• Title/Summary/Keyword: mandibular density

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Bisphosphonate Related Osteonecrosis of Jaw on Mandibular Molar Area: a Case Report (하악 구치부에 발생한 Bisphosphonate Related Osteonecrosis of Jaw의 치험례)

  • Park, Jae-An;Yoon, Kyu-Ho;Cheong, Jeong-Kwon;Bae, Jung-Ho;You, Kyung-Ha;Jo, Kyu-Hong;Shin, Jae-Myung;Baik, Jee-Seon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.32 no.5
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    • pp.478-483
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    • 2010
  • Bisphosphonates are synthetic analogue and have high affinity on bone remodeling site. Since they have a long half-reduction time, they accumulate at bone and act for a long time. They are widely used in osteo-porosis derived from imflammatory bowel disease or postmenopausal osteoporosis patient for bone mineral density improvement. In addition, they neutralize hypercalcemia owing to bone metastasis of malignancy. However, a jaw bone necrosis was recently reported in some patients who have taken bisphosphonates for a long time. It is called Bisphosphonate Related Osteonecrosis of Jaws (BRONJ). It can come spontaneous-ly, but more often after oral surgery including tooth extraction. In this case, a 80-year-old woman was treated with bisphosphonate (sodium alendronate) for 2 years to improve bone mineral density. She had her left lower second molar tooth extracted at local clinic. After extraction, she had inflammatory symptoms like a pain, a cheek swelling, and a discharge of pus. She was referred to our clinic for treatment. We treated meticulously from dressing to surgery. After following up about 1.5 years, the jaw lesion was successfully healed. So we report this case.

The effect of varying peripheral bone structure and bone density on the occlusal stress distribution of human premolar regions (사람 소구치부위에서 주위골의 구조 및 밀도변화가 교합력에 의한 치아의 응력분포에 미치는 영향)

  • Suh, Ye-Joon;Shim, June-Sung;Lee, Keun-Woo;Chung, Moon-Kyu;Lee, Ho-Yong
    • Journal of Dental Rehabilitation and Applied Science
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    • v.19 no.1
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    • pp.7-15
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    • 2003
  • This study used FEM(Finite Element method) based on micro-CT images to see the effects of occlusal force distribution with varying bone density and structure. the mandibular premolar region from human cadaver, thickness of 10mm was imaged using micro-CT. the cross sectional images were taken every $10{\mu}m$. these were reconstructed and the longitudinal image at the mid point of mesiodistal of the speciman was obtained for the specimen for the FEM. The stress disribution produced by a vertical force at 100N and 100N horizontal were analyzed by MSC Nastran FEM Package. according to the result of this study the occlusal force distribution depends on the structure of cancellus bone and for further information on the occlusal force distribution on the tooth and the surrounding structure requires further studies on cancellus bone structure. CEJ of all model show the highest peak and region whice meet teeth and bone show second high peak. Original model and cortical bone add model show different stress distribution. Stress distribution changed according to bone structures and densities.

MANDIBULAR DISTRACTION OSTEOGENESIS WITH COMPRESSION FORCE - BONE DENSITY, HISTOLOGICAL FINDINGS AND TMJ RESPONSE (압축력을 병용한 하악골 신장술)

  • Hwang, Young-Seob;Heo, June;Kim, Uk-Kyu;Park, Seong-Jin;Hwang, Dae-Seok;Kim, Yong-Deok;Chung, In-Kyo;Kim, Kyu-Cheon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.28 no.6
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    • pp.531-548
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    • 2006
  • The purpose of this study was to investigate the biomechanical, histologic findings of distracted regenerate and TMJ response in modified distraction osteogenesis (DO) technique combined with compression force as biomechanical stimulation method which has been suggested in 2002, and developed thereafter by authors. This study was performed with two experiments. First experiment was designed to explore the optimal ratio of compression force versus distraction force for the new DO technique. Second experiment was planned to evaluate the reaction of TMJ tissue, especially condyle, disc after application of the DO technique with compression force. Total 52 New Zealand adult male-rabbits with 3.0kg body weight were used for the study. For the first study, 30 adult male-rabbits underwent osteotomy at one side of mandibular body and a external distraction device was applied on each rabbit with same manner. In the control group of 10 rabbits, final 8 mm of distraction with 1 mm rate per day was done with conventional DO technique after 5 latency days. For the experimental group of 20 rabbits, a compression force with 1 mm rate per day was added to the distracted mandible on 3-latency day after over-distraction (over-lengthening). As the amount of the rate of compression versus distraction, experimental subgroup I (10 rabbits) was set up as 2 mm compression versus 10 mm distraction (1/5) and experimental subgroup II (10 rabbits) was set up as 3 mm compression versus 11 mm distraction (about 1/3). All 30 rabbits were set up to obtain final 8 mm distraction and sacrificed on postoperative 55 day to analysis on biomechanical, and histologic findings of the bone regenerates. For second study, 22 adult male-rabbits were used to evaluate TMJ response after the DO method application with compression force. In the control group, 10 rabbits was used to be performed with conventional DO method, on the other hand, in a experimental group of 10 rabbits, 10 mm distraction with 2 mm compression (1/5 ratio) was done. The remaining 2 rabbits served as the normal control group. Histomorphologic examinations on both condyle, histological studies on condyle, disc were done at 1, 2, 3, 4, 7 weeks after distraction force application. The results were as follows: 1. On the bone density findings, the experimental group II (force ratio - 1/3) showed higher bone density than the other experimental group (force ratio - 1/5) and control group (control group - $0,2906\;g/cm^2$, experimental group I - $0.2961\;g/cm^2$, experimental group II - $0.3328\;g/cm^2$). 2. In the histologic findings, more rapid bone maturation like as wide lamellar bone site, more trabeculae formation was observed in two experimental groups compared to the conventional DO control group. 3. In morphologic findings of condyle, there were no differences of size and architecture in the condyle in the control and experimental groups. 4. In histologic findings of condyles, there were thicker fiberous and proliferative layers in experimental group than those of control group until 2 weeks after distraction with compression force. But, no differences were seen between two groups on 3, 4, 7 weeks after compression. 5. In histologic findings of disc, more collagen contents in extracellular matrix, more regular fiber bundles, and less elastin fibers were seen in experimental group than control group until 2 weeks after distraction with compression. But, no differences were seen between two groups on 3, 4, 7 weeks after distraction with compression. From this study, we could identify that the new distraction osteogenesis technique with compression stimulation might improve the quality of bone regeneration. The no remarkable differences on TMJ response between control and experimental groups were seen and TMJ tissues were recovered similarly to normal TMJ condition after 3 weeks.

Minimizing the risk of perioperative cardiovascular complications in homozygous familial hypercholesterolemia: a case report

  • Khan, Saad;Min, Samuel;Willard, Garrett;Lo, Iris;D'Souza, Rachael;Park, Aaron
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.20 no.1
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    • pp.39-44
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    • 2020
  • Homozygous familial hypercholesterolemia (HoFH) is a rare inherited disorder that presents as abnormally elevated levels of low-density lipoprotein cholesterol and premature heart disease, requiring frequent intervention through lipid apheresis for management. The risk of perioperative cardiac events is higher in patients with HoFH because of its pathophysiological manifestations in the vascular system. Careful cardiac precautions and anesthetic assessments are necessary to ensure patient safety. In the following case report, we discuss the clinical course and anesthetic considerations for a 14-year-old girl with HoFH undergoing sedation for dental extractions and mandibular molar uprighting in an outpatient oral surgery clinic. Considerations included the use of heparin in the patient's weekly plasma lipid apheresis treatment. In order to reduce the risks of peri- and postoperative bleeding and perioperative cardiac events, the operation was scheduled for 4 days after apheresis. This allowed for adequate heparin clearance, while also reducing the likelihood of possible cardiac events. A literature review revealed no results for the outpatient management of patients with HoFH undergoing sedation for noncardiac procedures. Our reported case serves as a clinical example for physicians to be utilized in the future.

Observation of trabecular changes of the mandible after orthognathic surgery using fractal analysis

  • Kang, Hyeon-Ju;Jeong, Song-Wha;Jo, Bong-Hye;Kim, Yong-Deok;Kim, Seong-Sik
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.38 no.2
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    • pp.96-100
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    • 2012
  • Objectives: This study sought to evaluate trabecular changes in the mandible using fractal analysis and to explain the transient osteopenia related to rapid orthodontic tooth movement after orthognathic surgery. Materials and Methods: Panoramic radiographs were taken of 26 patients who underwent bilateral sagittal split ramus osteotomy. Radiographs taken before the surgery and 1 month after surgery were overlapped, and $40{\times}40$ pixel square regions of interest were selected near the mandibular canines and 1st molars. After the image processing procedure, the fractal dimension was calculated using the box-counting method. Results: Fractal dimension after orthognathic surgery decreased in a statistically significant manner (P<0.05). The change in fractal dimension on the canine side had greater statistical significance as compared to that seen on the 1st molar side. Conclusion: This study found that bone density decreases after orthognathic surgery due to transient osteopenia related to the regional acceleratory phenomenon. This result can provide a guide to evaluating orthodontic tooth movement after orthognathic surgery.

Prediction of osteoporosis using fractal analysis on periapical and panoramic radiographs (치근단 및 파노라마 방사선사진에서 프랙탈 분석을 이용한 골다공증 예측)

  • Kim, Joo-Yeon;Jung, Yun-Hoa;Nah, Kyung-Soo
    • Imaging Science in Dentistry
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    • v.38 no.3
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    • pp.147-151
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    • 2008
  • Purpose : The purpose of this study was to investigate whether fractal analysis of periapical and panoramic radiographs was useful in predicting osteoporosis risk. Materials and Methods : 37 postmenoposal women between the age of 42 and 79 were classified as normal and osteoporosis group according to the bone mineral density of lumbar vertebrae and periapical and panoramic radio-graphs were taken. Fractal dimensions at periapical areas of mandibular first molars were calculated to differentiate the two groups. Results : The mean fractal dimensions of normal group on periapical and panoramic radiographs were $1.413{\pm}0.079$, $1.517{\pm}0.071$ each. The mean fractal dimensions of osteoporotic group on periapical and panoramic radiographs were $1.498{\pm}0.086$, $1.388{\pm}0.083$ each. The mean fractal dimension from peripaical radiographs of osteoporotic group was statistically significantly higher than that of normal group. The mean fractal dimension from panoramic radiographs of osteoporotic group was statistically significantly lower than that of normal group. Conclusion : Fractal analysis using periapical and panoramic radiographs was useful in predicting osteoporosis.

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Periosteal reaction as a crucial radiographic finding for desmoplastic fibroma of the jaw bone in children: A case report

  • Motevasseli, Safa;Yousefi, Zahra;Kajan, Zahra Dalili;Modanlou, Reza;Roudbari, Niousha
    • Imaging Science in Dentistry
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    • v.52 no.3
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    • pp.319-326
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    • 2022
  • This report presents the case of a 5-year-old boy with a hard swelling on the right side of the mandible body. An important point of this case is that the primary imaging finding was fine spicules in the inferior border of the mandible on panoramic radiography without significant changes in bone density. Cone-beam computed tomography views revealed a lytic lesion on the lingual side of the right mandibular body with the destruction of the lingual cortex and periosteal reaction from the midline to the first molar area. Careful attention to this radiographic finding in the primary stage in the absence of other significant imaging findings, particularly in children, could result in the early diagnosis of desmoplastic fibroma. Therefore, a better prognosis can be expected following early surgical treatment.

Is conservative treatment (enucleation using modified Carnoy's solution) of odontogenic keratocyst in the maxilla good prognosis?

  • Woo Young Jeon;Jung Ho Park;Jeong-Kui Ku;Jin-A Baek;Seung-O Ko
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.49 no.5
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    • pp.287-291
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    • 2023
  • Odontogenic keratocysts (OKCs) located in the maxillae have rarely been reported in the literature. Standard treatment modalities for OKC range from marsupialization to marginal resection. However, most of the studies on OKC treatment have been related to mandibular OKCs. The anatomical structure and loose bone density of the maxillae and the empty space of the maxillary sinus could allow rapid growth of a lesion and the ability to tolerate tumor occupancy in the entire maxilla within a short period of time. Therefore, OKCs of the maxillae require more aggressive surgery, suchas resection. As an alternative, this report introduces a modified Carnoy's solution, a strong acid, as an adjuvant chemotherapy after cyst enucleation. This report describes the clinical outcomes of enucleation using a modified Carnoy's solution in patients with large OKCs on the posterior maxillae. In three cases, application of a modified Carnoy's solution had few side effects or morbidity. Each patient was followed for four to six years, and none showed any signs of recurrence. In conclusion, adjuvant treatment with a modified Carnoy's solution can be considered a treatment option capable of reducing the recurrence rate of OKC in the maxillae.

Morphometric Study of the Irradiation Effect on the Cartilage Formation in the Rat Mandibular Condyle (방사선 조사가 백서 하악과두 연골 형성에 미치는 영향에 관한 형태계측학적 연구)

  • Kim Jeong-Hwa;Heo Min-Suk;Lee Sam-Sun;Choi Soon-Chul
    • Journal of Korean Academy of Oral and Maxillofacial Radiology
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    • v.29 no.1
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    • pp.87-103
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    • 1999
  • Purpose: This study was undertaken to quantitatively estimate the degree of the damage and recovery of the irradiated rat condylar cartilage using the Image Analyzer. Materials and Methods: Experimental animals were 16 male rats of the Sprague-Dawley strain at the age of 20 day irradiated with the dose of 10 Gy in their head and neck region. Four rats were sacrificed at the each of the following time intervals - 1, 4, 7 and 14 days, respectively. The same number of control group animals were sacrificed at the each age of 21. 24, 27 and 34 days, respectively. The specimens were stained with 0.5% toluidine blue and examined with light microscope. The condylar cartilage was divided into 4 zones; fibrous zone, proliferating zone, upper hypertrophic zone, and lower hypertrophic zone. And then, the proliferating zone was subdivided into 2 layers - upper and lower layer, and upper and lower hypertrophic zone were subdivided into three layers, respectively - upper, middle and lower layer. With the aid of Image Analyzer, morphometric analysis was performed. The thickness, the numerical density of cells, the cell area density, the extracellular matrix area density, the mean area of single cell, the mean area of extracellular matrix per single cell were measured and analysed. Results: In the experimental group, the thickness of the fibrous zone was slightly increased and that of the proliferating zone and the upper and the lower hypertrophic zone was markedly decreased. With time, the thickness of the fibrous zone was gradually increased and that of the proliferating zone and the upper and the lower hypertrophic zone was steadily in the decreased state. The numerical density of cells of the proliferating zone was increased on post-irradiated 1 day, but decreased after post-irradiated 4 day, and that of the upper hypertrophic zone was decreased. The numerical density of cells of the lower hypertrophic zone was decreased in the early stage and then was decreased or not significantly different from that of the control group with time. In the experimental group, the cell area density of the fibrous zone and the proliferating zone was decreased in the early stage and then gradually increased or not significantly different from that of the control group with time. The cell area density of the upper and the lower hypertrophic zone was varied with time. The extracellular matrix area density value were totally opposite to the cell area density values: The mean area of single cell of the fibrous zone and the proliferating zone was .decreased on post-irradiated 1 day, and increased after post-irradiated 4 day. The mean area of single cell of the upper hypertrophic zone was varied with each layer and time. In the experimental group, the mean area of extracellular matrix per single cell of the fibrous zone was not significantly different with control group, and that of the proliferating zone was decreased on post-irradiated 1 day, and increased after post-irradiated 4 day. The mean area of extracellular matrix per single cell of the lower hypertrophic zone was increased in the early stage. and that of upper hypertrophic zone was varied with each layer and time. Conclusion: The condylar cartilages of rats were affected by irradiation, but the changes were vaned with each layer and time. By morphometric analysis. the changes of the cells of the condylar cartilage of irradiated rat could be calculated quantitatively.

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A STUDY ON THE STABILITY OF 5 DIFFERENT SURFACE TREATMENT METHODS TO DENIAL IMPLANT USING RESONANCE FREQUENCY AND HISTOMORPHOMETRIC ANALYSIS (표면처리가 다른 5종 임플랜트의 안정성에 관한 연구)

  • Kim Sun-Jong;Shin Sang-Wan;Jung Sung-Min;Ryu Jae-Jun
    • The Journal of Korean Academy of Prosthodontics
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    • v.43 no.1
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    • pp.78-94
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    • 2005
  • Purpose. The purpose of this study was to compare the effects of various surface treatments by measuring resonance frequency and histomorphometric analyses. Material and methods. In 5 adult dogs, the mandibular premolar were extracted. Six months later, 30 screw titanium implants (Dentium Co., Seoul, Korea) 6mm in length and 3.4mm in diameter, were placed in the mandibles of 5 dogs. Implants were divided into five groups following to surface treatment methods ; Group 1 is machined controls, Group 2 is sandblasted with large grit and acid-etched (SLA), Group 3 is anodized (Autoelectric Co., Korea, 660Hz, Duty10), Group 4 is hydroxyapatite(HA) coated by ion beam assisted deposition(E-beam), Group 5 is hydroxyapatite(HA) coated with Sol-gel coating process. Resonance frequency was measured implant placement immediately, and 3, 6 weeks and 10 weeks of healing perods. With the animal subject's sacrifice 10 weeks after implantation, implants were removed on bloc and histologic and computer-based histomorphometric analyses were performed. Histomorphometric analysis involved quantification of the entire bone to metal contact around the implants. Statistical analyses were performed using the SPSS for Windows (ver. 9.0 SPSS Inc.) Statistical differences were considered significant at P<0.05. Results. The results were as follows : 1) In five groups, mean value of resonance frequency analysis(RFA) were highest in group 5 (Sol-gel implant) at implantation and those of group 4 (E-beam)was highest at 10 weeks . but there was no correlation between surface treatments and RFA. 2) In all surface treatment groups, the RFA values of implants decreased until 3 weeks and increased to 10 weeks. 3) The percentage of direct bone-to-implant contact (BIC) had statistical significance between five groups in cancellous bone, (P<0.05) the percentage of bone density inside the thread had no statistical significance between five groups. (P>0.05) 4) There was a significant difference between cortical bone and cancellous bone in BIC. (P<0.05) and bone density. (P<0.05) 5) There was a correlation between the RFA value of implants at 10 weeks and BIC in cancellous bone, and between the RFA value of implants at 10 weeks and bone density in cortical bone. (P<0.05). Conclusions. These results indicate that surface treatment does not affect the implant stability in case of good bone quality.