• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.2
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• pp.94-100
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• 2009

Purpose: As the interest and demand for esthetics grow up with medical development, the number of patients who want to correct dentofacial deformities by orthognathic surgery has increased. And the success of orthognathic surgery is dependent upon satisfaction of patients in great measure. Therefore the purpose of this study is to examine functional disability, sensory disturbance and esthetic satisfaction of the patients after orthognathic surgery. Material and methods: Among 89 patients who orthognathic surgery was performed at Seoul National University Bundang Hospital during the period from July 2003 to July 2008, 46 patients were considered in the study. Patients were surveyed with questionnaires and visual analogue scale(VAS) which author has designed. The analysis and comparison were performed according to gender, follow up span, and type of surgery based on answer of questionnaires. Results and conclusions: Total satisfaction rate was 76%. And there was statistical significant difference between subjective evaluation of facial esthetics before the surgery and that of after surgery(p<0.05). Differences in occurrence of functional disability, sensory disturbance between groups were not observed. In conclusion, the operator should understand the postoperative self-satisfaction of the patients and complications. If we can communicate with the patients before operation. patients' satisfaction rate will increase after operation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.2
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• pp.106-111
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• 2009

Bisphosphonates have been approved for Paget's disease, cancer-related hypercalcemia, bone involvement in multiple myeloma or solid tumors and osteoporosis. Although, underlying pathophysiological mechanisms remain unclear, it seems that bisphosphonates inhibit osteoclast precursor cells, modulate migratory and adhesive characteristics and induce apoptosis of osteoclasts. Furthermore impacts on angiogenesis, microenvironment and signal transduction between osteoclasts and osteoblasts. In this report, we present a case of oral bisphosphonates induced osteonecrosis of the mandible in a 84-year-old patient who received for two years. Two tapered screw vent implants(Zimmer, USA) were placed in the area of first and second molar. Two weeks later after crowns restored, some inflammatory signs and symptoms were observed on the second molar area. Sequestrum was formed and the sequestrum was removed with the implant. Frequent follow-up checks and oral hygiene maintenances were done and the first molar implant was restored. There is insufficient evidence suggests that duration of oral bisphosphonate therapy correlates with the development and severity of osteonecrosis. Therefore, dentists should not overlook the possibility of development of bisphosphonate induced osteonecrosis in patients who have taken oral forms of medication for less than three years.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.2
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• pp.120-124
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• 2009

The concept of biostimulation of wounds by low-level laser therapy(LLLT) is attracting considerable attention. Although its effect on whole tissues has been studied quite extensively, the biological and cellular mechanisms underlying LLLT have not been clarified. In an experimental radius fracture in rabbits, Tang and Chai reported that LLLT enhanced the activity of red blood cells, macrophages, fibroblasts, chondrocytes, and osteoclasts within the fracture area. The purpose of the present study was to evaluate the effect of LLLT with a GaAlAs diode laser device on bone healing in rabbit mandibular fractures. We use 12 rabbits for this study. All rabbits were fractured mandible angle area using saw in anesthetic condition. In control group(n=6), none treatment was performed at fracture site. In experimental group(n=6), LLLT with a GaAlAs diode laser was radiated at fracture site daily for 7 days. All rabbits were sacrificed at 6 weeks later from performed fracture day. We studied the immunohistochemical staining of CD34 and Vimentin and the histochemical analysis for calcium and phosphorus content. The results were as follows. 1. In the histological and immunohistological staining, after 6week, fibroblasts, osteogenic cells and collgen fibers were observed more in experimental group than in control group. 2. In the histochemical analysis, the amount of calcium and phosphorus contents of the experimental group were more than the control group. From the results obtained, we suggest that the bone healing is stimulated by low-level laser irradiation in bone fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.2
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• pp.125-130
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• 2009

For many years, intermaxillary fixation using arch bar has been operated in treatment of mandibular fracture patients. But it has many complications including injury of operators and assistants cause by wire, inflammation of periodontium. For that reasons alternatives are required; osteosynthesis technique using mini plate, intermaxillary fixation using IMF screws have been available. Treatment by arch bar fixation, however, is still valuable to treat craniomaxillary fracture patients. The purpose of this study is to know effect arch bar on periodontium and influence gingival gel on periodontium applied by arch bar. 40 mandibular fracture patients are monitored. 30 patients were applied by arch bar, 10 patients were not. And the former were classified by 3 categories; Nano vitamin and Mastic gel were applied to 10 patients respectively and any gingival gel was not used to 10 patients. Clinical attachment level, bleeding on probing and periodontal depth of each group were measured and compared before operation and on 2 weeks and 6 weeks after operation. Mann-Whitney U test was used to analyze result which leads to this conclusion. 1. Whether arch bar is applied or not, treatment of mandlbular fracture gave rise to gingivitis, but 6 weeks after operation, gingivitis is restored to the same level as the state before operation. 2. More severe gingivitis appeared when arch bar is applied to mandibular fracture than when it is not. 3. Both gingival gel used in this study can reduce gingivitis which can be caused by arch bar. 4. In this study, Mastic gel is more effective for prevent gingival inflammation cause by arch bar than nano vitamin. In regard to this result, gingivitis is considered to be available because it is reversible and does not induce periodontal disease. Gingival gel is regarded to be helpful for patients applied by arch bar to feel less discomfort.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.3
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• pp.227-237
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• 2007

Microglial cell activation is known to contribute to neuropathic pain following spinal sensory nerve injuries. In this study, I investigated its mechanisms in the case of trigeminal sensory nerve injuries by which microglial cell and p38 mitogen-activated protein kinase (p38 MAPK) activation in the medullary dorsal horn (MDH) would contribute to the facial pain hypersensitivity following mandibular nerve transection (MNT). And also investigated the changes of trigeminal ganglion neurons and ERK, p38 MAPK manifestations. Activation of microglial cells was monitored at 1, 3, 7, 14, 28 and 60 day using immunohistochemical analyses. Microglial cell activation was primarily observed in the superficial laminae of the MDH. Microglial cell activation was initiated at postoperative 1 day, maximal at 3 day, maintained until 14 day and gradually reduced and returned to the basal level by 60 days after MNT. Pain hypersensitivity was also initiated and attenuated almost in parallel with microglial cell activation pattern. To investigate the contribution of the microglial cell activation to the pain hypersensitivity, minocycline, an inhibitor of microglial cell activation by means of p38 MAPK inhibition, was administered. Minocycline dose-dependently attenuated the development of the pain hypersensitivity in parallel with inhibition of microglial cell and p38 MAPK activation following MNT. Mandibular nerve transection induced the activation of ERK, but did not p38 MAPK in the trigeminal ganglion. These results suggest that microglial cell activation in the MDH and p38 MAPK activation in the hyperactive microglial cells play an important role in the development of facial neuropathic pain following MNT. The results also suggest that ERK activation in the trigeminal ganglion contributes microglial cell activation and facial neuropathic pain.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.3
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• pp.204-210
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• 2007

This study was intended to compare the cranial base morphology between the mandibular prognathism and maxillary retrognathism in skeletal class III patients. The subject of the present study was composed of 88 patients divided into two groups; Group 1 (Skeletal Class III with mandibular prognathism. SNA within normal range, SNB over normal range, n=54) and Group 2(Skeletal Class III with maxillary retrognathism. SNA below normal range, SNB within normal range, n=34). Lateral cephalogram were taken immediate before surgery and 18 landmarks were used to analyze the characteristics of cranial base and maxillomandibular skeleton. The result revealed that cranial base angle is significantly smaller in Group 1 than Group 2, which implies the influence of the cranial base angulation on the mandibular position. However the posterior cranial base length did not influence the mandibular horizontal position and anterior cranial base length did not influence the maxillary horizontal position. As the anterior cranial base length was closely related with ramal height, it is recommendable to investigate the regulatory mechanism of chondrogenesis of cranial base and condyle cartilage in the future research.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.3
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• pp.247-255
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• 2007

The bone morphogenic protein(BMP) can promote migration and growth of mesenchymal cells and initiate process for bone and cartilage formation. Cartilage-derived morphogenic protein(CDMP)-1 and -2 belong to the bone morphogenetic protein family in the transforming growth factor(TGF)-${\beta}$ superfamily. Although pleomorphic adenoma of the salivary glands is an epithelial tumor, it frequently shows ectopic cartilaginous formation with biomolecular studies. The mechanism of pathogenesis in cartilaginous formation is still controversy. We examined the expression and localization of CDMP-1 and -2, in comparison with the localization of cartilaginous matrix proteins, in human normal salivary glands and 20 cases of pleomorphic adenoma using immunohistochemical methods. The results were followed. 1. CMP-1 was immunolocalized in the striated ducts and the intercalated ducts, but not expressed in excretory duct, CDMP-2 was not expressed in the normal salivary glands. 2. CMP-1 was immunolocalized in the ductal cell and cuboidal neoplastic myoepithelial cells around the chondroid areas of the pleomorphic adenomas, whereas these molecules were not localized in the spindle-shaped neoplastic myoepithelial cells of the myxoid element in these tumors. CDMP-2 was expressed neither in normal salivary glands nor in any elements of the pleomorphic adenomas. 3. In transmission electron microscopic view, the tumor cells are composed of modifed myoepithelial cells between hyaline and myxoid stroma. 4. In Immuno-blot analysis, strong overexpression of CDMP-1 was frequently seen in pleomorphic adenomas, but the level of CDMP-2 was expressed minimally in pleomorphic adenoma. From the these results, it should be suggested that undifferentiated neoplastic myoepithelial cells around the chondroid areas expressed CDMP-1 and suggested that this molecule may play a role in the differentiation of neoplastic myoepithelial cells in pleomorphic adenoma, but not CDMP-2.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.2
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• pp.113-118
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• 2008

Temporomandibular joint disorder (TMD) can induce severe pain but, its pathogenic mechanisms remain poorly understood. In this study, we analyzed proteomes of human synovial fluid in the superior joint space in the patients with TMD, which is obtained during the treatment arthrocentesis. We've got this result that one of the spots was consistently down-regulated in synovial fluid of patients with TMD from analysis of protein pattern. Its molecular weight was estimated to be 33 kDa. Synoviolin was identified in our proteomics analysis of LC/MS/MS. This protein was recently reported as one of the proteins that might affect rheumatoid arthritis (RA). Synoviolin that might be associated with RA was detected in synovial fluid of patients with TMD. We can conclude that synoviolin might be involved not only in the pathogenesis of RA but also in TMD. In result, synoviolin might be involved in the pathogenesis of TMD and can be candidates as new therapeutic targets of TMD or early detection biomarkers.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.2
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• pp.119-130
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• 2008

Absorbable atelo-collagen sponge $TERUPLUG^{(R)}$, Termo Co. Tokyo, Japan) is inserted in the extraction wound where alveolar bone is exposed. It protects wounds and promotes the formation of granulation. This is made of atelo-collagen, to minimize antigenicity, which is cross-linked by heat treatment for biocompatibility. $TERUPLUG^{(R)}$ consists of between 85 and 95 % of collagen type I and between 5 to 15 % of collagen type III. The raw material for the collagen is derived from bovine skin. It features a sponge block design and is shaped for easy insertion in the extraction wound. This study was designed to find out the bone healing capacity of $TERUPLUG^{(R)}$. We implanted $TERUPLUG^{(R)}$ (experimental group I) and $TERUPLUG^{(R)}$ with rhBMP-2 (experimental group II) in the rabbit cranium defect and then histologically analysed the specimen. The results were as follows. 1. In the 4 weeks, a lot of the newly formed collagen fibers around material of the experimental group I implanted $TERUPLUG^{(R)}$ were observed. But, in the experimental group II implanted $TERUPLUG^{(R)}$ with rhBMP-2, a little of newly formed collagen fibers around material were observed. The cell proliferating activity and apoptosis of the experimental group I, II was positive in and around the implanted material. 2. In the 8 weeks, the amount of newly formed and matured bone in the experimental group II was more observed than the experimental group I and control group. The results of this study indicate that absorbable atelo-collagen sponge ($TERUPLUG^{(R)}$) is relatively favorable bone void filler with biocompatibility and has the better bone healing capacity in case of application with rhBMP-2.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.5
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• pp.206-210
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• 2014

Objectives: To identify post-treatment prognostic factors for medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods: We evaluated 54 MRONJ patients who visited the Department of Dentistry, Ajou University Hospital, from May 2007 to March 2014. Twenty-one patients were surgically managed with debridement or sequestrectomy and 33 patients were conservatively managed using antibiotics. Correlations of age, sex, stage, bisphosphonate duration and type, and drug holiday with the prognosis of MRONJ were investigated. Correlations were verified by logistic regression analysis and t-tests with a significance level of 0.05. Results: Clinical outcomes were evaluated on the basis of both clinical and radiographic findings. Twelve out of 21 surgically managed patients showed a favorable prognosis and nine patients relapsed. Thirty-one of the 33 conservatively managed patients showed no specific change in prognosis, and two patients worsened. Statistical analyses of the conservative management group did not reveal any correlation of the above factors with the prognosis of conservative management. Drug holiday was the only prognostic factor in the surgical management group (P=0.031 in logistic regression analysis, P=0.004 in t-test). Conclusion: Drug holiday is a prognostic factor in the surgical management of MRONJ. Because the drug holiday in the patients of the poor prognosis group occurred 1.5 to 4 months prior to surgical management, we recommend a drug holiday more than 4 months before surgery.