• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권3호
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• pp.250-261
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• 2006

Diabetes mellitus, as a major health problem for the elderly, is associated with an extensive list of complications involving nearly every tissue in the body and has been shown to alter the properties of bone and impair fracture healing in both human and animals. The objective of this study was to examine the healing process of a mandibular fracture in the streptozotocin-induced rats histomorphometrically and histologically. A standardized fracture model was chosen and based on blood-glucose value at the time of surgery. A total of 11-weeks old 36 rats were divided into 2 groups; One is a streptozotocin-induced diabetic group and the other is a non-diabetic group. All was fractured experimentally. Three animals from each group were killed 1, 2, 4, 6, 8 and 12 weeks after fracture and specimens were processed undecalcified for quantitative bone histomorphometric and histologic studies. The diabetic group showed a significant decrease of histomorphometry-based parameter including trabecular bone volume, trabecular thickness in comparison to the non-diabetic rat. This was confirmed histologically. In conclusion, this study suggests that in streptozotocin-induced diabetics, the healing process of bone fracture was impaired and delayed about 2-3 weeks comparing to non-diabetics.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권3호
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• pp.262-266
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• 2006

The silver nanocrystalline is widely used for biological field because of its biocompatibility and anti-microbial effect. The objective of this study was to evaluate the therapeutic efficacy of the silver nanocrystalline ointment on the temporomandibular joint (TMJ) capsulitis. Total 39 patients were included in this study and all patients were received single topical application of the silver nanocrystalline ointment (group A, n=30) or placebo ointment (group B, n=19). Measured variables were maximum mouth opening (MMO), visual analog scale (VAS) for pain, and VAS for function. In results, we could not assess any therapeutic efficacy of single application in the chronic TMJ capsulitis (p>0.05). However, the single application of silver nanocrystalline ointment showed significant improvement in MMO and VAS for pain compared to placebo effect in the acute TMJ capsulitis (p<0.05). We could not find any complications related to ointment application in both groups. In conclusion, the single application of silver nanocrystalline ointment was effective in improving patient's symptom in acute TMJ capsulitis without any noticing complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권3호
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• pp.222-225
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• 2006

The treatment objective of mandibular fracture is a return to normal function. According to Champy, a rigid fixation of mandibular angle fracture is performed by using 4 or 6 holes titanium miniplates on the external oblique ridge of mandible. However, the limitations of metal plate such as hypersensitivity, interference with the cranio-facial growth of growing child, secondary bone resorption around the plate, foreign body reaction, declination of primary callus formation, and bone atrophy due to the lack of normal stress reaction of the bone have been reported. Recently, biodegradable miniplate has been introduced and used as an alternative to the metal plate despite its lower strength than that of the titanium plate and the side effect caused by the resorption in the body. In this study, 61 patients diagnosed as mandibular angle fracture and treated from Jan. 1998 to Dec. 2004 in our department have been reviewed. Metal plate fixation was used in 50 patients and biodegradable plate fixation in 11 patients on the external oblique ridge around the fractured mandibular angle according to the principle of monocortical osteosynthesis by Champy. We compared the incidence of side effects and the degree of bony union at the mandibular inferior border in two different fixation methods. In conclusion, we have found that one miniplate regardless of matter could provide enough strength to grasp bony fragments of the tension site and compress the inferior border of mandible without any complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권3호
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• pp.272-278
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• 2006

Purpose: This study is designed to evaluate biocompatibility of three types of absorbable collagen GBR membrane in vitro. Material and Method: The human PDL fibroblasts culture was obtained through typical way and the cells used in the experiment was forth passage. The membranes examined were Experimental group A, B, C. All the 3-experimental groups were made of bovine pericardium and the membranes were excised into 5$\times$5mm respectively. The samples of the membranes were fixed on the 24-well plate with the double-sided adhesive tape. Then, 2ml of cell suspension which included $2{\times}10^4$cells was inoculated into the 24-well plate, and the cells were cultured for 1 week. Cellular viability and the alkaline phosphatase activity were measured with ELISA. The membranes in the culture were processed to examine with SEM. Results: The survival rate was highest in control and Experimental group A is the next, group B and group C in order of the value. The values are analyzed for statistical difference using Wilcoxon test. All the values of experimental groups are significantly lower than those of control, and the vaules among the experimental groups significantly differ from each other. Alkaline phosphatase level was identical order with the viable cell rate. SEM examination revealed that the PDL fibroblasts adherent on culture dish (control) and group A were spindle-shaped, but on group B and C, the cells were round-shaped without processes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권5호
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• pp.474-481
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• 2006

The endoscopic assisted approach for the treatment of condylar fracture is a less invasive alternative treatment modality and is considered to be able to overcome the limited access to the operation field to obtain an accurate reduction and fixation. Six patients with condylar neck and subcondylar fracture underwent the endoscopic assisted open reduction and internal fixation through the transoral approach at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The endoscope was inserted through an intraoral incision and the reduction of fracture fragment was performed via a transbuccal approach with two transcutaneous stab incisions. Five patients showed anatomic reduction without any complications. One patient, whose fracture site was fixed with a single plate, showed displacement of fractured condylar segment during the follow up period. No patient had any facial nerve damage.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권5호
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• pp.447-452
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• 2006

Purpose: In order to clarify the correlation of mandibular setback using bilateral intraoral vertical ramus osteotomy (BIVRO) and post-surgical transverse mandibular width (TMW), this study examined the pre- and postsurgical changes in hard and soft tissues of TMW and the relationship of TMW and the amount of mandibular setback. Patients and Methods: One-hundred seven patients who had undergone BIVRO were evaluated radiographically and clinically. A comparison study of the changes in hard and soft tissue after surgery in all 107 patients was performed with preoperative, 1 month, 3 month, 6 month and 1 year postoperative posteroanterio cephalograms and clinical photographs by tracing. And this changes were evaluated in parts to amounts of mandibular setback. Results: Statistically significant increases of TMW in hard and soft tissue from preoperative to postoperative 1 month were seen. TMW in hard tissue from 1 month to 1 year postopertive were gradually decreased. TMW in soft tissue was not changed uniformly but almost equal to pre-operative width. And there was no significant correlation between TMW and amount of mandibular setback. Conclusions: The results show that mandibular setback using BIVRO did not significantly influence increasing of TMW in soft tissue.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권5호
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• pp.537-542
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• 2008

BSSRO is most frequently operated among orthognathic surgery techniques for repairment of maxillofacial deformities. In case of patients with maxillofacial asymmetry accompanying mandibular protrusion who are operated by BSSRO, this study considers the recovering time for masticatory force of each tooth and Masseteric EMG and the adequate time enabling normal occlusion. The patients who are operated with BSSRO under general anesthesia in Dankook Dental Hospital, Department of OMS are selected for this study. The control group is devided into 2. 26 patients with facial asymmetry accompanying mandibular protrusion are selected for group 1 and their maximum voluntary bite force and masseteric EMG are measured. Group 2 is formed by volunteers with healthy dentition who are measured maximum bite force and masseteric EMG on both sides of the mouth. At the week of 3rd, 5th, 7th, 9th and 11th, Mann-Whitney U test is carried on for statistical analysis and the result is as follows. 1. Patients with mandibular protrusion showed apparently low maximum bite force and masseteric EMG than patients with normal occlusion. 2. In comparison with control group 1, Occlusal force is regained in incisors and canines at the 9th week and in premolars and molars, 11th week and masseteric EMG is regained at 11th week. 3. Comparing to normal occlusal patients, no recovery could be found in experimental group in every parts of the mouth.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권5호
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• pp.555-561
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• 2008

Purpose: The goal of this study was to develop a technique for creating a computerized composite maxillofacial-dental model, based on point-based surface best fit algorithm and to test its accuracy. The computerized composite maxillofacial-dental model was made by the three dimensional combination of a 3-dimensional (3D) computed tomography (CT) bone model with digital dental model. Materials and Methods: This integration procedure mainly consists of following steps : 1) a reconstruction of a virtual skull and digital dental model from CT and laser scanned dental model ; 2) an incorporation of dental model into virtual maxillofacial-dental model by point-based surface best fit algorithm; 3) an assessment of the accuracy of incorporation. To test this system, CTs and dental models from 3 volunteers with cranio-maxillofacial deformities were obtained. And the registration accuracy was determined by the root mean squared distance between the corresponding reference points in a set of 2 images. Results and Conclusions: Fusion error for the maxillofacial 3D CT model with the digital dental model ranged between 0.1 and 0.3 mm with mean of 0.2 mm. The range of errors were similar to those reported elsewhere with the fiducial markers. So this study confirmed the feasibility and accuracy of combining digital dental model and 3D CT maxillofacial model. And this technique seemed to be easier for us that its clinical applicability can good in the field of digital cranio-maxillofacial surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권5호
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• pp.550-554
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• 2008

Bisphosphonates (BPs) are a class of agent used to treat patient with osteoporosis or malignant bone metastases. BPs can be categorized into 2 groups: nitrogen-containing and non-nitrogen containing. Nitrogen-containing BPs are considered to have more toxicity. Despite their clinical benefits, bisphosphonate-related osteonecrosis of jaw(BRONJ) is a significant complication to patients receveing these drugs. Since the first description of BRONJ in 2003 by Marx, the number of reports on BRONJ has been rapidly increasing. BRONJ is considered as an emerging problem in oral & maxillofacial surgery. Generally, osteonecrosis in the maxilla is rare, however BRONJ is found both in the maxilla and the mandible. This is an important feature of BRONJ compared to common infectious osteomyelitis of the jaw. Growing number of case reports, suggest that bisphosphonate therapy may cause exposed, necrotic bone. BRONJ has simillar features compared to IORN (infected osteoradionecrosis). BRONJ has meaningful features established through the interestigation on histopathologic and radiographic findings. These features have an impact on treatment plan and prognosis. This presentation contemplates on features of histopathologic and radiographic findings in bisphosphonate-related osteonecrosis of the jaw.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권5호
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• pp.543-549
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• 2008

Distraction osteogenesis is a commonly used technique for mandibular lengthening, but changes in the temporomandibular joint(TMJ) have not been well documented. The TMJ is one of the most complex joint in the body and is composed of a fibrous surface layer, a proliferative zone, hypertrophic cartilage, and bone. The shape and role of the TMJ change and modify during a person's life-time. Possible complications that can arise after mandibular distraction include failure of the formation, failure of callus, infection, disturbance of TMJ and of occlusion. However, there are only a few reports on changes in the TMJ as a result of distraction osteogenesis. Hence, the goal of this study was to evaluate the change of the TMJ after experimental distraction of mandibular ramus in rabbit. We studied histological changes of mandibular condyle, articular disk and retrodiscal tissue, and also examined the collagen I gene expression and MMP-1 gene expression. The results were as follows. 1. In the histological staining, experimental condylar surface showed more thick fibrous articular layer and proliferative layer, compared with the control condyle and experimental articular disc showed thick and dense collagen fibers compared with the control disc. 2. In the collagen I and MMP-1 gene RT-PCR analysis, experimental discs showed increased collagen I expression compared with the control disc, while MMP-1 gene expression was decreased compared with the control disc. The retrodiscal tissue was almost equal expressions of the collagen I and MMP-1 genes compared with the control retrodiscal tissue. These findings suggest that histological and biomolecular changes occur in condyles and discs after unilateral mandibular distraction osteogenesis.