• Journal of the Korean Academy of Esthetic Dentistry
• /
• v.28 no.2
• /
• pp.64-73
• /
• 2019

Various techniques have been developed, and the development of piezo electric devices have made it possible to widen the alveolar ridge even if the residual bone is dense or if there is a lack of cancellous bone between the cortical bones. In the operation of the mandibular posterior area, the flap is easily accessible to the ramus bone, from which high quality autogenous bone can be obtained, compared to other parts. A small autologous bone block can be used with particulated bone graft material using one screw for bone regeneration instead of a large autologous bone with two screws. The tapered implant design can minimize buccal bone fracture, even in severely atrophic mandibular areas. We report a case of 4 years following implant placement with ridge splitting and small autogenous bone graft in severly atrophic mandible. This report demonstrates a case of functional and aesthetic restoration in a patient through a collaboration.

• The Journal of the Korean dental association
• /
• v.50 no.6
• /
• pp.329-338
• /
• 2012

Introduction: The purpose of this study is to evaluate the clinical results of vertical alveolar ridge augmentation using autogenous block bone graft, especially resorption rate, and outcomes of dental implants placed in the grafted site. Patients and Methods: Medical records and radiographs were reviewed. Twenty-seven patients who have been received the autogenous block bone graft which harvested from chin, ramus, and ilium, and the implant installation on 31 areas(22 maxillas and 9 mandibles) were included. Eight implants were installed simultaneously at the time of bone graft in 4 patients, and 65 implants were installed after 4.9 months(range 2~18 months) of autogenous block bone graft in 23 patients. The resorption amount and rate of augmented bone, and the success and survival rates implants were evaluated. Results: Mean height of the augmented block bone was $5.9{\pm}2.3mm$(range from 2.5 to 13.0 mm). Mean follow-up period after block bone graft was 30.4 months(range from 16 to 55 months). Mean resorption of the augmented block bone was $2.0{\pm}1.5mm$ (range from 0.5 to 7.24 mm). The success and survival rates of the implants were 78.1 % and 98.6%, respectively. Conclusion: This study indicates that the autogenous block bone graft is a useful and stable method for alveolar ridge augmentation for dental implant. And more augmentation is needed to compensate the resorption of the grafted bone.

• Journal of Korean Dental Science
• /
• v.4 no.2
• /
• pp.59-66
• /
• 2011

Purpose: This research sought to determine the resorption rate of bone grafted to the maxillary sinus according to the grafted material's type, patient's age, systemic disease, implant size, site of implant placement, and residual ridge height. Materials and Methods: This research targeted 24 patients who had immediate Osstem$^{(R)}$ implant (US Plus$^{(R)}$) placement after bone graft. The panorama was taken before the surgery, after the surgery, and 6 months after the surgery. Vertical height change and resorption rate of the grafted bone were measured with the same X-rays and compared. The influence of the following factors on the grafted bone material's resorption rate was evaluated: grafted material type, patient's age, systemic disease, implant size, site of implant placement, and residual ridge height. Results: Patients in their 40s had $34.0{\pm}21.1%$ resorption rate, which was significantly higher compared to the other age groups (P<0.05). There was no significant relationship between systemic disease and grafted bone resorption. There was no significant relationship between implant size (diameter, length) and grafted bone resorption. There was no significant relationship between the site of implant placement and grafted bone resorption. The ramal bone-grafted site was significantly more resorbed than the ramal bone/Bio-Oss$^{(R)}$-grafted site, maxillary tuberosity bone/Bio-Oss$^{(R)}$-grafted site, and ramal bone/maxillary tuberosity bone/Bio-Oss$^{(R)}$-grafted site (P<0.05). There was no significant difference in the grafted bone resorption rate in the sinus between more than 4 mm and less than 4 mm residual ridge heights. After an average of 6 months, a second surgery was done; given an average follow-up of 1.9 years, the success rate and survival rate of the implant were 96.9% and 98.4%, respectively. Conclusion: These results indicate that the bone resorption rate of grafted bone among patients in their 40s is higher compared to patients in their 50s and over, and that only autogenous bone (ramus) shows higher resorption rate than the mixed graft of autogenous bone and xenogenous graft (Bio-oss) after maxillary sinus graft.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.21 no.2
• /
• pp.209-214
• /
• 1999

Chronic recurrent TMJ dislocation results in difficulty of mastication, speaking, and swallowing due to the limitation of the mandibular movement. Etiologic factors are considered as the looseness of the capsule and ligaments, the decrease of the articular eminence, condylar morphologic change, muscular disharmony near by TMJ, and the decrease of the vertical length of the mandibular ramus. Treatment approach has been suggested that surgical methods are selected for the correction of the etiologic factors when conservative treatments are not effective. Many surgical methods have been reported such as eminectomy, eminence augmentation, condylotomy, and zygomatic arch down fracture technique. We performed the eminence augmentation through interpositional bone graft in chronic recurrent TMJ dislocation. This method leads to favorable postoperative result without recurrence and complication, so we report the case with related references.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.31 no.3
• /
• pp.207-215
• /
• 2009

Purpose: The aim of the present study is to evaluate the long term bone healing after horizontal ridge augmentation using auto block bone graft for implant installation timing. Materials and Methods: Five Beagle dogs(which were 14 months old and weighted approximately 10kg). In surgery 1(extraction & bone defect), premolars(P2, P3,P4) were extracted and the buccal bone plate was removed to create a horizontally defected ridge. After three months healing, in surgery 2(ridge augmentation). Auto block bone grafts from the mandibular ramus were used in filling the bone defects were fixed with stabilizing screws. The following fluorochrome labels were given intravenously to the beagle dogs: oxytetracycline 1week after the surgery, alizarin red 4 weeks after the surgery, calcein blue 8 weeks after the surgery. The tissue samples were obtained from the sacrificed dogs of 1, 4, 8, 12, 16 weeks after the surgery. Non-decalcified sections were prepared by resin embedding and microsection to find thickness of $10{\mu}m$ for the histologic examination and analysis. Results: 1. We could achieve the successful reconstruction of the horizontal bone defect by auto block bone graft. The grafted bone block remained stable morohologically after 16 weeks of the surgery. 2. In the histologic view. We observed osteoid tissue from the sample $4^{th}$ week sample and active capillary reconstruction in the grafted bone from the $12^{th}$ week sample. Healing procedures of auto bone grafts were compared to that of the host bone. 3. Bone mineralization could be detected from the $8^{th}$ week sample. 4. Fluorochrome labeling showed active bony changes and formation at the interface of the host bone and the block graft mainly. Bony activation in the grafted bone could be seen from the $4^{th}$ week samples. Conclusions: Active bone formation and remodeling between the grafted bone and host bone can be seen through the revascularization. After the perfect adhesion to host bone, Timing of successful implant installation can be detected through the ideal ridge formation by horizontal ridge augmentation.

• Journal of Periodontal and Implant Science
• /
• v.31 no.1
• /
• pp.73-91
• /
• 2001

The present study was performed to compare effects of demineralized freeze-dried bone allograft(DFDBA) with deproteinized bovine bone mineral(DBBM) on periodontal fenestration defect in rats. Twelve adult male rats weighing 500 to 540 grams were used in this study. Periodontal fenestration defects were surgically created with tapered fissure bur(${\Phi}1mm$) at the left side of buccal surface of the mandible. The defect size was from anterior border of the first molar to anterior of the ascending ramus mesiodistally and from just below the alveolar crest to apically 1.5-2mm area apicocoronally with 2mm in depth. Rats were divided into control group, test group I and II. Four defects were assigned to the test group I grafted with DBBM and other 4 defects were assigned to the test group II grafted with DFDBA. The rest of defects were the negative control group. At 10 days and 35 days after surgery, 12 rats were sacrificed through intracardiac perfusion and specimens were obtained prepared with Hematoxylin-Eosin stain for light microscopic evaluation. The results of this study were as follows : 1. In the control group, new bone, osteoid, dense connective tissue were observed in the defects at 10 days. new bone formation was not found but loose connective tissue was formed in the defect and fibrous encapsulation of graft materials was shown in two test groups at 10 days. 2. In all groups, new bone formation was shown in the defect at 35 days. And in the control group, bone formation increased at 35 days than at 10 days. 3. In the test group I and II at 35 days, graft materials were combined with new bone and joined host bone. There was very close contact between new bone, graft materials, and host bone with no gaps. 4. In the test group I and II, new bone formation was similar to that in the control group but not exeeded. In conclusion, in the test group I new bone formation was similar to that in the test group II at 35 days, but there was infiltration of inflammatory cells at 10 days. DFDBA and DBBM were considered as the biocompatible graft materials and effective in the regeneration of new bone.

• The Journal of the Korean dental association
• /
• v.50 no.12
• /
• pp.743-754
• /
• 2012

urpose : The purpose of this study was to evaluate the US II plus/GS II Osstem$^{(R)}$ implants through the study for the clinical success rate during the installation of the Osstem¢Á implants after bone graft. Materials and Methods : This study was researched in the 4 medical institutions: Chonnam National University, Chosun University, Bundang Seoul National University Hospital, and FM dental clinic from May, 2002 to September, 2009. Based on the total number of 60 patients whose treatment was the installation of the US II plus/GS II Osstem¢Á implants after bone graft, we evaluated success rate of implants. We analysis the distribution of patient's age and gender, edentulous area, bone type, fixture length and diameter, installation and loading time, donor site, bone graft material and method, antagonistic teeth, and survival and success rate. From these analyses we got the following results. Results : 1. In this study, the total number of patients who have been installed with US II plus implant was 27, and total of 52 implants were installed. The average age was 38.9, with 16 male, and 11 female patients. 2. The total number of patients who have been installed with GS II implant was 33, and total of 54 implants were installed. The average age was 49.7, with 24 male, and 9 female patients. 3. As for bone graft method, either autogenous bone or a mix of autogenous and heterogenous bone was used(88.4%) for US II plus. Chin, iliac, and Maxillary tuberosity were the donor sites for autogenous bone graft, and onlay method of bone graft was performed. 4. Allogenic bone or a mix of autogenous and heterogenous bone was used(77.8%) for GS II. Chin, ramus, and tibia were the donor sites for autogenous bone graft, and GBR method of bone graft was performed. 5. The duration from the installation of implants to setting of final prosthesis was average of 16 months and 10 months for US II plus and GS II respectively. Also, the final follow up period was average of 31 months and 28 months respectively. During this period, one GS II implant was removed from 1 patient due to failure of early osteointegration. 6. The survival rates were 100% and 98.1%, and success rates were 94.2% and 94.4% for US II plus and GS II implant respectively. Conclusion : On the evaluation of our clinical study, both US II plus and GS II Osstem¢Á implants showed the excellent clinical results after bone graft.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.31 no.5
• /
• pp.386-393
• /
• 2009

Objectives: This study was performed to evaluate course of the inferior alveolar canal in the mandibular ramus and to find safety zone when ramal bone is harvested. Patients and Methods: From January, 2009 to February, 2009, the 20 patients who visited in the Department of Oral and Maxillofacial Surgery, Sanbon Dental Hospital. Wonkwang University and the Conebeam CT was taken of various chief complaints, were selected. The patients who had left and right mandibular first molar and incisor missing, jaw fracture and bone pathology were excluded. The R point was defined as the point which occlusal plane was crossed to the mandibular anterior ramus(external oblique ridge). In the cross-sectional coronal and axial views, the inferior alveolar canal position to the R point, buccal bone width(BW), alveolar crest distance(ACD), distance from alveolar crest to occlusal plane(COD) and inferior alveolar canal to sagittal plane(CS) were measured and horizontal distance(HD), vertical distance(VD) and nearest distance(ND) were measured. Results: The inferior alveolar canal is located $6.19{\pm}1.21\;mm$ from the R point. Horizontal distance from the R point were $13.07{\pm}2.45\;mm$, vertical distance from the R point were $14.24{\pm}2.41\;mm$ and nearest distance from the R point were $10.12{\pm}1.76\;mm$. The course of the inferior alveolar canal was positioned within $0.61{\pm}0.68\;mm$. The distance from external buccal bone to the inferior alveolar canal was increased from the R point anteriorly. Conclusions: It is considered that the mandibular ramus from the R point to 10 mm anteriorly can be harvested safely at ramal bone grafting.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.26 no.6
• /
• pp.644-651
• /
• 2000

In cases of severe alveolar bony resorption in the edentulous posterior maxillae, implant placement is limited anatomically due to maxillary sinus. If the ridge is atrophic, the various bone grafting methods are required for the ridge augmentation. But the result of the onlay grafting procedure is not always promising. On the posterior maxilla, maxillary sinus mucosa lifting and bone grafting into the sinus floor, subantral augmentation(SA) technique are recommended. Various SA procedures have been developed for implant installation. We perfer to simultaneous block bone graft and implant installation through the residual alveolar ridge into the grafted block bone to fix the grafted bone and to gain the primary stability of the installed fixture. When a sagittal skeletal discrepancy in present due to the severe alveolar bony resorption of the maxilla, the advancement of the maxilla by Le Fort I osteotomy simultaneously with installation of implant fixtures combined with sinus lifting and interpositional bone graft procedure can be indicated. We applied various SA techniques for implant installtion to the 46 edentulous posterior maxillae, and total 154 implants were installed at our department from 1992 to 1999. Various SA techniques were classified in detail and the indications of each techniques were discussed. The changes of residual bony height following SA procedure were studied. The results were as follows. 1. The SA procedure combined with bone graft and simultaneous fixture installation were performed in 41 cases, 126 fixtures were installed and 5 fixtures were removed out of them. Le Fort I osteotomy procedure combined with sinus lifting and interpositional bone graft simultaneous with fixture installation were performed in 5 cases. Total 28 fixtures were installed and 2 fixtures were removed so far. 2. Autogenous block bone graft into sinus floor were performed in 35 cases, autogenous particulated marrow cancellous bone(PMCB) graft in 9 cases, and demineralized human bone powder in 2 cases. The donor site for bone graft were anterior iliac bone in 39 cases, posterior iliac bone in 3 cases and mandibular symphysis in 1 case and mandibular ramus in 1 case. 3. In 9 cases with which SA procedure had been performed with the block bone graft, the change of pre- and postoperative residual bony height were measured using MPR(multiplanar reformatted)-CT. The mean residual bony height was 8.0mm preoperatively, 20.2mm at 6 months following up operation and we gained average 12.2mm alveolar bony height. So, we can recommend this one-stage subantral augmentation and fixture installation technique as a time conserving, safe and useful method for compromised posterior edentulous maxilla.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.35 no.6
• /
• pp.474-480
• /
• 2009

These is a cases of chronic suppurative osteomyelitis occurred in the mandibular body to condyle of 48-year-old male patient. Extensive bone destruction was noted on the right mandibular body, angle, ascending ramus, mandibular notch and condylar region. We made a treatment plan that radicular mandibular resection from body to condyle and mandibular reconstruction with vascularized fibular flap at first time. But, we could observe marked bone regeneration with only mild curettage, local wound care and massive antibiotic therapy. So we preserved the anterior ramus portion of mandible. Defected mandibular condyle was reconstructed with costochondral graft. In this paper we present the case of a patient who has chronic osteomyelitis in mandibular area.