• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.3
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• pp.241-248
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• 2008

Tibial bone grafts provide an adequate volume of cancellous bone with cortical bone, high biologic value of bone, minimal gait disturbance and complications, and no special contraindications, and offer a superior clinical results than any other donor sites. Lateral appoach in tibial bone graft was used to gain large bone volume traditionally, but medial approach provides low morbidity associated with the tibial anatomic structure, simple and safety surgical procedure, and better comfortable to patients recently. We have undertaken clinical and retrospective studies on patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from April 2004 to January 2008. 50 patients have maxillofacial bony defect as resection of bening tumor, cyst enucleation, alveolar bone resorption, sinus pneumatization were received the tibial proximal autogenous particulated cancellous bone grafts. They were analyzed sex, age, diagnosis of recipient site, lesion size, dornor site, cortical bone repositioning, complications and we concluded favorable following results. 1. Medial approach for proximal tibia is safer and technically easier than lateral approach, associated with the proximal tibial anatomic structures, and short operative times. 2. Proximal tibia provides an adequate bone volume with predictability for oral and maxillofacial reconstruction. 3. Patients rarely complain of pain, swelling, discomfort and dysfunction such as gait disturbance. In conclusion, medial approach for proximal tibial graft seems to be a valuable tool for oral and maxillofacial reconstruction.

• Journal of Korean Neurosurgical Society
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• v.52 no.4
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• pp.396-403
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• 2012

Objective : The predictors of cranioplasty infection after decompressive craniectomy have not yet been fully characterized. The objective of the current study was to compare the long-term incidences of surgical site infection according to the graft material and cranioplasty timing after craniectomy, and to determine the associated factors of cranioplasty infection. Methods : A retrospective cohort study was conducted to assess graft infection in patients who underwent cranioplasty after decompressive craniectomy between 2001 and 2011 at a single-center. From a total of 197 eligible patients, 131 patients undergoing 134 cranioplasties were assessed for event-free survival according to graft material and cranioplasty timing after craniectomy. Kaplan-Meier survival analysis and Cox regression methods were employed, with cranioplasty infection identified as the primary outcome. Secondary outcomes were also evaluated, including autogenous bone resorption, epidural hematoma, subdural hematoma and brain contusion. Results : The median follow-up duration was 454 days (range 10 to 3900 days), during which 14 (10.7%) patients suffered cranioplasty infection. There was no significant difference between the two groups for event-free survival rate for cranioplasty infection with either a cryopreserved or artificial bone graft (p=0.074). Intergroup differences according to cranioplasty time after craniectomy were also not observed (p=0.083). Poor neurologic outcome at cranioplasty significantly affected the development of cranioplasty infection (hazard ratio 5.203, 95% CI 1.075 to 25.193, p=0.04). Conclusion : Neurologic status may influence cranioplasty infection after decompressive craniectomy. A further prospective study about predictors of cranioplasty infection including graft material and cranioplasty timing is necessary.

• The Journal of the Korean dental association
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• v.37 no.1 s.356
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• pp.62-68
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• 1999

Patients who present with severe maxillary bone loss Secondary to trauma or resorption provide a unique diagnosis and difficulty in implant installation. To solve this problem, various bone grafting methods and graft materials can be used in these compromised cases. But for the patients required wide reconstruction, autogenous iliac bone has been used widely because of easy harvesting of much corticocancellous bone. Usually, implant installations are performed 6-12 months later after grafting. but this method necessary long treatment period and additional surgery. To avoid this disadvantages, bone grafting with immediate implant installations are frequently used. But special care is necessary to prevent postoperative complication in this method. We present three cases of veneer grafting with immediate implant installation. These patients had a knife-edge shaped alveolar bone due to labial alveolar bone loss. We reconstructed this alveolar bone with veneer grafting with iliac bone and performed immediate implant installation. There was no complications during healing periods in these three cases. Six months later, we found good survival of grafting bone and osseointegration of these implants, so we could perform prosthetic treatment successfully.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.2
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• pp.152-156
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• 2007

Giant cell tumor of bone is relatively common neoplasm usually involving epiphysis of long bone. And rarely it involves the diaphysis or metaphysis without epiphyseal extension. We report on an 18-year-old girl with giant cell tumor of ulnar diaphysis. She was treated with wide excision and reconstuction with nonvascularized autogenous fibular graft. We harvested fibular fragment preserving fibular continuity to reduce donor site morbidity. Surgical outcome and functional result was excellent.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.1
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• pp.29-34
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• 1999

Chondroblastoma is an uncommon neoplasm in bone, occurring at the epiphysis or apophysis of growing long bones and is known to have a recurrence rate of around 10% after surgical treatment. We reviewed 14 patients of pathologically proven chondroblastoma, who were surgically treated, from December 1987 to August 1997. The location of tumors was proximal femur in 4 cases, distal femur in 4 cases, proximal tibia in 2 cases, patella in 1 case, proximal humerus in 1 case and calcaneus in 1 case. The most common complaint was pain. In all nine cases in which MRI was performed, the MR imaging showed a lobulated low signal intensity(SI) rim. Low SI foci within the tumor were present in 4 of 9 cases and corresponded to calcification seen on radiographs or CT. Bone marrow edema was also present in 4 of 9 cases on MR imaging. The average duration of follow-up was 2 years, 5 months, ranging from 1 year to 7 years, 2 months. Twelve patients were treated by curettage and autogenous bone graft, one by curettage only, and one by curettage and bone cementing. Two cases which showed local recurrence were treated with curettage and bone graft. Two recurred cases had the presence of bone marrow edema on MR imaging. The presence or absence of bone marrow edema may be a useful indication of tumor activity, although further study will be required.

• The Journal of Advanced Prosthodontics
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• v.2 no.1
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• pp.7-13
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• 2010

Although most researchers agree that platelet-rich plasma (PRP) is a good source of autogenous growth factors, its effect on bone regeneration is still controversial. The purpose of this study was to evaluate whether increasing angiogenic factors in the human PRP to enhance new bone formation through rapid angiogenesis. MATERIAL AND METHODS. In vitro, the human platelets were activated with application of shear stress, $20\;{\mu}g/ml$ collagen, 2 mM $CaCl_2$ and 10U thrombin/$1\;{\times}\;10^9$ platelets. Level of vascular endothelial growth factor (VEGF) and platelet microparticle (PMP) in the activated platelets were checked. In the animal study, human angiogenic factors-enriched PRP was tested in 28 athymic rat's cranial critical bone defects with $\beta$-TCP. Angiogenesis and osteogenesis were evaluated by laser Doppler perfusion imaging, histology, dual energy X-ray densinometry, and micro-computed tomography. RESULTS. In vitro, this human angiogenic factors-enriched PRP resulted in better cellular proliferation and osteogenic differentiation. In vivo, increasing angiogenic potential of the PRP showed significantly higher blood perfusion around the defect and enhanced new bone formation around acellular bone graft material. CONCLUSION. Angiogenic factor-enriched PRP leads to faster and more extensive new bone formation in the critical size bone defect. The results implicate that rapid angiogenesis in the initial healing period by PRP could be supposed as a way to overcome short term effect of the rapid angiogenesis.

• Journal of Dental Rehabilitation and Applied Science
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• v.23 no.2
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• pp.145-155
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• 2007

The advent of osseointegration and advances in biomaterials and techniques have contributed to increased application of dental implants in the restoration of maxillary partial edentulous patients. Often, in these patients, soft and hard tissue defects result from a variety of causes, such as infection, trauma, and tooth loss. These create an anatomically less favorable foundation for ideal implant placement. Reconstruction of the atrophic maxillary alveolar bone through a variety of regenerative surgical procedures has become predictable; it may be necessary prior to implant placement or simultaneously at the time of implant surgery to provide a restoration with a good long-term prognosis. Regenerative procedures are used for horizontal and vertical ridge augmentation. Many different techniques exist for effective bone augmentation. The approach is largely dependent on the extent of the defect and specific procedures to be performed for the implant reconstruction. It is most appropriate to use an evidenced-based approach when a treatment plan is being developed for bone augmentation cases. The cases presented in this article clinically demonstrate the efficacy of using a autogenous block graft, guided bone regeneration, ridge split, immediated implant placement technique on the atrophic maxillary area.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.6
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• pp.467-473
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• 2009

Purpose: The aim of this study is to compare volume and revascularization of autogenous block bone grafts in simultaneously cortical perforation of recipient beds and grafts, and only cortical perforation of recipient beds. Materials and methods: Two block bone in 8mm diameter was harvested in both skull using trephine bur on 20 New Zealand white rabbits. Harvested block bone was grafted on both inferior border of mandible. On the left side(experimental side), cortical bone of recipient beds and graft were perforated, and on the right side(control side), the only recipient bed was perforated. The rabbits had been sacrificed and infused the India ink for the observation of revascularization at 20 day and 40 day after surgery. The specimens were processed for H-E staining and quantitative analysis(independent t-test, p<0.01) was made under an optical microscope. In additional, specimens were processed for the observation of revascularization. Results: After 20 days, more bone volume was observed in experimental group, but no significant difference between two groups(p=0.106). There were significantly more bone volume in the experimental group at 40 days after surgery(p<0.01). After 20 days, more discrete vascular sprouts were observed in experimental side, but no difference at 40 days after surgery. Conclusion: We conclude that the cortical perforation of both the recipient beds and grafts improve revascularization at early stage and overall graft persistence.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.4
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• pp.243-249
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• 2010

Tissue engineered bone (TEB) can replace an autogenous bone graft requiring an secondary operation site as well as avoid complications like inflammation or infection from xenogenic or synthetic bone graft. Adult mesenchymal stem cells (MSC) for TEB are considered to have various ranges of differentiation capacity or multipotency by the donor site and age. This study examined the effect of age on proliferation capacity, differentiation capacity and bone morphogenetic protein-2 (BMP-2) responsiveness of human bone marrow stromal cells (hBMSC) according to the age. In addition, to evaluate the effect on enhancement for osteoblast differentiation, the hBMSC were treated with Trichostatin A (TSA) and 5-Azacitidine (5-AZC) which was HDAC inhibitors and methyltransferase inhibitors respectively affecting chromatin remodeling temporarily and reversibly. The young and old group of hBMSC obtained from the iliac crest from total 9 healthy patients, showed similar proliferation capacity. Cell surface markers such as CD34, CD45, CD90 and CD105 showed uniform expression regardless of age. However, the young group showed more prominent transdifferentiation capacity with adipogenic differentiation. The osteoblast differentiation capacity or BMP responsiveness was low and similar between young and old group. TSA and 5-AZC showed potential for enhancing the BMP effect on osteoblast differentiation by increasing the expression level of osteogenic master gene, such as DLX5, ALP. More study will be needed to determine the positive effect of the reversible function of HDAC inhibitors or methyltransferase inhibitors on enhancing the low osteoblast differentiation capacity of hBMSC.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.4
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• pp.306-312
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• 2010

Purpose: The purpose of this experiment was to evaluate the clinical effect of cultured autoglogous osteoblasts as a way to treat the defect of mandible in rabbits. Materials and Methods: Twelve rabbits were used to determine the rate of osteogenesis. The osteoblasts were obtained from the iliac crest of rabbits using aspiration. They were then cultured in Dulbecco's Modified Eagles's Medium (DMEM) with beta-glycerophosophatate, L-ascorbicacid, and dexamethasone to proliferate and differentiate osteoprogenitor cells. The expression of osteogenic markers were detected by reverse transcription-polymerase chain reaction (RT-PCR) and silver nitrate staining techniques. Five, 10-mm holes were placed in each rabbit mandible to simulate defective regions with the use of a low speed trephine bur. In the experimental group, the previously cited defects were grafted with both activated osteoblastic and autogenous bone. The control group, however, was only grafted with autogenous bone. Both groups were then analyzed at 2, 4, and 8-week intervals using bone histomorphometric analysis. Results: According to histomorphologic analysis, the rates of new bone formation at the 2, 4, and 8-week intervals were 36%, 51%, and 23% for the control group, respectively; 52%, 39%, and 28%, for the experimental group, respectively. The experimental group showed higher rates of new bone formation compared to the control group at both the 2-week and 8-week interval. Conclusion: Bone marrow-derived osteoblasts seems to be a promising bone graft material.