• Archives of Plastic Surgery
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• 제36권4호
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• pp.445-449
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• 2009

Purpose: A successful surgical treatment for a wide alveolar cleft with bone graft is difficult to achieve due to several factors such as the limitation of gingivoperiosteal flap, the presence of large scar tissues, and the poor blood circulation. To overcome these problems, alveolar distraction osteogenesis using Liou alveolar distraction device was applied. We analyzed the consequences of this surgical treatment. Method: Between 2006 January and 2007 August, we have conducted analysis on the methods and consequences of Liou alveolar distraction osteogenesis for 6 patients. The age of patients was 12 years and 6 months in average. The follow up period was 19 months in average. The Reverse L osteotomy followed by the placement of the Liou alveolar distraction device was performed. After serial distraction, the distractor was removed after 5 months of the process of osteogenesis, and the result was analyzed using the computed tomography and the x-ray films of the alveolar bone and the teeth. Results: The alveolar cleft with 12.5 mm in average width was filled with 8.5 mm of newly formed bone tissue in average width after 5 months of osteogenesis. Among the 6 cases, 5 required the additional bone graft and 1 case only required the gingivoperioplasty. The newly formed bone tissues did not show any signs of bone resorption. However, a considerable degree of teeth displacement was shown. Conclusion: For the alveolar cleft too wide to be reconstructed by a general bone graft, it is strongly recommended to perform the reverse L osteotomy of the cleft side with Liou alveolar distraction device to initiate the alveolar osteogenesis. However, the migrated teeth showed some degree of relapse, thus, the orthodontic treatment is essential following the distraction osteogenesis treatment.

• 대한치과교정학회지
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• 제27권3호
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• pp.421-430
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• 1997

치조골은 치아의 치배와 치근의 발육에 따라 발달하고 치아의 맹출에 따라 골침착이 계속된다. 골의 성분은 끊임없이 소실되고 다시 첨가되며 균형이 깨지는 경우 치조골의 흡수 또는 과다 침착이 일어난다. 교정치료에 의한 치아의 재위치시 치조골의 흡수로 인한 치조골높이의 상실이 나타날 수 있으며 이의 평가를 위한 여러 선학들의 연구가 시도되었다. 임상연구방법중 재현성과 규격성이 가능한 방사선사진을 이용하게 되었고 그중 치조골의 변화에 관한 객관적인 평가를 위한 구치부의 교익사진을 사용하게 되었다. 교정치료 전후에 치조골높이가 어느 정도의 변화를 나타내는지를 알아보기 위해 치료전 구치부의 관계가 Cl I인 10-13세(평균 12.2세)아동을 대상으로 구강내 상태가 양호하며 선천적 결손이 없으며 심한 치주질환이나 전신질환이 없고, 치료전후의 교익사진이 있는 환자를 무작위로 총 20명을 축출하여 연구대상으로하였고 상하악 좌우측의 견치, 소구치, 구치부의 치아의 이동량, 장축의 변화와 치주높이의 변화를 분석한 결과 다음과 같은 결과를 얻었다. 1. 상하악좌우측의 견치, 소구치, 구치부의 치아의 이동량, 장축의 변화와 치주높이의 변화량을 나타내는 계측치의 평균 표준편차와 중앙값을 구하였다. 2. 상하악좌우측의 치조골의 높이의 치료전후 계측치비교시 거의 모든 계측치에서 하악보다는 상악에서 변화량이 크게 나타났다. 3. 근원심간의 비교시 3D3과 4M3은 상하 좌우측 모두 원심측이 4M3과 4D3은 근심측이, 4D3과 5M3은 원심측이, 5M3과 5D3은 근심측이, 5D3과 6M3은 근심측이 변화량이 큰 것으로 나타났다. 4. 상하악좌우측의 견치, 소구치, 구치부의 치아의 이동량(TX,TY)과 장축의 변화 (A)를 나타내는 계측항목의 비교시 좌우측 모두 상악의 34TX, 34TY, 34A가 크게 나타났고 이 부위의 치조골높이의 변화가 다른 부위에 비해 컸다.정중구개봉합부를 급속확장시킨 후 신생골 형성은 보정 14일이 지난 후부터 관찰되기 시작하였으며, 보정 28일이 지난 후에는 신생골형성이 훨씬 왕성하게 진행되었음을 관찰할 수 있었다.위 판별식으로 본 연구대상을 판별한 결과, 전체정판별률은 $92.86\%$였다.왜소치가 발견되지 않았다. 작은 군(S군)사이에 수평적 골격관계는 차이가 없으나 수직적 골격관계는 L군이 S군에 비해 하악골이 하방으로 많이 성장한 경향을 보여주었다. 하지만 성인 남자군인 G2군에서는 이부비율에 따른 안면골격의 뚜렷한 형태적 차이를 보여주지 않았다.교하면 bisphosphonate는 indomethacin에 비해 골흡수 억제효과가 더 크며 투여시간에 따른 제약도 더 적은 것으로 사료된다.ubstance P는 인간의 치주인대세포에서 교원질 합성을 억제하였다. 이 효과는 procollagen mRNA와 gelatinase 생성의 정상(steady-state) 수준의 변화 때문이 아니라 prostaglandin 생성과 연관이 있음을 알았다.EX>는 골기질의 주성분인 type I 교원질의 합성을 선택적으로 억제하는 기능과 alkaline phosphatase의 활성을 크게 증가시키지 못한 점 등으로 미루어 볼 때, 골개조를 억제하는 방향으로 작용한다고 볼 수 있으며, 교정치료 과정중 골개조를 억제하는 부위에서 사용을 시도해 볼 수 있겠다.>신뢰구간은 상악에서 정상교합군은 $79.5-81.0\%$, 비발치군은 $81.6-84.9\%$, 발치군은 $70.1-72.2\%$로 나타났으며, 하악에서 정상교합군은 $79.8-82.2\%$, 비발치군은 $82.1-85.5\%$, 발치군은 $73.1-75.1\%$로 나타났다. 7. 최대치아근원심폭경합, 기저악궁폭경,

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권3호
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• pp.276-282
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• 2008

Objective: This is to report the efficacy of the sandwich technique for bone augmentation in a moderate atrophic posterior mandible through clinical and histological results in two cases. Subjects and Method: Two patients selected had moderate bone resorption in left lower edentulous area. Sandwich osteotomy using the piezosurgery was performed and the osteomized alveolar segments were elevated by 6mm in each two patients. The interpositional mineral allograft materials were inserted in the atrophic posterior mandibles. After four months healing period, bone biopsies in the grafted areas and placement of dental implants were performed. In both cases, panoramic views were taken preoperatively to measure the alveolar bone height for diagnosis, to monitor patient healing, and to evaluate bone healing and bone gain. Results: Sufficient vertical bone height was gained by using the sandwich technique and implants were placed successfully. In radiological evaluation, there was minimal resorption of bone height after the second operation and in histomorphometric evaluation, they showed favorable new bone formation without inflammation in the grafted areas. Conclusion: The sandwich technique can be an effective choice for augmenting vertical bone height in the atrophic mandible. More of cases and long term follow-up are needed to evaluate bone resorption and implant prognosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권5호
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• pp.444-450
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• 2007

In general, labiolingual or buccolingual widths of residual alveolar bone are insufficient in edentulous area, because of alveolar resorption. Horizontal augmentation is bone graft procedure with a view to reinforcing horizontally insufficient bone quantity for installation of implants. The standard method is taking appropriate amount of block bone from intraoral or extraoral autogenous bone, and solid fixation with screws or mini-plate on labial or buccal side of residual alveolar bone. The purpose of this study is to discuss clinical usefulness of horizontal augmentation with autogenous block bone by observation and analysis of course of 41 implants installed to 12 patients by horizontal augmentation in Seoul National University Bundang Hospital from July, 2002 to December, 2005. The mean age of patients is 52.7, from 19 to 70, and the number of men and women is each 2 and 10. Block bone was taken from symphysis, body, ramus of mandible or iliac bone. And 6 types of implants were installed simultaneously or not, the diameters of implants are from 3.3 to 5.5mm, the lengths are from 8 to 15mm. The operator added artificial bone grafting material and optionally covered with membrane. The mean periods of observation after operation and final prosthetics were 28.6 and 17.0 months. As a result, 40 among 41 implants survived, the survival rate was 97.6%. Average 0.9mm crestal resorption was observed at final point of time by periapical view of each patients. Major complication related to the procedure was numbness in 7 patients.

• The Journal of Advanced Prosthodontics
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• 제13권1호
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• pp.55-64
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• 2021

PURPOSE. To investigate the biomechanical effect of marginal bone resorption (MBR) on the mandibular mini implant (MI)-retained overdenture (MI-OD) on the edentulous model. MATERIALS AND METHODS. The experimental mandibular edentulous model was modified from a commercial model with 2 mm thick artificial soft tissue under denture base. Two MIs (Φ2.6 mm × 10 mm) were bilaterally placed between the lateral incisor and the canine area and attached with magnetic attachments. Three groups were set up as follows: 1) alveolar bone around the MI without MBR (normal group), 2) with MBR to 1/2 the length of the implant (resorption group), and 3) complete denture (CD) without MI (CD group). Strain around the MI, pressure near the first molar area, and displacement of denture were simultaneously measured, loading up to 50 N under bilateral/unilateral loading. Statistical analysis was performed using independent-samples t test and one-way ANOVA (α=.05). RESULTS. The strain around the MI with MBR was approximately 1.5 times higher than that without MBR. The pressure in CD was higher than in MI-ODs (P<.05), while there was no statistical difference between the normal and resorption group (P>.05). Similarly, the CD demonstrated a greater displacement of the denture base than did the MI-ODs during bilateral and unilateral loadings (P<.05). CONCLUSION. The strain around the MI with MBR was approximately 1.5 times higher than that without MBR. The pressure on posterior alveolar ridge and denture displacement of MI-ODs significantly decreased compared to CDs, even when MBR occurs. Bilateral balanced occlusion was recommended for MI-ODs, especially when MBR occurred.

• 대한치과교정학회지
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• 제46권6호
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• pp.379-385
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• 2016

Objective: Forced eruption has been proposed for the reconstruction of deficient bone and soft tissue. The aim of this study was to examine the changes in the alveolar ridge width and the vertical levels of the interproximal bone and papilla following forced eruption. Methods: Patients whose hopeless maxillary anterior teeth were expected to undergo severe bone resorption and soft tissue recession upon extraction were recruited. In addition, patients whose maxillary anterior teeth required forced eruption for restoration due to tooth fracture or dental caries were included. Before and after forced eruption, the interproximal bone height was measured by radiographic analysis, and changes in the alveolar ridge width and the interproximal papilla height were measured with an acrylic stent. Results: This prospective study demonstrated that the levels of the interproximal alveolar bone and papilla were significantly increased by 1.36 mm and 1.09 mm, respectively, in the vertical direction. However, the alveolar ridge width was significantly reduced by an average of 0.67 mm in the buccolingual direction. The changes in the level of the interproximal alveolar bone and papilla were positively correlated. Conclusions: Although the levels of the interproximal bone and papilla were significantly increased, the alveolar ridge width was significantly decreased following forced eruption. There was a modest positive and significant correlation between the changes in the height of the interproximal alveolar bone and the papilla. Based on our findings, modification of vertical forced eruption should be considered when augmentation of the alveolar ridge width is required.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권3호
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• pp.238-247
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• 2005

The placement of different graft materials and/or the use of occlusive membranes to cover the extraction socket entrance are techniques aimed at reducing alveolar ridge resorption and enhancing bone formation. However, in spite of its clinical advantage, the use of graft materials in fresh extraction socket has been questioned because particles of the grafted material have been found in alveolar sockets with fibrous union. The purposes of this study were to evaluate whether alveolar ridge resorption following tooth extraction could be reduced and bone formation could be enhanced by the application of absorbable gelatin spongy or gelatin spongy soaked with platelet rich plasma(PRP) used as a space filler in clinical and radiographic aspects. Eighty patients who were scheduled for extraction of both third molars were participated and carried out by one experienced surgeon. Following extraction of teeth, one extracted socket were treated with gelatin spongy as an experimental group A and the other were treated with gelatin spongy and PRP as an experimental group B. The routine extracted socket were healed without any treatment as a control group. From the period of extraction to 12 weeks postoperatively, we examined the clinical course and radiographic evaluation on socket at regular interval. Both experimental groups showed faster wound healing process than control clinically. Vertical gingival height of the extraction socket were less changed statistically in both experimental groups than control. The horizontal width change of the extraction socket were not significant statistically in any group. Radiographic changes of the alveolar bone height were less changed in both experimental groups and bone density were showed higher than control. There were a little difference between experimental group A and B. In conclusion, absorbable gelatin sponge and with PRP were considered as having preservation effects of extraction socket and stimulation of bone formation process after extraction.

• Journal of Periodontal and Implant Science
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• 제48권3호
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• pp.193-200
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• 2018

Purpose: The present study describes 3 patients with chronic periodontitis and consequent vertical resorption of the alveolar ridge who were treated using implant-based restoration with guided bone regeneration (GBR). Methods: After extraction of a periodontally compromised tooth, vertical bone augmentation using a K-incision was performed at the healed, low-level alveolar ridge. Results: The partial-split K-incision enabled soft tissue elongation without any change in buccal vestibular depth, and provided sufficient keratinized gingival tissue during GBR. Conclusions: Within the limits of this study, the present case series demonstrated that the novel K-incision technique was effective for GBR and allowed normal implant-based restoration and maintenance of a healthy periodontal condition. However, further long-term follow-up and a large-scale randomized clinical investigation should be performed to evaluate the feasibility of this technique.

• 대한치과교정학회지
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• 제34권1호
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• pp.47-61
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• 2004

교정치료의 목표는 치아와 악골의 기능성과 심미성을 높이며 안정성을 도모하는 데에 있지만, 치료 과정 중에 치근 흡수와 치조골 흡수와 같은 여러 가지 후유증이 발생할 수 있다 이러한 치근첨의 흡수는 예측이 불가능하고, 상아질 부위까지 파급될 수 있으며, 발생 후 비가역적이다. 치조골 흡수는 치주 지지의 관점에서 매우 중요한 후유증이다. 이에 여러 가지 구강악습관 중 손톱 깨물기 습관을 가진 아동의 교정 치료 전, 후의 치근과 치조골 높이 변화를 고찰하여, 교정 치료 시 적절한 생역학을 고려하고, 치근흡수와 치조골 상실의 가능성에 대처하고자 본 연구를 시행하였다. 연구대상은 1997년 7월부터 1999년 2월까지 연세대학교 치과대학병원 교정과에 교정치료를 목적으로 내원한 $10\~15$세까지의 청소년 중 큰 골격 변이가 없고, 함께 내원한 부모로부터 손톱 깨물기 습관이 있다고 확인되고 전형적인 손톱 형태 -정기적인 손톱 깎는 일이 없이 치아로 손톱을 뜯는 습관으로 변연이 불규칙한 손톱의 형태 -를 가진 환자 63명을 실험군으로, 같은 연령대의 손톱 깨물기 습관이 없는 환자63명을 대조군으로 설정하였다. 교정 치료 후 실험군은 31명, 대조군은 22명이었다. 교정 치료 전(T1)과 치료 후(T2), 각 군의 전치부 치근단 방사선 사진을 채득하여 치근의 길이와 치조골의 높이를 평가하여 다음과 같은 결과를 얻었다. 1. 교정 치료 전 실험군의 평균 치관/치근 비는 상악 4전치와 하악 우측 측절치에서 대조군보다 유의성 있게 큰 값을 보여주었다. 2. 교정 치료 전 실험군의 치근 길이는 하악 양측 중절치와 상$\cdot$하악 우측 측절치에서 상대적으로 대조군보다 더 짧은 값을 보였다. 3. 교정 치료 전 실험군의 치간골에서 대조군보다 유의성 있는 상실을 보인 곳이 있었다. 4. 교정 치료 후 실험군과 대조군 모두 치근 길이의 감소와 치간골 소실이 있었다. 5. 교정 치료 후 실험군에서 모든 치아의 치관/치근 비의 변화와 치근의 길이 감소가 대조군보다 유의성 있게 크게 나타났다. 6. 교정 치료 후 실험군의 모든 치아의 치간골 높이가 대조군보다 유의성 있게 감소하였다.

• Journal of Periodontal and Implant Science
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• 제26권4호
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• pp.859-872
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• 1996

The purpose of this study was to evaluate the effect of low concentrative ${\beta}-APN$ on the periodontal ligament and relationship between lathyrintic bodies and osteoclast cells near the by alveolar bone. Mandibles including teeth and periodontiums of 24 Sprague-Dawley rat was used. ${\beta}-APN$ 0.2g/kg/day soluted in mineral water was administrated for 5 days before sacrifice in experimental group. 3 rats on each day was sacrificed on 1, 3, 7, 11 days after stop administration ${\beta}-APN$. Histologic examination and the activity of osteoclasts by tartrate resistant acid phosphatase was observed. The results were as follows : 1. In experimental group, the The small foci of lathyrintic bodies surrounded by palisading fibroblasts were seen obviously on 1, 3 days and decreased after 7 days. On 11 days, fibroblasts of periodontal ligament similar to control group. 2. The lathyrintic bodies were seen in the middle zone of periodontal ligament of pressured area like furcation area, alveolar crest, bone resorption area than tensioned area of apposition area. 3. In experimental group of 1, 3 days, lathyrintic bodies were much seen in the area that osteoclasts was much distributed area. After 7 days, experimental group was seen the control group. In conclusion, rathyrintic bodies were formed by low concentrative ${\beta}-APN$ chiefly on the pressured area like furcation area, alveolar crest, bone resorption area than tensioned area of apposition side in periodontal tissue and concerned with osteoclast cells.