As treatment expectations of dental patients continue to escalate we, as restorative dentists, must provide an interdisciplinary treatment approach to ensure optimum results for our patients. In recent years the disciplines of periodontics, endodontics and oral surgery have continued to develop closer working relationships with the field of restorative dentistry. Unfortunately, this is not the common relationship that exists with the discipline of orthodontics. Most orthodontic therapy is directed at the treatment of malocclusion and is conducted with limited or no input from the restorative dentist. Orthodontics offers countless ways of assisting the restorative dentist in achieving treatment goals. Several of these orthodontic opportunities to enhance the restorative treatment plan are reviewed. (+info)
A promising periodontal procedure for the treatment of adjacent gingival recession defects.
(2/25)
Various clinical reports on the reconstruction of gingival recession defects have been published in the past decade. Several techniques have been used to achieve root coverage, including creation of free gingival grafts, laterally positioned flaps or semilunar coronally positioned flaps, as well as guided tissue regeneration and connective tissue grafting. This article focuses on the importance of connective tissue grafting, combined with a recent approach known as the tunnel procedure, in managing gingival recession defects with a single operation. This procedure originated in 1985 with an envelope design and a subepithelial connective tissue graft for single gingival recession defects and is used today for coverage of multiple adjacent gingival recession defects. Histological evaluation of such connective tissue grafts demonstrates periodontal regeneration in human subjects. Clinical trials have yielded good results, including early tissue healing because of increased blood supply, good esthetic results, excellent patient cooperation and avoidance of secondary periodontal plastic surgery. These benefits underline the appropriateness of this technique, which improves the success rate of connective tissue grafting and increases the amount of root coverage. (+info)
Esthetic periodontal considerations in orthodontic treatment--the management of excessive gingival display.
(3/25)
This paper examines various esthetic periodontal considerations during orthodontic treatment. The management of excessive gingival display caused by altered passive eruption is reviewed, with emphasis on causes, recognition, diagnosis and surgical management of this problem. A case of orthodontic treatment of excessive gingival display associated with altered passive eruption of the maxillary incisors is reviewed to demonstrate appropriate management. With proper diagnosis, soft-tissue periodontal procedures after completion of orthodontic treatment can enhance the patient's final appearance. (+info)
Unique creeping attachment after autogenous gingival grafting: case report.
(4/25)
This case report describes a unique creeping attachment that developed mesiobucally on a deep, wide recession (3 mm) and extended along the remaining buccal recession (2 mm) of a maxillary first molar with a full-crown gold restoration subsequent to autogenous gingival grafting. Complete coverage of the root by this degree of creeping attachment on a restored multirooted tooth has not previously been reported in the dental literature. (+info)
Management of patients with foreign body gingivitis: report of 2 cases with histologic findings.
(5/25)
Foreign body gingivitis is an inflammation of the gingiva, characterized by foci containing particles of foreign material in the connective tissue, which can have either a granulomatous or a lichenoid microscopic appearance. In clinical terms, it differs from other immune-mediated gingival disorders in its limited involvement of tissues other than the gingiva, as well as its relative resistance to treatment by topical corticosteroids. Two cases are presented, with a review of the clinical features, including characteristic desquamation and mottling of the marginal gingiva and symptoms of localized tenderness and pain; gingival recession was observed in both of the reported cases. Histologic examination revealed damaged epithelium and degeneration of the basal layer, as well as a mixed inflammatory cell infiltrate in the connective tissue with refractile or opaque particles of foreign material. Gingival inflammation and the severity of gingival erosions improved dramatically with careful debridement, improved home care and more frequent, diligent periodontal maintenance therapy. Free gingival grafts, together with excision of affected tissues, served to stabilize and reinforce the marginal tissues, as well as eliminating further clinical signs of the disease; excision alone was not as effective. Patients require careful dental and periodontal management as well as appropriate oral home care to avoid further mechanical damage to the gingiva; in addition, the use of dental abrasives and polishing agents should be restricted, particularly if gingival lesions are present. Home care recommendations include avoidance of dentifrices with certain chemical additives and rinses with a high alcohol content. (+info)
A modified double pedicle graft technique and other mucogingival interceptive surgeries for the management of impacted teeth: a case series.
(6/25)
Maxillary canine is one of the most common teeth that are impacted. This accounts for 1-2% of all patients who attend orthodontic treatment. The key to achieve maximal eruption of these teeth is their surgical exposure and the role of periodontist in such situations is to provide a functional and satisfactory width of attached gingiva on the labial surface. There are different techniques to surgically expose the impacted teeth, namely--gingivectomy technique, apically positioned flap, closed eruption technique, modified apically positioned flap, double pedicle flap and free gingival graft. Selection of the procedure is dependent on the positioning of the tooth in relation to mucogingival junction and attached gingiva. In the present case series we describe three different techniques for uncovering of impacted teeth, which are apically positioned flap, closed eruption technique and a modified double pedicle graft specially planned for the situation. These procedures when selected diligently using sound selection criteria will create adequate width of attached gingiva which minimizes or eliminates the future mucogingival problems. (+info)
Primary tuberculous gingival enlargement: a rare entity.
(7/25)
With the advent of effective drug therapy, tuberculous lesions of the oral cavity have become so rare that they are frequently forgotten. Primary gingival tuberculosis is extremely rare and usually manifests as ulcer. We report the first case of primary tuberculosis manifesting as gingival enlargement, which was the only presenting sign of tuberculosis. Diagnosis was based on histopathology (hematoxin and eosin staining), complete blood count, polymerase chain reaction assay and immunologic investigation with the detection of antibodies against Mycobacterium tuberculosis. The possibility of gingival enlargement due to drugs, leukemia, fungus and sarcoidosis was ruled out. Antituberculous therapy over 6 months was followed by surgical excision of the residual enlargement under local anesthesia. After 1-year follow-up there was no recurrence of the disease. This case emphasizes the need for dentists to include tuberculosis in the differential diagnosis of gingival enlargement so that they may play a role in its early detection. (+info)
Augmentation of keratinized gingiva through bilaminar connective tissue grafts: a comparison between two techniques.
(8/25)
AIM: A mucogingival deficiency is considered a potential risk factor for periodontal disease. In particular, mucogingival deficiency can lead to gingival recession, which is a pathological entity per se, due to the increased risk for dental hypersensitivity and root caries. The aim of this study was to evaluate and compare 2 bilaminar grafting techniques normally employed to achieve root coverage. METHODS: Thirty-five patients were divided into 2 groups. Group 1 included 19 patients with 49 gingival recessions treated by Nelson technique (as modified by Harris), while group 2 included 15 patients with 40 recessions treated by Langer technique. Clinical evaluation was performed at preoperative level (T0), after 1 month (T1) and after 1 year (T2). Statistical analysis was performed by means of Friedmann and Wilcoxon test and U-Mann-Whitney test. RESULTS: The statistical analysis did not reveal any significant difference between groups, both in terms of percentage of root coverage and of width of keratinizaed gingiva gain. A significant difference was only observed within each group, for the amount of keratinized gingiva at T1 vs T0 and at T2 vs T1. CONCLUSIONS: This study did not show any statistical difference between the Nelson and the Langer technique as to root coverage and gain in keratinized gingiva. (+info)