성견의 치주질환 이환 발치와에 매식된 Hydroxyapatite 피개매식체 주위의 신생골 형성에 관한 연구

Abstract

[한글]

발치직후 매식술 시행시 나타나는 열개형 골결손 부위에 탈회 냉동 건조 골편 (Demineralized freeze dried bone, DFDB) 과 골 유도 재생막 (Expanded polytetrafluoroethylenemembranes, GTAM) 사용에 따른 신생 골조직의 형성 양상과 계면 상태를 관찰하기 위하여,

성견에서 제 3,4 소구치 부위에 균일한 열개형 골결손부를 가지는 만성 치주염을 유발시킨 12주 후, 발치를 시행한 직후에 원주형의 Hydroxyapatite(HA)피개 매식체를 매식하고, 바로 봉합한 것을 대조군, 골결손부에 DFDB를 축조한 것을 실험 1군, 골결손부위를 GTAM

으로만 피개한 것을 실험 2군, DFDB를 축조하고 GTAM로 피개한 것을 실험 3군으로 하여 매식술 시행 12주 후에 실험동물을 회생시켜 광학현미경 및 형광현미경으로 관찰하여 다음과 같은 결과를 얻었다.

1. 열개형 골결손 부위의 신생골 형성이, 대조군에서는 거의 없었으며, 실험 1, 2, 3군에서는 상당량의 신생골 형성이 폭과 높이를 유지하고 진행되었고, 신생골 형성량은 실험 3군, 실험 2군, 실험 1군의 순서로 실험 3군에서 가장 많았다.

2. 형광 현미경 소견상, 열개형 골결손 부위의 신생골 형성은 주로 매식술 시행에 따른 치유의 초기 과정에서 일어났으며, 신생골의 골개형 정도는 실험 2군, 실험 3군, 실험1군의 순서로 실험 2군에서 가장 빠르게 나타났다.

3. 골결손부의 하부의 매식체와 골사이에서는 모든 군에서 염증상태의 발현 없이 골유착(osseointegration)을 이루었다.

4. 실험 2군, 실험 3군에서는 골유도 재생막 하부에 얇은 결합조직층이 존재하였다.

5. 12주의 연구기간동안 DFOB가 완전히 흡수되지 않았다.

AN EXPERIMENTAL STUDY OF THE NEW BONE FORMATION AROUND THE HYDROXYAPATITE COATED

IMPLANT INSERTED INTO THE PERIODONTALLY INV0LVED EXTRACT10N SOCKET OF DOG

Kyung Ho Han, D.D.S., M.S.D.

Department of Dental Science Graduate School, Yonsei University

(Directed by Assoc. Prof. Kyoo Sung Cho D.D.S., M.S.D., Ph.D.)

The purpose of this investigation was to evaluate the effect of the decalcified

freeze dried bone(DFDB) and guided tissue regeneration membrane(GTAM) on the new

bone formation around the hydroxyapatite coated implant inserted into the

periodontally involved extraction socket.

Experimental chronic periodontitis was induced by the ligation of orthodontic

elastic threads after surgically removed the buccal alveolar bone for creating

dehescence defect in the mandibular 3rd, 4th premolars of the mandible of the adult

dogs for 12 weeks.

HA coated implants were placed immediately after extraction in the blateral 3rd,

4th premolars.

4 types of procedures were performed on the dehescence defects as follows :

Control : sutured without DPDB and GTAM after placing implant

Experimental Ⅰ : group whish bony defects were filled with DPDB

Experimental Ⅱ : group which GTAM was place over bony defects

Experimental Ⅲ : group which bony defects were filled with DPDB and covered with

GTAM

Thereafter dogs were sacrificed at the 12 weeks and specimens were prepared for

light and fluorescent microscopic evaluation.

The results of this study were as follows :

1. In dehescence bone defect, new bone formation was minimal in control group but

in other 3 groups considerable amount of new bone formation was observed without

connective tissue in growth with the amount in descending order being experimental

Ⅲ, experimental Ⅱ, experimental Ⅰ.

2. In fluorescent microscopic examinations, new bone formation in the dehescence

bone defect mostly had taken place at the initial healing stage after implantation

with the rate in descending order being experimental Ⅱ, experimental Ⅲ,

experimental Ⅲ.

3. Aroud the implant under the dehescence bone defect osseointegration was

observedwithout inflammation in all experimental groups.

4. In Experimental group Ⅱ and Ⅲ, thin connective tissue layer was observed

beneath the GTAM.

5. DFDB was not resorbed completely throughout the experimental period. These

results indicate that new bone formation in bony defects can be attained by the use

of GTAM in immediate implantation. If OFDB is used concurrently with GTAM, new bone

formation may be delayed, but adequate width and height of bone formation can be

attained. The use of DFDB alone can not result in adequate repair of bony defects.

[영문]

The purpose of this investigation was to evaluate the effect of the decalcified freeze dried bone(DFDB) and guided tissue regeneration membrane(GTAM) on the newbone formation around the hydroxyapatite coated implant inserted into the periodontally involved extraction socket.

Experimental chronic periodontitis was induced by the ligation of orthodontic elastic threads after surgically removed the buccal alveolar bone for creating dehescence defect in the mandibular 3rd, 4th premolars of the mandible of the adult

dogs for 12 weeks.

HA coated implants were placed immediately after extraction in the blateral 3rd, 4th premolars.

4 types of procedures were performed on the dehescence defects as follows :

Control : sutured without DPDB and GTAM after placing implant

Experimental Ⅰ : group whish bony defects were filled with DPDB

Experimental Ⅱ : group which GTAM was place over bony defects

Experimental Ⅲ : group which bony defects were filled with DPDB and covered with GTAM

Thereafter dogs were sacrificed at the 12 weeks and specimens were prepared for light and fluorescent microscopic evaluation.

The results of this study were as follows :

1. In dehescence bone defect, new bone formation was minimal in control group but in other 3 groups considerable amount of new bone formation was observed without connective tissue in growth with the amount in descending order being experimental Ⅲ, experimental Ⅱ, experimental Ⅰ.

2. In fluorescent microscopic examinations, new bone formation in the dehescence bone defect mostly had taken place at the initial healing stage after implantation with the rate in descending order being experimental Ⅱ, experimental Ⅲ,

experimental Ⅲ.

3. Aroud the implant under the dehescence bone defect osseointegration was observedwithout inflammation in all experimental groups.

4. In Experimental group Ⅱ and Ⅲ, thin connective tissue layer was observed beneath the GTAM.

5. DFDB was not resorbed completely throughout the experimental period. These results indicate that new bone formation in bony defects can be attained by the use of GTAM in immediate implantation. If OFDB is used concurrently with GTAM, new bone

formation may be delayed, but adequate width and height of bone formation can be attained. The use of DFDB alone can not result in adequate repair of bony defects.