• 대한치과보철학회지
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• 제53권3호
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• pp.244-249
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• 2015

최근 디지털 기술이 발달하면서 임플란트 식립 시 가이드 템플릿을 이용하는 컴퓨터 가이드 수술이 활발하게 이루어지고 있으며, 임플란트 보철시 구강스캐너를 이용하는 방법이 소개되고 있다. 가이드 템플릿의 제작방법은 크게 RP 제작 시스템과 벡터 밀링 시스템으로 나눌 수 있는데, 각각은 우수한 정확성에도 불구하고 임상적 적용에 있어 약간의 아쉬운 점을 보이고 있다. 이에 본 증례에서는 CBCT 및 구강스캐너로 획득한 디지털 영상을 이용하여 쾌속조형법으로 왁스재료의 작업모형을 제작하고 그 위에 교정용 레진으로 금속애관을 픽업해 내는 방법을 사용하여 임플란트 수술용 가이드 템플릿을 제작하여 수술에 사용하였으며, 임상적으로 임플란트 식립 및 최종보철물 제작 시 만족스러운 결과를 얻을 수 있어서 이를 보고하고자 한다.

• Archives of Plastic Surgery
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• 제41권6호
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• pp.716-721
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• 2014

Background The aim of this study was to review the recipient vessels used in our cases of facial reanimation with free functional muscle transfer and to identify patient variables that may predict when the facial vessels are absent. From this we present a protocol for vessel selection in cases when the facial artery and/or vein are absent. Methods Patients were identified from November 2006 to October 2013. Data was collected on patient demographics, facial palsy aetiology, history of previous facial surgery/trauma and flap/recipient vessels used. A standard operative approach was adopted and performed by a single surgeon. Results Eighty-seven eligible patients were identified for inclusion amongst which 98 hemifaces were operated upon. The facial artery and vein were the most commonly used recipient vessels (90% and 83% of patients, respectively). Commonly used alternative vessels were the transverse facial vein and superficial temporal artery. Those with congenital facial palsy were significantly more likely to lack a suitable facial vein (P=0.03) and those with a history of previous facial surgery or trauma were significantly more likely to have an absent facial artery and vein (P<0.05). Conclusions Our algorithm can help to guide vessel selection cases of facial reanimation with free functional muscle transfer. Amongst patients with congenital facial palsy or in those with a previous history of facial surgery or trauma, the facial vessels are more likely to be absent and so the surgeon should then look towards the transverse facial vein and superficial temporal artery as alternative recipient structures.

• Clinics in Shoulder and Elbow
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• 제22권1호
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• pp.16-23
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• 2019

Background: We aimed to evaluate whether the use of our novel patient-specific guide (PSG) with 3-dimensional reconstruction in reverse total shoulder arthroplasty (RTSA) would allow accurate and reliable implantation of the glenoid and humeral components. Methods: 20 fresh-frozen cadaveric shoulders were used. The PSG group (n=10) and conventional group (n=10) was evaluated the accuracy and reproducibility of implant positioning between before and after surgery on the computed tomography image. Results: The superoinferior and anteroposterior offset in the glenoid component were $0.42{\pm}0.07$, $0.50{\pm}0.08$ in the conventional group and $0.45{\pm}0.03$, $0.46{\pm}0.02$ in the PSG group. The inclination and version angles were $-1.93^{\circ}{\pm}4.31^{\circ}$, $2.27^{\circ}{\pm}5.91^{\circ}$ and $0.46^{\circ}{\pm}0.02^{\circ}$, $3.38^{\circ}{\pm}2.79^{\circ}$. The standard deviation showed a smaller difference in the PSG group. The anteroposterior and lateromedial humeral canal center offset in the humeral component were $0.45{\pm}0.12$, $0.48{\pm}0.15$ in the conventional group and $0.46{\pm}0.59$ (p=0.794), $0.46{\pm}0.06$ (p=0.702) in the PSG group. The PSG showed significantly better humeral stem alignment. Conclusions: The use of PSGs with 3-dimensional reconstruction reduces variabilities in glenoid and humerus component positions and prevents extreme positioning errors in RTSA.

• Journal of International Society for Simulation Surgery
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• 제2권2호
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• pp.83-86
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• 2015

Recently, computer-assisted surgery is popular for performing well-planned operations. Computer-aided navigation system is helpful in maxillofacial surgery with real time instrument positioning and clear anatomic identification. Generally, segmental mandibulectomy and reconstruction flap surgery have done by extra-oral approach such as, submandibular approach. This case report describes performing intra-oral segmental mandibulectomy and reconstruction with monocortical deep circumflex iliac artery (DCIA) flap and CT guided implant surgery by using computer-aided surgical guide and navigation for managing ameloblastoma in a 31 years old female patient.

• 대한치과보철학회지
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• 제60권3호
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• pp.283-292
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• 2022

임플란트를 이용한 고정성 보철 치료를 위해서는 보철 치료에 적합한 위치에 임플란트가 식립되어야 하며 이를 위해 guided implant surgery와 CAD-CAM을 활용한 보철물 제작이 최근 널리 사용되고 있다. 수술 시에는 surgical guide를 이용해 flapless 방식으로 최소침습 보철수복이 가능 하다. 본 증례의 환자는 86세 남성 환자로 기존 의치 사용 시 불편함으로 치료를 원하였다. 환자는 전신질환으로 인해 가철성 국소의치 사용이 어려워 상악은 총의치, 하악의 경우 임플란트 고정성 보철물 수복하였다. 전신질환으로 인해 높은 출혈 위험성을 가지므로 surgical guide를 사용해 flapless 방식으로 임플란트를 식립하였다. 최종적으로 상악 총의치 및 하악 나사 유지형 지르코니아를 보철물을 제작하였으며, 만족스러운 기능 및 심미 회복을 보였기에 보고하는 바이다.

• The Journal of Advanced Prosthodontics
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• 제8권3호
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• pp.207-213
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• 2016

PURPOSE. A recently introduced direct drill-guiding implant surgery system features minimal tolerance of surgical instruments in the metal sleeve by using shank-modified drills and a sleeve-incorporated stereolithographic guide template. The purpose of this study was to evaluate the accuracy of this new guided surgery system in partially edentulous patients using geometric analyses. MATERIALS AND METHODS. For the study, 21 implants were placed in 11 consecutive patients using the direct drill-guiding implant surgery system. The stereolithographic surgical guide was fabricated using cone-beam computed tomography, digital scanning, computer-aided design and computer-assisted manufacturing, and additive manufacturing processes. After surgery, the positional and angular deviations between planned and placed implants were measured at the abutment level using implant-planning software. The Kruskal-Wallis test and Mann-Whitney U test were used to compare the deviations (${\alpha}=.05$). RESULTS. The mean horizontal deviations were 0.593 mm (SD 0.238) mesiodistally and 0.691 mm (SD 0.344) buccolingually. The mean vertical deviation was 0.925 mm (SD 0.376) occlusogingivally. The vertical deviation was significantly larger than the horizontal deviation (P=.018). The mean angular deviation was 2.024 degrees (SD 0.942) mesiodistally and 2.390 degrees (SD 1.142) buccolingually. CONCLUSION. The direct drill-guiding implant surgery system demonstrates high accuracy in placing implants. Use of the drill shank as the guiding component is an effective way for reducing tolerance.

• Clinics in Shoulder and Elbow
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• 제21권3호
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• pp.111-112
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• 2018

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.43.1-43.5
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• 2015

Image-guided surgery potentially enhances intraoperative safety and outcomes in a variety of craniomaxillofacial procedures. We explore the efficiency of one intraoperative navigation system in a single complex craniofacial case, review the initial and recurring costs, and estimate the added cost (e.g., additional setup time, registration). We discuss the potential challenges and benefits of utilizing image-guided surgery in our specific case and its benefits in terms of educational and teaching purposes and compare this with traditional osteotomies that rely on a surgeon's thorough understanding of anatomy coupled with tactile feedback to blindly guide the osteotome during surgery. A 13-year-old presented with untreated syndromic multi-suture synostosis, brachycephaly, severe exorbitism, and midface hypoplasia. For now, initial costs are high, recurring costs are relatively low, and there are perceived benefits of imaged-guided surgery as an excellent teaching tool for visualizing difficult and often unseen anatomy through computerized software and multi-planar real-time images.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권6호
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• pp.381-389
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• 2013

Two patients with partial edentulous maxilla were scheduled to undergo installation of implant fixtures using a tooth-supported surgical template based on computer assisted treatment planning. After 3-dimensional (3D) computed tomographic scanning was transferred to the OnDemand3D (Cybermed Co., Seoul, Korea) software program for virtual planning, fixtures of MK III Groovy RP implant of the Br${\aa}$nemark System (Nobel Biocare AB Co., G$\ddot{o}$teborg, Sweden) was installed using the In2Guide (CyberMed Co., Seoul, Korea) tooth-supported surgical template with a Quick Guide Kit (Osstem Implant Co., Seoul, Korea) system in the posterior maxilla of each patient. Sinus floor elevation with a xenogenic bone graft procedure was also performed simultaneously in one patient. Fixture installations were completed successfully without complications, such as sinus mucosa perforation, bony bleedings, fenestrations, or others. During the last two-year follow-up period after prosthetics delivery, each implant was found to be fine with no other minor complications. The entire procedures are reported and the literatures on use of tooth-supported surgical template was reviewed.

• 대한치과보철학회지
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• 제57권1호
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• pp.57-65
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• 2019

Computer guided implant surgery와 computer-aided design/computer-aided manufacturing, computer guided implant surgery (CAD/CAM) 기술의 발전은 수복 기반 임플란트 치료의 완성도를 한층 더 높였으며, 3D printing을 통한 국소의치의 제작도 빈도가 늘고 있다. 본 증례는 디지털 치의학의 작업 흐름을 따라서 콘빔컴퓨터단층촬영을 통한 치료 계획 수립 및 수술용 스텐트의 제작과 그를 바탕으로 한 임플란트 식립을 하였으며, 맞춤 지대주와 보철물을 제작하였다. 그 후 전자 서베잉과 3D printing을 통한 국소의치 금속 구조물 및 최종적으로 지르코니아 온레이의 제작을 통해 전악 수복을 완성하여 기능과 심미적으로 만족스러운 결과를 얻을 수 있었다.