• Journal of Oral Medicine and Pain
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• v.38 no.1
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• pp.19-28
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• 2013

With Korea's rapid entry to aged society, elderly population has become a major age group both in the whole society and medical field and its importance will be constantly stressed out. Elderly population is also important in the field of oral medicine which deals with chronic and recurrent diseases in the orofacial region of non-dental origin but there exist few studies indicating epidemiology of elderly patients in this regards. This study aimed to investigate change of age distribution of new patients in a university-based dental hospital and oral medicine clinic for last decade and to investigate clinical epidemiology of elderly patients (${\geq}$ 65 years) of oral medicine clinic. This study was performed retrospectively using medical records of the new patients in Dankook University Dental Hospital in 2001 and 2011. According to the study, percentage of elderly new patients increased in both dental hospital and oral medicine clinic and degree of the increase was greater in oral medicine clinic than in the whole hospital (p=0.000). 13.5% of adult patients ${\geq}$ 18 years of oral medicine clinic were elderly patients ${\geq}$ 65 years. 83% of elderly patients were suffering from one or more systemic diseases. Although TMD was the most common reason for elderly patients who visited oral medicine clinic, oral soft tissue diseases, dry mouth, burning mouth syndrome and oromandibular dystonia was more frequently diagnosed in elderly patients compared to adult patients aged 18 to 64 years. Pain severity and interference of Brief Pain Inventory and depression and anxiety scores of Hospital Anxiety Depression Scales were higher in elderly patients than in the adult patients (p<0.05). Increase of elderly patients with chronic oral diseases and pain needs more attention of dentists and specialists of oral medicine to improvement of assessment and development of tailored management because large portion of the elderly patients have systemic diseases, polypharmacy and impaired communication, possibly restricting treatment options.

• The Journal of Korean Academy of Prosthodontics
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• v.53 no.1
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• pp.39-45
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• 2015

Loss of continuity of the mandible destroys the balance and symmetry of mandibular function, leading to altered mandibular movements and deviation of the residual fragment towards the resected side. Apart from deviation, other dysfunctions include difficulty in swallowing, speech, mandibular movements, mastication, and respiration are accompanied. In general, surgical reconstruction is considered first then proceeds to the prosthetic restorations. However, patients with systemic disease such as BRONJ (Bisphosphonate related osteonecrosis of the Jaw), surgical reconstruction may be limited. Thus, the prosthetic restoration remains as the only resort. Numerous prosthetic methods are employed to minimize deviation and to improve masticatory efficiency, function and esthetics. If a removable partial denture is the selected treatment modality, maximum stability of the partial denture base may be accomplished with a functional impression procedure by means of eliminating lateral and horizontal forces caused by the functional movements of the lips, cheeks and tongue. Also, Twin occlusion is used to obtain a favorable occlusal relationship and check support for esthetics. The purpose of this case report is to demonstrate how neutral zone impression technique and twin occlusion scheme were applied to restore a hemi-mandiblectomy patient with BRONJ syndrome to achieve satisfactory results in functional and esthetic aspects.

• The Journal of Korean Academy of Prosthodontics
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• v.31 no.4
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• pp.549-564
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• 1993

The purpose of this study was to research the condylar path and the anterior angle of glenoid fossae and classify the patterns of condylar path. Thirty male and female dental students with normal occlesion and masticatory system ranging in age from 21 to 30, without present symptoms and an)r history of TM joint disturbance, were selected for this study. Transcranial radiographs of TM joints under mandibular lateral movement were obtained. By the computer analysis on the radiographs, the angle of posterior slope of articular eminance, the sagittal condylar guidance angie, condylar movement patterns and the height of glenoid fossa was measured respectively, and studied their interrelationship comparatively. The results obtained were as follows : 1. The total distance of condylar movement on balancing side during mandibular lateral movement was 4.55mm for Lt. and 4.78mm for Rt. when mandible moved from C.R. to canine to canine relation and 7.86mm for the Lt. and 8.10mm for the Rt. when mandible moved from C.R. to 7.5mm. 2. The horizontal distance of condylar movement on balancing side during mandibular lateral movements was 3.16mm for the Lt. and 3.52mm for the Rt. when mandible moved from C.R. to canine to canine relation and 6.10mm for the Lt. and 6.30mm for the Rt. when mandible moved from C.R. to 7.5mm. 3. The sagittal condylar guidance angle on balancing side during mandibular lateral movements was $45.96^{\circ}$ for the Lt. and $43.22^{\circ}$ for the Rt. when mandible moved from C.R. from canine to canine relation and $41.14^{\circ}$ for the Lt. and $39.77^{\circ}$ for the Rt. when mandible moved from C.R. to 7.5mm. 4. The height of glenoid fossa was 8.23mm for the Lt. and 7.80mm for the Rt. and the angle of posterior slope of articular eminence was $38.30^{\circ}$ for the Lt. and $38.79^{\circ}$ for the Rt. by method-A and $55.61^{\circ}$ for the Lt. and $55.64^{\circ}$ for the Rt. by method-B. 5. The sequence of the frequency of condylar movement patterns on balancing side during mandibular lateral movement were concave type(30 cases), convex type(16 cases), reverse S shape curve(9 cases) and S shape curve(5 cases) when mandible moved from C.R. to canine to canine relation and concave type(27 cases), 5 shape curve(13 cases), convex type(11 cases) and reverse S shape curve(9 cases) when mandible moved from C.R. to 7.5mm.

• The Journal of Korean Academy of Prosthodontics
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• v.35 no.1
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• pp.15-29
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• 1997

The author performed this study to investige the relationship between condylar movements recorded with Pantronic and mandibular movements at incisal area recorded with BioEGN. For this study 24 patients with Temporomandibular disorders(TMDs) and 30 dental students without any masticatory symptoms were selected as patients group and control group, respectively. The items recorded with Pantronic(Denar Corp., USA) were immediate side-shift, orbiting path, protrusive path, and PRI. BioEGN(Bioelectric-gnathography, Bioresearch Inc., USA) were sued to measure the amount of mandibular torque movement in frontal and horizontal plane and also the distance of mandibular translation at incisal area. Amount of mandibular rotational torque movement was analyzed by angle and difference between both condyles in frontal and horizontal plane. The collected data were processed with SAS program and conclusion were as follows : 1. Mean value of items recorded with Pantronic were not significantly differed between patients group and control group except the item of pantographic reproducibility index(PRI). The value of PRI was 39.5 in patients group, and 29.5 in control group. 2. The amount of mandibular torque movement was not differed tin early protrusive and early left excursion between patients group and control group, but in early right excursion, patients group showed more value than control group did. 3. The distance on sagittal plane in early eccentric movements were longer in patients group than those in control group, but the distance of maximal eccentric movements were not significantly differed between patients group and control group. 4. Items which showed significant correlation with PRI were progressive side-shift, and horizontal torque movement in early protrusion and right excursion. 5. The angle of protrusive path of affected side was greater than of non-affected side in unilaterally affected patients, but the protrusive angle of preferred chewing side was not differed from that of contralateral side in control group. 6. The amount of torque movement in early protrusion and right excursion were greater in patients with coincidence of affected side and preferred chewing side than in patients without coincidence.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.3
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• pp.327-333
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• 2016

Tourette's syndrome is a chronic neuropsychiatric disorder characterized by the presence of vocal and multiple motor tics. Tics are defined as brief, intermittent, repetitive, unpredictable, purposeless, and stereotyped movements or sounds. Some patients experience physical pain from intense and complex tics. In addition, motor tics can result in self-injury which is a common feature of Tourette's syndrome. A 9-year-old boy was referred by the department of neuropsychiatry because of a severe tongue laceration. His parents reported that he had been biting his tongue irregularly for 2 months before referral and suffered from an intense burning sensation. The repeated biting resulted in ulcers on the tongue, which quickly worsened and led to progressive difficulty chewing and swallowing food. We offered to give him a two-piece removable appliance to limit tongue biting; it was made of soft silicone and fitted to both the maxillary and mandibular arches. As we emphasized that the device could help alleviate his pain, he agreed to accept it and adapted well. Just 3 weeks later, his tongue lesions had healed significantly.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.441-447
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• 2007

Internal derangement of the temporomandibular joint(TMJ) is defined as an abnormal relationship of the articular disc to the condyle. Mandibular manipulation is one of the conservative treatments to be considered first to manage the patients with anterior disc displacement without reduction. Mandibular manipulation is used to increase articular mobility and to restore the displaced disc into an anatomically normal position. While Farrar's technique has been popularly used, Minagi et al., Mongini and Suarez introduced the manipulation technique conducted by the patients themselves. But there is no study on the efficacy of self-manipulation technique, comparing with conventional one. The aim of this study was to investigate the efficacy of the conventional and self-manipulation technique, which was modified to complement the previously described technique by Minagi et al., in the treatment of patients with anterior disc displacement without reduction. TMD patients, who visited Department of Oral Medicine of Seoul National University Dental Hospital from December, 2002 to November, 2004 and were diagnosed as anterior disc displacement without reduction by TMJ magnetic resonance imaging (MRI) were enrolled. Conservative treatments including physical therapy, exercise, behavioral therapy, stabilization splint therapy, and manipulation therapy were done to every single patient until the symptomsimproved enough to discharge the patient. The charts were reviewed retrospectively according to the type of manipulation. In the results, patients whose maximum mouth opening was more than 40 mm was higher in the self-manipulation group(69.9%) than in the conventional manipulation group(42.9%). But difference between two groups was not significant. According to the fact that we decided to discharge the patients whentheir mouth opening increased to more than 40 mm and subjective symptoms such as pain and discomfort were improved as well, treatment period of discharged patients was significantly shorter in the self-manipulation group($29.2{\pm}12.3$ weeks) than in the conventional manipulation group ($61.0{\pm}38.0$ weeks) (p<0.01). In conclusion, in the treatment of TMD patients with anterior disc displacement without reduction, the self-manipulation technique which is performed by patients themselves is an effective treatment modality for increasing the range of mouth opening and shortening the total treatment period.

• The Journal of Korean Academy of Prosthodontics
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• v.46 no.4
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• pp.359-371
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• 2008

Purpose: The purpose of this study was to investigate the stress distribution in mandibular implant overdentures with telescopic crowns compared to bar attachment. Material and methods: Three-dimensional finite element models consisting of the mandibular bone, 4 implants, and primary bar-splinted superstructure or secondary splinted superstructure with telescopic crowns were created. Vertical and oblique loads were directed onto the occlusal areas of the superstructures to simulate the maximal intercuspal contacts and working contacts such as group function occlusion. Maximum stress and stress distribution were analysed in mandibular bone, implant abutments, and superstructures. Results: 1. In comparison of von Mises stress on mandibular bone, telescopic overdenture had a little lower stress values in vertical load and working side load except oblique load. In the mandible, the telescopic overdenture distributed more uniform stress than the bar overdenture. 2. In comparison of von Mises stress on implant abutments, telescopic overdenture had much lower stress values in all load conditions. In implant abutments, the telescopic overdenture distributed stress similar to the bar overdenture. Stress was concentrated on the distal surfaces of the posterior implant abutments in both mandibular overdentures. 3. In comparison of von Mises stress on superstructures, the telescopic overdenture had much more stress values in all load conditions. However, the telescopic overdenture distributed more uniform stress on superstructure than the bar overdenture. In the bar overdenture, stress was concentrated on each cental area of bar structures and connected area between implant abutments and bar structures. Conclusion: In the results of this study, the telescopic overdenture had lower stress values than the bar overdenture in mandibular bone and implant abutments, but more stress values in superstructures. However, if optimal material was selected in making superstructures, the telescopic overdenture was compared to the bar overdenture in stress distribution.

• The Korean Journal of Nuclear Medicine
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• v.31 no.3
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• pp.388-394
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• 1997

Temporomandibular (TM) joint Pain results from many etiologic factors. The aim of this study was to evaluate the utility of Bone SPECT in patients with TM joint pain. The subjects were 34 patients with TM joint pain. All patients underwent plain radiography, planar bone scan, and Bone SPECT The intensity of radioisotope uptake at TM joint was graded into three; no increased uptake above the background activity as grade 0, uptake similar to occipital bone as grade I, and uptake similar to maxillary sinus as grade II. Clinical findings and therapeutic methods were reviewed. Twenty-seven patients (80%) out of 34 patients with TM joint pain had increased uptake in bone SPECT. Twenty-one (78%) out of 27 patients had increased uptake in the mandibular condyle and remaining six patients (22%) had uptake in the mandibular and maxillary arch, which proved to be dental problem. Seven patients (21%) out of 34 were grade as 0, four (12%) were grade I, 23 (68%) were grade II. Four patients with grade I had clicking sound and symptoms which were subsided with medication in all cases. Among 23 patients with grade II, 7 patients had clicking sound and 14 patients underwent medication and decompression therapy. With Planar bone scan, 11 cases (32%) had increased uptake in TM joint area. Plain radiography revealed narrowing, distension, erosion and limitation of TM joint in 16 cases (47%). Bone SPECT can be valuable for screening and managing the patients with TM joint pain. Patients with grade II needed intensive treatment such as joint aspiration. However degree of the radioisotope uptake did not well correlated with clinical symptoms.

• Journal of Korean Physical Therapy Science
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• v.10 no.2
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• pp.62-72
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• 2003

The purpose of this study is to prove the efficacy of the Kaltenborn-Evjenth Orthopedic Manipulative Therapy and the Conventional Physical Therapy that influence changes in pain and range of motion when those therapies are applied to patients with temporomandibular pint movement restriction. The subjects of the study were 30 randomly selected patients who had been diagnosed with temporomandibular pint movement restriction and had endured pain for more than two weeks. These patients had visited one of three hospitals in Pyongchon 00 Hospital. The subjects were divided into two groups with 15 patients each. The Kaltenborn-Evjenth Orthopedic Manipulative Therapy was applied to one group and the Conventional Physical Therapy was applied to the other group, once a day for three days. Then, the pain perception degree was measured by using the Visual Analogue Scale(VAS) and a digital device(Absolute Digimatic) measured the range of motion for each group. The average and standard errors were calculated for each measured items and a paired t-test was used for identifying significance in the differences in the pain perception degree and the range of motion between the two groups according to therapy. The significant level was set as ${\alpha}=0.05$. The changes in the pain perception degree were statistically significant in both groups; however, the group that received Kaltenborn-Evjenth Orthopedic Manipulative Therapy(KE-Group) showed more significant changes in a decrease in the pain perception degree than did the group that received the Conventional Physical Therapy(CPT-Group). Both groups showed significant results regarding changes in the range of motion: however, the KE-Group showed more of a significant difference in the average of the range of motion than did the CPT-Group(p<0.001). Comparing the changes in the range of motion between the two groups, the KE-Group showed a significant result which means that the KE-Group had a higher therapy effect than did the CPT-Group(p<0.05). Based on the results of this study, we found that the Kaltenborn-Evjenth Orthopedic Manipulative Therapy decreased pain and increased the range of motion. With such findings, we expect that the Kartenborn-Evjenth Orthopedic Manipulative Therapy can be used as an effective treatment method for patients with tempomrnandibular pint movement restriction and that the treatment period can be reduced with this therapy as well.

• Journal of Oral Medicine and Pain
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• v.37 no.4
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• pp.205-211
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• 2012

A 35 year-old female presented with the complaint of sudden occurrence of bite change and concurrent opening limitation, as well as pain in the right temporomandibular joint (TMJ) during mouth opening. From her history it was revealed that she had simple clicking of right TMJ for several years before onset of these symptoms, and that the clicking sound subsided recently after development of opening limitation. On clinical examination, anterior open bite, midline shift of the mandible to right, and premature contacts on left posterior teeth were observed. Maximum mouth opening and lateral movement to left were also restricted. On magnetic resonance images, the right TMJ showed anterior disc displacement without reduction and the posterior joint space is greatly collapsed by retrusion of the condyle. It was thought that the sudden occurrence of occlusal change would be resulted from abrupt displacement of the mandible associated with development of the anterior disc displacement without reduction. The stabilization appliance traction therapy was performed initially for first 3 months along with physical and pharmacologic therapy. However, the anterior open bite and opening limitation didn't resolve and the position of mandible still remained altered. So the stabilization appliance was changed to intermaxillary traction device. Then the mandible returned progressively to normal position and the occlusion became more stable and comfortable. After 5 months of intermaxillary traction therapy, the anterior open bite was dissolved completely and the occlusion became stabilized satisfactorily along with recovery of normal mouth opening range. On post-treatment magnetic resonance image, remodeling of condylar head was observed.