1/213. Tissue necrosis after subgingival irrigation with fluoride solution. Irrigation of periodontal pockets with fluoride solution after scaling and root planing is occasionally recommended to inhibit the growth of pathogenic bacteria in the periodontal pocket. At the same time, irrigation enables mechanical removal of loosely adhering plaque and debris. Due to its toxicity, fluoride solution deposited in the periodontium may lead to tissue damage. We report in this paper, a case of extensive periodontal tissue necrosis and permanent loss of alveolar bone after irrigation of periodontal pockets with stannous fluoride solution. The literature on the toxic effects of fluoride on the local tissues is briefly reviewed and arguments for a re-evaluation of the use of stannous fluoride for pocket irrigation are provided. ( info) |
2/213. Periodontal and peri-implant bone regeneration: clinical and histologic observations. The principle of guided tissue regeneration by barrier membranes to restore lost periodontal tissue around natural teeth has also been used around osseointegrated implants in an attempt to restore alveolar ridge defects. While most periodontal procedures in the literature describe root coverage by mucogingival surgery, which achieves healing through soft tissue attachment, regeneration of denuded root surfaces is performed by guided tissue regeneration using expanded polytetrafluoroethylene barrier membranes and demineralized freeze-dried bone allografts as inductive/conductive materials. In this study the technique is applied in two partially exposed cylindrical hydroxyapatite-coated implants in extraction sites in one patient. Surgical reentry in both sites is presented, with histologic examination revealing new bone formation on the exposed root surface and the hydroxyapatite-coated implants. ( info) |
3/213. Resin-ionomer and hybrid-ionomer cements: part II, human clinical and histologic wound healing responses in specific periodontal lesions. Twenty-five subjects with a total of 50 subgingival restorations participated in this study. At the beginning of the investigation, nine teeth that were considered hopeless because of the extent of their pathology were selected for extraction to evaluate histologically the restorations and their effect on the adjacent tissues. The purpose of this article is to demonstrate the responses to the clinical applications as well as to the placement of resin-ionomers in subgingival lesions. Clinical and histologic evidence of epithelial and connective tissue adherence to resin-ionomer restorative materials was observed during the healing process. ( info) |
4/213. guided tissue regeneration procedure applied to the treatment of endodontic-periodontal disease: analysis of a case. The clinical condition of a patient with chronic adult-type periodontal disease, as well as gingival recession reaching the tooth apex on a mandibular lateral incisor, is discussed. Because the use of conventional techniques would have resulted in tooth loss, the guided tissue regeneration procedure was applied, with successful results. ( info) |
5/213. Simultaneous team approach of a crown-lengthening procedure and an operative restoration: technique and long-term effect. Traditionally, crown-lengthening procedures to expose subgingival caries for operative restorative work are carried out in a two-stage approach. A disadvantage of this procedure is that the gingival margin associated with the treated tooth moves apically; this may create an esthetic problem. Resin-modified glass-ionomer cement has been demonstrated to have good biocompatibility with dental hard and soft tissues. Surgical and restorative procedures were combined at the same appointment in an effort to achieve a restoration with minimal change in the gingival margin. Four patients have been treated with this one-stage team approach and followed for 8 to 13 months. The clinical results demonstrated this team approach procedure is excellent for the dentition when esthetics is a consideration. ( info) |
6/213. crest syndrome and periodontal surgery: a case report. crest syndrome is a slowly progressive form of systemic scleroderma. It is characterized by calcinosis cutis, Raynaud's phenomenon, esophageal involvement, sclerodactyly, and telangiectasia. There are limited reports of dental treatment for patients with this syndrome, and no reports of periodontal surgical procedures. This paper presents a case report of periodontal surgical treatment in a 38-year-old female patient with crest syndrome, and a discussion of the clinical manifestations of the syndrome as they relate to dental treatment. ( info) |
7/213. Adverse effects associated with a bioabsorbable guided tissue regeneration device in the treatment of human gingival recession defects. A clinicopathologic case report. This clinicopathologic case report documents an adverse effect associated with the use of a polylactic acid-based barrier in the treatment of human gingival recession defects. A total of 27 consecutively treated patients, in whom guided tissue regeneration with a polylactic acid barrier was used to correct gingival recession defects, were evaluated. This adverse effect consisted of a midradicular-apical swelling, generally asymptomatic, with no apparent predilection for gender, age, tooth type or location (maxilla/mandible), or surgical procedure. It was observed in 14 of 27 (52%) patients and 22 of 41 (54%) defects. The swelling decreased in size over time and in most cases, it completely resolved within 12 months postsurgery. Histopathologic evaluation of a 14-week specimen indicated characteristics (multinucleated giant cells, foamy macrophages) consistent with a foreign body reaction. These findings suggest that patients undergoing GTR procedures with synthetic absorbable devices for the treatment of gingival recession defects should be advised of the possible occurrence of such an adverse effect. ( info) |
8/213. Esthetic restoration of a single-tooth dental implant using a subepithelial connective tissue graft: a case report with 3-year follow-up. This case report describes the use of a subepithelial connective tissue graft to restore the gingival papillae and augment ridge soft tissues adjacent to a dental implant. The patient was referred for periodontic and prosthodontic evaluation after the placement of an implant--with the implant head 6.5 mm below the adjacent cementoenamel junction--in an area of inadequate bone volume with deficient interproximal papillae and ridge soft tissues. The resulting esthetic defect was restored by means of a combined technique that used a subepithelial connective tissue graft and an emergence profile-contoured crown. A 3-year clinical follow-up with complete regeneration of the gingival papillae is described. ( info) |
9/213. Human histologic evaluation of root coverage obtained with a connective tissue with partial thickness double pedicle graft. A case report. The use of a connective tissue graft combined with a pedicle graft has been proven an effective method to achieve root coverage. However, little is known about the histologic results in humans. A connective tissue with partial thickness double pedicle graft was performed on 2 teeth scheduled for extraction for prosthetic reasons. The procedures were clinically successful (100% and 83.3% root coverage). At 6 months postoperative, the teeth were extracted with conservative block sections and analyzed histologically. Two different healing patterns were seen. The first was characterized by a long junctional epithelial attachment that extended well beyond the original gingival margin and occasionally almost to the original bone level with minimal connective tissue adjacent to the tooth. The other pattern was a short junctional epithelium that stopped at the previously exposed root surface. In this pattern, there was predominately connective tissue adjacent to the tooth with some isolated areas of epithelium. No new bone or cementum was seen in any section. The use of a technique that combines a connective tissue graft with a pedicle graft can produce root coverage and a successful clinical result. However, the histological evaluation of this case report revealed that true regeneration was not seen in this study, only repair. ( info) |
10/213. Improvement of multiple facial gingival recession by non-surgical and supportive periodontal therapy: a case report. We report a case of multiple facial gingival recession which was improved by non-surgical and supportive periodontal therapy. The patient, a 28-year-old Japanese woman, presented for treatment of multiple facial gingival recession ranging from 1 to 4 mm on teeth 5 through 12 and 19 through 30. Periodontal plastic surgery to cover the exposed multiple root surfaces was suggested. However, because of emotional problems, the patient did not wish to undergo the procedures and instead accepted non-surgical periodontal therapy including oral hygiene instruction, scaling, and root planing. The exposed root sites were monitored at periodic maintenance visits, and gradual improvement through a coronal increase of the gingival margin was noted. The possible etiologic factors and healing process associated with this case are discussed. ( info) |