Periodontal evaluation of two mucoperiosteal flaps used in removing impacted mandibular third molars.

This study compared the results of two types of access flap used in removing impacted mandibular third molars. Fifteen patients were given periodontal examinations consisting of measurements of attachment level, level of the gingival margin, and width of the masticatory mucosa at three locations around the mandibular second molars. The examinations were done preoperatively, and two, six, and 12 weeks after removal of the impacted molars. Analyses of variance indicated that there was no significant difference between the two flap techniques and, therefore, the choice of flap technique is one of operator preference. There was a significant decrease in mean sulcus depth at all measured points for either flap technique, indicating a generally healthier condition around mandibular second molars 12 weeks after the surgical removal of mandibular third molars.

Histologic evaluation of the effects of intrasulcular toothbrushing on human sulcular epithelium.

Nineteen young adult Caucasian males had an average Gingival Index Score of 0.47. Each was asked to demonstrate his present method of toothbrushing: thirteen used the scrub method, and six combined the scrub and roll methods. Control gingival tissue specimens were taken from the mandibular left first bicuspid or first molar regions, and the area was allowed to heal for 40 days. Following complete healing, intrasulcular brushing was used in the mandibular left posterior segment, for 30 seconds daily for a period of 40 days. The brushing was done by the investigator on 28 days and by the subjects on 12 days. The average Gingival Index Score following intrasulcular brushing was 0.25. A gingival specimen was taken from the experimental area of the mandibular left second bicuspid region. Histological findings in control specimens from 13 subjects showed parakeratinization for varying distances in the sulcus epithelium apical to the gingival crest. In six specimens a complete absence of sulcus keratinization was observed. The average Inflammatory Index Score was 1.21. Following intrasculcular brushing, 18 specimens showed a parakeratin layer apical to the gingival crest; in 14, it extended the entire length of the coronal sulcular epithelium or apparent clinical sulcus, whereas in four more it extended well beyond the gingival crest into the sulcus. In the six subjects whose control specimens showed an absence of keratin apical to the gingival crest, parakeratinization of part or all of the clinical sulcus was found following intrasulcular brushing. The average Inflammatory Index Score was 1.015. A moderately intense acute inflammatory reaction was observed within the attachment epithelium in three subjects. Possible therapeutic benefits and hazards of intrasulcular brushing are discussed.

Observation of the mitochondria of the sulcular epithelium of clinically inflamed and clinically healthy gingiva.

Ten human males with an average age of 22 years, free from any known systemic disease, were selected for this study. Each subject had a mild gingivitis around at least one lower incisor tooth. This was confirmed by the color, contour, and consistency of the tissue. The area was probed for gingival sulcus depth and a radiograph confirmed that there was no interproximal bone involvement. A specimen was excised from the inflamed area and examined histologically for inflammatory cell density and an inflammatory index number was assigned to the tissue. The gingivitis was treated and personal oral hygiene instructions were explained to the subjects. Healing continued uneventfully for ten to twelve weeks. A second specimen was excised from near the original area, examined histologically, and an inflammatory index number was assigned to the tissue. The ultrastructure of the sulcular epithelium and the connective tissue adjacent to the sulcular epithelium of all specimens was examined at powers varying from 3,500 to 70,000. The sulcular epithelium showed no positively recognizable mitochondria. Mitochondria in the connective tissue adjacent to the basal layer of the sulcular epithelium were abundant and well formed. There was no correlation between the number and morphology of mitochondria in the treated and untreated specimens.