• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.13.1-13.12
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• 2016

Background: Mandibular motion tracking system (ManMoS) has been developed for orthognathic surgery. This article aimed to introduce the ManMoS and to examine the accuracy of this system. Methods: Skeletal and dental models are reconstructed in a virtual space from the DICOM data of three-dimensional computed tomography (3D-CT) recording and the STL data of 3D scanning, respectively. The ManMoS uniquely integrates the virtual dento-skeletal model with the real motion of the dental cast mounted on the simulator, using the reference splint. Positional change of the dental cast is tracked by using the 3D motion tracking equipment and reflects on the jaw position of the virtual model in real time, generating the mixed-reality surgical simulation. ManMoS was applied for two clinical cases having a facial asymmetry. In order to assess the accuracy of the ManMoS, the positional change of the lower dental arch was compared between the virtual and real models. Results: With the measurement data of the real lower dental cast as a reference, measurement error for the whole simulation system was less than 0.32 mm. In ManMoS, the skeletal and dental asymmetries were adequately diagnosed in three dimensions. Jaw repositioning was simulated with priority given to the skeletal correction rather than the occlusal correction. In two cases, facial asymmetry was successfully improved while a normal occlusal relationship was reconstructed. Positional change measured in the virtual model did not differ significantly from that in the real model. Conclusions: It was suggested that the accuracy of the ManMoS was good enough for a clinical use. This surgical simulation system appears to meet clinical demands well and is an important facilitator of communication between orthodontists and surgeons.

• Archives of Pharmacal Research
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• v.20 no.1
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• pp.24-28
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• 1997

In the present study, a pharmacokinetic model to address the effects of the diffusional barrier between splanchnic bed and enterocytes on the extent of presystemic and systemic intestinal elimination of drugs was developed. The model is composed of five compartments, ie., gut lumen, enterocyte, splanchnic bed, liver and central compartments. The equations for various pharmacokinetic parameters important for estimating the quantitative differences between presystemic and systemic intestinal and hepatic elimination of drugs were derived. A simulation study demonstrated that the diffusions[ barrier present between splanchnic blood and enterocytes can have significant effects on oral bioavailability and systemic clearance of drugs. In conclusion, the model can be useful for a better understanding of the effects of diffusional barrier on the extent of administration-route dependent intestinal and hepatic elimination of drugs, especially those with high hydrophilicity and/or charge(s) under physiological conditions.

• Journal of International Society for Simulation Surgery
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• v.1 no.1
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• pp.32-36
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• 2014

Reconstruction of the maxilla is quite a difficult challenge for reconstructive surgeons. The maxilla is the most important part of the midface, which contributes to facial esthetics, mastication, swallowing, speech, supporting orbital contents and sinus function. Free fibular flap is most versatile to reconstruct jaw bone because of its adequate length, containing both soft and bony tissues and acceptance of dental implants. In this case report, a reconstruction of the maxilla using free fibular flap and dental implants is described in which rapid prototype was used before surgery to simulate the final prosthetic results.

• Pediatric Infection and Vaccine
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• v.18 no.2
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• pp.109-116
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• 2011

Purpose : Pneumococcus is one of the most important causes of invasive infection through the childhood period. In January 2008, the Clinical and Laboratory Standards Institute (CLSI) published revised penicillin breakpoints for Streptococcus pneumoniae and penicillin susceptibility rates of S. pneumoniae increased in Korea. This study was performed to determine the probability of oral amoxicillin for the empirical treatment achieving bactericidal exposure against pneumococcus using pharmacodynamics model. Methods : Twenty-three isolates of pneumococci were subjected to determine minimum inhibitory concentration (MIC) for ${\beta}$-lactams and macrolide. For the ${\beta}$-lactams, exposure of fT >MIC (time that free drug concentrations remain above the MIC) for 50% of the administration interval have determined the probability of target attainment (PTA), and regimens that had a PTA >90% were considered optimal. An analysis was performed by applying MIC of 23 isolates to a 5000-patient Monte Carlo simulation model. Results : Among 23 isolates from healthy children, 7 (30.4%) isolates were MIC ${\leq}$1.0 ${\mu}g$/mL and 19 (82.6%) were MIC ${\leq}$2 ${\mu}g$/mL for amoxicillin. Amoxicillin 40 mg/kg/day achieved PTA >90% at MIC ${\leq}$1.0 ${\mu}g$/mL but PTA decreased to 52% at MIC 2 ${\mu}g$/mL, whereas amoxicillin 90 mg/kg/day can predict 97% of PTA at MIC 2 ${\mu}g$/mL. Overall, oral amoxicillin 90 mg/ kg/day for the empirical treatment against pneumococcus can expect more successful response in Korean children. Conclusion : Considering the resistantce pattern of pneumococci in Korean children, we estimate that oral amoxicillin 90 mg/kg/day will provide a pharmacodynamic advantage for the empirical treatment against pneumococcus. And low dose amoxicillin or macrolide are expected to have higher chance of treatment failure than high dose oral amoxicillin.

• Journal of the Institute of Electronics and Information Engineers
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• v.53 no.12
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• pp.169-174
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• 2016

In this study, we evaluated the virtual reality model for dental implant surgery and discussed about the method to make the surgical environment for virtual reality with practical patient data. The anatomical model for patient face was fabricated by facial and oral scan data based on CT data. The simulation scenario was composed step by step fashion with Unity3D. From incision and sinus bone graft procedure which is needed to this patient model to implant installation and bone graft was included in this scenario. We used the HMD and leap motion for immersiveness and feeling of real operation. Twenty training doctor was attended this simulation study, and surveyed their satisfactory results by questionnaire. Implant surgery education program was showed the possibilities of educational tool for dental students and training doctors. Virtual reality for surgical education with HMD and leap motion had advantages, in terms of cheap prcie, easy access.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.4
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• pp.321-329
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• 2001

To establish systematic diagnosis and treatment planning of dentofacial deformity patient including facial asymmetry or hemifacial microsomia patient, comprehensive analysis of three dimensional structure of the craniofacial skeleton is needed. Even though three dimensional CT has been developed, landmark identification of the CT is still questionable. In recent, a method for correcting cephalic malpositioning that enables accurate superimposition of the landmarks in different stages without using any additional equipment was developed. It became possible to compare the three-dimensional positional change of the maxillomandible without invasive procedure. Based on the principle of the method, a new program was developed for the purpose of diagnosis and treatment planning of dentofacial deformity patient via three dimensional visualization and structural analysis. This program enables us to perform following menu. First, visualization of three dimensional structure of the craniofacial skeleton with wire frame model which was made from the landmarks observed on both lateral and frontal cephalogram. Second, establishment of midsagittal plane of the face three dimensionally, with the concept of "the plane of the best-fit". Third, examination of the degree of deviation and direction of deformity of structure to the reference plane for the purpose of establishing surgical planning. Fourth, simulation of expected postoperative result by various image operation such as mirroring, overlapping.

• Journal of International Society for Simulation Surgery
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• v.2 no.2
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• pp.90-93
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• 2015

The fibula free flap has now become the most reliable and frequently used option for mandible reconstruction. Recently, three dimensional images and printing technologies are applied to mandibular reconstruction. We introduce our recent experience of mandibular reconstruction using three dimensionally planned fibula free flap in a patient with gunshot injury. The defect was virtually reconstructed with three-dimensional image. Because bone fragments are dislocated from original position, relocation was necessary. Fragments are virtually relocated to original position using mirror image of unaffected right side of the mandible. A medical rapid prototyping (MRP) model and cutting guide was made with 3D printer. Titanium reconstruction plate was adapted to the MRP model manually. 7 cm-sized fibula bone flap was designed on left lower leg. After dissection, proximal and distal margin of fibula flap was osteotomized by using three dimensional cutting guide. Segmentation was also done as planned. The fibula bone flap was attached to the inner side of the prebent reconstruction plate and fixed with screws. Postoperative evaluation was done by comparison between preoperative planning and surgical outcome. Although dislocated condyle is still not in ideal position, we can see that reconstruction was done as planned.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.44 no.2
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• pp.59-65
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• 2018

Objectives: This study aimed to optimize the thread depth and pitch of a recently designed dental implant to provide uniform stress distribution by means of a response surface optimization method available in finite element (FE) software. The sensitivity of simulation to different mechanical parameters was also evaluated. Materials and Methods: A three-dimensional model of a tapered dental implant with micro-threads in the upper area and V-shaped threads in the rest of the body was modeled and analyzed using finite element analysis (FEA). An axial load of 100 N was applied to the top of the implants. The model was optimized for thread depth and pitch to determine the optimal stress distribution. In this analysis, micro-threads had 0.25 to 0.3 mm depth and 0.27 to 0.33 mm pitch, and V-shaped threads had 0.405 to 0.495 mm depth and 0.66 to 0.8 mm pitch. Results: The optimized depth and pitch were 0.307 and 0.286 mm for micro-threads and 0.405 and 0.808 mm for V-shaped threads, respectively. In this design, the most effective parameters on stress distribution were the depth and pitch of the micro-threads based on sensitivity analysis results. Conclusion: Based on the results of this study, the optimal implant design has micro-threads with 0.307 and 0.286 mm depth and pitch, respectively, in the upper area and V-shaped threads with 0.405 and 0.808 mm depth and pitch in the rest of the body. These results indicate that micro-thread parameters have a greater effect on stress and strain values.

• Journal of Periodontal and Implant Science
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• v.42 no.1
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• pp.25-29
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• 2012

Purpose: There has been no attempt to establish an objective implant surgical evaluation protocol to assess residents' surgical competence and improve their surgical outcomes. The present study presents a newly developed assessment and rating system and simulation model that can assist the teaching staffs to evaluate the surgical events and surgical skills of residents objectively. Methods: Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed regarding surgical competence and assessment tools. Particularly, medical journals reporting rating and evaluation protocols for various types of medical surgeries were thoroughly analyzed. Based on these studies, an implant surgical technique assessment and rating system (iSTAR) has been developed. Also, a specialized dental typodont was developed for the valid and reliable assessment of surgery. Results: The iSTAR consists of two parts including surgical information and task-specific checklists. Specialized simulation model was subsequently produced and can be used in combination with iSTAR. Conclusions: The assessment and rating system provided may serve as a reference guide for teaching staffs to evaluate the residents' implant surgical techniques.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.2
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• pp.158-166
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• 2009

The application of CT with basis on 3 dimensional-reconstruction is getting more widely practiced. With the data obtained from cone-beam computed tomography(CBCT), not only the diagnosis of the patient with skeletal abnormality but also the virtual simulation of the orthognathic surgery were performed and its application would be popular in orthodontic field. We reported a case, a 19-year old man who was diagnosed mandibular prognathism and required orthognatic surgery. In this case, the virtual orthognathic surgery was simulated and surgical wafer was fabricated by using CBCT data. That wafer was applied the actual orthognathic surgery. After preoperative orthodontic treatment, we prepared surgery as follows. : (l)Acquisition of 3D image data, (2)Reconstruction of 3-dimensional virtual model, (3)Virtual model surgery, (4)Extraction of stere-olithographic image, (5)Check-up for occlusal interference, (6)Fabrication of surgical stent by stereolithography. Bilateral sagittal split ramus osteotomy was operated and used stereolithographic surgical stent. 1 month later, we superimposed CBCT datas of virtual surgery and that of actual surgery, and then compared the result. CT data's application for othognathic surgery yielded satisfactory outcomes.