• 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.

• Journal of Periodontal and Implant Science
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• 제44권6호
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• pp.300-306
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• 2014

Purpose: A laterally positioned flap (LPF) combined with a subepithelial connective tissue graft (SCTG) is one of the conventional approaches for resolving gingival recession defects, with the advantages of flap flexibility and extended coverage of the tissue graft. However, thus far, evidence is lacking for the use of this technique for the treatment of advanced gingival recession defects. This report discusses three Miller class III cases with interproximal bone loss and wide and deep defects treated with a combination procedure of a modified laterally positioned flap (mLPF) and SCTG. Methods: mLPF combined with SCTG was performed for each case. The defect size and the degree of hypersensitivity at baseline and the final appointment in each case were documented. Results: The three cases had a mean initial defect of $7.7{\pm}1.5mm$ and a mean residual defect of $1.7{\pm}1mm$ at the 6-, 3-, and 36-month follow-up, respectively, after the root coverage surgery. The symptom of hypersensitivity was improved, and the patients were satisfied with the clinical outcomes. Conclusions: The results demonstrated that the combination of mLPF with SCTG is promising for treating these advanced cases with respect to obtaining the expected root coverage with the gingival tissue.

• 대한치과의사협회지
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• 제56권4호
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• pp.208-216
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• 2018

Patients with malocclusion may present with preexisting mucogingival problems susceptible to attachment loss during or after orthodontic treatment. Lower anterior teeth especially show a high prevalence of gingival recession following orthodontic treatment. This case report demonstrates hard tissue augmentation of labially thin or deficient alveolar bone (dehiscences and fenestrations) to prevent attachment loss during or after orthodontic treatment. Three patients presented clinically prominent root surfaces and dehiscences and fenestrations on cone-beam computed tomography (CBCT) in lower anterior teeth. Labial hard tissue augmentation of lower anterior teeth was performed with deproteinized bovine bone mineral and collagen membrane. Six months later, hard tissue augmentation reduced root prominence and created a greater volume of hard tissue on lower anterior area in clinical and radiographic findings. Hard tissue augmentation using xenograft could prevent attachment loss associated with orthodontic treatment and maintain stability of healthy periodontium.

• 대한구강악안면임플란트학회지
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• 제22권4호
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• pp.210-218
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• 2018

Purpose: The purpose of this study was to investigate the validity and reproducibility of a method based on cone-beam computed tomography (CBCT) technology for the visualization and measurement of gingival soft-tissue dimensions. Material and Methods: A total of 66 selected points in soft-tissue of the ex vivo head of an adult pig were investigated in this study. For the measurement of radiographic thickness (RT), wet soft-tissue surfaces were lightly covered with barium sulfate powder using a powder spray. CBCT was taken and DICOM files were assessed for soft-tissue thickness measurement at reference points. A periodontal probe and a rubber stop were used for the measurement of trans-gingival probing thickness (TPT). After flap elevation, actual thickness of soft-tissue (actual thickness, AT) was measured. Correlation analysis and intraclass correlation coefficients analysis (ICC) were performed for AT, TPT, and RT. Results: All variables were distributed normally. Strong significant correlations of AT with RT and TPT values were found. The two ICC values between TPT vs. AT and RT vs. AT differed significantly. Conclusion: Our results indicated that correlation of RT was stronger than that of TPT with AT. We concluded that soft tissue measurement with CBCT could be a reliable method, compared to the trans-gingival probing measurement method.

• Journal of Periodontal and Implant Science
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• 제44권2호
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• pp.94-99
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• 2014

Purpose: Various surgical techniques target achieving adequate keratinized tissue around dental implants; however, these techniques are usually performed before implant placement or upon the exposure of submerged implants. The aim of this case report is to describe a simultaneous placement of an interpositional free gingival graft (iFGG) with that of nonsubmerged implants in a patient lacking keratinized tissue and to assess the longterm outcome of this grafted gingiva. Methods: A wedge-shaped free gingnival graft (FGG), including an epithelium-connective tissue (E-C) portion and a connective-tissue-only (CT) portion, was harvested from the palate. The CT portion was inserted under the buccal flap, and the E-C portion was secured tightly around the implants and to the lingual flap. Results: At the 8-year follow-up, the gingival graft remained firmly attached and was well maintained, with no conspicuous shrinkage or reported discomfort during oral hygiene procedures. The use of an iFGG at a nonsubmerged implant placement minimizes the required number of surgical steps and patient discomfort while providing adequate buccal keratinized tissue. Conclusions: Therefore, the technique could be considered an alternative method in increasing the keratinized tissue for cases that have a minimal amount of keratinized tissue.

• Journal of Periodontal and Implant Science
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• 제23권1호
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• pp.37-47
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• 1993

The native connective tissue attachment of the periodontium is known to be a complex consisting of gingival fibroblasts, periodontal ligament cells, gingival epithelial cells, cementum, alveolar bone and extensive extracellular matrix (collagen, glycoprotein and proteoglycans). The purpose of this study was to evaluate the effects of natural extracts on DNA, collagen and protein synthesis and inhibition of cytokine production in the gingival and periodontal ligament fibroblasts and gingival epithelial cells. Healthy gingival tissue was obtained from orthodontic treatment patients, and gingival epithelial cells, gingival fibroblasts and periodontal ligament cells were isolated and cultured from the samples. After treated with Ginseng protein, Pluronic F-68, Scutellariae Radix, centella asiatica, PDGF, IGF, DNA synthesis, total protein and collagen synthesis, and cytokine production of gingival epithelial cell, gingival fibroblast and periodontal ligamentcells were measured. MTT method for DNA synthesis, Peterkofsky and Dingerman method for total protein and collagen synthesis, and IL-1 ELISA kit for cytokine production were used. The proliferation of epithelial cells was enhanced in Centella asiatica, Ginseng protein, Pluronic F-68 and Scutellariae Radix. The activities of PDL cells were increased in PDGF, IGF, and Pluronic F-68. Higher collagen synthesis was observed in Scutellariae Radix and total protein synthesis was increased in Scutellariae Radix and PDGF. The inhibitory effects on IL-1, IL-6, $TNF-{\alpha}$ were observed in all exrracts.

• Journal of Periodontal and Implant Science
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• 제50권3호
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• pp.146-158
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• 2020

Purpose: The aim of this study was to investigate and identify the main causes of periodontal tissue change associated with labial gingival recession by examining the anterior region of patients who underwent orthodontic treatment. Methods: In total, 45 patients who had undergone orthodontic treatment from January 2010 to December 2015 were included. Before and after the orthodontic treatment, sectioned images from 3-dimensional digital model scanning and cone-beam computed tomography images in the same region were superimposed to measure periodontal parameters. The initial labial gingival thickness (IGT) and the initial labial alveolar bone thickness (IBT) were measured at 4 mm below the cementoenamel junction (CEJ), and the change of the labial gingival margin was defined as the change of the distance from the CEJ to the gingival margin. Additionally, the jaw, tooth position, tooth inclination, tooth rotation, and history of orthognathic surgery were investigated to determine the various factors that could have affected anterior periodontal tissue changes. Results: The mean IGT and IBT were 0.77±0.29 mm and 0.77±0.32 mm, respectively. The mean gingival recession was 0.14±0.57 mm. Tooth inclination had a significant association with gingival recession, and as tooth inclination increased labially, gingival recession increased by approximately 0.2 mm per 1°. Conclusions: In conclusion, the IGT, IBT, tooth position, tooth rotation, and history of orthognathic surgery did not affect labial gingival recession. However, tooth inclination showed a significant association with labial gingival recession of the anterior teeth after orthodontic treatment.

• Journal of Periodontal and Implant Science
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• 제51권2호
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• pp.88-99
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• 2021

Purpose: Direct intraoral scanning and superimposing methods have recently been applied to measure the dimensions of periodontal tissues. The aim of this study was to analyze various correlations between labial gingival thickness and underlying alveolar bone thickness, as well as clinical parameters among 3 tooth types (central incisors, lateral incisors, and canines) using a digital method. Methods: In 20 periodontally healthy subjects, cone-beam computed tomography images and intraoral scanned files were obtained. Measurements of labial alveolar bone and gingival thickness at the central incisors, lateral incisors, and canines were performed at points 0-5 mm from the alveolar crest on the superimposed images. Clinical parameters including the crown width/crown length ratio, keratinized gingival width, gingival scallop, and transparency of the periodontal probe through the gingival sulcus were examined. Results: Gingival thickness at the alveolar crest level was positively correlated with the thickness of the alveolar bone plate (P<0.05). The central incisors revealed a strong correlation between labial alveolar bone thickness at 1 and 2 mm, respectively, inferior to the alveolar crest and the thickness of the gingiva at the alveolar crest line (G0), whereas G0 and labial bone thickness at every level were positively correlated in the lateral incisors and canines. No significant correlations were found between clinical parameters and hard or soft tissue thickness. Conclusions: Gingival thickness at the alveolar crest level revealed a positive correlation with labial alveolar bone thickness, although this correlation at identical depth levels was not significant. Gingival thickness, at or under the alveolar crest level, was not associated with the clinical parameters of the gingival features, such as the crown form, gingival scallop, or keratinized gingival width.

• Journal of Periodontal and Implant Science
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• 제23권3호
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• pp.622-634
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• 1993

Gingiva is remarkly sensitive to certain drugs. Especially, long term use of phentoin, dihydropyrydine (including nifedipine), cyclosporin and other drugs can be lead to pathologic changes in gingival tissue, especially in terms of proliferation of epithelium and connective tissue. Recent study in terms of proliferation of epithelium and connective tissue. Recent study is focused on the inhibition of drug-induced gingival hyperplasia by using medicaments. The purpose of this study was to investigate on the pharmacological effects of nifedipine, retinoic acid and glycyrrhetini acid to the activity in human gingival fibroblast. Human gingival fibroblasts were cultured from the healthy gingiva of orthodontic patients. Gingival fibroblasts were trypsinized and cultured in growth medium added $5{\mu}g/ml$ of nifedipine, $10^{+7}M$ of retinoic acid and glycyrrhetinic acid. The passage number of cultured fibroblasts were between fifth and eighth. The cell morphology was examined by inverted microscope and the cell acitivity was measured by the MTT assay. Nifedipine at the concentration of $5{\mu}g/ml$ was revealed significantly effective to increase the cell activity and lipopolysaccharide was cofactor to increase cell activity in the presence of nifedipine. However, retinoic acid was significantly effective on the globular change of cell morphology and loss of cell process regardless of the presence of nifedipine and LPS. Cell activity was significantly decreased by the glycyrrhetinic acid at the concentration of $10^-M$ regardless of the presence of nifedipine and LPS. These results suggested that the increased cell activity by nifedipine might be modulated by retinoic acid and glycyrrhetinic acid. Further study is needed to clarify on their toxicological effects during cellular modulation and mRNA expression change.

• Journal of Periodontal and Implant Science
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• 제30권1호
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• pp.133-146
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• 2000

Histological studies indicate a tetracycline HCl similar to citric acid to induce connetive tissue repair in animals. When tetracycline HCl was used as a root conditioning agent in humans, there was a trend toward more connective tissue attachment than in root planing alone. The purpose of this study was to evaluate clinical effect of tetracycline HCl in the treatment of gingival recession. 44 teeth in 12 patients with bilaterally gingival recession & Miller classification I, II gingival recession were selected and 22 teeth were treated with 125mg/ml tetracycline HCl , the others was not treated with tetracycline HCl. Gingival recession, pocket depth, clinical attachment level, width of keratinized gingiva were observed at baseline, postoperative 4, 12, 20weeks. Both groups were statistically analyzed by Wilcoxon signed Ranks Test & Wilcoxon's rank sum test(Mann-whitney test) using SPSS program.(5% significance level) The results were as follows: 1........The change of gingival recession, clinical attachment level, keratinized gingiva in both groups were increased significantly at 4, 12, 20 weeks. 2.......The pocket depth exhibited no marked changes throughout the entire investigation in both groups. 3........The change of gingival recession in tetracycline group was increased significantly than control group at 4, 12, 20 weeks and the percentage of root coverage was 93% in tetracycline group and 83% in control group. 4........The change of clinical attachment level, pocket depth, keratinized tissue from baseline to 4, 12, 20 weeks was not differ significanltly in both group.