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PubMed1984

Recession in sites with inadequate width of the keratinized gingiva. An experimental study in the dog.

The present investigation was performed to assess the inflammatory response in gingival units subsequent to the placement of restorations with subgingivally located margins. 3 beagle dogs were used. Cotton floss ligatures were placed around the neck of the mandibular third and fourth premolars of all dogs. The ligatures were exchanged once a month during the first 6 months of experiment. When 40-50% of the height of the supporting tissues had been lost in an experimental periodontitis the ligatures were removed but the animals allowed to accumulate deposits for another 60 days. The inflamed periodontal tissues were subsequently excised using either an "apically placed flap" procedure or a "gingivectomy" procedure. In the flap procedure the main part of the keratinized gingiva was preserved while in the gingivectomy procedure the keratinized part of the gingiva was removed in toto. Following scaling and root planing the animals were during a maintenance period of 4 months placed on a program involving chlorhexidine application and mechanical tooth cleaning twice daily. On Day 0 a notch was prepared in the buccal surface of each root at the level of the gingival margin. Furthermore, steel bands were placed along the buccal surface of each root of the third and fourth premolars and secured with an apical margin at the level of 1 mm apical to the notch. The bands were cemented to the root surfaces by a cement. The dogs were allowed to accumulate plaque and calculus for 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2004

Re-eruption of traumatically intruded mature permanent incisor: case report.

This case report describes a case of intrusion of the right mature permanent central incisor. After gingivectomy and endodontic treatment with changes of the intracanal dressing (calcium hydroxide paste) every 30 days, spontaneous re-eruption was observed. We conclude that waiting for spontaneous re-eruption associated with gingivectomy and endodontic treatment is an alternative treatment for severe intrusive luxations in mature permanent teeth.

Child↗

PubMed1985

Focus of epithelial dysplasia arising in hereditary gingival fibromatosis.

The gingiva of a 32-year-old black male was biopsied for evidence of vasculitis, but instead an area of epithelial dysplasia was found. Further investigation revealed that the patient and several members of his family had hereditary gingival fibromatosis. Treatment included four quadrants of gingivectomy plus inverse bevel incisions for trimming those areas which were too thick for simple gingivectomy. Histopathologic examination of the excised tissues supported the diagnosis of gingival fibromatosis, but no other areas of epithelial dysplasia were seen. To our knowledge, this is the only reported instance of a premalignancy or malignancy arising in gingival fibromatosis, and thus there is no reason to regard the gingival disorder as predisposing to carcinoma. However, the pedigree reported here supports a previous suggestion that hereditary gingival fibromatosis is not as rare among blacks as the literature has indicated.

Adult↗

PubMed1990

[Familial gingival fibromatosis: report of a case].

One family of familial gingival fibromatosis was presented. Case 1 is an 11 years old girl. Gingival fibromatosis was noted by delayed eruption of permanent teeth. Fibromatosis was seen in whole gingiva and lower 1/2 to 1/3 of the tooth crowns was covered. Gingivectomy was performed. Case 2 was 42 years old man, who was father of case 1. Firstly gingival swelling was noted at the age of 10 years. He had operations of gingivectomy at the age of 28 years. It recurred and fibromatosis was seen in whole gingiva and lower 1/2 to 1/3 of the tooth crowns was covered. Cytogenetically no abnormality was seen in the chromosomes of both cases. Reported cases of familial and non-familial gingival fibromatosis in Japan were reviewed.

Adult↗

PubMedDate not supplied

[Remodelling of the crown for occlusal equilibration in partially edentulous patients].

Two clinical cases of partial edentulous patients with irregular occlusal plane and their treatment are presented. The authors emphasize the role of occlusal rehabilitation before any prosthetic treatment. Gingivectomy, osteoplastic surgery and crown reshaping are used. Occlusal relationships before fixed or removable prosthodontics is applied, are essential to insure correct mandibular movements and the dento-maxillary system homeostasis. Two clinical cases of patients with irregular occlusal plane because of teeth migrations (horizontal or vertical) after long-term edentation are presented. Both cases were by crown reshaping after pulpectomy and gingivectomy to obtain a regular occlusal plane. Prosthetic treatment was applied only after these preparations. We achieved good results concerning the dento-maxillary functions.

Adult↗

PubMed1989

[Gingival hyperplasia induced by nifedipine. Report of two cases].

Two cases of gingival hyperplasia associated with the administration of nifedipine are presented in this paper. Case 1, a 66 years old woman appeared with severe gingival enlargement, which was located at the right anterior and premolar region. Both attached gingivae and interdental papillae were hyperplastic, and the enlargement was more pronounced at the labial surfaces. The patient discontinued nifedipine, and after scaling and root planning, gingivectomy was performed. One month postoperatively the gingivae were in perfect health. Case 2, a 68 years old man presented with gingival enlargement mainly of the interdental papillae of the anterior and posterior region, which was more pronounced at the labial surfaces. Gingivectomy was performed at the upper anterior region after deep scaling, but the patient did not discontinue nifedipine. Three weeks postoperatively, recurrence of hyperplasia was noticed. In both cases histologically the gingival epithelium was parakeratininized and exhibited elongated rete pegs. The underlying connective tissue comprised of dense collagen fibres and the inflammatory cells which were present in the connective tissue, were mainly plasma cells and lymphocytes.

Aged↗

PubMed1988

Changes in teeth and gingiva of dogs following laser surgery: a block surface light microscope study.

The effect of laser surgery on tissues of the periodontal apparatus was studied histologically in dogs using block surface light microscopy, a novel microscopical method. With this approach, changes in the hard and soft tissue components were concomitantly demonstrated; the method enabled preservation of the in situ relationship between these components. Following laser surgery, healing in the gingiva was delayed as suggested by the presence of epithelial ulcerations and dense inflammatory infiltrate. In the enamel and cementum the application of laser resulted in crater-like defects that could be avoided only partially by insertion of a tinfoil shield into the gingival sulcus. In the vicinity of the cementoenamel junction these defects were filled with epithelium or periodontal ligament fibers; the close proximity of the hard and soft tissues at the defect sites suggested occurrence of new attachment. Enamel defects located coronal to the gingiva contained bacterial plaque. These histologic results do not demonstrate any substantial advantage of laser over conventional knife gingivectomy. Such advantage may be accomplished with the design of a special intraoral handpiece and further experiments.

Animals↗

PubMed1985

Sensation information, self-instruction and responses to dental surgery.

The interaction effects of presurgery anxiety and two intervention strategies upon adjustment during dental surgery were examined. Patients undergoing gingivectomy (N = 113) were randomly assigned to one of four information groups: sensation, self-instruction, combined sensation and self-instruction, or control; and separated according to level of trait and state anxiety. Results showed an interaction effect between the information conditions and state anxiety (p less than .05). Compared with the control group, high state anxiety subjects reported less tension (p less than .05) and distress (p less than .05) after receiving sensation information; less tension (p less than .005) after receiving self-instruction information; and increased positive self-statements (p less than .05) with the combined information. Low-state anxiety subjects showed negative treatment effects; sensation information alone (p less than .001) or combined with self-instruction (p less than .01) reduced the number of reported positive self-statements.

Adaptation, Psychological↗

PubMed1978

Improving orthodontic results in cases with maxillary incisors missing.

This article has aimed at providing information on how to improve clinical orthodontic results in cases in which maxillary central and lateral incisors are missing. Different sections deal with (1) treatment approach and mechanics, (2) details in finishing, (3) modifications of clinical tooth crowns by special procedures (grinding, composite "corners," gingivectomy), (4) functional considerations and root resorption, and (5) retention.

Bicuspid↗

PubMed1999

An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery. A double-blind, split-mouth, cross-over study.

Organ transplant patients are frequently medicated with triple immunosuppressive therapy that includes both cyclosporin and the corticosteroid, prednisolone. Many of these patients experience gingival overgrowth that necessitates surgical intervention. Chronic dosing with corticosteroids can lead to suppression of the hypothalamic-pituitary axis, and subsequent adrenocortical suppression. To circumvent possible suppression, supplementary steroids are administered to such patients prior to so-called "stressful events". We have examined the need for supplementary steroids in 20 organ transplant patients undergoing gingival surgery under local anaesthesia to correct their drug-induced gingival overgrowth. All patients were operated upon in the first half of the morning. Prior to gingival surgery, resting blood pressure (BP) and serum ACTH concentrations were determined. Immediately before surgery patients received either intravenous hydrocortisone 100 mg or placebo in random, double-blind order. Each patient required 2 gingivectomies and thus acted as their own placebo control. BP was measured at various time points throughout surgery and upto 2 h postoperatively. On completion of surgery, a further blood sample was taken to determine ACTH concentration. There was no significant difference (p>0.05) between placebo and hydrocortisone treatments for BP and ACTH measurements. No patient experienced any symptoms that were suggestive of adrenocortical suppression. One patient did experience postural hypotension prior to gingival surgery, but this is attributed to his antidepressant medication. We can conclude from this study that immunosuppressed organ transplant patients taking the maintenance dose of prednisolone (5-10 mg/day) do not require corticosteroid cover prior to gingival surgery under local anaesthesia. We would however, advocate monitoring of their blood pressure throughout the procedure.

Adrenocorticotropic Hormone↗

PubMed2002

Hereditary gingival fibromatosis: a case report.

BACKGROUND/AIMS: Hereditary gingival fibromatosis is characterized by various degrees of attached gingival overgrowth. It usually develops as an isolated disorder but can be one feature of a syndrome. A case of a 38-year-old female is reported who presented a generalized severe gingival overgrowth, involving the maxillary and mandibular arches and covering almost all teeth. The clinical differential diagnosis included drug-induced overgrowth as well as idiopathic gingival fibromatosis. TREATMENT: Excess gingival tissue was removed by conventional gingivectomy. As the gingival enlargement was generalized to all quadrants, on both sides, the surgery was carried out under general anaesthesia. The postoperative course was uneventful and the patient's appearance improved considerably. Post-surgical follow-up after 20 months demonstrated a slight recurrence CONCLUSIONS: Hereditary gingival fibromatosis is a rare disorder characterized by the proliferative fibrous overgrowth of the gingival tissue. Resective surgery of the excess tissue is the treatment available. However, recurrence is a common feature.

Adult↗

PubMed2004

Gingival endothelial and inducible nitric oxide synthase levels during orthodontic treatment: a cross-sectional study.

This study uses a cross-sectional design to examine the endothelial and inducible nitric oxide synthase (eNOS and iNOS, respectively) levels of gingival tissue. Fifteen subjects, 10 female and 5 male individuals (aged 14.6-21.2 years; mean 17.4 +/- 1.8 years), who needed extraction of the four first premolars for orthodontic reasons and who had indications for a gingivectomy were enrolled in the study. In each patient, two maxillary/mandibular premolars were extracted, and two months later an orthodontic appliance was placed in the same arch. A canine undergoing treatment for distal movement served as the test tooth (TT), whereas its contralateral canine was used as the control tooth (CT). The CT was included in the orthodontic appliance but was not subjected to the orthodontic force. Two weeks after the orthodontic appliance placement, clinical data consisting of the presence of supragingival plaque, bleeding on probing, and probing depth were collected from each experimental tooth. Immediately after, gingival tissue was collected from the distal aspect of each TT and CT for immunohistochemistry, messenger RNA reverse transcription by polymerase chain reaction, and Western blot analysis for both eNOS and iNOS. The results showed that no differences in clinical conditions occurred between the experimental teeth. On the contrary, both the eNOS and iNOS levels and the expression of the TTs were significantly greater than those of the CTs (all comparisons significant to P < .01). Our results indicate a role for gingival eNOS and iNOS during the early phases of orthodontic treatment in humans.

Adolescent↗

PubMed2005

Gingival fibromatosis and significant tooth eruption delay in an 11-year-old male: a 30-month follow-up.

This case report describes the dental management of an unusual case of idiopathic gingival fibromatosis with multiple impacted primary teeth, and the absence of eruption of permanent teeth, in an 11-year-old boy and at the 30-month follow-up. The patient presented with severely enlarged gingival tissues affecting both arches and multiple retained and non-erupted primary teeth. He had already been subjected to localized gingivectomies at the ages of 7 and 9 years. He had no known syndrome and there was no family history of any similar disorder. The patient was treated under general anaesthesia to remove the excessive gingival tissues using apically positioned flaps. During the surgical procedure, over-retained and unerupted impacted primary teeth were extracted in order to facilitate the eruption of the permanent successors. Two years postoperatively, there was no recurrence of the gingival enlargement. Overdentures were then constructed because none of the permanent teeth had yet erupted. Furthermore, pre-eruptive coronal resorption was detected radiographically affecting the crown of the unerupted 36. Thirty months postoperatively, no recurrence of gingival enlargement was seen, but the permanent teeth had still not erupted.

Anodontia↗

PubMed1994

Cyclosporin, nifedipine and gingival hyperplasia: a randomized controlled study.

Nifedipine increases the frequency and severity of gingival hyperplasia associated with CyA therapy in renal transplant recipients and this effect appears to be independent of whole-blood CyA levels. De novo malignancies have been reported arising in areas of gingival hyperplasia, in a group already at high risk of malignancy. Patients receiving CyA and nifedipine should receive advice regarding the need for strict oral hygiene to control the initial development of gingival hyperplasia, with severe cases being promptly referred for gingivectomy and histological examination.

Calcium Channel Blockers↗

PubMed1978

Clinical assessment of periodontal dressings.

Forty-one patients requiring gingivectomy in one or more areas were used for a clinical evaluation of three different periodontal dressings. Sixty-five operations were performed. Whenever possible different dressings were tested in the same patient. The type of dressing was chosen randomly, applied by one operator and left in place for 1 week. The patients were supplied with analgetic tablets. At day 7 the condition of the dressing was evaluated before removal. The patients' subjective experiences of pain, swelling, bleeding and fever, as well as use of pain relieving tablets, were recorded. The wound was evaluated with regard to the degree of epithelialization, presence of denuded bone and granulation tissue. The tendency to bleeding and the sensitivity of the teeth to a water spray (15 degrees C) were tested. At day 14 and 21 the same evaluation procedure was repeated. In addition the presence of plaque in the operated area was assessed. One of the dressings more frequently induced pain and swelling than the others. Tablet consumption was also higher when this dressing had been used. No statistically significant differences were found in the clinical assessment of wound healing, tendency to bleeding and the sensitivity of teeth.

Adult↗

PubMed1985

Improved periodontal conditions following therapy.

The aim of the present clinical trial was to evaluate the effect of different modes of periodontal therapy on patients with moderately advanced periodontal disease and to express the findings in terms of probing pocket depth and attachment level alterations at periodontal sites with different initial probing depths. The material consisted of 16 patients, 35-65 years of age. Following a Baseline examination including assessments of oral hygiene status, gingival conditions, probing pocket depths and probing attachment levels, the patients were subjected to periodontal treatment. A "split-mouth" design approach of therapy was used and the jaw quadrants were randomly selected for the following different treatment procedures: (1) scaling and root planning, (2) scaling and root planing in conjunction with a gingivectomy procedure, (3) scaling and root planing in conjunction with an apically repositioned flap procedure without bone recontouring, (4) scaling and root planing in conjunction with an apically repositioned flap procedure including bone recontouring, (5) scaling and root planing in conjunction with a modified Widman flap procedure without bone recontouring and (6) scaling and root planing in conjunction with a modified Widman flap procedure including bone recontouring. The patients were following active treatment enrolled in a supervised maintenance care program including "professional tooth cleaning" once every 2 weeks during a 6-month period of healing, after which a final examination was performed. The investigation demonstrated that active therapy including meticulous subgingival debridement resulted in a low frequency of gingival sites which bled on probing, a high frequency of sites with shallow pockets (less than 4 mm) and the disappearance of pockets with a probing depth of greater than 6 mm. Between the Baseline examination and the 6-month re-examination, the probing attachment level for initially shallow pockets remained basically unaltered, but with a tendency of a minor apical shift. This occurred in all 6 treatment groups. For sites with initial probing depths of 4-6 mm and greater than 6 mm, there was in all groups some gain of probing attachment. This gain was most pronounced in the initially deeper (greater than 6 mm) pockets. With the use of regression analysis, the "critical probing depth" (CPD) value (i.e. the initial probing depth value below which loss of attachment occurred as a result of treatment and above which gain of probing attachment level resulted) was calculated for each of the 6 methods of treatment used. A comparison of the CPD-values between the 6 treatment groups did not reveal any major differences.

Adult↗

PubMed1987

Longevity: a critical factor in evaluating the effectiveness of periodontal therapy.

A 47-year-old male patient with an advanced form of adult periodontitis presented for evaluation and treatment in 1963. There were several angular bony lesions and 3 molar teeth had an extremely questionable prognosis. The patient was treated by scaling, root planing and gingivectomy, with no attempt to alter the existing morphology of the effected alveolar bone. 23 years following periodontal therapy, there were marked changes of the contour of the marginal bone crest throughout, minimal pocket depth and acceptable gingival form. The patient was seen at regular 5-6 months intervals for maintenance therapy and his home care regimen was exemplary. Advanced cases of periodontitis can be treated successfully by simplistic methods if the "repair potential" of the patient is good and if regular maintenance visits and meticulous plaque control are carried out.

Dental Scaling↗

PubMed1992

Location of the mucogingival junction 18 years after apically repositioned flap surgery.

The apically repositioned flap procedure, by definition, implies that the mucogingival junction (MGJ) is shifted into an apical location. That this actually would be the case has never been shown in long-term studies. The 13 subjects in the present study had during the years 1964-1965 received treatment of moderately advanced periodontal disease (probing pocket depths less than or equal to 5 mm) in the lower jaw. An apically repositioned flap (ARF) procedure was applied in the left or right half of the mandible and a gingivectomy (GE) was performed in the contralateral side. Starting in December 1981, the patients were recalled for clinical and radiographic determination of long-term results. The width of the band of keratinized gingiva was measured clinically and the distance from the MGJ to the lower border of the mandible (LBM) was measured from orthopantomograms. Slightly less keratinized gingiva was observed on the sides where GE had been used. There was no statistically significant difference in the orthopantomographic distance from the MGJ to the LBM between ARF and GE operations. The results indicate that the apically repositioned flap procedure does not result in a permanent apical shift of the MGJ.

Aged↗