Hydroxyapatite 이식 및 구연산 도포가 성견 골내낭 치유에 미치는 영향에 대한 실험적 연구

Abstract

[한글]

본 눈문의 목적은 골내낭에 hydrozyapatite 이식술 및 치근면에 PH1 의 구연산처리를 시행한 경우에, 통상적인 치근활택술을 겸한 치은판막술과으 LCLDB양상을 조직학적으로 비교, 관찰함에 있다.

성견의 상하악 소구치 부위에 외과적으로 3면 골내낭을 형성하고, 만성 치주염을 야기시키기 위한 방법으로 9주간 tin-foil을 골내낭에 삽입한 후, 치은판막술을 시행하고 다음 4군으로 분류하여 시술하였다. 1. 치근활택술군(R군) 2. 치근활택술 및 구연산처리군

(CR군) 3. 치근활택술 및 hydroxyapatite 이식군(HR군) 4. 치근활택술, 구연산처리 및 hydroxyapatite 이식군(CHR군).

실험시작 후 2, 4, 8, 16주에 실험부를 적출, 탈회시켜 통법에 따라 H-E 염색, Gomori's trichrome 염색을 하고 광학 현미경으로 관찰하여 다음과 같은 결론을 얻었다.

1. Hydroxyapatite 이식군(HR군)과 구연산처리 및 hydroxyapatite 이식군(CHR군)의 경우, 4주에서 골내낭 기저부위에 hydroxyapatite 주의로 신생골 형성이 시작되어 16주에는 골형성이 증가되는 양상이 관찰되었으나, 골내낭 상부에는 치밀한 결합조직섬유에 의해 둘러싸여 있는 치유양상을 관찰하였다.

2. 치근활택술군(R군)과 구연산처리군(CR군)의 경우, 4주부터 성숙된 신생골이 관찰되어 16주에는 골내낭 부위가 치밀한 치조골로 재생되었다.

3. Hydroxyapatite 이식군(HR군)과 구연산처리 및 hydroxyapatite 이식군(CHR군)의 경우, 2주부터 16주까지 hydroxyapatite와 치근사이의 결합조직섬유는 주로 치근에 평행하게 주행하였다.

4. 치근활택술군(R군)과 구연산처리군(CR군)의 경우, 신생골과 신생백아질 사이의 결합조직섬유가 8주부터 수직배열을 시작하여 16주에는 치주인대의 기능적인 배열이 관찰되었다.

5. 구연산처리 및 hydroxyapatite 이식군(CHR군)의 2주 소견을 제외하고 전 실험군에서 2주부터 신생백아질 형성이 시작되어 16주 소견에서는 치조정 상부까지 형성되었다.

6. 치근활택술군(R군)의 2주 소견을 제외하고 치조정 하부까지의 부착상피 근단이동은 관찰할 수 없었고 16주의 전 실험군에서 치조정 상부의 소견은 신생 결합조직부착의 양상을 나타내었다.

이상의 소견을 종합하여 보면 hydroxyapatite 이식재료가 골내낭 치료시 충전물소써의 효과는 있으나 16주까지 치주인대의 기능적인 부착은 관찰할 수 없었으며, 치근에 구연산처리가 부가적인 신생부착을 증진시키는지는 확인되지 않았다.

[영문]

This study was undertaken to study the healing response of four periodontal regenerative procedures in the treatment of periodontal intraosseous defects on dogs.

After the mucoperiosteal flaps were raised, test procedures included ;

1) Root planing procedure (R)

2) Root planing with citric acid conditioning of the root(CR)

3) Root planing with grafting of hydroxyapatite (HR)

4) Root planing wth citric acid conditioning of the root and grafting of hydroxyapatite (CHR)

Eight dogs were equally divided into four groups in the test. Periodontal three-wall intrabony pockets were created artificially with surgical bur and chisel on the mesial surfaces of the third, fourth promolars and tin-folis were adapted to

make a chronic inflammatiry status.

All defects were reopened 9 weeks later and the foils were removed and bur-notches were made on one root at the base of each defect to serve as reference points and then four regenerative procedures were performed.

Thereafter, dogs were serially sacrificed on the 2,,4,8,16th week and the specimens were prepared and stained with hematixylin and eosin, and Gomori's trichrome stain for the light microscopic finding.

The results of this study were as follows:

1. In the hydroxyapatite grafting (HR) group and citric acid conditioning with hydroxyapatite grafting (CHR) group, new bone adjacent to hydroxyapatite particles in the most apical aspect of the defect was seen in the 4th week and considerable new bone adjacent to hydroxyapatite particles was seen in the apical zone of the infrabony defect, but the particles were surrounded by dense fibrous connective tissue in the coronal zone in the 16th week.

2. In the root planing (R) group and citric acid conditioning (CR) group, matured mew bone in intrabony defect was seen in the 4th week and intrabony defects were regenerated with new alveolare bone in the 16th week.

3. In the hydroxyapatite grafting (HR) group and cotric acid condigioning with hydroxyapatite grafting (CHR) group, connective tissue arrangement inperiodonral ligament space was predominantly parallel to the root from the 2nd week to the 16th week.

4. In the root planing (R) group and citric acid conditioning (CR) group, connective tissue fiber arrangement in periodontal ligament space was perpendicular to the root in the 8th week and new periodontal ligament attachment was seen in the 16th week.

5. New cementum formation on the root was seen in the 2nd week except CHR group and new cementum was extended onver the alveolar crest in allof the 16th week group.

6. The junctional epithelium didn't extend below the alveolar crest except 2nd week's R group and new supraalveolar connective tissue attachment was in all of the 16th week group.

The results suggested that hydroxyapatite be an effective filling material for intrabony defects. But hyfroxyapatite grafting didn't show a new periodontal ligament attachment until the 16th week and additional new attachtment was not found following the use of citric acid treatment compared with non-acid treatment.