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.

항혈소판 및 항응고제 복용하는 환자의 치과시술 후의 출혈 경향에 대한 후향적 평가

김경진,윤지언,박준,홍기은,김철훈,김정한,김복주 대한통합치과학회 2020 대한통합치과학회지 Vol.9 No.3

Patients with cardiovascular disease who take antiplatelets and anticoagulants are known to have an increased risk of bleeding from open dental surgery. This study is aimed at aiding the analysis of the tendency toward bleeding among patients taking antiplatelets and those taking anticoagulants and to develop guidelines related to drug management during their actual clinical dental care. A total of 413 patients over 65 years of age who visited the Oral and Maxillofacial Surgery Clinic at our hospital from January through December 2018, and underwent extraction and implant surgery participated. This included patients diagnosed with cardio-cerebral vascular disease who were prescribed antiplatelet and anticoagulant drugs. The medical histories of these patients were analyzed to evaluate the tendency toward bleeding depending on the type of drug, whether or not the drug was discontinued, and type of surgery (tooth extraction, implant). In the case of antiplatelet drugs, a total of 113 patients were included, and none of them returned to the hospital due to bleeding, even though the drug was discontinued. A total of 42 patients on anticoagulants were included, of which 2 (4.8%) returned to the hospital with bleeding but the bleeding was controlled through the appropriate hemostatic procedures. Statistically, the type of drug, the presence or absence of drug discontinuation, type of surgery, and occurrence of bleeding after dental surgery were not significant. Therefore, the risk of bleeding during tooth extraction and implant surgery is not significant, based on the findings of this investigation. Therefore, the drug should not be necessarily discontinued if discontinuation of antithrombotic agents increases the patient’s systemic risk, such as for the recurrence of cardiovascular blood clots.

하악 잔존 임플란트를 이용한 가철성 국소의치 수복 증례

송승례,홍석진,유태민,도레미,최정임 대한통합치과학회 2022 대한통합치과학회지 Vol.11 No.1

In a partially edentulous patient with a few remaining implants due to failure on multiple number of implants, implantassisted removable partial dentures (IARPDs) using remaining implants can be considered as an alternative treatment when further implant surgery is not available. IARPDs can be categorized as an overdenture type using attachment and a conventional removable partial denture type using surveyed crown. When the position of remaining implants is not ideal, it is known that the IARPDs using surveyed crown provides the ability to correct discrepancies and makes it easy to manufacture and maintain dentures although the evidence is still lacking. In this case, an 81-year-old female patient, the maxilla was restored with complete denture, and the mandible with IARPD using surveyed bridge on #i41i31=i33 and surveyed crown on #i36. She restored her masticatory function and was esthetically satisfied. Periodic follow-up after 3 months has been performed since the IARPD delivery to the patient. No sign of screw loosening of implants was detected. According to the reported design of IARPDs, it is recommended to place implants as an abutment of RPD in a symmetrical and strategic position to improve support, stability and retention of RPD. However, in this case, since the unilateral residual implant (#i36) was used as an abutment, there may be concerns about the lateral force applied to the implant due to rotation of the denture during mastication and deterioration of the stability of the denture. In order to compensate for these limitations, we intend to investigate considerations when manufacturing IARPDs.

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.

잔존 전치를 통해 수직고경을 결정한 양악 임시즉시의치 및 총의치 수복 증례

정세연,김성준,방대연 대한통합치과학회 2020 대한통합치과학회지 Vol.9 No.1

In patients who faced loss of all natural teeth, one of many choices is fabrication of interim immediate denture. This has a lot of clinical advantages. It can help the patient masticate and provide emotional stability because there is no need to stay edentulous without denture. In addition, it helps to maintain support and tension of muscles around mouth, vertical dimension when occlusion, and facial appearance. In this case of a 69-years-old male patient with few remaining anterior teeth which need to be extracted, interim immediate denture (IID) was used to improve patient’s convenience. Furthermore, maintenance of occlusal vertical dimension (OVD) and centric occlusion with existing interocclusal contacts was helpful. The final complete dentures showed appropriate vertical dimension and the patient was satisfied with the new dentures in respect of functional and esthetic aspects.

치과 공포를 갖고 있는 성인에서의 경구 및 아산화질소 복합 진정요법을 이용한 통합적 치과치료의 증례 보고

방난심,이재호,박원서,김기덕,임지영,정복영,김슬기 대한통합치과학회 2013 대한통합치과학회지 Vol.2 No.1

This case report represents to overview of the clinical guidance regarding patients with dental fear. A 43-year-old male patient visited the department of Advanced General Dentistry of Yonsei Dental Hospital for total oral examination and treatment. He had severe dental fear and needle phobia, so wanted general anesthesia or sedation during dental treatment. He got dental treatment under sedation with N2O inhalation and oral medication. He was monitored the vital sign of patient in every 5 minute during treatment procedures. We suggest a clinical guideline for the patient with severe dental fear using conscious sedation.

원심경사를 동반한 제3 하악대구치 발치로 야기된 설신경 감각저하: 증례 보고와 문헌 고찰

김근형,송승례,최정임,유태민 대한통합치과학회 2022 대한통합치과학회지 Vol.11 No.2

Extraction of the mandibular third molar is a frequently performed dental treatment, but since various complications can occur, it is necessary to evaluate the difficulty of extraction before treatment and proceed with careful treatment. The lingual nerve is responsible for the sensation of the anterior 1/3 of the tongue and the lingual soft tissue of the mandibular molars. The frequency of hypoesthesia of lingual nerve after extraction is lower than that of the inferior alveolar nerve, but recovery is slower due to the difference in anatomical structure and location from that of the lower alveolar nerve. The inclination of third molars is classified into mesioangulation, distoangulation, vertical, and horizontal. It is known that extraction of molars with distoangulation is difficult and may increase the probability of hypoesthesia. We report a case of hypoesthesia of lingual nerve after extraction disto-angular lower third molar, and review the literatures on the characteristic of third molar of distoangulation and potential risk factors causing hypoesthesia of lingual nerve.

경구 Chloral Hydrate 시럽(Pocral® Syrup) 과연 안전한가?

김현정 대한통합치과학회 2012 대한통합치과학회지 Vol.1 No.1

Chloral hydrate synthesized by the chlorination of ethanol, has been used empirically since 1890s. Now, Pocral® syrup, the commercialized oral form, is the main stream of oral sedatives in Korean pediatric dentistry. However, the safety of chloral hydrate is not approved by FDA as it has been used before FDA started to review drugs. Over decades, severe complications related to the overuse of chloral hydrate have been occurred through out the world even in Korea. Interestingly, the pharmaceutical companies in the States stop their marketing since 2012 due to its safety issue and the releasing of FDA guideline for unapproved drugs in 2006. In America, there is an alternative of Pocral® syrup, or midazolam syrup, for pediatric oral sedation. However, there is no midazolam syrup in Korea. Basically, Pocral® syrup is known as a safe oral sedative when administered appropriately according to the manufacturer’s information. The major cause of severe complications of pediatric sedation is related to over- or mis-use of chloral hydrate syrup. Already, many Korean pediatric dentists are accustomed to using Pocral® syrup and they know its advantages and disadvantages. According to most guidelines of pediatric sedation, we can use Pocral® syrup up to 70 mg/kg.

치과용 레이저 및 임플란트 엔진 시스템의 사용자 만족도 비교 연구

손영탁,손큰바다,이재목,유원재,김진욱,이규복 대한통합치과학회 2022 대한통합치과학회지 Vol.11 No.3

The purpose of this study was to compare the performance of each system by examining the satisfaction of dentists with dental laser and implant engines. 21 dentists at Kyungpook National University dental hospital and the dental clinic in Daegu were selected. A multi-type laser and implant engine system (BLP10/CRB46LN/LSR20NN, Saeshin, Daegu, Republic of Korea), an implant engine system (SurgicPro+/X-DSG20L, NSK, Kanuma, Japan), and a laser engine system (Epic 10/surgical handpiece 6400479, Biolase, Irvine, USA) were used for evaluation. The survey was conducted with 10 items for the implant system and 9 items for the laser system. The blind test was conducted without providing product information. After using each product, the questions were evaluated using a 5-point Likerttype scale and the satisfaction of the dentist was quantified. The statistical significance for product comparison was evaluated using the Kruskal-Wallis test (α=0.05). In the user satisfaction of the implant engine system, there was a significant difference when comparing Saeshin product and NSK product in ‘Cutting force when forming holes’ and ‘Fixability of the drill’ of functional items (P<0.05). In the user satisfaction of the laser engine system, there was a significant difference when comparing Saeshin product and Biolase product in ‘Adequacy of output during soft tissue incision’, ‘Ease to attachment and detachment of laser tip’, ‘Convenience of adjusting the angle of the laser tip’ of functional items (P<0.05). There was a significant difference in ‘Adequacy of handpiece weight’ and ‘Detachable method of laser tip’ in items for laser handpiece design (P<0.05). Each system had a significant difference in satisfaction with function and handpiece design, and improvements for each system could be observed.