From October 1989 through February 1999, 695 men with newly diagnosed prostate cancer in International Union against Cancer clinical stage T1b, T1c, or T2 were. Purpose: Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of. This Website Provides Over 10000 Free Medical Books and more for all Students and Doctors This Website the best choice for medical students during and after. After receiving payment, we’ll provide you account information via email to login and download ebooks. 13, book 2/ http:// 25 MUCOGINGIVAL SURGERY WITH FREE GINGIVAL GRAFT (STRIP TECHNIQUE) FOR AUGMENTATION OF THE ATTACHED. British Dental Journal 199, 146 - 149 (2005) Published online: 13 August 2005 . Subject Category: Periodontology. Background Systemic inflammation may impair vascular function, and epidemiologic data suggest a possible link between periodontitis and cardiovascular disease. Bony exostoses developed subsequent to free gingival grafts: case series : Article : British Dental Journal. British Dental Journal. ![]() Published online: 1. August 2. 00. 5 . Mandibular tori were observed in more than a quarter of modern dry skulls and palatal alveolar exostoses in more than a half. Both BE species may be found more usually in young male dentate subjects, probably from alveolar bone origin. Multiple exostoses are found somewhat less usually than mandibular tori or palatal alveolar exostoses on the maxillary buccal surface below the mucobuccal fold in the molar region. Other types of BE have been found over the past years associated with unusual postoperative conditions. Tooth Mobility - Miller Classification Class 0. Normal (physiologic) movement when force is applied. Mobility greater than physiologic. Rete pegs (or rete processes, or rete ridges) are the epithelial extensions that project into the underlying connective tissue in both skin and mucous membranes. Buccal bony exostosis (BBE) development secondary to soft tissue graft procedures has been reported in a small number of cases, eg as a consequence of shallow vestibules increasing with the use of skin grafts. The periodontal literature describes BBE development also at sites where free gingival grafts (FGG) have been used to increase the amount of gingiva (Pack et al. Efeoglu and Demiel. Definition </li></ul><ul><li>2. ![]() Periodontology 2000 has been ranked the number 1 journal in Dentistry, Oral Surgery & Medicine in the 2015 ISI Journal Citation Reports. Department of Periodontics I.T.S Dental College, Hospital & Research Centre Greater Noida 2nd April, 2014 Moderator- Dr. Occlusal trauma is a dental term that refers to the damage incurred when teeth are left in traumatic occlusion without proper treatment. When the maxillary and. Czuszak et al. 1. Otero- Cogide et al. Echeverria et al. All surgeries were achieved by accidental or intentional periosteal fenestration of the receipt sites. Top of page. Case 3. In 1. 97. 5 a 3. 7- year- old female patient underwent two FGG involving the buccal surface of teeth 3. Throughout the following 2. The patient was satisfied with the results and did not wish to have them corrected. Top of page. Case 4. In 1. 98. 6 a healthy 3. FGG at the buccal area of teeth 4. A linear fenestration was performed in the receipt site periosteum where the frenum was inserted. The clinical result was excellent, however the grafted area volume increased in the following years, presenting a larger hard consistent painless enlargement over the corresponding area. Since the patient was unconcerned, the BE was not removed. Top of page. Case 5. A 3. 1- year- old woman was referred to our private dental office presenting with the lower lip frenum insertion close to the lower incisors' papillae, 3. In 1. 98. 7, frenectomy with linear periosteal fenestration was accomplished to remove the muscle insertions in association with an FGG. Healing followed uneventfully and a wide keratinised gingiva was obtained. The grafted area maintained a healthy aspect, but with a slow and progressive volume increased over the time. After 1. 4 years, in 2. Flap reflection showed quite a resistant compact bone formation which was partially removed. Histological examination confirmed the exostosis diagnosis. Top of page. Discussion. BBE development subsequent to free gingival grafts has been reported in a small number of cases,8, 9, 1. The authors suggest that patients presenting toris or any kind of BE are highly susceptible to bony overgrowth responses. Another four reports have been adding hypotheses and clinical characteristics to this uncommon osseous proliferation. Efeoglu and Demirel. Czuszak et al. 1. FGG. Otero- Cagide et al. FGG may be the result of a periosteal trauma combination during site preparation and the activation of osteoprecursor cells contained in the connective tissue of the graft. Echeverria et al. FGG were located in the cuspid- premolar area. They suggested that the grafted areas may be influenced by factors acting at this level, eg excessive forces, surgical trauma and genetic factors. Among the related reports, all the authors suggest that the periosteal trauma seemed to be the main aetiological agent associated with the exostosis development. In cases of skin grafts, the occurrence of periosteum fenestration after the graft suture position has also been observed. This surgical trauma can be associated with the liberation of osteoprogenitor cells from the periosteum- bone interface inducing osteogenesis. We are in agreement with this because at our nine reported sites this osseous formation has been verified after surgical procedures in which periosteal trauma occurred, eg periosteal fenestration. At the first presented case the root was exposed and the exostosis covered the fenestration. Frenectomies were achieved through linear receipt site periosteum fenestrations,1. FGG placed over the fenestrated areas, when frenum attachments were toward the marginal gingiva interfering in oral hygiene. The majority of exostoses have been found in these areas. It is possible that when we were trying to leave the receipt site free from elastic fibres and muscle inserts (preparing the appropriate bed for the graft), micro- fenestrations may have occurred, and consequently, may have also stimulated the exostosis formation. It can be observed among the cases reported in the literature. Table 1). Accidental lesions may probably stimulate the bony formation development. In our five cases, these osseous formation developments have always been related with accidental or intentional periosteal fenestrations. However, bony overgrowth can be seen in three of these cases covering tooth roots that have been supporting fixed and removable prostheses. The concept that BE formation can occur in response to heavy occlusal forces with the purpose of reinforcing bone trabeculae, was initially described by Glickman and Smulow. This new bone formation, providing buttressing, was divided into exostosis and lippings. A previous study investigated the prevalence, characteristics and evidence for BBE or lippings formation in a sample of 4. BBE and lippings were found at 7% and 1. BBE were mainly observed around the upper premolar- molar area, especially in males. Lippings were seen in lower incisors, premolars and molars, with no gender distribution. However, the authors suggest that 'other factors may be of greater importance in the aetiology of buccal bone enlargements'. Case reports of benign osseous proliferation beneath posterior fixed partial denture pontics have been related in the dental literature. As aetiological agents we (the authors) suggest genetic factors, functional stresses and chronic irritation. Two patients (cases 3 and 5) had the graft areas associated with teeth that have been supporting removable partial dentures; the other one (case 1), to teeth that had been supporting a cantilever. It is possible that the combination of periosteal (fenestration) and occlusal function (as a low- grade irritation) is responsible for this osseous proliferation. Clinically, a review of the published reports (Table 1) suggested that canines and premolars, 8. BBE development. This fact was also observed by Echeverria et al. On the other hand, reasons for BE formation are more speculative. As previously mentioned, there have been patients who have developed BBE in the presence of other extraoral exostoses, as well. However, it should be noticed that intraoral toris were only observed in 1. Table 1). Sonnier et al. In contrast, the collective results from published case reports and the findings of the present paper (Table 1) indicate that 9. BBE after FGG, are females. Despite these differences, the development of such osseous overgrowths may be associated with the presence of teeth and their surrounding periodontal structures. Top of page. Conclusion. In conclusion, based on previous reports, periosteal trauma, eg fenestration, seems to be the main aetiologic agent associated with BBE development in areas where an autogenous FGG was placed. However, other stimuli alone, or in combination acting at this level, eg functional stresses and genetic factors, particularly in autogenous grafts, are of special interest. Thus, clinical studies with larger samples are needed to establish whether periosteal fenestration is the main aetiologic agent. Another sample of patients who underwent FFG and periosteum linear fenestration has been showing discreet clinical signs of exostosis formation, which will be confirmed by future postoperative visits.
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