2017년 3월부터 2019년 8월까지 연세대학교 치과대학병원 통합치의학과에서 통합치의학과 전문의에 의해 시행된 외래 전신마취 치과치료 증례에 대한 통계 연구

정지은,최석근,김기덕,박원서,정복영,방난심 대한통합치과학회 2019 대한통합치과학회지 Vol.8 No.3

Patients with disabilities or patients with severe dental phobia are not able to receive dental treatment properly in an outpatient clinic. For such patients, dental treatment under an outpatient general anesthesia has the advantage of obtaining proper coordination and receiving multiple dental treatments in one visit. In this study, a statistical analysis of 35 patients who underwent outpatient general anesthesia for 30 months, from March 2017 to August 2019, was performed by a specialist in Advanced General Dentistry. Among 35 patients, there were 32 patients with disabilities (91.4%) and 3 non-disabled people with dental phobia. In terms of age distribution, the majority of patients aged 20 to 39 years. An outpatient general anesthesia averaged 1.7 times per person and dental treatment time was 179 minutes under general anesthesia. 60% of patients received dental treatment in three or more departments (for example, periodontolgic, endodontic and prosthodontic) and 28.6% of 10 patients received treatment in two departments. As the demand for dental treatment of dental handicapped, including adults with disabilities, increases, the role of specialist in Advanced General Dentistry is expected to be important. 장애가 있는 환자나 치과공포증이 심한 환자는 외래에서 치과치료가 불가능하여 적절한 시기에 치과치료를 받지 못해 치과 질환의 발생 빈도 및 심도가 높다. 이런 환자의 경우 외래 전신마취 하 치과치료는 적절한 협조도를 얻을 수 있고 한 번의 내원으로 여러 치과치료를 받을 수 있다는 장점이 있다. 이번 연구에서는 통합치의학과를 전공한 1명의 전문의에 의해 2017년 3월부터 2019년 8월까지 2년 6개월, 30개월 동안 외래 전신 마취 하에 치과치료를 받은 35명의 환자에 대한 통계 분석을 해보았다. 35명의 환자 중 장애를 가진 환자가 32명(91.4%), 치과공포증을 가진 비장애인이 3명(8.6%)이었으며, 20~39세의 청, 장년층의 환자(25명, 71.4%)가 주를 이루었다. 총 35명의 환자에서 전신마취는 1인당 평균 1.7회, 전신마취 하 치과치료 시간은 179분 정도였다. 3개 분야 이상의 치과 치료를 받은 환자가 60%, 2개 분야의 치료를 받은 환자도 10명으로 28.6% 정도로 나타났다. 치과 공포증 환자를 포함하여 성인 장애인 치료 수요가 늘어나면서, 앞으로 이 분야에서 여러 영역의 치과치료를 환자 중심으로 진단하고 치료할 수 있는 통합치의학과 전문의의 역할이 중요할 것으로 생각된다.

모야모야병(Moyamoya disease) 환자의 치과치료시 고려사항 : 증례 보고

도레미,유태민,성낙환,송승례,신수일 대한통합치과학회 2019 대한통합치과학회지 Vol.8 No.1

Moyamoya disease is a chronic, progressive cerebrovascular disorder that leads to an abnormal vascular network at the base of a brain due to the stenosis or occlusion of the internal carotid artery. The purpose of this study is to provide a review of dental treatment considerations for Moyamoya disease patients. According to the article review, dental treatment of patients with Moyamoya disease needs the following considerations. Firstly, the treatment should consider stress reduction therapies. Secondly, bleeding tendency of patients should be taken into consideration. Lastly, medication treatment should be considered. As Moyamoya disease can be a progressive systemic vascular disease, if a bleeding operation is required in the dental treatment then medical consultation by a professional should precede the treatment. 모야모야병(Moyamoya disease)은 뇌경동맥의 협착이나 폐쇄에 의해서 뇌기저부에 비정상적 혈관망을 갖는 만성 진행성 뇌혈관 질환이다. 본 연구에서는 모야모야병에 대한 문헌 고찰과 함께 모야모야병 환자의 치과 치료 증례를 보고하면서, 모야모야병 환자에 대한 치과치료시 고려해야 사항에 대해 살펴보고자 한다. 모야모야병 환자의 치과 치료시 고려사항으로는 첫 번째로, 스트레스 감소 요법에 대한 고려가 필요하다. 두 번째로 출혈 경향에 대한 고려가 필요하며, 세 번째로 약물 처방에 대한 고려가 필요하다. 이 질환은 진행형인 전신 혈관 질환으로 고려될 수 있으므로, 치과 진료시 출혈을 일으키는 침습적 치료가 예정되어 있을시 반드시 의과 협진이 선행되어야 한다.

Modification of All-on-Four Treatment Concept for Severely Atrophic Mandible with CAD/CAM Customized Abutment and Prostheses: A Case Report

이원,강승환,이지혜,김은경 대한통합치과학회 2016 대한통합치과학회지 Vol.5 No.2

This article describes the treatment provided to a patient exhibiting severely atrophic mandibular posterior region complaining of the paresthesia of both alveolar ridges near the mental foramen. Severe atrophy of the alveolar ridge disabled any removable denture treatment to have sufficient retention and stability without irritating mental foramen area. Implant-supported fixed prosthesis was planned utilizing All-on-Four treatment concept. CAD/CAM abutment was customized for distally tilted implants and implant-supported fixed prosthesis was successfully fabricated.

상아질 접착에서의 Chlorhexidine의 효과

방난심,박원서,조진형,김기덕,이난주,곽은정,정복영 대한통합치과학회 2016 대한통합치과학회지 Vol.5 No.2

This review examines the fundamental mechanism of dentin-resin bond degradation, considers the factors related with this event and furthermore, describes the more practical way to prevent the degradation followed by restoration failure. In spite of rapid development of dental adhesive, dentin-resin bond stability and durability are still major challenge to clinicians. Bacause dentin has unique environments, which are humid and moist, compared to enamel, it is difficult to acquire complete bond. Also presence of endogeneous matrix-metalloproteinases (MMPs) in dentin substrate plays a crucial role in the degradation. So, in order to prevent the degradation, complete infiltration of resin monomer to moist dentin substrate and inhibition of MMPs are essential in bonding process. There are multiple in vivo and in vitro reports showing that the durability and longevity of the dentin-resin bond interface is increased when nonspecific enzyme inhibitors, especially Chlorhexidine (CHX) are used. Among many synthetic inhibitors, chlorhexidine (CHX) is the most widely used MMPs-inhibitor because of its ‘substantivity’. Via its cationic-chelation mechanism, it inhibits MMPs (especially MMP-2, -9) effectively and consequently, reduces nanoleakage and increases bond stability. Also the use of CHX does not affect the immediate bond strength overall and gives no harm to mechanical properties of following adhesive resin. To sum up, the adoption of CHX is recommended as means of improving bond stability at this time.

Effect of the Surface Treatment by Airborne-particle Abrasion on the Shear Bond Strength of Resin Cement to Hybrid Ceramic

오남식,Batzaya Tumur-ulzii,조성찬,함미현,김원호,이명현 대한통합치과학회 2019 대한통합치과학회지 Vol.8 No.3

The aim of this study was to investigate the effect of airborne-particle abrasion(APA) treatment on the shear bond strength of resin cement to hybrid ceramic, MAZIC Duro(Vericom, Korea). The hybrid ceramic specimens were treated with airborne alumina oxide particles and bonded with 6 types of resin cement (Rely X Ultimate Clicker, Multilink N, U-Cem, Super Bond C&B, Panavia F 2.0, and BisCem). All the steps were performed by the same operator according to the manufacturer's instructions of resin cement respectively. All specimens were subjected to shear bond strength testing using a universal testing machine with a crosshead speed of 1mm/min. All data were statistically analyzed using one-way analysis of variance and multiple-comparison least significant difference tests (α = 0.05). In this study, hybrid ceramic bonded with Super Bond and Rely X Ultimate Clicker were significantly stronger than those bonded using other resin cement (p<0.05).

MTA의 특성과 임상적 적용

방난심,김동진,김기덕,곽은정,정복영,박원서,조진형 대한통합치과학회 2016 대한통합치과학회지 Vol.5 No.2

Mineral trioxide aggregate (MTA) is a calcium silicate-based cement commonly used in endodontic procedures involving pulpal regeneration and hard tissue repair, such as pulp capping, pulpotomy, apexogenesis, apexification, perforation repair, and root-end filling. Since MTA’s introduction in 1993, numerous studies have been published regarding various aspects of this material. The purpose of this paper was to review the composition, properties, biocompatibility, and to give evidence-based recommendation for the clinical use of these materials.

당뇨쥐에서 임플란트 즉시 식립 후 조직계측학적 연구를 통한 임플란트 골유착 비교

표성운,허현아,박수현,김성민 대한통합치과학회 2016 대한통합치과학회지 Vol.5 No.2

Introduction: Dental implants are routinely used with high success rates in generally healthy individuals. By contrast, their use in patients with diabetes mellitus remains controversial as altered bone healing around implants has been reported. The present study aimed to investigate the bone healing response around immediately placed titanium implants in the rats with controlled and uncontrolled diabetes. Materials and Methods: Twenty rats were divided into the control, insulin-treated and diabetic groups. The rats received streptozotocin (60 mg/kg) to induce diabetes; animals in the insulin-treated group also received three units of subcutaneous slow-release insulin. A titanium implant (1.2×3 mm) was placed in the extraction socket of the maxillary first molar and was harvested at 2 and 4 weeks. After routine process of histologic process, section were measured for Bone-implant contact, bone density using Image analysis program. Results: After 2 weeks post-implantation, BCR (Bone contract ratio) of the control, the diabetic group and insulintreated group was 42.62%, 24.55% and 27.75%, respectively. The BCR of the control was lower than the diabetic group and insulin-treated group. After 4 weeks post-implantation, BCR (Bone contract ratio) of the control, the diabetic group and insulin-treated group was 45.32%, 39.14% and 43.84%, respectively. Also, the results of bone density was showed a similar pattern of the results of BCR. Conclusion: The immediate placement of titanium implants in the maxilla of controlled diabetic rat led to a wanted bone healing response. In conclusion, the results of this study suggest that immediate implant insertion in patients with controlled diabetes might be indicated.

개원의를 위한 치과진정법 근거기반 임상진료지침 개발

안소연,김현정,서광석,황경균,이덕원,김승오,김종빈 대한통합치과학회 2016 대한통합치과학회지 Vol.5 No.2

Sedation and analgesia are frequently administered to dental patients for procedures done outside the operating room. As dental sedation became more widely used in dental clinics, positive effects, such as control of anxiety and pain, have been noted. However, concurrent reports of side effects and severe complications related to dental sedation have also been on the rise. In response to this, dentists established the “Dental Sedation Guideline” at the Korean Academy of Dental Sciences in April 2010 in order to promote the practice of more effective and safer dental sedation. A revision to the dental sedation clinical practice guidelines was necessary because it had been 5 years since the establishment of the original guidelines. The definition of evidence-based clinical practice guidelines is “statements that are systematically developed to assist in the doctors’ and patients’ decision making in certain situations”. The study conduct systematic searching methods based on which evidence-based CPGs. The aim of this report was to discuss the development of Dental sedation Evidence-based Recommendations for dentists in the clinic.

근관 실러의 분류와 특성 비교

방난심,정복영,최동진,박원서,정지은,김기덕,곽은정 대한통합치과학회 2017 대한통합치과학회지 Vol.6 No.2

The aim of this review was to compare calcium hydroxide-based root canal sealers with various contemporary commercial sealers especially leakage / solubility aspect. An extensive search of the endodontic literature through pubmed was made to identify publications related to calcium hydroxide-based sealers, epoxy resin-based sealers, methacrylate resin-based sealers and bioceramic-based sealers. 1. All sealers leak in long-term evaluation (>60 days). (except MTA sealers, because they do not have long-term [>120 days] evaluation data yet.) 2. Some sealers have better short-term sealing ability (<30 days). (but, the result could be reversed in long-term evaluation and meaningless after some period, because all sealers leak eventually.) 3. Regardless of the type of sealers, leakage increases over time. 4. A lot of endodontic treatment failure cases are because of re-infection through various route. 5. It is very important for the long-term survival of endodontically treated teeth that installation of full coverage-type final restoration as soon as possible after endodontical treatment. (further research is required to estabilish the sealing ability of luting cement or core material) It seems right to use sealers that have best bacterial sealing ability during those period (about 20 days) until the installation of full coverage-type final restoration right after the endodontical treatment finished. In that case, calcium hydroxide-based sealers are very effective and efficient.

A Case of Acute Necrotizing Fasciitis Following Internal Jugular Vein Thrombophlebitis: Lemierre's Syndrome

이의석,박동석,장현석,김현준,Besana,임호경 대한통합치과학회 2017 대한통합치과학회지 Vol.6 No.2

Lemierre’s syndrome is caused by preexisting oropharyngeal infection and characterized by internal jugular vein (IJV) thrombophlebitis. Frequently, this syndrome involves metastatic infection in areas such as the peritoneum, muscles, and spleen. The most common etiologic organism is Fusobacterium necrophorum. In this case, a masticatory space abscess that originated from a tooth caused the IJV thrombophlebitis. The patient had preexisting hypertension, diabetes mellitus, hyperlipidemia, and Parkinson’s disease. Blood culture revealed Streptococcus sanguinis, and the patient received antibiotics that were highly sensitive to mentioned bacterium; additionally, an anticoagulant was used. With the widespread use of antibiotics, Lemierre’s syndrome has become uncommon, and related mortality rates have noticeably decreased. This has led the public to forget about the disease, but it can still be potentially fatal without early diagnosis and appropriate antibiotic treatment.