Treatment of a Localized Stage III Periodontitis in the Esthetic Zone with Guided Tissue Regeneration Technique on a Heavy Smoker Patient with 12-Year Follow- up: A Case Report.

This case report exhibits a heavy smoker female patient with a localized stage III periodontitis who has been under the smoking cessation program during the pre-surgical period, followed by a strict maintenance program for the past twelve years, after being treated with guided tissue regeneration techniques and restored with zirconia prosthetic crowns. A 50-year-old, heavy smoker (> 40 cigarettes per day), systemically healthy female patient presented complaining of mobility and pain in the upper right central incisor, which was temporarily splinted to the left central incisor using resin composite. After clinical and radiographic examination, significant damage of the attachment apparatus, deep periodontal lesions extending the middle portion of the root, and severe infrabony defect were noted. Following the initial hygienic phase, a guided tissue regeneration surgery using xenograft bone substitute covered by a resorbable collagen membrane was performed. After six months of healing, four zirconia crowns were cemented on the central and lateral incisors based on patient esthetic compliance. During the 12-year follow-up period, neither residual pockets nor gingival recession were observed, and perfect marginal bone stability, and esthetic and functional results were noted. This case shows the predictability of a conservative surgical technique, the guided tissue regeneration, based on appropriate treatment planning and a strict maintenance program. It also demonstrates the importance of at least a 6-month healing period after such surgeries, allowing complete tissue maturation and a re-establishment of the supra osseous gingival tissues in order to locate the prosthetic margins without interfering with the soft tissues integrity.

Correlations between Width of Keratinized Gingiva and Supracrestal Gingival Tissues Dimensions: A Retrospective Clinical Study.

AIM: The aim of this retrospective study is to assess potential correlation between the width of the keratinized gingiva (KG), and the dimensions of the supracrestal gingival tissue (SGT) components. MATERIALS AND METHODS: On the sample of 259 teeth of 79 patients, the following measurements were collected: width of KG, sulcus depth (SD), SGT, and biological width (BW) dimensions; separate correlations between measured elements were computed for males and females, for anterior and posterior, and for maxillary and mandibular teeth separately. RESULTS: Correlations between buccal KG and BW were present only for the upper anterior teeth and were nonsignificant in the female subsample, whereas the correlation between lingual KG and SGT were present only in females. Additionally, correlations between buccal KG and SD were present in upper anterior teeth only and were absent in the male subgroup. CONCLUSION: The width of the KG cannot routinely be used as an indicator for the dimensions of the SGT components. CLINICAL SIGNIFICANCE: While the width of the KG can hardly be a useful indicator in upper anterior teeth, probing depth and bone sounding prior to prosthetic rehabilitation remains an essential tool to ensure tissue preservation.

Changes in Keratinized Tissue Width Following Connective Tissue Grafts and Diode Laser- vs Blade-Gingivoplasty.

The objectives of this study were to clinically and histologically assess the capacity of bilaminar subepithelial connective tissue grafts (SCTGs) alone or in combination with gingivoplasty (Gv) to increase the keratinized gingiva width (KGW) in contralateral mandibular sites lacking KG (10 patients, 42 sites). The effects of Gv timing (1 vs 2 months) and technique (blade vs laser) were also evaluated. SCTGs alone resulted in mean KGW increase of 0.1 to 0.7 mm. Laser-Gv significantly increased KGW by an additional 1.9 mm at 4 months postabrasion as opposed to 0.9 mm achieved with blade-Gv. Histologically, laser-treated sites displayed parakeratinization with more pronounced rete pegs than observed in blade-abraded sites.

Single Sitting Surgical Treatment of Generalized Aggressive Periodontitis Using GTR Technique and Immediate Implant Placement with 10-Year Follow-Up.

This case report exhibits a patient with generalized aggressive periodontitis who has been under maintenance for the past 12 years after being surgically treated in a single sitting and restored with dental implants. A 41-year-old systemically healthy male patient presented complaining of lower anterior teeth mobility and pain in the upper right quadrant. After clinical and radiographic examination, the upper right molars and lower anterior incisors were deemed unrestorable. Covered by doxycycline, the patient received a nonsurgical periodontal treatment. Three weeks later, teeth extraction, immediate implant placement, immediate nonloading provisional prosthesis, and a guided tissue regeneration were performed at indicated areas in a single sitting. The clinical decisions were based on patient compliance, the status of the existing periodontal tissues, and the prognosis of the remaining teeth. During the 12-year follow-up period, no residual pockets were observed and there was no exacerbation of the inflammatory condition. Marginal bone stability is present on all implants. For aggressive periodontal disease, a high risk of relapse as well as limited success and survival of dental implants should be considered. This case shows proper containment of the disease based on appropriate treatment planning and a strict maintenance program.

Comparison of the Clinical Biological Width with the Published Standard Histologic Mean Values.

AIMS AND OBJECTIVES: Biologic width (BW) as defined by Cohen is the part of the supracrestal gingival tissues that occupy the space between the base of the gingival crevice and the alveolar crest; it includes the junctional epithelium and the connective tissue element. Interactions between dental crowns and the marginal periodontal tissues analyzed in many review papers concluded that the recognition of the BW, in terms of crown margin placement, is beneficial for periodontal health. Therefore, knowledge of the dimensions of the sum of the junctional epithelium and connective tissue attachment as well as the sulcus depth (SD) is of clinical relevance. The aim of the study is to compare the average SD and BW clinically measured around teeth with the standard application of a mean value of 0.69 mm and 2.04 mm, respectively, found by Gargiulo et al.in a histological study on cadavers. MATERIALS AND METHODS: Forty-two healthy patients with age ranging from 20 to 50 years presented to the Multidisciplinary Department at the Lebanese University. A total of 504 tooth sites of 126 teeth were selected and measured by two periodontists. All measurements were done on teeth requiring infiltration anesthesia for surgical, restorative, or endodontic procedures on neighboring tooth/teeth, which eliminate any ethical concerns. The SD and the distance from gingival margin to bone crest at four sites per tooth; mesial, midbuccal, distal, and midlingual/palatal were measured. Clinical, BW was calculated by subtracting SD from the distance between gingival margin to bone crest. STATISTICAL ANALYSIS: Friedman's ANOVA test, independent samples t-tests, and one-sample t-tests were applied. The IBM® SPSS® statistics 20.0 statistical package was used to carry out all statistical analyses. RESULTS: The BW is statistically significantly lower than the value stated by Gargiulo et al. (2.04 mm) with a mean value of 1.13 mm, whereas the SD is statistically significantly greater than the value stated by Gargiulo et al. (0.69 mm) with a mean value of 1.96 mm. CONCLUSION: It can be concluded that there is a need to create a patient/site-specific distance from the proposed margin of the restoration to the bone crest when restoring subgingivally fractured or carious teeth. This leads to more stable and healthy tissues when performing crown lengthening procedures. Therefore, using the term clinical, BW is more reliable and it should be used to reestablish stability and integrity of periodontal tissues around restored teeth.

Expression of Bone Morphogenetic Protein-2 and Histological Differentiation of Oral Squamous Cell Carcinomas

Background and Objective : Bone morphogenic protein-2 (BMP-2) plays an essential role in mesenchymal cell differentiation into osteoblasts، through many intracellular pathways which may also be active in tumors. Invasive oral squamous cell carcinomas account for more than 90% of head and neck malignancies in many cancer registries. They are classified into three types according to epithelial cell differentiation. The present study aimed to identify any relation between BMP-2 expression and tumor histology. Materials and methods: BMP-2 expression was compared immunohistochemically among 30 cases (19 male and 11 female, mean age 48 years) of oral squamous cell carcinoma, Division was into 3 groups (each containing 10 cases) according to the histological grade. Results: No significant correlation between BMP-2 expression and histological grade was observed. Changes in localization and cytoplasmic staining were also not apparent. Conclusion: From the results of this study BMP-2 does not appear to have any application as a prognostic marker for oral squamous cell carcinomas.