Gingival Soft Tissue Research Articles

Periodontal soft tissue management with a high pulse rate Er:YAG laser

The purpose of this study was to evaluate the effectiveness and safety of periodontal minor soft tissue surgery with the Er/YAG laser at a high pulse rate of 30 Hz and the subsequent clinical wound healing. Sixty-one patients were subjected to gingivectomy, removal of gingival melanin pigmentation, or frenectomy using the Er/YAG laser. Clinical parameters were evaluated before, immediately after, at 1 week and 4 weeks after surgery. The Er/YAG laser was capable of cutting or ablating gingival soft tissue easily and effectively with less or no bleeding as well as less pain. The healing process was uneventful without any complications or side effects. The results of this study suggest that the Er/YAG laser at 30 Hz could be used safely and effectively for minor periodontal soft tissue management without causing major thermal damage as well as the delay of wound healing.

Bilateral gingival metastasis of lung adenocarcinoma: Report of a case

Metastatic tumors to the oral region are uncommon and comprise only about 1% of all malignant oral neoplasms.1 Most reported cases involve the jaws rather than the soft tissues.2 Because gingival metastases are unusual, their diagnosis can pose a challenge to both clinicians and pathologists. Clinically, gingival metastatic tumors can closely resemble and easily be mistaken for benign reactive lesions or even a neoplasm, such as a hemangioma.3,4 We report a case of a poorly differentiated bronchogenic adenocarcinoma that metastasized to the gingival soft tissue in a patient with generalized gingival inflammation.

Differences in histochemical characteristics of gingival collagen after ER:YAG laser periodontal plastic surgery.

The aim of this study is to evaluate gingival collagen for the effect of treatment with the Erbium:YAG Kesler handpiece. The handpiece is designed for gingival resurfacing in cases of hypertrophic gingiva and gingival pigmentation. Lasers represent recent technological advances that afford new options for the treatment of periodontal diseases. However, lasers used for esthetic gingival soft tissue resurfacing require careful histopathological evaluation of the effects on tissue. In particular, it is important to determine the effect of laser irradiation on connective tissue, especially the collagen fibers. To date, no stage-wise clinical or histological studies have been performed addressing this issue. Ten patients underwent irradiation with the following parameters: energy per pulse, 500 mJ; repetition rate, 10 pps; spot size, 3 mm. Gingival biopsy specimens were derived from 6 patients with hypertrophic gingiva and 4 with gingival pigmentation. The patients were examined before laser treatment and at 7 and 14 days after laser treatment. The tissues were fixed in tymph node revealing solution (LNRS), embedded in paraffin, sectioned at 5 microm, and stained with hematoxylin & eosin. The status of collagen in the treatment site was examined under polarized light after picrosirius red (PSR) staining. PSR is a collagen stain that differentiates collagen fiber density or size by means of a spectrum of color changes under polarized light. The major colors are red, orange, yellow, and green. We found a significant difference in the properties of collagen fibers at the first week and at 14 days post-treatment. In the normal gingiva, the predominant polarization colors were in the red-orange range, signifying tightly packed, mature collagen. During the first postoperative week, collagen fibers exhibited polarization colors in the green to green-yellow range, implying loosely packed collagen fibers. After 2 weeks, collagen fibers reacquired their preoperative PSR characteristics. We conclude that sequential series of changes accompany photothermal treatment of the gingiva. The occurrence of this sequence in all successful outcome cases may suggest the importance of these temporally sequenced changes in collagen during gum healing. In any event, the status of PSR staining of gum collagen provides a useful adjunct in the assessment of gingival health.

A technique to manage gingival complications of third molar surgery.

Iatrogenic damage to the gingiva of the mandibular second molar is an often overlooked complication associated with surgery of impacted mandibular third molars. During impaction surgery, the peripheral gingival soft tissues may be damaged on flap elevation or destroyed during bone removal or tooth sectioning with rotary instruments. Loss of the often-thin band of keratinized gingiva of the second molar predisposes a patient to pain, plaque retention, inflammation, gingivitis, pocket formation, periodontitis, and alveolar bone loss. The surgically-induced bone defect associated with impaction removal exacerbates the aforementioned problems, which are difficult to treat with conventional techniques. This article attempts to address this issue and presents an new technique to manage such gingival complications.

Gingival metastasis as first sign of a rectal cancer

Metastases of internal tumors to the oral cavity are unusual and involve in most cases maxilla and mandible, while metastases of the gingival soft tissue are extremely rare. We report a case of gingival metastasis from rectai cancer.

Influence of Tooth Instrumentation Roughness on Gingival Tissue Reactions

Histological studies have demonstrated a relationship between the amount of subgingival plaque and the magnitude and extension of gingival tissue reactions. The objective of the present study was to evaluate inflammatory reactions in the gingival tissues facing plaque accumulation at a diamond and curet-instrumented root surfaces. Experimental, deep periodontal defects were established at buccal surfaces of mandibular and maxillary canine teeth in 5 beagle dogs. The root surfaces were instrumented by a flame-shaped, fine-grained. rotating diamond point, or by a sharp curet. Next, the dogs were fed a plaque-inducing diet for 70 days. The animals were then sacrificed, and tissue blocks of the experimental sites including teeth, alveolar bone, and gingival tissues were secured. The gingival soft tissue was processed for histomorphometric analyses at 3 levels. Epithelium and connective tissue area measurements showed no differences between the two instrumentations. Junctional epithelium (JE) cell point counts exhibited a higher proportion of inflammatory cells (IC)in specimens facing diamond compared to curet-instrumented defects. A higher proportion of IC was present within the coronal compared to the apical aspect of the JE for both instrumentations (P < 0.05). A significant difference in IC density between instrumentations was detected for non-infiltrated (P < 0.05), as well as for infiltrated (P < 0.01) connective tissue. The infiltrated connective tissue (ICT) inflammatory cell density was significantly (P < 0.01) and positively correlated to the JE inflammatory cell density (r = 0.75), and to area measurements of ICT (r = 0.55). The overall results demonstrate that the character of subgingival root instrumentations significantly affects gingival inflammatory reactions, most likely by influencing subgingival plaque formation.

Digital panoramic radiography: a clinical survey

The application of digital panoramic radiography with photostimulable phosphors to dental diagnosis was evaluated in 500 patients. Comparative intraoral films of selected groups of teeth and electronic magnifications of the same portion of the arches were obtained in 63 cases. Digital images improved the quality of dental examinations compared with film radiographs. The possibility of contrast modulation was helpful to compensate for the different radiographic densities of the arches and to improve the visibility of gingival soft tissues. In addition, digital radiography reduced the radiation dose administered to the patient. The use of digital panoramic radiography is proposed as a substitute for film studies in all hospitals where a central unit for digital radiology is available.

Reproducibility of data from a hand-held digital pulp tester used on teeth and oral soft tissue

Controlled studies of the reproducibility of data from electronic pulp testing instruments are limited and contain few statistical analyses. The reproducibility of these readings is important if the instrument is to be used for determining differences in sensitivity. Twenty human subjects (16 male) were used in this study. One incisor, one premolar, one molar tooth with small or no restorations, and two gingival soft tissue positions from each upper and lower arch of each subject were stimulated with the Analytic Technology vitality scanner. This procedure was repeated twice with a 5-minute rest between each trial, for a total of three trials. Each subject was then seen again after a period of at least 3 days, at which time the trials were repeated. The collected data were grouped by trial, tooth position, and day. Paired t test analysis of both the absolute difference between any two trials on the same day and the average of the absolute differences between corresponding trials on days 1 and 2 showed no statistically significant differences ( p>0.05). Accommodation to the stimulus was evaluated by examining differences in the mean values between the three same-day trials. The Analytic Technology vitality scanner was found to be reproducible both for consecutive same-day trials and for corresponding trials on different days. No same-day trends in meter readings were noted.

ポーセレンラミネートベニア補綴の短期予後

Laminate veneer restorations were made for 40 patients with 202 teeth were restored. After recalling for prognosis evaluation (for the duration varied from six months to three years two months), the results were summarized as follows:1. The examination of gingival soft tissue showed that 61 teeth (30.2%) were attached by plaque and 87 teeth (43.1%) had sign of gingivitis.2. Marginal adaptation and surface condition of restorations were still good.3. The color of restorations were evaluated “excellent” of “good” by both patients and dentists.4. After setting the restorations, four patients (10%) felt sensitive to cold water, however, the symptom disappeared within one week.5. Detachment and fracture occured to six teeth (3%) which were corrected by resetting or remaking if necessary.

Gingival health associated with porcelain veneers on maxillary incisors

The possible detrimental effect of acid-etched resin-bonded prostheses and porcelain veneers on plaque accumulation and gingival health is currently disputed. Some workers recommend no tooth preparation prior to veneering whilst others recommend tooth preparation to prevent adverse gingival soft tissue reactions. In order to test the possible gingival effects of veneers placed without tooth preparation, this study was set up to compare gingival health on veneered and non-veneered maxillary incisors within the same individual during periods of normal tooth cleaning and of no tooth cleaning. No significant differences were noted in plaque or gingival indices, or in gingival crevicular fluid volume, between the 72 veneered and non-veneered sites during either study period. The results of this study suggest that placing porcelain veneers on unprepared teeth does not increase the risk of gingivitis.

Fabrication of a teaching aid for dental soft tissue management and suturing

A technique for fabrication of a model to aid in teaching surgical management and suturing is presented. The model, which simulates dentition, supporting periodontium, and gingival soft tissue, can be made inexpensively in a dental laboratory.

Root resorption caused by mechanical injury of the periodontal soft tissues in rats.

The purpose of the present investigation was to study, histologically, the effect on the root surface of mechanical injury to the periodontal soft tissues in rats. The animals were subjected to mechanical injury with a flat, needle‐like instrument only in the gingiva and the cervical periodontal ligament of the first maxillary molar. Odontoclastic root resorption occurred in part of the root surface at the alveolar crest level at 1 day. It extended gradually in the coronal direction over the following days, reaching part of the root surface at the cementoenamel junction at 14 d, and undermining part of the dentin below the enamel just above the cementoenamel junction at 21 d. The result of the present study indicated that mechanical injuries of human gingival soft tissues being sustained accidentally or during dental treatments might cause odontoclastic resorption of the root surface.

Histologic study of tooth transplantation in the rabbit

Tooth transplantation between preimmunized unrelated mismatched animals appears to induce the same immunologic problems that appear in the grafting of other organs. Such transplants showed more inflammatory root resorption and ankylsis and less reattachment of periodontal ligaments than did allografts between compatible animals. It appears that transferring the teeth to the similar side, suturing the gingival soft tissue around the teeth, splinting the transplanted teeth, and antibiotic therapy improve results by minimizing the effects of surgical procedures and trauma. Surgical trauma is confirmed as an important factor, along with immunogenetic differences between donor and recipient, in determining the outcome of tooth transplantation.

Implanting of allogenic demineralized dentin in human gingival tissue.

Abstract Previous studies have shown that implants of allogenic demineralized dentin in the abdominal muscle of rats and guinea‐pigs, and possibly also in the gingival tissues of man, may induce heterotopic bone formation. A preliminary study of the bone‐inducing effect of allogenic demineralized dentin in human gingival soft tissue is reported.A total of 15 dentin specimens were implanted in the gingiva of six patients (32–58 years of age) who required surgical periodontal treatment. In addition, one implant was placed in the frenulum labiale superior of each of eight patients. The implants remained in the tissues for 4–30 weeks and showed evidence of varying degrees of resorption, but they appeared to be well tolerated. The amount of resorption was not related to the observation time. Dentinal tubules were invaded by connective tissue cells. In a few instances remineralized of the demineralized dentin seemed to have occurred. In one case, an area resembling newly‐formed hard tissue was observed. There was, however, no conclusive evidence of bone formation induced by the dentin implants.