Gingival fenestration defect treated with gingivectomy and gingivoplasty: A case report with an 8-year follow-up.

INTRODUCTION: Gingival fenestration (GF) is scarcely reported in the literature. We present a unique case of GF defect combined with gingivitis and altered passive eruption (APE). CASE PRESENTATION: An 18-year-old female patient with gingivitis, APE, and GF in the mandibular left central incisor presented for periodontal treatment. The gingival lesion was successfully treated with basic periodontal therapy gingivectomy, and gingivoplasty and resulted in an excellent aesthetic long-term outcome. This case report shows its 8-year clinical follow-up. CONCLUSION: There are no earlier reports dealing with the use of gingivoplasty for the treatment of GF, as it is not the usual therapeutic intervention for these defects. Gingivoplasty proved to be effective in treating GF. Why is this case new information? Available literature on gingival fenestration defects does not describe gingivectomy and gingivoplasty as a treatment of choice. Gingivectomy and gingivoplasty proved to be effective in treating gingival fenestration defects. What are the keys to successful management of this case? Proper diagnosis. What are the primary limitations to success in this case? Gingival fenestration has been defined when the overlying gingiva is denuded, exposing the root to the oral cavity. However, in this case report, only the crown was exposed because the patient had altered passive eruption.

Laterally Positioned Flap with Subepithelial Connective Tissue Graft Modified One-Stage Procedure for the Treatment of Deep Isolated Gingival Recessions in Mandibular Incisors.

The laterally positioned flap (LPF) has been proposed as a promising treatment for isolated gingival recessions (GRs) in mandibular incisors. Several modifications have been proposed to reduce the risk of gingival recession (GR) at the donor tooth site. Therefore, the aim of this was to describe a modified one-stage procedure of performing the LPF associated with the subepithelial connective tissue graft (LPF + SCTG) with the modifications for the treatment of deep isolated GR in mandibular incisors. The modified one-stage technique (LPF + SCTG) is unique because it was presented being bilaminar with tunneled connective tissue graft (CTG) in the adjacent tooth and extended to the flap donor site, without a submarginal incision in the adjacent tooth, taking the entire band of the keratinized tissue (KT) into the flap. In addition, 3 clinical cases were described using this surgical technique. Three healthy patients with Cairo RT1 or RT2 GRs on teeth 31 or 41 were treated with the LPF + SCTG technique. Probing depth (PD), clinical attachment level (CAL), complete root coverage (CRC), mean root coverage (MRC), recession depth (RD), and keratinized tissue width (KTW) were assessed at baseline and in the follow-up periods of 18, 24, and 48 months, in the cases 1, 2, and 3, respectively. The LPF + SCTG with the modifications presented is a predictable approach for the treatment of deep isolated RT1 and RT2 GRs in mandibular incisors that are well positioned in the bone envelope with the presence of KTW adjacent to GR and adequate vestibule depth in the donor area of the flap.

Manipulação de tecido mole peri-implantar na região lingual posterior de mandíbula / Peri-implant soft tissue management in the posterior lingual region of the mandible ­ a case report

O objetivo deste artigo foi relatar um caso clínico no qual foi realizada uma modificação da técnica de estabilização do enxerto de tecido conjuntivo (ETC) concomitante à etapa de reabertura, com o intuito de melhorar a qualidade da mucosa peri-implantar na região lingual posterior de mandíbula. Após anamnese, foi constatada no exame clínico a necessidade de exodontia do dente 34 e reabilitação protética na região do 34-36. Após cinco meses, foram instalados três implantes na região dos dentes 34, 35 e 36. Decorridos quatro meses, foi realizada a reabertura desses implantes e, pela ausência de mucosa queratinizada na região dos implantes instalados, optou-se por realizar um ETC na região lingual do 35 e 36. Este foi removido do palato e, para melhor adaptação desse enxerto no leito receptor, foi utilizado um perfurador de lençol de borracha para perfurar o ETC no local que correspondia aos cicatrizadores dos implantes 35 e 36, estabilizando-se assim o ETC no leito receptor. O retalho foi reposicionado, cobrindo totalmente o ETC e suturado. Após três anos, o tecido mole adjacente ao implante apresentava-se clinicamente estável e saudável, e a paciente encontrava-se satisfeita com o resultado. De acordo com o caso clínico relatado, esta nova abordagem para utilização do ETC, para criar uma faixa de gengiva queratinizada ao redor de implantes, mostrou-se efi ciente quanto à sua utilização de região posterior de mandíbula. Entretanto, estudos clínicos adicionais são necessários para avaliar a precisão desta técnica em outras condições clínicas.

The aim of this article is to report a clinical case where a modification of the technique of stabilization of the connective tissue graft concomitant to the reopening stage was performed in order to improve the quality of the periimplantar mucosa in the posterior lingual region of the mandible. After anamnesis, and clinical examination, the need to perform tooth 34 extraction and prosthetic rehabilitation in the region 34-36 was verifi ed. After 5 months, 3 implants were installed in the region of teeth 34, 35 and 36. After 4 months, the reopening of these implants was performed and because of the absence of keratinized mucosa in the region of the implants it was chosen to perform a connective tissue graft (CTG) in the lingual region of 35 and 36. The graft removed from the palate and for better adaptation bed, a rubber sheet punch was used to puncture it at the site corresponding to the implants 35 and 36 being stabilized in the recipient bed. The flap was repositioned, completely covering the CTG and sutured. After 3 years, the soft tissue adjacent to the implant was clinically stable, healthy and the patient was satisfied with the result. According to the reported clinical case, this new approach for the use of CTG to create a keratinized gingival band around implants proved to be efficient in its use of the posterior mandible region. However, additional clinical studies are needed to assess the accuracy of this technique in other clinical conditions.

Influence of low-level laser therapy on the healing process of autogenous bone block grafts in the jaws of systemically nicotine-modified rats: A histomorphometric study.

OBJECTIVE: To analyze the influence of low-level laser therapy (LLLT) on the bone healing process of autogenous bone block grafts installed in nicotine systemically modified rats. METHODS: Seventy-two rats (Wistar) were randomly assigned into 4 groups (n=18). SS-BG: saline application+bone graft. SS-BG/LLLT: saline application+bone graft+LLLT. NIC-BG: nicotine application+bone graft. NIC-BG/LLLT: nicotine application+bone graft+LLLT. After 30days of application of solutions, all animals received autogenous bone block graft in the jaw, with the donation from the parietal bone's calvarial area. Treatment with LLLT was in bed-graft interface, after accommodation of the graft. The animals in each group were sacrificed at 7, 14, and 28days after graft surgery. RESULTS: The histologic analyses of NIC-BG group depicted a delay of osteogenic activity in the recipient bed-graft interface and the irradiation of tissue with LLLT provided better bone healing. The histometric analysis revealed that SS-BG/LLLT and NIC-BG/LLLT groups showed increased bone formation compared to BG-SS and NIC-BG groups, after 14days (SS-BG 24.94%±13.06% versus SS-BG/LLLT 27.53%±19.07% and NIC-BG 14.27%±2.22% versus NIC-BG/LLLT 24.37%±11.93%) and 28days (SS-BG 50.31%±2.69% versus SS-BG/LLLT 58 19%±12.32% and NIC-BG 36.89%±8.40% versus NIC-BG/LLLT 45.81%±6.03%). CONCLUSION: Nicotine harms bone formation in the bed-graft interface and LLLT action can mitigate this.

Effects of low-level laser therapy on bone healing of critical-size defects treated with bovine bone graft.

OBJECTIVE: To histomorphometrically analyze the effect of low-level laser therapy (LLLT) on bone formation process in surgically created critical-size defects (CSDs) treated with bovine bone graft (BBG) and its influence over particles' resorption of BBG. METHODS: A 10-mm diameter CSD was surgically created in the calvaria of 64 male rats, which were distributed into 4 experimental groups: the C group (control), only blood clot; the LLLT group, LLLT (GaAlAs, 660nm) and blood clot; the BBG group, CSD filled with BBG; the BBG/LLLT group, LLLT and CSD filled with BBG. Animals were euthanized at either 30 or 60days post-operation. A histological analysis was performed. Additionally, the percentage of newly formed bone area (NFBA) and remaining particles areas (RPA) of BBG were histometrically evaluated and data statistically analyzed. RESULTS: The LLLT (5.82±2.05; 7.34±1.01) group presented significantly greater NFBA when compared to the C group (1.61±0.30; 5.59±0.94) at 30 and 60days post-operation (p<0.05). The BBG/LLLT group (7.39±1.45; 9.44±2.36) presented significantly greater NFBA than the BBG group (3.85±1.56; 8.02±0.63) at 30 and 60days postoperation (p<0.05). There was no significant difference in the mean percentage of implanted material RPA between the BBG and the BBG/LLLT groups. CONCLUSIONS: LLLT can improve bone formation process in CSD filled or not with BBG in rat calvaria, but it is not able to accelerate particles resorption of this material in the interior of bone defect.

Root coverage of adjacent gingival recessions with a combination of two surgical techniques

Introduction: The dentin hypersensitivity associated with gingival recession is an occurrence of high prevalence in the clinical routine of dentists. Coverage of exposed root surfaces represents a challenge for periodontal treatment. Objective: The purpose of the present study is to describe an approach for adjacent gingival recession treatment using a combination of two surgical techniques: the subepithelial connective tissue graft (SCTG) with a laterally positioned double flap. Case report: This surgical treatment was conducted in a 45-yearold female patient who complained of sensitivity when brushing the lower right teeth. Clinical and radiographic examinations showed gingival recessions (Miller Class III) with traumatic origin promoted for tooth brushing and the presence of thin periodontium in the region. In addition, interproximal bone loss was noted on vestibular face of the right mandibular second premolar and mesial root of the right mandibular first molar. At 12 postoperative months, it was observed that the association of the two surgical techniques promoted an almost complete coverage of the gingival recessions, an increased keratinized gingival band and the elimination of initial dentin hypersensitivity. Conclusion: The appropriate choice of techniques and patient compliance to the periodontal support therapy led to treatment success and periodontal health maintenance in the region during the whole follow-up period.

Effects of oestrogen deficiency and 17ß-estradiol therapy on bone healing in calvarial critical size defects treated with bovine bone graft.

OBJECTIVE: To histomorphometrically analyze the effect of ovariectomy-induced oestrogen deficiency and 17ß-estradiol therapy on bone healing of surgically created critical-size defects (CSDs) treated with bovine bone graft (BBG). METHODS: Forty-eight female rats were randomly assigned to the following 3 experimental groups (n=16): sham-operated animals (SHAM), ovariectomized animals (OVX) and ovariectomized animals treated with oestrogen (OVX+E2). OVX+E2 animals received daily subcutaneous injections of 17ß-estradiol (20µg/kg) from 8 days after ovariectomy until euthanasia. Thirty days after the surgery, an 8mm CSD was surgically created in each calvaria of all animals and filled with BBG. Animals were euthanized at either 30 or 60 days postoperative. A histological analysis, percentage of Newly Formed Bone Area (NFBA), osteoblast and osteoclast number was histomorphometrically performed (p≤0.05). RESULTS: At 30 days, SHAM group (8.82%±2.93) had significantly greater NFBA than OVX (4.66%±1.35) and OVX+E2 groups (5.85%±4.08) (p≤0.05). At 60 days, SHAM group (11.51%±3.08) and OVX+E2 group (9.84%±1.87) had significantly greater NFBA than OVX animals (5.12%±0.68) (p≤0.05). Fewer osteoblasts were observed in the OVX group at 30 (763.40±121.60) and 60 (696.60±80.92) days than in the SHAM group at 30 days (1356.00±95.38). Fewer osteoclasts were observed in the OVX+E2 group (3.25±2.16) than in the SHAM (9.75±1.82) and OVX (12.75±1.47) groups at 30 days (p≤0.05). CONCLUSIONS: Oestrogen deficiency compromises bone healing in calvarial CSDs treated with BBG in ovariectomized rats. After 60 days post-surgery, 17ß-estradiol therapy improved bone healing in calvarial CSDs treated with BBG in ovariectomized rats.

Oral Focal Mucinosis: Clinical Case Presentation With a Focus on Esthetic and Functional Surgical Resolution.

INTRODUCTION: When planning excisional surgery, alterations in the oral mucosa, particularly in esthetically important areas, represent a challenge. For cases involving an exophytic lesion with a vegetative tumoral aspect, a clinician may prioritize obtaining a definitive diagnosis by histopathologic and histochemical examinations over the preservation of esthetics or maintenance of the involved tooth. CASE PRESENTATION: A painless, hard lesion with normal coloration was present in the maxillary left central incisor of a patient for at least 6 years. A biopsy was performed to preserve oral mucosa and a treatment plan was established that included endodontic retreatment and prosthetic restoration. The histopathologic diagnosis was oral focal mucinosis, an uncommon and poorly characterized type of lesion. CONCLUSION: A conservative biopsy of the lesion facilitated an accurate diagnosis, promoted the patient's comfort, and achieved satisfactory esthetic results.

Abordagens periodontais na promoção da harmonia do sorriso / Periodontal approaches in promotion of harmony smile

Várias abordagens terapêuticas têm sido propostas com o objetivo de alcançar uma estética favorável e harmônica do sorriso. O presente estudo relata um caso clínico em que foi realizada gengivoplastia na região dos dentes anteriores superiores associada à osteotomia na região dos dentes posteriores superiores e remoção do freio labial superior, para promoção da harmonia do sorriso, por meio da diminuição do sorriso gengival e adequação do corredor bucal. Os procedimentos de osteoplastia, gengivoplastia e frenectomia foram planejados e realizados em uma única sessão. Também foi realizada a remoção cirúrgica do freio labial superior que se apresentava fibroso e com baixa inserção, e dos terceiros molares superiores direito e esquerdo, que se apresentavam semi-inclusos, para evitar complicações pós-operatórias. Consultas de acompanhamento foram realizadas aos sete, 15, 30 e 180 dias do pós- operatório. Aos sete dias, o tecido gengival encontrava-se em processo inicial de cicatrização. Aos 15 dias, o tecido gengival encontrava-se nos períodos finais da cicatrização, já apresentando as características normais. Aos 30 dias, foi observada completa cicatrização dos tecidos gengivais, sem exposição clínica das superfícies radiculares. Após 180 dias, os tecidos permaneceram saudáveis, demonstrando o sucesso do tratamento realizado. A paciente demonstrou completa satisfação com os resultados obtidos. Pôde-se concluir que, quando bem indicadas, a gengivoplastia e a osteotomia são abordagens terapêuticas promissoras para promoção da harmonia do sorriso.

Several therapeutic approaches have been proposed in order to achieve an esthetically pleasing and harmony smile. The present study reports a case in which gingivectomy was performed in the region of the upper anterior teeth combined with osteotomy in the region of the upper posterior teeth and removal of the superior labial frenum to promote harmony smile by decreasing the gummy smile and adequacy of buccal corridor. Osteoplasty gingivoplasty, and frenectomy procedures were planned and performed in a single session. The extraction of the maxillary third molars was also performed in order to avoid postoperative complications. Follow-up visits were performed at 7, 15, 30 and 180 days postoperatively. At 7 days, the gingival tissue was in the initial process of healing, demonstrating inflammation still in evidence. At 15 days, the gingival tissue was found in the final healing process, showing characteristics of normal health gum. At 30 days, there was complete healing of gingival tissues without clinical exposure of the root surfaces. After 180 days, tissues remained in healthy, demonstrating the success of the treatment. Patient showed complete satisfaction with the results. It can be concluded that, when properly indicated, the combination of gingivectomy, osteotomy and frenectomy procedures are promising therapeutic approaches for promoting harmony smile.

Treatment of experimental periodontitis in rats using repeated adjunctive antimicrobial photodynamic therapy.

The aim of this study was to histologically and histometrically evaluate the influence of repeated adjunctive antimicrobial photodynamic therapy (aPDT) on bone loss (BL) in furcation areas in rats. Periodontitis was induced by placing a ligature around the mandibular molar in 75 rats. The animals were divided into five groups: the SS group was treated with saline solution (SS); the SRP group received scaling and root planing (SRP); the aPDT1 group received SRP as well as toluidine blue (TBO) and low-level laser therapy (LLLT; InGaAlP, 660 nm; 4.94 J/cm(2)/point) postoperatively at 0 h; the aPDT2 group received SRP as well as TBO and LLLT postoperatively at 0, 24, 28, and 72 h; and the aPDT3 group received SRP, TBO, and LLLT postoperatively at 0, 48, 96, and 144 h. The area of BL in the furcation region of the molar was histometrically analyzed. Data were analyzed statistically (P < 0.05). Animals treated with a single episode of aPDT showed less BL at days 7 and 30 than those who received only SRP treatment. No significant differences were found among the aPDT groups (P > 0.05). Repeated aPDT did not improve BL reduction when compared to a single episode of aPDT.

Adjunctive antimicrobial photodynamic treatment of experimentally induced periodontitis in rats with ovariectomy.

BACKGROUND: The aim of this study is to compare antimicrobial photodynamic therapy (aPDT) as an adjunctive therapy to scaling and root planing (SRP) for the treatment of experimentally induced periodontitis in rats with ovariectomy (OVX) that are or are not treated with estrogen replacement. METHODS: A total of 270 female rats were divided into three groups: 1) normal rats; 2) rats with OVX; and 3) rats with OVX with estrogen replacement. Periodontal disease was induced through the introduction of a cotton thread around the mandibular left first molar. After 7 days, the ligature was removed, and the rats were randomly divided into the following treatment groups: 1) SRP plus saline solution; 2) SRP plus low-level laser therapy (LLLT); and 3) SRP plus toluidine blue O irrigation followed by LLLT. Ten rats from each group were euthanized at days 7, 15, and 30 after dental treatment. Bone loss (BL) in the furcation region was evaluated using histometric and immunohistochemical analyses. RESULTS: aPDT treatment resulted in reduced BL compared with SRP treatment at all time points. Additionally, rats treated with aPDT exhibited reduced numbers of tartrate-resistant acid-phosphatase-positive cells and more proliferating cell nuclear antigen-positive cells in all treatment groups regardless of estrogen status. Whereas rats treated with aPDT showed weak immunoreactivity to the receptor activator of nuclear factor-κ B ligand at day 7 post-treatment, strong osteoprotegerin immunoreactivity was observed at day 15 post-treatment. CONCLUSION: aPDT is an effective adjunctive therapy for the treatment of periodontitis in rats with OVX that are or are not given estrogen replacement therapy.

Effects of LLLT in combination with bisphosphonate on bone healing in critical size defects: a histological and histometric study in rat calvaria.

The purpose of this study was to analyze histologically the effect of low-level laser therapy (LLLT) in combination with bisphosphonate on bone healing in surgically created critical size defects (CSD) in rat calvaria. One hundred Wistar female rats sham operated (sham) and ovariectomized (Ovx) were maintained untreated for 1 month to allow for the development of osteopenia in the Ovx animals. A CSD was made in the calvarium of each rat, and the animals were divided into five groups according to following treatments: (1) sham rats (control), (2) Ovx rats, (3) Ovx rats treated with LLLT, (4) Ovx rats treated with bisphosphonate, and (5) Ovx rats treated with bisphosphonate and LLLT. Groups 4 and 5 were irrigated with 1 ml of bisphosphonate, and groups 3 and 5 were submitted to LLLT (GaAlAs), 660 nm, 24 J, and 0.4285 W/cm(2) on the CSD. Ten animals of each treatment were killed at 30 and 60 days. Histomorphometric assessments, using image analysis software, and histological analyses were performed. No defect was completely regenerated with the bone. Histometrically, it can be observed that groups 3 (37.49 ± 1.94%, 43.11 ± 2.39%) and 5 (35.05 ± 1.57%, 41.07 ± 1.89%) showed a significant bone neoformation when compared to groups 1 (16.81 ± 1.57%, 27.54 ± 1.49%), 2 (11.68 ± 0.98%, 22.51 ± 1.05%), and 4 (14.62 ± 1.70%, 25.67 ± 1.41%) in all experimental periods (P < 0.05). It was possible to conclude that the LLLT associated or not with bisphosphonate treatment was effective for stimulating bone formation in CSD in the calvaria of rats submitted to ovariectomy.

Enxerto de tecido conjuntivo para correção da margem peri-implantar / Subepithelial tissue graft for peri-implantar margin correction. Case report

A recessão de tecido mole frequentemente provoca insatisfação e desarmonia estética. O recobrimento de regiões peri-implantares é menos previsível quando comparado ao recobrimento dos elementos dentários. Este relato de caso clínico descreve a correção de um problema estético de um implante unitário com o uso de enxerto de tecido conjuntivo (ETC) associado com o reestabelecimento de um novo limite da margem gengival e do perfil de emergência da coroa. Após anamnese e exame clínico do paciente, foi constatado um implante instalado na região do dente 22 em posição vestibularizada no rebordo alveolar, com uma recessão de 5 mm em sua face vestibular. Em um primeiro procedimento cirúrgico, a coroa e o componente metálico foram removidos e um ETC, associado a um retalho posicionado coronalmente, foi realizado com o objetivo de reestabelecer o limite da margem gengival. Após 90 dias, foi constatado que o tecido na região do implante não apresentava espessura e volume adequados. Por isso, foi realizado um novo ETC. O procedimento de reabertura para instalação do cicatrizador foi realizado após quatro semanas e seguiu-se a instalação da prótese. Nos pós-operatórios de 180 e 360 dias, o tecido adjacente ao implante apresentou-se com contorno regular, cor compatível com saúde e ausência de sangramento. O paciente apresentava-se satisfeito com o resultado estético. Diante do resultado clínico e estético favorável, pôde-se concluir que o uso do ETC para corrigir deficiências estéticas parece ser favorável para reestabelecer um novo e estável contorno de tecido mole peri-implantar.

Aumento de gengiva queratinizada em mucosa peri-implantar / Increased keratinized gigiva in peri-implant mucosa

Introdução: Estudos recentes são direcionados a explorar a relação da faixa da mucosa queratinizada com a saúde dos tecidos peri-implantares. Quando esta faixa não é suficiente, uma cirurgia para o aumento de mucosa queratinizada pode ser indicada, pois tem sido relatado que a presença ou a reconstrução de tecido queratinizado ao redor de implantes pode facilitar os procedimentos restauradores, promover a estética e ainda permitir a manutenção de uma higienização oral rotineira sem irritação ou desconforto ao paciente. Dentre os procedimentos cirúrgicos disponíveis, a técnica do enxerto gengival livre é consagrada na literatura periodontal para aumento da faixa de mucosa queratinizada. Objetivo: Este estudo relata um caso clínico em que foi realizada cirurgia de enxerto gengival livre com objetivo de aumentar a faixa da mucosa queratinizada na região de implantes previamente instalados na maxila, para suporte de prótese tipo protocolo. Relato de caso: Foi realizada a cirurgia de enxerto gengival livre na região anterior da maxila, obtido do palato, na qual haviam sido instalados implantes osseointegrados para suporte de prótese tipo protocolo e a mucosa peri-implantar apresentava-se sem tecido queratinizado e inflamada. Após dois meses de reparação da cirurgia mucogengival, foi possível observar que o enxerto gengival livre favoreceu a saúde peri-implantar e os procedimentos protéticos de moldagem. Conclusão: Diante dos resultados clínicos, pode-se concluir que o enxerto gengival livre é uma técnica previsível e de fácil realização para aumento da faixa de mucosa queratinizada em mucosa peri-implantar de prótese protocolo.

Introduction: Recent studies have evaluated the relationship between the width of keratinized mucosa and peri-implant tissue health. Insufficiently wide keratinized tissue can be increased surgically, for example by free gingival grafting. The presence or reconstruction of keratinized tissue around the implant can facilitate restorative procedures, promote aesthetics and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. Objective: To describe a patient who underwent free gingival graft surgery to increase the width of keratinized tissue in the region of previously implants to support a type of prosthetic protocol. Case Report: A patient who had received dental implants to support a type of prosthetic protocol presented with inflamed peri-implant mucosa, but with no keratinized tissue. Free gingival tissue was obtained from the palate and grafted into the anterior maxilla. Sixty days after muco-gingival surgery, we observed that the free gingival graft favored peri-implant health and prosthetic casting. Conclusion: The free gingival graft technique is both easy to perform and effective in increasing the width of keratinized mucosa following implantation.

Use of the connective tissue graft for the coverage of composite resin-restored root surfaces in maxillary central incisors.

The purpose of this article is to report the use of the subepithelial connective tissue graft technique combined with the coronally positioned flap on a composite resin-restored root surface to treat Miller Class I gingival recessions associated with deep cervical abrasions in maxillary central incisors. Clinical measurements, including gingival recession height, probing depth, and bleeding on probing (BoP), were recorded during the preoperative clinical examination and at 2, 6, 12, and 24 months postoperatively. During the follow-up periods, no periodontal pockets or BoP were observed. The periodontal tissue of the teeth presented normal color, texture, and contouring. In addition, it was observed that creeping attachment had occurred on the restoration. This case report shows that this form of treatment can be highly effective and predictable in resolving gingival recession associated with a deep cervical abrasion.

Flabby ridge correction using an auxiliary technique with connective tissue graft.

A common finding in patients with edentulous maxilla and partially dentate mandible is mainly the presence of flabbiness in the anterior edentulous alveolar ridge that can compromise the retention and stability of a denture. Thus, this case report presents the correction of a flabby ridge, using an auxiliary technique combining surgical excision and autogenous connective tissue grafting. The technique improved the quality of the osteomucosal support of the alveolar ridge and increased the vestibule deepness, whose result increased the success rate of the new conventional total prosthesis.

Effects of two chronic stress models on ligature-induced periodontitis in Wistar rats.

OBJECTIVES: The present study aims at comparing the effects of physical and variable chronic stress on ligature-induced periodontitis in rats. DESIGN: Forty-eight adult Wistar rats were randomly assigned to four groups (n=12): physical stress, variable stress, positive control and negative control. The models of physical stress were immobilization and immobilization associated with exposure to cold. The models of variable stress were exposure to intermittent light, 24h isolation, oral cavity examination, crowded environment, smell of blood and noise. After 10 days of physical or variable stress animals underwent experimental induction of periodontal disease in one oral side. Positive control also underwent experimental induction of periodontal disease on the 10th day. Negative control did not receive any type of intervention. At the end of the experimental period (60 days), all animals were euthanized. After routine laboratory processing, images of the histological sections were digitised and submitted to histometric measurement using two parameters: histologic attachment loss and bone loss. RESULTS: Histological attachment loss and bone loss were greater (p<0.05) in the physical stress group than in the other groups (variable stress, positive and negative control groups). On the non-periodontitis side, these same histological parameters did not significantly differ amongst groups. CONCLUSIONS: Physical stress negatively modulated the response pattern to experimentally induced periodontitis in rats.

Influence of low-level laser therapy on wound healing in nicotine-treated animals.

Low-level laser therapy (LLLT) has been shown to have several biological effects that favor the healing process, and nicotine has been shown to delay the healing process. In this study we investigated the healing of open wounds created on the back of rats treated with nicotine with or without LLLT. Of 115 animals, 59 received subcutaneous injections of saline solution, and the others received subcutaneous injections of nicotine (3 mg/kg body weight), twice a day throughout the study period. After 30 days, skin wounds were created on the back of the animals. The animals receiving saline injections were divided into two groups: group 1 (G1, n = 29), in which the wounds were left untreated, and group 2 (G2, n = 30), in which the wounds were treated with LLLT (GaAlAs, 660 nm, 30 mW, 5.57 J/cm(2) per point, 0.39 J, 13 s per point, 0.42 W/cm(2)). The animals receiving nicotine injections were also divided into two groups: group 3 (G3, n = 29), in which the wounds were left untreated, and group 4 (G4, n = 27), in which the wounds were treated with LLLT. The animals were killed 3, 7 or 14 days after surgery. Wound healing was evaluated histologically both qualitatively and semiquantitatively. Wounds of G2 showed a delay in epithelial migration and connective tissue organization compared to those of G1. Wounds of G2 showed faster healing than those of G1; similarly, wounds of G4 showed more advanced healing than those of G3. LLLT acted as a biostimulatory coadjuvant agent balancing the undesirable effects of nicotine on wound tissue healing.

The influence of chronic stress imposed on pregnant rats on the induced bone loss in their adult offspring.

BACKGROUND AND OBJECTIVE: Stress during pregnancy may alter offspring susceptibility to diseases during adulthood. In the present study, female Lewis rats were subjected to chronic stress during the gestational period, and the effect of this stress was evaluated histometrically on the progression of ligature-induced bone loss in their adult offspring. MATERIAL AND METHODS: After confirming pregnancy, half of the pregnant rats were randomly designated as control animals (no stress regimen was imposed), and the other half was submitted to a chronic stress model (immobilization at cold temperature) between the 7th and the 18th gestational day. After birth, 12 male rats delivered by stressed mothers - Group 1 (G1) - and 12 male rats delivered by non-stressed mothers - Group 2 (G2) - were selected. When birthed rats reached 250 g of body weight, a silk ligature was placed around their maxillary right second molar in order to induce bone loss. The non-ligated left side served as a control. Sixty days later, these animals were sacrificed by anaesthetic overdose. After routine laboratorial processing, images of the histological sections were digitized and submitted for histometric measurement using two parameters: histological attachment loss and bone loss. RESULTS: On the ligated side, G1 presented with greater histological attachment and bone loss than G2 (p<0.05). On the non-ligated control side, neither of the groups presented with alterations in these parameters (p>0.05). CONCLUSION: The chronic stress regimen imposed on pregnant rats produced a greater progression of ligature-induced bone loss in their adult offspring.

A proporção plasma rico em plaquetas/enxerto ósseo autógeno pode influenciar o reparo ósseo de defeitos de tamanho crítico: um estudo radiográfico em calvária de ratos / The proportion platelet-rich plasma/particulate autogenous bone graft may influencebone healing in criticalsize defects: a radiographic study in rat calvaria

Introdução: Tem sido sugerido que enxertos ósseos associados ao Plasma Rico em Plaquetas (PRP) cicatrizam com maior densidade que os enxertos sem PRP. Contudo, esse resultado parece depender da proporção PRP/enxerto ósseo utilizada. Objetivo: O propósito deste estudo foi avaliar, radiograficamente, a influência da proporção PRP/enxerto de Osso Autógeno (OA) no reparo ósseo de defeitos de tamanho crítico (DTCs) criados cirurgicamente em calvárias de ratos. Material e método: Cinquenta ratos foram divididos em cinco grupos: C, OA, OA/PRP-50, OA/PRP-100 e OA/PRP-150. Um DTC de 5 mm de diâmetro foi criado na calvária de cada animal. No Grupo C, o defeito cirúrgico foi preenchido somente com coágulo sanguíneo. No Grupo OA, o defeito foi preenchido com enxerto de OA particulado. Nos grupos OA/PRP-50, OA/PRP-100 e OA/PRP-150, o defeito foi preenchido com enxerto de OA particulado associado a 50, 100 ou 150 µL de PRP, respectivamente. Os animais foram eutanasiados aos 30 dias pós-operatórios. Imagens radiográficas padronizadas das calvárias foram obtidas com o sistema Digora (Soredex, Finlândia). As imagens foram avaliadas por três examinadores por meio de escores, que indicaram o percentual de radiopacidade dos defeitos. Os escores obtidos foram submetidos ao Teste de Kruskal-Wallis (p < 0,05). Resultado: O Grupo C apresentou radiopacidade significativamente menor que os grupos OA, OA/PRP-50, OA/PRP-100 e OA/PRP-150 (p < 0,05). O Grupo OA/PRP-50 apresentou radiopacidade significativamente maior que os grupos OA/PRP-100 e OA (p < 0,05). Conclusão: Dentro dos limites deste estudo, pode-se concluir que a proporção PRP/enxerto de OA influencia a cicatrização de DTCs criados em calvárias de ratos.

Introduction: It has been suggested that bone grafts combined with platelet rich plasma (PRP) present greater density than bone grafts without PRP after healing process. However, this result may depend on proportion PRP/autogenous bone (AB) graft used. Objective: The purpose of this study was to analyze radiographically the influence of the proportion PRP/particulate autogenous bone (AB) graft on bone healing in surgically created criticalsize defects (CSD) in rat calvaria. Material and method: 50 rats were divided into 5 groups: C, AB, AB/PRP-50, AB/PRP-100 and AB/PRP-150. A 5 mm diameter CSD was created in the calvarium of each animal. In Group C the defect was filled by blood clot only. In Group AB the defect was filled with 0.01 mL of AB graft. In groups AB/ RP-50, AB/PRP-100 and AB/PRP-150 the defects were filled with 0.01 mL of AB graft combined with 50, 100 and 150 µL of PRP, respectively. All animals were euthanized at 30 days post-operative. Standardized radiographic images of the rat calvaria were obtained using Digora System (Soredex, Finland). The images were evaluated by three examiners using scores that indicated the percentage of radiopacity of the defect. The obtained data were subjected to statistical analysis (Kruskal-Wallis test, p <0.05). Result: Group C presented radiopacity significantly lower than groups AB, AB/PRP-50, AB/PRP-100 and AB/PRP-150. Group AB/PRP-50 showed radiopacity significantly greater than groups AB/PRP-100 and AB. Conclusion: It can be concluded that the proportion PRP/AB graft influences bone healing in CSD in rat calvaria.