Diagnosis of gingival tumefactions.
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The clinical impressions of the authors and a survey of mucogingival problems in children lead to the following conclusions: 1. Mucogingival problems occur in children. 2. The prevalence of such problems is 12 to 19% in sample of 100 patients examined. 3. Insufficient keratinized tissue is developmentally related to: a. eruption pattern of the permanent incisors. b. buccolingual width of the alveolar process. 4. The autogenous free gingival graft is recommended as an acceptable procedure to prevent incipient mucogingival problems from progressing. 5. Where orthodontic therapy is anticipated and coincidentally insufficient keratinized tissue exists, a free gingival graft should be performed prior to tooth movement. 6. Grafts would be recommended in children with 1 mm or less of keratinized tissue. 7. Grafts would not be recommended in children when there is over 2 mm of keratinized tissue. 8. Grafts would not be recommended in children with greater than 1 mm of attached gingiva.
A study was made of a series of 302 consecutive cases of localized hyperplastic lesions of the gingiva (epulides). The lesions were classified into five groups: pyogenic granuloma, calcifying fibroblastic granuloma, fibrous hyperplasia, peripheral giant cell granuloma and denture hyperplasia. The study indicates that there are some differences in age and sex distribution as well as in location between the different histological groups. Pyogenic granuloma was found to be the most common lesion on the gingiva. Pyogenic granuloma and calcifying fibroblastic granuloma occur in younger patients more often than fibrous hyperplasia, and thus may represent a stage in the development of fibrous hyperplasia. Denture hyperplasia occurs predominantly in females and it is suggested that its formation may be affected by hormonal alterations in the menopause.
A pathologic entity, the gingival fenestration, has been described. The lesion is seen infrequently in clinical practice, probably due to the short time span of its existence and the lack of acute symptoms. It is possible that it occurs with greater frequency than generally realized. A hypothesis is presented as to the method of formation of the gingival fenestration and it is suggested that the area should be treated as gingival recession extending to the apical border of the fenestration.
This study was undertaken to evaluate biometrically the changes that occur on the recipient as well as on the donor tooth with regard to gingival recession, sulcus depth and width of keratinized gingiva after performing a lateral sliding flap in the treatment of localized denuded roots. Fourteen teeth with gingival recession were treated using a lateral sliding flap. Measurements were recorded preoperatively and 1, 3 and 6 months after surgery. A mean gain of 2.69 mm of soft tissue coverage over the denuded root was found 6 months postoperatively which represents 69% of coverage. The mean gain in width of keratinized gingiva averaged 3.15 mm. On the donor tooth an average gingival recession of 1.1o mm was found after 6 months, and the width of keratinized gingiva decreased an average of 1.25 mm. Results remained stable after 30 days postsurgery.
A histologic review of 129 circumscribed mesenchymal lesions of the gingivae was performed. Two cases were peripheral reparative giant cell granulomas; eight were peripheral odontogenic fibromas; 41 were inflammatory hyperplasias; 68 were pyogenic granulomas; 11 were "hard fibromas"; one lesion exhibited the histologic features of a true fibroma.
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The prevalence and distribution of gingivitis and gingival recession were studied in 820 Nigerians aged 15, 19, 20 and 21 years sampled from Lagos educational establishments. The prevalence of gingivitis was relatively high at all ages. There was a high degree of correlation between the prevalence of gingivitis affecting mouths, papillae and margins. It therefore would appear that in those mouths with gingivitis, the proportion of affected papillae or margins to those not affected varies only within narrow limits. Although the peak prevalance of gingivitis was observed in the 15-year olds, the prevalence of gingival recession was higher in the 21-year-old students than in those aged 15 years. Gingival recession may be a sequel of gingivitis resulting from apical proliferation of the epithelial attachment with destruction of the subjacent periodontal tissues. Hence gingivitis should be distinguished from gingival recession in its prevalence and distribution.
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A series of 741 consecutive cases of localized hyperplastic lesions of the gingiva were studied. The lesions were reclassified into four groups: pyogenic granuloma, peripheral giant cell granuloma, fibrous hyperplasia and peripheral fibroma with calcification. This study indicates that there are some differences between these groups in age and sex distribution as well as in location and size of the lesion. Fibrous hyperplasia was the most common type, followed in descending order by pyogenic granuloma, peripheral fibroma with calcification and peripheral giant cell granuloma. The peripheral giant cell granuloma showed no sex predilection while fibrous hyperplasia, pyogenic granuloma and peripheral fibroma with calcification were more common in females. Pyogenic granuloma and peripheral fibroma with calcification occur in younger patients more often than fibrous hyperplasia, and thus may represent a stage in the development of fibrous hyperplasia.
Thirty-four areas of gingival recession in ten patients were treated by a coronally repositioned flap procedure. All but four of these areas had received a free gingiva graft previously. The postoperative evaluations of the wound healing were made at 2 weeks and at 1, 2, 4, 6 and 12 months after the final surgery. In most cases the amount of gingival recession was reduced with the average tissue gain being 1.82 mm. The gingival sulcus depth was unaffected by the procedure. Several cases showed total root coverage. Although the procedure described has many advantages, the authors feel these must be carefully weighed against the disadvantages before subjecting patients to such surgery.
A new case of the rare peripheral ameloblastoma of the gingiva is presented. Also the clinical and histomorphologic characteristics of the lesion were analyzed and studied in all previously documented cases. This tumor, and the basal cell carcinoma of the gingiva, probably represent the same lesion. It meets the same microscopic criteria as the intraosseous ameloblastoma, but its behavioral and clinical characteristics are completely different. The peripheral ameloblastoma usually occurs in the gingiva, is noninvasive, and local excision is usually curative. Recurrence of the neoplasm is uncommon, except when it is incompletely excised. The histogenesis and varied cellular pattern of the peripheral ameloblastoma and several other related odontogenic lesions of the gingiva illustrate the proliferative and differentiation potential of the basal cell layer of gingival epithelium.
This ongoing study was designed to determine the necessity for and effectiveness of the free autogenous graft in maintaining periodontal attachment. Four-year data are presented for 42 patients who initially had bilateral surfaces with inadequate attached keratinized gingiva including 22 patients who began with bilateral areas of recession and no attached gingiva. In both populations a free autogenous gingival graft was placed on one side and the contralateral side was treated by scaling and root planing to serve as the control. The results indicate that plaque and gingival indices significantly decreased over 4 years on both experimental (grafted) and control (nongrafted) sides. Neither side had further attachment loss but the grafted side showed "creeping" attachment with a concomitant decrease in recession. This study would indicate that facial gingival units with minimal or no attached keratinized gingiva can maintain attachment levels when inflammation is controlled.
Eighty patients, having received periodontal therapy previously, were divided into four groups, corresponding to one of four different types of dental floss being used. Seven to ten days after receiving a thorough prophylaxis, each patient had oral hygiene instruction by video tape, was given a toothbrush and a quantity of the test floss. At 0, 28 and 56 day intervals, the patients were scored for crevicular fluid flow and gingival bleeding. Data were analyzed statistically. Johnson and Johnson unwaxed dental floss was found to be slightly less effective in reducing gingival bleeding at the 56th day. It was also found that crevicular fluid flow was least with waxed floss use at the 56 day session. However, the range of variations was so minimal that no clinical significance could be ascribed to either finding. There were patients in each of the four floss groups with no fluid flow or bleeding during all three sessions.
Soft tissue grafts are regularly used in most periodontal practices to augment attached gingiva. Postoperative complications are few and of minor consequence. This case describes a possible arterio-venous shunt following removal of palatal mucosa as the donor tissue in a soft tissue autograft. The complication was managed by a surgical excision of the cavernous lesion. Healing thereafter was uneventful.
Two extensive periodontal recessive lesions in bilateral maxillary cuspid ares were treated surgically with free autogenous masticatory mucosal grafts. No attempt was made initially to achieve total root surface coverage. Evaluation of the sites during a 4-year postoperative period demonstrated unusual degrees of "creeping attachment." The maxillary left cuspid graft completely covered the root with 9 mm of gingival-equivalent tissue while the maxillary right cuspid area displayed 90% (7 mm) root surface coverage.
Citric acid root conditioning prior to free gingival autograft (FGA) coverage of denuded roots may increase the likelihood of reattachment, but controlled studies to determine the value of the procedure have not been done on human subjects. This investigation was done to compare the effects of FGA root coverage with and without citric acid pretreatment. Nineteen patients with 30 affected teeth participated in the study. Fifteen teeth received FGAs without citric acid pretreatment and 15 teeth received FGAs with citric acid pretreatment. Measurements of gingival recession and sulcus depth were made preoperatively and 30, 60 and 90 days following the surgical procedure. Free gingival autografts with and without citric acid pretreatment each significantly reduced the amount of exposed root, but no differences between groups were found. Except for the 90-day single tooth control group, mean sulcus depths were significantly decreased at 30, 60 and 90 days, but there were no differences noted between single tooth citric acid and control groups or multiple tooth citric acid and control groups. Citric acid treatment of affected roots prior to FGA coverage does not appear to be justifiable.