Effect of polydeoxyribonucleotide with xenogeneic collagen matrix on gingival phenotype modification: a pilot preclinical study

임현창,김창훈,이한규,전계원,허익,정종혁 대한치주과학회 2023 Journal of Periodontal & Implant Science Vol.53 No.6

Purpose: To investigate the effect of xenogeneic collagen matrix (XCM) with polydeoxyribonucleotide (PDRN) for gingival phenotype modification compared to autogenous connective tissue graft. Methods: Five mongrel dogs were used in this study. Box-type gingival defects were surgically created bilaterally on the maxillary canines 8 weeks before gingival augmentation. A coronally positioned flap was performed with either a subepithelial connective tissue graft (SCTG) or XCM with PDRN (2.0 mg/mL). The animals were sacrificed after 12 weeks. Intraoral scanning was performed for soft tissue analysis, and histologic and histomorphometric analyses were performed. Results: One animal exhibited wound dehiscence, leaving 4 for analysis. Superimposition of STL files revealed no significant difference in the amount of gingival thickness increase (ranging from 0.69±0.25 mm to 0.80±0.31 mm in group SCTG and from 0.48±0.25 mm to 0.85±0.44 mm in group PDRN; P>0.05). Histomorphometric analysis showed no significant differences between the groups in supracrestal gingival tissue height, keratinized tissue height, tissue thickness, and rete peg density (P>0.05). Conclusions: XCM soaked with PDRN yielded comparable gingival augmentation to SCTG.

Tissue integration of zirconia and titanium implants with and without buccal dehiscence defects

임현창,Ronald Ernst Jung,Christoph Hans Franz Hämmerle,Myong Ji Kim,Kyeong-Won Paeng,정의원,Daniel Stefan Thoma 대한치주과학회 2018 Journal of Periodontal & Implant Science Vol.48 No.3

Purpose: The purpose of the present study was to validate an experimental model for assessing tissue integration of titanium and zirconia implants with and without buccal dehiscence defects. Methods: In 3 dogs, 5 implants were randomly placed on both sides of the mandibles: 1) Z1: a zirconia implant (modified surface) within the bony housing, 2) Z2: a zirconia implant (standard surface) within the bony housing, 3) T: a titanium implant within the bony housing, 4) Z1_D: a Z1 implant placed with a buccal bone dehiscence defect (3 mm), and 5) T_D: a titanium implant placed with a buccal bone dehiscence defect (3 mm). The healing times were 2 weeks (one side of the mandible) and 6 weeks (the opposite side). Results: The dimensions of the peri-implant soft tissue varied depending on the implant and the healing time. The level of the mucosal margin was located more apically at 6 weeks than at 2 weeks in all groups, except group T. The presence of a buccal dehiscence defect did not result in a decrease in the overall soft tissue dimensions between 2 and 6 weeks (4.80±1.31 and 4.3 mm in group Z1_D, and 4.47±1.06 and 4.5±1.37 mm in group T_D, respectively). The bone-to-implant contact (BIC) values were highest in group Z1 at both time points (34.15%±21.23% at 2 weeks, 84.08%±1.33% at 6 weeks). The buccal dehiscence defects in groups Z1_D and T_D showed no further bone loss at 6 weeks compared to 2 weeks. Conclusions: The modified surface of Z1 demonstrated higher BIC values than the surface of Z2. There were minimal differences in the mucosal margin between 2 and 6 weeks in the presence of a dehiscence defect. The present model can serve as a useful tool for studying peri-implant dehiscence defects at the hard and soft tissue levels.

The effect of overlaying titanium mesh with collagen membrane for ridge preservation

임현창,이중석,최성호,정의원 대한치주과학회 2015 Journal of Periodontal & Implant Science Vol.45 No.4

Purpose: The aim of this study was to determine the effect of overlaying titanium mesh (TM) with an adjunctive collagen membrane (CM) for preserving the buccal bone when used in association with immediate implant placement in dogs. Methods: Immediate implant placements were performed in the mesial sockets of the third premolars of five dogs. At one site the TM was attached to the fixture with the aid of its own stabilizers and then covered by a CM (CM group), while the contralateral site received only TM (TM group). Biopsy specimens were retrieved for histologic and histomorphometric analyses after 16 weeks. Results: All samples exhibited pronounced buccal bone resorption, and a high rate of TM exposure was noted (in three and four cases of the five samples in each of the TM and CM groups, respectively). A dense fibrous tissue with little vascularity or cellularity had infil¬trated through the pores of the TM irrespective of the presence of a CM. The distances be¬tween the fixture platform and the first bone–implant contact and the bone crest did not differ significantly between the TM and CM groups. Conclusions: Our study suggests that the additional use of a CM over TM does not offer added benefit for mucosal healing and buccal bone preservation.

Oral signs of acute leukemia for early detection

임현창,김창성 대한치주과학회 2014 Journal of Periodontal & Implant Science Vol.44 No.6

Purpose: Systemic disease can manifest oral signs at an early phase, which may be crucialfor the diagnosis and timing of treatment. This report describes two patients who presentedwith gingival enlargement as an early sign of acute leukemia. Methods: Two patients presented with oral symptoms including severe gingival enlargement. The progress of their symptoms was associated with underlying systemic disease. Results: The patients were transferred to the Department of Hematology and diagnosedwith acute myelomonocytic leukemia. They received appropriate treatment and survived. Conclusions: Gingival enlargement can be caused by underlying systemic diseases. Accuratediagnosis and timely referral are important for preventing a fatal situation. It must beemphasized that some oral signs and symptoms may be closely correlated with systemicdiseases.

Effectiveness of biphasic calcium phosphate block bone substitutes processed using a modified extrusion method in rabbit calvarial defects

임현창,송경호,유훈,이중석,정의원,김석영,최성호 대한치주과학회 2015 Journal of Periodontal & Implant Science Vol.45 No.2

Purpose: This study evaluated the mechanical and structural properties of biphasic calcium phosphate (BCP) blocks processed using a modified extrusion method, and assessed their in vivo effectiveness using a rabbit calvarial defect model. Methods: BCP blocks with three distinct ratios of hydroxyapatite (HA):tricalcium phos¬phate (TCP) were produced using a modified extrusion method:HA8 (8%:92%), HA48 (48%:52%), and HA80 (80%:20%). The blocks were examined using scanning electron mi¬croscopy, X-ray diffractometry, and a universal test machine. Four circular defects 8 mm in diameter were made in 12 rabbits. One defect in each animal served as a control, and the other three defects received the BCP blocks. The rabbits were sacrificed at either two weeks (n=6) or eight weeks (n=6) postoperatively. Results: The pore size, porosity, and compressive strength of the three types of bone block were 140–170 μm, >70%, and 4–9 MPa, respectively. Histologic and histomorphometric observations revealed that the augmented space was well maintained, but limited bone for¬mation was observed around the defect base and defect margins. No significant differences were found in the amount of new bone formation, graft material resorption, or bone infil¬tration among the three types of BCP block at either of the postoperative healing points. Conclusions: Block bone substitutes with three distinct compositions (i.e., HA:TCP ratios) processed by a modified extrusion method exhibited limited osteoconductive potency, but excellent space-maintaining capability. Further investigations are required to improve the processing method.

Vertical bone augmentation using collagenated or non-collagenated bone substitute materials with or without recombinant human bone morphogenetic protein-2 in a rabbit calvarial model

임현창,팽경원,정의원,Goran I. Benic 대한치주과학회 2023 Journal of Periodontal & Implant Science Vol.53 No.6

Purpose: The aim of this study was to determine 1) the bone-regenerative effect of porcine bone block materials with or without collagen matrix incorporation, 2) the effect of a collagen barrier, and 3) the effect of adding recombinant human bone morphogenetic protein-2 (rhBMP-2) to the experimental groups. Methods: Four treatment modalities were applied to rabbit calvaria: 1) deproteinized bovine bone mineral blocks (DBBM), 2) porcine bone blocks with collagen matrix incorporation (PBC), 3) porcine bone blocks alone without collagen matrix incorporation (PB), and 4) PBC blocks covered by a collagen membrane (PBC+M). The experiments were repeated with the addition of rhBMP-2. The animals were sacrificed after either 2 or 12 weeks of healing. Micro-computed tomography (micro-CT), histologic, and histomorphometric analyses were performed. Results: Micro-CT indicated adequate volume stability in all block materials. Histologically, the addition of rhBMP-2 increased the amount of newly formed bone (NB) in all the blocks. At 2 weeks, minimal differences were noted among the NB of groups with or without rhBMP-2. At 12 weeks, the PBC+M group with rhBMP-2 presented the greatest NB (P<0.05 vs. the DBBM group with rhBMP-2), and the PBC and PB groups had greater NB than the DBBM group (P>0.05 without rhBMP-2, P<0.05 with rhBMP-2). Conclusions: The addition of rhBMP-2 enhanced NB formation in vertical augmentation using bone blocks, and a collagen barrier may augment the effect of rhBMP-2.

Late-term healing in an augmented sinus with different ratios of biphasic calcium phosphate: a pilot study using a rabbit sinus model

임현창,홍지연,이중석,정의원,최성호 대한치주과학회 2016 Journal of Periodontal & Implant Science Vol.46 No.1

Purpose: The aim of this pilot study was to determine the osteoconductivity and dimensional stability of augmented sinuses using different ratios of biphasic calcium phosphate (BCP) in a rabbit sinus model. Methods: Each sinus of New Zealand white rabbits (2.5–3.5 kg) was assigned to one of two groups: BCP with a hydroxyapatite to β-tricalcium phosphate (HA:β-TCP) ratio of 70:30 (group TCP30) and BCP with an HA:β-TCP ratio of 30:70 (group TCP70). After preparing a window in the antral wall of a sinus, the Schneiderian membrane was elevated, and the applicable material was grafted. A fluorochrome calcein green was injected five days before euthanizing the animals at four months post-surgery. The specimens were analyzed histologically, histomorphometrically, and by using micro-computed tomography (micro-CT). Results: Micro-CT analysis revealed that the total augmented volume and the new bone volume did not differ significantly between the two groups whereas the resorption of materials was greater in the TCP70 group. The trabecular thickness, number, and separation also did not differ significantly between the two groups. Histomorphometrically, the areas of total augmentation, new bone, and residual material, as well as the ratio of new-bonematerial contact did not differ significantly between the groups. Histologically, the residual particles were more scattered in the TCP70 group than in the TCP30 group. The fluorescence of the calcein green did not differ notably between the two groups. Conclusions: The osteoconductivity and dimensional stability of the two BCPs with different ratios tested in this study were comparable after four months of healing. Therefore, we conclude that both BCPs show promise as a bone substitute for sinus augmentation.

백서 피하층에서 흡수성 차단막의 초기 조직 반응

임현창,채경준,정의원,김창성,이용근,조규성,김종관,최성호,Lim, Hyun-Chang,Chae, Gyung-Joon,Jung, Ui-Won,Kim, Chang-Sung,Lee, Yong-Keun,Cho, Kyoo-Sung,Kim, Chong-Kwan,Choi, Seong-Ho 대한치주과학회 2007 Journal of Periodontal & Implant Science Vol.37 No.4

Purpose: Various kinds of biodegradable membranes are currently used in dental clinics. And the frequency and the necessity of their usage are increasing due to their numerous advantages. Therefore it is important to understand the difference of various membranes and histological reaction against implanted membranes. Materials and Methods: Biodegradable membranes of $Biogide^{(R)}$, $Resolute^{(R)}$, and $Tutodent^{(R)}$ were cut into small pieces by $1.0{\times}0.5cm$. The membranes were implanted 1.5cm apart from each other under the epithelium on the skull of 18 Sprague Dawley rats. The animals were sacrificed at 3, 7, and 14 days after surgical procedure. The specimens were examined by histological analysis. Results: 1. Early period after implantation of the membranes showed connective tissues surrounding membranes and there were a few inflammatory cells present. 2. In $Biogide^{(R)}$ and $Tutodent^{(R)}$ specimens, inflammatory cells and surrounding tissues were shown to infiltrate from outside with slight density difference inside. In $Resolute^{(R)}$ specimens, membranes were fragmented. Inflammatory cells and connective tissues were also observed inside. 3. In $Resolute^{(R)}$ specimen, giant cells were present which implicates that foreign body reaction has occurred. 4. $Biogide^{(R)}$ had lower integrity than other membranes and is not enough to be used alone in defect area. However, $Resolute^{(R)}$ had superior firmness than others. $Tutodent^{(R)}$ had middle level of integrity. Conclusion: This experimental model enabled to observe early inflammatory reactions and morphological changes of materials and can be used to develop and evaluate the efficacy of biodegradable membranes. Duplication of standardized human oral environment will be required in future experiments.

Immediate implant placement in conjunction with guided bone regeneration and/or connective tissue grafts: an experimental study in canines

임현창,팽경원,김명지,Ronald E. Jung,Christoph H. F. Hämmerle,정의원,Daniel S. Thoma 대한치주과학회 2022 Journal of Periodontal & Implant Science Vol.52 No.2

Purpose: This study was conducted to assess the effect of hard and/or soft tissue grafting on immediate implants in a preclinical model. Methods: In 5 mongrel dogs, the distal roots of P2 and P3 were extracted from the maxilla (4 sites in each animal), and immediate implant placement was performed. Each site was randomly assigned to 1 of the following 4 groups: i) gap filling with guided bone regeneration (the GBR group), ii) subepithelial connective tissue grafting (the SCTG group), iii) GBR and SCTG (the GBR/SCTG group), and iv) no further treatment (control). Non-submerged healing was provided for 4 months. Histological and histomorphometric analyses were performed. Results: Peri-implant tissue height and thickness favored the SCTG group (height of periimplant mucosa: 1.14 mm; tissue thickness at the implant shoulder and ±1 mm from the shoulder: 1.14 mm, 0.78 mm, and 1.57 mm, respectively; median value) over the other groups. Bone grafting was not effective at the level of the implant shoulder and on the coronal level of the shoulder. In addition, simultaneous soft and hard tissue augmentation (the GBR/SCTG group) led to a less favorable tissue contour compared to GBR or SCTG alone (height of periimplant mucosa: 3.06 mm; thickness of peri-implant mucosa at the implant shoulder and ±1 mm from the shoulder: 0.72 mm, 0.3 mm, and 1.09 mm, respectively). Conclusion: SCTG tended to have positive effects on the thickness and height of the periimplant mucosa in immediate implant placement. However, simultaneous soft and hard tissue augmentation might not allow a satisfactory tissue contour in cases where the relationship between implant position and neighboring bone housing is unfavorable.

Cone-beam computed tomographic analysis of the alveolar ridge profile and virtual implant placement for the anterior maxilla

임현창,강도욱,백혜현,홍지연,신승윤,정종혁,허익,신승일 대한치주과학회 2019 Journal of Periodontal & Implant Science Vol.49 No.5

Purpose: To analyze the ridge profile of the anterior maxilla using cone-beam computed tomography and to assess the clinical significance of the ridge profile by performing virtual implant placement. Methods: Thirty-two cone-beam computed tomography scans of anterior maxillae were included. For each tooth, a vertical line was made along the longitudinal axis, and 3 horizontal lines at 1-, 3-, and 5-mm levels below the labial bone crest were drawn perpendicularly to the vertical reference. At these levels, the thickness of the alveolar ridge (RT), and the labial (LT) and palatal bone plate (PT) were measured. Then, virtual implant placement using standard and tapered implants was performed. A generalized linear mixed model was used for statistical analysis. Results: The teeth were located labially based on the proportion of LT and PT with respect to RT. At the 1-mm level, the value of LT was between 1.0±0.4 mm for central incisors and 1.3±0.6 mm for canines. A large number of teeth had area(s) with less than 1-mm-thick labial bone between the 1- and 5-mm levels below the crest. The mean PT was generally thicker than the LT in all tooth types. The greatest mean value of labial concavity was observed for canines, compared to other tooth types. Men had a greater RT than did women, but had a comparable LT. Less apical fenestration was observed when tapered implants were used. Conclusions: Most teeth in the anterior maxilla had a thin labial bone plate, with no significant difference between sexes. Tapered implants may be advantageous for the anterior maxilla.