• Journal of Dental Rehabilitation and Applied Science
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• v.39 no.4
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• pp.276-284
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• 2023

After tooth extraction, alveolar bone is resorbed over time. Loss of alveolar bone and reduction of upper soft tissue poses difficulties in future implant placement and long-term survival of the implant. This case report focuses on increasing the soft and hard tissues at the implant placement site by using alveolar ridge augmentation and a xenogeneic collagen matrix as a soft tissue substitute in an extraction socket affected by periodontal disease. In each case, the width of the alveolar bone increased to 6 mm, 8 mm, and 4 mm, and regeneration of the interdental papilla around the implant was shown, as well as buccal keratinized gingiva of 4 mm, 6 mm, and 4 mm, respectively. Enlarged alveolar bone facilitates implant surgery, and interdental papillae and keratinized gingiva enable aesthetic prosthesis. This study performed alveolar ridge augmentation on patients with extraction sockets affected by periodontal disease and additionally used soft tissue substitutes to provide a better environment for implant placement and have positive effects for aesthetic and predictive implant surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.1
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• pp.89-92
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• 2011

Herpes simplex is caused by viruses of the herpesvirus hominus family. HSV have four categories: type 1, 2, 6, and 8. Generally HSV-1 affects the mouth. Once infected by HSV, the person's infection is permanent. Retrograde transport through adjacent neural tissue to sensory ganglia leads to a lifelong latent infection. Recently, we treated a patient with recurrent herpes-stomatitis mimicking acute necrotizing ulcerative gingivitis (ANUG). The results were satisfactorty so we report this case. 31 years old male patient showed sore throat, gingival ulceration, palpable both submandibular lymph node, and sulcular pus formation around posterior decayed teeth. This is the third time he has suffered from this symptom. Tentative diagnosis was acute necrotizing ulcerative gingivitis. Antibiotic therapy was started. But, intraoral symptom got worse in process of time. Especially ulcer of marginal gingiva got worse. Viral disease was suspected. We carried out viral cultivation. At the same time topical application of antiviral ointment (herpecid$^{(R)}$) was performed on oral ulcer unilaterally for the purpose of diagnosis and reducing pain experimentally. The next day pain was decreased dramatically on application area. Basing on the viral cultivation and clinical effect of antiviral ointment (herpecid$^{(R)}$), we have diagnosed it as a recurrent herpes-stomatitis and concluded that viral infection was major cause of disease and bacterial infection was secondary.

• The Journal of the Korean dental association
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• v.55 no.1
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• pp.30-41
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• 2017

Inadequate keratinized mucosa around dental implants can lead to more plaque accumulation, tissue inflammation, marginal recession and attachment loss. We evaluated the effects of free gingival and extracellular matrix membrane grafts performed to increase the insufficient width of keratinized tissue around dental implants in the posterior mandible. A 47-year-old female patient presented with discomfort due to swelling of the lower right second premolar area. Due to severe destruction of alveolar bone, the tooth was extracted. After 3 months, a guided bone regeneration (GBR) procedure was performed and then a dental implant was placed 6 months later. During the second-stage implant surgery, free gingival grafting was performed to increase the width of the keratinized tissue. After 12 months, a clinical evaluation was performed. A 64-year-old female patient had a missing tooth area of bilateral lower molar region with narrow zone of keratinized gingiva and horizontal alveolar bone loss. Simultaneous implant placement and GBR were performed. Five months after the first-stage implant surgery, a gingival augmentation procedure was performed with an extracellular matrix membrane graft to improve the width of the keratinized tissue in the second-stage implant surgery. After 12 months, a clinical evaluation was performed. In these two clinical cases, 12 months of follow-up, revealed that the increased width of the keratinized tissue and the deepened oral vestibule was well maintained. A patient showed a good oral hygiene status. In conclusion, increased width of keratinized tissue around dental implants could improve oral hygiene and could have positive effects on the long-term stability and survival rate of dental implants. When planning a keratinized tissue augmentation procedure, clinicians should consider patient-reported outcomes.

• Journal of Periodontal and Implant Science
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• v.38 no.1
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• pp.91-96
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• 2008

Purpose: One of the main objectives of periodontal reconstructive surgery is the coverage of exposed roots that occur due to gingival recession. and Aestheic concerns are usually the reason to perform root coverage procedure. This case report was performed to evaluate the effect of root coverage using subepithelial connective tissue graft(SCTG) on Miller's Class I marginal tissue recession. Materials and Methods: One patient, with two Miller's class I marginal tissue recession on both maxiallay canines, was treated with root coverage using SCTG (modified Nelson's technique). At baseline, the following measurements were recorded: 1) recession depth; 2) width of keratinized giniga. At 9, 10 months post-surgery, all clinical measurements were repeated. Result: 1) The mean root coverage from baseline to 9, 10 months post-surgery was 92.3%. 2) The mean recession depth decreased from 6.5 mm to 0.5 mm. 3) The mean width of keratinized gingiva increased from 1.25 mm to 3.5 mm. Conclusion: Within the above results, root coverage using SCTG is an effective procedure to cover Miller's class I marginal tissue recession defect. Also, patient with aesthetic concern could be satisfied with this result.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.3
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• pp.172-176
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• 2010

Postirradiation extraosseous osteogenic sarcomas are uncommon in the head and neck, despite the extensive use of high-dose radiation. It has been described as de novo radiation-induced neoplasm. We present a 73-year-old male who had been treated by radiotherapy for gingival cancer 7 years earlier and later developed extraosseous osteogenic sarcomas (EOSs) of the neck. Microscopically, the neck mass was composed with mesenchymal malignant cells with cartilaginous and osteogenic differentiation. Immunohistochemical stain demonstrated strong positivity of tumor cells for Snail, the one of major epithelial-mesenchymal transition (EMT) inducer. The E-cadherin expression was scarce, showing inverse relationship to Snail expression. Compared with previous squamous cell carcinoma (SCC) of the gingiva, the present EOS sample revealed the remained epithelial cells on cytokeratin immunohistochemistry, suggesting the tumor arise from the cells of epithelial origin. We have also reviewed the previous 6 cases of head and neck EOSs carefully. The clinicopathologic features of the unusual lesion suggest that it is an incomplete EMT of precedent epithelial malignancy rather than de novo pathology.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.4
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• pp.343-348
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• 2009

Kaposi's sarcoma was first descrided by Kaposi in 1872 as an idiopathic multiple hemorrhagic sarcoma. Its clinical features revealed to be erythematous red or purple macule started out, and developing into palpable dome-shaped nodules. Etiology is not defined to detail at present. Kaposi's sarcoma is classified to 4 categories; Classical, African, Epidemic and Immunosuppressive type. Epidemic categories is found approximately 20% of all AIDS patients and has strong predilection for head and neck region. The first case of immunosuppresive type Kaposi's sarcoma in patients with kidney transplants was reported in 1969. Kaposi's sarcoma accounts for 5% of all tumors associated with transplanted patients. The most common site of Kaposi's sarcoma in immunosuppressed patients are extremities, but rare in head and neck area. A 42 years old woman who had systemic lupus erythematosus visited to our clinic because of gingival hyperplasia, and excisional biopsy revealed Kaposi's sarcoma. We experienced a case of favorable results using excision and chemotherapy, so we report with review of literatures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.43.1-43.5
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• 2019

Background: Reconstructive surgery is often required for tumors of the oral and maxillofacial region, irrespective of whether they are benign or malignant, the area involved, and the tumor size. Recently, three-dimensional (3D) models are increasingly used in reconstructive surgery. However, these models have rarely been adapted for the fabrication of custom-made reconstruction materials. In this report, we present a case of maxillary reconstruction using a laboratory-engineered, custom-made mesh plate from a 3D model. Case presentation: The patient was a 56-year-old female, who had undergone maxillary resection in 2011 for intraoral squamous cell carcinoma that presented as a swelling of the anterior maxillary gingiva. Five years later, there was no recurrence of the malignant tumor and a maxillary reconstruction was planned. Computed tomography (CT) revealed a large bony defect in the dental-alveolar area of the anterior maxilla. Using the CT data, a 3D model of the maxilla was prepared, and the site of reconstruction determined. A custom-made mesh plate was fabricated using the 3D model (Okada Medical Supply, Tokyo, Japan). We performed the reconstruction using the custom-made titanium mesh plate and the particulate cancellous bone and marrow graft from her iliac bone. We employed the tunneling flap technique without alveolar crest incision, to prevent surgical wound dehiscence, mesh exposure, and alveolar bone loss. Ten months later, three dental implants were inserted in the graft. Before the final crown setting, we performed a gingivoplasty with palate mucosal graft. The patient has expressed total satisfaction with both the functional and esthetic outcomes of the procedure. Conclusion: We have successfully performed a maxillary and dental reconstruction using a custom-made, pre-bent titanium mesh plate.

• Journal of Periodontal and Implant Science
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• v.37 no.sup2
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• pp.353-369
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• 2007

Gingival tissue samples were obtained during periodontal surgery or tooth extraction. According to the patient's systemic condition & clinical criteria of gingiva, each gingival sample was divided into three groups. Group 1 (n=8) is clinically healthy gingiva without bleeding and no evidence of bone resorption or periodontal pockets, obtained from systemically healthy 8 patients. Group 2 (n=8) is inflamed gingiva from patients with chronic periodontitis. Group 3 (n=8) is inflamed gingiva from patients with chronic periodontitis associated with type 2 diabetes. Tissue samples were prepared and analyzed by Western blotting. The quantification of $IL-1{\beta}$, MMP-13 and TIMP-1 were performed using a densitometer and statistically analyzed by one-way ANOVA followed by Tukey test. 1. The expressions of MMP-13 and TIMP-1 showed increasing tendency in group 2 & 3 compared to group 1. 2. The expressions of $IL-1{\beta}$ & MMP-13 were showed increasing tendency in group 3 compared to group 2. 3. As $IL-1{\beta}$ levels were increasing, MMP-13 showed increasing tendency in group 3, and although $IL-1{\beta}$ , MMP-13 levels were increasing, TIMP-1 levels were similar expressed comparing to group 2. In conclusion, this study demonstrated that the expression levels of MMP-13 and TIMP-1 had increasing tendency in inflamed tissue. It can be assumed that $IL-1{\beta}$ and MMP-13 may be partly involved in the progression of periodontal inflammation associated to type 2 DM.

• Journal of Periodontal and Implant Science
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• v.37 no.sup2
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• pp.325-338
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• 2007

The purposes of this study were to compare and quantify the expression of IL-6, e1stase and ${\alpha}_1-PI$ in the gingival tissues of patients with type 2 diabetes mellitus and healthy adults with chronic periodontitis. Gingival tissue samples were obtained during periodontal surgery or tooth extraction. According to the patient's systemic condition & clinical criteria of gingiva, each gingival sample was devided into three groups. Group 1 (n=8) is clinically healthy gingiva without bleeding and no evidence of bone resorption or periodontal pockets, obtained from systemically healthy 8 patients. Group 2 (n=8) is inflammed gingiva from patients with chronic periodontitis. Group 3 (n=8) is inflammed gingiva from patients with chronic periodontitis associated with type 2 diabetes. Tissue samples were prepared and analyzed by Western blotting. The quantification of IL-6, elastase and ${\alpha}_1-PI$ were performed using a densitometer and statistically analyzed by one-way ANOVA followed by Tukey test. 1. The expression levels of IL-6 showed increasing tendency in group 2 and 3, and It was highest in group 3. 2. The expression of elastase showed increasing tendency in group 2 and 3, and It was highest in group 3. 3. The expression of ${\alpha}_1-PI$ showed increasing tendency in group 3 compared to group 1. 4. The ${\alpha}_1-PI$/elastase ratio was decreased in group 2 and 3 compared to group 1, especially most decreased in group 3. 5. As IL-6 levels were increasing, elastase showed increasing tendency in group 3, and although IL-6 and elastase levels were increasing, ${\alpha}_1-PI$ level in group 3 showed slightly increasing pattern comparing to group 1. In conclusion, this study demonstrated that the expression levels of IL-6 and elastase will be inflammatory markers of periodontal inflammed tissue and DM. The ${\alpha}_1-PI$/elastase ratio also may be important measuring inflmmatory factors in the progression of periodontal inflammation associated to type 2DM.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.4
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• pp.227-235
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• 2013

Purpose: High risk human papillomavirus (HPV) is the main source of cervical cancer, nearly up to 100%. Because there are no affordable data regarding the incidence of HPV in different sites of oral cavity, the purpose of this study is to review the previous article and to find out about the incidence and types of HPV in specific areas of oral cavity. Methods: We examined a total of 106 patients with oral cavity cancer for HPV detection. Available DNA chip (MY-HPV chip kit$^{(R)}$, Mygene Co., Korea) was used for the detection of low risk HPV types (6, 11, 34, 40, 42, 43, 44) and high risk HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 54, 56, 58). Patients were previously diagnosed as invasive cancer of oral cavity. Specimen used for HPV detection was extracted from the main mass during resection and were tested for HPV type, performed by a DNA chip method. Results: Histologic results showed that there were squamous cell carcinomas, mucoepidermoid carcinomas, cystadenocarcinomas, leiomyosarcoma and etc. Among HPV positive cancer, 2 patients showed positive for high risk HPV type 16, 3 patients showed positive for low risk HPV type 6 and the other 2 patients were positive for other types of HPV. Of the 7 patients with HPV positive, 4 patients were on the tongue, 3 on the lower gingiva. Conclusion: Most of the HPV positive cancers were on the tongue in our study. Cervical cancer of HPV infection is reported to be increasing in our society and because HPV infection largely spreads by sexual contact, the incidence of oral cancer with HPV infection is greatly assumed to be on the increase, simultaneously. Because the incidence of HPV on specific areas of oral cavity among oral cancer patients is not identified, more studies are ongoing.