• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.5
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• pp.428-433
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• 2004

Sinus floor augmentation has been proven an effective treatment procedure to increase bone volume in the posterior edentulous maxilla. Autogenous bone considered to be the best material for reconstructive bone surgery and has been successfully used as a graft material to augment posterior maxilla. However, the collection of autogenous bone required extra risks for morbidity and complaints. So, various bone graft materials included ${\beta}$-tricalcium phosphate(${\beta}$-TCP) has been introduced for replacing the autogenous bone. The objective of this clinical study was to determine the predictability of endosseous implant placed in a maxillary sinus with ${\beta}$-TCP grafting. We performed sinus elevation with ${\beta}$-TCP to install the implant in the 10 maxillary cases. The prosthetic procedure was performed 6-9 months after. The implant-prosthetics was checked about 1 year. We checked the implant and measured the maximum bite force to evaluate the function of the implant. There was not observed the specific problem and complication in dental implant and maxillary sinus in the grafted materials. The maximum bite force was 558N in case of natural tooth, 365N in implant without grafting, 318N in implant with ${\beta}$-TCP grafting. There was no significant difference between with and without sinus grafting on maximum bite force(p>0.05). As though the long term check-up is needed, the grafting of ${\beta}$-TCP as a osteoconductive materials can expand the volume and induce dense new bone formation in maxillary sinus. So, this short-term results support that ${\beta}$-TCP can be a suitable material for sinus augmentation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.6
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• pp.455-464
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• 2004

The purpose of this study was to evaluate and compare the influence of Steroid topical irrigation and implant surface on bone healing in the irradiated rabbit tibia. Implant to bone contact surface ratio and the pattern of bone healing around hydroxyapatite(HA) coated implant and pure titanium (Ti) implant which were inserted into the irradiated rabbit tibia were compared. 16 Korean house mature male rabbits were used as experimental animal. Each rabbit received 15 Gy of irradiation. 4 weeks after the irradiation, two holes were prepared in the irradiated tibia of each rabbits, where two surface type of implants were inserted :1) HA coated type and 2) pure Ti type. Right before placing implants, one group of rabbit received steroid irrigation and the other group did saline. After the irrigation, two implants of HA coated type and pure Ti type were inserted into the tibia of each rabbits. Each rabbit were sacrificed at 2nd, 4th, and 8th week after the implantation and the specimens were observed by the light microscope. The pattern of bone healing and histomorphometric analysis of the implant-bone interface were done. The results were as follows. 1. All implants inserted into the irradiated tibia of rabbit did not show any sign of clinical mobility and the bone around implants inserted into the irradiated tibia of rabbit did not show any resorption. 2. The bone to implant contact surface ratio around HA coated implants that received steroid irrigation got more bone to implant contact surface ratio than that of the saline irrigation. This result showed statistically significant(p<0.05). There was no statistically significant difference in 8th week group. 3. Though there was no statistically significant difference HA coated implants had more bone to implant contact surface ratio than pure Ti implant in 2nd and 4th groups, and there was no difference in 8th week group. 4. All implants inserted into the irradiated tibia of rabbit had exhibited successful osseointegraion.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.6
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• pp.545-550
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• 2004

Salivary glands, major and minor, are susceptible to a wide variety of pathologic conditions. Excision of the submandibular gland is a surgical procedure often undertaken. The procedure is the treatment of choice for patients with neoplasm of the submandibular gland and those with non-neoplastic submandibular disorders which are not controlled with conservative medical measures. Extirpation of the submandibular gland may also be undertaken for diagnostic purposes. We evaluated 84 patients who had been admitted to the dept. of oral and maxillofacial surgery of Pusan National University Hospital from January, 1989 to December, 2002 and had been performed submandibular gland excision. The results are as follows : 1. The patients undertaken the excision of the submandibular gland showed an age range of 16 to 71 years. The average was 49.1. 2. They consisted of 60 males(71.4%) and 24 females(28.6%), having 2.5 : 1 of genda ratio. 3. The most common symptom was swelling in 41 cases(48.8%), followed by the pain in 23 cases(27.4%). Other symptoms included mass, dysphagia, facial abnormaly and neck dyscinesia. 4. 42 cases(50.0%) showed sialadenitis and sialodochitis associated with salivary calculus. 5. According to the histopathologic study, all cases consisted of 17 neoplasmatic conditions(20.3%) and 67 non-neoplasmatic(79.7%). The neoplasmatic cases included 13 benign tumors and 4 primary malignant tumors. Sialadenitis and sialodochitis associated with or without salivary calculus were most marked, found in 50 cases(59.3%), in the non-neoplasmatic conditions. Pleoomorphic adenoma showed the highest frequency of the benign tumor.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.6
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• pp.509-515
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• 2004

Photodynamic therapy(PDT) has advanced to clinical trials for the treatment of a variety of solid tumors and presents an alternative treatment option for tumors resistant to chemo-and/or radio-therapy. PDT is based on the combination of laser light of appropriate wavelength and energy to activate a systemically or locally applied photosensitizer that concentrates preferentially in malignant tissues. In this study, phototoxicity of laser EIT 21 was analysed in human osteosarcoma cell(HOS) and the second objective of this study was to determine the ability of laser EIT 21 to induce apoptosis. This study demonstrated that laser EIT 21 had a phototoxicity to HOS cells. In order to examinate whether cell death was induced by necrosis or apoptosis, variety of techniques which assess apoptosis were used. TUNEL assay showed only a few the positive reaction on condensed nuclei. It is hard to find condensed or fragmented nuclei on HOS cells irradiated with laser EIT 21 in Hemastat and AO/EB stain. By DNA electrophoresis, cells also did not show DNA degradation characteristic of apoptosis with a ladder pattern of DNA fragments. Apoptosis-related factors were analyzed by western blotting. The expression of p53 was constant and cells irradiated with laser did not show the caspase-3 and PARP degradation, therefore we suggest that p53 and caspase-3 are not involved in laserinduced cell death.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.440-453
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• 2005

Objectives : To develop a bioactive membrane for guided bone regeneration (GBR), the biocompatibility and bone regenerating capacity of the cellulose membrane obtained from the Ascidians squirt skin were evaluated. Materials and methods : After processing the pure cellulose membrane from the squirt skin, the morphological study, amino acid analysis and the immunoreactivity of the cellulose membrane were tested. Total eighteen male Spraque-Dawley rats (12 weeks, weighing 250 to 300g) were divided into two control (n=8) and another two experimental groups (n=10). In the first experimental group (n=5), the cellulose membrane was applicated to the 8.0 mm sized calvarial bone defect and the same sized defect was left without cellulose membrane in the first control group (n=4). In the another experimental group (n=5), the cellulose membrane was applicated to the same sized calvarial bone defect after femoral bone graft and the same sized defect with bone graft was left without cellulose membrane in the another control group (n=4). Each group was sacrificed after 6 weeks, the histological study with H&E and Masson trichrome stain was done, and immunohistochemical stainings of angiogenin and VEGF were also carried out. Results : The squirt skin cellulose showed the bio-inductive effect on the bone and mesenchymal tissues in the periosteum of rat calvarial bone. This phenomenon was found only in the inner surface of the cellulose membrane after 6 weeks contrast to the outer surface. Bone defect covered with the bioactive cellulose membrane showed significantly greater bone formation compared with control groups. Mesenchymal cells beneath the inner surface of the bioactive cellulose membrane were positive to the angiogenin and VEGF antibodies. Conclusion : We suppose that there still remains extremely little amount of peptide fragment derived from the basement membrane matrix proteins of squirt skin, which is a kind of anchoring protein composed of glycocalyx. This composition could prevent the adverse immunological hypersensitivity and also induce bioactive properties of cellulose membrane. These properties induced the effective angiogenesis with rapid osteogenesis beneath the inner surface of cellulose membrane, and so the possibilities of clinical application in dental field as a GBR material will be able to be suggested.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.370-378
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• 2005

The purpose of this study is that evaluate the distribution and biological roles of TNF-a, interleukin-1${\beta}$(IL-1${\beta}$), interleukin-6(IL-6) and tissue inhibitors of metalloproteinase-1(TIMP-1) in the synovial fliud of patients with non-inflammatory chronic temporomandibular joint(TMJ) disorders in relation to pain during joint movements and magnetic resonance imaging(MRI) findings. TMJ synovial fluids aspirates were obtained from 36 patients (36 joints) with chronic TMJ disorders and from 8 controls(8 joints). Patients were divided to four groups. The control group was from healthy volunteers(8 joints), group I(18 joints) was patients with anterior disc displacement with reduction, group II(5 joints) was patients with disc displacement without reduction and group III (5 joints) was osteoarthritis. The TNF-${\alpha}$, IL-1${\beta}$ and IL-6 levels in the aspirates were determined by using an enzyme-linked immunosorbent assay and the TIMP-1 level was measured by an enzyme immunoassay. Following examinations for pain during joint movements and MRI observations, these cytokines' level and frequencies of detection were compared. The level of IL-1${\beta}$was not significant different in all groups. but the level of TNF-${\alpha}$, IL-6 and TIMP-1 were significant different among groups. The level of IL-6 and TIMP-1 were correlated to pain during movement(p<0.01) and the level of TNF-a(p<0.05). Also, the level of IL-6 was correlated to the level of TIMP-1(p<0.01). Especially, The level of the TIMP-1 level was significantly correlated to the pain during movement and showed very high levle of Pearson's correlation coefficient (r=0.833)(p<0.001). The results indicated that the TNF-${\alpha}$, IL-6 and TIMP-1 levels in the TMJ aspirates of patients with chronic TMJ disorders have been raised. Especially, IL-6 and TIMP-1 were very high levels in the patients who were degraded in the TMJ. Also, TNF-${\alpha}$, IL-6 and TIMP-1 showed the significant correlation in the chronic temporomandibular joint disorders. Therefore I suggest that these cytokines were also correlated to the pain during movement in the chronic temporomandibular joint disorders.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.379-389
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• 2005

Obstructive adenitis of the salivary gland following salivary stone or infectious disease of the gland and surrounding tissues is a common disease. It is often difficult to decide whether to perform total excision of the gland or to consider conservative treatment. The present study was designed to investigate histological, histochemical changes of submandibular gland after ligating the excretory duct for identifying the results of gland duct obstruction. A group of 40 rat of Sprague-Dawley weighing about $200{\sim}220gm$ were used in the present study. 30 rats had ligation of the main excretory ducts of submandibular glands just at the exit from the glands. For controls, 10 rats had a sham operation without duct ligation. They were inducted into euthanagia state by intracardial Ketamine injection in 1, 2, 3, 5, 7, 14, 21, 28, 35 and 42 days after the ligation. In each ligation period, 3 animals were used for ligation and one animal was for control. The submandibular glands were dissected out at sacrifice and stained with H&E, PAS, mucicarmine stain and histological examination were carried out under the light microscope. After examination and comparison of all specimens, the results were as follows: 1. In the features of H&E stain, acini disappeared by degrees after the ligation of the excretary duct and interstitial cells were displaced into fibrous connective tissue. Salivary gland had been atrophied with enlarging ducts and proliferating ductal cells. 2. Through total experimental period, a lot of vessels were observed and the atrophy of serous gland was severer than that of mucous gland. 3. The deep portion of submandibular glands showed severe degeneration rather than superficial portion of them after the ligation. 4. The changes which had enlarged ducts and proliferating ductal cells were observed in entire gland and more prominent in serous gland than mucous gland after the ligation. 5. Although PAS and mucicarmine reactions were decreased gradually after the ligation with the lapse of time, since 2 to 3 weeks they were strong positive reactions on entire gland, especially on duct-like structure. So, we can suggest that salivary gland will be atrophied but, survived acini will be redistributed around the ducts.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.399-408
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• 2005

In the progression of the Temporomandibular Joint Disorder(TMD), not only deformation and perforation of disc occur. But also fibrotic adhesion and inflammatory changes to the retrodiscal tissue can be seen in addition to the condylar degenerative change (e.g. osteoarthritis). However, the correct diagnosis,?planning for appropriate treatment, and prediction of prognosis are limited, because there are no means to stage the progression of the disorder. In this study relative signal intensity of retrodiscal tissue in MRI and the synovial fluid concentration of matrix metalloproteinase-2 (MMP-2), MMP-9, and Interleukin-6(IL-6) in the 23 temporomandibular joints(TMJ), from 17 patients with TMD were evaluated as a possible diagnostic marker. The relative signal intensity of retrodiscal tissue was referenced to brain gray matter with same region of interest(ROI) size. The concentrations of MMP-2, MMP-9, and IL-6 were evaluated by Enzyme Linked Immunosorbent Assay (ELISA). The collected data were compared with condylar degenerative change, joint effusion and disc position observed in MRI. The relative signal intensity of the retrodiscal tissue was increased significantly when degenerative changes were present. In addition, there was significantly high signal intensity in the presence of a disc displaced without reduction. The concentration of IL-6 was significantly increased when condylar degenerative change was no observed. And there were no changes in the levels of IL-6 according to disc position and joint effusion measurement. Moreover, there were no significant relevance between the concentration of total MMP-2 and active MMP-9 in synovial fluid, relative to degenerative changes in the mandibular condyle, to joint effusion, and to disc position observed on MRI images. In conclusion, the relative signal intensity of the retrodiscal tissue can be regarded as a mean of diagnosing the procession of TMD in a non-invasive manner. But more additional studies are required for the levels of MMP-2. MMP-9, and IL-6 to determine their potentials as a diagnostic marker for TMD.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.409-416
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• 2005

Purpose of study: The temporomandibular joint (TMJ) occupies a key functional role in mastication and contributes to normal deglutition, speech as well as cosmesis. When a large amount of mandible including the condyle head is resected, it is very difficult to reconstruct it as a functional unit. In this retrospective study, we present the functional, radiographic and cosmetic results of reconstructed temporomandibular joint using free fibular flap. Patients and Methods: Total 12 patients (M:F = 6:6) who underwent condylar reconstruction with the fibular flap were interviewed and examined by radiographs and Bio-PAK$^{(R)}$. Mean follow up periods was $47.7{\pm}20.0$ months and the average age was $38.7{\pm}15.3$ years. Remodeling of condyle and function of TMJ were evaluated and facial contour was judged subjectively. Results: All flaps were viable and no immediate postoperative complication had happened. One patient showed decreased mouth opening, so interpositional gap arthroplasty was performed. The resorption rates of reconstructed fibular were minimal and the condyle heads were changed into domeshaped neocondyle after 2 years. All patients had normal diet and no speech difficulty was reported. Nine patients were satisfied with their facial contour but three patients complained about the depression of cheek. Conclusion: The reconstruction of TMJ with free fibular flap was reliable methods and very effective means of restoring mandibular function. The functional and morphologic results were excellent and showed little complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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• pp.200-208
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• 2006

Amino acids are required for protein synthesis and energy sources in all living cells. The amino acid transport system L is a major nutrient transport system that is responsible for $Na^+$-independent transport of neutral amino acids including several essential amino acids. In malignant tumors, the L-type amino acid transporter 1 (LAT1), the first isoform of system L, is highly expressed to support tumor cell growth. In the present study, the expression and functional characterization of amino acid transport system L were, therefore, investigated in Saos2 human osteogenic sarcoma cells. RT-PCR and western blot analyses have revealed that the Saos2 cells expressed the LAT1 and the L-type amino acid transporter 2 (LAT2), the second isoform of system L, together with their associating protein heavy chain of 4F2 antigen (4F2hc) in the plasma membrane, but the expression of LAT2 was very weak. The uptakes of [${14}^C$]L-leucine by Saos2 cells were $Na^+$-independent and were completely inhibited by the system L selective inhibitor, 2-aminobicyclo-(2,2,1)-heptane-2-carboxylic acid (BCH). The affinity of [${14}^C$]L-leucine uptake and the inhibition profiles of [${14}^C$]L-leucine uptake by various amino acids in the Saos2 cells were comparable with those for the LAT1 expressed in Xenopus oocytes. The majority of [${14}^C$]L-leucine uptake is, therefore, mediated by LAT1 in the Saos2 cells. These results suggest that the transports of neutral amino acids including several essential amino acids into Saos2 human osteogenic sarcoma cells are for the most part mediated by LAT1. Therefore, the Saos2 human osteogenic sarcoma cells are excellent tools for examine the properties of LAT1. Moreover, the specific inhibition of LAT1 in tumor cells might be a new rationale for anti-tumor therapy.