Delayed Severe Gingivitis After Placement of Orthodontic Braces in an Atopic Teenager: A Case Report and Literature Review.

We report a case of a 15-year-old atopic patient presenting with delayed, severe ulcerative hypertrophic gingivitis after placement of orthodontic braces, which required removal of braces and restorative laser surgical procedures. Patch testing to multiple metals and chemicals showed weak positive reactions to steel bands and formaldehyde. The patient experienced urticarial, gingivitis, and other intraoral symptoms after patch testing and re-exposure to nickel-containing products. In contrast, nickel, cobalt, and cobalt-chromium (Co-Cr) bracket patch testing sites were negative. Nickel-caused contact dermatitis is Type IV delayed hypersensitivity reaction occurring at least 24 h after exposure. This reaction can result in intraoral blisters, ulcerations, eczematous and urticarial reactions of the face and more distant skin areas. This case illustrates the intraoral delayed response, symptom resolution after removing the braces, and brackets and local reactions upon subsequent nickel exposure, despite negative patch testing and lymphocyte stimulation test to nickel. This case further illustrates the difficulty associated with diagnosing nickel allergy.

Use of Tuberosity Connective Tissue for Root Coverage and Ridge Augmentation: Background and Technique.

Excess tissue often exists distal to the upper second molar, creating a pocket in the maxillary tuberosity. When removed from this location, this tissue can serve as an optimal piece of connective tissue (CT), helping to both prevent periodontal disease and treat periodontal recession while also aiding in restorative dentistry. This tissue is an ideal CT for root coverage and soft-tissue ridge-augmentation grafting. This article provides an overview of CT grafting, including a discussion of tuberosity CT and its advantages versus palatal CT. The authors describe two techniques for harvesting tuberosity tissue for CT grafts, the distal gingivectomy technique and the distal wedge technique, and show examples of various uses of tuberosity tissue for CT grafts.