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Background: Recession is a mucogingival condition affecting teeth causing hypersensitivity. Although many techniques are there for recession coverage, semilunar vestibular incision technique (SVIT) is a novel procedure for management of multiple gingival recession in maxillary teeth. Aim: To evaluate the efficacy of root coverage in maxillary teeth with multiple gingival recession using SVIT. Methodology: Twenty systemically healthy patients were recruited with Miller’s class I and II gingival recessions in maxillary teeth. Parameters such as recession height (RH), recession weight (RW), avascular surface area (ASA), width of keratinized gingiva (WKG), width of attached gingiva (WAG), and clinical attachment level (CAL) were measured at baseline three and six months post?surgery. Results: The outcome measures were statistically significant at baseline, three and six months. A reduction of 86% was achieved in terms of RH and RW. Gain in WKG and WAG as achieved at six?month follow?up was 31.5% and 55%, respectively. An 87% decrease in ASA was obtained and reduction in CAL was 82.4%. Between three and six months there was a significant increase in WAG. Conclusion: SVIT results in improved measures of attached gingiva on six?month follow?up.
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OBJECTIVE@#This study aimed to evaluate the clinical effect of periodontal microscopic surgery on the augmentation of attached gingiva and determined the clinical principle on how to use minimally invasive surgery to improve the surgery success rate.@*METHODS@#Twenty patients with insufficient attached gingiva around implants were selected. Periodontal microscopic surgery for free gingival graft was performed to increase the width of the attached gingiva around the implants. The survival state of the free gingiva was observed after surgery, and the width of the attached gingiva around the implants was recorded before and after surgery and 1 year after surgery. The shrinkage rate of the free gingival flap 1 year after surgery was analyzed to evaluate the stability of the flap.@*RESULTS@#The flaps of the 20 cases all survived. One year after the operation, the width of the attached gingiva was (3.05±0.44) mm, which increased compared with that of preoperation (2.56±0.31) mm and decreased compared with that of postoperative day (2.13±0.28) mm. The shrinkage rate of the attached gingiva was 41.22%±5.04%.@*CONCLUSIONS@#The application of microscopic surgery on the augmentation surgery of attached gingiva can increase the success rate and improve the quality and quantity of attached gingiva around implants.
Subject(s)
Humans , Dental Implants , Gingiva , General Surgery , Microsurgery , Oral Surgical Procedures , Surgical FlapsABSTRACT
The main purposes of periodontal graft surgery include achieving root coverage, improving the clinical attachment level and keratinized tissue, and advancing the procedure of periodontal plastic surgery. Autogenous graft, such as subepithelial connective tissue graft-based procedure, provide the best outcomes for mean and complete root coverage, as well as increase in keratinized tissue. However, a disadvantage of the procedure is in the location of the operation itself: the additional surgical site (palate). Therefore, clinicians are always looking for graft substitutes. This article will discuss the evidence supporting the use of 1) acellular dermal matrix (ADM); 2) xenogeneic collagen matrix (XCM); 3) recombinant human platelet-derived growth factor (rhPDGF); 4) enamel matrix derivative (EMD); 5) guided tissue regeneration (GTR); 6) living cellular construct (LCC), all of which are used in conjunction with coronally advanced flaps as alternatives to autogenous donor tissue. The decision tree for treatments of Miller recession-type defects are also discussed.
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The aesthetic demands of teeth by the public have improved with the increase in the living standard. Orthodontics, which is a method of aesthetic dentistry, is becoming increasingly important. Orthodontic treatment mainly involves the application of orthodontic force to the teeth and guides the reconstruction of the periodontal tissue, thereby changing the position of the teeth at the occlusal bone. Orthodontic treatment can also improve the dental occlusion caused by dentition crowding and teeth mobility to achieve long-term stability of periodontal tissue. The number of patients with periodontal disease is high in China, and the number of patients with periodontal disease that are eager to receive orthodontic treatment is increasing. Hence, the periodontal status during the orthodontic therapy should be explored along with periodontal therapy and orthodontic treatment. This article briefly demonstrates the assessment criteria of periodontal status before orthodontic treatment, the opportune moment selection for orthodontic treatment, and the supportive periodontal therapy. This study helps dentists develop individualized treatment programs and win a balanced, stable, and aesthetic impression.
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The field of periodontics has become increasingly discussed and advanced in recent decades. The techniques of periodontal soft tissue grafts are among these advancements. The techniques have been used more and more clinically not only in periodontics, but also in the areas of dental implantology, aesthetics, and orthodontics. In this article, we discuss the clinical indications and the advantages and disadvantages of several autogenous tissue grafts (e.g. pedical grafts, free gingival graft, and subepithelial connective tissue graft). These techniques have made root coverage and the rebuilding of attached gingival possible; therefore, it is necessary for all dentists to understand the applications of periodontal soft tissue grafts.
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@#In patients with anterior teeth loss, especially in patients with soft tissue defects, the aesthetic problem of soft tissue is still a major problem in the delayed planting restoration. In the restoration of anterior teeth, the health of the soft tissue around implants play a key role in guaranteeing the long-term success of dental implants. Therefore, consideration is worth being taken that how to deal with the soft tissue during the process of the delayed implant restoration as well as how to evaluate the effects after treatment. According to the process of the delayed implant operation sequence therapy-preoperative, intraoperative and postoperative treatment, this article will have a literature review and summary through these aspects as followings: the red aesthetic evaluation index, treatment of soft tissue around delayed implant, clinical curative effect evaluation.
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A presença ou ausência de gengiva inserida pode interferir na manutenção da saúde gengival, uma vez que sua deficiência leva à exposição radicular dificultando o processo de higienização, o que resulta na presença de biofilme e inflamação gengival com perda de inserção. Foi realizada terapia periodontal cirúrgica com enxerto gengival livre em paciente com recessão gengival classe III de Miller para aumento de faixa de tecido queratinizado. Após período de pós-operatório e acompanhamento de um ano e 12 meses, foi observado ganho e manutenção de volume e altura do tecido queratinizado enxertado, com saúde gengival e ganho de inserção. Nos casos onde há necessidade de reforçar áreas fragilizadas pela diminuição ou falta de gengiva inserida, a técnica de enxerto gengival livre apresenta boa previsibilidade e manutenção da faixa de tecido queratinizado, favorecendo o controle de biofilme e saúde gengival.
The presence or absence of attached gingiva may interfere with the maintenance of gingival health, since its defi ciency in some cases complicates the process of cleaning, resulting in the presence of biofilm and gingival inflammation with insertion loss. This case report describes a surgical technique based on free gingival graft in a patient with gingival recession Miller class III to increase keratinized tissue band. After the postoperative period of 12 months tissue improvement was observed, as well as, volume maintenance and height of keratinized grafted tissue along with gum health and insertion gain. In cases where there is need to strengthen weakened areas by reducing or lack of attached gingiva, the free gingival graft technique has good predictability and maintenance of keratinized tissue range, favoring the control of biofilm and gingival health.
Subject(s)
Humans , Female , Adult , Connective Tissue , Gingival Recession/therapy , Gingiva/transplantation , Gingivoplasty , Oral Surgical Procedures , Tissue Transplantation/methodsABSTRACT
Objective:To evaluate the effects of crown lengthening surgery by apically repositioned flap for the treatment of the teeth with inadequate width of attached gingiva. Methods:17 teeth with inadequate width of attached gingiva were included. The gingiva flap was repositioned apically. The distance between gingival margin to the root surface was recorded, the width of attached gingiva and other indicators were compared before and 6 months after surgery. Results:Edge of the defects the 17 teeth was below gingiva margin before surgery, root surface was exposed to the coronal gingival margin 6 months after surgery in 16 of the 17 cases (94. 11%). Api-cally displacement distance of the gingival margin was (3. 88 ± 0. 49) mm. The width of attached gingiva before and 6 months after sur-gery was (2.35 ±0.61) mm and (2.65 ±0.49) mm respectively(P>0.05). Conclusion: Crown lengthening with apically reposi-tioned flap surgery can effectively expose the root surface and create conditions for restoration of dental defects for teeth with inadequate attached gingiva, and can prevent over removal of the keratinized gingiva.
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Along with the better understanding of the pathogenesis of periodontal diseases, the treatment modalities for various periodontal diseases have also gone a step ahead. One of the most important and currently unsolved problems in clinical periodontics is the predictable successful treatment of inadequate width of attached gingiva. Recently, importance has been given to the use of platelet-rich fibrin (PRF) for predictably treating periodontal diseases. PRF is an intimate assembly of glycan chains, glycoproteins, and cytokines. These are enmeshed in a slowly polymerized fibrin network which has the potential to accelerate soft and hard tissue healing. This article presents the clinical results of treatment of inadequate width of attached gingiva with PRF.
Subject(s)
Adult , Fibrin/therapeutic use , Gingiva/abnormalities , Gingiva/anatomy & histology , Gingiva/surgery , Gingiva/therapy , Humans , Male , Periodontitis/surgery , Platelet-Rich Plasma , Surgical Flaps/methods , Surgical Flaps/transplantation , Young AdultABSTRACT
This article presented a series of cases using vascularized interpositional periosteal-connective tissue ( VIP-CT) flap with guide bone regeneration ( GBR) in peri-implant soft and hard tissue reconstuction at the esthet-ic zone of maxillary. Fifteen cases with bone and soft tissue defects underwent VIP-CT flap with GBR in the implant treatment. And the attached gingiva width was evaluated before treatment and six months and eighteen months after the operation. The width of attached gingival of six months and eighteen months after surgery was significantly dif-ferent from the preoperative value (P<0. 05). However, no statistically significant difference could be found at six months and eighteen months postoperative. The application of VIP-CT flap could increase the width of attached gin-giva around implants and the short-term effects were stable and favorable.
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Focal epithelial hyperplasia (FEH) is a human papillomavirus (HPV)-induced alteration of the oral mucosa that presents with a clinically distinct appearance. While other HPV-infected lesions such as squamous papilloma, verruca vulgaris, and condyloma acuminatum involve the skin, oral mucosa, and genital mucosa, FEH occurs only in the oral mucosa. The affected oral mucosa exhibits multiple papules and nodules with each papule/nodule being flat-topped or sessile. The affected region resembles the normal color of oral mucosa rather than appearing as a white color since the epithelial surface is not hyperkeratinized. Almost all cases present with multiple sites of occurrence. This rare, benign epithelial proliferation is related to low-risk HPV, especially HPV-13 and -32, and is not transformed into carcinoma. We report a case of FEH that arose on the attached gingiva of an East Asian male adult related to prosthesis without detection of any HPV subtype in HPV DNA chip and sequencing.
Subject(s)
Adult , Humans , Male , Asian People , Dental Prosthesis , Focal Epithelial Hyperplasia , Gingiva , Mouth Mucosa , Mucous Membrane , Oligonucleotide Array Sequence Analysis , Papilloma , Prostheses and Implants , Skin , WartsABSTRACT
The aim of this study was to clinically evaluate the use of alloderm to increase the width of attached gingiva. Nine patients were selected. The inclusion criteria were: attached gingiva smaller than 1 mm; Miller's class I and II gingival recession; patients able to attend control dental appointments; absence of periodontal pocket and endodontic treatment in the neighboring area where the acellular dermal graft would be placed. The clinical evaluation included: allograft shrinkage 7, 14, 21, 30, 60 and 90 days after surgery; width of attached gingiva at the end of the study; difference in color and mobility of allograft. Allograft shrinkage was calculated by comparing its area immediately after surgery to its areas in the other days. Five standardized photographs were taken, digitized and the allograft area was measured. Paired Student's t-test was used to compare the clinical data (α=0.05). The mean allograft shrinkage 90 days after surgery was 90.43 percent and the mean width was 1.27 mm. Difference in color was observed in only 1 subject and no allograft mobility was detected. The results showed a large shrinkage of allograft 90 days after its insertion, raising doubts as to its validity for increasing the width of attached gingiva.
O objetivo do presente estudo foi avaliar clinicamente o uso do Alloderm no aumento da faixa de gengiva inserida. Nove pacientes foram selecionados. Os critérios de inclusão foram: pacientes com faixa de gengiva inserida menor que 1 mm; recessão gengival classe I e II de Miller; pacientes com possibilidade de freqüentar as consultas de controle; ausência de bolsa periodontal e tratamento endodôntico nas áreas adjacentes onde o enxerto dérmico acelular será usado. A avaliação clínica incluiu: contração do aloenxerto 7, 14, 21, 30, 60 e 90 dias após a cirurgia; faixa de gengiva inserida obtida no fim do estudo; diferença de coloração em relação aos tecidos adjacentes; mobilidade do aloenxerto 90 dias após a cirurgia. A contração do aloenxerto foi calculada comparando a área imediatamente após a cirurgia com as áreas dos outros dias. Cinco fotos padronizadas foram tiradas dos estágios analisados, escaneadas e a área mensurada. O teste t de Student foi usado para comparar os dados clínicos (p<0,05). A média de contração 90 dias após a cirurgia foi de 90,43 por cento, faixa de gengiva inserida de 1,27 mm. Diferença de cor foi observada em um paciente e nenhuma mobilidade foi detectada. Os resultados mostraram uma grande contração do aloenxerto 90 dias após sua inserção, gerando dúvidas sobre sua validade no aumento da faixa de gengiva inserida.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Biocompatible Materials/therapeutic use , Collagen/therapeutic use , Gingiva/surgery , Gingival Recession/surgery , Gingivoplasty/methods , Absorbable Implants , Graft Survival , Gingiva/physiology , Longitudinal Studies , Skin, Artificial , Treatment OutcomeABSTRACT
This study was performed to evaluate the effect on the formation of keratinized attached gingiva when free gingival graft with strip technique was used. After the partial thickness flap was prepared, it was positioned apically more than 7mm using mucoperiosteal suture. At the donor site, strip was achieved with 2mm width, less than 1mm thickness, (mesiodistal teeth length + 6)*2 mm length. Then, it was divided into 2 same pieces and located at the recipient bed apico-coronally with more or less 3mm interval. Follow-up check was made at 1,2,4,8,12 weeks after the operation. The results of this study were as follows : 1. The inter-strip space was mostly filled with keratinized attached gingiva. 2. The contraction of the graft was nigligible, and 92% of planned area was filled with keratinized attached gingiva. 3. The inconvenience of the patients at donor site was minimal. 4. The width of the strip was widened. In conclusion, free gingival graft using strip technique is useful to achieve the keratinized attached gingiva maximally with free gingival graft minimally and to minimize the inconvenience of donor palatal site of the patients.
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The purpose of the present study was to evaluate the effect of incisor protrusion on the mucogingival parameters including the width of attached gingiva. Thirty-seven young adults with lower anterior crowding were selected for this study. From the study model, the degrees of relative and absolute protrusions were measured for each lower incisor. Clinical crown height, the width of keratinized gingiva, probing depth and the width of attached gingiva were measured with digital vernier calipers and Florida Probe System. Through comparing the difference of the above measurements between protruded and non-protruded incisors, and correlation analysis between each measurement, following results were obtained: 1. The protruded incisor showed narrow width of keratinized and attached gingiva comparing to non-protruded incisor. 2. The protruded incisor showed greater clinical crown height comparing to non-protruded side while there was no difference in the probing depth between protruded and non-protruded side. 3. The difference in the width of attached gingiva between protruded and non-protruded incisors showed higher significance in the lateral incisor than in the central incisor. 4. The degree of relative protrusion showed higher correlation with the width of attached gingiva than the degree of absolute protrusion. 5. Clinical crown height showed higher correlation with the width of attached gingiva than the degree of protrusion.
Subject(s)
Humans , Young Adult , Crowding , Crowns , Florida , Gingiva , Incisor , OverbiteABSTRACT
The purpose of this study was to investigate the width of attached gingiva of 414 subjects with healthy gingiva, or early stage of gingivitis. We compared the differences according to the tooth location, age (Yonger group : 14~30, Older group : 31~67) and gender. In addition, we compared the width of attached gingiva in the subjects with less than 2 sites of gingival recession(Re or =3) to study the relationship between the gingival recession and the width of attached gingiva. The results were as follows : 1. The width of keratinized gingiva was widest in maxillary incisors(5.3+/-1.4mm) and narrowest in mandibular right 1st bicuspid and mandibular right and left 2nd molars(3.5+/-1.1mm). 2. The width of attached gingiva was widest in maxillary right central incisor(3.8+/-1.5mm) and narrowest in mandibular right 2nd molar(1.2+/-1.0mm). 3. In the comparison between the age groups, the width of keratinized in older group was significantly(p<0.05) wider than that in younger group in maxillary right and left 1st bicuspids, mandibular right and left 1st and 2nd molars, maxillary right and left cuspids and mandibular right 1st bicuspid. There was no significant difference in the width of attached gingiva between the two groups except for maxillary right and left 1st molars and maxillary left 2nd molar. 4. In the comparison between male group and female group, in maxillary right and and left lateral incisors and cuspids, mandibular right and left cuspids and 1st bicuspids, the width of attached gingiva in female was significantly(p<0.05) wider than that in male group. 5. In the comparison between the Re 3 group and Re 2 group, there was no significant difference except for maxillary right and left 2nd molars and maxillary left 1st molar. 6. The frequency of gingival recession was in the order of mandibular right 1st bicuspid(16.6%), maxillary right 1st bicuspid(13.7%), maxillary and mandibular left 1st bicuspids(13.4%), mandibular left cuspid(10.5%), maxillary left and mandibular right cuspids(10.1%) and maxillary right cuspid(7.9%).