Gingival plasma cell granuloma.

Plasma cell granulomas (pseudotumors) are rare benign, tumor-like proliferations composed chiefly of plasma cells that manifest primarily in the lungs, but may occur in various anatomic locations. We report this case of a 54-year-old male who presented with an unusual maxillary anterior gingival overgrowth treated by excisional biopsy. Histological examination revealed a dense inflammatory cell infiltrate containing mainly plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma. Intraoral plasma cell granuloma is exceedingly rare, although case reports documenting such lesions have been reported. This case highlights the need to biopsy unusual lesions to rule out potential neoplasms.

Effect of nicotine on fibroblast beta 1 integrin expression and distribution in vitro.

BACKGROUND: Integrins are a family of transmembrane cell surface glycoproteins, and those with the beta 1-subunit function in both cell-to-cell and cell-to-substrate adhesion. The purpose of this study was to determine nicotine's effect on the expression and distribution of the beta 1 integrin subunit on the human gingival fibroblast cell surface. METHODS: Pure nicotine was diluted in medium to the following concentrations: 0 (control), 0.025, 0.05, 0.1, 0.2, and 0.4 microM. Human gingival fibroblasts (HFG) were grown for 24 hours in each concentration and fluorescein-labeled with a mouse monoclonal anti-human beta 1 antibody and secondarily incubated with a urease-labeled anti-mouse IgG antibody. After a final wash, the cells were incubated with urea/bromcresol blue substrate for 15 minutes at 37 degrees C and measured in a microplate reader at 570 nm. RESULTS: The integrin beta 1-subunit was detected on the HGF surface membrane by fluorescence labeling, and cell-enzyme-linked immunosorbent assay testing demonstrated its decreased expression with increasing nicotine concentrations that were statistically different at the concentrations of 0.2 and 0.4 microM versus controls (P < 0.05). CONCLUSIONS: Nicotine concentrations of 0.2 and 0.4 microM significantly decrease beta 1 integrin expression in human gingival fibroblasts that may affect cell-cell and cell-substratum adhesion during wound healing.

Treatment of gingival recession with collagen membranes.

Periodontal plastic surgical techniques to obtain root coverage traditionally have utilized autogenous soft tissue grafts. Guided tissue regeneration (GTR) increasingly is being used as an alternative to soft tissue grafting in attempting root coverage. Resorbable membranes in GTR therapy prevent the need for a second surgery to harvest donor tissue. GTR membranes composed of collagen are effective barriers that add to the thickness of the overlying gingiva and possess platelet-aggregating properties that may help in early wound healing. The cases presented here demonstrate the treatment of gingival recession with a resorbable collagen membrane.

Periodontal plastic surgical technique for gingival fenestration closure.

Gingival fenestration is an opening through oral keratinized tissue, usually unattached, that is observed in thin gingiva with usually thick subgingival calculus deposits. This lesion is seen infrequently but may be more common than has been reported; lack of symptoms may inhibit patient awareness. Because surgical correction usually is not required, there are very few reports in the literature concerning this lesion. The following report describes a case of gingival fenestration and surgical treatment with a connective tissue/periosteal graft.

Gingival recession treatment using a bilayer collagen membrane.

Traditional periodontal plastic surgery techniques for the management of gingival recession have typically used soft tissue grafts to obtain defect coverage with great clinical success. Clinicians using guided tissue regeneration (GTR) techniques are also enjoying significant success in periodontal plastic surgery procedures. GTR therapy utilizing bioabsorbable membranes offers the advantages of preventing a donor site surgery and a second surgical procedure for barrier removal. A new bioabsorbable bilayer collagen membrane that readily adapts to bone and tooth surfaces by a gel formation of collagen fibers and blood may be stabilized without sutures prior to soft tissue closure. This bioabsorbable membrane has been shown to be effective in guided bone regeneration procedures and in treating periodontal defects. This case demonstrates the treatment of gingival recession with a novel collagen bilayer membrane.

Pluronic polyol effects on human gingival fibroblast attachment and growth.

BACKGROUND: Enhanced speed of human gingival fibroblast (HGF) spreading and attachment, as affected by ionic bonding interactions, may facilitate cell orientation and subsequent collagen synthesis to promote early wound healing. The purpose of this study was to determine the in vitro effects of pluronic polyols, a family of widely used surfactants currently used as drug carriers for antibiotic, anti-inflammatory, and anti-neoplastic agents, on the attachment and growth of human gingival fibroblasts (HGF) to dentin and plastic surfaces using established tissue culture techniques. METHODS: Plastic culture wells containing Eagle's minimal essential media (EMEM) with 10% fetal calf serum and Pluronic F-68 or F-127 in concentrations from 1.2 x 10(-2) to 1.2 x 10(-10) M were incubated with HGF and run in replicates of ten. Attached cells were quantified by measuring the optical density of methylene blue-stained cells. Additional experiments were conducted using human dentin sections as a substrate and Pluronic F-68 or F-127 at a concentration of 1.2 x 10(-8) M. In these experiments, HGF were stained with acridine orange and quantified per unit area of dentin by fluorescence microscopy. RESULTS: Attachment and growth of HGF to both plastic and dentin were significantly increased over serum controls by very low concentrations of Pluronic F-68 and F-127 by 30 minutes, with attachment reaching a plateau at 2 hours. CONCLUSIONS: Pluronic polyols, a family of widely used surfactants, in very low dosages may be beneficial in early postsurgical wound healing by facilitating early attachment and enhancing the growth rate of human gingival fibroblasts.

Non-Hodgkin's lymphoma and periodontitis. A case report.

BACKGROUND: We describe an unusual case of extra-nodal non-Hodgkin's lymphoma that developed in the maxillae associated with localized severe periodontitis in a 64-year-old Caucasian male. The lymphoma was diagnosed less than 2 years following routine periodontal surgery and 8 weeks after the extraction of hopeless teeth in the associated area. METHODS: Two months following the extractions, the patient experienced pain and swelling in the maxillary right edentulous area mimicking an abscess, and reported for emergency care. An expansile lesion measuring 2.0 x 2.5 cm in diameter was noted on radiographic examination to extend into the right maxillary sinus. A definitive biopsy diagnosis of high-grade, small, non-cleaved, diffuse non-Hodgkin's lymphoma of the right posterior maxillae was established. The patient was subsequently treated by a combination of radiation, chemotherapy, and bone marrow transplantation. RESULTS: The maxillary tissues healed uneventfully, and the patient has been closely observed for approximately 5 years without symptoms or recurrence of the lymphoma. CONCLUSIONS: This case highlights the need for careful debridement of extraction sockets associated with severe periodontitis and argues for the routine submission of extracted teeth with adjacent soft tissue for microscopic analysis, to assist in the early diagnosis of potentially life-threatening malignancies.

Assessing the effectiveness of direct digital radiography barrier sheaths and finger cots.

BACKGROUND: Effective cross-contamination prevention is critical for direct digital radiography, or DDR, sensors, which are not sterilizable; however, current manufacturers' recommendations for standard precautions are limited to the use of plastic barrier sheaths, which are commonly known to tear or leak. The authors sought to determine the incidence of digital radiography barrier-sheath leakage, with and without additional latex finger cot protection, as measured by a water pressure test. METHODS: Four hundred plastic barrier sheaths were randomly assigned to four groups based on intraoral radiograph positioning device use and supplemental barrier protection with a latex finger cot. Sheaths were carefully placed to cover DDR sensors for a single intraoral use, gently removed from the sensors and tested for leakage through a water pressure technique. RESULTS: Perforations occurred in 44 to 51 percent of plastic sheaths after a single radiographic exposure. However, only up to 6 percent of the plastic sheaths that were covered by a latex finger cot leaked during the water pressure test. CONCLUSIONS: At least 44 percent of the plastic barrier sheaths leaked after a single intraoral radiographic exposure. Use of a latex finger cot over the plastic sheath significantly reduced leakage to no more than 6 percent. CLINICAL IMPLICATIONS: Latex finger cots used in conjunction with the standard plastic sheaths that cover DDR sensors may more effectively prevent cross-contamination than do plastic sheaths alone. Dentists who use DDR sensors during highly invasive dental procedures such as dental implant surgery are encouraged to consider supplemental barrier protection for these delicate, expensive and nonsterilizable sensors to prevent patient cross-contamination.

Gingival augmentation with a dermal allograft.

Gingival augmentation surgery with soft tissue autografts long has been the standard for increasing the width of keratinized oral tissue. Acellular dermal allografts, which have been used for several years by reconstructive surgeons, are a novel technique for achieving increased gingival tissue in place of soft tissue autografts. This report describes a case of gingival augmentation via an acellular dermal allograft. Reduced morbidity from donor site grafts and increased patient acceptance, along with highly successful clinical results, are the primary advantages of this acellular dermal allograft.

Resin to metal bond strengths using two commercial systems.

STATEMENT OF PROBLEM: A secure bond between resin and an alloy framework is necessary for clinical success in removable prosthodontics. PURPOSE: This study compared the shear bond strength of composite to composite to metal with two commercially available chemical bonding systems: a silicoating system (Silicoater) and a nitrogenous heterocycle-acrylonitrile system (Kevloc). MATERIAL AND METHODS: Fifty-two nickel-chromium cubes were cast and composite resin was bonded to the alloy surfaces according to manufacturer's directions. After storage at 35 degrees C for 15 days, and thermocycling at 5 degrees C and 55 degrees C for 1200 cycles, the bonds were fractured in shear on a universal testing machine. RESULTS: Mean bond strength for the silicoated sample was 10.93 MPa and for the heterocycle-acrylnitrate system 11.44 MPa. An unpaired t test revealed no difference between the groups (p = 0.60). Visual inspection of the fracture surfaces revealed that failure was adhesive at the resin-to-metal surface in almost all the specimens.

Inflammatory cervical root resorption following segmental orthognathic surgery. A case report.

An unusual case of bilateral inflammatory external/internal root resorption developed in the maxillae of a 28 year-old female approximately 4 years following routine segmental orthognathic surgery. The patient experienced dental pain in a tooth adjacent to a segmental osteotomy cut 8 months postsurgery, however, the tooth later became asymptomatic. A definitive diagnosis of inflammatory cervical root resorption was not established until nearly 4 years later on routine dental examination. The external/internal resorptive lesions were located 4 to 6 mm apical to the connective tissue attachment on 3 of the 4 tooth roots adjacent to osteotomy cuts. Two of the affected teeth required non-surgical root canal therapy due to pulpal communication with the resorptive defects. The lesions were accessed by flap surgery, thoroughly debrided, and obturated with an intermediate restorative material until definitive restorative therapy could be completed. All sites healed uneventfully and the patient has been closely observed for approximately 2 years without symptoms or recurrence of the resorptive lesions. Dental health care providers should be alert to the possible occurrence of inflammatory root resorption in sites adjacent to osteotomy cuts over extended periods of time. Routine radiographic examination may be beneficial in the postoperative management of the segmental orthognathic surgery patient.

The effects of different tetracyclines on the dentin root surface of instrumented, periodontally involved human teeth: a comparative scanning electron microscope study.

This in vitro study compares, by scanning electron microscope (SEM) examination, the surface effects of various topical applications of tetracycline on the instrumented dentin root surface of human teeth. Eighty-two (82) dentin samples were prepared from periodontally-compromised teeth planned for extraction. Solutions of tetracycline HCl, doxycycline, minocycline, sumycin, and a saline control were prepared and applied to the dentin samples for 0.5, 1, 3, 5, and 10 minutes. Each solution pH was measured: tetracycline HCI (pH 1.6), doxycycline (pH 2.2), minocycline (pH 3.8), sumycin (pH 4.4), and saline (pH 5.1). A tetracycline periodontal fiber was also evaluated at 1, 4, 7, and 10 days of exposure for dentin surface effects. Tetracycline HCI removed the dentin smear layer leaving clean and open tubules significantly better than other solutions tested in as little as 30 seconds. Doxycycline and minocycline produced similar results to each other, which were significantly better than sumycin and saline, but not as effective as tetracycline HCl. Smear layer removal was attained by doxycycline and minocycline in five to ten minutes; however, sumycin and the saline control ineffectively removed the surface smear layer and dentinal tubules remained partially to totally occluded by debris. The periodontal fiber did not significantly alter the surface smear layer. Results of this study suggest that tetracycline HCl is the best current tetracycline form for root surface conditioning as measured by its ability to affect both dentin smear layer removal and dentin tubule exposure.