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Soft tissue fenestrations are extremely rare in the natural dentition and have only recently been reported on dental implants. Although the pathogenesis of their formation is not completely understood, several predisposing risk factors have been identified, some of which may affect dental implants as well. This article presents a thorough review of the literature pertaining to gingival fenestration. It also describes the surgical management of lesions developed approximately six years following osseointegration of two dental implants.

A case report illustrating the successful treatment of a gingival fenestration with an acellular dermal matrix (ADM) allograft. After 2½ months of healing, the ADM was completely integrated into the soft tissues of the mandibular anterior gingiva with complete resolution of the gingival fenestration, resulting in excellent gingival esthetics.

Mucosal fenestrations are rarely encountered in clinical practice, and as such their management is not often reported. Their treatment might be further complicated due to a communication with the oral environment, making them more susceptible to accumulation of debris, plaque, and calculus, thereby reducing the probability of mucosal renewal. The aim of the present case report is to highlight one such rare clinical scenario and its apt and effective management. Surgical management of an uncommon presentation of concomitant gingival recession with an isolated mucosal fenestration in an atypical location, with an allograft matrix is presented here with 2 years' follow-up. A review of the literature reveals no previous application of AlloDerm graft for the management of a similar situation.

The health and suitability of mouth components play an important role towards defining facial attractiveness. An important component of the oral cavity is the color of the gingival tissue. Gingival melanin hyperpigmentation is caused by several reasons and affects people across ethnicity, race, age, and both gender. Lasers are presently being used for gingival melanin depigmentation. In this article, we reviewed studies on laser parameters, duration of gingival healing, pain perception during and after the operation, scores used for the evaluation of gingival melanin hyperpigmentation, follow-up period, treatment results, and recurrence reports. We conclude that laser ablation for gingival depigmentation is one of the most pleasant, reliable, acceptable, and impressive techniques available for treating gingival melanin hyperpigmentation.

Objective: The present study aimed to compare clinical outcomes during the recovery period after soft tissue surgery performed by an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser with those after surgery with the conventional method, in which a scalpel was used., Methods: A total of 44 epulis fissuratum removal surgeries were performed in 30 healthy volunteers using either an Er,Cr:YSGG laser (laser group) or a scalpel (conventional group), with the same number of lesions in each group. Both groups were controlled postoperatively on days 2, 7, 14, and 30. The visual analog scale (VAS) pain scores of the patients and healing, erythema, and suppuration in the surgical area were recorded with scores between 0 and 3. Total wound surface was measured by a ruler according to the Bates-Jensen Wound Assessment Tool., Results: The results of the present study demonstrated that there were no significant differences between the conventional group using analgesic and the laser group in terms of the VAS scores (p = 0.744) and edema (p = 0.206). Evaluation of wound surface revealed healing without any problem as of the 2nd day at a rate of 82% in the laser group and 59% in the conventional group., Conclusions: In conclusion, Er,Cr:YSGG laser was superior to scalpel regarding clinical outcomes, and led to a difference in the use of analgesic and local anesthetic.

Objective: The objective of this study is to evaluate and compare surgical stripping and neodymium-doped: yttrium, aluminum garnet (Nd:YAG) laser techniques for gingival depigmentation and to evaluate their effect on repigmentation., Background Data: Gingival depigmentation is often associated with repigmentation. Recurrence of pigmentation differs according to different treatment modalities., Materials and Methods: In this study, 40 maxillary sites from 20 patients presenting bilateral melanin gingival hyperpigmentation were selected. Contralateral quadrants in the maxilla were randomly assigned to receive Nd:YAG laser at 3 W, 30 mJ per pulse, with contact mode, and with a handpiece with a 300 μm diameter optic fiber and surgical stripping. Plaque index, Dummett Oral Pigmentation Index (DOPI), Hedin melanin index, size of pigmented area, time interval and extent of repigmentation, time taken for each of the procedures, assessment of pain, intraoperative bleeding index, and patient preference were compared from baseline to 6 months., Results: Comparison between Nd:YAG laser and surgical stripping group for plaque index, DOPI, Hedin index, size of pigmented area, time interval, and extent of repigmentation, at 6 months was statistically nonsignificant. Intergroup comparison for time taken, pain, and patient preference was statistically significant. Intragroup comparison for Nd:YAG laser and surgical stripping at 6 months for DOPI, Hedin index, and size of pigmented area was statistically significant., Conclusions: From the present study it can be concluded that Nd:YAG laser can be used as an alternative technique for gingival depigmentation. However, surgical stripping continues to remain as a cost-effective procedure.

This study was conducted to evaluate the usefulness of decellularized and lyophilized extracellular matrix, which was acquired from human amniotic membrane, for surgical closure of the mucogingival defects. Preliminarily, to create a gingival recession defect, silk ligature was applied on the gingival part of the upper incisor in the first (experimental) (n=20) and second (control) (n=20) groups. On the 14th day, the ligature was removed and the damaged gingival tissues were resected. The formed mucogingival defect, in the animals of the first group, was covered with acellular human amniotic three-dimensional scaffold with bone marrow stem cells. Animals with mucogingival defect of the second group were left untreated and served as controls. Unlike the animals from the control group, in animals from the experimental group the mucogingival defect already on the seventh day was completely closed and there was the newly formed epithelial lining, which in shape and color did not differ from the normal. Acellular human amniotic membrane as a three-dimensional scaffold boosts angiogenesis and increases the reparative regeneration of the damaged tissues; and it is well-tolerated by the gingival tissues. Hence, human amniotic membrane might be a suitable alternative to other conventional methods of treating gingival recession.

Background and Overview: There is insufficient literature on the lack of oral pigmentation in the esthetic zone. The aim of this case report was to illustrate the potential impact of loss of gingival pigmentation in the esthetic zone, describe its surgical treatment, and discuss the limited literature on this topic., Case Description: An African American woman with high smile line had localized loss of gingival melanin pigmentation as a complication after implant failure and attempted guided bone regeneration in site 8. A highly pigmented free gingival graft was collected from the facial-attached gingiva of the maxillary posterior teeth and placed onto the previously de-epithelialized recipient bed in the maxillary front. Some pigmentation of the graft was preserved and was visible a few weeks after surgery; some pigmentation recovered over time. At 6 months after surgery, the patient was satisfied with the esthetics. Complete recovery of pigmentation took 12 months, at which time the patient was ready to proceed with the final prosthetic work., Conclusions and Practical Implications: Gingival pigmentation can be restored using a free gingival graft from a highly pigmented area. When surgical procedures are performed in such cases, loss of gingival pigmentation should be part of the informed consent. However, further research, including histology, is needed., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Epulis is a benign hyperplasia of the oral soft tissues. Surgical excision always extends to the periosteum and includes scaling of adjacent teeth to remove any possible irritants. The esthetics of the soft tissues may be compromised, however. This article studies three cases in which an immediate laterally positioned flap (LRF) was used to repair mucogingival defects after epulis biopsies. After 24 months, the color and shape of the surgical areas were healthy and stable, nearly complete root coverage was evident, and no lesions reoccurred. For repairing gingival defects after biopsy, LRF appears to be minimally traumatic while promoting esthetic outcomes.

Fabrication of well-fitting complete dentures becomes a challenge in the presence of epulis fissuratum in the maxilla or severely resorbed alveolar tissue in the mandible. This clinical report describes the surgical and prosthetic treatment of a patient who presented with both problems. The neutral zone technique was used to improve the stability of the mandibular complete denture. Both dentures were fabricated prior to surgical excision of the epulis fissuratum and inserted immediately following the surgery.

Background: Soft tissue grafting for the purposes of increasing the width of keratinized tissue (KT) is an important aspect of periodontal treatment. A systematic review was analyzed, focusing on non-root coverage tissue grafts. The references were updated to reflect the current literature., Methods: To formulate the consensus report, group members submitted any new literature related to the topic that met criteria fitting the systematic review, and this information was reviewed for inclusion in this report. A consensus report was developed to summarize the findings from the systematic review and to guide clinicians in their treatment decision-making process., Results: Forty-six articles met the criteria for inclusion in the final analysis, and two articles were added that were used to formulate this consensus report. A list of eight clinically relevant questions was posed, and consensus statements were developed., Conclusions: The evidence suggests that a minimum amount of KT is not needed to prevent attachment loss (AL) when optimal plaque control is present. However, if plaque control is suboptimal, a minimum of 2 mm of KT is needed. The standard procedure to predictably gain KT is the autogenous gingival graft. There is limited evidence for alternative treatment options. However, additional research may offer promising results in certain clinical scenarios., Clinical Recommendations: Before patient treatment, the clinician should evaluate etiology, including the role of inflammation and various types of trauma that contribute to AL. The best outcome procedure (autograft) and alternative options should be reviewed with the patient during appropriate informed consent. Proper assessment of the outcome should be included during supportive periodontal care.

Background: Gingival augmentation procedures around natural teeth and dental implants are performed to facilitate plaque control, to improve patient comfort, to prevent future recession, and in conjunction with restorative, orthodontic, or prosthetic dentistry. The aim of this study is to answer the most common questions related to this treatment modality based on the most relevant and current knowledge in the field., Methods: Two reviewers worked to answer the five most common and clinically relevant questions with supporting literature to understand the role of gingiva around teeth. 1) What circumstances require an increased zone of keratinized tissue (KT), or is KT important? 2) What is the ideal thickness of an autogenous gingival graft? Is a thick autogenous gingival graft more effective than a thin autogenous gingival graft? 3) What are the alternatives to autogenous gingival grafting to increase the zone of attached gingiva? 4) Does orthodontic intervention affect soft tissue health and dimensions? 5) What is the patient-reported patient outcome for minimal KT compared with that for an enhanced zone of KT? An extensive literature search was performed using PubMed, the Cochrane Oral Health Group Specialized Trials Registry (the Cochrane Library), and the most respected journals in the field., Results: Although gingival augmentation procedures were first introduced in 1960s, there have not been in-depth comparative studies examining the five questions that have been proposed by the authors. Lack of relevant systematic reviews and randomized clinical trials (RCTs) on this topic do not allow authors to answer those questions with a strong level of evidence. However, the following can be recommended after reviewing case reports and case series on these topics. 1) There is enough clinical evidence to support maintaining an adequate band of gingiva for intracrevicular margin restoration. 2) Thick grafts do not appear to result in better clinical outcomes than thin grafts. Thick grafts are likely to result in more primary contraction, whereas thin grafts tend to be prone to secondary contraction. 3) Viable alternative treatment modalities are currently available that are capable of providing KT augmentation without the need for palatal donor tissue. 4) Appropriately applied orthodontic forces do not cause permanent damage to a healthy periodontium. The probability of recession during tooth movement in thin biotype is high to justify gingival augmentation when the dimension of gingiva is inadequate. In addition, cases in which there will be a facial tooth movement outside of the alveolar process need to be considered for a gingival augmentation procedure. 5) Although the articles that have been published on this topic did not consider patient-reported outcomes and esthetics as part of the overall treatment success assessment, patients who have received alternative treatment modalities that did not depend on palatal tissue harvesting appear to have reported more satisfaction and less discomfort after treatment., Conclusions: Autogenous gingival grafts are still considered to be the "gold standard" procedure with unmatched success rates and clinical success when gingival augmentation procedures are required. However, tissue-engineered materials may offer viable options to palatal tissue harvesting for gingival augmentation. KT augmentation may prevent the development and progression of gingival recession, especially when restorative margins may interact with the periodontium and/or orthodontic treatment is indicated. Patient-reported outcomes should be considered for future studies on this topic. Additional RCTs and systematic reviews are needed to support these conclusions.

Granuloma gravidarum (GG), an inflammatory lesion, develops in the oral mucosa of pregnant women in response to chronic low-grade irritants and hormonal factors. A persistent granuloma gravidarum post partum and appropriate management strategies are discussed. Patients must be encouraged to undergo regular dental check-ups during the gestational period. Simple oral hygiene measures are highly effective in combating most oral lesions encountered in pregnancy., (2015 BMJ Publishing Group Ltd.)

Maintaining healthy parodontium during teeth restoration procedures is an indispensable condition for obtain- ing regular functionning and esthetics. Thus, the knowledge of correct anatomy and the influence of filling and complement on paradontium tissue is vital. Difficulty in maintaining appropriate gingival biological width (GBW) is a frequent problem encountered in this type of reconstruction. Preservation of unchanged biological width conditions predictible treatment result and, what is more, lack of inflammatory lesions in marginal parodontium. The ideal situation for parodontium is localizing the filling/complement border supragingivaly, which is at least 3 mm from alveolar process edge. In the case, when the above conditions are impossible to fulfil, elongation of clinical crown is a metod of choice. The effect is possible to achieve by surgical treatment or combined orthodontic - surgical treatment. Surgical treatment is faster and preferred procedure for indirect reconstruction, where achieving high clinical crown is necessary. Three clinical cases of performing method of surgical clinical crown elongation were presented in the article. Performing the described procedure enables correct tooth crown reconstruction and, what is most important, keeping individual toothing.

The aim of this article was to report the clinical case of a male patient of 20 years with hyperpigmented gingiva and moderate fluorosis, whose smile was reestablished by the use of a laser assisted depigmentation procedure, an enamel microabrasion technique, followed by at-home bleaching and subsequent remineralization therapy. The association of these techniques presented excellent results and the patient was satisfied. All techniques are painless, fast and easy to perform, in addition to preserving the hard and soft dental structure. Treatment showed immediate and permanent results; these techniques must be divulged among professionals and their patients.

Object: Cerebrospinal fluid-diverting shunts are often complicated by bacterial infections. Dental procedures are known to cause transient bacteremia that could potentially spread hematogenously to these implanted devices. No literature currently exists to inform practitioners as to the need for prophylactic antibiotics for patients who possess these implants. The authors performed a retrospective study to assess whether dental procedures and poor oral health were associated with a higher likelihood of developing CSF-diverting shunt infections., Methods: Neurosurgical and pediatric dental records from January 2007 to December 2012 were reviewed for shunt surgeries and dental encounters. Indications for shunt surgery and infection rates were recorded. Dental records were reviewed for several markers of overall dental health, such as a DMFT (decayed, missing, and filled teeth) score and a gingival health/oral hygiene score. The association between these scores and the incidence of shunt infections were studied. Moreover, the relationship between the incidence of shunt infections and the timing and invasiveness of preceding dental encounters were analyzed., Results: A total of 100 pediatric patients were included in our study, for a total of 204 shunt surgeries. Twenty-one shunt infections were noted during the 6-year study period. Five of these shunts infections occurred within 3 months of a dental procedure. The odds ratio (OR) of developing a shunt infection within 3 months of a dental procedure was 0.98 (95% confidence interval [CI] 0.27-3.01), and was not statistically significant. The OR of developing a shunt infection after a high-risk dental procedure compared with a low-risk dental procedure was 1.32 (95% CI 0.02-16.29), and was not statistically significant. There was no significant association between measures of dental health, such as DMFT and gingival health score, and the likelihood of developing a shunt infection. The ORs for these 2 scores were 0.51 (95% CI 0.04-4.96) and 1.58 (95% CI 0.03-20.06), respectively. The study was limited by sample size., Conclusions: Dental health status and the number and type of dental procedures performed do not appear to confer a higher risk of developing a CSF-diverting shunt infection in this pediatric population.

Congenital epulis (CE) or "Granular cell epulis" also previously termed as "Neumann's tumor" is a benign growth arising from the mucosa of the gingiva, typically seen as a mass protruding from the infant's mouth, often interfering with respiration and feeding. These tumors generally present as a single mass arising from the upper alveolus. We report a rare case of two congenital epulides arising from the maxillary and mandibular alveolus in a day old female infant, which was surgically excised, allowing for early initiation of breast feeding. The tumor cells stained negative for S100 protein hence differentiating from other granular cell tumors. The clinical presentation, differential diagnosis in regard to the various neonatal oral swellings and the management of CE has been discussed.

Pyogenic granuloma is a benign, non-neoplastic, mucocutaneous lesion and is especially common on the tongue, lips, and gums. This case report presents a large oral pyogenic granuloma of the gingiva and the surgical treatment of this lesion with Nd:YAG laser. A 14-year-old female patient referred with a complaint of a swelling and growth on the buccal side of her mandibular left premolar teeth. A comprehensive intraoral examination revealed a localized gingival mass between mandibular left premolar teeth on the buccal aspect. The treatment selected was surgical removal using Nd:YAG laser with the following irradiation parameters: power output 4 W, energy 100 mJ, frequency 40 Hz, and pulsed emission mode. During surgery, complications including hemorrhage were not observed, and no scarring developed after surgery. The excised area gradually improved within 1 month. The use of Nd:YAG laser in the treatment of pyogenic granuloma reduced bleeding during surgery, with a consequent reduction in operating time, promoted rapid postoperative hemostasis, and has better patient acceptance.

Localized overgrowths of gingiva such as peripheral fibroma, peripheral ossifying/cementifying fibroma, pyogenic granuloma and peripheral giant cell granuloma belong to a common group of lesions designated as focal reactive overgrowths (FROG). These growths are reactive in nature. They occur in response to chronic, low grade irritation caused by plaque or any other irritant. Etiology, clinical features and treatment modes of these lesions are the same with slight variations. The present case series describes five different cases of FROG where the lesions were treated by surgical excision under local anesthesia followed by a three month re-evaluation where no recurrences were observed.

Introduction: Localized amyloidosis in the head and neck is a rare and generally benign condition. In the oral cavity, amyloidosis usually involves the tongue or buccal mucosa. We present the second case of oral amyloidosis arising in the gingiva ever reported, to the best of our knowledge., Case Presentation: A 73-year-old White Spanish man presented a persistent nodular mass involving his upper gingiva. The lesion was surgically resected and the histological examination revealed a subepithelial, multinodular amorphous and fibrillar accumulation. Staining of the specimen for Congo red proved positive, exhibiting a reddish colour under light microscopy and apple-green birefringence under polarized light. With immunohistochemical tests, pentagonal amyloid component was demonstrated. An extensive study excluded any systemic involvement; a diagnosis of localized primary amyloidosis was made. After 2 years of follow-up, no clinical progression to systemic amyloidosis or local recurrence was observed., Conclusions: Localized amyloidosis of the gingiva is an extremely rare condition that seems to show no clinically distinct feature. Histologic examination is the first step towards diagnosis, followed by immunohistochemical tests. The diagnosis of localized amyloidosis should always be integrated with blood tests, a bone marrow biopsy, echocardiography and digestive endoscopy to intercept systemic involvement.

Introduction: The development of various benign oral mucosal lesions associated with dental implants, such as pyogenic granuloma or peripheral giant cell granuloma, has been rarely reported. However, the occurrence of vascular diseases, such as hemangioma, related to dental implants has not been explored in the literature. In this study, we report a case of co-development of pyogenic granuloma and capillary hemangioma on the alveolar ridge associated with a dental implant in a patient undergoing antithrombotic therapy. To the best of our knowledge, this is first case of hemangioma formation associated with a dental implant., Case Presentation: A 68-year-old Korean man was referred for intermittent bleeding and a dome-shaped overgrowing mass on his upper alveolar ridge. He underwent dental implantation 5 years ago, and was started on warfarin for cerebral infarction a year ago. He had experienced gum bleeding and gingival mass formation 6 months after warfarinization; then, his implant fixture was removed. However, his gingival mass has been gradually increasing. The gingival mass was surgically excised, and revealed the coexistence of pyogenic granuloma and capillary hemangioma in histological analysis of the specimen. The lesion has showed no recurrence for more than a year., Conclusions: Regarding immunostaining features, the endothelial cell markers, CD34 and CD31, and the mesenchymal cell marker, vimentin, were strongly detected, but cell proliferation marker, Ki-67, was negatively expressed in the endothelial cells of the hemangioma portion. However, in the pyogenic granuloma portion, CD34 was almost negatively detected, whereas vimentin and Ki-67 were highly detected in the fibroblast-like tumor cells. According to these heterogeneous characteristics of the lesion, the patient was diagnosed with coexistence of pyogenic granuloma and capillary hemangioma associated with the dental implant on the attached gingiva. We recommend that patients with dental implants who have chronic peri-implantitis under antithrombotic therapy should be closely followed to ensure early detection of oral mucosal abnormalities.

This case series characterizes the clinicopathologic features and treatment of oral pyogenic granuloma in 8 cats. The cats reported here were patients originating from collaborative efforts at an academic clinical teaching hospital and a specialty dentistry/oral surgery referral practice. Although the initial biopsy results were variable, in all cases the diagnosis reflected an inflammatory process. A second clinicopathologic evaluation of these cases determined that all lesions were consistent with oral pyogenic granuloma. The location of the lesion was consistent among all cats within the present study Lesions developed at the vestibular mucogingival tissues of the mandibular first molar teeth. We propose that malocclusion and secondary traumatic contact of the ipsilateral maxillary fourth premolar tooth with the mandibular soft tissues is a possible contributing factor in the etiopathogenic mechanism.

Objective: Repigmentation variably occurs with different treatment methods in patients with gingival pigmentation. A systemic review was conducted of various treatment modalities for eliminating melanin pigmentation of the gingiva, comprising bur abrasion, scalpel surgery, cryosurgery, electrosurgery, gingival grafts, and laser techniques, to compare the recurrence rates (Rrs) of these treatment procedures., Material and Methods: Electronic databases, including PubMed, Web of Science, Google, and Medline were comprehensively searched, and manual searches were conducted for studies published from January 1951 to June 2013. After applying inclusion and exclusion criteria, the final list of articles was reviewed in depth to achieve the objectives of this review. A Poisson regression was used to analyze the outcome of depigmentation using the various treatment methods., Results: The systematic review was based on case reports mainly. In total, 61 eligible publications met the defined criteria. The various therapeutic procedures showed variable clinical results with a wide range of Rrs. A random-effects Poisson regression showed that cryosurgery (Rr = 0.32%), electrosurgery (Rr = 0.74%), and laser depigmentation (Rr = 1.16%) yielded superior result, whereas bur abrasion yielded the highest Rr (8.89%)., Conclusions: Within the limit of the sampling level, the present evidence-based results show that cryosurgery exhibits the optimal predictability for depigmentation of the gingiva among all procedures examined, followed by electrosurgery and laser techniques., Clinical Significance: It is possible to treat melanin pigmentation of the gingiva with various methods and prevent repigmentation. Among those treatment modalities, cryosurgery, electrosurgery, and laser surgery appear to be the best choices for treating gingival pigmentation., (© 2014 Wiley Periodicals, Inc.)

Metallic alloys can suffer corrosion, and metallic posts and cores used for restorative procedures may develop a blue-gray pigmentation in root dentin, which in turn changes the color of gingival tissues. Removing posts and cores may lead to root fracture, and bleaching agents have a limited effect on staining from alloy corrosion. Surgical techniques for correcting undesirable esthetic deficiencies have been investigated in the literature. This article describes the case of a patient with gingival discoloration caused by root pigmentation in the maxillary area. A subepithelial connective graft harvested from the palate was used to treat the gingival color discrepancy.

Oral health is affected by hormonal changes during pregnancy but is usually neglected by both the obstetrician and the patient during follow-up visits. Gingival enlargement is one of the most common oral lesions seen during pregnancy. Rarely, gingival enlargement can be very big, significantly affecting maternal nutrition and impairing haemodynamic status. A giant granuloma gravidarium and appropriate management strategies are discussed. Patients must be encouraged to undergo regular dental check-ups during pregnancy. Simple oral hygiene measures are highly effective in mitigating most oral lesions of pregnancy.

Background: Generation of site-appropriate tissue in the oral cavity includes the restoration of the correct anatomic type, amount, and distribution of the tissue. This study is a post hoc analysis of data collected during previously published results from two randomized clinical trials of a living cellular sheet (LCS; allogenic cultured keratinocytes and fibroblasts in bovine collagen) versus a free gingival graft (FGG), evaluating their ability to augment keratinized tissue or gingiva., Methods: Post hoc histologic and clinical (photographic) comparisons of the outcomes of treatment were performed on histologic and photographic data gathered in the two randomized clinical trials., Results: Histologic findings showed that LCS-treated sites resembled gingiva rather than alveolar mucosa. Photographic analysis indicated that LCS treatment resulted in more site-appropriate tissue than FGG in terms of tissue color, with adjacent untreated tissue, absence of scar formation or keloid-like appearance, and mucogingival junction alignment., Conclusion: Treatment of mucogingival defects with LCS resulted in the generation of tissue that is more site appropriate than tissue transplanted from the palate.

Background: The use of lasers in periodontology is a matter of debate, mainly because of the lack of consensual therapeutic protocols. In this randomized, split-mouth trial, the clinical efficacy of two different photoablative dental lasers, erbium:yttrium-aluminum-garnet (Er:YAG) and diode, for the treatment of gingival hyperpigmentation is compared., Methods: Twenty-one patients requiring treatment for mild-to-severe gingival hyperpigmentation were enrolled. Maxillary or mandibular left or right quadrants were randomly subjected to photoablative deepithelialization with either Er:YAG or diode laser. Masked clinical assessments of each laser quadrant were made at admission and days 7, 30, and 180 postoperatively by an independent observer. Histologic examination was performed before and soon after treatment and 6 months after irradiation. Patients also compiled a subjective evaluation questionnaire., Results: Both diode and Er:YAG lasers gave excellent results in gingival hyperpigmentation. However, Er:YAG laser induced deeper gingival tissue injury than diode laser, as judged by bleeding at surgery, delayed healing, and histopathologic analysis. The use of diode laser showed additional advantages compared to Er:YAG in terms of less postoperative discomfort and pain., Conclusions: This study highlights the efficacy of diode laser for photoablative deepithelialization of hyperpigmented gingiva. It is suggested that this laser can represent an effective and safe therapeutic option for gingival photoablation.

Aim: To identify critical elements in design and execution of coronally advanced flap, lateral positioned flap and their variations for the treatment of facial gingival recessions or peri-implant soft tissue dehiscences., Materials and Methods: Clinical studies were identified with both electronic and hand searches, and examined for the following aspects: flap design and incision techniques, flap elevation, root conditioning, flap mobility, flap stability and suturing. Moreover, prognostic factors for complete recession coverage were identified., Results: Some critical elements are evident in flap design and execution: the dimension and the thickness of tissue positioned over the denuded roots; the use on root surface of enamel matrix derivate; the stability and suturing of the flap in a position coronal to the cemento-enamel junction. The pre-determination of the clinical cemento-enamel junction, smoking status, operator surgical skills and the compliance to a supportive care programme have a role in obtaining and maintaining a complete root coverage., Conclusions: Different flap approaches are available when performing periodontal plastic surgery, resulting in a great variability in clinical outcomes. The possibility of using pedicle flaps alone to achieve complete soft tissue coverage of facial implant dehiscence has not yet been investigated., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This double-masked, randomized controlled trial with a split-mouth design aimed to compare patient- and professional-centered outcomes using different therapeutic approaches-neodymium-yttrium aluminum garnet (Nd:YAG) laser or scalpel technique-for gingival depigmentation. Patients presenting bilateral melanin gingival hyperpigmentation and who requested cosmetic therapy were recruited. Contralateral quadrants were randomly assigned to receive Nd:YAG laser (settings: 6 W, 60 mJ/pulse, and 100 Hz) or scalpel technique. Patient morbidity experienced at intratherapy and during the first postoperative week was evaluated. In addition, after 6 months, the cosmetic results achieved for the different therapeutic approaches were evaluated by patients and professionals. The chair time of each technique was also calculated. Patient-oriented outcomes concerning intratherapy morbidity did not demonstrate any differences between groups (p > 0.05), although a higher extent of discomfort/pain was experienced in the side treated by the scalpel technique compared to the Nd:YAG laser procedure during the first posttherapy week (p < 0.05). Regarding to cosmetic outcomes, no differences between techniques were observed for patient and professionals (p > 0.05). Significantly higher chair time was required for the scalpel technique than for the Nd:YAG laser therapy (p < 0.05). The Nd:YAG laser or the scalpel technique may be successfully used for the treatment of melanin gingival hyperpigmentation. However, the use of the Nd:YAG laser has presented advantages in terms of less discomfort/pain during the posttherapy period and a reduction of treatment chair time.

Gingival enlargements may adversely affect speech, mastication, tooth eruption, and esthetics. These enlargements can occur as a result of the administration of certain anticonvulsants, immunosuppressants, and calcium channel blockers. The present case report describes the treatment of a patient with a phenytoin-induced gingival enlargement. A case of gingival enlargement should be treated in a step-wise manner, including consultation with the patient's physician, substitution of the drug, nonsurgical therapy, surgical therapy (if needed), and supportive periodontal therapy after every 3 months. In this case, healing was uneventful, and no recurrences occurred 3 months postoperatively.

Contamination and subsequent retention of foreign bodies within wound surfaces may negatively influence healing following maxillofacial injuries. Larger foreign bodies that produce embedded or impalement injuries of soft tissues are easily detected. However, smaller contaminants, such as sand, gravel, food particles, wood splinters, and glass fibers, may not be easily identified in the initial examination, and their remnants may remain within the injury site even after debridement. Tissue reactions depend on the host response, type of foreign body, and nature of the wound surface. The purposes of this report are to: (1) detail the diagnosis and management of a peripheral pulse granuloma following retention of food particles within gingival sulci during a dental injury; and (2) provide a brief review of the diagnosis of foreign body-induced granulomas following maxillofacial injuries in children.

Purpose: The primary objective of this study was to evaluate the safety of a tissue-engineered human ex vivo-produced oral mucosa equivalent (EVPOME) in intraoral grafting procedures. The secondary objective was to assess the efficacy of the grafted EVPOME in producing a keratinized mucosal surface epithelium., Materials and Methods: Five patients who met the inclusion criteria of having one mucogingival defect or a lack of keratinized gingiva on a nonmolar tooth, along with radiographic evidence of sufficient interdental bone height, were recruited as subjects to increase the width of keratinized gingiva at the defect site. A punch biopsy specimen of the hard palate was taken to acquire oral keratinocytes, which were expanded, seeded, and cultured on an acellular dermal matrix for fabrication of an EVPOME. EVPOME grafts were applied directly over an intact periosteal bed and secured in place. At baseline (biopsy specimen retrieval) and at 7, 14, 30, 90, and 180 days postsurgery, Plaque Index and Gingival Index were recorded for each subject. In addition, probing depths, keratinized gingival width, and keratinized gingival thickness were recorded at baseline, 30, 90, and 180 days., Results: No complications or adverse reactions to EVPOME were observed in any subjects during the study. The mean gain in keratinized gingival width was 3 mm (range, 3 to 4 mm). The mean gain in keratinized gingival thickness was 1 mm (range, 1 to 2 mm). No significant changes in probing depths were observed., Conclusion: Based on these findings, it can be concluded that EVPOME is safe for intraoral use and has the ability to augment keratinized tissue around teeth. Future clinical trials are needed to further explore this potential.

Background: Gingival melanin depigmentation procedures are commonly associated with recurrence of pigmentation, which starts with migration of melanocytes from the adjacent free gingiva. The extent and rate of recurrence varies according to the treatment modalities used and duration of follow-up. The aim of this study is to compare the surgical stripping; carbon dioxide (CO2); and erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser techniques for gingival depigmentation and to evaluate their effect on histologic changes in melanocyte activity and clinical repigmentation., Methods: In this study, 140 sites from 35 patients with bilateral melanin hyperpigmentation were treated with surgical stripping (two sites per patient), "epithelial-peel" (CO2 laser, 2 to 4 W, continuous wave),and "brushstroke" (Er:YAG laser, 180 mJ, 10 Hz, long pulse) techniques. Surgical microscope monitoring was performed intraoperatively. Patient preference and perception of pain, change in Dummett oral pigmentation index (DOPI), Hedin index, and change in area of pigmentation from baseline to 6 months postoperatively were recorded. Twenty samples each from the three treatment modalities were selected for histologic analysis using hematoxylin and eosin and dihydroxyphenylalanine oxidase special stains., Results: At the 6-month postoperative visit, 15 of 70 (21.4%) and three of 20 (15%) of the surgical-treated; 10 of 35 (28.6%) and six of 20 (30%) of the Er:YAG-laser-treated; and eight of 35 (22.8%) and four of 20 (20%) of the CO2-laser-treated sites showed clinical and histologic repigmentation, respectively. Paired t test, analysis of variance, and χ(2) tests were used for statistical analyses. P values for comparison of microscopic evaluation, change in DOPI, Hedin index, and area of pigmentation were 0.001, which were statistically significant. Comparison for patient preference and pain indices gave statistically significant values for Er:YAG laser depigmentation (P = 0.001)., Conclusions: Clinical repigmentation after gingival depigmentation is an outcome of histologic changes in the melanocyte activity and density of the melanin pigments. Surgical stripping for gingival depigmentation remains the gold standard; however, Er:YAG laser and CO2 lasers can be effectively used but with distinct differences.

Objective: The purpose of this study was to optimize gingival laser photoablation by thermographic and autofluorescent feedbacks., Background Data: Photoablative laser treatment is commonly used for gingival de-epithelization in patients with chronic periodontitis or hyperpigmentation. The reduction of collateral thermal damage of periodontal tissues is crucial for optimal treatment outcome., Methods: Nineteen patients with chronic periodontitis, seven of whom showing gingival hyperpigmentation, were subjected to de-epithelization with an 810 nm diode laser used in continuous (1 W, 66.67 J/cm2) or pulsed wave mode (69 μJ, 18 μs, 8000 Hz, corresponding to peak/mean power of 3.8 W/0.6 W, 40 J/cm2), depending upon individual gingival features. Photoablation was controlled in real time with a 405 nm violet light probe, which stimulated a yellow autofluorescence of the laser-coagulated tissue. The temperature at the target tissue was controlled with an infrared thermographic probe. When appropriate, small biopsies were taken to evaluate epithelial ablation and thermal effects., Results: The energy density transferred to the treated tissue surface was computed based on the irradiation modality of the target tissues. Laser photoablation performed under thermographic control yielded complete removal of the gingival epithelium with minimal injury to the underlying lamina propria. Irradiation-evoked autofluorescence, conceivably the result of epithelial keratins, allowed very sharp recognition of the borders between laser-ablated and intact epithelium, thus preventing repeated irradiation., Conclusions: This study further supports the favorable characteristics of photoablative diode laser for gingival de-epithelization. Concurrent thermographic and fluorescent analysis can provide substantial help to the setup of a safe and well-tolerated protocol.

Oral lichen planus is a chronic autoinflammatory mucositis. Oral lesions are predominantly white; they tend to be bilateral while involving the buccal mucosa especially cheek, tongue, gums, lips, and palate. Many topical and systemic agents are currently used with unpredictable results. Fat grafting is characterized by the placement of multiple parcels of purified fat with blunt cannulas; at the beginning, it was introduced to improve facial aesthetics. Recently, it has been translated to other surgical cases such as posttraumatic deformities and craniofacial anomalies and as ancillary reconstructive procedure after tumor resections. The successful results of this procedure encouraged us to use this approach to a clinical case of oral lichen planus refractory to conventional therapy.

Pyogenic granuloma (PG) is a kind of inflammatory hyperplastic soft tissue lesion of the oral cavity. The lesion, however, is not related to infection and arise as a reactive growth in response to various stimuli. It has a very high vascularity because of the presence of numerous prominent capillaries. The lesion has a bleeding tendency, even after a minor traumatic episode, such as during mastication. Bleeding may be at times very severe and difficult to control. We present the case of a profusely bleeding young PG in a young teenage child.

A smile expresses a feeling of joy and success and also reveals self-confidence and kindness in an individual. A holistic smile is dictated not only by the shape, position and color of the teeth but also by the health of the gingival tissues. Gingival appearance is an important component of an attractive smile. Melonin, carotene and hemoglobin are the most common natural pigments contributing to the normal color of gingiva. Although physiologic and ethnic melanin pigmentation is not a medical problem, complaints about "black gums" are common. For de-pigmentation of gingiva, different treatment modalities have been reported such as bur abrasion, scraping with scalpel, partial thickness flap, gingivectomy, cryotherapy, electrosurgery, lasers, free gingival autografting, sub-epithelial connective tissue graft and combination techniques. In the present case reports, scalpel surgery and electrosurgery were performed for gingival de-pigmentation, which are simple and effective. The esthetic results were pleasing and healing was uneventful. Patients were satisfied with the outcome at three month follow-up as evidenced from their feedback.

Peripheral giant cell granuloma is a rare exophytic lesion that develops on the gingiva and alveolar ridge. Although the precise etiology of this lesion is unknown, it could represent a local reaction to trauma or irritation. Management requires a surgical excision of the lesion and elaborate recall due to possible recurrence. This report describes the clinical and histopathological features and management of a peripheral giant cell granuloma as it appeared in the maxillary anterior region of a 35-year-old female patient.

A 29-year-old woman consulted her dentist about a localgingival swelling which bled during tooth-brushing and had been present for 1 year. In the differential diagnosis, epulis gravidarum, a peripheral giant cell lesion, and peripheral ossifying granuloma were considered. After surgical removal, histopathological examination revealed a peripheral giant cell lesion. The presence of a peripheral giant cell lesion requires thorough excochleation of the underlying bone. If the bone is cleaned thoroughly, recurrence is rare.

Peripheral giant cell granuloma (PGCG) associated to dental implants is a very infrequent peri-implant soft-tissue complication, with only 11 cases recorded in the literature to date. The present study describes a 54-year-old woman presenting a swelling of the alveolar margin in the fourth quadrant in relation to a fixed prosthesis cemented over implants. Treatment consisted of complete resection of the lesion with implantoplasty of the exposed implant threads. The diagnosis of PGCG was confirmed by histological study, and no relapse has been recorded after 12 months of follow-up.

Although gingival pigmentation is physiologic in most cases, esthetic concerns regarding "black gums" are common among adolescents. Numerous procedures have been suggested to treat this problem. The aim of this study was to evaluate the efficacy of cryosurgery with liquid nitrogen for the removal of physiologic gingival pigmentation (PGP) in adolescents. Melanin pigmentation of the anterior segments in 15 patients was treated using liquid nitrogen. Standard digital photographs were taken preoperatively and at 3, 12, and 24 months postoperatively. Photographs were analyzed digitally and showed significant differences in gingival color between the preoperative and postoperative follow-ups. Cryosurgery successfully removed PGP in adolescents.

Purpose: Pyogenic granuloma is a relatively rare hyperplastic lesion of the oral tissues. Clinically it is heterogeneous and can be similar to malignant epithelial and mesenchymal neoplasms. The treatment of choice is the surgical excision of the lesion. This approach often results in unpleasant gingival defects, especially when the pyogenic granuloma is located in the esthetic zone., Materials and Methods: This report describes the clinical and histological findings of pyogenic granuloma diagnosed in the maxilla of a 24-year-old female, as well as the successful treatment of the mucogingival defect that occurred following excision of the lesion, by placement of a subepithelial free connective tissue graft with the envelope-technique concurrently with the biopsy procedure., Results: One-year postoperative complete root coverage of tooth 11 was achieved with a harmonious gingival contour, and no further recurrence was noted., Conclusion: Early diagnosis of pyogenic granuloma, and consequent therapy with adequate excision in a safe distance of at least 1 mm, is essential for prevention of neighboring structures and minimizing the risk of a relapse. Histopathological evaluation is obligatory to confirm the tentative clinical diagnosis and to exclude malignant neoplasms. The immediate esthetic rehabilitation with free connective tissue grafts presents a complementary procedure in the treatment of mucogingival defects after total excision of oralmucosal diseases.

Aim: Mucocele is a common lesion of the oral mucosa that results from alterations of the minor salivary glands due to mucous accumulation, causing swelling. Conventional surgical treatment was planned for these lesions in a group of children and the success rates of the therapy during the transitional period from mixed to permanent dentition were assessed with a series of follow-ups., Materials and Methods: A series of 23 cases of mucocele was observed in children under 10 years of age. Clinically the lesions consisted of a soft, bluish and transparent cystic swelling which normally resolved spontaneously and reappeared after rupture in few days. All cases were treated by conventional surgical procedure with excision of minor salivary glands and underwent a 3-year follow-up., Results: Out of the 23 cases, 19 (82.6%) were in the lower lip, 2 (8.6%) in the cheek, 1 (4.3%) in the retromolar area and 1 (4.3%) in the upper lip. Those in the lower lip, 15 (79%) were away from the midline and 4 (21%) at midline. One (4.3%) recurrence was seen at the 6-month follow-up. After 3 years, recurrence rate remained the same., Conclusion: Conventional surgical excision with removal of affected minor salivary glands in paediatric patients is a definite treatment for mucocele.

This paper presents three cases of peri-implant mucosal defects that were successfully treated with a newly proposed "pouch roll" implant soft tissue augmentation technique. This procedure uses a de-epithelialized connective tissue layer during the first or second stage of implant surgery over the underlying dental implant without the need for sutures. At 2 weeks, healing was remarkable, with excellent plaque control. At 3 months, only minimal tissue shrinkage was evident. As a result, a 2- to 3-mm increase in the width of the keratinized tissue was noted around the augmented implant site. This technique is an atraumatic, versatile, and cost-effective surgical modality that enhances the peri-implant soft tissue over the ridge with a soft tissue thickness ≥ 3 mm. The pouch roll implant soft tissue augmentation procedure provides an easy and less traumatic correction of a mild to moderate buccal ridge deficiency by thickening the soft tissue around the dental implant.

Gingival melanin pigmentation occurs in people of all races. Although clinical melanin pigmentation does not present a medical problem, demand for cosmetic therapy is commonly made by fair-skinned people with gingival melanin pigmentation. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially successful in individuals with compromised esthetics. Three cases are reported here where gingival depigmentation was done using three different techniques: electrosurgery; scalpel surgery; and surgical abrasion. The clinical results of the three methods have been compared.

Objectives: This study compared the use of diode and Er:YAG lasers in treating gingival melanin pigmentation (GMP) in terms of gingival depigmentation, local anesthesia requirements, postoperative pain/discomfort, depigmentation effectiveness, and total treatment duration., Study Design: Twenty patients (13 female, 7 male) referred with GMP were enrolled in the study. Patients were randomly divided into 2 groups. Group 1 was treated with a gallium aluminum arsenide diode laser with a continuous wavelength of 808 nm, and group 2 was treated with an Er:YAG laser with a continuous wavelength of 2,940 nm. Gingival depigmentation was performed by applying the laser at 1 W. Treatment was administered on a weekly basis until a normal pink gingival color was observable in clinical examination and photographs. In addition, patients were asked to evaluate the procedure by using a self-administered questionnaire., Results: Procedures were carried out without the need for any topical or local anesthetic, and no unpleasant events occurred during the actual procedure or the healing period. The total length of treatment was significantly shorter with the diode laser (group 1) than with the Er:YAG laser (group 2; P < .05). No melanin recurrence was detected during any follow-up session., Conclusions: Diode and Er:YAG lasers administered at 1 W both result in satisfactory depigmentation of GMP., (Copyright © 2012 Elsevier Inc. All rights reserved.)