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PubMed2002

Deep extension from carcinoma arising from the gingiva: CT and MR imaging features.

BACKGROUND AND PURPOSE: CT and MR imaging are useful for evaluating the extension of carcinomas in the face and neck. We evaluated the involvement by carcinoma arising from the gingiva (ie, gingival cancer) by using CT and MR imaging. METHODS: We retrospectively examined 122 patients with squamous cell carcinoma (SCCA) in the lower (88 patients) and upper (34 patients) gingiva. Extension of SCCA into the spaces of the face and neck was evaluated with CT and MR imaging, and findings were surgically confirmed. RESULTS: Spread into the face and neck spaces occurred in 58% of patients. The buccal space was the most common site of spread, occurring in 42% of the lower and of 47% of the upper gingival cancers. Spread into the masticator space occurred from the lower gingival cancers in the molar region (20%) but not from the anterior region. Masticator space involvement from the upper gingiva was rare (4%). The retromolar triangle and buccal space immediately anterior to the ramus served as a corridor for cancer extension from the lower gingiva into the masticator space. The sublingual space (11%) was a less common site of spread from the lower gingiva. CONCLUSION: Gingival cancers spread into the masticator, buccal, and sublingual spaces depending on the primary sites in the oral cavity. An understanding of the face and neck-space anatomy is important in diagnosing cancer extension in the oral cavity gingiva and in treating patients with such disease.

Aged↗
PubMed1979

Vascular permeability in the rat gingiva. A model of vessel response in chronic inflammation.

The vascular permeability of the vessels of clinically normal gingiva of rats was studied using the colloidal carbon technique. The connective tissue situated underneath the keratinised epithelium was normal, but that subjacent to the non-keratinised epithelium showed some degree of chronic inflammation and as a rule the vessels of the area exhibited increased vascular permeability. In the buccal gingiva the vessels labelled with carbon form loops situated 200 micrometers below the marginal gingiva, while in the interdental gingiva the altered vessels are just below the superficial epithelium. On electron microscopy the vessels in the inflamed areas showed many open endothelial junctions, and also pseudo-fenestration, and endoplasmic vesicles full of carbon. Little is known about vascular changes in chronic inflammation, and the rat gingiva seems to be a suitable model for their study.

Animals↗
PubMed1991

Arachidonic acid, prostaglandin E2 and leukotriene C4 levels in gingiva and submandibular salivary glands of rats fed diets containing n-3 fatty acids.

The effect of dietary n-3 fatty acids on prostaglandin E2 (PGE2) and leukotriene C4 (LTC4) levels in rat salivary glands and gingiva was examined in two separate nutritional studies. In the first set of experiments, two groups of male weanling Sprague-Dawley rats were fed semipurified diets containing 10% corn oil (control group) or 10% menhaden oil (experimental group). Rats were killed after 8 wk on the diets; the fatty acid composition of total phospholipids and the concentrations of PGE2 and its precursor, arachidonic acid, were measured in gingiva and submandibular salivary glands (SMSG). Dietary n-3 fatty acids were incorporated into the tissue phospholipids. Arachidonic acid levels were reduced by 56% in gingiva and SMSG of rats fed menhaden oil compared with the control rats fed the diet containing corn oil. The concentrations of PGE2 in SMSG and gingiva of rats fed the diet containing menhaden oil were reduced by 74% and 83%, respectively. In a subsequent nutritional study, we tested whether the diet-induced reduction in tissue arachidonic acid levels would also result in a corresponding decrease in LTC4 production. Three groups of rats were fed diets containing 5% corn oil (group 1), 4% ethyl ester concentrate of n-3 fatty acids plus 1% corn oil (group 2), or 5% ethyl ester concentrate of n-3 fatty acids (group 3). After 6 wk of feeding, gingiva and SMSG were analyzed for arachidonic acid content and in vitro production of LTC4.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1997

Morphometric analysis of collagen and elastic fibers in normal skin and gingiva in relation to age.

The morphometric parameters of the human gingival elastic fiber network were determined by image analysis and compared with human skin elastic fibers in relation to age. Similarly, collagen fibers were also investigated in both tissues. In this study, 47 healthy patients, 10-75 years old were studied for gingiva and another 50 patients in the same age range were included for skin biopsies. Three groups were compared: group 1 from the age of 10-24 years, group 2 from 25 to 49 years, and group 3 from 50 to 75 years. The diameters of the oxytalan fibers were invariable in both tissues, whatever the age considered. On the other hand, the diameters of elastic fibers increased regularly with age in the gingiva (P < 0.01) and in the skin (P < 0.01) between each age group. The area fraction occupied by the oxytalan fibers decreased significantly in both tissues (P < 0.01) for the skin and (P < 0.001) for the gingiva. The area fraction occupied by the gingival elastic fibers remained constant with age while the skin elastic fibers increased significantly with age between groups 2 and 1 (P < 0.01) and between groups 3 and 2 (P < 0.001). In the mid-dermis and in the mid-gingiva, the diameters of the collagen fibers increased strongly with age, between groups 2 and 1 (P < 0.01) and between groups 3 and 2 (P < 0.001). The area fraction occupied by the collagen bundles increased regularly with age in the mid-gingival (P < 0.05 between each age group), while a significant decrease was observed in the mid-dermis from the age of 50-75 years (P < 0.05). The results obtained contribute to a better understanding of some modifications which dermis and gingiva undergo with aging and provide data to perfect diagnosis and therapy in odontology and dermatology.

Adolescent↗
PubMed2003

Acellular dermal matrix allograft used to gain attached gingiva in a case of epidermolysis bullosa.

BACKGROUND: Epidermolysis bullosa (EB) is an acquired disease or inherited as either autosomal dominant or recessive with an incidence of 1/50,000. The prominent clinical characteristic of the disease is the development of bullae or vesicles in mucosa or skin in response to minor trauma. AIM: A female patient with a dystrophic type of EB had been put in a maintenance regimen after completion of the initial phase of periodontal therapy and followed for 7 years. The purpose of this report is to document acellular dermal matrix allograft application to increase the width of the attached gingiva in this patient experiencing difficulty in chewing and performing plaque control due to the dramatic loss of attached gingiva after 7 years of supportive periodontal therapy. METHODS: Under local anaesthesia and antibiotic coverage, the acellular dermal matrix allograft was applied in the anterior region of the upper jaw in order to increase the width of attached gingiva, thereby improving patient comfort. RESULTS: The healing was uneventful and a significant gain in attached gingiva dimensions was observed 9 months after the periodontal surgery. The procedure avoided a second surgical site, provided satisfactory results from an aesthetic point of view, and improved patient comfort. CONCLUSION: Acellular dermal matrix allograft may be regarded as an alternative in the treatment of EB cases to increase the width of attached gingiva and facilitate maintenance of the dentition.

Adolescent↗
PubMed2003

Analysis of the relationship between the severity of periodontal destruction and proteoglycan metabolism of gingiva and gingival crevicular flu.

BACKGROUND: Although it is well-described that proteoglycans (PGs) are among the major non-collagenous components of the matrix which are degraded during periodontal diseases, the relationship between PG metabolism and seventy of periodontal breakdown, the extent of degradation of PGs together with the resulting end-products, and the elimination pathways of these catabolic end-products is likely to need further clarification. OBJECTIVE: The main aim of the present study was to analyze the possible impact of severity of periodontal destruction on PG metabolism of gingiva and gingival crevicular fluid (GCF). MATERIAL AND METHODS: For this purpose, gingiva and GCF samples obtained from patients (n = 45) exhibiting sites (n = 57) with moderate periodontal breakdown (MP) or severe periodontal breakdown (SP) were analyzed for PG metabolism via spectrophotometric determination of uronic acid levels. Gingiva and GCF samples were obtained from the same sites in every patient to analyze the possible relationship between uronic acid content of gingival tissue and GCF. RESULTS: No significant differences were found in uronic acid levels between sites with MP and SP (p > 0.05). The uronic acid content of GCF and gingiva showed significant overlaps between MP and SP sites and uronic acid levels did not present any constant correlation with the clinical parameters (p > 0.05). In a similar manner, uronic acid content of GCF and gingival tissue was not correlated (p > 0.05). CONCLUSION: The lack of a significant correlation between the uronic acid content of gingival tissue and GCF may suggest that the passage of PG metabolites from gingiva to GCF is likely to be under the influence of multifactorial interactions rather than being linear. As a general measure of PG metabolism, uronic acid levels do not seem to be related with the severity of periodontal destruction and tend to act as different measures when compared to traditional clinical parameters.

Adult↗
PubMed2000

Expression of Tie-2, angiopoietin-1, angiopoietin-2, ephrinB2 and EphB4 in pyogenic granuloma of human gingiva implicates their roles in inflammatory angiogenesis.

Tie-2, angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), ephrin-B2 and Eph-B4 are all important vascular morphogenesis factors which exhibit their functions in angiogenesis and blood vessel remodeling in embryonic stage. However, their roles in post-natal inflammatory angiogenesis are still unclear. Pyogenic granuloma is a benign inflammatory lesion that mostly occurs on the gingiva of females with high levels of steroid hormones. Prominent capillary growth in hyperplastic granulation tissue is characteristic histopathologically in pyogenic granuloma. The purpose of this study was to detect and compare the expressions of Tie-2, Ang-1, Ang-2, ephrin-B2 and Eph-B4 among pyogenic granuloma on human gingiva, gingiva diagnosed with periodontitis and healthy gingiva by immunohistochemistry. The immunostaining revealed that all of the endothelial cells and some mesenchymal cells expressed Tie-2. The cells which expressed Ang-1 and Ang-2 were mainly macrophage- or monocyte-like mesenchymal cells and smooth muscle cells surrounding blood vessels. The expression of ephrin-B2 and Eph-B4 was not exclusively limited to the endothelial cells of arteries and veins, respectively, as in mice embryo. Eph-B4 was expressed in the endothelial cells of newly budding capillaries and venules while ephrin-B2 was expressed in macrophage-like mesenchymal cells. Some of the ephrin-B2 positive cells were in direct contact with endothelial cells. The statistical analysis demonstrated that all of the five factors were upregulated in pyogenic granuloma compared to healthy gingiva. In conclusion, the 5 polypeptides mentioned above may play important roles in the process of adult inflammatory neovascularization, especially in pyogenic granuloma. It is highly plausible that most of the new capillaries in inflammatory angiogenesis originated from venules instead of arterioles.

Adult↗
PubMed1999

Increasing the width of periodontal attached gingiva using an Nd:YAG laser and GTM: results of a clinical study.

OBJECTIVE: Demonstrate a new technique to increase the width of keratinized gingiva using a biological membrane material in place of donor tissue. SUMMARY BACKGROUND DATA: Most current surgical techniques require donor tissue as a graft to increase keratinized gingiva, which results in a second trauma site for the patient. METHODS: Using an Nd:YAG laser with contact tip. Laser energy at settings of 3.0-6.0 W continuous mode. Local anesthetic, lidocaine 2% and epinephrine 1:100,000, was administered. A mucogingival flap was made to the periosteum and reflected, followed by placement of a biological membrane, and sutured into place, over the surgical site. RESULTS: A total of 20 sites were treated on 20 different patients of 15 mandible and 5 maxillary sites. The average increase for all sites was 3.8 mm of keratinized gingiva per site. No adverse events (e.g., bleeding, allergic reactions, abscesses, or pain) after any of the treatments were noted during the entire observation. The treatment procedure led to significant improvements in width of gingiva. The 20 patients were pleased with this new technique using the Nd:YAG laser with contact tip. CONCLUSION: It may be concluded that the new procedure provides significant increase of keratinized gingiva with the advantage of minimal morbidity and pleasing cosmetic results. Further clinical studies are needed to compare traditional procedures with the laser augmentation technique.

Biocompatible Materials↗
PubMed1977

Gingival condition in areas of minimal and appreciable width of keratinized gingiva.

Sixteen dental, dental hygiene, and dental assisting students and dental faculty members who had contralateral or unilateral areas of minimal (less than or equal to 1.0 mm) and appreciable (greater than or equal to 2.0 mm) widths of keratinized gingiva on mid-buccal plaque-free surfaces of mandibular bicuspids were examined. Gingival exudate amounts and clinical inflammation based on color change and/or swelling and bleeding on probing were evaluated. The results showed that gingiva with "appreciable" width as well as gingiva with "minimal" width of keratinized tissue exhibited only minute amounts of gingival exudate. Also, there were generally no clinical signs of inflammation for both types of tissue. From the groups of 16, six subjects were selected who had contralateral pairs of minimal and appreciable keratinized gingiva. They were instructed to cease oral hygiene in the lower bicuspid area for 25 days. At day 0, 4, 7, 11, 14, 18, 21, and 25, plaque, gingival exudate, and clinical gingival inflammation were evaluated. Results revealed increases in plaque, gingival exudate scores and clinical gingival inflammation over the 25-day period with no apparent difference between the areas with minimal and appreciable width of keratinized gingiva.

Dental Plaque↗
PubMed1979

Vascular morphology in noninflamed healed gingiva of dogs.

The objective of this study was to determine if the regular vascular network previously reported as occurring in noninflamed marginal gingiva would become re-established following plaque control and treatment of gingiva by gingivectomy and scaling. Gingivectomies were performed on dogs with and without pre-experimental gingivitis in order to obtain gingival specimens healed for 4, 8 and 12 weeks. Plaque was controlled using toothbrushing and topical applications of 0.2% chlorhexidine gluconate. After 12 weeks, the animals were perfused via the carotid arteries with glutaraldehyde and Microfil latex compound. Specimens were processed for either routine histology or examination of vascular morphology in methyl salicylate cleared tissues. The absence of inflammation in healed gingiva was evaluated clinically, using the Gingival and Plaque Indices, and histologically. Results showed that in healed clinically and histologically noninflamed gingiva, the vascular morphology was established as a series of looped vessels which could readily be distinguished from the regular network of vessels described by Hock (1975) in marginal gingiva that had neither been inflamed nor resected.

Animals↗
PubMed1980

Influence of free gingival grafts on the health of the marginal gingiva.

In order to evaluate the effect of increasing the width of inadequate attached gingiva on the health of the marginal gingiva, 12 free gingival grafts were performed on 12 patients with less than 1.0 mm of attached gingiva on homologous contralateral pairs of mandibular teeth. A baseline examination, which included measurements of plaque, gingival exudate, sulcus bleeding, sulcus probing depth and width of attached gingiva, was done before surgery. One week after surgery, plaque was eliminated mechanically on the test and control sides. All measurements were repeated 7 and 14 weeks after surgery. During the week following the first postsurgical examination, individual oral hygiene instruction was given until the patient could show plaque-free test and control sites. The width of the attached gingiva increased significantly on the side where the grafting was performed (test side). The only other significant changes observed during the experiment were a decrease of the mid-buccal plaque index on the test side during the first 7 weeks following surgery and a decrease of the buccoproximal plaque index on the test and control sides during the total experimental period (14 weeks). None of the other clinical parameters measured showed significant differences when test and control sites were compared or when the same sites were compared longitudinally.

Adult↗
PubMed1987

Lack of association between width of attached gingiva and development of soft tissue recession. A 5-year longitudinal study.

The purpose of this study was to longitudinally monitor changes in the position of the soft tissue margin at 26 buccal sites surgically deprived of all gingival tissue. A baseline examination carried out 6 months after treatment revealed that the sites to be monitored were lacking or had only a minimal zone (less than 1 mm) of regenerated attached gingiva. 12 control sites with an "adequate" width of attached gingiva (greater than 1 mm) were also examined. Assessments of oral hygiene and gingival conditions, probing pocket depths, probing attachment levels, position of the soft tissue margin, and gingival width were carried out at baseline and after 5 years. The results revealed that in the test sites, a slight increase of the width of the gingiva occurred during the observation period. 7 out of the 26 areas showed a coronal regrowth of the soft tissue margin, while 2 sites showed a further apical displacement of the soft tissue margin. In the control areas, 3 sites developed recession accompanied by a reduction in the width of the gingiva. Hence, it appears that in patients maintaining a proper plaque control, the lack of an "adequate" zone of attached gingiva does not result in an increased incidence of soft tissue recessions.

Dental Plaque Index↗
PubMed1993

Dimensional alterations of the gingiva related to changes of facial/lingual tooth position in permanent anterior teeth of children. A 2-year longitudinal study.

Maxillary and mandibular anterior permanent teeth in 38 children aged 7-12 years were examined 2 x with an interval of 2 years to determine whether spontaneous facial/lingual tooth position changes were related to alterations of the widths of keratinized and attached gingiva and the clinical crown height. Measurements included dental plaque, gingival inflammation, probing depth, and width of keratinized and attached gingiva. In addition, study casts from the baseline and 2-year examinations were used to measure clinical crown height and tooth position. The results showed that significant alterations in the widths of the keratinized and attached gingiva took place when the teeth changed positions in facial or lingual directions. The changes in gingival widths could to some extent be coupled to changes in clinical crown height. In teeth moving lingually, the gingival widths increased and the clinical crown height decreased. In teeth moving facially, the gingival widths decreased, and the facial gingiva sometimes receded. These gingival alterations call for examination of the facial gingiva as part of the monitoring of the development of the permanent dentition.

Child↗
PubMed1993

On the relationship between crown form and clinical features of the gingiva in adolescents.

The purpose of the present study was to examine the relationship between the form of the crowns in the maxillary front tooth segment and (1) a group of morphological characteristics and (2) the thickness of the gingiva. 108 subjects devoid of symptoms of destructive periodontal disease were examined regarding, e.g., probing depth, thickness of the free gingiva, width of the keratinized gingiva and the contour of the marginal gingiva. From clinical photographs of the maxillary front tooth region, the width (at the apical third--CW) and the length (CL) of the crowns of the 6 front teeth were determined. A CW/CL-ratio was calculated for each tooth and averaged for each tooth region. The individual mean CW/CL-ratio values for the central incisors were ranked. After correction for incisal attrition, the 10 subjects ranked highest and the 10 ranked lowest were selected as having either a long-narrow (group N) or a short-wide (group W) form of the crown of the tooth. The data for each of the examined parameters were averaged for each tooth region in each subject and mean values for subjects in groups W and N were compared using the Student t-test. Stepwise multiple regression analysis, including data from the whole sample, was performed for each tooth region with the thickness of the free gingiva as the dependent variable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Roxithromycin penetration into gingiva and alveolar bone of odontoiatric patients.

The concentrations of the new macrolide antibiotic roxithromycin in plasma, saliva, gingiva, and alveolar bone were studied in 24 odontoiatric patients treated with a first dose of 300 mg p.o. followed by three maintenance doses of 150 mg p.o., 12-hourly. Samples of blood, saliva, gingiva, and bone were collected at various time points up to 24 h after the last dosing, and the roxithromycin concentration was measured microbiologically, using Bacillus subtilis ATCC 6633 as the reference organism. Pharmacokinetic analysis was performed according to a two-compartment open model with first-order absorption. The plasma, gingiva, and alveolar bone peak concentrations were 6.12 +/- 1.94 mg/l, 6.55 +/- 2.54 mg/kg, and 5.09 +/- 1.60 mg/kg, respectively. Low levels of roxithromycin were detected in saliva (0.67 +/- 0.12 mg/l at the 3rd h). The values of the area under the concentration-time curve for plasma, gingiva, and bone were 59.47 mg/l.h, 51.88 mg/kg.h and 46.80 mg/kg.h, respectively; the half-life values were 7.52 h for plasma and 6.36 and 5.20 h for gingiva and bone, respectively. These results indicate that roxithromycin reaches high levels in periodontal tissues.

Adult↗
PubMed1991

Quantitative immunohistochemical analysis of keratins and desmoplakins in human gingiva and peri-implant mucosa.

Quantitative immunohistochemistry was used to compare the distributions of keratins and desmoplakins in human gingiva and peri-implant mucosa (three specimens each). In gingiva, keratin 1 (a marker of cornification) and desmoplakins I & II (markers of desmosomes) stained most heavily in granular strata followed by corneal strata; keratin 13, a marker of non-cornifying stratified squamous cells, stained most heavily in suprabasal strata of oral sulcular epithelium. Keratin 19, a marker for junctional epithelium, stained the basal stratum of oral sulcular epithelium most heavily. In peri-implant mucosa, the patterns of staining were similar, except that staining for desmoplakins I & II was generally significantly reduced compared with gingiva, and junctional epithelium co-expressed keratins 13 and 19. Peri-implant junctional epithelial cells attached to titanium implant abutments were removed by trypsin/EDTA digestion, and also exhibited co-expression of keratins 13 and 19. Inflammatory cell infiltration was associated with reduction of keratin 1 staining in gingiva. The data indicate that the epithelia of gingiva and peri-implant mucosa are not composed of identical cell populations.

Analysis of Variance↗
PubMed2003

Differences between tooth stimulation and capsaicin-induced neurogenic vasodilatation in human gingiva.

Animal experiments have shown that the application of capsaicin to oral mucosa leads to a neurogenic inflammation associated with blood flow elevations in gingivomucosal tissues. In this investigation, we measured the tooth stimulation and capsaicin-evoked blood flow responses in maxillary gingiva in humans to study whether axon-reflex-mediated vasodilatation crosses the midline of the maxilla. The vasoactive reactions were mapped by laser Doppler imaging. Unilateral stimulation of alveolar mucosa and attached gingiva by capsaicin evoked a distinct neurogenic vasodilatation in ipsilateral gingiva, which rapidly attenuated at the midline. Capsaicin stimulation of alveolar mucosa provoked clear inflammatory reactions. In contrast to capsaicin stimuli, tooth stimulation produced symmetrical vasodilatations bilaterally in the gingiva. The ipsilateral responses were significantly smaller during tooth stimulation than during capsaicin stimuli. Analysis of these data suggests that capsaicin-induced inflammatory reactions in gingivomucosal tissues do not cross the midline in the anterior maxilla. The enhanced reaction found during stimulation of alveolar mucosa indicates that alveolar mucosa is more sensitive to chemical irritants than attached gingiva.

Adult↗
PubMed2005

Neuromagnetic evidence that gingiva area is adjacent to tongue area in human primary somatosensory cortex.

The somatotopic organization of the human primary somatosensory (SI) area in the cerebral cortex has been intensively studied for the hand, lip, and tongue, but little is known about the gingiva. Penfield concluded that the gingival SI area was above the tongue area, as shown in his famous homunculus map. However, our recent study suggested that the lingual gingiva area was not so different to the tongue area. To delineate the fine SI somatotopy of the gingiva area, evoked magnetic fields were measured in 6 healthy subjects for the stimulus of the anterior or posterior and upper or lower parts of the lip, buccal and lingual gingiva, and tongue. Source position was estimated by a current dipole model at the first peak of the posterior-oriented current in a total of 12 cerebral hemispheres contralateral to the stimulation side. No significant difference was found between the positions of anterior and posterior or upper and lower parts of each structure. Both buccal and lingual gingiva areas were localized adjacent to the tongue area, but significantly lower than the lip area. We believe that the fine SI somatotopy of the human oral structures should be reconsidered.

Adult↗