인간 타액선 선양낭성암종 조직 18례에 대한 면역조직화학적 염색을 시행하여 종물 주변의 정상 타액선 조직과 비교, 분석하여 다음과 같은 결과를 도출하였다. 1) EGF는 타액선 도관세포와 암종 조직의 50%에서 발현 되었으며, 정상 타액선 조직과 비교하여 암종 조직에서 발현이 증가되어 있지 않았다. 2) $TGF-{\alpha}$는 타액선 도관세포와 선포세포, 그리고 거의 모든 암종 조직에서 발현되었으며, 정상 타액선 조직과 비교하여 암종 조직에서 그 발현이 유의하게 증가되었다(P<0.05). 3) EGFR은 타액선 도관세포와 대부분의 암종 조직에서 발현되었으나, 발현의 강도에서 정상 타액선 조직과 암종 조직간의 차이는 없었다. 4) pEGFR은 정상 타액선 조직에서는 발현되지 않았으며, 암종 조직의 종양세포에서 그 발현이 증가되었다(P<0.05). 5) ErbB2/HER2는 타액선 도관세포와 거의 모든 암종 조직에서 발현되었으며, 정상 타액선 조직과 비교하여 암종 조직에서 그 발현이 유의하게 증가되었다 (P<0.05). 6) 검색된 인자들 중 $TGF-{\alpha}$와 ErbB2/HER2는 관사상체형 암종 조직에서와는 달리 충실형 암종 조직에서 100% 발현되어, 충실형 선양낭성암종의 증가된 악성도에 중요한 역할을 함을 암시하였다. 7) 종물 내의 종양관련 혈관내피세포에서도 위의 인자들이 모두 발현되어 종양관련 혈관내피세포는 선양낭성암종의 증식과 전이에 중요한 역할을 함을 알 수 있었다. 8) 종양 기질 내의 면역관련 세포들에서도 역시 위의 인자들이 발현되어 이들 세포들이 종양의 증식과 생존에 영향을 미칠 것이라는 추론을 가능하게 하였다. 위의 연구결과들을 종합하면 상피성장인자 신호전달계에 관여하는 인자들 중 $TGF-{\alpha}$, pEGFR, 그리고 ErbB2/HER2가 타액선 선양낭성암종에서 과발현 되었다. 따라서 이들 인자들이 타액선 선양낭성암종의 증식과 생존, 그리고 전이 과정에서 중요한 역할을 할 것이라는 추론을 가능하게 하였다. 추후 면역조직화학적 연구의 한계와 오류를 극복할 수 있는 기법으로 이들 인자들에 대한 재검색이 필요하리라 생각된다. 또한 과연 이들 인자들이 암생물학적으로 뿐만 아니라 임상적으로도 전이 및 환자 생존율과 관계된 인자로서의 가치가 있는지 평가해 보아야 할 것이다.

Autogenous bone grafts have been considered the gold standard for maxillofacial bony defects. However, this procedure could entail a complicated surgical procedure as well as potential donor site morbidity. Possibly the best solution for bone-defect regeneration is a tissue engineering approach, i.e. the use of a combination of a suitable scaffold with osteogenic cells. A major source of osteogenic cells is the bone marrow. Bone marrow-derived mesenchymal stem cells are multipotent and have the ability to differentiate into osteoblastic, chondrocytic, and adipocytic lineage cells. However, the isolation of cells from bone marrow has someproblems when used in clinical setting. Bone marrow aspiration is sometimes potentially more invasive and painful procedure and carries of a risk of morbidity and infection. A minimally invasive, easily accessible alternative would be cells derived from periosteum. The periosteum also contains multipotent cells that have the potential to differentiate into osteoblasts and chondrocytes. In the present study, we evaluated the osteogenic activity and mineralization of cultured human periosteal-derived cells. Periosteal explants were harvested from mandibule during surgical extraction of lower impacted third molar. The periosteal cells were cultured in the osteogenic inductive medium consisting of DMEM supplemented with 10% fetal calf serum, 50g/ml L-ascorbic acid 2-phosphate, 10 nmol dexamethasone and 10 mM -glycerophosphate for 42 days. Periosteal-derived cells showed positive alkaline phosphatase (ALP) staining during 42 days of culture period. The formation of ALP stain showed its maximal manifestation at day 14 of culture period, then decreased in intensity during the culture period. ALP mRNA expression increased up to day 14 with a decrease thereafter. Osteocalcin mRNA expression appeared at day 7 in culture, after that its expression continuously increased in a time-dependent manner up to the entire duration of culture. Von Kossa-positive mineralization nodules were first present at day 14 in culture followed by an increased number of positive nodules during the entire duration of the culture period. In conclusion, our study showed that cultured human periosteal-derived cells differentiated into active osteoblastic cells that were involved in synthesis of bone matrix and the subsequent mineralization of the matrix. As the periosteal-derived cells, easily harvested from intraoral procedure such as surgical extraction of impacted third molar, has the excellent potential of osteogenic capacity, tissue-engineered bone using periosteal-derived cells could be the best choice in reconstruction of maxillofacial bony defects.

Undifferentiated mesencymal stem cells(UMSCs) have been thought to be multipotent cells that can replicate as undifferentiated cells and that have the potential to differentiate into lineages of mesenchymal tissue including the bone, cartilage, fat, tendon, muscle, and marrow stroma. It can be used to sinus lifting, Guided bone regeneration, other bone graft in dental part. The purpose of this study is to evaluate the effect of mesencymal stem cells on sinus augmentation with autogenous bone, fibrin glue mixture in a rabbit model. 8 New Zealand white rabbits were divided randomly into 4 groups based on their time of sacrifice(1, 2, 4 and 8 weeks). First, undifferentiated mesenchymal stem cells were isolated from iliac crest marrow of rabbits and expanded in vitro. cell culture was performed in accordance with the technique described by Tsutsumi et al. In the present study, The animals were sacrificed at 1, 2, 4 and 8 weeks after transplantation, and the bone formation ability of each sides was evaluated clinically, radiologically, histologically and histomorphologically. According to the histological observations, Stem cell group showed integrated graft bone with host bone from sinus wall. At 2 and 4weeks, It showed active newly formed bone and neovascularization. At 8 weeks, lamella bone was observed in sinus graft material area. Radiologically, autobone with stem cell showed more radiopaque than autobone without stemcell. there were significant differences in bone volume between 2 and 4 weeks (p<0.05). In summary, the autobone with stem cells had well-formed, newly formed bone and neovasculization, compared with the autobone without stem cells (esp. 2 weeks and 4 weeks) The findings of this experimental study indicate that the use of a mixture of mesenchymal stem cell yielded good results in osteogenesis and bone volume comparable with that achieved by autogenous bone. Therefore, this application of this promising new sinus floor elevation method for implants with tissue engineering technology deserves further study.

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.

During distraction osteogenesis, the angiogenic activity is crucial factor in the new bone formation. The aim of this study was to detect the autocrine growth activity in the cellular components of the distracted periosteum with observation of the expression of vascular endothelial growth factor (VEGF) and its receptors following the mandibular distraction osteogenesis. Unilateral mandibular distraction (0.5 mm twice per day for 10 days) was performed in six mongrel dogs. Two animals were sacrificed at 7, 14, and 28 days after completion of distraction, respectively. The distracted lingual periosteum was harvested and processed for immunohistochemical examinations. After then, we observed the expression of VEGF, Flt-1 (VEGFR-1), and Flk-1 (VEGFR-2) in the osteoblasts and immature mesenchymal cells of the distracted periosteum. At 7 days after distraction, the expression of VEGF and its receptors were significantly increased in the cellular components of the distracted periosteum. Up to 14 days following distraction, the increased expressions were maintained in the osteoblastic cells. At 28 days after distraction, the expression of VEGF and its receptors decreased, but VEGF was still expressed weak or moderate in the osteoblastic cells of distracted periosteum. The expression pattern of VEGF and its receptors shown here suggested that VEGF play an important role in the osteogenesis, and these osteoblastic cell-derived VEGF might act as autocrine growth factor during distraction osteogenesis. In the other word, the cellular components in the distracted periosteum, such as osteoblasts and immature mesenchymal cells, might have autocrine growth activity during distraction osteogenesis.

According to the development of operation technique and biologic materials, oromaxillofacial surgery department have used many kinds of metal and biologic materials in ORIF and plastic surgery. In maxillofacial fracture, ORIF with metal plate and screw have short healing period and good prognosis. But ORIF with metal materials have many complications as maxillofacial abnormal growth, screw loosening, bone malunion. And metal materials have not used in infection site. The purpose of this study is to evaluate the clinical value of 10 condylar fracture patients operated with absorbable screw at Wonkwang university. Ten patients(8 males, 2 female, mean aged 28) who had mandibular condyle process fracture treated with PLLA implants(poly-l-lactide) was recalled for follow-up clinical and radiologic examination for 10 years. Mouth opening recorvered to more than 35mm and occlusion was stable in all patients. All fractured mandibular condyles showed anatomic good reduction and long-term stability with the use of resorbable miniplates and screw. Bone healing was satisfactory in all patients, and there was no evidence of abnormal resorption of condylar process.

The purpose of this study was to assess the influence of the presence and impacted state of the mandibular third molars on the incidence of mandibular condyle fracture. A retrospective study was designed for patients presenting to the Department of Oral and Maxillofacial Surgery, Kyungpook National University Hospital and Tae-gu Fatima Hospital for treatment of mandibular fractures from January 2003 to January 2006. The independent variables in this study were the presence, degree of impaction of third molars, and the outcome variables were the incidence of mandibular condyle fractures. Hospital charts and panoramic radiographs were used to determine and classify these variables. The demographic data included age, sex, mechanisms of injuries and number of mandibular condyle fractures. The study sample comprised 136 mandibular condyle fractures in 105 patients. Result of this study demonstrated a statistically significant difference in ipsilateral condyle fractures and mandibular third molar absence(P=0.032) and bilateral condyle fractures without another fracture and mandibular third molar absence(P=0.028).

A severely atrophic maxilla may disturb the proper implant placement. The various bone graft techniques are required for simultaneous or delayed implantation in the cases of atrophic alveolar ridges. We present 11 consecutive patients treated with simultaneous implantation using the autogenous inlay and/or onlay bone grafts from iliac crest to the floor of the maxillary sinus and the alveolar crest. In the cases of atrophic maxilla, a total 69 implants were simultaneously placed with autogenous iliac bone graft. 40 fixtures were inserted in the sinus floor simultaneously with subantral block bone graft, the other 29 fixtures were placed in the anterior or premolar areas with block or particulate bone graft. The vertical alveolar bone height was measured with Dental CT at the preoperation and 6 months postoperation. Moreover, the implant stability quotients (ISQ) were measured by $Osstell^{TM}$ during second implant surgery at 6 months later of first implantation. All implants were obtained successful osseointegration with the grafted bone. The mean vertical increases were 3.9mm in the anterior ridges and 12.8mm in the posterior ridges. During the second implant surgery, mean ISQ were 62.95 in the anterior ridge and 61.32 in the posterior ridge. We concluded that the simultaneous implantation with autogenous iliac bone graft were stable and available methods for severely atrophic maxilla.

Introduction: The fibular free flap is now considered as the first choice for long mandibular discontinuity defect. In spite of its good bone quality for implant installation, its diameter is too narrow to rehabilitate the masticatory function with implant installation. In this report, distraction osteogenesis was used for the augmentation of bone to install the dental implant in the mandible which was reconstructed with a vascularized fibular free flap. Patients and Methods: Three patients undertook the vertical augmentation of grafted fibular bone and dental implants were installed. On the day 8 post-surgery, the activation of the distractor was started at the rate of 1 mm twice a day. The total amount of distraction was 15 mm in two patients and 12.5 mm in one patient. Twelve implants were installed in three patients. Dental implants were simultaneously installed during removal of the distraction device in two patients. In one patient, the implant installation was delayed after device had been removed. All three patients showed the symptoms of mild to severe postoperative infection during the activation and consolidation. However, the distracted site showed undisturbed bone regeneration. Conclusion: The distraction osteogenesis showed the reliable results for the vertical augmentation of fibular bone which was used for the mandibular reconstruction. However, the great tendency of postoperative infection must be considered and clinically controlled.

Deep circumflex iliac artery (DCIA) flap can be harvested as a composite free flap and is often used to adequately reconstruct wide mandibular defects. However, the harvesting of this DCIA flap can result in severe osseous defect of the donor site causing a morphologic defect in the iliac crest. To reconstruct this defect of the iliac donor site, several innovative techniques using bioactive ceramic spacers, autogenous rib bone, polylactic acid mesh, or titanium plates have been introduced. Nonetheless, these methods have not been widely used due to high cost, secondary donor site morbidity, difficulty of use, and postoperative dissatisfaction. We used two titanium plates to reconstruct the donor iliac site defect at the harvesting time of primary DCIA flap surgery in the 30-year old female with an ameloblastoma in the left mandible. Postoperatively, both iliac sites were relatively balanced and there were few complications. At the 2 years follow-up, there were no specific abnormal radiographic findings and the patient was very satisfied with her esthetic iliac contouring. In our report, we evaluate the effect of two titanium plates on the reconstruction of the iliac donor site in the aspects of esthetics and usefulness. This technique has many advantages, such as reduced cost, simplicity, decreased postoperative pain or discomfort, and improved bilateral balance of both anterior iliac crest contours, especially in young female patients.

Dental implant has become one of the important option for completely or partially edentulous patients, But it is challenging to reconstruct the severely atrophic ridge. Insufficient bone volume could restrict to place the wide and long implant and because of excessive interocclusal clearance, improper prosthetics could be produced. In this case bone augmentation for implant dentistry is necessary procedure to improve the insufficient bone volume. Therefore, bone augmentation or GBR is the most important procedure for successful implant placement and for ideal crown- root ratio. There are various bone augmentation techniques have been introduced recently; like block bone graft, distraction osteogenesis, inlay graft, onlay graft, etc.... In severe bucco-lingual resorption area, ridge splitting is the first choice of the treatment, because it provides a place for implantation and also has compaction effect. This technique may be indicated for sharp mandible and maxillary ridges in patients whose bone quantity is inadequate for primary stabilization. We report that the clinical experience of bone augmentation using ridge splitting technique in bucco-lingual bone resorption area.