• Journal of Oral Medicine and Pain
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• 제35권2호
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• pp.119-122
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• 2010

이산화탄소 레이저(Carbondioxide laser, $CO_2$ laser)는 구강 연조직 수술에 가장 널리 사용되고 있는 레이저의 한 종류로 수분이 많은 연조직에 특히 좋은 친화력을 가지고 있다. 또한 수술도, 열소작술, 냉동수술, 전기수술 같은 기존의 외과적 술식들과 비교했을 때, 우수한 지혈 효과, 술 후 부종 감소, 세균집락 감소, 봉합 필요성 감소, 반흔 형성 감소, 술 후 통증 감소 같은 많은 장점들을 가지고 있다. 30세 남자가 상악 우측 구치부 협측 치은 부위에 발생한 경계가 뚜렷한 유경형 섬유성 병소를 주소로 내원하였다. 방사선 사진 검사 상 특기할 이상 소견은 관찰되지 않았다. 레이저를 이용한 절제 생검 계획하에 $CO_2$ 레이저(Panalas $CO5{\Sigma}$, Panasonic, 4.0W, 연속파 조사 방식)를 이용하여 보존적 절제술을 시행하였다. 병소의 절제 시 최소한의 출혈 양상으로 인해 우수한 시야 확보와 좋은 접근성을 유지할 수 있었고, 술 후 양호한 치유 경과를 보였으며, 환자는 아무런 불편감을 호소하지 않았다. 조직학적 진단은 "자극성 섬유종(Irritation fibroma)"이었다. $CO_2$ 레이저는 구강 내 병소의 외과적 치료에 적합한 많은 장점들을 가지고 있으므로, 치과의사들이 레이저의 특성을 잘 이해하고 레이저를 이용한 술기에 대한 지식을 적절히 습득하여 사용한다면, 구강 연조직 질환의 효율적인 치료를 위한 좋은 수단이 될 수 있을 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권3호
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• pp.191-198
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• 2007

The p53 which is well known as tumor suppressor gene is located at 17p13. p53 is a sequence-specific DNA binding transcription factor that responds to certain cytotoxic stresses, such as DNA damage, by enhancing the transcription of genes that regulate cell-cycle progression as well as programmed cell death. The p63 gene that is located at 3q27-29, is recognized members of the p53 family, and responsible for the transcription of 6 isoforms. Three isoforms ($TAp63{\alpha}$, $TAp63{\beta}$, $TAp63{\gamma}$) contain an N-terminal transactivation (TA) domain and can induce apoptosis. The other 3 isoforms (${\Delta}Np63{\alpha}$, ${\Delta}Np63{\beta}$, ${\Delta}Np63{\gamma}$) lack the TA domain and may function in a dominant-negative fashion by inhibiting the transactivation functions of p53 and TAp63 proteins, and thus act as oncoproteins. A number of studies have investigated the role of p63 in human squamous cell carcinomas from different organs. Only a few studies have examined ${\Delta}Np63$ isoform in oral squamous cell carcinoma including normal epithelium. This study aimed to evaluate expression of ${\Delta}Np63$ isoform in human oral squamous cell carcinoma tissue and normal mucosa. The 3 cases of well differenciated oral squamous cell carcinoma specimen including adjacent normal mucosa were examined, and immunohistochemical study with monoclonal antibody(4A4) and tumor cell apoptosis analysis with Transmission Electon Microscopy were studied. And, RT-PCR analysis was done for expression of ${\Delta}Np63$ isoform. The results were as followed. 1. Normal gingiva showed the restricted p63 expression in basal cell layer. 2. Well differentiated squamous cell carcinoma showed mainly p63 expression in overall area of malignancy, especially in basal cell layer to adjacent stromal tissue. 3. Tumor cells around keratinized area with no p63 expression disclosed less micro-organelle in decreased size cytoplasm and severe chromatin margination with nuclear destruction that means apoptosis. 4. Comparison of mRNA expression of ${\Delta}Np63$ isoform by RT-PCR showed variable expression of ${\Delta}Np63$ isoform, but ${\Delta}Np63{\alpha}$ was most highly expressed in all 3 tumor specimen. From theses results, it should be suggested that ${\Delta}Np63$ isoform expression in well differentiated squamous cell carcinoma was closely related to tumor oncogenesis, expecially overexpression of ${\Delta}Np63{\alpha}$ is a most important factor in tumor genesis of oral squamous cell carcinoma.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권2호
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• pp.141-150
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• 2008

We studied 1809 oral cancer patients who visited and were treated in 2002 at the 148 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons, which is composed of 39 dental university hospitals, 44 medical university hospitals, 64 general hospitals, and 1 unknown institution. The patients consisted of 1071 (59.2%) males and 738 (40.8%) females (male:female ratio, 1.45:1), who had a mean age of 65.2 years old. The tongue (40.2%) was the most common site affected, followed by the gingiva (32.7%), buccal mucosa (10.1%), and oral floor (9.0%). There were 6 cases of intraoral multiple cancer. In histopathological examinations, squamous cell carcinoma (88.7%) was the most common type found, followed by adenoid cystic carcinoma (2.1%), and mucoepidermoid carcinoma (1.7%). In addition, non-epithelial tumors comprised 1.8%, among which malignant melanoma was the most common type. Cases classified as T2N0 were the most common (32.1%), followed by T1N0 (21.4%), T4N0 (8.0%), and T2N1 (7.6%). Distant metastasis occurred in 17 patients (1.0%). The sizes of the non-epithelial malignant tumors ranged from 1.0 to 7.0 cm, with a mean size of 3.7 cm.

• Journal of Periodontal and Implant Science
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• 제29권4호
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• pp.821-838
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• 1999

On the basis of the evidences that electrical stimulation could enhance proliferation and differentiation of bone cells and promote healing and regeneration of bone, this study was performed to investigate the effects of electrical stimulation on human periodontal ligament cells and gingival fibroblasts in vitro, which also have important roles in regeneration of periodontium, and to evaluate the potential of clinical application of electrical stimulation. Human periodontal ligament cells and gingival fibroblasts were primarily cultured from the root surface of extracted premolar and the adjacent gingiva without periodontal diseases. In control group, the cells ($5{\times}10^4$ cells/ml)were incubated only in Dulbecco's Modified Eagle's Medium contained with 10% fetal bovine serum. In test groups, electrical stimulation was given at the current intensity of $0.25{\mu]A$(test group 1), $1.0{\mu}A$(test group 2), and $2.5{\mu}A$(test group 3) for 12 hours to the same culture media with the control group. After 12 hour exposure of electrical stimulation, the cells were incubated for 2 and a half days(60 hours), and then each group of cells was analyzed for cell proliferation, protein level, and activity of alkaline phosphatase. The results were as follows ; 1. The Rate of cell proliferation of every test group increased significantly in both periodontal ligament cells and gingival fibroblasts, and in periodontal ligament cells, test group 3 showed significantly increased proliferation compared to the other test groups(p<0.05). 2. In the protein levels, neither periodontal ligament cell nor gingival fibroblast showed statistically significant differences between control and test groups. 3. The activity of alkaline phosphatase in periodontal ligament cells increased significantly in all test groups(p<0.05), but there were no significant differences between 3 test groups. In gingival fibroblasts, the activity of alkaline phosphatase increased significantly only in test group 3(p<0.05). From the above results, it is concluded that electrical stimulation may have beneficial effects on the regeneration of destructed periodontal tissue in regard of the stimulation of periodontal ligament cells and gingival fibroblasts as well as electrically stimulated bone formation that has been known, and that electrical stimulation may have the potential of clinical application.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권2호
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• pp.151-156
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• 2006

술전 경부 임파절 평가의 정확성은 신체검사와 방사선학적 소견 모두에서 정확성의 한계를 보였으며, 정확성을 보다 높이기 위해서는 임상의사와 방사선의사간에 의견 교환이 중요하다고 사료된다. 그리고 필요에 따라서는 초음파 촬영, 세침 흡인세포검사(FNAC) 등의 보조적인 임파절 평가 방법을 이용하는 것도 전체 정진율을 높일 수 있을 것이다. 또한 구강암의 원발 부위가 고위험군인 경우에는 가음성도 비율이 높고, 방사선학적 검사에서 전체 정진율이 낮은 결과를 보이는 것으로 볼때, 지금까지 알려진대로 예방적 경부 곽청술을 보다 적극적으로 고려하는 것이 필요하다고 사료된다.

• Journal of Periodontal and Implant Science
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• 제36권3호
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• pp.783-796
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• 2006

The periodontium is a topographically complex organ consisting of epithelial tissue, soft and mineralized tissues. Structures comprising the periodontium include the gingiva, periodontal ligament (PDL) , cementum and the alveolar bone. The molecular mechanism of differentiation in PDL fibroblast cells remain unclear. Amino acid transporters play an important role in supplying nutrition to normal and cancer cells and for cell proliferation. Amino acid transport system L is a major nutrient transport system responsible for the Na+-independent transport of neutral amino acids including several essential amino acids. The system L is divided into two major subgroups, the L-type amino acid transporter 1 (LAT1) and the L-type amino acid transporter 2 (LAT2). In this study, the expression pattern of amino acid transport system L was, therefore, investigated in the differentiation of PDL fibroblast cells. To determine the expression level of amino acid transport system L participating in intracellular transport of amino acids in the differentiation of PDL fibroblast cells, it was examined by RT-PCR, observation of cell morphology, Alizaline red-S staining and uptake analysis after inducing experimental differentiation in PDL fibroblast cells isolated from mouse molar teeth. The results are as follows. 1. The LAT1 mRNA was expressed in the early stage of PDL fibroblast cell differentiation. This expression level was gradually reduced by differentiation- inducing time and it was not observed after the late stage. 2. The expression level of LAT2 mRNA was increased in time-dependent manner during differentiation induction of PDL fibroblast cells. 3. There was no changes in. the expression level of 4F2hc mRNA, the cofactor of LAT1 and LAT2, during differentiation of PDL fibroblast cells. 4. The expression level of ALP mRNA was gradually increased and the expression level of Col I mRNA was decreased during differentiation of PDL fibroblast cells. 5. The L-leucine transport was reduced by time from the early stage to the late stage in PDL fibroblast cell differentiation. As the results, it is considered that among neutral ammo acid transport system L in differentiation of PDL fibroblast cells, the LATl has a key role in cell proliferation in the early stage of cell differentiation and the LAT2 has an important role in the late stage of cell differentiation for providing cells with neutral amino acids including several essential amino acids.

• Journal of Periodontal and Implant Science
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• 제41권4호
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• pp.176-184
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• 2011

Purpose: The final goal of regenerative periodontal therapy is to restore the structure and function of the periodontium destroyed or lost due to periodontitis. However, the role of periosteum in periodontal regeneration was relatively neglected while bone repair in the skeleton occurs as a result of a significant contribution from the periosteum. The aim of this study is to understand the histological characteristics of periosteum and compare the native periosteum with the repaired periosteum after elevating flap or after surgical intervention with flap elevation. Methods: Buccal and lingual mucoperiosteal flaps were reflected to surgically create critical-size, "box-type" (4 mm width, 5 mm depth), one-wall, intrabony defects at the distal aspect of the 2nd and the mesial aspect of the 4th mandibular premolars in the right and left jaw quadrants. Animals were sacrificed after 24 weeks. Results: The results from this study are as follows: 1) thickness of periosteum showed difference as follows (P<0.05): control group ($0.45{\pm}0.22$ mm)> flap-elevation group ($0.36{\pm}0.07$ mm)> defect formation group ($0.26{\pm}0.03$ mm), 2) thickness of gingival tissue showed difference as follows (P<0.05): defect formation group ($3.15{\pm}0.40$ mm)> flap-elevation group ($2.02{\pm}0.25$ mm) > control group ($1.88{\pm}0.27$ mm), 3) higher cellular activity was observed in defect formation group and flap-elevation groups than control group, 4) the number of blood vessles was higher in defect formation group than control group. Conclusions: In conclusion, prolonged operation with increased surgical trauma seems to decrease the thickness of repaired periosteum and increase the thickness of gingiva. More blood vessles and high cellular activity were observed in defect formation group.

• Journal of Periodontal and Implant Science
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• 제39권2호
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• pp.111-118
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• 2009

Purpose: The integrity of interproximal hard/soft tissue has been widely accepted as the key determinant for success or degree of root coverage following the connective tissue graft. However, we reason that the gingival biotype of an individual, defined as the distance from the interproximal papilla to gingiva margin, may be the key determinant that influence the extent of root coverage regardless of traditional classification of gingival recession. Hence, the present study was performed with an aim to verify that individual gingival scalloping pattern inherent from biotype influence the level of gingival margin following the connective tissue graft for root coverage. Methods: Test group consisted of 43 single-rooted teeth from 21 patients (5 male and 16 female patients, mean age: 36.6 years) with varying degrees of gingival recession requiring connective tissue graft; 20 teeth of Miller class I and 23 teeth of Miller class III gingival recession, respectively. The control group consisted of contralateral teeth which did not demonstrate apparent gingival recession, and thus not requiring root coverage. For a biotype determination, an imaginary line connecting two adjacent papillae of a test tooth was drawn. The distance from this line to gingival margin at mid-buccal point and this distance (P-M distance) was designated as "gingival biotype" for a given individual. The distance was measured at baseline and 3 to 6 months examinations postoperatively both in test and control groups. The differences in the distance between Miller class I and III were subject to statistical analysis by using Student.s t-test while those between the test and control groups within a given patient were by using paired t-test. Results: The P-M distance at 3 to 6 months postoperatively was not significantly different between Miller class I and Miller class III. It was not significantly different between the test and control group in a given patient, either, both in Miller class I and III. Conclusions: The amount of root coverage following the connective tissue graft was not dependent on Miller's classification, but rather was dependent on P-M distance, strongly implying that the gingival biotype of a given patient may play a critical impact on the level of gingival margin following connective tissue graft.

• 대한소아치과학회지
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• 제32권4호
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• pp.657-661
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• 2005

유치의 치수절단술에 사용되는 약제로는 formocresol, ferric sulfate, 수산화칼슘 등이 있다. 그 중에서 formocresol은 치수조직의 고정능력과 높은 임상적 성공을 보임으로써 아직까지 널리 사용되고 있으나 자체독성이 매우 강하여 영구 계승치 치배의 변위나 결손, 법랑질 형성부전, 전신 흡수로 인한 돌연변이 가능성과 암유발 가능성 역시 보고되고 있다. 최근에는 formocresol의 근관내 적용시 불완전한 임시충전에 의한 미세누출로 주위 치은과 치조골의 괴사를 야기한 보고가 있으며 과잉의 formocresol을 적용하였을 경우에도 치조골의 괴사의 원인이 될 수 있다고 하였다. 본 증례는 개인치과에서 formocresol을 이용한 치수치료를 받은 후 지속되는 동통으로 인해 상악 좌측 제 2유구치를 발거하였으나, 증상이 개선되지 않아 본원에 의뢰되었다. 환아는 8세 남아로 심한 구취 및 계승 영구치 치관 주위로 환형의 치조골 괴사를 보여 부골절제술을 시행하고 1년 7개월간 관찰을 하였을 때 정상적인 치근 성장은 이루어졌으나 결손된 치조골 및 부착치은의 완전한 조직재생 소견은 관찰되지 않았다. Formocresol에 의한 치주조직에 대한 부작용은 비가역적이므로 formocresol의 사용에 있어 적응증 여부를 잘 판단해야 하며, 철저한 임시 가봉에 주의를 기울여야 할 것이다.

• 대한소아치과학회지
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• 제32권2호
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• pp.256-261
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• 2005

피부 경화증(scleroderma)은 만성 결체조직 질환으로 정확한 원인은 밝혀지지 않았으나 자가 면역 질환으로 알려져 있다. 대개 $30{\sim}50$세의 여성에서 호발하며 소아에서는 매우 드물다. 장기의 이환여부에 따라 국소성과 전신성 피부 경화증으로 분류할 수 있다. 국소적 형태는 예후가 양호하고 피부에만, 또는 피하 근육까지 이환되며, 내부 장기에는 이환되지 않는다. 전신적인 형태는 피부와 구강점막 및 위장계, 호흡계, 심혈관계 등을 포함하늘 전신 다발적 발생 (multisystemic involvement)이 특징적이다. 안면피부 이환시 작고 예리한 코, 무표정한 응시 (expressionless stare), 좁아진 입모양(narrow oral aperture) 등이 특징적이다. 대개 레이노 현상(Raynaud's phenomenon)이 존재하며 질환이 진행되면서 개구장애와 혀, 치은의 경화가 나타나게 된다. 피부 석회증(calcinosis cutis), 레이노현상(Raynaud's phenomenon). 식도 기능부전(esophageal dysfunction), 공지증(sclerodactyly), 모세혈관 확장증(telangioectasia)이 복합된 질환을 크레스트 증후군(CREST syndrome)이라 부른다. 피부 경화증의 치료는 국소적 및 전신적 스테로이드 치료, collagen cross-link inhibitor (D-penicillamine), 면역억제제 등을 사용한다. 개구제한의 치료는 설압자를 이용한 mouth stretching exercise를 통해 개선될 수 있다. 본 증례에서는 국소성 피부 경화증으로 진단되고 개구제한이 있는 6세 남아에게 아산화질소와 enflurane을 이용한 깊은 진정요법을 이용하여 상하악 제 1, 2 유구치의 우식치료 치험례를 보고한다.