구진상괴사성 결핵진 3례

손보성,송준영,정재봉,김병천,이상숙,류영욱,이규석 啓明大學校 醫科大學 1994 계명의대학술지 Vol.13 No.4

Papulonecrotic tuberculid is an eruption of necrotizing papules, particularly affecting the extremities and occurring in more or less symmetrical crops, and responding to antituberculosis therapy. Individual lesions heal with scarring. Histologically, vascular involvement is seen in early lesions. Late lesions are divided into two forms. In superficial forms, wedge shaped area of necrosis forms in epidermis and upper dermis. Epithelial and lymphoid cells gather around its periphery. In deep forms, with no epidermal change, granulomatous changes surrounded by well defined palisading histiocyte and lymphoid, epithelioid cells are seen. In mid-dermis and perivascular area, vessel shows vasculitis. In the first case, leukocytoclastic vasculitis and early granuloma formation were seen. In the second case, palisading granuloma formation was seen. In the third case, tuberculoid granuloma formation was seen. We report three cases of papulonecrotic tuberculid showing three different stages of histological finding, in individual cases.

치아의 견인을 위한 버튼 접착시 오염이 인장강도에 미치는 영향

최병재,김성오,이제호,손흥규 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.2

We already know that it is very difficult to obtain an 'isolated field' for direct bonding during the surgical exposure of unerupted teeth. The aim of this in-vitro study is to simulate the clinical situation of forced eruption and to evaluate the tensile strengths of preligatured button with several types of contamination which can happen during the surgical exposure of unerupted teeth. Four orthodontic direct bonding systems were used. (Ortho-One, Rely-a-Bond, Ortho-Two, PhaseⅡ) Each material was divided into four groups(n=20) : Group 1. (Control, no contamination), Group 2. (Rinse etching agent with saline instead of water), Group 3. (Blood contamination of etched surface for 30 seconds), Group 4. (Blood contamination of primed surface for 30 seconds) 320 bovine anterior permanent teeth were divided into the above mentioned 16 groups. Enamel surface was flattened and ground under water coolant. Pre-ligatured buttons were prepared to the same form. (Cut 0.25 ligature wire 10 cm in length. Twist the ligature wire 30 times clockwise. Mark the wire 15mm and 35mm points from button. Make a loop sticking two points together and twist the loop 6 times counterclockwise.) The bonded specimens were stored at 37℃ saline solution for 3 days. then the tensile strength of each sample was measured with Instron universal testing machine, crosshead speed of 0.5mm/min. the following results were obtained : 1. As compared to control groups (Group 1) of each material, Rely-a-Bond had a significantly lower mean tensile strengths than other material. (p<0.01) 2. In Group 2. of Ortho-One and Rely-a-Bond, the mean tensile strengths decreased about 7.7% and 11.1%, respectively with statistical significances. (p<0.05) 3. In Group 2. of Ortho-Two and PhaseⅡ, the mean tensile strengths did not decrease. 4. In Group 3. of Ortho-One, Rely-a-Bond, Ortho-Two, and PhaseⅡ, the mean tensile strengths decreased about 60.8%, 56.1%, 60.2%, and 46.0%, respectively with statistical significances. (p<0.01) 5. In Group 4. of Ortho-One and Rely-a-Bond, the mean tensile strengths did not decrease. 6. In Group 4. of Ortho-Two and PhaseⅡ, the mean tensile strengths were decreased about 20.95% and 22.28%, respectively with statistical significances. (p<0.01) There were formations of a hump shaped mass from bonding resin under blood contamination which disturbed direct bonding procedure. According to Reynolds, the proper bond strength for clinical manipulation should be at least 45N or about 4.5Kg.F. According to these results, it can be concluded that Ortho-One could be used during surgical exposure of unerupted teeth. In any case, blood contamination of the etched surface should be avoided, but the blood contamination of primed surface of Ortho-One may not decrease bond strength. Just 'blowing-out' is enough to remove blood from primed surface of Ortho-One. You can verify the clean surface of the primer of Ortho-One after blowing out the blood contamination.

Nd: YAG 레이저 조사가 Clacium Fluoride 형성 및 치아 내산성에 미치는 영향

최병재,김성오,손흥규,이제호,박광균 大韓小兒齒科學會 1999 大韓小兒齒科學會誌 Vol.26 No.2

불소도포시 주로 형성되는 calcium fluoride는 구강내 환경에서 pH에 의해 조절되는 불소의 저장고 역할을 하여 치아우식 예방에 있어서 중요한 역할을 하는 것으로 알려져 있다. 따라서 불소도포의 우식예방 효과는 calcium fluoride를 얼마나 많이 형성시켜 오래 지속시키는 가에 달려있다. 이에 치아 내산성 증가에 효과 있다고 알려진 Nd:YAG 레이저 조사가 calcium fluoride형성 및 치아 내산성에 미치는 영향에 대해 알아보기 위해서 실험을 시행하였다. 소의 영구전치에서 276개의 시편을 제작하여 아무런 처치를 하지 않은 군을 대조군으로 하고 1.23% acidulated phosphate fluoride (APF) 5분, 30분 도포 및 Nd:YAG 레이저 조사에너지 밀도 20J/㎠,40J/㎠의 조건에 따라 불소 도포군, 레이저 조사군, 불소 도포후 레이저 조사군, 레이저 조사후 불소 도포군으로 분류하였다. 불소도포를 시행한 경우 이를 다시 KOH 처리 여부에 따라 나누어 23개의 실험조건을 만들었다. 각 실험조건에 12개의 시편을 배정하고 이중 10개의 시편은 불소 및 무기인 측정에, 나머지 2개의 시편은 표면 관찰에 사용하였다. KOH 비처지군에서 0.1N HCIO4로 enamel biopsy를 시행하여 탈회 법랑질의 불소농도 및 탈회깊이를 측정하였으며, KOH 처치군에서는 1 M KOH로 24시간 처리하여 calcium fluoride를 정량 후 enamel biopsy를 시행하였다. 실험결과 얻어진 자료 및 주사 전자현미경 관찰 소견을 비교하여 다음의 결과를 얻었다. 1. KOH 비처치군에서 탈회된 법랑질의 불소농도는 레이저조사 후 불소도포시 레이저 에너지 밀도 증가에 따라 증가되는 경향을 보였다. 2. KOH 비처치군에서 법랑질 탈회깊이는 불소를 5분 도포후 레이저 20J/㎠를 조사한 경우를 제외하고는 레이저와 불소를 병행하여 처치시 각각을 단독으로 치치시보다 탈회깊이가 작았다 (p<0.05). 3. Calcium fluoride의 양은 레이저의 조사에 의해 유의 있게 증가하지 않았다 (p>0.05). 4. Calcium fluoride 입자는 불소만 도포한 경우에 비해 레이저 조사후 불소도포시 입자크기가 증가되었으며, 불소도포후 레이저 조사시 입자크기의 증가와 함께 일부 융합된 양상을 보였다. 5. KOH 처치군에서 법랑질의 불소농도는 불소를 30분 도포후 레이저를 조사한 경우를 제외하고는 대조군의 불소농도와 유의한 차이가 없었다(p>0.05). 6.KOH 처치군에서 불소와 레이저를 병행한 경우, 불소만 도포한 경우보다 탈횐된 법랑질의 깊이가 작았다 (p<0.05). 7. KOH 비처치군에서 탈회된 법랑질의 불소농도와 탈회깊이의 상관관계 (Spearman correlation coefficient: -0.6281)는 KOH 처치군 (Spearman correlation coefficient: -0.3792)에 비해 높은 음의 상관 관계를 보였고, 동일한 조건으로 불소도포 및 레이저 조사를 시행한 경우에 있어서 KOH 처리 여부에 따른 탈회법랑질 깊이의 유의차가 있는 경우 calcium fluoride의 형성량이 많았다. 이상의 실험결과로 미루어 보아 레이저 조사가 calcium fluoride의 형성량에 영향을 미치지 않았으나 레이저 조사의 영향으로 calcium fluoride의 용해가 감소하는 것으로 판단된다. 또한 불소도포 및 레이저 조사의 병행은 각각을 단독으로 처치한 경우에 비하여 치아 내산성 증가면에서 유리하므로 임상에서 불소도포주기 연장과 같은 유용한 결과를 얻을 수 있을 것으로 생각된다. Calcium fluoride. created by topical fluoride application, is the reservoir for fluoride ion regulated by pH in the oral environment. Therefore, the amount and the maintenance of calcium fluoride have an important role in preventing dental caries. The aim of this study is to evaluate the effect of Nd:YAG laser irradiaiton on the generation of calcium fluoride and the acid resistance of tooth enamel. The bovine anterior permanent teeth were prepared (n=276), and divided into following groups: no treatment(control), fluoride application alone, laser irradiation alone, laser irradiation after fluoride application, and fluoride application after laser irradiation. And each group was subdivided based on the application time of 1.23% acidulated phosphate fluoride (APF) (5 min and 30 min) and the irradiation energy of Nd:YAG laser (20J/㎠ and 40J/㎠). In case of fluoride application, each group was divided according to KOH treatment. Twenty three treatment conditions were made for this experiment and twelve specimens were assigned to each treatment condition. In each treatment condidtion, ten specimens were used for chemical analysis and two specimens were observed under SEM. In groups without treating KOH, fluoride content and the depth of enamel dissolved were measured using enamel biopsy technique. In groups with treating KOH, the amount of calcium fluoride was measured by the treatment with 1 M KOH for 24 hours and enamel biopsy was performed after KOH treatment. The results were analyzed by the fluoride content and the depth of enamel dissolved by enamel biopsy, amount and thickness of calcium fluoride, and the surface structures of enamel. The results are as follows: 1. In groups without treating KOH, the fluoride content of removed enamel showed a positive relationship with the energy density of laser when the laser irradiated before fluoride application. 2. In groups without treating KOH, the depth of enamel dissolved decreased more with the combined laser and fluoride treatment than with laser or fluoride treatment, except for the case of 20J/㎠ laser irradiation after 5 minute fluoride application (p<0.05). 3. The amount of calcium fluoride did not increased by laser treatment with no statistical significance(p>0.05). 4. The particle size of calcium fluoride increased in case of fluoride treatment after laser irradiation, compared with fluoride application alone. In case of laser treatment after fluoride application, the particle size of calcium fluoride increased and some of the particles fused as well. 5. There were no significant differences in the fluoride content of dissolved enamel between groups without treating KOH and control group, except for the case of laser irradiation after treatment of APF for 30 minutes (p>0.05). 6. In groups with treating KOH, depth of removed enamel in the groups of combined treatment with laser and fluoride was shallower than that in fluoride application groups (p<0.05). 7. In groups without treating KOH, the relationship between fluoride content and the depth of enamel dissolved showed more negative (Spearman correlation coefficient: -0.6281)than in groups with treating KOH (Spearman correlation coefficient: -0.3792). The greater amount of calcium fluoride could be found in case where there was a significant differences of the depth of enamel dissolved between groups with and without treating KOH. From these results, it can be concluded that laser seems to be a little effects on the amount of calcium fluoride formation, but has some effect on the lowering the solubility of calicium fluoride. As the combined treatment of laser and fluoride application showed more effective acid-resistant property, more extended recall period for fluoride application can be achieved with this combined treatment in the clinic.

미성숙 영구치의 치근파절에 관한 증례보고

최병재,손흥규,김수연,최형준 大韓小兒齒科學會 1997 大韓小兒齒科學會誌 Vol.24 No.3

During the eruption of permanent teeth, Traumatic root fractures in young permanent incisors are rare. They occur most commonly in the maxillary central incisors of male patient and are frequently seen in the coronal third of the root. Permanent incisors are very important in terms of esthetics as well as of function, and so conservative treatment is advisable. It is important to maintain vitality of pulp to achieve better result. Location of the fracture line determines the Prognosis. No clinical change were seen in this three case. A case of central incisor with apparent healing of a root fracture without any tratment is presented in this paper. Long term clinical observation is required periodically.

치주적 손상을 유발하는 latex-elastic ring의 부적절한 사용에 대한 증례보고

최원경,손흥규,최병재,이제호 大韓小兒齒科學會 1997 大韓小兒齒科學會誌 Vol.24 No.3

This paper presents improper use of latex-elastic ring in movement of teeth and its consequence. Simple orthodontic movement of teeth including closure of diastema may be achieved by the use of simple method with fixed or removable appliance associated with latex-elactic ring. But, if it is used alone, it acts as a local irritant and then produces localized periodontitis. In case of localized periodontitis resulting from latex-elastic ring, diagnosis is difficult because the patient is usually unaward of the presence of the rings on the roots of the involved teeth and because the ring is not probed and is radiolucent and therefore not discernible radiographically and clinically. Occasionally, surgery is requred for the detection. This case emphasizes the necessity that the use of latex-elastic ring in closing diastema should be accompanied with removable or fixed appliance as well as close professional supervision. Its use without adequate provision for stabilization or retention on the crowns of teeth results in destruction of periodontal support and the teeth may be lost.

구순 구개열 환아의 수유 보조 장치에 대한 증례보고

최형준,손흥규,최병재,박동석 大韓小兒齒科學會 1995 大韓小兒齒科學會誌 Vol.22 No.2

Cleft lip, cleft palate, cleft lip and palate are the most common congenital anomalies in cranio-orofacial region. These anomalies lead to esthetic problem as well as to difficulties in feeding and speech and also to chronic infection of upper airway and to disturbance of jaw growth during growing up. Especially, some difficulties during feeding make parents to be confused and puts infants in dangerous position. But these difficulties can be controlled by proper feeding methods according to pattern of cleft lip and palate. Among these feeding methods, feeding appliance is the most safe and relatively easy to manufacture. Early wearing of this appliance makes cleft lip and palate infants to a normal feeding and weight gain. As a member of team approach for the treatment of cleft lip and palate, a pediatric dentist should solve the feeding problems which cleft lip and palate infants and its parents are confronted and help in receiving further treatment.

부적절하게 수복된 stainless steel crown에 의해 야기된 하악 제1대구치 이소맹출 치험례

박주석,손흥규,최병재 大韓小兒齒科學會 2000 大韓小兒齒科學會誌 Vol.27 No.1

이소맹출이란 영구치열의 발육 과정 중에 국소적 맹출장애로 인하여 정상적 위치에서 벗어난 치아의 맹출을 말한다. 일반적으로 이소맹출은 2∼6% 정도의 이환율을 보이고, 제1대구치에서 호발하며 주로 상악에서 많이 나타나고 하악에서는 드물다. 이소맹출의 원인은 국소적 원인으로 부적절한 치열궁 길이. 상악 후방부의 성장 부족, 제1대구치의 근심 맹출, 비정상적으로 큰 제1대구치 등이 있고, 유전적인 원인으로 나타날 수도 있으며, 부적절하게 형성된 stainless steel crown에 의해서도 유발될 수 있다. 이소맹출된 치아 중 66%는 가역성이므로 3∼6개월 정도의 관찰 기간이 요구된다고 하였으며, 비가역성 이소맹출인 경우에는 brass wire 나 elastic separator를 이용한 비교적 간단한 치료 방법, 제2유구치의 distal discing, Humphrey appliance 등과 같이 제2유규치를 유지하면서 치료하는 방법 및 제2유구치 발거 후 가철식 장치나 cervical traction headgear를 이용하는 방법 등이 소개되고 있다. 본 증례는 연세대하교 치과대학병원 소아치과에 내원한 7세된 남환아로 구강 검사 및 방사선 검사 결과, 4년전 개인 치과의원에서 수복된 우측 하악 제2유구의 stainless steel crown을 제거하고, Humphrey appliance를 제작하여 장착하였으며, 약 10주 후에 고착 상태가 해소되었다. 본 증례에서와 같이 이소맹출은 부적절하게 형성된 stainless steel crown에 의해 일어날 수 있으므로, stainless steel crown의 수복 치료에 있어서, 적절한 크기의 선택, trimming 및 contouring 등이 매우 중요하다. Ectopic eruption is out of a normal position by local eruption disturbance in the developing permanent molar. The prevalence of ectopic eruption is reported to be the between 2 and 6%, most often associated maxillary first permanent molar, whereas, the occurrence for the mandibular is quite rare. The etiologic factors of ectopic eruption are inadequate arch length, lack of growth in the posterior region of the jaw, mesially inclined eruption path of first permanent molars, abnormally large first permanent molars, hereditary factor and a stainless steel crown which has been improperly restored. Ectopic eruption can be treated by the use of brass wire, separating elastics, distal disking and Humphrey appliance and the use of removable appliance and cervical traction headgear after extraction of the second primary molar. This case was that lower right first permanent molar was mesially tilted state by locking on the stainless steel crown of a lower right second primary molar. The stainless steel crown was removed and Humphrey appliance was set. Like this case, ectopic eruption could be happened by the stainless steel crown which improperly restored. In restoration of the stainless steel crown, selection of proper size, trimming and contouring are very important.

매복 과잉치 발거시의 전후방적 위치선정

최형준,손흥규,최병재,황동환 大韓小兒齒科學會 1996 大韓小兒齒科學會誌 Vol.23 No.3

Surgical removal of impacted mesiodens can be performed easily when exact position of mesiodens is identified. This case report is argued about methodological approach of exact antero-posterior postioning of mesiodens using conventional cross-sectional occlusal film and periapical film. The author concludes, 1. Among various methods of positioning mesiodens, exact position of mesiodens can be determined with occlusal film and periapical film. 2. On operation, exact antero-posterior position of mesiodens can be determined with comparing occlusal images of adjacent teeth and anatomic structure to real ones. 3. It is important that exact removal course of mesiodens has to be determined in addition to exact determination of one's position, and that it has to be determined in regard to position, morphological basis, direction of impacted pattern of mesiodens and adjacent anatomic structure. 4. In 2 cases presented, both are mesiodens of inverted conical type, and impacted direction are class Ⅰ and Ⅲ respectively according to classification author suggested, and surgery can be performed with ease by different approach directions.

생리적 및 염증성 유치 치근 흡수면의 미세구조

박윤희,손흥규,최병재 대한소아치과학회 2000 大韓小兒齒科學會誌 Vol.27 No.4

유치 치근 흡수가 일어나는 경우는 임상에서 많이 접할 수 있다. 유치 치근 흡수는 나이에 따른 생리적 흡수와 치아우식증 및 외상 등으로 비정상적으로 흡수되는 염증성 흡수로 나눌 수 있다. 염증성 흡수는 그 시기와 양상이 생리적인 치근 흡수와는 다르며, 흡수기전이나 흡수면의 미세구조에 있어서도 많은 차이가 있을 것으로 사료된다. 유치 치근 흡수면의 미세구조에 대한 연구는 많이 있었으나, 생리적 흡수면과 염증성 흡수면의 미세구조를 비교한 연구는 드물다. 본 연구는 생리적 흡수면과 염증성 흡수면의 형태 및 인접한 세포를 연구하기 위하여 생리적 및 염증성 흡수로 인해 발거된 유치 치근의 흡수 표면을 주사전자현미경상으로, 조직학적 형태를 광학현미경상으로 관찰하여 다음과 같은 차이점을 알 수 있었다. 1.주사전자현미경상에서 생리적 유치 치근 흡수 표면은 타원형, 원형 및 다각형 모양의 흡수소와가 관찰되었고, 염증성 흡수 표면은 크기가 작으며 형태가 다양하고 매우 불규칙한 무정형 형태의 흡수소와가 관찰되었다. 2.광학현미경상에서 생리적 유치 치근 흡수면은 흡수소와로 구성된 규칙적인 큰 흡수와가 관찰되었고, 염증성 흡수면은 불규칙한 흡수소와가 관찰되었다. 3.광학현미경상에서 생리적 유치 치근 흡수면에는 다핵거대세포가 흡수소와에 직접 접하고 있었으며, 염증성 흡수면은 간엽세포 및 염증세포가 많이 관찰되었다. 4.광학현미경상에서 염증성 치근 흡수면에서는 상아질 흡수를 보상하는 부분적인 백악질 형성이 관찰되었다. Deciduous teeth can be extracted for two reasons, one due to the physiologic resorption and the other by the inflammation at the apex after traumatic injury. Physiologic resorption may be different from pathologic resorption in timing and mechanism. Therefore we resumed the different features of physiologic and pathologic resorption root surfaces. Many previous studies showed micromorphology of resorbed surface of roots of deciduous teeth. But, few studies compared physiological and pathological root resorption surfaces. In this study, we carefully observed microscopic morphologies of those two different root surfaces by scanning electron microscope and histologic features by light microscope. The resultant differences between physiologic and pathologic resorption surfaces of deciduous teeth were as follows: 1. The morphology of pathologic resorption lacunae due to inflammation varied in size and shape with irregular boundaries compared with the physiologic areas from scanning electron microscope observations. 2. From light microscope observations, several large resorption fossae containing numerous resorption lacunae were found, whereas the resorption lacunae were irregular in shape with pathologic resorption surface. 3. Numerous multinucleated giant cells were closely attached to the physiologic resorption lacunae, whereas several kinds of mesenchymal cells with numerous inflammatory cells were found in the areas adjacent to the pathologic resorption surface. 4. Light microscope findings showed that compensating cementum formation took place along some of the areas of inflammatory dentinal resorption. In conclusion, several morphological differences were between physiologic and pathologic root resorption surfaces of human deciduous teeth. The future studies should include cytochemisty to clarify the cellular roles in resorption process observations of pulpal surfaces of coronal and radicular dentin to find the changes that occur in each phase of human deciduous tooth resorption.

Papilloma 에 관한 증례보고

이종갑,최병재,김종태,손흥규 大韓小兒齒科學會 1995 大韓小兒齒科學會誌 Vol.22 No.2

The squamous papilloma is a relatively common benign neoplasm that arises from the surface epithelium. It is typically an exophytic lesion whose surface may vary cauliflower-like to fingerlike in appearance, and while generally being a pedunculated lesion, it may arise from a sessile base. The most common sites of occurrence appear to be on the tongue and palatal complex, followed by the buccal mucosa, gingiva, and lips. It is also can be seen with some frequency on the alveolar ridge, floor of the mouth, and retromolar pad regions. Histologically, the papilloma is seen as a proliferation of the spinous cell layer in a papillary pattern often accompanies gyperkeratosis, acanthosis, and spinous cell layer in a papillary pattern often acconpanies hyperkeratosis, acanthosis, and basilar hyperplasia. Mitotic figures also may be prominent. The supporting fibrous connective-tissue stroma often contains prominent numbers of small blood vessels as well as an inflammatory cell infiltrate. The cause of papilloma is not well known, but suggested that chronic inflammatory irritation, mechanical irritation, and viral infection may be the causes. Recently association with papillomavirus is studied by morphological study, immuno-histochemistry, and DNA hybridization. These three cases were recovered by surgial excision without recurrence. By immunohistochemistry, Case 1 and Case 3 showed positive reaction to HPV antigen.