• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.301-307
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• 2004

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.

• KSBB Journal
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• v.21 no.6 s.101
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• pp.439-443
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• 2006

Biocompatibility and tissue regenerating capacity are essential characteristics in the design of collagenous biomaterials for tissue engineering. Attachment of glycosaminoglycans to collagen may add to these characteristics by creating an appropriate micro-environment. In this study, porous type I collagen matrices were crosslinked using dehydrothermal treatment and 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide, in the presence and absence of chondroitin sulfate (CS). The scaffold like discs in 3 mm diameter were inserted into the intralamellar stromal pockets of rabbit cornea. In 8 weeks of follow up, clinical evaluation including corneal neovascularization, opacity and transparency of the graft scaffold was performed, and the inflammatory reaction and migration of corneal fibroblast were evaluated histologically. No inflammation, neovascularization and opacity in any of the implant were observed. CS increased the corneal fibroblast invasion and the transparency. It is concluded that the type I collagen sponge showed a biocompatibility in corneal stromal layer and addition of CS slightly improved the quality of the bioartificial corneal stromal layer. These results could be useful for the development of corneal substitutes.

• Journal of Periodontal and Implant Science
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• v.33 no.1
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• pp.61-77
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• 2003

The major goals of periodontal therapy are the functional regeneration of periodontal supporting structures already destructed by periodontal disease as well as the reduction of signs and symptoms of progressive periodontal disease. There have been many efforts to develop materials and therapeutic methods to promote periodontal wound healing. Bone graft & guided tissue are being used for the regeneration of destroyed periodontium these days. Non-resorbable membranes were used for Guided tissue regeneration in early days, however more researches are focused on resorbable membranes these days. The aim of this study is to evaluate the osteogenesis of paradioxanone membrane on the calvarial critical size defect in Sprague Dawley rats. An 8 mm diameter surgical defect was produced with a trephine bur in the area of the midsagittal suture. The rats were divided into three groups: Untreated control group, Biomesh(R) group and paradioxanone group. The animals were sacrificed at 4, 8 and 12 weeks after surgical procedure. The specimens were examined by histologic, histomorphometric analyses. The results are as follows: 1. In histological view on Biomesh(R), no visible signs of resorption was observed at 4 weeks but progressive resorption was observed at 8 weeks through 12 weeks. Paradioxanone membrane expanded at 4 weeks, and rapid resorption was observed at 8 weeks. In both the membranes, inflammatory cells were observed around them. Inflammatory cells decreased with time but were still present at 12 weeks. More inflammatory cells were observed in paradioxanone membranes than in Biomesh(R) membrane. 2. The area of newly formed bone in the defects were 0.001${\pm}$0.001, 0.006${\pm}$0.005, 0.002${\pm}$0.003 at the 4 weeks, 0.021${\pm}$0.020, 0.133${\pm}$0.073, 0.118${\pm}$0.070 at the 8 weeks and 0.163${\pm}$0.067, 0.500${\pm}$0.197, 0.487${\pm}$0.214 at the 12 weeks in the control group, Biomesh(R) group and experimental group respectively. Compared to the control group, Biomesh(R) group displayed significant differences at 4,8, and 12 weeks and the paradioxanone group at 8 and 12 weeks.(P<0.05)

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.2
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• pp.129-136
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• 1991

The fibrin sealant was first designed as an alternative to surgical suture for the purpose of surface-to-surface union especially in parenchymal organs like the liver, spleen and kidney. The clinical application of currently used fibrin sealant was first introduced in 1972. The fibrin sealant consists of principal two components; lyophilized human fibrinogen and bovine thrombin. The fibrinogen component also contains coagulation factor XIII. A solution of aprotinin, an inhibitor of fibrinolysis is used to dissolve the fibrinogen and to provide the first component, and a solution of calcium chloride is also used to provide the second component. From July to December in 1990, during 6 months, we used fibrin sealant in the 28 patients of 33 various cases, in the following ways; supportive application of fibrin sealant after free autogenouse nerve graft for the repair of inferior alveolar nerve, facial nerve or accessory nerve, treament of hemangioma or lymphangioma to thrombosize and lead to the tumor shrinking, skin grafting to stimulate the adhesion and tissue repair, bone grafting in the patients of cleft alveolus, mandibular reconstruction or orthognathic surgery to facilitate the knitting of bone chips, tissue adhesion after tumor resection, radical neck dissection or flap reconstructions, and supportive adhesion of external auditory cannal after TMJ surgery via postauricular approach. No adverse effects were observed, none of the patients developed hepatitis or other blood transmitted disease, and the wound healing were acceptable.

• Journal of Periodontal and Implant Science
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• v.33 no.2
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• pp.301-310
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• 2003

The purpose of this study is to evaluate the biocompatibility and the biorsorbability of several types of calcium polyphosphate made through change of manufacturing process for 12 month. To solve limitation of calcium phosphate, we developed a new ceramic, Calcium Polyphosphate(CPP), and report the biologic response to CPP in extraction sites of beagle dog. Porous CPP blocks were prepared by condensation of anhydrous $Ca(H_2PO_4)_2$ to form non-crystalline $Ca(PO_3)_2$ and then milled to produce CPP powder. CPP powder, CPP block, and CPP granules added with $Na_2O$ were implanted in extraction sockets and histologic observation were performed at 12 months later. Like 3 months results, histologic observation at 12 months revealed that CPP matrix were mingled with and directly apposed to new bone without any adverse tissue reaction, CPP powder show direct bony contact, but new bone formation and fibrous tissue encapsulation showed in CPP block. 10% $Na_2O$ CPP granules show more inflammatory cells infiltration around graft materials compared at 3 month, but 15% $Na_2O$ CPP granules show less. This result revealed that regardless of addition of $Na_2O$, CPP had a high affinity for bone and had been resorbed slowly. From this results, it was suggested that CPP is promising ceramic as a bone substitute and addition of $Na_2O$ help biodegradation but optimal concentration of $Na_2O$ and other additive component to increase degradation rate should be determined in further study.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.96-102
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• 1997

The gracilis that is frequently used as a donor of free muscle trasfer is appropriate in the muscular shape and vascular position. This muscle is belonged to the second type of muscle group by the classification of the pattern of muscular nutrient vessel. The adductor branch or first perforating branch of deep femoral artery which supplies the proximal 1/3 of this muscle is a dominant one and this is used for the microscopic anastomosis of muscle or musculocutaneous flap. The minor vascular pedicles which enter the distal 1/3 of this of this muscle are branches of the superficial femoral artery and it is 0.5mm in diameter, 2cm in length with two venae comitantes. These minor pedicles supplies distal half of the gracilis muscle. This island musculocutaneous flap using distal vascular pedicle can be used to cover the defect of soft tissue around the distal femoral supra-condylar area, knee joint and proximal tibial condyle area which cause limitation of motion of knee joint, or in the cases that usual skin graft is impossible. The important operative procedure is as follows; The dissection is carried proximally and distally and the entire gracilis muscle including proximal and distal pedicle is completely dissected. After temporary blocking of the proximal vascular pedicle, the adequate muscle perfusion by the distal pedicle is identified and it is rotated to the recipient site around knee joint. The advantages of this procedure are simple, no need of microscopic vascular anastomoses and no significant functional loss of donor site. Especially in the cases of poor condition of the recipient vessel, this procedure can be used effectively. From 1991 to 1996, we performed 4 cases; complete survival of flap in 3 cases and partial survival of flap with partial necrosis in 1 case. This procedure is though to be useful in the small sized soft tissue defect of distal femoral supra-condylar area, knee joint and proximal tibial condylar area, especially in the defect of anterior aspect which expected to cause limitation of motion of knee joint due to scar contracture. But the problems of this procedure are the diameter of distal vascular pedicle is small and the location of distal vascular pedicle is not constant. To reduce the failure rate, identify the muscular perfusion of distal vascular pedicle after blocking the proximal pedicle, or strategic delay will be helpful.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.631-636
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• 2008

Purpose: Adipose tissue-derived stem cells(ADSC) has an osteoconductive potential and demineralized bone matrix(DBM) is an osteoinductive material. A combination of DBM and ADSC wound probably create osteoinductive properties. The purpose of this study is to determine the effect of the combination of DBM and ADSC mixture on healing of rat calvarial defect. Methods: Thirty adult male Sprague-Dawley rats were randomized into 3 groups(n=10) as 1) Control, 2) DBM alone, 3) DBM with ADSC mixture. DBM with ADSC mixture group has had a 3-day preculture of ADSC from groin fat pad. An 6 mm critical size circular calvarial defect was made in each rat. Defect was implanted with DBM alone or DBM with ADSC mixture. Control defect was left unfilled. 6 and 12 weeks after the implantation, the rats were sacrificed and the defects were evaluated by histomorphometric and radiographical studies. Results: Histomorphometric analysis revealed that DBM with ADSC mixture group showed significantly higher bone formation than DBM alone group(p<0.05). Although radiographs from DBM alone group and DBM with ADSC group revealed similar diffuse radiopaque spots dispersed throughout the defect. Densitometric analysis of calvarial defect revealed DBM with ADSC mixture group significantly higher bone formation than DBM alone(p<0.05). There was correlation of densitometry with new bone formation(Spearman's correlation of coefficient=0.804, 6 weeks, 0.802, 12 weeks). Conclusion: The DBM with ADSC mixture group showed the best healing response and the osteoinductive properties of DBM were accelerated with ADSC mixture. It will be clinically applicable that DBM and ADSC mixture in plastic and reconstructive surgery, such as alveolar cleft and congenital facial deformities that bone graft should be required.

• Journal of Periodontal and Implant Science
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• v.27 no.2
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• pp.363-377
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• 1997

The main goal of periodontal therapy is the regeneration of periodontal tissue which has been lost due to destructive periodontal diseases. Although conventional forms of periodontal therapy show sound clinical results, the healing results in long junctional epithelium. There have been numerous materials and surgical techniques developed for new attachment and bone regeneration. Bone grafts can be catagorized into: autografts, allografts, xenografts and bone substitutes. Synthetic bone substitute materials include hydroxyapatite, tricalcium phosphate, calcium carbonate, and Plaster of Paris. Calcium sulfate has found its use in dental practice for the last 30 years. Recent animal studies suggest that periodontal regeneration in 3 wall intrabony defect may be enhanced by the presence of calcium sulfate. And it is well known that 2 wall & 1 wall defect have less osteogenic potential, So we need to study the effect of calcium sulfate in 1 wall intrabony defect in dogs. The present study evaluates the effects of calcium sulfate on the epithelial migration, alveolar bone regeneration and cementum formation in intrabony defects of dogs. Four millimeter-deep one-wall intrabony defects were surgically created in the mesial aspect of anterior teeth and mesial & distal aspects of premolars. The test group received calcium sulfate grafts with a flap procedure. The control underwent flap procedure only. Histologic analysis following 8 weeks of healing revealed the following results: 1. The lengths of junctional epithelium were: 2.52mm in the control, and 1.89mm in the test group. There was no statistical significance between the two groups. 2. Alveolar bone formation were: 0.61mm in the control, and 1.88mm in the test group. There was a statistically significant difference between the two groups (p<0.05). 3. Cementum formations were: l.lmm in the control, and 2.46mm in the test group. There was a statistically significant difference between the two groups (p<0.05). 4. The length of CT adhesion were: O.97mm in the control, and 0.17mm in the test group. There was no statistically significant differences between the two groups These results suggest that the use of calcium sulfate in intrabony defects has little effect on junctional epithelium migration, but has significant effects on new bone and new cementum formations.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.176-183
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• 1999

Chronic osteomyelitis have been treated with wound dressing and antibiotics therapy often results in healing but foul odor pus discharges from the fibrotic soft tissues reactivates and requires appropriate control of the infection. Debridement of the wound, curettage and sequestrectomy, bone graft and immediate free flap transplantation is the curative protocol for the chronic osteomyelitis in the lower extremity. Authors have treated 7 cases of chronic osteomyelitis in the lower extremity with microsurgical free tissue transplantation at Department of Orthopedic Surgery, Chonbuk National University Hospital from December 1993 through February 1998. The results are as follows. 1. The chronic osteomyelitis occurred in tibial shaft in 4 cases, in calcaneus 2 cases and in femur 1 case. 2. Duration of the chronic osteomyelitis was at average 31.6 years. 3. Squamous cell carcinoma in the surrounding fibrotic tissue was biopsied in 1 case. 4. 4 cases had no trauma and occurred through hematogenous infection and 3 cases had fracture trauma. 5. Wound debridement and immediate free muscle transplantation had done in 5 cases and wound debridement, sequestrectomy and immediate free muscle transplantation in 2 cases. 6. Rectus abdominis muscle transplantation had peformed in 4 cases(57.1%), latissimus dorsi mucle 1 case(14.3%), latissimus dorsi myocutaneous 1 case(14.3%) and gracilis 1 case (14.3%). 6 cases of 7 were success(85.7%). 7. 1 case of failed latissimus dorsi musculocutaneous flap in thigh had done above knee amputation and 1 case of chronic posttraumatic osteoarthritis of the ankle joint had done below knee amputation at other hospital.

• Journal of Periodontal and Implant Science
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• v.28 no.1
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• pp.145-160
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• 1998

The ultimate goal of periodontal therapy is the regeneration of periodontal tissue which has been lost due to destructive periodontal disease, and numerous kinds of materials and techniques have been developed to achieve this goal. Bone grafts include autografts, allografts, xenografts and synthetic grafts. Among the synthetic grafts, bioactive glass has been used in dentistry for more than ten years and Fetner reported improved new bone formation and more amount of new attachment after grafting PerioGlas, a kind of bioactive glass, in 2-wall defects of monkeys in 1994. It Is well known that 1-wall defects have less osteogenic potential and more epithelial migration, so we need to study the erect of bioactive glass in 1-wall dejects in dogs. The present study evaluates the effect of bioactive glass on the epithelial migration, alveolar bone regeneration, cementum formation and gingival connective tissue attachment in intrabony detects of dogs. Four millimeter deep and four millimeter wide 1-wall defects were surgically cheated in the mesial aspects of premolars. The test group received bioactive glass with a flap procedure and the control underwent flap procedure only. Histologic analysis after 8 weeks of healing revealed the following results: 1. The height of gingival margin was 1.30{\pm}0.73mm$ above CEJ in the control and $1.40{\pm}0.78mm$ in the test group. There was no statistically significant difference between the two group. 2. The length of epithelial growth (the distance from CEJ to the apical end of JE) was $1.74{\pm}0.47mm$ in the control and $1.12{\pm}0.36mm$ in the test group. These was a statistically significant difference between the two groups (P<0.01). 3. The length of new cementum was $2.06{\pm}0.73mm$ in the control and $2.62{\pm}0.37mm$ in the test group. There was no statistically significant difference between the two groups. 4. The length of new bone was $1.83{\pm}0.74mm$ in the control and $2.39{\pm}0.59mm$ in the test group. There was no statistically significant difference between the two groups. These results suggest that the use of bioactive glass 1-wall intrabony defects has significant effect on the prevention of junctional epithelium migration, but doesn't have any significant effect on new bone and new cementum formation.