• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권6호
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• pp.592-596
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• 2010

The common local causes of active gingival bleeding are the vessel engorgement and erosion by severe inflammation and injury to hypervascularity lesion. Abnormal gingival bleeding is also associated with systemic bleeding disorders (liver disease, leukemia etc.). There are many conventional methods for gingival bleeding control, such as, direct pressure, packing, electrocoagulation, tight suture and application of hemostatic agents. If the continuous gingival bleeding is not stopped in spite of the all local application methods, the medical consultation should be obtained for systemic condition care and the major feeding arterial embolization. This is a case report of severe gingival bleeding and periodontitis control in a patient with liver cirrhosis and oral metastatic lesion of hepatocellular carcinoma. The bleeding lesion was placed in left buccal mucosa and gingiva of the left mandibular molars. The control methods were dental crown removal, primary endodontic drainage, gingival sulcus drainage and maxillary arterial embolization with medical consultation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권6호
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• pp.343-350
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• 2019

Objectives: The aims of this study were to determine the effectiveness of local compression in patients presenting to the emergency room with intraoral bleeding and to identify when complex haemostatic measures may be required. Materials and Methods: Five hundred forty patients who had experienced intraoral haemorrhage were retrospectively reviewed. The outcome variable was the haemostasis method used, i.e., simple (local compression with gauze) or complex (an alternative method after local compression has failed). Predictor variables were sex, age, American Society of Anesthesiologists (ASA) class, hepatic cirrhosis, bleeding disorder, use of antithrombotic agents, and site/cause of haemorrhage. Results: The mean patient age was 48.9±23.9 years, 53.5% were male, 42.8% were ASA class II or higher, and 23.7% were taking antithrombotic agents. Local compression was used most often (68.1%), followed by local haemostatic agents, sutures, systemic tranexamic acid or blood products, and electrocautery. The most common site of bleeding was the gingiva (91.7%), and the most common cause was tooth extraction (45.7%). Risk factors for needing a complex haemostasis method were use of antithrombotic agents (odds ratio 2.047, P=0.009) and minor oral surgery (excluding extraction and implant procedures; odds ratio 6.081, P=0.001). Conclusion: A haemostasis method other than local compression may be needed in patients taking antithrombotic agents or having undergone minor oral surgery.

• 대한치과의사협회지
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• 제50권8호
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• pp.474-481
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• 2012

The periodontal flap surgery is the most widely utilized surgical procedure to reduce the pocket depth and to access the subgingival root surfaces for scaling and root planing. The diagnosis of the periodontal lesion and the objective of the surgery will dictate the type of flap procedure which will be utilized to obtain the best result. The incisions, type of flap and the selection of suturing design must be planned and executed to fit the problem. Periodontal flaps are designed to preserve gingival integrity and to gain access to root surfaces for residual calculus removal and to thoroughly remove granulation tissue so bone defects can be visualized and treated. Gentle and efficient procedures result in optimum healing and minimal postoperative pain. When flaps need to be repositioned apically or less often, coronally, then the flaps must sit passively at the appropriate level before suturing. To ensure this, buccal and lingual flaps need to be elevated beyond the mucogingival junction so the elasticity of the mucosa allows for flap mobility. Sometimes it may be necessary to extend the flap elevation apically with a split incision approach to minimize the effect of the less elastic periosteum. Vertical incisions can aid in flap positioning by allow ing the clinician to suture the flap at a different level to the adjacent untreated gingiva. In osseous periodontal surgery, flaps are apically positioned to minimize postoperative pocket depth. In regenerative periodontal surgery including implant surgery, soft tissue cove rage of bony defects, graft materials, membranes, and bio logic agents is important so sulcular incisions and light suturing techniques are crucial.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권2호
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• pp.83-88
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• 2009

The purpose of this epidemiologic study was to provide clinically useful information on the fundamentals for both the diagnosis and treatment planning of oral squamous cell carcinoma, which comprises $80{\sim}90%$ of all oral cancers. One hundred and forty two patients diagnosed with oral squamous cell carcinoma were selected from a total of 220 patients with oral malignancies. The patients' medical and follow-up records were reviewed and their survival was traced. The highest occurrence rate was observed in those aged between 60 and 69 years. The tongue was the most common primary site(31.7%) for oral squamous cell carcinoma. The survival rate was calculated using the Kaplan-Meier method. The overall five-year survival rate of oral squamous cell carcinoma patients was 66.90%. The 5-year survival rate according to stage was 85.82% for stage I, and 49.98% for stage IV. The five-year survival rate according to the originating site was 91.67% for the retromolar trigone, 75.30% for the tongue, and 62.41% for the maxillary gingiva. In terms of cell differentiation, the majority(58.5%) was the well-differentiated type, which had a 5-year survival rate of 70.62%.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.56-60
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• 2009

Purpose: Palatal fracture and mandible fracture result in instability of dental arch. Because they divide the maxillary and mandibular alveolus sagittally and / or transversely and comminute the dentition, they permit rotation of dental alveolar segments and significantly increase the potential for fracture malalignment, complicating fracture treatment. Previous treatment of palatal fracture consisted of palatal splint application and rigid palatal vault stabilization. This procedure result in patient's oral discomfort and removal of palate and screw. Mandible fracture often results in malocclusion due to widening of posterior aspect of dental arch. So we introduce more simple method using intermolar traction wiring, which can protect the widening of dental arch and rotation of dental alveolar segment. Methods: Arch bar and intermolar traction wiring with wire 1 - 0, or 2 - 0 was applied. After exposure of fracture line, neutrooclusion was maintained with intermaxillary fixation. And then open reduction & internal fixation on maxillary fracture line, commonly maxillary buttress, alveolar ridge, pyriform aperture except palatal vault or mandibular fracture line. After 1 week, intermolar traction wiring was removed. We checked occlusion and postoperative radiologic finding. Results: From June of 2007 to October of 2007, 10 patient, who have maxillary fracture with palatal fracture and mandible fracture, underwent open reduction & internal fixation with intermolar traction wiring. All have satisfactory occlusion and there were no complication, like gingiva disease, mouth opening impairment and nonunion. Conclusion: The intermolar traction wiring accompany open reduction and internal fixation can be alternative method for restoration of dental arch in facial bone fracture.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권4호
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• pp.414-417
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• 1999

The congenital epulis of newborn is a rare benign tumor that occurs on the gingiva of the anterior alveolar ridge of the jaws, also known as a congenital granular cell tumor. Females are affected 8 - 10 times more often than males. The typical location is the alveolar ridge of the maxilla near the canine but the mandibular region can also be involved. The lesion may be sessile or pedunculated with red or normal color. The size of tumor varies from several millimeters to a few centimeters in diameter. Surgical excision is generally indicated and no recurrences have been noticed. Spontaneous regression is rare. It is histologically similar to the granular cell tumor, although pseudoepitheliomatous hyperplasia does not occur in the former lesion. Thus sheets of large, closely packed cells showing fine, granular, eosinophilic cytoplasm comprise the tumor mass. This is a case report of congenital epulis in the fetus. The lesion was detected in ultrasonogram, its size is 3cm in diameter. The infant showed nursing disturbance and respiratory obstruction after birth, so the tumor was surgically excised under local anesthesia.

• Journal of Periodontal and Implant Science
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• 제39권4호
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• pp.391-398
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• 2009

Purpose: The purpose of this study was to quantify and compare the expressions of CRP and M-CSF in the gingival tissues of the patients with chronic periodontitis associated to hypertension. Methods: Gingival tissue samples were obtained during periodontal surgery or tooth extraction. Clinically healthy gingival tissue samples from systemically healthy 12 patients were categorized as group 1 (n=12). Inflammatory gingival tissue samples from patients with chronic periodontitis were categorized as group 2 (n=12). Inflammatory gingival tissue samples from patients with chronic periodontitis associated with hypertension were categorized as group 3 (n=12). Tissue samples were prepared and analyzed by Western blotting. The quantification of CRP and M-CSF were performed using a densitometer and statistically analyzed by one-way ANOVA followed by Tukey test. Results: There were significant differences between group 1 and group 2 and between group 1 and group 3 in both CRP and M-CSF. The differences between group 2 and group 3 were not statistically significant in both proteins. However, the expression levels of CRP and M-CSF in hypertensive inflammatory gingiva showed increased tendency compared to non-hypertensive inflammatory gingiva. Conclusions: It is suggested that CRP and M-CSF might be used as inflammatory and bone resorption markers in periodontal diseased tissue. It is assumed that hypertension may be associated with the progression of periodontal inflammation and alveolar bone resorption.

• Journal of Periodontal and Implant Science
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• 제39권1호
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• pp.71-76
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• 2009

Purpose: Many researches showed loss of alveolar bone in fresh extraction socket and even in case of immediate implant placement. The aim of this study was to evaluate the effect of non-resorbable barrier membrane on the change of buccal and lingual alveolar bone in immediate implant placement into periapically infected extraction sockets. Materials and methods: Immediate implants were placed into artificially induced periapical lesion of mandibular premolars after complete debridement using buccal bone defect made by a 6mm trephine bur in 4 mongrel dogs. Before flap repositioning, a non-resorbable barrier membrane was placed on the buccal defect in the experimental group. No membrane was placed in the control group. In 12 weeks after placement, the dogs were sacrificed and undecalcified histologic specimens were prepared. The vertical distance from the smooth-rough surface interface(SRI) to gingiva, 1st bone contact and bone crest were measured in buccal and lingual side. The horizontal thicknesses of gingiva and bone at 0, 1, 2 and 3mm below SRI were measured. Results: The buccal bone was resorbed more than lingual bone in both groups and there was statistical significance(p<0.05). The distances from SRI to 1st bone contact were $2.45{\pm}2.35\;mm$ in experimental group and $4.49{\pm}3.10\;mm$ in control group. In all vertical level, lingual bone was thicker than buccal bone(p<0.05). Conclusion: Buccal bone was reduced more than lingual bone in immediate implant placement into periapically infected extraction sockets. Placement of non-resorbable barrier membrane reduced the buccal bone resorption. However there was no statistical significance.

• 구강회복응용과학지
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• 제35권4호
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• pp.253-259
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• 2019

본 증례 보고는 하악 전치에 발생한 치은 퇴축을 laterally closed tunnel technique을 이용하여 처치하였다. 환자는 모두 과거 교정 치료 시 하악 전치의 경사도를 변화시켰으며 치주 적으로 얇은 생체형을 가지고 있었다. 터널링법으로 수여 부를 형성하고 구개 측에서 채득한 결합조직이식편을 터널내에 위치시킨 후 판막의 변연을 치근 중앙부를 향해 측방으로 이동시켜 봉합하여 이식편을 피개 하였다. 얇은 치주 생체형에도 불구하고 치근 피개를 성공적으로 얻을 수 있었으며 각화 치은의 획득과 주변 조직과의 색, 형태 조화로 심미성을 달성할 수 있었다.

• Journal of Periodontal and Implant Science
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• 제24권2호
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• pp.376-389
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• 1994

A study was conducted to compare the effects of chlorhexidine mouthrinse and chlorhexidine acetate powder with periodontal pack during 4 weeks following periodontal surgery. Twelve patients were treated with Modified Widman flap procedures and devided into three groups of four patients each; control group, chlorhexidine mouthrinse group, chlorhexidine acetate powder group. Each group wasn't significant difference in clinical and microbiologic parameters at preoperation. Examination regarding plaque index, gingival index, pocket depth, change of gingival color postsurgically, pain index were performed by each methods and observed bacteria in gingiva by phase contrast microscope. Evaluations were made at 7, 14 and 28 days postsurgically. The results were as follows: l. In comparison of results revealed no significant differences in Plaque Index, Gingival Index, pocket depth and change of gingival color postsurgically. 2. The pocket depth of three experimental groups were significant reduced at 4 weeks. 3. Chlorhexidine mouthrinse group and chlorhexidine acetate powder group with periodontal pack were significant differences in pain index at 3, 4 days postsurgically. 4. Cocci and Non-motile rods were increased at 1, 2 weeks. But, motile rod and spirochete were increased at 4 weeks.