• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권1호
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• pp.41-52
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• 2012

Purpose: Triangulation is the process of determining the location of a point by measuring angles to it from known points at either end of a fixed baseline. This point can be fixed as the third point of a triangle with one known side and two known angles. The aim of this study was to find a clinically adaptable method for applying an optical tracking navigation system to orthognathic surgery and to estimate its accuracy of measuring the bone displacement by use of triangulation methods. Methods: In orthognathic surgery, the head position is not fixed as in neurosurgery, so that a head tracker is needed to establish the reference point on the head surface byusing an optical tracking system. However, the operation field is interfered by its bulkiness that makes its clinical use difficult. To solve this problem, we designed a method using an Aquaplast splinting material and a mini-screw in applying a head tracker on a patient's forehead. After that, we estimated the accuracy of measuring displacements of the ball marker by an optical tracking system with a conventional head tracker (Group A) and with a newly designed head tracker (Group B). Measured values of ball markers' displacements by each optical tracking system were compared with values obtained from fusion CT images for an estimation of accuracy. Results: The accuracy of the optical tracking system with a conventional head tracker (Group A) is not suitable for clinical usage. Measured and predictable errors are larger than 10 mm. The optical tracking system with a newly designed head tracker (Group B) shows 1.59 mm, 6.34 mm, and 9.52 mm errorsin threeclinical cases. Conclusion: Most errors were brought on mainly from a lack of reproducibility of the head tracker position. The accuracy of the optical tracking system with a newly designed head tracker can be a useful method in further orthognathic navigation surgery even though the average error is higher than 2.0 mm.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권1호
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• pp.26-33
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• 2012

Purpose: The golden ratio has been used for a long time to objectify and quantify 'beauty'. Dr. Marqurardt claims that the golden ratio can be applied in the maxillofacial field as well. The purpose of this study was to evaluate the diagnostic significance of using a facial 'phi' mask for analyzing Korean faces with characteristics of Class I, II, and III malocclusion. Methods: We studied twenty five Korean celebrities' frontal facial photos (10 males, 15 females) and 90 malocclusion patients' frontal facial photos (30 patients in each malocclusion classification: Class I, Class II, and Class III). Patients who received orthodontic treatment at Samsung Medical Center were selected for this study. After superimposition of the selected facial photo and facial 'phi' mask using Adobe Photoshop CS3, the ratio of the entire facial area, mid facial area, lower facial area and horizontal and vertical lengths were measured. Results: The facial ratio in photos of Korean faces showed larger vertical and horizontal ratios than the facial 'phi' mask with golden ratio, regardless of skeletal malocclusion (entire face: 115%, lower face: 125% larger than the mask). The results of the frontal photos of Class I, II, and III malocclusion patients using facial 'phi' mask showed that the vertical length and frontal face area was more significantly influenced by the area of the lower face than the midface. This means that the lower face has larger proportions in the facial areas. Conclusion: The ratio of facial 'phi' mask is matched with the ideal facial appearance that the contemporary Korean general public is seeking. Thus, the facial 'phi' mask may be a convenient tool for esthetic analysis of Korean faces. Reducing the area of the lower face is esthetically more desirable for almost all Korean people when planning orthognathic surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권1호
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• pp.12-16
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• 2012

Purpose: The purpose of this study is to evaluate the effect of exposure of hydroxyapatite coating on the amount of bone formation and stability in the dogs. Methods: In this study, hydroxyapatite coated implants (HAPTITE) was placed over the femur bone surface of four dogs about 1 mm. The experimental group was divided into 4 weeks group of 8 implants and 8 weeks group of 8 implants, and then they were sacrificed. The stability of implants was evaluated twice with Osstell$^{TM}$ mentor (Osstell AB, Goteborg, Sweden) at right after placement and sacrifice. The amount of bone formation was evaluated through histomorphometric examination. Results: The stability of implants was in normal range, and tended to increase as time goes by. Mean percentages of new bone formation rates were $90.5{\pm}6.6$ at uppermost 1 mm bone level adjacent to soft tissues (level 1) and $92.9{\pm}4.1$ at next 1 mm bone level (level 2) in 4 weeks group, $90.1{\pm}11.5$ at level 1 and $95.9{\pm}2.3$ at level 2 in 8 weeks group. Mean percentages of bone-implant contact rates were $85.1{\pm}10.8$ at level 1 and $88.1{\pm}13.8$ at level 2 in 4 weeks group, $88.5{\pm}14.4$ at level 1 and $95.3{\pm}3.1$ at level 2 in 8 weeks group. There was no statistically significant difference of new bone formation rate and bone-implant contact rate between uppermost 1 mm bone level adjacent to soft tissues and next 1 mm bone level. However, there was no significant difference in bone formation between 4 and 8 weeks groups. Conclusion: These results suggested that exposed hydroxyapatite coated implants to soft tissue showed favorable bone formation and implant stability.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권3호
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• pp.217-226
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• 2007

Purpose: Distraction osteogenesis is considered to take favorable effect on the TMJ and be beneficial to prevent the relapse after the mandibular advancement of Class II malocclusion patient. This is the report with literature review on the mandibular advancement in the patients showing preoperative condylar resorption and who need larger amount of advancement. Patients and method: Distraction osteogenesis using intraoral device was performed for three mandibular hypoplasia patients (one male and two females). All patients were adult over 18 years old. The patients showed condylar bony resorption preoperatively. The distraction was performed intraorally with modified SSRO. After 7 days of latency period, activation was performed at the rate of 1.0 mm/day with twice turn. The devices were removed after 4-8 month consolidation period. Results: Total advancement of mandible was average 13 mm. One patient showed openbite immediately after removal of distraction device. It took long time to guide the openbite with elastics. The comparison between cephalometries immediately after device removal and postoperative six month revealed average 3.4 mm relapse. This means that mandibular advancement with distraction osteogenesis needs overcorrection and elastic rehabilitation even after enough consolidation periods. Conclusion: Larger amount of mandibular advancement could be achieved with distraction osteogenesis in severe mandibular hypoplasia with condylar resorption. However, some relapse was found during the follow-up period and the over correction is considered to be needed. The effect of distraction osteogenesis seems to be investigated with long-term follow-up.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.2.1-2.9
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• 2015

Background: The aim of this study was to evaluate the effect of autogenous tooth bone as a graft material for regeneration of bone in vertical bony defects of the minipigs. Material and Methods: Six minipigs were used in this study. Four molars were extracted in the right mandibular dentition and sent to the Korea Tooth Bank for fabrication of autogenous tooth bone. Ten days later, each extraction site was implanted with MS Implant Narrow Ridge $3.0{\times}10mm$ fixture (Osstem, Seoul, Korea) after standardized 2mm-sized artificial vertical bony defect formation. Pineappleshaped Root-On type autogenous tooth bones were applied to the vertical defects around the neck area of the posterior three fixtures and the fore-most one was not applied with autogenous bone as a control group. Each minipig was sacrificed at 4, 8, 12 weeks after fixture installation and examined radiologically and histologically. Histological evaluation was done under light microscope with Villanueva osteochrome bone staining with semi-quantitative histomorphometric study. Percentage of new bone over total area (NBF) and bone to implant contact (BIC) ratio were evaluated using digital software for area calculation. Result: NBF were $48.15{\pm}18.02%$, $45.50{\pm}28.37%$, and $77.13{\pm}15.30%$ in 4, 8, and 12 weeks, respectively for experimental groups. The control group showed $37.00{\pm}11.53%$, $32.25{\pm}26.99%$, and $1.33{\pm}2.31%$ in 4,8,12 weeks, respectively. BIC ratio were $53.08{\pm}19.82%$, $45.00{\pm}28.37%$, and $75.13{\pm}16.55%$ in 4,8,12 weeks, respectively. Those for the control groups were $38.33{\pm}6.43%$, $33.50{\pm}29.51%$, and $1.33{\pm}2.31%$ in 4, 8, 12 weeks, respectively. Conclusion: Autogenous tooth bone showed higher score than control group in NBF and BIC in all the data encompassing 4,8,12 weeks specimens, but statistically significant only 12 weeks data in both NBF and BIC.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.36.1-36.7
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• 2015

Background: This study was performed to evaluate three-dimensional positional change of the condyle using three-dimensional computed tomography (3D-CT) following unilateral sagittal split ramus osteotomy (USSRO) in patients with mandibular prognathism. Methods: This study examined two patients exhibiting skeletal class III malocclusion with facial asymmetry who underwent USSRO for a mandibular setback. 3D-CT was performed before surgery, immediately after surgery, and 6 months postoperatively. After creating 3D-CT images by using the In-vivo $5^{TM}$ program, the axial plane, coronal plane, and sagittal plane were configured. Three-dimensional positional changes from each plane to the condyle, axial condylar head axis angle (AHA), axial condylar head position (AHP), frontal condylar head axis angle (FHA), frontal condylar head position (FHP), sagittal condylar head axis angle (SHA), and sagittal condylar head position (SHP) of the two patients were measured before surgery, immediately after surgery, and 6 months postoperatively. Results: In the first patient, medial rotation of the operated condyle in AHA and anterior rotation in SHA were observed. There were no significant changes after surgery in AHP, FHP, and SHP after surgery. In the second patient, medial rotation of the operated condyle in AHA and lateral rotation of the operated condyle in FHA were observed. There were no significant changes in AHP, FHP, and SHP postoperatively. This indicates that in USSRO, postoperative movement of the condylar head is insignificant; however, medial rotation of the condylar head is possible. Although three-dimensional changes were observed, these were not clinically significant. Conclusions: The results of this study suggest that although three-dimensional changes in condylar head position are observed in patients post SSRO, there are no significant changes that would clinically affect the patient.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.34.1-34.14
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• 2015

Background: Over the past 30-40 years, various carbon implant materials have become more interesting, because they are well accepted by the biological environment. The traditional carbon-based polymers give rise to many complications. The polymer complication may be eliminated through carbon fibres bound by pyrocarbon (carbon/carbon). The aim of this study is to present the long-term clinical results of carbon/carbon implants, and the results of the scanning electron microscope and energy dispersive spectrometer investigation of an implant retrieved from the human body after 8 years. Methods: Mandibular reconstruction (8-10 years ago) was performed with pure (99.99 %) carbon implants in 16 patients (10 malignant tumours, 4 large cystic lesions and 2 augmentative processes). The long-term effect of the human body on the carbon/carbon implant was investigated by comparing the structure, the surface morphology and the composition of an implant retrieved after 8 years to a sterilized, but not implanted one. Results: Of the 16 patients, the implants had to be removed earlier in 5 patients because of the defect that arose on the oral mucosa above the carbon plates. During the long-term follow-up, plate fracture, loosening of the screws, infection or inflammations around the carbon/carbon implants were not observed. The thickness of the carbon fibres constituting the implants did not change during the 8-year period, the surface of the implant retrieved was covered with a thin surface layer not present on the unimplanted implant. The composition of this layer is identical to the composition of the underlying carbon fibres. Residual soft tissue penetrating the bulk material between the carbon fibre bunches was found on the retrieved implant indicating the importance of the surface morphology in tissue growth and adhering implants. Conclusions: The surface morphology and the structure were not changed after 8 years. The two main components of the implant retrieved from the human body are still carbon and oxygen, but the amount of oxygen is 3-4 times higher than on the surface of the reference implant, which can be attributed to the oxidative effect of the human body, consequently in the integration and biocompatibility of the implant. The clinical conclusion is that if the soft part cover is appropriate, the carbon implants are cosmetically and functionally more suitable than titanium plates.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.33.1-33.9
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• 2015

Background: The porion (Po) is used to construct the Frankfort horizontal (FH) plane for cephalometrics, and the external auditory meatus (EAM) is to transfer and mount the dental model with facebow. The classical assumption is that EAM represents Po by the parallel positioning. However, we are sometimes questioning about the possible positional disparity between Po and EAM, when the occlusal cant or facial midline is different from our clinical understandings. The purpose of this study was to evaluate the positional parallelism of Po and EAM in facial asymmetries, and also to investigate their relationship with the maxillary occlusal cant. Methods: The 67 subjects were classified into three groups. Group I had normal subjects with facial symmetry ($1.05{\pm}0.52mm$ of average chin deviation) with minimal occlusal cant (<1.5 mm). Asymmetry group II-A had no maxillary occlusal cant (average $0.60{\pm}0.36$), while asymmetry group II-B had occlusal cant (average $3.72{\pm}1.47$). The distances of bilateral Po, EAM, and mesiobuccal cusp tips of the maxillary first molars (Mx) from the horizontal orbital plane (Orb) and the coronal plane were measured on the three-dimensional computed tomographic images. Their right and left side distance discrepancies were calculated and statistically compared. Results: EAM was located 10.3 mm below and 2.3 mm anterior to Po in group I. The vertical distances from Po to EAM of both sides were significantly different in group II-B (p=0.001), while other groups were not. Interside discrepancy of the vertical distances from EAM to Mx in group II-B also showed the significant differences, as compared with those from Po to Mx and from Orb to Mx. Conclusions: The subjects with facial asymmetry and prominent maxillary occlusal cant tend to have the symmetric position of Po but asymmetric EAM. Some caution or other measures will be helpful for them to be used during the clinical procedures.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.30.1-30.7
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• 2015

Background: The inferior alveolar nerve (IAN) may be injured during extraction of the mandibular third molar, causing severe postoperative complications. Many methods have been described for evaluating the relative position between the mandibular third molar and the inferior alveolar canal (IAC) on panoramic radiography and computed tomography, but conventional radiography provides limited information on the proximity of these two structures. The present study assessed the benefits of three-dimensional computed tomography (3D-CT) prior to surgical extraction of the mandibular third molar, to prevent IAN damage. Methods: This retrospective study included 4917 extractions in 3555 patients who presented for extraction of the mandibular third molars. The cases were classified into three groups, according to anatomical relationship between the mandibular third molars and the IAC on panoramic radiography and whether 3D-CT was performed. Symptoms of IAN damage were assessed using the touch-recognition test. Data were compared using the chi-square test and Fisher's exact test. Results: Among the 32 cases of IAN damage, 6 cases were included in group I (0.35 %, n = 1735 cases), 23 cases in group II (1.1 %, n = 2063 cases), and 3 cases in group III (0.27 %, n = 1119 cases). The chi-square test showed a significant difference in the incidence of IAN damage between groups I and II. No significant difference was observed between groups I and III using Fisher's exact test. In the 6 cases of IAN damage in group I, the mandibular third molar roots were located lingual relative to the IAC in 3 cases and middle relative to the IAC in 3 cases. The overlap was ${\geq}2mm$ in 3 of 6 cases and 0-2 mm in the remaining 3 cases. The mean distance between the mandibular third molar and IAC was 2.2 mm, the maximum distance 12 mm, and the minimum distance 0.5 mm. Greater than 80 % recovery was observed in 15 of 32 (46.8 %) cases of IAN damage. Conclusions: 3D-CT may be a useful tool for assessing the three-dimensional anatomical relationship and proximity between the mandibular third molar and IAC in order to prevent IAN damage during extraction of mandibular third molars.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권2호
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• pp.158-164
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• 2008

Purpose : Recently, various materials were developed for enhancing bone formation capacity. Platelet rich plasma(PRP) is an autologous source with several growth factors and obtained by sequestering and concentrating platelets by gradient density centrifugation. This study was to evaluate the effect of PRP on healing of grafted bone. Materials and methods : Two blood samples were obtained and analysed for measuring platelet counts of normal blood and PRP. In experimental group, two defects of mandibular bone, 10mm in diameter and 4.0mm deep, were created in the mandible and immediately grafted with autogenous bone chips mixed with PRP. In control group, same bone defects were prepared and grafted with autogenous bone chips. Gelform was used for carrier of PRP. 2 weeks, 4 weeks, 8 weeks later, each group was evaluated with histologi-cal and histomorphometric analyses. Results : According to histological observation, experimental group was showed more anastomosing newly-formed woven bone having osteoblastic activation than control group. According to histomorphometric analysis, there were 9.11% more newly-formed bone volume in experimental group than control group at 2 weeks, 7.91% more at 4 weeks, 20.08% more at 8 weeks. Conclusion: Our results demonstrated PRP in autogenous bone graft could enhance the bone formation.