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INTRODUCTION This case reports a biopsy of a large soft tissue defect with gingival grafting. The therapeutic approach presented here combines a partly de-epithelialized free gingival graft (PDFGG) with an envelope technique, which may be useful for cases needing a large reactive lesion biopsy. CASE PRESENTATION A patient with an aesthetic and functional complaint due to a fibroepithelial hyperplastic lesion was treated by excisional biopsy leaving a 10 mm cervical defect on tooth 23. A palatal PDFGG was harvested and sutured into the defect, using an "envelope technique" to improve the blood supply to the graft. The procedure is aimed at both recession coverage and reduction in root hypersensitivity. Stability of the outcome is demonstrated 9 months post-operative. CONCLUSIONS Gingival margin biopsies pose a significant challenge due to the need to combine significant tissue removal while providing a predictable aesthetic and functional outcome. The case is the first description of a successful grafting of a large residual gingival biopsy defect, resulting from using combined mucogingival surgical approach. This technique may be helpful for similar cases.

To assess the horizontal and vertical dimensional changes of the alveolar ridge when using a collagen matrix in combination with collagen embedded xenogenic bone substitute, in comparison with natural healing after tooth extraction.Patients that required extraction in non-molars areas were included. Test group-15 sockets were treated with deproteinized bovine bone mineral containing 10% collagen (DBBM-C), covered by a procaine collagen membrane (CMXs). Control group-15 sockets left for spontaneous healing. We used a custom-made acrylic stent as a reference for alveolar ridge measurements. Six-month postoperative, a single implant was placed in the experimental site. A core biopsy was taken from the site, using a trephine bur. Histomorphometric analysis assessed bone area, connective tissue, bone marrow, and residual bone graft.Six months later, horizontal ridge width at -3 mm showed a significant (p 0.05) reduction in both groups albeit smaller in the test group 1.19 ± 1.55 mm, compared with the control 2.27 ± 1.52 (p = 0.087). At -5 mm sub-crestally, statistically non-significant reduction was noted in both groups, 1.61 ± 1.53 and 1.96 ± 1.52 mm for the test and control groups, respectively (p = 0.542). Vertical changes were smaller in the test group (0.14 ± 1.84 mm) compared with control (0.98 ± 1.49 mm). Keratinized tissue (KT) width was 7.3 ± 2.13 and 7.5 ± 3.49 mm in the test and control groups, respectively. Newly formed bone occupied 33.79 ± 17.37% and 51.14 ± 23.04% in the test and control groups, respectively, (p = 0.11). Connective tissue volume was 33.74 ± 13.81% and 30.12 ± 18.32% in the test and control groups, respectively (p = 0.65). Bone marrow occupied 19.57 ± 10.26% and 18.74 ± 17.15% in the test and control groups, respectively (p = 0.91). Residual graft occupied 12.9 ± 9.88% in the test group.Alveolar ridge preservation using DBBM-C resulted in reductions of the vertical and horizontal dimensions albeit not reaching statistical significance. The larger than anticipated standard deviation and smaller inter-group differences might account for this phenomenon.

Background Denture enhances the risk of Candida colonization because of adherence to acrylic base and interference with salivary rinsing. Acrylic orthodontic appliances may also create retentive areas for food debris and microbial pathogens; moreover, patients are instructed to use the retainers at night, when salivary secretion is reduced. We studied the Candida colonization in orthodontic patients using acrylic retainer. Methods Participants were orthodontic patients with full compliance during the retention phase with no signs or symptoms or being at risk for Candida , divided into users of (a) Hawley retainer (study group) and (b) other retainers (vacuum-formed/fixed bonded retainer; control group). Collected data included demographic characteristics and habits. Samples were collected from palate mucosa, cultured and incubated (28°C) for 3 days. Positive Candida species were recultured to identify the Candida species. Results Fifty-one patients participated (mean age 20.9 ± 9.6 years); 22 had maxillary Hawley retainer and 29 had maxillary vacuum-formed/fixed bonded retainer. Candida albicans colonization in the hard palate was identified in 2 patients (3.9%)—1 (4.5%) from the Hawley retainer study group and 1 (3.4%) from the control group. Conclusions The hypothesis that palatal coverage by acrylic orthodontic retainer might enhance Candida colonization on the palatal mucosa is not supported by this pilot study.