• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.2
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• pp.108-118
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• 2010

Introduction: Maxillary posterior region, compared to the mandible or maxillary anterior region, has a thin cortical bone layer and is largely composed of cancellous bone, and therefore, it is often difficult to achieve primary stability. In such cases, sinus elevation with bone graft is necessary. Materials and Methods: In this research, 121 patients who had implant placement after bone graft were subjected to a follow-up study of 5 years from the moment of the initial surgery. The total survival rate, 5-year cumulative survival rate and the influence of the following factors on implant survival were evaluated; the condition of the patient (sex, age, general body condition), the site of implant placement, diameter and length of the implant, sinus elevation technique, closure method for osseous window, type of prosthesis and opposing teeth. Results: 1. The 5-year cumulative survival rate of total implants was 90.5%, there was no significant difference between sex, age, the site of implant placement, diameter and length of the implant, sinus elevation technique, and the type of opposing teeth. 2. Patients with diabetes mellitus < osteoporosis and smooth-surfaced machined group < hydroxyapatite (HA)-treated group and homogenous demineralized freeze dried allogenic bone (DFDB) bone graft only group had significantly lower survival rate. 3. With less than 4 mm of residual alveolar ridge height, lateral approach without closing the osseous window resulted in a significantly lower survival rate. 4. Restoration of a single implant showed a significantly lower survival rate, compared to cases where the superstructure was joined with several implants in the area. Conclusion: Patients with diabetes or osteoporosis need longer period of time for osseointegration compared to the normal, and the dentists must be prudent when choosing a surface treatment type and the bone graft material. Also, as the vertical dimension of the residual alveolar ridge can influence the result, staged implant placement should be considered when it seems difficult for the implant to gain primary stability from the residual bone with less than 4 mm of vertical dimension. It is recommended to obdurate the bone window and that the superstructure be connected with several impants in the peripheral area.

• Journal of Korean Neurosurgical Society
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• v.43 no.6
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• pp.288-293
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• 2008

Objective : Bone cement leakage is a well-known potential complication of percutaneous vertebroplasty (PVP) in patients with osteoporotic compression fracture. Even though there has been a controversy in the efficacy of antecedent venography to prevent this complication, many authors have performed intra osseous venography before bone cement injection. The goal of this study was to classify the venous drainage patterns of spine before PVP, and compare their patterns at different vertebral levels. Methods : The authors retrospectively reviewed 1,042 intraosseous venographic patterns in 321 patients with 574 osteoporotic compression fractures during six-year period in one institution. To classify venogram patterns, we selected simple lateral X-ray of spine taken immediately after injection of the contrast dye. We classified the venography patterns according to contrast leakage pattern and leakage direction as follows; trabecular (TR), trabecular anterior (TA), trabecular posterior (TP), trabecular anterior-posterior (TAP), trabecular lateral (TL), venous anterior(VA), venous posterior (VP), venous anterior-posterior (VAP), soft tissue (ST). Also, we compared venogram patterns according to different spinal levels. Results : In overall, the most common pattern was TP type accounting for 37.4% (390/1042) of all intraosseous venograms. This is followed by TAP in 21.5%, TR 17.4%, TA 116%, TL 5.8%, ST 4.1%, VA 1.2%, VP 0.6%, and VAP 0.4% in descending order of frequency. According to the spinal level, TR and TAP types were most common in thoracic spine (T6-T10), TP type was most common in thoraco-Iumbar spine (T11-L2), and TP and TAP types were most common in lumbo-sacral spine (L3-S1). Contrast dye leakage to soft tissue such as psoas muscle or disc were detected in 43 (4.1%) venograms. Direct venous drainage without staining of vertebral body was found in 23 (2.2%) venograms. The 8.3% of thoracic venogram showed direct venous drainage. Thoracic level showed a more tendency of direct venous drainage than other spine levels (p<001). Conclusion : The authors propose a new classification system of intra osseous venography during PVP. The trabecular-posterior (TP) type is most common through all spine, and venous-filling (V) type was most frequent in thoracic spine. Further study would be necessary to elucidate the efficacy of this classification system to prevent bone cement leakage during PVP.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.348-356
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• 2011

Objective : The safety and efficacy of various fusion substitutes in pyogenic osteomyelitis has not been investigated. We evaluated and compared the cadaveric allograft and titanium cages used to reconstruct, maintain alignment and achieve fusion in the management of pyogenic spinal infection. Methods : There were 33 patients with pyogenic osteomyelitis underwent fusion in this study. Fifteen of the 33 patients were operated on by fusion with allografts (cadaveric patella bones) and 18 of those were operated with titanium mesh cages filled with autologous cancellous iliac bone. After the affected disc and vertebral body resection with pus drainage, cadaveric allograft or titanium cages were inserted into the resected space. Posterior transpedicular screw fixation and rod compression in resected space, where cadaveric allograft or titanium cages were inserted, was performed to prevent the malposition in all patients except in 1 case. Recurrent infection was identified by serial erythrocyte sedimentation rate and cross reactive protein follow-up. Osseous union and recurred infection available at a minimum of 2 years following operation was identified. The amount of kyphosis correction and the subsidence were measured radiographically. Results : Spinal fusion was achieved in 29 of 33 patients. In the cadaveric allograft group, 93.3% of patient (14 of 15) showed the osseous union while 83.3% of patient (15 of 18) in the titanium cage group showed union. Subsidence was noted in 12 of the patients. Twelve patients (36.3%) showed unsettling amounts of subsidence postoperatively whereas 46.6% of patients in the cadaveric allograft group and 37.7% of patients in the titanium cage group showed similar subsidence, respectively. There were statistical difference in the fusion rate (p=0.397) and subsidence rate (p=0.276) between the two groups. There was significant statistical difference in the postoperative improvement of segmental kyphosis between the two groups (p=0.022), that is the improvement in sagittal alignment was greater in the titanium cage group than in the cadaveric allograft group. There was no case of recurred infection. Conclusion : The cadaveric allograft and titanium cages are effective and safe in restoring and maintaining sagittal plane alignment without increased incidence in infection recurrence in pyogenic osteomyelitis. The postoperative improvement of segmental kyphosis was better in the cage group.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.4
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• pp.718-724
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• 2008

Tooth impaction is a frequently observed eruption anomaly in pediatric dental practice. Young patients with impacted or unerupted teeth have more prediction for dentigerous cyst formation. Dentigerous cyst presents radiographic features, unilocular or multilocular radioluscency. Cysts occur most frequently in the premolar region except third molar. Dentigerous cysts can grow to a considerable size, and large cysts may be associated with a painless expansion of the bone in the involved area. Extensive lesions may result in facial asymmetry, osseous destruction, root resorption of proximal teeth and displacement of associated tooth. The nature of the causative tooth influences the type of surgical treatment required for the dentigerous cyst. If the cyst is associated with a supernumerary or wisdom tooth, complete enucleation of the cyst along with extraction of tooth may be the first treatment choice. Otherwise, preservation of the associated teeth should be considered to prevent a young patient from psychological and mental trauma because of the loss of tooth. We should consider the degree of tooth displacement, osseous destruction and growth pattern of oromaxillofacial area when planning treatment. Thus a proper and logical treatment planning can help a proper growth and development of oromaxillofacial area and can save the patient from a psychological and mental trauma. This report describes 4 cases of the management of impacted premolars and molars associated with dentigerous cysts in children.

• Journal of Periodontal and Implant Science
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• v.26 no.1
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• pp.47-67
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• 1996

The purpose of this study was to observe the effect of $Biocoral^R$ graft and bioglass 45S5 graft in combination with ePTFE membrane in periodontal osseous defects for new bone formation. Nine healthy dogs were used. Under general anesthesia, 3-wall defects were created on the mesial and distal surfaces of the maxillary right canines, the mesials of the maxillary right second premolars, the distals of the mandibular right canines and the mesials of the mandibular right third premolars. To induce periodontitis, a silicone rubber, $Provil^R$ light body, was injected under pressure into the defects. Ninety days later, $Provil^R$was removed and followed by thorough root planing. The followings were then applied in the mesial and distal defects of the maxillary right canines, the mesials of the maxillary right second premolars, the distals of the mandibular right canines and the mesials of the mandibular right third premolars by random selections : 1) ePTFE membrane only application, 2) $Biocoral^R$ graft, 3) $Biocoral^R$ graft and ePTFE membrane application, 4)Bioglass 45S5 graft, 5) Bioglass 45S5 graft and ePTFE membrane application. The membranes were removed 1 month later. The dogs were sacrified at 1, 2 and 3 months following the graft, and block sections were made, demineralized, embedded, stained and examined by light microscope and transmission electron microscope. On the sections from teeth treated with ePTFE membrane only, the defect demonstrated extensive connnective tissue and alveolar bone regeneration. The $Biocoral^R$ graft group demonstrated extensive bone regeneration compared with ePTFE membrane only group. In the $Biocoral^R$ graft plus ePTFE membrane group, regeneration of new alveolus and crest occurred within the defect. As the experimental period lengthened, bone regeneration was increased and bone bridge was formed among the graft particles. The but bioglass 45S5 graft group demonstrated extensive bone regeneration but the amount of new bone was less than that of the $Biocoral^R$ graft group. For the bioglass 45S5 graft plus ePTFE membrane group, the amount of new bone was also increased. As the experimental period lengthened, bone regeneration was increased. Multinucleated giant cells, fibroblasts and macrophages were observed. As the bone formation was increased, the number of such cells was decreased. In conclusion, the $Biocoral^R$ was found better than the bioglass 45S5 for new bone formation, and the use of ePTFE membrane alone or with $Biocoral^R$/bioglass 45S5 can be supported as potential methods of promoting bone formation.

• Journal of Biosystems Engineering
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• v.39 no.2
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• pp.122-133
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• 2014

Purpose: This study was to develop an effective process for fabricating biocompatible calcium phosphate powders (CPPs) using horse bones, and to investigate the characteristics of them. Methods: The characteristics of horse bone powders (HBPs) were investigated according to the different osseous tissue types (compact bone and cancellous bone), bone types (spine and tibia), pretreatment methods (cold water, $H_2O_2$, and hot water), sintering time (4, 8 and 12h), and sintering temperature (600, 900, 1100 and $1300^{\circ}C$). In addition, the grinding methods were compared based on the wet grinding (ball mill) and dry grinding (blade grinder) method to make it as powders. Finally, their cytotoxicity and cell viability were checked. Results: Regardless of the types of osseous tissues and bones, HBPs were well fabricated as biocompatible CPPs. It was also found that the pretreatment methods did not influence on the resultants, showing well-fabricated HBPs. Considering the processing time, the hot water method was the most suitable compared to other pretreatment methods. Further, 12h-sintering time was sufficient to remove residual organic compounds. The sintering temperatures greatly affected the properties of bone powders fabricated. The x-ray diffraction (XRD) peak of horse bone sintered at $600^{\circ}C$ was most closed to that of hydroxyapatite (HA). Our bioactivity study demonstrated that the HBPs fabricated by sintering horse bones at $1300^{\circ}C$ showed the best performance in terms of cell viability whereas the HBPs $1100^{\circ}C$ showed the cytotoxicity. Conclusions: Using various types of horse bone tissues, biocompatible CPPs were successfully developed. We conclude that the HBPs may have a great potential as biomaterials for various biological applications including bone tissue engineering.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.1-14
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• 2000

The purpose of this study was to evaluate the efficacy of adding autogenous bone to the toothash-plaster mixture in the healing process of bone. Full-thickness round osseous defects with the diameter of 20mm were made at the calvarial bone of adult dogs (n=19) bilaterally, which were thought to be critical size defect. The right defects were repaired with the toothash-plaster mixture plus autogenous bone (compressed volume 0.3cc) and the left defects with only toothash-plaster mixture. At 2-, 4-, 8-, 12- and 20- week after implantation, dogs were sacrificed and evaluated the osseous healing of bony defects clinically, radiographically, and microscopically. The results were as follows; 1. At the clinical observation, the wound healed very well without any problem except severe swelling in the early period after operation. Slight depression was recognized at the both sides when the portions of cranial defect were palpated. 2. There were statistically significant differences between toothash-plaster mixture groups and autogenous bone added groups at the same period, and among the groups in the bone density of the digital radiograms (P<0.001). There was a tendency that bone density was increasing with time. 3. In light microscopic examination, new bone formation was more active in the autogenous bone added groups than toothash-plaster mixture groups at the early period after implantation but there is little difference at 20-week after implantation. 4. In fluorescent microscopic examination, the fluorescent band could be observed at the area of active bone formation and the band was more distinct in the autogenous bone added groups then toothash-plaster mixture groups. 5. In transmitted electron microscopic examination, organelles such as rER, Golgi complex and secretory granule and osteoblast were observed. In summary higher volume ratio of autogenous bone is needed to improve the bone healing in that there is little difference between toothash-plaster mixture group and autogenous bone added group at the 20-week after implantation in spite of new bone formation was more active in the autogenous bone added groups than toothash-plaster mixture groups at the early period after operation.

• International Journal of Oral Biology
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• v.34 no.1
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• pp.21-28
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• 2009

Mutations in DLX3 are associated with both autosomal dominant hypoplastic hypomaturation amelogenesis imperfecta (ADHHAI) and tricho-dento-osseous (TDO) syndrome. ADHHAI is caused by a c.561_562delCT (2bp-del DLX3) mutation whereas TDO syndrome is associated with a c.571_574delGGGG (4bp-del DLX3) mutation. However, although the causal relationships between DLX3 and an enamel phenotype have been established, the pathophysiological role of DLX3 mutations in enamel development has not yet been clarified. In our current study, we prepared expression vectors for wild type and deletion mutant DLX3 products (4bp-del DLX3, 2bp-del DLX3) and examined the effects of their overexpression on the expression of the enamel matrix proteins and proteases. Wild type DLX3 enhanced the expression of matrix metalloprotease 20 (MMP20) mRNA and protein in murine ameloblast-like cells. However, neither a 4bp-del nor 2bp-del DLX3 increased MMP20 expression. Wild type DLX3, but not the above DLX3 mutants, also increased the activity of reporters containing 1.5 kb or 0.5 kb of the MMP20 promoter. An examination of protein stability showed that the half-life of wild type DLX3 protein was less than 12 h whilst that of both deletion mutants was longer than 24 h. Endogenous Dlx3 was also found to be continuously expressed during ameloblast differentiation. Since inactivating mutations in the gene encoding MMP20 are associated with amelogenesis imperfecta, the inability of 4bp-del or 2bp-del DLX3 to induce MMP20 expression suggests a possible involvement of such mutations in the enamel phenotype associated with TDO syndrome or ADHHAI.

• International Journal of Oral Biology
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• v.32 no.4
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• pp.119-125
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• 2007

Dlx3 is a homeodomain protein and is known to play a role in development and differentiation of many tissues. Deletion of four base pairs in DLX3 (NT3198) is causally related to tricho-dento-osseous (TDO) syndrome (OMIM #190320), a genetic disorder manifested by taurodontism, hair abnormalities, and increased bone density in the cranium. The molecular mechanisms that explain the phenotypic characteristics of TDO syndrome have not been clearly determined. In this study, we examined phenotypic characteristics of wild type DLX3(wtDlx3) and 4-BP DEL DLX3 (TDO mtDlx3) in C2C12 cells. To investigate how wtDlx3 and TDO mtDlx3 differentially regulate osteoblastic differentiation, reporter assays were performed by using luciferase reporters containing the promoters of alkaline phosphatase, bone sialoprotein or osteocalcin. Both wtDlx3 and TDO mtDlx3 enhanced significantly all the reporter activities but the effect of mtDlx3 was much weaker than that of wtDlx3. In spite of these differences in reporter activity, electrophoretic mobility shift assay showed that both wtDlx3 and TDO mtDlx3 formed similar amounts of DNA binding complexes with Dlx3 binding consensus sequence or with ALP promoter oligonucleotide bearing the Dlx3 binding core sequence. TDO mtDlx3 exhibits a longer half-life than wtDlx3 and it corresponds to PESTfind analysis result showing that potential PEST sequence was missed in carboxy terminal of TDO mtDlx3. In addition, co-immunoprecipitation demonstrated that TDO mtDlx3 binds to Msx2 more strongly than wtDlx3. Taken together, though TDO mtDlx3 acted as a weaker transcriptional activator than wtDlx3 in osteoblastic cells, there is possibility that during in vivo osteoblast differentiation TDO mtDlx3 may antagonize transcriptional repressor activity of Msx2 more effectively and for longer period than wtDlx3, resulting in enhancement of osteoblast differentiation.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.28 no.1
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• pp.27-36
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• 1998

The purpose of this study was to obtain information on the clinical and radiographic features of the fibro-osseous lesions in the jaws. For this study, the author examined and analysed the clinical records and radiographs of 71 cases of 68 patients in fibrous dysplasia, 35 cases of ossifying fibroma and 30 cases of 16 patients of periapical cemental dysplasia diagnosed by clinical and radiographic or histopathological examinations. The obtained results were as followings: L Fibrous dysplasia occurred most frequently in the 2nd decade (30.0％), ossifying fibroma in the 3rd-4th decades, periapical cemental dysplasia in the 4th decade, and all of three lesions showed slight predilection in females. In most cases, chief complaints were painless facial swelling in fibrous dysplasia and ossifying fibroma, and periapical cemental dysplasia was found accidentally in radiographs. 2. Fibrous dysplasia was occurred more frequently in maxilla, ossifying fibroma in mandible and both lesions in premolar-molar area. Periapical cemental dysplasia was occurred most frequently in the mandibular anterior area. The size of fibrous dysplasia was larger than that of ossifying fibroma, and the shape of ossifying fibroma was more round and elliptical than fibrous dysplasia whose was fusiform. 3. Fibrous dysplasia was shown homogeneous radiopaque shadow of 57.6％ and ossifying fibroma & periapical cemental dysplasia were shown mixed appearance of radiolucency and radiopacity shadows at 74.2％, 60.0％, respectively. 4. Fibrous dysplasia was entirely shown poorly defined at 87.7％, but ossifying fibroma & periapical cemental dysplasia were shown well outlined at 60.0％, 70.0％, respectively. 5. Cortical thinning and expansion were observed in fibrous dysplasia and ossifying fibroma, and severe in ossifying fibroma than fibrous dysplasia, and those signs were not seen in periapical cemental dysplasia. Loss of lamina dura was dominant in fibrous dysplasia and root resorption was dominant in ossifying fibroma. Displacement of mandibular canal and the degree of the increase of vertical dimension were alike in both lesions. Displacement of maxillary sinus or nasal cavity, thinning & expansion of the maxillary sinus were dominant in fibrous dysplasia. 6. Polyostotic fibrous dysplasia was occurred at 5.9％, Multiple periapical cemental dysplasia at 43.7％. Occurrence rate in the edentulous area of fibrous dysplasia and ossifying fibroma were 7.0％, 8.6％, respectively.