Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제31권1호
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pp.60-69
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2005
Orthopedic rapid maxillary expansion(RME) has been a common treatment modality used to widen narrow maxillae in young children. However, since more skeletally matured adolescents or adults has closed midpalatal suture, the result of RME was undesirable because of dental tipping with little or no basal skeletal movement and resulted to many other complications. After such treatment, complications often occurred such as alveolar bending, compression of periodontal ligament, extrusion, buccal tipping, and severe relapse. Thus, surgically assisted rapid maxillary expansion(SA-RME) is required, especially for patients over 14 years old, to skeletally release maxillary expansion. We used two methods of maxillary expansion surgery. Surgically assisted rapid maxillary expansion(SA-RME) & surgically assisted posterior segmental expansion(SA-PSE) were used for narrow maxilla. The study was divided into two groups(SA-RME group and SA-PSE group). SA-RME group was consisted of 2 males and 4 females, and the ages of materials ranged from 15 years to 25 years with a mean of 20.2 years. SA-PSE group was consisted of 1 male and 5 females, and the ages ranged from 13 years to 23 years with a mean of 18.7 years. Dental study models were fabricated before starting the expansion and immediately after the expansion was completed. It was fabricated again 1 month later, 3 months later when the expansion device was removed, and 6 months later after the expansion was completed. A repeated measures analysis of variance(ANOVA) test was applied to assess changes between each groups over time. The amount of expansion and the amount of tipping movement each in both groups were compared by using paired t-test and it was also compared between each subjects within the group by using independent t-test. Both SA-RME and SA-PSE group showed stable results, but SA-PSE group showed statical significance in tipping movement of second premolar. We compared 6 patients who recieved SA-RME with 6 patients who received SA-PSE, and appraised the clinical usefulness.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제42권3호
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pp.144-150
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2016
Objectives: We compared the transbuccal and transoral approaches in the management of mandibular angle fractures. Materials and Methods: Sixty patients with mandibular angle fractures were randomly divided into two equal groups (A, transoral approach; group B, transbuccal approach) who received fracture reduction using a single 2.5 mm 4 holed miniplate with a bar using either of the two approaches. Intraoperatively, the surgical time and the ease of surgical assess for fixation were noted. Patients were followed at 1 week, 3 months, and 6 months postoperatively and evaluated clinically for post-surgical complications like scarring, infection, postoperative occlusal discrepancy, malunion, and non-union. Radiographically, the interpretation of fracture reduction was also performed by studying the fracture gap following reduction using orthopantomogram tracing. The data was tabulated and subjected to statistical analysis. A P -value less than 0.05 was considered significant. Results: No significant difference was seen between the two groups for variables like surgical time and ease of fixation. Radiographic interpretation of fracture reduction revealed statistical significance for group B from points B to D as compared to group A. No cases of malunion/non-union were noted. A single case of hypertrophic scar formation was noted in group B at 6 months postsurgery. Infection was noted in 2 patients in group B compared to 6 patients in group A. There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up. Conclusion: The transbuccal approach was superior to the transoral approach with regard to radiographic reduction of the fracture gap, inconspicuous external scarring, and fewer postoperative complications. We preferred the transbuccal approach due to ease of use, minimal requirement for plate bending, and facilitation of plate placement in the neutral mid-point area of the mandible.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제37권2호
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pp.114-121
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2011
Introduction: The aim of this study was to demonstrate that the simulation surgery on rapid prototype (RP) model, which is based on the 3-dimensional computed tomography (3D CT) data taken before surgery, has the same accuracy as traditional orthograthic surgery with an intermediate splint, using an optoelectronic tracking navigation system. Materials and Methods: Simulation surgery with the same treatment plan as the Le Fort I osteotomy on the patient was done on a RP model based on the 3D CT data of 12 patients who had undergone a Le Fort I osteotomy in the department of oral and maxillofacial surgery, Seoul National University Dental Hospital. The 12 distances between 4 points on the skull, such as both infraorbital foramen and both supraorbital foramen, and 3 points on maxilla, such as the contact point of both maxillary central incisors and mesiobuccal cuspal tip of both maxillary first molars, were tracked using an optoelectronic tracking navigation system. The distances before surgery were compared to evaluate the accuracy of the RP model and the distance changes of 3D CT image after surgery were compared with those of the RP model after simulation surgery. Results: A paired t-test revealed a significant difference between the distances in the 3D CT image and RP model before surgery.(P<0.0001) On the other hand, Pearson's correlation coefficient, 0.995, revealed a significant positive correlation between the distances.(P<0.0001) There was a significant difference between the change in the distance of the 3D CT image and RP model in before and after surgery.(P<0.05) The Pearson's correlation coefficient was 0.13844, indicating positive correlation.(P<0.1) Conclusion: Theses results suggest that the simulation surgery of a Le Fort I osteotomy using an optoelectronic tracking navigation system I s relatively accurate in comparing the pre-, and post-operative 3D CT data. Furthermore, the application of an optoelectronic tracking navigation system may be a predictable and efficient method in Le Fort I orthognathic surgery.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제37권2호
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pp.122-126
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2011
Introduction: In the lateral window approach for a maxillary sinus bone graft, there has been considerable controversy regarding the placement of a barrier membrane over the osteotomy site. In particular, when there is no damage to the Schneiderian membrane, clinicians should decide whether to use a barrier membrane or not, considering the benefits and costs. This study presents the clinical cases to demonstrate that only repositioning the detached window can lead to satisfactory bony healing of the grafted material without using a barrier membrane in the lateral approach for a maxillary sinus bone graft. Materials and Methods: Five consecutive patients were treated with the same surgical procedures. After performing the antrostomy on the lateral maxillary wall using a round carbide bur and diamond bur, the bony window was detached by a gentle levering action. After confirming no perforation of the Schneiderian membrane, the grafting procedure was carried out the detached window of the lateral maxillary wall was repositioned over the grafted material without using a barrier membrane. A gross examination was carried out at the postoperative 6 month re-entry, and the the preoperative and postoperative dental computed tomography (CT) at re-entry were compared. Results: All the procedures in the 5 patients went on to uneventful healing with no complications associated with the bone graft. Satisfactory bone regeneration without the interference of fibrous tissue on the gap between the repositioned window and lateral wall of the maxillary sinus was observed in the postoperative 6 month re-entry. The CT findings at re-entry revealed the, reconstruction of the external cortical plate including repositioned bony window. In addition, the loss of the discontinuity of the lateral maxillary wall was confirmed. Conclusion: This preliminary report showed that the detached window, which was just repositioned on the grafted material, could function as a barrier membrane in the lateral approach for a maxillary sinus bone graft. Therefore additional morphometric and histologic studies will be needed.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제37권3호
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pp.176-183
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2011
Introduction: Very high aggressiveness and recurrence are important clinical characteristics of ameloblastoma compared to the other benign tumors. Therefore, an accurate diagnosis and treatment plan is important. This study examined the association of the clinical findings and recurrence based on the radiological findings of ameloblastoma. In recurrent cases, these results are expected to help in the diagnosis and treatment of ameloblastoma to examine the relevance with the clinical characteristics and radiological features. Materials and Methods: For a clinical (gender, age) and radiological (location, internal pattern, size, perforation, border pattern, impacted tooth, root resorption) evaluation, this study examined 156 cases of 147 patients diagnosed with ameloblastoma, who had been treated and in most cases regularly checked at the department of oral and maxillofacial surgery, Kyungpook National University Hospital, between January 1993 and December 2009. For a recurrent rate evaluation, a more than 3 years follow-up period is needed. Accordingly, 116 patients diagnosed with ameloblastoma between January 1994 and December 2007 were investigated. Results: The recurrence rate in all cases was 6.1% but was 7.8% in cases with follow-up periods more than 3 years. The male-to-female ratio was 3:2, showing a slight male predilection. Ameloblastoma had a peak occurrence in the second decade of life followed by the fourth decade of life. The mandibular angle area is the most frequent site of ameloblastoma (50.8%) in the jaws. Six cases of unilocular (7.8%) and 3 cases of multilocular (7.7%) ameloblastomas recurred. Seven cases of smooth (10%) and 2 cases of irregular (4.3%) ameloblastomas recurred. No cases of ameloblastomas without perforation of the cortical bone (0%) and 9 cases with a perforation of cortical bone (11.1%) recurred. Four cases of the ameloblastomas with impacted teeth (11.4%) and 5 cases of ameloblastomas without impacted tooth (6.2%) recurred. Seven cases of ameloblastomas with root resorption (10.9%) and 2 cases of ameloblastomas without root resorption (3.8%) recurred. Conclusion: A multiple smooth margin, unilocular ameloblastoma with an impacted tooth, root resorption tends to recur more easily. Therefore, they need to be treated more carefully and require a a longer follow-up.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제35권3호
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pp.164-169
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2009
Objectives : Administration methods of antibiotics implements a variety for indications and diseases. Therefore, it is impossible to produce a single guideline. Many antibiotics have been prescribed without specific index, by practicians for a long period of time. In general dental practice and oral and maxillofacial surgical practice, there is not a guidelines for antibiotics. Therefore, there is a dependency on pre-existent methods rather than following an exact guideline. Consequently, a controversy was issued that prescription of antibiotics tend to be misused or abused. And it is also direct relation to the tolerance of antibiotics as well. Moving forward, in this review we will be analyzing the exact usage and indication of antibiotics in dental treatment. Materials and Methods : 29 published articles of both domestic and international were researched through Pubmed and Kormed, and the review from these articles were performed accordingly. We examined the administration of antibiotics through the objective usage, that classified prophylactic and therapeutic. Results : For therapeutic usage, empirical prescription is mandatory for the first step. Next is to moderate the empirical prescription depending upon the result of its culture. Administration of antibiotics must be kept for 2days after the symptoms disappear. For a prophylactic use, we can generally pr escribe antibiotics to prevent local infection or systemic infection. Although the method of prescription and neccessity of antibiotics to prevent local in fection are controversial, exact guidelines of antibiotics to prevent systemic infection are established by AHA. Conclusion : Most crucial concept for prescript antibiotics is to determine if it is adequately suitable for all circumstances. In this decision making, a guideline for prescription of antibiotics in various dental surgical practice is necessary. This guideline can reduce the misusage and disusage of a ntibiotics in general dental practices and oral and maxillofacial surgical practices.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제35권4호
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pp.205-212
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2009
Purpose : The purpose of this study was to examine the expression of various angiogenic factors during osteoblastic differentiation of periostealderived cells and the effects of osteogenic inductive medium of periosteal-derived cells on the proliferation of endothelial progenitor cells. Materials and methods : Periosteal-derived cells were obtained from mandibular periosteums and introduced into the cell culture. After passage 3, the cells were divided into two groups and cultured for 21 days. In one group, the cells were cultured in the DMEM supplemented with osteogenic inductive agent, including 50g/ml L-ascorbic acid 2-phosphate, 10 nM dexamethasone and 10 mM -glycerophosphate. In the other group, they were cultured in DMEM supplemented without osteogenic inductive agent. VEGF isoforms, VEGFR-1, VEGFR-2, and neuropilin-1 mRNA expression was observed. Human umbilical cord blood-derived endothelial progenitor cell proliferation was also observed. Results : The expression of VEGF isoforms was higher in osteogenic inductive medium than in non-osteogenic inductive medium. The expression of VEGFR-2 was also higher in osteogenic inductive medium than in non-osteogenic inductive medium. However, the expression of VEGFR-1 and neuropilin-1 was similar in both osteogenic inductive medium and non-osteogenic inductive medium. In addition, conditioned medium from differentiated periosteal-derived cells stimulated human umbilical cord blood-derived endothelial progenitor cell numbers compared to conditioned medium from non-differentiated periosteal-derived cells. Conclusion : These results suggest that in vitro osteoblastic differentiation of periosteal-derived cells has angiogenic capacity to support endothelial progenitor cell numbers.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제35권3호
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pp.153-157
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2009
Recently, an increasing number of bisphosphonate related osteonecrosis of the jaw(BRONJ) is being reported. A guideline has been already established in the US, but it does not seem to be fully recognized by clinicians in Korea. Therefore, a survey study was done to inform and have clinicians realize the seriousness of BRONJ. 1,341 practitioners were randomly selected out of 13,405 practitioners(by Feb of 2008, KDA) in Korea. A questionnaire was given to them between May to July in 2008. Questions were designed to investigate each respondent's experience term years in the clinic, occupation, speciality, awareness on risk of bisphosphonate, experience on treating osteonecrosis patients, awareness about the guideline on BRONJ suggested by AAOMS and whether if they ask about bisphosphonate medication history to patients before invasive treatment. 45.1% of the clinicians have reported on experiencing delayed healing on bone exposed site after extraction both in the maxilla and the mandible. However, clinicians have asked the patients whether if they are on bisphosphonate or not in only 15.1% of these cases. 56.5% of the clinicians simply knew about BRONJ but only 28.9% of the clinicians were aware that bisphosphonate can cause osteonecrosis after invasive dental treatment. Only 19.3% knew about the contents of guideline on BRONJ and 57.2% were aware of the seriousness of BRONJ. Clinicians with shorter clinical experience term were more aware of BRONJ and the guideline on BRONJ than the experienced clinicians. But awareness of the possibility of BRONJ after invasive dental treatment were about the same regardless of their clinical experience. The results show that Korean clinicians need to be more aware about BRONJ. Data on BRONJ cases in Korea should be collected and provided with additional education to let Korean clinicians know and be more aware about BRONJ.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제33권2호
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pp.114-120
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2007
The augmentation of soft tissue defects is one of the critical problems in the oral and maxillofacial surgery. Various types of graft materials, both autologous and non-autologous, have been used for the augmentation of soft tissue in the facial region. However, it is not easy to choose an ideal material for soft tissue augmentation because each has its advantages and disadvantages. An ideal graft material should meet the following criteria : it should not leave a scar at the area from which it was taken; should have less likelihood of causing infection; should feel natural after implanted; and should be not absorbed. Among the materials meeting these criteria, human dermis and artificial dermis are commonly used for clinical purposes. The present study was aimed to investigate and compare the resorption rate and the histological change following the use of the autologous dermis, the human homogenous dermis $Alloderm^{(R)}$, and the artificial dermis $Terudermis^{(R)}$ to reconstruct the soft tissue defect. Twenty mature rabbits of either sex, weighing about 2 ㎏, were used. Each rabbit was transplanted with the autologous dermis, $Alloderm^{(R)}$, and $Terudermis^{(R)}$ size $1{\times}1-cm$ at the space between the external abdominal oblique muscle and the external abdominal oblique fascia. They were then divided into 4 groups (n=5 each) according to the time elapsed after the surgery: 1, 2, 4, and 8 weeks. The resorption rate was calculated by measuring the volume change before and after the transplantation, and H-E stain was preformed to observe the histological changes. The resorption rate after 8 weeks was 21.5% for the autologous dermis, 16.0% $Alloderm^{(R)}$, and 36.4% $Terudermis^{(R)}$, suggesting that $Alloderm^{(R)}$ is the most stable while $Terudermis^{(R)}$ is the most unstable. In microscopic examinations, the autologous dermis graft was surrounded by inflammatory cells and showed foreign body reactions. The epidermal inclusion cyst was observed in the autologous dermis graft. $Terudermis^{(R)}$ and $Alloderm^{(R)}$ demonstrated neovascularization and the progressive growth of new fibroblast. The results suggest that $Terudermis^{(R)}$ and $Alloderm^{(R)}$ can be availably for substituting the autologous dermis.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제33권2호
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pp.131-138
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2007
The purpose of this study was to observe the effect of calcium and vitamin D to the titanium implant osseointegration in animal model. 32 rats, 10 weeks of age, were divided into two group: additional calcium and vitamin D supplementation group and a control group. Titanium screw implant(diameter, 2.0mm; length, 3.5mm; pitch-height 0.4mm) were placed into tibia of 32 rats, 16 in the control group and 16 in the experimental group. The rats were sacrificed at different time interval(1, 2, 4, and 8 weeks after implantation) for histopathologic observation, histomorphometric analysis and immunohistochemistry with osteocalcin and osteopontin antibody. Histopathologically findings, newly formed bone was seen at 1 weeks and became lamellar bone at 2 weeks, and mature trabecullar bone was seen at 4 weeks experimental group. In control group, thickness of regenerated bone increased till 4 weeks gradually and trabecullar bone was seen at 8 weeks. By histomorphometric analysis, bone marrow density was increased significantly at 1 and 2 weeks in experimental group compared to control group. Osteocalcin immunoreactivity was strong at 1 week experimental group and reduced after 4 weeks gradually. But it was continuously weakly from 1 to 4 weeks in control group. Osteopontin immunoreactivity was very strong in newly formed bone from 2 to 8 weeks experimental group. And the amount of osteopontin expression was more abundant in experimental group. The results of this study suggest that calcium and vitamin D supplementation promotes bone healing around dental implants
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