• Journal of Microbiology and Biotechnology
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• v.25 no.3
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• pp.399-406
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• 2015

In this study, we developed a composite filler comprising cross-linked hyaluronic acid (HA) and human collagen (COL) derived from the human umbilical cord with the aim of improving its biocompatibility and longevity compared with commercially available fillers. After HA/COL composite fillers were made in two different ratios (10:1 and 5:1), the physical properties of the fillers were evaluated. The interior morphologies and in vivo weight change of these hydrogels were also characterized at 1-16 weeks after injection into mice. To evaluate their biocompatibility and durability in vivo, we injected the composite fillers into nude mice subcutaneously. The variations of injected gel weight were measured and compared with the commercial dermal fillers (Restylane and TheraFill). The composites showed improved or similar physical properties (complex viscosity of 19-22 × 10⁵ cP, and injection force of 10-12 N) over the commercial dermal fillers. Sixteen weeks following the injection, the ratio of remaining composite filler weight to initial weight (75.5 ± 16.9%; 10:1) was shown to be greater than that of the commercial fillers (43.2 ± 8.1%, Restylane; 12.3 ± 5.3%, TheraFill). In addition, immunohistochemical analysis with angiogenesis-related markers such as isolectin and vWF revealed newly formed blood vessels and cellular influx into the composite filler, which were not observed in the other fillers. These results clearly suggest that the HA/COL composite filler is a superior candidate for soft tissue reconstruction. The filler we developed may be a suitable candidate as an injectable dermal filler for tissue augmentation in humans.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.1
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• pp.66-72
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• 2011

A severely vertical resorbed ridge is a significant challenge in implant dentistry. To solve this problem, several augmentation techniques, such as guided bone regeneration (GBR), onlay bone grafts, distraction osteogenesis, and ridge splitting techniques, have been proposed and used for several years. Among these methods, vertical ridge augmentation using guided bone regeneration aims to build space and guide osteoblasts to this space to promote osteogenesis. The aim of guided bone regeneration is to maintain and stabilize the space and block the proliferation of adjacent soft tissue. In our hospital, we encountered a case of a woman in her forties with an atrophied mandible, who underwent implant surgery in the right mandible. Titanium reinforced Gore-Tex (TRG) was used to augment the mandible and titanium mesh was used in the left mandible. Favorable results were obtained. This report compares the two methods and reviews the relevant literature.

• Journal of Periodontal and Implant Science
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• v.40 no.3
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• pp.139-143
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• 2010

Purpose: Pink gingival esthetic especially on the anterior teeth has been an important success criterion in implant-supported restoration. Inter-implant papillae are a critical factor for implant esthetics, and various techniques for inter-implant papilla reconstruction have been introduced. The aim of this study is to suggest and evaluate a surgical technique for reconstructing inter-implant papillae. Methods: A 28-year-old man had an implant placed on the #13 and #14 area. Four months after implant placement, a second stage surgery was planned for inter-implant papilla reconstruction. At the time of the abutment connection, I-type incisions were performed on the #13i & #14i area followed by full-thickness flap elevation and connection of a healing abutment on underlying fixtures without suture. Results: Two weeks after the second stage implant surgery, soft tissue augmentation between the two implants was achieved. Conclusions: I-shaped incisions for papilla reconstruction performed during the second stage implant surgery were useful for inter-implant papilla reconstruction and showed a good esthetic result.

• The Journal of Advanced Prosthodontics
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• v.8 no.1
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• pp.70-74
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• 2016

In the maxillary anterior region, reconstruction of the localized alveolar ridge defect is very important in enhancing the esthetics of fixed partial denture. A 40-year-old female patient presented with a chief complaint of the inconvenience and unesthetic problem of 3-unit maxillary anterior prosthesis due to alveolar ridge resorption. After removal of old prosthesis, intraoral examination revealed moderate (buccolingually 4 mm) ridge deficiency in missing tooth region, leading to the diagnosis of Class I alveolar ridge defect. One of the reconstruction techniques to overcome this problem might be a technique that combines two types of soft tissue augmentation techniques. The purpose of this paper was to demonstrate the new combined technique of roll flap and combination onlay-interpositional graft utilized to acquire sufficient dimension of recipient area by one time of operation and to present the esthetic improvement of fixed partial denture by using this procedure in case of maxillary anterior localized ridge defect.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.489-492
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• 2009

Purpose: Autologous fat injection is ideal for patients who wish to add contour, projection and gross volumization of the aging, atrophic face and is claimed to be a safe procedure. However, there are several case reports in the literature where patients have suffered from acute visual loss and cerebral infarction after facial fat injection. This paper will explore a rare case of vessel related complication, an arteriovenous fistula that occurs after fat injection on forehead. Method: A 28 - year - old female who showed a non - tender, soft $1.0{\times}2.5cm$ sized mass on forehead for 3 weeks. A thrill could be detected on the totuous dilatated vessel - like structure around the mass. She had a fat injection on forehead for soft tissue augmentation 3 months prior to developing the mass. 3 - dimensional brain CT angiography showed arteriovenous fistula. Results: The fistula is totally excised with ligation of feeding vessels. Pathology report showed an atypical vessel which had intimal thickening, myxoid degeneration and thrombus formation. There were no evidences of recurrence at least for 2 months of follow - up. Conclusion: An occurrence of arteriovenous fistula after autologous fat injection is very rare. After perforation of artery and vein by coincidence, blood extravasates with the formation of a hematoma capsule and a pseudocapsule around it. The hematoma capsule would expand and clot would reabsorb resulting in a cavity leading to fistula formation. Other vessel related complications like acute visual loss or cerebral infarction are very severe. Therefore, surgeons should be cautious during facial fat injection to avoid vessel injuries.

• Restorative Dentistry and Endodontics
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• v.33 no.1
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• pp.39-44
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• 2008

The treatment of esthetic areas with single-tooth implants represents a new challenge for the clinician. In 1993, a modification of the forced eruption technique, called "orthodontic extrusive remodelling," was proposed as a way to augment both soft- and hard-tissue profiles at potential implant sites. This case report describes augmentation of the coronal soft and hard tissues around a fractured maxillary lateral incisor associated with alveolar bone loss, which was achieved by forced orthodontic extrusion before implant placement. Through these procedures we could reconstruct esthetics and function in a hopeless tooth diagnosed with subgingival root fracture by trauma.

• Archives of Plastic Surgery
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• v.42 no.2
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• pp.150-158
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• 2015

Background Fat is widely used in soft tissue augmentation. Nevertheless, it has an unpredictably high resorption rate. Clinically, external expansion with negative pressure is used to increase fat graft survival. In this study, fat graft recipient sites were preconditioned by external application of negative pressure in order to test for improvements in vascularity and fat graft survival. Methods Negative pressure was applied randomly to either the left or right dorsal ear of 20 New Zealand male white rabbits at a pressure of -125 mm Hg. The negative pressure was removed one week after the skin perfusion was measured. The skin flap at each ear was elevated, and 1 g of fat was grafted above the dorsal perichondrium. After one week, the fat weight, microvessel density, mature vessel density of the skin and fat, and amount of glycerol released were measured. Three months after the grafting, the same measurements were performed, with the exception of glycerol release. Results The fat survival rate of the experimental group ($75.4%{\pm}3.9%$) was higher than that of the control group ($53.1%{\pm}4.3%$) (P<0.001). Skin perfusion was higher in the experimental group. The glycerol release in the experimental group was significantly higher than in the control. The microvessel density of the skin and fat was significantly higher in the experimental group. Three months after the grafting, the skin and fat mature vessel density was significantly higher in the experimental groups. Conclusions Negative pressure prior to fat grafting increased the vascularity of the recipient site, and, accordingly, enhanced fat graft survival.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.3
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• pp.238-244
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• 2000

The present study was aimed to investigate the effect of osseointegration according to implant placement timing in the distracted alveolar bone using intraoral distraction device. Six adult mongrel dogs of either sex, weighing about 15kg, were used. The animals were divided into 4-week and 8-week groups according to the timing of implant installation. The left upper and lower premolars and first molars were extracted and an alveoloplasty was performed to simulate an atrophic ridge. After 12 weeks of healing, a segmental osteotomy was made and an intraoral distraction device which was designed for augmentation of vertical height of the edentulous ridge was applied. Latency period was allowed for 5 days and then distraction was made at a rate of 1.2mm/day for 8 days. Four or eight weeks after distraction, implants were installed. Twelve weeks after implant installation, the animals were sacrificed. Macroscopic, radiographic, and histologic examinations of distracted alveolar ridge were performed. No significant abnormalities such as infection and dehiscence of overlying soft tissue were observed. Radiographically, there was slight bone resorption around the medial and distal edges of the alveolar bone segment, and a new bone deposition was observed in the neighboring alveolar crest area in the both groups. The satisfactory osseointegration was achieved in the distracted gap of the both groups, but fibrous tissue appeared on the buccal side of implant in the distracted gap in 4-week group. These results suggest that proper timing of implant installation is 8 weeks rather than 4 weeks after distraction when dental implant is to be placed onto the distracted bone.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.4
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• pp.350-364
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• 1995

As early as 1889, treatment of ostemyelitis was reported using xenogeneic demineralized bone. In 1965, Urist discovered that demineralized long bone fragment, even when implanted in nonskeletal tissue, would stimulate osteogenesis. The clinical use of demineralized bone of Oral and Maxillofacial surgery is not new. The demineralized bone implants were used for 1) interposition within osteotomy gaps, cystic detects, alveolar clefts ; 2) augmentation, over intact bone surfaces ; 3) construction of new bone within soft tissue. Demineralized bone grafts invokes a induced osteogenesis which is the transformation of host cells into osteoblasts. Demineralized bone has identified several factors that modulate the osteogeneic response : sterilization method, recipient age, particle size etc. Especially, pulverization of bone matrix may enhance its osteoinductive properties, to allow rapid, efficient bridging of large defects. the purpose of the present report was to describe the potential efficacy of demineralized allogeneic bone powder of skull of rabbits as a particle size ; 212 ${\mu}m$, 710 ${\mu}m$, 1 mm each other. Microscopic finding in our experimental studies shown that 710 ${\mu}m$ demineralized bone powder is the most potent osteogenic response, and then 212 ${\mu}m$, 1 mm size. Densitometric analysis shown that density of all group was continue to increase until 4 weeks after operation, and then continue to decrease.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.431-438
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• 2008

Purpose: The common deformity after the correction of unilateral cleft lip nasal deformity is nasal asymmetry, and it is caused by the hypoplasia of the pyriform aperture. To correct this, many procedures have been applied, but still many problems are present. Authors performed the inlay and onlay insertion of porous high density polyethylene sheet(1 mm thickness $Medpor{(R)}$ sheet) in the hypoplastic pyriform margin of cleft side and obtained satisfactory results. Methods: 11 cases were performed and the mean follow up period was 15.1 months. Their mean age was 23.6 years. Under general anesthesia, bilateral pyriform margin was exposed. $Medpor{(R)}$ sheets in "match stick" like shaped were inlay inserted, and kidney shaped were onlay inserted fixating with two 6 mm titanium screws. After the surgery, the results was evaluated by photogrammetric analysis. On the basal view, the distance from the subalare and labiale superius' to the transverse baseline connecting the both cheilions was measured from the cleft side and the non-cleft side. Then, the postoperative symmetry was assessed by obtaining the cleft side against the non-cleft side as proportion index, defined as lateral and medial upper lip contour index. Results: There were 2 infections. The cause was because the inserted implant was too long and thus protruded to the base of nasal cavity. The lateral upper lip contour index was from 95.49 to 103.27, and medial upper lip contour index was from 90.92 to 100.49, it was statistically increased, and thus the symmetry was improved. However clinically mild depression remained at nostril floor. Conclusion: Authors performed porous high density polyethylene sheet inlay and onlay insertion for the hypoplasia of the pyriform margin in unilateral cleft lip nasal deformity. It was found that depressed pyriform margin and upper lip were corrected effectively except for the nostril floor, for which an additional soft tissue augmentation would be necessary. The inlay insertion has risk of protrusion, thus the guideline of the use of artificial prosthesis should be observed strictly.