[Clinical and histological evaluation of gingival grafts on denuded roots after citric acid application. Report of a case].
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Biomedical subjects
Publications and source records attributed to P Mattout.
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A case of juvenile periodontitis treated by autogenous bone grafting is reported. The patient, an 18-year-old female, presented with periodontal lesions around the incisors and the first lower left molar. The first molar was severely affected with bone defects at the mesial aspect and in the furcation region and, for this reason, was selected for grafting. Minced fragments of bone with its marrow, obtained from the patient's iliac crest, were implanted into the diseased periodontium. 1 year after treatment, clinical and radiological inspection revealed the presence of bone. This bone completely filled the furcation area of the tooth but only partially the mesial aspect. There was, also, significant bone fill in the supracrestal region.
An experimental periodontitis was produced in the upper right and left maxillary molar regions of three dogs. The apical zone of the bony defects were marked by cutting grooves into the root surfaces. The right side was used as a control while on the left side, the bony defect was treated with a graft of ligament tissue. The graft was obtained from a neighbouring area after removing the external wall of bone and sampling with a bone chisel. Four months after the grafting the dogs were sacrificed and an optical microscopic study was performed. One of the dogs died three days after operation. In the other two dogs a reattachment was observed in the groove on the control side: coronally to the groove, a long epithelial attachment was present between the radicular wall and the connective tissue. On the experimental side of dog 1, a reattachment was obtained up to the level of the cemento-enamel junction. In dog 2, a complete failure was noted since an important epithelial growth has migrated and invaded the radicular groove.
Rats, submitted to a sucrose diet for 12 months, were normally fed for another 6 months either with or without addition of the unsaponifiable residue of vegetable oils. It appears that unsaponifiable substances reinforce the collagen fiber network of the periodontium. The presence of a dense supracristal barrier accounts for the lack of an infraosseous pocket and for the limitation of bone resorption despite the high level of the sucrose diet.
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The substitution of the internal enamel epithelium by a squamous epithelium during tooth eruption has been studied histologically in rat molars. Just prior to eruption, cytolysis of the connective tissue covering the cusp tip determines hyperplasia in the oral epithelium. A conspicuous infiltration results. Infiltrated undifferentiated cells form distinct cords which seem to be attracted by the internal enamel epithelium. They reaggregate when they come into its contact and form an underlying epithelium. The process starts in the superficial part and progressively extends towards the cervix. Finally, the internal enamel epithelium is expelled when desquamation begins. The lack of mitoses in both stratum intermedium and internal enamel epithelium and the pyknosis observed in the former, clearly show that the cells of the embryonic dental bell do not take part in the formation of the squamous epithelium as some authors still suppose.
For the study of the role of periosteum and periodontal ligament in the phenomena of bone repair, fragments of palatal mucosa and maxillary or mandibular bone from adult rats and devoid of periosteum were cultivated in association. The survival went beyond 26 days. In the bone, the ligament side showed by the 12th day signs of osteogenesis, whereas the other side devoid of periosteal osteoblasts showed empty lacunea, as it is observed "in vivo".
In order to study the histological structure of healthy and pathological furcations in the rat, two groups of animals were submitted to two different diets: one normal and one rich in sucrose. In the first group, certain particularities were demonstrated in the periodontal ligament in the interradicular region: the fibrous network was very loose in this zone and the fibrous insertions were essentially cemento-cemental and not cemento-osseous. In the rats submitted to the high sucrose diet, a disequilibrium was noted between the apposition zones and the zones in bone and cementum resorption.
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