ABSTRACT
This blinded trial was conducted to analyze possible correlations between the cervical vertebrae maturation method (CVM) and the mineralization of mandibular teeth as described by Demirjian et al. (TMS). Panoramic and cephalometric radiographs of 500 orthodontic patients were analyzed by two blinded operators. TMS was utilized to analyze mineralization of second molar, second and first premolar and canine on the left side of the mandible; CVM stage was also evaluated. A blinded statistician performed statistical correlations and multiple regression analysis. Significant relations between CVM and TMS stages were identified for each tooth. Significant age differences resulted for CVM, second molar and second premolar (p<0.05). Significant correlations for second molar were observed between TMS D and CVM I-II, TMS G and CVM III, TMS H and CVM V-VI (p less than 0.01). Second molar stage G for both sexes indicates the ongoing of growth spurt. Stage G for boys and stage H for girls correlate significantly with the late part of PGS.
Subject(s)
Age Determination by Skeleton , Cervical Vertebrae/growth & development , Molar/chemistry , Tooth Calcification , Cephalometry , Female , Humans , Male , MandibleABSTRACT
OBJECTIVES: To investigate the quality of sleep and the psychological profiles of a large cohort of Italian patients with burning mouth syndrome (BMS) and to clarify the relationships between these variables and pain. METHODS: In this case-control study, 200 patients with BMS vs an equal number of age- and sex-matched healthy controls, recruited in 10 universities, were enrolled. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), Numeric Pain Intensity Scale (NRS) and Total Pain Rating Index (T-PRI) were administered. Descriptive statistics, including the Mann-Whitney U test and hierarchical multiple linear regression analysis, were used. RESULTS: Poor sleep quality (PSQI ≥ 5) was present in 78.8% (160) patients with BMS. BMS patients had statistically higher scores in all items of the PSQI and ESS than the healthy controls (p < .001). A depressed mood and anxiety correlated positively with sleep disturbance. The Pearson correlations were 0.570 for the PSQI vs HAM-D (p < .001) and 0.549 for the PSQI vs HAM-A (p < .001). Pain intensity (NRS) poorly correlated to sleep quality; the Pearson correlation was 0.162 for the PSQI vs NRS (p = .021). CONCLUSIONS: The BMS patients showed a poor sleep quality, anxiety and depression, as compared with the controls, highlighting the relationships between oral burning, sleep and mood.
Subject(s)
Burning Mouth Syndrome/epidemiology , Sleep Wake Disorders/epidemiology , Adult , Aged , Anxiety/epidemiology , Burning Mouth Syndrome/complications , Burning Mouth Syndrome/psychology , Case-Control Studies , Depression/epidemiology , Female , Humans , Male , Middle Aged , Pain/etiology , Prevalence , SleepABSTRACT
BACKGROUND: The role of vigorous root planing in the surgical treatment of gingival recession was recently questioned. The aim of the present randomized controlled split-mouth clinical study was to compare the effectiveness, in terms of root coverage, of hand and ultrasonic root instrumentation in combination with a coronally advanced flap for the treatment of isolated-type recession defects. METHODS: Eleven systemically and periodontally healthy subjects with bilateral recession defects (> or = 3 mm) of similar (< or = 1 mm) depth affecting contralateral teeth were enrolled in the study. Only Miller Class I gingival recession with no deep cervical abrasion or root caries/demineralization were included in the study. Control root exposures were treated with curets, whereas test roots were instrumented with ultrasonic piezoelectric devices. Randomization for test and control treatment was performed by a coin toss immediately prior to surgery. All recessions were treated with a coronally advanced flap surgical technique. The clinical reevaluation was made 6 months after surgery. RESULTS: The two approaches resulted in a high percentage of root coverage (95.4% in the control group and 84.2% in the test group) and complete root coverage (82% in the control group and 55% in the test teeth), with no statistically significant difference between them. Clinical attachment level gains were clinically significant in both groups (3.36 +/- 0.92 mm in the control group and 2.90 +/- 0.70 mm in the test group), with no statistically significant difference between them. The increase in keratinized tissue height was statistically significant in both groups (0.55 +/- 0.52 mm in the control group and 0.36 +/- 0.67 mm in the test group), with no difference between them. CONCLUSIONS: The present study failed to demonstrate any superiority, in terms of root-coverage results, for hand instruments over ultrasonic treatment of the root surface in combination with coronally advanced flap mucogingival surgery. Further studies of longer-term duration and larger sample size could help to establish the superiority of one form of root instrumentation in conjunction with root-coverage surgery.
Subject(s)
Dental Instruments , Gingival Recession/surgery , Root Planing/instrumentation , Adolescent , Adult , Double-Blind Method , Female , Gingival Recession/therapy , Gingivoplasty/methods , Humans , Linear Models , Male , Surgical Flaps , Treatment Outcome , Ultrasonics , Young AdultABSTRACT
BACKGROUND: Vertical releasing incisions might damage the blood supply to the flap and result in unesthetic visible white scars. The aim of the present study was to compare root coverage and esthetic outcomes of the coronally advanced flap (CAF) with and without vertical releasing incisions in the treatment of multiple gingival recessions. METHODS: Thirty-two systemically and periodontally healthy subjects with esthetic complaints due to the exposure of Miller Class I and II multiple (at least two) gingival recession defects (> or =1 mm) affecting adjacent teeth of the same quadrant of the upper jaw were enrolled in the study. Sixteen patients (with 45 gingival recessions) were randomly assigned to the control group, and the other 16 patients (with 47 recession defects) were assigned to the test group. All recessions were treated with a CAF; vertical releasing incisions were performed in the control group, whereas an envelope-type flap was used in the test group. The patient's postoperative morbidity was assessed 1 week after the surgery, whereas the esthetic evaluation, made by the patient and independent periodontist, and the clinical evaluation were made 1 year later. RESULTS: Surgical time was significantly shorter in the envelope-type CAF group. No statistically significant difference was demonstrated between the two groups in terms of recession reduction and clinical attachment level gain. A statistically greater probability of complete root coverage (adjusted odds ratio, 3.76; 95% confidence interval: 0.92 to 15.33; P <0.05) and a greater increase in buccal keratinized tissue height were observed with the envelope type of CAF. Patient satisfaction with esthetics was very high in both treatment groups, with no statistically significant differences between them. A better postoperative course and better results in the esthetic evaluation made by an independent periodontist were demonstrated in patients treated with the envelope type of CAF. CONCLUSIONS: Both CAF techniques were effective in reducing recession depth. The envelope type of CAF was associated with an increased probability of achieving complete root coverage and with a better postoperative course. Keloid formation along the vertical releasing incisions was responsible for the worst esthetic evaluation made by an independent expert periodontist.
Subject(s)
Esthetics, Dental , Gingiva/surgery , Gingival Recession/surgery , Gingivoplasty/methods , Patient Satisfaction , Surgical Flaps , Adult , Double-Blind Method , Female , Gingival Recession/classification , Humans , Male , Maxilla , Middle Aged , Young AdultABSTRACT
OBJECTIVES: A novel classification based on molecular methods to assess clonality defines three types of secondary oral squamous cell carcinoma (OSCC): second primary tumour (SPT) independent from the index tumour, local recurrence (LR), clonally related to the primary tumour, and second field tumour (SFT), derived from the same genetically altered mucosal field as the primary tumour. The present study applied mtDNA analysis in a group of patients experiencing a second loco-regional neoplastic manifestation. The purpose was to differentiate secondary tumours into LRs, SPTs and SFTs and evaluate the prognostic impact in terms of survival rate. MATERIAL AND METHODS: The study population comprised 23 patients who experienced a second neoplastic lesion after a surgical resection of primary OSCC. mtDNA D-loop analysis was applied in paired neoplastic lesions and in clinically and histologically normal mucosa. On the basis of mtDNA results, the second OSCC was classified as LR or SPT or SFT. Disease-free survival was defined as the duration between the appearance of the second neoplastic lesion and death of disease, or last follow-up visit. RESULTS: Seven secondary tumours were classified as LR, 12 as SFT, 4 as SPT. An altered mucosal field proved a variable significantly related to a better survival rate (p<0.05); 2/12 (16.6%) SFT events failed as compared to 5/7 LRs (71.4%) and 3/4 SPTs (75%). CONCLUSION: mtDNA analysis may be considered a useful tool to differentiate secondary tumours and might influence the choice of the most appropriate treatment in patients with multiple OSCCs.
Subject(s)
Carcinoma, Squamous Cell/pathology , Mouth Neoplasms/pathology , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/therapy , Female , Humans , Male , Middle Aged , Mouth Neoplasms/therapy , Prognosis , Survival Rate , Young AdultABSTRACT
The study aimed to assess the proliferative activity and karyotype in Oral Lichen Planus (OLP) lesions. G-banding chromosomal analysis of short-term primary cultures, and immunohistochemical expression of Ki67 and p53 were applied in 30 consecutive OLP patients divided into two groups according to clinical presentation of the lesions, and in nine subjects as negative controls. Mean values of Ki67 and p53 expression differed significantly (P<.01) between controls and patients groups with reticular or atrophic-erosive forms of OLP, whereas there was no significant difference between the two groups of patients with reticular or atrophic-erosive lesions. Six OLP patients showed clonal chromosome alterations, four of them associated with p53 overexpression. In conclusion, OLP is characterized by a high cellular turnover in most patients irrespective of clinical disease presentation. The genetic instability found in some patients should be interpreted as a consequence of the enhanced epithelial turnover, although we cannot rule out the possibility that some of the cytogenetic non-random anomalies observed represent early steps in cancer development.
Subject(s)
Chromosomal Instability/genetics , Ki-67 Antigen/analysis , Lichen Planus, Oral/genetics , Tumor Suppressor Protein p53/analysis , Adult , Aged , Epidemiologic Methods , Female , Humans , Karyotyping , Male , Middle AgedABSTRACT
One of the most commonly observed adverse effects of cyclosporin A (CsA) is the development of gingival overgrowth (GO). Fibroblasts are involved in GO, but the question why only a percentage of patients undergoing CsA treatment shows this side-effect remains unanswered. In a previous study, CsA has been demonstrated to induce over-expression of phospholipase C (PLC) beta(1) in fibroblasts of patients with clinical GO, in cells from both enlarged and clinically healthy gingival sites. In this work, we assessed the expression of PLCbeta isoforms to investigate whether the exaggerated fibroblast response to CsA related to increased PLCbeta(1) expression could also be detected in CsA-treated patients without clinical signs of GO. Our results support the hypothesis of a multi-factorial origin of gingival overgrowth, including specific changes within the gingival tissues orchestrating fibroblastic hyper-responsiveness as a consequence of a long-term in vivo exposure to cyclosporin A.
Subject(s)
Cell Nucleus/enzymology , Cyclosporine/adverse effects , Fibroblasts/enzymology , Gingival Overgrowth/enzymology , Immunosuppressive Agents/adverse effects , Isoenzymes/biosynthesis , Type C Phospholipases/biosynthesis , Adult , Blotting, Western , Case-Control Studies , Cells, Cultured , Enzyme Induction , Fibroblasts/drug effects , Genetic Predisposition to Disease , Gingiva/drug effects , Gingiva/enzymology , Gingival Overgrowth/chemically induced , Gingival Overgrowth/genetics , Heart Transplantation , Humans , Male , Microscopy, Electron, Transmission , Middle Aged , Phospholipase C beta , Statistics, NonparametricABSTRACT
Ghost cell odontogenic carcinomas are rare neoplasms that arise in the maxillary bones either from a calcifying odontogenic cyst or de novo. They are aggressive locally and can metastasize. We report herein a case of a ghost cell odontogenic carcinoma arising in the mandible of a Caucasian male 86 years of age. We have described the clinical and radiographic features, histological characteristics, immunohistochemistry findings, and surgical treatment. We especially focused on how Ki-67 expression guides the treatment choice. Finally, we reviewed 32 cases described in the literature and compared them with the cases described up until 2014 to help clinicians identify the diagnostic characteristics of and select appropriate treatment modalities for ghost cell odontogenic carcinomas.
Subject(s)
Ki-67 Antigen/analysis , Mandibular Neoplasms/pathology , Odontogenic Cyst, Calcifying/pathology , Tumor Suppressor Protein p53/analysis , Aged, 80 and over , Biopsy , Diagnosis, Differential , Humans , Male , Mandibular Neoplasms/diagnostic imaging , Odontogenic Cyst, Calcifying/diagnostic imaging , Radiography, PanoramicABSTRACT
The effects of a moderate dietary salt restriction on intralymphocytic sodium content and pressor response to stress (mental arithmetic, handgrip, and bicycle exercise) were tested in 25 young subjects with borderline hypertension. The study was performed by a randomized, cross-over, within-patient, experimental design. Diet did not significantly reduce blood pressure at rest but did so significantly in both systolic and diastolic blood pressure during stress and exercise. Variations in diastolic blood pressure induced by stimulation correlated significantly with intralymphocytic sodium content both before and during low-salt diet whereas no correlation was found in the case of systolic blood pressure and heart rate variations. These findings suggest that in young subjects with borderline hypertension, sodium homeostasis and blood pressure regulation are somehow interrelated, and that a moderate dietary salt restriction reduces both intralymphocytic sodium content and pressor response to adrenergic stimulation. This could be useful in preventing the development of sustained hypertension.
Subject(s)
Hypertension/diet therapy , Lymphocytes/analysis , Sodium/blood , Stress, Psychological/complications , Adolescent , Adult , Diet, Sodium-Restricted , Female , Humans , Hypertension/etiology , Male , Physical ExertionABSTRACT
The contamination of dental unit water lines (DUWL) is an emerging concern in dentistry. The aim of this study was to use an in vitro DUWL to model microbial contamination and evaluate the decontamination efficacy of tetraacetylethylenediamine (TAED) solutions. A DUWL biofilm model used to simulate clinical conditions was used to generate a range of biofilms in DUWL. Three distinct biofilms were generated: (1) biofilm from water, (2) biofilm from a mix of water + contaminating human commensal bacteria, (3) biofilm from water with contaminating oral bacteria added after biofilm formed. The contaminating oral species used were Streptococcus oralis, Enterococcus faecalis and Staphylococcus aureus. Decontamination by simple water flushing or flushing with TAED was evaluated (2, 5 and 10 min intervals). The DUWL tubes were split and samples were plated onto a range of media, incubated and bacteria enumerated. Water flushing did not reduce the number of microorganisms detected. Bacteria were not detected from any of the TAED sampling points for any of the biofilm types tested. Interestingly, if contamination was introduced to new DUWL along with the waterborne species a biofilm was formed containing only the waterborne species. If however, an existing biofilm was present before the introduction of "contaminating" bacteria then these could be detected in the biofilm. This implies that if the DUWL are new or satisfactorily cleaned on a regular basis then the associated cross-contamination aspects are reduced. In conclusion, TAED provides effective control for DUWL biofilms.
Subject(s)
Decontamination/methods , Dental Equipment/microbiology , Ethylenediamines/pharmacology , Gram-Positive Cocci/drug effects , Models, Biological , Water Supply , Biofilms/drug effects , Biofilms/growth & development , Colony Count, Microbial , Cross Infection/microbiology , Equipment Contamination , Gram-Positive Cocci/growth & development , Humans , Water MicrobiologyABSTRACT
The aim of the present study was to evaluate the efficacy of a between-patient disinfection procedures to maintain low bacterial counts in dental unit water line (DUWL) effluents, and control dental water line biofilms. Six dental units already in use, that had never been cleaned, were monitored for three weeks. During the first week only baseline contamination levels were assessed with no treatment of the system. In the second week lines were flushed with water for 30 s before treating each patient. During the third week, a disinfection procedure with 0.26% peracetic acid, followed by a water flush, was implemented before treating each patient. DUWL samples were collected both at the beginning and at the end of 216 dental procedures (72 during each period), plated on R2A agar and incubated at room temperature for seven days to obtain total bacterial counts in colony forming units per millilitre. To assess biofilm control, nine dental units (five never used and four old dental units with established biofilm) were used for 30 days in routine dental practice undergoing five between-patient DUWL disinfecting cycles every day. Water line samples were removed at baseline and at the end of the study and examined by scanning electron microscopy to determine the presence or absence of biofilms. A significant difference (P < 0.01) in mean DUWL bacterial counts was found between the three sets of observations. Biofilms were not present in any of the new dental units and a demonstrable reduction in the biofilms from the four dental units with previous presence of established biofilms was observed at the end of the study. In this study, a between-patient disinfection procedure consisting of flushing DUWL with peracetic acid with use of water was efficacious in the control of both microbial contamination of dental treatment water and dental water line biofilms.
Subject(s)
Biofilms , Dental Equipment/microbiology , Disinfectants/pharmacology , Disinfection/methods , Peracetic Acid/pharmacology , Water Microbiology , Colony Count, Microbial , Cross Infection/prevention & control , Humans , Water SupplyABSTRACT
A rapid test for the visual detection of anti-HCV antibodies in whole blood was evaluated in its accuracy when compared with EIA method. The rapid test was performed blind on 50 HCV EIA-positive (adsorbance greater than 3.0) and on 50 HCV EIA-negative samples. Each whole blood sample was 1:20, 1:50 and 1:100 diluted with saline solution for a total of 400 samples. Results showed a sensitivity of 100% when whole blood was tested, 96% when 1:20 diluted blood was tested, 30% when 1:50 diluted blood was tested and 4% when 1:100 diluted blood was tested. The specificity gave also better results and only one false-positive was found in all samples tested. The test took less than 3 min and only a mechanical pipette was required. In conclusion, the HCV Ab rapid test showed a very high accuracy and could be very useful for the detection of HCV-positive subjects in situations where rapid results are required or technical expertise is limited.
Subject(s)
Hepacivirus/immunology , Hepatitis Antibodies/blood , Hepatitis C/diagnosis , Immunologic Tests/methods , Case-Control Studies , Humans , Sensitivity and SpecificityABSTRACT
BACKGROUND: In an attempt to evaluate the influence of cyclosporin A (CsA) on fibroblast metabolism, the phospholipase C beta1, (PLC beta1) nuclear expression was evaluated in fibroblasts from heart transplantation patients treated with CsA who exhibited gingival overgrowth (GO) and from controls. METHODS: PLC beta1 was assessed by immunoblotting and immunocytochemistry means. RESULTS: Findings did not show any difference in terms of PLC beta1 expression between the 2 groups when fibroblasts were incubated in media without CsA, while the addition of CsA highly stimulated the fibroblasts from CsA-treated patients compared to controls. The abnormal fibroblastic response in CsA-treated patients was detected both in cells from enlarged gingival sites and in cells from clinically healthy gingival sites. CONCLUSIONS: These results do not explain whether the exaggerated reactivity to in vitro CsA is the consequence of a genetically transmitted susceptibility to CsA that identifies those subjects at risk for developing GO, or whether it is a secondary effect of the long-term in vivo exposure to CsA. However, the present data underline the lack of any close relationship between enhanced fibroblast activity and clinical signs of GO and support the hypothesis that some other factors, together with CsA, are involved in the pathogenesis of CsA-induced GO.
Subject(s)
Cyclosporine/pharmacology , Gingival Overgrowth/chemically induced , Gingival Overgrowth/enzymology , Immunosuppressive Agents/pharmacology , Isoenzymes/biosynthesis , Type C Phospholipases/biosynthesis , Adult , Case-Control Studies , Cell Nucleus/enzymology , Cells, Cultured , Culture Media, Conditioned , Female , Fibroblasts/drug effects , Fibroblasts/enzymology , Gingiva/drug effects , Gingiva/enzymology , Heart Transplantation , Humans , Immunohistochemistry , Male , Middle Aged , Phospholipase C beta , Up-RegulationABSTRACT
BACKGROUND: Various clinical studies have demonstrated that applying commercially available enamel matrix proteins (EMP) on the instrumented root surface during access flap surgery promotes clinically significant gains of clinical attachment and bone in intrabony defects. The aim of the present controlled clinical trial was to evaluate the adjunctive effect of filling the intrabony lesion with bovine porous bone mineral (BPBM) to a simplified papilla preservation (SPP) flap and EMP surgical procedure. METHODS: Sixty deep interproximal intrabony lesions in 60 patients with chronic periodontitis were treated with the SPP flap and EMP. In the 30 test defects, the intrabony component was filled with BPBM particles previously reconstituted with the EMP gel. A stringent infection control program was adopted for 1 year. The clinical and radiographical reevaluation was made 1 year after surgery. RESULTS: Both techniques resulted in clinically and statistically significant improvements between baseline and 1 year, in terms of clinical attachment level (CAL) gain, probing depth (PD) reduction, and radiographic bone fill; however, the BPBM test treatment showed statistically significantly greater CAL (5.8 +/- 1.1 versus 4.9 +/- 1.0) and radiographic bone (DEPTH) level gains (5.3 +/- 1.1 versus 4.3 +/- 1.5), and less increase in gingival recession (0.4 +/- 0.6 versus 0.9 +/- 0.5) than the control surgical procedure. CONCLUSION: The present study data supported the hypothesis that the adjunctive use of BPBM in grafting intrabony defects has the ability to improve clinical and radiographical outcomes achievable with EMP alone.
Subject(s)
Alveolar Bone Loss/surgery , Bone Matrix/transplantation , Bone Regeneration/drug effects , Bone Substitutes/pharmacology , Dental Enamel Proteins/pharmacology , Minerals/pharmacology , Adult , Analysis of Variance , Animals , Bone Transplantation/methods , Cattle , Female , Follow-Up Studies , Humans , Linear Models , Male , Middle Aged , Periodontal Attachment Loss/surgery , Periodontal Pocket/surgery , Prospective Studies , Surgical FlapsABSTRACT
BACKGROUND: Several studies have documented the clinical efficacy of guided tissue regeneration (GTR) with non-resorbable expanded polytetrafluoroethylene (ePTFE) membranes and enamel matrix proteins (EMP) in the treatment of infrabony defects. The objective of this controlled clinical study was to compare the clinical outcomes of 3 surgical modalities in the treatment of deep interproximal infrabony defects. METHODS: Ninety (90) defects in 90 healthy subjects affected by chronic periodontitis were assigned to 1 of 3 treatment groups by blocking to prognostic variables. The test group was treated with the application of EMP and the simplified papilla preservation (SPP) technique; the second group was treated with titanium-reinforced ePFTE membranes and the SPP technique; and the third group was treated with the SPP technique used as access flap control procedure. No differences were observed in terms of baseline oral hygiene and defect characteristics among the 3 groups, indicating that the blocking approach was effective. A stringent infection control program was adopted for 1 year. RESULTS: The 1-year results indicated that: 1) all treatment modalities resulted in clinically significant improvements in clinical attachment levels (CAL) and reduction in probing depth (PD); 2) a statistically significant treatment effect was demonstrated comparing the EMP test, the membrane control, and the flap control groups in terms of CAL gains; 3) both the EMP test and the membrane control groups showed significant CAL gains compared to the flap control group; 4) a statistically significantly greater amount of CAL gain was demonstrated in GTR-treated compared to EMP-treated patients; 5) deeper residual probing depths but smaller increases in gingival recession were demonstrated following EMP therapy; and 6) smoking habits reduced the clinical outcomes of both regenerative procedures. CONCLUSIONS: The use of a regenerative procedure is indicated in the treatment of deep vertical bony defects since both the regenerative techniques (GTR and EMD) in the present study resulted in clinically and statistically significant improvements in clinical parameters compared to the access flap procedure. The use of EMP can be helpful in esthetically-sensitive sites and in reducing patient morbidity.
Subject(s)
Alveolar Bone Loss/surgery , Bone Substitutes/therapeutic use , Dental Enamel Proteins/therapeutic use , Guided Tissue Regeneration, Periodontal , Membranes, Artificial , Polytetrafluoroethylene , Titanium , Adult , Analysis of Variance , Anti-Infective Agents, Local/therapeutic use , Chi-Square Distribution , Chlorhexidine/therapeutic use , Chronic Disease , Dental Plaque/prevention & control , Female , Follow-Up Studies , Gingival Recession/surgery , Humans , Male , Middle Aged , Mouthwashes/therapeutic use , Periodontal Attachment Loss/surgery , Periodontal Pocket/surgery , Periodontitis/surgery , Prospective Studies , Smoking/adverse effects , Statistics as Topic , Surgical Flaps , Treatment OutcomeABSTRACT
BACKGROUND: Various modifications of the laterally sliding flap have been proposed to reduce the risk of gingival recession at the donor tooth site, but the reported root coverage predictability was quite low. The goal of the present study was to evaluate the effectiveness with respect to root coverage of a modified surgical approach of the laterally moved flap procedure for the treatment of an isolated type of recession defect. METHODS: One hundred and twenty (120) isolated gingival recessions (Miller Class I or II) with specific features of the keratinized tissue lateral to the defects were treated with a new approach to the laterally moved flap. The main surgical modifications consisted of the coronal advancement of the laterally moved flap and the different thickness during flap elevation. Clinical evaluation was made 1 year after the surgery. RESULTS: At the 1-year examination, 97% of the root surface was covered with soft tissue and 96 defects (80%) showed complete root coverage. A statistical and clinically significant increase of keratinized tissue was observed. These favorable results were accomplished with no change in the position of gingival margin or in the height of gingival tissue at the donor tooth/site. CONCLUSIONS: The laterally moved, coronally advanced surgical technique was very effective in treating isolated gingival recessions. It combined the esthetic and root coverage advantages of the coronally advanced flap with the increase in gingival thickness and keratinized tissue associated with the laterally moved flap. The ideal gingival conditions must be present lateral to an isolated recession defect in order to render the proposed surgical technique an highly effective and predictable root coverage surgical procedure.
Subject(s)
Gingival Recession/surgery , Oral Surgical Procedures/methods , Surgical Flaps , Chlorhexidine/therapeutic use , Humans , Mouthwashes/therapeutic use , Postoperative Care , Regression Analysis , Surgical Wound Infection/prevention & control , Suture Techniques , Treatment OutcomeABSTRACT
The pathogenesis of vasovagal syncope during emotional stress is controversial. Several authors have postulated that the vasodepressor response in humans may be initiated by C-fiber mechanoreceptors situated in the heart and connected via cardiac vagal afferents to the medullary center for cardiovascular control. It has been argued that heart transplant patients cannot show any vasovagal reaction because the donor heart is transplanted completely deprived of any vagal or sympathetic innervation. In this report, however, 3 episodes of vasovagal syncope are documented in 3 heart transplant patients undergoing periodontal surgery. During vasovagal syncope in each of these patients, a dramatic fall in systolic blood pressure (from 137 +/- 5 mmHg to 76 +/- 3.6 mmHg) was detected, but, in contrast to what is observable in normal subjects, the heart rate did not show any relevant change (from 96.7 +/- 4.5 beats per minute to 102.6 +/- 7.6 beats per minute). These unexpected findings emphasize the marginal role of the heart on the pathogenesis of the vasovagal syncope and underline the fact that a vasovagal reaction can develop even in the absence of the bradycardia that is the primary symptom usually reported in the literature.
Subject(s)
Dental Care for Chronically Ill/adverse effects , Heart Transplantation , Oral Surgical Procedures/adverse effects , Syncope, Vasovagal/etiology , Adult , Aged , Blood Pressure , Female , Gingival Overgrowth/surgery , Humans , Hypotension/etiology , Male , Middle Aged , Stress, Physiological/complications , Vascular ResistanceABSTRACT
Gingival overgrowth (GO) is an adverse side-effect of Cyclosporin A (CsA) therapy. There is wide evidence that fibroblasts are the primary cellular influence on GO and it has been hypothesised that people developing GO have fibroblasts with an abnormal susceptibility to CsA. The purpose of the study was to analyse, on a macroscopic scale, the Cyclosporin effects on soft connective tissues in order to show whether subjects with an abnormal gingival connective reaction to Cyclosporin may have macroscopic signs of a similar reaction in connective tissues other than oral cavity. Twenty-two heart transplanted patients were enrolled in the study. All patients had been on a CsA-based immunosuppression regimen for at least six months (33.2 +/- 20.5). Hyperplastic Index (HI) was considered as the periodontal parameter relating to GO. Macroscopic evidence of the residual cicatrix following thoracotomy (P1) and connective tissue hyperproduction in the subclavian region conditioning the difficulty in probing the vein during myocardial biopsies (P2) were considered as the parameters relating to extraoral cicatricial activity. Both non parametric statistical analysis (Mann Whitney U-test, linear correlation by Spearman) and parametric analysis (Student t-test) were used to investigate the relationship between HI (dependent variable) and P1, P2 (independent variables). Results failed to demonstrate any significant correlation between gingival overgrowth and cicatricial tissue hyperproduction in sites other than the oral cavity. We conclude that the hyperproduction of collagen leading to GO in a certain percentage of subjects treated with CsA is a reaction limited to the oral cavity and not a consequence of a systemic fibroblastic hyperactivity. Our data suggest that the collagen disregulation at gingival level may be a consequence of a local perturbation whose aetiological factors are however still not known.
Subject(s)
Connective Tissue/drug effects , Cyclosporine/adverse effects , Gingival Overgrowth/chemically induced , Heart Transplantation , Immunosuppressive Agents/adverse effects , Adult , Cicatrix/chemically induced , Collagen/biosynthesis , Female , Fibroblasts/drug effects , Humans , Middle Aged , Statistics, NonparametricABSTRACT
Direct person-to-person transmission of periodontal bacteria through saliva has recently been widely reported and dental units have been demonstrated to retract saliva from patients under treatment and to release it into the mouths of subjects undergoing the next operation. In this study the presence of a group of periodontal pathogenic bacteria inside waterlines in dental units was investigated using polymerase chain reaction (PCR) based methods. Briefly, 18 dental units of three different manufacturers were studied. Dental units were divided into two groups according to their prevalent use in routine practice. The first group consisted of nine dental units characterized by the frequent use of high-speed dental hand-pieces directly inside the mouth and in contact with patients' saliva. The second group, as a control, consisted of nine dental units where high-speed dental hand-pieces were not in use. A one cm section of the waterline tubing connected to the high-speed hand-piece was removed from each dental unit to evaluate the presence of DNA of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Treponema denticola. Two specimens were positive for Prevotella intermedia DNA. All the positive results were from samples obtained from dental units categorised in the first group. These findings clearly suggest that dental units have the potential to transmit periodontal pathogens. Manufacturers should be invited to design dental units that incorporate automated devices to disinfect DUWLs between patients with minimal effort by dental staff.
Subject(s)
Bacteria/isolation & purification , Biofilms/growth & development , DNA, Bacterial/analysis , Dental Equipment/microbiology , Equipment Contamination , Aggregatibacter actinomycetemcomitans/growth & development , Aggregatibacter actinomycetemcomitans/isolation & purification , Bacteroides/growth & development , Bacteroides/isolation & purification , Humans , Periodontal Diseases/microbiology , Polymerase Chain Reaction , Porphyromonas gingivalis/growth & development , Porphyromonas gingivalis/isolation & purification , Prevotella intermedia/growth & development , Prevotella intermedia/isolation & purification , Treponema denticola/growth & development , Treponema denticola/isolation & purificationABSTRACT
PURPOSE: To evaluate the effectiveness of a dentin bonding agent containing HEMA compared to a resin emulsion in the reduction of cervical dentin hypersensitivity (CDH). MATERIALS AND METHODS: The study was a randomized-within-subject, double blind design. Twenty patients who were suffering from CDH from at least two teeth (canines and/or premolars) were enrolled. The subjective perceptions of pain in response to tactile, air blasts and cold ethyl chloride stimuli were evaluated using a visual analog scale (VAS) at baseline and 10 minutes, 1 week and 4 weeks after the treatments. Scotchbond 1 (a dentin bonding agent similar to Single Bond in the USA) and MS Coat (a resin emulsion), both applied according to the manufacturers' directions, were selected for the study. RESULTS: Multiple regression ANOVA for repeated measures showed that both treatments significantly reduced the CDS with respect the baseline values after just 10 minutes. There were no significant differences between the ability of the two treatments to reduce CDH for each of the three evaluation stimuli or for subjective evaluation.