• 대한두개안면성형외과학회지
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• 제10권1호
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• pp.49-54
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• 2009

상악골 악성종양의 경우 적출 후 골편들을 이식해 상악동 전체를 재건하는 경우는 재발이 많아 잘 시행하지 않는다. 이러한 이유로 안와하연의 재건을 통해 안구 및 안면윤곽만을 재건하는데, 저자들이 시행한 혈행화된 부분 두께의 골이식(vascularized split thickeness calvarium)은 술기방법에 있어 골피판이 혈관경에서 쉽게 분리되는 성질이 있어 시행에 주의가 필요하고 혈관경을 포함한 temporalis muscle이 부피감을 주므로 미용상 불리한 점이 있는 반면에 골편의 높은 생존율이 보장된다는 장점과 공여부의 합병증이 적다는 장점을 가진다. 또한 술후 복시 현상이나 안구함몰이 관찰되지 않았다는 점이 합리적인 술기임을 지지해준다. 따라서 측두동맥 및 정맥을 혈관경으로 하는 혈행화된 두정골 부분층 이식술은 안와하벽을 재건하는데 있어 안전하게 시행가능 한 술기였음을 보고하는 바이다.

• 대한치과의사협회지
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• 제36권11호통권354호
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• pp.794-799
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• 1998

Many references report that abnormal diastema except temporary diastema existing in mixed dentition period is caused by maxilary heavy labial frenum, malocclusion, progressive periodontal disease, and loss of posterior teeth. We can diagnose patient as diastema caused by periodontal disease, especially, in case of accompanying progressively destructed anterior maxillary alveolar bone defect, and interseptal bone defect. We report Multiple disciplinary approach for diastema associated with periodontal disease. Periodontal treatment(Guided Tissue -Regeneration, alveoloplasty, bone graft), or thodontic treatment (space closure, redistribution), and the final proshodontic restoration for retention were used.

• 구강회복응용과학지
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• 제34권4호
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• pp.331-337
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• 2018

상악골 결손을 갖고 있는 무치악 환자를 폐쇄장치로 수복할 때 임상가들은 많은 어려움을 겪게 된다. 결손부를 통한 공기의 누출, 안정성과 지지의 부족, 감소된 의치 피개 면적은 의치의 흡착과 변연 폐쇄를 어렵게 한다. 본 증례는 편평상피암에 이환된 우측 상악동 부위에 상악골 절제술을 받은 무치악 환자로 술전 치과 검진, 수술용 폐쇄장치, 이행 폐쇄장치, 그리고 최종 폐쇄장치에 이르는 단계적 치료 과정을 통해 보철적 재건을 완료하였다. 본 증례의 환자는 전상악골 및 양측 상악 결절이 온전하며 한정된 크기의 결손부를 가져 적절한 유지와 지지를 갖는 폐쇄장치를 제작할 수 있었으며 심미 및 기능면에서 양호한 예후를 보였기에 이를 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권2호
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• pp.167-172
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• 2009

The maxilla rarely undergoes necrosis due to its rich vascularity. Maxillary necrosis can occur due to bacterial infections such as osteomyelitis. viral infections such as herpes zoster and fungal infections such as mucormycosis, aspergillosis etc. Herpes zoster is a common viral infection, the oral soft tissue manifestations of which are widely known and recognized. Extremely rare complications such as osteonecrosis, and secondary osteomyelitis in maxilla were observed. But, reports of spontaneous tooth exfoliation and jaw osteonecrosis following herpes zoster infection in the distribution of the trigeminal nerve are extremely rare in the literature. We report a case of maxillary necrosis by herpes zoster in an uncontrolled diabetic patient. There was extensive necrosis of the buccal and palatal mucoperiosteum and exposure of the alveolar bone. This patient was successfully treated using a removal of necrotic bone and nasolabial flap. We briefly discuss different diseases which can lead to maxillary necrosis and a review. Analysis of the pathogenesis of herpes zoster and bone necrosis are discussed.

• Journal of Periodontal and Implant Science
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• 제38권sup2호
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• pp.405-412
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• 2008

Purpose: Pathologic tooth migration (PTM) commonly occurs in the anterior region and is associated with periodontal disease. The treatment of PTM of anterior teeth can be complex and time consuming, and a multidisciplinary approach is often required. Materials and Methods: The patient was a 38-year-old woman with a chief complaint of saving and realigning her elongated maxillary left central incisor. This paper describes the successful combined periodontal regenerative (guided tissue regeneration) and prosthetic treatment and a 2-year follow-up of maxillary central incisor with pathologic tooth migration, deep intrabony defect, and poor prognosis. Results: The right maxillary central incisor was restored by laminate veneer and the left by all-ceramic crown. The patient had no pain and discomfort and was satisfied with the outcomes of her treatment for 2 years. She has maintained her recall program at the Department of Periodontology at 3 months interval. Conclusion: The key step in the successful treatment of PTM in anterior region is to obtain a high level of cooperation from the patient. Maintenance of the treatment result of PTM is dependent on the continuous preservation of periodontal health.

• 대한치과의사협회지
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• 제47권3호
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• pp.122-130
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• 2009

For the successful guided bone regeneration(GBR) of maxillary bony defect, proper soft tissue coverage is one of the most important things. Soft tissue dehiscence can be most common reason of osseous reconstruction failure. If a vascular supply to the graft should not develop from the host tissue, then the graft may also foil. Both of these prerequisites can be aided by judicious use of the buccal fat pad(BFP). Many methods for adequate soft tissue coverage have been proposed and the use of the BFP is one of them. BFP is useful in posterior maxillary area, can cover larger area and have higher blood flow than other methods. so the use of the BFP may offer protection and early blood supply to maxillary bone graft. This report describes the history, anatomy, blood flow, and clinical usefulness with two clinical cases.

• 대한구순구개열학회지
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• 제12권1호
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• pp.21-32
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• 2009

Generally, an adult cleft lip or/and palate patient shows some amount of maxillary deficiency due to limitation of bony growth caused by heavy scars resulted from previous operations such as a cheiloplasty and/or a palatoplasty at an early child age. To solve the problem, advancement of the maxilla is usually required during orthognathic surgery. However, severe tensional force resulted from heavy scars on the palate and/or the lip, as well as the bony defect at the cleft area limited sufficient advancement of the maxillary segment and finally caused relapse of the reposed maxilla. Therefore, distraction osteogenesis of the maxilla was introduced for the successful maxillary advancement inthose kinds of patients. As both hard and soft tissues can be simultaneously and gradually extended with this technique, tensional force caused by heavy scars opposed to forward movement of the maxilla can be reduced to an extent not to develop severe relapse of the advanced maxilla. Since distraction osteogenesis of the maxilla was applied as one of standard protocols for the treatment of the patients with severe maxillary hypoplasia dueto cleft lip and/or palate, the devices for the distraction was improved to control the vectors of distraction with better and more stable. We have treated a 23-year-old male cleft patient with a severe maxillary hypoplasia using a newly developed a maxillary distraction device and a RP model for a pre-operative simulation surgery. As a result, we could successfully move the maxilla as we designed pre-operatively and also reduce much of operation time. Therefore, we report of the case to share our experience with colleagues.

• 대한치과보철학회지
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• 제53권1호
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• pp.74-80
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• 2015

구강암의 발생 시, 구순의 결손과 방사선치료에 의한 치주조직과 치경부우식증 등의 문제가 발생할 수 있다. ADI (Association of dental implantology)에 의하면 상 하악골에 대한 방사선치료가 최근에 시행되었을 경우 임플란트를 식립하는 것은 상대적 비적응증이 된다. 대부분의 경우 임플란트를 이용한 보철물의 제작이 어렵고 의치를 사용한 수복이 이루어지게 된다. 특히, 구강암 수술로 인한 구순결손은 의치의 유지에 심각한 영향을 주게 된다. 본 증례는 상순암을 가진 환자로 일차적으로 절제술을 시행하고, 이차적으로 방사선 치료가 정기적으로 이루어진 결과, 환자의 상악 치아들은 순차적으로 자연 발치되었고, 하악은 매우 불량한 치주상태를 나타내었다. 상악은 총의치에 의치접착제를 적용하여 구순결손에 의한 의치의 유지력 저하를 극복하였고, 하악에서는friction pin을 이용한 하악이중관의치가 2년 동안 성공적으로 사용되었다.

• Journal of Periodontal and Implant Science
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• 제44권3호
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• pp.147-155
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• 2014

Purpose: In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome. This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double-rotated palatal subepithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect. Methods: We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. The bone graft materials were filled above the alveolar defect and a titanium-reinforced nonresorbable membrane was placed to cover the graft materials. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture. Results: Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment. Conclusions: The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and harmonization with the recipient tissue.

• Journal of Periodontal and Implant Science
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• 제41권1호
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• pp.44-50
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• 2011

Purpose: Pathologic tooth migration (PTM) is a tooth displacement which is derived from imbalance of tooth retention force and is dominantly found out in maxillary anterior area. PTM in maxillary anterior area was tried to corrected with periodontal treatment and a clear aligner in this study and the result was evaluated clinically and radiographically. Methods: For the treatment of a patient with chronic periodontal disease accompanied by maxillary anterior pathologic tooth migration, clear aligner was applied to move teeth after a series of case-related periodontal therapy. Clinically, probing depth, gingival recession, clinical attachment level and mobility were measured pre- and post-treatment, and radiographic examination was performed as well. Results: Clinically, we found the decrease of the probing depth, gingival recession, clinical attachment level and mobility. And we could also acknowledge the reduction of vertical and horizontal dimension on infrabony defect radiographically. However, it is still controversial if there was an actual bone filling. Conclusions: Clear aligner is an effective appliance to move teeth since it costs little in terms of expense and time. In addition, it wraps whole crowns, providing advantages to deal with crowding, spacing, and size of arch. In short, clear aligner could be a useful treatment option for PTM patient, since it provides decreased probing depth, gingival recession, clinical attachment level, mobility and esthetical restoration.