Aplastic anemia is a disease characterized by general lack of bone marrow activity; it may affect not only the red blood cells but also the white blood cells and platelets, resulting in pancytopenia. Spontaneous gingival hemorrhage is present in some cases and it is related to the blood platelet deficiency. This case report presents the periodontal treatment of a patient with aplastic anemia. A 43-year-old female was referred for continuous gingival bleeding after periodontal treatment. Periodontal findings revealed generalized gingival imflammation, oozing of blood from gingival crevice, and it was diagnosed as adult periodontitis. Root planing and extraction of the upper left third molar with poor prognosis were put into operation after elevation of the platelet count with platelet transfusion. The extraction socket was sutured with 3-0 silk. Bleeding continued even after digital compression at the upper right second premolar, second molar, and left canine areas, which presented severe inflammation. Although platelets were transfused repeatedly, platelet count did not stay elevated since survival rate of the transfused platelets were low due to alloimmunization. Thrombin gauze packing was not effective. Bleeding ceased 3 days after treatment with transfusion of donor platelets. 20 days after the treatment, the gingiva was generally healthy except upper right second premolar and lateral incisor areas. The result of periodontal treatment was good, but bleeding control after treatment was troublesome. In the periodontal treatment of patient with aplastic anemia, elevation of the platelet count with platelet transfusion seems to be the best method for hemorrhage control.
Adult ; Anemia, Aplastic* ; Bicuspid ; Blood Platelets ; Bone Marrow ; Chronic Periodontitis ; Erythrocytes ; Female ; Gingiva ; Gingival Hemorrhage ; Hemorrhage ; Humans ; Incisor ; Inflammation ; Leukocytes ; Molar ; Molar, Third ; Pancytopenia ; Platelet Count ; Platelet Transfusion ; Prognosis ; Root Planing ; Silk ; Survival Rate ; Thrombin ; Tissue Donors

Periodontal disease and/or loss of teeth brings pathologic tooth migration that can result in esthetic and occlusal problems. Diastema and general spacing of the teeth, particularly in the anterior segments of the dentition are frequently developed in individuals with advanced periodontal disease. Thus, the overall treatment plan for a patient with advanced periodontal disease often involves periodontal orthodontic combined therapy. Orthodontic treatment in adults with periodontal disease is restricted to tooth alignment with special caution. Indirect bonding can achieve accurate bracket placement. A 38 year old woman with adult periodontitis was treated by periodontal therapy. Subsequently, her diastema was orthodontically corrected by indirect bonding technique. It must be an appropriate case report of periodontal-orthodontic combined therapy.
Adult ; Chronic Periodontitis ; Dentition ; Diastema ; Female ; Humans ; Periodontal Diseases ; Periodontitis* ; Tooth ; Tooth Migration

No abstract available.
Bicuspid* ; Molar*

The ultimate goal of periodontal therapy is the regeneration of periodontal tissue which has been lost due to destructive periodontal disease, and numerous kinds of materials and techniques have been developed to achieve this goal. Bone grafts include autografts, allografts, xenografts and synthetic grafts. Among the synthetic grafts, bioactive glass has been used in dentistry for more than ten years and Fetner reported improved new bone formation and more amount of new attachment after grafting PerioGlas , a kind of bioactive glass, in 2-wall defects of monkeys in 1994. It is well known that 1-wall defects have less osteogenic potential and more epithelial migration, so we need to study the effect of bioactive glass in 1-wall defects in dogs. The present study evaluates the effect of bioactive glass on the epithelial migration, alveolar bone regeneration, cementum formation and gingival connective tissue attachment in intrabony defects of dogs. Four millimeter deep and four millimeter wide 1-wall defects were surgically created in the mesial aspects of premolars. The test group received bioactive glass with a flap procedure and the control underwent flap procedure only. Histologic analysis after 8 weeks of healing revealed the following results: 1. The height of gingival margin was 1.30+/-0.73mm above CEJ in the control and 1.40+/-0.78mm in the test group. There was no statistically significant difference between the two groups. 2. The length of epithelial growth(the distance from CEJ to the apical end of JE) was 1.74+/-0.47mm in the control and 1.12+/-0.36mm in the test group. There was a statistically significant difference between the two groups(P<0.01) 3. The length of new cementum was 2.06+/-0.73mm in the control and 2.62+/-0.37mm in the test group. There was no statistically significant difference between the two groups. 4. The length of new bone was 1.83+/-0.74mm in the control and 2.39+/-0.59mm in the test group. There was no statistically significant difference between the two groups. These results suggest that the use of bioactive glass in 1-wall intrabony defects has significant effect on the prevention of junctional epithelium migration, but doesn't have any significant effect on new bone and new cementum formation.
Allografts ; Animals ; Autografts ; Bicuspid ; Bone Regeneration ; Connective Tissue ; Dental Cementum ; Dentistry ; Dogs* ; Epithelial Attachment ; Glass* ; Haplorhini ; Heterografts ; Osteogenesis ; Periodontal Diseases ; Regeneration ; Tooth Cervix ; Transplants

Diabetes mellitus is a systemic disease with profound effects on oral health and periodontal wound healing. Uncontrolled diabetes adversely affects surgical wound healing and is often associated with abnormal proliferation of fibroblasts. Human gingival fibroblasts and PDL cells were chosen because they are intimately involved in periodontal therapy and are important for the success of surgical procedure such as guided tissue regeneration. The aim of the present study was to elucidate whether cellular activity and collagen synthesis by glucose pre-treated human gingival fibroblasts and PDL cells are influenced by insulin, and whether healthy cells differ from glucose treated cells. Cells were cultured with DMEM at 37degrees C, 5% CO2, 100% humidified incubator. To evaluate the effect of glucose on gingival fibroblasts and periodontal ligament cells, the cells were seeded at a cell density of 1x10(4) cells/well culture plates and treated with 20 and 50mM of glucose for 5 days. Then MTT assay was carried out. To evaluate the effect of insulin on glucose-pretreated cells, the cells were seeded at a cell density of 1x10(4) cells/well culture plates and treated with 20 and 50mM of glucose for 5 days. After incubation, 10(3), 10(4) and 10(5)mU/l of insulin were also added to the each well and incubated for 2 days, respectively. Then, MTT assay and collagen synthesis assay were carried out. The results indicate that cellular activity of gingival fibroblasts significantly increased by glucose while periodontal ligament cells were unaffected and cellular activity of gingival fibroblasts and periodontal ligament cells were unaffected by insulin. Collagen synthesis of gingival fibroblast with 20mM glucose and insulin unaffected, but 50mM glucose and insulin increased than control. Collagen synthesis of periodontal ligament cell with 20mM glucose and 10(5)mU/l insulin significantly increased than other groups and 50mM glucose pretreated PDL cells significantly increased at 10(3)mU/l insulin but decreased at 10(4)mU/l insulin. Our findings indicated that these cell types differed in their growth response to glucose, and the increase in collagen synthesis was significantly raised at insulin level of 10(3)mU/l in gingival fibroblasts and periodontal ligament cells except 20mM glucose pretreated periodontal ligament cells.
Cell Count ; Collagen ; Diabetes Mellitus ; Fibroblasts* ; Glucose* ; Guided Tissue Regeneration ; Humans* ; Incubators ; Insulin* ; Oral Health ; Periodontal Ligament* ; Wound Healing

The purpose of this study was to investigate the effects of smoking on adult periodontitis after non-surgical periodontal therapy. The study population consisted of 40 patients with moderate to advanced periodontitis. Smokers(n=20) were defined as individuals smoking at least twenty cigarettes per day at the time of the initial examination. The non-smoking group(n=20) second and the fourth weeks after periodontal non-surgical therapy. The results were as follows; 1. Clinical indices including plaque index, gingival index, and pocket depth were decreased in both smoking and non-smoking group at the first, the second, and the fourth weeks. Especially, clinical indices of non-smokers were more significantly decreased than those of smokers. 2. Non-motile rods were increaseed and motile rods were reduced at the fourth week. spirochetes were reduced significantly in the non-smoking group at the fourth week. These results suggest that smoking play a minor role in adult periodontitis after non-surgical periodontal therapy.
Adult* ; Chronic Periodontitis* ; Humans ; Periodontal Index ; Periodontitis ; Smoke* ; Smoking* ; Spirochaetales ; Tobacco Products

Immune responses of periodontal tissue may be regulated by products of sensory afferent nerve endings such as neuropeptides. Substance P(SP), a tachykinin neuropeptide, has been previously reported to stimulate the activities of T lymphocyte. Therefore, I examined the role of SP in IL-2 production and cell proliferation by using a homogeneous line of T lymphocytes(Jurkat and HuT78). Cell proliferation rate was determined by [3H]-thymidine incorporation test, and IL-2 was quantitated by the growth rate of CD4+ IL-2-dependent T lymphocyte line CTLL-2. SP stimulated cell proliferation of T lymphocytes at the concentration of 10(-12) and 10(-8)M in a biphasic bell-shape dose-dependent manner. However, SP alone did not induce IL-2 release at the concentration range of 10(-6) to 10(-14)M. The upregulation of IL-2 release was observed when 10(-12)M SP was applied together with mitogens such as Con A or PHA+PMA on T cell lines, especially on Jurkat. Con A or PHA+PMA demonstrated to increase the rate of cell proliferation of Jurkat, which had shown to produce much amount of IL-2 indicating that mitogen-induced cell proliferation might be partially influenced by released IL-2. It was concluded that regulatory effects of SP on the immune/inflammatory response could be mediated through the costimulatory upregulation of IL-2 production and increase of cell proliferation of T lymphocyte.
Cell Line ; Cell Proliferation* ; Interleukin-2* ; Lymphocytes* ; Mitogens ; Nerve Endings ; Neuropeptides ; Substance P* ; T-Lymphocytes ; Tachykinins ; Up-Regulation

It was well known that calcium sulfate was biocompatible, resorbed rapidly in the body, had potential as a good barrier membrane. Platelet-derived growth factor(PDGF) was one of polypeptide growth factor that had been reported as a biological mediator which regulates activities of wound healing process including the cell proliferation, migration and metabolism. The purpose of this study was to evaluate the effects of a combination of calcium sulfate and PDGF on periodontal ligament cells in vitro to use as a regeneration promoting agent of periodontal tissue. Human periodontal ligament cells were prepared from the premolar tooth extracted for the orthodontic treatment. Cells were cultured in alpha-MEM contained with 20% FBS, at the 37degrees C, 100% of humidity, 5% Co2 incubator. Cells were inoculated and cultured into 96 well culture plate with 1x104cells/well of alpha-MEM for 1 day. After discarding the medium, those cells were cultured in alpha-MEM contained with 10% FBS alone(control group), in calcium sulfate(calcium sulfate group), in calcium sulfate treated with 15ng/ml of PDGF-BB(calcium sulfate+PDGF group), in alpha-MEM contained with 10% FBS treated with 15ng/ml of PDGF-BB(PDGF group) for 1, 2, 3 day respectively. And then each group was characterized by examining of the cell counting, MTT assay, collagen synthesis. The results were as follows. 1. In the analysis of cell proliferation by cell counting, both calcium sulfate group and calcium sulfate plus PDGF group showed no stastically significant difference compared to control group, but there was stastically significant difference between PDGF group and calcium sulfate group at 1, 2 day(P<0.05). 2. In the analysis of cell proliferation by MTT assay in calcium sulfate extracts, both calcium sulfate group and calcium sulfate plus PDGF group showed no stastically significant difference compared to control group, but there was stastically significant difference between PDGF group and calcium sulfate group at 2, 3 day, and between calcium sulfate plus PDGF group and calcium sulfate group at 2 day(P<0.05). 3. In the analysis of cell proliferation by MTT assay in transwell, both control group and PDGF group showed stastically significant difference compared to both calcium sulfate group and calcium sulfate plus PDGF group at 1 day, but there was no stastically significant difference compared to both calcium sulfate group and calcium sulfate plus PDGF group at 2, 3 day(P<0.05). 4. In the analysis of collagen synthesis by immunoblotting assay in calcium sulfate extracts, high level was detected on calcium sulfate group at 3 day, on calcium sulfate plus PDGF group at 1 day, on PDGF group at 2 day. On the basis of these results, calcium sulfate was biocompatible on the periodontal ligament cells and might have potential possibility as a vehicle of PDGF in the periodontal tissue regeneration.
Bicuspid ; Calcium Sulfate* ; Calcium* ; Cell Count ; Cell Proliferation ; Collagen ; Humans ; Humidity ; Immunoblotting ; Incubators ; Membranes ; Metabolism ; Periodontal Ligament* ; Platelet-Derived Growth Factor* ; Regeneration ; Tooth ; Wound Healing

Guided tissue regeneration, bone graft procedures, and application of growth factors have been used to regenerate lost periodontal tissues. Recently, enamel matrix derivative has been introduced into periodontal regeneration procedures in expectation of promoting new bone and cementum formation. The purpose of this study was to evaluate the effect of enamel matrix derivative in 1-wall intrabony defects in beagle dogs. For this purpose, each dog was anesthesized using intravenous anesthesia and mandibular 1st, 3rd premolars were extracted. 2 months later, the 1-wall intrabony defects(mesio-distal width; 4mm, depth; 4mm) were created on the distal side of 2nd premolars and mesial side of 4th premolars. The control group was treated with debridement alone,and experimental group was treated with debridement and enamel matrix derivative application. The healing processes were histologically and histometrically observed after 8 weeks and the results were as follows : 1. The length of junctional epithelium was 0.94+/-0.80mm in the control group, 0.57+/-0.42mm in the experimental group, with no statistically significant difference between groups. 2. The connective tissue attachment was 1.36+/-0.98mm in the control group, 0.38+/-0.43mm in the experimental group, with statistically significant difference between groups(P<0.05). 3. The new cementum formation was 2.49+/-1.06mm in the control group, 3.59+/-0.74mm in the experimental group, with statistically significant difference between groups(P<0.05). 4. The new bone formation was 1.92+/-0.97mm in the control group, 2.32+/-0.59mm in the experimental group, with no statistically significant difference between groups. Within the limitation to this study protocol, enamel matrix derivative application in 1-wall intrabony defect enhanced new cementum formation. Although there was no statistically significant difference, enamel matrix derivative also seems to be effective in inhibition of apical migration of junctional epithelium and new bone formation.
Anesthesia, Intravenous ; Animals ; Bicuspid ; Connective Tissue ; Debridement ; Dental Cementum ; Dental Enamel* ; Dogs* ; Epithelial Attachment ; Guided Tissue Regeneration ; Intercellular Signaling Peptides and Proteins ; Osteogenesis ; Regeneration ; Transplants

Periodontal disease is a bacterially caused by disease. To remove plaque and bacteria, it has been necessary to prescribe chemical drug to patient to subjugate therapeutic unvalue by mechanical scaling. As a patient on a high dosage of the antibiotics to maintain the effective concentration may produce unfavorable side effects, this decase demands the Slow-release local drug delivery system. The object of the experiment is to study on the slow-release local drug delivery effects of calcium sulfate compounded with tetracycline that mainly used in periodontal disease. Experimental groups were divided into four classes as follow: Group 1 : 10% tetracycline compounded modified calcium sulfate paste. Group 2 : compounded and hardened 10% tetracycline and calcium sulfate. Group 3 : compounded 10% tetracycline and calcium sulfate, used just before hardened. Group 4 : tetracycline-ethylene vinyl acetate fiber. In the four groups, release concentration, it's durability and the period of absorption by times are observed and concluded as follow: 1. An effective concentration(4microgram/ml) remained until 5 weeks in group 1, 9 days in group 2, 7 days in group 3, 15 days in group 4. 2. It was fully fused at 11.8 days average in group 2 and 14.8 days average in group 3. 3. There were no statistically significant results in tetracycline concentration until a week in group 2 and 3(p<0.05) These results suggest that tetracycline loaded calcium sulfate release sufficient tetracycline and fused in 11~14 days, so calcium sulfate is useful carrier as slow release local drug delivery system
Absorption ; Anti-Bacterial Agents ; Bacteria ; Calcium Sulfate* ; Calcium* ; Drug Delivery Systems ; Humans ; Periodontal Diseases ; Tetracycline*