- PDF Free Download

Size: px

Start display at page:

Download ""

윤영 순
5 years ago
Views:

1 - 대한치과보철학회지 Vol. 14 No. 1, 대합치상실로인한치조골변화에관한실험적연구 * 서울대학교대학원치의학과보철학전공 ( 지도장완식교수 ) 박의원 Ⅰ. 서언 Ⅱ. 연구재료및방법 Ⅲ. 연구성적 Ⅳ. 총괄및고안 Ⅴ. 결언참고문헌영문초록사진부도 < 목차 > I. 서언 치조골은발생학적으로백아질및치근막과더불어치낭 (dental sac) 에서기원되며, 또한기능적으로는치아를악골에고정유지하는치주조직의한구성성분이라하겠다. 치조골은타골조직과같이일단석회화가끝난이후이라도치아의발육과교환내지는교합등에수반되는기능적인압력의이상, 혹은대합치의상실등이원인이되어지속적인골질의재형성과흡수가야기되는내부개조 (internal remodeling) 현상에적응되는구조를가진다고보겠다 (12, 23). Baumhammer et al(1965) (15) 에의하면치조골은다른골조직에서보다대사활동이높고, 아울러여러자극에대해서도민감하게반응을나타내는조직이라하겠다. 인위적으로치아에자극이가해지는경우치조골의압박측에선골질의흡수가, 견인측 (tension side) 에서골질의첨가형성 (appositional formation) 이발현됨이알져진바가있는데, 그정도에대해서 Salzmann(1966) (18 ) 의소견에의하면생리적인치아이동시에비하여급속도로이루어지고, 또한저명하게야기됨이밝혀져치조골을위시한치주조직에서의반응상에대해서 Schwartz(1932) (2), Oppenhim(1940) (4), Reitan(1951) (7), Moskowitz and Kronman(1969) (21), Kronman(1971) (24) 및임 (1976) (28) 등에의하여여러면에관련을맺고검색되어왔으나그대부분은교정장치의기계적인조건을실험적으로부과한후치아이동에따르는변화상이관찰되어진소견들이라하겠다. 한편치조골은저작에수반된기능적인압력의이상또는상실에대해서아주민감하게반응하고현저한구조상의변화도나타내므로, 대합치의상실로인한치조골에서의반응상에관하여서도 Kellner(1920) (1), Yaeger(1959) (9), Baumhammer et al.i(1965) (15), Picton(1969) (19), Ohno(1973) (25) 에의하여서로다른실험동물을대상으로골질의내부개조현상과석회화상에대하여조직학적또는조직화학적으로검색된바가있으나, 치조골이저작기능에따라가해지는기계적인 stress 에대응되는현상에서, 다른골조직에비하여내부개조가왕성하며, 또한유기질이다른골질에비하여많이함유된다는보고가있으나 (15, 17), 대합치를상실한경우와관련하여규명된바는드문것같아이에저자는실험적으로대합관계를상실케한경우에있어서의다당류 * 본논문의요지는 1976 년 10 월 15 일제 19 회대한치과보철학회학술대회에서발표하였음. 41

2 및단백에대한소장과관련하여조직화학적인소견을검색한바가있어그지견을보고하고저한다. Ⅱ. 연구재료및방법 본연구에사용된실험동물은백서 (Sprague Dawley, 암수를가리지않았으며, 무게는 gm. 의것 )25 마리를사용했다. 대합치상실의실험조건의부여는 ether 마취하에서상악우측의제일, 제이및제삼구치을발치시술하고관찰대상은하악우측구치에대해서행하여졌는데, 이를실험군으로하고, 이와대조되는소견은같은개체의실험적처치를하지않은하악구치열에서관찰되었는데이를대조군으로다루어졌다. 검색방법으로는실험조건을부여한지 10일, 20일, 50 일, 70 일, 및 100일간의경과소견에서검경토록하였다. 상기시험동물에서얻어진조직편은 3% formic acid에서탈회, celloidin절편을제작하였다. 조직학적및조직화학적인검색방법은다당류를위한과요도산-Schiff(PAS) 반응 (McManus), 산성점액다당류를위한 colloidal iron 반응 (Pearse) 및담백질을위한 alloxan-schff 반응 (Yasuma-Ichikawa) 법에의거하여실시되었고일반적인소견은 H-E 염색과 Mallory azan 염색한표본에서검토되었다. Ⅲ. 연구성적 1) 대조군의소견치은측에면한치조골의표층과해면골의대부분을점하고있는소위지지골 (supporting alveolar bone) 에있어서는비교적 eosinophile한데비하여치근막에면한치조골변연부의고유치조골 (alveolar bone proper) 에있어서는근심측치조골벽에서 hematoxylin에농염되는경향으로나타나고, 골아세포 (osteoblast) 가치조정 (alveolar crest) 에서근심측치간중격골 (interseptal alveolar bone) 의치근막면에연하여배열되고있었다. 원심측치조골에선, 고유치조골에서의흡수와에해당하는곳에서파골세포 (osteoclast) 의출현상이관찰되었고, 일부섬유성백아질에도흡수되어상아질에까지이르고있었다. 해면골질 (sponge bone) 이주로된부위에는비교적굵은골량을이루고있었다 ( 부도 1참조 ). 근단부에서백아질의형성양은근심측이원심측보다약간많 이형성된경향으로관찰되었다. alloxan-schiff 염색에의한소견은상기고유치조골벽에서의 hematoxyline 호염성을나타내는부위에비교적농청염되는경향을나타내고있었다. 또한근심측의치근막에서는 azan 염색에서원심측보다담청색으로염색되는경향을나타내고, 일부섬유성백아질이결여된곳에선소위 Sharpeys 섬유의매입상이관찰되지않았다. PAS 반응양성물질은치근막에연한치조골정에서미약한반응으로나타나는반면에, 골아세포와파골세포가존재하는곳에선약간농염되는경향이었다. colloidal iron 반응은일반적으로석회화가된부위에서비교적강한염색소견으로발현되는경향이있는것같았다. 즉, 섬유성기질보다도고유치조골의층판골 (lamellated bone) 에서농염된소견이었다. 2) 실험군의소견 10일경과된경우에있어서는, 치근막에연한근원심측의치조정부와치근간중격 (interradicular septum) 의치조골변연부에서골의신생첨가형성이관찰되었고, 치근막의폭도다소좁아진소견으로검경되었다. 근단부에서는섬유성백아질의형성이야기된것같았다. colloidal iron반응은대조군에비하여치조골의치근막면에서염색성이저하되어진소견으로관찰되었고, PAS 및 alloxan-schiff반응소견은대조군에비하여치근간치조골의변연부에서약간증염되었다 ( 부도 2참조 ). 20일경과된경우에있어서는, 치근막에면한치조골벽에서, 골아세포의발현빈도와범위가 10일경과된경우에비하여약간증가된소견이었고, 이와아울러골질의첨가형성도다소진전된경향으로관찰되었다. 골아세포의출현상태는 10일경과의경우와같거나혹은감소되는경향이었다. 한편고유치조골을유지하고있는지지골이대조군에비하여섬유골로된골량 (trabecula) 이관찰되기도하였으나, 대조군에비하여발육이불량하였다. 백아질의형성은다소증가된소견이었다. PAS 및 alloxan-schiff 반응은치조골벽의섬유성골질에서다소약염되어지고있으나층판골측으로가면서증염되고 colloidal iron반응은근단부치조골벽에서 10일경과된경우보다약간농염되는경향이었다 ( 부도 3참조 ). 50일경과된경우에있어서는, 치근막에면하치조골벽에서골질의첨가형성이 20일경과된경우보다감소된경향이었고, 지지골에서는섬유골로된골량들로다공화된소견으로관찰되었다. 근단부에서백아질의형성량은 20일경과된경우보다현저하게증가되고있다. 치 42

3 근막의섬유성분은약간가늘어지고불규칙한주행을나타내는경향이관찰되었다. PAS 반응은 20 일의경우와유사하나, alloxan-schiff 반응은근단부의치조골표층에서다소농염되어진소견이었고, calloidal iron 반응은 20 일경과된소견과별차가없었다 ( 부도 4 참조 ). 70 일경과된경우에있어서는, 치조골에서골질의첨가형성이 50 일경과된경우보다적어지는경향이었다. 치근막의사주섬유 (oblique fiber) 군은거의치근면에평행하게주행하는것이많았다. 근단부에서백아질의증식은현저하게진행되었다. PAS 및 alloxan-schiff 반응은 50 일의경우와별차없었다. colloidal iron 반응에서는치근막에면한치조골벽에서다소증염되는경향으로관찰되고있었다 ( 부도 5 참조 ). 100 일이경과된경우에서는, 70 일의경우와거의같은소견으로관찰되어 70 일을전후해서치조골에서의변화상은거의없는것으로사료된다 ( 부도 6 참조 ). 부도 Ⅳ. 총괄및고안 일반적으로생체장기조직이기능을영유하고있는동안에는기능적인요구에적응되는구조를발현하기마련이다. 가령치주조직은교합관계를유지하고있는경우에저작기능을충분히이행할수있는구조를가진다. 이와같은구조는치아가맹출한후구강내에서의여러기능적인작용을받게됨으로서이루어지는것이라하겠다. 치주조직의한구성성분인치조골도저작기능과밀접한관계를가진다고교합에수반되어가하여지는여러양상의기계적인자극에대응할수있는구조를구비한다고보겠으나, 때로는치조골에가해지는자극이생리적인허용범위를넘어서강한기계적인자극으로작용되는경우가있을것이며, 반대로기능적인자극이형성되지않을경우, 다시말해서교합관계를상실한경우에는치주조직의구조도정상적인발육을나타낼수없는데서치아의위치적인이상이야기됨은잘알려진사실이라하겠다 (6, 19). 이와같이치조골은저작과관계되는치아와의구조적인구성요소를나타내어여러가지기능에대응해서구조적으로하나의저항성을이룬다고보겠다 (12). 임상보철시술에있어흔히임하게되는대합치의발거로인한상실, 혹은치관시술이되어있던것이붕괴되어, 대합치와의기능적인교합의상실에서야기될수있는 소견들을규명한다함은생물학적으로매우뜻있는대상이라하겠다. 이에본연구가기도한바는실험적으로대합치를상실시키고, 그영향이특히치조골에야기되는변화상을검색하는데있다하겠다. 이와같은조건을실험적으로재현시키기위하여백서의구치열을대상으로하여검색되어진결과를놓고일괄고안하건데, 먼저대조군에서의소견으로미루어봐, 백서의구치에선 Belting et al(1953) (8) 의의견과같이생리적으로원심이동을나타내는것이라하겠다. 백서구치에있어서의생리적인원심이동에대해 Hoffman and Schour(1940) (5) 는근심이동 (mesial drifting) 을한다고한바있었으나 Sicher and Weinmann(1944) (6) 은상하악의성장에관한관찰에서원심이동을입증하고, Belting et al(1953) (8) 은교합면방향으로원심이동함과동시에협설적으로도이동경사된다고하였다. 본실험에서도이와유사한생리적인원심경사를나타내고있었다 (10). Orban(1972) (1) 에의하면치조골에서고유치조골과이를유지하고있는내부의지지골의정상적인기능을영유하고있는골량 (trabecula) 들은굵은층판골 (lamellated bone) 로된다고한다. 그러나본실험소견에서치조골의구조를고안하건데, 섬유골질로된골량과다공화 (perforation) 의출현은아마도골질내부에서의소위 remodleling 현상에서야기된것이라하겠다. Kellner(1920) (1) 및 Picton(1969) (19) 의실험적보고에의하면, 골량조직의광범이한소실이야기되는데대해서 Lacroix(1971) (23) 는기계적인압력에대응하는하나의저항성에서나타나는것이라하고, Ohno(1973) (25) 는저작기능상실에서비롯된결과로보면서 Esohler(1939) (3) 의소위치아에기능적인작용이가해지지않을경우치주조직의정상적인발육은야기되지않는다는소견을뒷받침하고있다 (13, 16, 20). 이상은요컨데골질에가해지는여러양상의기계적인반응으로서야기된내부개조현상에서발현되는것으로사료되는데 (15, 23, 25) 그양상을본실험결과에서보건데, 먼저가장활발히변화하는시기 (10 일 20 일 ) 에있어서는치조골의치근막면에서근원심적인골질의첨가형성이이루어지고, 그다음으로 (50 일이후 ) 대합치상실의경우에서보는변화로는근단부에서백아질의증식이현저하게아우어지게되는데, 이기간중에는치조골에서의근원심적인골질의첨가형성이관찰되지만완만한상태에있다고보겠다 (22, 26, 27). 이러한소견에준해서골질의성상을조직화학적으로 43

4 검색한바로는, 먼저 hematoxylin 호염성의무구조한기질이첨가되면, 다음으로교원섬유를주성분으로하는기질로탈바꿈하고, 아울러이에산성점액당류를함유한골질을형성함이라사료된다 (11, 14). 한편백아질의증식소견은교합면방향으로의이동을가능케하는하나의구조적인요소하고사료되는것이다. Ⅴ. 결언 저자는임상보철시술시에흔히조우하는대합치의상실에서야기되는변화상을조직학적및조직화학적으로검색할목적에서, 실험적으로백서 (Sprague Dawley, 체중 gm.) 구치 ( 상악우측 ) 를발거하고그대합치 ( 하악우측 ) 에있어서의소견을발거한지 10 일, 20 일, 50 일, 70 일및 100 일이경과된결과를, 같은개체의기능적인교합관계를유지하고있는구치 ( 하악좌측 ) 에서의소견과대조검경한바, 다음과같은결언으로내릴수있었다. 1) 대조군에서는원심측치조골벽에서골질의흡수가야기되며, 근심측에서는골의첨가형성이야기되고있었으나, 대합치를상실한경우에선근원심측의치조골면에서골질의신생만있을뿐, 골의흡수현상은거의볼수가없었다. 2) 골의첨가형성은근원심치조골벽에서공히이루어졌으나그정도는발거한지 10 일내지는 20 일사이에서현저하였고이후는완만하였다. 3) 발거한지 50 일내지 70 일에이르러서는치근단부에서백아질의증식소견이현저하게이루어졌다. 4) 골질에서의첨가형성이활발한시기에있어서는골아세포에서비교적강한 PAS 양성반응을나타내고, 치조골의치근막면에서는 alloxan-schiff 반응이강하게반응되었다. 5)colloidal iron 반응은백아질의형성이현저할때치조골벽을연하여증염되는소견이었다. 참고문헌 1) TKellner : Orban s Oral histology(edited by Sicher and Bhaskar. T 7th. Ed. CV. Mosby Co, St. Louis 1972( 에서인용 ). 2) Schwartz : Tissue changes incidental to orthodontic tooth movemoent, Inct. J. Ortho, 18:331, ) Esohler : Zur Frage der Entwicklung des paradentiums. Z. Stomat ) Oppenhim : Artificial elongation of teeth. Am.J. Ortho. Oral Surg. 26: ) Hoffman and Schour : Quantitative studies in the development of the rat molar. Am. J. Ortho. Oral Surg. 26:854, ) Sicher and Weinmann : Bone growth and physiologic tooth movement. Am. J. Ortho. Oral. Surg. 30:109, ) Reitan : The initial tissue reaction incident to orthodontic tooth movement as related to the influence of function. Acta Odont. Scand., Suppl. 6:171, ) Belting, Schour, Weinmann and Shepro : Agechanges in the periodontal tissue of the rat molar. J. Dent. Res ) Yaeger : Histochemistry of bone matrix during rest and resorption. J. Dent. Res, 38: ) Bernick : Innervation of the developing molar teeth of rat. Anat. Rec ) Lam : Contour changes of the alveolar process following extractions. J. Pros. Den., 10: ) Fullmer : A histochemical study of periodontium disease in the maxillary alveolar process of 135 autopsies. J. Periodont. 32:206, ) Carneiro and Favd de Moraes : Radioautographic visualization of collagen metabolism in the periodontal tissue of the mouse. Archs Ora Biol. 10:833, ) Sognnaes : Microstructure and histochemical characterstics of the mineralized tissue. Ann. N.Y.Acad. Sci. 60:545, ) Baumhammers, Sttallard. and Zander: Remodeling of alveolar bone. J. periodent. 30:439, ) Zwarych and Quigley : The intermediate plexus of the periodontal ligament. J. Dent. Res. 44:383, ) Shimizu : Biochemical studies of alveolar bone. Bell Tokyo. Med. and Dent. Univ. 12:143, ) Salzmann : Tissue changes in orthodontic movement from practice of orthodontics. Vol. 44

5 II(edited by Salzmann.) J.B. Lippincott. Co., Philadelphia & Montreal. Iolz ) Picton : The effect of external forces on the periodontium. Biology of the periodontium(edited by Melcher and Brown) 363. Academic press. N.Y ) Comar, Kollar and Gargiulo : Local irritation and occlusal trauma as co-factors in the peridontal disease process. J.Periodont. 40:193, ) Moskowitz and Kronman: A histological and histochemical study of the movement in hamster. Angle Orthod. 39:171, ) Murayama: On the mineralization pattern of alveolar bone under the experimentally induced traumatic occlusion. Jap.J. of Oral. Biol. 11: ) Lacroix: The internal remodeling of bones(in the biochemistry and physiology of bone edited by Brone. Vol. III) Academic press. N.Y ) Kronman : Tissue reaction and recovery following experimental tooth movement. Angle Orthod. 41:125, ) Ohno : Studies on the bony healing process of tooth extraction sockets by means of microradiography and labeling method. Odontology. 60:839, ) Cleall : Growth of palate and maxillary dental arch. J. Dent. Res. 53:1226, ) Chiba : Studies on the changes of alveolar bone following tooth extraction by means of labeling method and microradiography. Jap. J. of Oral Biol. 18: ) 임 : 실험적치아이동시나타나는백서치주조직의변화에대한조직학적및실험적치아이동. 대한치과교정학회지 6:581,

6 = Abstract = AN EXPERIMENTAL STUDY ON THE CHANGES OF ALVEOLAR BONE FOLLOWING THE LOSS OF ANTAGONISTIC TEETH Wui Won Park, D. D. S., M. S. D. Department of Prosthodontics, Graduate School, Seoul National University (Directed by Prof. Wan Shik Chang, D. D. S., Ph. D.) The purpose of the current study was to investigate histologic changes in the alveolar bone of the lower molar region subsequent to the loss of their opposite molars, and to characterize chemical alterations by utilization of histochemical procedures. Twenty five rats(sprague Dawley), approximately gm body weight, were used in this experiment. In the treated animals, upper molars were removed. The animals were decapitated by groups at the following intervals after teeth removals : 10th, 20th, 50th, 70th and 100th day. The normal, untreated rats were used as controls. The molar region of lower jaw, including the intact alvelar bone and teeth was dissected and specimens were decalcified in 3% formic acid. After the tissues were fully decalcified, the specimens were embeded in celloidin and sectioned in mesiodistal plane. These sections were stained in the following staining methods. Mallory azan stain and hematoxylin-eosin stain were utilized for structural evaluation. Polysaccharides were demonstrated by means of the PAS reaction. Acidmucopolysaccharides were studied by means of the colloidal iron stain. Alloxan-Schiff reaction was used for protein. The results were as follows: 1. In the control animals, bone resorption was noted in the distal alveolar bone proper and bone apposition was shown in the mesial alveolar bone proper. But in the treated animals, bone apposition was observed on the mesial and distal walls of the alveolus and osteoclastic activity was not noted in any walls. 2. Bone apposition was most prominent from the 10th to 20th day after treatment. 3. Appositional growth of cementum along the surface of root was prominent from the 50th to 70th day after treatment. 4. In the area where osteoblastic activity was apparent, osteoblasts were stained strongly in the PAS and alloxan-schiff reaction. Aplastic resorption line showed strong alloxan-schiff reaction. 5. In the colloidal iron stain, the alveolar wall adjacent to the cementum apposition area was stained more strongly than the other areas. 46

7 박의원논문사진부도

Jksvs019(8-15).hwp

Jksvs019(8-15).hwp Grade I Grade II Grade III 12 대한혈관외과학회지 : 제 20 권 제 1 호 2004 Control Group A Group B Fig. 4. Microscopic findings of vein wall in control, group A and group B on the day of 7 after venous occlusion. The