Abordaje Terapéutico de Agrandamiento Gingival Influenciado por Ciclosporina y Nifedipino. Reporte de Caso / Therapeutic Approach of Gingival Enlargement Influenced by Cyclosporine and Nifedipine. Case Report

RESUMEN: Este reporte de caso muestra un paciente atendido en el Postítulo de Periodoncia de la Facultad de Odontología de la Universidad de Chile con diagnóstico de Agrandamiento Gingival influenciado por ciclosporina y nifedipino. El abordaje terapéutico consideró la fase sistémica, la fase higiénica con el tratamiento periodontal no quirúrgico para lograr la eliminación de la infección periodontal antes y después de la fase quirúrgica, y la fase de terapia de soporte periodontal. Se logró así la eliminación de los agrandamientos gingivales influenciados por ciclosporina y nifedipino.

ABSTRACT: This case report shows a patient attended in the Postgraduate Periodontics Program at the Faculty of Dentistry of the University of Chile with a diagnosis of Gingival Enlargement influenced by cyclosporine and nifedipine. The therapeutic approach considered the systemic phase, the hygienic phase with the non-surgical periodontal treatment to achieve the elimination of the periodontal infection before and after the surgical phase, and the phase of periodontal support therapy. Thus, the elimination of gingival enlargements influenced by cyclosporine and nifedipine was achieved.

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.

Comparison between Laser, Electrocautery and Scalpel in the Treatment of Drug-Induced Gingival Overgrowth: A Case Report.

Drug-induced gingival overgrowth (DIGO) is a well-recognized, unwanted side-effect associated with three major drug groups - anticonvulsants, immunosuppressants and the calcium channel blockers. The prevalence of this unwanted side effect is 25-80% and is also dependent on other factors such as type of drug, dosage, duration of treatment, genetic predisposition, and patient’s oral hygiene maintenance. Three different treatment modalities viz., scalpel, laser, and electrocautery can be used for treating DIGO. Each method carries its own merits and demerits. In the present case report, these three different treatment modalities are used in the same patient in order to compare their handling properties and effect on initial wound healing. Though scalpel remains to be gold standard treatment, use of laser finds some more advantages over the electrocautery for treatment of DIGO.

Gingival Enlargement: Revisited: A Case Series.

Gingival enlargement can be hereditary or acquired. More than 20 prescription medications are associated with gingival overgrowth. A detailed review on the risk factors and pathogenesis from various peer reviewed journals has been discussed in this article. The aim was to discuss the role of drugs causing gingival enlargement, the hereditary gingival fibromatosis (HGF) and its possible pathogenesis. The following case series highlights four cases of gingival enlargement, one being a case of HGF and the other three being drug-induced gingival enlargement. Variable etiopathogenesis such as age, genetic predisposition, pharmacokinetic variables, tissue homeostasis, inflammation and growth factors have been associated with this disease. Inflammatory changes that occur within the gingival tissues appear to orchestrate the interaction between the “modified fibroblast” and the drug. Alternatively, these drugs influence directly the inflammatory response in the form of enlargement. This information is valuable for the clinician as it will have implication to treat the patient effectively.

Gingival overgrowth and drug association: A review.

Drugs used locally or systemically induce several alterations in micro and macroscopic tissues. However, nearly 20 drugs have been reported so far in the literature associated with gingival enlargement. Many systemic diseases have limited therapeutic options and such drugs or their metabolites have an adverse influence on different systems/organs, and one of these is that they initiate or accelerate the overgrowth of gingival tissue. The increase in size may be to the extent that teeth may be partially or completely covered, and the resultant 'gummy smile' may result in aesthetic concern for the patient.In the presence of bacterial inflammation in the gingiva, many of these drugs enhance the production of collagen by fibroblast cells, and simultaneously retard the destruction of collagen and hence increase the bulk of gingival tissue. It is apparent that there is a subpopulation of fibroblasts which is sensitive to these drugs. The exuberant growth of gingival tissue is of great aesthetic concern, which may require mechanical removal of bacterial plaque, calculus, and surgical intervention, and/or substitution of the drug with analogs. A relatively healthy oral environment provided by the dentist will reduce local microflora that will help in eliminating the major focus of infection. Physicians, general practitioners, and dentists need to make a coordinated and concise treatment plan that will be beneficial for the patients. This article will facilitate full information to physicians to involve dentists in the multidisciplinary treatment plan.

Multidisciplinary treatment in a patient with nifedipine induced gingival enlargement

Adult patients have preexisting condition that are not seen in the adolescent population including tooth loss, severe skeletal dysplasias, periodontal disease and various forms of temporomandibular dysfunction[TMD]. Frequently, the preexisting conditions that are present in the adult patient interfere with the achievement of orthodontisc's general idealized goals. Problem-oriented synthesis of the dental needs of each case helps determine specific treatment objectives that one must establish before determining the treatment plan. A 51 years old patient approached the dental clinic to improve her smile esthetics. She was a skeletal class III high angled case with an increased lower facial height and a dentally class I with supraerupted upper right central incisor, mild spacing 4 mm of overall tooth material excess in the lower arch. Ginigival overgrowth associated with nifedipine intake was also recorded. As a more realistic treatment plan with an interdisciplinary approach was considered to be appropriate in terms of treatment efficacy and duration, a team comprising of a periodontist, an orthodontist and a restorative dentist was formed to manage the case. The importance of multidisciplinary approach in managing the case was explained. After gingivectomy, the patient was kept in a maintenance program, including oral hygiene instructions and professional tooth cleaning during the complete orthodontic treatment. Follow-up of the case for a year did not reveal any recurrence of the drug induced gingival enlargement. This case not only emphasizes the role of meticulous oral hygiene maintenance in preventing the recurrence of gingival enragement but also the ease with which adult cases would be managed efficiently with minimal endeavors by a team approach