Expanded polytetrafluoroethylene and dental rubber dam barrier membranes in the treatment of periodontal intrabony defects. A comparative clinical trial.

As observed in previous case reports, dental rubber dam (DRD) can be utilized as a barrier membrane in the guided tissue regeneration (GTR) technique for the treatment of periodontal intrabony defects. The purpose of the present study was (1) to confirm the validity of DRD as a suitable material in regenerative procedures and (2) to compare, in a split-mouth clinical trial, the effectiveness of DRD-made membranes in the treatment of periodontal intrabony defects versus that of expanded polytetrafluoroethylene (e-PTFE) barriers. 22 systemically healthy non-smoker adult periodontitis patients (7 male, 15 female) aged between 35 to 58 years were selected for the study. In each patient, a couple of 2-3 wall intrabony defects, located in different quadrants, were treated by a GTR technique using DRD (test sites) and e-PTFE (control sites), respectively. Performing a strict control of the oral hygiene level and of the marginal gingival health during the whole period of study, clinical (pocket probing depth, PPD; probing attachment level, PAL; gingival recession, GR) and intrasurgical (depth of the defect's intraosseous component, IOC; level of the alveolar crest, ACL) parameters were recorded at baseline and at the 1-year re-entry procedure in each experimental site. Furthermore, the coronal level of the newly formed tissue from the base of the defect (NFTL) and the vertical bone gain (VBG) were calculated at the time of membrane removal and after the re-entry procedure respectively. Membranes were removed from both test and control sites after 5 weeks; however, exposure of the membrane always occurred in test sites whereas it was observed in only 6 out of 22 control sites, this fact leading to an incomplete coverage of the regenerated tissue by the gingival flap in 18 out of 22 test sites. In both test and control sites, a statistically significant improvement of clinical and intrasurgical parameters occurred at the end of the study period; however, a significantly greater improvement was observed in control sites for PAL (+4.0 mm versus +3.0 mm; p<0.05) and VBG (3.9 mm versus 2.9 mm; p<0.05) although at the time of membrane removal, NFTL was similar between the experimental sites (test: 5.8; control: 5.6; p>0.05). Conversely, test sites exhibited a statistically significant greater increase in gingival recession (+1.9 versus +1.2; p<0.05) and alveolar crest resorption (-1.1 versus -0.3, p<0.01) in comparison to controls. It was concluded that (1) DRD is a suitable material to be used as a barrier membrane in GTR procedures although (2) e-PTFE membranes can provide a greater improvement in PAL and VBG, probably because of the difficulty in completely covering the regenerated tissue due to the fact that the gingival tissues have undergone a consistent recession in DRD-treated sites. Further studies are needed to demonstrate if an adequate coverage of the regenerated tissue in DRD-treated sites can eliminate these differences.

[Gingival hyperplasia in pregnancy. II. Etiopathogenic factors and mechanisms]. / Lesioni gengivali iperplastiche in gravidanza Nota II. Fattori e meccanismi eziopatogenetici.

The principal aspects of the hyperplastic pathology which frequently appears during pregnancy with a particular regard to the etiopathogenetic hypotheses are presented. The etiopathogenesis of the so-called pregnancy granuloma is rather complex, because in addition to the common irritant factors like bacterial plaque and calculus it is necessary to recognize the influence that hormonal modifications in pregnancy have on the predisposition to the development of gingival lesions. The hormonal influence acts by an intense inflammatory response and by a selective growth of some periodontal-pathogen and aggressive microbes, like Prevotella intermedia, whose increase in the subgingival plaque from the 3 degrees-4 degrees month of pregnancy coincide with the beginning of hyperplastic lesions. Sexual hormones seems to act as growth factors for the subgingival bacterial flora, in particular for Gram-negative anaerobic rods. The worsening of gingival conditions appears prevalently in the first quarter of pregnancy, in concomitance with the increase of urinary excretion of gonadotropins, that is in relation with an increased concentration of estrogens and progesteron in circulating blood. Sexual hormones could cause great modifications in peripheric vascular system, with a marked increase of vascular permeability and the following oedema of gingival tissues. In pregnancy the maternal immunological system presents some particular modifications, that allows to avoid the immunological rejection between mother and fetus, but reduce the reactivity of gingival tissues against local irritating factors.