• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.5
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• pp.386-393
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• 2009

Objectives: This study was performed to evaluate course of the inferior alveolar canal in the mandibular ramus and to find safety zone when ramal bone is harvested. Patients and Methods: From January, 2009 to February, 2009, the 20 patients who visited in the Department of Oral and Maxillofacial Surgery, Sanbon Dental Hospital. Wonkwang University and the Conebeam CT was taken of various chief complaints, were selected. The patients who had left and right mandibular first molar and incisor missing, jaw fracture and bone pathology were excluded. The R point was defined as the point which occlusal plane was crossed to the mandibular anterior ramus(external oblique ridge). In the cross-sectional coronal and axial views, the inferior alveolar canal position to the R point, buccal bone width(BW), alveolar crest distance(ACD), distance from alveolar crest to occlusal plane(COD) and inferior alveolar canal to sagittal plane(CS) were measured and horizontal distance(HD), vertical distance(VD) and nearest distance(ND) were measured. Results: The inferior alveolar canal is located $6.19{\pm}1.21\;mm$ from the R point. Horizontal distance from the R point were $13.07{\pm}2.45\;mm$, vertical distance from the R point were $14.24{\pm}2.41\;mm$ and nearest distance from the R point were $10.12{\pm}1.76\;mm$. The course of the inferior alveolar canal was positioned within $0.61{\pm}0.68\;mm$. The distance from external buccal bone to the inferior alveolar canal was increased from the R point anteriorly. Conclusions: It is considered that the mandibular ramus from the R point to 10 mm anteriorly can be harvested safely at ramal bone grafting.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.1
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• pp.67-70
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• 2009

Purpose: This study presents the use of mini implants for fixed restoration and implant supported overdenture to enable the practitioner to overcome the anatomic obstacles of ridge width and narrow interdental space. Patients and methods: This study consisted of 9 patients who required single implants for one or two teeth replacement and 1 patient who required implant supported overdenture after mandiblectomy, iliac bone graft due to ghost cell tumor. The ages ranged from 29 to 70 years (mean 51). All patients were in good health. Clinical and radiographs were taken pretreatment, postoperatively, during rehabilitation, and at follow ups. Results: Total implant survival rate was 94.7%. One implant was removed due to its mobility as a result of bad bone quality (Type IV) and patient's carelessness (Heavy smoker). All patients except one reported complete satisfaction regarding to function, aesthetics, and phonetics. Radiographic follow up every 3months postoperatively showed success in achieving function and maintaining marginal bone level. Conclusion: Clinician can overcome both severe ridge deficiency and small interdental space with mini implant.

• Journal of Periodontal and Implant Science
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• v.37 no.4
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• pp.791-803
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• 2007

The purpose of this study was to evaluate exophytically vertical bone formation in residual ridge of the beagle dog by the concept of guided bone regeneration with a titanium reinforced e-PTFE membrane combined with irradiated cancellous human bone. Twelve male beagle dogs(mean age 1.5 years and mean weight 12kg) were used for this study. The alveolar ridges after extraction of all mandibular premolars were surgically and horizontally removed. At 8 weeks after extractions, full-thickness flap was reflected and cortical bone was removed with round bur and copious irrigation. Rectangular parallelepiped(10mm in length, 5mm in width, and 4mm in height) bended with titanium-reinforced e-PTFE(TR e-PTFE) membrane was placed on the decorticated alveolar ridge, fixed with metal pins and covered with full-thickness flap and assigned as a control group. Test groups ere treated with TR e-PTFE membrane filled with irradiated cancellous human bone. Of twelve beagle dogs, four control dogs and four test dogs without membrane exposure to oral cavity were sacrificed at 8 and 16 weeks respectively. The surgical sites were dissected out, fixed in 4% buffered formaldehyde, dyed using a Villanueva staining technique, and processed for embedding in plastic resin. The cutting and grinding methods were routinely processed for histologic and histomophometric analyis of exophytic bone formation as well as statistical analysis. The results of this study were as follows: 1. Exophytic bone formation in the both of experimental groups was increased respectively after surgery from 23.40% at 8 weeks to 46.26% at 16 weeks in the control groups, from 40.23% at 8 weeks to 47.11% at 16 weeks in the test groups(p<0.05). 2. At 8 weeks after surgery, exophytic bone formation was made 40.23% in the test groups and 33.40% in the control groups. Exophytic bone formation was significantly made in the test group more than in the control group. At 16 weeks after surgery, exophytic bone formation was made 44.11% in the test groups and 46.26% in the control groups. Exophytic bone formation was made in the test groups more than in the control groups, but there was no statistically significant differences. 3. The membrane was fixed with metal pins to closely contact it to the bone surface. So, collapse and deviation of the membrane could be prevented and in growth of connective tissue also could be blocked from the periphery of the membrane. On the basis of these findings, wee suggest that intraoral experimental model for exophytic bone formation may be effective to evaluate the effect of bone graft material. And it indicates that combined use of membrane and ICB graft material is more effective than use of membrane only for exophytic bone formation.

• Journal of Periodontal and Implant Science
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• v.50 no.6
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• pp.418-434
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• 2020

Purpose: The purpose of the present study was to evaluate the effect of silica-calcium phosphate composite (SCPC) granules on bone regeneration in extraction sockets. Methods: Ten patients were selected for a split-model study. In each patient, bone healing in SCPC-grafted and control ungrafted sockets was analyzed through clinical, radiographic, histomorphometric, and immunohistochemical assessments 6 months postoperatively. Results: A radiographic assessment using cone-beam computed tomography showed minimal ridge dimension changes in SCPC-grafted sockets, with 0.39 mm and 1.79 mm decreases in height and width, respectively. Core bone biopsy samples were obtained 6 months post-extraction during implant placement and analyzed. The average percent areas occupied by mature bone, woven bone, and remnant particles in the SCPC-grafted sockets were 41.3%±12%, 20.1%±9.5%, and 5.3%±4.4%, respectively. The percent areas of mature bone and woven bone formed in the control ungrafted sockets at the same time point were 31%±14% and 24.1%±9.4%, respectively. Histochemical and immunohistochemical analyses showed dense mineralized bundles of type I collagen with high osteopontin expression intensity in the grafted sockets. The newly formed bone was well vascularized, with numerous active osteoblasts, Haversian systems, and osteocytes indicating maturation. In contrast, the new bone in the control ungrafted sockets was immature, rich in type III collagen, and had a low osteocyte density. Conclusions: The resorption of SCPC granules in 6 months was coordinated with better new bone formation than was observed in untreated sockets. SCPC is a resorbable bone graft material that enhances bone formation and maturation through its stimulatory effect on bone cell function.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.27 no.2
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• pp.97-104
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• 2018

Mandibular anterior region has high implant survival rates and better accessibility compared with any other region. Even if there are possibilities for perforation on lingual cortical bone due to improper drilling and bleeding caused by lingual artery damage, mandibular anterior region is a safe region because less amount of major anatomical structures exist compared with other regions. However, because of narrow bucco-lingual width of alveolar ridge, it is challengeable to obtain esthetic implant prosthesis. Although patients are less sensitive subjectively, mandibular anterior region is as difficult as maxillary anterior region in that implant placement location plays a critical role on the prognosis of implant prosthesis. One-piece implant is a very useful option for mandibular anterior region. Considering the narrow roots and thin alveolar bone of mandible, it is clinically difficult for implant diameter to be greater than 3mm In this case, we could approach the esthetic restoration in mandibular anterior region with one-piece implant and immediate loading.

• Restorative Dentistry and Endodontics
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• v.19 no.2
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• pp.345-371
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• 1994

Restorative procedures can lead to weakening tooth due to reduction and alteraton of tooth structure. It is essential to prevent fractures to conserve tooth. Among the several parameters in cavity designs, cavity isthmus and depth are very important. In this study, MO amalgam cavity was prepared on maxillary first premolar. Three dimensional. finite element models were made by serial photographic method and cavity depth(1.7mm, 2.4mm) and isthmus (11 4, 1/3, 1/2 of intercuspal distance) were varied. linear, eight and six-nodal, isoparametric brick elements were used for the three dimensional finite element model. The periodontal ligament and alveolar bone surrounding the tooth were excluded in these models. Three types model(B, G and R model) were developed. B model was assumed perfect bonding between the restoration and cavity wall. Both compressive and tensile forces were distributed directly to the adjacent regions. G model(Gap Distance: 0.000001mm) was assumed the possibility of play at the interface simulated the lack of real bonding between the amalgam and cavity wall (enamel and dentin). When compression occurred along the interface, the forces were transferred to the adjacent regions. However, tensile forces perpendicular to the interface were excluded. R model was assumed non-connection between the restoration and cavity wall. No force was transferred to the adjacent regions. A load of 500N was applied vertically at the first node from the lingual slope of the buccal cusp tip. This study analysed the displacement, von Mises stress, 1 and 2 direction normal stress and strain with FEM software ABAQUS Version 5.2 and hardware IRIS 4D/310 VGX Work-station. The results were as follows: 1. G model showed stress and strain patterns between Band R model. 2. B model and G model showed the bending phenomenon in the displacement. 3. R model showed the greatest amount of the displacement of the buccal cusp followed by G and B model in descending order. G model showed the greatest amount of the displacement of the lingual cusp followed by B and R model in descending order. 4. B model showed no change of the displacement as increasing depth and width of the cavity. G and R model showed greater displacement of the buccal cusp as increasing depth and width of the cavity, but no change in the displacement of the lingual cusp. 5. As increasing of the width of the cavity, stress and strain were not changed in B model. Stress and strain were increased on the distal marginal ridge and buccopulpal line angle in G and R model. The possibility of the tooth fracture was increased. 6. As increasing of the depth of the cavity, stress and strain were not changed in B and G model. Stress and strain were increased on the distal marginal ridge and buccopulpal line angle in R model. The possibility of the tooth fracture was increased.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.5
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• pp.519-526
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• 2000

Osteoporosis has recently been recognized as a major health problem in the elderly population. The disorder is manifested as a loss of bone mass accompanied by structural alteration of bone and increased incidence of fracture. Mandible also may be affected. So, I evaluated panoramic views of 66 postmenopausal women for finding the possibility of useful diagnostic mandibular parmeters of osteoporosis. To know the correlationship between skeleton and mandible, the average of the bone mineral density of lumbar from 2nd to 4th by the dual energy X-ray absorptiometry(DEXA, LUNAR DPZ. USA), and age and mandibular parameters, that is, the number of residual teeth, alveolar ridge resorption ratio, panoramic mandibular index (PMI), mandibular cortical width (MCW), angular cortical thickness (ACT), ramus cortical thickness (RCT), morphology of mandibular inferior cortical (MIC) were compared. And I divided the all tested women to the osteoporotic group and non-osteoporotic group by the use of T-score -2.0, which was derived from skeletal bone mineral density (BMD). To find the correlationship of the each group with mandibular parameters, t-test and discriminant analysis were done. The results of the t-test were that all parameters were highly related with 2 groups (p<0.05). Especially ACT, MIC, age have had even higher correlationship than others (p<0.001). The results of the discriminant analysis by the use of these ACT, MIC and age were that the discriminant function was Z = -2.973+(-1.447)$\times$(ACT)+1.131$\times$(MIC score)+(0.052)$\times$(age), the cutting score was 0.257 and the classification accuracy was 84.8%. Therefore I suggest that the consideration of the angular cortical thickness (ACT), the age of patient and the morphology of mandibular inferior cortical(MIC) may help find the osteoporosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.1
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• pp.85-92
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• 2005

Reconstruction of defect in the anterior part of the maxilla to enable implant placement or prothesis is a complicated treatment due to the anatomical position and lack of soft tissues. Two cases are presented in which autogenous iliac PMCB(particulate marrow and cancellous bone) with titanium mesh were used for premaxilla reconstruction and alveolar bone repair of the anterior maxillas prior to denture and implants fixation respectively. Cancellous bone from the anterior iliac crest was compressed and placed against a titanium mesh fixed to the bone of palate in a patient with severe defect of the anterior maxilla. There were no problem in the healing, and the anterior maxillas of two patients had increased height and width during the initial healing and remodeling. The clinical reports describe the use of titanium mesh for reconstruction of premaxilla. Autogenous bone grafts were harvested from the iliac crest and were loaded on a titanium mesh that were left in the patient's maxilla for 6 months before they were removed respectively. The radiographic analysis demonstrated that a 10mm vertical ridge augmentation had been achieved. In guided bone regeneration, the quantity of bone regenerated under the barrier has been demonstrated to be directly related to the amount of the space under the membrane. This space can diminish as a result of membrane collapse. To avoid this problem which involved the use of a titanium mesh barrier to protect the regenerating tissues and to achieve a rigid fixation of the bone segments, were used in association with autologous bone in 2 cases. The aim of this study was to evaluate the capability of a configured titanium mesh to serve as a mechanical and biologic device for restoring a vertically defected premaxilla.

• Imaging Science in Dentistry
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• v.50 no.2
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• pp.93-98
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• 2020

Purpose: Little is known regarding the accuracy of clinical magnetic resonance imaging (MRI) protocols with acceptable scan times in sinus graft assessment. The aim of this study was to evaluate the correlations between MRI and cone-beam computed tomographic (CBCT) measurements of maxillary sinus grafts using 2 different clinical MRI imaging protocols. Materials and Methods: A total of 15 patients who underwent unilateral sinus lift surgery with biphasic calcium phosphate were included in this study. CBCT, T1-weighted MRI, and T2-weighted MRI scans were taken 6 months after sinus lift surgery. Linear measurements of the maximum height and buccolingual width in coronal images, as well as the maximum anteroposterior depth in sagittal images, were performed by 2 trained observers using CBCT and MRI Digital Imaging and Communication in Medicine files. Micro-computed tomography (micro-CT) was also performed to confirm the presence of bone tissue in the grafted area. Correlations between MRI and CBCT measurements were assessed with the Pearson test. Results: Significant correlations between CBCT and MRI were found for sinus graft height (T1-weighted, r=0.711 and P<0.05; T2-weighted, r=0.713 and P<0.05), buccolingual width (T1-weighted, r=0.892 and P<0.05; T2-weighted, r=0.956 and P<0.05), and anteroposterior depth (T1-weighted, r=0.731 and P<0.05; T2-weighted, r=0.873 and P<0.05). The presence of bone tissue in the grafted areas was confirmed via micro-CT. Conclusion: Both MRI pulse sequences tested can be used for sinus graft measurements, as strong correlations with CBCT were found. However, correlations between T2-weighted MRI and CBCT were slightly higher than those between T1-weighted MRI and CBCT.