• The korean journal of orthodontics
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• v.24 no.3 s.46
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• pp.673-693
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• 1994

Most adults, unlike growing children, have some periodontal problems which can influence the outcome of the orthodontic treatment. In cases where periodontal disease progression resulted in marked reduction of periodontium, orthodontic treatment could result in the worsening of the periodontal conditions, and therefore orthodontic treatment planning in such adult patients requires special considerations for the periodontal problems. This study investigates the effects of horizontal orthodontic tooth movement on the changes in the mesial, distal and furcation areas of the disease affected periodontium of adult dogs with advanced bone loss. Six adult dogs with healthy periodontium were selected, and mandibular 2nd premolars were extracted. In the mandibular 3rd premolars, angular bony defects in the mesial and distal sides, and horizontal bony defects in the furcation areas were created. Those that received the flap operation and plaque control were designated as the control, those that had horizontal tooth movement without plaque control after the flap operation as Experimental group I, those that had horizontal tooth movement under plaque control without the flap operation as Experimental group II, and those that had horizontal tooth movement under plaque control after the flap operation as Experimental group III. The control group was sacrificed 2 months postoperatively, and the experimental groups were sacrificed 5 months after the initiation of tooth movement. Specimens were histologically analyzed under light microscope. The results were as follows; 1. After the horizontal tooth movements, Experimental group I and II showed angular bony defects in the mesial sides of the roots and the distal side of the furcation areas, which correspond to the pressure sides. 2. After the horizontal tooth movements, Experimental group I and II showed decreased level of alveolar bone crest in the distal sides of the roots, which correspond to the tension sides. 3. Long junctional epithelium in the control group has not been replaced by periodontal connective tissue after the horizontal tooth movements. 4. Limited formation of new bone was observed in the angular bony defects in the mesial and distal aspects of the roots in the control group. 5. Inflammatory cell infiltration in the connective tissue was most severe in the Experimental group I, followed by Experimental group II, III, and the control group in that order. These results seem to indicate that plaque control was the most influencing factor in the alteration of the periodontal tissue after the horizontal tooth movements in the periodontal tissue with alveolar bone defects.

• Imaging Science in Dentistry
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• v.48 no.2
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• pp.79-86
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• 2018

Purpose: This study aimed to carry out a systematic review of studies in the literature comparing conventional imaging techniques with cone-beam computed tomography in terms of the role of these techniques for assessing any of the following periodontal conditions and parameters: infrabony defects, furcation involvement, height of the alveolar bone crest, and the periodontal ligament space. Materials and Methods: Interventional and observational studies comparing conventional imaging techniques with cone-beam computed tomography were considered eligible for inclusion. The MEDLINE and Embase databases were searched for articles published through 2017. The PRISMA statement was followed during data assessment and extraction. Results: The search strategy yielded 351 publications. An initial screening of the publications was performed using abstracts and key words, and after the application of exclusion criteria, 13 studies were finally identified as eligible for review. Conclusion: These studies revealed cone-beam computed tomography to be the best imaging technique to assess infrabony defects, furcation lesions, the height of the alveolar bone crest, and the periodontal ligament space.

• Journal of Periodontal and Implant Science
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• v.30 no.4
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• pp.803-814
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• 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
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• v.31 no.2
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• pp.477-488
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• 2001

The present study evaluated of regeneration effect of platelet rich plasma on the treatment of grade II furcation involvement, with coralline calcium phosphate bone in humans. 30 teeth with grade II furcation defect were selected and 15 teeth(control) were treated with coralline calcium phosphate bone, the others(test) were treated with coralline calcium phosphate bone and platelet rich plasma. Pocket depth, clinical attachment level, width of keratinized gingiva width were measured at baseline, postoperative 3, 6months. from cementoenamel junction to alveolar crest and fundus were measured at baseline, 6months(re-entry). Both groups were statistically analyzed by Wilcoxon signed Ranks Test & Mann-whitney Test using SPSS program(5% significance level). The results were as follows: 1. Pocket depth, clinical attachment level, keratinized gingva width, cementoenamel junction - alveolar crest, cementoenamel junction - fundus were not differ significantly in both groups at baseline 2. The change of pocket depth, clinical attachment level, keratinized gingva width, cementoenamel junction - alveolar crest, cementoenamel junction - fundus in both groups were decreased significantly at 3, 6months(p<0.05). 3. The change of pocket depth, clinical attachment level in test group decreased significantly than control at 3, 6months(p<0.05). 4. The change of keratinized gingiva width, cementoenamel junctional - alveolar crest, cementoenamel junction - fundus were not differ significantly in both groups at 3, 6months. 5. The pocket depth, clinical attachment level, keratinized gingiva width exhibited marked changes at 3 months in both groups. In conclusion, the results of this study suggest that platelet rich plasma have adjunctive clinical treatment effect to periodontal regeneration in grade II furcation defects.

• Journal of Periodontal and Implant Science
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• v.34 no.2
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• pp.281-292
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• 2004

Periodontal defects of the furcation are characterized by several inherent anatomic factors that can make successful periodontal therapy difficult and results unpredictable. The severity and rate of occurrence of periodontal disease are directly related to the location of the furcation relative to the cementa-enamel junction and anatomical form of the root by limiting the accessibility and effectiveness of the periodontal instrumentation. This study investigated the reliability and accuracy of panoramic radiograph diagnoses of the periodontal state of mandibular molars, particularly regarding the diagnosis of furcation area periodontal defects, treatment planning, and prognosis prediction. This study examined a total of 110 teeth belonging to 33 subjects (19 male, 14 female) presenting with incipient to moderate periodontitis 4-7mmpocket depth. The alveolar bone level, length and width of the root trunk, and root separation angle were measured using the panoramic radiograph and compared to the results taken directly by retracting a full-thickness flap. The results of the study are as follows: 1. Data regarding the alveolar bone level of the mandibular first molar showed that the directly taken surgical measurements resulted in $5.1{\pm}0.9mm$ that was slightly deeper than the corresponding panoramic measurement resulted in $4.8{\pm}0.8mm$, but these differences were statistically insignificant (p>0.05). 2. The data of the directly taken surgical measurement of the mandibular second molar $(5.1{\pm}1.1mm)$ was slightly deeper than the corresponding panoramic measurement $(4.7{\pm}1.2mm)$, but these differences were statistically insignificant (p>0.05). 3. The measured values of the length and width of the mandibular first molar root trunks were determined to be $4.1{\pm}0.6mm$ and $7.3{\pm}0.9mm$, respectively, while the values of the mandibular second molar root trunks were determined to be $4.6{\pm}1.3mm$ and $7.6{\pm}0.9mm$ respectively. The differences between these values were found to be statistically significant (p<0.01). 4. The measured values of the root separation angle showed that the mandibular first molars averaged $34.5{\pm}4.4^{\circ}$, while the mandibular second molars averaged $23.0{\pm}10.0^{\circ}$. The differences between these values were found to be statistically significant (p<0.01).

• Journal of Periodontal and Implant Science
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• v.26 no.4
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• pp.967-987
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• 1996

The present study was to evaluate the healing patterns of guided tissue regeneration( GTR) using resorbable $Vicryl^{(R)}$(polyglactin 910) mesh and nonresorbable expanded polytetrafluoroethylene(ePTFE) membrane with or without bone grafting using autogeneous bone and demineralized freeze-dried bone allograft(DFDBA) in the grade II furcation defects. Mucoperiosteal flaps were reflected buccally in the mandibular 2nd, 3rd and 4th premolar areas and furcation defects were created surgically by removing $5{\times}6mm$ alveolar bone in 4 dogs. Root surfaces were thoroughly debrided of periodontal ligament and cementum, and notches were placed on root surface at the most apical bone level. In the right and left mandibular quadrant, each tooth was received $Vicryl^{(R)}$ mesh(ACE Surgical Supply Co., USA) only, $Vicryl^{(R)}$ mesh with DFDBA, $Vicryl^{(R)}$ mesh with autogeneous bone grafts, ePTFE membrane($Core-tex^{(R)}$ membrane, W.L. Gore & Associates Inc., USA) only, ePTFE membrane with DFDBA or ePTFE membrane with autogeneous bone grafts. For the fluorescent microscopic examination, fluorescent agents were injected at 2, 4 and 8 weeks after surgery. Four weeks after surgery, 2 dogs were sacrificed and ePTFE membranes were removed from remaining 2 dogs, which were sacrificed at 12 weeks after surgery. Undecalcified tissues were embedded in methylmethacrylate and $10{\mu}m$ thick sections were cut in a buccolingual direction. These sections were stained with hematoxylin-eosin stain and Masson's trichrome stain, and evaluated by descriptive histology and linear measurements. The results were as follows : 1) $Vicryl^{(R)}$ mesh group showed less connective tissue attachment than ePTFE membrane group. 2) The combination of GTR using $Vicryl^{(R)}$ mesh and osseous grafts resulted in new attachment and new bone formation more than GTR using $Vicryl^{(R)}$ mesh only. 3) GTR using ePTFE membrane, with or without osseous grafts, enhanced periodontal regeneration. 4) Root resorption and dentoalveolar ankylosis were observed in the areas treated with the combination of GTR and DFDBA. It was suggested that the effect of adjunctive bone grafting in GTR procedure depends on the materials and the physical properties of barrier membranes. $Vicryl^{(R)}$ mesh performed a barrier function and the use of adjunctive bone grafting may enhance the periodontal regeneration.

• Journal of Periodontal and Implant Science
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• v.36 no.2
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• pp.515-529
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• 2006

Periodontal regeneration refers to the restoration of bone, cementum and periodontal ligament to their original levels before damage from periodontal disease process. Various surgical techniques to the promotion of periodontal regeneration have been used. Bone graft and guided tissue regeneration have used for the regeneration of furcation involvements which caused by periodontal disease. Fibrin adhesive is agents that have been shown to be effective in periodontal regeneration and biological carrier. Calcium sulfate which is one of the resorbable barrier materials has used for guided tissue regeneration. The purpose of this study was to compare the clinical effects between bone graft using fibrin adhesive and calcium sulfate barrier in the mandibular class II furcation involvement. For the study, twenty-six class II furcation involved teeth were surgically treated. 13 furcation defects(test group) were treated with bonegraft and fibrin adhesive and the others(control group) were treated with bone graft and calcium sulfate barrier. Pocket depth, clinical attachment level and gingival recession were measured at baseline, postoperative 3 and 6 months. The results of the study are as follows: 1. The change of pocket depth and clinical attachment level in both groups was decreased significantly at 3, 6 months than at baseline(p<0.05). 2. The change of gingival recession in both groups was increased significantly at 3, 6 months than at baseline(p<0.05). 3. The change of pocket depth and clinical attachment level in both groups was decreased at 3, 6 months, and the change of gingival recession in both groups was increased at 3, 6 months but there were no statistically or clinically significant differences with both groups. 4. The significant reduction of the pocket depth and clinical attachment level exhibited marked changes at 3 months in both groups. In conclusion, the results of this study suggest that there are no statistically or clinically significant differences between fibrin adhesive and calcium sulfate barrier in the treatment of class II furcations using xenograft.

• Imaging Science in Dentistry
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• v.33 no.2
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• pp.71-77
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• 2003

Purpose : To evaluate and compare the efficacy of digital radiographic images in the detection of bone loss at the bifurcation area of the mandibular first molar with traditional film-based periapical radiographs, Materials and Methods : One dried human mandible with minimal periodontal bone loss around the first molar was selected and an artificial alveolar bone defect at the bifurcation area was serially prepared over 18 steps. Images were taken using a direct CCD-based system and with F-speed periapical films. The images were evaluated by seven interpreters (3 radiologists, 3 periodontologists, and 1 general dentist) using a 5-point confidence rating scale. Results : The readability of both periapical radiographs and digital image increased as the size of the artificial lesion and exposure time increased (p < 0.05). Periapical radiographs offered greater readability of smaller bone defects than digital images, and the coefficient of variation of mean score between periapical radiographs and digital images showed a significant difference. Conclusion : The experimental results indicate that a significant difference in the coefficient of variation of mean score exists between periapical radiographs and digital images, and that traditional film-based periapical images offer greater readability of smaller bone defects than digital images can presently offer.

• Journal of Korean Dental Science
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• v.4 no.1
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• pp.1-5
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• 2011

Purpose: Exact knowledge of the location and dimension of the pulp chamber help to maintain the pulp healthy during operative procedure and also reduces the risk of perforation of pulp chamber during root canal treatment. This in-vivo study was carried out to measure critical morphology of pulp chamber of mandibular molar using intra-oral periapical radiograph. Materials and Methods: Mandibular molar teeth of 56 patients were evaluated. The mandibular molar teeth whose pulp chamber was not violated by caries, restoration, fracture crown and those having closed apex were included in the study. The intraoral periapical radiographs were taken with paralleling angle technique using radio-opaque grid with 1 mm space. This grid was placed directly on the film. Results: In 94% of the mandibular first molars specimens the pulp chamber ceiling was at the level of the cemento-enamel junction. The measurements showing the lowest percentage variance were buccal cusp to furcation (approximately 11%) and buccal cusp to pulp chamber ceiling (approximately 15%). The distance from the cusp tip to pulp chamber ceiling height was approximately 6.0 mm, the distance from the pulpal floor to the furcation was approximately 3.0 mm, and the average height of a pulp chamber was 1.5 to 2.0 mm. Conclusion: The exact knowledge of distances of pulp chamber from various anatomical landmarks helps in proper assessment of root canals and ultimately avoids the failure of root canal treatment.

• Journal of Periodontal and Implant Science
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• v.25 no.2
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• pp.438-457
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• 1995

The origin of fibroblasts, their proliferative activity and roles in the early stages of periodontal regeneration were investigated in order to better understand the periodontal healing process in furcation defects of the beagle dog after guided tissue regeneration. Newly divided cells were identified and quantitated by immunolocalization of bromodeoxyuridine (BrdU) injected 1 hour prior to sacrificing the animals. The results were as follows :1. During periodontal healing in horizontal furcation defect, three different stages, namely the granulation tissue, connective tissue, and bone formation stages, were identified on the basis of major types of cells and tissue. 2. In the early stages of periodontal regeneration, both the remaining periodontal ligament and alveolar bone compartment were the major sources. 3. The majority of BrdU-labeled fibroblasts were located at the following areas ; 1) the coronal zone of the defect in case of the connective tissue fanned on the root surface. 2) the area within an 400 ${\mu}m$ distance from the remaining bone level in case of the periodontal ligament. 3) the area within an 100 ${\mu}m$ distance from the bone surface in case of areas of active bone formation.4. The highly proliferative fibroblasts adjacent to bone surface played a major role in the formation of osteoblast precursor cells, whereas both paravascular and endosteal cells played a minor role in new bone formation, In conclusion, it was suggested that the fibroblasts in the remaining periodontal ligament and bone will play a major role in periodontal regeneration, whereas both paravascular and endosteal cells will play a minor role in new bone formation.