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KMID : 0988420030150040343
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Journal of Dental Science (C.N.U.)
2003 Volume.15 No. 4 p.343 ~ p.355
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Histological Evaluation Following Grafting of Bilayer Artificial Dermis (Terudermis) in gingival Area
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Abstract
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The autogenous free gingival graft is the most predictable procedure currently used to increase the width of the attached gingiva in periodontal therapy. But the major disadvantage of the procedure is to create the 2ndary multiple surgical wounds at both a donor site and a recipient site. The other problem is the limited amount of available graft material. Therefore, recent researches have been focused on the development of the biomaterial to substitute gingival tissue. The purpose of this study was to compare the histologic healing after grafting of bilayer artificial dermis and free gingival graft.
Four non-smoking subjects (mean age, 32.5 years) in systemically healthy state and good oral hygiene were selected according to their particular needs for correction of mucogingival deformities as suggested by Nabers : 1) zones of minimal attached gingiva, 2) areas of thin gingiva, 3) areas of inadequate vestibular formation, and 4) frenum problems. The recipient sites were prepared through the conventional free gingival graft procedure and were grouped according to the graft materials : Experimental group-bilayer artificial dermis (Terudermis ; Terumo Co. Japan)(n=5) ; Control group-free gingival graft with autogenous palatal mucosa(n=6).
Biopsies were harvested from 11 sites (containing adjacent attached gingiva and graft) at 1, 2, 3 and 6 weeks postsurgery to evaluate histologic healing.
At the third week in the experimental group and at the second week of in the control group, the grafts has been stabilized on the recipient bed and the graft border has been blended into the surrounding tissue. In the experimental group, the epitheial migration from the adjacent tissue to graft was observed after 1 week of grafting and the distribution of the inflammatory cells were reduced, collagen layer of the artificial dermis was lost and the basement membrane was formed after 3 weeks of grafting. At 6 weeks of grafting, both groups demonstrated orthokeratinized epithelium and increased thickness of epithelial tissue, similar to the adjacent tissue and the rete peg formation. It was difficult to distinguish the graft from adjacent normal tissue.
Histologic evaluation revealed a biologic acceptance and incorporation of the collagen layers of the graft tissue to the host tissue, without severe inflammatory response.
In conclusion, a bilayer artificial dermis is essentially similar to autogeneous free gingival graft in the correction of mucogingival problems, and has the advantages of decreased patient morbidity(no donor site) and availability of abundant amounts of graft material when needed.
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