Bisphosphonate-associated osteonecrosis (BRONJ) is an adverse event associated with bisphosphonate drug treatment. An 81-year-old female has been taking bisphosphonates orally once a month for three years complained of pain in the left mandibular molar area after implant placement. Tenderness and fistula were formed. Extensive osteosclerosis in posterior area of the left mandible and bone resorption around distal side of #37i were shown on radiographs. She was given oral antibiotics for 6 weeks and bone resorption was improved. A 70-year-old male had a history of intravenous injection of bisphosphonates for blood cancer complained of #46i implant mobility. There was buccal fistula on #45 site. Radiographically, severe bone resorption and extensive osteosclerosis were shown. He was treated with removal of implant and inflammatory tissue. Patients who have taken bisphosphonates may develop BRONJ after tooth extraction or implant placement and are needed to meticulous plaque control for preventing BRONJ.

본 연구는 MRI 검사 시 임플란트 자석 틀니의 자기 유지력 변화와 구조물 간의 금속 인공물을 분석하였다. 연구 방법으론 자기 유지력 변화의 평가를 위해 자석 구조체를 고속스핀에코 시퀀스로 검사하며 자력을 30분 간격으로 최대 90분까지 측정하였고, 금속 인공물 평가를 위해 자석 구조체와 임플란트 팬텀의 축상면 이미지에서 금속 인공물 크기를 측정하였다. 자석 구조체의 자력은 1.5T 검사에선 1.11 ∼ 5.29G의 차이를, 3.0T 검사에선 0.78 ∼ 2.97G의 차이를 보였으나 검사 시간과는 유의미한 상관관계를 보이지 않았다(p>0.05). 금속 인공물의 크기는 1.5T 장비에서 임플란트 팬텀은 15.02mm ∼ 21.97mm, 자석 구조체 팬텀은 87.86mm ∼ 102.54mm, 3.0T 장비에서 임플란트 팬텀은 19.15mm ∼ 25.81mm, 자석 구조체 팬텀은 94.18mm ∼ 125.56mm로 나타났다. 이로 인해 자석 구조체의 자력은 MRI 검사 시간에 따른 유의미 한 변화를 보이지 않으며, 자력을 가진 구조물이 일반적인 구조물보다 더 큰 금속 인공물을 보인다는 것을 알 수 있었다. 따라서 MRI 검사는 임플란트 자석 틀니의 자기 유지력에 영향을 미치지 않으며, 금속 인공물을 줄이기 위해 검사 전 자력을 가지는 삽입물은 제거되어야 한다.

The purpose of this study was to established the manufacturing process technology of an ultra-thin, multi-functional micro-implant(MFMI) that was optimized in fractured small animals, not mainly large animals. The test results showed a reckon type plate was more suitable than a straight plate because of excellent deformation energy. It was found that the structure of the hole and the screw could be fastened in all directions with the limited contact design of the threaded part cut off in 4 directions. It was possible to manufacture a reckon type plate reflecting the neck part of 2.0 mm width. It was confirmed that the plate hole could be stably and easily deformed and fastened without damaging the hole through the round type bending device.

Animal orthopedic implants are an area that has recently been come into the light due to growing number of single-person households and increasing of interest in pets. The purpose of this study was to investigate a method to design and manufacture a bushing in a desired direction and angle with the environment of use, while the bone joint plate could be stably deformed during animal fracture surgery. It was found that the bone joint plate was capable of deformation in all directions and was designed to be transformed to the desired angle without degrading the basic properties of bending strength. Also, it was found that the bushing-type bone joint plate could be controlled in multiple directions and angle at omni-directional movements(0°-360°) and 0°-10° moving forward, backward and side to side.

Recently, a number of recent reports have reported cases of bone marrow defect (BMD) in the mandible. Among the diseases seen by BMD in radiographs, focal osteoporotic bone marrow defect(FOBMD) is asymptomatic, which is discovered incidentally and localized radiolucency. Because it varies in size, shape, trabeculae and border definition, it needs to biopsy to differential diagnose other intraosseous lesions that show radiological bone marrow defects. This cases report discusses the pre-operation considerations in patients planning to implant the mandible and suspected to have FOBMD in radiographs. The following 4 cases in Dental Hospital of Wonkwang University were taken in panoramic and Cone beam computed tomography(CBCT). In all cases, there were radiolucent lesion diagnosed with FOBMD under radiologic differential diagnosis. In three of cases the implant were placed without treatment plan change and one case changed the treatment plan with removable partial denture. BMD is anatomical state that can affect primary stability of implant fixture. During implant placement, it can lead to unexpected results that fixture is fallen into BMD and the nerve may be damaged after implant fixture removal to cause hyperesthesia. Preoperative diagnosis of these lesions by differential diagnosis with panoramic and CBCT can prevent the complications by changing the treatment plan or paying attention to the manipulation during surgery.

Nicotine of tobacco component has a controversial impact in the clinical outcome of dental implants. Although numerous nicotine effects on bone healing around implants have been presented, it is rarely reported in vitro study about normal human osteoblast(NHost) from oral and maxillofacial area at the surface of implants. The purpose of the present study was to evaluate the effect of nicotine on the proliferation and differentiation response of NHost to plasmatic and salivary levels of nicotine reported in smokers at the surface of screw-type plasma-sprayed titanium implants. NHosts were seeded on the surface of titanium implants and cultured for 21 days in α-MEM supplemented with 10% FBS, 50mg/ml ascorbic acid, 5mM β-glycerophosphate and 100nM dexamethasone. Seeded implants were exposed to various nicotine concentration(0.05-0.5mg/ml) from 1 to 21 days, and characterized for cell morphology, proliferation, differentiation, alkaline phosphatase(ALP) activity and ionized calcium concentration(Cai) of medium. Continuous exposure to higher nicotine concentration(above 0.3mg/ml) induced a dose- and time-dependent vacuolation of the cytoplasm, and a tendency to detach from the implant surface. 0.05mg/ml(lower nicotine concentration) did not cause significant effects in the cell proliferation and ALP activity. 0.1-0.2mg/ml caused evident dose-dependent effects in increased cell proliferation, ALP activity and earlier onset of matrix mineralization at levels up to 0.2mg/ml, while a dose-dependent inhibitory effect at 0.3-0.5mg/ml. Cai concentration of control group was decreased at 14 days. Increased Cai concentration at 0.1-0.2mg/ml, decreased Cai concentration at 0.3mg/ml and no change at 0.5mg/ml during the culture period were seen. It suggested that nicotine concentration could paly an role in modulating NHost activity as a contributing factor associated with proliferation and differentiation of NHost at the surface of implants.

With the multiple practices of bone graft using different artificial bone regenerative substitutes, the bone graft procedures have been widely performed to increase the bony stabilization of dental implant. Xenogenic bone graft materials have been well developed because of their good biocompatibility and abundant source of bone materials. The present study demonstrated the histological findings from excellent bony remodeling in xenogenic bone graft biopsies compared to those findings in autogenous bone graft. For the graft bone biopsies which were usually done in 5-9 months after graft bone insertion, five types of histological grades including excellent, favorable, partial, degenerative, and poor bony remodeling could be assessed to give prognostic information for dental implant. However, recently the xenograft bone materials have been much improved and produced strong osteogenic effect. Among 239 cases of trephine bur-supported core bone biopsy the excellent bony remodeling was found in 20 cases (13.1%) out of 153 xenogenic bone grafts and in 13 cases (43.3%) out of 30 autogenous bone grafts. They produced abundant new bones on the surface of the graft bones in 5–9 months, and the graft bones were partly resorbed and also surrounded by the repetitive deposition of new bone. The osteophytic new bones showed strong birefringence under polarizing microscope, and were gradually elongated and anastomosed with each other to form trabecular bony networks which became proper stress-baring structures for dental implant. Their marrow stromal tissues were composed of loose connective tissue which was well vascularized but rarely infiltrated with inflammatory cells. The present study compared the histological features of excellent bony remodeling between xenogenic and autogenous bone grafts. Although the ratio of excellent bony remodeling in xenogenic bone graft was still low, 13.1%, the recent advance of xenogeic bone products was remarkable in biological aspect and almost comparable to the autogenous bones. Therefore, it was suggested that the xenogenic bone graft will be applicable to the bone regeneration procedures for dental implant with beneficial output in the near future.

The trauma of incisive canal associated dental implant placement in the anterior maxilla can cause the nasopalatine duct cyst. It is difficult to identify the nasopalatine duct cyst or the location of the incisive canal, only using periapical radiograph or panorama radiograph. So it is necessary to take computed tomography scan for an analysis on the relation between the implant and the incisive canal. This case report present the patient had the nasopalatine duct cyst following the placement of dental implant in the anterior maxilla, and was undergone implant removal and cyst enucleation with bone graft.

A 57 years old female received xenogenic bone graft for the extraction socket augmentation of right maxillary molars and for the sinus floor elevation six months ago. The bone graft sites were healed uneventfully and showed marked radiopacity in the postoperative X-ray view. Before dental implant insertion the bone biopsy was made using trephine bur and examined pathologically. The graft bones showed minimum new bone deposition with dysplastic epithelium. The epithelium was proliferative on the surface of graft bones forming epithelial strands and nests, similar to the odontogenic epithelium. The immunohistochemical study was performed using different antisera of odontogenic markers, growth factors, oncogenes, etc. The epithelial cells were strongly positive for pan-keratins, EGF, pAKT, and HSP-70, consistently positive for PCNA, p53, EGFR, 14-3-3, and survivin, slightly positive for ameloblastin, but rarely positive for amelogenin. Particularly the matrix of graft bone was slightly positive for EGF. Taken together, it is presumed that the abnormal epithelium on the graft bones was derived from odontogenic epithelial elements, Malassez epithelial rests, distributed at the periodontal tissue of maxillary molars, and that they might undergo dysplastic proliferation affected by the release of growth factors and osteogenic proteins from the graft bones. It is also suggested that the graft bone substitutes inserted for the dental implant possibly have a potential to induce the proliferation of odontogenic epithelial rests leading to the pathogenesis of odontogenic cysts and tumors.

목 적 : 3.0T 자기 공명 영상에서 강자성 임플란트로 인해 발생한 자화감수성 인공음영에 대한 시퀀스별 WARP기법의 적정한 VAT(view angle tilting)값을 알아보았다. 대상 및 방법 : 자화감수성 인공음영(susceptibility artifact image)이 head용 워터 팬텀영상의 왜곡정도를 평가하기 위하여 head용 워터 팬텀에 강자성 임플란트(ferromagnetic implant)인 금속 와이어를 부착하여 영상을 획득하였다. 진행하였고(VAT(view angle tilting)) Warp를 사용하였다. 사용된 장비는 3.0T MRI system(MAGNETOM Skyra, Siemens, Munich, Germany)이었으며 20ch head/neck coil을 사용하여 TSE T2, TSE T1, FLAIR, Turbo IR T1 시퀀스에 WARP를 적용하여 VAT를 0~100% 범위내에서 10%씩 변화하여 각각 24개의 axial 영상을 얻었다. TSE T2 영상변수는 TR/TE 4410ms/79ms, Matrix 512×291이었으며, TSE T1 영상변수는 TR/TE 693ms/10ms, Matrix 512×291이었으며, Turbo IR T1 영상변수는 TR/TE 2000ms/9.5ms, Matrix 384×307이었으며, FLAIR 영상변수는 TR/TE 9000ms/96ms, Matrix 384×180이었다. 시퀀스별로 slice thickness 4mm, slice gap 0.4mm, NEX 1, bandwidth는 500Hz 였다. 정량평가는 팬텀영상의 대부분을 ROI로 설정 하여 표준편차를 구하였다. 정성 평가는 팬텀 영상 내에 dark area크기, image blurring 정도를 5점 척도로 하여 영상의 변화가 없는 경우 1점, 영상의 질이 약간 우수한 경우 2점, 보통 3점, 우수한 경우 4점, 매우 우수한 경우 5점으로 숙련된 방사선사 3명이 관찰 후 평가하였다. 결 과 : 정량분석으로 TSE T2와 TSE T1의 표준편차(SD)는 VAT 10%에서 VAT 적용전보다 많은 감소를 보였으며, VAT가 증가 할수록 감소하는 경향을 나타냈다. 그러나 IR 계열의 FLAIR와 Turbo IR T1은 WARP의 적용에 따른 영상차이가 없었다. 변동계수는 모든 시퀀스에서 30%이하였다. 또한 VAT 변화에 따라 영상의 위치변화도 나타났다. 정성분석으로 TSE T2는 VAT가 30~60%일 때 우수한 것으로 나타났고, TSE T1은 VAT가 10~70%일 때 우수한 것으로 나타났다. FLAIR와 Turbo IR T1은 WARP사용에 따른 영상의 변화가 없었다 결 론 : WARP는 TSE T2와 TSE T1의 자화감수성 인공음영을 줄이는데는 매우 효과적인 영상기법이었다. 그러나 WARP는 VAT를 증가시키면 image blurring도 증가함으로 VAT값을 최소화해서 사용 되어져야 할 것으로 사료된다.

Primary oral squamous cell carcinoma (OSCC) associated with dental osseointegrated implants is very rare. We experienced two patients who had received dental implant surgery before they were diagnosed with OSCC. We report these cases to emphasize the importance of differential diagnosis of malignant lesions associated with dental implants. Additionally, we also suggest that bone graft materials around implants can serve as a potential inducer of invasiveness in cancer cells.

Development of squamous cell carcinoma around dental implants is an uncommon clinical manifestation with only a few cases described in the literature. Recently, we observed primary squamous cell carcinoma that developed from leukoplakia around dental implants. We report this case to emphasize the importance of careful oral examination, for implant surgery has to be preceded by thorough evaluation of oral mucosal conditions.

The purpose of this study is evaluating about the survival rate and causes of failed implants. In this study, the 371 implants was evaluated for the survival rate and failing factors of implant. The survival rate was 96.5%. The failure rate was 3.5%. The average life time of implants was 50 months. The average age of patients treated was 49 years old. In total 371 cases, 13 cases failed implants were removed. The causes of failing implants were poor oral hygiene, excessive occlusal loading, smoking, and etc. The leading causes of failed implants were improper oral hygiene and excessive occlusal loading. In conclusion, I suggest that the periodic plaque control and occlusal force management can improve the survival rate of implants.

Dental implants were used for reconstruction of oromaxillofacial defects and they were widely used in dental and medical fields. The implant materials are various , including titanium and ceramics such as zirconium. The property of implant materials have biocompatibility and mechanical strength. Titanium has direct bone anchorage without any other tissues between implant's interface. many researcher's had studied for raising the osseointegration success rate through various method. It was reported over 95% success ratio. many researcher's study the enhancing the speed of bone remodelling and osseointegration. Low Level Laser Therapy is one of the method to accelerlate the speed of bone remodelling and osseointegration. Thus it raise initial stability. The purpose of this study was to evaluate the effect of diode laser irradiation for ossoeintegration in implant interface and between the implants threads. 24 New Zealand white rabbits which were about 3Kg, used for experiment. 2 implant's were implanted every rabbit's tibia. 2 weeks, 4 weeks, 8 weeks after implantation, tissue sample were removed from sacrificed rabbit's tibia. 8 rabbit's were sacrificed every 2, 4, 8 weeks and undecalcified sample were got from tissue sample. The undecalcified samples were investigated by optical microscope. 2 weeks, 4 weeks, 8 weeks experimental groups which were irradiated low level laser therapy showed rapid bone remodelling than control groups. it showed many difference especially in initial stage. Low level laser irradiation increase the volume of new bone formation in implant interface . It was suggested that there were many influence in bone remodelling in early stage, because these were many differences between experimental and control groups. Low level laser irradiation were helpful for immediate loading implant

본 논문은 두 편으로 구성된 치과용 임플란트 구조설계에 대한 논문 중 두 번째 논문으로 첫 번째 논문에서 구조해석 비 교연구를 통하여 그 구조적 성능이 확인된 새로운 임플란트 구조모델에 대하여 시험 설계도면을 작성하여 완성하였으며, 이를 근거로 실제로 CNC 공작기계 등을 이용하여 임플란트를 가공․제작하고, 이를 평가함으로써 치과용 임플란트 구조 설계를 완성하였다. 설계도면 작업은 전용 Tool인 MDT를 이용하여 수행하였으며, 가공작업은 CNC 선반, 범용밀링머신, Wire EDM 등을 이용하여 수행하였다. 전자현미경을 이용하여 임플란트 표면의 가공 상태를 최종 평가 확인하였다. 평가 결과 매우 양호한 상태의 임플란트 시험제품을 설계 제작하였다.

본 논문은 두 편으로 구성된 치과용 임플란트 구조설계에 대한 논문 중 첫 번째 논문으로 먼저 치과용 임플란트의 종류 및 특징에 대하여 조사 분석을 수행하였다. 이를 통하여 현재 사용 중인 대표적인 치과용 임플란트들의 장단점들을 비교분 석하였다. 그 결과를 토대로 새로운 임플란트 구조모델을 제안하였다. 특히 제안된 새로운 구조형상의 임플란트에 대하여 기존의 대표적인 임플란트들과 유한요소해석 기법을 이용한 구조해석 비교연구를 수행하였다. 구조해석 비교연구를 수행한 결과 본 논문에서 제안한 치과용 임플란트의 구조적 성능의 우수성이 확인되었다. 본 연구에서 구조해석 비교연구를 수행한 치과용 임플란트 제품은 3i 임플란트 제품과 Sargon 임플란트 제품이다. 이들은 모두 수입 제품들인데 임플란트 종류 및 특 징 조사 결과 현재 임상으로 사용 중인 임플란트들은 대부분 골내식립형인데 이들도 그들 중 하나임을 알 수 있었다.

Peri-implantitis (PI) is bacteria-induced inflammatory condition which affects the alveolar bone and soft tissue around implants and may result in the loss of supporting bone. Attenuation of the P. gingivalis lipopolysaccharide (LPS)-induced inflammatory response can be a new therapeutic approach in the treatment of PI. This study was conducted to evaluate the anti-inflammatory effect of 635-nm light-emitting diode (LED) irradiation over MG63 osteoblast-like cell. Scratch was made on MG63 cells with or without LPS, then 635-nm irradiated. The expression of the cyclooxygenase-2 (COX-2) proteins was evaluated with western blot. The production of the prostaglandin E2 (PGE2) and expression of the receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) was measured with enzyme-linked immunoassay, and the cytokine profile was evaluated with the human inflammation antibody array. Wound closure effect presented in the cells treated with LPS was observed more significantly in the cells with 635-nm irradiation than the cells without irradiation. The 635-nm irradiaiton reduced LPS-induced expression of the COX-2 and production of the PGE2. Also, 635-nm irradiation affect the expression of RANKL, OPG, and proinflammatory cytokines. These results indicate that 635-nm irradiation could reduce the alveolar bone resorption induced by LPS stimulation through the inhibition of COX-2 expression and PGE2 production, the suppression of proinflammatory cytokine, and the modulation of RANKL/OPG balance in MG63 cells.