• Journal of Periodontal and Implant Science
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• 제45권6호
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• pp.216-222
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• 2015

Purpose: After extraction, the alveolar bone tends to undergo atrophy in three-dimensions. The amount of alveolar bone loss in the horizontal dimension has been reported to be greater than the amount of bone loss in the vertical dimension, and is most pronounced in the buccal aspect. The aim of this study was to monitor the predictive alveolar bone level following the extraction of anterior teeth seriously involved with advanced chronic periodontitis. Methods: This study included 25 patients with advanced chronic periodontitis, whose maxillary anterior teeth had been extracted due to extensive attachment loss more than one year before the study. Periapical radiographs were analyzed to assess the vertical level of alveolar bone surrounding the edentulous area. An imaginary line connecting the mesial and the distal ends of the alveolar crest facing the adjacent tooth was arbitrarily created. Several representative coordinates were established in the horizontal direction, and the vertical distance from the imaginary line to the alveolar crest was measured at each coordinate for each patient using image analysis software. Regression functions predicting the vertical level of the alveolar bone in the maxillary anterior edentulous area were identified for each patient. Results: The regression functions demonstrated a tendency to converge to parabolic shapes. The predicted maximum distance between the imaginary line and the alveolar bone calculated using the regression function was $1.43{\pm}0.65mm$. No significant differences were found between the expected and actual maximum distances. Likewise, the predicted and actual maximum horizontal distances did not show any significant differences. The distance from the alveolar bone crest to the imaginary lines was not influenced by the mesio-distal spans of the edentulous area. Conclusions: After extraction, the vertical level of the alveolar ridge increased to become closer to the reference line connecting the mesial and distal alveolar crests.

• 대한치과보철학회지
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• 제55권2호
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• pp.187-197
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• 2017

과도한 수직피개를 가진 과개교합 환자에서 안정적인 유지접촉이 없는 경우 연조직 외상, 치질 파괴, 대합치 정출의 문제가 일어날 수 있고 이는 결과적으로 교합평면의 붕괴와 기능적, 심미적 문제로 이어진다. 치아의 상실과 마모가 발생된 환자에 대한 치료계획 수립 시 올바른 교합수직고경 설정을 통해 환자의 안정적인 악간관계를 회복시켜야 한다. 본 증례는 중심위에서 극심한 면 대 면 접촉이 발생된, 편측 구치부가 상실된 과개교합 환자에게 수직고경 증가를 동반한 완전구강회복술을 시행한 증례를 보고하였다. 보철수복 공간 확보를 위해 수직고경증가를 동반한 완전구강회복술로 안정적인 교합관계와 조화로운 전방, 측방유도를 얻어 환자의 기능적, 심미적 문제를 해결할 수 있었다.

• 대한소아치과학회지
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• 제47권2호
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• pp.213-218
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• 2020

어린이의 맹출 중인 치아는 느슨한 치주 인대와 덜 석회화 된 치조골로 둘러싸여 있기 때문에 외상에 취약하다. 외상에 의한 치아의 완전 탈구는 상악 중절치에 가장 빈번하게 발생한다. 탈구된 치아의 재식 후 예후는 구강 외 보존 시간과 상태에 영향을 받는다. 외상 당한 전치의 예후가 불량한 경우 소구치의 전치부 자가 이식은 임플란트 보철이 어려운 성장기 청소년 환자의 적절한 치료 방법으로 받아들여진다. 이 증례 보고는 외상당한 전치와 불량한 구강 위생 및 심한 총생을 가진 청소년 환자에서 치근이 완성된 소구치의 전치부 자가 이식을 통한 심미적 회복의 결과를 기술하고 있다. 복잡하고 어려운 구강 문제의 개선을 위해 포괄적이고 장기간에 걸친 치료가 진행되었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권1호
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• pp.85-92
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• 2005

Reconstruction of defect in the anterior part of the maxilla to enable implant placement or prothesis is a complicated treatment due to the anatomical position and lack of soft tissues. Two cases are presented in which autogenous iliac PMCB(particulate marrow and cancellous bone) with titanium mesh were used for premaxilla reconstruction and alveolar bone repair of the anterior maxillas prior to denture and implants fixation respectively. Cancellous bone from the anterior iliac crest was compressed and placed against a titanium mesh fixed to the bone of palate in a patient with severe defect of the anterior maxilla. There were no problem in the healing, and the anterior maxillas of two patients had increased height and width during the initial healing and remodeling. The clinical reports describe the use of titanium mesh for reconstruction of premaxilla. Autogenous bone grafts were harvested from the iliac crest and were loaded on a titanium mesh that were left in the patient's maxilla for 6 months before they were removed respectively. The radiographic analysis demonstrated that a 10mm vertical ridge augmentation had been achieved. In guided bone regeneration, the quantity of bone regenerated under the barrier has been demonstrated to be directly related to the amount of the space under the membrane. This space can diminish as a result of membrane collapse. To avoid this problem which involved the use of a titanium mesh barrier to protect the regenerating tissues and to achieve a rigid fixation of the bone segments, were used in association with autologous bone in 2 cases. The aim of this study was to evaluate the capability of a configured titanium mesh to serve as a mechanical and biologic device for restoring a vertically defected premaxilla.

• Journal of Periodontal and Implant Science
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• 제25권3호
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• pp.648-658
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• 1995

The present study has been performed to evaluate the clinical, microbiological, biochemical and immunological parameters associated with the periodontal disease activity in adolescent periodontitis. 21 young adolescents with evidences of periodontal attachment loss participated in the study for upto 3 years of examination. Probing pocket depths and attachment levels of whole dentitions were annually recorded and 4 deepest pockets, with initial probing depth ${\geq}$ 4mm, were selected as the representative experimental sites of a patient. Sites experiencing attachment loss ${\geq}$ 1mm during the 3-year experimental period were designated as the active sites and these sites were examined for the microbiological and biochemical profiles at the time when attachment loss occurred. Microbiological assay included cultural studies and PerioScan for monitoring BANA(+) organisms(e.g. Porphyromonas gingivalis, Treponema denticola, Bacteriodes forsythus). Biochemical assay has been performed for monitoring GCF levels of neutral protease. Serum IgG and IgG2 titers against Porphyromonas gingivalis 381 were determined of a patients at the beginning and the end of the study, respectively for patient-based analysis. The results indicated that the parameters consisting of microbiological cultures and GCF neutral protease exhibited low association with the periodontal disease activity in adolescents. However, the specificity for microbiological culture of the selected periodontopathic organisms(Aa,Pg,Pi) were considerably high. Moreover, the clinical pameters such as bleeding on probing and presence of plaque as well as IgG levels against Pg at the baseline exminations were closely associated with the subsequent evidences of attachment loss during the whole experimental period(3-year).

• Journal of Periodontal and Implant Science
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• 제33권2호
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• pp.139-147
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• 2003

The roots of teeth exposed by gingival recession, may be successfully covered by various type of gingival grafting procedures. Vascularization of the recipient site is an essential determinant of the grafts' survival during the first healing stages. It has been suggested that a procedure by which they stimulate the periosteum presurgically will induce the proliferation of neo-endothelium in the site to be operated. The purpose of this study is to evaluate the variations in the gingival blood flow during 4weeks after periosteal stimulation in patient scheduled to receive gingival grafts and to compare variations in the gingival blood flow between smoker and non-smoker. Laser Doppler Flowmetry(floLAB(R), Moor Instruments Ltd, England ; wave length = 780mm. Max. power =l.6mW) was used to measure the gingival blood flow. 112 sites of 68 male patients (32 smokers and 36 non-smoker), aged between 23 and 48 years (smoker : 24-44 years. mean=32.6, non-smoker : 23-48 years, mean=28.5) were monitored for the blood flow. Gingival blood flow measured at before periosteal stimulation, 1-, 2-, 3-, and 4-weeks after periosteal stimulation from 10 a.m. to 2 p.m. The difference of blood flow in each measuring time, each measuring site and between smokers and non-smokers were statistically analyzed by MANOVA. The results were as follows : (1) Blood flow stayed increased for 2 weeks, and then, it was a tendency to decrease(p<0.05). (2) There was no statistically significant difference of blood flow change between smokers and non-smokers. (3)The blood flow at middle site had lower than mesial and distal site during the measuring periods(p<0.05). The present study suggested that blood flow change following periosteal stimulation was significant difference, thus periosteal stimulation before gingival graft might induce favorable results in gingival recession patient.

• Journal of Periodontal and Implant Science
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• 제24권3호
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• pp.541-560
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• 1994

The present study was performed to evaluate the relationship between the serotype or the genotype of Actnobacillus actinomycetemcomitans (A. a.) and the severity of periodontal disease. Total 64 A. a. clinical isolates were sampled from 46 sites of 20 subjects classified into the group I (1 periodontally healthy subject, 2 gingivitis patients, 5 ealry adult periodontitis patients), group II (3 moderatelly adult periodontitis patients) and group III (1 advanced adult periodontitis patient, 8 RPP patients). Southern bolt hybridization (fingerprinting) patterns of the five reference strains, A. a. strain ATCC 29523 (serotype a), ATCC 29522 (Serotype b), ATCC 43719 (serotype c), IDH 781 (serotype d) and IDH 1705 (serotype e), were used as the five basic genotypic patterns (A, B, C, D, E). NT type was designated as one which did dnot represent any of those five basic types. The serotypes were determined by ELISA technique with the serum samples from pre-immunized rabbit. Based on subject-based analysis, it was noted that genotypes A and C, NT, and B, D, E were significantly related to the disease groups I, II, and III, respectively. It was also noted that both the serotypes a and c were significantly related to the disease group I and II, while serotypes were significantly related bm), and serotypes b and nd were frequently found in sites with severe attachment loss (LA>6mm). The results indicated that the significant relationship can be delineated beteen the genotypes and the serotypes of Acinobacillus actinomycetemcomitans and the periodontal disease severity. The results also indicated that genotyping can provide more detailed information on its relationship with the disease severity based on both the patient-based and the site-based analyses.

• 대한심미치과학회지
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• 제23권2호
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• pp.80-85
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• 2014

가지런한 치열을 얻기 위해 교정 치료는 치아 보존적인 의미에서 단연 First choice가 일 수 밖에 없다. 그러나 왜소치나 치아 크기의 불균형인 경우, 변색 치아나 파절, 심한 마모 치아인 경우 교정만으로는 심미적으로 완성도 높은 결과를 가져올 수 없다. 모든 치료에서 그러하지만, 특히 심미 치료에서는 치아 교정과 보철 치료, 혹은 치주 치료 및 임플란트등 항상 통합적인 진단과 치료계획이 필요한 경우가 많다. 그리고 다양한 치과 분야의 협진 진료가 필요한 환자에서는 안모와 치아의 심미적 만족뿐 아니라 기능적인 교합관계를 이룸으로써 장기간 안정적이며 조화로운 상태가 유지될 수 있는 치료가 전제되어야 한다. 본 증례는 전치부와 소구치에 cross bite가 있고, 상악 우중절치 절단에 마모가 있는 37세 여성 환자에서 교정과 라미네이트 수복치료를 동반한 경우이다. 치아교정을 통하여 전체적인 치아 위치를 재구성하여 기능교합을 이루었고, 최소한의 치질삭제로 라미네이트 수복치료를 함으로써 전치부 심미를 회복하였다. 최종 보철물을 장착하고 2년간 주기적인 follow up통해 예후를 관찰중이며, 부정교합의 재발이나 보철물 파절은 현재까지 관찰되지 않았다.

• Journal of Periodontal and Implant Science
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• 제27권4호
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• pp.701-722
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• 1997

It was reported that low dose doxycycline(LDD) regimen could inhibit pathologically elevated collagenase activity in the gingival crevicular fluid of petients with adult periodontitis without producing typical antibiotic side effects. The purpose of this study was to evaluate the effects of LDD regimen(20mg) administered during non-surgical therapy on clinical index and gingival crevicular fluid enzyme activity in diabetics who are at high risk for periodontal disease. Forty-nine subjects having at least two sites with probing pocket depths greater than 4mm were selected. In this double-blind, placebo-controlled study, the patients were administered 20 mg doxycycline capsule or placebo capsule b.i.d. for 2 weeks. Clinical parameters of dental plaque, gingival inflammation, probing pocket depth and probing attachment level were assessed at week 0, 2, 4, and 8. Gingival crevicular fluid samples were collected at the same time to evaluate the activities of collagenase and elastase. Clinical parameters and elastase activity were significantly reduced in all groups compared to the baseline value after treatment. Significantly greater reduction in pocket depth and gain in attachment level was shown in the LDD-administered group compared to placebo group in both adult periodontitis and diabetic patients. Total collagenase activity was also reduced significantly in all groups after treatment, but the greater reduction was seen in the LDD-administered diabetics group compared to relevant placebo group(at 4, 8week). Significantly greater reduction in active collagenase activity was also seen in the LDD-administered group compared to placebo group in diabetic patients(at 2, 4, 8week). These results indicated that use of low dose doxycycline could be aueseful adjunct to instrumentation therapy in the management of diabetic patient with periodontitis as well as adult periodontitis patient.

• 대한치과보철학회지
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• 제52권1호
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• pp.42-47
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• 2014

광범위한 치아 상실과 마모로 인한 교합면의 파괴로 수직고경이 감소된 경우 안모의 변화, 전방 유도의 상실로 인한 반대 교합을 보일 수 있으며, 또한 턱관절의 문제를 발생 시킬 수도 있다. 이러한 경우 교합 수직 고경의 증가를 통한 전악 수복을 고려할 수 있으며, 적절한 환자의 수직 고경 평가가 필요하다. 본 증례는 80세의 남자 환자로 전반적인 보철계획을 주소로 내원하였으며, 치아상실 및 마모에 따른 전치부의 반대 교합과 교합 수직 고경의 감소가 관찰되었다. 진단 모형과 방사선 사진, 임상적 검사를 이용하여 교합 관계를 분석하여 교합 수직 고경 증가를 결정하였다. 진단 wax up을 시행하였고 임시 보철물을 제작하였다. 3개월의 적응 기간 후 상악 고정성 보철물과 하악 임플란트 지지 피개의치로 최종 수복하였다. 장착 후 8개월경과 관찰 중이며 양호한 심미적 기능적 개선을 보였다.