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The possible ways of diagnosis periodontal disease are examined in the light of what is reported in the literature. Particular stress is laid on the importance of the diagnosis of diseases "activity", a condition that is indispensable for the implementation of correct periodontal therapy.

The possible treatment of periodontal infrabone defects is examined in the light of current developments. The possibility of using alloplastic grafts to create new periodontal structures is discussed in particular detail.

BACKGROUND: Nikolsky's sign is a clinical sign which is elicited by a horizontal, tangential pressure to the mucosa and/or skin resulting in blisters extending and separating or peeling away. Few data are currently available in the literature about its usefulness, specificity, and sensitivity in the diagnosis of either oropharyngeal or cutaneous bullous diseases. The purpose of this study was to determine the sensitivity and specificity of the gingival Nikolsky's sign in the identification of an autoimmune blistering disease. METHODS: Over a period of 13 years, we recruited 566 patients with autoimmune oral bullous and non-bullous diseases who possessed either maxillary or mandibular gingival mucosal lesions. All patients were subjected to a test causing a gingival Nikolsky's sign at their first visit during the diagnostic algorithm and in the active disease phase before commencing treatment. RESULTS: A total of 566 patients (184 with and 382 without bullous lesions) had at least gingival involvement. A positive gingival Nikolsky's sign resulted in 100 (17.7%) of 566 patients: 86 patients with bullous lesions (53 with pemphigus vulgaris, eight with mucous membrane pemphigoid, 22 with bullous/mixed lichenoid lesions, and three with erythema multiforme) and 14 with non-bullous lesions (12 with non-bullous lichenoid lesions and two with systemic lupus erythematous/mixed connective tissue disease). Thus, the specificity of Nikolsky's sign was higher (96.3%) than the sensitivity (46.7%). CONCLUSION: The results of this study support the use of Nikolsky's sign of the gingival mucosa as a viable test to establish the presence of oral bullous diseases.

A group of patients with lichen planus, a pathology affecting the cutis and mucosa which may affect the oral cavity, were studied. All patients underwent laboratory tests to assess hepatic function. Prick tests, using a series of haptens found in materials used in dental reconstruction work, were also performed in 53 patients who possessed dental prostheses. The statistically significant correlation between lichen planus, especially in its erosive form, and hepatic damage is underlined. However, the correlation between sensitivity to the haptens contained in materials for dental reconstruction work and lichen planus was not significant.