Free gingival graft following biopsy: a case report of tissue management.

Excisional biopsies require wide margins to facilitate removal of diseased tissue. Such margins often result in soft-tissue defects. These defects can cause reduced esthetics, ineffective oral hygiene performance, and postsurgical root sensitivity. This case documents the combination of two dental procedures: biopsy and the free gingival graft. A pyogenic granuloma, as diagnosed by histologic report, was removed by excisional biopsy and the resultant defect repaired by using a free gingival graft. Palatal tissue was grafted immediately to the site of the biopsy and sutured in place to cover the loss of attached tissue and papilla. At 6 months, the graft appeared to restore gingival health and maintain both esthetics and function in the surgical biopsy site. The patient was well served by correcting the resultant biopsy defect in a one-step procedure which encouraged healing and an excellent esthetic result.

Retention of multi-rooted teeth with class III furcation lesions utilizing resins. Report of 17 cases.

BACKGROUND: Treatment of periodontally diseased multi-rooted posterior teeth has conventionally consisted of scaling and root planing, apically positioned flaps, tunneling, root amputation, root resection, guided tissue regeneration, osseous grafting, and combination osseous graft and barrier membrane techniques. Successful treatment has often been directed and measured by how well the clinician obtains sufficient access to facilitate patient hygiene efforts. Long-term success is predicated upon tooth retention and the arrest of further destruction within the furcation area. METHODS: Seventeen adult periodontal patients with Class III furcation defects were evaluated. Using an open flap procedure, a resin-ionomer was placed into all 3 furcation defects. The patients were placed on quarterly maintenance appointments and the teeth evaluated up to 1 year. RESULTS: The results revealed that sealing the furcations of multi-rooted teeth with hopeless prognoses seems to be a viable alternative to accessing the same intraradicular areas for maintenance using more conventional modes of therapy. Sealing further decreases the surface area of the furca and simplifies future maintenance. CONCLUSIONS: The present study showed that teeth with hopeless prognoses might be retained by decreasing probing depths, bleeding upon probing, and mobility when furcation areas are sealed with a resin-ionomer.

Treatment of the palato-gingival groove with guided tissue regeneration. Report of 10 cases.

The purpose of this study is to demonstrate the potential of using a barrier in the treatment of palato-gingival groove defects. The study group consisted of 10 patients. Prior to treatment, the palato-gingival groove on maxillary lateral incisors was measured with calibrated periodontal probe from the cemento-enamel junction (CEJ) to the free gingival margin (FGM) and from the FGM to the base of the pocket (BP). Probing depth (PD) was calculated and bleeding on probing indicated. Surgical procedures consisted of flap reflection, removal of granulation tissue, and scaling and root planning of the groove. An expanded polytetrafluoroethylene membrane was sutured over the palato-gingival groove. Six months postsurgery, all measurements were repeated. Statistical analysis compared results using means, standard deviations, and paired t tests. Results showed an improvement in clinical attachment gain, probing depth reduction, and decreased bleeding on probing. This study demonstrates the potential of guided tissue regeneration in the treatment of palato-gingival groove defects. A random blinded clinical trial is necessary, however, to fully assess the potential of this procedure in treatment of palato-gingival groove defects.

Gingiva thickness in guided tissue regeneration and associated recession at facial furcation defects.

Consistently successful regenerative therapy for furcation defects using membrane techniques remains a challenge for clinicians. The purpose of this study was to determine if the thickness of tissue used to cover the membrane influences postsurgery recession. Thirty-seven (37) moderate to advanced adult periodontitis patients presenting with at least one mandibular or maxillary molar class 1 or 2 facial furcation involvement participated in the study. Mid-facial presurgery recession was recorded from the cemento-enamel junction to the free gingival margin at a reproducible point. Mid-facial tissue thickness was measured using calipers at a point 5 mm apical to the gingival margin of the mucogingival flap reflected at the time of guided tissue regeneration surgery. Patients were divided into 2 groups based upon tissue thickness measurement. Patients were then re-evaluated for recession at 6 months postsurgery. Sixteen (16) patients with tissue thickness < or = 1 mm demonstrated a mean 2.1 mm increase in recession, while 21 patients with tissue thickness > 1 mm exhibited a mean 0.6 mm increase in recession. We conclude that there is less post-treatment recession (P < 0.01) for tissue thickness > 1 mm than tissue thickness < or = 1 mm. Hence, thickness of gingival tissue covering a membrane appears to be a factor to consider if post-treatment recession is to be minimized or avoided.

Clinical evaluation of guided tissue regeneration in the treatment of maxillary class II molar furcation invasions.

This investigation assessed and compared the clinical efficacy of combined open flap debridement/occlusive membrane therapy versus open flap debridement therapy alone, in the treatment of maxillary periodontal furcation defects. Seventeen patients presenting with advanced adult periodontitis, including at least one pair of Class II maxillary furcal defects, comprised the study group. Following completion of a hygienic phase of treatment, measurements were made with calibrated periodontal probes to determine soft tissue recession, probing pocket depths, and attachment levels. Each pair of furcation defects was surgically exposed and hard tissue measurements obtained. Defects were treated with either open flap debridement and a polytetrafluoroethylene periodontal membrane or open flap debridement alone. Membranes were removed at 4 to 6 weeks. Six months postsurgery, soft tissue measurements were repeated and all sites were surgically re-entered to obtain hard tissue measurements. No statistically significant differences were found in recession, probing depth reductions, clinical attachment gains, or resorption of alveolar crest height between test and control groups. Results for these parameters were inconsistent and unpredictable. Statistically significant improvements were found, however, in horizontal open probing attachment (HOPA) and vertical open probing attachment (VOPA) between experimental and control sites. The GTR procedure as used in this study likely has limited application as a therapeutic modality for Class II furcations of maxillary molars. Modifications or improvements in the procedure may result in more predictable healing of these lesions.