골 유도 재생술 후 감소된 임플란트 주위 부착 각화 점막 증대를 위한 유리 치은 이식술 증례

김득한,지숙,방은경,Kim, Deug-Han,Ji, Suk,Pang, Eun-Kyoung 대한치주과학회 2008 Journal of Periodontal & Implant Science Vol.38 No.4

Purpose: During guided bone regeneration procedures for the augmentation of deficient alveolar ridge, primary closure of flap is necessary. For primary flap closure, flap is repositioned coronally and the zone of attached keratinized mucosa may decreased. The need for attached keratinized mucosa around dental implants is still controversial, but sufficient peri-implant attached keratinized mucosa would be beneficial for functional and esthetic aspects. This case report presents three cases that demonstrated free gingival graft for increasing the zone of peri-implant attached keratinized mucosa which was decreased after guided bone regeneration. Materials and Methods: In first case, maxillary incisors were extracted and guided bone regeneration was performed simultaneously. Because the membrane was exposed at 3 weeks after operation, the membrane was removed and free gingival graft was performed for primary flap closure. Free gingival graft was performed again at implant placement for the increase of attached keratinized mucosa. In second case, guided bone regeneration was performed on lower right first molar area, and implant was placed with free gingival graft. In third case, lower right molar area showed insufficient attached keratinized mucosa after implant placement with guided bone regeneration. When abutments were connected, free gingival graft with apically positioned flap was performed. Result: In these three cases, the zone of attached keratinized mucosa around dental implants was decreased after guided bone regeneration. And the increase of peri-implant attached keratinized mucosa could be obtained effectively by free gingival graft. Conclusion: Free gingival graft could be a effective treatment method increasing the zone of attached keratinized mucosa which was decreased after guided bone regeneration procedures.

치은부에 이식한 이중인공진피의 조직학적 치유

김민정,정현주,김옥수,김영준,Kim, Min-Jeong,Chung, Hyun-Ju,Kim, Ok-Su,Kim, Young-Joon 대한치주과학회 2003 Journal of Periodontal & Implant Science Vol.33 No.2

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.

근단변위판막술과 함께 유리치은이식술을 사용하여 임플란트 주변 각화치은을 증대시킨 2건의 증례 보고

백원선(Won-Sun Baek),차재국(Jae Kook Cha),이재홍(Jae-Hong Lee),이중석(Jung-Seok Lee),정의원(Ui-Won Jung) 대한치과의사협회 2016 대한치과의사협회지 Vol.54 No.4

Narrow zone of attached gingiva and shallow vestibule around the implants might contribute to difficulty of cleasing, periimplant mucositis caused by incomplete cleansing and further peri-implantitis. The aim of this case report is to present modification of soft tissue biotype around the implants by free gingival grafts according to timing of surgical intervention and shape of free gingiva. A 44 year-old male patient had a missing area on lower right second molar area with 1 to 2 mm of narrow attached gingiva zone and wanted to be treated by implant placement. In radiographic analysis, there was enough alveolar bone to install an implant, free gingiva from hard palate was grafted following implant placement using double layer flap. The width of attached gingival was increased to 4 to 5mm and well maintained during 5 months of follow up. A 69 year-old female patient also had a missing area on lower right first and second molar area with 1 to 2 mm narrow attached gingiva. Since she had systematically angina pectoris and dental phobia, minimal invasive free gingival graft after implants placement was planned. After 2 months of implant surgery, free gingival graft surgery was performed with healing abutments connection. The grafted gingiva was composed of two strip shaped free gingiva, and they were immobilized by periodontal pack. The width of attached gingival was increased to 4 to 5mm and well maintained during 10 months of follow up. With prosthesis delivery, the patients recovered ideal periodontal environment around implants and masticatory function. In conclusion, periodontal health and masticatory function could be achieved through implant placement and free gingival graft.

Management of Gingival Oral Lichen Planus with Free Gingival Graft: 10-Year Follow-Up Case Report

Chang, HeeYung,Shim, YoungJoo Korean Academy of Orofacial Pain and Oral Medicine 2022 Journal of Oral Medicine and Pain Vol.47 No.3

Oral lichen planus (OLP) is a chronic oral mucosal disease affecting the buccal cheek, tongue, palate, lip, and gingival mucosa. Lesions in the gingiva make it difficult to control dental plaque due to pain. As a result, the disease is often accompanied by gingivitis or periodontitis. If OLP and dental plaque are not properly managed, the patient's periodontal condition will worsen. Thus, clinicians treating OLP should emphasize periodic visits and dental plaque control. Here, we report the management of a patient who struggled with OLP for 20 years and discuss the importance of periodic regular observations and active periodontal management.

교정 치료 중인 환자의 치주수술

박신영(Shin-Young Park) 대한치과의사협회 2017 대한치과의사협회지 Vol.55 No.3

Gingival recession is one of the common mucogingival problems during the orthodontic treatment. The causes of the gingival recession are similar to gingival recession in patients with periodontal diseases. Accumulation of bacterial deposits around the natural teeth induces the gingival inflammation and gingival recession occurs in the teeth with the lack of the supporting bone. However, malpositioned teeth which are labially positioned teeth or rotated teeth are more risky for gingival recession. Once root is exposed to oral cavity due to gingival recession, the orthodontic tooth movement is compromised and esthetic problems appeared. In addition, excessive gingival recession over the mucogingival junction jeopardizes the oral hygiene control, which has a risk of further gingival recession and bone loss around the tooth. To cover exposed root or to prevent further gingival recession, mucogingival surgery with gingival graft is recommended for the patients under orthodontic treatment. This case report aimed to present the mucogingival treatments of gingival recession observed during orthodontic treatment. Case I had had initial slight gingival recession before the orthodontic treatment. However, during the retraction phases, the gingival recession progressed and the periodontal treatment was referred. In case II, miller Class III gingival recession was occurred after correction of rotation. Both cases were treated by coronally advanced flap with free gingival grafts and recovered to the level of adjacent teeth despite of complete root coverage was not achieved in Case II. After periodontal treatment, orthodontic treatment was successfully completed. In conclusion, mucogingival surgery during the orthodontic treatment is recommended for the successful orthodontic treatment as well as periodontal health.

측방변위판막술 후 재발된 하악 전치부 순면 치은퇴축의 유리치은이식술을 이용한 치근 피개

주명재(Myung-Jae Joo),차재국(Jae-Kook Cha),이중석(Jung-Seok Lee),정의원(Ui-Won Jung) 대한치과의사협회 2017 대한치과의사협회지 Vol.55 No.7

The purpose of this case report is to present a case of free gingival graft for treatment of mandibular incisor labial gingival recession relapsed after laterally positioned flap surgery. A 22 year-old female patient with discomfort and labial gingival recession on left mandibular central incisor was treated. The patient had been treated root coverage on same site by laterally positioned flap surgery, but treated site had relapsed in one month. Exposed root surface was covered by free gingiva from left palatal area. Although gingival color did not completely match with adjacent gingiva, more than 5mm keratinized gingiva was attained. The patient showed no further recurring pain and recession on gingiva after 5 months from the surgery. In conclusion, the root coverage with gain of keratinized gingiva could be achieved through free gingival graft from palate on relapsed gingival recession.

Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement

Sohn, Joo-Yeon,Park, Jung-Chul,Cho, Kyoo-Sung,Kim, Chang-Sung Korean Academy of Periodontology 2014 Journal of Periodontal & Implant Science Vol.44 No.2

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.

Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement

손주연,박정철,조규성,김창성 대한치주과학회 2014 Journal of Periodontal & Implant Science Vol.44 No.2

Purpose: Various surgical techniques target achieving adequate keratinized tissue arounddental implants; however, these techniques are usually performed before implant placementor upon the exposure of submerged implants. The aim of this case report is to describea simultaneous placement of an interpositional free gingival graft (iFGG) with thatof nonsubmerged implants in a patient lacking keratinized tissue and to assess the longtermoutcome of this grafted gingiva. Methods: A wedge-shaped free gingnival graft (FGG), including an epithelium–connectivetissue (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 securedtightly around the implants and to the lingual flap. Results: At the 8-year follow-up, the gingival graft remained firmly attached and was wellmaintained, with no conspicuous shrinkage or reported discomfort during oral hygieneprocedures. The use of an iFGG at a nonsubmerged implant placement minimizes the requirednumber of surgical steps and patient discomfort while providing adequate buccalkeratinized tissue. Conclusions: Therefore, the technique could be considered an alternative method in increasingthe keratinized tissue for cases that have a minimal amount of keratinized tissue.

변형된 유리치은 이식술을 이용한 구강-상악동 농루의 치험례

박세호,한지영,Park, Se-Ho,Han, Ji-Young 대한치주과학회 2008 Journal of Periodontal & Implant Science Vol.38 No.1

Purpose: Surgical intervention into the maxillary posterior area can lead to inadvertent communication with the maxillary sinus. Spontaneous healing of 1 to 2 mm openings can occur. However, in patients with larger oro-antral communications and those with a history of sinus disease, surgical closure is often indicated. Materials and Methods: In this case, a modified free gingival graft technique was used. The oro-antral sinus track after extraction was about $2{\times}4\;mm$. But the patient had a history of Caldwell-Luc operation. Immediately after extraction, a modified free gingival graft was used for the closure of oro-antral sinus track. Result: A modified free gingival graft technique was successfully used for the closure of oro-antral sinus track. With this technique, esthetic results including similar colors, textures were achieved. Conclusion: It is thought that this technique is very useful in the closure of oro-antral sinus track.

Strip 형 유리치은 이식술이 부착지은 형성에 미치는 영향

이동열,권영혁,박준봉,허익,정종혁,Lee, Dong-Yeol,Kwon, Young-Hyuk,Park, Joon-Bong,Herr, Yeek,Chung, Jong-Hyuk 대한치주과학회 2006 Journal of Periodontal & Implant Science Vol.36 No.2

This study was performed to evaluate the effect on the formation of keratinized attached gingiva when free gingival graft with strip technique was used. After the partial thickness flap was prepared, it was positioned apically more than 7mm using mucoperiosteal suture. At the donor site, strip was achieved with 2mm width, less than 1mm thickness, (mesiodistal teeth length + 6)$^{\ast}$2 mm length. Then, it was divided into 2 same pieces and located at the recipient bed apico-coronally with more or less 3mm interval. Follow-up check was made at 1,2,4,8,12 weeks after the operation. The results of this study were as follows : 1. The inter-strip space was mostly filled with keratinized attached gingiva. 2. The contraction of the graft was nigligible, and 92% of planned area was filled with keratinized attached gingiva. 3. The inconvenience of the patients at donor site was minimal. 4. The width of the strip was widened. In conclusion, free gingival graft using strip technique is useful to achieve the keratinized attached gingiva maximally with free gingival graft minimally and to minimize the inconvenience of donor palatal site of the patients.