Kim, Sang-Yul;Lee, Jae-Kwan;Chang, Beom-Seok;Um, Heung-Sik
Journal of Periodontal and Implant Science
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제44권2호
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pp.65-70
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2014
Purpose: The purpose of this retrospective study was to evaluate the effect of patient compliance with supportive periodontal therapy (SPT) on tooth loss in Korean adults. Methods: The periodontal records of 134 patients were reviewed for this study. They completed active periodontal treatment from 1999 to 2001 and were placed on a schedule of periodic follow-up visits for SPT. Patient compliance was classified into complete compliance (CC), erratic compliance (EC), and noncompliance (NC) groups. Re-examinations were carried out $11.0{{\pm}}0.8$ years after the active periodontal treatment. The prognosis for each tooth was determined as good, questionable, or hopeless according to the bone loss observed in pretreatment radiographs. Results: The rate of tooth loss of the CC group was significantly lower than that of the NC group. The tooth loss/patient and the tooth loss/patient/year were not significantly different between the three groups. The rates of tooth loss in the good, questionable, and hopeless prognosis groups were 6.7%, 9.5%, and 13.2%, respectively. For the teeth with a good prognosis, the rate of tooth loss of the CC group was significantly lower than that of the NC group (0.4% vs. 5.1%). For the teeth with a questionable prognosis, the CC group showed a significantly lower rate of tooth loss than did the EC group (4.1% vs. 30.7%) or the NC group (4.1% vs. 25.6%). For the teeth with a hopeless prognosis, the rates of tooth loss were not significantly different among the three groups. Conclusions: Within the limits of this study, the patients who showed a poor compliance with SPT were more likely to lose teeth than were the regularly compliant patients. However, the risk of tooth loss with a hopeless prognosis was high irrespective of the compliance.
The purpose of this study was to evaluate the clinical validity of multi-rooted teeth subjected to root-resection treatment. Over a period of 1-7 years, 60 root-resected molars in 59 patients were examined clinically and radiographically. All patients were p0eriodically recalled once or twice a year. Root-resections were due to periodontal, more specifically furcal bone loss or marginal bone loss,in 34 cases and extensive dental carious destruction in 10 cases. In other cases,root-resections resulted from 6 cases of root fracture, 6 cases of periodontal-endodontic combined lesion, and 1 case of endodontic problem. Root-resection was carried out on 26 maxillary molars and 34 mandibular molars. The results are as follows; 1. 14 cases(23.3%) were considered failures. 8 cases(13.3%) of them occurred within the first year(8 cases, 13.3%), 4 cases(6.7%)between 1-3 years, and 2 cases(3.3%) between 4-7 years. 2. 8 cases(13.3%) were considered failures due to periodontal reasons, 3 cases(5%) due to root fracture, 2 cases(3.3%) due to endodontic problem, and 1 case(1.7%) due to prosthetic problem. 3. 37 cases(61.7%) showed up for the recall appointments, and the percentage of failures(13.5%) was lower compared with that of all patients(23.3%). The results of the present study indicate that the prognosis of root-resected teeth is favourable if attention is paid to the selection of proper case and to achieving optimal oral hygiene and periodic check up.
The aim of this study was to investigate the effect of third molar extraction on the periodontal status of the adjacent second molar. A total of 61 second molars in 31 adult periodontitis patients were examined. Among them, 27 second molars without adjacent third molars were included in the test group, and 34 second molars with third molar were included in the control group. Clinical parameters including plaque index, gingival index, and pocket depth and radiographic bone loss were measured around the second molar both in test and control group. The result showed that: (1) the mean plaque index and gingival index of control group were higher than these of the test group but the difference was not statistically significant, (2) the mean pocket depth of the control group was higher than the test group significantly at distal and buccal surface, (3) radiographic hone loss was greater in control group than test group significantly, (4) in Pearson correlation analysis between the age of extraction and radiographic bone loss in the test group, a positive relationship was shown(p<0.01). Within limitation of this study, it may be concluded that third molar extraction in periodontitis patients showed an improvement in periodontal status in contrast the patients group having third molar, therefore earlier a removal of third molar may minimize radiographic hone loss of the adjacent second molar.
Several extraction cases with advanced bone loss as a result of periodontal disease, root or labial bone fracture, extensive caries, and periapical lesions occur esthetic, functional problems and severe bone loss. Therefore, to treat these cases used several surgical methods and socket preservation among this therapies have been evaluated simple, effective and good prognosis in the implant placement. Socket preservation therapy have been used with barrier membranes or/and graft materials. Deproteinized bovine bone mineral have been evaluated ideal grafting materials. Recently, calcium-phosphate thin film coated bovine bone powders were developed in our country, but the study for these material wasn't reported. When two types of xenograft materials were implanted in extraction sockets of Beagle dogs, the effects of these were analyzed after 4 weeks and 8 weeks histological views. The results of this study were as follows. 1. In control groups, 4 weeks after implantation, the extraction sockets were filled with connective tissue which has dilated vessels and epithelial growth. And after 8 weeks, irregular connective bundles were observed. But new bone formation was not seen. 2. In Bio-Oss groups, epithelial growth was not seen and bone powder was covered with connective tissue fiber. New bone formation was found around the interproximal bone. There was no special change seen after 8 weeks, connective tissue fibers became more regular, and bone growth near bone powder was not made well. 3. In Ca-P BBP groups, epithelial cells didn't grow in the extraction sockets, there was a lot of new bone made around the bone powder after 8 weeks, new bone around bone powder was replaced with mature bone. It is thought that bone powder grafting into the extraction sockets is very useful for conservation of ridge, and Ca-P BBP is more effective in bone formation than Bio-Oss.
Cemental tears are uncommon form of root fracture that can lead to rapid localized periodontal attachment loss. Studies have described periodontal breakdown as being associated with the separation of the cementum from the underlying tooth structure. The aim of this case report is to assess the outcome of treatment of cemental tear with several surgical treatment regimens. Three patients with cemental tear were treated with different surgical method. In all three cases, the cemental tear occurred on maxillary right central incisors. In each case, the root fragment were removed, the localized defect was treated using different surgical methods including guided tissue regeneration and bone graft followed by scaling and root planting. In all three cases, symptoms subsided after the treatment and clinical attachment level was improved up to 2 mm at 3 month after surgery. Both conventional and regenerative periodontal surgery could achieve successful outcomes.
Purpose: The purpose of this study was to preliminarily evaluate the influence of diabetes mellitus (DM) on periodontal tissue without establishment of periodontitis. Methods: Seven-week-old db/db mice were used for the diabetic experimental group and systematically healthy mice of the same age were used as controls. After 1 week of acclimatization, the animals were sacrificed for hard and soft tissue evaluation. The pattern of bone destruction was evaluated by stereomicroscope evaluation with alizarin red staining and radiographic evaluation by microscopic computerized tomography images. Histological evaluation was performed with hematoxylin and eosin stain for evaluation of soft tissue changes. Results: In both stereomicroscope evaluation and radiograph image analysis, aggressive form of bone destruction was observed in diabetic animals when compared to the systematically healthy controls. In histological evaluation, apical migration of junctional epithelium with slight inflammatory cell infiltration was observed with disarrangement of connective tissue fibers. Conclusions: Within the limits of this study, diabetic animals presented distortion in periodontal attachment and an aggressive bone loss pattern when compared to the healthy controls, suggesting that DM has an independent effect on periodontal tissue destruction irrespective of the presence or absence of periodontal disease.
Since $Gr{\"{o}}nadhl$ et al introduced a digital subtraction radiography into periodontal dignosis in 1983, many reports using this system has aimed to assess the peroiodontal disease activity and the alveolar bone changes after periodontal treatment. The present study was performed to evaluate the usefulness of digital subtraction radiography for asessing an alveolar bone changes in 3 months after periodontal flap surgery. Serial intraral raiographs were taken from 5 normal subjects and 6 periodontally diseased patients using customized bite blocks attached to film holder in fxation device and digitized by image processing system(consisting of IBM 386, digital frame grabber, CCD camera, Image-pro II software). And the reference parameters were measured by pixel unit and compared with respective radiographs. The serial radiographs showed a little and statistically insignificant difference in reference paramenters. The conventional intraoral radiographs, the subtraction images and the clor enhanced subtraction images were reviewed by 4 examiners and the examiner's agreement rates were compared. The subtraction images and its color enhanced images showed higher examiner's agreement rate than the conventional radiographs. And the propotions of sites diagnosed with bone loss or gain after periodontal surgery were highter in the subtraction images and its color enhanced images than in the conventional radiographs. Especially, in color enhanced images, the unber of bone agin sites tended to increase according to post-surgery periods. These results indicate that projection geometry could be standardized with the divice used in this study, and the subtraction radiography may be useful to assess an alveolar bone changes after periodntal flap surgery.
Purpose: The present study describes 3 patients with chronic periodontitis and consequent vertical resorption of the alveolar ridge who were treated using implant-based restoration with guided bone regeneration (GBR). Methods: After extraction of a periodontally compromised tooth, vertical bone augmentation using a K-incision was performed at the healed, low-level alveolar ridge. Results: The partial-split K-incision enabled soft tissue elongation without any change in buccal vestibular depth, and provided sufficient keratinized gingival tissue during GBR. Conclusions: Within the limits of this study, the present case series demonstrated that the novel K-incision technique was effective for GBR and allowed normal implant-based restoration and maintenance of a healthy periodontal condition. However, further long-term follow-up and a large-scale randomized clinical investigation should be performed to evaluate the feasibility of this technique.
Background : Repeated dis/re-connection of implant abutment caused bone loss around implant fixtures due to the new formation of biologic width of the mucosal-implant barrier. The aim of this clinical study was to evaluate whether the repeated dis/re-connection of implant abutment cause bone loss clinically and the effect of cleansing methods on a bone loss during the early healing period. Methods : A total 50 implants were installed in 20 patients and repeated dis/re-connection of abutment was performed at the time of surgery and once per week for 12 weeks. 0.9% normal saline solution as group1 and 0.1% chlorhexidine solution as group 2 was used to clean abutments. All patients had radiographs taken at the placement of implant and 4, 8, and 12 weeks postoperatively. The data for bone loss around implant were analyzed. Results: The marginal bone loss at 12 weeks were $1.28{\pm}0.51mm$, $1,32{\pm}0,57mm$ in the mesial and distal sides in group1, $1.94{\pm}0.75mm$, $1.81{\pm}0.84mm$ in group 2, respectively. In view of marginal bone loss, there was not a significant statistical difference between groups. Conclusions : Repeated dis/re-connection of implant abutment may not cause marginal bone loss around implant fixture although limited samples and short-term observation period. In spite of more bone loss in group 2, there was no statistical significant difference between groups. In context of those results, the clinical significance of the repeated dis/re-connection of implant abutment and the cleansing method of abutments is debatable when it comes to marginal bone loss during early healing period.
The successful use of osseointegrated implants to replace missing teeth has been demonstrated for both the completely and the partially edentulous patients. Many studies have confirmed an excellent long-term prognosis. The successful outcome of any implant procedure is surely dependent on the interrelationship of the various components that includes the following: biocompatibility of the implant material, macroscopic and microscopic nature of the implant surface, the status of the implant bed in both a health(noninfected) and a morphologic(bone quality) context, the surgical technique, the undisturbed healing phase, the subsequent prosthetic design, and long-term loading phase. Periodontally compromised patients have poor status of the implant bed and periodontal pathogen. No longitudinal data are available whether these factors affect the prognosis of implants. In this study, 102 machined $Br{{\aa}}nemark$ implants are inserted to analyze the success rate of 1-4 years and marginal bone loss in 49 chronic periodontitis patients. The following conclusions could be drawn from this study. 1. The cumulative success rate of implants at the 4-year of loading was 95.10%. 2. 5 failed implants have been removed. One implant have been removed due to infection, two implants were removed due to failure of osseointegration. and other two implants were removed due to mechanical failure caused by over-loading. 3. Mean marginal bone loss from the time of loading was 0.94mm at first year, 1.12mm at second year, 1.25mm at third year. These results suggest that implant therapy is good treatment modality in chronic periodontitis patients, and periodontal treatment including oral hygiene program is completed prior to insertion of implants.
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