• 제목/요약/키워드: Bony Change

검색결과 131건 처리시간 0.029초

상악동저 점막 거상술을 이용한 인공치아 임프란트 동시 식립술 후 예후에 관한 임상적 연구 (SUBANTRAL AUGMENTATION WITH AUTOGENOUS BONE GRAFT FOR SIMULTANEOUS IMPLANT INSTALLATION)

  • 김명진;김태영;황경균;유상진;명훈;김수경;김종원;김규식
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제26권6호
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    • pp.644-651
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    • 2000
  • In cases of severe alveolar bony resorption in the edentulous posterior maxillae, implant placement is limited anatomically due to maxillary sinus. If the ridge is atrophic, the various bone grafting methods are required for the ridge augmentation. But the result of the onlay grafting procedure is not always promising. On the posterior maxilla, maxillary sinus mucosa lifting and bone grafting into the sinus floor, subantral augmentation(SA) technique are recommended. Various SA procedures have been developed for implant installation. We perfer to simultaneous block bone graft and implant installation through the residual alveolar ridge into the grafted block bone to fix the grafted bone and to gain the primary stability of the installed fixture. When a sagittal skeletal discrepancy in present due to the severe alveolar bony resorption of the maxilla, the advancement of the maxilla by Le Fort I osteotomy simultaneously with installation of implant fixtures combined with sinus lifting and interpositional bone graft procedure can be indicated. We applied various SA techniques for implant installtion to the 46 edentulous posterior maxillae, and total 154 implants were installed at our department from 1992 to 1999. Various SA techniques were classified in detail and the indications of each techniques were discussed. The changes of residual bony height following SA procedure were studied. The results were as follows. 1. The SA procedure combined with bone graft and simultaneous fixture installation were performed in 41 cases, 126 fixtures were installed and 5 fixtures were removed out of them. Le Fort I osteotomy procedure combined with sinus lifting and interpositional bone graft simultaneous with fixture installation were performed in 5 cases. Total 28 fixtures were installed and 2 fixtures were removed so far. 2. Autogenous block bone graft into sinus floor were performed in 35 cases, autogenous particulated marrow cancellous bone(PMCB) graft in 9 cases, and demineralized human bone powder in 2 cases. The donor site for bone graft were anterior iliac bone in 39 cases, posterior iliac bone in 3 cases and mandibular symphysis in 1 case and mandibular ramus in 1 case. 3. In 9 cases with which SA procedure had been performed with the block bone graft, the change of pre- and postoperative residual bony height were measured using MPR(multiplanar reformatted)-CT. The mean residual bony height was 8.0mm preoperatively, 20.2mm at 6 months following up operation and we gained average 12.2mm alveolar bony height. So, we can recommend this one-stage subantral augmentation and fixture installation technique as a time conserving, safe and useful method for compromised posterior edentulous maxilla.

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성견 하악골 절단 후 기계적 골 견인에 의해 형성된 골 신장부에 대한 시기별 조직학적 변화 (HISTOLOGICAL CHANGES IN THE ELONGATED BONE AFFECTED BY OSTEODISTRACTION OF THE MANDIBLE IN THE DOG)

  • 백선호;안병근;박영주;박희건;박준우;이건주;이용찬;조병욱
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제27권5호
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    • pp.404-416
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    • 2001
  • Purpose : Traditionally, the treatement of choice has been a bone grafting procedure to increase the length of bone in case of actual length discrepancy. But, bone grafting procedure has many disadvantages, for example, graft resorption, donor site morbidity, and so on. So, many trials have been performed to avert the use of autogenous bone graft via introducing new materials or methods. And, one of those trials has been realized by the development of a technique inducing bone lengthening by osteotomy (or corticotomy) and slow gradual distraction of the osteotomized segments. This new technique of bone lengthening dates back to the early 20th century. But, the majority of information concerning the biology of new bone formation during bone lengthening and technical details of the procedure were produced by extensive clinical and experimental studies performed by Ilizarov, a Russian surgeon. According to Ilizarov, with adequate blood supply, preservation of periosteum, rigid fixation of the osteotomized segments, and proper rate and rhythm of distraction, intramembranous bone rapidly develops within the distraction gap in the limb lengthening procedure. In the limb lengthening, many orthopedic surgeons try to observe the biologic and clinical principles recommended by Ilizarov. In the oral and maxillofacial region, however, not a few studies must be performed to apply this surgical technique in the clinical cases. Besides, the mechanism of bone formation in the distraction gap is not clear, yet. The purpose of this experiment was to scrutinize serially the histological changes in the elongated bone affected by osteodistraction of the mandibular body in an adult canine model. In addition, it was performed to confirm the presence of specific region(s) which was important in the bone formation in the gap through the observation of the expression pattern of osteocalcin and osteonectin with the immunohistochemical examination. Materials and Methods : The experimental and control specimens were obtained from seven adult male mongrel dogs weighing over 20kg. The distractors were custom-made linear extraoral devices and bicortical fixation screws were 2.3mm in diameter, 50mm in total length, 15mm in screw length. The distractors were devised to produce a linear gap of 0.75mm between two bony segments every $360^{\circ}$ turn of the rotation rod of the device. The mandibular body of the right side of each animal was corticotomized perpendicular to the occlusal plane and then two bony segments were separated completely by careful manipulation of the segments with bone forceps. The left side of each animal was left intact. This side was served as control. At sixth day after osteotomy and fixation of the segments were performed, distraction of the segments was commenced with a rate of 1.1mm/day and a rhythm of two/day for ensuing 7 days. The animals were euthanized at the 16th. 29th, and 44th day after the osteotomy. The bony specimens were decalcified, embedded in paraffin, sectioned $5{\mu}m$ thick and stained with H&E. The prepared specimens were examined under the light microscope. And, immunohistochemical examinations using anti-osteocalcin antibody (OC1, Biodesign, USA) and anti-osteonectin antibody (Haematologic Technologies Inc., Essex, VT) to locate the expressions of osteocalcin and osteonectin, respectively, were performed. Results : 1. New bone was observed already at the 16th. day after osteotomy. This suggests that new bone formation in osteodistraction was commenced at an early stage of the regenerative process. But, radiologically and microscopically, bony union was not completed in the distraction gap at the 44th. day after osteotomy. Therefore, rigid fixation must be maintained between the bony fragments till the complete bony union is confirmed clinically rather than one month or so after the completion of distraction.

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골격성 III급 부정교합자의 체질량지수에 따른 술후 연조직 변화 (THE THICKNESS OF SOFT-TISSUE BASED ON BODY MASS INDEX AND POSTOPERATIVE CHANGE IN PROGNATHIC PATIENTS)

  • 김은철;이상철
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제21권3호
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    • pp.288-297
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    • 1999
  • This study has been carried out in order to measure the thickness of soft-tissue on lateral cephalographs based on body mass index(BMI) and the change in soft-tissue thickness after surgical correction of mandibular protrusion. The control material in cephalometric study comprised students at The Dental College, 38 persons, aged 21~24 years and the patient material comprised 20 women and 12men, aged 19~28 years with mandibular protrusion.The thickness of the soft-tissue based on BMI in control and study groups, the comparison between them, immediate postoperative change in the thickness, 6 months after surgery, ratio of soft-tissue response and correlation was established through various statistical methods. The result were as follows : 1. The groups based on BMI showed significant differences each other as regards the linear measurements. The thickest soft-tissue was measured 13.6mm, 15.47mm, 16.76mm at Ss, the thinnest at G' 6.0mm, 6.7mm, 7.26mm respectively. 2. The differences between control and experimental groups based on BMI showed to be significant. There were no differences at G'. The soft-tissue in prognathic patients was thicker at Ss, Ls and thinner at Li, Ls, Pg', Gn', Me'. Differential gap was greater in overweight groups. 3. The immediate soft-tissue change after surgery showed the increase at Li, Ls, Pg', Gn', Me' except G', Ls in all groups. 4. The postoperative soft-tissue change 6 months after surgery was similar with immediate change. The soft-tissue shows the increase in the thickness at Li, Pg', Gn', Me' and the greatest difference occurred at Li, 1.1mm, 0.98mm, 1.2mm respectively. 5. The patients with lower BMI index showed higher soft-tissue response to bony movement at Pg'. The immediate response ratio was 91%, 87%, 81% in A,B,C groups respectively, the response 6 months after surgery showed 96%, 91%, 84%.

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Treatment of Nonsyndromic Craniosynostosis Using Multi-Split Osteotomy and Rigid Fixation with Absorbable Plates

  • Nam, Su Bong;Nam, Kyeong Wook;Lee, Jae Woo;Song, Kyeong Ho;Bae, Yong Chan
    • 대한두개안면성형외과학회지
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    • 제17권4호
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    • pp.211-217
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    • 2016
  • Background: Nonsyndromic craniosynostosis is a relatively common craniofacial anomaly and various techniques were introduced to achieve its operative goals. Authors found that by using smaller bone fragments than that used in conventional cranioplasty, sufficiently rigid bone union and effective regeneration capacity could be achieved with better postoperative outcome, only if their stable fixation was ensured. Methods: Through bicoronal incisional approach, involved synostotic cranial bone together with its surrounding areas were removed. The resected bone flap was split into as many pieces as possible. The extent of this 'multi-split osteotomy' depends on the degree of dysmorphology, expectative volume increment after surgery and probable dead space caused by bony gap between bone segments. Rigid interosseous fixation was performed with variable types of absorbable plate and screw. In all cases, the pre-operational three-dimensional computed tomography (3D CT) was checked and brain CT was taken immediately after the surgery. Also about 12 months after the operation, 3D CT was checked again to see postoperative morphology improvement, bone union, regeneration and intracranial volume change. Results: The bony gaps seen in the immediate postoperative brain CT were all improved as seen in the 3D CT after 12 months from the surgery. No small bone fragment resorption was observed. Brain volume increase was found to be made gradually, leaving no case of remaining epidural dead space. Conclusion: We conclude that it is meaningful in presenting a new possibility to be applied to not only nonsyndromic craniosynostosis but also other reconstructive cranial vault surgeries.

The diagnosis of coronoid impingement using computed tomography

  • Baik Jee-Seon;Huh Kyung-Hoe;Park Kwan-Soo;Park Moo-Soon;Heo Min-Suk;Lee Sam-Sun;Choi Soon-Chul
    • Imaging Science in Dentistry
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    • 제35권4호
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    • pp.231-234
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    • 2005
  • Coronoid impingement can cause limitation of mouth opening. In many cases, it appears to be related to the coronoid hyperplasia. We present a case of mouth opening limitation caused by coronoid impingement on the posterior surface of the zygomatic bone without coronoid hyperplasia. The bony changes in coronoid and zygoma including surface irregularity and discontinuity of the cortex and sclerotic change of inner medullary space were noted on computed tomography (CT) scans in different level of axial planes. Through another CT scans in open mouth position could demonstrate that those bony changes were caused by the contact of both surfaces against each other. In case coronoid impingement is suspected of the many possible causes, the open mouth CT scans will be needed to reveal the direct impingement of coronoid on zygoma even without coronoid hyperplasia.

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Radiologic assessment of bone healing after orthognathic surgery using fractal analysis

  • Park Kwan-Soo;Heo Min-Suk;Lee Sam-Sun;Choi Soon-Chul;Park Tae-Won;Jeon In-Seong;Kim Jong-Dae
    • Imaging Science in Dentistry
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    • 제32권4호
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    • pp.201-206
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    • 2002
  • Purpose : To evaluate the radiographic change of operation sites after orthognathic surgery using the digital image processing and fractal analysis. Materials and Methods : A series of panoramic radiographs of thirty-five randomly selected patients who had undergone mandibular orthognathic surgery (bilateral sagittal split ramus osteotomy) without clinical complication for osseous healing, were taken. The panoramic radiographs of each selected patient were taken at pre-operation (stage 0), 1 or 2 days after operation (stage 1), 1 month after operation (stage 2), 6 months after operation (stage 3), and 12 months after operation (stage 4). The radiographs were digitized at 600 dpi, 8 bit, and 256 gray levels. The region of interest, centered on the bony gap area of the operation site, was selected and the fractal dimension was calculated by using the tile-counting method. The mean values and standard deviations of fractal dimension for each stage were calculated and the differences among stage 0, 1, 2, 3, and 4 were evaluated through repeated measures of the ANOVA and paired t-test. Results : The mean values and standard deviations of the fractal dimensions obtained from stage 0, 1, 2, 3, and 4 were 1.658±0.048, 1.580±0.050, 1.607±0.046, 1.624±0.049, and 1.641 ±0.061, respectively. The fractal dimensions from stage 1 to stage 4 were shown to have a tendency to increase (p < 0.05). Conclusion: The tendency of the fractal dimesion to increase relative to healing time may be a useful means of evaluating post-operative bony healing of the osteotomy site.

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구강검진에서 임상검사와 비교한 파노라마방사선사진의 유용성 (Efficacy of panoramic radiography as a screening procedure in dental examination compared with clinical evaluation)

  • 안서영;안창현;최갑식
    • Imaging Science in Dentistry
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    • 제37권2호
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    • pp.83-86
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    • 2007
  • Purpose : To evaluate the efficacy of panoramic radiography by comparing the results of clinical examination with radiographic findings. Materials and Methods: We studied 190 patients (20 men and 170 women; mean age, 40 years; range, 22 to 68 years) who visited the health promotion center of Korea Medical Science Institute and were examined both clinically and by panoramic radiography. We compared results from both examinations. Treatment options by clinical examination were described as "no treatment indicated", "treatment of dental caries", "removal of calculus", "treatment of periodontal disease", "prothodontic treatment" and "extraction of the third molar". Findings taken from the panoramic radiography were: dental caries, periapical lesion, alveolar bone loss, calculus deposition, retained root, impaction of the third molar, disease of maxillary sinus, bony change of mandibular condyle, etc. Results: The prevalence of panoramic findings were: 37.9% of dental caries, 17.4% of periapical lesions, 44.7% of alveolar bone losses, 62.6% of calculi deposition, 7.9% of retained roots, 26.8% of third molar impactions, 6.3% of diseases of maxillary sinus, 2.1 % of bony changes of mandibular condlye and 35.8% of miscellaneous lesions. Abnormal conditions revealed by panoramic radiography which had not been discovered on clinical examination were: 24.2% of the patients had dental caries, 17.4% had periapical lesions, 7.4% had calculi deposition, 5.3% had retained roots, 15.3% had third molar impactions. The opposite cases were: 5.2% had dental caries, 12.6% had calculi deposition, and 9.5% had third molar impactions. Conclusion: The use of panoramic radiography as a supplement to the clinical examination might be a valuable screening technique.

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측두 하악 관절 장애 환자의 파노라마 영상과 cone beam형 전산화 단층 영상의 비교 (Comparison of bony changes between panoramic radiograph and cone beam computed tomographic images in patients with temporomandibular joint disorders)

  • 이동렬;김연중;송윤헌;이남호;임용규;강승택;안석준
    • 대한치과교정학회지
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    • 제40권6호
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    • pp.364-372
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    • 2010
  • 본 연구는 교정 진단 및 치료 계획에 어려움을 줄 수 있는 측두 하악 관절 장애 증상을 보이는 환자의 cone beam computed tomography (CBCT) 영상과 파노라마 영상을 비교하여 파노라마 영상의 유용성을 알아보고자 하였다. 2008년 6월부터 2008년 11월까지 측두 하악 관절 부위의 이상 증상으로 치과 의원에 내원한 환자를 대상으로 임상 진단과 파노라마 촬영을 시행 후 CBCT로 촬영한 106명, 212개 관절을 대상으로 영상의 결과를 비교하였다. 2명의 치과의사가 하악 과두의 골변화의 양상을 관찰하여 정상(normal), 편평화(flattening), 골경화(sclerosis), 골증식체(osteophyte), 침식(erosion)으로 나누었다. 그 결과로 첫째, 검사자간 신뢰도에서 파노라마(weighted kappa: 0.714), CBCT (weighted kappa: 0.727) 각각의 영상 진단 일치도가 높았다. 둘째, CBCT 영상에 대한 파노라마 영상의 A 검사자의 민감도는 82.4%, 특이도는 58.1%였으며 B 검사자는 각각 84.3%, 61.5%였다. 셋째, 파노라마 영상과 CBCT 영상이 5% 유의수준에서 두 영상 간 판독이 동일하지 않았다. 이상의 결과는 파노라마 영상이 CBCT 영상과 비교할 때 비교적 높은 80% 이상의 민감도를 보여 측두 하악 관절 골 변화의 일차적인 진단수단으로 임상적으로 유용하게 사용될 수 있다는 것과 측두 하악 관절의 골 변화가 파노라마 영상에서 불분명한 경우 CBCT를 사용하였을 때 더욱 정밀한 진단이 될 수 있다는 것을 보여주었다.

턱관절의 골관절염을 동반한 신성골이영양증 환자 증례보고 (A Case Report : TMJ Osteoarthritis in a Patient with Renal Osteodystrophy)

  • 이기호
    • Journal of Oral Medicine and Pain
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    • 제38권3호
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    • pp.247-253
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    • 2013
  • 신성골이영양증 (Renal osteodystrophy)은 만성 신질환 환자에서 관찰되는 골격성 변화를 특징으로 하는 질환으로 칼슘과 인 대사의 변화, 그리고 이차성 부갑상선 기능항진증의 결과로 나타난다. 방사선학적으로 지골의 말단, 장골과 악골 부위의 골막하 부위의 침식을 흔하게 관찰할 수 있다. 악안면 영역에서 골변화는 골밀도의 감소, 방사선 투과성 병소 (갈색 종양 : brown tumor), 피질골의 비박화와 치조백선의 소실을 보인다. 그러나 이러한 골변화가 악관절에 발생하는 것은 흔치 않은 일이다. 본 증례는 양측 하악 과두의 골변화를 보인 신성골이영양증 환자를 보고하고자 한다. 지난 10년 간 혈액 투석 치료와 3개월 전 신장암 수술 병력이 있는 41세 남자 환자가 좌측 턱의 통증을 주소로 2011년 2월 단국대학교 치과대학부속 치과병원 구강내과에 내원하였다. 양측 악관절의 골관절염과 유사한 방사선학적 소견을 보였고, 전치부 개방교합이 관찰되었다. CBCT를 이용한 방사선학적 특징과 생화학적 지표를 통해 신성골이영양증으로 인한 양측 턱관절의 골관절염으로 진단 되어 환자는 내과에서 신성골이영양증의 치료 방법의 하나인 칼슘 및 비타민 D 복용고 부갑상선 절제술을 시행 받았고, 그 동안 턱관절의 통증 조절을 위해 본원에서는 행동 요법과 약물 치료, 물리치료만 시행하였다. 약 1년 3개월 후 재검사에서 하악골의 골밀도와 피질골 두께가 증가하였고, 하악 과두 외형이 비교적 명확하게 바뀌었다. 골변화는 만성 신장 질환의 초기 단계부터 시작되므로 치과의사는 이러한 질환의 징후 및 가능성을 신속히 감별할 수 있어야 한다. 또한 골관절염과 신성골이영양증의 치료 프로토콜이 다르기 때문에 두 질환을 감별하는 것이 중요하다.

경피골막증: 증례보고 (A Case of Pachydermoperiostosis)

  • 남영오;고성훈;오석준
    • Archives of Plastic Surgery
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    • 제35권3호
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    • pp.316-320
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    • 2008
  • Purpose: Pachydermoperiostosis is a rare hereditary disease characterized by finger clubbing, periosteal reaction, and pachydermia. The underlying pathogenic mechanism of this disease remains unclear. This disease is known to be associated with a variety of diseases such as cranial suture defect, bone marrow failure, hypertrophic gastropathy, Crohn's disease, and female escuchen. Methods: A 50-year-old male had digital clubbing of both hands, coarse hypertrophic skin changes of face, progressive thickening and furrowing on the scalp(cutis verticis gyrata), persistent pain in the limbs and joints. Other cutaneous features include moderate blepharoptosis, pole-like lower legs and feet. Results: We performed surgical excision for hypertrophic skin change of scalp because of frequent eczematous skin change, severe itching sensation and cosmetic problem. Diagnosis is confirmed by bony proliferative periosteal reaction, pathologic findings, and characteristic clinical findings. Conclusion: Pachydermoperiostosis is manifested by finger clubbing, and hypertrophic skin changes causing coarse facial features with thickening and periosteal bone formation. We experienced a case of pachydermoperiostosis. Brief review of related literature is given.