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PubMed2006

Comparison of acellular dermal graft and palatal autograft in the reconstruction of keratinized gingiva around dental implants: a case report.

The use of autogenous gingival grafts has proved to be an effective and predictable way to increase the amount of keratinized gingiva. However, discomfort and pain at the donor site are unavoidable. Acellular dermal matrix (ADM) allograft can be used as a donor tissue to eliminate the need for another surgical site and alleviate pain and trauma. The purpose of this study was to evaluate the effectiveness of ADM allograft in increasing the width of keratinized gingiva around dental implants. A patient with inadequate keratinized gingiva around dental implants in maxillary and mandibular anterior regions received either an ADM graft or palatal autograft by random allocation. The width of keratinized gingiva and other clinical periodontal parameters were recorded initially and at 3 and 6 months after surgery. Both grafts provided satisfactory results. The width of keratinized tissues was increased by using the ADM allograft, but by a lesser amount than seen with the autogenous gingival graft.

Adult↗

PubMedDate not supplied

Cholinergic components in human gingiva in healthy and inflamed states.

Acetylcholine (ACh) and acetylcholinesterase (AChE) are main components in cholinergic nervous system. ACh is a natural constituent of many parts of the nervous system and its chief role is neurotransmission. It is not entirely unique in function to the cholinergic tissues of the human body. Gingiva is the part of the oral mucosa which contains numerous mast cells. They contain a variety of biologically active substances including neurotransmitters such as 5-hydroxytryptamine, histamine etc. In the dental literature accessible to authors no data were found on ACh and AChE in the different oral structures in health and inflamed conditions. Therefore gingiva samples from 50 human individuals representing varying grades of inflammatory involvement have been utilised in the present study. ACh and AChE were estimated in the gingiva tissues by flurometric and spectrophotometric methods. This study established hithero unknown "norms" for the ACh and AChE contents of the clinically normal gingiva, which are found to be 0.85 +/- 0.06(SE) ug/g and 210 +/- 18(SE) micromoles ACh hydrolysed/hr/gm/wet tissues. Results also revealed that the range of variations of ACh is high and AChE is low in all the inflamed states of gingival tissues.

Acetylcholine↗

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↗

PubMedDate not supplied

The distribution of Langerhans cells and CD1a antigen in healthy and diseased human gingiva.

The distribution of CD1a antigen in gingival epithelium of clinically healthy gingiva was examined and compared with the distribution in gingival epithelium of adult periodontitis lesions. Cryostat sections were examined with monoclonal antibodies to CD1a antigen using the ABC immunoperoxidase technique. In healthy gingiva, CD1a was limited to Langerhans cells (LC) which were observed throughout the length of the external epithelium and orosulcular epithelium. The numbers of LC expressed either per unit length of orosulcular epithelium or per mm2 were similar to the numbers in external gingiva. Junctional epithelium contained few if any dendritic LC. The numbers of LC in pocket epithelium of adult periodontitis lesions were significantly lower compared with orosulcular epithelium of healthy tissue and compared with external gingiva of diseased tissue (p less than 0.005). In many sections, no LC were identified in pocket epithelium. In 5 of 8 adult periodontitis sites, CD1a was also observed in association with the membranes of suprabasal keratinocytes in external and pocket epithelium in areas where no LC were identified. These findings provide further evidence that changes in gingival epithelial cells occur in periodontal disease which are analogous to those documented in dermatological diseases and suggest that epithelium may play a role in gingival homeostasis and in the pathogenesis of periodontal diseases.

Antibodies, Monoclonal↗

PubMed1989

Ultrastructural changes of collagen and elastin in human gingiva during orthodontic tooth movement.

After 15 days of mesializing or distalizing orthodontic treatment, 10 permanent premolars of young patients were extracted with the interdental gingiva. The connective tissues of the compressed or stretched interdental papillae were compared to that of untreated samples by light and transmission electron microscope. Large collagen fibres bundles represented by fibrils with a banding pattern of 64 nm and a mean diameter of 75 nm were observed in compressed interdental gingiva. Several elastic fibres with a mean diameter of 950 nm were also present. In some central areas of compressed gingiva collagen fibrils longitudinally split into widely spaced microfibrils were often observed in proximity to the elastic fibres. In stretched and untreated interdental papillae the collagen fibrils presented a mean diameter of 66 nm and 57 nm respectively. In both groups, few elastic fibres ranging in diameter 600 nm were seen. The increased size of the gingival collagen fibrils undergoing pressure and tension is indicative of remodelling of the fibrous collagen system. The fair increase in number and size of elastic fibres in compressed gingiva suggests that the elastic fibre system takes over the place whenever a collapse of the collagenous framework occurs.

Child↗

PubMed1985

A comparison of energy metabolism and the effects of beta-adrenergic stimulation in the tongue and attached gingiva of the dog.

Glucose-6-phosphate (G6P), ATP, phosphorylcreatine (CP) and lactate were assayed in the tongue attached gingiva of dogs. The G6P content was found to be significantly higher, and both the ATP and CP contents even more significantly higher in the tongue than in the attached gingiva. Lactate content was not significantly different in the gingiva and in the tongue. The changes in the concentrations of G6P, ATP, CP and lactate due to the intravenous infusion of isoproterenol hydrochloride (1 micrograms/kg/min) were as follows. In the tongue, G6P exhibited a significant increase, but the decrease in ATP and CP contents as well as the increase in lactate content were not significant. It is possible that these effects were the result of the activation of beta-adrenergic receptors by isoproterenol. In the attached gingiva, there was no significant change in the G6P, ATP, or CP content. Lactate increased to a greater degree than the other three components, but similarly did not reach the significant level.

Adenosine Triphosphate↗

PubMed1993

T-cell receptor gamma delta-expressing intraepithelial lymphocytes are present in normal and chronically inflamed human gingiva.

The phenotypic profile of leucocytes in diseased and normal gingival tissue was studied in situ and in isolated gingival mononuclear cell (GMC) preparations. T-cell receptor (TcR)gamma delta + cells showed preferential localization to epithelium, both in normal and inflamed gingiva, and were present in crevicular as well as oral epithelium. In normal gingiva > or = 30% of the isolated leucocytes expressed TcR gamma delta, of which the majority were CD4- CD8-, and expressed CD45RA. The proportion of TcR gamma delta + cells in GMC from periodontitis tissue varied between 2 and 32%. In contrast to normal gingiva the majority of TcR gamma delta + cells in diseased tissue were CD8+ and expressed CD45RO. Thus expression of the CD8 antigen on gingival TcR gamma delta + cells is probably a consequence of immune activation. Numerous Langerhans' cells and keratinocytes expressing the major histocompatibility complex (MHC) class I-like antigen, CD1, were present within normal and inflamed gingival epithelium in close proximity to the TcR gamma delta + cells. Most CD1a+ cells were scattered within oral epithelium. CD1c+ cells were localized close to the basal layer of crevicular epithelium. No CD1b+ cells were found. TcR alpha beta + cells, CD4+ and B cells were restricted to lamina propria of periodontitis lesions. The presence of intraepithelial TcR gamma delta + cells in normal gingiva suggests that they constitute the 'first line of defence' against the potentially harmful microflora in the oral cavity. Induction of CD8 and CD45RO antigens on TcR gamma delta + cells in periodontitis tissue indicate that they play a significant role in the disease. CD1 molecules on Langerhans' cells and keratinocytes may be the restriction elements for the CD8+ TcR gamma delta + cells.

Adolescent↗

PubMed1985

Aphthous stomatitis with involvement of attached gingiva.

Involvement of the attached gingiva by aphthous stomatitis is considered uncommon. This report presents two cases in which patients with aphthous stomatitis developed ulcers on multiple mucosal surfaces, including the attached gingiva. The gingival ulcers began on the marginal gingiva and enlarged to form V- or U-shaped ulcers on the attached gingiva. Other disorders producing gingival ulceration were excluded on the basis of history, clinical features, bacterial culture, viral culture, and biopsy with routine microscopic study as well as direct immunofluorescence.

Adult↗

PubMed1998

Cryosurgical treatment of melanin-pigmented gingiva.

OBJECTIVE: Abnormal deposition of melanin in gingiva can often occur. Complaints of "black gums" are common, and demand for depigmentation is usually made for esthetic reasons. A simple and effective cryosurgical technique to eliminate the pigmentation is the subject of this article. STUDY DESIGN: Twenty patients with dark gingiva were treated by direct application of liquid nitrogen with a cotton swab for 20 to 30 seconds. RESULTS: The treated gingiva appeared normal within 1 to 2 weeks after 1 or 2 cryosurgical treatments. The acceptance of the treatment was excellent. CONCLUSIONS: This was a simple, bloodless cryosurgery for the depigmentation of gingiva, requiring no local anesthesia or sophisticated equipment.

Adolescent↗

PubMed2003

Spontaneous regression of extranodal malignant lymphoma occurred in the gingiva.

The spontaneous regression of malignant neoplasm is an extremely rare event. Here we report a case of extranodal malignant lymphoma occurring in the upper gingiva, which regressed spontaneously. A 78-year-old female had noticed a diffuse bucco-lingual swelling of the left maxillary gingiva in the incisor regions for a month, and she visited our department on 20 January 1999. Intraoral examination revealed diffuse swelling and redness in the maxillary gingiva of the incisor regions. Cervical and underarm lymphadenopathy was not detected. Surgical biopsy of the swollen gingiva revealed a malignant lymphoma, with diffuse large cells, B cell type. She was clinically staged as IE. After biopsy, the tumor spontaneously decreased in size; finally, the mass completely disappeared after 3 weeks. After regression, the lesions were externally irradiated with 30 Gy total dose. The patient has been free from disease for 36 months after regression.

Aged↗

PubMed1976

Use of palatal mucosa and lyophilized dura mater to create attached gingiva.

Gingival extension procedures using free palatal mucosal autografts or homologous lyophilized dura were compared clinically. Palatal mucosa was transplanted in 68 cases and lyophilized dura in 16 cases. The width of the zone of attached gingiva was measured before surgery and at regular intervals up to 2 years postoperatively. The width of the attached gingiva remained relatively constant in the mucosal transplant group from 1 month postoperatively, with an average relapse of about 20%. In the dura group the width of attached gingiva showed a marked decrease until 3 months after surgery with an average relapse of approximately 63%. If a preset minimal width of the attached gingiva is considered to be the criterion of success, the superiority of the palatal mucosa grafting procedure is demonstrated.

Dura Mater↗

PubMedDate not supplied

Comparison of aminolevulinic-acid-induced fluorescence from normal and inflamed gingiva in the canine model.

Fluorescence spectroscopic detection using 5-amino levulinic acid (ALA) may provide an effective, noninvasive approach for early detection of oral cancer. In the present study, the use of ALA-induced fluorescence ratio (red/orange) to differentiate between normal and gingivitis-affected gingiva is investigated. Five dogs with varying degrees of gingivitis are studied. Based on previous studies, a dose of 25 mg/kg of ALA is administered intravenously to the dogs. Autofluorescence and ALA-induced fluorescence from three sites: normal gingiva, pigmented gingiva, and gingivitis, are detected with a fiber optic probe coupled to an optical multichannel analyzer. Four dogs show higher and earlier ALA-induced fluorescence from the gingivitis site as compared to the unpigmented gingiva. In two dogs, ALA-induced fluorescence peaks are seen 15 min after ALA administration. Statistical analysis using mean separation procedures reveal differences in the fluorescence from the various sites in each dog. Using a fluorescence (ratio) cutoff of 1.5, the sensitivity and specificity are found to be 92 and 80%, respectively, 1 h after administration of ALA. The indications from this study-that the characteristic protoporphyrin IX (PpIX) fluorescence is seen earlier and in higher magnitude in more vascular areas of the oral cavity-has implications for oral cancer diagnosis.

Algorithms↗

PubMed1982

The peripheral ameloblastoma of the gingiva. Case report and literature review.

A new case of the rare peripheral ameloblastoma of the gingiva is presented. Also the clinical and histomorphologic characteristics of the lesion were analyzed and studied in all previously documented cases. This tumor, and the basal cell carcinoma of the gingiva, probably represent the same lesion. It meets the same microscopic criteria as the intraosseous ameloblastoma, but its behavioral and clinical characteristics are completely different. The peripheral ameloblastoma usually occurs in the gingiva, is noninvasive, and local excision is usually curative. Recurrence of the neoplasm is uncommon, except when it is incompletely excised. The histogenesis and varied cellular pattern of the peripheral ameloblastoma and several other related odontogenic lesions of the gingiva illustrate the proliferative and differentiation potential of the basal cell layer of gingival epithelium.

Ameloblastoma↗

PubMed2002

Large cell carcinoma of the lung metastatic to the mandibular gingiva.

BACKGROUND: Although metastases of malignant tumors to the jaws are not unusual, metastases to the gingival soft tissues are relatively rare. METHODS: The clinicopathologic features of a metastatic tumor in the mandibular gingiva originating from lung cancer are described. The patient, a 61-year-old man, was admitted to the hospital with complaints of bloody sputum and chest pain while coughing. The patient's chest radiograph showed an abnormal mass in the left upper lobe. After admission, the patient noticed a swelling of the right mandibular gingiva. Histological and immunohistochemical analysis for tumors of the gingiva and the lung were performed. RESULTS: Radiographic examination did not indicate involvement of the underlying bone. The histopathological findings showed that the gingival tumor consisted of a large cell carcinoma, and the mass of the upper lobe displayed the same histology as that found in the gingiva. Immunohistochemical investigation of the gingival tumor revealed similar results to those found in the mass of the lung. Based on the clinicopathologic findings, this case was diagnosed as primary lung cancer with the gingival tumor deemed metastatic. Multiple metastases were found in areas other than the oral cavity; radiation and chemotherapy for the gingival tumor were performed due to persistent bleeding and pain. CONCLUSIONS: The resemblance of this gingival mass to an inflammatory lesion demonstrates the need for a detailed examination. This case also emphasizes the need to evaluate positive treatment needed to relieve complications in the mouth, even if the prognosis of the primary tumors remains unfavorable.

Carcinoma, Large Cell↗

PubMed2005

Papillary squamous cell carcinoma presenting on the gingiva.

BACKGROUND: Papillary squamous cell carcinoma (PSCC) is a rare variant of squamous cell carcinoma. PSCC can occur as either an in situ or invasive tumor. The sites of occurrence in order of the most to least prevalent are the larynx, oropharynx, and nasopharynx. We present an unusual case of PSCC occurring on the gingiva. METHODS: A 72-year-old white female presented with a chief complaint of tooth mobility in the right posterior mandible. Clinical examination revealed a Miller's Class 2 mobility of tooth #28 along with an erythematous, papillary appearance of the lingual gingiva on teeth #27, #28, and #29. Her dental history revealed treatment of tooth #28 with locally delivered antibiotics. Her medical history revealed a diagnosis of breast cancer 8 years prior to examination that was treated with partial mastectomy and radiation therapy. An initial differential clinical diagnosis of verrucous carcinoma or metastatic carcinoma was made. RESULTS: Surgical therapy included extraction of tooth #28 and an excisional biopsy of the lesion on the lingual gingiva. Microscopic evaluation of the gingival specimen revealed a neoplastic papillary proliferation of the surface epithelium with a thick layer of parakeratin, deep parakeratin-lined crypts, and a thickened spinous cell layer along with islands and strands of malignant epithelium. The microscopic appearance of the lesion was characteristic for PSSC. The patient's tumor was removed via a block resection that included teeth #27 through #31 and a radical neck dissection. CONCLUSIONS: This is a case report of PSCC occurring on the gingiva. This report demonstrates that, even though oral cancers involving the periodontium are a relatively rare occurrence, periodontists cannot be complacent about the diagnosis of periodontal bone loss. It also highlights the importance of utilizing a histopathologic examination to confirm the clinical diagnosis for any suspicious lesion.

Aged↗

PubMed2004

[An analysis of angles related to gingival cone and marginal gingiva in natural dentition].

PURPOSE: There are no reports on numerical investigation of suitable shapes of restoration. This study examines the relationship between gingival cone and marginal gingiva in natural dentition, and discusses the standard angles for giving a suitable shape at the gingival cone of restoration. METHODS: Twenty dental casts of healthy subjects with normal dentition were examined. The angles between gingival cone and marginal gingiva (CG angle), and the angles between gingival cone and the long axis of the tooth crown (CA angle) were measured. RESULTS: The mean CG angles of each site were measured between 96.7 degrees (palatal surface of the upper first molar) and 123.9 degrees (labial surface of the lower central incisor). Within the same kind of teeth, lower significant differences were observed among upper and lower, or buccal and lingual surfaces. The CG angles of anterior teeth were 9.5 to 19.2 degrees larger than those of posterior teeth. The CA angles of anterior teeth were negative, and the apex of gingival cone of anterior teeth was directed toward the incisal edge. Conversely, the CA angles of posterior teeth were positive, and the apex was directed toward the root apex. Significant negative correlation was found between CA angle and CG angle (p<0.001). CONCLUSIONS: These results suggested that the relationship between gingival cone and marginal gingiva is fairly constant throughout their angles, and that the cervical shape could affect the shape of marginal gingiva.

English Abstract↗

PubMedDate not supplied

Necrosis of gingiva and alveolar bone caused by acid etching and its treatment with subepithelial connective tissue graft.

The misuse of various chemicals in dentistry may cause damage to gingiva and alveolar bone. In this case report, we describe necrosis of the gingiva and alveolar bone caused by acid etching. A patient whose caries on the cervical third of the root of his mandibular right first molar were treated 2 days earlier presented to our clinic with severe pain and discomfort in the treated area. Intraoral examination revealed a spreading gingival ulceration and exposed alveolar bone. The patient was followed and a week later, when the gingival inflammation had decreased, periodontal surgery was performed. A full-thickness flap was raised and necrotic gingiva and bone were removed. As a result, only a narrow band of keratinized gingiva remained. To treat the gingival recession and protect the underlying bone, a subepithelial connective tissue graft was placed during the same session. After the operation, the patient"s complaints resolved. Subepithelial connective tissue graft can be an important treatment approach in cases of necrosis and gingival recession caused by the misuse of various chemicals.

Acid Etching, Dental↗

PubMed1998

Squamous cell carcinoma of gingiva and edentulous alveolar ridge: a clinicopathologic study.

All oral squamous cell carcinomas were retrieved from the files of Temple University's Oral Pathology Laboratory from 1967 through 1994 for a clinicopathologic study of those occurring on the gingiva. A total of 1,193 cases had sufficient data for tabulation and statistical analysis, of which 300 (25%) arose on the gingiva or alveolar ridge. The largest number of these cases (211/300) occurred on the mandibular gingiva or alveolar ridge. The mean age of the patients was 66.66 years, with males accounting for 57% of cases. Many case comparison analyses of oral squamous cell carcinomas do not separate oral subsites or specifically address carcinoma of the gingiva. The results were compared with other published series and suggest that further studies are needed because of the wide range of reported figures on the incidence of gingival squamous cell carcinomas.

Adult↗