• Journal of Periodontal and Implant Science
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• 제36권2호
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• pp.305-318
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• 2006

This study was performed to evaluate the effect on the formation of keratinized attached gingiva when free gingival graft with strip technique was used. After the partial thickness flap was prepared, it was positioned apically more than 7mm using mucoperiosteal suture. At the donor site, strip was achieved with 2mm width, less than 1mm thickness, (mesiodistal teeth length + 6)$^{\ast}$2 mm length. Then, it was divided into 2 same pieces and located at the recipient bed apico-coronally with more or less 3mm interval. Follow-up check was made at 1,2,4,8,12 weeks after the operation. The results of this study were as follows : 1. The inter-strip space was mostly filled with keratinized attached gingiva. 2. The contraction of the graft was nigligible, and 92% of planned area was filled with keratinized attached gingiva. 3. The inconvenience of the patients at donor site was minimal. 4. The width of the strip was widened. In conclusion, free gingival graft using strip technique is useful to achieve the keratinized attached gingiva maximally with free gingival graft minimally and to minimize the inconvenience of donor palatal site of the patients.

• Journal of Periodontal and Implant Science
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• 제31권1호
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• pp.243-258
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• 2001

Gingival recession is exposure of the root surface with apical shift in the position of gingiva. The incidence of gingival recession is 8% in children and 100% after the age of 50. Recession tends to be found in patients with healthy gingiva, but more frequentely found in patients with periodontal disease, and it often causes mucogingival defects. Buccal surface of premolar is the area not only for severe gingival recession and cervical abrasion, but also the area of numbers of buccal frenum and less keratinized gingiva. Threrfore, the goal of this study was to observe the patients with periodontitis and examine whether there are clinical relations between gingival recession and cervical abrasion of premolar and other factors related with the condition of periodontal health. Generally healthy 218 patients who had periodontitis, aged between 18 and 78, were examined for depth of periodontal poket, width of attached gingival, gingival recession, cervical abrasion, and frenum of mid-buccal surface of premolar at the Department of Periodontics in Dankook University Dental Hospital and following is the result. 1. The average gingival recession and cervical abrasion of premolar with periodontal disease was 0.76mm and 0.29mm and each has 43% and 14% of incidence. Also the width of attached gingiva of mid-buccal surface was 1.77mm. the average periodontal pocket depth is 2.0mm and 47% of frequently seen was narrow single shaped frenum, and the interdistance of the frenum was mostly over 4mm. 2. With statistical significance(P<0.05), the incidence of gingival recession increased with age and was related much more with female than male, the first premolar than the second premolar, and with narrow attached gingiva and frenum. 3. With statistical significance(p<0.05), the incidence of cervical abrasion increased with age and was related with the area of the first premolar and narrow attached gingiva, but the sexual and frenum differences were not statistically significant (p>0.05). 4. The severity of gingival recession increased with age and was more related with female than male, the first premolar than the second premolar. And the area of narrow attached gingiva and frenum showed more gingival recession and the distance of frenum was more highly related than shape, and they were statistically significant (p<0.05). 5. With statistical significance(p<0.05), the severity of cervical abrasion increase with age and was observed at the first premolar and narrow attached gingiva. But the sexual and frenum differences were not statistically significant (p>0.05).

• Journal of Periodontal and Implant Science
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• 제29권3호
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• pp.635-645
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• 1999

The present study examines the effects of orthodontic treatment of surgically exposed impacted upper canines or ectopically erupted upper canines to periodontal condition and whether various opening procedures have significant difference in postoperative periodontal status. The subjects included 23 orthodontic patients(7 men, 16 women) with unilateral upper canine impaction treated either with closed eruption technique(group I), with apically positioned flap procedure (group II), and those with canines ectopically erupted through keratinized gingiva (group III). In each subject, the ectopic canine was orthodontically aligned, and changes in periodontal tissue were assessed by measuring keratinized gingival width, attached gingival width, probing depth and bone probing depth. In all three groups, the width of keratinized gingiva was preserved while showed no signs of detrimental periodontal condition such as gingival recession. In all three groups, no significant difference in periodontal pocket depth from control was observed. The width of attached gingiva was significantly greater in patients treated with apically positioned flap procedure(group II) than in patients on other groups.

• 대한치과의사협회지
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• 제54권4호
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• pp.296-305
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• 2016

Narrow zone of attached gingiva and shallow vestibule around the implants might contribute to difficulty of cleasing, periimplant mucositis caused by incomplete cleansing and further peri-implantitis. The aim of this case report is to present modification of soft tissue biotype around the implants by free gingival grafts according to timing of surgical intervention and shape of free gingiva. A 44 year-old male patient had a missing area on lower right second molar area with 1 to 2 mm of narrow attached gingiva zone and wanted to be treated by implant placement. In radiographic analysis, there was enough alveolar bone to install an implant, free gingiva from hard palate was grafted following implant placement using double layer flap. The width of attached gingival was increased to 4 to 5mm and well maintained during 5 months of follow up. A 69 year-old female patient also had a missing area on lower right first and second molar area with 1 to 2 mm narrow attached gingiva. Since she had systematically angina pectoris and dental phobia, minimal invasive free gingival graft after implants placement was planned. After 2 months of implant surgery, free gingival graft surgery was performed with healing abutments connection. The grafted gingiva was composed of two strip shaped free gingiva, and they were immobilized by periodontal pack. The width of attached gingival was increased to 4 to 5mm and well maintained during 10 months of follow up. With prosthesis delivery, the patients recovered ideal periodontal environment around implants and masticatory function. In conclusion, periodontal health and masticatory function could be achieved through implant placement and free gingival graft.

• Journal of Periodontal and Implant Science
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• 제15권1호
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• pp.88.2-88.2
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• 1985

• 대한소아치과학회지
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• 제26권1호
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• pp.69-76
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• 1999

The mandibular buccal frenum is defined as a fold of mucous membrane at the posterior labial vestibule and attaches the lips and the cheeks to the alveolar mucosa, gingiva, and underlying periosteum. The buccal frenum becomes a problem when its attachment is too close to the marginal gingiva. It may then pull on healthy gingiva, encourage plaque formation and interfere with tooth brushing. Especially, heavy buccal frenum mucogingivally results in insufficent attached gingiva, inadequate vestibular depth and high frenum attachment and also difficulty in eruption of mandibular premolar. Frenotomy, frenectomy and mucogingival surgery are used in treating heavy buccal frenum. Frenotomy with autogenous free gingival graft has been used popularly because of its stable result. But, it is difficult in younger children because of inadequate donor site, difficulty in making recipient site and behavior management. Frenotomy with apically positioned flap is considered as more efficient way for a very young child with heavy buccal frenum. Additionally, modified deep sedation with $N_2O-O_2$ can be used as an adjunct for the effective treatment outcome. Decrease in muscle pull, adequate width of attached gingiva and increased vestibular depth can be expected from this treatment approach.

• 대한소아치과학회지
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• 제21권2호
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• pp.510-517
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• 1994

It is a relatively common clinical experience to see a impacted maxillary central incisor. This is apparent at the dental age of about eight years and over, when the patient is in the early mixed dentition stage. The adjacent teeth may tilt toward the site of the missing tooth with resulting space closure and midline deviation. Most often, the central incisor is impacted labially. The labial impaction has been indicated as the most difficult to manage. Each of the current articles describing labial impactions shows at least one case with mucogingival recession or a minimal zone of attached gingiva. This report described the surgical uncovering and orthodontic-physiologic positioning methods with labially impacted maxillary central incisors. Through surgical exposure and direct bonding of lingual botton, the central incisors were brought into proper eruption path with elastic traction. The case 1 and 2 were treated with the physiologic erupting forces. The case 3 was applied with continuous orthodontic force. The case 1 and 2 resulted in good positioning, good esthetics and adequate width of keratinised gingiva. The case 3 resulted in local inflammation and inadequate width of keratinised gingiva.

• 대한소아치과학회지
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• 제28권3호
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• pp.383-390
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• 2001

상악중절치의 매복은 임상적으로 흔히 볼 수 있다. 대부분의 경우 중절치는 협측에 매복되어 있다. 이러한 협측매복은 치료가 무척 어렵다. 협측매복시 치은퇴축과 부착치은의 상실,치주낭이 발견된다. 따라서 성공적인 치료를 위해서는 외과적 술식을 통해서 부착치은의 소실을 최소화해야 할 것이다. 매복치의 위치와 부착치은의 양에 따라 수술방법으로 간단한 치은절제술(gingivectomy)외에도 필요하면 근단변위판막술(apically positioned flap), 측방변위판막술(laterally positioned flap), 유리치은 이식술(free gingival graft) 등과 같은 여러 판막술과 치아의 생리적인 맹출기전을 복제한 폐쇄 맹출법 (closed eruption technique)을 고려 할 수 있다. 하지만 치은절제술은 근단변위판막술에 비하여 부착치은의 양이 적어 많은 양의 부착치은 이 필요한 경우에는 근단변위판막술이 적응증이며 매복치아가 nasal spine근처에 있을 때는 폐쇄 맹출법을 선택해야 할 것이다. 본 증례에서 두 증례에서는 근단변위 판막술을 한 증례에서는 폐쇄 맹출법을 사용한 바 다음과 같은 결론을 얻었다. 폐쇄 맹출법이 더 심미적이었으나 부착치은의 양은 작았다. 이에 상악 중절치의 매복의 경우에서 올바른 임상적, 방사선학적인 검사를 통해 적응증에 맞는 외과적 수술로써 외과적 견인후 합병증을 최소화할 수 있었다.

• 대한치과교정학회지
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• 제37권3호
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• pp.212-219
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• 2007

현재 교정용 미니 임플란트의 식립부위에 대한 연구는 주로 구치부 치근사이 공간에 집중되어 왔으며, 연조직에 관한 연구는 부족하다. 본 연구의 목적은 하악골에서 전치부와 구치부의 치근사이 피질골과 연조직 두께를 측정하여 해부학적인 지도를 만들고, 한국인의 평균 부착치은의 폭경을 제시하는데 있다. 연구를 위하여 자원한 남자 15명, 여자 15명 총 30명을 대상으로 하였으며, 평균연령은 27세 3개월이었다. 구강 내 인상을 채득한 후 석고모형을 만들어 0.5 mm두께의 평판으로 스텐트를 제작하였다. 스텐트의 중절치에서 제1대구치까지 치근사이 치은변연을 연결한 선에 방사선 불투과성의 표식을 부착하고 구강 내에 장착한 후 3차원 CT 영상을 얻고, 각 치근사이 치조정 하방에서 2, 4, 6, 8 mm부위의 피질골 두께를 측정하였다. 연조직 두께는 스텐트의 각 치근사이 치조정 하방에서 2, 4, 6, 8 mm부위에 구멍을 뚫고 구강 내에서 근관치료용 파일을 연조직에 통과시켜 측정하였다. 석고모형 상에서 중절치에서 제1대구치까지 각 치근중앙 부위에서 부착치은의 폭경을 측정하였다. 연구결과 하악골에서 전체대상자의 평균 피질골 두께는 $1.33{\pm}0.38mm$이었으며 전치부에서 구치부로 갈수록 두꺼워지고, 평균 연조직 두께는 $1.49{\pm}0.54mm$이었으며 치근단 쪽으로 내려가면서 두께가 변하지 않았다. 평균 전체 두께는 $2.82{\pm}0.70mm$이었으며 전치부에서 구치부로 갈수록 두꺼워졌다. 부착치은의 폭경은 전치부가 구치부보다 넓었다. 이상의 결과는 피질골과 연조직 두께, 부착치은의 폭경을 고려하여 미니 임플란트의 식립부위를 결정하는 것이 필요함을 시사하였다.

• 대한소아치과학회지
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• 제37권4호
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• pp.512-518
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• 2010

임상적으로 흔히 관찰되는 상악 영구 전치의 매복은 대부분 치조골 순측에 매복되어 있다. 치조골의 순측에 매복되어 정상적인 맹출을 기대할 수 없을 때, 매복 원인을 제거 후 관찰하거나 필요시 외과적 노출술 또는 교정 장치물을 부착하여 교정적인 견인을 고려할 수 있다. 일반적으로 매복치아가 치조점막부에 위치하거나, 치조골내 깊이 매복되어있는 경우, 단순히 치은절제술과 치조골 제거에 의한 매복치의 외과적 노출은 부착치은 폭경의 감소, 치은염 발생, 변연 치조골 상실 등을 초래할 수 있다. 따라서 치아를 외과적으로 노출시키고 교정 장치물을 부착시킨 후 다시 판막을 피개하는 폐쇄 맹출법으로 교정적 견인을 하는 것이 일반적이다. 그러나 매복 치아가 가동성 점막 직하방에 존재한다면 근단 변위 판막술을 통해, 단순히 치은의 절제를 통한 노출시 발생하는 합병증을 방지할 수 있고, 매복치의 맹출 유도를 더 용이하게 시행할 수 있다. 본 증례는 상악 영구 절치의 미맹출을 주소로 본원에 내원한 환아들을 대상으로 하여 근단 변위 판막술을 시행한 결과 부착치은의 상실없이 맹출 유도를 얻고 심미성에서 양호한 결과를 얻을 수 있어 보고하는 바이다.