탈회 염산농도가 동종골 이식 치유 과정에 미치는 영향에 관한 실험적 연구

엄인웅(In Woong Um),김은철(Eun Cheol Kim) 대한구강악안면외과학회 1993 대한구강악안면외과학회지 Vol.19 No.2

It is generally beleived that the demineralization process does not remove BMP, while the undemineralized bone contains this protein, the bone mineral seems to hinder its action so that the demineralization process make the bone inducing agents more available to the host tissue. The purpose of this study was to evaluate the influence of HC1 concentration o the healing process of 0.4N, 0.5N, and 0.6N HC1 demineralized allogenic bone graft respectively compared with the autografted bone. The results were as follows: 1. Inflammatory cell infiltration appeared at 2 weeks and disappeared at 4 weeks in all experimental groups, but especillay severe in 0.4N HC1 demineralized group at 2 weeks. 2. Neovascularization around graft material in 0.5 and 0.6N groups were more than in 0.4N HC1 group. 3. Osteoblastic activity in 0.5 and 0.6N groups were more than in0.4 HC1 group. 4. There were no significant differences of bone resorption among 0.4, 0.5 and k0.6N HC1 groups. 5. New bone formation and mineralization in 0.5 and 0.6N HC1 groups were more than in 0.4N group and were similar to autograft group.

A CASE REPORT OF SURGICAL CORRECTION OF NASOMAXILLARY HYPOPLASIA DUE TO CONGENITAL SYPHILIS BY LE FORT II OSTEOTOMY WITH CORONAL APPROACH

엄인웅,김창수,Um, In-Woong,Kim, Chang-Soo Korean Association of Maxillofacial Plastic and Re 1991 Maxillofacial Plastic Reconstructive Surgery Vol.13 No.1

Le Fort II 골절단술 및 전방 이동술은 비상악골의 형성 부전증이나 짧은 코, 또는 상악골에 대비하여 상대적인 하악 전돌증 환자에 있어 고려 대상이 되어 왔다. 이러한 비상악골 형성 부전증의 원인으로는 외상, 토순 또는 구개열로 인한 발육부전, 선천성 매독증과 같은 감염 증상 등을 들 수 있다. Le Fort II 골절단술 및 전방 이동술은 1973년 Henderson 과 Jackson 에 의해 처음으로 보고되었고, 그 후 1980년 Steinhauser, Kinnebrew 등에 의해 변화되어 왔다. Le Fort II 골절단술에 있어서의 관상 절개술은 paranasal incision에 비해 안면부 술후 반흔이 남지 않아 심미적으로 우수하며, 두부의 상부 1/2까지 노출이 가능하여 수술시야가 좋으며, 안면 신경 손상 및 lacrimal apparatus 손상의 위험이 적다는 장점 이 외에도 nasofronatal osteotomy site와 pterygomaxiliary osteotomy site를 위한 bone graft의 donor site로서 skull bone을 immediate로 사용할 수 있다는 장점이 있다. 본 교실에서는 선천성 매독의 후유증의 하나인 비상악골 형성부전증을 가진 23세의 여자 환자에 있어서 관상 절개술을 통한 Le Fort II 골절단술을 통한 전하방 이동 및 하악지의 시상골 절단술을 시행하여 양호한 결과를 얻었기에 이에 보고하는 바이다. Maxillofacial deformities are not considered to be a trouble in social life but function. So many maxillofacial plastc surgeons has made efforts to overcome these troubles and bring out more positive life. The proper proportion and shape decide esthetic quality. Lower third of face was consist with lip, cheek, mandibular lower border and mandibular angle. Widening lower third of face give a impression with muscular and recklessness. And lower and wide mandibular angle makes face square shape. Unilateral involvement cause asymmestric face. These face is considered unfavorable, especially in Korea or Japan. We prevent a number of with mandibular angle Bulging which was corrected with mandibular osteotomy or masseter myotomy.

가토 탈회 동종골편 이식시 조직반응에 관한 연구

전영환,김영조,민승기,엄인웅,이동근,Jun, Young-Hwan,Kim, Young-Jo,Min, Seung-Ki,Um, In-Woong,Lee, Dong-Keun 대한악안면성형재건외과학회 1993 Maxillofacial Plastic Reconstructive Surgery Vol.15 No.1

To repair bony defects with tansplanted bone in the body, fresh autogenous bone is undoubtly, the most effective bone graft for clinical applications. But the demineralized bone has the matrix-induced bone formation which was suggested by Urist in 1965. Many authors assisted that demineralized bone powder induces phenotypic conversion of mesenchymal cells into osteoblasts, with high-density bone formation. The process of inducing differentiated cells becomes osteogenic properties. The purpose of this study was to evaluate the osteoinductive capacity of allogenic freeze-dried demineralized bone block (FDD, $7{\times}7mm$) and to compare FDD with the same sue of deep-frozen allogenic bone(DF), fresh autogenous bone (A) after implantation. The histological and ultrastructural features of tissue responses were examined after 1, 2, 4, 6, 8 weeks implantation of each experimental groups in the operative site of the New Zealand white rabbits. The results were as follows : 1. Inflammatory cell infiltration generally has appeared at 1 week, but reduced at 4 weeks in each group, but most severe in DF group. 2. Osteoblastic activity has increased for 4 weeks, but decreased at 6 weeks in each group and there was no significant difference among experimental groups. 3. New bone formation has begun at 1week, least activations in A groups, and showed the revesal line of bone formation among each group at 6 to 8 weeks. 4. Bone resorption has appeared at 1 week, but disappeared at 4 weeks in both A and DF groups, but more severe in DF than A groups. 5. In ultrastructural changs, the DF group have showed the most remarkable osteoclastic activities among experimental groups. 6. Osteoid or tangled collagen fibrils near the implanted sites were replaced by more mature, lamellated bony trabeculae during bone remodeling. There was little difference among each experimental groups. 7. During the convertion osteoblasts to osteocytes which embedded within the bone matrix, there was organ-less-poor cytoplasm, increased nuclear chromatin, abundant rough endothelial reticulum (RER) in each groups. From the above the findings, the DF group shored more bone resorption and foreign body reaction than FDD and A groups, and FDD group showed more new bone formation or osteoblastic activity than DF and A groups in early stage. There was no significant difference of cellular activities among the FDD DF, and A groups according to the time.

가토 대퇴골골에 중첩이식된 단순냉동 및 냉동 건조 동종골의 치유과정에 관한 실험적 연구

정호용(Ho Yong Chung),이동근(Dong Keun Lee),엄인웅(In Woong Um),신기영(Ki Young Shin),우승철(Seung Chul Woo) 대한구강악안면외과학회 1994 대한구강악안면외과학회지 Vol.20 No.2

The use of autologous bone grafts for ridge augmentation is widely accepted. However, the development of other bone graft substitutes reduced the importance of the site from which grafting material is taken. Allogeneic bone grafts are a potential alternative. The variables that may influence the results of allogeneic bone grafts, are whether the grafts are cortical or cancellous, chips or blocks, undecalcified or fully decalcified, deep freeting or freeze-dried, etc.. In an experimental study of the femurs of rabbits on which the onlay undecalcified cortical bone grafts were performed, we observed the histologic differences between deep forzen and freeze-dried cortical allogeneic bone grafts on the healing and repair processes. These results can be compared to those from autologous bone grafts. The from autologous bone were: 1. The inflammatory reaction with macrophages and lymphocytes were observed in the first week, but disappeared before 4 weeks. The inflammatory reaction was more severe in the deep frozen group. 2. In the freeze-dried group, the bony union was earlier than the deep frozen group. 3. The osteoblastic activity of grafts increased for the first 6 weeks then decreased slightly by 8 weeks. Osteoblasts were more active in the autologous and freeze-dried groups. 4. New bone formation was slower in the deep frozen group in the first two weeks, but after two weeks there were no distinguishable differences between the groups. 5. The bone resorptions around the grafts continued far 6 weeks after the operation. The bone resorptions were greater in the deep frozen group. 6. More capillary proliferations in the intersurfaces and grafts were observed in the autologous and freeze-dried group. In the results as written above, the freeze-dried group was superior to deep frozen group in the healing process, but in fact, there were considered that the undecalcified, freeze-dried or deep frozen allogeneic bones could be used in the onlay graft for augmentation of jaws.

冷凍 乾燥 및 脫灰 骨의 組織 反應에 關한 實驗的 硏究

In Woong Um(嚴仁雄),Byong Il Min(閔丙一) 대한구강악안면외과학회 1993 대한구강악안면외과학회지 Vol.19 No.1

To evaluate the osteoinductive capacity of the bank bone procured from the oral and maxillofacial surgery patients, the histological and ultrastructural features of tissue response were studied after implantation of decalcified and undecalcified human bone which were partially decalcified in 0.5N HCl, approximately 1㎣ size with freeze-drying. The recipient site was chosen to a calvarial bone of the New Zealand white rabbit. Demineralized and undemineralized bone matrix showed different tissue response around the grafted matrix. After implantation of the demineralized bone matrix, there were no evidence of foreign body reaction and resorption, but were newly synthesized woven bone composed of irregular collagen fibers in early stage compared with the undemineralized bone matrix which showed osteoclast-like giant cells and reversal lines. At later stage of demineralized bone matrix, woven bone and scattered capillary formation have shown with a hematopoietic marrow and compact bone with the evidence of remodelling. Activities of collagen synthesis were not seen in typical osteoblasts but in fibroblastic or mesenchymal cells of the recipient sites. There were no significant differences of cellular activities between the demineralized and undemineralized bone groups in later stage.

동종골의 탈회에 사용되는 HCL의 S-mutans에 대한 항균 효과

엄인웅(In Woong Um),이동근(Dong Kuen Lee),김현진(Hyun Jin Kim) 대한구강악안면외과학회 1992 대한구강악안면외과학회지 Vol.18 No.2

To determine the bactericidal effect of the HCL, used in demineralization procedure in banked allogeneic bone, we use the modified disk diffusion method using in antibiotic sensitivity tests with S-mutans. Various concentrations of HCL were used to evaluate the pH effect of the HCL on S-mutans from 0.01N to 2.0N. The results obtained were as follows: 1. Minimal bactericidal effects were showed in the 0.5N (pH 2.33). 2. Incresed concentration showed more bactericidal effect on the platting disk. 3. The bactericidal effect showed might be from the lowered pH effect. 4. The vacuum dried disk showed similar bactericidal effects to the HCL exposed disk. We can suppose from the above results that the demineralization procedure with 0.5N HCL may help the sterilization procedure of the allogeneic bone graffs preparation. Freeze-drying procedure after demineralization did not alter the bactericidal effects of HCL. But further study will be needed to evaluate the bactericidal effect of the HCL on non-specific pathogens in oral and maxillofacial regions and the effect on certain virus may be beyond the scope of this experiment.

동맥혈액가스분석을 이용한 구강악안면외과 환자의 술후 저산소증 발생빈도에 관한 임상적 연구

강명수(Myung soo Kang),민승기(Seung Ki Min),엄인웅(In Woong Um),이동근(Dong Kuen Lee) 대한구강악안면외과학회 1992 대한구강악안면외과학회지 Vol.18 No.2

In this study, oxygen saturation was obtained by ABGA and continuous monitoring for 12 hours at the postanesthesia room in 42 patients, who received operation under general anesthesia by department of oral and maxillofacial surgery. The data including age, sex, duration of operation, type of operation, intermaxillary fixation and smoking habit were as follows. 1. the incidence of postoperative hypoxemia in the patient of oral & maxillofacial surgery were observed 13 patients (30.9%) of 42 patients. The hypoxemia occured at immediate postoperation (26.2%), postoperative 6hrs (7%), postoperative 12hrs (2.3%). 2. In age distribution, seventh decade was the highest age group to occur of hypoxemia and increased the incidence rate of hypoxemia follow to aging. 3. In sex distribution, incidence of hypoxemia was more common tendency in female than male. 4. According to operation time, the more high incidence of hypoxemia in a long time operation than in a short time operation. 5. According to type operation, surgery to induced severe injury of surrounding tissue such as cancer surgery was more common incidence of post operative hypoxemia. 6. The ratio of hypoxemia was developed in IMF and non IMF patients in 38%, 27% respectively.

임플란트 식립시 동종뼈 막의 임상적 활용

이은영,김경원,엄인웅,Lee, Eun-Young,Kim, Kyoung-Won,Um, In-Woong 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.3

The biologic principle of guided bone regeneration(GBR) has been studied extensively in hopes of regenerating alveolar bone. Various materials have been utilized as regenerative membranes and grafting materials in implant surgery. To improve the ability of membranes, several types of membrane have been developed. Various materials have been utilized as regenerative membranes; however, all materials have disadvantages, and the ideal membrane material is yet to be identified. In these cases, a homologous gelatinized bone matrix(GBM) were used as a regenerative material in conjunction with the placement of endosseous root implants. 22 patients participated in this study, and 42 implants were inserted. The result of 1st operative surgery was uneventful, inflammatory reaction and dehiscences were not observed except for only one case. After the final protheses, all implants were functioning successfully. The major advantages in the use of GBMs for guided bone regeneration are of very wide application such as membrane and graft material, and that a second procedure to remove the material is not necessary, and the GBMs are accepted by the surrounding tissues without complications. The purpose of this study was to observe the usefulness of GBMs in dental implant surgery.

가토 하악 과두 동종이식시 냉동보존제가 과두 연골에 미치는 영향에 관한 실험적 연구

김귀희(Kui Hee Kim),이동근(Dong Keun Lee),엄인웅(In Woong Um),김영조(Young Jo Kim),김은철(Eun Cheol Kim) 대한구강악안면외과학회 1994 대한구강악안면외과학회지 Vol.20 No.2

Loss of function in the Temporomandibular joint (TMJ) arising from congenital disorders, tumors, trauma, and various arthritides has long been a challenge to the reconstructive surgeon. Although reconstruction to date has been performed with various prosthetic devices or autogenous costochondral grafts, these procedures have the potential of complication and morbidity from the harvest procedures. There have been many animal transplant studies of specific cryogenically preserved allografts joint and several extensive clinical studies of human joints transplantation in the international orthopedic literature. However, the use of preserved allogeneic mandibular condyles (bone and cartilaginous articular surface) for reconstruction of the TMJ has not been described. Various methods of preservation of allogeneic condyle have been introduced to enhance the storage and sterility, and to remove antigenecity. Current methods of articular cartilage chondrocytes preservation include refrigeration (-4℃), deep-freezing (-70℃), and cryopreservation. An experimental procedure was designed to determine the effects of cryopreservative agents with deep frozen and freeze-dried allogeneic condylar graft by pretreatment with DMSO (Dimethyl sulphoxide) and Glycerol. The aim of this study was to compare the microscopic differences between deep frozen and freeze dried allogeneic condyle grafts pretreated with DMSO and Glycerol, and to produce a satisfactory method of chondrocytes preservation, as a preliminary in preparation for widespread application in Wonkwang University bone banking procedures. Comparison were made among four types of Temporomandibular joint transplants in rabbits : 1) Deep-frozen with DMSO, 2) Freeze-dried with DMSO, 3) Deep-Frozen with Glycerol, and 4) Freeze-dried with Glycerol. The results of the study were; 1. Inflammatory cell infiltration of articular surface was most severe in the Freeze-dried with Glycerol group and was least severe in the Deep-frozen with DMSO groups. 2. Viability of bone below the subchondral zone showed few differences among four experimental groups. But the Glycerol groups were less viable than the DMSO groups. 3. Degenerative change of condylar cartilage appeared after 1 week and disappeared after 6 weeks. The most intense change was in the Freeze-dried with Glycerol group. 4. Maturing of condylar cartilage began at 2 weeks and there were no differences between Freeze-dried and Deep-frozen groups. But DMSO groups appeared more than Glycerol groups. 5. There were no differences between the groups in the degree of endochondral ossification after 2 weeks. This data hold out great promise for the future development of a frozen-joint bank. Our studies showed that Deep-frozen cryopreservation pretreated with DMSO can offer a more preservation method of the osteochondral allografts.

발치 후 즉시 임플란트 식립시 이식된 hBMP-I의 조직학적 고찰

이은영(Eun-Young Lee_,김경원(Kyoung-Won Kim),최희원(Hee-Won Choi),엄인웅(In-Woong Um),정호용(Ho-Yong Chung) 대한구강악안면외과학회 2004 대한구강악안면외과학회지 Vol.30 No.4

A low molecular weight component named bone morphogenetic protein(BMP) chemically isolated from the organic matrix of bone, induce postfetal connective tissue cells surrounding small blood vessels to differentiate into cartilage and bone. The end product of BMP is a spherical ossicle of lamella bone filled with red bone marrow for the functional loading. This is a important point that the graft material is embedded the defect site during the implant surgery. Because present knowledge of the relationship between BMP and bone regeneration arises mainly from studies of induced bone formation in heterotopic sites, it would be helpful to determine whether BMP plays any part in the process of bone healing. The BMPs have been shown to play crucial roles in normal skeletal development as well as bone healing and are able to activate transcription of genes involved in cellular migration, proliferation, and differentiation. The delivery of BMP on matrices has been efficacious in the treatment of defect bone in implant surgery. The purpose of the histologic study was to evaluate the effect of DLB(demineralized lyophilized bone) coated with purified human BMP(hBMP-I) in immediate implant surgery with bony defect to obtain the functional structure of implant asap. The ability of a graft of hBMP-I to accelerate bony defect repair provides a rationale for its use in immediate implant surgery that have large bone defect in edentulous area.