• 대한치과보철학회지
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• 제35권3호
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• pp.435-444
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• 1997

Transmandibular implant system은 하악골이 심하게 흡수된 환자에게 특히 유용하게 사용할 수 있다. 또한 여러 문헌에서도 높은 성공률을 보이고 있다. 저자가 시행한 증례에서도 환자는 높은 만족감과 의치의 안정성 및 저작효율의 증대를 보였다. 하지만 성공적인 보철물의 제작을 위해서는 신중한 진단과 치료계획 및 위에서 열거한 여러 가지 고려사항들을 참고해야 한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.21.1-21.6
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• 2020

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

• 대한구순구개열학회지
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• 제15권1호
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• pp.1-10
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• 2012

Parry-Romberg syndrome(PRS) is a degenerative disease characterized by progressive hemifacial atrophy. A 10-year-old girl who had been treated for linear scleroderma at the dermatologic department visited the orthodontic department. The frontal facial photograph showed mild facial asymmetry. On the left side, mild atrophy of soft tissue, enophthalmos, cheek depression, and dry skin with dark pigmentation were observed. The radiograph showed the hypoplasia of both the maxilla and mandible on the left side. This case report describes the treatment of a patient with PRS for 7 years. To minimize the effect of progressive atrophy on the facial growth, a hybrid appliance was used. The facial photos and radiographic records were periodically taken to analyze the progression of PRS. Although it is impossible to prevent the progression of facial asymmetry, it appears to be possible to limit the atrophic effect. After the stabilization of PRS, the orthodontic treatment by the fixed appliance was performed. Additionally, autologous fat graft was performed three times at 6 month intervals. After the treatment, the patient had a confident smile and facial asymmetry was improved.

• Imaging Science in Dentistry
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• 제32권3호
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• pp.141-145
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• 2002

Purpose : The purpose of this study was to propose standard values for alveolar and basal bone in normal adult mandibles, and radiologically analyze the remodeling process of the edentulous mandible by examining molar areas and comparing them to the established normal values. Materials and Methods : Panoramic and CT scans of mandible were performed on 20 normal adults and 20 edentulous or partially edentulous adults. In both groups, arch half diameter and distance of alveolar bone were measured. Also the distance from the mandibular canal to the caudal edges, the buccal and lingual external borders of basal bone, were measured. A statistical comparison between the mean values of normal and edentulous mandibles was carried out in the selected areas. Results : There was evidence of decreasing arch half diameter and distance in the edentulous mandible, but statistically no significant change was seen between the normal and edentulous alveolar bone. There was evidence of decreasing buccal basal bone and increasing in the lingual basal bone in the edentulous mandible. A statistically significant difference between normal and edentulous mandibles was noted in the buccal basal bone. Conclusion: There was an inward and forward atrophic change of the edentulous mandibular molar area compared to the control. CT scanning required the use of sophisticated and expensive procedures to analyze the remodeling process of edentulous mandibles. Consequently, the development and application of a more simplified and objective radiographic procedure for broad and long-term study of remodeling procedures of edentulous mandible was recommended.

• 대한두개안면성형외과학회지
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• 제9권2호
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• pp.45-50
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• 2008

Purpose: Traditionally, titanium miniplate has been used for rigid fixation of mandible fractures. However, the limitations of metal plate have been reported such as hypersensitivity, interference with the cranio-facial growth of growing child, secondary bone resorption around the plate, foreign body reaction, declination of primary callus formation, and bone atrophy, and so forth. Recently, biodegradable miniplate has been introduced and used as an alternative to the metal plate despite of its lower strength. This study evaluated the usefulness and stability of biodegradable plate and screw for treatment of mandible fractures. Methods: In this study, 61 patients(92 areas) diagnosed as mandible fracture in the last 2 years have been reviewed. We used titanium plate and screw in 32 patients, and biodegradable plate and screw($INION^{(R)}$) in 29 patients. Stability of plates and screws, bony healing process and its side effects were observed by clinical and radiographic assessment. Results: In the titanium material group, one of malocclusion, two of mouth opening limitation, three of pain, three of palpation were shown. The plate of six patients involved in these complications were removed. In the biodegradable group, two of mouth opening limitation, two of pain, one of localized wound infection were shown and one plate was removed secondarily. Conclusion: There was no statistical difference between two groups in bony healing and complication rates. Biodegradable implants show efficient stability during initial bone healing and low side effects in long-term follow up periods.

• 대한치과보철학회지
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• 제57권2호
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• pp.171-175
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• 2019

치조제가 심하게 흡수된 하악의 정확한 해부학적 구조를 채득하는 것은 매우 어렵다. 이 경우 보다 정확한 인상을 채득하기 위하여 수정모형 제작법을 통한 기능 인상 채득이 추천된다. 이를 위해서는 양측에 2개의 임플란트 크라운을 이용하여 적절한 고정원을 얻을 필요가 있다. 이를 통해 임플란트 피개의치에서는 불가능하였던 수정모형 제작법을 시행할 수 있다. 본 증례에서는 하악의 치조제가 심하게 흡수된 80세 여환을 하악 양측 견치 부위의 임플란트 크라운을 지대치로 한 가철성 국소의치를 이용하여 수복하였다. 가철성 국소의치의 금속구조물을 이용하여 개인 트레이를 제작하고 수정모형 제작을 위한 이차 인상을 채득하였다. 환자는 앞선 2회의 피개의치 실패 후 제작된 최종 보철물에 만족하였다. 치료 초기에 행해진 피개의치 치료에서는 부정확한 인상법에 따른 부적절한 보철물로 인해 술자와 환자 모두 만족하지 못했지만, 2개의 임플란트를 적절한 고정원으로 이용함으로써 성공적인 수복이 가능하였다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권1호
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• pp.50-54
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• 2012

According to Luhr's classification, a fracture in the mandible with a width of less than 15-20 mm is considered to be an atrophic mandibular fracture and its incidence is very rare. Because of the reduced cross-sectional area and smaller contact area of the fractured ends as well as the poorly vascularized bony structure and delayed bone healing, an atrophic mandibular fracture is a great challenge for oral and maxillofacial surgeons. Surgeons tend to perform closed reduction, because open reduction is considered a non-life-saving surgery among elderly patients. Thus, most of them have limited experience in surgical management. According to recent reports, open reduction yields a good result, and the Association for Osteosynthesis (AO) group has recommended open reduction. This is a case report of our two experiences of open reduction and rigid fixation of atrophic mandibular fractures by the AO principle. Articles were also reviewed here.

• 대한치과교정학회지
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• 제10권1호
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• pp.29-36
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• 1980

Inclined plane, one of frequently used orthodontic appliances, may cause posterior displacement of mandible and injure the normal growth of temporomandibular joint. So author carried out the mandibular posterior displacement experimentally induced by inserting inclined plane in the rat incisors in order to investigate the histological reactions occuring in the temporomandibular joint of experimental animals. Following results were obtained. 1. The posterior displacement of condyle resulted in the widening of anterior synovial space with anterior condylar hyperplasia and posterior condylar atrophy. In addition, tissue changes were more severe in young rats than in adult rats. 2. The tissue reactions were localized only to condylar head ana there were no evidence of traumatic features in young rats. In adult rats, hemorrhage was an additional finding 1 week after experiment. 3. The remodelling processes were accompanied by the increasing or reduction of fibrous layer and subsequent replacement by cartilage layer occured massively and abruptly in young rats, it occured slightly and slowly in adult rats. 4. The remodelling process of injured condyle occured from 1 week to 4 weeks after experiment and completed between 8 weeks after experiment.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권2호
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• pp.154-165
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• 2006

Objectives : It is difficult to place implants at a severely atrophied edentulous mandible because of vertical and horizontal alveolar defect. The autogenous and allogenic bone graft and guided bone regeneration are useful, but there are some limitations such as the resorption and infection of the grafted bone, and insufficiency of soft tissue. Distraction osteogenesis has recently evolved a challenging technique to overcome major draws of conventional augmentation procedures, we, therefore, report the four applications of implant placement after vertical alveolar distraction osteogenesis. Patients and Methods : Four patients(all female, mean age: $60{\pm}6$ years) with severe alveolar ridge deficiencies at their anterior mandible were treated with vertical alveolar distraction osteogenesis by intraoral device(Track 1.5, 15 mm model, KLS Martin, Tuttlingen, Germany) and placement of implants (Branemark MK III, TiUnite). After the latency periods of 5, 7, 8 days, distraction rhythm and rate were $0.5\;mm{\times}2\;times/day$ in the case of good bone quality, and $0.25\;mm{\times}3\;times/day$ in the case of poor bone quality. After consolidation periods of mean fifteen weeks, five implants for each patients were placed at the interforaminal area. Results : On average, a vertical gain of $11.38{\pm}1.38\;mm$ was obtained by distraction. And all distraction zone showed complete ossification by panoramic radiography. There were no postoperative complications other than numbness of lower lip in one case. Total twenty implants in four patients were placed and their outcomes were satisfactory. Conclusion : It is a useful method to place five implants after vertical distraction osteogenesis of the severely atrophied mandible for the implant-supported fixed prosthesis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권3호
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• pp.222-225
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• 2006

The treatment objective of mandibular fracture is a return to normal function. According to Champy, a rigid fixation of mandibular angle fracture is performed by using 4 or 6 holes titanium miniplates on the external oblique ridge of mandible. However, the limitations of metal plate such as hypersensitivity, interference with the cranio-facial growth of growing child, secondary bone resorption around the plate, foreign body reaction, declination of primary callus formation, and bone atrophy due to the lack of normal stress reaction of the bone have been reported. Recently, biodegradable miniplate has been introduced and used as an alternative to the metal plate despite its lower strength than that of the titanium plate and the side effect caused by the resorption in the body. In this study, 61 patients diagnosed as mandibular angle fracture and treated from Jan. 1998 to Dec. 2004 in our department have been reviewed. Metal plate fixation was used in 50 patients and biodegradable plate fixation in 11 patients on the external oblique ridge around the fractured mandibular angle according to the principle of monocortical osteosynthesis by Champy. We compared the incidence of side effects and the degree of bony union at the mandibular inferior border in two different fixation methods. In conclusion, we have found that one miniplate regardless of matter could provide enough strength to grasp bony fragments of the tension site and compress the inferior border of mandible without any complications.