Sclerotherapy for the recurrent granulomatous epulis with pingyangmycin.

BACKGROUND: Relapse of granulomatous epulis is common after surgery because of local irritations, hormonal level in vivo, or incomplete resection. Currently, if recurrence occurs, then extraction of the teeth adjacent to the lesion is commonly performed, which may influence the aesthetics or masticatory function. Thus, a more effective and less aggressive treatment method is urgently demanded, particularly for the recurring lesion. This study investigated the effects of the intralesional pingyangmycin (PYM) injections for the recurrent granulomatous epulis and assessed the complications. MATERIAL AND METHODS: A total of 16 patients with recurrent granulomatous epulis underwent intralesional PYM injections, between July 2010 and June 2014. The effects and complications of the treatment were retrospectively reviewed. RESULTS: The total number of injections performed was 48 (for all patients). The median number of injections per patient was three (range, two to four). All cases completely recovered with no recurrence and resorption of the alveolar bone after a follow-up of more than 12 months. The complications included slight bleeding, local swelling and pain following injection. All these symptoms resolved 7 to 10 days after the injection. CONCLUSIONS: In summary, intralesional PYM injections may be a preferred option for recurring granulomatous epulis.

Journey From Black To Pink Gums: Management Of Melanin Induced Physiological Gingival Hyper Pigmentation.

Smile is an expression of happiness, self-confidence, kindness and beauty. Along with teeth and lips, gingiva is also a vital component of smile. Melanin induced gingival hyper pigmentation may appear un-aesthetic especially when it is associated with high smile line, upper anterior labial segment and is uneven in appearance. It affects individuals from all races. Generally, it is believed that melanin induced gingival hyper pigmentation is confined to individuals from dark races. But studies have shown that Iranian, Indian, Italian, Arabian, Greek. German, French, Japanese, Chinese, Jewish, Thai, Malaysian and other ethnic groups also display clinical gingival pigmentation.1 Gingival hyper pigmentation may result in psychological distress especially when the appearance is of utmost importance for the individuals. This article aims to focus on the physiology, clinical appearance and treatment options available for the melanin induced gingival hyper pigmentation along with the reported recurrence in the light of current literature.

Interdisciplinary treatment for an adult with a unilateral cleft lip and palate.

A young man, age 18 years 4 months, with a concave profile, a skeletal maxillary deficiency, and a severe alveolar cleft with an unesthetic appearance of the maxillary anterior teeth was referred for orthodontic treatment. After a detailed review of his pretreatment records, both surgical and nonsurgical treatment plans were presented to the patient, who opted for a nonsurgical interdisciplinary approach. His complex 3-dimensional malocclusion required palatal expansion, dental extractions, and periodontal and prosthodontic consultations and treatment, in addition to comprehensive orthodontic therapy. MBT (Xinya, HangZhou, China) 0.022 × 0.028-in appliances combined with a mini-implant to enhance the orthodontic anchorage were used to level, align, and establish a Class I relationship. After the orthodontic treatment, a combined restorative and periodontal approach was used to enhance the patient's esthetic and functional outcomes. Both the final result and the 1-year follow-up records demonstrate that the treatment goals of establishing proper occlusion, normal function, a balanced profile, better esthetics, and a stable outcome were achieved. The purpose of this case report is to demonstrate that an interdisciplinary treatment protocol can significantly improve the transverse discrepancies and achieve a satisfactory occlusion with a balanced profile in patients with cleft lip and palate.

[A case of gingival myiasis caused by Wohlfahrtia magnifica]. / Wohlfahrtia magnifica'dan kaynaklanan gingival miyaz olgusu.

Myiasis is an infestation of living or dead tissue of humans and animals by diptera larvae. Gingival myiasis is a rare pathology and is mainly associated with poor oral hygiene, alcoholism, senility, suppurative lesions, mouth breathing, mental retardation and hemiplegia. Myiasis is most common during summer since the fly population increases during this season. Mostly it occurs in farmers and people who live in tropical climates. Gingival myiasis in humans in Turkey is limited to only a few cases. According to our literature research, this is the first case of gingival myiasis produced by larvae of Wohlfahrtia magnifica in a Turkish adult. According to our best knowledge, it is also the first gingival myiasis case that one of the causative larva had grown to the adult stage in Turkey. A 43 years old male patient who perceived the presence of live maggots in his mouth was referred to our clinic. Clinical findings of gingival myiasis were observed. The patient had no history of systemic disease but oral hygiene was poor. Clinical and radiographic examination indicated that he had chronic periodontitis. Before the dental treatment seven larvae and during the scalling five larvae were elevated from the gingival sulcus. The body of the larvae composed of 12 segments and they were 8-10 mm in length. One of the larvae which was sent to the microbiology laboratory were placed into sheep liver to resume life and the other larvae were placed into 70% alcohol solution. After 9-10 days, the larva which was placed in the liver became pupa. Approximately 15 days later, the pupa became an adult fly. The larvae were identified as the second stage larvae of Wohlfahrtia magnifica. Treatment consisted of removal of the maggots from the gingival sulcus, followed by scaling and oral hygiene instruction. Non-surgical periodontal treatment was applied and the patient was followed-up for 3 months. After non-surgical periodontal treatment, patient didn't accept the flap operation. The most important point for the prevention of gingival myiasis is to establish a good oral hygiene, together with the elimination of environmental factors which support the proliferation of the flies.

Plaque control improves the painful symptoms of oral lichen planus gingival lesions. A short-term study.

BACKGROUND: Lichen planus is a mucocutaneous disease with manifestation in the oral mucosa, the gingiva being one of the most affected regions. In some cases, the lesion may be painful and lead to fragility of the tissues, so that precise diagnosis and adequate treatment are indispensible factors for improving the clinical condition. The aim of this study was to evaluate the effectiveness of plaque control in the improvement of clinical features and painful symptoms of oral lichen planus with gingival involvement. METHODS: Twenty patients diagnosed with gingival lichen planus confirmed by histopathological examination were selected. The patients were evaluated by a trained examiner, with regard to the clinical features of the lesions [Index of Escudier et al. (Br J Dermatol, 157, 2007, 765)]; painful symptoms (Visual Analog Scale); and periodontally, as regards the visible plaque and gingival bleeding indices. Periodontal treatment consisted of supragingival scaling and oral hygiene instruction, with professional plaque removal afterward for a period of 4 weeks. The entire sample was evaluated at the baseline and at the conclusion of treatment, and the results were analyzed by the Wilcoxon nonparametric test. RESULTS: The data demonstrated that the majority of patients were women (90%), with a mean age of 55.9 years. Periodontal treatment resulted in statistically significant reduction (P < 0.05) in the periodontal indices, with consequent improvement in the clinical features and painful symptoms of the lesions. CONCLUSIONS: It was demonstrated that plaque control was effective in improving the clinical features and painful symptoms of oral lichen planus with gingival involvement.

Cost-effectiveness of personalized plaque control for managing the gingival manifestations of oral lichen planus: a randomized controlled study.

AIM: To undertake cost-effectiveness and cost-benefit analyses of an intervention to improve oral health in patients presenting with the gingival manifestations of oral lichen planus (OLP). MATERIALS & METHODS: Eighty-two patients were recruited to a 20-week randomized controlled trial. The intervention was personalized plaque control comprising powered tooth brushing and inter-dental cleaning advice. The primary outcome measure was the oral health impact profile (OHIP) with secondary outcomes of pain, plaque index, mucosal disease score and cost-effectiveness. Private cost data and stated willingness-to-pay (WTP) values for treatment were obtained from intervention patients at 20 weeks. RESULTS: Overall, 81% of intervention patients showed improvement in both plaque index and mucosal disease score at 20 weeks compared to 30% of controls that continued with their usual plaque control regimen. All intervention group patients stated a positive WTP value. The mean net value of the treatment was £172 compared to the incremental cost of the treatment estimated at £122.75. The cost-effectiveness analysis resulted in an incremental cost-effectiveness ratio of £13 per OHIP point. CONCLUSIONS: The tailored plaque control programme was more effective than control in treating the gingival manifestations of oral lichen planus. The programme is cost effective for modest values placed on a point on the OHIP scale and patients generally valued the treatment in excess of the cost.

A rare case of gingival myiasis in a 2-year-old child.

BACKGROUND: Myiasis is the infestation of live human and vertebrate animal with larvae of Diptera fly which feed on the host dead or living tissue. Gingival myiasis is a very rare disease and associated with poor oral hygiene, senility, suppurative oral lesions, mental retardation and other conditions. CASE REPORT: A case of gingival myiasis in a 2-year-old otherwise healthy child is reported. Treatment consisted of mechanical removal of larvae, extraction of the adjacent devitalized teeth and debridement of necrotic tissues. CONCLUSION: Clinicians dealing with oral medicine should be aware of this very rare condition in children.

Management of oral melanin pigmentation.

Melanin is an endogenous pigment responsible for human tissue coloration of the skin, mucosa, hair, eyes and parts of the brain. In the skin, its function is protection from the harmful effects of UV radiation. Its purpose in oral tissues has not yet been determined. Oral pigmentation could be an esthetic issue for some patients, particularly when it is located on the anterior labial gingiva in individuals with a high smile line. This article presents and describes several different approaches for the management of oral melanin pigmentation.

Interventions for replacing missing teeth: maintaining and recovering soft tissue health around dental implants.

BACKGROUND: It is important to institute an effective supportive therapy to maintain or recover soft tissue health around dental implants. Different maintenance regimens have been suggested, however it is unclear which are the most effective. OBJECTIVES: To assess the effects of different interventions for 1) maintaining and 2) recovering soft tissue health around osseointegrated dental implants. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and to an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 2 June 2010. SELECTION CRITERIA: All randomised controlled trials comparing agents or interventions for maintaining or recovering healthy tissues around dental implants. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using standardised mean differences for continuous data and risk ratios for dichotomous data with 95% confidence intervals. MAIN RESULTS: Five trials compared interventions for maintaining soft tissue health around implants and a further six trials compared interventions to recover soft tissue health where there was evidence of peri-implant mucositis. No statistically significant differences were found between the effectiveness of powered versus manual toothbrushes for either maintaining or recovering soft tissue health. There was no statistically significant difference found between different types of self administered antimicrobials for maintaining soft tissue health (hyaluronic acid gel compared to chlorhexidine gel, amine fluoride/stannous fluoride mouthwash compared to chlorhexidine mouthwash) and triclosan dentifrice compared to sodium fluoride dentifrice showed no statistically significant difference in recovering soft tissue health. However chlorhexidine irrigation was more effective in reducing plaque and marginal bleeding scores compared to chlorhexidine mouthwash and Listerine mouthwash was found to be statistically significantly better than placebo with regard to reducing mean plaque scores and marginal bleeding scores. When interventions administered by dental professional were compared there was no statistically significant difference found between chlorhexidine and physiologic solutions as irrigants at second stage surgery to maintain health of soft tissues. In patients with peri-implant mucositis two trials evaluated interventions performed by dental professionals. There was no statistically significant difference between mechanical debridement followed by either minocycline or chlorhexidine gel, or between debridement with a titanium curette compared to an ultrasonic debridement tool. AUTHORS' CONCLUSIONS: There was only low quality evidence for which are the most effective interventions for maintaining or recovering health of peri-implant soft tissues. The included RCTs had short follow-up periods and few subjects and although overall the risk of bias of the studies was either low or unclear, only single trials were available for each outcome. There was no reliable evidence as to which regimens are most effective for long term maintenance. This should not be interpreted as meaning that current maintenance regimens are ineffective. There was weak evidence that antibacterial mouthrinses are effective in reducing plaque and marginal bleeding around implants. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according to the CONSORT guidelines (www.consort-statement.org/).

Oral mucous membrane pemphigoid in a 6-year-old boy: diagnosis, treatment and 4 years follow-up.

BACKGROUND: Childhood oral pemphigoid is extremely rare and usually takes the form of desquamative gingivitis. CASE REPORT: We describe a 6-year-old boy who presented with gingival bleeding, pain, eating difficulty, and peeling of the gums. Clinical examination revealed desquamative gingivitis with no extra-oral involvement. The diagnosis was established as oral pemphigoid based on the clinical, histological, and immunofluorescence findings. Symptoms resolved on treatment with occlusive topical corticosteroids. The patient was a carrier of the HLA-DQB(1)*0301 allele. CONCLUSION: Mucous membrane pemphigoid should be considered in the differential diagnosis of chronic desquamative gingivitis in childhood. Occlusive therapy with topical fluocinonide may alleviate the symptoms.

Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin.

OBJECTIVE: To propose a safe and reproducible injection point for botulinum toxin-A (BTX-A) as a supplementary method for the treatment of gummy smile, as determined by assessment of the morphologic characteristics of three lip elevator muscles. MATERIALS AND METHODS: A total of 50 hemi-faces from 25 adult cadavers (male 13, female 12; ages, 47 to 88 years) were used in this study. Topographic relations and the directions of the lip elevator muscles (ie, levator labii superioris [LLS], levator labii superioris alaeque nasi [LLSAN], and zygomaticus minor [ZMi]), were investigated. Possible injection points were examined through the study of predetermined surface landmarks. RESULTS: The insertion of the LLS was covered partially or entirely by the LLSAN and the ZMi, and the three muscles converged on the area lateral to the ala. The mean angle between the facial midline and each muscle vector was 25.8 +/- 4.8 degrees for the LLS, 55.7 +/- 6.4 degrees for the ZMi, and -20.2 +/- 3.2 degrees for the LLSAN; no significant differences were noted between male and female subjects or between left and right sides. The three vectors passed near a triangular region formed by three surface landmarks. The center of this triangle, named the "Yonsei point", was suggested as an appropriate injection point for BTX-A. The clinical effectiveness of the injection point was demonstrated in selected cases with or without orthodontic treatment. CONCLUSIONS: Under careful case selection, BTX-A may be an effective treatment alternative for patients with excessive gingival display caused by hyperactive lip elevator muscles.

Oral focal mucinosis: review of the literature and seven additional cases.

Oral focal mucinosis (OFM) is a rare, asymptomatic, benign lesion of unknown etiology that usually involves the mandibular gingiva. This article reports on seven patients, six of whom had lesions that involved the gingiva and one that involved the palate. All cases demonstrated the classic lobular, myxomatous mesenchymal tissue with stellate cells. In all cases, immunohistochemical staining for S-100-protein expression was negative, thus excluding the principal differential diagnoses of myxoid neurofibroma and neurothekeoma (nerve sheath myxoma). This article seeks to bring OFM to the attention of clinicians and pathologists who must consider the differential diagnosis of gingival and palatal nodules.

Giant Peripheral Ossifying Fibroma Treated With Piezosurgery and Platelet-Rich Fibrin: A Rare Case Report.

INTRODUCTION: The peripheral ossifying fibroma (POF) is a benign reactive lesion that exclusively arises from gingiva. The lesion may gain considerably large sizes and present peculiar clinical and radiographic features that would then allow it to be called a giant POF; in that case, its otherwise simple surgical extraction could create a challenge. Thus, we elect here, for the very first time, a plausible alternative for treating giant POF: piezosurgery followed by placement of platelet-rich fibrin (PRF). CASE PRESENTATION: A 31-year-old black male presented a large asymptomatic nodule on the lower gingiva; the lesion had caused vestibular displacement of teeth and had been present for 18 years. Following the diagnostic hypothesis of a giant POF, an excisional biopsy was performed under local anesthesia using piezosurgery (microvibration of 36,000 times/sec was used in a bone cortical working mode), which confirmed the diagnosis. The surgical procedure was facilitated with the use of piezosurgery followed by placement of PRF, being the trans- and postoperative periods occurred with no complications. One year after the treatment, the patient shows no signs of disease recurrence and remains under follow-up. CONCLUSIONS: Giant POF is a rare gingival reactive lesion that can reach large dimensions, causing teeth displacement, functional, and esthetic impairments. The lesion can be successfully managed with piezosurgery and PRF, as illustrated herein, avoiding extensive bone loss and damage to the surrounding soft tissues.

Treatment of Amalgam Tattoo With a New Technique: Mucoabrasion and Free Connective Tissue Graft.

INTRODUCTION: A new technique was performed for the removal of an amalgam tattoo (AT), consisting in mucoabrasion combined with a free connective tissue graft (FCTG). CASE PRESENTATION: A 59-year-old female presented with a large AT involving the alveolar mucosa and gingiva between teeth #7 and #8, where endodontic treatment and apicoectomy was performed 21 years ago. To avoid compromising esthetics, the lesion was managed with a new technique including mucoabrasion and an FCTG. At the 53-month follow-up, the patient exhibited a naturally appearing soft tissue with no evidence of the AT. CONCLUSION: When performing a one-stage treatment of removing ATs in areas of high esthetic demand, it is possible to achieve good results and ideal gingival color.

Diagnosis and treatment of oral focal mucinosis: a case series.

BACKGROUND: Oral focal mucinosis, the oral counterpart of cutaneous focal mucinosis, is a rare disease. As it has no characteristic clinical or radiological features, diagnosis is established by histopathological and immunohistological examination. We present three cases of oral focal mucinosis occurring in the retromolar (which is extremely rare) and gingival regions. CASE PRESENTATION: Case 1 involved a 26-year-old Japanese man with radiolucency in the right retromolar region on panoramic radiograph and computed tomography; no obvious protrusion was observed in the region. This finding was clinically diagnosed as a tumor of the retromolar region. Case 2 involved a 60-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 7 × 6 mm and exhibited elastic hardness and healthy-colored mucosa. The lesion was diagnosed as an epulis. Case 3 involved a 47-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 10 × 10 mm and exhibited elastic hardness and redness of the surface mucosa. This lesion was also diagnosed as an epulis. Resection was performed in all three cases, and the lesions were histopathologically diagnosed as oral focal mucinosis. Postoperative courses were uneventful and, thus far, there have been no recurrences. CONCLUSIONS: Although it is difficult to diagnose oral focal mucinosis based on clinical symptoms and imaging findings, the disease should be considered a possibility when diagnosing benign oral tumors. We believe that an emphasis on histopathologic study is essential to confirm the clinical suspicion.

Interventions for replacing missing teeth: maintaining and recovering soft tissue health around dental implants.

BACKGROUND: It is important to institute an effective supportive therapy to maintain or recover soft tissue health around dental implants. Different maintenance regimens have been suggested, however it is unclear which are the most effective. OBJECTIVES: To test the null hypotheses of no difference between different interventions (1) for maintaining healthy peri-implant soft tissues, and (2) for recovering soft tissue health, against the alternative hypothesis of a difference. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and to an internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 13 June 2007. SELECTION CRITERIA: All randomised controlled trials comparing agents or interventions for maintaining or recovering healthy tissues around dental implants. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using standardised mean differences for continuous data and risk ratios for dichotomous data with 95% confidence intervals. MAIN RESULTS: Eighteen RCTs were identified. Nine of these trials, which reported results from a total of 238 patients, were included. Follow ups ranged between 6 weeks and 1 year. No meta-analysis could be made since every RCT tested different interventions. Listerine mouthwash showed a reduction of 54% in plaque and 34% in marginal bleeding compared with a placebo. Two trials evaluated the efficacy of powered and sonic toothbrushes compared to manual toothbrushing and showed no statistically significant differences, though more patients liked the sonic brush. No statistical differences were found between brushing with a hyaluronic or a chlorhexidine gel, between cleaning with an etching gel or manually, between injecting a chlorhexidine or a physiologic solution inside the implant's inner part and between submucosal minocycline and a chlorhexidine gel. When an amine fluoride/stannous fluoride (AmF/SnF(2)) mouthrinse was compared with a chlorhexidine one, no statistically significant differences were found for implant failures and staining index while patients preferred and had less taste change with the AmF/SnF(2) mouthrinse. Self administered subgingival chlorhexidine irrigation resulted in statistically significantly lower plaque and marginal bleeding than a chlorhexidine mouthwash, however the mouthwash was given at a suboptimal dosage. AUTHORS' CONCLUSIONS: There was only little reliable evidence for which are the most effective interventions for maintaining or recovering health of peri-implant soft tissues. The included RCTs had short follow-up periods and few subjects. There was not any reliable evidence for the most effective regimens for long term maintenance. This should not be interpreted as current maintenance regimens are ineffective. There was weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as an adjunct to routine oral hygiene, is effective in reducing plaque and marginal bleeding around implants. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according to the CONSORT guidelines (http://www.consort-statement.org/).

Periodontal diseases of children and adolescents.

Children and adolescents are subject to several periodontal diseases. Although there is a much lower prevalence of destructive periodontal diseases in children than in adults, children can develop severe forms of periodontitis. In some cases, this destructive disease is a manifestation of a known underlying systemic disease. In other young patients, the underlying cause for increased susceptibility and early onset of disease is unknown. These diseases are often familial, suggesting a genetic predisposition for aggressive disease. Current modalities for managing periodontal diseases of children and adolescents may include antibiotic therapy in combination with non-surgical and/or surgical therapy. Since early diagnosis ensures the greatest chance for successful treatment, it is important that children receive a periodontal examination as part of their routine dental visits.

The dilemma of the open gingival embrasure between maxillary central incisors.

AIM: The aim of this report is to present the etiology, diagnosis, and treatment planning strategy in the presence of an open gingival embrasure between the maxillary central incisors. BACKGROUND: The open gingival embrasure or "black triangle" is a visible triangular space in the cervical region of the maxillary incisors. It appears when the gingival papilla does not completely fill in the interdental space. The space may occur due to: (1) disease or surgery with periodontal attachment loss resulting in gingival recession; (2) severely malaligned maxillary incisors; (3) divergent roots; or (4) triangular-shaped crowns associated with or without periodontal problems and alveolar bone resorptions. REPORT: The post-treatment prevalence in adult orthodontic patients is estimated to be around 40% compromising the esthetic result. CONCLUSION: Several methods of managing patients with open gingival embrasure exist, but the interdisciplinary aspects of treatment must be emphasized to achieve the best possible result. The orthodontist can play a significant role in helping to manage these cases. CLINICAL SIGNIFICANCE: Various treatment strategies are available to treat cases of an undesirable black triangle and are dependent on the etiology of the condition.