• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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• pp.209-215
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• 2006

Preoperative neoadjuvant chemotherapy using cisplatin and 5-FU is generally given in oral and maxillofacial cancer. At tissue level both inflammation and fibrosis occur after chemotherapy. The cellular changes mimic those of a granulating wound, with activated macrophages and fibroblasts replacing the malignant cells as they are erradicated. Stromal cells, together with extracellular matrix components, provide the microenvironment that is pivotal for tumor cell growth, invasion, and metastatic progression. Vascular endothelial growth factor(VEGF), an important regulator of angiogenesis in cancer, induces mitogenesis of vascular endothelial cells, and vascular permeabilization and microvessel formation in a tumor are associated with tumor nutrition and oxygenation. Also, they are associated with chemotherapeutic drug delivery. Oxygen delivery to tumor appears to rely on a network of microvessels, On the other hand, the tumor microvessel is clearly an important factor in chemotherapeutic drug delivery to cancer cells, and the efficacy of drug delivery can be high in richly vascularized tumors. So, this study was conducted to evaluate the effect of neoadjuvant chemotherapy on microvessel density from 11 patients with tongue cancers. Our results showed that neoadjuvant chemotherapy was seemed to decrease VEGF expression in tumor cells, however, it did not significantly alter VEGF expression in tumor-associated macrophages. Also, Neoadjuvant chemotherapy had little effect on the microvessel density using CD34, and tumor-associated macrophage level using CD68. Thus, tumorassociated macrophages seem to be the key factor associated with the maintenance of microvessel density after neoadjuvant chemotherapy in tongue cancer.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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• pp.241-249
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• 2006

Purpose For the reconstruction of craniofacial deformities, the distraction osteogenesis is an useful method which can make new soft tissues as well as new bone. Although the distraction osteogenesis is an effective procedure in quantitative aspects, the new bone formed by this procedure can be coarse in qualitive aspects sometimes. Materials and methods Twelve rabbits, weighing about 2 kg, were included and the prefabricated distraction device were used. After a latency period of 5 days, in the experimental group (n=6), the mandible was distracted at the rate of 1.0 mm/day for 2 days and then compressed with 1.0 mm for the next 3rd day, therefore distracted totally to a length of 1.0 mm for 3 days. This procedure was repeated 5 times and, as a result, the experimental group was distracted to a length of 5.0 mm for 15 days finally. In the control group (n=6), the mandible was distracted totally to a length of 5.0 mm at the rate of 1 mm/day. At 2 weeks and 8 weeks of consolidation in the control group, 3 rabbits in each group were sacrificed and their biopsy specimens from the distracted mandible were taken. Results All animals showed the mandibular elongation clinically and radiographically. Histologically, many blood vessels, osteoblasts and immature bones formed by osteoid deposition were observed in the experimental group at 2 weeks. At 8 weeks, the bony trabeculae were thicker than the ones in the control group and were composed of lamella bones and woven bones in the experimental group. On histomorphometric analysis, the bone deposition area of the distracted site was broader in the experimental group $(273.8{\pm}115.7\;cm^2)$ than the one in the control group $(199.4{\pm}101.4\;cm^2)$. Futhermore, the modified rate of bone deposition area was higher in the experimental group (48${\pm}$20%) than the one in the control group (35${\pm}$18%). However, these data showed no significant differences statistically. Conclusion These results suggest that the distraction osteogenesis by using an alternating distraction/compression protocols is an effective method for increasing new bone formation in distracted areas.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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• pp.230-234
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• 2006

Purpose: This study presents radiographic and laboratory analysis and comparison of bone resorption rate of grafted endochondral bone and intramembranous bone on the aspect of height and volumetric change. Patients and Methods: 18 partially edentulous patients who needed alveolar ridge augmentation for implant placement during the years 2002 to 2004 were selected for this study. Group A consisted of 5 males & 3 females who were treated with intraoral(intramembranous) bone and Group B consisted of 8 males & 2 females who were treated with iliac(endochondral) bone. Non-standard periapical X-ray was taken at day 1, 2 month, 4 months, 8 months after the surgery. Resorption rate of grafted bone were measured on these X-rays and compared. Also we calculated volume of grafted bone with models which was fabricated at 1.5 months, 6 months. Results: There was bone resorption in both groups. Group B showed more bone resorption than Group A. In Group A, the resorption rate according to the radiographic measurements was 9.81 %, and resorption rate according to volumetric measurement was 16.5 %. In group B, the resorption rate according to the radiographic measurements was 15.9 %, and resorption rate according to volumetric measurement was 30.6 %. Significant difference is on radiographic resorption of post-op 2, 4, 8 months on two groups (P < 0.05). Also significant difference is on volume resorption on two groups (P < 0.05). Conclusion: We found that more bone resorption occurred with iliac(endochondral) bone and when we use intraoral bone, that bone can maintain their vitality for alveolar ridge augmentation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.464-473
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• 2006

Purpose: This study was performed to evaluate relationship between the inferior alveolar nerve injury and the findings of panoramic and tomographic images for preventing inferior alveolar nerve injury after the 3rd molar extraction. Material and Method: From April, 2005 to June, 2005, The 190 patients who visited in the Department of Oral and Maxillofacia Surgery, Chonnam National University Hospital and the panoramic radiographies were taken for extraction of the mandibular third molar, was selected. Among 215 mandibular third molars, Scanora tomographic imagings were taken in the 90 teeth which were overlaped to the mandibular canal in the panoramic imagies. In panoramic radiographies, the angulation, the level, the root morphology, and the superimposition sign of the mandibular third molars with the mandibular canal were evaluated. In the tomographic radiographies, the location and distance of the mandibular third molar from the canal were also evaluated. The relationships between these findings and the inferior alveolar nerve injury were examined. Results: In the panoramic findings, the inferior alveolar nerve injuries were occurred in the darkened roots (5 molars, 7%), the uncontinuous radiopaque image (3 molars, 7%), and the depositioned mandibular canal (2 molars, 10%). In the tomographic findings of 90 molars, 20 molars also had the superimposition imagies. Five molars in those molars (25%) had the inferior alveolar nerve injury after extraction. There were 10 patients who had the inferior alveolar nerve injury. The sensory was began to be recovered in 9 patients, except 1 patient, within 2 weeks, then fully recovered within 3 months. Conclusion: These results indicate that the depth mandibular third molar and the superimposition sign may be related with the risk of the inferior alveolar nerve injury after extraction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.436-446
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• 2006

The purpose of this study was to isolate and identify the bacteria in chronic maxillary sinusitis (CMS) lesions from 3 patients and to determine the antimicrobial susceptibility of them against 10 antibiotics. One of them was odontogenic origin and the others were non-odontogenic origin. Pus samples were collected by needle aspiration from the lesions and examined by culture method. Bacterial culture was performed in three culture systems (anaerobic, CO2, and aerobic incubator). Identification of the bacteria was performed by 16S rRNA gene (16S rDNA) nucleotide sequencing method. To test the sensitivity of the bacteria isolated from the maxillary sinusitis lesions against seven antibiotics, penicillin G, amoxicillin, tetracycline, ciprofloxacin, cefuroxime, erythromycin, clindamycin, and vancomycin, minimum inhibitory concentration (MIC) was performed using broth dilution assay. Our data showed that enterobacteria such as Enterobacter aerogenes (30%), Klebsiella pneumoniae (25%), and Serratia marcescens (15%) were predominately isolated from the lesion of non-odontogenic CMS of senile patient (70 year old). Streptococcus spp. (40.3%), Actinomyces spp. (27.4%), P. nigrescens, M. micros, and P. anaerobius strains were isolated in the lesion of odontogenic CMS. In the lesion of non-odontogenic CMS, Streptococcus spp. (68.4%), Rothia spp. (13.2%), and Actinomyces sp. (10.5%) were isolated. The susceptibility pattern of 10 antibiotics was determined according to the host of the bacteria strains ratter than the kinds of bacterial species. Even though the number of CMS was limited as three, these results indicate that antibiotic susceptibility test must be accompanied with treatment of CMS. The combined treatment of two or more antibiotics is better than single antibiotic treatment in the presence of multidrug-resistant bacteria in the CMS lesions.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.410-417
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• 2006

The present study was aimed to compare the resorption rate and the histological change of the autogenous dermis and the artificial dermis (Terudermis$^{(R)}$) after the transplantation, and to report the clinical results of the use of Terudermis$^{(R)}$ in order to restore the soft tissue defect. Twenty mature rabbits, weighing about 2 kg, were used for the experimental study. The autogenous dermis and the Terudermis$^{(R)}$ size 1${\times}$1 cm were transplanted to the space between the external abdominal oblique muscle and the external abdominal oblique fascia of the each rabbits. They were divided into 4 groups (n=5 each) and gathered at 1, 2, 4, and 8 weeks after the transplantation. The resorption rate was calculated, and H-E stain was preformed to observe the histological changes. The chart review of the 17 patients who received Terudermis$^{(R)}$ graft to the facial soft tissue defects was conducted for the clinical study. The resorption rate at 8 weeks after the transplantation was 21.5% for the autogenous dermis, and 36.4% Terudermis$^{(R)}$. In microscopic examinations, the infiltration of the inflammatory cells and the epidermal inclusion cyst were observed in the autogenous dermis graft. The neovascularization and the progressive growth of the new fibroblast were shown in the Terudermis$^{(R)}$ graft. In clinical data of 17 patients, the size of the grafted Terudermis$^{(R)}$ was from 1.5$cm^2$ to 7.5$cm^2$ (average 3.5$cm^2$). Follow-up ranged from 5 to 25 months. Fourteen patients with cleft palate demonstrated stability of the graft and unremarkable complications. But unstability of the graft and the partial relapse were observed in three patients received the vestibuloplasty. These results indicate that Terudermis$^{(R)}$ can be available substitute of autogenous dermis because of the stability about resorption, the histocompatibility, and the unremarkable clinical complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.426-429
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• 2006

The fibroblast in the periodontal ligaments received various stress. Among them, compression and tension are quite important and they are related to the remodeling of tooth and alveolar bone. We studied the change of expression of interleukin-6 (IL-6) and interleukin-8 (IL-8) in the fibroblasts of the periodontal ligaments by real-time RT-PCR and ELISA. In results, the relative activity of IL-6 mRNA in 2 hours after was 1.54${\pm}$0.08 and 1.00${\pm}$0.05 in control and test, respectively (P<0.05). Its 12 hours after was 1.23${\pm}$0.06 and 2.78${\pm}$0.14 in control and test, respectively (P<0.05). The relative activity of IL-8 mRNA in 2 hours after was 1.00${\pm}$0.05 and 0.24${\pm}$0.01 in control and test, respectively (P<0.05). Its 12 hours after was 1.23${\pm}$0.06 and 0.63${\pm}$0.03 in control and test, respectively (P<0.05). The concentration of IL-6 was 1.02${\pm}$0.16 ng/ml, 0.90${\pm}$0.14 ng/ml, and 1.32${\pm}$0.12 ng/ml (P<0.05) in control, 2, and 12 hours after, respectively. The concentration of IL-8 was 2.26${\pm}$0.17 ng/ml, 1.70${\pm}$0.26 ng/ml (P<0.05), and 0.84${\pm}$0.47 ng/ml (P<0.05) in control, 2, and 12 hours after, respectively. In conclusion, the expression of IL-6 was significantly increased after the application of the static compressive force, but IL-8 was significantly decreased. Considering their known function, their expression is quite important in tooth and bone resorption.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.418-425
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• 2006

Purpose: This study was aimed at evaluating the histological changes of new bone and expression of osteopontin (OPN) after mandibular distraction osteogenesis. Materials and Methods: Unilateral mandibular distraction (0.5 mm twice per day for 10 days) was performed in eight adult dogs. Two animals were sacrificed at 7, 14, 28 and 56 days after completion of distraction, respectively. The distracted bones and contralateral non-distracted control bones were harvested and processed for histological and immunohistochemical examinations. Results: The new bone was arranged to tension direction after distraction osteogenesis. 7 days after distraction, numerous osteoblasts lining the immature trabecular bone and fibroblast-like cells in the fibrous intrezone were observed. 14 days after distraction, the new formed trabecular bones were thickened compared with 7 days after distraction. 28 days after distraction, the fibrous interzone was almost filled with newly calcified bone, and it was more hardened at 56 days after distraction. Increased OPN signals detected in the osteoblasts lining the trabecular bone and fibroblast-like cells in the fibrous interzone at 7 and 14 days after distraction. At 28 days after distraction, the OPN was weakly expressed in the osteoblasts, and it was not detected in all cellular components of distracted bone at 56 days later of distraction. Conclusions: After distraction osteogenesis, the distracted zone was completely calcified during the 56 days of consolidation period. In this study, the staining intensity of OPN increased in the osteoblasts and fibroblast-like cells at 7 and 14 days after distraction. The expression pattern of this protein shown here suggested that OPN play an important role in the osteogenesis during the early consolidation period.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.5
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• pp.571-577
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• 2008

Introduction: Possible etiologic factors associated with bone loss around implants after implantation are surgical trauma, occlusal overload, periimplantitis, presence of micro gap and the formation of biologic distances. Tarnow et al. observed that the crestal bone loss was greater when the distance between the implants was <3mm than when the implants were ${\geq}\;3mm$ apart. The aim of this study was to evaluate the influence of different interimplant distance on marginal bone and crestal bone resorption in the beagle dogs. Materials and methods: The mandibular premolars of 5 dogs were extracted bilaterally. After 12 weeks of healing, each dog received 7 implants. On each side, implants were separated by 2mm (Group 1) and by 5mm (Group 2). After 16 weeks of healing, the dogs were sacrificed. Marginal bone loss was determined through linear measurements made between the implant-abutment junctions and the most coronal portions of the bone in contact with the implant surface. A line was drawn uniting the implant-abutment junctions of the adjacent implants, and a linear measurement was made at the midpoint in the direction of the most coronal peak of the interimplant bone crest to determine the crestal bone loss. Both of them was measured radiologically and histologically. Result and conclusion: In radiological analysis, the mean of marginal bone loss was $1.26{\pm}0.14mm$ for group 1 and $1.23{\pm}0.34mm$ for group 2, the mean of crestal bone loss was $1.10{\pm}0.14mm$ for group 1 and $1.02{\pm}0.30mm$ for group 2. The results were not statistically significant between 2 groups. In histological analysis, the mean of marginal bone loss was $1.63{\pm}0.48mm$ for group 1 and $1.62{\pm}0.50mm$ for group 2, the mean of crestal bone loss was $1.23{\pm}0.35mm$ for group 1 and $1.15{\pm}0.39mm$ for group 2. The differences were also not statistically significant. The clinical significance of this result is that the increase in the crestal bone loss results in the increase in the distance between the base of the interproximal contact of the crowns and the bone crest, and this determines if papilla will be present or absent between implants. Considering this fact, keeping up sufficient interimplant distance is important to minimize crestal bone loss.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.5
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• pp.532-536
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• 2008

Purpose: This study was designed to evaluate effect of EMD on proliferation of HPDLCs and MC3T3-E1 cells in high glucose condition in vitro. Material and method: The Human PDL fibroblasts(HPDLCs) were obtained through typical way and the cells used in this experiment were divided in 4 groups. $1{\times}10^4/ml$ HPDLCs suspension was cultured in typical DMEM and assigned to group 1. The cells cultured in DMEM which included 400mg/dl glucose are allocated to group 3. Group 2 and 4 are established by adding EMD to group 1 and 3 respectively. These control and experimental groups had been cultured for 24 and 48 hours, and MTT assay was conducted. The differences of each group in cellular proliferation was evaluated. The same experiment was conducted for preosteoblast (MC3T3-E1) with adding $25\;{\mu}g/ml$ EMD. Results: EMD had the same effect on both PDL cells and MCT3T3-E1 cells. The experimental group had more meaningful differences and active cellular proliferation than the control group did. The EMD accelerated cellular proliferation not only in normal glucose condition but also in high glucose condition. The same results were observed via MTT assay; EMD-added experimental group had more meaningful differences and showed higher cellular activity than control group did. Each experimental and control group was inspected for statistical significance through Kruskal-Wallis Test. Statistical significances were observed among these groups. (SPSS 12.0 Chicago, IL, USA, p=0.008, p=0.011) Conclusion: EMD is considered to accelerate proliferation of PDL cells and MC3T3-E1 cells in high glucose condition as well as normal glucose condition.