• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권4호
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• pp.229-238
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• 2017

Objectives: The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction. Materials and Methods: Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer's assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05. Results: Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction. Conclusion: The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.

• 대한치과마취과학회지
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• 제3권2호
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• pp.87-91
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• 2003

Background: The purpose of this study was to compare the availability of propofol and fentanyl (P + F) with diazepam and morphine (D + M) for intravenous conscious sedation during third molar surgery. Methods: Forty patients without systemic disease were operated under IV conscious sedation administered by either of the two techniques. Monitoring consisted of continuous observation of pulse rate, blood pressure, oxygen saturation, and the respiratory rate and were recorded every 15 minutes. Cooperation score was measured 5 and 15 minutes after induction of IV sedation. Following the operation, the surgeon and patients completed questionnaires including pain visual analog scale, amnesia, and side effects. Results: The P + F group was significantly more cooperative than the D + M group. The side effects of D + M group included pain on injection, nausea/vomiting and abdominal pain. The side effects of P + F group included talkativeness, nausea/vomiting, temporary apnea, pain on injection and vertigo. Conclusions: In this study, there were following benefits in the P + F group; more cooperative status and less pain perception. But respiratory depression developed in some patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권5호
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• pp.252-261
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• 2023

Objectives: Patients undergoing oral surgery exhibit high anxiety, which may elevate their cortisol levels and affect postoperative recovery. Overweight patients are often encountered in the dental clinic due to the increasing prevalence of overweight. We aimed to investigate the relationships between preoperatively assessed body mass index (BMI), serum cortisol and high-sensitivity C-reactive protein (hs-CRP) levels, and visual analog scale (VAS) scores and preoperative anxiety in patients undergoing mandibular third molar (MM3) extraction and to identify predictors of postoperative complications. Patients and Methods: We analyzed 43 patients (age, 20-42 years) undergoing MM3 extraction. At the first visit, patients completed the Modified Dental Anxiety Scale (MDAS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaires. Their BMI and VAS scores were also calculated. The participants underwent blood tests 1 hour before MM3 extraction. On the first postoperative day, the participants' VAS scores and serum hs-CRP levels were reevaluated. Results: We found that BMI was significantly correlated with preoperative VAS scores. Further, BMI and preoperative hs-CRP levels were significantly correlated among women and patients undergoing extractions of fully impacted MM3s. No correlations were found between serum cortisol and other variables. The preoperative MDAS and VAS scores were significantly positively correlated, especially among patients undergoing extractions of fully impacted MM3s. Multiple linear regression showed that BMI and the eruption status of the MM3 were significant predictors of postoperative hsCRP levels and VAS scores, respectively. Conclusion: In MM3 removals, patients with higher BMI showed elevated hs-CRP and higher VAS scores before surgery. Patients with higher anxiety among those undergoing extractions of fully impacted MM3s showed higher preoperative VAS scores. The two main predictors of postoperative complications were BMI and MM3 eruption status.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권3호
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• pp.153-160
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• 2024

Objectives: This study identifies factors for differential diagnosis among lesions by retrospectively comparing panoramic and cone-beam computed tomography images and analyzing the characteristics of lesions associated with impacted mandibular third molars (IMTs). Materials and Methods: A retrospective cohort study was conducted in patients who simultaneously underwent IMT extraction surgery and related benign tumor resection or cyst enucleation at our institution from 2017 to 2021. To compare the characteristics of each group, two comparative analyses were conducted. The first comparison considered the most frequently observed lesions associated with IMTs: dentigerous cysts, odontogenic keratocysts (OKCs), and ameloblastoma. The second comparison involved placing dentigerous cysts, which have a relatively low recurrence rate, into group A and placing OKC, ameloblastoma, and odontogenic myxoma, which have high recurrence rates, into group B. Results: Significant differences in the size of the lesion were found in the order of ameloblastoma, OKC, and dentigerous cyst (P<0.05). The buccolingual width of ameloblastoma differed significantly from that of the other groups, with no significant difference observed between the OKCs and dentigerous cysts (P=0.083). Conclusion: Patient age and lesion size differed significantly among lesion types associated with IMTs, with younger age and larger lesions for OKCs and odontogenic tumors. OKCs are likely to have a larger mesiodistal width than dentigerous cysts. The buccolingual width of ameloblastomas was larger than those of dentigerous cysts and OKCs.

• 대한치과교정학회지
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• 제23권4호
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• pp.565-606
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• 1993

The purpose of this study was to evaluate the change of before and after treatment of anterior openbite malocclusions treated by Multiloop Edgewise Archwire technique. The openbite sample consisted of 4 male and 12 female adults, treated with nonextraction or third molar extraction. The normal sample consisted of 58 subjects, which have pleasing facial profile and normal occlusion and no experience of orthodontic or prosthodontic treatment. The 58 subjects of normal sample were subdivided by cephalemetric vertical relationship of face. The 40 subjects, cephalometric vertical relationship of face was in normal range, classified as Normal Sample group 1. The 18 subjects, increased cephalometric vertical relationship of face, classified as Normal Sample group 2. The computerized cephalometric analysis was accomplished with 50 reference points for 22 skeletal measurements, 46 dentoalveolar measurements, 8 soft tissue measurements. Statistical analysis of the data was carried out with paired t-test, Student's t-test, and DUNCAN test using SAS(PC version), The results were as follows : 1. There were no statistically significant differences in skeletal measurement between before and after treatment. The major changes were in dentoalveolar region. 2. After treatment, the long axis of maxillary and mandibular posterior teeth were distally tipped-back, and uprighted to bisected occlusal plane. The interincisal angle was increased. 3. There were no statistically significant increase in the upper posterior dental height and statistically significant decrease in the lower posterior dental height. The upper anterior dental height was increased, but there was no statistically significant increase in the absolute upper anterior dental hight. The lower anterior dental height was increased. 4. After treatment, the maxillary occlusal plane to palatal plane angle and the mandibular occlusal plane to mandibular plane angle were statistically significant increased. Then, there were no statistically significant difference between after treatment group and normal sample group 2. 5. After treatment, the percentage of upper lip length to upper anterior dental height was decreased. Then, There were no statistically significant difference between after treatment group and normal sample group 2.

• 대한치과교정학회지
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• 제34권5호
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• pp.394-407
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• 2004

본 연구의 목적은 III급 부정교합의 치료 시에 하악 제3대구치의 존재가 하악 치열의 원심 치군 이동(distal en masse movement) 및 치료 기간에 미치는 영향을 평가하기 위한 것이다. 서울대학교병원 교정과에 내원하여 III급 부정교합으로 진단을 받고, 이에 대한 교정 치료를 받은 36명(남자: 9명, 여자: 27명)을 선택하였다. 모든 환자는 제3대구치 이외의 다른 치아는 발거하지 않았다. 이를 하악 제 3대구치의 발거 시기에 따라 세 군으로 분류하였는데. 제1군은 하악 제 3대구치를 발거하지 않고 MEAW를 사용하여 치료를 종료한 12명이며, 제 2군은 MEAW 적용 후에 하악 제 3대구치를 발거한 8명. 제 3군은 MEAW를 적용하기 전에 하악 제3대구치를 발거한 18명이다 각 환자들에 대하여, 전체 치료 기간 및 MEAW 적용 기간을 구하였으며, 치료 전 후의 측모 두부 계측 방사선 사진을 분석하였다. 각 군에 대한 치료 기간 및 치료 전 후의 변화를 ANOVA를 이용하여 통계 처리하였으며, 다음과 같은 결론을 얻었다. 전체 치료 기간은 각 군 사이에 유의성 있는 차이가 없었으나, MEAW를 적용한 기간은 제 2군(MEAW 적용 후에 하악 제3대구치를 발거한 군)에서 가장 길었다. 제3군(MEAW를 적용하기 전에 하악 제3대구치를 발거한 군)에서, 치료 후에 형성된 overjet이 가장 컸다. 제3군(MEAW를 적용하기 전에 하악 제5대구치를 발거한 군)의 경우 치료 후에 IMPA가 감소하였으나, 제1군(하악 제3대구치를 발거하지 않고 치료를 종료한 군)과 제 2군(MEAW 적용 후에 하악 제3대구치를 발거한 군)에서는 IMPA가 증가하였다 제2대구치의 원심 치체 이동량은 세 군 사이에 유의성 있는 차이가 없었으나. 원심 경사 이동량은 세 군 사이에 통계적으로 유의한 차이가 있었으며 제 2군 제 3군 제 1군의 순이었다. 따라서, MEAW를 적용하기 이전에 하악 제3대구치를 발거하는 것이 III급 부정교합의 교정적 치료에 더 좋을 것으로 판단된다. 제 2군의 경우, 하악골의 전방 회전 결과, 하악 평면각의 감소가 있었으며 이러한 골격 변화가 치료 기간의 연장에 영향을 주었다고 판단된다.

• Journal of Korean Dental Science
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• 제6권2호
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• pp.58-66
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• 2013

Purpose: The inferior alveolar nerve (IAN) can be damaged as a result of minor oral surgical procedure such as third molar extraction or implant placement. Repair of the injured IAN involves difficulty of access, and research studies are limited to elucidating the process of regeneration by surgical methods. This study sought to establish the rabbit animal model to apply polymeric membrane functionalized with nerve growth factor after a crush lesion for the evaluation of nerve regeneration using the electrophysiologic method. Materials and Methods: The IAN of 2 adult male New Zealand white rabbits (4 nerves) were exposed bilaterally, and crush injury rendered by jeweler's forceps was applied. Nerve conduction velocity was examined electrophysiologically using electromyography before, after, and 4 weeks after the crush injury. To evaluate the regeneration, the pattern of action potential of IAN was recorded, and the characteristics of neurons were histologically observed. Result: After the crush injury, afferent activity decreased in the injured group. Electromyography could not be recorded after four weeks because tissues surrounding the injured nerve collapsed. Decrease in the mean number of axons was observed in the injured part with membrane. Conclusion: Despite the limited result, the present animal model study may provide a possible way to research on the methods of enhancing the recovery of nerve injuries in clinical situations. For clinically widespread acceptance, however, it should gain more consecutive and scientific evidences.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권2호
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• pp.135-139
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• 2003

저자 등은 본과에 내원하여 함치성 낭종으로 진단된 5명의 소아 환자에서 보존적인 조대술을 이용하여 매복된 영구치를 발거하지 않고 이차 치유를 유도하였다. 술 후 병소는 신생골로 치유되었으며 매복 영구치도 정상적인 위치로 맹출하였다. 이와 같이 소아에서 함치성 낭종의 경우 주기적인 예후 관찰이 가능하다면 보다 보존적인 조대술 등을 이용시에는 영구치의 정상적인 유도와 낭종의 치유를 유도할 수 있으리라 사료된다. 또한 인접치아의 경사 등에 의한 정상적인 치아의 맹출이 어려운 경우에는 교정치료와 병행시에 정상적인 영구 치열을 확보할 수 있을 것으로 사료되어 문헌고찰과 함께 보고하는 바이다.

• Journal of Oral Medicine and Pain
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• 제42권4호
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• pp.89-101
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• 2017

Purpose: The purpose of this study is to investigate the prevalence of temporomandibular disorders (TMDs) in children and adolescents, their characteristic contributing factors, the characteristic features of symptoms and symptoms, and the response to treatment. Methods: We studied the researches, that were the results of the searches for words such as temporomandibular disorder, TMD, children, adolescents, and juvenile through PubMed and DBpia. Results: According to a study conducted in Busan, the ratio of adolescents increased from 18.3% to 21% in 2008 compared to 2000, and the proportion of boys increased from 38.58% to 45.38%. One of the characteristic contributing factors for adolescents is the macrotrauma such as jaw trauma, vehicle accidents, sports, physical abuse, forceful intubation, and third molar extraction. The second is a microtrauma from parafunctional habit such as bruxism, clenching, hyperextension, wind instrument, and fingernail biting that can cause joint overload, cartilage breakdown, synovial fluid alterations, and other changes within the joint. The diagnosis of TMDs in juvenile adolescents is not significantly different from that of adults. Medical history, clinical examination and radiological examinations are required. Conclusions: In the temporomandibular joint history and assessment, all comprehensive dental history examination is required, including head and neck pain, mandibular dysfunction, previous orofacial trauma, history of present illness with an account of current symptoms. For the treatment and management of temporomandibular arthritis in juvenile adolescents, understanding the characteristics of TMDs in juvenile adolescents and thoroughly analyzing appropriate diagnosis and possible contributing factors through comprehensive history taking & examination, conservative treatment, including fast and active cautions education, will be essential.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권2호
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• pp.145-153
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• 2022

Background: Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). Methods: A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 ㎍) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann-Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. Results: The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). Conclusion: Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.