• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.6
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• pp.347-353
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• 2023

This case report presents inferior alveolar nerve (IAN) repositioning as a viable approach for implant placement in the mandibular molar region, where challenges of severe alveolar bone width and height deficiencies can exist. Two patients requiring implant placement in the right mandibular molar region underwent nerve transposition and lateralization. In both cases, inadequate alveolar bone height above the IAN precluded the use of short implants. The first patient exhibited an overall low alveolar ridge from the anterior to posterior regions, with a complex relationship with adjacent implant bone level and the mental nerve, complicating vertical augmentation. In the second case, although vertical bone resorption was not severe, the high positioning of the IAN within the alveolar bone due to orthognathic surgery raised concerns regarding adequate height of the implant prosthesis. Therefore, instead of onlay bone grafting, nerve transposition and lateralization were employed for implant placement. In both cases, the follow-up results demonstrated successful osseointegration of all implants and complete recovery of postoperative numbness in the lower lip and mentum area. IAN repositioning is a valuable surgical technique that allows implant placement in severely compromised posterior mandibular regions, promoting patient comfort and successful implant placement without permanent IAN damage.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.33.1-33.7
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• 2019

Background: The concept of the ideal morphology for the alveolar bone form is an important element to reconstruct or restore the in maximizing esthetic profile and functional alveolar bone restoration. The purpose of this preliminary study is to evaluate the normal alveolar bone structure to provide the standard reference and guide template for use in diagnosing for implant placement, determining the correct amount of bone augmentation in actual clinical practice and producing prostheses based on three-dimensional imaging assessment of alveolar bone. Methods: This study was included 11 men and 11 women (average age, 22.6 and 24.5 years, respectively) selected from among 127 patients. The horizontal widths of alveolar bone of maxilla and mandible were measured at the crestal, mid-root, and root apex level on MDCT (multi-detector computed tomography) images reconstructed by medical imaging software. In addition, tooth dimensions of the central incisors, canines, second premolars, and first molars of maxilla and mandible, including the horizontal width of the interdental alveolar bone crest, were also measured and statistically analyzed. Results: The horizontal alveolar bone width of the palatal side of maxilla showed a distinct increment from the alveolar bone crest to the apical region in both anterior and posterior areas. The average widths of the maxillary alveolar ridge were as follows: central incisor, 7.43 mm; canine, 8.91 mm; second premolar, 9.57 mm; and first molar, 12.38 mm. The average widths of the mandibular alveolar ridge were as follows: central incisor, 6.21 mm; canine, 8.55 mm; second premolar, 8.45 mm; and first molar, 10.02 mm. In the buccal side, the alveolar bone width was not increased from the crest to the apical region. The horizontal alveolar bone width of an apical and mandibular border region was thinner than at the mid-root level. Conclusions: The results of the preliminary study are useful as a clinical guideline when determining dental implant diameter and position. And also, these measurements can also be useful during the production of prefabricated membranes and customized alveolar bone scaffolds.

• Journal of Periodontal and Implant Science
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• v.44 no.5
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• pp.216-221
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• 2014

Purpose: This retrospective study compares the amount of bone resorption around implants between an autogenous tooth bone graft (AutoBT) and a synthetic bone graft after a bone-added crestally approached sinus lift with simultaneous implant placements. Methods: In all, 37 patients participated in this study. Seventeen patients were grouped as group I and underwent an AutoBT-added sinus lift using the crestal approach. The remaining 20 patients were grouped as group II and underwent synthetic bone grafting. Both groups received the implant placements simultaneously. Of the 37 participating patients, only 22 patients were included in the final results: Eleven patients of group I and 11 patients of group II. Before the surgery, the distance from the alveolar crest to the sinus floor was measured using panoramic radiography. After the surgery, the distance was measured again from the neck of the implant thread to the most superior border of the added graft materials. Then, the amount of sinus lift was calculated by comparing the two panoramic radiographs. After a year, a panoramic radiograph was taken to calculate the resorption of the bone graft material from the radiograph that was taken after the surgery. The significance of the resorption amount between the two types of graft materials was statistically analyzed. Results: The bone height was increased to an average of 4.89 mm in group I and 6.22 mm in group II. The analysis of panoramic radiographs 1 year after the surgery showed an average bone resorption of 0.76 mm and 0.53 mm, respectively. However, the degree of lifting (P=0.460) and the amount of bone-grafted material resorption (P=0.570) showed no statistically significant difference. Conclusions: Based on this limited study, AutoBT can be considered a good alternative bone graft to a synthetic bone graft in a bone-added sinus lift, when extraction is necessary prior to the surgery.

• Clinics in Shoulder and Elbow
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• v.19 no.4
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• pp.216-222
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• 2016

Background: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. Methods: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. Results: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was $3.09^{\circ}$. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. Conclusions: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.

• Journal of Periodontal and Implant Science
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• v.36 no.3
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• pp.601-611
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• 2006

임프란트 식립을 필요로 하는 환자의 수평적 치조제 결손의 증대를 위해 골유도재생술과 병용한 bioactive glass (BG) $(Biogran^{(R)})$ 이식의 골재생 양상을 각기 다른 치유기간을 부여한 4명의 환자에서 평가하였다. 6, 8, 10, 18개월의 치유기간 후 임프란트 식립부위에서 조직절편을 채득하여 골재생을 조직계측학적으로 평가하였다. 임프란트 식립을 위한 surgical reentry시 모든 이식부위는 임상적으로 명확한 수평적 치조제 폭경의 증가를 관찰할 수 있었다. 하지만 조직학적 분석결과 BG는 불량한 골전도성을 나타내었다. 6, 8개월의 치유기간후, 이식부위에서 신생골이 거의 관찰되지 않았으며(2.5%이하), 이식부와 기존 골의 경계부위에서 BG particle에 대한 신생골 성장과 결합양상 또는 관찰할 수 없었다. 10개월의 치유기간후 기존 골조직으로부터 성장한 신생골의 BG particle과의 직접적인 접촉양상을 일부 관찰할 수 있었다. 이식부는 13.2%의 광물화된 신생골조직을 보였고, 대부분의 BG particle은 결체조직으로 둘러싸여 있었다. 18개월의 치유기간이 부여된 환자의 조직절편에서 신생골은 이식부의 10.7%를 차지하여 비교적 낮은 신생골 형성양을 나타내었고, 이식부에 존재하는 잔존BG particle은 대부분은 결체조직으로, 일부분에서 광물화된 골조직으로 둘러싸여 있었다. 6, 8, 10, 18개월에서 잔존 BG particle양은 전체 이식부 면적에 대해서 각기 22.3%, 26.5%, 30.7%, 18.7%로 나타났다. 본 증례보고는 비록 한정적인 4명의 환자에서의 조직계측학적 평가결과이지만, 수평적 치조제 결손의 증대를 위해 골유도재생술과 병용한 bioactive glass이식은 불량한 골전도성으로 인해 효과적인 골재생을 위한 이식재로서는 적절하지 않을 수 있음을 나타낸다.

• Imaging Science in Dentistry
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• v.46 no.2
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• pp.109-115
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• 2016

Purpose: Sinus elevation procedures have become a routine and reliable way to gain bone volume in the edentulous maxilla for dental implant placement. Presence of bony septations and pathology in the maxillary sinus often cause complications leading to graft or implant failure or both. The aim of this study was to retrospectively evaluate the prevalence of pathology, direction of the septa, and sinus width measured at 2 mm, 5 mm, and 10 mm from the sinus floor in maxillary sinuses using cone-beam computed tomography (CBCT). Materials and Methods: Seventy-two sinuses from 36 random preoperative CBCT scans referred for implant therapy were retrospectively evaluated for the number, prevalence, and direction of bony septations and presence of pathology. Width of the sinus was also measured at 2 mm, 5 mm, and 10 mm from the sinus floor to account for the amount of bone available for implant placement. Results: Maxillary sinus septa were found in 59.7%. Presence of a single septum was noted in 20 sinuses (27.7%), followed by two septa in 17 sinuses. The most common direction of the septum was the transverse direction. Retention pseudocyst and mucosal thickening were the most commonly seen abnormality/pathology. Conclusion: Based on the high prevalence of septa and sinus pathology in this sample, a preoperative CBCT scan might be helpful in minimizing complications during sinus augmentation procedures for dental implant therapy.

• Journal of Dental Rehabilitation and Applied Science
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• v.31 no.2
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• pp.126-133
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• 2015

Periodontal tissue destroyed by inflammation is difficult to achieve regeneration of the tissue and esthetic restorations only by surgical methods. In particular, improvement of esthetics is more difficult if the problem is related to the implant. A 23 year old woman suffered from unesthetic anterior implant prosthesis. According to her dental history, a repeated bone graft and soft tissue graft failed at a local dental clinic. It was needed to resolve the inflammation and to improve the esthetics. A free gingival graft and ridge augmentation accompanied by guided bone regeneration and a vascularized interpositional periosteal connective tissue graft was performed. Instead of implant prosthesis, a conventional fixed bridge was adopted for better esthetic result. The patient was satisfied with the esthetic conventional fixed prosthesis. This case report introduces esthetic rehabilitation of unesthetic implant prosthetics in the maxillary anterior dentition by a combination of surgical and prosthetic approaches.

• The Journal of Korean Academy of Prosthodontics
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• v.27 no.1
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• pp.181-192
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• 1989

Loss of teeth causes the inevitable reduction of residual ridge. Among the various methods solving this problem, hydroxyapatite proved to be useful for correction of ridge defect and irregularity. The purpose of this study is to evaluate the tissue responses of two types Of hydroxyapatites and resin polymer. Calcitite 2040 (Calcitek Inc.), Interpore 200 (Interpore Int.), and HTR polymer (HTR Sciences) were implanted into the jaw of an adult dog. The procedure was designed to obtain the results of 1 week, 2 week, 4 week, and 12 week-intervals. And after 12 weeks from the first operation day, the dog was sacrificed and evaluated histologically by light microscope. The results were as follows : 1. The mucosa was healed after two weeks. 2. After 1 week, there were acute inflammatory cells, but diminished after 2 weeks and were not seen after 12 weeks. 3. The hydroxyapatites implanted in soft tissues were surrounded by fibrous connective tissue. And some foreign body giant cells were found. 4. Calcitite and Interpore particles implanted subperiosteally were surrounded by newly formed bone after 12 months. And direct contact between bone and particles was noted. 5. The HTR particles implanted in soft tissues were encapsulated by fibrous connective tissues. The sample where the particles contacted directly to bone could not obtained by some probable insufficiencies of surgical technique or care of the animal. And the residue of HTR particles was digested by macrophage.

• Journal of Korean Dental Science
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• v.14 no.1
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• pp.1-11
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• 2021

Purpose: The alveolar ridge preservation (ARP) is widely conducted for implant placement. However, experimental results using deproteinized porcine bone mineral (DPBM) have been scarce. This retrospective study evaluated factors affecting the primary stability of implants in an area where ARP was performed using DPBM. Materials and Methods: Thirty-eight patients were divided into two groups based on the primary stability, with torque value of 30 Ncm as borderline. To determine the factors that affect the primary stability of implants, we collected data from patients' medical records including age, sex, reentry time, socket location, remaining bone wall at the time of extraction, and type of collagen membrane, as well as from radiographs and histomorphometric analysis. Result: The results showed statistically significant difference for the remaining extraction socket wall (P=0.014), residual graft (P=0.029), and fibrovascular tissue (P=0.02) between the two groups. There was an insignificant tendency toward the time of reentry surgery (P=0.052) and location (P=0.077). All implants placed in sites using DPBM functioned well up to 3 years. Conclusion: Within the limitations of the present study, extraction socket wall, residual graft, and fibrovascular tissue can affect the primary stability at the time of implant placement on grafted sites using DPBM and collagen membranes. In addition, reentry time and locations can be considered. In future studies, comparative experiments in quantified models will be required to supporting the findings.

• Journal of Korean Dental Science
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• v.17 no.2
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• pp.84-91
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• 2024

Achieving both esthetic and functional implant rehabilitation is crucial for the successful treatment of the anterior maxilla. Adequate peri-implant alveolar bone and soft tissue are essential for optimal rehabilitation of the esthetic area, and there is a direct association between the implant position and prosthetic outcomes. Immediate provisionalization may also be advantageous when combined with augmentation. This case report described the implant placement in a 25-year-old female patient who had lost her right maxillary lateral incisor (#12) due to trauma-induced avulsion. The treatment involved simultaneous grafting and collagenated, deproteinized bovine bone mineral, along with subepithelial connective tissue taken from the right maxillary tuberosity. A polyetheretherketone abutment and non-functional immediate provisionalization were performed by removing both the proximal and occlusal contacts on the composite resin crown. Clinical and radiographic evaluations revealed maintenance of stable ridge contour aspects for six months following surgical treatment. In summary, implant rehabilitation in the esthetic zone can be successful using simultaneous soft and hard tissue grafts. Moreover, soft tissue stabilization post-subepithelial connective tissue grafting can be achieved through early or immediate visualization, along with immediate implant placement.