Journal of the Korean Association of Oral and Maxillofacial Surgeons
- P-ISSN2234-7550
- E-ISSN2234-5930
- SCOPUS, KCI, ESCI
ISSN : 2234-7550
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e-SubmissionVol.34 No.2
Abstract
Temporomandibular joint disorder (TMD) can induce severe pain but, its pathogenic mechanisms remain poorly understood. In this study, we analyzed proteomes of human synovial fluid in the superior joint space in the patients with TMD, which is obtained during the treatment arthrocentesis. We’ve got this result that one of the spots was consistently down-regulated in synovial fluid of patients with TMD from analysis of protein pattern. Its molecular weight was estimated to be 33 kDa. Synoviolin was identified in our proteomics analysis of LC/MS/MS. This protein was recently reported as one of the proteins that might affect rheumatoid arthritis (RA). Synoviolin that might be associated with RA was detected in synovial fluid of patients with TMD. We can conclude that synoviolin might be involved not only in the pathogenesis of RA but also in TMD. In result, synoviolin might be involved in the pathogenesis of TMD and can be candidates as new therapeutic targets of TMD or early detection biomarkers.
Abstract
Absorbable atelo-collagen sponge (TERUPLUG(R), Termo Co. Tokyo, Japan) is inserted in the extraction wound where alveolar bone is exposed. It protects wounds and promotes the formation of granulation. This is made of atelo-collagen, to minimize antigenicity, which is cross-linked by heat treatment for biocompatibility. TERUPLUG(R) consists of between 85 and 95 % of collagen type I and between 5 to 15 % of collagen type III. The raw material for the collagen is derived from bovine skin. It features a sponge block design and is shaped for easy insertion in the extraction wound. This study was designed to find out the bone healing capacity of TERUPLUG(R). We implanted TERUPLUG(R) (experimental group I) and TERUPLUG(R) with rhBMP-2 (experimental group II) in the rabbit cranium defect and then histologically analysed the specimen. The results were as follows. 1. In the 4 weeks, a lot of the newly formed collagen fibers around material of the experimental group I implanted TERUPLUG(R) were observed. But, in the experimental group II implanted TERUPLUG(R) with rhBMP-2, a little of newly formed collagen fibers around material were observed. The cell proliferating activity and apoptosis of the experimental group I, II was positive in and around the implanted material. 2. In the 8 weeks, the amount of newly formed and matured bone in the experimental group II was more observed than the experimental group I and control group. The results of this study indicate that absorbable atelo-collagen sponge (TERUPLUG(R)) is relatively favorable bone void filler with biocompatibility and has the better bone healing capacity in case of application with rhBMP-2.
Abstract
Purpose: The objective of this study was to evaluate the clinical parameters in terms of the midazolam sedation in patients undergoing dental practice. Patients and Methods: Total 28 patients were included in this study. They received the dental practice in the daycare center and sedation was done with midazolam. The recorded variables were blood pressure, pulse rate, SpO2, and patient’s response. The differences between observations were analyzed with paired samples t-test. Results: The blood pressure was significantly decreased after the administration of midazolam and the systolic pressure was significantly increased at the start of operation (P<0.05). The pulse rate was significantly increased after lidocaine injection (P<0.001). The amnesic effect was shown 21 cases out of 28 cases (75%). Conclusions: The effect of midazolam on pulse rate was not significant. However, midazolam could decrease the blood pressure significantly. Therefore, the sedation with midazolam could be successfully used in the dental practice, particularly for the patients having the hypertension.
Abstract
Loss of E-cadherin (E-cad) expression has been found in multiple cancers and is postulated to facilitate tumor cell dissociation and metastais. Promotor methylation may provides an alternative pathway for loss of gene function. This study evaluated the role of hypermethylation in the down-regulation of E-cad in oral squamous cell carcinoma (OSCC). We examined the E-cad expression by immunohistochemical staining and detected methylation status by methylation-specific polymerase chain reaction (MSP) in 20 OSCC tissues. Overally, 12 (60%) cases of hypermethylation of E-cad were detected and we found there were no correlation between methylation and age, histologic grade, lympn node metastasis, tumor size and clinical stage. However, Eleven (73.3%) of 15 samples which was negative for E-cad staining showed hypermethylation of E-cad promotor region. On the other hand, only one (20%) of 5 E-cad positive sample was observed with methylated status. The underexpression of E-cad was found to be related to promotor hypermethylation (p=0.035). In conclusion, we suggest that hypermethylation play a role in inactivation of E-cad gene and may be a appreciable biomarker for diagnosis and treatment of OSCC.
Abstract
We studied 1809 oral cancer patients who visited and were treated in 2002 at the 148 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons, which is composed of 39 dental university hospitals, 44 medical university hospitals, 64 general hospitals, and 1 unknown institution. The patients consisted of 1071 (59.2%) males and 738 (40.8%) females (male:female ratio, 1.45:1), who had a mean age of 65.2 years old. The tongue (40.2%) was the most common site affected, followed by the gingiva (32.7%), buccal mucosa (10.1%), and oral floor (9.0%). There were 6 cases of intraoral multiple cancer. In histopathological examinations, squamous cell carcinoma (88.7%) was the most common type found, followed by adenoid cystic carcinoma (2.1%), and mucoepidermoid carcinoma (1.7%). In addition, non-epithelial tumors comprised 1.8%, among which malignant melanoma was the most common type. Cases classified as T2N0 were the most common (32.1%), followed by T1N0 (21.4%), T4N0 (8.0%), and T2N1 (7.6%). Distant metastasis occurred in 17 patients (1.0%). The sizes of the non-epithelial malignant tumors ranged from 1.0 to 7.0 cm, with a mean size of 3.7 cm.
Abstract
Different kinds of forces can be applied to the biological tissue. The analysis of the applied force is highly important to explain the mechanism of cellular response. In this study, the applied force to the collagen gel was analyzed by the finite elements analysis. The model received two different kinds of static force (compression and tension). The force range was 50g to 400g. In results, von Mises stress was concentrated in the peripheral region in the compression model. It was concentrated in the central area in the tension model. However, the compressive force was high in the peripheral area of the compression model and the tensional force was also high in the same area of the tension model. In conclusion, the applied force could be different to the region and it should be considered in the experiment to analyze the effects of the mechanical force on the cells.
Abstract
The aim of this study was to evaluate the efficacy of a topical 0.2% hyaluronic acid (HA) preparation in the management of wound after removal of arch bar for facial bone fracture and a suture site after orthognatic, oral cancer or oral surgery. Forty patients participated in a randomized, placebo controlled, double-blind trial to evaluate the efficacy of the topical HA and preparation. HA topically applied to the wound after removal of arch bar or stitch out, 3 times a day for 4 weeks. Evaluation is performed once a week for 4 weeks. For subjective evaluation, relative pain reduction in visual analog scale (VAS) and existence of heat sensation was accessed. For objective evaluation, gross evaluation, papilla index, existence of wound dehiscence, redness and swelling was checked. The same evaluation was performed in each arch bar group and suture group. For whole subject, 0.2% HA group resulted higher reduction than placebo group in pain of site in first week with significancy. Same findings were seen other weeks but there was no significancy. 0.2% HA group had better result than placebo in objective evaluation (papilla index, wound dehiscence, redness and swelling), but in gross evaluation placebo had better result than 0.2% HA group with no significancy. Subject was divided into suture group and arch bar group. Same aspect was seen, but only suture group had significancy not arch bar group in pain reduction score. 0.2% HA group resulted higher reduction than placebo group in pain of site in first week with significancy, especially in suture group. It reveals topical application of HA in wound especially suture site reduced pain in early stage. And 0.2% HA group had better result than placebo in papilla index, redness and swelling with no statistical significancy. In conclusion, HA has effect of pain reduction and healing promotion in the mucosal wound after oral surgery.
Abstract
Excessive concentration of stress which is occurred in occlusion around the implant in case of the implant supported fixed partial denture has been known to be the main cause of the crestal bone destruction. Therefore, it is essential to evaluate the stress analysis on supporting tissue to get higher success rates of implant. The purpose of this study was to evaluate the effects of stress distribution and deformation in 3 different types of three-unit fixed partial denture supported by two implants, using a three dimensional finite element analysis in a three dimensional model of a whole mandible. A mechanical model of an edentulous mandible was generated from 3D scan, assuming two implants were placed in the left premolars area. According to the position of pontic, the experiments groups were divided into three types. Type I had a pontic in the middle position between two implants, type II in the anterior position, and type III in the posterior position. A 100-N axial load was applied to sites such as the central fossa of anterior and posterior implant abutment, central fossa of pontic, the connector of pontic or the connector between two implants, the mandibular boundary conditions were modeled considering the real geometry of its four-masticatory muscular supporting system. The results obtained from this study were as follows; 1. The mandible deformed in a way that the condyles converged medially in all types under muscular actions. In comparison with types, the deformations in the type II and type III were greater by 2-2.5 times than in the type I regardless of the loading location. 2. The values of von Mises stresses in cortical and cancellous bone were relatively stable in all types, but slightly increased as the loading position was changed more posteriorly. 3. In comparison with type I, the values of von Mises stress in the implant increased by 73% in Type II and by 77% in Type III when the load was applied anterior and posterior respectively, but when the load was applied to the middle, the values were similar in all types. 4. When the load was applied to the centric fossa of pontic, the values of von Mises stress were nearly 30 35% higher in the type III than type I or II in the cortical and cancellous bone. Also, in the implant, the values of von Mises stress of the type II or III were 160 170% higher than in the type I. 5. When the load was applied to the centric fossa of implant abutment, the values of von Mises stress in the cortical and cancellous bone were relatively 20 25% higher in the type III than in the other types, but in the implant they were 40-45% higher in the type I or II than in the type III. According to the results of this study, musculature modeling is important to the finite element analysis for stress distribution and deformation as the muscular action causes stress concentration. And the type I model is the most stable from a view of biomechanics. Type II is also a clinically acceptable design when the implant is stiff sufficiently and mandibular deformation is considered. Considering the high values of von Mises stress in the cortical bone, type III is not thought as an useful design.
Abstract
This study was performed to evaluate the effect of the implant recipient site preparation methods on primary stability of implants with the instruments of OsstellTM and Periotest in the iliac bone of cadaver. Methods and materials: The 8 iliac bones in 4 cadavers and implants treated with resorbable blasting media (RBM) were used. Periotest (Simens AG, Germany) and OsstellTM(Model 6 Resonance Frequency Analyser: Integration Diagnostics Ltd., Sweden) were used to measure primary stability of implants. Implants were inserted into the iliac crest of the cadaver. In control group, the recipient site was prepared according to the manufacturer’s recommendation: 1.8 mm guide drill, 2.0 mm initial drill, 2.7 mm pilot drill, 2.7 mm twist drill, 3.0 mm twist drill, 3.3 mm pilot drill, 3.3 mm twist drill, and 3.3 mm countersink drill as well as tapping drill were used in order. In the group 1, implant recipient sites were prepared by sequentially drilling from 1.8 mm guide drill to 3.0 mm twist drill and then inserted implants without countersinking and tapping. In the group 2, implant recipient sites were prepared to 3.0 mm twist drill and countersink drill and then inserted implants without tapping. In the group 3, the sites were prepared to 3.0 mm twist drill and countersink drill as well as tapping drill. In the group 4, the sites were prepared to 3.3 mm twist drill. In the group 5, the sites were prepared to 3.3 mm twist drill and countersink drill. A total of 60 implants were placed (n=10). The stability was measured using OsstellTM and Periotest mesiodistally and buccolingually. To compare the mean stability of each group statistically, One-way ANOVA was used and correlation of instrument were analyzed using SPSS 12.0. The results obtained were as follows; 1. The stability of group 1 measured using OsstellTM and Periotest buccolingually showed the highest, and there are significant difference statistically between control group and experimental group 1,2,4 in each instruments respectively (p<0.05). 2. The stability of group 1 measured using OsstellTM and Periotest mesiodistally showed the highest. There are significant difference statistically between control group and all experimental groups in OsstellTM, and between control group and experimental group 1,2,3,4 (p<0.05). 3. There are high correlation between the measurements of OsstellTM and Periotest (p<0.05). Conclusion: These results indicate that the primary stability of implant can be obtained by the recipient sites preparation with smaller diameter drill than that of implant or minimal drilling.
Abstract
This epidemiologic research was carried out to investigate the degree and aspects of symptoms of patients suffered from TMD using RDC/TMD. Subjects and Methods: Subjects were the patients who had visited to SNUBH dental clinic from Jan. 2005 to Dec. 2005, and total 117 patients were included (M: 22, F:95). The signs and symptoms of physical, psychological and behavioral factors were retrospectively evaluated by questionnaires in the RDC/TMD. The patients were examined through clinical and radiological method, and diagnosed by same investigator. They were divided into 3 groups such as osteoarthritis group (group 1), internal deragnement (group 2), myofascial pain dysfunction syndrome group (MPDS, group 3). In addition, in patient with complex diagnosis they were divided into subgroups in detail (ex. group 1+group 2). In the questionnaire, several items were selected to calculate the graded pain score (grade 0~IV), depression and vegetative symptoms, nonspecific physical symptoms(pain items included) and nonspecific physical symptoms(pain items excluded) in each group. Results: As a result of classification by diagnostic criteria of this study, the patients were distributed to 45% of group 1, 47% of group 2, 8% of group 3 in this study. In younger patients (under 25-year old, n=40), group 2 was occupied 57% (n=23) and group 1 was 35%, group 3 was 8%, while group 1 was occupied 75% in elderly-patients (over 40-year old, n=28) in present study (group 2: 21%, group 3: 4%). In the analysis of depression and vegetative symptoms, majority of patients in Group 2 were included in‘ normal’, and in Group 3 it appeared to have larger proportion of‘ moderate’ &‘ severe’than others. According to nonspecific physical symptoms, there have been tendencies of higher ratio of‘ severe’in patients with MPDS. In graded pain score, more than half (58%) of subjects were included in grade 0 and low disability (Grade I and II), and 27% were revealed high disability (grade III, IV).
Abstract
The piercing is increasing in western culture, and has also become gradually popular among Korean teenagers recently However, the accident happens sometimes such as loss of a bar into the tongue or mouth floor during the procedure. Because of the rare cases, few treatment of choices can be made when a bar is lost inside the mouth floor. In this case, the bar was removed under fluoroscope, without giving significant damage to the adjacent structure. 18 years old female patient visited the emergency room in our hospital. She attempted to pierce her tongue herself and could not find the bar which was lost in the mouth floor. The radiographs revealed that the needle was somewhere inside the mouth floor, but if incision were to be made it would be too deep to find the bar. The bar was reomoved through fluoroscope easily. Primary closure was done by 5-0 Vicryl and stitch-off was done 1 week later. The patient didn’t have any speech problems and complications.
Abstract
A variety of mechanisms may generate pain resulting from injury to the peripheral nervous system. None of these mechanisms is disease-specific, and several different pain mechanisms may be present simultaneously in any one patient. Diagnosis of neuropathic pain is often easily made from the information gathered on neurologic examination and from patient history. Evidence of sensory disturbances elicited by examination combined with laboratory tests confirming injury to peripheral nerve establishes the diagnosis of neuropathic pain. Although treatment of neuropathic pain may be difficult, optimum treatment can be achieved if dentist has a complete understanding of the therapeutic options. Pharmacologic therapy has been the mainstay of treatment. Selection of an appropriate pharmacologic agent is by trial and error since individual response to different agents, doses, and serum level are highly variable. An adequate trial for each agent tried is key to pharmacologic treatment of neuripathic pain. If pharmacologic treatment is not effective, nerve block using lidocaine, steroid and alcohol and neurectomy must be considered for treatment option.
Abstract
Patients who have repaired cleft lip and palate generally undergo restriction of maxillary growth. Concave facial profile is often exhibited with relatively normalized mandible. Horizontal and sagittal deficiency of the maxilla could cause anterior and posterior crossbites. In growing patients, orthodontic and orthopedic treatment is acceptable with maxillary expansion and protraction. However, surgical approach has to be accompanied with orthodontic treatment in skeletally matured patients. We used SARPE and BSSRO to expand the constricted maxilla and retract the mandible in a patient who had cleft palate repaired in infancy. Through SARPE, orthodontic treatment and BSSRO, we sufficiently expanded the maxillla and improved facial profile.
Abstract
Ameloblastoma is the most frequently accuring odontogenic tumor in mouth. The biologic behavior of this neoplasm is locally invasive tumor with a high rate of recurrence. But in case of unicystic ameloblastoma, it was known that the neoplasm can be treated by marsupialization and the recurrence rate is lower. In our clinic, we tried to treat one of ameloblastoma cases by marsupialization and finished the treatment by enucleation via intra-oral approach with sagittal ramus osteotomy. This is a report of that case about 29 years old female patient.
Abstract
The present study was aimed to examine the effect of acellular dermal matrix (AlloDerm ) grafted to the experimental tissue defect on tissue regeneration. Materials and Methods: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and AlloDerm graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-㎜ diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, AlloDerm graft, AlloDerm graft impregnated with rhBMP-2, and AlloDerm graft with rhTGF- 1. The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. Results: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of AlloDerm graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of AlloDerm with no satisfactory results in the group of AlloDerm graft. In the groups of the AlloDerm graft with rhBMP-2 or rhTGF- 1, there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the AlloDerm with regeneration features. However, the fibrous capsule also remained as in the group of AlloDerm graft, which separated the AlloDerm and the adjacent bone. Conclusions: These results suggest that AlloDerm can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF- 1.
Abstract
This study was performed to investigate the incidence, types of fracture, treatment, associated fracture and complications in patients with nasal bone fracture. Materials and methods: Clinical examination, patient’s records and radiographic images were evaluated in 230 cases of nasal bone fractures who were treated at the Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital for recent 5 years; from January 2002 to December 2006. Results: 1. The age of patient was ranged from 4 to 77 years (mean age=36.6 years); Males was 75.7% (n=174), and females 24.3% (n=56). 2. The cause of the nasal bone fracture in this study was a fall or slip down (28.8%, n=66), sports accident (26.0%, n=60), fighting (21.3%, n=49), traffic accident (9.6%, n=22), industrial trauma (7.8%, n=18), and the others (6.6%, n=15). 3. For the patterns of fracture, simple fracture without displacement occured in 10.4% (n=24). Simple fracture with displacement without septal bone fracture was found in 49.5% (n=114). Simple fracture with displacement in company with septal bone fracture showed in 32.6% (n=75). Comminuted fracture with severe depression was presented in 7.4% (n=17). 4. The reduction the displaced nasal bone was carried out in 2 to 10 days (mean 6.8 days) after the injury. 5. Nasal bone fracure associated with Le Fort I fracture (6.5%, n=6.5), Le Fort II fracture (7.4%, n=17), Le Fort III fracture (1.3%, n=3), NOE fracture (13.9%, n=32), ZMC fracture (17.4%, 40), maxillary bone fracture (8.3%, n=19), orbital blow-out fracture (15.7%, n=36), frontal bone fracture (1.3%, n=3) and alveolar bone fracture (10.9%, n=25). 6. The major type of treatment method was closed reduction in 90% (n=207), open reduction in 3% (n=7), and observation in 7% (n=16). 7. There were some complications such as ecchymosis, hyposmia, hypo esthesia and residual nasal deformity which are compatible. Open rhinoplasty was conducted for 3 patients who had residual nasal deformity. Conclusions: These results suggest that most of nasal bone fractures are occurred physically active aged groups(age 10-49 years) and could be treated successfully with closed reduction at 7 days after the injury.