bromochloroacetic-acid and Gingival-Diseases

Gingival augmentation procedures around natural teeth and dental implants are performed to facilitate plaque control, to improve patient comfort, to prevent future recession, and in conjunction with restorative, orthodontic, or prosthetic dentistry. The aim of this study is to answer the most common questions related to this treatment modality based on the most relevant and current knowledge in the field.. Two reviewers worked to answer the five most common and clinically relevant questions with supporting literature to understand the role of gingiva around teeth. 1) What circumstances require an increased zone of keratinized tissue (KT), or is KT important? 2) What is the ideal thickness of an autogenous gingival graft? Is a thick autogenous gingival graft more effective than a thin autogenous gingival graft? 3) What are the alternatives to autogenous gingival grafting to increase the zone of attached gingiva? 4) Does orthodontic intervention affect soft tissue health and dimensions? 5) What is the patient-reported patient outcome for minimal KT compared with that for an enhanced zone of KT? An extensive literature search was performed using PubMed, the Cochrane Oral Health Group Specialized Trials Registry (the Cochrane Library), and the most respected journals in the field.. Although gingival augmentation procedures were first introduced in 1960s, there have not been in-depth comparative studies examining the five questions that have been proposed by the authors. Lack of relevant systematic reviews and randomized clinical trials (RCTs) on this topic do not allow authors to answer those questions with a strong level of evidence. However, the following can be recommended after reviewing case reports and case series on these topics. 1) There is enough clinical evidence to support maintaining an adequate band of gingiva for intracrevicular margin restoration. 2) Thick grafts do not appear to result in better clinical outcomes than thin grafts. Thick grafts are likely to result in more primary contraction, whereas thin grafts tend to be prone to secondary contraction. 3) Viable alternative treatment modalities are currently available that are capable of providing KT augmentation without the need for palatal donor tissue. 4) Appropriately applied orthodontic forces do not cause permanent damage to a healthy periodontium. The probability of recession during tooth movement in thin biotype is high to justify gingival augmentation when the dimension of gingiva is inadequate. In addition, cases in which there will be a facial tooth movement outside of the alveolar process need to be considered for a gingival augmentation procedure. 5) Although the articles that have been published on this topic did not consider patient-reported outcomes and esthetics as part of the overall treatment success assessment, patients who have received alternative treatment modalities that did not depend on palatal tissue harvesting appear to have reported more satisfaction and less discomfort after treatment.. Autogenous gingival grafts are still considered to be the "gold standard" procedure with unmatched success rates and clinical success when gingival augmentation procedures are required. However, tissue-engineered materials may offer viable options to palatal tissue harvesting for gingival augmentation. KT augmentation may prevent the development and progression of gingival recession, especially when restorative margins may interact with the periodontium and/or orthodontic treatment is indicated. Patient-reported outcomes should be considered for future studies on this topic. Additional RCTs and systematic reviews are needed to support these conclusions.

Topics: Autografts; Gingiva; Gingival Diseases; Gingivoplasty; Guided Tissue Regeneration, Periodontal; Humans; Keratins; Orthodontics, Corrective; Patient Satisfaction; Surgical Flaps

Soft tissue grafting for the purposes of increasing the width of keratinized tissue (KT) is an important aspect of periodontal treatment. A systematic review was analyzed, focusing on non-root coverage tissue grafts. The references were updated to reflect the current literature.. To formulate the consensus report, group members submitted any new literature related to the topic that met criteria fitting the systematic review, and this information was reviewed for inclusion in this report. A consensus report was developed to summarize the findings from the systematic review and to guide clinicians in their treatment decision-making process.. Forty-six articles met the criteria for inclusion in the final analysis, and two articles were added that were used to formulate this consensus report. A list of eight clinically relevant questions was posed, and consensus statements were developed.. The evidence suggests that a minimum amount of KT is not needed to prevent attachment loss (AL) when optimal plaque control is present. However, if plaque control is suboptimal, a minimum of 2 mm of KT is needed. The standard procedure to predictably gain KT is the autogenous gingival graft. There is limited evidence for alternative treatment options. However, additional research may offer promising results in certain clinical scenarios.. Before patient treatment, the clinician should evaluate etiology, including the role of inflammation and various types of trauma that contribute to AL. The best outcome procedure (autograft) and alternative options should be reviewed with the patient during appropriate informed consent. Proper assessment of the outcome should be included during supportive periodontal care.

Topics: Autografts; Dental Plaque; Gingiva; Gingival Diseases; Gingivoplasty; Guided Tissue Regeneration, Periodontal; Humans; Keratins; Patient Satisfaction

Topics: Alveolar Process; Citrates; Citric Acid; Epithelial Attachment; Gingiva; Gingival Diseases; Gingival Recession; Gingivoplasty; Humans; Keratins; Mouth Mucosa; Periodontal Ligament; Periosteum; Tooth Root; Vestibuloplasty; Wound Healing

Generation of site-appropriate tissue in the oral cavity includes the restoration of the correct anatomic type, amount, and distribution of the tissue. This study is a post hoc analysis of data collected during previously published results from two randomized clinical trials of a living cellular sheet (LCS; allogenic cultured keratinocytes and fibroblasts in bovine collagen) versus a free gingival graft (FGG), evaluating their ability to augment keratinized tissue or gingiva.. Post hoc histologic and clinical (photographic) comparisons of the outcomes of treatment were performed on histologic and photographic data gathered in the two randomized clinical trials.. Histologic findings showed that LCS-treated sites resembled gingiva rather than alveolar mucosa. Photographic analysis indicated that LCS treatment resulted in more site-appropriate tissue than FGG in terms of tissue color, with adjacent untreated tissue, absence of scar formation or keloid-like appearance, and mucogingival junction alignment.. Treatment of mucogingival defects with LCS resulted in the generation of tissue that is more site appropriate than tissue transplanted from the palate.

Topics: Allografts; Animals; Autografts; Biopsy; Cattle; Cicatrix; Collagen; Color; Epithelial Cells; Esthetics, Dental; Fibroblasts; Follow-Up Studies; Gingiva; Gingival Diseases; Humans; Keloid; Keratinocytes; Keratins; Mouth Mucosa; Photography; Tissue Engineering; Tissue Scaffolds; Treatment Outcome

Ideally tissue-engineered products should maintain the characteristics of the original tissue. For example, skin represents orthokeratinized epithelium and oral gingiva represents parakeratinized epithelium. The aim of this study was to develop an autologous full-thickness gingiva substitute suitable for clinical applications and to compare it with our autologous full-thickness skin substitute that is routinely used for healing chronic wounds. Autologous full-thickness skin and gingiva substitutes were constructed under identical culture conditions from 3-mm punch biopsies isolated from the upper leg or gingiva tissue, respectively. Both consisted of reconstructed epithelia on acellular dermis repopulated with fibroblasts. To compare the characteristics of the original and reconstructed tissue, differential morphological observations and expression of differentiation markers (keratins 6, 10, and 17 and stratum corneum precursors involucrin, loricrin, and SKALP) were determined. Skin and gingiva substitutes were transplanted onto therapy-resistant leg ulcers or tooth extraction sites in order to determine their effects on wound healing. The tissue-engineered constructs maintained many of the differential histological and immunohistochemical characteristics of the original tissues from which they were derived. The skin substitute was orthokeratinized, and the gingiva substitute was parakeratinized. Transplantation of skin (n = 19) and gingiva substitutes (n = 3) resulted in accelerated wound healing with no adverse effects. As identical culture systems were used to generate both the skin and gingiva substitutes, the differences observed in tissue (immuno)histology can be attributed to intrinsic properties of the tissues rather than to environmental factors (e.g., air or saliva). This study emphasizes the importance of closely matching donor sites with the area to be transplanted. Our results represent a large step forward in the area of clinical applications in oral tissue engineering, which have until now greatly lagged behind skin tissue engineering.

Topics: Cells, Cultured; Gingiva; Gingival Diseases; Humans; Keratins; Ki-67 Antigen; Leg Ulcer; Organ Size; Organ Specificity; Pilot Projects; Salvage Therapy; Skin, Artificial; Tissue Distribution; Tooth Extraction; Transplantation, Autologous; Wound Healing

In patients with symmetric recessions in their canine and premolar regions, one side was supplied with an epithelium-containing and the other with an epithelium-free graft from the hard palate. Both sides were studied and compared. After six months, the size of the connective tissue transplants was reduced by 50% (that of the epithelium transplants by 0%). Within half a year, the width of the attached gingiva had decreased by 36% in the case of connective tissue transplants (epithelium transplants by 15%) and the vertical graft width by 60% (epithelium transpltnas 17%). Our clinical and histological findings suggest that grafting of heterotopic connective tissue transplants is not equal to epithelium-containing transplants.

Topics: Adolescent; Adult; Epithelium; Female; Gingival Diseases; Gingivoplasty; Humans; Keratins; Male; Middle Aged; Mouth Mucosa; Transplantation, Autologous

Mucogingival conditions are deviations from the normal anatomic relationship between the gingival margin and the mucogingival junction. Mucogingival surgery is plastic surgery designed to correct defects in the gingiva surrounding the teeth. Common mucogingival conditions are recession, absence, or reduction of keratinized tissue, and probing depths extending beyond the mucogingival junction. Surgical techniques used to augment cosmetic mucogingival defects include the free gingival autograft, the subepithelial connective tissue graft, rotational flaps, lateral sliding flaps, coronally repositioned flaps, and the use of acellular dermal matrix grafts.

Topics: Biocompatible Materials; Collagen; Connective Tissue; Esthetics, Dental; Gingiva; Gingival Diseases; Gingival Recession; Gingivoplasty; Humans; Keratins; Periodontal Pocket; Plastic Surgery Procedures; Surgical Flaps; Tissue and Organ Harvesting

This paper presents three cases of peri-implant mucosal defects that were successfully treated with a newly proposed "pouch roll" implant soft tissue augmentation technique. This procedure uses a de-epithelialized connective tissue layer during the first or second stage of implant surgery over the underlying dental implant without the need for sutures. At 2 weeks, healing was remarkable, with excellent plaque control. At 3 months, only minimal tissue shrinkage was evident. As a result, a 2- to 3-mm increase in the width of the keratinized tissue was noted around the augmented implant site. This technique is an atraumatic, versatile, and cost-effective surgical modality that enhances the peri-implant soft tissue over the ridge with a soft tissue thickness ≥ 3 mm. The pouch roll implant soft tissue augmentation procedure provides an easy and less traumatic correction of a mild to moderate buccal ridge deficiency by thickening the soft tissue around the dental implant.

Topics: Connective Tissue; Dental Implant-Abutment Design; Dental Implants; Follow-Up Studies; Gingiva; Gingival Diseases; Gingivoplasty; Humans; Keratins; Surgical Flaps; Wound Healing

Topics: Aged; Biopsy; Collagen; Diagnosis, Differential; Epithelium; Female; Gingival Diseases; Humans; Keratins; Maxillary Diseases; Odontogenic Cysts

To investigate the clinical and histologic features of frictional keratoses located exclusively on the facial attached gingiva and establish whether these belong to the category of leukoplakia.. Over a period of 15 years, 159 patients presenting with oral keratotic plaques, located exclusively on the facial attached gingival mucosa, excluding the edentulous alveolar ridge and retromolar pad area, were retrospectively selected. Clinical and histologic features and the symptoms and progression of these lesions were carefully assessed.. The presence of oral frictional keratosis located exclusively on the facial attached gingival mucosa was clinically and immunohistologically diagnosed in 14 of 159 patients (8.8%). Eleven patients (78.5%) showed unilateral involvement, whereas 3 patients (21.5%) had bilateral involvement. The disappearance of the lesions was accomplished in only 9 of 14 patients, resulting from discontinuation of bad habits. Clinically, these lesions appeared as distinct, sharply demarcated, isolated, asymptomatic, homogeneous whitish-plaques that were neither removable nor painful. The plaques did not create discomfort, change shape, or develop into malignancy. Histologically, these plaques showed features superimposable to those present in benign alveolar ridge keratoses.. The results highlighted that frictional keratoses on the facial attached gingival mucosa 1) are rare findings, 2) clinically appear as "true leukoplakia" but histologically have the same features as benign alveolar ridge keratoses, 3) have no propensity for malignant transformation, 4) have a good prognosis, and 5) have a specific cause, and resolution is accomplished if the frictional element is eliminated. Thus, these must be removed from the category of leukoplakia.

Topics: Adult; Diagnosis, Differential; Epithelium; Female; Fluorescent Antibody Technique, Direct; Follow-Up Studies; Friction; Gingiva; Gingival Diseases; Humans; Keratins; Keratosis; Leukoplakia, Oral; Male; Middle Aged; Retrospective Studies; Toothbrushing

To assess periodontal health of individuals with a lateral lower lip piercing and describe associated periodontal, dental and mucosal complications.. A split-mouth study was performed in a sample of 50 patients with a lateral lower lip piercing who attended the Periodontal Pathology and Surgery Unit of the Dental School of the University of Barcelona. The patients underwent periodontal, dental and mucosal examination on both the piercing and the control sides.. Piercing users were predominantly women (78%), with a mean age of 21.3 years (SD=4.4). The amounts of keratinized and attached gingiva were significantly lower on the piercing side, and the prevalence of gingival recession was higher (p=0.012). The canine and first bicuspid teeth were the most affected. Tooth fractures and cracks were more frequent on the piercing side (20%) when compared with the control (4%). Mucosal alterations were found in seven patients.. The use of lateral lower lip piercings enhances gingival recession and reduces the amounts of keratinized and attached gingiva. These ornaments are also associated with tooth fractures and cracks.

Topics: Analysis of Variance; Body Piercing; Cross-Sectional Studies; Female; Functional Laterality; Gingiva; Gingival Diseases; Humans; Keratins; Keratosis; Lip; Male; Statistics, Nonparametric; Young Adult

Focal palmoplantar and gingival keratosis is a rare autosomal dominant disease whose clinical features, and in particular, pathologic alterations and molecular etiology remain to be well defined. Recently we observed a German family affected by the disease in at least 3 consecutive generations. The 4 patients examined showed circumscribed and painful hyperkeratosis at the weight-bearing plantar skin since infancy, rather mild palmar hyperkeratosis, and continuous leukokeratosis confined to the maxillary and mandibulary attached gingiva. There were no nail changes, subungeal keratoses, or follicular hyperkeratosis. Light and electron microscopy of the plantar and gingival lesions revealed alterations of epidermolytic hyperkeratosis. Mutations in the known keratin genes were excluded by linkage analysis using microsatellite markers. We conclude that focal palmoplantar and gingival keratosis is a clinically distinct palmoplantar ectodermal dysplasia that is pathologically characterized by epidermolytic alterations, but is most probably not caused by a mutation in a keratin gene.

Topics: Adult; Child; Ectodermal Dysplasia; Female; Genetic Linkage; Genotype; Gingival Diseases; Humans; Keratins; Keratoderma, Palmoplantar; Keratosis; Male; Middle Aged; Mutation; Pedigree

A study was conducted to observe the changes in areas with untreated mucogingival defects over an 18-year period. The results in this group after 4 and 10 years were previously published.. Upon entering dental school, a group of 39 freshman dental students were assessed for plaque index, gingival index, probing depth, and width of keratinized tissue. At that time, 112 sites of inadequate keratinized gingiva were found. Seventeen of the original 39 participants with a total of 61 sites were reassessed for the same parameters after 18 years.. The results revealed that 19 sites showed a slight increase in keratinized tissue, 35 were unchanged (for a total of 54 stable sites), and 7 sites showed a slight decrease in keratinized tissue. The mean width of keratinized tissue at the beginning of the study was 1.74+/-0.545 mm and 2.02+/-0.885 mm after 18 years. This represented a small, but statistically significant increase in the width. The plaque index (PI) and gingival index (GI) of this group at baseline (PI = 0.77+/-0.439 and GI = 0.93+/-0.447) and at 18 years (PI = 0.36+/-0.344 and GI = 0.65+/-0.303) indicated a high level of oral hygiene and gingival health.. It was concluded that in the absence of gingival inflammation, areas with small amounts of keratinized tissue may remain stable over long periods of time.

Topics: Dental Plaque Index; Gingiva; Gingival Diseases; Humans; Keratins; Longitudinal Studies; Mouth Mucosa; Periodontal Index; Time Factors

Topics: Child; Connective Tissue; Diagnosis, Differential; Epithelium; Follow-Up Studies; Gingival Diseases; Granuloma, Pyogenic; Humans; Keratins; Keratoacanthoma; Male; Maxilla

The aim of this study was to show the micromorphologic findings (epithelium, connective tissue, bone) in a region of pronounced gingival invagination after space closure by analyzing a maxilla taken in autopsy from a 19-year-old woman who was orthodontically treated. The dental records were also at our disposal. The second left premolar was congenitally absent. This area displayed before therapeutic horizontal bone atrophy. For space closure, the first upper left molar was moved mesially with a fixed appliance. After space closure, pronounced gingival invagination was diagnosed. The lateral segments of the specimen were prepared histologically in the horizontal plane. The microscopic observations revealed deep epithelial proliferation, hyperkeratinization, and one isolated keratin pearl in the connective tissue. Irrespective of location, the broad connective tissue layer showed disparate characteristics. Cell-rich, loose connective tissue with low fiber density were dominant in the subepithelial layer. The epiperiosteal layer displayed multiple tough fibers, some running parallel, some with reticular meshing, permeated with many blood vessels. Very few inflammatory cells were detected in the soft tissue. The bone had been resorbed in the mesiopalatal area of the molar (tooth movement direction) apart from one small isolated bony islet. These observations suggest that inflammatory influences were unlikely for marginal bone loss mesiopalatal to the tooth.

Topics: Adult; Alveolar Process; Anodontia; Atrophy; Bicuspid; Blood Vessels; Bone Resorption; Connective Tissue; Diastema; Epithelium; Female; Gingiva; Gingival Diseases; Humans; Keratins; Maxilla; Maxillary Diseases; Molar; Periosteum; Tooth Movement Techniques

The gingival cyst of the adult exhibits an epithelial lining that is essentially the same as the lateral periodontal cyst. Although the gingival cyst of the adult exhibits some morphologic variability, its lining is generally considered to be nonkeratinized. Nonetheless, rare cases of gingival cyst of the adult that exhibit a keratinized epithelial lining have been reported in the literature. There is now a growing tendency to consider this variant as a separate entity. This article describes six cases of gingival cysts that exhibit the histologic features of the odontogenic keratocyst. Evidence from this series suggests that the biologic behavior of this subset of gingival cysts is different from that of the generic gingival cyst of the adult and that the term peripheral odontogenic keratocyst more accurately describes this entity.

Topics: Adult; Aged; Female; Gingival Diseases; Humans; Keratins; Male; Middle Aged; Periodontal Cyst

A rare case of multiple keratin-containing gingival cysts is presented. It is suggested that either a common dental lamina stem cell with diverging differentiation pathways or another cell of origin may be responsible for the formation of these unique cysts.

Topics: Adult; Female; Gingival Diseases; Humans; Keratins; Mandibular Diseases; Periodontal Cyst; Recurrence

In this work the problems due to shortage of proper or adherent gum have been analyzed, further has been referred the clinical cases corresponding to the periodontal indications, which foresee the reconstruction of an insufficient superficial periodontium. Moreover have been described the surgical techniques of the free graft.

Topics: Adult; Epithelial Attachment; Gingiva; Gingival Diseases; Gingival Recession; Humans; Keratins

A case with a firm asymptomatic nodule of 1 cm diameter on the gingiva between the left upper cuspid and first bicuspid is presented. Radiographic examination did not reveal any pathology of the bone in that region. Histologic examination revealed a cyst wall lined by squamous stratified epithelium, characteristic to the lining of an odontogenic keratocyst. It is suggested that the term peripheral odontogenic keratocyst be used for the diagnosis of this lesion.

Topics: Adult; Epithelium; Gingival Diseases; Humans; Keratins; Male; Maxilla; Odontogenic Cysts

A study was conducted to observe the changes in areas with untreated mucogingival defects over a 4-year period. Upon entering dental school, a group of freshman students were assessed for Plaque Index, Gingival Index, probing depth, and width of keratinized gingiva. These same students were reassessed for the same parameters at the end of their senior year. Of the 112 sites in 39 individuals, 33 sites revealed a slight increase in keratinized gingiva, 69 sites were unchanged, and 10 sites showed a slight decrease. These changes were minimal and not statistically significant. The Plaque Index, Gingival Index, and probing depth mean values showed a small but statistically significant improvement. In this group of students with a high degree of oral hygiene, areas with inadequate zones of attached gingiva were able to be maintained without further recession and without surgery.

Topics: Dental Plaque Index; Double-Blind Method; Gingiva; Gingival Diseases; Gingival Pocket; Gingival Recession; Humans; Keratins; Longitudinal Studies; Periodontal Index

The present investigation was performed to assess the inflammatory response in gingival units subsequent to the placement of restorations with subgingivally located margins. 3 beagle dogs were used. Cotton floss ligatures were placed around the neck of the mandibular third and fourth premolars of all dogs. The ligatures were exchanged once a month during the first 6 months of experiment. When 40-50% of the height of the supporting tissues had been lost in an experimental periodontitis the ligatures were removed but the animals allowed to accumulate deposits for another 60 days. The inflamed periodontal tissues were subsequently excised using either an "apically placed flap" procedure or a "gingivectomy" procedure. In the flap procedure the main part of the keratinized gingiva was preserved while in the gingivectomy procedure the keratinized part of the gingiva was removed in toto. Following scaling and root planing the animals were during a maintenance period of 4 months placed on a program involving chlorhexidine application and mechanical tooth cleaning twice daily. On Day 0 a notch was prepared in the buccal surface of each root at the level of the gingival margin. Furthermore, steel bands were placed along the buccal surface of each root of the third and fourth premolars and secured with an apical margin at the level of 1 mm apical to the notch. The bands were cemented to the root surfaces by a cement. The dogs were allowed to accumulate plaque and calculus for 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Bicuspid; Dental Restoration, Permanent; Dogs; Gingiva; Gingival Diseases; Gingivitis; Keratins; Ligation; Periodontium; Time Factors

Controversy surrounds the importance of keratinized gingiva in maintaining periodontal health. A well-defined animal model system is necessary to evaluate longitudinally the role of keratinized gingiva when plaque control is inadequate or where dental procedures (restorative, prosthetic or orthodontic) alter the periodontal environment. Facial gingiva was excised from eight primary incisors in miniature swine. Contralateral teeth were used as controls. The experimental teeth exhibited mucogingival defects at 3 and 6 month observation periods. The secondary teeth erupting into the experimental regions also exhibited recession and chronic mucogingival defects. The marginal tissue in regions devoid of keratinized gingiva demonstrated clinical signs of inflammation. No progressive gingival recession was present. Excision of keratinized gingiva to produce mucogingival defects in swine provides a convenient model system for evaluating the effect of dental procedures on periodontal health where little or no keratinized gingiva is present.

Topics: Animals; Chronic Disease; Gingiva; Gingival Diseases; Gingivectomy; Keratins; Longitudinal Studies; Male; Swine; Swine, Miniature

Topics: Adult; Child; Connective Tissue; Gingiva; Gingival Diseases; Humans; Keratins; Mouth Diseases; Mouth Mucosa; Transplantation, Autologous

The present study was performed to examine the alterations of the position of the marginal soft tissue ("gingival margin") on the buccal surface of teeth in patients who following periodontal surgery were enrolled in a supervised maintenance care program for 10--11 years. The material consisted of 43 patients with severe destruction of the periodontal tissues. Following initial treatment comprising scaling, root planing and instructions in plaque control measures, deepened periodontal pockets were eliminated by the use of an apically repositioned flap procedure including osseous surgery to eliminate bony defects. After treatment, the patients were recalled once every 3--6 months for maintenance care. In all patients, the distance between the cemento-enamel junction and the gingival margin on the buccal surfaces of all treated teeth was assessed (1) prior to surgery, (2) after initial healing, and (3) at a reexamination 10--11 years after treatment. In addition, the presence or absence of keratinized gingiva was determined. The results showed that (1) during active periodontal treatment the position of the gingival margin was shifted in an apical direction, (2) this displacement was to some extent compensated for by a coronal regrowth during the postoperative maintenance care period, (3) the alterations of the position of the gingival margin followed a similar pattern in areas with and without a zone of keratinized gingiva, (4) the number of gingival units devoid of keratinized gingiva decreased during the maintenance care period.

Topics: Adult; Gingiva; Gingival Diseases; Humans; Keratins; Middle Aged; Periodontal Diseases; Retrospective Studies

When treating patients, the objectives of restorative therapy must be clear. The first and most basic objective is preservation of the teeth. The attainment of this objective would be far less complex if it could be considered independent of restoration of function, comfort and esthetics, but such is not the case. The latter objectives usually require sophisticated restorative dentistry and often include restorations with intracrevicular margins. Although it is widely accepted that the best restorative margin is one that is placed coronal to marginal tissue, most restorations have margins in the gingival crevice, and permanent tissue damage is common. In attempting to reach his objective, the restorative dentist must remember the fundamental precept of the health professions, which is: Do no harm. Daily observation of the three physiologic dimensions permits the therapist to restore teeth with minimal injury to the periodontium.

Topics: Connective Tissue; Dental Occlusion, Traumatic; Dental Restoration, Permanent; Epithelium; Gingiva; Gingival Diseases; Gingivoplasty; Humans; Keratins; Mouth Mucosa; Periodontal Diseases; Periodontium

Gingival cysts with clinical manifestations are relatively uncommon lesions. The present study adds thirty-three new cases to the literature and analyzes their clinical and histologic features. The mandibular cuspid and first premolar region was found to be the most common location. The epithelial lining of the cysts was of several types. The most common type was a thin, flattened lining with or without localized thickenings (buds). Other types included nonkeratinized stratified squamous epithelium, keratinized stratified squamous epithelium, and parakeratinized epithelium with palisading basal cells. Gingival cysts should be distinguished from lateral periodontal cysts on the basis of their origin in the gingiva rather than in bone. It appears that most gingival cysts with clinical manifestations are of odontogenic origin.

Topics: Adolescent; Adult; Aged; Child; Connective Tissue; Cysts; Cytoplasm; Diagnosis, Differential; Epithelium; Female; Gingival Diseases; Humans; Keratins; Male; Middle Aged

Hereditary mucoepithelial dysplasia is an autosomal, dominantly inherited disorder affecting all of the orificial mucosa with cataracts, follicular keratosis of skin, nonscarring alopecia, bouts of pneumonia, spontaneous pneumothorax, and terminal cor pulmonale. The oral lesion is a fiery red, flat or micropapillary-appearing mucosa most frequently involving the gingiva and hard palate. All oral and pharyngeal mucosa may be involved, however. Red scrotal mucosa of the tongue is common. Histologically, the oral mucosa shows a lack of cornified and keratinized cells, a decrease in the thickness of the epithelial cell layer, dyshesion, and dyskeratosis. Papanicolaou smears show lack of epithelial cell maturation, poikilocytosis, anisocytosis, large paranuclear cytoplasmic vacuoles, and cytoplasmic strand-shaped inclusions. Ultrastructural features include a paucity of desmosomes, intercellular accumulations of amorphous material, cytoplasmic vacuoles, and paranuclear lesions with strands of material resembling gap junctions and desmosomes. The condition most likely represents a basic defect in gap junction and desmosome formation.

Topics: Adult; Cell Adhesion; Cytoplasm; Desmosomes; Epithelium; Female; Gingiva; Gingival Diseases; Humans; Inclusion Bodies; Infant; Intercellular Junctions; Keratins; Mouth Diseases; Mouth Mucosa; Mucous Membrane; Syndrome; Vacuoles

Topics: Adolescent; Adult; Blood Vessels; Chromium Alloys; Collagen; Denture Bases; Denture, Partial, Removable; Female; Gingiva; Gingival Diseases; Gingival Pocket; Gingivitis; Humans; Keratins; Lymphocytes; Male; Methylmethacrylates; Middle Aged; Plasma Cells; Stomatitis; Stomatitis, Denture

Topics: Alveolar Process; Epithelial Cells; Epithelium; Female; Gingiva; Gingival Diseases; Humans; Keratins; Male; Palate; Transplantation, Autologous; Wound Healing

Topics: Gingival Diseases; Histocytochemistry; Humans; Keratins

Topics: Gingiva; Gingival Diseases; Histocytochemistry; Humans; Keratins; Nevus

Topics: Adolescent; Ameloblastoma; Fetus; Geriatrics; Gingival Diseases; Gingivectomy; Humans; Keratins; Odontogenesis; Odontogenic Cysts; Pathology; Pathology, Oral; Radiography, Dental; Surgery, Oral

Topics: Disease; Gingiva; Gingival Diseases; Humans; Keratins