미성숙 영구치의 치수치료

송제선,Song, Je Seon 대한치과의사협회 2019 대한치과의사협회지 Vol.57 No.8

For dental pulp treatment of immature permanent teeth, direct pulp capping or partial/cervical pulpotomy (apexogenesis) procedures can be used if the dental pulp is vital. MTA (Mineral Trioxide Aggregate) is regarded as the first choice dressing material for these procedures because its higher success rate. It can be also used successfully for devitalized dental pulp which has been treated by calcium hydroxide. This apexification procedure with MTA has a few advantage such as short treatment period and increase of resistance against root fracture. Recently, regenerative endodontic treatment was introduced for devitalized immature pulp. It can maintain pulp vitality and lead to continuing root development although the dental pulp was devitalized.

소아 및 청소년의 심리/인지적 발달

송제선(Je Seon Song) 대한치과의사협회 2016 대한치과의사협회지 Vol.54 No.11

Psychological and cognitive development in child and adolescent periods is key knowledge for understanding children and adolescents’ behavior and inducing their actions. So far, psychoanalytic approaches have been primarily researched by Freud’s analytical tools and Piaget’s analysis on cognitive developments have been mainly employed to explore children and adolescents’ psychological developments. In addition, other various theories have been suggested in order to explain children and adolescents’ psychological developments. However, in reality, it is difficult to integrate diverse theoretical lens to investigate children and adolescents’ psychological developments. Considering this constraint, in clinical dentistry, the conventional theoretical instruments have been still widely employed to guide children and adolescents’ behavior.

유치의 치수와 치주인대에서 분리한 줄기세포의 특성

송제선 ( Je Seon Song ),김승혜 ( Seung Hye Kim ),김성오 ( Seong Oh Kim ),최병재 ( Byung Jai Choi ),김정희 ( Jeong Hee Kim ),곽성욱 ( Sung Wook Kwak ),정한성 ( Han Sung Jung ) 한국조직공학과 재생의학회 2010 조직공학과 재생의학 Vol.7 No.5

Many studies have found adult stem cells in human teeth or correlated tissues. However, most of these stem cells were found in the permanent teeth or pulp from exfoliated deciduous teeth. The aim of the present study was to characterize stem cells isolated from the functional dental pulp and periodontal ligament of deciduous teeth. Dental pulp tissue was obtained from deciduous teeth by extirpation during treatment for dental caries, and periodontal tissue was obtained from deciduous teeth that were extracted for orthodontic reasons or space management. We observed cell outgrowth from these tissues in ``explants culture``, and named these cells as deciduous dental pulp stem cells (DDPSCs) and deciduous periodontal ligament stem cells (DPDLSCs), respectively. These stem cells presented embryonic stem cell markers (Oct-4 and Nanog), an ectomesenchymal stem cell marker (Nestin), and mesenchymal stem cell markers (Stro-1 and CD146). In differentiation media, DDPSCs and DPDLSCs were able to change into cells that produce lipid vacuoles or cells that induce extracellular mineral aggregation, expressing genes correlated with adipogenesis (PPARγ2 and LPL) or osteogenesis (ALP and BSP), respectively. This is the first report of the presence of multipotent stem cells in the functional dental pulp and periodontal ligament tissue of deciduous teeth, which can be isolated using an explants culture method. These tissues can be obtained easily during routine dental procedures, and could therefore represent a good source of adult stem cells for use in regenerative medicine.

지연된 출혈로 밝혀진 경증 혈우병 A에 대한 증례 보고

송제선(Je Seon Song),최병재(Byung-Jai Choi),김성오(Seong-Oh Kim),이제호(Jae-Ho Lee),손흥규,김형준(Hyung Jun Kim),최형준(Hyung-Jun Choi) Asia association of Disability and Oral health 2008 International Journal of Disability and Oral Healt Vol.4 No.2

Hemophilia A is an X-linked disorder resulting from a deficiency in factor Ⅷ. Hemophilia A is classified into severe, moderate, and mild forms. A 12-month old boy visited for uncontrolled bleeding on the upper labial frenum area. Spontaneous bleeding occurred about 13 days ago. We sutured the wound. However, the patient returned after 6 days with large hematoma formation. Consultation to the hematologist and laboratory examination were carried out. Activated PTT was elongated and factor Ⅷ was only 6%. He was diagnosed as mild hemophilia A. Fresh frozen plasma (FFP) was provided and hemostasis was achieved. At 5-day check-up, no more bleeding was observed. For the management of prolonged bleeding in hemophilia A patient, not only local hemostatic measures, but factor Ⅷ replacement therapy, antifibrinolytics, and Desmopressin are also available. Mild hemophilia A often occurs without either familial or medical history. It is often first detected by dental trauma.

수련병원 내 소아치과 전공의 진정법 교육 현황 조사

문소연,송제선,신터전,최성철,양연미,Moon, Soyeon,Song, Je Seon,Shin, Teo Jeon,Choi, Sungchul,Yang, Yeonmi 대한소아치과학회 2021 大韓小兒齒科學會誌 Vol.48 No.3

이 연구의 목적은 소아치과 수련기관들의 지도전문의를 통하여 전공의를 대상으로 한 진정법 교육 현황과 보수교육에 관한 의견을 알아보고자 하였다. 전국 18개의 소아치과 수련기관에 Google 설문지 프로그램을 이용한 설문을 메일로 보낸 후 응답한 자료를 수집하여 분석하였다. 전공의를 대상으로 한 진정법 교육 시기는 1년차 교육(61.1%)과 1 - 3년차 통합교육(55.6%)이 주로 이루어지는 것으로 나타났고, 타과파견 여부에서는 5기관(27.8%)이 원내 마취과 파견을 보내고 있었다. 전공의가 진정법을 처음 사용하는 시기는 1년차 하반기(50%)가 가장 높게 나타났고, 진정법 시행 시에 감독관이 참여하는 기간에는 참여하지 않는 곳부터 수련 기간 내내 참여하는 곳까지 다양하게 나타났다. 진정법 교육은 모든 수련기관에서 진행이 되고 있으나 여러 방면에서 전공의가 얻을 수 있는 경험의 편차가 나타났다. 추후 보수교육의 필요성은 모든 기관에서 필요하다고 답을 하였고, 보수교육 시간 및 방법에 대해서는 다양하게 응답하였으나, 이를 종합해보면 매년 1 - 2시간의 이론교육과 2 - 3년에 한 번의 술기 및 시뮬레이션 교육이 필요할 것으로 사료된다. The purpose of this study was to investigate current status of sedation training for the residents in pediatric dentistry training institutions and opinions about continuing education after the residency program. Surveys were sent to 18 pediatric dentistry training institutions by e-mail, and the responses were collected and analyzed. Most of the sedation education period for the residents were the 1st-year education (61.1%) and 1 - 3 years of integrated education (55.6%). In terms of an externship, 5 institutions (27.8%) sent their residents to the department of anesthesiology. Second half of the 1st year (50%) was the highest for a resident to use sedation for the first time. The period of supervisor participation varied from not participating at all to whole time throughout the residency program. The sedation training is conducted at all training institutions, but there were variations in the experience that a resident can gain. All training institutions agreed on the necessity of continuing education of the sedation, but there were various opinions regarding time, method, and the period of review course. Overall, this study suggested that continuing education should be consisted of 1 - 2 hours of didactic education every year and clinical skills and simulation training in every 2 - 3 years.

한국 어린이의 골 성숙도와 치아 석회화 단계 간의 상관관계

김성진,송제선,김익환,김성오,최형준,Kim, Seong Jin,Song, Je Seon,Kim, Ik-Hwan,Kim, Seong-Oh,Choi, Hyung-Jun 대한소아치과학회 2021 大韓小兒齒科學會誌 Vol.48 No.3

이 연구의 목적은 한국 아동의 골 성숙 단계와 여러 치아들의 석회화 단계 간의 상관관계를 알아보고자 하는 것이다. 만 6 - 14세의 남아 359명, 여아 384명의 수완부 방사선사진, 측방두부규격 방사선사진, 파노라마 방사선사진을 분석하여 평가하였다. 하악 좌측의 7개 영구치의 치아 석회화 단계는 Demirjian이 제시한 방법에 의해 평가되었다. 골 성숙도 단계를 평가하기 위하여 수완부 방사선 사진은 Fishman이 제시한 skeletal maturity indicators(SMI)에 따라 평가되었고, 측방두부규격 방사선사진은 Baccetti가 제시한 cervical vertebral maturation(CVM) 방법에 따라 평가되었다. Spearman의 순위상관분석을 시행한 결과 치아 석회화 단계와 골 성숙도 간에 유의미하게 높은 상관관계가 나타났다(r = 0.40-0.84, p < 0.001). 7개의 영구치 중에서 하악 제2대구치가 골 성숙도와 가장 높은 상관관계를 보인 반면 중절치가 가장 낮은 상관관계를 나타내었다. 남녀 모두에서 하악 견치의 stage G와 하악 제2대구치의 stage F가 SMI 6단계와 CS 3단계에서 나타날 확률이 가장 높았다. 이 연구의 결과에 따르면 치아 성숙도와 골 성숙도 사이에 높은 상관관계가 있으므로, 파노라마 방사선사진에서의 치아 성숙도 평가는 성장기 아동의 골 성숙도를 평가하는 보조적 수단으로 활용될 수 있다. The aim of this study was to investigate the relationships between the stages of calcification of various teeth and skeletal maturity stages among Korean subjects. The samples were derived from hand-wrist, panoramic radiographs, and lateral cephalograms of 743 subjects (359 males and 384 females) with ages ranging from 6 to 14 years. Calcification of seven permanent mandibular teeth on the left side were rated according to the system of Demirjian. To evaluate the stage of skeletal maturation, hand-wrist radiographs were analyzed by skeletal maturity indicators (SMI) system of Fishman and lateral cephalograms by cervical vertebral maturation (CVM) method of Baccetti. Statistically significant relationships were found between dental calcification and skeletal maturity stages according to Spearman rank-order correlation coefficients (r = 0.40-0.84, p < 0.001). The second molar showed the highest correlation and central incisor showed the lowest correlation for female and male subjects. For both sexes, canine stage G and second molar stage F were related to SMI 6 and CS 3. Because of the high correlation coefficients, this study suggests that tooth calcification stages from panoramic radiographs might be clinically useful as a maturity indicator of the pubertal growth period in Korean patients.

연세대학교 치과대학병원 소아치과의 진정법의 변화 양상

이고은,송제선,김성오,이제호,최병재,최형준,Lee, Koeun,Song, Je Seon,Kim, Seong-Oh,Lee, Jaeho,Choi, Byungjai,Choi, Hyung-Jun 대한소아치과학회 2018 大韓小兒齒科學會誌 Vol.45 No.2

진정작용은 행동조절이 어렵고 광범위한 치료가 필요하거나 의학적 문제가 있는 어린이의 치과 치료에 유용한 행동조절 방식이다. 본 연구의 주된 목적은 연세대학교 치과대학병원 소아치과에서 사용하는 진정제와 진정치료의 경향을 분석하여 진정법의 사용의 변화를 살펴보는데 있다. 본 연구는 2011년 - 2016년까지 연세대학교 치과대학병원 소아치과의 전자의무기록(EMR)을 바탕으로 환자 및 진정법을 검토하였다. 연구 결과에 따르면, 진정법으로 치료받은 환자들의 수가 일반적으로 증가했다. 남자가 여자보다 진정법을 이용한 치과 치료를 더 많이 받았으나 2015년부터는 유사한 비율로 적용되고 있다. 전신질환(ASA II) 환자의 치료 비율은 2013년에 감소했지만, 이후에는 일정하게 유지되었다. 4 - 5세 및 6 - 10세의 진정 치료 비율은 일반적으로 증가하는 반면, 0 - 2세 및 11세 이상은 감소했다. 3세는 비교적 일정한 비율로 유지되고 있다. 가장 자주 사용되는 진정법은 아산화질소 흡입진정법이었으며, chloral hydrate의 사용이 감소하는 동안 benzodiazepine계열의 사용이 증가했다. 최근에는 행동관리 기법으로 진정법이 확대되고 있다. 그러나 안전한 사용을 위하여 다차원적 접근이 요구되고 있으며, 진정제 사용의 안전성과 효능에 대한 추가 연구 역시 동반 수행되어야 한다. Sedation is a useful behavior management technique for dental patients who may be uncontrollable or have medical problems. The aim of this study is to investigate the changes in patterns of sedative treatments in pediatric dentistry by analyzing the distribution of patients and used sedative agents. Patients and sedative agents were reviewed based on the electronic medical records (EMR) of the department of pediatric dentistry in Yonsei University Dental Hospital from 2011 to 2016. The number of patients who were treated under sedation generally increased. Male received more sedation treatment than female by 2014, and they became similar from 2015. The treatment percentage of patients with systemic disease decreased in 2013, remained constantly afterwards. The ratio of sedative treatment for the age 4 - 5 and age 6 - 10 generally increased, while that of the age 0 - 2 and older than age 11 decreased. The ratio of the age 3 remained steady. Nitrous oxide was the most frequently used sedative agent. The use of benzodiazepine increased while the use of chloral hydrate decreased. Although the use of sedation has expanded, multidimensional approaches for ensuring safety have been less focused. Therefore, it is necessary to explore further studies for the safety and efficacy of the use of sedation.

색소실조증 환자의 치과적 특성 : 증례보고

송지혜(Jihyeo Song),이고은(Koeun Lee),송제선(Je Seon Song),이제호(Jaeho Lee),최형준(Hyung-Jun Choi) Asia association of Disability and Oral health 2018 대한장애인치과학회지 Vol.14 No.2

본 증례는 유전적 피부질환의 하나로 피부의 착색과 망막의 이상 그리고 다수의 유치 및 영구치 결손과 치아의 형태 이상을 나타내는 색소실조증 환자에 대한 보고이다. 현재 환자는 큰 불편감 없이 유치를 유지하고 있으며 향후 영구치열기까지 정기적인 관찰과 관리가 필요하며, 영구치열 완성 후 영구적인 보철적 수복이 필요할 것으로 사료된다. Incontinentia pigmenti(IP), or Block-Sulzberger syndrome is a rare X-linked dominant genodermatosis that affects almost in female infant and is usually lethal for males in utero. IP is characterized by four cutaneous stages and is frequently associated with dental, ocular, central nervous system and structural anomalies. Dental problems are congenital missing of teeth, delayed eruption, abnormal crown shape. We reported a case of 5 year-old female with IP. She had congenital missing of multiple primary and permanent teeth, accessory cusp and cone-shaped crowns. Systemically, she had a problem of retina and hyperpigmented macules on her trunk and extremities as typical character of IP. As the syndrome involves many different medical problems and needs comprehensive consideration. Dental care should be performed in a multidisciplinary consultation system.

얼굴의 수직성장을 이용하여 III급 부정교합을 치료하는 구강내 가철식 장치의 치료기간분석

송지혜,김성오,송제선,이제호,최형준,Song, Jihyeo,Kim, Seong-Oh,Song, Je Seon,Lee, Jaeho,Choi, Hyung-jun 대한소아치과학회 2019 大韓小兒齒科學會誌 Vol.46 No.2

Vertical facial growth triggers the rotation of mandible to move the chin point to the downward and backward direction, which showed remarkably effective result making the less prominent chin. Recently, the intraoral removable appliance utilizing class III elastic demonstrated the vertical growth trigger mechanism. The treatment change was very fast and wearing was quite easy, compared to extraoral appliances. The purpose of this study was to verify the duration of the treatment on class III malocclusion using intraoral removable appliances, which designed to accelerate vertical facial growth. 56 patients were selected with the complaint of the protruded mandible and class III malocclusion (overjet : -3 - 0 mm, overbite : 0 - 4 mm). Information like; age at start, duration of the treatment events, type of the treatment, overjet, overbite etc. was collected and calculated. The average age of the patients delivering the initial brace was $8.75{\pm}1.10year$. Most of the anterior crossbite was resolved within 6 months. The total treatment period was $21.79{\pm}10.73months$ with the additional procedures like the alignment of anterior teeth and torque control using additional removable and fixed orthodontic appliances. The correlation study showed that patient's cooperation (p = 0.000) and the use of fixed appliance (p = 0.032) were significantly influenced on treatment duration. 본 연구의 목적은 혼합치열기 초기에 III급 부정교합을 보이는 어린이에서 수직성장을 유도하는 III급 고무줄을 걸 수있도록 고안된 구강내 가철식장치를 사용하여 반대교합을 치료시, 그 구체적인 치료기간을 알아보고, 이에 영향을 주는 변수를 확인하는 것이다. 본 소아치과에 III급 부정교합을 주소로 내원하여 구강내 가철식 장치로 치료를 완료한 56명의 환자를 대상으로 치료개시 연령, 치료기간 및 치료유형, 수평피개량, 수직피개량 등의 자료를 수집하였다. 환자군의 교정개시 연령은 8.75세이었고, 교합이 넘어갈때까지 3.31개월, 이후 정상 피개까지 1.90개월이 소요되어, 대부분이 개시 6개월 이내에 개선되었다. 전체 치료기간은 21.79개월이었고 환자의 협조도(p = 0.000)와 고정식 교정장치의 여부(p = 0.032)가 치료기간에 유의하게 영향을 주었다. 결론적으로 본 연구의 가철식장치는 수년간 장시간 장착하며 악정형력을 주는 구강외 장치에 비해서 그 치료기간이 6개월 이내로 짧으며, 혼합치열기 III급 부정교합 어린이에서 효과적으로 이용할 수 있다.

우치에서 레진 침투법 및 불소 적용의 탈회 저항성 비교

이두영,김익환,송제선,김성오,손흥규,이제호,Lee, Doo-Young,Kim, Ik-Hwan,Song, Je Seon,Kim, Seong-Oh,Son, Heung Kyu,Lee, Jaeho 대한소아치과학회 2018 大韓小兒齒科學會誌 Vol.45 No.2

본 실험의 목적은 초기 우식 부위에 레진 침투법과 불소 적용 후 탈회 저항성을 비교하기 위함이다. 인공 우식을 유발한 시편을 대조군, 1.23% 산성불화인산염(Acidulated phosphate fluoride(APF))군, 레진 침투군으로 분류하고 각 재료를 적용 후 재탈회시켰다. 이후 공초점 레이저 현미경(Confocal Laser Scanning Microscope(CLSM))을 이용하여 탈회 깊이를 측정하였고 주사전자현미경(SEM)을 이용하여 법랑질 표면 거칠기를 관찰하였다. CLSM을 이용하여 탈회 깊이를 측정하였을 때 대조군, 1.23% 산성불화인산염군, $Icon^{(R)}$ caries infiltrant군 순으로 감소하였다. 탈회 깊이는 1.23% 산성불화인산염군, $Icon^{(R)}$ caries infiltrant군이 대조군에 비해서는 유의성 있는 차이를 보이지만 두 군 간의 차이가 없었다(p < 0.05). 표면거칠기는 대조군에서 매우 거칠고 표면이 불규칙한 양상을 보였고 1.23% 산성불화인산염군, $Icon^{(R)}$ caries infiltrant 군으로 갈수록 표면 거칠기와 불규칙성은 감소하였다. The aim of this study is to compare the differences of the demineralization resistance of resin infiltration and 1.23% acidulated phosphate fluoride in bovine teeth with artificial caries. We applied 1.23% Acidulated phosphate fluoride (APF) gel and $Icon^{(R)}$ caries infiltrant on the artificial bovine enamel carious lesion and then demineralized all samples. The depth of demineralization was measured by using Confocal Laser Scanning Microscope (CLSM) and observed the roughness and irregularity of the enamel was observed by Scanning Electron Microscope (SEM). In this experiment with demineralization resistance on smooth artificial carious lesion, less depth of demineralization, roughness, and irregularity of enamel was observed in APF gel and $Icon^{(R)}$ group than in the control group. There was no significant difference between the depth of demineralization of 1.23% APF gel and $Icon^{(R)}$ caries infiltrant group. However, resin infiltration is beneficial as less roughness and irregularity was observed on the enamel surface than when 1.23% APF gel is applied.