• Journal of Periodontal and Implant Science
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• v.24 no.1
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• pp.109-119
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• 1994

An essential fact in the regeneration of new periodontal tissue after periodontal therapy is the reattachment of collagen fibers to the tooth. Two phenomena play a fundamental role in preventing new connective tissue attachment to the exposed root surface ; 1) The apical migration of the junctional epithelium 2) The contamination of cementum by toxic substances, especially endotoxins. Authors have used rat submucosal implantation of root sections to study the connective tissue healing to periodontally diseaed root, previously planed and demineralized with citric acid and tetracycline- HCl. The results were obtained as follows. 1. The connective tissue attachment was increased in tetracycline, citric acid, non disease, scaling and root planing order and inflammatory reaction was seen in the rat teeth, no treatment group. 2. Collagen fiber attachment at the dentin surface was more increased than cementum surface 3. In 2 week of citric acid and tetracycline-HCl specimens, osteoid was seen near the fibrotic band. 4. In the MT view, collagen fiber formation was increased with time and the numerous collagen fiber and connective tissue was more densly attached to the tooth surfaces in the tetracycline-HCl group than the citric acid group.

• Journal of Periodontal and Implant Science
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• v.23 no.2
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• pp.283-299
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• 1993

The purpose of this study was to observe early connective tissue attachment on dentin surface treated with citric acid, tetracycline, and fibrin sealants and compare their conditioning effects on dentin surface. Experimental dentin blocks conditioned with citric acid, tetracycline or fibrin sealant, and only root planned control block were surgically implanted in the pouch under buccal mucoperiosteal flaps of left mandible, right maxilla, left maxilla, right mandible of 18 male rabbits. Rabbits were sacrificed after 1 and 6 hours, 1, 3, 7 and 14 days after implantation and then specimens including dentin block and surrounding soft tissue were obtained, and prepared for light and transmission electron microscopic examination. 1 and 6 hours after dentin block implantation, there was plasma proteins adsorption followed by fibrin clot formation and no differences among specimens. At the 1-day observation interval, delicate fibrin network was observed in the all groups, and there were proliferative fibroblasts, angiogenesis and macrophage in the all 3-day specimens. Cellular aggregates and abundant connective tissue adhered dentin surface and tetracycline or citric acid treated group showed much proliferative fibroblast and abundant collagen fibers at 1 week. But at 2 week, citric acid treated group showed much proliferative fibroblast and abundant collagen fibers. These observations suggested that new connective tissue attachment to dentin was initiated by the adsorption of plasma proteins to the dentin surface and followed by fibrin clot formation. Tetracycline and citric acid seemed to make dentin surface more biologically favorable for the connective tissue attachment.

• The Journal of the Korean dental association
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• v.55 no.3
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• pp.230-239
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• 2017

Root coverage can be an efficacious treatment not only in aspect of dental symptoms like root caries and hypersensitivity, but also in aspect of esthetic problem. There are several predictable methods for gaining a connective tissue attachment to an exposed root surface. Among them, this case report will deal with three cases using enamel matrix derivative and connective tissue graft to recover esthetic and physiological periodontal environment and its form. This case report deals with three patients with gingival recession which has occurred by different causes. They were treated with de-epithelialized graft accompanied by application of enamel matrix derivative. 6-12 months later, all three patients showed considerable root coverage and clinically stable condition of healing. In conclusion, within the limitation of this study, de-epithelialized connective tissue graft accompanied by application of enamel matrix derivative shows stable and clinical acceptable results in aspect of root coverage.

• Applied Microscopy
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• v.27 no.3
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• pp.321-332
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• 1997

The dermal papilla is known to playa major role in influencing the form and dynamics of the hair follicle, which probably involves regulatory substances crossing the basal lamina. But little is known about the junctions between the dermal papilla and the surrounding epithelial cells of the hair bulb, or between the connective tissue and the epithelial cells on the outside of the hair follicle. This study was performed to identify the ultrastructural differences between dermoepidermal junction of the skin and connective tissue-epithelial junctions on the outside of the hair follicle and around the dermal papilla of normal anagen hair follicles in the human fetal scalp skin. Electron microscopic findings of dermoepidermal junction in scalp skin showed that basal lamina was very irregular and undulated, and it contained many attachment plaques of hemidesmosomes with sub-basal dense plates, tonofilaments, and anchoring filaments. Also invaginations of plasma membrane of basal keratinocytes were seen. There were clear differences both on the outside of the follicle and around the dermal papilla as compared with similar junction in the skin. In particular, neither hemidesmosomes nor tonofilaments, as seen in dermoepidermal junction, were observed in the dermal papilla. Also attachment plaque, sub-basal dense plate and anchoring filaments were not observed at the junction on the outside of the follicle and the dermal papilla. There were some differences between connective tissue-epithelial junctions on the outside of the hair follicle and around the dermal papilla, ie, smoothness of basal lamina and orthogonal arrangement of collagen fibers were seen in the outside of hair follicle, but not in the dermal papilla. These results indicate that the mechanical connection between the hair follicle and the connective tissue component is much weaker than that between the corresponding components in skin, and it reflects the dynamic processes during the anagen phase of the hair follicle compared to the relatively permanent state of the epidermis.

• Journal of Periodontal and Implant Science
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• v.25 no.1
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• pp.146-152
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• 1995

A mucogingival grafting procedure has been developed to cover denuded root surfaces. The subepithelial connective tissue graft is composed of a free connective tissue graft and an overlying pedicle graft. The source of connective tissue graft were trap door approach and thining of a full thickness palatal flap. The purpose of this study was compare a two different connective tissue obtaining method. In this study, where palatal pocket was present, pocket elimination was performed, and the tissue normally discarded after thinning of the palatal flap was used as a grafting material. The results were as follows : 1. The mean difference between trap door approach and thinning procedure for root coverage were $2.1{\pm}O.lmm$, $2.2{\pm}O.2mm$. 2. The mean difference between trap door approach and thinning procedure for pocket depth change were $O.2{\pm}O.lmm$, $O.2{\pm}O.2mm$. 3. The mean difference between trap door approach and thinning procedure for attachment gain were $2.1{\pm}O.2mm$, $2.4{\pm}O.2mm$. 4. The esthetics in recipient site, both color match and tissue contour, were acceptable to the patient in all cases. 5. Therefore, thinning procedure were similar to trap door approach in root coverage effect.

• Journal of Periodontal and Implant Science
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• v.27 no.2
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• pp.379-394
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• 1997

Several methods have been used for regeneration of tissue lost by periodontal disease. Subepithelial connective tissue graft technique, one of the technniques of mucogingival surgery, is used for the regeneration in esthetic problems such as recession, and denuded root coverage. This study is performed to evaluate the healing process and the regeneration and reattachment of periodontal tissue, including the reconstruction of junctional epithelium, and connective tissue. Alveolar defects in five adult dogs were treated with periodontal surgery and were attained by removing the marginal alveolar bone by $4{\time}3mm$ from CEJ in the labial side of incisors, and root surfaces were planed. The experimental sites were divided into two groups as follows. 1. root planing alone(control group) 2. with connective tissue graft (Experimental Group) In the two groups flaps were positioned and sutured tightly, the healing processes were observed and were histologically compared with each other after 2days, 4days, 1week, 2weeks, 4weeks. The results were obtained as follows : 1. In the two groups blood clots were observed as early as 2 and 4 days, and were resorbed at 1 week. 2. In the two groups moderate inflammation was observed as early as 2 and 4 days, decreased at 1 and 2 weeks, and disappeared at 4 weeks. 3. Junctional Epithelium migration was more significant in the control group, and was restrained by graft materials in the experimental group. 4. Features of connective tissue fiber attachment partially showed the parallel pattern in the two groups from 2 weeks, and entirely from 4weeks. 5. Anastomosis, between graft and connective tissue, appeared from 4 days in the experimental group and the border between them was not discriminated at 4weeks.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.8 no.1
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• pp.28-35
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• 1999

The preservation of a healthy periodontal attachment is the most significant factor in the long-term prognosis of a restored tooth. The 'Biologic Width' is composed of the connective tissue attachment and the epithelial attachment in the dentogingival junction. The violation of the biologic width may result in a progressive inflammatory process and crestal bone loss. So a careful soft tissue management is needed to preserve it for the gingival health and an esthetic restoration. The following clinical cases show the five different situations of the violation of the biologic width and their management.

• Journal of Periodontal and Implant Science
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• v.23 no.1
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• pp.67-76
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• 1993

After periodontal surgery, the potential healing responses were occurred by interaction among junctional epithelium, gingival connective tissue, alveolar bone and periodontal ligament. The only cell that created periodontal regeneration was derived from periodontal ligament. The aim of the study was to evaluate the regenerative effects of the collagen membrane($collacote^{\circ}C$) and autogenous connective tissure graft with periosteum. Experimental periodontitis were created in furcation area of 4 adult dogs with bone removal and gutta percha packing. After 6 weeks later, the gutta percha was removed and experiment was performed divided by 3 groups. 1) Flap operation(control group). 2) Flap operation with collage membrane(Experimental group I). 3) Flap operation with autogenous connective tissue graft with periosteum (Experimental group II). After dogs were sacrificed after two and three weeks, specimens were prepared and stained with hematoxylin-eosin and masson-trichrome stain for light microscopic study. The results were as follows : 1. In all gruoups, connective tissue compartments were increased from two to three weeks especially in experimental group I. 2. Collagen membrane and connective tissue were increased collagen deposits of periodontal ligament. Therefore collagen fiber attached to tooth surface was seen. 3. In al experimental groups, newly forming alveolar bone was seen. 4. Collagen membrane and connective tissue were which prevented proliferation of epithelium, aided connective tissue new attachment and influenced periodontal regeneration.

• The korean journal of orthodontics
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• v.28 no.3 s.68
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• pp.431-440
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• 1998

While periodontal disease results in the extrusion of upper incisors with interdental spacing in adult patient, the intrusive movement should be executed for the rehabilitation in terms of esthetics and function. The present study was peformed to investigate the periodontal response following orthodontic intrusion of teeth with infrabony pocket. Bone defect and periodontal disease were produced adjacent to the both maxillary second lateral incisors in four adult dogs. Four weeks later, a flap operation was performed to eliminate inflammation and a reference notch was made on the root surface at the level of bottom of each defect. Two weeks after periodontal surgery, 4 weeks of intrusion and subsequent another 4 weeks of retention was executed on the right side of incisors while left incisors served as the control. Through the histologic analysis, following results were obtained. 1. Histologic section of control side showed the reduction of pocket depth after flap operation. However, the status of long junctional epithelium was observed while new connective tissue attachment occurred in a small area adjacent newly formed cementum 2. Epithelial attachment was less around the intruded incisor while new connective tissue attachment was much more compared to the control side. 3. Plenty of cells were observed in the connective tissue around the reference notch of the intruded incisor and the degree of the new cementum formation was higher in the intruded incisor than the control. The results of the present study suggested that an orthodontic intrusion of periodontally involved and extruded incisors could be carried out with a desirable periodontal response, provided that inflammation is under control.

• Journal of Periodontal and Implant Science
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• v.30 no.3
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• pp.651-661
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• 2000

A mucogingival grafting procedure has been developed to cover denuded root surface. The subepithelial connective tissue graft technique is very predictable and allows for a good esthetic results and minimum patient discomfort on the palate. However, in areas where there is a lack of vestibular depth and keratinized attached tissue, the presence of frena or heavy muscle attachment, covering the connective tissue graft with a mucosal flap is very difficult. The purpose of this study is to evaluate an alternative technique of root coverage using the free connective tissue graft. The results were as follows: 1. Probing depths didn't seem to vary significantly from the preoperative to postoperative period. 2. The amount of keratinized tissue showed an increase of $5.9{\pm}0.97mm$ from the preoperative level. 3. Total clinical exposed root coverage increase 72.2% compare with preoperative level. 4. The shrinkage from gingival margin is $4.2{\pm}1.15mm$ and the mean shrinkage rate is 40.1%. 5. The depth of the vestibule increased with the average distance from cementoenamel junction to mucogingival junction being $7.4{\pm}1.65mm$.