• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.29 no.6
• /
• pp.485-493
• /
• 2007

Introduction: Although several types of calcium-phosphate coumpound have been frequently applied to osseous defects at maxillofacial area for many years, there is a controversy about its efficiency on bone conductivity comprared to xenograft bone substitute. Alloplastic carbonapatite has been introduced to improve disadvantages of hydroxyapatite and to mimic natural bone containing carbon elements. However, a preclinical study about its efficiency of osteoconductivity has not been reported. This study was performed to evaluate the early osteoconductive potential of synthetic carbonapatite with multiple pores relative to anorganic bovine xenograft. Materials and methods: Total 5 beagle dogs were used for maxillary augmentation model. The control (anorganic bovine xenograft) and experimental groups (synthetic carbonapatite) were randomly distributed in the mouth split design. After bone graft, all animals were sacrificed 4 weeks after surgery. Histological specimens with Masson Trichrome staining were made and histomorphometrically analysed with image analyser. The statistical analysis was performed using paired t-test. Results: In both groups, all animals had no complications. The experimental group showed relatively much new bone formation around and along the bone substitutes, whereas it was clearly reduced in the control group. The ratios of new bone area to total area, to material area and to the residual area excluding materials were higher in the experimental group ($0.13{\pm}0.03,\;0.40{\pm}0.13,\;0.20{\pm}0.06$ respectively) than in the control group ($0.01{\pm}0.01,\;0.03{\pm}0.02,\;0.03{\pm}0.03$, respectively). And the differences between both groups were statistically significant (p<0.001, <0.01, <0.01, respectively), while the ratio of material area to total area in two groups was not significant. Conclusion: Carbonapatite showed a high osteoconductivity in the early stage of bone healing compared to bovine derived anorganic bone substitute. This study suggests that this bone materials can be applied as a reliable bone substitute in the clinical treatment.

• Imaging Science in Dentistry
• /
• v.42 no.4
• /
• pp.243-247
• /
• 2012

Purpose: This study was performed to compare the inverted digital images and film-based images of dry pig mandibles to measure the periodontal bone defect depth. Materials and Methods: Forty 2-wall bone defects were made in the proximal region of the premolar in the dry pig mandibles. The digital and conventional radiographs were taken using a Schick sensor and Kodak F-speed intraoral film. Image manipulation (inversion) was performed using Adobe Photoshop 7.0 software. Four trained examiners made all of the radiographic measurements in millimeters a total of three times from the cementoenamel junction to the most apical extension of the bone loss with both types of images: inverted digital and film. The measurements were also made in dry mandibles using a periodontal probe and digital caliper. The Student's t-test was used to compare the depth measurements obtained from the two types of images and direct visual measurement in the dry mandibles. A significance level of 0.05 for a 95% confidence interval was used for each comparison. Results: There was a significant difference between depth measurements in the inverted digital images and direct visual measurements (p>|t|=0.0039), with means of 6.29 mm ($IC_{95%}$:6.04-6.54) and 6.79 mm ($IC_{95%}$:6.45-7.11), respectively. There was a non-significant difference between the film-based radiographs and direct visual measurements (p>|t|=0.4950), with means of 6.64mm($IC_{95%}$:6.40-6.89) and 6.79mm($IC_{95%}$:6.45-7.11), respectively. Conclusion: The periodontal bone defect measurements in the inverted digital images were inferior to film-based radiographs, underestimating the amount of bone loss.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.32 no.6
• /
• pp.529-536
• /
• 2010

Purpose: The Purpose of this study is to show the total survival rate of implants with maxillary sinus grafting and the effects that reach the survival rate by classifying types of graft materials, implant type, operation method, residual bone height and evaluate graft material resorption rate after sinus grafting Patients and Methods: 61 dental implants placed with sinus bone grafting in 24 patients at Wonkwang University Sanbon Dental Hospital were installed simultaneously or after regular healing. Various bone grafts (autograft, xenograft, allograft, alloplast) and fourth implant type (GSII, Xive, Implantium, Novel biocare) were used. All implants were investigated clinically and radiographically, being with average 20 months follow-up period after installation. Results: 3 fixtures were lost, resulting in 95.1% cumulative survival rate of 61 osseointegrated dental implant. Survival rate according to bone material type, Implant type, operation method, residual bone height, have no statistically significant differencies. The mean preoperative residual alveolar bone height was 4.75 mm, average postoperative height of graft materials 10.8 mm, vertical bone resorption rate was 10% after 2 years. Resorption rate according to operation method was 7% (simultaneous) and 5% (delayed) after 1 year. Conclusion: It can be suggested that maxillary sinus grafting may have predictable result with various bone graft materials and implant type, residual bone height, operation method

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.40
• /
• pp.32.1-32.8
• /
• 2018

Background: The free vascularized fibula flap presents many advantages such as sufficient length of the bony segment, good vascularization, better quality of the bone, and a long vascular pedicle, but it is also associated with some disadvantages with regard to prosthetic rehabilitation because of its limited height. Improvement in bone height is necessary for ideal dental implant treatment of reconstructed mandibles. Case presentation: For two squamous cell carcinoma patients, mandibular bone reconstruction was performed secondarily with the peroneal flap after tumor resection. Since the bone height was insufficient at the time of implant treatment, occlusion reconstruction by dental implant was performed after vertical distraction osteogenesis. Conclusions: Vertical distraction osteogenesis is a suitable treatment option for alveolar ridge deficiency resulting from fibula transplantation for mandibular reconstruction following tumor surgery.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.31 no.3
• /
• pp.207-215
• /
• 2009

Purpose: The aim of the present study is to evaluate the long term bone healing after horizontal ridge augmentation using auto block bone graft for implant installation timing. Materials and Methods: Five Beagle dogs(which were 14 months old and weighted approximately 10kg). In surgery 1(extraction & bone defect), premolars(P2, P3,P4) were extracted and the buccal bone plate was removed to create a horizontally defected ridge. After three months healing, in surgery 2(ridge augmentation). Auto block bone grafts from the mandibular ramus were used in filling the bone defects were fixed with stabilizing screws. The following fluorochrome labels were given intravenously to the beagle dogs: oxytetracycline 1week after the surgery, alizarin red 4 weeks after the surgery, calcein blue 8 weeks after the surgery. The tissue samples were obtained from the sacrificed dogs of 1, 4, 8, 12, 16 weeks after the surgery. Non-decalcified sections were prepared by resin embedding and microsection to find thickness of $10{\mu}m$ for the histologic examination and analysis. Results: 1. We could achieve the successful reconstruction of the horizontal bone defect by auto block bone graft. The grafted bone block remained stable morohologically after 16 weeks of the surgery. 2. In the histologic view. We observed osteoid tissue from the sample $4^{th}$ week sample and active capillary reconstruction in the grafted bone from the $12^{th}$ week sample. Healing procedures of auto bone grafts were compared to that of the host bone. 3. Bone mineralization could be detected from the $8^{th}$ week sample. 4. Fluorochrome labeling showed active bony changes and formation at the interface of the host bone and the block graft mainly. Bony activation in the grafted bone could be seen from the $4^{th}$ week samples. Conclusions: Active bone formation and remodeling between the grafted bone and host bone can be seen through the revascularization. After the perfect adhesion to host bone, Timing of successful implant installation can be detected through the ideal ridge formation by horizontal ridge augmentation.

• Journal of Periodontal and Implant Science
• /
• v.54 no.2
• /
• pp.96-107
• /
• 2024

Purpose: Deproteinized bovine bone or synthetic hydroxyapatite are 2 prevalent bone grafting materials used in the clinical treatment of peri-implant bone defects. However, the differences in bone formation among these materials remain unclear. This study evaluated osteogenesis kinetics in peri-implant defects using 2 types of deproteinized bovine bone (Bio-Oss^® and Bio-Oss/Collagen^®) and 2 types of synthetic hydroxyapatite (Apaceram-AX^® and Refit^®). We considered factors including newly generated bone volume; bone, osteoid, and material occupancy; and bone-to-implant contact. Methods: A beagle model with a mandibular defect was created by extracting the bilateral mandibular third and fourth premolars. Simultaneously, an implant was inserted into the defect, and the space between the implant and the surrounding bone walls was filled with Bio-Oss, Bio-Oss/Collagen, Apaceram-AX, Refit, or autologous bone. Micro-computed tomography and histological analyses were conducted at 3 and 6 months postoperatively (Refit and autologous bone were not included at the 6-month time point due to their rapid absorption). Results: All materials demonstrated excellent biocompatibility and osteoconductivity. At 3 months, Bio-Oss and Apaceram-AX exhibited significantly greater volumes of formation than the other materials, with Bio-Oss having a marginally higher amount. However, this outcome was reversed at 6 months, with no significant difference between the 2 materials at either time point. Apaceram-AX displayed notably slower bioresorption and the largest quantity of residual material at both time points. In contrast, Refit had significantly greater bioresorption, with complete resorption and rapid maturation involving cortical bone formation at the crest at 3 months, Refit demonstrated the highest mineralized tissue and osteoid occupancy after 3 months, albeit without statistical significance. Conclusions: Overall, the materials demonstrated varying post-implantation behaviors in vivo. Thus, in a clinical setting, both the properties of these materials and the specific conditions of the defects needing reinforcement should be considered to identify the most suitable material.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.36 no.3
• /
• pp.116-123
• /
• 2014

Purpose: The purpose of this study was to evaluate risks for wound dehiscence after guided bone regeneration (GBR) in dental implant surgery. Methods: Patients who received dental implant therapy with GBR procedure at Seoul National University Bundang Hospital (Seongnam, Korea) from June 2004 to May 2007 were included. The clinical outcome of interest was complications related to dental implant surgery. The factors influencing wound dehiscence, classified into patient-related factors, surgery-related factors and material-related factors, were evaluated. Results: One hundred and fifteen cases (202 implants) were included in this study. Wound dehiscence (19.1%) was considered a major complication. The risk of wound dehiscence was higher in males than in females (odds ratio=4.279, P =0.014). In the main graft, the allogenic group had the lowest risk of wound dehiscence (odds ratio=0.106, P =0.006). Though the external connection group had a higher risk of wound dehiscence than the internal connection group (odds ratio=2.381), the difference was not significant (P =0.100). Conclusion: In this study, male gender and main graft have the highest risk of wound dehiscence. To reduce wound dehiscence after GBR, instructions on postoperative care with supplementary procedure for the protection of the wound dehiscence is recommended, especially to male patients. A main graft with a gel base can reduce the risk of wound dehiscence.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.30 no.5
• /
• pp.495-499
• /
• 2008

For the successful placement of dental implants, adequate alveolar bone height and width are required. Alveolar distraction osteogenesis is an effective method that resolves insufficient alveolar bone height for dental implant placement, and thus has been clinically applied with satisfactory results. But, minor and major problems may occur during the treatment. In the following report, we studied for such problematic cases. The problems are as follows: 1) sharp edges of the transport segment, 2) infection, 3) soft tissue dehiscence, 4) limitation of distraction, 5) numbness, 6) insufficient bone formation. But, most of them were answered by simple solutions and did not jeopardize the final outcomes. Distraction osteogenesis can be considered a safe and predictable procedure for lengthening the alveolar bone.

• Journal of Korean Dental Science
• /
• v.13 no.2
• /
• pp.67-72
• /
• 2020

Purpose: This clinical study presented the effectiveness of 2-stage posterior maxillary segmental osteotomy (PMSO) under local anesthesia in gaining interarch space to restore the posterior mandibular segment with dental implants. Materials and Methods: Nine patients who received two-stage PMSO for mandibular implant placement from 2003 to 2011 were included in the study. Of the 9 patients, 7 were female and 2 were male. Ages ranged form 28 to 72 (mean 46.6). Potential complications were investigated such as sinus infection, survival of bone segment, inflammatory root resorption of adjacent teeth, relapse of bone segment and timing of implant placement, delivery of implant prosthesis and stability of bone segment. Result: None of the patients showed relapse or complication. Bone segments were stabilized by opposed implant prosthesis. Conclusion: Office-based 2-stage PMSO under local anesthesia can be considered a stable and predictable procedure. Also pedicle damage can be avoided by allowing favor of blood supply to the bone segments. From these advantages, it can be concluded that this surgical procedure can decrease post-operative complications.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.29 no.4
• /
• pp.353-360
• /
• 2007

In a one-stage approach, where the implant installation is performed simultaneously with the iliac bone graft, various complications are observed. The observed complications are as follows; severe bone resorption at the maxillary anterior region and the area adjacent to the nasal cavity, shortage of soft tissue to cover the augmented alveolar bone, difficulties with oral hygiene care caused by the diminished vestibular space and non-esthetic prosthesis. These are good reasons for choosing the two-stage approach over the one-stage approach in spite of all the advantages it has, and should be taken into careful consideration when diagnosing and planning treatment using the one-stage approach.