The significance of split-face studies and electromyography in forehead rejuvenation

Background@#Botulinum toxin is a neurotoxic substance with a wide range of uses, from the treatment of musculoskeletal spasms to antiaging regimens by improving wrinkles. Split-face studies in which drugs are injected in the right and left sides of the faces have been actively conducted in botulinum toxin studies. In this study, we aimed to investigate the reliability of a split-face study for determining the effectiveness of botulinum toxin based on eyebrow height and movement, and electromyography results. @*Methods@#Thirty-one women aged 35 to 55 years were included in the study. Eyebrow height was measured as the distance from the eyebrows to the upper eyelid margin on the primary gaze, and eyebrow movement was measured as the distance when the forehead was wrinkled for 5 seconds. A noninvasive method was used for electromyography of the frontalis muscles. @*Results@#No statistically significant differences in right and left eyebrow heights and movements, and electromyography findings (p= 0.256, p= 1.000, and p= 0.978, respectively) were found. Pearson correlation analysis showed that electromyography muscle activity is positively associated with eyebrow movement, respectively (p< 0.001). @*Conclusion@#We advocate the reliability of split-face study and the usefulness of electromyography of frontalis muscle in forehead rejuvenation research.

A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-to-implant breast reconstruction

Background@#Mastectomy flap necrosis is a common and challenging complication of direct-to-implant (DTI) breast reconstruction. The PICO single-use negative-pressure wound therapy device may reduce the complications associated with skin flap necrosis. We evaluated the relationship between PICO use and the incidence of mild, moderate, and severe skin flap necrosis in patients at high risk of necrosis. @*Methods@#Using medical records from January 2015 to March 2019, we retrospectively analyzed patients who underwent DTI breast reconstruction after oncological breast surgery at a single institution and identified those at high risk for skin flap necrosis. During this period, PICO was used selectively for patients deemed to be at particularly high risk. Patient demographics, operative characteristics, and the degree of skin flap necrosis were compared according to whether PICO was used. @*Results@#Of 117 patients (122 breasts), 45 were deemed to be at high risk of skin flap necrosis. PICO was applied to 38 of these breasts, and seven breasts received a conventional dressing. Skin flap necrosis occurred in 30 breasts (24 in the PICO group [63.2%] vs. 6 in the no-PICO group [85.7%]). Significantly fewer cases of severe skin flap necrosis were observed in the PICO group (2/38 [5.3%]) than in the no-PICO group (3/7 [42.9%]) (P=0.004). There were no significant between-group differences in outcomes measured using BREAST-Q scores. @*Conclusions@#Use of a single-use negative-pressure wound therapy device can reduce the risk of severe skin flap necrosis in patients at high risk of skin flap complications associated with DTI breast reconstruction.

Pin-site scar revision with subcisions and acellular dermal matrix

External fixation is widely used in orthopedic and reconstructive surgery. However, it may leave retracted and depressed scars because it involves the percutaneous placement of transosseous pins or wires that are secured to an external scaffolding. These scars do not resolve or improve spontaneously, causing patients to experience dissatisfaction and possibly requiring a surgical intervention. Moreover, the management of scars that arise from external fixator pin sites is challenging because of their fibrotic and depressive features. However, by using subcisions and inserting acellular dermal matrix under the scars, the contour of the scars can be improved easily. Therefore, we present a case of pin-site scar revision using a technique that we developed.

Healing pattern of the mucous membrane after tooth extraction in the maxillary sinus

PURPOSE: To investigate the healing pattern of the mucous membrane after tooth extraction necessitated by periodontal disease in the maxillary sinus. METHODS: One hundred and three patients with 119 maxillary sinuses were investigated. Before implant placement, cone-beam computed tomography (CT) scanning was performed. The causes of extraction, the time elapsed since extraction, smoking, periodontal disease in adjacent teeth, and gender were recorded. In addition, the thickness of the mucous membrane of the maxillary sinus and the height of residual alveolar bone at the extracted area were calculated from CT images. RESULTS: The thickness of the mucous membrane in the periodontal disease group (3.05+/-2.71 mm) was greater than that of the pulp disease group (1.92+/-1.78 mm) and the tooth fracture group (1.35+/-0.55 mm; P<0.05). The causes of extraction, the time elapsed since extraction, and gender had relationships with a thickening of the mucous membrane of the maxillary sinus (P<0.05). In contrast, the height of the residual alveolar bone at the extracted area, periodontal disease in adjacent teeth, and smoking did not show any relation to the thickening of the mucous membrane of the maxillary sinus. CONCLUSIONS: The present study revealed distinct differences in healing patterns according to the causes of extraction in the maxillary sinus, especially periodontal disease, which resulted in more severe thickening of the mucous membrane.

Healing pattern of the mucous membrane after tooth extraction in the maxillary sinus

PURPOSE: To investigate the healing pattern of the mucous membrane after tooth extraction necessitated by periodontal disease in the maxillary sinus. METHODS: One hundred and three patients with 119 maxillary sinuses were investigated. Before implant placement, cone-beam computed tomography (CT) scanning was performed. The causes of extraction, the time elapsed since extraction, smoking, periodontal disease in adjacent teeth, and gender were recorded. In addition, the thickness of the mucous membrane of the maxillary sinus and the height of residual alveolar bone at the extracted area were calculated from CT images. RESULTS: The thickness of the mucous membrane in the periodontal disease group (3.05+/-2.71 mm) was greater than that of the pulp disease group (1.92+/-1.78 mm) and the tooth fracture group (1.35+/-0.55 mm; P<0.05). The causes of extraction, the time elapsed since extraction, and gender had relationships with a thickening of the mucous membrane of the maxillary sinus (P<0.05). In contrast, the height of the residual alveolar bone at the extracted area, periodontal disease in adjacent teeth, and smoking did not show any relation to the thickening of the mucous membrane of the maxillary sinus. CONCLUSIONS: The present study revealed distinct differences in healing patterns according to the causes of extraction in the maxillary sinus, especially periodontal disease, which resulted in more severe thickening of the mucous membrane.

Clinical study of guided bone regeneration of extracted socket with PLA/PGA membrane and silk fibroin membrane / 대한치주과학회지

PURPOSE: This study was designed to compare the bond regeneratiom effects of treatment using silk fibroin membrane ( Nanogide-S (R)) resorbable barrier with control group treated by polyactic acid / polylacticglycolic acid membrane(Biomesh (R) ) METHODS:44 severe bone loss on extraction socket from 44 patients were used in this study. In experimental group 22 sites of them were treated by silk fibrin membrane as and the other 22 sites were treated by polyactic acid/ polylacticglycolic acid membrane as a control group. Clinical parameters including recovered bone width, length and radiographic parameter of vertical length were evlauated at base line and 3 months after surgery. RESULTS: 1) Severe bone width, length was significantlly decreased in two group. 2) Bone width, length was significantlly decreased in two group. 3) Decreased bone width, length and radiographic examination differences between group. CONCLUSIONS: On the basis of these results, silk fibrin resorbable membrane has similar bone regeneration ability to polyactic acid / polylacticglycolic acid membrane in guided bone regeneration for severe bone loss defect on extraction socket.

Effect of poly(lactide-co-glycolide) (PLGA) on bone regeneration in rabbit calvaria / 대한치주과학회지

PURPOSE: The purpose of this study is to histologically and histomorphometrically evaluate the effect of PLGA on bone regeneration compared with bone graft material. METHODS:The experimental study was conducted in 10 rabbits with 2 different healing periods of 2 and 4 weeks. Following surgical exposure of the calvarium, 4 circular bone defects with a diameter of 4.6mm were formed. Rabbits were divided into control group, test groups I, and II. 10 defects assigned to the test group I were grafted with Nu-oss and other 10 defects assigned to the test group II were grafted with PLGA. The rest of the defects were in the negative control group. At 2nd and 4th week after surgery, 10 rabbits were sacrificed through intracardiac perfusion and then specimens were obtained. Histological analysis was performed following staining with trichorme and transversal sectioning of the calvarial bone. RESULTS: A group which used PLGA showed tissue reactions characterized by severe inflammation, rather than distinctive new bone formation. CONCLUSIONS: The present experimental investigations have failed to prove any beneficial effects of PLGA. PLGA used in this study exhibited foreign body reactions and a less favorable pattern of new bone formation in comparison to control group. CONCLUSION: PLGA did not function as scaffold. Further investigations of many types of micro PLGA that could improve its potential in GBR procedures are needed.

Ridge Augmentation Using Vascularized Interpositional Periosteal- Connective Tissue (VIP-CT) in Conjunction with Anterior Implant Placement in Maxilla: Report of Three Cases / 대한치주과학회지

PURPOSE: The aim of augmentation of the alveolar ridge is to restore absorbed alveolar ridges for future implant site or esthetic prosthodontic restoration. The present clinical report describes the anterior maxillary augmentation cases using a soft tissue rotated palatal flap, and considers various problems of before and after surgery. Method: First & second patients were treated by vascularized interpositional periosteal-connective tissue(VIP-CT) flap for horizontal soft tissue augmentation. Especially second patient was progressed with bone grafting at the same time. Third patient was treated by the same flap with bone graft and implant placement in single tooth missing premaxillary area. RESULT: The obtained horizontal augmentation width measured 0.5~2.7 mm. CONCLUSION: This technique constitutes a viable approach for augmentation the anterior sector of alveolar ridge with the placement of dental implants. But it needs correct diagnosis preparation and careful surgery skill.

Gingival recession of lower anterior incisors in orthodontic treatment / 대한치주과학회지

PURPOSE: These case reports show the orthodontic treatment of lower anterior incisors with gingival recession. MATERIALS AND METHODS: Three cases were treated by an orthodontist and a periodontist. Each case had lingually tilted lower anterior incisors, anterior crossbite and skeletal Cl III pattern. RESULTS: A variety of etiological factors were thought to cause gingival recession: aging, oral hygiene, tooth malpositioning, occlusal trauma. CONCLUSION: Due to the interaction among many possible contributing factors, it is difficult to predict whether further gingival recession may occur at a given site. The position and the movement of the lower anterior incisors with gingival recession are important factors in diagnosis and orthodontic treatment planning.

Connective tissue graft for root coverage / 대한치주과학회지

PURPOSE: The treatment of gingival recessions is needed to reduce root sensitivity and improve esthetical satisfaction. Several surgical techniques have been proposed to achieve these goals. The use of connective tissue grafts has made esthetic root coverage a predictable procedure. Numerous clinical studies have represented that using connective tissue grafts to cover exposed root surface showed high success rates. This is a case report which demonstrates the technique to obtain root coverage of a buccal recession defect. MATERIALS AND METHODS: A 35-year-old patient with a high level of oral hygiene was selected for the study. This patient had one Class I Miller recession defect in the mandible. A coronally advanced flap in combination with the connective tissue graft was chosen for the treatment. After surgery, the patient was told to visit the hospital once a week for his oral management and professional prophylaxis. The depth of initial recession was 4.0 mm. RESULT: After three months, it reduced to 0.0 mm, and the average recession reduction was 4.0 mm. The average root coverage was 100%. CONCLUSION: The connective tissue graft is both effective and predictable way to produce root coverage in increasing the width of CAL and KT of various adjacent gingival recessions.

Inhibitory effects of Enterococcus faecium isolated from Korean infants on oral pathogens / 대한치주과학회지

PURPOSE: The probiotic effects of lactic acid bacteria have widely been researched in diverse human pathogens, but only a few effects are reported against oral pathogens. The antimicrobial effects of the Enterococcus faecium 7413 isolated from Korean infants on the 9 pathogen including 6 oral streptococci were investigated the clinical use of the antimicrobial peptide for oral microflora control. MATERIALS AND METHODS: E. faecium 7413 was identified by morphological, biochemical tests and 16S rDNA sequence analysis. Inhibitory effects of culture supernatants were determined for their ability to grow on agar plate containing pathogenic bacteria. RESULT: The culture supernatant of Enterococcus faecium 7413 showed inhibitory effects on oral pathogens, namely Streptococcus pyogenes KCTC 3556, S. pneumoniae KCTC 5080, S. mutans ATCC 25175, S. anginosus ATCC 33397, S. constellatus KCTC 3268, S. intermedius ATCC 27823 and Shigella flexneri KCTC 2008. Whereas it did not affect the multiplication of E. coli strains, KCTC 1041 and ATCC 43894. CONCLUSION: The data obtained in this study could be useful for future development of effective probiotics allowing prevention for oral pathogens.

Comparative S tudy Of Osseointergration On Different Immediate Implants In Extraction Sockets Of Beagle Dogs / 대한치주과학회지

Recently, immediately after losing teeth, implant placement has been greatly attempted. Implant can help restoration of tooth functions within short time. This study was an attempt to examine the extent of osseointergation when the implants will be placed immediately after teeth extraction using domestic implant systems. Implants were inserted in beagle dogs and evaluated the clinical, radiological, histological and histomorphometric assay at 6 weeks and 12 weeks. For experimental materials, STAGE-1(R)(4.1x8mm, Lifecore, USA), SS-III(R)(4.0x8mm, OSSTEM, Korea) and IFI(R)(4.0x8 mm, DIO, Korea) implants treated with RBM were placed. All the placed site showed normal results without fail and inflammation clinically and radiologically. As a result of measurement by periotest, it showed -2 ~ -5 and stable status comprehensively. There was no statistically significant difference among implants(p<0.05). Bone tissue adjacent to implant showed increased marrow tissue at 6 weeks. Nevertheless, osteogenic structure was not observed remarkably. In a 12 weeks opinion, bone tissue composed of osseointegration along implant interface showed significantly decreased marrow tissue containing central vessels unlike a 6 weeks opinion and matured compact bone whose osteogenic structure is well formed. BIC were 42.4%, 32.0% and 34.9%, respectively in 6 weeks and there was no statistically significant difference among groups(p<0.05). In 12 weeks, BIC were 58.8%, 61.9% and 57.5%, respectively and there was no statistically significant difference among groups(p<0.05). It is considered that all 3 implant systems are suitable for immediate implant placement.

Study on Osseointegration of the Immediate Placement Using Korean Implant Systems in Beagle Dog / 대한치주과학회지

This study was attempted to evaluate home-manufactured implants by placing Stage-1(R) Implant (Lifecore. Co., USA) whose surface is treated with RBM that has already been varified clinically, Chaorum(R) Implant(Chaorum Co., Korea) whose surface treatment is same as that of Stage-1 Implant and Atlas(R) Implant(Cewellmedi Co., Korea) whose surface is treated with anodic oxidation immediately after the teeth of experimental animals were extracted to compare histological findings among them. Stage-1 Implant(diameter: 3.5mm, length: 10mm), Chaorum Implant(diameter: 3.3mm, length: 8.5mm) and Cowell medi Implant(diameter: 4.0mm, length: 8.0mm) were placed into the mandible premolars of 2 adult beagle dogs immediately after their teeth were extracted, and then histological findings were analyzed at 6 weeks. After those implants were inserted directly after their teeth were extracted, the results of periotest were recorded, radiography was done, the subjects went through thorough control for 6 weeks, and then comparison among periotest, radiography and histological finding was made. After comparison of those findings, the values of periotest were satisfactory and bone healing was relatively satisfactory on radiography at 6 weeks. For osseointegration with the bone tissue, Stage-1 was 45.3%, Chaorum 55.3%, and Cowellmedi 52.5%, which was a satisfactory result. Although implant surgery immediately after teeth were extracted involves difficulties among recent implant surgeries, it is being frequently used in that it may reduce surgery hours, the frequency of surgery, and bone loss for patients. This experiment was conducted to evaluate the technological levels of home-manufactured implants that have been remarkably developed in recent years and in conclusion, those implants showed nearly similar result.

Effects of irradiated frozen allogenic bone on bone formation in human fetal osteoblasts / 대한치주과학회지

The purpose of this study was to investigate the effects of irradiated frozen allogenic bone(IFAB) on the cell proliferation and differentiation of human fetal osteoblasts. Human fetal osteoblasts(hFOB1) were cultured to examine the cellular proliferation for 3 days and 5 days with 1mg/ml, 100microgram/ml, 10microgram/ml, 1microgram/ml, 100ng/ml, 10ng/ml, 1ng/ml of IFAB, and to compare the ALP synthesis to control groups for 3 days with DMEM/F-12 1:1 Mixture and 1mg/ml, 100microgram/ml, 10microgram/ml, 1microgram/ml, 100ng/ml, 10ng/ml, 1ng/ml of IFAB. To compare the calcium accumulation, hFOB1 cultured for 23 days were quantified and photographed. The cellular proliferation of hFOB1s treated with IFAB was increased at 5 days to control(p<0.05). The activity of ALP in hFOB1s treated with 100ng/ml IFAB was significantly increased at 5 days(p<0.05). A quantified calcium accumulation in hFOB1 was significantly increased at 100ng/ml, 10ng/ml of IFAB(p<0.05). In the present study, we found that IFAB play a important role of bone formation in the early stage. There was considered that IFAB could be used in the bone graft material.

Study on osseointegration of a Korean Transitional implant system in beagle dog / 대한치주과학회지

PURPOSE: Recently, dental implant systems have been widely used for the treatment of the extraction site, but we have been confronted with many limitations in esthetics, phonetics and function. Transitional implants(TI) were developed as a method of providing fixed provisional restorations during conventional implant healing. Until now, little data have been provided on korean transitional implants. The purpose of this study is to evaluate the implant placement site histologically after 4 weeks and 8 weeks. MATERIALS AND METHODS: Test group( IntermetzzoTM MEGAGEN, KOREA) and control group(Mini Drive Lock, Intra Rock, U.S.A.) were immediately placed in interseptal or interproximal bone of beagle dog after mandibular premolars extraction, and had a healing period with non-submerged state but without loading, Both TI surfaces were composed of rough surfaces. RESULTS: In the test group, the average percentage of BIC were respectively 39.40%(SD7.35) after 4 weeks and 44.05%(16.76) after 8 weeks, and In the control group were 50.75%(1.48) and 59.40%(0.00). DISCUSSION: We evaluated the initial ability of the osseointegration of TI through this study. Because TI is placed with a conventional implant simultaneously and loaded immediately, the ability of osseointegration is a very important factor for the success of TI during the initial healing phase. CONCLUSION: The results of the histological evaluation of these two groups were similar to those mentioned in other studies for osseointegration of implant.

Clinical study on therpeutic effects of Guided tissue regeneration by Nanogide-C(R) and Biomesh(R) in furcation defects / 대한치주과학회지

This study was designed to compare the effects of treatment using chitosan membrane (Nanogide-C(R)) resorbable barrier with control treated by polylactic acid/polylacticglycolic acid membrane(PLA/PLGA membrane, Biomesh(R)). 44 furcation defecs from 44 patients with class 2 furcation degree were used for this study, 22 sites of them were treated by chitosan membrane as experimental group and 22 site were treated by PLA/PLGA membrane as control group. Clinical parameters including probing depth, gingival recession, attachment level and radiographic examination were evlauated at base line, 1 month, 2 month and 3 month. after surgery. Statistical test used to analyze these data included paired t-test, one way ANOVA. The results are as follows : 1. Probing depth was significanlly decreased in the two group and there were significant differences between groups(p<0.05). 2. Gingival recession was not significanlly increased in the two group and there were no significant differences between groups(p<0.05). 3. Loss of attachment was statistically decreased in the two group and there were no significant differences between groups(p<0.05). 4. Horizontal bone level was significanlly increased in the two group and there were significant differences between groups(p<0.05). On the basis of these results, chitoans resorbable membrane has similar potential to PLA/PLGA membrane in GTR for furcation defect.

Osteoblastic differentiation of adult stem cells by Biphasic Calcium Phosphate / 대한치주과학회지

The present study was to determine the influence of micro-macro biphasic calcium phosphate(MBCP) on proliferation and differentiation of human marrow-derived mesenchymal stem cells. Primary stem cells were cultured from bone marrow and 3-4 passaged cells were used. This study tested the proliferative effects by cell counting. Collagen sythensis, alkaline phosphatase activity, expression of osteocalcin and bone sialoprotein by Western blot analysis were evaluated. The cellular proliferation of ASC was not influenced by MBCP. Collagen synthesis of ASC cultured on MBCP significantly increased at 5th and 7th days(p<0.05). The ALP activity in ASC cultured on MBCP significantly increased at 5th and 7th days(p<0.05). The expression of OC and BSP incresaed in ASC cultured on MBCP. These results suggest that MBCP may stimulates the osteoblastic activity of ASC.

Protective Effect of Heat Shock Protein 70 Against Oxidative Stresses in Human Corneal Fibroblasts

We evaluated DNA protection effect of heat shock protein (HSP) against cytotoxic effects of exogenous nitric oxide (NO) and reactive oxygen intermediate (ROI). Cultured human corneal fibroblasts were divided into 4 groups. Control (Group I) was not exposed to a sub-lethal heat treatment. Other 3 groups were exposed to 43 degrees C for 1 hr, then incubated at 37 degrees C during different duration (1, 6, 24 hr, Group II, III, IV, respectively). Expression pattern of HSP 70 was analyzed by Western blot. Cell viability was measured by MTT assay and the relationship between HSP 70 expression and DNA damage was examined by terminal deoxyribonucleotidyl transferase mediated dUTP-digoxigenin nick and labeling (TUNEL) stain and single cell gel electrophoresis. Expression pattern of HSP 70 was dependent on recovery times. Cell viability following heat treatment was significantly increased and the TUNEL positive cell number was decreased at 6 hr. In single cell gel electrophoresis, tail moments were increased in a dose-dependent manner by SNAP and X/XO. Following heat treatment, tail moments showed decreased significantly at 6 hr. These results suggest that induction of HSP 70 by sub-lethal heat treatment is closely related with cytoprotective effects against oxidative stresses in human corneal fibroblasts.

Four Cases of Avellino Corneal Dystrophy Concurrent with Floppy Eyelid Syndrome

PURPOSE: Avellino corneal dystrophy (ACD) is the most common form of inherited corneal disorder in Korea. To report 4 cases of ACD concurrent with floppy eyelid syndrome (FES), which had not been previously reported, and to find an additional mutation. METHODS: Five patient in 2 families who were diagnosed as ACD patient were examined whether they had FES. PCR, cold-SSCP and sequencing analysis were performed for identification of genetic defect. RESULTS: Four of 5 ACD patients showed FES which characterized by easily everted eyelid and conjunctival papillary reaction. In one family, succeeding two generations had this feature. We identified R124H mutation in all 5 ACD patients, however, no additional mutation wsa identified in BIGH3 gene. CONCLUSIONS: One case series suggested that there may be some linkage between the genes responsible for ACD and FES.

Fungal Keratitis Caused by Chromomycetes

PURPOSE: Chromomycetes is a plant parasite and one of the pigmented filamentous fungi, which rarely causes human infection. The authors report the first case of fungal keratitis caused by chromomycetes in korea. METHODS: A 65-year-old woman developed pain, redness, and an yellowish-brown infiltrate in her right eye. She had a history of corneal scratch by a pumpkin stalk and transferred by a local clinic after management for about 1 months. The clinical features suggested fungal keratitis, and the patient was undertaken surgical debridement with amniotic membrane graft and treated with oral terbinafine with natamycin and amphotericin B eyedrops. Surgically taken biopsy specimen was cultured. Amniotic membrane was removed after 1 week. After slight improvement of symptom, necrotizing ulceration was enlarged in spite of continuous antifungal therapy. Lamellar keratoplasty with amniotic membrane graft was done with antifungal therapy. Systemic agent was changed to fluconazole. Clinical improvement was achieved after about 2 months. The fungus was identified as Fonsecaea pedrosoi. RESULTS: Fungal keratitis was successfully treated with antifungal medication combined with amniotic membrane graft. CONCLUSIONS: This is a rare case of infectious keratitis caused by chromomycetes. But its clinical course was severe, so exact culture and identification following aggressive surgical and medical treatment was needed.