Wound healing effect of a one-week Aloe Vera mouthwash: a pilot study / Efeito de reparação tecidual de uma semana de enxaguante bucal de Aloe Vera: um estudo piloto

Aloe Vera, a perennial Liliaceae plant, has medical, cosmetic, and wound-healing properties. Aloe vera has antioxidant, anti-cancer, anti-diabetic, and regenerative effects. Glucommannan increases collagen synthesis and aids healing after ginivectomy treatment. Natural mouthwashes may offer gingival wound healing efficacy with reduced side-effects when compared to Chlorhexidine. Objective: the objective of this clinical study was to compare the effects on wound healing of a one-week Aloe vera mouthwash with chlorhexidine mouthwash before gingivectomy surgical therapy. Material and Methods:a total of 45 individuals experiencing inflammatory gingival enlargement were included in the study. They underwent professional mechanical plaque removal and were then randomly divided into three groups. In group I, comprising 15 patients, participants were advised to utilize 100% Aloe vera juice as a mouthwash twice daily. Group II, also consisting of 15 patients, was instructed to use Chlorhexidine (0.2%) mouthwash twice daily. The Control group, which consisted of 15 patients, was recommended to use a placebo mouth rinse in addition to mechanical plaque removal. During the second visit, which occurred one week after the initial visit, the enlarged gingival tissue was surgically removed through scalpel gingivectomy. Immunohistochemical (IHC) analysis was performed on the excised tissue to measure the l evels of fibroblast growth factor-2. Results: when compared to the control group, Aloe vera showed significant differences regarding the expression of fibroblast growth factor-2(FGF-2), and highly significant differences in angiogenesis. At the same time, there were substantial differences in angiogenesis w ith no significant differences in the expression of FGF2 between Chlorhexidine and control groups. Conclusion: aloe vera has exhibited potential wound-healing effects as i t s ignificantly affected the IHC expression of FGF2 and angiogenesis when used as an adjunct to plaque control before gingivectomy surgical therapy (AU)

Aloe Vera, uma planta perene de Liliaceae, tem propriedades médicas, cosméticas e cicatrizantes. Aloe vera tem efeitos antioxidantes, anticancerígenos, antidiabéticos e regenerativos. O glucomanano aumenta a síntese de colágeno e auxilia na cicatrização a pós o tratamento de gengivectomia. Enxaguatórios bucais naturais podem oferecer efi cácia na reparação de feridas gengivais com efeitos colaterais reduzidos quando comparados à clorexidina. Objetivo:O objetivo deste estudo clínico foi comparar os efeitos na cicatrização de feridas de uma semana de enxaguatório bucal de Aloe vera com clorexidina antes da terapia cirúrgica de gengivectomia. Material e Métodos: um total de 45 indivíduos com aumento gengival inflamatório foram incluídos no estudo. Eles foram submetidos à remoção mecânica profissional da placa e foramdivididos aleatoriamente em três grupos. No grupo I, composto por 15 pacientes, os participantes foram orientados a utilizar 100% de suco de Aloe vera como enxaguante bucal duas vezes ao dia. O grupo II, também composto por 15 pacientes, foi instruído a usar enxaguante bucal com clorexidina (0,2%) duas vezes ao dia. O grupo controle, composto por 15 pacientes, foi recomendado o uso de enxaguatório bucal placebo além da remoção mecânica da placa. Durante a segunda visita, que ocorreu uma semana após a visita inicial, o tecido gengival aumentado foi removido cirurgicamente por meio de gengivectomia com bisturi. A análise imuno-histoquímica (IHC) foi realizada no tecido excisado para medir os níveis do fator de crescimento de fibroblastos-2 (FGF-2). Resultados: quando comparado ao grupo controle, o Aloe vera apresentou diferenças significativas em relação àexpressão do FGF-2, e diferenças altamente significativas na angiogênese. Ao mesmo tempo, houve diferenças substanciais na angiogênese, sem diferenças significativas na expressão de FGF-2 entre a clorexidina e os grupos controle. Conclusão: Aloe vera exibiu potenciais efeitos de cicatrização de feridas, pois afetou significativamente a expressão IHC de FGF-2 e a angiogênese quando usada como adjuvante no controle de placa antes da terapia cirúrgica de gengivectomia (AU)

Apport de la technique combinée gingivectomie-frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique: à propos d'un cas / contribution of the combined gingivectomy-frenectomy technique in the management of gingival growth associated with a pathological frenulum: about a case

Introduction : La prise en charge de l'accroissement gingival repose sur un entretien médical bien mené, un examen clinique rigoureux, un diagnostic bien posé et une exérèse chirurgicale. Cependant, une récidive de la lésion peut être observée avec un rendu gingival souvent inesthétique. L'objectif de ce travail était d'illustrer, à travers un cas clinique, l'apport de la gingivectomie et de la frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique. Observation : Il s'agissait d'un patient âgé de 27 ans, venu consulter pour un problème esthétique lié à une excroissance gingivale. L'examen exo-buccal a mis en évidence, une asymétrie faciale dans le sens horizontal. La lésion gingivale était visible au sourire et évoluant depuis plus de 5 ans. L'examen endo-buccal a relevé la présence d'une gingivite induite par le biofilm, d'un frein de type 4 de Placek associés à un accroissement gingival pédonculé saignant au contact et siégeant entre la 11 et la 21. Après la thérapeutique initiale et une réévaluation, une gingivectomie à biseau interne (GBI) associée à une frénectomie ont été réalisées. L'examen anatomo-pathologique a mis en évidence un épulis fibreux ou fibrome périphérique avec absence de signes histologiques de malignité. L'évolution après 6 mois est marquée par une muqueuse gingivale cliniquement saine avec absence de récidive. Conclusion : L'apport de la gingivectomie et de la frénectomie est un atout important en termes de résultat clinique et de limitation de récidives dans l'exérèse des excès gingivaux combinés à un frein labial pathologique.

Introduction: Gingival growth is a change in the size and/or multiplication of cells, the gingival vascular system and the extracellular matrix. Management is based on a wellconducted medical interview, a rigorous clinical examination, a well-made diagnosis and surgical excision. However, a recurrence of the lesion can be observed with an often unsightly gingival rendering. The objective of this work was to illustrate, through a clinical case, the contribution of gingivectomy and frenectomy in the management of gingival growth associated with a pathological frenulum. Observation: It was a patient aged 27 who came to consult for an aesthetic problem related to a gingival growth. The exo-oral examination highlighted, a facial asymmetry in the horizontal direction. The gum lesion was visible on the smile and had been evolving for more than 5 years. The endooral examination noted the presence of biofilm-induced gingivitis, a type 4 Placek frenulum associated with pedunculate gingival growth bleeding on contact and sitting between 11 and 21. After initial therapy and reassessment, an internal bevel gingivectomy (IGG) combined with frenectomy was performed. The anatomo-pathological examination revealed fibrous epulis or peripheral fibroid with absence of histological signs of malignancy. The evolution after 6 months is marked by a clinically healthy gingival mucosa with no recurrence. Conclusion: The contribution of gingivectomy and frenectomy is an important asset in terms of clinical outcome and limitation of recurrence in the excision of excess gingival combined with a pathological labial frenulum.

Colágeno tipo I en el agrandamiento gingival inducido por tratamiento ortodóntico: un estudio inmunohistoquímico piloto / Type I Collagen in Gingival Overgrowth Induced by Orthodontic Treatment: A Pilot Immunohistochemical Study / Colágeno do tipo I no aumento gengival induzido por tratamento ortodôntico: um estudo imuno-histoquímico piloto

el tratamiento ortodóntico es responsable del agrandamiento gingival (ag), una condición clínica caracterizada por el crecimiento patológico, difuso o localizado del tejido gingival. La acumulación excesiva de la matriz extracelular (mec), incluyendo el colágeno tipo I, parece contribuir a las manifestaciones patológicas del ag. El objetivo del artículo es identificar y describir la distribución del colágeno tipo I en el tejido gingival de pacientes con ag por ortodoncia fija. Materiales y métodos: estudio de tipo descriptivo que analizó los tejidos gingivales de sujetos diagnosticados con ag portadores de ortodoncia (test, n = 5) e individuos periodontalmente sanos (control, n = 5). Las muestras se obtuvieron mediante gingivectomía. Todas las biopsias fueron fijadas, incluidas en parafina, cortadas y analizadas por medio de la coloración rojo picrosirius/verde rápido, con el propósito de distinguir las fibras de colágeno. Mediante una reacción inmunohistoquímica, el colágeno tipo I fue identificado con anticuerpo monoclonal. Resultados: en los pacientes con ag por tratamiento ortodóntico, se identificó un tejido epitelial hiperplásico con aumento evidente de las prolongaciones epiteliales y un tejido conectivo con abundantes haces de fibras de colágenos, principalmente en la lámina basal y la zona subyacente. Las fibras de colágeno tipo I en los tejidos de pacientes con ag por ortodoncia fueron gruesas de aspecto desorganizado, con una tinción inmunohistoquímica intensa, en comparación con las fibras del grupo control. Conclusiones: el aumento de fibras de colágenos, en especial de colágeno de tipo I, es un hallazgo histológico que caracteriza a los pacientes con ag por ortodoncia fija.

Orthodontic treatment is responsible for gingival overgrowth (go), a clinical condition charac-terized by pathological, diffuse, or localized growth of gingival tissue. Excessive accumulation of the extra-cellular matrix, including type I collagen, contributes to the pathological manifestations of go. The objective of this study is to identify and describe the distribution of type I collagen in the gingival tissue of patients with go because of fixed orthodontics. Materials and Methods: A descriptive study that analyzed the gingival tissues of subjects diagnosed with go with orthodontic (test, n = 5) and periodontally healthy individuals (control, n = 5). The samples were obtained by gingivectomy. All the biopsies were fixed, embedded in paraf-fin, and cut and analyzed using picrosirius red/fast green staining, in order to distinguish the collagen fiber. By means of an immunohistochemical reaction, type I collagen was identified with a monoclonal antibody. Results: A hyperplastic epithelial tissue was identified with an evident increase in epithelial processes and connective tissue with abundant bundles of collagen fiber, mainly in the basal lamina and the underlying area in patients with go because of orthodontic treatment. Type I collagen fiber in the tissues of patients with orthodontic go were thick and disorganized in appearance with intense immunohistochemical stain-ing, compared to the fibers of the control group. Conclusions:The increase in collagen fibers, particularly type I collagen, is a histological finding that characterizes patients with go because of fixed orthodontics.

• tratamento ortodôntico é responsável pelo aumento gengival (ag), uma condição clínica caracterizada pelo crescimento patológico difuso ou localizado do tecido gengival. O acúmulo excessivo de matriz extracelular (mec), incluindo colágeno tipo I, parece contribuir para as manifestações patoló-gicas do ag. O objetivo deste trabalho é identificar e descrever a distribuição do colágeno do tipo I no tecido gengival de pacientes com AG devido à ortodontia fixa. Materiais e métodos: estudo descritivo que analisou os tecidos gengivais de indivíduos diagnosticados com ag em uso de ortodontia (teste, n = 5) e indivíduos periodontalmente saudáveis (controle, n = 5). As amostras foram obtidas por gengivectomia. Todas as biópsias foram fixadas, embebidas em parafina, cortadas e analisadas com coloração picrosirius vermelho/verde rápido, a fim de distinguir as fibras colágenas. Usando uma reação imuno-histoquímica, o colágeno tipo I foi identificado com anticorpo monoclonal. Resultados: em pacientes com ag devido ao tratamento ortodôntico, foi identificado tecido epitelial hiperplásico com evidente aumento das exten-sões epiteliais e tecido conjuntivo com abundantes feixes de fibras colágenas, principalmente na lâmina basal e região subjacente. As fibras de colágeno tipo I em tecidos de pacientes com ag ortodôntico eram espessas com aspecto desorganizado e intensa coloração imuno-histoquímica, em comparação com as fibras do grupo controle. Conclusões: o aumento das fibras colágenas, principalmente do colágeno do tipo I, é um achado histológico que caracteriza os pacientes com ag devido à ortodontia fixa.

Evaluation of the botulinum toxin effects in the correction of gummy smile 32 weeks after application / Avaliação dos efeitos da toxina botulínica na correção do sorriso gengival 32 semanas pós-aplicação

INTRODUCTION: The use of botulinum toxin type A (BTX-A) to correct gummy smile has become popular in recent years. OBJECTIVE: To evaluate the effects of BTX-A application in the correction of gummy smile 2 and 32 weeks after application. METHODS: The sample comprised 35 patients (30 female, 5 male) at a mean age of 25.51 years (±5.59) with gummy smile due to muscular hyperfunction. In each patient, 2U of botulinum toxin was applied in the levator labii superioris alaeque nasi, 2 mm from the nasolabial fold. Photographs of spontaneous smiles were taken at 3 stages: before, 2 and 32 weeks after BTX application. Measurements of the gingival display were performed with the Radioface Studio 2 Software, and the calibration used the actual size of the right maxillary central incisor. Comparison of the three stages evaluated was performed with repeated measures ANOVA and Tukey tests. RESULTS: Gingival display decreased significantly 2 weeks after BTX-A application and increased after 32 weeks but did not return to the initial value. CONCLUSION: There was a significant improvement in gummy smile 2 weeks after botulinum toxin application, and a significant relapse in the gingival display after 32 weeks, however not returning to baseline values.

INTRODUÇÃO: A toxina botulínica tipo A (BTX-A) tem se tornado popular na correção do sorriso gengival nos últimos anos. OBJETIVO: Avaliar os efeitos da aplicação de BTX-A na correção do sorriso gengival 2 e 32 semanas após a aplicação. MÉTODOS: A amostra compreendeu 35 pacientes (30 mulheres, 5 homens) com uma idade inicial média 25,51 anos (±5,59) portadores de sorriso gengival devido à hiperfunção muscular. Em cada paciente foi aplicado 2U de BTX-A no músculo elevador superior da asa do nariz, 2 mm a partir da dobra nasolabial. Foram feitas fotografias dos sorrisos espontâneos dos pacientes em 3 fases: antes, 2 e 32 semanas após a aplicação de BTX-A. As medidas da exposição gengival foram feitas com o Software Radioface Studio 2, e a calibração utilizou o tamanho real do incisive central superior direito. A comparação das 3 fases foi feita com ANOVA de medidas repetidas e teste de Tukey. RESULTADOS: A exposição gengival diminuiu significantemente 2 semanas após a aplicação e aumentou novamente após 32 semanas, mas não retornando aos valores iniciais. CONCLUSÃO: Houve uma melhora significante no sorriso gengival 2 semanas após a aplicação de toxina Botulínica, e uma recidiva significante após 32 semanas, mas não retornando aos valores iniciais.

Desfechos periodontais e qualidade de vida relacionada à saúde bucal em indivíduos de transplante de células tronco hematopoiéticas, fígado e rim: um estudo transversal comparativo / Periodontal outcomes and quality of life related to oral health in hematopoietic stem, liver and kidney transplant individuals: a comparative cross-sectional study

Esse estudo observacional transversal comparativo teve como objetivos avaliar os parâmetros clínicos periodontais, índice gengival modificado (IGM), índice de placa visível (IPV), crescimento gengival induzido por drogas (CGID), mensurar volume e fluxo do fluido crevicular gengival (FCG), perda dentária bem como o impacto da saúde bucal auto-relatada na qualidade de vida, em pacientes pré e pós-transplante de células tronco hematopoiéticas (TCTH), fígado (TX-fígado), rim (Tx-rim), comparados a indivíduos sem doença sistêmica diagnosticada. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (UFMG) (CAAE-18019619.1.0000.5149). A amostra foi recrutada dentre usuários da Faculdade de Odontologia da UFMG, de março a dezembro de 2019. Foram registrados: IGM, IPV, profundidade à sondagem (PS), sangramento à sondagem (SS), nível de inserção clínico (NIC), recessão gengival (RG), CGID, fluxo e volume do FCG e número de dentes presentes. O instrumento Oral Health Impact Profile (OHIP-14) foi aplicado para avaliar a Qualidade de Vida Relacionada à Saúde Bucal (QVRSB). O grupo controle incluiu pacientes sem doença sistêmica diagnosticada, pareados por sexo e idade. Os dados foram analisados pelo programa SPSS versão 25. Análises descritivas e comparativas foram realizadas usando os testes de Wilcoxon, Mann Whitney e Kruskal-Wallis seguido de Dunn-Bonferroni. Modelos de regressão logística binária condicional estimaram a Odds-Ratio, considerando como desfechos presença de periodontite e prevalência de alto impacto na QVRSB. Em todos os testes, o nível de significância de 5% foi adotado. As frequências de periodontite foram maiores em indivíduos em condição de transplante que no grupo controle, na fase pré-transplante e nos pacientes Tx-fígado. O diagnóstico mais frequentemente encontrado foi a periodontite estágio I localizada. As medianas de IPV, PS, NIC, volume e fluxo do FCG foram maiores em pacientes de transplante comparados aos controles (p<0,05). Comparados aos respectivos controles, os grupos Tx-fígado e Tx-rim apresentaram medianas de IPV e PS significativamente maiores. O número de dentes presentes foi menor no grupo Tx fígado que no Tx rim (p=0,027). No modelo ajustado final, nenhuma variável mostrou associação com a presença de periodontite (p>0,05). Pacientes de transplante tiveram pior percepção do impacto na QVRSB que os indivíduos controle (p=0,015). Os grupos TCTH (p=0,008) e Tx-fígado (p=0,033) foram mais impactados que seus controles. Na regressão logística, a variável transplante não afetou a frequência de alto impacto na QVRSB. No modelo final ajustado, a escolaridade e o número de dentes presentes permaneceram como fatores preditores do impacto da saúde bucal na qualidade de vida auto-relatada. Indivíduos com menor escolaridade (OR = 3,590; 1,021-12,622) e com menor número de dentes (OR = 4,991; IC95% 1,386-17,970) tiveram maior impacto na QVRSB. Concluiu-se, que as frequências de periodontite foram maiores em indivíduos em condição de transplante, na fase pré e em pacientes Tx-fígado. A periodontite estágio I localizada foi o diagnóstico mais frequente. A condição de transplante não afetou a presença de periodontite. O número de dentes presentes e a escolaridade tiveram impacto na QVRSB dos indivíduos em condição transplante, e estes demonstram uma pior percepção que os controles.

This cross-sectional observational study aimed to assess periodontal clinical parameters, modified gingival index (MGI), visible plaque index (VPI), drug-induced gingival overgrowth (DIGO), measuring gingival crevicular fluid (GCF) volume and flow , tooth loss as well as the impact of self-reported oral health on quality of life, in patients before and after hematopoietic stem cell (HSCT), liver (Tx-liver), kidney (Tx-kidney) transplantation compared to individuals without diagnosed systemic disease. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (UFMG) (CAAE-18019619.1.0000.5149). The sample was recruited from users of the Faculty of Dentistry at UFMG, from March to December 2019. The outcomes MGI, VPI, probing depth (PD), bleeding on probing (BoP), clinical attachment level (CAL), gingival recession (GR), DIGO, flow and volume of GCF and number of teeth present were recorded. The Oral Health Impact Profile instrument (OHIP-14) was applied to assess the Oral Health Related Quality of Life (HRQoL). The control group included patients without diagnosed systemic disease, matched for sex and age. The data were analyzed using the SPSS software version 25. Descriptive and comparative analyzes were performed using the Wilcoxon, Mann-Whitney and KruskalWallis followed by Dunn-Bonferroni tests. To estimate the Odds-Ratio, conditional binary logistic regression models were used, considering as outcomes presence of periodontites and prevalence of hight impact on OHRQoL. In all tests, the significance level of 5% was adopted. The frequency of periodontitis was higher in individuals undergoing transplantation than in the control group, in the pre-transplant phase and in Tx-liver patients. The most frequently found diagnosis was localized stage I periodontitis. The medians of VPI, PD, CAL, GCF volume and flow were higher in transplant patients compared to controls (p <0.05). The Tx-liver and Tx-kidney groups had significantly higher VPI and PD medians than their respectives controls. Comparing the transplant groups, the number of teeth present was lower in Tx-liver than in Tx-kidney (p = 0.027). In the final adjusted model, no variable was associated with the presence of periodontitis (p> 0.05). Transplant patients had a worse perception of the impact on OHRQoL than control subjects (p = 0.015). The groups HSCT (p = 0.008) and Tx-liver (p = 0.033) were more impacted than their controls. In logistic regression, the transplant variable did not affect the frequency of high impact on OHRQoL. In the final adjusted model, schooling and the number of teeth present remained as predictors of the impact of oral health on self-reported quality of life. Individuals with less education (OR = 3.590; 1.021-12.622) and with fewer teeth (OR = 4.991; 95% CI 1.386-17.970) had a greater impact on HRQoL. It was concluded that the frequencies of periodontitis were higher in individuals in a transplant condition, in the pre-transplantation phase and in Tx-liver patients. Localized stage I periodontitis was the most frequent diagnosis. The transplant condition did not affect the presence of periodontitis. The number of teeth present and education had an impact on the HRQoL of transplantation individuals, and these demonstrate a worse perception than the controls.

Agrandamiento gingival inducido por fenitoínas / Phenytoin induced gingival enlargement

Se entiende por agrandamiento gingival el incremento en masa y volumen del tejido gingival. Se considera una condición benigna de la cavidad oral, por lo general de manejo rutinario, que logra regularse con medidas simples de control del biofilm microbiano. El agrandamiento gingival puede ser producido por diversas condiciones clínicas, hereditarias, deficiente higiene oral o fármacos. La epilepsia afecta a 1% de la población mundial y requiere el uso de fármacos antiepilépticos o anticonvulsivantes para lograr su control, dentro de éstos la fenitoína actúa como un bloqueador selectivo de los canales de sodio sensibles al voltaje y constituye uno de los fármacos más empleados por su capacidad en el control de crisis focales y generalizadas. La fenitoína se ha relacionado con los agrandamientos gingivales como uno de sus efectos adversos, los cuales se incluyen dentro de las enfermedades por fármaco inducidas en la cavidad oral. El objetivo de este artículo es brindar la información necesaria sobre el manejo correcto de pacientes con agrandamiento gingival producido por fenitoínas y a la vez poder conocer las consecuencias de estos fármacos en la cavidad oral (AU)

Gingival enlargement means the increase in mass and volumen of the gingival tissue. It is considered a benign condition of the oral cavity, usually of routine management, wich can be regulated with simple measures of biofilm control. The gingival enlargement can be produced by diverse clinical conditions, hereditary deficient oral higiene or drugs. Epilepsy affects 1% of the world population and requires the use of antiepileptic or anticonvulsant drugs to achieve its control, within these phenytoin acts as selective blocker or voltage ­ sensitive sodium channels and is one of the most used grugs for its ability to control focal and generalized crises. Phenytoin has been linked to gingival enlargement as one of its adverse effects which is included within the drug diseases induced in the oral cavity. The objective of this article is to provide the necessary information on the correct managment of patients with gingival enlargemen produced by phenytoins and at the same time to know the consequences of these drugs in the oral cavity (AU)

Periodontal management of a patient with chronic kidney disease: a case report

The association between periodontal disease and chronic kidney disease (CKD) has been recognized over the years. Gingival overgrowth may be a side effect of some of the drugs prescribed for patients with CKD. Objective: The objective of this manuscript was to report the dental management of a patient with chronic renal disease who presented periodontitis and gingival overgrowth. Case report: A 55 years old male patient sought dental treatment, and was diagnosed with generalized periodontitis in advanced stage and gingival overgrowth. The overgrowth was associated to the use of amlodipine, a longacting calcium channel blocker. The treatment consisted of interruption of amlodipine, sessions of oral hygiene instruction and basic periodontal therapy. Thereafter, conventional periodontal therapy, with scaling and root planning of the four hemiarches, surgical periodontal therapy and gingivectomy of the overgrowth were performed. Considering periodontal sites with a probing depth (PD) > 4mm at baseline, mean PD was reduced (baseline: 5.94 ± 1.80; follow-up: 2.76 ± 1.38), as well as mean clinical attachment loss (baseline: 5.55 ± 1.51; followup: 4.52 ± 1.47). Periodontal disease was controlled and there was no recurrence of gingival overgrowth after 18 months of follow-up. Conclusion: The management of the reported patient with CKD and periodontal involvement included discontinuation of amlodipine, basic and advanced periodontal therapy and gingivectomy. Proper oral hygiene may help to prevent recurrence of the gingival overgrowth and to maintain periodontal health.

Introdução: A associação entre doença periodontal e doença renal crônica (DRC) tem sido reconhecida nos últimos anos. O crescimento gengival excessivo pode ser um efeito colateral de alguns medicamentos prescritos para pacientes com DRC. Objetivos: O objetivo deste estudo foi relatar o manejo odontológico de um paciente com DRC que apresentava periodontite e aumento gengival. Relato do caso: Um paciente do sexo masculino, 55 anos, procurou atendimento odontológico e foi diagnosticado com periodontite generalizada em estágio avançado e crescimento gengival associado ao uso de anlodipina, um bloqueador dos canais de cálcio de ação prolongada. O tratamento consistiu em interrupção da anlodipina, sessões de instruções de higiene bucal e terapia periodontal básica. Posteriormente, foi realizada terapia periodontal convencional, com raspagem e alisamento radicular dos quatro hemiarcos, seguida de cirurgia periodontal a retalho e gengivectomia. Considerando os sítios periodontais com profundidade de bolsa à sondagem (PBS) > 4mm no início do tratamento, a média de PBS foi reduzida (início: 5,94 ± 1,80; final: 2,76 ± 1,38), bem como a média do nível clínico de inserção (início: 5,55 ± 1,51; final: 4,52 ± 1,47). A doença periodontal foi controlada e não houve recorrência do crescimento gengival após 18 meses de acompanhamento. Conclusão: O tratamento odontológico deste paciente com DRC e envolvimento periodontal incluiu a interrupção da anlodipina, terapia periodontal básica e avançada e gengivectomia. A higiene bucal adequada pode ajudar a prevenir a recorrência do crescimento gengival excessivo e a manutenção de um estado periodontal saudável.

LipStaT® Surgery, A Novel Technique for the Treatment of Gummy Smile: Case Report / LipStaT®, Una novedosa técnica quirúrgica para el tratamiento de la sonrisa gingival, reporte de casos Gummy Smile and LipStat® Technique

Background: The lip stabilization technique (LipStaT®) is a novel surgical approach for the management of gummy smile. It is an outpatient technique, minimally invasive, with low risk of morbidity and low incidence of complications. The goal of the technique is to reduce the excessive gingival display during smile. Objective: to describe the LipStaT® technique including its indications, preoperative evaluation, surgical approach and patient post procedure care instructions. Clinical Cases: the authors present two female patients, aged 20 and 31 years, with excessive gingival display (over 3mm) and with experiences of failures with other procedures. The LipStaT® technique allowed to achieve aesthetic, harmonic and functional results. Conclusion: The LipStaT® technique is a safe outpatient procedure that allows to obtain predictable results, which are well accepted by patients.

Introducción: La técnica de estabilización labial (LipStaT®), es un novedoso abordaje quirúrgico para el manejo de la sonrisa gingival. Es una técnica ambulatoria, mínima-mente invasiva, con baja morbilidad e incidencia de complicaciones. La meta de la técni-ca es reducir la excesiva cantidad de encía que se visualiza durante la sonrisa. Objetivo:Describir la técnica LipStaT® incluyendo sus indicaciones, evaluación preoperatoria, abordaje quirúrgico y las indicaciones posteriores a la intervención. Presentación del caso: Los autores presentan dos pacientes, mujeres, entre 20 y 31 años, con visuali-zación excesiva de la encía de más de 3mm al sonreír y con experiencias de fracasos con otros procedimientos. La técnica LipStaT® permitió lograr un resultado estético, armónico y funcional. Conclusión: Este es un procedimiento seguro, ambulatorio, que permite obtener resultados predecibles y bien aceptados por los pacientes.

Agrandamiento gingival medicamentoso en paciente con trasplante renal tratado con ciclosporina A / Drug-induced gingival enlargement in a kidney transplant patient treated with cyclosporine A

Resumen El agrandamiento gingival medicamentoso se describe como un aumento de volumen anormal, exagerado y deformante de las encías, provocado por la ingesta de algunos medicamentos. Entre los más comunes se encuentran: fármacos anticonvulsivantes, antihipertensivos, particularmente los antagonistas del calcio e inmunosupresores. Se presentó el caso de un paciente del sexo masculino, de 44 años de edad, con antecedentes de hipertensión arterial e insuficiencia renal crónica, durante 10 y tres años respectivamente. Después de 22 meses de haber recibido un trasplante renal y tratamiento con ciclosporina, acude a consulta por aumento del volumen de las encías en ambos maxilares, clínicamente compatible con agrandamiento gingival medicamentoso generalizado y grave.

ABSTRACT Drug-induced gingival enlargement is described as an abnormal, exaggerated, and deforming growth of the gingiva caused by the ingestion of some medications. Anticonvulsants, antihypertensive calcium channel blockers and immunosuppressants are among the most common drugs. We present a 44-year-old male patient with a history of arterial hypertension and chronic renal failure, for 10 and three years, respectively. Twenty-two months after receiving a kidney transplant and treatment with cyclosporine, he visited the clinic due to an increase in the volume of the gums in both jaws, clinically compatible with a generalized and severe gingival enlargement.

Agrandamiento gingival medicamentoso en paciente con trasplante renal tratado con ciclosporina A / Drug-induced gingival enlargement in a kidney transplant patient treated with cyclosporine A

El agrandamiento gingival medicamentoso se describe como un aumento de volumen anormal, exagerado y deformante de las encías, provocado por la ingesta de algunos medicamentos. Entre los más comunes se encuentran: fármacos anticonvulsivantes, antihipertensivos, particularmente los antagonistas del calcio e inmunosupresores. Se presentó el caso de un paciente del sexo masculino, de 44 años de edad, con antecedentes de hipertensión arterial e insuficiencia renal crónica, durante 10 y tres años respectivamente. Después de 22 meses de haber recibido un trasplante renal y tratamiento con ciclosporina, acude a consulta por aumento del volumen de las encías en ambos maxilares, clínicamente compatible con agrandamiento gingival medicamentoso generalizado y grave.

Effects of cyclosporin, nifedipine and phenytoin on gingival myofibroblast transdifferentiation in monkeys

Abstract Objective: Myofibroblasts have been associated with the development of several pathologic fibrotic conditions. This longitudinal study aims to assess the proliferative and antiapoptotic effects of cyclosporin, nifedipine and phenytoin on gingival connective tissue cells of nonhuman primate, as well as to analyze a possible role of myofibroblasts in gingival overgrowth. Materials and Methods: Gingival samples from the right superior canine area were obtained from 12 male monkeys ( Sapajus spp ) to comprise the control group. After one week, the animals were randomly assigned to three groups, which received daily oral doses of cyclosporin, nifedipine or phenytoin for 120 days. Gingival samples were collected from the left superior canine area of two animals of each group at 52 and 120 days. Histological sections were stained with hematoxylin and eosin, and immunoreacted against α-SMA, Ki- 67 and bcl-2. Results: α-SMA immunoreaction was negative in the control and experimental groups. Similarly, no difference between groups concerning immunostaining against Ki-67 and bcl-2 was observed in connective tissue cells. Conclusion: Based on this methodology, it may be concluded that gingival overgrowths induced by cyclosporin, nifedipine and phenytoin are not associated with neither myofibroblast transdifferentiation, proliferation nor apoptosis of gingival connective cells in monkeys.

Capillary hemangioma of the gingiva in an adult: a rare case report

Objective: We report a case of a 40-year-old female with gingival overgrowth in the right maxillary anterior region which has been excised at a peripheral hospital that caused displacement, mobility of associated teeth and lip incompetency. Case description: A case of recurrent gingival overgrowth in the right maxillary anterior region in a 40-year-old female with associated teeth displacement and mobility and lip incompetency. There was a radiologic evidence of bone loss. Excisional biopsy was carried out and the histologic diagnosis was Capillary Hemangioma. Conclusion: Capillary Hemangioma should be considered as one of the differential diagnosis in cases of gingival overgrowth ofmaxillary anterior region, which mimics pyogenic granuloma

Agrandamiento gingival farmacoinducido: Serie de casos / Drug-induced gingival enlargement: Series of cases

Resumen Introducción: El agrandamiento gingival (AG) es una condición benigna de la cavidad oral que se caracteriza por el crecimiento excesivo en masa y volumen de la gingiva. Esta lesión no es únicamente provocada por factores hereditarios ni de deficiente higiene oral, sino también por ingesta de medicamentos, entre los cuales se encuentran fármacos antihipertensivos, anticonvulsivantes e inmunosupresores. Objetivo: Sensibilizar respecto a la prevención o atención temprana en pacientes con patologías que ameritan el uso de antihipertensivos y anticonvulsivantes, conjuntamente con el odontólogo para tratar o evitar el agrandamiento gingival fármaco inducido (AGFI). Materiales y métodos: Se reporta una serie de casos clínicos de pacientes con agrandamiento gingival por distintos fármacos, entre los que se encuentran fenitoina, amlodipino y nifedipino; se aplicaron medidas de fase higiénica periodontal y gingivectomía para obtener mejores efectos. Resultados: Se obtuvieron resultados satisfactorios con una disminución considerable del AGFI. Conclusiones: Es importante el manejo integral en conjunto con el médico tratante para realizar seguimiento del fármaco que pueda encontrarse generando agrandamiento gingival. Emplear un abordaje inicial con estrategias de higiene periodontal, y en casos severos y como último recurso la intervención quirúrgica periodontal con gingivectomía y gingivoplastia.

Abstract Introduction: Gingival enlargement (GA) is a benign condition of the oral cavity that is characterized by the excessive growth of the gingiva in mass and volume. This lesion is not only caused by hereditary factors or poor oral hygiene, but also by the intake of medications, including antihypertensive, anticonvulsant and immunosuppressive drugs. Objective: To sensitize the prevention or early care in patients with pathologies that merit the use of antihypertensive and anticonvulsants in conjunction with the dentist, to treat or avoid the drug-induced gingival enlargement (DIGE). Materials and methods: A series of clinical cases of patients with gingival enlargement by various drugs are reported, including Phenytoin, Amlodipine and Nifedipine. Periodontal and gingivectomy hygienic phase measures were applied to obtain better effects. Results: Satisfactory results were obtained with a considerable decrease in DIGE. Conclusions: The integral management is important in conjunction with the treating physician to follow up the drug that can be generating gingival enlargement. It is necessary to employ an initial approach with strategies of periodontal hygiene, and in severe cases and, as last resort, the periodontal surgery with gingivectomy and gingivoplasty.

Relationship of orthodontic treatment and periodontal soft tissue health / 华西口腔医学杂志

With the increasing number of the orthodontic patients, the relationship between periodontal and orthodontic becomes increasingly close. Orthodontic treatment can improve periodontal status, but the adverse clinical problems of periodontal tissue during orthodontic treatment are relatively common. In this paper, we discuss the problems of soft tissue, including causes, prevention, and treatment of gingivitis, gingival enlargement, gingival recession, and gingival invagination in orthodontic treatment.

A Novel Method to Study the Effects of Cyclosporine on Gingival Overgrowth in Children / 대한소아치과학회지

Previous studies to elucidate the etiology of cyclosporine(Cs)-induced gingival overgrowth in children have not completely excluded all factors that may cause differences among individuals. This study examined the effect of cyclosporine on the metabolism of type 1 collagen(CoL-I) in experimental models that controlled the effects of biological variations on individuals. Five 5-week-old male Sprague-Dawley rats were administered Cs by gastric feeding for 6 weeks. Gingival specimens were harvested from the mandibular posterior area before beginning Cs administration and at 2, 4, and 6 weeks thereafter. Gingival fibroblasts were cultured from all the 20 biopsies collected from the gingiva. Half of the fibroblasts collected prior to the Cs administration were designated as Control. The other half of the fibroblasts were treated with Cs in vitro and called in vitro test group(Tt). The fibroblasts collected 2, 4, and 6 weeks after the Cs administration were called in vivo test groups : T2, T4, T6, respectively. Immunofluorescence microscopy was used to detect CoL-I in all the fibroblasts. CoL-I was analyzed at both the gene and protein expression levels by real-time polymerase chain reaction and western blotting. Changes in CoL-I before and after Cs treatment were evaluated from the gingiva of each rat. There was no significant difference in gene expression of CoL-I in the control and test groups. CoL-I protein expression levels of fibroblasts increased in in vitro Cs treatment for each individual, and also increased in in vivo Cs treatment. In this study, the experimental method that control biological variations that can occur due to differences among individuals was useful. Subsequent studies on other factors besides CoL-I and in-depth studies in humans are needed.

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.

Research progression of the relationship between integrin α2β1 and drug-induced gingival overgrowth / 华西口腔医学杂志

Drug-induced gingival overgrowth (DIGO) is characterized by fibrous gingival hyperplasia and increased gingival volume. DIGO is histologically associated with proliferation of cells and deposition of extracellular matrices, particularly collagen. Integrin α2β1 is related to collagen phagocytosis and involved in the occurrence and progression of DIGO. This paper reviews the progress of research on the relationship between integrin α2β1 and DIGO.

Spontaneous teeth migration after periodontal treatment in the patients with drug-induced gingival enlargement

Anticonvulsants, calcium channel blockers and immunosuppressants are representative drugs related with gingival enlargement. Clinical signs and symptoms caused by drug-induced gingival enlargment frequently appear within 1 to 3 months after medication. At initial stage, it is limited to attached gingiva but may extend coronally and interfere with esthetics, mastication and speech. Interproximal spaces are common beginning area and pathologic teeth migration could be occurred by the lesion. Withdrawal or substitution of medication would be the most effective treatment of drug-induced gingival enlargement. However, periodontal treatment and further supportive periodontal therapy should be provided where change in medication is impossible. The present study reports the cases which show the resolution of inflammation with spontaneous teeth migration without change in medication. In all cases discussed in this report could be efficiently managed with proper periodontal treatment and further supportive periodontal therapy.

Harmonização da estética dentogengivofacial / Harmonization of dental, gingival and facial aesthetics

Atualmente a busca pela excelência estética tem-se tornado o objetivo principal no tratamento odontológico. O sorriso gengival é uma das queixas dos pacientes, já que tal situação pode influenciar a autoestima e o relacionamento social. A beleza do sorriso não está apenas na forma, posição e cor dos dentes, mas também nas características do tecido gengival, que devem ser tão harmoniosas quanto os dentes. O desenvolvimento de novas técnicas como a aplicação de toxina botulínica pode ser uma opção terapêutica mais conservadora quando comparada à intervenção cirúrgica no tratamento do sorriso gengival. O propósito deste trabalho é mostrar o caso de um paciente que apresentou discrepância dentogengival e sorriso gengival, tendo sido tratado pela cirurgia gengival ressectiva e aplicação de toxina botulínica, com vistas a otimizar a harmonia do sorriso e a estética facial(AU)

Currently, the search for aesthetic excellence is the main goal of the dental treatment. The gingival smile is a common patients' complaint, because it may influence the self-steem and social relationship. The beauty of the smile is not only related to tooth shape, position and shade, but also to the features of the gingival tissue, which should be as harmonious as the teeth. The development of new techniques, such as the application of botulinum toxin, may be a more conservative therapeutic option when compared to surgical intervention for the treatment of the gingival smile. The aim of this paper is to present a case report of dentogingival discrepancy and gingival smile, which has been treated with gingival resection surgery and application of botulinum toxin, optimizing the harmony of the smile and facial aesthetics(AU)

Effect of chlorhexidine varnish on gingival growth in orthodontic patients: a randomized prospective split-mouth study

Introduction: Fixed orthodontic appliances patients suffer limitations on the effective control of biofilm by mechanical methods, bringing the need of a coadjutant in the control of inflammation and oral health improvement.Objective: The aim of this prospective split-mouth blind study was to analyze the effect of a 40% chlorhexidine (CHX) varnish on gingival growth of patients with orthodontic fixed appliances. Methods: Healthy teenage patients with fixed orthodontic appliances and increased gingival volume were recruited (n = 30). Each individual was his own control, having in the maxilla one control side and one treatment side. An application of varnishes occurred on the vestibular area of the upper premolars and first molar crowns, on the control side (placebo varnish) and on the experimental side (EC40(r) Biodentic CHX varnish). The varnishes and sides were randomly chosen and its identification and group was kept by a third party observer and it was not revealed to the researchers and participants until the end of study. In order to establish a baseline registration, digital photographs were taken by a trained photographer before varnish application at baseline (T0), as well as 14 days (T14) and 56 days (T56) after the application. The gingival volume was calculated indirectly using the vestibular areas (mm2) of the upper second premolars' clinical crowns by RapidSketch(r) software, at all study times. The data were analyzed using ANOVA and the Turkey-Krammer test.Results:It was observed, in the final sample of 30 individuals, that at T0, the control and treatment groups were similar. At T14 and T56, a progressive reduction of the clinical crown area was seen in the control group, and an increase in the average area was detected in the experimental group (p < 0,05).Conclusions: The use of 40% CHX varnish decreases the gingival overgrowth in patients undergoing orthodontic treatment. Further studies are necessary to set the action time and frequency of application.

Introdução: pacientes com aparelhos ortodônticos fixos sofrem limitações no controle efetivo de biofilme por métodos mecânicos, trazendo a necessidade de um coadjuvante no controle na inflamação e melhora na saúde bucal.Objetivo:esse estudo cruzado prospectivo randomizado teve como objetivo analisar o efeito do verniz de clorexidina (CHX) a 40% no crescimento gengival de pacientes com aparelhos ortodônticos fixos.Métodos:indivíduos adolescentes com aparelhos ortodônticos fixos e aumento de volume gengival foram recrutados para a pesquisa (n = 30). Cada participante atuou como seu próprio controle, tendo, na maxila, um lado controle e um tratamento. No lado controle, aplicou-se verniz placebo e no lado experimental, o verniz EC40(r) Biodentic CHX, ambos na face vestibular das coroas dos pré-molares e primeiro molar superiores. Os vernizes e lados foram escolhidos de forma aleatória e a identificação deles e a que grupo pertenciam foi mantida por um terceiro observador, não sendo revelada aos pesquisadores nem aos participantes até o final do estudo. Fotografias digitais foram tiradas por um fotógrafo treinado, antes da aplicação do verniz no tempo inicial (T0), bem como 14 dias (T14) e 56 dias (T56) após a aplicação. O volume gengival foi calculado indiretamente, por meio das áreas vestibulares (mm2) das coroas dos segundos pré-molares superiores, com o softwareRapidSketch(r), em todos os tempos de estudo. Os dados foram analisados usando ANOVA e teste de Turkey-Krammer.Resultados:na amostra final de 30 indivíduos, observou-se que, em T0, os grupos controle e tratamento foram semelhantes. Já em T14 e T56, foi observada uma progressiva redução na área da coroa clínica no grupo controle, e um aumento na área média do grupo experimental (p< 0,05).Conclusão:o uso do verniz de CHX a 40% diminui o excessivo crescimento gengival em pacientes sob tratamento ortodôntico. Estudos futuros são necessários para se determinar o tempo de ação e a frequência de aplicação.