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PubMed1983

Role of attached gingiva for maintenance of periodontal health. Healing following excisional and grafting procedures in dogs.

The present study was undertaken to analyze the role of attached gingiva for the maintenance of periodontal health in sites with normal and reduced height of the supporting apparatus. Furthermore, the effect of excision and grafting of gingiva on some parameters describing dimensions and location of the periodontal tissues was evaluated. 7 beagle dogs were used. A baseline examination comprised assessments of dental plaque, gingival conditions, attachment level, position of the gingival margin and width of the keratinized and the attached gingiva. In the right side of the jaws (experimental side) a 6-month period of periodontal tissue breakdown was followed by surgical excision of the entire zone of the gingiva. After another 4-month period of healing with daily plaque control, a gingival graft was inserted in one quadrant of the experimental side to regain a zone of attached gingiva while the other quadrant of the experimental side was left ungrafted. In the left side of the jaws (control side), the teeth were subjected to daily meticulous plaque control during the entire study. In one of the control quadrants the entire zone of the keratinized and attached gingiva was excised at a time point corresponding to the grafting procedure in the experimental side, while the gingiva in the remaining control jaw quadrant was left unoperated. Clinical examinations of all control and experimental tooth units were repeated at certain time intervals during the course of the study. The final examination was carried out 4 months after grafting. The results of the experiment showed that in sites exposed to careful plaque control measures gingival health could be established and maintained without sign of recession of the gingival margin or loss of attachment, independent of (1) presence or absence of attached gingiva, (2) width of keratinized gingiva or (3) height of the supporting attachment apparatus. Following surgical excision of the entire gingiva, all buccal sites regained a zone of keratinized gingiva, but most sites were lacking attached gingiva. Furthermore, grafting of gingival tissue significantly increased the width of the keratinized and the attached gingiva but had no obvious effect on the position of the gingival margin or the level of the attachment.

Animals↗
PubMed1975

Complement factors in gingival crevice material from healthy and inflamed gingiva in humans.

The presence and levels of complement factors C3, C4, C5, and C3 proactivator, were determined by electroimmuno assay in gingival cervice material from five individuals with healthy gingiva and from six patients with chronically inflamed gingiva. Higher concentrations of C3 and C4 were found in samples from chronically inflamed gingiva when compared to those healthy gingiva. The amount of C3 in material from healthy as well as from inflamed gingiva was related to that in plasma, when the albumin in plasma and gingival crevice material was used as a reference. The same was found for C4 in samples from healthy gingiva but in those from inflamed gingiva, the values were significantly lower when related to plasma levels. C5 could not be found in material from healthy gingiva but was present in material from inflamed gingiva. C3 proactivator was present in material from inflamed gingiva in the converted form. No C3 proactivator was found in material from healthy gingiva with the methods used. Analysis of C3 in samples from inflamed gingiva, using crossed immunoelectrophoresis, showed that C3 was converted in these samples. The results indicate that the complement system may be activated in gingival crevice material from inflamed gingiva.

Adult↗
PubMed2001

Leptin within healthy and diseased human gingiva.

BACKGROUND: Plasma leptin concentrations are reported to be elevated in patients with inflammatory diseases. There is no consensus concerning the biological mechanism for this phenomenon. To date, tissue leptin concentrations have not been assessed within normal or inflamed gingiva. The purpose of this study was to assess concentrations of human leptin within healthy and diseased gingiva to define its possible role in periodontal disease progression. METHODS: Healthy (non-hemorrhagic gingiva adjacent to a < or =3 mm gingival sulcus) and inflamed gingiva (hemorrhagic gingiva adjacent to a > or =3 mm periodontal pocket) were studied. Leptin, vascular endothelial growth factor (VEGF; to assess potential vascular expansion), and interleukin-6 (IL-6; to assess periodontal disease activity and severity) concentrations were assessed within solubilized gingival biopsies by enzyme-linked immunosorbent assay. Data were grouped by sulcular depth and compared by factorial analysis of variance, regression analysis, and Scheffé comparisons. RESULTS: Leptin concentrations were highest within gingiva adjacent to a < or =3 mm sulcus and progressively declined within gingiva adjacent to a > or =3 mm sulcus. VEGF concentrations were highest within gingiva adjacent to 4 to 6 mm pockets and nearly equivalent in healthy (< or =3 mm sulcus) and severely diseased gingiva (>6 mm sulcus). IL-6 was positively correlated and leptin negatively correlated with adjacent probing depth; IL-6 concentration was significantly higher and leptin significantly lower in gingiva adjacent to >6 mm pockets compared to sites adjacent to <6 mm pockets (P<0.001). CONCLUSIONS: Human leptin is present within healthy and marginally inflamed gingiva and decreases in concentration as the adjacent probing depth increases. When leptin concentrations decreased (> or =3 mm sulcus), VEGF concentrations increased, suggesting that leptin could be released from gingiva coincident to vascular expansion. Thus, gingiva, in addition to adipose tissue, could be a source of circulating leptin in patients with periodontal disease. This possibility requires further investigation.

Adolescent↗
PubMed2002

Microcirculation of the healthy human gingiva.

The purpose of this study was to evaluate the microcirculation in healthy human gingiva. Forty-two adult volunteers with clinically healthy gingiva participated. The ages of this research sample ranged from 20 to 30 years. Periodontal conditions were evaluated and assessed by using the qualitative plaque index, gingival index, gingival bleeding index, tooth mobility, and laser Doppler flow-metry (LDF) on 12 maxillary and mandibular anterior teeth. The LDF data were recorded on the facial aspect of the free gingiva, interdental gingiva, attached gingiva, and alveolar mucosa of 12 maxillary and mandibular anterior teeth, utilizing an acrylic stent to stabilize the probe. This technique was then modified to circumvent contamination by saliva and gingival exudate. Blood flow in the maxillary anterior gingiva differed significantly from that in the mandibular anterior gingiva in interdental gingiva, attached gingiva, and alveolar mucosa, at P< 0.01. The maxillary anterior gingiva, at each point on the stent, showed significant differences in the mean LDF, at P< 0.01. For the mandibular anterior gingiva, the difference was significant only in the alveolar mucosa region.

Journal Article↗
PubMed2000

Improvement of macromolecular clearance via lymph flow in hamster gingiva by topical warming and massage.

The lymphatic system is very important for macromolecular clearance in various tissues, especially in the gingiva. However, the kinetics of macromolecular clearance via the lymph flow in the gingiva are poorly understood. The aim of this study was to investigate whether thermal or mechanical stimulation affects macromolecular clearance via the lymph flow in the gingiva. Carbon black suspension was injected into the mandibular gingiva of anesthetized hamsters and its drainage into cervical lymph nodes was examined. Clearance of 14C-methylated bovine albumin and tritiated water from the gingiva and their drainage into submandibular lymph nodes and blood was quantified. The effect of topical warming or massage on clearance of 14C-methylated albumin from the gingiva during a 15 min period was examined. In addition, the influence of neurochemical antagonists on the stimulatory effect of topical warming on albumin clearance was investigated. Submandibular lymph nodes were clearly delineated by carbon black 10 min after the injection. More radiolabeled albumin appeared in submandibular lymph nodes than in serum, while more tritiated water appeared in serum. Topical warming (45 degrees C, 2 min) and warming plus massage (with a silicon rubber brush, 20 s) decreased the radiolabeled albumin in the gingiva 15 min after the injection. There was less radiolabeled albumin in the gingiva after gingival warming plus massage than after warming. Previous injection of HOE140 or propranolol into the gingiva diminished the stimulatory effect of topical warming on albumin clearance. It was concluded that topical warming plus massage improves macromolecular clearance via the lymph flow in hamster gingiva.

Albumins↗
PubMed1988

Morphological changes in the attached and keratinized gingiva and gingival sulcus in the mixed dentition period. A 5-year longitudinal study.

A longitudinal study was undertaken to examine the changes in the sulcus probing depth, keratinized and attached gingiva during the mixed dentition period. 54 children aged 7 to 9 years at the first examination were examined twice, with an interval of 5 years. Sulcus probing depth and keratinized gingiva were examined at the buccal aspect of the incisors, and either right or left cuspids and posterior areas. The width of the attached gingiva was obtained by subtracting the probing depth from the width of the keratinized gingiva. When compared to primary predecessors, the permanent teeth had a deeper probing depth, narrower attached gingiva and at the maxillary teeth, a wider keratinized gingiva. When a permanent tooth was present at both examinations, there was a significant increase in width of the attached gingiva with a corresponding decrease in probing depth, and a slight beginning of an increase in the width of keratinized gingiva. Previous and the present findings indicate that during the early years after eruption of the permanent tooth, an increase in width of the attached gingiva takes place, without occlusal migration of the marginal gingiva whereas, at later stages, this coronal migration takes place, concomitant to tooth eruption.

Child↗
PubMed2003

Microcirculation and micromorphology of healthy and inflamed gingivae.

Inflammation changes the microcirculatory and micromorphological dynamics of human gingiva. Laser Doppler flowmetry (LDF) and a replica technique for scanning electron microscopy (SEM) were used to examine the facial soft tissues of six maxillary anterior teeth, before and after treatment, in 12 patients exhibiting clinically healthy tissues and in 12 others with moderate gingivitis. All patients received oral hygiene instructions and scaling. The gingiva in the gingivitis group became healthy within 3 months after treatment. LDF results were recorded at the free gingivae, interdental gingivae, attached gingivae, and alveolar mucosae of the six maxillary anterior teeth. The gingival blood flows in the gingivitis group before treatment were significantly different from those in the healthy gingiva group. Flows were restored to the same level as the healthy gingiva, with no significant difference, at P > 0.01, 3 months after treatment. However, there were significant differences among sites during the same period. In addition, blood flow was reduced to a normal level after the inflammation subsided. Initially, the gingival morphology of the inflamed sites exhibited irregular free gingival margins, in contrast to that of healthy gingivae, which were characterized by rounded margins closely adapted to the tooth. One month post-treatment, the gingivae exhibited a wrinkled appearance, but they had reverted to normal micromorphology by 3 months post-treatment. The replica impression technique can be used to record gingival micromorphology both before and after reduction of inflammation.

Adolescent↗
PubMed2004

Effect of gingiva on laser doppler pulpal blood flow measurements.

The purpose of this study was to evaluate the effect of labial and palatinal gingiva on laser Doppler pulpal blood flow measurements. Twenty upper central incisor teeth determined to be vital from 20 volunteers were included into the study. To stabilize the probe, a laboratory-made acrylic splint positioned the probe labially on the cervical third of the tooth crown. We collected measurements without any gingival covering, and under three conditions: after application of an opaque paste on the labial gingiva, the palatal gingiva, or both the labial and palatal gingiva. The measurement values decreased 46% when there was opaque paste on labial gingiva, 10% on palatinal gingiva, and 63% on both. The decrease in the values when there was an opaque paste on palatinal gingiva was not statistically significant (p > 0.05). The differences between all other groups were statistically significant (p < 0.05). In these measurements, the contribution of labial gingiva to laser Doppler pulpal blood flow measurements is more than that of palatinal gingiva.

Adult↗
PubMed1983

Regeneration of gingiva following surgical excision. A clinical study.

The present clinical trial was carried out in order to analyze whether a zone of keratinized and attached gingiva may regenerate following surgical excision of the gingiva. In addition the alterations occurring in the position of the "soft tissue margin" and the clinical attachment level were assessed. 6 patients, scheduled for periodontal surgery in the canine-premolar regions of both quadrants of the lower jaw, participated in the trial. A Baseline examination performed prior to surgery comprised assessments at the buccal surface of the teeth of dental plaque, gingivitis, probing depth, clinical attachment level, position of the "soft tissue margin" and width of the zones of keratinized and attached gingiva. The entire zone of keratinized and attached gingiva was removed surgically using either a "gingivectomy" or a "flap-excision" procedure. In the "gingivectomy" procedure the wounded area was left to heal by second intention, while in the "flap-excision" procedure the alveolar mucosa was repositioned in a coronal position to achieve complete coverage of the surgically exposed alveolar bone. During healing the patients' oral hygiene status was carefully supervised. All parameters included in the Baseline examination were assessed at reexaminations performed 1, 3, 6 and 9 months following surgery. Already 1 month after surgery all "gingivectomy" units and 9 out of the 14 "flap-excision" units demonstrated presence of a zone of keratinized gingiva. At the final examination (9 months following surgery) all surgically treated buccal areas had regained a zone of keratinized gingiva. However, a zone of attached gingiva reformed less frequently. The examination performed 3 months after surgery revealed that the "soft tissue margin" and the clinical attachment level had become displaced in apical direction, 0.9 and 0.4 mm, respectively. Between the 3-month and the 9-month examinations, however, no further alterations were observed and the gingival units were healthy, independent of the presence or absence of attached gingiva or the width of the zone of keratinized gingiva.

Adult↗
PubMed2000

Oxygen sufficiency in the gingiva of smokers and non-smokers with periodontal disease.

BACKGROUND: Epidemiological studies have demonstrated deteriorating effects of smoking on periodontal tissue. The aims of this study were to compare oxygen saturation of hemoglobin in the gingiva (GSo2) of smokers and non-smokers and to evaluate the chronic effect of smoking on gingival oxygen sufficiency. METHODS: GSo2 was determined using tissue reflectance spectrophotometry in 110 papillary gingival sites of 62 smokers and 100 sites of 60 non-smokers. RESULTS: No significant difference was found in GSo2 between smokers and non-smokers. In the model of ANOVA with covariates, age (P= 0.0048) and probing depth (P= 0.0012) had significant effects on GSo2. No significant effect was found in either smoking status (P= 0.3557) or the modified gingival index (MGI) (P= 0.3824). The interaction effect between smoking status and the MGI was highly significant (P = 0.0003) indicating that the effect of smoking status on the GSo2 should be compared at each level of the MGI score. GSo2 in healthy gingiva was significantly lower in smokers than non-smokers (P = 0.0014), while smokers showed higher GSo2 than non-smokers in moderately inflamed gingiva (P = 0.0356). The GSo2 in inflamed gingiva was significantly decreased compared with healthy gingiva in non-smokers (P = 0.0044), while smokers showed no significant difference between healthy and inflamed gingiva (P= 0.2772 to 0.8665). GSo2 in smokers was consistently and significantly lower than that of healthy gingiva of non-smokers (P = 0.0391 to 0.0004). CONCLUSIONS: Smokers exhibit possibly lower function of oxygen sufficiency in healthy gingiva and reduced ability to adapt the function in inflamed gingiva than non-smokers. This suggests that smokers have functional impairments in the gingival microcirculation.

Adult↗
PubMed2006

[Influence of metal-ceramic fixed dental restorations on the occurrence of discoloration of gingiva].

BACKGROUND: Adverse effects of dental cast alloys on the health of patients are the problem in clinical practice. The aim of this paper was to describe the case of a patient with discolorated gingivae in the presence of fixed dental restorations and used diagnostic and therapeutic procedures. CASE REPORT: A 30-year old pacient, presented with the complaints about unsatisfactory esthetic of his fixed dental restorations. He complained about the greyish discoloration of gingivae, inappropriate color of the crowns, and a larger space between the central incisors. Both discolorated and normal gingivae around the fixed dental restorations were taken by excision and the samples of gingivae were examined histopathologically, and by using the Atomic Absorption Spectrophotometry test (AAS). Histopathological examination of the discolorated gingivae showed the presence of non-specific inflammation with a foreign body. AAS revealed the presence of various metals in the samples and the higher metal contents in the samples of discolorated gingivae as compared with the samples of normal gingivae. New metal-ceramic crowns were made for the patient. CONCLUSION: A main cause of greyish discoloration of gingivae was presence of a metal in gingival tissue. After the excision of discolorated gingivae old metal-ceramic crowns should be replaced with new crowns.

Crowns↗
PubMed1983

Plaque-induced gingival inflammation in the absence of attached gingiva in dogs.

The purpose of this experiment was to evaluate the effect of plaque infection on gingival units (1) with or without support of attached gingiva and (2) with different height of the attachment apparatus. 7 beagle dogs were used. Prior to the initiation of the study 4 different types of "dentogingival" units had been established in each dog by the use of excisional and grafting procedures, namely (1) normal non-operated free gingival units supported by a wide zone of attached gingiva and normal height of the attachment apparatus, (2) regenerated free gingival units supported by loosely attached alveolar mucosa and normal height of the attachment apparatus, (3) regenerated free gingival units supported by loosely attached alveolar mucosa and reduced height of the attachment apparatus and (4) regenerated free gingival units supported by a wide zone of attached gingiva and reduced height of the supporting apparatus. A baseline examination involved assessments of plaque, gingivitis, gingival exudate, probing depth, clinical attachment level, position of the "soft tissue margin" and width of attached gingiva. Following this examination 2 of the dogs were scheduled for biopsy and sacrificed. The remaining 5 dogs were for 40 days placed on a diet regimen which allowed plaque accumulation. The clinical examination was repeated and biopsies sampled at the end of this period. Following preparation the biopsy material was subjected to histometric and morphometric analysis. The results showed that the free gingiva which regenerated following surgical excision of the entire gingiva or following soft tissue grafting, was in most respects, clinically as well as histologically, similar to the "normal" free gingiva. The data obtained after 40 days of plaque accumulation did not reveal any differences between the various "dentogingival" units regarding size and apical extension of the infiltrated portion of the connective tissue. It was concluded that a free gingival unit which is supported by loosely attached alveolar mucosa is not more susceptible to inflammation than a free gingival unit which is supported by a wide zone of attached gingiva.

Animals↗
PubMed1995

Compartmentalization of inflammatory cell phenotypes in normal gingiva and peri-implant keratinized mucosa.

The interpretation of studies aimed at understanding the pathophysiology of periodontal breakdown has been hampered by an insufficient understanding of the physiology of host responses in clinically healthy gingiva. This investigation was aimed at the evaluation of the in situ phenotype and topographic distribution of the inflammatory cells in clinically normal gingiva and peri-implant keratinized mucosa (PIKM). Soft tissue biopsies were obtained from clinically healthy gingiva or PIKM in 14 patients. Acetone fixed, cryostat sections were stained with a panel of monoclonal antibodies with a three stage avidin-biotin immunoperoxidase technique. Numbers of positive cells/mm2 were determined with a calibrated image analysis system. The major findings of the study were: (i) the presence of significantly higher densities of phenotypically characterized mononuclear cells in the ICT than in the JE in both gingiva and PIKM; (ii) the absence of a significant difference in PMN densities between JE and ICT in both gingiva and PIKM; (iii) the absence of statistically significant differences in densities of phenotypically characterized leukocytes associated with gingiva and PIKM; (iv) the presence of regional differences in the relative proportions of immunocompetent cells in both the gingiva and PIKM. It is concluded that inflammatory cells are selectively distributed in gingiva and PIKM. Unique functional compartments could be identified. The observed compartmentalization requires selective regulatory mechanisms.

B-Lymphocytes↗