Osseointegration of Dental Implants in a Patient with Hajdu-cheney Syndrome

Background:

Hajdu-Cheney Syndrome (HCS) is a rare hereditary bone metabolism disorder characterized by acro-osteolysis, short stature, craniofacial changes, periodontitis and premature tooth loss. Extensive search of the current literature revealed no reports of implant placement in patients with HCS.

Case Report:

A 22-year old woman with osteoporosis, generalized advanced chronic periodontitis and premature tooth loss was referred to the Postgraduate Clinic of Periodontology, University of Athens-Greece. The patient was diagnosed in 2001 with HCS. The patient received non-surgical periodontal treatment and several teeth were extracted due to extensive alveolar bone loss.

After careful consideration of the possible implications deriving from the patient’s condition and having taken her young age into account, initially, a dental implant was placed in the upper right first premolar region. Specific protocols such as longer healing periods were implemented, so five years after placement and successful osseointegration of this implant, four additional dental implants were placed in the posterior regions of the maxilla and the mandible. Prosthetic rehabilitation followed 6 months after implant placement. Upon completion of periodontal treatment, the patient was enrolled in a periodontal maintenance program.

Results:

Clinical and radiographic examination of the patient during the periodontal maintenance program after implant placement revealed no abnormalities in the implant region.

Conclusion:

Patients with HCS suffer from periodontitis, bone destruction and premature tooth loss. This case indicates the successful osseointegration of dental implants in patients with HCS. However, further research is required in order to determine the predictability of dental implant placement in those patients.

Historical insights in the progression and development of gingivectomy

During the last three centuries since the identification of periodontal disease, various non-surgical and surgical forms of periodontal therapy have been described and documented in the dental literature. The main objective of periodontal treatment has been initially the removal of "diseased gingiva," either through the implementation of various surgical techniques, or through the application of caustic drugs or pressing patches. Although the differences in the suggested techniques created significant controversies between some of the greatest clinicians and researchers in dentistry, their main goals remained the rehabilitation of the oral cavity and the therapeutic management of the problems sustained from periodontal disease.

Syndecan-1 immunohistochemical expression in gingival tissues of chronic periodontitis patients correlated with various putative factors

BACKGROUND AND OBJECTIVE

Limited information is available on the expression and distribution of syndecan-1 within human gingival tissues/cells and on putative factors that might affect its expression. Therefore, the objective of the present study was to determine immunohistochemically the expression and distribution of syndecan-1 in the gingival tissues of patients with chronic periodontitis and to examine the correlation of syndecan-1 expression with various putative factors (environmental, patient/systemic and local factors).

MATERIAL AND METHODS

Gingival specimens were surgically excised from the area of the junctional/pocket epithelium (study group 1, including 30 chronic periodontitis patients) or the gingival oral epithelium (study group 2, comprising another 30 chronic periodontitis patients), adjacent to teeth with poor prognosis. Standard two-step immunohistochemistry and semi-quantitative evaluation of immunohistochemical staining were used to determine syndecan-1 expression. Statistical analyses on the impact of various putative factors were performed.

RESULTS

In the junctional/pocket epithelium or the oral epithelium, syndecan-1 expression was weak to moderate in the suprabasal and basal epithelial cells and absent to weak in the internal basal lamina, external basal lamina and gingival connective tissue matrix. Syndecan-1 expression in the junctional/pocket epithelium was statistically significantly stronger than in the oral epithelium in inflammatory cells within the underlying gingival connective tissue (primarily plasma cells and lymphocytes) and in scattered fibroblast-like cells.

CONCLUSIONS

Syndecan-1 expression in the junctional/pocket epithelium or the oral epithelium can exhibit a significant positive correlation with the severity/degree of histologically evaluated local gingival inflammation, but in general is not significantly correlated with age, smoking, full-mouth and local clinical (probing pocket depth and clinical attachment level) and radiographical parameters (radiographical bone loss) of periodontal status.

Prevalence and distribution of bone defects in moderate and advanced adult periodontitis

The purpose of the present investigation was to evaluate the prevalence and distribution of different forms of bone defects using direct observation during periodontal surgery. 286 patients with moderate or advanced adult periodontitis diagnosed during clinical and radiographic examination provided a sample of 5476 teeth. After full thickness mucoperiosteal flaps were raised, osseous defects were explored and classified according to their morphology as interdental craters, hemisepta and infrabony defects with 1, 2, 3 or 4 osseous walls. 981 defects were detected; 533 were in the maxilla and 448 in the mandible (15.4% and 22.4%, respectively, of the teeth examined). The posterior mandibular segment had the highest % of teeth with defects (33.8%) followed by the posterior maxillary segment (19.9%). The proportions of teeth with defects in the anterior segments of both arches were similar. The comparison between maxilla and mandible showed a highly significant difference for the posterior segments (p= 0.00001) but no difference for the anterior segments (p=0.88). The distribution of defects differed between the maxilla and the mandible, both for the posterior and anterior segments. Craters accounted for almost half the defects, being more prevalent in posterior segments, while hemisepta formed the lowest proportion. Anatomical variations in shape and the original morphology of the alveolar bone between the maxilla and the mandible and the anterior and posterior regions might have been the reason for the differences observed.