Conventional versus laser gingivectomy in the management of gingival enlargement during orthodontic treatment: a randomized controlled trial.

OBJECTIVES: To compare the use of diode laser with conventional surgery evaluating the effectiveness of gingivectomy as an adjunct to non-surgical periodontal treatment in the management of gingival enlargement (GE) during orthodontic treatment. TRIAL DESIGN: Prospective three-arm parallel group randomized clinical trial with 1:1:1 allocation ratio. METHODS: Sixty subjects (33 males and 27 females), with a mean age of 14.4 ± 1.9 years, were selected according to inclusion criteria: overgrown gingivae on the labial side of the anterior teeth secondary to fixed appliance therapy, six maxillary anterior teeth present, and healthy non-smokers patients. Patients were enrolled in the study and randomly assigned to three groups by a computer-generated randomization list and by a block size of 4. The allocation information was concealed in opaque and sealed envelopes by the statistician. In the first group, all subjects underwent a conventional scalpel gingivectomy of the maxillary anterior sextant. In the second group, all subjects were treated using laser-assisted gingivectomy; while subjects assigned to the third group underwent only non-surgical periodontal treatment and served as control group (CG). The observer who performed all the measurements was blinded to the group assignment. Blinding was obtained by eliminating from the elaboration file every reference to patient group assignment. Intergroup comparisons of changes in the periodontal parameters were conducted at 1, 3, and 6 months using ANOVA with repeated measures and Tukey's post hoc tests. The significance level was set at P <0.05. RESULTS: After 1 month, the TGs showed a significant improvement of all periodontal parameters when compared with the CG. No statistically significant differences were observed between the two TGs. At the 3-month observation, a relapse occurred in the TGs, while the CG showed the greater improvement of soft tissue health. In the 6-month versus 3-month evaluation, no significant differences between the three groups were found for any periodontal measurements. In the long-term evaluation (6 months versus baseline), a significant greater reduction of pockets were found in the TGs when compared with the CG. CONCLUSIONS: The adjunct use of both scalpel gingivectomy and laser gingivectomy was more effective in controlling gingival inflammation than non-surgical periodontal treatment alone at 1, 3 and 6 months. In the control group, greater improvement in the periodontal parameters were observed within 3 months, depending on a self-care approach for the management of GE. LIMITATIONS: This study was a short-term study (6-month follow-up). TRIAL REGISTRATION: ClinicalTrials.gov (registration number: NCT03514316).

A Clinical Investigation of a Dual Zinc plus Arginine Dentifrice in Reducing Established Dental Plaque and Gingivitis Over a Six-Month Period of Product Use.

OBJECTIVES: The objective of this single-center, double-blind, parallel-group, randomized six-month clinical study was to evaluate the clinical efficacy of a new Dual Zinc plus Arginine dentifrice (Colgate-Palmolive Co., New York, NY, USA) containing zinc (zinc oxide, zinc citrate) 0.96%, 1.5% Arginine, and 1450 ppm fluoride as sodium fluoride in a silica base in reducing established dental plaque and gingivitis over a six-month period, relative to that of a regular fluoride dentifrice containing 1450 ppm fluoride as sodium fluoride in a silica base (Colgate- Palmolive Co., New York, NY, USA). METHODS: A total of 100 adult male and female subjects from Santo Domingo, Dominican Republic were enrolled in this clinical study. During the baseline visit, the dental examiner clinically measured three gingival parameters (gingival index, gingival severity index, gingival interproximal index) and three plaque parameters (plaque index, plaque severity index, plaque interproximal index). The examining clinician also performed an assessment of the oral soft and hard tissues. All subjects were then assigned a subject identification number in chronological order from 001 to 100 and were randomly assigned to one of two treatment groups following a computer-generated randomization list. They were provided with their assigned dentifrice and an adult, soft-bristled toothbrush for home use, and were instructed to brush twice daily (morning and evening) for one minute with the assigned dentifrice for a period of six months. Subjects returned to the study facility site for their follow-up evaluation of plaque and gingivitis parameters after three and six months. RESULTS: Ninety-six (96) subjects completed the study. At the three-month evaluation, subjects in the Dual Zinc plus Arginine dentifrice group exhibited statistically significant (p < 0.001) reductions in all gingival and plaque parameters relative to subjects in the fluoride dentifrice group. For gingival parameters, reductions were 18.8% for gingival index, 33.3% for gingival severity index, and 19.1% for gingival interproximal index. For plaque parameters, reductions were 11.0% for plaque index, 22.4% for plaque severity index, and 9.8% for plaque interproximal index. At the six-month evaluation, subjects in the Dual Zinc plus Arginine dentifrice group presented continuous statistically significant (p < 0.001) reductions in all three gingival and plaque parameters when compared to the subjects in the fluoride dentifrice group. For gingival parameters, reductions were 26.3% for gingival index, 56.6% for gingival severity index, and 29.2% for gingival interproximal index. For plaque parameters, reductions were 30.1% for plaque index, 61.9% for plaque severity index, and 28.0% for plaque interproximal index after six months of product use. CONCLUSIONS: The overall results of this double-blind clinical study support the conclusion that a Dual Zinc plus Arginine dentifrice containing zinc (zinc oxide, zinc citrate) 0.96%, 1.5% Arginine, and 1450 ppm fluoride as sodium fluoride in a silica base provides significantly greater reduction in dental plaque and gingivitis parameters as compared to a regular fluoride dentifrice containing 1450 ppm fluoride as sodium fluoride in a silica base after three months and six months of product use.

Open flap debridement of peri-implantitis with or without adjunctive systemic antibiotics: A randomized clinical trial.

AIMS: To investigate clinical, radiographic and microbiological outcome over 12 months following open flap debridement of peri-implantitis with or without antibiotics. MATERIALS AND METHODS: Peri-implantitis was surgically treated with or without Zithromax® in 19 control and 20 test individuals. Probing pocket depth (PPD), gingival inflammation (BOP), intra-oral radiographs and microbial samples were studied. Per protocol and intent-to-treat analyses were performed. RESULTS: The mean difference (reduction) in PPD values between baseline and month 12 in the test and control groups was 1.7 mm (SD ± 1.1, 95% CI: 1.1, 2.3, p < .001) and 1.6 mm (SD ± 1.5, 95% CI: 0.8, 2,4, p < .001), respectively. Data analysis failed to show study group differences for BOP, PPD, radiographic bone level and microbial load. Successful treatment (per protocol: PPD ≤ 5 mm, no BOP, no suppuration and no bone loss ≥0.5 mm) at 12 months in test and control groups was 7/15 (46.7%) and 4/16 (25.0%). Bacterial load reduction was similar in study groups with a temporary reduction following treatment. CONCLUSIONS: Surgical treatment of peri-implantitis with adjunctive systemic azithromycin did not provide 1-year clinical benefits in comparison with those only receiving open flap debridement.

Cryotherapy for localized juvenile spongiotic gingival hyperplasia: preliminary findings on two cases.

BACKGROUND: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a distinct subtype of inflammatory gingival hyperplasia that shows lack of response to traditional periodontal treatment, and after surgical excision, recurrence rate of 6-16% has been reported. CASE REPORT: Two girls (11- and 9-year-old) with multifocal red patches along the maxillary and mandibular labial gingiva showed no regression of the lesions after basic periodontal treatment. Surgical excision of focal lesion in each case was performed, which showed typical features of LJSGH. In both cases, the lesions presented recurrence. Hence, cryotherapy sessions in all lesions were performed. CONCLUSION: Cryotherapy appears to be successfully in LJSGH and well received by paediatric patients.

Gingival fenestration defect treated with gingivectomy and gingivoplasty: A case report with an 8-year follow-up.

INTRODUCTION: Gingival fenestration (GF) is scarcely reported in the literature. We present a unique case of GF defect combined with gingivitis and altered passive eruption (APE). CASE PRESENTATION: An 18-year-old female patient with gingivitis, APE, and GF in the mandibular left central incisor presented for periodontal treatment. The gingival lesion was successfully treated with basic periodontal therapy gingivectomy, and gingivoplasty and resulted in an excellent aesthetic long-term outcome. This case report shows its 8-year clinical follow-up. CONCLUSION: There are no earlier reports dealing with the use of gingivoplasty for the treatment of GF, as it is not the usual therapeutic intervention for these defects. Gingivoplasty proved to be effective in treating GF. Why is this case new information? Available literature on gingival fenestration defects does not describe gingivectomy and gingivoplasty as a treatment of choice. Gingivectomy and gingivoplasty proved to be effective in treating gingival fenestration defects. What are the keys to successful management of this case? Proper diagnosis. What are the primary limitations to success in this case? Gingival fenestration has been defined when the overlying gingiva is denuded, exposing the root to the oral cavity. However, in this case report, only the crown was exposed because the patient had altered passive eruption.

Local concentration of systemic amoxicillin and metronidazole in healthy and inflamed gingiva: a comparative in vivo study.

BACKGROUND: One of the most recommended methods of systemic antibiotic administration in periodontics is the combination of amoxicillin and metronidazole, which has great inhibitory effect on periodontal pathogens. The aim of this study is to determine the local concentrations of these drugs in gingiva and compare its distribution in healthy and inflamed tissues. METHODS: The study population was selected from patients referred to our department. Fifteen subjects were referred for crown lengthening, and another 15 subjects required flap surgery because of severe periodontitis. All 30 patients received three doses of amoxicillin 500 mg plus metronidazole 250 mg before surgery. Tissue samples were gathered during surgery, and chemotherapy was continued for 7 days with 8-h intervals. After 7 days, during the second appointment, the next samples were collected. Samples were sent to the laboratory to determine the drug concentration with the use of high-performance liquid chromatography. RESULTS: Amoxicillin concentration in healthy gingival tissue was not detectable. The concentrations after 24 h and 7 days of administration were 25.9±4.1 and 124.8±18 µg/mL, respectively. The values for metronidazole were 28.86±1.7, 1.70±0.3, and 36.0±1.5 µg/mL. CONCLUSIONS: The combination of systemic amoxicillin and metronidazole for 7 days has sufficient gingival connective tissue concentration much more than the minimum inhibitory concentration in healthy and inflamed tissue.

Acellular dermal matrix graft for gingival augmentation: a preliminary clinical, histologic, and ultrastructural evaluation.

BACKGROUND: The aim of this study was to evaluate clinically, histologically, and ultrastructurally the integration process of the acellular dermal matrix used to increase the band of keratinized tissue while achieving gingival inflammation control. METHODS: Ten patients exhibiting a mucogingival problem with bands of keratinized tissue

Feline chronic gingivostomatitis is more prevalent in shared households and its risk correlates with the number of cohabiting cats.

OBJECTIVES: The aim of this study was to determine whether feline chronic gingivostomatitis (FCGS) is more prevalent in shared vs single-cat households, whether the number of cohabiting cats or outdoor access represent risk factors for FCGS and whether the number of cohabiting cats is a useful prognostic indicator for standard surgical treatment. METHODS: Cats diagnosed with FCGS (study group) in the past 5 years at a referral institution were identified. The number of cohabiting cats, outdoor access, number of other cohabiting cats diagnosed with FCGS, ⩾6 month surgical outcome, when applicable, and historical signs of upper respiratory disease among any of the cohabiting cats, as well as patient demographic information, were recorded. Data were collected from medical records and by means of a telephone interview with the owners. The same information was collected from a group of cats of similar demographic characteristics diagnosed with periodontal disease but free of FCGS (control group). RESULTS: Seventy-six cats were included, of which 36 (47%) had FCGS and 40 (53%) served as controls. Bivariate analysis showed that cats with FCGS were significantly more likely to come from shared households, and had significantly more total cats per household compared with controls. Multivariate analysis also showed that cats in shared households had a significantly increased odds of FCGS compared with those from single-cat households. Historical signs of upper respiratory disease and outdoor access among cats within the same household were not associated with FCGS. The number of cohabiting cats was not associated with surgical outcome. CONCLUSIONS AND RELEVANCE: Cats with FCGS are more likely to live in shared households. The risk of FCGS correlates with the number of cohabiting cats. The epidemiological features of FCGS may support an infectious etiology. The number of cohabiting cats within a household is not a useful prognostic indicator for standard surgical treatment of FCGS.

Influence of Periodontal Disease on cardiovascular markers in Diabetes Mellitus patients.

The objective of the present study was to establish if individuals with Diabetes Mellitus (DM2) and periodontal diseases (gingivitis or periodontitis) presented an increase in the concentration of modified LDL (moLDL) and what is the influence of periodontal treatment on the decrease of moLDL particles with consequent improvement in the parameters of DM2. Twenty-four diabetic patients with periodontitis (Group 1) and twenty-four diabetic patients with gingivitis (Group 2) were followed up for a period of 12 months. Group 1 was treated with periodontal debridement, and Group 2 received supra-gingival scaling and prophylaxis. In both groups, periodontal clinical parameters: probing depth (PD), clinical attachment level (CAL), gingival resection (GR), bleeding on probing index (BOP) and plaque index; inflammatory serum markers (glycemia, A1c, total cholesterol, HDL-cholesterol (HDL-c), LDL-cholesterol (LDL-c), triglycerides and hs-CRP) and oxidized LDL (oxLDL) were measured at baseline, t = 6 and t = 12 months after treatment. Solutions of LDL were analyzed using the nonlinear optical Z-Scan and optical absorption techniques. The periodontal clinical parameters showed significant improvement (p < 0.05) in both Group after 12 months. For both groups, total cholesterol, HDL-c, LDL-c, triglycerides and A1c levels did not show significant reductions after periodontal therapy. hs-CRP levels in Group 1 presented a significant reduction after 12 months. The glycemic rate and the oxLDL concentrations did not show significant differences as a function of time. The optical measurements of LDL solutions revealed an improvement of the LDL-c quality in both groups. Periodontal debridement was able to improve periodontal parameters and the quality of LDL-c in diabetic patients but without changes in the oxLDL concentration in both groups. Considering the clinical relevance, the reduction of infectious and inflammatory sites present in the oral cavity through periodontal therapy may help with the control and prevention of hyperglycemia and precursors of cardiovascular diseases.

Inflammatory fibrous hyperplasia treated with a modified vestibuloplasty: a case report.

AIM: The purpose of this report is to present a case of surgical and prosthetic treatment of a woman with inflammatory fibrous hyperplasia (IFH) and her evaluation during a six month period. BACKGROUND: IFH is a benign pathology, prevalent in female patients, and principally associated with ill-fitting prosthetic devices in need of adjustment. It is common for patients to require surgical removal of the hyperplastic tissue and fabrication of a new prosthesis. CASE REPORT: A 55-year-old female with a history of smoking presented with a chief complaint of missing the scheduled adjustment of her maxillary complete denture and the presence of moveable tissue under the denture. Surgical excision of the hyperplastic tissue followed with fixation of the prosthesis for six months to guide the healing of the soft tissue and to reshape the contours of the maxillary supporting tissues. SUMMARY: Surgical removal of hyperplasic soft tissue is a routine procedure, and the fixation of the prosthesis for the support of tissue during healing improves intraoral conditions for the fabrication of a new prosthesis in the future.

CAD/CAM techniques help in the rebuilding of ideal marginal gingiva contours of anterior maxillary teeth: A case report.

BACKGROUND AND OVERVIEW: "Pink esthetics," which are considered to be as important as "white esthetics," have attracted increasing attention. To date, clinicians rarely have applied computer-aided design and computer-aided manufacturing (CAD/CAM) techniques in the rebuilding of the contour of the marginal gingiva in the esthetic zone. CASE DESCRIPTION: In this case report, the authors describe a female patient who had gingival inflammation and an asymmetrical contour of the marginal gingiva of the anterior maxillary teeth because previously placed ceramic crowns violated the biological width. The authors used a 3-dimensional-printing surgery template to guide precise crown-lengthening surgery to expose subgingival shoulders and to obtain an ideal marginal gingival contour. Then the authors used interim CAD/CAM crowns to induce the growth of the interdental papilla by 0.5 to 1.5 millimeters. Finally, the patient had a symmetrical and well-balanced contour of the marginal gingiva. In addition, the authors reduced the patient's "black triangle" areas to the greatest possible extent. CONCLUSIONS AND PRACTICAL IMPLICATIONS: This case report illustrates that CAD/CAM products, including 3-dimensional-printing surgery templates and CAD/CAM interim crowns, are helpful in shaping and rebuilding the ideal contour of the marginal gingiva in the esthetic zone, such as the anterior maxillary teeth.

Localized bacillary angiomatosis in the oral cavity: observations about a neoplasm with atypical behavior. Description of a case and review of the literature.

Bacillary angiomatosis is a rather frequent infectious pathology appearing mainly in the skin but can also affect the liver, spleen, heart, bones, lungs, muscles, central nervous system and other organs. The localization of the lesion in the oral cavity is rather rare, as it is evident in the literature. Bacillary angiomatosis can be clinically similar to the Kaposi's sarcoma and histologically confused with angiosarcoma, epitheloid hemangioma and pyogenic granuloma. A case of bacillary angiomatosis of the oral cavity in an immuno-competent patient is described. The high tendency to relapse, the capability in migration and to involve several localizations at the same time have induced the authors to deepen the research to exclude the possibility that it could be a Kaposi's sarcoma or a pyogenic granuloma and to get to an accurate diagnosis in order to resolve the disease.

Gingival Margin Stability After Mucogingival Plastic Surgery. The Effect of Manual Versus Powered Toothbrushing: A Randomized Clinical Trial.

BACKGROUND: Oscillating-rotating power toothbrushes have been proven to be clinically efficacious. To the best of the authors' knowledge, a clinical evaluation of the safety of these toothbrushes after surgical root coverage procedures has not been published. The aim of this study is to evaluate the gingival margin (GM) stability with the use of an oscillating-rotating toothbrush compared with a manual toothbrush. METHODS: Sixty healthy individuals with at least one Miller Class I or II gingival recession underwent a surgical root coverage procedure. Soft-bristle manual and powered toothbrushes were given to participants randomly assigned to control and test groups, respectively. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), and recession depth (RD) were recorded at baseline and 1, 3, and 6 months after completion of the surgical procedure. Data analyses were performed using linear random-intercept models to take into account within-participant correlations over time. Temporal trend differences across treatments by including treatment-time interaction terms were then tested using a global Wald test. RESULTS: Use of a powered toothbrush resulted in a significantly greater reduction of recorded periodontal clinical indices compared with a manual device (FMPS, P = 0.05; FMBS, P = 0.005; RD, P = 0.004). No significant differences were noticed between the two experimental groups both for PD (P = 0.03) and clinical attachment level (P = 0.11). Complete root coverage was significantly higher in participants who used the powered toothbrush compared with the manual toothbrush at 6 months (control, 66.67%; test, 96.67%; P = 0.002). CONCLUSION: Use of an oscillating-rotating powered toothbrush with a soft-bristle head resulted in higher GM stability after root coverage procedures compared with the use of a manual soft-bristled toothbrush.

Clubbed fingers in a patient with inflammatory gingival hyperplasia.

The association of clubbing with miscellaneous diseases and its diagnostic implications are such that its detection should prompt consideration of the underlying etiology. We encountered a 48-year-old woman with clubbed fingers and a cauliflower-like gingival swelling on the hard palate of the upper jaw. There were no conventionally well-known causes for clubbing. Histological examination of gum biopsy specimen revealed a diagnosis of inflammatory gingival hyperplasia. As an etiology of clubbed fingers, gingivitis was suggested, since clubbing was regressed in parallel with remission of the gingivitis after the treatment by extraction of anterior teeth. Possible involvement of an autoimmune process in the pathogenesis was also considered, because of concomitant elevation of serum anti-double strand DNA antibodies. We recommend examination of the oral cavity for search of an inflammatory disease in cases with clubbed fingers, particularly when other common causes are not apparent.

Gingivostomatitis.

Gingivostomatitis (GS) with various patterns of disease may require antiviral therapy, steroids, laser fulguration, immunomodulation drugs, or nonsteroidal anti-inflammatory drugs. The use of cyclosporine as an immunomodulation drug has long-term benefits in reduction of the immunologic events that contribute to GS. Whole-mouth extraction or partial extraction (premolars and molars), with radiographic conformation that all root remnants have been removed, may be the most viable option in nonresponsive and or intractably painful stomatitis in noncompliant cats or dogs. Oral inflammation subsided after extraction without the need for further medication in approximately 70% of the cats from two studies with previous chronic unrelenting oral disease. The combination of immunomodulation with cyclosporine together with laser resection of proliferative tissue should be recommended if extraction of teeth is not desired. Removal of proliferative oral tissues by lasing (carbon dioxide laser) removes the tissue that maybe producing tissue antigens and the area where bacteria are sequestered. The use of anti-inflammatory medications is recommended in the management of GS. Therapeutic success is achieved when there is elimination of proliferative tissue and inflammation.

Lymphoplasmacytic gingivitis in a cat.

A 12-year-old male neutered short haired cat was presented due to difficulty eating and pawing at the face. Examination revealed severe gingivitis and stomatitis throughout the oral cavity. Gingival biopsy provided a diagnosis of lymphoplasmacytic stomatitis. Extraction of all premolars and molars resulted in elimination of all clinical signs.

Plasma cell gingivitis with severe alveolar bone loss.

Plasma cell gingivitis is a rare benign condition of the gingiva characterised by sharply demarcated erythaematous and oedematous gingiva often extending up to the muco gingival junction. It is considered a hypersensitive reaction. It presents clinically as a diffuse, erythaematous and papillary lesion of the gingiva, which frequently bleeds, with minimal trauma. This paper presents a case of a 42-year-old man who was diagnosed with plasma cell gingivitis, based on the presence of plasma cells in histological sections, and severe alveolar bone loss at the affected site, which was managed by surgical intervention.

Impact of cigarette smoking on clinical outcomes of periodontal flap surgical procedures: a systematic review and meta-analysis.

BACKGROUND: Periodontal flap surgery is frequently used to remove subgingival deposits, yielding consequential reductions in gingival inflammation and probing depth (PD) with a gain in clinical attachment level (CAL) to treat advanced periodontal disease. However, clinical studies have reported diminished periodontal healing in smokers compared with non-smokers. The aim of the present systematic review and meta-analysis was to assess the impact of cigarette smoking on clinical outcomes following periodontal flap surgical procedures. METHODS: A systematic electronic review of articles relevant to periodontal flap surgical procedures in smokers was conducted from 1977 to March 2014 inclusive, using predefined, optimized search strategies. Meta-analyses were done separately for changes in the two primary outcomes of PD and CAL. RESULTS: The initial search yielded 390 titles and abstracts. After screening, eight controlled clinical studies were finally selected. Three studies were assessed as having a low risk of bias, two as having moderate risk of bias, and three as having a high risk of bias. Qualitative assessment of the articles consistently showed an improved treatment effect among non-smokers versus smokers. The reduction in PD in smokers and non-smokers ranged from 0.76 to 2.05 mm and 1.27 to 2.40 mm, respectively. For CAL, the gain in non-smokers versus smokers ranged from 0.29 to 1.6 mm and 0.09 to 1.2 mm, respectively. Meta-analysis on eight studies reporting on 363 study participants demonstrated an increased reduction in mean (95% confidence interval) PD of 0.39 (0.33 to 0.45) mm. Similar results were found for mean gain in CAL (0.35 [0.30 to 0.40] mm, n = 4 studies). CONCLUSIONS: Considering the relatively homogenous information available, the authors conclude that active smokers could be candidates for periodontal flap surgical procedures. However, the magnitude of the therapeutic effect is compromised in smokers compared with non-smokers. Therefore, cigarette smokers should be: 1) encouraged to abstain from smoking; and 2) thoroughly informed preoperatively of substantial reduction in clinical outcomes compared with non-smokers.

Focal facial inflammation of the attached gingiva.

An unusual gingivitis noted as a discrete lesion involving the facial attached gingiva in a focal and confined area has been described in two adolescent females. A unique histopathologic appearance includes a striking intraepithelial edema associated with a focal area of acute and chronic inflammation. Inconclusive immunologic study of one patient indicated an epithelial-connective tissue immune complex deposition suggestive of but not typical of that seen in pemphigoid.

Longitudinal evaluation of the excisional new attachment procedure in humans.

Evaluation of the Excisional New Attachment Procedure (ENAP) was extended to 3 years postoperatively. Generally, there was an overall mean increase in sulcus depth of 0.5 mm; an overall mean increase in recession of 0.1 mm; and an overall mean decrease in the amount of previously gained new attachment of 0.6 mm between 1 year and 3 years after surgery. These values reflected a statistically significant, but clinically insignificant, difference in mean sulcus depth and mean attachment level between the two evaluation periods. Only one tooth site demonstrated clinical findings worse than those determined preoperatively. These results are similar to those of other longitudinal studies.