• Journal of Periodontal and Implant Science
• /
• 제30권4호
• /
• pp.793-803
• /
• 2000

Procedures for treatment of molar furcation invasion defects range from open flap debridement, apically repositioned flap surgery, hemisection, tunneling or extraction, to regenerative therapies using bone grafting or guided tissue regenerative therapy, or a combination of both. Several clinical evaluations using regenerative techniques have reported the potential for osseous repair of treated furcation invasions. Regenerative treatment of maxillary molars are more difficult due to the multiple root anatomy and multiple furcation entrances therefore, purpose of this study was to evaluated histologically self-curing glass-ionomer cement and light-curing glass-ionomer cement as a barrier in the treatment of a bi-furcated maxillary premolar. Five adult beagle dogs were used in this experiment. With intrasulcular and crestal incision, mucoperiosteal flap was elevated. Following decortication with 1/2 high speed round bur, degree II furcation defect was made on maxillary third(P3), forth(P4) and fifth(P5) premolar. 2 month later experimental group were self-curing glassionomer cement and light-curing glassionomer cement. After 4, 8 weeks, the animals were sacrificed by vascular perfusion. Tissue block was excised including the tooth and prepared for light microscope with Gomori's trichrome staining. Results were as follows. 1. In all experiment group, there were not epithelial down growth and glass ionomer cement were encapsulated connective tissue. 2. In 4 weeks experiment I group slighly infiltrated inflammatory cells but not disturb the new bone or new cementum formation. 3. In 8 weeks, experiment groups I, II were encapsulated fine connective tissue. 4. Therefore glass-ionomer cement filling to the grade III maxillary furcations with multiple root anatomy and multiple furcation entrances were possible clinical methods and this technique is useful method for Maxillary furcation involvement.

• Journal of Periodontal and Implant Science
• /
• 제29권1호
• /
• pp.103-115
• /
• 1999

The ultimate goal of periodontal therapy is the regeneration of periodontal tissue which has been lost due to destructive periodontal disease. Various periodontal procedures have been used throughout the years in an attempt to reestablish attachment of periodontal tissues to root surfaces affected by periodontitis. Flap debridement surgery has been demonstrated to be a successful procedure in gaining the probing attachment level and reducing probing depth. A tendency towards impaired wound healing following periodontal procedures in smokers has been clinically documented. But, previous clinical studies on healing response in smokers are based on a retrospective design. The purpose of this study was to evaluate the treatment outcome following flap debridement surgery in smokers compared to nonsmokers. 25 patients with moderate to advanced periodontitis were included for study. Among these patients, 13 patients were smokers, and 12 patients were nonsmokers. Mucoperiosteal flap was raised with the sulcular incision. No antibiotic treatment was administered postsurgery. The patients was recalled at monthly intervals during a period of 6 months following the surgery. The patients were received supragingival scaling and oral hygiene reinforcement. All the recordings, including modified O' Leary plaque control record, bleeding on probing, probing pocket depth, probing attachment level,were recorded, presurgery and 6 months postsurgery. The changes of all the recordings at 6 months after flap debridement surgery revealed the following results: 1. PI on all the dentitions and surgical sites showed no statistical significance between smokers and nonsmokers at presurgery. But, smokers demonstrated a significantly lower % of PI than nonsmokers at 6 months postsurgery. 2. Smokers demonstrated a greater % of BOP sites than nonsmokers on the surgical sites and all the dentitions, presurgery and 6 months postsurgery. But, there was no statistical significance between two groups. 3. Smokers exhibited significantly less reduction of probing depth in the 3 mm or less probing pocket depth(PPD) group, 6mm or more PPD group and total PPD group when compared to nonsmokers at 6 months postsurgery. 4. Smokers exhibited significantly less gain of probing attachment level(PAL) in the 3mm or less PPD group, 6 mm or more PPD group and total PPD group when compared to nonsmokers at 6 months postsurgery.

• Journal of Periodontal and Implant Science
• /
• 제41권4호
• /
• pp.176-184
• /
• 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
• /
• 제26권1호
• /
• pp.103-116
• /
• 1996

This study was performed to observe the bacterial adhesion and penetration to e-PTFE membrane following guided tissue regeneration(GTR) procedure and to evaluate the association of the membrane exposure and bacterial contamination with the clinical outcome. For the study, ten infrabony defects in 9 patient were treated by mucoperiosteal flap operation including placement of the e-PTFE membrane. The treated teeth were monitored weekly for the membrane exposure, gingival recession and gingival inflammation. The membranes were retrieved after 4 to 6 weeks, examined by SEM for bacterial contamination and adherent connective tisue elements, and observed under LM for the bacterial penetration into membrane. Three months postsurgery, the defect sites were clinically reexamined for the changes in attachment level and probing depth. Comparison of the ultrastuctural findings and clinical outcome revealed that extent of membrane exposure and bacterial contamination of the membrane was inversely associated with clinical attachment gain. From this finding, the extent of membrane exposure and the bacterial contamination on the apical portion of the e-PTFE membrane at the time of removal seemed to be a critical determinant on the clinical outcome of GTR and the membrane exposure needs to be controlled for optimal results.

• Archives of Plastic Surgery
• /
• 제33권1호
• /
• pp.61-66
• /
• 2006

The purpose of this study is to introduce the method of palate repair that combines minimal hard palate dissection and radical retropositiong of levator musculature, which was presented by Sommerlad. As this method presents, additional use of the operating microscope enables atraumatic and radical dissection, and it might provide more improved speech function to the patients. A total of 17 patients with cleft palate underwent Sommerlad's method from December 2003 to August 2004. The mean follow-up period was 4.5 months. The use of a microscope provided high quality variable magnification and good illumination at the operating field. Repair was carried out through incisions at the margins of cleft with mucoperiosteal flap elevation. Muscles were rearranged and repaired properly. It was unable to evaluate the improvement of speech because the patients were too young to learn meaningful speech. Average operating time including anesthetic induction time, V-tube insertion and recovery from anesthesia was 2 hours 45 minutes which was not quite different from conventional method's operating time. Oronasal fistula developed in 2 patients of them. One of them was healed spontaneously. As meticulous and radical muscle dissection was possible with Sommerlad's method, we could minimize the trauma to the muscular and neurovascluar structure. In addition, we expect better faculty of speech as a result of this method although longer follow-up time was unavailable.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제38권2호
• /
• pp.85-89
• /
• 2012

Objectives: This study was to evaluate the effect of vertical bone gain and success rate and analyze the failure cases using the hydrodynamic piezoelectric internal sinus elevation (HPISE) technique. Materials and Methods: Patients who had been operated in the three centers including Daegu Catholic University Medical Center were selected for this study. The mucoperiosteal flap was elevated, and the sinus floor was then broken by specially designed piezoelectric insert, with hydraulic pressure applied to the sinus membrane for even elevation. Afterward, implants were placed. Panoramic radiogram or computed tomogram was taken before and after surgery and at the second operation and prosthesis placement. Later, changes in vertical height were measured and compared. The survival rate was based on the criteria of Buser et al. and Cochran et al. Results: In this study, 8 implants failed out of a total of 169 implants, resulting a success rate of 95.3%. These failure cases were due to insufficient initial stability or sinus membrane perforation. The mean of radiographic vertical height change at prosthesis placement was 5.7 mm (0.5-10.5 mm). Conclusion: In this study, HPISE technique was found to be a predictable treatment for atrophic maxilla and an alternative technique to the lateral approach.

• Journal of Periodontal and Implant Science
• /
• 제24권1호
• /
• pp.87-97
• /
• 1994

The ultimate goal of periodontal therapy is to fully reconstruct the periodontal attachment apparatus. Commonly used techniques for treatment of infrabony defects include a combination of root planing, curettage and root treatment. To prevent the apical migration of epithelial cells, the technique of guided tissue regeneration is used. The aim of this study is to compare the effects of root treatment with Citric acid & Tetracycline and Guided tissue regeneration in dogs. Experimental periodontitis was induced by the ligation of orthodontic elastic threads in the upper right and left premolars 3, 4 of five adult dogs for 6 weeks. 4 types of procedures were performed as follows; 1) Control graup : Mucoperiosteal flap 2) Experinental I : GTR used Gore-tex(R) membrane 3) Experinental II : Root treatment with citric acid (PHl) 4) Experinental III : Root treatment with tetracycline HCl (50mg/ml) There after, dogs were serially sacrificed at the 1, 2, 4, 5, 8 weeks, and the specimens were prepared, and stained with hematoxylin-eosin for the light microscopic evaluation. The results of this study were as follows; 1. Junctional epithelium reached to the notch through the furcation area in control group at 8 weeks. 2. In the aspects of the inflammatory cell infiltration, control group showed severe aggregation than experimental group I, II, III through the experimental period 3. New cementum was observed over the notch from 5 weeks in experimental group II 4. In the aspects of the amount of new bone formation, experimental group was better than control group, but there was not significant differences among the experimental group, I, II, III

• Journal of Periodontal and Implant Science
• /
• 제24권1호
• /
• pp.120-130
• /
• 1994

The purpose of the present investigation was to compare the effectiveness of porous hydroxyapatite (PHA) and coralline based porous calcium carbonate(PCC) as implant materials in human periodontal osseous defects. 10 adult patients having periodontitis and 2 similar angular osseous defects ${\ge}$5mm as verified by radiographic analysis and clinical probing depth ${\ge}$4mm were selected. The measurements were recorded just before surgery and after 6 month. Clinical parameters used in this study included gingival recession, pocket depth, probing attachment level, Sulcus Bleeding Index, Plaque Index, tooth mobility and bone defect depth measurements. After initial therapy, patients were treated with mucoperiosteal flap surgery. The contralateral bony defects in each patient randomly assigned to either bone graft material, one with PHA(Interpore 200) and the other with coralline based calcium carbonate(Biocoral). After 6 month both groups showed statistically significant reduction of pocket depth, Sulcus Bleeding Index, Plaque Index and significant improvement in probing attachment level. No statistically significant differences were found between the groups. There were 3.0mm or 68% of bone repair with PHA and 3.1mm, 61% with PCC. These values were likewise not significantly different. The data and clinical impression strongly suggest that both PHA and PCC are alloplastic implants with clinically apparent acceptance by the soft and hard tissue and that they can be used as bone graft materials successfully.

• Journal of Periodontal and Implant Science
• /
• 제30권4호
• /
• pp.803-814
• /
• 2000

Current acceptable methods of promoting periodontal regeneration are basis of removal of diseased soft tissue, root treatment, guided tissue regeneration, graft materials, biological mediators. Platelet Rich Plasma have been reported as a biological mediator which regulate activities of wound healing progress including cell proliferation, migration, and metabolism. The purpose of this study is to evaluate the possibility of using the Platelet Rich Plasma as a regeneration promoting agent for furcation involvement defect. Five adult beagle dogs were used in this experiment. With intrasulcular and crestal incision, mucoperiosteal flap was elevated. Following decortication with 1/2 high speed round bur, degree II furcation defect was made on mandibular third(P3), forth(P4) and fifth(P5) premolar. 2 month later experimental group were PRP plus bovine bone and bovine bone only. After 4, 8 weeks, the animals were sacrificed by perfusion technique. Tissue block was excised including the tooth and prepared for light microscope with Gomori's trichrome staining. At 4 weeks after surgery, there were rapid osteogenesis phenomenon on the defected area of the Platelet Rich Plasma plus bovine bone group and early trabeculation pattern was made with new osteoid tissue produced by activated osteoblast. Bone formation was almost completed to the fornix of furcation by 4 weeks after surgery. In conclusion, Platelet Rich Plasma can promote rapid osteogenesis during early stage of periodontal tissue regeneration.

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