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PubMed1985

Subepithelial connective tissue graft technique for root coverage.

This article describes the use of the subepithelial connective tissue graft as a donor source for root coverage. The success of these grafts has been attributed to the double-blood supply at the recipient site from the underlying connective tissue base and the overlying recipient flap. Four cases have been illustrated to demonstrate the versatility of this procedure for areas of single or multiple root coverage especially in the maxillary arch, coverage of existing crown margins and areas requiring a combination of ridge augmentation and root coverage. An increase of 2 to 6 mm of root coverage has been achieved in 56 cases over 4 years with minimal sulcus depth and no recurrence of recession. The donor site is a closed wound which produces less postoperative discomfort.

Connective Tissue↗
PubMed1985

Effects of mandibular orthognathic treatment on mucogingival tissues.

Twenty-four patients receiving comprehensive orthognathic care including genioplasty were studied to evaluate the effect of orthognathic treatment on the mucogingival complex in the mandibular anterior region. Parameters measured prior to and after therapy were: width of keratinized gingiva, width of attached gingiva and gingival recession. A subjective assessment of tissue thickness was accomplished. A statistically significant decrease in width of both keratinized and attached gingiva was noted following orthognathic therapy in the mandibular anterior area. In six of 24 patients, gingival recession was a clinically significant finding. The actual pretreatment width of keratinized and/or attached tissue did not seem to be the critical factor in development of recession. Risk of recession appeared to increase when genioplasty was combined with mandibular advancement and tended to occur at sites in which the keratinized gingiva and underlying bone appeared thin.

Adolescent↗
PubMed1985

Repair of anterior gingival deformity with durapatite. A case report.

After the extraction of a maxillary anterior tooth, a gingival deformity may occur due to the loss of the labial plate of bone. This often creates an esthetic problem in the construction of a fixed partial denture. In the past, various surgical techniques have been devised to eliminate this gingival defect. A technique using durapatite is discussed.

Dental Implantation↗
PubMed1985

Effects of citric acid treatment on pedicle flap coverage of localized recession.

Citric acid conditioning of denuded roots prior to laterally positioned pedicle flap (LPPF) coverage may increase the likelihood of reattachment, but no controlled studies to determine the efficacy of the procedure in managing naturally occurring defects in humans have been reported. This investigation compared the effects of LPPF root coverage with and without citric acid (pH1) pretreatment in a group of patients with gingival recession and associated denuded roots. Thirty-six patients participated in the study. Eighteen received LPPFs without citric acid pretreatment and 18 received LPPFs with citric acid pretreatment. Gingival recession and sulcus depth were measured preoperatively and 30, 60 and 90 days after the surgical procedure. LPPFs both with and without citric acid pretreatment reduced significantly the amount of exposed root, but no differences between groups were found. For sulcus depth, the 90-day value for the citric acid group was significantly increased over the preoperative level, but no other changes were noted. There appears to be no clinical justification for using citric acid conditioning as an adjunct to LPPF coverage of denuded roots.

Adult↗
PubMed1985

Covering localized areas of root exposure employing the "envelope" technique.

A new method for covering localized areas of root exposure with free connective tissue grafts uses connective tissue obtained from the depth of the hard palate, leaving only a narrow surface defect at the donor site. The graft is positioned directly over the exposed root, but its major part is placed in an "envelope" previously created by an undermining partial thickness incision in the tissues surrounding the defect. In this way, both sides of the graft are in intimate contact with these tissues which offer support and nourishment. Clinical results 2 to 8 months postoperatively are favorable.

Adolescent↗
PubMed1986

Coronal positioning of tissue previously treated with freeze-dried dura mater grafts. Report of a case.

Root surfaces exposed to the oral environment may present a variety of problems to dental patients. Mucogingival surgical procedures represents one approach to the management of these concerns. Procedures currently in use often require two or three wounds, and sometimes two surgical sessions. Recent observations suggest that an allograft, freeze-dried dura mater, amy serve as a donor material in mucogingival surgery. This report describes the use of coronally positioned flap procedures to treat residual areal of recession 4 years after placement of freeze-dried dura mater allografts.

Dura Mater↗
PubMed1986

Root coverage and ridge augmentation in Class IV recession using a coronally positioned free gingival graft.

Although root coverage is not anticipated in Class IV recession, occasionally this can be accomplished if there is an edentulous area adjacent to the tooth to be grafted. This edentulous area allows the surgeon to more intimately adapt the graft to the interproximal surface of the root. A second procedure to coronally position the healed graft may be required. A case demonstrating this technique is presented.

Alveoloplasty↗
PubMed1987

The subpedicle connective tissue graft. A bilaminar reconstructive procedure for the coverage of denuded root surfaces.

A mucogingival grafting procedure has been developed to cover denuded root surfaces. This procedure, the subpedicle connective tissue graft, is a bilaminar graft that is composed of a free connective tissue graft and an overlying pedicle graft. By overlaying grafted free connective tissue with a pedicle, the otherwise compromised section of free graft which covers a denuded root surface is supplied by plasmatic circulation from capillaries in the vascular portion of the pedicle allowing it to survive. In this report 29 teeth were treated and monitored for as long as 42 months. In the group with advanced recession of 7 to 10 mm, there was an average of 88% coverage. The subpedicle graft created a healthy, functional, and esthetic result that appeared resistant to further breakdown. The subpedicle graft is indicated when a single surgical procedure is desired that will predictably cover denuded root surfaces when there is inadequate keratinized gingiva available for a pedicle graft and where the prognosis is poor for root coverage with a free gingival graft.

Adolescent↗
PubMed1987

A longitudinal study of untreated mucogingival defects.

A study was conducted to observe the changes in areas with untreated mucogingival defects over a 4-year period. Upon entering dental school, a group of freshman students were assessed for Plaque Index, Gingival Index, probing depth, and width of keratinized gingiva. These same students were reassessed for the same parameters at the end of their senior year. Of the 112 sites in 39 individuals, 33 sites revealed a slight increase in keratinized gingiva, 69 sites were unchanged, and 10 sites showed a slight decrease. These changes were minimal and not statistically significant. The Plaque Index, Gingival Index, and probing depth mean values showed a small but statistically significant improvement. In this group of students with a high degree of oral hygiene, areas with inadequate zones of attached gingiva were able to be maintained without further recession and without surgery.

Dental Plaque Index↗
PubMed1989

Occurrence of gingival recession in adults.

The occurrence of gingival recession was investigated in adults by age and gender and in relation to their dental status and frequency of toothbrushing. A total of 258 dentate subjects were clinically examined. Their mean age was 46 years and they had an average of 19.4 natural teeth. Gingival recession was recorded as present if any root surface was clearly visible without retraction of the gingival tissue. Recession was found on at least one tooth surface in 68% of subjects. Mean number of surfaces with recession was 7.2 for women and 10.4 for men. Subjects with gingival recession had fewer natural teeth than did those without recession. The two groups did not differ from each other in the number of filled teeth and decayed teeth. Mandibular teeth had more surfaces with recession than did maxillary ones. Sites of recession occurred quite symmetrically. Frequent toothbrushers had, both in the maxilla and mandible, more surfaces with recession than had those brushing their teeth infrequently. Frequent toothbrushing had a greater association with recession among women and in the youngest age group.

Adult↗
PubMed1989

Coronal positioning of existing gingiva: short term results in the treatment of shallow marginal tissue recession.

Although not a new procedure, coronal positioning of existing gingiva may be used to enhance esthetics and reduce sensitivity. Unfortunately when recession is minimal and the marginal tissue is healthy, many periodontists do not suggest treatment. This article outlines a simple surgical technique with the criteria for its use which results in a high degree of predictability and patient satisfaction.

Gingiva↗
PubMed1992

A 10-year longitudinal study of untreated mucogingival defects.

A study was conducted to observe the changes in areas with untreated mucogingival defects over a 10-year period. The results in this group after 4 years were previously published. Upon entering dental school, a group of 39 freshman dental students were assessed for plaque index, gingival index, probing depth, and width of keratinized gingiva in 112 sites of inadequate keratinized gingiva. Eighteen of the original 39 participants were reassessed for the same parameters in 64 sites after 10 years. The results revealed that 22 sites showed a slight increase in keratinized gingiva, 32 were unchanged, and 10 sites showed a slight decrease in keratinized gingiva. The mean width of keratinized gingiva at the beginning of the study was 1.73 +/- 0.542 mm and was 2.01 +/- 0.864 mm after 10 years. This represented a small, but statistically insignificant, increase in the width of keratinized gingiva. The Plaque Index and Gingival Index of this group at baseline and at 10 years indicated a high level of oral hygiene and gingival health. It was concluded that in the absence of gingival inflammation, areas with small amounts of keratinized gingiva may remain stable over long periods of time.

Dental Plaque Index↗
PubMed1994

Cystinosis and gingival hyperplasia: demonstration of cystine crystals in gingival tissue and unusual aspects of management.

A patient with nephropathic cystinosis developed gingival hyperplasia secondary to cyclosporine-A therapy for his renal allograft. The typical crystals described on electron microscopic examination of other organs of patients with cystinosis were seen in the resected gingiva of this patient. These crystals have not been previously described in this location. Unusual aspects of the management of this patient are discussed.

Adult↗
PubMed1995

A case of myiasis gingiva.

A case of myiasis gingiva was diagnosed in an investigation designed to evaluate the histopathological features of the adjacent tissues of 100 advanced periodontal lesions. The patient was a 36-year old female and her chief complaint was discomfort and swelling in the area between the upper left central and lateral incisors. The patient's medical history, review of the symptoms, and family history were non-contributory and her oral hygiene was acceptable. The surgeon was not aware of anything unusual during the operation. Although the Parasitology Department was unable to define the entomologic identification of the infesting parasite from histopathological tissue slides, it was agreed that this case of myiasis might be produced by larvae of genus Sarcophaga or Enterobius vermicularis.

Adult↗
PubMed1997

Report of a gingival "surgical cyst" developing secondarily to a subepithelial connective tissue graft.

The subepithelial connective tissue graft is a valuable technique used to cover exposed root surfaces or to increase the zone of attached gingiva. Cysts, such as the gingival cyst of the adult, are epithelial-lined cysts which may arise from heterotropic glandular tissue, a proliferating rete peg, remnants of the dental lamina, or traumatic implantation of epithelial tissue. In this paper, a case report is described of a "surgical cyst" or cystic morphogenesis of surgically implanted epithelium developing secondarily to a subepithelial connective tissue graft.

Aged↗
PubMed1998

Gingival salivary gland choristoma. A case report.

Gingival salivary gland choristoma is an extremely rare disturbance of glandular development. A review of the literature disclosed only 5 reported cases of this entity and 7 gingival salivary gland tumors or alterations. We present a case of this condition present in a 43-year-old female patient, which was found while reviewing casts for the design of a prosthetic appliance. This case suggests that embryonal pluripotentiality of gingival epithelial cells is retained and that development of salivary glands in gingival tissue is feasible. An additional discussion about its histogenesis is presented.

Adult↗
PubMed1999

Spontaneous early exposure of submerged implants: I. Classification and clinical observations.

BACKGROUND: It is believed that during the osseointegration phase of submerged dental implants, complete mucosal coverage and isolation of the implant from the oral cavity avoids trauma and infection and establishes favorable conditions for osseointegration. Spontaneous early exposure is one of the complications that could adversely affect osseointegration of implants. METHODS: This study clinically classifies spontaneous early exposure and describes and analyzes this complication in a group of 148 patients treated with 372 submerged implants: 216 (58%) in the mandible and 156 (42%) in the maxilla. Edentulous sites were exposed by mid-crestal incisions and full thickness gingival flaps. Incisions were closed in an attempt to achieve complete closure and healing by primary intention. Measurements were taken to avoid mechanical trauma to the mucosa over the implants. Patients were followed up weekly and examined to identify early exposures. Perforations were classified according to the degree of exposure from 0 (no perforations) to 4 (complete exposure). RESULTS: Of the implants 51 (13.7%) presented spontaneous early exposure, (13%) in the mandible and 23 (14.7%) in the maxilla. Class 2 perforation was the most frequent, followed by Class 3, Class 1 and Class 4. Inflammation at the mucosal orifices of the perforations was minimal, but no objective index (bleeding, probing) was taken in order to avoid morphological changes of the lesions that were biopsied for histological examination. CONCLUSIONS: Early perforation and partial exposure of the implant's covering device are a focus for plaque accumulation which, if left untreated, may result in inflammation, damage to the peri-implant mucosa, and possible peri-implant loss.

Biopsy↗