Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
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DISPLACEMENT OF MAXILLARY LATERAL INCISOR CAUSED BY IDIOPATHIC GINGIVAL FIBROMATOSIS

특발성 치은 섬유종증에 의한 상악 측절치의 변위

  • Jung, Ji-Sook (Department of Pediatric Dentistry, College of Dentistry, Gangneung-Wonju National University) ;
  • Park, Ho-Won (Department of Pediatric Dentistry, College of Dentistry, Gangneung-Wonju National University) ;
  • Lee, Ju-Hyun (Department of Pediatric Dentistry, College of Dentistry, Gangneung-Wonju National University) ;
  • Seo, Hyun-Woo (Department of Pediatric Dentistry, College of Dentistry, Gangneung-Wonju National University) ;
  • Lee, Suk-Keun (Department of Oral Pathology, Oral Science Research Center, College of Dentistry, Gangneung-Wonju National University)
  • 정지숙 (강릉원주대학교 치과대학 소아치과학교실) ;
  • 박호원 (강릉원주대학교 치과대학 소아치과학교실) ;
  • 이주현 (강릉원주대학교 치과대학 소아치과학교실) ;
  • 서현우 (강릉원주대학교 치과대학 소아치과학교실) ;
  • 이석근 (강릉원주대학교 치과대학 구강병리학교실 및 구강과학연구소)
  • Received : 2011.07.18
  • Accepted : 2011.08.17
  • Published : 2011.08.31
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Abstract

Idiopathic gingival fibromatosisrarely occurs, but frequently recurred after surgical removal. It usually occurs in generalized symmetrical pattern but sometimes in localized unilateral pattern. The localized pattern usually affects the maxillary molar and tuberosity area. This disease usually causes tooth migration, malocclusion, and problems in eating, speech, and esthetics. A boy showed dense gingival fibromatosis localized at primary maxillary right lateral incisor area at the age of 5 years, and his maxillary right lateral incisor become severely displaced at the age of 9 years. He had no medical and hereditary factors relevant to the gingival fibromatosis. However, the dense fibrous tissue was dominant in his labial gingiva of maxillary right incisors. In order to realign the displaced incisors by orthodontic treatment, the dense fibrous tissue covered the defect space between the central incisor and the displaced lateral incisor was surgically removed. The removed specimen was examined by simple immunohistochemical(IHC) array method. IHC array showed increased expression of CTGF, HSP-70, MMP-1, PCNA, CMG2, and TNF-${\alpha}$ in keratinocytes, fibroblasts, endothelial cells, and macrophages of gingival fibromatosis tissue. Therefore, it was suggested that the gingival fibromatosis be caused by the concomitant overexpression of CTGF, HSP-70, MMP-1, PCNA, CMG2, and TNF-${\alpha}$, and resulted in the fibroepithelial proliferation and the inflammatory reaction of gingival tissue.

특발성 치은 섬유종증은 드물게 나타나는 질환으로 외과적 제거 후에도 쉽게 재발될 수 있다. 이 질환은 보통 전반적인 양상으로 양측성으로 나타나고, 때때로 국소적인 양상으로 편측성으로 나타나기도 하며, 국소적인 양상일 경우 보통 상악구치 부나상악 결절 부위에 나타난다. 이 질환으로 인해 치아 변위, 부정 교합, 저작, 발음, 심미적인 문제 등이 발생할 수 있다. 5세 남아가 상악 우측 유측절치 부위의 치은 비대를 주소로 내원하였고, 9세경에 재내원 시 상악 우측 측절치의 심한 변위가 관찰되었다. 본 환아는 이 질환에 연관된 어떠한 의과적 병력 및 가족력이 없었으며, 임상적, 조직병리학적 검사 결과 특발성 치은 섬유종증으로 진단되었다. 교정적인 방법으로 변위된 치아를 재배열시키기 위해 상악 우측 중절치와변위된상악 우측 측절치 부위의 과증식된섬유성 조직을 외과적으로 제거하였다. 이 질환의 유전적 특성을 알기 위해 제거된 조직을 간단한 면역조직화학 배열법을 사용해 평가하였다. 평가 결과 병소 조직의 각질세포, 섬유모세포, 내피세포, 대식세포 내에 CTGF, HSP-70, MMP-1, PCNA, CMG2, TNF-${\alpha}$의 증가된 발현이 관찰되었다. 따라서 치은 섬유종증은 치은 조직의 섬유 상피성 증식과 염증 반응에 의한 CTGF, HSP-70, MMP-1, PCNA, CMG2, TNF-${\alpha}$의 수반하는 과발현에 의해 발생되었다.

Keywords

References

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