¹ßÇàÀÏ: 2008.08.25, 291p, Ä®¶óÀμâ, ÃâÆÇ: ³ª·¡ÃâÆÇ»ç¸ñÂ÷¥°.ÀÓÇöõÆ® ÁÖÀ§ Á¡¸·(Transmucosal Attachment)ÀÇ »ý¹°ÇÐÀû ÀÇ¹Ì¿Í ÀÓ»óÀû Á߿伺 A. Ä¡ÁÖÁ¶Á÷°ú ÀÓÇöõÆ® ÁÖÀ§Á¶Á÷ÀÇ ºñ±³ B. ÀÓÇöõÆ® ÁÖÀ§Á¶Á÷ÀÇ ±¸Á¶¿Í Å©±â C. ÀÓÇöõÆ® ÁÖÀ§Á¡¸· °áÇÕÁ¶Á÷ÀÇ ±¸¼º¼ººÐ D. ÀÓÇöõÆ® ÁÖÀ§Á¡¸·°ú ÀÓÇöõÆ®ÀÇ ºÎÂø E. ÀÓÇöõÆ®¿Í ÀÚ¿¬Ä¡¾ÆÀÇ C-T fiberÀÇ ÁÖÇà¹æÇâ 1. ÀÓÇöõÆ®ÀÇ C-T fiberÀÇ ÁÖÇà¹æÇâ 2. Gingival C-T fibersÀÇ ÁÖÇà¹æÇâ F. ÀÓÇöõÆ® ÁÖÀ§Á¡¸·ÀÇ »ý¸®Àû Æø°æ (Biologic width) 1. ¿¬Á¶Á÷ À¯ÂøÀÇ ¹Ýº¹Àû Æı«°¡ ÀÓÇöõÆ® ÁÖÀ§Á¶Á÷ÀÇ Ä¡À¯¿¡ ¹ÌÄ¡´Â ¿µÇâ 2. ÀÓÇöõÆ® design¿¡ µû¸¥ »ý¸®Àû Æø°æÀÇ ÀǹÌÀÇ Â÷ÀÌ G. ÀÓÇöõÆ® ÁÖÀ§ÀÇ papillaÀÇ Çü¼º¿¡ ¿µÇâÀ» ¹ÌÄ¡´Â ¿äÀÎ 1. Ä¡¾Æ¿Í Ä¡¾Æ»çÀÌÀÇ papilla 2. Ä¡¾Æ¿Í ÀÓÇöõÆ® »çÀÌÀÇ papilla 3. ÀÓÇöõÆ®¿Í ÀÓÇöõÆ® »çÀÌÀÇ papilla ¥±. Basic techniques for the soft tissue management in implant dentistry A. Soft Tissue Management¸¦ ÁغñÇÔ¿¡ ÀÖ¾î¼ ±âº»ÀûÀ¸·Î °®Ãß¾î¾ß ÇÒ »çÇ× B. ÀÓÇöõÆ® Ä¡·á¿µ¿ª¿¡¼ Soft tissue management techniqueµéÀÌ »ç¿ëµÇ´Â ¸ñÀû C. Suture & Suturing 1. SutureÀÇ ¸ñÀû 2. Suturing¿¡ »ç¿ëµÇ´Â ±â±¸µé 3. Knot & tying 4. Grip of needle holder 5. Park¡¯s suturing maneuver for stable and speedy suture 6. Suturing techniques III. ¿øÈ°ÇÑ Primary Closure¸¦ À§ÇÑ Soft tissue techniques A. Classification of incision lines according to situations 1. Incision along the center of remaining keratinized gingiva 2. Incision for the not-completely healed extraction socket 3. Crestal incisions on where the ridge augmentation is necessary 4. Subcrestal incisions / Vestibular incisions B. Classification of incision line according to the shape of incision 1. Beveled incision vs Perpendicular incision 2. Full thickness flap vs Full-partial thickness flap C. Connective tissue graft and Free gingival graft for primary closure 1. Severely gravitated maxillary molar¸¦ °¡Áø °í°´¿¡¼ immediate implant placement & primary closure¸¦ ½Ç½ÃÇÏ¿´´ø Áõ·Ê 2. Primary closure¸¦ À§ÇØ connective tissue graft°¡ ¼º°øÀûÀ¸·Î »ç¿ëµÇ¾ú´ø Áõ·Ê IV. Maxillary anterior immediate implant placement and soft tissue management A. Maxillary anterior immediate implant placementÁõ·Ê¿¡¼ primary closureÀÇ ÀÇ¹Ì¿Í techniques B. Maxillary anterior immediate implant placement½Ã optimal implant positioning 1. ±ÙÇù½É¸é(Mesio-distal plane) °£ °í·Á»çÇ× 2. Çù¼³¸é(Labio-palatal plane)°£ °í·Á»çÇ× 3. ¼öÁ÷Àû(Apico-coronal plane) °í·Á»çÇ× C. Provisional restorationÀ̳ª healing abutment·Î¼ socket closure¸¦ ´Þ¼ºÇÑ Áõ·Êµé case1 -Immediate tooth replacement for the endodontically failed tooth case2 -Immediate tooth replacement for the fractured tooth case3 -Immediate tooth replacement for the fractured canine due to cervical caries D. Connective tissue graft³ª FGG·Î¼ socket closure¸¦ ´Þ¼ºÇÑ Áõ·Êµé case1 -Immediate implant placement & connective tissue graft for soft tissue ridge augmentation case2 -Periodontitis·Î ÀÎÇØ ¹ß°ÅµÈ »ó¾Ç ÁßÀýÄ¡¿¡ ´ëÇØ immediate implant placementÈÄ FGG·Î¼ primary closure¸¦ ÀÌ·ç¾ú´ø Áõ·Ê case3 -AvulsionµÇ¾ú´ø two central incisors°¡ ¼øÂ÷ÀûÀ¸·Î ÆÄÀýµÇ¸é¼ ÀÓÇöõÆ®·Î ±³Ã¼ÇÏ¿´´ø µÎ Áõ·Ê case4 -»ó¾Ç ÀüÄ¡ºÎ immediate implant placement ½Ã oval free gingival graft¸¦ È°¿ëÇÏ¿© primary closure¸¦ ¾ò¾ú´ø Áõ·Ê(I) case5 -»ó¾Ç ÀüÄ¡ºÎ immediate implant placement ½Ã oval free gingival graft¸¦ È°¿ëÇÏ¿© primary closure¸¦ ¾ò¾ú´ø Áõ·Ê(II) E. Immediate implant placement¸¦ ½ÃµµÇÏ¸é¼ extraction socket³»ÀÇ granulation tissue¸¦ ÀÌ¿ëÇÏ¿© socket closure¸¦ ´Þ¼ºÇÏ¿´´ø Áõ·Ê V. Keratinized and Attached gingiva¸¦ À§ÇÑ soft tissue management A. Periodontal tissue¿Í Peri-implant tissueÀÇ Â÷ÀÌÁ¡ B. ¾ðÁ¦ keratinized and attached gingiva¸¦ ¸¸µé °ÍÀΰ¡? C. Apically positioned flap (APF) case1 -ÇÏ¾Ç overdenture Áõ·Ê¿¡¼ ÀÌÂ÷¼ö¼ú½Ã ½Ç½ÃÇÑ APF case2 -ÇÏ¾Ç ±¸Ä¡ºÎ Áõ·Ê¿¡¼ ÀÌÂ÷¼ö¼ú½Ã ½Ç½ÃÇÑ APF case3 -ÇÏ¾Ç ±¸Ä¡ºÎ Áõ·Ê¿¡¼ fixtureÀÇ ½Ä¸³°ú µ¿½Ã¿¡ ½Ç½ÃÇÑ APF D. Free gingival graft case1 -Ridge destructionÀÌ ½ÉÇÏ°Ô ÁøÇàµÈ ÇÏ¾Ç ±¸Ä¡ºÎ Áõ·Ê¿¡¼ ÀÌÂ÷¼ö¼ú½Ã ½Ç½Ã ÇÑ FGG case2 -ÇÏ¾Ç ±¸Ä¡ºÎ Áõ·Ê¿¡¼ ÀÏÂ÷¼ö¼ú°ú ÇÔ²² ½Ç½ÃÇÑ FGG case3 -ÇÏ¾Ç Àü¾Ç ÀÓÇöõÆ® ÁÖº¯ÀÇ mucogingival problemÀ» ¼öÁ¤Çϱâ À§ÇÑ FGG case4 -»ó¾Ç overdenture¿ë ÀÓÇöõÆ® ÁÖº¯ÀÇ mucogingival problemÀ» ¼öÁ¤Çϱâ À§ÇÑ FGG E. Double flap technique on the regenerated ridge VI. Papilla & esthetic soft tissue contour¸¦ À§ÇÑ STM A. The approaches to make esthetic peri-implant tissues at the maxillary anterior B. Reconstruction of the Interdental papilla C. Esthetic dentistry¿¡¼ ¿ì¸®°¡ ±â¾ïÇÏ°í ÀÖ¾î¾ß ÇÒ ¸î °¡Áö ¼öÄ¡µé D. Single tooth implant¿¡¼ proximal gingival filling¿¡ ´ëÇÑ JemtÀÇ ÀÌ·Ð E. Biologic consideration of interdental papilla F. Papillary reconstructionÀ» À§ÇÑ °í·Á»çÇ×µé G. Papilla¿¡ ¿µÇâÀ» ¹ÌÄ¡´Â ¿ä¼Òµé¿¡ ´ëÇÑ ÀÌÇØ¿Í °í·Á H. »ó¾ÇÀüÄ¡ºÎ¿¡¼ °á¼ÕºÎ¿¡ µû¸¥ ÀûÀýÇÑ ½Ä¸³À§Ä¡ 1. »ó¾Ç 6 ÀüÄ¡°¡ °á¼ÕµÈ °æ¿ì 2. »ó¾Ç 4 ÀüÄ¡°¡ °á¼ÕµÈ °æ¿ì 3. »ó¾Ç ÁßÀýÄ¡¿Í ÃøÀýÄ¡°¡ °á¼ÕµÈ °æ¿ì 4. ÃøÀýÄ¡¿Í °ßÄ¡°¡ °á¼ÕµÈ °æ¿ì 5. »ó¾Ç ¾ç ÁßÀýÄ¡¿Í ÇÑÂÊ ÃøÀýÄ¡°¡ °á¼ÕµÈ °æ¿ì 6. »ó¾Ç ¾ç ÁßÀýÄ¡°¡ °á¼ÕµÈ °æ¿ì 7. ÁßÀýÄ¡¿Í ÃøÀýÄ¡°¡ ¿¬¼Ó °á¼ÕµÈ Áõ·Ê¿¡¼ÀÇ Ä¡·á¿¹ 8. External root resorptionÀ» º¸ÀÌ´Â »ó¾Ç ÁßÀýÄ¡¿¡¼ immediate tooth replacement·Î¼ gingival contour¸¦ À¯ÁöÇÏ¿´´ø Áõ·Ê I. ÀÜÁ¸ Ä¡±ÙÀ» ÀÌ¿ëÇÑ papilla-holding technique·Î¼ gingival contour¸¦ À¯ÁöÇÏ¿´´ø Áõ·Ê J. Surgical techniques for Papillary Regeneration 1. Flap Designs for Papillary Regeneration at the second stage surgery Ư¡ÀÌ Ã¥¿¡ ¼Ò°³µÈ Conceptµé°ú Techniqueµé¸¸À¸·Îµµ ¿©·¯ºÐÀÇ ÀÓÇÁ¶õÆ® ÀÓ»óÀÌ º¸´Ù ¾ÈÁ¤µÇ°í dz¿ä·Ó°Ô µÉ°ÍÀ̶ó°í ¹Ï½À´Ï´Ù.´Ù¸¸ ¾î¶² ÀÓ»óÀûÀÎ Techniqueµé°ú ¸¶Âù°¡Áö·Î soft tissue management¸¦ ÀßÇÒ ¼ö ÀÖÀ¸·Á¸é »ó´ç±â°£ÀÇ Leaning curve°¡ ÀÖ¾î¾ß ÇÑ´Ù´Â °ÍÀº ¸í½ÉÇÏ¿©¾ß ÇÕ´Ï´Ù.ÀÌ Ã¥¿¡ ÀÚ¼¼È÷ ¼Ò°³µÈ technical guideµéÀÌ ¿©·¯ºÐÀÇ ¼ö°í¸¦ Å©°Ô ÁÙ¿© ÁÙ °ÍÀÔ´Ï´Ù. ¸¹Àº ºÐµéÀÌ ÀÌ Ã¥À¸·ÎºÎÅÍ Å« benefitÀ» ¾òÀ» ¼ö ÀÖ°Ô µÇ±â¸¦ ¹Ù¶ø´Ï´Ù. ÀúÀÚ ¾à·Â: Thomas J.HanUCLA School DentistryÀú¼: Bone, Soft Tissue & Implant Systems-2ÀúÀÚ ¾à·Â: ¹Ú±¤¹ü°æºÏ´ëÇб³ Ä¡°ú´ëÇÐ Á¹¾÷´ë±¸ ¹Ì¸£Ä¡°úº´¿ø ´ëÇ¥¿øÀå(ÁÖ)¸Þ°¡Á¨ °øµ¿´ëÇ¥ÀÌ»çÀú¼: Current Soft Tissue Management in Implant Dentistry Bone, Soft Tissue & Implant Systems-1Bone, Soft Tissue & Implant Systems-2ÀúÀÚ ¾à·Â: ·ù°æÈ£Àü³²´ëÇб³ Ä¡°ú´ëÇÐ Á¹¾÷±¤ÁÖ ¹Ì¸£Ä¡°úº´¿ø ´ëÇ¥¿øÀå(ÁÖ)¸Þ°¡Á¨ °øµ¿´ëÇ¥ÀÌ»çÀú¼: Bone, Soft Tissue & Implant Systems-1ÀúÀÚ ¾à·Â: ¹®Àͻ󿬼¼´ëÇб³ Ä¡°ú´ëÇÐ Á¹¾÷¿¬¼¼´ëÇб³ Ä¡°ú´ëÇÐ Ä¡ÁÖ°ú ±³¼ö¿¬¼¼´ëÇб³ ¿µµ¿¼¼ºê¶õ½º Ä¡°úº´¿ø Ä¡ÁÖ°úÀåÀú¼: Bone, Soft Tissue & Implant Systems-2