Porous polyethylene을 이용한 관골증대술의 임상연구

국민석,안진석,김영준,박홍주,오희균,Kook, Min-Suk,An, Jin-Suk,Kim, Young-Joon,Park, Hong-Ju,Oh, Hee-Kyun 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.3

The malar mound defines the contour of the lateral face between the inferior orbital rim and the mandible, and hypoplasia or asymmetry of this region is readily noticeable. A flat, hypoplastic malar eminence can make the face blunt and wearisome, which contributes to a premature aged appearance. Patients with congenital or traumatic flattening of the malar eminence can obtain esthetic improvement with implants. Indications for placement of malar implants to improve the appearance of subtle flattening or to enhance the esthetic harmony of a patient's face have been suggested in several studies. Many augmentation materials, such as silicone, proplast, polyamide, and porous polyethylene implants have been used. Many methods of localization have been described, the key to proper placement of the implants lies in a through understanding of the esthetics of the malar mound. From August 2001 to June 2007, 12 patients with malar depression who visited the Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital were treated by augmentation malarplasty with Porous polyethylene. The location and amount of augmentation are determined by preoperative interview, physical examinations, facial models and radiographic findings. 12 patients were satisfied with the results of augmentation malarplasty and severe complications were not occurred.

가토대퇴정맥에서 미세혈관문합시 Argatroban의 국소세척 및 전신투여가 혈전형성에 미치는 영향

국민석(Min-Suk Kook),박홍주(Hong-Ju Park),오희균(Hee-Kyun Oh) 대한구강악안면외과학회 2005 대한구강악안면외과학회지 Vol.31 No.4

Purpose: For the reconstruction of maxillofacial defect created by trauma, infection, or tumor etc, the role of microvascular anastomosis or vessel graft has been increased. Many methods has been tried to increase the success rate of microvascular anastomosis. Various anticoagulants and thrombolytic agents have been used to reduce the failure rate of microvascular anastomosis and avoid re-operation. Many drugs, however, have been used in the limited cases because most of these drugs may cause complications, such as allergy, fever or systemic bleeding. This study was performed to evaluate the influence of the Argatroban on patency and thrombosis in microvascular anastomosis when it is used for local irrigation or general administration. Materials & methods: Eight mature rabbits, weighing 2kg, were used. After exposing both femoral veins, the artificial thrombotic model was made by crushing injury using a smooth needle holder, and the transverse incision were made on femoral vein. The animals were divided into 4 groups according to Argatroban administration methods; control group (n=4), topical irrigation of lumen with saline solution; experimental group 1 (n=4), topical irrigation of lumen with Argatroban saline solution; experimental group 2 (n=4), topical irrigation of lumen with heparin followed by intravenous injection of Argatroban; experimental group 3 (n=4), topical irrigation of lumen with Argatroban followed by IV of Argatroban. Microvascular anastomosis was done with 10-0 Ethilon. The patency was evaluated by empty-and-refill test 30 minutes and 3 days after microanastomosis. The thrombus formation was examined 3 days after microanastomosis by surgical microscope. The histologic findings were also examined. Results: 1. Thirty minutes after microvascular anastomosis, the patency of all experimental groups was better than that of control group, but there was no significant difference among groups. 2. Three days after microvascular anastomosis, the patency of all experimental groups was more improved than that of control group (p<0.05). There was no significant difference among experimental groups. 3. Three days after microvascular anastomosis, the amount of thrombus in all experimental groups was less than that of control group (p<0.05). There was no significant difference among experimental groups. 4. Histologically, a lot of luminal thrombus was observed around sutured area in control group. Few luminal thrombus was observed in all experimental groups. The necrotic changes were observed on the sutured vein wall in all specimens. Conclusion: These results indicate that topical irrigation and/or intravenous administration of Argatroban is effective in improving patency and preventing thrombus formation after microvascular anastomosis.

상악동저 거상술 후 Osstem Implant (US II / SS II)의 다기관 후향적 임상연구

국민석(Min-Suk Kook),박홍주(Hong-Ju Park),김수관(Su-Gwan Kim),김영균(Young-Kyun Kim),조용석(Yong-Seok Cho),최갑림(Gab-Lim Choi),오영학(Young-Hak Oh),오희균(Hee-Kyun Oh) 대한구강악안면외과학회 2008 대한구강악안면외과학회지 Vol.34 No.3

Purpose: The purpose of this study was to evaluate the Osstem􀋓 implants (US II/SS II implants) through the retrospective study for the clinical success rate during the installation of the Osstem􀋓 implants (US II/SS II implants) by using of the procedures of maxillary sinus floor elevation. Materials and methods: The current study was researched in the 6 medical institutions: Chonnam National University, Chosun University, Pusan DaeDong Hospital, Bundang Seoul National University Hospital, Ap-Seon Clinic, and All Clinic. Based on the total number of 116 patients whose treatment was the installation of the US II/SS II implants with the procedures of the maxillary sinus floor elevation, they were conferred on the dental records of the patients under the joint consultation of the 6 medical institutions. On the dental recording charts, there were included in as the following; the name of the institutions, gender, age, with or without smoking or drinking, with or without the generalized diseases, the height of the alveolar bone on the operational sites, elapsed edentulous state period, the state of the opposed or adjacent teeth, the methods of the maxillary sinus floor elevation, secondary time period for surgery, the lengths, types, and diameters of implants, with or without bone transplantation or the types of bone, postoperative current bone height, current adjacent soft tissue state of the implants, with or without the success of the installations of the implants. We have done our survey with the clinical and radiolographical examinations and dental questionaries. The success and survival rate of the implants was evaluated. Results 1. Total number of the patients with the installation of the US II implants were 62. The 252 numbers of US II implants were installed on the 89 maxillary sinuses. The patient s mean age was 54.1 years old and there were 36 men and 27 women. 2. Total number of patients with the installation of SS II implant were 57. The 165 numbers of SS II implants were planted on the 80 maxillary sinuses. Their mean age was 48.7 years old and there were 37 men and 20 women. 3. The follow-up period was 30.7 months(21-49 mon) on average. The vertical bone loss of installed implants after the procedures of the maxillary sinus elevation was 1.1 mm on average in SS II and 1.3 mm on average in US II. There existed no statistical significance on each group. The mean enlarged bone height after the maxillary sinus floor elevation was 8.2 mm. 4. For the procedures of the maxillary sinus elevation, the Lateral approach technique occupied 87.1%, which was the most used one. In addition, the most frequently used transplanted bone was autogenous bone only which was 72.7% during the maxillary sinus floor elevation. 5. The complication of maxillary sinus floor elevation were perforation of sinus membrane, disesthesia on doner site, exposure of cover screw and exposure of maxillar bone. 6. The survival rate of US II and SS II after maxillary sinus floor elevation was 99.2% and 95.8%, respectively. And the success rate of US II and SS II after maxillary sinus floor elevation was 97.6% and 89.7%, respectively. Conclusion : On the evaluation of the analysis of our study, both US II and SS II implants showed the excellent clinical results by use of the procedures of maxillary sinus floor elevation.

비글견 경골에서 임플란트 식립 시 혈소판 농축 혈장이 골형성에 미치는 영향

국민석(Min-Suk Kook),정승곤(Seunggon Jung),심경미(Kyung-Mi Shim),강성수(Seong-Soo Kang),박홍주(Hong-Ju Park),유선열(Sun-Youl Ryu),오희균(Hee-Kyun Oh) 대한구강악안면외과학회 2010 대한구강악안면외과학회지 Vol.36 No.2

Introduction: The purpose of this study is to evaluate the effect of platelet rich plasma in bone formation and osseointegration of implant installed in the bone marrow space. Materials and Methods: Five beagle dogs were used as experimental animals. Two implants were installed on each tibia in the dogs. Implants of the control group were installed with no additional graft. Those of the experimental group 1 were installed with autogenous bone graft from the ilium autogenous bone. Platelet rich plasma (PRP) alone was used in experimental group 2 and the mixture of PRP and autogenous bone was used in experimental group 3. The animals were sacrificed at 8 weeks after implantation. The parts of tibia containing implant were harvested and radiographs were taken for radiographic examination. The specimens were prepared for histological examination and histomorphometric analysis of implant-bone contact ratios. Results: 1. All implants showed sufficient osseointegration in the cortical bone radiographically and histologically, but osseointergration in the marrow space was not satisfactory. 2. Histomorphometrically, the implant-bone contact ratios in the bone marrow was sequentially high in the experimental group 3 (autogenous bone+ PRP group), group 1 (autogenous bone group), group 2 (PRP group), and control group (non-additive). 3. It was verified that there was statistical significance between two experimental groups (group 1 and 3) and the other groups (group 2 and control group). (P<0.005) 4. However, there was no statistical significance between group 3 and group 1, also group 2 and control group respectively. Conclusion: These results suggest that platelet rich plasma is effective to osseointegration in the implant installation but there is no statistical significance.

MC3T3 preosteoblast cell line의 5-(and-6)-carboxy-2’,7’-dichlorofluorescein diacetate, succinimidyl ester mixed에 의한 fluorescent labelling

국민석(Min-Suk Kook) 대한구강악안면외과학회 2005 대한구강악안면외과학회지 Vol.31 No.6

Background. 5-(and-6)-carboxy-2’,7’-dichlorofluorescein diacetate, succinimidyl ester mixed (CFSE) is the fluorescent labelling agent of living cells and used to trace the cells in vivo after transplatnation of various cells. The CFSE labelled cells can maintain fluorescence for up to 7 days after labelling. The MC3T3-E1 cell line (MC3T3) has been used for many studies about osteoblast, which is well known as a mouse preosteoblast. So the CFSE would be used to trace the transplanted MC3T3. However there are few reports about CFSE labelling of MC3T3. This study is aimed to know about adequate concenturation and incubation time of CFSE to MC3T3. Materials and methods. The MC3T3 was incubated in a humidified atmosphere of 95% air with 5% CO2 at 37℃ using α-minimal essential medium(α-MEM) containing10% FBS and gentamycin. Ten mM CFSE solution in dimethylsulphoxide (DMSO: 1%) was diluted with phosphate buffered saline (PBS) and final concentration of culture medium was, respectively, 5, 10, 15, 20, 25 and 30 μM. Then the MC3T3 was incubated with CFSE in a humidified atmosphere of 95% air with 5% CO2 at 37℃ for 5, 10, 15, 20, 25, 30, 35, 40 and 45 minutes in each concentration. The fluorescence of CFSE labelled cells was analysed with a inverted fluorescence microscope. The duration of cell labelling was also studied. Trypan blue dye exclusion test was done for cell viability. Results. For concentration between 5 and 10 μM, CFSE did not significantly label the MC3T3 in vitro. The destruction of MC3T3 was observed at the concentration of 20 μM. In the concentration of 15 μM, the best labelling was obtained at an incubation period between 15 and 30 minutes. The MC3T3 labelled with an incubation period of 15 minutes at 15 μM was still fluorescent 7 days after CFSE labelling. The mean cell viability was 95.93%. Conclusion. These results suggests an incubation period of 15 minutes at 15 μM of CFSE provides best labelling of MC3T3 in vitro.

하악전돌증환자에서 하악지시상분할골절단술 후 전산화단층촬영을 이용한 근심골편의 횡적인 변화에 관한 연구

김영준,국민석,박홍주,오희균,Kim, Young-Joon,Kook, Min-Suk,Park, Hong-Ju,Shet, Uttom Kumar,Oh, Hee-Kyun 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.3

Purpose: This study was performed to evaluate transverse changes of proximal segment after bilateral sagittal split ramus osteotomy (BSSRO) using 3-D CT in mandibular prognathism. Patients and methods: Twenty-two patients who underwent BSSRO for mandibular set-back in class III malocclusion without facial asymmetry were examined. Miniplates were used for the fixation after BSSRO. Facial CT was taken before and after BSSRO within 3 months. Frontal-ramal inclination (FRI), inter-gonial width (IGW) and intercondylar width (ICW) were measured in 3-D CT images using V-works $4.0^{TM}$ program. Student t-test was used to compare the changes between pre- and post-operative measurements using SPSS 10.0 program. Results: 1. Mean peroperative FRI value ($12.87{\pm}3.43^{\circ}$) was slightly increased to postoperative value ($14.13{\pm}3.72^{\circ}$) (p < 0.05). The average FRI increased 10.42% and the range was from $-2.46^{\circ}$ to $3.34^{\circ}$. 2. Mean peroperative IGW ($99.01{\pm}5.36$) was slightly decreased to postoperative IGW ($96.51{\pm}5.88mm$) (p < 0.05). The average IGW decreased 2.52 % and the range was from $-6.61^{\circ}$ to 0.91 mm. 3. Mean preoperative ICW ($125.01{\pm}5.30mm$) was slightly decreased to postoperative ICW ($125.40{\pm}5.45mm$) (p < 0.05). There is no significant difference between pre- and post-operative ICW. 4. There was significant correlationship between FRI difference and IGW difference (p < 0.05). Conclusions: These results indicate that the lower ramus of the proximal segment is moved inward after BSSRO procedure for mandibular set-back.

가토에서 신장된 하악골에 대한 혈소판농축혈장의 효과

배금휴,국민석,박홍주,오희균,Bae, Kum-Hyu,Kook, Min-Suk,Park, Hong-Ju,Oh, Hee-Kyun 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.4

For reconstruction of the bony defect, distraction osteogenesis has many advantages in comparison with bone graft. However, it needs long consolidation period for sufficient bone maturity. This study is performed to evaluate the effect of PRP injection into the distracted mandible on bone formation in rabbits. Twelve house rabbits, weighing 2 kg, were used. All animals underwent bilateral mandibular osteotomy under general anesthesia. A internal distractor divice was positioned along a plane perpendicular to the line of osteotomy. After 5 days of latency period, distraction osteogenesis was started at a rate of 1 mm/day for 9 days which was distracted 9 mm totally. After completion of distraction, 0.5 ml of PRP which collected in rabbit blood was injected into the distracted mandible on experimental group, whereas no injection was done in control group. Macroscopical, radiographical, and histological, and histomorphometric examinations were performed 2, 4 and 8 weeks after distraction. All animals showed distracted mandible and severe anterior cross-bite. In radiographical findings 2 weeks after distraction, more radiopacity in the distracted gap was found in experimental group than that of control group. At 4 weeks after distraction, distracted bone was similar to normal bone in experimental group. In histological findings, 1) At 2 weeks after distraction, number of osteoblasts and angiogenesis in the distracted gap was found in experimental group than that of control group. 2) At 4 weeks after distraction, more active and distinct bone in the distracted gap was found in experimental group than that of control groups. 3) At 8 weeks after distraction, more dense and matured lamellated bone in the distracted gap was found in experimental group than that of control group. In histomorphometrical findings 8 weeks after distraction, more bone formation was observed in experimental group than control group (p<0.01). These results indicate that administration of PRP into the distracted mandible can promote bone formation.

하악전돌자에서 3차원영상을 이용한 하악지시상분할골절단술과 관련된 하악골의 해부학적 연구

박충열,국민석,박홍주,오희균,Park, Chung-Ryoul,Kook, Min-Suk,Park, Hong-Ju,Oh, Hee-Kyun 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.4

Sagittal split ramus osteotomy(SSRO) has been commonly performed in the mandibular prognathism. The previous studies of the mandibular anatomy for SSRO have mostly been used in dry skull without consideration of age, sex or jaw relationship of patients. This study was performed to evaluate the location of mandibular canal and the anatomy of ramus, such as the location of mandibular lingula and the ramal bone marrow, which were associated with SSRO procedures, in the patients with mandibular prognathism and normal young adults by using computerized tomographs(CT) and 3D images. The young adults at their twenties, who were considered to complete their skeletal growth, and seen in the Department of Orthodontics and Oral and Maxillofacial Surgery in Chonnam National University Hospital between March 2000 and May 2003, were selected. This study was performed in 30 patients (15men, 15women) who were diagnosed as skeletal class I normal relationship, and another 30 patients (15men, 15women) who were diagnosed as skeletal class III relationship upon clinical examination and lateral cephalometric radiographs. The patients were divided into 2 groups : Class I group, the patients who had skeletal class Ⅰ normal relationship(n=30, 15men, 15women), and Class III group, the patients who had skeletal class III relationship(n=30, 15men, 15women). Facial CT was taken in all patients, and pure 3D mandibular model was constructed by V-works version 4.0. The occlusal plane was designed by three points, such as the mesiobuccal cusp of both mandibular 1st molar and the incisal edge of the right mandibular central incisor, and used as a reference plane. Distances between the tip of mandibular lingula and the occlusal plane, the sigmoid notch, the anterior and the posterior borders of ramus were measured. The height of ramal bone marrow from the occlusal plane and the distance between mid-point of mandibular canal and the buccal or lingual cortex of the mandible in the 1st and 2nd molars were measured by V-works version 4.0. Distance(Li-OP) between the occlusal plane and the tip of mandibular lingula of Class III Group was longer than that of Class I Group in men(p<0.01), but there was no significant difference in women between both groups. Distance(Li-SN) between the sigmoid notch and the tip of mandibular ligula of Class III group was longer than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(Li-RA) between the anterior border of ramus and the tip of mandibular lingula of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Distance(Li-RP) between the posterior border of ramus and the tip of mandibular lingula of Class III Group was slightly shorter than that of Class I Group in men(p<0.05), but there was no significant difference in women between both groups. Distance(RA-RP) between the anterior and the posterior borders of ramus of Class III Group was shorter than that of Class I Group in men and women(p<0.01). Longer the distance(SN-AN) between the sigmoid notch and the antegonial notch was, longer the vertical ramal length above occlusal plane, higher the location of mandibular lingula, and shorter the antero-posterior ramal length were observed(p<0.01). Height of ramal bone marrow of Class III Group was higher than that of Class I Group in men and women(p<0.01). Distance between mandibular canal and buccal cortex of Class III Group in 1st and 2nd lower molars was shorter than that of Class I Group in men and women (p<0.05 in 1st lower molar in men, p<0.01 in others). These results indicate that there are some anatomical differences between the normal occlusal patients and the mandibular prognathic patients, such as the anterior-posterior length of ramus, the height of ramal bone marrow, and the location of mandibular canal.

발치 후 즉시 매식된 서로 다른 두종의 RBM표면 처리된 임플란트에 대한 다기관 후향적 임상연구

박홍주,국민석,김수관,김영균,조용석,최갑림,오영학,오희균,Park, Hong-Ju,Kook, Min-Suk,Kim, Su-Gwan,Kim, Young-Kyun,Cho, Yong-Seok,Choi, Gab-Lim,Oh, Young-Hak,Oh, Hee-Kyun 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.3

Purpose. This multicenter retrospective study was performed to evaluate the survival and success rates of immediate placement of USII and SSII Osstem implant (Osstem implant Co, Korea) on the maxillary and mandibular anterior and premolar areas. Materials and methods. Dental records were obtained in 37 patients who were treated with immediate implantation on the maxillary and mandibular anterior and premolar areas in 6 different clinics. The 98 implants were evaluated both clinically and radiographically using predefined success criteria. Results. There was no failed implant in all patients. The mean follow up period was 24.7 months (ranged from 12 to 58 months), and 25.1 months (ranged from 16 to 35 months) in USII and SSII implants, respectively. The crestal bone loss was 3 mm in 3 USII implants during 41 months, and in 1 SSII implant during 22 months. The overall success rate was 94.2% and 97.7% in USII and SSII implants, respectively. The age, gender, diameter, or length of implants, and type of surgery were not influenced to the success rate of immediate implantation. Conclusion. These results suggest that USII and SSII Osstem implant can be used successfully in immediate implantation on the maxillary and mandibular anterior and premolar areas.

RBM 처리된 임플란트 표면의 인공치태 제거 효과 연구

박재완,국민석,박홍주,최충호,홍석진,오희균,Park, Jae-Wan,Kook, Min-Suk,Park, Hong-Ju,Shet, Uttom Kumar,Choi, Choong-Ho,Hong, Suk-Jin,Oh, Hee-Kyun 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.4

Purpose: This study was to evaluate the removal effect on artificial plaque from RBM treated implant surfaces that are exposed due to peri-implantitis. Materials and methods: Artificial plaque with Streptococcus mutans and acquired pellicle adhered to RBM treated implant discs. Study materials divided into one control and six test groups. In test groups, physical and chemical methods used to remove plaques. Prophyflex, Professional Mechanical Tooth Cleaning (PMTC) and interdental brush as mechanical treatments and 0.1% Chlorhexidine, Citric acid, HCl tetracycline as a chemical treatment were used. To analyses the study, disc weight was measured for remaining plaque quantities and SEM(Scanning Electronic Microscope) findings was taken for evaluation of surfaces. Results: 1. In weight changes, there was significant difference between each treatment group and the control group (p<0.05). Therefore all treatment methods using this study have good ability for remove plaques. 2. In weight changes, there was no significant difference between mechanical and chemical group, and there were no significant differences between each groups (p>0.05). 3. SEM findings after mechanical treatment disclosed as follows; Prophyflex group looked like sound implant surface, and there were some paste on implant surface at PMTC group, and there were some artificial plaque at interdental brush group. 4. SEM findings after chemical treatment disclosed as follows; there were some dark lesions which were supposed as the product from Streptococcus mutans at Chlorhexidine, Citric acid and HCl tetracycline groups. Conclusion: All six methods using in this study have good ability to remove artificial plaque on RBM treated implant. According to SEM findings, prophyflex is a superior method for removing of dental plaque among test groups.