동탄이즈치과 대표원장 교정과전문의 임병서 입니다.
토요일 너무 바쁜 진료를 끝내고,
부산에서 일부러 올라오신 분 미팅하느라 집에 좀 늦게 귀가했는데요.
그러고 지금...
일요일 밤까지 밖에 나가 본 적이 없네요 ㅠ
최근 몇년간 이런 적이 오랜만이라, 좋으면서 당황스럽네요.
일요일 아침이면 강의하러 나간 지 이제 벌써 2년이 되었네요.
대한치과교정학회 업무때문에 빠진 적 몇번을 제외하고는, 매주 일요일에는 밖에 있었던 것 같습니다.
작년 여름에 찍은 사진인데,
이때도 벌써 코로나때문에 사회적 거리두기로 한 테이블에 한명씩 앉아 있는 게 보이네요.
통합치의학과 전문의과정 치과교정학 분야를 담당하고 있는데요.
시간도 많이 뺐기긴 하지만,
개인적으로 얻는 것도 많아서 즐겁습니다.
오늘도 어제에 이어 송곳니매복치 교정 얘기를 해보려고 합니다.
말씀드렸듯이 윗니 송곳니가 매복되기 쉬운 치아이고,
미소시 심미적인 면에서 영향을 많이 미치기도 하며,
더 앞쪽에 있는 앞니 치근을 흡수해버릴 가능성이 높아서,
아주 높이 묻혀있지 않는 한
교정적으로 살살 끌어내려서 배열하는 것이 좋습니다.
어떠신가요? 별로 문제없어보이나요?
일단 눈에 띄는 것이,
사진상, 오른쪽두번째 앞니가 약간 뻐드려져 보이는 정도?
일단, 그게 눈에는 거슬리는군요.
앞니의 하얀반점은 치아가 만들어지는 과정 중,
무기질침착에 문제가 생겨서 만들어진 거라 쉽게 제거할 수 없습니다.
이쪽에서 보면 좀 더 보이는데요,
살짝 색깔이 묻어있는 치아가 역시 뻐드러진게 보이고 그 뒤는 유치의 송곳니네요.
즉, 영구치 송곳니가 결손된 거로 보입니다.
엑스레이로 보면,
확실히 알 수 있습니다. 보이시나요?
아, 송곳니매복치가 있어서 그 앞에 있는 앞니의 뿌리를 누르고 있구나
그래서 약간 뻐쳐있는 모습을 보였구나, 하고 짐작할 수 있게 되겠습니다
CT로 확인하면 정확한 위치를 시각화할 수 있지만,
위에 전체 아치가 나온 사진에서 보면,
이미 유치의 송곳니 바깥쪽 잇몸이 불룩한 것으로 봐서
여기에 매복되어 있구나 짐작할 수 있습니다.
파란 화살표 부분인데, 불룩한게 보이시나요?
이렇게 치아 바깥쪽으로 매복된 경우와,
천장쪽으로 매복된 경우로 나눠 볼 수 있는데요.
얘기가 길어지니까 다음에 나눠서 해보겠습니다.
일단 이런 경우가 치료하기 좀 더 까다롭다는 정도 말씀드리겠습니다.
외모상으로 치열이 양호하고, 교합관계도 좋은 편이라,
교정치료가 구지 필요한가 싶기도 하시겠지만,
앞에 엑스레이에서 보듯이 앞니의 치근을 흡수하고 있고,
계속 방치하면 더 전방에 있는 치아도 침범할 가능성이 있어서,
치료개입을 하기로 결정했습니다.
치료 후의 모습입니다.
잘 내려와서 배열된 것을 볼 수 있습니다.
이 과정에 상당히 애를 먹었는데,
치아의 움직임이 상당히 더뎠기 때문입니다.
가끔 아무런 이유없이 치아이동이 더딘 환자분을 보게 됩니다.
교정과의사로서 당황스럽지요.
결국에는 꼭 해결이 되긴 하지만,
불편한 교정장치를 2년-3년 가지고 있게 하는 것에 대한 미안한 마음은 교정의사의 숙명이라 하겠습니다.
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