bromochloroacetic-acid and Periodontal-Diseases

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

To provide an overview on the biology and soft tissue wound healing around teeth and dental implants.. This narrative review focuses on cell biology and histology of soft tissue wounds around natural teeth and dental implants.. The available data indicate that: (a) Oral wounds follow a similar pattern. (b) The tissue specificities of the gingival, alveolar and palatal mucosa appear to be innately and not necessarily functionally determined. (c) The granulation tissue originating from the periodontal ligament or from connective tissue originally covered by keratinized epithelium has the potential to induce keratinization. However, it also appears that deep palatal connective tissue may not have the same potential to induce keratinization as the palatal connective tissue originating from an immediately subepithelial area. (d) Epithelial healing following non-surgical and surgical periodontal therapy appears to be completed after a period of 7–14 days. Structural integrity of a maturing wound between a denuded root surface and a soft tissue flap is achieved at approximately 14-days post-surgery. (e) The formation of the biological width and maturation of the barrier function around transmucosal implants requires 6–8 weeks of healing. (f) The established peri-implant soft connective tissue resembles a scar tissue in composition, fibre orientation, and vasculature. (g) The peri-implant junctional epithelium may reach a greater final length under certain conditions such as implants placed into fresh extraction sockets versus conventional implant procedures in healed sites.

Topics: Connective Tissue; Dental Implants; Epithelium; Granulation Tissue; Humans; Keratins; Periodontal Diseases; Periodontium; Time Factors; Tooth; Wound Healing

A considerable amount of effort has been directed at finding methods for modifying the nonkeratinized sulcular epithelium on the assumption that a keratinized surface may offer a better barrier to antigens and bacterial products present in the gingival sulcus. It is argued here that keratinization in itself may not confer greater impermeability, for nonkeratinized epithelia also have been shown to resist the penetration of certain substances. Moreover, few workers have considered the role of junctional epithelium in the initiation of periodontal disease although experimental evidence suggests that this may be a permeable tissue. As formation of a surface with barrier properties seems to be a concomitant of epithelial differentiation while attachment is a property of relatively undifferentiated epithelial cells, attempts to induce junctional epithelium to differentiate could result in a loss of epithelial attachment to the tooth. It is suggested that attempts to keratinize the sulcular region, on theoretical grounds, may be unjustified.

Topics: Epithelial Attachment; Epithelium; Gingiva; Humans; Keratins; Periodontal Diseases; Periodontium; Permeability

The aim of this study was to correlate radiographic examination with the clinical periodontal condition in cases of biologic width invasion by overextending restoration margins in restored premolars and molars.. The present pilot study involved nine people (mean age 32 years) with biologic width invasion by 21 surfaces overextending restoration margins in restored premolars and molars. Radiographs were made in a standardized unit using the interproximal technique and were evaluated by a single calibrated investigator. The clinical periodontal parameters were analyzed with the use of a computerized periodontal probe. Exploratory analysis and Spearman's correlation were used to perform statistical analyses (SPSS, p < 0.05).. The most prevalent teeth with biologic width invasion were second premolars and first molars. Mean plaque index was 30.76%, and bleeding on probing was 27.0%. The mesial surface was invaded in 47.6% of cases and the distal surface in 52.4%. The 21 sites with biologic width invasion were found in patients with the following periodontal status: periodontal health (11 sites), gingivitis (2 sites), mild periodontitis (7 sites) and moderate periodontitis (1 site). There was a correlation between plaque index and bleeding on probing with the horizontal component of the bone level.. There was correlation between the radiographic parameters of biologic width invasion and clinical conditions. The measure of the bone crest level correlated with the gingival recession. The horizontal component of bone defect correlated with plaque index and bleeding on probing.

Topics: Adult; Alveolar Bone Loss; Alveolar Process; Bicuspid; Dental Plaque Index; Dental Restoration, Permanent; Female; Gingiva; Gingival Recession; Gingivitis; Humans; Keratins; Male; Molar; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Index; Periodontitis; Periodontium; Pilot Projects; Radiography; Surface Properties

Immediate implant placement has several advantages, such as reduction in the number of surgical treatments and reduction of the time between tooth extraction and the placement of the definitive prosthesis. However, there are still some situations that could jeopardize the success of the aforesaid therapy, such as the presence of an infection caused by periodontal disease or periapical lesions. The aim of this case series is to evaluate the clinical success of implants placed in fresh extraction sockets that showed clinical signs of periodontal disease.. Thirteen patients (six males and seven females, 24 to 65 years old) are included in this case series. After initial examination and treatment planning, all patients underwent the periodontal treatment deemed necessary to facilitate wound healing. Twenty teeth were extracted as a result of an infection. Second-stage surgery was performed 4 months after the initial procedure. The following clinical parameters were evaluated for each patient at the time of implant placement and at the end of the 12-month follow-up period: 1) clinical attachment level (CAL); 2) presence or absence of mobility; 3) presence or absence of pain; and 4) presence or absence of suppuration. The bone level was measured as the distance from the implant shoulder to the first bone-implant contact (distance bone-implant [DIB]) by periapical radiographs. The stability and health of the soft tissue were clinically evaluated by means of the plaque score.. The healing period was uneventful for all the patients. All the implants were osseointegrated. At the end of the 12-month follow-up period, patients were asymptomatic and showed no signs of infection or bleeding when probed. The mean CAL at the mid-buccal location per implant was 0.8 mm at baseline and 0.9 mm at the end of the follow-up. The mean width of keratinized mucosa measured at the mid-buccal location per implant at baseline and 1-year visits was 3.2 ± 0.4 mm and 3.3 ± 0.5 mm, respectively. The periapical radiographs, obtained in a standardized manner, revealed a mean increase of 0.5 mm in the DIB value. At the 12-month follow-up, the presence of plaque was observed in 44 of the 80 sites analyzed.. Based on the results of this case series, placement of implants in fresh extraction sockets affected by infection may be a valid operative technique that leads to predictable results if adequate preoperative and postoperative care is taken.

Topics: Adult; Aged; Alveolar Bone Loss; Bone Substitutes; Dental Implants, Single-Tooth; Dental Plaque Index; Female; Follow-Up Studies; Gingiva; Gingival Hemorrhage; Humans; Immediate Dental Implant Loading; Keratins; Male; Membranes, Artificial; Middle Aged; Osseointegration; Pain Measurement; Patient Care Planning; Periodontal Attachment Loss; Periodontal Diseases; Radiography, Bitewing; Suppuration; Surgical Flaps; Tooth Extraction; Tooth Socket; Treatment Outcome; Wound Healing; Young Adult

Aim of the present study was to evaluate the influence of orthognathic surgery on the development of periodontal and microbiological changes.. Fifteen consecutively treated patients with a mean age of 24.9±7.7 years receiving orthognathic surgery were included in the present study. Plaque index (PI) and concentrations of 11 periodonto-pathogenic bacteria were recorded one day prior to surgery (t(0)) and one week (t(1)) and six weeks (t(2)) post-surgery. In addition, a complete periodontal examination including pocket probing depth (PPD), gingival recession (GR), clinical attachment level (CAL), bleeding on probing (BOP) and width of keratinized gingiva (WKG) was conducted at t(0) and t(2). For statistical analysis, general linear model and paired t-test were applied.. A significant increase of PI (t(0)-t(1), p=0.037) was followed by a significant decrease (t(1)-t(2), p=0.017). Apart from Eikenella corrodens (p=0.036), no significant microbiological changes were recorded. PPD significantly increased on oral sites (p=0.045) and GR especially on buccal sites (p=0.001). In the incision area the development of GR was significantly higher on the test (buccal) than on the control sites (oral). Both gingival biotypes were affected by GR.. Orthognathic surgery causes statistically significant changes of periodontal parameters, but these changes do not necessarily impair the aesthetic appearance of the gingival margin.

Topics: Aggregatibacter actinomycetemcomitans; Bacteroides; Campylobacter rectus; Capnocytophaga; Dental Plaque; Dental Plaque Index; Eikenella corrodens; Eubacterium; Female; Follow-Up Studies; Fusobacterium nucleatum; Gingiva; Gingival Hemorrhage; Gingival Recession; Humans; Keratins; Male; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Peptostreptococcus; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Pocket; Periodontium; Porphyromonas gingivalis; Prevotella intermedia; Treponema denticola; Young Adult

The aim of the present paper was to analyse, on patient and implant basis, factors related to peri-implant lesions.. Two hundred and eighteen patients treated with titanium implants were examined for biological complications at existing implants 9-14 years after initial therapy. The effects of several potentially explanatory variables, both on patient and on implant levels, were analysed.. On the implant level, the presence of keratinized mucosa (p = 0.02) and plaque (p = 0.005) was associated with mucositis (probing depth > or =4 mm + bleeding on probing). The bone level at implants was associated with the presence of keratinized mucosa (p = 0.03) and the presence of pus (p < 0.001). On the patient level, smoking was associated with mucositis, bone level and peri-implantitis (p = 0.02, <0.001 and 0.002, respectively). Peri-implantitis was related to a previous history of periodontitis (p = 0.05).. Individuals with a history of periodontitis and individuals who smoke are more likely to develop peri-implant lesions.

Topics: Aged; Alveolar Bone Loss; Dental Implants; Dental Plaque; Disease; Female; Follow-Up Studies; Humans; Keratins; Male; Middle Aged; Mouth Mucosa; Periodontal Diseases; Periodontal Pocket; Periodontitis; Risk Factors; Smoking; Suppuration; Titanium

The increased use of implants in orthodontics has stimulated interest in augmenting bone in patients who have deficient alveolar ridges that preclude ideal implant placement. A nonsurgical technique for increasing the amount of available bone for implant site development and fixture placement is orthodontic extrusion, or forced eruption. The concept of a tooth moving coronally by orthodontic means and the clinical alterations in the soft tissue architecture of the periodontium demonstrated during orthodontic extrusive movement of periodontally compromised teeth have demonstrated a direct relationship of pocket depth reduction, accompanied with an immature appearing tissue, "the red patch." This article will describe the periodontium during eruptive tooth movement.

Topics: Alveolar Bone Loss; Color; Dental Implantation, Endosseous; Dental Implants; Gingiva; Gingival Pocket; Humans; Incisor; Keratins; Maxilla; Periodontal Diseases; Periodontal Pocket; Periodontitis; Periodontium; Radiography; Root Canal Therapy; Tooth Eruption; Tooth Movement Techniques; Wound Healing

Immunocytochemical analysis was carried out on samples of 5-, 6-, and 9-week old regenerated soft tissue taken from healing periodontal defects treated by guided tissue regeneration using expanded polytetrafluorethylene (ePTFE) membranes. A panel of monoclonal and polyconal antibodies to cytokeratins, vimentin, and collagen was used to label cells and collagen types I, III, and IV. Epithelium was identified in 7 of the 9 samples examined, in addition to mesenchymal cells staining positively for vimentin and co-distribution of collagen types I, III, and IV in all samples. Clinical observations indicated that exposure of the ePTFE membranes during healing was a frequent occurrence, and the presence and quantity of epithelium found within the healing defect beneath the membrane may be related to the extent to which this occurs.

Topics: Adult; Collagen; Fibrinogen; Guided Tissue Regeneration, Periodontal; Humans; Immunohistochemistry; Keratins; Periodontal Diseases; Polytetrafluoroethylene; Vimentin

The purpose of this clinical study was to evaluate the periodontal condition of teeth having submarginal restorations associated with either narrow or wide zones of keratinized gingiva. Fifty-eight teeth in 26 individuals were selected and then divided into two groups according to the width of the keratinized gingiva at the midfacial aspect of the tested tooth. Group I consisted of 30 teeth with greater than or equal to 2.0 mm, and Group II consisted of 28 teeth with less than 2.0 mm of keratinized gingiva. Each group was equally subdivided into subgroup "A" having teeth with a full coverage, subgingival type of restoration for at least 2 years, and subgroup "B" representing contralateral homologous teeth, in the same individual, with no subgingival restoration. Clinical examination of individual teeth included determination of plaque and gingival indices, gingival fluid, probing depth, bleeding tendency and bone level. Data were subjected to statistical analysis using the Student t test and a two-way analysis of variance to determine any significant differences in variables between teeth with and without subgingival restorations, in narrow and wide zones of keratinized gingiva. The findings were: (1) teeth with subgingival restorations and narrow zones of keratinized gingiva showed statistically significant higher gingival scores than teeth having submarginal restorations with wide zones of keratinized gingiva. (2) Teeth without subgingival restorations showed no statistical difference between narrow and wide zones of keratinized gingiva (P greater than 0.05).

Topics: Adult; Aged; Aged, 80 and over; Denture, Partial, Fixed; Gingiva; Gingival Recession; Humans; Keratins; Middle Aged; Periodontal Diseases; Periodontal Index; Time Factors

Topics: Adolescent; Adult; Aged; Antibodies; Basement Membrane; Cell Adhesion; Cell Movement; Cells, Cultured; Collagen; Dental Enamel; Epithelial Attachment; Epithelial Cells; Gingiva; Humans; Keratins; Laminin; Middle Aged; Mouth Mucosa; Periodontal Diseases; Periodontium; Receptors, Cell Surface; Receptors, Transferrin; Tooth

Topics: Adult; Aggressive Periodontitis; Epithelium; Female; Gingiva; Humans; Immunoenzyme Techniques; Keratins; Male; Periodontal Diseases; Periodontitis

The present study was undertaken to analyze the role of attached gingiva for the maintenance of periodontal health in sites with normal and reduced height of the supporting apparatus. Furthermore, the effect of excision and grafting of gingiva on some parameters describing dimensions and location of the periodontal tissues was evaluated. 7 beagle dogs were used. A baseline examination comprised assessments of dental plaque, gingival conditions, attachment level, position of the gingival margin and width of the keratinized and the attached gingiva. In the right side of the jaws (experimental side) a 6-month period of periodontal tissue breakdown was followed by surgical excision of the entire zone of the gingiva. After another 4-month period of healing with daily plaque control, a gingival graft was inserted in one quadrant of the experimental side to regain a zone of attached gingiva while the other quadrant of the experimental side was left ungrafted. In the left side of the jaws (control side), the teeth were subjected to daily meticulous plaque control during the entire study. In one of the control quadrants the entire zone of the keratinized and attached gingiva was excised at a time point corresponding to the grafting procedure in the experimental side, while the gingiva in the remaining control jaw quadrant was left unoperated. Clinical examinations of all control and experimental tooth units were repeated at certain time intervals during the course of the study. The final examination was carried out 4 months after grafting. The results of the experiment showed that in sites exposed to careful plaque control measures gingival health could be established and maintained without sign of recession of the gingival margin or loss of attachment, independent of (1) presence or absence of attached gingiva, (2) width of keratinized gingiva or (3) height of the supporting attachment apparatus. Following surgical excision of the entire gingiva, all buccal sites regained a zone of keratinized gingiva, but most sites were lacking attached gingiva. Furthermore, grafting of gingival tissue significantly increased the width of the keratinized and the attached gingiva but had no obvious effect on the position of the gingival margin or the level of the attachment.

Topics: Animals; Dogs; Gingiva; Keratins; Periodontal Diseases; Periodontium; Time Factors; Wound Healing

The present clinical trial was carried out in order to analyze whether a zone of keratinized and attached gingiva may regenerate following surgical excision of the gingiva. In addition the alterations occurring in the position of the "soft tissue margin" and the clinical attachment level were assessed. 6 patients, scheduled for periodontal surgery in the canine-premolar regions of both quadrants of the lower jaw, participated in the trial. A Baseline examination performed prior to surgery comprised assessments at the buccal surface of the teeth of dental plaque, gingivitis, probing depth, clinical attachment level, position of the "soft tissue margin" and width of the zones of keratinized and attached gingiva. The entire zone of keratinized and attached gingiva was removed surgically using either a "gingivectomy" or a "flap-excision" procedure. In the "gingivectomy" procedure the wounded area was left to heal by second intention, while in the "flap-excision" procedure the alveolar mucosa was repositioned in a coronal position to achieve complete coverage of the surgically exposed alveolar bone. During healing the patients' oral hygiene status was carefully supervised. All parameters included in the Baseline examination were assessed at reexaminations performed 1, 3, 6 and 9 months following surgery. Already 1 month after surgery all "gingivectomy" units and 9 out of the 14 "flap-excision" units demonstrated presence of a zone of keratinized gingiva. At the final examination (9 months following surgery) all surgically treated buccal areas had regained a zone of keratinized gingiva. However, a zone of attached gingiva reformed less frequently. The examination performed 3 months after surgery revealed that the "soft tissue margin" and the clinical attachment level had become displaced in apical direction, 0.9 and 0.4 mm, respectively. Between the 3-month and the 9-month examinations, however, no further alterations were observed and the gingival units were healthy, independent of the presence or absence of attached gingiva or the width of the zone of keratinized gingiva.

Topics: Adult; Gingiva; Gingivectomy; Humans; Keratins; Middle Aged; Periodontal Diseases; Regeneration; Surgical Flaps; Time Factors

Topics: Adolescent; Cephalometry; Female; Gingiva; Humans; Keratins; Longitudinal Studies; Male; Odontometry; Orthodontics, Corrective; Periodontal Diseases; Tooth

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

Topics: Adult; Connective Tissue; Epithelium; Female; Gingiva; Gingivectomy; Gingivitis; Humans; Keratins; Male; Middle Aged; Periodontal Diseases; Time Factors; Wound Healing

Topics: Adult; Cell Membrane Permeability; Chromatin; Desmosomes; Epithelium; Female; Humans; Keratins; Mast Cells; Microscopy, Electron; Middle Aged; Periodontal Diseases

Topics: Animals; Dental Enamel; Epithelial Cells; Gingiva; Glycosaminoglycans; Haplorhini; Histocytochemistry; Humans; Keratins; Periodontal Diseases; Tooth Eruption

Topics: Alveolar Process; Animals; Blood Cell Count; Bone Marrow Cells; Chronic Disease; Gingivitis; Keratins; Periodontal Diseases; Periodontium; Phagocytosis; Rabbits

Topics: Humans; Keratins; Periodontal Diseases; Periodontium

Topics: Gingiva; Gingivectomy; Humans; Keratins; Massage; Oral Health; Periodontal Diseases; Postoperative Care; Toothbrushing; Wound Healing

Topics: Adult; Basophils; Eosinophils; Gingiva; Humans; Keratins; Male; Massage; Methods; Middle Aged; Periodontal Diseases; Periodontitis; Saliva; Time Factors

Topics: Epithelium; Gingiva; Humans; Keratins; Microscopy, Electron; Periodontal Diseases

Topics: Adult; Female; Formaldehyde; Gingiva; Humans; Keratins; Keratosis; Male; Massage; Mouthwashes; Periodontal Diseases; Toothbrushing

Topics: Keratins; Mouth Mucosa; Periodontal Diseases

Topics: Absorptiometry, Photon; Adolescent; Adult; Analysis of Variance; Epithelium; Female; Freeze Drying; Gingiva; Humans; Keratins; Male; Microradiography; Middle Aged; Periodontal Diseases