• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권1호
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• pp.16-22
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• 2017

Objectives: Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ. Materials and Methods: Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level. Results: BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and 'responder group' and 'non-responder group,' but there was no significant difference with the 'worsened group.' In addition, the age of the patients was a relative factor with BRONJ stage. Conclusion: With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권5호
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• pp.225-231
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• 2018

Objectives: The purpose of this study was to investigate the demographic and clinical characteristics of patients with medication-related osteonecrosis of the jaw (MRONJ) and to elucidate factors affecting recurrence in surgical treatment. Materials and Methods: A total of 51 patients who were diagnosed with MRONJ were analyzed according to demographic and clinical features and treatment results through a retrospective chart review from 2013 to 2017 in the Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul in Korea. Results: Alendronate composed the majority of medication doses (55.6%), followed by ibandronate (20.0%), risedronate (15.6%), and zoledronate (6.7%). Forty patients (88.9%) were given oral medication, and five patients (11.1%) were intravenously treated, and the mean duration of medication use was $61.1{\pm}42.9$ months. A total of 10 patients (22.2%) had a drug holiday before MRONJ-induced dental treatment lasting an average of $6.8{\pm}7.0$ months. MRONJ occurred 2.7 times more in the mandible, with 41 cases (73.2%) occurring in the mandible and 15 cases (26.8%) occurring in the maxilla, and the prevalence of affected posterior parts (premolar-molar) was six times greater than that of the anterior parts (incisor-canine) (48 cases vs 8 cases, 85.7% vs 14.3%). The most common dental cause of MRONJ was tooth extraction (69.6%). Regarding recurrence, there was no statistical difference in recurrence rate according to either site or stage. However, recurrence occurred in 4 out of 34 cases (11.8%) in the primary closure group and 9 out of 20 cases (45.0%) in the secondary healing group, and there was a statistical difference with respect to closure technique. Conclusion: The identified risk factors in patients taking bone resorption inhibitors can aid dental clinicians in ensuring prevention and proper treatment of MRONJ.

• 시큐리티연구
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• 제44호
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• pp.7-35
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• 2015

본 논문은 관광이 기간산업인 호주 퀸즐랜드주를 대상으로 민간시큐리티 산업의 선진화 과정과 제도적 개선점 등에 대해 검토하였다. 90년대 중반을 기점으로 단계적으로 진행된 제1,2차 개혁과정의 검토를 통해 제도운영상의 종합적인 성과 및 개선사항을 점검하였으며, 사례분석을 통해 도출한 시사점은 Button(2012)과 Prenzler와 Sarre (2014)가 제시한 표준모델(Best Practice Model)에 대입하여 개선방안을 논의하였는데, 주요 내용은 다음과 같다. 첫째, 퀸즐랜드주는 연방정부의 시큐리티 사업자 규제 권고안을 충실히 이행하고 있으나 현장에서의 실시간 음주 약물 측정, 정신장애정도에 대한 감정, 경비 사업자 측근(close associates)에 대한 프로파일링 등과 같은 선제적 규제기법은 케이스-바이-케이스로 운용중이어서 보다 적극적인 쇄신이 요구된다. 둘째, 퀸즐랜드주 시큐리티 자문업 기계경비업자들의 경우 교육 훈련 과정 이수의 법적의무가 없어 자율준수로 운영되는 현행 커리큘럼의 의무화 방안 역시 재고되어야 한다. 마지막으로, 퀸즐랜드주 시큐리티사업자에 대한 현장관리감독은 관광특구에 크게 집중되어 있어 관리당국인 공정거래청(Fair Trading)에서 그 범위를 확대하는 등 능동적인 개입이 필요하다고 판단된다. 호주 시큐리티서비스 산업이 한국에 주는 의미 있는 시사점으로는 첫째, 교육훈련의 표준화 공인화와 같은 지속적인 제도정비 개선노력 둘째, 이 같은 시큐리티산업의 전략적 육성과 경쟁력 향상 도모를 통한 민 경 공조체계의 실효성 강화 등을 대표적으로 꼽을 수 있다. 국내에서는 사경비자격제도에 해당하는 산업보안관리사, 공인탐정사 등의 전문자격증이 정부산하 협회 혹은 민간단체 등에서 발급되는 관계로 일관성 신뢰성에 대한 문제가 제기되어 왔고 공신력 부여 방안에 대한 논의 또한 지속되어 온 것이 사실이다. 따라서 호주의 모범선행사례를 참조하여 자격제도 관리 운영의 노하우 활용방안에 대한 체계적 접근을 모색해 볼 필요가 있다고 사료된다.