측두 하악 장애의 진단과 치료

김철훈(Chul Hoon Kim) 대한치과의사협회 2012 대한치과의사협회지 Vol.50 No.5

Temporomandibular disorder(TMD) is described as a cluster of disorders characterized by pain in the preauricular area and/or the muscles of mastication; limitations or deviations in mandibular range of motion; and noises in the TMJ during mandibular function. The most common symptom in TMD patients is pain that is aggravated by chewing or other jaw function. These symptoms are appeared when the stimuli loaded in TMJ are over the physiologic tolerance. The primary goal in treatment of TMD is to alleviate pain and /or mandibular dysfunction. TMD treatment can be divided into 2 categories: reversible and irreversible methods. Reversible methods include medication, thermal therapy, habit modification, physical therapy, appliance therpy and arthrocentesis and lavage and irreversible methods include arthroscopic lysis, surgery, occlusal adjustment et al. It is widely accepted that reversible methods are ther first choice of treatments. However if reversible ones are not effective, irreversible methods are considered.

일 지역 여성의 결혼 전 건강검진에 대한 인지, 의도 및 이행정도

김철훈(Kim, Chul-Hoon),신유정(Shin, You-Joung),김명수(Kim, Myoung-Soo) 한국산학기술학회 2010 한국산학기술학회논문지 Vol.11 No.7

본 연구의 목적은 일 지역 여성의 결혼 전 건강검진에 대한 인지, 의도, 이행정도를 파악하고, 미혼여성의 검진의도 및 기혼여성의 검진이행을 예측하는 요인을 규명하기 위한 연구로 총 257명의 연구대상자를 대상으로 하였 다. 자료는 결혼 전 건강검진에 대한 인지(인식, 태도, 주관적 규범, 행동통제인식), 의도, 이행정도를 묻는 질문지를 이용하여 조사하였고, 분석은 SPSSWIN 12.0 프로그램을 활용하여 평균, 표준편차, χ²-test, t-test, 다중회귀분석 (multiple Logistic regression)을 이용하였다. 결혼 전 건강검진을 수행한 정도를 살펴본 결과 28.4%의 기혼여성이 수 행한 것으로 나타났고, 35%의 미혼여성과 71.6%의 기혼 여성이 결혼전 건강검진에 대해 들어본 적이 있는 것으로 나타났다. 결혼 전 건강검진에 대한 태도는 미혼과 기혼여성에게서 각각 23.04점, 22.55점(t=1.39, p=.16), 주관적 규범 은 각각 14.49점과 14.46점 (t=.13, p=.90)으로 미혼여성이 기혼여성에 비해 긍정적이었으나 통계적으로 유의한 차이가 없었다. 하지만, 행동통제인식에서는 미혼여성이 15.46점, 기혼여성이 16.79점(t=5.32, p<.001)로 두 군간 유의한 차이 가 있었다. 미혼여성의 검진의도에 영향을 미치는 요인은 검진의 필요성(OR=14.186, t=.001)이었고, 기혼여성의 검진 이행에 영향을 미치는 요인은 검진에 대해 들은 경험(OR=7.765, p=.012)과 행동통제인식(OR=1.423, p=.025)이었다. 이 결과는 여성의 결혼 전 건강검진의 의도 및 실천을 증진시키기 위해서는 검진의 필요성에 대한 인지강화, 행동통제인 식의 강화가 필요하며 이를 위한 프로그램의 개발이 지역사회를 중심으로 이루어져야 함을 제시해준다. The objectives of this study were to identify recognition, intention and practice to premarital examination of women and to define the predictors of intention and compliance to examination. The subjects for this study were 257 women at a university, college, a bank worker and health clinic visitor in Busan city. The date for this study was collected from August 25th to September 24th 2006 by structured questionaries, and were analyzed mean, standard deviations(SD), χ²-test, t-test and multiple Logistic regression using SPSS/WIN 12.0. The mean performance of the premarital examination was 28.4%. Thirty-five point five percent of unmarried women and 71.6 percent of married women had experience of heard premarital examination. The score of attitude toward premarital examination were that single women was 23.04 and married women was 22.55, respectively. The scores of behavioral control cognition between unmarried women and married women were statistically significant different. The predictor of premarital examination intention was necessity of premarital examination, and the predictors of examination compliance were experience of hearing examination and behavioral control cognition. Based on the results of this study, promoting recognition and behavioral control cognition by community healthcare organization and health professionals for empowering the premarital examination of women were needed.

A retrospective randomized study of success rates according to abutment selection in DENTIS submerged implant with an internal hex connection

Eun-Hee Kim(김은희),Joeng-Eun Lee(이정은),Hee-Seong Hwang(황희성),Chul-Hoon Kim(김철훈),Jung-Han Kim(김정한),Bok-Joo Kim(김복주) 대한치과의사협회 2018 대한치과의사협회지 Vol.56 No.11

PURPOSE. The purpose of this study is to determine the efficacy of the DENTIS submerged-type implant with an internal hex connection and to build corresponding abutment-selection criteria. MATERIAL AND METHODS. A total of 204 patients received submerged implant fixtures with an internal hex connection at the Dong-A University Hospital Dental clinic in Busan from January 2013 and May 2016. Three specific abutments, UCLA abutments, customized abutments, ready-made abutments, were randomly selected. Implant success was defined as the basis of the International Congress of Oral Implantologists(ICOI, 2007) criteria. The relationship between the implant success rate and the abutment factor was analyzed using the Kruskal-Wallis test(P<.05). RESULTS. A total of 508 implants were placed in 204 patients. After a mean observation period of 38.6 months, 493 out of 508 implants were in normal function, yielding an overall success rate of 97.05%. A total of 15 implants failed: 10 in the maxillary molar area, 4 in the mandibular molar area, and 1 in the mandibular incisal area. All of the implant failures occurred in a singleimplant prosthesis, especially high in the maxillary molar area. The Kruskal-Wallis analysis showed that abutment selection has no significant correlation with implant failure(P>.05). CONCLUSION. DENTIS submerged implants with an internal hex connection showed predictable results with a success rate of 97.05%. It is no influence on the success rate in the selection of submerged implant abutment with an internal hex connection.

당뇨 유도 백서 경골에 매식한 티타늄 임플란트 주위에 지방조직 유래 줄기세포 적용 시 골치유에 미치는 영향

김민구(Min-Gu Kim),정인교(In-Kyo Jung),신상훈(Sang-Hun Shin),김철훈(Chul-Hoon Kim),김복주(Bok-Joo Kim),김정한(Jung-Han Kim),황영섭(Young-Sup Hwang),정유진(Eu-Gene Jung),김진우(Jin-Woo Kim),김욱규(Uk-Kyu Kim) 대한구강악안면외과학회 2010 대한구강악안면외과학회지 Vol.36 No.5

Introduction: Diabetes mellitus, as a major health problem for the elderly has been shown to alter the properties of the bone and impair bone healing around a titanium implant in both humans and animals. The aim of this study was to examine the effect of adipose-derived stem cells on the healing process around a titanium implant in streptozotocin-induced diabetic rats. Materials and Methods: Thirteen rats were divided into two groups: adipose-derived stem cells injected group and a control group. A titanium screw implant (diameter: 2.0 mm, length: 3.5 mm) was placed into both tibia of 13 rats: 13 right tibia as the control group and 13 left tibia as the experimental group. The rats were sacrificed at different intervals (1, 2, and 4 weeks) after implantation for histopathology observations and immunohistochemistric analysis. Results: The histopathological findings revealed earlier new formed bone in the experimental group than the control group. In particular, at 1 week after implantation, the experimental group showed more newly formed bone and collagen around the implant than the control group. In immunohistochemistric analysis, osteoprotegerin (OPG) expression in the experimental group increased early compared to that of the control group until 2 weeks after implantation. However, after 2 weeks, OPG expression in the experimental group was similar to OPG expression in the control group. The receptor activator of nuclear factor κB ligand (RANKL) expression in the experimental group increased early compared to that of the control group, and then decreased at 2 weeks. After 2 weeks, the level of RANKL expression was similar in both groups. Conclusion: These results suggest that adipose-derived stem cells in implantation can promote bone healing around titanium, particularly in diabetes mellitus induced animals.

Le Fort I 골절단술에서 posterior impaction의 양과 occlusal plane angle, incisor inclination의 변화 관계에 관한 연구

김복주(Bok-Joo Kim),김민구(Min-Gu Kim),김정한(Jung-Han Kim),김철훈(Chul-Hoon Kim) 대한구강악안면외과학회 2010 대한구강악안면외과학회지 Vol.36 No.5

Introduction: In the management of dentofacial deformities, variable movement of the maxilla can be made possible by a Le Fort I osteotomy. Posterior impaction of the maxilla necessary for rotation of the maxillomandibular complex enhances the functions and esthetic results. In cases of posterior impaction of the maxilla, an increase in the figure of the occlusal plane angle and incisor inclination can occur. This study reports the relationship between the amount of posterior impaction and the change in the occlusal plane angle and incisor inclination in a Le Fort I osteotomy by preoperative and postoperative lateral cephalograms. Materials and Methods: Twenty patients who had undergone orthognathic surgery in Dong-A University Medical Center participated in this study. Lateral cephalometrics, within 3 weeks prior to surgery and 3 days after surgery, were used for analysis. Pre and postoperative measurements of the occlusal plane angle and incisal inclination based on the Frankfort horizontal (FH) plane were performed. X and Y were defined as the amount of vertical change in the upper incisor tip and the amount of vertical change in the upper first molar mesial cup tip through the operation. The amount of final posterior maxillary impaction was determined by subtracting Y from X, which is the difference in vertical height. According to the amount of posterior maxillary impaction, the change in the occlusal plane angle and incisal inclination was measured. Results: The average posterior maxillary impaction was 2.91 mm and the average change in the occlusal plane angle and incisal inclination was 6.54after surgery. As a result, each mm of posterior maxillary impaction changed the occlusal plane angle and incisal inclination by 2.25. Statistically, there was high significance. Two cases were observed: one with the same amount of posterior maxillary impaction performed on both the right and left showing 2.20, and the other with a different amount of posterior maxillary impaction performed showing 2.35. In this case, there was no significance difference between the two cases. Conclusion: Each mm of posterior maxillary impaction changes the occlusal plane angle and incisal inclination by an average of 2.25. In posterior maxillary impaction, there was no significant difference in the amount of change in the occlusal plane angle and incisal inclination regardless of whether there was an equal amount of posterior maxillary impaction on both sides. This study is expected to help in the presurgical orthodontic preparation and presurgical treatment planning.

이하선 천엽에 발생한 지방종의 치험례

김정한(Jung-Han Kim),김철훈(Chul-Hoon Kim),김민구(Min-Gu Kim),송진우(Jin-Woo Song),정유진(Eu-Gene Jung),김복주(Bok-Joo Kim) 대한구강악안면외과학회 2010 대한구강악안면외과학회지 Vol.36 No.5

A lipoma is a benign tumor of matured adipose tissue that usually occurs at the shoulder, back, and abdomen. 13% of lipomas occur in the head and neck area. However, the incidence of lipoma in the parotid gland is very low, approximately 2.5%. A conservational surgical excision is recommended in cases of lipoma of the parotid gland, with only 1-2% of lipomas recurring. We report a case of a lipoma in the parotid gland that was removed by conservational surgical excision. The lesion was exposed by the pre-auricular approach and the tissue was detached. After the parotid gland envelop was exposed, a yellowish mass is observed that was easy to remove due to capsulation. Most authors recommend a surgical excision of the superficial lobe of the parotid gland as the treatment for a lipoma in the parotid gland. However, enucleation only may be a sufficient treatment when a lipoma occurs in the superficial lobe or around the parotid gland. A patidectomy is not needed when a lipoma is located at the superficial lobe of the parotid gland, and a conservational surgical excision is suitable. Therefore, a clinical diagnosis is important for reducing the damage to the facial nerve.

Oxidative Stress and HSP70 Expression Upon Cerebral Isehemia-Reperfusion in Mongolian Gerbil

박영미,김철훈,도윤정,최은미,안영수,Park, Young-Mee,Kim, Chul-Hoon,Do, Yun-Jeong,Choi, Eun-Mi,Ahn, Young-Soo The Korean Society of Pharmacology 1996 대한약리학잡지 Vol.32 No.3

허혈/재관류 뇌손상에서 활성산소류의 역할이 중요시되고 있다. 본 연구에서는 모래쥐의 총경동맥을 묶었다 풀어줌으로써 실험적 허혈/재관류 손상을 유도하고 산화성 스트레스 발생 유무와 이러한 산화성 스트레스가 세포손상으로 연결되는지를 알아보고자 하였다. 해마는 뇌조직 중에서도 특히 산화성 스트레스에 취약한 부분이므로 해마에서 얻은 조직을 대뇌피질에서 얻은 조직과 비교분석하였다. 또한, 이들 부위에서 heat shock protein 70(HSP70)의 발현이 허혈/재관류 손상에 미치는 영향도 검색하고자 하였다. 허혈/재관류에 의한 산화성 스트레스의 지표로써 글루타치온 산화정도, GSSG/(GSH+2xGSSG)를 측정하였을 때 주로 해마에서 산화지표가 상승됨을 관찰하였다. 한편 산화성 스트레스가 세포손상으로 연결되는지를 알아보고자 지질과산화물을 측정하였다. 두 부위 모두에서 지질과산화물 형성의 증가가 있었으며 대뇌피질에서보다 해마에서 더 증가됨을 알 수 있었다. 지질과산화물 형성의 정도나 시간적 변화양상이 글루타치온 산화의 그것들과 유사하였다. 이러한 결과들은 허혈/재관류에 의해 산화성 스트레스가 형성되며 동시에 이러한 산화성 스트레스가 세포 손상을 초래함을 보여준다. 또한 산화성 스트레스 및 산화성 세포손상 정도가 대뇌피질보다는 해마에서 더 큰 것을 알 수 있었다. 그러나, 피질과 해마에서 HSP70의 기초발현(basal level) 정도는 차이가 없었다. 이는 해마의 취약성이 HSP70 발현 결핍에 기인하지 않았음을 나타낸다. 반면 허혈/재관류에 의한 HSP70의 발현유도는 해마조직에서 제대로 이주어지지 않았고 northern blot결과 이는 전사단계에서의 부친에 의한 것으로 나타났다. 이러한 결과들로 볼 때 허혈/재관류에 의한 뇌손상에서 HSP70 유도정도를 측정하는 것이 세포의 취약성을 예측할 수 있는 지표로 유용하게 사용될 수 있을 것으로 사료된다. A critical role of oxygen-derived free radicals has been implicated in ischemia/reperfusion (I/R)-induced brain damage. In this study, we have produced experimental I/R to the brains of Mongolian gerbil (Meriones unguiculatus) by a transient occlusion and release of the common carotid arteries. We have attempted to determine whether the oxidative stress is generated upon I/R and whether this oxidative stress is linked to the cell damage. Since hippocampus has been suggested as one of the most vulnerable regions of the brain to the oxidative stress, we analyzed samples from hippocampus in comparison with those from cortex. In addition, we have examined the expression of heat shock protein 70kD species (HSP70) in these regions in order to evaluate a possible role of this protein in I/R-induced brain damage. To determine whether the oxidative stress is produced upon I/R, we measured the glutathione oxidation, GSSG/ (GSH + 2xGSSG), as an index of oxidative stress. We found an increase of the glutathione oxidation primarily in hippocampus upon I/R. To determine whether this oxidative stress is linked to the cell damage, we measured the degree of lipid peroxidation upon I/R. We found an increase of lipid peroxidation in both regions. However, the magnitude of increases was greater in hippocampus than in cortex. In addition, we found that changes in both the magnitude and the temporal patterns of glutathione oxidation closely correlated with those of lipid peroxidation. Our study provides biochemical evidences that the oxidative stress is generated upon I/R and this oxidative stress is linked to the oxidative cell damage. Our study also provides evidences that the degree of oxidative stress as well as oxidative cell damage is greater in hippocampus than in cortex. We could not find difference in the basal level of HSP70 expression between hippocampus and cortex, indicating that the intrinsic vulnerability of hippocampus cannot be explained by the lower level of HSP70 expression. We did find, however, that the induction of HSP70 expression upon I/R was impaired in the hippocampus. This impairment appeared to be at the transcriptional level. These results suggest that the measurement of HSP70 induction may be employed as a useful predictor of differential cellular susceptibilities to the I/R-induced brain damage.

상악골 부분 절제술 시행한 환자에서 Artificial Palate로 안모지지를 재현한 폐색장치를 이용한 수복 증례

윤희경,황희성,김철훈,김정한,김복주,Yoon, Hee-Kyoung,Hwang, Hee-Seong,Kim, Chul-Hoon,Kim, Jung-Han,Kim, Bok-Joo 대한치과보철학회 2017 대한치과보철학회지 Vol.55 No.3

상악골 부분 절제술을 시행한 많은 환자에서 안모의 변형으로 심리적 우울감에 취약할 뿐만 아니라 연하, 저작 기능이 저하되며 발음 장애가 발생한다. 폐색장치를 통한 악안면 보철적 치료는 저작, 연하, 발음 기능의 회복뿐 아니라 적절한 안모로 회복시켜주며 장치를 사용하는 환자들의 삶의 질을 향상해준다. 본 증례는 상악골 부분 절제술 시행한 환자에서 수술 부위 안정화 기간 사용한 임시 폐색장치로 적절한 안면 지지의 정도를 예측할 수 있었고 이를 반영하여 artificial palate를 제작하였다. 이는 적절한 안면 지지를 재현하여 최종 폐색장치를 제작하는 간단한 접근법을 제시하였고 기능적, 심미적 부분에서 만족할 만한 결과를 얻어 이를 보고하고자 한다. Patients with maxillectomy defects predisposed to not only difficulty in deglutition, mastication, speech but also psychological depression from impaired facial esthetics that affect life quality. Obturator prostheses play a important role in restoring the lost form, function and the quality of life for patients with maxillectomy defects. This clinical report presents the simplified approach to predict the degree of adequate facial support by Artificial palate which reflected from a maxillary interim obturator during the stabilization period after maxillectomy.

가토의 측두하악관절원판 결손에서 간세포 성장인자가 치유에 미치는 영향

김복주,성화식,김철훈,김규천,황희성,신상훈,Kim, Bok-Joo,Seong, Hwa-Sik,Kim, Chul-Hoon,Kim, Gyoo-Cheon,Hwang, Hee-Sung,Shin, Sang-Hun 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.1

Purpose: The purpose of this study is to investigate the therapeutic use of Hepatocyte growth factor(Adv.CMV.HGF) in temporomandibular joint disc defect. Materials and methods: Twelve New Zealand white rabbits, weighing 2.5 - 3.0 kg, were used in this experiment. Defects(2 mm in diameter) were created in their TMJ discs. Recombinant Adv.CMV.HGF with gelatin sponge($Gelfoam^{(R)}$) as carrier was implanted in the defects. We divided the rabbits into four batches according to the duration of the implantation - of 1, 4, 8, 12 weeks - and both left and right TMJ of each rabbit in all groups were used in the research : left joints were used as experiment group and right were control group. Each batch of rabbits was killed one, four, eight and twelve weeks after the experimentation respectively, and called Group A, B, C, and D. (Group A = 1 wk, B = 4 wks, C = 8 wks, and D = 12 wks) Results: The experimental group showed a significant increase in the number of chondroblasts and active cell differentiation at the margin of the defects. Compared to the control group, in the experiment group chondroblasts increased and chondrocytes showed a columnar arrangement, which is witnessed at the time of cell differentiation. Conclusion: This study supports the case that Avd.CMV.HGF may be useful in the repair of articular disc of the rabbit TMJ.

Full-mouth rehabilitation by immediate implantation combined with orthognathic surgery: a clinical report

안혜림,허지예,김철훈,황희성,김복주,Ahn, Hye-Rim,Heo, Ji-Ye,Kim, Chul-Hoon,Hwang, Hee-Seong,Kim, Bok-Joo The Korean Academy of Prosthodonitics 2016 대한치과보철학회지 Vol.54 No.1

악교정 수술과 임플란트 보철을 통한 전악재건술의 임상적 치료는 보철과 의사에게 도전적인 과제이다. 본 증례는 골격적 부조화를 가진 다발성 우식증 환자의 진단과 치료에 있어서 치의학의 여러 분야의 협진을 보여주었다. 그 결과로 악교정 수술을 동반한 발치 후 즉시 임플란트 식립 및 조기 하중을 가하는 임플란트 보철물에 의한 전악 재건이 예견가능하고 효과적인 치료 방법이었기에 이를 보고하고자 한다. Clinical therapy that combines full-mouth rehabilitation with immediate implantation and orthognathic surgery poses a challenge to prosthodontists. This clinical report describes a multidisciplinary approach to the diagnosis and treatment of a patient presenting with skeletal discrepancy and rampant caries. The results thus achieved indicate that full-mouth rehabilitation by fixed immediate and early loading implantation accompanied by orthognathic surgery can be a predictable and effective treatment procedure.