Internal Bevel Research Articles

Flap surgery with bone graft and periodontal membrane in generalized chronic periodontitis patient

Objectives: The aim of this case report is to present a flap surgical procedure with bone graft and periodontal membrane in generalized chronic periodontitis patients.
 Case Report: A 51-years-old male patient came to RSGM Saraswati bringing a referral from a colleague for dental and periodontal treatment. The patient came with complaints that the lower left gingiva often feels swollen, pain and mobility. Clinical examination revealed edema, sulcus exudate and positive percussion on tooth 36, the deepest pocket depth of 13 mm on the disto-buccal site. X-ray and blood laboratory examinations were carried out before surgery. Flap surgery is performed by internal bevel, sulcular and horizontal incisions with opening of the envelope flap, cleaning and smoothing of bone defects, application of collagen bone grafts and periodontal membranes, suturing with absorbable suture on the periodontal membrane and nylon on the gingiva flap.
 Conclusion: Flap surgery with bone graft and periodontal membrane is one of the options for reconstructive surgery to repair periodontal tissue in cases of generalized chronic periodontitis. The results showed the repair of periodontal tissue both soft tissue and alveolar bone of tooth 36.

Different managements for surgical approaches in the aesthetic and functional treatment of type IB altered passive eruption

Aesthetics has been one of the most discussed and explored subjects in today’s dentistry. Therefore, the search for procedures aimed at facial harmonization has been more frequent in dental offices. The gingival smile is characterized by excessive gingival exposure to the smile being one of the main complaints of the patients who seek a dental surgeon in order to obtain facial aesthetics, being able to present different causes. It is extremely important to correctly diagnose each case so that the correct etiology is stable and successful in the treatment to be performed. Objective: In the present paper, two clinical cases of patients with complaints of gingival smile and short teeth were reported in which the etiology of both was type IB altered passive eruption. Case report: Due to the individual characteristics of each patient, each case was solved with different surgical approaches. In the first case, the patient had a thick periodontium and therefore the clinical crown lenghtening procedure was performed through the internal bevel gingivoplasty with osteotomy and osteoplasty. In the second case, the patient had a thin periodontium, and it was possible to perform a clinical crown lenghtening using the flapless technique. Conclusion: Therefore, although both cases present the same etiology, different periodontal surgical techniques were used, which allowed for satisfactory results for the patients.

A case report of unique unilateral idiopathic gingival enlargement

Gingival enlargement is usually characterized as an increase in the size of the gingiva. Idiopathic gingival enlargement is a rare condition and the etiology usually will be undetermined. The enlargement may be generalized enlargement or it may be confined to either of the jaws. The gingival enlargement is usually treated according to the type of enlargement encountered. In this article, we discussed a rare case report of a 15-year-old young adult with unilateral idiopathic gingival enlargement with unknown etiology and the management of the enlargement with internal bevel gingivectomy. There was no recurrence observed at 2 and 6 months maintenance visits and the healing was better with no discomfort for the patient. Key Words: Gingival enlargement, internal bevel gingivectomy, idiopathic gingival enlargement, hereditary gingival hyperplasia.

SURGICAL INTERVENTION OF IDIOPATHIC GINGIVAL ENLARGEMENT BY LEGDE AND WEDGE TECHNIQUE

Increase in the size of gingiva referred to as “gingival enlargement,” usually overlls the interproximal spaces, ballooning out over the teeth and sometimes even protruding into the oral cavity. It may occur as localized enlargement in relation to a single tooth, a group of teeth, or may be generalized involving the entire dentition. Sometimes, it may appear as diffuse enlargement of gingiva without any specic etiologic factor. It is then considered as idiopathic enlargement. Patient with gingival hyperplasia should be examined to exclude other reasons to determine the idiopathic gingival bromatosis or not. Treatment is not required in all cases of idiopathic gingival hyperplasia. Surgical excision is indicated if mechanical problems exist. In this case report, an idiopathic gingival enlargement was successfully treated using gingivectomy by ledge and wedge procedure. This describes an unusual case of non-syndromic generalized idiopathic gingival bromatosis in a 19-year-old female. Surgical treatment in the form of ledge and wedge procedure with internal bevel gingivectomy was performed .The surgical technique performed yielded functionally as well as esthetically satisfying results and at the same time, it maintains the integrity of periodontium

ATYPICAL PLASMA CELL GINGIVOSTOMATITIS: A RARE CASE REPORT

ATYPICAL PLASMA CELL GINGIVOSTOMATITIS: A RARE CASE REPORT

Surgical Management of Plaque Induced Gingival Enlargement: A Case Report

Introduction: Gingival enlargement or gingival overgrowth, a common trait of gingival disease, is characterized by an increase in the size of gingiva with multifactorial etiology. Purpose: This case report aimed to discuss gingival enlargement case along with the treatment plan of the patient.Case presentation: A 50-year-old female patient reported the swelling in the gums of teeth in lower front region since six months ago. Gingival enlargement was treated with modified Widman flap procedure, internal bevel incision, and bone recontouring. These treatment modalities showed significant clinical improvement in the form of pocket depth reduction and gingival contour Conclusion: Dental plaque bacteria served as initial factor of inflammation which induce the occurrence of gingival enlargement. Surgical treatment can be done if the initial phase still presenting gingival enlargement with firm consistency with minimum inflammation.

Geometry design, meshing analysis and error influences of face-hobbed cycloidal bevel gears with double circular-arc profile for a nutation drive

As the core components of nutation drive, the internal meshing pair of bevel gear must be delicately designed to achieve desirable operational performances for the transmission device. For this purpose, this paper designs a face-hobbed internal meshing pair of cycloidal bevel gears with double circular-arc profile (DCAP). First, a cutter head with DCAP cutting edges is designed to generate the tooth surface of internal gear pair. Then, the tooth geometry of the external and internal bevel gears are derived according to the meshing theory. Finally, a finite element model is developed to simulate the meshing characteristics of the gear pair. The simulation results reveal that the proposed face-hobbed cycloidal bevel gear pair with DCAP has higher contact/bending strength, better load sharing and smaller transmission error compared with the logarithmic spiral bevel gear pair with DCAP. The effects of four typical manufacturing errors on meshing characteristics of the proposed bevel gear pair are investigated to provide fundamental references for the tolerance design of cycloidal bevel gears.

Alternative aesthetic treatment of dental agenesis: a case report

Objective: To restore the self-esteem of an adolescent patient with dental agenesis through an alternative conservative aesthetic treatment. Methodology: A case report. Demarcation of the gingival plasty area and determination of bleeding points for gingivoplasty with a periodontal probe, incision using the internal bevel technique with a 15c scalpel blade and Kirkland's gingivotome. Composite resin increment technique by conditioning the enamel with 37% phosphoric acid for 30 seconds, washing with water for 1 minute and drying with absorbent paper. Application of the Adhesive System Adapter Single Bond 2 and light curing for 20 seconds. Soon after, with the aid of a Uvenner matrix, the resin Z350xt filtek supreme color B1 enamel was used for a thin veneer, photoactivated 3 times for 20 seconds. Interproximal excesses were removed with sandpaper. Results: The treatment, based on a gingivoplasty and reanatomization in composite resin, restored the patient's smile and self-esteem directly and quickly. Conclusion: A multidisciplinary planning based on the principles of conservative restorative dentistry is capable of restoring the aesthetic patterns of the smile, thus restoring the patient's self-esteem and social well-being.

ALTERED PASSIVE ERUPTION:A CASE REPORT

An esthetic smile is directly related to the alignment and contour of the gingiva. Excessive gingival exposure (gummy smile) may be the reason for an unaesthetic smile. It can be caused by various etiological factors, one such factor is altered passive eruption. We report a case of a 24-year-old female patient who came with the chief complaint of an unaesthetic smile, diagnosed with altered passive eruption along with its surgical management involving an internal bevel gingivectomy and osseous resective procedure.

Mathematical modelling and simulation machining of CNC milling of double-arc spiral internal bevel gear with nutation drive

The machining method of double-arc spiral internal bevel gear with nutation drive-by milling cutter was proposed in this paper. The mathematical modelling of milling cutter trajectory and axial cut-off of forming milling cutter was established, the special machining tool model of bevel gear was further developed by Solidcam, the simulation machining of bevel gear was carried out. Then, the gear model obtained after simulation was compared and analyzed with the theoretical gear model, and the ideal experimental results, confirmed the CNC modelling milling method processing technology could be used to process bevel gears, the research is very important to improve the development of nutation dynamic transmission.

Rare occurrence of orofacial granulomatosis with deformity in gingiva – unusual case report

Persistent soft tissue enlargement in the orofacial region is often considered a feature of a chronic disease, termed as orofacial granulomatosis (OFG). Systemic diseases like crohn's, inflammatory bowel syndrome present OFG as their oral manifestation, but it may also be seen in the absence of these diseases. To the best of the authors' knowledge and literature search, this is the first case of OFG with gingival deformity related to cigarette smoking. A 25-year-old male patient presented with chief complaint of swelling on his upper lip, increase in the size of gingiva and hypersensitivity in the maxillary anterior teeth region. After thorough history of disease initiation in response to cigarette smoking, clinical examination, histopathological findings, the diagnosis of OFG associated with cigarette smoking was made. Treatment included cessation of cigarette smoking, internal bevel gingivectomy, with proper medication. Single treatment modality may not be effective in such cases. Therefore, early and precise diagnosis with sequential treatment including elimination of etiological agent, anti-inflammatory drugs or even plastic surgeries may be required for improving patient's health, appearance and comfort.

Crown Lengthening Surgery for Enhancing Restorative Treatment in Esthetic Zone

For obtaining adequate retention for restoring cases like subgingival caries or extensive caries that shortens the tooth, short clinical crown, and fractures, it is usually necessary to disclose more tooth structure. Crown lengthening procedure is done to increase the clinical crown length for restorative or esthetic reasons without breaching the biologic width. These procedures are also utilized to improve the appearance and retention of restorations placed within the esthetic zone. We report a case of crown lengthening surgery with an internal bevel gingivectomy which was done in our department without compromising tooth support and esthetics.

The edge out punch: An advancement that reduces transections in follicular unit excision hair transplantation.

The follicular unit excision (FUE) technique has become the preferred method for hair transplants over the traditional strip harvest technique due to low scar visibility and shorter recovery time for the patient. However, a limitation of the FUE technique is the potential for graft trauma due to the small diameter, sharp punches used to harvest individual follicular units. Here, we introduce the novel edge out FUE punch that is designed with a thicker wall and has an internal bevel. We describe how the dynamics of this punch reduces the risk of follicle transection. A review of the available literature and information on the edge out punch in comparison with other punch shapes, as well as the authors' experience in this area, is provided. The edge out punch is designed with thick walls and an internal bevel, placing the sharp cutting edge on the outer diameter. The dynamics of this punch aid in directing the graft into the center of the punch lumen and keeps the sharp cutting edge away from the hair follicles deeper in the dermis, reducing the risk of follicle transection. The dynamics of the forces generated by the edge out punch aid in minimizing follicular transections during graft harvesting. By understanding the dynamics behind this novel punch, hair restoration surgeons (HRSs) can optimize their surgical technique to obtain consistently high-quality grafts during FUE.

In Vitro Comparison of Microbial Leakage of the Implant-Healing Abutment Interface in Four Connection Systems.

This study sought to assess microbial leakage through the implant-healing abutment interface in 4 dental implant connection systems. Ten implants of each of the 3i (double hexagon + flat to flat; group 1), IDI (internal hexagon + Morse taper; group 2), Swiss Plus (external bevel + internal octagon; group 3), and Tapered Screw-Vent (internal bevel + internal hexagon; group 4) systems were used in this in vitro, experimental study. Healing abutments were screwed to the implants with 10 Ncm torque. Implants were immersed in Escherichia coli suspension for 24 hours. Samples were taken of the internal surface of implants and cultured. The number of grown colonies was counted after 24 hours of culture and after 7 and 14 days of immersion in microbial suspension. The same was repeated with healing abutments torqued to 10 and 20 Ncm. With 10 Ncm torque, all specimens in all groups showed microleakage at one day with the highest microleakage in one sample in group 3. At 7 days, the highest microleakage was noted in one specimen in group 2. With 20 Ncm torque, group 3 showed significantly higher microleakage than other groups at 1 and 7 days (P < .05). Increasing the torque decreased microleakage in all groups except for group 3. Microbial leakage occurred in almost all implant systems in our study. In one-stage implant placement, healing abutments should be preferably torqued to 20 Ncm to minimize microleakage. Optimal torque for healing abutment insertion should be analyzed individually for each system.

Crack propagation through sandwich bones due to low-velocity projectile impact.

Projectile impact in sandwich bones typically results in formation of conoidal wounds exhibiting a larger region of damage on the inner cortical plate termed the bevel. To date, a number of hypotheses have been put forward to explain the formation of this wound type. The plug and spall hypothesis suggests that the conoidal morphology is produced by a two-phase mechanism of shear plug formation followed by internal bevel production during projectile exit. In contrast, the cone crack hypothesis suggests that such wounds are produced by cone crack propagation through the three laminae of the sandwich bone, resulting in the formation of bioceramic conoids consisting of all three bone laminae. In order to test these hypotheses, 28 non-human sandwich bones were impacted with 6-mm carbon steel spheres at velocities ranging from 26 to 96metres per second (m/s). Impacts were filmed utilizing high-speed videography and fracture morphology analysed using micro-computerized tomography (μ-CT). Sequential increase in velocity successfully captured the genesis of conoidal wounds. Low-velocity impact produced circular depressed fractures in the outer cortex exhibiting angulated cortical fracture edges. An increase in velocity resulted in translaminar fracture and production of one intact and three fragmentary bioceramic conoids. At the highest velocities, conoids were fragmented and lost in the ejecta plume, with attached fragments undergoing dynamic movement during and after perforation. Significantly, projectile exit was not required for bevel production. The implications of these findings in wound interpretation are discussed.

Comparison of two training protocols in periodontal surgery teaching for undergraduate students

Objective: To compare the efficacies of two training protocols, i.e. the multimedia instruction and the conventional method, in periodontal surgery teaching for undergraduate students. Methods: One hundred and twenty-three dental undergraduates in their pre-clinical training course were recruited and divided into two groups according to the learning grade matching principle: the experimental group (multimedia instruction, 60 students) and the control group (conventional method, 63 students). The teaching aim was to train the students gingivectomy and periodontal flap surgery by using the pig jaws. The conventional teaching method of teacher-demonstrating and student-practicing was used in the control group, and the practice time of the students' for each surgery was 45 minutes. A standardized teaching video combined with the teachers' explanations of the key steps was used in the experimental group. The students' practice time for each surgery was 60 minutes. The efficacy of teaching protocol was evaluated by the teachers according to the scoring criteria set by the teaching group. Results: In gingivectomy training, accuracy of fixed points, angle of postoperative gingival margin and morphology of gingiva of the experimental group were better than those of the control group. The experimental group also had more complete and continuous excised gingivae and more thorough adjacent gingival removal. The total scores of the experimental group were significantly higher than those of the control group (92.8±2.6 vs. 89.9±3.7, P<0.05). In periodontal flap surgery training, the experimental group operated the blade around the shape of the tooth better in internal bevel incision than the control group. Additionally, the incision position of internal bevel incision, periosteal integrity after flapping and flap depth of the experimental group were better than those of the control group. Besides, the experimental group had smoother flap edge and more thorough debridement. The total scores of the experimental group were significantly higher than those of the control group (92.2±4.1 vs. 89.2±4.4, P<0.05). Conclusions: The teaching efficacy of multimedia instruction was better than that of the conventional method. Its value needs to be further tested in future teaching practice.

A novel hypothesis for the formation of conoidal projectile wounds in sandwich bones.

When perforated by a projectile, sandwich bones typically exhibit wounds with a distinct conoidal morphology that is widely utilised both in wound diagnosis and trajectory determinations. However, the dynamic fracture mechanisms underlying this intriguing wound type have yet to be experimentally verified. The most frequently quoted hypothesis for their formation, plug and spall, is difficult to reconcile with the conoidal morphology exhibited by such wounds. The present article carries out a high-speed videographic and micro-computerised tomographic (μ-CT) analysis of perpendicularly produced projectile wounds induced from 139.15 to 896.84metres per second (m/s) in pig scapulae. Fundamental data on energy absorption, wound shape and bevel symmetry are presented. Cross-sectional fracture morphology revealed by μ-CT raises the novel hypothesis that tensile stresses induced by the projectile in the outer cortex elicit cone crack formation and that this cone crack then propagates catastrophically through the entire sandwich structure. This process results in the momentary formation of a bioceramic conoid, a conoidal volume of bone consisting of all three sandwich bone layers separated from the parent bone by the internal bevel. Fragmentation of the separated volume leaves the conoidal wound behind as its counterpart. The significance of this hypothesis in terms of differential diagnosis and interpretation of bevel shape is discussed.

Hereditary Gingival Fibromatosis: a Case Report with Seven-Year Follow-up.

IntroductionHereditary gingival fibromatosis (HGF) is a rare disease characterized by gingival enlargement, normal color with benign and firm consistency. This growth may be exacerbated by use of drugs and plaque build-up. The treatment for this clinical condition is surgical excision of the enlarged gingival tissue or the extraction of all teeth.Case ReportA 20-year-old Brazilian female handicapped patient with a chief complaint of exaggerated gingival enlargement who had been prescribed Carbamazepine and Gardenal was referred to our center. According to the clinical presentation and family history, the final diagnosis of gingival enlargement was HGF. Full dental treatment was performed, including basic periodontal treatment, restorations, sealants, and gingivoplasty with internal bevel. Special care was taken to ensure that there was no change in patient’s anticonvulsant medication. The patient has been monitored for seven years without signs of recurrence of gingival hyperplasia due to constant professional and home control of plaque.

Fracture tooth reattachment

Anterior teeth fractures occur daily, with the main patient demand to restore esthetically the resultant defect. There is nothing more esthetic than the tooth itself. Many techniques were described to use the fractured piece to restore this defect in case of accurate fit. The objective of this article is to summarize these techniques to give the dental practitioners the opportunity to restore the fractured tooth more conservatively and in the same time more esthetically. Also it throws light on the prevalence and etiology of tooth fracture. Frontal teeth are subjected to traumas more than other teeth in the mouth. These traumas may lead to tooth fracture with or without pulp involvement. In attempts to restore the fractured tooth in more esthetic and conservative manner, the fractured piece may be used as a restorative material. This treatment modality has gained increased popularity among dental practitioner due to the continuous development in the adhesive field. Several techniques were used. These techniques include, simple reattachment, external chamfer, over contouring, internal dentin bevel, and internal enamel bevel. All these techniques try to afford the highest fracture resistance accompanied with the least possible tooth preparation. Combination of two or more technique would result in better performance.Keywords:Bevel, bonding, reattachment, tooth fracture.

Crown lengthening surgery: A periodontal makeup for anterior esthetic restoration

With the increasing popularity of esthetic dentistry, an understanding of the therapeutic modalities brought about by an interdisciplinary approach has developed. As a result, crown lengthening procedures have become an integral component of the esthetic armamentarium and are utilized with increasing frequency to enhance the appearance and retention of restorations placed within the esthetic zone. The present case is managed with an internal bevel gingivectomy together with bone recontouring without compromising tooth support and esthetics.