• 대한두개안면성형외과학회지
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• 제25권2호
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• pp.71-76
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• 2024

Background: The rising incidence of dialysis-dependent end-stage renal disease (ESRD) has underscored the need for collaboration between plastic surgeons and nephrologists, particularly concerning preoperative and postoperative management for facial reconstruction. This collaboration is essential due to a scarcity of comprehensive information in this domain. Methods: A study initiated in January 2015 involved 10 ESRD cases on dialysis undergoing Mohs micrographic surgery for facial skin cancer, followed by reconstructive surgery under general anesthesia. To ensure surgical safety, rigorous measures were enacted, encompassing laboratory testing, nephrology consultations, and preoperative dialysis admission. Throughout surgery, meticulous control was exercised over vital signs, electrolytes, bleeding risk, and pain management (excluding nonsteroidal anti-inflammatory drugs). Postoperative assessments included monitoring flap integrity, hematoma formation, infection, and cardiovascular risk through plasma creatinine levels. Results: Adherence to the proposed guidelines yielded a notable absence of postoperative wound complications. Postoperative plasma creatinine levels exhibited an average decrease of 1.10 mg/dL compared to preoperative levels, indicating improved renal function. Importantly, no cardiopulmonary complications or 30-day mortality were observed. In ESRD patients, creatinine levels decreased significantly postoperatively compared to the preoperative levels (p< 0.05), indicating favorable outcomes. Conclusion: The consistent application of guidelines for admission, anesthesia, and surgery yielded robust and stable outcomes across all patients. In particular, the findings support the importance of adjusting dialysis schedules. Despite the limited sample size in this study, these findings underscore the effectiveness of a collaborative and meticulous approach for plastic surgeons performing surgery on dialysis-dependent patients, ensuring successful outcomes.

• Archives of Plastic Surgery
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• 제51권1호
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• pp.36-41
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• 2024

Background Among breast reconstruction methods, implant-based breast reconstruction has become the mainstream. However, periprosthetic infection is still an unresolved problem. Although published articles have revealed that limited use of antibiotics is sufficient to reduce infection rates, the number of surgeons still preferring elongated usage of antibiotics is not less. The aim of our study is to validate the appropriate duration of antibiotic use to reduce infection rate after implant-based breast reconstruction. Methods A retrospective study reviewed medical record of 235 patients (274 implants for reconstruction) who underwent prepectoral direct to implant breast reconstruction using acellular dermal matrix wrapping technique. Infection rates were analyzed for the patients administered postoperative prophylactic antibiotics until drain removal and those who received only perioperative prophylactic antibiotics for 24 hours. Results Of the 274 implants, 98 who were administered prophylactic antibiotics until drain removal had an infection rate of 3.06% (three implants) and 176 who received prophylactic antibiotics no longer than 24 hours postoperatively had an infection rate of 4.49% (eight implants). A total of 11 patients diagnosed with postoperative infection clinically, 8 were salvaged by antibiotic treatment, and 3 had implant removal and replacement with autologous flap. Postoperative antibiotic prophylaxis duration had no statistically significant effects in the risk of infection (p = 0.549). Conclusion The duration of prophylactic antibiotics after surgery was not related to infection risk. Further study with a large number of patients, randomized control study, and route of antibiotics is needed.

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

• Journal of Periodontal and Implant Science
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• 제28권4호
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• pp.645-660
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• 1998

The purpose of this study was to make and ascertain a decision making process on the base of patient-oriented utilitarianism in the treatment of patients of chronic adult periodontitis. Fifty subjects were chosen in Yonsei Dental hospital and the other fifty were chosen in Severance dental hospital according to the selection criteria. Fifty four patients agreed in this study. NS group(N=32) was treated with scaling and root planing without any surgical intervention, the other S group(N=22) done with flap operation. During the active treatment and healing time, all patients of both groups were educated about the importance of oral hygiene and controlled every visit to the hospital. When periodontal treatment needed according to the diagnostic results, some patients were subjected to professional tooth cleaning and scaling once every 3 months according to an individually designed oral hygienic protocol. Probing depth was recorded on baseline and 18 months after treatments. A questionnaire composed of 6 kinds(hygienic easiness, hypersensitivity, post treatment comfort, complication, functional comfort, compliance) of questions was delivered to each patient to obtain the subjective evaluation regarding the results of therapy. The decision tree for the treatment of adult periodontal disease was made on the result of 2 kinds of periodontal treatment and patient's ubjective evaluation. The optimal path was calculated by using the success rate of the results as the probability and utility according to relative value and the economic value in the insurance system. The success rate to achieve the diagnostic goal of periodontal treatment as the remaining pocket depth less than 3mm and without BOP was $0.83{\pm}0.12$ by non surgical treatment and $0.82{\pm}0.14$ by surgical treatment without any statistically significant difference. The moderate success rate of more than 4mm probing pocket depth were 0.17 together. The utilities of non-surgical treatment results were 100 for a result with less than 3mm probing pocket depth, 80 for the other results with more than 4mm probing pocket depth, 0 for the extraction. Those of surgical treatment results were the same except 75 for the results with more than 4mm. The pooling results of subjective evaluation by using a questionnaire were 60% for satisfaction level and 40% for no satisfaction level in the patient group receiving nonsurgical treatment and 33% and 67% in the other group receiving surgical treatment. The utilities for 4 satisfaction levels were 100, 75, 60, 50 on the base of that the patient would express the satisfaction level with normal distribution. The optimal path of periodontal treatment was rolled back by timing the utility on terminal node and the success rate, the distributed ratio of patient's satisfaction level. Both results of the calculation was non surgical treatment. Therefore, it can be said that non-surgical treatment may be the optimal path for this decision tree of treatment protocol if the goal of the periodontal treatment is to achieve the remaining probing pocket depth of less than 3mm for adult chronic periodontitis and if the utilitarian philosophy to maximise the expected utility for the patients is advocated.

• 대한골관절종양학회지
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• 제7권4호
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• pp.139-143
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• 2001

목적 : 근위 경골 종양의 광범위 절제술에 따른 재건술은 적절한 연부 조직의 피복(cover age), 슬관절 신전 장치(knee extensor apparatus), 특히 슬개건의 견고한 재부착이 어려워 슬관절의 기능적 결과가 만족스럽지 않은 것으로 알려져 있는바, 근위 경골의 골육종으로 광범위 절제 후 종양 대치물 삽입으로 사지 구제술을 시행 받은 환자에서 기능을 평가하고 문제점을 분석하기 위하여 본 연구를 시행하였다. 대상 및 방법 : 1992년 4월부터 1998년 10월까지 경골 근위부의 골육종으로 확진된 후 종양 대치물을 이용한 사지 구제술을 시술 받은 11명을 대상으로 하였다. 남자가 6명, 여자가 5명이었으며, 환자의 나이는 15세에서 65세로 평균 23.7세였다. 추시 기간은 최단 1년에서 최장 4년 6개월로, 평균 2년 5개월이었다. 최종 기능평가는 1993년 국제 사지 보존 회의(International Symposium On Limb Salvage; ISOLS)에서 수정 보완한 방법을 이용하여 동통, 기능(functional activity), 환자의 정서적 만족도(emotional acceptance), 보조기 사용여부(use of external support), 보행 능력(walking ability), 그리고 보행 상태(gait)등 여섯 가지로 나누어 평가하였다. 각각의 요소를 최하 0점에서 최고 5점으로 하고 그 중간을 정도에 따라 1, 2, 3, 4점으로 점수화하여 정상 기능에 대한 백분율(% )로 표시하여 분석하였다. 결과 : 기능 평가 성적은 정상 기능에 대해 최고 86.7%에서 최저 53.3%로 평균 68.3%를 나타냈으며, 세부적으로 보면 동통이 82.5%, 기능이 62.5%, 정서적 만족도가 67.5%, 보조기 사용여부는 77.5%, 보행능력은 62.5%, 보행상태는 57.5%였다. 슬관절의 평균 운동범위는 신전 5도, 굴곡 85도였으며, 5례에서 최소 5도, 최고 15도, 평균 10도의 신전 제한(extension lag)을 보였다. 합병증으로는 2명에서 수술 후 감염 소견을 보였으며 1명은 항생제 치료로 호전되었으나 다른 1명은 종양 구조물 제거 후 관절고정술로 전환이 필요하였다. 결론 : 경골 근위부의 골육종 환자에서 광범위 절제 후 종양 대치물 삽입에 의한 사지구제술의 기능 평가 성적은 감염이 합병되지 않은 경우에는 전반적으로 양호하였으나, 동통 소실, 보조기 사용여부에 비해 슬관절의 부분 강직 및 extension lag로 인해 기능, 정서적 만족도, 보행등에서 덜 만족스러웠다. 임상적으로 더 만족스러운 결과를 얻기 위해 수술 후 대퇴사두근 강화 운동 및 굴곡 운동 등의 적극적인 재활 치료가 필요한 것으로 생각된다.

• Journal of Periodontal and Implant Science
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• 제26권4호
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• pp.779-797
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• 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
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• 제29권4호
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• pp.873-893
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• 1999

The ultimate goal of periodontal therapy is the regeneration of periodontal tissue and repair of function. For more than a decade there have been many efforts to develop materials and bioactive molecule(such as growth factor and differentiation factors) to promote periodontal wound healing. Among the bioactive molecules, bone morphogenetic protein(BMP) was studied for periodontal wound healing. Since Urist demonstrated that demineralized bone matrix could induce the formation of cartilage and bone in ectopic site, many studies on BMP have been reported. Among those BMPs, it was reported that rhBMP-2 enhanced the healing of bone defects in animal studies and clinical studies. However, its efficacy in periodontal regeneration, especially 1-wall intrabony defects is still unknown. The purpose of this study was to examine the effect of rhBMP-2/ACS on the epithelial migration, gingival connective tissue adhesion, cementum formation, alveolar bone regeneration in intrabony defects of dogs. Four millimeter deep and four millimeter wide 1-wall defects were surgically created in the mesial aspects of the 3rd incisors. The test group received rhBMP-2/ACS with a flap procedure and the control underwent buffer/ACS with a flap procedure. Histologic analysis after 8 weeks of healing revealed the following results: 1. The length of epithelial growth(the distance from alveolar crest to the apical end of JE) was $0.9{\pm}1.5mm$ in the control group and $1.2{\pm}1.4mm$ in the test group. There was no statistically significant difference between the two groups. 2. The length of connective tissue adhesion was $2.4{\pm}1.3mm$ in the control group and $1.2{\pm}1.1mm$ in the test group. The control group showed significantly enhanced adhesion(P<0.05). 3. The length of new cementum was $0.9{\pm}1.0mm$ in the control group and $1.7{\pm}0.8mm$ in the test group. The test group showed significantly enhanced cementum regeneration(P<0.05). 4. The length of new bone height was $1.9{\pm}0.6mm$ in the control group and $2.4{\pm}0.9mm$ in the test group. There was no statistically significant difference between the two groups. 5. The new bone area was $4.7{\pm}1.7mm^2$ in the control group and $8.0{\pm}2.0mm^2$ in the test group. The test group showed significantly enhanced bone formed area(P<0.05). 6. The new bone density was $73.0{\pm}8.6%$ in the control group and $66.6{\pm}15.3%$ in the test group. There was no statistically significant difference between the two groups. These results suggest that the use of rhBMP-2 in 1-wall intrabony defects has significant effect on new cementum and new bone formation area, but doesn't have any significant effect on the prevention of junctional epithelium migration and new bone formation height.

• Journal of Chest Surgery
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• 제30권4호
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• pp.363-372
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• 1997

본 연구는 1986년 6월 3일부터 1995년 12월 31일까지 서울대학교 어린이 병원 흉부외과에서 경험한 144례의 대동맥 교약증 환아를 대상으로, 술후 결과에 영향을 미치는 여러 가지 요소들을 분석하였다. 환아의 평균 연령은 15.73+32.43(범 위 0.1-191.0, 중앙값=3.3)개월이 었고, 이중 11)례(78.5%)의 환아는 영아, 25례(17.4%)는 신생아였다. 환아를 대동맥궁 협 착 부위와 동반 심기형에 따라(제 1형:국소 협착, 제2형:대동맥 헙부 협착, 제3형 :대동맥 협부 및 횡대동맥궁 협착, h:심실중격결손증 동반, B:기타 복 잡 심기 형 동반) 9가지로 분류한 결과, 1, IA, IB, I, IIA, IIB, III, IIIA, IIIB형이 각각 25, 9, 6, 24, 35, 15, 4, 19, 7례 였다. 수술방법은 쇄골하동맥편 교약성형술(subclavian-flap coarctoplasty, SFC: 60례), 절단 및 문합술(resection and anastomo sis, R&A: 44례), 확장된 대동맥성형술(extended aortoplasty, Ex-Ao: 26 례), 덮개포편술(onlay patch, Onlay: 14례)이 사용되었다. 총수술 사망률은 16.0%(23/144)였고, 수술 사망률을 높이는 인자로 협착부위(I, II, III형) 동반 심기형(0, A, B), 환아의 연령, 수술방법, 단계수술 \ulcorner부 등이 분석되었는데 이중 횡대동맥궁협착을 동반하는 III형(I형 사망률=2.5%(1/40), II형=17.6% (13/74), III형=30%(9/30); p(0.01), B형(0형 사망률=3.8%(2/53), A형 =15.9%(10/63), B형 =39.3%(11/28); p(0.01) 등이 의미있는 위험 인자였다. 생존환아 121례는 술후 평균 29.1+28.8(범위 0-129.2)개월 외래 추 적되 었으며 이중 술후 협착을 보였던 경우는 18례로 14.9%의 헙착률은 보였다. 생존환자중 77례의 환자 (I형 20명. ll형 42명, 111형 15명)에서 술전, 술후 3개월 이내, 술후 6개월이후의 심에코도상의 대동맥 각 부위 크기에 관한 자료의 입수가 가능하였으며 이를토대로무명동맥 직근위부의 상행대동맥 직경에 대 한 대동맥협부 직경의 비율(대동맥협부지수)및 경동맥부위의 횡대동맥 직경비율(횡대동맥지수)을구하 여 형태 별로 술전, 수술 직후 6개월이상 경과후의 대동맥 크기 변화의 양상을 관찰하였다. 제 I, II, III형 모두에서 술전에 비하여 술후 평균 대동맥협부지수의 의미있는 증가가 관찰되었으며(p<0.01),제 III형에서는 횡대동맥지수의 의미있는 증가도 관찰되었다(p<0.01). 재헙착으로 진단된 I, II형의 수술직후 대 동맥협부지수와 111형의 횡대동맥 지수는 비협착군에 비하여 의미있게 작았는데 이는 아마도수술 당시 협 착 부위의 완전제거가 이루어지지 않은 것이 원인이라고 사료되었다. 본 분석에서는 어린 연령(3개월 이하), 3개월이하에 시행한 쇄골하동맥편 교약성형술이 의미있는 재협착의 위험요소로 밝혀졌다. 결론 적으로 저자등은 본연구를 통하여 대동맥협부지수, 횡대동맥 지수 등이 개개 대동맥교약 환아의 해부학 적, 임상적 특징을 파악하는데 도움이 되는 도구라는 사실을 발견하였고 아울러 교약의 해부학적 특성, 동반 심기 형, 연령, 수술방법 등이 수술사망 및 재협착에 영향한다는 사실을 입증하였다.

• 대한핵의학회지
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• 제30권1호
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• pp.130-138
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• 1996

전기화상후 조직이나 뼈의 상태를 관찰하고 창상변연절제술, 피부판 이식후 경과 관찰 및 절단술여부와 부위를 정하는 데 골스캔이 지표가 되고 골결손이 있는 환자에서 피부판 이식술 시행후 경과가 호전되었는지 여부를 알기 위해 골스캔검사가 유용하다고 알려져 있다. 본 연구에서는 1991년부터 1995년 11월까지 본원에 내원한 전기화상 환자중 골스캔 및 경과관찰이 가능했던 37명을 대상으로 골스캔의 유용성을 조사하였다. 골스캔 시행시기는 대상환자 37명 모두에서 1주일이 내에 골스캔을 시행하였다. 저압전류에 수상한 환자는 8명, 고압전류에 수상한 환자는 29명이었다. 유입부별 분포를 보면 수부가 27례, 두부가 6예, 견관절부위가 2예, 좌흉벽부위가 1예, 수혜부위가 1예로 나타났다. 사출부별 분포는 저압전류 8명에서는 사출부위를 찾을 수 없었고 고압전류 29명중 족부가 22예, 수부가 3예, 견관절부위가 2예, 좌측 흉부가 1예, 둔부부위가 1예 순으로 나타났다. 유입부의 골스캔 소견은 저압전류에 손상받은 환자8명 모두 봉와직염 소견을 보였고 고압전류에 손상받은 환자 29명줌 15명은 골수염, 10명은 봉와직염, 4명은 골결손 소견으로 나타났다. 사출부의 골스캔 소견은 저압전류 손상 8명을 제외한 고압전류 손상 환자29명 모두 봉와직염 소견을 보였다. 피부이식이나 피부판 이식술 시행후 추적관찰이 가능했던 4명의 환자모두 피부이식이나 피부판 이식술 시행후, 골결손 부위가 좋아지는 것을 관찰할 수 있었다. 심근에 섭취가 증가된 경우가 2예, 간에 섭취가 증가된 경우가 1예, 신장에 섭취가 증가된 경우가 6예였는데, 혈청 칼슘농도, 심전도, 심근 효소, 간기능 검사 및 신기능 검사상에서는 이상이 없는 것으로 나타났다. 결론적으로 골스캔은 전기화상후 손상부위를 평가하는데 도움이 되고 봉와직염과 골수염의 감별진단, 피부이식이나 피부판 이식술후 평가에 도움이 된다. 그러나 인체 내부 장기의 손상평가는 앞으로 많은 연구가 필요할 것으로 생각된다.

• Journal of Periodontal and Implant Science
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• 제38권2호
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• pp.237-246
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• 2008

Purpose: If bone grafts and guided tissue regeneration are effective individually in treating osseous defects, then the questionis, what would happen when they are combined. Bone grafts using Calcium Carbonate(Biocoral) and Guided Tissue Regeneration using Calcium Sulfate(CALMATRIX) will maximize their advantages and show the best clinical results in intrabony defects. This study was to compare the effects of a combination of CS and CC with control treated only with modified widman flap in a periodontal repair of intrabony defects. Materials and Methods: 30 patients with chronic periodontitis were used in this study. 10 patients were treated with a combination of CS and CC as the experimental group II and another 10 patients were treated with CC as the experimental group I, and the remaining 10 patients, the control group were treated only with modified widman flap. Clinical parameters including probing depth, gingival recession, bone probing depth and loss of attachment were recorded 6 months later. Results: The probing depth changes were $3.30{\pm}1.34\;mm$ in the control group, $4.2{\pm}1.55\;mm$ in the experimental group I(CC) and $5.00{\pm}1.33\;mm$ in the experimental group II(CS+CC). They all showed a significant decrease 6 months after surgery(p<0.01). There was a significant difference(p<0.05) between the control and experimental group. However there were no significant difference(p<0.05) between the experimental group I and II. The gingival recession changes w $-1.30{\pm}1.25\;mm$ in the control group, This is a significant difference(p<0.01). However, there was a $-0.50{\pm}0.53\;mm$ change in the experimental group I(CC) and $-0.60{\pm}0.97\;mm$ in the experimental group II(CS+CC). In addition, in terms of gingival recession, there was a no significance difference(p<0.05) among the groups. The clinical attachment level changes were $2.00{\pm}1.33\;mm$ in the control group, $3.60{\pm}1.58\;mm$ in the experimental group I(CC) and $4.40{\pm}1.17\;mm$ in the experimental group II(CS+CC). They all showed a significant decrease 6 months after surgery(p<0.01). There was a significant difference(p<0.05) between the control and experimental group. However there was a no significance difference(p<0.05) between the experimental group I and II. The bone probing depth changes were $0.60{\pm}0.52\;mm$ in the control group, $3.20{\pm}1.48\;mm$ in the experimental group I(CC) and $4.60{\pm}1.43\;mm$ in the experimental group II(CS+CC). All of them showed a significant decrease 6 months after surgery(p<0.01), there was a significance difference(p<0.05) among the groups. Conclusion: Treatment using a combination of CS and CC have a potential to improve periodontal parameters in intrabony defects and More efficient clinical results can be expected in intrabony defects less than 2 walls grafted with CS and CC.