• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권1호
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• pp.60-64
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• 1999

Recently, for the reconstruction of bony defect and cosmetic improvement, many graft materials and implants have been widely used in the various surgical situations. The alloplastic materials have many advantages such as simplicity of operation, no additional need of surgery, and easy manipulation. The $Medpor^{TM}$(porous high-density polyethylene, Porex Co., USA) was initially studied in 1972 for surgical implant and introduced as an implant material for oral and maxillofacial region by Sauer and King in 1988. This material permits full ingrowth of bone into the implants, substantially increasing the implant's incorporation into the recipient site. It can be shaved during the surgery, which results in an improvement and prefabricated various size and shapes to fit into the surgical defect. The $Medpor^{TM}$ was used in 32 patients from 1995 to 1997 at the maxillofacial region. It was used for paranasal augmentation in 24 cases, for malar augmentation in 2 cases, for infraorbital augmentation in 2 cases, for mandibular angle augmentation in 2 cases, for mandibular body augmentation in 2 cases, for chin vertical augmentation in 1 case. It was mainly fixed with miniplate or screw. There were few complications except one infection and one exposure of the implant.

• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.180-184
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• 2010

Objective : To prevent temporal depression after the pterional craniotomy, this study was designed to examine the safety and aesthetic efficacy of the brushite calcium phosphate cement (CPC) in the repair and augmentation of bone defects following the pterional craniotomy. Methods : The brushite CPC was used for the repair of surgically induced cranial defects, with or without augmentation, in 17 cases of pterional approach between March, 2005 and December, 2006. The average follow-up month was 20 with range of 12-36 months. In the first 5 cases, bone defects were repaired with only brushite CPC following the contour of the original bone. In the next 12 cases, bone defects were augmented with the brushite CPC rather than original bone contour. For a stability monitoring of the implanted brushite CPC, post-implantation evaluations including serial X-ray, repeated physical examination for aesthetic efficacy, and three-dimensional computed tomography (3D-CT) were taken 1 year after the implantation. Results : The brushite CPC paste provided precise and easy contouring in restoration of the bony defect site. No adverse effects such as infection or inflammation were noticed during the follow-up periods from all patients. 3D-CT was taken 1 year subsequent to implantation showed good preservation of the brushite CPC restoration material. In the cases of the augmentation group, aesthetic outcomes were superior compared to the simple repair group. Conclusion : The results of this clinical study indicate that the brushite CPC is a biocompatible alloplastic material, which is useful for prevention of temporal depression after pterional craniotomy. Additional study is required to determine the long-term stability and effectiveness of the brushite calcium phosphate cement for the replacement of bone.

• Journal of Periodontal and Implant Science
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• 제49권3호
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• pp.171-184
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• 2019

Purpose: To evaluate the effects of intra-alveolar socket grafting, subepithelial connective tissue grafts, and individualized abutments on peri-implant hard and soft tissue outcomes following immediate implant placement. Methods: This randomized experimental study employed 5 mongrel dogs, with 4 sites per dog (total of 20 sites). The mesial roots of P3 and P4 were extracted in each hemimandible and immediate dental implants were placed. Each site was randomly assigned to 1 of 4 different treatment groups: standardized healing abutment (control group), alloplastic bone substitute material (BSS) + standardized healing abutment (SA group), BSS + individualized healing abutment (IA group), and BSS + individualized healing abutment + a subepithelial connective tissue graft (IAG group). Clinical, histological, and profilometric analyses were performed. The intergroup differences were calculated using the Bonferroni test, setting statistical significance at P<0.05. Results: Clinically, the control and SA groups demonstrated a coronal shift in the buccal height of the mucosa ($0.88{\pm}0.48mm$ and $0.37{\pm}1.1mm$, respectively). The IA and IAG groups exhibited an apical shift of the mucosa ($-0.7{\pm}1.15mm$ and $-1.1{\pm}0.96mm$, respectively). Histologically, the SA and control groups demonstrated marginal mucosa heights of $4.1{\pm}0.28mm$ and $4.0{\pm}0.53mm$ relative to the implant shoulder, respectively. The IA and IAG groups, in contrast, only showed a height of 2.6mm. In addition, the height of the mucosa in relation to the most coronal buccal bone crest or bone substitute particles was not significantly different among the groups. Volumetrically, the IA group ($-0.73{\pm}0.46mm$) lost less volume on the buccal side than the control ($-0.93{\pm}0.44mm$), SA ($-0.97{\pm}0.73mm$), and IAG ($-0.88{\pm}0.45mm$) groups. Conclusions: The control group demonstrated the most favorable change of height of the margo mucosae and the largest dimensions of the peri-implant soft tissues. However, the addition of a bone substitute material and an individualized healing abutment resulted in slightly better preservation of the peri-implant soft tissue contour.

• 대한두개안면성형외과학회지
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• 제19권2호
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• pp.108-113
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• 2018

Background: The aim of our retrospective study is to evaluate the management of isolated orbital floor fractures considering the clinical, functional and aesthetic results according to the surgical approach and the type of materials used. Methods: Retrospectively, clinical, radiological, surgical, and ophthalmological data from 79 patients were collected from January 2010 to December 2016. Furthermore, included patients were interrogated on functional and aesthetic satisfaction. Results: The main causes of trauma were physical aggression followed by accidents. The median time between trauma and surgery was 4 days. The most common surgical approaches were the subciliary and the transconjunctival ones. Alloplastic materials were used in 75 patients. In two patients, we used a combination of two grafts. Patients experienced minor immediate complications. On follow-ups, none of our patients suffered from ocular movement restrictions. Patients treated by subciliary approach had higher risk of retractile scaring compared to other surgical approaches. In our study, patients agreed to complete a questionnaire assessing functional and aesthetic outcomes with a high satisfaction score. No association between the implant material used and the results has been assessed. Conclusion: This study describes the results of orbital floor reconstructions. Despite a variety of materials used and surgical approaches performed, we believe that the transconjunctival approach is the most suitable option with a high satisfaction score.

• 대한수의학회지
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• 제44권1호
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• pp.131-136
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• 2004

Osseointegration involves anchoring dental implants to stable bone rather than to soft-tissue. Clinical osseointegration is currently defined as the process whereby alloplastic material is asymptomatically and rigidly fixed and maintained in bone during functional loading. Full osseointegration is necessary for the success of long-term dental implants. Recent developments in computer assisted measurement of bone formation have improved maxillofacial examination and osseointegration. Computer assisted examination has also proved effective in dental implantology. This investigation was aimed to determine osseointegration in immediate and delayed implantation in the dog mandible using dental computed tomography (CT) and bone scintigraphy. Five adult (mean age of 2 years) mongrel dogs with a mean weight of 9.1 kg were used in this investigation. Titanium alloy implant systems with 4 mm in diameter and 10 mm in length were chosen for insertion. The second and third left mandibular premolars in each dog were extracted for the delayed implant insertion. Twelve weeks later, the second and third right mandibular premolars were extracted for the immediate implant insertion. Before the delayed and immediate implantation procedures and 0, 4, 8, and 12 weeks after the insertions, dental CT and scintigraphy were conducted. The CT and scintigraphic images indicate that reconstruction of bone surrounding of the immediate implant can be as successful as reconstruction of bone surrounding of the delayed implant.

• 대한두개안면성형외과학회지
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• 제13권2호
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• pp.125-129
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• 2012

Purpose: Methylmethacrylate is the most commonly used alloplastic material in cranioplasty. However during the polymerization of methylmethacrylate, a significant exothermic reaction takes place. This reaction may result in thermal injury to the brain tissue and other soft tissues. Also it is difficult to make three-dimensional methylmethacrylate implant that is perfectly matched to the defect during the operation time. We report on the molding technique of methylmethacrylate implant using plaster mold and the rapid prototyping model in cranioplasty. Methods: A 44-year-old male was referred to the department for severe frontal hollowness. He was involved in an automobile accident resulting in large frontal bone defect with irregular margin. The preformed patient-specific methylmethacrylate implant was made using plaster mold and the rapid prototyping model before the operative day. The methylmethacrylate implant was placed in the frontal defect and rigidly fixed with miniplates and screws on the operative day. Results: The operation was performed in an hour. In the 6 months follow-up period, there were no complications. Patient was satisfied with the results of cranioplasty. Conclusion: Safe cranioplasty was performed with the preformed patient-specific methylmethacrylate implant using plaster mold and the rapid prototyping model. The result of this method was satisfactory, aesthetically and functionally.

• Archives of Plastic Surgery
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• 제35권2호
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• pp.174-180
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• 2008

Purpose: While radiotherapy remains an essential part of the multidisciplinary treatment of cancers, it may cause unwanted consequences such as tissue break down and chronic non-healing wounds as a result of hypoxia, hypovascularity, and hypocellularity. The conservative treatment of osteoradionecrosis was effective only in the early stages or has a limited result. The surgical treatment of osteoradionecrosis includes various local fasciocutaneous flaps, local myocutaneous flaps and different kinds of free flaps with cancellous bone graft or alloplastic material after removal of all devitalized tissue. This study reviews recent cases of osteoradionecrosis in Severance hospital and investigates the use of various flaps for reconstruction of osteoradionecrosis. Methods: From 2000 to 2006, a total of 29 patients, nine men and twenty women with a mean age of 60.4 years were identified and included in the study. Fasciocutaneous flaps were used on 7 patients and myocutaneous flaps were used on the remaining patients. Mean follow-up period was 10.4 months. Results: In the fasciocutaneous flap group, we noted two complications including total flap failure and a partial flap necrosis. In the myocutaneous flap group, four complications were noted including a partial flap necrosis and 3 cases of wound dehiscence. Considering the complications noted in this study, the natural history of progression to flap necrosis appeared to follow the following sequence of events: marginal flap necrosis, infection, wound dehiscence, flap floating and partial flap necrosis, serially. Conclusion: Successful surgical treatment of osteoradionecrosis includes wide radical debridement and reconstruction with a well vascularized flap like myocutaneous flap or fasciocutaneous flap.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.597-602
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• 2013

Background The forehead, which occupies about one third of the face, is one of the major determinants of a feminine or masculine look. Various methods have been used for the augmentation of the forehead using autologous fat grafts or alloplastic materials. Methylmethacrylate (MMA) is the most appropriate material for augmentation of the forehead, and we have used an injection-molding technique with MMA to achieve satisfactory results. Methods Under local anesthesia with intravenous (IV) sedation, an incision was made on the scalp and a meticulous and delicate subperiosteal dissection was then performed. MMA monomers and polymers were mixed, the dough was injected into the space created, and manual molding was performed along with direct inspection. This surgery was indicated for patients who wanted to correct an unattractive appearance by forehead augmentation. Every patient in this study visited our clinics 3 months after surgery to evaluate the results. We judged the postoperative results in terms of re-operation rates caused by the dissatisfaction of the patients and complications. Results During a 13-year period, 516 patients underwent forehead augmentation with MMA. With the injection-molding technique, the inner surface of the MMA implant is positioned close to the underlying frontal bone, which minimizes the gap between the implant and bone. The borders of the implant should be tapered sufficiently until no longer palpable or visible. Only 28 patients (5.4%) underwent a re-operation due to an undesirable postoperative appearance. Conclusions The injection-molding technique using MMA is a simple, safe, and ideal method for the augmentation of the forehead.

• Journal of Periodontal and Implant Science
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• 제24권1호
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• pp.120-130
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• 1994

The purpose of the present investigation was to compare the effectiveness of porous hydroxyapatite (PHA) and coralline based porous calcium carbonate(PCC) as implant materials in human periodontal osseous defects. 10 adult patients having periodontitis and 2 similar angular osseous defects ${\ge}$5mm as verified by radiographic analysis and clinical probing depth ${\ge}$4mm were selected. The measurements were recorded just before surgery and after 6 month. Clinical parameters used in this study included gingival recession, pocket depth, probing attachment level, Sulcus Bleeding Index, Plaque Index, tooth mobility and bone defect depth measurements. After initial therapy, patients were treated with mucoperiosteal flap surgery. The contralateral bony defects in each patient randomly assigned to either bone graft material, one with PHA(Interpore 200) and the other with coralline based calcium carbonate(Biocoral). After 6 month both groups showed statistically significant reduction of pocket depth, Sulcus Bleeding Index, Plaque Index and significant improvement in probing attachment level. No statistically significant differences were found between the groups. There were 3.0mm or 68% of bone repair with PHA and 3.1mm, 61% with PCC. These values were likewise not significantly different. The data and clinical impression strongly suggest that both PHA and PCC are alloplastic implants with clinically apparent acceptance by the soft and hard tissue and that they can be used as bone graft materials successfully.

• Journal of Periodontal and Implant Science
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• 제38권2호
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• pp.171-178
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• 2008

Purpose: The aim of this study was to evaluated biphasic calcium phosphate applied in surgically created 1-wall periodontal intrabony defects in dogs by histometrical analysis. Material and Method: Critical sized($4\;mm\;{\times}\;4\;mm$), one wall periodontal intrabony defects were surgically produced at the proximal aspect of mandibular premolars in either right and left jaw quadrants in four canines. The control group was treated with debridement alone, and experimental group was treated with debridement and biphasic calcium phosphate application. The healing processes were histologically and histometrically observed after 8 weeks. Results: In biphasic calcium phosphate group, more new bone and cementum formation, less epithelium and connective tissue attachment were observed compared to other groups. But there was no statistical significance. Conclusion: Though the statistically significant difference could not be found, it seemed that there was more new bone and cementum formation with applying biphasic calcium phosphate in 1 wall intrabony defects in dogs by preventing junctional epithelium migration.