매복된 하악 제2대구치 맹출유도의 치험례

한수경,김정욱,이상훈,김종철,한세현,장기택 大韓小兒齒科學會 2004 大韓小兒齒科學會誌 Vol.31 No.1

정상적인 하악 성장에서, 하악 제1대구치 후방의 치배는 근심경사되어 있다. 보통 이러한 근심경사는 자발적으로 해소되나, 항상 그런 것만은 아니다. 첫 번째 증례는 14세 여아로서 가족이 모두 하악 제2대구치가 매복된 병력을 가지고 있었다. 환아 역시 양측 모두 매복되어 분절호선과 개방용 코일 스프링으로 치료하였다. 두 번째 증례는 14세 남아 환자로 Halterman 장치를 이용하여 매복된 하악 우측 제2대구치를 치료하였다. 세 번째 증례는 11세 남아로서 고정성 교정 치료 중, 하악 양측 제2대구치가 매복되었다. 분절호선과 개방용 코일 스프링 구리선으로 치료하였다. In the normal growth and development of the mandible, the molar tooth buds distal to the first permanent molar have a mesial inclination. This inclination is usually self-correcting, but, unfortunately this self-correction does not always occur. The first case is about, 14-year old female patient with familial history of lower second molar impaction. Hew lower second molars were both impacted, and she was treated with sectional wires and open-coil springs. The second case, 14-year-old male, we treated his impacted #47 with Halterman appliance. The third case, 11-year-old male, his both mandibular second molars were impacted during full-fixed orthodontic treatment. They were treated with brass wire sectional wire and open coil spring.

불소를 포함시킨 가철성 교정장치용 Resin의 불소 방출과 굴곡강도에 관한 연구

한세현,손동수,장기택,김종철,이상훈 大韓小兒齒科學會 1997 大韓小兒齒科學會誌 Vol.24 No.2

For the purpose of investigating the continuous fluoride releasing from acrylic resin using removable appliances by incorporating fluoride into polymethylmethacrylate during the construction of the appliances, two kinds of fluoride were blended with acrylic powder and devided into five groups as follows. Group 1: no fluoride (control) Group 2: NaF 5 wt% Group 3: NaF 10 wt% Group 4: CaF₂ 5 wt% Group 5: CaF₂10 wt% Resin specimens were tested in vitro for fluoride release with fluoride electrode and flexural strength with Instron. The results were as follows; 1. After 24 hrs, released fluoride concentration(ppm) was the most in group 3(126.5±14.15) then, next, group 2(49.5±4.92), group 5(2.67±1.08), group 4(0.81±0.30),group 1(0.03±0.01) in order, but after 28 days, group 3(3.37± 0.31), group 5(1.25±0.25), group 4(0.74±0.19), group 2(0.68±0.07), group 1(0.03±0.01). 2. Fluoride releasing of NaF gruops were faster and more amount than CaF₂groups initially but decreased significantly, later. 3. Flexural strength(㎏/㎠ ) was the biggest in group 1(602.90±69.32), and then group 4(568.98±20.16), group 5(556.19±5.26), group 2(536.12±30.35), group 3(508.44±26.16) in order, the difference between control group and NaF GROUPS were statistically significant(p<0.05).

아동의 부착치은 폭경에 대한 연구

한세현,이상훈,김정욱,김종철,유인아 大韓小兒齒科學會 2000 大韓小兒齒科學會誌 Vol.27 No.1

각화치은, 부착치은의 폭경, 치은열구의 깊이에 대해 성인에서는 많은 연구가 있었으나 아동에서의 연구는 드물었기 때문에, 유치열기, 혼합치열기 및 영구치열기의 모든 치아에 대하여 아동의 협측 각화치은 및 부착치은의 폭경과 치은 열구 깊이에 대한 정상치을 구하고, 악골의 발육 및 치아의 맹출과의 관련성를 고찰하며, 점막치은문제의 발현빈도를 조사하고자 하였다. 결론은 다음과 같다. 1. 유치열의 부착치은 폭경은 상악 유측절치 및 유견치에서 각각 3.50mm, 3.55mm로 최대값은, 하악 제1유구치에서 1.35mm로 최소값은 나타내었다. 영구치열의 경우에는 상악 측절치에서 3.00mm로 최대값을, 하악 제1소구치에서 0.55mm로 최소값은 나타내었다. 상하악 동명치아 비교시 상악 치아가 하악 치아보다 더 큰 값을 나타내었고, 남녀간 차이에는 특별한 규칙이 발견되지는 않았다. 2. 연령증가에 따른 부착치은 폭경의 변화 양상은 유치열의 경우 유견치, 제1유구치, 제2유구치에서 6세부터 증가하였다. 영구치의 경우 남자에서는 하악 중절치와 상악 제1대구치의 측정값만이 연령에 따른 층가 추세를 나타냈으나(P<0.05), 여자에서는 상하악 중절치 측절치 및 상악 제1대구치에서 통계적으로 유의성 있는 각화치은 폭경의 증가 추세를 관찰 할 수 있었다(P<0.05). 3. 치아교대기에서 부착치은 폭경의 차이는 남자 상악 중절치를 제외한 모든 경우에 유치에서의 측정값이 영구치에서의 측정값보다 큰 것으로 나타났다(P<0.05). 4. 6세부터 12세까지는 각화치은의 폭경과 치은열구의 깊이는 대부분 유치 초기값보다 그 계승영구치 최종값이 더 높은 값을 나타냈으나(P<0.05), 부착치은의 폭경에서는 유치 초기와 그 계승영구치 최종값 사이에 통계적으로 유의성 있는 차이가 나타나지 않았다. 5. 점막치은 문제 발현 빈도는 남녀에 상관없이 유치열은 상하악 제1유규치가, 영구치열은 상하악 모두 제1소구치가 최고치를 나타냈으며 유치에서 보다 그 대응 계승영구치에서 그 빈도가 더욱 높게 나타났다. 연령증가에 따라 점막치은 문제의 발현 빈도는 유치열, 영구치열에서 모두 감소하였으나, 하악 제1유규치, 하악 영구견치, 제1. 제2소구치의 경우 연령 의 증가와 상관없이 비슷하게 유지되거나 증가하는 경향을 보였다. The aim of this study is (1) to establish the baseline information concerning the width of keratinized gingival, depth of gingival sulcus and width of attached gingiva on the buccal surface of the teeth : and (2) to determine the relationship between the above values and tooth eruption: and (3) to estimate the frequency of mucogingival problems. The results were as follows: 1. The mean width of attached gingiva of the children aged 6-12 proved to be wider in the maxilla than in the mandible. Of the primary teeth, the widest width was found in the areas of maxillary primary lateral incisors and maxillary primary canines (3.50mm and 3.55mm). The narrowest was noted in the area of mandibular first primary molars (1.34mm). In the permanent dentition, the greatest width was found in the areas of maxillary permanent lateral incisors (3.00mm). The narrowest was noted in the area of mandibular first premolars (0.55mm). 2. In the primary dentition, the width of attached gingiva of primary canines and first and second primary molars became wider from the age of six as the age increased. In the permanent dentition of the boys, only mandibular central incisors and maxillary first molars showed the tendency towards increase in the width of attached gingiba with increasing age. In the permanent dentition of girls, central and lateral incisors of both jaws and maxillary first molars showed statistically significant increase in the width of attached gingiva with increasing age (p<0.05). 3. At the age of tooth change, the attachcd gingiva of primary teeth were almost wider than those of successive permanent teeth(p<0.05). 4. During the period of 6 to 12 years of age, the width of keratinized gingiva and the depth of gingival sulcus of permanent tooth at the age of twelve were larger than those of primary tooth at the of six (p<0.05). 5. The maximum in the frequency of mucogingival problems was found in the areas of upper and lower first primary molars of primary dentition, and in the upper and lower first premolars of permanent dentition regardless of sex. The frequency was higher in primary teeth than in the corresponding successive permanent teeth. These teeth showed tendency towards increase in mucogingival problems with age.

자해로 인한 구강내 손상의 치과적조절 : 증례 보고

이상익,김영재,이상훈,김종철,한세현,장기택 大韓小兒齒科學會 2005 大韓小兒齒科學會誌 Vol.32 No.2

자해 행위(self-injurious behavior)란 자살 의도 없이 자신의 신체 일부를 무의식적 혹은 고의로 손상시키는 것으로 정의한다. 이는 머리 및 몸 때리기, 피부 절단 혹은 손가락 깨물기 등의 형태로 나타나며, 눈, 성기 및 구강 내 자해 행위(self-inflicted oral mutilation)를 포함한다 자해 행위는 일반적으로 정신지체, 혼수상태, 정신과적 문제, 약물의 독성 혹은 성격장애를 지닌 환자에게서 일어날 수 있다 소아 환자에서 자해 행위는 보통 입술, 협점막 및 혀 깨물기 둥이 보고되고 있으며, 이러한 구강 내 자해 행위를 방지하기 위해 치과적 조절 방법들이 소개되고 있다. 본 증례에서는 구강 내 자해 소견을 보인 두 명의 소아 환자들에 대해, 각각 변형된 activator 형태의 가철성 장치, 후방으로 연장된 tongue-rake 장치 및 mouth guard 둥을 사용하여 양호한 치유과정을 보였기에 보고하는 바이다. Self-injurious behavior is defined as deliberated harm to one's own body without suicidal intent. It usually occurs as head banging or hitting, body hitting, skin cutting, or finger biting and includes ocular, genital, and self-inflicted oral mutilation. Self-injurious behavior can occur with mental retardation, coma, psychotic problem, poisoning, or character disorders. In pediatric patients, self-injurious behavior usually is reported to lip, cheek and tongue biting, and many kinds of dental management methods have been introduced to prevent self-injurious behavior patients from self biting. This report presents two self-inflicted oral mutilation patients who were all treated successfully with appliances such as modified activator without wire for retention, modified tongue-rake appliance and mouth guard.

유치열에서 scissors bite의 치료에 대한 증례보고 : CASE REPORT

문성권,김정욱,이상훈,한세현,장기택 大韓小兒齒科學會 2006 大韓小兒齒科學會誌 Vol.33 No.2

중심교합위 상태에서 편측이나 양측으로 구치부의 상악치아가 하악치아의 협측으로 위치한 경우를 scissors bite라고 한다. 이런 부정교합은 상악의 폭이 크거나 하악의 폭이 좁은 경우 발생한다. 이로 인해 턱의 성장이 방해를 받고 악궁간 부조화를 유발하며 적절한 저작을 할 수 없게 된다. 따라서 scissor bite는 즉시 차단 교정을 해야 하며 일반적으로 scissors bite의 치료는 고정성 또는 가철성 장치를 이용하여 하악을 확장한다. 이에 저자는 scissors bite를 보이는 환아의 4세의 두명의 남아에게 Schwarz 장치를 이용하여 양호한 결과를 얻어 scissors bite의 치료법 제시에 도움이 되고자 보고하는 바이다. A scissors bite in the posterior teeth occurs when the upper teeth are positioned totally or unilaterally buccal to the lower teeth in centric occlusion. This malocclusion can result from either excessive width of maxilla, deficient width mandible, or combination of both. The malocclusion can lead to hindered growth of jaws or to asymmetry between the jaws. Besides, the severe lingual inclination of the mandibular posterior teeth prevents adequate mastication. Thus, the scissors bite is in need of immediate interceptive orthodontic interbention. The common treatments of the scissors bite is to expand the mandibular arch: fixed or removable appliances. In our clinic, we made a seccess in treatment of the scissors bite using the Schwarz appliance. We treated the scissors bite using the lower Schwarz appliance for a mean observation period of 21 months. The subjects were 2 boys, aged 4 years.

응급실 전담의 상주가 심정지 환자의 소생에 미치는 영향

이한식,장문준,지훈상 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Major factors influencing the outcome after cardiopulmonary resuscitation(CPR) of cardiac arrest patients are the technique of CPR, response time and early defibrillation. Others like patient's characteristics and drugs used in resuscitation play minor role. To determine if the emergency physician affects the outcome of CPR, 318 consecutive victims with cardiac arrest who CPR were attempted in emergency room. The results were as follows : 1. The first group without emergency physician was 102 patients and the second group with emergency physician was 216 patients. 2. Among the factors affecting the outcome of CPR, patient's characteristics(sex, age, cause, injury severity score), prehospital factors(response time, use of ambulance, prehospital care) and the duration of CPR have no statistical differences between two groups. 3. Among the prehospital cardiac arrest patients and whom arrested in emergency room, use of defibrillation does not showed statistical differences between two groups. 4. The statistically significant factors(p<0.05) between two groups were initial defibrillation energy, defibrillation frequency and drugs like epinephrine, atropine and lidocaine. These results were similar among the prehospital, in-emergency room and the total cardiac arrest patients. 5. The outcome of CPR showed no significant differences on prehospital cardiac arrest patients analysis of all the data, there were no significant factors affecting the outcome of the CPR except the role of emergency physician. 6. Low survival rate(1.9%) on group Ⅱ, reflect the lacking of other important factors affecting the CPR other than emergency personnel. In conclusion, the involvement of full time emergency physician on CPR is an important factors in resuscitation of arrested patients in emergency room.

Electrosurgery를 이용한 치료증례

이상훈,이광수,한세현,윤재웅 大韓小兒齒科學會 1996 大韓小兒齒科學會誌 Vol.23 No.3

Electrosurgical technique have been used in dentistry as an aid to soft tissue management for nearly 60 years. However, it was not until the late 1960s that the principles of electrosurgery were understood and improved equipment became available. Electrosurgery is a surgical procedure performed on soft tissue utilizing controlled high frequency electrical(radio-frequency) currents in the range of 1,500,000 to 7,500,000 cyclesper second. The radio-frequency energy used in electrosurgery is able to cut and coagulate tissue because it focuses the energy at the small, active electrode. Advantages of electrosurgery for soft-tissue management during dental procedures include improved hemostasis, ease of tissue modification, improved visibility and so on, but adverse healing response-including necrosis of soft tissue and sequestration of alveolar bone-have been reported. The present report provides examples of treatment of soft tissue and pulp tissue of primary teeth by electrosurgery. The results are as follows ; 1. Electrosurgical techniques can be used for various procedures in pedodontics. 2. Electrosurgical procedures provide improved hemostasis and visibility in the operating field, which enable to remove, reshape, and contour soft tissues easily. 3. In pulpotomy technique, it was difficult to expect the variable pulpal response based on the degree of heat accumulation and the conditions of pulp tissues. Therefore, electrosurgical pulpotomy could not be considered as a method superior to formocresol pulpotomy. 4. A greater degree of dexterity and experiences in manipulation of the electrode is required compared with the conventional scalpel surgery.

외상 환자의 세포 면역학적 변화

지훈상,이한식,민진식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Thirty trauma patients admitted to our emergency center had lymphocyte phenotypic subsets characterized throughout hospital course. The immunosuppressive disease and CNS injury patients were exclude. There was no mortality in our studied cases. T-lymphocyte(CD-3), T helper(CD-4), T suppressor(CD-8) and B-lymphocyte(CD-19) were quantified by monoclonal antibodies and flowcytometric analysis. Results were analyzed on the day of admission 1st day, 2nd day, 4th day and 8th day among three groups: Injury severity score(ISS) below 15(n=10), 15-25(n=10), over 25(n=10). The patients were compared to 20 healthy controls. The immunologic depression was maximal on 2nd day and nearly recovered on 8th day. ISS over 25 group was most significantly depressed in all subset of T- lymphocyte, but ISS 15-25 group was slightly depressed less than ISS below 15 group. The B-lymphocyte was changed in similar pattern like as all subset of each ISS group, but the initial B-lymphocyte slightly increased comparing controls. Therefore the immunologic depression is affected by severity of trauma, and the severe and mild depression of immune system is included. The patterns of immune depression of T-lymphocyte and its subset were double peak in mild and severe trauma patients. The B-lymphocyte is stimulated in severe trauma patients during the initial stage of injury.

치과용 접착제를 사용한 접착 아말감의 결합 강도

감동훈,한세현,이상대 大韓小兒齒科學會 1999 大韓小兒齒科學會誌 Vol.26 No.2

아말감의 단점은 건전 치질 삭제와 미세 누출을 줄이기 위한 접착 아말감(bonded amalgam)에 사용되는 치과용 접착제의 접착 강도를 측정하고 파절면을 관찰하여 콤포지트 레진과 비교 평가하였다. 발거한 우전치의 순면을 직경 8mm의 원형으로 천공하여 얻은 부분을 순면이 바깥쪽으로 향하도록 아크릴릭 레진 블록에 매몰하여 상아질과 법랑질군을 각각 55개씩 준비하였다. 1군:Superbond C&B, 2군: Panavia 21, 3군: All-Bond 2, 4군: Fuji I Glass Ionomer Luting Cement, 5군: Scotchbond Multi-Purpose(RestorativeZ-100)의 5개 군으로 나누어 지름 6.3mm 깊이 1.5mm의 구멍이 뚫린 충전용 틀(mold)을 위치시키고 표면을 접착제로 처리한 후 아말감 충전을 하였다. 5군은 레진 충전후 40초간 광중합하였다. 각 시편은 아말감 충전 24시간 후 접착 강도 측정용 기구에 장착하고 만능 시험기에서 0.2mm/min의 cross-head 속도로 하중을 가하여 시편이 탈락할 때까지의 하중값(kg)을 측정하고, 파절면을 검사하여 다음과 같은 결론을 얻었다. 1. 상아질군에서 1, 2, 4군은 5군에 비하여 통계학적으로 유의성 있게 낮은 접착 강도를 보였다(P<0.05) 2. 법랑질군에서 4군은 5군에 비하여 통계학적으로 유의성 있게 낮은 접착 강도를 보였다.(P<0.05) 3. 2군에서는 상아질군에서 법랑질군에 비하여 통계학적으로 유의성 있게 낮은 접착 강도를 보였으나(P<0.05), 다른 접착제에서는 상아질군과 법랑질군에서의 접착 강도가 유의성 있는 차이를 보이지 않았다.(P>0.05) 4. Cohesive failure 는 1E군과 5D에서 관찰되었고, mixed failure는 1, 5군에서 관찰되었으며 2, 3, 4군에서는 adhesive failures만 관찰되었다. The purpose of this study was to measure and analyze the bond strength of bonded amalgam using dental adhesives and to compare this with light-curing composite resin. Sections 8mm in diameter were punched out from the labial surface of bovine anterior teeth. These were embedded in clear acrylic resin blocks with labial surface facing out. 55 specimens were made for enamel and dentin each. After dividing these into 5 groups. group 1: Superbond C&B, group 2: Panavia 21, group 3: All-Bond 2, group 4: Fuji I Glass Ionomer Luting Cement, group 5: Scotchbond Multi-Purpose(RestorativeZ-100), molds with holes of 6.3mm in diameter and 1.5mm in depth were placed over the specimens. The exposed tooth surfaces were treated with adhesives and the molds were filled with amalgam. In group 5, the mold was filled with composite resin and light-cured for 40 seconds. The author measured all specimens for bond strength 24 hours after amalgam filling and analyzed fracture surfaces. The following results were obtained. 1. Among the dentin groups, groups 1, 2 and 4 showed significantly lower bond strength compared with group 5(P<0.05). 2. Among the enamel groups, group 4 showed significantly lower bond strength compared with group 5(P<0.05). 3. In group 2, 2D showed significantly lower bond strength compared with group 2E(P<0.05). Other adhesives showed no such differences in bond strength between dentin and enamel(P>0.05). 3. Cohesive failure was observed in groups 1E and 5D, while mixed failure was seen in groups 1 and 5. Only adhesive failures were noted in groups 2, 3, 4.

Collagenase와 esterase가 상아질 접착강도와 nanoleakage에 미치는 영향

정영정,한세현,김종철,이상훈,김정욱,김영재,장기택 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.3

본 연구는 상아질 접착계면에서 collagenase와 esterase가 접착강도와 극미세누출에 미치는 영향을 살펴보기 위해 시행하였다. 발치된 치아의 교합면 상아질에 Single Bond 2(SB)와 Clearfil SE bond(SE)를 사용하여 상아질-레진 접착시편을 제작하고,시편을 인산완충용액(PBS)에 24시간(I),또는 PBS(II),collagenase 용액(III),esterase 용액(IV)에 4주간 보관 한 후 질산은 용액으로 염색하였다. 시편의 미세인장접착강도(μTBS)와 질산은 침투 면적을 측정하여 다음과 같은 결과를 얻었다. 1. SB군의 접착강도가 II∼IV군에서 SE군에 비해 낮은 값을 나타내었다(p<O.05). SB군은 II∼IV군의 접착강도가 I군에 비해 낮은 값을 보였으나(p<O.05),SE군의 접착강도는 I∼IV군간에 차이를 보이지 않았다(p>O.05). 2. SB군의 질산은 침투 면적이 SE군에 비해 높았으며(p<O.05),SB군과 SE군에서 질산은 침투 면적은 I ∼ IV군간에 차이를 보이지 않았다(p>O.05). 3. 접착강도와 질산은 침투 면적은 SE군의 I, II,III군에서 음의 상관관계를 보였다(p<O.05). The purpose of this study was to evaluate the effects of collagenase and esterase on dentin bond strength and nanoleakage. Resin composites were bonded to occlusal dentin of premolars with Single Bond 2(SB) and Clearfil SE Bond(SE). After the microtensile specimens were prepared and stored in PBS for 24 hours(I) or, PBS(II), collagenase(III), esterase(IV) solution for 4 weeks, the specimens were stained with silver nitrate solution. Microtensile bond strength(μTBS) and silver penetration area were measured and, the results were as follows: 1. For group II, III, and IV, the bond strengths of SB were lower than those of SB(p<0.05). The bond strengths of SB II, III, and IV were lower than that of SB I(p<0.05). There was no difference among the bond strengths of SE I ∼ IV groups(p>0.05). 2. Silver penetration areas of SB were higher than those of SE for all storage groups(p<0.05). In SB and SE groups, there was no significant difference of silver penetration area among I ∼ IV groups(p>0.05). 3. SE I, II, and III showed inverse relationship between the bond strengths and the silver penetration areas(p<0.05).