Research progress on cemental tears in terms of clinical diagnosis and treatment / 口腔疾病防治

@#A cemental tear is defined as an incomplete or complete detachment of the cementum along the dentino-cemental junction (CDJ) or the incremental line within the body of the cementum, which can also involve part of the root dentine adjacent to the cementum. The pathogenesis of cemental tears is not fully elucidated. From the literature review, possible predisposing factors were identified, including tooth type, sex, age, periodontitis, previous periodontal treatment or root canal treatment, history of dental trauma, and occlusal trauma or excessive occlusal force. The morphology of cemental tears can be either piece-shaped or U-shaped, which usually contributes to periodontal and periapical breakdown. Clinically, cemental tears have a unitary periodontal pocket and present with symptoms mimicking localized periodontitis, apical periodontitis, and vertical root fractures. Imaging examination is of great significance for the clinical diagnosis of cemental tears, which often manifest as thin ‘prickle-like’ radiopaque masses located longitudinally adjacent to the affected root surface. Exploratory surgery is needed in some cases. Although intraoperative cemental fragments and cemental lines on the root surface can assist in the diagnostic process, histopathology examination is the gold standard for the diagnosis of cemental tears. The treatment methods vary depending on the timing of the correct diagnosis and the clinical or radiological manifestations. With the development of regenerative biomaterials and the development of intentional replantation, an increasing number of affected teeth can survive for a long time. The aim of this review is to systematically describe the biological basis and predisposing factors, clinical features, radiographic and histological characteristics, diagnosis and clinical management of cemental tears, and treatment outcomes to help make a clear diagnosis and develop a personalized treatment plan.

The effectiveness of minimal flap surgery in the treatment of sub-gingival class V cavities / 实用口腔医学杂志

Objective:To evaluate the effectiveness of minimal flap surgery in the treatment sub-gingival caries ( class V cavities) . Methods:57 teeth(4 incisors, 13 canines, 38 premolars and 2 molars) with sub-gingival caries in 42 patients were treated by com-bined gingival flap surgery. Sub-gingival caries was fully exposed and the lesion was fully removed, then the deffects were filled with flowing resin. Before operation, 6 and 12 months after treatment, PD, SBI and gingival recession were examined. Results:Success rate of the treatment was 98. 25%. No statistically significant difference of the indexes was found during 12-month-follow up. Conclu-sion:Minimal flap surgery is effective for the treatment of sub-gingival caries ( class V cavities) .

Concomitant or Delayed Intra-abdominal Operation in Immediate Breast Reconstruction with TRAM Flap

PURPOSE: As patients who take immediate breast reconstructions with TRAM flap have increased, concomitant or delayed other elective intra-abdominal operations in these patients also have increased. There are few reports of concomitant or delayed intra-abdominal operation in TRAM flap patients. We report our experiences and outcomes of these operations which is safe and feasible. METHODS: We reviewed the charts and postoperative follow-up results of 11 patients among 471 consecutive patients who took immediate breast reconstruction with TRAM flap from December of 2002 to September of 2006. Four patients took concomitant intra-abdominal operation and 7 patients took delayed intra-abdominal operation between 1 to 52 months after TRAM flap RESULTS: There were no significant postoperative abdominal and systemic complications. One patient who took concomitant intra-abdominal operation presented partial skin necrosis of abdomen, but recovered completely with conservative treatments. Two patients took transfusion in peri-operative periods. CONCLUSION: Concomitant or delayed intra-abdominal operation in immediate breast reconstruction with TRAM flap could be performed safely and feasibly when it is necessary. Furthermore, it could be helpful to patients and surgeons.

Reconstruction of the Lower Extremity Using the Various Flap Operations

There are some difficulties in the reconstruction according to anatomic regions of the lower extremity such as thigh, knee, anterior tibia, heel and so on. The earlier the normal tissue saved and the necrotic tissue removed, the less the patients had complications and functional disability. There are many kinds of flap surgery in the reconstruction of the lower extremity such as local skin flap, local fasciocutaneous flap, local muscle flap and free flap. We have done 71 cases using the various flap operation excluding direct closure and skin graft among the patient of lower extremity injury from Jul. 1997 to Oct. 2002. Among 71 cases, 46 cases were due to traffic accidents and mechanical damages and 4 cases were burn, 5 cases were diabetic ulcer, 16 cases were cancer and other skin defects. Lower leg and foot were the most common lesion and the next was knee and thigh. And in the flap operations we have done, 32 cases(45%) were local skin flap, 18 cases(25%) were local fasciocutaneous flap, 6 cases(9%) were local muscle flap, 15 cases(21%) were free flap and so on. In early postoperative complications, the total flap necrosis was seen in 1 case, the partial necrosis in 6 cases, the infection in 5 cases and the hematoma or seruma in 3 cases. The bulky flap and ulceration were seen in 3 cases respectively and needed secondary operation after long term follow-up. The area below the knee joint is limited by its low vascularity, low tissue flexibility, high infectiousness and long periods of wound healing, and the reconstruction of the weight bearing heel needs proper skin thickness and durability. The better reconstruction of the lower extremity needs many experiences of various methods to us and we should know about their advantages and disadvantages.

The effect of flap operation and metronidazole gel combined therapy on the treatment of the juvenile periodontitis / 대한치주과학회지

The aim of the study was to investigate the effect of surgical therapy combined with the usage of metronidazole gel in the treatment of juvenile periodontitis by comparing clinical indices of flap operation along with application of metronidazole gel and flap operation only. Comparing clinical indices of the baseline, 3 months after surgery, 6 months after surgery statistically, the results are as follows; 1. Bleeding on probing (BOP) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p0.05). However, there was no statistically significant difference in these groups (p>0.05). 2. Pocket probing depth (PPD) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p0.05). However, there was no statistically significant difference in these groups (p>0.05). 3. Loss of attachment level(LOA) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p0.05). In conclusion, flap operation was effective on the treatment of juvenile periodontitis. However, combined therapy of metronidazole gel could not give rise to any significant adjunctive effect on the treatment outcome.

Decision Making on the Non surgical, Surgical Treatment on Chronic Adult Periodontitis / 대한치주과학회지

The purpose of this study was to make and ascertain a decision making process on the base of patient-oriented utilitarianism in the treatment of patients of chronic adult periodontitis. Fifty subjects were chosen in Yonsei Dental hospital and the other fifty were chosen in Severance dental hospital according to the selection criteria. Fifty four patients agreed in this study. NS group(N=32) was treated with scaling and root planing without any surgical intervention, the other S group(N=22) done with flap operation. During the active treatment and healing time, all patients of both groups were educated about the importance of oral hygiene and controlled every visit to the hospital. When periodontal treatment needed according to the diagnostic results, some patients were subjected to professional tooth cleaning and scaling once every 3 months according to an individually designed oral hygienic protocol. Probing depth was recorded on baseline and 18 months after treatments. A questionnaire composed of 6 kinds(hygienic easiness, hypersensitivity, post treatment comfort, complication, functional comfort, compliance) of questions was delivered to each patient to obtain the subjective evaluation regarding the results of therapy. The decision tree for the treatment of adult periodontal disease was made on the result of 2 kinds of periodontal treatment and patient's ubjective evaluation. The optimal path was calculated by using the success rate of the results as the probability and utility according to relative value and the economic value in the insurance system. The success rate to achieve the diagnostic goal of periodontal treatment as the remaining pocket depth less than 3mm and without BOP was 0.83+/-0.12 by non surgical treatment and 0.82+/-0.14 by surgical treatment without any statistically significant difference. The moderate success rate of more than 4mm probing pocket depth were 0.17 together. The utilities of non-surgical treatment results were 100 for a result with less than 3mm probing pocket depth, 80 for the other results with more than 4mm probing pocket depth, 0 for the extraction. Those of surgical treatment results were the same except 75 for the results with more than 4mm. The pooling results of subjective evaluation by using a questionnaire were 60% for satisfaction level and 40% for no satisfaction level in the patient group receiving non-surgical treatment and 33% and 67% in the other group receiving surgical treatment. The utilities for 4 satisfaction levels were 100, 75, 60, 50 on the base of that the patient would express the satisfaction level with normal distribution. The optimal path of periodontal treatment was rolled back by timing the utility on terminal node and the success rate, the distributed ratio of patient's satisfaction level. Both results of the calculation was non surgical treatment. Therefore, it can be said that non-surgical treatment may be the optimal path for this decision tree of treatment protocol if the goal of the periodontal treatment is to achieve the remaining probing pocket depth of less than 3mm for adult chronic periodontitis and if the utilitarian philosophy to maximise the expected utility for the patients is advocated.