• Journal of Periodontal and Implant Science
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• v.47 no.5
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• pp.264-272
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• 2017

Purpose: This study evaluated trends in tooth extraction due to acute and chronic periodontal disease (PD) using data from the National Health Insurance Service-National Sample Cohort for 2002-2013. Methods: A random sample of 1,025,340 individuals was selected as a representative sample of the population, and a database (DB) of diagnostic and prescription codes was followed up for 12 years. We used multivariate logistic regression analysis to assess the incidence of total extraction (TE), extraction due to periodontal disease (EPD), and immediate extraction due to periodontal disease (IEPD) according to sociodemographic factors (sex, age, household income, health status, and area of residence). Results: The incidence of tooth extraction was found to be increasing, and at a higher rate for TE in PD patients. In 2002, 50.6% of cases of TE were caused by PD, and this increased to 70.8% in 2013, while the number of cases of IEPD increased from 42.8% to 54.9% over the same period. The incidence rates of extraction due to acute and chronic PD increased monotonically. We found that the incidence rates of TE, EPD, and IEPD were all 2-fold higher among patients with high income levels and those who were not beneficiaries of health insurance. Conclusions: The rates of TE, EPD, and IEPD have been steadily increasing despite dental healthcare policies to expand public health insurance coverage, increasing the accessibility of dental clinics. Moreover, the effects of these policies were found to vary with both income and education levels. Consistent patient follow-up is required to observe changes in trends regarding tooth extraction according to changes in dental healthcare policies, and meticulous studies of such changes will ensure optimal policy reviews and revisions.

• Journal of Dental Rehabilitation and Applied Science
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• v.20 no.2
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• pp.121-134
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• 2004

This article describes a clinical protocol for the conventional rehabilitation of patient diagnosed with partial anodontia. A combined dental therapy approach was used and included endodontic therapy and root capping on the maxillary central incisors, fabrication of a maxillary overdenture, and fabrication of mandibular konus overdenture supported by 3 konus abutments. Within this protocol, tooth-supported overdenture prostheses are used for 2 purposes: first, to obtain the most rigid retention and function at an established maxillary-mandibular relationship; and second, to continuously maintain function and esthetic appearance applying immediate dentures after teeth extraction. The idea behind this protocol and its associated clinical procedures is presented along with a discussion compared with implant therapy. In the case introduced, and after 7 years of observation, the therapy can be seen as a success. We increased the occlusal vertical height in this case, but it would be more appropriate to see this as recovering the occlusal vertical height that was lost. The process of increasing the occlusal vertical height, that is restoration of the face, modification of the extrinsic occlusion of the incisors, and retraction of the mandible is very difficult and important. Ultimately, class III malocclusion is fixed, adequate occlusal vertical height is gained, and the retracted posterior anodontial portion is restored by prosthodontic dentures based on the rigid support theory. The result of the therapy done on the later-achieved malocclusion with partial anodontia on the posterior portion must consider the following in order to maintain the safety of the esthetics of the tooth and face for a period of time: 1) occlusal restoration with an ideal occlusal vertical height, 2) allowance of the final occlusion induced by the functional relationship of the upper and lower jaw, 3)final occlusion functionally induced by the lip competence limit.

• Journal of Periodontal and Implant Science
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• v.41 no.1
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• pp.10-16
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• 2011

Purpose: Avulsed tooth can be completely recovered, if sound periodontal ligament (PDL) of tooth is maintained. Although a lot of storage solutions have been explored for the better storage of avulsed tooth, there is a shortcoming that the preservation time is much short. On the other hand, there has been studies that (-)-epigallocatechin-3-gallate (EGCG), the most abundant polyphenol in green tea, which is related to the anti inflammatory, antioxygenic, and antibacterial effects, allows the successful preservations of tissues and cells. This study evaluated the effect of EGCG on avulsed-teeth preservation of Beagle dogs for a period of time. Methods: The atraumatically extracted teeth of Beagle dogs were washed and preserved with 0/10/$100\;{\mu}M$ of EGCG at the time of immediate, period 1 (4 days in EGCG-contained media and additional 1 day in EGCG-free media), period 2 (8 days in EGCG-contained media and additional 2 days in EGCG-free media) and period 3 (12 days in EGCG-contained media and additional 2 days in EGCG-free media). Then, the cell viabilities of preserved teeth was calculated by dividing optical density (OD) of 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay with OD of eosin assay to eliminate the measurement errors caused by the different tissue volumes. Results: From the results, the immediately analyzed group presented the highest cell viability, and the rate of living cells on teeth surface decreased dependent on the preservation period. However, the $100\;{\mu}M$ of EGCG-treated group showed statistically significant positive cell activity than EGCG-free groups throughout preservation periods. Conclusions: Our findings showed that $100\;{\mu}M$ EGCG could maintain PDL cell viability of extracted tooth. These results suggest that although EGCG could not be a perfect additive for tooth preservation, it is able to postpone the period of tooth storage. However, further in-depth studies are required for more plausible use of EGCG.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.92-98
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• 2010

Purpose: To analyze results of treating acromioclavicular injuries using clavicle hook plates. Materials and Methods: Between February 2008 and April 2010, 18 patients with acromioclavicular joint injury treated by clavicle hook plates were reviewed. Using the Rockwood classification, 7 dislocations were classified as type III injuries and 11 as type V injuries. Implant removal was done at least 3 months from initial fixation. Simple X-rays were taken for comparing the state of reduction, and clinical outcomes were evaluated by the Korean Shoulder Scoring System and the American Shoulder Elbow Society score. The average follow-up period was 9 months. Results: On weight bearing X-rays, the average coracoclavicular distance showed a 114% increase compared to the contralateral side at the time of injury. It decreased to 23% by the last follow-up. The mean Korean Shoulder Scoring System and the American Shoulder Elbow Society score were 80 and 74 at the last follow-up. Conclusion: The immediate stability these plates provide allows rapid rehabilitation. Clavicle hook plate fixation for acromioclavicular joint dislocation is considered an effective method for ensuring satisfactory results both radiologically and clinically.

• Journal of Periodontal and Implant Science
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• v.44 no.1
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• pp.13-19
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• 2014

Purpose: The purpose of this study was to retrospectively evaluate the survival of periodontally hopeless teeth that were intentionally extracted and replanted after a delay and to compare the radiographic characteristics of the survival group with those of the failure group. Methods: The clinical and radiographic data from patients who underwent delayed intentional replantation between March 2000 and July 2010 were reviewed. Twenty-seven periodontally hopeless teeth were extracted and preserved in medium supplemented with antibiotics for 10-14 days. The teeth were then repositioned in the partially healed extraction socket and followed for 3 to 21 months. The radiographic parameters were analyzed using a paired t test and the cumulative survival rate was analyzed using Kaplan-Meier analysis. Results: Seven replanted teeth failed and the overall cumulative survival rate was 66.4%. In the survival group, the amount of bone loss was reduced from 68.45% to 34.66% three months after replantation. There was radiologic and clinical evidence of ankylosis with 5 teeth. However, no root resorption was found throughout the follow-up period. In the failure group, bone formation occurred from the bottom of the socket. However, a remarkable radiolucent line along the root of a replanted tooth existed. The line lengthened and thickened as time passed. Finally, in each case of failure, the tooth was extracted due to signs of inflammation and increased mobility. Conclusions: Delayed intentional replantation has many advantages compared to immediate intentional replantation and could serve as an alternative treatment for periodontally involved hopeless teeth. However, techniques for maintaining the vitality of periodontal structures on the tooth surface should be developed for improved and predictable results.

• Journal of Periodontal and Implant Science
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• v.47 no.4
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• pp.211-218
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• 2017

Purpose: The purpose of the present study was to perform a pattern analysis in patients with temporomandibular disorder (TMD) resulting from unilateral mastication due to chronic periodontitis. Methods: Thirty participants with signs or symptoms of TMD who engaged in unilateral mastication due to periodontitis-related discomfort (test group) were selected. Another 30 subjects exhibiting signs or symptoms of TMD resulting from unilateral mastication not due to chronic periodontitis (control group) were also recruited. An interview-based questionnaire was administered, and an examination of the temporomandibular joint (TMJ) with determination of periodontal status was performed. Results: The duration of unilateral mastication was significantly longer in the control group than in the test group. There was a significant negative correlation between the duration of unilateral mastication and the Community Periodontal Index score. Using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I algorithms, all the subjects were assigned to 3 main groups. The test group exhibited significantly a higher diagnostic distribution of group III (arthralgia, osteoarthritis, or osteoarthrosis), and in both the test and control groups, the number of diagnoses was larger for the non-chewing side. The control group showed a significantly higher diagnostic distribution of group I (myofacial pain), and in both the test and control groups, the number of diagnoses was larger for the chewing side. Conclusions: The results of the present study indicate that unilateral mastication due to chronic periodontitis could induce not only pain but also structural TMJ changes if adequate treatment is not administered and supported within a short time from the onset of the condition. Therefore, immediate treatment of chronic periodontitis is recommended to prevent not only the primary progress of periodontal disease, but also secondary TMJ-related problems. Furthermore, subjects who have suffered chronic long-term periodontitis without treatment should be urged to undergo a TMJ examination.

• Archives of Plastic Surgery
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• v.44 no.5
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• pp.407-412
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• 2017

Background Among the various signs and symptoms of orbital fractures, certain clinical findings warrant immediate surgical exploration, including gaze restriction, computed tomographic (CT) evidence of entrapment, and prolonged oculocardiac reflex. Despite proper surgical reconstruction, prolonged complications such as diplopia and gaze restriction can occur. This article evaluated the prognostic factors associated with prolonged complications of orbital fractures with muscle incarceration. Methods The medical records of 37 patients (37 orbits) with an orbital fracture with muscle incarceration from January 2001 to January 2015 were reviewed. The presence of Incarcerated muscle was confirmed via CT, as well as by intraoperative findings. Various factors potentially contributing to complications lasting for over 1 year after the injury were categorized and analyzed, including age, cause of injury, injury-to-operation time, operative time, fracture type, nausea, vomiting and other concomitant symptoms and injuries. Results All patients who presented with extraocular muscle limitations, positive CT findings, and/or a positive forced duction test underwent surgery. Of the 37 patients, 9 (24%) exhibited lasting complications, such as diplopia and gaze restriction. The mean follow-up period was 18.4 months (range, 1-108 months), while that of patients who experienced prolonged complications was 30.1 months (range, 13-36 months). Two factors were significantly associated with prolonged complications: injury-to-operation time and nausea/vomiting. Loss of vision, worsening of motility, and implant complication did not occur. Conclusions Patients who present with gaze limitations, with or without other signs of a blow-out fracture, require a thorough evaluation and emergent surgery. A better prognosis is expected with a shorter injury-to-operation time and lack of nausea and vomiting at the initial presentation.

• Journal of Periodontal and Implant Science
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• v.30 no.2
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• pp.257-277
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• 2000

New techniques for regenerating the destructed periodontal tissue have been studied for many years. Current acceptable methods of promoting periodontal regeneration are basis of removal of diseased soft tissue, root treatment, guided tissue regeneration, graft materials, and biological mediators. Platelet Rich Plasma has been reported as a biological mediator which regulates activities of wound healing progress including cell proliferation, migration, and metabolism. The purpose of this study is to evaluate the effects of using the Platelet Rich Plasma as a regeneration promoting agent for furcation involvement defect. Five adult beagle dogs were used in this experiment. The dogs were anesthetized with Ketamin HCl(0.1 ml/kg, IV)and Xylazine hydrochloride($Rompun^{(R)}$, Bayer, 0.1 ml/kg, IM) and conventional periodontal prophylaxis were performed with ultrasonic scaler and hand instruments. With intrasulcular and crestal incision, mucoperiosteal flap was elevated. Following decortication with 1/2 high speed round bur, degree II furcation defect was made on mandibular third(P3), forth(P4) and fifth(P5) premolar, and stopping was inserted. After 4 weeks, stopping was removed, and bone graft was performed. Ca-P was grafted in P3(experimental group I), Combination of Ca-P and plasma rich platelet were grafted in P4(experimental group II), and P5 was remained at control group.Systemic antibiotics(gentamicin sulfate)and anlgesics(phenyl butazone) were administrated intramuscular for 2 weeks after surgery. Irrigation with 0.1% Chlorhexidine Gluconate around operate sites was performed during the whole experimental period except one day immediate after surgery. Soft diets were fed through the whole experiment period. After 4, 8 weeks, the animals were sacrificed by perfusion technique. Tissue block was excised including the tooth and prepared for light microscope with Gomori's trichrome staining. At 4 weeks after surgery, there were rapid osteogenesis phenomenon on the defected area of the Platelet Rich Plasma plus Ca-P BBP group and early trabeculation pattern was made with new osteoid tissue produced by activated osteoblast. Bone formation was almost completed to the fornix of furcation by 8 weeks after surgery. In conclusion, Platelet Rich Plasma can promote rapid osteogenesis during healing of periodontalregeneration.

• Journal of Periodontal and Implant Science
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• v.29 no.4
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• pp.893-914
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• 1999

Tooth mobility may be the decisive factor that determines whether dental treatment of any kind is undertaken. Although tooth mobility in isolation says little in itself, the finding of increased tooth mobility is of both diagnostic and prognostic importance. Only the detection of an increase or decrease in mobility makes an evaluation possible. Thus prior to treatment, we must understand the pathologic process causing the observed the tooth mobility and decide whether the pattern and degree of observed tooth mobility is reversible or irreversible. And then it must be decided whether retention and treatment or extraction and replacement. The purpose of this study was to compare tooth mobility at different time period during root planing and flap operation and to relate changes in mobility to each treatment method. Twenty-one patients (287 teeth) with chronic adult periodontitis were treated with root planing(control group) and flap operation(experimental group), and each group was divided 3 subgroups based upon initial probing pocket depth (1-3mm, 4-6mm, 7mm and more). Tooth mobility was measured with $Periotest^{(R)}$ at the day of operation, 4 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 8 weeks, 12 weeks after each treatment. Tooth mobility, attachment loss, radiographic bone loss, and bleeding on probing were measured at the day of operation, 4 weeks, 8 weeks and 12 weeks after treatment. 1. In group initial probing depth was 1-3mm, tooth mobility had no significant difference after root planing and flap operation. 2 . In group initial probing depth was 4-6mm, 7mm and more, tooth mobility had decreased in 12 weeks after root planing(p<0.01). And the mobility had increased after flap operation(p<0.01) and was at peak in 1 week, and decreased at initial level in 4 weeks, below the initial level in 12 weeks(p<0.01). 3. In 1 week, significant difference in tooth mobility between control and experimental group was found(p<0.01) but, in 12 weeks no difference between two groups was found. 4. Change of immediate tooth mobility after treatment was more larger in deep pocket than in shallow one. In group with the same probing pocket depth, the change of tooth mobility in molar group was greater than that of premolar group. 5. Tooth mobility before treatment was more strongly correlated with radiographic bone loss (r=0.5325) than probing depth, attachment loss and bleeding on probing, in 12 weeks after treatment, was more strongly correlated with attachment loss($r^2$=0.4761) than probing depth and bleeding on probing. Evaluation of the treatment effect and the prognosis after root planing and flap operation were meaningful on tooth initial probing depth 4mm and more. After flap operation, evaluation of the prognosis should be performed at least in 4 weeks and in 12 weeks after treatment, no difference in tooth mobility between two groups was observed. Radiographic bone loss and attachment loss were good clinical indicators to evaluate tooth mobility.

• Journal of Periodontal and Implant Science
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• v.28 no.2
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• pp.309-320
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• 1998

The periodontal health has been evaluated clinically by various epidemiological indices, and in researches by measurement of gingival crevicular fluid. Laser Doppler flowmetry is a reliable and objective method that allows immediate measurement of erythrocyte flux in approximately one cubic mm of the capillary bed without disturbing the tissues. The purpose of the present study was to determine whether human gingival blood flow was different according to measuring area, measuring time, and sex or not. Forty volunteers with good general and periodontal health, aged early twenties and unmarried, were selected. Laser Doppler flowmetry($floLAB^{(R)}$, Moor Instruments Ltd., England) was applied to measure the gingival blood flow of marginal gingiva, interdental papilla, attached gingiva and alveolar mucosa. The blood flow of interdental papilla was measured at 9-10 AM, 1-2 PM, and 5-6 PM. The difference of blood flow according to measuring area and measuring time was statistically analyzed by one way AOVA and Dunkan test, and the difference of blood flow between men and women was statistically analyzed by t-test. (1) Mean blood flow was significantly higher in alveolar mucosa than in the gingiva(p<0.05), and there was no significant difference in blood flow between marginal gingiva and interdental papilla(p>0.1). (2) Mean blood flow was significantly higher at 5-6 PM than at 9-10 AM and 1-2 PM(p<0.05). But there was no significant difference in gingival blood flow between 9-10 AM and 1-2 PM(p>0.1). (3) There was no significant difference in gingival blood flow between men and women(p>0.1). The above results suggest that the measurment of gingival blood flow using laser Doppler flowmetry may be clinically applicable to early determination of gingival inflammation and evaluation of healing status, but further studies are necessary to standardize and simplify the measuring procedure.