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.

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.

The objective of this study was to compare peri-implant bone formation among uncoated (UC), hydroxyapatite (HA), collagen plus hydroxyapatite (CH), and silk plus hydroxyapatite (SH) implant groups. Surface coating was applied using the aerosol deposition method. The morphology of MG63 cells on the implant surfaces were examined by scanning electron microscopy (SEM) after 8 h cultures on the each of implant groups. After 48 h cultures, MTT assay was performed to compare cell viabilities of each group. Subsequently, a total of 20 implants from each group were installed in the tibia of the rabbits. The animals were sacrificed at 6 weeks after the implant installation. The peri-implant bone formation was evaluated from the histological sections. In the SEM images, SH coating implant showed better attachment of MG63 cells to the implant surface than the other groups. It also showed adequate cell viabilities and peri-implant bone formations compared with other implant groups. From these in vitro and vivo experiments, SH coating can be a possible candidate for the surface treatment of dental implant. This study was supported by a grant from the Next-Generation BioGreen21 Program (Center for Nutraceutical & Pharmaceutical Materials no. PJ009013)

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.

Previous clinical studies have demonstrated that gabapentin, a drug that binds to the voltage-gated calcium channel α2δ1 subunit proteins, is effective in the management of neuropathic pain, but there is limited evidence that addresses the participation of glial cells in the antiallodynic effects of this drug. The present study investigated the participation of glial cells in the anti-nociceptive effects of gabapentin in rats with trigeminal neuropathic pain produced by mal-positioned dental implants. Under anesthesia, the left mandibular second molar was extracted and replaced by a miniature dental implant to induce injury to the inferior alveolar nerve. Mal-positioned dental implants significantly decreased the air-puff thresholds both ipsilateral and contralateral to the injury site. Gabapentin was administered intracisternally beginning on postoperative day (POD) 1 or on POD 7 for three days. Early or late treatment with 0.3, 3, or 30 μg of gabapentin produced significant anti-allodynic effect in the rats with mal-positioned dental implants. On POD 9, in the mal-positioned dental implants group, OX-42, a microglia marker, and GFAP, an astrocyte marker, were found to be up-regulated in the medullary dorsal horn, compared with the naive group. However, the intracisternal administration of gabapentin (30 μg) failed to reduce the number of activated microglia or astrocytes in the medullary dorsal horn. These findings suggest that gabapentin produces significant antinociceptive effects, which are not mediated by the inhibition of glial cell function in the medullary dorsal horn, in a rat model of trigeminal neuropathic pain.

In order to improve osseointegration of dental implants with bone we studied an implant with holes inside its body to deliver bioactive materials based on a proposed patent. Bioactive materials can be selectively applied through holes to a patient according to diagnosis and the integration progress. After the bioactive material is applied, bone can grow into the holes to increase implant bonding and also enhance surface integration. In order to improve the concept and study the effect of bioactive material injection on implant integration, design optimization and integration research were undertaken utilizing the finite element method. A 2-dimensional simulation study showed that when bone grew into the holes after the bioactive material was injected, stress vertically distributed in the upper part of the implant was relieved and mild stress appeared at the opening of the injection holes. This confirmed the effect of the bioactive material and the contribution of the injection holes, but the maximum stress increased ten-fold at the opening. In order to reduce the maximum stress, the size, location, and the number of holes were varied and the effects were studied. When bioactive materials formed an interface layer between the implant and the mandible and four holes were filled with cortical and cancellous bones all the stress concentrated opposite to the loading side without holes disappeared. The stresses at the four outlets of the holes was mildly elevated but the maximum stress value was ten-fold greater compared to the case without the bioactive material.

Brain MRI 검사에서는 영상을 얻기 위해 RF Pulse를 인체에 조사하게 되는데 이때 조사된 RF Pulse 에너지의 상당부분은 우리 몸에 그대로 흡수되게 되고 이로 인해 인체의 온도가 상승하게 되는데 노출정도에 따라 인체에 영향을 주게 된다. 그리고 같은 RF Pulse 에너지를 주었더라도 인체에 금속이 삽입되었다면 금속으로 인한 전자파 전도도가 증가하기 때문에 SAR가 증가하고 체온도 변화하게 된다. 이에 Brain MRI 검사 시 치아 임플란트의 재료에 따라 발생되는 두부 전체의 SAR와 온도의 변화를 비교 분석하고자 한다. 실험은 인체 두부모델에 1.5Tesla MRI장비에서 발생되는 64MHz RF Pulse 주파수, 3.0Tesla MRI장비에서 발생되는 128MHz RF Pulse 주파수를 조사한 뒤 치아 임플란트 재료를 Titanium과 Al2O3로 변화시킨 경우 두부 전체의 SAR와 온도 변화를 알아본다. 치아 임플란트 재료의 변화에서 Titanium을 사용하였을 때, 두부 전체의 SAR와 온도는 높게 나타났다. 하지만 Al2O3을 사용하였을 때, Titanium보다 두부 전체의 SAR와 온도는 낮게 나타났다. 치아 임플란트의 재료는 금속의 비중이 작은 경금속이면서 전기적 도체인 Titanium과 비교했을 때 전기전도도가 낮은 전기적 부도체인 Al2O3에서 두부 전체의 SAR와 온도는 낮게 나타났다. 치아 임플란트 재료가 Titanium 일 경우 SAR의 최대값은 제한치보다 월등히 높기 때문에 향후 Titanium의 치아 임플란트 재료를 삽입한 환자가 Brain MRI 검사를 할 경우 환자의 생물학적 영향과 관련된 연구가 필 요할 것이다. 또한, 치아 임플란트 시술 시 Titanium보다는 Al2O3 재질의 치아 임플란트를 사용하는 것이 Br ain MRI 검사에서 인체 두부 전체의 SAR와 온도를 감소시키는 방안이라는 점을 발견할 수 있었다.

Brain MRI 검사에서는 영상을 얻기 위해 RF Pulse를 인체에 조사하게 되는데 이때 조사된 RF Pulse 에너 지의 상당 부분은 우리 몸에 그대로 흡수되게 되고 이로 인해 인체 온도가 상승하게 되는데 노출 정도에 따라 인체에 영향을 주게 된다. 이러한 RF Pulse 에너지는 MRI 장비의 발전으로 인해 자기장의 세기가 1.5 Tesla에서 3 Tesla, 3 Tesla에서 7 Tesla로 높아지는 시점에서 자기장의 세기 변화에 따른 두부 전체의 SAR 와 온도의 변화를 알아보고 위의 결과가 치아 임플란트 사용 여부에 따른 결과의 차이를 알아보기 위해 연 구를 시작하게 되었다. 실험은 인체 두부 모델에 1.5 Tesla MRI 장비에서 발생되는 64 MHz RF Pulse 주파수, 3.0 Tesla MRI 장비 에서 발생되는 128 MHz RF Pulse 주파수, 7 Tesla MRI 장비에서 발생되는 298 MHz RF Pulse 주파수를 조 사하고 위의 실험을 치아 임플란트를 사용하였을 때와 사용하지 않았을 때로 나누어 XFDTD 프로그램을 사용하여 머리 주변의 SAR와 체온의 변화를 각각 실험하였다. 치아 임플란트를 하지 않았을 때보다 치아 임플란트를 하였을 때 SAR값은 7T의 RF Pulse 주파수 256MH z에서 최대 약 5800배의 차이를 나타냈으며 주파수가 증가할수록 치아 임플란트 사용으로 인한 SAR값의 차이는 크게 나타났다. 치아 임플란트를 하지 않았을 때보다 치아 임플란트를 하였을 때 두부전체의 온도 변화는 2배에서 최대 4배 가까운 온도 상승을 나타내었다. 또한 RF Pulse 주파수가 증가할수록 SAR값은 증 가하지만, 두부 전체의 온도는 감소하였는데 이는 주파수가 증가할수록 파장이 작을수록 인체표면에 흡수 되는 양이 많아지기 때문이다. 향후 치아 임플란트 유무와 RF Pulse 주파수의 세기 변화로 인한 이상 반응 요인에 대한 연구를 통해 인 체의 생리적 연구와 생화학적 연구 등 인체에 대한 영향과 관련하여 연구가 필요하다고 하겠다.

At the Brain MRI examination, RF Pulse are irradiated on the human head in order to acquire MR images. At this time, a considerable part of the irradiated RF Pulse energy is absorbed in our body and the temperature of the human head will rise depending on the degree of exposure, so it will affect the human head. Even if the same RF Pulse energy is given, if the metal is inserted in the human head, the conductivity of the human head is greatly increased by the metal, so the SAR value increases and the temperature also rises. Therefore, we started this research with the question as to whether there is difference between the change in SAR value and temperature displayed on the head of the human according to use or not of the dental implant. Experiments were using the XFDTD program on a 128 MHz RF Pulse frequency by a 3.0 tesla MRI. We can see that both are increasing that the average value of SAR and temperature that absorbed by the human head model used the dental implant. In addition, the average maximum SAR value and the maximum temperature rise in the brain part are shown below the international safety standard value but the influence can not be ignored because of the result may change according to the increase in the number of dental implant. And as future tasks. we need to the simulation of temperature rise and SAR due to an increase in the number of implants and volumes of teeth, dental implant material.