A controlled study of cases of gingivectomy regeneration of alveolar bone after gingivectomy.
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Alveolar Process↗
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Root surface caries subsequent to gingivectomy in rats inoculated with Streptococcus sobrinus (mutans) and Actinomyces viscosus.
We studied the effect of oral infection with cariogenic micro-organisms on alveolar bone loss and root surface caries subsequent to gingivectomy in rats. Thirty-six rats were fed diet MIT 200 (67% sucrose); one-half, the controls, had antibiotics added to the diet. At ages 18, 19, and 21 days, the experimental group was orally infected with streptomycin-resistant Streptococcus sobrinus (mutans) 6715 and Actinomyces viscosus M-100. At age 30 days, all animals were subjected to a gingivectomy on maxillary and mandibular left quadrants. The experimental group was re-inoculated at age 36 days. Animals were killed seven weeks after surgery. Jaws were stained, and planimetric measurements of exposed root surface area and caries on lingual/palatal surfaces of 1st and 2nd molars were made from video images with a computer/digitizer. Compared with the non-operated contralateral quadrants, gingivectomy significantly increased exposed root surface area in the maxilla and in the mandible in both the control and experimental groups. Oral inoculation significantly increased exposed root surface in mandibular (but not maxillary) quadrants which had received a gingivectomy, but had no effect on non-gingivectomized quadrants. There was no caries in the control group, whereas ten rats in the experimental group had root surface caries lesions, all in quadrants which had received a gingivectomy. This rat model should prove useful in further studies of root surface caries.
Actinomyces↗
Postoperative pain experience after gingivectomies using different combinations of local anaesthetic agents and periodontal dressings.
The present study examines postoperative pain experience following 243 gingivectomies in Norwegian patients using possible combinations of 3 local anaesthetics (lidocaine-adrenalin, prilocaine-felypressin or mepivacaine) and 3 periodontal dressings (Coe-pak, Wondrpak or Nobetec). When Coe-pak was used, the mean pain score was higher (P less than 0.05) in the group treated with lidocaine-adrenalin 4 to 6 h after gingivectomy than the groups treated with prilocaine-felypressin or mepivacaine. There was no significant difference between the groups treated with prilocaine-felypressin or mepivacaine. When Wondrpak or Nobetec were used, there was no significant difference between any of the local anaesthetics used. The present finding shows that the local anaesthetic combination of lidocaine-adrenalin (1:80,000) gives rise to a higher mean postoperative pain experience after gingivectomy than prilocaine-felypressin or mepivacaine. However, the relative difference in pain experience seen after gingivectomy when using the present local anaesthetic agents is masked when using an eugenol-containing periodontal dressing. Thus, the higher pain experience reported after lidocaine-adrenalin may only be clinically important when using periodontal dressings without local anaesthetic components such as eugenol.
Adult↗
The potential use of CO2-laser gingivectomy for phenytoin-induced gingival hyperplasia in mentally retarded patients.
Patients with hyperplastic states of the gingiva, i.e., phenytoin hyperplasia, nifedipine hyperplasia, cyclosporin hyperplasia, gingival fibromatosis and others may be treated by laser gingivectomy as no bone surgery is involved in these cases. Patients who are mentally retarded may represent special care problems postoperatively after conventional surgical gingivectomy i.e., unintentional removal of surgical dressing, postoperative bleeding etc. Therefore, the potential use of CO2-laser gingivectomy for mentally retarded persons was evaluated in a prospective study comprising 15 patients with fenytoin hyperplasia of the gingiva. No intra- or postoperative bleeding occurred and no surgical dressing was applied. The majority of the patients did not need any analgesics postoperatively. Healing was uncomplicated and the time needed for healing was of the same order of magnitude as after surgical gingivectomy.
Adolescent↗
The effects of different levels of dietary sucrose on root caries subsequent to gingivectomy in conventional rats infected with Actinomyces viscosus M-100.
Three groups of weanling, Sprague-Dawley-derived rats were inoculated with Actinomyces viscosus M-100 and fed powdered diet containing either 67%, 5%, or 0% confectioner's sugar. Two further groups were fed diet containing 5% confectioner's sugar and inoculated with Streptococcus sobrinus 6715 or S. sobrinus 6715 plus A. viscosus M-100. The most coronal 1 mm of gingiva was removed from maxillary and mandibular right molar quadrants (gingivectomy), and the animals re-inoculated following gingivectomy. The animals were killed 64 days following gingivectomy, and the lingual surface of mandibular first molar roots was measured for exposed root-surface area and root caries. In the groups of rats infected with A. viscosus M-100, root caries area was significantly greater in the group fed diet containing 67% confectioner's sugar. Sucrose level did not significantly affect the amount of exposed lingual first molar root area regardless of whether the tooth had been subjected to a gingivectomy. In the groups of rats receiving diet containing 5% confectioner's sugar, there were no significant differences in root caries area or exposed root-surface area, regardless of the infection status of the animals. In the rat model presented here, a high level of dietary sucrose was a necessary condition for the initiation of root caries in the absence of other readily fermentable carbohydrates.
Actinomyces↗
Caries on root surfaces exposed following gingivectomy in conventional rats infected with Streptococcus sobrinus and Actinomyces viscosus.
To study the ability of bacteria associated with coronal caries to initiate root surface caries, a rat model was used. Root surfaces were exposed by gingivectomy in rats fed a caries-promoting diet and orally inoculated with either Actinomyces viscosus M-100, Streptococcus sobrinus (mutans) 6715, or both. A fourth group received a diet containing antibiotics. The animals were sacrificed 64 days following the gingivectomy performed on the right molar quadrants. Gingivectomy significantly increased exposed lingual root length and root caries incidence. There were no caries on non-gingivectomy root surfaces. Root surface caries incidence in the groups inoculated with A. viscosus and A. viscosus plus S. sobrinus did not differ. For both these groups, root caries incidence was significantly greater than that for the group inoculated with S. sobrinus alone. Root caries incidence in this latter group did not differ from that in the control group.
Actinomyces↗
Surgical treatment of cyclosporine A- and nifedipine-induced gingival enlargement: gingivectomy versus periodontal flap.
The purpose of this study was to compare probing depth resolution achieved by gingivectomy and periodontal flap techniques in the treatment of cyclosporine A- and nifedipine-induced gingival enlargement. Ten kidney transplant patients who were receiving cyclosporine A and nifedipine for at least 6 months participated in the study. Five patients were randomly assigned to the gingivectomy group and 5 patients to the periodontal flap group. Only anterior segments of the oral cavity (canine to canine) were surgically treated. Clinical measurements, including probing depths, plaque index, and gingival sulcus index, were taken at baseline, 6 weeks, 6 months, and 1 year. Results showed that probing depths, while similar for both groups in the first 6 weeks of the study, were significantly shallower for the periodontal flap group when compared to the gingivectomy group at 6 months (2.48 +/- 0.34 mm versus 4.87 +/- 0.79 mm, respectively) and 1 year (322 +/- 0.65 mm versus 6.40 +/- 1.02 mm, respectively). Within its limitations, this study suggests that the pocket reduction achieved by the periodontal flap may be sustained for longer periods of time than by the gingivectomy technique in the treatment of cyclosporine A- and nifedipine-induced gingival enlargement.
Adolescent↗
[Gingivectomy].
The gingivectomy is the oldest surgical approach in periodontal therapy. During the centuries, the technique has been modified. Just at the middle of our century, gingivectomy was the most important surgical method in periodontal treatment. Indication for performance of the gingivectomy is the complete elimination of the periodontal pocket (gingival overgrowth/e.g. hyperplasia, subgingival caries, subgingivally located crown margins. The physiologic design of the free gingival margin by surgical means, gingivoplasty, must be taken under consideration. Depending on the long and painful healing for the patient, gingivectomy should be preserved for the indications above. Wherever possible, is recommended a flap procedure like the apically repositioned flap.
Anesthesia, Dental↗
Assessment of tooth mobility using small loads. IV. The effect of periodontal treatment including gingivectomy and flap procedures.
Tooth mobility at loads below 100 p, gingival fluid amounts and bone score heights were studied in five subjects. In all 28 maxillary anterior teeth were investigated during a period of 68 weeks. In order to enlarge upon a previous investigation of tooth mobility following periodontal surgery (Persson 1980), the effects on tooth mobility of gingivectomy and flap procedures were compared. A split-mouth technique was used for the two surgical procedures which were performed during one session. No preoperative differences of the investigated parameters were found. During the first weeks after surgery, an increase of tooth mobility was seen which amounted to +80% maximum (flap side) and +13.1% (gingivectomy side). The final tooth mobility changes were -60% on the flap side and -40% on the gingivectomy side. No significant differences of tooth mobility were found between the two surgical methods. The present findings of tooth mobility following surgery also indicated a considerable time lapse before any major decrease of tooth mobility took place.
Adult↗
Effect of folic acid on recurrence of phenytoin-induced gingival overgrowth following gingivectomy.
This study examined the effect of folic acid supplementation on the recurrence of phenytoin-induced gingival overgrowth following gingivectomy. 8 residents of an institution for the developmentally disabled were randomly assigned to a treatment (N = 4) or control (N = 4) group. Subjects in the treatment group received an oral supplementation of 5 mg of folic acid daily during the study; those in the control group did not. A gingivectomy with an external beveled incision made to the crest of the alveolus was completed by quadrants. The following data were obtained prior to gingivectomy, 2 weeks following the last quadrant of surgery, and at 3 and 6 months post-surgery: plaque and gingival index scores, red blood cell folic acid levels, free phenytoin blood levels, photographs, and impressions. % change in overgrowth was determined from cross-sectional area measurements made on dies obtained from bucco-lingual cuts on stone models. Differences across time between and within groups were tested by a two-factor repeated measure analysis of variance. The groups did not differ in plaque and gingival index scores or free phenytoin blood levels. The treatment group had significantly higher red blood cell folic acid levels (p less than or equal to 0.0001). Reduction in gingival overgrowth as a result of surgery was similar in both groups. Although the treatment group had significantly less recurrence of gingival overgrowth (p less than or equal to 0.05), the mean differences amounted to only 6-7% at 3 and 6 months.
Adult↗
The remodeling of human gingival tissues following gingivectomy.
A total of 30 facial gingivectomies were carried out for reduction of suprabony pockets (mean +/- S.D. preoperative pocket depth 2.8 mm +/- 0.3 mm). Remodeling of the gingival margin was monitored by clinical measurements. The following techniques were utilized: A polyvinyl stent was constructed for each surgical quadrant. This stent covered the occlusal margins of the involved teeth and contained the fixed point of reference. Preoperatively, the following measurements were taken: the distance from the fixed point to (a) the height of the free gingival margin, and (b) the base of the clinical pocket. For control purposes similar measurements were taken at the facial surface of an adjacent tooth. A standard gingivectomy to the base of the clinical pocket was then performed and a periodontal dressing was applied for 1 week. Utilizing the stent (fixed point of reference), measurements were taken of the healing margin and control sites inn the same manner as preoperatively; 1,4,8 and 12 weeks after surgery. Our findings indicate that 12 weeks after gingivectomy, the newly formed free gingival margin was located coronally to the line of incision in all cases. The mean pocket depth at 12 weeks after surgery was 0.7 mm +/- 0.2 mm. However, the mean gain in coronal marginal height was 1.2 mm +/- 0.3 mm. Thus, a clinical coronal pocket closure of about 0.5 mm seemed to have taken place at the soft tissue-tooth interface. Measurements at the nonoperated control site showed no significant variations in crevicular depth during the experimental period. We therefore conclude that the excisional reduction of a crevice to 0 mm depth was altered by gingival remodeling during the healing phase. In our experience, this remodeling took place within 3 months after surgery and clinically appeared as a limited coronal pocket closure and gain of marginal height.
Adult↗
Gingival fluid flow after gingivectomy related to mechanical or chemical plaque control.
The effects of mechanical tooth cleaning and 0.2% chlorhexidine mouthrinses on healing after gingivectomy were compared in 8 patients by means of a "split mouth" technique. The experiment began after periodontal pack removal on day 7. Gingival fluid was sampled immediately before and on days 14, 21, 28, 35 after gingivectomy. The results showed that mechanical and chemical plaque control were equally effective in promoting healing after gingivectomy as evaluated by gingival fluid measurements.
Adult↗
Increase in volume of lignocaine/adrenaline-containing local anaesthetic solution causes increase in acute postoperative pain after gingivectomy.
A randomized, single-blind, within-patient, crossover study was done in 44 patients (27 women and 17 men mean age 47 years, range 29-63) who had bilateral 'identical' gingivectomies. On one occasion a standard volume of local anaesthetic containing lignocaine 2% and adrenaline (1/80 000) was infiltrated into the mucosal tissue before operation. On the other occasion double the standard volume was infiltrated. The intensity of pain postoperatively was recorded by the patients on 100 mm visual analogue scale every hour for an 11-hour observation period. The intensity of pain when double volume had been given was significantly higher than that after the standard volume from 2 to 8 hours postoperatively (P < 0.04), the median (range) being 52.0 mm (0.0-434.0) compared with 30.5 mm (0.0-359.0) after the standard volume (P < 0.005). Doubling the volume of local anaesthetic containing adrenaline that was infiltrated increased the intensity of acute pain after gingivectomy.
Adult↗
The present status of the gingivectomy procedure.
The use of the conventional gingivectomy procedure is indicated to achieve optimum gingival contour and to eliminate supra-alveolar pockets where these do not extend beyond the muco-gingival junction. The instrument of choice for the procedure is a gingivectomy knife. Where a blood-free field is required, electrosurgery may be used provided the instrument is not brought into contact with bone. The maintenance of good oral hygiene is essential.
Animals↗
The effect of chlorhexidine mouthrinse on healing after gingivectomy.
The purpose of this investigation was to evaluate the effect of 0.2% chlorhexidine gluconate mouthrinse following gingivectomy on plague under the dressing and on healing. Twenty-eight patients with indications for gingivectomy were selected. Coe-Pak was used as surgical dressing. In addition to unsual home care, the patients rinsed twice daily with chlorhexidine or placebo for 21 d after surgery. The study followed a cross-over double-blind design. Gingival exudate was assessed and Pl I and G I were registered at 7, 14, and 21 d postsurgically. The study indicated that chlorhexidine did not influence the amount of plaque under the dressing, and it was uncertain whether chlorhexidine had any effect on the healing process when the surgical area was covered by Coe-Pak. However, (1) after the surgical dressing was removed, the chlorhexidine maintained plaque scores at the same low level as under the dressing, (2) healing was was promoted when chlorhexidine was used, and (3) the presence of a dressing in one side of the mouth did not prevent the patient from maintaining good oral hygiene.
Adolescent↗
Epithelial reattachment after gingivectomy in the rat.
It is known that an epithelial reattachment occurs a few days after gingivectomy. Depending upon the surgical procedure and the animal species used, different times have been proposed to obtain a complete reattachment. Nevertheless, it is not known whether there is a correlation between the time required and the sequence of morphologic events involved in this process. To investigate this matter, gingivectomies were performed in the maxillary molars of rats. Specimens were taken 1 to 14 days after the operation and processed for light and electron microscopy. The new junctional epithelium appeared at the 5th day, but the earliest signs of reattachment complex formation were evident at the 8th day. Rudimentary hemidesmosomes and lamina lucida appeared in epithelial cells bordering remnants of fibrin. Anchoring filaments that formed between the earliest hemidesmosomes and the subjacent fibrin crossed the lamina lucida. Simultaneously, segments of lamina densa appeared. At the 11th day insertion of tonofilaments into the attachment plaques and insertion of anchoring filaments in the lamina densa were observed. At the 14th day, full development of the reattachment complex was evident.
Animals↗
[Use of fluorescence microscopy in the cytochemical evaluation of wound healing after gingivectomy].
The authors investigated in 60 cases the healing process after gingivectomy. The investigation was performed by means of fluorescence microscopy, the presence of nucleic acids (RNA, DNA) and of polysaccharides in the cells being demonstrated. The cytochemical RNA reactions were the most sensitive indicator of wound healing after gingivectomy. Solcoseryl gel accelerated the epithelization of the gingival wound after the surgical intervention, which shortens the period of recuperation.
Adult↗
Melanin repigmentation after gingivectomy: a 5-year clinical and transmission electron microscopic study in humans.
The epithelium-melanin unit is formed by the melanocytes and keratinocytes. There is little information available about the behavior of melanocytes after surgical injury. Five white patients with comparable gingival pigmentation underwent gingivectomy to remove bandlike melanin pigmentations for cosmetic reasons. Biopsy specimens were taken from gingivectomy sites and healing areas 2, 3, 6, 7, 15, 50, and 180 days and 1.5, 3, and 5 years after the procedure. Transmission electron microscopic study revealed melanocytes in the process of migration and undergoing mitosis 6 and 7 days postoperatively. These cells exhibited, in the 15-day specimens, renewal of their dendritic processes and the four different stages of melanosome development. Keratinocytes were devoid of pigmented material until 50 days postoperatively. Clinically, the intensity of the pigmentation varied among the patients. Two reached baseline coloration 1.5 years postsurgery, while three returned to baseline coloration by 3 years postsurgery. Thus, gingival resective procedures, if performed solely for cosmetic reasons, offer no permanent results. (Int J Periodont Rest Dent 1993; 13:85-92.)
Adult↗