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Violation of the biologic width could induce different periodontal consequences depending on many factors such as the type of the restorative material used. In this study, the histological performance and the marginal adaptation of three filling materials (amalgam, composite resin and compomer) are evaluated after a period of three months. Class V cavities with apical margin located at the alveolar bone crest were prepared on Pointer dogs teeth and restored with these three materials. Histological analysis showed that lesions in epithelial attachment were mainly noticed with amalgam fillings and the scale of inflammatory cells was the highest when amalgam was used. Compomer showed the best marginal adaptation.

Amalgam, composite resin and compomer are frequently used in operative dentistry today. Earlier studies have shown the periodontal consequences induced by these materials if they have intracrevicular restorative margins. This study was performed on dogs where Class V cavities with apical margin located at the alveolar bone crest were prepared and restored with these materials. Three months later, the experimental and control sites were prepared for histological analysis. Mean bone loss was significant only with compomer. The mean length of the supracrestal connective tissue was almost the same with the three fillings. The length of epithelial attachment was the highest with composites. There was a decrease in the length of the biologic width from Day 0 to Day 90.

In periodontal therapy, frenectomy is indicated when the frenum exerts tension on the gingival margin and interferes with proper oral hygiene. The procedure is also employed when the frenum prevents closure of a diastema during orthodontic therapy. Frenectomy should be done after the canines have erupted and before retention is started to prevent separation of the teeth. For an improved surgical and cosmetic result, the authors propose a triangular-shaped gingival graft after the frenum has been excised. The advantage of the procedure is to create an area of attached gingiva and enhance healing.

The treatment of an exposed root surface may be indicated for an aesthetic improvement of a gingival recession. The surgical technic depends on the type of the recession, the quality and the quantity of the keratinized gingiva apically or laterally from the recession. The purpose of this study is to evaluate the minimal quantity of keratinized gingiva necessary to obtain a root coverage. 10 recessions on maxillary cuspids were treated with coronally repositioned flap. Less than 3 mm of keratinized gingiva was present apically to the exposed root surface. All patients received oral hygiene instructions, plaque control and scaling and root planing. Gingival recession, width of keratinized gingiva and loss of attachment were measured at the time of surgery and three months postoperatively. The mean recession was 5.20 mm (+/- SE = 0.36) prior to treatment and the keratinized gingiva was 1.70 mm (+/- 0.16) high at T0. The mean gain of root coverage was 3.43 mm (+/- 0.29) at three months post-operatively. At T0 and 3 months post-operatively, the measures of recessions showed a statistically difference confirming the validity of the technic. The absence of correlation between initial height of keratinized gingiva and the coverage result (r = 0.05) indicates that initial width of keratinized gingiva does not affect the coverage results.

Although there is no scientific data to support the concept, it is proposed that a band of attached gingiva around implants is clinically desirable. This can be accomplished by the use of gingival grafts either at the time of the second operation or at a later date. This seems preferable to mucogingival surgery performed before implants insertion.

In recent years, much emphasis has been placed on the refinement and enhancement of prosthetic components and techniques in implant dentistry, while the surgical protocol has remained fairly constant. The evolution of the concept of the immediate placement of fixtures into extraction sites, along with the related concept of guided tissue regeneration, is a major advancement in the surgical field. It provides significant benefit to both patient and clinician in terms of the reduced treatment time and an enhanced prognosis related to biomechanics and aesthetics.

The use of expanded polytetrafluorethylene membranes to attain bone regeneration around dental implants is described. Membranes discourage "non-desirable" cells form colonizing the healing site. These cells are essentially derived from gingival epithelium and gingival connective tissue. It is suggested that this procedure could be employed directly after tooth extraction.

The authors experience on twelve patients in the field of bone grafting prior to implant surgery is presented. The technique employed depends largely on the anatomical location of bone insufficiency, such as: 1) Where there is not enough bone beneath sinus locations, grafting with cancellous iliac bone blended with coral particles is suggested. 2) Where the jaw is not sufficiently thick, such as in the incisor-cuspid regions, the authors employ cancellous and/or cortical bone grafts. 3) Horizontal osteotomy and interposition of cortical-cancellous bone graft is proposed where there is a lack of bone height in the incisor-cuspid regions. The results of the various techniques are analysed from a clinical, radiographic and histologic perspective. Twelve patients have been treated with 2 years follow-up.

Gingival mucus in an older patient is the site of the slowing-down of the cellular turnover, of a lessening of metabolic activity and of keratinisation. The resistance to mechanical attacks and bacteria lessens thus its potential for repair. Thus one notes a worsening state of parodontal complaints during old age. By means of a study carried out at the Clinique de Parodontie of the Institut d'Odonto-Stomatologie in Dakar, we propose to attempt to see if the presence of gingival retraction can be linked with parodontal senescence by means of observing 318 patients.

17 intrabony periodontal defects on 14 patients were surgically treated by a alloplastic graft using micro-granules of natural coral. Criteria of evaluation were standardized probing and reproducible radiographs. The measures, made at day 0 and one year post-implantation showed a reduction in probing pocket depth (4.38 mm +/- 0.43) assessed more through a gain of clinical attachment (3.38 mm +/-0.30) than an increase of the gingival recession (1.00 mm +/- 0.20). These results are statistically significant.

Gingival thickness is a clinical characteristic which should be given more consideration in evaluating muco-gingival problems. It is proposed that thick gingiva prevents gingival recession and is of particular significance when fixed prosthesis is being employed. The technique outlined includes a connective graft from the lamina propria of the palatal mucosa into the gingival connective tissue. A case report documents the technique.

The short and mid-term regenerative therapy in the furcation lesions seems to be promising. The aim of this review is to describe different technics used today. The limits of this therapy, the gain of bone level and/or gain of attachment level and the complementarity of their biological principles are discussed.

Many types of materials are available for the regeneration of the periodontium destroyed by periodontal disease. In view of the fact that there are not many properly structured classical studies relative to the same, one cannot conclude that these materials regenerate bone, the periodontal ligament and the cementum which make up the periodontium. In this article, many classical studies relative to the use of bone grafts are carefully examined and analyzed.

Frequency severity of gingival recessions was studied with Stahl and Morris indices. The results showed that the localization of gingival recession was more important on the mandible (37%) than on the maxillary (27.6%) it, also demonstrated the importance of various etiologies and particularly the association of trauma - tooth malposition (81%).

Osseo or bio-integrated implantology has become the turning point in modern dentistry and every decision regarding treatment planning should take into consideration the possibility of implant, and combine the knowledge of specialists such as periodontists, implantologists and prosthodontists. The psychological, medical and local evaluation will decide about the choice of the right patient for implant in order to resolve a unit, partial or full edentation. The periodontal therapeutic of the residual teeth will be realized before any insertion of implants and will focus more on elimination of the periodontal diseases on teeth that should be maintained, that on the maintenance on the arches of teeth with poor prognosis. The early extraction of these teeth and their immediate replacement by implants are recommended on certain conditions. The two step procedure in surgical implantology should respect the biological principles in order to obtain and maintain the osseo or bio-integration. The objectives of the post-implantology periodontal treatment will not be limited only to the elimination of the pocket around the implant, but will also create an optimal environment of keratinized attached gingiva around the collar of the implant, necessary for functional and esthetic purposes. The prosthodontic treatment on implants will be conducted with care and according to the perio-occluso prosthetic principles. It is finally essential to preserve the gingival health around the implant and to prevent a gingivitis to become a peri-implantitis, by a regular maintenance and evaluation.

For the general practitioner, the superficial periodontal structure is an obstacle when trying to gain access, control and visualization to juxta or infra gingival preparations. A temporary restoration will maintain and protect those limits and in many cases it is a very efficient procedure. Sometimes it is necessary to enhance the gingival preparation by sophisticated methods. There are many different technics available to the practitioner. In this article we will describe the technics with easy clinical use and those respecting the gingival tissue (mechanical, physico-chemical).

A case of furcation involvement of a maxillary molar is reported. The treatment consisted in applying the concept of Controlled Tissue Regeneration using a Goretex membrane. After removal of the membrane the result is satisfactory. The membrane is then examined under transmission electronic microscope. The lateral aspect of the membrane (in contact with the proliferating epithelial tissue) show a marked bacterial proliferation.

A major research problem over the past 10 years is to obtain a new attachment after treatment of roots previously exposed to periodontal disease. Among the most recent studies, two main objectives of surgery are suggested: a selection of cell population and to arrest epithelial migration by guided tissue regeneration with a membrane, and a biological and chemical root preparation with citric acid and fibronectin. A technique for the treatment of deep osseous lesion is put forward here: the association of biodegradable membrane--natural coral--citric acid and fibronectin.

Restoring gum epithelial-conjunctive attachment on calcified tooth surfaces is the main objective of every treatment program of periodontal lesions. Research works are resulting today in a better understanding of biological mechanisms involved in tissue healing or rebuilding processes. These scientific studies allow to control such new therapeutics that can create a biocompatible environment essential to the metabolism of regenerating cells.

Mandibular incisors had to be extracted on a 52 years old patient. The aim of this investigation was to study, the periodontal healing of teeth surgically displaced after bone resections (alveolar, buccal and apical). 3 years later, the teeth were extracted and treated for microscopic observation. No new attachment was seen on the curetted roots, except where the periodontal ligament had been preserved. The concept of cellular sociology was suggested to explain the sites of radicular resorption. An hypothesis was then put forward: epithelial formations present in the periodontal ligament are not of an embryologic origin (Malassez debris) but are issued from the migration of epithelial cords during new formation of the junctional epithelium.

One of the main aspects from a patient's standpoint regarding periodontal therapy is esthetics; the clinician who wants to control the disease by pocket elimination may underestimate this fact. This article describes a conservative surgical approach and a type of modified vertical mattress suture which allows repositioning of soft tissues to a preoperative level. A discussion follows on how such a conservative approach respects the philosophy of modern periodontal therapy.

The combination VICRYL and bone wax is studied as filling material in periodontal locations in dogs. Histological studies were carried out at one, two, six and nine months. Bone formation is already quite marked at two months, and total at six months. A desmodont and a secondary cement are formed. At six and nine month, reattachment is excellent.

An experimental periodontitis was produced in the upper right and left maxillary molar regions of three dogs. The apical zone of the bony defects were marked by cutting grooves into the root surfaces. The right side was used as a control while on the left side, the bony defect was treated with a graft of ligament tissue. The graft was obtained from a neighbouring area after removing the external wall of bone and sampling with a bone chisel. Four months after the grafting the dogs were sacrificed and an optical microscopic study was performed. One of the dogs died three days after operation. In the other two dogs a reattachment was observed in the groove on the control side: coronally to the groove, a long epithelial attachment was present between the radicular wall and the connective tissue. On the experimental side of dog 1, a reattachment was obtained up to the level of the cemento-enamel junction. In dog 2, a complete failure was noted since an important epithelial growth has migrated and invaded the radicular groove.

Regeneration of connective tissue structures lost as a result of periodontal disease remains the major goal of periodontal therapy. The ability of cells of the periodontium to adhere to the tooth surface is central to a number of phenomenons. Among these are cellular migration, morphogenesis and wound healing. Several classes of molecules appear to mediate the ability of cells to adhere. These cells utilize a group of receptors called Integrins to anchor themselves to the extra-cellular matrix. The receptors are transmembrane heterodimers which serve as bridges which communicate informations between the extra-cellular matrix and the cytoskeleton.

A well known development of the chronic periodontal disease is reviewed. However, the histological picture of a gingiva varies at a much lower speed than its clinical picture, and slower than previously described. In presence of periodontitis there may exit a zone of reversible disease of about 2 mm, which give the possibility of obtaining a re-attachment of unknown magnitude. A new connective tissue attachment (on top of the re-attachment) seems only possible if the periodontal ligament cells are allowed to proliferate coronally.