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2017년 3월부터 2019년 8월까지 연세대학교 치과대학병원 통합치의학과에서 통합치의학과 전문의에 의해 시행된 외래 전신마취 치과치료 증례에 대한 통계 연구
정지은,최석근,김기덕,박원서,정복영,방난심 대한통합치과학회 2019 대한통합치과학회지 Vol.8 No.3
Patients with disabilities or patients with severe dental phobia are not able to receive dental treatment properly in an outpatient clinic. For such patients, dental treatment under an outpatient general anesthesia has the advantage of obtaining proper coordination and receiving multiple dental treatments in one visit. In this study, a statistical analysis of 35 patients who underwent outpatient general anesthesia for 30 months, from March 2017 to August 2019, was performed by a specialist in Advanced General Dentistry. Among 35 patients, there were 32 patients with disabilities (91.4%) and 3 non-disabled people with dental phobia. In terms of age distribution, the majority of patients aged 20 to 39 years. An outpatient general anesthesia averaged 1.7 times per person and dental treatment time was 179 minutes under general anesthesia. 60% of patients received dental treatment in three or more departments (for example, periodontolgic, endodontic and prosthodontic) and 28.6% of 10 patients received treatment in two departments. As the demand for dental treatment of dental handicapped, including adults with disabilities, increases, the role of specialist in Advanced General Dentistry is expected to be important. 장애가 있는 환자나 치과공포증이 심한 환자는 외래에서 치과치료가 불가능하여 적절한 시기에 치과치료를 받지 못해 치과 질환의 발생 빈도 및 심도가 높다. 이런 환자의 경우 외래 전신마취 하 치과치료는 적절한 협조도를 얻을 수 있고 한 번의 내원으로 여러 치과치료를 받을 수 있다는 장점이 있다. 이번 연구에서는 통합치의학과를 전공한 1명의 전문의에 의해 2017년 3월부터 2019년 8월까지 2년 6개월, 30개월 동안 외래 전신 마취 하에 치과치료를 받은 35명의 환자에 대한 통계 분석을 해보았다. 35명의 환자 중 장애를 가진 환자가 32명(91.4%), 치과공포증을 가진 비장애인이 3명(8.6%)이었으며, 20~39세의 청, 장년층의 환자(25명, 71.4%)가 주를 이루었다. 총 35명의 환자에서 전신마취는 1인당 평균 1.7회, 전신마취 하 치과치료 시간은 179분 정도였다. 3개 분야 이상의 치과 치료를 받은 환자가 60%, 2개 분야의 치료를 받은 환자도 10명으로 28.6% 정도로 나타났다. 치과 공포증 환자를 포함하여 성인 장애인 치료 수요가 늘어나면서, 앞으로 이 분야에서 여러 영역의 치과치료를 환자 중심으로 진단하고 치료할 수 있는 통합치의학과 전문의의 역할이 중요할 것으로 생각된다.
모야모야병(Moyamoya disease) 환자의 치과치료시 고려사항 : 증례 보고
도레미,유태민,성낙환,송승례,신수일 대한통합치과학회 2019 대한통합치과학회지 Vol.8 No.1
Moyamoya disease is a chronic, progressive cerebrovascular disorder that leads to an abnormal vascular network at the base of a brain due to the stenosis or occlusion of the internal carotid artery. The purpose of this study is to provide a review of dental treatment considerations for Moyamoya disease patients. According to the article review, dental treatment of patients with Moyamoya disease needs the following considerations. Firstly, the treatment should consider stress reduction therapies. Secondly, bleeding tendency of patients should be taken into consideration. Lastly, medication treatment should be considered. As Moyamoya disease can be a progressive systemic vascular disease, if a bleeding operation is required in the dental treatment then medical consultation by a professional should precede the treatment. 모야모야병(Moyamoya disease)은 뇌경동맥의 협착이나 폐쇄에 의해서 뇌기저부에 비정상적 혈관망을 갖는 만성 진행성 뇌혈관 질환이다. 본 연구에서는 모야모야병에 대한 문헌 고찰과 함께 모야모야병 환자의 치과 치료 증례를 보고하면서, 모야모야병 환자에 대한 치과치료시 고려해야 사항에 대해 살펴보고자 한다. 모야모야병 환자의 치과 치료시 고려사항으로는 첫 번째로, 스트레스 감소 요법에 대한 고려가 필요하다. 두 번째로 출혈 경향에 대한 고려가 필요하며, 세 번째로 약물 처방에 대한 고려가 필요하다. 이 질환은 진행형인 전신 혈관 질환으로 고려될 수 있으므로, 치과 진료시 출혈을 일으키는 침습적 치료가 예정되어 있을시 반드시 의과 협진이 선행되어야 한다.
전자담배 (E-cigarettes; Electronic Nicotine Delivery System)와 치과팀의 역할
강일현,안소연,김아현 대한통합치과학회 2017 대한통합치과학회지 Vol.6 No.1
The direct effects of electronic cigarette on oral health have yet to be grounded, but there is a possibility of adverse effects as a cigarette. However there is a lack of understanding about electronic cigarettes. Therefore this paper aims to give a general overview of the definition and use of electronic cigarettes, quasi-drugs for quitting smoking, the effects on general health and oral health, and the role of dental teams.
치주 및 임플란트 주위 질환과 상태에 대한 새로운 분류
양수진,최동진,정지은,박원서,정복영,김기덕,방난심 대한통합치과학회 2020 대한통합치과학회지 Vol.9 No.3
The new classification of periodontal and peri-implant diseases and conditions has recently been discussed and adopted by the 2017 World Workshop co-sponsered by the American Academy of Periodontolgy (AAP) and the European Federation of Periodontology (EFP). This workshop profoundly updated the 1999 international classification system of periodontal diseases and conditions that had been denounced by some to have shortcomings such as diagnostic imprecision and application difficulties in both the clinical and scientific field; but had nonetheless been widely used over the past two decades. The workshop aimed to rectify the classification scheme by implementing current findings considering the nature and pathophysiology of periodontal and peri-implant diseases. Case definitions of each classification were also added to elaborate the details and propose a clear standard for diagnosis and treatment. The purpose of this article is to review the updated classification scheme of periodontal and peri-implant diseases and conditions and acknowledge the changes made to the 1999 classification. By this the readers will be able to precisely diagnose and treat patients presenting periodontal or peri-implant diseases based on up-to-date evidence.
백서의 두개골 결손부에서 제대혈 유래 간엽줄기세포의 골재생에 관한 연구
이의석,장현석,권종진,이진용,임재석,서병무,윤정현,임재형 대한통합치과학회 2013 대한통합치과학회지 Vol.2 No.1
It has been suggested that umbilical cord blood (UCB) contains multipotent stem cells. Some authors suggest that within UCB are cells with potential for differentiation down mesenchymal lineages and UCB is one of the readily available sources of stem cells that may be used for bone regeneration. Isolation and characterization of these cells has been accomplished in some centers. Differentiation of these cells down multiple lineages has been documented. The use of UCB derived stem cells was investigated in this animal studies. Polycaprolactone‐20% tricalcium phosphate (PCL‐TCP) polymers allow for cellular adherence and differentiation and are adequate scaffolds for bone regeneration in tissue engineering strategies. The purpose of this study was to evaluate the potential of MSCs from UCB seeded onto PCL‐TCP composite scaffolds for bone tissue engineering. MSCs were isolated from UCB. MSCs from UCB seeded onto PCL‐TCP scaffolds were then implanted in calvarial bone defect of the athymic mouse. As a control, in each mouse was treated with scaffold only. At six and twelve weeks post‐implantation, histological examinations were performed. MSCs from UCB with PCL‐TCP scaffolds did not exhibited bone regeneration in calvarial bone defects in athymic mouse. Histological examination did not reveal the presence of regenerated bone of the defect. MSCs from UCB should be considered further applications in tissue‐engineered bone regeneration.
Coumadin을 복용중인 환자의 치주치료 후 발생한 술 후 과다출혈
박원서,김기덕,정복영,방난심,조지헌 대한통합치과학회 2013 대한통합치과학회지 Vol.2 No.1
치과치료 후 환자의 지혈에 문제가 발생했다면 우선 국소적으로 지혈을 방해하는 요소가 있는지, 전신적인 문제인지를 감별하는 것이 중요하다. 만약 전신적인 원인이 존재한다면 국소적인 압박지혈만으로는 출혈을 조절하기 힘든 상황이 발생할 수 있다. Coumadin은 대표적인 항응고제 약물로 판막수술, 부정맥 등에 사용된다. 그러나 이 약물의 safe zone이 매우 좁아서 투약방법, 환자의 식습관, 약물투여 등에 민감하게 영향을 받을 수 있고 Coumadin toxicity가 발생할 가능성이 높다. 본 증례에서는 판막수술 후 Coumadin을 복용중인 환자에서 치주치료 후 발생한 술 후 과다출혈 증례를 경험한바, 술 후 출혈의 원인과 예방법에 대해 정리하고자 한다.
치과 공포를 갖고 있는 성인에서의 경구 및 아산화질소 복합 진정요법을 이용한 통합적 치과치료의 증례 보고
방난심,이재호,박원서,김기덕,임지영,정복영,김슬기 대한통합치과학회 2013 대한통합치과학회지 Vol.2 No.1
This case report represents to overview of the clinical guidance regarding patients with dental fear. A 43-year-old male patient visited the department of Advanced General Dentistry of Yonsei Dental Hospital for total oral examination and treatment. He had severe dental fear and needle phobia, so wanted general anesthesia or sedation during dental treatment. He got dental treatment under sedation with N2O inhalation and oral medication. He was monitored the vital sign of patient in every 5 minute during treatment procedures. We suggest a clinical guideline for the patient with severe dental fear using conscious sedation.
항혈소판 및 항응고제 복용하는 환자의 치과시술 후의 출혈 경향에 대한 후향적 평가
김경진,윤지언,박준,홍기은,김철훈,김정한,김복주 대한통합치과학회 2020 대한통합치과학회지 Vol.9 No.3
Patients with cardiovascular disease who take antiplatelets and anticoagulants are known to have an increased risk of bleeding from open dental surgery. This study is aimed at aiding the analysis of the tendency toward bleeding among patients taking antiplatelets and those taking anticoagulants and to develop guidelines related to drug management during their actual clinical dental care. A total of 413 patients over 65 years of age who visited the Oral and Maxillofacial Surgery Clinic at our hospital from January through December 2018, and underwent extraction and implant surgery participated. This included patients diagnosed with cardio-cerebral vascular disease who were prescribed antiplatelet and anticoagulant drugs. The medical histories of these patients were analyzed to evaluate the tendency toward bleeding depending on the type of drug, whether or not the drug was discontinued, and type of surgery (tooth extraction, implant). In the case of antiplatelet drugs, a total of 113 patients were included, and none of them returned to the hospital due to bleeding, even though the drug was discontinued. A total of 42 patients on anticoagulants were included, of which 2 (4.8%) returned to the hospital with bleeding but the bleeding was controlled through the appropriate hemostatic procedures. Statistically, the type of drug, the presence or absence of drug discontinuation, type of surgery, and occurrence of bleeding after dental surgery were not significant. Therefore, the risk of bleeding during tooth extraction and implant surgery is not significant, based on the findings of this investigation. Therefore, the drug should not be necessarily discontinued if discontinuation of antithrombotic agents increases the patient’s systemic risk, such as for the recurrence of cardiovascular blood clots.
안소연,김현정,서광석,황경균,이덕원,김승오,김종빈 대한통합치과학회 2016 대한통합치과학회지 Vol.5 No.2
Sedation and analgesia are frequently administered to dental patients for procedures done outside the operating room. As dental sedation became more widely used in dental clinics, positive effects, such as control of anxiety and pain, have been noted. However, concurrent reports of side effects and severe complications related to dental sedation have also been on the rise. In response to this, dentists established the “Dental Sedation Guideline” at the Korean Academy of Dental Sciences in April 2010 in order to promote the practice of more effective and safer dental sedation. A revision to the dental sedation clinical practice guidelines was necessary because it had been 5 years since the establishment of the original guidelines. The definition of evidence-based clinical practice guidelines is “statements that are systematically developed to assist in the doctors’ and patients’ decision making in certain situations”. The study conduct systematic searching methods based on which evidence-based CPGs. The aim of this report was to discuss the development of Dental sedation Evidence-based Recommendations for dentists in the clinic.
잔존 전치를 통해 수직고경을 결정한 양악 임시즉시의치 및 총의치 수복 증례
정세연,김성준,방대연 대한통합치과학회 2020 대한통합치과학회지 Vol.9 No.1
In patients who faced loss of all natural teeth, one of many choices is fabrication of interim immediate denture. This has a lot of clinical advantages. It can help the patient masticate and provide emotional stability because there is no need to stay edentulous without denture. In addition, it helps to maintain support and tension of muscles around mouth, vertical dimension when occlusion, and facial appearance. In this case of a 69-years-old male patient with few remaining anterior teeth which need to be extracted, interim immediate denture (IID) was used to improve patient’s convenience. Furthermore, maintenance of occlusal vertical dimension (OVD) and centric occlusion with existing interocclusal contacts was helpful. The final complete dentures showed appropriate vertical dimension and the patient was satisfied with the new dentures in respect of functional and esthetic aspects.