PURPOSE: Stimulating the proliferation and migration of periodontal ligament cells (PDLCs) has become the main goal of periodontal regeneration. To accomplish this goal, regeneration procedures have been developed, but results have not been predictable. Recently, tissue engineering using enamel matrix derivatives (EMDs) and growth factors has been applied to periodontal regeneration; however, the mechanism of EMDs is largely unknown. The aim of this study was to investigate the effects of EMDs on the proliferation and release of growth factors from PDLCs. MATERIALS AND METHODS: Human PDLCs were removed from individually extracted 3rd molars of healthy young adults, and cultured in the media containing EMDs (Emdogain, Biora, Malmo, Sweden) at concentration of 0, 12.5, 25, 50, 100, and 200 µg/mL each. Cell proliferation and ALP (alka-line phosphatase) activity were measured. The evaluation of growth factors released by PDLCs was also performed by one-way analysis of variance (ANOVA) and Bonferroni's multiple comparison test. RESULTS: Significantly increased proliferation and ALP activity were observed in PDLCs treated with over 25 µg/mL and 50 µg/mL EMDs, respectively. Additionally, treatment of PDLCs with 50 µg/mL resulted in significantly increased release of vascular endothelial growth factor (VEGF) and transforming growth factor (TGF)-β after 24 h and 48 h, respectively. CONCLUSION: EMDs enhance the proliferation and ALP activity of PDLCs, and promote the release of growth factors, including VEGF and TGF-β, from PDLCs. Therefore EMDs could be one of the effective methods for periodontal regeneration.
Cell Proliferation ; Dental Enamel* ; Humans* ; Intercellular Signaling Peptides and Proteins* ; Molar ; Periodontal Ligament* ; Regeneration ; Tissue Engineering ; Transforming Growth Factors ; Vascular Endothelial Growth Factor A ; Young Adult

PURPOSE: Studies reported controversial results about prognosis of root resection with 0%-38% failure rate. The purpose of this study is to consider clinical efficacy of root resection. MATERIALS AND METHODS: This study reported three cases of root resection which were performed on different sites. In first case, lower right first molar showed pus discharge and 7 mm of probing pocket depth. It was diagnosed as fracture of mesial root. Hemisection of mesial root was performed In second case, upper right first molar showed severe bone loss on disto-buccal root and 7 mm of probing pocket. Resection of disto-buccal root was performed In third case, lower left second molar showed severe bone loss on distal root including apex and 15mm of probing pocket depth. Hemisection of distal root was performed. RESULT: In these three cases of root resection, compromised molars were treated successfully and conserved. CONCLUSION: Root resection is a successful procedure treating compromised multi-rooted teeth and conserving teeth when proper case selection is performed.
Molar ; Prognosis ; Suppuration ; Tooth

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.
Alveolar Process ; Bone Regeneration ; Dental Implants ; Incisor ; Keratins ; Membranes ; Molar ; Mucous Membrane ; Transplants

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(r2=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.
Adult ; Male ; Female ; Humans

PURPOSE: In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome. This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double-rotated palatal subepithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect. METHODS: We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. The bone graft materials were filled above the alveolar defect and a titanium-reinforced nonresorbable membrane was placed to cover the graft materials. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture. RESULTS: Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment. CONCLUSIONS: The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and harmonization with the recipient tissue.
Alveolar Process ; Alveolar Ridge Augmentation ; Bone Regeneration ; Bone Transplantation ; Connective Tissue ; Guided Tissue Regeneration ; Humans ; Maxilla ; Membranes ; Middle Aged ; Necrosis ; Palate ; Suppuration ; Surgical Flaps ; Tissue Donors ; Transplants* ; Treatment Outcome

We aimed to evaluate the effects of onlay-type grafted human freeze-dried corticocancellous bone block (FDBB) and deproteinized bovine bone with collagen (DBBC) loaded with Escherichia coli-produced recombinant human bone morphogenetic protein-2 (ErhBMP-2) on space maintenance and new bone formation in rat calvaria. Collagen sponge (CS), FDBB, or DBBC disks (8×4 mm) with ErhBMP-2 (2.5 µg) were implanted onto the calvaria of male Sprague-Dawley rats, whereas CS with buffer was implanted onto the calvaria as controls (n=20/carrier). Rats were killed at 2 or 8 weeks post-surgery for histologic and histomorphometric analyses; total augmented area, new bone area, and bone density were evaluated. At both time-points, all ErhBMP-2 groups showed significantly higher new bone area and bone density than the control group (p<0.05). ErhBMP-2/FDBB and ErhBMP-2/DBBC groups showed significantly higher total augmented area than ErhBMP-2/CS group (8 weeks), and ErhBMP-2/FDBB group showed significantly higher new bone area and bone density than ErhBMP-2/DBBC group (p<0.05). ErhBMP-2/CS group showed the highest bone density (p<0.05). Combining ErhBMP-2 with FDBB or DBBC could significantly improve onlay graft outcomes, by new bone formation and bone density increase. Moreover, onlay-grafted FDBB and DBBC with ErhBMP-2 could be an alternative to autogenous block onlay bone graft.
Animals ; Bone Density ; Bone Substitutes* ; Collagen ; Escherichia* ; Humans* ; Inlays* ; Male ; Osteogenesis* ; Porifera ; Rats* ; Rats, Sprague-Dawley ; Skull ; Space Maintenance, Orthodontic* ; Transplants

Purpose: The aim of this study was to investigate and identify the main causes of periodontal tissue change associated with labial gingival recession by examining the anterior region of patients who underwent orthodontic treatment. Methods: In total, 45 patients who had undergone orthodontic treatment from January 2010 to December 2015 were included. Before and after the orthodontic treatment, sectioned images from 3-dimensional digital model scanning and cone-beam computed tomography images in the same region were superimposed to measure periodontal parameters. The initial labial gingival thickness (IGT) and the initial labial alveolar bone thickness (IBT) were measured at 4 mm below the cementoenamel junction (CEJ), and the change of the labial gingival margin was defined as the change of the distance from the CEJ to the gingival margin. Additionally, the jaw, tooth position, tooth inclination, tooth rotation, and history of orthognathic surgery were investigated to determine the various factors that could have affected anterior periodontal tissue changes. Results: The mean IGT and IBT were 0.77±0.29 mm and 0.77±0.32 mm, respectively. The mean gingival recession was 0.14±0.57 mm. Tooth inclination had a significant association with gingival recession, and as tooth inclination increased labially, gingival recession increased by approximately 0.2 mm per 1°. Conclusions In conclusion, the IGT, IBT, tooth position, tooth rotation, and history of orthognathic surgery did not affect labial gingival recession. However, tooth inclination showed a significant association with labial gingival recession of the anterior teeth after orthodontic treatment.

In implant restorations, it is difficult for the patient to percept any symptoms. In addition, they are absent of shock absorbers, which can lead to mechanical failure if stress distribution is not considered. Since maxillary anterior multiple-implant restorations play a significant role in guiding the functional movement of the mandible by distributing lateral force, it is crucial to form appropriate occlusion. The use of the T-scan system is more advantageous in assessing ‘dynamic occlusion’, such as the change of occlusion over time, the amount of tooth contact during functional movement, and assessing the occlusion in the less-visible posterior teeth. The case is reported as it has satisfactory results in harmonious anterior guidance of a maxillary anterior multiple-implant restoration using T-scan analysis.
Humans ; Mandible ; Prostheses and Implants* ; Shock ; Tooth

Purpose: The aim of this study is to evaluate bone change around the implant in patients who underwent alveolar ridge preservation for implantation in the posterior teeth using radiographic data measuring changes of mesial, distal crestal bone level according to post-implantation, post-final prosthesis delivery and follow-up periods. Materials and methods: In total, 36 implants were placed in 32 patients. The mesial and distal crestal bone level of all the areas where alveolar ridge preservation was performed uses panoramic images taken post-implantation, post-final prosthesis delivery, and follow-up period each was measured and evaluated as a vertical value. The following factors were analyzed: associations between changes of crestal bone level and factors (e.g., age, sex, systemic diseases, dentist, implant location, tooth, bone type, membrane). The statistical analysis was performed using the mean, standard deviation and independent t-test, paired t-test (P < .05). Results: Analysis of crestal bone level differences between periods shows statistically significant differences (P < .05). There was no statistically significant difference when the changes of crestal bone level between post-implantation, post-final prosthesis delivery and follow-up periods were correlated with each factors. Conclusion After alveolar ridge preservation, bone around the implant remained stable during the maintenance period without being affected by the patient and surgical factors, and alveolar ridge preservation is considered a clinically usable procedure.

Purpose: The aim of this study is to evaluate bone change around the implant in patients who underwent alveolar ridge preservation for implantation in the posterior teeth using radiographic data measuring changes of mesial, distal crestal bone level according to post-implantation, post-final prosthesis delivery and follow-up periods. Materials and methods: In total, 36 implants were placed in 32 patients. The mesial and distal crestal bone level of all the areas where alveolar ridge preservation was performed uses panoramic images taken post-implantation, post-final prosthesis delivery, and follow-up period each was measured and evaluated as a vertical value. The following factors were analyzed: associations between changes of crestal bone level and factors (e.g., age, sex, systemic diseases, dentist, implant location, tooth, bone type, membrane). The statistical analysis was performed using the mean, standard deviation and independent t-test, paired t-test (P < .05). Results: Analysis of crestal bone level differences between periods shows statistically significant differences (P < .05). There was no statistically significant difference when the changes of crestal bone level between post-implantation, post-final prosthesis delivery and follow-up periods were correlated with each factors. Conclusion After alveolar ridge preservation, bone around the implant remained stable during the maintenance period without being affected by the patient and surgical factors, and alveolar ridge preservation is considered a clinically usable procedure.