Histologic Analysis of Clinically Healthy Human Gingiva in Patients with Altered Passive Eruption.

The purpose of this study was to histologically examine the clinically healthy gingiva of patients with altered passive eruption (APE). Five patients with type 1 APE were enrolled. They underwent scaling and polishing and received oral hygiene instructions. After 6 months of supervised plaque control and uninterrupted gingival clinical health (Gingival Index (GI) = 0 and no Bleeding on Probing (BoP)), upper anterior teeth were surgically treated. During the surgical procedure, the excised gingival margin was collected to be histologically examined. In four out of five patients, signs of inflammation including spongiosis and neutrophil exocytosis could be found in the epithelium of the gingival sulcus. Ulceration with exposure of the lamina propria and inflammatory granulation tissue were evident in the most severe cases. Normal density and orientation of collagen fibers could be seen within the superficial and the deep portions of connective tissue, with an increase in size and number of the deep collagen fibers and a reduced laxity of the superficial ones. In conclusion, the clinically healthy gingiva of APE patients showed features compatible with persistent inflammation, possibly due to recurrent traumatisms caused by an incisally placed gingival margin.

Experimental gingivitis in patients with and without altered passive eruption.

BACKGROUND: Individuals with altered passive eruption (APE) are assumed to be more susceptible to periodontal diseases. To date, this hypothesis has not been sufficiently supported by scientific evidence. The aim of this study, using an experimental gingivitis model, was to examine the development and resolution of gingival inflammation in patients with APE when compared to patients with normal gingival anatomy. METHODS: A localized experimental gingivitis was induced in 9 patients with APE (test group) and 9 patients without APE (control group) in the maxillary right quadrant. After 21 days, patients were instructed to resume proper home oral hygiene procedures. At baseline (day 0) and at days 7, 14, 21, 28, 35, and 42, plaque index (PlI), gingival index (GI), and gingival crevicular fluid volume (GCF) were evaluated for teeth 6 (canine), 7 (lateral incisor) and 8 (central incisor) of test and control groups. RESULTS: During the experimental gingivitis phase (days 0 to 21), the rate of change in gingival inflammation (GI) was dramatically different between the APE test group and the control group. On day 21, at the time of maximum plaque accumulation, the GI of the APE test group was a 109% greater than the GI of the test group (P ≤ 0.001) despite similar plaque levels (P = 0.436). During the resolution of inflammation phase (days 22 to 42), the APE test group continued to exhibit statistically higher GI scores than the control group (P = 0.029). CONCLUSION: In the presence of similar amounts of plaque deposits and plaque accumulation rates, APE patients exhibited differences in the development and resolution of plaque-induced gingival inflammation when compared to controls.

Early Wound Healing Score: a system to evaluate the early healing of periodontal soft tissue wounds.

PURPOSE: Numerous indices have been proposed to analyse wound healing in oral soft tissues, but each has specific shortcomings. A new method of analysis, the Early Wound Healing Score (EHS), was evaluated in the present study. The aim was to assess more accurately early healing by primary intention of surgical incisions in periodontal soft tissues. METHODS: Twenty-one patients were treated with different surgical procedures comprising 1 or 2 vertical releasing incisions as part of a surgical access flap. Twenty-four hours after surgery, early wound healing at the vertical releasing incisions was assessed using the EHS. This score assessed clinical signs of re-epithelialization (CSR), clinical signs of haemostasis (CSH), and clinical signs of inflammation (CSI). Since complete wound epithelialization was the main outcome, the CSR score was weighted to be 60% of the total final score. Accordingly, a score of 0, 3, or 6 points was possible for the assessment of CSR, whereas scores of 0, 1, or 2 points were possible for CSH and CSI. Higher values indicated better healing. Accordingly, the score for ideal early wound healing was 10. RESULTS: Thirty vertical releasing incisions were assessed in 21 patients. At 24 hours after incision, 16 vertical releasing incisions (53.33%) received the maximum score of CSR, while 6 cases (20%) received an EHS of 10. None of the cases received 0 points. CONCLUSION: The EHS system may be a useful tool for assessing early wound healing in periodontal soft tissue by primary intention after surgery.