Journal of the Korean Association of Oral and Maxillofacial Surgeons
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v.34
no.5
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pp.571-577
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2008
Introduction: Possible etiologic factors associated with bone loss around implants after implantation are surgical trauma, occlusal overload, periimplantitis, presence of micro gap and the formation of biologic distances. Tarnow et al. observed that the crestal bone loss was greater when the distance between the implants was <3mm than when the implants were ${\geq}\;3mm$ apart. The aim of this study was to evaluate the influence of different interimplant distance on marginal bone and crestal bone resorption in the beagle dogs. Materials and methods: The mandibular premolars of 5 dogs were extracted bilaterally. After 12 weeks of healing, each dog received 7 implants. On each side, implants were separated by 2mm (Group 1) and by 5mm (Group 2). After 16 weeks of healing, the dogs were sacrificed. Marginal bone loss was determined through linear measurements made between the implant-abutment junctions and the most coronal portions of the bone in contact with the implant surface. A line was drawn uniting the implant-abutment junctions of the adjacent implants, and a linear measurement was made at the midpoint in the direction of the most coronal peak of the interimplant bone crest to determine the crestal bone loss. Both of them was measured radiologically and histologically. Result and conclusion: In radiological analysis, the mean of marginal bone loss was $1.26{\pm}0.14mm$ for group 1 and $1.23{\pm}0.34mm$ for group 2, the mean of crestal bone loss was $1.10{\pm}0.14mm$ for group 1 and $1.02{\pm}0.30mm$ for group 2. The results were not statistically significant between 2 groups. In histological analysis, the mean of marginal bone loss was $1.63{\pm}0.48mm$ for group 1 and $1.62{\pm}0.50mm$ for group 2, the mean of crestal bone loss was $1.23{\pm}0.35mm$ for group 1 and $1.15{\pm}0.39mm$ for group 2. The differences were also not statistically significant. The clinical significance of this result is that the increase in the crestal bone loss results in the increase in the distance between the base of the interproximal contact of the crowns and the bone crest, and this determines if papilla will be present or absent between implants. Considering this fact, keeping up sufficient interimplant distance is important to minimize crestal bone loss.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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v.37
no.5
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pp.355-364
/
2011
Introduction: This study evaluated nerve recovery through retrospective study of patients with lingual nerve damage. Patients and Methods: The patients who visited Seoul National University Dental Hospital for an injury to the lingual nerve from April 1988 to August 2009 were enrolled in this study (n=41). The relevance of various factors including the causes of damage, age, etc. was analyzed by the subjective improvement based upon questionnaires and the clinical records. The evaluation variants were a subjective assessment and neurosensory examination composed of the direction, contact threshold, two-point discrimination, pin prick, thermal discrimination and current perception threshold. Results: The causes of lingual nerve damage were an extraction of the lower third molar (75.6%), local anesthesia (9.7%), incision and drainage (4.88%), trauma (2.44%). The evaluation of subjective prognosis exhibited no difference in sensory improvement depending on the cause, age and gender. Based upon the subjective evaluation, 44.7% of patients showed sensory improvement. The first hospital visit from injury was shorter in the group showing subjective improvement (3.41 months) than those showing no improvement (5.24 months) (P=0.301). Thirty six out of 41 patients were treated with only conservative therapy and 5 patients were treated by surgical intervention. Neurosensory examinations revealed improvement, although not statistically significant, and the degree was higher in the subjectively improved group. The contact threshold discrimination showed the highest correlation with subjective improvement (P=0.069). Most of the sensory recovery was gained within 12 months and the degree of improvement at the tip of the tongue was higher than that of the dorsum (P<0.001). Conclusion: The damaged lingual nerve improved at a rate of 44.7% and mostly within 12 months after the incident. There was no difference between the subjective prognosis and neurosensory examination depending on the cause of damage, age and gender, whereas the contact threshold discrimination was the best variant that reflected the subjective prognosis statistically.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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v.31
no.4
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pp.300-305
/
2005
Purpose: For the reconstruction of maxillofacial defect created by trauma, infection, or tumor etc, the role of microvascular anastomosis or vessel graft has been increased. Many methods has been tried to increase the success rate of microvascular anastomosis. Various anticoagulants and thrombolytic agents have been used to reduce the failure rate of microvascular anastomosis and avoid re-operation. Many drugs, however, have been used in the limited cases because most of these drugs may cause complications, such as allergy, fever or systemic bleeding. This study was performed to evaluate the influence of the Argatroban on patency and thrombosis in microvascular anastomosis when it is used for local irrigation or general administration. Materials & methods: Eight mature rabbits, weighing 2kg, were used. After exposing both femoral veins, the artificial thrombotic model was made by crushing injury using a smooth needle holder, and the transverse incision were made on femoral vein. The animals were divided into 4 groups according to Argatroban administration methods; control group (n=4), topical irrigation of lumen with saline solution; experimental group 1 (n=4), topical irrigation of lumen with Argatroban saline solution; experimental group 2 (n=4), topical irrigation of lumen with heparin followed by intravenous injection of Argatroban; experimental group 3 (n=4), topical irrigation of lumen with Argatroban followed by IV of Argatroban. Microvascular anastomosis was done with 10-0 Ethilon. The patency was evaluated by empty-and-refill test 30 minutes and 3 days after microanastomosis. The thrombus formation was examined 3 days after microanastomosis by surgical microscope. The histologic findings were also examined. Results: 1. Thirty minutes after microvascular anastomosis, the patency of all experimental groups was better than that of control group, but there was no significant difference among groups. 2. Three days after microvascular anastomosis, the patency of all experimental groups was more improved than that of control group (p<0.05). There was no significant difference among experimental groups. 3. Three days after microvascular anastomosis, the amount of thrombus in all experimental groups was less than that of control group (p<0.05). There was no significant difference among experimental groups. 4. Histologically, a lot of luminal thrombus was observed around sutured area in control group. Few luminal thrombus was observed in all experimental groups. The necrotic changes were observed on the sutured vein wall in all specimens. Conclusion: These results indicate that topical irrigation and/or intravenous administration of Argatroban is effective in improving patency and preventing thrombus formation after microvascular anastomosis.
Background: Cleft lip and palate deformity have unknown patterns of maxillofacial growth and development. The maxillofacial growth can be affected either by congenital or environmental factors such as infection and trauma. Surgical repair of cleft lip and palate may interfere the subsequent growth and development of maxillofacial region. The purpose of this study is to evaluate the characteristics of maxillofacial growth patterns in adult cleft lip and palate patients. Materials and Methods: The material for this study consisted of 17 adult male patients with cleft lip and palate. Cephalometric tracing and measurements were done by one investigator. The relationship between 17 cleft lip and palate patients and Korean norms were evaluated statistically. Results: There were statistically differences in Na. perpendicular to point A, SNA angle, effective maxillary length, maxillofacial differencial. Wit's appraisal and upper incisor to point A(p < 0.01). Pogonion to Na. perpendicular also statistically differed(p < 0.05). Other measurements didn't statistically differ. Conclusion: It was evident that in adult cleft lip and palate patients, maxilla was retruded and short. Careful cleft lip and palate repair and treatment are recommended for facilitating normal growth of maxilla.
Orthodontists often treat cases which are difficult to treat with conventional orthodontics. In such cases, it could be treated with surgical procedures with the help of an oral surgeon. Especially, transverse deficiency of the mandible can be corrected by widening the transverse width of mandibular symphysis, using distraction osteogenesis. Transverse widening of mandibular sympysis is known as a safe treatment but still complications could occur during the treatment. We are reporting some complications of cases that mandibular symphysis transverse widening were applied. Some cases showed complications because of the inappropriate osteotomy line. Since straight vertical osteotomy line was inclined to the left, only the left bony segment was likely to expand. According to bio-mechanical considerations, it will be better to perform a step osteotomy, cutting the eccentric area of the alveolar crest and the centric area of the basal symphyseal area. Complications could also occur by the failure of the distraction device. The tooth borne distraction device was attached on the lingual side of the tooth with composite resin. During the distraction period, it was impossible to obtain appropriate distraction speed and rhythm because of frequent fall off of the distraction device. Therefore, distraction device should be attached firmly with orthodontic band or bone screw, etc. Tooth mobility increasement could also occur as a complication. 'Walking teeth phenomenon' was observed during the distraction period, showing severe teeth mobility and pain during mastication. These symptoms fade out during the consolidation period. Since the patient could feel insecure and uncomfortable, it should be notified to the patient before the procedure. Finally, alveolar crestal bone loss could occur. Alveolar crestal bone loss occurred because of lack of distraction device firmness and teeth trauma caused by lower lip biting habit. Therefore, adequate firmness of the distraction device and habit control will be needed.
Purpose : Ridge expansion osteotomy (REO) has been introduced when it is necessary to expand narrow crestal ridge with simultaneous implant placement. This study has designed to evaluate the clinical availability of REO. Materials and methods : Subject were patients who had visited Seoul National University Bundang Hospital from July. 2003 to December, 2005 for implant placement using REO by one surgeon. Intraoperative and postoperative complication, failure of initial osseointegration and marginal bone resorption were estimated using electronic medical record and periapical radiography. Twenty?three patients, 8 males and 15 females, mean age 51, ranged 18 to 72, were treated for mean 26 months, ranged from 16 months to 46 months. Results : Mean diameter and length of implants placed at upper anterior, were 3.72mm and 13.32mm each other. Guided bone regeneration and ridge splitting were accompanied in this study. Five cases of cortical bone fracture, three cases of crestal bone loss more than 2mm, 2cases of gingival recession, and 2 cases of infection were noted, but there were no implants removed because of disintegration. Success rate of implant was 91.7%, even if survival rate of implant was 100%. In addition, there were no statistical significance between the success rate of REO and bone graft(p>0.05). Conclusion : Based on the results of the present study, it can be concluded that REO technique is reliable for implant placement at atrophic ridge with adequate height compared to bone graft and other osteotomies for ridge expansion, but care should be taken of esthetic problem such as gingival recession because of crestal bone resorption from trauma by osteotome.
Kim, Min Gyun;Lee, Seung Tae;Park, Joo Yong;Choi, Sung Weon
Maxillofacial Plastic and Reconstructive Surgery
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v.37
/
pp.7.1-7.7
/
2015
Background: Osteoradionecrosis is a delayed complication from radiation therapy which causes chronic pain, infection and constant deformity after necrosis. Most of the osteoradionecrosis occurs spontaneously or after the primary oncologic surgery, dental extraction or by trauma of prosthesis. The treatment of osteoradionecrosis relies on both conservative measures and surgical measures. The fibular osteocutaneous free flap has become more popular choice for reconstruction of maxillofacial defects as a treatment of osteoradionecrosis. Methods: We presented our experiences from 7 patients with osteoradionecrosis who have had reconstruction surgery with fibular osteocutaneous free flap at National Cancer Center during the recent 5 years. We performed segmental mandibular resection with fibular osteocutaneous free flap for all 7 patients of advanced osteoradionecrosis who were not controlled by conservative treatment such as wound irrigation, debridement, and antibiotics. Results: A wide range of techniques were available for the reconstruction of composite defects resulted from the treatment of advanced mandibular osteoradionecrosis. Significant improvement was noted in relieving pain and treating trismus after the surgery however difficulty in swallowing and xerostomia showed less improvement. Conclusions: We concluded that fibular osteocutaneous free flap can be performed safely in patients with osteoradionecrosis and yields positive outcomes with significantly increased success rate. The fibular osteocutaneous free flap was our preferred choice for the mandibular reconstruction due to its versatility and predictability.
Barba, Lucia;Berrocal, Ana Luisa;Hidalgo, Alejandro
Imaging Science in Dentistry
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v.48
no.2
/
pp.103-109
/
2018
Purpose: To analyze cone-beam computed tomography (CBCT) use, indications, and exposure parameters in San $Jos{\acute{e}}$, Costa Rica. Materials and Methods: A cross-sectional study was performed. All CBCT examinations over a period of 6 months at 2 radiological centers in San $Jos{\acute{e}}$, Costa Rica were evaluated. The examinations were performed with Veraview EPOC X550 and Veraviewepocs 3D R100 equipment. The patients' age and sex, clinical indication for CBCT, region of interest (ROI), repeat examinations, specialty of the referring dentist, field-of-view (FOV), tube voltage (kV), tube current (mA), and radiation dose (${\mu}Gy$) were evaluated. Patients were classified by age as children (${\leq}12years$), adolescents(13-18 years), and adults(${\geq}19years$). Results: The mean age of the 526 patients was 49.4 years. The main indications were implant dentistry and dental trauma. The most frequent ROIs were posterior, while anterior ROIs were much less common. The highest percentage of repeat examinations was in children. Fifty-six percent of the referring dentists were specialists. The most commonly used FOV was small. The mean tube voltage and current were 79.8 kV and 7.4 mA for Veraview EPOC X550 and 89.9 kV and 6 mA for Veraviewepocs 3D R100, respectively. The mean doses for children, adolescents, and adults were $6.9{\mu}Gy$, $8.4{\mu}Gy$, and $7.8{\mu}Gy$, respectively. Conclusion: Although CBCT was most commonly used in adults for implant dentistry, most repeat examinations were in children, and the highest mean dose was in adolescents. Additional dose optimization efforts should be made by introducing low-dose protocols for children and adolescents.
Kim, Il-Kyu;Ryu, Seong-Hyun;Kim, Jae-Woo;Kim, Dong-Soo;Choi, Jin-Ho
Maxillofacial Plastic and Reconstructive Surgery
/
v.27
no.2
/
pp.183-187
/
2005
The coronal approach has been used for over a century by neurosurgeons to access to the anterior cranium. Indications for the coronal approach expanded from use in the correction of congenital skeletal anomalies to applications in acute maxillofacial trauma and secondary deformity correction, oncologic surgery and reconstruction, and esthetic surgery. Complications were such as injury to frontal branch of the facial nerve, motor nerve paralysis, hematoma under flap, trismus, ptosis, epiphora, infection and anterior temporal depression. $Medpor^{(R)}$ is made up of dense polyethylene connected in porous structures. It is easily shapable without collapsing the pores due to it's hardness and tissue growth takes place at the porosities. Based on these advantages, $Medpor^{(R)}$ has been used in augmentation and restoration in craniofacial defect. A temporal depression after the coronal approach for treatment of Le Fort III fracture was successfully reconstruction with $Medpor^{(R)}$ and we report this case with review of literature.
The purpose of this study was to determine the cause and risk factors of removing bone plateby investigating and analyzing 359 patients who underwent reduction of fracture or orthognathic surgery with bone plate insertion over the past 3 years. Patients were evaluated with respect to age, smoking status, reason for insertion of plates, the numbers of inserted plates, sites of insertion, time between insertion and removal, reasons for removal of plates. The removal rate of bone plates was 33.1%. Of these, 17.0% of patients had clinical symptoms which led to remove plates. The removal rate of men was 29.9% and the rate of women was 39.2%. There were high removal rates from less than 20s (45.8%) and 20s (34.4%) those who are relatively young age group. On the other hand people in their 50s had a removal rate of 27.8% which was higher than those in their 60s with a rate of 20.7%. The removal rate of bone plate inserted into the mandible was 33.5%, and the removal rate of bone plate inserted into the maxilla was 34.7%. The mean period between the insertion and removal of bone plate was 10.9 months. The main reason for the removal of bone plate was the patient's requirement (44.5%). The most common cause of clinical symptoms was infection (22.7%). Infection was manifested within about a year and led to the plate being removed. Therefore, lowering the possibility of infection after surgery could decrease the removal rate of bone plate.
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