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ISSN : 0376-4672
Purpose: The aim of this study was to show the clinical results of combination of Nd-YAP (1340nm) laser therapy with conventional endodontic and periodontal treatment. Materials and Methods: Four patients with chronic advanced periodontitis and endodontic infection were treated with conventional treatment and Nd-YAP laser therapy. Occlusal adjustment and splinting were done for stabilization of the teeth with severe horizontal and vertical mobility. The protocol for periodontal treatment was followed as scaling and root planing, pocket irrigation with 3% H2O2, and exposure of Nd-YAP laser using 320㎛ optical fiber with 160 mJ/pluse, 30 Hz. The other protocol for endodontic treatment was followed as access opening, canal preparation by hand and rotary instrument, canal filling, and exposure of Nd- YAP laser using 200㎛ optical fiber with 200 mJ/pluse , 10 Hz and 180 mJ/pluse, 5 Hz which were used respectively for disinfection and canal filling. The assessments of probing depth, mobility, and radiography were made prior to and after treatment. Result: All of these four clinical cases showed good healing of periodontium, which presented decrease of mobility and pocket depth, and increase of bone regeneration and bone density on the radiography. Conclusion: The bactericidal effect of Nd-YAP laser would provide benefits for improving clinical results that are obtained from conventional therapy.
치주치료의 목표는 첫 번째로는 치석제거 및 치근활택술과 같은 치은연상, 연하의 기계적 치료에 의해 bacterial load를 줄이는 것이다. 이러한 원인 치료 후 잔존해 있는 치주낭은 치은연하 biofilm의 형성을 촉진하는 환경적 요소가 된다. 또한 치주낭은 구강위생술식과 전문적인 유지치료에도 불구하고 질환의 진행을 야기시킬 수 있다. 이런 경우 부가적인 수술 치료에 의해 치주낭과 골결손을 감소시키거나 없애줄 수 있으며 환자로 하여금 치태제거가 쉽고 간편해질 수 있다. 심한 부착 소실을 동반한 만성 치주염은 다양한 방법에 의해 성공적으로 치료될 수 있는데 이들 환자들은 임상적, 방사선학적으로 치주조직의 심한 파괴를 보인다. 심한 수평적 또는 수직적 골 소실, 7 mm 이상의 부착소실 또는 치주낭, 진전된 치아동요도, class II 또는 III 치근 이개부 병변, 병적 치아이동과 같은 양상을 보인다. 치료법의 선택은 각 환자에 대한 치료 목표에 달려있다. 다양한 골 결손부에 따라 다양한 수술적 접근이 시도될 수 있다. 특히 골내낭 또는 angular defect에 대한 치료로 최근 문헌들에서 다섯가지 방법: open flap debridement (OFD), guided tissue regeneration (GTR), enamel matrix derivatives를 이용한 조직재생, 골이식재의 충전, combined periodontal regeneration tech (CPRT, 차폐막, EMD와 골 또는 골대체물)이 제안되었다. 이러한 치료의 성공을 위해서는 집에서의 구강위생, 주기적 내원 및 유지 관리에 대한 환자의 순응이 필수적이다. 이 글에서는 다양한 골 결손부 접근 중 골이식술에 대한 목적, 골이식재의 선택, 적응증, 술식과 성공에 관하여 설명하고자 한다.
Purpose: Infection with HIV-1 virus has become a critical worldwide public health problem. The oral complications of HIV infection with its progression of impairment of the host response to combat infection present unique challenges to the periodontists. Material and Methods : Medline research was carried out to find relationship of the progression of HIV infection to the occurrence of oral lesions including the HIV-related periodontal diseases. Results: The linear gingival erythema, necrotizing ulcerative periodontitis, necrotizing ulcerative gingivitis and oral candidiasis are common lesions in HIV-infected individuals. The linear gingival erythema and necrotizing ulcerative periodontitis lesions in HIV-infected subjects were found to have a similar microbiological profile. There are several general considerations in the periodontal management of the HIV-infected patient with or without periodontal disease. The altered immunity and host response in patients with HIV infection may also affect the incidence and severity of other common forms of periodontal disease not associated with HIV infection. Conclusion: Periodontal diseases in HIV-infected individuals present unique challenges in diagnosis, monitoring, treatment and maintenance. Therefore exact HIV staging, geographic location, antiviral and antimicrobial therapies and oral habits should be taken into consideration when treating HIV-infected patients.