• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제37권
• /
• pp.27.1-27.7
• /
• 2015

The aim of this study was to evaluate the clinical relevance of autogenous fresh demineralized tooth (Auto-FDT) prepared at chairside immediately after extraction for socket preservation. Teeth were processed to graft materials in block, chip, or powder types immediately after extraction. Extraction sockets were filled with these materials and dental implants were installed immediately or after a delay. A panoramic radiograph and a conebeam CT were taken. In two cases, tissue samples were taken for histologic examination. Vertical and horizontal maintenance of alveolar sockets showed some variance depending on the Auto-FDT and barrier membrane types used. Radiographs showed good bony healing. Histologic sections showed that it guided good new bone formation and resorption pattern of the Auto-FDT. This case series shows that Auto-FDT prepared at chairside could be a good material for the preservation of extraction sockets. This study will suggest the possibility of recycling autogenous tooth after immediate extraction.

• 대한두개안면성형외과학회지
• /
• 제16권1호
• /
• pp.24-28
• /
• 2015

Background: Acute auriculocephalic angle refers to an ear with helix that is spaced closely to the cranium. An increasing number of patients with acute auriculocephalic angle wish to undergo corrective operation for aesthetic purposes. However, there is a paucity of data regarding acute auriculocephalic angle. This paper proposes a treatment protocol for patients with acute auriculocephalic angle. Methods: We performed a retrospective analysis of patients undergoing acute auriculocephalic angle (4 patients, 6 ears). Patient records were reviewed for demographic data as well as auricular measurements at preoperative, immediate postoperative and final follow-up evaluations. Results: All of the patients were men with a mean age of 36.5 years (range, 23-52 years). The mean follow-up period was 47.5 months (range, 28-60 months). Postoperative auriculocephalic angle was close to the normal auriculocephalic angle ($25^{\circ}-30^{\circ}$) without notable scars. Moreover, the patients had minimal contractions of the skin flaps without any hematoma or relapse. Conclusion: We propose the following three treatment protocols for patients with acute auriculocephalic angle: the posterior auricular muscle should be sufficiently released, the mastoid area should be augmented using implants, the skin should be repositioned with a superior auricular flap.

• 대한심미치과학회지
• /
• 제23권1호
• /
• pp.34-40
• /
• 2014

부분 무치악을 수복하는 데 있어서 선택할 수 있는 치료의 옵션으로는 전통적인 국소의치와 임플란트 지지-고정성 보철물 등이 있다. 하지만, 환자의 전신적 또는 구강의 상태(수술적인 술식이 제한되는 전신병력, 지지조직의 부족 그리고 골유착에 실패한 임플란트)와 치료비용에 대한 허용 정도에 따라 모든 옵션이 항상 가능한 것은 아니다. 가철성 국소의치는 임플란트 고정성 보철물에 비해 구강위생 관리 및 상,하악 악간관계의 부조화를 수정하기에 편리한 장점이 있다. 최근에는 전략적 위치에 임플란트를 식립하여 기존 악궁 형태에서는 제한되는 국소의치 디자인의 한계를 개선할 수 있는 임플란트지지형 RPD(Implant Supported Removable Partial Denture)가 새로운 방안으로 대두되고 있다. ISRPD는 전략적 위치에 임플란트를 식립하여 역학적인 한계를 극복할 수 있을 뿐 만 아니라 전악의 임플란트지지형 고정성 보철이 제한되는 환자에서 보다 경제적이고 현실적인 보철적 해결책이 될 수 있다. 따라서, RPD를 이용한 보철계획 수립시 전략적 위치에서의 임플란트의 사용은 고전적인 가철성 국소 의치에서보다 유지력과 안정성을 증진시키고 구강위생관리 또한 용이하여 환자의 적응도를 높이는 방안으로 고려될 수 있다. 본 증례는 상악 양측 구치부의 임플란트 고정성 보철,하악의 bar-type overdenture를 사용중이던 59세 남성환자에서 상악 #15i임플란트의 abutment screw fracture와 임플란트의 골유착 실패로 인한 다수 임플란트를 발거 후 남은 #15i,24i,25,26,i의 잔존 임플란트와 #23 자연치를 활용해 상악에 ISRPD를 적용한 경우이다. #23 surveyed crown, #24i=25i=26i surveyed bridge 및 #15i에 gold coping을 제작하여 국소의치의 지지와 유지,안정을 도모하였다.최종 보철물을 장착하고 2년간 주기적인 follow up 통해 예후를 관찰중이며 지대치로 사용한 임플란트에서 screw loosening이나 파절, 골흡수 등의 증상은 현재까지 관찰되지 않았다.

• Journal of Periodontal and Implant Science
• /
• 제48권6호
• /
• pp.360-372
• /
• 2018

Purpose: It has been suggested that resonance frequency analysis (RFA) can measure changes in the stability of dental implants during osseointegration. This retrospective study aimed to evaluate dental implant stability at the time of surgery (primary stability; PS) and secondary stability (SS) after ossseointegration using RFA, and to investigate the relationship between implant stability and cortical bone thickness. Methods: In total, 113 patients who attended the Tohoku University Hospital Dental Implant Center were included in this study. A total of 229 implants were placed in either the mandibular region (n=118) or the maxilla region (n=111), with bone augmentation procedures used in some cases. RFA was performed in 3 directions, and the lowest value was recorded. The preoperative thickness of cortical bone at the site of implant insertion was measured digitally using computed tomography, excluding cases of bone grafts and immediate implant placements. Results: The mean implant stability quotient (ISQ) was $69.34{\pm}9.43$ for PS and $75.99{\pm}6.23$ for SS. The mandibular group had significantly higher mean ISQ values than the maxillary group for both PS and SS (P<0.01). A significant difference was found in the mean ISQ values for PS between 1-stage and 2-stage surgery (P<0.5). The mean ISQ values in the non-augmentation group were higher than in the augmentation group for both PS and SS (P<0.01). A weak positive correlation was observed between cortical bone thickness and implant stability for both PS and SS in all cases (P<0.01). Conclusions: Based on the present study, the ISQ may be affected by implant position site, the use of a bone graft, and cortical bone thickness before implant therapy.

• 대한치과보철학회지
• /
• 제61권4호
• /
• pp.284-292
• /
• 2023

안정적인 구치부 교합지지는 적절한 저작기능과 정상적인 안모의 유지를 위해 매우 중요하다. 특히 65세 이상의 고령환자에서는 저작기능이 충분한 영양섭취와 환자의 전신건강에 직접적인 영향을 미친다. 본 증례에서는 상악 무치악, 하악 양측 구치부 치아 상실을 보이는 고령환자의 구치부 교합지지를 회복해주기 위해 상악 총의치를 제작하여 이상적인 교합평면을 설정하였고, 하악 양측 구치부에 컴퓨터 가이드 임플란트 식립 수술을 진행하였다. 임플란트 지지 임시 수복물을 이용한 임플란트 즉시부하를 통해 환자가 수술 후에도 음식 섭취를 원활하게 할 수 있도록 하였다. 하악 구치부 지르코니아 고정성 보철수복을 완료한 후, 상악 총의치 인공치의 교합면을 Cobalt-Chrome계 금속 합금으로 치환하여 마모 저항성을 향상시켰다. 상악 가철성 총의치, 하악 양측 구치부 고정성 보철 치료를 통해 환자의 교합지지와 저작기능을 빠르게 회복해주고, 최종 치료단계에서는 마모에 대한 장기적 안정성도 얻을 수 있었기에 이를 보고하고자 한다.

• 대한치과보철학회지
• /
• 제56권4호
• /
• pp.330-337
• /
• 2018

무치악 환자에게 임플란트 지지 고정성 보철수복 치료는 그 효용성이 검증되었으나, 복잡한 치료과정이 수반된다. 반면, 현대 치의학에서 디지털 기술력은 나날이 발전하여 현재 무치악 환자의 임플란트 수복치료까지 그 범위를 확장하였다. 본 증례에서는 66세 하악 무치악 환자의 임플란트 고정성 보철 수복에 대하여 진단부터 수술, 임시수복물 및 최종수복물의 디자인과 제작까지 디지털 시스템을 모든 단계에 이용하였다. 수술 전 진단단계에서 구강스캐너를 이용한 점막스캔과 환자의 안정적인 기존 총의치 교합을 토대로 임시수복물을 디자인하였다. 수술가이드를 이용하여 무절개 임플란트 식립 후에 사전제작한 임시수복물을 임플란트와 연결하여 즉시 임시수복물로써 사용하였다. 디지털 기술을 이용하여 안정적인 교합이 형성된 임시수복물의 수직고경과 중심위를 이전하여 최종수복물을 디자인 및 제작 하였다. 디지털 기술을 활용하여 환자의 수직고경과 교합을 보전하는 방법을 사용함으로써 무치악환자에서 복잡할 수 있는 임플란트 치료의 간단한 프로토콜을 정립하였기에 보고하는 바이다.

• 대한치과보철학회지
• /
• 제38권4호
• /
• pp.552-560
• /
• 2000

Purpose : The purpose of this study was to determine proper position and angulation of an implant for immediate implantation. Materials and Method : From the years 1997 to 2000. 52 Denta $scan^R$ views, 22 upper and 32 lower jaw with an average age of 43 and 40 respectively, were investigated, which comprise intact upper and lower 6 anterior teeth and premolars. On the Denta $scan^R$, the optimal placement for the immediated implantation was simulated. The measuring methods included 1) Angulation difference between tooth long axis and alveolar bone process. 2) Angulation difference of long axis between tooth and installing fixture 3) Distance between center of tooth at cervical area and center of fixture. 4) Distance from root apex to the bone limit of vital structure. One sample t-test was used for statistical analysis. Result : The results were as follows. 1) At the maxillary central incisor and lateral incisor, angulation difference of long axis between tooth and installing fixture was respectively 0.5 and 3.2 degrees with the fixture center's palatally positioned 2mm apart from tooth center. 2) At the lower anterior 6 teeth, that was about $-2.8^{\circ}\;to\;-4.6^{\circ}$ with the fixture center's lingually positioned 1mm apart from tooth center. 3) At the maxillary canine and premolar, that was respectively $11.8^{\circ}\;and \;7.2^{\circ}$ with the fixture center palatally positioned $2\sim2.4mm$ apart from tooth center. 4) At the lower premolar area, that was about $0^{\circ}\;to\;2^{\circ}$ with the fixture center's lingually positioned $0.5{\sim}1mm$ apart from tooth center. 5) Distance from root apex to the bone limit of vital structure, at the maxillary anterior and premolars. was the range of 10 to 12mm, and at the mandibular anterior teeth and the 1st premolar, that was the range of 18 to 20mm. Conclusion : The proper implant position of maxillary anterior and premolar teeth is as paralleled as or more buccally angulated than long axis of tooth with the fixture center's palatally positioned. In mandiblular anterior region, long axis of implants is lingully angulated compared with long axis of tooth and in premolar, almost parelleled with long axis of tooth and alveolar process.

• 대한심미치과학회지
• /
• 제26권1호
• /
• pp.17-23
• /
• 2017

임플란트 식립시기가 심미적인 부분에 영향을 미치는 것에 대한 연관성을 평가하기 위해 전치부 영역에 식립된 34개의 임플란트 (27명 환자)를 후향적으로 조사했다. 즉시, 조기 및 지연식립으로 시기별로 그룹을 나누고 모든 환자를 보철완료 1년후에 연조직 평가를 시행했다. 통계적으로 그룹별 유의한 의미는 없었다. 식립 시기에 상관없이 만족할 만한 최종결과를 위해 다양한 골이식술과 연조직 이식술이 이루어졌다. 즉, 식립시기로 그 결과를 결정지을 수 없다는 점은 다각적인 면에서 고려사항이 요구된다는 점을 시사한다.

• Archives of Plastic Surgery
• /
• 제45권3호
• /
• pp.229-238
• /
• 2018

Background Nipple-sparing mastectomies (NSMs) are increasingly performed to obtain the best aesthetic and psychological outcomes in breast cancer treatment. However, merely preserving the nipple-areolar complex (NAC) does not guarantee a good outcome. Darkly pigmented NACs and a tendency for poor scarring outcomes are particular challenges when treating Asian patients. Herein, we review the reconstructive outcomes following NSM at Singapore General Hospital. Methods All breasts reconstructed following NSM over an 11-year period from 2005 to 2015 were reviewed. Information was collected from the patients' records on mastectomy indications, operative details, and complications. Patient satisfaction, breast sensation, and aesthetic outcomes were evaluated in 15 patients. Sensation was quantified using the Semmes-Weinstein monofilament test. Results A total of 142 NSMs were performed in 133 patients for breast cancer (n=122, 85.9%) or risk reduction (n=20, 14.1%). Of the procedures, 114 (80.2%) were autologous reconstructions, while 27 (19.0%) were reconstructions with implants. Complications occurred in 28 breasts (19.7%), with the most common complication being NAC necrosis, which occurred in 17 breasts (12.0%). Four breasts (2.8%) had total NAC necrosis. The overall mean patient satisfaction score was 3.0 (good). The sensation scores were significantly diminished in the skin envelope, areola, and nipple of breasts that had undergone NSM compared to non-operated breasts (P<0.05). Half of the subset of 15 patients in whom aesthetic outcomes were evaluated had reduced nipple projection. Conclusions Immediate reconstruction after NSM was performed with a low complication rate in this series, predominantly through autologous reconstruction. Patients should be informed of potential drawbacks, including NAC necrosis, reduced nipple projection, and diminished sensation.

• The Korean Journal of Pain
• /
• 제34권1호
• /
• pp.106-113
• /
• 2021

Background: We aimed to investigate the analgesic efficacy of an erector spinae plane block (ESPB) in immediate breast reconstruction (IBR) with a tissue expander. Methods: Adult women undergoing IBR with a tissue expander after mastectomy were randomly assigned to either intravenous patient-controlled analgesia (IV-PCA) alone (group P) or IV-PCA plus ESPB (group E). The primary outcome was the total amount of opioid consumption during 24 hours postoperatively between the two groups. Secondary outcomes were patient satisfaction, pain score at rest and on shoulder movement using numerical rating scale, incidences of postoperative nausea and vomiting (PONV), and a short form of the brief pain inventory (BPI-SF) at 3 and 6 months after surgery between the groups. Results: Fifty eight patients completed the study. At 24 hours postoperatively, total opioid consumption was significantly less in group E than in group P (285.0 ± 92.0, 95% confidence interval [CI]: 250.1 to 320.0 vs. 223.2 ± 83.4, 95% CI: 191.5 to 254.9, P = 0.005). Intraoperative and cumulative PCA fentanyl consumption at 3, 6, 9, and 24 hours were also less in group E than in group P (P = 0.004, P = 0.048, P = 0.020, P = 0.036, and P < 0.001, respectively). Patient satisfaction was higher in group E (6.9 ± 1.8 vs. 7.8 ± 1.4, P = 0.042). The incidences of PONV was similar. Conclusions: The ESPB decreased postoperative opioid consumption and increased patient satisfaction without significant complications after IBR with a tissue expander after mastectomy.