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The keratinization potential of crevicular epithelium: an experimental study
Quarterly
Dental
Review
STARK M. M., NICHOLSON D. J. and SOELBERG K. B. Effects of retraction cords and elactrosurgery upon blood pressure and tissue regeneration in rhesus monkeys, J. Dent Res. 56 (1977) 881487. Gingival retraction using chemicals or electrosurgery may produce (a) systemic haemodynamic effects and (6) alterations in gingival levels. This work was carried out on 3 rhesus monkeys to investigate the effects of different retraction methods. The haeodynamic effects were assessed by blood pressure measurements taken via intracardiac end intra-arterial cannulas. The gingival margin levels were measured from fixed reference points on all the teeth. The tests were done using the various retraction techniques following the production chamfer finishing edges 0.5-I mm below the gingival Four retraction techniques were crest. studied: 1. Non-epinephrine (aluminium sulphatel impregnated cord. 2. Eight per cent r-epinephrine impregnated cord. 3. Spark gap generator electrosurgical device. 4. Fully rectified current electrosurgical unit. The non-epinephrine retraction cord produced no effect on blood pressure and no loss of tissue height. The 8 per cent repinephrine cord resulted in an increase in blood pressure which was maintained for 20-30 minutes. No loss in gingival height resulted. The spark gap generator caused a substantial increase in blood pressure which was maintained for 25-30 minutes and also caused considerable tissue loss. The fully rectified current electrosurgical unit resulted in increased blood pressures and tissue loss. G. A. Smith
FRY H. R. and APP G. R. Histological evaluation of the effects of human intrasulcular toothbrushing on sulcular epithelium, J. Periodonrol. 49 (1978) 163-173. An investigation was conducted using the Butler No. 300 Adult Right Kind/Sub-G toothbrush in intrasulcular brushing, the method being used on the mandibular left posterior teeth for 30 seconds daily for a
361
period of 40 days. On 28 days the brushing was undertaken by the investigator and on the remaining 12 by the subject. Comparative histological findings indicated that the epithelium of the crevicular epithelium will keratinize to some degree and that keratinization appeared to increase with intrasulcular brushing. This method of brushing did, however, traumatize the interdental papillae in some of the subjects taking part in the study, causing progressively increasing irritation and tenderness. Many subjects did not find this method of brushing a simple one. A. Bryan Wade
SPRAY J. R., GARNICK J. J., DOLES L. R. and KLAWITTER J. J. Microscopic demonstration of the position of periodontal probes, J. Periodonrol. 49 (1978) 148-152. A graduated blade consisting of the end of a University of Michigan ‘0’ probe was inserted into the orifice, the gingival crevices and pockets of 15 anterior and premolar teeth destined for extraction in the mouths of 13 patients, whose ages ranged from 20 to 71. Subsequent histometric and microscopic evaluation of 8 specimens obtained from 6 subjects showed that the penetration of the blade was resisted by condensation of connective tissue. The junctional epithelium appeared to offer little resistance to the penetration of the metal probe which was inserted at a force varying between 15 and 20 g. It is concluded that the health of connective tissue in the area beneath the junctional epithelium is probably more important in limiting the apical movement of a probe than the junctional epithelium itself. A. Bryan Wade
GELFAND l-l. B., TEN CATE A. R. and FREEMAN E. The keratinization potential of crevicular epithelium: an experimental study, J. Periodonrol. 49 (1978) 113-I 18. Free grafts consisting of crevicular epithelium and
non-keratinized the underlying
Journal of Dentistry,
362
connective tissue were placed on recipient beds in the non-keratinized alveolar mucosa of rhesus monkeys. After 4 weeks the grafts resembled keratinized gingiva clinically and this observation was confirmed histologically. Electron microscopic examithat the supporting nation showed and changes in the connective tissue crevicular epithelium made the graft tissue identical with keratinized gingival tissue in the 4-week specimens. It is therefore concluded that crevicular epithelium has the potential to keratinize but that this is prevented by inflammation in the underlying connective tissue. A. Bryan Wade
WALSH T. F. and WAITE I. M. A comparison of postsurgical healing following ddbridement by ultrasonic or hand Periodonrol. 49 (1978) 201instruments,J.
205. Root debridement at the time of periodontal flap surgery was undertaken on one side of the mouth using an ultrasonic scaler and on the other side with hand instruments. Healing was evaluated over a period of 3 weeks using the Gingival Index, crevicular fluid measurements and the Plaque and Retention Indices. It was found that healing was more rapid as evaluated by the Gingival Index and crevicular fluid when ultrasonic debridement had been used, but no difference was registered in the Plaque or Retention Index. Postoperative pain appeared to be the same with both techniques. A. Bryan Wade
GOASLINO
G.
D.,
ROBERTSON
8.
B.,
MAHAN C. J., MORRISON W. W. and OLSON J. V. Thickness of facial gingiva, J. Periodonfol.
48 (1977) 768-771. A device to measure the thickness of the gingiva is described. A probe is used to penetrate the gingival tissue, both to the tooth surface and to the bone of the alveolar process and, utilizing a differential transformer coupled to an oscillator and digital voltmeter, the distance of penetration is determined.
This was undertaken on the facial aspect of certain maxillary and mandibular teeth, penetration being made at the depth of the gingival crevice and midway between this point and the mucogingival junction. It was found that the probe assembly was accurate to 0.01 mm and that the average range of differences in reproducibility tests never exceeded 0.15 mm. Free gingival thickness averaged 1.56 f 0.39 mm and the thickness of the attached gingiva was 1.25 f 0.42 mm, the total mean thickness for all areas being 1.41 mm. Thickness of the mandibular free and attached gingiva and the maxillary free gingiva increased as measurements were made in a posterior direction, whereas thickness of the maxillary attached gingiva remained fairly constant. The thickness measured at the depth of a crevice was directly ,proportional to the width of the free gingiva. Thickness measured midway between the depth of the crevice and the mucogingival junction was inversely proportional to the width of the attached gingiva. A. Bryan Wade
MORMANN W. and CIANCIO S. G. Blood supply of human gingiva following periodontol surgery.’ A fluorescein angiographic study, J. Periodontol. 48 (1977) 681-692. A method of studying the gingival vasculature following the intravenous injection of sodium fluorescein is described. Different types of flaps were constructed in various individuals and photographed at intervals from 24 hours to 7 days. As a result it is recommended that flaps should be broad enough at their base to include major gingival vessels, that the length of a flap should not exceed its width by the ratio of 2 : 1 and that minimal tension should be reduced by suturing techniques, the tissue being managed gently during the surgical procedure. Partial thickness flap preparations to cover avascular sites should not be too thin so that sufficient blood vessels are included in them. The apical portion of periodontal flaps should be full thickness whenever possible. A. Bryan Wade
Vol. ~/NO. 4
Dental
Review
STARK M. M., NICHOLSON D. J. and SOELBERG K. B. Effects of retraction cords and elactrosurgery upon blood pressure and tissue regeneration in rhesus monkeys, J. Dent Res. 56 (1977) 881487. Gingival retraction using chemicals or electrosurgery may produce (a) systemic haemodynamic effects and (6) alterations in gingival levels. This work was carried out on 3 rhesus monkeys to investigate the effects of different retraction methods. The haeodynamic effects were assessed by blood pressure measurements taken via intracardiac end intra-arterial cannulas. The gingival margin levels were measured from fixed reference points on all the teeth. The tests were done using the various retraction techniques following the production chamfer finishing edges 0.5-I mm below the gingival Four retraction techniques were crest. studied: 1. Non-epinephrine (aluminium sulphatel impregnated cord. 2. Eight per cent r-epinephrine impregnated cord. 3. Spark gap generator electrosurgical device. 4. Fully rectified current electrosurgical unit. The non-epinephrine retraction cord produced no effect on blood pressure and no loss of tissue height. The 8 per cent repinephrine cord resulted in an increase in blood pressure which was maintained for 20-30 minutes. No loss in gingival height resulted. The spark gap generator caused a substantial increase in blood pressure which was maintained for 25-30 minutes and also caused considerable tissue loss. The fully rectified current electrosurgical unit resulted in increased blood pressures and tissue loss. G. A. Smith
FRY H. R. and APP G. R. Histological evaluation of the effects of human intrasulcular toothbrushing on sulcular epithelium, J. Periodonrol. 49 (1978) 163-173. An investigation was conducted using the Butler No. 300 Adult Right Kind/Sub-G toothbrush in intrasulcular brushing, the method being used on the mandibular left posterior teeth for 30 seconds daily for a
361
period of 40 days. On 28 days the brushing was undertaken by the investigator and on the remaining 12 by the subject. Comparative histological findings indicated that the epithelium of the crevicular epithelium will keratinize to some degree and that keratinization appeared to increase with intrasulcular brushing. This method of brushing did, however, traumatize the interdental papillae in some of the subjects taking part in the study, causing progressively increasing irritation and tenderness. Many subjects did not find this method of brushing a simple one. A. Bryan Wade
SPRAY J. R., GARNICK J. J., DOLES L. R. and KLAWITTER J. J. Microscopic demonstration of the position of periodontal probes, J. Periodonrol. 49 (1978) 148-152. A graduated blade consisting of the end of a University of Michigan ‘0’ probe was inserted into the orifice, the gingival crevices and pockets of 15 anterior and premolar teeth destined for extraction in the mouths of 13 patients, whose ages ranged from 20 to 71. Subsequent histometric and microscopic evaluation of 8 specimens obtained from 6 subjects showed that the penetration of the blade was resisted by condensation of connective tissue. The junctional epithelium appeared to offer little resistance to the penetration of the metal probe which was inserted at a force varying between 15 and 20 g. It is concluded that the health of connective tissue in the area beneath the junctional epithelium is probably more important in limiting the apical movement of a probe than the junctional epithelium itself. A. Bryan Wade
GELFAND l-l. B., TEN CATE A. R. and FREEMAN E. The keratinization potential of crevicular epithelium: an experimental study, J. Periodonrol. 49 (1978) 113-I 18. Free grafts consisting of crevicular epithelium and
non-keratinized the underlying
Journal of Dentistry,
362
connective tissue were placed on recipient beds in the non-keratinized alveolar mucosa of rhesus monkeys. After 4 weeks the grafts resembled keratinized gingiva clinically and this observation was confirmed histologically. Electron microscopic examithat the supporting nation showed and changes in the connective tissue crevicular epithelium made the graft tissue identical with keratinized gingival tissue in the 4-week specimens. It is therefore concluded that crevicular epithelium has the potential to keratinize but that this is prevented by inflammation in the underlying connective tissue. A. Bryan Wade
WALSH T. F. and WAITE I. M. A comparison of postsurgical healing following ddbridement by ultrasonic or hand Periodonrol. 49 (1978) 201instruments,J.
205. Root debridement at the time of periodontal flap surgery was undertaken on one side of the mouth using an ultrasonic scaler and on the other side with hand instruments. Healing was evaluated over a period of 3 weeks using the Gingival Index, crevicular fluid measurements and the Plaque and Retention Indices. It was found that healing was more rapid as evaluated by the Gingival Index and crevicular fluid when ultrasonic debridement had been used, but no difference was registered in the Plaque or Retention Index. Postoperative pain appeared to be the same with both techniques. A. Bryan Wade
GOASLINO
G.
D.,
ROBERTSON
8.
B.,
MAHAN C. J., MORRISON W. W. and OLSON J. V. Thickness of facial gingiva, J. Periodonfol.
48 (1977) 768-771. A device to measure the thickness of the gingiva is described. A probe is used to penetrate the gingival tissue, both to the tooth surface and to the bone of the alveolar process and, utilizing a differential transformer coupled to an oscillator and digital voltmeter, the distance of penetration is determined.
This was undertaken on the facial aspect of certain maxillary and mandibular teeth, penetration being made at the depth of the gingival crevice and midway between this point and the mucogingival junction. It was found that the probe assembly was accurate to 0.01 mm and that the average range of differences in reproducibility tests never exceeded 0.15 mm. Free gingival thickness averaged 1.56 f 0.39 mm and the thickness of the attached gingiva was 1.25 f 0.42 mm, the total mean thickness for all areas being 1.41 mm. Thickness of the mandibular free and attached gingiva and the maxillary free gingiva increased as measurements were made in a posterior direction, whereas thickness of the maxillary attached gingiva remained fairly constant. The thickness measured at the depth of a crevice was directly ,proportional to the width of the free gingiva. Thickness measured midway between the depth of the crevice and the mucogingival junction was inversely proportional to the width of the attached gingiva. A. Bryan Wade
MORMANN W. and CIANCIO S. G. Blood supply of human gingiva following periodontol surgery.’ A fluorescein angiographic study, J. Periodontol. 48 (1977) 681-692. A method of studying the gingival vasculature following the intravenous injection of sodium fluorescein is described. Different types of flaps were constructed in various individuals and photographed at intervals from 24 hours to 7 days. As a result it is recommended that flaps should be broad enough at their base to include major gingival vessels, that the length of a flap should not exceed its width by the ratio of 2 : 1 and that minimal tension should be reduced by suturing techniques, the tissue being managed gently during the surgical procedure. Partial thickness flap preparations to cover avascular sites should not be too thin so that sufficient blood vessels are included in them. The apical portion of periodontal flaps should be full thickness whenever possible. A. Bryan Wade
Vol. ~/NO. 4