• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권3호
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• pp.338-345
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• 1991

선천성 혹은 술후성 기형으로 발생하는 구개인두 부전증은 구강과 비강사이의 부적절한 폐쇄기능으로 인해 과비음 등의 발음장애를 초래한다. 그 원인으로는 구개파열, 인두비대증, 편도선절제술후의 구개와 인두의 비율 부조화, 구개인두 괄약근의 기형, 구래부전마비, 연구개 결손, 상악골 전진 절단술 등이 있다. 구개인두 부전증의 진단에는 임상적, 방사선학적 검사와 더불어 섬유광학 비내시경을 이용한 구개인두의 기능검사가 강조된다. 수술방법으로는 구개성형술, 인두증강술, 인두성형술, 인두피판술 등이 있다. 근자에는 상부기저형 인두피판술이 널리 사용되고 있는데, Hogan등이 개선시킨 술식에 의하면, 넓고 긴 피판을 얻을 수 있고 피판의 Raw surface를 연구개의 비강측 점막으로 덮을 수 있으며 측방 통로를 조절할 수 있다는 장점이 있다. 이에 저자등은 본인에 내원한 구개인두 부전증 환자 7례에서 상부기저형 인두피판을 이용하여 구강과 비강 사이의 측방 통로를 적절히 조절함으로서 발음을 개선시켜 본 바 양호한 임상성적을 얻었기에 보고하는 바이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권6호
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• pp.324-331
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• 2023

Objectives: The purpose of this study was to evaluate the outcomes of implants placed in horizontally augmented alveolar ridges using porcine bone grafts and to investigate the long-term stability of the porcine bone grafts. Materials and Methods: A retrospective analysis was conducted on 49 sites that underwent horizontal ridge augmentation using porcine bone grafts and implant placement with a follow-up period longer than 5 years. Furthermore, additional analysis was conducted on 24 sites where porcine bone grafts were used exclusively for horizontal ridge augmentation and implant placement. Results: The mean follow-up period after prosthesis loading was 67.5 months, with a mean marginal bone loss of 0.23 mm at 1 year and a cumulative mean marginal bone loss of 0.40 mm over the entire follow-up period. Of the 49 implants, 2 were lost and 3 did not meet the success criteria, resulting in a survival rate of 95.9% and a success rate of 89.8%. In 24 sites, the mean marginal bone loss was 0.23 mm at 1 year and 0.41 mm at 65.8 months, with 100% survival and success rates. Conclusion: Porcine bone grafts can be successfully used in horizontal ridge augmentation for implant placement in cases of ridges with insufficient horizontal width.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권2호
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• pp.154-165
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• 2006

Objectives : It is difficult to place implants at a severely atrophied edentulous mandible because of vertical and horizontal alveolar defect. The autogenous and allogenic bone graft and guided bone regeneration are useful, but there are some limitations such as the resorption and infection of the grafted bone, and insufficiency of soft tissue. Distraction osteogenesis has recently evolved a challenging technique to overcome major draws of conventional augmentation procedures, we, therefore, report the four applications of implant placement after vertical alveolar distraction osteogenesis. Patients and Methods : Four patients(all female, mean age: $60{\pm}6$ years) with severe alveolar ridge deficiencies at their anterior mandible were treated with vertical alveolar distraction osteogenesis by intraoral device(Track 1.5, 15 mm model, KLS Martin, Tuttlingen, Germany) and placement of implants (Branemark MK III, TiUnite). After the latency periods of 5, 7, 8 days, distraction rhythm and rate were $0.5\;mm{\times}2\;times/day$ in the case of good bone quality, and $0.25\;mm{\times}3\;times/day$ in the case of poor bone quality. After consolidation periods of mean fifteen weeks, five implants for each patients were placed at the interforaminal area. Results : On average, a vertical gain of $11.38{\pm}1.38\;mm$ was obtained by distraction. And all distraction zone showed complete ossification by panoramic radiography. There were no postoperative complications other than numbness of lower lip in one case. Total twenty implants in four patients were placed and their outcomes were satisfactory. Conclusion : It is a useful method to place five implants after vertical distraction osteogenesis of the severely atrophied mandible for the implant-supported fixed prosthesis.

• 대한치과의사협회지
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• 제49권9호
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• pp.520-526
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• 2011

Vascularized iliac crest flap include bone tissue of good quality and quantity for mandible segmental defect. Even if fibular flap can contain longer bone tissue, iliac crest has esthetic shape for mandible body reconstruction and large height for implant. Conventional vascularized iliac crest osteomyocutaneous flap is too bulky for reconstruction of intraoral soft tissue defect. But modified flap can reduce soft tissue volume, so is good for functional reconstruction of oral mucosa. It takes only one month for completely replace oral mucosa. The final mucosal texture is much better than other skin paddle flap, especially for implant prosthesis. Donor site morbidity of this method looks same level or less with other modalities functionally and socially. In case of oral mucosa-mandible combined defect, vascularized iliac crest with internal oblique muscle flap shows good outcomes for hard and soft tissue.

• 대한치과보철학회지
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• 제55권4호
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• pp.458-466
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• 2017

구강종양을 절제한 경우 악안면 구조의 상실로 인해 발음, 저작, 심미 등 기능장애를 유발하게 되므로 기능회복을 위해 보철 수복이 필요하다. 이때 임플란트를 이용하면 보철물의 효과적인 기능 향상을 기대할 수 있다. 하지만 골절제술을 시행한 후, 이식골의 성공률과는 별개로 연조직이 감염에 취약한 형태를 갖기 쉬우며 이식골은 염증에 이환된 경우 빠른 속도로 파괴가 발생할 수 있다. 성공적인 보철치료를 위해서는 보철치료에 앞서 적절한 연조직 처치와 보철수복 후 잦은 정기검진을 통해 임플란트의 예후와 연관된 각별한 주의가 필요하다.

• 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권1호
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• pp.17-25
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• 1996

There are many reports of the surgical management for the craniofacial abnormalities arising from the irradiation of the head and face for treatment of childhood cancers. Since the mordern combined-modality theraphy for childhood cancers began in the late 1960s and the early 1970s, recent reports have described the occular, dental and maxillo-facial abnormalities after irradiation in long-term survivors of cancers of the head and face. The resultant deformities may be known to be difficult to reconstruct with surgical techniques. This paper describes the late reconstructive surgery for the unilateral orbital and malar hypoplasia after eyeball enucleation and irradiation during childhood to correct the facial asymmetry and expand the contracted orbital socket into the functional dimension for the retaining eyeball prosthesis with spherical implant. We reports the satisfactory preliminary results from the midfacial osteotomy through the supero-lateral orbital rim and malar bone and the antero-lateral repositioning with the autogenous bone grafting in 26 year-old female patient who will be planned to make the new eyeball prosthesis by the department of ophthalmology.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권1호
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• pp.2-8
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• 2012

Introduction: Auto-tooth bone graft material consists of 55% inorganic hydroxyapatite (HA) and 45% organic substances. Inorganic HA possesses properties of bone in terms of the combining and dissociating of calcium and phosphate. The organic substances include bone morphogenetic protein and proteins which have osteoinduction capacity, as well as the type I collagen identical to that found in alveolar bone. Auto-tooth bone graft material is useful as it supports excellent bone regeneration capacity and minimizes the possibility of foreign body reaction,genetic diseases and disease transmission. Materials and Methods: Implant placement combined with osteoinductive regeneration,preservation of extraction socket, maxillary sinus augmentation, and ridge augmentation using block type,powder type, and block+powder type autobone graft materialwere performed for 250 patients with alveolar bone defect and who visited the Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University from September 2009 to August 2011. Results: Clinical assessment: Among the 250 patients of auto-tooth bone graft, clinical assessment was performed for 133 cases of implant placement. The average initial stabilization of placed implants was 74 implant stability quotient (ISQ). Radiological assessment: The average loss of crestal bone in the mandible as measured 6 months on the average after the application of prosthesis load was 0.29 mm, ranging from 0 mm to 3.0 mm. Histological assessment: In the histological assessment, formation of new bone, densified lamellated bone, trabecular bones, osteoblast, and planting fixtures were investigated. Conclusion: Based on these results, we concluded that auto-tooth bone graft material should be researched further as a good bone graft material with osteoconduction and osteoinduction capacities to replace autogenous bone, which has many limitations.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.36.1-36.8
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• 2019

Background: This study aims to examine the outcome of simultaneous maxillary sinus lifting, bone grafting, and vertical ridge augmentation through retrospective studies. Methods: From 2005 to 2010, patients with exhibited severe alveolar bone loss received simultaneous sinus lifting, bone grafting, and vertical ridge augmentations were selected. Fifteen patients who visited in Seoul National University Bundang Hospital were analyzed according to clinical records and radiography. Postoperative complications; success and survival rate of implants; complications of prosthesis; implant stability quotient (ISQ); vertical resorption of grafted bone after 1, 2, and 3 years after surgery; and final observation and marginal bone loss were evaluated. Results: The average age of the patients was 54.2 years. Among the 33 implants, six failed to survive and succeed, resulting in an 81.8% survival rate and an 81.8% success rate. Postoperative complications were characterized by eight cases of ecchymosis, four cases of exposure of the titanium mesh or membrane, three cases of periimplantitis, three cases of hematoma, two cases of sinusitis, two cases of fixture fracture, one case of bleeding, one case of numbness, one case of trismus, and one case of fixture loss. Prosthetic complications involved two instances of screw loosening, one case of abutment fracture, and one case of food impaction. Resorption of grafted bone material was 0.23 mm after 1 year, 0.47 mm after 2 years, 0.41 mm after 3 years, and 0.37 mm at the final observation. Loss of marginal bone was 0.12 mm after 1 year, and 0.20 mm at final observation. Conclusions: When sinus lifting, bone grafting, and vertical ridge augmentation were performed simultaneously, postoperative complications increased, and survival rates were lower. For positive long-term prognosis, it is recommended that a sufficient recovery period be needed before implant placement to ensure good bone formation, and implant placement be delayed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제40권4호
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• pp.181-187
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• 2014

Objectives: The purpose of this preliminary study is to evaluate the effectiveness of a customized, three-dimensional, preformed titanium mesh as a barrier membrane for peri-implant alveolar bone regeneration. Materials and Methods: Ten patients were recruited for this study. At the time of implant placement, all patients had fenestration or a dehiscence defect around the implant fixture. A mixture of particulate intraoral autologous bone and freeze-dried bone allograft was applied to the defect in a 1 : 1 volume ratio and covered by the preformed titanium mesh. A core biopsy specimen was taken from the regenerated bone four months postoperatively. Patients were followed for 12 months after the definitive prosthesis was placed. Results: Satisfactory bone regeneration with limited fibrous tissue was detected beneath the preformed titanium mesh. Histologic findings revealed that newly formed bones were well-incorporated into the allografts and connective tissue. New growth was composed of approximately 80% vital bone, 5% fibrous marrow tissue, and 15% remaining allograft. All implants were functional without any significant complications. Conclusion: The use of preformed titanium mesh may support bone regeneration by maintaining space for new bone growth through its macro-pores. This preliminary study presents the efficacy of a preformed titanium mesh as a ready-to-use barrier membrane around peri-implant alveolar bone defect. This preformed mesh is also convenient to apply and to remove.