Synovial plica of the elbow - detailed measurements and how to implicate its relevance in clinical practice.

PURPOSE: The synovial plica of the elbow is a fold of synovial tissue, which is said to be a remnant of the embryonic septa of normal articular development and is located around the radiocapitellar joint. The objective of the present study was to provide morphometric properties of the synovial plica of the elbow and its relation to surrounding structures in asymptomatic patients. METHODS: A retrospective study was conducted to establish the morphometric characteristics of the synovial plica of the elbow. The results of 216 consecutive patients, who for different reasons during the five year period of time underwent magnetic resonance imaging (MRI) of an elbow, were analyzed. RESULTS: Plica was found in a total of 161 of 216 elbows (74.5%). The mean width of the plica was set to be 3.00 mm (SD: 1.39). The mean length of the plica was established at 2.91 mm (SD: 1.13). An analysis of sexual dimorphism was also included. Potential correlations were analyzed for each of the categories and age. CONCLUSIONS: The synovial plica of the elbow is a clinically relevant anatomical structure. Analyzing the morphometric parameters of the synovial plica is necessary to properly evaluate synovial plica syndrome, which can commonly be confused with other sources of lateral elbow pain such as tennis elbow, oppression of the radial and/or posterior interosseous nerve, or snapping of the triceps tendon. The authors suggest that the thickness of the plica may not be the golden diagnostic feature as there are no statistically significant differences in this parameter between symptomatic and asymptomatic patients. A precise and accurate diagnosis of synovial fold syndrome and/or differentiation from other sources of lateral elbow pain must be performed, as the surgical treatment, even if performed properly, will be unsuccessful because of a misdiagnosed source of pain.

In Vivo Evaluation of Periodontal Phenotypes Using Cone-Beam Computed Tomography, Intraoral Scanning by Computer-Aided Design, and Prosthetic-Driven Implant Planning Technology.

BACKGROUND Two clinical parameters, the gingival thickness (GT) and the width of keratinized tissue (WKT), describe the gingival phenotype, which is defined as the 3-dimensional volume of the gingiva. The periodontal phenotype additionally includes the thickness of the labial plate of the alveolar crest (TLPAC). MATERIAL AND METHODS Thirty patients with healthy periodontium on the upper canines and incisors underwent measurements for crestal, supracrestal, free gingival thickness (FGT), the alveolar crest-gingival margin (AC-GM), alveolar crest-cementoenamel junction distance, and the TLPAC at 2, 4, and 8 mm apically from the edge of the alveolar crest using cone-beam computed tomography (CBCT) with computer-aided design and prosthetic-driven implant planning technology. For each tooth, the gingival and periodontal phenotype was evaluated on the basis of the gingival thickness, width of keratinized tissue (WKT), and TLPAC measurements. Each patient's periodontal phenotype was evaluated according to the coronal width/length ratio of both the upper central incisors. RESULTS The dentogingival units had varying average values for the 3 periodontal phenotypes (thin phenotype: FGT 0.65±0.06 mm, WKT 4.85±1.18 mm, AC-GM 3.17±0.64 mm, TLPAC2 0.66±0.28 mm; medium phenotype: FGT 0.87±0.07 mm, WKT 5.49±1.23 mm, AC-GM 3.36±0.65 mm, TLPAC2 0.76±0.37 mm; and thick phenotype: FGT 1.20 mm, WKT 6.00 mm, AC-GM 3.90 mm, TLPAC2 0.90 mm). Positive correlations were seen among WKT, FGT, AC-GM, and TLPAC2. CONCLUSIONS Positive correlations between the FGT and WKT, and the AC-GM distance confirm that measurements using CBCT with computer-aided design and prosthetic-driven implant planning technology can evaluate the gingival phenotype and TLPAC2 for the periodontal phenotype.

Dental Health Status and Oral Health Care in Nursery School-Aged Children and their Parents Living in Poznan (Poland).

OBJECTIVES: The aim of this study was to evaluate the dental health status of nursery age children and parents. The use of dental services was assessed. SUBJECTS AND METHODS: The study was performed in nursery schools located in Poznan, Western Poland. Clinical examination was carried out in 157 children (48.41% males and 51.59% females), aged 10-42 months. Dental health status (the number of teeth with caries, fillings and extracted) of their parents was determined on the basis of data obtained from a questionnaire. The questions also concerned information on child's and parents' dental check-ups and opinion on their predisposition to dental caries. RESULTS: Clinical examination revealed that 21.05% of boys and 18.51% of girls had dental caries. Most mothers had from 1 to 5 either carious and/or filled teeth (47.13%) or extracted teeth due to carious process (61.15%); the fathers' values were similar at 46.50 and 66.24%, respectively. More mothers (84.71%) than fathers (72.62%) had regular dental check-ups (p = 0.02). The analysis of mother-father-child triads showed that when both parents visited the dentist regularly, more children were free of caries (56.68%) in comparison to those with the disease (13.38%; p < 0.001). CONCLUSIONS: This study showed that the dental health status, as well as oral care of nursery school children and their parents, is unsatisfactory. Therefore, there is a need to introduce an intensive dental educational program focusing on dental prophylaxis for nursery age children and their parents or caregivers.

Reproducibility of the PIROP ultrasonic biometer for gingival thickness measurements.

OBJECTIVES: Gingival thickness (GT) has a great importance in periodontal flap design, gingival recession, and soft tissue esthetic. The aim of this study was to determine the reproducibility of PIROP ultrasonic biometer, which is specially designed for human GT measurements and to compare with the invasive transgingival probing technique. MATERIALS AND METHODS: GT was measured in 25 periodontally healthy volunteers both by PIROP and an endodontic spreader on the attached gingiva. Reproducibility was assessed by calculating standrad deviaton (SD) in five repeated measurements and Pearson correlation coefficient (r). Agreement between the two methods was evaluated based on Bland-Altman limits of agreement (LoA). RESULTS: No systemic bias in GT was observed between the two methods. The repeatability of the PIROP was better than the spreader method (SD = 0.14 mm vs 0.20 mm, P < 0.001). With five repetitions, the measurement error of the PIROP was halved. The correlation among the repeated observations were strong (r = 0.86) for the ultrasonic, weak (r = 0.34) for the invasive method. The LoA between the two methods was -0.58 to +0.75 mm. CONCLUSION: PIROP is a reliable device for GT measurements, but it is recommended to repeat the measurement a few times to improve the precision in individual case. CLINICAL SIGNIFICANCE: PIROP ultrasonic biometer could be used in routine practice to reliably measure the GT in noninvasive way. After short learning curve the measurement can be done quickly and conveniently.

Computer-Guided Immediate Full-Arch Implant Reconstruction of the Mandible in Severe Periodontally Compromised Patients: Three-Dimensional Analysis of Bone Volume Changes.

PURPOSE: Comprehensive rehabilitation in patients with severe periodontal destruction may require the use of dental implants. The primary aim of this study was to evaluate bone volume changes in periodontally compromised patients over a 12-month follow-up period after immediate full-arch implant reconstruction of the mandible. The secondary aim was to evaluate the repeatability of 3D bone volume change measurement methods around dental implants. The null hypothesis was that bone volume would decrease in the first year after delivery of the definitive prosthetic reconstruction. MATERIALS AND METHODS: This retrospective study analyzed CBCT scans of 16 patients before and after computer-guided immediate full-arch implant reconstruction of the mandible. The bone volume change in the mandibular body and around the implants and the peri-implant bone area in coronal and axial cross sections were calculated. RESULTS: The average bone gain for the mandibular body was 3.3% ± 1.8%. The average bone volume increase in the peri-implant area was 23.2% ± 16.7%. The interobserver and intraobserver ICC values for 3D measurements were high (> 0.85). CONCLUSION: The null hypothesis was rejected. Both mandibular body and peri-implant surroundings undergo bone remodeling in the form of bone gain over 12 months after immediate implantation.

Laterally Positioned Flap Procedure with Augmented or Nonaugmented Palatal Connective Tissue Grafts in the Treatment of Multiple Adjacent Gingival Recessions: A Two-Year Follow-Up Study.

The most commonly used technique for covering gingival recessions is the coronally advanced flap (CAF) technique due to its high success rate. In clinical situations where there is less keratinized tissue apical to the defect due to unfavorable anatomical conditions, a more advantageous technique for this situation should be considered, specifically the laterally positioned flap (LPF). The aim of this study was to compare the gingival thickness after gingival recession coverage using the laterally positioned flap supported by an augmented and non-augmented connective tissue graft (CTG). Thirty-four patients with 105 gingival recessions of Miller's class I and/or II were enrolled in this study. The method of choice was the laterally positioned flap. The test group was treated with previously augmented CTG harvested from the palatal mucosa while the control group was treated with a non-augmented CTG. Clinical measurements were recorded at baseline, 6, 12 and 24 months after intervention. Clinical results showed a statistically more significant percentage of average and complete gingival recession coverage in the test group. The LPF in combination with an augmented CTG proves to be an effective alternative to the CAF. Greater improvement in gingival thickness was observed in the LPF with augmented CTG than in non-augmented CTG.

Comparison of the Effectiveness of the Ultrasonic Method and Cone-Beam Computed Tomography Combined with Intraoral Scanning and Prosthetic-Driven Implant Planning Method in Determining the Gingival Phenotype in the Healthy Periodontium.

The aim of this study was to compare the effectiveness of two diagnostic methods: ultrasonic gingival thickness measurement (UGTM) and cone-beam computed tomography, intraoral scanning by computer-aided design technology with prosthetic-driven implant planning software (CBCT/CAD/PDIP) in determining the gingival phenotype (GP). Thirty periodontally healthy patients were examined. The ultrasonic device Pirop G® with a frequency of 20 MHz and CBCT/CAD/PDIP were used to measure gingival thickness at upper canines and incisors in three points localized midbuccally, namely free gingival thickness (FGT), supracrestal (SGT) and crestal (CGT). Probing depth (PD), clinical attachment level (CAL) and width of keratinized tissue (WKT) were measured using periodontal probe. Intra-examiner and inter-examiner agreement and agreement between methods were evaluated using Bland-Altman analyses. Comparing both methods in the determination of SGT (bias = 0.17 mm, SD = 0.25 mm, p < 0.000) and CGT (bias = -0.45 mm, SD = 0.32 mm, p < 0.000) 95.0% and 95.6% agreement were found, respectively, and in the FGT range only 93.3% (bias = -0.45 mm, SD = 0.32 mm, p < 0.000). The presence of positive correlations between WKT and SGT was shown. A positive correlation between SGT and WKT confirms the purpose of measuring these parameters for the evaluation of the GP. Both the ultrasonic method and cone-beam computed tomography combined with intraoral scanning and prosthetic-driven implant planning method were useful in determining gingival phenotype, however, the ultrasonic method was more accurate for measuring GT.

The repeatability and reproducibility of gingival thickness measurement with an ultrasonic device.

BACKGROUND: Successful periodontal and implant surgery as well as orthodontic treatment often depends on gingival and mucosal thickness. So far there has been no generally accepted protocol of measuring the thickness of gingiva by non-invasive methods. OBJECTIVES: The aim of the study was to evaluate the repeatability and reproducibility (%R&R) of the 20 MHz A-Scan ultrasonic device in measuring gingival thickness (GT) in the mucogingival complex. MATERIAL AND METHODS: A 2-stage study utilizing non-invasive ultrasonic methods was conducted. In the 1st stage, 3 operators got calibrated by measuring previously established GT in porcine cadaver jaws. In the 2nd stage, 1 periodontally healthy subject was recruited in the study. Three operators performed the measurements of GT in maxillary left central and lateral incisors and canines, using the 20 MHz A-Scan ultrasonic device with a probe of 1.7 mm in diameter. The thickness was measured in 4 standardized points located in the free gingiva (FGT), supracrestal gingiva (SGT), crestal gingiva (CGT) and the mucosa (MGT). RESULTS: The analysis of variance (ANOVA) method was used to quantify %R&R. The repeatability and reproducibility of the measurements was 8.4%. Interobserver reproducibility varied from 0.8% to 13.4%. The average intraobserver coefficient of variation (CV) was 6.6% (1.9-13.6%). The median of the reproducibility of all measurements was 8.1 %. Nevertheless, the median of CV was variable to the observer, i.e. 5.4%, 6.5%, 6.4%. CONCLUSIONS: The obtained results in %R&R prove the good recognition of methodology as well as the usefulness of the device. Non-invasive ultrasonic biometer GT measurements are crucial in periodontology as well as in other fields of dentistry.

A Preliminary Clinical Comparison of the Use of Fascia Lata Allograft and Autogenous Connective Tissue Graft in Multiple Gingival Recession Coverage Based on the Tunnel Technique.

BACKGROUND: The most effective method for treating gingival recessions (GR) is with an autogenous connective tissue graft (CTG) via flap surgery. Often, however, the amount of CTG that can be grafted is insufficient to cover all of a patient's gingival recessions at one time. OBJECTIVES: The objective of this study was to provide a 6-month comparative assessment of the results of covering multiple Miller Class I and II gingival recessions with a Fascia Lata Allograft (FL) and a CTG harvested from palatal mucosa. MATERIAL AND METHODS: The study comprised a total of 30 people who underwent multiple gingival recession (GR) procedures using a modified, coronally advanced tunnel technique (MCAT). The patients were divided into two groups of 15 according to the type of materials used for gingival augmentation purposes: FL for the test group and CTG for the control group. A clinical assessment was made at baseline, as well as 3 and 6 months following surgery. The following factors were assessed: recession depth, recession width, probing depth, clinical attachment level, height of keratinized tissue (HKT), distance between the cemento-enamel junction and the muco-gingival junction (CEJ-MGJ), API, SBI. The following values were calculated: average root coverage (ARC), complete root coverage (CRC). RESULTS: No statistically significant differences were observed between the groups in terms of clinical parameters assessed after 6 months, apart from CRC, which was 94.87 ± 0.14 mm in the control group and 94.24 ± 0.20 mm in the study group (p = 0.034). The average HKT in the control group after 6 months amounted to 2.86 ± 1.60 mm, and in the test group to 3.09 ± 0.95 mm, which translates into an increase in comparison to the baseline values of 0.73 mm (p < 0.001) and 0.48 mm (p = 0.017), respectively. CONCLUSION: FL Allografts may serve as an alternative to autogenous CTG in multiple gingival recession coverage procedures based on the tunnel technique.

Augmentation of the hard palate thin masticatory mucosa in the potential connective tissue donor sites using two collagen materials-Clinical and histological comparison.

BACKGROUND: Due to the similarity of keratinized gingival and palatal mucosa the latter can pose as a potential donor site for gingival recession coverage. However, its availability is restricted and a thin transplant bears the risk of being rejected. The aim of the present study was to compare the clinical and histological results of thin palatal mucosa augmentation, using lyophilized Biokol® xenogenous collagen sponge and a suspension of xenogenous Gel 0® pure collagen with non-augmented tissue from the same patients. MATERIALS AND METHODS: Ten patients simultaneously underwent bilateral augmentation procedures using Biokol® and Gel 0® collagen material. The donor sites were augmented 8 weeks prior to the harvesting of the connective tissue graft (CTG) for the gingival recession coverage procedures. Prior to the implantation of the collagen material and during the course of harvesting the augmented CTG, tissue specimens were taken for histological examination. Prior to the commencement of the study and after it, the parameters of palatal gingival thickness at 4mm (PGT1), and at 8mm apical to the gingival margin (PGT2) around the teeth neighboring the operating fields were determined. RESULTS: In both groups the palatal mucosa had thickened significantly in both measuring sites. An intergroup comparison revealed greater thickening of the masticatory mucosa in the Biokol® group at both measuring points. The histological image of the grafts, obtained from sites augmented using both test methods, revealed a typical pattern of mature fibrous connective tissue. No epithelial cells were found. CONCLUSION: Augmentation of thin masticatory mucosa using Biokol® or Gel 0® collagen materials resulted in a significant thickening of the mucosa, which could be demonstrated to be greater in the first group.

Multiple gingival recession coverage with an allogeneic biostatic fascia lata graft using the tunnel technique--A histological assessment.

BACKGROUND: Autogenous connective tissue graft (CTG) that can be safely harvested from the palatal mucosa is limited. Often a multi-stage surgical procedure is needed to cover multiple gingival recessions (MGR). To address this problem, efforts are being made to explore substitutes suitable in size to ensure surgical treatment in a single visit.The objective of the present study was the histological evaluation of tissue in the recipient site after augmentation with a hydrated biostatic Fascia Lata Allograft (FLA) in conjunction with MGR coverage at different healing stages. MATERIAL AND METHODS: Twelve patients needing bilateral multiple gingival recession coverage participated in this study. On the test side, the tunnel technique with FLA was used, while CTG, harvested from the palatal mucosa, was used to cover MGR on the control side. Histological assessment was performed 3, 6, 9 and 12 months after augmentation. RESULTS: FLA was well tolerated by the host tissue. During all investigation periods histological images of all patients in the test side revealed a slow process of incorporation of the material grafted in the host connective tissue, showing a colonization of the graft with host fibroblasts and formation of new blood vessels. After 12 months, the graft had fully remodeled into connective tissue of the host gingiva. CONCLUSION: Apart from the limitations of the present study, we conclude that the FLA may serve as a substitute for autogenous CTG harvested from the palatal mucosa and can be applied as a technique for covering MGR in a single visit.

The use of a biostatic fascia lata thigh allograft as a scaffold for autologous human culture of fibroblasts--An in vitro study.

The method for covering gingival recession defects and augmenting keratinized gingiva involves the use of autogenuous connective tissue grafts obtained from palatal mucosa in combination with various techniques of flap repositioning or tunnel techniques. In the case of multiple gingival recession defects the amount of connective tissue available for grafting is insufficient. Therefore, the use of substitutes is necessary. The most widely used material in recent years has been the acellular dermal matrix allograft. The disadvantage of its application lies in the absence of cells and blood vessels, which increases incorporation time. Primary cultured human autologic fibroblasts are commonly used to optimize the healing process. The aim of this study was to examine the in vitro biocompatibility of human fascia lata allograft as a new scaffold for primary cultured human autologic fibroblasts. For that, a fibroblast culture obtained from a fragment of gingival tissue taken from the hard palate mucosa of a subject was used. After 14 days the colony cells were inoculated on a fragment of human fascia lata allograft. After a further 7 days of incubation the material was frozen, cut and prepared for histochemical examination. After two weeks of incubation, and 7 days after inoculation on a fragment of fascia lata allograft numerous accumulations of the cultured fibroblast were found that had a typical structure and produced collagen fibres. A human fascia lata allograft can be used as a scaffold for primary cultured human autologic fibroblasts. Further studies should confirm the clinical efficacy of this solution.

Assessment of gingival thickness using an ultrasonic dental system prototype: A comparison to traditional methods.

Knowledge of periodontal anatomy is essential when performing surgical and non-surgical procedures in the field of oral healthcare. Gingival thickness (GT) is often assessed for this purpose. A dental system prototype was recently developed for quantitative, non-invasive GT assessment by high-frequency (HF) ultrasound. Laboratory trials were conducted to validate system performance against a traditional method of assessment. A system with a 50 MHz broadband, spherically-focused transducer was used. The transducer was housed in a small, hand-held probe equipped with a continuous water supply. A-scans were obtained and thickness at each location was determined. For comparison, the traditional method of transgingival probing through tissue with an endodontic k-file needle was also implemented. Preliminary experiments were performed on phantoms simulating the anatomical and acoustic properties of human periodontal tissues. A porcine cadaver was obtained for further laboratory trials. The speed of sound through porcine gingiva was determined to be 1564 ± 21 m/s. Finally, a multiple-point experiment involved GT assessment in an array of locations on the buccal gingival surface in the fourth quadrant. Ultrasonic measurements were found to yield similar GT values to those obtained from invasive methods. Results obtained in this experiment validate the applicability of ultrasound as a diagnostic tool for assessing periodontal anatomy.