Absceso gingival después de aumento de reborde alveolar con técnica en rollo modificada. Reporte de caso / Gum Abscess after an Alveolar Ridge Augmentation with the Modified Roll Technique. A Case Report

Antecedentes: La técnica en rollo modificado se ha utilizado ampliamente para mejorar el aspecto estético de las deficiencias de los rebordes alveolares durante el tratamiento de rehabilitación y, así, disminuir el dolor posoperatorio. Objetivo: Describir un caso clínico en el que se realizó un aumento del reborde alveolar por medio de una técnica en rollo modificada que presentó un absceso durante las primeras semanas posoperatorias. Se describe también manejo clínico del caso. Resultados: Después del diagnóstico clínico y microbiológico, se realizó tratamiento antibiótico. En el control a los cuatro meses se observó resolución completa del absceso.

Background: The modified roll technique has been widely used to improve the aesthetics of the alveolar ridge deficiencies during the rehabilitation treatment and, in turn, to reduce the postoperative pain. Objective: To describe a clinical case of an alveolar ridge augmentation with the modified roll technique in which an abscess appeared during the first postoperative weeks. The clinical management of the case is also detailed herein. Results: After a clinical and microbiological diagnosis, the patient was indicated an antibiotic treatment. In the postoperative four-month checkup, a full solution of the abscess was observed.

Detection of herpes simplex virus type 1 in gingival crevicular fluid of gingival sulcus/periodontal pocket using polymerase chain reaction.

INTRODUCTION: Pathogenesis and some characteristics of periodontitis cannot be fully explained by bacterial etiology alone. Herpes viruses may bridge the gap between clinical characteristics and molecular understanding of periodontal destruction. OBJECTIVE: The aim of this study was to investigate the prevalence of herpes simplex virus type 1 (HSV-1) in gingival crevicular fluid (GCF) of healthy and damaged periodontium in Serbian population and to explore potential correlation between the presence of this virus and the level of periodontal destruction. METHODS: Samples were collected from gingival sulcus/periodontal pockets by sterile paper points and the presence of viral DNA in gingival crevicular fluid was assessed by PCR. RESULTS: There was no statistically significant difference in HSV-1 in presence between periodontitis patients (PG = 38.9%) and healthy controls (HC = 32.3%), (Chi-square test, with Yates' correction p = 0.7574). However, HSV-1 positive patients showed significantly higher values of parameters of periodontal destruction (PPD = 7.11 +/- 2.52, CAL = 5.46 +/- 2.34) than periodontitis patients without HSV-1 in gingival crevicular fluid (PPD = 4.70 +/- 1.79, CAL = 3.39 +/- 2.65) (p values respectively, p = 0.002 and p = 0.023, Independent Samples T-Test). HSV-1 occurred more often in deeper (PPD > or = 6 mm) (69.2%) than in shallow pockets (3 mm < PPD < 6 mm) (18.2%) (Chi-square test, with Yates' correction, p = 0.008). Plaque index was lower in the HSV-1 positive group (0.84 +/- 0.69 vs. 1.43 +/- 0.76, p = 0.023, Independent Samples T-Test). CONCLUSION: This study demonstrated that the presence of HSV-1 in the gingival crevicular fluid coincides with a higher degree of tissue destruction in patients with periodontitis.

Effect of smoking status on pocket probing depth and bleeding on probing following non-surgical periodontal therapy.

AIM: Cigarette smoking is a risk factor for periodontitis incidence and progression. Contrasting results were obtained when the impact of cigarette smoking on the clinical outcomes of non-surgical periodontal therapy (NSPT) was evaluated. The present study was designed to evaluate the smoking status as outcome determinant of NSPT. METHODS: Two groups of patients with different smoking status (smoker group, S, and non-smoker group, NS) were retrospectively selected from a pool of patients seeking care for periodontitis. The effectiveness of NSPT was assessed by evaluating the changes in 1) the prevalence of sites with different pocket probing depth (PPD), and 2) the patient- and site-specific bleeding. RESULTS: Group S comprised of 65 patients (mean age: 45.6+/-8.7 years; 24 males and 41 females) and group NS comprised of 66 patients (mean age: 46.8+/-11.7 years; 17 males and 49 females). A statistically significant increase in the prevalence of sites with PPD< or =3 mm (P<0.000), as well as a significant decrease in the prevalence of sites with PPD 4/6 mm (P<0.000) and PPD> or =7 mm (P< or =0.01) was detected at re-evaluation. BoP scores were significantly reduced for the entire dentition (P<0.000) as well as for sites with PPD< or =3 mm (P<0.01) and PPD 4/6 mm (P<0.000) in both group S and group NS. No statistically significant differences in the post treatment change of PPD and BoP scores were detected between groups. CONCLUSION: Our results seem to suggest that smoking status has a limited, if any, effect on the clinical outcomes of NSPT.

Experimental gingivitis in type 1 diabetics: a controlled clinical and microbiological study.

OBJECTIVE: To monitor clinical and microbiological changes during experimental gingivitis in type 1 diabetics and non-diabetics. MATERIALS AND METHODS: Nine type 1 diabetics with good/moderate metabolic control and nine age-gender matched non-diabetics were recruited. Probing pocket depths in all subjects did not exceed 4 mm and none were affected by attachment loss. According to the original model, an experimental 3-week plaque accumulation resulting in experimental gingivitis development and a subsequent 2-week period of optimal plaque control were staged. Subgingival plaque samples were collected at days 0, 21 and 35 from one site per quadrant, pooled and analysed using checkerboard DNA-DNA hybridization. RESULTS: Diabetics (mean age 25.6+/-5.8 standard deviation (SD), range 16-35 years) had a mean HbA1c level of 8.1+/-0.7% (SD), while non-diabetics (mean age 24.8+/-5.7 (SD), range 15-36 years) were metabolically controlled (HbA1c< or =6.5%). Between Days 0, 21 and 35, no statistically significant differences in mean plaque and gingival index scores were observed between diabetics and non-diabetics. At days 7 and 21, however, diabetics showed statistically significantly higher percentages of sites with gingival index scores > or =2 compared with non-diabetics. Mean DNA probe counts of the red and orange complex species increased significantly (p<0.05) between days 0 and 21 and decreased significantly (p<0.05) between days 21 and 35 in both groups. CONCLUSION: Both diabetics and non-diabetics react to experimental plaque accumulation with gingival inflammation. Type 1 diabetics, however, develop an earlier and higher inflammatory response to a comparable bacterial challenge.

The possibility of detecting subgingival calculus by laser-fluorescence in vitro.

The aim of the present study was to investigate laser-fluorescence effects on the root surface. The possibility of detecting subgingival calculus should be evaluated to control complete calculus removal after scaling and root planing. Twenty freshly extracted human teeth, partially covered with calculus on the root surface, were fixed on a translation stage. The specimens were irradiated by light from a laser source (diode laser, <1 mW) with a wavelength of 655 nm using the Diagnodent trade mark -system. To simulate the conditions in a periodontal pocket during the measurement procedure, the teeth were covered by a layer of physiological saline solution or blood in order to determine the influence of different inflammatory fluids. The root surface was scanned on a line of about 1 cm in steps of 0.5 mm. The start and end was marked by a notch. The results of the laser-fluorescence detection were compared to clinical and histological findings. Clinically apparent calculus on the root surface was always accompanied with a statistically significant increase of laser-fluorescence values ( p < 0.05). These values were not influenced by the different fluids ( p < 0.05). The laser-fluorescence values were reproducible ( p > 0.05). After scaling, when no debris remained at the root surface, laser-fluorescence values decreased significantly ( p < 0.05). The histological findings supported the clinical results. In conclusion, the present study indicates that laser-fluorescence values on the root surface are strongly correlated to the presence of calculus. This fluorescence effect can basically be used to develop a new detecting system for subgingival calculus in periodontal pockets.

Longitudinal peri-implant clinical responses in anterior mandibles of female patients: a preliminary report.

STATEMENT OF PROBLEM: There is a need for specific documentation that successful osseointegration related to Brânemark implants can be maintained, despite an apparent clinically vulnerable peri-implant soft tissue status. PURPOSE: This study monitored longitudinal peri-implant clinical responses in the mandible and sought to question whether a relatively deep mucogingival pocket will give rise to a greater loss of peri-implant bone than a shallow pocket. METHODS AND MATERIAL: Subjects, 8 women patients (mean age 62 years), were treated with Brânemark mandibular osseointegrated implant-supported prostheses. Four of these subjects had limited (average <3.5 mm) and 4 had unlimited (average > or =3.5 mm) peri-implant pocket probing depths and constituted the control and test subgroups, respectively. Longitudinal changes in peri-implant PAL and radiographic bone support were assessed. RESULTS: Overall probing attachment levels (PALs) of the peri-implant mucogingival complex showed little change. The PAL loss was only minimally significant within the control subjects, and not significant for test subjects. The difference in these mucogingival responses between test and control subjects was significant (P = .04). There was no significant overall longitudinal change in peri-implant bone levels. The longitudinal change of peri-implant bone level was not significant within or between the control and test subjects.

Incidence and severity of phenytoin-induced gingival overgrowth in epileptic patients in general medical practice.

This investigation examines the incidence of phenytoin-induced gingival overgrowth in a population of epileptic patients who attend General Medical Practices for treatment of their epilepsy and compares the gingival changes with an otherwise healthy group of patients. The plaque score, gingival index, and gingival overgrowth did not differ significantly between the two groups (P > 0.05). A significant correlation was observed between plaque score and gingival overgrowth in the phenytoin-treated patient, but in this group there was no correlation between gingival overgrowth and salivary concentration of the drug. The overall incidence of clinically significant overgrowth (13%) is considerably less than in other studies.

[Relationship between diabetic retinopathy and the condition of the marginal periodontium and residual dentition]. / Die Beziehung zwischen diabetischer Retinopathie und dem Zustand von marginalem Parodont und Restgebiss.

Fifty-two diabetics were examined by a dentist. A slight, not significant relationship was established between the metabolic disease and the condition of the teeth by means of a partial correlation. Of the available variables permitting an evaluation of the severity of diabetes, retinopathy proved to be the best predictor of the amount of tooth destruction.

Some considerations on the role of cementum in periodontal disease.

The protective role of cementum against root resorption is discussed in relation to buried teeth, orthodontic treatment, replantation and periodontal disease. The essential feature seems to be a layer of partially calcified precementum or vital cementoblasts. Root resorption close to the epithelial attachment, although not common, is probably the result of death of cementoblasts caused by irritants from bacterial plaque, and the presence of severe of prolonged inflammation. Cementum exposed in the pocket can be affected in different ways by these irritants, and rendered unacceptable for re-attachment to periodontal tissue. Successful re-attachment procedures involve either the removal of the affected cementum or its treatment with agents partially to decalcify such as acids, or detoxify by phenol for example. Examples of treatment embodying some of these principles are illustrated by two case histories of localised gingival recession and one of intra-bony pocketing associated with an acute lateral periodontal abscess. In this case a follow-up radiograph taken 16 years later is presented as evidence of the permanence of repair which can be achieved. Root resorption which often follows the use of fresh autogenous bone from the ilium is then discussed and the conclusion reached that the vital cells in the transplant discourage the migration of cementoblasts from the adjacent periodontium. The cementum and dentine thus remain unprotected and susceptible to resorption.

Accelerated reattachment with cementogenesis to dentin, demineralized in situ. II. Defect repair.

Three surgical experiments, with histologic evaluation, were performed to study induced gingival reattachment to tooth root dentin demineralized in situ during flap surgery in adult mongrel dogs. Experiments demonstrated aspects of: (1) Weekly histochemical and morphological sequences of repair; (2) Repair of chronically inflamed bony defects simulating periodontal pockets; and (3) Six and 12 month repair of reattached surgical defects. Flap reattachment with cementogenesis was induced by in situ root demineralization using citric acid at pH 1.0 applied for 2 minutes. Results demonstrate: (1) The production of anchoring cementum pins extending into dentin tubules widened by demineralization; (2) Reattachment with cementogenesis of inflamed gingiva to roots exposed to chronically-infected surgical defects for 3 months; (3) Success in repairing chronic interproximal one-walled and labial one surface defects by reattachment; (4) Relative failure to repair bifurcation and horizontal bone defects by flap reattachment; and (5) Complete alveolar bone repair over most labial defects by 1 year, with maintenance of a periodontal ligament between induced bone and cementum. These findings, together with previous reports of induced reattachment to demineralized roots, provide further evidence for mechanisms and consistency and suggest that this regenerative phenomenon may be useful in repairing osseous defects in periodontal therapy.