1/18. 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.- - - - - - - - - - ranking = 1keywords = gingival (Clic here for more details about this article) |
2/18. Implant site development using orthodontic extrusion: a case report.One of the most important factors in the successful placement of endosseous implants is the presence of adequate alveolar bone at the recipient site. alveolar bone loss associated with destructive periodontal disease frequently results in osseous defects that may complicate subsequent implant placement. Typically, such defects are treated prior to or at the time of implant surgery using the principles of guided bone regeneration. Under certain circumstances, however, such defects may be managed non-surgically by orthodontic extrusion. orthodontic extrusion can be used to increase the vertical bone height and volume and to establish a more favourable soft-tissue profile prior to implant placement. The addition, the increase in the vertical osseous dimension at interproximal sites may assist in the preservation of the interdental papillae and can further enhance gingival aesthetics. This report illustrates the treatment sequence for site development with orthodontic extrusion prior to immediate implant placement.- - - - - - - - - - ranking = 0.125keywords = gingival (Clic here for more details about this article) |
3/18. A case of Burkitt's lymphoma that presented initially with resorption of alveolar bone.A 16-year-old male was evaluated for a 1-month history of alveolar bone resorption, which had been treated with endodontics by a neighborhood dentist. Intraoral examination showed slight gingival swelling and teeth mobility. However, no tumor mass was seen. The panoramic image showed resorption of alveolar bone and loss of teeth lamina dura. Because he complained of general fatigue, he was introduced to the internist. Biopsies of gingiva and bone marrow aspiration revealed a massive proliferation of lymphoblasts expressing CD10, 19, 20 and hla-dr antigens on the surface. Their karyotypes were abnormal; 46, XY, t (8;14) (q24;q32). Accordingly, he was diagnosed as Burkitt's lymphoma, and received intensive chemotherapy which relieved his symptoms and decreased his tumor. However, his disease soon became refractory to chemotherapy, and he died 11 weeks after the onset.- - - - - - - - - - ranking = 0.125keywords = gingival (Clic here for more details about this article) |
4/18. Clinical effect of etidronate on alveolar pyorrhoea associated with chronic marginal periodontitis: report of four cases.Etidronate 200 mg daily was administered to four female patients with periodontitis and resultant alveolar pyorrhoea for periods of 2 weeks, followed by off-periods of 10 weeks or more, for 2-3 years. The macroscopic appearance of gingival mobility of the teeth, depth of periodontal pockets, and X-ray findings of alveolar bones improved markedly during this time. The effects were first observed after 6-12 months of treatment. These findings indicate that bisphosphonates may be effective in the treatment of periodontitis and resultant alveolar pyorrhoea. The effect may be mediated by the inhibitory action on bone resorption and the anti-inflammatory action of etidronate. Concomitant conventional dental management is also required.- - - - - - - - - - ranking = 0.125keywords = gingival (Clic here for more details about this article) |
5/18. Regenerative treatment of serious periodontosis with grafting of cancellous iliac bone and gingival flaps and replanting of patients' teeth.The purpose of this study was to assess the ability of serious periodontosis patients to regain satisfactory biting function, using the patients' own teeth, by regeneration of the alveolar bone. Twelve serious periodontosis patients whose alveolar bone was markedly absorbed and whose teeth were quite unstable were treated with replanting of their teeth and grafting of cancellous iliac bone and gingival flaps by the clinical team, which consisted of plastic surgeons and dentists. No patients developed postoperative complications (e.g., infections), and grafted iliac bone took in all patients. The total number of replanted teeth was 65, and only 4 of them fell off (92% take rate). Three to 4 months after surgery, the replanted teeth received prosthetic treatment so that the patients could begin biting. Ten patients were monitored for 5 months or longer, and they started to eat normal food after the fifth month. Regained biting function and satisfaction of having food were almost the same as before the periodontosis became severe in these 10 patients. Regeneration of alveolar bone was confirmed in later radiographs. To date, the maximum follow-up period is 2 years and 8 months (average = 1 year and 6 months). All patients have good biting function, and there have been no findings of absorption of reconstructed alveolar bone or of the root of replanted teeth. This treatment method would be quite useful for patients with serious periodontosis.- - - - - - - - - - ranking = 0.625keywords = gingival (Clic here for more details about this article) |
6/18. Generalized aggressive periodontitis in a prepubertal patient: a case report.A 10-year-old boy presented with generalized gingival inflammation, extensive alveolar bone loss, and tooth mobility. Clinical and radiographic examination supplemented by microbiologic investigation led to a diagnosis of classically termed prepubertal periodontitis (now known as generalized aggressive periodontitis). Other than severe periodontitis, the child was systemically healthy. Neither unusual infections nor abnormalities in neutrophil functions were detected. Microbiologic examinations by culture revealed the presence of the periodontal pathogen actinobacillus actinomycetemcomitans. Treatment consisted of extraction of mobile teeth, supragingival and subgingival debridement, subgingival curettage, and root planing combined with a 1-week prescription of a combination of metronidazole and amoxicillin. Scanning electron microscopy of extracted teeth revealed hypoplastic and aplastic cementum at the periodontally exposed and intact surfaces. Clinical and microbiologic follow-up was continued over a 1-year period. No periodontal lesions have been detected, and A actinomycetemcomitans could not be isolated from the subgingival areas of the remaining teeth at the end of the first year. Since A actinomycetemcomitans was the main pathogen present in the subgingival microflora of the patient, it might play a key role in the etiology of prepubertal periodontitis.- - - - - - - - - - ranking = 0.75keywords = gingival (Clic here for more details about this article) |
7/18. The AAMOP case challenge: a rapidly enlarging pigmented lesion of the buccal mucosa.A slowly growing gingival enlargement of the right anterior maxilla was observed in a 56 year-old woman. The clinical features, differential diagnosis and novel management approach are discussed. See if you can make the diagnosis.- - - - - - - - - - ranking = 0.125keywords = gingival (Clic here for more details about this article) |
8/18. Formation of mucogingival defects associated with intraoral and perioral piercing: case reports.BACKGROUND: The authors provide clinical findings in five patients wearing oral jewelry to illustrate the risks of experiencing periodontal injury associated with body piercing involving intraoral and perioral sites. They also present a literature review of other adverse dental and medical consequences attributed to oral piercing. CASE DESCRIPTIONS: Five young adult patients with tongue and lip piercing sought dental care. Each patient exhibited some degree of gingival recession and mucogingival defects in proximity of their oral jewelry. Three of these patients had probing depths ranging from 5 to 8 millimeters in the affected areas. CLINICAL IMPLICATIONS: Intraoral and perioral jewelry may be associated with the development of significant mucogingival deformities. Because severe attachment loss can develop even when gingival recession is minimal, it is critical that patients with oral piercing routinely undergo comprehensive periodontal assessment. The authors urge clinicians to educate patients about the potential risks regarding the practice of oral piercing.- - - - - - - - - - ranking = 1keywords = gingival (Clic here for more details about this article) |
9/18. Hereditary gingival fibromatosis associated with generalized aggressive periodontitis: a case report.BACKGROUND: Hereditary gingival fibromatosis is a rare, genetically inherited overgrowth condition that is clinically characterized by a benign fibrous enlargement of maxillary and mandibular keratinized gingiva. A syndromic association between gingival fibromatosis and a wide variety of other genetically inherited disorders has been described. However, its coexistence with aggressive periodontitis has not been reported. methods: A 24-year-old African-American female, patient (proband X, [Px]) reported with a chief complaint of tooth mobility and gingival enlargement. Clinical examination revealed moderate to severe gingival overgrowth on both mandible and maxilla. Generalized attachment loss and mobility of the teeth were observed. Radiographic evaluation demonstrated severe alveolar bone loss. The patient was diagnosed with gingival fibromatosis and aggressive periodontitis based on the clinical and radiographic findings. Her brother (Bx) and her mother (Mx) were evaluated and diagnosed with gingival fibromatosis suggesting that this is a dominant trait in the family and gingival fibromatosis might be of hereditary origin. In addition, the brother also exhibited localized aggressive periodontitis. Medical history revealed no other systemic or local contributory factors associated with the oral findings in any of the subjects. RESULTS: Surgical therapy included internal bevel gingivectomy combined with open flap debridement procedures for Px and Bx. Only internal bevel gingivectomy was performed for Mx since there was mild bone resorption and no intrabony defects. At the time of surgery, gingival biopsies were obtained and fixed in 4% paraformaldehyde. Multiple serial sections were stained with hematoxylin and eosin. Microscopic evaluation of the gingival specimens revealed large parallel collagen bundles associated with scarce fibroblasts in the connective tissue. The collagen bundles reached into the subepithelial connective tissue where elongated rete-pegs were also observed. Following the completion of the treatment, no signs of recurrence or bone resorption were observed over 2-year follow-up. CONCLUSIONS: This is the first report of hereditary gingival fibromatosis associated with aggressive periodontitis. Combined treatment comprising removal of fibrotic gingival tissue and traditional flap surgery for the elimination of intrabony defects represents a unique treatment approach in periodontal therapy. Two-year follow-up revealed that both the gingival overgrowth and the destructive lesions were successfully treated.- - - - - - - - - - ranking = 5.4868038225192keywords = gingival overgrowth, gingival, overgrowth (Clic here for more details about this article) |
10/18. Periodontal status in two siblings with severe congenital neutropenia: diagnosis and mutational analysis of the cases.BACKGROUND: Severe congenital neutropenia (SCN), also known as Kostmann syndrome, was originally reported as an autosomal recessive disease of neutrophil production. The disease is characterized by a maturation arrest of neutrophil precursors at the promyelocytic stage of differentiation and by extremely low levels of mature neutrophils in peripheral blood. methods: A 6-year-old male presented with a complaint of gingival swelling and bleeding, and swelling at the left side of his face. Upon clinical examination, severe inflammation of all gingival tissues was apparent, and a periapical abscess with mobility was noted on the left mandibular second molar. Medical and dental histories revealed numerous recurrent bacterial infections associated with oral and non-oral tissues. His medical history with recurrent infections led us to evaluate his 3-year-old sister to determine the status of her oral health. inflammation of her oral tissues and recurrent bacterial infections were apparent. Their consanguineous parents were in good health. To assist in identifying possible systemic diseases underlying the inflammatory situation in the siblings, consultations were requested from the Pediatric hematology Department at Selcuk University and Pediatric Oncology Department at Gulhane Military Medical Academy. RESULTS: Based on absolute neutrophil count (< or =200/mm(3)) and bone marrow aspiration findings consistent with early maturation arrest in myelopoiesis, the cases were diagnosed as SCN. No chromosomal abnormality was detected upon cytogenetic examination. Sequencing analysis also revealed no mutation in the neutrophil elastase or growth factor independent-1 (GFI-1) genes in these patients. Severe periodontal disease, attachment loss, and mobility for over 50% of the deciduous teeth were noted. Within 6 months, the male sibling lost all of his deciduous teeth due to periapical and periodontal infections. His sister presented with tooth mobility for all mandibular incisors. Monthly visits, including scaling, polishing, and 0.2% chlorhexidine digluconate irrigation were performed to support their oral hygiene and to avoid recurrent oral infections. We have been able to stabilize these patients' periodontal conditions during a 2-year follow-up period. CONCLUSION: This case report emphasizes the role of periodontists and pediatric dentists in the diagnosis of diseases linked with neutrophil and other systemic disorders and highlights the need to optimize the health of oral tissues with regular appointments.- - - - - - - - - - ranking = 0.25keywords = gingival (Clic here for more details about this article) |
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