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Diagnosis and Effect of Maxillary Expansion in Pediatric Sleep-Disordered Breathing (소아 수면호흡장애의 진단과 상악확장술의 치료효과)

  • Kim, Doyoung;Baek, Kyounghee;Lee, Daewoo;Kim, Jaegon;Yang, Yeonmi
    • Journal of the korean academy of Pediatric Dentistry
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    • v.46 no.4
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    • pp.369-381
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    • 2019
  • The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023). In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.

Histomorphometric Study of Sinus Bone Graft using Various Graft Material (다양한 골이식재료를 이용한 상악동 골이식 4개월 후 조직형태계측학적 평가)

  • Lee, Ji-Young;Kim, Young-Kyun;Kim, Su-Gwan;Lim, Sung-Chul
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.2
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    • pp.141-147
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    • 2011
  • The aim of this study was to evaluate histomorphometrically and compare the efficiency of various bone graft material and autogenous tooth bone graft material which were used in sinus bone graft procedure. Subjects were the 24 patients who had treated with sinus bone graft using lateral approach from October 2007 to September 2009 at SNUBH. The average age was $52.51{\pm}11.86$ years. All cases was taken after 4month of procedure and divided into 3 groups according to bone graft material. Group 1: autogenous tooth bone graft material, Group 2: OrthoblastII(integra lifescience corp. Irvine, US)+Biocera(Osscotec, seoul, korea), group 3: DBX(Synthes, USA)+BioOss(Geistlich Pharm AG, Wolhusen, Switzerland). Total 37 implant placement area were included and evaluated(7 in group 1, 10 in group 2, 20 in group 3). Evaluation of new bone formation, ratio of woven bone to lamellar bone, ratio of new bone to graft material were performed on each tissue section. Kruskal-Wallis test was used for statistical analysis(SPSS Ver. 12.0, USA). New bone formation were $52.5{\pm}10.7%$ in group 1, $52.0{\pm}23.4%$ in group 2, $51.0{\pm}18.3%$ in group 3. There were no statistical significant differences between each groups. Ratio of woven bone to lamella bone were $82.8{\pm}15.3%$ in group 1, $36.7{\pm}59.3%$ in group 2, $31.0{\pm} 51.2%$ in group 3. Ratio of new bone to graft material were $81.3{\pm}10.4%$ in group 1, $72.5{\pm}28.8%$ in group 2, $80.3{\pm}24.0%$ in group 3. After 4 month of healing period, all group showed favorable new bone formation and around graft material and implant. Within limitation of our study, it is suggested that autogenous tooth bone graft material might be used as novel bone graft material for sinus bone graft.

Influences of Unilateral Mandibular Block Anesthesia on Motor Speech Abilities (편측 하악전달마취가 운동구어능력에 미치는 영향)

  • Yang, Seung-Jae;Seo, In-Hyo;Kim, Mee-Eun;Kim, Ki-Suk
    • Journal of Oral Medicine and Pain
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    • v.31 no.1
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    • pp.59-67
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    • 2006
  • There exist patients complaining speech problem due to dysesthesia or anesthesia following dental surgical procedure accompanied by local anesthesia in clinical setting. However, it is not clear whether sensory problems in orofacial region may have an influence on motor speech abilities. The purpose of this study was to investigate whether transitory sensory impairment of mandibular nerve by local anesthesia may influence on the motor speech abilities and thus to evaluate possibility of distorted motor speech abilities due to dysesthesia of mandibular nerve. The subjects in this study consisted of 7 men and 3 women, whose right inferior alveolar nerve, lingual nerve and long buccal nerve was anesthetized by 1.8 mL lidocaine containing 1:100,000 epinephrine. All the subjects were instructed to self estimate degree of anesthesia on the affected region and speech discomfort with VAS before anesthesia, 30 seconds, 30, 60, 90, 120 and 150 minutes after anesthesia. In order to evaluate speech problems objectively, the words and sentences suggested to be read for testing speech speed, diadochokinetic rate, intonation, tremor and articulation were recorded according to the time and evaluated using a Computerized Speech $Lab^{(R)}$. Articulation was evaluated by a speech language clinician. The results of this study indicated that subjective discomfort of speech and depth of anesthesia was increased with time until 60 minutes after anesthesia and then decreased. Degree of subjective speech discomfort was correlated with depth of anesthesia self estimated by each subject. On the while, there was no significant difference in objective assessment item including speech speed, diadochokinetic rate, intonation and tremor. There was no change in articulation related with anesthesia. Based on the results of this study, it is not thought that sensory impairment of unilateral mandibular nerve deteriorates motor speech abilities in spite of individual's complaint of speech discomfort.

Analysis of relationship between cracked tooth syndrome and occlusion using Q-ray and T-scan (큐레이(Q-ray)와 티스캔(T-scan)을 사용한 치아균열증후군(cracked tooth syndrome)과 교합 사이의 상관관계에 대한 분석)

  • Ahn, Do-Gwan;Choi, Jin-Woo;Kim, Yuseong;Pyo, Se-Wook;Kim, Hee-Kyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.59 no.3
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    • pp.271-280
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    • 2021
  • Purpose. The aim of this study was to evaluate the relationship between the patient's occlusion and a cracked tooth by using T-scan occlusal analysis and a quantitative light-induced fluorescence (QLF) technology. Materials and methods. This study was carried out on 51 patients having cracked teeth between January, 2019 and December, 2020. The tooth crack was determined with a Q-ray pen and QLF parameters (ΔFmax and ΔRmax) were obtained by a Q-ray software. T-scan tests were conducted to all subjects and then, the occlusal force and disclosing time were analyzed. Mann-Whitney U test was performed to compare the occlusal force and disclosing time between cracked teeth groups and contra-lateral normal teeth groups (α = .05). Mann-Whitney U test was performed to compare ΔFmax and ΔRmax according to the results of cold/bite tests (α = .05). A Spearman correlation analysis was run to determine the relationship between ΔFmax or ΔRmax and occlusal force or disclosing time (α=.05). Results. The mean occlusal force and disclosing time were significantly higher on cracked teeth than on normal teeth (P < .05). The ΔFmax or ΔRmax were not significantly different according to the results of cold/bite tests (P > .05). There was no correlation between ΔFmax or ΔRmax and occlusal force or disclosing time (P > .05). Conclusion. There was a significant relationship between occlusion and cracked tooth syndrome. QLF has the potential to be a valuable tool for the diagnosis of tooth crack in clinical practice.

Identification of Mesiodens Using Machine Learning Application in Panoramic Images (기계 학습 어플리케이션을 활용한 파노라마 영상에서의 정중 과잉치 식별)

  • Seung, Jaegook;Kim, Jaegon;Yang, Yeonmi;Lim, Hyungbin;Le, Van Nhat Thang;Lee, Daewoo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.48 no.2
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    • pp.221-228
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    • 2021
  • The aim of this study was to evaluate the use of easily accessible machine learning application to identify mesiodens, and to compare the ability to identify mesiodens between trained model and human. A total of 1604 panoramic images (805 images with mesiodens, 799 images without mesiodens) of patients aged 5 - 7 years were used for this study. The model used for machine learning was Google's teachable machine. Data set 1 was used to train model and to verify the model. Data set 2 was used to compare the ability between the learning model and human group. As a result of data set 1, the average accuracy of the model was 0.82. After testing data set 2, the accuracy of the model was 0.78. From the resident group and the student group, the accuracy was 0.82, 0.69. This study developed a model for identifying mesiodens using panoramic radiographs of children in primary and early mixed dentition. The classification accuracy of the model was lower than that of the resident group. However, the classification accuracy (0.78) was higher than that of dental students (0.69), so it could be used to assist the diagnosis of mesiodens for non-expert students or general dentists.

Alveolar ridge preservation using granulation tissue for esthetic implant restoration on maxillary anterior tooth (상악 전치부의 심미적 임플란트 수복을 위한 육아 조직(Granulation tissue)을 이용한 치조제 보존술)

  • Lee Chang Kyun
    • Journal of the Korean Academy of Esthetic Dentistry
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    • v.32 no.1
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    • pp.16-22
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    • 2023
  • Esthetic factors are very important in the success of maxillary anterior implant restoration. However, achieving esthetic results is difficult, especially in cases where periodontitis has resulted in severe alveolar bone loss. In the case of maxillary anterior teeth, the alveolar ridge resorption that begins immediately after tooth extraction interferes with the esthetic implant restoration. Therefore immediate implant placement can be performed to minimize the alveolar ridge resorption. However, in severe bone loss cases, immediate implant placement could result in esthetic failure, and this result might cause irreparable problems. We can also perform alveolar ridge preservation and then place implants later. On JCP published in 2019, there is the consensus of European academy of periodontology on the extraction socket management and the timing of implant placement. This consensus states that alveolar ridge preservation should be considered when there is severe labial bone loss in an esthetically important area such as maxillary anterior region. On performing the alveolar ridge preservation, we cannot obtain the primary wound closure, so secondary wound healing is induced with open membrane technique or soft tissue grafting should be performed for primary wound closure. However, the secondary wound healing can have a negative impact on bone regeneration, and soft tissue grafting such as FGG or CT graft can be burdensome for both patients and dentists. On the other hand, by using the granulation tissue in the extraction socket, primary closure can be achieved without soft tissue grafting. Also some studies have shown that granulation tissue in periodontal defects contains stem cells that may help in tissue regeneration. Based on this, implant restorations were performed on maxillary anterior teeth with severe alveolar bone loss by alveolar ridge preservation using granulation tissue. In spite of the severe bone defect of the extraction socket, relatively esthetic results could be obtained in implant restorations.