Speculations on periodontal attachment loss

Evaluation of gingival fiber retention technique on the treatment of patients with chronic periodontitis: A comparative study

The destructive action of the chronic periodontitis on the periodontal tissues has provided a continuous challenge to the dental profession to develop better methods to achieve repair of the recession regions and even regeneration of post periodontal tissues.

AIMS

To assess the effect of periodontal muco-periostal flap surgery with gingival fiber retention technique on minimizing the post surgical recession.

MATERIALS AND METHODS

The sample for the study comprised of 20 patients. The criteria for selection included patients with moderate periodontitis, with minimum recession in the anterior teeth, with adequate width of the attached gingiva, and with no traumatic occlusion. Periodontal muco-periosteal flap surgery with gingival fiber retention technique was done in the experimental site with internal bevel incision, and in control site, muco periosteal flap surgery with crevicular incision was done. Thereafter, observation period was of one week, four weeks, and eight weeks were done for both the sites.

STATISTICAL ANALYSIS USED

The results were subjected to statistical analysis using student's t'-test.

RESULTS

The result of this study suggests that the periodontal flap surgery with gingival fiber retention technique has a beneficial effect on the anterior teeth, as it maintains the esthetics, recontours the gingiva with minimal recession. The area of recession was more on the control site as compared to experimental site at 4 weeks, 8 weeks and 12 weeks.

CONCLUSIONS

Gingival fiber retention technique showed less post-surgical recession and also there was fall in values of plaque index, gingival index, and periodontal index scores, throughout the study.

Formation of mucogingival defects associated with intraoral and perioral piercing: case reports

BACKGROUND

The authors provide clinical findings in five patients wearing oral jewelry to illustrate the risks of experiencing periodontal injury associated with body piercing involving intraoral and perioral sites. They also present a literature review of other adverse dental and medical consequences attributed to oral piercing.

CASE DESCRIPTIONS

Five young adult patients with tongue and lip piercing sought dental care. Each patient exhibited some degree of gingival recession and mucogingival defects in proximity of their oral jewelry. Three of these patients had probing depths ranging from 5 to 8 millimeters in the affected areas.

CLINICAL IMPLICATIONS

Intraoral and perioral jewelry may be associated with the development of significant mucogingival deformities. Because severe attachment loss can develop even when gingival recession is minimal, it is critical that patients with oral piercing routinely undergo comprehensive periodontal assessment. The authors urge clinicians to educate patients about the potential risks regarding the practice of oral piercing.

Age-related development of the long-junctional epithelium in the senescence-accelerated mouse

The mesial gingiva of the maxillary first molar of SAM-R/1/Iw (senescence-accelerated mouse, resistant/1/Iwate) and the P/2/Iw (prone/2/Iwate) were studied morphologically by quantitative and qualitative methods as a function of age (one-, two-, six-, 12-, and 16-month-old). In this region, neither plaque nor periodontitis has been found (Sashima et al., 1990a). Statistical analyses of the gingival tissues in this region in both strains showed that, with age, the length of the junctional epithelium (JED) increased, the depth of the gingival sulcus (GSD) did not change, and the height of the gingival crest (GCD) decreased. Therefore, long-junctional epithelium developed, and gingival recession occurred, since a periodontal pocket did not develop with age in either strain. In particular, there was a strong correlation between the JED and age in both strains (r = 0.84, p less than 0.05 for the R/1/Iw, and r = 0.92, p less than 0.05 for the P/2/Iw). The JED, GSD, and GCD of the P/2/Iw were higher than each of those in the R/1/Iw after six months of age; however, there were no significant differences between the R/1/Iw and the P/2/Iw for any age group (one-, two-, six-, 12-, and 16-month-old).

Some predictors of radiographic alveolar bone height reduction over 6 years

The present study was undertaken to 1) develop a model to predict the proportion of sites with alveolar bone height reduction over 6 years by means of a few factors, 2) build a second model to predict the initial values of the dependent variable, and 3) describe the relationship between initial bone loss and the bone loss over 6 yr with age. 142 subjects (18-67 yr) were examined radiographically at baseline and 6 yr later using a standardized method. For each subject, the proportion of sites depicting significant alveolar bone height reduction during the study was assessed. Explanatory variables were: presence of initial bone loss, local plaque retaining factors, age, sex, number of missing teeth at baseline and rheumatoid arthritis. Employing multiple regression analysis, the combined effect of initial bone loss, plaque retaining factors, age and rheumatoid arthritis provided the best model suited to predict the proportion of sites undergoing bone loss over time. However, age, plaque retaining factors and number of missing teeth were the best predictors of initial bone loss. A logistic regression model was then used to study the significance of these predictors at the site level. This model indicated that alveolar bone loss over time at a given site is related mainly to presence of local factors and initial bone loss at that site as compared to the effect of other sites with local factors and initial bone loss in the subject. Age demonstrated a linear relationship with initial bone loss and a curvilinear relationship to periodontal disease progression.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal probe use in general practice in Florida

Use of the periodontal probe in 134 Florida dental practices was studied. Results indicated that 62% of the practices performed a complete recorded periodontal probing for new patients. Recall patients received a complete recorded periodontal probing in 57% of the practices at a mean frequency of 12.7 months. Selected site probing was performed in 22% of the offices as part of the new patient examination, and in 34% of the offices as part of the recall examination. In the examinations in 57% of the practices, changes in pocket depths were detected that could suggest changes in connective tissue levels.

Relative stability of deep- versus shallow-side bone levels in angular proximal infrabony defects

The relative changes with time, in the position of the coronal margin of the mesial and distal bone of proximal, angular infrabony defects, were investigated. Tracings of the radiographs of 51 mandibular posterior sites, treated by flap curettage, with a mean post-surgical duration of 11.8 years, were measured using a digitizer pad. The group consisting of shallow-side sites (N = 51), exhibited no significant change in the bone height with time; however, there was a significant decrease in bone height in the deep-side group (N = 51). The mean area of proximal bone decreased significantly with time. The defects were divided into early (N = 25) and advanced (N = 26) angular groups, and then into deep- and shallow-side subgroups. In the early defect group, there was a significant decrease in the mean bone height of the deep-side subgroup. There were no differences in the changes of mean bone level of the remaining 3 subgroups with time. There was no correlation between changes in bone levels of adjacent mesial and distal sides of angular defects with time (r = 0.27). There was no difference between the deep- and shallow-side groups in the number of sites which gained, lost or evidenced no change in bone height. In the study population, the bone height of 73% of the deep-side, and 84% of the shallow-side sites was either unchanged or in a more coronal position.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodic subgingival antimicrobial irrigation of periodontal pockets. II. Microbiological and radiographical observations

The purpose of this study was to evaluate the microbiological effects of repeated subgingival irrigation of deep periodontal pockets as a single measure of treatment as well as combined with mechanical debridement, and to study the concomitant radiographical changes of the alveolar bone. 2-3 interproximal sites per jaw quadrant in 10 patients showing a probing depth of greater than or equal to 6 mm and bleeding on pocket probing were selected for the study. The pockets in the various quadrants were randomly assigned to professionally performed subgingival irrigation with 0.2% chlorhexidine gluconate, 3% hydrogen peroxide or saline or to non-irrigation. During a first phase of treatment, the pockets were periodically irrigated (every 2nd-3rd day during weeks 1-2 and 5-6) and no subgingival mechanical debridement was performed. During a second phase, subgingival scaling and root planning were carried out with adjunctive subgingival irrigation of the pockets. During the entire trial, the patients' plaque control was carefully supervised. Sampling of the subgingival microflora was performed before and after the first and second treatment phases and 3 months after the termination of the active treatment. Dark-field assessment and cultivation of the bacterial samples were performed. The radiographical examination was carried out at the start of each treatment phase and 3 months after the termination of phase II and the radiographs were analysed by the use of a subtraction technique. The results demonstrated that periodic subgingival antimicrobial irrigation per se had only limited and transient effects on the subgingival microflora.(ABSTRACT TRUNCATED AT 250 WORDS)

Restorative margins and periodontal health: a new look at an old perspective

The indiscriminate placement of the margins of dental restorations into the gingival crevice for the purpose of esthetics or protection from decay can no longer be considered good practice. The junctional epithelium and the supracrestal fibers, together, have been called the biologic width, which is considered to have a length of 2 mm. A more accurate term for the biologic width, one that expresses the function and diversity of the component tissues while avoiding reference to dimension, is the "subcrevicular attachment complex." The most accurate anatomic structure from which to take measurements for margin placement is the healthy, stable gingival margin. It is clinically visible, unlike the biologic width, and should replace the latter as the landmark of choice for placing dental margins. Surgical crown lengthening will be necessary when restorations will end at or below the alveolar crest.