The Prosthetic Management of a Case of Epulis Fissuratum by a Novel Technique / El manejo protésico de un caso de épulis fisurado con una técnica novedosa

ABSTRACT: The clinical management of the epulis involves the elimination of causal factors, excision of fibrous tissue excess accompanied by an appropriate prosthetic rehabilitation. The confection of interim prosthesis or the rectification of old prosthesis for the setting up of a tissue conditioner if necessary, to improve the healing and prevent the decrease of the vestibule depth after the surgical exeresis. Throughout this paper, we are going to present a new technique for the correction of old prostheses poorly adapted for the management of a case of the epulis fissuratum.

RESUMEN: El manejo clínico de un épulis comprende la eliminación de los agentes causales y la eliminación del tejido fibroso, acompañado de una adecuada rehabilitación protésica. Es necesaria la confección de una prótesis provisional o la rectificación de la prótesis vieja, para la colocación del acondicionador de tejidos si fuera necesario para mejorar el sanado y prevenir la disminución de la profundidad del vestíbulo después de la exéresis quirúrgica. En este artículo, presentaremos una nueva técnica para la corrección de la prótesis desajustada en el manejo de un caso de épulis fisurado.

Giant Peripheral Ossifying Fibroma Treated With Piezosurgery and Platelet-Rich Fibrin: A Rare Case Report.

INTRODUCTION: The peripheral ossifying fibroma (POF) is a benign reactive lesion that exclusively arises from gingiva. The lesion may gain considerably large sizes and present peculiar clinical and radiographic features that would then allow it to be called a giant POF; in that case, its otherwise simple surgical extraction could create a challenge. Thus, we elect here, for the very first time, a plausible alternative for treating giant POF: piezosurgery followed by placement of platelet-rich fibrin (PRF). CASE PRESENTATION: A 31-year-old black male presented a large asymptomatic nodule on the lower gingiva; the lesion had caused vestibular displacement of teeth and had been present for 18 years. Following the diagnostic hypothesis of a giant POF, an excisional biopsy was performed under local anesthesia using piezosurgery (microvibration of 36,000 times/sec was used in a bone cortical working mode), which confirmed the diagnosis. The surgical procedure was facilitated with the use of piezosurgery followed by placement of PRF, being the trans- and postoperative periods occurred with no complications. One year after the treatment, the patient shows no signs of disease recurrence and remains under follow-up. CONCLUSIONS: Giant POF is a rare gingival reactive lesion that can reach large dimensions, causing teeth displacement, functional, and esthetic impairments. The lesion can be successfully managed with piezosurgery and PRF, as illustrated herein, avoiding extensive bone loss and damage to the surrounding soft tissues.

Treatment of Amalgam Tattoo With a New Technique: Mucoabrasion and Free Connective Tissue Graft.

INTRODUCTION: A new technique was performed for the removal of an amalgam tattoo (AT), consisting in mucoabrasion combined with a free connective tissue graft (FCTG). CASE PRESENTATION: A 59-year-old female presented with a large AT involving the alveolar mucosa and gingiva between teeth #7 and #8, where endodontic treatment and apicoectomy was performed 21 years ago. To avoid compromising esthetics, the lesion was managed with a new technique including mucoabrasion and an FCTG. At the 53-month follow-up, the patient exhibited a naturally appearing soft tissue with no evidence of the AT. CONCLUSION: When performing a one-stage treatment of removing ATs in areas of high esthetic demand, it is possible to achieve good results and ideal gingival color.

Diagnosis and treatment of oral focal mucinosis: a case series.

BACKGROUND: Oral focal mucinosis, the oral counterpart of cutaneous focal mucinosis, is a rare disease. As it has no characteristic clinical or radiological features, diagnosis is established by histopathological and immunohistological examination. We present three cases of oral focal mucinosis occurring in the retromolar (which is extremely rare) and gingival regions. CASE PRESENTATION: Case 1 involved a 26-year-old Japanese man with radiolucency in the right retromolar region on panoramic radiograph and computed tomography; no obvious protrusion was observed in the region. This finding was clinically diagnosed as a tumor of the retromolar region. Case 2 involved a 60-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 7 × 6 mm and exhibited elastic hardness and healthy-colored mucosa. The lesion was diagnosed as an epulis. Case 3 involved a 47-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 10 × 10 mm and exhibited elastic hardness and redness of the surface mucosa. This lesion was also diagnosed as an epulis. Resection was performed in all three cases, and the lesions were histopathologically diagnosed as oral focal mucinosis. Postoperative courses were uneventful and, thus far, there have been no recurrences. CONCLUSIONS: Although it is difficult to diagnose oral focal mucinosis based on clinical symptoms and imaging findings, the disease should be considered a possibility when diagnosing benign oral tumors. We believe that an emphasis on histopathologic study is essential to confirm the clinical suspicion.

Treatment of gingival defects with gingival mesenchymal stem cells derived from human fetal gingival tissue in a rat model.

BACKGROUND: The study aimed to evaluate the efficacy and safety of gingival mesenchymal stem cells (GMSCs) from human fetal gingival tissue used for treating gingival defects in a rat model. METHODS: GMSCs were isolated from human fetal gingival tissue and identified by flow cytometry for nestin, Oct4, vimentin, NANOG, CD105, and CD90. The immunogenicity of GMSCs was analyzed by mixed lymphocyte reactions; the tumorigenicity of GMSCs was evaluated by xenotransplanting into nude mice. The gingival defect animal model was established by mechanical resection in rats. GMSCs were transplanted into the defective area, and the regeneration of gingival tissue was observed twice weekly. Four weeks after transplantation, the gingival tissue was surgically cut down, and the graft was analyzed by immunohistochemistry staining for human mitochondrial antigens and rat CD3 and CD20. RESULTS: GMSCs from human fetal gingival tissue positively expressed nestin, Oct4, vimentin, NANOG, CD105, and CD90. There was no cell aggregation after mixed lymphocyte reactions, and interleukin-2 did not increase. Inoculation of GMSCs into nude mice for 6 months showed no tumor formation. GMSCs were transplanted into the gingiva defects of rats. One week after transplantation, the defect area was reduced, and after 3 weeks the morphology and color of local gingival tissue was similar to normal gingival tissue, and gingival height was the same as the normal control group. CONCLUSIONS: Using GMSCs from human fetal gingival tissue to treat gingival defects is a safe and effective innovative treatment method.

A report on the clinical-pathological correlations of 788 gingival lesion

Background: The diagnosis and treatment of a variety of non-plaque related gingival diseases have become an integrated aspect of everyday dentistry. The aim of this study was to analyse the relationship between clinical appearance and histopathological features of gingival lesions in a large Northern Italian population. Material and Methods: A retrospective study of 788 cases of gingival and alveolar mucosal biopsies was set up. Statistical analysis was performed by calculating the odds ratio and 95% confidence interval (C.I.), in order to assess the degree of association between the clinical parameters considered (primary lesions) and the single pathologies, statistically evaluated by Mantel-Haenszel tests. The correlation between clinical and histological diagnosis was classified as follow: 1) expected data (ED): provisional clinical diagnosis; 2) real data (RD): final histopathology diagnosis; 3) concordant data (CD): correspondence between the expected data and real data. The correlation was calculated as follow: CC (complete concordance) = CD x 100 / ED, this expressing the percentage in which the clinical and the histological diagnosis overlapped. Results: The most frequently observed and biopsied primary lesions resulted to be exophytic, followed by mucosal colour changes and finally by losses of substance. The statistically significant association between primary lesion and their manifestation in gingival pathologies was reported. Volume increases, for instance, were positively correlated to plasma cell epulis, pyogenic granuloma, fibrous reactive hyperplasia and hemangioma. Verrucous-papillary lesions were most often seen in verrucous carcinoma, verrucous leukoplakia and mild dysplasia. White lesion resulted to be related to leukoplakia or oral lichen planus. Red lesions resulted to be related only oral lichen planus. Erosive vesicle-bullous lesions were linked to disimmune pathologies. Ulcerative lesions were positively associated to oral squamous cell cancer. Finally, potentially malignant disorders have the most percentage high concordance. Among the malignant lesions, the correlation increased up to the squamous cell carcinoma and leukaemia. Conclusions: This article presented the frequency and the clinico-pathological concordance of all primary lesions and the histopathological diagnosis of gingival lesions. For every primary lesion, it is possible to correlate a specific histopathological diagnosis in a statistical manner. This can be a valuable aid for not specialist clinicians who daily observe mucosae and have the opportunity to intercept major diseases (AU)

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Orientações ao cirurgião-dentista no tratamento periodontal de gestantes / Guidance to the dental surgeon in periodontal treatment of pregnant women ­ literature review

A gestação é um período especial na vida da mulher, contudo, devido às alterações biológicas, físicas e hormonais, essas pacientes apresentam-se com maior pré-disposição às doenças bucais, que por sua vez criam situações adversas no ambiente bucal. Portanto, este trabalho visou dispor sobre as alterações ocorridas na cavidade bucal da gestante, assim como medidas e tratamento durante este período. Em condições bucais normais, um indivíduo apresenta inúmeras bactérias patológicas que, quando entram em desequilíbrio com o hospedeiro, podem acarretar diversas doenças, como a doença periodontal. Esta se caracteriza por uma afecção crônica consequente da colonização de bactérias gram-negativas, as quais afetam a região subgengival ocasionando aumento local e sistêmico das prostaglandinas e citocinas, sendo que na gravidez promove alterações no aspecto da gengiva, como hiperemia, sangramento gengival e edema, relacionadas à placa bacteriana, aumento nos níveis hormonais, déficit nutricional e estado transitório de imunodepressão. Devido às várias mudanças físicas e psíquicas ocorridas durante o período da gestação, é de extrema importância que o cirurgião-dentista tenha um conhecimento sobre as principais características de cada trimestre gestacional, assim como sobre as indicações e cuidados a serem tomados durante o período de atendimento que, por sua vez, são importantes para promover um tratamento seguro e com menor risco de efeitos à gestante e ao bebê.

Pregnancy is a special time for women; however, due to biological, physical, and hormonal changes, these patients are more prone to oral diseases, which in turn creates adverse conditions. The aim of this paper is to discuss the changes seen in the oral cavity as well as its correspondent treatment measures. Under normal conditions, an individual can have several types of pathological bacteria predisposing periodontal disease when the balance between the disease and the host is disturbed. This is characterized as a chronic infection due to gram-negative species at the subgingival area increasing the local and systemic prostaglandin and cytokine levels, which in pregnant women provoke alterations such as hyperemia, gingival bleeding, and edema related to plaque, increasing the hormonal levels, nutritional deficit, and still creating an immunosuppressive transitory state. Considering the physical and psychological conditions related, it is necessary to know the main characteristics at each pregnancy period, as well as the indications and treatment care to promote a safe treatment with a lower risk for future babies and mothers.

Journey From Black To Pink Gums: Management Of Melanin Induced Physiological Gingival Hyper Pigmentation.

Smile is an expression of happiness, self-confidence, kindness and beauty. Along with teeth and lips, gingiva is also a vital component of smile. Melanin induced gingival hyper pigmentation may appear un-aesthetic especially when it is associated with high smile line, upper anterior labial segment and is uneven in appearance. It affects individuals from all races. Generally, it is believed that melanin induced gingival hyper pigmentation is confined to individuals from dark races. But studies have shown that Iranian, Indian, Italian, Arabian, Greek. German, French, Japanese, Chinese, Jewish, Thai, Malaysian and other ethnic groups also display clinical gingival pigmentation.1 Gingival hyper pigmentation may result in psychological distress especially when the appearance is of utmost importance for the individuals. This article aims to focus on the physiology, clinical appearance and treatment options available for the melanin induced gingival hyper pigmentation along with the reported recurrence in the light of current literature.

Sclerotherapy for the recurrent granulomatous epulis with pingyangmycin.

BACKGROUND: Relapse of granulomatous epulis is common after surgery because of local irritations, hormonal level in vivo, or incomplete resection. Currently, if recurrence occurs, then extraction of the teeth adjacent to the lesion is commonly performed, which may influence the aesthetics or masticatory function. Thus, a more effective and less aggressive treatment method is urgently demanded, particularly for the recurring lesion. This study investigated the effects of the intralesional pingyangmycin (PYM) injections for the recurrent granulomatous epulis and assessed the complications. MATERIAL AND METHODS: A total of 16 patients with recurrent granulomatous epulis underwent intralesional PYM injections, between July 2010 and June 2014. The effects and complications of the treatment were retrospectively reviewed. RESULTS: The total number of injections performed was 48 (for all patients). The median number of injections per patient was three (range, two to four). All cases completely recovered with no recurrence and resorption of the alveolar bone after a follow-up of more than 12 months. The complications included slight bleeding, local swelling and pain following injection. All these symptoms resolved 7 to 10 days after the injection. CONCLUSIONS: In summary, intralesional PYM injections may be a preferred option for recurring granulomatous epulis.

Treatment Concept for a Patient with a High Smile Line and Gingival Pigmentation: A Case Report.

Today, innovative restorative materials and techniques allow for minimally invasive prosthetic procedures, which are paramount to the preservation of hard and soft dental tissues. An integrated approach combining dental and esthetic medical therapies could be useful to improve the quality of life of patients, improving function, esthetics, and self-confidence. Oral esthetics depends on several variables, including tooth visibility and proportions as well as healthy gingival tissues. Proper integration between teeth and periodontal tissues plays an important role in esthetic success, which is mainly represented by an appealing smile. The present case report was aimed at describing the multidisciplinary treatment of a woman who was unsatisfied with the shape of her central incisors and the dark gingival pigmentation displayed by a high smile line. The patient was treated with minimally invasive combined periodontal, prosthetic, and esthetic medical techniques. The described multidisciplinary approach based on surgical gingival depigmentation, adhesive ceramic veneers, and selective botulinum toxin injection was effective in solving the undesired high smile line and achieving patient satisfaction.

Repigmentación melánica de la melanosis gingival: revisión sistemática / Melanin repigmentation of gingival melanosis: systematic review

La melanosis gingival o pigmentación melánica fisiológica es definida como una alteración caracterizada por un cambio en la coloración de la encía, en la cual la encía adquiere una tinción oscura ocasionada por una acumulación de melanina. Objetivo El propósito de esta revisión fue evaluar la literatura actual sobre el grado de repigmentación gingival luego del tratamiento de la melanosis. Material y método Búsqueda detallada en las bases de datos PubMed, Cochrane y Embase para obtener la información sobre las técnicas de tratamiento y resultados posoperatorios de cada procedimiento quirúrgico. Resultados De los 219 artículos identificados inicialmente, 22 cumplieron con los criterios de inclusión (reportes de casos, series de casos, ensayos clínicos y revisiones sistemáticas). Las técnicas con el escalpelo evidenciaron una repigmentación al cabo de 3 meses a 3 años y las técnicas con el uso de láser diodo entre 18-24 meses. Las técnicas de criocirugía, electrocirugía, laser Er:YAG y láser Nd:YAG evidenciaron escasa o nula repigmentación. Conclusión La repigmentación melánica es más común en las técnicas que utilizan el escalpelo, siendo el rango de recurrencia entre 3 meses a 3 años. La heterogeneidad de los estudios limita la realización de un metaanálisis con respecto a los resultados de tratamiento de la melanosis gingival.

Gingival melanosis or physiological gingival melanin pigmentation is a disorder that causes a change in the colour of the gums, which acquire a dark stain caused by an accumulation of melanin Objective The purpose of this review was to assess the current literature on treatment of gingival melanosis and assessing the degree of gingival repigmentation. Material and method A detailed search was conducted in the PubMed, Cochrane and Embase databases for information on treatment techniques and post-operative results of each surgical procedure. Results Of the 219 articles initially identified, 22 met the inclusion criteria (case reports, case series, clinical trials, and systematic reviews). Scalpel techniques showed a repigmentation after 3 months - 3years, and techniques using laser diode between 18-24 months. Techniques with cryosurgery, electro-surgery, Er: YAG laser and Nd: YAG laser showed little or no repigmentation. Conclusion Melanin repigmentation is more common in techniques that use the scalpel, with recurrences ranging from between 3months and 3years. The heterogeneity of the studies limited the performing of a meta-analysis on the results of treatment of gingival melanosis.

Encía artificial en prótesis implantoasistida: indicaciones y aplicaciones clínicas / Artificial gingiva in implant-supported prosthesis: indications and clinical applications

En la rehabilitación odontológica integral actual, hay que evaluar los parámetros clínicos para una restauración sobre implantes dentales. El tratamiento del sector anterior de ambos maxilares en situaciones clínicas complejas, hace que el éxito sea difícil de alcanzar, inclusocuando todos los objetivos establecidos de diagnóstico y de planificación del tratamiento, sean respetados y puedan realizarse. El objetivo es imitar la apariencia de los dientes contiguos para simular la dentición natural, con un enfoque en la estética de los tejidos gingivales adyacentes a las restauraciones sobre implantes. En los casos en que el tejido óseo y la pérdida mucogingivales marcada y procedimientos quirúrgicos adicionales no son viables, se requerirá de tratamientos alternativos. Uno de ellos podría ser el uso de encía artificial para reconstruir las deficiencias de tejidos duros y blandos. Este artículo describe diferentes indicaciones y aplicaciones clínicas de la encía artificial en prótesis implanto asistida.

In the current comprehensive dental rehabilitation, clinical parameters for success restoration on dental implants must be evaluated.Treatment of both anterior maxillary and mandibular jaws in complex clinical situations makes success difficult to achieve, even when allestablished goals in diagnosis and treatment planning, are respected and can be made.The goal is to mimic the appearance of the adjacent teeth to simulate natural dentition, with a focus on the aesthetics of the gingival tissuesnext to implant restorations. In cases where the bone and mucogingival tissues loss are marked and additional surgical procedures shouldnot be viable, it will require alternative treatment options. One of them could be the use of artificial gingiva to rebuild the deficiencies ofhard and soft tissues.This article describes different indications and clinical applications in artificial gum assisted implant prosthesis.

Treatment of a "Gummy Smile": Understanding Etiology is Key to Success.

When dealing with excessive gingival display it is important for the treating clinician to properly identify the etiology, as potential etiologic factors can vary widely. Treatment decisions in this case involving a patient with high lip dynamics and a "gummy smile" were complicated because treatment recommendations differed for each of the several etiologies involved. The treatment performed, which included orthodontics combined with crown lengthening and in which the final restorations were segmented anterior to posterior to give both the clinician and laboratory improved control, was designed to meet the patient's desired esthetic outcome while addressing the areas of risk established in the preoperative assessment.

Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo-Controlled Clinical Trial.

BACKGROUND: This study evaluates the effects of ozone therapy (OT) on the early healing period of deepithelialized gingival grafts (DGG) placed for non-root coverage gingival augmentation by laser Doppler flowmetry (LDF). METHODS: Thirty-three patients were assigned to study groups: 1) test: DGG + OT; or 2) control group: DGG alone. Thirty patients completed the study. Ozone was applied on DGGs placed in the recipient bed and donor site immediately after surgery and at days 1 and 3 post-surgery. Blood perfusion in the recipient site was measured by LDF on the day of surgery and at 1, 2, 3, 6, 8, 10, and 13 days after surgery. Quality of life (assessed by the Oral Health Impact Profile-14) and pain at donor/recipient sites (assessed by visual analog scale) were also investigated. RESULTS: Increase in blood perfusion units in the test group was significantly higher than control group at 1, 2, 3, 6, and 8 days post-surgery (P <0.001). Significant differences occurred between test and control groups in terms of visual analog scale values during the first week post-surgery for both donor and recipient sites (P <0.05). The ozone-treated group showed significantly higher quality of life than control group on postoperative day 6 (P = 0.002). CONCLUSIONS: OT enhanced blood perfusion units in the first postoperative week. This outcome is also consistent with improvement in wound healing, accompanied by an increase in quality of life and decrease in postoperative pain in the test group.

Hallazgos citológicos de la enfermedad gingivo-periodontal pre y post-tratamiento en pacientes atendidos en la Cátedra de Periodoncia de la FOUNNE / Pre- and post-treatment findings of gingivo-periodontal disease in patients who attended the Department of Periodontics, FOUNNE

Describir y comparar las alteraciones citológicas encontradas en la pared blanda de la bolsa periodontal y margen gingival vestibular de pacientescon enfermedad gíngivo-periodontal en el pre y post tratamiento. Material y métodos: Se estudiaron 38 pacientesmayores de 24 años y menores de 61 años, de ambos sexos, quienes acudieron a la Cátedra de Periodoncia de la Facultad de Odontología de la UNNE. Las muestras citológicas fueron tomadas con cureta de Gracey, se fijaron en alcohol de 96 grados y se colorearon con la técnica de Papanicolaou. En la evaluación citológica se consideró: tipos celulares, grado de queratinización y otros elementos acompañantes del fondo. Resultados: Se observó un mayor porcentaje deperiodontitis moderada (63 por ciento), predominando en el sexo masculino (56 por ciento) y el promedio de edad fuede 49 y 61 años (53 por ciento). Los extendidos pre- tratamiento presentaron mayor celularidad con células superficiales de núcleos picnóticos, células reactivas y abundantes células inflamatorias. En los posttratamiento predominó la mayor queratinización con escamas epiteliales y células con características reparativas (metaplásicas) y menor porcentaje decélulas inflamatorias y hematíes. Conclusiones: la citología exfoliativa gingival constituye un método diagnóstico complementario sencillo en la evaluación y seguimiento del tratamiento y evolución de pacientes con periodontitis...