bromochloroacetic-acid and Jaw--Edentulous

To review the biological processes of wound healing following periodontal and periimplant plastic surgery when different technologies are used in a) the coverage of root and implant dehiscences, b) the augmentation of keratinized tissue (KT) and c) the augmentation of soft tissue volume.. An electronic search from The National Library of Medicine (MEDLINE-PubMed) was performed: English articles with research focus in oral soft tissue regeneration, providing histological outcomes, either from animal experimental studies or human biopsy material were included.. Barrier membranes, enamel matrix derivatives, growth factors, allogeneic and xenogeneic soft tissue substitutes have been used in soft tissue regeneration demonstrating different degrees of regeneration. In root coverage, these technologies were able to improve new attachment, although none has shown complete regeneration. In KT augmentation, tissue-engineered allogenic products and xenogeneic collagen matrixes demonstrated integration within the host connective tissue and promotion of keratinization. In soft tissue augmentation and peri-implant plastic surgery there are no histological data currently available.. Soft tissue substitutes, growth differentiation factors demonstrated promising histological results in terms of soft tissue regeneration and keratinization, whereas there is a need for further studies to prove their added value in soft tissue augmentation.

Topics: Biocompatible Materials; Dental Implants; Guided Tissue Regeneration, Periodontal; Humans; Intercellular Signaling Peptides and Proteins; Jaw, Edentulous; Keratins; Membranes, Artificial; Periodontal Diseases; Periodontium; Plastic Surgery Procedures; Tissue Engineering; Tooth; Tooth Root; Wound Healing

Dentinogenic ghost cell tumor (DGCT) is a rare neoplasm, representing 1.9% to 2.1% of all odontogenic tumors. Few cases of DGCT have been reported and only 11 show no bone involvement. A rare case of peripheral DGCT is reported, located in the anterior mandible of a 45-year-old man. The patient presented a slow painless growth in the canine region of an edentulous mandible. Radiographically, no bone involvement was registered. The lesion was enucleated and microscopically characterized by islands of epithelial cells showing ameloblastomalike features in fibrous tissue. Dysplasic dentin and ghost cells were frequently observed. Areas showing a connection between tumor cells and the overlying mucosa were also identified. Immunohistochemical analysis demonstrated positivity for pan-cytokeratin, cytokeratin-14, and 2 neural markers. Denditric cells (Langerhans cells and melanocytes) were identified inside tumoral islands. A rare case of peripheral DGCT is reported, with immunohistochemical analysis and a review of the English literature.

Topics: Dental Arch; Dentin; Dentin Dysplasia; Humans; Jaw, Edentulous; Keratin-14; Keratins; Langerhans Cells; Male; Mandibular Neoplasms; Melanocytes; Middle Aged; Odontogenic Tumors; S100 Proteins

The aim of this investigation was to evaluate the significance of keratinized mucosa (KM) around dental implants both clinically and biochemically for 12 months.. Fifteen edentulous patients treated with implant-retained overdentures in edentulous mandible (four implants per patient). Based on the presence of keratinized mucosa on the buccal surfaces, implants were divided into two groups: Implants having minimal 2 mm of KM on their buccal surfaces and implants having no KM on their buccal surfaces. Thirty-six implants were included in the evaluations; 19 implants in 15 patients had minimal 2 mm of KM on their buccal surfaces and 17 implants in 15 patients had no KM on their buccal surfaces. Clinical measurements of Plaque Index, Gingival Index, probing depths, and Bleeding on Probing were performed and peri-implant crevicular fluid (PICF) were collected immediately before loading (baseline) and at 6th, 12th months after loading. Interleukin-1 beta (IL-1 β) and tumor necrosis factor-alpha (TNF-α) have been assessed in the crevicular fluid. Results were analyzed by repeated-measures of variance (ANOVA) and Wilcoxon signed rank tests.. After 12 months of evaluation the results of ANOVA showed that implants with KM had lower levels of TNF-α total amounts than implants without KM (P < 0.05). Additionally, TNF-α total amounts were significantly higher at 12(th)  month compared to baseline for implants without KM (P < 0.05). Plaque index and Gingival index values were also found significantly higher for implants without KM (P < 0.05). For IL-1 β and PICF volume levels the differences between the implant groups were non significant, whereas the differences between the periods were significant. (P < 0.05) Additionally, both of the groups had higher levels of PII and BoP scores when compared to baseline (P < 0.05).. The results of this study showed that an adequate band of keratinized mucosa was related with less plaque accumulation and mucosal inflammation as well as pro-inflammatuar mediators, suggesting that it may be critical especially for plaque control and plaque associated mucosal lesions around dental implants.

Topics: Dental Implants; Dental Plaque Index; Dental Prosthesis, Implant-Supported; Denture, Complete, Lower; Denture, Overlay; Female; Follow-Up Studies; Gingiva; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Inflammation Mediators; Interleukin-1beta; Jaw, Edentulous; Keratins; Male; Mandible; Middle Aged; Mouth Mucosa; Periodontal Index; Periodontal Pocket; Prospective Studies; Tumor Necrosis Factor-alpha

The question of the importance of keratinized mucosa around dental implants for the prevention of peri-implant disease could not be answered in the relevant literature so far.. To investigate the influence of peri-implant keratinized mucosa on long-term peri-implant soft-tissue health and stability over a period of 5 years.. A total of 386 mandibular dental implants were placed in 73 completely edentulous patients, and subsequently restored with fixed full-arch prostheses. At prosthesis delivery (baseline) and after 3, 6, 12, 18, 24, 36, 48 and 60 months, modified plaque index (mPlI), modified sulcus bleeding index (mBI), distance between implant shoulder and mucosal margin (DIM) and width of peri-implant keratinized mucosa (KM) were recorded. Statistical analysis included multivariate logistic regression, multivariate ordinal logistic regression, generalized estimating equations and Bonferroni's correction.. Fifty-eight patients with 307 implants completed the 5-year study. Statistically significantly higher plaque accumulation on lingual sites (mean mPlI 0.67, SD 0.85), bleeding tendencies on lingual sites (mean mBI 0.22, SD 0.53) and larger soft-tissue recession on buccal sites (mean DIM -0.69 mm, SD 1.11 mm) were found when the width of KM was <2 mm, compared to sites with>or=2 mm of KM (mean mPlI 0.40, SD 0.68, P=0.001; mean mBI 0.13, SD 0.41, P<0.01; mean DIM -0.08 mm, SD 0.86 mm, P<0.001). The width of keratinized mucosa had no effect on bleeding tendency or plaque accumulation on buccal sites (P>0.05).. In patients exercising good oral hygiene and receiving regular implant maintenance therapy, implants with a reduced width of <2 mm of peri-implant keratinized mucosa were more prone to lingual plaque accumulation and bleeding as well as buccal soft-tissue recession over a period of 5 years.

Topics: Adaptation, Physiological; Adult; Aged; Dental Health Surveys; Dental Implants; Dental Plaque; Dental Prosthesis, Implant-Supported; Denture, Complete, Lower; Female; Gingival Recession; Humans; Jaw, Edentulous; Keratins; Longitudinal Studies; Male; Mandible; Middle Aged; Mouth Mucosa; Oral Hygiene; Prospective Studies; Statistics, Nonparametric; Treatment Outcome

The aim of the present study was to develop a method to study the healing process after gingival grafting and to observe the histologic results after use of the modified edentulous ridge expansion technique. A 47-year-old nonsmoking woman with a noncontributory past medical history affected by edentulism associated with a horizontal alveolar ridge defect was referred to the authors for surgical correction of the deficit to improve implant support and the final esthetics of an implant-borne prosthesis. At the 4-month follow-up visit, a biopsy was performed by a punch technique in the same sites of healing abutment connection. The tissue was elevated from the attached gingival. Clinically, the grafted tissues seemed to be attached to the bone surfaces. The histologic findings revealed dense grafted tissues, providing long-term stability to the area. No ligament or bone, characteristic for periodontal regeneration, were observed. The presence of thick attached keratinized tissue around implants may constitute a protective factor against marginal inflammation or trauma.

Topics: Alveolar Ridge Augmentation; Autografts; Biopsy, Needle; Collagen; Connective Tissue; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis, Implant-Supported; Female; Follow-Up Studies; Gingiva; Humans; Jaw, Edentulous; Keratins; Middle Aged; Surgical Flaps

To test the hypothesis of the outcome of complete arch flapless guided implant surgery mandibular rehabilitations in the presence or absence of a residual band of keratinized mucosa (KM) < 6 mm wide in the vestibular-lingual aspect, with and without a modification of the surgical protocol.. Thirty-nine patients were included in this study (12 men and 27 women), with a mean age of 62.5 years (range, 42 to 79 years), divided into 3 groups of 13 patients according to the status of residual band of KM: group 1, KM < 6 mm rehabilitated through a modified guided surgical protocol with flap opening to preserve KM; group 2, KM ≥ 6 mm; and group 3, KM < 6 mm; patients from both groups 2 and 3 were rehabilitated through flapless guided implant surgery without modification of the protocol. Group 2 and 3 patients were age- and sex-matched with group 1. Outcome measures were clinical attachment loss (CAL) ≥ 2 mm after 1 year (backward conditional regression), incidence of dehiscences, dental plaque, bleeding, and implant infections. The level of significance chosen was 5%.. Thirty-nine patients with 156 implants were followed for 1 year, and no dropouts occurred. Absence of a residual band of KM ≥ 6 mm in the vestibular-lingual aspect was significantly associated with CAL (odds ratio, 39.1; P = .036) and dehiscences (P = .003).. Within the limitations of this study, the absence of a residual band of KM ≥ 6 mm wide in the vestibular-lingual aspect in patients rehabilitated in the complete edentulous mandible with flapless guided implant surgery may be associated with CAL and a higher incidence of dehiscences after 1 year of follow-up. This possible association needs to be confirmed in studies with stronger designs and longer follow-ups.

Topics: Adult; Aged; Case-Control Studies; Dental Implantation, Endosseous; Dental Plaque; Female; Follow-Up Studies; Gingiva; Gingival Hemorrhage; Humans; Immediate Dental Implant Loading; Jaw, Edentulous; Keratins; Male; Mandible; Middle Aged; Patient Care Planning; Peri-Implantitis; Periodontal Attachment Loss; Pilot Projects; Postoperative Complications; Surgery, Computer-Assisted; Surgical Flaps; Surgical Wound Dehiscence; Treatment Outcome

The present study is a 5-year clinical and radiographic follow-up of 51 patients who had undergone a combined vestibuloplasty with a split skin graft and lowering of the floor of the mouth. Our purpose was to examine the effect of clinically evident graft pathology on the residual ridge reduction. The clinical records of the graft condition were classified into: healthy graft, partial loss of keratinization, and total loss of keratinization. The residual ridge reduction was monitored by ridge height measurements at different locations, and by the symphyseal and mandibular body areas. Patients with clinical signs of graft pathology (reddening, loss of keratinization) suffered a significantly more severe residual ridge reduction than those with a healthy skin graft (p less than 0.01). Subsequent findings including smear tests showing Candida albicans hyphae, and improvement of graft condition after antimycotic therapy, indicated that the graft pathology observed is a candidiasis.

Topics: Adult; Aged; Alveolar Bone Loss; Alveolar Process; Candidiasis, Oral; Cephalometry; Female; Follow-Up Studies; Humans; Jaw, Edentulous; Keratins; Male; Mandibular Diseases; Middle Aged; Mouth Floor; Mouth Mucosa; Radiography; Skin Transplantation; Vestibuloplasty

These histologic observations of the epithelium and connective tissue are in close agreement with a host of earlier workers. The striking feature is an increase in thickness of epithelium due to an increase in constituent cell layers, but a decrease in keratinization, with keratin mainly of the parakeratinized variety. There is a definite reduction of collagen fiber network in regions of stress where the fibers present an irregular arrangement in contrast to the normal wavy pattern. Marked chronic inflammatory exudate is also seen. Histochemical investigation of the connective tissue under dentures revealed the presence of a highly elastic and resistant oxytalan fiber network, especially in regions that showed a reduction in collagen fibers. Thus the connective tissue response under dentures is in sharp contrast to what is expected. This abnormal behavior of the connective tissue is probably a reaction to the changes in epithelium. As a result of reduction in keratinization, a highly resistant and protective layer, the connective tissue exhibits altered metabolism and function. We hypothesize that connective tissue takes up a more dominant role of protection and absorption of stress, a role hitherto fulfilled by the epithelium. Thus stresses exerted by dentures on connective tissues are prevented from reaching the bone where they could cause resorption. We therefore feel that denture wear not only results in change within the epithelium, but in an equally significant reaction of the connective tissue. This reaction results in the appearance of a highly resistant and elastic oxytalan fiber system, which assists the connective tissue to react successfully to the stresses exerted on it.

Topics: Adult; Aged; Biopsy, Needle; Collagen; Contractile Proteins; Denture, Complete, Upper; Extracellular Matrix Proteins; Humans; Jaw, Edentulous; Keratins; Middle Aged; Mouth Mucosa; Palate; RNA Splicing Factors; Stress, Mechanical

Topics: Atrophy; Denture, Complete; Epithelium; Humans; Jaw, Edentulous; Keratins; Mouth Mucosa