A papilla on the gum appeared and disappeared. An effective technique for papillary regeneration
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Gingivitis is an inflammation of the mucous membranes of the gums, which can be infectious or non-infectious, acute or chronic.
For gingivitis is involved in the process of the gum without the circular ligament between the attached gum and the neck of the tooth. When such a connection between the gum and tooth is involved, periodontitis develops, which can result in tooth loss.
Types and forms of gingivitis (classification)
According to the flow there are:1. Acute gingivitis– has a pronounced course; with proper treatment and elimination of the causes of gum development, the gums are completely restored and recovery occurs. Transition to a chronic form is possible. This form of gingivitis most often affects children, adolescents and young adults.
2. Chronic gingivitis– the symptoms of the disease are often erased, patients sometimes get used to them. In a chronic course, periods of exacerbations and remissions are observed. Over time, irreversible changes form in the gums, possibly forming pockets between the tooth and gum and exposing the tooth root.
According to the prevalence of the process, gingivitis is:
1. Local or focal gingivitis– the gums are affected in the area of one or more teeth and interdental spaces.
2. Generalized or widespread gingivitis– the gums are affected throughout the jaw, most often both the upper and lower ones. Generalized gingivitis is a reason to think about the presence of more serious diseases in the body, resulting in problems with the gums, for example, diabetes, immunodeficiencies, including AIDS, and digestive diseases.
Types of gingivitis depending on the form of gum inflammation:
1. Catarrhal gingivitis– This is the most common form of gum inflammation and can occur acutely or chronically. Catarrhal gingivitis is characterized by serous inflammation, manifested by swelling, pain, redness and mucus discharge from the inflamed mucous membranes of the gums.
2. Ulcerative gingivitis (Vincent ulcerative-necrotizing gingivitis)– this form of gingivitis is less common and is usually the result of catarrhal inflammation. Associated with the activity of bacteria that destroy mucosal tissue with the formation of ulcers and pus.
3. Hypertrophic (hyperplastic) gingivitis– always has a chronic course. This form usually occurs as a consequence of a long-term inflammatory process in the gums. It is characterized by the proliferation of tissue of the mucous membrane of the gums (the medical term is proliferation).
There are two forms of hypertrophic gingivitis:
- Edema form – in the tissues of the mucous membranes of the gums there is pronounced swelling, blood circulation is increased, that is, a chronic inflammatory process is observed. This form is partially reversible, meaning that with proper treatment, gum overgrowth can be reduced.
- Fibrous form - Connective (scar) tissue grows in the mucous membrane, but there are no longer signs of inflammation; this is the outcome of a chronic process and, unfortunately, irreversible. This is a visible cosmetic defect and discomfort when eating solid food.
Separately, the following forms of gingivitis can be distinguished:
1. Gingivitis in pregnant women- This is a fairly common phenomenon that a woman in an interesting position encounters. Usually this is hypertrophic gingivitis, its edematous form. The development of such gingivitis is associated with hormonal changes in the body of the expectant mother.
2. Adolescent gingivitis- oddly enough, it is children, teenagers and young people who are the most common patients diagnosed with gingivitis (8 out of 10 visitors to dental clinics with complaints of gum problems). In most cases, this contingent is diagnosed with acute catarrhal gingivitis, a so-called “mild degree” of the disease, but in the presence of hormonal imbalances, the development of a chronic hypertrophic form of the disease is possible.
3. Herpetic gingivitis– inflammation of the gums caused by the herpes simplex virus. In most cases, this is acute ulcerative-necrotizing gingivitis against the background of chronic herpetic infection. Herpetic ulcers are usually located not only on the gums, but also on the mucous membranes of the entire oral cavity. Typically, such gingivitis indicates problems with the immune system.
4. Desquamative gingivitis. With this form of gingivitis, partial rejection of the surface epithelium of the gum mucosa occurs. First, red spots appear that form blisters; after they open, painful ulcers appear. The peculiarity of this gingivitis is that the causes are unknown; it is always a generalized and chronic process with an undulating course.
Causes of gingivitis
There are many reasons for the development of gum inflammation, and each of us encounters them in everyday life. There are two groups of reasons that lead to gingivitis. Firstly, these are internal causes, that is, those processes that normally or pathologically occur in the body and act on the gums. Secondly, these are external factors that injure, irritate and inflame the gums. The main causes of gingivitis are dental disease, infection and poor oral care. Other factors in most cases predispose to gum inflammation, although they can also act as separate causes.
External causes of gingivitis development
1. Infections and disorder hygiene oral cavity– pathogenic bacteria settle on the teeth, mucous membranes of the gums and oral cavity, and can cause inflammation. Infections enter through food, the remains of which remain in the mouth, dirty hands, toys, pacifiers, kitchen utensils, and when using dirty toothbrushes. Gingivitis can also be caused by so-called “childhood infections”, that is, chicken pox, measles, rubella, scarlet fever and others.
2. Tartar is a plaque on the teeth that is saturated with calcium salts and hardens; its color ranges from yellow to brown. Such plaque forms over time in almost every person; it is difficult to remove at home. A dentist can handle this task better. Tartar is often deposited in the gingival crevices, pushing the gums back and injuring them. In addition, dental plaque is a good environment for the development of various bacteria. As a result, gingivitis is inevitable.
3. Caries– always a source of chronic infection.
4. Going to the dentist may result in gingivitis. This is an incorrect filling, tooth extraction, trauma to the mucous membrane during dental treatment, prosthetics, the use of mouth guards to correct the bite, and so on.
5. Dental implant failure.
6. Physical irritants: high and low temperatures, trauma from solid food or various objects, rough brushing of teeth, and the effects of radiation.
7. Chemical irritants. Alcohol, the use of low-quality toothpaste, mouthwash and other “dental chemicals,” a love of candy, vinegar, spices, and accidents ingesting various solutions lead to chemical burns. A burn damages the mucous membrane, preparing the ground for bacteria to attach.
8. Smoking– combined effect on the oral mucosa. Cigarette smoke is a chemical and physical irritant. In addition, smoking reduces local and general immunity, accelerates the deposition of tartar, and affects the nervous system, which contributes to impaired salivation. Smoking is one of the reasons for the development of atrophic gingivitis.
Photo: smoker's teeth.
9. Breathing through the mouth and snoring – this causes the mucous membranes of the mouth to dry out, which promotes the growth of bacteria.
10. Habits foods also contribute to gum inflammation. This is a love for sweet, spicy, sour and salty foods, the predominance of soft foods in food, and a lack of raw plant foods in the menu. This all irritates and injures the mucous membranes of the oral cavity.
Internal causes of gingivitis development
| Cause of Gingivitis | A form of gingivitis that can develop | How does gingivitis develop? |
| Teething | Acute catarrhal gingivitis | A growing tooth always injures the gum from the inside. Most often, children suffer both when they grow baby teeth and when they are replaced with permanent ones. Adults encounter this problem with the growth of so-called “wisdom teeth” or 3 molars (eights). |
| Malocclusion and other abnormalities of the jaw | Chronic catarrhal gingivitis, Less commonly, ulcerative and hypertrophic forms. | Incorrectly positioned teeth during chewing periodically or constantly injure the gums and other mucous membranes of the oral cavity. |
Immunity disorders:
| Chronic gingivitis, generalized forms. | Reduced general or local (in the oral cavity) immunity cannot fight various bacteria, viruses and fungi, as a result - any physical or mechanical irritation of the gums leads to the development of gingivitis. |
| Lack of vitamins– vitamin deficiency and hypovitaminosis | Catarrhal and ulcerative gingivitis can occur acutely or chronically. | The most classic manifestation of gingivitis is scurvy, a deficiency of vitamin C that occurs in cold countries and deserts. A lack of vitamin C leads to disruption of the formation of collagen - the building material of connective tissue, which is present in absolutely all organs and tissues. Deficiency of vitamins A, E, and group B also predisposes to gingivitis. |
| Digestive disorders and helminthic infestations | Chronic gingivitis | When the digestive system malfunctions, various conditions arise:
|
Hormonal disorders:
| Any forms of chronic gingivitis, generalized forms often develop. Hormonal imbalances are most often the cause of the development of hypertrophic gingivitis. | Hormonal problems lead to metabolic disorders. Collagen metabolism suffers - as a result, a faster transition of chronic gingivitis into a hypertrophic form. In addition, due to disturbances in protein metabolism, immunity and resistance to many infections suffer. |
Taking certain medications - to a greater extent these are hormones (hormonal contraceptives, steroids), as well as anticonvulsants.
Intoxication of the body due to drug use, poisoning with heavy metal salts, severe infectious pathologies, tuberculosis, liver or kidney diseases.
Etiology of gingivitis
Gingivitis can be caused by various infections, both those that are normally present in the oral cavity, and pathogenic ones that come from outside. The most common causes of gingivitis are staphylococci, streptococci, E. coli, Candida fungi, and herpesvirus. Infections such as tuberculosis and syphilis can also lead to gingivitis.Symptoms
The first signs of gingivitis
The first sign of gingivitis – This bleeding gums. The intensity of bleeding depends on the severity of the inflammatory process. Brushing your teeth and eating solid foods (such as an apple) usually cause bleeding. But during severe processes, blood may appear without any particular irritation of the gums, especially after sleep.Main symptoms
- Bleeding gums;
- soreness in the gum area, which increases while eating, especially when eating irritating foods, such as hot or cold, sweet, spicy or salty;
- itching, swelling and redness of the gums in a limited area or throughout the entire mucous membrane of one or both jaws;
- bad breath;
- the presence of ulcers, ulcers, blisters;
- increase or decrease in gum volume;
- increased body temperature and other symptoms of intoxication - weakness, poor appetite, even refusal to eat, poor health, etc.
Symptoms of gingivitis depending on the type
| Type of gingivitis | Patient complaints | Changes during examination of gums, photo |
| Acute catarrhal gingivitis |
| The gum bleeds when pressed on it, is swollen, bright red, loose, and the interdental papillae are enlarged in size. It is possible to identify single small ulcers. In most cases, teeth have plaque and tartar.  |
| Chronic catarrhal gingivitis |
| The gum bleeds, has a bluish tint, its thickening is noted, the gums resemble a cushion above or below the tooth (due to swelling). Tartar deposits are detected, the teeth do not become loose. |
| Ulcerative-necrotizing gingivitis |
|
Common problem: Loss of gingival papillae and the appearance of “black triangles”.
Loss of gingival papillae, especially in the anterior maxilla, is a serious aesthetic problem and can cause significant psychological discomfort in patients with a high smile line.
The World Health Organization defines health as physical and psychological well-being. Therefore, dentists should strive to improve the patient’s appearance when restoring teeth (bridges, veneers, composite restorations) and gum correction. In other words, the goal of dental care is to ensure the physical and psychological well-being of the patient by optimizing the aesthetics of the teeth and gums.
Due to the prevalence of loss of interdental papillae and the aesthetic defects associated with this condition, there is a need to solve this problem (Fig. 4-3a and 4-3b).
Effective solution: Measuring biological width using bone probing.
In 1961, Gargiulo et al published the results of measurements of the depth of the periodontal sulcus, epithelial and connective tissue attachment, i.e. biological width (Fig. 4-3c). It is known that violation of the biological width leads to the development of gingivitis and periodontitis, even with careful oral hygiene (Fig. 4-3d). Tarnow et al." revealed an inverse relationship between the probability of filling the interdental space with the gingival papilla and the distance between the interdental contact and the alveolar ridge (Fig. 4-3).
In the past, dentists paid attention to the location of the contact point solely for reasons of preventing food from entering the
Rice. 4-Pros. A forced smile does not bring satisfaction to the patient. There are “black triangles” between the teeth
Rice. 4-ЗБ. Patient's smile line
Rice. 4-3d. When carrying out treatment, the biological width was not taken into account, which led to the development of gingivitis, despite careful hygiene
Rice. 4-Ze. The probability of the gingival papilla filling the interdental space depending on the distance between the contact point and the bone edge (Tarnow et al.
interdental space and, taking this circumstance into account, prosthetics were performed, including the anterior group of teeth (Fig. 4-3f and 4-H). The coronal boundary of the interdental contact is determined by aesthetic criteria, and the apical boundary depends on the distance to the alveolar bone (Fig. 4-3h).
In an article devoted to the features of the dentogingival complex, Kois
described the use of periodontal parameters in prosthetic treatment planning and a method for determining the contour of the alveolar ridge margin. It was this author who first demonstrated the feasibility of probing the bone before prosthetics.
After local anesthesia has been administered, the periodontal probe is inserted until it makes contact with the bone (Fig. 4-3i.
Rice. 4-3f. Symmetrical arrangement of contact points in the anterior part of the upper dentition.
and 4-3j), the obtained values are documented in the patient’s chart (Fig. 4-3k). In the future, these data can be used to create a composite restoration, orthodontic movement of teeth and the manufacture of prosthetics, such as veneers and crowns (Fig. 4-31 and 4-3).
Without a thorough analysis of the parameters of the dentogingival complex, it is impossible to achieve predictable regeneration of the gingival papillae (Fig. 4-3p).
The application of the technique described above and the use of the obtained data when performing prosthetics allows us to obtain a satisfactory result (Fig. 4-3).
Rice. 4-Zd. Wax-up of upper anterior teeth (Kubein-Meesenberg et al.
). Localization of contact points is determined using interproximal cones
Rice. 4-3h. The relationship between the apical border of the interdental contact point and the level of the alveolar ridge (Tarnow et al.
Rice. 4-3j. Probing the bone crest
Rice. 4-3i. Measuring the size of the gingival papilla and the distance between the bone level and the contact point
Rice. 4-Zk. Documenting indicators in a special form
The interdental papilla is the gum tissue located in the space between the teeth. It helps protect the roots of your teeth and prevents food from getting stuck between your teeth, leading to decay. Due to its location, it is susceptible to recession and deterioration from neglect or improper brushing, as well as dental problems such as gingivitis.
Structure of the interdental papilla
Papilla means a small, nipple-like projection, and papillae is the plural form of the word.
In this case, they are gum structures that protrude between the teeth. The structure of the interdental papilla is dense connective tissue covered with oral epithelium. Between your incisors, the interdental papillae are shaped like a pyramid. They are wider for your back teeth.
Healthy interdental papillae are coral pink in color. They are firmly attached to your teeth, with no gaps. They have the shape of triangles and are proportional to the teeth.
If the papilla recedes, you are left with a black triangle. If they are inflamed, they may be swollen, painful, red, or bleeding. As with all gingival tissues, the interdental papilla is unable to regenerate itself or grow back if lost due to recession or improper cleaning, then forever. Restoring papillae around dental implants is a challenge for periodontists.
Problem for the dentist
When the interdental papilla is reduced or absent, it leaves the appearance of a triangular gap.
Alternatively, during orthodontic treatment, drug-induced gum disease, or periodontal disease, the interdental papillae may appear bulbous and puffy.
A periodontist or gum specialist is able to perform surgery that can predictably regenerate the gum, although the papilla is difficult to restore.
In situations where the interdental papillae are prominent, the periodontist is able to perform a gingivectomy to remove excess tissue and restore the area. However, these procedures can be complex and expensive.
Interdental papillae are susceptible to gingivitis, which is a major concern for dentists. One of the main ways to prevent gingivitis is to take care of your teeth.
Gingivitis
Gingivitis is a reversible form of gum disease that affects only the attached and loose gum tissue that surrounds your teeth. This is a reversible condition that can be properly treated with professional dental plaque removal along with routine home dental cleaning. Home care may include a prescribed antibacterial mouth rinse known as chlorhexidine gluconate.
The dentist can confirm the extent of gum disease and plan treatment accordingly. However, if left untreated or improperly treated, gingivitis can develop and continue to progress into periodontitis, which is even more serious. Periodontitis, unlike gingivitis, is irreversible and often leads to tooth loss.
Regular visits to the doctor and dental exams can help keep gum disease under control or eliminate it completely.
If you are concerned about gingivitis or other dental problems, be sure to talk to your dentist about the problem.
Doctor of Dentistry, private practice (periodontics and prosthetic dentistry) (Leon, Spain)
Doctor of Dentistry, private practice (periodontology) (Pontevedra, Spain); Associate Professor at the University of Santiago de Compostela
In order for the restoration to look natural and the restored teeth to perform their function correctly, it is necessary to take into account the structure of the gums, the appearance of the lips and the patient’s face as a whole. Mucogingival surgery is available to treat gum recession.
Interdental gingival papilla- This is the area of gum between two adjacent teeth. It not only serves as a biological barrier that protects periodontal structures, but also plays a significant role in the formation of the aesthetic appearance. The absence of interdental gingival papillae can lead to problems with pronunciation, as well as the retention of food debris in the interdental spaces.
If the interdental gingival papilla is lost, its regeneration is quite difficult. Only a few such cases are known in dental practice. However, none of the reports contain information about methods that can restore the gingival papilla. This report describes a surgical method for restoring mucosa and gingival papilla in the pontic pontic area in the presence of bone deficiency.
Surgical technique
The patient, 45 years old, came to the clinic for treatment of periodontal pathology. She complained about the mobility of the two upper central incisors. The patient wanted to restore her appearance and also eliminate periodontal pathology. The central incisors had mobility of the 3rd degree, the depth of the pockets during probing was 10 mm and 8 mm. In the area of the right lateral incisor, a periodontal pocket with a depth of 10 mm was also found in combination with a vertical bone defect, which indicated a deficiency of bone tissue under the gingival papilla (Fig. 1 a, b).
Rice. 1a. Recession found on the labial side of teeth 11 and 12
Rice. 1b. Recession found on the labial side of teeth 11 and 12
A 7 mm deep pocket was also found in the area of tooth 22.
When collecting anamnesis, no allergies, concomitant diseases or bad habits were revealed. The patient was classified as ASA class 1. Several weeks before surgery, the patient was taught oral hygiene, in addition, subgingival deposits were removed and root surfaces were cleaned. After removal of granulation tissue in the area of the gingival papilla in the area of the 12th tooth, soft tissue recession to a height of 3 mm was discovered. In accordance with Miller's classification, she was assigned class III. On the vestibular side, in the area of teeth 11 and 12, soft tissue recession to a height of 2 mm was also detected (Fig. 2).
Rice. 2. Vertical defect and class III mobility of teeth 11 and 21
Due to the loss of bone around the two central incisors, the decision was made to remove them (Fig. 3).
Rice. 3 a - d. The first large connective tissue graft was used in the area of the intermediate part of the bridge to protect the interincisal gingival papilla. We made sure that the temporary prosthesis does not put undue pressure on the graft
When smiling, the patient's gums were partially exposed (no more than a third of the length of the coronal part). At the same time, the color of the gum mucosa was heterogeneous. Photographs, x-rays were taken, alginate impressions were taken and masticography was performed. Based on digital analysis of photographs, diagnostic models were made, which were then placed in the articulator. The patient was then given treatment options. A tooth-supported bridge represents the most current option for replacing missing teeth, especially as an alternative to complex vertical guided bone regeneration, which would require frequent examinations and strict patient compliance. The use of such a prosthesis is less risky than installing an implant-fixed prosthesis if bone and soft tissue are not present in sufficient quantities. The patient had a high sociocultural level and aesthetic preferences. Taking into account other personal factors, in particular the patient’s place of residence, we were forced to choose the fastest, most effective and reliable solution. During her first three visits to the hygienist, the patient cried. Given her emotional instability, we abandoned a comprehensive therapeutic approach to reduce the risk of psychological trauma and possible failure. After the existing problem was explained to the patient, she agreed to remove two central incisors, correct the gums in the area of the intermediate part of the bridge, as well as the gingival papilla using several connective tissue grafts. On the same day, after appropriate preparation of the canines and lateral incisors, a temporary fixed prosthesis was installed. The neck of tooth 12 was prepared accordingly, taking into account the likely future soft tissue reconstruction. Endodontic treatment of the lateral incisors was required. Silicone impressions were made to create a second, more accurate, long-lasting temporary prosthesis and to re-evaluate the case from a biological, functional, and esthetic perspective. Four weeks later, soft tissue recession was detected due to bone resorption on the vestibular side of the maxillary alveolar process.
First, a large connective tissue graft was used (Fig. 4).
Rice. 4 a - d. After the second stage of surgery, the volume of tissue in the area of the right central incisor and the papilla between it and the lateral incisor was increased
Using several soft tissue incisions, a tunnel was created in the area of the pontic pontic (Fig. 4). A 6-0 nylon suture was used to secure the graft. We ensured that the temporary prosthesis did not place undue pressure on the graft (Fig. 4). Then we took a break for 4 months. At the end of the period, an increase in the volume of soft tissues was revealed, which still remained insufficient (Fig. 5).
Rice. 5 a - d. The connective tissue graft was installed using a tunnel approach after frenectomy
We needed more tissue in the area of the right central incisor and the gingival papilla between teeth 11 and 12. The depth of the pocket during probing is 7 mm (Fig. 5). Given the loss of 3-4 mm of papilla tissue, we can conclude that the probable probing depth was 10 mm with a 5 mm bone defect at the level of the papilla. After this, the second phase of surgery began (Fig. 5). The preoperative status of the interdental gingival papilla was determined using the Norland and Tarnow classification. The interdental gingival papilla, vestibular and palatal gingiva were numbed with local anesthesia using 1 capsule of Ultracaine® (articaine HCl/epinephrine, 40/0.005 mg/ml) and 1:100,000 epinephrine solution. For better visualization of the surgical field, a surgical dissecting loupe was used. First, a semicircular incision was made at the mucogingival junction to reposition the labial frenulum (Fig. 6).
Rice. 6 a - d. A diamond cutter was used to remove part of the transplanted epithelium
The second incision was made with a microscalpel from the lost gingival papilla along the gingival sulcus around the neck of the lateral incisor. The blade was turned towards the bone. The incision was made through the entire thickness of the gum tissue and provided access for a mini-curette. The third incision was made along the apical border of the semicircular incision directly in the direction of the bone (Fig. 6). As a result, a gingival-papillary complex was formed. Its mobility was necessary to create free space under the gingival papilla and install a connective tissue graft. In addition, some mobility of the palate tissue was also ensured. The resulting flap was fixed coronally using a curette directed along the gingival sulcus and a small periotome. The amount of donor tissue required was determined during a preoperative assessment of gingival and incisal height in comparison with the expected new location of the gingival papilla. A section of connective tissue of significant size and thickness with a section of epithelium 2 mm wide was taken from the patient’s palate (Fig. 5). An area of epithelium was taken to obtain denser and more fibrous connective tissue, as well as to better fill the space under the coronally fixed tissue flap. The use of a large volume of tissue increased the chances of successful graft engraftment, since the graft was nourished by blood perfusion from a larger area. An area of epithelium was placed on the buccal side of the coronally fixed tissue flap, but was not covered by it (Fig. 6), since epithelium is denser than connective tissue and therefore better suited as a base for the repositioned flap. The connective tissue portion of the graft was placed in the gingival sulcus of the lost gingival papilla to prevent movement of the tissue flap and retraction of the papilla (Fig. 6). A 6-0 nylon suture (interrupted suture) was used to secure the graft in position and stabilize the wound. This microsurgical approach was made possible by using a Zeiss optical microscope. The wound on the palate is closed with a continuous suture. The patient is prescribed amoxicillin (500 mg, three times a day, 10 days), as well as an alcohol-free mouthwash with chlorhexidine (twice a day, 3 weeks). Keratinizing epithelial cells and food debris could be removed from the wound surface using a cotton swab soaked in chlorhexidine gluconate. After 4 weeks, the stitches were removed. The patient was also prohibited from using mechanical means to clean teeth in the wound area for 4 weeks. An earlier examination of the patient was impossible due to the remoteness of her place of residence. The postoperative period passed without complications. The third stage of surgery took place before installation of the permanent prosthesis. Using a diamond cutter, part of the transplanted epithelium was removed (Fig. 7).
Rice. 7 a - c. Transformation of the intermediate part of the bridge after the first and second operations
The area between the pontic and the lateral incisors was not probed for 6 months. As a result of probing, a gingival pocket with a depth of 5 mm was discovered in the area of the lateral incisor, which was only 1 mm greater than the depth of the gingival pocket in the area of tooth 22.
results
The patient's condition was assessed 3 months after the first surgical procedure. Only horizontal tissue growth was achieved in the pontic pontic area (Fig. 8).
Rice. 8 a, b. After the second stage of surgical intervention, the edge of the soft tissue of the gingival papilla was 3-4 mm closer to the incisors than before the operation, while there was no bleeding, and probing did not give negative results
The depth of probing in the area of the lateral incisor before the second operation was 7 mm. A recession of 3 mm in diameter was found in the area of the right lateral incisor (Miller class III). After the second stage of surgical intervention, the edge of the gingival papilla was 3-4 mm closer to the incisors than before the operation. The depth during probing decreased by 4-5 mm. An examination carried out after 2 years showed that the clinical results recorded 3 months after surgery had improved. In particular, there was no black triangle between the artificial crowns of the lateral and central incisors (Fig. 9 a, b).
Rice. 9 a. When checked after two years, no black triangle was found between the lateral and central incisors
Rice. 9 b. When checked after two years, no black triangle was found between the lateral and central incisors
There was no retraction or compression of the papillary tissue, and the probing depth did not increase. Radiographic examination showed improvement in the condition of the underlying bone (Fig. 10).
Rice. 10 a - d. Radiographic examination showed significant improvement in the condition of the underlying bone, although no bone graft was used
The depth of the gingival groove of the papilla is greater than on the opposite side, there is no bleeding, and probing does not give negative results. The success of the procedure depended on the following factors:
- The space between the bone and the coronally fixed gingival papilla was filled with a connective tissue graft.
- The connective tissue was well stabilized by the suture.
conclusions
In clinical cases that present not only a medical but also an aesthetic problem, reconstructive surgery can mask tissue loss, but the patient rarely achieves an ideal appearance. To improve the results of such intervention, periodontal plastic procedures can be used. The use of optics and microsurgical instruments is recommended. This allows the surgeon to improve visibility, avoid unnecessary incisions, and increase the chances of a favorable treatment outcome.
Gingivitis, periodontitis - behind these incomprehensible names lies a dangerous disease for teeth associated with inflammation of the gums, which, if left untreated, can lead to tooth loss.
What are the causes of this disease and how to deal with it correctly?
Today, more than half of humanity suffers from inflammation of the gums, and the reasons for this are very different - from poor lifestyle to poor heredity or disruption of the body due to hormonal changes.
In this case, inflammatory processes can differ in the nature of their course and treatment methods. In order to correctly decide on therapy and know what to do, you should familiarize yourself with all the possible nuances.
Causes of the inflammatory process
The reasons for the development of inflammatory processes in the gums can be both external and internal. They also differ in the scale of impact. It is the correctly identified cause of inflammation that becomes the key to effective treatment.
General factors
Gum problems can result from:
- smoking;
- lack of minerals and vitamins in the body;
- diseases of the gastrointestinal tract and cardiovascular system;
- diabetes mellitus;
- hormonal imbalances;
- infectious processes;
- taking certain medications (for example, antidepressants, birth control, or nasal drops may have a negative effect);
- reduced immunity.
Local factors
These include:
- teething;
- injury, thermal or chemical burns of the gums;
- development of dental calculus;
- poor oral hygiene, accumulation of toxin-producing microorganisms;
- improper prosthetics or filling, in which the gum is injured by the overhanging edge of the crown or filling (inflammation localized within one or two teeth occurs).
The photo shows examples of gum inflammation
Gingivitis - we will survive this trouble
The listed factors quite often lead to the development of such dangerous inflammatory processes in the gums as gingivitis and periodontitis. In this case, a generalized nature of inflammation is observed, implying damage to the entire oral cavity.
This form of inflammation occurs most often. The disease can be provoked by both general and local factors.
The following symptoms are characteristic of this type of inflammatory process:
- slight swelling, bleeding and redness of the gums;
- changing the acute shape of the gingival papillae to a dome-shaped one;
- the appearance of an unpleasant odor and taste, itching sensation;
- soreness of the gums upon contact with food;
- fever, general weakness;
- formation of abundant plaque (at the initial stage).
A mild form of the disease (only the gingival papillae are affected) can be replaced by moderate and severe forms with damage to the free part of the gums and their entire space, respectively.
The photo shows a chronic process, the cure of which will require an integrated approach.
Ulcerative gingivitis
In this case, inflammatory processes affect the mucous membranes of the gums, provoking the development of tissue necrosis near the gingival margin and inflammation of regional lymph nodes.
The most likely cause of this process, along with hypothermia, infectious diseases and reduced immunity, is poor oral hygiene.
Symptoms characteristic of catarrhal gingivitis include:
- the presence of dirty gray plaque at the top of the gingival papillae, the removal of which leads to bleeding gums;
- temperature rise with increased heart rate, pale skin and loss of appetite.
When this form of the disease develops, it is extremely important to start treatment in a timely manner.
The photo shows a severe form of the disease with purulent inflammation, which requires antibacterial and surgical treatment.
Hypertrophic gingivitis
A feature of this form is the reactive proliferation of connective fibrous tissue and epithelial basal cells, caused by chronic inflammation of the mucous membranes of the gums. Most often, such disorders are caused by changes in the functioning of the endocrine system, lack of vitamins and metabolic disorders.
The following symptoms of the disease appear:
- thickening of the epithelium (if untreated, keratinization is possible);
- a significant increase in gum size, a change in its color to dark red (granulating course of hypertrophic gingivitis);
- severe compaction of gum tissue, the appearance of painful sensations on palpation (fibrous development).
Inflammatory processes in the oral area
In addition to generalized inflammation of the entire gingival surface, local processes are possible in certain areas due to the development of periodontitis, injury to the gums by the crown, and the eruption of wisdom teeth.
Also, inflammatory processes in the gums of pregnant women stand apart. We will talk about these situations.
Periodontitis
Fistula with periodontitis
A characteristic feature of periodontitis is the formation of a cyst at the apex of the root of the affected tooth in the form of a pus-filled sac, which causes swelling, swelling and soreness of the gums.
In this case, the swelling is fickle, appearing and disappearing.
The cause of the development of the disorder is advanced caries that has developed into pulpitis, or poor-quality filling of root canals during the treatment of pulpitis or at the stage of preparation for prosthetics.
An X-ray image, compared by a doctor with the results of a visual examination, allows making a final diagnosis and establishing periodontitis. In this situation, the image clearly shows a change in the bone tissue in the area of the tooth root and poor quality of the filling.
Inflammatory process during pregnancy
Changes in the condition of the gums with the development of bleeding and swelling are very often observed during pregnancy.
The provoking factor, dentists call, is a change in a woman’s hormonal levels, which, with deterioration of oral hygiene, leads to the development of gum inflammation.
You need to be especially attentive to the condition of the oral cavity in the second and third trimesters (the hypertrophic process shown in the photo is typical for these periods).
In the absence of timely treatment, inflammation can quickly progress, not only aggravating the general condition of the expectant mother, but also provoking premature birth and the birth of underweight babies.
Prosthetics and installation of crowns
Incorrect prosthetics with the installation of crowns or dentures with overhanging edges cause permanent injury to the gums, which ultimately develops a large-scale inflammatory process.
In such a situation, a periodontal pocket of sufficiently deep depth can form in the interdental space, in which inflammation develops.
Negative effects of wisdom teeth
Cutting figure eights is one of the likely causes of inflammation of the gums, which swell and become painful in the tooth area.
The presence of slight swelling is considered normal, but if the inflammation becomes widespread, you should immediately consult a doctor due to the risk of wound infection.
The most common type of inflammation of the gums during the eruption of wisdom teeth is pericoronitis, which is associated with the entry of food particles under the gingival hood covering the molar and the development of pathogenic microorganisms there.
In this case, not only the gums around the tooth can become inflamed, but also neighboring tissues, which can lead to a purulent abscess.
You can cope with the disease only with the participation of a specialist who will prescribe appropriate therapy using antiseptic solutions for washing, rinsing or, if necessary, excise the hood that creates trouble or completely remove the wisdom tooth.
An integrated approach to treatment
It is necessary to begin treatment of the inflammatory process from the moment the first symptoms are detected. Therapy aimed at eliminating inflammation is quite multifaceted, so you can choose the most suitable method of treatment.
Consultation and initial examination of a specialist
First of all, the dentist visually assesses the condition of the oral cavity and the degree of the inflammatory process.
One of the first measures for such complaints is a complete sanitation of the mouth, which, as a rule, is followed by the removal of deposits on the teeth using a special ultrasonic device.
Sanitation of the oral cavity through the treatment of teeth affected by caries can eliminate the acute inflammatory process (in particular, alleviate the condition of necrotizing ulcerative gingivitis). Also, this measure is necessary to reduce the risk of re-development of inflammation.
Removing plaque from teeth makes it possible to eliminate one of the main causes of inflammation - exposure to pathogenic microorganisms.
After ultrasonic cleaning, the teeth are polished, creating a smooth surface on which plaque will not collect. If the gums are very inflamed and bleeding, polishing is carried out when the process becomes less acute.
Anti-inflammatory therapy
Anti-inflammatory treatment of gum inflammation is carried out using various medications: antiseptic solutions for rinsing from a syringe, therapeutic periodontal dressings and applications.
Depending on the cause of the inflammatory process, the following treatment methods are used:
If antibacterial therapy is required, then medications are selected from the group of macrolides (Sumamed, Azithromycin), cephalosporins (Ephodox, Cefazolin) and penicillins (Augmentin, Amoxiclav).
If hypertrophic gingivitis develops, surgical intervention may be required at the discretion of the dentist.
Antibiotics (in tablet form) are prescribed to all patients with necrotizing ulcerative gingivitis and for persistent acute gingivitis. The most commonly used medications are: Clindamycin, Ofloxacin, Augmentin, Azithromycin, Lincomycin.
The course of antibiotic therapy is chosen by the doctor individually.
Treatment regimen for gum inflammation at home
In addition to antibiotics, to relieve inflammation, irrigation of the oral cavity with Proposol aerosol and lubrication of the affected areas with dental ointments, such as Metrogyl or Solcoseryl, can be prescribed. The use of drugs in gel form is preferable, since its base promotes the absorption of the active substance into the gums.
To boost immunity, your doctor may prescribe vitamins - ascorbic acid or ascorutin. If desired, they can be replaced with rosehip infusion.
Tactics for action at home for inflammation and soreness of the gums are presented in the diagram.
Treatment of inflammation caused by injury
If the cause of the inflammatory process is injury to the gums by the overhanging edge of the filling, first of all, the offending area is cut down or the filling material is completely replaced.
If prosthetics fail, drug therapy similar to the treatment of gingivitis may first be prescribed, after which, depending on the result, the need to replace the crowns for a complete cure is considered.
Features of choosing toothpaste and brush
Inflammation of the gums requires an integrated approach to treatment, therefore, along with properly selected drug therapy, it is necessary to carefully consider the choice of toothbrush and toothpaste.
The paste should contain:
- anti-inflammatory components(extracts of ginseng, sage, chamomile, calendula, St. John's wort, cloves);
- antibacterial substances(having an effect on gram-negative and gram-positive bacteria - triclosan, used in conjunction with a copolymer that prolongs the action of the component);
- regenerating gum tissue products (oil solutions of vitamins A and E, carotoline, some enzymes).
It should be noted that toothpastes with antibacterial components are not intended for daily use due to the negative impact on the oral microflora in case of long-term use. Such pastes can be used for no longer than 3 weeks, after which it is necessary to take a 5-6 week break.
The only option that is suitable for daily use and has not only a therapeutic, but also a preventive effect, are toothpastes with a natural component such as tea tree oil.
A brush suitable for cleaning an inflamed oral cavity should be soft enough so that the mucous membrane and gums do not experience excessive pressure. You can use the brush for no longer than one month.
Preventive actions
Inflammation of the gums, especially in the acute stage, requires long-term and complex treatment, so you should remember about preventive measures that will significantly reduce the risk of developing such a disease and do not postpone a visit to the doctor if alarming symptoms appear.
