An alternative maneuver to treat gingival recession

This article reports a clinical case in which was applied autologous bone graft associated with subepithelial connective tis- sue graft, harvested by gingivectomy procedure with technical modifications to increase gingival graft extension, also to be used as guided tissue regeneration, to treat a single gingival recession. After 1 year and 2 months of follow-up, the cover- age of the recession was 4.0 mm, which corresponded to the gain of attached keratinized gingival tissue. An increase in the gingival tissue thickness was observed, without significant probing depth. The procedures applied to treat this case may be biologically and clinically useful to treat gingival recession.

Occlusal trauma can not be compared to orthodontic movement or Occlusal trauma in orthodontic practice and V-shaped recession

The mechanisms of tissue changes induced by occlusal trauma are in no way comparable to orthodontic movement. In both events the primary cause is of a physical nature, but the forces delivered to dental tissues exhibit completely different characteristics in terms of intensity, duration, direction, distribution, frequency and form of uptake by periodontal tissues. Consequently, the tissue effects induced by occlusal trauma are different from orthodontic movement. It can be argued that occlusal trauma generates a pathological tissue injury in an attempt to adapt to new excessive functional demands. Orthodontic movement, in turn,performs physiological periodontal bone remodeling to change the position of the teeth in a well-planned manner, eventually restoring normalcy.

Genome-wide DNA profiling of marginal zone lymphomas identifies subtype-specific lesions with an impact on the clinical outcome

Marginal zone B-cell lymphomas (MZLs) have been divided into 3 distinct subtypes (extranodal MZLs of mucosa-associated lymphoid tissue [MALT] type, nodal MZLs, and splenic MZLs). Nevertheless, the relationship between the subtypes is still unclear. We performed a comprehensive analysis of genomic DNA copy number changes in a very large series of MZL cases with the aim of addressing this question. Samples from 218 MZL patients (25 nodal, 57 MALT, 134 splenic, and 2 not better specified MZLs) were analyzed with the Affymetrix Human Mapping 250K SNP arrays, and the data combined with matched gene expression in 33 of 218 cases. MALT lymphoma presented significantly more frequently gains at 3p, 6p, 18p, and del(6q23) (TNFAIP3/A20), whereas splenic MZLs was associated with del(7q31), del(8p). Nodal MZLs did not show statistically significant differences compared with MALT lymphoma while lacking the splenic MZLs-related 7q losses. Gains of 3q and 18q were common to all 3 subtypes. del(8p) was often present together with del(17p) (TP53). Although del(17p) did not determine a worse outcome and del(8p) was only of borderline significance, the presence of both deletions had a highly significant negative impact on the outcome of splenic MZLs.

Effects of implant design on marginal bone changes around early loaded, chemically modified, sandblasted Acid-etched-surfaced implants: a histologic analysis in dogs

A minimal marginal bone loss around implants during early healing has been considered acceptable. However, the preservation of the marginal bone is related to soft tissue stability and esthetics. Implant designs and surfaces were evaluated to determine their impact on the behavior of the crestal bone. The purpose of this study is to evaluate histologic marginal bone level changes around early loaded, chemically modified, sandblasted acid-etched-surfaced implants with a machined collar (MC) or no MC (NMC).

Soft tissue dehiscence coverage around endosseous implants: a prospective cohort study

AIM: To evaluate the healing outcome of soft tissue dehiscence coverage at implant sites. MATERIAL AND METHODS: Ten patients with one mucosal recession defect at an implant site and a contralateral unrestored clinical crown without recession were recruited. The soft tissue recessions were surgically covered using a coronally advanced flap in combination with a free connective tissue graft. Healing was studied at 1, 3 and 6 months post-operatively. RESULTS: Soft tissue dehiscences were covered with a coronal overcompensation of the flap margin up to 1.2 mm after the procedure. After 1 month, the coverage shrank to a mean of 75%, after 3 months to 70% and after 6 months to 66%. CONCLUSIONS: The implant sites revealed a substantial, clinically significant improvement following coronal mucosal displacement in combination with connective tissue grafting, but in none of the sites, a could complete implant soft tissue dehiscence coverage be achieved.

Natural antibodies target virus-antibody complexes to organized lymphoid tissue

Natural antibodies (NA) specific for infectious pathogens are found at low titer (usually <1:40) in the serum of healthy, non-immunized, individuals. Therefore, NA are part of the first line of defence against blood borne microorganisms. They directly neutralize viral infections or lyse pathogens by activating the complement cascade. In addition, recent studies highlighted their role in the pooling of infectious pathogens and other antigens to the spleen. This prevents infection of vital target organs and enhances the induction of adaptive immune responses. Specific T and B-cell responses are exclusively induced in highly organized secondary lymphoid organs including lymph nodes and the spleen. As a consequence, mice with disrupted microorganisation of lymphoid organs have defective adaptive immunity. In addition, some pathogens including lymphocytic choriomeningitis virus (LCMV), Leishmania and HIV developed strategies to destroy the splenic architecture in order to induce an acquired immunosuppression and to establish persistent infection. NA antibodies enhance early neutralizing antibodies in the absence of T help mainly by targeting antigen to the splenic marginal zone. In addition, by activating the complement cascade, NA enhance T cell and T-cell dependent B-cell responses. Therefore, natural antibodies are an important link between innate and adaptive immunity.

Comparison of a new, minimally invasive strabismus surgery technique with the usual limbal approach for rectus muscle recession and plication

AIM: To present a novel, minimally invasive strabismus surgery (MISS) technique for rectus muscle operations. METHODS: In this prospective study with a non-concurrent, retrospective comparison group, the first 20 consecutive patients treated with MISS were matched by age, diagnosis and muscles operated on, with 20 patients with a limbal opening operated on by the same surgeon at Kantonsspital, St Gallen, Switzerland. A total of 39 muscles were operated on. MISS is performed by applying two small radial cuts along the superior and inferior muscle margin. After muscle separation from surrounding tissue, a recession or plication is performed through the resulting tunnel. Alignment, binocular single vision, variations in vision, refraction, and number and types of complications during the first 6 postoperative months were registered. RESULTS: Visual acuity decreased at postoperative day 1 in both groups. The decrease was less pronounced in the group operated on with MISS (difference of decrease 0.14 logMAR, p<0.001). An abnormal lid swelling at day 1 was more frequent in the control group (21%, 95% confidence interval (CI) 9% to 41%, 5/24 v 0%, 95% CI 0 to 13%, 0/25, p<0.05). No significant difference was found for final alignment, binocular single vision, other visual acuities, refractive changes or complications (allergic reactions, dellen formation, abnormal conjuctival findings). A conversion to a limbal opening was necessary in 5% (95% CI 2% to 17%, 2/39) of muscles. CONCLUSIONS: This study shows that this new, small-incision, minimal dissection technique is feasible. The MISS technique seems to be superior in the direct postoperative period as better visual acuities and less lid swelling were observed. Long-term results did not differ in the two groups.

State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)

BACKGROUND Controversy exists in the literature between the role of orthodontic treatment and gingival recession. Whilst movement of teeth outside the alveolar bone has been reported as a risk factor for gingival recession, others have found no such association. FINDINGS The Angle Society of Europe devoted a study day to explore the evidence surrounding these controversies. The aim of the day was for a panel of experts to evaluate the current evidence base in relation to either the beneficial or detrimental effects of orthodontic treatment on the gingival tissue. CONCLUSIONS There remains a relatively weak evidence base for the role of orthodontic treatment and gingival recession and thus a need to undertake a risk assessment and appropriate consent prior to the commencement of treatment. In further prospective, well designed trials are needed.

Soft and hard tissue histologic dimensions around dental implants in the canine restored with smaller-diameter abutments: a paradigm shift in peri-implant biology

PURPOSE To evaluate the biologic width dimensions around implants with nonmatching implant-abutment diameters. MATERIALS AND METHODS Five canines had their mandibular premolars and first molars removed bilaterally and replaced with 12 implants that had nonmatching implant-abutment diameters. On one side, six implants were placed in a submerged surgical approach, and the other side utilized a nonsubmerged approach. Two of the implants on each side were placed either 1 mm above, even with, or 1 mm below the alveolar crest. Two months later, gold crowns were attached, and the dogs were sacrificed 6 months postloading. Block sections were processed for histologic and histomorphometric analyses. RESULTS The bone level, connective tissue length, epithelial dimension, and biologic width were not significantly different when the implants were initially placed in a submerged or nonsubmerged surgical approach. The bone level was significantly different around implants placed 1 mm above the crest compared to implants placed even with or 1 mm below the alveolar crest. The connective tissue dimension was not different for any implant level placement. The epithelial dimension and biologic width were significantly greater for implants placed 1 mm below the alveolar crest compared to implants placed even with or 1 mm above the alveolar crest. For five of six implant placements, connective tissue covered the implant/abutment interface. CONCLUSIONS This study reveals a fundamental change in the biologic response to implants with nonmatching implant-abutment diameters. Unlike implants with matching implant-abutment diameters, the connective tissue extended coronally past the interface (microgap). This morphologic tissue alteration represents a significant change in the biologic reaction to implant-abutment interfaces and suggests that marginal inflammation is eliminated or greatly reduced in these implant designs.

Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial

BACKGROUND A newly developed collagen matrix (CM) of porcine origin has been shown to represent a potential alternative to palatal connective tissue grafts (CTG) for the treatment of single Miller Class I and II gingival recessions when used in conjunction with a coronally advanced flap (CAF). However, at present it remains unknown to what extent CM may represent a valuable alternative to CTG in the treatment of Miller Class I and II multiple adjacent gingival recessions (MAGR). The aim of this study was to compare the clinical outcomes following treatment of Miller Class I and II MAGR using the modified coronally advanced tunnel technique (MCAT) in conjunction with either CM or CTG. METHODS Twenty-two patients with a total of 156 Miller Class I and II gingival recessions were included in this study. Recessions were randomly treated according to a split-mouth design by means of MCAT + CM (test) or MCAT + CTG (control). The following measurements were recorded at baseline (i.e. prior to surgery) and at 12 months: Gingival Recession Depth (GRD), Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Keratinized Tissue Width (KTW), Gingival Recession Width (GRW) and Gingival Thickness (GT). GT was measured 3-mm apical to the gingival margin. Patient acceptance was recorded using a Visual Analogue Scale (VAS). The primary outcome variable was Complete Root Coverage (CRC), secondary outcomes were Mean Root Coverage (MRC), change in KTW, GT, patient acceptance and duration of surgery. RESULTS Healing was uneventful in both groups. No adverse reactions at any of the sites were observed. At 12 months, both treatments resulted in statistically significant improvements of CRC, MRC, KTW and GT compared with baseline (p < 0.05). CRC was found at 42% of test sites and at 85% of control sites respectively (p < 0.05). MRC measured 71 ± 21% mm at test sites versus 90 ± 18% mm at control sites (p < 0.05). Mean KTW measured 2.4 ± 0.7 mm at test sites versus 2.7 ± 0.8 mm at control sites (p > 0.05). At test sites, GT values changed from 0.8 ± 0.2 to 1.0 ± 0.3 mm, and at control sites from 0.8 ± 0.3 to 1.3 ± 0.4 mm (p < 0.05). Duration of surgery and patient morbidity was statistically significantly lower in the test compared with the control group respectively (p < 0.05). CONCLUSIONS The present findings indicate that the use of CM may represent an alternative to CTG by reducing surgical time and patient morbidity, but yielded lower CRC than CTG in the treatment of Miller Class I and II MAGR when used in conjunction with MCAT.

Indication and timing of soft tissue augmentation at maxillary and mandibular incisors in orthodontic patients. A systematic review.

OBJECTIVE To assess the indication and timing of soft tissue augmentation for prevention or treatment of gingival recession when a change in the inclination of the incisors is planned during orthodontic treatment. MATERIALS AND METHODS Electronic database searches of literature were performed. The following electronic databases with no restrictions were searched: MEDLINE, EMBASE, Cochrane, and CENTRAL. Two authors performed data extraction independently using data collection forms. RESULTS No randomized controlled trial was identified. Two studies of low-to-moderate level of evidence were included: one of prospective and retrospective data collection and one retrospective study. Both implemented a periodontal intervention before orthodontics. Thus, best timing of soft tissue augmentation could not be assessed. The limited available data from these studies appear to suggest that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontics may yield satisfactory results with respect to the development or progression of gingival recessions. However, the strength of the available evidence is not adequate in order to change or suggest a possible treatment approach in the daily practice based on solid scientific evidence. CONCLUSIONS Despite the clinical experience that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontic treatment may be a clinically viable treatment option in patients considered at risk, this treatment approach is not based on solid scientific evidence. Moreover, the present data do not allow to draw conclusions on the best timing of soft tissue augmentation when a change in the inclination of the incisors is planned during orthodontic treatment and thus, there is a stringent need for randomized controlled trials to clarify these open issues.

Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging?

Spontaneous pneumomediastinum commonly occurs in healthy young men or parturient women in whom an increased intra-alveolar pressure (Valsalva maneuver, asthma, cough, emesis) leads to the rupture of the marginal pulmonary alveoli. The air ascends along the bronchi to the mediastinum and the subcutaneous space of the neck, causing cervico-fascial subcutaneous emphysema in 70-90% of cases. Ninety-five forensic cases, including five cases of hanging, were examined using postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy until December 2003. This paper describes the findings of pneumomediastinum and cervical emphysema in three of five cases of hanging. The mechanism of its formation is discussed based on these results and a review of the literature. In conclusion, when putrefaction gas can be excluded the findings of pneumomediastinum and cervical soft tissue emphysema serve as evidence of vitality of a hanged person. Postmortem cross-sectional imaging is considered a useful visualization tool for emphysema, with a great potential for examination and documentation.

The Expanded Human Kallikrein (KLK) gene family : genomic organisation, tissue specific expression and potential functions

The tissue kallikreins are serine proteases encoded by highly conserved multigene families. The rodent kallikrein (KLK) families are particularly large, consisting of 13 26 genes clustered in one chromosomal locus. It has been recently recognised that the human KLK gene family is of a similar size (15 genes) with the identification of another 12 related genes (KLK4-KLK15) within and adjacent to the original human KLK locus (KLK1-3) on chromosome 19q13.4. The structural organisation and size of these new genes is similar to that of other KLK genes except for additional exons encoding 5 or 3 untranslated regions. Moreover, many of these genes have multiple mRNA transcripts, a trait not observed with rodent genes. Unlike all other kallikreins, the KLK4-KLK15 encoded proteases are less related (25–44%) and do not contain a conventional kallikrein loop. Clusters of genes exhibit high prostatic (KLK2-4, KLK15) or pancreatic (KLK6-13) expression, suggesting evolutionary conservation of elements conferring tissue specificity. These genes are also expressed, to varying degrees, in a wider range of tissues suggesting a functional involvement of these newer human kallikrein proteases in a diverse range of physiological processes.