• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.1
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• pp.78-83
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• 2020

Objectives: The discontinuation of bisphosphonate (BP) treatment before tooth extraction may induce medication-related osteonecrosis of the jaw (MRONJ). Whether the long-term discontinuation of BP treatment before tooth extraction affects the risk of developing MRONJ after tooth extraction or whether extended drug holidays induce systemic side effects remains unclear. The present study assessed the incidence of MRONJ among patients who underwent tooth extraction and did not discontinue BP therapy prior to the procedure. Materials and Methods: Patients were classified according to whether or not they discontinued BP therapy before tooth extraction. Differences in the incidence of MRONJ after tooth extraction were compared between the two groups using the chi-squared test. Results: The BP-continuation (BPC) and BP-discontinuation (BPDC) groups included 179 and 286 patients, respectively. One patient in the BPC group and no patients in the BPDC group developed MRONJ (P=0.385). The patients in the BPDC group stopped receiving BP therapy at a mean of 39.0±35.5 months prior to tooth extraction. Conclusion: The possibility of pre-existing MRONJ in the extraction area must be considered during the extraction procedure. Routine discontinuation of BP medications for several months before the extraction procedure should be carefully considered, as evidence of its efficacy in reducing the development of post-extraction MRONJ is limited.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.4
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• pp.317-321
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• 1993

Two patients with maxillary developmental deficiency who have previously undergone cheiloplasty and palatoplasty were operated on by simultaneous two jaw surgery and maxillary advancement surgery respectively. And the following results were obtained. 1. After the operation, maxilla shifted superiorly, and then inferiorly without noticible posterior relapse. 2. Postoperative mandibular relapse to the anterior direction was evident in both cases. 3. It is highly suggested that definitive measures to enhance postoperative stability in orthognathic surgery on the cleft lip and palate patients be developed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.6
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• pp.588-593
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• 2006

Cyst is pathologic disease develops in hard tissue as well as soft tissue, which is lined by epithelium filled with liquid, semi-liquid, or air. Origins and symptoms of the cyst are various according to region, and symptoms are malocclusion, diversion of root, tooth mobility, periapical swelling, discoloration and lesion expansion, because the odontogenic cysts begin in the numerous rests of odontogenic epithelium. But almost cysts produce no symptoms unless secondary infection occurs. Treatment of small cysts may include extraction, endodontic therapy, and apical surgery. Treatment of a large cysts usually involves surgical removal (enucleation), Marsupialization(a method of decompression) or combination of two before mentioned. Bone graft is done for helping of bone defect healing at the same time of enucleation This clinical research from January 2000 to December 2005, analyzed by the age, sex, classification, size, region, treatment method, whether or not of bone graft of cyst in the jaw in Daegu Catholic University Hospital.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.2
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• pp.94-99
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• 2017

Objectives: Idiopathic bone cavity (IBC) is an uncommon intra-osseous cavity of unknown etiology. Clinical features of IBC are not well known and treatment modalities of IBC are controversial. The purpose of this study was to investigate the clinical characteristics of 27 IBC patients who underwent surgical exploration. Materials and Methods: A total of 27 consecutive patients who underwent surgery due to a jaw bone cavity from April 2006 to February 2016 were included in this study. Nine male and 18 female patients were enrolled. Patients were examined retrospectively regarding primary site, history of trauma, graft material, radiographic size of the lesion, presence of interdental scalloping, erosion of the inferior border of the mandible, complications, results of bone graft, and recurrence. Results: Female dominance was found. Maxillary lesion was found in one patient, and bilateral posterior mandibular lesions were found in two patients. The other patients showed a single mandibular lesion. The posterior mandible (24 cases) was the most common site of IBC, followed by the anterior mandible (5 cases). Two patients with anterior mandibular lesion reported history of trauma due to car accident, while the others denied any trauma history. Radiographic cystic cavity length over 30 mm was found in 10 patients. Seven patients showed erosion of the mandibular inferior border. The operations performed were surgical exploration, curettage, and bone or collagen graft. One bilateral IBC patient showed recurrence of the lesion during follow-up. Grafted bone was integrated into the native mandibular bone without infection. One patient reported necrosis of the mandibular incisor pulp after operation. Conclusion: Differential diagnosis of IBC is difficult, and IBC is often confused with periapical cyst. Surgical exploration and bone graft are recommended for treating IBC. Endodontic treatment of involved teeth should be evaluated before operation. Bone graft is recommended to reduce the healing period.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.417-421
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• 2005

This study was to analyze the changes of levels of alkaline phosphatase before and after enucleation of jaw cysts combined with bone grafting, and to evaluate biochemically the effectiveness of the early detection of bone healing and infection as a prognostic marker. Eighteen patients (13 males, 5 females) with cystic lesions of the jaws were divided into two groups. The bone graft group underwent enucleation and bone graft. The control group underwent only enucleation. Both groups were measured levels of ALP before surgery, and plus-minus 4 weeks postoperatively. The more discriminating results were obtained in the bone graft group. The results were as follows : 1. Levels of ALP after enucleation of jaw cysts were decreased in all patients with and without bone graft. 2. The bone graft group showed more marked decrease in variation of levels of ALP than the control group.(p=0.008) This should be considered as a result of increased osteoblastic activity and new bone formation. 3. Such variation could be used as a prognostic marker for bone healing after cyst operation. In the cost/benefit ratio, measurement of ALP activity could be useful as a convenient procedure in routine clinical practice.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.2
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• pp.57-61
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• 2014

Bisphosphonate is used widely for osteoporosis treatment, but a rising concern is the risk of osteonecrosis after long-term bisphosphonate use. Such cases are increasing, suggesting a need for research to prevent and treat bisphosphonate-related osteonecrosis of jaws. A 63-year-old female took bisphosphonate (Fosamax$^{(R)}$) for four years for treatment of osteoporosis and stopped medication two months ago because of unhealed wound. She was treated with marginal mandibulectomy maintaining the inferior border, and a metal plate was placed to prevent mandible fracture. Four months after the mandibulectomy, mandible reconstruction surgery using iliac bone and allograft was done. Six months after reconstruction, implant placement and treatment with an overdenture was done without complications. This study presents a case with a successful result.

• The Journal of the Korean dental association
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• v.57 no.2
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• pp.100-104
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• 2019

Orthognathic surgery is designed to correct problems of the jaw and face and restore facial harmony. The limitations of orthognathic surgery occur at all steps of the surgical workflow: preoperative planning, simulation, and operation. Many studies have shown the accuracy and advantages of 3 dimensional computer-assisted program for orthognathic surgery. The purpose of this paper is to introduce the accuracy of the maxillary repositioning in patients who underwent orthognathic surgery using a 3 dimensional computer assisted surgery program. The reliability of computer guided orthognathic surgery using splint and surgical guide need to be improved further. The 3 dimensional computer assisted analysis seems to be more precise to interpret than two-dimensional analysis. High-precision planning of orthognathic surgery has predictable results. Three-dimensional computer assisted orthognathic surgery has the following advantages : planned surgical movement is possible, splints guide with CAD/CAM technology; and increase predictable results .Computer assisted simulation surgery ensures accuracy during surgery, thereby facilitating predictable results. It may provide solution that enables surgeon to perform planned surgery more accurately.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.5
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• pp.428-436
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• 2008

For Longevity of implant, considerations of biomechanical and microbiological aspects must be done. Recently, due to the remarkable development of bone grafting procedure. Implant has been implanted into the more favorable sites but peri-implantitis resulted from periodontal bacteria may obscure the long-term prognosis. Although many different modalities have been introduced to treat the failed implant. Implant's surface and irreversible bony destruction around the implant prevents good result. After Er,Cr:YSGG (waterlase) laser using the wave-length of 2780nm has been introduced to dental field, good results have been reported. Because waterlase uses the hydrokinetic force of water. It is excellent device to detoxify the implant surface mechanically without the heat generation and damage to the implant surface. We designed to evaluate waterlase effect on the peri-implantitis has been occurred after implantation. Four beagle dogs were involved. We have made four premolar extraction in each right and left side of the lower jaw and placed two implants in the anterior of the jaw as a control and six implant were placed posterior in each socket after extraction immediately as an experimental group. We tied floss-silk in each implant to make peri-implantitis intentionally. After three months, we explored peri-implant sites on each experimental fixtures. Using waterlase laser irradiation was performed on that implantitis sites under 3W, air 30% and water 20% intensity for 2 minutes. In control group, we repositioned the flap to cover the exposed fixture without any supportive care. Three months later, we sacrificed experimental animals and extracted and preparated bone blocks with Donath and Breuner (982), Donath (988)'s methods and examined under microscope. We have obtained good re-osseointegration around fixtures after treating with waterlaser irradiation. But it was shown fibroosseointegration in the control group.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.1
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• pp.54-61
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• 2011

Introduction: Bisphosphonates is used widely for the treatment of the Paget's disease, multiple myeloma, bone metastases of malignant tumors with the prevention of pain and their pathological fracture. However, it was recently suggested that bisphosphonates related osteonecrosis of the jaw (BRONJ) is a side effect of bisphosphonate use. Materials and Methods: Twenty-four individuals, who were referred to the Department of Oral and Maxillofacial surgery, Dankook University Dental Hospital, were selected from those who had exposed bone associated with bisphosphonates from January, 2005 to December, 2009 according to the criteria of American Association of Oral and Maxillofacial Surgeons (AAOMS) for BRONJ. The patients group consisted of 7 males and 17 females between the age of 46 to 78 years (average 61.8 years). Each patient had panoramic imaging, computed tomography (CT), whole body bone scanning performed for a diagnosis and biopsy sampling from the necrotizing tissue. C-terminal cross-linking telopeptide of type I collagen (CTX) level of patients who had undergone surgical intervention was measured 7 days before surgery. Results: The main cause of bone exposure was post-extraction (15), chronic periodontitis (4), persistent irritation of the denture (3). Twenty people had undergone BRONJ treatment for two to eight months except for 4 people who had to maintain the bisphosphonates treatment to prevent a metastasis and bone trabecular pain with medical treatment. When the bisphosphonate treatment was suspended at least for 3 months and followed up according to the AAOMS protocols, the exposed necrotizing bones were found to be covered by soft tissue. Conclusion: Prevention therapy, interruption of bisphophonates for at least 3 months and cooperation with the physician for conservative treatment are the essential for treating BRONJ patient with high risk factors. The CTX level of BRONJ patients should be checked before undergoing surgical intervention. Surgical treatments should be delayed in the case of a CTX level <150 pg/mL.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.2
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• pp.150-160
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• 2005

Background: For normalization of displaced anatomical structure by large cyst, two-step procedure (decompression and enucleation afterward) has been recommended. However, the histological transformation after cystotomy for decompression was shown frequently in secondary enucleation. Therefore, analyses about effects and histological changes after decompression have been necessary. Methods: 48 cases diagnosed as large odontogenic cyst in the jaw and treated by decompression and secondary enucleation were retrospectively analyzed in clinical, rediographical, and histological aspects. Results: In dentigerous cyst, decompression was much useful. Impacted permanent teeth were erupted and reduction rate was higher than that of odontogenic keratocyst (OKC) and apical periodontal cyst. In OKC, among the 29 cases, 11 cases showed no-keratosis, proliferation and rete-ridge elongation after decompression. 4 cases showed no-keratosis, only. 7 cases showed orthokeratosis and rete-ridge elongation and 6 cases showed reteridge elongation, only. 1 case had no change. And the recurrence rate for OKCs was 10.3%. For all odontogenic cysts in this study, dysplasia was not found in cystic lining after decompression. Conclusions: This study implied that decompression for large odontogenic cyst was useful treatment modality because it was conservative treatment and recurrence rate was low although long treatment period was required.