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Parameters of the Attached Epithelial Reformation Following Gingivectomy Loyola University Chicago Loyola eCommons Master's Theses Theses and Dissertations 1978 Parameters of the Attached Epithelial Reformation Following Gingivectomy Carl J. Laudando Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_theses Part of the Oral Biology and Oral Pathology Commons Recommended Citation Laudando, Carl J., "Parameters of the Attached Epithelial Reformation Following Gingivectomy" (1978). Master's Theses. 2983. https://ecommons.luc.edu/luc_theses/2983 This Thesis is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Master's Theses by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1978 Carl J. Laudando PARAMETERS OF THE ATTAOffiD EPITHFLIAl REFO~~TION FOLLOWING GINGIVECT01'~1Y By Carl J. Laudando PARAMETERS OF TI-!F ATTArnED EPITHELIAL REFO~~TION FOLL01VING GINGIVECTOJvfY By Carl J. Laudando, B.S., D.D.S. A Thesis Submitted to the Faculty of the Graduate School of Loyola University in Partial Fulfillment of the Requirements for the Degree of ~/faster of Science in Oral Biology May 1978 T ~·' • DEDICATION To my mother and father, Ignatius and Rose Laudando, for their never ending encouragement, love and understanding. To my wife, Nancy, for her love, sacrifice, and patience. ] ACKNOWLFDGJvlF.t,rrs I would like to express my appreciation to the members of my advisory committee: Doctor Lawrence Jenkins, Doctor Anthony W. Gargiulo, Doctor Patrick Toto, Doctor Hal McReynolds, and Doctor Daniel Grant for their assistance and recommendations during the research and writting of this thesis. Their recommendations in the preparations of this thesis were most helpful. In particular, I would like to thank Doctor Jenkins for his constant guidance and direction during the many months of preparation, or­ ganization, and writing of this research project. ii TARLF. OF CONTF~~S CHAPTER PAGE I I,I\;'TRODUCTION .........•.•.....•......... 1 II RFVIEW OF THF. LITERATIJRF ............... 3 III MATERIALS Ai'ID l\fETHODS •................ 12 IV RESULTS ..•.....•.........•............ 15 v DISCUSSION ......•..................... 21 VI CONCLUSION ............................ 26 VII SUrv1J'-1ARY .......................•....... 2 8 VIII TABLES ................................ 31 IX ILLUSTRATIONS ......•.................. 55 BIBLIOGRAPHY ..•....................... 60 iii GIAPTIR I U..,l'TRODUCTION Various theraputic procedures have been developed aimed at restoring to a healthy state the pathologically altered relationship of the periodon­ tal tissues to the tooth surface. Many investigators have studied the heal­ ing patterns of these various procedures.l,2 Most of these investigations have been concerned with histological evaluation of the gingiva and attach­ ment apparatus of teeth following various theraputic procedures.3,4,5,6,7,8,9 The gingivectomy is one such nrocedure. It is a widely used thera­ putic procedure aimed at restoring to a healthy state the pathologically altered gingival tissues. The usefulness of the gingivectomy as a technique in the treatment of periodontal disease has been affirmed by many investi­ gators.l0,11,12,13,14 It results in the excision of a large portion of the gingival connective tissue. The jtmctional and sulcular epithelium are lost with the coronal portion of the oral epithelium. The wound which results consists of an open connective tissue bed limited on one side by the tooth and the other by the cut edge of the severed oral epithelium. The adjacent epithelium will proliferate to form a new lining over the exposed connective tissue and will eventually give rise to a new oral, stilcular and junctional epithelium. Clinical opinion, hm..-ever, varies as to the marginal position and sulcular depth of the newly formed gingival unit following a gingivectomy procedure. Some limited human data and animal studies have been published 1 2 describing the position of the gingival margin.l5,16 Some human stlldies are contradictory as to the healing of the gingival margin. Some indicate an apical shift of the marginl7 while others describe a coronal gain of the gingival margin.l5,18,19,20 To study this nhenomenon it is necessary to measure the shift of the attachment and gingiva from a constant reference point, The use of an acry­ lic stent has proven to be a reliable means to attain this goal.20,21 The measurement of the attacrunent and pocket depth have been performed using a calabrated periodontal probe. T11e use of the probe as a measuring device has been shown to be a very reliable source for measurement.22,23 It is therefore the intent of this research to study the effect of a gingivectomy on the marginal position and sulcular depth of the newly fo~­ ed gingival sulcus. GIAPTER II LITERATITRE REVIEW Resection of gingival tissue has been one method of periodontal therapy for the elimination of gingival pockets. As long ago as 1746 and 1757, Pierre Fauchard24 and Bourdet25 respectively described there- section of diseased gingival tissues. Various surgical procedures de- scribed in the literature included a gingivectomy but involved, in fact, other procedures as well. It was not until 1912, that Pickerall26 first described in a book an operation for pyorrhea called a gingivectomy. It should be noted that in the earlier literature (prior to 1950) the described gingivectomy procedures, in fact, may not have been merely resection of soft tissue but included other procedures as we11. 27 •28 •29 Actually, there was considerable inconsistency in what exactly was per- 30 f orme d dur1ng . a g1ng1vectomy. proced ure 1n. t h e ear1 y 1"1terature. Not until 1950, had the term "gingivectomy" been defined. Miller31 defined gingivectomy as the operation of cutting away all loose infected and diseased gingival tissue to eradicate the periodontal pocket. In the same year, Goldrnan10 termed and devised a technique of "gingivoplasty" ernphasing form and function. He defined gingivoplasty as artifically re- sharping the gingiva to create physiologic gingival contours. Thus, in the literature following these definitions, more standar- dization of the technique in reported procedures was achieved. This aware- ness in regard to procedure type is necessary to uroperly interpret especi- ally the early periodontal literature in reference to the surgical technique. 3 4 In the definition of gingivectomy, reference is made to the perio­ dontal "pocket". In 1953, Cross and Wade32 defined a periodontal pocket as a pathologically deepened gingival crevice. The literature presents a vast number of articles concerned with techniques, indications and contraindications of the gingivectomy~l,33,34,35 The general opinion indicates that the gingivectomy procedure can be utilized in the excision of the soft tissue wall of the pocket not extending beyond the mucogingival junction and not involving infrabony defects. Removal of deposits is recognized as an important aspect of perio­ dontal care. But whether or not pre-surgical scaling is of value is 1lll­ certain. Glickman (1956), 36 concluded that pre-scaling exerts no beneficial effect on the outcome of the gingivectomy procedure. Pre-scaling did not improve the healing nor reduce the healing time following periodontal sur­ gery. Ambrose and Detamore38 (1960) were unable to prove the value of pre- surgical root planing. Bernier and Kaplan (1947), 39 attributed the more rapid epithe- lization and consolidation of underlying connection of connective tissue to the presence of the surgical dressing. In consideration of surgical procedures, upon completion of the surgical technique, surgical dressings are often placed. Waerhaug and Loe43 observed that a gingivectomy dressing was slightly irritating but it did not 41 prevent healing and apparently it does not cause any damage. Stahl (1969) observed that the use of a pack did not influence the healing parameters. Anatomical descriptions of surface gingival tissue have been 5 42 described in the early periodontal literature by King (1945) as "matt in texture, just distant from the dental margin." Orban (1948) 43 de- scribed the "free gingival groove" distinguishing the free gingiva from the attached gingiva. Also, stippling, mucogingival line, interdental grooves and folds, and interdental papilla were described. Gingival anatomy was reported by Goldrnan. 14 These represent the literatures' most regarded anatomic description of the gingiva. Histologically, Orban44 described surface epithelium as kera- tinized. Epithelium of alveolar mucosa as not keratinized without the ridge formation found in the gingiva. Gingiva is plentiful in collagenous fibers without or scant in elastic fibers; while alveolar mucosa is poor in collagen fiber bundles and rich in elastic fibers. Orban also was con- cerned with the importance of the epithelial attachment. Gottlieb (1921) 45 presented the first evidence of the existence 4 of an epithelial attachment. 1Vaerhaug A in 1952, stated that there was no 47 epithelial attachment just a close apposition. Listgarten in 1966, demonstrated, with the electron microscope, that the presence of an epithe- lial attachment to the teeth does exist. There is a considerable arnmmt of research that has been perfonned 48 on the healing of the gingivectomy. In 1929, Lundquist studied the epithe- lial regeneration after a gingivectomy, finding
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