Gingival inflammation in the Flemish painter Hendrick ter Brugghen's Unequal Couple painting.

The evaluation of painting in terms of medicine and dentistry is increasingly shared in academic publications. The clear depiction of gingival inflammation seen in the female figure in Hendrick ter Brugghen's Unequal couple attracted our attention. It is interesting to note the meticulous transfer of the actual condition of the diseased gingival tissues and the painter's very high observational ability. Although there may be many more examples of observational depictions, we believe that 'dental humanities' will develop by discussing such art works.

Preference of Suture Specifications in a Selected Periodontal and Implant Surgeries in Turkey.

OBJECTIVE: Various suture materials and needles are now available for use in the dental surgery. The aim of this study was to determine the preference of suture materials among Turkish dentists by a dental survey. MATERIALS AND METHODS: The survey was prepared and sent electronically to Turkish dentists through e-mail and/or Facebook. Dentists were asked to report their graduation year from dental school and their specialty if they have one. In addition, the type periodontal/implant operations and the frequency of those operations applied by them were questioned. The participants were to indicate their suture preferences for these procedures in a multiple-choice questionnaire. RESULTS: Fifty-seven regular dentists, 49 periodontists, 22 oral surgeons, and 8 other specialists completed a self-administered survey. The majority of clinicians worked in private practice (77.9%). Nonabsorbable sutures were the most preferred for all procedures except periodontal plastic surgery. In regenerative surgeries, monofilament, 5-0 diameter suture material on a reverse cutting, 3/8 circle needle was preferred. In addition, for mucogingival surgery, 5-0 diameter suture material on a reverse cutting and 3/8 circle needle was favored. For dental implants, 4-0 diameter suture material on a reverse cutting and 3/8 circle needle was preferred. Monofilament and braided sutures were selected almost equally for implant operations. CONCLUSIONS: In periodontal and implant surgeries, dentists highly preferred the use of nonabsorbable sutures. In addition, the shape and diameter of needle had an important role in the selection of suture material. The present study's results may serve as a guide for the future studies.

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

BACKGROUND: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

BACKGROUND: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.

Management of regional odontodysplasia: a 10-year-follow-up case report and literature review.

The aim of this article was to review the literature and present a case of regional odontodysplasia (ROD) with special emphasis on clinical and radiographic features. A 6-year-old girl was referred to our department with the chief complaint of missing her permanent maxillary left central incisor, lateral incisor, and both of her canines. The gingiva of the involved region was enlarged, fibrous, and tense. Radiographic examination showed abnormal tooth formation and shortened roots. After 3 years of follow up with temporary prosthetic rehabilitation, periodontal surgery was performed. Following forced eruption and levelling, abnormal tooth eruption and root development were observed. ProRoot MTA (Dentsply-Maillefer, Ballaigues, Switzerland) was used for root canal treatment. Intracanal fiber posts selected and access cavities were restored with composite resin. Prosthetic rehabilitation was completed with zirconia ceramic crowns. The time of diagnosis, characteristics of the present/existing symptoms, and functional and esthetic needs of the patient should be considered to determine the optimal treatment modality for ROD.

EFP Delphi study on the trends in Periodontology and Periodontics in Europe for the year 2025.

AIM: The aim was to assess the potential trends in Periodontology and Periodontics in Europe that might be anticipated by the year 2025, using the Delphi method. MATERIAL AND METHODS: The expert opinion of 120 experts was sought through the use of an open-ended questionnaire, developed by an advisory group, containing 40 questions concerning the various trends in periodontology. RESULTS: The experts (113 responders) expect a stabilization of the prevalence of periodontitis, both for the chronic as well as the aggressive cases, but an increase in implant-related diseases up to the year 2025. Concurrently, the importance of implants is seen to be increasing. They foresee an increased demand for postgraduate periodontology and implantology training. This is mirrored in an increase in publications for implant dentistry and increase in demand and need for training. Concerning the patients, better-informed individuals seeking more routine check-ups are expected. CONCLUSION: A continued need for specialized periodontists, but also well trained dental practitioners is foreseen for next decade in Europe. Apart from periodontology they will be increasingly exposed to and trained in implant dentistry.

Treatment of Multiple Adjacent Miller Class III Gingival Recessions with a Modified Tunnel Technique: A Case Series.

Modified coronally advanced tunnel (MCAT) technique with connective tissue graft (CTG) was used in treating multiple adjacent Miller Class III gingival recessions in nine patients. Clinical evaluations were recorded at baseline and 12 months after surgery. The results showed that 50% of complete root coverage and 78% of mean root coverage were attained 1 year after surgery and interdental space fill was 73% at 12 months. The study demonstrated that CTG using the MCAT technique may be an efficient way to treat multiple adjacent Miller Class III gingival recessions, especially when aiming for interdental space fill. Success, however, seems to be related to the amount of tissue present initially.

Primary prevention of peri-implantitis: managing peri-implant mucositis.

AIMS: Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are--in contrast to periodontitis--at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis. METHODS: Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants. RESULTS: Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation. CONCLUSIONS: Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri-implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal.

Impact of periodontitis on chemokines in smokers.

OBJECTIVE: The aim of this study was to investigate the chemokine expression profiles in gingival crevicular fluid (GCF) and serum in patients with advanced chronic periodontitis and to assess the impact of smoking on local and systemic levels of chemokines. MATERIALS AND METHODS: Thirty patients with chronic periodontitis (CP; 20 smokers and 10 non-smokers) and 20 periodontally healthy subjects (10 smokers and 10 non-smokers) were recruited. Clinical parameters included the plaque index (PI), gingival index (GI), and bleeding on probing (BOP). Macrophage inflammatory protein-1 alpha (MIP-1α), macrophage inflammatory protein-1 beta (MIP-1ß), monocyte chemoattractant protein-1 (MCP-1), and regulated on activation normal T cell expressed and secreted chemokine (RANTES) were measured in gingival crevicular fluid (GCF) and serum using a multiplex immunoassay. RESULTS: MIP-1α levels were significantly lower (10.15 ± 1.48; p = 0.039) while MIP-1ß levels were significantly higher (42.05 ± 8.21; p = 0.005) in sera from non-smoker patients with CP compared to non-smoker healthy subjects. MCP-1 concentration in sera was significantly higher in smoker periodontitis patients (8.89 ± 1.65) compared to non-smoker patients with periodontitis (8.14 ± 0.97; p = 0.004). MIP-1α and RANTES were significantly higher in GCF of the patients with CP (p = 0.001) while there were no statistically significant correlations between the GCF levels of these analytes and the smoking status. CONCLUSION: Periodontal inflammation increases the chemokine concentrations in the GCF while smoking suppresses chemokine levels in serum suggesting that different local and systemic mechanisms are involved during the response to periodontitis in smokers. CLINICAL RELEVANCE: Understanding the local and systemic chemokine responses in smokers will enable the development of biologically-based treatment methods for chronic periodontitis.

Thickness of palatal masticatory mucosa and its relationship with different parameters in Turkish subjects.

BACKGROUND: The aim of the study was to clinically investigate the mucosal variations in different parts of hard palate subject to soft tissue harvesting and its relationship with selected parameters in patients with gingival recessions. MATERIALS & METHODS: Fifty periodontally healthy, dentate subjects (13 males) with gingival recessions were enrolled into the study. After initial periodontal therapy they were scheduled for surgical procedures. Palatal masticatory mucosa of five teeth was evaluated at five different points from the gingival margin and two points on the buccal gingival mucosa were evaluated on the day of surgical intervention via bone sounding method. Totally 27 assessments were performed for each patient. RESULTS: The overall mean thickness of palatal masticatory mucosa (PMM) was 2.55±0.49mm. The mean mid-facial gingival thickness was 1.11±0.39mm. The PMM showed an increase towards the posterior and raphe palatina. No difference was observed between genders, and no association of body mass index (BMI) and age with PMM was determined. An association was observed between the thicknesses of mid-facial gingival and palatal masticatory mucosa. CONCLUSION: The thickness of PMM in this study seems to be less than other reports possibly due to ethnicity or measurement design. Canine and premolar region reveals higher thickness values, and the increase in the tissue thickness towards the midline should also been taken into consideration. Clinicians planning soft tissue harvesting from the palate should take this variation into consideration. In this regard transmucosal probing of the donor site may provide valuable information where considerable variation exists.

The comparison of acellular dermal matrix allografts with free gingival grafts in the augmentation of peri-implant attached mucosa: a randomised controlled trial.

PURPOSE: The purpose of this randomised controlled trial is to compare the efficacy of two techniques for enhancing peri-implant keratinised mucosa: acellular dermal matrix allograft versus free gingival grafts. MATERIALS AND METHODS: Thirty-six patients having implant sites with less than 1.5 mm of keratinised mucosa width were randomly assigned to two groups. Thirty-six implants placed in 18 patients received acellular dermal matrix allografts (ADM group), while 36 implants placed in 18 individuals received free gingival grafts (FGG group). Plaque index (PI), gingival index (GI), probing depth (PD) and the width of attached mucosa (WAM) were measured at baseline and at 1, 3 and 6 months following surgery. RESULTS: WAM in the FGG group was significantly greater than the ADM group at 3 (P = 0.026) and 6 months (P < 0.001). In the FGG group, final gain of WAM was greater (1.58 mm in ADM group, 2.57 mm in FGG group) (P < 0.001) and postoperative relapse was smaller (2.68 mm in the ADM group, 1.73 mm in the FGG group) (P < 0.001). PI and GI scores were greater in the ADM group at 6 months (P = 0.016 and P = 0.61, respectively). The FGG group demonstrated a greater PD value at 3 months (P < 0.001), however there was no significant difference between the groups at 6 months (P = 0.317). CONCLUSIONS: Although ADM allografts are capable of increasing the width of peri-implant keratinised mucosa, FGGs seem to be more effective. ADM allografts may be the application of choice at implant sites in need of major grafts and in patients where a donor site should be avoided for medical or psychological reasons.

Iatrogenic orthodontic dental trauma: a case report.

Iatrogenic trauma can be defined as any adverse condition in a patient resulting from treatment by a physician or dentist. Orthodontic treatment carries with it the risks of tissue damage and treatment failure. The aim of this article is to present traumatic oral tissue lesions resulting from iatrogenic orthodontic origin with a 2-year follow-up period based on orthodontic intervention followed by periodontal surgery. The management of traumatic injuries is dependent on the severity of the involvement of the periodontal tissues. While, in most cases, the elimination of the offending agent and symptomatic therapy is sufficient, in severe cases, or when the injury resulted in permanent defects, periodontal/regenerative therapy may be necessary. The dentist must be aware of these risks in order to help the patient make a fully informed choice whether to proceed with orthodontic treatment. The skill, experience, and up-to-date knowledge of dentists are the main factors to prevent possible iatrogenic traumas.

The comparison of two techniques to increase the amount of peri-implant attached mucosa: free gingival grafts versus vestibuloplasty. One-year results from a randomised controlled trial.

AIMS: The objective of this randomised controlled trial was to compare the efficacy of two techniques for increasing the amount of keratinised mucosa around implants: free gingival grafts versus classic vestibuloplasty. MATERIALS AND METHODS: Sixty-four patients with 64 implants presenting keratinised mucosa <1.5 mm and showing signs of peri-implant mucositis were randomly assigned to two groups. Thirty-two implants received free gingival grafts (FGG group) while 32 implants were treated via vestibuloplasty (VP group). Plaque Index (PI), Gingival Index (GI), probing depth (PD) and the width of attached mucosa (WAM) were measured at baseline and 1, 3, 6 and 12 months following surgery. RESULTS: WAM in the FGG group was significantly greater than the VP group at 3, 6 and 12 months (P = 0.000). In the FGG group, the final gain in WAM was greater (2.36 mm in FGG group, 1.15 mm in VP group) (P = 0.000) and the postoperative relapse was smaller (2.00 mm in FGG group, 3.06 mm in VP group) (P = 0.000). The VP group had higher PD values at 3, 6 and 12 months (P = 0.02, P = 0.024, P = 0.000, respectively). CONCLUSIONS: The application of FGG is a more predictable method for enhancing the width of attached mucosa in the vicinity of implants compared with classic vestibuloplasty.