[Gingival recession. I].
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Biomedical subjects
Publications and source records attributed to H Smukler.
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This paper explores, by means of clinical observation, toothbrush misuse and its relationship to gingival recession/clefting. The morphology of the lesions created is correlated with the vigor, duration, frequency and direction of the toothbrush abuse. In addition, histologic observations of biopsied tissue from different types of clefts and recessions are used as a basis for discussion of the possible pathogenesis of this type of lesion.
This descriptive study compared the healing of mucoperiosteal and "stimulated" osteoperiosteal flaps for the treatment of surgically created periodontal recessions in dogs. Surgically created defects on the canine teeth of 10 healthy mongrel dogs were covered by specially designed, cemented copper bands for 4 weeks (Several maxillary premolar teeth were managed in the same way). A plaque and calculus-promoting diet was fed to the animals during this period. When the bands were removed the diet was altered and an intensive oral hygiene program was instituted. The contralateral tooth, chosen randomly, was utilized for placement of the mucoperiosteal lateral sliding flap and acted as the control. The experimental side was surgically stimulated 21 days prior to elevation of a "stimulated" osteoperiosteal flap for repositioning over the denuded roots. The animals were sacrificed with an overdose of Nembutal and block sections for histologic study were taken at periods ranging from 14 to 50 days. Histologic findings indicate that healing of the stimulated flaps was accompanied by the formation of a relatively short dentogingival epithelium, cementogenesis which varied in amount and type, and new connective fiber insertion into cementum. By contrast, the mucoperiosteal flaps healed with a long dentogingival epithelial relationship and no cementogenesis or connective tissue reattachment.
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In order for successful coverage of denuded roots to be accomplished, correctly applied fundamental biological principles must be considered in the choice and utilization of the surgical modality. In this report some representative clinical cases are presented to indicate favorable results that may be achieved with stimulated osteoperiosteal pedicle flaps. These cases are part of an ongoing clinical and statistical evaluation.
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The effects of vital root resection upon the remaining pulp were studied in twenty-six periodontally involved human molars. The pulp was extirpated 14 days after the intervention. Granulomatous tissue present in the pulp chamber protruded from the site of the exposure as a polyp in eleven cases. Mild chronic inflammatory changes were present in the coronalmost part of the radicular pulp. The apical pulp was not affected at this time interval.
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An investigation was designed to study the clinical and histological effects of delaying endodontic therapy for a period of 2 weeks without dressing of the exposed pulp, after vital intentional root amputation had been carried out on periodontally involved teeth. From the results obtained it was possible to conclude that: 1. Endodontics, prior to surgical root amputation, remains the treatment of choice. 2. When preoperative endodontics is not possible, the approach used in this study will provide good results without severe, adverse clinical or histological effects. 3. The altered periodontal condition and tooth form do not interfere with the performance of definitive endodontics 2 weeks after surgery. 4. Definitive preparation of the cut tooth surface at the time of root amputation facilitates maintenance of oral hygiene after removal of the periodontal dressings. 5. The high percentage of involvement of the distobuccal root of the first maxillary molar in periodontal situations requiring correction by root amputation, may be due to the anatomy of this root.
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