• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권1호
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• pp.15-20
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• 2019

Objectives: The aim of this study was to use four sets of success criteria to evaluate the outcomes of arthrocentesis treatment with hyaluronic acid injection in patients with internal derangement (ID) of the temporomandibular joint (TMJ). Materials and Methods: The study included 40 patients diagnosed with unilateral Wilkes stage III TMJ dysfunction. Clinical parameters, including maximum mouth opening (MMO) and pain during function, were evaluated preoperatively, 6 months, and 1 year after TMJ arthrocentesis. Outcomes were assessed and compared using four sets of success criteria from the following: the American Association of Oral and Maxillofacial Surgeons (AAOMS; MMO ${\geq}35mm$ and visual analogue scale [VAS] score ${\leq}3$), Murakami et al.'s criteria (MMO >38 mm and VAS score <2), Emshoff and Rudisch criteria (MMO ${\geq}35mm$ and >50% pain reduction), and patient self-reports (self-evaluation of treatment as successful or unsuccessful). Results: Significant improvements in MMO and pain reduction during function were observed between the preoperative period and 6 months and 1 year postoperatively (P<0.01). The success rates of treatment determined using AAOMS (52.5%), Emshoff and Rudisch criteria (57.5%), and self-reported patient criteria (40.0%) were similar. Application of the Murakami et al. criteria reported the lowest success rate (12.5%). Conclusion: The AAOMS and Emshoff and Rudisch criteria are consistent with patient expectations and can be used to assess treatment efficacy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권1호
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• pp.21-28
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• 2019

Objectives: Osteoradionecrosis (ORN) is one of the most severe complications resulting from radiotherapy (RT) in patients with head and neck cancer (HNC). It is characterized by persistent exposed and devitalized bone without proper healing for greater than 6 months after a high dose of radiation in the area. To describe the profile and dental management of ORN in HNC patients undergoing RT in an oncological clinical research center. Materials and Methods: A retrospective descriptive study was performed to analyze dental records from HNC patients with ORN treated at an oncological clinical research center from 2013 to 2017. A total of 158 dental records for HNC patients were selected from a total of 583 records. Afterwards, this number was distributed to three examiners for manual assessments. Each examiner was responsible for selecting dental records that contained an ORN description, resulting in 20 dental records. Results: Mean patient age was 60.3 years with males being the most affected sex (80.0%). The most affected area was the posterior region of the mandible (60.0%) followed by the anterior region of the mandible (20.0%) and the posterior region of the maxilla (10.0%). The factors most associated with ORN were dental conditions (70.0%) followed by isolated systemic factors (10.0%) and tumor resection (5.0%). There was total exposed bone closure in 50.0% of cases. The predominant treatment was curettage associated with chlorhexidine 0.12% irrigation (36.0%). Conclusion: Poor dental conditions were related to ORN occurrence. ORN management through less invasive therapies was effective for the closure of exposed bone areas and avoidance of infection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권2호
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• pp.83-90
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• 2019

Objectives: This study evaluated the predictive factors for survival of patients with oral squamous cell carcinoma (OSCC) and investigated the overall and disease-specific survival (DSS) outcomes. Materials and Methods: A total of 67 consecutive patients who underwent surgery for OSCC from January 2006 to November 2014 were included in this study. Patients were classified according to age, sex, pTNM stages, primary sites, smoking and alcohol drinking habits, depth of invasion, perineural and lymphovascular invasion, cell differentiation and postoperative radiotherapy. Kaplan-Meier methods were used to estimate the survival categorized by patient groups. Cox regression methods were used to investigate the main independent predictors of survival. Results: Nineteen patients died of OSCC during follow-up periods. Another five patients died of other diseases including lung adenocarcinoma (n=1), cerebral infarction (n=1), general weakness (n=2), and pneumonia (n=1). The tongue (n=16) was the most common site for primary origin, followed by buccal mucosa (n=15), mandibular gingiva (n=15), maxillary gingiva (n=9), floor of mouth (n=9), retromolar trigone (n=2), and palate (n=1). Eleven patients had pTNM stage I disease, followed by stage II (n=22) and stage IV (n=34). No patients had pTNM stage III disease in this study. The overall survival of all patients was 64.2% and the DSS was 71.6%. DSS of patients with stage I and II disease was 100%. Stepwise Cox regression showed the two predictors for DSS were pTNM stage (P<0.0001, odds ratio=19.633) and presence of metastatic lymph nodes (P=0.0004, odds ratio=0.1039). Conclusion: OSCC has been associated with poor prognosis; however, there were improved survival outcomes compared with past studies. Advanced-stage disease and presence of metastatic lymph nodes were associated with poorer survival compared with early-stage OSCC and absence of neck node metastasis. Stage I and II OSCC were associated with excellent survival results in this study.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권2호
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• pp.91-96
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• 2019

Objectives: This study aimed to investigate the effects of chronic restraint stress on the osseointegration of titanium implants. Materials and Methods: Twenty adult male Wistar albino rats were used in the study. After surgical insertion of titanium implants into the metaphyseal part of the tibial bone, rats were randomly divided into two groups: a control group (CNT group) and an experimental restraint stress group (RS group). In the CNT group, titanium implants were inserted surgically, and rats received no further treatment during the 47-day experimental period. In the RS group, restraint stress was applied for 3 hours per day for 45 days, beginning 2 days after implant surgery. Weight of the rats was measured prior to surgery and at the end of the study to analyze the effects of stress. At the end of the experimental period, rats were euthanized, and implants and surrounding bone tissues were used for undecalcified histological analysis. Serum cortisol levels were assessed in cardiac blood samples from the rats following centrifugation. Results: Average weight of rats in the RS group was lower than that of rats in the CNT group after the experimental protocol had been completed (P<0.05). Further, serum cortisol levels were higher in the RS group than in the CNT group (P<0.05). There were no significant differences in boneimplant connection levels between the two groups (P>0.05). Conclusion: The data analyzed in this study suggest that chronic restraint stress did not adversely affect rats during a 45-day osseointegration period.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권1호
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• pp.9-14
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• 2019

Objectives: This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement. Materials and Methods: Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (${\leq}25\;years$, >25 and ${\leq}40\;years$, >40 and ${\leq}60\;years$), VAS pain level (${\leq}5$, >5 and ${\leq}7$, >7 and ${\leq}10$), and ROM (<25 and ${\geq}25mm$). Odds ratios (ORs) were used to describe the proportional benefit of each variable the on successful outcome of arthrocentesis. For the OR to be clinically relevant or even clinically noticeable, we assumed that the OR would need to be larger than 2. Results: Mean preoperative pain score was $6.49{\pm}1.560$ and at 6 months postoperative was $0.46{\pm}1.147$ with an average decrease of pain score 6 (P<0.001). The mean preoperactive maximum mouth opening was $26.14{\pm}4.969mm$ and mean maximum mouth opening at 6-month inerval was $38.92{\pm}3.392mm$. The mean increase in the mouth opening was a mean difference of 12.78 mm (P<0.001). Logistic regression showed that the maximum benefit occurred in patients aged <25 years (OR, 12.01; P=0.012), a VAS pain level of >7 (OR, 11.25; P=0.039), and a maximum vertical opening of <25 mm (OR, 7.70; P=0.038). Conclusion: Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권6호
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• pp.259-268
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• 2018

Objectives: The purpose of this study was to evaluate the synergic effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) and low-level laser therapy (LLLT) on bisphosphonate-treated osteoblasts. Materials and Methods: Human fetal osteoblast cells (hFOB 1.19) were cultured with $100{\mu}M$ alendronate. Low-level Ga-Al-As laser alone or with 100 ng/mL rhBMP-2 was then applied. Cell viability was measured with MTT assay. The expression levels of receptor activator of nuclear factor kappa-B ligand (RANKL), macrophage colony-stimulating factor (M-CSF), and osteoprotegerin (OPG) were analyzed for osteoblastic activity inducing osteoclastic activity. Collagen type and transforming growth factor beta-1 were also evaluated for bone matrix formation. Results: The results showed that rhBMP-2 and LLLT had a synergic effect on alendronate-treated osteoblasts for enhancing osteoblastic activity and bone matrix formation. Between rhBMP-2 and LLLT, rhBMP-2 exhibited a greater effect, but did not show a significant difference. Conclusion: rhBMP-2 and LLLT have synergic effects on bisphosphonate-treated osteoblasts through enhancement of osteoblastic activity and bone formation activity.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권1호
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• pp.29-33
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• 2019

Objectives: Bone density seems to be an important factor affecting implant stability. The relationship between bone density and primary and secondary stability remains under debate. The aim of this study was to compare primary and secondary stability measured by resonance frequency analysis (RFA) between different bone types and to compare implant stability at different time points during 3 months of follow-up. Materials and Methods: Our study included 65 implants (BioHorizons Implant Systems) with 3.8 or 4.6 mm diameter and 9 or 10.5 mm length in 59 patients. Bone quality was assessed by Lekholm-Zarb classification. After implant insertion, stability was measured by an Osstell device using RFA at three follow-up visits (immediately, 1 month, and 3 months after implant insertion). ANOVA test was used to compare primary and secondary stability between different bone types and between the three time points for each density type. Results: There were 9 patients in type I, 18 patients in type II, 20 patients in type III, and 12 patients in type IV. Three implants failed, 1 in type I and 2 in type IV. Stability values decreased in the first month but increased during the following two months in all bone types. Statistical analysis showed no significant difference between RFA values of different bone types at each follow-up or between stability values of each bone type at different time points. Conclusion: According to our results, implant stability was not affected by bone density. It is difficult to reach a certain conclusion about the effect of bone density on implant stability as stability is affected by numerous factors.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권4호
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• pp.192-198
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• 2019

Objectives: Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. Materials and Methods: The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. Results: Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. Conclusion: Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권4호
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• pp.199-206
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• 2019

Objectives: In mandibular edentulism, the treatment option with a two-interforaminal implant-retained bridge and a removable partial denture is rarely evaluated in literature. The aim of this in vitro study was to evaluate the stress distribution of this treatment option by comparing it with traditional treatment options with interforaminal implants in the edentulous mandible. Materials and Methods: Two interforaminal implants were placed in a formalin-fixed cadaver mandible, and overdentures with three different types of attachments were fabricated: (1) two ball attachments and an overdenture, (2) a Dolder bar and an overdenture, and (3) screw-retained two-implant inter-canine porcelain fused to a metal bridge and an implant-assisted removable denture (IARD) with precision attachments. Three biting conditions were generated for each denture type, and the strains were documented under vertical loading of 100 N. Results: The calculated strain values from measured strains in all measurement sites and loading conditions for the screw-retained two-implant intercanine porcelain fused to a metal bridge and a cast framework partial denture with precision attachments situation were lower than in the other scenarios (P<0.05). Conclusion: Within the limitations of the present study, it can be concluded that an IARD may be a reasonable and valuable alternative to ball attachments or a bar in two interforaminal implants, especially when the patients prefer to be able to show their teeth even when they take out their removable dentures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권4호
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• pp.207-214
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• 2019

Objectives: Medically compromised patients often fear required dental surgical procedures that can increase the risk of medical emergency when combined with reduced tolerance for stress. A stress reduction protocol (SRP) helps doctors minimize treatment-related stress and improves patient management with minimum complications. Diabetes and co-morbid hypertension carry 4-fold risk of aggravation of cardiovascular emergencies and 7.2-fold risk of mortality. Diabetic neuropathy can result in difficult diagnosis of myocardial infarction and reduces chances of surviving a myocardial infarction compared with a non-diabetic person. The aim of the study was to assess the feasibility of a protocol for management of patients having both diabetes and hypertension who required minor oral surgery to minimize the rate of cardiovascular emergencies. Materials and Methods: A prospective study was conducted in 140 patients having both diabetes and hypertension who required minor oral surgical procedures. A systematic approachable protocol was designed for management of such patients. Results: Among 140 patients, 6 patients (4.3%) had cardiovascular complications, while 3 patients (1 with syncope and 2 with hypertension) did not require any intervention other than observation. Two patients were managed with aspirin and nitroglycerin, and 1 patient had possible myocardial infarction (overall incidence 0.7%) with chest pain, S-T segment elevation on electrocardiogram, and troponin level of 0.60 ng/mL. Conclusion: The proposed protocol helps to improve management of patients having both diabetes and hypertension. We recommend that patients with uncontrolled diabetes and uncontrolled hypertension and/or patients having history of cardiovascular complication should be treated in a medical facility with a readily available cardiology unit. This facilitates prompt response to emergency and instant implementation of treatment, helping to reduce morbidity and mortality.