ABSTRACT
A exposição excessiva de gengiva durante o sorriso é denominada como sorriso gengival. O fator etiológico dessa alteração é variado e sua identificação é fundamental para confecção de um plano de tratamento eficaz. O planejamento clínico pode ser realizado utilizando uma abordagem dinâmica e digital do sorriso. Sendo assim, software, exames imaginológicos, modelo virtual 3D e guia cirúrgico aumentam a qualidade e a precisão do tratamento, trazendo inúmeros benefícios para o paciente. Objetivo: demonstrar a importância do fluxo digital no planejamento e na correção do sorriso gengival. Relato de caso: paciente apresentou queixas em relação ao tamanho dos dentes e ao excesso de exposição de gengiva durante o sorriso. Após exames clínico e radiográfico, foi possível realizar o diagnóstico do fator etiológico como erupção passiva alterada (EPA). O tratamento de escolha foi o recontorno gengival associado à realização de osteotomia e osteoplastia. Para uma maior precisão do tratamento, foi confeccionado um guia cirúrgico duplo. Após o procedimento, a paciente foi orientada e medicada. Considerações finais: a abordagem digital do sorriso favoreceu um tratamento cirúrgico preciso, eficaz e satisfatório para a paciente, reestabelecendo assim a harmonia dento-gengivo-facial.(AU)
Excessive gum exposure during a smile is called a gum smile. The etiologic factor of this alteration is varied, the identification is essential to create an effective treatment plan. Clinical planning can be performed using a dynamic and digital smile approach. Therefore, software, imaging tests, 3D virtual model and the surgical guide increase the quality and precision of the treatment thus bringing numerous benefits to the patient. Objective: this case report aims to demonstrate the importance of digital flow in smile planning and correction of a gum smile. Case report: the patient presented complaints regarding tooth size and excessive gum exposure during the smile. After the clinical and radiographic examination, the etiological factor was diagnosed as an altered passive eruption (APE). The treatment of choice was the gingival contour associated with osteotomy and osteoplasty. For the precision of the treatment, a double surgical guide was made. After the procedure the patient was guided and medicated. Conclusion: the digital smile approach favored an accurate, effective and satisfactory surgical treatment for the patient thus restoring the tooth-gingival-facial harmony.(AU)
Subject(s)
Humans , Female , Adult , Smiling , Tooth Crown/surgery , Gingiva/surgery , Osteotomy/methods , Tooth Eruption , Tomography, X-Ray Computed , Treatment Outcome , Gingivectomy/methodsABSTRACT
Introduction : Altered passive eruption is a condition inprominence rather than at the cementoenamel junction. It’s adevelopmental anomaly clinically associated with a gingivalsmile with short, square teeth. Difficult to detect, most of thesecases are often overlooked or misdiagnosedCase report: This work highlights the clinical presentationof altered passive eruption of two cases along with sequentialapproach for management of each condition. The follow-upwas 12 months.Conclusion: Altered passive eruption presents a greatchallenge for the practitioner with regards to both diagnosisand therapeutic management. The practitioner must make theright diagnosis, establish an appropriate treatment plan, anddiscuss the various therapeutic possibilities with the patient inorder to satisfy their esthetic request.
ABSTRACT
Periodontal tissue, especially the alveolar bone, are closely associated with the progress and efficacy of orthodontic treatment. Prior to and during orthodontic treatment, dentists should fully evaluate the status of periodontal hard tissues to prevent clinical problems. This article aims to discuss bone issues associated with orthodontic treatment, including gingival papilla absence, alveolar bone insufficiency, excessive cortical resistance, and altered passive eruption, etc. The mechanism and prevention methods of these problems are also described.
Subject(s)
Gingiva , PeriodontiumABSTRACT
Cuando el tejido blando se posiciona excesivamente sobre las coronas anatómicas de los dientes, frecuentemente visto en adultos y que resulta en coronas clínicas cortas, es una condición que ha sido descrita en la literatura por diversos autores como ®erupción pasiva alterada¼. Se define como una relación dentogingival en la que el margen gingival se posiciona en la corona anatómica y no se aproxima a la unión cemento-esmalte debido a la alteración en los patrones de desarrollo y eruptivos de la unidad dentogingival. En este artículo se describe cómo la cirugía plástica periodontal puede remodelar el aparato de inserción, restablecer el espacio biológico adecuado, eliminar la exposición excesiva de la encía y exponer las dimensiones correctas de los dientes. En este reporte se presentan 3 casos de erupción pasiva alterada, abarcando su diagnóstico, clasificación clínica y tratamiento a través de cirugía periodontal para corregir las alteraciones estructurales y devolver la estética.
When the soft tissue is positioned excessively on anatomical crowns of teeth, frequently seen in adults and resulting in short clinical crowns, a condition has been described in the literature by several authors as "altered passive eruption". It is defined as a dentogingival relationship wherein the gingival margin is positioned coronally on the anatomic crown, and does not attach to the cement-enamel junction due to the disruption in the development and eruptive patterns of the dentogingival unit. This article describes how periodontal plastic surgery can remodel the attachment apparatus, re-establish the correct biological width, eliminate the excessive showing of gingiva, and expose the correct dimensions of teeth. In this report, 3 cases are presented of altered passive eruption, and includes the diagnosis, clinical staging and treatment through periodontal surgery to correct the structural and aesthetic appearance.
Subject(s)
Humans , Male , Adult , Female , Periodontal Diseases/surgery , Periodontal Diseases/diagnosis , Tooth Eruption/physiologyABSTRACT
Abstracts: Background & Objective: The domain of periodontics has changed from being strictly a health service to one, where smile enhancement has been brought to the forefront of treatment planning. In the composition of a beautiful smile, the form, balance, symmetry and relationship of the elements make it attractive or unattractive. Altered passive eruption is one of the conditions where a large portion of the anatomic crown remains covered by the gingiva which compromises dentofacial aesthetics. Periodontal plastic procedures, such as the basic gingivectomy, osseous correction or the apically positioned flap, may be used to change the silhouette form of teeth and their relative proportion. Here is a case of a 22-year-old healthy male with altered passive eruption (type 1A) with treatment that resulted in a revised silhouette form for the tooth which is more elliptical and attractive so as to resolve the unwarranted excessive display of gingiva apparent during smiling.
ABSTRACT
Introducción: Un tratamiento integral bucal involucra la evaluación de las características faciales, actividad muscular, y la relación entre la dentición visible y los tejidos blandos para mejorar función y estética del paciente. Algunas condiciones fisiológicas y/o patológicas resultan en la exposición excesiva de la encía ocasionando un aspecto negativo, limitando la expresión facial. Una de las principales causas de una sonrisa gingival es la erupción pasiva alterada o retardada. El alargamiento de corona es una técnica quirúrgica muy valiosa para procedimientos restaurativos, diseñada para aumentar el tamaño de la corona clínica. Como parte de un manejo interdisciplinario, los implantes dentales son una opción de tratamiento cuando existen dientes ausentes. Caso clínico: Paciente femenina de 56 años acude al Departamento de Periodoncia e Implantología porque no le gusta la apariencia de sus dientes ni su sonrisa. A la exploración clínica se observa biotipo grueso, márgenes gingivales irregulares, coronas clínicas irregulares y cortas, ausencia dentales y dimensión vertical disminuida. Radiográficamente el margen óseo se encuentra a nivel de unión cemento esmalte. El diagnóstico es erupción pasiva alterada. Con el Departamento de Prótesis Bucal y con base al encerado diagnóstico se deciden hacer alargamientos de corona con cirugía ósea en dientes anteriores superiores e inferiores, colocación de implantes en zona de dientes 36 y 46 y rehabilitación protésica con el sistema Captek. Resultados: Los resultados fueron favorables, se logró obtener armonía dentofacial y dentoperiodontal, así como función, estética y satisfacción en la paciente.
Introduction: A comprehensive, inter-disciplinary treatment of the mouth involves the following aspects: assessment of facial characteristics and muscle activity as well as existing relationship between visible dentition and soft tissues to improve patients' aesthetics and function. There are some physiological and/or pathological conditions which result in excessive exposition of the gums. This causes a negative appearance and limits facial expression. Altered or delayed eruption is one of the main causes of gummy smile. In restorative procedures, crown elongation is considered a very valuable surgical technique. This technique has the aim of lengthening the size of the clinical crown. As part of an inter-disciplinary treatment, dental implants represent an option in cases where there are missing teeth. Clinical case: 56 year old female patient attended the Implantology and Periodontics Department complaining of not liking the appearance of her teeth and smile. Clinical exploration disclosed thick biotype, irregular gingival margins, short and uneven clinical crowns, missing teeth as well as decreased vertical dimension. X ray assessment revealed bony margin at the level of enamel and cement junction. Emitted diagnosis was: Altered Passive Eruption. Based on diagnostic wax-up and after consultation with the Oral Prosthesis Department, treatment selected was crown elongation with bone surgery in upper and lower front teeth, implant placement in areas of teeth 36 and 46 as well as rehabilitation following the Captek system. Results: Results were favorable. Dentofacial and dental-periodontal harmony were achieved, as well as function, aesthetics and the patient's satisfaction.
ABSTRACT
El aumento coronario es un procedimiento quirúrgico periodontal que consiste en eliminar encía y hueso para crear una corona clínica más larga y desplazar el margen gingival en sentido apical. Se reporta el caso de un paciente de 16 años de edad con diagnóstico de agrandamiento gingival , al cual se le realiza un aumento coronario anterosuperior. El objetivo de este tipo de cirugía es corregir alteraciones del margen gingival y favorecer la estética en pacientes con exposición incompleta de corona y con una línea de sonrisa alta
Crown lengthening is a periodontal surgical procedure of removing gum and bone to create a longer clinical crown and move the gingival margin apically. We report a patient of 16 years of age diagnosed with gingival enlargement, which underwent an anterior crown lengthening. The aim of this type of surgery is to correct abnormalities of the gingival margin and promote the aesthetics in patients with incomplete crown exposure and a high smile line
Subject(s)
Humans , Male , Adolescent , Crown Lengthening , Surgery, Oral/methods , Esthetics, Dental , Periodontics , Tooth Crown , DentistryABSTRACT
Patients who clinically display excessive gingival and short teeth require a thorough diagnosis and treatment plan to provide a predictable aesthetic outcome. This article illustrates multi-disciplinary approach in the treatment of a patient with altered passive eruption.
ABSTRACT
PURPOSE: Excessive gingival display and short clinical crowns due to altered passive eruptions are major concerns for a considerable number of patients visiting dental clinics. Altered passive eruptions could be corrected through various types of periodontal surgery conformable to a classification. 3 cases are reported here on the esthetic correction of altered passive eruption to evaluate results of crown lengthening procedure. METHODS:Three patients whose major complaints were excessive gingival display and short teeth were picked out for this case study. Before treatment, clinical and radiological exam was performed to choose type of surgery. Thickness and width of keratinized gingiva was measured in all three patients then they were treated by surgical methods including flap operation and depigmentation under subsequent diagnosis. RESULTS: Uneventful healing and stable gingival margin were observed in all three patients except recurrence of gingival pigmentation of one patient. CONCLUSIONS: The treatment of altered passive eruption requires precise diagnostic procedure and could achieve better esthetic outcomes when it is accompanied by other orthodontic and orthognathic treatment.
Subject(s)
Humans , Crown Lengthening , Crowns , Dental Clinics , Gingiva , Keratins , Pigmentation , Recurrence , ToothABSTRACT
PURPOSE: Passive eruption is characterized by the apical shift of the dentogingival junction. As this occurs, the length of the clinical crown increases as the epithelial attachment migrates apically. Altered passive eruption occurs when the margin of gingiva is malpositioned incisally on the anatomic crown in adulthood and results in excessive gingiva. The purpose of this article is to evaluate esthetic results of crown lengthening procedure in altered passive eruption.s. MATERIALS AND METHODS: Three patients who complained "My front teeth look too short" were included. Bone sounding with periodontal probe revealed that alveolar bone crest was close to CEJ. Based on the diagnostic information, a diagnosis of altered passive eruption was made. They were performed apically positioned flap procedure with osseous resection. RESULTS: Six months later, all patients achieved favorable esthetic results and gingival margins were healthy and stable. CONCLUSION: When the diagnostic procedures reveal alveolar bone crest levels approximating the CEJ, apically positioned flap procedure with osseous resection is indicated.