• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.1-14
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• 2000

The purpose of this study was to evaluate the efficacy of adding autogenous bone to the toothash-plaster mixture in the healing process of bone. Full-thickness round osseous defects with the diameter of 20mm were made at the calvarial bone of adult dogs (n=19) bilaterally, which were thought to be critical size defect. The right defects were repaired with the toothash-plaster mixture plus autogenous bone (compressed volume 0.3cc) and the left defects with only toothash-plaster mixture. At 2-, 4-, 8-, 12- and 20- week after implantation, dogs were sacrificed and evaluated the osseous healing of bony defects clinically, radiographically, and microscopically. The results were as follows; 1. At the clinical observation, the wound healed very well without any problem except severe swelling in the early period after operation. Slight depression was recognized at the both sides when the portions of cranial defect were palpated. 2. There were statistically significant differences between toothash-plaster mixture groups and autogenous bone added groups at the same period, and among the groups in the bone density of the digital radiograms (P<0.001). There was a tendency that bone density was increasing with time. 3. In light microscopic examination, new bone formation was more active in the autogenous bone added groups than toothash-plaster mixture groups at the early period after implantation but there is little difference at 20-week after implantation. 4. In fluorescent microscopic examination, the fluorescent band could be observed at the area of active bone formation and the band was more distinct in the autogenous bone added groups then toothash-plaster mixture groups. 5. In transmitted electron microscopic examination, organelles such as rER, Golgi complex and secretory granule and osteoblast were observed. In summary higher volume ratio of autogenous bone is needed to improve the bone healing in that there is little difference between toothash-plaster mixture group and autogenous bone added group at the 20-week after implantation in spite of new bone formation was more active in the autogenous bone added groups than toothash-plaster mixture groups at the early period after operation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.6
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• pp.391-397
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• 2012

Purpose: The purpose of this study was to evaluate the effectiveness of the platelet-rich fibrin (PRF) used in combination with the porcine cancellous bone as a scaffold, in promoting bone regeneration in the bone defects ofthe rabbit calvaria. Methods: Ten rabbits were used in the study. Three round-shaped defects (diameter 8.0 mm) were created in the rabbit calvaria and were filled with nothing (control group), porcine cancellousbone (Experimental Group 1, porcine bone) and PRF-mixed porcine cancellous bone (Experimental Group 2). TS-GBB is a xenogenic bone-substitute product comprised of a high heat-treated mineralized porcine cancellous bone. Animals were sacrificed at 6 weeks and 12 weeks for the histological and radiographic evaluations. Results: In the micro computed tomography and histological results, the experimental groups 1 and 2 showed more bone formation, remodeling, and calcification than the control group. The new bone formation ratio showed theGroup 2 to be larger than Group 1 at6 and 12 weeks. However, there was no significant difference between the experimental groups 1 and 2 in the new bone formation area, at the 6 and 12 weeks (P>0.05). Conclusion: The PRF-mixed group showed more bone formation than the porcine cancellousbonegroup (TS-GBB), butthere was a no significant difference. The PRF may not lead to enhanced bone healing when grafted with the porcine cancellous bone.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.6
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• pp.384-390
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• 2012

Purpose: The purpose of this study is to examine in vivo osteogenesis of cultured human periosteal-derived cells and polydioxanone/pluronic F127 scaffold. Methods: Two one-year-old miniature pigs were used in this study. $2{\times}10^6$ periosteal-derived cells in 1 mL medium were seeded by dropping the cell suspension into the polydioxanone/pluronic F127 scaffold. These cell-scaffold constructs were cultured in osteogenic Dulbecco's modified Eagle's medium for 7 days. Under general anesthesia with azaperone and tiletamine-zolazepam, the mandibular body and ramus of the pigs were exposed. Three bony defects were created. Polydioxanone/pluronic F127 scaffold with periosteal-derived cells and the scaffold only were implanted into each defect. Another defect was left empty. Twelve weeks after implantation, the animals were sacrificed. Results: New bone formation was clearly observed in the polydioxanone/pluronic F127 scaffold with periosteal-derived cells. Newly generated bone was also observed in the scaffold without periosteal-derived osteoblasts and empty defect, but was mostly limited to the periphery. Conclusion: These results suggest that cultured human periosteal-derived cells have good osteogenic capacity in a polydioxanone/pluronic F127 scaffold, which provides a proper environment for the osteoblastic differentiation of these cells.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.2
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• pp.100-105
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• 2012

Purpose: In general, the surgical treatment for mandibular retrognathism is represented by two methods, distraction osteogenesis (DO) and mandibular osteotomy surgery. The DO is mostly preferred when the degree of advancement of mandible is large. However, the postoperative stability of mandibular advancement using DO have not been actively investigated. Therefore, in the present study we have compared the postoperative stability between DO and bilateral sagittal split ramus osteotomy (BSSRO) in mandibular retrognathism. Methods: Seven patients who had been treated by DO and thirteen patients with BSSRO were included in this study. Serial lateral cephalograms were analyzed by manual tracing and the amount of the mandibular elongation was measured. To evaluate the postoperative stability, positional changes of the condylar position and B point were analyzed. Results: Mean amount of mandibular advancement was $6.51{\pm}3.57mm$ for BSSRO group and $12.43{\pm}4.35mm$ for DO group, respectively. There was no significant difference in age between the two groups (P>0.05). Mean follow up periods were 10.77 months for BSSRO group and 11.28 months for DO group, respectively. After mandibular advancement, mean positional changes in the condyle were $0.56{\pm}1.43mm$ horizontally and $0.72{\pm}1.61mm$ vertically for BSSRO group and $0.53{\pm}1.56mm$ horizontally and $0.56{\pm}1.75mm$ vertically for DO group, respectively. Mean change of distance from B point to Y-axis was $-1.76{\pm}0.83mm$ for BSSRO group and $-2.14{\pm}1.82mm$ for DO group, respectively. According to the condylar position and B point, there were no significant differences in postoperative stability between the two groups (P>0.05). Conclusion: There was no significant difference in postoperative stability between DO and BSSRO group according to condylar position and B point. Based on the results of the present study, it is hypothesized that DO would be a good treatment choice for severe mandibular retrognathism because DO could achieve more mandibular advancement and concurrent soft tissue elongation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.6
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• pp.474-484
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• 2007

Purpose: The effect of platelet-rich plasma(PRP) on osteogenesis of marrow-derived osteoblasts on histomorphometric analysis in the mandible of rabbit was assessed. Materials and Method: Bone marrow cells were obtained from iliac bone of rabbits and were cultured in a Dulbecco's Modified Eagle's Medium(DMEM) with Dexamethasone, L-Ascortic acid, ${\beta}$-Glycerophosphate to proliferate and differentiate into osteoblasts for $4{\sim}5$ weeks. The expression of osteogenic mar-kers was detected by reverse transcription-polymerase chain reaction(RT-PCR) and silver nitrate stain. Then we prepared bony defects in the mandible of rabbit, 10.0mm in diameter and 4.0mm deep, by trephine bur. In the control group, the defects were filled with autogenous bone and cultured osteoblasts. In the experimental group, the defects were filled with autogenous bone, cultured osteoblasts and PRP. 2 weeks, 4 weeks, 8 weeks later, each group was evaluated with histological and histomorphometric analyses. Results: In vitro, osteoblasts were identified on RT-PCR and silver nitrate stain. According to histological observation, at 2 weeks well-developed anasto-mosing newly-formed woven bone was observed, at 4 weeks anastomosing newly-formed woven bone having osteoblastic activation was observed, and at 8 weeks thick newly-formed woven bone was observed in both control and experimental groups. According to histomorphometric analysis, there were 1.5% more newly-formed bone volume in experimental group than control group at 2 weeks, 28.4% more at 4 weeks, 4.3% more at 8 weeks. Particularly there were significant differences in bone volume at 4 weeks and 8 weeks new bone. Conclusion: Our results demonstrated PRP may enhance osteogenesis of marrow-derived osteoblasts at 4 weeks, 8 weeks.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.6
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• pp.509-512
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• 2007

Purpose: The Le Fort I osteotomy is a commonly performed maxillary procedure for dentofacial deformity. One of the risks of this procedure is major hemorrhage resulting from injury to the descending palatine artery. So it is very important to know the exact position of the descending platine artery. An increased understanding of the position of this artery can minimize the intra-operative bleeding while allowing extension of the bone cuts to achieve exact positioning maxilla. The aim of this investigation was to study the position of the descending palatine artery as it relates to the Le Fort I osteotomy. Methods and patients: Total 40 patients who underwent Le Fort I osteotomy in SNUDH OMFS were studied in this study. We measured the distance from the pyriform aperture to the descending palatine artery (DPA distance) using a ruler. We investigated the relationship between DPA distance, the distance from A point to the McNamara line on lateral cephalography and the patient's body height. Results: The average distances from the pyriform rim to the descending palatine artery were 35.3 mm on the right (range: $30{\sim}40mm$) and 33.7mm (range: $30{\sim}41mm$) on the left in males. Those in females were 33.4 mm on the right (range: $28{\sim}40mm)$ and 32.8mm (range: $27{\sim}38mm$) on the left. The significances between the distance the DPA distance, the body height and the distance from A point to McNamara line were not found. Conclusion: Injury to the descending palatine artery during Le Fort I osteotomy can be minimized by not extending the osteotomy more than 30 mm posterior to the pyriform aperture in mal, and 27 mm in female.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.3
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• pp.248-254
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• 2005

The purpose of this study was to investigate the distribution of stress within the regenerated bone surrounding the implant using three dimensional finite element stress analysis method. Using ANSYS software revision 6.0 (IronCAD LLC, USA), a program was written to generate a model simulating a cylindrical block section of the mandible 20 mm in height and 10 mm in diameter. The $5.0{\times}11.5-mm$ screw implant (3i, USA) was used for this study, and was assumed to be 100% osseointegrated. And it was restored with gold crown with resin filling at the central fossa area. The implant was surrounded by the regenerated type IV bone, with 4 mm in width and 7 mm apical to the platform of implant in length. And the regenerated bone was surrounded by type I, type II, and type III bone, respectively. The present study used a fine grid model incorporating elements between 250,820 and 352,494 and nodal points between 47,978 and 67,471. A load of 200N was applied at the 3 points on occlusal surfaces of the restoration, the central fossa, outside point of the central fossa with resin filling into screw hole, and the functional cusp, at a 0 degree angle to the vertical axis of the implant, respectively. The results were as follows: 1. The stress distribution in the regenerated bone-implant interface was highly dependent on both the density of the native bone surrounding the regenerated bone and the loading point. 2. A load of 200N at the buccal cusp produced 5-fold increase in the stress concentration at the neck of the implant and apex of regenerated bone irrespective of surrounding bone density compared to a load of 200N at the central fossa. 3. It was found that stress was more homogeneously distributed along the side of implant when the implant was surrounded by both regenerated bone and native type III bone. In summary, these data indicate that concentration of stress on the implant-regenerated bone interface depends on both the native bone quality surrounding the regenerated bone adjacent to implant and the load direction applied on the prosthesis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.4
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• pp.291-299
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• 2005

Objectives : It is well known that cigarette smoking is harzardous to the osseointegration of dental implant, due to the impaired wound healing accompanied by reduced alveolar bone density. The aim of this study is to evaluate the influence of cigarette smoke on the implant osseointegration by the time factor consideration. Materials and methods : Twenty-four male Spraque-Dawley rats (8 weeks, weighting 200 to 250g) were used in this study. In the experimental group, 13 rats were exposed to cigarette smoke, 8 minutes per day during 6 weeks, and 12 rats in the control group were not exposed at any time. RBM (Resorbed blasting media) surfaced implant (diameter 3.3mm, length 5.0mm, AVANA Co., Korea) was placed in the right femur of each rat. Each implant with surrounding bone was prepared with microtome (cutting band 0.2mm$^{(R)}$, EXAKT Co., Germany) after 1 day, 2, 4, 8 and 12 weeks and stained with toluidine blue (1%). Another clinical investigation of each implant was also done at each evaluation time. Results : Clinical investigation around implant fixture showed that there were no significant differences between the control and experimental group. Microscopic observation around implant fixture showed that there were significant differences between the control and experimental group at the initial stage after implant fixture installation. Experimental group showed a decreased bone to implant contact within 4 weeks compared to control group, but showed similar characteristics after 4 weeks. Conclusion : Smoking inhalation effect on the dental implant showed the impaired wound healing by vasoconstriction and decreased intramedullary blood flow at initial stage of osseointegration. This experimental results can be clinically useful to the implant surgery of smoking patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.3
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• pp.274-287
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• 2000

The use of dental implants has increased tremendously in recent years and is expected to increase even more in the future. The successful outcome of any implant procedure is surely dependent on interrelationship of the various components of an equation that includes biocompatibility of implant material, macroscopic and microscopic nature of the implant surface, the status of implant bed, surgical technique, undisturbed healing phase and subsequent prosthetic design and long-term loading phase. The purpose of this study was to clarify the effects of adrenalectomy on the osseointegration of pure titanium implants. Seventy rats, 11 weeks of age, were divided into two groups : an adrenalectomized group and a control group. Titanium screw implant(diameter, 2.0mm; length, 3.5mm) was placed into left tibia of 70 rats, 35 in control group and 35 in the experimental group. The rats were sacrificed at different time interval (1, 2, 3, 4, 6, 8, and 12 weeks after implantation) for histopathologic observation, histomorphometric analysis and immunohistochemistry with fibronectin and CD44 antibody. The results obtained from this study were as follows: 1. Histopathogically, findings, newly formed bone was seen at 3 weeks control group and became lamellar bone at 12 weeks. At 6 weeks, lipocytes were observed in bone marrow space. Thickness of regenerated trabecular bone increased till 6 weeks after then, that decreased gradually. 2. By histomorphometric analysis, marrow bone density and contact ratio of marrow bone to implant decreased significantly from 8 to 12 weeks in experimental group compared to control group and also total bone to implant contact ratio decreased significantly from 4 to 12 weeks in experimental group compared to control group. 3. Fibronectin immunoreactivity was very strong at 3 and 4 weeks control group. And after that reduced gradually. But it was continuously strong from 1 to 12 weeks experimental group. 4. CD44 immunoreactivity was very strong in the newly formed osteoblasts at 3 and 4 weeks control group. But it reacted minimally later. However, it reacted continuously strong from 3 to 12 weeks experimental group. From these results, bone to implant contact ratio decreased gradually from 4 weeks in adrenalectomized group compared to control group. CD44 and fibronectin immunoreactivities were strong at all times in adrenalectomized rats. Therefore, it could be stated that immature bone remained continuously for a long time and not readily proceeded into mature status.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.5
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• pp.383-393
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• 2007

The aim of the present study is to investigate the effect of anodized surface of osseointegration implants by using of resonance frequency analysis (RFA) and histomorphometric analysis. A total of 96 screw-shaped implants were devided into 4 groups. Seventy-two implants were prepared by electrochemical oxidation with 3 different ways; Group 1 (n=24) were prepared at galvanostatic mode in 0.25M sulfuric acid and phosphoric acid, Group 2 (n=24) were prepared at galvanostatic mode in calcium glycerophosphate and calcium acetate, and Group 3 (n=24) were prepared at galvanostatic mode in 0.25M sulfuric acid and phosphoric acid followed by Calcium metaphosphate(CMP) coating. Control group (n=24) were the RBM surfaced implants. The implants were placed in the mandibles of 12 mini pigs. Bone tissue responses were evaluated by resonance frequency analysis(RFA) and histomorphometric analysis that were undertaken at 2, 4 and 6weeks after implant placement. The following result were obtained. 1. Twenty-two of 96 implants (4 in control group, 5 in group 1, 7 in group 2, and 6 in group 3) were failed due to faliure of osseoitegration. The failure rate of osseointegration was 22.9%. 2. The mean values of RFA in control, group 2 and groups 3 showed the similar values, but there was no significant difference among groups. 3. Histomorphometric evaluation demonstrated significantly higher bone-to-implant contact ratio in group 2 at 3 and 4 weeks after implant placement than other groups (p<0.05), but there was no significant difference among groups at 6weeks after implant placement.