| Infantile congenital agranulocytosis or Kostmann syndrome is a rare hereditary kind of severe neutropenia. The typical symptoms, which appear since the first days of life, are abscesses located on various parts of the body: ear, cutis, lung and oral cavity. These abscesses are due to an almost total disimmunity typical of the neutropenia. The aim of this article is to describe the most typical signs of this pathology in the oral cavity, reporting a case observed in our department in Florence, italy. On the basis of the personally observed case and of the review of the literature, it is possible to consider, as a characteristic finding in Kostmann syndrome, a typical very serious periodontal pathology, which is similar to the prepubertal periodontitis in deciduous dentition. At the age of 19 years the patient showed a dramatic compromise of the masticatory function. It is obvious that the lack of response of the host can obstruct the interaction between the host and the microbic flora, because the lack of neutrophils increases the susceptibility of the patient to every kind of infection, even to periodontitis. A periodontal prophylaxis, since the very first observations, followed by a rigorous maintenance with frequent and regular professional hygienic treatments could be effective in controlling the effects of periodontal disease and could reduce the tragic evolution. We need to recognise that it could be hard to monitor the oral situation correctly in these patients, as they have a continuously poor systemic condition. Finally in these cases the rehabilitative therapy is very problematical. ( info) |
42/337. Using platelet-rich plasma to accelerate soft tissue maturation in esthetic periodontal surgery. The transposition of connective tissue to increase the zone of keratinized tissue and/or for root coverage has become an integral part of the surgical dental practice. In an effort to reduce the incidence of postoperative complications occasionally observed with these procedures, the incorporation of platelet-rich plasma and its growth factors has been introduced into the surgical protocol. documentation of several cases requiring esthetic soft tissue grafting procedures and the use of regenerative barriers to obtain root coverage with the incorporation of platelet-rich plasma is presented. ( info) |
43/337. Papillon Lefevre syndrome: management of a case. Papillon Lefevre syndrome is a rare syndrome autosomal recessive in nature, manifesting as keratosis palmoplantaris with periodontitis. A case of Papillon Lefevre syndrome present in a 12 year old boy is presented. Only the permanent maxillary canines were present in the oral cavity when the patient was first seen, and despite efforts towards preservation, they had to be extracted. (complete dentures were made and the patient was followed up for 26 months. ( info) |
44/337. Periodontal healing in humans using anorganic bovine bone and bovine peritoneum-derived collagen membrane: a clinical and histologic case report. The authors report the clinical and histologic data on the healing of a severe periodontal lesion obtained in a one-walled intrabony defect using anorganic bovine bone under a bovine peritoneum-derived collagen membrane. Eight months after surgery, a bone-like tissue replaced the lost tissues. A biopsy of this tissue was carried out. In the part of the specimen closer to the residual bony wall of the original defect, anorganic bone particles (ABP) appeared to be surrounded by a layer of newly formed bone; its osteocyte lacunae were colonized by osteocytes from the host, and actively secreting osteoblasts were observed in many microscopic fields. No resorption phenomena were observed in the ABP Newly formed cementum with actively secreting cementoblasts was present on the tooth surface, and well-oriented fibers inserting in both newly formed cementum and bone were observed. In an area far from residual bone, all ABP did not appear to be surrounded by newly formed bone. Osteocytic lacunae appeared not to be colonized by cells, and ABP was surrounded by dense connective tissue without osteoblasts near the grafted particles. A very limited amount of newly formed bone, without relations with ABP, was observed close to the root surface. From a clinical point of view, anorganic bone in association with a collagen membrane can be effective in the treatment of bony defects characterized by an unfavorable architecture. From a histologic point of view, the clinical appearance of bone regeneration is not always confirmed in the part of the defect far from the bony walls. ( info) |
45/337. case reports: evolution of prosthetic rehabilitation for a patient with severe loss of periodontal support. This paper describes the development of a technique to make a fixed bridge for a patient with severe reduction of periodontal support. Initially, the bridge was temporarily cemented over copings. However, when the super-structure was periodically removed for inspection, the copings were easily dislodged, with a risk of fracture of the abutment teeth. Consequently, the technique was modified by using lateral screws to fix the bridge to the copings. This design allows easy periodical removal, cleaning, repair and inspection of the abutment teeth. ( info) |
46/337. Papillon-Lefevre syndrome: serum immunoglobulin g (IgG) subclass antibody response to periodontopathic bacteria. A case report. BACKGROUND: Papillon-Lefevre syndrome (PLS) is a rare autosomal recessive disorder which is characterized by palmar-plantar hyperkeratosis and rapid periodontal destruction of both primary and permanent dentitions. In this case report, we present clinical features, and microbiological and immunological findings of 40 month-old Thai male PLS patient. methods: Microbiological examinations consisted of bacterial culture methods utilizing selective media, morphological identification, and biochemical tests. In addition, the specific serum IgG subclass antibody titers reactive with etiologic periodontal bacteria were determined by the dot-blot immunological analysis and enzyme linked immunosorbent assay (ELISA). RESULTS: The examinations revealed that the patient harbored 3 major suspected periodontopathic microorganisms, A. actinomycetemcomitans, P. gingivalis, and P. intermedia. The patient's serum IgG1, IgG2, and IgG3, but not IgG4, titers against A. actinomycetemcomitans were dramatically increased. The predominant IgG subclass was IgG1. In contrast, the IgG titers against other tested bacteria, P. gingivalis, P. intermedia, and F. nucleatum, appeared to be similar to those of a healthy control. CONCLUSIONS: A. actinomycetemcomitans seems to play a pivotal role in the bacteria-host interaction in PLS periodontal pathogenesis. Response of the specific serum IgG subclass antibody titers against the A. actinomycetemcomitans antigen has been demonstrated. This association warrants further investigation. ( info) |
47/337. The mandibular molar class III furcation invasion: a review of treatment options and a case report of tunneling. BACKGROUND: The predictable management of a mandibular molar that has lost all of its interradicular periodontal support-in other words, that has experienced a Class III furcation invasion, or FI-often is a frustrating and disappointing process for both clinician and patient. The strategic value of retaining such a periodontally involved tooth must be determined by both the patient and dentist before a treatment option is selected. In this article, the authors present and describe various therapeutic plans available for Class III FIs in mandibular molars, discussing the advantages and disadvantages of each approach. They focus particularly on a surgical technique called "tunneling," which is performed to debride the remaining soft and hard tissues in the furcal area; this, in turn, allows access for effective oral hygiene and maintenance. CASE DESCRIPTION: The authors report on the 23-year result of a case involving tunneling. The procedure facilitated the retention of a mandibular molar with a Class III FI in a manner acceptable to both the patient and the clinician. CLINICAL IMPLICATIONS: Tunneling, in a properly selected patient who is motivated to perform careful oral hygiene, can result in comfortable, functional, healthy retention of the affected tooth, with a minimal commitment of time and financial outlay. ( info) |
48/337. Enhanced periodontal response and esthetics of implant-supported bridge by the use of galvanoforming technique: case report. BACKGROUND: Galvanoforming restorations have been placed over the past 15 years successfully. They offer several advantages over alloy restorations, including enhanced response to the periodontal tissues, biocompatibility, and superior esthetics. PURPOSE: The purpose of this report is to show the use of the galvanoforming process in dental implant restorations to transfer the benefits of this technique. MATERIALS AND methods: Two standard Branemark fixtures were placed submerged in the lower mandible for the restoration of a three-unit bridge. The impression was taken at fixture level, and two cast individual telescope abutments were inserted. The galvanoforming restoration was seated conventionally without any screw retention. RESULTS: An implant-supported galvanoforming bridge is functioning successfully. The use of biocompatible materials does not compromise the stability of the restoration; instead, the effect on the periodontal tissues is excellent, resulting in less plaque accumulation and bleeding on probing. Microgaps were avoided by conventional seating on the individual telescope gold abutments, revealing superior occlusal esthetics. CONCLUSIONS: This case report demonstrates the practicability of the biocompatible galvanoforming procedure for implant-supported restorations enhancing periodontal response and esthetics. ( info) |
49/337. Metastatic breast carcinoma mimicking periodontal disease on radiographs. BACKGROUND: Tumors can metastasize to the jaws, oral soft tissues, or salivary glands. Metastasis from distant organs and tissues to the jaws or oral cavity is considered rare. RESULTS: The mandible is the most common site of metastasis of the oral and maxillofacial region. Radiographically, there is usually an area of radiolucency with hazy outline. Such lesions are manifested as radiopaque or sclerotic areas. CONCLUSIONS: Radiographic view of a tumor in the present case mimicked a periodontal lesion with an osteolytic area around the roots. ( info) |
50/337. Site-specific chlorhexidine: a periodontal alternative. Three case reports demonstrate the clinical use of an adjunctive chlorhexidine chip capable of sustaining local antimicrobial activity for 7-10 days. The chip is easy to place, requires no additional chair time for removal, is self-adherent, and can be provided to periodontal maintenance patients on a recurring basis. This is another adjunct that can be part of the clinician's armamentarium when presented with a clinically challenging localized periodontal defect. ( info) |