• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권4호
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• pp.261-270
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• 2004

The purpose of this experiment was to examine the histological changes and the pattern of expression of type I, II collagen in the elongated area by distraction osteogenesis in the rabbit mandible. Sixteen rabbits weighing 2.5kg-3kg were used for this experiment. Experimental group was distracted at the rate of 0.7mm, twice/day for 7days, and control group was only osteotomized. After 5 days latency, osteotomic site is distracted for 7days. Consolidation period is 28days. The animal was sacrificed at the 3rd, 7th, 14th, 28th day after the operation. The distracted bone was examined by histological analysis and RT-PCR analysis. The results were summarized as follows: 1. Experimental group was observed that the gaps between the distracted bone edges were occupied by new bone. 2. Expression of Type I collagen were detected throughout the experiment in both groups and Expression of Type I collagen were markedly increased during distraction and consolidation period in experimental group than control group. 3. Expression of Type II collagen were detected throughout the experiment in both groups and expression of Type II collagen were maintained at high level during distraction and consolidation period in experimental group than control group. From these results, in contrast to type II collagen, type I collagen seemed to be more expressed by mechanical stimuli during distraction and consolidation period. The predominent mechanism of new bone formation in the distraction gap was intramembranous bone formation, but some of the regenerated bone was formed by endochondral ossification.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권6호
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• pp.498-510
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• 2001

Distraction osteogenesis refers to the biological process responsible for new bone formation between bone segments by gradual distraction after osteotomy. For the past several years, various inconveniences including a protracted consolidation period that requires patients to wear a distractor frame longer, as well as higher medical costs, have not been remedied by improvements in osteotomy, distraction rate and monitoring system. Furthermore, side effects such as pin tract infections and soft tissue swelling may arise due to the long treatment period. These drawbacks form the rationale of this study which purports to seek a method by which the consolidation period can be reduced. This paper examines how platelet-rich plasma(PRP), known to facilitate osteogenesis, influences bone formation when applied in distracted area. Ten mongrel dogs, which were made to wear external distractor frames after osteotomy in both sides of the mandible, were used as subjects. After a 7day period of latency, distraction was carried out at a rate of 1mm/day for 14 consecutive days. After the onset of distraction, 2ml of PRP and a mixture of calcium gluconate and thrombine were injected into the center of the distracted callus on the left side of the mandible. The left was injected with PRP while the right side was set as the control site without PRP treatment. Execution at the onset of distraction and in 2 weeks, 4 weeks and 8 weeks after the consolidation period, clinical and radiographic tests, bone mineral density examination, histological examination and histomorphometric analysis were conducted to compare both sides. The results are summarized as follows: 1. Based on the clinical examination at two weeks, more remarkable cortical bone formation was found on the buccal and lingual side of the distracted area in the PRP treatment site than in the control site. No visual difference was found between the PRP treatment site and the control site at four eight weeks. 2. Based on the radiological examination, a distinct increase in the radiopaque appearance of the PRP treatment site was revealed at two weeks, but this increase appeared to slow down at four and eight weeks. 3. Examination of bone mineral density revealed a significant difference at two weeks with the PRP treatment site yielding density two times higher than the control site. This difference lessened after four weeks, and disappeared at eight weeks. 4. The histomorphometric examination revealed that about 20% more bony trabeculae area(20%, higher) was formed in the PRP treatment site than in the control site. In conclusion, it can be said that PRPs effect on stimulating bone formation in the PRP treatment site manifest as early as two weeks. Trabeculae formation likewise increased throughout the whole period. If this result can be applied to humans, the consolidation period can be reduced by injecting PRP into the distracted area.

• 한국임상수의학회지
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• 제20권3호
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• pp.351-356
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• 2003

The aim of this experiment was to study the calcium sulfate on early bone consolidation in distraction osteogenesis in the canine mandible. Twelve dogs were used and divided into control group (group A, 4 heads), sodium hyaluronate injection group (group B, 4 heads), mixture of calcium sulfate and sodium hyaluronate injection group (group C, 4 heads). Each group were subdivided into 3 weeks testing group (totally 6 heads) and 5 weeks testing group (totally 6 heads). Mandibular distraction was started at the 5th day after the mandibular osteotomy and continued for 10 days by 1 mm a day. After the distraction on the 10th day of mandibular distraction, 0.5 m1 saline in group A, 0.5 m1 sodium hyaluronate in group B, and 0.5 ml mixture of calcium sulfate and sodium hyaluronate in group C were each injected in mandibular distraction lesion. And X-ray examination, bone mineral density, and histopathological findings were examined. The radiological findings were the most radiopaque in group C, and the most radiolucent in group A in both 3 and 5 week testing group. The level of bone mineral density was also the highest in group C, and the lowest in group C in both 3 and 5 week testing group. The histopathological findings of new bone formation were the most remarkable in group C in both 3 and 5 week testing group. New bone formation of group A was not present in both 3 and 5 week testing group. In conclusion, calcium sulfate is a kind of material that can stimulate early bone formation and can shorten the duration of bone consolidation. And it can be effective in clinical usage.

• 한국임상수의학회지
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• 제19권2호
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• pp.165-173
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• 2002

The purpose of this study was to evaluate the effect of chitosan-calcium sulfate mixture on early bony consolidation in osteodistracted dogs. The experimental group was divided into 3 groups: saline group(Control), chitosan group(Group CH) and chitosan-calcium sulfate mixture group(Group CH+CS). Four dogs were allocated to each group and classified into B week observation subgroups and 5 week observation subgroups, respectively. Two dogs were allocated to each subgroup. The lateral surface of the left mandibular body was exposed in the subperiosteal plane and vertical osteotomy was carried out on the mandibular body. An external distraction device was applied to the mandibular body. Mandibular distraction was started 5 days after the osteotomy at a rate of 1 m per day for a total of 10 w distraction for 10 days. After completion of distraction, chitosan, chitosan-calcium sulfate and saline were injected into the distracted zone of the group CH, group CH+CS and control. The external device was left in place for 3 or 5 weeks to allow for bony consolidation. Serial radiographs were carried out every week. Two dogs of each group, six dogs in total, were sacrificed at 3 weeks, and the other six dogs at 5 week after distraction. Bone specimens of the distracted mandibles were taken for histologic examination. New bone was not noted in the distracted zone of 3 week observation subgroups in the control and group CH. However, new bone was developed in the group CH+CS with a narrow fibrous interzone in the area of the distracted zone. While osteogenesis was mild in the margin of the distracted Bone of 5 week observation subgroup in the control, new bone was noted much in the group CH and group CH+CS. However, osteogenesis was noted more significantly in the group CH+CS than that of group CH. In conclusion, chitosan-calcium sulfate mixture was more effective on early bony consolidation in distraction osteogenesis

• 대한치과교정학회지
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• 제34권2호
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• pp.131-142
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• 2004

본 연구는 골절단을 이용한 치아-치조골 분절의 급속 치아이동 후 치수, 치주인대 및 치조골의 변화를 유성견에서 평가하고자 하였다. 하악 제4소구치의 근심, 원심, 치근단 부위에서 피질골을 절단하여 치아-골 분절을 형성하고 하악 제3소구치를 발거하면서 협측, 설측 부위의 피질골을 삭제하였다. 1주 휴지기 부여에 따라 휴지기군과 비휴지기군으로 나누어 치아의존형 견인장치로 6일 동안 견인하고 강화기를 거친 후 0주, 1주, 2주, 4주, 6주, 8주에 희생시켜 치수 치주인대 및 치조골의 조직 변화를 임상적, 방사선적, 조직학적 및 면역화학적으로 평가하여 다음과 같은 결과를 얻었다. 1 치아이동 양과 강화기 동안의 조직 치유 양상에서 휴지기 유무에 따른 차이는 없었다. 2. 견인측에서 골형성은 강화기 8주까지 계속되었는데 강화기 1-2주에 가장 활발하였으며 6-8주간의 변화는 적었다. 3. 비휴지기군의 강화기 1주에서 치조골 흡수 및 파골세포 출현, 염증세포 침윤이 가장 많았으며, 특징적으로 파상아세포가 압박측의 치주인대와 치수 내에 나타났다. 4. $TGF-\beta$는 치조골의 골기질 및 골모세포, 파골세포, 치수 내 파상아세포에서 강양성 발현을 보인 반면 치수, 백악모세포, 무세포성 백악질에서 경미한 양성 발현을 나타내는 부위 특이성이 있었다. 5. $TGF-\beta$는 견인측 치주인대의 치조골에 인접한 혈관 및 치주인대세포, 골모세포에서 강화기 초기 1-2주에 주로 발현되었으며 6주 이후에는 발현이 크게 감소하였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권2호
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• pp.123-131
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• 2007

Introduction: Distraction osteogenesis is widely used as for bone lengthening in patients with maxillofacial deformity and alveolar bone atrophy. One of the major problems in distraction osteogenesis is long consolidation period for 2-3 months, in which the devices have to be fixed on the bone to prevent relapse. It results in scar formation on the face, disturbance of mastication and speech. This study was performed to evaluate the stimulating effect of pulsed electromagnetic field on the early bone consolidation in distraction osteogenesis. Materials and methods: Total 10 rabbit were used (5 for control group, 5 for experimental group). A vertical osteotomy in the mandibular body was performed and the distraction device was fixed. After 5 days distraction was done 1mm per a day for 7 days. A pulsed electromagnetic field (38 Gauss, 60 Hz) was applied for 8 hours per day and it continued for 5 days immediately after distraction in the experimental group. Both groups were sacrificed after 2 weeks. Histological specimens with H&E and Masson Trichrome staining were made and histomorphometrically analysed with image analyser. Results: The device for distraction osteogenesis was displaced in one animal for each group, therefore, only four animals in both groups were evaluated. In both groups, a new bone formation was observed in the distracted area after 2 weeks. The bone formation was enhanced in the experimental groups ($31.76{\pm}8.68%$) compared with control group ($9.94{\pm}3.23%$), its difference was statistically significant (p<0.001). Conclusion: This study suggests that electrical stimulation with electromagnectic field may be effective in the early bone formation after distraction osteogenesis. Further studies with large number of animals are needed before clinical application.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권2호
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• pp.120-127
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• 2011

Purpose: This study was designed to examine whether the use of neuromuscular electrical stimulation (NMES) after mandibular distraction osteogenesis accelerated bone formation and consolidation. Methods: Eight adult dogs underwent mandibular left body osteotomy. After a 3 day latency period, a distraction rod device was activated at a rate of 1.0 mm once per day for 10 days. After the completion of mandibular lengthening, NMES group was treated twice daily with 2 hours of NMES for 14, and 28 days, while non-NMES group did not receive NMES. The distracted segment was evaluated radiolgraphically histologically and than immunohistochemically for osteopontin (OPN) to evaluate new bone formation and consolidation. Results: Radiography, did not demonstrate significantly different images between the group and the NMES group. Histological examination however, showed that the new bone formation 14 and 28 days after distraction was better in the NMES group when compared to non-NMES group. Immunohistochemical analysis demonstrated that the staining intensity of OPN increased more in the NMES group than in non-NMES group during early consolidation. Conclusion: The results of this study demonstrated that the use of NMES can promote bone formation and consolidation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권5호
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• pp.368-379
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• 2004

Distraction osteogenesis is a biologic process of new bone formation between the surfaces of bone segments that are gradually separated by incremental traction. Distraction osteogenesis is clinically applied as a new treatment modality of mandibular hypoplasia or bony defect area in maxillofacial area by many studies of distraction devices and method. But disadvantage of distraction osteogenesis shows unfavorably long consolidation period and relapse tendency. Therefore. this experiment was designed to investigate the effectiveness of combined application of distraction and compression force for improving of bone quality and shortening of treatment period during distraction osteogenesis. Twenty-one Sprague-Dawley rats with $300{\sim}350gm$ were used. These were divided into two group as distraction group and combination group was applied with compression force in the consolidation period. The rat were sacrificed for gross finding, radiographic and histologic findings. at 2, 4 weeks after distraction. The result were follow : 1. On radiographic finding, all experimental groups appeared more radiopacity than control groups both at 2, 4 weeks after distraction. 2. On histologic finding, trabeculae of bone and mature lamellar bone were showed increasingly in experimental group. Ossification occured rapidly. From this study, we may suggest that compression force application in consolidation period during distraction osteogenesis can be useful method improve bone quality and to shorten the treatment period. But more experimental and clinical studis are necessitated on effects of compression force application during distraction osteogenesis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제28권2호
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• pp.103-113
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• 2002

Distraction osteogenesis is a biologic process of new bone formation between the surfaces of bone segments that are gradually separated by incremental traction. Distraction osteogenesis is clinically applied as a new treatment modality of mandibular hypoplasia or bony defect area in maxillofacial area by many studies of distraction devices and method. But, disadvantages of distraction osteogenesis shows unfavorably long consolidation period and relapse tendency. Therefore, this experiment was designed to investigate the effectiveness of combined application of distraction and compression force for improving of bone quality and shortening of treatment period during distraction osteogenesis. Twenty-five Sprague-Dawley rats with $300{\sim}350gm$ were used. These were divided into two group as distraction group and combination group. The distraction group was added with conventional method during distraction osteogenesis, but the combination group was applied with compression force in the consolidation period. The rats were sacrificed for gross finding, radiographic and histologic findings at 3, 6 weeks after distraction. The results were as follow: 1. On radiographic finding, all combination of distraction and compression force group appeared more radiopacity than distraction group both at 3 weeks and 6 weeks after distraction group. 2. On histologic finding, the formation of mature lamellar bone were showed increasingly in combined group at 6weeks after distraction group. From this study, we may suggest that compression force application in consolidation period during distraction osteogenesis can be useful method to improve bone quality and to shorten the treatment period. But more experimental and clinical studies is necessitated on ideal application timing and method of compression force application during distraction osteogenesis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권4호
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• pp.278-286
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• 2011

Introduction: This study examined the predictability of new bone formation in the pneumatized maxillary sinus using only fibrin-rich blocks with concentrated growth factors as an alternative to bone grafts. Materials and Methods: Maxillary sinus augmentation was performed in thirty-three patients with a deficient alveolar bone height (mean 3.9 mm). All patients were treated consecutively with sinus membrane elevation via the lateral window approach and panoramic radiograms and cone-beam computed tomograms were taken to evaluate the remaining bone height and the new bone formation in the maxillary sinus, before and after surgery. Four biopsy specimens were taken at the time of implant consolidation (after an average of five months healing) and were stained by H & E and Trichrome staining. Results: None of the patients had postoperative complications during implant consolidation. After an average of 5 months since sinus augmentation, newly formed bone was observed in all cases by a radiographic evaluation. In 4 biopsy samples, newly formed bone was observed along the floor of the replaced bony window. The osteoblast lining and well distinguished Osteocytes in the lacunas were observed in the newly formed bone. Of the 74 implants (4 different surfaced implants - resorbable blast media-surfaced (RBM), Hydroxyapatite (HA) coated, acid-etched, sintered porous-surfaced implant) placed, one RBM implant failed. The success rate was 98.6% after a mean of 15 months. Discussion: These results suggest that maxillary sinus augmentation using fibrin rich block with concentrated growth factors is a successful and predictable technique.