Gingival Clefts Research Articles

The absence of proximal contact point on periodontal parameters of teeth moved into extraction sites.

The aim of study was to evaluate periodontal conditions of upper canines and second premolars with and without proximal contact of individuals undergoing orthodontic treatment associated to extractions of the upper first premolars. The study selected upper canines and premolars of individuals undergoing orthodontic treatment without extractions (30 hemiarches - control group), or with extraction of the upper first premolars and whose canines and second premolars had interproximal contact (16 hemiarches - group 1) or diastema (17 hemiarches - group 2). Clinical (plaque index, probing depth, gingival bleeding index, height of the gingival margin, clinical attachment loss and gingival clefts) and radiographic (crest height, bone height and bone-crest discrepancy) parameters of the distal surfaces of canines and mesial surfaces of premolars were evaluated. Group 1 had worse results when compared to the control group for the levels of plaque in canines and premolars and for probing depth in canines (distal and mean) and in premolars (lingual and mean), as well as increasing tendency of clinical attachment loss (lingual and mean) in premolars. Plaque level in canines in group 1 was also significantly higher than in group 2. There was no difference between group 2 and the control group. The lack of proximal contact between canines and second premolars did not significantly affect their periodontal characteristics.

Prospective Clinical Investigation of Orthodontic Relapse from Gingival Clefts

Background: Orthodontic space closure following premolar extraction may result in gingival cleft formation. This may contribute to orthodontic relapse due to reopening of extraction spaces. Purpose: 1) To see the effects gingival clefts have on relapse and opening of closed extraction spaces after orthodontic treatment. 2) To record any changes in cleft severity that may occur. 3) To evaluate any relationship between gingival phenotype and cleft severity. Methods: Subjects recruited from previous study in which gingival clefts were measured during space closure. The clinical measures included the occurrence and severity of clefts and their relationship to gingival phenotype. Results: Sites with a cleft (N=42) had 42.86% relapse and those without (N=19) had 36.84% relapse. Conclusions: As gingival cleft severity increases, the amount of relapse distance is likely to increase. Patients with a thick gingival phenotype who obtain gingival clefts in extraction sites during orthodontic treatment are more likely to have relapse post-treatment compared to sites which did not develop a gingival cleft.

Gingival clefts revisited: Evaluation of the characteristics that make one more susceptible to gingival clefts.

Orthodontic space closure after premolar extraction commonly results in the formation of a gingival cleft, which may contribute to orthodontic relapse and poor periodontal health. The purpose of this study was to examine clinical parameters that may predispose patients to gingival clefts. Twenty-nine patients planned for treatment with premolar extractions (n=87) and orthodontic space closure were evaluated in this prospective study. The clinical measures included width of keratinized buccal gingiva, thickness of buccal gingiva, thickness of buccal bone, time of space closure, and the occurrence (presence or absence) and severity (volume) of cleft formation. The association of the clinical measures with gingival cleft formation and severity was assessed separately for patients according to age group: young adolescent (≤13years of age), adolescent (14-18years of age), and adult (≥19years of age). The overall incidence of gingival cleft formation was 73.2%, with a trend toward greater cleft formation in the young adolescents (79.4%) than in the adolescent and adult groups (69.2% and 68.2%, respectively). The mean severity of clefts exhibited a significant positive association with age group-young adolescent (26.6mm2), adolescent (27.9mm2), and adult (41.5mm2). Buccal bone thickness was significantly correlated with gingival phenotype in the adolescent and adult groups (r=0.42 and r=0.52, respectively; both, P<0.05). Rate of space closure was significantly correlated with cleft formation (r=0.71; P<0.001) in the adult group. The formation of gingival clefts is common after premolar extraction and space closure. Adults with a thinner gingival phenotype were more likely to develop gingival clefts of greater severity. The rate of space closure was significantly and inversely correlated with cleft formation in adults, reflecting a greater likelihood of cleft formation with slower space closure. Although various clinical parameters show a correlation to both severity and incidence of clefts, all patients undergoing postextraction space closure appear to be at risk and should be monitored.

ALTERNATIVE APPROACH IN THE TREATMENT OF A GINGIVAL CLEFT ASSOCIATED WITH LABIAL FRENULUM. A 3-YEAR FOLLOW-UP. (Case Report)

INTRODUCTION: The term Gingival cleft refers to a fissure in the gingival tissues and is usually caused by traumatic oral hygiene, abnormal frenula, trauma from occlusion, orthodontic, or pierce related trauma. Gingival clefts are classified depending on the extent of the inclusion of the gingival thickness into red and white. The recommended treatment approach for the incomplete white clefts is the gingivectomy of the affected keratinized tissue followed by a coronally advanced flap for the root coveradge, while the complete white clefts are treated with a laterally moved, coronally advanced flap, or a free gingival graft procedure. OBJECTIVE: This report presents a case with a spontaneous healing of an incomplete gingival cleft associated with a maxillary labial frenulum after an alternative frenuloectomy approach. METHODS: M.G. (45) with a localized chronic periodontitis, an abnormal papillary maxillary frenulum and an incomplete white cleft on the marginal gingiva of the left central incisor. An alternative frenuloectomy approach combined with a free gingival graft was selected for the correction of the abnormal frenulum. RESULTS:On the sixth month after the surgical procedure an almost complete recovery of the gingival margin was observed.The result at the third year demonstrates a stable gingival margin with a complete tissue recovery. CONCLUSION: The applied combined surgical approach led to a complete gingival recovery of the incomplete white gingival cleft without the commonly used gingivectomy and CAF. Further research is recommended to clarify the adjunctive benefits of the FGG in patients with gingival clefts associated with abnormal frenula.

Healing processes following tooth extraction in orthodontic cases

This article reviews the normal and pathological healing processes that take place after tooth extraction in orthodontic cases, and their associated complications within the mucosa or alveolar socket, such as gingival clefts or bone defects. The general and local factors that are involved in such deficient healing cases are detailed, in parallel to surgical procedure to enhance ridge preservation or to ‘regenerate’ tissues. The relationships between the orthodontist and periodontist are underlined, because both praticioners assess patient’s risk factors and follow him during this treatment stage.

The Influence of Occlusal Trauma on Gingival Recession and Gingival Clefts

The aim of this study was to investigate the centric occlusal contact pattern in maximum intercuspation and to study the nature of occlusal contacts during maximum intercuspation to protrusive, lateroprotrusive and lateral excursive movements. Fifty subjects having gingival recession and ten subjects having gingival clefts belonging to age group of 18-25years were selected after obtaining informed consent from the student's population. The selected subjects were examined and the location and extent of gingival recession, gingival clefts and occlusal wear facets were recorded. The type of occlusion and the nature of occlusal contact in maximum intercuspation and eccentric mandibular movements were also recorded using articulating foil and shimstock. Chi square test, Fisher's exact test (F) and Z test were used to statistically analyse the data obtained. Among the three occlusal concepts, gingival recession was more commonly related to group function than to canine protected occlusion. Canine protected occlusion was associated with gingival recession on the labial surface while in group function occlusion; the recession was distributed equally on the facial surface of the anterior as well as posterior teeth. Nearly all subjects showed interferences in protrusive, lateroprotrusive and lateral excursive movements on teeth showing gingival recession and gingival clefts. Occlusal wear was seen on all teeth having gingival clefts and on most teeth having gingival recession. These results suggest that occlusal interferences in maximum intercuspation and eccentric movements in one form or the other and absence of mutually protected occlusion can contribute to gingival lesions such as gingival recession and clefts.

Orthodontic space closure in combination with membrane supported healing of extraction sockets (MHE) a pilot study.

In periodontology and implantology the guided bone regeneration (GBR) technique represents a well established and successful method for augmentation of alveolar bone. The aim of the present study was to evaluate what advantages, if any, are offered for orthodontic space closure by membrane supported healing of extraction sockets (MHE) (criteria: rate of movement, incidence of gingival clefts, atrophy of the alveolar bone). Within the scope of orthodontic therapy with a complete fixed appliance, three girls aged 11-14 years with indication for extraction of the first premolars were unilaterally augmented with an e-PTFE membrane (Gore-Tex((R)), W. L. Gore & Associates, Flagstaff, AZ, USA) immediately after premolar extraction. The study was performed in the split-mouth technique. An atraumatic extraction without digital compression was performed on the control side. The membranes were fixed with a Frios((R)) fixation set (Friadent, GmbH, Mannheim, Germany) and removed after 6 to 8 weeks. 1 week after membrane removal, space closure was started simultaneously with passive rectangular segmented archwires using Sentalloy((R)) closed coil springs (GAC International, Inc., Gräfelfing, Germany) at a constant force of 200 cN. The transversal and vertical dimensions of the alveolar bone the rate of space closure were determined clinically and radiographically. Complications were not observed in any patient. The MHE-treated alveolar region showed pronounced stability of the transversal dimension. Space closure was performed in all cases without gingival clefts being induced. The control side showed distinct atrophy as well as gingival clefts. No differences were recorded in the rate of space closure. The MHE technique seems to be a suitable means of creating favorable periodontal conditions for tooth movement, especially in cases of alveolar bone loss after extraction or trauma.

Effects of incisor repositioning on monkey periodontium after expansion through the cortical plate

The anterior teeth of five adult pigtail monkeys were moved lingually to correct a previously induced extreme labial displacement. (Roots had been moved through the labial bone to create bone dehiscence, loss of attachment, and gingival recession.) Eight months later, repositioning was performed with fixed appliances (Fig. 3). The teeth were retained in their more normal arch position for 5 months, after which clinical and histologic measurements were made of several periodontal parameters. The canines were not moved and served as reference teeth. Measurements were made to record changes in the levels of the gingival margin, the mucogingival junction, and the marginal bone relative to a fixed point on the tooth crowns, and the width of keratinized gingiva. Oxytetracycline was administered three times to label areas of osteogenesis in the periodontium. The incisors were retracted lingually a mean of 1.8 mm. The marginal bone level increased (moved coronally) a mean of 2.5 mm. and 3.1 mm. for maxillary and mandibular incisors, respectively (Table II). The tetracycline labels showed that osteogenesis occurred in the periodontium to a significant degree. The anchor canines had a loss of 1.1 mm. marginal bone (moved apically). Effects on gingival clefts and keratinized gingiva were slight. These observations demonstrate that in monkeys reapposition of labial bone can occur in a coronal direction, once teeth in extreme labial position with bone dehiscence and gingival recession are moved to a more normal environment. The effects on the periodontal soft tissues (width of keratinized gingiva, recession, attachment level) were, on the other hand, negligible in this study.

Repair of gingival clefts

Two cases of extensive gingival clefts are presented with surgical methods used for their correction. The theoretical basis for their pathogenesis is briefly described.

Occurrence and distribution of interdental gingival clefts following orthodontic movement into bicuspid extraction sites: P. B. Robertson, L. D. Schultz, and B. M. LevyJ. Periodontol.48:232–235, April, 1977

Occurrence and distribution of interdental gingival clefts following orthodontic movement into bicuspid extraction sites: P. B. Robertson, L. D. Schultz, and B. M. LevyJ. Periodontol.48:232–235, April, 1977

Occurrence and Distribution of Interdental Gingival Clefts following Orthodontic Movement into Bicuspid Extraction Sites

Forty patients in active retention following orthodontic tooth movement into premolar extraction sites were examined for the occurrence and distribution of interdental gingival clefts, defined as an invagination of interproximal tissue with definite mesial and distal peaks having a depth of at least 1 mm. Fourteen of the forty orthodontic patients demonstrated clefts in one or more of the premolar extraction sites. No clefts were observed in premolar areas of orthodontic patients who did not require premolar extraction or in patients without previous orthodontic treatment. Interdental clefts occurred most frequently at the buccal aspect of mandibular first premolar extraction sites. The presence of the cleft appears to have clinical implications, both in terms of orthodontic relapse, and maintenance of gingival health.

Occlusal traumatism—its pathological effects and diagnosis

The pathological effects of occlusal disturbances may be seen in the temporomandibular articulation and related musculature and in certain periodontal tissues. Periodontal traumatism may be primary or secondary. The treatment of primary traumatism usually requires only changes in the force applied on a tooth; treatment of secondary traumatism requires many procedures, sometimes including permanent splinting. Occlusal overloading is not an etiological factor in gingivitis, gingival hyperplasia, or pocket formation, and ordinarily will not cause gingival recession, gingival clefts or resorption of the alveolar crest.

Microscopic studies of the periodontium of the anterior teeth of a 4-year-old boy

1. 1. The changes occurring in the periodontium of the anterior deciduous teeth of a 4-year-old boy were studied. The jaws and teeth were fixed in a formol acetic acid-alcohol solution, decalcified, dehydrated, and embedded in nitrocellulose in the usual manner. 2. 2. As absorption of the deciduous anterior teeth progresses, the lingual alveolar bone undergoes extensive destruction, especially at the crestal region, lowering the latter and weakening the support; finally only spicules of bone remain. 3. 3. At the beginning stages of shedding, the changes in the periodontal membrane are slight; however, they become intensified as the resorptive process continues. During the later stages secondary occlusal trauma is initiated, producing severe degenerative changes to the labial alveolar bone as well as to the periodontal membrane. 4. 4. The microscopic appearance of the gingivae varied from normal to that of gingivitis. Calculus deposits were found in the anterior teeth. 5. 5. Gingival clefts were noted in the interproximal areas of both the upper and lower jaws, and their development has been described. 6. 6. The base of the epithelial attachment was found on the cementum in the anterior central incisors, whereas it was limited to the cementoenamel junction in the other anterior teeth.

Microscopic studies of the periodontium of the primary dentition of monkeys. I. Anterior teeth during the mixed dentitional period

1. 1. The changes occurring to the periodontium of the anterior primary teeth during the mixed dentitional state were studied by various stains. The jaws and teeth were fixed in a modified P.A.F. solution, decalcified, dehydrated, and embedded in nitrocellulose in the usual manner. 2. 2. The microscopic appearance of the gingivae varied from normal to severe gingivitis. Calculus deposits were a constant finding whenever gingivitis was present. 3. 3. The base of the epithelial attachment was found on the cementum in the earlier stages of shedding and continued to migrate apically until the tooth was exfoliated. This proliferation became accelerated with the complication of inflammation. 4. 4. Gingival clefts were noted in the interproximal areas, and their development described. 5. 5. During the mixed dentitional period, the alveolar bone undergoes extensive destruction especially at the crestal region, lowering the latter and weakening the support to the teeth. 6. 6. At the beginning stages of shedding the changes in the periodontal membrane are slight; however, they become intensified as the exfoliation process continues. During the later stages secondary occlusal trauma is initiated producing severe periodontal changes.