Morphology and dimensions of the dentogingival unit in the altered passive eruption

Objetives: This study define altered passive eruption (APE) and evaluate the morphology of the dentogingival unit. Material and Methods: 123 individuals subjected to clinical examination and parallel profile radiography of the upper central incisor. An evaluation was made of the correlation between the clinical diagnosis of APE and the degree of gingival overlap; by using a 19% overlap to define APE (Kappa concordance index = 0.7). The Mann- Whitney / Wilcoxon test was used to identify the variables influencing APE. Results: Statistically significant differences were observed between the teeth with and without APE: gingival width (p = 0.0073), clinical crown length (p = 0.0000), smiling exposed gums (p = 0.0000), bone crest thickness (p = 0.0030), connective tissue attachment thickness (p = 0.0003) and biological width (p = 0.0015). Conclusions: The APE is characterized by: a gingival overlapping of over 19% of the length of the anatomical crown, increased gingival width and gingival smile; furthermore is associated to a thick bone crest and connective tissue attachment. Statistical analysis confirms two morphological patterns of APE

Altered passive eruption (APE) : a little-known clinical situation

Gummy smile constitutes a relatively frequent aesthetic alteration characterized by excessive exhibition of the gums during smiling movements of the upper lip. It is the result of an inadequate relation between the lower edge of the upper lip, the positioning of the anterosuperior teeth, the location of the upper jaw, and the gingival margin position with respect to the dental crown. Altered Passive Eruption (APE) is a clinical situation produced by excessive gum overlapping over the enamel limits, resulting in a short clinical crown appearance, that gives the sensation of hidden teeth. The term itself suggests the causal mechanism, i.e., failure in the passive phase of dental eruption, though there is no scientific evidence to support this. While there are some authors who consider APE to be a risk situation for periodontal health, its clearest clinical implication refers to oral esthetics. APE is a factor that frequently contributes to the presence of a gummy or gingival smile, and it can easily be corrected by periodontal surgery. Nevertheless, it is essential to establish a correct differential diagnosis and good treatment plan. A literature review is presented of the dental eruption process, etiological hypotheses of APE, its morphologic classification, and its clinical relevance

Palatal fenestration after orthodontic treatment. Intermodal approach and evolution. A case report

A 15-year-old patient is referred to the Department of Periodontics of the University of Valencia. The patient reported dissatisfaction with the position of upper right canine after orthodontic treatment. Previously, in a private center, surgical approaches were performed for the traction of the canine included. On clinical examination at first appointment, generalized plaque-induced gingivitis was observed, with palatal fenestration of the root of upper right lateral incisor of approximately 75% of the total surface, with suppuration and very little gingiva inserted at the cervical level, which presents a buccal torque of the crown. Radiologically, a mild rhizolysis and bone loss adjacent to upper right lateral incisor was observed. An interdisciplinary treatment is decided between the departments of Orthodontics, Endodontics and Periodontics: - Canal treatment of upper right lateral incisor, performing a retrograde filling of the cavity with Biodentine ® (Septodent, Saint Maur de Fossés, France). - Orthodontic treatment, modifying the torque and improving the stability. - Periodontal treatment, performing a connective tissue graft by Langer technique adapted to the case. After the conclusion of the orthodontic treatment, an improvement in the situation is observed. The graft was performed, presenting at 3 months a line of fenestration in the mucosa. At 4 years, the patient is asymptomatic, without suppuration, with a total closure of the fenestration

A controlled clinical study of periodontal health in anticoagulated patients : assessment of bleeding on probing

According to the Spanish Society of Cardiology, 700,000 patients receive oral anticoagulants, and in these cases bleeding on probing (BOP) could be altered. However, no studies have analyzed the periodontal status of these patients and the effects anticoagulants may have upon BOP. A study was made of the possible relationship between plaque index, probing depth, INR (International Normalized Ratio) and acenocoumarol dose versus the clinical signs of BOP in a sample of anticoagulated patients. Likewise, an analysis was made of oral hygiene habits and attitude towards bleeding in these patients. A controlled observational clinical study was made in La Ribera Hospital (Valencia, Spain) involving 44 anticoagulated patients treated with Sintrom® (acenocoumarol) and a homogeneous control group of 44 non-anticoagulated patients. A survey on oral hygiene habits and attitude towards bleeding was carried out, and the main periodontal parameters were recorded. Probing depth was the parameter with the strongest correlation to BOP (p<0.001), followed by the plaque index (p<0.002). In contrast, no relationship was observed between acenocoumarol dose or INR and BOP. Mean BOP was greater in the control group than in the anticoagulated group (p<0.001). Oral hygiene habits and attitude towards bleeding differed significantly between groups. We have found no explanation why BOP was greater in the control group. What seems clear is that in the presence of the same plaque index and probing depth, anticoagulated patients did not bleed more than non-anticoagulated patients. A lack of knowledge of health and oral hygiene habits was observed in these subjects

Hereditary gingival fibromatosis : characteristics and treatment approach

Hereditary gingival fibromatosis (HGF) is a rare disorder characterized by a benign, non-hemorrhagic, fibrous gingival overgrowth that can appear in isolation or as part of a syndrome. Clinically, a pink gingiva with marked stippling can be seen to cover almost all the tooth, in many cases preventing eruption. HGF usually begins during the transition from primary to permanent teeth, giving rise to a condition that can have negative psychological effects at that age. As it does not resolve spontaneously, the treatment of choice is gingivectomy, which can be performed with an internal or external bevel incision, depending on each case and bearing in mind the changes that will take place at the dentogingival junction (DGJ). This paper describes clinical aspects and treatment in two eight-year-old boys with HGF, considering different facets of the surgical approach with conscious sedation in young children

Periodontal regeneration in clinical practice

The regeneration or restitution of lost supporting tissue has always been considered the ideal objective of periodontal therapy. However, attempts to convert this intention into solid clinical practice can become tremendously complex, the results of which are very different from the original intention. The aim of this article is to offer an up-to-date, general perspective on periodontal regeneration, orienting the clinician within the global strategy for oral treatment. To this end, we revise the healing process of periodontal injury, the different therapeutic approaches, the interpretation of the results, and finally, limiting factors in periodontal regeneration

Assessment of the capacity of a pyrophosphate-based mouth rinse to inhibit the formation of supragingival dental calculus. a randomized double-blind placebo-controlled clinical trial

This study aimed to analyze the efficacy of an anti-calculus mouth rinse and its possible adverse effects on the mucosa and teeth. This randomized double-blind placebo-controlled clinical trial included 40 patients with treated and managed periodontal disease, all with a history of rapid calculus formation. Patients used a pyrophosphate-based test mouth rinse (B) or a placebo (A). A range of parameters were measured for: saliva (saliva flow, pH and chemical composition); calculus (Volpe-Manhold [V-M] index, weight, and volume); adverse effects on mucosa and teeth; and the patients? subjective perceptive of mouth rinse efficacy. The test mouth rinse B produced reductions in urea, uric acid, and phosphorous, calcium, saliva flow, and increases in pH. V-M index and calculus weight decreased after using the test mouth rinse. Calculus volume decreased with both mouth rinses. No changes to the mucosa or teeth were observed. Patients perceived that the test mouth rinse was more effective. The test/B and placebo mouth rinses both modified certain parameters in saliva composition, particularly reductions in urea, uric acid, and phosphorous. Calcium tended to increase after using the test-B mouth rinse. The results did not demonstrate the anticalculus efficacy of the pyrophosphate-based mouth rinse or positive effects on saliva flow or composition. This field requires further research, as no product has been developed that prevents calculus formation completely

Clinical evaluation of dental and periodontal status in a group of oncological patients before chemotherapy

Objective: To evaluate the dental status of 88 cancer patients before chemotherapy. Material and methods: Eighty-eight patients with cancer in different body locations were studied and compared with a control group. Dental plaque was assessed by means of the Silness and Löe index, dental status with the DMFT index, and periodontal status with the modified CPI index. Results: In the oncological patients the mean Silness and Löe index was 1.28±0.11. Patients showed multiple missing teeth (mean number 7.55±0.80); the mean number of decayed teeth was 2.10±0.36; and the mean number of filled teeth was 2.27±0.37. As to periodontal status, the mean modified CPI index was 1.45±0.11. In the control group, the mean Silness and Löe index was 0.94±0.00. The mean number of decayed teeth was 1.21±0.25; the mean number of missing teeth was 4.97±0.67; and the mean number of filled teeth was 4.82±0.44. The mean modified CPI index was 1.29±0.10. Conclusions: Oncological patients in our study showed more dental plaque versus healthy patients and more decayed and missing teeth. However, patients in the control group showed more filled teeth than cancer patients. Periodontal status as determined by the modified CPI index was similar in both patient groups

Performance of the dentogingival junction with mta and biodentine on the treatment of invasive cervical resorptions. A literature review and case report

Invasive cervical resorption (ICR) is an uncommon phenomenon (0.1%), however, it represents a challenge to the structural and functional integrity of the dentogingival junction, as well as a risk for the survival of the affected tooth. They are character

Epigenetics and periodontics : a systematic review

Despite decades of research, our knowledge of several important aspects of periodontal pathogenesis remains incomplete. Epigenetics allows to perform dynamic analysis of different variations in gene expression, providing this great advantage to the static measurement provided by genetic markers. The aim of this systematic review is to analyze the possible relationships between different epigenetic mechanisms and periodontal diseases, and to assess their potential use as biomarkers of periodontitis. A systematic search was conducted in six databases using MeSH and non-MeSH terms. The review fulfilled PRISMA criteria (Preferred Reporting Items for Systematic reviews and Meta-analysis). 36 studies met the inclusion criteria. Due to the heterogeneity of the articles, it was not possible to conduct quantitative analysis. Regarding qualitative synthesis, however, it was found that epigenetic mechanisms may be used as biological markers of periodontal disease, as their dynamism and molecular stability makes them a valuable diagnostic tool. Epigenetic markers alter gene expression, producing either silencing or over-expression of molecular transcription that respond to the demands of the cellular surroundings. Gingival crevicular fluid collection is a non-invasive and simple procedure, which makes it an ideal diagnostic medium for detection of both oral and systemic issues. Although further research is needed, this seems to be a promising field of research in the years to come