Evaluation of 2 techniques of epithelial removal in subepithelial connective tissue graft surgery: a comparative histological study.

PURPOSE: Subepithelial connective tissue grafts (SCTGs) are commonly performed for the treatment of gingival recession due to their high predictability. This study evaluated and histologically compared connective tissue grafts in terms of the presence of epithelial remnants and composition of the tissue types that were present (epithelium, lamina propria, and submucosa). METHODS: Ten patients underwent epithelium removal using 2 different techniques: the use of a blade (group B) and through abrasion (group A). Twenty samples were collected and each tissue type was analyzed histologically in terms of its area, thickness, and proportion of the total area of the graft. RESULTS: In 4 samples (40%) from group B (n=10) and 2 samples (20%) from group A (n=10), the presence of an epithelial remnant was observed, but the difference between the groups was not statistically significant (P>0.05). Likewise, no statistically significant differences were observed between the groups regarding the area, mean thickness, or proportion of the total area for any of the tissue types (P>0.05). CONCLUSIONS: Histologically, SCTGs did not show statistically significant differences in terms of their tissue composition depending on whether they were separated from the epithelial tissue by abrasion or by using a blade.

Free gingival graft to increase gingival dimensions in Down syndrome patients: clinical case report

Introduction:Down Syndrome (DS) patients have increased susceptibility to the development of periodontal diseases by the occurrence of several factors, such as inadequate hygiene, mouth breathing, dental morphology, leukocyte reduction and increased inflammatory mediators. Objective:This study aimed to review the literature on the main aspects of DS and present a clinical case of a DS patient treated with basic periodontal therapy and free gingival graft surgery. Case report: DS patient, leucoderma, aged 26 years showed gingival recession and little amount of keratinized tissue in the area of teeth #31 and #41. After surgery, there was an increase in the keratinized tissue band. Conclusion: The free gingival graft surgery performed in DS patients was effective, as the increase of keratinized tissue band occurred.

Rapid orthodontic extrusion using an interocclusal appliance for the reestablishment of biologic width: a case report.

A multidisciplinary treatment of a case of subgingival fracture in a maxillary anterior tooth is presented. This case report describes a simple method involving an interocclusal appliance and an elastic band for rapid orthodontic extrusion to reestablish biologic width. In addition, a simple technique for surgical recontouring following the coronal displacement of the gingival margin prior to restoration of fractured tooth is explained.

Orthodontic extrusion and implant site development using an interocclusal appliance for a severe mucogingival deformity: a clinical report.

A multidisciplinary therapy used to treat a patient with a severe mucogingival deformity in the area of maxillary anterior teeth is presented. The simple technique uses an interocclusal appliance and elastic band for orthodontic extrusion to correct the mucogingival deformity and develop an implant site. This approach is designed to increase the amount of keratinized tissue and new alveolar bone, which are necessary for the development of an implant site. Clinical and radiographic examinations at the 5-year follow-up revealed a successful tooth replacement and improved esthetic appearance that was achieved with multidisciplinary treatment. The advantages and disadvantages of this technique are discussed.

Bismuth subgallate as a topical hemostatic agent at palatal donor sites.

OBJECTIVE: To present bismuth subgallate as a simplified and efficient method for promoting hemostasis at palatal donor sites, as evaluated by measuring hemostasis time and delayed bleeding. METHOD AND MATERIALS: Ten patients received the bismuth subgallate paste as a topical hemostatic agent, while another 10 patients received moistened gauze pressure. The time to obtain complete hemostasis, defined as no visual bleeding, was recorded for each subject. RESULTS: Bismuth subgallate paste was found to decrease hemostasis time, when compared with moistened gauze pressure. The mean hemostasis time for the bismuth subgallate group was significantly shorter (2.6 +/- 0.7 minutes) when compared to the moistened gauze group (7.2 +/- 1.4 minutes). While delayed bleeding was observed in the moistened gauze group, no statistically significant difference was found between the groups (P = .10). CONCLUSION: The use of bismuth subgallate as a topical hemostatic for palatal wounds may be an option when performing free soft tissue grafts.

Experimental surgical and orthodontic extrusion of teeth in dogs.

The purpose of this study was to evaluate histologically the root surfaces of teeth submitted to orthodontic and surgical extrusion procedures in a dog model. Eighteen adult male dogs, divided into six groups of three dogs each, were used in the study. Each animal underwent two procedures: rapid orthodontic extrusion and surgical extrusion of the maxillary lateral incisors. The animals were sacrificed to produce samples at 7, 14, 45, 90, 120, and 180 days after surgery for assessment of cross sections of the coronal, medial, and apical thirds of the treated teeth. At early time points, some active surface and inflammatory resorption was observed exclusively in the surgical extrusion group; however, samples collected at later times demonstrated functional repair of the resorption gaps in both groups. Ankylosis was observed as a minor event and was apparently of a transient nature in samples of the surgical extrusion group. The results demonstrate the importance of maintaining the periodontal ligament and cementum surface; both are vital for the prevention of root resorption. It may be postulated that orthodontic extrusion is more conservative and physiologic than surgical extrusion; however, the results showed that function was restored in both groups.

Efeito de agentes para desmineralização sobre a rugosidade da superfície radicular / The effect of deminarization agents on the root surface roughess

O objetivo da instrumentação periodontal é remover depósitos calcificados, placa e endotoxinas bacterianas, criando uma superfície lisa e descontaminada. Para isso, a instrumentação mecânica torna-se imprescindível, podendo ser associada à utilização de agentes para desmineralização da superfície radicular. Visto que não há trabalhos na literatura avaliando o efeito da utilização desses agentes sobre a rugosidade radicular, este estudo utilizou 40 dentes humanos monorradiculares extraídos, sendo divididos aleatoriamente em quatro grupos de dez dentes, sendo os mesmos instrumentados com 30 golpes de curetas de Gracey 5/6. Os dentes foram então seccionados no sentido longitudinal e separados em duas metades, sendo que cada uma delas foi sorteada para receber um dos tratamentos (ácido cítrico pH1 ou Edta 24% ou ácido fosfórico 37% ou salina). Após a aplicação dos tratamentos, cada metade tratada foi analisada em um rugosimento junto com seu homólogo controle (só instrumentado). Os resultados demonstraram não haver diferença estatisticamente significante (teste "t" Student, p<0,05) entre os grupos tratados e os respectivos controles; também não se observou diferenças significativas entre os tratamentos (Anova). Dentro dos limites do presente estudo, pôde-se concluir que os agentes utilizados para desmineralização não alteraram significativamente a rugosidade radicular em comparação com a instrumentção mecânica isoladamente e que também não houve diferença entre as substancias testadas com à relação à rugosidade da superficie radicular.

Aspectos periodontais e ortodônticos na exposição de caninos superiores inclusos / Periodontal and orthodontic surgical exposure of maxillary impacted canines

Os caninos superiores apresentam o período e o trajeto mais longo de desenvolvimento, desde o ponto de formação até o seu destino final, na linha de oclusão. A erupção ectópica e a inclusão do canino superior permanente são problemas clínicos freqüentes. Seu diagnóstico é baseado no exame clínico e radiográfico, incluindo radiografias panorâmicas, oclusais, periapicais, telerradiografias de perfil e tomografias computadorizadas. O diagnóstico e o tratamento desse problema, geralmente, requerem perícia e cooperação do clínico geral, odontopediatra, cirurgião bucomaxilofacial, periodontista, assim como do ortodontista. O tratamento do canino superior incluso requer a interação cirúrgica e ortodôntica. Dois métodos de exposição cirúrgica são utilizados: exposição aberta, onde o acessório é instalado depois que o canino irrompe livremente, e exposição fechada com a fixação de um acessório, seguida pela tração com forças ortodônticas suaves. Os caninos superiores inclusos requerem mínimos efeitos no periodonto e efeitos colaterais mínimos aos dentes adjacentes e aos tecidos gengivais. O tratamento ortodôntico de dentes inclusos necessita de controle adicional de placa bacteriana pelo profissional e pelo paciente.

The maxillary canines presents the longest development period from its origin and to final destination in the occlusion line. The diagnosis and treatment of this problem usually requires the expertise and cooperation of the general practitioner, the pediatric dentist, the oral surgeon and the periodontist, as well as the orthodontist. The ectopic eruption and impaction of maxillary permanent canines is a clinical problem frequently encountered and the diagnosis of impaction is based on both clinical and radiographic examinations as panoramic, occlusal, periapical, lateral headfilm and the computed tomography. The impacted maxillary canine is a difficult orthodontic problem, often requiring surgical and orthodontic cooperation. Two methods of surgical exposure are commonly used: open exposure, where traction is placed after the canine erupts freely, and closed exposure with placement of an auxiliary attachment, followed by traction with orthodontic forces. The management of impacted maxillary canines requires minimal effects on the periodontium and minimal consequences to the adjacent teeth and gingival tissues. Orthodontic treatment of impacted teeth might require additional professional and personal plaque control measures.

Effect of bismuth subgallate (local hemostatic agent) on wound in rats: histological and histometric findings

O objetivo do presente trabalho foi avaliar o efeito do subgalato de bismuto (SGB) no processo de reparação de feridas. Em 40 ratos Wistar, duas feridas padronizadas foram feitas no dorso dos animais utilizando-se um bisturi circular para biópsia (punch) de 3,5 mm X 2,0 mm. As feridas teste foram preenchidas com SGB e as controle, com salina 0,9 por cento e avaliadas com 1, 4, 7, 11 e 18 dias. A evolução qualitativa do tecido de granulação foi avaliada histologicamente e imagens digitalizadas foram medidas histometricamente. A avaliação histológica não demonstrou diferenças significativas entre teste e controle e histometricamente, houve diferenças significativas (ANOVA- dias 1 e 4; teste student, p<0,05 - dias 7, 11 e 18) em relação aos parâmetros analisados, ou seja, no dia 1: área de ulceração; dia 2: distância entre bordas epiteliais; dia 7, 11 e 18: área de tecido de granulação. Pode-se concluir que o SGB apresenta-se biocompatível aos tecidos em reparação e não interferiu significativamente com o desenvolvimento do processo de reparação.

Effect of bismuth subgallate (local hemostatic agent) on wound healing in rats. Histological and histometric findings.

The aim of this research was to evaluate the effect of bismuth subgallate on wound healing. In 40 Wistar rats, two standard wounds (3.5 mm x 2 mm) were made using a biopsy punch on the back of each animal. Test wounds were filled with bismuth subgallate and control wounds with 0.9% saline. At 1, 4, 7, 11 and 18 days, the qualitative evolution of the granulation tissue morphology was observed and digitalized histologic images were evaluated. There were no significant histological differences between test and control. Histometrically, there were statistically significant differences between test and control (ANOVA--days 1 and 4; Student t test, p < 0.05--days 7, 11 and 18) in terms of the following parameters: area of ulceration--day 1; distance between epithelial edges--day 4; area of granulation tissue--days 7, 11 and 18. It was concluded that bismuth subgallate is biocompatible to the healing tissue, and did not interfere with the normal development of wound healing.

The Influence of Nicotine on the bone loss rate in ligature-induced periodontitis. A histometric study in rats / A influência da nicotina na perda da taxa óssea nas contenções periodontais. Um estudo histométrico em ratos

Background: The present study investigated the possible influence of nicotine on the bone loss rate in the furcation region due to ligature-induced periodontitis rats. Methods: Twenty adult male Wistar rats were included. After anesthesia, the tooth was randomly assigned to receive the cotton ligature in the sulcular area, while the contralateral tooth was left unligated. The animals were randomly assigned to one of the following treatments, including daily intraperitoneal injections: group A, 2 µl/g body weight of saline solution; group B, 2 µl/g body weight of a nicotine solution with 0.13 µl of nicotine/ml of saline solution; group C, 2 µl/g body weight of a nicotine solution with 0.19 µl of nicotine solution with 0.26 µl of nicotine/ml of saline solution. Thirty days later, the animals were sacrificed and the specimens routinely processed for serial decalcificed sections...

O fumo como fator de risco à doença periodontal / The risk factor of tabacco in periodontitis

O impacto desfavorável do tabagismo, estatisticamente demonstrado em Saúde Pública, tem sido documentado em vários estudos epidemiológicos. No âmbito odontológico, isto pode ser avaliado na evolução da doença periodontal, pela associação de casos avançados de periodontite em pacientes fumantes. A proposta deste trabalho é apresentar uma revisão bibliográfica, com os estudos mais recentes sobre o papel do fumo como fator de risco à doença periodontal, as implicações no pós-operatório de cirurgias periodontais e implantes, as associações do consumo de drogas como a maconha e o "crack" , pelo paciente periodontalmente comprometido

Aplicaçäo do Subgalato de Bismuto como Hemostático em Cirurgia Periodontal / Use of Bismuth Subgallate as a hemostatic agent in Periodontal Surgery

A necessidade de um método ou substância eficaz para homostasia e a observaçäo do uso de hemostáticos compatíveis na Medicina, levou ao conhecimento de um produto conhecido como Subgalato de Bismuto. O uso específico deste material como adstringente na hemostasia foi descrito na Otorrinolaringologia na década de 60 e atualmente tem sido utilizado também em Odontologia, especificamente em cirurgias periodontais que resultem em exposiçäo do tecido conjuntivo, com resultados clínicos favoráveis