Use of Collagen Matrix Scaffolds as a Substitute for Soft Tissue Augmentation: Case Series.

INTRODUCTION: The presence of keratinized mucosa (KM) around natural teeth is believed to be beneficial in certain restorative, prosthetic, and orthodontic situations. Lack of adequate KM is common and predictably treated by autogenous gingival grafts (AGGs); however, AGGs have the disadvantages of harvest site morbidity, limited donor site availability, and compromised esthetics. CASE PRESENTATION: This case series presents the use of the xenogeneic porcine bilayer collagen matrix (BCM) in increasing the width of attached KM around natural teeth. Patients with a limited amount of KM, shallow vestibule, and aberrant frenum attachment were treated using this graft material. The patients were followed up to 4.5 years postoperatively and were evaluated regarding the amount of KM, gingival margin stability, and tissue esthetics. CONCLUSIONS: Within the limitations of the sample size of patients in this report, the BCM appears to be a viable alternative option to AGG for increasing the width of KM gingiva around teeth. This method resulted in gain of KM, gingival margin stability, vestibular deepening, aberrant frenum elimination, and favorable esthetics in terms of color matching, texture, and contour blending. This xenogeneic graft material could be used in cases where the autogenous graft supply is limited or in highly esthetically demanding cases. Additionally, it could be an alternative option when a second surgical site is not desired by the patient or a less invasive procedure is preferred by the clinician in certain medical conditions. Well-controlled long-term studies are required to validate our limited clinical observations.

Surgical Management of Implant-Associated Gingival Fenestrations.

Soft tissue fenestrations are extremely rare in the natural dentition and have only recently been reported on dental implants. Although the pathogenesis of their formation is not completely understood, several predisposing risk factors have been identified, some of which may affect dental implants as well. This article presents a thorough review of the literature pertaining to gingival fenestration. It also describes the surgical management of lesions developed approximately six years following osseointegration of two dental implants.

Surgical Management of Implant-Associated Gingival Fenestrations.

Soft tissue fenestrations are extremely rare in the natural dentition and have only recently been reported on dental implants. Although the pathogenesis of their formation is not completely understood, several predisposing risk factors have been identified, some of which may affect dental implants as well. This article presents a thorough review of the literature pertaining to gingival fenestration. It also describes the surgical management of lesions developed approximately six years following osseointegration of two dental implants.

Regression of Calcium Channel Blocker--Induced Gingival Enlargement in the Absence of Periodontal Therapy.

AIM: To illustrate the negative effect of calcium channel blocker (CCB) drugs on the gingival tissues and the reversibility of these lesions. CASE DESCRIPTION: The authors examined a forty-eight year-old male patient with drug-induced gingival enlargement associated with diltiazem, a CCB drug. Prior to initiating the proposed periodontal treatment, the patient was advised to consult his physician, for a possible switch to a different anti-hypertensive drug. The patient returned to the clinic three months later with a significant regression of the gingival overgrowth, which was induced by the patient ceasing the prescribed regimen without medical consultation or periodontal intervention. CONCLUSION: Although CCBs are effective cardiovascular drugs, they can negatively impact the oral health by promoting gingival overgrowth in some patients. Substitution of these drugs is strongly recommended prior to any periodontal intervention in order to improve prognosis and prevent recurrence, and should be done only by the medical providers.

The effect of long-term aspirin intake on the outcome of non-surgical periodontal therapy in smokers: a double-blind, randomized pilot study.

OBJECTIVE: The objective of this parallel, double-blind, randomized pilot study was to determine the effect of a daily dose of 325 mg of aspirin (ASA) on the clinical outcomes of scaling and root planing in a selected group of adult smokers. BACKGROUND: The response to periodontal therapy is inferior among smokers compared to non-smokers. Long-term intake of ASA has been shown to exert a positive impact on reducing both the prevalence and severity of periodontitis, among high-risk groups of subjects such as heavy smokers and diabetics. It is reasonable to assume that systemic administration of ASA in conjunction with reduction of the bacterial load by scaling and root planing may improve and prolong the benefits of periodontal therapy. To date, only few prospective interventional clinical studies have specifically addressed the periodontal needs of smokers. METHODS: The study includes 24 smokers. The following clinical parameters were measured preoperatively and at 3, 6, 9 and 12 mo postoperatively: (i) gingival index; (ii) plaque index; (iii) probing depth; (iii) probing attachment level; (iv) gingival recession; and (v) bleeding scores. Study subjects received scaling and root planing over several visits and were randomly assigned into two equal groups; a control group (C), which received a placebo and a test group (T), which took a daily dose of 325 mg ASA. No additional therapy was provided over the 1 year observation period. RESULTS: There were more statistically significant differences (p < 0.05; one- tailed) between pretest and posttest scores in the T group than in the C group. Mean percent increase in sites with probing depth 1-3 mm (T: 8.78; C: 7.21); mean percent reduction in sites with probing depth 4-6 mm (T: -7.25; C: -5.09 not statistically significant, NS); mean percent reduction in sites with probing depth ≥ 7 mm (T: -1.42; C: -02.09); mean percent reduction in sites with probing attachment level 3-4 mm (T: -3.63; C: 0.48 NS); mean percent reduction in sites with bleeding on probing (T: -12.37; C: -2.59 NS) (p < 0.05, NS). CONCLUSIONS: Daily intake of 325 mg of ASA following scaling and root planing improved treatment outcomes in smokers, without an increase in gingival bleeding tendency. ASA promoted a higher incidence of shallow pockets and more gain in attachment level.

Odontogenic keratocyst: a case report and review of an old lesion with new classification.

The odontogenic keratocyst (OKC) is distinctive among jaw cysts given its tendency toward recurrence and aggressive clinical behavior. This paper presents a well-documented case of OKC and a review of the diagnostic features, treatment modalities and new evidence supporting the reclassification and renaming of this unique pathologic process.

Association of antimicrobial and clinical efficacy: periodontitis therapy with minocycline microspheres.

OBJECTIVE: The objective of this study was to investigate the association between the antimicrobial and clinical efficacy of minocycline hydrochloride microspheres when used adjunctively with scaling and root planing. METHODS: 127 subjects with moderate-to-advanced chronic periodontitis were randomly assigned to receive either minocycline microspheres plus scaling and root planing (n = 62) or scaling and root planing alone (n = 65). Deoxyribose nucleic acid analysis and clinical data were obtained at baseline and 30 days after treatment. End points included changes in the mean sum of red complex bacteria, pocket depth, number of deep pockets, bleeding on probing, and clinical attachment level from baseline to day 30. Regression analysis determined the association between microbiological and clinical efficacy. RESULTS: Minocycline microspheres plus scaling and root planing reduced pocket depth, the number of deep pockets and bleeding on probing, and increased clinical attachment level significantly more than scaling and root planing alone (p < 0.05). Comparing minocycline microspheres plus scaling and root planing with scaling and root planing alone, the number needed to treat for a 2 mm pocket depth reduction difference was 6.5. Pocket depth reduction correlated significantly with a decrease in the numbers and proportions of red complex bacteria. Minocycline microspheres significantly improved all clinical parameters compared to scaling and root planing alone. CONCLUSIONS: The addition of minocycline microspheres to scaling and root planing led to a greater reduction in the proportions and numbers of red complex bacteria. The reduction in pocket depth was significantly correlated with the reduction of the proportions and numbers of red complex bacteria. Additionally, there were statistically greater improvements in all clinical parameters examined.

Mechanical therapy with adjunctive minocycline microspheres reduces red-complex bacteria in smokers.

BACKGROUND: Smoking increases the risk for periodontal disease and reduces the healing response. We examined the antimicrobial and clinical effects of scaling and root planing (SRP) with and without minocycline HCl 1 mg microspheres (MM) relative to smoking status in subjects with periodontitis. METHODS: A total of 127 subjects (46 never smokers, 44 former smokers, and 37 current smokers) with moderate to advanced periodontitis were randomized to receive MM + SRP (N = 62) or SRP alone (N = 65). Subgingival plaque samples collected at baseline and day 30 were examined for the presence of 40 periodontal bacteria by DNA probe analysis. RESULTS: MM + SRP reduced red-complex bacteria (RCB) numbers and proportions to a greater extent than SRP alone, irrespective of smoking status. RCB numbers were not reduced by SRP in current smokers. The difference in the reduction in numbers of RCB by SRP relative to MM + SRP in current smokers was statistically significant (P <0.05). Numbers and proportions of orange complex bacteria (OCB) were reduced in all groups treated with MM + SRP. Proportions of OCB increased in current smokers treated with SRP alone. In current smokers, MM + SRP significantly reduced probing depth (PD), increased clinical attachment level (CAL), and reduced bleeding on probing (BOP) to a greater extent than SRP alone (P <0.05). CONCLUSIONS: SRP alone was ineffective at reducing numbers or proportions of RCB or OCB in current smokers, whereas MM + SRP significantly reduced both. MM + SRP also improved PD, BOP, and CAL to a greater extent than SRP alone independent of smoking status.

Minocycline HCl microspheres reduce red-complex bacteria in periodontal disease therapy.

BACKGROUND: The objective of this trial was to measure the antimicrobial effects of a minocycline HCl microsphere (MM) local drug-delivery system when used as an adjunct to scaling and root planing (SRP). DNA probe analysis for 40 bacteria was used to evaluate the oral bacteria of 127 subjects with moderate to advanced chronic periodontitis. METHODS: Subjects were randomly assigned to either SRP alone (N = 65) or MM + SRP (N = 62). The primary endpoints of this study were changes in numbers and proportions of the red-complex bacteria (RCB) and the sum of Porphyromonas gingivalis, Tannerella forsythia (formally T. forsythensis), and Treponema denticola relative to 40 oral bacteria at each test site from baseline to day 30. Numbers of RCB from the five test sites were averaged to provide a value for each subject. RESULTS: MM + SRP reduced the proportion of RCB by 6.49% and the numbers by 9.4 x 10(5). The reduction in RCB proportions and numbers by SRP alone (5.03% and 5.1 x 10(5), respectively) was significantly less. In addition, MM + SRP reduced probing depth by 1.38 mm (compared to 1.01 mm by SRP alone), bleeding on probing was reduced by 25.2% (compared to 13.8% by SRP alone), and a clinical attachment level gain of 1.16 mm (compared to 0.80 mm by SRP alone) was achieved. CONCLUSION: These observations support the hypothesis that RCBs are responsible for periodontal disease and that local antimicrobial therapy using MM + SRP effectively reduces numbers of RCBs and their proportions to a greater extent than SRP alone.

Comparison of the Hydrabrush powered toothbrush with two commercially-available powered toothbrushes.

INTRODUCTION: An examiner-blinded, randomized, parallel, three-cell, controlled clinical trial was conducted to compare the efficacy of a new powered toothbrush (Hydrabrush) to that of two presently marketed power brushes (Oral-B and Sonicare) in reducing stain, supragingival plaque, gingivitis and the signs of periodontitis while monitoring safety. METHODS: One hundred ten subjects were randomly assigned to three groups (35--Oral-B group, 36--Sonicare group, and 39--Hydrabrush group). Subjects were instructed to use the assigned powered toothbrush according to the manufacturer's instructions for 2-minutes duration twice per day. Clinical examinations conducted at baseline and at weeks 4, 8, and 12 included the following parameters: (1) oral tissues; (2) staining; (3) plaque index; (4) gingivitis; (5) probing depth; (6) clinical attachment loss; and 7) bleeding on probing. RESULTS: The results showed that the body intensity and extent of stain and the gingival intensity and extent of stain at 8 and 12 weeks, respectively, were significantly less in the Hydrabrush group compared with the Sonicare group. The modified gingival index (MGI) in all groups significantly decreased over the 12 weeks. However, the groups did not differ from each other statistically. At 4, 8 and 12 weeks, the Hydrabrush group had statistically significantly less plaque than the Sonicare group. At 4 weeks, the Hydrabrush group had statistically significantly lower mean probing depth than both the Oral-B and Sonicare groups. At 8 and 12 weeks, the Hydrabrush group had statistically significantly lower mean probing depths than the Sonicare group. With regard to mean percentage of sites with probing depth > or =4 mm, the Hydrabrush group had statistically significantly fewer sites > or =4 mm at 4, 8 and 12 weeks. Differences among the groups in clinical attachment loss at 4, 8 and 12 weeks were representative of small imbalances at baseline. No differences were seen among the treatment groups with regard to gingival recession and bleeding on probing. CONCLUSIONS: With the exception of clinical attachment loss, all subject groups were balanced for all measured clinical parameters at baseline. Tooth stain became significantly less in the Hydrabrush group compared with the Sonicare group at 8 and 12 weeks. At all examinations, the Hydrabrush group had statistically significantly less plaque than the Sonicare group. At 4 weeks, the Hydrabrush group had statistically significantly lower mean probing depth than both the Oral-B and Sonicare groups, and at 8 and 12 weeks, the Hydrabrush group had statistically significantly lower mean probing depth than the Sonicare group. With regard to mean percentage of sites with probing depth > or =4 mm, the Hydrabrush group had statistically significantly fewer sites > or =4 mm when compared to the other two tested brushes at all examinations. No differences were seen among the treatment groups with regard to gingival recession and bleeding on probing and none of the tested brushes caused any adverse reactions.