2018年 · 第53卷第03期

The upper anterior teeth are extremely important to the aesthetics and pronunciation function of patients, especially the patients with severe periodontitis often have severe soft and hard tissue defects in the missing tooth area. Therefore, implant denture restoration for such patients should not only restore the function, but also achieve the aesthetic effect and long-term periodontal stability and health^[1,2]。 A patient with chronic periodontitis and severe bone defect in anterior teeth was treated in the Department of Periodontology of the Ninth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine. The patient was treated with periodontal-implant-restoration combination. After controlling periodontal inflammation, the soft and hard tissue increment was performed at the same time with implant surgery, and the temporary crown was used to induce gingival papilla and gingivoplasty and final permanent restoration. The treatment method shortened the treatment time and ensured the periodontal health, which was consistent with the successful implant therapy of chronic periodontitis patients reported in the previous literature^[3,4]In this case, the patient also obtained satisfactory aesthetic restoration results, which are reported below.

Gingival recession is characterized by atrophic changes in the periodontal tissue, characterized by a displacement of the gingival margin from the physiological position located in the crown of the enamel-cemental boundary to the root, resulting in pathological exposure of the tooth root surface^[1]。 Mythri et al.^[2]Studies have shown that the most common cause of gingival recession is plaque accumulation, followed by improper brushing, smoking, wrongDeformity and high attachment of labiobuccal frenulum, etc. Because gingival recession occurring on the buccal side of teeth, especially in the anterior tooth region, brings aesthetic troubles to patients, so this part of patients pays special attention to the problem of gingival recession. The surgical methods for gingival recession have been evolving with the maturity of technology and the change of patients' needs. Since 1990s, due to the increasing aesthetic needs of patients, the pursuit of complete root coverage also emphasizes the integration effect of the affected tooth area and the surrounding soft tissue, that is, the perfect gingival shape^[3]。 Some studies have shown that subepithelial connective tissue transplantation combined with coronary reduction flap is superior to other procedures in root coverage, keratinization increment, long-term stability and aesthetic effect. The success rate of operation is 91%, and the complete root coverage rate is 27% ~89%. It is regarded as the gold standard for the treatment of gingival recession^[4,5]。

At present, the number of patients visiting periodontology for aesthetic treatment is increasing, and improving the "poor" smile caused by root exposure is one of the main demands. Clinically, root surface exposure is often accompanied by dentin sensitivity, and when recession develops further, abnormal gingival margin morphology can hinder plaque control, ultimately leading to periodontal inflammation. For such patients, doctors not only need to conduct a comprehensive evaluation before surgery, but also need to communicate with patients in detail about the cause of the disease, treatment plan and expected outcome. A patient with full-mouth multi-tooth gingival recession was diagnosed and treated in the Department of Periodontology of the Ninth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine. The report is as follows.

Aggressive periodontitis is more common in young patients, characterized by periodontal attachment and rapid loss of periodontal bone tissue, often with pathological displacement of teeth, which seriously affects aesthetics and function. For the treatment of aggressive periodontitis, a multidisciplinary combination of treatments is usually required, with a comprehensive treatment design for optimal outcomes^[1]。 A patient with aggressive periodontitis was admitted to the Department of Stomatology, the Second Affiliated Hospital of Zhejiang University School of Medicine. After multidisciplinary comprehensive treatment, such as basic periodontal treatment, periodontal surgery and orthodontic treatment, the longitudinal observation for 6 years showed satisfactory results, which are now reported as follows.

Patients with aggressive periodontitis usually have moderate to severe periodontal tissue destruction at a young age, which in turn causes tooth displacement and loss, which has adverse effects on function and appearance^[1,2,3]。 These young patients tend to have relatively high quality of life and social requirements, so they need not only to restore periodontal tissue health, but also to balance functional and aesthetic reconstruction during treatment. This requires a multidisciplinary team of experts such as periodontal, restorative, and orthodontists to work together to complete the treatment of aggressive periodontitis. A patient with extensive aggressive periodontitis was admitted to the periodontal department of Peking University School of Stomatology and Stomatological Hospital. After perfect basic periodontal treatment, the functional and aesthetic reconstruction was performed by combining implant, restoration and orthodontic treatment. The report is as follows.

Langerhans cell histiocytosis (LCH) is a monoclonal dysplastic disease of dendritic Langerhans cells with unknown pathogenesis, which occurs in children and adolescents, and can also occur in adults. LCH can involve multiple organs and is commonly found in bone marrow, liver, spleen and lymphoid tissues of children^[1]。 The first symptom of periodontal tissue destruction is rare in patients, and it is easy to be misdiagnosed as severe periodontitis because of the lack of typical clinical history and specific clinical symptoms. A patient with LCH was admitted to the Department of Stomatology, the First Affiliated Hospital of Zhengzhou University. After basic periodontal treatment and chemotherapy in hematology, his condition was stable. The report is as follows.