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PubMed1995

Prevalence of nifedipine-induced gingival hyperplasia.

This study investigated the prevalence of gingival hyperplasia in subjects who were undergoing treatment with a calcium channel blocker, nifedipine, in dentate and edentulous subjects. In addition, the relationship between gingival hyperplasia and 5 other variables (duration of nifedipine intake, dose, age, oral hygiene index, and number of teeth) was investigated. Results of statistical analyses showed overwhelming evidence that the percent of nifedipine subjects with gingival hyperplasia was greater than that of the control subjects (P < 0.05) and that, across treatment group, the percent of dentate subjects with hyperplasia was significantly higher than that for edentulous subjects (P < 0.05). The chi2 test showed a strong univariate relationship between gingival hyperplasia and, separately, oral hygiene and number of teeth. For 24% of the subjects with gingival hyperplasia index (GHI) values of 2 or 3, gingivectomy was performed, and the tissues were prepared for histological examination. Microscopic examination of the biopsy material showed findings similar to those from previously reported cases of nifedipine- or phenytoin-induced hyperplasia.

Age Factors↗
PubMed1995

Massive gingival enlargement and alveolar bone loss: report of two cases.

We present two cases of massive gingival enlargement and osteolysis of alveolar bone in a 30-year-old female and a 36-year-old male. The etiology could not be established in either case. Histologically, both lesions contained hyperplastic fibrous connective tissue and intense plasma cell infiltrates. Both patients responded well to extensive gingivectomy, extraction of all teeth, and alveoplasty.

Adult↗
PubMed1999

Gingival fibromatosis combined with cherubism and psychomotor retardation: a rare syndrome.

Gingival fibromatosis is frequently an isolated condition, but rarely associated with some uncommon syndromes. This paper describes an 11-year-old patient with pronounced gingival enlargement, cherubic facial appearance, and psychomotor retardation and discusses the major aspects of the case. The most striking finding orally was the presence of grossly hyperplastic gingiva, which completely covered all teeth except the occlusal surfaces of some teeth. The swelling in the lower part of the face and the appearance of sclera beneath the iris suggest cherubism. The diagnosis was confirmed by the detection of giant cell regenerative granuloma and perivascular eosinophilic particles and osteoclasts after biopsy of the mandible. In this case, surgery was the only effective way to treat the patient. A full-mouth gingivectomy procedure was performed under general anesthesia in 2 stages. The case was followed for 12 months and no recurrence was seen. An appropriate oral hygiene regimen was established.

Biopsy↗
PubMed1999

Effectiveness of periodontal therapy in patients with drug-induced gingival overgrowth. Long-term results.

BACKGROUND: Drug-induced gingival overgrowth (DGO) is one of the well-recognized side effects of cyclosporin A (CsA) or nifedipine (Ni). After surgical periodontal therapy, the incidence of DGO recurrence is not known. The aim of this study was to evaluate the results of surgical periodontal therapy in patients receiving CsA or Ni and who exhibit severe long-term DGO. In addition, the relationship between various variables and the recurrence of severe DGO after periodontal surgery was investigated. METHODS: A total of 38 patients, 22 with CsA-induced DGO and 16 with Ni-induced DGO, were included in this study. At baseline, patients received initial periodontal therapy, after which either the upper or lower anterior segment in each patient was surgically treated. Surgical periodontal therapy consisted of the flap technique with a 90 degrees gingivectomy incision. Following surgery, patients were placed on a maintenance therapy recall program and were monitored for 18 months. Patients were seen once a month for the first 3 months and once every 3 months for the following 15 months. Plaque index (PI), papilla bleeding index (PBI) and DGO scores in the treated segments were recorded at each recall appointment. Attendance at recall appointments was also noted for each patient. RESULTS: Recurrence of severe DGO was observed in 13 of the 38 patients (34%) 18 months following periodontal surgery. Multiple regression analysis indicated that age, gingival inflammation, and attendance at recall appointments were significant determinants of the recurrence of severe DGO. CONCLUSIONS: This study suggests that regular re-motivation and professional care at frequent recall appointments after periodontal surgery are of great importance in patients receiving CsA or Ni. By maintaining periodontal health, the life quality of these patients may be raised.

Adult↗
PubMed2001

Preprosthetic periodontal surgery in the interproximal area with modification of the COL area: anatomic and histologic study in dogs.

BACKGROUND: Due to its concave morphology, a COL creates difficulties for proper oral hygiene. When this characteristic is accentuated by tooth position or caries and when restorations are necessary, they should be corrected by preprosthetic surgery. However, there are no data proving the efficacy of the procedures. The purpose of this study was to evaluate tissue response to preprosthetic surgery to modify COL morphology. METHODS: Five mongrel dogs received apically positioned flaps, osteotomy/plasty, and RAI (restorative alveolar interface technique) on the maxillary right third bicuspid and first molar; on the same teeth on the left side, a large tissue excision similar to gingivectomy and RAI were performed. Histologic specimens stained with hematoxylin and eosin and Mallory were evaluated at hour 0 and 1, 2, 3, and 4 weeks under light microscopy. RESULTS: At hour 0, hemorrhage in the remaining interproximal tissue on the left side, and denuded bone modified by the osteotomy on the right side, were observed. At 1 week, both sides showed the presence of granulation tissue and the beginning of reepithelialization and fiber formation. At 2 weeks, the papillae were rebuilt and epithelialized, with fewer inflammatory cells and dilated blood vessels, with a convex morphology. At 3 weeks, the papillae were convex and saddle shaped, with thicker epithelium and denser connective tissue. The general aspect was similar to attached gingiva. However, on the right side, the total extension of the interproximal tissues was longer and had a less accentuated convex curvature. At 4 weeks, the tissues were more mature, but the morphologic and histological findings were similar to 3 weeks. CONCLUSION: Both techniques modified the COL morphology, suggesting that the RAI technique was effective; but the apically positioned flap with osteotomy and RAI created a more extensive convex surface and more interproximal space for the prosthesis. It is recommended that this technique be considered for use in humans.

Alveolar Process↗
PubMed2005

Hereditary gingival fibromatosis: report of a five-generation family using cellular proliferation analysis.

BACKGROUND: Hereditary gingival fibromatosis (HGF) is an uncommon condition characterized by an accumulation of extracellular matrix resulting in a fibrotic enlargement of the gingiva. The goal of this article is to describe one kindred affected with HGF and discuss the diagnosis, treatment, and control of the disease. The pattern of inheritance, histopathologic characteristics, and proliferative potential of epithelial and mesenchymal cells of HGF are also emphasized. METHODS: To characterize the pattern of inheritance and the clinical appearance of gingival overgrowth, 117 family members were examined. The recurrence risk was estimated by the use of a genetic analysis program. Immunohistochemistry against the proliferating cell nuclear antigen (PCNA) and pKi-67 was performed to assess cellular proliferation of normal gingiva (NG) and HGF cells. RESULTS: Examination of the family pedigree demonstrated an autosomal dominant trait of inheritance, and a sibling recurrence risk of 0.085 and an offspring recurrence risk of 0.078, indicating that HGF was a consequence of genetic alteration with low penetrance. Unaffected and affected members transmitted the disease to their offspring. The affected patients showed a generalized but mild gingival overgrowth. Surgical treatment consisted of a combination of gingivectomy and gingivoplasty. Histologic examination showed that the gingival lesions of all patients were quite similar, with increased amounts of collagen fiber bundles in the connective tissue. Immunohistochemistry revealed that the proliferative potential of epithelial cells was significantly higher in the HGF group compared to the NG group, whereas mesenchymal cells from both groups were negative for the proliferative markers. CONCLUSION: Our data demonstrated that, in the studied family, HGF is transmitted by an autosomal dominant pattern with incomplete disease penetrance, and although the gingival enlargement resulted from an excessive accumulation of collagen fibers, HGF is characterized by an increase in the proliferation rate of epithelial cells.

Cell Proliferation↗
PubMed2005

Post-surgical infections: prevalence associated with various periodontal surgical procedures.

BACKGROUND: Of the various adverse outcomes that may be encountered following periodontal surgery, the risk of infection stands at the forefront of concern to the surgeon, since infection can lead to morbidity and poor healing outcomes. This paper describes a large-scale retrospective study of multiple surgical modalities in a diverse periodontal practice undertaken to explore the prevalence of clinical infections post-surgically and the relationship between diverse treatment variables and infection rates. METHODS: A retrospective review of all available periodontal surgical records of patients treated in the Department of Periodontics at Wilford Hall Medical Center, San Antonio, Texas, was conducted. The sample comprised 395 patients and included 1,053 fully documented surgical procedures. Surgical techniques reviewed included osseous resective surgery, flap curettage, distal wedge procedures, gingivectomy, root resection, guided tissue regeneration, dental implant surgery, epithelialized free soft tissue autografts, subepithelial connective tissue autografts, coronally positioned flaps, sinus augmentations, and ridge preservation or augmentation procedures. Infection was defined as increasing and progressive swelling with the presence of suppuration. The impact of various treatment variables was examined including the use of bone grafts, membranes, soft tissue grafts, post-surgical chlorhexidine rinses, systemic antibiotics, and dressings. Results were analyzed using Fisher's exact test and Pearson's chi-square test. RESULTS: Of the 1,053 surgical procedures evaluated in this study, there were a total of 22 infections for an overall prevalence of 2.09%. Patients who received antibiotics as part of the surgical protocol (pre- and/ or post-surgically) developed eight infections in 281 procedures (2.85%) compared to 14 infections in 772 procedures (1.81%) where antibiotics were not used. Procedures in which chlorhexidine was used during post-surgical care had a lower infection rate (17 infections in 900 procedures, 1.89%) compared to procedures after which chlorhexidine was not used as part of post-surgical care (five infections in 153 procedures, 3.27%). The use of a post-surgical dressing demonstrated a slightly higher rate of infection (eight infections in 300 procedures, 2.67%) than non-use of a dressing (14 infections in 753 procedures, 1.86%). Despite these trends, no statistically significant relationship was found between post-surgical infection and any of the treatment variables examined, including the use of perioperative antibiotics. CONCLUSIONS: The results of this study confirm previous research demonstrating a low rate of postoperative infection following periodontal surgical procedures. Although perioperative antibiotics are commonly used when performing certain regenerative and implant surgical procedures, data from this and other studies suggest that there may be no benefit in using antibiotics for the sole purpose of preventing post-surgical infections. Further large-scale, controlled clinical studies are warranted to determine the role of perioperative antibiotics in the prevention of periodontal post-surgical infections.

Alveolar Ridge Augmentation↗
PubMed2005

Treatment of gingival fibromatosis associated with Zimmermann-Laband syndrome.

BACKGROUND: Gingival fibromatosis is a rare condition characterized by a generalized enlargement of the buccal and lingual aspects of the attached and marginal gingiva. METHODS: This case report describes the periodontal management of a 13-year-old female patient with gingival fibromatosis associated with Zimmermann-Laband syndrome. The patient presented with gingival enlargement involving the maxillary and the mandibular arches, anterior open bite, and non-erupted teeth. Periodontal treatment included gingivectomy in all four quadrants. RESULTS: Histopathologic evaluation of the excised tissue supported the diagnosis of gingival fibromatosis. A significant improvement in esthetic appearance and eruption of the non-erupted teeth were obtained. The patient was referred for appropriate orthodontic treatment and has been closely followed for the earliest signs of recurrence of gingival enlargement. CONCLUSIONS: The successful therapy for gingival fibromatosis depends on correctly identifying the etiological factors and improving the impaired function and esthetic appearance through surgical intervention and adjunctive orthodontics. Maintaining treatment results depends on preservation of periodontal health.

Abnormalities, Multiple↗
PubMed2006

[Case report of prosthetic treatment for defected jaw with enucleation of the right maxillary sinus tumor].

PATIENT: The patient is a 71-year-old woman who had undergone a gingivectomy due to a gingival carcinoma of right maxillary sinus and a denture was made for the defected jaw. DISCUSSION: During three years and six months, |3 serves as the guidance tooth had suffered from various symptoms, from the detachment of the neighboring tooth to the use of an OP anchor followed by a partial fracture of the cuspid root. However, |3 has not been removed in accordance to the patient's request. In addition, a relining provided indirectly to the denture, it is still maintained and used for mastication, pronunciation and swallowing functions without difficulty. CONCLUSION: This is a case that a denture was made for the defected jaw. However, it is important ot take measures in the future, as the remaining tooth is not expected to be preserved for long.

Deglutition↗
PubMed1974

Quantitative long-term determinations of the alveolar bone mineral mass in man by 125-I absorptiometry. II. Following periodontal surgery.

The influence on the alveolar bone mineral mass of two common techniques of periodontal surgery, mucoperiosteal flap operation and gingivectomy, was investigated in patients with periodontal disease. The bone reaction, similar with respect to type of treatment, was characterised by a loss of mineral mass during three to four weeks after surgery. The maximum loss was 0.3 mg - mm-minus 2 on an average (10 to 15 per cent). A remineralization of the alveolar bone followed towards the presurgical level, which was reattained after four to six months.

Absorption↗
PubMedDate not supplied

A modified double pedicle graft technique and other mucogingival interceptive surgeries for the management of impacted teeth: a case series.

Maxillary canine is one of the most common teeth that are impacted. This accounts for 1-2% of all patients who attend orthodontic treatment. The key to achieve maximal eruption of these teeth is their surgical exposure and the role of periodontist in such situations is to provide a functional and satisfactory width of attached gingiva on the labial surface. There are different techniques to surgically expose the impacted teeth, namely--gingivectomy technique, apically positioned flap, closed eruption technique, modified apically positioned flap, double pedicle flap and free gingival graft. Selection of the procedure is dependent on the positioning of the tooth in relation to mucogingival junction and attached gingiva. In the present case series we describe three different techniques for uncovering of impacted teeth, which are apically positioned flap, closed eruption technique and a modified double pedicle graft specially planned for the situation. These procedures when selected diligently using sound selection criteria will create adequate width of attached gingiva which minimizes or eliminates the future mucogingival problems.

Adult↗
PubMed1975

[Late results in surgical treatment of periodontal diseases].

The authors re-examined 102 patients who had undergone periodontal surgical intervention 1--15 years ago. In 50% the results were good, in 25% they were mediocre, and in 25% they were poor. The results from gingivectomies were better than those from flap operations. The operation results were better in younger patients. The proportion of lost teeth was 14%. Oral hygiene was unsatisfactory in 65,7% of the cases. The relatively unfavourable results may be explained by the tardiness of intervention and the neglect of oral hygienic measures.

Adolescent↗
PubMed1976

[Prospects of surgical treatment in hydantoin-induced gingival hyperplasia].

During the past 20 years, gingivectomies were carried out in 100 out-patients of the maxillo-facial clinic of the Heidelberg university hospitals because of intensive gingival hyperplasia. 57% of the patients were epileptics who had been hydantoin-containing preparations. Follow-ups were made in 41 patients. The group of epileptics was critically compared with that of non-epileptics. In addition to the rate of recurrences, especially oral hygiene, existing bite abnormalities and the degree of mental retardation were considered. It was surprising that the number of recurrences did not drop when the hydantoin containing preparation was postoperatively discontinued. Even in edentulous regions of the jaws of two patients, recurrences of considerable size were found.

Adolescent↗
PubMed1999

Infiltrated lidocaine 2% with epinephrine 1:80,000 causes more postoperative pain than lidocaine 2% after oral soft tissue surgery.

A controlled, randomized, double-blind, within-patient, crossover study was made with 50 patients (28 women and 22 men) of mean age 47 years (range, 32-69 years) who were subjected to identical bilateral gingivectomies. On one occasion, lidocaine 2% was infiltrated as the local anesthetic. On the other occasion, lidocaine 2% with epinephrine 1:80,000 was given. Postoperative pain intensity was recorded by the patients on a 100-mm visual analogue scale every hour during an 11-hour observation period. The mean pain intensity was numerically higher after lidocaine 2% at 0 hours and 1 hour postoperatively. Then the mean pain intensity after lidocaine 2% was lower than that after lidocaine 2% with epinephrine 1:80,000 throughout the remaining observation period. The difference in pain intensity was statistically significant (P < .05) at 2, 4, 5, 6, and 7 hours after surgery. Mean sum (SEM) pain intensity over the 11-hour observation period was lower (P = .03) after lidocaine 2%, 66.5 (13.4) mm than after lidocaine 2% with epinephrine 1:80,000, 92.6 (15.4) mm. The study shows that high epinephrine concentration (1:80,000) increases the postoperative pain after dental soft tissue surgery with mild pain.

Adult↗
PubMed2000

Hereditary gingival fibromatosis: review of the literature and a case report.

Hereditary gingival fibromatosis is a proliferative fibrous lesion of the gingival tissue that causes esthetic and functional problems. Both genetically and pharmacologically induced forms of gingival fibromatosis exist. This paper reports a case of severe generalized hereditary gingival fibromatosis in a 5-year-old girl. Treatment consisted of surgical removal of the hyperplastic fibrous tissue in a series of conventional gingivectomies. Postoperative examination 36 months after the final procedure revealed no signs of recurrence.

Child, Preschool↗
PubMed2002

The ramp mattress suture: a new suturing technique combined with a surgical procedure to obtain papillae between implants in the buccal area.

This article has been written to show the opportunity and eventually the predictability to obtain new papillae between implants and a better esthetic result by the use of a new suturing technique. After raising a full-thickness flap from the palatal to the vestibular side, it can be stabilized in such a position using a new suturing technique (ramp mattress suture) to apply pressure and tearing forces on the flap in an apicocoronal direction at the vestibular site and an opposite traction in a coronoapical direction at the palatal site. The ramp mattress suture seems to be capable of pulling the flap in an apicocoronal direction in the vestibular site, as well as in a coronoapical direction in the palatal site. Thanks to such a mattress suture, it will be possible to obtain a more coronal gingival margin. After an adequate healing period of approximately 5 weeks, a vestibular scalloped gingivectomy is performed around the vestibular surface of the abutment to create either a scalloped gingival margin or interproximal papillae only in the vestibular area, forming a gingival ramp in a palatovestibular direction to reasonably reduce the residual increased vestibular depth and optimize the esthetic result. Eight patients, for a total of 56 papillae, were treated with this new suturing technique. The esthetic results satisfied both clinician and patient expectations.

Adult↗
PubMed2003

Effects of Er:YAG laser on periodontal therapy.

The use of the laser in dentistry has been widening due to its increasing use in surgery and medicine. In the field of periodontology, the most commonly used lasers have been CO2 and Nd:YAG lasers. According to the last reviews reporting the use of lasers in periodontal therapy, these lasers were considered unsuitable for dental treatment, due to various shortcomings, such as the carbonization and severe thermal damages caused on the target and surrounding tissues, and therefore their use has been confined to soft tissue procedures. Technological advances and improvements have increased the choices of the available laser systems. Among them, Er:YAG lasers seem to be of promising use. The Er:YAG laser is a solid-state crystal laser operating in the infrared wavelength (2,940 nm). Due to its high absorbability in water and hydroxyapatite, several studies have shown the effectiveness of this laser for both hard and soft tissue ablation, and its bactericidal effects with less or even no pain under clinical applications. The variety of the potential applications for this laser has been studied and the interest about its use in dental practice has increased among practitioners. This review includes studies regarding the use of Er:YAG laser on hard tissue procedures, such as calculus removal and osseous surgery as well as soft tissue management, like gingivectomy, gingival curettage and melanin removal.

Absorption↗
PubMed1998

A protocol for maintaining or increasing the width of masticatory mucosa around submerged implants: a 1-year prospective study on 53 patients.

Masticatory mucosa around implants may be useful to enhance esthetics and/or plaque control. This study proposes simplified guidelines for maintaining or obtaining a minimal amount of masticatory mucosa around submerged implants in cases of partial edentulism, and for keeping the need for additional surgery to a minimum. Free gingival grafts were used in the mandibular arch when the width of buccal masticatory mucosa was less than 2 mm. The width of masticatory mucosa expected to be available for attachment to the bone surface buccal to implants was estimated by measuring the distance between the emergence of the implant from bone and the mucogingival junction. When this distance was 3 mm or less, the use of an apically positioned flap for implant exposure was preferred over gingivectomy. The amount of masticatory mucosa buccal to implants was measured 2 weeks, 6 months, and 12 months after implant exposure. In no case was the width of masticatory mucosa less than 2 mm at 1 year. Therefore, this protocol is recommended for the treatment of cases where the presence of an adequate amount of masticatory mucosa is necessary to ensure a satisfying appearance or is useful for facilitating oral hygiene.

Adult↗