3-year observations on gingival recession in mandibular incisors in children

28 children aged 6-13 years, with gingival recession localized to mandibular incisors, were monitored longitudinally to evaluate any changes of the labial periodontal tissues. Measurements included dental plaque, gingival inflammation, gingival recession, probing depth, probing attachment level, keratinized and attached gingiva. Following baseline examination, the incisors were observed at yearly intervals over 3 years. The results showed that a high level of oral hygiene was maintained and that gingival inflammation occurred only to a minor degree throughout the observation period. Gradual reductions in the amount of gingival recession and probing attachment levels took place in all children except for 1 of the subjects with 1 severely malpositioned tooth. Probing depths and widths of keratinized and attached gingiva remained relatively unchanged. The finding that gingival recession in mandibular incisors in young children often improves over time suggests that preventive or reparative treatment in this part of the developing dentition may not be necessary. Decisions about such treatment should be postponed until any spontaneous improvement has taken place.     

Dimensional alterations of the gingiva related to changes of facial/lingual tooth position in permanent anterior teeth of children

Abstract Maxillary and mandibular anterior permanent teeth in 38 children aged 7–12 years were examined 2 × with an interval of 2 years to determine whether spontaneous facial/lingual tooth position changes were related to alterations of the widths of keratinized and attached gingiva and the clinical crown height. Measurements included dental plaque, gingival inflammation, probing depth, and width of keratinized and attached gingiva. In addition, study casts from the baseline and 2-year examinations were used to measure clinical crown height and tooth position. The results showed that significant alterations in the widths of the keratinized and attached gingiva took place when the teeth changed positions in facial or lingual directions. The changes in gingival widths could to some extent be coupled to changes in clinical crown height. In teeth moving lingually, the gingival widths increased and the clinical crown height decreased. In teeth moving facially, the gingival widths decreased, and the facial gingiva sometimes receded. These gingival alterations call for examination of the facial gingiva as part of the monitoring of the development of the permanent dentition.     

Role of keratinized gingiva for gingival health

Abstract The present study was carried out in the Beagle dog in order to determine if variations of the width of the zone of keratinized gingiva occur in the canine dentition, if the width alters during the development of destructive periodontitis and if, subsequent to surgical excision of the periodontal lesion, the regenerated gingival margin differs from that of a normal, noninflamed gingiva. Five dogs were used. A baseline examination comprised assessments of dental plaque, gingival conditions and width of the zone of keratinized gingiva. Cotton floss ligatures were placed around the teeth on the right side of the jaws and plaque was allowed to accumulate in order to induce periodontal tissue breakdown. After 150 days the inflamed periodontal tissues around the experimental teeth were removed surgically using a “gingivectomy” or a flap procedure. In the “gingivectomy” procedure the entire zone of the keratinized gingiva was excised whereas the main part of the keratinized tissue was maintained with the flap procedure. During a healing period of 120 days plaque control was carried out daily. On the left side of the jaws (control side) a careful toothcleaning program was performed during the entire observation period of 270 days. Clinical examinations of all control and experimental tooth units were repeated on days 150 and 270. Biopsies were sampled from both sides of the jaws on day 270. In histological sections the free gingival tissue was subjected to histometric assessments and a stereologic analysis based on a standardized morphometric point-counting procedure. In addition, the number of leukocytes residing within the junctional epithelium was determined. The results showed that in Beagle dogs the width of the keratinized gingiva (WKG), on the facial aspect of premolars and molars, varies between 2 and 6 mm. During a period of 270 days of careful plaque control, the WKG was maintained unaltered. In comparison, a phase of experimental periodontitis resulted in a substantial decrease of the WKG. Subsequent to the excision of the inflamed periodontal tissues, which in some cases included the entire zone of the keratinized gingiva, a new free gingival unit developed. In most respects the structural composition of this regenerated gingival unit was similar to that of a normal control unit. Furthermore, in the absence of plaque, the regenerated soft tissue was free from signs of inflammation independent of presence or absence or width of the keratinized zone.     

Alterations of the position of the marginal soft tissue following periodontal surgery

The present study was performed to examine the alterations of the position of the marginal soft tissue ("gingival margin") on the buccal surface of teeth in patients who following periodontal surgery were enrolled in a supervised maintenance care program for 10--11 years. The material consisted of 43 patients with severe destruction of the periodontal tissues. Following initial treatment comprising scaling, root planing and instructions in plaque control measures, deepened periodontal pockets were eliminated by the use of an apically repositioned flap procedure including osseous surgery to eliminate bony defects. After treatment, the patients were recalled once every 3--6 months for maintenance care. In all patients, the distance between the cemento-enamel junction and the gingival margin on the buccal surfaces of all treated teeth was assessed (1) prior to surgery, (2) after initial healing, and (3) at a reexamination 10--11 years after treatment. In addition, the presence or absence of keratinized gingiva was determined. The results showed that (1) during active periodontal treatment the position of the gingival margin was shifted in an apical direction, (2) this displacement was to some extent compensated for by a coronal regrowth during the postoperative maintenance care period, (3) the alterations of the position of the gingival margin followed a similar pattern in areas with and without a zone of keratinized gingiva, (4) the number of gingival units devoid of keratinized gingiva decreased during the maintenance care period.     

下颌后牙区“香肠技术”植骨后颊侧角化龈宽度的临床观察

目的　探讨下颌后牙区“香肠技术”植骨后颊侧角化龈宽度的变化及其与植骨量的相关性,并评价颊侧角化龈宽度不足患者进行游离龈移植术后的临床效果。方法    选择2019年4月至2020年9月在大连市口腔医院种植科因牙列缺损行下颌后牙区“香肠技术”植骨后种植修复患者24例。测量所有患者植骨前后的颊侧角化龈宽度以及植骨后当天植骨量,对植骨前后的角化龈宽度进行比较,并分析植骨后角化龈宽度变化与植骨量的相关性。对植骨后6个月颊侧角化龈宽度不足2 mm的患者进行腭部游离龈移植术,移植术后3个月复查,对获得的种植体颊侧角化龈宽度、龈瓣收缩率进行观察和评价。结果     24例患者平均植骨量为（629.30 ± 226.42）mm3,植骨后角化龈宽度平均减少量为（1.15 ± 0.82）mm,植骨量与角化龈宽度减少量呈正相关。12例进行游离龈移植术患者的术后角化龈宽度增加,移植术后3个月龈瓣收缩率为（22.89 ± 2.85）%。结论    “香肠技术”植骨术后角化龈宽度有所减小,与植骨量呈正相关;游离龈移植后龈瓣收缩较少,可显著增加种植体周围角化龈宽度。     

8～14岁儿童附着龈宽度与牙龈炎相关性的研究

目的:探讨8~14岁儿童附着龈宽度与牙龈炎之间的相关性。方法:对天津市204名8~14岁儿童进行口腔检查,选择11、16、26、31、36、46为指数牙,记录颊侧附着龈宽度,并检查探诊深度(probingdepth,PD)、探诊出血指数(bleeding of probing,BOP)、牙菌斑指数(plaque index,PLI)、龈沟出血指数(sulcusbleeding index,SBI)等牙周临床指标。结果:Spearman相关分析显示儿童牙龈的附着龈宽度与SBI、PLI、PD之间呈较弱的负相关关系(r值分别为-2.000,-1.810、-2.120,且P<0.05),t检验可得附着龈宽度<1 mm、≥1 mm时BOP%存在差异(P<0.05)。结论:附着龈的宽度有可能影响儿童牙龈炎症的发生,且对于维护牙周组织的健康起到一定的作用。     

下颌后牙区不同时机游离龈移植的效果对比

目的对不同时机的游离龈移植术（FGG）增加下颌后牙区种植体周颊侧角化龈的临床效果进行评价。 方法选择2018年10月至2020年10月就诊于东莞健力口腔医院修复种植科下颌后牙区单牙缺失角化牙龈不足的患者（宽度为2 ~ 4 mm）共40例,将纳入的40例患者进行编号,以随机数字表法抽取20例为实验组,其余20例为对照组。实验组种植Ⅰ期手术时放置愈合基台同期行FGG。对照组种植Ⅰ期手术潜入式愈合,3个月Ⅱ期手术时放置愈合基台同期行FGG。术后观察移植物的存活情况,测量术前牙槽嵴顶剩余角化龈宽度,测量颊侧FGG后即刻、移植术后2个月、戴牙后即刻和戴牙后6个月的颊侧角化龈宽度,使用SPSS 20.0软件对移植物存活率、颊侧不同时间点角化龈宽度等进行统计分析,采用配对t检验进行比较,以P<0.05认为差异有统计学意义。 结果两组手术均获得成功,伤口正常愈合,组织瓣均存活。术前实验组和对照组牙槽嵴顶余留角化龈宽度分别为（2.9 ± 0.3）和（3.0 ± 0.3）mm,差异无统计学意义。实验组和对照组术后即刻种植体颊侧龈缘中点角化龈宽度分别为（4.9 ± 0.5）和（4.9 ± 0.5）mm,差异无统计学意义（t = 0.2,P = 0.8）。实验组和对照组术后2个月颊侧龈缘中点角化龈宽度分别为（4.2 ± 0.4）和（4.5 ± 0.4）mm,差异有统计学意义（t = -2.9,P<0.05）。实验组和对照组戴牙当天种植体颊侧龈缘中点角化龈宽度为（3.2± 0.4）和（3.7± 0.5）mm,差异有统计学意义（t = -2.6,P<0.05）。实验组和对照组戴牙后6个月种植体颊侧龈缘中点角化龈宽度为（3.1 ± 0.4）和（3.5 ± 0.3）mm,差异有统计学意义（t = -3.7,P<0.05）。 结论当下颌后牙区剩余角化龈为2 ~ 4 mm时,FGG在种植Ⅰ期手术同期及Ⅱ期手术同期均能获得较好的增加角化龈的效果。相比于种植Ⅰ期手术同期进行FGG,Ⅱ期手术同期FGG能获得更好的颊侧角化龈的宽度,但会增加手术次数。     

Recession: A 4-year longitudinal study after free gingival grafts

Free gingival grafts were performed on recession areas around 42 teeth in 12 patients, with postoperative evaluation of recurrent recession after 1, 6, 12, 24, and 48 months. No changes in degree of recession were observed during the 4-year period. The vestibuloplasties, which were always wider than the transplants, exhibited recurrence up to the transplant margin 6 months after surgery, while the transplants themselves exhibited an average shrinkage of 25%. In addition, 25% of the increase in vestibular depth achieved by the surgery was lost 1 month postoperatively, but there was a tendency toward increasing vestibulum depth during the ensuing 47 months. Gingival sulcus depths was not affected by the surgery.     

Morphological changes in the attached and keratinized gingiva and gingival sulcus in the mixed dentition period

Abstract A longitudinal study was undertaken to examine the changes in the sulcus probing depth, keratinized and attached gingiva during the mixed dentition period. 54 children aged 7 to 9 years at the first examination were examined twice, with an interval of 5 years. Sulcus probing depth and keratinized gingiva were examined at the buccal aspect of the incisors, and either right or left cuspids and posterior areas. The width of the attached gingiva was obtained by substracting the probing depth from the width of the keratinized gingiva. When compared to primary predecessors, the permanent teeth had a deeper probing depth, narrower attached gingiva and at the maxillary teeth, a wider keratinized gingiva. When a pennanent tooth was present at both examinations, there was a significant increase in width of the attached gingiva with a corresponding decrease in probing depth, and a slight beginning of an increase in the width of keratinized gingiva. Previous and the present findings indicate that during the early years after eruption of the permanent tooth, an increase in width of the attached gingiva takes place, without occlusal migration of the marginal gingiva whereas, at later stages, this coronal migration takes place, concomitant to tooth eruption.     

Lack of association between width of attached gingiva and development of soft tissue recession

The purpose of this study was to longitudinally monitor changes in the position of the soft tissue margin at 26 buccal sites surgically deprived of all gingival tissue. A baseline examination carried out 6 months after treatment revealed that the sites to be monitored were lacking or had only a minimal zone (less than 1 mm) of regenerated attached gingiva. 12 control sites with an "adequate" width of attached gingiva (greater than 1 mm) were also examined. Assessments of oral hygiene and gingival conditions, probing pocket depths, probing attachment levels, position of the soft tissue margin, and gingival width were carried out at baseline and after 5 years. The results revealed that in the test sites, a slight increase of the width of the gingiva occurred during the observation period. 7 out of the 26 areas showed a coronal regrowth of the soft tissue margin, while 2 sites showed a further apical displacement of the soft tissue margin. In the control areas, 3 sites developed recession accompanied by a reduction in the width of the gingiva. Hence, it appears that in patients maintaining a proper plaque control, the lack of an "adequate" zone of attached gingiva does not result in an increased incidence of soft tissue recessions.     

牙周膜龈手术的临床应用Ⅰ：自体组织的应用

近年来,随着口腔科学的迅速发展,牙周病学方面的新技术和新材料也层出不穷。膜龈手术已在包括牙周再生、牙周美容、种植、正畸等方面得到了越来越广泛的应用。膜龈手术主要包括：1）带蒂软组织瓣术,可以覆盖暴露的牙根表面,也可以结合游离结缔组织移植术达到覆盖根面的治疗效果;2）游离牙龈移植术,不但可以重建附着龈,还可以保护牙齿健康,防止牙龈退缩;3）结缔组织移植术,是治疗牙龈退缩最常用的术式。本文主要以笔者多年的临床经验为基础,采用手术临床照片结合简要文字的方式,介绍常见的各种膜龈手术的适应证、优缺点和临床应用,以使口腔医师能更好地了解并掌握该技术。     

The role of keratinized gingiva in plaque-associated gingivitis in dogs

Abstract The present experiment was designed to examine if a dento-gingival unit with a wide zone of keratinized gingiva (KG) provides a more efficient seal against plaque infection than a unit with a narrow zone of KG or lack of such gingiva. Five beagle dogs were used. In a preparatory experiment three categories of gingival units were established in each dog, namely (1) regenerated gingiva with a wide zone of KG (healed following a “flap” procedure), (2) regenerated gingiva with an “insufficiently” wide zone of KG (healed following a “gingivectomy” procedure), and (3) non-operated control gingiva with a normal zone of KG. Clinical and histological examinations carried out at the end of the preparatory period revealed that all gingival units, non-operated as well as regenerated units, met the criteria of health. All tooth-cleaning measures were abolished. After 40 days of plaque accumulation the clinical examination (Plaque Index, Gingival Index and Gingival Exudate) was repeated and biopsies were sampled. Following preparation the biopsy material was subjected to histometric and morphometric analysis. The results showed that the free gingiva of units with wide and narrow zones of KG responded to microbial colonization by an inflammatory reaction, the location and extension of which did not vary with the width of the keratinized gingiva. It was concluded that, in the presence of plaque, a dento-gingival unit with a narrow zone of, or with lack of, gingiva has an equal capacity for inflammatory response against plaque infection as a unit with a wide zone of KG.     

牙周膜龈手术的临床应用Ⅱ：异体材料的应用

牙周膜龈手术主要用于治疗牙龈退缩,增加临床附着水平和牙龈角化组织（附着龈）,以及牙周美容。近年来牙周膜龈手术技术和材料发展迅速,自体上皮下游离软组织移植术一直被公认为是效果最好和最稳定的术式,但由于存在多手术区的缺点,研究人员也一直在探索代替自体组织的材料。本文主要介绍目前临床常用的几种膜龈手术异体材料：1）同种无细胞上皮基质;2）异种胶原基质;3）重组人血小板衍生生长因子;4）釉质基质衍生物蛋白;5）引导组织再生膜;6）组织工程来源结构。应用异体材料的牙周膜龈手术,不仅避免了自体组织的缺点,有些手术效果可以等同甚至超过自体组织,因此异体材料的应用有着广泛的前景。本文介绍了牙周膜龈手术中常用异体材料的优缺点和适应证,并简要介绍了各种膜龈手术的临床选择思路。     

The width of radiologically-defined attached gingiva over permanent teeth in children

Abstract Several authors have determined clinically the width of attached gingiva (AG) over the deciduous and early permanent dentitions in children. They have noticed that when comparing the width of AG over deciduous teeth to the width of AG over the succeeding newly erupted permanent teeth, a clear diminishing in AG can be seen. The aim of the present cross-sectional study was to assess the width of radiologically-defined AG (RAG) over the permanent teeth of 6-, 10-and 12-year-old children. Altogether 123 subjects were recruited. The mucogingival junction (MGJ) was revealed with Schiller's iodine solution and marked over each tooth with a piece of metal wire before taking a panoramic radiograph. The width of RAG over permanent teeth was measured from the radiographs as the midfacial distance from the cementoenamel junction to the mucogingival junction. When comparing the width of RAG over 1st molars and the 1st and 2nd incisors, statistically significant differences were found between 6- and 10-year-olds, between 6- and 12-year-olds and between 10- and 12-year-olds. For the 1st maxillary incisor, the difference in width was not statistically significant between ages 10 and 12 years. The findings seem to justify the conclusion that an inadequate width of AG will correct itself from 6 to 12 years of age without interference by means of periodontal surgery.     

膜龈增宽术在口腔种植临床上的应用

目的：寻找牙种植龈缘不足的解决方法。方法：24例50颗种植牙附着龈严重不足患者在种植Ⅱ期术中行膜龈增宽术伴前庭沟加深术．术后两周测量附着龈宽度增加量。结果：附着龈宽度增加量最少5mm，最多10mm。平均8.1mm，失败两例。结论：膜龈增宽术可增加牙种植后附着龈宽度。     

Role of attached gingiva for maintenance of periodontal health

The present study was undertaken to analyze the role of attached gingiva for the maintenance of periodontal health in sites with normal and reduced height of the supporting apparatus. Furthermore, the effect of excision and grafting of gingiva on some parameters describing dimensions and location of the periodontal tissues was evaluated. 7 beagle dogs were used. A baseline examination comprised assessments of dental plaque, gingival conditions, attachment level, position of the gingival margin and width of the keratinized and the attached gingiva. In the right side of the jaws (experimental side) a 6-month period of periodontal tissue breakdown was followed by surgical excision of the entire zone of the gingiva. After another 4-month period of healing with daily plaque control, a gingival graft was inserted in one quadrant of the experimental side to regain a zone of attached gingiva while the other quadrant of the experimental side was left ungrafted. In the left side of the jaws (control side), the teeth were subjected to daily meticulous plaque control during the entire study. In one of the control quadrants the entire zone of the keratinized and attached gingiva was excised at a time point corresponding to the grafting procedure in the experimental side, while the gingiva in the remaining control jaw quadrant was left unoperated. Clinical examinations of all control and experimental tooth units were repeated at certain time intervals during the course of the study. The final examination was carried out 4 months after grafting. The results of the experiment showed that in sites exposed to careful plaque control measures gingival health could be established and maintained without sign of recession of the gingival margin or loss of attachment, independent of (1) presence or absence of attached gingiva, (2) width of keratinized gingiva or (3) height of the supporting attachment apparatus. Following surgical excision of the entire gingiva, all buccal sites regained a zone of keratinized gingiva, but most sites were lacking attached gingiva. Furthermore, grafting of gingival tissue significantly increased the width of the keratinized and the attached gingiva but had no obvious effect on the position of the gingival margin or the level of the attachment.     

Cyclosporine-induced gingival overgrowth in beagle dogs

Development of gingival overgrowth during daily long-term cyclosporine A treatment was studied in 2-yr-old beagles. Gingival enlargement developed in five of 12 dogs (42%), primarily in the mandibular anterior area. The earliest gingival changes occurred by 3 wk as an increase in the size of the interdental papillae. The lesions progressively became more severe, in some cases obscuring portions of teeth by wk 6. The redundant tissue exhibited an increase in connective tissue components and an inflammatory infiltrate primarily of plasma cells. Severity of the overgrowth varied in responding animals; both incidence and severity were related to the CSA concentration in blood. The mean CSA blood levels of responders were significantly greater than nonresponders at wk 3, 6 and 10. Since beagles develop gingival overgrowth similar to humans, they provide an excellent model to investigate the roles of local and systemic factors in the induction of gingival overgrowth.     

植体周角化龈研究进展

种植牙周围角化龈对抵抗菌斑刺激及机械创伤起到屏障作用,无论从功能还是美观角度,对最终种植修复成功有着重要意义.早期研究表明,至少2 mm的角化龈(其中附着龈至少1mm)才能维护牙周健康.角化龈的存在有利于植体周围菌斑控制及后期维护,但关于角化龈确切的量与种植体周围感染的关系尚有争议.文章就近年来植体周角化龈的研究做一综...