This study has been done to prove that keratinized gingiva is required for the periodontal health and to analyse the adequate width that is necessary. Until now, the study on frenum has been documented on changing its location. But the location or the formation of the frenum has not been reported. This experiment has used 173 patients from the department of periodontology of Dankook University to investigate the width of keratinized gingiva, the formation of the frenum and its location for the frequency. This study also looks into the relationship between the gingival recession and the structure of the frenum, and affects they have on periodontal health. The width of the keratinized gingiva in the mandible has been found to be highest in the lateral incisor than in the central incisor. The width decreased from the canine to the first premolar until it reached the molar. The interproximal area of the mandibular frenum was 77.9%, which was greater than the frequency(22.1%) from the midline of the teeth. The highest frequency of frenum was at 30.6% in between the both central incisor then second greatest at 20.6% in between the right canine and the right first premolar. Frenum was not found in between the second premolar and the distal area. In the morphology of the frenum, it was found that 43.4% out of 551 parts were found to be a single narrow frenum, and the double or triple ligamented form of the complex frenum were found in similar frequency of 237 parts, but the broad frenum was rarely frequent. The incisal area was popular mostly with the single narrow frenum, the left premolar area frequented 57.4%, and the right premolar frequented 64.7%. Because the distance between the frenum apex and the gingival margin measured to be about 5mm or greater, the frenum apex started in the mucogingival junction and not just below the keratinized gingiva. In the 551 area investigated, 48.3% of gingiva showed recession, incisal area had recession the least at 44.9%, right buccal side at 47.4%, and right buccal side frequented the highest at 52.1%. The teeth that showed recession recessed at the average of 2.151.0.mm and the left canine showed the greatest amount of gingival recession. In the investigation to find out if the keratinized gingiva and the gingiva recession had mutually related somehow, the width of keratinized gingiva showed no affect on the probing depth, but had affected in the gingiva recession. This investigation showed that the gingival recession and the morphology of the frenum related in that, the single narrow frenum had recessed the least and the broad frenum recessed the most. With this analysis, a conclusion was drawn that the morphology of the frenum had affected in the gingical recession.

Removal of subgingival calculus is essential for the success in periodontal treatment. Subgingival instrumentation is used for the removal of all bacterial plaque and calculus. In this study, Gracey curet and Ultrasonic curet were used on single rooted teeth to conduct subgingival scaling and root planning. The remaining amount of calculus was evaluated according to type of instrument, depth of pocket, and tooth surface. 24 teeth were extracted from 14 patients being treated at department Periodontology Seoul Advantist dental hospital were used. Total 96 area(4 surface per teeth) were evaluated. 12 teeth treated with Gracey curet were used as the control group and the other 12 teeth treated with Ultrasonic curet were examined for experimental group. The 4 surfaces of the teeth(buccal, mesial, lingual or palatal, distal) were observed through the stereomicroscope and the images of the surface were captured and saved in CCD. The images were displayed on the monitor and the amount of calculus remained was evaluated by overlapping 10x10 grid pixel screen produced by Microsoft power point. The results evaluated were as follows 1. There was no statistically significant difference in residual calculus and tooth position following scaling and root planning of all group, but statistically significant correlation with residual calculus, probing depth, instruments and tooth surface. 2. There was statistically significant correlation between residual calculus and probing depth, but no statistically significant difference in residual calculus, tooth surface and tooth position on experimental(Ultrasonic curet) group. 3. There was no statistically significant difference in residual calculus according to the pre-treatment pocket depth and tooth position, but statistically significant correlation with tooth surface. The amount of residual calculus increase with mesial, distal, buccal and lingual(or palatal) surface on control(Gracey curet) group. 4. The Gracey curet showed better results than ultrasonic curet in mesial and distal surface, and there is significant difference. The results demonstrate that ultrasonic curet alone is inadequate for thorough subgingival debridement and suggest that Ultrasonic curet with Gracey curet should be more effective.
Calculi ; Debridement ; Dental Scaling* ; Humans ; Seoul ; Tooth ; Ultrasonics*

Periodontal defects of the furcation are characterized by several inherent anatomic factors that can make successful periodontal therapy difficult and results unpredictable. The severity and rate of occurrence of periodontal disease are directly related to the location of the furcation relative to the cemento-enamel junction and anatomical form of the root by limiting the accessibility and effectiveness of the periodontal instrumentation. This study investigated the reliability and accuracy of panoramic radiograph diagnoses of the periodontal state of mandibular molars, particularly regarding the diagnosis of furcation area periodontal defects, treatment planning, and prognosis prediction. This study examined a total of 110 teeth belonging to 33 subjects (19 male, 14 female) presenting with incipient to moderate periodontitis 4-7mm pocket depth. The alveolar bone level, length and width of the root trunk, and root separation angle were measured using the panoramic radiograph and compared to the results taken directly by retracting a full-thickness flap. The results of the study are as follows: 1. Data regarding the alveolar bone level of the mandibular first molar showed that the directly taken surgical measurements resulted in 5.1+/-0.9mm that was slightly deeper than the corresponding panoramic measurement resulted in 4.8+/-0.8mm, but these differences were statistically insignificant (p>0.05). 2. The data of the directly taken surgical measurement of the mandibular second molar (5.1+/-1.1mm) was slightly deeper than the corresponding panoramic measurement (4.7+/-1.2mm), but these differences were statistically insignificant (p>0.05). 3. The measured values of the length and width of the mandibular first molar root trunks were determined to be 4.1+/-0.6mm and 7.3+/-0.9mm, respectively, while the values of the mandibular second molar root trunks were determined to be 4.6+/-1.3mm and 7.6+/-0.9mm respectively. The differences between these values were found to be statistically significant (p<0.01). 4. The measured values of the root separation angle showed that the mandibular first molars averaged 34.5+/-4.4degrees, while the mandibular second molars averaged 23.0+/-10.0degrees. The differences between these values were found to be statistically significant (p<0.01). The results of the study show that when directly taken surgical measurements of periodontal defect depth are compared to depths indirectly measured using standard panoramic radiograph, the values are slightly deeper, but that these values are statistically insignificant. These results imply that panoramic radiograph is a reliable and effective means of making clinical diagnosis of incipient to moderate periodontitis.
Diagnosis ; Humans ; Male ; Molar* ; Periodontal Diseases ; Periodontitis ; Prognosis ; Tooth

Bone or bone substitute has been widely used for the reconstruction of bony defect developed by trauma, infecton, cyst, tumor, congenital abnormality, etc. Owing to its variety in quality and quantity, the use of alloplasts is increased rapidly. Among the various graft materials, HA has been studied and applied in clinic most exensively. When HA applied to bony defect, it is considered to help the bone healing by osteoconduction but tends to be encapsulated with fibrous tissue and floated in the applied area by the lack of consolidation. Bioglass is considered as a subsitute which can cover such weak point of HA. Bone defect were artificially prepared in the calvaria of the rats followed by grafts of HA and bioglass into defects. Sequential sacrifice was peformed at the 3rd, 7th, 14th and 28th day of experiment. The staining of the obtained specimen was performed with H&E, MT, immunohistochemical stain and then histological examinaions were carried out under the light and scanning electron microscope. 1. In the features of H&E stain, infiltration of chronic inflammatory cell were present in all group at the 3rd and 7th day of experiment with decrease at the 14th day in bioglass group. The infiltration of inflammatory cells was more active in control and HA group whereas the formation of granulation tissue was more active in bioglass group was larger and more irregular than in HA group. 2. The features of MT stain showed new bone formation from the 7th day in all groups and the evidence of advanced calcification was observed at the 28th day. 3. In the features of immunohistochemical stain, bioglass group showed more PCNA positive response in the osteoblasts at the site of new bone formation and the lower activity of undifferentiated mesenchymal cells than HA group. 4. In scanning electron microscopic features, fibrous tissue formation and osteoid attached to HA was observed in the HA group after the 7th day. In bioglass group, osteoid formation was observed between the absorbed bioglass. Generally in HA group, bone formation progressed with characteristic of the fibrous and osteoid tissue mainly attached to the surface and the high activity of undifferented mesenchymal cells was seen at the graft site. In bioglass group, osteoid tissue formation was seen between the irregulary absorbed bioglass and the increased PCNA positive response was observed in the osteoblast at the new bone formation site.
Animals ; Bone Regeneration ; Bone Substitutes ; Congenital Abnormalities ; Durapatite* ; Granulation Tissue ; Osteoblasts ; Osteogenesis ; Proliferating Cell Nuclear Antigen ; Rats* ; Skull ; Transplants

The purpose of this study was to examine the frequency of dehiscence bone defect on peri-implant and to compare the difference between resorbable membrane and non-resorbable membrane in bone regeneration on peri-implant. Amomg the patients, 22 patientswho have recieved an implant surgery at the department of Periodontics in Dankook University Dental Hospital showed implant exposure due to the dehiscence defect and 27 implants of these 22 patients were the target of the treatment. Gore-Tex(R) and Bio-mesh(R) were applied to the patients and treated them with antibiotics for five days both preoperatively and postoperatively. Reentry period was 26 weeks on average in maxilla and 14 weeks on average in mandible. The results were as follows: 1. Dehiscence bone defect frequently appeared in premolar in mandible and anterior teeth in maxilla respectively. 2. Among 27 cases, 2 membrane exposures were observed and in these two cases, regenerated area was decreased. 3. In non-resorbable membrane, bone surface area 9.25+/-4.84 preoperatively and significantly increased to 11.48+/-7.52 postoperatively.(P<0.05) 4. In resorbable membrane, bone surface area was 14.80+/-8.25 preoperatively and meaningfully widened to 17.61+/-10.67 postoperatively.(P<0.05) 5. The increase of bone surface area in non-resorbable membrane was 2.23+/-3.38 and the increase of bone surface area in resorbable membrane was 2.80+/-3.00 ;therefore, there was no significant difference between these two membranes(P<0.05). This study implies that the surgical method using DFDB and membrane on peri-implant bone defect is effective in bone regeneration regardless the kind of the membrane, and a similar result was shown when a resorbable membrane was used.
Anti-Bacterial Agents ; Bicuspid ; Bone Regeneration* ; Humans ; Mandible ; Maxilla ; Membranes* ; Periodontics ; Tooth

A mucogingival grafting procedure has been developed to cover denuded root surface. The subepithelial connective tissue graft technique is very predictable and allows for a good esthetic results and minimum patient discomfort on the palate. However, in areas where there is a lack of vestibular depth and keratinized attached tissue, the presence of frena or heavy muscle attachment, covering the connective tissue graft with a mucosal flap is very difficult. The purpose of this study is to evaluate an alternative technique of root coverage using the free connective tissue graft. The results were as follows: 1. Probing depths didn't seem to vary significantly from the preoperative to postoperative period. 2. The amount of keratinized tissue showed an increase of 5.9+/-0.97mm from the preoperative level. 3. Total clinical exposed root coverage increase 72.2% compare with preoperative level. 4. The shrinkage from gingival margin is 4.2+/-1.15mm and the mean shrinkage rate is 40.1%. 5. The depth of the vestibule increased with the average distance from cementoenamel junction to mucogingival junction being 7.4+/-1.65mm.
Connective Tissue* ; Humans ; Palate ; Postoperative Period ; Tooth Cervix ; Transplants*

The purpose of this study was to evaluate clinical changes in graft size after treatment with connective tissue autograft in human. 40 premolar teeth in 23 patients having the following mucogingival problemswere selected. The width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth were measured at the initial examination, 2, 12 and 24 weeks following the connective tissue autograft and free gingival autograft. The change of width of extension, attached gingiva including free marginal gingiva, width of transplant and clinical sulcus depth according to healing process in both graft procedures was statistically analyzed by ANOVA test and independent t-test using SPSS program. The results were as follows: 1. The change of keratinized gingiva in both grafting procedures was increased significantly at 24 weeks post-op. 2. The clinical sulcus depth exhibited no marked changes throughoutthe entire investigation in both grafting procedures. 3. After 12 weeks, no dimensional variation was seen in graft size in both grafting procedures. 4. Shrinkage differs significantly in both grafting procedures. From the day of graft to 24 weeks after surgery the percentages of shrinkage were connective tissue autograft 55% and free gingival autograft 29%.
Autografts* ; Bicuspid ; Connective Tissue* ; Gingiva ; Humans ; Tooth ; Transplants*

Osseointegrated titanium implants have become an integral therapy for the replacement of teeth lost. For dental implant materials, titanium, hydroxyapatite and alumina oxide have been used, which of them, titanium implants are in wide use today. Titanium is known for its high corrosion resistance and biocompatability, because of the high stability of oxide layer mainly consists of TiO2. With the development of peri-implantitis, the implant surface is changed in surface topography and element composition. None of the treatments for cleaning and detoxification of implant surface is efficient to remove surface contamination from contaminated titanium implants to such extent that the original surface elemental composition. In this sights, the purpose of this study was to evaluate rough surface titanium implants by means of scanning electron microscopy(SEM) and X-ray photoelectron spectroscopy(XPS) with respect to surface appearance and surface elemental composition. Moreover, it was also the aim to get the base for treatments of peri-implantitis. For the SEM and XPS study, rough surface titanium models were fabricated for control group. Six experimental groups were evaluated: 1) long-time room exposure, 2) air-powder abrasive cleaning for 1min, 3) burnishing in citric acid(pH1) for 1min, 4) burnishing in citric acid for 3min, 5) burnishing in tetracycline for 1min, 6) burnishing in tetracycline for 3min. All experimental treatments were followed by 1min of rinsing with distilled water. The results were as follows: 1. SEM observations of all experimental groups showed that any changes in surface topography were not detected when compared with control group. (750x magnification) 2. XPS analysis showed that in all experimental groups, titanium and oxygen were increased and carbon was decreased, when compared with control group. 3. XPS analysis showed that the level of titanium, oxygen and carbon in the experimental group 3(citric acid treatment for 1min, followed by 1min of distilled water irrigation) reached to the level of control group. 4. XPS analysis showed that significant differences were not detected between the experimental group 1 and the other experimental groups except of experimental group 3. The Ti. level of experimental group 2, air-powder abrasive treatment for 1min followed by 1 min of saline irrigation, was lower than the Ti. level of tetracycline treated groups, experimental group 5 and 6. From the result of this study, it may be concluded that the 1min of citric acid treatment followed by same time of rinsing with distilled water gave the best results from elemental points of view, and can be used safely to treat peri-implantitis.
Aluminum Oxide ; Carbon ; Citric Acid ; Corrosion ; Decontamination* ; Dental Implants ; Durapatite ; Oxygen ; Peri-Implantitis ; Tetracycline ; Titanium* ; Tooth ; Water

Periodontal supporting tissue goes through destruction by chronic inflammatory periodontal disease as two aspect. One is qualitive aspect such as alteration of periodontium, the other is quantitative aspect such as alveolar bone loss. According to many authors, PDL is responsible for biting force, and there are two means for measuring PDL's function - mobility test and biting force test. This study was conducted to compare the biting force with remaining bone level, that is, quantitative aspect of periodontium, in anterior and premolar teeth at periodontal maintenance phase. 17 patients on periodontal maintenance phase during 6 months at minimum were selected for this study. For the same condition, 4 anterior, canine, premolar teeth were tested by MPM-3000 bite-force register at the same time(a.m.10-12), the same position, the same posture, by the same examiner. Patients of TMD, ill-fitting prosthesis, general disease, malocclusion and the teeth of TFO, absence of opposing teeth, malposition were excluded. Remaining bone level was measured on the panorama X-ray film through 5 level from 1mm below CEJ to root apex. Teeth were examined twice, and bigger one was selected. If the values showed large difference, examinatin was re-done and the mean was selected. The results were as follows ; 1. In the 4 anterior group, as the remaining bone is decreased, the average of maximal biting force is decreased. Especially, at 3/5 bone level, maximal biting force is decreased significantly(p<0.01). 2. In the canine group, as the remaining bone is decreased, the average of maximal biting force is decreased. Especially, at 2/5 bone level, maximal biting force is decreased significantly(p<0.01). 3. In the premolar group, as the remaining bone is decreased, the average of maximal biting force is decreased. Especially, at 3/5 bone level, maximal biting force is decreased significantly(p<0.05). From the results of this study, clinicians could utilize these efficiently when they have to determine the proper restorative materials, time for tooth extraction. treatment plan, prognosis.
Alveolar Bone Loss ; Bicuspid* ; Bite Force* ; Humans ; Malocclusion ; Periodontal Diseases ; Periodontium ; Posture ; Prognosis ; Prostheses and Implants ; Tooth Cervix ; Tooth Extraction ; Tooth* ; X-Ray Film

In periodontal regeneration treatment, access to the frucation area is very difficult. Thus complete removal of plaque, calculus and endotoxin is somewhat impossible. In this study, teeth that were extracted due to periodontal disease were used. The furcation area was treated with periodontal curette, ultrasonic scaler, roto bur and they observed using SEM. The result was follows 1. The group treatment with curette showed remaining plaque, the cementum existed in most of the surface and partial dentinal tubule orifice could be seen. 2. The group treatment with ultrasonic scaler showed less removalof plaque compared to curette and irregular surface could be seen. 3. The group treatment with roto bur showed cleaner surface and many dentinal tubule orifice could be seen compared to the curette and ultrasonic scaler groups. Thus when suing treatments such as bone grafting or guided tissue regeneration, it is considered that the furcation area should be treatment with Roto bur.
Bone Transplantation ; Calculi ; Dental Cementum ; Dentin ; Guided Tissue Regeneration ; Periodontal Diseases ; Regeneration ; Tooth ; Ultrasonics