT촬영을 하여 디지털 치료계획을 시행하였다. 이때 치조정 접근을 위한 디지털 치료계획도 시행하였으며 이를 이용하여 각 환자당 치조정접근 상악동 거상술용 가이드와 임플란트 식립용 가이드 총 2개의 가이드를 제작하였다. 결과 : 총 5명의 환자에서 치조정 접근 상악동 거상술 가이드를 이용하여 별다른 문제없이 안정적으로 8개의 임플란트를 식립하였다. 결론 : 네비게이션 가이드 시스템를 사용한 치조정 접근 상악동 거상술은 술전 디지털 치료계획을 통해 잔존골이 부족한 상악에서 안전하고 정확한 임플란트 식립을 가능하게 할 것이라 사료된다.
Occlusal appliance is a removable device which fits over the occlusal surfaces of the teeth in one arch, devised to provide precise occlusal contact with the opposing teeth. Occlusal appliance is usually made of hard acrylic resin and allows optimum dentition in which condyle may assume in its most orthopedically stable position. Occlusal appliance is used to treat various kinds of temporomandibular disorders, including joint and muscle pain, disc derangements, parafunctional habits like bruxism and clenching, and degenerative joint diseases of TMJ. There are various types of occlusal appliances, but stabilization appliance and anterior positioning appliance are most frequently used. Stabilization appliance is fabricated to provide optimum occlusal relationship for the patient. This appliance is indicated for muscle and joint pain disorders and helpful for reducing parafunctional habits like bruxism. Anterior positioning appliance is designed to protrude mandible to a position that is more anterior than the intercuspal position. It is primarily used to treat disc displacement with reduction, intermittent lock and joint noises but some inflammatory disorders including retrodiscitis can be managed with this appliance. Occlusal appliance therapy is a successful treatment in reducing symptoms, and many previous reports indicates that its success rate is 70-90%. However, controversy exists over the exact mechanism by which occlusal appliance reduce symptoms. Occlusal appliance therapy is reversible, non-invasive therapy and effective therapeutic modalities for temporomandibular disorders. For the successful outcome, careful selection of the patient is needed. Also, it should be monitored regularly for the improvement of the disorder and the occurrence of side effects.
Proper diagnosis and management of temporomandibular disorder (TMD) is essential. For this purpose, clinical examination as well as imaging examination of the temporomandibular joint (TMJ), surrounding structures, and masticatory muscles are required. Confirmation of diagnosis by imaging prevents delay in diagnosis and prevents chronic progression of TMD signs and symptoms. TMJ can be imaged using a variety of modalities, including conventional radiography represented by panoramic radiography, magnetic resonance imaging (MRI), computed tomography (CT), cone-beam CT (CBCT), and bone scans. The present study briefly explains the characteristics and indications of the imaging modalities used in the diagnosis of TMD according to the diagnostic criteria for temporomandibular disorders (DC/TMD), and presents representative images. However, imaging of TMJ can be challenging due to the anatomical complexity of the TMJ area. The use of panoramic radiography for pathological changes in the TMJ area is not enough due to overlapping of anatomical structures. With CT and CBCT, bony changes can be better identified. A three-dimensional image view is required for an accurate imaging diagnosis of TMJ. CBCT provides a high-resolution multiplanar reconstruction of the TMJ with low radiation dose without overlap of bone structures. Furthermore, MRI is a non-invasive dynamic imaging modality that is considered the gold standard for imaging the soft tissue components of the TMJ. MRI can be useful in evaluating the position and shape of the articular disc, and diagnosing TMJ disc displacement. It can also determine the early signs of TMD and the presence of joint effusion. Bone scans show whether bone changes and inflammatory reactions observed on other imaging modalities are active. The diagnostic value of imaging depends to a large extent on the equipment used and the experience of the examiner. It is recommended that the results of imaging examination be interpreted in conjunction with those of clinical examination. The information presented here is of great help to clinicians and researchers who are treating and studying TMD.
Temporomandibular disorders are a collective term encompassing a variety of pathological conditions in the stomatognathic region, manifesting with the pain and dysfunction. Diverse modalities of physiotherapy are recommended for the relief of pain, the rehabilitation of function and the facilitation of injury recovery, which include the cryotherapy, thermotherapy, electrotherapy and phototherapy according to the physical properties of the applied therapeutic stimuli. Therefore, it is necessary for dental clinicians to understand the characteristics of each modality of physiotherapy for the proper application. This review focused on the clinical considerations for the careful application of physiotherapy, including the underlying mechanisms, the expected effects, indication, contraindication and caution.
