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Clinical and anatomical factors limiting treatment outcomes of gingival recession: a new method to predetermine the line of root coverage.

Complete root coverage is not always achievable, even in gingival recession with no loss of interproximal attachment and bone. The cemento-enamel junction is the most widely used referring parameter to evaluate root coverage results. The aim of the present study was to describe the most frequent diagnostic mistakes that may lead to incomplete root coverage in Miller Class I and II gingival recessions and to suggest a method to predetermine the level/line of root coverage in non-molar teeth. The line of root coverage (i.e., the level/line to which the soft tissue margin will be positioned after the healing process of a root coverage surgical technique) was predetermined by calculating the ideal vertical dimension of the interdental papilla of the tooth with the recession defect. This method was applied to 120 recession-type defects affecting non-molar teeth of 80 young healthy subjects that were treated with root coverage surgical procedures over the last 5 years. All recessions were Miller Class I or II and were associated with at least one of the following characteristics: 1) traumatic loss of the tip of the interdental papilla(e); 2) tooth rotation; 3) tooth extrusion with or without occlusal abrasion; and 4) a cervical abrasion defect with no evidence of the cemento-enamel junction. The line of root coverage may be considered the clinical cemento-enamel junction because it may substitute the anatomic cemento-enamel junction when this is no longer clinically visible on the tooth with recession or when the ideal conditions to obtain complete root coverage are not fully represented.

Dental Occlusion, Traumatic↗

Comparative 6-month clinical study of a semilunar coronally positioned flap and subepithelial connective tissue graft for the treatment of gingival recession.

BACKGROUND: The purpose of this randomized clinical trial was to compare the outcome of gingival recession therapy using the semilunar coronally positioned flap (SCPF) or the subepithelial connective tissue graft (SCTG). METHODS: Seventeen patients with bilateral Miller Class I buccal gingival recessions (<or=4 mm) in maxillary canines or premolars were selected. The recessions were randomly assigned to receive either the SCPF or the SCTG. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline and 6 months post-surgery. Patient satisfaction with esthetics, root sensitivity, and postoperative pain was also evaluated. RESULTS: The average percentages of root coverage for SCPF and SCTG were 90.95% and 96.10% (P<0.05), respectively, and the complete root coverage observed was 52.94% and 76.47%, respectively. The SCTG showed a statistically significant increase in TKT (P<0.05). There were no significant differences between the two groups with regard to RH, RW, WKT, PD, and CAL. The esthetic condition after both treatments was considered satisfactory by the patients. CONCLUSION: The findings from this study indicate that SCPF and SCTG can be successfully used to treat Class I gingival recession.

Adult↗

Gingival recession treatment with connective tissue grafts in smokers and non-smokers.

BACKGROUND: Cigarette smoking can adversely affect the results of many periodontal procedures. The purpose of this study was to determine whether cigarette smoking affects wound healing of subepithelial connective tissue grafts. METHODS: Seventeen systemically healthy patients with 22 Miller Class I or II mucogingival defects were divided into a non-smoker group or smoker group. Patients were regarded as smokers if they reported smoking 10 to 20 cigarettes per day. The following parameters were documented at the surgery date and 3 and 6 months postoperatively: recession depth (RD), recession width (RW), keratinized gingiva height measured apico-coronally (KG), relative attachment level (RAL), probing depths (PD), bleeding on probing (BOP), and the full-mouth plaque score (FMP). Salivary cotinine samples were taken at the surgery to confirm the smoking history and to quantify cigarette use. RESULTS: Non-smokers (0- to 10-ng/ml cotinine level) healed with statistically more recession coverage than the smokers (>10-ng/ml cotinine level) (98.3% versus 82.3%, respectively; P=0.001). Six months postoperatively, the non-smokers healed with a 0.2-mm mean recession depth compared to a 1.0-mm mean recession depth for the smokers. This difference in recession depth was statistically significant (P=0.014). CONCLUSIONS: Root coverage with connective tissue grafts appears to be negatively associated with cigarette smoking. Smokers should consider smoking cessation or reducing the use of cigarettes for optimal results with connective tissue grafts.

Adult↗

Treatment of adjacent gingival recessions with subepithelial connective tissue grafts and the modified tunnel technique.

OBJECTIVE: There has been great interest in the treatment of gingival recession defects, especially with subepithelial connective tissue grafting. Recent advances have focused on subepithelial connective tissue grafting by the tunnel technique. In this clinical study, a modified periodontal plastic surgery technique for coverage of adjacent gingival recessions was performed. This surgical modification was based on the tunnel technique without vertical incisions, where the partial dissection was converted to a full-thickness dissection at the mucogingival area to supply more blood vessels. METHOD AND MATERIALS: Patients, each contributing at least two adjacent buccal gingival recessions, were treated. Subepithelial connective tissue grafting was used to cover the defects. Gingival recession, probing depth, and attachment level were measured at baseline and 8 months posttreatment. RESULTS: There were statistically significant improvements in attachment level and gingival recession after 8 months; the mean gain in attachment was 3.67 mm and the mean root coverage was 3.28 mm, which translated to mean root coverage of 95%. CONCLUSION: These findings suggest that subepithelial connective tissue grafting with a modified tunnel approach, in which the partial-thickness flap is converted to a full-thickness flap in a coronoapical direction, results in adequate early healing and highly predictable root coverage in adjacent gingival recessions.

Connective Tissue↗

Autosomal recessive retinitis pigmentosa in a Pakistani family mapped to CNGA1 with identification of a novel mutation.

PURPOSE: To map the locus for autosomal recessive retinitis pigmentosa in a large Pakistani family and to determine the causative mutation. METHODS: A large family with multiple individuals affected by autosomal recessive retinitis pigmentosa was ascertained in the Punjab province of Pakistan as part of an ongoing project between the CEMB, Lahore, Pakistan and the NEI to identify genetic causes of eye diseases. After initial analysis of previously identified autosomal recessive retinitis pigmentosa loci, a genome wide scan was performed using microsatellite markers at about 10 cM intervals. Two point lod scores were calculated and haplotypes were analyzed in order to define disease locus. Bidirectional dideoxynucleotide sequencing was used to screen for mutations in candidate genes. RESULTS: In the genome wide scan, autosomal recessive retinitis pigmentosa in this Pakistani family showed linkage to an 11.7 cM region of chromosome 4p12 between D4S405 and D4S1592 with a maximum lod score of 2.90 with D4S405 at theta;=0.01 Sequence analysis of CNGA1 identified a 2 bp deletion in exon 8: c.626_627delTA resulting in a frameshift, p.Ser209fsX26 in the translated protein. This mutation results in deletion of the COOH terminal 482 of 690 total amino acids in CNGA1 and their replacement by 25 novel amino acids before a premature termination. The mutation is found in a homozygous state in all 7 affected individuals and was heterozygous in all 15 unaffected family members examined. The mutant allele of CNGA1 itself shows linkage to the disease with maximum lod score of 4.43 at theta;=0. CONCLUSIONS: The autosomal recessive retinitis pigmentosa in this family is caused by a mutation in CNGA1 gene. To our knowledge, this is the first report in which both linkage analysis and identification of a mutation support CNGA1 as a cause for autosomal recessive retinitis pigmentosa.

Base Sequence↗

The oral cavity hygiene as the basic element of the gingival recession prophylaxis.

The purpose of the study was the evaluation of the dental plaque and the influence of determined hygienic factors on gingival recession occurrence in 455 students of The Medical University of Bialystok. All the subjects were examined in artificial light, with the use of the probe, mirror, and parodontometer. The distribution of stained dental deposits were estimated with the use of the plaque index according to Quigley and Hein. Moreover, the students were to fill a survey of their own project concerning hygienic habits. The results underwent statistical analysis. The dental plaque was not present in 71 people. Gingival recession was revealed in 134 out of 455 subjects. The majority of medical students brushed their teeth twice a day, using medium hard toothbrush or electric toothbrush with appropriate movements and medium strength while brushing. The frequency of brushing the teeth, hardness of the toothbrush, the use of electric toothbrush, the movements during brushing the teeth, the strength of brushing, the frequency of toothbrush change, the age, and sex have significant influence on the number of recession. The increase in the gingival recession in students is connected with: large pressure on the brush while toothbrushing, too frequent brushing and toothbrush change, the use of hard toothbrush and additional hygienic items, movements while brushing, the age (the number of recession elevates with the age), and sex (women showed more recession than men).

Adolescent↗

Analysis of the Community Periodontal Index of Treatment Needs--study on adults in France. IV. The significance of gingival recession.

A total of 1005 persons were examined using the CPITN criteria which were recorded for every tooth. All the teeth were also measured on both their buccal and lingual aspects to assess the amount of gingival recession. The combination of pocket depth and gingival recession was computed using a specially written program: 93.8 per cent of the teeth had 1 mm or less gingival recession; 82.5 per cent of the teeth with gingival recession did not present pockets; 26.6 per cent of all subjects had at least one tooth with gingival recession of 2 mm or more but only 9.9 per cent had at least one tooth with 2 mm or more gingival recession and a periodontal pocket.

Adolescent↗

[Genetic characteristics of recessive sensorineural hearing loss].

Genetic characteristics of recessive sensorineural hearing impairment mediated by 5 recessive genes were studied. One of these is responsible for early progressive hearing loss, others causing congenital deafness. The incidence of early progressive recessive hearing loss in a population is 1:20,000, gene frequency being 0.007; the incidence of heterozygotes for this gene is 1.4%. The incidence of each of 4 forms of recessive congenital hearing loss in a population is 1.125:10,000, the frequency of these genes being 0.0106; the incidence of heterozygotes for each of these genes is 2.1%. The total frequency of all recessive genes for sensorineural hearing impairment is 0.0494 and the incidence of heterozygotes for all genes is 9.9%. The frequency of different genotypes for recessive genes specifying sensorineural hearing loss was established, based on the data obtained.

Child↗

Clinical consequences of heterozygosity for autosomal-recessive diseases.

Heterozygotes of autosomal-recessive diseases can often be recognized by special heterozygote tests, since enzyme activities are normally reduced in comparison with the normal homozygote state. In Drosophila, the majority of recessive lethal mutations shows a reduction of fitness in heterozygotes, whereas in a strong minority fitness of heterozygotes is increased. This review will be devoted to a consideration of the extent to which heterozygotes for a wide variety of nominally recessive diseases are subject either to an increased liability for common diseases or slight shifts of behavioral characteristics. The available evidence has been collected and will be discussed in three steps: Most studies are available for phenylketonuria. For this group of diseases, a slight reduction of average--especially verbal--I.Q. in heterozygotes has been reported together with signs of a slightly increased cerebral irritability, a possible slight increase of risk for mental disease, and an increase of blood phenylalanine levels in stress situations. The PKU example is used to discuss methodological problems involved in such studies. Other conditions for which relevant deviations in heterozygotes are possible or even likely include among others lipid storage diseases, microcephaly, myoclonus epilepsy, Wilson's disease, galaktokinase deficiency, homocystinuria, recessive myotonia and ataxia- teleangiectasia (increased cancer risk). Since heterozygotes for autosomal recessive diseases are common, it is possible that an appreciable fraction of "multifactorial" genetic liabilities for common, "constitutional" or mental disease might simply be due to heterozygosity for genes whose homozygous affects are already well known. By the same token, much of the "normal" genetic variability influencing cognitive performance (I.Q.)--especially in the lower range--and personality characteristics could also be caused by recessive genes in the heterozygous state.

Adolescent↗

[A genetic disorder of vitamin A metabolism is recessively white canaries].

A discussion of vitamin A and carotene metabolism in recessively white canaries has been going on for years. This colour canary is reputed to be a 'weak' bird. In the present study, the concentrations of vitamin A, total carotenoid and beta carotene in the serum, liver and feed of both coloured and recessively white canaries were determined. The most important conclusions are: - The normal concentration of vitamin A in the livers of health canaries varies from 500 to 1,500 I.U. of vitamin A per gram of liver. - This is achieved by administering an amount of approximately 15,000 U.U. of vitamin per kg of egg feed. The intake through the feed by each canary will then be approximately 800 I.U. of vitamin A/kg. of body weight daily. - Carotenoids are practically not resorbed from the intestine by recessively white canaries. Vitamin A is also absorbed to a less extent by these birds than it is by canaries which are not recessively white. For their supplies of vitamin A, recessively white canaries are completely dependent on the pressure of vitamin A in the feed. - It would appear to be essential to increase the vitamin A content of the egg feed for recessively white canaries to 20,000 I.U./kg. of egg feed.

Animal Feed↗

Should recessions of the medial recti be graded from the limbus or the insertion?

In a series of 27 patients who were operated on for esotropia, we compared patient response to surgery and the distance the medial recti were recessed from the insertion and corneoscleral limbus. We found a much more significant correlation between the response and the amount the muscles were recessed from the insertion than from the corneoscleral limbus. Using partial correlation coefficients, we found that when we corrected for the amount of recession from the insertion, there was not a significant correlation between the response to surgery and the amount the muscles were recessed from the corneoscleral limbus. This suggests that the apparent correlation between the response to surgery and the amount of recession from the corneoscleral limbus simply reflects that the greater the recession from the corneoscleral limbus, the farther the muscle is likely to end up posterior to the insertion.

Accommodation, Ocular↗

Observations of the anterior epitympanic recess in the human temporal bone.

The structure of the anterior epitympanic recess was examined in 50 human temporal bones. The recess was found in 48 temporal bones (96%) and showed three different structural types. In type A, the least developed type (38%), a main cavity is seen above the tensor tympanic fold. The recess is divided into two cavities by the tensor tympanic fold, which stretches to the anterosuperior tympanic tegmen in type B, the intermediate type (40%). The tensor tympanic fold is fused with the superior mallear fold in type C, the best-developed type (18%), with the recess being contiguous with the eustachian tube. The shape of the anterior epitympanic recess is influenced by the ratio between the cavities above and below the tensor tympanic fold, ie, by the embryologic development of the saccus anticus and the anterior saccule of the saccus medius. The structural variations in this recess must be kept in mind during the surgical management of middle ear diseases.

Ear, Middle↗

Cellular lining of the sheep pineal recess studied by light-, transmission-, and scanning electron microscopy: morphologic indications for a direct secretion of melatonin from the pineal gland to the cerebrospinal fluid.

In the sheep, the pineal hormone melatonin displays nocturnal levels 20 times as high in the cerebrospinal fluid of the third ventricle as in the jugular blood. Moreover, in the pineal recess, the evagination of the third ventricle into the pineal stalk, the levels of melatonin in the cerebrospinal fluid are even higher than in the ventral part of the third ventricle. This finding suggests melatonin to be secreted directly from the pineal gland to the ventricular lumen of the pineal recess of this species. We have, therefore, studied the interface between the sheep pineal gland and the cerebrospinal fluid by light-, scanning-, and electron microscopy of the pineal recess, as well as the permeability of the interface by tracer injections into the third ventricle. First, we show that the classic ependymal lining of the third ventricle disappears in the superior part of the recess. In this area, bulging pinealocytes, displaying immunoreactivity for serotonin, directly appose the cerebrospinal fluid. This pineal-cerebrospinal fluid interface of the sheep is large compared with other species, especially rodent species. Intraventricular injections of horseradish peroxidase and fluorescein isothiocyanate showed that both these tracers could permeate from the pineal recess into the sheep pineal parenchyma. This permeation was due to the presence of gap and intermediate junctions connecting the pinealocytes apposing the ventricular lumen. Thus, our results show that endocrine cells in this specialized area of the ventricular system are in direct contact with the cerebrospinal fluid. This finding supports the physiological concept of a direct secretion of melatonin into the cerebrospinal fluid of the sheep pineal recess.

Animals↗

Design and construction of shoulder recesses into the beam aperture shields for improved patient positioning at the FiR 1 BNCT facility.

Improvements have been made at the FiR 1 BNCT facility to ease the positioning of the patient with a tumor in the head and neck region into a lateral neutron beam. Shoulder recesses were constructed horizontally on both sides of the beam aperture. When shoulder recesses are not needed, they are filled with neutron attenuating filling blocks. MCNP simulations using an anthropomorphic human model BOMAB phantom showed that the main contribution to the increase in the effective dose to the patient's body due to the shoulder recesses was from the neutron dose of the arm. In a position when one arm is inside the shoulder recess, the maximal effective dose of the patient was estimated to be 0.7Sv/h. Dose measurements using the twin ionization chamber technique showed that the neutron dose increased on the sides as predicted by the MCNP model but there was no noticeable change in the gamma doses. When making the recesses into the lithium containing neutron shield material tritium contamination was confined using an underpressurized glove box and machine tools with local exhaust. The shoulder recesses give space for more flexible patient positioning and can be considered as a significant improvement of the Finnish BNCT facility.

Boron Neutron Capture Therapy↗

The effect of bilateral horizontal rectus recession on visual acuity, ocular deviation or head posture in patients with nystagmus.

PURPOSE: This work was undertaken to evaluate the effect of bilateral horizontal rectus recession on visual acuity, ocular deviation and head posture in patients with nystagmus. METHODS: Twenty patients underwent recession of 4 horizontal rectus muscles to dampen the nystagmus. At least 2 muscles were recessed posterior to the equator. RESULTS: Monocular and binocular visual acuity improved from 1 to 3 Snellen lines after the procedure in 13 patients (76.5%). Visual changes in log MAR notations were statistically significant with Wilcoxon analysis in each and both eyes. Preoperative binocular visual acuity was 0.73 +/- 0.26 log MAR that reached to 0.62 +/- 0.32 log MAR after surgery (P = 0.02). The greatest improvement was observed in patients with congenital motor nystagmus. Ten patients had horizontal strabismus in addition to nystagmus before the surgery. One-millimeter additional recession of both medial rectus muscles caused an average reduction of 6 PD in esotropia. Corresponding figures for similar additional recessions of the lateral rectus muscles was 11 PD for correction of exotropia. Abnormal head posture decreased in all the cases and improved completely in most of them. CONCLUSIONS: Large horizontal rectus recession can improve visual acuity and decrease nystagmus in sensory and motor types. By revision in surgical planning, strabismus and abnormal head posture can also be corrected.

Adolescent↗

Bilateral medial rectus muscle recession: results in children with developmental delay compared with normally developed children.

PURPOSE: We sought to compare bimedial rectus muscle recession (BMR) results for esotropia in children with developmental delay with the results in normal children. METHODS: A retrospective analysis of all the children that underwent standard BMR surgery for esotropia during a 10 year period was undertaken. The surgical results of children with developmental delay were compared with those of normal children. RESULTS: In the developmentally delayed group, the mean angle of esotropia before surgery was 53+/-12 PD, the mean amount of medial rectus recession was 5.4+/-0.56 mm, 0.84 mm less than the standard amount of recession, and at the last follow-up visit only 56% achieved surgical success (within 10 PD of orthophoria). Among the failures, 86% were undercorrected, only one patient developed consecutive exotropia after surgery. In the developmentally intact group, the mean angle of esotropia before surgery was 37.4+/-8 PD, the mean amount of medial rectus recession was 5.2+/-0.65 mm, and 94% achieved surgical success. Among surgical failures, we observed only a single case of overcorrection. CONCLUSION: A higher rate of surgical failure was found in developmentally delayed children who received a smaller recession amount of the medial rectus muscles when compared with the developmentally normal children who received a standard amount of recession. The main reason for surgical failure in the developmentally delayed group, in a follow-up period of 2 years, was undercorrection of the angle of esotropia. It seems that decreasing the surgical table by a certain amount in children with developmental delay may lead to undercorrection. Therefore, we need to delineate the ideal amount of surgery in this unique group of individuals.

Child↗

Slanted lateral rectus recession for exotropia with convergence weakness.

OBJECTIVE: To evaluate the efficacy of slanted recession of the lateral rectus (LR) muscle for exotropia (XT) with convergence weakness. DESIGN: Predesigned, nonrandomized, comparative trial. PARTICIPANTS: Twelve study patients and six control subjects with XT greater at near than at distance by > or =10 prism diopters (PD). INTERVENTION: Twelve consecutive patients underwent slanted LR recession, and six consecutive control subjects underwent standard LR recession. MAIN OUTCOME MEASURES: Between-groups comparison of the postoperative ocular alignment at distance and near, and the difference between them, as well as the stereopsis. RESULTS: Slanted LR recession reduced the XT to <8 PD in all patients at distance and in 11/12 patients at near. Additionally, the mean difference between the distance and near exodeviation was reduced from 14+/-4.5 PD preoperatively to 2.9+/-2.4 PD postoperatively. All patients in the control group demonstrated postoperative deviations of <8 PD at distance, but all had residual exodeviations >8 PD at near. Three of the study patients gained gross stereopsis postoperatively. CONCLUSIONS: Slanted recession of the LR is superior to standard recession in reducing both distance and near XT and in collapsing the difference between them. This technique may also have a positive impact on gross stereopsis.

Accommodation, Ocular↗

Do high levels of unemployment influence the health of those who are not unemployed? A gendered comparison of young men and women during boom and recession.

Research has shown that health among young people, particularly women, deteriorates during a recession compared to a boom. It seems that the trade cycle mainly affects the health of those who are not long-term unemployed. The aim of this study was to analyse the relation between the health of non-unemployed people and the levels of unemployment in society. Two groups of young people aged 21 were surveyed, one in 1986 (the boom group, n = 1083) and one in 1994 (the recession group, n = 898). The non-response rate was 2% in the first and 10% in the second group. Both groups were investigated with a self-administered questionnaire, which included questions about somatic and psychological health, as well as experiences of employment, unemployment, education and labour market programmes. Young men and women generally reported more somatic and psychological symptoms during recession than boom. The only exception was psychological symptoms among men, which was of the same magnitude during both periods. Poorer health during recession was found among women in work and in labour market programmes, as well as among both male and female students. Multiple regression analysis was performed in order to analyse if the occupational-related health effects of the trade cycle remained after controlling for possible moderating factors. The effects of unemployment in society on young people's health may be mediated through pessimism about the future, high demands and financial problems. Lack of control over the work situation may also be an important contributing factor to ill health among women during recession. The trade cycle was correlated with ill health among women only. Possible explanations for poorer health among women during a recession were discussed.

Adult↗