234 research outputs found
Plaque‐induced gingivitis: Case definition and diagnostic considerations
No full textClinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC
Gingival Recession Treatment: Guided Tissue Regeneration With Bioabsorbable Membrane Versus Connective Tissue Graft
No full textBACKGROUND: Gingival recession represents a significant concern for patients and a therapeutic problem for clinicians. Several techniques have been proposed to achieve root coverage. The purpose of this randomized clinical trial was to evaluate the effect of a guided tissue regeneration (GTR) procedure in comparison to connective tissue graft (CTG) in the treatment of gingival recession defects. METHODS: Twelve patients, each contributing a pair of Miller Class I or II buccal gingival recessions, were treated. In each patient one randomly chosen defect received a poly(lactic acid)-based bioabsorbable membrane, while the paired defect received a CTG. Clinical recordings included oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT). RESULTS: Mean RD statistically significantly decreased from 2.5 mm presurgery to 0.5 mm with GTR (81% root coverage), and from 2.5 mm to 0.1 mm with CTG (96% root coverage), at 6 months postsurgery. Prevalence of complete root coverage was 58% for the GTR group and 83% for the CTG group. Mean CAL gain was 2.0 mm for the GTR group and 2.2 mm for the CTG group. No statistically significant differences between treatment groups were observed for changes in RD, RW, PD, CAL, and KT. CONCLUSIONS: Treatment of human gingival recession defects by means of either GTR or CTG results in clinically and statistically significant improvement of the soft tissue conditions of the defect when pre- and post-treatment measurements were compared. Although differences between CTG and GTR in mean root coverage and prevalence of complete coverage consistently favored the CTG procedure, the differences in measurements were not statistically significant
Adverse Effects Associated With a Bioabsorbable Guided Tissue Regeneration Device in the Treatment of Human Gingival Recession Defects. A Clinicopathologic Case Report
No full textThis 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
Implant Patient Compliance Varies by Periodontal Treatment History.
No full textBACKGROUND: This retrospective study aims to assess compliance to supportive periodontal therapy (SPT) among patients treated with dental implants with different periodontitis histories and the possible influence of their compliance on peri-implant marginal bone level. METHODS: Dental records of 106 patients treated with at least one dental implant were reviewed. A single operator who did not provide care to the patients recorded the following during the first year of implant function (first year of follow-up), during the first 5 years of follow-up, and during the entire follow-up duration: 1) number of recalls; 2) compliance, calculated from registered attendance; 3) periodontal disease history; 4) peri-implant radiographic bone level from most recent examination; and 5) clinical parameters including probing depth and bleeding on probing. Clinical and radiographic parameters were assessed at site level and analyzed for possible associations among them and with demographic parameters. RESULTS: Collected data were based on 156 implants with an average of 6.5 ± 3.4 years (range: 1 to 13 years) in function. Patients with periodontitis history demonstrated greater compliance than patients without periodontitis history during the two longer follow-up times. Over time, the majority of patients demonstrated partial compliance (71% to 80% of patients). Peri-implant bone level averaged 0.9 ± 1.1 mm, without significant association with compliance level; however, positive periodontitis history and more years in function were significantly associated with greater peri-implant bone loss. CONCLUSIONS: Patients with implants partially comply with scheduled SPT, regardless of periodontitis history. Patients who had received periodontal treatment demonstrated better compliance than those without prior periodontal therapy experiences
The Effect of Suturing Protocols on Coronally Advanced Flap Root‐Coverage Outcomes: A Meta‐Analysis
No full textThe purpose of this systematic review and meta-analysis was to investigate whether suturing protocols (suture removal timing and/or type of suture material) influence root coverage outcomes in recession defects treated with a coronally advanced flap (CAF) procedure.
Databases (MEDLINE, EMBASE) were searched for randomized clinical trials (RCTs) that assessed single-tooth, Miller Class I/II recession defects, surgically treated by CAF. Mixed-effects linear regression analysis evaluated differences on complete root coverage (CRC) between RCTs with early (<10 days postoperatively) and late (≥10 days) suture removal, as well as between RCTs using absorbable and non-absorbable sutures removed ≥10 days postoperatively.
Seventeen RCTs were eligible for inclusion. Overall, data from 325 single gingival recession defects revealed a statistically significant superior proportion of sites exhibiting CRC when sutures were removed ≥10 days postoperatively compared to those in which sutures were removed <10 days (P = 0.03). Conversely, there were no significant differences in CRC outcomes between absorbable and non-absorbable sutures when they were removed ≥10 days after surgery (P = 1.00). The majority of included RCTs (59%) reported use of non-absorbable suture materials.
Within the limitations of the available data, it can be concluded that early suture removal (<10 days) can negatively influence root-coverage outcomes in single-tooth defects treated by a CAF procedure. There is a strong need for studies designed specifically to investigate suturing protocols in root-coverage procedures
Periodontal soft tissue root coverage procedures: A systematic review from the AAP regeneration workshop
No full textThis paper aims to create a "bridge" between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice.
This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well.
Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes.
All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT
Voclosporin‐Induced Gingival Enlargement: A Case Report
No full textThe gingiva (gums) is often a site in the mouth where changes or reactions can occur in response to certain systemic medications. Some drugs, particularly those used to treat autoimmune conditions or following organ transplants, can cause the gums to grow excessively, a condition known as drug-induced gingival enlargement (also known as gingival overgrowth). In this report, we document the case of a 27-year-old woman with lupus nephritis who developed gingival enlargement after starting a medication called voclosporin. This drug is a newer treatment option for lupus nephritis, but until now had not been linked to gingival enlargement. The patient experienced significant gum swelling, bleeding, and pain, making it difficult for her to eat. After trying nonsurgical treatments with limited success, and given her objection to surgical therapy, the medication was gradually stopped in consultation with her physician. The enlargement of the gums significantly improved once the drug was discontinued. This report highlights for the first time, to the authors\u27 knowledge, the development of gingival enlargement in response to voclosporin therapy and the significant improvement of the condition upon cessation of drug usage
Management of Severe Gingival Recession Using a Double Papilla Connective Tissue Graft: A 2-Year Follow-Up Case Study
No full textGum recession is a common condition where the gum tissue pulls away from the teeth, exposing the roots and making them more prone to damage. This report describes the treatment of a 30-year-old woman who had severe gum recession on her lower left canine tooth, caused by her long-term habit of scratching the gums with her fingernail. To restore the lost tissue and protect the tooth, a double papilla flap (a surgical technique that moves nearby tissue) along with a connective tissue graft (transplanted tissue from the roof of the mouth) was used. Over 2 years, the recession was reduced by almost 90%, and the tissue over the tooth became healthier and stronger. Although her habit caused some recession to return, the thickened tissue allowed for natural healing once she controlled her habit again. This case highlights how proper surgical technique selection and execution, combined with patient behavior changes, can successfully treat severe gum recession. It also demonstrates how ultrasound imaging can be used as a non-invasive tool to monitor soft tissue healing over time
A Taxa de Insucesso de Implantes Dentários Unitários Substituindo Implantes que Falharam Pode ser Superior à Taxa de Insucesso de Implantes Inseridos em Locais não Tratados Previamente com Implantes
No full textPeripheral Calcifying Odontogenic Cyst in Maxillary Anterior Gingiva: A Case Report
No full textBACKGROUND: Calcifying odontogenic cysts (Gorlin cysts) most commonly present centrally and have only rarely been reported in peripheral locations. The purpose of this report is to describe a new case of peripheral calcifying odontogenic cyst (PCOC) occurring in the anterior maxillary gingiva and to review the management and differential diagnosis of such a lesion. METHODS: A 37-year-old female presented with a long-standing submucosal nodule on the gingiva between the maxillary central incisors, with asymptomatic growth over the last three years. Following an initial incisional biopsy, a diagnosis of PCOC was established. To exclude the possibility of a central process, a corresponding small field of view cone beam CT scan was obtained and the patient returned for a 6 mm excisional biopsy to the depth of the periosteum. RESULTS: Results of these additional assessments supported the original diagnosis of PCOC. Following uneventful healing of the second biopsy, no recurrence or other clinical findings were noted at 1-year follow-up. CONCLUSION: While rare, the peripheral variant of calcifying odontogenic cyst, and other peripheral counterparts to recognized central cysts and tumors, should be considered in a differential diagnosis for a benign gingival nodule. Gingival tissue should be submitted for histologic evaluation to ensure a neoplastic process is not present. KEY POINTS: Various lesions may present on the gingiva as a bump ; these can represent common clinical entities, such as pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell granuloma, and fibroma, or more rare conditions that may not be adequately considered in the differential diagnosis. A rarely documented case of peripheral calcifying odontogenic cyst (PCOC; Gorlin cyst) on the maxillary anterior gingiva of an adult female is reported here and compared with the few other similar PCOC cases in the literature. A biopsy of gingival lesions is always necessary to establish the correct diagnosis and provide the appropriate treatment. PLAIN LANGUAGE SUMMARY: Several different lesions can appear on the gingiva (gums). Some are quite common, and some are rare. This report documents the occurrence of a new case of calcifying odontogenic cyst (Gorlin cyst), a type of cyst that has been rarely found outside the jawbone, presenting as a bump on the gingiva between the maxillary central incisor teeth of an adult female. Because of the patient history, a peripheral calcifying odontogenic cyst (PCOC) was not initially suspected. Following a biopsy, a PCOC diagnosis was given. The possibility of a lesion within the bone was then excluded by an X-ray (cone beam CT) scan examination. A second, more extensive biopsy confirmed the diagnosis and the removal of the lesion. The patient had no complications or recurrence for the following 12 months. This case highlights the need to always biopsy lesions presenting on the gums to obtain a proper diagnosis and provide the correct treatment
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