하악골 매식 부위 계측을 위한 나선형 단층촬영술의 신뢰도

김기덕,박창서,Kim Kee-Deog,Park Chang-Seo 대한영상치의학회 1997 Imaging Science in Dentistry Vol.27 No.2

The purpose of this study was to evaluate the accuracy and usefulness of spiral tomography through the comparison and analysis of SCANORA cross-sectional tomographs and DentaScan computed tomographic images of dry mandibles taken by a SCANORA spiral tomographic machine and a computed tomographic machine. Thirty-one dry mandibles with full or partial edentulous areas were used. To evaluate the possible effect of location in the edentulous area, it was divided into 4 regions of Me (region of mental foramen), MI (the midportion between Me and M2), M2 (the midportion between mental foramen and mandibular foramen) and S (the midportion of the mandibular symphysis). A ZPC column (sized 4 mm x 5 mm) was seated on the edentulous regions of Me, MI, M2 and S using the acrylic stent. Then SCANORA spiral tomography and computed tomography were taken on the edentulous regions which contained the ZPC column. The ZPC columns and cross-sectional images of the mandible were measured in the radiographs by three observers and the differences between the two imaging modalities were analysed. The results were as follows: 1. In comparing the actual measurements of the ZPC column and measurements in the radiographs, the mean error of the DentaScan computed tomography was 0.07 mm in vertical direction and -0.06 mm in horiwntal direction, while the mean error of the SCANORA spiral tomography was 0.06 mm in vertical direction and -0.12 mm in horizontal direction. There was a significant difference between the two radiographic techniques in the horizontal measurement of the ZPC column of the symphysis region (p<0.05). But there was no significant difference in the measurements of other regions (p>0.05). 2. In measurements of the distance from the alveolar crest to the inferior border of the mandible (H), and of the distance from the alveolar crest to the superior border of the mandibular canal (Y), there was no significant difference between the two radiographic techniques (p>0.05). 3. In measurements of the distance from the lingual border of the mandible to the buccal border of the mandible (W), and of the distance from the lingual border of the mandible to the lingual border of the mandibular canal (X), there was a significant difference between the two radiographic techniques in measurements of the midportion between the mental foramen and the mandibular foramen (M2) (p<0.05). But there were no significant differences in measurements of the other regions of symphysis (S), mental foramen (Me), the first one-fourth portion between the mental foramen and the mandibular foramen (M1) (p>0.05). 4. Considering the mean range of measurements between observers, the measurements of SCANORA spiral tomography showed higher value than those of DentaScan computed tomography, except in measurements of symphysis (S). 5. On the detectability of the mandibular canal, there was no significant difference between the two radiographic techniques (p>0.05). In conclusion, SCANORA spiral tomography demonstrated a higher interobserver variance than that of DentaScan computed tomography for implant site measurements in the posterior edentulous area of the mandible. These differences were mainly the result of difficulty in the detection of the border of the mandible in SCANORA spiral tomography. But considering the cost and the radiation exposure, SCANORA spiral tomography can be said to be a relatively good radiographic technique for implant site measurement.

악관절원판 천공의 방사선학적 연구

김기덕,박창서,Kim Kee-Deog,Park Chang-Seo 대한영상치의학회 1990 Imaging Science in Dentistry Vol.20 No.2

Thirty-nine patients (forty-four joints) who had been diagnosed as having meniscus perforation of the temporomandibular joint by inferior joint space arthrography and had been treated by surgical procedures were evaluated retrospectively. Information of clinical findings, arthrotomographic findings and surgical findings was collected on a standardized form and evaluated. The results were as follows: 1. On the 34 patients of 38 joints which were surgically confirmed perforation of meniscus or its attachments of the temporomandibular joint, there were 29 females and 5 males (5.8:1). The average age was 36 years (range 17 to 70). 2. The common clinical findings of group that had meniscus displacement without reduction and with perforation were pain on the affected joint and limitation of mouth opening. In the group showing meniscus displacement with reduction and with perforation the common clinical findings were pain and clicking on the affected joint. 3. 32 joints (84.2%) were arthrotomographically anterior meniscus displacement without reduction and with perforation, 6 joints (15.8%) showed anterior meniscus displacement with reduction and with perforation. 4. Joints categorized arthrotomographically as having meniscus displacement without reduction and with perforation were less likely to have full translation of the condyle in comparison with the normal or meniscus displacement with reduction and with perforation groups. (p<0.05) 5.The arthrographic findings of 44 joints having meniscus perforation were compared with surgical findings, there were 6 false positive findings of meniscus perforation, the reliability of arthrographic findings of meniscus perforation was a 86.4% correlation with surgical findings. 6. On the site of perforations of 38 joints which were surgically confirmed perforation of meniscus or its attachments, twenty-three of perforations (60.5%) were in location at the junction of the meniscus and posterior attachment, forteen (36.9%) were located at the posterior attachment and one (2.6%) was at the meniscus itself.

3차원영상 전산화단층촬영을 이용한 한국인 아래턱뼈의 체질인류학적 연구 - 3차원영상의 정확도 평가

김기덕(Kee-Deog Kim),김희진(Hee-Jin Kim),한승호(Seung-Ho Han),박창서(Chang-Seo Park) 대한체질인류학회 1999 대한체질인류학회지 Vol.12 No.1

저자들은 아래턱뼈의 전산화단층촬영을 시행하여 3차원 영상 및 다 평면 영상재구성을 시행한 후 얻어 진 영상에서의 계측치를 실제 마른 뼈에서의 계측 치와 비교 분석하여 3차원 CT 영상 및 다 평면 영상재구성 영상의 정확도 및 신뢰도를 평가하고 3차원 CT 영상 및 다 평면 영상재구성 영상의 체질인류학적 연구에 있어서의 유용성을 검증하고자 본 연구를 시행하였다. 상태가 양호한 마른 아래턱뼈 29개를 선택하고 총 16개의 계측 항목을 대상으로 계측한 후 다음과 같은 결과를 얻었다. 1. 아래턱뼈의 실제 계측 치와 3차원 CT 영상에서의 계측치의 상관계수(y)는 턱뼈몸통 길이 (Go-Pg)를 제외하고는 0.95에서 0.99사이의 값을 보여 매우 높은 상관관계를 나타내었다. 2 아래턱뼈의 실제 계측 치와 3차원 CT 영상에서의 계측치의 평균 차이를 고찰한 결과 모든 계측항목에서 두 계측치 간의 평균 차이는 -0.52mm에서 0.42mm사이의 값을 나타내었고 이러한 평균 차이의 표준편차는 0.28mm에서 2.70mm 사이의 값을 나타내었다. 3. 아래턱뼈의 실제 계측 치와 3차원 CT 영상에서의 계측 치와의 차이가 1mm 이내인 경우가 352개로 총 464개의 계측치중 75.9%였고, 계측치의 차이가 2mm이내인 경우는 445개로 총464개의 계측치중 95.9%였다. 결론적으로 CT를 사용한 3차원 CT 영상 및 다 평면 영상재구성 CT 영상이 체질인류학적 연구에 유용하게 사용 될 수 있을 것으로 여겨진다.

3차원 전산화단층찰영 영상을 이용한 얼굴 연조직 두께 계측

정호걸,김기덕,한승호,신동원,허경석,이제범,박혁,박창서,Jeong Ho-Gul,Kim Kee-Deog,Han Seung-Ho,Shin Dong-Won,Hu Kyung-Seok,Lee Jae-Bum,Park Hyok,Park Chang-Seo 대한영상치의학회 2006 Imaging Science in Dentistry Vol.36 No.1

Purpose : To evaluate accuracy and reliability of program to measure facial soft tissue thickness using 3D computed tomographic images by comparing with direct measurement. Materials and Methods : One cadaver was scanned with a Helical CT with 3 mm slice thickness and 3 mm/sec table speed. The acquired data was reconstructed with 1.5 mm reconstruction interval and the images were transferred to a personal computer. The facial soft tissue thickness were measured using a program developed newly in 3D image. For direct measurement, the cadaver was cut with a bone cutter and then a ruler was placed above the cut side. The procedure was followed by taking pictures of the facial soft tissues with a high-resolution digital camera. Then the measurements were done in the photographic images and repeated for ten times. A repeated measure analysis of variance was adopted to compare and analyze the measurements resulting from the two different methods. Comparison according to the areas was analyzed by Mann-Whitney test. Results : There were no statistically significant differences between the direct measurements and those using the 3D images (p>0.05). There were statistical differences in the measurements on 17 points but all the points except 2 points showed a mean difference of 0.5 mm or less. Conclusion : The developed software program to measure the facial soft tissue thickness using 3D images was so accurate that it allows to measure facial soft tissues thickness more easily in forensic science and anthropology.

악골에 발생한 석회화 치성낭의 임상 및 방사선학적 고찰

윤혜림,김기덕,박창서,Yoon Hae-Rym,Kim Kee-Deog,Park Chang-Seo 대한영상치의학회 1996 Imaging Science in Dentistry Vol.26 No.2

Nine cases presented with a calcifying odontogenic cyst to the Dental Hospital of the College of Dentistry, Yonsei University. from January 1987 to September June, 1996, Clinical or histopathological findings were observed according to each radiologic criteria. The results obtained are as follows : 1. The male to female ratio was 2 : 1 with a mean age of 25 years. 2. The radiographic appearences of nine cases were well-defined radiolucent lesions in which eight cases were shown unilocular lesions and only one lesion was seen multilocular lesion. 3. Radiologically. three of nine cases were pure radiolucent lesions and others, six cases were radiolucent contained a variable amount of radiopaque material. 4. Histologically, two cases were classified simple cyst, five were cyst associated odonoma, two were neoplastic type. 5. Histological findings according to the radiological classification, two of three radiolucenct lesions were simple cysts; another was a cyst associated with odontoma. While, four of six radiologic mixed lesions turned out to be a cyst associated with odontoma, two was the neoplastic type.

단층촬영 각도의 변화가 하악과두의 골 증식성 병소의 인식에 미치는 영향

한상선,김기덕,Han Sang-Sun,Kim Kee-Deog 대한영상치의학회 1999 Imaging Science in Dentistry Vol.29 No.1

Purpose: To find out the effects that different tomographic angles have on the osteophytic lesion detectability of condyle head by comparison the individualized lateral tomographic image with the various tomographic angled images using SCANORA/sup (R)/. Materials & Methods: This study is performed to simulate osteophytic lesions by a series of dentin chips placed at six locations on condyle head. The control angle is 15° and from this angle. tomographic angle were varied with -10°, +10°, +20°. All the images with each sized dentin chip were scored by three dental radiologists with the use of confidence levels for presence or absence of the lesion, each examiner viewed one of the images twice. A rating scale from 0 to 2 (0, lesion definitely not present; 1. uncertain if lesion is present; 2, lesion definitely present). Responses were assessed by Tukey' s multiple comparison method and kappa value. Results: 1. The lesion size of 0.3 mm could not be detected in all the tomographic angles. As the size of the lesion increased the average value of lesion detectability also increased. 2. In the lesion sizes of 0.7 mm there was statistically significant difference between the 15° control angle and the altered tomographic angles (p<0.05). In 1.0 mm lesion there was no significant difference in the ±10° altered angles (p >0.05). but there was significant difference in the altered angle (p<0.05). In the lesion sizes of 0.3 mm and 2.0 mm there was no significant difference between the 15° control angle and all the altered angles (p >0.05). 3. In the anteromedial. anterosuperior, anterolateral area there was no significant difference between the 15° control angle and the ±10° altered angle (p >0.05), but in the comparison with the +20° altered angle there was significant difference (p<0.05). Conclusion: When imaging the lateral tomography of the temporomandibular joint used by SCANORA/sup (R)/, it can be considered that in the osteophytic lesion size of 2 mm and above, the tomographic angle difference within +20° to the horizontal angle of the condyle. has little effect on the lesion detectability. And in the lesion size of 1 mm, the altered angle within ±10° also has little effect on the lesion detectability.

부분 무치악 하악골의 치조골 및 기저골 변화에 관한 방사선학적 평가

박창서,김기덕,Park Chang-Seo,Kim Kee-Deog 대한영상치의학회 2002 Imaging Science in Dentistry Vol.32 No.3

Purpose : The purpose of this study was to propose standard values for alveolar and basal bone in normal adult mandibles, and radiologically analyze the remodeling process of the edentulous mandible by examining molar areas and comparing them to the established normal values. Materials and Methods : Panoramic and CT scans of mandible were performed on 20 normal adults and 20 edentulous or partially edentulous adults. In both groups, arch half diameter and distance of alveolar bone were measured. Also the distance from the mandibular canal to the caudal edges, the buccal and lingual external borders of basal bone, were measured. A statistical comparison between the mean values of normal and edentulous mandibles was carried out in the selected areas. Results : There was evidence of decreasing arch half diameter and distance in the edentulous mandible, but statistically no significant change was seen between the normal and edentulous alveolar bone. There was evidence of decreasing buccal basal bone and increasing in the lingual basal bone in the edentulous mandible. A statistically significant difference between normal and edentulous mandibles was noted in the buccal basal bone. Conclusion: There was an inward and forward atrophic change of the edentulous mandibular molar area compared to the control. CT scanning required the use of sophisticated and expensive procedures to analyze the remodeling process of edentulous mandibles. Consequently, the development and application of a more simplified and objective radiographic procedure for broad and long-term study of remodeling procedures of edentulous mandible was recommended.

전산화단층사진을 이용한 치성각화낭과 법랑모세포종의 감별진단

은상아,김기덕,박창서,Eun Sang-A,Kim Kee-Deog,Park Chang-Seo 대한영상치의학회 2002 Imaging Science in Dentistry Vol.32 No.2

Purpose: The objective of this study is to find the differentiating characteristics of ameloblastomas and odontogenic keratocysts of the jaw by analyzing computed tomography (CT) images of the lesions, clarify radiological characteristics associated with jaw lesions, and to make a diagnsis based on these findings. Materials and Methods : Test subjects were chosen among the patients who were diagnosed as having an odontogenic keratocyst or ameloblastoma at the Yonsei University Dental Hospital from January 1996 to December 2000 and had CT scans taken preoperatively. The subject pool was comprised of 51 cases of odontogenic keratocyst and 37 cases of ameloblastoma. The following measures were used for image analysis of the lesion: the anatomic location, CT pattern, mesiodistal width, buccolingual width, the ratios between mesiodistal width and buccolingual width, height, CT number, homogeneity of radiodensity, the appearance of a sclerotic rim, continuity of adjacent cortical bone, and displacement and resorption of adjacent teeth. Results: Comparing the CT patten, mesiodistal width, buccolingual width, height, CT number, homogeneity, appearance of sclerotic rim, continuity of adjacent cortical bone, there were statistically significant differences between ameloblastoma and odontogenic keratocyst test subjects (p<0.05). Comparing the ratios between mesiodistal width and buccolingual width, displacement and resorption of adjacent teeth, there were no statistically significant differences (p>0.05). Conclusion: We compared odontogenic keratocysts and ameloblastomas in CT scans. They occurred most frequently in the posterior to the ramus of the mandible. The findings of patterns of the CT images showed that size and border of lesions were more aggressive in ameloblastomas than in odontogenic keratocysts. The internal contents represented an increased attenuation area (IAA) in odontopenic keratocyst. Odontogenic keratocysts were shown to have higher CT numbers than ameloblastomas.

악골에 발생한 백악질 및 골화성섬유종의 임상 및 방사선학적 고찰

조은영,김기덕,박창서,Jo Eun-Young,Kim Kee-Deog,Park Chang-Seo 대한영상치의학회 1997 Imaging Science in Dentistry Vol.27 No.2

The purpose of this study was to know the proper diagnosis and to establish the treatment plan of cementifying and ossifying fibroma in the jaws through the clinical, raiological, and histopathologic considerations. The authors compared and analyzed the c1inicoradiologic features of the thirteen cases of cementifying and ossifying fibroma, diagnosed at the Dental college hospital in Yonsei university, Seoul, Korea, during the period from 1980 to 1995. The obtained results were as follows : 1. Cementifying and ossifying fibroma occured in the mean age, 44 years, ranged from 29 to 65 years and the male to female ratio was approximately 1:5. 2. Swelling was the most common frequent presenting complaints. Other reported symptoms included pain, tooth mobility and asymptom. 3. The frequency of the lesions was twelve cases in the mandible and one case in the maxilla. And eleven of thirteen cases were distributed on the premolar and molar region. 4. Radiologically, eight of thirteen cases were well defined lesions, five cases were relatively well defined lesions. And nine of thirteen cases were mixed lesions, three cases were radiopaque lesions, and only one case was purely radiolucenct lesion. 5. Histologically, seven of thirteen cases were classified ossifying fibroma, four cases were cemento-ossifying fibroma, and two cases were cementifying fibroma.

치과치료시 고혈압적 응급상황 관리 -증례 보고-

황재호,김기덕,우은정,이민혜,담추금,박원서,Hwang, Jae-Ho,Kim, Kee-Deog,Woo, Eun-Jung,Lee, Min-Hye,Tan, Chiu-Chin,Park, Won-Se 대한치과마취과학회 2010 Journal of Dental Anesthesia and Pain Medicine Vol.10 No.2

Medical emergencies are not rare in dental practice but when an emergency does occur it can be life-threatening. Medical emergency such as hypertensive crisis can be encountered in dental practice and the dentist should be competent in emergency management by taking life support courses. This report shows 3 cases of hypertensive crisis during dental treatment and we discuss proper management of the patients. The medical and dental management for the hypertensive crisis included a correct diagnosis, pharmacological usages for pain control and stress relieving environment making.