• Journal of Periodontal and Implant Science
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• 제33권2호
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• pp.289-299
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• 2003

The autogenous free gingival graft is the most predictable procedure currently used to increase the width of　the attached gingiva in periodontics. But the major disadvantage of the procedure is to create the multiple surgical wounds at both a donor site and a recipient site. The other problem is the limited amount of available　graft material in oral cavity. Therefore, recent researches have been focused to develop the biomaterial to substitute the autogenous gingival tissue. The purpose of this study was to evaluate the histologic healing after　grafting of bilayer artificial dermis, compared to the free gingival graft. Four non-smoking subjects (mean age, 32.5 years) in systemically healthy state and good oral hygiene were selected according to their particular needs for correction of mucogingival problems as suggested by Nabers(1966). The recipient sites were prepared through the procedure for the free gingival graft and were grouped according to the graft materials: Experimental group(n=5) - bilayer artifcia1 dermis ($Terudermis^{(R)}$; Terumo Co. Japan) and Control group(n=6) - free gingival graft with autogenous palatal mucosa. Biopsies were harvested at 1,2,3 and 6 weeks postsurgery to evaluate histologically. At the third week in the experimental group and at the second week of in the control group, the grafts has been clinically stabilized on the recipient bed and the graft border has been blended into the surrounding tissue. In the experimental group after 1 week of grafting, the epithelial migration from the adjacent tissue to graft material was seen and after 3 weeks of grafting, the : nflmmation decreased, collagen layer of the artificial dermis was lost and the basement membrane of epithelium was formed. After 6 weeks of grafting, both groups demonstrated orthokeratinized epithelium and increased thickness of epithelial tissue and the rete peg formation, similar to the adjacent tissue, Histologic evaluation revealed a biologic acceptance and incorporation of the collagen layers of the graft tissue to the host tissue, without foreign body reaction. In conclusion, a bilayer artificial dermis is essentially similar to autogeneous free gingival graft in the correction of mucogingival problems, and has the advantages of decreased patient morbidity (no donor site) and availability of abundant amounts of graft material when needed.

• 대한소아치과학회지
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• 제27권1호
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• pp.122-134
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• 2000

각화치은, 부착치은의 폭경, 치은열구의 깊이에 대해 성인에서는 많은 연구가 있었으나 아동에서의 연구는 드물었기 때문에, 유치열기, 혼합치열기 및 영구치열기의 모든 치아에 대하여 아동의 협측 각화치은 및 부착치은의 폭경과 치은열구 깊이에 대한 정상치를 구하고, 악골의 발육 및 치아의 맹출과의 관련성을 고찰하며, 점막치은 문제의 발현빈도를 조사하고자 하였다. 결론은 다음과 같다. 1. 유치열의 부착치은 폭경은 상악 유측절치 및 유견치에서 각각 3.50mm, 3.55mm로 최대값을, 하악 제1유구치에서 1.34mm로 최소값을 나타내었다. 영구치열의 경우에는 상악 측절치에서 3.00mm로 최대값을, 하악 제1소구치에서 0.55mm로 최소값을 나타내었다. 상하악 동명치아 비교시 상악 치아가 하악 치아보다 더 큰 값을 나타내었고, 남녀간 차이에는 특별한 규칙이 발견되지는 않았다. 2. 연령증가에 따른 부착치은 폭경의 변화 양상은 유치열의 경우 유견치, 제1유구치, 제2유구치에서 6세부터 증가하였다. 영구치의 경우 남자에서는 하악 중절치와 상악 제 1대구치의 측정값만이 연령에 따른 증가 추세를 나타냈으나(p<0.05), 여자에서는 상하악 중절치 측절치 및 상악 제1대구치에서 통계적으로 유의성 있는 각화치은 폭경의 증가 추세를 관찰할 수 있었다(p<0.05). 3. 치아교대기에서 부착치은 폭경의 차이는 남자 상악 중절치를 제외한 모든 경우에 유치에서의 측정값이 영구치에서의 측정값보다 큰 것으로 나타났다(p<0.05). 4. 6제부터 12세까지는 각화치은의 폭경과 치은열구의 깊이는 대부분 유치 초기값보다 그 계승영구치 최종값이 더 높은 값을 나타냈으나(p<0.05), 부착치은의 폭경에서는 유치 초기와 그 계승영구치 최종값사이에 통계적으로 유의성 있는 차이가 나타나지 않았다. 5. 점막치은 문제 발현 빈도는 남녀에 상관없이 유치열은 상하악 제 1유구치가, 영구치열은 상하악 모두 제 1소구치가 최고치를 나타냈으며 유치에서보다 그 대응 계승영구치에서 그 빈도가 더욱 높게 나타났다. 연령증가에 따라 점막치은 문제의 발현 빈도는 유치열, 영구치열에서 모두 감소하였으나, 하악 제1유구치, 하악 영구 견치, 제1, 제2소구치의 경우 연령의 증가와 상관없이 비슷하게 유지되거나 증가하는 경향을 보였다.

• 대한소아치과학회지
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• 제26권1호
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• pp.69-76
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• 1999

The mandibular buccal frenum is defined as a fold of mucous membrane at the posterior labial vestibule and attaches the lips and the cheeks to the alveolar mucosa, gingiva, and underlying periosteum. The buccal frenum becomes a problem when its attachment is too close to the marginal gingiva. It may then pull on healthy gingiva, encourage plaque formation and interfere with tooth brushing. Especially, heavy buccal frenum mucogingivally results in insufficent attached gingiva, inadequate vestibular depth and high frenum attachment and also difficulty in eruption of mandibular premolar. Frenotomy, frenectomy and mucogingival surgery are used in treating heavy buccal frenum. Frenotomy with autogenous free gingival graft has been used popularly because of its stable result. But, it is difficult in younger children because of inadequate donor site, difficulty in making recipient site and behavior management. Frenotomy with apically positioned flap is considered as more efficient way for a very young child with heavy buccal frenum. Additionally, modified deep sedation with $N_2O-O_2$ can be used as an adjunct for the effective treatment outcome. Decrease in muscle pull, adequate width of attached gingiva and increased vestibular depth can be expected from this treatment approach.

• 대한치과의사협회지
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• 제50권8호
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• pp.474-481
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• 2012

The periodontal flap surgery is the most widely utilized surgical procedure to reduce the pocket depth and to access the subgingival root surfaces for scaling and root planing. The diagnosis of the periodontal lesion and the objective of the surgery will dictate the type of flap procedure which will be utilized to obtain the best result. The incisions, type of flap and the selection of suturing design must be planned and executed to fit the problem. Periodontal flaps are designed to preserve gingival integrity and to gain access to root surfaces for residual calculus removal and to thoroughly remove granulation tissue so bone defects can be visualized and treated. Gentle and efficient procedures result in optimum healing and minimal postoperative pain. When flaps need to be repositioned apically or less often, coronally, then the flaps must sit passively at the appropriate level before suturing. To ensure this, buccal and lingual flaps need to be elevated beyond the mucogingival junction so the elasticity of the mucosa allows for flap mobility. Sometimes it may be necessary to extend the flap elevation apically with a split incision approach to minimize the effect of the less elastic periosteum. Vertical incisions can aid in flap positioning by allow ing the clinician to suture the flap at a different level to the adjacent untreated gingiva. In osseous periodontal surgery, flaps are apically positioned to minimize postoperative pocket depth. In regenerative periodontal surgery including implant surgery, soft tissue cove rage of bony defects, graft materials, membranes, and bio logic agents is important so sulcular incisions and light suturing techniques are crucial.