A 29-year-old male patient was referred to Dept. of Dentistry due to halitosis and food impaction, who had been diagnosed as progressive systemic sclerosis at Dept. of Dermatology, SNUH. Oromaxillofacially lips were slightly thin, rigid and shiny. Pale gingiva and pinched nose were found also. Radiographically, uniform extreme widening of periodontal ligament space was found.
The present study invetigates the effects of root planing only(control group), DFDBA alone(test group 1) and combined use of DFDB and Dura mater(test group 2) in dehiscence defects in dogs. The results of 8weeks post-surgery by histological comparison between the three groups are as follows. 1. The contol group showed minimum regeneration of new cementum and new bone with limited migration of epitheilal cells, and healed by connective tissue attachment. 2. The test group 1 showed minimum regeneration of new cementum and new bone with limited migration of epitheilal cells, and healed by connective tissue attachment. 3. The test group 2 showed significant amount of the new cementum and new bone. 4. Both control and test groups healed without any observable root resorption and ankylosis. The above the results suggest that the use of resorbable Dura mater only does not improve the regeneration of new bone and periodontal ligament due to difficulties of space making, but the combined use with DFDB may be more effective.
Radiographic diagnosis of periapical lesions is based on many factors, including anatomical limitations such as thickness of the cortical bone; positioning of the apical abscess to the cortical bone; and is complicated by proximity to other anatomical structures and neighboring teeth. With conventional radiographs, these structures are often superimposed. Dental CBCT with its associated geometric accuracy offers accurate visualizations of the complex relationships and boundaries between teeth, related anatomical features, and their associated pathology. Its images also provide us internal tooth morphology, periodontal ligament space, the presence or absence of periapicl lesions in association wi th critical anatomical structures and maxillary sinus involement. Using 3 D imaging makes it easier for clinicians to detect, diagnosis, and develop highly effective treatment plans. Now, 4 cases of periapical and periodontal pathosis with CBCT images are to be presented including periapical abscess, furcation involvement, periapical pathosis involving maxillary sinus, and osteomyelitis. CBCT analyze specific area of interest and provides the highly detailed anatomical information. It also facilitates earlier and more accurate diagnosis, and treatment planning decisions and more predictable outcome.
The 3 beagle dogs aged over one and half years and weighed 14 to 16 Kg were utilized in this study. Horizontal furcation defects were induced around 3rd, and 4th premolars bilaterally. BMP-4 in conjunction with EGF and BMP-4 only were applied in the right and left premolars respectively. 1 animal was sacrificed at 2nd week, 4th week, and 8th week, after regenerative surgery respectively. Semi-thin sections using glass-knife were stained with hematoxylin- eosin and trichrome for light microscopic study. The results were as follows : 1 . The long junctional epithelial downgrowth was observed in both area applied with BMP-4 and with BMP-4 and EGF at 2nd week after the surgery. 2 . The extensive regeneration of new bone and cementum was appeared at 4th week and the maturation of bone was observed at 8th week in both area applied with BMP-4 and with BMP-4 and EGF. 3 . The root ankylosis and resorption was presented along the exposed root surface at the coronal 1/3 of defect in the BMP-4 applied site, but it was not shown in the site applied with BMP-4 in conjunction with EGF at the 4th week. At 8th week, the root ankylosis was apparently appeared in the BMP-4 and EGF applied site as well as in the BMP-4 applied site. 4 . The periodontal ligament tissue including Sharpey's fiber inserted into cementum and alveolar bone, was formed along the exposed root surface in the area applied with BMP-4 only, but in the site applied with BMP-4 and EGF, the collagen fiber running parallel to the root surface without Sharpey's fiber, was observed in the periodontal ligament space at 4th and 8th week. Within the above results, BMP-4 had the remarkable capability to regenerate the periodontal tissue and EGF had possibility to prevent from the root ankylosis. Therefore, growth factors including BMP-4 and EGF may have the strong possibility to be utilized in the clinical periodontal treatments.
In order to evaluate the effect of platelet-derived growth factor(PDGF-BB) and guided tissue regeneration(GTR) technique on the regeneration of destructed periodontal tissue,intentional through-and-through furcation defects(4mm in height) were made on both mandibular 2nd and 4th premolars of 8 adult male dogs(30-40lb). Experimental group 1 was composed of the premolars that were treated by only topical application of PDGF-BB with 0.05M acetic acid without any barrier membrane. Experimental group 2 was composed of the premolars that were treated by GTR with expanded polytetrafluoroethylene membrane(ePTFE : Gore-tex periodontal material, USA). Experimental group 3 was composed of the premolars that were treated by GTR with ePTFE after topical application of PDGFBE. Control group was composed of the premolars that were treated by coronally positioned flap operation only without use of PDGF-BB and ePTFE membrane. All ePTFE membranes were carefully removed 4 weeks after regenerative surgery, and all experimental animals were sacrificed 8 weeks after regenerative surgery. The light microscopic findings were as follows ; (1) In experimental group 1, rapid new bone formation along the-root surface with multiple ankylosis and root resorption by multinucleated giant cells, and dense connective tissue in the central portion of the furcation defects were observed. (2) In experimental group 2, it was observed that the furcation defects were filled with newly formed bone, Sharpey's fibers were embedded into new cementum on root dentin of furcation fornix area, but the central portion and the area under furcation fornix were still filled with dense connective tissue. (3) In experimental group 3, the furcation defects were regenerated with newly formed dense bone and regular periodontal ligament with Sharpey's fibers embedded into newly formed cementum and bone underneath fornix area. (4) In control group, unoccupied space, apical migration of epithelium, dense infiltration of inflammatory cells in subepithelial connective tissue in relation to heavy plaque accumulation, and root resorption by inflammatory reaction were shown, but any new cementum formation on resorbed dentin surface could not be observed. The present study demonstrated that the combined therapy of PDGF-BB and GTR could enhance the regeneration of destructed periodontal tissue.
Autotransplantation is the transplantation of embeded, impacted, or unerupted tooth, into extraction socket or surgically prepared socket in the same individual. Clinically, successful autotransplantation must show radiolucent space(periodontal ligament space) between transplanted tooth and supporting bone, lamina dura, no root resorption, no ankylosis, no inflammatory change, and physiologic tooth mobility. It is important that procedure is atraumatic, and the instruments should not contact the root surface during procedure. We performed autotransplantation of impacted mandibular canine that transversely located beneath the apices of the mandibular incisors with uncompletely developed apex. In radiographs and clinical evaluation, this transplant showed successful clinical finding except irregularity of mesial root surface after 14 months. It is conclued that transplantation of canine with $\frac{1}{2}{\sim}\frac{3}{4}$ root development provides a good chance of pulp survival, limited risk of root resorption and ensures sufficient final length, and is thus recommended.
Luciano Augusto Cano Martins;Danieli Moura Brasil;Deborah Queiroz Freitas;Matheus L Oliveira
Imaging Science in Dentistry
/
제53권1호
/
pp.61-67
/
2023
Purpose: The aim of this study was to objectively detect simulated tooth ankylosis using a novel method involving cone-beam computed tomography (CBCT). Materials and Methods: Tooth ankylosis was simulated in single-rooted human permanent teeth, and CBCT scans were acquired at different current levels (5, 6.3, and 8 mA) and voxel sizes (0.08, 0.125, and 0.2). In axial reconstructions, a line of interest was perpendicularly placed over the periodontal ligament space of 21 ankylosed and 21 non-ankylosed regions, and the CBCT grey values of all voxels along the line of interest were plotted against their corresponding X-coordinates through a line graph to generate a profile. The image contrast was increased by 30% and 60% and the profile assessment was repeated. The internal area of the resulting parabolas was obtained from all images and compared between ankylosed and non-ankylosed regions under different contrast enhancement conditions, voxel sizes, and mA levels using multi-way analysis of variance with the Tukey post hoc test(α=0.05). Results: The internal area of the parabolas of all non-ankylosed regions was significantly higher than that of the ankylosed regions(P<0.05). Contrast enhancement led to a significantly greater internal area of the parabolas of non-ankylosed regions (P<0.05). Overall, voxel size and mA did not significantly influence the internal area of the parabolas(P>0.05). Conclusion: The proposed novel method revealed a relevant degree of applicability in the detection of simulated tooth ankylosis; increased image contrast led to greater detectability.
The present study evaluated the effects of guided tissue regeneration using biodegradable membrane, with and without calcium-phosphate thin film coated deproteinated bone powder in beagle dogs. Contralateral fenestration defects(6 × 4 mm) were created 4 mm apical to the buccal alveolar crest on maxillary canine teeth in 5 beagle dogs. Ca-P thin film coated deproteinated bone powder was implanted into one randomly selected fenestration defect(experimental group). Biodegradable membranes were used to provide bilateral GTR. Tissue blocks including defects with overlying membranes and soft tissues were harvested following a four- & eight-week healing interval and prepared for histologic analysis. The results of this study were as follows. 1.......The regeneration of new bone, new periodontal ligament, and new cementum was occurred in experimental group more than control group. 2.......The collapse of biodegradable membranes into defects were showed in control group and the space for regeneration was diminished. In experimental group, the space was maintained without collapse by graft materials. 3........In experimental group, the graft materials were resorbed at 4 weeks after surgery and regeneration of bone surrounding graft materials was occurred at 8 weeks after surgery. 4.......Biodegradable membranes were not resorbed at 4 weeks and partial resorption was occurred at 8 weeks but the framework and the shape of membranes were maintained. No inflammation was showed at resorption. In conclusion, the results of the present study suggest that Ca-P thin film coated deproteinated bone powder has adjunctive effect to GTR in periodontal fenestration defects. Because it has osteoconductive property and prohibit collapse of membrane into defect, can promote regeneration of much new attachment apparatus.
Using barrier membrane, guided bone regeneration(GBR) and guided tissue regeneration(GTR) of periodontal tissue are now widely studied and good results were reported. In bone regeneration, not all cases gained good results and in some cases using GTR, bone were less regenerated than that of control. The purpose of this study is to search for the method to improve the success rate of GBR and GTR by examination of the cause of the failure. For these study, rats and beagle dogs were used. In rat study, 5mm diameter round hole was made on parietal bone of the rat and 10mm diameter of bioresorbable membrane was placed on the bone defects and sutured. In 1 ,2, 4 weeks later, the rats were sacrificed and Masson-Trichrome staining was done and inspected under light microscope for guided bone regeneration. In dog study, $3{\times}4mm^2$ Grade III furcation defect was made at the 3rd and 1th premolar on mandible of 6 beagle dogs. The defects were covered by bioresorbable membrane extending 2-3mm from the defect margin. The membrane was sutured and buccal flap was covered the defect perfectly. In 2, 4. 8 weeks later. the animals were sacrificed and undecalcified specimens were made and stained by multiple staining method. In rats. there was much amount of new bone formation at 2 weeks. and in 4 weeks specimen, bony defect was perfectly dosed and plenty amount of new bone marrow was developed. In some cases, there were failures of guided bone regeneration. In beagle dogs, guided tissue regeneration was incomplete when the defect was collapsed by the membrane itself and when the rate of resorption was so rapid than expected. The cause of the failure in GBR and GTR procedure is that 1) the membrane was not tightly seal the bony defects. If the sealing was not perfect, fibrous connective tissue infiltrate into the defect and inhibit the new bone formation and regeneration. 2) the membrane was too tightly attached to the tissue and then there was no space to be regenerated. In conclusion, the requirements of the membrane for periodontal tissue and bone regeneration are the biocompatibility, degree of sealingness, malleability. space making and manipulation. In this animal study. space making for new bone and periodontal ligament, and sealing the space might be the most important point for successful accomplishment of GBR and GTR.
Purpose: The aim of this study was to evaluate the stemness of cells from canine dental tissues and bone marrow. Methods: Canine periodontal ligament stem cells (PDLSC), alveolar bone stem cells (ABSC) and bone marrow stem cells(BMSC) were isolated and cultured. Cell differentiations (osteogenic, adipogenic and chondrogenic) and surface antigens (CD146, STRO-1, CD44, CD90, CD45, CD34) were evaluated in vitro. The cells were transplanted into the subcutaneous space of nude mice to assess capacity for ectopic bone formation at 8 weeks after implantation. Results: PDLSC, ABSC and BMSC differentiated into osteoblasts, adipocytes and chondrocytes under defined condition. The cells expressed the mesenchymal stem cell markers differently. When transplanted into athymic nude mice, these three kinds of cells with hydroxyapatite /${\beta}$- tricalcium phosphate (HA/TCP) carrier showed ectopic bone formation. Conclusions: This study demonstrated that canine dental stem cells have stemness like bone marrow stem cells. Transplantation of these cells might be used as a therapeutic approach for dental stem cell-mediated periodontal tissue regeneration.
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