Traumatic Lesions of the Gingiva: A Case Series

Efficacy of buccal pad fat as a new approach in the treatment of gingival recession: a systematic review

OBJECTIVE

This systematic review evaluates the efficacy of buccal pad fat (BPF) as an autologous graft in the treatment of gingival recession (GR). Thus, the research question explores if the BPF can serve as a viable alternative to the gold standard connective tissue graft.

MATERIALS AND METHODS

Only seven studies met the inclusion criteria were critically appraised including the randomized controlled clinical trials, and case series. The inclusion criteria were systemically healthy individuals in the age range (18-65 years old) with Miller's classification of GR either class I, II, III, or IV while exclusion criteria were patients with poor oral hygiene, pregnant and lactating patients, teeth with caries, any prior surgery in the relevant regions, and use of medications.

RESULTS

The review included 117 patients with 136 GR defects. The age of participants ranges from 20 to 65 years old with the higher percentage of root coverage (%RC) at 6 months in the pedicled BPF group which was 89.30%while the lowest (%RC) at 6 months in the same group was 46.78%. The BPF group's width of keratinized gingiva (WKG) values indicate a notable improvement, suggesting a positive impact on WKG compared to the control group.

CONCLUSIONS

BPF can be considered as a promising graft to augment gingival tissues at different sites in the oral cavity with different Miller's classes of GR providing a new era in GR treatment.

Malocclusion in cats associated with mandibular soft tissue trauma: a retrospective case-control study

OBJECTIVES

The aim of this study was to determine whether an association existed between cephalometric measurements, maxillomandibular dental arch distances and the occurrence of traumatic malocclusions in the mandibular soft tissues of cats.

METHODS

Cats that had presented for dental consultations and that underwent cone-beam CT during diagnostic assessment were included in the study and categorised as cases and controls in a 1:2 ratio. Cases were designated as cats with a clinical diagnosis of malocclusion causing trauma to the buccal mandibular soft tissues or pyogenic granuloma secondary to the trauma, and controls were designated as cats with the absence of such diagnoses and without a history of other musculoskeletal anomalies in the head. Cephalometric measurements, including skull and facial indexes, as well as distances and angulations between dental crowns and crown tips, were calculated and analysed statistically.

RESULTS

In total, 72 cats (24 cases and 48 controls) were included in the study. Cephalometric measurements revealed a significant association between the skull and facial indexes and the occurrence of traumatic malocclusions in the caudal teeth. Brachycephaly was a strong predictor of the occurrence of traumatic malocclusions. In addition, the space between crown tips and teeth angulations was a contributing factor to the trauma.

CONCLUSIONS AND RELEVANCE

Cats with traumatic malocclusions in the cheek teeth tend to present a narrower interdental space between the maxillary and mandibular carnassial teeth, mostly attributed to skeletal and dental malocclusion. These findings can be used to help raise awareness about this disease in cats and its association with brachycephaly. Cut-off values have been proposed and could be used in the selection of cats by breeders to reduce the occurrence of this disease.

Complications and treatment errors in nonsurgical periodontal therapy

Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.

Management of iatrogenic chloroform mucosal burn in the palate: a case report

Chloroform is used widely in endodontic treatments for solving gutta-percha points, but it can have destructive effects if it comes in to contact with oral mucosa. This article presents a case of necrotic ulcer of palatal and buccal mucosa due to injudicious use of chloroform in endodontic treatment, which has caused severe destruction in maxilla. A conservative treatment method of repeated curettage and irrigation was used and although the lesion healed completely, it had major effects on the patient’s quality of life including loss of two teeth. It is important that dentist be aware of the devastating effects of imprudent application of various chemicals used in dentistry. The conservative treatment used for this case can be helpful option for similar cases.

A study to evaluate the prevalence of teeth without clinically detectable mucogingival junction

Context:

The mucogingival junction (MGJ) is one of the important anatomical entities which mark the apical termination of attached gingiva, except that at palatal side. Its position is genetically determined like other organs and tissues in our body. There are certain anatomic aberrations such as abnormal teeth eruption or high frenal attachments and pathologies, such as periodontitis, leading to its absence. There are no studies on the prevalence of teeth having no clinically detectable MGJ. There is a resurgence of importance of attached gingiva, reflected by the definite presence of MGJ, through the field of dental implantology.

Aims:

We aim to evaluate the prevalence of teeth without clinically detectable MGJ on the buccal aspect of dentate alveolar processes.

Settings and Design:

This cross-sectional observational clinical study was conducted in the department of periodontology which was approved by the institutional ethical committee.

Materials and Methods:

Periodontally healthy as well as diseased patients of age 18–50 years were included in the study. The detection of MGJ was carried out by visual method, tension test, rolling probe method, and Lugol's iodine solution, and confirmation from any two methods was considered for the absence of MGJ. The etiology of MGJ absence (gingival recession, pocket till MGJ, trauma, abnormal frenal attachment, malposition of tooth, abnormal habits, severe abrasion, etc.,) was also evaluated.

Statistical Analysis Used:

Simple statistics in the form of averages and percentages were used for calculations.

Results:

A total of 130 subjects (3637 teeth) were examined out of which 32 (24.6%) subjects showed no clinically detectable MGJ. In all subjects, on an average, every subject has 28 teeth and out of the total 3637 teeth analyzed, only 91 (2.5%) teeth were without detectable MGJ.

Conclusion:

Almost 25% of the population may show a tooth or few teeth without a clinically detectable MGJ. The prevalence of teeth without clinically detectable MGJ per mouth is very low at 0.7 (approximately 1 tooth/subject).

Histopathologic Spectrum of Intraoral Irritant and Contact Hypersensitivity Reactions: A Series of 12 cases

BACKGROUND

Irritant contact stomatitis (ICS) and contact hypersensitivity stomatitis (CHS) are often caused by alcohol, flavoring agents and additives in dentifrices and foods, and contactants with high or low pH. A well-recognized contactant for ICS is Listerine™ mouthwash, while that for CHS is cinnamic aldehyde. However, many other flavoring agents and even smokeless tobacco are contactants that cause mucosal lesions that are entirely reversible. The objective of this study is to 1) present cases of ICS and CHS with a clear history of a contactant at the site and the histopathologic features of the resulting lesion and 2) define the histopathologic features that characterize such lesions.

METHODS

12 cases of ICS and CHS with known contactants that exhibited distinct histopathologic patterns were identified.

RESULTS

ICS are characterized by three patterns in increasing order of severity namely: 1) superficial desquamation, 2) superficial keratinocyte edema, and 3) keratinocyte coagulative necrosis with/out spongiosis and microabscesses. CHS is characterized by two patterns namely plasma cell stomatitis with an intense plasma cell infiltrate and a lymphohistiocytic infiltrate with or without non-necrotizing granulomatous inflammation. Three patterns of the latter are recognized: (1) lymphohistiocytic infiltrate at the interface with well-formed or loosely aggregated non-necrotizing granulomas; (2) lymphohistiocytic infiltrate at the interface with peri- and para-vascular lymphohistiocytic nodules; and (3) lymphohistiocytic infiltrate at the interface with peri- and para-vascular lymphohistiocytic nodules containing non-necrotizing granulomas. The same contactant may elicit ICS and CHS, while one histopathologic pattern may be brought on by various contactants.

CONCLUSION

ICS and CHS have distinct histologic patterns. Recognizing that these patterns are caused by contactants would help clinicians manage such mucosal lesions.

Iatrogenic acid-induced gingival recession during crown cementation: A case report

Accidental contact of various chemicals in dentistry may cause damage to the gingiva. A male patient presented for a full mouth rehabilitation with ceramic crowns. The patient underwent the steps of ceramic crown preparation uneventfully. At the time of crown delivery, cotton rolls were placed in several vestibular areas for isolation. They were regularly changed during different steps of etching and cementation process, which included the use of Multilink Primer B (Ivoclar Vivadent™). On removal of the cotton roll in the area of upper right canine, the gingival tissues appeared blanched and grayish white. The cotton roll was found to have absorbed some etching material in it. As the patient was asymptomatic, he was dismissed. Two weeks later, the patient presented with inflammation and gingival recession in the same area. Initially, he was treated palliatively, and subsequently, he received a connective tissue graft on the upper right canine. This case report showed that acid etching material used during the prosthodontic cementation may have caused a gingival recession, which was successfully treated with tunnel flap and connective tissue graft. Optimal isolation of the operative field should be performed to avoid this problem.

Evaluation of the Effectiveness of the Use of the Diode Laser in the Reduction of the Volume of the Edematous Gingival Tissue after Causal Therapy

AIM

The aim of this study was to evaluate and compare two different techniques for the treatment of plaque-induced gingivitis, demonstrating whether the causal therapy supported by diode laser can allow a resolution of the edema caused by gingivitis in less time compared to the single traditional causal therapy.

MATERIALS AND METHODS

Twenty-five patients between 20 and 60 years of age with a specific diagnosis of gingivitis were evaluated at the CLID-HSR oral hygiene department. Once the clinical parameters (bleeding index, plaque index, recession, and clinical attack level) were recorded, each of them was subjected to a professional oral hygiene session and instructed in correct home hygiene procedures. Through a split-mouth protocol for each individual patient, hemi-arches were treated by simple randomization to be treated with causal therapy supported by the action of the diode laser (experimental therapy) and which with traditional causal therapy (control therapy). A first intraoral scan was performed before therapy (T0), which was repeated 20 min after rinsing with CHX. The intraoral scans were repeated at a control 7 (T1) and 14 days (T2) after the session. For each intraoral scan, a volumetric value was calculated, proportional to the edema of the gingival tissues, using special digital software. The operator who carried out the volumetric measurements on the software was not aware of the therapy implemented on each half-arch. The operator who carried out the statistical analysis was not aware of the therapy applied to each group. The collected data were statistically compared in order to detect any differences between the volumetric variations between the two therapy groups and within the therapy groups over time. After evaluating the distribution of data by means of the Kolmogorov-Smirnov statistical test, the appropriate nonparametric tests were chosen to carry out the statistical comparisons.

RESULTS

Based on the analysis of the gingival-periodontal health parameters and the volumetric value of the treated areas, no statistically significant differences were detected between the areas treated with the adjuvant action of the diode laser compared to those treated with causal therapy alone.

CONCLUSIONS

With the limitations of this study, in accordance with the statistical results obtained, diode laser therapy does not allow a faster resolution of gingival edema compared to traditional therapy; the two treatment techniques for plaque-induced gingivitis, therefore, have the same efficacy.

Soft-Tissue Grafting Solutions

Many soft-tissue grafting solutions are available for reconstruction and restoration of volume and esthetics of keratinized attached mucosa at compromised periodontal and peri-implant interfaces. Presence of healthy soft tissues is crucial for functional and esthetic implant success as well as longevity of natural dentition. The options available each provide unique characteristics with different indications. This article is intended to provide an efficient and comprehensive overview of this topic, covering the essentials of periodontal anatomy and physiology, indications for soft-tissue grafting, and keys in recipient and donor-site preparation, and exploring the available procedural arsenal in soft-tissue grafting.

Systemic disease or periodontal disease? Distinguishing causes of gingival inflammation: a guide for dental practitioners. Part 2: cancer related, infective, and other causes of gingival pathology

Periodontitis and gingivitis are highly prevalent inflammatory diseases of the oral cavity, and typically are characterised by the presence of dental plaque. However, other causes of oral inflammation exist, which can resemble plaque-induced gingivitis and periodontitis, and may thus first be seen by a dental practitioner. This paper aims to provide dentists with an understanding of the manifestations of systemic diseases to the periodontium and highlights anamnestic and clinical clues important for distinguishing between plaque-induced and non plaque-induced lesions. In the first part of this series immune-mediated and hereditary conditions as causes of gingival lesions were discussed; this second part highlights cancer-related gingival lesions as well as those caused by specific pathogens, medication or malnutrition. A clear clinical, epidemiological and visual overview of the different conditions is provided. Early diagnosis of non plaque-related causes of gingival lesions can be vital for affected patients. Therefore, dental practitioners should be aware of the various manifestations of systemic diseases to the periodontium.

A 3-year prospective clinical and patient-centered trial on subepithelial connective tissue graft with or without enamel matrix derivative in Class I-II Miller recessions

BACKGROUND AND OBJECTIVE

The study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of Class I-II Miller periodontal recession defects.

MATERIAL AND METHODS

This prospective clinical study evaluated 80 patients over a 3 years follow-up in a private periodontal practice. A total of 144 maxillary and mandibular anterior teeth were divided into two groups: group 1 (CTG with EMD-80 teeth) and group 2 (CTG only-64 teeth). Recession (REC), keratinized tissue (KT) width, % root overage, patient-centered outcomes, and pain visual analog scale (P-VAS) were compared between the two groups.

RESULTS

At 3 years follow-up at a patient level, statistically significant changes in REC were achieved in both group 1 (4.65 ± 1.84 to 0.39 ± 0.19 mm) and group 2 (4.43 ± 1.11 to 0.92 ± 0.43 mm). Complete root coverage (CRC) was achieved in 66.4% of group 1 and 50.1% of group 2. At both patient and tooth level, the 3-year outcomes were superior for group 1 compared with group 2 in terms of % root coverage, REC, and KT width. Clinical attachment loss (CAL) was reduced in group 1 compared with group 2 at the tooth level analysis only (<.01). Significantly less pain was reported using the pain visual analog Scale (P < .001) at the two weeks follow-up post-surgery in group 1.

CONCLUSIONS

Addition of EMD results in improved root coverage outcomes and higher amounts of keratinized tissue width 36 months after treatment of multiple adjacent recessions on maxillary and mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days after the surgery.

Non-plaque-induced gingival diseases

While plaque-induced gingivitis is one of the most common human inflammatory diseases, several non-plaque-induced gingival diseases are less common but often of major significance for patients. The non-plaque-induced gingival lesions are often manifestations of systemic conditions, but they may also represent pathologic changes limited to gingival tissues. A classification is proposed, based on the etiology of the lesions and includes: Genetic/Developmental disorders; Specific infections; Inflammatory and immune conditions and lesions; Reactive processes; Neoplasms; Endocrine, Nutritional and metabolic diseases; Traumatic lesions; and Gingival pigmentation.

Non-plaque-induced gingival diseases

While plaque-induced gingivitis is one of the most common human inflammatory diseases, several non-plaque-induced gingival diseases are less common but often of major significance for patients. The non-plaque-induced gingival lesions are often manifestations of systemic conditions, but they may also represent pathologic changes limited to gingival tissues. A classification is proposed, based on the etiology of the lesions and includes: Genetic/Developmental disorders; Specific infections; Inflammatory and immune conditions and lesions; Reactive processes; Neoplasms; Endocrine, Nutritional and metabolic diseases; Traumatic lesions; and Gingival pigmentation.

The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review

Introduction:

Orofacial pain of periodontal origin has a wide range of causes, and its high prevalence and negative effect on patients' quality of life make intervention mandatory. This review provides a periodontological overview of the field of orofacial pain, focusing on the entities which involve the periodontal tissues and may be the cause of this pain or discomfort.

Methods:

The study comprised a literature search of these pathologies conducted in the MEDLINE/PubMed Database. Acute infectious entities such as gingival and periodontal abscesses are emergencies that require a rapid response. Periodontitis associated with endodontic processes, necrotizing periodontal disorders, desquamative gingivitis, gingival recession, and mucogingival herpetic lesions, cause mild to severe pain due to tissue destruction and loss. Other lesions that lead to periodontal discomfort include gingival enlargement and periodontal ligament strains associated with occlusal trauma, parafunctional habit and the impaction of food or foreign bodies.

Conclusion:

A range of therapeutic, pharmacological and surgical alternatives are available for the management of these injuries. However, the wide variety of causes of orofacial pain or periodontal discomfort may confuse the clinician during diagnosis and may lead to the wrong choice of treatment.

Gingival recession in orthodontic patients 10 to 15 years posttreatment: A retrospective cohort study

INTRODUCTION

The aims of this study were to retrospectively investigate the long-term development of gingival recession in a cohort of orthodontic patients and to compare the prevalence of gingival recession in orthodontically treated patients 10 to 15 years posttreatment to that of untreated subjects with malocclusion.

METHODS

The sample included 88 patients with mean ages of 12.1 years (SD, 2.4 years) at pretreatment, 15.1 years (SD, 2.4 years) at posttreatment, and 27.9 years (SD, 2.5 years) 10 to 15 years posttreatment. The control group comprised 102 untreated patients seeking orthodontic treatment with a mean age of 28.7 years (SD, 3.1 years). Gingival recession was evaluated on study models.

RESULTS

The prevalence of both labial/buccal and lingual/palatal gingival recession increased during orthodontic treatment with further increases during the long-term posttreatment period; 98.9% of the orthodontically treated participants had at least 1 labial/buccal recession, and 85.2% of the patients had at least 1 lingual/palatal recession 10 to 15 years posttreatment. In addition, the proportion of patients with multiple labial/buccal or lingual/palatal recession sites increased considerably in the same time period. The prevalences of labial/buccal gingival recession were similar in the orthodontically treated patients 10 to 15 years posttreatment and the untreated controls. Study group patients with a crossbite before treatment showed 2.73 more recessions (95% CI, 0.28-5.17; P = 0.029) than did those without a transverse discrepancy. Untreated subjects with crowding greater than 3 mm per arch had 3.29 more recessions (95% CI, 0.73-5.68; P = 0.012) to 4.92 more recession sites (95% CI, 1.70-8.15; P = 0.003) than did those with mild or no crowding.

CONCLUSIONS

Within the limitations of this study, it seems that, in regard to the prevalence of gingival recession, orthodontically treated patients are not compromised in the long term compared with those with malocclusion that was untreated for many years.

Fibrotic encapsulation of orthodontic appliance in palate

Iatrogenic trauma though not serious is very common in dental practice. Orthodontic treatment can inflict such injuries as they are prolonged over a long period of time. Ill-fabricated orthodontic appliances, such as wires and brackets, or the patients' habits such as application of constant pressure over the appliance can traumatize the adjacent oral soft tissues. In rare cases, these appliances can get embedded into the mucosa and gingival tissues. This case report describes one such case of iatrogenic trauma to the palatal mucosa due to entrapment of a tongue spike appliance and its surgical management.

Non-surgical management of tooth hypersensitivity

Tooth sensitivity is a common complaint of patients in dental practices. Studies have demonstrated dentinal hypersensitivity to affect 10-30% of the population. There are various potential causes of tooth sensitivity and a variety of available treatment options. This narrative review will discuss the possible aetiology of this condition, as well as the treatment modalities available. A tailor-made treatment plan that starts with the most non-invasive treatment options and escalates only when those options have proven insufficient in alleviating symptoms should be provided for each patient. Only after all non- and less-invasive methods have failed to reduce the symptoms should more invasive treatment options, such as root-coverage, be considered.

Displacement and force distribution of splinted and tilted mandibular anterior teeth under occlusal loads: an in silico 3D finite element analysis

Background

Fixed orthodontic retainers have numerous advantages, but it is not known whether they can exert pathological forces on supporting tissues around the splinted teeth. The purpose of this study was to investigate how the inclination of the lower anterior teeth can affect dental displacement and also change the direction of occlusal loads exerted to dental and its supporting tissues.

Methods

Four three-dimensional finite element models of the anterior part of the mandible were designed. All the models contained the incisors and canines, their periodontal ligament layers (PDLs), the supporting bone (both spongy and cortical), and a pentaflex splinting wire placed in the lingual side of the teeth. Teeth inclination was considered to be 80° (model 1), 90° (model 2), 100° (model 3), and 110° (model 4) to the horizontal plane. The lower incisors were loaded with a 187-N vertical force. Their displacement patterns and the stress in their PDLs were evaluated.

Results

In incisors with 80° of inclination, less than a 0.1-mm lingual displacement was seen on the incisal edge and a similar distance of displacement towards the labial was seen on their root apices. However, in models with 90°–110° of inclination, the incisal edge displaced labially between about 0.01 and 0.45 mm, while root apices displaced lingually instead. By increasing the angle of the teeth, the strain in the periodontal ligament increased from about 37 to 58 mJ. The von Mises stresses around the cervical and apical areas differed for each tooth and each model, without a similar pattern. Increasing the angle of the teeth resulted in much higher cervical stresses in the incisors, but not in the canines. In the lateral incisor, cervical stress increased until 100° of inclination but reduced to about half by increasing the angle to 110°. Apical stress increased rather consistently in the incisor and lateral incisors, by increasing the inclination. However, in the canines, apical stress reduced to about half, from the first to fourth models.

Conclusions

Increasing the labial inclination can mostly harm the central incisors, followed by the lateral incisors. This finding warns against long durations of splinting in patients with higher and/or patients with reduced labial bone thickness.

Acute periodontal lesions

This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.

The prevalence of oral mucosal lesions in children:a single center study

PURPOSE

Studies regarding oral health are mainly conducted on adult population and there is a lack of epidemiologic data on the oral health of children. The purpose of this study was to evaluate the prevalence and distribution of oral lesions in Turkish children.

MATERIALS AND METHODS

A cross-sectional survey was carried out on total of 1041 Turkish children attended by the outpatient Oral Medicine and Surgery Department of İstanbul University.

RESULTS

Examinations were performed and 277 of whom had a total of more than 30 different type of lesions detected. The fissured tongue (3.4%) was the most frequent lesion, followed by traumatic lesions (3.2%) and the cheek biting (2.5%).

CONCLUSION

This is the first study in Turkey on oral lesions in this age group. We hope that our study will be a baseline data for future studies and for sure there is a need for more goodquality epidemiological studies in this area.

Evaluation of premalignant and malignant lesions by fluorescent light (VELscope)

Aim:

The purpose of this study was the early detection of premalignant and malignant oral soft lesions by fluorescent light (VELscope).

Materials and Methods:

A total of 748 patients were evaluated through clinical and fluorescent light analysis of the entire oral cavity. Any lesion that was detected underwent a surgical excision biopsy as the golden standard for the detection of the lesion's histology; then a comparison was made between the results to assure the efficacy of the fluorescent light analysis outcome.

Results:

About 9.4% of the lesions detected were abnormal lesions and 83.09% had loss of fluorescent light effect. Based on the use of surgical biopsy, the machine had a sensitivity of 74.1% and a specificity of 96.3%. According to the statistical analysis, the P value was much lower than 0.05, so we can conclude that at 95% confidence level, there was significant agreement between VELscope results and biopsy results. Kappa coefficient value was approximately 0.5, which means that the strength of the agreement was medium.

Conclusion:

VELscope can be used as a clinical diagnostic aid in the detection of premalignant and malignant lesions of the oral cavity. In addition, it helps in the detection of the borders in both surgical biopsy and surgical excision.

Rebuilding Anterior Dental Esthetics: Interdisciplinary Treatment of an Iatrogenically Induced Marginal Tissue Recession

INTRODUCTION

Root canal perforation during endodontic therapy is one of the most commonly encountered clinical situations that necessitates interdisciplinary therapy.

CASE PRESENTATION

This case report presents the use of periodontal and prosthodontic teamwork to treat severely deteriorated anterior esthetics caused by an iatrogenically induced marginal tissue recession defect.

CONCLUSION

In the case of deterioration of anterior dental esthetics, an interdisciplinary approach can successfully restore both esthetics and function, as observed in this case report.

Iatrogenic Factors Affecting the Periodontium: An Overview

The principal reason of gingival inflammation is bacterial plaque, along with other predisposing factors. These predisposing factors are calculus, malocclusion, faulty restorations, complications associated with orthodontic therapy, self- inflicted injuries, use of tobacco & radiation therapy. The contributing factors to gingival inflammation & periodontal destruction are deficient dental restorations and prosthesis. Inadequate dental procedures that add to the weakening of the periodontal tissues are referred to as iatrogenic factors.

The consequences of tongue piercing on oral and periodontal tissues

This paper is discussing the potential consequences that may arise by the implementation of piercing in the oral cavity and is also categorizing the consequences according to their extent and severity. Furthermore, this paper is reviewing some possible oral hygiene methods that can prove to be auxiliary in decreasing the potential complications arising from oral piercing. This literature review is based on articles published from 1985 to 2012.

Indication and timing of soft tissue augmentation at maxillary and mandibular incisors in orthodontic patients. A systematic review

OBJECTIVE

To assess the indication and timing of soft tissue augmentation for prevention or treatment of gingival recession when a change in the inclination of the incisors is planned during orthodontic treatment.

MATERIALS AND METHODS

Electronic database searches of literature were performed. The following electronic databases with no restrictions were searched: MEDLINE, EMBASE, Cochrane, and CENTRAL. Two authors performed data extraction independently using data collection forms.

RESULTS

No randomized controlled trial was identified. Two studies of low-to-moderate level of evidence were included: one of prospective and retrospective data collection and one retrospective study. Both implemented a periodontal intervention before orthodontics. Thus, best timing of soft tissue augmentation could not be assessed. The limited available data from these studies appear to suggest that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontics may yield satisfactory results with respect to the development or progression of gingival recessions. However, the strength of the available evidence is not adequate in order to change or suggest a possible treatment approach in the daily practice based on solid scientific evidence.

CONCLUSIONS

Despite the clinical experience that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontic treatment may be a clinically viable treatment option in patients considered at risk, this treatment approach is not based on solid scientific evidence. Moreover, the present data do not allow to draw conclusions on the best timing of soft tissue augmentation when a change in the inclination of the incisors is planned during orthodontic treatment and thus, there is a stringent need for randomized controlled trials to clarify these open issues.

"Tetracycline hydrochloride chemical burn" as self-inflicted mucogingival injury: A rare case report

Injuries to oral soft tissue can be accidental, iatrogenic, and factitious trauma. Chemical, thermal, and physical agents are the main causative agents for oral soft-tissue burns. The present case describes the chemical burn of oral mucosa caused by tetracycline hydrochloride and its management. Diagnosis was made on the basis of definitive history elicited from the patient. The early detection of the lesion by the patient and immediate institution of therapeutic measures ensure a rapid cure and possible prevention of further mucogingival damage. In addition, we believe that proper guidance and education of the patient is an important prophylactic measure in preventing this self-inflicting injury.

Retrospective investigation of gingival invaginations: Part II: microbiological findings and genetic risk profile

BACKGROUND AND OBJECTIVE

Gingival invaginations are a frequent finding during tooth extraction and following orthodontic space closure. Based on the interdental localization and sometimes pronounced depth, it has been suggested that a gingival invagination may impede oral hygiene. In Part I of this series, the time until active tooth movement and the localization of extraction were identified as potential risk factors for the development of gingival invagination. The aims of the present study were the analysis of the microbial spectrum of a gingival invagination in comparison with pool samples of the sulcus of Ramfjord teeth, on the one hand, and the importance of genetic variations of the pro-inflammatory mediator interleukin-1 (IL-1) and its receptor antagonist (IL-1-RN), on the other hand. In addition, a possible role of smoking as a risk factor was evaluated.

SUBJECTS AND METHODS

A total of 30 patients with (n=16) and without (n=14) gingival invagination were examined for the presence of eleven periodontal pathogen bacterial species with a commercially available test (micro-IDent®Plus, Hain Lifescience, Nehren, Germany). The genetic evaluation was performed with the GenoType® IL-1 test (Hain Lifescience).

RESULTS

The results of the microbiological analysis of gingival invaginations showed that the bacterial flora might differ or even be higher than the pool sample from sulcus regions. The genetic evaluation demonstrated that in the group without gingival invagination only 14% showed an IL-1 polymorphism, whereas this value was twice as high (35%) in the group with gingival invagination. In addition, a combination of both polymorphisms IL-1 and IL-1-RN was only found in patients with gingival invagination (25%). Interestingly, smoking patients showed a significant increase of the severity of the gingival invagination.

CONCLUSION

This retrospective study demonstrated that gingival invagination might be accompanied with an altered microbiological bacterial spectrum and a genetic IL-1 polymorphism. In addition, smoking was identified as another potential risk factor for the severity of gingival invaginations.

Interfaces between orthodontic and periodontal treatment: their current status

The contextual relationships between orthodontics and periodontology are diverse and complex. While the consequences of orthodontic tooth movements are discussed in terms of possible damage and improvements in the long-term health of periodontal tissues orthodontic treatment of adults is a routine clinical procedure nowadays, even in patients presenting already-damaged periodontal tissues. As developments in both fields have been so rapid, there is a constant need for evidence-based concepts in this interdisciplinary field. The goal of this review was to discuss the latest aspects of interdisciplinary treatment and to reflect on the latest developments in research. A treatment scheme is also presented which aims to facilitate coordination of the orthodontic treatment of patients with periodontal diseases.

Severe Localized Gingival Recession Developing During Pregnancy

INTRODUCTION

Gingival recession typically develops over a long period of time. Development or progression of gingival recession in a short time and in the absence of acute trauma is exceedingly rare. The aim of this case report is to present a case of severe gingival recession developing in a systemically healthy patient during the last trimester of a routine pregnancy.

CASE PRESENTATION

A 34-year-old woman, successfully treated 3 years earlier for a localized gingival recession on tooth #24, compliant with home care and maintenance visits, discontinued maintenance during pregnancy. A localized 2-mm deep Miller Class I recession defect on tooth #26 was under follow-up and had been stable during maintenance. The patient presented at 2-months postpartum. She reported that she had noticed localized inflammation and progression of the recession on tooth #26 during the last gestational trimester; she denied any history of trauma. During examination, the recession on tooth #26 had progressed into a 6-mm deep Miller Class II defect. The defect was treated with a connective tissue graft procedure. At 14 months after surgery, the clinical outcome remained satisfactory and stable.

CONCLUSIONS

Rapid and severe localized gingival recession can occur during routine pregnancy. In light of the evidence indicating safety of routine periodontal care during pregnancy, pregnant females should be encouraged to continue their maintenance periodontal care to minimize the potential of irreversible sequelae from pregnancy-associated gingival inflammation.

Implementation and validation of an extraction course using mannequin models for undergraduate dental students

OBJECTIVE

There is a gap in the education of dental undergraduate students between theoretical knowledge and the practical procedure of tooth extraction. It was the aim of this study to implement and validate an undergraduate course for oral extraction using mannequin models, in order to enhance practical competence in this field of dentistry.

MATERIAL AND METHODS

A one-term oral extraction course was implemented as part of the oral surgery curriculum for undergraduate dental students, including 4 h of theoretical education, followed by 4 h of practical training in tooth extraction on mannequin models, with the students divided into small groups. Forty-nine students attending this extraction course were asked to validate their training in dental extraction using a questionnaire (TRIL-mod; University of Trier, Trier, Germany). The students' practical competence in oral extraction was assessed by a senior supervisor at the end of the course, using a standardized checklist.

RESULTS

All questionnaires were returned. Overall, the course was rated with an average score of 4.7 (rating range: 1-6; 1 = worst/6 = best). The assessment of practical skills yielded a successful and complete performance of tooth extraction by 94% of the students.

CONCLUSIONS

A tooth extraction course using a mannequin model is appreciated by dental students and can achieve a sufficient level of competence in tooth extraction with reasonable educational efforts.

Traumatic chemical oral ulceration: a case report and review of the literature

A 34-year-old man experienced extensive oral ulceration as a consequence of attempted ingestion of sulphuric acid as part of an act of deliberate self harm. All oral lesions healed within 28 days after local and systemic therapy. Oral ulceration has many potential causes ranging from physical trauma to malignancy. Chemicals are a less common cause of traumatic ulceration. Most chemical burns are characterised by mild to moderate tissue damage that heals spontaneously within seven to 15 days without scarring.

A retrospective study of trauma-associated oral and maxillofacial lesions in a population from southern Taiwan

OBJECTIVE

The aim of this retrospective analysis was to determine the age, gender, frequency and distribution of trauma-associated hard tissue and soft tissue lesions of the oral and maxillofacial region in a population from southern Taiwan.

PATIENTS AND METHODS

Approximately 10% of the 27,995 biopsy records of patients with history of trauma resulting in lesions who were treated at our institution between 1991 and 2006 were examined for this study.

RESULTS

In the included records, there were 2,762 soft tissue and 26 hard tissue lesions. Mucocele was the most frequent trauma-associated soft tissue lesion (955 cases). The youngest patients were those who presented with mucocele (mean age = 27.3 years), while the oldest patients were those with peripheral giant cell granuloma (58 years). The lower lip was the most frequent site of occurrence of mucocele (676, 64.5%) and was also the predominant site of occurrence of all soft tissue lesions (815, 29.5%), followed by the buccal mucosa (654, 23.4%) and the tongue (392, 14.2%). Trauma-associated hard tissue lesions included only osteoradionecrosis (24 cases) and traumatic bone cysts (2 cases).

CONCLUSION

As little data of this nature have been reported from populations of Asian developing countries, the findings of this retrospective analysis is valuable for epidemiological documentation of type of traumatic oral lesions as well as for informing the professionals and the layman about the importance of this category of oral lesions.

Oral ulcers: clinical aspects. A tool for dermatologists. Part I. Acute ulcers

Oral ulcers are generally painful lesions that are related to various conditions developing within the oral cavity. They can be classified as acute or chronic according to their presentation and progression. Acute oral ulcers are be associated with conditions such as trauma, recurrent aphthous stomatitis, Behçet's disease, bacterial and viral infections, allergic reactions or adverse drug reactions. Chronic oral ulcers are associated with conditions such as oral lichen planus, pemphigus vulgaris, mucosal pemphigoid, lupus erythematosus, mycosis and some bacterial and parasitic diseases. The correct differential diagnosis is necessary to establish the appropriate treatment, taking into account all the possible causes of ulcers in the oral cavity. In the first part of this two-part review, acute oral ulcers are reviewed.

The association of orthodontic treatment and fixed retainers with gingival health

BACKGROUND

The use of postorthodontic fixed retainers made of wire and composite resin bonded to the lingual/palatal tooth aspect is a common practice that can affect gingival health. The purpose of this study was to evaluate the association of orthodontic treatment and fixed retainers with gingival health.

METHODS

The study included 92 consecutive subjects who arrived for routine dental examination at a military dental clinic between May and August 2007. Plaque and gingival indices, gingival recession, probing depth, and bleeding on probing were measured at the anterior sextants. When a fixed retainer was present, the distance was measured between the retainer and incisal edge and to the cemento-enamel junction. Past orthodontic treatment and smoking habits were self-reported. Postorthodontic patients were sorted by the presence or absence of fixed retainers.

RESULTS

The mean probing depth was 1.90 +/- 0.2 mm, and gingival recession was 0.06 +/- 0.02 mm; 20.8% of all sites exhibited bleeding on probing. Current smoking was reported by 20 (21.7%) patients. Labial gingival recession was significantly greater in treated (0.13 +/- 0.2 mm) patients compared to non-treated patients (0.05 +/- 0.2 mm; P = 0.03). Localized lingual gingival recession was significantly greater in teeth with fixed retainers (0.09 +/- 0.2 mm) compared to teeth with no fixed retainers (0.01 +/- 0.1 mm; P = 0.0002), as were plaque and gingival indices and bleeding on probing. Plaque on the lingual/palatal aspect showed a weak, positive correlation with lingual gingival recession (r = 0.16; P = 0.033).

CONCLUSION

Orthodontic treatment and fixed retainers were associated with an increased incidence of gingival recession, increased plaque retention, and increased bleeding on probing; however, the magnitude of the difference in recession was of low clinical significance.

Gingival recession in young adults: occurrence, severity, and relationship to past orthodontic treatment and oral piercing

INTRODUCTION

Gingival recession can be localized or generalized and associated with at least 1 tooth surface. As a result, gingival recession leads to root surface exposure, often causing esthetic impairment, fear of tooth loss, increased susceptibility for root caries, and dentin hypersensitivity. The prevalence, extent, and severity of gingival recession in a young adult Israeli population were evaluated, and the relationship between orthodontic therapy and other potential risk indicators and gingival recession was assessed.

METHODS

Our cohort included 303 consecutive healthy patients who had routine dental examinations at a military dental center. Information was collected regarding age, smoking habits, oral piercing, oral hygiene habits, and past orthodontic treatment. Clinical examination included visible gingival inflammation, visible dental plaque, and gingival recession on the facial aspects of all teeth.

RESULTS

Gingival recession was found in 14.6% of the subjects and in 1.6% of all examined teeth. The prevalence, extent, and severity of recession correlated with past orthodontic treatment. A negative correlation was found between plaque on the buccal tooth aspect and gingival recession. There was no correlation between gingivitis or smoking habits and recession. Prevalence was related to oral piercing.

CONCLUSIONS

Gingival recession is not uncommon in young adults and is related to past orthodontic treatment and oral piercing. Patients undergoing orthodontic treatment or about to pierce the tongue or lips should be advised regarding these findings.

Oral piercing: dental considerations and the legal situation in Spain

Body piercing has become increasingly popular in Western countries, especially among young people. However, not everyone is aware of its potential risks, which may develop local and systemic complications shortly after, or long after the piercing procedure. Given that the oral cavity is one of the most frequent sites for piercing placement, the aim of this paper is to familiarise the oral healthcare professional with oral piercing and its possible sequelae in order to educate patients prior to and after piercing practices and address any complications that may arise.

Iatrogenic trauma to oral tissues

BACKGROUND

Iatrogenic trauma can be defined as any trauma that has been induced by the dentist's activity, manner, or therapy. The aim of this article is to present traumatic oral tissue lesions of iatrogenic origin.

METHODS

Thirteen cases of chemical (due to ferric sulfate and formocresol), physical (due to orthodontic wires and appliances), and thermal (due to electrosurgery) injuries to the oral tissues are reported.

RESULTS

Chemical, physical, and thermal injuries in the oral, gingival, or palatinal mucosa of iatrogenic origin can exhibit various clinical features. The management of traumatic injuries is dependent on the severity of the involvement in the periodontal tissues. While, in most cases, the elimination of the offending agent and symptomatic therapy were sufficient, in severe cases, or when the injury resulted in permanent defects, periodontal surgery and regenerative therapy may be necessary.

CONCLUSIONS

The skill, experience, and up-to-date knowledge of dentists are the main factors to prevent possible iatrogenic traumas. Although "To err is human," careful practice is very important for the principle "Primum non nocere" ("First do no harm").