• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.1
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• pp.36-48
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• 2008

To repair bone defects in the oral and maxillofacial field, bone grafts including autografts, allografts, and artificial bone are used in clinical dentistry despite several disadvantages. The purpose of this study was to evaluate new bone formation and healing in rat calvarial bone defects using hydroxyapatite (HA, $Ca_{10}[PO_4]_6[OH]_2,\;Bongros^{(R)}$, Bio@ Co., KOREA) and tricalcium phosphate (${\beta}-TCP,\;Ca_3[PO_4]_2$, Sigma-Aldrich Co., USA) mixed at various ratios. Additionally, this study evaluated the effects of type I collagen (Rat tail, BD Biosciences Co., Sweden) as a basement membrane organic matrix. A total of twenty, 8-week-old, male Sprague-Dawley rats, weighing 250-300g, were divided equally into a control group (n=2) and nine experimental groups (n=2, each). Bilateral, standardized transosseous circular calvarial defects, 5.0 mm in diameter, were created. In each experimental group, the defect was filled with HA and TCP at a ratio of 100:0, 80:20, 70:30, 60:40, 50:50, 40:60, 30:70, 20:80, and 0:100 with or without type I collagen. Rats were sacrificed 4 and 8 weeks post-operation for radiographic (standardized plain film, Kodak Co., USA), histomorphologic (H&E [Hematoxylin and Eosin], MT [Masson Trichrome]), immunohistochemical staining (for BMP-2, -4, VEGF, and vWF), and elementary analysis (Atomic absorption spectrophotometer, Perkin Elmer AAnalyst $100^{(R)}$). As the HA proportion increased, denser radiopacity was seen in most groups at 4 and 8 weeks. In general radiopacity in type I collagen groups was greater than the non-collagen groups, especially in the 100% HA group at 8 weeks. No new bone formation was seen in calvarial defects in any group at 4 weeks. Bridging bone formation from the defect margin was marked at 8 weeks in most type I collagen groups. Although immunohistochemical findings with BMP-2, -4, and VEGF were not significantly different, marked vWF immunoreactivity was present. vWF staining was especially strong in endothelial cells in newly formed bone margins in the 100:0, 80:20, and 70:30 ratio type I collagen groups at 8 weeks. The calcium compositions from the elementary analysis were not statistically significant. Many types of artificial bone have been used as bone graft materials, but most of them can only be applied as an inorganic material. This study confirmed improved bony regeneration by adding organic type I collagen to inorganic HA and TCP mixtures. Therefore, these new artificial bone graft materials, which are under strict storage and distribution systems, will be suggested to be available to clinical dentistry demands.

• Journal of Periodontal and Implant Science
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• v.38 no.1
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• pp.7-14
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• 2008

Purpose: Chitosan & chitosan derivative(eg. membrane) have been studied in periodontal regeneration, and recently many studies of chitosan have reported good results. If chitosan's effects on periodontal regeneration are enhanced, we can use chitosan in many clinical and experimental fields. For this purpose, this study reviewed available literatures, evaluated comparable experimental models. Materials and Methods: Ten in vivo studies reporting chitosan's effects on periodontal tissue regeneration have been selected by use of the 'Pubmed' and hand searching. Results: 1. In Sprague Dawley rat calvarial defect models, amount of newly formed bone in defects showed significant differences between chitosan/chitosan-carrier/chitosan-membrane groups and control groups. 2. In beagle canine 1-wall intrabony defect models, amount of new cementum and new bone showed significant differences between chitosan/chitosan-membrane groups and control groups. The mean values of the above experimental groups were greater than the control groups. Conclusion: The results of this study have demonstrated that periodontal regeneration procedure using chitosan have beneficial effects, which will be substitute for various periodontal regenerative treatment area. One step forward in manufacturing process of chitosan membrane and in use in combination with other effective materials(eg. bone graft material or carrier) may bring us many chances of common use of chitosan in various periodontal area.

• Journal of Periodontal and Implant Science
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• v.30 no.2
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• pp.241-257
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• 2000

Autogenous periosteal grafts are an attractive alternative to existing barrier membrane materials since they meet the reqiurements of an ideal material. But no histological data are available on the effectiveness of periosteal membranes in the treatment of periodontal defects. The purpose of this study was to evaluate effect of autogenous periosteal graft on periodontal regeneration histologically. Class II furcation defects were surgically created on the second, third and the fourth premolars bilaterally in the mandibules of six mongrel dogs. The experimental sites were divided into three groups according to the treatment modalities; control group - surgical debridement only; Group I- autogenous periosteal membrane placement after surgical debridement; Group II-autogenous periosteal membrane placement after surgical debridement and bone grafting. The animals were sacrificed at 2, 4 and 12 weeks after periodontal surgery and the decalcified and undecalcified specimens were prepared for histological and histometrical analysis. Clinically all treated groups healed without significant problems. Under light microscope, at 2 weeks, control group showed significant apical epithelial migration and bone remodelling only below the notch area. But for the group I, II with autogenous periosteal graft, less apical migration of epithelium appeared and large amount of osteoid tissue showed above the notch area. Grafted periosteal membrane was indiscernable at 4 weeks, so periosteal membrane might be organized to surrounding tissues. Histometrically, at 4 and 12 weeks, all the test and control groups didn't show significant change of epithelial zone but new attachment level tended to be gained in the test groups than control group. These results suggest that autogenous periosteal grafts should be a good alternative for guided tissue regeneration.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.5
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• pp.444-450
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• 2007

In general, labiolingual or buccolingual widths of residual alveolar bone are insufficient in edentulous area, because of alveolar resorption. Horizontal augmentation is bone graft procedure with a view to reinforcing horizontally insufficient bone quantity for installation of implants. The standard method is taking appropriate amount of block bone from intraoral or extraoral autogenous bone, and solid fixation with screws or mini-plate on labial or buccal side of residual alveolar bone. The purpose of this study is to discuss clinical usefulness of horizontal augmentation with autogenous block bone by observation and analysis of course of 41 implants installed to 12 patients by horizontal augmentation in Seoul National University Bundang Hospital from July, 2002 to December, 2005. The mean age of patients is 52.7, from 19 to 70, and the number of men and women is each 2 and 10. Block bone was taken from symphysis, body, ramus of mandible or iliac bone. And 6 types of implants were installed simultaneously or not, the diameters of implants are from 3.3 to 5.5mm, the lengths are from 8 to 15mm. The operator added artificial bone grafting material and optionally covered with membrane. The mean periods of observation after operation and final prosthetics were 28.6 and 17.0 months. As a result, 40 among 41 implants survived, the survival rate was 97.6%. Average 0.9mm crestal resorption was observed at final point of time by periapical view of each patients. Major complication related to the procedure was numbness in 7 patients.

• Journal of Korean Dental Science
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• v.16 no.2
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• pp.218-226
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• 2023

Treatment of multiple gingival recession defects is usually more challenging than that of single gingival recession. Various techniques for the treatment of multiple gingival recession have been established. Recently, vestibular incision subperiosteal tunnel access (VISTA) technique has been considered to exhibit high predictive ability. Connective tissue graft (CTG) has also been considered a gold standard technique owing to its high predictability of root coverage. However, this technique requires a suitable donor site and has clinical disadvantages, such as additional pain. Thus, in this case presentation, platelet-rich fibrin (PRF) was used as an alternative material for CTG along with VISTA. We herein report cases of two patients with Miller's class I and III multiple gingival recession defects, respectively. These patients underwent VISTA along with the use of a PRF membrane. They were followed up for 12 months postoperatively, and their clinical parameters, including probing depth, depth of gingival recession, clinical attachment level, and width of attached gingiva at baseline and at 2, 6, and 12 months postoperatively, were assessed. The patient with class 1 recession defects exhibited a significant amount of root coverage, which remained stable during the follow-up period. Whereas the patient with class 3 recession defects had lesser amount of coverage compared to class 1 patient. The partial coverage observed may be attributed to not only anatomical factors but also the technique-sensitive nature of the procedure. Considering these results, the use of VISTA along with PRF is a viable option for treating gingival recession, as it does not cause discomfort to patients. However, various factors need to be considered during the surgical procedure.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.2
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• pp.153-159
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• 1991

The use of the autogenous free fat is a well-known procedure to fill in superficial depressions resulting from the traumatic or congenital defects. The major donor site for this procedure was the abdominal subcutaneous fat or buttocks. In 1977, Egyedi was the first to report the use of the buccal fat pad as a pedicled graft. The buccal fat pad is a structure usually considered to be a nuisance when encountered in intraoral procedures such as facial bone osteotomies, elevation of buccal falp, or procedures on Stensen's duct. In these operations, appearance of the buccal fat pad complicates surgical exposure. The buccal fat pad is a lobulated convex mass of fatty tissue covered by a very delicate membrane, and is described as having a body from which four processes extend. These projection serve as a filling material between the various muscular structures in the area. Recently malar depression was augmented with the pedicled buccal fat pad in 3 cases, and it was used for the reconstruction of the nasolabial fold in one case.

• Journal of Periodontal and Implant Science
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• v.38 no.2
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• pp.163-170
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• 2008

Purpose: Biphasic calcium phosphates have been of great interest recently. Mixing adequate ratios of hydroxyapatite(HA) and beta-tricalcium phosphate($\beta$-TCP) allowed to control the resorption rate without distorting its osteoconductive property. This study evaluated the bone formation effect of newly developed biphasic calcium phosphate(BCP) in calvarial defect of rabbits. Materials and Methods: 6 male New Zealand rabbits were used. Four defects with 8mm in diameter were created on each animal. BCP with HA/$\beta$-TCP ratio of 7:3 and particle size of $0.5{\sim}1.0\;mm$ was used as the test group and bovine bone with $0.25{\sim}1.0\;mm$ particle size, as the control group. Both test and control group materials were randomly implanted in the calvarial defects and were covered witha polymer membrane. The animals were sacrificed after 12, 24, and 48 weeks of implantation under general euthanasia. Resin blocks were obtained and were stained by masson's trichrome for histological observation. Results: Overall results were uneventful without any defect exposure or inflammation. The amount of new bone formation and bone maturity increased with increase in healing period at both groups. New bone in test group was mostly formed along the material particle surrounded by osteoblasts, and observation of osteoblastic stream was also present. Bone maturity increased as it was closer to thedefect margins. Under the same healing period, the test group showed more bone formation than the control group with more stable bovine bone particles remaining even after 48 weeks, whereas considerable resorption took place in BCP. Almost total defect closure was observed in test group with new bone formation in the central part of the defect. However, limited new bone formation was observed in the control group. Conclusion: Within the limits of the study, the present study reveals the newly developed BCP to be a good osteoconductive material. However, further studies are needed to be conducted in a different study model with a larger sample size.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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• pp.189-199
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• 2006

Purpose of study: Partial thickness skin graft is the golden standard regimen for full-thickness skin defect caused by burn or trauma. However, in case of extensive burns of more than 50% of total body surface area, the donor site is not sufficient to cover all defects. As a second choice, allograft, xenograft and synthetic materials have been used to treat skin defect. Among them the amniotic membrane(AM) was used as a biological dressing for centuries because of its potential for wound healing. In this study, quantification of EGF in AM and effect of AM-collagen complex on full thickness skin defects was examined. Materials & Methods: The concentration of EGF in fresh, deep frozen and freeze-dried AM was evaluated by ELISA. EGF-R immunostaining was performed in freeze-dried AM. SD rats weighing 250${\sim}$300g was used for wound healing experiment. Three full thickness skin defects(28mm diameter) were made on dorsal surface of SD rat. The control group was covered by Vaselin gauze and AM-collagen complex and $Terudermis^{(R)}$. was grafted in two other defects. Healing area, Cinamon's score were evaluated before biopsy. Grafted sites were retrieved at 3 days, 1 week, 2 weeks and 4 weeks after operation. H & E and Factor VIII immunohistochemical stain was performed to evaluate the microscopic adhesion and structural integrity and microvessel formation. Results: 1. EGF concentration of fresh, deep frozen and freeze-dried AM showed similar level and EGF-R was stained in epithelial layer of freeze-dried AM. 2. At 4 weeks after grafting, the healing area of AM-collagen and Terudermis group was 99.29${\pm}$0.71% and 99.19${\pm}$0.77 of original size. However, that of control group was 24.88${\pm}$2.90. 3. The Cinamon's score of AM-Collagen and $Terudermis^{(R)}$. group at 4 weeks was 15.6${\pm}$1.26 and 14.6${\pm}$3.13 and that of control group was 3.7${\pm}$0.95. Significant difference was observed among control and experimental groups(p<0.05). 4. Histologic examination revealed that AM protected leukocyte infiltration and epithelial migration was nearly completed at 4 weeks. $Terudermis^{(R)}$. group showed mild neutrophil infiltration until 2 weeks and completion of epithelization at 4 weeks. Control group showed massive leukocyte infiltration until 4 weeks. 5. Microvessels were increased sharply at 1 week and control group at 1 and 4 week showed significant differences with $Terudermis^{(R)}$. group of same interval(p<0.05) but no differences were found with AM group(p<0.05). Conclusion: EGF and EGF-R were well preserved in freeze-dried AM. AM attached to collagen acted as excellent biologic dressing which had similar effect with $Terudermis^{(R)}$. AM showed anti-inflammatory action and healing was completed at 4 weeks after full-thickness skin defect.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.4
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• pp.352-358
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• 2011

Purpose: This study evaluated the prognosis and survival rate of SLA (Sandblasted, Large-grit and Acid-etched) implants and it also evaluated the prosthodontic complications and the associated factors. Methods: Twenty seven patients (14 men and 13 women, mean age: 54.9) who visited Chosun University Hospital Implant Center with the chief desire for placement of an implant in an edentulous area from March, 2008 to December 2008 and who received placement of a SLA implant ($Implantium^{(R)}$, Dentium Co., Korea) were selected for this study. Results: The average follow-up period was 15 months and the study was based on the treatment records, radiographs and clinical examinations. A total of 69 implant cases were retrospectively assessed for the width and length of the implant, the primary and secondary stability, the combined surgery, the employed bone graft material and barrier membrane, the status of the opposing tooth, implant failure and the prosthetic complications. During the follow-up period (average: 15 months), the accumulative survival rate of the 69 implants in 27 patients was 100%. Complications such as infection, sinusitis and fixture exposure after surgery were seen for 5 implants in 4 patients. Complications such as screw loosening, contact loosening and peri-implant gingivitis after prosthodontic treatment occurred in 7 cases (10.14%). Conclusion: This study reports placement of SLA implants may cause various complications, yet the final accumulative survival rate was 100%. The SLA implant ($Implantium^{(R)}$) has an excellent clinical survival rate and outcome.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.1
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• pp.1-11
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• 2012

Purpose: The purpose of this study was to evaluate the bone regeneration capacity of silk fibroin (SF) when combined with beta tricalcium phosphate (${\beta}$-tricalcium phosphate [TCP]) and rh-bone morphogenetic protein (BMP) in vivo by micro-computed tomography (CT), soft x-ray, and histological analysis. Methods: A total of 56 critical size defects formed by a trephine bur made on 28 adult female Spague-Dawley rats were used for this study and the defect size was 5.0 mm in diameter. The defects were transplanted with (1) no graft material (raw defect), (2) autogenous bone, (3) SF ($10{\mu}g$), (4) SF-BMP ($10{\mu}g$, $0.8{\mu}g$ each), and (5) SF+${\beta}$-TCP ($10{\mu}g$). At 4 and 8 weeks after operation, the experimental animals were sacrificed. Samples were evaluated with soft x-ray, histological examinations and 3-dimensional micro-CT analysis. Results: In the 3-dimensional micro-CT evaluation, bone volume and bone surface data were higher in the SF-BMP ($12.8{\pm}1.5$, $138.6{\pm}45.0$ each) (P<0.05) and SF-TCP ($12.3{\pm}1.5$, $144.9{\pm}30.9$ each) group than in the SF group ($6.1{\pm}3.3$, $77.2{\pm}37.3$ each) (P<0.05), except for the autogenous group ($15.0{\pm}3.0$, $190.7{\pm}41.4$ each) at 4 weeks. At 8 weeks, SF-BMP ($16.8{\pm}3.5$, $173.9{\pm}34.2$ each) still revealed higher (P<0.05) bone volum and surface, but SF-TCP ($11.3{\pm}1.5$, $1132.9{\pm}52.1$ each) (P=0.5, P=0.2) revealed the same or lower amount compared with the SF group ($13.8{\pm}2.7$, $127.5{\pm}44.8$ each). The % of bone area determined by radiodensity was higher in the SF-TCP ($31.4{\pm}9.1%$) and SF-BMP ($36.2{\pm}16.2%$) groups than in the SF ($19.0{\pm}10.4$) group at the period of 4 weeks. Also, in the histological evaluation, the SF-BMP group revealed lower inflammation reaction, lower foreign body reaction and higher bone healing than the SF group at postoperative 4 weeks and 8 weeks. The SF-TCP group revealed lower inflammation at 4 weeks, but accordingly, as the TCP membrane was absorbed, inflammatory and foreign body reaction are increased at 8 weeks. Conclusion: The current study provides evidence that the silk fibrin can be used as an effective grafted material for tissue engineering bone generation through a combination of growth factor or surface treatment.