Aumento de coroa clínica: reparação do desequilíbrio dentogengival com finalidade estética / Clinical crow augmentum: repair of the dentogengival imbalance with aesthetic purpose

O anseio por um sorriso harmônico tem se tornado cada vez maior, uma vez que muitos pacientes relatam desconforto ao sorrir, pois correlacionam a estética do sorriso a problemas de baixa autoestima e em alguns casos suscetibilidade a alterações psicossociais decorrente aos padrões estéticos impostos pela sociedade. O sorriso gengival é uma das grandes queixas relatadas por pacientes. A exposição excessiva de gengiva maxilar pode ser decorrente a fatores gengivais, ósseos, dentários e musculares. Dentre os tratamentos disponíveis para diminuir essa exposição, contamos com cirurgias periodontais, aplicação de toxina botulínica, tratamentos ortodônticos, cirurgia ortognática e reposicionamento labial. O tratamento adequado será definido de acordo com o fator etiológico de cada caso. Diante disso o objetivo do trabalho é realizar um relato de caso sobre aumento de coroa clínica estética. A paciente estava descontente com a exibição de uma grande quantidade gengival ao sorrir. Após estudos clínicos e de imagem o diagnóstico foi de erupção passiva alterada, tipo IB. O tratamento de escolha foi a gengivoplastia associada a remodelação óssea osteotomia e osteoplastia. O tratamento estético vai além de uma boa aparência, através deste trabalho, foi possível evidenciar impactos benéficos que o sorriso harmônico pode acarretar na vida do indivíduo, atendendo suas expectativas e a do cirurgião-dentista(AU)

The desire for a harmonic smile has become increasing, since many patients report discomfort when smiling, as they correlate smile aesthetics to problems of low self-esteem and in some cases susceptibility to psychosocial changes due to aesthetic standards imposed by society. Gummy smile is one of the major complaints reported by patients. Excessive exposure of the maxillary gingiva may be due to gingival, bone, dental and muscular factors. Among the treatments available to reduce this exposure, we have periodontal surgeries, botulinum toxin application, orthodontic treatments, orthognathic surgery and lip repositioning. The appropriate treatment will be defined according to the etiological factor of each case. Therefore, the objective of this work is to carry out a case report on aesthetic clinical crown augmentation. Patient discount with the display of a large amount of gingival when smiling. After clinical and imaging studies, the diagnosis was an altered passive eruption, type IB. The treatment of choice was gingivoplasty associated with bone remodeling, osteotomy and osteoplasty. Final comments and conclusions: The aesthetic treatment goes beyond a good appearance, through this work, it was possible to evidence beneficial impacts that the harmonic smile can have on the individual's life, meeting their expectations and that of the dentist(AU)

Reposicionamiento Labial. Caso Clínico

El reposicionamiento labial es un procedimiento quirúrgico mínimamente invasivo que se utiliza para tratar una sonrisa gingival, la cual, es una afección en la que una cantidad significativa de la encía queda expuesta cuando una persona sonríe y puede deberse a una variedad de factores, como un exceso de tejido gingival, un labio superior corto o músculos hiperactivos del labio superior, entre otros. El alargamiento clínico de la corona, por otro lado, consiste en eliminar el exceso de tejido gingival y, si es necesario, el tejido óseo para exponer una mayor parte de la corona natural del diente. Se reporta un caso clínico de paciente femenino de 31 años que presentó una sonrisa gingival provocada por hipermovilidad de labio superior y un exceso de tejido gingival localizado. El plan de tratamiento involucró una combinación de reposicionamiento labial y alargamiento de corona. Los resultados estéticos fueron significativos, con la sonrisa del paciente más equilibrada y proporcionada. Se redujo la cantidad de tejido gingival expuesto cuando la paciente sonreía y la longitud de los dientes fue más visible, lo que dio como resultado una sonrisa de aspecto más natural, además de aumentar su aceptación al sonreír.

SUMMARY: Lip repositioning is a minimally invasive surgical procedure used to treat a gummy smile, which is a condition in which a significant amount of the gum is exposed when a person smiles and may be due to a variety of factors, such as excess gum tissue, a short upper lip or overactive muscles of the upper lip, among others. Clinical crown lengthening, on the other hand, involves removing excess gingival tissue and, if necessary, bone tissue to expose more of the natural crown of the tooth. Clinical case: A clinical case of a 31-year-old female patient who presented a gummy smile caused by hypermobility of the upper lip and an excess of localized gingival tissue is reported. The treatment plan involved a combination of lip repositioning and crown lengthening. The aesthetic results were significant, with the patient's smile more balanced and displayed. The amount of the patient's exposed gum tissue when smiled was reduced and the length of the teeth was more visible, resulting in a more natural-looking smile, as well as increasing their acceptance of smiling.

Prospective study of the aesthetic effect of botulinum toxin a when injected into the muscles of facial expression

Botulinum neurotoxin A (BoNT-A) causes an anticholinergic effect on neuronal fibers, which control muscle contraction and autonomic disorders. Thus, it has been widely used in facial aesthetics, decreasing the action of motor muscles and consequent wrinkles. This preliminary study evaluated the effect of BoNT-A in 77 patients, the treatment satisfaction index was defined in percentage (from 0% to 100%). The evaluation was carried out on 15th, 30th, 60th, 90th, and 180th days after BoNT. The data were analyzed using the Friedman, Student t, Mann-Whitney test with t (alpha=0.05). The results showed that at 15th and 30th days the scores were similar in all muscles with high level of satisfaction and until 90th days the scores decreased significantly for Corrugator supercilii 79.38%, Occipitofrontalis 71.46%, Orbicularis oculi 70.43%; but the satisfaction was good. At 180 days, there was a drop in effectiveness in all treated muscles since the scores decreased significantly, showing low satisfaction by the participants. This study demonstrated that the BoNT-A had attested satisfaction effect by participants for up to 90th days, but at 180th days the satisfaction was low. In the comparative analyzes between women under 40 and over 40 years of age, there was no significant differences.

O sorriso gengival e o resgate da auto e stima mediante a odontologia estética: revisão integrativa / The gingival smile and the rescue of self-esteem through aesthetic den-tistry: Integrative review / La sonrisa gingival y el rescate de la autoestima através de la odonto-logía estética: Revisión integrativa

Introdução:O sorriso gengival tem mostrado ser um fator de desconforto estético e psicológico, além de afetar as relações interpessoais e a autoestima dos pacientes. Di-ante disso, procedimentos estéticos têm sido desenvolvidos com o intuito de melhorar a qualidade de vida de quem os procuram. Objetivo:Analisar qual o impacto que os procedimentos odontológicos estéticos possuem na recuperação da autoestima e satis-fação dos pacientes com sorriso gengival. Metodologia:A temática é abordada por meio da revisão integrativa da literatura. Para a seleção dos artigos utilizou-se as bases dedados: MEDLINE, LILACS, SciELO, BBO e PubMed, publicações escritas em in-glês, português ou espanholno período de 2010 a 2020. A amostra desta revisão cons-tituiu-se de 06 artigos. Resultados:Foi observado que o sorriso gengival causa descon-forto estético e psicológico ao indivíduo. As prevalências das etiologias relacionadas foram erupção passiva ou tardia dos dentes, extrusão dentoalveolar anterior, excesso maxilar e lábio superior curto. Os procedimentos mais utilizados foram a aplicação de toxina botulínica, a qual mostrou-se ser promissora para a correção do sorriso gen-gival assim como o reposicionamento labial. Conclusões:Os estudos mostraram que os procedimentos odontológicos estéticos para correção do sorriso gengival contri-buem para satisfação do paciente e melhora da autoestima e as técnicas menos invasi-vas e com melhor pós-operatório apontadas, são a aplicação da toxina botulínica e o reposicionamento labial (AU).

Introduction:The gingival smile currently is a factor of aesthetic and psychological discomfort and affects interpersonal relationships and self-esteem of patients. There-fore, aesthetic procedures have been developed in order to improve the quality of life of those who seek it. Objective:To analyze the impact that aesthetic dental procedures have on the recovery of self-esteem and satisfaction of patients with a gingival smile. Methodology:The theme is addressed through an integrative literature review. The followingdatabases were used for the selection of articles: Medline via VHL, Lilacs, SciElo, BBOand PubMed, publications written in English, Portuguese or Spanish, from 2010 to 2020. The sample of this review consisted of 06 articles. Results: It was observed that the gingival smile causes aesthetic and psychological discomfort to the individual. The most used procedures are applying botulinum toxin, which has shown to be promising for the correction of the gingival smile and lip repositioning. The prev-alence of related etiologies was passive or delayed tooth eruption, anterior dentoalve-olar extrusion, maxillary excess, and short upper lip. Conclusions:Studies have shown that aesthetic dental procedures to correct gingival smile contribute to patient satisfactionand improve self-esteem. Less invasive techniques with better post-oper-ative results are the application of botulinum toxin and lip repositioning (AU).

Introducción: La sonrisa gingival ha demostrado ser un factor de incomodidad esté-tica y psicológica, además de afectar las relaciones interpersonales y la autoestima de los pacientes. Por lo tanto, se han desarrollado procedimientos estéticos con el fin demejorar la calidad de vida de quienes los buscan. Objetivo: Analizar el impacto que los procedimientos dentales estéticos tienen en la recuperación de la autoestima y la satisfacción de los pacientes con sonrisa gingiva . Metodología: El tema se aborda a través de la revisión integrativa de la literatura. Para la selección de artículos, se utili-zaron las siguientes bases de datos: MEDLINE, LILACS, SciELO ,BBO y PubMed, pu-blicaciones escritas en inglés, portugués o español, de 2010 a 2020. La muestra de esta revisión consistió en 06 artículos.Resultados:Se observó que la sonrisa gingival causa molestias estéticas y psicológicas al individuo. La prevalencia de etiologías relaciona-das fue erupción pasiva o tardía de los dientes, extrusión dentoalveolar anterior, ex-ceso maxilar y labio superior corto. Los procedimientos más utilizados fueron la apli-cación de toxina botulínica, que resultó ser prometedora para la corrección de la son-risa gingival, así como el reposicionamiento de labios.Conclusiones: Se observó que la sonrisa gingival causa molestias estéticas y psicológicas al individuo. La prevalencia de etiologías relacionadas fue erupción pasiva o tardía de los dientes, extrusión den-toalveolar anterior, exceso maxilar y labio superior corto. Los procedimientos más utilizados fueron la aplicación de toxina botulínica, que resultó ser prometedora para la corrección de la sonrisa gingival, así como el reposicionamiento de labios (AU).

Gummy smile treatment by Aesthetic Crown Lengthening on altered passive eruption case

@#An attractive smile enhances the appearance and acceptance of an individual in society. Gum exposure more than 3 mm is generally considered unattractive and known as a gummy smile, which is usually considered an aesthetic problem. At present, patients have a greater desire for more aesthetic results that may influence the planning of dental treatments. This case report aimed to describe the surgical sequence of aesthetic crown lengthening to improve smile profile and eliminate gummy smile. We reported a 21-year-old non-smoking woman with no pertinent medical history who presented with a chief complaint of an unattractive smile due to excessive gingival display. The gingival display in the smile was 5 mm, and the width to height ratio of the central incisor was 121%. Neither periodontal problems nor teeth mobility was detected. Assessment for the condition was excessive gingival display due to altered passive eruption. The overall prognosis for this case was good. The primary treatment plan proposed to the patient was an aesthetic crown lengthening. Altered passive eruption class I subtype A was a case conclusion, and aesthetic crown lengthening with gingivectomy without osseous reduction was the selected treatment. In conclusion, aesthetic crown lengthening should be considered as a surgical component of aesthetic therapy to improve smile profile and eliminate gummy smile.

Smile Correction Using Lip Repositioning, Crown Lengthening And Depigmentation

The aim of this case report was to evaluate the clinical outcomes following modified lip repositioning and gingivectomy along with depigmentation in a patient with excessive gingival display. A 22 year old female patient came with the chief complaint of gummy smile and blackened gums. On evaluation, the patient presented with hyperactive lip and moderate vertical maxillary excess. Aless invasive modified lip repositioning procedure was carried out. A partial thickness strip of mucosa was removed leaving the midline frenum intact and the lip mucosa was sutured to the mucogingival line. As the clinical crown length was shorter than the anatomic crown length, crown lengthening by gingivectomy was performed. Laser depigmentation was carried out to treat gingival hyperpigmentation. The patient was evaluated after 2 weeks, 1 and 6 months respectively. An approximate reduction in gingival display of around 3 mm was found and the results were stable at the end of 6 months. Gingival repigmentation had occurred at the end of 6 months, therefore depigmentation procedure was repeated inorder to the maintain the esthetics. In this case, we emphasize on the stable and satisfactory treatment outcome of a non invasive approach made to treat excessive gingival display instead of more invasive surgical treatment.

Tratamiento de la sonrisa gingival excesiva mediante reposicionamiento labial / Treatment of excessive gingival smile using lip repositioning

Los pacientes de hoy exigen una sonrisa atractiva que no sea causa de vergüenza al expresarla. La sonrisa gingival excesiva es una condición clínica en la que se expone la encía (≥ 4 mm) al sonreír. Para su manejo se debe establecer un buen diagnóstico y etiología para determinar la mejor opción de tratamiento dentro de las diversas técnicas descritas en la literatura. Se describe un caso en una paciente con sonrisa gingival excesiva de 8-9 mm causada por crecimiento vertical maxilar, erupción pasiva alterada y labio superior hiperactivo. Después de explicarle los pros y los contras, decidió realizarse sólo la cirugía de reposicionamiento labial, debido a que rechazó la cirugía ortognática y el alargamiento de coronas, obteniendo un buen resultado desde el postoperatorio inmediato con una gran satisfacción de la paciente y pocas complicaciones posteriores (AU)

Today's patients demand an attractive smile and do not cause them to feel embarrassed when expressing it. Excessive gingival display smile is a condition in which the gum (≥ 4 mm) exposed when smiling. Good diagnosis and etiology should be established to determine its treatment. A case described in a patient with an excessive gingival smile of 8-9 mm, caused by vertical maxillary growth, altered passive eruption and hyperactive upper lip. Who after explaining the pros and cons, decided to perform only lip repositioning surgery, because I refuse orthognathic surgery and elongation of crowns. Obtaining a good result, from the immediate postoperative, with great patient satisfaction and few subsequent complications (AU)

Use of autonomous maximal smile to evaluate dental and gingival exposure / 대한치과교정학회지

OBJECTIVE: This study was performed to validate the autonomous maximal smile (AMS) as a new reference for evaluating dental and gingival exposure. METHODS: Digital video clips of 100 volunteers showing posed smiles and AMS at different verbal directives were recorded for evaluation a total of three times at 1-week intervals. Lip-teeth relationship width (LTRW) and buccal corridor width (BCW) were measured. LTRW represented the vertical distance between the inferior border of the upper vermilion and the edge of the maxillary central incisors. Intraclass correlation coefficients (ICCs) for reproducibility, and the m-value (minimum number of repeated measurements required for an ICC level over 0.75), were calculated. RESULTS: LTRW and BCW of the AMS were 1.41 and 2.04 mm, respectively, greater than those of the posed smile (p < 0.05), indicating significantly larger dental and gingival exposure in the AMS. The reproducibility of the AMS (0.74 to 0.77) was excellent, and higher than that of the posed smile (0.62 to 0.65), which had fair-to-good reproducibility. Moreover, the m-value of the AMS (0.88 to 1.05) was lower than that of the posed smile (1.59 to 1.85). CONCLUSIONS: Compared to the posed smile, the AMS shows significantly larger LTRW and BCW, with significantly higher reproducibility. The AMS might serve as an adjunctive reference, in addition to the posed smile, in orthodontic and other dentomaxillofacial treatments.

La toxina botulínica como adyuvante en el tratamiento de la sonrisa gingival / Botulinum toxin as an adjuvant in the treatment of gummy smile

RESUMEN: La búsqueda de la excelencia estética es un objetivo importante de la odontología. La sonrisa gingival es una de las principales quejas estéticas, ya que perjudica la autoestima y las relaciones sociales del paciente. Nuevas técnicas como la aplicación de la toxina botulínica (TB) pueden tornarse una opción terapéutica más conservadora, y ayudar a disminuir las proporciones de las intervenciones quirúrgicas resectivas. El propósito de este trabajo es describir la aplicación de la TB como adyuvante de la cirugía gingival resectiva, a través del reporte de un caso clínico de discrepancia dentogingival y sonrisa gingival. Con la cirugía resectiva el equilibrio dentogingival fue mejorado, y la aplicación de TB tipo A causó la dehiscencia uniforme del labio superior, devolviendo la armonía facial. La TB es un complemento útil y conservador en la mejora estética de la sonrisa, y puede aumentar los resultados de la cirugía gingival resectiva.

ABSTRACT: The search for aesthetic excellence is an important goal in dentistry. The gummy smile is one of the main aesthetic complaints as it can affect self-esteem, and prejudice the patients' social relationships. New techniques, such as the application of botulinum toxin (BT) may become a more conservative treatment option and help to reduce the proportions of resective surgery. The purpose of this paper is to describe the application of BT, used as an adjuvant to gingival resection surgery, using a case report of a dento-gingival discrepancy and gummy smile. The resection surgery improved the dento-gingival equilibrium and the application of BT led to a uniform dehiscence of the upper lip, and facial harmony. BT is a useful and conservative adjuvant in the aesthetic enhancement of the smile, and can improve the outcomes of gingival resection surgery.

Aplicación de toxina botulínica tipo A para el manejo de la sonrisa gingival / Application of type-A botulinic toxin for the management of gummy smile

La toxina botulínica tipo A puede ser utilizada en diversas situaciones de interés odontológico, entre ellas, los trastornos temporo-mandibulares, hábitos parafuncionales, hipertrofia del músculo masetero, parálisis facial, asimetría de labios y, más recientemente, en los casos de hipermiotonía labial y sonrisa gingival. El objetivo de este trabajo es reportar el caso de un paciente con queja estética de sonrisa gingival. La aplicación de la toxina botulínica promovió la dehiscencia uniforme del labio superior y minimizó la molestia causada por la sonrisa gingival de forma rápida y poco invasiva, mostrando que esta puede convertirse en una alternativa terapéutica eficaz para el tratamiento de la sonrisa gingival, favoreciendo la estética facial y la autoestima del paciente.

Botulinum toxin type A could be used in various situations of dental interest including temporomandibular disorders, parafunctional habits, masseter muscle hypertrophy, facial paralysis, lip asymmetry and more recently in the cases of hyper myotonic lips and gummy smile. The aim of this paper is to report the case of a patient with complaint of gingival aesthetic smile. The application of botulinum toxin promoted the uniform dehiscence of the upper lip and minimized the discomfort caused by the gummy smile in a fast and little invasive way, showing that botulinum toxin can become an effective therapeutic alternative for the treatment of gummy smile, favoring facial aesthetics and patient self-esteem.

Associação de técnica cirúrgica e toxina botulínica para correção de sorriso gengival / Association of surgical technique and botulinum toxin in gummy smile management ­ case report

O sorriso gengival caracteriza-se pela exposição de 3 mm ou mais de gengiva ao sorrir. Para o paciente, pode gerar incômodo e, com isso, abalar sua autoestima e seu estado emocional. A perfeição de um sorriso não está apenas associada à coloração dos dentes, mas também à harmonia dos dentes, da gengiva e dos lábios. Quando a aplicação de toxina botulínica é associada ao procedimento cirúrgico, torna-se vantajosa, com a redução da exposição gengival sem a necessidade de outra intervenção cirúrgica. O propósito deste artigo foi relatar o caso de uma paciente que foi submetida à gengivoplastia associada à aplicação de toxina botulínica tipo A, para correção do sorriso gengival. A associação das técnicas se mostrou uma alternativa segura e efetiva no tratamento de correção do sorriso gengival.

Gummy smiles are observed when 3 mm or more gingival tissue is exhibited. For patients, it can be considered annoying at smiling, and interfere with his/her self esteem. Perfection of a smile is not just linked to dental color and shape, but to the harmony of teeth, gums and lips. Botulinum toxin associated to gingivoplasty is a promissing approach, once there is no need for a second surgical intervention to reduce gum exhibition. The aim of this paper is to report a case of gingivoplasty associated to botulinum toxin to manage a patient gummy smile. It was observed that the association of both techniques presented as a safe effective approach to treat gummy smile in cases of excessive maxilla.

Total intrusion and distalization of the maxillary arch to improve smile esthetics / 대한치과교정학회지

This case report illustrates the successful treatment of a patient with skeletal Class II malocclusion and an unesthetic smile involving excessive gingival display and large buccal corridors. By applying dual buccal interradicular miniscrews, total intrusion of the maxillary dentition along with distalization was induced to improve both the occlusion and smile esthetics. In addition to the conventional cephalometric superimposition, three-dimensional superimposition was performed and evaluated to validate the treatment outcome.

Soluções cirúrgicas combinadas para o sorriso gengival / Surgical combined solutions for the gummy smile

A estética vem sendo cada vez mais requisitada em nossos consultórios, dada a sua divisão entre "estética branca" e "estética vermelha". A gengiva compõe um belo sorriso de maneira tão importante quanto os dentes. A exposição gengival excessiva gera desarmonia estética e é denominada sorriso gengival. O tratamento do sorriso gengival vem sendo cada vez mais desmistificado e apresenta maior procura e aceitação por parte dos pacientes. Do ponto de vista periodontal, pode-se realizar gengivoplastia e gengivectomia com bisel interno ou externo, com ou sem osteotomia, dependendo da etiologia e características periodontais do paciente. No presente estudo, foram realizadas, na mesma paciente, a técnica de bisel interno no arco superior e a técnica de bisel externo no inferior. Buscou-se, assim, esclarecer em qual momento cada técnica é indicada.

Esthetics has been a common issue in the dental offi ce, for this being divided into "white" and "pink" esthetics. The gingival tissue is so fundamental as the dental element in the smile composition. Excessive gingival display results in what has been known as the gummy smile. The proposed treatments have been simplifi ed and more and more requested by patients. From the periodontal point of view, the gingivoplasty and the gingivectomy can be made with internal or external bevel, with or without osteotomy, depending on the etiology and periodontal characteristics. In this case report, the internal bevel technique was performed in the maxillary arch and the external bevel technique in the mandibular arch. The indications for both techniques are discussed here.

Nonsurgical correction of a severe anterior deep overbite accompanied by a gummy smile and posterior scissor bite using a miniscrew-assisted straight-wire technique in an adult high-angle case / 대한치과교정학회지

In the present report, we describe the successful use of miniscrews to achieve vertical control in combination with the conventional sliding MBT™ straight-wire technique for the treatment of a 26-year-old Chinese woman with a very high mandibular plane angle, deep overbite, retrognathic mandible with backward rotation, prognathic maxilla, and gummy smile. The patient exhibited skeletal Class II malocclusion. Orthodontic miniscrews were placed in the maxillary anterior and posterior segments to provide rigid anchorage and vertical control through intrusion of the incisors and molars. Intrusion and torque control of the maxillary incisors relieved the deep overbite and corrected the gummy smile, while intrusion of the maxillary molars aided in counterclockwise rotation of the mandibular plane, which consequently resulted in an improved facial profile. After 3.5 years of retention, we observed a stable, well-aligned dentition with ideal intercuspation and more harmonious facial contours. Thus, we were able to achieve a satisfactory occlusion, a significantly improved facial profile, and an attractive smile for this patient. The findings from this case suggest that nonsurgical correction using miniscrew anchorage is an effective approach for camouflage treatment of high-angle cases with skeletal Class II malocclusion.

Smile Design: From Ape To Human.

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.

Treatment of excessive gingival display using lip repositioning technique: a case report

The gummy smile is becoming one of the most frequent complaints reported by patients unhappy with your smile. According to the etiology, will be proposed various treatments. The purpose of this case report is to describe the lip repositioning technique, softening the gummy smile of the patient. It concludes that the lip repositioning technique is suitable for the correction of the gummy smile.

Utilização da toxina botulínica tipo A associada à cirurgia gengival ressectiva: relato de caso / Utilization of botulinum toxin type A associated to the resective gingival surgery: case report

A toxina botulínica tipo A vem sendo amplamente utilizada na Medicina com finalidade cosmética ou terapêutica, angariando indicações cada vez mais abrangentes. Na Odontologia, é indicada em disfunções temporomandibulares, distonia orofacial, bruxismo, briquismo, hipertrofia de masséter, sialorreia, assimetrias faciais de origem muscular, sorriso gengival e assimetrias labiais que podem causar exposição acentuada da gengiva. Recentemente, vem sendo indicada a aplicação profilática de toxina botulínica em casos após reabilitações sobre implantes dentários, reduzindo forças mastigatórias e protegendo as próteses e implantes da carga excessiva. O propósito deste trabalho é relatar o caso de uma paciente que apresentou discrepância entre a relação dentária e gengival bem como sorriso gengival. Foram realizadas as cirurgias gengivais ressectivas e a aplicação de toxina botulínica, alcançando resultado satisfatório à paciente. A toxina botulínica apresenta resultado transitório, sendo necessária a reaplicação após 6 meses com a recorrência do sorriso gengival.

Widely used in medicine, botulinum toxin type A, is in cosmetic or therapeutic use, is raising broader indications. In dentistry, it is indicated in temporomandibular disorders, orofacial dystonia, bruxism, dental clenching, hypertrophy of the masseter, drooling, facial asymmetry of muscular origin, gummy smile and lip asymmetries that can cause severe gum exposure. Recently, it has been shown the prophylactic application of botulinum toxin in patients after rehabilitation on dental implants, reducing masticatory forces and protecting the prostheses and implants. The purpose of this article is to report the case of a patient who presented discrepancy of relation between tooth and gingival and gummy smile. The gingival resective surgery and botulinum toxin application were performed, reaching satisfactory outcome to patient. Botulinum toxin presents transient results, being necessary the reapplication after 6 months because recurrence of gummy smile.

Three-dimensional evaluation of maxillary anterior alveolar bone for optimal placement of miniscrew implants / 대한치과교정학회지

OBJECTIVE: This study aimed to propose clinical guidelines for placing miniscrew implants using the results obtained from 3-dimensional analysis of maxillary anterior interdental alveolar bone by cone-beam computed tomography (CBCT). METHODS: By using CBCT data from 52 adult patients (17 men and 35 women; mean age, 27.9 years), alveolar bone were measured in 3 regions: between the maxillary central incisors (U1-U1), between the maxillary central incisor and maxillary lateral incisor (U1-U2), and between the maxillary lateral incisor and the canine (U2-U3). Cortical bone thickness, labio-palatal thickness, and interdental root distance were measured at 4 mm, 6 mm, and 8 mm apical to the interdental cementoenamel junction (ICEJ). RESULTS: The cortical bone thickness significantly increased from the U1-U1 region to the U2-U3 region (p < 0.05). The labio-palatal thickness was significantly less in the U1-U1 region (p < 0.05), and the interdental root distance was significantly less in the U1-U2 region (p < 0.05). CONCLUSIONS: The results of this study suggest that the interdental root regions U2-U3 and U1-U1 are the best sites for placing miniscrew implants into maxillary anterior alveolar bone.

Tratamiento interdisciplinario de paciente con sonrisa gingival: Reporte de un caso / Interdisciplinary treatment of patient with gummy smile: Case report

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.

Descripción de las causas y tipos de tratamiento efectuados en dientes con invasión del espacio biológico o con necesidad de cirugía preprotésica: serie de casos / Descrição das causas e tipos de tratamentos efetuados em dentes com invasão de espaço biológico e/ou necessidade de cirurgia pré-protésica: série de casos / Description of causes and treatment types made in teeth with biological space invasion and/or in need of pre-prosthetic surgery: case series

Antecedentes: la decisión de rehabilitar o extraer un diente la determina conocer las causas de la destrucción dental que influyen en el plan de tratamiento y pronóstico. Objetivo: describir indicaciones, tratamientos quirúrgicos periodontales previos a la restauración dental, dientes más afectados y edad de pacientes con invasión del espacio biológico (IEB) o necesidad de cirugía preprotésica. Método: este trabajo es una serie de casos de 162 pacientes de ambos sexos, quienes fueron atendidos en las clínicas de pregrado de la Universidad Evangélica de El Salvador (UEES). Después del análisis clínico y radiográfico, se verificó la necesidad de procedimientos periodontales para la recuperación de espacio biológico o cirugías preprotésicas. Resultados: el 28% de los pacientes fueron hombres, y el 72%, mujeres. Las causas de IEB y tratamiento preprotésico más frecuentes fueron caries, márgenes subgingivales de restauraciones y fracturas. Los dientes más afectados fueron los premolares y primeros molares. El 60% de los procedimientos se realizaron en pacientes entre 23 y 42 años. Los tratamientos más frecuentes fueron alargamiento de corona clínica con ostectomía (62%), sin ostectomía (23,5%) y gingivectomía con electrobisturí (8,7%). Conclusión: caries, fracturas dentales y restauraciones subgingivales fueron las causas más frecuentes de IEB. El colgajo periodontal con ostectomía continúa siendo el procedimiento más utilizado para resolver dichos problemas. El reconocimiento de las causas de la IEB, los dientes más afectados, la edad de los pacientes y el tipo de tratamiento efectuado establecerá un mejor pronóstico rehabilitador, haciendo énfasis en las medidas operatorias necesarias para reducir el fracaso de la rehabilitación.

Background: The decision to rehabilitate or extract a tooth is determined by the knowledge of the causes of dental destruction affecting treatment plan and prognosis. Aim: Describe indications, surgical periodontal therapy prior to dental restoration, most affected teeth and age of the patients with invasion of biological space (IBS) and/or pre-prosthetic surgery. Methods: This is a case series report of 162 patients, male and female, who were treated at the predoctoral dental program of Universidad Evangélica de El Salvador. After clinical and radiographic analysis, the need for periodontal procedures for the recovery of biological space and/or pre-prosthetic surgery was verified. Results: 28% of patients were male and 72% female. The most common causes of IBS and/or pre-prosthetic treatment were caries, restorations with subgingival margins, and fractures. The most affected teeth were the premolarsand first molars. 60% of the procedures were performed in patients between 23-42 years of age. The most common treatments were clinical crown lengthening without ostectomy (23.5%), with ostectomy (62%), and electrosurgical gingivectomy (8.7%). Conclusion: Caries, fractured teeth and subgingival restorations were the most common causes of IBS The periodontal flap with ostectomy remains to be the most used procedure to solve these problems. Recognizing the causes of the IBS, the most affected teeth, the age of the patients and the type of treatment will allow for a better rehabilitating prognosis, emphasizing on the operative measures necessary to reduce rehabilitation failures.

Antecedentes: a decisão entre conservar ou extrair um dente é determinada pelo conhecimento das causas que produzem a destruição dental que influem no plano de tratamento e prognostico dos dentes envolvidos. Objetivo: descrever os procedimentos cirúrgicos periodontais realizados previamente à restauração dental, etiologia, dente mais afetado e idade dos pacientes. Método: este relatório é uma série de casos de 162 pacientes de ambos os sexos que foram tratados nos clínicas da graduação da Faculdade de Odontologia da Universidade Evangélica de El Salvador. Posterior ao analise clínico, radiográfico e diagnóstico se realizou o plano de tratamento, onde se verificou a necessidade de procedimentos periodontais para a recuperação do espaço biológico (EB) e/ou pré-protéticos. Os procedimentos foram realizados por um operador treinado na área da periodontia. Resultados: 28% dos pacientes foram homens e 72% mulheres. As causas mais freqüentes de invasão do EB e/ou tratamento pré-protético foram caries, margens sub-gengivais de restaurações e fraturas. Os dentes mais afetados foram os pré-molares e primeiros molares. 60% dos procedimentos foram realizados em pacientes entre 23 y 42 anos. Os tratamentos mais freqüentes foram: Aumento de Coroa Clínica associado à Osteotomia (62%), sem Osteotomia (23,5%) e gingivectomia com eletrobisturi (8,7%). Conclusão: o reconhecimento das causas da invasão do EB, os dentes mais afetados, grupo etário e tipo de tratamento efetuado, permitirão estabelecer um melhor prognóstico reabilitador, pondo maior ênfase nas medidas reabilitadoras direcionadas à redução da falha ou fracasso reabilitador.