no abstract available

Long-term periodontal stability is one of the major issues of periodontal therapy. Besides a successful active therapy and a meticulous periodontal maintenance phase, the initial risk assessment for each single tooth is of utmost importance. However, the literature contains only limited guidelines and recommendations concerning periodontal risk assessment. In particular, when teeth are to be used as abutments for a new prosthetic reconstruction, long-term periodontal stability should be expected. This clinical report discusses the clinical considerations concerning periodontal risk assessment, and factors that aid in the decision-making process.

Keywords: decision-making, implants, periodontal therapy, risk assessment

Human and animal studies suggest that the thickness of the marginal tissue is a determinant of susceptibility to gingival recession during facial tooth movement. When thin facial marginal tissues are inflamed, there is even greater concern about the risk of attachment loss during orthodontic treatment. This report describes a case where a subepithelial acellular dermal matrix allograft was used to augment the thickness of gingival tissue and the zone of attached gingiva overlying prominent mandibular incisor roots prior to orthodontic treatment of a young patient. Use of an allograft shortened the procedure time and eliminated the need for palatal donor sites. The graft enhanced the tissue thickness facial to the mandibular anterior teeth and produced relatively little post-operative discomfort. Although plaque-induced inflammation developed around the mandibular anterior teeth during orthodontic treatment, there was no loss of attachment.

Keywords: gingival graft, gingival recession, gingivitis

Abnormal dental morphology and position have been associated with severe periodontal diseases due to increased plaque accumulation and unfavourable gingival contour. Restoring the favourable contour becomes an important part of the treatment in such cases and can be challenging for the dental practitioner. This case report highlights the multidisciplinary approach for the management of an endodontically periodontally involved molar fused to a supernumerary tooth. The treatment needs and sequence for the management of endodontic-periodontic lesions are discussed and illustrated.

Keywords: cervical enamel projection, endodontic-periodontic, fusion, supernumerary

Background: Lichen sclerosus et atrophicus (LSA) is an uncommon disorder of unknown aetiology. The disease is clinically characterised by white, macular lesions on the skin and is usually associated with atrophic condition affecting the vulva and peri-anal skin. Involvement of the oral mucosa with or without concurrent genital or skin lesions has been reported only occasionally. In view of the rarity of reported cases, one lesion affecting only the labial mucocutaneous area is presented. A 17- year-old female patient came to us with the chief complaint of an unaesthetic appearance of her maxillary anterior teeth as well as receding gums. A white mucosal lesion was seen affecting the labial mucosa along with severe bone and gingival tissue loss around her maxillary incisors.
Case report: Clinical examination suggested the diagnosis of LSA, which was confirmed by the histopathological report of the lesion. Intralesional injections of steroids were given twice at an interval of 1 week, accompanied by thorough Phase 1 therapy and instructions for proper maintenance of oral hygiene. The mucosal condition resolved in 4 weeks, the involved teeth were saved and the patient was scheduled for regular recall visits. After 1 year, the patient was satisfied with the treatment outcome.
Conclusion: Although rare in the oral cavity, LSA may affect the periodontal issues. The clinician should be aware of clinical and histopathological findings of this condition.

Keywords: lichen sclerosus (LSA), oral, periodontal tissues, treatment

Background: The loss of the interdental papilla is one of the adverse events that can occur after periodontal therapy. It can cause food impaction, aesthetic deformities and phonetic problems. The objective of this study was to evaluate the effect of the distance from the contact point to the crestal bone on the degree of vertical loss of interdental papillae.
Study design: A total of 125 interproximal sites from 26 patients were examined. Prior to transperiodontal bone probing, the class of the interdental papilla was determined based on the classification system developed by Nordland and Tarnow1. The distance from the contact point to the crestal bone was measured by probing under local anaesthesia.
Results: The results revealed that when the distance from the contact point to the crestal bone was <= 5 mm, in 98.4% of the cases the papilla did not shrink. When the distance was >= 7 mm, 100% of papilla shrinkage was classified as class III. A significant association (Fisher exact test, P < 0.001) was observed between the degree of loss of interdental papilla and the distance from the contact point to the bone crest.
Conclusion: The distance of the base of the contact point to the coronal portion of the bone crest measured by bone probing is highly associated with the degree of the vertical loss of the interdental papilla.

Keywords: contact point, interdental papilla, periodontology

Scaling and root planing has always been considered an indispensable procedure in periodontal disease management. As a result of instrumentation, dentinal tubules become exposed and sensitivity develops. Besides causing discomfort, the condition may deter a person from establishing or maintaining adequate oral hygiene procedures, further complicating oral health. Although materials have been tested to alleviate post-operative dentinal hypersensitivity, the issue has not been comprehensively addressed in the literature. Moreover, very few 'in office' topical medicaments available for dentine hypersensitivity meet the requirements of the ideal desensitising agent. In view of the ongoing search for an ideal desensitiser, this article evaluates the clinical efficacy of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and HEMA-G (aqueous solution of hydroxyethyl methacrylate and glutaraldehyde) desensitisers in managing dentine hypersensitivity following scaling and root planing.
Study design: Forty-eight patients undergoing periodontal treatment were included in the study. These patients presented with hypersensitivity following phase I therapy. After taking the baseline scores, agents were applied and reductions in post-operative dentine hypersensitivity were evaluated using the verbal rating scale at 0, 1, 4, 10 and 28 days. The results were analysed by percentage reduction in hypersensitivity and showed statistically significant differences between the control and treated teeth.
Results: Significant decreases were recorded for all the three test stimuli for group I (CPP-ACP) and group II (HEMA-G). Control group patients demonstrated a statistically non-significant (P > 0.05) decrease in mean discomfort score, observed from day 0 to day 4, which subsequently became significant on day 10. A highly significant (P < 0.0001) decrease was observed at day 28 for all the test stimuli, indicating that patients within the control group were also experiencing relief.
Conclusion: The study concluded that subgingival scaling and root planing followed by single application of CPP-ACP or HEMA-G provided higher short-term reductions in dentine hypersensitivity compared with controls.

Keywords: casein phosphopeptide, Gluma, hypersensitive dentine, scaling and root planing

The objective of the investigation was to assess changes of periodontal variables, particularly the gingival width, hyperplasia index and the subgingival flora, after changing medication from ciclosporin A to tacrolimus. Ten patients with gingival enlargement were included in the study. Plaque index, gingival index and hyperplasia index together with papillary and marginal gingival width were measured immediately after the change-over as well as after 4, 8 and 26 weeks. At the beginning and end of the investigations, probing depths were determined and subgingival plaque samples were assessed using polymerase chain reactions to Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Eikenella corrodens, Porphyromonas gingivalis, Fusobacterium nucleatum, Prevotella intermedia, Treponema denticola and Capnocytophaga. Significant improvements were found in the probing depth, the hyperplasia index and the papillary gingival width after 8 and 26 weeks as well as in the marginal gingival width after 8 weeks. T. forsythia was significantly reduced at the end of the study into subgingival plaque. The change in medication from ciclosporin A to tacrolimus had positive effects on clinical variables and the subgingival biofilm.

Keywords: ciclosporin A, gingival enlargement, subgingival biofilm, tacrolimus