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Differences in Unmet Healthcare Needs among the Elderly by the Level of Medical Vulnerability: Implications for Securing Essential Healthcare Resources for the Medically Vulnerable Elderly (의료취약성 정도에 따른 노인의 미충족의료 경험 비교: 의료취약계층 노인의 필수적 의료자원 보장을 위한 시사점)

  • Shin, Serah
    • Journal of Family Resource Management and Policy Review
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    • v.26 no.3
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    • pp.49-64
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    • 2022
  • This study aims to investigate unmet healthcare needs due to economic or non-economic difficulties among the elderly aged 65 or older. Using Korea Health Panel Survey (KHPS) data from 2018, the elderly are classified into one of four groups (health insurance subscribers, non-take-up, lower income relief, and medical aid recipients) based on their level of medical vulnerability. For hospital or dental care, the prevalence rates of unmet healthcare needs due to economic and non-economic difficulties are 12.6% and 10.6%, respectively. The prevalence rate of unmet healthcare needs due to economic difficulty in the medically vulnerable group was much higher than that of the non-vulnerable group-that is, health insurance subscribers. After controlling for other influential factors, medical vulnerability has a great impact on the prevalence rates of unmet healthcare needs due to economic difficulties. Compared to health insurance subscribers, the non-take-up, the lower relief, and the medical aid recipients are 1.4 times, 3.3 times, and 2.4 times more likely to experience unmet healthcare needs due to economic difficulty, respectively. The results of this study can provide important policy implications for securing essential healthcare resources for the elderly.

Accuracy of CAD-CAM RPD framework according to manufacturing method: A literature review (국소의치 구조물(framework)의 CAD-CAM 제조방식에 따른 정확도: 문헌고찰)

  • Yi, Yuseung
    • The Journal of Korean Academy of Prosthodontics
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    • v.59 no.3
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    • pp.370-378
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    • 2021
  • Purpose. The purpose of this study was to evaluate the currently published literatures investigating the accuracy of computer-aided design and computer-aided manufacturing removable partial denture (CAD-CAM RPD) framework with different manufacturing techniques and methods. Materials and methods. A comprehensive search for literatures was conducted in PubMed database using specific keywords with the patient, intervention, comparison, and outcome (PICO) question, "Is there a difference in accuracy of RPD frameworks manufactured using digital workflow according to the manufacturing process and methods?" Results. A total of 7 articles were selected. Two studies compared intraoral scanning and laboratory scanning for RPD frameworks and had heterogenous results. In the studies using different manufacturing process, RPD frameworks had clinically acceptable accuracy in both subtractive and additive manufacturing. Polyetheretherketone (PEEK)-milled RPD frameworks showed higher fit accuracy than traditionally casted or 3D printed RPDs. Direct milling method showed a higher accuracy than indirect milling method. However, in rapid prototyping, indirect method showed higher accuracy than direct method. Conclusion. The RPD frameworks fabricated using CAD-CAM technology showed a clinically acceptable level of accuracy regardless of manufacturing process or techniques. Consistent results have not been reported regarding the digital impression methods, which were intra oral scanning or laboratory scanning, and further studies are needed.

Morphological Analysis of the Mental Foramen and Anterior Loop of the Mandibular Canal using Computed Tomography (전산화단층촬영 방사선영상을 이용한 이공과 하악관 전방고리의 형태학적 분석)

  • Kim, Yong-Gun
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.3
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    • pp.317-326
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    • 2011
  • The mental foramen and anterior loop of the mandibular canal are important landmarks for mandibular surgical procedures. The purpose of this study was to analyze the shape and position of the mental foramen and anterior loop of the mandibular canal on the computed tomography (CT) images, and apply the results clinically. CT images of 96 patients (33 male, 36 female, age range 17~43 years, mean $24.6{\pm}4.99$ years) were enrolled. The horizontal and vertical position of the mental foramen, as well as the distance from the root apices were measured. The distance of the anterior loop of the mandibular canal to the root apices, and the buccal angle were measured. The mental foramen was found mostly below the second premolar observed in 81 cases (46.0%), between the first and second premolars in 67 cases (38.0%), and between the second premolar and first molar in 19 cases (10.2%). The mean distance between the mental foramen and the lower border of the mandible was $12.20{\pm}1.77$ mm, the mean distance between the mental foramen and root apex was $5.16{\pm}0.98$ mm. The mean distance of the anterior loop of the mandibular canal was $5.80{\pm}2.00$ mm. The buccal angle measured at $47.7{\pm}9.07^{\circ}$. The distance between the root apex and mental foramen measured as $5.16{\pm}0.98$ mm on panoramic radiography, and $6.2{\pm}3.07$ mm on CT. The mean distance between the mental foramen and mandibular canal was $5.39{\pm}1.62$ mm. When performing surgical procedures such as installing dental implants, it is important to minimize surgical trauma, especially the risk of damage to the mental nerve. To optimize the surgical outcome, a careful assessment of the shape and position of the mental foramen and the anterior loop of the mandibular canal must be made. CT images are useful for finding such anatomic structures.

The effectiveness of sealing technique on in-office bleaching (전문가 미백시 sealing technique의 효율성에 관한 연구)

  • Lee, Yoon;Kwon, So-Ran;Park, Jeong-Won
    • Restorative Dentistry and Endodontics
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    • v.33 no.5
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    • pp.463-471
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    • 2008
  • This study investigated the clinical effectiveness and safety of sealed bleaching compared to conventional in-office bleaching using a randomized clinical trial of split arch design. Ten participants received a chairside bleaching treatment on the upper anterior teeth, and each side was randomly designated as sealed or control side. A mixture of Brite powder (PacDent, Walnut, USA), 3% hydrogen peroxide and carbamide peroxide (KoolWhite, PacDent, Walnut, USA) were used as bleaching agent. The control side was unwrapped and the experimental side was covered with a linear low density polyethylene (LLDPE) wrap for sealed bleaching. The bleaching gel was light activated for 1 hour. The tooth shades were evaluated before treatment, after treatment, and at one week check up by means of a visual shade (VS) assessment using a value oriented shade guide and a computer assisted shade assessment using a spectrophotometer (SP). The data were analyzed by paired t-test. In the control and sealed groups, the visual shade scores after bleaching treatment and at check up showed statistically significant difference from the preoperative shade scores (p<.05). The shade scores of the sealed group were significantly lighter than the control immediately after bleaching and at the check-up appointment (p<0.05). Compared to prebleaching status, the ${\Delta}E$ values at post bleaching condition were $4.35{\pm}1.38\;and\;5.08{\pm}1.34$ for the control and sealed groups, respectively. The ${\Delta}E$ values at check up were $3.73{\pm}1.95\;and\;4.38{\pm}2.08$ for the control and sealed groups. ${\Delta}E$ values were greater for the sealed group both after bleaching (p<.05) and at check up (p<.05). In conclusion, both ${\Delta}E$ and shade score changes were greater for the sealed bleaching group than the conventional bleaching group, effectively demonstrating the improvement of effectiveness through sealing.

ERUPTION TIME AND SEQUENCE OF PERMANENT TEETH IN STUDENTS FROM E-ELEMENTARY SCHOOL (E-초등학교 어린이의 영구치 맹출시기 및 순서)

  • Kwon, Joung-Hyun;Choi, Byung-Jai;Lee, Jae-Ho;Kim, Seong-Oh;Son, Heung-Kyu;Choi, Hyung-Jun
    • Journal of the korean academy of Pediatric Dentistry
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    • v.36 no.2
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    • pp.253-261
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    • 2009
  • The purpose of this study was to present new data on the timing and sequence of permanent teeth emergence and to compare these findings with the results of earlier studies. The dental examinations had been performed to E-elementary school students, who visited the Yonsei University Dental Hospital between 1998 and 2005; 1,307 boys and 1,312 girls with the age ranging from 6 to 12 years old. The followings were concluded. 1. Eruption time of the maxillary permanent teeth is as follows. It was 6.81 years in male and 6.73 years in female for the central incisor, 7.78 years in male and 7.65 years in female for the lateral incisor, 10.48 years in male and 9.92 years in female for the canine, 9.76 years in male and 9.63 years in female for the first premolar, 10.66 years in male and 10.49 years in female for the second premolar, 6.39 years in male and 6.26 years in female for the first permanent molar, and 12.13 years in male and 12.03 years in female for the second permanent molar. 2. Eruption time of the mandibular permanent teeth is as follows. The central incisor could not be determined in this study, but it is assumed to erupt before the age of 6.08. In the mandible, eruption time was 6.78 years in male and 6.65 years in female for the lateral incisor, 9.76 years in male and 9.05 years in female for the canine, 9.82 years in male and 9.59 years in female for the first premolar, 10.67 years in male and 10.52 years in female for the second premolar, 6.22 years in male and 6.12 years in female for the first permanent molar, and 11.58 years in male and 11.14 years in female for the second permanent molar. 3. The eruption sequence is as follows. In the maxilla, the first permanent molar erupted first, followed by the central incisor, the lateral incisor, the first premolar, the canine, the second premolar, and the second permanent molar. In the mandible, the central incisor erupted first, followed by the first permanent molar, the lateral incisor, the canine, the first premolar, the second premolar, and the second permanent molar. 4. Tooth eruption occurred earlier in female compared to male by average of 0.19 year in the maxilla and 0.29 year in the mandible. 5. In both male and female, the hiatus (interval of rest) occurred between the emergence of lateral incisor and first premolar in the maxilla while it was observed between the lateral incisor and canine in the mandible. Male had a hiatus of 1.98 years in the maxilla and 2.90 years in the mandible, while the female's were 1.98 years and 2.40 years, respectively.

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Clinical and radiographic evaluation of $Neoplan^{(R)}$ implant with a sandblasted and acid-etched surface and external connection (SLA 표면 처리 및 외측 연결형의 국산 임플랜트에 대한 임상적, 방사선학적 평가)

  • An, Hee-Suk;Moon, Hong-Suk;Shim, Jun-Sung;Cho, Kyu-Sung;Lee, Keun-Woo
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.2
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    • pp.125-136
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    • 2008
  • Statement of problem: Since the concept of osseointegration in dental implants was introduced by $Br{{\aa}}nemark$ et al, high long-term success rates have been achieved. Though the use of dental implants have increased dramatically, there are few studies on domestic implants with clinical and objective long-term data. Purpose: The aim of this retrospective study was to provide long-term data on the $Neoplan^{(R)}$ implant, which features a sandblasted and acid-etched surface and external connection. Material and methods: 96 $Neoplan^{(R)}$ implants placed in 25 patients in Yonsei University Hospital were examined to determine the effect of the factors on marginal bone loss, through clinical and radiographic results during 18 to 57 month period. Results: 1. Out of a total of 96 implants placed in 25 patients, two fixtures were lost, resulting in 97.9% of cumulative survival rate. 2. Throughout the study period, the survival rates were 96.8% in the maxilla and 98.5% in the mandible. The survival rates were 97.6% in the posterior regions and 100% in the anterior regions. 3. The mean bone loss for the first year after prosthesis placement and the mean annual bone loss after the first year for men were significantly higher than that of women (P<0.05). 4. The group of partial edentulism with no posterior teeth distal to the implant prosthesis showed significantly more bone loss compared to the group of partial edentulism with presence of posterior teeth distal to the implant prosthesis in terms of mean bone loss for the first year and after the first year (P<0.05). 5. The mean annual bone loss after the first year was more pronounced in posterior regions compared to anterior regions (P<0.05). 6. No significant difference in marginal bone loss was found in the following factors: jaws, type of prostheses, type of opposing dentition, and submerged /non-submerged implants (P<0.05). Conclusion: On the basis of these results, the factors influencing marginal bone loss were gender, type of edentulism, and location in the arch, while the factors such as arch, type of prostheses, type of opposing dentition, submerged / non- submerged implants had no significant effect on bone loss. In the present study, the cumulative survival rate of the $Neoplan^{(R)}$ implant with a sandblasted and acid-etched surface was 97.9% up to a maximum 57-month period. Further long-term investigations for this type of implant system and evaluation of other various domestic implant systems are needed in future studies.

A Study on the Patient Exposure Doses from the Panoramic Radiography using Dentistry (치과 파노라마 촬영에서 환자의 피폭선량에 관한 연구)

  • Park, Ilwoo;Jeung, Wonkyo;Hwang, Hyungsuk;Lim, Sunghwan;Lee, Daenam;Im, Inchul;Lee, Jaeseung;Park, Hyonghu;Kwak, Byungjoon;Yu, Yunsik
    • Journal of the Korean Society of Radiology
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    • v.7 no.1
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    • pp.17-24
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    • 2013
  • This study estimate radiation biological danger factor by measuring patient's exposed dose and propose the low way of patient's exposed dose in panoramic radiography. We seek correcting constant of OSL dosimeter for minimize the error of exposed dose's measurement and measure the Left, Right crystalline lens, thyroid, directly included upper, lower lips, the maxillary bone and the center of photographing that indirect included in panoramic radiography by using the human body model standard phantom advised in ICRP. In result, the center of photographing's level of radiation maximum value is $413.67{\pm}6.53{\mu}Gy$ and each upper, lower lips is $217.80{\pm}2.98{\mu}Gy$, $215.33{\pm}2.61{\mu}Gy$. Also in panoramic radiography, indirect included Left, Right crystalline lens's level of radiation are $30.73{\pm}2.34{\mu}Gy$, $31.87{\pm}2.50{\mu}Gy$, and thyroid's level of measured exposed dose can cause effect of radiation biological and we need justifiable analysis about radiation defense rule and substantiation advised international organization for the low way of patient's exposed dose in panoramic radiography of dental clinic and we judge need the additional study about radiation defense organization for protect the systematize protocol's finance and around internal organs for minimize until accepted by many people that is technological, economical and social fact by using panoramic measurement.

SPONTANEOUS ERUPTION OF ECTOPIC IMPACTED TOOTH BY INTENTIONAL EXTRACTION OF DECIDUOUS TOOTH (의도적 유치발치술에 의한 이소매복 영구치의 맹출유도)

  • Choi, In-Young;Kim, Seung-Hye;Kim, Seong-Oh;Choi, Hyung-Jun;Lee, Jae-Ho;Choi, Byung-Jai;Son, Heung-Kyu;Song, Je-Seon
    • Journal of the korean academy of Pediatric Dentistry
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    • v.38 no.4
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    • pp.385-390
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    • 2011
  • When many factors involved in the eruption of the teeth act as negative effects, they can cause eruption disturbance. Periodic observation, space acquirement, surgical exposure, orthodontic traction, orthodontic traction accompanied with surgical exposure, and surgical repositioning are considered as the treatment options of an impacted tooth, which is a form of eruption disturbance. In the first case, a male patient, age 9, visited Yonsei University Dental Hospital (YUDH) with a chief complaint of ectopic impaction of the upper left lateral incisor. We extracted the upper left primary lateral incisor and primary canine, and 5 months later, a window opening procedure was executed. Eight months later, the upper left lateral incisor partially erupted, and 18 months after the extraction, the axis of the tooth improved and the tooth erupted spontaneously. In the second case, a male patient, age 10, visited YUDH with a chief complaint of ectopic impaction of the upper right first premolar. We extracted the upper right first primary molar. Ten months later, the upper right first premolar erupted partially, and 19 months after the extraction, the upper right first premolar erupted spontaneously. We reported two cases in which improvement of eruption path and spontaneous eruption of an ectopic impacted tooth was achieved by extracting the deciduous tooth which interfered with the proper eruption of it.

Retrospective study on three-dimensional characteristics of mesiodens using CBCT in pediatric dentistry (치과용 Cone-beam CT를 이용한 상악 정중과잉치의 3차원적 특성에 관한 후향적 연구)

  • Ryu, GiYoun;Song, Ji-Soo;Shin, Teo Jeon;Hyun, Hong-Keun;Kim, Jung-Wook;Jang, Ki-Taeg;Lee, Sang-Hoon;Kim, Young-Jae
    • Journal of the korean academy of Pediatric Dentistry
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    • v.48 no.1
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    • pp.77-94
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    • 2021
  • The purpose of this study was to investigate the three-dimensional characteristics of mesiodens using Cone-beam Computed Tomography(CBCT) and analyze the factors affecting complications and anesthetic methods of extraction. This study evaluated 602 mesiodens of 452 patients who underwent extraction of mesiodens at the department of Pediatric Dentistry in Seoul National University Dental Hospital between 2017 and 2019. The ratio of mesiodens patients over total patient per year was gradually increased over the past 20 years. Mesiodens with labio-palatally horizontal direction while root directing labial were the most common among the mesiodens with horizontal direction. Mesiodens were the most common at the cervical side of the adjacent teeth(37.0%) and mesiodens located in the near-palatal side were observed about 3.83 times higher than the far-palatal side. Most of the mesiodens(82.1%) were in contact with adjacent permanent teeth on all three sides of the CBCT and 46.2% of mesiodens had curved roots. The patient's age, vertical position, presence of complications, and proximity showed a significant difference in the selection of general anesthesia among anesthetic methods. The direction and vertical position of mesiodens had a significant effect on complications. These results provide a better understanding of mesiodens for establishing an accurate diagnosis and treatment plan.

Root and Canal Morphology of Maxillary Primary Molar using CBCT and 3D CT (CBCT 및 3D CT를 활용한 상악 유구치 치근과 근관 형태)

  • Kim, Joon Hee;Kim, Hyuntae;Shin, Teo Jeon;Hyun, Hong-Keun;Kim, Young-Jae;Kim, Jung-Wook;Jang, Ki-Taeg;Song, Ji-Soo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.48 no.4
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    • pp.437-448
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    • 2021
  • The purpose of this study is to analyze morphological characteristics of maxillary primary molar's root and root canal. 268 children aged 3 - 7 years (175 boys, 93 girls) who had CBCT (152 children) and 3D CT (116 children) taken in Seoul National University Dental Hospital from January 2006 to April 2020 were included. The number of roots and root canals were analyzed in 1002 teeth without any root resorption or periapical pathologies. Curvature, angulation, length of root and root canal, as well as cross-sectional shapes of the root canal were analyzed in 218 teeth. By using Mimics and 3-Matics software, volume, surface area, and volume ratio of root canal was analyzed in 48 teeth. More than half of maxillary primary molars have 3 roots and 3 root canals. The degree of symmetry of root canal type was about 0.63 (Cohen's kappa coefficient). The most frequent shape of roots and canals was linear in 1st primary molars and curved in 2nd primary molars. Angulation, length of root and root canals was the largest on palatal roots. Most teeth showed ovoid or round shapes at apex. The largest root canal volume, surface area, volume ratio was found in the palatal roots.