• Journal of Periodontal and Implant Science
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• v.36 no.1
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• pp.223-237
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• 2006

The purpose of the present study was to evaluate the effect of bone graft materials including deproteinized bovine bone(DBB), demineralized freeze-dried bone(DFDB), freeze-dried bone(FDB) on bone formation in guided bone regeneration using perforated titanium membrane(TM). 16 adult male rabbits(mean BW 2kg) were used in this study and 4 rabbits allotted to each test group. Intramarrow penetration(diameter 6.5mm) was done with round carbide bur on calvaria to promote blood supply and clot formation in the wound area. The test groups were devided into 4 groups as follows: TM only(test 1), TM +DBB(test 2), TM +DFDB(test 3), TM +FDB(test 4). Perforated titanium membrane was contoured in rectangular parallelepiped shape(0.5mm pore diameter, 10mm in one side, 2mm in inner height), filled the each graft material and placed on the decorticated carvaria. Perforated titanium membrane was fixed with resorbable suture materials. The animals were sacrificed at 2, 8 weeks after the surgery. Non-decalcified preparations were routinely processed for histologic analysis. The results of this study were as follows: 1. Perforated titanium membrane was biocompatible. 2. Perforated titanium membrane had capability of maintaining the space during the healing period but invasion of soft tissue through the perforations of titanium membrane decreased the space available for bone formation. 3. In test 1 group without bone graft material, the amount of bone formation and bone maturation was better than other test groups. 4. Among the graft materials, the effect of freeze-dried bone on bone formation was best. 5. In the test groups using deproteinized bovine bone, demineralized freeze-dried bone, bone formation was a little. The spacemaking capability of the membrane may be crucial for bone formation. The combined treatment with the perforated titanium membrane and deproteinized bovine bone or demineralized freeze-dried bone failed to demonstrate any added effect in the bone formation. Minimization of size and numbers of perforations of titanium membrane or use of occlusive titanium membrane might be effective to acquire predictable results in the vertical bone formation.

• Journal of Periodontal and Implant Science
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• v.35 no.4
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• pp.949-959
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• 2005

이 연구는 임플란트를 식립하기를 원하는 전신건강상태가 양호하며 구강위생상태가 좋은 14명 환자(남자:8명, 여자:6명, 평균나이 : 44세)의 20개의 발치와 내에 흡수성 차폐막(BioMesh. Sam Yang Corporation, Korea)과 함께 탈회냉동 건조동종 골(dem-ineralized freezedried bone allografts, $250-500{\mu}m$. Pacific Coast Tissue Bank, U.S.A.)과 이종골(Bovine-Bone, Bio-Oss 0.25-1.0 mm, Geistlich, Biomaterials and Osteohealth, Switzerland)을 1:1(부피)로 혼합하여 이식한 후 그 치유양상을 관찰하고자 조직학적 및 면역조직화학적으로 평가하였다. 이직재가 탈락되는 것을 방지하기 위하여 발치한 후 1개윌이 경과된 후에 이식재와 차폐막을 위치시켰다. 표본제작을 위하여 이식술을 시행한 지 약 6개윌 후에 임플란트를 식립하기 직전 식립부위에서 trephine bur로 골을 채취하였는데, 20증례 중 7증례에서 임플란트를 식립하기 전에 차폐막이 노출되었다. 차폐막이 노출되지 않은 것을 대조군으로, 노출된 것을 실험군으로 설정하였다. 조직학적인 관찰을 위하여 통상적인 방법에 따라 탈회 표본을 제작하였고, alkaline phosphotase(ALP)틀 이용하여 면역조직화학적 염색을 시행한 후 골 형성 상태를 평가하여 다음과 같은 결과를 얻었다. 본 연구에서는 발치와내에서 골유도재생술 후 나타나는 치유 형태를 5가지 형태로 분류할 수 있었다. Type I, II와 III는 새로운 골 형성을 나타내지 않았고, 면역조직화학적 검사 시 ALP 음성 소견을 나타내었다. Type V는 새로운 골 형성과 ALP 양성 소견을 나타내었으나 염증, 괴사, 결합조직의 증식 등은 없었다. Type IV와 Type V의 차이는 결합조직의 증식여부로 구분되었다. 막이 노출되지않은 증례들 중 7 증례에서는 Type V의 치유 형태를, 2증례에서는 Type IV의 치유 형태를 나타내었다. 막이 노출되었던 증례에서는 Type I, II, III의 다양한 치유 형태를 나타내었다. 본 연구결과, 발치와 내에 골유도재생술을 시행한 후 차폐막의 노출 여부가 신생골 형성에 중요한 영향을 미칠 것으로 사료되며, 본 연구에서 분류한 치유 형태가 향후 골유도재생술 후의 결과 분석에 활용될 수 있을 것으로 사료된다.

• Journal of Periodontal and Implant Science
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• v.36 no.1
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• pp.147-154
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• 2006

Surgical intervention in the posterior maxillary region requires detailed knowledge of maxillary sinus anatomy and the possible anatomical variations. This study evaluated the incidence, location of maxillary sinus septa by using radiographic (panoramic radiography and computed tomography) findings and comparison of panoramic radography with CT in antral anatomical variation. This study was based on data from 70 sinuses in partial dentate maxilla. The sample consisted of 61 patients(25 women and 36 men, with ages ranging between 19 and 77 years and a mean age of $49.4{\pm}11.3$ years) who were being treatment-planned to receive implant-supported restorations. First, the panoramic images were examined for the presence of antral septa by radiologist and examiner who don't know about CT findings. And incidence of antral septa was evaluated using an axial plane of CT image. The incidence of septa was compared between panoramic radiography and CT. The accuracy of the incidence was compared between radiologists and dentists. A total of 20 septa were found in 70 sinuses on CT image and the prevalence of one or more septa per sinus was found to be 28.6%. The assumed incidence of septa on panoramic radiography was $27.6%{\pm}2.2%$ in radiologist and $31.9%{\pm}5.8%$ in dentists. Erroneous diagnosis rate was 11.42% in radiologist and 15.96% in dentists. 40% of antral septa were located in the anterior(premolar) region, 30% of septa were located in the middle(first molar) and posterior(second molar) region separately. Prior to implant placement, it seems appropriate to consider panoramic radiography as a standard radiographic examination and periapical radiographs may be used to complete the findings in regions not sharply depicted in the panoramic radiograph. And cross-sectional imaging should be used in sites with severe bone loss and close proximity of the maxillary sinus.

• Journal of Periodontal and Implant Science
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• v.35 no.4
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• pp.939-948
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• 2005

The role of the periosteum on osteointegration of $Bio-Oss^{(R)}$(Geistlich, Wolhusen/Switzerland) was studied in rabbit calvarial defect. 12 New Zealand white male rabbits between 2.8 and 4 kg were included in this randomized, blinded, prospective study. Each rabbit was anesthetized with Ketamine HCl(5 mg/kg) and Xylazine HCl(1.5 ml/kg). An incision was made to the bony cranium and the periosteum was reflected. Using a 6-mm trephine bur(3i. USA), four 8-mm defects were created with copious irrigation. The defects were classified into barrier membrane($Tefgen^{(R)}$, Lifecore Biomedical. Inc, U.S.A.) only group as a control, $Bio-Oss^{(R)}$ with barrier membrane group, $Bio-Oss^{(R)}$ with periosteum covering group, and $Bio-Oss^{(R)}$ without periosteum covering group. There were 2 rabbits in each group. The wound was closed with resorbable suture materials. Rabbits were sacrificed using phentobarbital(100 mg/kg) intravenously at 1, 2, and 4 weeks after surgery. The samples were fixed in 4% paraformaldehyde, and decalcified in hydrochloric acid decalcifying solution(Fisher Scientific, Tustin, CA) at $4^{\circ}C$ for 2-4 weeks. It was embedded in paraffin and cut into 6 ${\mu}m$ thickness. The sections were stained with H & E and observed by optical microscope. The results were as follows; 1. The periosteum played an important role in osteointegration of $Bio-Oss^{(R)}$ in bone defects. 2. When the periosteum remained intact and $Bio-Oss^{(R)}$ was placed on the defect, $Bio-Oss^{(R)}$ with periosteum covering has been incorporated into the newly formed bone from 2-week postoperatively. 3. When the periosteum was removed at the surgical procedure, invasion of connective tissue took place among the granules, and new bone formation was delayed compared to periosteum covering group. Therefore, when the bone grafting was performed with periosteal incision procedure to achieve tension-free suture, the integrity of the overlying periosteum should be maintained to avoid fibrous tissue ingrowth.

• Journal of Periodontal and Implant Science
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• v.42 no.6
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• pp.204-211
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• 2012

Purpose: This study was performed to establish an experimental rabbit model for single-stage maxillary sinus augmentation with simultaneous implant placement. Methods: Twelve mature New Zealand white rabbits were used for the experiments. The rabbit maxillary sinuses were divided into 3 groups according to sinus augmentation materials: blood clot (BC), autogenous bone (AB), and bovine-derived hydroxyapatite (BHA). Small titanium implants were simultaneously placed in the animals during the sinus augmentation procedure. The rabbits were sacrificed 4 and 8 weeks after surgery and were observed histologically. Histomorphometric analyses using image analysis software were also performed to evaluate the parameters related to bone regeneration and implant-bone integration. Results: The BC group showed an evident collapse of the sinus membrane and limited new bone formation around the original sinus floor at 4 and 8 weeks. In the AB group, the sinus membrane was well retained above the implant apex, and new bone formation was significant at both examination periods. The BHA group also showed retention of the elevated sinus membrane above the screw apex and evident new bone formation at both points in time. The total area of the mineral component (TMA) in the area of interest and the bone-to-implant contact did not show any significant differences among all the groups. In the AB group, the TMA had significantly decreased from 4 to 8 weeks. Conclusions: Within the limits of this study, the rabbit sinus model showed satisfactory results in the comparison of different grafting conditions in single-stage sinus floor elevation with simultaneous implant placement. We found that the rabbit model was useful for maxillary sinus augmentation with simultaneous implant placement.

• Journal of Periodontal and Implant Science
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• v.38 no.1
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• pp.75-82
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• 2008

Purpose: The purpose of this study was to evaluate exophytically vertical bone formation in the mandibular premolar area of beagle dogs by the concept of guided bone regeneration with a titanium reinforced e-PTFE membrane combined with human demineralized freeze-dried bone. Materials and Methods: Four one-year old beagle dogs were divided into control and experimental group. All mandibular premolars were extracted and surgical vertical defects of 5 mm in height were created in the extracted sockets. At 8 weeks after the extraction, TR e-PTFE membrane sized with 8 mm in length, 5 mm in width, and 4 mm in height was placed on the decorticated mandible, fixed with metal pins and covered with full-thickness flap and assigned as control group. In experimental group, decorticated mandibule was treated with TR e-PTFE membrane and human demineralized freeze-dried bone. The animals were sacrificed at 16 weeks after the regenerative surgery, and new bone formation was assessed by histomorphometric as well as statistical analysis. Results: Average of new bone formation was 38% in the control group, whereas was 25% in the experimental group (p<0.05). Average of connective tissue formation was 42% in the experimental group, whereas was 30% in the control group (p<0.05). The lamellar bone formation with haversian canals was observed in the both groups. In the experimental group, the particles of human demineralized freeze-dried bone were observed after 16 weeks and complete resorption of graft was not observed. Conclusion: On the basis of these findings, we conclude that titanium reinforced e-PTFE membrane may be used alone for vertical guided bone regeneration, but demineralized freeze-dried bone has no additional effect on vertical guided bone regeneration.

• Journal of Periodontal and Implant Science
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• v.38 no.1
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• pp.59-66
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• 2008

Purpose: It has been shown that the inorganic polyphosphate is effective for the regeneration of bones through the preliminary animal test of rabbits. The most effective concentration of the polyphosphate, however, is not known yet. Moreover, the effectiveness of carriers inside human body is not confirmed.. Materials and Methods: In this study, we examined the effect of the concentration of the inorganic polyphosphate on the process of the bone regeneration using the 6 weeks old rabbits with the weight of 2.0 kg in average. We performed the experiment using TR-ePTFE membrane(membrane) filled with collagen immersed in 4%, 8% of inorganic polyphosphate, respectively, following removal of the proper sized cortical bones from the rabbit calvaria. The experimental results were compared with the one of the following four groups: The negative control group for membrane only, the positive control group for membrane filled with collagen, the first experimental group for membrane filled with collagen immersed in 4% of inorganic polyphosphate, and the second experimental group for membrane filled with collagen immerse in 8% of inorganic polyphosphate. The fragments of the tissue with membrane obtained from each group of the sacrificed rabbits for 8 or 16 weeks sustained after surgery were then prestained by the Hematoxylin-Eosin stain and coated by resin to form non-decalcified specimens for the histologic examination and analysis. New bone formation was assessed by histomorphometric and statistical analysis. Results: 1. All groups have shown better bone regeneration at 16weeks than 8weeks. 2. Negative control group has shown more bone regeneration relative to the other groups at 8 and 16 weeks. 3. All experimental groups have shown better bone regeneration relative to positive control group. 4. At 16 weeks, the first experimental group has shown more bone regeneration compared to the second experimental group. Exophytic bone formation is not good at the first and the second experimental groups compared with negative control group. But, the use of 4% inorganic polyphosphate was more effective to bone formation than the use of 8% inorganic polyphosphate. Conclusion: With above results, it is suggested the use of inorganic polyphosphate with vehicle under TR-ePTFE membrane.

• Journal of dental hygiene science
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• v.2 no.2
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• pp.105-113
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• 2002

This study was aimed to investigate the practice on the infection control and dental waste disposal in dental clinic. The data used in this study had been collected in 100 dental clinics located in Seoul city from August to October, 2001. It was shown that examination instruments, oral surgery instruments, and periodontal instruments were almost sterilization in dental clinic. It was high in the recognition of individual protection but it was low in the degree of practice. Therefore, the practice in infection control is very important to dental team for safety of patients and operators.

• Journal of Periodontal and Implant Science
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• v.36 no.2
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• pp.273-288
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• 2006

The purpose of this study was to evaluate exophytically vertical bone formation in rabbit calvaria by the concept of guided bone regeneration with a custom-made porous titanium membrane combined with bone graft materials. For this purpose, a total of 12 rabbits were used, and decorticated calvaria were created with round carbide bur to promote bleeding and blood clot formation in the wound area. Porous titanium membranes (0.5 mm in pore diameter, 10 mm in one side, 2 mm in inner height) were placed on the decorticated calvaria, fixed with metal pins and covered with full-thickness flap. Experimental group I was treated as titanium membrane only. Experimental group II, III, IV was treated as titanium membrane with BBM, titanium membrane with DFDB and titanium membrane with FDB. The animals were sacrificed at 8 and 12 weeks after surgery, and new bone formation was assessed by histomorphometric as well as statistical analysis. 1. Porous titanium membrane was biocompatable and capable of maintaining the regeneration space. 2. At 8 and 12 weeks, all groups demonstrated exophytic bone formation and there was a statistical significant difference among different groups only at 12 weeks. 3. The DFDB group revealed the most new bone formation compared to other groups (p<0.05). 4. At 12 weeks, DFDB and FDB groups showed the most significant resorption of graft materials (p<0.05). 5. The BBM was not resorbed at all until 12 weeks. 6. The fixation metal pin revealed excellent effect in peripheral sealing. On the basis of these findings, we conclude that a porous titanium membrane may be used as an augmentation membrane for guided bone regeneration, and DFDB as an effective bone forming graft material. The fixation of the membrane with pin will be helpful in GBR technique. However, further study is required to examine their efficacy in the intraoral experiments.

• Journal of Dental Rehabilitation and Applied Science
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• v.28 no.4
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• pp.385-395
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• 2012

This clinical report presents the case using overlay dentures to treat a patient with cleft lip and palate and malocclusion. This patient requires vigorous treatment such as orthodontic treatment and combined orthodontic/oral surgery procedures. Overlay denture can be used as an alternative treatment option. Intraoral and radiographic examinations were done. The vertical dimension of occlusion was evaluated for proper prosthetic procedures and the surveying in the diagnostic cast was done. Considering the tissue and teeth undercut, the alterations of teeth shape were done. Final preparation and impression was performed. After the evaluation of vertical dimension and occlusion with wax-denture, the dentures were polymerized. Clinical remounting and occlusal adjustment were done on the articulator. Overlay dentures were delivered and the patient was recalled for relining. The overlay dentures satisfied patient's esthetic and functional requirements and provided a stable occlusion. Overlay dentures in this case were a reversible and relatively inexpensive treatment for this patient, however the potential possibilities of caries and periodontal disease as a result of poor oral hygiene should be prevented with periodic recall.