Kim, Dong-Su;Kim, Il-Kyu;Jang, Keum-Soo;Park, Tae-Hwan;Kim, Kyu-Nam;Son, Choong-Yul
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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v.34
no.2
/
pp.166-179
/
2008
Excessive concentration of stress which is occurred in occlusion around the implant in case of the implant supported fixed partial denture has been known to be the main cause of the crestal bone destruction. Therefore, it is essential to evaluate the stress analysis on supporting tissue to get higher success rates of implant. The purpose of this study was to evaluate the effects of stress distribution and deformation in 3 different types of three-unit fixed partial denture sup-ported by two implants, using a three dimensional finite element analysis in a three dimensional model of a whole mandible. A mechanical model of an edentulous mandible was generated from 3D scan, assuming two implants were placed in the left premolars area. According to the position of pontic, the experiments groups were divided into three types. Type I had a pontic in the middle position between two implants, type II in the anterior posi-tion, and type III in the posterior position. A 100-N axial load was applied to sites such as the central fossa of anterior and posterior implant abutment, central fossa of pontic, the connector of pontic or the connector between two implants, the mandibular boundary conditions were modeled considering the real geometry of its four-masticatory muscular supporting system. The results obtained from this study were as follows; 1. The mandible deformed in a way that the condyles converged medially in all types under muscular actions. In comparison with types, the deformations in the type II and type III were greater by 2-2.5 times than in the type I regardless of the loading location. 2. The values of von Mises stresses in cortical and cancellous bone were relatively stable in all types, but slightly increased as the loading position was changed more posteriorly. 3. In comparison with type I, the values of von Mises stress in the implant increased by 73% in Type II and by 77% in Type III when the load was applied anterior and posterior respectively, but when the load was applied to the middle, the values were similar in all types. 4. When the load was applied to the centric fossa of pontic, the values of von Mises stress were nearly $30{\sim}35%$ higher in the type III than type I or II in the cortical and cancellous bone. Also, in the implant, the values of von Mises stress of the type II or III were $160{\sim}170%$ higher than in the type I. 5. When the load was applied to the centric fossa of implant abutment, the values of von Mises stress in the cortical and cancellous bone were relatively $20{\sim}25%$ higher in the type III than in the other types, but in the implant they were 40-45% higher in the type I or II than in the type III. According to the results of this study, musculature modeling is important to the finite element analysis for stress distribution and deformation as the muscular action causes stress concentration. And the type I model is the most stable from a view of biomechanics. Type II is also a clinically accept-able design when the implant is stiff sufficiently and mandibular deformation is considered. Considering the high values of von Mises stress in the cortical bone, type III is not thought as an useful design.
Many different appliances have been used to move teeth or to attempt to inhibit or stimulate growth of the jaws. Especially, Orthopedic force was used to apply a constant force on the mandible. Various orthopedic forces bring the changes of surrounding tissue, growth and development on the mandibular joint. Author carried out this study to find the histological changes of the mandibular joint in rats when the mandible applied posterior displacement. For the purpose of this study, $009\times036inch$ closed coil spring and 030inch orthopedic wire were used between the post occipital region and the chin region in order to render the orthopedic forces, posteriorly. The experimental animals vu. used 1 month old (GroupI), 3 months old (Group II), and 12 months old (Group III) rats. Following results were obtained; 1. At the beginning of the experimental Group I, there were predominant increment of Cartilage layer in the posterior parts of condylar head. Especially, the mature chondrocyte zone was increased. 2. In the experimental Group II, the chondroblastic zone was decreased while it showed slightly increased mature cartilage zone. 3. In the experimental Group III, the mature chondrocyte zone was disappeared gradually and there was a tendency to reduce the endochondral bone formation in condylar head. 4. After 30 days of experimental Group I and in experimental Group II, there was a tendency to decrease the immature cellular zone in the glenoid fossa by pressure. 5. There were no histological changes in the articular disc by pressure.
We report an unusual case of lateral medullary infarction after successful embolization of the vertebral artery dissecting aneurysm (VADA). A 49-year-old man who had no noteworthy previous medical history was admitted to our hospital with a severe headache. Computed tomography (CT) revealed a subarachnoid hemorrhage, located in the basal cistern and posterior fossa. Cerebral angiography showed a VADA, that did not involve the origin of the posterior inferior cerebellar artery (PICA). We treated this aneurysm via endovascular trapping of the vertebral artery distal to the PICA. After operation, CT revealed post-hemorrhagic hydrocephalus, which we resolved with a permanent ventriculoperitoneal shunt procedure. Postoperatively, the patient experienced transient mild hoarsness and dysphagia. Magnetic resonance image (MRI) showed a small infarction in the right side of the medulla. The patient recovered well, though he still had some residual symptom of dysphagia at discharge. Such an event is uncommon but can be a major clinical concern. Further investigation to reveal risk factors and/or causative mechanisms for the medullary infarction after successful endovascular trapping of the VADA are sorely needed, to minimize such a complication.
Kim, In-Kyeong;Wang, Kyu-Chang;Kim, In-One;Cho, Byung-Kyu
Journal of Korean Neurosurgical Society
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v.48
no.4
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pp.375-379
/
2010
The Chiari 1.5 malformation is defined as a tonsillar hemiation within a Chiari I malformation with additional caudal descent of the brainstem through the foramen magnum. We describe a patient with Chiari I malformation who evolved to Chiari 1.5 malformation during longitudinal follow-up. A 15-year-old girl presented with neck pain during exercise for two years. She had been diagnosed with Chiari I malformation with mild hydrocephalus after minor cervical trauma at the age of six years. At that time, she was asymptomatic. After she complained of aggravated neck pain, neuroimaging (nine years after first imaging) revealed caudal descent of the brainstem and syringomyelia in addition to progression of tonsillar hemiation. Posterior fossa decompressive surgery resulted in complete resolution of neck pain. Based on neuroimaging and operative findings, she was diagnosed as Chiari 1.5 malformation. Neuroimaging performed seven months after surgery showed an increased anterior-posterior diameter of the medulla oblongata and markedly decreased syringomyelia. This case demonstrates progressive developmental process of the Chiari 1.5 malformation as an advanced form of the Chiari I malformation.
Journal of Korean Academy of Oral and Maxillofacial Radiology
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v.9
no.1
/
pp.13-18
/
1979
The purpose of this study was to investigate the radiographic images of Temporomandibular joint trouble patients. This study included 186 patients with the chief complaints of TMJ pain and dysfunction. Their age ranged from 17 to 68 years. All patients were identified in the department of Dental mary of College of Dentistry, Seoul National University, Apr. 1978 to Jun. 1979. The author has observed the radiographic variations of two positions of condylar head taken by modified transcranial oblique-lateral projection, which are one in centric occlusion and the other in 1 inch(2.54㎝) mouth open. The results were obtained as follows; 1. In centric occlusion, the distances and positional relationship between the summit of condylar head and the deepest point of articular fossa revealed more or less large variations; Normal range is of 37.9%, anterior displacement of 37.3% and posterior displacement of 22.6%. 2. In the horizontal movement of condylar heads when on 1 inch mouth open, it was revealed that normalrange was of 46.5%, anterior displacement of 12.3%, posterior displacement of 41. 1 %. 3. In the positional interrelationship of both condylar heads when on 1 inch mouth open, it was revealed that symmetry(71. 5%) occurred approximately 2.5 times as many as asymmetry. 4. In both centric occlusion and 1 inch mouth open, it was showed that almost all estimated figures were greater in male than in female, and in the horizontal movement of condylar head when on 1 inch open, it was showed that hypermobility was dominant in male and hypomobility in female.
Marques, Aline Louise Nascimento;Figueroba, Sidney R.;Mafra, Marco Antonio Tridapalli;Groppo, Francisco Carlos
Journal of Dental Anesthesia and Pain Medicine
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v.22
no.3
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pp.227-231
/
2022
Although rare, complications can occur with anesthetic procedures. The posterior superior alveolar nerve (PSAN) block anesthetic technique has a high success rate, but positive aspiration can cause bruising, transient diplopia, blurred vision, and temporary blindness in approximately 3% cases. When edema occurs, it is occasionally massive, especially in the infratemporal fossa, and the resulting hematoma is usually unsightly. A 20-year-old woman presented with massive edema followed by hematoma in the upper right jaw immediately after PSAN block administration, which subsequently spread to the oral mucosa. The patient did not report any complications during the anesthetic procedure. However, after the injection was administered, the patient experienced anesthetic sensations, which rapidly evolved to facial edema. There was mild pain, but without intraoral or extraoral bleeding. The patient was prescribed medicines and instructed to perform contrast therapy. Although hematomas and edema are rare, they are difficult to prevent. The choice of local anesthetic and appropriate application of the anesthetic technique can minimize their occurrence.
The purpose of this study was to qunatatively analyze the stress patterns induced in the abutment, superstructure, supporting bone and to determine the deflection of abutment and superstructure by appling occlusal force to natural teeth supported fixed prostheses and implant-supported fixed prostheses. The analysis has been conducted by using the two dimensional finite element method. The implant and natural tooth-supported bridge has a first molar pontic supported by mandibular second bicuspid and implant posterior retainer, which were rigidly(Model A) or flexible(Model B). The natural teeth-supported bridge has a first molar pontic supported by mandibular second bicuspid and second molar, which were rigidly splinted together(Model C). 63.5kg(Load P1) of localized load on central fossa of first molar pontic and 24kg(Load P2) of distributed load on each occlusal surface were applied respectively. 1. The coronal portion of premolar pontic and posterior abutment in fixed partial denture deflected inferiorly in order of Model B, Model C and Model A under Load P1 and Load P2. 2. Mesial displacement of the coronal portion of premolar showed in Model A, Model B and Model C under Load P1, but mesial displacement of that in Model B and distal displacement of that in Model A and Model C showed under Load P2. 3. Mesial displacement of the coronal portion of the pontic and distal displacement of the coronal portion of posterior abutment showed in Model A, Model B and Model C under Load P1 and Load P2. Displacement in the case of Model B was greater than that of Model A and Model C. 4. In the case Model A under Load P1 and Load P2, high stress apically was concentrated in the mesiocervical portion of the posterior abutment than in the disto-cervical portion of the premolar. 5. In the case of Model B under Load P1 and Load P2 high stress was concentrated in the case of the premolar than in that of posterior abutment and high stress especially was concentrated in the connected portion of pontic and posterior abutment. 6. In the case of Model C under Load P1 and Load P2, high stress was concentrated in the distal area of the cornal portion of premolar and the mesial area of the coronal portion of posterior abutment, and stress pattern was anteroposterially symmetric around the pontic. 7. Load P1 and Load P2 compared, stress magnitude was different but stress pattern was similar in Model A, Model B and Model C. 8. Under Load P1 and P2, stress magnitude in the mesial distal portion and the portion of root apex of the posterior abutment was in order of Model B, Model A and Model C.
Journal of the korean academy of Pediatric Dentistry
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v.35
no.2
/
pp.357-366
/
2008
Posterior cross-bite is a relatively frequent malocclusion in primary and early mixed dentition and the reported prevalence of posterior cross-bite varies from 7% to 23%. It has been defined as a transverse discrepancy in arch relationship which the palatal cusp of the upper posterior teeth do not occlude in the central fossa of the opposing lower teeth, and can be manifested in a single tooth or in a group of teeth. Posterior cross-bite does not often self-correct and therefore immediate treatment is recommended. Occlusal adjustment to eliminate premature contact that causes mandibular deviation, expansion of narrow maxillary arch, arrangement of the individual teeth to treat asymmetry within the dental arch are the methods of treating cross-bite. In the present case, functional posterior cross-bite was observed in the primary and the early mixed dentition children. The children were treated by the slow maxillary expansion and occlusal adjustment. The outcome of periodic examinations after the correction of cross-bite was favorable.
Cortical support is an important factor, as the engagement of the fixture in strong compact bone offers an increased load-carrying capacity and initial stability. Because of the poor bone quality in the posterior mandible and other anatomic considerations, it has been suggested that implant fixtures be placed in these locations with apical engagement of the lingual cortical plate for so-called bicortication. The purpose of this investigation was to determine the effect of cortical engagements and in addition polyoxymethylene(POM) intramobile connector(IMC) of IMZ implant on implant load transfer in edentulous posterior segment of mandible, using three-dimensional (3D) finite element analysis models composed of cortical and trabecular bone involving single implant. Variables such as (1) the crestal peri-implant defect, (2) the apical engagement of lingual cortical plate, (3) the occlusal contact position (a vertical load at central fossa or buccal cusp tip), and (4) POM IMC were investigated. Stress patterns were compared and interfacial stresses along the bone-implant interface were monitored specially. Within the scope of this study, the following observations were made. 1) Offset load and angulation of fixture led to increase the local interfacial stresses. 2) Stresses were concentrated toward the cortical bones, but the crestal peri-implant defect increased the interfacial stresses in trabecular bone. 3) For the model with bicortication, it was noticed that the crestal cortical bone provided more resistance to the bending moment and the lingual cortical plate provided more support for the vertical load. But Angulation problem of the fixture from the lingual cortical engagement caused the local interfacial stress concentrations. 4) It was not clear that POM IMC had the effect on stress distribution under the present experimental conditions, especially for the cases of crestal peri-implant defect.
Cavernous hemangioma can occur in the entire brain but rarely in cerebellum, especially in the pediatric age group. Headache, seizure, gait disturbance, recurrent bleeding may be seen. This tumor is a relatively benign condition but if the lesion located in the posterior fossa or the brain stem bleeds, irreversible brain damage may occur because of its restrictive space. Moreover, it must be differentiated from malignant tumors. We report 12.6 year-old boy who represented posterior neck myalgia as the presenting symptom. The pain continued for about a month despite analgesic medications. Brain MRI showed intracranial hemorrhage in the left cerebellum (4.5 cm) representing repeated hemorrhages at different times and originated from the cavernous hemangioma accompanied by mild hydrocephalus. The lesion was surgically removed successfully and the cavernous hemangioma was confirmed by pathologic findings. After the follow-up period of 14 months, he is in good condition without any complications.
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