• Journal of the korean academy of Pediatric Dentistry
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• v.44 no.1
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• pp.108-115
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• 2017

Numerous therapeutic approaches are available for impacted teeth, including orthodontic retraction, implantation, and autogenous tooth transplantation. Autotransplantation is a promising method, especially for juvenile patients, as it enables preservation of the function of the periodontal tissues, as well as continued alveolar bone growth. This report describes autotransplantation in two cases in which the tooth was fully-ectopically impacted. With case 1, an ectopically impacted premolar was extracted and transplanted in an upright position, and regenerative endodontic treatment was performed using a platelet-rich fibrin clot and mineral trioxide aggregate (MTA). With case 2, a calcifying odontogenic cyst with an impacted left mandibular second molar was treated by enucleation. The tooth was transplanted into the proper position 3 months after enucleation, and endodontic treatment was performed using MTA. In both cases, autotransplantation appeared to provide a simple and rapid treatment option for patients with ectopically impacted teeth. These cases demonstrate that autotransplantation of ectopically impacted teeth is a viable treatment option rather than implant placement or prosthesis, especially in juvenile patients.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.22 no.1
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• pp.47-55
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• 2013

There have been a great number of developments in clinical techniques and dental materials in dentistry to date. Looking at these developments, while it could be seen that functional elements such as mastication were prioritized rather than aesthetic aspect in the past, aesthetic needs of patients have steadily increased over time and accordingly the aesthetic has become considered a priority in the development of dentistry. Although the first to be considered in discussing the aesthetic in clinical dentistry will be the white aesthetic that is the tooth part of prosthesis, the pink aesthetic that refers to the harmony of such prosthesis with gingiva can be an important consideration not to be ignored aesthetically. However, the harmony with the gingiva often cannot be obtained only by the beautiful prosthesis, and in particular, the pontic and implant areas have poor conditions to achieve the gingival (pink) aesthetic due to the absorption of alveolar ridge compared to natural teeth. Among the most important elements of the gingival aesthetic are the gingival level and the interproximal papilla height. It is very difficult to make the gingival aesthetic in the case of insufficient alveolar ridge, and the recovery of ridge volume and contour is necessary in order to overcome this condition. To this end, the most widely used method is the "connective tissue graft". Many techniques of the connective tissue graft have already been introduced for the ridge augmentation, and each technique has different purposes, and advantages and disadvantages. Rather, due to the excessive amount of techniques, there is confusion about selecting the right technique at a certain time. However, the goal is clear. Ways to increase the success rates must be found, and at the same time, a more favorable way to the gingival aesthetic is to be chosen. Thus, in this study, considerations for the gingival aesthetic that makes harmony and the techniques to achieve it are discussed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.3
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• pp.276-281
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• 2010

The maxillary posterior area is the most challenging site for the dental implant. After missing of teeth on maxillary posterior area due to periodontal problems, the remaining alveolar ridge is usually very thin because of not only pneumatization of maxillary sinus but also destruction of alveolar bone. The maxillary sinus bone graft procedure is one of the most predictable and successful treatments for the rehabilitation of atrophic and pneumatized endentulous posterior maxilla. But, in case of severe destruction of alveolar bone due to periodontal problems, very long crown length is still remaining problem after successful sinus graft procedures. We performed vertical augmentation of maxillary posterior alveolar ridge using mandibular ramal block bone graft with simultaneous sinus graft. After this procedures, we could get more favorable crown-implant ratio of final prosthodontic appliance and more satisfactory results on biomechanics. This is a preliminary report of the vertical augmentation of maxillary posterior alveolar ridge using mandibular ramal block bone graft with simultaneous sinus graft, so requires more long-term follow up and further studies.

• The Journal of the Korean dental association
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• v.47 no.6
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• pp.364-372
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• 2009

치주 질환으로 인하여 소실된 치주조직을 재생시키려는 여러 술식이 많이 연구되고있다. 그 중 bioactive factor의 적용은 치주조직의 재생에 있어서 우수한 치료법으로 평가되고 있으며, 이를 수용부에 적절히 적용하기 위한 운반체로 생체친화적인 중합체가 이용되고 있다. 본 연구의 목적은 PLGA를 Inorganic filler에 혼합시킨 재료를 성견의 일벽성 골내낭에 적용하여 이 재료의 생체 친화성과 생체 흡수도를 보고자 하는 것이다. 5마리의 비글견에서 제 3 소구치를 모두 발치한 뒤, 8주간의 치유기간이 지나고 제 2 소구치 원심면과 제 4 소구치 근심면에 5mm 깊이, 4mm폭의 일벽성 골내낭을 형성하였다. 좌측 defect에는 PLGA/inorganic filler matrix를 이식하였고 우측에는 아무것도 이식하지 않은 대조군으로 나누어 술 후 8주에 희생하여 치유 결과를 조직학적으로 비교 관찰하였다. 조직학적 분석 결과, 모든 결손부에서 염증의 소견이 관찰되지 않았으며 치근흡수와 유착은 발견되지 않았다. 백악질과 치조골, 치주인대를 포함한 치주조직의 재생에 있어서 대조군, 실험군 간에 조직학적으로 치유양상에 있어 차이를 많이 보이지 않았으며 PLGA/inorganic filler matrix는 8주 내에 완전히 흡수되어 결합조직이나 신생골내에서 그 흔적을 발견할 수 없었다. 이러한 결과는 PLGA/inorganic filler matrix는 생체친화성 및 생체흡수성이 우수한 재료로서 치주 조직의 재생 치료에 있어서 신체활성인자의 scaffold로 사용될 수 있는 가능성을 보여주었다.

• Journal of Periodontal and Implant Science
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• v.36 no.1
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• pp.239-251
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• 2006

결합조직이식을 이용한 치근피개 술식에 많은 관심이 집중되고 있다. 최근에는 acellular dermal matrix가 자가 결합조직 이식편의 대체물로써 소개되었다. 본 실험의 목적은 치근피개를 위해 acellular dermal matrix을 사용시, 그 임상 효과 빚 조직 치유 양상을 평가하고, 이를 자가 결합조직 이삭시의 결과와 비교하기 위함이다. 3마리의 성견에 인위적인 치은 퇴축부 형성을 위해서, 상악 좌우견치의 협측에서 각화치은을 모두 제거하고, 법랑백악경계부로부터 12mm 정도 치조골을 삭제한 후에 판막을 봉합하였다. 그 후 35일을 치유 기간으로 부여하였다. 총 6 부위의 결손부가 실험에 포함되었고, 각각 3 부위씩이 대조군과 실험군으로 분류되었다. 실험군에서는 acellular dermal matrix 이식과 치관측 변위 판막을 시행하였고, 대조군에서는 치은 퇴축부위에 자가 결합조직 이식과 치관측 변위 판막을 시행하였다. 치주낭 깊이, 임상적 부착 수준, 치은 퇴축 높이, 각화조직 높이 등을 인위적 결손부 형성전, 치은 피개술 시행 직전, 피개술 시행후 4주 경과시에 각각 측정하였다. 술후 4주시에, 상악 좌우 견치 부위에서 시편을 얻어 조직학적으로 관찰하고 Wilcoxon signed rank test 와 Mann-Whitney U test으로 통계처리하였다. 임상결과 관찰시, 대조군과 실험군 모두에서, 술전과 비교시 치은 퇴축 감소와 각화조직의 증가, 임상 부착수준의 개선이 나타났다.(p ( 0.05) 평균 치근 피개율은 실험군에서 61.33(5.67%(n=3), 대조군에서 55.67(5.67%(n=3) 이었고, 대조군과 실험군에서 임상결과에서는 통계학적으로 유의성 있는 차이는 없었다.(p ( 0.05). 조직학상으로는, 두 군 모두에서 이식편이 수여부에 잘 융화되어 있었고 비슷한 치유 양상을 보였다. 이상의 실험결과에 의하면, Acellular dermal matrix은 치근피개술 시행시에 결합조직 이식편의 대용품으로 사용할 수 있고 비슷한 피개 결과를 얻을수 있었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.4
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• pp.314-318
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• 2009

The aim of this study was to evaluate the clinical applicability of a ridge splitting technique for reconstruction of narrowed edentulous alveolar ridges for dental implantation. 41 patients with 47 edentulous areas were included in this study. After corticotomy of a rectangular buccal segment and about 3-4 weeks healing period, the alveolar ridge was splitted, implant was placed. The initial ridge width varied between 2.5 and 7.0mm, average was 3.99mm. 68 dental implants were placed, and the gap between the implants and the bone is filled with various bone graft material, or none. All splitted sites showed sufficient bone volume for insertion of the implants at the moment of implantation. Over 1 year of follow-up period, five implants(7.3%) had mobility in two patients, among them, 2 implants(2.9%) sustained infection and removed. And any other complications were not noted. Our conclussion is that ridge splitting of the narrow edentulous area is a reliable and safe procedure in horizontally deficient ridges.

• Journal of Periodontal and Implant Science
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• v.23 no.3
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• pp.535-563
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• 1993

New techniques for regenerating the destructed periodontal tissue have been studied for many years. Current acceptable methods of promoting periodontal regeneration alre basis of removal of diseased soft tissue, root treatment, guided tissue regeneration, graft materials, biological mediators. Platelet-derived growth factor (PDGF) is one of polypeptide growth factor. PDGF have been reported as a biological mediator which regulate activities of wound healing progress including cell proliferation, migration, and metabolism. The purposes of this study is to evaluate the possibility of using the PDGF as a regeneration promoting agent for furcation involvement defect. Eight adult mongrel dogs were used in this experiment. The dogs were anesthetized with Pentobarbital Sodium (25-30 mg/kg of body weight, Tokyo chemical Co., Japan) and conventional periodontal prophylaxis were performed with ultrasonic scaler. With intrasulcular and crestal incision, mucoperiosteal flap was elevated. Following decortication with 1/2 high speed round bur, degree III furcation defect was made on mandibular second(P2) and fourth(P4) premolar. For the basic treatment of root surface, fully saturated citric acid was applied on the exposed root surface for 3 minutes. On the right P4 20ug of human recombinant PDGF-BB dissolved in acetic acid was applied with polypropylene autopipette. On the left P2 and right P2 PDGF-BB was applied after insertion of ${\beta}-Tricalcium$ phosphate(TCP) and collagen (Collatape) respectively. Left mandibular P4 was used as control. Systemic antibiotics (Penicillin-G benzathine and penicillin-G procaine, 1 ml per 10-25 1bs body weight) were administrated intramuscular for 2 weeks after surgery. Irrigation with 0.1% Chlorhexidine Gluconate around operated sites was performed during the whole experimental period except one day immediate after surgery. Soft diets were fed through the whole experiment period. After 2, 4, 8, 12 weeks, the animals were sacrificed by perfusion technique. Tissue block was excised including the tooth and prepared for light microscope with H-E staining. At 2 weeks after surgery, therer were rapid osteogenesis phenomenon on the defected area of the PDGF only treated 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 8 weeks after surgery. New cementum fromation was observed from 2 weeks after surgery, and the thickness was increased until 8 weeks with typical Sharpey’s fibers reembedded into new bone and cementum. In both PDGF-BB with TCP group and PDGF-BB with Collagen group, regeneration process including new bone and new cementum formation and the group especially in the early weeks. It might be thought that the migration of actively proliferating cells was prohibited by the graft materials. In conclusion, platelet-derived growth factor can promote rapid osteogenesis during early stage of periodontal tissue regeneration.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.1
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• pp.34-40
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• 2004

Unerupted maxillary anterior teeth is not a common case, However it may present practitioners with management problem. The cause of impaction is considered to be multifactorial, and local cause is the most common. These impacted teeth require surgical intervention, removal, transplantation, or surgical exposure, with or without orthodontic traction to align the malpositioned tooth. The preferred option is surgical exposure and orthodontic correction. Surgical intervention and orthodontic correction should not be delayed to avoid unnecessary difficulties in aligning the tooth in the arch. Surgical exposure should be performed with the intent of providing sufficient attached gingiva rather than simply uncovering the crown, which results in only alveolar mucosal attachment. Attached gingiva is essential to secure the gingival tissues to the adjacent teeth at the dentogingival junction. Thus preventing loss of periodontal tissues as a result of the pull of the surrounding soft tissues and facial muscles. Labially impacted maxillary anterior teeth uncovered with an apically positioned flap technique have more un- esthetic sequelae than those uncovered with a closed-eruption technique. In the case of severly displaced impacted teeth, autotransplantation ensures preservation of the alveolar bone and will facilitate future placement of an osseointegrated implant once growth has ceased or if ankylosis/resorption of the transplant occurs.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.3
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• pp.263-269
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• 2001

Median cleft of the lower lip and/or mandible is a rare congenital anomaly, first mentioned by Couronne in 1819. Monroe(1966), Fujino(1970), Ranta(1984) and Oostrom(1996) conducted comprehensive reviews and list cases in literature. Median cleft varies greatly, from a simple vermilion notch to a complete cleft of the lip involving the tongue, the chin, the mandible, the supporting structures of the median of the neck, and the manubrium sterni. The associated anomalies include ankyloglossia, cleft tongue, neck contraction, heart lesion, absence of hyoid bone, and so on. The etiology of median cleft is unknown. Various possibilities, such as failure of mesodermal penetration into the midline, failure of fusion of mandibular processes, external factors apart from the embryogenic pattern such as pressure, position in utero, circulatory failure caused placental adhesion, diseases in pregnancy, and so on, have been discussed. A 8-year-old girl was referred to the Dept. of Oral & Maxillofacial Surgery, Kyungpook National University Hospital and had been aware of the fact that at birth "she had something wrong with her mouth." Shortly after birth she had been examined by a plastic surgeon and at that time surgical procedure had been performed to release the tongue from the lower jaw and lip at local hospital. On admission, she had a slight notching of lower lip and two fibrous frenum ran from the lip along the ventral surface of the tongue, diastema between her mandibular central incisors, and slightly constricted bifid mandible associated independent movement of the two halves of mandible. The patient had autogenous iliac bone graft to reconstruct the mandibular midline defect. The postoperative result was uneventful. In future, the correction of the soft tissue deformities such as notching of the lower lip and partial ankyloglossia will be required for the esthetic and functional improvement.

• Journal of Periodontal and Implant Science
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• v.35 no.1
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• pp.251-261
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• 2005

Alveolar ridge defects may limit or restrict placement of implants. The purpose of this study was to evaluate clinical and histopathologic results which occur following guided bone regeneration using platelet-rich plasma, bovine bone powder and e-PTFE membrane in the localized alveolar bone defects. Ten patients who required guided bone regeneration in implant placemnet, were slelected. Alveolar crest height and width were measured at baseline and, afer 2nd surgery 5 months later At 5 months , we obtained histopathological results as follows: 1. Alveolar crest height was an average of $8.20{\pm}3.74$ mm preoperatively and decreased to an average of $7.40{\pm}1.84$ mm postoperatively. There was no significant difference. 2. Alveolar crest width was an average of $4.25{\pm}2.03$ mm preoperatively and significantly increased to an average of $7.20{\pm}2.44$ mm postoperatively (P<0.01) 3. The change of Alveolar crest height and width were $0.80{\pm}1.40$ mm, $2.95{\pm}1.09$ mm 4. Histopathological evaluations revealed new bone formation with graft material and laminated bone containing the presence of osteocyte-like cell In conclusion, guided bone regeneration using platelet-rich plasma, bovine bone powder and e-PTFE membrane would provide a viable therapeutic alternative for implant placement in the localized alveolar defect or implant failure