• 대한치과보철학회지
• /
• 제60권2호
• /
• pp.168-174
• /
• 2022

상악 전치부의 임플란트 식립 시 치은 퇴축이나 골 결손 문제를 동반하는 경우에는 심미적인 임상 결과를 얻기가 쉽지 않다. 본 증례에서는 상악 우측 중절치에서 순측 치조골판의 소실이 진단되어 발치 후 연조직을 확보한 후에 골 이식을 동반하는 임플란트 식립을 계획하였다. 또한 이상적인 임플란트 식립 위치를 위해 디지털 가이드 수술을 시행하였고, 치조골 결손부가 광범위하기 때문에 하악지에서 자가골 채취 후 이종골과 함께 골유도재생술을 동반하였다. 충분한 임플란트의 골 유착 기간을 거친 뒤 2차 수술 및 인상 채득을 통한 임시 보철물을 제작하였고, 주기적인 외형 조정을 통해 연조직의 형태를 개선하였다. 최종 보철물 제작시에는 양극 처리를 시행한 맞춤형 지대주를 사용하여 자연 치아의 색조를 유도하였고, 구강 스캔을 통하여 임시 보철물의 형태를 재현해 줌으로써 심미적이고 기능적인 지르코니아 보철물을 장착해 주었다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제14권4호
• /
• pp.255-268
• /
• 1992

There are various modalities in the treatment of facial asymmetry, but in severe case with TMD by actively growing deformed condyle, the treatment choice is removing the condyle growth center and TMD symptom such as click or muscular discomfort. In our one case, the patient was complain of facial asymmetry. There are severe deformed condyle head with bird-head fashion and enlarged mandibular ramus and body vertically about 18 mm, overgrowthed Rt. mandible body horizontally about 20 mm. She had intermittent Lt. TMJ clicking and muscular discomfort. The author diagnosed it as Lt. hemimandibular hyper-plasia & R, hemimandibular elongation, a combination form with TMD. the condyle was in active growing state in scintigraphic analysis. So we extirpated the deformed condyle by intrasoral sagittal split ramus osteotomy and reshaped the condyle and mandibular distal fragment extraorally. The distal fragment was readapted in glenoid fossa and fixated. In Rt. mandibular body area, autogenous onlay bone graft on the inferior border of mandible was performed to correct the asymmetry. The clicking and facial asymmetry was corrected and we report this results with other literature findings.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제29권5호
• /
• pp.444-450
• /
• 2007

In general, labiolingual or buccolingual widths of residual alveolar bone are insufficient in edentulous area, because of alveolar resorption. Horizontal augmentation is bone graft procedure with a view to reinforcing horizontally insufficient bone quantity for installation of implants. The standard method is taking appropriate amount of block bone from intraoral or extraoral autogenous bone, and solid fixation with screws or mini-plate on labial or buccal side of residual alveolar bone. The purpose of this study is to discuss clinical usefulness of horizontal augmentation with autogenous block bone by observation and analysis of course of 41 implants installed to 12 patients by horizontal augmentation in Seoul National University Bundang Hospital from July, 2002 to December, 2005. The mean age of patients is 52.7, from 19 to 70, and the number of men and women is each 2 and 10. Block bone was taken from symphysis, body, ramus of mandible or iliac bone. And 6 types of implants were installed simultaneously or not, the diameters of implants are from 3.3 to 5.5mm, the lengths are from 8 to 15mm. The operator added artificial bone grafting material and optionally covered with membrane. The mean periods of observation after operation and final prosthetics were 28.6 and 17.0 months. As a result, 40 among 41 implants survived, the survival rate was 97.6%. Average 0.9mm crestal resorption was observed at final point of time by periapical view of each patients. Major complication related to the procedure was numbness in 7 patients.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제33권2호
• /
• pp.112-119
• /
• 2011

Purpose: Collagen membranes are used extensively as bioabsorbable barriers in guided bone regeneration. However, collagen has different effects on tissue restoration depending on the type, structure, degree of cross-linking and chemical treatment. The purpose of this study was to evaluate the inflammatory reaction, bone formation, and degradation of dehydrothermal treated porcine type I atelocollagen (CollaGuide$^{(R)}$) compared to of the non-crosslinked porcine type I, III collagen (BioGide$^{(R)}$) and the glutaldehyde cross-linked bovine type I collagen (BioMend$^{(R)}$) in surgically created bone defects in rat mandible. Methods: Bone defect model was based upon 3 mm sized full-thickness transcortical bone defects in the mandibular ramus of Sprague-Dawley rats. The defects were covered bucolingually with CollaGuide$^{(R)}$, BioMend$^{(R)}$, or BioGide$^{(R)}$ (n=12). For control, the defects were not covered by any membrane. Lymphocyte, multinucleated giant cell infiltration, bone formation over the defect area and membrane absorption were evaluated at 4 weeks postimplantation. For comparison of the membrane effect over the bone augmentation, rats received a bone graft plus different covering of membrane. A $3{\times}4$ mm sized block graft was harvested from the mandibular angle and was laid and stabilized with a microscrew on the naturally existing curvature of mandibular inferior border. After 10 weeks postimplantation, same histologic analysis were done. Results: In the defect model at 4 weeks post-implantation, the amount of new bone formed in defects was similar for all types of membrane. Bio-Gide$^{(R)}$ membranes induced significantly greater inflammatory response and membrane resorption than other two membranes; characterized by lymphocytes and multinucleated giant cells. At 10 weeks postoperatively, all membranes were completely resorbed. Conclusion: Dehydrotheramal treated cross-linked collagen was safe and effective in guiding bone regeneration in alveolar ridge defects and bone augmentation in rats, similar to BioGide$^{(R)}$ and BioMend$^{(R)}$, thus, could be clinically useful.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제23권2호
• /
• pp.169-173
• /
• 2001

본 교실에서는 조선대학교 구강악안면외과에 내원한 중안면성장부전을 동반한 하악전돌증소견을 보이는 22세 여자 환자의 치료에 있어서 변형 LeFort III 골절단술과 양측 하악지 시상분할골절단술 그리고 자가 장골 이식술을 동시에 시행하여 기능적 심미적으로 만족할 만한 결과를 얻었기에 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제31권3호
• /
• pp.243-248
• /
• 2009

Purpose: Rehabilitation of the edentulous posterior maxilla with dental implants often poses difficulty because of insufficient bone volume caused by pneumatization of the maxillary sinus and by crestal bone resorption. Sinus grafting technique was developed to increase the vertical height to overcome this problem. The present study was designed to evaluate the sinus floor augmentation with anorganic bovine bone (Bio-$cera^{TM}$) using histomorphometric and clinical measures. Patients and methods: Thirteen patients were involved in this study and underwent total 14 sinus lift procedures. Residual bone height was ${\geq}2mm$ and ${\leq}6mm$. Lateral window approach was used, with grafting using Bio-$cera^{TM}$ only(n=1) or mixed with autogenous bone from ramus and/or maxillary tuberosity(n=13). After 6 months of healing, implant sites were created with 3mm diameter trephine and biopsies taken for histomorphometric analysis. The parameters assessed were area fraction of new bone, graft material and connective tissue. Immediate and 6 months after grafting surgery, and 6 months after implantation, computed tomography (CT) was taken and the sinus graft was evaluated morphometric analysis. After implant installation at the grafted area, the clinical outcome was checked. Results: Histomorphometry was done in ten patients.Bio-$cera^{TM}$ particles were surrounded by newly formed bone. The graft particles and newly formed bone were surrounded by connective tissue including small capillaries in some fields. Imaging processing revealed $24.86{\pm}7.59%$ of new bone, $38.20{\pm}13.19%$ connective tissue, and $36.92{\pm}14.51%$ of remaining Bio-$cera^{TM}$ particles. All grafted sites received an implant, and in all cases sufficient bone height was achieved to install implants. The increase in ridge height was about $15.9{\pm}1.8mm$ immediately after operation (from 13mm to 19mm). After 6 months operation, ridge height was reduced about $11.5{\pm}13.5%$. After implant installation, average marginal bone loss after 6 months was $0.3{\pm}0.15mm$. Conclusion: Bio-$cera^{TM}$ showed new bone formation similar with Bio-$Oss^{(R)}$ histomorphometrically and appeared to be an effective bone substitute in maxillary sinus augmentation procedure with the residual bone height from 2 to 6mm.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제32권5호
• /
• pp.447-453
• /
• 2010

The hemifacial microsomia is characterized by variable underdevelopment of the craniofacial skeleton, external ear, and facial soft tissues. So, patients with hemifacial microsomia have an occlusal plane canting and malocclusion with facial asymmetry. Distraction osteogenesis (DO) with an intraoral or extraoral device is a technique using tension to generate new bone with gradual bone movement and remodeling. DO has especially been used to correct craniofacial deformities such as a hemifacial microsomia, facial asymmetry, and mandible defect that could not adequately be treated by conventional reconstruction with osteotomies. It has a significant advantage to lengthen soft and hard tissue of underdeveloped site without bone graft and a few complication such as nerve injury or muscle contracture. A 13-years old girl visited our clinic for the chief complaint of facial asymmetry. She had a left hypoplastic maxilla and mandible, occlusal plane canting and malocclusion. We diagnosed hemifacial microsomia and lanned DO to lengthen the affected side. Le Fort I osteotomy, left mandibular ramus and symphysis osteotomy were performed. The internal distraction devices fixed with screw on maxillary and mandibular ramus osteotomy sites. External devices were adapted to lower jaw for DO on symphysis osteotomy site and to upper jaw for rapid maxillary expansion (RME). At 7days after surgery, distraction was started at the rate of 1mm per day for 13days, and after 4months consolidation periods, distraction devices were removed. Simultaneous multiple maxillo-mandibular distraction osteogenesis with RME resulted in a satisfactory success in correcting facial asymmetry as well as occlusal plane canting for our hemifacial microsomia.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제11권2호
• /
• pp.53-59
• /
• 1989

법랑아세포종은 결체조직에 최소의 유도적인 변화를 나타내며 양성이지만 지속성이나 국소적으로 악성양상을 띄는 가장 흔한 형태의 치계 종양이다. 호발연령은 주로 20세부터 50세 사이이며, 임상증상은 환자마다 다양하게 나타나며 상악보다 하악에 호발하며 완만한 성장 속도를 나타낸다. 법랑아세포종의 방사선학적 특징은 병소의 본질과 국소적인 골반응에 의하며, 재발은 약 33%로 흔하며 이것은 불완전한 병소부의 제거로 인한 것이다. 29세의 여성환자에서 하악 우측 소구치부터 하악지까지 발생한 재발성 법랑아세포종의 외과적 절재후 장골 이식과 금속판을 이용한 즉시 재건술을 시행한바 이러한 재건술을 이용하여 양호한 기능, 단기간의 악간고정 기간, 그리고 다른 재건술 보다 용이하였던 바 이에 지견을 얻어 보고드리는 바입니다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제34권4호
• /
• pp.485-489
• /
• 2008

Basal cell nevus syndrome is a hereditary disease of an autosomal dominant trait with variable conditions such as basal cell carcinomas of the skin, deformity of rib, fusion of vertebrae, mental retardation, hypertelorism, and multiple odontogenic keratocysts. A 32 years old man with pus discharge from fistula on the vestibule of left upper 1st molar visited to Chosun University Dental Hospital. Radiographic evaluation revealed multiple maxillary and mandibular cysts that had multilocular radiolucency on left mandibular body area, thining of inferior border of left border of ramus and well defined unilocular radiolucency above right upper 1st and 2nd molar and from left upper 1st premolar to 2nd molar. In chest PA view, he had a forked rib in the left 4th rib and in skull PA view the calcification of falx cerebri was observed. There was not any skin lesion. After the preliminary evaluation, the patient was diagnosed with basal cell nevus syndrome and he underwent marsupialization for decreasing the size of cystic lesion and came to hospital for dressing 3days a week. As time goes by, the size of lesion decreased. So, one and half year after marsupialization, he underwent cyst enucleation and iliac bone graft for the mandibular lesion and buccal fat pad grafts for the maxillary lesions. After the surgery, the patient experienced normal healing without any complications and he is on long-term follow-up.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제33권1호
• /
• pp.55-61
• /
• 2011

Conventional slinding genioplsty has the risk of mental nerve injury after operation and difficult to correct vertical asymmetry of chin. So, authors propose a new genioplasty to correct asymmetry of chin. Switching genioplasty is a modification method of conventional genioplasty. Between mandibular right and left canine, osteotomy line of triangular shape make until mandibular lower border. In large side, osteotome line of wedge shape is added to reduction. After osteotomy, segment of wedge shape was separated from chin. Distal segment was rotated to reduction side. Because of rotation of distal segment, space is made in opposite side. Seperated segement of wedge shape from large side is switched this space to fill. So, stability of distal segment is achieved. Authors applied to swiching genioplasty the patients who was remained the chin asymmetry after both sagittal split ramus osteotome was done because mandible asymmetry. After operation, patient and operator were satisfied with excellent esthetic results without any other complication. The switching genioplasty is effective surgical technique for chin asymmetry because it has more advantages than conventional sliding genioplasty. First, other donor side does not need for bone graft. Second, the switching genioplasty can reduce infection, bone resroption, dehiscence, capsular contraction after allograft. Third, have little mental nerve damage. Forth, anteroposterior correction is possible. Fifth, operation time is less than other genioplasty for chin asymmetry.