Periodontal Treatment Of Gingival Enlargement Due To Cyclosporine: Case Series

Year 2013, Volume: 23 Issue: 1, 82 - 88, 01.01.2013

Esra Baltacıoğlu Pınar Yuva Mümin Yılmaz Özlem Saraç Atagün Malike Aslan Kehribar , Güven Aydın Nilsun Bağış

Abstract

Aim: In this case series, we present periodontal treatment and follow-up of three cases who have been using cyclosporine for over ten years and with gingival enlargement. Materials and Method: Following clinical and radiographic examination, three male patients whose ages were 37, 47 and 55 were diagnosed with generalized gingival enlargement due to cyclosporine and chronic periodontitis. As a result of consultations, scanning and root planning under antibiotic proflaxy and oral hygiene training were given. Following initial periodontal treatment, partial healing was observed in periodontal tissues and it was decided that fullthickness flap be applied to the sites where gingival enlargement due to long-term cyclosporine use was observed. Results: After the applied surgical treatments, an environment in which the patients could maintain oral hygiene was obtained; at the same time, elimination of deep periodontal pockets was achieved. Discussion: In all the three cases, not only gingival enlargement but also chronic periodontitis condition was observed. Since bacterial plaque could not be eliminated in these patients, periodontitis condition may advance and periodontal inflammation may have a negative effect on the general health of patients. Routine periodontal control of patients will be useful for patients' general health. Olgu Sunumu/ Case Report

Keywords

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Siklosporine Bağlı Dişeti Büyümelerinin Periodontal Tedavisi: Olgu Serisi

Abstract

Amaç: Bu olgu serisinde böbrek transplantasyonu nedeniyle 10 yılı aşkın süredir siklosporin kullanan ve dişeti büyümeleri bulunan 3 olgunun periodontal tedavisi ve klinik takibi sunulmaktadır. Materyal ve Metod: Yaşları 37, 47 ve 55 olan 3 erkek hastaya klinik ve radyografik muayene sonucunda siklosporine bağlı generalize dişeti büyümesi ve kronik periodontitis teşhisi kondu. Yapılan konsültasyonlar sonucunda, antibiyotik proflaksisi altında diştaşı temizliği ve kök yüzeyi düzeltmeleri ve oral hijyen eğitimleri verildi. Başlangıç periodontal tedavileri takiben periodontal dokularda kısmi periodontal iyileşme sağlanırken, uzun dönem siklosporin kullanımına bağlı şiddetli dişeti büyümesi gözlenen bölgelere tam-kalınlık flap cerrahisi uygulanılmasına karar verildi. Sonuçlar: Uygulanılan cerrahi tedaviler sonucunda, hastaların ağız hijyenini idame ettirebileceği bir ortam elde edilirken, aynı zamanda derin periodontal ceplerin de eliminasyonu sağlandı. Tartışma: Her üç olguda sadece dişeti büyümesi değil aynı zamanda kronik periodontitis tablosu gözlenmektedir. Bu hastalarda, bakteriyal plak birikimi elimine edilemediğinden periodontitis tablosu ilerleyebilir ve periodontal inflamasyon, hastaların genel sağlığı üzerinde olumsuz etki yaratabilir. Böbrek transplantasyonu geçirmiş hastaların rutin periodontal kontrollerinin yapılması, hastaların genel sağlığı açısından yararlı olacaktır

Keywords

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References

• Ghafari A, Poorabbas R, Takieh JA, Sepehrvand N, Sepehrvand C, Hatami S. Gingival Enlargement and Its Risk Factors in Kidney Transplant Patients Receiving Cyclosporine A. Iran J Kidney Dis 2010; 4: 66 -70.
• Brunet L, Miranda J, Farre M, Berini L, Mendieta C. Gingival enlargement induced by drugs. Drug Saf 1996; 15: 219 - 31.
• Brunet L, Miranda J, Roset P, Berini L, Farre M, Mendieta C. Prevalence and risk of gingival enlargement in patients treated with anticonvulsant drugs. Eur J Clin Invest 2001; 31: 781-88.
• Nakib N, Ashrafi SS. Drug-induced gingival overgrowth. Dis Mon 2011 ; 57: 225 - 30.
• Calne RY, Rolles K, White DJ, Thiru S, Evans DB, McMaster P, Dunn DC, Craddock GN, Henderson RG, Aziz S, Lewis P. Cyclosporin-A initially as the only immunosuppressant in 34 recipients of cadaveric organs 32 kidneys, 2 pancreas and 2 livers. Lancet 1979; 2: 1033 - 6.
• Meller AT, Rumjanek VM, Sansone C, Allodi S. Oral mucosa alterations induced by cyclosporin in mice morphological features. J Periodont Res. 2002; 37: 412-5.
• Afonso M, Bello VDO, Shibli JA, Sposto MR. Cyclosporine A-Induced Gingival Overgrowth in Renal Transplant Patients. J Periodontol 2003; 74: 51- 6.
• Cotrim P, De Andrade CR, Martelli-Junior H, Graner E, Sauk JJ, Coletta RD. Expression of matrix metalloproteinases in cyclosporin-treated gingival fibroblasts is regulated by transforming growth factor (TGF)-beta1 autocrine stimulation.. J Periodontol 2002; 73: 1313 - 22.
• Tüter G, Serdar MA, Yalim M, Gürhan IS, Baloş K. Evaluation of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 levels in gingival fibroblasts of cyclosporin A-treated patients. J Periodontol 2002;73: 1273 - 8.
• Craig RG. Interactions between chronic renal disease and periodontal disease. Oral Dis 2008; 4: 1Ünlü G, Ipek F. Renal transplantasyonlu hastada siklosporin kullanımına bağlı gingival hiperplazi. Vaka raporu. Atatürk Üniv. Diş Hek. Fak Derg 2001; 11: 64 - 8.
• Seymour RA, Jacops DJ. Syclosporine and gingival tissues. J Clin Periodontol 1992; 19: 1
• Ellis JS, Seymour RA, Taylor JJ, Thomason JM. Prevalence of gingival overgrowth in transplant patients immunosuppressed with tacrolimus. J Clin Periodontol 2004; 31: 126 -31.
• Somacarrera ML, Hernandez G, Acero J, Moskow BS. Factors related to the incidence and severity of cyclosporine-induced gingival overgrowth in transplant patients. A longitudinal study. J Periodontol 1994; 65: 671-5.
• Shaqman M, Ioannidou E, Burleson J, Hull D, Dongari-Bagtzoglou A. Periodontitis and Inflammatory Markers in Transplant Recipients. J Periodontol 2010; 81; 666 -72.
• Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999; 4: 1-7.
• Angelopolous AP, Goaz PW. Incidence of diphenylhydantoin gingival hyperplasia. J Oral Surg 1972; 34: 898 - 906.
• Silness J, Löe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22: 121-35.
• Spolidorio LC, Spolidorio DM, Holzhausen M. Effects of long-term cyclosporin therapy on the periodontium of rats. J Periodontal Res 2004; 39: 257Chae HJ, Ha MS, Yun DH, Pae HO, Chung HT, Chae SW, Jung YK, Kim HR. Mechanism of Cyclosporine-induced Overgrowth in Gingiva. J Dent Res 2006; 85: 515 -9.
• Myrillas TT, Linden GJ, Marley JJ, Irwin CR. Cyclosporin A regulates interleukin-1beta and interleukin-6 expression in gingiva: implications for gingival overgrowth. J Periodontol 1999; 70: 294 - 300.
• Nakao K, Yoneda K, Osaki T. Enhanced cytokine production and collagen synthesis of gingival fibroblasts from patients with denture fibromatosis. J Dent Res 1995; 74: 1072 - 78.
• Kataoka M, Kido J, Shinohara Y, Nagata T. Druginduced gingival overgrowth--a review. Biol Pharm Bull 2005; 28: 1817-21.
• Kataoka M, Shimizu Y, Kunikiyo K, Asahara Y, Yamashita K, Ninomiya M., Morisaki I, Ohsaki Y, Kido J, Nagata T. J Cell Physiol 2000; 182: 351
• Hyland PL, Traynor PS, Myrillas TT, Marley JJ, Linden GJ, Winter P, Leadbetter N, Cawston TE, Irwin CR. The effects of cyclosporin on the collagenolytic activity of gingival fibroblasts. J Periodontol 2003; 74: 437- 45.
• McGaw T, Lam S, Coates J. Cyclosporin-induced gingival overgrowth correlation with dental plaque scores, gingivitis scores, and cyclosporin levels in serum and saliva. Oral Surg Oral Med Oral Pathol 1987; 64: 293 - 7.
• Williamson MS, Miller EK, Plemons J, Rees T, Iacopino AM. Cyclosporine A upregulates interleukin-6 gene expression in human gingiva possible mechanism for gingival overgrowth. J Periodontol 1994;65: 895 - 903.
• Spolidorio LC, Spoldidorio DMP, Massucato EMS, Neppelenbrock KH, Camanha NH, Sanches MH. Oral health in renal transplant recipients administered cyclosporine A or tacrolimus. Oral Dis 2006; 12: 309 -14.
• Ebersole J, Cappelli D. Acute-phase reactants in infections and inflammatory diseases. Periodontol 2000 2000; 23:19 - 49.
• Mavrogiannis M, Ellis JS, Thomason JM, Seymour RA. The management of druginduced gingival overgrowth. J Clin Periodontol 2006; 33: 434 - 9.
• Somacarrera ML, Lucas M, Scully C, Barrios C. Effectiveness of periodontal treatments on cyclosporine-induced gingival overgrowth in transplant patients. Br Dent J 1997; 183: 89 - 94.
• Modéer T, Dahllöf G. Development of phenytoininduced gingival overgrowth in noninstitutionalized epileptic children subjected to different plaque control programs. Acta Odontol Scand 1987; 45: 81-5.
• Montebugnoli L, Servidio D, Bernardi F. The rôle of time in reducing gingival overgrowth in hearttransplanted patients following cyclosporin therapy. J Clin Periodontol 2000; 27: 611- 4.
• Glaude R, Snider ME. Intracellular accumulation of azithromycin by cultured human fibroblasts. Antimicrob Agents Chemother 1990; 34: 1056
• Baltacıoğlu E, Aslan M, Saraç Ö, Şaybak A, Yuva P. Analysis of clinical results of systemic antimicrobials, combined with non-surgical periodontal treatment, in generalized aggressive periodontitis: a pilot study. J Can Dent Assoc 2011; 77: b97.
• Hernández G, Arriba L, Frías MC, de la Macorra JC, de Vicente JC, Jiménez C, de Andrés A, Moreno E. Conversion from cyclosporin A to tacrolimus as a non-surgical alternative to reduce gingival enlargement: a preliminary case series. J Periodontol 2003;74: 1816 - 23.
• Mir S, Sozeri, Kara OD, Toroslu E. The evaluation immunosuppresant drugs in renal transplantation: Review. Turkiye Klinikleri J Pediatr 2009; 18: 305 - 12.
• Sagiroglu T, Yıldırım M, Meydan B, Cobanoglu M. Retrospective analysis of kidney transplanted patients. Turkiye Klinikleri J Pediatr 2009; 36 :75 - 9.
• Seymour RA, Ellis JS, Thomason JM. Risk factors for drug-induced gingival overgrowth. J Clin Periodontol 2000; 27: 217 - 23.
• Newman MG, Takei HH, Klokkevold PR, Carranza FA. Carranza’s Clinical Periodontology, Treatment of Gingival Enlargement. 11th Edition, WB Saunders Company 2012; 556 - 61. Yazışma Adresi Dr. Mümin Yılmaz
• Karadeniz Teknik Üniversitesi Dişhekimliği Fakültesi Periodontoloji Anabilim Dalı T Telf: 05397117433 e-mail: [e-mail]??