Effect of retention of gingival sulcular epithelium on attachment and pocket depth after periodontal surgery

Periodontal response to mechanical non-surgical therapy: a review

This literature review is concerned with the ability of personal oral hygiene and mechanical instrumentation to establish and maintain periodontal health. Clinical, microbiologic, and histologic responses to non-surgical therapy are evaluated to provide guidelines for expected treatment results. Factors that may limit the effectiveness of non-surgical therapy as a closed procedure are also addressed. These include length of therapy, skill of therapists, patient compliance, responsibility of clinician for maintenance, and disease activity status of the patient.

Formation of interdental soft tissue defects after surgical treatment of periodontitis

This study monitored the development and repair of interdental soft tissue defects following surgical treatment of periodontitis in 21 patients. Open flap curettage was performed at 100 interdental areas with follow-up examinations 1, 3, and 6 months later. Interdental gingival contours were assessed both clinically and indirectly with silicone elastomer impressions from which stone models were obtained; defect depths were then calculated using the Reflex Microscope. Two types of defect were identified at the 1-month follow-up: 13 interdental clefts (mean depth, 1.8 mm); and 30 craters, (mean depth, 1.6 mm). Although clefts tended to persist, craters showed a strong tendency to repair. Thus, at the 6-month follow-up, the depths of clefts and craters were 1.3 mm and 0.7 mm respectively. The development of soft tissue defects did not appear to be related to the use of a periodontal dressing nor did the existence of an underlying bone defect appear to be of etiological importance. Pre-operative probing depths, however, were positively associated with the occurrence of soft tissue craters (P = 0.02). Pre-operatively, the overall mean probing depth and frequency of bleeding on probing were 5.3 mm and 100% respectively. At 6 months, these values were reduced to 2.0 mm and 22%. When clefts, craters, and interdental areas with no soft tissue defect were compared, no significant differences in probing depth reduction or frequency of bleeding were observed at any time point.(ABSTRACT TRUNCATED AT 250 WORDS)

Fate of pocket epithelium in an apically positioned flap

The fate of periodontal pocket epithelium when sulcular incisions are used in apically positioned flap surgery was investigated by serial histology. Human subjects received apically positioned flap segments on the facial aspect of anterior teeth timed to give 1, 3, 5, 7, 21 and 35 days of healing on the day of extraction. Companion surgeries for comparison consisted of similar flaps, but utilized an inverse bevel primary incision. Assessment of the sulcular incision specimens revealed that epithelial degeneration and dissolution occurred within 7 days and resulted in a collagen-to-collagen attachment of the periodontal flap to the alveolar bone. The inverse bevel incision was consistently effective in removing the pocket epithelium and resulted in healing by a connective tissue union of the flap to the alveolar bone. By 21 days of healing, the 2 surgical methods were indistinguishable histologically. On the basis of this investigation, it is suggested that the inverse bevel primary incision traditionally advocated for apically positioned flap surgeries may be replaced by the more rapid and simple sulcular incision as the preferred technique.

Elimination of epithelium from healing postsurgical periodontal wounds by ultra-low temperature. Initial observations

Prevention of epithelial migration into healing postsurgical periodontal wounds may enhance connective tissue attachment. This study attempted to destroy selectively epithelium on gingival flap surfaces by ultra-low temperature. Sixteen sites in four young adult cats received subcrestal reverse bevel incisions followed by sulcular incisions. Full thickness periodontal flaps were reflected, the remaining supracrestal soft tissue surrounding the teeth was removed, and exposed root surfaces were curetted. Narrow zones measuring about 4 mm along the coronal margins of the flaps were exposed to ultra-low temperature for 5 seconds using a gas expansion cryoprobe cooled to -81 degrees C and placed at the oral gingival aspects of the flaps. Flaps were then repositioned and sutured. Control sites were sham-operated with the cryoprobe kept at room temperature (25 degrees C). Gingival biopsies were taken at 1 hour and at 2, 4, 8 and 12 days following surgery. Microscopically, 1-hour postfreezing and control specimens appeared similar. At 2 and 4 days, large surface areas of corium were denuded of epithelium or were covered by necrotic debris. Mild inflammatory responses were noted within the corium. At 8 days, the epithelium almost completely covered the corium with some initial formation of crevicular epithelium. After 12 days, crevicular epithelium was observed in all tissue sections. No significant morphologic damage to the connective tissue was noted at any time. We, therefore, concluded that low cryodoses can effectively destroy oral gingival epithelium without causing significant morphologic damage to the underlying lamina propria at this level of observation.