rhBMP-2의 작용기전과 구강악안면 영역의 골재생을 위한 rhBMP-2의 활용

황순정(Soon Jung Hwang),박민우(Min-Woo Park),박재봉(Jae bong Park),박현수(Hyun Soo Park),백승준(Seung-Jun Paek),설희경(Hee-Kyung Sul),이경진(Kyung jin Lee),홍동환(Dong-Hwan Hong) 대한치과의사협회 2015 대한치과의사협회지 Vol.53 No.1

To overcome shortcoming of autogeneous, allogenic, xenogenic and alloplastic bone grafts, various growth factors related to bone regeneration have been identified and developed. Among them, rhBMP 2 is regarded as the most potent osteoinductive growth factor and it can trigger the differentiation of mesenchymal stem cells to osteogenic cells for accelerated new bone formation And several commercial products of rhBMP 2 are available in Korea. It is applied to maxillary sinus augmentation, guided bone regeneration and preservation of extraction socket. In this review, the development, action mechanism and clinical applications of rhBMP 2 will be described.

구강악안면부 외상발생의 역학적 평가

황순정 ( Soon Jung Hwang ),배성숙 ( Sung Suk Bae ) 한국치위생과학회 2012 치위생과학회지 Vol.12 No.4

In this study, 1,495 cases of computerized data collected as disease entities of oral and maxillofacial injuries among patient visiting S university hospital located in Seoul in 2009 were analyzed and following results were obtained. It was found that the injury incidence in male was greater than in female (1.49:1), it occurred most frequently in the age of 7∼14 years old (19.6%), and its most frequent cause was falling down (25.9%). Injuries occurred in other place including beach and open-air (24.7%) most frequently, often developed in anterior teeth (43.2%) and posterior teeth (43.1%), their incidence was relatively higher between 15:00∼17:00 (10.4%) and 19:00∼23:00 (7.1%) O`clock. In the relationship between causes of the injury and the diagnosis based on the international classification of disease), falling, fall, impingement, violence, traffic accident, sports and own making accident caused most frequently lip and oral open injuries (S01.5), open fracture of tooth (S02.51), close fracture of tooth (S02.50), close fracture of mandible (S02.60), close fracture of tooth (S02.50), respectively. From the above results, it is necessary to understand general characteristics of oral and maxillofacial injuries and to consider their trends for the establishment of systematic complement policies and for the performing safety training and public relations activities.

치과용 소형 C자형 투시장치를 이용한 하악 연조직에 위치한 부러진 기구의 제거: 증례보고

박성수,양훈주,황순정,Park, Sung-Soo,Yang, Hoon-Joo,Hwang, Soon-Jung 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.6

Intraoperative breakage of instruments can be occurred unexpectedly. To prevent damage of neighboring important anatomic structures and consequent complications, broken instruments should be removed as soon as possible. There have been several methods to remove broken instruments. One of them is the Carm fluoroscopy which is commonly used for locating metal foreign bodies. However, its application for removal of broken instruments in the oral and maxillofacial area is not common. In our experiences with the removal of two broken instruments in mandibular area, the newly developed dental mini C-arm was used to find broken instrument in soft tissue, because it gives real-time in situ information for the intraoperative location. We report two cases with broken instruments, a broken dental needle in the pterygomandibular space and a broken straight bur in the mandibular angle area. They were identified and could be removed safely using a dental mini C-arm.

임플란트 식립을 위한 치조골 증강술의 임상적 분석

팽준영,명훈,황순정,서병무,최진영,이종호,정필훈,김명진,Paeng, Jun-Young,Myoung, Hoon,Hwang, Soon-Jung,Seo, Byoung-Moo,Choi, Jin-Young,Lee, Jong-Ho,Choung, Pill-Hoon,Kim, Myung-Jin 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.4

Objectives: Distraction osteogenesis has recently evolved a challenging technique to overcome the limitations of conventional augmentation procedures. The aim of this report was to evaluate the clinical result of alveolar distraction osteogenesis for implant installation. Methods: Twenty five patients with alveolar ridge deficiencies were treated with vertical alveolar distraction osteogenesis by intraoral device (total 27 devices: 25 extraosseous and 2 intraosseous devices). After the latency periods of 5-7 days, activation of the device was started. The distraction rhythm and rate was 0.75-1.0 mm a day with 2 or 3 times a day. After 3-4 months, dental implants were placed with removing the distractor simultaneously. Results: On average, a vertical gain of $9.8{\pm}3.4\;mm$ was obtained by distraction osteogenesis. Total 84 implants were installed. Average follow up period was $13.5{\pm}7.5$ months. No implant was removed during the follow up period. Three patients showed infection during the distraction osteogenesis. Three devices were broken and 2 devices among them were replaced with new one. Conclusion: Relatively larger amount of alveolar bone augmentation could be obtained with distraction osteogenesis. For the ideal anatomically and functionally ideal regeneration of alveolar bone to install dental implant, the complication of distraction should be controlled.

한국인에 있어서 하행구개동맥의 위치 연구 (Le Fort I형 골 절단술과 관련하여)

이일구,명훈,황순정,서병무,이종호,정필훈,김명진,최진영,Lee, Il-Gu,Myoung, Hoon,Hwang, Soon-Jung,Seo, Byoung-Moo,Lee, Jong-Ho,Choung, Pil-Hoon,Kim, Myung-Jin,Choi, Jin-Young 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.6

Purpose: The Le Fort I osteotomy is a commonly performed maxillary procedure for dentofacial deformity. One of the risks of this procedure is major hemorrhage resulting from injury to the descending palatine artery. So it is very important to know the exact position of the descending platine artery. An increased understanding of the position of this artery can minimize the intra-operative bleeding while allowing extension of the bone cuts to achieve exact positioning maxilla. The aim of this investigation was to study the position of the descending palatine artery as it relates to the Le Fort I osteotomy. Methods and patients: Total 40 patients who underwent Le Fort I osteotomy in SNUDH OMFS were studied in this study. We measured the distance from the pyriform aperture to the descending palatine artery (DPA distance) using a ruler. We investigated the relationship between DPA distance, the distance from A point to the McNamara line on lateral cephalography and the patient's body height. Results: The average distances from the pyriform rim to the descending palatine artery were 35.3 mm on the right (range: $30{\sim}40mm$) and 33.7mm (range: $30{\sim}41mm$) on the left in males. Those in females were 33.4 mm on the right (range: $28{\sim}40mm)$ and 32.8mm (range: $27{\sim}38mm$) on the left. The significances between the distance the DPA distance, the body height and the distance from A point to McNamara line were not found. <Simple Regression Analysis> Conclusion: Injury to the descending palatine artery during Le Fort I osteotomy can be minimized by not extending the osteotomy more than 30 mm posterior to the pyriform aperture in mal, and 27 mm in female.

상악 전치부의 전하방 이동을 위한 치조골신장술

양훈주,이수연,황순정,Yang, Hoon-Joo,Lee, Su-Yeon,Hwang, Soon-Jung 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.5

Alveolar distraction osteogenesis (ADO) has been regarded as an acceptable treatment for the alveolar bone deficiency. For ADO at anterior maxillary area, the vector should be oriented to forward and down-ward direction to get an adequate occlusion with mandibular teeth and to increase bone length and width for implant placement. However, the conventional commercial distraction devices for ADO are designed to allow mainly downward movement of alveolar segment, even though a forward movement can be obtained a little by controlling of inclination of device. To make ADO with controllable bidirectional vector possible, we used customized devices using self-manufactured ABDUL (Alveolar Bone Distractor Using Lag screw principle) and commercial orthodontic palatal expansion device ($Hyrex^{(R)}$). In all cases (n = 4), ADO could be performed successfully and dental implants were able to placed with adequate occlusion. We report the procedures, advantages and disadvantages of these methods.

임플란트 표면의 Ca-P 코팅 방법이 MG63 골모유사세포 반응에 미치는 영향에 대한 in vitro 연구

김일연,정성민,황순정,신상완,Kim, Il-Yeon,Jung, Sung-Min,Hwang, Soon-Jung,Shin, Sang-Wan 대한치과보철학회 2009 대한치과보철학회지 Vol.47 No.4

연구목적: 본 연구에서는 양극산화 임플란트 표면에 서로 다른 두 가지 방법, Ion beam-assisted deposition (IBAD)법과 Sol-gel법으로 Ca-P 코팅한 임플란트 시편에 골모세포를 배양하였을 때 세포의 증식, 분화, 형태에 어떠한 영향을 미치는지 조사하고자 한다. 연구재료 및 방법: 지름 10 mm, 두께 2 mm 인 상업용 순수 titanium grade IV 재질의 디스크를 제작하였고, 모든 시편은 acetone, 70% ethanol, 증류수에서 각각 10분씩 세척 후 건조하였다. 모든 표면은 300 V의 constant voltage하에서 양극 산화 (anodized)시킨다. 실험군은 양극산화 임플란트 표면에 각각 IBAD법과 Solgel법으로 Ca-P 코팅하였다. 각 표면의 미세표면 거칠기(Ra)를 측정하였고, SEM을 통해 표면의 형상을 관찰하였다. 골모세포을 배양한 후 각 표면군의 세포 증식, ALP 활성도 및 RT-PCR를 통한 골세포 분화 능력 검증을 하였으며, SEM을 통해 세포의 형상도 확인하였다. 통계분석은 SPSS (version 12.0) 프로그램을 이용하여 Kruskal-Wallis Test로 각 군의 유의성을 검증하였다 ($\alpha$=0.05). 결과: IBAD법으로 Ca-P 코팅한 표면이 Sol-gel법으로 Ca-P 코팅한 표면보다 표면 거칠기 (Ra) 값이 더 크게 나타났다 (P<.05). IBAD법으로 Ca-P 코팅한 표면이 Sol-gel법으로 Ca-P 코팅한 표면 보다 세포 증식이 더 활발하고 골세포 조기 분화 정도를 확인 할 수 있는ALP 활성도 또한 더 높게 나타났다 (P<.05). SEM 관찰 결과IBAD법으로 Ca-P 코팅한 표면에 골모세포들이 친화성을 띄면서 안정적으로 부착되었다. 결론: IBAD법으로 Ca-P 코팅한 표면이 Sol-gel법으로 Ca-P 코팅한 표면보다 더 우수한 세포 반응을 보였다. IBAD법으로 Ca-P 코팅한 표면의 세포들은 증식이 잘 이루어지고 잘 분화된 골모세포 형상을 보이고 ALP 활성도 또한 높아 골 형성을 증가시켜 높은 골-임플란트 접촉을 보일 것이다. Purpose: The purpose of this study was to evaluate the response of osteoblast-like cells to Ca-P coated surface obtained via Ion beam-assisted deposition (IBAD) method and Sol-Gel process on anodized surface by cellular proliferation and differentiation. Material and methods: The surface of a commercially pure titanium (Grade IV) discs with dimension of 10mm diameter and 2 mm thickness was modified by anodic oxidation under a constant voltage of 300 V. The experimental groups were coated with Ca-P by the IBAD method and Sol-Gel process on anodized surface. The surface roughness (Ra) of specimens was measured by optical interferometer and each surface was examined by SEM. To evaluate cell response, MG63 cells were cultured and cell proliferation, ALP activity and the ability of cell differentiation were examined. Also, cell morphology was examined by SEM. The significant of each group was verified by Kruskal-Wallis Test ($\alpha$=.05). Results: The Ra value of Ca-P coated surface by IBAD method was significantly higher than Ca-P coated surface by Sol-gel process (P < .05). The level of cell proliferation and ALP activity was higher in Ca-P coated surface by IBAD method (P<.05). The expression of ALP showed higher level expression in Ca-P coated surface by IBAD method. Cells grown on Ca-P coated surface by IBAD method were uniformly distributed and developed a very close layer. Conclusion: These experiments showed better performances of Ca-P coated surface by IBAD method with respect to Ca-P coated surface by Sol-gel process. Ca-P coated surface by IBAD method appear to give rise more mature osteoblast characteristics and might result in increased bone growth and bone-implant contact.

구순구개열 환자의 상악골 열성장에서 골신장술을 위한 Internal distraction device와 Rigid external distraction의 비교

팽준영,명훈,황순정,서병무,최진영,이종호,정필훈,백승학,김명진,Paeng, Jun-Young,Myoung, Hoon,Hwang, Soon-Jung,Seo, Byoung-Moo,Choi, Jin-Young,Lee, Jong-Ho,Choung, Pill-Hoon,Baek, Seung-Hak,Kim, Myung-Jin 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.4

Distraction osteogenesis for the advancement of hypoplastic maxilla of cleft patients has shown successful results. In this report, rigid external distraction(RED) system and internal distraction device were used for maxillary advancement. Each system has its advantages and disadvantages. Larger amount of advancement can be achieved with RED system. But complex external device may give patients psychological stress. Internal device is invisible. However its distraction amount have limitation for the advancement (< 20mm) and the vector cannot be changed freely during distraction. The authors treated five cleft patients with maxillary hypoplasia(three with RED system and two with internal distractor). Their results were clinically satisfactory. We present the pros and cons of RED and internal system for maxillary distraction osteogenesis.

구강악안면 영역에서의 측두근판(temporal muscle flap)을 이용한 재건술

배찬용(Chan-Yong Bae),황순정(Soon-Jung Hwang) 대한구강악안면외과학회 2002 대한구강악안면외과학회지 Vol.28 No.1

Temporal muscle flap is usefull for the reconstruction of tissue defect at the oral and maxillofacial area. This article reports 3 cases of temporal muscle flap for the soft tissue reconstruction of infraorbital, palatal and mandibular retromolar area after tumor ablation. The advantages and disadvantage, postoperative complications and technical variations were reviewed and our 3 cases were evaluated in this aspects.

컴퓨터단층촬영과 파노라마상을 이용한 한국인 하치조관의 하악에서의 협, 설측 위치 관계에 대한 연구

신홍수(Hong-Soo Shin),황순정(Soon-Jung Hwang) 대한구강악안면외과학회 2002 대한구강악안면외과학회지 Vol.28 No.1

When bilateral sagittal split ramus osteotomy or mandibular angle reduction are carried out, we have to consider the position of inferior alveolar nerve. For bone splitting or resection using a saw or an osteotome, the bucco-lingual position of the inferior alveolar nerve plays an important role in the preventing perioperative complications such as paresthesia or anesthesia. Because it is rare to find literatures concerning the mean anatomic position of the inferior alveolar nerve in Koreans, we investigated 30 patients who underwent to take CT and orthopantomogram for implant surgery, and evaluated the bucco-lingual position and vertical relationship of the inferior alveolar nerve at the mandible. The results showed that the distance between inferior alveolar nerve and buccal plate was the farthest at mandibular second molar (7.1􀅭7.4mm) and the nearest at mandibular angle area (4.4􀅭4.8mm). But it was no statistical relationship between the bucco-lingual postion of inferior alveolar nerve on the CT and its vertical position on the OPT. In conclusion, the results suggest that a careful surgical procedure is needed at the mandibular angle area to avoid a nerve damage and there are sufficient bone materials at the mandibular second molar are for bilateral sagittal split ramus osteotomy or mandibular angle reduction or plate fixation. And OPT is not usefull for the evaluation of a relative bucco-lingual position of inferior alveolar nerve in relation to its vertical postion on the OPT.