편측관상봉합 조기유합증 환자에서 컴퓨터단층촬영을 이용한 두개 기저부의 술후 변화 예측

김영석,김진형,김용욱,유선국,이혜연,김기덕,박병윤 大韓成形外科學會 2004 Archives of Plastic Surgery Vol.31 No.2

두개골의 3차원 영상 분석을 위한 전산화단층촬영 방법의 비교 : 상층 두께가 3차원 영상의 계측에 미치는 영향

정호걸,김기덕,박혁,김동욱,정해조,김희중,유선국,김용욱,박창서 대한구강악안면방사선학회 2004 Imaging Science in Dentistry Vol.34 No.3

Purpose : To evaluate the quantitative accuracy of three-dimensional (3D) images by means of comparing distance measurements on the 3D images with direct measurements of dry human skull according to slice thickness and scanning modes. Materials and Mathods : An observer directly measured the distance of 21 line items between 12 orthodontic landmarks on the skull surface using a digital vernier caliper and each was repeated five times. The dry human skull was scanned with a Helical CT with various slice thickness (3, 5, 7 mm) and acquisition modes (Conventional and Helical). The same observer measured corresponding distance of the same items on reconstructed 3D images with the internal program of V-works 4.0 (Cybermed Inc., Seoul, Korea). The quantitative accuracy of distance measurements were statistically evaluated with Wilcoxons’ two-sample test. Results : 11 line items in Conventional 3 mm, 8 in Helical 3mm, 11 in Conventional 5 mm, 10 in Helical 5 mm, 5 in Conventional 7 mm and 9 in Helical 7 mm showed no statistically significant difference. Average difference between direct measurements and measurements on 3D CT images was within 2 mm in 19 line items of Conventional 3 mm, 20 of Helical 3 mm, 15 of Conventional 5 mm, 18 of Helical 5 mm, 11 of Conventional 7mm and 16 of Helical 7 mm. Conclusion : Considering image quality and patient’s exposure time, scanning protocol of Helical 5 mm is recommended for 3D image analysis of the skull in CT.

단층촬영 각도의 변화가 하악과두의 골 증식성 병소의 인식에 미치는 영향

김기덕,한상선 大韓口腔顎顔面 放射線學會 1999 Imaging Science in Dentistry Vol.29 No.1

Purpose: To find out the effects that different tomographic angles have on the osteophytic lesion detectability of condyle head by comparison the individualized lateral tomographic image with the various tomographic angled images using SCANORA . Materials & Methods: This study is performed to simulate osteophytic lesions by a series of dentin chips placed at six locations on condyle head. The control angle is 15°and from this angle, tomographic angle were varied with -10°, +10°+20°. All the images with each sized dentin chip were scored by three dental radiologists with the use of confidence levels for presence or absence of the lesion, each examiner viewed one of the images twice. A rating scale from 0 to 2 (0, lesion definitely not present; 1, uncertain if lesion is present; 2, lesion definitely present). Responses were assessed by Tukey's multiple comparison method and kappa value. Results: 1. The lesion size of 0.3mm could not be detected in all the tomographic angles. As the size of the lesion increased the average value of lesion detectability also increased. 2. In the lesion sizes of 0.7mm there was statistically significant difference between the 15°control angle and the altered tomographic angles (p<0.05). In 1.0mm lesion there was no significant difference in the ±10°altered angles (p<0.05), but there was significant difference in the altered angle(p<0.05). In the lesion sizes of 0.3mm and 2.0mm there was no significant difference between the 15°control angle and all the altered angle(p>0.05). 3. In the anteromedial, anterosuperior, anterolateral area there was no significant difference between the 15°control angle and the ±10°altered angle(p>0.05), but in the comparison with the +20°alterd angle there was significant difference(p>0.05). Conclusion: When imaging the lateral tomography of the temporomandibular joint used by SCANORA, it can be considered that in the osteophytic lesion size of 2mm and above, the tomographic angle difference within +20°to the horizontal angle of the condyle, has little effect on the lesion detectability. And in the lesion size of 1mm, the altered angle within ±10°also has little effect on the lesion detectability.

영상재구성 전산화 단층촬영에서 촬영조건의 변화가 하악골 술전 임플란트 부위 평가에 미치는 영향

김기덕,박창서 大韓口腔顎顔面 放射線學會 1999 Imaging Science in Dentistry Vol.29 No.1

Purpose: To evaluate the effect of variable scanning protocols of computed tomography for evaluation of pre-implant site of the mandible through the comparison of the reformatted cross-sectional images of helical CT scans obtained with various imaging parameters versus those of conventional CT scans. Materials and Methods: A dry mandible was imaged using conventional nonoverlapped CT scans with 1 mm slice thickness and helical CT scans with 1 mm slice thickness and pitches of 1.0, 1.5, 2.0, 2.5 and 3.0. All helical images were reconstructed at reconstruction interval of 1 mm. DentaScan reformatted images were obtained to allow standardized visualization of cross-sectional images of the mandible. The reformatted images were reviewed and measured separately by 4 dental radiologists. The image qualities of continuity of cortical outline, trabecular bone structure and visibility of the mandibular canal were evaluated and the distance between anatomic structures were measured by 4 dental radiologists. Results: On image qualities of continuity of cortical outline, trabecular bone structure and visibility of the mandibular canal and in horizontal measurement, there was no statistically significant difference among conventional and helical scans with pitches of 1.0, 1.5 and 2.0. In vertical measurement, there was no statistically significant difference among the conventional and all imaging parameters of helical CT scans with pitches of 1.0, 1.5, 2.0, 2.5 and 3.0. Conclusion: The images of helical CT scans with 1 mm slice thickness and pitches of 1.0, 1.5 and 2.0 are as good as those of conventional CT scans with 1 mm slice thickness for evaluation of predental implant site of the mandible. Considering the radiation dose and patient comfort, helical CT scans with 1 mm slice thickness and pitch of 2.0 is recommended for evaluation of pre-implant site of the mandible.(J Korean Oral Maxillofac Radiol 1999:29:21-32)

약관절원판 천공의 방사선학적 연구

김기덕,박창서 大韓口腔顎顔面 放射線學會 1990 Imaging Science in Dentistry Vol.20 No.2

Thirty-nine patients (forty-four joints) who had been diagnosed as having meniscus perforation of the temporomandibular joint by inferior joint space arthrography and had been treated by surgical procedures were evaluated retrospectively. Information of clinical findings, arthrotomographic findings and surgical findings was collected on a standardized form and evaluated. The results were as follows : 1. On the 34 patients of 38 joints which were surgically confirmed perforation of meniscus or its attachments of the temporomandibular joint, there were 29 females and 5 males(5.8:1). The average age was 36 years(range 17 to 70). 2. The common clinical findings of group that had meniscus displacement without reduction and with perforation were pain on the affected joint and limitation of mouth opening. In the group showing meniscus displacement with reduction and with perforation the common clinical findings were pain and clicking on the affected joint. 3. 32 joints(84.2%) were arthrotomographically anterior meniscus displacement without reduction and with perforation, 6 joints(15.8%) showed anterior meniscus displacement with reduction and with perforation. 4. Joints categorized arthrotomographically as having meniscus displacement without reduction and with perforation were less likely to have full translation of the condyle in comparison with the normal or meniscus displacement with reduction and with perforation groups.(p<005) 5. The arthrographic findings of 44 joints having meniscus perforation were compared with surgical findings, there were 6 false positive findings of meniscus perforation, the reliability of arthrographic findings of meniscus perforation was a 86.4% correlation with surgical findings. 6. On the site of perforations of 38 joints which were surgically confirmed perforation of meniscus or its attachments, twenty-three of perforations(60.5%) were in location at the junction of the meniscus and posterior attachment, forteen(36.9%) were located at the posterior attachment and one (2.6%) was at the meniscus itself.

일반 측방 두부규격 방사선사진과 측방 두부규격 전산화 방사선사진에서의 계측점의 신뢰도에 대한 비교 연구

김형돈,박창서,김기덕 大韓口腔顎顔面 放射線學會 1997 Imaging Science in Dentistry Vol.27 No.1

The purpose of this study was to compare & to find out the variability of head film measurements(landmarks identification) between Fuji computed radiographic cephalometry and conventional cephalometry. 28 Korean adults were selected. Lateral cephalometric FCR film and conventional cephalometric film of each subject was taken. Four investigators identified 24 cephalometric landmarks on lateral cephalometric FCR film and conventional cephalometric film. The comparable measurements between lateral cephalometric FCR film and conventional cephalometric film were statistically analysed. The results were as follows: 1. In FCR film & conventional film, coefficient of variation (C.V.) of 24 landmarks was taken horizontally & vertically. There is no significant difference of rank order of landmarks in C.V. between two films. 2. In comparison of significant differences of landmarks variability between FCR film & conventional film, horizontal value of coefficient of variation showed significant differences in four landmarks among twenty-four landmarks, but vertical value of coefficient of variation showed significant differences in sixteen landmarks among twenty-four landmarks. FCR film showed significantly less variability than conventional film in 17 subjects among 20(4+16) subjects that showed significant difference.

치수 치근단 병소의 전구 위험요인으로서의 제 2 형 당뇨의 역할에 관한 소고

김진희,배광식,서덕규,홍성태,이윤,홍삼표,금기연 大韓齒科保存學會 2009 Restorative Dentistry & Endodontics Vol.34 No.3

Diabetes Mellitus (DM) is a syndrome accompanied with the abnormal secretion or function of insulin, a hormone that plays a vital role in controlling the blood glucose level (BGL). Type 1 and 2 DM are most common form and the prevalence of the latter is recently increasing. The aim of this article was to assess whet her Type 2 DM could act as a predisposing risk factor on the pulpo-periapical pathogenesis. Previous literature on the pathologic changes of blood vessels in DM was thoroughly reviewed. Furthermore, a histopathologic analysis of artificially-induced periapical specimens obtained from Type 2 diabetic and DM-resistant rats was compared. Histopathologic results demonstrate that the size of periapical bone destruction was larger and the degree of pulpal inflammation was more severe in diabetic rats, indicating that Type 2 DM itself can be a predisposing risk factor that makes the host more susceptible to pulpal infection. The possible reasons may be that in diabetic state the lumen of pulpal blood vessels are thickened by atheromatous deposits, and microcirculation is hindered. The function of polymorphonuclear leukocyte is also impaired and the migration of immune cells is blocked. leading to increased chance of pulpal infection. Also, lack of collateral circulation of pulpal blood vessels makes the pulp more susceptible to infection. These decrease the regeneration capacity of pulpal cells or tissues, delaying the healing process. Therefore, when restorative treatment is needed in Type 2 DM patients, dentists should minimize irritation to the pulpal tissue under control of BGL. 당뇨(Diabetes Mellitus)란 혈당을 조절하는 인슐린의 분비나 기능에 장애를 야기하는 질환으로 인슐린 의존성 여부에 따라 제 1 형과 제 2 형으로 분류된다. 본 종설은 최근 증가 추세에 있는 제 2 형 당뇨가 치수 치근단 병소의 병인 과정에 전구 위험 요인으로 작용할 수 있는지를 평가 하고자 문헌고찰을 통해 당뇨의 병인 과정에서 특징적으로 나타나는 혈관 합병증에 관해 알아보고, 부가적으로 제 2 형 당뇨 쥐 모델에서 인위적인 치수감염 후 얻은 치근단 조직의 조직병리학적 분석을 시행하였다. 조직학적 관찰 결과 제 2 형 당뇨 쥐에서 대조군에 비해 치수 치근단 병소의 크기가 증가하였고, 치수 염증 반응도 심하게 나타난 것으로 보아 당뇨 자체가 숙주를 감염에 취약한 상태로 만드는 전구 위험요소로 작용하였음을 알 수 있었다. 이러한 이유로는 첫째, 당뇨 시 전반적으로 나타나는 혈관 내 죽상 침착(atheromatous deposits)에 의해 혈관 내벽의 두께가 두꺼워져 미세 순환의 장애는 물론 탐식 세포의 기능 저하, 면역 세포의 혈류 이동이 차단되어 치수 감염 시 쉽게 치근단 병소로 이환될 가능성이 높고, 둘째 치수 혈관에서 특징인 측부 순환(collateral circulation)의 부재에 따른 살균성 다형핵 백혈구의 활동 억제를 포함한 미세 혈관계의 취약성으로 인해 치수 조직의 재생능이 저하되어 추가적인 감염원의 공격에 대한 방어 및 치유 저하를 더욱 심화시키기 때문인 것으로 사료된다. 따라서 제 2 형 당뇨 환자의 수복치료 시 치과의사는 당뇨 조절 하에서 치수 조직의 자극을 최소화하기 위한 세심한 처치가 필요하다.

3차원 전산화단층촬영 영상을 이용한 얼굴 연조직 두께 계측

정호걸,김기덕,한승호,신동원,허경석,이제범,박혁,박창서 대한구강악안면방사선학회 2006 Imaging Science in Dentistry Vol.37 No.1

Purpose : To evaluate accuracy and reliability of program to measure facial soft tissue thickness using 3D computed tomographic images by comparing with direct measurement. Materials and Methods : One cadaver was scanned with a Helical CT with 3 mm slice thickness and 3 mm/sec table speed. The acquired data was reconstructed with 1.5 mm reconstruction interval and the images were transferred to a personal computer. The facial soft tissue thickness were measured using a program developed newly in 3D image. For direct measurement, the cadaver was cut with a bone cutter and then a ruler was placed above the cut side, The procedure was followed by taking pictures of the facial soft tissues with a high-resolution digital camera. Then the measurements were done in the photographic images and repeated for ten times. A repeated measure analysis of variance was adopted to compare and analyze the measurements resulting from the two different methods. Comparison according to the areas was analyzed by Mann-Whitney test. Results : There were no statistically significant differences between the direct measurements and those using the 3D images (p>0.05). There were statistical differences in the measurements on 17 points but all the points except 2 points showed a mean difference of 0.5 mm or less. Conclusion : The developed software program to measure the facial soft tissue thickness using 3D images was so accurate that it allows to measure facial soft tissues thickness more easily in forensic science and anthropology. (Korean J Oral Maxillofac Radiol 2006; 36 : 49-54)

측두하악관절장애 환자의 자기공명영상에서 관찰되는 악관절 삼출

고지영,김기덕,박창서 대한구강악안면방사선학회 2001 Imaging Science in Dentistry Vol.31 No.2

Purpose : The purpose of this study was to find the relationship among the joint status, pain and effusion in patients with temporomandibular joint disorders. Materials and Methods : Materials included 406 patients (812 joints) with clinical records and bilateral TMJ MRIs in TMJ clinic, Yongdong Severance Hospital. All joints were classified in 4 groups in MR images according to the disc status of joint; normal disc position, disc displacement with reduction (DDcR), early and late stage of disc displacement without reduction (DDsR), and also 2 groups according to the bony status of joint; normal bony structure and osteoarthrosis. MR evidence of joint effusion was categorized in 4 groups according to its amount. To determine the relationship between joint pain and joint effusion, 289 patients with unilateral TMJ symptoms were selected from total materials. Result : Joint effusion was found 8.0% in normal disc position,32.6% in DDcR, and 59.2% in DDsR (83.1% in early state and 23.1% in late stage). Joint effusion was found 39.7% in osteoarthrosis and 35.0% in normal bony structure. Joint effusion was more found in the painful joints (49.8%) than in the painless joints (22.4%) (p 〈 0.001). Joint effusion in the early stage of DDsR only was more found significantly in painful joints (91.9%) than in painless joints (62,1%)(p〈 0.001). Conclusion : MR evidence of joint effusion might be related to disc displacement regardless of the presence of osteoarthrosis, and the early stage of DDsR was found more frequently combined with joint effusion and joint pain.(Korean J Oral Maxillofac Radiol 2001;31:73-84)

태양열 온수급탕 시스템에 관한 연구 : 아파트를 중심으로 With relevance to Apartment

송인춘,김기세,구현덕,김병수,나기태 忠南大學校 産業技術硏究所 1999 산업기술연구논문집 Vol.14 No.1

This work was carried out to propose a model of the most effective layout and installation for applying the Solar Hot Water system to apartment and to offer the basic data for promoting the destribution of this Solar Hot Water system in the country. For this purpose, the performed experiments are as followings: 1)Measurement and analysis of the amount of hot water adn the cost of water used in apartment of which the area is 30 to 40 pyung. 2)to esimate the efficiency of Solar Hot Water System in accordance with an angle of inclination. 3) Analysis of economical efficiency the annual expected saving cost produced by replacing the existing hot water system with the Solar Hot Water System. 4)Proposal of the best model for installing the Solar Hot Water System in apartment by considering the place and sunshine,and compaison of merit and demerit of this system.