골내결손부에서의치주조직재생 : 증례보고

Transcription

1 ISSN Implantology 2015; 19(4): 228~232 골내결손부에서의치주조직재생 : 증례보고 김설희, 김태일서울대학교치의학대학원치주과학교실 Periodontal Regeneration in Intrabony Defects: A Case Report Sul-hee Kim, Tae-il Kim Department of Periodontology, School of Dentistry, Seoul National University, Seoul, Korea Abstract Intrabony defects are bony defects whose infrabony component affects primarily one tooth. Several surgical approaches are performed for periodontal regeneration of intrabony defects including new bone, cementum, and periodontal ligament. Clinical improvement and histologic evidence of regeneration therapies have been reported; however, limitations in the predictability and effectiveness have also been also reported. Guided tissue regeneration and application of bone replacement grafts, enamel matrix derivative and recombinant human platelet-derived growth factor-bb are reportedly efficacious in regenerating intrabony defects. Defects with a depth >3 mm and a radiographic defect angle <25 degrees were reported to be most appropriate to regenerative procedures. Factors negatively affecting regeneration included smoking and excessive tooth mobility. Proper case selection, patient proficiency in good oral hygiene, and regular supportive treatment are required to maintain long-term results. Regenerative procedures including guided tissue regeneration with bone graft and application of EMD were performed in presented cases. Clinical and radiologic improvements were shown without any complications. Key Words: enamel matrix derivative, guided tissue regeneration, intrabony defect, regeneration Reprint requests: Tae-il Kim Department of Periodontology, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: , Fax: periopf@gmail.com Received for publication: December 16, 2015 Revised for publication: December 19, 2015 Accepted for publication: December 22, 2015 교신저자 : 김태일 (03080) 서울시종로구대학로 101 서울대학교치의학대학원치주과학교실 Tel: , Fax: periopf@gmail.com 원고접수일 : 2015 년 12 월 16 일원고수정일 : 2015 년 12 월 19 일게재확정일 : 2015 년 12 월 22 일 Copyright The Korean Academy of Oral & Maxillofacial Implantology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 228 Implantology Vol. 19 No. 4, 2015

2 서론 증례보고 1. Case 1 대한구강악안면임프란트학회지 19 권 4 호,

3 Case Report A B C D E G F H Fig. 1. (A) Preoperative radiograph. (B) Preoperative clinical lateral view. Narrow interproximal distance is shown. (C) Incision for guided tissue regeneration. (D) The design of 4 membranes. (E) The site of operation was sutured after applying bone graft and membrane. (F) Periapical radiographic view of operation site immediately. (G) Periapical radiographic view after 1 year. (H) Periapical radiographic view after 20 months. Sul-hee Kim et al. : Periodontal Regeneration in Intrabony Defects: A Case Report. Implantology Case 2 ö 230 Implantology Vol. 19 No. 4, 2015

4 A B C D E G F H Fig. 2. (A) Preoperative radiograph. (B) Preoperative clinical occlusal view. Narrow interproximal distance is shown. (C) Incision for guided tissue regeneration. (D) The application of Emdogain in #37 distal area. (E) The site of operation was sutured. (F) Periapical radiographic view of operation site immediately. (G) Clinical occlusal view after 2 weeks. (H) Panoramic radiographic view after 7 months. Sul-hee Kim et al. : Periodontal Regeneration in Intrabony Defects: A Case Report. Implantology 2015 대한구강악안면임프란트학회지 19 권 4 호,

5 Case Report 총괄및고찰 References 결론 1. Papapanou PN, Tonetti MS. Diagnosis and epidemiology of periodontal osseous lesions. Periodontol ; 22: Bowers GM, Chadroff B, Carnevale R, et al. Histologic evaluation of new attachment apparatus formation in humans. Part III. J Periodontol. 1989; 60: Mellonig JT. Human histologic evaluation of a bovine-derived bone xenograft in the treatment of periodontal osseous defects. Int J Periodontics Restorative Dent. 2000; 20: Ridgway HK, Mellonig JT, Cochran DL. Human histologic and clinical evaluation of recombinant human platelet-derived growth factor and beta-tricalcium phosphate for the treatment of periodontal intraosseous defects. Int J Periodontics Restorative Dent. 2008; 28: Reynolds MA, Aichelmann-Reidy ME, Branch-Mays GL, et al. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review. Ann Periodontol. 2003; 8: Aichelmann-Reidy ME, Reynolds MA. Predictability of clinical outcomes following regenerative therapy in intrabony defects. J Periodontol. 2008; 79: Kao RT, Nares S, Reynolds MA. Periodontal regeneration-intrabony defects: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015; 86(2 Suppl): S77-S Sculean A, Pietruska M, Arweiler NB, et al. Four-year results of a prospective-controlled clinical study evaluating healing of intra-bony defects following treatment with an enamel matrix protein derivative alone or combined with a bioactive glass. J Clin Periodontol. 2007; 34: Reynolds MA, Kao RT, Camargo PM, et al. Periodontal regeneration - intrabony defects: a consensus report from the AAP Regeneration Workshop. J Periodontol. 2015; 86(2 Suppl): S105-S Tonetti MS, Prato GP, Cortellini P. Factors affecting the healing response of intrabony defects following guided tissue regeneration and access flap surgery. J Clin Periodontol. 1996; 23: Cortellini P, Carnevale G, Sanz M, et al. Treatment of deep and shallow intrabony defects. A multicenter randomized controlled clinical trial. J Clin Periodontol. 1998; 25: Implantology Vol. 19 No. 4, 2015