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Reestablishing the occlusal plane in full mouth rehabilitation patient, using Shilla system (전악수복환자에서 Shilla system을 이용한 교합평면 재구성 증례)

  • Yang, Min-Soo;Vang, Mong-Sook;Park, Sang-Won;Lim, Hyun-Phil;Yun, Kwi-Dug;Yang, Hong-So
    • The Journal of Korean Academy of Prosthodontics
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    • v.51 no.1
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    • pp.33-38
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    • 2013
  • Occlusal plane is a sagittal expression of dental arch form, and it composes the shape of occlusion, which is one of the most important elements of Maxillo-oral system. In this case, vertical, horizontal coordinates of bionic-median-sagittal plane was produced in articulator, and to achieve relation of left and right position of upper, lower teeth and deficits in alveola, Shilla system was used to reconstruct occlusal plane. In this case, a 41 year-old male patient visited for fracture of 10 unit metal-ceramic fixed partial denture of upper anterior teeth and for overall treatment. Clinical, radiographical, model examination was held, full mouth rehabilitation was achieved by placing dental implant. Maxillo-oral relation was recorded using Gothic arch Tracer complex and were mounted. And for the next step, we estimated original occlusal plane using Shilla system. After analysis we produced diagnosis wax pattern. On the basis of this, radiography stent was manufactured and dental implant was placed, and temporary prosthesis was made by using diagnosis wax pattern. Cross mounting and anterior guiding table were performed in order to reproduce temporary restoration morphology and bite pattern, followed by final restoration made of all ceramic crown with zirconia coping. As stated above, appropriately esthetic and functional results can be seen in using Shilla system in diagnosis and treatment procedure of full mouth rehabilitation patient.

Treatment of Subclavian Artery Injury in Multiple Trauma Patients by Using an Endovascular Approach: Two Cases (다발성 외상환자에서 혈관계 접근을 통해 치료한 쇄골하동맥 손상 2례)

  • Cho, Jayun;Jung, Heekyung;Kim, Hyung-Kee;Lim, Kyoung Hoon;Park, Jinyoung;Huh, Seung
    • Journal of Trauma and Injury
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    • v.26 no.3
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    • pp.243-247
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    • 2013
  • Introduction: Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique. Case 1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent($8mm{\times}40mm$ in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period. Case 2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period. Conclusion: The challenge of repairing an SA injury can be overcome by using an endovascular approach.

A Case of Renovascular Hypertension Due to Renal Artey Stenosis Related to Moyamoya Disease (모야모야병과 동반된 신 동맥 협착에 따른 신성 고혈압을 보인 1례)

  • Kim, Joung-A;Kim, Seung;Kim, Hyo-Sun;Shin, Jae-Il;Jeong, Il-Cheon;Kim, Dong-Seok;Kim, Myung-Joon;Lee, Do-Yun;Lee, Jae-Seung
    • Childhood Kidney Diseases
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    • v.11 no.2
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    • pp.294-298
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    • 2007
  • Moyamoya disease is a progressive cerebrovascular disorder with stenosis or occlusion of the bilateral internal carotid arteries with abnormal vascular networks at the base of the brain. Previous reports have shown that there are extracranial vascular involvements in Moyamoya disease, especially in the renal artery. We report a 7-year-old patient with Moyamoya disease associated with renovascular hyper tension, who presented in infancy with seizures and hemiparesis. Renal angiography showed multiple stenoses of the right renal artery. Although renal artery stenosis in Moyamoya disease has been effectively treated with balloon angioplasty, stent implantation, or surgery, bat-loon angioplasty could not be done in this patient due to multiple stenoses. His blood pressure was successfully controlled with medical treatment, and remained normotensive during the follow up period of 6 months.

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Successful Renal Autotransplantation for the Treatment of Severe Renovascular Hypertension in a 14-year-old Boy (신 자가이식을 통한 14세 소년에서 발생한 심한 신성 고혈압의 성공적인 치료)

  • Ji, Min-Chul;Park, Se-Jin;Choi, Jae-Young;Ko, Young-Guk;Kim, Myoung-Soo;Kim, Ji-Hong;Shin, Jae-Il
    • Childhood Kidney Diseases
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    • v.14 no.2
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    • pp.223-229
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    • 2010
  • Percutaneous transluminal renal angioplasty (PTRA) is the current treatment of choice for renal artery revascularization, but renal autotransplantation has been an alternative treatment for complex cases. Here we report a 14-year-old boy with severe hypertension successfully treated with PTRA and renal autotransplantation. Doppler ultrasonography and computed tomography (CT) angiography revealed slight narrowing in the right renal artery ostium and complete obstruction in the left renal artery ostium with multiple collaterals. PTRA with stent insertion was performed for the treatment of the right renal artery, but it was impossible for the left renal artery due to the total obstruction. Therefore, left nephrectomy for autotransplantation was done with the peritoneal approach and the left kidney was autotransplanted to the ipsilateral iliac fossa. Postoperatively, Doppler ultrasonography and mercapto-acetyl-triglycine (MAG-3) renogram were performed, which showed normal renal artery blood flow and kidney function. Blood pressure was normalized and anti-hypertensive drugs were gradually tapered. Fibromuscular dysplasia was suspected to be responsible for the renal artery stenosis based on clinical aspects. In conclusion, renal autotransplantation is also a good treatment option for children with severe renovascular hypertension when endovascular treatment has failed or is not possible.

The thickness of palatal masticatory mucosa (구개 저작 점막의 두께에 대한 연구)

  • Han, Kwang-Hee;Kim, Dong-Jin;Yun, Jeong-Ho;Jung, Ui-Won;Kim, Chang-Sung;Cho, Kyoo-Sung;Chai, Jung-Kiu;Kim, Chong-Kwan;Choi, Seong-Ho
    • Journal of Periodontal and Implant Science
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    • v.34 no.3
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    • pp.573-580
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    • 2004
  • The Palatal masticatory mucosa was widely used as a donor site in periodontal and implant surgery. but there were relatively few studies investigating the thickness of the palatal mucosa in dentate subjects. The purpose of this study was to study the thickness of palatal masticatory mucosa in korean subjects by direct clinical technique. Forty systemically and periodontally healthy subjects(20 males:20 females) participated in this study. A bone sounding method using a periodontal probe with minimal anesthesia and a prepared clear acrylic stent was utilized to assess the thickness of palatal mucosa at 24 measurement points defined according to the gingival margin and mid palatal suture. The results are as follows; 1. Mean thickness of palatal masticatory mucosa was $3.5{\pm}0.4mm$. and no gender differences were identified in the thickness of palatal masticatory mucosa. 2. The thickness of palatal masticatory mucosa increased from canine to second molar area(with the exception of the first molar area). canine and first molar areas were significantly thinner than other areas(P<0.05). 3. The thickness of palatal masticatory mucosa significantly increased in the sites farther from the gingival margin towarding the mid-palate(P<0.05). The results suggest that within the limits of the present study, premolar area appears to be the most appropriate donor site for soft tissue grafting procedures.

Spontaneous Perinephric Urinoma after the Removal of a Foley Catheter in a Girl with Acute Kidney Injury (급성 신부전 환아에서 유치 도뇨관 제거 후 발생한 신 주위 요낭종 1례)

  • Yang, Tae Hwan;Yim, Hyung Eun;Yoo, Kee Hwan
    • Childhood Kidney Diseases
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    • v.17 no.2
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    • pp.127-131
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    • 2013
  • Urinomas can occur after renal trauma or perforation of the collecting system during an endosurgical procedure. However, spontaneous urinomas are very rare. Here we report a case of a spontaneous perinephric urinoma following the removal of a Foley catheter in an 18-year-old girl with acute kidney injury caused by septic shock. The patient had been treated for septic shock, acute kidney injury, and acute respiratory distress syndrome, and had a Foley catheter in place for seven days. After Foley catheter removal, the patient complained of consistent voiding difficulty. An abdominal computed tomography scan showed a large amount of left perinephric fluid, and the aspirated fluid included urothelial cells, confirming the diagnosis of a urinoma. The urinoma was successfully treated by insertion of a double-J stent into the left ureter. This report discusses the available literature on urinomas, and their clinical features, diagnosis, and treatment.

Full mouth rehabilitation of edentulous patient with fixed implant prosthesis (고정성 임플란트 보철물을 이용한 완전 무치악 환자의 구강회복 증례)

  • Shi, Hee-Hyun;Kim, Jong-Jin;Baik, Jin;Cha, Hyun-Suk;Lee, Joo-Hee
    • Journal of Dental Rehabilitation and Applied Science
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    • v.37 no.3
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    • pp.147-156
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    • 2021
  • There are various treatment options such as conventional complete denture, hybrid prosthesis and implant-supported fixed prosthesis for fully edentulous patients. In case of implant-supported fixed prosthesis, compared to removable prosthesis, it is difficult to place the implant in the correct position considering the anatomical contours of the final prosthesis. In this case, a full mouth rehabilitation with implant-supported fixed prosthesis was performed for a patient who required extraction of all remaining teeth due to dental caries and chronic periodontitis. In the implant placement stage, the implant was placed in the desired position using a surgical guide fabricated considering the anatomical contours of the final prosthesis, and the function and esthetics were evaluated through correction and re-fabrication of the fixed provisional restoration. A final restoration of porcelain fused to gold prosthesis was delivered to the patient based on the provisional restoration. To cope with complications such as loosening of screws and fracture of porcelain, a screw-retained type prosthesis was fabricated for the posterior part and a screw-cement-retained type prosthesis for the anterior part. As a result, the patient showed an improved prognosis in terms of functional and esthetics after the final prosthesis was delivered.

Fundamental Study of Relative Measurement for Accurate Measurement of Stent Size in Computed Tomography Angiography (컴퓨터단층 혈관조영술에서 스텐트 사이즈의 정확한 측정을 위한 상대적 측정법의 기초연구)

  • Lee, Seung-Young;Hong, Joo-Wan;Kang, Su-Mi;Kim, Su-Bin;Joon, Sang-Hoon;Heo, Yeong-Cheol
    • Journal of the Korean Society of Radiology
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    • v.13 no.5
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    • pp.713-720
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    • 2019
  • The purpose of this study was to propose a new measurement method for accurate measurement of vessel diameter in computed tomography angiography(CTA). CTA test was performed after non-ionic iodine contrast agent was flowed at a constant rate to self-maded perfusion phantom. After obtaining raw data, images were reconstructed with multi-planar reconstruction(MPR) and maximal intensity projection(MIP). Diameters of vascular models were measured for each technique. Relative and conventional measurements were then compared. The mean diameter of the vascular model was closer to the actual measurement when relative measurement was used compared to that when conventional measurement was used both in MPR and MIP. Relative measurements of MPR and MIP were closer to actual measurement than those of conventional measurement (34% VS, 24%, p<0.05). The relative measurement method proposed in this study was closer to the actual measurement than the conventional measurement method. However, both test methods were still larger than actual results. Therefore, further study of relative measurement method is needed using this study as basic data.

Aspiration-Retriever Technique for Stroke with Large Bore Intermediate Catheter : A Single Center Experience

  • Nam, Ji Won;Jung, Na Young;Park, Eun Suk;Kwon, Soon Chan
    • Journal of Korean Neurosurgical Society
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    • v.64 no.5
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    • pp.732-739
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    • 2021
  • Objective : Early successful reperfusion is associated with favorable outcomes in acute ischemic stroke (AIS). The purpose of this study was to achieve successful recanalization by a combined mechanical thrombectomy technique, the Aspiration-Retriever Technique for Stroke (ARTS), which is composed of a flexible large lumen distal access catheter and a retrievable stent as the first-line strategy of mechanical thrombectomy. Methods : We retrospectively reviewed 62 patients with AIS who underwent mechanical thrombectomy from 2018 to 2019 at our institute by a senior neurointerventionalist. Among them, patients who were treated using the ARTS technique with the soft torqueable catheter optimized for intracranial access (SOFIA®; MicroVention-Terumo, Tustin, CA, USA) as the first-line treatment were included. Patients who had tandem occlusions or underlying intracranial artery stenosis were excluded. The angiographic and clinical outcomes were evaluated. The angiographic outcome was analyzed by the rate of successful recanalization, defined as a Thrombolysis in Cerebral Infarction score of 2b or 3 at the end of all procedures and the rate of successfully achieving the first pass effect (FPE), defined as complete recanalization with a single pass of the device. The clinical outcomes included the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS), and mortality. Results : A total of 27 patients (mean age, 59.3 years) fulfilled the inclusion criteria. The successful recanalization rate was 96% (n=26) while the FPE rate was 41% (n=11). The mean post-procedural NIHSS change was -3.0. Thirteen patients (48%) showed good clinical outcomes after thrombectomy with the ARTS technique (mRS at 90 days ≤2). Postoperative complications occurred in seven of 25 patients : hemorrhagic transformation in six patients (22%) and distal embolization in one patient (4%). Mortality was 15% (n=4). Conclusion : Although the clinical outcomes using the ARTS technique with a flexible large lumen distal access catheter performed as the frontline thrombectomy in patients with AIS were not significantly superior than those of other studies, this study showed a high rate of successful endovascular recanalization which was comparable to that of other studies. Therefore, ARTS using the SOFIA® catheter can be considered as the first choice of treatment for AIS due to large vessel occlusion.

Posterior rehabilitation considering mandibular movement with digital facebow transfer and virtual articulator: A case report (디지털 안궁이전과 가상교합기를 이용하여 하악의 운동을 고려한 구치부 수복 증례)

  • Kim, Min-Beom;Kwon, Ho-Beom;Lim, Young-Jun;Kim, Myung-Joo
    • The Journal of Korean Academy of Prosthodontics
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    • v.60 no.4
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    • pp.431-441
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    • 2022
  • The digital facebow device records the trajectory of the mandibular movement where it is then reflected on the computer-aided design software, leading to an improvement on treatment outcomes of prosthetic restorations. In this clinical case, using a digital technology, an implant placement and prosthetic restoration were done in a patient who has lost maxillary and mandibular molars. Following an intraoral scan, a surgical stent for implant surgery was fabricated based on digital diagnostic wax-up, and implants were installed. After six months of sufficient osseointegration, customized abutments and the first temporary prostheses were delivered. Then two months later, at an abutment level, an intraoral scan and digital facebow transfer device were used to mount the intraoral scan data on a virtual articulator, and record the mandibular movements. Once the second temporary prostheses were fabricated and delivered on a basis of the mandibular movement, the definitive zirconia prostheses were designed and delivered based on a stabilized occlusion that was duplicated via double scan technique.