• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권1호
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• pp.27-30
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• 2013

Dental implantation in the mandibular anterior region is considered a safe and reliable surgical procedure. On the other hand, several articles have reported that inadvertent hemorrhage of the sublingual artery can result in life-threatening airway obstruction. Surgical ligation under intubation or tracheostomy is the most widely used approach for controlling mouth floor bleeding in this highly vascular region. Nonetheless, surgically exploring the bleeding focus is difficult because of anatomical distortion followed by widespread edema and swelling. Since swelling of the mouth floor advances quickly, timely management is essential for favorable postoperative outcome. This paper reports a case of immediate hemorrhage control with angiographic embolization to perform rapid hemostasis before the ongoing swelling causes airway obstruction. Less invasive, angiographic embolization can prevent neurovascular damage during a surgical exploration of injured vascular structures on the mouth floor.

• Journal of Periodontal and Implant Science
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• 제51권3호
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• pp.213-223
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• 2021

Purpose: The atmospheric pressure plasma jet (APPJ) has been introduced as an effective disinfection method for titanium surfaces due to their massive radical generation at low temperatures. Helium (He) has been widely applied as a discharge gas in APPJ due to its bactericidal effects and was proven to be effective in our previous study. This study aimed to evaluate the safety and effects of He-APPJ application at both the cell and tissue levels. Methods: Cellular-level responses were examined using human gingival fibroblasts and osteoblasts (MC3T3-E1 cells). He-APPJ was administered to the cells in the experimental group, while the control group received only He-gas treatment. Immediate cell responses and recovery after He-APPJ treatment were examined in both cell groups. The effect of He-APPJ on osteogenic differentiation was evaluated via an alkaline phosphatase activity assay. In vivo, He-APPJ treatment was administered to rat calvarial bone and the adjacent periosteum, and samples were harvested for histological examination. Results: He-APPJ treatment for 5 minutes induced irreversible effects in both human gingival fibroblasts and osteoblasts in vitro. Immediate cell detachment of human gingival fibroblasts and osteoblasts was shown regardless of treatment time. However, the detached areas in the groups treated for 1 or 3 minutes were completely repopulated within 7 days. Alkaline phosphatase activity was not influenced by 1 or 3 minutes of plasma treatment, but was significantly lower in the 5 minute-treated group (P=0.002). In vivo, He-APPJ treatment was administered to rat calvaria and periosteum for 1 or 3 minutes. No pathogenic changes occurred at 7 days after He-APPJ treatment in the He-APPJ-treated group compared to the control group (He gas only). Conclusions: Direct He-APPJ treatment for up to 3 minutes showed no harmful effects at either the cell or tissue level.

• Journal of Periodontal and Implant Science
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• 제52권1호
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• pp.77-87
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• 2022

Purpose: This pilot study assessed the immediate in vivo effect of high peak pulse power neodymium-doped yttrium aluminum garnet (Nd:YAG) laser monotherapy on selected red/orange complex periodontal pathogens in deep human periodontal pockets. Methods: Twelve adults with severe periodontitis were treated with the Laser-Assisted New Attachment Procedure (LANAP®) surgical protocol, wherein a free-running, digitally pulsed, Nd:YAG dental laser was used as the initial therapeutic step before mechanical root debridement. Using a flexible optical fiber in a handpiece, Nd:YAG laser energy, at a density of 196 J/cm² and a high peak pulse power of 1,333 W/pulse, was directed parallel to untreated tooth root surfaces in sequential coronal-apical passes to clinical periodontal probing depths, for a total applied energy dose of approximately 8-12 joules per millimeter of periodontal probing depth at each periodontal site. Subgingival biofilm specimens were collected from each patient before and immediately after Nd:YAG laser monotherapy from periodontal pockets exhibiting ≥6 mm probing depths and bleeding on probing. Selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, and Campylobacter species) were quantified in the subgingival samples using established anaerobic culture techniques. Results: All immediate post-treatment subgingival biofilm specimens continued to yield microbial growth after Nd:YAG laser monotherapy. The mean levels of total cultivable red/orange complex periodontal pathogens per patient significantly decreased from 12.0% pretreatment to 4.9% (a 59.2% decrease) immediately after Nd:YAG laser monotherapy, with 3 (25%) patients rendered culture-negative for all evaluated red/orange complex periodontal pathogens. Conclusions: High peak pulse power Nd:YAG laser monotherapy, used as the initial step in the LANAP® surgical protocol on mature subgingival biofilms, immediately induced significant reductions of nearly 60% in the mean total cultivable red/orange complex periodontal pathogen proportions per patient prior to mechanical root instrumentation and the rest of the LANAP® surgical protocol.

• 구강회복응용과학지
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• 제27권3호
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• pp.267-275
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• 2011

구치부 부분 결손 환자에서 즉시하중군과 지연하중군의 임상적 성공률을 측정하기 위한 전향적 연구가 계획되었다. 즉시하중군에서는 17명의 환자에 42개의 GSIII 임플란트(Osstem, Korea)를 식립하고 48시간 안에 하중을 가하였다. 대조군인 지연하중군에서는 15명의 환자에 27개의 GSIII 임플란트를 식립하고 평균 $2.6{\pm}1.7$개월 후에 하중을 가하였다. 하중 전 1차안정성을 ISQ로 측정하였고 임상증상, 동요도, 연조직 반응을 식립 직후, 3개월 후, 6개월 후, 12개월 후에 평가하였다. 변연골 흡수량은 치근단 방사선 영상으로 측정하였고 Mann-Whitney test (${\alpha}$=0.05)와 repeated measured ANOVA (${\alpha}$=0.05)로 두 군의 차이를 검정하였다. 식립 직후 실험군과 대조군의 ISQ는 각각 $80.3{\pm}7.1$과 $69{\pm}17$이었다. 실험군은 95.23%의 성공률을, 대조군은 100% 성공률을 나타냈다. 3개월과 6개월 후 실험군의 변연골 흡수량은 대조군에 비해 유의성 있게 컸다(p<0.05). 하지만 12개월 후 두 군의 차이는 관찰되지 않았다 (p>0.05). 변연골 흡수량은 성별과 식립위치에 따른 차이가 없었다 (p>0.05). 실험의 한계 내에서, 1차안정성이 획득된다면 구치부 식립 GSIII 임플란트의 즉시하중은 예지성 있는 치료법이라고 여겨진다.

• Archives of Plastic Surgery
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• 제38권2호
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• pp.212-216
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• 2011

Purpose: Ameloblastomas are rare benign tumors of odontogenic origin, and compose about 1% of all oral and maxillomandibular cysts and tumors. Because this neoplasm has a high rate of local recurrence, segmental mandibulectomy with a 1~2 cm safety margin and immediate microsurgical reconstruction is an accepted treatment modality. The authors experienced four mandibular reconstruction cases that underwent secondary dental implantation. Here, the authors describe these cases and their long-term results. Methods: Four patients with ameloblastoma of the mandible underwent segmental mandibulectomy and reconstruction with a free fibula osseous flap from January 1999 to May 2005, followed by secondary dental implantation. Recurrence, bony union, implant osseointegration, and functional and aesthetic results were evaluated by radiologic imaging, by physical examination, and by using photographs. Results: All free flaps survived with no evidence of flap loss. To date, no recurrence has been noted clinically or radiologically. Imaging after mandibular reconstruction with a free fibular flap revealed satisfactory bony unions and mandibular contours. The patients achieved good aesthetic and functional results after the secondary implantation. Conclusion: Mandibular reconstruction using a fibular osseous flap and secondary dental implantation can produce good functional and aesthetic results after segmental mandibulectomy for ameloblastoma.

• Journal of Periodontal and Implant Science
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• 제51권2호
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• pp.100-113
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• 2021

Purpose: Previous studies have solely focused on fresh extraction sockets, whereas in clinical settings, alveolar sockets are commonly associated with chronic inflammation. Because the extent of tissue destruction varies depending on the origin and the severity of inflammation, infected alveolar sockets may display various configurations of their remaining soft and hard tissues following tooth extraction. The aim of this study was to classify infected alveolar sockets and to provide the appropriate treatment approaches. Methods: A proposed classification of extraction sockets with chronic inflammation was developed based upon the morphology of the bone defect and soft tissue at the time of tooth extraction. The prevalence of each type of the suggested classification was determined retrospectively in a cohort of patients who underwent, between 2011 and 2015, immediate bone grafting procedures (ridge preservation/augmentation) after tooth extractions at Seoul National University Dental Hospital. Results: The extraction sockets were classified into 5 types: type I, type II, type III, type IV (A & B), and type V. In this system, the severity of bone and soft tissue breakdown increases from type I to type V, while the reconstruction potential and treatment predictability decrease according to the same sequence of socket types. The retrospective screening of the included extraction sites revealed that most of the sockets assigned to ridge preservation displayed features of type IV (86.87%). Conclusions: The present article classified different types of commonly observed infected sockets based on diverse levels of ridge destruction. Type IV sockets, featuring an advanced breakdown of alveolar bone, appear to be more frequent than the other socket types.

• 구강회복응용과학지
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• 제25권3호
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• pp.243-253
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• 2009

임플란트 술식에서 방사선 영상 기술, 컴퓨터 소프트웨어의 발전으로 정확한 진단 및 surgical guide의 제작이 가능해졌다. 본 증례는 양악 무치악 환자에서 고정성 임플란트 보철을 위해 CAD/CAM technique을 이용하여 수술을 하고 즉시 하중을 가한 증례이다. Planning software program을 이용하여 해부학적 구조물과 단면상을 고려하여 상 하악에 각각 6개씩의 임플란트를 최적의 위치에 계획하였다. 정밀한 surgical guide 이용하여 미리 계획된 위치와 방향으로 무절개 임플란트 식립 수술을 시행하였다. 즉시 사용 가능한 고정성 임시 보철물을 미리 제작해 수술 직후 장착하여 환자의 만족도를 높였으며, 이를 6개월간 평가하여 심미적이며, 기능적으로 안정적인 최종 보철물을 제작할 수 있었다.

• 대한치과보철학회지
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• 제57권3호
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• pp.245-253
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• 2019

골격성 3급 부정교합의 악교정 수술로 구강기능과 안모를 개선할 수 있다. 악골부조화가 클수록 술전 교정치료에 의한 치아 이동량이 더욱 커지기 때문에 치주조직에도 큰 변화를 줄 수 있는데, 특히 하악 전치부 치주조직의 파괴가 주로 발생된다. 이 보고는 20년전 골격성 3급 부정교합과 하악전돌로 악교정수술을 받은 후 하악 전치부의 심한 동요 및 반대교합의 해결을 위해 내원한 49세 여성환자의 증례로, Face Hunter, Plane System 및 ARCUS digma II를 이용하여 Top-Down concept의 개인 맞춤형 분석으로 치료계획을 수립하였다. 하악 전치부 발치를 동반한 순측 치조골 성형술과 임플란트 식립 후 즉시임시치관에 의한 즉시부하를 시행하였다. 최종 보철물은 CAD/CAM에 의한 Zirconia 수복물로 제작 후 구강 내에서 나사유지형으로 장착하였다. 6개월이 경과한 현재까지 보철물의 파절과 동요 등은 관찰되지 않았으며, 기능 및 심미적으로 만족스러운 결과를 얻었기에 보고하고자 한다.

• 대한심미치과학회지
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• 제32권1호
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• pp.16-22
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• 2023

상악 전치부 임플란트 수복의 성공에 있어서 심미적인 요소는 매우 중요한 부분입니다. 하지만 심미적인 결과를 얻는 것은 쉬운 일이 아니며 특히 치주염으로 인해 치조골 소실이 심하게 발생한 경우라면 더욱 그러합니다. 상악 전치부의 경우, 발치 직후부터 시작되는 치주 조직의 위축이 심미적 수복을 방해하므로 이를 최소화하기 위해 발치 즉시 임플란트를 시행하기도 합니다. 하지만 치조골 소실이 심한 경우 발치 즉시 식립은 심미적 실패를 가져올 가능성이 있고, 이런 결과는 돌이킬 수 없는 문제를 야기합니다. 그래서 치조제 보존술(Alveolar ridge preservation)을 시행하고 이후에 임플란트를 식립하는 방법으로 접근하기도 합니다. 2019년 JCP에 발치 후 임플란트 식립 시기와 발치와 처치에 대한 유럽치주학회의 consensus가 수록되어 있는데 여기서도 '심미적으로 중요한 부위에서 순측 치조골의 소실이 심하게 발생한 경우 치조제 보존술을 고려해야 한다고 언급하고 있습니다. 치조제 보존술을 하게 되면 primary closure가 어렵기 때문에 open membrane technique으로 이차치유를 유도하거나 FGG, CT graft를 시행하게 됩니다. 하지만 이차 치유 과정은 골재생에 부정적인 영향을 줄 수 있고, 연조직 이식은 환자와 술자에게 부담이 될 수 있습니다. 반면 치조골 결손이 심한 발치와에 있는 육아 조직(Granulation tissue)을 이용하게 되면 연조직 이식 없이도 primary closure를 얻을 수 있습니다. 또한 육아 조직에 조직 재생에 도움이 될 수 있는 줄기세포가 함유되어 있다는 연구들이 있습니다. 이를 근거로 치조골 및 연조직 결손이 심한 상악 전치부 치아를 육아 조직을 이용한 치조제 보존술을 통해 임플란트 수복을 시행하였습니다. 결손이 심한 발치와임에도 불구하고 비교적 심미적인 임플란트 수복 결과를 얻을 수 있었습니다.

• Journal of Korean Dental Science
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• 제2권2호
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• pp.12-17
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• 2009

Purpose : To determine whether peri-implant crestal bone loss could be affected by systemic disease, primary ISQ value, implantation method (submerged vs. non-submerged), surface treatment, and bone density Materials and methods : Patients who underwent fixture installation from June 24, 2005 to October 23, 2008 at Seoul National University Bundang Hospital were evaluated. A total of 157 patients (male: 52, female: 85) had 346 fixtures installed. Among them, 49 patients had periapical radiographs taken 1 year after prostheses were first set. A total of 97 fixtures were implanted. In particular, 30 fixtures were installed in patients with systemic diseases such as diabetes mellitus, cardiovascular disease, hypertension, and liver disease. The immediate stability of implants was measured with $Osstell^{tm}$. Implant surface treatment was classified into two groups (RBM, Cellnest (Anodized)), and bone density, into four groups (D1~D4). The bone resorption on the mesial and distal areas of fixtures was measured with periapical radiographs using the paralleling technique, and the mean value was calculated. The length determination program in IMPAX (AGFA, Belgium) was used. Results : At least 332 out of 346 (96%) installed GS II implants were successfully osseointegrated 1 year after prostheses were first set. The mean value of the bone resorption of the installed GS II implants was 0.44mm. The minimum value was 0mm, and the maximum value, 2.85mm. There was a statistically significant difference between the implantation methods (submerged, non-submerged) with regard to the amount of alveolar bone loss 1 year after prostheses were first set (p<0.05). Non-submerged implants showed less crestal bone loss. Note, however, that other variables had no correlation with crestal bone loss (p>0.05). Conclusion : There was a statistically significant difference between the 1-stage method and 2-stage method with regard to the amount of alveolar bone loss 1 year after prostheses were first set. Systemic disease, primary ISQ value, surface treatment, and bone density were not associated with alveolar bone loss. Other variables were assumed to have a correlation with alveolar bone loss.