Evaluating the Effect of Attached Gingiva Height on Pre-implant Tissue

Background: Many patients refer to their load implants while there is no attached gingiva in the area of prosthetic implants – unlike the attached gingivae found with natural teeth. The important role played by gingiva in comforting the patient and preventing gingival inflammation has not been fully appreciated yet. This study aimed to evaluate the association between the attached gingival height with gingival inflammation and patients’ comfort. Methods: This retrospective cohort study was conducted to examine 80 implants (Dio uf) placed in 63 patients. At least two months had passed since the patients had had implant crown. The patients were divided into three groups: attached gingiva, gingival up to 2 mm, and at least 2 mm of attached gingiva. Indices such as bleeding on probing (BOP), the amount of plaque, gingival index and patient comfort during brushing and chewing were evaluated. Statistical data were analyzed using the Kolmogorov– Smirnov test, Levene’s test and independent t-test. Results: By increasing the height of attached gingiva, decreases were observed in probing depth (P value=0.004), BOP (P value=0.001), the degree of plaque index (P value=0.006), and gingival index (P value=0.003); and this association was statistically quite significant. By increasing the attached gingiva height, furthermore, the patients felt less discomfort when brushing and chewing; however, the findings were not statistically significant in terms of patients’ comfort during chewing (P value=0.364). Conclusions: Increasing the height of attached gingiva reduced the symptoms of gingival inflammation, but increased patients’ comfort when chewing and brushing.

Idiopathic pigmented gingival fibromatosis: A case report

Gingival fibromatosis is a rare and heterogeneous group of disorders that develop as slowly progressive, local or diffuse enlargements within marginal and attached gingiva or interdental papilla. Gingival fibromatosis is a condition that can occur as an isolated disease or as a part of a syndrome or chromosomal abnormality. Here, we present the case of a 28-year-old male with pigmented gum enlargement in the maxilla and mandible. The clinical, radiographic, and histopathological features have been described in detail.

Multifocal periapical cement dysplasia in Ehlers-Danlos Typ VIII combined with leukoencephalopathy in de novo-mutation of c.890G>A, G297D [pEDS]

Periodontal Ehlers-Danlos syndrome type VIII (pEDS) is rare and caused by mutation in complement 1 subunit. Lack of attached gingiva, pretibial plaques, joint mobility, skin fragility, and easy bruising consolidate the diagnosis. We describe a case of de novo-mutation of pEDS with generalized periapical cemento dysplasia (PCD) and leukoencephalopathy.

Rare Genetic Disorders Affecting the Periodontal Supporting Tissues in Adolescence

In adolescents periodontal destruction may be the primary manifestation of an as yet unrecognized rare systemic disease, and it may be up to the periodontist to make the correct tentative diagnosis. Many genetic diseases that present with primary periodontal manifestations in adolescence affect immune function, sometimes with only mild or absent systemic features. They include periodontal Ehlers-Danlos syndrome (lack of attached gingiva, various connective tissue abnormalities), Papillon-Lefèvre syndrome (palmoplantar hyperkeratosis), and plasminogen deficiency (fibrin deposition within mucous membranes). Other immune disorders with severe periodontitis manifesting in adolescence are usually diagnosed in early childhood due to unmistakeable systemic features. They include Cohen syndrome (developmental disorder, truncal obesity, and microcephaly), Hermansky-Pudlak Syndrome (oculocutaneous albinism, bleeding diathesis, and other systemic manifestations), glycogen storage disease type 1b, and Chediak-Higashi syndrome (pyogenic infections, albinism, and neuropathy). The structural integrity of periodontal tissue is affected in genodermatoses such as Kindler syndrome, a type of epidermolysis bullosa. In primary hyperoxaluria, inflammatory periodontal destruction is associated with renal calculi. Breakdown of periodontal tissues independent of dental plaque biofilm-induced periodontitis is found in hypophosphatasia (highly variable skeletal hypomineralization) or isolated odontohypophosphatasia, hypophosphatemic rickets and primary hyperparathyroidism. Finally, alveolar osteolysis mimicking localized periodontitis may be due to neoplastic processes, e.g., in neurofibromatosis type 1 (typical skin features including café au lait macules and neurofibromas), Langerhans cell histiocytosis (locally destructive proliferation of bone marrow-derived immature myeloid dendritic cells), and Gorham-Stout disease (diffuse cystic angiomatosis of bone).

Prevalence of Gingival Pigmentation and its Association with Gingival Biotype and Skin Colour

Introduction: The facial appearance depends on several oral and extraoral factors including colour of facial skin and pigmentation of gingival epithelium. The colour of the gingiva varies among individuals and is thought to be associated with cutaneous pigmentation which ranges from light to dark brown or black colour. Objective: To assess the prevalence of physiological gingival pigmentation, gingival biotype and their association with skin colur in Nepalese subjects visiting Kantipur Dental College and Hospital (KDCH). Methods: This was an analytical cross-sectional study which was carried out from February 2020 to June 2020 in all patients of age-group 16 to 80 years visiting the Department of Periodontics at KDCH after ethical approval. Patients were recruited by convenience sampling and examined thoroughly to find out gingival biotype and extent of gingival pigmentation intraorally as well as skin colour extraorally. Results: In this study, 210 patients were examined among which, 105 (50%) were males and 105 (50%) were females. Out of 210, 33 (15.7%) had pink tissue without pigmentation, 84 (40%) had pigmentation only in attached gingiva, 58 (27.6%) in attached gingiva and interdental papilla, 32 (15.2%) had diffuse pigmentation involving all parts of gingiva, 2 (1%) had in marginal gingiva only, and 1 (0.5%) in marginal gingiva and interdental papilla. Conclusion: A strong association was found between gingival pigmentation and facial skin colour in present study (P <0.001). Establishing the pattern of gingival pigmentation in Nepalese population will help to choose a specific depigmentation therapy that will harmonise with skin colour.

Techniques and materials used to optimize attached gingiva size: literature review

The aim of this review was to examine the techniques for performing keratinized gingival augmentation and grafts, as well as the materials used, which are often required to ensure proper wound closure. Tissue engineering of the oral mucosa represents an interesting alternative to obtain sufficient autologous tissue to repair oral soft tissue defects using biodegradable scaffolds and can improve vascularization and epithelialization, which are critical for successful outcomes.

Extramedullary Plasmacytomas of the Oral Cavity: A Case Report and Review of the Literature

Introduction: Multiple myeloma is a hematologic malignancy characterized by the proliferation of plasma cells and typically presents with lesions in bone, known as plasmacytomas. Through hematogenous spread, extramedullary plasmacytomas can develop in soft tissue in any location of the body. This case report describes a patient with multiple myeloma who presented with an extramedullary plasmacytoma on his maxillary gingiva and provides an updated review on the classification and characterization of extramedullary plasmacytomas of the oral cavity. Case description: A 53-year-old male with a known diagnosis of multiple myeloma was referred to our clinic for evaluation of a gingival nodule, which was tender to palpation and had been present for a month. Clinical examination revealed a 1.5 cm violaceous, red nodule of the maxillary buccal attached gingiva, which did not blanch on palpation. He had a similar 1 cm, smooth, red nodule of his cutaneous skin on his left arm. Radiographic examination with within normal limits without evidence of dental or bony pathology. An incisional biopsy revealed the diagnosis of plasmacytoma, indicating relapse and progression of the patient’s multiple myeloma.Practical implications: Multiple myeloma can present in the oral cavity either as intra-bony plasmacytomas, paraskeletal plasmacytomas, or extramedullary plasmacytomas in the soft tissue. Extramedullary disease representative of hematogenous spread is concerning for high-risk disease with a poor risk prognosis.

Gender- and age-related differences in the width of attached gingiva and clinical crown length in anterior teeth

Background The anatomical features of the gingiva and the clinical crowns and their interrelation, especially in aesthetically and functionally demanding areas, are important in complex dental or implant-retained prosthetic rehabilitations. This observational cross-sectional study was designed to evaluate gender- and age-related differences in the width of attached gingiva (WAG), the clinical crown length (CCL), and their interrelation in the anterior teeth to determine the relationship between the pink and white aesthetics. Methods Eighty (54 females, 26 males) fully dentate Caucasian participants between the ages of 20 and 25 years and 36 probands (23 females, 13 males) between the ages of 45 and 55 years were included in the present study. The CCL of the maxillary and mandibular canines, as well as the central incisors of the maxilla and mandible, were determined with a dental sliding caliper measuring from the middle margin of the gingiva at its deepest point to the incisal edge. The clinical investigation of the WAG was performed by inserting a periodontal probe into the gingival sulcus in the middle of the buccal surface to firstly measure the probing pocket depth. The distance between the gingival margin and mucogingival junction (MGJ) was then measured with a Beerendonk sliding caliper in the middle of the labial curvature, and the clinical WAG was determined by subtraction of the measured probing depth. For the statistical analysis, the Mann–Whitney U test, the Wilcoxon-Test, the Spearman’s rank correlation, and a two-factorial non-parametric analysis were used. Results There was no correlation between the CCL and the WAG in a healthy periodontium. Gender influenced the CCL, with men having significantly longer teeth than women in both maxilla (P ≤ 0.01) and mandible (P ≤ 0.05). Age did not influence the CCL significantly neither in the upper (P = 0.06) nor in the lower jaw (P = 0.33). Gender did not show to have a significant influence on the WAG of maxilla (P = 0.69) and mandible (P = 0.26). But differences in the WAG between young and old participants were observed in both upper (P ≤ 0.01) and lower jaw (P ≤ 0.05). Conclusion The present observational study demonstrated that the mean values of cohorts with mixed age groups and genders should not be considered when attempting to determine the ideal relationships between the pink and white aesthetics since the statistical analyses showed significant differences between different age groups and genders.

HEREDITARY GINGIVAL FIBROMATOSIS: CLINICAL CASES AND LITERATURE REVIEW

Gingival fibromatosis (GF) is characterized by a slow and progressive proliferation that can affect the marginal and attached gingiva, or the inter-dental papillae. This condition can be localized or generalized, with varying degrees of severity.GF may develop in susceptible individuals as a side effect of systemic medications or as idiopathic gingival fibromatosis. It may also be related to hereditary factors and occurs as a non-syndromic hereditary gingival fibromatosis or as a part of a syndrome.Our aim is to describe trought four cases of hereditary gingival fibromatosis and a literature review the clinical features,etiopathogenesis, histopathological characteristics and treatment of this condition.