• 대한치과보철학회지
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• 제57권3호
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• pp.219-224
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• 2019

목적:컴퓨터 가이드 임플란트 수술에서 방사선 영상과 디지털 영상과의 정합은 필수적인 과정이다. 본 연구의 목적은 마이크로스크류의 사용이 가이드 수술을 위한 영상정합 과정에서 작업시간과 술자편의성에 미치는 영향을 조사하는 것이다. 재료 및 방법: 연구모형의 제작을 위해 Kennedy class I 하악 덴티폼에 마이크로스크류 2개를 후구치 삼각 부위에 식립 후 컴퓨터 단층촬영과 디지털 스캔을 통해 방사선 영상과 스캔 영상을 획득하였다. 영상들은 잔존 치아 부위만을 이용하는 방법과 치아와 마이크로스크류를 이용하는 방법을 이용하여 12명의 술자에 의해 중첩되었다. 이 중첩된 영상에 대하여 작업시간, 술자편의성, 만족도의 자료가 수집되고, Mann-Whitney U test을 통해 분석되었다. 결과: 작업시간은 영상정합 조건 사이에 통계학적인 차이가 없었다 (P > .05). 술자편의성과 만족도는 치아와 마이크로스크류를 이용하는 방법에서 잔존 치아 부위만을 이용하는 방법보다 높았다 (P < .001). 결론: 영상정합에서 마이크로스크류의 이용은 작업시간의 단축에는 영향을 미치지 않지만 술자편의성과 만족도는 향상시킨다.

• Journal of Computing Science and Engineering
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• 제4권4호
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• pp.368-387
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• 2010

We propose a novel method for the registration of 3D CT scans to 2D endoscopic images during the image-guided medialization laryngoplasty. This study aims to allow the surgeon to find the precise configuration of the implant and place it into the desired location by employing accurate registration methods of the 3D CT data to intra-operative patient and interactive visualization tools for the registered images. In this study, the proposed registration methods enable the surgeon to compare the outcome of the procedure to the pre-planned shape by matching the vocal folds in the CT rendered images to the endoscopic images. The 3D image fusion provides an interactive and intuitive guidance for surgeon by visualizing a combined and correlated relationship of the multiple imaging modalities. The 3D Magic Lens helps to effectively visualize laryngeal anatomical structures by applying different transparencies and transfer functions to the region of interest. The preliminary results of the study demonstrated that the proposed method can be readily extended for image-guided surgery of real patients.

• Investigative Magnetic Resonance Imaging
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• 제19권3호
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• pp.191-195
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• 2015

We present a 53-year-old woman with a large chest wall mass in the interpectoral space, which was eventually confirmed as a lipogranuloma resulting from hydrogel implant rupture. Ultrasonography (US) showed reduced implant volume with surrounding peri-implant fluid collection, suggesting the possibility of implant rupture. A heterogeneously hypoechoic mass was found between the pectoralis major and minor muscles adjacent to the ruptured implant. On magnetic resonance imaging (MRI), there was a large mass in the left interpectoral space of the upper inner chest wall. The mass showed slightly high signal intensity (SI) on pre-contrast T1-weighted image (WI) with mixed iso and high SI on T2-WI. The signal of the mass was suppressed using the water suppression technique but not with the fat suppression technique on T2-WI. The mass showed diffuse enhancement upon contrast enhancement. The enhancing kinetics showed persistent enhancement pattern. US-guided core needle biopsy revealed a lipogranuloma and removal confirmed a ruptured PIP hydrogel implant.

• Journal of Periodontal and Implant Science
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• 제53권5호
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• pp.388-401
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• 2023

Purpose: This study investigated the accuracy of free-hand implant surgery performed by an experienced operator compared to static guided implant surgery performed by an inexperienced operator on an anterior maxillary dental model arch. Methods: A maxillary dental model with missing teeth (No. 11, 22, and 23) was used for this in vitro study. An intraoral scan was performed on the model, with the resulting digital impression exported as a stereolithography file. Next, a cone-beam computed tomography (CBCT) scan was performed, with the resulting image exported as a Digital Imaging and Communications in Medicine file. Both files were imported into the RealGUIDE 5.0 dental implant planning software. Active Bio implants were selected to place into the model. A single stereolithographic 3-dimensional surgical guide was printed for all cases. Ten clinicians, divided into 2 groups, placed a total of 60 implants in 20 acrylic resin maxillary models. Due to the small sample size, the Mann-Whitney test was used to analyze mean values in the 2 groups. Statistical analyses were performed using SAS version 9.4. Results: The accuracy of implant placement using a surgical guide was significantly higher than that of free-hand implantation. The mean difference between the planned and actual implant positions at the apex was 0.68 mm for the experienced group using the free-hand technique and 0.14 mm for the non-experienced group using the surgical guide technique (P=0.019). At the top of the implant, the mean difference was 1.04 mm for the experienced group using the free-hand technique and 0.52 mm for the non-experienced group using the surgical guide technique (P=0.044). Conclusions: The data from this study will provide valuable insights for future studies, since in vitro studies should be conducted extensively in advance of retrospective or prospective studies to avoid burdening patients unnecessarily.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권5호
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• pp.402-407
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• 2010

Introduction: The planning of implant surgery is an important factor for the implant prosthesis. Stereolithographic (SLA) surgical stents based on a computer simulation are quite helpful for clinicians to perform the surgery as planned. Although many clinical and technical trials have been performed for computed tomography (CT)-guided implant stents to improve the surgical procedures and prosthetic treatment, there are still many problems to solve. We developed a system of a surgical guide based on 3 dimensional (3D) CT for implant therapy and achieved satisfactory results in the terms of planning and operation. Materials and Methods: Fifteen patients were selected and 30 implant fixtures were installed. The preoperative CT data for surgical planning were prepared after obtaining informed consent. Surgical planning was performed using the simulation program, Ondemend3D In2Guide. The stents were fabricated based on the simulation data containing information of the residual bone, the location of the nerve, and the expected design of the prostheses. After surgery with these customized stents, the accuracy and reproducibility of implant surgery were evaluated based on the computer simulation. The data of postoperative CT were used to confirm this system using the image fusion technique and compare the implant fixtures between the planned and implanted. Results: The mean error was 1.18 (${\pm}0.73$) mm at the occlusal center, 1.23 (${\pm}0.67$) mm at the apical center, and the axis error between the two fixtures was $3.25^{\circ}C$ (${\pm}3.00$). These stents showed superior accuracy in maxilla cases. The lateral side error at the apical center was significantly different from the error at the occlusal center but there were no significant differences between the premolars, 1st molars and 2nd molars. Conclusion: SLA surgical stents based on a computer simulation have the satisfactory accuracy and are expected to be useful for accurate planning and surgery if some errors can be improved.

• 대한치과보철학회지
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• 제48권4호
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• pp.294-300
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• 2010

연구 목적: 컴퓨터-가이드 임플란트 수술은 전통적인 방법에 비해 여러 가지 장점을 가진다. 본 연구의 목적은 가이드 수술용 템플릿 제작을 위한 좌표동기화 5축 정밀가 공공정의 정확도를 범용 CAD 소프트웨어를 통해 역설계공학의 방법으로 평가하는 것이다. 연구 재료 및 방법: 악궁 형태의 모형에 거타퍼쳐 스타핑을 매식한 10 개의 모형을 만들고 상부에 실리콘 인상재를 이용하여 인공치은을 덮어 스타핑의 위치를 보이지 않게 가렸다. 모형의 하면에 동기화를 위한 좌표동기화 형상을 만든 뒤 Cone beam CT에서 3차원 영상을 얻었다. 임플란트 계획 소프트웨어의 CT 이미지 상에서 매식된 스타핑과 동일한 방향으로 스타핑의 1/2 깊이까지 가상의 시술계획을 하고, 스타핑의 방향벡터와 저지점 (1/2지점) 데이터를 석고모형의 영상으로 좌표동기화 하였다. 이후 모형하면의 좌표동기화 형상을 이용하여 가공기기상의 좌표로 좌표변환을 통해 가공좌표동기화를 하였다. 5축 밀링머신의 좌표동기화판에 모형을 고정한 후, 동기화된 가공데이터에 의거하여 스타핑과 동일한 직경의 드릴로 계획된 벡터와 깊이로 정확히 가공 하였다. 모델에 정확히 안착되는 인상트레이를 CT 장비에 미리 고정한 상태에서, 인상트레이에 모델을 적합하여 이미지를 획득한 뒤 3차원 재구성하는 방법으로 영상을 중첩하여 비교 분석하였다. SolidWorks (Dassault Systems, Concord, USA) 범용 CAD 상에 영상을 불러들여 역설계공학의 방법으로 실린더 상부, 하부의 중점에서의 위치편차와 각도편차를 조사하였다. 통계는 SPSS (release 14.0, SPSS Inc., Chicago, USA)를 이용하여 각 편차 사이의 상관관계를 분석하였다 ($\alpha$ = 0.05). 결과: 위치 편차로 인하여 모든 드릴 보어 (bore)에서 상부 1/2에 잔존하는 거타퍼쳐의 일부를 관찰할 수 있었다. 실험 모형상에서 계획된 이미지와 드릴링 후CT에서 역설계를 거친 이미지 사이의 위치편차는 상부에서 0.31 (0.15 - 0.42) mm, 하부에서 0.36 (0.24 - 0.51) mm, 각도편차는 1.62 (0.54 - 2.27)$^{\circ}$이었다. 실린더 상부와 하부 위치 편차는 양의 상관관계를 가졌다 (Pearson Correlation Coeffocient = 0.904, P= .013). 결론: 좌표동기화 5축 정밀가공 공정은 가이드 수술용 템플릿을 제작하는 데에 적합한 정확도를 가진다.

• Imaging Science in Dentistry
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• 제39권3호
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• pp.149-156
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• 2009

Purpose : The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. Materials and Methods : We devised a patient-specific stent for patient-to-image registration and navigation. Three-dimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. Results : The accuracy over 8 anatomical landmarks showed an overall mean of $0.56{\pm}0.16\;mm$. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. Conclusion : The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.

• 대한치과보철학회지
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• 제53권2호
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• pp.157-166
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• 2015

본 증례는 하악 완전 무치악 환자에서 인상채득과 석고모형 제작과정 없이 CBCT와 구강스캐너를 이용하여 수술 전에 한 번의 치과방문으로 임플란트 식립과 동시에 즉시 보철수복을 시행하는 방법을 제시하였다. 무치악 부위 연조직 형태, 수직교합고경, 상하악 악궁관계에 대한 정보는 환자가 사용하고 있는 의치를 스캔하여 얻었다. 이 방법은 무치악 환자에서 임플란트를 이용한 보철수복 과정을 기존의 방법보다 내원 횟수를 단축시켰다.

• Journal of Periodontal and Implant Science
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• 제50권6호
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• pp.406-417
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• 2020

Purpose: This study investigated whether the placement of ribose cross-linked collagen (RCLC) membranes without primary soft tissue closure predictably resulted in sufficient alveolar ridge preservation in contained and non-contained extraction sockets. Methods: Membranes were positioned across extraction sockets, undermining full-thickness flaps, and the gingival margins were fixed by double-interrupted sutures without crossed horizontal mattress sutures for 1 week. In non-contained sockets, a bone substitute was used to support the membrane within the bony envelope. Radiographs and clinical images obtained 4 months later were analyzed by ImageJ software using non-parametric tests. Results: In 18 patients, 20 extraction sockets healed uneventfully and all sites received standard-diameter implants (4.1, 4.8, or 5.0 mm) without additional bone augmentation. Soft tissues and the muco-gingival border were well maintained. A retrospective analysis of X-rays and clinical photographs showed non-significant shrinkage in the vertical and horizontal dimensions (P=0.575 and P=0.444, respectively). The new bone contained vital bone cells embedded in mineralized tissues. Conclusions: Within the limitations of this pilot study, open healing of RCLC membranes may result in sufficient bone volume for implant placement without additional bone augmentation in contained and non-contained extraction sockets.

• Journal of Periodontal and Implant Science
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• 제26권3호
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• pp.771-778
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• 1996

The assessment of alveolar bone changes on dental radiographs to indicate progression of periodontal diseases or healing response to therapy is routine procedure. However, the diagnostic accuracy in detecting small alveolar bone changes is very limited. Recently, guided bone regeneration therapy is popular, but the quantification of new bone is somewhat difficult with conventional evaluation method. To quantificate the amount of new bone, various evaluating methods have been introduced including histomorphometry, radiomorphometry, biochemical analysis, X-ray probe microanalysis, scanning electron microscope backscatter method. In this study, guided bone regeneration using resorbable membrane with & without PDGF-BB is quatificated through histomorphmetry to evaluate the efficacy of histomorphometric analysis. 4 beagle dogs and 8 Sprague-Dawley rats were selected as experimental animals. In beagle dog experiment, $4{\times}4mm$ Class II defects were created in maxillary both second premolars, and biodegradable membrane containing PDGF-BB(experimental group) were covered over one defect, and same membrane without PDGF-BB(control group) were covered over the other defect. At 2 weeks, 5 weeks after surgery, each beagle dogs were sacrificed, and the tissues were treated by undecalcified fixation. In Sprague-Dawley rat experiment, 5mm round defect were created in temporal bone, the same membranes were covered on the defects. At 1 week, 2 weeks after surgery, each rats were sacrificed, and undecalcified fixation were taken. After grinding tissue specimen, we analyse them histomorphometrically using image analysis system. In beagle dog 2 weeks specimens, new bone formation area were $0.03123mm^2$ in experimental group,and $0.03012mm^2$ in control group. At 5 weeks specimens, $0.15324mm^2$ in experimental group, and $0.09123mm^2$ in control group. In Sprague-Dawley rat specimens, new bone fomation area were $0.20448mm^2$ in 1 week experimental group, $0.03604mm^2$ in 1 week control group. At 2 weeks specimens, $0.46349mm^2$ in experimental group, $0.17741mm^2$ in control group. The results indicated that histomorphometric analysis of new bone formation using image analysis system is very effective quantification method to evaluate the efficacy of treatment modalities.