1/8. Subgingival plaque and loss of attachment in periodontosis as observed in autopsy material.Histologic sections from six autopsy cases which from a clinical point of view fitted into the criteria of periodontosis were examined with the aim at evaluating the role of subgingival plaque in the etiology of the loss of attachment in this condition. The following pertinent observations were made: 1. The subgingival plaque in most instances was not calcified to form calculus. 2. The thickness of the subgingival plaque varied between 20 and 200 mu (0.02-0.2 mm). 3. Where loss of attachment had taken place, the distance from the most apical part of the subgingival plaque to the most apical point of the epithelial cuff varied between 0.2 and 1.1 mm; this distance was never found to be more than 1.1 mm. This would indicate a cause and effect relationship, the plaque being the obvious cause. 4. There was very severe chronic inflammation in the soft tissue bordering upon the plaque with resulting collagenolysis. 5. The cellular infiltration and the collagenolysis may be limited to a zone of 1 to 2 mm in the immediate vicinity of the plaque. Between the inflamed area and the surface of the gingivae buccally and lingually there may be a fairly wide zone of healthy tissue which hides the symptoms of inflammation from being observed on a clinical examination. In turn this could leave the clinician with the impression that attachment has been lost and bone resorbed because of degenerative changes. The following conclusions can be made: In these six cases of "alveolar bone loss vastly out of proportion to what one would expect from the local etiologic factors in the patient at that age" there was no morphologic evidence that degenerative changes were responsible for the loss of attachment. On the contrary inflammatory changes induced by the subgingval plaque dominated the histopathologic picture.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/8. Features of severe periodontal disease in a teenager with chediak-higashi syndrome.BACKGROUND: chediak-higashi syndrome (C-HS) is a rare congenital disease characterized by defective neutrophil function with abnormal lysosomal inclusions, neutropenia, and reduced chemotaxis. The complete syndrome includes oculocutaneous albinism with photophobia, neurologic features, recurrent infections, and enterocolitis. methods: A 14-year-old male C-HS patient was referred to us because of serious periodontal destruction with acute inflamed gingiva and ulcers. Clinical and biological investigations were performed, leading to the diagnosis of C-HS. RESULTS: Laboratory findings included neutropenia and hypergammaglobulinemia. Peripheral blood smears showed giant granules in neutrophils, eosinophils, and granulocytes. bone marrow smears showed giant inclusions in leukocyte precursor cells. These granules and inclusions were characteristic of chediak-higashi syndrome. Oral radiographic status showed extensive loss of alveolar bone leading, in most cases, to tooth exfoliation. bacteria often associated with periodontitis were detected in subgingival plaque samples, including fusobacterium nucleatum, campylobacter rectus, prevotella melaninogenica, peptostreptococcus anaerobius, and clostridium sp. Biopsies of periodontal tissues for light and electronic microscopic examinations revealed massive bacterial invasion of the epithelial tissue, epithelial cells, and connective tissue. Ultrastructural observations of periodontal polymorphonuclear leukocytes showed defective granulation, with abnormal granules not discharging their lysosomal content against engulfed bacteria. Viable dividing bacteria were found in the cytoplasm. CONCLUSIONS: In this case, early-onset periodontitis seems to be the expression of C-HS granulocyte deficiency. Periodontal treatment of these patients is often unsuccessful. This case report illustrates the importance of the dentist in initiating clinical and biological investigations in such early aggressive periodontitis in young patients.- - - - - - - - - - ranking = 71.314243706839keywords = connective (Clic here for more details about this article) |
3/8. Current trends in gingival recession coverage--part I: the tunnel connective tissue graft.The recession of the gingiva is increasingly becoming a more prominent condition in the oral health of many patients and should be treated at its earliest detection. The multifactorial etiology, decision modality, and current trends followed in the treatment of gingival recession are discussed in this presentation. The correction of Class I and II gingival recessions are presented as a means of minimizing surgical trauma and achieving predictable aesthetic results. Part II of this discussion will present alternative techniques in treating gingival recession.- - - - - - - - - - ranking = 285.25697482736keywords = connective (Clic here for more details about this article) |
4/8. A case report of chronic neutropenia: clinical and ultrastructural findings.This case report of severe periodontitis concerns a young male patient with chronic idiopathic neutropenia seen between 1981 and 1983 by the School of Dental medicine of Geneva and from 1984 to 1988 by the Eastman Dental Hospital of london. The patient was maintained by intermittent systemic antibiotics, subgingival chlorhexidine irrigation, conventional debridement, brushing, and wire-mesh and composite splinting of loose teeth. After leaving school, at the patient's express wish, the extreme downhill pattern of the periodontitis resulted in removal of affected teeth and overdenture construction. The extracted teeth and associated soft tissues were examined for relevant plaque and host response features. The intact morphotypes associated with the advancing front of the lesion were invariably Gram-negative or positive coccoid cells, or less commonly short rods, as in all documented forms of periodotitis. connective tissue destruction was associated with a leucocyte accumulation comprising mainly polymorphonuclear neutrophils (PMN) and plasma cells. Both were observed degenerated more deeply than in routine adult periodontitis, including PMN lysosome loss and lymphocyte maturation within peripheral blood vessels. Only in one instance, one part of the superficial connective tissue of one block contained bacteria. It was concluded that the features of plaque and the lesion suggest a typical first line of defence response as in other forms of periodontitis. From the consideration of the 10 years clinical history of the patient, it is clear that non-surgical management is possible even in extreme cases, without any compromise of the patient's oral or systemic health, and in accord with the patient's wishes.- - - - - - - - - - ranking = 72.314243706839keywords = connective, soft (Clic here for more details about this article) |
5/8. Asymmetrical dental caries and streptococcus mutans infection.A 27-year-old woman chewed unilaterally and had restorations and caries only on the right side of the dentition. The left side had a greater amount of soft and hard deposits and more severe periodontal disease. Plaque samples from occlusal and interproximal tooth surfaces were collected and cultured. The proportion of streptococcus mutans of the total anaerobic count in the plaque samples from the right side was 1,000 to 10,000 times as high as from the left side. The proportion of S mutans of the total streptococcus was 6% to 20% on the right and less than 1% on the left side.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
6/8. Ultrastructure of the periodontal lesion in a case of Papillon-Lefevre syndrome (PLS).In this study, 11 permanent teeth and their associated soft tissues from an 11-year-old boy with PLS were examined. Plaque, cementum and periodontal tissues were examined by scanning (SEM) and transmission electron microscopy (TEM). Except for depressed lymphocyte transformation, there were no abnormal haematological data. Local findings included abnormally thin cementum, extensive destruction of the periodontal ligament were still attached to the root, and severe inflammation of the soft tissues. Few bacteria were found in any of the soft tissue layers. The apical border plaque was restricted to gram- cocci and rods. The features observed in this case of PLS may indicate primary defects of cementum or ligament attachment, or disruption of fibroblast and cementoblast function due to the rapid advance of the disease process. Lack of bacterial invasion in the pocket soft tissue casts doubt on its involvement in the present case of severe periodontitis. The restricted range of morphotypes observed suggests a limited range of associated organisms. Further research is required to clarify the role of the host response and to identify the organisms involved.- - - - - - - - - - ranking = 4keywords = soft (Clic here for more details about this article) |
7/8. Lack of effect of citric acid treatment of root surfaces on the formation of new connective tissue attachment.Previous reports have described an accelerated induction of new attachment and repair of furcations in dogs after treatment of roots surfaces with citric acid, but few controlled clinical studies have examined its usefulness in surgical treatments for periodontitis. This study compared the effects of a comprehensive surgical plaque control procedure with or without citric acid treatment for generalized and localized effects on gingival height, probing pocket depth and attachment level in 72 teeth in 3 patients who were treated surgically for moderate periodontitis and examined every 3 months for 1 year. No statistically significant differences in the effects of the 2 treatments were observed. These observations suggest that there is no clinical advantage of citric acid conditioning of the root surface during surgical treatment of periodontitis.- - - - - - - - - - ranking = 285.25697482736keywords = connective (Clic here for more details about this article) |
8/8. behavior modification for orthodontic patients: an exploratory approach to patient education.The purpose of this project was to explore the usefulness of a behavior modification approach in changing oral hygiene habits of orthodontic patients. Two orthodontists identified patients in their practice who exhibited excessive plaque formation and inflammation and referred them to a health educator/dental hygienist. The health education program was subsequently presented to fifty-three patients, 8 to 18 years of age. Three counseling sessions with parental participation were scheduled approximately 2 weeks apart. The program consisted of a model for counseling, a rising and retiring survey to identify home routines, a list of "possible reinforcers" geared toward preteen interests, a monitoring card to record toothbrushing behavior, and a contract signed by both parent and child. Behavioral change in oral hygiene habits was measured through general assessment of toothbrushing technique, plaque accumulation, and soft-tissue appearance. Change in frequency of brushing was measured by patient self-monitoring. Patient and parental comments, as well as educator reactions, were considered in the over-all evaluation of the project.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |