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Experimental study on the acellular dermal matrix graft for the root coverage in dog

Title
Experimental study on the acellular dermal matrix graft for the root coverage in dog
Other Titles
성견에서 ADM(acellular dermal matrix)의 치근피개 효과에 관한 실험적 연구
Authors
조민영
Issue Date
2005
Department/Major
임상치의학대학원 임상치의학과임플란트치의학전공
Publisher
이화여자대학교 임상치의학대학원
Degree
Master
Abstract
Objectives: Root coverage procedures using subgingival soft tissue grafts have attracted much interest within the past 2 decades. Recently, acellular dermal matrix (ADM) has been introduced as a substitute for palatal connective tissue graft in gingival augmentation procedures. This study was planned to evaluate effectiveness and histological healing appear-ance of an acellular dermal matrix allograft for the root coverage and compared the materials to the autogenous connective tissue graft (CT), when used with a coronally positioned flap procedure. Materials and Methods: Three male mongrel dogs were used for this study. Artificial gingival recessions were created surgically by removing all keratinized gingiva through raising a mucoperiosteal flap and ostectomy. Then, the flaps were coronally positioned via a partial thickness flap technique and sutured back. The gingival defects were left untreated for 35 days and healed naturally. A total of 6 recessions (left and right canine area) were made for surgical trials and randomly assigned to the test group and the contralateral recession to the control group. In the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. In the control group, the exposed root surfaces were treated by placement of a connective tissue graft in combination with a coronally positioned flap. Clinical parameters including probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), and height of keratinized tissue (HKT) were recorded at the beginning of the experiments, before surgical coverage, and 4 weeks after the surgery respectively. After 4 weeks healing, dogs were euthanazied; the specimens including the canines and the surrounding periodontal tissues were harvested, fixed in 10% formalin and processed for histologic examination. Results: Both groups exhibited significant improvements in terms of root coverage, clinical attachment level and height of the keratinized tissue gains compared to baseline values. The mean percentages of the root coverage were 61.33 % and 55.67 % in the ADM and CT groups. No significant differences were observed between the two techniques for recession height, clinical attachment level, and height of the keratinized tissue improvements. Histologically, both the ADM and CT were well incorporated within the recipient tissues. Conclusion: The results suggest that acellular dermal matrix allograft can be a useful substitute for autogenous connective tissue grafts in root coverage procedures.;목적 결합조직이식을 이용한 치근피개 술식에 많은 관심이 집중되고 있다. 최근에는 acellular dermal matrix 가 자가 결합조직 이식편의 대체물로써 소개되었다. 이 연구는 치근피개를 위해 acellular dermal matrix을 사용시, 그 임상 효과 및 조직 치유 양상을 평가하고, 이를 자가 결합조직 이식시의 결과와 비교하기 위함이다. 실험 재료 및 방법 3마리의 성견에 인위적인 치은 퇴축부 형성을 위해서, 상악 좌우견치의 협측에서 각화치은을 모두 제거하고, 법랑백악경계부로부터 12mm 정도 치조골을 삭제한 후에 판막을 봉합하였다. 그 후 35일을 치유 기간으로 부여하였다. 총 6 부위의 결손부가 실험에 포함되었고, 각각 3 부위씩이 대조군과 실험군으로 분류되었다. 1. 실험군에서는 acellular dermal matrix 이식과 치관측 변위 판막을 시행하였다. 2. 대조군에서는 치은 퇴축부위에 자가 결합조직 이식과 치관측 변위 판막을 시행하였다. 치주낭 깊이, 임상적 부착 수준, 치은 퇴축 높이, 각화조직 높이 등을 인위적 결손부 형성전, 치은 피개술 시행 직전, 피개술 시행후 4주 경과시에 각각 측정하였다. 술후 4주시에, 상악 좌우 견치 부위에서 시편을 얻어 조직학적으로 관찰하고 Wilcoxon signed rank test 와 Mann-Whitney U test으로 통계 처리하였다. 결과 1. 대조군과 실험군 모두에서, 술전과 비교시 치은 퇴축 감소와 각화조직의 증가, 임상 부착 수준의 개선이 나타났다. (p≤ 0.05) 2. 평균 치근 피개율은 실험군에서 61.33±5.67%(n=3), 대조군에서 55.67±5.67%(n=3) 이었다. 3. 대조군과 실험군에서 임상결과에서는 통계학적으로 유의성 있는 차이는 없었다. (p>0.05) 4. 조직학상으로는, 두 군 모두에서 이식편이 수여부에 잘 융화되어 있었고 비숫한 치유 양상을 보였다. 결론 Acellular dermal matrix은 치근피개술 시행시에, 결합조직 이식편의 대용품으로 사용할 수 있고 비숫한 피개 결과를 얻었다.
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