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This report describes 3 cases of ciliated epithelium-lined radicular cysts among 256 apical periodontitis lesions and also illustrates the occurrence of an Actinomyces-infected periapical cyst. Serial and step serial sections of 256... more
This report describes 3 cases of ciliated epithelium-lined radicular cysts among 256 apical periodontitis lesions and also illustrates the occurrence of an Actinomyces-infected periapical cyst. Serial and step serial sections of 256 plastic-embedded root apices with attached apical periodontitis lesions that were prepared for a previous investigation were reviewed for the presence of ciliated epithelium-lined radicular cysts. The lesions that were found to have such epithelial lining were examined in a transmission electron microscope to elaborate the fine structure of the ciliated cells. A total of 3 ciliated columnar epithelium-lined cysts was found among the 256 apical periodontitis lesions examined. Two of the lesions also contained stratified squamous epithelium. All 3 lesions affected maxillary premolars. One of the lesions was a true cyst, and the other 2 were periapical pocket cysts. The lumen of 1 of the latter revealed the presence of typical "ray-fungus" actinomycotic colonies. Although the stratified squamous component of the epithelia that lined the radicular cysts reported here may be derived from the cell rests of Malassez, the ciliated epithelial cells may be of sinus origin. Microbial agents from diseased root canals can advance into radicular cysts, particularly in pocket cysts, with the possible threat of such infection in upper posterior teeth spreading into the maxillary sinus.
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Trials aiming at isolating cultures and subcultures of cells from the periodontal ligament to uncover special features of such tissue-residing population are related to the past decade [1]. Moreover, the idea of cell-delivery systems, and... more
Trials aiming at isolating cultures and subcultures of cells from the periodontal ligament to uncover special features of such tissue-residing population are related to the past decade [1]. Moreover, the idea of cell-delivery systems, and especially with stem cells, to initiate periodontal regeneration is not new. However, describing suitable animal models for such new techniques is less documented in the literature and sometimes underestimated. The wide range of animal species allows appropriate selection of bio-models for different investigations. Each species has unique similarities and dissimilarities to humans. While many studies could ensure the initiation of periodontal regeneration using stem cells extracted from the periodontium, seeding of human periodontium-derived stem cells (pdSCs) on collagen carriers could induce major features of periodontal regeneration when implanted in experimental periodontal defects in the athymic immunodeficient rat as could be shown in our studies. However, remarkable notifications regarding the results obtained in our studies were the induction of malignant tumors (squamous cell carcinoma) in the majority of investigated animals. Considering the data presented in the literature, our studies seems to be the first that demonstrates the initiation of malignant tumors when using human pdSCs. The patients from whom the pdSCs had been extracted, the animal model used and a possible oncogenic alteration of the pdSCs themselves might all be factors behind the tumors’ initiation. In our present studies, the animal model used and the related experimental periodontal defect, as a heterologous model, could successfully present two important biological features after implantation of pdSCs; namely periodontal repair and tumorigenicity. Although not fully histo-morphometrically assessed in our studies, these features are very important for further investigations and for future more-controlled studies. However, further studies using advanced histological, immunological and genetic techniques are required to assure different supposals presented in the current studies regarding stem cell-based periodontal regeneration and stem cell-tumorigenesis.
Research Interests: Genetics, Dentistry, Orthodontics, Dance Studies, Creative processes in contemporary dance, and 19 moreDental Research, Anthropology Of Dance, Dance History, Dance and Aesthetics, Stem Cell, Dance Education, Dentistry Education, Dance, Cell Biology (Health Sciences), Dental Education, Dance Research, Dance Movement Therapy, History of Dentistry, Squamous Cell Carcinoma, Periodontal Ligament, Animal Model, Dentistry and Orthodontics, Cancer Stem Cell, and Delivery System
Research Interests: Dentistry, Wound Healing, Immunohistochemistry, Stratification, Antibodies, and 19 moreCell Differentiation, Humans, Keratinocytes, Basement Membrane, Collagen, Female, Male, Connective tissue, Follow-up studies, Aged, Middle Aged, Palate, Epithelium, Epithelial cells, Adult, Mouth mucosa, Biological markers, Keratins, and Laminin
In maxillofacial surgery, intrasulcular incisions are often used. This prospective case series was established to evaluate the detrimental effects of intrasulcular incisions on periodontal structures. In 35 patients, measurements of... more
In maxillofacial surgery, intrasulcular incisions are often used. This prospective case series was established to evaluate the detrimental effects of intrasulcular incisions on periodontal structures. In 35 patients, measurements of probing depth and crown length before and 10 months postoperatively were performed to calculate changes of attachment level and gingival recession. In a subgroup, surgically treated sites were compared with untreated control sites. A nonparametric test was applied for longitudinal and split-mouth comparisons. Overall, intrasulcular incisions did not induce significant attachment loss. The frequency of sites losing ≥2 mm of attachment was 5.0%, 2.6%, and 4.7% at mesial, buccal, and distal sites, respectively. Intrasulcular incisions caused only a slight increase in gingival recession by 0.4 ± 0.5, 0.2 ± 0.3, and 0.3 ± 0.4 mm at mesial, buccal, and distal sites, respectively. Within the limitations of the study design, it can be concluded that intrasulcular incisions without additional vertical incisions do not impose a serious risk for attachment loss and/or gingival recession.
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Tissue engineering technologies combine the biological properties of living cells and physicochemical properties of individually designed materials in order to enable the creation of artificial tissues like cartilage, bone, mucosa,... more
Tissue engineering technologies combine the biological properties of living cells and physicochemical properties of individually designed materials in order to enable the creation of artificial tissues like cartilage, bone, mucosa, periodontium, etc. for potential use in oral and maxillofacial surgery. Living cells, three-dimensional cell housing scaffolds, and bioactive factors are used to produce an implantable tissue forming device for regenerative and functional repair. The aim of the discipline, oral and maxillofacial surgery is to develop reconstructive and regenerative tissue engineering technologies. This goal can be reached by surgically oriented research including: cell sources, growth and differentiation, bioreactors, experimental and clinical applications like cartilage, bone, and periodontal tissue engineering. The understanding of fundamental biology associated with tissue regeneration will be essential for the development of approaches to enhance cell function, angiogenesis, and cell differentiation in the future.
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Stem cell therapy is a promising area in regenerative medicine. Periodontal granulation tissues are often discarded during conventional surgery. If stromal stem cells can be isolated from these tissues, they can be used for subsequent... more
Stem cell therapy is a promising area in regenerative medicine. Periodontal granulation tissues are often discarded during conventional surgery. If stromal stem cells can be isolated from these tissues, they can be used for subsequent surgery on the same patient. Fifteen human periodontal granulation tissue samples were obtained from intrabony defects during surgery. Immunohistochemistry (IHC) was carried out on five of the samples to identify STRO-1, a marker of mesenchymal stem cells. Five samples underwent flow cytometry analysis for the same marker. The remaining five samples were characterized by “colony formation unit-fibroblast” (CFU-f) assay and selected for proliferation assay, flow cytometry of stem cell markers, immunocytochemistry (ICC), multipotent differentiation assays, and repairing critical-size defects in mice. The ratio of STRO-1+ cells detected by IHC was 5.91 ± 1.50%. The analysis of flow cytometry for STRO-1 was 6.70 ± 0.81%. Approximately two thirds of the CFU-f colonies had a strong reaction to STRO-1 in ICC staining. The cells were multipotent both in vitro and in vivo. Mice given bone grafts and stem cells showed significantly better bone healing than those without stem cells. Multipotent stromal stem cells can be isolated from human periodontal granulation tissues. These cells improve new bone formation when transplanted in mouse calvarial defects. Isolating stem cells from relatively accessible sites without extra procedures is clinically advantageous. This study demonstrated that human periodontal granulation tissues contain isolatable multipotent stem cells. The cells may be a good source for autotransplantation in subsequent treatment.
Research Interests: Dentistry, Flow Cytometry, Immunohistochemistry, Stem Cell, Regenerative Medicine, and 21 moreCell separation, Stem cell Therapy, Cell Differentiation, Bone graft, Humans, Mice, Animals, Skull, Adipogenesis, Mesenchymal Stem Cell, Granulation Tissue, Chondrogenesis, Osteogenesis, Bone Formation, Cell Proliferation, Hydroxyapatites, Bone Substitutes, Mesenchymal Stromal Cells, Bone Transplantation, fibroblasts, and Alveolar bone loss
The plastic periodontal surgery includes not only the stop of the progression of gingival recession, but also, if possible, the complete coverage of exposed root surfaces and the improvement of the functional and aesthetic mucogingival... more
The plastic periodontal surgery includes not only the stop of the progression of gingival recession, but also, if possible, the complete coverage of exposed root surfaces and the improvement of the functional and aesthetic mucogingival conditions. Repair or regeneration of lost structures up to a certain extent is possible with the currently known evidence-based and minimal invasive methods of plastic periodontal surgery. Die plastische Parodontalchirurgie beinhaltet nicht nur einen Stopp der Progression der gingivalen Rezession, sondern auch, wenn möglich, die vollständige Deckung der exponierten Wurzeloberfläche und die Verbesserung der funktionellen und ästhetischen mucogingivalen Verhältnisse. Mit den heute bekannten minimalinvasiven und Evidenz basierenden Methoden der plastischen Parodontalchirurgie ist die Regeneration beziehungsweise Reparation der verloren gegangenen Strukturen bis zu einem bestimmten Ausmaß möglich.
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La recherche de protocoles favorisant l’hémostase et la cicatrisation est un problème récurrent dans toutes les disciplines chirurgicales. Les concentrés plaquettaires, en tant que colles biologiques enrichies en cytokines, ont été... more
La recherche de protocoles favorisant l’hémostase et la cicatrisation est un problème récurrent dans toutes les disciplines chirurgicales. Les concentrés plaquettaires, en tant que colles biologiques enrichies en cytokines, ont été utilisés dans une multitude de situations cliniques afin d’évaluer leurs effets présumés. En ophtalmologie, ils furent ajoutés au traitement chirurgical des déchirures de la macula. En chirurgie plastique, ils servent de colles de fibrine afin de prévenir la formation de cicatrices chéloïdes, au rendu esthétique et aux qualités mécaniques très préjudiciables. En chirurgies parodontale, péri-implantaire et maxillofaciale, ils jouent le rôle de liant biologique entre les différents éléments d’une greffe osseuse ou gingivale et de gel de protection du site opératoire, au même titre que les colles de fibrine utilisées antérieurement. Cependant, les travaux publiés souffrent de nombreux biais et de l’absence de méthodologie réellement scientifique pour en évaluer la portée. Et ces lacunes analytiques renforcent les doutes quant à l’identité biologique de ces préparations : gel plaquettaire ou colle de fibrine ?The search for protocols supporting the haemostasis and the cicatrisation is a recurring problem in all the surgical disciplines. The platelet concentrates, as biological adhesives enriched in cytokines, were used in a multitude of clinical situations in order to evaluate their supposed effects. In ophthalmology, they were added to the surgical treatment of macular holes. In plastic surgery, they are used as fibrin adhesives in order to prevent the formation of keloid scars, which aesthetic and mechanical qualities are very prejudicial. In periodontal, peri-implant and maxillo-facial surgeries, they play the biological role of link between various elements during bone grafts or gingival surgeries and the role of protective seal in the operational site, as well as the fibrin adhesives used before. However, published works suffer from many skews and the really scientific absence of methodology to evaluate the range of it. And these analytical gaps reinforce the doubts as for the biological identity of these preparations: platelet gel or fibrin adhesive?
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A reliable, soft tissue allograft, AlloDerm ® is reported in this preliminary study. Processed from allograft skin obtained from tissue banks, it is an acellular dermal graft whose native framework is maintained. This dermal graft has... more
A reliable, soft tissue allograft, AlloDerm ® is reported in this preliminary study. Processed from allograft skin obtained from tissue banks, it is an acellular dermal graft whose native framework is maintained. This dermal graft has been used in conjunction with ultrathin autografts to ...
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Today an increasing number of patients seek aesthetic improvement through minimally invasive procedures, and interest in soft tissue augmentation and filling agents is rising steadily. However, a thorough understanding of these... more
Today an increasing number of patients seek aesthetic improvement through minimally invasive procedures, and interest in soft tissue augmentation and filling agents is rising steadily. However, a thorough understanding of these substances, their indications and contraindications, as well as a profound knowledge of different implantation techniques is essential to provide an aesthetically pleasing result for the patient. This presentation gives an overview of the current injectable biomaterials, their major indications, advantages and disadvantages, with focus on collagen, hyaluronic acid, poly-l-lactide, and autologous fat grafting.
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We present the case of Kindler syndrome in a 17-year-old man. After excision, histomorphological analysis, and wound closure of a chronic unstable scar in the right popliteal region, a basal cell carcinoma was diagnosed accidentally. A... more
We present the case of Kindler syndrome in a 17-year-old man. After excision, histomorphological analysis, and wound closure of a chronic unstable scar in the right popliteal region, a basal cell carcinoma was diagnosed accidentally. A malignancy was not suspected, although the patient already had biopsies, multiple trials of debridement, and skin grafting earlier elsewhere. While an initial attempt to close the defect with a microsurgical flap was abandoned, due to microvascular irregularities, a wound closure was achieved with a free skin graft. The postoperative histomorphologic analysis revealed the surprising diagnosis of a basal cell carcinoma, fortunately with free margins. At follow-up 1 year later, the grafted area was stable, and there was no recurrent disease. A preoperative histomorphologic analysis of the complete excised chronic wound, especially in known skin disorders—regardless of young age—is mandatory. Furthermore, the presented case showed that an abnormal deposition of collagen, and enhanced coprostasis with migration of granulocytes, destroys the normal consistency of small vessels and presents a limitation for microsurgical procedures in these patients.
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Descending necrotizing soft tissue infections involving the neck and chest are a rare but hazardous sequela of periodontal infections. These infections are associated with significant mortality.The high mortality rates of this condition... more
Descending necrotizing soft tissue infections involving the neck and chest are a rare but hazardous sequela of periodontal infections. These infections are associated with significant mortality.The high mortality rates of this condition are attributed to significant delays in diagnosis and treatment of common periodontal infections that have progressed to severe disease without overt clinical signs or symptoms. As with all necrotizing soft tissue infections, making a timely diagnosis requires that the examining physician maintain a reasonable index of suspicion when the patient with an oropharyngeal infection is encountered. Coverage of the most common infecting organisms with appropriate antibiotics accompanies surgical therapy. Hyperbaric oxygen remains an adjunctive therapy of unproven efficacy. The cornerstone of therapy, however, is surgical with aggressive and complete debridement of all nonviable tissue without regard for the size or complexity of the resulting wound. In the case described below, this goal could not have been achieved without the immediate availability of reconstructive expertise to preserve vital structures in the neck and upper mediastinum.
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Parodontale chirurgie is niet beperkt tot de chirurgische behandeling van het geïnfecteerde parodontium. In 1993 introduceerde Miller de term periodontal plastic surgery, in het Nederlands‘parodontale plastische chirurgie’. Deze omvat... more
Parodontale chirurgie is niet beperkt tot de chirurgische behandeling van het geïnfecteerde parodontium. In 1993 introduceerde Miller de term periodontal plastic surgery, in het Nederlands‘parodontale plastische chirurgie’. Deze omvat alle chirurgische ingrepen die gericht zijn op het voorkomen en corrigeren van anatomische afwijkingen, ontwikkelingsstoornissen en traumatische of pathologische afwijkingen van de gingiva, de alveolaire mucosa en het alveolaire bot. In korte tijd is er grote belangstelling voor parodontale plastische chirurgie ontstaan. Vorig jaar, op het congres van de European Federation of Periodontology (EFP) in Stockholm, kreeg dit onderwerp heel veel aandacht. Voorbeelden van parodontale plastische chirurgie zijn: gingiva-augmentatie (zie ook TP nr. 3, 2010), recessiebedekking (TP nr. 12, 2009), behandeling van peri-implantaire zachte weefsels, kroonverlenging, frenulumextirpatie, socket preservation technique (TP nr. 5, 2010), papilla preservation technique, ridge augmentation technique en parodontale regeneratie met glazuurmatrix proteïnen (Emdogain). Alveolaire botchirurgie, zoals botaugmentatie, behoort tevens tot deze groep en wordt vooral uitgevoerd tijdens (pre-)implantologische behandelingen. In dit artikel wordt op enkele van deze technieken dieper ingegaan.
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For the purpose of obtaining high bone forming efficacy, development of chitosan was attempted as a tool useful as a scaffolding device. Porous chitosan matrices, chitosan–poly(l-lactide) (PLLA) composite matrices and chitosan coated on... more
For the purpose of obtaining high bone forming efficacy, development of chitosan was attempted as a tool useful as a scaffolding device. Porous chitosan matrices, chitosan–poly(l-lactide) (PLLA) composite matrices and chitosan coated on PLLA matrices were dealt with in this research. Porous chitosan matrix was fabricated by freeze-drying and cross-linking aqueous chitosan solution. Porous chitosan matrix combined with ceramics and constituents of extracellular matrices were prepared and examined for their bone regenerative potential. Composite porous matrix of chitosan–PLLA was prepared by mixing polylactide with chitosan and freeze-drying. All chitosan based devices demonstrated improved bone forming capacity by increasing mechanical stability and biocompatibility. Release of platelet-derived growth factor-BB (PDGF-BB) from these matrices exerted significant osteoinductive effect in addition to the high osteoconducting capacity of the porous chitosan matrices. The hydrophobic surface of PLLA matrices was modified by chitosan to enhance cell affinity and wettability. The chitosan coated PLLA matrix induced increased osteoblast attachment as compared with intact PLLA surface. Overall results in this study demonstrated the usefulness of chitosan as drug releasing scaffolds and as modification tools for currently used biomaterials to enhance tissue regeneration efficacy. These results may expand the feasibility of combinative strategy of controlled local drug delivery concept and tissue engineered bone formation in reconstructive therapy in the field of periodontics, orthopedics and plastic surgery.
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The increased demand for mucogingival aesthetics has required the optimization of periodontal procedures. Microsurgery is a minimally invasive technique that is performed with the surgical microscope and adapted instruments and suture... more
The increased demand for mucogingival aesthetics has required the optimization of periodontal procedures. Microsurgery is a minimally invasive technique that is performed with the surgical microscope and adapted instruments and suture materials. While this hardware and knowledge of various operations are necessary to achieve patient aesthetic expectations, clinicians must be willing to undergo an extended period of systematic training to become familiar with novel operating procedures and instruments. This article describes the application of the surgical microscope to provide enhanced perioplastic treatment.
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With the development of various reconstructive and regenerative techniques in the 1980s, mucogingival surgery evolved into periodontal plastic surgery. This article highlights the surgical procedures which currently can be classified... more
With the development of various reconstructive and regenerative techniques in the 1980s, mucogingival surgery evolved into periodontal plastic surgery. This article highlights the surgical procedures which currently can be classified under the concept of Periodontal Plastic Surgery. The learning objective of this article is a review and update of these surgical procedures.
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... This definitive book presents the medical and surgical aspects of periodontics in full color, organized to coincide with topics in the AAP's Vision 2020 Objectives. ... Content is organized to coincide with the AAP's... more
... This definitive book presents the medical and surgical aspects of periodontics in full color, organized to coincide with topics in the AAP's Vision 2020 Objectives. ... Content is organized to coincide with the AAP's Vision 2020 Objectives. ...
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In the 1980s, mucogingival surgery evolved into periodontal plastic surgery with various techniques designed to produce root coverage in areas of marginal tissue recession, to augment deficient ridges, and to lengthen crowns in cases of... more
In the 1980s, mucogingival surgery evolved into periodontal plastic surgery with various techniques designed to produce root coverage in areas of marginal tissue recession, to augment deficient ridges, and to lengthen crowns in cases of excessive gingival display. Periodontal plastic surgery not only enables the dentist to reconstruct but also to regenerate lost tissues.
Research Interests: Dentistry, Adolescent, Humans, Smoking, Female, and 7 moreMale, Middle Aged, Adult, Mouth mucosa, Tooth Eruption, Tooth, and Gingival Recession
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Many options are available today for treatment of the cosmetic dentistry patient. Composites, veneers, and porcelain crowns have become an art form, with the gingival tissue serving as the frame. Clinicians providing cosmetic dental... more
Many options are available today for treatment of the cosmetic dentistry patient. Composites, veneers, and porcelain crowns have become an art form, with the gingival tissue serving as the frame. Clinicians providing cosmetic dental services must keep aware of the different techniques available for soft tissue contouring. Only recently has periodontal plastic surgery been presented at dental meetings, and little information exists in the research literature. This review brings the practicing dentist up to date on scientific and clinically relevant articles on soft tissue contouring. By working with the shape and contour of the gingiva, a more complementary esthetic final result is possible.
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Recent technological advances lead to an increase in the options for the treatment of the periodontal diseases. Lasers utilized for gingival soft tissue resurfacing mainly for esthetics purposes, require careful histopathological... more
Recent technological advances lead to an increase in the options for the treatment of the periodontal diseases. Lasers utilized for gingival soft tissue resurfacing mainly for esthetics purposes, require careful histopathological evaluation of the effects on tissue. Up to date no comparative clinical or histological studies have been performed, aiming at demonstration of the effects of laser irradiation on connective tissue, especially its most important component -- the collagen fibers. The alteration in the structures of this tissue plays the most important role in the healing process. The aim of the present study is to evaluate the influence of Erbium: YAG - Kesler's hand piece on gingival tissue. This handpiece is designed for gingival resurfacing, in cases of 'Gummy smile' and gingival pigmentation. The following irradiation parameters were used: energy per pulse -- 500 mJ, repetition rate 10 pps, spot size 3 mm. Gingival biopsies specimens of 10 patients, 6 with 'Gummy smile' and 4 with gingival pigmentation were examined before laser treatment, and at 7 and 14 days after laser treatment. The tissues were fixed in LNRS, embedded in paraffin, and sectioned into 5 micrometer thickness, dewaxed in xylol and stained with H&E and Picrosirius Red (PSR). The sections were examined by polarization microscopy. PSR is a collagen stain that differentiates collagen fiber density by the range of colors from green through yellow to red, and/or fiber size. This was utilized in the present study to evaluate the hypothesis that Erbium -- YAG (Er: YAG) laser energy is capable of remodeling the collagen fibers in the gingival connective tissue through a photothermal process. We found a significant difference between the structures of collagen fibers at the first week and at 14 days post treatment. In the normal gingiva the predominant polarization colors were in the red-orange range, signifying tightly packed, mature collagen. During the first postoperative week, collagen fibers exhibit mainly polarization colors in the green to green-yellow range implying less packed intermediate collagen fibers. After two weeks, collagen fibers required their preoperative polarizing texture. These findings strongly suggest that the 'quality' rather than the quantity of gingival collagen fibers play an important role in order for collagen shrinkage and reproduction to occur.
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The field of dental implantology has expanded treatment options available to patients with incomplete dentitions. With the use of regenerative techniques and periodontal plastic surgery procedures, the periodontium and its surrounding... more
The field of dental implantology has expanded treatment options available to patients with incomplete dentitions. With the use of regenerative techniques and periodontal plastic surgery procedures, the periodontium and its surrounding tissues can be modified in an attempt to re-create normal function and esthetics. This article describes a combination of surgical procedures, including the placement of endosseous dental implants, guided tissue regeneration, and periodontal plastic surgery, used to restore function and esthetics in the maxillary anterior region.
Research Interests: Dentistry, Biomedical Engineering, Humans, Female, Male, and 5 moreMaxilla, Middle Aged, Adult, Incisor, and Dental Esthetics
Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of... more
Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of hindering oral hygiene. Two clinical cases are reported in which gingival overgrowths were removed by excisional biopsy, resulting in unsightly defects. The first clinical case presents an invasive approach for the treatment of a recurrent pyogenic granuloma in the anterior maxilla, and the second depicts a complete removal of a peripheral odontogenic fibroma in the posterior maxilla. In both situations, the soft-tissue defects were repaired by periodontal plastic surgery, including a laterally positioned flap and a coronally positioned flap, respectively. Periodontal plastic surgery successfully restored the defects that resulted from biopsies, and no recurrence has been noticed in the 5-year postoperative follow-up period. The combination of biopsy and periodontal plastic surgery in a one-step procedure seems to be suitable to remove gingival overgrowths in most areas of the mouth, regardless of esthetic significance. Such procedures seem to restore gingival health, encourage healing, and create both esthetics and function in the excised area.
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ABSTRACT Periodontal plastic procedures are performed to prevent or correct anatomical, developmental, traumatic, or plaque induced defects of the gingiva, alveolar mucosa, or bone. The majority of these procedures are performed in... more
ABSTRACT Periodontal plastic procedures are performed to prevent or correct anatomical, developmental, traumatic, or plaque induced defects of the gingiva, alveolar mucosa, or bone. The majority of these procedures are performed in combination with restorative and/or orthodontic therapy with the primary goal of enhancing aesthetics. In this review some of the more prominent techniques currently available to address mucogingival deficiencies including pedicle grafts, free soft tissue grafts, and combination grafts are illustrated. In addition, potential complications associated with periodontal plastic procedures are discussed.
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Mucogingival surgery currently encompasses surgical management of many defects thought to be untreatable when the term mucogingival surgery was introduced in the 1950s. Mucogingival surgery has now expanded beyond the treatment of... more
Mucogingival surgery currently encompasses surgical management of many defects thought to be untreatable when the term mucogingival surgery was introduced in the 1950s. Mucogingival surgery has now expanded beyond the treatment of recession and problems associated with attached gingiva. Additionally, it would now include correction of ridge form, exposing unerupted teeth for orthodontic treatment, crown lengthening for esthetic purposes, and frenal surgery. With this in mind, mucogingival surgery has been redefined as "periodontal plastic surgery."
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Epidermolysis bullosa (EB) is a group of genetic disorders in which patients frequently present with fragile skin and mucosal surfaces that blister following minor trauma; 23 subtypes have been recognized, but their precise pathogenesis... more
Epidermolysis bullosa (EB) is a group of genetic disorders in which patients frequently present with fragile skin and mucosal surfaces that blister following minor trauma; 23 subtypes have been recognized, but their precise pathogenesis and etiology remain ...
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The aim of this study is to evaluate gingival collagen for the effect of treatment with the Erbium:YAG Kesler handpiece. The handpiece is designed for gingival resurfacing in cases of hypertrophic gingiva and gingival pigmentation. Lasers... more
The aim of this study is to evaluate gingival collagen for the effect of treatment with the Erbium:YAG Kesler handpiece. The handpiece is designed for gingival resurfacing in cases of hypertrophic gingiva and gingival pigmentation. Lasers represent recent technological advances that afford new options for the treatment of periodontal diseases. However, lasers used for esthetic gingival soft tissue resurfacing require careful histopathological evaluation of the effects on tissue. In particular, it is important to determine the effect of laser irradiation on connective tissue, especially the collagen fibers. To date, no stage-wise clinical or histological studies have been performed addressing this issue. Ten patients underwent irradiation with the following parameters: energy per pulse, 500 mJ; repetition rate, 10 pps; spot size, 3 mm. Gingival biopsy specimens were derived from 6 patients with hypertrophic gingiva and 4 with gingival pigmentation. The patients were examined before laser treatment and at 7 and 14 days after laser treatment. The tissues were fixed in tymph node revealing solution (LNRS), embedded in paraffin, sectioned at 5 microm, and stained with hematoxylin & eosin. The status of collagen in the treatment site was examined under polarized light after picrosirius red (PSR) staining. PSR is a collagen stain that differentiates collagen fiber density or size by means of a spectrum of color changes under polarized light. The major colors are red, orange, yellow, and green. We found a significant difference in the properties of collagen fibers at the first week and at 14 days post-treatment. In the normal gingiva, the predominant polarization colors were in the red-orange range, signifying tightly packed, mature collagen. During the first postoperative week, collagen fibers exhibited polarization colors in the green to green-yellow range, implying loosely packed collagen fibers. After 2 weeks, collagen fibers reacquired their preoperative PSR characteristics. We conclude that sequential series of changes accompany photothermal treatment of the gingiva. The occurrence of this sequence in all successful outcome cases may suggest the importance of these temporally sequenced changes in collagen during gum healing. In any event, the status of PSR staining of gum collagen provides a useful adjunct in the assessment of gingival health.
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Most periodontal esthetic procedures can be grouped into one of the following areas: crown lengthening, alveolar ridge preservation/augmentation, soft tissue grafts, and the correction of an open interproximal space. Soft tissue... more
Most periodontal esthetic procedures can be grouped into one of the following areas: crown lengthening, alveolar ridge preservation/augmentation, soft tissue grafts, and the correction of an open interproximal space. Soft tissue abnormalities, with the exception of the loss of the interproximal papilla, can be resolved predictably, improving esthetics and even creating restorative opportunities. In addition to a discussion of the pretreatment esthetic evaluation, an overview of periodontal plastic surgery procedures is presented, along with an example of the "Periodontal Enhancement Prescription," which facilitates communication between offices.
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Background: The evidence for the efficacy of periodontal plastic surgery (PPS) in the treatment of recession defects has not yet been systematically evaluated. The objective of this review was to systematically review the efficacy of PPS... more
Background: The evidence for the efficacy of periodontal plastic surgery (PPS) in the treatment of recession defects has not yet been systematically evaluated. The objective of this review was to systematically review the efficacy of PPS in achieving root coverage in the treatment of localized gingival recession. The following surgical procedures have been considered in this review: guided tissue regeneration (GTR), free gingival graft (FGG), connective tissue graft (CTG), and coronally advanced flap (CAF).Methods: Randomized and controlled trials, as well as case series of at least 6 months' follow-up, were searched. Data sources included electronic databases and hand-searched journals. Screening, data abstraction and quality assessment were conducted independently and in duplicate.Results: Regarding recession reduction, a limited but statistically significant greater benefit was found for CTG compared with GTR (weighted mean difference: 0.43 mm, 95% CI: 0.62–0.23). No differences were found comparing either GTR with CAF or resorbable versus non-resorbable GTR barriers. Gain in attachment was also similar for each of the three comparisons. Analysis of single arms of trials and case series demonstrated that PPS can have a marked improvement on clinical parameters but heterogeneity was often high and only partly explained by initial defect depth.Conclusions: Overall, PPS was effective in reducing gingival recessions with a concomitant improvement in attachment levels. Even though no single treatment can be considered superior to all the others, CTG was statistically significantly more effective than GTR in recession reduction. Further research is needed to identify the factors most associated with successful outcomes.