A conservative approach for keratinized tissue augmentation: Report of two cases.

BACKGROUND: Free gingival graft harvested from the palate is considered the most predictable method to augment the keratinized tissue (KT). However, the anatomical limitations of the palate, and associated patient morbidity and complications restrict clinicians from performing these procedures in adolescents. Color mismatch with the native tissues resulting in poor esthetic appearance is another concern. To overcome these limitations, this article reports a surgical approach known as labial gingival graft (LGG) as an alternative to palatal graft. METHODS: Two adolescent patients presenting with absence of attached gingiva and shallow gingival recession in the mandibular incisor region were treated with LGG harvested from the labial KT of teeth adjacent to those requiring KT augmentation. RESULTS: The procedure was well tolerated by the patients. At the final follow-up (3.5- and 2 years from baseline), a significant gain in KT with complete root coverage was achieved in both patients. Both professional and patient-centered esthetic evaluations revealed excellent color match making the grafted area imperceptible from the adjacent mucosa. CONCLUSIONS: The proposed technique was found to be simple and predictable, and was associated with minimal morbidity and no complications. Clinicians may consider performing LGG procedure when sufficient KT can be harvested from adjacent donor site. The selection of such techniques is of particular relevance in children who are vulnerable to complications associated with more invasive procedures. KEY POINTS: Why are these cases new information? To the best of our knowledge, this article is the first to present the use of labial gingival graft harvested from adjacent keratinized mucosa in adolescent patients. What are the keys to successful management of these cases? Proper case selection in terms of sufficient amount of keratinized tissue to harvest as labial gingival graft from adjacent teeth. Use of smaller instruments, small-sized needles, and sutures under magnification to minimize trauma to the tissues /graft. Preparation of an immobile periosteal bed and suturing protocol that minimizes the dead space and ensures revascularization of graft. What are the primary limitations to success in these cases? A prerequisite of the presence of thick gingiva and sufficient dimensions of KT around the adjacent teeth further limits its applicability in all cases.

Metallothionein levels in gingival crevicular fluid, saliva, and serum of smokers and non-smokers with chronic periodontitis.

BACKGROUND: Metallothionein (MT), a cysteine rich protein is involved as a radical scavenger in several pathological conditions associated with oxidative stress; however, its role in periodontal disease still remains elusive. The aim of this cross-sectional study is to determine the serum, saliva and gingival crevicular fluid (GCF) levels of MT in smokers (S) and non-smokers (NS) with chronic periodontitis (CP), and compare them with those of periodontally healthy (PH) individuals. METHODS: A total of 85 participants were enrolled: 45 patients with CP (23 S [CP+S] and 22 NS [CP+NS]) and 40 PH individuals (20 S [PH+S] and 20 NS [PH+NS]). In all the study participants, clinical periodontal parameters (plaque index, gingival index, sulcus bleeding index, probing depth, and clinical attachment level) were recorded and samples of serum, saliva and GCF were collected. Enzyme-linked immunosorbent assay was used to determine the levels of MT in the samples. RESULTS: All periodontal clinical parameters were significantly higher in the CP groups as compared to PH groups (P < 0.05). MT levels in CP+S group were significantly raised in comparison to other three groups. There was no statistically significant difference in MT levels among CP+NS and PH+S groups (P > 0.05); however, relatively higher levels were observed in GCF and saliva in CP+NS group. When all the study groups were observed together, MT levels were positively correlated with clinical parameters. CONCLUSIONS: Results of present study suggest that smoking and CP can induce the synthesis of MT owing to increased oxidative stress and heavy metals intoxication. Further longitudinal studies with large sample size and an interventional arm are needed to substantiate the role of MT as a potential biomarker in periodontitis.

Inflammatory myofibroblastic tumor manifesting as recurrent generalized gingival enlargement: Report of a rare case.

Oral inflammatory myofibroblastic tumor (IMT) is extremely rare and its manifestation as generalized gingival enlargement (GGE) has never been reported. We are reporting the case of 50-year-old female patient presenting with recurrent GGE for 4 years. Panoramic radiograph revealed severe bone loss in posterior sextants and root resorption in some teeth. Initial incisional biopsy was suggestive of chronic inflammatory infiltrate with fibrocollagenous tissue. Definitive treatment comprised of surgical excision of the enlarged gingiva with a tapering dose of steroid therapy. Histopathological and immunohistochemical examination from a repeat biopsy of deeper tissues was suggestive IMT. No recurrence was found at 2 years follow up. Recurrent GGE with advanced bone loss and external root resorption should raise the suspicion of a locally aggressive lesion. Dentists should be aware of oral IMT and include it in differential diagnosis of gingival enlargements for comprehensive management to avoid recurrence of the lesion.

Periodontal Microsurgical-Assisted Pouch and Tunnel Approach in Combination with Subepithelial Connective Tissue Graft for the Management of Class IIB and IIC Multiple Adjacent Gingival Recessions in Mandibular Anterior Segment.

Gingival recession (GR) is an early and common clinical expression found in a majority of the population which increases with age. Different factors contribute to its etiology. It is a matter of concern for the patient which may be due to altered function and esthetics etc. Multiple conventional plastic surgical procedures are recommended for the management of GR depending on isolated or multiple GR. The present report described the plausible etiology of multiple adjacent GRs and classified it according to a new well-elaborated recession classification system proposed by Kumar and Masamatti, due to the limitation and applicability of most commonly used Miller's GR classification in the present clinical situation and its successful management through periodontal microsurgical-assisted pouch and tunnel approach in conjunction with subepithelial connective tissue grafting without any complication 6 months postoperatively.

An unusual case of idiopathic gingival fibromatosis.

Idiopathic gingival fibromatosisis, a condition of undetermined cause can develop as an isolated disorder, but mostly it is associated with some syndrome. It usually begins at the time of eruption of permanent teeth but can develop with the eruption of deciduous dentition and rarely present at birth. This case report describes an unusual case of non-syndromic generalized idiopathic gingival fibromatosis in a 15-year-old male present since birth. Surgical treatment in the form of ledge and wedge procedure with internal bevel gingivectomy was performed. No recurrence of enlargement was seen after 2 years of follow-up.

Primary Non-Hodgkin Lymphoma of Palatal Gingiva.

INTRODUCTION: Non-Hodgkin lymphomas (NHLs) are a heterogeneous group of lymphoproliferative malignancies that can disseminate to organs and tissues that do not ordinarily contain lymphoid cells (extranodal sites). Primary extranodal NHL of the oral cavity is rare, and gingiva is one of the rarest intraoral sites involved. The majority of oral NHLs reported are of diffuse large B-cell type. Such lymphomas are more prevalent in immunocompromised patients. Because of their malignant nature, early recognition, diagnosis, and treatment are essential for a patient's survival. To the best of our knowledge, this report presents the first case of diffuse mixed small and large B-cell lymphoma involving the gingiva in a non-immunocompromised patient. CASE PRESENTATION: A female patient presented with a growth located on the palatal aspect of the right maxillary molar region involving marginal and interdental gingiva. Routine laboratory tests and clinical examination were within normal limits. An incisional biopsy of the gingival tissue was evaluated using histologic techniques and immunohistochemistry. A diagnosis of extranodal diffuse mixed small and large B-cell lymphoma was established. The patient underwent a complete workup to rule out other systemic lesions, thereby supporting the primary nature of the lesion. CONCLUSION: Gingival overgrowth may rarely be the first manifestation of extranodal NHL. Only histopathological examination of the specimen with immunohistochemistry can ascertain a confirmed diagnosis of NHL. The present case report stresses the importance of routine biopsy examination for growth lesions of long duration when an infectious etiology has been ruled out, even if the lesions appear benign.

Clinical evaluation of guided tissue regeneration combined with autogenous bone or autogenous bone mixed with bioactive glass in intrabony defects.

Conflicting data exist on the combined use of grafting materials and barrier membranes in comparison to guided tissue regeneration (GTR) with membrane alone. The aim of the present study was to compare the clinical outcomes of GTR with collagen membrane (CM) alone (control group) or CM combined with autogenous bone graft (test group 1) or autogenous bone mixed with bioactive glass (test group 2) in intrabony defects. A total of 32 intraosseous defects in 22 subjects were treated randomly. After 6 months, significant probing depth reduction, clinical attachment level gain (CAL) and defect resolution were observed in all groups with significantly greater improvements in the test groups. There was no significant difference between the two test groups in any parameter. Results of the present study suggest that autogenous bone can be mixed with bioactive glass if the amount of the harvested bone is not sufficient.