오훼돌기에 매복된 과잉치: 증례보고

박원서,이제호,박혁,정호걸,김기덕,Park, Won-Se,Lee, Je-Ho,Park, Hyok,Jung, Ho-Gul,Kim, Kee-Deog 대한영상치의학회 2010 Imaging Science in Dentistry Vol.40 No.2

Impaction of tooth is a situation in which an unerupted tooth is wedged against another tooth or teeth or otherwise located so that it cannot erupt normally. The supernumerary tooth is also called as hyperdontia and defined as the condition of having additional tooth to the regular number of teeth. The most common supernumerary tooth is a mesiodens, which is a mal-formed, peg-like tooth that occurs between the maxillary incisors. The supernumerary tooth is commonly impacted but they are frequently impacted on maxilla. Ectopic impaction of supernumerary tooth on mandibular condyle, coronoid process, ascending ramus, and pterygomandibular space is very rare condition. In this case, we report a case of impacted supernumerary tooth on mandibular sigmoid notch without definite pathologic change.

악교정 수술을 위한 디지털 모형 수술의 정확성 평가

김봉철,박원서,강연희,이충국,유형석,강석진,이상휘,Kim, Bong-Chul,Park, Won-Se,Kang, Yon-Hee,Yi, Choong-Kook,Yoo, Hyung-Suk,Kang, Suk-Jin,Lee, Sang-Hwy 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.6

The accuracy of model surgery is one of important factors which can influence the outcome of orthognathic surgery. To evaluate the accuracy of digitalized model surgery, we tried the model surgery on a software after transferring the mounted model block into a digital model, and compared the results with that of classical manual model surgery. We could get the following results, which can be used as good baseline analysis for the clinical application. 1. We made the 3D scanning of dental model blocks, and mounted on a software. And we performed the model surgery according to the previously arranged surgical plans, and let the rapid prototyping machine produce the surgical wafer. All through these process, we could confirm that the digital model surgery is feasible without difficulties. 2. The digital model surgery group (Group 2) showed a mean error of $0.0{\sim}0.1mm$ for moving the maxillary model block to the target position. And Group 1, which was done by manual model surgery, presented a mean error of $0.1{\sim}1.2mm$, which is definitely greater than those of Group 2. 3. Remounted maxillary model block with the wafers produced by digital model surgery from Group 2 showed the less mean error (0.2 to 0.4 mm) than that produced by manual model surgery in Group 1 (0.3 to 1.4 mm). From these results, we could confirm that the digital model surgery in Group 2 presented less error than manual model surgery of Group 1. And the model surgery by digital manipulation is expected to have less influence from the individual variation or degree of expertness. So the increased accuracy and enhanced manipulability will serve the digital model surgery as the good candidate for the improvement and replacement of the classical model surgery, if careful preparation works for the clinical adjustment is accompanied.

Point-based surface best fit 알고리즘을 이용한 디지털 치아 모형과 3차원 CT 영상의 중첩 정확도

김봉철,이채은,박원서,강정완,이충국,이상휘,Kim, Bong-Chul,Lee, Chae-Eun,Park, Won-Se,Kang, Jeong-Wan,Yi, Choong-Kook,Lee, Sang-Hwy 대한구강악안면외과학회 2008 대한구강악안면외과학회지 Vol.34 No.5

Purpose: The goal of this study was to develop a technique for creating a computerized composite maxillofacial-dental model, based on point-based surface best fit algorithm and to test its accuracy. The computerized composite maxillofacial-dental model was made by the three dimensional combination of a 3-dimensional (3D) computed tomography (CT) bone model with digital dental model. Materials and Methods: This integration procedure mainly consists of following steps : 1) a reconstruction of a virtual skull and digital dental model from CT and laser scanned dental model ; 2) an incorporation of dental model into virtual maxillofacial-dental model by point-based surface best fit algorithm; 3) an assessment of the accuracy of incorporation. To test this system, CTs and dental models from 3 volunteers with cranio-maxillofacial deformities were obtained. And the registration accuracy was determined by the root mean squared distance between the corresponding reference points in a set of 2 images. Results and Conclusions: Fusion error for the maxillofacial 3D CT model with the digital dental model ranged between 0.1 and 0.3 mm with mean of 0.2 mm. The range of errors were similar to those reported elsewhere with the fiducial markers. So this study confirmed the feasibility and accuracy of combining digital dental model and 3D CT maxillofacial model. And this technique seemed to be easier for us that its clinical applicability can good in the field of digital cranio-maxillofacial surgery.

하악 제3대구치 발치를 위한 예방적 항생제의 효용성

강상훈,김정인,박원서,이충국,이상휘,Kang, Sang-Hoon,Kim, Jung-In,Park, Won-Se,Yi, Choong-Kook,Lee, Sang-Hwy 대한구강악안면외과학회 2008 대한구강악안면외과학회지 Vol.34 No.3

This study analyzed the incidence of wound infection after the operation of mandibular third molar extraction in relation with antibiotic prophylaxis with the object of young and healthy patients. The study object was 1,177 mandibular third molars of 850 men of 20 to 25 years old without any specific systemic disease. Three methods of preventive antibiotic medication were selected according to the preventive antibiotic medication previously reported; three experimental groups were selected based on them, and the antibiotic used was amoxicillin($^{(R)}Kymoxin$, Yuhanyanghaeng, Seoul). The group 1 includes the patients that took the antibiotic orally before the operation(one hour earlier, 500mg) and for three days after the operation(250mg per time, three times/day), the group 2 is the ones that took the same antibiotic orally only once about one hour before the operation(500mg), and the group 3 did not take any antibiotics before and after the operation. And to compare the difficulties and the degrees of extraction during operations which can be possibly related to the wound infection after the operations, the mandibular third molars' impacted depths and extraction methods were investigated as well. To check if the wound was infected, observations with an internal of one week were performed twice after the operation, and the meaningfulness of the infection incidence was verified through Chi-square test using SPSS program(SPSS Inc., IL, USA). There was no statistically significant difference between the antibiotic medication methods and the wound infection incidence after the operation among the experimental groups. As examining the relations between the mandibular third molar operation methods and the wound infection incidence after the operation, there existed a statistically meaningful difference in the infection incidence according to the operation methods(p=0.020). And there was no statistically significant difference in the wound infection incidence according to the impacted depth of the mandibular third molar. Therefore, it is thought that there exists little necessity of prophylatic antibiotics medication when extracting the mandibular third molar of young and healthy men without any systemic disease in general; however, in case when it is expected that the possibility of infection will be high or the wound on the tissue will be severe, it is sure that the prophylactic antibiotics medication will be necessary.

경골 근위부 골채취를 위한 내측 및 외측 접근법시의 삼차원적 길이계측

남웅(Woong Nam),박원서(Won-Se Park),정호걸(Ho-Gul Jeong),허경석(Kyung-Seok Hu),차인호(In-Ho Cha) 대한구강악안면외과학회 2007 대한구강악안면외과학회지 Vol.33 No.4

Purpose : The aim of this study was simply assessing linear measurements in the lateral and medial approach, respectively, for bone harvesting using anatomic and three-dimensional (3D) computed tomographic (CT) analyses on a dried cadaveric proximal tibia. In addition, the availability of the three-dimensional computed tomographic (3D-CT) analysis was also estimated. Materials and methods : Ten dried proximal tibia were obtained from five Korean cadavers. Four the reference points, the SM (superior-medial), IM (inferior-medial), SL (superior-lateral), and IL (inferior-lateral) were marked around the tibial tuberosity. The PM (posterior-medial) and PL (posterior-lateral) points were randomly marked at points farthest from the lateral and medial reference points, respectively, in the posterior border of the superior articular surface of both condyles. All measurements were obtained on the dried proximal tibia. After computed tomography had been performed, the three dimensional images were reconstructed using V works 4.0™ (Cybermed Inc., Seoul, Korea), and the length between the reference points were measured three dimensionally using the method described above. The error between the mean actual and mean 3D-CT measurements was calculated in order to determine the availability of the three dimensional computed tomographic analysis. Results : The length between the reference points was greatest at the IL-PM, which averaged 65.39 mm±10.35. This was followed by the SL-PM with 63.24 mm±8.10, the IM-PL with 58.09 mm±10.02, and the SM-PL with 51.99 mm±9.06. The differences between the IL-PM and SM-PL were 13.4 mm. The mean values were 55.04 mm in the medial approach and 64.32 mm in the lateral approach, and the differences between medial and lateral were 9.28 mm. The error between the mean actual and mean 3D-CT measurements was 0.31% and the standard deviation was 0.28%. Conclusion : The anatomical and three dimensional computed tomographic analysis indicates that there was only a 9.28 mm linear difference between the lateral and medial approach. This is consistent with previous studies, which showed that there was little difference between the two approaches in terms of the bone volume. In addition, the error (0.31%) and the standard deviation (0.28%) were considered low, demonstrating high accuracy of 3D-CT. Therefore it can be used in preoperative treatment planning.

하악공 전달마취 후 발생한 일시적인 시력 저하

임지영,윤희정,방난심,정복영,김기덕,박원서,Lim, Gee-Young,Yun, Hee-Jung,Pang, Nan-Sim,Jung, Bock-Young,Kim, Kee-Deog,Park, Won-Se 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.1

One of the most common procedures in dentistry is the inferior alveolar nerve block anesthesia but visual problem can occur during this procedure. Transient visual acuity decrease after inferior alveolar nerve block anesthesia can result from unintended intravascular injection. In this case report, we present ocular complication that has rarely been reported. The understanding of anatomy related to this case is discussed with suggestions for proper management of the patients. The dental management for ocular complications includes a correct diagnosis, management by understanding of patient's anatomic variations. This will prevent intravascular injection.

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.

하악공 전달마취후 복시 -증례보고-

최은혜,서지영,정복영,김성태,김기덕,박원서,Choi, Eun-Hae,Seo, Ji-Young,Jung, Bock-Young,Kim, Sung-Tae,Kim, Kee-Deog,Park, Won-Se 대한치과마취과학회 2007 Journal of Dental Anesthesia and Pain Medicine Vol.7 No.2

Inferior alveolar nerve block anesthesia is one of the most common procedures in dental clinic. Although it is well known as safe procedure, complications always can be occurred. Ocular complications such as diplopia, loss of vision, opthalmoplegia are very rare, but once it happens, dentist and patient can be embarrassed and rapport will be decreased between them. We experienced one diplopia case after inferior alveolar nerve block anesthesia and treated without any further complication. We report this case and describe the cause, diagnosis, and treatment objectives of diplopia caused by inferior alveolar nerve block anesthesia.

Minimally Invasive Laser-Assisted Biopsy of the Oral Lesions for Oral Graft-Versus-Host Disease after Hematopoietic Stem-Cell Transplantation

김윤미,윤희정,김현실,김기덕,정복영,방난심,박원서,Kim, Yun-Mi,Yun, Hee-Jung,Kim, Hyun-Sil,Kim, Kee-Deog,Jung, Bock-Young,Pang, Nan-Sim,Park, Won-Se The Korean Academy of Orofacial Pain and Oral Medi 2012 Journal of Oral Medicine and Pain Vol.37 No.3

조혈줄기세포이식은 면역 결핍 질환, 자가 면역 질환, 악성 조혈 종양의 주된 치료법이다. 이종 조혈줄기세포이식의 주요한 합병증은 이식편대 숙주질환이다. 구강 점막 생검은 이식편대 숙주 질환의 확진과 치료계획 수립을 위해 필요하나 영양 결핍과 화학 요법으로 인해 전신상태가 불량한 환자에게 출혈과 균혈증을 일으킨다. 본 논문에서는 레이저를 이용한 최소 침습적 조직생검의 효능을 평가하였다. 모두 3개의 증례가 소개되었고 모든 환자의 의료 기록, 임상 사진, 조직병리학적 결과가 레이저를 이용한 조직생검의 효능을 평가하기 위해 검토되었다. 모든 환자는 생검 후 불편감이 없었고 심각한 합병증이 발생하지 않았다. 생검 조직의 질이 이식편대 숙주 질환을 확진하는 데에 적당했다. 구강 점막의 레이저를 이용한 최소 침습적 생검은 통상의 조직병리학적 생검에 비해 출혈을 일으키지 않아 감염과 균혈증, 술 후 흉터 생성을 줄이므로 이식편대 숙주 질환의 확진에 이로울 것이다. Hematopoietic stem-cell transplantation (HSCT) is a treatment for immune deficiency, autoimmune diseases, and hematopoietic malignancies. The main complication of allogenic HSCT is graft-versus-host disease (GVHD). Oral mucosal biopsy is needed for a definitive diagnosis and treatment planning of GVHD, but this procedure causes bleeding and bacteremia in a poor general condition. We evaluated the efficacy of laser-assisted biopsy as a minimally invasive treatment. Three cases were described in this article. All patients' medical records, clinical photographs, and histopathologic findings were reviewed. All patients felt comfortable and no severe complications occurred. The quality of the obtained biopsy material was adequate for a definitive diagnosis of GVHD. Laser-assisted, minimally invasive biopsy of the oral mucosa does not cause bleeding, and it reduces the chances of infection, bacteremia, and postoperative scarring compared to the usual histopathologic biopsy procedure. It would thus be advantageous to use this procedure to biopsy GVHD patients.

악교정수술 골절단술시 컴퓨터 네비게이션 시스템의 이용: Technical Note

김문기,강상훈,최영수,김정인,변인영,박원서,이상휘,Kim, Moon-Key,Kang, Sang-Hoon,Choi, Young-Su,Kim, Jung-In,Byun, In-Young,Park, Won-Se,Lee, Sang-Hwy 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.3

Surgery with the computer navigation system can make it possible to identify important anatomical structures which are difficult to be confirmed with the naked eye in the operation, and has extended their applications in various surgical fields. The head and neck surgery especially requires detailed anatomical knowledges and these knowledges have influences on postoperative functions and esthetics of a patient. In the orthognathic surgery, we should take osteotomies in the precise locations of the jawbones and move segments to the intended positions. There are so many important anatomical structures around the osteotomy-sites in the orthognathic surgery that the prevention of damage to these structures to obtain satisfactory results without any complication. There are vessels of the pterygoid plexus posterior to the pterygoid plate in the maxilla and the mandibular nerve enters the mandibluar foramen in the mandibular ramus. These locations should be confirmed perioperatively to avoid any injury to these structures. The navigation-assisted surgery may be helpful for this purpose. We performed navigational orthognathic surgeries with preoperative CT images and obtained satisfactory results. The osteotomy was performed in the proper location and damaging the surrounding important anatomical structures was avoided by keeping the saw away from them with the real-time navigation. It may be required to develop proper devices and protocols for the navigation-assisted orthognathic surgery.