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PubMed2000

Esthetic gingival recontouring--a plea for honesty.

There continues to be a tremendous amount of confusion in the dental literature and among practitioners regarding the diagnosis and treatment of gingival discontinuities. The purpose of this article is to present a rationale for gingival recontouring, illustrated by a case report. A patient requested gingival recontouring. Because the preoperative evaluation was inadequate, a simple gingivectomy procedure was performed. After healing, the tissue had rebounded to its preoperative levels. The patient was then evaluated more comprehensively, and gingival recontouring was accomplished with a mucoperiosteal flap and osseous recontouring. The tissue subsequently healed at the correct position and remained stable. To reliably perform gingival recontouring procedures, the dentist must have a clear understanding of the biologic width. By using diagnostic bone sounding, the practitioner can determine the appropriate surgical procedure that will ensure an esthetic and stable postoperative result.

Adult↗
PubMed1997

[A study on the treatment and restoration of the complete fractured teeth].

In order to keep the fractured teeth with their important function of mastication the authors had adopted a kind of improved calvital preparation to carry out the pulp treatment for 56 cases, 63 teeth, together with periodontal washing, the application of medicine and the periodontal treatment of gingivectomy and flap operation, etc. from Jan. 1989 to Jan. 1993. The regularization of the filling of the fragmental area, the combination and the fixation of the split tooth were strengthened with spiral root post and dentin retaining nails, and then the full cast crown was restorated. The results were satisfied. It turns out that complete fracture of posterior teeth, thought to be pulled out in the past because they had split well below the gum, or even affected the pulp chamber floor, can be kept if given treatment and proper restoration.

Adult↗
PubMed1992

Soft tissue management during implant maintenance.

Peri-implant soft tissue problems seen during the maintenance phase of implant therapy include an inadequate zone of keratinized tissue, mobility of grafted tissue, mucosal "pouching," gingival hyperplasia, gingival fistulas, and gingivitis. Techniques to alleviate or reduce these problems include free soft tissue autografts, apically positioned flaps, reduction of tissue thickness by a flap procedure or gingivectomy, and increased attention to the control of inflammation.

Adult↗
PubMed1999

[Exploration of the dental peri-implantitis therapy]

OBJECTIVE:Our study is try to establish the treatment mehtod for periimplantitis from clinical aspect,so as to treat failing implant effectively.METHODS:Peri-implantitis was treated using four methods:(1)essential treatment,(2)gingivectomy,(3)flap operation,(4)guided bone regeneration(GBR).Clinical peri-implant assessments included probing depth (PD),gingival index(GI),mibility (MOB),data analysis was carried out using singed-rank test.RESULTS:27 cases were successfully treated,and the rate was 71.05%,11 implants were extracted,the parameters before and after treatment have significant difference.CONCLUSION:It is essential to maintain good oral hygiene,determine the standard of diagnosis of peri-implantitis and successful treatment.

Journal Article↗
PubMed2004

[Preservation of alveolar bone of un-restorable traumatized maxillary incisors for future].

UNLABELLED: Anterior maxillary implantation is a challenging treatment for both the surgeon and prosthodontist due to high esthetic demands in this area. However, it is the most traumatized and most exposed region to habits. Prompt and appropriate management can significantly improve prognosis of many dentoalveolar injuries, especially in young patients. Unfortunately, many traumatized teeth are overtreated or left untreated, which lead to a much more complicated treatment at the time of permanent restoration at adulthood. The facial cortical plate over the roots of the maxillary teeth is thin and porous. Periapical infections, as well as prolonged and stubborn surgical treatments (repeated root end surgeries) can cause resorption of the labial plate, migrate to a more palatal position, and may later require an augmentation procedure prior to implant placement. The treatment-options of traumatized, anterior maxillary, un-restorable fractured root and ankylosed infraocluded teeth, in relation to preservation of the adjacent alveolar bone for future use of dental implantation will be discussed. The recommended treatment of crown-root fracture of permanent incisor includes removal of the coronal fragment and supragingival restoration of the fractured root. In severe cases in which the fracture line positions deeply under the gingival margin, this treatment may be supplemented by gingivectomy and/or osteotomy, as well as surgical or orthodontic extrusion of the root. In young patients, use of these treatment options as temporary treatment to preserve the facial cortical plate is important. Preservation of alveolar dimension will enable implantation after the completion of growth and development. Dento-alveolar ankylosis accompanied by replacement resorption is a serious complication following severe injury to the periodontal membrane. This complication develops mainly following avulsion and intrusion but also following lateral luxation and root fracture. Replacement resorption develops after severe damage to the periodontal ligament cells that cover the root surface. As a result of this damage, the periodontal ligament is replaced by bone tissue, causing ankylosis between bone and tooth. Following ankylosis, resorption of cementum and root dentin occurs. These processes eventually result in replacement of the entire root by bone. In young children it could arrest the growth of the alveolar process and create an infra-occluded tooth, resulting in a severe bony defect that is difficult to correct. In addition, loss of the maxillary incisor leads to serious esthetic and restorative problems, particularly when the trauma occurs at a young age. Therefore, ankylosed teeth should be treated as soon as diagnosed. Alternative treatments include intentional extraction and immediate replantation of the ankylosed tooth to its socket after embedding the tooth and the socket in Emdogain. This treatment is indicated only when the ankylosis or the replacement resorption is diagnosed at an early stage or has affected only a small area of the root. When the resorption is diagnosed at a later stage, auto transplantation of first lower pre-molar to the anterior region or decoronation of the ankylosed tooth may be considered. Decoronation is a simple and safe surgical procedure for preservation of alveolar bone prior to implant placement. It should be considered as a treatment option for teeth affected by replacement resorption. The alternative treatment of surgical extraction of an ankylosed tooth often leads to considerable bone loss and reduced bone volume in the oro-facial dimension. This may later necessitate an augmentation procedure. CONCLUSION: Scrupulous diagnosis of teeth and the alveolar bone after a traumatic injury is necessary. Treatment is multidisciplinary, requiring endodontic, surgical, orthodontic, operative and prosthetic compliance. An individual treatment plan for each patient is necessary. General rule do not apply. Periodic check-up is essential.

Adult↗
PubMed2004

Peri-implant diseases. A systematic review of the literature.

Peri-implantitis surrounding oral implants is an inflammatory process affecting the soft and hard tissues resulting in rapid loss of supporting bone associated with bleeding and suppuration. The etiopathogenesis of early and late peri-implantitis is less well understood and seems to be related to the peri-implant environment and to the soft tissues/implant interface, to patient-related factors (smoke, systemic diseases, plaque control) and to host-parasite equilibrium. However, there is wide scientific evidence that demonstrates the direct correlation between oral microbiota and peri-implant mucositis or peri-implantitis. In particular, adherence and colonization of microbiota on plaque-exposed biomaterials, like c.p. titanium, are discriminant factors for the development of infection. Regenerative or resective surgical approaches are proposed for the treatment of peri-implantitis depending on the morphology and the shape of bone defects. The therapeutical approach of peri-implantitis surrounding dental implants comprises several aspects such as the removal of supra-gingival bacterial plaque, an appropriate surgical approach, the removal of granulation tissue and detoxification of the exposed implant surface, the elimination of the anaerobic ecosystem by the removal of peri-implant pocket (gingivectomy or apically repositioned flap) or by the regeneration of the peri-implant hard tissues and, finally, the establishment of an efficient plaque control regimen.

Dental Implants↗
PubMed2005

[Study on the expression of IL-10 mRNA and the protein in gingival tissues of patients with chronic periodontitis].

PURPOSE: To investigate the cell type which express IL-10 mRNA and the protein in gingival tissues of patients with chronic periodontitis. METHODS: 12 patients with chronic periodontitis who were undergoing flap operation were randomly chosen as periodontitis group;10 patients undergoing gingivectomy were chosen as gingivitis group;6 patients undergoing extraction of impacted teeth were chosen as control group. Assays of in situ hybridization and immunohistochemistry were used to observe the expression of IL-10 mRNA and the protein in gingival tissues of each group respectively . Wilcoxon test was used to compare the expression of IL-10 of each group at two levels; differences between the two groups were analyzed by one-way ANOVA test. RESULTS: IL-10 mRNA and the protein were all expressed in gingival tissues of periodontium,they were found in lymphocytes, fibroblasts and macrophages. There were no significant differences between two levels of IL-10 expression of periodontitis group and control group (P>0.05) gingivitis group,P<0.05). The IL-10 expression of periodontitis group was significantly higher than gingivitis group and control group (P<0.01); The IL-10 mRNA expression of periodontitis group was significantly higher than control group (P<0.01),but there was no significant difference between the IL-10 mRNA expression of periodontitis group and gingivitis group (P>0.05). CONCLUSION: There is a local secretion mechanism of IL-10 in the periodontal tissues.

Case-Control Studies↗
PubMedDate not supplied

[Nasotracheal fiberoptic intubation under remifentanil for sedation and analgesia in a boy with a difficult airway due to giant gingival hypertrophy].

A 9-year-old boy diagnosed with gingival hypertrophy and with a history of West syndrome and associated low platelet levels underwent gingival reduction surgery. Because difficult intubation was foreseen, the fiberoptic tube was inserted through the nose with the patient breathing spontaneously under remifentanil for sedation and analgesia. The procedure was carried out under balanced general anesthesia and with standard monitoring. At the end of gingivectomy, a tracheostomy was performed and the patient was transferred to the pediatric intensive care unit for postoperative observation.

Airway Obstruction↗
PubMed2006

[Effects of enamel matrix proteins on the proliferation of human gingival epithelial cells in vitro].

PURPOSE: To evaluate the effect of enamel matrix proteins (EMPs) on the proliferation of human gingival epithelial cells in vitro. METHODS: EMPs were extracted from pig tooth germ by acetic acid. The gingival tissues cut off during gingivectomy were separated into two parts through Dispase II digestion and the epithelium part was cultured to acquire the gingival epithelial cells. The first passage epithelial cells were inoculated into 96-well plate, 22500 cells per well, and exposed to different concentrations of EMPs (50, 100, 200 microg/ml respectively). The control was epithelial cells cultured in the same medium except without EMPs. The proliferation rates were carried out over a 5-day period and assessed by an MTT assay and the data were analysed by one-way variance. RESULTS: It was shown that gingival epithelial cells well attached and spread on EMPs-coated substrata. There were no significant differences between the control group and various concentrations of EMPs groups at the initial stage, however, EMPs at a concentration of 200 microg/ml significantly inhibited gingival epithelial cells proliferation from day 3 over the experiment. CONCLUSIONS: The proliferation of gingival epithelial cells was significantly inhibited by EMPs in a dose- and time-dependent manner, which provides some evidence for the mechanism of EMPs in promoting the periodontal tissue regeneration.

Animals↗
PubMed1991

The pulsed Nd:YAG dental laser: review of clinical applications.

Since the first demonstration of a laser in 1960, numerous applications of this unique form of energy have been developed for the manufacturing, electronic, consumer and medical industries. Recent technological innovations have permitted development of lasers appropriate for use in the dental operatory. The carbon dioxide laser has been used for soft tissue surgery; the Nd:YAG laser has both soft and hard tissue applications. Advantages of laser treatment over conventional methods include minimal cellular destruction and tissue swelling, hemostasis, increased visualization of surgical sites and reduced post-operative pain. Additionally, it is possible to perform many procedures without needing anesthesia. Soft tissue clinical applications of the Nd:YAG laser include gingivectomies, gingivoplasties, operculectomies, biopsies, incising and draining procedures, frenectomies and treatment of aphthous ulcers; hard tissue clinical applications include vaporizing decay, etching enamel and dentin, desensitizing exposed root structure and creating temporary analgesia. As both clinical experiences and scientific investigations expand, possible future applications of the dental laser may well include development of new dental adhesives and composite systems, new methods for managing caries and new endodontic treatments. With its numerous benefits, the laser is having a positive impact on patients and the dental team.

Adult↗
PubMed1991

Perio-prosthetic management in restoring teeth with reduced clinical crown in children.

The purpose of this article is to underline the importance and to discuss the indications and techniques of crown lengthening procedures prior to prosthetic treatment of mutilated or undererupted permanent teeth of children. The aim of surgical crown lengthening is the exposure of at least 3 to 4 mm of healthy tooth structure coronally to the alveolar crest, length that will allow the formation of the new epithelial attachment and the existence of 1 to 2mm of tooth structure for the construction of a biologically acceptable crown margin. If the margin of the defect is inadequate distance from the alveolar crest the surgical procedure involves reduction of the attachment complex and is limited to the soft tissues only (a gingivectomy, apically repositioned full thickness flap, distal wedge). When the margin of the defect is close to the alveolar crest, less than 3 mm, the surgery involves also modification of the hard tissues of the periodontium (apically repositioned full thickness flap with ostectomy-osteoplasty). Although cases of children generally call for a conservative approach, the necessity for harmony between restorative procedures and materials with the supporting structures make surgical intervention inevitable.

Child↗
PubMed1991

Evaluation of the utilization of complex periodontal care in an industrialized country with a national health insurance.

This paper presents an analysis of the utilization of periodontal care, subject to prior agreement, over a period of 3 months. It concerns insured persons covered by the Caisse Primaire d'Assurance Maladie de Lyon, which represents 5 per cent of the French population. It details 516 cases. The mean (+/- SD) age of the persons requiring care was 43 +/- 12.6 years; their dental health was good, and 58 per cent were women. The nature and geographical locality of the periodontal treatments are given and 1323 procedures are listed, with a high proportion of gingivectomies and flap operations.

Adult↗
PubMed1990

[Treatment-effect on cyclosporin A-induced gingival hyperplasia in patients with organ transplantation: a longitudinal study].

In the present study a newly developed concept for avoiding recurrences after the periodontal surgical treatment of cyclosporin A-induced gingival hyperplasia is described. Conventional gingivectomy results in restitutio per secundam, which promotes recurrences. To avoid this we tried to achieve a restitutio per primam by using a modified surgical technique. Ten patients, four treated under general anesthesia and six on an outpatient basis, were treated with this technique. Patients were monitored for 20 month. Pre- and postoperative care was performed in a standardized manner for all patients. During the surveillance, a long-term suppression of the cyclosporin-induced gingival hyperplasia could be found, but it was not possible to avoid recurrences totally.

Adolescent↗
PubMed1990

[Immunohistochemical studies on the peptidergic nerve distribution in hard palate mucosa and gingiva of the rat. 2. Responses of calcitonin gene-related peptide (CGRP)-containing nerve fibers on wound healing of the mucosa].

This study investigated morphological changes of CGRP-containing nerve fibers during wound healing of the rat oral mucosa following resection of the transverse palatine ridge and gingivectomy. The tissue was immunohistochemically examined at 0, 3, 7, 14, 21, 28 and 70 days after surgical injury. The following results were obtained. 1) The Transverse Palatine Ridge. At shorter survival periods (0 and 3 days), CGRP-containing nerve fibers adjacent to the surgical defect degenerated and decreased in number. By 7 days, tissue repair had advanced and the defect had been filled with granulation tissue. Thin nerve fibers were found in and around the granulation tissue, especially nearby newly proliferating blood vessels. At 14 days, extensive regeneration of thin nerve fibers was observed in the repaired tissue. Many of them were found singularly in deeper layers of the repaired tissue, and some in bundles reaching the base of the epithelium. Some of these sprouts appeared to have existed only transiently because their number somewhat reduced by 21 days. The defect was filled with scar tissue at 28 days and mucous structure did not return to normal even at 70 days. Nerve fibers neither regenerated to regain the original density nor formed subepithelial plexuses. 2) The Gingiva. At 0 and 3 days, CGRP-containing nerve fibers near the cut surface of gingiva degenerated and their number decreased. At 7 days, a few thin regenerating fibers were found entering the epithelium on the oral side. Sprouts were also seen around small blood vessels deep in the granulation tissue. By 14 days, the nerve fibers had gradually increased with progress of tissue repair. However, rapid, transient increase in number of fibers, like that observed for the palatine ridge, was not noted. By 21 days, the junctional epithelium had regenerated, and regenerating fibers had redistributed into and beneath the sulcal epithelium. At 28 and 70 days, the repaired marginal gingiva were indistinguishable from normal (and control) marginal gingiva as regards the histology and CGRP-innervation. There were, however, a few exceptions in which junctional epithelium did not fully recover. In these animals, regeneration of CGRP-containing fibers was barely discernible in or around the sulcal epithelium.

Animals↗
PubMed1990

Tissue reaction involving an intraoral skin graft and CP titanium abutments: a clinical report.

Focal areas of gingival hyperplasia surrounding the transmucosal portions of titanium implants have been attributed to poor hygiene, lack of attached gingival tissues, and titanium allergy. Following mandibular vestibuloplasty and placement of a split-thickness skin graft, two of five patients developed persistent proliferation of the epithelial tissue surrounding endosseous CP titanium dental implants. In both circumstances, traditional gingivectomy procedures, chemotherapeutic agents, and aggressive oral hygiene measures failed to adequately control the hyperplastic response. Following replacement of the titanium abutments with custom-fabricated gold abutments, the epithelial condition appeared to return to normal.

Adult↗
PubMed1990

Late complications in pediatric cardiac transplant recipients.

Late complications occurring more than 3 months after cardiac transplantation were analyzed in 29 pediatric patients in whom 31 cardiac transplantations were performed. Age at transplantation ranged from 3 months to 18 years (mean, 11.3 years) with follow-up ranging from 3.5 to 54 months (mean, 21.6 months). There were seven late deaths and two patients with retransplantations. Of nine grafts lost, eight were due to acute rejection, and one was due to coronary disease. Four of the grafts lost were secondary to patient noncompliance with prescribed immunosuppression. The mean rejection frequency more than 1 year after cardiac transplantation was significantly higher in those patients who eventually lost their grafts; however, these patients could not be distinguished by their rejection frequency in the first year. Eight patients had coronary disease, with five diagnosed at autopsy, two at cardiac retransplantation, and one by angiography. All eight patients were on double immunosuppression; none of the 19 patients on triple therapy had coronary disease with similar follow-up. There were 12 serious infections in eight patients (four associated with OKT3) with no deaths. Five patients had arrhythmias requiring treatment including two pacemakers; four of the five were associated with rejection episodes. Twelve of 29 patients developed early hypertension, and five developed late hypertension (greater than 1 year). There were two malignancies; one patient with Hodgkin's lymphoma was cured with chemotherapy, and one patient with histiocytic lymphoma was discovered at autopsy. Two patients had cholecystectomies, and five patients required laser gingivectomies.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1988

Changing concepts of periodontal treatment: surgical and non-surgical.

Periodontal disease can be successfully treated by non-surgical procedures including supra- and subgingival scaling and root planing with hand or ultrasonic instruments. This non-surgical treatment is recommended for the initial management of all cases with the institution of a plaque control programme. Such management should be the basis of all periodontal therapy. The results obtained are mainly dependent on the skillfulness of the operator and the morphology of the pockets as well as upon patient related factors. Additional treatment, i.e. periodontal surgery, may be necessary if resolution of subgingival inflammation is not obtained. Pocket elimination by the use of surgical procedures (gingivectomy, flap operation with bone surgery) may be preferred in regions of the mouth where the aesthetic result is unimportant and where the removal of alveolar bone does not jeopardize the periodontal support of neighbouring teeth. In situations with deep infrabony pockets especially in anterior regions and in furcation areas a reconstructive surgical technique is the therapy of choice. Recent research in the field of guided tissue regeneration may, in the future, change the traditional approach to periodontal surgery.

Female↗
PubMedDate not supplied

[Periodontal osseous surgery: osteoplasty and osteotomy].

Elimination of the periodontal pocket is a prime objective of periodontal therapy. Normally the gingiva is consistent with the underlying bone, and aberration in gingival form can be corrected by gingivectomy or gingivoplasty if the gingiva is supported by good bony architecture. If periodontitis has caused marginal irregularities or septal deformities the complete elimination of the periodontal pocket is done by osteoplasty or osteoectomy. The Authors through a review of the literature have examined these surgical techniques.

Alveolar Process↗