Long-term evaluation of human teeth after Le Fort I osteotomy: a histologic and developmental study.

Transient pulpal vascular ischemia and direct injury to the apices of the teeth have been implicated as the causes of degenerative and atrophic pulpal changes in experimental animals after Le Fort I osteotomy despite the presence of collateral circulation. The long-term clinical effect of these pathologic changes in human teeth has not been studied. Seventeen maxillary third molar teeth from 10 patients whose postsurgical follow-up ranged from 6 months to 78 months (mean, 40 months) were extracted. The long-term biologic effects of Le Fort I osteotomy on the pulp and on the development of teeth were retrospectively evaluated with clinical and standard histologic techniques. Normal teeth from patients who were not operated on were used as controls. Histologic examination revealed an intact pulpal circulation and minimal pathologic changes in the pulpal tissue. Clinical and radiographic studies showed that the growing teeth developed normally after surgery. The Le Fort I downfracture procedure had little discernible long-term effect on the pulp and on the development of human third molar teeth.

Bovine bone morphogenetic protein (bBMP) fraction-induced repair of craniotomy defects in the rhesus monkey (Macaca speciosa).

Large cranial defects do not always heal spontaneously, especially in humans; often they have to be obturated with metallic or acrylic fillers. Bilateral cranial trephine defects, measuring 14-20 mm in diameter, were created in three Rhesus monkeys, providing a typical primate model system for investigations in comparative physiology of bone regeneration. Each skull had one control and one experimental trephine defect. Control defects were implanted with bovine serum albumin (BSA). Experimental defects were implanted with 100-200 mg of a partially purified fraction of bovine bone morphogenetic protein (bBMP) in two monkeys. In one monkey, the BMP was incorporated in a 1:1 poly(lactic) poly(glycollic) acid copolymer, high-viscosity formula. The animals were killed at eight weeks, ten weeks, and 16 weeks after implantation. The tissue responses were analyzed by computed histomorphometry and routine histologic examination. At each time interval, the BMP implanted defects produced more complete regeneration than the control implants. The morphogenetic response occurred in the following sequences: mesenchymal cell proliferation, chondrogenesis, and increased bone formation. BMP-induced osteogenesis may initiate the regenerative process. The copolymer releases BMP but may constitute a barrier to the end stages of replacement by new bone, and would be more useful in a low-viscosity rapidly biodegradable form.

Clinical oral medicine. An exciting facet of postdoctoral periodontic training.

This paper briefly reviews the historical relationship between oral medicine and periodontics. The reasons for including structured clinical oral medicine in a postdoctoral program in periodontics are discussed. Problems and solutions to such an integrated program are outlined. Guidelines for broadening the base of the field of periodontics by expanding the specialty more vigorously into the area of clinical oral medicine are provided.

Lysine as a prophylactic agent in the treatment of recurrent herpes simplex labialis.

The amino acid lysine is an agent that has been proposed for treating the clinical symptoms of recurrent herpes simplex labialis. This study examined the efficacy of long-term prophylactic lysine supplementation. Twenty-six volunteers with a history of frequently recurring herpetic lesions completed a 12-month double-blind crossovers study. The experimental group received daily oral supplements of 1,000 mg 1-lysine. Serum samples were analyzed at scheduled intervals. In most instances, members of the lysine group reported significantly fewer lesions than the control group. Similarly, those who were taken off lysine supplementation generally showed a significant increase in lesion frequency. Quantitative hematologic measurements revealed the most clinically useful relationship. Data from this sample population indicated that when a person's serum lysine concentration exceeded 165 nmol/ml there was a corresponding significant decrease in recurrence rate. Conversely, the frequency rate increased significantly as concentration levels fell below 165 nmol/ml. These results suggest that prophylactic lysine may be useful in managing selected cases of recurrent herpes simplex labialis if serum lysine levels can be maintained at adequate concentrations.

Pharmacologic management of stomatologic problems.

A wide variety of diseases of the soft tissues of the oral cavity occur. Some of the common and significant problems have been presented with recommendations for their management. Diagnosis and patient evaluation including adequate laboratory studies when required, are the keys to a more successful outcome of treatment. Antibiotics and short-term anti-inflammatory steroids benefit selected cases. In others, treatment may require a team approach in concert with the physician. Dentists should be alert to causes of the oral lesions, especially in cases of xerostomia, candidiasis, and nutritional deficiencies. This article should form a basis for therapy of stomatologic problems.

Prepubertal periodontitis affecting the deciduous and permanent dentition in a patient with cyclic neutropenia. A case report and discussion.

Neutropenia is a transient or chronic blood disorder characterized by a decrease in the number of circulating polymorphonuclear leukocytes (PMNs). Neutrophils are a major cellular defense against infection, and depletion of these cells is potentially fatal. Stomatitis and gingivitis frequently are seen in patients with neutropenia. Therefore, the diagnosis of severe oral pathoses of obscure origin must include a differential white blood cell count. The importance of the dentist's role is dramatically illustrated in the rare case reported here, since the oral condition was the reason for this patient's definitive blood work-up. The report illustrates the importance of the laboratory assessment in dental patients with unusual periodontal destruction or other inexplicable oral changes.

Gingival findings in spontaneous scurvy. A case report.

This case report presents clinical observations of alterations in periodontally diseased soft tissues associated with the development of scurvy. The sudden clinical appearance of the gingival lesions suggested a differential diagnosis of scurvy, acute leukemia and diabetes. Such lesions may develop prior to or simultaneous with extraoral findings. Coordination of systemic and local therapy effectively resolved the disease state. The dentist may be the first source of consultation for the patient with scurvy. An appreciation for this rare but potentially devastating condition is necessary for satisfactory management of the disease.

Immunopathology of periodontal disease. II. Immunofluorescent studies on the localized immune response in periodontitis and juvenile periodontitis.

Local immunologic responses were studied in eleven patients with periodontitis, ten patients with juvenile periodontitis, and ten control subjects by performing immunofluorescence on gingival biopsies. F(ab')2 monospecific conjugates to human IgG, IgM, IgA, IgD, and kappa and lambda light chains were used as well as monospecific conjugates to human IgE and properdin. Biopsies from patients with juvenile periodontitis displayed a more intensified immunologic response as evidenced by increases of (I) positive cells stained with a F(ab')2 antihuman immunoglobulin conjugate; (2) IgG, IgM, and kappa and lambda containing cells; (3) extracellular fluorescence of IgG, IgM, IgA, and kappa and lambda light chains; and (4) properdin deposition. Neither IgD nor IgE conjugates reacted significantly with biopsies from the three patient groups. These findings support our previous conclusion that immunologic responses in periodontitis and juvenile periodontitis appear qualitatively similar, but that patients with juvenile periodontitis exhibit a more intense immune response.

Oral manifestations of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease). Review and case reports.

A review of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu Disease) is presented. Special emphasis is placed on the oral manifestations which include hemorrhagic vesicles, nodules, papules and ulcers that involve the gingiva and other areas of the mucosa. Two cases are included which were seen in a periodontic clinic prior to the medical diagnosis. The nature of the practice of periodontics necessitates a broad understanding of the systemic diseases reflected in the oral cavity. Hereditary hemorrhagic telangiectasia is one such disease.

Immunopathology of periodontal disease. I. Immunologic profiles in periodontitis and juvenile periodontitis.

Eleven patients with periodontitis, ten patients with juvenile periodontitis and ten control subjects were studied to compare systemic and local immunologic responses and various other blood parameters. A more intensified immunologic response was seen in juvenile periodontitis as compared to periodontitis or controls as evidenced by: (1) greater number of plasma cells and lymphocytes in biopsy specimens of involved gingiva stained by Harris hematoxylin and eosin; (2) significant decrease in serum C4 levels and slightly elevated serum IgG levels as determined by radial immunodiffusion; (3) marked increase of positive fluorescing cells in biopsy specimens stained with antihuman immunoglobulin conjugate and an increase in complement deposition in the same tissues as determined by immunofluorescence. No significant differences among the two groups of patients and control subjects were observed with respect to complete blood counts, coagulation studies, or blood glucose levels. These findings suggest that the immunologic responses in periodontitis and juvenile periodontitis are qualitatively similar, but that the intensity of the response is greater in juvenile periodontitis.

Bone remodeling in periodontal lesions.

This study was designed to investigate sites of major alveolar bone formation as a result of resorption of the interdental crest in periodontal lesions. Bone samples were taken from twelve patients requiring surgery as part of their periodontal treatment. Tetracycline was used in all cases to label bone recently formed. The selected areas were periodontal pockets ranging in depth from 6 to 8 mm. The bone deformities were of crater-form configuration. The buccal and lingual plates were removed. Later, the dehydrated speciemns were embedded in bioplastic and cut to sections 70 mu thick. Controls were healthy pieces of bone taken from the same patient in unaffected areas. Yellow fluorescent tetracycline labeling was observed in both periosteal and trabecular bone. In the trabecular bone, labeling was exhibited in the lamella of some Haversian systems, away form the bone resorption. There was a direct relationship between bone resorption and bone apposition as seen by the presence of tetracycline in the buccal and lingual alveolar plates. Controls showed only minimal labeling. The results of this study have posed the question as to whether inflammation could be the stimulus in the reactivation of osteocytes or bone formation, in the buccal and lingual walls of the periodontal lesions.

Oral factitious injuries.

The subject of oral factitious injuries is reviewed and four cases are reported. It is noted that self-inflicted oral injuries are not limited to the soft tissue but may result in destruction of bone and tooth structure. While children are more often the subjects of self-injurious behavior about the oral cavity, adults may also exhibit similar conduct. Emotional problems are often co-existent with self-inflicted oral injuries, however, in some cases there does not seem to be a readily descernible emotional disturbance. Since factitious injuries often pose diagnostic problems for the dentist, some diagnostic suggestions are included.

Cervical enamel projections as an etiologic factor in furcation involvement.

Two thousand molars in 200 East Indian skulls were examined for the occurrence, location, and grade of cervical enamel projections. The relationship between the enamel projections and furcation involvements was studied. Several findings resulted. The incidence of cervical enamel projections in molars was 32.6%. The incidence of cervical enamel projections varied between molars. The mandibular second molars showed the highest incidence of enamel projections (51.0%), followed by the maxillary second molars (45.6%). The lowest incidence was seen in the maxillary first molars (13.6%). Grade 1 enamel projections were the most frequently encountered. Cervical enamel projections occurred most frequently on the buccal surfaces of teeth. There was a positive, statistically significant relationship between tooth surfaces with grade 2 and 3 enamel projections and periodontally involved furcations. However, no etiologic relationship was found between grade 1 projections and furcation involvements. There seems to be a physiologic relationship between bone and enamel projections. The alveolar crest has a tendency to follow the outline of the enamel projection, and a channel much wider than a normal periodontal membrane space accommodates the enamel projection as it extends toward the furcation. The results indicate that when cervical enamel projections are severe enough to approach or enter the furcation area (grades 2 and 3), they may be an etiologic factor in the breakdown of these furcations.