Cerrahi Periodontal Tedavi

Periodontal
parametrelerin Estetik Mukogingival
iyileştirilmesi

Destek Doku Cerrahisi Proteze hazırlık

Ceplerin ortadan Dokunun yeniden

kaldırılması oluşturulması
 Mukogingival Sınır

Serbest Dişeti Yapışık Dişeti Keratinize Dişeti

 hareketli mukoza
keratinize olmayan

yapışık
CT
keratinize CT CEJ
JE
OE

E
hareketli
keratinize OSE

The Anatomy o

Mukoza tipleri
 1

led appearance.
2

Mukoza tipleri
3
The Anatomy of Periodontal Tissues 15
4
The Anatomy o

ridges. Thus, the depressions on the surface

espond with the fusion sites (1–3) between
surface of the epithelium (shown in Fig. 1-
cations (1–3). The depressions (1–3) seen on
nce of epithelial ridges which merge at
urface of the epithelium is characterized by
the same model as that shown in Fig. 1-17b.
ce of the epithelium facing the connective
shows a photograph of the subsurface (i.e.
hen present, give the gingiva its character-
ace exhibits the minute depressions (1–3)
f the oral epithelium of the attached gingiva.
presents a magnified model of the outer
glycogen-containing granules start to occur. Such
granules are believed to be related to the synthesis of
keratin.

b
SC
Fig. 1-29 is a photomicrograph of the stratum granu- OSE
losum and stratum corneum. Keratohyalin granules
keratinize
(arrows) are seen in the stratum granulosum. There
is an abrupt transition of the cells from the stratum
hareketli
granulosum to the stratum corneum. This is indica-
tive of a very sudden keratinization of the cytoplasm E
of the keratinocyte and its conversion into a horny
squame. The cytoplasm of the cells in the stratum
corneum (SC) is filled with keratin and the entire
apparatus for protein synthesis and energy produc-
tion, i.e. the nucleus, the mitochondria, the endoplas-
OE
mic reticulum, and the Golgi complex, is lost. In a
parakeratinized epithelium, however, the cells of the
stratum corneum contain remnants of nuclei. Kerati- JE
nization is considered a process of differentiation Fig. 1-29
rather than degeneration. It is a process of protein
synthesis which requires energy and is dependent on CEJ CT

The Anatomy of Periodontal Tissues

functional cells, i.e. cells containing a nucleus and a
keratinize
normal set of organelles.
CT
yapışık
Summary: The keratinocyte undergoes continuous

11
differentiation on its way from the basal layer to the
surface of the epithelium. Thus, once the keratinocyte
has left the basement membrane it can no longer
divide but maintains a capacity for production of
protein (tonofilaments and keratohyalin granules). In
the granular layer, the keratinocyte is deprived of its
energy- and protein-producing apparatus (probably
by enzymatic breakdown) and is abruptly converted
into a keratin-filled cell which, via the stratum
corneum, is shed from the epithelial surface.
keratinize olmayan
Fig. 1-30 illustrates a portion of the epithelium of the
hareketli mukoza
alveolar (lining) mucosa. In contrast to the epithe-
lium of the gingiva, the lining mucosa has no stratum
corneum. Notice that cells containing nuclei can be
identified in all layers, from the basal layer to the
 lls in the stratum
tin and the entire
d energy produc-
dria, the endoplas-
plex, is lost. In a
ver, the cells of the
Mukoza tipleri
s of nuclei. Kerati-
of differentiation Fig. 1-29 The Anatomy o
process of protein
d is dependent on OSE keratinize
eriodontal Tissues

g a nucleus and a hareketli

E
rgoes continuous OE
11

basal layer to the JE

ce the keratinocyte
CEJ CT keratinize
it can no longer
CT
yapışık
for production of
yalin granules). In
e is deprived of its
paratus (probably
bruptly converted keratinize olmayan
via the stratum hareketli mukoza
ial surface.
 attached gingiva (3.94 – 1.19 MPa) was similar to that
of the lingual attached gingiva, and this strength value Volume 82 • Number 8

was significantly higher than all other regions of oral

mucosa tested (P <0.005). The buccal attached gin-
Biomechanical Behavior of Oral
giva exhibited the highest tensile stiffness with
Soft Tissues
a Young modulus value of 19.75 – 6.20 MPa, which
was significantly higher than the alveolar mucosa
Selda † and Peter S. McFetridge‡
(of Goktas,*
both lingual John J.and Dmytryk,
buccal aspects), and the buccal
Influencemucosa (P <0.005).
of Architectural However,
Heterogeneity there was
on Tissue Mechanicsno significant Volume 82 • Number 8
difference
Background:in stiffness
Little attention has between
been giventhe lingual and buccal
to understand-
ing the variation in biomechanical
aspects of the attached gingiva, or between behavior of oral soft tis- the lingual
sues, and this represents an obstacle for the development of
and buccal
biomaterials thatalveolar
perform with mucosa
appropriate sections
biomechanical (Table 1).
Table 1.
Viscoelasticity.
characteristics. With this as Stress relaxation
our motivation, a uniaxialcurves me- for the
chanical analysis was performed on lingual and buccal as-
porcine
Tensile tissue
attached(Fig.
Properties 1D)
and displayed
Stress a typical
mucosa, Relaxation buccal non-linear Data of tissues
the Porcine Oral Soft Tissue
O
pects of the gingiva, alveolar and ral soft are complex bi-
viscoelastic
mucosa tissue
to gain insight intoresponse, where theand
human tissue performance stress within ologic systems with the compo-
site-specific mechanical variation. nents of their extracellular matrix
the tissue
Methods: decayed
A discrete with time
quantitative until
mechanical equilibrium
Tensile
evaluation Properties*
of values
(ECM) responding differentially to phys-Stress Relaxation Data*
were
each softreached.
tissue region 30using
Thetensile,
lingual alveolar
dynamic mucosa demon-
compression, iologic stresses. These tissues are sub-
and stress relaxation analysis was conducted to correlate tis-
Tensile jected to a wide variety of mechanical
Young Initial Equilibrium
strated
sue structurea significantly
with function as assessedhigherhistologically.
viscoelasticity compared forces, including hydrodynamic forces,
toResults:
the attached
Results confirm gingiva Failure
(lingual
the keratinized andStrength
gingiva tobuccal)
have and Moduluselongation, Stress,
the
compression, friction,sand0
Stress, sN
increased tensile strength (3.94Load
Region
buccal mucosa (n = – 1.19
8; P MPa) and stiffness
(N)<0.05). (MPa)viscoelastic
The (MPa) during saliva(MPa)
shear generated flow, mas- (MPa) (s0-sN)/s0†
(Young modulus of 19.75 – 6.20 MPa) relative to non-kerati- tication, speech, toothbrushing, and so
properties
nized
Lingual mucosal of
attachedregions, thewhere
gingiva lingual –and
densely
10.89 bbuccal
arranged
2.74 2.83alveolar
elastin – 0.99d,e mucosa
fibers forth.
18.83 – 5.98 the oral1.88
1-4 Among c-e
– 0.11c-e
soft tissues, the 0.97 – 0.08c-e 0.48 – 0.02c,d
contribute to a tissue with increased viscoelastic properties.
were found to be statistically similar.
Dynamic compression analysis indicateda,c-e
The meanattached (– SD)gingiva,c-ealveolar
the instantaneous c-e buccal mucosa have
mucosa, and
Buccal attached gingiva 19.74 – 5.04 3.94 – 1.19 19.75 – 6.20 1.84 – the
attracted 0.23 most
c-e
0.96 – 0.14c-e 0.47 – 0.06c,d
values(Eint
modulus for the modulus
), steady initial (Estress
s), and peak(sstress
o), equilibrium
increased stressbecause of controversy
attention among
(sN),
Lingual
values
and (s
alveolar mucosa
found in theobuccal
-sN)/s
with loading frequency and strain amplitude,
o ratio,
10.54
attached
–gingiva.
2.18
with the highest b,e clinicians regarding
abmeasure 1.72 –of0.51 tissuequantity
visco-
4.79 – 2.54a,b the 0.25necessitya,b,e
– 0.03 or
of keratinized gingiva required
0.1 – 0.01a,b,e 0.59 – 0.04a,b,e
elasticity,
Conclusion: These wereinvestigations
tabulatedquantify in Table 1.
b the biomechani- to support health around natural teeth
Buccal alveolar
cal properties mucosa
of oral soft 8.93
tissues –
and 2.06
show 1.29
region-to-region – 0.19a,b and5.74 dental– implants.
1.15a,b,e 5-8 0.21
The – 0.02a,b,e 0.09 – 0.01a,b,e 0.56 – 0.06a,b
mucogingi-
Dynamic compressive properties. A representa-
variation that details structure–function relationships and pro- val junction demarcates the attached
tive key
Buccal
vides graph
mucosa of compressive
parameters 9.08 – 1.66
to aid development stress
b
1.06 –that
versus
of biomaterials time
0.10a-cisgingiva
shown
2.48from– 0.37 a,b,d
the alveolar0.39
mucosa,– 0.03 a-d
which 0.19 – 0.03a-d 0.51 – 0.04c
perform
in are
Figure with appropriate biomechanical properties. J frequency,
Peri-
–2A. At= 10% strain and 1 Hz on thethe buccal side of the cheek transi-
* Data mean SD (n 9). Pairwise comparisons (statistical significance set at P <0.05) are reported between the groups: a versus lingual attached
odontol 2011;82:1178-1186. tions to dthe buccal mucosa.9 The sur- e
gingiva;
b
buccalversus attached gingiva
buccal attached gingiva;
c
displayed
versus lingual the alveolar
highest facepeak
mucosa; Figure
versus buccal 2. mucosa; versus buccal mucosa.
alveolar
of all three mucosal tissues is
† Contribution
KEY WORDS of the viscous components relative to the total stress. A) Representative graph of compressive stress versus time for the buccal
stress values,
Biocompatible after
materials; which strength;
compressive the stress connectiveof each covered subse- with a stratified squamous epi-
attached gingiva
thelium bound to the underlying connec- at 10% strain and 1 Hz frequency, with the first cycle
quentelasticity;
tissue; cycle epithelium;
decreased tensile tostrength.
a steady-state value. The
tive tissues by a network
generating of the
anchoring
largest peak, after which the peak stress value of each
percent
Tissue strain remained
strips 3 · 30 mm (n = 9) were secured and constant for the subsequent
fibrils.10,11
peated indecreased
cycle reverseto order for the
a steady-state value.same
B) The region. Both
percent strain remained
* School of Chemical, Biological and Materials Engineering, University of Oklahoma, The ultrastructure of the different oral
cycles
Norman, OK.(Fig. 2B).
preloaded to 0.003
† Department of Periodontics, Nof Oklahoma
University at a College
cross-head velocity
of Dentistry, Oklahoma City, oftissuesseries
soft constant
showed with
is in accordance for the
similarsubsequent cycles. C) Peak stress. Maximum
their results indicating the testing or- stress
OK.The peak stress exhibited by the buccal attached
5 mm/min. Samples were preconditioned with five specific function
der and values
within
time for each
the oral tissue
hadcavity. section on
no effect during thetissue
the initial compression cycle at a
stress–strain
‡ J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida,
Mukogingival Sınır
 Mukogingival Sınır

mm

5
3
1
1 2 3 4 5 6 7
1
3

5
7
20-30 YEARS
9
40-50 YEARS
mm
ed to the underlying
 Vestibül derinliğinin klinik önemi

• Keratinize doku kronik irritasyona daha dayanıklıdır

• Vestibül derinliği yanak hareketleri ile alveol mukozasının
ilişkisini sınırlar
• Fırçalamak ve ağız bakımı için hareket alanı sağlar
• Hareketli ptotezlerin tutuculuğunu etkiler
• Keratinize ve non-keratinize yapılardan oluşur
• Hareketli dokular non-keratinize dir ?????????
• Hareketsiz dokular keratinizedir.
 Diş çekimi
Dişeti çekilmesi
Periodontal hastalık
 Short Communication
Lack of association between width Jan L. Wennstrom
Department of periodontology, Schoo! of
Dentistry, University of Gothenburg,
Gothenburg, Sweden
of attached gingiva and
development of soft tissue
recession
A 5-year iongltudinal study

Wennstrom JL: Lack of association between width of attached gingiva and devel-
opment of soft tissue recession. A 5-year longitudinal study. J Clin Periodontol
1987: 14: 181-184.

Bu çalışmanın sonuçlarına göre

Abstract. The purpose of this study was to longitudinally monitor changes in the
position of the soft tissue margin at 26 buccal sites surgically deprived of all
gingival
182 tissue. A baseline examination carried out 6 months after treatment
Wennstrom

yapışık diş eti miktarının yetersiz

revealed that the sites to be monitored were lacking or had only a minimal zone
Table i. Comparison of mean values l±s.d.) for lest and control sites at baseline and after 5
( < 1 mm) of regenerated attached gingiva. 12 control sites with an "adequate" showing an apical displacement of the
years soft tissue margin (i.e., increase of re-
width of attached gingiva (> 1 tnm) were also examined. Assessments of oral during the 5 years of obser-
cession)
Test sites Control sites

olduğu durumlarda bile

hygiene and gingiva! conditions, baseline probing
after 5 years pocket depths,
baseline probing
after 5 yearsattachment
vation were found in 1 patient (Fig. 3).
levels,
plaque index
position of the soft0+0
tissue margin,
0+ 0
and gingiva!
0+0
widt!i were
0+0
carriedThe out
2 control teeth in this particular
at baseline
gingival index and after 5 years. 0 + 0 The results
0.3 + 0.3 revealed 0that
+ 0 in the + 0.2 sites, patient
0.2 test a slightas well as I of the test teeth with
increase of the width of the gingiva occurred during the observation period, 7attached gingiva exhibited loss
probing depth 1.4 + 0.4 1.8 + 0.3* 1.5 + 0.4 1.3 + 0.4 lack of
width l.5±0.5 2.3 + 0.6* 3.6±0.5 3.3 + 0.9 of probing attachment. A coronal re-
out of ofgingiva
the 26 areas showed
change in location of:
a coronal regrowth of the soft tissue margin, while 2
growth of the soft tissue margin was
sites showed
soft tissue margin" a further apical displacement
+ 0.4 ±0.4* of the soft
- tissue margin.
-0.3±0.7 In the
observed in 7 of the test areas, out of

ve dişetine komşu restorasyon

control
attachmentareas.
level' 3 sites developed - recession
+ 0.1 ±0.4 accompanied by- 0a. 2reduction ±0.4 in the3 areas also showed gain of prob-
which
" width of the
( + ) coronal gingiva.(—)
displacement, Hence, it appears that in patients maintaining a proper
apical displacement
Key words:
ing attachment (Table 2). Attached gingiva - gingival re-
* plaque cession - i<eratinized gingfva.
control,
Statistically thechange
sigtiificant lack from
of an "adequate"
baseline zone of attached gingiva does not result
(0.01 <;)<0.05).

olmadığı şartlarda
in an increased incidence of soft tissue recessions. Discussion Accepted for publication 5 November 1986
tissue margin; (4) width of the keratin- observation. No major changes were The present study demonstrated that
ized and the attached gingiva after observed in the control sites with respect the lack of or the presence of minimal

tached of gingivaby in
was determined sub-an the
areaclinical
healing revealed
appearance that of14the
of some
doku sağlığı korunabilmektedir.
staitiitig of the alveolar rtiticosa with an to the mean values for the various par- amounts of attached gingiva at the buc-
iodine solution. The width of the at- ameters examined. Figs. 1 and 2 present cal aspects of teeth does not necessarily
A narrowportion zone of 26result
surgically gingiva was
in the development of softsurgically
tissue removed around
tracting
exhibiting the probing depth from
a localized the testre-sites treated
soft tissue at baselinesites
and were
after 5lacking
years, an attachedAs a 26
recessions. matter of fact, only 2 teeth in the man-
canine-premolar
measure
cessiondescribing
is oftentheconsidered
width of the gin-
to be theA closerportion
analysis of
of gingiva
the data revealed,
and that the out of 26 sites with
remain- lack ofjaw
dibular or with
of 6 only
patients. Following sur-
giva. All assessments were confined to however, that the soft tissue margin had a minimal zone (< 1 mm) of attached
 Short Communication
Lack of association between width Jan L. Wennstrom
Department of periodontology, Schoo! of
Dentistry, University of Gothenburg,
Gothenburg, Sweden
of attached gingiva and
development of soft tissue
recession
A 5-year iongltudinal study

Wennstrom JL: Lack of association between width of attached gingiva and devel-
opment of soft tissue recession. A 5-year longitudinal study. J Clin Periodontol
1987: 14: 181-184.

Bu çalışmanın sonuçlarına göre

Abstract. The purpose of this study was to longitudinally monitor changes in the
position of the soft tissue margin at 26 buccal sites surgically deprived of all
gingival
182 tissue. A baseline examination carried out 6 months after treatment
Wennstrom

yapışık diş eti miktarının yetersiz

revealed that the sites to be monitored were lacking or had only a minimal zone
Table i. Comparison of mean values l±s.d.) for lest and control sites at baseline and after 5
( < 1 mm) of regenerated attached gingiva. 12 control sites with an "adequate" showing an apical displacement of the
years soft tissue margin (i.e., increase of re-
width of attached gingiva (> 1 tnm) were also examined. Assessments of oral during the 5 years of obser-
cession)
Test sites Control sites

olduğu durumlarda bile

hygiene and gingiva! conditions, baseline probing
after 5 years pocket depths,
baseline probing
after 5 yearsattachment
vation were found in 1 patient (Fig. 3).
levels,
plaque index
position of the soft0+0
tissue margin,
0+ 0
and gingiva!
0+0
widt!i were
0+0
carriedThe out
2 control teeth in this particular
at baseline
gingival index and after 5 years. 0 + 0 The results
0.3 + 0.3 revealed 0that
+ 0 in the + 0.2 sites, patient
0.2 test a slightas well as I of the test teeth with

kusursuz ağız bakımı varlığında

increase of the width of the gingiva occurred during the observation period, 7attached gingiva exhibited loss
probing depth 1.4 + 0.4 1.8 + 0.3* 1.5 + 0.4 1.3 + 0.4 lack of
width l.5±0.5 2.3 + 0.6* 3.6±0.5 3.3 + 0.9 of probing attachment. A coronal re-
out of ofgingiva
the 26 areas showed
change in location of:
a coronal regrowth of the soft tissue margin, while 2
growth of the soft tissue margin was
sites showed
soft tissue margin" a further apical displacement
+ 0.4 ±0.4* of the soft
- tissue margin.
-0.3±0.7 In the
observed in 7 of the test areas, out of

ve dişetine komşu restorasyon

control
attachmentareas.
level' 3 sites developed - recession
+ 0.1 ±0.4 accompanied by- 0a. 2reduction ±0.4 in the3 areas also showed gain of prob-
which
" width of the
( + ) coronal gingiva.(—)
displacement, Hence, it appears that in patients maintaining a proper
apical displacement
Key words:
ing attachment (Table 2). Attached gingiva - gingival re-
* plaque cession - i<eratinized gingfva.
control,
Statistically thechange
sigtiificant lack from
of an "adequate"
baseline zone of attached gingiva does not result
(0.01 <;)<0.05).

olmadığı şartlarda
in an increased incidence of soft tissue recessions. Discussion Accepted for publication 5 November 1986
tissue margin; (4) width of the keratin- observation. No major changes were The present study demonstrated that
ized and the attached gingiva after observed in the control sites with respect the lack of or the presence of minimal

tached of gingivaby in
was determined sub-an the
areaclinical
healing revealed
appearance that of14the
of some
doku sağlığı korunabilmektedir.
staitiitig of the alveolar rtiticosa with an to the mean values for the various par- amounts of attached gingiva at the buc-
iodine solution. The width of the at- ameters examined. Figs. 1 and 2 present cal aspects of teeth does not necessarily
A narrowportion zone of 26result
surgically gingiva was
in the development of softsurgically
tissue removed around
tracting
exhibiting the probing depth from
a localized the testre-sites treated
soft tissue at baselinesites
and were
after 5lacking
years, an attachedAs a 26
recessions. matter of fact, only 2 teeth in the man-
canine-premolar
measure
cessiondescribing
is oftentheconsidered
width of the gin-
to be theA closerportion
analysis of
of gingiva
the data revealed,
and that the out of 26 sites with
remain- lack ofjaw
dibular or with
of 6 only
patients. Following sur-
giva. All assessments were confined to however, that the soft tissue margin had a minimal zone (< 1 mm) of attached
 Short Communication
Lack of association between width Jan L. Wennstrom
Department of periodontology, Schoo! of
Dentistry, University of Gothenburg,
Gothenburg, Sweden
of attached gingiva and
development of soft tissue
recession
A 5-year iongltudinal study

Wennstrom JL: Lack of association between width of attached gingiva and devel-
opment of soft tissue recession. A 5-year longitudinal study. J Clin Periodontol
1987: 14: 181-184.

Bu çalışmanın sonuçlarına göre

Abstract. The purpose of this study was to longitudinally monitor changes in the
position of the soft tissue margin at 26 buccal sites surgically deprived of all
gingival
182 tissue. A baseline examination carried out 6 months after treatment
Wennstrom

yapışık diş eti miktarının yetersiz

revealed that the sites to be monitored were lacking or had only a minimal zone
Table i. Comparison of mean values l±s.d.) for lest and control sites at baseline and after 5
( < 1 mm) of regenerated attached gingiva. 12 control sites with an "adequate" showing an apical displacement of the
years soft tissue margin (i.e., increase of re-
width of attached gingiva (> 1 tnm) were also examined. Assessments of oral during the 5 years of obser-
cession)
Test sites Control sites

olduğu durumlarda bile

hygiene and gingiva! conditions, baseline probing
after 5 years pocket depths,
baseline probing
after 5 yearsattachment
vation were found in 1 patient (Fig. 3).
levels,
plaque index
position of the soft0+0
tissue margin,
0+ 0
and gingiva!
0+0
widt!i were
0+0
carriedThe out
2 control teeth in this particular
at baseline
gingival index and after 5 years. 0 + 0 The results
0.3 + 0.3 revealed 0that
+ 0 in the + 0.2 sites, patient
0.2 test a slightas well as I of the test teeth with

kusursuz ağız bakımı varlığında

increase of the width of the gingiva occurred during the observation period, 7attached gingiva exhibited loss
probing depth 1.4 + 0.4 1.8 + 0.3* 1.5 + 0.4 1.3 + 0.4 lack of
width l.5±0.5 2.3 + 0.6* 3.6±0.5 3.3 + 0.9 of probing attachment. A coronal re-
out of ofgingiva
the 26 areas showed
change in location of:
a coronal regrowth of the soft tissue margin, while 2
growth of the soft tissue margin was
sites showed
soft tissue margin" a further apical displacement
+ 0.4 ±0.4* of the soft
- tissue margin.
-0.3±0.7 In the
observed in 7 of the test areas, out of

ve diş etine komşu restorasyon

control
attachmentareas.
level' 3 sites developed - recession
+ 0.1 ±0.4 accompanied by- 0a. 2reduction ±0.4 in the3 areas also showed gain of prob-
which
" width of the
( + ) coronal gingiva.(—)
displacement, Hence, it appears that in patients maintaining a proper
apical displacement
Key words:
ing attachment (Table 2). Attached gingiva - gingival re-
* plaque cession - i<eratinized gingfva.
control,
Statistically thechange
sigtiificant lack from
of an "adequate"
baseline zone of attached gingiva does not result
(0.01 <;)<0.05).

olmadığı şartlarda
in an increased incidence of soft tissue recessions. Discussion Accepted for publication 5 November 1986
tissue margin; (4) width of the keratin- observation. No major changes were The present study demonstrated that
ized and the attached gingiva after observed in the control sites with respect the lack of or the presence of minimal

tached of gingivaby in
was determined sub-an the
areaclinical
healing revealed
appearance that of14the
of some
doku sağlığı korunabilmektedir.
staitiitig of the alveolar rtiticosa with an to the mean values for the various par- amounts of attached gingiva at the buc-
iodine solution. The width of the at- ameters examined. Figs. 1 and 2 present cal aspects of teeth does not necessarily
A narrowportion zone of 26result
surgically gingiva was
in the development of softsurgically
tissue removed around
tracting
exhibiting the probing depth from
a localized the testre-sites treated
soft tissue at baselinesites
and were
after 5lacking
years, an attachedAs a 26
recessions. matter of fact, only 2 teeth in the man-
canine-premolar
measure
cessiondescribing
is oftentheconsidered
width of the gin-
to be theA closerportion
analysis of
of gingiva
the data revealed,
and that the out of 26 sites with
remain- lack ofjaw
dibular or with
of 6 only
patients. Following sur-
giva. All assessments were confined to however, that the soft tissue margin had a minimal zone (< 1 mm) of attached
Keratinize dokunun arttırılması

Yapışık dokunun arttırılması

TEDAVI YAKLAŞIMLARI
!13
!13
!14
!14
5.YIL
J. periodont res. 6: 282-293. 1971

Conservation of tissue specificity

after heterotopic transplantation of
gingiva and alveolar mucosa
T. KARRING, E. OSTERGAARD AND H . LOE

Department of Periodontology, The Royal Dental College,

Aarhus, Denmark

In eight monkeys separate tissue flaps of the buccal gingiva and alveolar mucosa adjacent to
premolar teeth were transposed. In addition, free palatal grafts were transplanted to the
anterior maxillary and mandibular alveolar mucosa. The grafting and the sacrifice of the
animals were timed to yield observation periods of 5 and 14 days, 1-8. 10 and 12 months.
Serial sections were obtained from the grafted and control ti.ssues. After 2 months the grafted
tissues displayed clinical features which were identical to those of the respective donor tissues.
This appearance did not change throughout the experimental period. Tissue characteristics such
a.s the distribution of coUagenous, elastic and silver-stained fibers, the absence or presence of a
keratin layer and localization of PAS-positive material in the epithelium were maintained. The
tissue specificities of the gingival, alveolar and palatal mucosa were conserved after heterotopic
transplantation. Thus, the clinical a?id structural features of these tissues are genetically rather
than functionally determined. It is suggested that grafting of keratinized tissues is a better
method for predetermining the postsurgicai width of gingiva than the methods of mucogingival
surgery ordinarily used.

hereditary mechanisms rather than by func-

Introduction
tional adaptation.
In the adult organism, tissue differentiation Differences between keratinized palatal
Keratinize Dişeti Gerekli mi ?
Bu çalışmanın sonuçlarına göre
keratinize diş eti miktarının yetersiz
olduğu durumlarda bile
kusursuz ağız bakımı varlığında
ve dişetine komşu restorasyon
olmadığı şartlarda
doku sağlığı korunabilmektedir.
Bu çalışmanın sonuçlarına göre
keratinize diş eti miktarının yetersiz
olduğu durumlarda bile
kusursuz ağız bakımı varlığında
ve dişetine komşu restorasyon
olmadığı şartlarda
doku sağlığı korunabilmektedir.
Bu çalışmanın sonuçlarına göre
keratinize diş eti miktarının yetersiz
olduğu durumlarda bile
kusursuz ağız bakımı varlığında
ve dişetine komşu restorasyon
olmadığı şartlarda
doku sağlığı korunabilmektedir.
as regulators of the consistency of the connective
exposed to mechanical stimulation. Thus, the tissues
tissue (Fig. 1-48c). If the gingiva is suppressed, the
seem to adapt to environmental stimuli. The presence
macromolecules become deformed. When the pres-
of keratinized epithelium on the masticatory mucosa
sure is eliminated, the macromolecules regain their
has been considered to represent an adaptation
original form. Thus, the macromolecules are impor-
EPITELYAL MEZANKIMAL DOKULAR
tant for the resilience of the gingiva.
to mechanical irritation released by mastication.
However, research has demonstrated that the char-

NG
AM
AM

AM
AM
G

Fig. 1-49 Fig. 1-50

Epitelin özellikleri genetik olarak belirlenmiştir,
İşlevsel uyum sözkonusu değildir.

Karring T, Ostergaard E, Loe H. Conservation of tissue specificity after heterotrophic

transplantation of gingiva and alveolar mucosa. J Periodontal Res 6: 282, 1971
!24
 EPITELYAL MEZANKIMAL DOKULAR

Epitelin özellikleri altındaki bağ dokusu tarafından belirlenmektedir

HAZIR DOKU GREFTLERI
7.ay
 Keratinize Dokunun Arttırılması
SDG-Hazır Greft

1st 3rd 6th Final Post-op

Group Baseline
month month month Gain Relapse

ADM 0,89 5,15 3,61 2,47 1,58 -2,68

YDM

SDG 1,01 5,32 3,84 3,58 2,57 -1,73

P 0,128 0.211 0.012* 0.000* 0.000* 0.000*

C Basegmez*, ZC Karabuda§, K Demirel†

 Volume 77 • Number 8

Significance of Keratinized Mucosa in

Maintenance of Dental Implants With
Different Surfaces
Dyeus M. Chung,* Tae-Ju Oh,* Jeffrey L. Shotwell,† Carl E. Misch,* and Hom-Lay Wang*

Background: The need for keratinized mucosa (KM) or immobile ker-

atinized mucosa (i.e., attached mucosa [AM]) for the maintenance of
osseointegrated endosseous dental implants has been controversial.
J Periodontol 2006; 77:1410-1420.
The purpose of this study was to investigate the significance of KM in
the maintenance of root-form dental implants with different surfaces.
Methods: A total of 339 endosseous dental implants in place for at

A
least 3 years in 69 patients were evaluated. The width of KM and AM, s the number of dental
modified plaque index (mPI), gingival index (GI), modified bleeding implant procedures and
index (mBI), probing depth (PD), and average annual bone loss (ABL) their complexity in-
were measured clinically and radiographically by a masked examiner. crease, the maintenance of os-

Özellikle posterior bölgelerdeki

Based on the amounts of KM or AM, implants were categorized as fol- seointegrated implants in a state
lows: 1) KM <2 mm (KL); 2) KM ‡2 mm (KU); 3) AM <1 mm (AL); of health with appropriate func-
and 4) AM ‡1 mm (AU). Implants were further subdivided into the fol- tion and esthetics emerges as a
lowing four subgroups based on their surface configurations: 1) smooth new challenge. In addition to a
implantlar çevresinde KD ve YM
surface implants (SI) with KM <2 mm (SKL); 2) SI with KM ‡2 mm
(SKM); 3) rough surface implants (RI) with KM <2 mm (RKL); or 4) RI
history of poor oral hygiene
and edentulism, structural differ-
with KM ‡2 mm (RKM); or 1) SI with AM <1 mm (SAL); 2) SI with AM ences in implants (i.e., lack of

eksikliği daha fazla plak birikimi

‡1 mm (SAM); 3) RI with AM <1 mm (RAL); or 4) RI with AM ‡1 mm
(RAM). The effect of KM or AM on clinical parameters was evaluated
cementum and periodontal liga-
ment, less vascular supply and
by comparing the different KM/AM groups. In addition, the significance fewer fibroblasts, parallel rather

ve dişeti iltihabı ile

of the presence of KM on implant prostheses types (i.e., fixed versus re- than perpendicular orientation of
movable) and on implant locations (i.e., anterior versus posterior) was supracrestal connective tissue,
evaluated. and the subgingival location of
Results: Comparison of ABL among the four subgroups in KM or AM crowns) that are different from
sonuçlanmaktadır.
failed to reveal statistically significant differences (P >0.05); however,
statistically significantly higher GI and mPI were present in SKL or SAL
natural teeth make them more
susceptible to the development
compared to the other three subgroups (P <0.05). GI and mPI were sig- of inflammation and bone loss

İmplant markası durumu

nificantly higher in KL (0.94 and 1.51) than KU (0.76 and 1.26) and
higher in AL (0.95 and 1.50) than AU (0.70 and 1.19) (P <0.05), respec-
when exposed to plaque accumu-
lation or microbial invasion.1-12
tively. The difference in GI between posterior implants with or without For these reasons, the pre-

değiştirmemektedir.
an adequate amount of KM was also significant (P <0.05). vention of biologic seal break-
Conclusions: The absence of adequate KM or AM in endosseous age around implants is one of
dental implants, especially in posterior implants, was associated with the goals in implant mainte-

Ancak kemik kaybında bir artış

higher plaque accumulation and gingival inflammation but not with nance.
more ABL, regardless of their surface configurations. Randomized con- An adequately keratinized
trolled clinical trials are needed to confirm the results obtained in this zone of masticatory mucosa for
retrospective clinical study. J Periodontol 2006;77:1410-1420. maintaining gingival health is

saptanmamıştır.
KEY WORDS
Dental implants; maintenance; mucosa.
usually defined as ‡2 mm of
masticatory gingiva with ‡1 mm
of attached gingiva.13 However,
whether lack of an adequately
keratinized mucosa (KM) com- !36
* Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan,
Ann Arbor, MI. promises the maintenance of
† Department of Biologic and Materials Science, School of Dentistry, University of Michigan.

doi: 10.1902/jop.2006.050393
!38
10 yrs
Zamanlama: ikinci cerrahi
Yüksek Frenumun Düzeltilmesi

!42