상, 하악골 유래 조골세포의 골형성 능: 일차 연구

양훈주,송윤미,김리연,오지혜,조태형,김인숙,황순정,Yang, Hoon Joo,Song, Yoon Mi,Kim, Ri Youn,Oh, Ji Hye,Cho, Tae Hyung,Kim, In Sook,Hwang, Soon Jung 대한악안면성형재건외과학회 2013 Maxillofacial Plastic Reconstructive Surgery Vol.35 No.1

Purpose: Maxilla and mandible have different patterns of cortical and trabecular bone and different bone mineral densities, even though both are components of the jaw bone. However, cellular differences between maxilla- and mandible derived osteoblasts (OBs) have rarely been studied. We hypothesize that maxilla- and mandible-derived OBs show different responses to $17{\beta}$-estradiol (E2), which is one of the critical factors for bone formation. This study compares skeletal site-specific cell responses between maxilla- and mandible-derived human OBs to E2. Methods: Maxilla- and mandible-derived OBs derived from an identical donor were separately isolated from a total of five normal healthy subjects aged 18~44 years old, cultured with a treatment of 100 nM estrogen. The responses between maxilla- and mandible-derived OBs to E2 were evaluated and compared using cell proliferation, alkaline phosphatase (ALP) activity and gene expression of osteoprotegerin (OPG), ALP, insulin-like growth factor-1 (IGF-1), and estrogen receptor ${\alpha}$ ($ER{\alpha}$). Results: E2 did not have any distinct effects on the proliferation of both types of OBs. Mandible-derived OBs exhibited higher ALP activity than maxilla-derived OBs in the non-treated condition, which was common in all tested individuals. ALP activities of both types of OBs showed a minor increasing tendency with the treatment of E2, even though there was no statistical significance in some specimens. The gene expression of OB by E2 was diverse, depending on the individuals. There was increased expression of OPG, IGF-1, or $ER{\alpha}$ gene in the part of subjects, which was more repeated in maxilla-derived OBs. In particular, OPG or ALP induction by E appeared less frequently in mandible-derived OBs. Conclusion: Current results revealed that E2 affects maxilla- and mandible-derived OBs into facilitating the osteogenic process despite individual differences. Mandible-derived OBs are less sensitive to bone-forming gene expression by E2.

구순구개열 태아의 비정상적인 상악골 성장형태에 대한 연구

김성민(Soung Min Kim),김정환(Jung Hwan Kim),김지혁(Ji Hyuck Kim),박영욱(Young Wook Park),이종호(Jong Ho Lee),이석근(Suk Keun Lee) 대한구강악안면외과학회 2007 대한구강악안면외과학회지 Vol.33 No.3

This study is aimed to elucidate the abnormal growth pattern of human fetal maxilla with cleft lip and palate (CLP). Total 71 fetal maxillae with CLP were obtained from aborted human fetuses. They were examined radiologically for the dimensional changes of maxillary trapezoid (MT) formed by maxillary primary growth centers (MxPGC)(Lee et al., 1992). In palatal radiogram of the CLP maxilla, the MT was traced by the anterior and posterior MxPGCs, and the dimensions of anterior and posterior maxillary widths, maxillary length, and MT length (MTL), and MT area were measured for evaluation of the basic growth pattern of the developing maxilla. The growth of anterior and posterior MxPGCs was severely retarded in the prenatal maxillae with CLPs, showing abnormal shape of MT. Cleft lip subjects without cleft palate also showed arrested growth of MT. Unilateral cleft lipalveolar cleft or cleft palate (UCL-AC/CP) and bilateral cleft lip-alveolar cleft or cleft palate (BCL-AC/CP) showed enhanced abnormal MT pattern. The abnormality of MT was most marked in BCL-AC/CP. It was also observed that the craniofacial malformations other than CLPs produced abnormal MT. In conclusion, the MT growth of prenatal CLP maxilla was severely arrested and resulting in abnormal MT shape on the palatal radiogram. BCL-AC/CP showed more protruded nasal septum than other types of CLPs, while UCL-AC/CP showed severe deviation of the protruded nasal septum towards the non-cleft side. Cleft lip only subjects also showed the abnormal growth of MT. These data suggest that the MT is primarily involved in CLPs, and MT shape could be utilized as a sensitive indicator for the analysis of maxillary malformation in different types of CLPs.

양악 악교정 수술에서 르포트 I형과 U-자형 복합 골절단술 후 상악골의 안정성에 관한 임상적 연구

김민근,박영욱,Kim, Min-Keun,Park, Young-Wook 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.6

Postoperative skeletal stability was evaluated in combination of Le Fort I and U-shaped osteotomies for superior repositioning of maxilla in bi-maxillary surgeries in 30 consecutive patients. The fifteen patients underwent Le Fort I osteotomy alone and the other fifteen patients underwent Le Fort I and U-shaped osteotomies. In all patients, the maxilla was first osteomized and fixed with absorbable plates system. A bilateral sagittal split ramus osteotomy (BSSRO) of the mandible was then carried out and fixation was performed using absorbable plates. Maxillo-mandibular fixation with rubber ring was used for two weeks post-operatively in all patients. Lateral cephalograms were obtained pre-operatively, 1 day post-operatively, 6 months after surgery. The changes in anterior nasal spine (ANS), point A, upper incisior (U1), and point of maxillary tuberosity (PMT) were examined. The maxillas in the fifteen patients of both examination group were repositioned nearly in their planned positions during surgery and no significant post-operative changes in the examined points of the maxilla were found. These results suggest that a combination of a Le Fort I and U-shaped osteotomy is a useful technique for reliable superior repositioning of the maxilla. The post-operative change in the maxilla using this combination osteotomy was comparatively stable.

The factors that influence postoperative stability of the dental implants in posterior edentulous maxilla

Kim, Yun-Ho,Choi, Na-Rae,Kim, Yong-Deok Korean Association of Maxillofacial Plastic and Re 2017 Maxillofacial Plastic Reconstructive Surgery Vol.39 No.-

Background: All clinicians are aware of the difficulty of installing a dental implant in posterior maxilla because of proximate position of maxillary sinus, insufficient bone width, and lower bone density. This study is to examine which factors will make the implantation in the posterior maxilla more difficult, and which factors will affect the postoperative implant stability in this region. Methods: Five hundred seventy-three fixtures on the maxilla posterior were included for this study from all the patients who underwent an installation of the dental implant fixture from January 2010 to December 2014 at the Department of Oral and Maxillofacial Surgery in Pusan National University Dental Hospital (Yangsan, Korea). The postoperative implant stability quotient (ISQ) value, fixture diameter and length, presence of either bone graft or sinus lift, and graft material were included in the reviewed factors. The width and height of the bone bed was assessed via preoperative cone beam CT image analysis. The postoperative ISQ value was taken just before loading by using the OsstellTM $mentor^{(R)}$ (Integration Diagnostics AB, Gothenburg, Sweden). The t test and ANOVA methods were used in the statistical analysis of the data. Results: Mean ISQ of all the included data was 79.22. Higher initial bone height, larger fixture diameter, and longer fixture length were factors that influence the implant stability on the posterior edentulous maxilla. On the other hand, the initial bone width, bone graft and sinus elevation procedure, graft material, and approach method for sinus elevation showed no significant impact associated with the implant stability on the posterior edentulous maxilla. Conclusions: It is recommended to install the fixtures accurately in a larger diameter and longer length by performing bone graft and sinus elevation.

Short dental implants in the posterior maxilla: a review of the literature

Zeinab Rezaei Esfahrood,Loghman Ahmadi,Elahe Karami,Shima Asghari 대한구강악안면외과학회 2017 대한구강악안면외과학회지 Vol.43 No.2

The purpose of this study was to perform a literature review of short implants in the posterior maxilla and to assess the influence of different factors on implant success rate. A comprehensive search was conducted to retrieve articles published from 2004 to 2015 using short dental implants with lengths less than 10 mm in the posterior maxilla with at least one year of follow-up. Twenty-four of 253 papers were selected, reviewed, and produced the following results. (1) The initial survival rate of short implants in the posterior maxilla was not related to implant width, surface, or design; however, the cumulative success rate of rough-surface short implants was higher than that of machined-surface implants especially in performance of edentulous dental implants of length <7 mm. (2) While bone augmentation can be used for rehabilitation of the atrophic posterior maxilla, short dental implants may be an alternative approach with fewer biological complications. (3) The increased crown-to-implant (C/I) ratio and occlusal table (OT) values in short dental implants with favorable occlusal loading do not seem to cause peri-implant bone loss. Higher C/I ratio does not produce any negative influence on implant success. (4) Some approaches that decrease the stress in posterior short implants use an implant designed to increase bone-implant contact surface area, providing the patient with a mutually protected or canine guidance occlusion and splinting implants together with no cantilever load. The survival rate of short implants in the posterior edentulous maxilla is high, and applying short implants under strict clinical protocols seems to be a safe and predictable technique.

Malignant Fibrous Histiocytoma of the Maxilla

오윤경(Yoon Kyeong Oh),여환호(Hwan Ho Yeo) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.3

악성 섬유성 조직구종은 성악골부위에서는 매우 드물게 발생하는 악성 종양으로서, 두경부에 발생되는 예가 전체 악성 섬유성 조직구종의 7%이며 이들 7%중 12%가 성악골에 발생한다고 한다. 성악골의 악성 섬유성 조직구종은 국소재발이나 원격전이가 55%의 환자들에게 발생하며 평균 생존기간은 성악골, 하악골 및 구강연부조직의 악성 섬유성 조직구종에 관한 연구에서 30개월로 보고되었다. 성악골의 악성 섬유성 조직구종은 일차적으로 근치적 수술요법이 주 치료방법이다. 방사선치료에 관한 보고들은 대상환자들이 적어서 지금까지 체계적으로 보고되지 않았고, 중례보고에 의한 종양의 퇴행 또는 조직학적 변화가 발표된 바 있으며 일부 저자들은 수술후 방사선치료가 도움이 되지 않으므로 재발성 또는 수술 불가능한 경우에 시행하기를 권하기도 한다. 재발성 또는 전이성 악성 섬유성 조직구종 환자들에서 항암화학요법으로 33%의 관해율을 보였다는 보고가 있다. 저자들은 성악골의 악성 섬유성 조직구종 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Malignant fibrous histiocytoma(MFH) of the maxilla is a rare malignant bone tumor. Seven percents of all MFH occur in the head and neck. Approximately 12% of these tumors occur in the maxilla. Local recurrence or distant metastasis was reported in 55% of cases of maxillary MFH. The mean survival time of 30 months was reported from a review of 14 MFHs in the maxilla, mandible and oral soft tissues. MFH of the maxilla is best treated surgically but radiacal neck dissection does not appear to be indicated unless there is clinical evidence of lymph node metastases. Although the use of radiation therapy for head and neck MFH has not been studied for a series of cases, individual cases of regression or histological change have been reported. Other authors have reported numbers of cases who received radiation therapy without benefit. Response to combination chemotherapy has been reported in 33% of 23 patients with recurrent or metastatic MFH. We report here a case of MFH occurring in the maxilla with a review of literature about the clinical behavior and treatment of these lesions.

한국인 7-17세 아동의 두개저, 상악, 하악의 성장에 관한 준종단적 연구

손병화,김형순 대한치과교정학회 1999 대한치과교정학회지 Vol.29 No.1

한국인 7세-17세 아동의 두 개저, 상악, 하악의 사춘기 성장 양상을 파악해 보고자 남자 251개, 여자 286개의 측모두부계측방사선 사진을 이용, 10개의 계측점과 16개의 계측항목을 설정하고 계측항목에 대한 계측치와 각 연령별 년간 누년차를 산출한 다음 이들간의 통계적 유의성을 검증하였으며 각 계측항목을 두 개저, 상악, 하악의 세군으로 분류하고 또 남녀별 로 분류하여 비교함으로써 다음과 같은 결론을 얻었다. 1. 한국인 성장기 아동에 있어서의 성장은 남자 아동에 비해 여자 아동이 빠른 시기에 일어났다. 2. 두 개저, 상악골, 하악골 모두 사춘기 성장을 나타내었으나 두 개저의 성장은 안면골 성장에 비해 상대적으로 작았다. 3. 두 개저 성장에 있어서 전두개저 길이의 증가에 비해 중두개저 및 후두개저의 길이 증가가 현저했으며 사춘긱 성장증가(circumpuberal growth spurt) 양상도 보다 명확했다. 4. 상악골의 전하방 이동은 상악골 자체의 길이 성장과 상악골 주위 봉합부의 성장에 따른 변위가 종합된 결과로 두 개저에 대한 상악골의 상대적 위치를 나타내는 Ar-ANS와 Ar-Pr 이 상악골 자체의 길이 성장을 나타내는 ANS-PNS 보다 많은 성장량을 보였다. 5. 하악골은 수평 성장량에 비해 수직 성장이 약간 크게 나타났으나 유의할 수준은 아니다. 6. 상악 치조골과 하악 치조골은 유치 탈락후 영구치 맹출시기에 최대 성장률을 보인후 감소하는 경향을 보이지만 하악 치조골의 수직성장에서는 사춘기 성장증가가 관찰되었다. Lateral cephalograms of 251 males and 286 females were taken and pubertal growth pattern of cranial base, maxillary and mandible of 7 to 17 years old Korean children was evaluated. 10 landmarks and 16 analytical measurements were evaluated. Analytical measurement and annual difference for each age group was calculated and tested for statistical significance. Analytical measurements were classified into three group which were cranial base, maxillary and mandibular measurements and also classified into make and female measurements. Following results were achieved. 1. The circumpuberal growth spurt was earlier in Korean females than in males. 2. Cranial base, maxilla and mandible showed circumpuberal growth. The cranial based showed a relatively smaller amount of growth than the facial complex. 3. Middle and posterior cranial base length showed a greater increase than anterior cranial base length and circumpuberal growth spurt was also more definite. 4. the forward and downward growth of maxilla results from maxillary growth itself and transposition of the maxilla due to circumsutural growth aroud the maxilla. Ar-AN S and Ar-Pr which represent maxillary position relative to the cranial base showed more growth than ANS-PNS which represents maxillary bone growth. 5. mandible showed more vertical growth than horizontal growth but without significance. 6. Alveolar growth of maxilla and mandible show maximum growth rate of the time of permanent teeth eruption following loss of deciduous teeth. After this period alveolar growth shows a decreasing tendency.

Aggressive central odontogenic fibroma in the maxilla: A case report

조봉혜,정연화,황재준 대한영상치의학회 2022 Imaging Science in Dentistry Vol.52 No.4

A central odontogenic fibroma is a rare benign tumor composed of mature fibrous connective tissue with variable amounts of odontogenic epithelium. It appears at similar rates in the maxilla and mandible. In the maxilla, it usually occurs anterior to the molars. Radiographically, central odontogenic fibroma commonly presents as a multilocular or unilocular radiolucency with a distinct border. This paper reports a case of an aggressive central odontogenic fibroma involving the right posterior maxilla of a 53-year-old man. Radiographs showed an extensive soft tissue mass involving the entire right maxilla with frank bone resorption. The patient had a history of 2 operations in the region, both more than 2 decades ago. Although it was impossible to confirm the previous diagnoses, it was presumed that this case was a recurrent lesion.

Aggressive central odontogenic fibroma in the maxilla: A case report

Bong-Hae, Cho,Yun-Hoa, Jung,Jae-Joon, Hwang Korean Academy of Oral and Maxillofacial Radiology 2022 Imaging Science in Dentistry Vol.52 No.-

A central odontogenic fibroma is a rare benign tumor composed of mature fibrous connective tissue with variable amounts of odontogenic epithelium. It appears at similar rates in the maxilla and mandible. In the maxilla, it usually occurs anterior to the molars. Radiographically, central odontogenic fibroma commonly presents as a multilocular or unilocular radiolucency with a distinct border. This paper reports a case of an aggressive central odontogenic fibroma involving the right posterior maxilla of a 53-year-old man. Radiographs showed an extensive soft tissue mass involving the entire right maxilla with frank bone resorption. The patient had a history of 2 operations in the region, both more than 2 decades ago. Although it was impossible to confirm the previous diagnoses, it was presumed that this case was a recurrent lesion.

상악골 전방 견인이 상악골체의 변위에 미치는 영향

고정석,김종철 대한치과교정학회 1995 대한치과교정학회지 Vol.25 No.5

골격성 부정교합에 대한 악정형 치료시, 바람직한 악정형 효과를 얻기 위해서는 악정형 장치의 역학 현상에 대한 분석이 필요하다. 상악의 저성장에 기인한 골격성 Ⅲ급 부정교합의 치료를 위한 상악골의 전방견인시 바람직한 견인력 방향과 견인 위치를 알아보기 위해, 성인 두개골을 대상으로 3차원 유한 요소 모델을 제작하여, 제1소구치와 제1대구치에서 각각 교합평면에 평행 또는 20˚하방으로 500g의 전방 견인력을 주어 상악골체의 각 부분에서 응력과 변위를 분석하여 다음과 같은 결과를 얻었다. 1. 모든 경우 상악골이 반시계 방향으로 회전하는 양상을 보였다. 2. 견인력 방향에 따른 상악골의 회전은, 20˚하방으로 견인하는 경우가 평행하게 견인하는 경우보다 더 적었다. 3. 견위 위치에 따른 상악골의 회전은, 평행하게 견인시에는 견위 위치가 제1대구치일 때가, 20˚하방으로 견인시에느 제1소구치일 때가 더 적었다. 이상의 결과 견인력 작용선이 상악골체의 저항 중심점에 가장 근접하여 반시계 방향으로의 변위가 가장 적게 일어난 제1소구치에서 20˚하방으로 견인한 경우가 바람직한 견인력 방향과 견인 위치로 판단되었다. In the orthopedic therapy, the biomechanical analysis of the appliance is necessary to get a desirable orthopedic effect. The purpose of this study was to investigate the desirable direction and application position of the protraction force. The protraction force of 500g was applied to the first premolar or to the first molar. The direction of force application was paralell or 20˚downward to the occlusal plane respectively. The stress distribution and the displacement within the maxilla was analyzed by a 3-dimensional finite element method. The findings obtained were as follows : 1. Protraction forces caused a counterclockwise rotation of the maxilla. 2. The degree of maxillary rotation was less when the force was applied 20˚downward direction to the occlusal plane than when applied to the parallel direction. 3. The degree of rotation of maxilla was greater when the parallel force was applied to the 1st premolar than when applied to the first molar, whereas it was greater when force is applied 20˚downward than at the first premolar. In conclusion, the 20˚downward protraction from the first premolar induced the least counterclockwise rotation of the maxilla and was thought as the desirable direction and application position of the protraction force.