흡수성 차폐막의 조직반응에 관한 비교연구

홍승범,권영혁,이만섭,허익,Hong, Seung-Bum,Kwon, Young-Hyuk,Lee, Man-Sup,Herr, Yeek 대한치주과학회 2002 Journal of Periodontal & Implant Science Vol.32 No.3

The purpose of this study is to evaluate histologically the resorption and tissue response of various resorbable collagen membranes used for guided tissue regeneration and guided bone regeneration, using a subcutaneous model on the dorsal surface of the rat. In this study, 10 Sprague-Dawley male rats (mean BW 150gm) were used and the commercially available materials included acellular dermal matrix allograft, porcine collagen membrane, freeze-dried bovine dura mater. Animals were sacrificed at 2,6 and 8 weeks after implantation of various resorbable collagen membranes. Specimens were prepared with Hematoxylin-Eosin stain for light microscopic evaluation. The results of this study were as follows: 1. Resorption : Inner portion of porcine collagen membrane was resorbed a lot at 6 weeks, but its function was being kept for infiltration of another tissues were not observed. Freeze-dried bovine dura mater and acellular dermal allograft were rarely resorbed and kept their structure of outer portion for 8 weeks. 2. Inflammatory reactions : Inflammatory reaction was so mild and foreign body reaction didn't happen in all of resorbable collagen membranes, which showed their biocompatibility. 3. In all of resorbable collagen membranes, multinuclcated giant cells by foreign body reactions were not observed. Barrier membranes have to maintain their function for 4-6 weeks in guided tissue regeneration and at least 8 weeks in guided bone regeneration. According to present study, we can find all of the resorbable collagen membranes kept their function and structure for 8 weeks and were rarely resorbed. Foreign body reaction didn't happen and inflammatory reaction was so mild histologically. Therefore, all of collagen membranes used in this experiment were considered proper resorbable membranes for guided tissue regeneration and guided bone regeneration.

치과 임상에서 조직유도재생술의 의미

장현선 대한구강악안면병리학회 2018 대한구강악안면병리학회지 Vol.42 No.4

Guided tissue regeneration(GTR) is regenerative operating technique at dental clinic. The vertical bone defect can be treated by GTR. The purpose of this study is to present the importance of GTR at dental clinic. The vertical bone defect was observed on distal side of mandibular right 2nd molar. The patient had been treated scaling, root planing and GTR. Both nonresorbable occluding membrane and resorbable occluding membrane can be used as GTR operation. The former was used in this study. Nonresorbable occluding membrane can exclude epithelial cells from healing defect. The Bio-Oss bone graft used at GTR operation. A radiograph demonstrates that the regenerative part was observed by GTR. In conclusion, GTR operating effect has importance on vertical defect at dental clinic.

이종골 이식시 Fibrin adhesive의 사용이 골 재생에 미치는 영향에 관한 조직병리학적 연구

고영우,임성빈,정진형,이종헌,Ko, Young-Woo,Lim, Sung-Bin,Chung, Chin-Hyung,Lee, Chong-Heon 대한치주과학회 2003 Journal of Periodontal & Implant Science Vol.33 No.1

Several effective treatment methods and materials have been developed for the treatment of furcation involvement. Currently, the combination of guided tissue regeneration (GTR) and bone grafts is the most commonly prescribed method of treating furcation involved defects. But because these cases often present with poor accessibility, placement of the membrane may be difficult and consequently, clinically impractical. In this study, the alveolar bone healing patterns of adult beagle dogs presenting with alveolar bone destruction treated by one of two methods - treatment using solely bone allografts (BBP(R)), or treatment using bone allografts (BBP(R)) stabilized by a fibrin adhesive - were comp ared. The effects of the fibrin adhesive on the initial stabilization of the newly formed bone, subsequent regeneration of bone, and the feasibility of the clinical application of the fibrin adhesive were analyzed. The results of the study were as follows: 1. Clinical signs of inflammation at the 4-8 week interval were not observed: but signs of mild inflammation were histologically observed at the 4-week interval. 2. Allografts stabilized by fibrin adhesive showed good bone formation, whereas defects treated with only the allograft material showed incomplete alveolar bone regeneration. 3. Allografts stabilized by fibrin adhesive showed a decrease in the amount old bone with a concurrent increase in the formation of new lamellar bone four weeks post-op, whereas defects treated with only the allograft material showed no new lamellar bone formation at the same interval. 4. In detects treated with only the allograft material, the defective area was filled with connective tissue 8-weeks post-op, whereas fibrin adhesive stabilized allografts showed viable connections between the original bone and the newly formed bone, in addition to neovascularization 8-weeks post-op. The results of this study show that concurrent use of fibrin adhesive materials can stabilize the allograft material and aid in new bone formation Although the stability of fibrin adhesives fall short of the results achievable by GTR membranes, in cases presenting with poor accessibility that contraindicate the use of membranes, fibrin adhesive materials provide a viable and effective alternative to graft stabilization and new bone formation.

유도조직재생술에 의한 발치창의 골치유 및 즉시 임프란트 매식에 대한 임상적 연구

박광호 大韓顎顔面成形再建外科學會 1996 Maxillofacial Plastic Reconstructive Surgery Vol.18 No.2

Early implantation before sufficient ossification has taken place usually results in osseointegartion failure due to reduced bone-fixture interface area. However, various studies have shown successful osseointegration results following immediate implants concurrently with GTR. The clinical trends have been to shorten the patients' edentulous state by immediate implantation, and reduce the alveolar bone resorption. However, it may be difficult to attain the complete soft tissue coverage of the sites, increasing the chance of infection. Furthermore, there may be more studies needed on the clinical behaviors of e-PTFE membranes, various modofications in the membrane materials and bone graft materials. Various animal and clinical studies have been reported on the successful osseointagration following immediate implantation, but the long-term follow-up studies are limited. The present study investigated 16 immediately-implanted implants with GTR therapy with or without calcium carbonate grafting on 11 patients 3 years after installation and 24-30 months after functional loading. Based on the clinical, radiographic and histologic findings, the following results have been attained. 1. Clinically, stability has been shown on all 16 implants throughout the investigated periods. 2. Radiologically, the alveolar bone loss has progressed up to the polished neck portion but not beyond it, suggesting the progressive osseointegration from the GTR therapy. 3. The GTR method used in the present study is easy to use clinically, and may be appied in the regeneration of ossoeous defects around implants and in the immediate implantation. 4. The difficulty in complete tissue coverage may be avoided by delaying the installation for 2 to 3 weeks after the extraction allowing certain degree of soft tissue healing.

치주 재생 수술: 임상증례

김현성 ( Hyun Sung Kim ),장현선 ( Hyun Sun Jang ) 조선대학교 구강생물학연구소 2007 Oral Biology Research (Oral Biol Res) Vol.31 No.3

Biocompatibility of 17β-Estradiol-loaded PLA/PLGA Membrane

강경희,박일수,임정옥,박진우,서정민,서조영 한국생체재료학회 2003 생체재료학회지 Vol.7 No.3

The current study investigated the cytocompatibility and subcutaneous tissue reaction of 17-estradiol-loaded polylactide/poly(lactide-co-glycolide) (PLA/PLGA) membranes as an occlusive barrier and guided tissue regeneration (GTR). From the release kinetics of 17-estradiol from PLA/PLGA membranes, 17-estradiol was released for prolonged period. The mean concentration of 17-estradiol released from a 5.0 mg 17-estradiol-loaded membrane was 73.87 g/ml per day. Over the 40 days of release study, approximately 40% of the total drug was released. From the evaluation of cell viability on 17-estradiol-loaded PLA/PLGA membranes by MTT assay, the PLA/PLGA membranes demonstrated non-cytotoxic behavior. In addition, the tissue response to implantation of the membranes in an animal model exhibited a minimal inflammatory reaction. Moreover, no membrane resorption occurred and mechanical stability was maintained for at least six weeks. Accordingly, the current histological and cytological observations confirmed that PLA/PLGA membranes could be a useful alternative as a biocompatible occlusive membrane. Plus, the results of the release experiment demonstrated that PLA/PLGA membranes could also be effectively applied as a local delivery system to exert a periodontal regenerative activity.

골재생유도술에 의한 골재생과정에서의 골기질 유전자 발현 양상

이창곤,류현모,신홍인,Lee, Chang-Kon,Ryoo, Hyun-Mo,Shin, Hong-In 대한악안면성형재건외과학회 1999 Maxillofacial Plastic Reconstructive Surgery Vol.21 No.3

골재생유도술에 의한 골재생 과정에서의 생물학적 현상을 보다 구체적으로 이해하고자 인위적으로 골결손부를 형성하고, 비흡수성 비공유성 차폐막을 이용하여 골성회복 시 주위 연조직의 유입을 차단한 다음 골수강 및 골면으로부터 유래되는 세포들에 의한 골성회복 양상과 이때 이들 세포의 조골세포로의 분화정도를 판정하기 위하여 비교원성 골기질 단백질인 OSN, OPN 그리고 OSC mRNA의 발현 양상을 비교 검토하여 다음과 같은 결과를 얻었다. 실험 전기간에 걸쳐 골재생유도술을 시행한 군에서 보다 신속하고 양호한 골성회복을 보였다. 차폐막을 처리한 실험군에서는 인접골의 주변부로부터 신생골이 형성되어 조골세포의 분화가 조기에 골결손부에 국한되어 유도된 반면, 대조군에서는 주변연조직의 개입으로 인하여 실험군 보다는 약 1주정도 신생골의 형성이 지연되었으며, 따라서 골수강 내의 기질세포의 조골세포로의 분화 역시 지연되었다. 이상의 사실에서 골창상부에서 차폐막에 의해 형성된 차폐공간은 기질 세포들의 보다 신속한 조골세포로의 분화 증식과 이들에 의해 신생된 골주들의 빠른 골 개조를 조장하였음을 시사한다. To investigate the expression pattern of noncollagenous bone matrix proteins such as osteonectin(OSN), osteopontin(OPN) and osteocalcin(OSC) mRNA during bony healing procedure induced by guided bone regeneration method, we made artificial defects on bilateral femur of rats. Then induced bony healing by application of a nonabsorbable PTFE membrane in experimental sites and without its application in control sites for 3 weeks. The mRNA expression pattern at specimens obtained at 1, 2 and 3 weeks after operation was detected by in situ hybridization method using its antisense mRNA probes. The experimental sites revealed more rapid and favorable bony healing than control sites and new bone formation was limited within defected area by inhibitory activity of bone marrow cells. In experimental sites, the OSN and OSC mRNA were expressed strongly on osteoblasts of regenerating cortical bone at 1st week and on osteoblasts lining the trabecular bone in marrow space at 3rd week, whereas, in control sites, their expression were noted on osteoblasts lining the reactively formed sponge bones at 2nd and 3rd week. In addition, the OPN mRNA was expressed on osteoblasts and osteoclasts at sites of remodeling and osteocytes of remained trabecular bone of defected area in experimental sites and on macrophages at 1st week and osteoclasts at sites of remolding at 2nd and 3rd week in control sites. The above findings suggest that the more rapid and favorable bony healing might be induced by blocking of invading fibrous connective tissue into bony defects. And the earlier expression of OSN and OSC mRNA on osteoblasts of experimental sites suggest that the formation and resorption of regenerating bone was more rapidly progressed in confined spaces made by applicate membranes.

e-PTFE 차단막을 이용한 조직유도재생술시 e-PTFE 차단막의 노출이 치주조직의 초기치유에 미치는 영향

문익상,김지은,송건영,Moon, Ik-Sang,Kim, Ji-Eun,Song, Kun-Young 대한치주과학회 1999 Journal of Periodontal & Implant Science Vol.29 No.3

The aim of the present study was to evaluate the effect of the expanded polytetrafluoroethylene (e-PTFE) membrane exposure on the initial healing of the periodontal tissue in guided tissue regeneration (GTR) procedure. 90 sites selected from 90 patients were treated with gingival flap surgery supported by an e-PTFE membrane. The material included angular bony defects with probing attachment loss of > 5mm or degree II furcation involvement. Treated sites were classified with membrane exposure group and non-exposure group at membrane removal and evaluated healing type. The results were obtained as follows. 1. e-PTFE membrane was exposed at 61 sites (67.8%) among 90 sites. 2. Thirteen sites (14.4%) depicted rapid healing type, 65 sites (72.2%) depicted typical healing type, 9 sites (10%) showed delayed healing type and 3 sites (3.3%) were categorized as adversed healing type. 3. In e-PTFE membrane exposure group, 1 site (1.6%), 51 sites (83.6%), 6 sites (9.8%) and 3 sites (4.9%) showed rapid healing type, typical healing type, delayed healing type and adverse healing type respectively. 4. In e-PTFE membrane non-exposure group, 12 sites (41.3%), 14 sites (48.3%) and 3 sites (10.3%) showed rapid healing type, typical healing type and delayed healing type respectively. Adverse healing type was not observed. 5. The rate of favourable healing between e-PTFE membrane exposure group and non-exposure group was not statistically significant(p=0.56). These results suggest that the prevention of membrane exposure may be important to obtain rapid healing type. However favourable healing could be obtained with stringent infection control program even if membrane was exposed.

Combined periodontal regenerative and prosthetic treatment of pathologic migration of anterior teeth

Lee, Ju-Youn Korean Academy of Periodontology 2008 Journal of Periodontal & Implant Science Vol.38 No.2

Purpose: Pathologic tooth migration (PTM) commonly occurs in the anterior region and is associated with periodontal disease. The treatment of PTM of anterior teeth can be complex and time consuming, and a multidisciplinary approach is often required. Materials and Methods: The patient was a 38-year-old woman with a chief complaint of saving and realigning her elongated maxillary left central incisor. This paper describes the successful combined periodontal regenerative (guided tissue regeneration) and prosthetic treatment and a 2-year follow-up of maxillary central incisor with pathologic tooth migration, deep intrabony defect, and poor prognosis. Results: The right maxillary central incisor was restored by laminate veneer and the left by all-ceramic crown. The patient had no pain and discomfort and was satisfied with the outcomes of her treatment for 2 years. She has maintained her recall program at the Department of Periodontology at 3 months interval. Conclusion: The key step in the successful treatment of PTM in anterior region is to obtain a high level of cooperation from the patient. Maintenance of the treatment result of PTM is dependent on the continuous preservation of periodontal health.

Combined periodontal regenerative and prosthetic treatment of pathologic migration of anterior teeth

이주연 대한치주과학회 2008 Journal of Periodontal & Implant Science Vol.38 No.2

Purpose: Pathologic tooth migration (PTM) commonly occurs in the anterior region and is associated with periodontal disease. The treatment of PTM of anterior teeth can be complex and time consuming, and a multidisciplinary approach is often required. Materials and Methods: The patient was a 38-year-old woman with a chief complaint of saving and realigning her elongated maxillary left central incisor. This paper describes the successful combined periodontal regenerative (guided tissue regeneration) and prosthetic treatment and a 2-year follow-up of maxillary central incisor with pathologic tooth migration, deep intrabony defect, and poor prognosis. Results: The right maxillary central incisor was restored by laminate veneer and the left by all-ceramic crown. The patient had no pain and discomfort and was satisfied with the outcomes of her treatment for 2 years. She has maintained her recall program at the Department of Periodontology at 3 months interval. Conclusion: The key step in the successful treatment of PTM in anterior region is to obtain a high level of cooperation from the patient. Maintenance of the treatment result of PTM is dependent on the continuous preservation of periodontal health. (J Korean Acad Periodontol 2008;38:405-412) Purpose: Pathologic tooth migration (PTM) commonly occurs in the anterior region and is associated with periodontal disease. The treatment of PTM of anterior teeth can be complex and time consuming, and a multidisciplinary approach is often required. Materials and Methods: The patient was a 38-year-old woman with a chief complaint of saving and realigning her elongated maxillary left central incisor. This paper describes the successful combined periodontal regenerative (guided tissue regeneration) and prosthetic treatment and a 2-year follow-up of maxillary central incisor with pathologic tooth migration, deep intrabony defect, and poor prognosis. Results: The right maxillary central incisor was restored by laminate veneer and the left by all-ceramic crown. The patient had no pain and discomfort and was satisfied with the outcomes of her treatment for 2 years. She has maintained her recall program at the Department of Periodontology at 3 months interval. Conclusion: The key step in the successful treatment of PTM in anterior region is to obtain a high level of cooperation from the patient. Maintenance of the treatment result of PTM is dependent on the continuous preservation of periodontal health. (J Korean Acad Periodontol 2008;38:405-412)