Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic collagen matrix - 1-year randomised follow-up.

PURPOSE: A comparative, ultrasound evaluation of the thickness of keratinized mucosa (TKT) around implants one year after gingival augmentation (GA) by means of a connective tissue graft (CTG) and the xenogeneic collagen matrix (CMX). MATERIALS AND METHODS: A total of 75 bone level tapered implants (Conelog® Camlog) were inserted in 57 patients in the aesthetic area of both jaws. The patients were divided into 3 groups: control group I- without GA; group II- GA 3 months before implantation, and group III- GA 3 months after implantation. Groups II and III were divided into two subgroups depends on type of material used for GA: (a) CMX (Mucograft®, Geistlich Pharma AG) and (b) CTG. The patients underwent a clinical and ultrasound examination before, then after 3 and 12 months following GA respectively to evaluate TKT at two points using ultrasound equipment (Pirop®, Echoson). Point 1 was considered to be in the middle of the line connecting the cemento-enamel junction (CEJ) to the adjacent teeth, and point 2 on the mucogingival junction (MGJ). RESULTS: Three months after GA, the highest increase in gingival thickness was noted in group IIIb (point 1 - 0.95mm, 2 - 1.01mm). However, 12 months after GA the highest gingival thickness was observed in group IIb (point 1 - 1.76mm, 2 - 1.36m) and next IIIb (point 1 - 1.52mm, 2 - 1.15mm). CONCLUSIONS: Both CTG and Geistlich Mucograft® increased TKT, but higher values were noted using CTG augmentation before implantation. An ultrasonic device can be used as a non-invasive, reliable, and reproducible method for evaluating TKT.

Into the Paradigm of Local Factors as Contributors for Peri-implant Disease: Short Communication.

Although some systemic conditions have been associated with peri-implant disease, local contributing factors largely remain to be determined. This study aimed at evaluating, based on clinical photographs obtained from peri-implantitis treatment publications, the possible local contributing factors involved in its development based upon a survey obtained from three experienced clinicians (> 20 years of expertise). Cohen's kappa index was used to test the interexaminer reliability. "Too-buccal implant position" was the only parameter to reach almost perfect interexaminer agreement (κ = 0.81). "Thin-tissue biotype" and "minimal presence of keratinized mucosa" demonstrated moderate agreement (κ = 0.43 and κ = 0.58, respectively). The rest of the parameters studied based on clinical photographs were fair or poor. Therefore, based on this clinicians' survey, implants too buccally placed, minimal or a lack of keratinized mucosa, and thin-tissue biotype might contribute to a higher susceptibility of developing peri-implantitis. These factors must be the focus of attention in future cross-sectional studies on the incidence of peri-implant diseases.

Correlación entre biotipo gingival, ancho y grosor de encía adherida en zona estética del maxilar superior / Correlation between gingival biotype, width and thickness of attached gingiva in an aesthetic of the upper jaw

Actualmente, para realizar distintos procedimientos odontológicos se hace necesaria una correcta evaluación del biotipo periodontal utilizando las herramientas adecuadas que nos permitan medir de manera certera su grosor. El objetivo de esta investigación fue evaluar distintos métodos diagnósticos, correlacionándolos con la medición directa de ancho y grosor de encía adherida en la zona anterosuperior del maxilar. Se reclutaron 30 pacientes periodontalmente sanos, y en los dientes 1.1, 1.2 y 1.3 se realizó: identificación del biotipo según parámetros visuales, medición directa del ancho, grosor de encía adherida y transparencia de la sonda periodontal como método indirecto. Mediante la transparencia de la sonda, el biotipo grueso fue el más prevalente (53,3 por ciento), observándose más en hombres (62,5 por ciento) versus mujeres (37,50 por ciento). Según parámetros visuales, el biotipo fino fue más prevalente (56,7 por ciento) que el grueso (43,3 por ciento), y al comparar ambos métodos no existieron diferencias significativas. Se observó un ancho promedio de la encía adherida de 2,79 mm y un grosor de 1,06 mm, presentándose valores más elevados en el biotipo grueso (ancho 2,94 mm y grosor 1,10 mm) versus el fino (ancho 2,67 mm y grosor 1,01 mm). Según los resultados obtenidos podemos concluir que tanto el diagnóstico visual como la transparencia de la sonda son válidos para identificar el biotipo gingival. Sin embargo, la inspección visual mostró menor reproducibilidad y mayor porcentaje de error al definir biotipo fino.

To perform different dental procedures it is currently necessary to make a correct assessment of periodontal biotype, using the right tools that allow its thickness to be accurately measured. The objective of this study was to evaluate different diagnostic methods and correlating them with direct measurement of width and thickness of attached gingiva in the front upper jaw area. The study included 30 periodontally healthy patients, in whom biotype identification was performed on teeth 1.1, 1.2 and 1.3, using visual parameters, direct measurement of the width and attached gingiva thickness, and transparency of the periodontal probe as an indirect method. According to the transparency of the probe, the thick biotype was the most frequent (53.3 percent) was observed more in men (62.5 percent) than women (37.50 percent). According to the visual parameters, thin biotype was more prevalent (56.7 percent) than the thick biotype (43.3 percent). There were no significant differences on comparing the 2 methods. The mean width of attached gingiva was 2.79 mm and a thickness of 1.06 mm, being greater in the thick biotype (width 2.94 mm and thickness 1.10) than in the thin biotype (width 2.67 mm and thickness 1.01 mm). According to the results, it can be concluded that both the visual diagnosis and transparency of the probe are valid to identify the gingival biotype. However, a lower reproducibility by visual inspection was observed, and the thin biotype showed a higher error rate.

Parámetros mucogingivales y dentarios en estudiantes de odontología chilenos / Mucogingival and dental parameters in Chilean dental students

Fueron analizados los parámetros de proporción dentaria, posición del cénit gingival, posición y tamaño de las papilas interdentarias, biotipo gingival, cantidad de encía queratinizada y línea de la sonrisa en las 6 piezas anterosuperiores en 31 estudiantes de odontología chilenos. Se estableció un patrón de proporción dentaria similar al descrito previamente en la literatura. La posición de cénit presentó un patrón definido. El biotipo gingival fino fue el más frecuente. Los incisivos laterales presentaron la mayor cantidad de encía queratinizada, seguidos por los incisivos centrales y luego los caninos. La altura de la papila a nivel de los caninos fue mayor que en los incisivos centrales, mientras que los valores más bajos fueron encontrados a nivel de los incisivos laterales. Existió una predominancia de la línea de la sonrisa media.

Tooth proportion, gingival zenith position, position and size of the interdental papillae, gingival biotype, amount of keratinized gingiva and smile line position were evaluated in the 6 upper front teeth in 31 Chilean dental students. The tooth proportion pattern was similar to that described previously in the literature. The zenith position showed an established pattern. A thin gingival biotype was found more frequently. Lateral incisors showed the highest amount of keratinized tissue, followed by central incisors and then the canines. The height of the papillae at the canines was higher than central incisors, while the lowest values were found in the lateral incisors. There was a predominance of a medium smile line.

Consideraciones periodontales y protéticas para el tallado de piezas dentarias / Periodontal and prosthetic considerations for teeth grinding

Las preparaciones dentales para prótesis fija, involucran al tejido duro, además la proximidad que existe con la encía hace necesario la comprensión de su estructura y la función del aparato de protección, para que las restauracionesno invadan el ancho biológico constituido por el epitelio de unión y las fibras gingivales; basándonos en los estudios de Gargiulo en 1961, donde la inserción del tejido conjuntivo mide 1.07 mm y la adherencia epitelial 0.97 mm en promedio, sumados al espacio del surco gingival. El biotipo periodontal es de vital importancia para la elección de la altura de terminación del hombro de la preparación, donde el mismo deberá establecerse, previo sondaje óseo a no menos de 2.5 mm de la cresta según Kois (2008). La utilización de materiales y técnicas para la toma de impresiones definitivas deben ser amigables con los tejidos blandos a fin de no producir alteraciones y que las restauraciones sean predecibles, tanto funcional como estéticamente en el transcurso del tiempo

Dental preparations fixed prosthesis, involving the hard tissue, there is also proximity to the gum is necessary to understand the structure and function of the protection device, to restorations without invading the biologic width consisting of the epithelium junction and the gingival fibers; based on Gargiulo studies in 1961, where the insertion of the connective tissue and epithelial measured 1.07 mm 0.97 mm in average adhesion, coupled with sulcular space. The periodontal biotype is of vital importance for the choice of the termination of the shoulder height of the preparation, where it must be established prior tobone sounding no less than 2.5mm crest according Kois (2008). The use of materials and techniques for making final impressions should be friendly soft so as not to alter tissues and restorations predictable, both functionally and aesthetically over time.

Correlation between gingival thickness and gingival recession in humans / Correlação entre espessura do tecido gengival e recessão gengival

Gingival recession is characterized by the apical migration of the gingival margin, exposing the root surface. Studies have demonstrated several etiological factors for gingival recession such as periodontitis, traumatic toothbrushing, use of oral piercing, and past orthodontic therapy, among others. It might not be possible to identify and quantify the influence of each factor, and gingival recession at some sites may be the result of the combination of these factors. Gingival recession affects individuals at all ages, with prevalence increasing as time passes. The aim of this study was to observe whether there is correlation between gingival thickness and gingival recession. Fifty-five subjects of both genders aged 18-35 years participated in the study. The volunteers were under treatment at the School of Dentistry of the Federal University of Rio Grande do Sul. Buccal gingival thickness was measured on incisors, canines and bicuspids, under anesthesia, following inclusion and exclusion criteria. Statistical analysis was performed with STATA version 10.1. The results had a Pearson Correlation Coefficient of -0.216. Linear regression had a statistically significant p-value of 0.025. It may be concluded that there is weak negative correlation between gingival thickness and gingival recession.

A recessão gengival é caracterizada pelo deslocamento apical da margem gengival, expondo a superfície radicular. Pesquisas têm apresentado vários fatores relacionados à etiologia da recessão gengival como: periodontite, escovação traumática, uso de piercing oral, tratamento ortodôntico passado, entre outros. Pode não ser possível identificar e quantificar a influência de cada fator,e a recessão gengival, em determinados sítios, pode ser o resultado da confluência de várias causas. A prevalência da recessão gengival atinge indivíduos de todas as idades, aumentando significativamente com o passar dos anos. O objetivo do presente estudo foi observar se existe correlação entre a espessura do tecido gengival e a recessão gengival. Participaram da pesquisa pacientes de ambos os gêneros, com idade entre 18 e 35 anos, que estavam em tratamento nas clínicas odontológicas da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul.Foram medidas a espessura e recessão gengival das faces vestibulares dos dentes incisivos, caninos e pré-molares, previamente anestesiados, seguindo os critérios estabelecidos para inclusão e exclusão no estudo. Para avaliação e comparação dos resultados foi utilizado o programa estatístico STATA versão 10.1. Os resultados mostraram que a correlação de Pearson entre a espessura gengival e a recessão foi de -0.216. A regressão linear apresentou um p= 0.025, estatisticamente significativo. Pode-se concluir que existe uma correlação fraca e inversa entre espessura gengival e recessão gengival.

Avaliação e correlação clínica/tomográfica dos biótipos periodontais / Clinical/Tomographic evaluation and correlation of the periodontal biotypes

O biótipo gengival, definido como a espessura da gengiva no sentido vestíbulo-lingual, desempenha importante papel na homeostasia dos tecidos periodontais, podendo ser considerado um preditor no sucesso em longo prazo das terapias periodontais e periimplantares. Assim sendo, é de suma importância reconhecer as dimensões do tecido gengival e as diferentes formas de qualificá-lo e principalmente quantificá-lo. Apesar de haver descrito na literatura inúmeros métodos para este fim, existem poucos estudos comparando a efetividade de um método em relação a outro. Desta maneira, este estudo buscou avaliar se há concordância entre avaliações clínicas e tomográficas na classificação do biótipo gengival, se existe correlação entre o biótipo gengival e a espessura óssea subjacente, além de descrever um novo método de tomada tomográfica que permita a análise quantitativa do biótipo gengival. Foram avaliados 12 indivíduos os quais realizaram tomografias computadorizadas de feixe cônico como exame imaginológico de diagnóstico ou planejamento pré-cirúrgico. Em cada paciente foram realizados quatro diferentes métodos de avaliação qualitativa da espessura gengival (transparência a sondagem, transgengival, visual através de fotografia e tomográfico), dois métodos de avaliação quantitativa (transgengival e tomográfico) da espessura gengival e avaliação da espessura óssea através da tomografia computadorizada de feixe cônico. Os resultados foram avaliados estatisticamente através do teste KAPPA, Teste t pareado e coeficiente de correlação de Pearson (pM0.05). O novo método de tomada tomográfica descrito neste estudo é eficaz para avaliação do biótipo gengival, havendo grande concordância (86,1% Kappa 0,51) e forte correlação (r=0,824) entre ele e o método transgengival (padrão ouro). A correlação entre a espessura óssea e a espessura gengival foi moderada quando utilizado o método transgengival e tomográfico (r=0,567 e r=0,653 respectivamente).

The gingival biotype, defined as the thickness of the gum in the bucco-lingual direction, plays an important role in the homeostasis of the periodontal tissues and can be considered a predictor of long-term success of periodontal and peri-implant therapies. It is therefore of paramount importance to recognize the dimensions of the gingival tissue and the different ways to qualify it and especially quantify it. Although there are numerous methods described in the literature for this purpose, there are few studies comparing the effectiveness of one method over another. Thus, this study sought to evaluate whether there is concordance between clinical assessment and CT in the classification of gingival biotype, if there is a correlation between the gingival biotype and the underlying bone thickness, and describe a new method of tomographic tapping for the quantitative analysis of biotype gingival. They evaluated 12 individuals who underwent computed tomography cone beam as imaginologic diagnostic test or pre-surgical planning. In each patient were performed four different methods of qualitative evaluation of the gingival thickness (transparency of periodontal probe, transgengival, look through photo and tomographic), two quantitative assessment methods (transgingival and tomographic) gingival thickness and assessment of bone thickness by CT Cone beam computed. The results were statistically evaluated by Kappa test, paired t test and Pearson's correlation coefficient (pM0.05). The new method of making tomographic described in this study is effective for evaluating gingival biotype, there is great agreement (86.1% Kappa 0.51) and strong correlation (r = 0.824) between it and the transgingival method (gold standard). The correlation between the bone thickness and moderate gingival thickness was used as the transgingival and tomographic method (r = 0.567 and r = 0.653 respectively).

Oral and neck examination for early detection of oral cancer--a practical guide.

Cancer of the head and neck region presents a challenge since, unlike other areas of the body, the boundaries are not always easy to delineate. The functional morbidity associated with head and neck cancer and its treatment are considerable. Head and neck cancer is described as cancer of the lip, mouth, tongue, tonsil, pharynx (unspecified), salivary gland, hypopharynx, larynx and other. Oral cancer refers to cancers of the lip, tongue, gingivae, floor of the mouth, palate (hard and soft), maxilla, vestibule and retromolar area up to the anterior pillar of the fauces (tonsil). When patients present with oral cancer, over 60% of them have regional (lymph node) and sometimes distant (metastatic) spread. The overall five-year survival rates for oral cancer average at between 50 and 80%, depending on the stage of the disease, varying from 86% for stage I to 12-16% for stage IV. The incidence of 'field cancerisation'/unstable oral epithelium is high (17%), and even after successful treatment our patients need to be monitored for dental care and further disease. Unlike other areas in the body, the oral epithelium is readily accessible for examination and even self-examination. Dentists and dental hygienists are effective clinicians in the examination of the oral cavity for mouth cancer. An oral and neck examination must be part of every dental examination. An examination protocol is suggested here, which is similar to, but more detailed than, the standardised oral examination method recommended by the World Health Organisation, and consistent with those protocols followed by the Centres for Disease Control and Prevention and the National Institutes of Health.

Preservación de márgenes gingivales mediante la utilización de implante de carga diferida / Preservation of gingival margins using delayed implant loading

Se presenta la rehabilitación de un sector estético involucrando pieza dentaria a implante unitario, realizado mediante la técnica convencional de carga diferida y 2 tiempos quirúrgicos. A los 6 meses se instala mesoestructura maquinada y se cementan 2 coronas obtenidas por tecnología CAD/CAM. Se establece una discusión entre las distintas alternativas que podrían haberse elegido para resolver esta situación clínica

The color of human gingiva and mucosa: visual measurement and description of distribution.

No soft tissue shade guide is available for matching the color of denture resins to human intraoral soft tissues. To determine the color of both the gingiva and the alveolar mucosa, intraoral soft tissue colors of 150 men and women were assessed under standardized lighting conditions. Colors of the papilla, attached gingiva, and alveolar mucosa in the central incisor region of the maxilla and mandible were examined using Munsell color tabs and their corresponding notations (value, hue, chroma). Statistical evaluation was performed by using frequency tables and multiple regression (level of significance p=0.05). Color ratings for the maxillary interincisal papilla lay in the yellow hue spectrum. A high incidence of ratings was found between 7/6 2.5R and 7/4 5R (Munsell color notations). Two further peaks were identified for the colors 3/6 2.5 R and 8/4 10R. Five peaks with the highest frequency of ratings were present with regard to the color of the mucosa in the maxillary incisal region: 6/6 2.5R, 7/6 2.5R, 6/8 5R, 5/8 7.5RP, and 5/6 10RP. In the mandible, a similar pattern was found. Using the results from visual matching tests, five color frequency peaks were identified. They could be used to construct an intraoral soft tissue shade guide.

Cementum on Smilodon sabers.

The maxillary canines of Smilodon californicus Bovard, 1907 have a deeply curved cementoenamel junction. The gingiva of modern cats is attached to the tooth at the cementoenamel junction and provides tactile and other dental information to the animal. The presence of cementum at the cervix of the maxillary canines, also called sabers, would indicate that the gingiva in Smilodon was attached in this region. Such an attachment would be advantageous, providing stability and sensory input for the large tooth. Also, gingiva at the cervix would impact the manner in which the teeth were used. Previous study using scanning electron microscopy of dental casts was indirect. The purpose of this study was to confirm by direct methods the presence of cementum at the cervix of Smilodon californicus sabers. Parts of three Smilodon californicus sabers were sectioned and examined with light and scanning electron microscopy (EDS). In addition, percent weight of calcium and phosphorus was measured in enamel, dentin, and cementum using electron dispersive spectroscopy. Cementum was identified in the cervical region of each saber. Spectroscopy confirmed that the tissue is calcified and the mineral is hydroxyapatite. Percent calcium and percent phosphorus of individual tissues were highly variable between specimens. However, the ratios of calcium to phosphorus were not significantly different from the hydroxyapatite standard. In the future, bite models will have to take the presence of soft tissues into account.

Alveolar ridge preservation at tooth extraction.

The principles of guided bone regeneration, which are at the core of contemporary periodontal therapy, have evolved into the present generation of barrier membranes, which greatly improve the overall result by not requiring primary closure. The supplemental addition of calcium sulfate to the graft materials appears to accelerate the rate of vital bone formation. In the future, these procedures are likely to become less invasive and more predictable, barrier membranes may not be needed and additional materials will be available that will accelerate the formation of bone.

Tratamiento estético integral del sector anterior de la boca / Comprehensive esthetic treatment of the anterior section of the mouth

Los diferentes elementos del rostro, ojos, nariz, labios, mentón, boca, etc., en forma aislada no determinan la belleza. La integración armónica de estos elementos son determinantes de la estética facial. Dentro de ellos, la boca juega un papel preponderante con una disposición, forma, tamaño y color de dientes adecuada, en relación con los márgenes gingivales y con los llamados puntos de referencia del rostro. El tener una agradable sonrisa y una buena apariencia en el momento de hablar, se ha convertido en una necesidad en la vida moderna, en el campo de las relaciones sociales, laborales y humanas en general. Se hace una revisión de las bases de la estética dental: 1) marco y puntos de referencia; 2) proporciones e idealismo; 3) simetría y 4) perspectiva e ilusión. Como parte de estas bases, se analizan los principios macro estéticos y micro estéticos. Finalmente, se presenta un caso clínico como aplicación de los fundamentos descritos

Improvement of macromolecular clearance via lymph flow in hamster gingiva by topical warming and massage.

The lymphatic system is very important for macromolecular clearance in various tissues, especially in the gingiva. However, the kinetics of macromolecular clearance via the lymph flow in the gingiva are poorly understood. The aim of this study was to investigate whether thermal or mechanical stimulation affects macromolecular clearance via the lymph flow in the gingiva. Carbon black suspension was injected into the mandibular gingiva of anesthetized hamsters and its drainage into cervical lymph nodes was examined. Clearance of 14C-methylated bovine albumin and tritiated water from the gingiva and their drainage into submandibular lymph nodes and blood was quantified. The effect of topical warming or massage on clearance of 14C-methylated albumin from the gingiva during a 15 min period was examined. In addition, the influence of neurochemical antagonists on the stimulatory effect of topical warming on albumin clearance was investigated. Submandibular lymph nodes were clearly delineated by carbon black 10 min after the injection. More radiolabeled albumin appeared in submandibular lymph nodes than in serum, while more tritiated water appeared in serum. Topical warming (45 degrees C, 2 min) and warming plus massage (with a silicon rubber brush, 20 s) decreased the radiolabeled albumin in the gingiva 15 min after the injection. There was less radiolabeled albumin in the gingiva after gingival warming plus massage than after warming. Previous injection of HOE140 or propranolol into the gingiva diminished the stimulatory effect of topical warming on albumin clearance. It was concluded that topical warming plus massage improves macromolecular clearance via the lymph flow in hamster gingiva.

Predicting porcelain thickness required for dental shade matches.

STATEMENT OF PROBLEM: Production of a ceramic dental restoration that matches a target shade is dependent on porcelain thickness. Even when adequate porcelain thickness exists, clinical shade matches are difficult to achieve. PURPOSE: This study predicted the thickness of dentin porcelain required to obtain a clinical shade match (

Clinical evaluation of a single crystal sapphire tooth implant in human beings.

Single crystal sapphire implants are commercially prepared ceramics of aluminum oxide. These endosseous implants have been placed in patients at Washington University since 1978. The course of patients has been followed closely with periodic clinical and radiographic evaluations. Sapphire is well tolerated by hard and soft tissue and provides excellent abutments for fixed partial dentures.

Single-crystal sapphire endosseous dental implant loaded with functional stress--clinical and histological evaluation of peri-implant tissues.

Peri-implant tissues of the single-crystal sapphire implant connected with neighbouring teeth by a metal bridge-work were examined clinically, radiographically, and histologically in ten monkeys. Professional tooth cleaning was performed during the study. At 3-12 months after insertion, most of the implants were firmly connected to the surrounding tissues and peri-implant gingiva was regarded as healthy, based on various periodontal parameter scores. Destructive changes of the peri-implant bone were not found radiographically. Histologically, peri-implant gingiva was revealed to show similar structure to that of the gingiva around natural teeth. Direct bone-implant interface was observed at 3 months after insertion, while a thin loose fibrous connective tissue layer was present between bone and implant at 6 and 12 months. Such different interrelationship between bone and implant might be attributable to the difference in distribution of functional stress.