• 대한심미치과학회지
• /
• 제32권1호
• /
• pp.16-22
• /
• 2023

상악 전치부 임플란트 수복의 성공에 있어서 심미적인 요소는 매우 중요한 부분입니다. 하지만 심미적인 결과를 얻는 것은 쉬운 일이 아니며 특히 치주염으로 인해 치조골 소실이 심하게 발생한 경우라면 더욱 그러합니다. 상악 전치부의 경우, 발치 직후부터 시작되는 치주 조직의 위축이 심미적 수복을 방해하므로 이를 최소화하기 위해 발치 즉시 임플란트를 시행하기도 합니다. 하지만 치조골 소실이 심한 경우 발치 즉시 식립은 심미적 실패를 가져올 가능성이 있고, 이런 결과는 돌이킬 수 없는 문제를 야기합니다. 그래서 치조제 보존술(Alveolar ridge preservation)을 시행하고 이후에 임플란트를 식립하는 방법으로 접근하기도 합니다. 2019년 JCP에 발치 후 임플란트 식립 시기와 발치와 처치에 대한 유럽치주학회의 consensus가 수록되어 있는데 여기서도 '심미적으로 중요한 부위에서 순측 치조골의 소실이 심하게 발생한 경우 치조제 보존술을 고려해야 한다고 언급하고 있습니다. 치조제 보존술을 하게 되면 primary closure가 어렵기 때문에 open membrane technique으로 이차치유를 유도하거나 FGG, CT graft를 시행하게 됩니다. 하지만 이차 치유 과정은 골재생에 부정적인 영향을 줄 수 있고, 연조직 이식은 환자와 술자에게 부담이 될 수 있습니다. 반면 치조골 결손이 심한 발치와에 있는 육아 조직(Granulation tissue)을 이용하게 되면 연조직 이식 없이도 primary closure를 얻을 수 있습니다. 또한 육아 조직에 조직 재생에 도움이 될 수 있는 줄기세포가 함유되어 있다는 연구들이 있습니다. 이를 근거로 치조골 및 연조직 결손이 심한 상악 전치부 치아를 육아 조직을 이용한 치조제 보존술을 통해 임플란트 수복을 시행하였습니다. 결손이 심한 발치와임에도 불구하고 비교적 심미적인 임플란트 수복 결과를 얻을 수 있었습니다.

• 대한치과보철학회지
• /
• 제51권3호
• /
• pp.175-182
• /
• 2013

연구 목적: 본 연구에서는 알렌드로네이트 투여기간의 차이가 백서의 상악 제 1대구치 발치와의 초기 창상치유에 미치는 영향을 알아보고자 하였다. 연구 재료 및 방법: 4주령 Sprague Dawley Rat (Body weight 130-140 g) 15마리를 이용하여 알렌드로네이트(Merial Inc., Parramatta, Australia) 투여군(실험군)과 투여하지 않은 대조군으로 나누고 실험군은 다시 투여기간에 따라 1주 투여군부터 2주 투여군, 4주 투여군, 6주 투여군까지 총 4개의 실험군으로 나눴다. 실험군에 정해진 시기(발치 5 주전, 발치 3주전, 발치 1주전, 발치 시)부터 발치 1주 후까지 알렌드로네이트를 1 mg/kg의 농도로 주 3회 피하주사 한 후 6주 투여군과 대조군에서 한 개체씩을 이용하여 미세배열(microarray)분석을 실시하였고, 다른 시편들을 이용하여 조직학적 분석을 시행하였다. 발치와 내에서의 신생골의 형성 비율과 발치와 주위 골에서 활성을 잃은 뼈에 대해 분석하였고, 파골세포 표지자인 TRAP 염색을 하여 분석하였다. 통계적인 분석으로 크루스컬-왈리스 검정(Kruskal Wallis test)을 실시하였다(${\alpha}=.05$). 결과:발치 후 1주 시점에서의 발치와 내에서의 신생골의 생성 비율은 대조군보다 ($16.77%{\pm}1.36%$) 4주 투여군($14.99%{\pm}6.26%$)에서 더 낮게 나오는 경향은 있었지만 유의 하지는 않았다. 투여기간이 증가할수록 활성을 잃은 골수강(empty lacuna)의 수는 증가하였고, TRAP positive cell 수는 감소하는 경향이 있으나 유의하지는 않았다. 결론: 본 예비실험을 통해서 알렌드로네이트의 투여기간이 증가할수록 신생골의 생성 비율이 감소되고 활성을 잃은 뼈들이 많아지며 파골세포의 수는 줄어드는 경향이 있음을 알 수 있었으나 통계적으로 유의차는 없었다.

• Journal of Periodontal and Implant Science
• /
• 제31권4호
• /
• pp.669-687
• /
• 2001

On the basis of the evidence that electrical stimulation could promote healing and regeneration of bone, this study was performed to investigate the effects of electrical stimulation on rat extraction socket, and to evaluate the potential of clinical application of electrical stimulation. Forty rats were used and divided into control groups(l0)and the experimental groups(30) in this study. The maxillary 1st molar were extracted in both groups. In experimental group, electrical stimulation was given at the current intensity of lmA(Test-1), l0mA(Test-2), 25mA(Test-3) each day. At 1,3,5,7 days after the tooth extraction, rats in both groups were serially sacrificed. And the specimens were prepared with Hematoxylin-Eosin stain for the light microscopic evaluation. The results of this study were as follows; 1. At 1 day after the extraction, the periodontal ligament was found in the extraction socket wall. The formation of blood clot with dense infiltration of inflammatory cells in control group and there were less inflammatory cells in test group. 2. At 3 day after the extraction, the cells and collagen of the periodontal ligament were so actively proliferated and synthesized that invaded into the connective tissue of the extraction sockets in the control group. There were the formation of new bone in the basal & lateral portion of socket wall in test -2 and -3. 3. At 5 days after the extraction, there were no formation of new bone in control group. But the more electrical stimulation was applied, the more formation of new bone in test group. 4. At 7 days after the extraction, the extraction sockets were almost filled with trabecular bone in each group. Bone maturarity was remarkable in test-3. 5. The electrical stimulation at l0mA and 25mA was more effective in the bone formation at 5 and 7 days after the extraction. From the above results, electrical stimulation could promote the extraction socket wound healing, and be utilized in the clinical application of the residual ridge expansion.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제34권2호
• /
• pp.155-161
• /
• 2012

Platelet-rich fibrin (PRF) is a strong but flexible fibrin including a enrich platelet which contain growth factors and cytokines. PRF can be made very simply and requires no artificial additives unlike platelet-rich plasma. While PRF is remodeled and released in the tissue, this induces cell growth, vascularization, collagen synthesis, osteoblast differentiation and an anti-inflammatory reaction. Taking advantage of these functions, PRF can stimulate regeneration of bone and soft tissue in a diverse number of ways during the course of hemostasis, wound coverage, preservation, and reconstruction of alveolar bone. Moreover, the use of PRF to improve bone regeneration has become a recent technique in implantology. In this study, through a literature review of PRF's existing clinical applications, we classified a range of potential PRF oral and maxillofacial surgery applications including preservation of extraction sockets, guided bone graft, sinus lift, dressing and periodontal treatment. This trial gave us chance to confirm the usefulness of PRF. Recently, updated clinical studies results concerning skin and tendon wound healing have become available. These results suggest that the usage of RPF will gradually expand.

• Journal of Periodontal and Implant Science
• /
• 제24권1호
• /
• pp.64-86
• /
• 1994

The authors have transplanted periodontally involved roots which had been root planed into healthy and periodontally involved extraction sockets, and studied the root resorption patterns as well as its effect on new bone formation and wound healing. Alveolar bone around mandibular premolars of 6 adult dogs has been surgically removed, followed by ligation of orthodontic elastic wires for 8 weeks inducing chronic periodontal disease. After removing the crown portions, roots were extracted, and notches were made on the root surfaces discriminating healthy and periodontally involved areas using burs. Controls and experimental groups were divided as follows. Control I : Transplantation of periodontally involved root into healthy extraction sockets. Control II : Transplantation of periodontally involved root into diseased extraction sockets. Experimental group I : Transplantation of root planed roots into healthy extraction sockets. Experimental group II : Transplantation of root planed roots into diseased extraction sockets. Extraction sockets were sutured after transplantations, completely submerging the roots. Healing progress was histologically observed at 2nd, 8th, 12th, and 20th weeks, and the results were as follows ; 1. No inflammation or infection within the extraction sockets had been observed in all groups throughout the experimental period. 2. Reversal lines were observed at week 2 in all groups, clearly discriminating socket walls and new bone, and numerous blood vessels were observed in the new bone trabeculae. 3. Experimental groups showed markedly less root resorption compared to the controls at week 2, but as time progressed, severe resorptions were present in all groups. 4. Localized areas of new bone ankylosis were observed, and the rest of the areas showed collagen fiber insertion with new bone formation at its periphery. 5. No clear differences were found in healing and alveolar bone regeneration between healthy and diseased extraction sockets. 6. The amount of root resorption and ankylosis had increased up to week 8 and 12, showing ankylosis of new bone and the roots. However, no further increase in ankylosis was observed at week 20. 7. Most of the cementum on healthy roots was directly ankylosed to new bone at week, 2, and were gradually resorbed and replaced by new bone thereafter. These results appear to indicate that root planing may inhibit early root resorption of transplanted roots, but gradual replacement by alveolar bone and collagen fibers eventually occur. Condition of the roots or presence of disease in extraction sockets do not appear to make marked differences in alveolar bone regeneration process.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제36권6호
• /
• pp.473-480
• /
• 2010

Introduction: Tooth requiring extraction before radiotherapy in head and neck cancer patients should be performed as long as possible before the initiation of radiation therapy. Conventionally, a minimum 2-week waiting primary healing period is recommended. Although the above 2-week period is ideal, it is not uncommon for the radiotherapist and cancer patient to feel an urgent need to proceed with radiotherapy despite the need for dental care. Therefore, alternative approaches for early radiotherapy, including conservative endodontic treatment and a 1-week waiting primary healing period after dental extraction at the time of radiotherapy were considered and applied based on a literature review Materials and Methods: The clinical study involved 120 head and neck cancer patients who were treated at Wonju Christian Hospital, Wonju College of Medicine, Yonsei University, from January 1995 to December 2004. Results: In the clinical study, there were no specific complications, such as, post-extraction wound infections, radiation osteitis and osteoradionecrosis over the recent 10 years despite the early radiotherapy. Conclusion: Based on the clinical study, a minimum 1-week waiting primary healing period for oral care before radiotherapy is suitable for early radiotherapy in head and neck cancer patients.

• Imaging Science in Dentistry
• /
• 제45권3호
• /
• pp.199-203
• /
• 2015

A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제35권2호
• /
• pp.112-119
• /
• 2009

Extracellular matrix(ECM) is known to function as a reservoir of endogenous growth factors, can be an effective delivery system of growth factor that easily lost bioactivity in solution. Fibrillar collagens like type I collagen, are the major constituent of the ECM and structural protein of bone. Also, it can be a scaffold for osteoblast migration. The purpose of this study was to compare the effects of absorbable Atelo-collagen Sponge($Teruplug^{(R)}$) insertion in tooth extraction sites on periodontal healing of the mandibular second molar after the extraction of the impacted third molar. The study population comprised 31 cases who had been scheduled for surgical removal of impacted mandibular third molars. All patients were in good general health and were not using any medication that would influence wound healing after surgery. In 15 cases control group, none was inserted into the tooth extraction site. In 16 cases experimental groups, $Teruplug^{(R)}$ was inserted into the tooth extraction site. We evaluated tooth mobility, pocket depth, gingival margin level preoperatively and 1 week, 2 weeks, 4 weeks, and 3 months postoperatively. The change was compared with two groups using Mann-Whitney test. The results were as follows. 1. There was no significant change of tooth mobility on both groups. 2. There was tendency of decreasing of previous pocket depth causing tooth extraction on both groups. 3. On gingival margin level, there was various change according to initial swelling and loss of attachment on both groups. 4. There was tendency of decreasing of gingival margin level on both groups because of removal of inflammation and decreasing of previous pocket depth. 5. There was large change of pocket depth on buccal middle, distal, lingual distal area because of tooth extraction and bone reduction. Compared with the control group and experimental group, we observed significant difference during some periods. The results of this study suggest that absorbable atelo-collagen sponge($Teruplug^{(R)}$) is relatively favorable bone void filler with prevention of tissue collapse, food packing and enhance periodontal healing.

• 한국산학기술학회논문지
• /
• 제15권9호
• /
• pp.5628-5636
• /
• 2014

현재 많은 나라들은 자생식물을 활용한 산업소재를 개발하는 데 지대한 관심을 가지고 있다. 특히 화장품 산업은 친환경, 자연친화적인 소재를 찾는데 집중하고 있는 추세이다. 우수한 생리활성 물질을 포함한 식물을 식물세포배양기술을 이용하여 대량으로 배양하고 그 함유물을 고농도로 얻음으로 효과적인 소재로 개발하려고 노력하고 있다. 이에 본 연구는 항암, 항균, 항산화, 항염 등의 효능이 입증되어 세계적으로 주목받고 있는 개똥쑥을 선택하여 식물세포배양기술을 이용해 유도한 캘러스의 화장품 소재로서의 가능성을 확인하고자 하였다. 약 6개월 동안 식물세포배양기술로 개똥쑥 캘러스를 유도하였고, 유도된 캘러스를 얻어 열수 및 에탄올 추출하여 약 2개월간 다양한 효능을 시험하였다. HPLC 분석을 통하여 열수 및 에탄올 추출물의 유효성분에 차이를 보임을 확인하였다. 또한 효능평가에서도 차이를 보였다. 개똥쑥 캘러스 에탄올 추출물을 처리하였을 경우 항염관련 단백질인 COX-2의 발현을 50% 이상 감소시키고 wound healing assay를 통해 상처 치유능이 70%정도 증가함을 확인하였다. 이를 통해 개똥쑥 캘러스 추출물이 자연친화적, 친환경적인 소재로써 항염 및 상처치료 관련 제품에 기여할 것으로 예상된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제36권1호
• /
• pp.57-61
• /
• 2010

In the presence of acute pericoronitis of mandilbular third molar, antibiotic therapy and early incision and drainage are the method of choice, followed by definitive surgical extraction of the tooth as soon as it becomes subacute. If excision of the overlying tissues is decided on, it should be done adequately. All overlying tissues must be throughly excised, and the crown portion of the unerupted tooth should be completely exposed. After excision has been completed, the wound should be managed with a surgical dressing. This should be allowed to remain approximately 7 days. And then, surgical extraction of the impacted mandibular third molar can be done usually. In this operation, there are many complications, such as, postoperative bleeding, infection, trismus, dysphasia and paresthesia. The surgeon are discredited and medicolegal problem may be occurred in the presence of many distressed complications. Therefore, the relatively nonsurgical treatment is the method of choice. So, authors selected the conservative treatment methods of incision and drainage, primary endodontic drainage, operculectomy without surgical extraction of the mandibular third molars. The results were more favorable without the postoperative complication in Wonju old offender prison.