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Extraosseous/peripheral Ameloblastoma (EPA) is a rare, benign odontogenic soft tissue tumour with the same histological characteristics as the more common intraosseous subtypes. The EPA appears in the soft tissue of the gingiva and the mucosa of the alveolar process often as unspecified painless swelling. The present case report describes an EPA in the aesthetic area of the left anterior maxilla. Based on the clinical finding the suspected diagnosis of a gingival cyst was made. Firstly, this case should highlight the importance of a proper histopathologic evaluation whenever a biopsy is performed. Furthermore, this report should illustrate a step-by-step procedure from the surgical re-excision of the EPA with a safetymargin to the healing phase to the aesthetic satisfying rehabilitation by using periodontal plastic surgery.

The quality of intraoral scanning systems is steadily improving, and they are becoming easier and more reliable to operate. This opens up possibilities for routine clinical applications. A special aspect is that overlaying (superimposing) situations recorded at different times facilitates an accurate three-dimensional difference analysis. Such difference analyses can also be used to advantage in other areas of dentistry where target/actual comparisons are required. This article presents potential indications using a newly developed software, explaining the functionality of the evaluation process and the prerequisites and limitations of 3D monitoring.

Many orthodontic treatments involve tooth extraction. Gingival invagination is a common side effect after orthodontic extraction space closure leading to compromised oral hygiene and the space closure being hampered. Even the long-term stability of the orthodontic treatment result may be jeopardized. The aim of this study was to identify risk factors for the development of gingival invagination and possible implications on oral health and orthodontic treatment results.A total of 30 patients presenting 101 tooth extractions and subsequent orthodontic space closure were investigated to detect the presence of gingival invagination. The time required until active space closure, the thoroughness of space closure, and probing depths mesial and distal to the extraction site in addition to age, gender and the Periodontal Screening Index were investigated. A new coding system to describe the extent of gingival invagination is introduced for the first time here.Gingival invagination developed more frequently in the lower jaw (50%) than the upper (30%). Complete penetration occurred in the upper jaw in 6% of the patients and in the lower jaw in 25%. All patients without gingival invagination revealed complete space closure, whereas only 70% in the group with gingival invagination did so. The time until initiation of space closure took significantly longer in patients with gingival invagination (7.5 ± 1.4 months) than in patients without (3.3 ± 0.8 months). Probing depths of the adjacent teeth were significantly greater in regions with invaginations.Thus, the time required until space closure was initiated and the extraction site are important risk factors for the development of gingival invagination. The consequences of gingival invagination are instable space closure and deeper probing depths mesial and distal to the extractions. However, no statements concerning the mid- to long-term effects on oral health can be made.

The objective of this clinical, randomized, examiner-blinded split-mouth study was to compare the efficacy, the side effects and patients acceptance of two over-the-counter bleaching systems (strips versus gel) with respect to the bleaching times required to achieve six grades of whitening in human teeth. Tooth shades were documented by matching with the VITA shade guide, or dered according to value and assigned a numeric ranking from 1 to 16, lightest to darkest. Twenty-six adults participated in the study. Both treatments were applied twice daily according to the manufacturer's instructions. Efficacy and the PBI were measured by a dental examiner. Tooth hypersensitivity, gingival irritations as well as patients acceptance were recorded by a visual analog scale ranging from 0 to 10. In order to detect changes in the enamel surface due to treatment epoxy casts of the study teeth were analysed by SEM. A total of 20 volunteers completed the study. The subjects teeth treated with the strips-system exhibited a 6.0 +/- 0.0 mean shade scores improvement compared to baseline (53.7 cycles; 1610.3 min), and the subjects teeth treated with the gel-system exhibited a 3.3 +/- 1.4 mean shade scores improvement (64.6 cycles; 969.0 min). However, both treatments were able to whiten teeth statistically significantly compared to baseline. Side effects caused by the two systems were minimal and reversible. None of the teeth studied showed detectible enamel surface changes in the subsequent SEM analysis. Both methods were well accepted.

The congenital granular cell tumor is a rare lesion of newborns located on the alveolar ridge with a marked predilection for female infants. Histologically these tumors are characterized by large eosinophilic granular cells, similar to granular cell tumors in adults which are often seen as Abrikossoff tumors. Immunohistochemical studies revealed the different histogenesis and evolution of both these tumor entities. We report on a female newborn infant with a congenital epulis of the left anterior maxillary alveolar ridge. This case demonstrates a rare congenital tumor of newborns and reveals the histogenetic differences to granular cell tumors in adults.

Four members of a family in three generations are presented who were affected by a rare syndrome (mucosa hyperkeratosis syndrome). This syndrome is characterized by autosomal-dominant inheritance, white lesions of the gingiva, and palmoplantar hyperkeratosis. The four affected members of the family revealed an abnormal keratinization of the gingiva and palmoplantar epidermis. Biopsies of plantar and gingival lesions histologically showed acanthosis and hyperkeratotic cornification of the epithelium. Electron microscopy demonstrated the features of epidermolytic hyperkeratosis.From the differential diagnostic point of view, the mucosa hyperkeratosis syndrome has to be distinguished from the Jadassohn-Lewandowsky syndrome and the Howel-Evans' syndrome, which is associated with esophageal carcinoma.

Results of the veterinary examination of feral cats living in a delimited area of Berlin city are presented. Between 1996 and 1999 thirty nine cats were investigated, among them eleven individuals twice. All animals were positive for one or several pathologies, but only seven cats were in bad condition. Most common were periodontal and gingival diseases, followed by conjunctivitis. Five cats were positive for FIV, seven for FeLV, one tomcat for both. Twenty six cats vanished during the study period of 42 months, only one third of cats survived and remained in the study area throughout. Four cats were given to pet lovers, nine cats disappeared without trace, seven animals died in traffic accidents and six cats died of illnesses. Cats less than three years of age vanished more often than expected from their representation in the population. Dirty or large feeding places for cats constitute a source of infections. Feeding sites should be accessible to only few individuals and left-overs that may attract stray cats, rats or birds should not remain at feeding places.

Therapy resistant swellings of the maxillary region and unilateral nasal discharge in older horses are mainly thought to be consequences of neoplasias of the oral cavity, especially of the gingiva and the teeth, or to develop from tumours of the nasal cavity. We report an unilateral swelling of the left nasal and buccal region in a 13-year-old gelding, which was accompanied by an aggressive destruction of involved osseous tissue due to a severe proliferative granulomatous inflammation. The granuloma was caused by the nematode Halicephalobus (syn. Micronema) deletrix. This nematode infection is known for over 30 years, even though the here reported form is uncommon and rarely diagnosed. However, this report shows that even in cases of unilateral maxillary swellings in horses a granulomatous inflammation due to nematodiasis should be considered as an additional differential diagnosis.

For this article all cases of suspected drug-induced discolouration of teeth and gingiva reported between 1.1.1989 and 31.5.1997 have been collected. As far as documented all discolourations were reversible and represented exclusively undesired but not serious adverse drug effects. In the literature such events are usually not mentioned. Thus, sense and intention of this work is to draw attention to certain adverse effects that are hitherto not well known.

23 extraction sites from group I (14 patients, average age 25 years, two months) which exhibited gingival invagination during orthodontic space closure with fixed appliances were compared with an equal number of extraction sites without gingival invaginations from group II patients (13 patients, average age 22 years, three months). Clinical analysis criteria were: interdental distance, treatment period, depth of gingival invagination, plaque index, gingival index, and probing depth. The marginal bone level at the teeth and the interdental bone height were measured by radiographs. Comparisons of the group I information with the information from group II obtained by applying the same analysis criteria revealed that, given proper oral hygiene, the presence of gingival invaginations (mean depth 2.7 +/- 1.1 mm) has no influence on the hygienic state and, the level of gingival inflammation in the invagination area. However, a marginal bone loss at the teeth mesial and distal to the extraction sites, a reduction of the interdental crestal bone height, and an extended time frame for orthodontic space closure must be expected.

Various tumorlike reactions of the oral mucous membranes under the term Epulis are summarized. These histologically different benign or malignant neoplasms of the gingiva are not very frequent. The differential diagnosis on a clinical basis like symptoms and macroscopic appearance is not easy. Sometimes under these harmless appearing lesions highly aggressive and malignant tumors may be hidden; as there are carcinomas, sarcomas, metastases, tumors of the salivary glands or malignant lymphomas. The therapy of choice is the complete removal including the underlaying periosteum. Occasionally the adjacent bone and tooth have also to be resected. Because of the harmless clinical appearance a histological examination is always required. Some clinical and pathohistological impressive examples are presented.

Benign and malign forms of tumors of the peripheral nervous system also occur in the region of jaw and face. They demonstrate a quite different dignity and different courses. Very well known is the neurofibromatosis (Recklinghausen) which can be observed in several variants in face. The possibility is pointed out that primarily benign tumours of the peripheral nervous system may be degenerated to malign ones and the course as well as the therapy with benign and malign tumours are being described.

Caries prevalence and pathological disposition of the gingiva and periodontium in patients with a variety of chronic diseases were investigated in differentiated studies. The results demonstrate the necessity of specific preventive dental measures taking into consideration the concrete pathological situation.

A 27-year-old white female patient, claiming her psychiatric disorder to stem from a mercury intoxication caused by amalgam restorations, was examined. Circumscribed gingival pigmentations were found around PM crowns cemented on amalgam fillings. The histologic and metallographic examination of the incisional biopsy sample of the pigmented lesion together with the toxicological results revealed no indication of a mercury intoxication. In order to enable corrosive reactions to proceed as slowly as possible PM crowns should not be in contact with amalgam fillings, as this case showed.

Free mucosal grafting is a simple, safe and predictable procedure. It is indicated in the treatment of progressive recessions in patients with reduced attached gingiva, in recurrent traumatic marginal lesions inspite of correct tooth brushing, in refractory dental neck hypersensitivity and for cosmetic reasons in patients with recessions. In these situations advancement grafting is done as a secondary procedure. To prevent the potential occurrence of recessions free mucosal grafting may also be indicated prophylactically before orthodontic or prosthetic management. The management concept in patients with recessions as well as the indications of the procedure, the technique used at our department and aspects of planning surgery are discussed.

The fluorescein angiographs of the attached gingiva of 10 out of 12 subjects showed distinct areas of ischaemia which were clinically not discernible when standardized tensions of 100 g or 200 g tensions were exerted on the mandibular frenum. The fluorescein angiographs were reproducible in 3 out of 4 cases and the ischaemic areas reached the adjacent gingival margins in 5 cases. Possible hypoxic damage of the periodontium by tension of frenum is discussed.

Gingival recessions in the upper jaw were covered by a modified bridging flap and follow-up examinations were carried out over three years. After one year the covering result was 72% and after three years 66%.

The diagnosis of acute lymphatic non-T-non-B leukaemia of common ALL type was confirmed in a 22-year-old woman. Cytostatic treatment brought full remission for 21/2 years. Renewed cytostatic treatment for recurrence brought about a mucormycosis in the mid-face region during a period of protracted agranulocytosis, despite antibiotic prophylaxis with ketoconazole and cotrimoxazole. The causative mucor organism was demonstrated in smears and biopsy material. The infection was successfully treated with i.v. amphotericin B and débridement of the affected tissue. There remained large tissue defects in the region of gum, nose, upper lip and right oral cavity. Previously the mortality rate of mucormycosis in the course of leukaemia was 100%.

50% of patients with periodontopathy, exhibited the presence of amyloid in the clinically-altered gums. The biopsy specimen of the gums was examined microscopically by means of the crossed polar method. Seemingly-normal gum biopsies were, in all cases, amyloid positive. Amyloid was detected in two out of ten cases of healthy mucosa libera of the cheek. It was assumed that this deposition of amyloid was the consequence of a locally-limited pathological process. These results cast doubt on the possibility of tracing the pericollagenic form of general amyloidosis through gingival biopsy. An alternative procedure would be to biopsy the mucosa libera of the cheek.