1/18. bone regeneration following damage by polysulphide impression material. A case report. Two days after polysulphide rubber impressions had been taken of gold inlay cavities in 6 and 7, a 22-year-old female dental student developed a painful swelling between 5 and 6. A radiograph revealed the presence of an irregular radiopaque body within the cancellous bone of the interdental septum between 5 and 6. At operation, 1 month later, the interdental septum was seen to have been destroyed and its position occupied by impression material and inflammatory tissue. When the lesion was reopened 2 years later to correct slight recurrent pocketing, significant regeneration of bone was found to have occurred. ( info) |
2/18. 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. ( info) |
3/18. Osseous autografts. II. Histological responses to osseous coagulum-bone blend grafts. Three human intraosseous lesions were treated using osseous coagulum-bone blend as graft material. These sites were surgically removed 6 to 13 weeks after treatment and the blocks prepared for histologic analysis. Periodontal remodeling at the site of grafting was noted in all specimens. This remodeling involved the osseous walls, periodontal ligament, cementum and graft spicules. Both osteoclastic and osteoblastic activities were seen at the borders of the spicules. Exfoliation of spicules was particularly frequent in the six-week specimen. Nevertheless, regenerating of both bone and cementum was actively taking place even in this early specimen and was still evident in the older specimens. Of particular interest was the apparent marked increase in cementogenesis at the graft sites and the variations in parallel or functional orientation of the periodontal ligament in these areas. Significant functional orientation of segments of the periodontal ligament were seenin the early specimens, but not in the latter one. The reason for such variations in ligament pattern is not known at this time. ( info) |
4/18. Human histology of new attachment after root coverage using subepithelial connective tissue graft. BACKGROUND, AIMS: connective tissue grafts are used successfully in periodontal therapy for root coverage. However, reports on the histologic interface between the root surface and the grafted tissue have been few in number. This report describes a case study in which a subepithelial connective tissue graft was placed in a 27-year-old female on the maxillary left side. methods: The graft (15 mm long, 10 mm wide, 1.5 mm thick) included palatal periosteum and was placed with the periosteal side facing the exposed bone and root surfaces. RESULTS: 15 weeks after grafting, the teeth presented with residual recessions of 1 mm, and buccal probing depths were approximately 1 mm. 14 months post-surgery, the 1st maxillary premolars on both sides were extracted for orthodontic therapy. Clinical parameters at the graft site remained as at 15 weeks. Histologic analysis of tooth #24 showed that the sulcular epithelium was keratinized; epithelium lining the dentin exhibited rete ridges projecting into the gingival connective tissue; and junctional epithelium extended over new cementum. New connective tissue attachment was also observed, including periodontal ligament. CONCLUSION: Biological width was comparable pre- and post-surgery, indicating a real gain in attachment of 3.9 mm. ( info) |
5/18. amlodipine-induced gingival overgrowth: periodontal responses to stopping and restarting the drug. A case history of a woman with gingival overgrowth (GO) induced by amlodipine is presented. A 49-year-old Japanese woman, who was taking amlodipine, had gingival overgrowth and swelling on examination. No specific periodontal treatment was provided to the patient for the GO; however, the amlodipine was replaced with an ACE inhibitor after consultation with her medical practitioner. Within two months, the suspension of amlodipine resulted in a significant improvement in her periodontal condition. Failure to control the hypertension caused the physician to re-prescribe amlodipine. After three months, the gingival overgrowth returned; however, its severity was less when compared with the original periodontal condition, due to reduction in drug dose and periodontal therapy. This experience suggests that temporary suspension of a drug which can induce GO can improve the periodontal condition without the aid of surgical treatment. ( info) |
6/18. Clinical periodontal findings and microflora profiles in children with chronic neutropenia under supervised oral hygiene. BACKGROUND: This is the first known case report that used a polymerase chain reaction (PCR)-based method to help identify the oral microflora in patients with chronic neutropenia. In this study, we report clinical periodontal findings and microflora profiles of 2 children, 1 with severe congenital neutropenia (SCN, Kostmann type) and 1 with cyclic neutropenia (CN). methods: The SCN patient had severe gingivitis, whereas the patient with CN had mild gingivitis in the gingival margins. Monthly oral cleaning instruction and review were performed without subsequent periodontal therapy. oral hygiene conditions remained satisfactory and visible plaque was scarce, despite the persistence of mild gingivitis. Under supervised oral hygiene, we examined the presence of periodontal pathogens from patient plaque samples. RESULTS: By a PCR-based method, prevotella nigrescens, bacteroides forsythus, campylobacter rectus, and capnocytophaga gingivalis were detected in the SCN patient and P. intermedia, C. rectus, C. gingivalis, and C. sputigena in the CN patient, suggesting the existence of periodontal pathogens. actinobacillus actinomycetemcomitans, porphyromonas gingivalis, treponema denticola, and C. ochracea were not found in either patient. CONCLUSIONS: Use of 1% povidone iodine solution and local antibiotic application under supervised oral hygiene were helpful to improve gingival conditions in patients with chronic neutropenia. ( info) |
7/18. Acellular dermal matrix allograft in the treatment of mucogingival defects in children: illustrative case report. Mucogingival defects can occur in children and are of particular concern when orthodontic treatment is indicated. The rationale for surgical intervention is predicated on the need to repair the mucogingival defect and to establish adequate thickness of attached gingiva. The free gingival graft, usually obtained from the hard palate, is often used to increase the amount of attached gingiva. The prospect of a second surgical site, and its inherent risks and complications, which may include pain, discomfort, and bleeding, is especially undesirable in children. Important to consider is the possibility that a child may not have adequate tissue thickness at the donor site. A case report is presented utilizing the alternative soft tissue graft, Alloderm, to correct a mucogingival defect prior to orthodontic treatment. Adhering to the free gingival autograft technique, an acellular dermal matrix allograft was utilized at the graft site. The patient revealed good post-operative healing, tissue vascularization, and a healthy zone of attached gingiva at the six month follow up visit. Comparable results to the conventional autograft were obtained with less surgical time, surgical sites, and discomfort to the patient. ( info) |
8/18. verapamil-induced gingival overgrowth: a clinical, histologic, and biochemic approach. verapamil-induced overgrowth was most prominent in the anterior regions and interproximal areas associated with plaque retention. Despite periodontal therapy, overgrowths recurred 1 month after gingivectomy. Discontinuation of the drug resulted in regression of the overgrowths. Histologic findings showed inflamed connective tissue covered by an acanthotic, thickened oral epithelium with long rete pegs containing dyskeratotic pearls. The proliferation rate and protein and collagen production of fibroblasts from the overgrowth sites were markedly lower than in the control cells cultured from healthy gingiva. Incubation of fibroblasts in the presence of verapamil reduced protein and collagen synthesis. ( info) |
9/18. Plaque control in the treatment of juvenile periodontitis. With the purpose of establishing to what extent "periodontosis" responds to total plaque control, 21 such patients were observed over periods ranging from 8 to 34 years. Total plaque control in the present context means complete removal of all supragingival plaque by the patient and complete removal of all subgingival plaque by the dentist. The results were evaluated in terms of the number of lost teeth and the percentage of lost attachment during the observation period. It was observed that "periodontosis" cases responded to total plaque control in the same way as do ordinary cases, but with periodontosis, incomplete plaque control on any teeth led to extremely rapid bone loss and eventually to extraction. The reason for this is the unusually rapid apical migration of the subgingival plaque which is the most typical feature of the juvenile periodontitis. Some attachment and some teeth were lost in most of the patients, but a sufficient number of teeth with a sufficient amount of supporting tissue were maintained to provide a set of natural teeth that functioned well. This study shows that the reduced resistance to the invasion of subgingival plaque can be compensated for by a correspondingly strong emphasis on total plaque control. The term "periodontosis" is misleading, and should be replaced by the name "juvenile periodontitis" as suggested by Lehner et al. (1974). ( info) |
10/18. Induced reattachment in periodontic-endodontic lesions by root demineralization in situ. A new method of root preparation to enhance reattachment of gingival tissues to root dentin has been developed through extensive animal research. The improved technique may aid periodontists and endodontists in the management of deep combined lesions. This article reviews essentials of experimental animal data and presents case reports of three different clinical approaches to combined lesion closure attempts utilizing surgical and chemical root preparation. ( info) |