• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권3호
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• pp.68-73
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• 1990

Fibrous dysplasia is an idiopathic skeletal disorder in which medullary bone is replaced and disturbed by poorly organized, structually unsound fibroosseous tissue, which may produce cortical expansion. When facial bones are involed, considerable esthetic deformity may result. The term monostotic fibrous dysplasia has been applied when one bone is involved : when more than one bone is affected, the term polyostotic used. The polyostotic form may be accomplished by pigmented skin lesion (Jaffe type), or by pigmented skin lesions with endocrine disturbance (Albright syndrome). No general agreement exists on the cause of fibrous dysplasia. A few authors have suggested that fibrous dysplasia arises as a resujlt of trauma. It occurs predominantly in infant, adolescent females and runs a variable clinical course. When several bones are involed, it tends to be unilateral. Involements of alveolar bone may produce displacement of teeth with malocclusion, or loss of teeth, or both. Radiographycally, it shows an indistinctly delimited osteolytic defect with a bubble - like pattern, but without a sclerotic rim. The preferred treatment is almost always surgery. If the lesion is extensive, surgical intervention with use of recontouring procedures aimed at the correction of esthetic or funtional disturbances is preferred treatment. Now, we present a case of fibrous dysplasia on the left maxilla and the zygoma treated by bony contourign via hemicoronal flap and intraoral approach with good results.

• Journal of Periodontal and Implant Science
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• 제38권3호
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• pp.475-482
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• 2008

Purpose: To evaluate the safety and efficiency of bone regenerative abilities of silk fibroin nanomembrane(Nanoguide-S) Material and Methods: The objects were 38 patients who had large defect at extraction sockets caused by chronic periodontitis and silk fibroin nano matrix were used on experimental group(N=19) and PLA/PLGA matrix were used on control group(N=19). The width, height, and length by crown-apical direction(socket depth) of defects were measured with the occlusal plane as a reference plane, and tooth axis direction, perpendicular to tooth axis direction were measured on radiographs at 3 months pre-operative, 3 months post-operative. Result: Tissue response to silk fibroin nano matrix and Biomesh were clinically satisfactory and complications such as swelling, exudation, ulceration and vesicles were not found except the ordinary discomfort of operated portion. 3 months later, the width, height, and length by crown-apical direction (socket depth) of defects were clinically improved in both groups with no significant difference. 3 months later radiolucency of tooth axis direction and perpendicular to tooth axis direction were all increased in both groups with no significant difference. Conclusion: By these results biodegradadable silk fibroin nano matrix was efficient in GBR on alveolar bone resorption caused by periodontitis compared to Biomesh.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.413-417
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• 2022

The authors present a unique case of osteonecrosis of a cortical half of a fibula free flap that has not been reported in the literature yet. This complication was associated with the impairment of the vascularization of periosteum in the cortical half of fibula that was fixated with a nonlocking reconstructive 2.0-mm plate and screws but other factors could have been involved. The patient was submitted to excision of a cemento-ossifying fibroma that resulted in a left hemimaxilectomy mesoinfrastructure defect classified as the Cordeiro type 2B. The 42-year-old female patient was submitted to reconstruction with an osteomusculocutaneous fibula free flap plus a segment of fibula graft. The two bone segments of the free flap used to reconstruct the anterior and left alveolar crest were fixated with a reconstructive 2.0-mm plate of matrixMANDIBLE system. The only reported complication was an oronasal fistula that healed with conservative treatment and the referred osteonecrosis of the external cortical half of the fibula free flap with plate exposure at 2.5 years postoperatively. Surgical excision of the osteonecrosed cortical half of the fibula with the plate and screws was performed, while the other cortical underwent bone union as corroborated by computed tomography scans.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권3호
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• pp.241-248
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• 2008

Tibial bone grafts provide an adequate volume of cancellous bone with cortical bone, high biologic value of bone, minimal gait disturbance and complications, and no special contraindications, and offer a superior clinical results than any other donor sites. Lateral appoach in tibial bone graft was used to gain large bone volume traditionally, but medial approach provides low morbidity associated with the tibial anatomic structure, simple and safety surgical procedure, and better comfortable to patients recently. We have undertaken clinical and retrospective studies on patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from April 2004 to January 2008. 50 patients have maxillofacial bony defect as resection of bening tumor, cyst enucleation, alveolar bone resorption, sinus pneumatization were received the tibial proximal autogenous particulated cancellous bone grafts. They were analyzed sex, age, diagnosis of recipient site, lesion size, dornor site, cortical bone repositioning, complications and we concluded favorable following results. 1. Medial approach for proximal tibia is safer and technically easier than lateral approach, associated with the proximal tibial anatomic structures, and short operative times. 2. Proximal tibia provides an adequate bone volume with predictability for oral and maxillofacial reconstruction. 3. Patients rarely complain of pain, swelling, discomfort and dysfunction such as gait disturbance. In conclusion, medial approach for proximal tibial graft seems to be a valuable tool for oral and maxillofacial reconstruction.

• Journal of Periodontal and Implant Science
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• 제42권4호
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• pp.127-135
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• 2012

Purpose: The aim of this study was to compare the clinical outcome of open flap debridement (OFD) with a biphasic calcium phosphate (BCP) graft to that of OFD without BCP graft for the treatment of intrabony periodontal defects (IBDs). Methods: The study included 25 subjects that had at least one intrabony defect of 2- or 3-wall morphology and an intrabony component ${\geq}4$ mm as detected radiographically. Subjects were randomly assigned to treatment with (BCP group, n=14) or without BCP (OFD group, n=11). Clinical parameters were recorded at baseline and 6 months after surgery and included the plaque index, gingival index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). A stringent plaque control regimen was enforced for all of the patients during the 6-month observation period. Results: In all of the treatment groups, significant PD reductions and CAL gains occurred during the study period (P<0.01). At 6 months, patients in the BCP group exhibited a mean PD reduction of $3.7{\pm}1.2$ mm and a mean CAL gain of $3.0{\pm}1.1$ mm compared to the baseline. Corresponding values for the patients treated with OFD were $2.5{\pm}0.8$ mm and $1.4{\pm}1.0$ mm, respectively. Compared to OFD group, the additional CAL gain was significantly greater in the patients in BCP group (P=0.028). The additional PD reduction was significant for the BCP group (P=0.048). The REC showed a significant increase in both groups, and the amount of recession was significantly smaller in the BCP group than OFD group (P=0.023). In radiographic evaluation, the height of the bone fill in the BCP group was significantly greater than OFD group. Conclusions: The clinical benefits of BCP found in this study indicate that BCP may be an appropriate alternative to conventional graft materials.

• Imaging Science in Dentistry
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• 제41권3호
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• pp.115-121
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• 2011

Purpose : This article is to describe a modified device for intraoral radiography which was developed to obtain reproducible radiographic images for assessment of distal osseous defects of the mandibular second molar (2 Mm) after impacted third molar (3 Mm) surgery. Materials and Methods : A commercial available alignment system for posterior region was modified by adding a reference gauge pin (millimetric) and threading a hollow acrylic cylinder at the ring of the radiographic positioner to attach the X-ray collimator. The design included customized resin acrylic stent for the occlusal surface of the 2Mm in maximum intercuspal position, individualizing the biteblock positioner. Periapical radiographs were taken before and after surgical extraction of 3 Mm, employing the radiographic technique of parallelism described by Kugelberg (1986) with this modified film holder and inserting the gauge pin on the deepest bone probing depth point. Results : This technique permitted to obtain standardized periapical radiographs with a moderate to high resolution, repeatability, and accuracy. There was no difference between the measurements on the pre- and post-operative radiographs. This technique allowed better maintenance of the same geometric position compared with conventional one. The insertion of the gauge pin provided the same reference point and localized the deepest osseous defect on the two-dimensional radiographs. Conclusion : This technique allowed better reproducibility in posterior radiographic records (distal surface of 2 Mm) and more accurate measurements of radiographic bone level by the use of a millimetric pin.

• Journal of Periodontal and Implant Science
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• 제28권1호
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• pp.145-160
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• 1998

The ultimate goal of periodontal therapy is the regeneration of periodontal tissue which has been lost due to destructive periodontal disease, and numerous kinds of materials and techniques have been developed to achieve this goal. Bone grafts include autografts, allografts, xenografts and synthetic grafts. Among the synthetic grafts, bioactive glass has been used in dentistry for more than ten years and Fetner reported improved new bone formation and more amount of new attachment after grafting PerioGlas, a kind of bioactive glass, in 2-wall defects of monkeys in 1994. It Is well known that 1-wall defects have less osteogenic potential and more epithelial migration, so we need to study the erect of bioactive glass in 1-wall dejects in dogs. The present study evaluates the effect of bioactive glass on the epithelial migration, alveolar bone regeneration, cementum formation and gingival connective tissue attachment in intrabony detects of dogs. Four millimeter deep and four millimeter wide 1-wall defects were surgically cheated in the mesial aspects of premolars. The test group received bioactive glass with a flap procedure and the control underwent flap procedure only. Histologic analysis after 8 weeks of healing revealed the following results: 1. The height of gingival margin was 1.30{\pm}0.73mm$ above CEJ in the control and $1.40{\pm}0.78mm$ in the test group. There was no statistically significant difference between the two group. 2. The length of epithelial growth (the distance from CEJ to the apical end of JE) was $1.74{\pm}0.47mm$ in the control and $1.12{\pm}0.36mm$ in the test group. These was a statistically significant difference between the two groups (P<0.01). 3. The length of new cementum was $2.06{\pm}0.73mm$ in the control and $2.62{\pm}0.37mm$ in the test group. There was no statistically significant difference between the two groups. 4. The length of new bone was $1.83{\pm}0.74mm$ in the control and $2.39{\pm}0.59mm$ in the test group. There was no statistically significant difference between the two groups. These results suggest that the use of bioactive glass 1-wall intrabony defects has significant effect on the prevention of junctional epithelium migration, but doesn't have any significant effect on new bone and new cementum formation.

• Journal of Periodontal and Implant Science
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• 제27권2호
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• pp.347-361
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• 1997

The present study investigates the effects of DFDB graft combined with Calcium sulfate membrane on the periodontal wound healing in dehiscence defects of dogs. Following the initiation of general anesthesia by I.V. administration of 30mg/kg of pentobarbital, first premolar was extracted and full-thickness flap was elevated from the second to the fourth premolar. The portion of premolars coronal to the alveolar crest was removed and mesial and distal roots separated to produce single rooted teeth. Exposed root canals were sealed with Caviton and covered completely with flaps sutured. Following the healing period of 12 weeks, the surgical sites were uncovered and $4{\times}4mm$ dehiscence defects were surgically created. Those defects with DFDB graft combined with Calcium sulfate membrane following root planing, were designated as test sites and those with flap surgery-only were designated as controls. 1. No foreign-body reaction or inflammation were observed in either groups. Calcium sulfate was completely resorbed in the test sites. 2. Significantly greater amounts of new cementum was observed in test sites compared with the controls. Significant amounts of functionally orientated collagens were observed in the test sites. 3. New bone formation was observed in significantly greater amounts in test sites. The results suggest that combined graft of DFDB and calcium sulfate is extremely biocompatible with a potential for new bone and cementum formation, and functional alignment of periodontal ligaments.

• 대한소아치과학회지
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• 제28권4호
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• pp.649-653
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• 2001

Chiari malformation은 하부 뇌간과 소뇌가 대공 속으로 들어가 하향 편위의 소견을 보이는 중추 신경계의 기형으로 3가지 type으로 분류된다. 본 증례는 7세 10개월 된 여환이 10일전부터 칫솔질시 상악 우측 어금니가 아프고 얼굴이 약간 붓고 아프다는 주소로 내원하였는데, 임상구강검사결과 상악 우측 제1대구치 원심에 치은낭이 형성되어 있었고 동요도와 동통이 존재하였다. 악골 방사선사진검사결과 상악 구치부의 골밀도가 정상에 비해 낮으며, 특히 좌우측 제1대구치 하방의 골의 부재가 보였다. 유년성 치주염의 가진 하에 치주치료 중 전신질환과의 연관성 문진으로 Chiari malformation의 의과적 병력을 확인한 후 3차원 전산화단층촬영을 시행하였다. 두개골이 전반적으로 않으며 다수의 골결손이 관찰되고 대공이 다소 커져있으며 후두골과 상악골의 골밀도가 감소되어 있었고 특히 상악 구치부의 치조골이 거의 없어 상악 좌우측 제1대구치가 부유치처럼 보였다. 이에 본원 신경외과로 협의진료를 의뢰하여 계속적으로 관찰하고 있는 중이다. 소아에서 치주염이 의심될 때 leukemia, hystiocytosis X, hypoposphatasia 등의 잠재된 전신질환과 연관되어 있을 수 있으므로 적절한 검사를 시행해야 하며 전신질환의 근본적인 원인을 치료할 수 있도록 고려해야 한다.

• 대한치과보철학회지
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• 제56권1호
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• pp.40-49
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• 2018

상, 하악 전치부 치아의 비심미적인 비율을 갖게 되는 원인은 매우 다양하다고 보고된다. 특히 하악 치조골의 정출을 동반한 전치부 치아의 마모 시, 치은연 상승에 의한 치은 노출 양 증가 및 부적절한 치아 비율로 인해 심각한 기능적, 심미적 문제를 일으킬 수 있다. 이런 경우, 임상적, 방사선학적 방법을 이용한 수직고경 평가와 함께 미소선, 연조직 및 경조직의 형태뿐 아니라 치아의 해부학적 형태와 비율 또한 고려하여야 하는데, 수직고경의 증가 또는 임상적 치관 연장술 및 보철적 수복을 통해 치아간의 근/원심, 폭/길이 비율을 개선시켜야 하며, 이 때 전방 유도를 함께 고려해야 심미적, 기능적으로 만족스러운 치료결과 및 예후를 얻을 수 있다. 본 증례는 48세 남성 환자로서 만성치주염으로 인한 상악 좌, 우측 중절치 및 하악 좌측 중절치의 결손, 하악 전치부 치아의 마모 및 치조골의 정출 등으로 인하여 비심미적인 상, 하악 전치부 비율을 갖고 있었으며, 체계적인 진단 및 치료계획을 통해 기능적, 심미적으로 만족할 만한 결과를 얻었기에 이를 보고하고자 한다.