• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제30권4호
• /
• pp.316-322
• /
• 2004

A low molecular weight component named bone morphogenetic protein(BMP) chemically isolated from the organic matrix of bone, induce postfetal connective tissue cells surrounding small blood vessels to differentiate into cartilage and bone. The end product of BMP is a spherical ossicle of lamella bone filled with red bone marrow for the functional loading. This is a important point that the graft material is embedded the defect site during the implant surgery. Because present knowledge of the relationship between BMP and bone regeneration arises mainly from studies of induced bone formation in heterotopic sites, it would be helpful to determine whether BMP plays any part in the process of bone healing. The BMPs have been shown to play crucial roles in normal skeletal development as well as bone healing and are able to activate transcription of genes involved in cellular migration, proliferation, and differentiation. The delivery of BMP on matrices has been efficacious in the treatment of defect bone in implant surgery. The purpose of the histologic study was to evaluate the effect of DLB(demineralized lyophilized bone) coated with purified human BMP(hBMP-I) in immediate implant surgery with bony defect to obtain the functional structure of implant asap. The ability of a graft of hBMP-I to accelerate bony defect repair provides a rationale for its use in immediate implant surgery that have large bone defect in edentulous area.

• Archives of Reconstructive Microsurgery
• /
• 제1권1호
• /
• pp.39-44
• /
• 1992

Benign peripheral nerve tumors, although infrequent, must be considered as a possible cause of pain and disability in the extremities. There are three varieties of these tumors that are of clinical importance: neurilemmomas, neurofibromas, and post-traumatic neuroma. Neurilemmomas are the most common primary solitary tumor of the peripheral nerve trunks, and are almost always benign, Neurofibromas may occur as a solitary nerve tumor, but can present as multiple lesions as in von Recklinghausen's disease. Clinically, this tumor may presents as a solitary mass in the subcutaneous tissue which is centrally located with the nerve fibers travelling through the tumor mass. Traumatic neuroma is the proliferation of nerve elements with connective tissue during the process of regeneration from severed nerves undergoing Wallerian degeration, and is therefore not a true neoplasm. A neuroma-in-countinuity is the result of partial severance of a nerve, or of a crushing or traction injury in which all or part of the epineurium and perineurium is intact. We experienced each of the three varieties. With magnification, the neurilemmoma was removed by meticulous dissection from the parent nerve preserving the normal fascicles to which it was attached. The neurofibroma was excised and the nerve was reconstructed with interposed vein graft and the neuroma-in-continuity was excised and reconstructed with sural nerve graft. We report histologic characteristics of each tumors and the methods to repair the nerve defects after tumor excision with brief discussion.

• Journal of Periodontal and Implant Science
• /
• 제26권3호
• /
• pp.735-751
• /
• 1996

An ultimate goal of periodontal therapy is to stop the disease process and to regenerate a functionally-oriented periodontium destroyed as a result of periodontal disease. The purpose of this study was to observe the effect of grafting granulation tissue obtained from extraction socket on the regeneration of horizontal furcation defect. Six dogs were used in this study. All mandibular first and third premolars were extracted. At 2, 3, and 5 days after extraction, tissues were obtained from extraction socket of 1 mongrel dog and examined by light microscope. Granulation tissue obtained at 5 days after extraction was chosen as the graft material. Five days later, horizontal furcation defects were created surgically at mandibular second and fourth premolars in the right and left side of the 5 beagle dogs. The entrance area of the artificially prepared "key hole" defects were about $3\;4mm^2$. By random selections, 2 exposed furcation defects were grafted with granulation tissue obtained from extraction socket as experimental group and 1 furcation defect was as control. The flaps were replaced to their original position and sutured with 4-0 chromic cat-gut. Three dogs were sacrificed 4 weeks and two dogs 8 weeks after surgery, and the prepared specimens were examined by light microscope. At 4 weeks, furcations were filled with epithelial lining and fibrous connective tissue infiltrated with chronic inflammatory cells. New bone formation was observed in all groups. Only experimental group showed new cementum formation. At 8 weeks, new cementum, functional arrangement of new PDL fiber, root resorption, and some ankylotic union of newly formed alveolar bone and root surface were observed in all groups. Experimental group showed that epithelial downgrowth was inhibited and new bone formation was more active compared to control. The success rate of the furcation defect healing was higher in experimental group than control. These results suggested that grafting of granulation tissue obtained from extraction socket which combined with reconstructive periodontal flap surgery may promote periodontal regeneration of horizontal furcation defect.

• Journal of Periodontal and Implant Science
• /
• 제32권2호
• /
• pp.429-455
• /
• 2002

There are numerous kind of materials and techniques to regenerate the periodontal tissue which has been lost due to destructive periodontal disease, including bone graft material. Many bone graft materials have been reported and among these materials, synthetic material has been developed fin the long time because of its sufficient supply economically. Calcium sulfate which was evaluated as including much calcium, has been used in the clinical field. In the dental field calcium sulfate has been used as bone graft material and Kim reported that improved bone formation and more amount of new attachment after grafting calcium sulfate. but, because calcium sulfate has the problem that it generates the heat in setting period and resolves fast, we need to evaluate the effect of the improved calcium sulfate on periodontal tissue. The present study evaluates the effect of paste type calcium sulfate on the epithelial migration, alveolar bone regeneration, cementum formation and gingival connective tissue attachment in intrabony defect in dogs. Four millimeter deep and four millimeter wide 3-wall defects were surgically created in the mesial or distal aspects of premolars or molars. the test group received paste-type calcium sulfate with a flap procedure and the control group underwent flap procedure only. Histologic analysis after 8 weeks of healing revealed the following results : 1. The length of epithelial growth(the distance from CEJ to the apical end of JE) was 0.52${\pm}$0.26mm in the control and 0.56${\pm}$0.25mm in the test group. there was no statistically significant difference between the two groups. 2. The length of connective tissue adhesion was 1.74${\pm}$1.06mm in the control and 1.28${\pm}$0.57mm in the test group. there was no statistically significant difference between the two groups. 3. The length of new bone was 2.01${\pm}$0.95mm in the control and 2.62${\pm}$0.81mm in the test group. there was no statistically significant difference between the two groups. 4. The length of new cementum was 1.86${\pm}$0.80mm in the control and 2.77${\pm}$ 0.86mm in the test group. there was a statistically significant difference between the two groups.(P<0.01) These results suggest that the use of paste type calcium sulfate in 3-wall intrabony defects has significant effect on new cementum formation , but doesn't have any significant effect on the prevention of junctional epithelium migration and new bone formation. Finally, the paste type calcium sulfate that is used in this study is suggested to be the material that can have a significant effect on the periodontal healing, if its biocompatibility is improved.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제31권3호
• /
• pp.243-248
• /
• 2009

Purpose: Rehabilitation of the edentulous posterior maxilla with dental implants often poses difficulty because of insufficient bone volume caused by pneumatization of the maxillary sinus and by crestal bone resorption. Sinus grafting technique was developed to increase the vertical height to overcome this problem. The present study was designed to evaluate the sinus floor augmentation with anorganic bovine bone (Bio-$cera^{TM}$) using histomorphometric and clinical measures. Patients and methods: Thirteen patients were involved in this study and underwent total 14 sinus lift procedures. Residual bone height was ${\geq}2mm$ and ${\leq}6mm$. Lateral window approach was used, with grafting using Bio-$cera^{TM}$ only(n=1) or mixed with autogenous bone from ramus and/or maxillary tuberosity(n=13). After 6 months of healing, implant sites were created with 3mm diameter trephine and biopsies taken for histomorphometric analysis. The parameters assessed were area fraction of new bone, graft material and connective tissue. Immediate and 6 months after grafting surgery, and 6 months after implantation, computed tomography (CT) was taken and the sinus graft was evaluated morphometric analysis. After implant installation at the grafted area, the clinical outcome was checked. Results: Histomorphometry was done in ten patients.Bio-$cera^{TM}$ particles were surrounded by newly formed bone. The graft particles and newly formed bone were surrounded by connective tissue including small capillaries in some fields. Imaging processing revealed $24.86{\pm}7.59%$ of new bone, $38.20{\pm}13.19%$ connective tissue, and $36.92{\pm}14.51%$ of remaining Bio-$cera^{TM}$ particles. All grafted sites received an implant, and in all cases sufficient bone height was achieved to install implants. The increase in ridge height was about $15.9{\pm}1.8mm$ immediately after operation (from 13mm to 19mm). After 6 months operation, ridge height was reduced about $11.5{\pm}13.5%$. After implant installation, average marginal bone loss after 6 months was $0.3{\pm}0.15mm$. Conclusion: Bio-$cera^{TM}$ showed new bone formation similar with Bio-$Oss^{(R)}$ histomorphometrically and appeared to be an effective bone substitute in maxillary sinus augmentation procedure with the residual bone height from 2 to 6mm.

• Journal of Chest Surgery
• /
• 제29권8호
• /
• pp.836-843
• /
• 1996

본 연세대학교 의과대학 흉부외과학 교실에서는 1985년 부터 1992년까지 청색성 선천성 심장기형환자에서 시행한 체 폐동맥 단락술에 사용되 었던 PTFE (polytetrafluoroethylene) 인조 혈관을 재수술시 절 제하여 꽝학 현미경 및 전자 현미경으로 관찰하였다. 체폐 동맥 단락술의 종류는 Blalock-Taussig형 10 례. Waterstone-Cooley형 1례, Pott 형 1례등이었다. 사용된 PTFE 인조 혈관의 크기는 5mm가 10개, 4mm가 1개, 6mm가 1개였다 이들의 평균 사용 시간은 31개월(12개월에서 55개월)이었다. 10개월에서 20개월사이의 PTFE 인조 혈관은 틈새에 매우 많은 혈소판이 끼어 있었고 내막 비후가 관찰되었다. 40 개월이상 기능을 하는 PTFE 인조 혈관에서는 혈관 내피 세포가 광학 및 전자 현미경으로 관찰되었다. 막힌 PTFE 인조 혈관의 내면은 매우 심한 내막 비후와 혈전으로 차 있었다. 이와 같은 우리의 경험을 토대로 PTFE인조 혈관과 자신의 혈관이 연결되는 부위에 결체조직이 잘붙어 혈관내피세포가 덮을수 있게 된다면 혈소판의 응집을 막아 오랫동안 기능을 유지할 수 있을 것으로 생각된다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제35권1호
• /
• pp.18-24
• /
• 2013

Purpose: This study is performed to determine the effects of titanium cap with various sizes of pores on bone formation during guided bone regeneration (GBR). Methods: Calvaria from 10 adult male rabbits were chosen as the recipient sites. A trephine bur with a diameter of 10 mm was used to form one round groove on each side of sagittal suture of the cranium, and a round bur with a diameter of 1.5 mm was used to form 6 small holes on the inner circles of round grooves to induce bleeding. In the control group, bone graft was not conducted, and closed titanium cap was fixed in the round groove. Bone graft was not performed in groups 1 and 2, but fixed on titanium caps with 0.2 mm, and 0.5 mm sized pores, respectively. For groups 3, 4, and 5, a synthetic bone graft material (${\beta}$-tricalcium phosphate, Cerasorb$^{(R)}$, Germany) was transplanted, and titanium caps without pore, with 0.2 mm and 0.5 mm sized pore were fixed, respectively. The animals were sacrificed 4 weeks after, and clinical, radiographical, and histomorphometrical evaluation of bone regeneration was performed. Results: In all groups, there were no clinical signs of infection, inflammation or wound dehiscence. Radiographic evaluation revealed well-defined semi-circular radiopacity inside the titanium cap of groups 3, 4, and 5. Histologically, the inner surface of the hemisphere was evenly lined with newly formed bone tissue, as well as grafted bone material in the group 3. In groups 4 and 5, the insertion of connective tissue was observed along the inner surface. However, the overall surface area between the grafts with different holes yielded no statistical significance in the histomorphometrical evaluation. Conclusion: Although the total area of newly formed bone showed no significant difference, excellent bone formation tendency was observed histologically when closed caps were used with bone graft was accompanied.

• Journal of Periodontal and Implant Science
• /
• 제26권4호
• /
• pp.779-797
• /
• 1996

치주 질환에 의해 상실된 치주 조직의 재생과 기능 회복을 위해 골 이식재의 사용을 포함한 많은 치료법들이 이용되었다. 골 이식술을 위해 자가골 이식, 동종골 이식, 이종골 이식, 골 대체 물둥이 이용되어왔다. 이중 탈회 냉동 건조 동종골은 약 20년 전부터 치주 영역에서 사용되어 왔으나 탈회 냉동 건조 동종골의 골내 치주낭 이식의 효과에 대한 연구는 찬반 양론이 대립된다. 탈회 냉동 건조골은 제작 방법 중 특히, 탈회에 의해 탈회 냉동 건조골의 생물학적 성격이 결정되며 이에 따라 치주 조직 재생 능력에도 변화가 있을 수 있다. 이에 본 연구에서는 탈회 시간에 따른 탈회 냉동 건조골 이식이 성견의 3면 골내 치주낭에서 치주 조직 재생에 미치는 영향을 알아보고자 성견의 전치부에 $4mm{\times}4mm{\times}4mm$크기의 3면 골 내낭을 형성한 후 치주 수술만 시행한 군을 대조군으로, 탈회를 시키지 않은 냉동 건조골을 이 식한 군을 실험 I 군으로, 12 시간 탈회시킨 탈회 냉동 건조골을 이식한 군을 실험 n군으로, 24시간 탈회시킨 탈회 냉동 건조골을 이식한 군을 실험 III군으로 설정하여 14주 후에 치유 결과를 조직학적으로 비교 관찰하여 다음과 같은 결과를 얻었다. 1. 결합 조직 유착은 대조군에서 $0.62{\pm}0.14mm$, 실험 I 군에서 $0.42{\pm}0.11mm$, 실험 n군에서 $0.63{\pm}0.43mm$, 실험 III군에서 $0.52{\pm}0.11mm$로 계측되었으며 대조군과 실험군간에 유의성 있는 차이는 없었다. 2. 신생골 형성은 대조군에서 $3.17{\pm}0.24mm$, 실험 I군에서 $3.15{\pm}0.56mm$, 실험 n 군에서 $3.22{\pm}0.36mm$, 실험 III군에서 $3.28{\pm}0.74mm$ 로 계측되었으며 대조군과 실험군간에 유의성 있는 차이는 없었다. 3. 신생 백악질 형성은 대조군에서 $4.19{\pm}0.46mm$, 실험 I군에서 $3.23{\pm}0.64mm$, 실험 II군에서 $4.13{\pm}1.82mm$, 실험 III군에서 $3.13{\pm}0.62mm$로 계측되었으며 대조군과 실험군간에 유의성 있는 차이는 없었다.

• Journal of Periodontal and Implant Science
• /
• 제26권3호
• /
• pp.605-624
• /
• 1996

Various bonegraft materials and the technique of guided tissue regeneration have been used to regenerate lost periodontal tissue. Calcium sulfate has been known as a bone graft material because of good biocompatibility, rapid resorption and effective osteoinduction. It has been known that calcium sulfate works as a binder to stabilize the defect when it is used with synthetic graft materials. The effects on the regeneration of pericxiontal tissue were studied in dogs after grafting 3-wall intrabony defects with calcium carbonate and calcium sulfate and covering with calcium sulfate barrier. The 3-wall intrabony defectstdmm width, 4mm depth, 4mm length) were created in anterior area and treated with flap operation alone(contol group), with porous resorbable calcium carbonate graft alonetexperirnental group 1), with calcium sulfate graft alonetexperimental group 2) and with composite graft of 80% calcium carbonate and 20% calcium sulfate with calcium sulfate barriertexperimental group 3). Healing responses were histologically observed after 8 weeks and the results were as follows: 1. The alveolar bone formation was $0.59{\pm}0.19mm$ in the control group, $1.80{\pm}0.25mm$ in experimental group 1, $1.61{\pm}0.21mm$ in experimental group 2 and $1.94{\pm}0.11mm$ in experimental group 3 with statistically significant differences between control group and all experimental groups(P<0.05). There were statistically significant differences between experimental group 1 and group 2 (P<0.05). 2. The new cementum formation was $0.48{\pm}0.19mm$ in the control group. $1.72{\pm}0.26mm$ in experimental group 1, $1.43{\pm}0.17mm$ in experimental group 2, $1.89{\pm}0.15mm$ in experimental group 3 with statiscally significant differences between control group and all experimental groups (p<0.05). There were statistically significant differences between experimental group 1 and group 2, and between experimental group 2 and group 3(P<0.05). 3. The length of junctional epithelium was $1.61{\pm}0.20mm$ in the contol group, $0.95{\pm}0.06mm$ in experimental group 1, $1.34{\pm}0.16mm$ in experimental group 2, $1.08{\pm}0.11mm$ in experimental group 3 with statiscally significant differences between control group and experimental group 1. and btween control group and experimental group 3(p<0.05). There were statistically significant differences between experimental group 1 ,and group 2, and between experimental group 2 and group 3(P<0.05). 4. The connective tissue adhesion was $1.67{\pm}O.20mm$ in the control group, $1.33{\pm}0.24mm$ in experimental group 1. $1.23{\pm}0.16mm$ in experimental group 2, $1.08{\pm}0.14mm$ in experimental group 3 with statistically significant differences between control group and all experimental groups(p<0.05). There were nostatistically significant differences between all experimental groups. As a result, epithelial migration was not prevented when calcium sulfate was used alone, but new bone and cementum formation were enhanced. Epithelial migration was prevented and new bone and cementum formation were also enhanced when calcium carbonate was used alone and when both calcium carbonate and calcium sulfate were used.

• Journal of Periodontal and Implant Science
• /
• 제26권1호
• /
• pp.1-26
• /
• 1996

This study was performed to estimate the effects of cultured bone cell inoculated on porous type hydroxyaptite for the regeneration of the artificial alveolar bone defect. In this experiment 3 beagle dogs were used, and each of them were divided into right and left mandible. Every surgical intervention were performed under the general anesthesia by using with intravenous injection of Pentobarbital sodium(30mg/Kg). To reduce the gingival bleeding during surgery, operative site was injected with Lidocaine hydrochloride(l:80,000 Epinephrine) as local anesthesia. After surgery experimental animal were feeded with soft dietl Mighty dog, Frisies Co., U.S.A.) for 1 weeks to avoid irritaion to soft tissue by food. 2 months before surgery both side of mandibular 1st premolar were extracted and bone chips from mandibular body were obtained from all animals. Bone cells were cultured from bone chips obtained from mandible with Dulbecco's Modified Essential Medium contained with 10% Fetal Bovine Serum under the conventional conditions. Porous type hydroxyapatite were immerse into the high concentrated cell suspension solution, and put 4 hours for attachin the cells on the surface of hydroxyapatite. Graft material were inserted on the artificial bone defect after 3 days of culture. Before insertion of cellinoculated graft material, scanning electronic microscopic observation were performed to confirm the attachment and spreading of cell on the hydroxyapatite surface. 3 artificial bone defects were made with bone trephine drill on the both side of mandible of the experimental animal. First defect was designed without insertion of graft material as negative control, second was filled with porous replamineform hydroxyapatite inoculated with cultured bone marrow cells as expermiental site, and third was filled with graft materials only as positive control. The size of every artificial bone defect was 3mm in diameter and 3mm in depth. After the every surgical intervention of animals, oral hygiene program were performed with 1.0% chlorhexidine digluconate. All of the animals were sacrificed at 2, 4, 6 weeks after surgery. For obtaining histological section, tissus were fixed in 10% Buffered formalin and decalcified with Planko - Rycho Solution for 72hr. Tissue embeding was performed in paraffin and cut parallel to the surface of mandibular body. Section in 8um thickness of tissue was done and stained with Hematoxylin - Eosin. All the specimens were observed under the light microscopy. The following results were obtained : 1. In the case of control site which has no graft material, less inflammatory cell infiltration and rapid new bone forming tendency were revealed compared with experimental groups. But bone surface were observed depression pattern on defect area because of soft tissue invasion into the artificial bone defect during the experimental period. 2. In the porous hydroxyapatite only group, inflammatory cell infiltration was prominet and dense connective tissue were encapsulated around grafted materials. osteoblastic activity in the early stage after surgery was low to compared with grafted with bone cells. 3. In the case of porous hydroxyapatite inoculated with bone cell, less inflammatory cell infiltration and rapid new bone formation activity was revealed than hydroxyapatite only group. Active new bone formation were observed in the early stage of control group. 4. The origin of new bone forming was revealed not from the center of defected area but from the surface of preexisting bony wall on every specimen. 5. In this experiment, osteoclastic cell was not found around grafted materials, and fibrovascular invasion into regions with no noticeable foreign body reaction. Conclusively, the cultured bone cell inoculated onto the porous hydroxyapatite may have an important role of regeneration of artificial bone defects of alveolar bone.