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Guided tissue regeneration was employed to effect regeneration of a disfigured edentulous ridge, with a poorly positioned implant in place. Demineralized freeze dried bone and an expanded polytetrafluoroethylene membrane were utilized and resulted in growth of new, bone-like material in both a bucco-lingual and apico-occlusal dimension, totally submerging the unusable implant.
BACKGROUND: Clinical studies and recent histological evidence following mucogingival surgery for the treatment of gingival recession have documented that when closely adapted to a previously exposed root surface, connective tissue is capable of forming a new attachment. Despite these findings, no clinical tests have been conducted to examine the ability of connective tissue to reduce probing depth (PD) and increase clinical attachment levels (CAL) when it is implanted into periodontal osseous defects. The purpose of this paper is to report the clinical results on a patient following 2 subperiosteal connective tissue grafts. METHODS: Subperiosteal connective tissue grafts were placed in 2 sites of periodontal bone loss and deep pocketing in one patient. Following flap reflection and root preparation, a connective tissue graft 1.5 to 2.0 mm in thickness was draped and sutured over each osseous defect and then completely covered by the external flap. RESULTS: Ten months following subperiosteal connective tissue grafting, tooth #7 had 4 mm of CAL gain. Tooth #10 had 3 mm of CAL gain 8 months postoperatively. Both teeth had 1 mm gain in gingival recession. Both teeth probed 3 mm postoperatively. CONCLUSIONS: When connective tissue was grafted into 2 periodontal osseous defects, there were significant reductions in probing depth and gains in CAL. There was minimal postoperative gingival recession. The new clinical attachment gain remained stable for 8 to 10 months following subperiosteal connective tissue grafting.
BACKGROUND: Peripheral giant cell granuloma (PGCG) is a relatively rare hyperplastic lesion of the oral cavity. The lesion occurs in females more frequently than males and more often in the mandible than the maxilla. Although the precise etiology of PGCG is unknown, it might represent a local reaction to trauma or irritation. METHODS: In general, treatment requires a wide excision of the lesion due to its possible recurrence. RESULTS: This report describes the clinical and histopathological findings of PGCG diagnosed in the maxilla of a young male, as well as the successful treatment of a gingival defect that occurred following excision of the lesion, by placement of a subepithelial connective tissue graft concurrently with the biopsy procedure. CONCLUSIONS: This report emphasizes the importance of having histopathological data to confirm the clinical diagnosis, and the importance of an adequate excision to prevent recurrence even in less extensive cases.
BACKGROUND: Multiple recession defects can be successfully treated using envelope-type coronally advanced flaps. The aim of the present study was to evaluate the long-term (5 years) stability of clinical outcomes achieved with the surgery and the association between patient variables and long-term stability. METHODS: Seventy-three Miller Class I and II gingival recessions affecting 22 young, systemically healthy subjects were treated with coronally advanced flaps with no releasing incisions. All patients were instructed to perform a coronally directed roll technique to minimize the toothbrushing trauma to the gingival margin. The clinical reevaluation was made 1 year after the surgery. At this point, 13 patients took part in a supportive periodontal care program consisting of oral hygiene instructions, control of toothbrushing technique, and professional tooth cleaning every 4 months. The remaining nine patients did not participate and received only sporadic care by general dentists. At 5 years post-surgery, all patients were reexamined. RESULTS: At the 5-year examination, 94% of the root surfaces initially exposed due to gingival recession were still covered with soft tissue, and 85% of the treated recession defects showed complete coverage. Complete root coverage in all recessions was maintained in 15 out of 22 patients (68%). The long-term stability of the soft-tissue margin in the treated sites was significantly influenced by the patient's regular participation in the recall program and the susceptibility to gingival recession in other areas of the mouth. A statistically significant increase of keratinized tissue (0.80 +/- 0.64 mm) was observed between the 1- and 5-year observation visits, and the average increase of keratinized tissue between the baseline and the 5-year follow-up amounted to 1.38 +/- 0.90 mm. This increase was significantly affected by the baseline keratinized tissue (KT) and recession (REC) depth: in particular, the 5-year increase in the amount of keratinized tissue was greater in sites with a greater recession depth and lower amount of keratinized tissue at baseline. CONCLUSIONS: 1) The successful root coverage results obtained with the coronally advanced flap for multiple recession defects were well maintained over the 4-year observation period. 2) Negative patient characteristics such as a lack of compliance with a supportive care program and individual susceptibility to gingival recession were significantly associated with the recurrence in gingival recession. 3) The increase in keratinized tissue height that followed the coronally advanced flap procedure may be attributed to the tendency of the mucogingival line to regain its genetically determined position.
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UNLABELLED: The purpose of this study was to investigate the relationship between a harmonious profile and normal occlusion, differences between good and poor groups, and the characteristics of a good group from normal occlusion group and after orthodontic treatment groups. The sample included 60 subjects with normal occlusion (normal subjects) and 88 after orthodontic treatment subjects (orthodontic subjects). Evaluators were 20 students and 20 orthodontists from Tokyo Dental College. For the purpose of profile evaluation, normal and orthodontic subjects were classified into 3 groups (good, mediocre, and poor) based in their external profile lines. Lateral Roentgen-cephalograms were used to measure hard and soft tissues. Mean values and Student's t-test were calculated statistically. RESULTS: 1. The frequencies of the good and poor subjects were similar in both normal subjects and orthodontic subjects. When considering the mediocre group, however, the normal subjects were more likely to have a better profile than the other subjects. 2. There were differences in hard tissues between the good group and the poor group in both the normal subjects and the orthodontic subjects, but only slight differences in soft tissues. 3. In the good groups of both normal and orthodontic subjects (all subjects), the edges of the upper and lower central incisors and upper and lower lips retruded, the ratio of upper facial height to total facial height was greater and the chin region was thicker than in the poor group. Additionally, in the good group of normal subjects, the maxilla protruded and the anteroposterior difference between the maxilla and mandible was larger.
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Hypohidrotic ectodermal dysplasia is a rare congenital disease that affects several ectodermal structures. The condition is usually transmitted as an x-linked recessive trait, in which gene is carried by the females and manifested in males. Manifestations of the disease differ in severity and involve teeth, skin, hair, nails and sweat and sebaceous gland. Ectodermal dysplasia is usually a difficult condition to manage. Prosthodontically, because of the typical oral deficiencies, and afflicted individuals are quite young to receive extensive prosthodontic treatment, which restores their appearance and helps them, for the development of positive self-image. This case report describes the management of upper jaw with over denture with copings on existing teeth i.e. two permanent peg shaped centrals as well as lateral incisors. However with adequate of retainer lower denture was provided with a new treatment modality.
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Within the last 20 years there was an important change in the operative treatment of breast cancer. New considerations on the tumor biology resulted to the conviction, that the operative radicality does not affect the overall survival rate. This was in addition the birth hour of the breast conserving surgery and of the efforts of reconstructive procedures of the female breast. Muscle flap procedures got more and more importance in clinical practice. This paper gives an overview on our concept of breast conserving therapy and primary reconstruction in case of carcinoma of the breast, which is based on oncoplastic aspects. With consideration this model we are enabled to improve the cosmetic results even in cases with larger tumors.
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A new soft tissue flap design technique, called "the palatal sliding strip flap" (PSSF), has been developed to improve the soft tissue surgical results at stage 2 implant surgery. The purpose of this flap design is to help form papillae between implants and between natural teeth in the anterior area of the maxilla. The flap is designed and managed so that the palatal attached mucosa slides in a labial direction to create papillae and at the same time augment the labial ridge. This surgical approach is valid, predictable, and has a low risk-to-benefit ratio. This new flap design is indicated for a variety of clinical situations, especially for the problematic maxillary soft tissue reconstruction around teeth and implants.
Conservative therapy has been the therapy of choice for patients with breast cancer in early stage. The results of 397 patients treated with conservative therapy and radiotherapy over the breast and lymph node areas (when necessary) are analyzed. The results obtained in the different risk groups and according to the irradiation mode of the tumoral bed are compared. The likelihood of remaining local disease free at 7 years was 94.9 (95% CI: 90.7-99.1). No significant differences were observed regarding the mode of overprinting the tumoral bed: external radiotherapy or brachytherapy, regarding control and aesthetic result; also, no differences were observed between the different risk groups. The existence of a subgroup of patients with contraindication for conservative therapy is currently not demonstrated.
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