• Health Policy and Management
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• v.34 no.2
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• pp.196-210
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• 2024

Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

• The Journal of Korean Academy of Prosthodontics
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• v.47 no.2
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• pp.108-118
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• 2009

Statement of problem: Volume stability, microstructure reproducibility and fluidity along with compatibility with dental stone must be in consideration in order to use tissue conditioner as a material for functional impression. There are few studies concerning the influence of time factor in oral condition on surface roughness of the stone and optimal retention period in the oral cavity considering such changes in surface roughness. Purpose: The purpose of this study was to find out the influence of various kinds of tissue conditioner, its powder/liquid ratio and immersion time on surface roughness of the stone. Material and methods: Materials used in this study were the three kinds of tissue conditioners(Coe-Comfort, Visco-Gel, Soft-Liner) and were grouped into three: group R-mixed with standard powder/liquid ratio that was recommended by the manufacturers, group M-mixed with 20% more powder, group L-mixed with 20% less powder. Specimens were made with the size of 20 mm diameter and 2 mm width. Each tissue conditioner specimens were subdivided into 5 groups according to the immersion time(0 hour, 1 day, 3 days, 5 days, 7 days), completely immersed into artificial saliva and were stored under $37^{\circ}C$. Specimens of which the given immersion time elapsed were taken out and were poured with improved stone, making the stone specimens. Surface roughness of the stone specimens was measured by a profilometer. Results: Within the limitation of this study, the following results were drawn. 1. Major influencing factor on surface roughness of the stone model made from tissue conditioner was the retention period(contribution ratio($\rho$)=62.86%, P<.05) of the tissue conditioner in oral cavity to make functional impression. 2. In case of Coe-Comfort, higher mean surface roughness value of the stone model with statistical significance was observed compared to that of Soft-Liner and Visco-Gel as immersion time changes(P<.05). 3. In case of group L(less), higher mean surface roughness value of the stone model with statistical significance was observed compared to that of R(recommended) and M(more) group as immersion time changes(P<.05). Conclusion: We may conclude that as the retention period of time in oral cavity influences surface roughness of the stone model the most and as the kind of tissue conditioner and its P/L ratio may influence also, clinician should well understand the optimal retention period in oral cavity and choose the right tissue conditioner for the functional impression, thus making the functional impression with tissue conditioner usefully.

• The korean journal of orthodontics
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• v.32 no.4 s.93
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• pp.275-291
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• 2002

Of various factors indicated for effective use of straight wire appliances, there was a great lack of studies both domestic and international about the curvatures of tooth crowns. This study was performed to investigate the labio/buccal clinical crown curvatures of Korean permanent teeth. For this study, three-dimensional laser scanning was performed on 36 dental casts with normal anatomic structures. Andrews plane and Facial axis of clinical crown (FACC) were designated as horizontal and vertical reference planes respectively. 2 or 3 lines, 1mm apart, were drawn superior, inferior, left and right of these reference planes. A three-dimensional coordinate table was made for points formed by crossing these lines, and averages of each coordinate point on the 36 dental casts were obtained. The curvature equation was made using three-dimensional coordinate points (x,y,z) and by this curvature equation, the curve ratio of each tooth was obtained. Curve ratio changes of each section of teeth were calculated by curve ratios of simplified curves. These two dimensional curves were simplified horizontally and vertically Conclusions for this study are as follows. 1. The basic data of labial and buccal clinical crown curvatures were obtained about Korean permanent teeth. 2. No significant difference was found between male and females. 3. Individual tooth characteristics 1) In maxillary central incisors, the difference in the curve ratio between the gingival and incisal sides was greater than for the other teeth. And the gingival side showed a greater curve ratio. 2) Maxillary canines showed more curvatures in the mesio-occlusal surface than the other surfaces. 3) In maxillary $1^{st}$ premolars, more curvatures were found in mesio-occlusal and disto-gingival surface, thus showing a twisted crown surface, but in maxillary $2^{nd}$ premolars, the crown curvatures of mesial and distal ends became parallel to each other. 4) No significant difference in crown curvatures was found between mandibular central and lateral incisors. 5) Occluso-gingival curvatures of mandibular$2^{nd}$ premolar turned out to be more rounded than mandibular $1^{st}$ premolars or maxillary $2^{nd}$ premolars. From the above conclusions, it can be deduced that the same bracket bases can be used for mandibular central and lateral incisors. But for maxillary $1^{st}\;and\;2^{nd}$ premolars and for mandibular $1^{st}\;and\;2^{nd}$ premolars, because crown curvatures showed significant differences, when making bracket bases there is ample reason to make bracket base curves differently for each type of tooth.

• Journal of Oral Medicine and Pain
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• v.30 no.4
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• pp.457-464
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• 2005

The purpose of our study was to investigate whether the intrapulpal temperature during cavity preparation of enamel or dentin with Er:YAG laser still remained in range of safety for dental pulp protection when combined with appropriate water flow rate. The effect of different pulse repetition rates at the same pulse energy during ablation was evaluated as well. Caries-free, restoration-free extracted human molar teeth were prepared for the specimen and divided two experimental groups of enamel and dentin. Each group comprised 5 specimens and each of tooth specimens were embedded into a resin block each and measuring probe was placed on the irradiated pulpal walls. For experiments of dentin ablation, enamel layers were prepared to produce dentin specimen with a same dentin thickness of 2 mm. A pulse energy of Er:YAG laser was set to 300 mJ and three different pulse repetition rates of 20 Hz, 15 Hz and 10 Hz were employed. Laser beam was delivered with 3 seconds and less per application over enamel and dentin surfaces constant sized by $3\;mm{\times}2\;mm$ and water spray added during irradiation was a rate of 1.6 ml/min. Temperature change induced by Er:YAG laser irradiation was monitored and recorded While enamel was ablated, there was no significant difference of temperature related to pulse repetition rates(p=0.358) and temperature change at any pulse repetition rate was negligible. Significant statistical difference in temperature changes during cavity preparation in dentin existed among three different pulse groups(p=0.001). While temperature rise was noticeable when the dentinal wall was perforated, actual change of temperature due to Er:YAG laser irradiation was not enough to compromise safety of dental pulp when irradiation was conjugated with appropriate water spray. Conclusively, it can be said that cavity preparation on enamel or dentin with an Er:YAG laser is performed safely without pulp damage if appropriate volume of water is sprayed properly over the irradiated site.

• The korean journal of orthodontics
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• v.28 no.4 s.69
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• pp.547-561
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• 1998

Obstructive sleep apnea (OSA) is a disorder characterized by repetitive episode of upper airway collapse during sleep. Recent studies showed that not only the anatomic factors but the physiologic factors of the upper airway also have effcts on the occurrence of apnea and that the genioglossus muscle also plays an important role in the maintenance of the upper airway. A variety of therapies were performed to treat OSA, and among them the use of mandibular repositioning appliances showed reasonable results. But there is still a lack of research on the structural and physiological mechanism upon the use of mandibular repositioning appliances. The author selected 26(male 17, female 9) OSA patients that came to the Yonsei University Dental Hospital, Department of Orthodontics, and 20 normal adults (male 10, female 10) and took cephalometric radiographs of them in a supine position before and after the placement of the mandibular repositioning appliance to see the structural changes of the upper airway and compare the therapeutic effects between the two groups. We also studied the waking genioglossus muscle activity in OSA patients and investigated the difference in the electromyogram of the genioglosssus muscle upon the change in body posture and the use of mandibular repositioning appliance. Following results were obtained. 1. Among the cephalometric measurements of the upper airway structure, the length of the soft palate, maximum thickness of the soft Palate and SPAS, MAS, VAL, H-H1, MP-H showed statistically significant differences between the normal and OSA groups, but the IAS and EAS showed no statistically significant differences between the two groups. 2. In both the normal and OSA groups, as the epiglottis moved forward on wearing the mandibular repositioning appliance, the epiglottis level of the upper airway increased and the maximum thickness of the soft palate changed and the hyoid bone also moved forward, but the IAS in both groups showed various results and the effect of the mandibular repositioning appliance on the structure of the upper airway was different in the two groups. 3. Upon changing the position, the electromyogram of the genioglossus muscle showed a increasing tendency but there was no statistically significant differences, and when the mandibular repositioning appliance were worn there was a statistically significant increase in the electromyogram of the genioglossus muscle in both the upright and supine positions. The mandibular repositioning appliances not only have an effect on the anatomical structure of the upper airway but also on the physiology of the upper airway. There are different responses to the use of mandibular repositioning appliance between the normal and OSA groups therefore it could be considered to have the different physiology of the upper airway between the two groups.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.24 no.1
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• pp.4-12
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• 2015

Purpose: Due to the presence of various muscles around lips, variety of facial expression can be made and changes from aging process such as wrinkles can develop on the facial skin by the action of multiple muscles. In animals, skin and muscles are developed in the entire body. On contrast, they are well developed only in the face and just one is present in the neck and the palm. Alar band was defined as outer wrinkle formed by zygomaticus minor muscle, which is common in Koreans. This study aimed to investigate clinical prevalence of alar band. Materials & Methods: Subjects were chosen from 780 new patients who visited private clinic in Gyeonggi province for orthodontic treatment. Presence of alar band was examined from the smile extraoral photos. Correlation among skeletal form, lip protrusion, gender, and age were evaluated. Results: Prevalence of alar band was higher in women (27.9%) than in men (18.5%) with statistical significance (p<0.05). With respect to age, prevalence of alar band was 19.4% in age 0-9 y, 16.9% in age 10-19 y, 31.2% in age 20-29 y, 39.5% in age 30-39, 56.5% in age 40-49. Prevalence was gradually increased from patients in their 20s to patients in their 40s and statistical significance was found (p<0.001). Concerning SN_NP, prevalence was 26.2% in normodivergent facial type, 22.0% in hyperdivergent facial type, and 32.2% in hypodivergent facial type. Hypodivergent facial group had higher prevalence but statistical significance was not observed. Statistically significant difference was not found regarding upper lip. However, prevalence of the alar band was 26% in patients with normal lower lip, 14.7% in patients with pretruded lower lip, and 33.3% in retruded lower lip. The prevalence was higher in patients with retruded lower lip with statistical significance (p<0.05). Conclusions: 27.8% on previous anatomical study and this study showed 27.8% prevalence of alar band in clinical smile photographs. Clinical photograph study showed that alar band was more prominent in women, older people, and people with retruded lips with statistical significance. This will provide valuable diagnostic information for esthetic consideration.

• Journal of Dental Rehabilitation and Applied Science
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• v.26 no.4
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• pp.405-417
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• 2010

Previous studies have already shown that mouthguard is effective in protecting jaw bone, teeth and oral tissue against sports trauma. However, other than severe trauma, repetitive force, such as disorders like clenching, cause teeth or oral tissue damage. These kinds of disorders usually present pathologic attrition in the posterior teeth, resorption in alveolar bone, loss of teeth and destruction of occlusion. Wearing a mouthguard is believed to be effective in preventing these disorders. But its effect is not examined thoroughly enough. The purpose of this study is to identify whether mouthguard is effective in reducing strain caused by clenching. Mandibular first molars in the normal occlusal relationship without any history of dental treatment were chosen. Biaxial type strain gauge was placed on the buccal surface of the tooth. Having maximum occlusal force, measured by load cell, as a standard, clenching intensity were divided into three stages; moment of slightly tooth contact, medium bite force (50% of maximum bite force), maximum bite force. Strain occurring in dentition in each stage with and without mouthguard was measured. Changes in strain (on dentition) between each stage and difference in strain, between with or without mouthguard were recorded by PCD-300 analyzer and PCD-30 soft ware. The data was statistically analyzed by Wilcoxon signed rank test. The following results were drawn; Without mouthguard, strain given on dentition increased as the clenching force increased. With mouthguard, strain given on dentition also increased as the clenching force increased. With mouthguard, strain decreased, in all cases of clenching force stages. Data on the moment of slightly tooth contact stage, had no statistical significance. However, with mouthguard, 50-90% of decrease in strain could be obtained in maximum occlusal force, compared to the group without mouthguard. Mouthguard decreased the strain on the dentition, caused by clenching. Therefore, mouthguard seems to be effective in preventing damage on dentition, by acting against clenching, which occurs both consciously and unconsciously during sports activities.

• Restorative Dentistry and Endodontics
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• v.8 no.1
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• pp.123-131
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• 1982

The purpose of this study was to observe the responses of the remaining pulp tissue after pulpotomy upon the several kinds of $Ca(OH)_2$ products and the responses of periapical tissue upon some root canal filling materials after extirpation. For pulpotomy, the class V cavities were prepared on the premolars, molars and upper canines, and the pulp was amputated. Each drug was placed over the amputated tissue and cavity was sealed with zinc oxide eugenol cement. The drugs which were used for the study were Dycal (Caulk Co. U.S.A.), Cavitec (Kerr Co. U.S.A.), Calvital, Nobudyne and Neodyne (Neo Dental Chemical Products). For extirpation, the endodontic cavities were prepared on the lingual surfaces of anterior teeth, and the pulp tissues were extirpated as routine method. After enlarging, irrigation, and measuring of root length by taking X-ray, each root canal filling material was filled in the canal with gutta percha cone, and endodontic cavity was sealed with zinc oxide eugenol cement. Zinc oxide eugenol, $Ca(OH)_2$ (Eli Lilly Co. U.S.A.) and Vitapex (Neo Dental Chemical Products) were used as root canal filling materials. Animals were sacrificed after 1, 3 and 6 weeks following the operation. The teeth were decalcified in formic acid, sectioned and stained with hematoxylin eosin. Microscopic examination revealed as follows. 1. Dycal: The dentin bridge formation was observed at the 3rd week after pulpotomy. Inflammatory conditions which were infiltration of inflammatory cells and dilatation of blood vessels were kept in remaining pulp tissue at the 6th week. 2. Calvital: The dentin bridge was observed at the 1st week after pulpotomy. As the time clasped, the pulp tended to be the fibrous degeneration. 3. Cavitec, Nobudyne and Neodyne: In the case of Cavitec and Nobudyne, the incompleted and irregular dentin bridge was observed at the 6th week, and in Neodyne, was observed at the 3rd week. The severe inflammatory changes were seen in the remaining pulp tissue. As the time clasped, the fibrous degeneration tended to spread in the remaining pulp tissue. 4. $Ca(OH)_2$: Osteocementum was formed at the 3rd week, the matrix of cementum and dentin were resorted, and infiltration of lymphocytes was seen in periapical tissue when $Ca(OH)_2$ was used as canal-filling materials. S. ZOE and Vitapex The cementum like substance was seen in periapical portion at the 1st week, when ZOE and Vitapex were used as root canal filling materials. As the time elapsed, the matrix of cementum and dentin tended to be resorted. At the 6th week, the inflammatory condition of periapical tissue was continued in the case of ZOE, but was reduced in the case of Vitapex.

• Journal of Oral Medicine and Pain
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• v.34 no.3
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• pp.227-235
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• 2009

Many of the protective functions of saliva can be attributed to the biological, physical, structural, and rheological characteristics of salivary glycoproteins. Therefore, the development of ideal saliva substitutes requires understanding of the rheological as well as biological properties of human saliva. In the present study, we investigated the changes of salivary enzymatic activities by saliva substitutes and compared viscosity of saliva substitutes with human saliva. Five kinds of saliva substitutes such as Moi-Stir, Stoppers4, MouthKote, Saliva Orthana, and SNU were used. Lysozyme activity was determined by the turbidimetric method. Peroxidase activity was determined with an NbsSCN assay. $\alpha$-Amylase activity was determined using a chromogenic substrate, 2-chloro-p-nitrophenol linked with maltotriose. The pH values of saliva substitutes were measured and their viscosity values were measured with a cone-and-plate digital viscometer at six different shear rates. Various types of saliva substitutes affected the activities of salivary enzymes in different ways. Stoppers4 enhanced the enzymatic activities of hen egg-white lysozyme, bovine lactoperoxidase (bLP), and $\alpha$-amylase. Saliva Orthana and SNU inhibited bLP activity and enhanced $\alpha$-amylase activity. MouthKote inhibited $\alpha$-amylase activity. Moi-Stir inhibited the enzymatic activities of bLP and $\alpha$-amylase. The pH values were very different according to the types of saliva substitutes. Stoppers4, MouthKote, and Saliva Orthana showed lower values of viscosity at low shear rates and higher values of viscosity at high shear rates compared with unstimulated and stimulated whole saliva. Moi-Stir and SNU displayed much higher values of viscosity than those of natural whole saliva. Collectively, our results indicate that each saliva substitute has its own biological and rheological characteristics. Each saliva substitute affects the enzymatic activity of salivary enzyme and finally oral health in different ways.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.2
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• pp.243-254
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• 2002

For the purpose of evaluating the biocompatability of 3 kinds of metallic materials frequently used in pediatric dentistry (stainless steel crown, orthodontic band, orthodontic wire), cellular and molecular studies, including cell growth and proliferation, screening of cell death with determination of types whether necrosis or apoptosis and changes in expressions of related signaling molecules were examined, using cultured human gingival fibroblasts (HGF-1), HGF-1 was cultured in Dulbecco's modified Eagle's medium. among which the 3rd to 6th generations of HGF-1 were used. The specimen were divided into stainless steel crown (R), band (B) and wire (W). The immunocytochemical study was done for the detection of anti-PCNA (proliferating cell nuclear antigen) labeling. With extracted protein, western blot was done for the detection of ERK1/2, JNK, and p38, using individual antibodies. Cultured cells proliferated, remarkably till 7 day and slightly at 11 day. There was no statistical significance in the counts of proliferating HGF-1 between control and experimental groups (p>0.05). Relative growth rates were no statistically significant difference between control and experimental groups (p>0.05). PCNA labeling indexes showing similar patterns in control and experimental groups. The expressions of ERK1 and ERK2, p38 were similar in control and experimental groups. The expression of JNK increased at 1st day, slightly decreased at 4th day and markedly increased at 7th and 11 day. Although the patterns of control and experimental groups were similar, the increased expressions of JNK at late period suggest a possible stress due to inhibited cell growth and proliferation, and worse culture condition. Conclusively, the 3 kinds of metal specimens used in this study did not induce cellular and molecular hazards during short term culture of HGF-1. But, for the better clinical stability, the establishment of long period culture and animal experiment was thought necessary.