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Root coverage and papilla reconstruction using autogenous osseous and connective tissue grafts.
Int J Periodontics Restorative Dent. 2001 Apr;21(2):141-7.
Azzi R, Takei HH, Etienne D, Carranza FA.
Previous studies have reported that the distance from the interdental crest of bone to
the apical portion of the contact of the two approximating teeth must be 5 mm or less
to support a stable interdental papilla. The reconstruction of a stable, long-term papilla
for esthetic purposes must therefore consider interdental bone reconstruction. Autogenous
osseous graft material was harvested from the tuberosity and augmented with a
subperiosteal connective tissue graft for papilla reconstruction between the
maxillary central incisors. Flap design, osseous graft fixation with a screw,
connective tissue placement, wound closure, and suturing techniques are presented.
To enhance the final result, porcelain veneers were bonded to the approximating
central incisors. This case report demonstrates a surgical procedure that has not
been reported to date for papilla reconstruction to enhance periodontal esthetics.
Surgical treatment of cyclosporine A- and nifedipine-induced gingival enlargement: gingivectomy versus periodontal flap.
J Periodontol. 1998 Jul;69(7):791-7.
Pilloni A, Camargo PM, Carere M, Carranza FA
The purpose of this study was to compare probing depth resolution achieved by
gingivectomy and periodontal flap techniques in the treatment of cyclosporine A-
and nifedipine-induced gingival enlargement. Ten kidney transplant patients who were
receiving cyclosporine A and nifedipine for at least 6 months participated in the study.
Five patients were randomly assigned to the gingivectomy group and 5 patients to the
periodontal flap group. Only anterior segments of the oral cavity (canine to canine)
were surgically treated. Clinical measurements, including probing depths, plaque index,
and gingival sulcus index, were taken at baseline, 6 weeks, 6 months, and 1 year.
Results showed that probing depths, while similar for both groups in the first 6
weeks of the study, were significantly shallower for the periodontal flap group when
compared to the gingivectomy group at 6 months (2.48 +/- 0.34 mm versus 4.87 +/- 0.79 mm, respectively)
and 1 year (322 +/- 0.65 mm versus 6.40 +/- 1.02 mm, respectively). Within its limitations, this study suggests
that the pocket reduction achieved by the periodontal flap may be sustained for longer periods of time than by the gingivectomy technique in the treatment
of cyclosporine A- and nifedipine-induced gingival enlargement.
The strip gingival autograft technique.
Int J Periodontics Restorative Dent. 1993;13(2):180-7.
Han TJ, Takei HH, Carranza FA.
In keeping with the concept of rapid epithelialization of close wound edges, the strip
technique was developed to maximize the area of gingival grafting with less trauma to
the donor site or the recipient site. An incision is made and a partial-thickness flap
is reflected so that stable periosteum is left. The apical mucosal border of the recipient
site is sutured to the periosteum. Donor tissues are obtained in 2-mm-wide strips,
transferred to the recipient site, and sutured. Dry foil and surgical packing are used
to stabilize and protect the site during healing. The donor site
is rapidly epithelialized (within 10 days) and produces minimal patient discomfort.
The use of autogenous periosteal grafts as barriers for the treatment of Class II furcation involvements in lower molars.
J Periodontol. 1991 Dec;62(12):775-80.
Lekovic V, Kenney EB, Carranza FA, Martignoni M.
This study clinically analyzed the efficacy of a connective tissue graft including the
periosteum used as a barrier to enhance new attachment and osseous regeneration. Fifteen
patients, with no systemic diseases, and adult periodontitis including 2 Class II furcation
involvements in lower molars comprised the study group. After completion of the initial
phase of therapy, all patients were treated with full-thickness periodontal flaps,
using sulcular incisions, and thorough scaling and root planing. One furca, selected
at random, had a connective tissue graft, obtained from the palate and including the
periosteum, placed over the furca with the flap sutured over the top of this graft.
Control furcas received no graft and the flap was sutured in its original position.
Both molars were treated in the same session. The following presurgical measurements
were made: probing pocket depth, attachment level, gingival recession, sulcular
bleeding index, and plaque index. The horizontal and vertical dimensions of the
osseous defects were recorded after flap elevation and debridement. Six months
later all clinical parameters were again measured and reentry flaps were
performed to measure the bony defects. No statistically significant differences
were found preoperatively between control and experimental molars with respect
to soft tissue and osseous measurements. Six months after surgery, the
experimental molars showed, in comparison to the controls, significant
reduction in pocket depth and gain in attachment level as well
as in vertical and horizontal measurements of the inter-radicular osseous defect.
Current status of periodontal therapy for furcation involvements.
Dent Clin North Am. 1991 Jul;35(3):555-70.
Carranza FA, Jolkovsky DL.
The treatment of furcation involvements is difficult because of the anatomic problems
that interfere with the clinician's accessibility in treating the area and the patient's
ability in maintaining adequate plaque control afterwards. The goal of traditional
methods of treatment is to arrest the progression of bone loss; the rate of success
with these methods has been poor, except for Grade I involvements. Advances in the
last decade have resulted in the development of treatment techniques that attempt to
reconstruct the lost periodontal structures. These techniques have greatly improved
the prognosis of Grade II furcation involvement. The recommended technique combines
the principles of guided tissue regeneration using polytetrafluoroethylene membranes
with grafting with porous hydroxyapatite. The use of decalcified freeze-dried bone
instead of hydroxyapatite also may be a successful method. Grade III and IV furcation
involvements still have a poor long-term prognosis because predictable reconstructive
techniques for their treatment have not been
demonstrated. When possible, a root resection approach may be advisable.
Bacterial invasion in experimental gingivitis in man.
J Periodontol. 1987 Dec;58(12):837-46.
Saglie FR, Pertuiset JH, Rezende MT, Sabet MS, Raoufi D, Carranza FA.
Gingival biopsies of the mesial papilla area of the first molar were obtained from each
patient at 0-, 14- and 21-day intervals during plaque formation. The biopsies were fixed,
serially sectioned, and Gram-stained. The incidence and distribution of the bacteria-like
structures were studied by microscopy. In all the specimens the bacterial nature of
Gram-stained material was substantiated. In the epithelium the highest number
of bacteria was found at the outer layer of marginal oral epithelium, sulcular
epithelium and apical oral epithelium along with a decreasing pattern of
penetration progressing deeper into the layers of tissue. For junctional
epithelium the situation was just the opposite. Each subject had significantly
higher counts at Day 21 than at Day 14 for both epithelium and connective tissue.
Also significantly higher counts were found in connective tissue compared with
epithelium. The higher bacterial density of intragingival bacteria was associated
with the higher gingival and plaque indices. This study suggests that early
stages of gingival inflammation may be mediated by invasion of bacteria.
The role of the specialist periodontist.
Int Dent J. 1986 Mar;36(1):8-11.
Carranza FA.
The major portion of periodontal care of the population belongs in the hands of the
general dentist. This is because of the overwhelming number of patients with periodontal
disease and the intimate relationship between the periodontal condition and restorative
dentistry. The probable increase, in the near future, in the number of patients with
periodontal problems will necessitate a greater understanding and an increased level
of expertise for their solution on the part of the general practitioner of dentistry.
However, there will always be a need for specialists to treat particularly difficult
cases, patients with systemic health problems and situations in which complex
prosthetic construction requires absolute assurance of reliable results.
The presence of bacteria within the oral epithelium in periodontal disease. I. A scanning and transmission electron microscopic study.
J Periodontol. 1985 Oct;56(10):618-24.
Saglie FR, Carranza FA, Newman MG.
The presence of bacteria within the gingival oral epithelium and adjacent connective
tissue in cases of periodontitis and localized juvenile periodontitis have been described
using scanning and transmission electron microscopy. The following bacterial morphotypes
were identified: cocci, short rods, filaments and few spirochetes in periodontitis and
mainly coccobacillary-shaped bacteria in localized juvenile periodontitis.
Also Mycoplasma-like structures were identified in the localized juvenile periodontitis
cases. Tunnel-like formations at different depths of the oral epithelium
contained higher numbers of bacteria than those seen on the adjacent oral surface.
Identification of specific bacteria in
the oral epithelium may have important pathogenic and therapeutic implications.
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