One of the most challenging factors affecting impression quality and good marginal fit is the gingival retraction method, which aims to separate the gingiva from the tooth to expose the finishing line of the prepared ...One of the most challenging factors affecting impression quality and good marginal fit is the gingival retraction method, which aims to separate the gingiva from the tooth to expose the finishing line of the prepared tooth. Bleeding and contamination from the crevicular fluid may compete for space with the impression material within the sulcus, leading to indistinct preparations and a lack of detail at the margin. In addition, such procedures might damage the PDL and cause permanent recession. Flowable composite cable, as opposed to traditional retraction cords, offers the proper marginal seal and visibility during the impression record because of its lower viscosity, improved adaptability, and elastic properties. The aim of this report is to present a brand-new, innovative method for controlling gingival hemorrhage in addition to the gingival retraction in restorative and prosthodontic treatment by utilizing a flowable composite during the final impression record procedure. In these case reports, the flowable composite cord technique is used instead of traditional gingival cords to modify and refine the gingival tissue before taking the traditional final impression or digital scan. Two cases were done for patients undergoing fixed prosthodontics and veneer treatment within a 2-year follow-up period. In addition, the flowable composite cord was used as temporary restoration before the final prosthetic cementation or under the provisional crowns. As a result, clean and healthy gingival tissues render cementation of the final prosthesis quicker and easier to perform. The patients in both cases claimed that their prosthodontic treatments, which involved the application of a flowable composite cord to temporarily retraction the gingiva, had produced good outcomes at the yearlong follow-up. In conclusion, the flowable composite cord technique is found to be a useful tool to improve the quality of impressions in fixed prosthodontics by providing excellent access for impression material to record fine details of the finish line of the prepared tooth structure, and to alter the inflamed tissue into a healthy tissue.展开更多
Hereditary gingival fibromatosis(HGF)is a rare inherited condition with fibromatoid hyperplasia of the gingival tissue that exhibits great genetic heterogeneity.Five distinct loci related to non-syndromic HGF have bee...Hereditary gingival fibromatosis(HGF)is a rare inherited condition with fibromatoid hyperplasia of the gingival tissue that exhibits great genetic heterogeneity.Five distinct loci related to non-syndromic HGF have been identified;however,only two diseasecausing genes,SOS1 and REST,inducing HGF have been identified at two loci,GINGF1 and GINGF5,respectively.Here,based on a family pedigree with 26 members,including nine patients with HGF,we identified double heterozygous pathogenic mutations in the ZNF513(c.C748T,p.R250W)and KIF3C(c.G1229A,p.R410H)genes within the GINGF3 locus related to HGF.Functional studies demonstrated that the ZNF513 p.R250W and KIF3C p.R410H variants significantly increased the expression of ZNF513 and KIF3C in vitro and in vivo.ZNF513,a transcription factor,binds to KIF3C exon 1 and participates in the positive regulation of KIF3C expression in gingival fibroblasts.Furthermore,a knock-in mouse model confirmed that heterozygous or homozygous mutations within Zfp513(p.R250W)or Kif3c(p.R412H)alone do not led to clear phenotypes with gingival fibromatosis,whereas the double mutations led to gingival hyperplasia phenotypes.In addition,we found that ZNF513 binds to the SOS1 promoter and plays an important positive role in regulating the expression of SOS1.Moreover,the KIF3C p.R410H mutation could activate the PI3K and KCNQ1 potassium channels.ZNF513 combined with KIF3C regulates gingival fibroblast proliferation,migration,and fibrosis response via the PI3K/AKT/mTOR and Ras/Raf/MEK/ERK pathways.In summary,these results demonstrate ZNF513+KIF3C as an important genetic combination in HGF manifestation and suggest that ZNF513 mutation may be a major risk factor for HGF.展开更多
Three-dimensional collagen matrices of porcine origin are being used as substitutes for soft tissue grafts in periodontal plastic surgery in search of aesthetic and natural results. This in vitro study aimed to compar...Three-dimensional collagen matrices of porcine origin are being used as substitutes for soft tissue grafts in periodontal plastic surgery in search of aesthetic and natural results. This in vitro study aimed to compare Fibro-Gide® (GeistlichBiomaterials) and Mucoderm® (BotissBiomaterials) matrices during the initial phase of soft tissue formation. For this purpose, samples of 5 × 5 mm were obtained, and then human fibroblasts were plated on them. After 24, 48 and 72 h, cell viability was assessed using an MTT assay, and the secretion of type I collagen, MMP-2, TIMP-1 and TIMP-2 was analyzed by ELISA immunoassay. The control group (C) consisted of cells plated on polystyrene without the matrices. The morphology of the surfaces was also examined using scanning electron microscopy (SEM), as was the average roughness (Ra) of the samples by a profilometer. Topographic analysis revealed that roughness was significantly higher on Mucoderm® than on Fibro-Gide® (p 0.05). The synthesis of type I collagen, MMP-2 and TIMP-1 were significantly higher from cells plated on Fibro-Gide® than on Mucoderm®, in all time points (p ® than on Mucoderm® (p ® induced an increase in type I collagen, MMP-2 and TIMP-1 and TIMP-2.展开更多
Gingival hyperplasia or gingival overgrowth, which is a common trait of gingival disease, is characterized by an increase in the size of the gingiva. Gingival hyperplasia according to past reports has numerous etiolog...Gingival hyperplasia or gingival overgrowth, which is a common trait of gingival disease, is characterized by an increase in the size of the gingiva. Gingival hyperplasia according to past reports has numerous etiological factors one of which is pregnancy due to increased hormone levels. Although pregnancy does not directly cause gingival hyperplasia, it may catalyze local etiological factors. Objectives: To determine the frequency and clinical aspects of gingival hyperplasia during pregnancy. Methodology: We conducted a cross sectional descriptive study from November 2021 to June 2022 at the Yaoundé Gyneco-Obstetrics and Pediatrics Hospital. Data were collected using a pretested questionnaire and clinical assessments done using dental consultation kits. Data were analyzed with the International Business Machine Statistical Package for Social Sciences (IBM SPSS) version 21.0 software. Results: We recruited 231 eligible participants for our study. Of 231, 101 (43.7%) had gingival hyperplasia. Most of our study population were between 20 - 40 years old and gingival hyperplasia was most commonly found in the 3<sup>rd</sup> trimester (60.7%). We reported that 31.3% of our population had a plaque score 2 and only 7.8% had consulted a dentist during pregnancy. We also observed that 93.3% of our population manifested a mild/moderate form of the disease while 6.9% had a severe form. Our study showed that 72.3% and 27.3% had a localized and generalized form of the disease, respectively. Conclusion: We concluded that gingival hyperplasia is a common pathology in pregnant women. It is most found in the third trimester. It presents more commonly as a localized form, and degree of severity is mostly moderate.展开更多
Calcium channel blocker-induced gingival overgrowth (CCB-GO) is increasing in elderly patients who have been prescribed medication for hypertension for years. The purpose of the present study was to analyze the compre...Calcium channel blocker-induced gingival overgrowth (CCB-GO) is increasing in elderly patients who have been prescribed medication for hypertension for years. The purpose of the present study was to analyze the comprehensive protein expression levels of candidate biomarkers in gingival crevicular fluid (GCF) from CCB-GO patients. Eleven GO patients (10 males and one female, mean ± SD: age: 64.4 ± 14.0 years) who had been systemically prescribed CCBs, either amlodipine or nifedipine, for hypertension for at least 12 months were recruited. Before (baseline) and 4 weeks after initial periodontal treatments, subgingival plaque and GCF samples were taken from two sites per patient: sites affected by CCB-GO and chronic periodontitis. Measurement of clinical parameters and quantitative analysis of periodontopathic bacteria using real-time PCR were performed. Biomarkers/cytokines in GCF were examined using multiplex bead immunoassays. The Mann-Whitney U test was used to compare the collected data between groups. The correlations between pairs of biomarkers were assessed using the Spearman correlation relationship. Levels of two of the 14 biomarkers, interleukin (IL)-1β and transforming growth factor (TGF)- β, were significantly decreased in CCB-GO sites after initial periodontal therapy. The intragroup comparison at baseline showed that counts of Treponema denticola in the GO group were significantly higher than those in the chronic periodontitis group (P β and TGF-β in CCB-GO patients. These factors are involved in initiation and progression of GO as well as periodontitis.展开更多
The morphological characteristics of periodontal tissue and tooth tissue in gingival biotype are one of the indicators reflecting the individual differences of periodontal tissue in patients.Gingival biotypes of anter...The morphological characteristics of periodontal tissue and tooth tissue in gingival biotype are one of the indicators reflecting the individual differences of periodontal tissue in patients.Gingival biotypes of anterior teeth are often related to the prognosis of smile aesthetic treatment,which is one of the reference indexes for predicting the success rate of aesthetic treatment such as restoration,implant,periodontal,orthodontic and so on.Gingival biotypes have individual differences,so different gingival biotypes have different responses to different external stimuli.In the current clinical work,the correct evaluation of gingival biotype,especially the accurate measurement of gingival thickness,is the basis of reasonable choice of treatment and prognosis evaluation.展开更多
Gingival enlargement is one of the frequent features of gingival diseases. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. They can be categorized base...Gingival enlargement is one of the frequent features of gingival diseases. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Based on the existing knowledge and clinical experience, a differential diagnosis can be formulated. Subsequently, after detailed investigation, clinician makes a final diagnosis or diagnosis of exclusion. A perfect diagnosis is critically important, since the management of these lesions and prevention of their recurrence is completely dependent on it. Furthermore, in some cases where gingival enlargement could be the primary sign of potentially lethal systemic diseases, a correct diagnosis of these enlargements could prove life saving for the patient or at least initiate early treatment and improve the quality of life. The purpose of this review article is to highlight significant findings of different types of gingival enlargement which would help clinician to differentiate between them. A detailed decision tree is also designed for the practitioners, which will help them arrive at a diagnosis in a systematic manner. There still could be some lesions which may present in an unusual manner and make the diagnosis challenging. By knowing the existence of common and rare presentations of gingival enlargement, one can keep a broad view when formulating a differential diagnosis of localized(isolated, discrete, regional) or generalized gingival enlargement.展开更多
Drug-induced gingival overgrowth(DIGO) is recognized as a side effect of nifedipine(NIF);however, the underlying molecular mechanisms remain unknown. In this study, we found that overexpressed mi R-4651 inhibits cell ...Drug-induced gingival overgrowth(DIGO) is recognized as a side effect of nifedipine(NIF);however, the underlying molecular mechanisms remain unknown. In this study, we found that overexpressed mi R-4651 inhibits cell proliferation and induces G0/G1-phase arrest in gingival mesenchymal stem cells(GMSCs) with or without NIF treatment. Furthermore, sequential window acquisition of all theoretical mass spectra(SWATH-MS) analysis, bioinformatics analysis, and dual-luciferase report assay results confirmed that high-mobility group AT-hook 2(HMGA2) is the downstream target gene of mi R-4651. Overexpression of HMGA2 enhanced GMSC proliferation and accelerated the cell cycle with or without NIF treatment. The present study demonstrates that mi R-4651 inhibits the proliferation of GMSCs and arrests the cell cycle at the G0/G1 phase by upregulating cyclin D and CDK2 while downregulating cyclin E through inhibition of HMGA2 under NIF stimulation. These findings reveal a novel mechanism regulating DIGO progression and suggest the potential of mi R-4651 and HMGA2 as therapeutic targets.展开更多
Implant insertion is an alternative to classical treatment with bridges after tooth extraction or traumatic tooth loss in the anterior and premolar region of the upper and lower jaw. Nevertheless both types of prosthe...Implant insertion is an alternative to classical treatment with bridges after tooth extraction or traumatic tooth loss in the anterior and premolar region of the upper and lower jaw. Nevertheless both types of prosthetic treatment inhere major gingival aesthetic pitfalls by physiological vertical and horizontal resorption. Aim of the study was to investigate if the immediate insertion of root analogue single-stage implants and prosthetic treatment could prevent gingival recessions and bone resorption thus keeping the natural gingival aesthetics untouched. Between 2003 and 2006, 348 root analogue Q1-Implants (TRINON Karlsruhe GmbH/Germany) were inserted in 342 patients’s premolar and molar regions immediately after tooth extraction or traumatic tooth loss and treated with provisional resin crowns. The observation period with recurring 6-month clinical and radiographic check-ups was a minimum of 5 years. Of 348 inserted implants 4 (1.15%) were lost resulting in an overall success rate of 98.85%. In the first 12 weeks after surgery a mean recession of the buccal gingival margin of 0.2 mm (SD 0.34) could be detected, after final prosthetic treatment an overall mean recession of 0.2 mm (SD 0.13) within the survey period. Immediate implant insertion of root analogue single stage implants and immediate prosthetic treatment with provisional resin crowns after minimal invasive tooth extraction seems to be appropriate to prevent bone resorptions of the buccal alveolar crest and the recessions of the gingiva and papillae and thus suggests to be the preferable treatment to keep the natural gingival and papillary aesthetics untouched preventing further traumatic surgical gingival reconstructions.展开更多
The most significant factor for the success in soft tissue grafts is the synergistic relation between vascular configuration and involved tissues. In the soft tissue graft procedures, site specific donor tissue is ass...The most significant factor for the success in soft tissue grafts is the synergistic relation between vascular configuration and involved tissues. In the soft tissue graft procedures, site specific donor tissue is assumed to have improved potential for function and aesthetic survive at recipient sites. On a clinical level, using site specific gingival unit graft that placed on traditionally prepared recipient site, results in predictable root coverage. In this case report the clinical effectiveness of gingival unit transfer(GUT) technique performed on Miller Ⅲ recession was presented and a similar recession case treated with free gingival graft(FGG) technique for comparison. Probing depth, recession depth, keratinized tissue width and clinical attachment level clinical parameters were measured at baseline and postoperative 8 mo. Percentage of defect coverage was evaluated at postoperative 8 mo. Creeping attachment was assessed at postoperative 1, 3, 6 and 8 mo. The GUT revealed better defect coverage and creeping attachment results than the FGG in the treatment of Miller Ⅲ defects.展开更多
Drug-induced gingival overgrowth(DIGO)is a pathological growth of gingival tissue,primarily associated with calcium channel blockers and immunosuppressants.Consequently,it is mainly seen in cardiovascular and transpla...Drug-induced gingival overgrowth(DIGO)is a pathological growth of gingival tissue,primarily associated with calcium channel blockers and immunosuppressants.Consequently,it is mainly seen in cardiovascular and transplanted patients.Nifedipine remains the main calcium channel blocker related to the development of this unpleasant side-effect.As for immunosuppress-ants,cyclosporin is the leading causative agent,whereas other drugs from this druggroup,including tacrolimus,have better safety profiles.Accumulated collagen with inflammatory infiltrates is the histological hallmark of this condition.Several factors are involved in the pathogenesis and can increase the risk,such as male gender,younger age,pre-existing periodontal inflammation,and concomitant use of other DIGO-inducing medications.Patients with DIGO may experience severe discomfort,trouble with speech and mastication,pain,and teeth loss,aside from cosmetic implications.Furthermore,these patients also have an increased risk for cardiovascular diseases.The interdisciplinary approach and cooperation with dental care experts are necessary for patient management.Treatment includes discontinuing the drug and switching to one with a better profile,improving oral hygiene,and surgical removal of enlarged tissue.Recognizing the potential of commonly used medications to cause DIGO and its effect on patients'health is necessary for early detection and adequate management of this complication.展开更多
Periodontitis, is an infectious ailment of multifactorial origin, that brings about destruction of bone and surrounding tissues. There are various oral pathogens that may be responsible for the destruction. The host e...Periodontitis, is an infectious ailment of multifactorial origin, that brings about destruction of bone and surrounding tissues. There are various oral pathogens that may be responsible for the destruction. The host encounters these microbial invasions and their products by the production and release of inflammatory mediators from the cells within the body. Glutathione-S-transferase (GST) are a group of enzymes that utilize glutathione in conditions resulting in oxidative stress. These enzymes play a key role in the detoxifycation of such substance. It aids in preventing damage to important cellular components caused by release of free reactive oxygen species. Ceruloplasmin is a ferroxidase enzyme. It plays a role as an anti-inflammatory agent, by its ability to scavenge free radicals within the body. The present study was targeted at evaluating the levels of Glutathione-S-Transferase (GST) and Ceruloplasmin as diagnostic markers for patients with chronic periodontitis in gingival crevicular fluid (GCF) and the gingival tissues. Thirty patients were divided into two groups. Experimental group comprising of 15 subjects with chronic perio- dontitis and the control group was composed of 15 healthy individuals. Highly significant changes in GST between the diseased and normal patients (P = 0.001) were detected. There was a decrease in GST level in both gingival tissue & GCF in diseased patients when compared to the control patients. The ceruloplasmin levels in GCF and gingival tissues showed no difference between the control and diseased group. Hence,these results indicate a relationship suggesting that GST produced during chronic inflammation could be used as biomarker that indicate periodontal disease .展开更多
The objective of the study was to describe the prevalence and severity of gingival overgrowth (GO) among patients on anti-hypertensive pharmacotherapy at a Nairobi hospital in Kenya and to evaluate the relationship be...The objective of the study was to describe the prevalence and severity of gingival overgrowth (GO) among patients on anti-hypertensive pharmacotherapy at a Nairobi hospital in Kenya and to evaluate the relationship between GO and associated risk factors among these patients. The study design was a cross-sectional survey using a consecutive convenient sampling method. All the patients were examined for gingival enlargement by the method described by Seymour, et al. and modified by the authors to allow for measurement in millimetres. Gingival inflammatory status and plaque scores were also evaluated. The results showed that of the 164 hypertensive patients recruited, 20.7% had gingival overgrowth. Slightly over half (56.1%) of these patients were on calcium channel blockers (CCB). Patients on CCB had a higher prevalence (31.5%) of GO compared to those on non-CCB (7%). This difference was statistically significant (Yates χ2 = 13.39: 1 df: P = 0.000) with an odds ratio of 6.17 (95% CI 0.21 - 19.45). There was no statistically significant association between gender, drug dosage, plaque levels and gingivitis with GO. In conclusion, usage of CCB pharmacotherapy showed a significant association with GO.展开更多
Skin aging shows an imbalance between synthesis and degradation of the extracellular matrix. The overproduction of degradative enzymes (MMPs) during the chronology- and photo-induced aging leads to a degradation of th...Skin aging shows an imbalance between synthesis and degradation of the extracellular matrix. The overproduction of degradative enzymes (MMPs) during the chronology- and photo-induced aging leads to a degradation of the elastic and collagen networks. In a model of collagen and elastin destruction, we showed that the gingival fibroblast was able to preserve these macromolecules by inhibiting the overproduction of metalloproteinases by overproduction of TIMP-1 and modulation of the inflammatory cytokines activity. The objective of this study is to evaluate the effect of the gingival fibroblasts on human skin. The results in vitro and ex vivo show that the gingival fibroblast protects the skin collagen and elastic network by the inhibition of MMPs which leads to an overproduction of the TIMP-1. Moreover, the gingival fibroblast modulates the activity of some enzymes responsible for the inflammation;they inhibit the IL-1β and stimulate the production of TGF-β1. In vivo studies with a duration of six months and 50 women with pronounced wrinkles show that the culture supernatant of gingival fibroblasts diluted to 5% leads to a statistically significant decrease in the number and length of wrinkles.展开更多
Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for...Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for more than ten years,in the buccal area of the anterior left mandible.According to the clinical features and the radiological diagnosis of odontogenic keratocyst,a conservative surgery with enucleation and curettage was performed.Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma.After 12-month of follow-up,no evidence of recurrence was found.Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.展开更多
AIM: To study the comparison in terms of root coverage the effect of gingival massaging using an ayurvedic product and semilunar coronally repositioned flap(SCRF) to assess the treatment outcomes in the management of ...AIM: To study the comparison in terms of root coverage the effect of gingival massaging using an ayurvedic product and semilunar coronally repositioned flap(SCRF) to assess the treatment outcomes in the management of Miller's class Ⅰ gingival recessions over a-6mo period. METHODS: The present study comprised of total of 90 sites of Miller's class-Ⅰ gingival recessions in the maxillary anteriors, the sites were divided into three groups each comprising 30 sites, Group Ⅰ-were treated by massaging using a Placebo(Ghee) Group Ⅱ-were treated by massaging using an ayurvedic product(irimedadi taila). Group Ⅲ-were treated by SCRF. Clinical parameters assessed included recession height, recession width, probing pocket depth, width of attached gingiva, clinical attachment level and thickness of keratinized tissue. Clinical recordings were performed at baseline and 6 mo later. The results were analyzed to determine improvements in the clinical parameters. The comparison was done using Wilcoxon signed rank test. The overall differences in the clinical improvements between the three groups was done using Kruskal-Wallis test. The probability value(P-value) of less than 0.01 was considered as statistically significant.RESULTS: Non-surgical periodontal therapy and gingival massaging improves facial gingival recessions and prevents further progression of mucogingival defects. Root coverage was achieved in both the experimental groups. The SCRF group proved to be superior in terms of all the clinical parameters.CONCLUSION: Root coverage is significantly better with semilunar coronally repositioned flap compared with the gingival massaging technique in the treatment of shallow maxillary Miller class Ⅰ gingival recession defects.展开更多
The present study demonstrates that the expression of c-Jun and c-Fos are elevated in gingival fibroblast cells treated with angiotensin Ⅱ and cyclosporine.The healthy human gingival tissues were collected and gingiv...The present study demonstrates that the expression of c-Jun and c-Fos are elevated in gingival fibroblast cells treated with angiotensin Ⅱ and cyclosporine.The healthy human gingival tissues were collected and gingival fibroblasts were isolated and cultured.We used RT-PCR and Western blot analysis to identify the expression of c-Jun and c-Fos in cyclosporine and angiotensin II treated human gingival fibroblast cells.We found that angiotensin Ⅱ in combination with cyclosporine induces c-Jun and c-Fos expressions significantly;however,the angiotensin Ⅱ antagonist losartan inhibits the expression of c-Jun and c-Fos(p<0.01).The data suggest that angiotensin Ⅱ in combination with cyclosporine modulates the expression of c-Jun and c-Fos in human gingival fibroblast cells.展开更多
BACKGROUND Cyclosporine is an immunosuppressive agent used effectively for treatment of a rare haematological disorder known as medullary aplasia.This drug prevents several side effects,including gingival enlargement(...BACKGROUND Cyclosporine is an immunosuppressive agent used effectively for treatment of a rare haematological disorder known as medullary aplasia.This drug prevents several side effects,including gingival enlargement(GE)which compromises aesthetics,phonetics and chewing,and also predisposes patients to periodontitis.CASE SUMMARY This clinical case reports a 41-year-old woman who presented with cyclosporineinduced GE with underlying periodontitis and medullary aplasia.The management of the disease was approached through multidisciplinary strategy which allowed for accurate diagnosis and a strategic treatment based on the systemic condition and severity of oral pathology.The diagnosis was confirmed through histopathological analysis.The treatment was carried out in phases:Initial(oral hygiene motivation,mechanical supragingival plaque control,and non-surgical therapy);systemic treatment,corrective treatment,and maintenance.CONCLUSION Multidisciplinary management of cyclosporine-induced GE and medullary aplasia allows for correct diagnosis and effective treatment of this pathological expression through a phased therapeutic approach.展开更多
We report a case of syndromic gingival fibromatosis with notable ocular lesions,bilateral congenital cataracts,esotropia,and high myopia of a 21-year-old male patient from China.The patient was diagnosed with gingival...We report a case of syndromic gingival fibromatosis with notable ocular lesions,bilateral congenital cataracts,esotropia,and high myopia of a 21-year-old male patient from China.The patient was diagnosed with gingival fibromatosis based on his massive gingival overgrowth and histological findings that were consistent with gingival fibromatosis through a gingival biopsy.Lens opacity features were presented and phacoemulsificaion with intraocular lens(IOL)implantation was performed to manage the cataracts in both eyes.Transmission electronic microscopy was used to investigate the ultrastructure of the removed lens tissue.We also review the literature on gingival fibromatosis and briefly summarize the ocular manifestations of this rare disease.展开更多
文摘One of the most challenging factors affecting impression quality and good marginal fit is the gingival retraction method, which aims to separate the gingiva from the tooth to expose the finishing line of the prepared tooth. Bleeding and contamination from the crevicular fluid may compete for space with the impression material within the sulcus, leading to indistinct preparations and a lack of detail at the margin. In addition, such procedures might damage the PDL and cause permanent recession. Flowable composite cable, as opposed to traditional retraction cords, offers the proper marginal seal and visibility during the impression record because of its lower viscosity, improved adaptability, and elastic properties. The aim of this report is to present a brand-new, innovative method for controlling gingival hemorrhage in addition to the gingival retraction in restorative and prosthodontic treatment by utilizing a flowable composite during the final impression record procedure. In these case reports, the flowable composite cord technique is used instead of traditional gingival cords to modify and refine the gingival tissue before taking the traditional final impression or digital scan. Two cases were done for patients undergoing fixed prosthodontics and veneer treatment within a 2-year follow-up period. In addition, the flowable composite cord was used as temporary restoration before the final prosthetic cementation or under the provisional crowns. As a result, clean and healthy gingival tissues render cementation of the final prosthesis quicker and easier to perform. The patients in both cases claimed that their prosthodontic treatments, which involved the application of a flowable composite cord to temporarily retraction the gingiva, had produced good outcomes at the yearlong follow-up. In conclusion, the flowable composite cord technique is found to be a useful tool to improve the quality of impressions in fixed prosthodontics by providing excellent access for impression material to record fine details of the finish line of the prepared tooth structure, and to alter the inflamed tissue into a healthy tissue.
基金supported by National Natural Science Foundation of China(82302078,32170617,31970558,82170920)National Key R&D Program of China(2021YFC1005301,2022YFC2703303)+1 种基金Natural Science Foundation of Guangdong Province of China(2022A1515012621)Grant for joint research projects from Shenzhen Hospital,Southern Medical University(22H3AUN04).
文摘Hereditary gingival fibromatosis(HGF)is a rare inherited condition with fibromatoid hyperplasia of the gingival tissue that exhibits great genetic heterogeneity.Five distinct loci related to non-syndromic HGF have been identified;however,only two diseasecausing genes,SOS1 and REST,inducing HGF have been identified at two loci,GINGF1 and GINGF5,respectively.Here,based on a family pedigree with 26 members,including nine patients with HGF,we identified double heterozygous pathogenic mutations in the ZNF513(c.C748T,p.R250W)and KIF3C(c.G1229A,p.R410H)genes within the GINGF3 locus related to HGF.Functional studies demonstrated that the ZNF513 p.R250W and KIF3C p.R410H variants significantly increased the expression of ZNF513 and KIF3C in vitro and in vivo.ZNF513,a transcription factor,binds to KIF3C exon 1 and participates in the positive regulation of KIF3C expression in gingival fibroblasts.Furthermore,a knock-in mouse model confirmed that heterozygous or homozygous mutations within Zfp513(p.R250W)or Kif3c(p.R412H)alone do not led to clear phenotypes with gingival fibromatosis,whereas the double mutations led to gingival hyperplasia phenotypes.In addition,we found that ZNF513 binds to the SOS1 promoter and plays an important positive role in regulating the expression of SOS1.Moreover,the KIF3C p.R410H mutation could activate the PI3K and KCNQ1 potassium channels.ZNF513 combined with KIF3C regulates gingival fibroblast proliferation,migration,and fibrosis response via the PI3K/AKT/mTOR and Ras/Raf/MEK/ERK pathways.In summary,these results demonstrate ZNF513+KIF3C as an important genetic combination in HGF manifestation and suggest that ZNF513 mutation may be a major risk factor for HGF.
文摘Three-dimensional collagen matrices of porcine origin are being used as substitutes for soft tissue grafts in periodontal plastic surgery in search of aesthetic and natural results. This in vitro study aimed to compare Fibro-Gide® (GeistlichBiomaterials) and Mucoderm® (BotissBiomaterials) matrices during the initial phase of soft tissue formation. For this purpose, samples of 5 × 5 mm were obtained, and then human fibroblasts were plated on them. After 24, 48 and 72 h, cell viability was assessed using an MTT assay, and the secretion of type I collagen, MMP-2, TIMP-1 and TIMP-2 was analyzed by ELISA immunoassay. The control group (C) consisted of cells plated on polystyrene without the matrices. The morphology of the surfaces was also examined using scanning electron microscopy (SEM), as was the average roughness (Ra) of the samples by a profilometer. Topographic analysis revealed that roughness was significantly higher on Mucoderm® than on Fibro-Gide® (p 0.05). The synthesis of type I collagen, MMP-2 and TIMP-1 were significantly higher from cells plated on Fibro-Gide® than on Mucoderm®, in all time points (p ® than on Mucoderm® (p ® induced an increase in type I collagen, MMP-2 and TIMP-1 and TIMP-2.
文摘Gingival hyperplasia or gingival overgrowth, which is a common trait of gingival disease, is characterized by an increase in the size of the gingiva. Gingival hyperplasia according to past reports has numerous etiological factors one of which is pregnancy due to increased hormone levels. Although pregnancy does not directly cause gingival hyperplasia, it may catalyze local etiological factors. Objectives: To determine the frequency and clinical aspects of gingival hyperplasia during pregnancy. Methodology: We conducted a cross sectional descriptive study from November 2021 to June 2022 at the Yaoundé Gyneco-Obstetrics and Pediatrics Hospital. Data were collected using a pretested questionnaire and clinical assessments done using dental consultation kits. Data were analyzed with the International Business Machine Statistical Package for Social Sciences (IBM SPSS) version 21.0 software. Results: We recruited 231 eligible participants for our study. Of 231, 101 (43.7%) had gingival hyperplasia. Most of our study population were between 20 - 40 years old and gingival hyperplasia was most commonly found in the 3<sup>rd</sup> trimester (60.7%). We reported that 31.3% of our population had a plaque score 2 and only 7.8% had consulted a dentist during pregnancy. We also observed that 93.3% of our population manifested a mild/moderate form of the disease while 6.9% had a severe form. Our study showed that 72.3% and 27.3% had a localized and generalized form of the disease, respectively. Conclusion: We concluded that gingival hyperplasia is a common pathology in pregnant women. It is most found in the third trimester. It presents more commonly as a localized form, and degree of severity is mostly moderate.
文摘Calcium channel blocker-induced gingival overgrowth (CCB-GO) is increasing in elderly patients who have been prescribed medication for hypertension for years. The purpose of the present study was to analyze the comprehensive protein expression levels of candidate biomarkers in gingival crevicular fluid (GCF) from CCB-GO patients. Eleven GO patients (10 males and one female, mean ± SD: age: 64.4 ± 14.0 years) who had been systemically prescribed CCBs, either amlodipine or nifedipine, for hypertension for at least 12 months were recruited. Before (baseline) and 4 weeks after initial periodontal treatments, subgingival plaque and GCF samples were taken from two sites per patient: sites affected by CCB-GO and chronic periodontitis. Measurement of clinical parameters and quantitative analysis of periodontopathic bacteria using real-time PCR were performed. Biomarkers/cytokines in GCF were examined using multiplex bead immunoassays. The Mann-Whitney U test was used to compare the collected data between groups. The correlations between pairs of biomarkers were assessed using the Spearman correlation relationship. Levels of two of the 14 biomarkers, interleukin (IL)-1β and transforming growth factor (TGF)- β, were significantly decreased in CCB-GO sites after initial periodontal therapy. The intragroup comparison at baseline showed that counts of Treponema denticola in the GO group were significantly higher than those in the chronic periodontitis group (P β and TGF-β in CCB-GO patients. These factors are involved in initiation and progression of GO as well as periodontitis.
文摘The morphological characteristics of periodontal tissue and tooth tissue in gingival biotype are one of the indicators reflecting the individual differences of periodontal tissue in patients.Gingival biotypes of anterior teeth are often related to the prognosis of smile aesthetic treatment,which is one of the reference indexes for predicting the success rate of aesthetic treatment such as restoration,implant,periodontal,orthodontic and so on.Gingival biotypes have individual differences,so different gingival biotypes have different responses to different external stimuli.In the current clinical work,the correct evaluation of gingival biotype,especially the accurate measurement of gingival thickness,is the basis of reasonable choice of treatment and prognosis evaluation.
文摘Gingival enlargement is one of the frequent features of gingival diseases. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Based on the existing knowledge and clinical experience, a differential diagnosis can be formulated. Subsequently, after detailed investigation, clinician makes a final diagnosis or diagnosis of exclusion. A perfect diagnosis is critically important, since the management of these lesions and prevention of their recurrence is completely dependent on it. Furthermore, in some cases where gingival enlargement could be the primary sign of potentially lethal systemic diseases, a correct diagnosis of these enlargements could prove life saving for the patient or at least initiate early treatment and improve the quality of life. The purpose of this review article is to highlight significant findings of different types of gingival enlargement which would help clinician to differentiate between them. A detailed decision tree is also designed for the practitioners, which will help them arrive at a diagnosis in a systematic manner. There still could be some lesions which may present in an unusual manner and make the diagnosis challenging. By knowing the existence of common and rare presentations of gingival enlargement, one can keep a broad view when formulating a differential diagnosis of localized(isolated, discrete, regional) or generalized gingival enlargement.
基金supported by grants from the National Natural Science Foundation of China(81625005 to Z.P.F.)the Program for“Hundred-Thousand-Ten thousand”Talents in Beijing(2018A16 to Z.P.F.)。
文摘Drug-induced gingival overgrowth(DIGO) is recognized as a side effect of nifedipine(NIF);however, the underlying molecular mechanisms remain unknown. In this study, we found that overexpressed mi R-4651 inhibits cell proliferation and induces G0/G1-phase arrest in gingival mesenchymal stem cells(GMSCs) with or without NIF treatment. Furthermore, sequential window acquisition of all theoretical mass spectra(SWATH-MS) analysis, bioinformatics analysis, and dual-luciferase report assay results confirmed that high-mobility group AT-hook 2(HMGA2) is the downstream target gene of mi R-4651. Overexpression of HMGA2 enhanced GMSC proliferation and accelerated the cell cycle with or without NIF treatment. The present study demonstrates that mi R-4651 inhibits the proliferation of GMSCs and arrests the cell cycle at the G0/G1 phase by upregulating cyclin D and CDK2 while downregulating cyclin E through inhibition of HMGA2 under NIF stimulation. These findings reveal a novel mechanism regulating DIGO progression and suggest the potential of mi R-4651 and HMGA2 as therapeutic targets.
文摘Implant insertion is an alternative to classical treatment with bridges after tooth extraction or traumatic tooth loss in the anterior and premolar region of the upper and lower jaw. Nevertheless both types of prosthetic treatment inhere major gingival aesthetic pitfalls by physiological vertical and horizontal resorption. Aim of the study was to investigate if the immediate insertion of root analogue single-stage implants and prosthetic treatment could prevent gingival recessions and bone resorption thus keeping the natural gingival aesthetics untouched. Between 2003 and 2006, 348 root analogue Q1-Implants (TRINON Karlsruhe GmbH/Germany) were inserted in 342 patients’s premolar and molar regions immediately after tooth extraction or traumatic tooth loss and treated with provisional resin crowns. The observation period with recurring 6-month clinical and radiographic check-ups was a minimum of 5 years. Of 348 inserted implants 4 (1.15%) were lost resulting in an overall success rate of 98.85%. In the first 12 weeks after surgery a mean recession of the buccal gingival margin of 0.2 mm (SD 0.34) could be detected, after final prosthetic treatment an overall mean recession of 0.2 mm (SD 0.13) within the survey period. Immediate implant insertion of root analogue single stage implants and immediate prosthetic treatment with provisional resin crowns after minimal invasive tooth extraction seems to be appropriate to prevent bone resorptions of the buccal alveolar crest and the recessions of the gingiva and papillae and thus suggests to be the preferable treatment to keep the natural gingival and papillary aesthetics untouched preventing further traumatic surgical gingival reconstructions.
文摘The most significant factor for the success in soft tissue grafts is the synergistic relation between vascular configuration and involved tissues. In the soft tissue graft procedures, site specific donor tissue is assumed to have improved potential for function and aesthetic survive at recipient sites. On a clinical level, using site specific gingival unit graft that placed on traditionally prepared recipient site, results in predictable root coverage. In this case report the clinical effectiveness of gingival unit transfer(GUT) technique performed on Miller Ⅲ recession was presented and a similar recession case treated with free gingival graft(FGG) technique for comparison. Probing depth, recession depth, keratinized tissue width and clinical attachment level clinical parameters were measured at baseline and postoperative 8 mo. Percentage of defect coverage was evaluated at postoperative 8 mo. Creeping attachment was assessed at postoperative 1, 3, 6 and 8 mo. The GUT revealed better defect coverage and creeping attachment results than the FGG in the treatment of Miller Ⅲ defects.
文摘Drug-induced gingival overgrowth(DIGO)is a pathological growth of gingival tissue,primarily associated with calcium channel blockers and immunosuppressants.Consequently,it is mainly seen in cardiovascular and transplanted patients.Nifedipine remains the main calcium channel blocker related to the development of this unpleasant side-effect.As for immunosuppress-ants,cyclosporin is the leading causative agent,whereas other drugs from this druggroup,including tacrolimus,have better safety profiles.Accumulated collagen with inflammatory infiltrates is the histological hallmark of this condition.Several factors are involved in the pathogenesis and can increase the risk,such as male gender,younger age,pre-existing periodontal inflammation,and concomitant use of other DIGO-inducing medications.Patients with DIGO may experience severe discomfort,trouble with speech and mastication,pain,and teeth loss,aside from cosmetic implications.Furthermore,these patients also have an increased risk for cardiovascular diseases.The interdisciplinary approach and cooperation with dental care experts are necessary for patient management.Treatment includes discontinuing the drug and switching to one with a better profile,improving oral hygiene,and surgical removal of enlarged tissue.Recognizing the potential of commonly used medications to cause DIGO and its effect on patients'health is necessary for early detection and adequate management of this complication.
文摘Periodontitis, is an infectious ailment of multifactorial origin, that brings about destruction of bone and surrounding tissues. There are various oral pathogens that may be responsible for the destruction. The host encounters these microbial invasions and their products by the production and release of inflammatory mediators from the cells within the body. Glutathione-S-transferase (GST) are a group of enzymes that utilize glutathione in conditions resulting in oxidative stress. These enzymes play a key role in the detoxifycation of such substance. It aids in preventing damage to important cellular components caused by release of free reactive oxygen species. Ceruloplasmin is a ferroxidase enzyme. It plays a role as an anti-inflammatory agent, by its ability to scavenge free radicals within the body. The present study was targeted at evaluating the levels of Glutathione-S-Transferase (GST) and Ceruloplasmin as diagnostic markers for patients with chronic periodontitis in gingival crevicular fluid (GCF) and the gingival tissues. Thirty patients were divided into two groups. Experimental group comprising of 15 subjects with chronic perio- dontitis and the control group was composed of 15 healthy individuals. Highly significant changes in GST between the diseased and normal patients (P = 0.001) were detected. There was a decrease in GST level in both gingival tissue & GCF in diseased patients when compared to the control patients. The ceruloplasmin levels in GCF and gingival tissues showed no difference between the control and diseased group. Hence,these results indicate a relationship suggesting that GST produced during chronic inflammation could be used as biomarker that indicate periodontal disease .
文摘The objective of the study was to describe the prevalence and severity of gingival overgrowth (GO) among patients on anti-hypertensive pharmacotherapy at a Nairobi hospital in Kenya and to evaluate the relationship between GO and associated risk factors among these patients. The study design was a cross-sectional survey using a consecutive convenient sampling method. All the patients were examined for gingival enlargement by the method described by Seymour, et al. and modified by the authors to allow for measurement in millimetres. Gingival inflammatory status and plaque scores were also evaluated. The results showed that of the 164 hypertensive patients recruited, 20.7% had gingival overgrowth. Slightly over half (56.1%) of these patients were on calcium channel blockers (CCB). Patients on CCB had a higher prevalence (31.5%) of GO compared to those on non-CCB (7%). This difference was statistically significant (Yates χ2 = 13.39: 1 df: P = 0.000) with an odds ratio of 6.17 (95% CI 0.21 - 19.45). There was no statistically significant association between gender, drug dosage, plaque levels and gingivitis with GO. In conclusion, usage of CCB pharmacotherapy showed a significant association with GO.
文摘Skin aging shows an imbalance between synthesis and degradation of the extracellular matrix. The overproduction of degradative enzymes (MMPs) during the chronology- and photo-induced aging leads to a degradation of the elastic and collagen networks. In a model of collagen and elastin destruction, we showed that the gingival fibroblast was able to preserve these macromolecules by inhibiting the overproduction of metalloproteinases by overproduction of TIMP-1 and modulation of the inflammatory cytokines activity. The objective of this study is to evaluate the effect of the gingival fibroblasts on human skin. The results in vitro and ex vivo show that the gingival fibroblast protects the skin collagen and elastic network by the inhibition of MMPs which leads to an overproduction of the TIMP-1. Moreover, the gingival fibroblast modulates the activity of some enzymes responsible for the inflammation;they inhibit the IL-1β and stimulate the production of TGF-β1. In vivo studies with a duration of six months and 50 women with pronounced wrinkles show that the culture supernatant of gingival fibroblasts diluted to 5% leads to a statistically significant decrease in the number and length of wrinkles.
文摘Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for more than ten years,in the buccal area of the anterior left mandible.According to the clinical features and the radiological diagnosis of odontogenic keratocyst,a conservative surgery with enucleation and curettage was performed.Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma.After 12-month of follow-up,no evidence of recurrence was found.Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.
文摘AIM: To study the comparison in terms of root coverage the effect of gingival massaging using an ayurvedic product and semilunar coronally repositioned flap(SCRF) to assess the treatment outcomes in the management of Miller's class Ⅰ gingival recessions over a-6mo period. METHODS: The present study comprised of total of 90 sites of Miller's class-Ⅰ gingival recessions in the maxillary anteriors, the sites were divided into three groups each comprising 30 sites, Group Ⅰ-were treated by massaging using a Placebo(Ghee) Group Ⅱ-were treated by massaging using an ayurvedic product(irimedadi taila). Group Ⅲ-were treated by SCRF. Clinical parameters assessed included recession height, recession width, probing pocket depth, width of attached gingiva, clinical attachment level and thickness of keratinized tissue. Clinical recordings were performed at baseline and 6 mo later. The results were analyzed to determine improvements in the clinical parameters. The comparison was done using Wilcoxon signed rank test. The overall differences in the clinical improvements between the three groups was done using Kruskal-Wallis test. The probability value(P-value) of less than 0.01 was considered as statistically significant.RESULTS: Non-surgical periodontal therapy and gingival massaging improves facial gingival recessions and prevents further progression of mucogingival defects. Root coverage was achieved in both the experimental groups. The SCRF group proved to be superior in terms of all the clinical parameters.CONCLUSION: Root coverage is significantly better with semilunar coronally repositioned flap compared with the gingival massaging technique in the treatment of shallow maxillary Miller class Ⅰ gingival recession defects.
文摘The present study demonstrates that the expression of c-Jun and c-Fos are elevated in gingival fibroblast cells treated with angiotensin Ⅱ and cyclosporine.The healthy human gingival tissues were collected and gingival fibroblasts were isolated and cultured.We used RT-PCR and Western blot analysis to identify the expression of c-Jun and c-Fos in cyclosporine and angiotensin II treated human gingival fibroblast cells.We found that angiotensin Ⅱ in combination with cyclosporine induces c-Jun and c-Fos expressions significantly;however,the angiotensin Ⅱ antagonist losartan inhibits the expression of c-Jun and c-Fos(p<0.01).The data suggest that angiotensin Ⅱ in combination with cyclosporine modulates the expression of c-Jun and c-Fos in human gingival fibroblast cells.
文摘BACKGROUND Cyclosporine is an immunosuppressive agent used effectively for treatment of a rare haematological disorder known as medullary aplasia.This drug prevents several side effects,including gingival enlargement(GE)which compromises aesthetics,phonetics and chewing,and also predisposes patients to periodontitis.CASE SUMMARY This clinical case reports a 41-year-old woman who presented with cyclosporineinduced GE with underlying periodontitis and medullary aplasia.The management of the disease was approached through multidisciplinary strategy which allowed for accurate diagnosis and a strategic treatment based on the systemic condition and severity of oral pathology.The diagnosis was confirmed through histopathological analysis.The treatment was carried out in phases:Initial(oral hygiene motivation,mechanical supragingival plaque control,and non-surgical therapy);systemic treatment,corrective treatment,and maintenance.CONCLUSION Multidisciplinary management of cyclosporine-induced GE and medullary aplasia allows for correct diagnosis and effective treatment of this pathological expression through a phased therapeutic approach.
基金Supported by the Zhejiang Medical Science Research Foundation of China(No.2009A108)
文摘We report a case of syndromic gingival fibromatosis with notable ocular lesions,bilateral congenital cataracts,esotropia,and high myopia of a 21-year-old male patient from China.The patient was diagnosed with gingival fibromatosis based on his massive gingival overgrowth and histological findings that were consistent with gingival fibromatosis through a gingival biopsy.Lens opacity features were presented and phacoemulsificaion with intraocular lens(IOL)implantation was performed to manage the cataracts in both eyes.Transmission electronic microscopy was used to investigate the ultrastructure of the removed lens tissue.We also review the literature on gingival fibromatosis and briefly summarize the ocular manifestations of this rare disease.
