• 제목/요약/키워드: Bone augmentation

검색결과 350건 처리시간 0.028초

의료영상 분석과 유한요소법을 통한 추체 성형술의 다양한 인자들에 대한 생체 역학적 효과 분석 (A Biomechanical Study on the Various Factors of Vertebroplasty Using Image Analysis and Finite Element Analysis)

  • 전봉재;권순영;이창섭;탁계래;이권용;이성재
    • 대한의용생체공학회:의공학회지
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    • 제25권3호
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    • pp.171-182
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    • 2004
  • 본 연구에서는 의료 영상과 유한요소 해석을 이용하여 골절된 척추체의 치료를 위해 골 시멘트를 주입하는 추체 성형술(vertebroplasty)에 영향을 미치는 여러 인자들에 대해 생체 역학적으로 분석하여 평가하고자 하였다. 의료 영상을 통해 구현된 모델들은 분석하고자 하는 인자에 대하여 크게 단분절과 다분절 유한요소 모델의 2 가지 형태로 구분하였다. 단분절 유한요소 모델을 통해 골다공증의 정도, 주입된 골 시멘트의 양, 골 시멘트의 주입량 및 환자에게 주입된 골 시멘트 양의 적절성을 평가하였으며, 골 시멘트의 주입이 척추체의 구조적 안정성에 미치는 효과를 분석하기 위하여 척추체 상종판에 수직 압축하중을 가하여 이때의 최대 수진 변위량을 분석하였다. 또한 단분절 척추체의 강성도(stiffness) 값을 산출한 뒤, 정상 상태의 척추체의 강성도 값으로 정규화 하였다. 다분절 유한요소 모델의 경우, 압박 골절 상태를 적용하여 척추 만곡의 변화가 인체에 미치는 영향을 분석하기 위하여 골절의 정도를 3 가지로 구현하였으며, 모델의 최상부에 압축 하중을 가한 후의 척추 만곡의 변화 정도를 분석하였다. 추체 성형술에 대한 다양한 인자들에 대한 분석 결과, 추체 성형술을 통해 환자의 골밀도가 상대적으로 높은 경우(BMD 50mg/$m\ell$이상)와 환자의 척추체 망상골 부피의 약 15%에 해당하는 골 시멘트 주입 시 가장 큰 척추체의 구조적 안정성의 증가 효과를 가져올 것으로 예측되었다. 또한 척추 골절이 미치는 영향에 대한 분석 결과, -2.8$^{\circ}$의 정상적인 후만곡을 가지는 T12∼L2 운동 분절이 골절의 모델링 후 약 9∼17$^{\circ}$의 큰 전만곡을 가지게 되었으며 이러한 척추 만곡의 변화는 동일한 하중 하에서 급격한 척추 만곡의 변화를 야기하는 것으로 나타났다. 또한 골절의 정도가 심할수록 척추 변형은 더욱 크게 증가하는 것으로 나타났다. 이러한 연구 결과들로부터, 전반적으로 추체 성형술은 골 시멘트의 주입량 또는 골밀도에 상관없이 약화된 척추체의 자체의 구조적 안정성의 증가 효과를 가져왔으며 골절로 인해 추체의 높이가 손상되었을 경우 이를 회복하는 것이 중요한 인자의 하나임을 나타내는 결과로 사료되어진다.

수종의 흡수성 차단막의 생체 분해도와 조직학적 반응 (Resorbability and histological reaction of bioabsorbable membranes)

  • 석헌주;권석훈;김창성;최성호;전동원;김종관
    • Journal of Periodontal and Implant Science
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    • 제32권4호
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    • pp.781-800
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    • 2002
  • The major goals of periodontal therapy are the functional regeneration of periodontal supporting structures already destructed by periodontal disease. There have been many efforts to develop materials and therapeutic methods to promote periodontal wound healing. With the development of non-resorbable membrane, GTR has proved to be the representive technique of periodontal regeneration. However, due to various clinical problems of non-resorbable membrane, resorbable membrane was developed and it showed to be clinically effective. The newly developed Para-Dioxanone membrane has a characteristic of non-woven fabric structures which is different from the generally used membranes with structure of mesh form. In addition, Chitosan membrane has been developed to apply its adventage maximally in GTR. Although a number of different types of membranes had been clinically used, researches on absorption rate of membranes were inadequate and limited to subjective opinions. However, since long term period of resorption and space maintenance are required in implant or ridge augmentation, accurate verification of resorption rate is clinically important. In this study, we had implanted Resolut(R), Biomesh(R), Para-Dioxanone membrane and Chitosan membrane (Size : 4mm ${\times}$ 4mm) on dorsal side of Sprague Dawley rat, and sacrified them after 4 weeks, 8 weeks, 12 weeks respectively. Histologic observation was carried out, and the following results were obtained by calculating the objective resorption rate. 1. In case of Resolut(R), external resorption took place initially, followed by internal resorption. Surface area are 5.76${\pm}$2.37$mm^2$, 4.90${\pm}$l.06$mm^2$, 4.90${\pm}$0.98$mm^2$ at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 31.6${\pm}$4.5%, 52.8${\pm}$9.4%, 56.4${\pm}$5.1% respectively. 2. Biomesh(R) showed a pattern of folding, relatively slow resorption rate with small size of membrane. Surface area are 3.62${\pm}$0.82$mm^2$, 3.63${\pm}$0.76$mm^2$, 4.07${\pm}$1.14$mm^2$ at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 26.1${\pm}$5.8%, 30.9${\pm}$3.4%, 29.2${\pm}$3.6%, respectively. 3. Para-Dioxanone membrane was surrounded by fibrous conncetive tissue externally, and resorption took place internally and externally. Surface area are 5.96${\pm}$1.05$mm^2$, 4.77${\pm}$10.76$mm^2$, 3.86${\pm}$0.84$mm^2$ at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 30.7${\pm}$5.1%, 53.3${\pm}$4.4%, 69.5${\pm}$3.1%, respectively. 4. Each fiber of Chitosan membrane was surrounded by connective tissue and showed external resorption pattern. It showed little invasion of inflammatory cells and excellent biocompatability. The resorption rate was relatively slow. Surface area are 6.01${\pm}$2.01$mm^2$, 5.49${\pm}$1.3$mm^2$, 5.06${\pm}$1.38$mm^2$ at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 31.3${\pm}$3.6%, 38.4${\pm}$3.80%, 39.7${\pm}$5.6%, respectively. Consequently, Para-Dioxanone membrane and Chitosan membrane are found to be clinically effective for their excellent tissue reaction and biocompatibility. Futhermore, the advantage of bone regenerating ability as well as the relatively long resorption period of Chitosan membrane, it might be widely used in implant or ridge augmentation.

꿀벌 꽃가루 열수 추출물의 수지상 세포 활성화 및 Th1 반응에 미치는 효과 (Effect of bee pollen extract on activation of dendritic cells and induction of Th1 immune response)

  • 조은지;김이은;변의홍
    • 한국식품과학회지
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    • 제50권4호
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    • pp.444-450
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    • 2018
  • 본 연구는 꿀벌 꽃가루 추출물(BPW)의 면역 활성에 관하여 알아보기 위하여, 선천면역계의 대표적인 수지상세포와 후천면역계의 대표적인 비장세포에 BPW를 처리 하여 면역세포의 활성능을 관찰하였다. 수지상 세포에 BPW를 처리하여 세포 생존율, 산화질소(II)와 사이토카인($TNF-{\alpha}$, IL-6과 $IL-1{\beta}$) 분비능과 세포 표면분자를 관찰 하였다. 세포 생존율은 수지상 세포에 BPW를 처리하였을 때, 세포 독성을 일으키지 않았으며 주요 면역 활성 인자인 산화질소(II) 분비능을 관찰한 결과, 농도 의존적으로 증가하는 것을 확인하였다. 또한 사이토카인의 분비능을 관찰한 결과, $TNF-{\alpha}$, IL-6과 $IL-1{\beta}$의 함량이 농도 의존적으로 증가하는 것으로 관찰되었다. 또한 활성화된 면역세포의 세포 표면에서 발현되는 CD80과 CD86의 발현과 항원제시에 밀접한 관련이 있는 MHC class I, II의 발현이 유의적으로 증가하는 것으로 관찰되었다. 또한 후천면역에서 중요한 역할을 수행하는 면역 T 세포가 다량 분포하는 지라 세포를 분리하여 BPW를 처리 하였을 때 Th1 세포가 분비하는 사이토카인의 함량이 농도 의존적으로 증가되는 것으로 나타났다. 이러한 결과로 미루어 볼 때 BPW는 선천면역뿐만 아니라 후천면역에 관여하는 다양한 면역세포의 활성화에 직간접적으로 관여하는 것으로 사료된다.

류마티스 관절염 환자의 말초혈액 단핵세포에서 Phosphoinositide 3-Kinase (PI3K)/Akt와 Nuclear Factor KappaB (NF-κB) 신호전달을 통한 IL-17 생성조절 (Regulation of Interleukin-17 Production in Patients with Rheumatoid Arthritis by Phosphoinositide 3-kinase (PI3K)/Akt and Nuclear Factor KappaB (NF-κB) Dependent Signal Transduction Pathway)

  • 김경운;조미라;이상헌;민소연;박미경;박성환;주대명;김호연
    • IMMUNE NETWORK
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    • 제3권4호
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    • pp.310-319
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    • 2003
  • Inflammatory mediators has been recognized as an important role in the pathogenesis of rheumatoid arthritis (RA). IL-17 is increasingly recognized as an important regulator of immune and inflammatory responses, including induction of proinflammatory cytokines and osteoclastic bone resorption. Evidence of the expression and proinflammatory activity of IL-17 has been demonstrated in RA synovium and in animal models of RA. However, the signaling pathways that regulate IL-17 production remain unknown. In the present study, we investigated the role of the phosphatidylinositol 3 kinase (PI3K)-Akt pathway in the regulation of IL-17 production in RA. PBMC were separated from RA (n=24) patients, and stimulated with various agents (anti CD3, anti CD28, PHA, ConA, IL-15). IL-17 levels were determined by sandwich ELISA and RT-PCR. The production of IL-17 was significantly increased in cells treated with anti-CD3 antibody, PHA, IL-15 or MCP-1 (P<0.05). ConA also strongly induced IL-17 production (P<0.001), whereas TNF-alpha, IL-1beta, IL-18 or TGF-beta did not. IL-17 was detected in the PBMC of patients with osteoarthritis (OA) but their expression levels were much lower than those of RA PBMC. Anti-CD3 antibody activated the PI3K-Akt pathway and activation of the PI3K-Akt pathway resulted in a pronounced augmentation of nuclear factor kappaB ($NF-{\kappa}B$). IL-17 production by activated PBMC in RA is completely or partially blocked in the presence of $NF-{\kappa}B$ inhibitor PDTC and PI3K-Akt inhibitor, wortmannin and LY294002, respectively. Whereas the inhibition of AP-1 and extracellular signal-regulated kinase (ERK)1/2 did not affect IL-17 production. These results provide new insight into that PI3K/Akt and $NF-{\kappa}B$ dependent signal transduction pathway could be involved in the overproduction of key inflammatory cytokine, IL-17 in rheumatoid arthritis.

근단변위판막술과 함께 유리치은이식술을 사용하여 임플란트 주변 각화치은을 증대시킨 2건의 증례 보고 (Free gingival graft in combination with apically positioned flap for establishment of keratinized gingiva around the implants: Report of two cases)

  • 백원선;차재국;이재홍;이중석;정의원
    • 대한치과의사협회지
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    • 제54권4호
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    • pp.296-305
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    • 2016
  • Narrow zone of attached gingiva and shallow vestibule around the implants might contribute to difficulty of cleasing, periimplant mucositis caused by incomplete cleansing and further peri-implantitis. The aim of this case report is to present modification of soft tissue biotype around the implants by free gingival grafts according to timing of surgical intervention and shape of free gingiva. A 44 year-old male patient had a missing area on lower right second molar area with 1 to 2 mm of narrow attached gingiva zone and wanted to be treated by implant placement. In radiographic analysis, there was enough alveolar bone to install an implant, free gingiva from hard palate was grafted following implant placement using double layer flap. The width of attached gingival was increased to 4 to 5mm and well maintained during 5 months of follow up. A 69 year-old female patient also had a missing area on lower right first and second molar area with 1 to 2 mm narrow attached gingiva. Since she had systematically angina pectoris and dental phobia, minimal invasive free gingival graft after implants placement was planned. After 2 months of implant surgery, free gingival graft surgery was performed with healing abutments connection. The grafted gingiva was composed of two strip shaped free gingiva, and they were immobilized by periodontal pack. The width of attached gingival was increased to 4 to 5mm and well maintained during 10 months of follow up. With prosthesis delivery, the patients recovered ideal periodontal environment around implants and masticatory function. In conclusion, periodontal health and masticatory function could be achieved through implant placement and free gingival graft.

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상악동 거상술 시 Waters' Projection의 유용성에 대한 임상적 연구 (Clinical Availability of Waters' Projection in Sinus Elevation Procedures)

  • 서미현;김성민;하지영;이정근;명훈;이종호
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제35권2호
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    • pp.88-93
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    • 2013
  • Purpose: Maxillary sinus elevation has been widely used to enable insertion of endosseous implants in severely resorbed maxilla. Maxillary sinusitis after this procedure was considered to be the major drawback, therefore, preoperative evaluation of paranasal sinus is considered to be important. In order to evaluate the condition of the sinus, we used Waters' projection. In this study, asymptomatic patients were evaluated by Waters' view, and compared to timing to assess the sinus cavity. Methods: The retrospective study was based on 14 patients who were performed sinus elevation surgery in Seoul National University Dental Hospital. These patients did not show any signs of maxillary sinusitis. These patients were taken Waters' view at preoperative, postoperative 1 day, 3 months, 6 months. In Waters' view, presence of air fluid level, radiopacity of sinus wall, or radiopacity of entire maxillary sinus were evaluated. The density, and sinus dimension changes were assessed using Adobe Photoshop CS5$^{(R)}$ (Adobe Systems Inc., San Jose, CA, USA). Results: Findings of Waters views in patients with clear maxillary sinus at preoperative time were followed by elevated sinus floor with transplanted bone, mucosal swelling, and air fluid level. At postoperative 3 months, and 6 months, the radiographic findings were similar to preoperative state. By contrast, patients with preoperative mucosal swelling, or haziness in sinus cavity showed radiopacity entire sinus in Waters' view. In cases of the patients who were treated with simultaneous treatment to mucosal swelling, good status of sinus cavity were found. Conclusion: Although Waters' projections provide the limited information, and is less sensitive method compared with computed tomography, it is simple, easy, and economical method to assess of maxillary sinus. We suggest using Waters' view as radiographic routine tool for evaluation of sinus condition, especially in the sinus elevation surgery.

구강외과 수술용 스텐트 기반 영상유도 수술 시스템의 개발 (Development and application of stent-based image guided navigation system for oral and maxillofacial surgery)

  • 이우진;김대승;이원진;이삼선;최순철;허민석;허경회;김명진;이지호
    • Imaging Science in Dentistry
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    • 제39권3호
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    • pp.149-156
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    • 2009
  • Purpose : The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. Materials and Methods : We devised a patient-specific stent for patient-to-image registration and navigation. Three-dimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. Results : The accuracy over 8 anatomical landmarks showed an overall mean of $0.56{\pm}0.16\;mm$. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. Conclusion : The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.

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골다공증환자에서 임프란트의 생존율에 대한 후향적 연구 (A retrospective study of survival rate of dental implants placed in osteoporosis patients)

  • 이근;엄유정;정의원;김창성;최성호;조규성;채중규
    • Journal of Periodontal and Implant Science
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    • 제39권4호
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    • pp.413-423
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    • 2009
  • Purpose: The presented study aims to evaluate the effects of osteoporosis on dental implants by analyzing a 12-year cumulative survival rate of implants placed in patients with osteoporosis. Methods: 37 patients with history of osteoporosis were selected from a pool of dental implant patients treated at the Department of Periodontology in Yonsei University Hospital between 1993 and 2007. The cumulative survival rate is quantified using data collected from 164 placed implants in the selected 37 patients. Results: 3 out of the 164 implants failed and the cumulative survival rate was observed at 95.1%. The survival rates of the implants according to patients' age were 97.41% (<60) and 100% ($60\leq$). The lower survival rate was directly proportional to younger age, and this relationship is statistically significant (P<0.05). The survival rates of implants according to diagnostic criteria were 95.45% (osteopenia) and 98.59% (osteoporosis; 2 out of 142 implants placed in osteoporosis patients failed). The difference in the two survival rates is statistically significant (P<0.05). The survival rates according to the region of implants do not have statistically significant difference. The survival rates according to the different length and diameter of the implants do not have statistically significant difference. The survival rates of implants accompanied and not accompanied by bone augmentation were 92.11% and 100%, respectively. The difference in the two survival rates is statistically significant (P<0.05). The survival rates of implants placed in patients with and without history of medication for osteoporosis treatment are 96.67% and 99.04%, respectively. The difference in the two survival rates is statistically significant (P<0.05). Conclusions: A high cumulative survival rate of dental implants, similar to one found in non-osteoporosis patients, is observed in osteoporosis patients, indicating the possibility that placing dental implants on patients with osteoporosis can be considered with high treatment predictability.

사후전산화단층촬영의 법의병리학 분야 활용을 위한 조건부 적대적 생성 신경망을 이용한 CT 영상의 해상도 개선: 팬텀 연구 (Enhancing CT Image Quality Using Conditional Generative Adversarial Networks for Applying Post-mortem Computed Tomography in Forensic Pathology: A Phantom Study)

  • 윤예빈;허진행;김예지;조혜진;윤용수
    • 대한방사선기술학회지:방사선기술과학
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    • 제46권4호
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    • pp.315-323
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    • 2023
  • Post-mortem computed tomography (PMCT) is commonly employed in the field of forensic pathology. PMCT was mainly performed using a whole-body scan with a wide field of view (FOV), which lead to a decrease in spatial resolution due to the increased pixel size. This study aims to evaluate the potential for developing a super-resolution model based on conditional generative adversarial networks (CGAN) to enhance the image quality of CT. 1761 low-resolution images were obtained using a whole-body scan with a wide FOV of the head phantom, and 341 high-resolution images were obtained using the appropriate FOV for the head phantom. Of the 150 paired images in the total dataset, which were divided into training set (96 paired images) and validation set (54 paired images). Data augmentation was perform to improve the effectiveness of training by implementing rotations and flips. To evaluate the performance of the proposed model, we used the Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index Measure (SSIM) and Deep Image Structure and Texture Similarity (DISTS). Obtained the PSNR, SSIM, and DISTS values of the entire image and the Medial orbital wall, the zygomatic arch, and the temporal bone, where fractures often occur during head trauma. The proposed method demonstrated improvements in values of PSNR by 13.14%, SSIM by 13.10% and DISTS by 45.45% when compared to low-resolution images. The image quality of the three areas where fractures commonly occur during head trauma has also improved compared to low-resolution images.

원위 대퇴골 인대 부착부의 강도 비교 - 사체의 대퇴골에 행한 실험적 연구 - (Comparative Biomechanical Study of Stiffness on Ligamentous Attached Sites of Distal Femur - Experimental Laboratory Study on Cadaver Femora -)

  • 곽지훈;심재앙;양상훈;김동희;이범구
    • 대한정형외과스포츠의학회지
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    • 제8권1호
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    • pp.26-32
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    • 2009
  • 목적: 사체의 원위 대퇴골을 이용하여 각각의 인대가 붙는 부위의 골 강도를 비교함으로서 재건술이나 인대 보강 술식시 고정에 참고할 수 있는 지표로 삼고자 하였다. 대상 및 방법: 10구의 사체, 15개의 원위 대퇴골을 이용하여 골밀도 측정 후 5 개의 원위 대퇴골에 5.0 mm 유관나사를 각각의 인대 부착부, 즉 전방 십자 인대, 후방 십자 인대, 내측 측부 인대, 외측 측부 인대의 부착부에 삽입하고 최대 인장 강도를 측정하였고(실험 1), 10개의 원위 대퇴골을 이용하여 돼지의 신전건을 각각의 인대 부착부, 즉 전방 십자 인대, 후방 십자 인대, 내측 측부 인대, 외측 측부 인대의 부착부에 삽입하고 흡수성 간섭 나사로 고정 후 최대 인장 강도를 측정하였다(실험 2). 결과: 골밀도 검사는 실험 1이 $1.205{\pm}0.137\;g/cm^2$, 실험 2가 평균 $1.236{\pm}0.089\;g/cm^2$로 양 군간의 차이는 없었으며, 실험 1의 최대 인장 강도는 전방 십자 인대 군이 평균 $519.1{\pm}111.7$ N, 후방 십자 인대 군이 평균 $638.9{\pm}144.4$ N, 내측 측부 인대군이 평균 $169.7{\pm}56.0$ N, 외측 측부 인대 군이 평균 $225.6{\pm}61.5$ N으로 후방 십자 인대 군, 전방 십자 인대 군, 외측 측부 인대 군, 내측 측부 인대 군 순이었고, 실험 2의 최대 인장 강도는 전방 십자 인대 군이 평균 $310.6{\pm}31.0$ N, 후방 십자 인대 군이 평균 $379.9{\pm}47.4$ N, 내측 측부 인대 군이 평균 $104.01{\pm}14.4$ N, 외측 측부 인대 군이 평균 $131.5{\pm}21.9$ N으로 실험 1과 동일한 순이었다. 양 실험 모두 전방 십자 인대 군과 후방 십자 인대 군 간, 내측 측부 인대 군과 외측 측부 인대 군 간 강도의 유의한 차이는 없었으며, 내측 측부 인대 군과 외측 측부 인대 군이 전방 십자 인대 군과 후방 십자 인대 군에 비해 강도가 유의하게 낮았다. 결론: 대퇴 터널과 동일한 두께, 최소 길이의 간섭 나사못 고정은 불충분한 고정력을 제공하므로 전방 십자인대, 후방 십자인대, 내, 외측 측부 인대 재건술시 부가적인 술식이 필요하며 특히 외측 측부 인대와 내측 측부 인대 부착 부위의 강도는 후방십자 인대와 전방 십자 인대 부착 부위의 강도에 비해 현저히 약하므로 외측 또는 내측 측부 인대 재건술 및 보강술시 고정 방법에 대해 주의를 요하며 이를 보강할 수 있는 술식이 필요로 하다고 사료된다.

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