1/383. Abnormal deposition of type VII collagen in Kindler syndrome. Kindler syndrome is an extremely rare genetic disorder with features of epidermolysis bullosa and poikiloderma congenitale. Approximately 70 cases have been documented in the past 50 years, but only a few investigations of the basement membrane components have been done on these patients. The aim of this study was to examine the components of the basement membrane zone in search of the pathobiological defect(s) responsible for the clinical findings from a female 16-year-old patient diagnosed with Kindler syndrome. This patient also suffered from advanced early-onset periodontal disease. Biopsies were taken from inflamed gingiva and noninflamed oral mucosa as part of periodontal treatment. The basement membrane zone was examined using immunofluorescence microscopy to bullous pemphigoid antigens 1 and 2, collagen types IV and VII, laminins-1 and -5, and integrins alpha3beta1 and alpha6beta4. The biopsies studied revealed blistering with trauma above the level of lamina densa based on distribution of type IV collagen and laminin-1 at the blister floor. In the noninflamed mucosa, discontinuous areas of the basement membrane zone were found. Expression of the basement membrane zone components and the integrins studied appeared otherwise normal with the exception of type VII collagen which was found in abnormal locations deep in the connective tissue stroma. Our results suggest that Kindler syndrome is associated with abnormalities in the construction of the basement membrane, especially in the expression of type VII collagen. These alterations are likely to play a role as etiological factors leading to blister formation and early onset periodontal disease. ( info) |
2/383. Histological investigation of the tissue response to hydroxyapatite used as an implant material in periodontal treatment. patients with severe periodontitis and who had one or more teeth with infrabony pockets were treated by periodontal surgery with implantation of hydroxyapatite particles into the bone defects at the time of surgery. Subsequently, in three patients it was found necessary to extract a tooth for reasons not related to the previous periodontal treatment. Specimens that included the local soft tissues and crestal bone attached to the teeth were obtained at 22, 40 and 80 weeks after placement of the implant. They were decalcified and stained with haematoxylin and eosin and examined under light microscopy. The healing response was found to vary between specimens, and between sites within the same specimen. The early stage of healing showed the implant particles surrounded by collagen. Subsequently, varying degrees of resorption of the periphery of the particles was seen, and at some sites bone deposition was observed. These different healing responses were found to be progressing concurrently at sites in close proximity. Further work is needed to confirm the histological findings described in the paper. ( info) |
3/383. Treatment considerations in rapidly progressive periodontitis: a case report. This article presents a concept for the control of periodontal pathogens in early-onset periodontitis and demonstrates the reparative potential of periodontal tissue when the infection is under control. The patient discussed here was diagnosed with rapidly progressive periodontitis. We were able to reduce the bacterial mass with scaling and root planing and, in conjunction with systemic antibiotics, return the microbial profile to the normal range. Microbiological testing was used to monitor the microbiota and to adjust antimicrobial treatment. Improvements in probing depths and attachment levels were monitored for more than 1 year. Tissue response to this treatment made surgical intervention unnecessary. Although not essential, orthodontic treatment enhanced cleansability and improved esthetics. ( info) |
4/383. guided tissue regeneration in the management of severe periodontal-endodontic lesions. diagnosis of combined periodontal-endodontic lesions can prove difficult and frustrating. They are often characterised by extensive loss of periodontal attachment and alveolar bone, and their successful management depends on careful clinical evaluation, accurate diagnosis, and a structured approach to treatment planning for both the periodontic and endodontic components. Recent advances in regenerative periodontics have led to improved management of periodontal-endodontic lesions. This paper reviews the management of such lesions in light of these recent advances and illustrates this through reports of two patients who had severe periodontal involvement. ( info) |
5/383. Treatment of Class II furcation lesions using an autogenous periosteal barrier. Over the last two decades, guided tissue regeneration has achieved significant advances in periodontal healing that confirm the efficacy of periodontal regeneration. Several types of barriers have been utilized to apply this principle to periodontal wound healing. The objective of this article is to review the literature and principles of guided periodontal tissue regeneration (GPTR) in the treatment of Class II furcation defects and to describe a surgical technique that utilizes the neighboring periosteum of the furcation lesion as a barrier for the clinical application of GPTR. ( info) |
| Three cases are presented where early exposure of a resorbable membrane occurred during guided tissue regeneration therapy. An antimicrobial regimen was selected to determine whether infection of exposed membranes could be controlled to the point of achieving acceptable clinical results without membrane removal. The results suggest that with the use of the antimicrobial regimen: (1) exposure is compatible with successful clinical results, and (2) removal is not necessary. ( info) |
7/383. Severe, rapidly progressing peri-implantitis. The replacement of teeth by means of titanium implants is a safe and predictable procedure in most patients. Some studies show that a small number of patients lose the majority of their implants. Unfortunately, it is impossible to identify these patients prior to surgery. It is important to report such cases so that we may, in the future, be able to identify them before surgery. The present case showed a severe and rapid exfoliation of titanium implants. Out of 8 implants inserted in the anterior lower jaw of this patient, only two maintained osseointegration over a 2-year period. ( info) |
8/383. Cemental tear treated with guided tissue regeneration: a case report 3 years after initial treatment. Cemental tear is a rare but probably underdiagnosed condition that may be a factor in rapid periodontal breakdown. The present case report describes the regenerative treatment of a periodontal lesion around a mandibular canine in a 50-year-old woman. The preoperative radiograph revealed a small cemental tear within an intrabony lesion. The three-wall bony lesion was treated with a barrier membrane and followed for 3 years. periodontal pocket reduction was 5.5 mm, and attachment gain amounted to 3.5 to 4.5 mm Standardized radiographs showed remarkable, 1.6-mm bone fill of the intrabony lesion. Also, a band of keratinized tissue had formed. ( info) |
| hypophosphatasia (HOPS) is an inherited disorder characterized by the defect of skeletal mineralization due to tissue-nonspecific alkaline phosphatase (TNSALP) deficiency. In this study we analyzed the TNSALP gene from a Japanese patient with HOPS, his parents, his brother, and unrelated normal controls. The proband is a 25-year-old Japanese male diagnosed with childhood hypophosphatasia. The patient reported premature exfoliation of the deciduous teeth and severe periodontal destruction of the permanent dentition. Genomic dna was extracted from peripheral leukocytes of subjects. Eleven pairs of the polymerase chain reaction (PCR) primers were used to amplify the coding exons according to the published sequence data of the TNSALP gene. The PCR amplified samples were subjected to PCR-single strand conformation polymorphism (SSCP) analysis and PCR-allele specific oligonucleotide (ASO) analysis. In PCR-SSCP analysis of the patient's genomic dna, the fragments containing exons 9 and 10 revealed abnormal mobilities. These abnormal mobilities (exons 9 and 10) were also found from his mother and father's genomic dna, respectively. The sequencing analysis of the abnormal bands extracted from the SSCP gel showed a T to C transition at nucleotide position 1155 (T1155C) in exon 9 and G1320A in exon 10. PCR-ASO analysis confirmed these missense point mutations. PCR-ASO analysis also confirmed that mutation-specific oligonucleotides corresponded to the new mutations and did not hybridize with PCR products from normal control genomic DNAs. These results indicated that the proband was a compound heterozygote who inherited T1155C mutation in exon 9 from the mother and G1320A mutation in exon 10 from the father. Both of them are new missense point mutations and appear to cause significant changes in the structure and function of TNSALP. ( info) |
10/383. Leukocyte adhesion deficiency in a child with severe oral involvement. Leukocyte adhesion deficiency is a rare inherited defect of phagocytic function resulting from a lack of leukocyte cell surface expression of beta2 integrin molecules (CD11 and CD18) that are essential for leukocyte adhesion to endothelial cells and chemotaxis. A small number of patients with leukocyte adhesion deficiency-1 have a milder defect, with residual expression of CD18. These patients tend to survive beyond infancy; they manifest progressive severe periodontitis, alveolar bone loss, periodontal pocket formation, and partial or total premature loss of the primary and permanent dentitions. We report on a 13-year-old boy with moderate leukocyte adhesion deficiency-1 and severe prepubertal periodontitis. This case illustrates the need for the dentist to work closely with the pediatrician in the prevention of premature tooth loss and control of oral infection in these patients. ( info) |