• Journal of Periodontal and Implant Science
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• v.34 no.1
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• pp.223-241
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• 2004

The purpose of this present study evaluated the osseous response around Ca-P coated xenogenic bone and compared osteogenic potential of Ca-P coated xenogenic bone to that of combination with type I collagen derived from bovine tendon as a biocompatible binder to prevent migration of bone particle on the repair of calvarial defects in rabbits. To study the effects of Ca-P coated xenogenic bone and collagen on bone healing, four 5-mm-diameter skull defect were made in calvaria with trephine filled with an autogenous bone chip or Ca-P coated xenogenic bone or Ca-P coated xenogenic bone and type I collagen (1:1 mixture by volume) or left empty. The defects were evaluated histologically at 1, 2, 4 and 8 weeks following implantation. Ca-P coated xenogenic bone at the calvarial defects of rabbits showed osteoconductivity at the margin of defect in the early stage of bony healing, but no direct contact with new bone was observed. With time passed by, it was resorbed slowly and showed consistent inflammatory reaction. An additional use of type I collagen derived from bovine tendon improved clinical handling, but no new bone formation was observed histologically. Above all, autogenous bone graft showed most prominent healing in quantity and density of new bone formation. According to this study, the use of Ca-P coated xenogenic bone alone and combination with type I collagen did not showed effective healing in quantity and density of new bone formation.

• The Journal of the Korean bone and joint tumor society
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• v.17 no.2
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• pp.73-78
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• 2011

Purpose: This study was aimed to evaluate the result of inlay cortical strut bone grafts for large cysts or cavitary bone lesions in long bones. Materials and Methods: Seven patients with large cyst or cavitary bony lesions were managed with curettage, allogeneic inlay cortical strut and cancellous bone grafts. Additional plate and screw fixations were performed in 6 patients. There were three SBCs, two FDs with secondary ABC changes, one FD and one post-cement spacer removal state. Three of them had pathologic fractures. Progression of bone healing and mechanical support and functional result were evaluated. The mean follow-up period was 25.4 months. Results: Incorporations into host bones were progressed in all, average 4.2 months in six metaphyseal regions and 5.8 months in five diaphyseal regions respectively. Full structural supports were achieved in all except one patient without any additional procedures. No allograft-related complication was developed. Mean functional score according to the MSTS criteria was 29.6 at last follow up. Conclusion: Inlay cortical strut graft provided additional mechanical stability and bone stock for screw purchase in large cyst or cavitary defects of long bones, which allow early mobilization and excellent functional outcome.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.129-138
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• 2016

Purpose: Due to recent advances in internal fixation techniques, instrumentation and orthopedic implants there is an increasing number of humeral shaft fracture treated operatively. As a consequence, an increased number nonunion after operative fixation are being referred to our center. The aim of this study is to report the common error during osteosynthesis that may have led to nonunion and present a systematic analytical approach for the management of aseptic humeral shaft nonunion. Methods: In between January 2007 to December 2013, 20 patients with humeral shaft nonunion after operative procedure were treated according to our treatment algorithm. We could analysis x-rays of 12 patients from initial treatment to nonunion. In a subgroup of 12 patients the initial operative procedure were analyzed to determine the error that may have caused nonunion. The following questions were used to examine the cases: 1) Was the fracture biology preserved during the procedure? 2) Does the implant construct have enough stability to allow fracture healing? Results: In 19 out of 20 patients have showed radiographic evidence of union on follow up. One patient has to undergo reoperation because of the technical error with bone graft placement but eventually healed. There were 2 cases wherein the treatment algorithm was not followed. All patients had problems with mechanical stability, and in 13 patients had biologic problems. In the analysis of the initial operative fixation, only one of 12 patients had biologic problems. Conclusion: In our analysis, the common preventable error made during operative fixation of humeral shaft fracture is failure to provide adequate stability for bony union to occur. And with these cases we have demonstrated a systematic analytic management approach that may be used to prevent surgeons from reproducing the same fault and reduce the need for bone grafting.

• Journal of Periodontal and Implant Science
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• v.32 no.2
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• pp.389-402
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• 2002

BMP can induce ectopic bone formation when implanted into sites such as rat muscle and can greatly enhance healing of bony defects when applied exogenously. In addition, BMP stimulated osteoblastic differentiation in vitro in various types of cells. The aim of this study was to investigate the effect of recombinant human bone morphogenetic protein(rhBMP-2) on the proliferation and osteoblastic differentiation of human periodontal ligament cells and gingival fibroblasts. The cell number and alkaline phosphatase activity were measured in 3 experimental groups of human periodontal ligament cells and gingival fibroblasts (control group, rhBMP-2 50ng/ml group, and rhBMP-2 100ng/ml group) at 1 and 2 weeks after culture. At the same time, total RNA of cultured cells were extracted and reverse trascription polymerase chain reaction(RT-PCR) was performed to determine the expression of mRNA of bone matrix protein. RhBMP-2 had no effect on the cell proliferation of human periodontal ligament cells and gingival fibroblasts. Alkaline phosphatase activity was elevated significantly by rhBMP-2 in both cells. And periodontal ligament cells showed significantly higher alkaline phosphatase activity than gingival fibroblasts. ${\beta}$-actin, type I collagen, alkaline phosphatase, BMP-2 mRNA were expressed in all of the samples. Osteopontin, osteocalcin mRNA were expressed in all periodontal ligament cell groups, and rhBMP-2 50ng/ml group, rhBMP-2 100ng/ml group of 2 week culture period of gingival fibroblasts. Bone sialoprotein mRNA was only expressed in rhBMP-2 50ng/ml group and rhBMP-2 100ng/ml group of 2-week culture period. These results suggest that rhBMP-2 stimulates osteoblastic differentiation in human periodontal ligament cells and gingival fibroblasts in vitro.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.139-146
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• 2000

The aim of this study was to assess whether the functional regeneration of a lyophilized autografted cartilage could be improved by implanting a vascularized muscle flap into the medullary canal of autografted proximal humerus. A hemijoint reconstruction using a lyophilized osteochondral autograft in proximal humerus was done in 4 rabbits for control, and combined with an vascularized intramedullary muscle flap in another 4 rabbits for the experimental group. Graft healing and the repair process of osteochondral graft were followed by serial radiographs and histologic changes for 9 weeks after experiments. Each two rabbits in control and in experimental group on 5th and 9th week after implantation of hemijoint were sacrified. The results were as follows: 1. All of control and experimental froups on 5th week united solidly on osteotomized site radiologically, but their articular cartilages were destroyed more seriously in the control than that in experimental group with muscle flap on 5th and 9th week after experiment... 2. Histochemically, the cartilage surface are completely destroyed and revealed with severe osteoarthritic changes on all cartilage layers in control, but cartilaginous erosions are mild to moderate and their arthritic changes are also mild with somewhat regeneration of chondrocytes on deep layers more prominetly on 9th week of the experimental group. 3. The amount of collagen and protenized matrix which was determined by Masson-Trichrome stain was markedly decreased that means the weakness of bony strength and low osteogenic potential in lyophilized cartilage. These results suggest that an intramedullary vascularized muscle flap can improve the functional results of lyophilized osteochondral autograft by providing both increased vascularity and populations of mesenchymal cells to initiate new bone formation on osteotomized site as well as the regeneration of deep layers in articular cartilage. In clinical relevances, this lyophilized hemijoint autograft combined with an intramedullary vascularized muscle pedicle graft might be used very effectively for the treatment of malignant long bone tumors to preserve the joint functions, all or partly, and so to replace it with the artificial joint after tumor excision and hemijoint autograft.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.691-694
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• 2010

Purpose: Central giant cell granuloma is a rare, benign giant cell tumor which commonly develops in areas near the teeth. It accounts for approximately less than 7% of benign tumors of the mandible. Clinically, central giant cell granuloma is classifed into aggressive and non-aggressive type, and usually requires surgical treatment. There has been no report of central giant cell granuloma in plastic surgery field of the country, and we report a case with a brief review of the diagnosis and treatment of the disease. Methods: A 23-year-old male presented with a hard, non-tender, growing mass with the size of $4.0{\times}3.0\;cm$ on mandible for several months. Computed tomography scan showed a solid mass within thinned outer cortex on mandible. The thinned outer cortex was excised with the mass and the inner cortex was partially removed burring. After the tumor removal, mandible was fixed by reconstruction plate. Results: Pathologic report showed numerous large multinucleated giant cells, diffusely distributed in a background of ovoid-to-spindle-shaped mononuclear cells. There was no evidence of recurrence after 1 year follow up. Bony defect was regenerated and we removed the reconstruction plate. Conclusion: Removal of central giant cell granuloma results in defect of outer cortex, which can be reconstructed by using reconstruction plate, autologous bone graft or bone cement. We used reconstruction plate as a conservative method to induce secondary healing of the outer cortical defect area, which resulted in normal mastication and occlusion with no recurrence.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.669-671
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• 2006

Purpose: Congenital insensitivity to pain with anhidrosis(CIPA) is a rare form of autosomal recessive peripheral sensory neuropathy. Patients with CIPA show loss of pain sensation, which leads to corneal ulcers and opacities, self-mutilation of the tongue and fingertips, as well as fractures with subsequent joint deformities and chronic osteomyelitis. The purpose of this report is to highlight the fact that pressure sores also are a potential complication of CIPA. Methods: This case report describes a patient presenting with pressure sores resulting from CIPA. A 5-year-old boy was referred to our department for the treatment of a $5{\times}5cm$ sacral pressure sore as a result of a hip spica cast applied for the treatment of a left hip joint dislocation. He had a history suggesting CIPA such as multiple bony fractures, mental retardation, recurrent hyperpyrexia, anhidrosis, and clubbing fingers due to oral mutilation. A microscopic examination of the sural nerve showed mainly large myelinated fibers, a few small myelinated fibers and an almost complete loss of unmyelinated fibers. After wound preparation for two weeks, the exposed bone was covered with two local advancement flaps. Results: Two weeks later, complete wound healing was achieved. A 16-month follow-up showed no recurrence. However, the patient presented with a new pressure sore on the left knee due to orthosis for the treatment of the left hip joint dislocation. Conclusion: The early diagnosis of CIPA and special care of pressure sores are important for preventing and treating pressure sores resulting from CIPA.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.5
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• pp.457-464
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• 2008

Purpose: The aim of this study was to evaluate the clinical results of implants which were installed with maxillary sinus elevation by using lateral window technique. Materials and methods: We performed the maxillary sinus elevation by lateral window technique to 87 patients who visited Dept. of Oral & Maxillofacial Surgery, Chonnam National University Hospital from January, 2003 to January, 2007. When the residual bone height was from 3 mm to 7 mm, the sinus elevation and simultaneous implant installation was mostly performed. When the residual bone height was less than 3 mm, the sinus elevation was performed and the delayed implant installation was done after 5 or 6 months. No artificial membranes were used for coverage of the lateral bony window site and freeze dried fibrin sealant was applied to the grafted bone. The mean follow-up period was 28.5 months (ranged from 10 months to 48 months) Results: 1. Unilateral sinus elevations were performed in 51 patients and bilateral sinus elevations were performed in 36 patients. And the total number of sinus elevation procedure was 123 cases. 2. The sinus elevation and simultaneous implant installation was performed in 89 sinuses and 249 implants were installed. The sinus elevation and delayed implant installation was performed in 44 sinuses and 141 implants were installed. The total number of implants were 390 in 133 sinuses. The average healing period after sinus elevations was 6.1 months in delayed implant installation. 3. Only autogenous bone, autogenous bone mixing with allografts or autogenous bone mixing with xenografts were used as graft materials. 4. The average period from first surgery to second surgery was about 7.2 months. 5. Some patients complications, such as perforation of sinus membrane, swelling, infection and exposure of cover screw. Two implants were removed in the infected sinus. 6. The survival rate of implants with maxillary sinus elevation by lateral window technique was 99.5% and the success rate of implants was 95.1%. Conclusions: These results indicated that the implants which were installed with maxillary sinus elevation by lateral window technique showed high survival and success rates.

• Journal of Periodontal and Implant Science
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• v.31 no.1
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• pp.21-41
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• 2001

The goal of Periodontal treatment is predictable periodontal regeneration. But until now, many products including GTR materials and growth factors are beyond of complete regeneration. BMP can induce ectopic bone formation when implanted into sites such as rat muscle and can greatly enhance healing of bony defects when applied exogenously. BMP can promote periodontal regeneration by their ability to stimulate new bone and new cementum formation. But little is known about optimal conditions required for the application. Root conditioning is used for bioacive root change so altered root surface provides a substrate that promotes chemotaxis, migration and attachment of peridontal cells encouraging connective attachment to the denuded root surface. The aim of this study is to investigate whether the acid conditioning change effect of rhBMP-2 on human periodontal ligament cell and osteoblast cell line. 288 periodontally involved root dentin slices are divided into 6 groups, each 48, 1)control, 2)treated with BMP, 3)treated with citric acid 4)treated with citric acid+BMP 5)treated with tetracycline 6)treated with TC+BMP. Each group was devided half, so 12 root dentin slices were seeded with periodontal ligament cells and 12 were seeded with osteoblasts. At day 2 and 7, cell number, protein assay, ALP activitiy was measured. To investigate morphology of cultured cells, SEM was employed. Statistical analysis was performed with SPSS 8.0 either t-test or ANOVA test. The results are ; Protein assay and cell number was slightly decreased in CA+BMP group compared to Ca group but it was not statistically significant and ALP activity was much more increased in CA+BMP group compared to CA group so there was no statistically significance between BMP and CA+BMP group and statistically significant compared to control group. Cell number and protein assay was slightly increased in TC group and ALP activity was much less the BMP group and CA group. Cell number and protein and ALP activity was not much increased in TC+BMP group. TC group and TC+BMP group showed cell morphology change in SEM. This results suggested that application of root surface with citric acid before BMP treatment might give better result in periodontal regeneration.

• Journal of Periodontal and Implant Science
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• v.42 no.4
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• pp.119-126
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• 2012

Purpose: The aim of this study was to determine whether biphasic calcium phosphate (BCP) bone substitute with two different concentrations of Escherichia coli-expressed recombinant human bone morphogenetic protein 2 (ErhBMP-2) enhances new bone formation in a standardized rabbit sinus model and to evaluate the concentration-dependent effect of ErhBMP-2. Methods: Standardized, 6-mm diameter defects were made bilaterally on the maxillary sinus of 20 male New Zealand white rabbits. Following removal of the circular bony windows and reflection of the sinus membrane, BCP bone substitute without coating (control group) was applied into one defect and BCP bone substitute coated with ErhBMP-2 (experimental group) was applied into the other defect for each rabbit. The experimental group was divided into 2 subgroups according to the concentration of ErhBMP-2 (0.05 and 0.5 mg/mL). The animals were allowed to heal for either 4 or 8 weeks and sections of the augmented sinus and surrounding bone were analyzed by microcomputed tomography and histologically. Results: Histologic analysis revealed signs of new bone formation in both the control and experimental groups with a statistically significant increase in bone formation in experimental group 1 (0.05 mg/mL ErhBMP-2 coating) after a 4-week healing period. However, no statistically significant difference was found between experimental group 1 and experimental group 2 (0.5 mg/mL ErhBMP-2 coating) in osteoinductive potential (P<0.05). Conclusions: ErhBMP-2 administered using a BCP matrix significantly enhanced osteoinductive potential in a standardized rabbit sinus model. A concentration-dependent response was not found in the present study.