* , , * X 30 102 TempbondTM (mucogingival junction, MGJ) X X

Transcription

*
,
, *
X
30
102
TempbondTM
(mucogingival junction, MGJ)
X
X
(presence)
(Image J software)
[1]
[2]
(contact point)
(length of the papilla) [3]
(interdental distance)
(p<0.001)
(bone crest)
(keratinized gingiva)
[4]
[1]
[2]
(p<0.05)
[3]
5mm
X
(
13:269-278, 2008)
X
(interproximal dental
papilla)
1
2
(Black triangle, dark triangle, or black
(gingival col)
hole problem)
: 97
area)
6
15
,
:
: 97
8
20
,
(contact
3-5
: 97
10
16
222 5
E-mail: [email protected]
J Taiwan Periodontol 13. No4. 2008
269
[2]
(cementoenamel junction, CEJ)
6
[3]
[4]
Olsson and Lindhe7
(thin and scalloped)
(thick
2007
9
2007
12
30
8-10
and flat)
20
7
Kurth and Kokich11
5mm
(interdental black triangle)
[Plaque and Gingival index
38%
(Loe & Silness 1963)17]
0
1
(embrasure)
(spacing)
MacGuire12
Kassab and Cohen13
88%
18
64
(crowding)
2:1
65
Tempbond˛
(Kerr dental, West Collins Orange, CA)
50%
90
Chang 14
(mucogingival
junction, MGJ)(
14
)
X
Tarnow et al.2
Dentsply RinnXCP
film holder
X
X
5mm
7mm
Wu et
al.15
X
Chang 16
X
[1]
270
Tempbond™
(Nikon Coolpix
4500, Nikon, New York, USA)
2272*1704
30
JPEG
18-20
5
Image J (NIH
free software)
(
[Generalized Estimating Equations
(GEE) 21,22 ]
)
D3
D1
D4
D1
D2
GEE
D2
D3
(
)
D4
30
78
[
(mean)
28
53.8
150
X
11.5 years]
48
(spacing)
(crowding)
102
(D1)
5.23
(D2)
3.82 0.71 mm
(D3)
4.41
(D4)
1.65
1.63 mm
1.29 mm
0.66 mm(
)
GEE
(D1)
3
5mm
4mm
100%
77.78%
D1
91.49%
mm
6mm
D1
5
D1
7.69%
GEE
(P<0.001)
D1:
(
)
D2:
(D2)
D3:
(
)
mm
4
5mm
3
6
GEE
D4:
(P=0.5781)(
)
271
D1, D2, D3, D4
(mean value)
(mm)
D1
D2
D3
D4
5.23 ± 1.63
3.82 ± 0.71
4.41 ± 1.29
1.65 ± 0.66
(Parameter)
(Estimate)
(SE of Estimate)
D1
-4.775
0.7575
< 0.001
D2
-0.1677
0.3014
0.5781
D3
0.0488
0.1504
0.7485
D4
-0.8667
0.2886
< 0.05
GEE
P
(D1)
3
4
5
6
7
8
9
10
9
20
14
43
2
0
0
0
0
45
0
0
4
4
24
15
8
4
2
57
9
20
18
47
26
15
8
4
2
102
(%)
100
100
77.78
91.49
7.69
0
0
0
0
44.12
(%)
0
0
22.22
8.51
92.31
100
100
100
100
55.88
(D2)
272
3
4
5
6
9
20
14
2
45
6
31
18
2
57
15
51
32
4
102
(%)
60
39.21
43.75
50
44.12
(%)
40
60.79
56.25
50
55.88
(D3)
2
3
4
5
6
7
8
0
6
12
11
11
4
1
45
2
8
14
10
18
5
0
57
2
14
26
21
29
9
1
102
(%)
0
42.86
46.15
52.38
37.93
44.44
100
44.12
(%)
100
57.14
53.85
47.62
62.07
55.56
0
55.88
(D4)
1
2
3
4
10
28
7
0
45
8
32
14
3
57
18
60
21
3
102
(%)
55.56
46.67
33.33
0
44.12
(%)
44.44
53.33
66.67
100
55.88
(D3)
4
6mm
2mm
2
8mm
8mm
(P<0,001)
D4
(P=0.2612)
GEE
D1 5mm
(P=0.7485)(
)
(D4)
D1
3mm
77.78%
6mm
7.69%
D1=5mm
(odds ratio)
(odds) 5.527
GEE
(P<0.05)(
D1
5mm
)
D1
D4
GEE
D1
273
1
Chang14,16,38,39
(diastema)5
Caviton
(GC Coporation, Tokyo, Japan)
23
X
Caviotn
(interdental
black triangle)
MGJ
23
X
24-28
Tempbond TM
29
Tempbond TM
30-34
Tempbond TM
35
X
Tempbond TM
(interdental black triangle)
Tarnow2
X
5
mm
100%
Tarnow2
5mm
X
15,16
al.18
5mm
77.78%(14/18)
Tarnow et al.2
Lee et
98%
X
Wu et al.15
X
Tarnow et al.2
Tarnow
X
Tarnow et al. 2
Wu et al.15
Lee et al.
18,36,37
endodontic sealer (Tubil-
Seal, Kerr dental, West Collins Orange, CA.)
MGJ
(1mm
)
X
endodontic
sealer
274
Chang16
X
TempbondTM
Lee et al.37
Gastaldo 40
5mm
3mm
3mm
1. Kokich VG. Adjunctive role of orthodontic
therapy. In : Newman MG, Takei HH, Klokkevold
PR & Carranza, FA (eds). Carranza's Clinical
Periodontology, 10th edition, pp. Missouri:
Elseiver Inc; 856-870, 2006.
Chang 39
2. Tarnow DP, Magner AW, Fletcher P. The
effect of the distance from the contact point
to the crest of bone on the presence or
(multif-
actorial logistic regression)
absence of the interproximal dental papilla. J
Periodontol, 63: 995-996, 1992.
3. Cohen B. Morphological factors in the
(confounding factors)
pathogenesis of periodontal disease. Brit
Dent J, 107: 31-39, 1959.
4. Cohen B. A study of the periodontal epithelium.
Brit Dent J, 112: 55-64, 1962.
5. Fiorellini JP, Kim DM, Ishikawa SO. The
gingiva. In: Newman MG., Takei HH,
Klokkevold PR & Carraza FA (eds).
GEE
Carranza
5mm
s Clinical Periodontology, 10th
edition, pp. Missouri: Elseiver Inc, 46-67,
2006.
275
6. Lindhe J, Karring T. Anatomy of the
periodontium. In : Lindhe J, Karring T, Lang
NP, eds. Clinical Periodontology and Implant
Dentistry, 3rd ed. Copenhagen: Munksgaard,
19-68, 1998.
7. Olsson M, Lindhe J. Periodontal characteristics
in individuals with varying form of the upper
central incisors. J Clin Periodontol, 18: 7882, 1991.
8. Oschsenbein C, Ross S. A reevaluation of
osseous surgery. Dental Clinics of North
America, 13: 87-102, 1969.
9. Becker W, Oschsenbein C, Tibbetts L, Becker
BE. Alveolar bone anatomic profiles as
measured from dry skulls: clinical ramifications.
J Clin Periodontol, 24: 727-731, 1997.
10. Weisgold A. Contours of the full crown
restoration. Alpha Omegan, 70: 70-77, 1997.
11. Kurth JR, Kokich VG. Open gingival embrasure
after orthodontic treatment in adults:
prevalence and etiology. Am J Orthod
Dentofacial Orthop, 120: 116-123, 2001.
12. McGuire MK, Miller L. Maintaining esthetic
restorations in the periodontal practice. Int J
Periodontics Restorative Dent, 16: 231-239,
1996.
13. Kassab MM, Cohen RE. The etiology and
prevalence of gingival recession. J Am Dent
Assoc, 134: 220-225, 2003.
14. Chang LC. The presence of a central papilla
is associated with age but not gender. J Dent
Sci, 1(4): 161-167, 2006.
15. Wu YJ, Tu YK, Huang SM, Chan CP. The
influence of the distance from the contact
point to the crest of bone on the presence of
276
16.
17.
18.
19.
20.
21.
22.
23.
24.
the interproximal dental papilla. Chang Gung
Med J, 26: 822-828, 2003.
Chang LC. The association between embrasure
morphology and central papilla recession. J
Clin Periodontol, 34: 432-436, 2007.
Loe H, Silness J. Periodontal disease in
pregnancy. I. Prevalence and severity. Acta
Odontologica Scandinavica, 21: 533-551,
1963.
Lee DW, Kim CK, Park KH, Cho KS, Moon
IS. Non-invasive method to measure the
length of soft tissue from the top of the
papilla to the crestal bone. J Periodontol, 76:
1311-1314, 2005.
Attaelmanan A, Borg E, Gronndahl HG.
Digitisation and display of intra-oral films.
Dentomaxillofac Radiol, 29: 97-102, 2000.
Kim TS, Ben DK, Eickholz P. Accuracy of
computer-assisted radiographic measurement
of interproximal bone loss in vertical bone
defects. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod, 94: 379-387, 2002.
Liang KY, Zeger SL. Longitudinal data
analysis using generalized linear models.
Biometrika, 73: 13-22, 1986.
Liang KY, Zeger SL. Regression analysis for
correlated data. Annu Rev Public Health, 14:
43-68, 1993.
Agudio G, Pini Prato GP, Nevins M,
Cortenilli P, Ono Y. Esthetic modifications in
periodontal therapy. Int J Periodontics
Restorative Dent, 9: 288-299, 1989.
Ingber JS. Forced eruption: Part 1. A method
of treating one and two wall infrabony
osseous defects-Rationale and case report. J
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
Periodontol, 45: 199-206, 1974.
Ingber JS. Forced eruption: Part 2. A method
of treating nonrestorable teeth- Periodontal
and restorative considerations. J Periodontol,
47: 203-216, 1976.
Ingber JS, Rose LF, Coslet JG. The
"biological width" - A concept in periodontics
and restorative dentistry. Alpha Omegan, 10:
62-65, 1977.
Ingber JS. Forced eruption: alteration of soft
tissue cosmetic deformities. Int J Periodontics
Restorative Dent, 9: 417-425, 1989.
Ingber JS. Forced eruption. In: Marks MH.
Corn H (eds). Atlas of Adult Orthodontics:
Functional and Esthetics Enhancement.
Philadelphia: Lea & Febiger, 413-447, 1989.
Miller PD, Allen EP. The development of
periodontal plastic surgery. Periodontol 2000,
11: 7-17, 1996.
Shapiro A. Regeneration of interdental
papillae using periodic curettage. Int J
Periodontics Restorative Dent, 5(5): 27-33,
1985.
Beagle JR. Surgical reconstruction of the
interdental papilla: Case report. Int J
1992.
Han TJ, Takei HH. Progress in gingival
papilla reconstruction. Periodontol 2000, 11:
65-68, 1996.
Azzi R, Etienne D, Zarranza F. Surgical
reconstruction of the interdental papilla. Int J
1998.
Tinti C, Parma Benfenati S. The ramp
35.
36.
37.
38.
39.
40.
mattress suture: A new suturing technique
combined with a surgical procedure to obtain
papillae between implants in the buccal area.
Int J Periodontics Restorative Dent, 22: 6369, 2002.
Miller PD Jr. Root coverage using a free soft
tissue autograft following citric acid
application. Part I: Technique. Int J
Periodontics Restorative Dent, 2(1): 65-70,
1982.
Lee DW, Park KH, Moon IS. Dimension of
interproximal soft tissue between adjacent
implants in two distinctive implant systems. J
Periodontol, 77: 1080-1084, 2006.
Lee DW, Park KH, Moon IS. Dimension of
keratinized mucosa and the interproximal
papilla between adjacent implants. J
Periodontol, 76: 1856-1860, 2005.
Chang LC. The central papilla height in
association with age and gender-assessed
with a new method. Chin J Periodontol, 11:
271-279, 2006.
Chang LC. Assessment of parameters
affecting the presence of the central papilla
using a non-invasive radiographic method. J
Periodontol, 79:603-609, 2008.
Gastaldo JF, Cury PR, Sendyk WR. Effect of
the vertical and horizontal distances between
adjacent implants and between a tooth and an
implant on the incidence of interproximal
papilla. J Periodontol, 75: 1242-1246, 2004.
277
Factors influencing the presence or recession
of the interproximal dental papilla
Min-Chieh Chen,
Chiu-Po Chan, Whei-Lin Pan, Yuh-Ren Ju, Yu Fang Liao*
Department of Periodontics, *Craniofacial Orthodontics,
Chang Gung Memorial Hospital, Keelung and Taipei Chang Gung University
The presence of interproximal dental papillae between maxillary anterior teeth is a key esthetic
factor of great concern to dentists and patients. The purpose of this study was to determine the factors
that might influence the presence or recession of the interproximal dental papilla between maxillary
anterior teeth. A total of 102 interproximal sites of maxillary anterior teeth in 30 patients were
examined. Tempbond™ mixed with barium sulfate was applied by a periodontal probe to the tip of the
interproximal dental papillae and mucogingival junction. Periapical films using parallel technique were
taken. The presence of interproximal dental papilla was determined on radiographs. If the tip of the
interproximal dental papilla was at the base of the contact point, the papilla was recorded as being
present. If not, the papilla was considered to be recessed. The radiographs were transferred into a
computer and calibrated and measured with the image J software. The following factors were measured
: [1] the distance from the base of the contact point to the bone crest. [2] The length of the interproximal
dental papilla. [3] The width of keratinized gingiva. [4] The interdental distance. Results revealed that :
[1] The number of interproximal dental papilla present had a significant decrease (p<0.001) when the
distance from the contact point to bone crest increased. [2] The number of interproximal dental papilla
present also had a significant decrease (p<0.05) when the interdental distance increased. [3] The
distance from the contact point to the bone crest was the predominant factor, especially when it was 5
mm. Results also showed that this noninvasive method using radiographs is a reliable guideline for
clinical evaluation of the interproximal dental papilla. To understand better the interaction of different
factors associated with the presence of interproximal dental papilla, further studies are indicated. (J
Taiwan Periodontol 13:269-278, 2008)
Key words: contact area, alveolar bone crest, interproximal dental papilla, keratinized gingiva,
interdental distance, radiography
Received: June 15, 2008 Revised: August 20, 2008 Accepted: October 16, 2008
Address reprint requests and correspondence to: Dr. Min-chieh Chen, Department of Periodontics, ChangGung Memorial Hospital, No.222, Maijin Rd., Keelung, TAIWAN E-mail: [email protected]
278
*
*#
*
*#
*#
*#
*
#
(
13:279-290, 2008)
(open flap debridement)
(resective)
(intra-osseous defect)
Trombelli2
(regenerative)
(bone graft)
1
(progression)
(clinical attachment level)
(periodontal probing depth)
: 97 7
1
,
: 97 9
8
,
: 97 10
16
100
279
18
28
38
48
34
(intraoral
autogenous bone) 3
autogenous
35
21
(extraoral
bone) 4,5
(professional
(decalcified freeze-dried bone allograft
prophylaxis)
DFDBA)6,7
(31-33)
(bovine derived xenograft)
(crowding)
Bio-Oss®
(donor site)
(probing pocket depth)
8
9-10mm
(300
)
37
47
46
5mm
(grade III furcation involvement)
(bleeding on probing)
9
(
7%
37.1
0.7%
)
10
17.8
0.5%
0.111
2.1
21
(secondary caries)
Bio-Oss ®
(hydroxyapatite
DFDBA
HA)
37
46
(
47
(furcational bone loss)
)
12
13,14
(localized severe chronic
periodontitis)
21
35
(Gingival index)
0.28
0.91
(Plaque index)
1.02
0.31
(Bleeding on probing)
8%(
280
)
37
47
32.1%
8-
(initial periapical radiography)
281
37
Phase I periodontal therapy
47
45
46
282
47
(re-evaluation)
8mm
47
46
44-47
incision)
47
47
furcational bone loss
(intracrevicular
(distal extension incision)
Bio-Oss®
47
4-0
(nylon suture, 4-0)
(modified mattress suture)
36
Phase I periodontal therapy
9 mm
37
37
37
36-37
Bio-Oss®
37
9mm
(
37
)
(barrier membrane)
46
4-0
(nylon suture, 4-0)
(unpredictable)
46
283
46
284
(46-47)
45
(open flap debridement)
47
44
47
(ostectomy)
(intracrevicular
incision)
46
(
47
)
47
(distal extension incision) (
-
)
(demineralized bovine xenograft
46
(
)
4-0
Bio-Oss®)
(nylon suture)
(modified mattress suture)
(osteoplasty)
(odontoplasty)
(tunnel preparation) (
37
(
)
(
47
)
-
)
bone fill
amoxicillin
46
7mm
(Plaque index) O'Leary
(Gingival index)
(O'Leary plaque index)
(Bleeding on probing)
285
(500mg
)
(0.12%
chlorhexidine gluconate
)
(guided tissue regeneration)18,19
(platelet-rich plasma)
20
Bio-Oss ®
(supportive
periodontal treatment)
Chen21
(
(plaque control record)
)
37
Bio-Oss®
)
15%
(
Bio-Oss®
(animal model)
47
(bone remodeling)
3-4mm
22
(osseous level)
(
) 37
23
(osteoclastic
47
(bone fill)
(
Bio-Oss®
lacunae)
(vascular channel)
Bio-Oss®
)
24-26
27,28
26,29-31
23,32,33
Skoglund
Oss®
Bio-
6
Stavropoulos34,35
Bio-Oss®
10
25
8-9mm
37
3-4mm
47
46
15-17
3mm
(forced eruption)
286
46
(guided bone regeneration)
46
6.
Bio-Oss®
7.
8.
9.
1. Papapanou PN, Wennstrom JL. The angular
bony defect as indicator of further alveolar bone
loss. J Clin Periodontol, 18:317-322, 1991.
2. Trombelli L, Heitz-Mayfield LJ, Needleman
I, Moles D, Scabbia A. A systematic review
of graft materials and biological agents for
periodontal intraosseous defects. J Clin
Periodontol, 29 Suppl 3:117-135, 2002.
3. Froum SJ, Thaler R, Scopp IW, Stahl SS.
Osseous autografts. II. Histological responses
to osseous coagulum-bone blend grafts. J
Periodontol, 46:656-661, 1975.
4. Schallhorn RG, Hiatt WH. Human allografts
of iliac cancellous bone and marrow in
periodontal osseous defects. II. Clinical
observations. J Periodontol, 43:67-81, 1972.
5. Dragoo MR, Sullivan HC. A clinical and
histological evaluation of autogenous iliac
10.
11.
12.
13.
bone grafts in humans. I. Wound healing 2 to
8 months. J Periodontol, 44:599-613, 1973.
Bowers GM, Chadroff B, Carnevale R, et al.
Histologic evaluation of new attachment
apparatus formation in humans. Part III. J
Periodontol, 60:683-693, 1989.
Bowers GM, Chadroff B, Carnevale R, et al.
Histologic evaluation of new attachment
apparatus formation in humans. Part II. J
Periodontol, 60:675-682, 1989.
Cohen RE, Mullarky RH, Noble B, Comeau
RL, Neiders ME. Phenotypic characterization
of mononuclear cells following anorganic
bovine bone implantation in rats. J
Periodontol, 65:1008-1015, 1994.
Gross JS. Bone grafting materials for dental
applications: a practical guide. Compend
Contin Educ Dent, 18:1013-1036, 1997.
Benke D, Olah A, Mohler H. Proteinchemical analysis of Bio-Oss bone substitute
and evidence on its carbonate content.
Biomaterials, 22:1005-1012, 2001.
Jensen SS, Aaboe M, Pinholt EM, HjortingHansen E, Melsen F, Ruyter IE. Tissue
reaction and material characteristics of four
bone substitutes. Int J Oral Maxillofac
Implants, 11:55-66, 1996.
Valdre G, Mongiorgi R, Ferrieri P, Corvo G,
Cattaneo V, Tartaro GP. [Scanning electron
microscopy (SEM) and microanalysis (EDS)
applied to the study of biomaterials for dental
use]. Minerva Stomatol, 44:55-68, 1995.
Nielsen IM, Ellegaard B, Karring T. Kielbone
in healing interradicular lesions in monkeys. J
Periodontal Res, 15:328-337, 1980.
287
14. Nielsen IM, Ellegaard B, Karring T. Kielbone
in new attachment attempts in Humans. J
Periodontol, 52:723-728, 1981.
15. Oxford GE, Quintero G, Stuller CB, Gher
ME. Treatment of 3rd molar-induced periodontal
defects with guided tissue regeneration. J
Clin Periodontol, 24:464-469, 1997.
16. Kugelberg CF. Periodontal healing two and
four years after impacted lower third molar
surgery. A comparative retrospective study.
Int J Oral Maxillofac Surg, 19:341-345, 1990.
17. Kugelberg CF, Ahlstrom U, Ericson S,
Hugoson A, Thilander H. The influence of
anatomical, pathophysiological and other
factors on periodontal healing after impacted
lower third molar surgery. A multiple
regression analysis. J Clin Periodontol,
18:37-43, 1991.
18. Karapataki S, Hugoson A, Falk H, Laurell L,
Kugelberg CF. Healing following GTR
treatment of intrabony defects distal to
mandibular 2nd molars using resorbable and
non-resorbable barriers. J Clin Periodontol,
27:333-340, 2000.
19. Karapataki S, Hugoson A, Kugelberg CF.
Healing following GTR treatment of bone
defects distal to mandibular 2nd molars after
surgical removal of impacted 3rd molars. J
Clin Periodontol, 27:325-332, 2000.
20. Sammartino G, Tia M, Marenzi G, di Lauro
AE, D'Agostino E, Claudio PP. Use of
autologous platelet-rich plasma (PRP) in
periodontal defect treatment after extraction
of impacted mandibular third molars. J Oral
Maxillofac Surg, 63:766-770, 2005.
288
21. Chen CC, Wang HL, Smith F, Glickman GN,
Shyr Y, O'Neal RB. Evaluation of a collagen
membrane with and without bone grafts in
treating periodontal intrabony defects. J
Periodontol, 66:838-847, 1995.
22. Thaller SR, Hoyt J, Dart A, Borjeson K,
Tesluk H. Repair of experimental calvarial
defects with Bio-Oss particles and collagen
sponges in a rabbit model. J Craniofac Surg,
5:242-246, 1994.
23. Skoglund A, Hising P, Young C. A clinical
and histologic examination in humans of the
osseous response to implanted natural bone
mineral. Int J Oral Maxillofac Implants,
12:194-199, 1997.
24. Hutchens LH, Jr. The use of a bovine bone
mineral in periodontal osseous defects: case
reports. Compend Contin Educ Dent, 20:365378, 1999.
25. Richardson CR, Mellonig JT, Brunsvold MA,
McDonnell HT, Cochran DL. Clinical
evaluation of Bio-Oss: a bovine-derived
xenograft for the treatment of periodontal
osseous defects in humans. J Clin Periodontol,
26:421-428, 1999.
26. Scheyer ET, Velasquez-Plata D, Brunsvold
MA, Lasho DJ, Mellonig JT. A clinical
comparison of a bovine-derived xenograft
used alone and in combination with enamel
matrix derivative for the treatment of
periodontal osseous defects in humans. J
Periodontol, 73:423-432, 2002.
27. Camargo PM, Lekovic V, Weinlaender M, et
al. A controlled re-entry study on the
effectiveness of bovine porous bone mineral
used in combination with a collagen
membrane of porcine origin in the treatment
of intrabony defects in humans. J Clin
Periodontol, 27:889-896, 2000.
28. Paolantonio M, Scarano A, Di Placido G,
Tumini V, D'Archivio D, Piattelli A.
Periodontal healing in humans using
anorganic bovine bone and bovine peritoneumderived collagen membrane: a clinical and
histologic case report. Int J Periodontics
Restorative Dent, 21:505-515, 2001.
29. Lekovic V, Camargo PM, Weinlaender M,
Nedic M, Aleksic Z, Kenney EB. A comparison
between enamel matrix proteins used alone or
in combination with bovine porous bone
mineral in the treatment of intrabony
periodontal defects in humans. J Periodontol,
71:1110-1116, 2000.
30. Velasquez-Plata D, Scheyer ET, Mellonig JT.
Clinical comparison of an enamel matrix
derivative used alone or in combination with
a bovine-derived xenograft for the treatment
of periodontal osseous defects in humans. J
Periodontol, 73:433-440, 2002.
31. Pietruska MD. A comparative study on the
32.
33.
34.
35.
use of Bio-Oss and enamel matrix derivative
(Emdogain) in the treatment of periodontal
bone defects. Eur J Oral Sci, 109:178-181,
2001.
Schlegel AK, Donath K. BIO-OSS--a
resorbable bone substitute? J Long Term Eff
Med Implants, 8:201-209, 1998.
Piattelli M, Favero GA, Scarano A, Orsini G,
Piattelli A. Bone reactions to anorganic bovine
bone (Bio-Oss) used in sinus augmentation
procedures: a histologic long-term report of
20 cases in humans. Int J Oral Maxillofac
Implants, 14:835-840, 1999.
Stavropoulos A, Kostopoulos L, Mardas N,
Nyengaard JR, Karring T. Deproteinized
bovine bone used as an adjunct to guided
bone augmentation: an experimental study in
the rat. Clin Implant Dent Relat Res, 3:156165, 2001.
Stavropoulos A, Kostopoulos L, Nyengaard
JR, Karring T. Fate of bone formed by guided
tissue regeneration with or without grafting
of Bio-Oss or Biogran. An experimental
study in the rat. J Clin Periodontol, 31:30-39,
2004.
289
Treatment of distal circumferential bony defects
around the mandibular secondary molars with
demineralized bovine xenograft - A case report
Yu-Hsiang Chou* Kai-Fang Hu* Kun-Yen Ho*# Yi-Min Wu *#
Chi-Cheng Tsai*# Ya-Ping Ho*#
*Kaohsiung Medical University, Chung-Ho Memorial Hospital, Division of Periodontology
#Faculty
of Dentistry, College of Dental Medicine, Kaohsiung Medical University
Treatment of deep circumferential bony defects around the mandibular secondary molars is a great
challenge to periodontist. The morphology of the bony defect, the amount of the keratinized gingiva,
the depth of the vestibule, and the accessibility for instrumentation are considered as important factors
associated with the clinical outcome of treatment. Many treatment modalities with disparate results had
been reported. We provide a case report that had distal circumferential bony defects around her bilateral
mandibular secondary molars. Demineralized bovine xenograft was grafted into the bony defects after
open flap debridement and thorough root planing. The clinical outcome of the surgery was satisfied as
evaluated by clinical examination including probing depth, attachment level and radiographic bone fill.
In conclusion, the findings of the present case, although based on a small number of observations,
suggested that the enhanced clinical result in the treatment of circumferential defects in consequence of
using demineralized bovine xenograft. Additional studies in a larger number of patients are needed to
determine the predictability of the treatment modality in longevity. (J Taiwan Periodontol 13:279-290,
2008)
Key words: demineralized bovine xenograft mandibular secondary molar circumferential defect
Received: July 1, 2008 Revised: September 8, 2008 Accepted: October 16, 2008
Address reprint requests and correspondence to: Dr. Ya-Ping Ho, Kaohsiung Medical University, Chung-Ho
Memorial Hospital, Division of Periodontology No.100 , Tzyou 1st Road Kaohsiung 807 , TAIWAN
E-mail:[email protected]
290
(idiopathic thrombocytopenic purpura)
13,000/
L
(
13:291-299, 2008)
(idiopathic thrombocytopenic purpura
ITP)
(1)
(thrombocytopenia)
Willebrand's disease
62
(2)von
56
(3)
1
: 97 7
25
,
:97 9 10
,
:97 10
2
235 2F
291
2007
3
1
CBC
2~3
33
APTT
13,000/
47
3
L
450,000/ L
Hb
11.0
APTT
Hct
33.0
(
(
)
)
(
)
(
(
32
3
)
X
)
2
3
9,000/
)
(
292
PT
1
150,000/ L
32
DC
X
(
2
L
)
25
27
33
(
(
)
3
19
4
Urobilinogen
10
)
2007
28
6
7
WBC
Creatinine
(
(
5
)
)
293
CBC
DC
HE
PT APTT
3
1
Sample condition
Accetable
-
-
RBC count
3.89
3.5 ~ 9.1
103/
L
WBC count
6.6
3.8 ~ 4.9
106/
L
Hb
11.0
12.0 ~ 15.0
g/dL
Hct
33.0
35.0 ~ 44.0
%
MCV
84.8
83.8 ~ 98.0
fL
MCH
28.2
28.4 ~ 33.8
pg
MCHC
33.3
33.4 ~ 35.2
g/dL
Platelet count
13
157 ~ 377
RDW
13
11.7 ~ 14.9
%
Neutrophil-S
60.9
39.4 ~ 72.6
%
Lymphocyte
29.7
21 ~ 51
%
Monocyte
7.9
4.60 ~ 11.0
%
Eosinophil
1.1
0.4 ~ 7.6
%
Basophil
0.4
<1.3
%
PT
10.4
9.5 ~ 12.0
sec
I.N.R
0.93
-
-
Control
13
-
sec
APTT
47
25-36
sec
103/
L
-ocytes)
7
2
10
(phagocytic cells)
150,000/
(megakary
294
450,000/ L
L
150,000/ L
( tapering dose)
(96 )
2
Prednisolone 5mg
12
QD
7
3 12
Prednisolone 5mg
7
QD
7
4 9
Prednisolone 5mg
3
QD
21
4 30
Prednisolone 5mg
3
QD
28
5 28
Prednisolone 5mg
1
QD
28
6 25
Prednisolone 5mg
1
QD
7
8 6
Prednisolone 5mg
1
QOD
28
9 3
Prednisolone 5mg
1
QOD
28
3
(96 )
Platelet count(/ L)
3 01
13,000
3 02
9,000
3 19
62,000
4 30
40,000
5 28
157,000
6 25
186,000
8 06
206,000
11 06
299,000
6
7
1
(thrombocytopenia)3
100,000/
L
50,000/
100,000/
L
(thrombocytopenic purpura)
L
50,000/
(petechiae)
L
(hemorrhagic
vesicles)
20,000/
L
4
295
6
7
6
7
(1)
(2)
(3)
1,3,5
(hemolytic uremic syndrome
HUS)
(1)
(decreased bone marrow
(thrombotic
thrombocytopenic purpura
TTP)
(disseminated intravascular coagulation
production)
DIC)
(2)
(thiazide diuretics)
(splenic sequestration)
(heparin)1
(idiopathic thrombocytopenic purpura)
(portal
3,6,7
hypertension)
(leukemia)
(3)
(lymphoma)
(accelerated destruction of
platelets)
296
13,000/
1
3
20
40
L
BT(bleeding time)
1
BT
Hb
Hct
(coombs' test)
1,3
(glucocorticoid)
20,000/
20,000
50,000/
L
L
(prednisolone
1~2mg/kg/day)
(ASH)
3
2/3
60
1
ITP
L3
50,000/
10
prednisolone 60mg
40
(tapering dose)
(myelodysplasia
)3
prednisolone 5mg
60mg
35mg
3
62,000/
40,000
L
5
TTP HUS
19
4
11,12
30
28
DIC
DIC
13
(IVIG)
(anti-RHD)1,3
PT
APTT
ITP
56
60mg
TTP HUS
prednisolone
1
prednisolone
1761
ITP
25%
5%
8
60
9
ITP
297
7. Fotos PG, Graham WL, Bowers DC, Perfetto
SP. Chronic autoimmune thrombocytopenic
14
purpura. A 3-year study. Oral Surg Oral Med
Oral Pathol, 55(6):564-7, 1983.
8. George JN, el-Harake MA, Raskob GE.
Chronic idiopathic thrombocytopenic purpura.
N Engl J Med, 331(18):1207-11, 1994.
9. Frederiksen H, Schmidt K. The incidence of
idiopathic thrombocytopenic purpura in
adults increases with age. Blood, 94(3):90913, 1999.
10. George JN, Woolf SH, Raskob GE. Idiopathic
1. Braunwald E, Fauci SA, Kasper LD, Hauser
thrombocytopenic purpura: a guideline for
LS, Longo LD, Jameson LJ. Harrison's
diagnosis and management of children and
Principles of Internal Medicine. 15th ed,
adults. American Society of Hematology.
McGraw-Hill Co, U.S., pp.358, 745-747,
Ann Med, 30(1):38-44, 1998.
2001.
11. Colman RW, Marder VJ, Clowes AW, Geroge
2. Guyton CA, Hall EJ. Text Book of Medical
JN, Goldhaber SZ. Hemostasis and Thrombosis:
Physiology. 10th ed, W.B. Saunders Co, U.S.,
Basic Principles and Clinical Practice. 5th ed,
pp.419-420, 2000.
Lippincott Williams & Wilkins Co., U.S.,
3. Lichtman AM, Beutler E, Kipps JT,
pp.1613, 2006.
Seligsohn U, Kaushansky K, Prchal TJ.
12. Fenner M, Frankenberger R, Pressmar K,
Williams Hematology. 7th ed, McGraw-Hill
John S, Neukam FW, Nkenke E. Life-
Co, U.S., pp.1749-1770, 2006.
threatening thrombotic thrombocytopenic
4. Carranza AF, Newman GM. Clinical
purpura associated with dental foci. Report of
Periodontology. 8th ed, W.B. Saunders Co,
two cases. J Clin Periodontol, 31(11):1019-
U.S., pp.198, 1996.
23, 2004.
5. Neville WB, Damm DD, Allen MC, Bouguot
13.
J. Oral & Maxillofacial Pathology, 2nd ed,
W.B. Saunders Co, U.S., pp.508-509, 2001.
pp.102,113, 2005.
6. Ripamonti U, Petit JC, Penfold G, Lemmer J.
14. Ripamonti U, Petit JC, Penfold G, Lemmer J.
Periodontal manifestations of acute autoimmune
Periodontal manifestations of acute autoimmune
thrombocytopenic purpura. A case report. J
thrombocytopenic purpura. A case report. J
Periodontol, 57(7):429-32, 1986.
Periodontol, 57(7):429-32, 1986.
298
Gingival bleeding disorders and idiopathic
thrombocytopenic purpura: Case report
Yi-Hung Lin Kuo-Yang Tsai Chia-Ching Chen Jen-Hsin Hsu Chun-Tai Lu
Changhua Christian Hospital
Clinically, we need to exam the oral condition of patients with gingival bleeding disorders.
Otherwise, we should consider their systemic diseases, especially the problems of hemostasis which is
the major cause of gingival bleeding disorders. Once disorders of hemostasis was suspected, we need to
arrange blood tests and consult relative specialists to make sure our diagnosis. The case was idiopathic
thrombocytopenic purpura which caused gingival bleeding. Except the patient
s oral symptoms,
patechiae was noted on the skin of face and extremity, and the platelet count was only 13,000/ L.
After the treatment with steroid prescribed by the hemo-oncologist, the platelet count increased to
normal range, and gingival bleeding disorders also disappeared. (J Taiwan Periodontol 13:291-299,
2008)
Key words: gingival bleeding disorders, idiopathic thrombocytopenic purpura, thrombocytopenia
Received: July 25, 2008, Revised: September 10, 2008, Accepted: October 2, 2008
Address reprint requests and correspondence to: Dr. Lu Chun-Tai, Dental Department, Changhua Christian
Hospital. 135 Nanhsiao Street, Changhua 500, TAIWAN E-mail: [email protected]
299
300
1,3
2,3
1,3
1,3
1,3
1
2
3
#16
#14
#15
#16
X
(
13:301-314, 2008)
2
3,4,5
6
1
: 97
6
13
,
:
: 97
9
4
,
: 97
10
24
199
301
#13
95
7
3
#14
#26
#44
#42
#31
95
#23
9
#11 #12
#13 #21 #22 #23 #24 #25 #32 #31
7,8
(reline)
(rebase)
#41
#42
#43
(occlusal adjustment)
(
94
(
)
#14 #26 #31 #44
#13
#12
#11
#21
#22
#23
#24
#31
#32
#33
#34
#42
#43
#14
#15
#16
#37
#41
#44
#24
#25
#17
#26
#45
#31
#46
#11
#25
#13
#12
#21
#43
#42XX#32#33
#35
#27
#36
#47)
#22
#23
#13
#23 #24 #25 #31 #42
#43
#23 #42
#35 #36
302
#37
#15 #16 #17
#41
#45
#46
#47
(#46)
(#45)
95
7
#44
(#44)
#45
#46
4 x10mm 3I (Implant Innovations, Inc.)
95
7
#44
#45
#46
4x10mm
3I (Implant Innovations, Inc.)
(
)
(
(
)
)
303
(#35)
(#36)
95
8
#35
#36
(#37)
#37
95
#35
4X10mm 3I
(
8
(healing
#37
abutment)
(Implant Innovations, Inc.)
)
96
2
(
95
304
#36
4 x10mm
11
(
)
(
)
)
#16
#14
#15
6mm
(healing
abutment)
(healing
abutment)
(#16)
(#15)
#14
#15
#16
4 X 11.5 mm
(#14)
#14
#15
#16
305
96
9
97
2
X
#14
#15
#16
(osteotome)
(sinus elevation)
macroporous
TM
biphasic calcium phosphate (MBCP ) (Triosite,
(
Zimmer Co.,Rungis,France)
97 2 #14 #15 #16
#14 #15 #16
(Implant Innovations, Inc.)
4 X 11.5 mm 3I
(
(
306
)
)
97
#14
#15
#16
97
)
)
4
(
16
6
(
)
97
X
6
(
)
9
307
97
6
97
6
10,11,12
X
80%
9
13
(recent
myocardial infarction) 18
(valvular prostheses)
308
(severe
renal disorder)
(treatment
- resistant diabetes)
(physical and mental state)
(ethical
19
considerations)
(generalized secondary osteoporosis)
?
(chronic or severe alcoholism)
19
(treatment - resistant
osteomalacia)
(active
radiotherapy)
(severe hormone
deficiency)
(drug addiction)
(motivation)
(desire)
14
20
20
D(Vitamin D) estrogen
Dao
(repair)
15
?
(root form)
16
21
17
Khadivi
Lindhe
18
22,23
?
(realistic need)
(feasible need)
1.5%24
(self-perceived need)
(expressed demand)
25,26,27
309
80
X
0.4mm
1mm 36
1.2mm
25
207
(long contact
37
point)
10
28,29
17,24
22
24
25,28,29,31,32,38,39
30
28,31
25, 31, 32
6,33
(implant
retained and supported prostheses)
(Tongue
hyperactivity)
(centric
occlusion position)
24,28
(Freedom
in centric)
40
(Restorative space)
34
5mm
(Implant supported)
(implant-
retained prostheses)
(interarch distance)
(self-esteem)
17
3
(vertical alveolar ridge augmentation)
4
41,42,43
6
2
1
2
(onlay bone grafts)
(distraction
1
4
6
17
implant )
35
310
Aspen Publication.
40
3. Osterberg T, Mellstrom D. Tobacco smoking
A major risk factor for loss of teeth in three
43,44
70-year-old cohorts. Community Dent Oral
43,44
Epidemiol, 14
367-370, 1986.
4. Osterberg T, Carlsson GE, Mellstrom D, Sundh
W. Cohort comparison of dental status in the
adults Swedish population between 1975 and
1981.Community Dent Oral Epidemiol, 19
(distal free end)
195-200, 1991.
5. Hugosson A, Koch G, Bergendahl T. Oral
health of individuals aged 3-80 years in
Jonkoping,Sweden, in 1973 and 1983.II. A
review of clinical and radiographic findings.
Swed Dent J, 10
175-194, 1986.
6. Nordenram A, Landt H. Oral implants in
X
aged patients. In
Holm Pedersen P, Loe H.
Geriatric Dentistry.Copenhagen,Munksgaard,
PP 353-361,1986.
7. Agerberg G, Carlsson GE. Chewing ability in
relation to dental and general health analysis
of data obtained from a questionnaire.
Odontol Scand , 39
147-153, 1981.
8. Ettinger RL. Diet, nutrition and masticatory
ability in a group of elderly edentulous patients.
Aust Dent J, 18
12-9, 1973.
9. Jabbari Y AI ,.Nagy W N, Iacopino A M.
Implant dentistry for geriatric patients
1. Bailey R, Gueldner S, Ledikwe J, SmiciklasWright H. The Oral Health of Older Adults.
An Interdisciplinary Mandate. J Gerontol
Nurs, 31
11-17, 2005.
2. Martin, W. Oral health in the elderly. Geriatric
nutrition.(2nd ed.) 1999. Gaithersburg, MD.
A
review of the literature .Quintessence Int,
34 281-285, 2003.
10. Henriksson PA, Wallenius K. The mandible
and osteoporosis.1 A quantitative comparison
between the mandible and the radius. J Oral
Rehabil, 1
67-74, 1974.
311
11. Roberts E, Gonsalves M. Aging of bone
tissue. In Holm-Pedersen P, Loe H. Geriatric
Dentistry. Copenhagen, Munksgaard PP 8394, 1986.
12. Holm-Pedersen P. Studies on healing capacity
in young and old individuals (thesis).
Copenhagen Munksgaard, 1973
13. Ship JA, Chavez EM. Management of
systemic diseases and chronic impairments in
older Adults
Oral health considerations.
Gen Dent, 48 557-558, 2000.
14. Chanavaz M. Patient screening and medical
evaluation for implant and prosthetic surgery.
J Oral Implant, 24 222-229, 1998.
15. Dao TT, Anderson JD, Zarb GA. Is osteoporosis
a risk factor for osseointegration of dental
implants? Int J Oral Maxillofac Implants, 8
133-44, 1993.
16. Shernoff A, Colwell JA, Bingham SF. Implants
for type II diabetic patients Interim report.
Implant Dent, 3 183-185, 1994.
17. Zarb GA, Schmitt A. Osseointegration for
elderly patients The Toronto study. J Prosthet
Dent, 72 559-568, 1994.
18. Khadivi V. The impact of cardiovascular
disease on the success rate the surgical phase
of the osseointegration technique (Thesis).
Toronto Faculty of Dentistry, University of
Toronto, 1993.
19. Holm-Pedersen P, Vigild M, Nitschke I,
Berkey DB. Dental care for aging populations
in Denmark,Sweden,Norway,United Kingdom,
and Germany. J Dent Edu, 69 987-997, 2005.
20. Muller F, Wahl G, Fuhr K.Age-related
satisfaction with complete dentures, desire for
312
improvement and attitude to implant treatment.
Gerodontology,11 7-12, 1994.
21. Zarb G, Albrektsson T. Osseointegrated A
requiem for the periodontal ligament? Int J
Periodontics Restorative Dent, 11 88-91, 1991.
22. Lindhe J, Socransky SS, Nyman S, Westfelt
E, Haffajee A.Effect of age on healing following
periodontal therapy. J Clin Periodontol, 12
774-87, 1985.
23. Holm-Pedersen P. Influence of age on tissue
healing. In Worthington P, Branemark P-I,
eds. Advanced osseointegration surgery.
Chicago Quintessence Publishing, PP 4756, 1992.
24. Zarb GA, Schmitt A. The longitudinal clinical
effectiveness of osseointegrated dental
implants The Toronto study Part III
Problems and complication encountered.J
Prosthet Dent, 64 185-194, 1990.
25. Torsten Jemt. Implant Treatment in Elderly
Patients. Int J of Prosthodont, 6 456 - 461,
1993.
26. Zarb G, Schmitt A. Terminal dentition in elderly
patients and implant therapy alternatives. Int
Dent J, 40 67-73, 1990.
27. Kondell PA , Nordenram A, Landt H. Titanium
implants in the treatment of edentulousness.
The influence of patient's age on prognosis.
Gerodontics, 4 280-284, 1988.
28. Zarb GA, Schmitt A. The longitudinal clinical
effectiveness of osseointegrated implants
The Toronto study
Part I
Surgical results.
J Prosthet Dent, 63 451-457, 1990.
29. Zarb GA, Schmitt A. Implant therapy alternatives
for geriatric edentulous patients. Gerodontology
, 10 28-32, 1993.
30. George A. Zarb, Adrianne Schmitt. Osseointegration
immediately placed dental implants-a case
report. Int J Periodontics Restorative Dent,
The Toronto study. J
22 451-461, 2002.
38. Friberg B, Jemt T, Lekholm U. Early failures
of 4641 consecutively placed Branemark
dental implants. A study from stage one surgery
to connection of the completed prostheses. Int
for elderly patients
Prosthet Dent, 72 559-68, 1994..
31. Adell R, Lekholm U, Eriksson B, Branemark
P-I, Jemt T. A long-term follow-up study of
osseointegrated implants in the treatment of
the totally edentulous jaw. Int J Oral
Maxillofac Implants, 5 347-350, 1990.
32. van Steenberghe D, Quirynen L, Callberson
M, Demanet M. A prospective evaluation of
697 consecutive intra-oral fixtures ad modum
Branemark in rehabilitation and edentulism.
J Head Neck Pathol, 6 53-58, 1987.
33. Lewis GR. Aging and the accuracy of jaw muscle
control. Gerodontology, 7 139-144, 1988.
34. Norton MR .Single -tooth implant-supported
restorations. Planning for an aesthetic and
functional solution.Dental update, 28 170175, 2001.
35. Feichtinger M, Gaggl A, Schultes G, Karcher
H. Evaluation of distraction implants for
prosthetic treatment after vertical alveolar
ridge distraction
A clinical investigation.Int
J Prosthodont, 16 19-24, 2003.
36. Salama H, Salama MA, Garber D,Adar P.
The interproximal height of bone a guidepost to predictable aesthetic strategies and
soft tissue contours in anterior tooth
replacement, Prac Periodontics. Aesthet Dent,
10 1131-1141, 1998.
37. Hureler MB, Zuhr O,Schenk G,Schoberer
J Oral Maxillofac Implants, 6 142-146, 1991.
39. Cox JF, Zarb GA. The longitudinal clinical
efficacy of osseointegrated dental implants
A 3-year report. Int J Oral Maxillofac Implants,
2 91-100, 1987.
40. Mericske-Stern R. Overdentures with roots or
implants for elderly patients A comparison.
J Prosthet Dent, 72 543-550, 1994.
41. Muller F, Wahl G, Fuhr K. Age-related
satisfaction with complete dentures, desire for
improvement and attitude to implant treatment.
Gerodontology, 11 7-12, 1994.
42. Van den Bergh LPA, ten Bruggenkata CM,
Tuinzing DB. Preimplant surgery of the bony
tissue. J Prosthet Dent, 80 175-183, 1998.
43. Cordioli G, Majzoub Z, Castanga S. Mandibular
overdentures anchored to single implants A
five-year prospective study. J Prosthet Dent,
78 159-165, 1997.
44. Krennmair G, Ulm C. The symphyseal single
tooth implant for anchorage for a mandibular
complete denture in geriatric patients A
clinical report.Int J Oral Maxillofac Implants,
16 98-104, 2001.
U,Wachtel H,Bolz W.Distraction Osteogenesis
A treatment tool to improve baseline
conditions for esthetic restorations on
313
Multiple implants treatment in an elderly
patient - A case report
Yen-Li Wang1,3 Lin-Ming Yuh2,3 Whei-Lin Pan1,3 Yuh-Ren Ju1,3 Chiu-Po Chan1,3
1Periodontal department, Dental section, Taipei Chang Gung Memorial Hospital
2Prosthodontic
department, Dental section, Taipei Chang Gung Memorial Hospital
3Chang Gung University
With the transition of population structure, there is a marked increase in the ratio of elderly people
in Taiwan society. The elderlies nowadays keep more natural teeth than before. However, with the
request for better life quality, the conventional removable prostheses no longer satisfy their needs of
esthetics and function, and thus osseointegrated implants and fixed prostheses are more commonly
considered for elderly patients. To improve the efficacy of treatment and the satisfaction of elderly
patients, it is necessary to make a comprehensive treatment plan, which takes into consideration of the
patient's physical and psychological conditions, the bone condition, the possible risk of surgery, and the
adaptation after surgery. In this report, an 83-year-old male patient strongly requested to replace the
posterior missing teeth with fixed prostheses. After detailed evaluation, the lower bilateral and upper
right posterior edentulous areas were all restored with implants. In general, the patient was in good
health without any major systemic disease. Six implants were placed at lower bilateral posterior areas.
Sinus lifting procedure was done at #16 area , and three implants (#14, #15, #16) were placed
simultaneously. Full mouth prosthetic treatment was completed and now the patient is under regular
maintenance. Radiographic and clinical examinations after 16 months since the last implant placement
showed that the implants were in good condition. In addition, the patient was very satisfied with both
the esthetics and function of the prostheses. This case report reveals that under meticulous preoperative
evaluation and treatment, elderly patients can adapt to implant rehabilitation well , and attain satisfying
results. (J Taiwan Periodontol 13:301-314, 2008)
Key words: elderly patients, implant, implant-supported prostheses
Received: June 13, 2008 Revised: September 4, 2008 Accepted: October 24, 2008
Address reprint requests and correspondence to: Dr. Chiu-Po Chan, Department of periodontics, Chang Gung
Memorial Hospital, No.199, Tung Hwa N. Road, Taipei, TAIWAN. E-mail [email protected]
314
(insufficient interarch space)
(occlusal vertical dimension)
(crown lengthening procedure)
(
13:315-325, 2008)
(Orthognathic surgery)3
(4)
(increase occlusal vertical dimension)
1,2
: (1)
1,2
(2)
(crown lengthening procedure)
(orthodontic treatment)
: 97 9
30
,
:97 10
(3)
25
,
:97 11
15
901
315
(overjet)
3mm
3mm
X
(
)
/
1.5/1
1/3
#13
#24
#48
#24
32
(
)
#16
#18
#23
#38
#46
#47
#11
#25
#15
#15
#26
#12
#14
#28
#34
#36
#15
#27
#33
#17
#17
#35 #45
(supraeruption)
#33
#21
#15
#13
#17
#22-24
#35
#21
#27
#37
#44
#33-35
#38
(Angle's Class I relationship)
(overbite)
316
5mm
(fixed partial dentures)
4
(fixed partial dentures
combined implant prostheses)
:
(2)
(1)
(oral hygiene instruction)
(2)
#37
(3)
24
#33-35
#22-
(resin restoration) #37
(4)
(provisional
removable partial denture)
(5)
#13
#15
#21
#22
#45
#24
#33
#35
#48
(6)
(7)
#24
#27
#27
#33
#36
#21-25
#13
#35
#46
#22-27
#15
#21
(8)
#47
#48
#46
#33 #35 #45 #13
#15 #21 #22 #24 #27
(9)
#33-35
#36
(3)
#45
(4)
(
)
#47
:
(5)
#13
#15
#21
#24
#27
#33
#35
(
)
(1)
(post&core)
(6)
#48
#36 #46 #47
(7)
(porcelain-fused-to-metal)
(gingival margin)
(
(
/
1/1
)
-25
#22-27
#33-35
#36
#46
)
#21
#45
#47
317
36
318
46
47
3
4.1x12mm SP Straumann ITI
(anchorage)
(miniscrew implant)
(
)
(intrusion)
(8)11
(
)
(
)
319
5:(1)
(cervical perforation)
(2)
(3)
3mm
6,7
(biological width)
Herrero8
#15
/
1/1
11
(Restorative-driven procedure)
11
320
(marginal bone level)
81%
79%
86% 11
0.6mm
(Ferrule
effect)
Libman
9
5mm
Nicholls12
1.5mm
(
/
/
Shillingburg 13
(forced eruption)
10
/
1
(
)
14
3mm
15
GP
1
(
)
3mm
)
(
)
77% 76% 85%
321
Tooth number
13
12
11
21
22
23
Length
10
10
11
10
8.5
9
Width
8.5
7
9
9
7
8.5
W/L
85%
70%
87%
90%
82%
84%
Tooth number
13
12
11
21
22
23
Length
11
9.5
11
11
9.5
11
Width
8.5
7
9
9
7
8.5
W/L
77%
74%
87%
87%
74%
77%
DeLuca22,23
3mm
(
25cy)
16
4mm
(Late implant failure and
/
1
marginal bone loss)
18
19
20
20
21
/
1. Studsukh T-T. Treatment of patient with
severely worn dentition: A clinical report. J
Prosthodont, 16:219-225, 2007.
322
2. Phuong D. Doan, Gary R. Goldstein. The use
2002
of a diagnostic matrix in the management of
12. Libman W, Nicholls J. Load fatigue of teeth
the severely worn dentition. J Prosthodont,
restored with cast post and core and complete
16:277-281, 2007.
crowns. Int J Prosthodont, 8:155-161, 1995.
3. Mopsik ER, Buck RP, Connors JO, Watts LN.
13. Shillingburg HT, Hobo S, Whitsett LD.
Surgical intervention to reestablish adequate
Fundamentals of fixed prosthodontics. 2nd
intermaxillary space before fixed or
ed. Chicago: Quintessence Publishing Co, 19-
removable prosthodontics. J Am Dent Assoc,
20:79-86, 1991.
95(5):957-60, 1977.
4. Walker M, Hansen P. Template for surgical
crown lengthening: Fabrication technique. J
Prosthodont, 7:265-267, 1998.
14. Sorenson J, Martinoff J. Clinically significant
factors in dowel design. J Prosthet Dent,
52:28-35, 1984.
15. Kvist T, Rydin R, Reit C. The relative
5. Simon Y, Sebastiano A. Crown legthening:
frequency of periapical lesions in teeth with
Basic principles, indications, techniques and
root canal retained post. J Endo, 15:578-580,
clinical case report. NY state Dent J,
1989.
70(8):30-6, 2004.
16. Goodacre C, Campagni W, Aquilino S. Tooth
6. Bragger U, Lauchenauer D, Lang NP.
preparations for complete crowns: An art
Surgical crown lengthening of the clinical
form based on scientific principles. J Prosthet
crown. J Clin Periodontol, 19:58-63, 1990.
Dent, 85:363-376, 2001.
7. Herrero F, Scott JB, Maropis PS, Yukna RA.
17. Heasman L, Stacey F, Preshaw PM,
Clinical comparison of desired versus actual
McCracken GI, Hepburn S, Heasman PA.
amount of surgical crown lengthening. J
The effect of smoking on periodontal
Periodontol, 66:568-571, 1995.
treatment response: a review of clinical
8. Wagenberg BD, Eskow RN, Langer B.
Exposing adequate tooth structure for
restorative dentistry. Int J Perio Res Dent,
5:321-332, 1989.
9. Gargiulo A, Wentz F, Orban B. Dimensions
and relations of the dentogingival junction in
evidence. J Clin Periodontol, 33:241-253,
2006.
18. Georgia K. Johnson and Margaret Hill.
Cigarette smoking and the periodontal
patient. J Periodontol, 75:196-209, 2004.
19. Preber H, Bergstrom J. Effect of cigarette
humans. J Periodontol, 32:261-267, 1961.
smoking on periodontal healing following
10. David A, Raphael P, Barry M. Restoring teeth
surgical therapy. J Clin Periodontol,
following crown lengthening procedures. J
Prosthet Dent, 65:62-65, 1991.
17(5):324-328, 1990.
20. Trombelli L, Scabbia A: Healing response of
11. Magne P, Belser U. Chapter 2 in bonded
gingival recession defects following guided
porcelain restorations. Quintessence Pub. Co.
tissue regeneration procedures in smokers
323
and non-smokers. J Clin Periodontol, 24:529533, 1997.
21. Tonetti M. S, Pini Prato G, Cortellini P. Effect
of cigarette smoking on periodontal healing
following GTR in infrabony defects. J Clin
Periodontol, 22:229-234, 1995.
22. DeLuca S, Habsha E, Zarb G. The Effect of
324
Smoking on Osseointegrated Dental
Implants. Part I: Implant Survival. Int J
Prosthodont, 29:491-498, 2006.
23. DeLuca S, Zarb G. The Effect of Smoking on
Osseointegrated Dental Implants. Part II:
Peri-implant Bone Loss. Int J Prosthodont,
29:560-566, 2006.
The application of crown lengthening procedure
and elevation of occlusal plane to create the
interarch space: A case report
Chih-Wen Cheng, Chun-Jung Chen, Lian-Ping Mau* , Jui-Chung Chang** , Iok-Chao Pang**
Dental Department, Chi Mei Medical Center, Liouying campus
*Periodontic Division, Dental Department, Chi Mei Medical Center, Tainan
** Prosthodontic Division, Dental Department, Chi Mei Medical Center, Tainan
It is difficult and complicated to restore a case with insufficient interarch space. The critical factor
of treatment depends upon patient s condition. Therefore, a comprehensive oral examination for
treatment planning is very important. The case reports a female patient who has an insufficient interarch
space due to partial edentulism for a long period of time. Under the prerequisite of maintaining the
original occlusal vertical dimension, crown lengthening procedures were performed on all upper teeth
and lower posterior teeth. To create sufficient interarch space through combination with elevation of
occlusal plane, upper arch was restored with fixed partial dentures and lower arch was restored with
fixed partial dentures and implant prostheses. This simplified method combined with crown lengthening
procedure and occlusal rehabilitation, the problems of insufficient interarch space and gummy smile
were resolved without neither orthodontic treatment nor alteration of the occlusal vertical dimension.
For cases with insufficient interarch space, the preprosthetic treatment planning and cast analysis are the
key elements of success.(J Taiwan Periodontol 13:315-325, 2008)
Key words: crown lengthening procedure, insufficient interarch space, treatment planning
Received: September 30, 2008, Revised: October 25, 2008, Accepted: November 15, 2008
Address reprint requests and correspondence to: Dr. Iok-Chao Pang, Dental Department, ChiuMei Medical
Center 901 Chung-Hwa Road, Yung Kang City, Tainan 710, TAIWAN E-mail:[email protected]
325
326
(
13:327-337, 2008)
pneumatization
1,2
Boyne
: 97
7
17
,
:
: 97
8
16
,
: 97
10
22
5
327
James
3
X
3cmx3cm
4-7
(retention cyst)
Caldwell-Luc lateral window
sinus lifting
Cerasorb
8
Nicolaas M.
1997
SinboneHT
9
Epi-Guide
Augmentin 375 mg
(amoxicillin
328
(A) Panoramic view
(B) Sagittal view
500mg
)
Schneiderian membrane
X
329
(A)Panoramic view
Caldwell-Luc lateral
window sinus lifting
MBCP
PeriAid
A
Augmentin 375 mg
1.2
330
0.8
( B)Sagittal view
A)
5
5
(B)
7
7
B
331
A)Panoramic view
(B)Sagittal view
4-9
332
seromucinous gland
15-19
1.4%
9.6%17,20
self-limited
38%
(31%)
17.6%18
(29%)10
oroantral communication
21
8
15
11
12,13
14
sinus
retention cyst
X
333
7% 35%4,6,22-24
25
23,26
1. Löe H, Anerud A, Boysen H, Smith M. The
natural history of periodontal disease in man.
Tooth mortality rates before 40 years of age. J
Periodontal Res, 13:563- 572, 1978.
2. Laurell L, Romao C, Hugoson A. Longitudinal
study on the distribution of proximal sites
showing significant bone loss. J Clin
Periodontol, 30:346-352, 2003.
3. Boyne PJ, James RA. Grafting of the maxillary
sinus floor with autogenous marrow and
bone. J Oral Surg, 38: 613-616, 1980.
334
4. Jensen OT, Shulman LB, Block MS, Iacono
VJ. Report of the sinus consensus conference
of 1996. Int J Oral Maxillofac Implants,
13(Suppl.):5-45, 1998.
5. Tong DC, Drangsholt M, Beirne OR. A review
of survival rates for implants placed in
grafted maxillary sinuses using metaanalysis. Int J Oral Maxillofac Implants,
13:175-182, 1998.
6. Khoury F. Augmentation of the sinus floor
with mandibular bone block and simultaneous
implantation: A 6-year clinical investigation. Int
J Oral Maxillofac Implants, 14: 557-564, 1999.
7. Hürzeler MB, Kirsch A, Ackermann KL,
Quinones CR. Reconstruction of the severely
resorbed maxilla with dental implants in the
augmented maxillary sinus: A 5-year clinical
investigation. Int J Oral Maxillofac Implants,
11: 466-475, 1996.
8. Devorah Schwartz-Arad, The Prevalence of
Surgical Complications of the Sinus Graft
Procedure and Their Impact on Implant
Survival. J Periodontol, 75:511-516, 2004.
9. Nicolaas M. Maxillary Sinus Function After
Sinus Lifts for the Insertion of Dental
Implants. J Oral Maxillofac Surg, 55:936939, 1997.
10. Christian Beaumont: Prevalence of Maxillary
Sinus Disease and Abnormalities in Patients
Scheduled for Sinus Lift Procedures. J
Periodontol, 76:461-467, 2005.
11. Druce HM: Diagnosis of sinusitis in adults:
History, physical examination, nasal
cytology, echo and rhinoscope. J Allergy Clin
Immunol, 90:436, 1992.
12. Havas TE, Motbey JA, Gullane PJ. Prevalence
of incidental abnormalities on computed
tomographic scans of the paranasal sinuses.
Arch Otolaryngol Head Neck Surg, 114:856859, 1988.
13.Kennedy DW, Zinreich SJ. The functional
endoscopic approach to inflammatory sinus
disease: Current perspectives and technique
modifications. Am J Rhinol, 2:89-96, 1988.
14. Nicolaas M. Timmenga, Maxillary Sinusitis
After Augmentation of the Maxillary Sinus
Floor: A Report of 2 Cases. J Oral Maxillofac
Surg, 59:200-204, 2001.
15. Paparella MM. Mucosal cyst of the maxillary
sinus: diagnosis and management. Arch
Otolaryngol, 77:650-670, 1963.
16. Gardner DG. Pseudocysts and retention cysts
of the maxillary sinus. Oral Surg Oral Med
Oral Pathol, 58: 561-567, 1984.
17. Ruprecht A, Batniji S, El-Neweihi E. Mucous
retention cyst of the maxillary sinus. Oral Surg
Oral Med Oral Pathol, 62:728-731, 1986.
18. Halstead CL. Mucosal cysts of the maxillary
sinus: report of 75 cases. J Am Dent Assoc,
87:1435-1441, 1973.
19. Myall RW, Eastep PB, Silver JG. Mucous
retention cysts of the maxillary antrum. J Am
Dent Assoc, 89:1338-1342, 1974.
20. Rhodus NL. The prevalence and clinical
significance of maxillary sinus mucous
retention cysts in a general clinic population.
Ear Nose Throat J, 69:82-87, 1990.
21. J Skladzien, J A Litwin. Maxillary sinus
polyps secondary to dental extraction. J
Laryngology Otology, 114: 350-253, 2000.
335
22.Kirsch A, Ackermann KL, Hurzeler MB,
Hutmacher D. Sinus grafting with porous
hydroxyapatite. In: Jensen OT, ed. The Sinus
Bone Graft, 1st ed. Chicago: Quintessence
Books, 79-94, 1999.
23.Ziccardi VB, Betts NJ. Complications of
maxillary sinus augmentation. In: Jensen OT,
ed. The Sinus Bone Graft, 1st ed. Chicago:
Quintessence Books, 201-208, 1999.
24.Wannfors K, Johansson B, Hallman M,
Strandkvist T. A prospective randomized
336
study of 1- and 2-stage sinus inlay bone
grafts: 1 year follow-up. Int J Oral Maxillofac
Implants, 15:625-632, 2000.
25. Buiter C: Endoscopy of the upper airways.
Thesis. Amsterdam, The Netherlands,
Exerpta Medica, 1976.
26. Regev E, Smith RA, Perrot DH, Porgel MA.
Maxillary sinus complications related to
endosseous implants. Int J Oral Maxillofac
Implants, 10:451-461, 1995.
Sinus augmentation into sites with mucosal
pathologies of maxillary sinus
Te-Chou Wang Suefang Kung *
Section of Periodontics, Department of Dentistry, Chang Gung Memorial Hospital
*Section of Periodontics, Department of Dentistry, Chang Gung Memorial Hospital/
School of Medicine, Chang Gung University
Sinus augmentation procedures are commonly used to increase bone height and to facilitate
implant placement in the maxillary posterior areas. Mucosal pathologies in maxillary sinuses including
mucosal thickening and retention cysts, associated or not associated with sinusitis, are occasionally
found on the dental radiographs or computed tomographic (CT) films. These are traditionally
considered as contraindications for sinus lifting procedures. This report, however, presents two cases in
which sinus lifting surgery were performed in patients with mucosal pathologies of maxillary sinuses.
The first case presented a 47-year-old female patient with an asymtomatic retention cyst in her left
maxillary sinus. The second case was a 55-year-old male patient presented with bilateral thickened
Schneiderian membrane and mild symptoms of sinusitis. In both cases, sinus lift and grafting
procedures with lateral approach were successfully performed, without subsequent complications in the
sinuses and grafted sites. (J Taiwan Periodontol 13:327-337, 2008)
Key words: Dental implants, sinus augmentation, Schneiderian membrane, retention cyst
Received: July 17, 2008 Revised: August 16, 2008 Accepted: October 22, 2008
Address reprint requests and correspondence to: Dr. Suefang Kung, Department of Dentistry, Chang Gung
Memorial Hospital. 5 Fushin Street, Kweisan, Taoyuan, Taiwan 333. E-mail: [email protected]
337
338
human
gingival epithelial cells
gingival fibroblast
12
4
(
7
14
28
3
12
)
PLA-PGA
3
(2.31mm)
2.6mm
2.47mm
e-PTFE
@@
@@
@@
3@
S5
.Y
1.01mm
1.05mm
e-PTFE
(0.74mm)
PLA-PGA
(
13:339-349, 2008)
1,2,3
;
1980
;
(0.5mm/
: 97
3
13
,
:
: 97
7
4
,
: 97
11
)
24
110
250
339
4
1983
Nyman
Gottlow
11,12,13,14
e-PTFE(expanded-polytetrafloroethene
Postlethwahe 15
)
Nyman
Saleman 16
Gottlow
5,6,7,8
;
17
e-
PTFE
e-
PTFE
Nyman
Locci
DNA
Gottlow
e-PTFE
; Schegel18
8
65
Saleman 16
Johns 19
Millipore
9,10,11
6
10
PLA-PGA
PLA-PGA
(
e-PTFE
)
0.5-lmm
5
7
6
340
8
(
PLA-PGA
)
(24
e-PTFE
wells)
0.3ml
103cell/ml
1.2ml
37
0.004
24
24
well
18
5% CO2
0.5%trypsin
Flowcytometric analysis
2.34*104 RBC/ml
PLA-PGA®
glycolide
trimethylene
carbonate
glycolide
Student t test
3%Glutaraldehyde
90% 95%
lactide
100%
70%
80%
100% and 100%
15
16
24
(S2400
Hitachi
Japan)
e-PTFE
12
expanded- polytetrafluoroethylene
12
(e-PTFE)
4
3
Ketalar(l0mg/kg)
e-PTFE
Pentobarbiturates
2%Lidocaine(1:50000 epinephrine)
12mm
No.15
8mm
well
341
1982
PGA
89.02cells
14.08 6.74 cells
releasing line
cell
gingival epithelial
24
round bur
143.75 cells
CEJ
400 cells e-PTFE
10mm
20,21
(P2)
e-PTFE
PLA-PGA
85.25 cells (
)
24
1
1
(P1)
(Ml)
2
2
(M2)
human gingival fibroblast
:1
2
PLA-PGA
1,21,22
PLA-PGA
PTFE
1
2
e-
4
3
PLA-PGA
n = 3
e-
PTFE
1
4%
fibroblast
human gingival
EDTA solution
PLA-PGA
e-PTFE
1
24
tometric Analysis
2
4
Flowcy24 well
3
human gingival fibroblast cell
624.67
31.52cells
PLA-
PLA-PGA
Flowcytometric Analysis
1.01 mm
e-PTFE
24
gingival epithelial cell
624.67 31.52
143.75 46.37
PLA-PGA
1982
89.02
400 53.21
e-PTFE
14.08
6.74 *
85.25 10.11 *
* : Significant difference , P < 0.05
342
PLA-PGA
24
PLA-PGA
1.05 mm
24
PLA-PGA
PLA-PGA
(x1.0k)
(x1.0k)
e-PTFE
e-PTFE
mm
PLA-PGA
0.9 mm
3
0.74mm
2.6 mm
1
2.47mm
2
PLA-PGA
e-PTFE
2.31mm
4
1
1.05 mm
PLA-PGA
PLA-PGA
2
0.9
e-PTFE
Cementum Height (mm)
Bone height (mm)
1.05
0
PLA-PGA
0.9
0
e-PTFE
0.9
0
2.6
1.01
PLA-PGA
2.47
1.05
e-PTFE
2.31
0.74
343
4
2
3
5
PLA-PGA
23
1
2
24
4
2
4
3
1982
Nyman11
(e-PTFE)
e-PTFE
1
2
4
2
4
3
1
2
Gottlow27
Becker28
Stahl
Froum29
4
3
Karring Nyman23,24,25,26
344
Karring30
Iglhaut31
14
6,20,21,22
21
21
CEJ
10mm
24
e-PTFE
PLA-PGA
(
)
e-PTFE
PLA-PGA
15,16
12
12
Aukhil
0.004
5
3
Blumenthal
3
24
Jansen
1
2
1986
Schmitz 21
4
3
345
PLAPGA
2.6mm
1.01 mm
PLA-PGA
e-PTFE
glycolide
trimethylenecarbonate
glycolide
lactide
24
PLA-PGA
PLA-PGA
4
2
PLA-PGA
4
4
0.9
mm
3
2.47 mm
e-PTFE
3
PLA-PGA
2.6mm
2.47mm
e-PTFE
(2.31mm);
e-PTFE
1.01mm
(0.74mm)
1.05mm
e-PTFE
PLA-
PGA
e-PTFE
e-PTFE
PLA-PGA
e-PTFE
1
2
4
1. Kon S, Ruben MP, Bloon AA, et al.
Regeneration of Periodontal Ligament Using
Resorbable and Noresorabable Membrane
346
2.
3.
4.
5.
6.
7.
8.
9.
:Clinical, Histological, and Histometric Study
in Dog. Int J Periodontics Restorative Dent,
11:59-71, 1991.
Pitura S, Tal H, Soldinger M, et al. Collagen
membranes prevent apical migration of
epithelium during periodontal wound healing.
J Periodontal Res, 22: 331-333, 1987.
Blumental NM. The Use of Collagen
Membranes to Guide Regeneration of New
Connective Tissue Attachment on Dogs. J
Periodontol, 59:830-836, 1988.
Pitura S, Tal H, Soldinger M, et al. Partial
Regeneration of Periodontal Tissues Using
Collagen Barriers. J Periodontol, 59:380-386,
1988.
Aukhil I, Simpson DM, Schaberg TV. An
experimental study of new attachment
procedure in beagle dogs. J Periodontal Res,
18: 643-654, 1983.
Card SJ, Caffesse RG, Smith BA, et al. New
Attachment Following the Use of a Resorbable
Membrane in the Treatment of Periodontal in
Dogs. Int J Periodontics Restorative Dent,
9:59-69, 1989.
Caffesse RG, Nasjieti CE, Morrison EC, et al.
Guided Tissue Regeneration: Comparison of
Bioabsorbable
and Non-Bioabsorbable
Membranes. Histologic and Histometric
Study in Dogs. J Periodontol, 65:583-591,
1994.
Zeilin G, Gritli-Linde A, Linde A. Healing of
mandibular defect with different biodegradable
and non- biodegradable membranes: an experimental
study in rats. Biomaterials, 16:601-609, 1995.
Galgut P, Pitrola R,Waite I, et al. Histological
10.
11.
12.
13.
14.
15.
16.
17.
evaluation of biodegradable and nondegradable membranes placed transcutaneously
in rats. J Clin Periodotol, 18:581-586, 1991.
Hyder PR, Dowell P, Singh G, et al. FreezeDried, Cross-linked Bovine Type 1 Collagen:
Analysis of Properties. J Periodontol, 63;
3:182-186, 1992.
Chaput C, Guirguis S, Leroux JC, et al.
Characterization of thermosensitive chitosan
gels for the sustained delivery of drugs. Int J
Pharm, 203:89-98, 2000.
Francis Suh JK, Howard WT. Application of
chitosan-based polysaccharide biomaterials in
cartilage tissue engineering: a review.
Biomaterials, 21:2589-2598, 2000.
Pack YJ, Lee YM, Park SN, et al. Platelet
derived growth factor releasing chitosan
sponge for periodontal bone regeneration.
Biomaterials, 21:153-159, 2000.
Aiba S, Minoura N, Taguchi C, et al. Covalent
immobilization of chitosan derivatives onto
polymeric film surfaces with the use of
photosensitive hetero-bifunctional crosslinking
reagent. Biomaterials, 8:481-488, 1987.
Postlethwaite AE, Seyer JM, Kang AH.
Chemotactic attraction of human fibroblast to
type I, 11, III collagens and collagen derived
peptides. Proc Natl Acad Sci U S A, 75:817875, 1978.
Saleman E. Biollogy, Biotechnology and
Biocompatibility of collagen. Biocompatibilty
of Tissue Analogs. 1 st ed. Boca Raton,
FLCRC Press, pp.27, 1985.
Locci P, Calvitti M, Belcastro S, et al. Phenotype
expression og gingival fibroblast cultured on
347
18.
19.
20.
21.
22.
23.
24.
25.
348
membrane used in guided tissue regeneration.
J Periodontol, 68 :857-863, 1997.
Schegel AK, Mohler H, Busch F, et al.
Preclinical and clinical studies of a collagen
membrane (Bio-Gide). Biolmaterials, 18:535538, 1997.
Johns LP, Merritt K, Agrarwal S, et al.
Immunogenicity of a bovine collagen
membrane in guided tissue regeneration. J
Dent Res, 71:298, 1992.
Fine A, Goldstein R H. The effect of
transforming growth factor B on cell
proliferation and collagen formation by lung
fibroblasts. J Biol Chem, 262: 3897-3902,
1987.
Schmitz JP, Hollinger JO. The critical size
defect as an experimental model for
craniomandibulofacial nonunions. J Clin
Orthod, 205:229-308, 1986.
Alberius P, Dahin C, Linde A. Role of
osteopromotion in experimental bone grafting
to the skull: A study in adult rats using a
membrane technique. J Oral Maxillofac Surg,
50:829-834, 1992.
Karring T, Nyman S, Lindhe J, et al. Healing
following implantation of periodontitis
affected roots into bone tissue. J Clin
Periodotol, 7:96-105, 1980.
Nyman S, Karring T , Lindhe J, Planten S, et
al. Healing following implantation of
periodontitis affected roots into gingival
connective tissue. J Clin Periodotol, 7:394401, 1980.
Karring T, Isidor F, Nyman S, Lindhe J, et al.
New attachment formation on teeth with a
26.
27.
28.
29.
30.
reduced but healthy periodontal ligament. J
Clin Periodotol, 12:51-60, 1985.
Nyman S, Gottlow J, Karring T, Lindhe J, et
al. The regenerative potential of the
periodontal ligament. An experimental study
in the monkey. J Clin Periodotol, 9:257-265,
1982.
Gottlow J, Nyman S, Karring T, Lindhe J, et
al. New attachment formation as the result of
controlled tissue periodontium by guided
tissue regeneration. J Clin Periodotol,
11:494-503, 1984.
Becker W, Becker B, Prichard R, et al. Root
isolation for new attachment procedure: a
surgical and suture method. Three case
reports. J Periodontol, 58: 819-826, 1987.
Stahl S, Forum S, Tarnow D, et al. Human
histological responses to guided tissue
regenerative techniques in intrabony lesions.
Case reports on 9 sites. J Clin Periodotol,
17:191-198, 1990.
T. Karring, S. Nyman, J. Lindhe, and M.
Silirat, et al. Potentials for root resorption
during periodontal wound healing. J Clin
Periodotol, 11: 41 52 ,1984.
31. J. Iglhaut, I. Aukhil, D. M. Simpson, M. C.
Johnston, and G. Koch, et al. Progenitor cell
kinetics during guided tissue regeneration in
experimental periodontal wounds. J
Periodontal Res, 23:107 117, 1988.
Biological evaluation of periodontal
regenerative barriers
Ching-Kai Lin Jen-Chang Yang* Nai-Chia Teng* Yu-Hwa Pan Wen-Hsiang Hsu*
Haw-Ming Huang* Wei-Jen Chang*+
Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
*College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
+Department of Dentistry, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
This study was to examine the historical changes of implanted three commercial GTR (Guided
Tissue Regeneration) membranes for confirming the clinical feasibility in vitro and vivo. Among the
resorbable GTR membranes, the collagen membrane is collagen base, and the PLA-PGA membrane is
synthesized membrane, while the e-PTFE (Expanded polytetrafluoroethylene) is synthesized but nonresorbable. The membrane material was placed on the bottom of the hole of prepared culture well, then
2 culture wells were assembled to a study device by silicone sealing. And all of devices were placed in
24 wells culture plate. After 24 hours incubation, flowcytometric analysis was performed to measure
the numbers of cells in the collection. Membranes were observed at SEM on both up-side and downside. Then Beagle dogs were used as animal model. Buccal mucoperiosteal flaps were reflected in the
bilateral mandibular premolar and molar areas. Buccal alveolar bone was reduced on 1st and 2nd
premolar and molar to a level 5 mm apical to the cemento-enemel junction (CEJ). Root surface was
denuded of periodontal ligament and cementum, and notches were placed at the bone level of each root.
The tested GTR barriers were implanted in critical bone defect areas. Flaps were coronally positioned
and sutured. Two beagle dogs were sacrificed each time as the designed time period after surgery.
Histological and histometirc evaluation at 7 days , 14 days, 28 days, 3 months were performed postoperatively to determine the healing response of each treatment modality. Both the cementum height
and bone height were measured as the index of tissue occlusion effect. Like all resorbable GTR
membrane, the collagen membrane and the PLA-PGA membrane were observed membrane resorption
and cells infiltration in the fibril network after 24 hours incubation. But the collagen membrane and the
PLA-PGA membrane enhanced the cementum regeneration of 2.6mm and 2.47mm averagely after
3months implantation. On the contrast, cementum height of 2.31 mm was observed in e-PTFE group.
The collagen membrane and the PLA-PGA membrane seemed to be efficient in treatment of Guided
Tissue Regeneration. (J Taiwan Periodontol 13:339-349, 2008)
Key words: Guided Tissue Regeneration Periodontal membrane
Received: March 13, 2008 Revised: July 4, 2008 Accepted: November 24, 2008
Address reprint requests and correspondence to: Dr. Wei Jen Chang, College of Oral Medicine, Taipei
Medical University, 250 Wu Shin Street, Taipei 110, TAIWAN E-mail: [email protected]
349
350
SP1
Clinical Applications of Emdogain®
Dr. Hidetaka Kimura
Enamel matrix proteins (Emdogain®) has multiple uses in reconstructive dentistry. Above all
Emdogain®, which is thought to be regenerate periodontium destroyed by periodontitis, provide
sufficient outcomes as a treatment technique to intrabony defect.
This presentation will present some cases in which Emdogain was applied to periodontal
regenerative therapy for the patients with severe periodontitis. The indication for Emdogain treatment
will be also described.
351
SP2
Soft Tissue Management Using Root Coverage
Dr. Tomoko Takeda
Private practice since 1987, currently at Shimokitazawa
Graduated from Tokyo Dental Collage in 1981
Graduated from New York University Perio-Implant CED in 2004
Certified dentist of Japanese Academy of Clinical Periodontology in 2004
Certified instructor of ISCD in 2007
Affiliated with AAP, JACP, JSP, Japanese Society of Oral Implantology and International Society
of CAD /CAM Dentistry
Gingival recession, root exposure, wedge-shaped defect and hyperesthesia often found in daily
clinical are caused by attached gingival deficiency, highly-placed frenum, vestibular narrowing or
cacoethic brushing. Annals of Periodontology” (AAP) was published in 1996 based on the concept
that Periodontal Plastic Surgery has been developed in order to solve above-mentioned problems. This
book defines that it is a periodontal surgical procedure to correct or prevent anatomical, embryologic,
traumatic morphologic defect or the one caused by periodontal treatment.”
Root coverage has been developed for the purpose of remedying root exposure having some
problems by using periodontal plastic surgery. Especially in recent years, needs for dental esthetics is
drastically increasing. Combined with needs for root coverage that can get patients satisfaction in a
short period of time, various procedures have been considered and developed. During the early stages it
was to prevent gingival recession rather than to cover the root. However, the ratio of coverage has
increased to 90% since 1980 by using connective tissue implant. At the same time the purpose has
changed from just covering the root to also obtaining new attachment.
Even now there are various procedures newly reported in order to be more esthetic and regenerate,
not only applying them to exposed root but also applying as one of the procedures before prosthesis
including implant.
This time, I would like to weigh various root coverage procedures and on that basis I would also
like to weigh the pros and cons of soft tissue management for natural dentition as well as implant by
using root coverage that I am now engaged on. And also, please let me hear your opinion.
352
BR1
Preparation of Periodontal Board: Oral Test
353
SP3
Digital Photography and Intraoral Technique
Dr. Paul P. Lin
Dr. Ruey-Cheng Yu
354
SP4
2008
Periodontal Treatment Needs and Developing Program in National Health Insurance in Taiwan 2008
Dr. Hongmin Lai
Indiana
Diplomate
Dr. Yen-Ting Chen
18
99%
60%
2007
15-29%
48
(91004C)
(needs)
(demands)
355
CE1
Evidence-Based Medicine for Decision Makings in Periodontal Regeneration
Dr. Suefang Kung
/
UCLA D.D.S.
UCSF M.S.
Evidence-Based Medicine (EBM) is the integration of best available evidences, clinical expertise
and patient value in medical practice. It is also a set of procedures, pre-appraised resources and
information tools to assist practitioners to apply evidence from research in the care of individual
patients. The aims of this presentation are to introduce the basic knowledge in Evidence-based
Medicine and to discuss the application of EBM strategies in our everyday practice in periodontal
therapy. The first part is to introduce objectives and methods of EBM, along with the history of EBM
and Cochrane collaboration. We will then illustrate a well-built clinical situation which is related to
periodontal regeneration in periodontitis patient. Methods in literature search and evidence evaluation
will be carried out to demonstrate the EBM strategies in making decisions in each step of treatment.
The essential resources are also listed for future use by EBM practitioners.
356
CE2
The Use of Collagen Membrane in GTR/GBR and Case Discussion
Dr. Hsein-Kun Lu
Professor, College of Oral Medicine, Taipei Medical University.
Chair of Councilor Board, Association for Dental
Science Research, Taiwan.Supervisor, Academy of Periodontology, Taiwan.
e-PTFE
(GLA
GPA)
20
e-PTFE
GLA
GPA
Collagen membrane needs allogenic graft as be the support in GTR/GBR technique. The
unique character of tissue integration is the best part of the reason for using collagen membrane in
GTR/GBR. It is simple, straight forward, predictable, and no need for suturing and secondary intention.
357
CE3
Application of Tissue Engineering and Gene Therapy for Regeneration
Dr. Hen-Li Chen
Oral Health Sciences
Doctor of Philosophy
Tissue engineering and gene therapy are emerging fields of biomedicine. Tissue engineering
approach uses cells, scaffolds, and signals individually or in combination for regeneration. Gene
therapies exert their therapeutic effects via modification of the genetic material of the cells. The use of
protein-base signals suffers from short half life in vivo. Gene therapy can be used for sustained release
of signals. With the extraordinary advances made in tissue engineering and gene therapy studies in
recent years, their impact on dentistry has become more and more significant. The purpose of this
presentation is to introduce the current status of tissue engineering and gene therapy studies in dentistry,
especially for periodontics. The basic principles and approaches in tissue engineering and gene therapy
will be reviewed. Our studies in craniofacial bone regeneration, periodontal regeneration and periimplant healing will be reported as examples. Though tissue engineering and gene therapy are mostly
during animal study stage, their application in dental practice is expected to come within the next ten
years.
358
CE4
Stem Cells for Periodontal Therapy
Dr. Kuo Yuan
(ABP Diplomate
359
CE5
Contemporary Treatment Modalities for Periodontally Compromised Dentition
Dr. Bor-Jian Chen
TUFT
360
CE6
Updates of Socket Preservation: Histological Evidences at Different Timing of Grafting
Dr. Cheng-Sheng Ho
(Fellowship)
(site development)
(osteoinductive)
(osteoconductive)
6
9
1
2
2
6
3
6
(bone grafting)
361
CE7
Non-Surgical Ridge Augmentation in Esthetic Zone: Indications and Limitations
Dr. Yu-Min Cheng
To achieve an optimal esthetic result in esthetic zone for implant rehabilitation has been quite
challenging surgically and restoratively ever since. The treatment outcome is always limited esthetically
if the previous dentition had been periodontally compromised. Even if several surgical procedures had
been performed to correct the ridge deformity, the Pink esthetics is usually jeopardized. Enhancing
the ridge topography at/before tooth extraction for future implant placement is necessary to achieve
better esthetic outcome. The efficacy of tooth movement to correct periodontal defect has been well
documented. By utilizing extrusive tooth movement, one can predictably enhance the volume of the soft
tissue as well as the vertical height of alveolar bone without surgical intervention prior to implant
surgery. Thus, a favorable outcome could be expected. This presentation will address
1. Strategy for single implant vs. multiple implants placement within esthetic zone.
2. Efficacy of extrusive tooth movement for implant site development and it's clinical applications.
3. Limitations of extrusive tooth movement for implant site development.
362
CE8
Preservation of Implant / Failing Implant: Role of Soft / Hard Tissue
Dr. Chuen-Chyi Tseng
ITI
Dr. Yi-Min Wu
Dental implant plays an important role in oral rehabilitation. Like natural dentition, dental implant
is surrounded by soft tissue and hard tissue in oral cavity. Solid foundation and rigid peri-implant seal is
critical to dental implant for a long-term successful implant therapy. How to preserve and create implant
site in a desirable situation of soft and hard tissue is an important issue in clinical practice. The aim of
this presentation will focus on the role of soft / hard tissue on the preservation of implant and failing
implant. The content of this report will include: 1. The role of soft / hard tissue in natural dentition and
implant therapy; 2. To preserve and/or create implant site for implant therapy and implant esthetic; 3.
To maintain the hard tissue for implant long-term purpose; 4. The role of keratinized mucosa in
maintaining the peri-implant health.
363
CE9
Current Management of Peri-Implantitis
Dr. Chi-Chou Huang
(
(
)
,
)
Dr. Lang 2003
364
CIST
RF1-1
The Role of Elastin in the Molecular Mechanism of Gingival Keratinization
RF1-2
4
The Effect of Intraosseous Adenovirus-mediated BMP4 Gene Therapy on
Dental Implant Stability
RF1-3
PGE2
The Effect of Addition of Lipopolysaccharide (LPS) and Prostaglandin E2
(PGE2) on the Osteoblast-like Cells
RF1-1
RF2-2
RF3-1
RF3-2
RF3-3
RF3-4
The Existence of Mesenchymal Progenitors in Primary Human Gingival
Fibroblast-like Cell Populations
The Expression of Toll-like Receptors in Human Gingival Epithelium
The Relationship between General Bone Mineral Density and Oral Condition in
Taiwanese
Correlations of Coronary Artery Calcification and Periodontal Status
Changes of Periodontal Status in Patients Undergoing Bone Marrow Transplantation
Evaluation of anatomic structures of maxillary sinus for implant therapy
RF3-5
Reconstruction and Localization of Mandibular Foramen Using CT Image in
Taiwanese
RF3-6
Resonance Frequency Analysis Measurements of ITI Implant Primary Stability
at Implant Placement Surgery
RF3-7
Correlation between gingival biotype and clinical esthetic features in Taiwanese
young adults
RF3-8
Factors Influencing the Presence or Recession of the Interproximal Dental Papilla
365
RF4-1
RF4-2
RF4-3
RF4-4
RF4-5
RF4-6
Diagnosis and Management of Cemental Tears of Mandibular Molars: Report of
Two Cases
Hereditary Gingival Fibromatosis: A Case Report
Signs and Symptoms of Localized Periodontal Destruction over Upper Anterior
Due to Iatrogenic Application of Elastic Band: Report of Three Cases
Dental Treatment for
Traumatically Injured Patient: A Case Report
The Internal Tooth Resorption Following EDTA Surface Treatment and
DFDBA/ Enamel Matrix Derivative Regenerative Surgery: A Case Report
Treatment of a Combined Periodontic-Endodontic Lesion- A Case Report
RF4-7
Bone Cavity Formation Following Extraction of a Mandibular Molar with
Pulpal-Periodontal Combined Lesion: Report of Two Cases
RF4-8
Guided Tissue Regeneration in the Treatment of Combined Large Periapical and
Marginal Lesions: Report of Cases
RF4-9
Autogenous Tooth Transplantation and Dental Implant for Oral Rehabilitation in
Adult Patients: A Clinical Report
RF4-10
RF4-11
Interdisciplinary Treatment of Periodontics, Orthodontics, Prosthodontics, and
Implantology for a Patient with Generalized Severe Chronic Periodontitis: A
Case Report
Narrow Diameter Implant in Limited Space: A Case Report
,
RF4-12
366
Computed Tomography Aided Surgical and Prosthetic Treatment Planning for
an Implant-supported Overdenture in Severely Atrophic Edentulous Mandible:
A Case Report
RF4-13
RF4-14
:
The Combination of Sinus Lift and Vertical Ridge Augmentation with Titanium
Mesh: A Case Report
Early Implant Placement in Esthetic Zone: A Case Report
RF4-15
Combination of Soft Tissue Graft, Bone Substitute plus Regenerative
Membrane, and Frenumnectomy to Enhance Anterior Implant Region Esthetics:
Report of Two Cases
RF4-16
Significant Increase of Serum Amylase Level after Dental Implantation: A Case
Report
RF4-17
RF4-18
RF4-19
RF4-20
Open Sinus Lifting in Atrophic Maxillae: A Case Report
Ridge-splitting Technique with Simultaneous One-Stage Implant Placement for
the Rehabilitation of Deficient Mandibular Edentulous Ridge: A Case Report
Management of Peri-Implantitis Caused by Residual Cement: A Case Report
:
Hereditary Gingival Fibromatosis: Two Cases Report
367
RF1-1
The Role of Elastin in the Molecular Mechanism of Gingival Keratinization
Tzu-Yuan Hung, Po-Chen Hsieh, Chia-Wen Chang, Tung-Yiu Wong, Shih-Chung Liao,
Chi-Chou Huang, Kuo-Yuan
National Cheng Kung University, Medical Collage, Institute of Oral Medicine, Tinan
(elastin)
K1
K4
K10
K13
transwell
elastin
K4
(KGF
elastin
(NOK)
KGF
K13
NKGF)
organotypic culture
NKGF
elastin
elastin
neutrophil
elastase
NOK
matrix metalloproteinase-
12 (macrophage elastase; MMP-12)
elastin
K4
K13
culture
transwell
NKGF
elastin
neutrophil
elastase
NOK
MMP-12
K4
elastin
elastin
organotypic
K13
elastin
elastin
elastase
368
elastin
elastin
RF1-2
The Effect of Intraosseous Adenovirus-mediated BMP4 Gene Therapy on Dental
Implant Stability
0
Nai-Chai Kuo, 0 Yu-Lin Lai, Hen-Li Chen
Department of Periodontology, Taipei Veterans General Hospital, Taiwan
Department of Dentistry, National Yang-Ming University, Taiwan
4 (bone morphogenetic
protein-4, BMP4)
BMP4
BMP4
1
(LacZ
0
4
BMP4
4
)
8
8
BMP4
BMP4
BMP4
BMP4
4
369
RF1-3
PGE2
The Effect of Addition of Lipopolysaccharide (LPS) and Prostaglandin E2 (PGE2)
on the Osteoblast-like Cells
0
( )
Yung-Ting
Chi-Cheng Tsai
Department of Periodontology, Faculty of Dentistry, Kaohsiung Medical University, Kaohsiung
Hsu, 0
(PGE2)
RANKL
OPG
OPG
RANKL
(PGE2)
RANKL OPG
MC3T3E1 cells
Collagen
g/ml
)
2.5
37
5
CO2
E. coli LPS 0.1
g/ml
PCR(RT-PCR)
24hr
48hr
flexible plate(Bioflex Culture Plateg/ml
72hr
1
g/ml
mRNA
RANKL OPG
PGE2
RANKL
OPG
RANKL
PGE2 2.5
g/ml
RANKL
370
g/ml
(0.1
OPG
g/ml
1
g/ml)
OPG/RANKL
LPS
OPG/RANKL
OPG
g/ml
PGE2 2.5
PGE2 1
PGE2 1.25
PGE2
RANKL
OPG
PGE2
RF2-1
The Existence of Mesenchymal Progenitors in Primary Human Gingival Fibroblastlike Cell Populations
1
1
1
1
1
2
2
Woei-Yean Khoo, 1 Chun-Li Chen,1 Chien-Mei Liu,1 Lein-Tuan Hou,1 Bu-Yuan Liu2
1Graduate Institute of Dental Sciences and Department of Periodontology
2Department of Oral Pathology, School of Dentistry, College of Medicine, National Taiwan University
Background: Recently, the discovery of multipotent stem cell populations residing in periodontal
ligament (PDL) and dental pulp provides exciting prospects of resource for periodontal or tooth
regeneration. The expense of a tooth and difficulty in cultivating PDL and pulp cells, however, hinders
the clinical application of PDL and pulp cells in tissue engineering for repairing dental tissues. In
contrast, gingival cells could be easily harvested and expanded in vitro. Furthermore, gingiva has been
reported to develop from an ectomesenchymal origin rather than a mesenchymal one, and
ectomesenchymal stem cells are believed to be pluripotent during early development. Thus, the possible
existence of ectomesenchymal stem cells in gingiva makes it of great importance to investigate the
putative stem cell or progenitor cell populations in gingival fibroblasts. The purpose of this study is through
flow cytometry and induced differentiation to prove the existence of putative stem cell populations in gingiva.
Materials and Methods: Gingival fibroblast-like cells (GFs) from 5 subjects were isolated. The cell
characterization and induced osteogenic and adipogenic differentiations of these 5 gingival fibroblastlike cells were analyzed and demonstrated by the flow cytometry, and molecular as well as
immunohistochemical methods.
Results: In this study, we observed all 5 primary human GFs expressed high level of mesenchymal
stem cell markers, such as CD29, CD90, CD44 and CD105, whereas they showed distinctly low levels
of dental-origined stem cell markers, such as Stro-1 and CD146. Although we did notice substantial
difference in differentiation potentials between GFs form different individuals, all of them demonstrated
the potentials to differentiate into at least one mesenchymal lineage, including osteoblasts or adipocytes.
Conclusions: We speculate that primary human GFs comprise of not only fibroblasts but also
mesenchymal progenitor cells (MPCs) of osteogenic and adipogenic lineages and possibly some
mesenchymal stem cell (MSCs), to some extent. These observations provide clues in clinical
applications of gingival cells in cell-based regeneration for dental tissue repair in future.
371
RF2-2
The Expression of Toll-like Receptors in Human Gingival Epithelium
1
1
1
1
2
1
2
YC Chen,
1
TY Hu,1 CM Liu,1 JH Jeng,1 CC Ku2
1Graduate
Institute of Dental Sciences and Department of Periodontology, School of Dentistry
2Graduate
Institute of Immunology, College of Medicine, National Taiwan University
Background: Epithelial lining of the skin and digestive tract is the first physical barrier against the
invasion of various overlying microflora. The epithelium also actively interacts with our immune
system to maintain an optimal immune response. The emerging roles of Toll-like receptors (TLRs) in
the development of chronic periodontitis prompt us to study the TLRs expression in gingival tissues and
their activation in gingival epithelial cells.
Materials and Methods: Human gingival tissues were collected from periodontally diseased and sound
subjects (n=7 for each group). The expression of TLR4 and TLR9 were detected by immunohistochemical
(IHC) staining. The expression of type I interferons and IL-8 in the Ca9-22 gingival epithelial cells
upon activation of TLRs was measured with real-time PCR.
Results: The expression of TLR4 and TLR9 was up-regulated in diseased gingiva by immunohistochemical
analysis. Correspondingly, an increased frequency of nuclear translocation of nuclear factor- B (NFB), a hall-mark of TLRs signaling, was observed. Stimulation of Ca9-22 epithelial cells by ODN
2216, an activating ligand of TLR9, increased the transcription of Type I and Type II Interferon genes.
Therefore, the activation of TLR9 in human gingival epithelium may cause increased secretion of
Interferon- , - , and invading pathogens.
, which may contribute the activation of host defense mechanism against
Conclusions: Our data indicate that gingival epithelial cells express functional TLR4 and TLR9, which
can be activated by ligands derived from periodontal pathogens to mediate cytokine gene expression.
These events can be crucial in the pathogenesis of periodontal diseases.
372
RF3-1
The Relationship between General Bone Mineral Density and Oral Condition in
Taiwanese
Pang-Ning Chuang, Ching Tong
Division of Periodontics, Department of Dentistry, Taichung Veterans General Hospital.
(BMD-bone mineral density)
39
al.1999
6
0
X
1
2
Klemetti et al.1994
45
Jowitt et
(MCI-
mandibular cortical index)
373
RF3-2
Correlations of Coronary Artery Calcification and Periodontal Status
01
3
1
1,2
1,2
1,2
2
2
3
Chen-Kang Wu, 0 1 Tsung-Hsien Lin,3 Kun-Yen Ho,1,2 Yea-Pyng Ho,1,2 Chi-Cheng Tsai,1,2
Kai-Fang Hu,2
1Faculty
of Dentistry, College of Dental medicine
2Division
of Periodontics, Department of Dentistry
3Division
of Cardiology, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan
cytokines
MMP
fibrinogen
30
16
PPD(probing pocket
depth) CAL(clinical attachment level) BOP(bleeding on probing)
Agaston score
4 mm
374
RF3-3
Changes of Periodontal Status in Patients Undergoing Bone Marrow Transplantation
Te-Chou Wang,
Hwey-Chin Yeh
Department of Periodontics, Devision of Dentistry, Lin-Kou Medical Center, Chang Gung Memorial
Hospital
Background: The immune system could be destroyed and replaced with donor in patients who received
bone marrow transplantation (BMT). It might result in a compromised immunity of patients during
and/or after BMT. Periodontal disease is known as an infection disease and subjects' response to
bacterial plaque is mediated by immune system. Information on changes of susceptibility to periodontal
disease in BMT patients was limited in documents. The purpose of this study was to evaluate changes
of periodontal status in hematological patients who underwent BMT.
Materials and Methods: Twenty hematological patients were referred for dental prophylaxis before
BMT. Patients' age, gender, hematological disease and type of BMT were recorded. Radiographic, intraoral examinations and periodontal parameters were measured. Dental and periodontal treatments, if
needed, were provided before BMT. All measurements were repeated at least 6 months after BMT.
Results: The relationship between changes of clinical attachment levels and patient's hematological
diseases was not statistically significant. Neither was the type of BMT, with or without chemotherapy,
levels of radiotherapy before BMT, or an existence of graft-versus-host-disease. However, patients with
a relapse of hematological disease showed significant loss of clinical attachment level.
Conclusion: This study demonstrated that change of immunity during BMT did not affect periodontal
status significantly, whereas aggressive form of periodontal attachment loss might occur in
hematological patients with post-BMT relapse.
375
RF3-4
Evaluation of anatomic structures of maxillary sinus for implant therapy
Chien-hsing Wang, Yi-chun Lin, Bor-Jian Chen, Yu-lin Lai
Dental Department, Veterans General Hospital-Taipei
School of Dentistry, National Yang-ming University
(sinus septa)
2002
2008
38
40.8%
39.5%
100%
72.4%
7.9%
35.1%
20%
10%
6.30
376
19.7%
26.3%
17.9%
3.70
15.9%
3.14
35%
30%
5%
6.41
6.23 2.96
RF3-5
Reconstruction and Localization of Mandibular Foramen Using CT Image in
Taiwanese
01
1
1
Lian-Ping Mau
Jun-Jung Chen,
2
2Dental
2
2
0 1,
1Dental
1
Chuen-Chyi
Tseng,1
2
3
3
Iok-Chao Pang,1 Kuo-Ching Huang, 2
Miin-Jye Wen3
Department, Chi Mei Medical Center, Tainan
Department, Chi Mei Hospital, Liouying Campus, Tainan
3Department
of Statistics, National Cheng Kung University, Tainan
Background: To perform dental treatments in the lower jaw, there are quite often need inferior alveolar
nerve block. Therefore, inferior alveolar nerve block is an absolutely important skill for a dentist in
daily practice. Mandibular foramen (MF) is the place where local anesthesia solution is deposited. In
order to achieve adequate local anesthesia, MF becomes an important landmark structure. The aim of
this study was to determine the relationship between dentition and MF in Taiwanese adult population.
Materials and Methods: 65 mandibular dental CT images were selected from our data bank. There are
28 males and 37 females. The average age is 44.23 years old, range 20 to 72 years old. Dental CT
images were performed using Implant Max® software. The Occlusal plane (OP) is defined as the
horizontal plane between opposite mandibular posterior teeth parallel to the floor. The inferior alveolar
nerve was reconstructed and the MF was located. Then the cross section over the lingula parallel to the
OP was located, the anteroposterior and superoinferior relationship of the lingula was measured.
Results: The results showed (1) Lingula is 12.93mm posteriorly to the internal anterior ramus (IAR),
18.93mm posteriorly to the external anterior ramus (EAR) and 17.47mm anteriorly to the posterior ramus
(PR). (2) Lingula is 6.35mm above the occlusal plane (OP). (3) Inferior MF is 1.69mm below the OP. (4) The
position of lingula between males and females and right and left side is not statistically significant.
Conclusions: This study demonstrated that lingula is located just posterior to the middle of the ramus
correspond to the EAR to PR and just above the occlusal plane. This identify the landmarks that would
provide the most reliable and predictable indicators of the exact position of the MF to the clinician
during the inferior alveolar nerve block procedure. (This study was supported by Chi Mei Medical
Center, Grant no. CMFHR9644)
377
RF3-6
Resonance Frequency Analysis Measurements of ITI Implant Primary Stability at
Implant Placement Surgery
01
2
1
1
2
1
2
Mei-Yin Lin, 0 1 Chun-Jung Chen,2 Lian-Ping Mau,1 Kuo-Ching Huang,2 Chuen-Chyi Tseng1
1Dental
Department, Chi-Mei Medical Center, Tainan
2Dental
Department, Chi Mei Medical Center, Liouying Campus, Tainan
(primary stability)
(osseointegration)
(resonance frequency analysis)
67
115
)
ISQ
(78.42)
28
39
45.6
)
ITI
(ISQ
(79.11)
(
(bone quality)
77.78
(74.48)
10mm
78.19
4.1mm
(78.42)
(75.79)
(Type II
ISQ
(77.98)
4.8mm
80.18)
(78.13)
(75.79)
12mm
(Type III
77.41)
ITI
378
RF3-7
Correlation between gingival biotype and clinical esthetic features in Taiwanese
young adults
01
1
2
2
2
2
Chun-Jung Chen, 0 1 Chia-Hu Chien,2 Iok-Chao Pang, 2 Chuen-Chyi Tseng2
1Dental Department, Chi Mei Hospital, Liouying Campus, Tainan
2Dental Department, Chi-Mei Medical Center, Tainan
(dental implant)
osseointegration)
(success
(anterior aesthetic)
(gingival
biotype)
39
22.9
21
(
18
)
SPSS
(
)
(
)
379
RF3-8
Factors Influencing the Presence or Recession of the Interproximal Dental Papilla
01
2,4
1
3,4
2,4
2,4
2
3
4
Min-Chieh Chen, 0 1 Chiu-Po Chan,2,4 Yu-Fang Liao,3,4 Whei-Lin Pan,2,4
1Division of Dentistry, Chang-Gung Memorial Hospital, Keelung
2Department
of Periodontics, Chang-Gung Memorial Hospital, Taipei
3Craniofacial
Orthodontics, Chang-Gung Memorial Hospital, Taipei
4College
Yuh-Ren Ju2,4
of Medicine, Chang-Gung University, TaoYun
X
30
102
Tempbond˛
(mucogingival junction, MGJ)
X
X
(presence)
(Image J software)
[1]
the papilla)
(contact point)
[3]
(bone crest)
(keratinized gingiva)
[1]
[2]
[4]
(length of
(p<0.001) [2]
(p<0.05)
[3]
5 mm
X
380
RF4-1
Diagnosis and Management of Cemental Tears of Mandibular Molars: Report of Two
Cases
1,3
2
1
1
2
3
3
Hsueh-Jen Lin, 1,3 Chiu-Po Chan,2 Chen-Tsai Wu,1 Jiiang-Huei Jeng3
1Dental Department, Show Chwan Memorial Hospital, Changhua
2Chang Gung University, Department of Periodontics, Chang Gung Memorial Hospital, Taipei
3Graduate
Institute of Clinical Dentistry, College of Medicine, National Taiwan University and National
Taiwan University Hospital, Taipei
(cemental tear)
57
(biopsy)
38
10mm
C-
1/3
381
RF4-2
Hereditary Gingival Fibromatosis: A Case Report
0
Pei-Chi Kao, 0 Cheing-Meei Liu, Yuh-Yuan Shiau, Thai-Yen Ling
Department of Periodontology, National Taiwan University Hospital
Institute of Pharmacology, College of Medicine, National Taiwan University
Background: Hereditary gingival fibromatosis (HGF) is a genetic disorder characterized by a
progressive enlargement of the attached gingiva and various degrees of soft tissue dimensional change.
It usually develops as an isolated oral manifestation but can be one feature of an associated genetic
syndrome. This article was a case report to show the hygienic and esthetic improvement after adequate
periodontal treatment in the patient with HGF, and to present the histopathologic characteristics of
fibromatotic tissue. The gene expression profiles of the resectional tissue were also analyzed in order to
explore the putative genes regulation in the pathogenesis.
Materials and Methods: A case of a 36-year-old male was reported, who presented a generalized
severe gingival overgrowth, involving the maxillary and mandibular arches and covering almost all
teeth. The x-ray photography indicated the alveolar bone of the patient was normal. Meanwhile, seven
of the patient's family members also presented HGF with different degree. Surgical treatment consisted
of quadrant-by-quadrant conventional gingivectomy procedures. And histopathologic analysis by H&E
stain was carried out to observe the morphologic characteristics in the HGF sample. To characterize the
genes expression profiles of the sample, microarray analysis was performed to compare with the normal
gingival tissues.
Results: The postoperative courses were uneventful and the patient's appearance improved
considerably. Post-surgical follow-up after 11months demonstrated no recurrence. The overgrowth
lesions contained well-structured epithelium with elongated and thin papillae inserted in expanded
fibrous connective tissue The gene expression profiles derived form microarray analysis showed that
there were several genes with significant high or down regulated comparing to control group, such as
homo sapiens arylacetamide deacetylase-like 2 (AADACL2) and homo sapiens carbohydrate (Nacetylgalactosamine 4-0) sulfotransferase 9 (CHST9).
Conclusions: Hereditary gingival fibromatosis is a rare disorder characterized by the proliferative
epithelial and fibrous overgrowth of the gingival tissue in Chinese population. Resectional surgery of
the excess tissue is the available treatment. For further studies, to interpret the pathogenesis of HGF by
ingenuity pathway analysis according microarray results will be our subsequent work.
382
RF4-3
Signs and Symptoms of Localized Periodontal Destruction over Upper Anterior Due
to Iatrogenic Application of Elastic Band: Report of Three Cases
Yan-Ting Lin,
Hsiang-Hsi Hong
Department of Periodontics, Devision of Dentistry, Lin-Kou Medical Center, Chang Gung Memorial
Hospital
x
x
3
-
8
#11#21
III
x
4-9mm
#11#21
11
#21#22
4-8mm
III
x
#21#22
8
#11#21
2-6mm
III
x
#21#22
x
1.
2.
3.
divergence)
(extrusion)
(granulation island)
5.
6.
(crown
4.
(root convergence)
7. x
383
RF4-4
Dental Treatment for a Traumatically Injured Patient: A Case Report
0
Yu-shan Huang, 0 Bor-jain Chen, Yi-chun Lin, Yi-chen Hiseh,
Department of Dentistry, Taipei Veterans General Hospital, Taiwan
School of Dentistry, National Yang-Ming University
Yu-lin Lai
(tunnel technique)
384
RF4-5
The Internal Tooth Resorption Following EDTA Surface Treatment and DFDBA/
Enamel Matrix Derivative Regenerative Surgery: A Case Report
0
Chih-Hao Huang 0
Department of dentistry, Buddhist Tzu-Chi general hospital, Hualien, Taiwan
Background: The internal tooth resorption following periodontal regenerative therapy is uncommon.
This case report provides information regarding adverse reactions following the usage of EDTA surface
treatment and DFDBA/ Enamel matrix derivative(EMD) regenerative surgery.
Materials and Methods: A 45-year-old man in good general health presented with a uncomfortable
feeling on right mandibular molars. Further periodontal examination revealed probing depths of the
right mandibular first molar ranged from 3 to 9 mm, and lingual furcation grade I involvement was
noted. Radiographs revealed that the tooth had mesial and distal angular bony destruction, furcation
radiolucency and heavy calculus deposition. The patient's periodontal diagnosis was generalized
moderate to severe chronic periodontitis. Treatment of the tooth consisted of cause-related therapy,
scaling/ root planing, EDTA surface treatment, DFDBA bone grafting and EMD regeneration.
Results: Six months after surgical treatment, a correction of intrabony defect was observed. Clinical
probing depths reduced to no more than 3mm with only slight recession and no furcation involvement.
Bone fill was radiographically noted. However, severe hypersensitive sensation following surgery
sustained more than 2 years without obvious abnormal electrical pulp test response. Although
hypersensitivity gradually faded off after three years, an internal tooth resorption was noticed 4 years
after regenerative surgery.
Conclusion: It appears that some cases of mandibular molar intrabony defects treated by EDTA surface
treatment, and DFDBA/ EMD regenerative therapy that are complicated by severe hypersensitive
consequence, an internal tooth resorption may happen later.
385
RF4-6
Treatment of a Combined Periodontic-Endodontic Lesion- A Case Report
10
Chun-Ya Chan, 10 Fu-Ying Lee
Department of Periodontology, Division of Dentistry, Chang Gung Memorial Hospital, Lin Kou
Medical Center, Taoyan
Background: Symptoms and signs of a combined periodontic-endodontic lesion usually mimic the
characteristics of both periodontal and endodontic diseases. It is even confused and difficult in
diagnosis when a periapical lesion extends coronally to meet a periodontal pocket or when a periodontal
pocket is associated with anatomic deformities.
Case Report: A 53-year-old female was diagnosed with generalized moderate to severe periodontitis.
Non-surgically periodontal therapy has been completed, whereas a 12-mm pocket constantly existed at
the mesial surface of her right mandibular first premolar, tooth #44. Severe bone destruction adjacent to
the tooth was evident on radiograph. The pulp was tested non-vital. It was therefore diagnosed as a
combined periodontic-endodontic lesion. Root canal treatment was firstly performed and followed by
periodontally surgical debridement. The bony defect was grafted with demineralized freeze dried bone
allograft (DFDBA) alone. Wound healing was uneventfully. Supportive periodontal therapy was
maintained every 6 months. After 8 years of follow-up, clinical periodontal parameters of tooth #44 was
well maintained. Although recession of marginal tissue was noted, bone fill surrounding the tooth was
suggested on radiograph.
Conclusion: Comprehensive examinations with assistance of radiograph and pulp vitality test help
periodontists to accurately identify a combined periodontic-endodontic lesion, which could be
maintained in health when treatments in sequence were provided.
386
RF4-7
Bone Cavity Formation Following Extraction of a Mandibular Molar with PulpalPeriodontal Combined Lesion: Report of Two Cases
Hsiu-Wan Meng,
Pein-Chi Wei, Yu-Ren Ju
Department of Periodontics, Division of Dentistry, Chang Gung Memorial Hospital
(Hematoma)
(Degeneration)
(Organization)
33
#47
#46
MOD
X
#46
#47
#47
#46
X
#47
D)x3.8mm(B-L)
(undermined)
#46
3.8mm
(
50
6mm(M15mm
)
#36
#36
5mm
X
2.2mm
#46
#36,37
10mm
(Lamina dura)
(Pyogenic granuloma)
387
RF4-8
Guided Tissue Regeneration in the Treatment of Combined Large
Periapical and Marginal Lesions: Report of Cases
1
2,3,4,5
1
2
3
4
5
Hsiang-hsun Huang, 1 Tony Shing-zeng Dung2,3,4,5
1Tsong Kwun Dental Clinic
2Department
3Tzuchi
of Dentistry, Buddhist Tzuchi General Hospital, Taipei
University
4National
Yang-Ming University
5Taipei
Medical University
Background: The maintenance of single teeth may often be of crucial importance for the prognosis of
the total dentition. The successful treatment of large combined perioodontal and periradicular defects by
combined endodontic and periodontal regenerative therapy is described.
Case Reports: This study reports the treatment of three cases with combined large periapical and
marginal lesions. The defect was thoroughly debrided and the exposed root surface was planed with
curettes, ultrasonics and rotory instruments. After endodontic treatment, guided tissue regeneration is
utilized to regenerate lost periodontium. The defects were filled with alloplasts (Interpore 200, Bio-Oss,
or MBCP) and resorbable membranes (Resolute XT, PeriAid, or EpiGuide). The influence of the
individual components used in treatment is discussed. The advantage and disadvantage of the treatment
modality is analyzed.
Results & Conclusion: Patients were followed for 1-10 years. The clinical and radiographic results
demonstrated excellent pocket depth reduction and bone fill. All treatments were considered successful.
Long-term evaluation of the treatment outcome deserves further study.
388
RF4-9
Autogenous Tooth Transplantation and Dental Implant for Oral Rehabilitation in
Adult Patients: A Clinical Report
0 1,2,3
4
1
5
6
2
3
4
5
6
Tony Shing-zeng Dung, 0 1,2,3
1Department
3Taipei
5Dr.
Jeng-feng Huang,4
of Dentistry, Tzuchi Hospital, Taipei
Medical University, Taipei
4Boston
Lin and partners Dental Clinic, Taipei
Kim-Choy Low,5
2National
John Jing-Jong Lin6
Yang-Ming University, Taipei
Dental Clinic, Taipei
6Lin
Jing-Jong Orthodontic Center, Taipei
Background: Implant-supported fixed dentures are a predictable treatment modality for edentulous
patients. Autotransplantation is an alternative treatment for replacing lost teeth when suitable donor
teeth are available.
Case Report: This clinical report presents two cases of successful autogenous tooth transplantation and
dental implants for oral rehabilitation in patients under adult orthodontic treatment. A comparison of the
two treatment modalities as well as success rates will be also discussed. One third molar and one
premolar with complete root development were autogenously transplanted from their original sockets
into new recipient sites in the mandible. In both cases, teeth were transplanted immediately after tooth
extractions. To provide better adaptation of the donor teeth, the recipient alveolar sites were remodeled
using surgical burs. Root canal treatment commenced before transplantation and the canals were
medicated with a calcium hydroxide paste. Following successful transplantation, root canals were
sealed and provisional restorations were made. Both patients were successfully treated with autogenous
tooth transplantation and dental implant simultaneously.
Conclusion: Autogenous transplantation of teeth with complete root formation may be considered as a
viable treatment option to conventional prosthetic and implant rehabilitation for both therapeutic and
economic reasons. Careful surgical and endodontic procedure, together with careful case selection may
lead to satisfactory aesthetic and functional outcomes.
389
RF4-10
Interdisciplinary Treatment of Periodontics, Orthodontics, Prosthodontics, and
Implantology for a Patient with Generalized Severe Chronic Periodontitis: A Case Report
01
1
1,4
2,4
3
1
2
1,4
1,4
1,4
3
4
Yu-Hsiang Chou,t1 Ya-Ping Ho,1,4 Jen-Chyan Wang,2,4 Szu-Ting Chou,3 Kai-Fang Hu1
Kun-Yen Ho,1,4 Yi-Min Wu,1,4 Chi-Cheng Tsai1,4
1Division of Periodontics 2Division of Prosthodontics
3Division of Orthodontics, Kaohsiung Medical University Hospital
4Faculty of Dentistry, College of Dental Medicine, Kaohsiung Medical University
Background: Advanced periodontal disease is primarily characterized as severe attachment loss and
reduction of alveolar bony support. Pathological tooth migration, labial inclination, spacing, and loss of arch
integrity are in consequence. The sequelae often cause esthetic and functional problems to the patient. It is
impossible to manage the complicated dental condition with periodontal therapy alone. Interdisciplinary
approach is necessary. In this case report, we describe an interdisciplinary treatment, including periodontics,
orthodontics, prosthodontics and implantology for a patient suffered from generalized severe chronic periodontitis.
Case Report: A 50-years-old male patient complained his chewing function was insufficient for a long
time. After oral and radiographic examinations, generalized severe chronic periodontitis was diagnosed.
More than 50% attachment loss of almost all his teeth was noted. In addition, he also manifested symptoms
and signs of posterior bite collapse described previously. Professional phase I periodontal treatment was
performed at first. After re-evaluation of periodontal condition, we provided open flap debridement and
thorough root planing before orthodontic treatment. Active orthodontic treatment for realignment of the
malpositioned teeth and for reconstruction of stable occlusion was finished in 23 months. He rejected to
extract some poorly prognostic teeth because he had very strong motivation to preserve his natural teeth and
had very good oral hygiene care ability. Therefore, his upper dentition was restored with a telescopic
denture. The edentulous areas of lower arch were reconstructed with implant-supported crowns via guided
bone regeneration. Definite prosthesis was fabricated after upper immediate denture delivery eight months
later. The treatment outcomes, including the periodontal condition, occlusion, and implant prosthesis were
stable via clinical and radiographic evaluations. His chewing function, esthetics and phonetics were
improved significantly. The patient was satisfied with the results of the combined treatment modality.
Conclusion: In the periodontally compromised patient, such as this case, a close interdisciplinary treatment
modality is crucial for successful outcomes. Advanced periodontal-orthodontic-prosthodontic-implant
treatment may result not only in the rehabilitation of function to the periodontally deteriorated dentition but
also a significant enhancement in occlusion, esthetics, and periodontal maintenance.
390
RF4-11
Narrow Diameter Implant in Limited Space: A Case Report
1
1,2
1
1
2
Chia-Yun Tsai,
1Department
2Faculty
1
1
Yi-Min Wu,1,2
Ching-Fang Tsai,1
Yu-Chuan Tseng1
of Dentistry, Kaohsiung Medical University Hospital
of Dentistry, Kaohsiung Medical University
Background: Four positional parameters contribute to the success of the implant restoration, including
buccolingual, mesiodistal, apicocoronal positions relative to the implant platform and angulation of the
implant. This report presents a case of improper space distribution, after orthodontic treatment, a
narrow diameter implant was placed in lower anterior limited space.
Case Presentation: A 26 years old female patient presented with pus discharge from lower right area.
Radiographic and clinical evaluation demonstrated a 42x43x bridge and root resorption of 42. After
evaluation, 42 was extracted. Orthodontic treatment was performed to align teeth and a proper space
between 41 and 43 was created. A 3i micromini-implant 3.25 mm x 13 mm was chosen to implant at
42 edentulous area due to the tooth size of 42 should be small. Autogeneous bone graft was taken from
torus mandibularis and placed at buccal crestal area. Then a healing abutment was setting onto the
implant. After the eight months healing phase, a final implant impression was made and a all ceramic
crown was delivery.
Conclusion: Our case demonstrated that a site have limited tooth diameter, a narrow diameter implant
can be satisfied with function, aesthetic and phonetic and integrated successfully.
391
RF4-12
Computed Tomography Aided Surgical and Prosthetic Treatment Planning for an Implantsupported Overdenture in Severely Atrophic Edentulous Mandible: A Case Report
01
1
2
1
1
1
Ting-An Chou, 0 1
1Department
Whei-Lin Pan,1
of Periodontology,
Pi-Lun Chen,2
2Department
Yuh-Ren Ju,1
Chiu-Po Chan1
of Prosthodontics
Background: When planning for implant placement in clinically challenging cases,
detailed evaluation of potential osteotomy sites by advanced diagnostic methods is
necessary. Computed tomography reveals to be the most precise radiographic technique till
now.
Case Report: The 45-year old healthy male has a very atrophic edentulous mandible
and limited interarch space. By the dental CT, we could measure the bone height for
implant placement precisely. No adequate bony height was left when we put ideal
implant position as prosthetic requirement. We planned to implant three fixtures more
buccally to gain longer fixture-support by CT guided-surgical stent. Finally three implants
were placed on #45, #47, #37 edentulous areas.
Conclusion: In this report, we will describe how to use dental CT to analyze the
optimal position and support of implants for the severely compromised bone
characteristic.
392
RF4-13
The Combination of Sinus Lift and Vertical Ridge Augmentation with Titanium
Mesh: A Case Report
Shih- Chung Liao,
Kuo Yuan, Ju-Chun Fan Chiang
Department of Stomatolgy, National Cheng Kung University Hospital.
Background: After extraction of teeth due to periodontitis in the maxillary upper posterior area, the site
of extraction often demonstrated a vertical bone defect and a close distance to maxillary sinus.
Meanwhile, we have to reconstruct the site with combination of sinus lift and vertical ridge
augmentation for placement of implant.
Materials and Methods: The right upper first molar was extracted due to severe periodontitis in a 40
y/o male. The combination of sinus lift and vertical ridge augmentation was performed over the site 2
months later. After 6 months uneventful healing period, the second stage surgery was performed .The
prosthesis was delivered and functioned.
Results: The height and width of the site was increased significantly and the sinus demonstrated bone
filled around the implant on the radiograph. The function of the implant is well.
Conclusions: We have to reconstruct the bone in the cases with severe bone destruction. In order to get
esthetic and function, the regeneration of bone was not only performed in the sinus but in the vertical
direction.
393
RF4-14
Early Implant Placement in Esthetic Zone: A Case Report
0
2
2
2
Yee-Ting Siaw, 0
Chuen-Chyi Tseng,
Chih-Wen Cheng,2 Iok-Chao Pang2
Periodontal Division, Dental Department, Chi Mei Medical Center, Tainan
2Prosthodontic
Division, Dental Department, Chi Mei Medical Center, Tainan
(immediate implantation)
(early implant placement)
(primary
stability)
28
(GBR)
(second stage surgery)
(early implant placement)
394
RF4-15
Combination of Soft Tissue Graft, Bone Substitute plus Regenerative Membrane, and
Frenumnectomy to Enhance Anterior Implant Region Esthetics: Report of Two Cases
0
Wen-Chieh Lo 0
Private practice
Background: Implant esthetics in anterior area is the most challenged work for dentists. Tooth lost for
a long time, severe periodontitis and trauma usually cause severe bone resorption and soft tissue
deficiency. Guided bone regeneration (GBR) is often necessary in deficient ridge or for immediate
implant when patient asks for shorter period of treatment. Sometimes staged soft and/or hard tissue
graft is needed in second stage or even after prosthesis delivery.
Materials and Methods: Case 1: Patient asked immediate implantation at the maxillary left central
incisor with severe periodontitis and extensive bony defect. Cover screw exposure and high frenum
attachment were noted after implant inserted and combined with GBR. Frenectomy, bone graft with
regenerative membrane and connective tissue (CT) graft were performed to increase height and
thickness of soft tissue. Frenectomy can increase the stability of the graft area. Case 2: Ridge
resorption, lack of keratinized tissue and high frenum attachment were noted at patient's maxillary
anterior area due to tooth lost for a long time. Neck margin of implant at upper central incisors was
exposed after prosthesis treatment. Patient also complained of insufficient lip contour. Frenectomy, CT
graft and bone graft were performed.
Result: 1, Esthetics in the maxillary anterior areas of these two cases was improved. 2, Patient was
satisfied with the fullness of facial contour in the second case. 3, Keratinized soft tissue was increased
and maintained stable at one year follow-up.
Conclusion: Many factors influence implant esthetics. Problems of soft tissue at the implant site must
be assessed. Techniques for soft tissue management in the esthetic zone enhance mucosal thickness
around implants and give a more predictable result.
395
RF4-16
Significant Increase of Serum Amylase Level after Dental Implantation: A Case
Report
Yen-Li Wang,
Yuh-Ren Ju, Chiu-Po Chan, Whei-Lin Pan
Department of Periodontics, Chang Gung Memorial Hospital, Taipei.
Background: People with pancreatic disease are often found to have elevated serum levels of exocrine
pancreatic enzymes, such as amylase and lipase. Determination of elevated enzyme levels has been one
of the most convenient diagnostic tests and is particularly useful in patients with an acute phase of
pancreatic disease. High blood amylase and lipase levels may occur in patients with clinically mild or
severe acute pancreatitis, and a rapid fall in these levels may mean either resolution or extension of the
disease.
Case Report: In our case, the patient received dental treatment including tooth extraction and dental
implant. Either time it was found that the serum amylase level was elevated after dental treatment, and
dropped down thereafter. The only clue of amylase elevation is dental treatment, which was supposed to
cause some form of trauma to the patient. After evaluating the pancreatic serum levels and physical
examination by physician, it was thought unlikely to progress into acute pancreatitis.
Conclusion: The relation between dental treatment and increased serum amylase level is not available
in papers so far. The case gives us some insights. First, the time span between dental treatment and
blood test in patients with elevated serum amylase level should be long enough. Second, the dental
treatment may cause elevated serum amylase level to rise, which should be noticed, but may not be
worried.
396
RF4-17
Open Sinus Lifting in Atrophic Maxillae: A Case Report
,0 1
1
1
2
1
1
2
Cheng-Pang Lan, 0 1 Whei-Lin Pan,1 Pi-Lun Chen,2 Yuh-Ren Ju,1 Chiu-Po Chan1
1Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
2Department
of Prosthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
Background: Reconstruction of the atrophic edentulous posterior maxilla poses a signi_cant challenge
to the clinician. Hard tissue augmentation therapy prior to implant placement and prosthetic
reconstruction is often necessary due to pneumatization of the maxillary sinus. Comprehensive
management of this area requires meticulous diagnosis and treatment planning prior to initiation of
augmentation, implant, or prosthetic therapies.
Case Report: A 61-year-old male patient presented the upper left edentulous maxillae with
pneumatized sinus. The computed tomography revealed only 2-3mm crestal bone height for edentulous
area. This case report represents placement of two implants in the severely atrophic maxillae by open
sinus lifting procedure. Open sinus lifting procedure was performed and augmented with bone graft and
membrane. After 10 months uneventful healing, tomogram showed crestal bone height increased to
12mm and two implants were installed.
Conclusion: In this case report, open sinus elevation is used for future implant site development in
atrophic maxillary edentulous ridge.
397
RF4-18
Ridge-splitting Technique with Simultaneous One-Stage Implant Placement for the
Rehabilitation of Deficient Mandibular Edentulous Ridge: A Case Report
1
1
2
1
2
E-Ling Lin, 1 Chun-Jen Cheng,2 Hwey-Chin Yeh1
1Department of Periodontics 2Department of General Dentistry, Division of Dentistry, Chung Gung
Memorial Hospital Lin Ko Medical Center, Taoyun, Taiwan
Background: Although onlay-inlay grafts, sandwich osteotomies, guided bone regeneration,
piezoelectricity, and alveolar distraction have been indicated for augmentation in the mandibular region,
each of these techniques involves risks, complications and usually require staged approach and involve
multiple surgical sites. It is difficult to demonstrate that a particular surgical procedure offers better
outcome as compared to another. A staged ridge-splitting technique enables immediate implant
placement and lateral ridge augmentation in thin crests and may prevent neurosensorial deficiencies.
Case Report: A 57-year-old female sought for full mouth rehabilitation and implant therapy.
Insufficient bone width was noted at right mandibular edentulous ridge via CT evaluation. Corticotomy
was first performed under anesthesia and flap elevation. One month later, ridge-splitting technique
using synthetic particulate bone graft and a resorbable membrane was performed simultaneously with
three one-stage implant placement. These implants were restored with fixed partial denture after 6
months. Peri-implant conditions were assessed clinically and radiographically. Implant-supported fixed
prosthesis has stayed in health and function for 6 months.
Conclusion: Ridge-splitting technique with simultaneous one-stage implant placement is a valid
reconstructive procedure for deficient mandibular ridges. It helps in reducing surgical trauma and
condensing treatment time. Long-term, multi-center studies are required to provide further insight into
this technique.
398
RF4-19
Management of Peri-Implantitis Caused by Residual Cement: A Case Report
1
2
1
1
2
Lin Cheng-Jyun, 1 Huang Kuo-Ching,2 Tseng Chuen-Chyi1
1Department of Periodontics, ChiMei medical center, Tainan
2Department
of Periodontics, ChiMei medical center, Liouying Campus, Tainan
Branemark ®
34
implant
24
3
X
399
RF4-20
Hereditary Gingival Fibromatosis: Two Cases Report
0
Ying-Huei Yeh, 0 Chih-Hao Huang
Department of dentistry, Buddhist Tzu-Chi general hospital, Hualien, Taiwan
1/175,000
25
12
25
12
400
SUBJECTS INDEX
Autogenous Tooth Transplantation : Literature Review and A Case Report
75
A Review and Treatment in Drug Induced Gingival Overgrowth
217
Bone block grafts from mandibular symphysis for ridge augmentation -A case report
33
Biological Evaluation of Periodontal Regenerative Barriers
339
Bisphosphonate -related osteonecrosis (BRON) of the jaw : Case report
231
Central Papilla Area in Young Adults with or without Central Papilla Recession
99
Combined therapy of surgical crown lengthening, apicoectomy, and ridge augmentation in the
treatment of maxillary anterior teeth: A case report
23
External apical root resorption during orthodontic treatment
41
Expression of heat shock proteins in periodontal tissue
127
Effect of bioactive glass: literature review
139
Factors influencing the presence or recession of the interproximal dental papilla
269
Geometrical Characteristics on Anterior Loop of Inferior Alveolar Nerve in Taiwanese
11
Gingival Bleeding Disorders and Idiopathic Thrombocytopenic Purpura:Case Report
291
Incomplete osteointegration of one-staged non-submerged implant placement: Case report
209
Influences of Biphasic Calcium Phosphate Scaffold Porosity on Bone Tissue-Engineering : Literature
review
247
Implant restoration in severely resorbed and HA-augmented ridge -A case report
57
401
Interdisciplinary Therapy of Orthodontics and Implantology for Trauma Patient: A Case Report
65
Management and prevention of dental implant displaced into maxillary sinus: a case report and
literature review
51
Mandibular Incisive Canal on Dental CT Image in Taiwanese
239
Multiple implants treatment in an elderly patient - A case report
301
New trend for dental care
255
Periodontal full treatment case report
109
Periodontal full treatment case report and literature review
189
Recording of Gingival Overgrowth in Rats: Comparison of Two Measurements
1
Sinus Augmentation into Sites with Mucosal Pathologies of Maxillary Sinus
327
The application of crown lengthening procedure and elevation of occlusal plane to create the
interarch space: A case report
315
The consideration of orthodontic treatment in periodontal therapy -literature review
87
The relationship of vitamins vs. oral and periodontal tissue diseases -Literature review
147
The role of chemokines in periodontal disease
157
The relationship of Hyperbaric oxygen v.s. Periodontitis -Literature review
169
The influence of laser on dental implant in the treatment of peri-implantitis:literature review
177
Treatment of distal circumferential bony defects around the mandibular secondary molars with
demineralized bovine xenograft - A case report
279
402
KEY WORDS INDEX
A
alveolar bone crest 13:269
anterior loop 13:11
antiepileptic drugs 13:217
apicoectomy 13:23
autogenous tooth transplantation 13:75
autotransplantation 13:75
B
bioactive glass 13:139
biphasic calcium phosphate 13:247
bisphosphonate 13:231
bone block graft 13:33
C
calcium channel blockers 13:217
central papilla 13:99
circumferential defect 13:279
chemokine 13:157
chronic periodontitis 13:109,189
complications 13:51
contact area 13:269
crown lengthening procedure 13:315
cyclosporine 13:1
cytokines 13:169
D
demineralized bovine xenograft 13:279
dental CT 13:11,239
dental implant 13:33,51
dental implants 13:327
differential diagnosis 13:255
donor tooth 13:75
E
elderly patients 13:301
embrasure 13:99
embrasure morphology 13:99
enamel destruction 13:255
Er:YAG laser 13:177
etiology of incomplete osseointegration 13:209
erosion 13:255
external apical root resorption 13:41
G
gingival bleeding disorders 13:291
gingival overgrowth 13:1,217
guided bone regeneration 13:57,65
guide tissue 13:109
guided tissue regeneration 13:189,339
H
heat shock proteins 13:127
HO-1 13:169
hydroxyapatite 13:57
hyperbaric oxygen 13:169
I
idiopathic thrombocytopenic purpura 13:291
immunosuppressants 13:217
implant 13:177,209,301
inflammation 13:127
interproximal dental papilla 13:269
implant-supported prostheses 13:301
inferior alveolar nerve 13:11
insufficient interarch space 13:315
interdental distance 13:269
403
intrabony defect 13:109
K
keratinized gingiva 13:1,269
J
jaw bone 13:231
M
macroporosity 13:247
mandibular incisive nerve 13:239
mandibular secondary molar 13:279
mandibular symphysis 13:33
maxillary sinusitis 13:51
mental foramen 13:11
microporosity 13:247
N
NO 13:169
O
one-stage non-submerged implant 13:209
oral 13:147
oral health care 13:255
orthodontic treatment 13:41,87
osseointegration 13:209
osseous defect 13:139
osteonecrosis 13:231
P
peri-implantitis 13:177
periodontal disease 13:147,157,169
periodontal ligament (PDL) 13:75
404
periodontal membrane 13:339
periodontal treatment 13:109,189
periodontal therapy 13:87
periodontitis 13:127
PGE2 13:169
pore interconnectivity 13:247
probing 13:1
R
radiography 13:269
recipient site 13:75
regeneration 13:109
retention cyst 13:327
ridge augmentation 13:23,33,57,65,189
ridge preservation 13:65
root resorption 13:41
S
sinus augmentation 13:327
schneiderian membrane 13:327
surgical crown lengthening 13:23
T
third molar 13:75
treatment planning 13:315
treatment outcome 13:139
thrombocytopenia 13:291
V
vitamin 13:147
AUTHORS INDEX
C
Chan Chiu-Po
13:33,269,301
Chang Jui-Chung
13:315
H
Ho Albert Cheng-Sheng
Chang Li-Ching
13:99
Ho Cheng-Hsu
Chang Wei-Jen
13:339
Ho Kuen-Yen
Chen Bor-Jian
13:189
Chen Che-Yi
13:157
Chen Chia-Ching
Chen Chih-long
13:23
13:11,51,209,239,315
Chen Chun-Li
13:177
Chen Hen-Li
13:41,139
Chen Jui-Ling
13:41
Chen Min-Chieh
Chen Pi-Lun
13:33,269
13:33,57,65
Chen Shyuan-Yow
Chen Yen-Hua
Ho Ya-Ping
Hsieh Yao-Dung
13:291
Chen Chun-Jung
13:109
13:87
Hsieh Yi-Chen
Hsu Jen-Hsin
Hsu Yueh-Min
Hsu Wen-Hsiang
Hu Kai-Fang
13:57
13:339
13:279
13:147,157,169,247
J
13:75
Ko Ellen Wen-Ching
13:147,157,169,247
Kung Sue-Fang
,217,247
L
Lai Yu-Lin
13:147,157,169,217
Lee Ying-Lin
,247
Li Jui-Kai
13:279
F
13:1,147,157,169,217,247
13:33,269,301
13:65
Kuang Shou-Hsin
13:1,147,157,169
13:1
13:231,291
Huang Ren-Yeong
Cheng Chun-Jen
G
13:189
13:189
K
Fu Earl
13:127
Huang Ming-Hsia
13:315
Chiu Hsien-Chung
13:279
13:11,51,209,239
Cheng Chih-Wen
Chih Yu-Kun
13:127,279
Huang Kuo-Ching
Ju Yuh-Ren
Chiang Cheng-Yang
13:1
13:339
13:157
Cheng Wan-Chien
13:255
Huang Haw-Ming
Cheng Chia-Jung
Chou Yu-Hsiang
13:1
Gau Ching-Hwa
13:41
13:127,327
13:41,139,189
13:99
13:189
Liang Shih-Yi
13:169
Liao Yu Fang
13:269
Liaw Gwo-An
13:51
Lin Chih-Hao
13:147,169,247
405
Lin Ching-Kai
13:339
Lin Hsiu-Na
13:57
Y
Lin Hung-Ta
13:109
Yang Beender
Lin Jar-hen
Lin Mei-Yin
Lin Shih-jung
13:75
13:209
13:23
13:339
Yang Yueh-Chao
13:109
Yeh Hwey-Chin
13:41,139,189
Yen Jui-Ying
Lin Yi-Hung
13:231,291
Yuh Lin-Ming
Lin Yu-Heng
13:75
W
Lin Yu-Ren
13:177
Wang Chen-Ying
Liu Che-Yu
13:127
Wang Te-Chou
Liu Hung-kai
Lo Jyy-Shin
Lu Chia-Fang
Lu Chun-Tai
13:177
13:217
13:147,169,247
13:65
13:11,239
Yang Jen-Chang
Lin Yi-Chun
Liu Chin-Lung
13:11,51,209,239
Tseng Chuen-Chyi
Wang Yen-Li
13:75
13:139
13:301
13:177
13:327
13:301
Wen Miin-Jye
13:11,239
Wong Huei-An
13:231
Wu Yi-Min
13:279
13:231,291
M
Mau Lian-Ping
13:11,239,315
P
Pan Yu-Hwa
Pan Whei-Lin
13:57,339
13:33,57,65,269,301
Pang Iok-Chao
13:11,239,315
S
Shen E-Chih
13:1
T
Tai I-Chi
Teng Nai-Chia
Tong Ching
13:127
13:339
13:87
Tsai Chi-Cheng
13:279
Tsai Kuo-Yang
13:231,291
406
407
408
(
)
Press, Great Britian, pp.87-91, 1976.
(
)
11(2):39-44, 1992.
(
Index
Medicus
)
pp.267-271,1989.
1.
Chen CC, Tsai CC, Relationship
Genco RJ, Wilson ME, De Nardin E.
between specific serum antibody
Periodontal complications and neutrophil
levels and periodontal destruction.
abnormalities. In " Contemporary
Chin Dent J, 8:170-178, 1989.
Periodontics " 1st ed, Genco RJ, Goldman
H, Cohen DW eds, CV Mosby Co, St.
2.
Mukherjee S. Formation and prevention
Louis, pp.203-220, 1990.
of supragingival calculus. J Periodont
Res, 3(suppl 2):1-33,1968.
A.
3.
Okayama K. Determination of lewis
Feng F Shyy CC, Liang PL, Hou LT.
blood group antigens in human dental
Treatment of osseous defects with
calculus by ELISA. Nihon Univ Dent
gingival fibroblast-coated hydroxyapatite
J(Japan), 67:27-36, 1993. (In Japanese,
particles A longituidinal study. J Dent
English abstract)
Res, 73:355(2027), 1994.
@@@@@@@@@@@@@@@@@@@@@@@
B.
Ayers AJ. Retention of resin restorations by means of enamel etching and
by pins. M.S.D. Thesis, Indiana University,
Indianapols, 1971.
pp.111-115,
1986.
C.
Eastman Kodak Company. Eastman
Organic Chemicals. Rochester NY,
Pickard HM. A Manual of Operative
Catalog No. 49, pp.2-3, 1977.
Dentistry. 4th ed, Oxford University
409

* , , * X 30 102 TempbondTM (mucogingival junction, MGJ) X X

Transcription

Similar documents

Penny-Power-7-IMPLANT-SEM

Informational Flyer - Osteogenics Biomedical

www.odscompanies.com/members

www.odscompanies.com/members

Bone Regeneration Made `Simple`

Dia-Compe Taiwan Co., Ltd.

DIGITAL IMAGING - THE NEW STANDARD OF CARE

drill sequence

full example here (1.2 MB, pdf)

Managed Care of North America, Inc. (MCNA Dental Plans) offers a