Biomedical subjects
Publications and source records attributed to K L Pasquinelli.
As the demand for esthetic dentistry has increased, dentistry has developed techniques to meet this demand. Periodontal plastic surgery has been part of this effort. This article outlines the scope of periodontal plastic surgery procedures to aid the dental team in diagnosis and treatment of esthetic dental cases.
An area of deep, long-standing recession on a mandibular first premolar was treated for root coverage in a 40-year-old woman. The recession was 6.0 mm deep with a probing depth of 2.0 mm, and there was no attached gingiva. A thick (1.5-mm) free autogenous epithelium and connective tissue graft from the palate was placed to the cementoenamel junction of the tooth after instrumentation and tetracycline conditioning of the root surface. The tooth and facial soft tissues were removed in block section 10.5 months later. At the time of extraction, there had been a gain of 5.0 mm of root coverage, and there was 5.0 mm of keratinized gingiva on the facial aspect. The probing depth was 1 mm. Histologic measurement showed 4.4 mm of new attachment and 4.0 mm of new bone growth. The coronal extent of the new attachment and new bone were in an area previously exposed by recession.
THIS CASE REPORT DESCRIBES clinical and laboratory findings for a 60-year-old woman with recently diagnosed Crohn's disease and severe generalized periodontitis. Comparison of dental radiographs taken in 1975, in 1983, and at the time of our evaluation in 1986 revealed dramatic progression of alveolar bone loss over that period. Standard laboratory blood tests did not reveal any remarkable significant leukocyte abnormalities, but flow cytometric analysis of lymphocytes revealed a paucity of B cells stained with anti-light chain antibodies, and an increased proportion of T lymphocytes which were dully-stained with anti-CD5 monoclonal antibody. B cell function as determined by in vitro proliferative responsiveness to anti-IgM antibody was only about 50% of that observed with cells from two healthy normal subjects. Serum leukotriene B4 (LTB4) was elevated to 150% of normal values, in spite of the fact that the patient was taking a systemic anti-inflammatory drug which is known to reduce LTB4 levels. The microbial flora was highly mixed and included several putative periodontopathic bacteria. Therapy consisted of oral hygiene instruction, scaling and root planing, mucoperiosteal-flap curettage, extracoronal splinting, and selective extraction of three teeth. The periodontal status improved markedly with therapy. Possible relationships between the patient's immunological status, her Crohn's disease, and the severe periodontal breakdown are discussed.