Plasminogen is a proenzyme which is converted into active plasmin by plasminogen activators on the fibrin surface.
Plasminogen plays an important role in many events, such as cell migration, angiogenesis, and fibrinolysis.
It passes into the bloodstream in proenzyme form after being synthesized in the liver and turns into plasmin, the active enzyme format. Mucosal areas acquire a coarse appearance due to the accumulation of fibrin in the absence of complete or partial plasminogen. For this reason, the term “ligneous”, which means “woody” in Latin, is used.The term “ligneous periodontitis” was first defined by Gunhan et al. as a periodontal disease characterized by membranous gingival overgrowth and severe bone loss due to the accumulation of amyloid-like material. The most characteristic features of this destructive periodontal disease are widespread membranous, nodular gingival enlargements in both maxilla and mandible leading to rapid tooth loss despite several treatment attempts .
Several therapeutic approaches to reduce the bacterial load to decrease the inflammation and thus the progression of the disease have been attempted; these procedures include scaling and root planing, chlorhexidine rinsing, administration of antibiotics, and periodontal surgery.Neering et al. have reported that patients with PLG-deficiency Type I may benefit from nonsurgical periodontal therapy including full mouth disinfection in combination with adjunctive antibiotic therapy and a strict supportive periodontal therapy regime every three months .
Scully et al. suggested that gingival lesions can be controlled by topical heparin or intravenous purified plasminogen. Gunhan et al. stated that systemic fibrinolytic and antithrombotic agents may prove more beneficial than local treatments, because the ligneous lesions tend to involve several mucosal areas .
Traditional periodontal treatment options for managing gingival enlargements include either gingivectomy or flap surgeries.
The main objective is to excise the enlargements and reestablish healthy gingival margins and contours.The healing pattern in flap surgeries is by primary intention, whereas in gingivectomy, it involves healing by secondary intention. These healing mechanisms involve the formation of a fibrin clot, which creates a framework for normal periodontal tissues to grow back.
However, in patients with plasminogen deficiency, the inadequacy of plasmin results in the overgrowth of fibrin. This is the main reason for the failure of conventional periodontal treatment modalities in these patients.
The healing pattern in flap surgeries is by primary intention, whereas in gingivectomy, it involves healing by secondary intention. These healing mechanisms involve the formation of a fibrin clot, which creates a framework for normal periodontal tissues to grow back.
However, in patients with plasminogen deficiency, the inadequacy of plasmin results in the overgrowth of fibrin. This is the main reason for t
2. Introduction:
• Plasminogen is a proenzyme which is converted into active plasmin by plasminogen activators on
the fibrin surface.
• Plasminogen plays an important role in many events, such as cell migration, angiogenesis, and
fibrinolysis.
• It passes into the bloodstream in proenzyme form after being synthesized in the liver and turns into
plasmin, the active enzyme format.
PLASMINIGEN PLASMIN
PRO ENZYME ACTIVE FORM
4. Mucosal areas acquire a coarse appearance due to the accumulation of fibrin in the absence
of complete or partial plasminogen. For this reason, the term “ligneous”, which means
“woody” in Latin, is used.
• The term “ligneous periodontitis” was first defined by Gunhan et al. as a periodontal
disease characterized by membranous gingival overgrowth and severe bone loss due to
the accumulation of amyloid-like material.
9. Case report:
Ligneous Periodontitis in a Patient with Type 1
Plasminogen Deficiency: A Case Report and Review of the
Literature
Arun sadasivan, Roshni Ramesh ,Deepu George
Mathew
Case Reports in Dentistry Volume 202
10.
11.
12. Case report :
Destructive membranous periodontal disease (ligneous
periodontitis): a case report and 3 years follow-up
T. Baykul and Y. Bozkurt
BRITISH DENTAL JOURNAL VOLUME 197 NO. 8
OCTOBER 23 2004
13.
14. TREATMENT
• The most characteristic features of this destructive periodontal disease are
widespread membranous, nodular gingival enlargements in both maxilla and
mandible leading to rapid tooth loss despite several treatment attempts .
• Several therapeutic approaches to reduce the bacterial load to decrease the
inflammation and thus the progression of the disease have been attempted;
these procedures include scaling and root planing, chlorhexidine rinsing,
administration of antibiotics, and periodontal surgery.
15. • Neering et al. have reported that patients with PLG-deficiency Type I may benefit
from nonsurgical periodontal therapy including full mouth disinfection in
combination with adjunctive antibiotic therapy and a strict supportive
periodontal therapy regime every three months .
• Scully et al. suggested that gingival lesions can be controlled by topical heparin or
intravenous purified plasminogen.
16. • Gunhan et al. stated that systemic fibrinolytic and antithrombotic agents may
prove more beneficial than local treatments, because the ligneous lesions
tend to involve several mucosal areas .
• Traditional periodontal treatment options for managing gingival
enlargements include either gingivectomy or flap surgeries.
• The main objective is to excise the enlargements and reestablish healthy
gingival margins and contours
17. • The healing pattern in flap surgeries is by primary intention, whereas in
gingivectomy, it involves healing by secondary intention. These healing
mechanisms involve the formation of a fibrin clot, which creates a framework
for normal periodontal tissues to grow back.
• However, in patients with plasminogen deficiency, the inadequacy of plasmin
results in the overgrowth of fibrin. This is the main reason for the failure of
conventional periodontal treatment modalities in these patients.
18. REFERENCES
• Sadasivan A, Ramesh R, Mathew DG. Ligneous Periodontitis in a Patient with Type 1
Plasminogen Deficiency: A Case Report and Review of the Literature. Case Rep Dent.
2020 Mar 24;2020:5680535
• Baykul T, Bozkurt Y. Destructive membranous periodontal disease (ligneous
periodontitis): a case report and 3 years follow-up. Br Dent J. 2004 Oct 23;197(8):467-8.
doi: 10.1038/sj.bdj.4811739.
• Bektaş-Kayhan K, Koca-Ünsal RB, Başaran B, Çelkan T. Ligneous Periodontitis Associated
with Plasminogen Deficiency: A Review of the Literature with Two Additional Cases.
Cyprus J Med Sci 2022;7:718-730.
