• Journal of Oral Medicine and Pain
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• 제39권2호
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• pp.35-45
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• 2014

Many therapeutic modalities including continuous positive airway pressure, surgery, and oral appliances are used to treat patients with sleep-disordered breathing. However, there are no definitive treatment modalities for individual patients due to various causes of sleep-disordered breathing. Clinicians should have select best options for individual patients and it is quite challenging process. Oral appliances attracted clinical attention for its convenience and safety. Several designs of oral appliances are introduces such as soft palate lifter, tongue retaining device, and various appliances which aimed to mandibular advancement. Among these oral appliances, mandibular advancement devices (MADs) are considered the most excellent based on their effectiveness and patient tolerance. Although MADs are not guarantee dramatic outcome and less consistent than continuous positive airway pressure, they offer several advantages over continuous positive airway pressure and surgical methods, including non-invasiveness, silence, portability, and tolerability, simplicity. Therefore, general dental practitioner who had passed sleep dental curriculum or coursework can treat the patients with sleep problems. This article reviews the history, clinical indications, suggested mechanism of actions, various positive effects and several side effects, factors predicting a favorable outcome, determining amounts of mandibular advancement, compliance and long-term efficacy of MADs use.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권6호
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• pp.275-281
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• 2018

Objectives: Isolated mandibular fractures contribute to approximately 45% of maxillofacial traumas. Improper management of mandibular fractures can cause myriad potential complications and can lead to serious functional and aesthetic sequelae. The objective of the study is to design a stepwise approach for managing isolated mandibular fractures using open reduction and internal fixation (ORIF) with regional anesthesia on outpatient basis. Materials and Methods: Patients with isolated mandibular fractures presenting to the department of maxillofacial surgery were selected for ORIF under regional anesthesia based on occlusion, age, socioeconomic status, general condition, habits, and allied medical ailments. Standard preoperative, intraoperative, and postoperative protocols were followed. All patients were followed up for a minimum of 4 weeks up to a maximum of 1 year. Results: Of 23 patients who received regional anesthesia, all but one had good postoperative functional occlusion. One patient was hypersensitive and had difficulty tolerating the procedure. Two patients developed an extraoral draining sinus, one of whom was managed with local curettage, while the other required hardware removal. One patient, who was a chronic alcoholic, returned 1 week after treatment with deranged fracture segments after he fell while intoxicated. Conclusion: With proper case selection following a stepwise protocol, the majority of mandibular fractures requiring ORIF can be managed with regional anesthesia and yield minimal to no complications.

• 대한치과보철학회지
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• 제58권4호
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• pp.349-355
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• 2020

외상, 구강암, 선천적 요인 등에 의한 구강 결손시 음식물의 섭취, 흡입성 폐렴 방지, 안모 지지를 위하여 치과용 obturator가 제작된다. 그러나 기존의 전통적인 인상 채득 방법을 이용한 obturator제작 시, 제작 과정에서 술자와 환자, 기공사 모두 번거로운 과정을 거쳐야 하며, 환자는 악안면 보철 치료가 가능한 치과 보철 전문의가 있는 병원을 찾아 방문해야 하는 어려움이 있다. 그러나, 3D printing을 포함한 CAD-CAM 기술을 이용하면 비교적 간단하게 hollow obturator를 제작할 수 있고, 보철 전문의가 없는 지역에서도, 지역 치과의사와 멀리 떨어져 있는 보철 전문의 간의 협진을 통해 수월한 치료가 가능할 수 있다. 본 연구에서는 한국의 상악 구개 결손 환자들의 치료를 위해, 일본에서 obturator를 디자인하고 한국에서 3D printing하여 성공적으로 obturator를 제작하였고, 더불어 원격 치료의 가능성을 확인하였기에 보고하는 바이다.

• Restorative Dentistry and Endodontics
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• 제42권1호
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• pp.60-64
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• 2017

Root canal anatomy is complex, and the recognition of anatomic variations could be a challenge for clinicians. This case report describes the importance of cone beam computed tomographyic (CBCT) imaging during endodontic treatment. A 23 year old woman was referred by her general dental practitioner with the chief complaint of spontaneous pain in her right posterior maxilla. From the clinical and radiographic findings, a diagnosis of symptomatic irreversible pulpitis was made and endodontic treatment was suggested to the patient. The patient underwent CBCT examination, and CBCT scan slices revealed seven canals: three mesiobuccal (MB1, MB2, and MB3), two distobuccal (DB1 and DB2), and two palatal (P1 and P2). Canals were successfully treated with reciprocating files and filled using single-cone filling technique. Precise knowledge of root canal morphology and its variation is important during root canal treatment. CBCT examination is an excellent tool for identifying and managing these complex root canal systems.

• Restorative Dentistry and Endodontics
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• 제43권4호
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• pp.38.1-38.9
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• 2018

The restoration of endodontically treated teeth (ETT) with more than one cusp missing and thin remaining walls is challenging for the general practitioner. The use of posts combined with full coverage restorations is a well-established approach, yet not following the minimal invasive principles of adhesive dentistry. Endocrowns are indirect monoblock restorations that use the pulp chamber of the ETT for retention. In this study the fabrication of 4 endocrowns and their clinical performance will be discussed. Two clinical cases include computer-aided design/computer-aided manufacturing manufactured molar endocrowns (one feldspathic ceramic and one hybrid composite-ceramic restoration) and the other two are dental laboratory manufactured resin composite premolar endocrown restorations. The modified United States Public Health Service criteria were used to assess the clinical behavior of the restorations at different follow up periods. Endocrown restorations present a satisfactory clinical alternative, either by the use of resin composite or glass ceramic and hybrid materials. Specific guidelines with minimal alterations should be followed for an endocrown restoration to be successful. Due to limited evidence regarding the long term evaluation of this restorative technique, a careful selection of cases should be applied.

• 대한장애인치과학회지
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• 제15권1호
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• pp.7-13
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• 2019

The aim of this study was to clarify the barriers of dental treatment for special needs patients felt by dentists and to determine the dentist-related factors contributing to the obstacles in treatment planning and decision making. Questionnaires were distributed and responded by dentists working at five public-based special care clinics in South Korea. Factors divided into three parts (dentist demographics, clinical factors, and educational and administrational factors) were assessed and analyzed for correlations between dentist-related factors and dentist-felt burdens for special care treatment. Fisher's exact test and Chi-square test were used at the level of 0.05. A total of 34 dentists responded to the questionnaires. Almost all dentists had obstacles in the treatment of special needs patients in terms of the patients' lack of cooperation (94.1%), proxy communication with caregivers (94.1%), payment reward system (63.6%), deficient workforce (67.7%), and others. The longer dentists had been practicing for special needs patients, the more they were dissatisfied with the reward system and a longer time was spent for communication with patients and their caregivers (p<0.05). For specialists, more obstacles were experienced in treatment planning due to a deficiency in the clinical information obtained from their patients compared to general practitioners (p<0.05). A total of 82.4% of the respondents approved of mandatory educational programs for special care dentists. There were practitioner-based factors related to the amount of obstacles felt by special care dentists. To overcome the treatment barrier of special needs patients, in-depth education and training are required in special care dentistry.

• 구강회복응용과학지
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• 제19권3호
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• pp.239-245
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• 2003

The occurrence and pattern of tooth wear are related to cultural, dietary, occupational, and geographic factors, Excessive occlusal wear can result in pulpal exposure, occlusal disharmony, functional inability. Surface loss can be differentiated into 3 general causal categories: i) mechanical loss, which includes attrition, ii) abrasion chemical loss including erosion, and finally iii) a proposed biomechanical category described as abfraction. Considering that mechanical wear is frequently asymptomatic, patients may have parafunctional habit. Structured clinical decision analysis in fixed prosthodontics, as other branches of dentistry do, allows the practitioner to consider the patient's problems more thoroughly based on the clinical data and extenuation factors. This discipline of decision making is intended to complement the experience level and educational background of the clinician in assisting the patient through the decision process. Additionally, CDA helps the clinician define not only the pre-existing condition of the patient prior to irreversible therapy, but also better treatment strategies for the patient over an extended period. The systematic nature of decision analysis stimulates the dentists to pay further attention to those factors, which is germane to the overall complexity of the case, and exclude factors, which have little influence on its final outcome. Further implementation of computerized databases, procedural outcome probabilities based on clinical and laboratory studies and the clinical experience of those who use it, may provide quite a promising future in the field of structured and formalized clinical decision analysis.

• 한국병원경영학회지
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• 제26권1호
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• pp.71-82
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• 2021

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.

• Journal of Oral Medicine and Pain
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• 제34권4호
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• pp.397-407
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• 2009

본 연구는 6개월 이상의 만성 비치성 구강안면통증(orofacial pain, OFP) 환자들을 대상으로 통증으로 인한 사회심리적 영향을 평가하고, 대학병원의 구강안면통증 전문클리닉에 내원한 OFP 환자들의 임상적 특성(유발사건, 이전 치료병력 등)을 조사하고자 하였다. 연구를 위하여 2008년 9월부터 6개월간 단국대학교 치과대학 부속 치과병원 구강내과 구강안면통증클리닉에 내원한 초진환자 중 OFP 환자들의 초진시 진료기록과 면담 전 대기실에서 작성한 만성통증척도(Graded Chronic Pain Scale, GCPS) 설문지를 조사분석하였다. 본원에 지난 6개월간 내원한 다양한 비치성 구강안면통증 572 명의 환자들 중 63%는 이전 치료 경험이 있었고 약물치료, 상담, 물리치료의 순으로 빈도가 높았고, 전문과목은 일반치과와 정형외과의 순서였다. 환자들의 89.2%는 턱관절장애였고 6.4%는 삼차신경통을 포함한 신경병성동통, 4.5%는 2가지 이상의 OFP가 공존하는 복합성 안면통증(mixed OFP)이었다. 통증의 발생과 관련한 유발요인에 대해서는 환자들의 약 35%가 인지하고 있었으며, 외상, 치과치료의 순으로 빈도가 높았다. OFP 환자의 약 반 정도(46%)는 만성 통증을 가진 환자였으며, 이 중 40%에 이르는 많은 환자들이 구강안면통증으로 인하여 일상적인 활동과 사회적 활동 및 업무능력에 상당히 제한(high disability)을 받는다고 보고하였다. 여성일수록, 나이가 많을수록, 통증병력이 길수록(>5년) 그리고 턱관절장애보다는 신경병성 통증과 복합성 구강안면통증 환자들이 더 심한 사회심리적 활동제한을 보였다.(p=0.000) 이러한 연구결과는 환자가 자신의 만성통증에 수반되는 사회적, 심리적 장애(disability)를 잘 이해할 수 있도록 사회심리적 지원이 필요하며, 가능한 한 조기에 전문가에게 내원하여 정확한 진단을 받을 필요가 있음을 보여준다.

• 대한소아치과학회지
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• 제38권1호
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• pp.25-32
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• 2011

거주지 주변 소아치과 전문 의원의 수가 빠르게 증가하고 있는 요즘 대학병원의 소아치과에 내원하는 환자들의 내원 경로와 내원 동기는 의원급 소아치과에 내원하는 환자의 내원 경로, 동기와는 다를 것으로 예상된다. 2010년 5월 1일부터 7월 31일까지 서울대학교 치과병원 소아치과에 신환으로 내원한 환자의 자료를 조사 분석하고, 보호자를 대상으로 한 설문 조사결과를 바탕으로 대학병원에 신환으로 내원한 환자의 내원 경로와 내원 동기 등에 관하여 알아보고, 환자 및 보호자가 어떠한 기준으로 병원을 선택하고 내원하는지 살펴보았다. 1. 조사기간 동안 내원한 신환의 평균 연령은 6.2세였다. 2. 전체 신환 중 남자 환자는 54.5%, 여자 환자는 45.5%로 남자가 여자보다 더 많은 비율을 차지하였다. 3. 보호자를 대상으로 한 설문조사에서 서울대학교 소아치과에 내원하게 된 경위는 타 치과에서 대학병원으로의 권유가 가장 많았으며, 그 다음은 주변의 추천, 예전에 치료 받던 병원이라서, 거주지와의 접근성이 좋음, 브랜드 네임, 인터넷 검색 순으로 나타났다. 4. 내원 전 타 치과를 방문한 경험이 있는 환자는 75%로 나타났다. 1) 타 치과 방문 후 내원한 환자의 71%는 1군데 방문 후 내원하였으며 3군데 이상 방문 후 내원한 환자도 약 4% 정도로 나타났다. 2) 이전에 방문한 치과의 전문성 여부를 살펴보았을 때 소아 전문치과가 아닌 곳을 방문 후 내원하는 경우가 약간 많게 나타났다. 3) 타 치과를 방문 후 본원에 다시 내원하게 된 이유는 진단의 정확성을 확인하기 위해서라는 경우가 60.7%로 가장 많았으며, 이전 병원에서 대학병원으로 의뢰, 비용상의 문제, 기타 의견, 이전 치과의 접근성 불편 순으로 나타났다. 90% 이상의 환자들이 진단의 정확성을 재확인하거나 이전 병원에서 대학병원으로 의뢰하여 재내원한 것으로 나타났다. 4) 본원에서 치료를 원치 않는 경우, 치료를 원치 않는 가장 큰 이유는 교통 불편, 접근성이 어렵다는 점이었다. 어린 연령의 환아와 보호자가 동행해야 하며 잦은 간격으로 여러 번 내원해야 하는 소아치과 진료의 특성상 접근성이 재내원 여부를 주저하는 가장 큰 요인으로 작용한 것으로 보인다.