• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제45권2호
• /
• pp.51-67
• /
• 2019

As dental implant surgery and bone grafts were widely operated in Korean dentist, many bone substitutes are commercially available, currently. For commercially used in Korea, all bone substitutes are firstly evaluated by the Ministry of Health and Welfare (MOHW) for safety and efficacy of the product. After being priced, classified, and registration by the Health Insurance Review and Assessment Service (HIRA), the post-application management is obligatory for the manufacturer (or representative importer) to receive a certificate of Good Manufacturing Practice by Ministry of Food and Drug Safety. Currently, bone substitutes are broadly classified into C group (bone union and fracture fixation), T group (human tissue), L group (general and dental material) and non-insurance material group in MOHW notification No. 2018-248. Among them, bone substitutes classified as dental materials (L7) are divided as xenograft and alloplastic bone graft. The purpose of this paper is to analyze alloplastic bone substitutes of 37 products in MOHW notification No. 2018-248 and to evaluate the reference level based on the ISI Web of Knowledge, PubMed, EMBASE (1980-2019), Cochrane Database, and Google Scholar using the criteria of registered or trademarked product name.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제25권4호
• /
• pp.356-360
• /
• 1999

PURPOSE : This is to review the complicated jaw fractures that had been referred for revision of the unsatisfactory results, and to provide proper managements for the easily complicated jaw fractures. MATERIALS & METHODS : Twenty-nine patients who had been revised due to malunion or complicated fractures of facial bones for last 3 years were reviewed. The main problems required for revision, type of fractures complicated, the primary managements to be reclaimed, the specialties to be involved, the management to be reclaimed, time elapsed to seek reoperation, type of revision surgeries, residual complication were analysed with medical records, radiographs and final examinations. RESULTS: The major complaints were malocclusion(79.3%), facial disfigurement(41.3%), TMJ problems (13.7%), neurologic problems(10.3%), non-union(10.3%), and infection(6.8%). Unsatisfactory results were occurred most frequently after improper management of the multiple fractures of the mandible (62.2%), combined fractures of maxilla and mandible (20.6%), fracture of zygomatico-maxillary complex and midpalate (17.2%). The complications to be corrected were widened or collapsed dental arches (79.3%), improperly reduced condyles (41.3%), painful TMJ (34.4%), limited jaw excursion (31.0%), over-reduction of zygoma (13.7%), and nonunion with infection(13.7%). and dysesthesia (10.3%). The primary managements were nendereet by plastic surgeons in 82.7%(24/29) and by oral surgeons in 7.6%(2/29). Main causes of malunion are inadequate ORIF in 76%, unawareness & delay in 17%, and delayed due to systemic cares in 17%. 76% of 29 patients had been in state of intermaxillary fixation for over 4 weeks. Revision were done by means of "refracture and ORIF"in 48.2%(14/29), orthognathic osteotomies with bone grafts in 55.1%(16/29), and camouflage countering & alloplastic implantations in 37.9%(11/29), TMJ surgeries in 17.2%, micro-neurosurgeries in 11.6%. Residual complications were limited mouth opening in 24.1% (7/29), paresthesia in 13.7%, resorption of reduced condyle in 10.3%. CONCLUSIONS : Failure of initial treatment of jaw fractures is due to improper diagnosis and inadequate treatment with lack of sufficient knowledge of stomatognathic system. It is crucial to judge jaw fracture and patients accurately, moreover, the best way of treatments has to be selected. Consideration of these factors in treatment could minimize the complication of jaw fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제32권2호
• /
• pp.138-141
• /
• 2006

Introduction : In recent years, vascularized, i.e., living bone grafts, have been widely applied in the field of oral and maxillofacial surgery, as a method of treatment of congenital or acquired non-unions, and a large defects in mandible. The vascularized fibular graft has been especially used for this purpose because of its shape and mechanical strength. The postoperative hypertrophy of grafted fibula is of particular interest to us. Material and methods : This study was undertaken to determine the volume change(indirect methods) and radiographic appearance of a free vascularized fibular graft as it responds to the mechanical and physiologic features of its new environment. In order to elucidate the long term effect on fibular mass after mandibular reconstruction, change in various method of volume change was utilized as indirect measure of change in long-term. Results : The younger the patient, the more prominent and rapid the hypertrophy of the graft. the hypertrophy of the graft never exceeded the diameter of the recipient bone, except for callus enlargement after stress fracture of the grafted bone. Conclusion : Etiologic explanations for this phenomenon have not been clarified in the previeous literature. some of the factors implicated include a periosteal reaction or new bone formation, as seen at the onset of bone union after a fracture in a child, a reaction to the mechanical loading on the graft and a reaction to the circulatory changes resulting from the grafting procedure.

• 대한의용생체공학회:의공학회지
• /
• 제24권5호
• /
• pp.401-410
• /
• 2003

본 연구에서는 유한요소법을 이용하여 대퇴골 전자간 골절 치료에 대한 다양한 수술기법을 골밀도 변화에 따라 생체역학적으로 분석하여 이를 평가하고자 한다. 이에 구현된 모델들은 압박 고관절 나사만을 이용하여 시술한 모델 (Type I), 삽입된 압박 고관절 나사 주위에 시멘트 영역을 확보한 뒤 골 시멘트로 보강하는 시술을 구현한 모델 (Type II),대학교추가의 골소실이 없이 시멘트를 가압하여 주입하는 시술을 구현한 모델 (TypeIII)의 3가지 형태로 구현하였다. 시술 상황에 따라 골절부위와 삽입물의 경계면 주위에 접촉요소를 사용하기 위해 적절한 마찰계수를 설정하였으며, 골다공증 정도 (Singh Indices, II∼V)에 따라 대퇴골의 물성치를 적절하게 적용시켰다. 각 모델에 있어 골밀도 변화에 따른 수술기법의 차이를 분석하기 위하여 다음과 같은 인자를 분석하였다 : (a) 대퇴골두 내에서의 von Mises 응력 부피비, (b) 대퇴골두 망상골과 인공 삽입물내에서의 최대 von Mises 응력 (PVMS), (c) 대퇴골두 내에서의 최대 von Mises 변형률 (MVMS), (d) 골절 부위와 인공 삽입물 주위에서의 미세운동량. 수술기법 중 Type III가 대퇴골두 내에서 골밀도 변화에 상관없이 가장 낮은 PVMS, MVMS 수치를 보여 가장 효율적인 결과를 나타내었다. 이는 기존 시술법 (Type I,II)에 비해 내고정 실패 가능성이 가장 적을 것으로 예측되었다. 특히, 골밀도가 낮을 때에는 Type III의 수술 효과가 더욱 커지는 것으로 나타났다. 또한, 삽입물 주위에서 미세운동량을 분석한 결과, Type III의 수치가 다른 시술법들의 15∼20%로 나타나 시멘트를 가 압하여 보강하는 시술법이 삽입물 주위의 미세운동을 억제하는데 있어 가장 효과적이다는 것을 증명하는 것이다. 이러한 결과로부터, 압박 고관절 나사를 이용한 대퇴골두 전자간 골절 치료에 있어 골 시멘트를 가압하여 보강하는 방법이 골밀도가 낮은 환자에 있어 인공삽입물의 내고정 및 골유합에 가장 큰 효과를 보일 것으로 사료된다.