Treatment of Gingival Fenestration with Connective Tissue Graft: A Case Report.

Here, we report a case of gingival fenestration requiring periodontal plastic surgery. The patient was a 32-year-old man presenting with the chief complaint of esthetic impairment and gingival twitching due to gingival fenestration. Baseline examination revealed localized periodontal breakdown, including gingival fenestration in the lower right central incisor (#41). Periodontal examination revealed 3% of sites with a probing depth of ≥4 mm and 8.9% with bleeding on probing. Radiographic examination revealed vertical bone loss in #15 and 36, together with buccal fenestration in #41. Based on a clinical diagnosis of chronic periodontitis with gingival fenestration, initial periodontal therapy comprised plaque control and scaling and root planing. Following suppression of inflammation, occlusal adjustment was performed in the anterior teeth. As plastic surgery, combined use of an elevated flap and a connective tissue graft was applied at #41. Following reevaluation, the patient was placed on maintenance care. The patient's periodontal condition has remained stable over a 6-month period.

Treatment of Severe Chronic Periodontitis with Surgical and Prosthetic Intervention: A 9-year Follow-up Case Report.

A 60-year-old woman presented with the chief complaint of mobility of tooth #16. Gingival swelling and calculus were observed. Clinical examination revealed that 49.4% of sites had a probing depth (PD) of ≥4 mm and 72% of sites bleeding on probing. Radiographic examination revealed vertical bone resorption in #35 and horizontal resorption in other regions. Periapical region radiolucency on #16 and 27 suggested a perio-endo lesion. The clinical diagnosis was severe chronic periodontitis. Initial periodontal therapy mainly comprised the following: oral hygiene instruction; quadrant scaling and root planing (SRP); extraction of #16, 27, and 31; and placement of provisional restorations. Open flap debridement was performed for teeth with a PD ≥4 mm. Bone defects exceeding the root apex were found in #17, 41, 42, and 45 intraoperatively. Teeth #41, 42, and 45 were extracted. After confirming the stability of the periodontal tissue, final prostheses were placed on #14-17, 13-22, 35-37, 33-43, 44-46, and 47. Following reevaluation, the patient was placed on supportive periodontal therapy (SPT). After 6 years, the patient experienced dull pain in and pus discharge from #17. Repeated SRP yielded no improvement, so the tooth was extracted and a removable partial denture placed on #16 and 17. Nine years have passed since the start of SPT and the level of plaque control has remained adequate and periodontal condition stable.

Periodontal Regenerative Therapy of Intrabony Defects Using Deproteinized Bovine Bone Mineral in Combination with Collagen Barrier Membrane: A Multicenter Prospective Case-Series Study.

This multicenter prospective case series study aimed to evaluate the outcome of periodontal regenerative therapy using a deproteinized bovine bone mineral (DBBM) in combination with a collagen barrier (CB) in the treatment of intrabony defects. A total of 36 nonsmoking patients with chronic periodontitis were recruited in five centers in Japan. All patients had at least one intrabony defect of ≥ 3 mm. The surgical procedures included access for debridement using a papilla preservation technique. Defects were filled with DBBM and covered with CB. Clinical evidence after 6 months supported the effectiveness of the combination therapy in the treatment of intrabony defects.

Enhanced healing of surgical periodontal defects in rats following application of a self-assembling peptide nanofibre hydrogel.

AIM: The aim of this study was to investigate the effects of a self-assembling peptide (SAP) nanofibre hydrogel on healing of surgical periodontal defects in rats. MATERIALS AND METHODS: In vitro interactions between rat periodontal ligament (PDL) cells and SAP hydrogel (2.5% RADA16) were assessed by cell proliferation assays. In vivo, maxillary first molars of 45 Wistar rats were extracted and after healing, bilateral periodontal defects were surgically created mesially in second molars. Defects were treated with RADA16, Matrigel, or left unfilled. After 2 and 4 weeks, defect healing was evaluated by microcomputed tomography, histological and immunohistochemical analyses. RESULTS: Periodontal ligament cells grown on RADA16 showed an gradual increase in proliferation up to 72 h. At 4 weeks post surgery, the bone volume fraction and trabecular thickness of defect areas in the RADA16 group were significantly greater than those in other groups. Histologically, enhanced new bone formation was observed in the RADA16 group. At 4 weeks, PDL-like collagen bundles ran oblique to the root surface in the RADA16 group. Expression levels of PCNA-positive cells, vascular endothelial growth factor and osteopontin in the RADA16 group were significantly greater than those in other groups. CONCLUSIONS: Within the limitations of the study, application of the SAP hydrogel promoted healing of surgical periodontal defects by enhancing cell recruitment and possibly angiogenesis.

Point-of-care detection of Tannerella forsythia using an antigen-antibody assisted dielectrophoretic impedance measurement method.

UNLABELLED: The importance of periodontal treatment planning based on diagnosis with clinical detection of periodontal pathogens has been well recognized. However, reliable detection and quantification methods that can be conveniently used at chair-side have yet to be developed. This study aimed to evaluate the clinical use of a novel apparatus which uses an antigen-antibody reaction assisted dielectrophoretic impedance measurement (AA-DEPIM) for the detection of a prominent periodontal pathogen, Tannerella forsythia. A total of 15 patients with a clinical diagnosis of chronic periodontitis, three periodontally healthy volunteers and two with gingivitis were subjected to clinical and microbiological examinations. Saliva samples were analyzed for the presence of T. forsythia using AA-DEPIM, PCR-Invader and real-time PCR methods. The measurement values for total bacteria and T. forsythia using the prototype AA-DEPIM apparatus were significantly greater in periodontitis group than those in healthy/gingivitis group. Using the AA-DEPIM apparatus with tentative cut-off values, T. forsythia was detected for 14 (12 with periodontitis and 2 either healthy or with gingivitis) out of 20 individuals. The measurement for the detection of T. forsythia by the AA-DEPIM method showed a significant positive correlation with the detection by PCR-Invader (r = 0.541, p = 0.01) and the real-time PCR method (r = 0.834, p = 0.01). When the PCR-Invader method was used as a reference, the sensitivity and specificity of the AA-DEPIM method were 76.5% and 100%, respectively. The results suggested that the AA-DEPIM method has potential to be used for clinically evaluating salivary presence of T. forsythia at chair-side. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR) UMIN000012181.

Effect of collaborative intervention by medical and dental professionals on adherence to smoking abstinence.

The need for smoking cessation care is widely recognized. It is, however, difficult to achieve continued smoking abstinence, even when cessation has initially been achieved. The aim of this study was to determine the effectiveness of a collaborative smoking cessation program involving both medical and dental professionals on smoking abstinence. A total of 10 patients visiting our Smoking Cessation Outpatient Clinic were followed up and monitored for smoking abstinence. All received smoking cessation care consisting mainly of counseling by dental and medical professionals and pharmacotherapy. They also concurrently received an oral examination, instruction on oral hygiene, and professional tooth cleaning. The 4-week smoking abstinence rate was 90.0% on completion of the program. One patient failed to complete the program. At one month after the program, 8 out of 9 patients remained abstinent (4-month abstinence; 88.9%). At 3 months after the program, 7 patients remained abstinent (6-month abstinence; 77.8%). Follow-up was impossible in one patient. Within the limitations of the present study, it is suggested that such collaborative intervention including subsequent dental care has the potential to promote short-term adherence to smoking abstinence.

Effect of basic fibroblast growth factor (FGF-2) in combination with beta tricalcium phosphate on root coverage in dog.

OBJECTIVE: In root coverage treatment, periodontal regeneration in gingival recession-type defects is an important challenge for the periodontist. The aim of this study was to histometrically investigate the effect of combined use of basic fibroblast growth factor (FGF-2) and beta tricalcium phosphate (ß-TCP) on root coverage in dogs. MATERIALS AND METHODS: Sixteen adult beagle dogs were used. Buccal gingival recession defects were surgically created bilaterally in the maxillary canines. The defects in each animal were randomly assigned to: (1) an FGF-2 alone (control) group or (2) FGF-2/ß-TCP (experimental) group. At 2, 4 or 8 weeks following surgery, specimens were obtained and subjected to microscopic examination and histometric assessment. RESULTS: Inhibition of epithelial down-growth was observed in both groups. At week 2, in the newly formed connective tissue at the coronal portion, the FGF-2/ß-TCP group showed significantly greater numbers of proliferating cell nuclear antigen-positive cells than the FGF-2 group (55.8 ± 4.8 vs 12.0 ± 1.4, p < 0.01). In the FGF-2/ß-TCP group, new attachment was observed at 8 weeks and the extent of new bone and cementum formation was significantly greater in the FGF-2/ß-TCP group than that in the FGF-2 alone group. In both groups, the dentin surface beneath the new cementum presented minor irregularities, but no replacement resorption was observed. CONCLUSIONS: FGF-2 used in combination with ß-TCP enhances formation of new bone and cementum without significant root resorption in root coverage in this dog model. This combination warrants further investigation in periodontal regeneration in root coverage treatment.

Coverage of gingival recession defects using acellular dermal matrix allograft with or without beta-tricalcium phosphate.

The aim of this study was to investigate the effect of beta-tricalcium phosphate (ß-TCP) particles in combination with acellular dermal matrix (ADM) allograft in gingival recession. Experimental gingival recession defects were created in beagle dogs and randomly assigned to one of the following groups: ADM, ADM + ß-TCP, or coronally positioned flap (CPF; control). Tissues were histologically examined at 4, 8, or 16 weeks following treatment. A greater thickness of gingiva was observed at the sites treated in both the ADM + ß-TCP and ADM groups than in the CPF group. The ADM + ß-TCP group showed a statistically significant increase in both new bone and cementum formations compared to the ADM group. The results suggest that the combination of ß-TCP and ADM is more effective in promoting new bone and cementum formations than ADM graft alone.

Effect of platelet-derived growth factor-BB on root resorption after reimplantation of partially denuded tooth in dog.

The prognosis for a reimplanted tooth depends largely on the condition of the root. Platelet-derived growth factor (PDGF)-BB has been shown to regenerate periodontal tissue in animal and human clinical studies. However, information regarding the effect of PDGF-BB on tooth reimplantation is limited. The objective of this study was to investigate the effect of PDGF-BB on root resorption after reimplantation of a partially denuded tooth in dog. A total of 15 healthy female beagle dogs were used. Mandibular third and fourth premolars were endodontically treated and then extracted as atraumatically as possible. The coronal portion of each root was carefully scaled and planed. The roots on the right side of the mandible were treated with PDGF-BB and reimplanted, while the roots on the left side served as controls. After 2, 4, or 8 weeks, specimens were collected and processed for histopathological examination. By the 4th week after reimplantation, new periodontal ligament (PDL)-like tissue had formed around the PDGF-BB-treated root surfaces and new bone. By the 8th week, healing of the PDGF-BB-treated roots was characterized by newly formed PDL with inserting attachment formation. In contrast, control roots showed multiple areas of replacement resorption. Immunohistochemical staining of proliferating cell nuclear antigen (PCNA) performed at 2 weeks after reimplantation showed that the number of PCNA-positive cells in the connective tissue area was statistically significantly greater in the PDGF-BB-treated group than in the control group (P < 0.001). The application of PDGF-BB resulted in a significantly lower occurrence and extent of root resorption and ankylosis. These results suggest that the use of PDGF-BB reduces occurrence of ankylosis and root resorption in tooth reimplantation.