Hyun-Suk Kim

A clinical evaluation of botulinum toxin-A injections in the temporomandibular disorder treatment

BackgroundThis study clinically evaluated the effect of botulinum toxin type A (BTX-A) in the temporomandibular disorder (TMD) treatment using Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).MethodsA total of 21 TMD patients were recruited to be treated with BTX-A injections on the bilateral masseter and temporalis muscles and were followed up by an oral and maxillofacial surgeon highly experienced in the TMD treatment. For each patient, diagnostic data gathering were conducted according to the RDC/TMD. Characteristic pain intensity, disability points, chronic pain grade, depression index, and grade of nonspecific physical symptoms were evaluated. Wilcoxon signed-rank test was applied for statistical analysis.ResultsThe results showed that more than half of the participants (85.7xa0%) had parafunctional oral habits such as bruxism or clenching. In comparison between pre- and post-treatment results, graded pain score, characteristic pain intensity, disability points, chronic pain grade, and grade of nonspecific physical symptoms showed statistically significant differences after the BTX-A injection therapy (pu2009<u20090.05). Most patients experienced collective decrease in clinical manifestations of TMD including pain relief and improved masticatory functions after the treatment.ConclusionsWithin the limitation of our study, BTX-A injections in masticatory musculatures of TMD patients could be considered as a useful option for controlling complex TMD and helping its associated symptoms.

Evaluation of soft tissue changes around the lips after bracket debonding using three-dimensional stereophotogrammetry.

OBJECTIVEnTo evaluate the changes in soft tissue around the lips after orthodontic bracket debonding using three-dimensional (3-D) stereophotogrammetry.nnnMATERIALS AND METHODSn3-D facial images of 20 subjects (10 men and 10 women; mean age, 26.81 ± 7.23 years) were taken with a white light scanner before and after debonding the labial brackets. Two images acquired from each subject were superimposed, and 15 soft tissue landmarks around the lips were plotted and analyzed. Statistical analysis was performed using both paired and independent t-tests (P < .05).nnnRESULTSnThere were no significant changes in position of any landmark on the x (left-right)- or y (vertical)-axes after removal of the brackets. However, the landmarks in the oral commissures and lower lip (LLP, -0.55 mm; Li, -0.44 mm; Ch-L, -0.56 mm, all P < .05) on the z (anteroposterior)-axis showed statistically significant differences. There were no significant positional changes of most landmarks on the x-, y-, or z- axes after bracket removal among the various genders and lip thicknesses.nnnCONCLUSIONSnThere was a slight retrusion in the oral commissure and lower lip areas after debonding, but no changes were found in the upper lip area. This study showed that 3-D stereophotogrammetry can be useful in evaluating facial soft tissue changes in orthodontic patients.

Clinical Diagnosis and Treatment of Herpes Zoster in an Immunocompromised Dental Patient: A Case Report

Herpes zoster (HZ) is an acute, unilateral inflammatory viral infection characterized by a rash with painful blisters in a localized area of the body. HZ is often associated with intense pain in the acute phase and presents postherpetic neuralgia in the chronic phase. During the prodromal stage of the HZ from the trigeminal nerve, however, the only presenting symptom may be odontalgia, which could be particularly difficult to diagnose. This distinctive syndrome occurs predominantly in the immunocompromised or elderly individuals. In this article, we report a case of HZ developed in the trigeminal nerve of a 60-year-old immunocompromised female patient, whose symptoms including atypical, non-odontogenic odontalgia had improved after series of antiviral treatments.

Evaluation of bone healing using rhBMP-2 soaked hydroxyapatite in ridge augmentation: a prospective observational study

BackgroundThe goal of this study is to evaluate complication and effectiveness of alveolar ridge augmentations using a hydroxyapatite-based alloplastic bony substitute with rhBMP-2.MethodsA total of 10 patients (4 males, 6 females; 58.5u2009±u20098.6xa0years) participated in this clinical research. Alveolar ridge augmentations were performed in edentulous (4 maxillary posterior, 5 mandibular posterior, and 1 mandibular anterior) regions. Anorganic bovine bone (ABB; Bio-Oss®, Geistlich Pharma AG, Wolhusen, Switzerland) was used as the bone graft material in the control group (nxa0=u20095)) while hydroxyapatite-based alloplastic bony substitute with rhBMP-2(HA+rhBMP-2; NOVOSIS®-Dent, CGBio Inc., Seongnam, Korea) was used in the experimental group (nxa0=u20095). In order to evaluate relative changes in bone volume and resorption rate of the bone graft material, CBCT radiographs were taken immediately and at 4xa0months after the bone graft in all subjects. Among the 10 patients, 8 received dental implants in Seoul National University Bundang Hospital, while the others received in local clinics. Bone specimens for further histomorphometric examinations were gained from these 8 patients using trephine burs during the implant placements. Clinical, radiographic, and histomorphometric evaluations were focused because of the small sample size.ResultsWhen CBCT radiographs were compared between immediately and at 4.07u2009±u20090.13xa0months after the bone graft, both alveolar bone widths (ABB 2.52u2009±u20090.18xa0mm, HA+rhBMP-2 1.75xa0±xa00.85xa0mm) and heights (ABB 1.68u2009±u20090.17xa0mm, HA+rhBMP-2 1.57u2009±u20090.28xa0mm) increased in the two groups. Resorption rates of transplanted bone graft material in the alveolar bone widths and heights were (ABB 29.7u2009±u20098.8%, HA+rhBMP-2 31.5u2009±u20097.4%) and (ABB 39.2u2009±u200921.8%, HA+rhBMP-2 52.6u2009±u20096.5%), respectively. Histomorphometrically, ABB group showed bone formation via osteoconduction and HA+rhBMP-2 group via osteoinduction. HA+rhBMP-2 group showed more bone formation around the bone graft materials than the ABB group. Postoperative complications were not found in all subjects.ConclusionsOur study had following conclusions: (1) Ridge augmentations using HA+rhBMP-2 could be clinically useful to supplement implant placements in edentulous regions. (2) Serious postoperative complications related to the graft material did not occur.

Extraction socket sealing using palatal gingival grafts and resorbable collagen membranes

BackgroundSocket sealing surgery is performed for the preservation of the form and volume of the soft tissue by covering the resulting socket with autogenous soft tissue graft or membrane barriers. This procedure is usually necessary to improve the esthetic results of the maxillary anterior or premolar areas.MethodsThis study retrospectively investigated cases involving the open membrane technique or socket sealing surgery with a palatal gingival graft or collagen membrane where implant placement and bone grafting were performed immediately after tooth extraction. From January 2005 to December 2008, socket sealing surgery was performed in 24 patients, and 25 implants were placed.ResultsAll implants were successful in the follow-up period. In the palatal gingival graft group, the mean marginal bone loss was 1.17xa0mm during the mean follow-up period of 81.0xa0months. In the collagen membrane group, the mean marginal bone loss was 1.23xa0mm during the mean follow-up period of 76.9xa0months. There was no significant difference between the two groups.ConclusionsConsequently, socket sealing surgery is effective at minimizing the loss of soft tissue and alveolar bone.

Randomized controlled clinical trial of 2 types of hydroxyapatite-coated implants on moderate periodontitis patients

Purpose The aim of this study was to compare and analyze the peri-implant tissue conditions and prospective clinical outcomes associated with 2 types of hydroxyapatite (HA)-coated implants: (1) fully HA-coated implants and (2) partially HA-coated implants with resorbable blast medium on the coronal portion of the threads. Methods Forty-four partially edentulous patients were randomly assigned to undergo the placement of 62 HA-coated implants, and were classified as the control group (partially HA-coated, n=30) and the test group (fully HA-coated, n=32). All patients had chronic periodontitis with moderate crestal bone loss around the edentulous area. The stability and clinical outcomes of the implants were evaluated using the primary and secondary implant stability quotient (ISQ), as well as radiographic, mobility, and peri-implant soft tissue assessments around the implants. The Wilcoxon signed-rank test and the Mann-Whitney test were used to evaluate differences between and within the 2 groups, with P values <0.05 considered to indicate statistical significance. Results The fully HA-coated implants displayed good retention of crestal bone, and insignificant differences were found in annual marginal bone loss between the 2 types of HA-coated implants (P>0.05). No significant differences were found in the survival rate (group I, 100%; group II, 100%) or the success rate (group I, 93.3%; group II, 93.8%). The fully HA-coated implants also did not significantly increase the risk of peri-implantitis (P>0.05). Conclusions The fully HA-coated implants did not lead to an increased risk of peri-implantitis and showed good retention of the crestal bone, as well as good survival and success rates. Our study suggests that fully HA-coated implants could become a reliable treatment alternative for edentulous posterior sites and are capable of providing good retention of the crestal bone.

A retrospective clinical study of single short implants (less than 8 mm) in posterior edentulous areas

PURPOSE The goal of this study was to evaluate the clinical outcome of single short implants, less than 8 mm in length, placed in the posterior area. MATERIALS AND METHODS A total of 128 patients (75 male and 53 female, mean age: 52.6±11.2 years) with 154 implants participated. Implant marginal bone loss, and survival and success rates were measured. RESULTS The mean follow-up period was 51.35±24.97 months. A total of 128 implants, 8 mm in length, were placed in patients who had mean marginal bone loss of 0.75 mm. These implants had a survival rate of 95.3%. Twenty-six implants, 7 mm in length, were placed in areas with a mean marginal bone loss of 0.78 mm and had a survival rate of 96.2%. Both marginal bone loss and survival rate were not statistically different among the groups. In the maxilla, 34 implants showed a mean marginal bone loss of 0.77 mm and a survival rate of 97.1%. In the mandible, 120 implants showed a mean marginal bone loss of 0.75 mm and a survival rate of 95.0%. The average marginal bone loss around all implants was 0.76±0.27 mm at the last follow-up review after functional loading. The survival rate was 95.6% and success rate was 93.5%. CONCLUSION In our study, single short implants less than 8 mm in length in the posterior areas had favorable clinical outcomes.

Intentional partial odontectomy—a long-term follow-up study

BackgroundThe surgical extraction of the third molar is the most frequently encountered procedure in oral and maxillofacial surgery and is related with a variety of complications. This study examined the efficacy of intentional partial odontectomy (IPO) in the third molars which have no periapical lesions and are located near important anatomical structures such as inferior alveolar nerve.MethodsSeven patients (four males, three females, 39.1xa0±xa011.6xa0years), who received IPO to reduce the risk of inferior alveolar nerve injury (IANI), were followed long-term. The treated teeth were horizontally impacted third molars in the mandibular left (nxa0=xa05) or mandibular right (nxa0=xa04) areas and were all ankylosed with the surrounding alveolar bone. During the IPO, the bone around the crown was removed to expose the crown, and then the tooth was resected at cement-enamel junction (CEJ). Any secondary trauma to the healthy root was minimized and remained intact after primary suture.ResultsThe mean follow-up time was 63.2xa0±xa029.8xa0months, and all sites showed good bone healing after the crown removal. Also, sensory abnormality was not found in any patients after IPO. In one patient, the bone fragments erupted 4xa0months after IPO. In other patient, an implant placed on second molar site adjacent to the third molar that received IPO was explanted about 2xa0years after the patient’s persistent discomfort.ConclusionsIn case where high risk of IANI exists, IPO may be chosen alternatively to surgical extraction to reduce the risk of nerve damage.

Minimal invasive horizontal ridge augmentation using subperiosteal tunneling technique.

BackgroundThe goal of this study was to retrospectively evaluate the prognosis of minimal invasive horizontal ridge augmentation (MIHRA) technique using small incision and subperiosteal tunneling technique.MethodsThis study targeted 25 partially edentulous patients (10 males and 15 females, mean age 48.8u2009±u200919.7xa0years) who needed bone graft for installation of the implants due to alveolar bone deficiency. The patients took the radiographic exam, panoramic and periapical view at first visit, and had implant fixture installation surgery. All patients received immediate or delayed implant surgery with bone graft using U-shaped incision and tunneling technique. After an average of 2.8xa0months, the prosthesis was connected and functioned. The clinical prognosis was recorded by observation of the peri-implant tissue at every visit. A year after restoration, the crestal bone loss around the implant was measured by taking the follow-up radiographs.One patient took 3D-CT before bone graft, after bone graft, and 2xa0years after restoration to compare and analyze change of alveolar bone width.ResultsThis study included 25 patients and 39 implants. Thirty eight implants (97.4xa0%) survived. As for postoperative complications, five patients showed minor infection symptoms, like swelling and tenderness after bone graft. The other one had buccal fenestration, and secondary bone graft was done by the same technique. No complications related with bone graft were found except in these patients. The mean crestal bone loss around the implants was 0.03xa0mm 1xa0year after restoration, and this was an adequate clinical prognosis.A patient took 3D-CT after bone graft, and the width of alveolar bone increased 4.32xa0mm added to 4.6xa0mm of former alveolar bone width. Two years after bone graft, the width of alveolar bone was 8.13xa0mm, and this suggested that the resorption rate of bone graft material was 18.29xa0% during 2xa0years.ConclusionsThe bone graft material retained within a pouch formed using U-shaped incision and tunneling technique resulted with a few complications, and the prognosis of the implants placed above the alveolar bone was adequate.