Healing After Partial Denudation of the Alveolar Process<Link Href="#Fn 1"/>
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Healing after Partial Denudation adjacent areas. The gingivectomy was done with a bev• eled incision which extended to the alveolar crest. Then of the Alveolar Process* the labial soft tissues, including the periosteum were removed over the experimental tooth leaving a strip of exposed bone 3 to 4 mm apically from the alveolar crest by (Fig. 1), and approximately 6 mm wide mesiodistally. EMMETT R. COSTICH,** D.D.S., PH.D. Measurements from the reference notch to the re• SIGURD P. RAMFJORD,*** L.D.S., PH.D. maining soft tissue attachment, to the alveolar crest and to the apical border of the bone exposure were recorded ALTHOUGH extensive buccal and lingual denudation of at the completion of the experimental surgery. the alveolar process has been abandoned, bone is often exposed at the alveolar crest and in interproximal areas A surgical dressing (Wondr-Pak) was placed over the during periodontal surgery. The purpose of the present blood covered bone and soft tissue wound. The dressing investigation was to study the healing after surgical de• was changed at weekly intervals until the wound healed. nudation of small areas of the alveolar process in Some specimens were obtained before the healing was humans. complete and in these cases the dressing was retained until the removal of the experimental block section. MATERIAL Clinical pictures and measurements from the refer• Ten immediate denture patients at The University of ence notch to the free gingival margin, and to the attach• Michigan, School of Dentistry, participated in the study. ment level on the root surface were obtained just before The patients were in good health and varied from 26 to removal of the specimens. 57 years of age. Dental records, roentgenograms and The surgical removal of block specimens was done clinical pictures of the patients were available. The perio• according to a previously published method.1 dontal health status varied from clinically normal gin• giva to moderately advanced periodontitis. A block The specimens were fixed in buffered formalin, de• section of the experimental tooth with adjacent buccal calcified and embedded in celluloidin. The entire blocks soft tissues and alveolar process, at least to the middle were sectioned in a serial manner and every fifth section of the root, was obtained from each patient at the time was stained and studied. However, from the central area of insertion of the immediate denture. of the wound about twenty consecutive sections were stained. METHOD A micrometer eye piece was used to measure from A standard record was kept providing detailed infor• the slides the distances from the reference notch to the mation about periodontal status and functional rela• following: the gingival margin, the connective tissue tions of the experimental teeth. A transverse horizontal attachment to cementum, and the alveolar crest. notch extending into dentin was made on the labial sur• face of the experimental tooth, to serve as reference for clinical measurements before, during and after the sur• RESULTS gery.1 The notch was made with a small diamond wheel, A. Clinical and Histometric Findings about 2 mm incisally to the free gingival margin. Meas• None of the patients experienced any severe pain or urements from the gingival margin of the notch to the discomfort, although it took 3 to 4 weeks before the free gingival margin, and to the bottom of the gingival surgical lesion appeared to be healed. sulcus or pocket were obtained with a blunted no. 2 silver point of the type used for root canal therapy. A All clinical and histometric measurements have been cotton plier was used to grasp the point at the spot compiled in Table 1. where the beaks of the plier fit into the reference notch. The measurements were made with a Boley gauge. The presurgical measurements were obtained imme• diately prior to the anesthesia for the surgery. The meas• A labial and interproximal gingivectomy was then urements at the time of surgery were taken immediately performed on the experimental tooth and the immediate after completion of the experimental surgery, and "level of surgery" refers to soft tissue attachment to the tooth *The University of Michigan, School of Dentistry, Ann Arbor, at that time. Healing time indicates the time interval Michigan 48104. between the experimental surgery and the removal of ** University of Kentucky, College of Dentistry, Department the specimen. The clinical posthealing measurements of Oral Surgery, Lexington, Kentucky 40506. * * *The University of Michigan, School of Dentistry, Depart• were recorded immediately prior to the anesthesia for ment of Periodontics, Ann Arbor, Michigan 48104. the surgical removal of the specimens. The listed micro- Page 5/127 Page 6/128 COSTICH AND RAMFJORD Table 1 Clinical and Histometric Measurements in Milimeters Pre- Time of surgical Surgery Post Healing Results l ) ) Clinical Microscopic l l l r l r r l l y y e h h Leve f f g g m m l m m (yrs. (yrs. l l tt o o n n n n e e Gingiva Gingiva r r f f r r Teet Teet e e y y e e t t tt Surger Surger Botto Gingiva Alveola o o Botto Gingiva Alveola Alveola Apica Botto Botto Leve Leve Gingiva Gingiva Gai Gai Gai Gai f f o o o g g o o oo Tim Tim Exposur o oo oo oo r r r r e e g g e Patien Patien n n n o o ) ) n t t n n t t ff t t t t Numbe Numbe t t t t t t o o o o l l h h h t h hh t h h hh hh hh hh Numbe Numbe s s s s Posthealin Posthealin ee o o d d Bon Bon Crevic Crevic Bon Surger Surger Crevic Crevic ee f f f f f ff ff (days (days an an Lowerin Leve Lowerin Leve o o Los Los Los Los o Cres Margi Margi Notc Notc Attachmen Attachmen o Notc Notc o Healin Healin Margi Nptc oo Cres NotcNotc Notc Margi oo NotcNotc NotcNotc NotcNotc MargiMargi AntagonisAntagonis TootToot AgAg CasCas -1.0 +0.3 3.6 -0.6 1 8 33 - 2.0 3.9 4.3 6.X) 9.0 7 5.6 5.7 4.9 4.9 5.7 .8 +0.5 3.2 +0.9 2 8 57 + 1.5 4.3 4.4 4.8 9.0 7 4.7 5.0 3.5 3.5 4.3 +0 >-3.8 2.8 -2.2 3 7 35 - 1.2 3.4 3.2 6.2 9.5 14 4.0 4.0 4.2 5.6 >10.0 -2.2 +0.1 4 7 37 + 1.6 2.6 4.0 5.0 8.0 14 3.5 5.0 3.2 4.1 4.6 -1.5 +0.4 1.9 -0.7 2.6 -0.2 5 8 28 + 1.5 3.2 4.8 5.5 8.5 22 4.1 4.2 3.9 5.0 6.2 -1.8 -0.3 2.3 +0.1 6 9 34 + 2.2 5.3 5.3 6.0 8.4 24 4.5 5.3 4.8 5.2 6.3 +0.1 2.6 -0.1 7 10 51 + 2.2 4.5 5.0 6.0 9.5 25 4.8 4.9 4.2 4.9 5.9 +0.4 +0.1 1.3 +0.8 8 7 26 + 2.2 3.7 4.3 4.5 8.7 41 3.5 4.3 3.0 3.5 y 8.C +0.2 >-3.5 -0.5 2.7 +0.5 9 8 28 + 1.7 4.0 4.5 5.0 8.4 41 4.4 5.2 3.2 4.0 5.5 0.0 -2.7 2.4 -0.3 10 10 37 + 1.3 3.4 3.7 4.6 7.0 43 3.7 4.2 3.5 4.0 7.: -0.6 scopic measurements represent the average from three ments from the notch to the level of surgery at the time randomly selected tissue sections. Under Results are of surgery and the posthealing attachment level meas• listed as loss ( — ) or gain ( + ) differences between the ured microscopically, indicating that the attachment clinically obtained presurgical measurements between level remained fairly well where it was placed at the the notch and the bottom of the crevice and posthealing time of surgery. (See last column, Table 1.) microscopic measurements between the notch and the connective tissue attachment level. This comparison of B. Histologic Findings measurements is of limited significance since in most The ten specimens represent essentially four time in• instances there had not been sufficient time for comple• tervals of healing (1 week, 2 weeks, 3 weeks and 6 tion of the healing. Similarly, loss ( —) or gain ( + ) weeks, see Table 1). A composite description of the of bone is based on comparison of the clinical meas• histologic findings will be given for each of these time urements at the time of surgery and the microscopic intervals. measurements from the posthealing specmiens. In two One Week After Experimental Surgery (Cases 1 and instances (Case 3 and Case 8), no labial bone was 2, Table 1 ). The labial bone is denuded for 3 to 4 mm present in the block sections indicating considerable loss apically to the alveolar crest (Fig. 2A). The surface of of bone. The gingival margin did not regain its presurgi• the bone is necrotic with empty lacunar spaces. The cal position. This is indicated in the next to the last col• periodontal aspect of the alveolar bone is vital.