ABSTRACT
RESUMEN: El objetivo de este artículo es evaluar el éxito clínico de una nueva alternativa para crear papilas en implantes de carga inmediata, que se realizó en una paciente de sexo femenino de 26 años de edad. Se inició el tratamiento con la confección de una guía quirúrgica, previo a la manipulación de los tejidos para crear las papilas peri-implantarias. En la cirugía se realizan 2 incisiones semilunares, unidas por una incisión perpendicular, las que al suturarlas sobre ellas mismas permitió crear las papilas; se instala un implante con buena estabilidad primaria y se toma la impresión para la rehabilitación. A las 24 horas se instala una corona atornillada, mostrando la presencia de las papilas de forma inmediata. Se realiza controles hasta los 20 meses de función, evidenciando buena estabilidad de las papilas mesial y distal sin presentar ningún tipo de complicación.
ABSTRACT: The aim of this paper is to evaluate the clinical success of a new alternative to create papillae in immediate load implants, which was performed in a 26-yearold female patient. The treatment was started with the preparation of a surgical guide, prior to the manipulation of tissues to create the peri-implant papillae. In the surgery, two semilunar incisions are made, joined by a perpendicular incision, which when sutured on them allowed to create the papillae. An implant with good primary stability is installed and the impression is taken for rehabilitation. At 24 h a screwed crown is installed, showing the presence of the papillae immediately. Controls are performed up to 20 months of function, demonstrating good stability of the mesial and distal papillae without presenting any type of complication.
Subject(s)
Humans , Female , Adult , Dental Implants, Single-Tooth , Dental Papilla/surgery , Immediate Dental Implant Loading , Radiography, Panoramic , Dental Implants , Informed ConsentABSTRACT
La reconstrucción de la estética gingival (rosada) es un tema importante en la odontología implanto-soportada moderna, y cualquier resultado estético comprometido se considera un fracaso. En la literatura se proponen variados enfoques quirúrgicos y no quirúrgicos para reconstruir la papila interdental perdida. En esta técnica modificada, el extremo distal del injerto pediculado fue dividido en dos partes creando una estructura bífida, que luego se colocó alrededor del pilar y suturó por vestibular. Esta técnica dio como resultado un aumento significativo de volumen de la papila en las direcciones coronaria y vestibular. El injerto de tejido conectivo pediculado subepitelial asociado con un colgajo coronalmente desplazado parece ser un abordaje viable para el tratamiento de la papila ausente, asociado con restauraciones implanto-soportadas.
Rebuilding the pink esthetic is an important issue in modern esthetic implant dentistry, and any compromised esthetic results following implant-supported restorations are considered failures. Several surgical and nonsurgical approaches are proposed in the literature to reconstruct the lost interdental papilla. In this modified technique the distal end of the pedicle graft was divided into two parts creating a bifid, which were then placed around the abutment and sutured on the facial aspect. This technique resulted in a significant gain of papillary volume in both coronal and facial directions. The subepithelial connective pedicle graft associated with a coronally advanced flap seems to be a viable approach for the treatment of missing papilla associated with implant-supported restorations.
Subject(s)
Humans , Female , Middle Aged , Surgical Flaps , Gingiva/transplantation , Plastic Surgery Procedures/methods , Connective Tissue/transplantation , Gingivoplasty/methods , Gingival Recession/surgery , Gingival Recession/pathologyABSTRACT
Este artigo procurou enfatizar a importância de se realizar uma adequada avaliação tecidual antes de iniciar reabilitações estéticas, além de sugerir possíveis condutas para restabelecer a arquitetura gengival. No caso clínico apresentado, os incisivos centrais superiores foram tracionados lentamente por aparatologia ortodôntica, visando nivelar o arco gengival e devolver a papila interdental. Após a obtenção de um quadro gengival mais harmônico, a forma dental foi restaurada com facetas cerâmicas para alcançar um bom resultado estético.
This article emphasizes the importance of adequate tissue assessment before starting aesthetic restorations, as well as to suggest possible guidelines to restore the gingival architecture. In the clinical case presented, the upper central incisors were orthodontically extruded, aiming to level the gingival arch and to retrieve the dental papillae. After obtaining a more harmonic gingival architecture, the dental form was restored with ceramic veneers to achieve good aesthetic result.
Subject(s)
Humans , Female , Adult , Dental Papilla , Esthetics, Dental , Gingiva , Orthodontic ExtrusionABSTRACT
To analyze the expression of transforming growth factor-beta 1 inheterotopic grafts of adult dental apical papilla. Methodology: The apical papilla of adult Wistar rats was grafted in the ear of the same donor rats. 1, 3, 7 and14 days after grafting, rats were perfused and the tissue containing the graft was processed for histological conventional technique and for immunohistochemical detection of transforming growth factor-beta 1. Results: Heterotopically grafted apical papilla developed osteoid dentine. In an early post-grafting stage, odontoblast-like cells organized themselves in palisade and synthesized dentine. However, newly formed dentine possessed the structural appearance of reactive osteoid dentine, which was systematically destroyed by the activity of osteoclaste-like cells. Transforming Growth Factor-beta 1 was observed in mesenchymal cells, extracellular matrix of the graft and surrounding host tissue, while odontoblast-like cells were systematically devoid of immunoreactivity. Conclusion: The different expression of transforming growth factor-beta 1 between normal tissue and grafted tissue development suggests that in heterotopic graft conditions the inflammatory mediation of the transforming growth factor-beta 1 prevails against its morphogenetic role...
Analizar la expresión del factor transformador del crecimiento-beta1 en trasplantes heterotópicos de papila dental del incisivo de la rata adulta. Metodología: La papila apical del incisivo de 12 ratas Wistar adultas fue trasplantada en la oreja de las mismas ratas donantes, y perfundidas 1, 3, 7 y 14 días postrasplante. El tejido fue procesado para histología convencionaly para la detección inmunohistoquímica del factor transformador del crecimiento-beta1. Resultados: La papila apical trasplantada desarrolló osteodentina. En fases tempranas postrasplante se observaron células parecidas a los odontoblastos que se organizaron en empalizada y segregaron dentina que se depositó sobre su superficie apical o secretora. Esta dentina evolucionó a osteodentina caracterizada por perder su estructura tubular e incluir a las células odontoblásticas en lagunas de su matriz. Finalmente, la osteodentina presentó procesos líticos mediados por células de tipo osteoclasto. Durante todo el proceso la expresión del factor transformador del crecimiento-beta1 se restringió a las células mesenquimales, a la matriz del trasplante y a las zonas circundantes del huésped, estando ausente en los odontoblastos, a diferencia de lo que sucede durante la odontogénesis normal. Conclusión: La diferente localización de la expresión del Factor Transformador de crecimiento beta1 entre el tejido hospedero y el trasplantado sugieren que en condiciones de trasplante heterotópico de papila dental la mediación inflamatoria del Factor Transformador de crecimiento beta1 prevalece sobre su papel morfogenético...
Subject(s)
Animals , Rats , Dental Papilla , Odontoblasts , Transforming Growth Factor beta1 , Transplantation, Heterotopic , Rats, WistarABSTRACT
La sonrisa y específicamente los dientes hacen parte de un rostro atractivo. La presencia de diastemas es una de las quejas estéticas más comunes entre los pacientes. Es responsabilidad del odontólogo ofrecer la técnica más apropiada para resolver esos espacios indeseados. La prioridad para el tratamiento de diastemas es la creación del punto de contacto sin perjudicar la anatomía armónica de los dientes involucrados para conseguir la formación de la papila interdental. La utilización de resinas compuestas directas es una opción estética y funcional para tratar tejido sano de forma mínimamente invasiva. El objetivo de este reporte de caso clínico es describir detalladamente el cierre de diastema utilizando restauraciones directas adhesivas.
The smile and specially the teeth are important for an attractive face. The presence of diastema is the most common esthetic complain among patients. It is responsibility of the dentist to offer the best treatment to solve these undesirable spaces. The priority for the diastema treatment is to create a contact point without interfering in the harmonic shape of the teeth involved to achieve the formation of the dental papilla. The use of direct composite resins is an esthetic and functional option to treat intact tissue with a minimum intervention. The purpose of this case report is to describe in details the diastema closure using direct resin composite restoration.
Subject(s)
Humans , Female , Adult , Diastema/therapy , Esthetics, Dental , Dental Papilla , Composite Resins/therapeutic useABSTRACT
A papila interdental e o comportamento dos tecidos moles peri-implantares são considerados um ponto crítico para o sucesso estético em osseointegração e geralmente apresenta-se como um desafio clínico. O presente artigo tem o objetivo de revisar as classificações propostas na literatura em relação ao comportamento do tecido gengival e perimplantar. Foi realizada uma pesquisa no banco de dados Medline entre 1985 a 2005, tendo sido selecionados 8 artigos. Os métodos foram aplicados e comparados destacando suas vantagens e desvantagens no uso clínico. Os métodos descritos são específicos e com finalidades distintas. Os métodos são eficazes, visto que todos possibilitam uma medida fácil e prática dos tecidos, podendo comparar o início e o fim do tratamento, além de uma melhor comunicação entre os clínicos.
The interdental papilla and the behavior of soft peri-implant tissues are considered a critical point for the aesthetic success in osseointegration and generally it is presented as a clinical challenge. The present article has the objective to revise the classifications proposals in literature in relation to the behavior of the gingival and to peri-implant tissues. A Medline research was made between 1985 and 2005, and 8 articles were selected. All the methods had been evaluated through a comparative analysis detaching its advantages and disadvantages in the clinical use. The methods described are specific with different purposes. All the methods are efficient (for distinct ends) when are carried through correctly, since all make possible an easy and practical measure of papilla, being able to compare the beginning and end of the treatment beyond one better communication between the clinical.