Treatment of Gingival Fenestration with Connective Tissue Graft: A Case Report.

Here, we report a case of gingival fenestration requiring periodontal plastic surgery. The patient was a 32-year-old man presenting with the chief complaint of esthetic impairment and gingival twitching due to gingival fenestration. Baseline examination revealed localized periodontal breakdown, including gingival fenestration in the lower right central incisor (#41). Periodontal examination revealed 3% of sites with a probing depth of ≥4 mm and 8.9% with bleeding on probing. Radiographic examination revealed vertical bone loss in #15 and 36, together with buccal fenestration in #41. Based on a clinical diagnosis of chronic periodontitis with gingival fenestration, initial periodontal therapy comprised plaque control and scaling and root planing. Following suppression of inflammation, occlusal adjustment was performed in the anterior teeth. As plastic surgery, combined use of an elevated flap and a connective tissue graft was applied at #41. Following reevaluation, the patient was placed on maintenance care. The patient's periodontal condition has remained stable over a 6-month period.

Endodontic-periodontal management of two rooted maxillary lateral incisor associated with complex radicular lingual groove by using spiral computed tomography as a diagnostic aid: a case report.

AIM: To present the successful endodontic and periodontal management of a two rooted maxillary lateral incisor tooth with a complex radicular lingual groove and severe periodontal destruction using spiral computed tomography as a diagnostic aid. SUMMARY: A 30-year-old male patient presented with a chief complaint of mobility and discharge of pus in an upper front tooth. Clinical examination revealed a sinus tract on the labial gingival surface and a 10-mm-deep periodontal pocket associated with maxillary left lateral incisor tooth. On the lingual side, a groove emerging from cingulum, continuing mesioapically down the lingual aspect of tooth was found. Intraoral periapical radiographs demonstrated a lateral periodontal defect around the mesial aspect and a diffuse radiolucency at the apex of maxillary left lateral incisor tooth. The sinus tract was traced with gutta-percha to the maxillary left lateral incisor that showed an accessory root surrounded by a large radiolucent area. A spiral computed tomographic scan for better understanding of the complicated root canal morphology of the tooth was performed. Based on the clinical, radiographic and spiral computed tomographic findings, a diagnosis of an endo-perio lesion in tooth 22 was made. Management consisted of conventional root canal treatment, radiculoplasty, root resection of accessory root and surgical curettage of the periodontal defect. Follow-up with radiographic examination at 3 months and 1 year was performed. At 1-year recall, the patient was asymptomatic, there was no evidence of the sinus tract and a 3-mm nonbleeding pocket was present in relation to tooth 22. Progression of hard tissue healing was observed in the periapical radiograph taken 1 year postoperatively. KEY LEARNING POINTS: The key to achieving favourable results in this particular type of developmental anomaly is accurate diagnosis and treatment planning. The health of the periapical osseous tissues appears to be the provital factor for tooth retention. A favourable outcome can only be achieved with a comprehensive treatment approach that effectively manages all local factors that are contributing to the disease process.

Commentary: A Translational Medicine Approach to Tooth Transplantation.

The autogenous tooth transplantation approach to replace missing teeth has been in use for a long time. Different surgical techniques have been developed to improve prognosis and longevity of transplanted teeth with complete root formation. Many factors reportedly affected short- and long-term success of the procedure: complications such as ankylosis and root resorption up to the tooth exfoliation have occurred frequently. Several studies have appeared on this issue over the years. However, outcomes of transplantations have not yet been conclusively determined as no randomized clinical trials have been published on this issue, and their effectiveness has been evaluated only in observational studies. On the other hand, interesting information from specific experimental studies on the healing pattern of the interface between the root surface and alveolar bone in the replantation/transplantation model, and from non-related studies dealing with mechanically induced periodontal trauma, has been available and potentially useful since the 1970s to 1980s. However, this information has not been incorporated into clinical literature regarding tooth autotransplantation. This commentary aims to show how information from related and unrelated experimental models was translated to a clinical setting and led to a novel approach, successfully applied, in the autotransplantation of a multirooted tooth with completed root formation.

Furcation involvement--a suggested rationale for treatment.

Furcation involvement is classified and methods of treatment discussed. Evidence is presented to indicate that altered plaque elimination techniques are essential in the furcation region.

Evaluation of the results of periodontal treatment by means of digital subtraction of radiographic images.

UNLABELLED: This article presents general principles and a sample case of application of digital subtraction of x-rays for objective evaluation of results of treatment in dentistry. PURPOSE: Evaluation of the results of surgical periodontal treatment by means of digital subtraction of radiographic images taken before and 12 month after surgery. MATERIAL AND METHODS: For evaluation of the results of guided tissue regeneration treatment of deep bony defects digital periapical x-rays were taken before and 12 months after surgery. Pairs of images obtained during treatment were calibrated to equalize vertical x-ray beam angulation followed by calibration to radiological contrast and density. Next the comparison of images taken before and after treatment was performed by means of special computer software designed to subtract content of given images. RESULTS: Digital subtraction showed that the radiological density in regions where surgery was performed has decreased over a period of 12 months meaning that the mineral content which is responsible for absorbing x-ray photons has increased. Some local foci of subsurface hypomineralization were found on subtractions images. These foci couldn't be detected clinically because hypomineralization was taken place within bone. CONCLUSIONS: Digital subtraction of x-rays taken before and after surgery treatment is detailed and objective method of evaluating results particularly when changes of surface and subsurface bone mineralization around teeth must be examined.

The clinical and radiological assessment of periodontal bone loss treatment using Emdogain.

UNLABELLED: ADMISSION: Emdogain is the only one biomaterial using biomicra effect which is practiced in periodontal surgery. PURPOSE: The purpose of the study was a clinical and radiological assessment of bone loss treatment using Emdogain. MATERIAL AND METHODS: There were 19 persons examined (11 women and 8 men) which have bone loss treated. Initial and monitoring examination after 10 months embraced clinical parameters such as PPD, CAL and radiological--based on intraoral x-ray pictures. Emdogain treatment was made according to surgical procedures. RESULTS: The research has shown reduction of the depth of periodontal pockets average about 3.4 mm and attachment connective tissue growth about 2.2 mm. Bone loss filling was on 67.1% level. DISCUSSION: Bone loss filling and growth of connective tissue attachment are in our research lower than in most of the others publications. Our observation concerned 10 months period so we should expect better effects after longer time. MOTIONS: Emdogain is safe and effective regeneration material.