Gingival Overgrowth Research Articles

A case report of plaque-induced gingival enlargement - unlike the ordinary

Gingival enlargements are one of the most common conditions affecting the periodontium. These enlargements occur due to a variety of factors, like plaque accumulation, hormonal changes, or systemic drug influence. Improper oral hygiene and microbial dysbiosis predispose an individual to plaque-induced gingival enlargement. The treatment strategy involves thorough oral prophylaxis and stringent oral hygiene maintenance. Described here is a case report of plaque-induced gingival enlargement, which has been managed with complete non-surgical and localized surgical periodontal therapy. The therapeutic intervention significantly reduced clinical parameters like bleeding on probing and periodontal pocket depth.

Epithelial-to-mesenchymal transition, inflammation, subsequent collagen production, and reduced proteinase expression cooperatively contribute to cyclosporin-A-induced gingival overgrowth development.

Drug-induced gingival overgrowth (DIGO), induced by certain immunosuppressive drugs, antihypertensive agents, and antiepileptic drugs, may contribute to the formation of deeper periodontal pockets and intractableness in periodontitis. To date, multiple factors such as enhanced matrix production, inflammation, and reduced matrix degradation might be involved in the pathogenesis of DIGO. We have previously reported that SPOCK-1, a heparan sulfate proteoglycan, could affect gingival thickening by promoting epithelial-to-mesenchymal transition (EMT) in gingival keratinocytes. However, few studies have investigated whether a combination of these factors enhances the DIGO phenotype in animal models. Therefore, we investigated whether SPOCK-1, periodontal inflammation, and cyclosporin-A (CsA) could cooperatively promote gingival overgrowth. We first confirmed that Spock-1 overexpressing (Spock1-Tg) mice showed significantly thicker gingiva and greater alveolar bone loss than WT mice in response to ligature-induced experimental periodontitis. DIGO was induced by the combination of CsA administration and experimental periodontitis was significantly enhanced in Spock1-Tg mice compared to that in WT mice. Ligature-induced alveolar bone loss in CsA-treated Spock1-Tg mice was also significantly greater than that in CsA-treated WT mice, while being accompanied by an increase in Rankl and Col1a1 levels and a reduction in matrix metalloprotease expression. Lastly, SPOCK-1 promoted RANKL-induced osteoclast differentiation in both human peripheral blood mononuclear cells and murine macrophages, while peritoneal macrophages from Spock1-Tg mice showed less TNFα and IL-1β secretion than WT mice in response to Escherichia coli lipopolysaccharide. These results suggest that EMT, periodontal inflammation, and subsequent enhanced collagen production and reduced proteinase production contribute to CsA-induced DIGO pathogenesis.

Evaluation of ABCB5 immunostained epithelial stem cells in oral squamous cell carcinoma, inflammatory gingival hyperplasia and normal mucosa

ABSTRACTOral cancer is the most prevalent head and neck cancer. Although tumor markers have been investigated for detecting the progression and prognosis of oral cancer, no reliable marker has been identified. We investigated the expression of ATP binding cassette subfamily B member 5 (ABCB5) positive stem cells in oral squamous cell carcinoma (OSCC) and in inflammatory gingival hyperplasia. We used tissue samples from normal subjects, patients with inflammatory gingival hyperplasia, and patients with OSCC. Samples were investigated using anti-ABCB5 monoclonal antibody immunohistochemistry to detect epithelial stem cells. Staining density, intensity, and immunoreactive scores of ABCB5 were analyzed for the three study groups. We found ABCB5 immunostaining in all three study groups, but different distributions of ABCB5 expression in different layers of the epithelium. We found no significant difference in staining intensity between inflammatory hyperplasia and normal mucosa, but we found significantly stronger expression in OSCC compared to normal and inflammatory hyperplasia individually. Elevated expression of ABCB5 in OSCC suggests an increased subpopulation of tumor cells with an undifferentiated stem cell phenotype, which facilitates cancer initiation and progression.

A Retrospective Histological Study on Palatal and Gingival Mucosa Changes during a Rapid Palatal Expansion Procedure.

The most common inflammatory reactions in the oral mucosa are found at the gingival level. The treatment of these inflammations requires, first of all, the removal of the causative factor; often, this maneuver is sufficient. The aim of this retrospective study was to evaluate clinical and histopathological changes that occur in terms of gingival and palatal mucosa enlargement during palatal expansion treatment and their evolution during treatment. Twenty-five (n = 25) research participants, aged between thirteen and twenty-six years old, were examined in this retrospective study. At the end of the treatment, fragments of tissue from the affected level were obtained via incisional biopsy and sent to the histopathology laboratory for a specialized examination. The changes identified were specific to mechanical traumatic injuries, thus excluding hyperplasia from other etiologies (infectious, tumoral, or non-mechanical traumatic). The examined fragments showed hyperplasia. The histopathological examination revealed the mechanical character of the lesion, strengthening the causal relationship between the insertion of the expander and the occurrence of hyperplasia of the palatal mucosa. The type of palatal expander influenced the degree of inflammation, with the severity of hyperplasia being more pronounced in the case of mini-implant-anchored rapid palatal expander (MARPE) usage than in the case of tooth-borne rapid palatal expander (RPE) usage. The analysis of the distance between the expander and the palatal mucosa did not provide conclusive results; the incidence and severity of the reaction were variable in patients with the same distance between the expander and the palatal or gingival mucosa.

Histoplasmosis: A Mimicker of Granulomatosis with Polyangitis

A 31-year-old male from the southern part of India with no known comorbidities presented with painful oral erosions over his palate following a dental procedure. Over 2 months, it progressed to the desquamation of blackish necrotic skin, gingival hypertrophy associated with intermittent fever and odynophagia. He had elevated acute-phase reactants. Biopsy of the gingiva showed necrotising vasculitis. ANCA was weakly positive for the cytoplasmic pattern by immunofluorescence. The HRCT chest showed a single cavitating nodule in the right upper lobe and a non-cavitary nodule in the left upper lobe with right maxillary sinus thickening. With the above clinical and biopsy findings, granulomatosis with polyangiitis was the first consideration. He was referred to our centre since the oral lesions did not improve and nodular swellings developed on the palate. The examination showed cervical lymphadenopathy, which was subjected to an excision biopsy. It showed extensive areas of necrosis with karyorrhectic debris and numerous intracellular and extracellular round-to-ovoid spore-like structures. Special stains were positive for histoplasmosis. Abdomen imaging showed adrenal enlargement. Cultures were negative, which could be due to the fact that he was on multiple medications. He was treated with amphotericin and itraconazole. His symptoms improved. But later, he had worsening clinical parameters suggestive of a progressive disseminated form of histoplasmosis. In spite of aggressive efforts, he couldn’t be resuscitated owing to the dissemination of the organism. Even though considered to be more common in immunosuppressed individuals in nonendemic areas, it is reported in immunocompetent individuals as well and should be strongly suspected if the clinical picture fits so for early diagnosis and aggressive management to prevent fatal complications. There have been only fewer case reports of histoplasmosis from the southern part of India. ANCA is only rarely reported false positively in histoplasmosis.

Preliminary clinical study of mucoadhesive propolis gel to gingival disorders control in patients with fixed orthodontic appliances.

Aims: Gingival hyperplasia (GH) etiology is diverse and ranges from acute or chronic inflammatory processes and is commonly observed in patients with fixed orthodontic appliances. Propolis has been globally studied and has anti -inflammatory and antimicrobial properties, however, there are few clinical studies involving orthodontics. Study design: This clinical study aims to obtain preliminary evidence of an oral gel containing 5% Brazilian propolis (BPG) in GH and gingivitis control on patients with fixed orthodontic appliances. Place and Duration study: Clinic Orthodontics, Faculty of Dentistry/UFMG, Belo Horizonte, Brazil, from March to October 2013. Methodology: Thirty patients were selected, but only 10 participated and reached the end of the study. The patients were submitted to questionnaire and a complete prophylaxis of dental structures before initiating the gel use(T0) and they were instructed to use the gel two times daily after brushing (morning and evening) during 30 days (T30). Patients were evaluated considering plaque and gingival index and photographs collection of first premolars - measuring gingiva of the clinical crown area. The SPSS version 18.0 statistical program, Shapiro Wilk normality test, presenting a normal or parametric distribution and all analyzes were performed using Student's t Test for paired samples. Results: BPG show statistically significant reduction of GBI and GSI (GB1 p =0.207; GB2 p = 0.122), respectively. Conclusion: Considering this study model, 5% propolis gel had effective in reducing GH and gingivitis. However, a double blind and randomized clinical studies with higher number of patients should be made to give greater credibility for gel use.

Acute Non-Lymphoblastic Leukemias Presenting with Gingival Hyperplasia: Diagnosis and Management Updates

Background: Leukemias represent a heterogeneous group of hematological malignancies, which are characterized by the disordered proliferation of neoplastic hematopoietic cells, with the diffuse bone marrow involvement. Most frequent oral findings in leukemias are cyanotic or erythematous gingival hyperplasia with or without necrosis, petechiae, ecchymoses, mucosal ulcers and hemorrhage. Gingival hyperplasia is reported as a consistent symptom, which forwards patients for a dentistry consultation, that may lead to an early diagnosis of acute leukemias. The recognition of gingival enlargement as an initial oral manifestation of leukemic involvement assumes major practical significance, especially for the early diagnosis of non-lymphoblastic leukemias. Objectives: The aims of researches were the evaluation of diagnosis and management of hyperplastic gingivitis in acute leukemias. Material and Methods: The patients' follow-up and treatment were realized at the comprehensive cancer center. Our observational, analytical and descriptive study enrolled 8 patients with acute leukemias, who were treated at the Institute of Oncology from Moldova between 2012-2023. The diagnosis was asserted by the bone marrow aspiration with cytochemical reactions, tissue biopsy, buccal swab, or fine needle aspiration cytology. The immunophenotyping was performed in selected cases. The types of acute leukemias were assessed and distinguished according to the 2017 Revision of WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. This prospective study was related to the hospitalized and outpatient care. Results: Hyperplastic gingivitis developed in cases with myelomonocytic and monocytic acute leukemias. The leukemia patients were admitted to the Institute of Oncology with a history of fatigue, fever, bone pain, gingival bleeding and enlargement detected by dentistry and family doctors from the consulting centers. ECOG-WHO performance score was 2-3. The intra-oral examination revealed generalized gingival hyperplasia. There were the amounts of plaque and calculus, which did not justify the enlargement degree. The gingiva was spongy and painless on palpation, with solitary sectors of necrosis and mucosal bleeding. Multiple soft and tender lymph nodes ranging from 0.8-1.5 cm in diameter were palpable bilaterally in the cervical and axillary regions. Splenomegaly of various degree was revealed by ultrasound scan in all patients. Complete blood count values ranged between: Hb 66-104 g/l, RBC 2.3-3.7 x 10 12/l, WBC 11.3-47.2 x 10 9/l, PLT 17.0-115.0 x 10 9/l, blast cells 17-65%. The bone marrow aspiration detected hypercellularity, myeloid and monocytic blast cells (31.0-58.0%), as well as monocytes (9.0-14.0%). The studied cases were not suggestive of presence of FLT3 mutations. Hyperplastic gingivitis regressed in 5 (62.5%) cases after the achievement of complete (4 patients) and partial (1 patient) hematological responses under the first-line combined chemotherapy with conventional doses of cytarabine, anthracyclines and etoposide (2 patients). Local treatment included daily administration of oral steroids, antiseptic and hemostatic drugs. The narrative review of the recent references revealed that 37-53% of patients with monocytic and myelomonocytic leukemias were reported to develop gingival hyperplasia. Conclusions: Hyperplastic gingivitis emerges in acute leukemias mostly due to the gingival infiltration with neoplastic blast cells. Gingival hyperplasia may regress under the combined chemotherapy and local treatment in patients with complete or partial hematological responses. Early diagnosis and treatment, thus, can increase the leukemia patients' prospects for complete hematological and local responses.

Multiple nodular swellings with gingival hyperplasia and joint contractures.

Multiple nodular swellings with gingival hyperplasia and joint contractures.

Drug-Induced Gingival Enlargement- A Practical Insight Into its Etiopathogenesis and Management

Drug-induced gingival enlargements are a familiar finding in a dental setup. They are seen especially in the patient on anti-convulsant, immunosuppressive, and calcium channel blockers therapy. Amlodipine used primarily as a monotherapy or in combination therapy in the management of a trailing disease like hypertension is associated with gingival enlargement constantly. This case report unveils the management of amlodipine-induced gingival enlargement and accentuates the important considerations regarding etiopathogenesis and practical ways of managing the case on a daily basis.

Comparison between Hyaluronic Acid and Chlorhexidine in the treatment of Orthodontically induced gingival enlargement: A randomized controlled trial

Introduction: The study aimed to assess and compare the effectiveness of chlorhexidine and hyaluronic acid when used as an adjuvant to professional mechanical plaque removal (PMPR) in the treatment of orthodontically induced gingival enlargement. Methods: The study conducted was a randomized controlled clinical trial involving 45 patients. The patients will be categorized into 3 groups; control group receiving conventional PMPR, study 1 group receiving PMPR and chlorhexidine (CHX), and study 2 group receiving PMPR and hyaluronic acid (HA). Probing depth (PD), Gingival overgrowth index (GOI), gingival bleeding index (GBI), and plaque index (PI), will be recorded at baseline, 1 month, 2 months, and 4 months’ post therapy. A bivariate analysis was conducted to evaluate the parameters in function of the three study groups, and to evaluate the changes in PD and GBI between baseline, month 1, month 2 and month 4 in the three study groups. Results: A significant reduction in probing depth and gingival bleeding was observed in the three groups (p 0.05). The change in PD, PI, GBI and GOI was more in Group 1 and Group 2 than in the control group. Hyaluronic acid demonstrated the same effect of chlorhexidine. Conclusions: HA is just as effective as CHX in treating gingival enlargement. Based on the acceptance of HA by patients generally and the negative effects of CHX, HA may be a potential alternative to CHX.

NCMP-24. RECURRENT BOUTS OF SCURVY DURING GLIOBLASTOMA REMISSION

Abstract Various nutritional deficiencies are more common in patients with cancer, including thiamine, iron and vitamin B12 deficiences, and can be associated with metabolic stress, treatments given and reduced nutritional intake or absorption. Vitamin C deficiency and scurvy have also been reported as a rare complication in cancer patients, but are not frequently seen in the developed countries. We report a 29 year old woman who underwent partial resection of a bifrontal isocitrate dehydrogenase, methylated glioblastoma followed by radiation and temozolomide four years prior. Her tumor remained stable since that time, but she had ongoing decreased appetite and sensitivity to food smells and tastes, which restricted her diet substantially. She had mild chronic anemia and was underweight, but had remained stable. She presented to us with acutely worsening fatigue, lower limb edema and a new rash that was superficially petechial in appearance. She had gingival hyperplasia and friability, and a jaundiced appearance. No deep venous thrombosis was found and liver tests were normal, giving a picture of scurvy. Her serum vitamin C level was undetectable, B12 was 75, folate 3.4, hemoglobin 6.1, albumin 3.2 and vitamin D 11.5. She was given intravenous and oral ascorbic acid as well as other supplementation and had immediate resolution of limb swelling and greatly improved appetite and energy. One year later, with glioblastoma still stable off treatment, she had recurrent worsening fatigue, appetite and gingivitis, and typical petechia-like rash appeared within minutes of IV placement for MRI contrast in the associated vein. She declined repeat serum testing but symptoms resolved on resuming high dose oral vitamin supplementation. Vitamin C has been studied as a supplement in glioblastomas, but also shown to reduce etoposide toxicity. Vitamin C and other nutritional deficiencies may be more common in brain tumor patients, but under-diagnosed.

Drug Induced Gingival Enlargement: Non-Surgical Management

Gingival overgrowth was a side effect of several different drug classes, including anticonvulsants, immunosuppressants, and calcium channel blockers. Extracellular collagenous matrix components accumulate together with varying degrees of inflammation to describe it. The anti-epileptic phenytoin is one of the main medications linked to gingival overgrowth. It affects gingival tissues by changing the metabolism of extracellular matrix. This paper aims to present a case report on non-surgical management of phenytoin drug induced gingival enlargement.

Tuberous Sclerosis or Bourneville-pringle disease: A rare case report

Introduction: Tuberous sclerosis or Bourneville’s disease is rare autosomal dominant neurocutaneous. Which is characterized by Skin changes, neurological issues, and the development of hamartomas in several organs that cause morbidity and mortality. The gingival hyperplasia, fibromas, hypopigmented lesion’s and enamel hypoplasia are the most typical features of presentation. The case report emphasises on the crucial clinical characteristics, radiographic characteristics, and laboratory abnormalities of Tuberous Sclerosis assisting in the early detection and treatment of such a rare illness. Case presentation: In this report, we present a case of tuberous sclerosis in a 25-year- old female who displayed abnormal body movement along with a hypopigmented macule, ash leaf spots, periungual fibroma, gum hyperplasia, and hematuria with pain in the bilateral flank. Conclusion: Our aim is to raise awareness for tuberous sclerosis by using this instance to highlight the disease's rarity and the difficulty in identifying and treating cases like this.

The Intraoral Findings of the Patient with Robinow Syndrome and the Related Dental Treatment Approaches: A Case Report

Initially defined by Robinow et al. in 1969, Robinow syndrome is an exceptionally uncommon (1:500,000) hereditary disorder showing five distinct phenotypes. Although skeletal system symptoms are intense in all phenotypes, maxillofacial indications and genital organ hypoplasia are also present. Maxillofacial appearances can be listed as follows: hypertelorism, midface hypoplasia, wide and flat nose, low nasal bridge, downturned oral commissures, low-set ears, and micrognathia. In oral manifestations, gingival hyperplasia, tongue, and dental abnormalities are frequently encountered. The detection of intraoral and extraoral findings by the dentist plays a significant role in the diagnosis of this disease. Additionally, every new case documented will help dentists plan treatment approaches. Therefore, in this case report we aimed to describe the manifestations of a patient with Robinow syndrome who was referred to us by a pediatric cardiologist for her dental treatments and also the treatment approach under general anesthesia.

Periodontal health in adequately controlled and inadequately controlled type 2 diabetes: A cross-sectional study.

Objective: To compare health status in term of clinical attachment loss and pocket depth adequately-controlled vs. inadequately-controlled type 2 diabetes. Study Design: Cross-Sectional study. Setting: Department of Periodontology, Khyber College of Dentistry, Peshawar. Period: 1st May 2021 to 30th January 2022. Material & Methods: A total of 142 participants with Type 2 diabetes mellitus (DM), aged between 35 and 65 years, and with a DM duration exceeding 3 years, along with a minimum of seven teeth per arch determined through clinical examination, were included. Participants with type 1 diabetes mellitus, smokers, pregnant women, those on medications inducing gingival enlargement, those who underwent periodontal therapy in the last six months, and patients undergoing orthodontic treatment were excluded. Pocket depth and clinical attachment loss at six points on each reference tooth (including upper and lower first molars, first premolars, and central incisors) were measured using a Michigan 'O' Probe featuring William markings on a periodontal pocket chart. The arithmetic mean value was then calculated. To compare the two groups (adequately controlled diabetics and inadequately controlled diabetics), the mean pocket depth and mean clinical attachment loss were analyzed separately using an independent samples t-test. Results: The mean duration of DM, age, periodontal pocket depth, clinical attachment were 6.42 ±2.76 years, 50.77 ±9.50 years, 4.03 ±0.74mm, and 4.74 ±0.74mm. The males were 80(56%) and females were 62(44%). The mean PPD was less in well controlled (3.45±0.36mm) than poorly controlled diabetes (4.76±0.36mm) statistically significantly (p<0.001). Similarly mean CAL was less in adequately controlled (4.16±0.36mm) than inadequately controlled diabetes (5.47±0.36mm) statistically significantly (p<0.001). Conclusion: Inadequately controlled diabetes mellitus is associated with adverse periodontal health status.

Proteomic analysis of salivary inflammatory biomarkers of developmental gingival enlargements in patients with West and Noonan syndromes: a preliminary pilot single-center retrospective study.

The aim of the preliminary pilot single-center retrospective cross-sectional study was to analyze and compare the presence of non-secretory salivary inflammatory biomarkers in pediatric patients with West syndrome, Noonan syndrome, and a healthy control group. A total of 60 saliva samples were collected during dental check-ups. The saliva samples collected were analyzed by liquid chromatography. The results were analyzed with a t-test, and the statistical significance was given by a p-value lower than 0.05. We found statistical significance for defensin α1 (p=0.006) and thymosin β4 (p=0.025) in the Noonan syndrome. In the West syndrome, only the defensin α1 had a statistically significant difference with the other groups (p=0.022). Proteomic analysis revealed an overexpression of peptides related to the innate (thymosin β4) and acquired (defensin α1, α3) immunity. West and Noonan's syndromes showed the overexpression of molecular biomarkers involved in the pathogenesis of chronic periodontitis. The inflammatory status is triggered and amplified by the abnormal overgrowth of gingival tissues, the amplified release of proinflammatory cytokines from the immune cells, and the poor cooperation in maintaining adequate oral hygiene.

GUMMY SMILE, PANORAMIC REVIEW, DESCRIPTION, ETIOLOGY, EPIDEMIOLOGY, TREATMENT AND PROGNOSIS

Introduction: gummy smile is defined as a non-pathological condition that causes aesthetic disharmony in which more than 3 mm of gingival tissue is present when smiling. The smile is an essential aesthetic component of the face and significantly determines the perception of beauty and personality of each person. Objective: to detail the current information related to the gingival smile, description, etiology, epidemiology, evaluation, treatment and prognosis. Methodology: a total of 42 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 34 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: gingival smile, gingival hyperplasia, maxillary excess, orthognathic surgery. Results: Gummy smile presents a prevalence between 10.5% and 29% of young adults, being more frequent in women, and this prevalence is reduced with age due to the drooping of the upper and lower lips, which reduces the exposure of the gingiva and upper incisors. The perception of excessive gingival display is subject to cultural and ethnic preferences, showing that the amount of gingiva presented that is found to be unaesthetic or excessive is relative and changes between men and women. Conclusions: the smile is a common human expression that represents multiple feelings, as well as an essential esthetic component of the face and significantly determines the perception of beauty and personality of each person. The gummy smile is a non-pathological condition that causes aesthetic disharmony in which more than 3 mm of gingival tissue is present when smiling. A gummy smile can usually have repercussions in the perception and psychosocial behavior of the affected individual. The etiology of the gummy smile presents several factors, which usually manifest themselves at the same time. Treatment should be targeted according to the origin of the condition. Among the less invasive treatment alternatives are botulinum toxin injection and hyaluronic acid injection. The surgical repertoire includes gingivectomy, modified lip repositioning and orthognathic surgery. KEY WORDS: gummy smile, gingival hyperplasia, maxilla, orthognathic surgery.

Removal of Fibromatous Epulis Around The Anterior Maxillary Teeth (Case Report)

Fibromatous epulis is one of the most common features of the gingival enlargement. This condition results from inflammation of the gingiva, leading to fibrotic overgrowth caused by local or systemic factors. These enlargements increase gingival pocket depth, which may lead to periodontal disease causing functional disturbances in mastication, altered speech, aesthetics, and even psychological problems. A- 42-year-old male patient with gingival fibrotic overgrowth known as fibromatous epulis on proximal teeth in the middle upper front region extended to the palatal and accompanied by slight pain. The clinical appearance of this lesion was firm, slightly soft, and fibrotic, with 6 mm probing depth and bleeding on gingival probing at the proximal of 11 and 21 teeth region. In this case, periodontal surgery to eliminate gingival enlargement was a gingivectomy under local anaesthesia. The fibromatous epulis was entirely eliminated by gingivectomy, also effectively treated the inflammation, facilitated oral prophylaxis procedure, and increased the aesthetics.

Efficacy of hyaluronic acid gel and photobiomodulation therapy on wound healing after surgical gingivectomy: a randomized controlled clinical trial

BackgroundSurgical gingivectomy can be considered the gold standard treatment for gingival enlargement. The healing of wound site after gingivectomy occurs slowly by secondary intention. To accelerate the wound healing process, several studies have been conducted evaluating the effect of various treatment modalities. Photobiomodulation therapy (PBMT) was proposed to provide minimally invasive and painless treatment as well as to decrease discomfort of the patient following the surgical process. Another factor that is expected to improve the healing after surgery is topical application of chemotherapeutic agents such as Hyaluronic acid (HA). This study aims to assess the effect of topically applied HA gel after PBMT on the healing of wound site after surgical gingivectomy.MethodsThis randomized controlled clinical trial included twenty-six surgical gingivectomy wound sites, equally divided into two groups, Group-I (test group): the surgical sites after gingivectomy were irradiated with a diode laser (980 nm, 0.2 W) then covered by 2% HA gel loaded in a special custom-made soft transparent tissue guard appliance for each patient. Group II (control group): the surgical sites were irradiated with a diode laser (980 nm, 0.2 W) only. Wound healing was assessed subjectively by Landry healing index on the 3rd, 7th, 14th and 21st days after surgery, and pain perception was assessed by the patients using visual analog scale (VAS) throughout the 21 days of the follow up period. Comparisons between the two study groups were performed using Mann-Whitney U test, while comparisons between different time points were performed using Friedman test. Significance was inferred at p value < 0.05.ResultsBy the end of the follow-up period, surgical sites of the test group showed excellent healing compared to the control group. There were no significant differences in VAS scores between both groups (p > 0.05).ConclusionsApplication of 2% HA gel as an adjunctive to PBMT was found to have significant clinical effects and higher power of repair among test group when compared to that achieved by PBMT alone in control group.Trial registrationThis study was retrospectively registered on ClinicalTrials.gov and first posted on 28th of March 2023 with an identifier number: NCT05787912.

Conventional gingivectomy for chronic gingival enlargement in orthodontic treatment: a case report

Background: Gingival enlargement, also known as gingival overgrowth, is an enlargement of the gum tissue. There are many possible causes for enlarged gums. Gingival enlargement is general feature of gingival diseases. It is common note to chronic inflammatory gingival enlargement was caused by poor of oral hygiene. Orthodontic braces can interfere with good oral hygiene, contributing to the development of the inflammatory process. One of the most common soft tissue problems related to fixed orthodontic appliances is gingival hypertrophy or hyperplasia. Maintaining oral hygiene is hindered in cases of gingival hypertrophy due to orthodontic appliances. The most widely used surgical method to treat gingival hypertrophy is gingivectomy.&#x0D; Case Report : A 27-year-old patient was referred to the periodontal clinic of Airlangga University Dental Hospital because of primary gingival swelling with gingival bleeding during brushing in the anterior mandibular region. On intra oral examination showed excessive gingival with probing depth was range 4 mm on teeth 42-32, revealing the presence of pseudopockets. Clinical examination revealed generalized gingival enlargement as well as generalized bleeding on examination. After explaining the condition and treatment to the patient, he was registered for phase I treatment. After evaluating phase I therapies, phase II treatment with gingivectomy and gingivoplasty were required using a scalpel.&#x0D; Conclusion: Conventional gingivectomy gives satisfactory result in treating the inflammatory gingival enlargement.