A rare case of gingival necrosis following an extraoral injection of dermal filler.

BACKGROUND: The utilization of dermal fillers for cosmetic procedures has increased dramatically in the past several years, and so is the number of reported adverse events and complications. Most of these reports are centered on extraoral facial structures such as skin, nose, forehead, and eyes. However, as this report illustrates, intraoral complications are also possible and require appropriate management. Our extensive search of the medical and dental literature has failed to yield any such report. METHODS AND RESULTS: An injection of dermal filler composed of hyaluronic acid for managing a deep nasolabial fold resulting in an arterial occlusion is presented. Patient exhibited facial skin necrosis, with ecchymoses and crusting, extending to the right eye. Transient diplopia and vision changes were also present. Additionally, intraoral necrosis of the palatal mucosa extending from the right central incisor to the molars and approaching the midline was noted. Patient was managed palliatively until complete re-epithelization was noted, with no further loss of periodontal attachment. CONCLUSION: This case illustrates a rare oral complication of extraoral injection of a dermal filler, and its management. The clinicians should be aware of the potential risks of these cosmetic procedures. Early detection and timely management may prevent lasting damage and discomfort. Additionally, some of these complications may require a well-coordinated multidisciplinary involvement to restore health and functions (plastic surgeon, dermatologist, ophthalmologist, and a periodontist). KEY POINTS: Why is this case new information? Previous reports of adverse effects linked to dermal fillers were limited to extraoral structures such as the facial skin, nose, forehead, and eye. To the authors' best knowledge, this is the first and only documented case of intraoral necrosis following dermal filler injection What are the keys to successful management of this case? The most important step in managing intra-arterial filler injection and occlusion is the immediate injection of hyaluronidase enzyme to minimize the extent of tissue necrosis. In the case of ocular involvement, immediate referral to an ophthalmologist is required What are the primary limitations to success in this case? Success of managing the adverse effects of vascular occlusion following filler injection depends on several factors, including the anatomical area of occlusion, its extend, along with timely treatment.

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.

Management of heat-induced bone necrosis following thermal removal of gutta-percha.

Many endodontically treated teeth require a post to improve the retention of the coronal restoration, which necessitates removal of the coronal part of the gutta-percha from the canal by thermal method, among other techniques. However, this technique carries the risk of heat conduction to the attachment unit of the periodontium and infliction of permanent damage especially in cases where the remaining root's dentin walls are thin. The overall objective of this article is to report on the clinical manifestations, histologic description, and periodontal management of three cases of heat-induced damage following thermal removal of gutta-percha.

Managing a Lateral Periodontal Cyst With Bone Graft: A Computed Tomography Assessment 18 Months Postoperatively.

The lateral periodontal cyst is a rare benign lesion that is generally asymptomatic and commonly discovered by routine intraoral radiography. Reports on proper management of this lesion are readily available. However, the literature is sparse regarding the long-term outcomes following surgery. A traditional radiographic technique does not provide an adequate image of the healing, and a patient may resist the prospect of a reentry procedure. The current report is the first to utilize a cone-beam computed tomography scan to evaluate the healing potential of a freeze-dried bone allograft approximately 18 months postoperatively.

The Potential Role of Curcumin in Periodontal Therapy: A Review of the Literature.

Periodontitis is a chronic inflammatory disease in the oral cavity caused by bacterial biofilm attached to tooth surfaces. The periodontal pathogenic microorganisms trigger the disease process; however, the destruction of the periodontium is mostly caused by the host's immune response to the bacterial insults. The main thrust of periodontal therapy has been centered traditionally on reducing the microbial load by mechanical and antimicrobial means. This approach has been reported to be effective for the majority of patients and sites. However, modulating the host response by anti-inflammatory agents could provide another viable pathway to managing poorly responding periodontal patients. The overall objective of this paper is to review current data pertinent to curcumin and its dual anti-inflammatory and antimicrobial properties and to explore its potential in managing patients with periodontal diseases. Curcumin has a wide biological spectrum that could provide clinicians with an alternative anti-inflammatory and antimicrobial agent for managing a variety of maladies including periodontal diseases. However, large-scale longitudinal randomized clinical trials are needed to prove efficacy and effectiveness of curcumin in managing periodontitis. Furthermore, its structure requires modification in order to improve its bioavailability and its clinical effectiveness. Further research aiming at improving its delivery and formulation will enhance its dual potential as an important anti-inflammatory and anti-microbial agent in periodontology.

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.

Non-Orthodontic, Non-Restorative Closure of Acquired Diastemata.

AIM: To illustrate the reversibility of "pathologic tooth migration" in several patients that were managed by periodontal therapy alone, along with a review of the relevant literature. BACKGROUND: Pathologic tooth migration (PTM) is a common phenomenon among patients seeking dental care. Different etiologic factors have been implicated in PTM: loss of periodontal support, occlusal interferences, posterior bite collapse, and various oral habits such as: lip biting, tongue thrusting, and playing wind instruments. Identification of all the causative factors involved in PTM is crucial for a successful treatment outcome. Managing severe cases of acquired diastemata may necessitate a complex and a sequential intervention involving periodontic, orthodontic and prosthodontic measures. However, "spontaneous regression" of teeth to their original position may occur in certain cases after elimination of the offending factors. CONCLUSION: "Spontaneous" closure of acquired diastemata could occur following surgical and/or non-surgical periodontal therapy or removal of occlusal interferences. Correction of pathologically migrated teeth without orthodontic or restorative treatment is feasible, but unpredictable.

Root amputation: a new look into an old procedure.

A treatment option for managing furcation invasions is root amputation. Long-term survival of resected molars requires a complete harmony of sequential endodontic, periodontic, restorative and maintenance procedures. The main objective of this article is to provide a concise historical perspective of this procedure and to review available literature regarding its efficacy and limitations. It also illustrates a current modification of the procedure using guided bone regeneration (GBR) and socket preservation to eliminate some of the potential disadvantages of the traditional root amputation procedure.

Provisional prostheses during ridge augmentation and implant dentistry.

Recent advancements in ridge augmentation and bone regeneration have expanded the pool of patients that could benefit from dental implants. However, providing the patient with a temporary prosthesis during the wound healing phase without impairing the process is a challenging task. This article summarizes available information pertaining to provisional prostheses, both tooth-supported and soft tissue-supported, that may meet the patient needs. The advantages and disadvantages of each class of prosthesis, along with indications and contraindications, were taken into consideration to aid the restorative dentist in choosing the optimal provisional for their patients.

An unusual case of gingival enlargement: peripheral odontogenic fibroma.

The peripheral odontogenic fibroma (POdF) is an uncommon gingival enlargement. It is a benign, unencapsulated exophytic gingival mass, which is composed of fibrous connective tissue associated with various amounts of calcifications and islands of odontogenic epithelium.The lesion is usually firm to palpation and non-tender, and it could be mistaken for other more common exophytic gingival lesions, such as peripheral ossifying fibroma, pyogenic granuloma, or peripheral giant cell granuloma. Therefore, a histopathologic examination is necessary for accurate diagnosis. This article presents a well-documented case of POdF and a review of the literature in regards to its diagnostic features, treatment modalities, and recurrence.

Gummy smile: could it be genetic? Hereditary gingival fibromatosis.

Gingival enlargement is common among patients and can be caused by a variety of etiological factors. The most common reason is poor oral hygiene and high bacterial load that leads to gingival inflammation and enlargement. Other implicated factors include systemic drugs, such as phenytoin (Dilantin) taken by epileptic patients, calcium channel blockers such as nifedipine (Procardia) and verapamil (Calan) for the treatment of hypertension, arrhythmia and angina. Another class of medication associated with gingival enlargement is immunosuppressive agents given to organ-transplant patients to prevent rejection of the new element such as cyclosporine. Some enlargements could be associated with other conditions such as puberty, pregnancy or diabetes or be a symptom of a systemic disease (leukemia, Wegener's granulomatosis or sarcoidosis). In rare cases the cause for the enlargement is genetic and termed hereditary gingival fibromatosis (HGF). HGF is a genetic disorder characterized by a progressive enlargement of the gingiva. Histologically, the gingiva is characterized by an accumulation of dense fibrous connective tissue. This is believed to be due to an imbalance between synthesis and degradation of extracellular matrix composed mainly of collagen molecules or due to an alteration in fibroblast proliferation. Different pathogenic mechanisms have been proposed and examined over the years but no precise process has been identified. The main objective of this paper is to discuss this genetic anomaly and support it with clinical cases of a mother and her two children. It will focus on the clinical and histologic characteristics of HGF as well as known biologic and genetic features and treatment modalities.

Gummy smile: could it be genetic? Hereditary gingival fibromatosis.

Gingival enlargement is common among patients and can be caused by a variety of etiological factors. The most common reason is poor oral hygiene and high bacterial load that leads to gingival inflammation and enlargement. Other implicated factors include systemic drugs, such as Phenytoin (Dilantin) taken by epileptic patients, Calcium Channel Blockers such as Nifedipine (Procardia) and Verapamil (Calan) for the treatment of hypertension, arrhythmia and angina. Another class of medication associated with gingival enlargement is immunosuppressive agents given to organ-transplant patients to prevent rejection of the new element, such as Cyclosporine. Some enlargements could be associated with other conditions such as puberty, pregnancy or diabetes or be a symptom of a systemic disease (leukemia, Wegener's granulomatosis or sarcoidosis). In rare cases the cause for the enlargement is genetic and termed Hereditary Gingival Fibromatosis (HGF). HGF is a genetic disorder characterized by a progressive enlargement of the gingiva. Histologically, the gingiva is characterized by an accumulation of dense fibrous connective tissue. This is believed to be due to an imbalance between synthesis and degradation of extracellular matrix composed mainly of collagen molecules or due to an alteration in fibroblast proliferation. Different pathogenic mechanisms have been proposed and examined over the years but no precise process has been identified. The main objective of this paper is to discuss this genetic anomaly and support it with clinical cases of a mother and her two children. It will focus on the clinical and histologic characteristics of HGF as well as known biologic and genetic features and treatment modalities.