• Journal of Korean Neurosurgical Society
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• 제30권11호
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• pp.1271-1277
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• 2001

Objectives : Since vertebroplasty has been introduced, we performed short segment pedicle screw fixation with augmented intra-operative vertebroplasty in patients with unstable thoraco-lumbar fracture. Our intentions are to demonstrate the efficacy and indication of this new technique compare to conventional methods. Material and Methods : The surgery comprised of pedicle screw fixations on one level above and below the fracture site, and the fractured level itself, if pedicle is intact, and intra-operative vertebroplasty under the fluoroscopic guide with in-situ postero-lateral bone graft. Also, in cases of bone apposition, we removed those with small impactor through a transfascetal route. During the last 2 years, we performed in seven(7) unstable thoraco-lumbar fracture patients who consisted of two different characteristics, those four(4) with primary or secondary osteoporosis and three(3) of young and very healthy. All patients were followed clinically by A.S.I.A. score and radiography. Results : Mean follow up period was 14 months. We observed well decompressed state via transfascetal route in cases of bone fragments apposition and no hardware pullout in osteoporotic cases, no poly-methyl-methacrylate (PMMA) leakage through the fracture sites into the spinal canal, and no kyphotic deformities in both cases during follow-up periods. All patients demonstrated solid bony fusion except one following osteoporotic compression fracture on other sites. Conclusions : In the management of unstable thoraco-lumbar fracture, we believe that this short segment pedicle screw fixation with augmented intra-operative vertebroplasty reduce the total length or levels of pedicle screw fixation without post-operative kyphotic deformity.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권3호
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• pp.241-248
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• 2011

Purpose: The aim of this study was to present the clinical results of maxillary sinus augmentation implants and to evaluate the effects of various factors on the implant survival rate. Methods: In a total of 112 patients, 293 implants after sinus augmentation were performed. The total survival rate and the influence of the following factors on implant survival were evaluated; patient characteristics (sex, age, smoking, general disease), graft material, implant surface, implant installation stage, site of implant placement, length and width of implant, closure method for osseous window, residual alveolar bone height. Results: 1. Age ranged from 16 to 70 yr, with a mean of 45.7 yr. 2. Cumulative survival rate for the 293 implants with the maxillary sinus augmentation procedure was 94.9%. 3. Simultaneous implant installation was performed in 122 patients and delayed implant installation was performed in 117 implants. The average healing period after sinus elevation was 7.3 months for delayed implant installation and this procedure had a significantly higher survival rate. 4. There were no significant differences in sex, age, smoking, general disease, site of implant placement, length and width of implant, residual alveolar bone height and the survival rate. 5. RBM (Resorbable Blasting Media) implant surface and allograft groups had significantly lower survival rates. Conclusion: These data suggest that maxillary sinus augmentation may give more predictable results for autogenous bone grafts and delayed implant placement.

• Journal of Periodontal and Implant Science
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• 제26권3호
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• pp.735-751
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• 1996

An ultimate goal of periodontal therapy is to stop the disease process and to regenerate a functionally-oriented periodontium destroyed as a result of periodontal disease. The purpose of this study was to observe the effect of grafting granulation tissue obtained from extraction socket on the regeneration of horizontal furcation defect. Six dogs were used in this study. All mandibular first and third premolars were extracted. At 2, 3, and 5 days after extraction, tissues were obtained from extraction socket of 1 mongrel dog and examined by light microscope. Granulation tissue obtained at 5 days after extraction was chosen as the graft material. Five days later, horizontal furcation defects were created surgically at mandibular second and fourth premolars in the right and left side of the 5 beagle dogs. The entrance area of the artificially prepared "key hole" defects were about $3\;4mm^2$. By random selections, 2 exposed furcation defects were grafted with granulation tissue obtained from extraction socket as experimental group and 1 furcation defect was as control. The flaps were replaced to their original position and sutured with 4-0 chromic cat-gut. Three dogs were sacrificed 4 weeks and two dogs 8 weeks after surgery, and the prepared specimens were examined by light microscope. At 4 weeks, furcations were filled with epithelial lining and fibrous connective tissue infiltrated with chronic inflammatory cells. New bone formation was observed in all groups. Only experimental group showed new cementum formation. At 8 weeks, new cementum, functional arrangement of new PDL fiber, root resorption, and some ankylotic union of newly formed alveolar bone and root surface were observed in all groups. Experimental group showed that epithelial downgrowth was inhibited and new bone formation was more active compared to control. The success rate of the furcation defect healing was higher in experimental group than control. These results suggested that grafting of granulation tissue obtained from extraction socket which combined with reconstructive periodontal flap surgery may promote periodontal regeneration of horizontal furcation defect.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권5호
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• pp.276-283
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• 2012

Objectives: Curettage and enucleation are two of the most common procedures performed in oral and maxillofacial surgery units. To access a cystic lesion, the buccal cortical plate is removed. The no reposition (NR) group underwent surgery without repositioning the buccal cortical plate. The reposition (R) group underwent surgery with a repositioning of the buccal cortical plate. This study compared the two surgical procedures in terms of bone healing and complications. Materials and Methods: Patients who underwent curettage and enucleation surgery were enrolled in this study. Panoramic radiographs of the patients in both the NR group (n=26) and R group (n=34) were taken at the baseline and at 6, 12 and 24 months after surgery. The radiolucent area was calculated to evaluate bony healing in each radiograph. The complications were analyzed through a review of the medical records. Results: The correlation between bony healing and surgical approach was not significant in the 6th, 12th, and 24th month (P<0.05). The complication rate was not associated with gender, graft material, bone graft and drain insertion (P<0.05). On the other hand, the R group had a higher complication rate (35.3%) than the NR group (0%). The difference in the mean lesion size between the NR group ($37,024{\pm}3,617$ pixel) and R group ($92,863{\pm}15,931$ pixel) was significant (independent t test, P=0.004). Conclusion: Although the reposition method is chosen when the lesion size is large, it is associated with more complications. Indeed, infection, discomfort and recurrence of the lesion were the most common complications in the R group. Furthermore, the R method does not have a strong point in terms of bone healing compared to the NR method. Therefore, the R method cannot be considered an ideal approach and should be used in limited cases.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권1호
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• pp.1-11
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• 2012

Purpose: The purpose of this study was to evaluate the bone regeneration capacity of silk fibroin (SF) when combined with beta tricalcium phosphate (${\beta}$-tricalcium phosphate [TCP]) and rh-bone morphogenetic protein (BMP) in vivo by micro-computed tomography (CT), soft x-ray, and histological analysis. Methods: A total of 56 critical size defects formed by a trephine bur made on 28 adult female Spague-Dawley rats were used for this study and the defect size was 5.0 mm in diameter. The defects were transplanted with (1) no graft material (raw defect), (2) autogenous bone, (3) SF ($10{\mu}g$), (4) SF-BMP ($10{\mu}g$, $0.8{\mu}g$ each), and (5) SF+${\beta}$-TCP ($10{\mu}g$). At 4 and 8 weeks after operation, the experimental animals were sacrificed. Samples were evaluated with soft x-ray, histological examinations and 3-dimensional micro-CT analysis. Results: In the 3-dimensional micro-CT evaluation, bone volume and bone surface data were higher in the SF-BMP ($12.8{\pm}1.5$, $138.6{\pm}45.0$ each) (P<0.05) and SF-TCP ($12.3{\pm}1.5$, $144.9{\pm}30.9$ each) group than in the SF group ($6.1{\pm}3.3$, $77.2{\pm}37.3$ each) (P<0.05), except for the autogenous group ($15.0{\pm}3.0$, $190.7{\pm}41.4$ each) at 4 weeks. At 8 weeks, SF-BMP ($16.8{\pm}3.5$, $173.9{\pm}34.2$ each) still revealed higher (P<0.05) bone volum and surface, but SF-TCP ($11.3{\pm}1.5$, $1132.9{\pm}52.1$ each) (P=0.5, P=0.2) revealed the same or lower amount compared with the SF group ($13.8{\pm}2.7$, $127.5{\pm}44.8$ each). The % of bone area determined by radiodensity was higher in the SF-TCP ($31.4{\pm}9.1%$) and SF-BMP ($36.2{\pm}16.2%$) groups than in the SF ($19.0{\pm}10.4$) group at the period of 4 weeks. Also, in the histological evaluation, the SF-BMP group revealed lower inflammation reaction, lower foreign body reaction and higher bone healing than the SF group at postoperative 4 weeks and 8 weeks. The SF-TCP group revealed lower inflammation at 4 weeks, but accordingly, as the TCP membrane was absorbed, inflammatory and foreign body reaction are increased at 8 weeks. Conclusion: The current study provides evidence that the silk fibrin can be used as an effective grafted material for tissue engineering bone generation through a combination of growth factor or surface treatment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권3호
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• pp.170-175
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• 2009

Purpose : The purpose of this study is to evaluate 7-year survival rate of implants placed without bone graft in posterior maxilla and compare the survival rate by the age and gender of patient, length and diameter of implant, region of implant placement, bicortical engagement of fixture, and connection of prosthesis. Material and methods : 78 patients (170 implants) who visited our institution from 2002 to 2007 and were followed up with panoramic view and medical records. Kaplan-Meier survival analysis and Log Rank (Mantel-Cox) test were used. Results and conclusions : A 7-year cumulative survival rate for implants placed in posterior maxilla without sinus graft was 95.3%. The survival rate in men was 91.8%, significantly lower than 98.8% in woman.(p<0.05). However, the survival rate by the length of the implants did not show any significant differences.(p>0.05), while the wide platform implant resulted in 85% survival rate which was statistically lower than 98.5% in regular platform. The posterior maxillary implants engaged bicortically showed 97.6% of 7-year Survival rate, comparing 88.6% in not engaged implants. The survival rate of the single implant was 91.2%, while 98.5% in splinted prosthesis. Therefore, the bicortical engagement of the fixtures and splinted prosthesis may be recommended to get a long-term survival rate in posterior maxilla.

• 대한정형외과스포츠의학회지
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• 제6권1호
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• pp.38-44
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• 2007

목적: 자가건을 이용한 전방 십자 인대 재건술 후 이차 관절경 검사 소견으로 이식건의 상태를 평가하고 이식건 주위의 변화를 관찰하여 의미를 알아보고자 한다. 대상 및 방법: 2003년 6월부터 2007년 2월까지 자가건을 이용한 관절경적 전방 십자 인대 재건술을 시행 받은 환자 중 이차 관절경 검사를 시행한 22예를 대상으로 평균 15.1$(7\sim31)$개월에 이차 관절경 검사를 시행하였다. 슬괵건 15예, 슬개건 7예였다. 이식건의 긴장도는 탐침 시 이동 거리로 측정하였고, 활액막 형성 정도는 관절경 소견을 시각 등급으로 나눴으며 재건술 전과 이차 관절경 검사 시에 Lysholm 점수, Lachmann 검사, KT-2000 계측 차이로 이식건 상태를 확인 하였다. 결과: 이식건의 긴장도는 슬괵건 군이 정상 11예 느슨함 4예였고, 슬개건 군이 정상 3예, 느슨함 2예, 부분 파열 2예였다. 활액막 형성 정도는 슬괵건 군이 good 11예, half 3예, pale 1예였으며 슬개건 군이 good 4예, half 3예였다. Lysholm 점수는 수술 전에 비하여 자가 슬개건에서 더 의미있게 상승하였고(p<0.05), KT-2000 계측 결과는 두 군간의 의미있는 차이는 없었다. 결론: 자가건을 이용한 전방 십자 인대 재건술 후 이차 관절경 검사에 의한 결과는 슬괵건 군이 슬개건 군보다 우수하였으나 장기적인 추시가 필요하다.

• 대한두개안면성형외과학회지
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• 제16권1호
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• pp.11-16
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• 2015

Background: Source material used to fill calvarial defects includes autologous bones and synthetic alternatives. While autologous bone is preferable to synthetic material, autologous reconstruction is not always feasible due to defect size, unacceptable donor-site morbidity, and other issues. Today, advanced three-dimensional (3D) printing techniques allow for fabrication of titanium implants customized to the exact need of individual patients with calvarial defects. In this report, we present three cases of calvarial reconstructions using 3D-printed porous titanium implants. Methods: From 2013 through 2014, three calvarial defects were repaired using custom-made 3D porous titanium implants. The defects were due either to traumatic subdural hematoma or to meningioma and were located in parieto-occipital, fronto-temporo-parietal, and parieto-temporal areas. The implants were prepared using individual 3D computed tomography (CT) data, Mimics software, and an electron beam melting machine. For each patient, several designs of the implant were evaluated against 3D-printed skull models. All three cases had a custom-made 3D porous titanium implant laid on the defect and rigid fixation was done with 8 mm screws. Results: The custom-made 3D implants fit each patient's skull defect precisely without any dead space. The operative site healed without any specific complications. Postoperative CTs revealed the implants to be in correct position. Conclusion: An autologous graft is not a feasible option in the reconstruction of large calvarial defects. Ideally, synthetic materials for calvarial reconstruction should be easily applicable, durable, and strong. In these aspects, a 3D titanium implant can be an optimal source material in calvarial reconstruction.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권5호
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• pp.219-223
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• 2014

During surgical procedures, unexpected material, including surgical instruments and tissue segments, may get lost in the surgical field. Most of these should be immediately removed to prevent further complications, such as vital organ irritation, infection, and inflammatory pseudo-tumor formation. However, it is not always easy to define the exact location of the foreign body, especially if the item is very small and/or it is embedded in the soft tissue of the head and neck region. Intraoperative real-time radiological imaging with C-arm fluoroscopy can be useful to trace the three-dimensional location of small and embedded foreign bodies in the oral and maxillofacial area. We describe an unusual case of an embedded micro-screw in the intrinsic tongue muscle that had been dropped into the sublingual space during a lower alveolar bone graft procedure. The lost foreign body was accurately identified with C-arm fluoroscopy and safely removed without any further complications.

• Archives of Reconstructive Microsurgery
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• 제17권1호
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• pp.42-47
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• 2008

Introduction: To evaluate the efficacy of superior gluteal artery-pedicled iliac crest for the treatment of avascular necrosis of femoral head. Material & Method: From January 2001 to October 2001, we used the superior deep branches of superior gluteal artery for the pedicled posterior iliac crest bone graft to revascularize the avascular femoral head in 4 patients. They were 1 man and 3 women, and the mean age of the patients was 34 years (range, 27 to 60). The average follow-up after surgery was over 57 months (range, 15 to 82). We analyzed the clinical results by the Harris hip score, and evaluated the vascularity of the femoral head by radiographic methods. Results: All cases showed no evidence of collapse on femoral heads and good revascularizations on the radiographic images. The average Harris hip score was 88.5 points. There was no complication. Conclusion: The revascularization procedure using the superior gluteal artery-pedicled posterior iliac crest was thought to be one of the effective and promising techniques for the treatment of the avascular necrosis of femoral head.