A pilot study on the consistency of biological widths measured by periodontal probe and cone-beam CT / 中华口腔医学杂志

Objective@#To compare the consistency of the biological widths measured by using cone-beam CT (CBCT) and periodontal probe in patients with two different gingival biotypes.@*Methods@#Totally 27 patients [13 males, 14 females, (37.6±13.7) years old], who planned to receive the crown lengthening surgery, were recruited under the inclusion and exclusion criteria in Department of Periodontology, School of Stomatology, The Fourth Military Medical University during November 2017 to June 2018. A total of 40 teeth (14 front teeth, 26 posterior teeth) were involved in this study. The patients were divided into two groups according to their gingival biotypes: thin gingival biotype [5 males, 8 females, (40.2±15.0) years old, 21 teeth] and thick gingival biotype [8 males, 6 females, (35.1±11.9) years old, 19 teeth]. All the teeth were checked before crown lengthening procedures by using CBCT, and the biological widths and sulcus depths were measured during the surgery by using periodontal probes (Hu-Friedy, U S A). The data were recorded and statistically analyzed.@*Results@#There were no significant differences of the biological widths between the two measuring methods amongst all of the 40 teeth [periodonial probe: (1.64±0.26) mm; CBCT: (1.69±0.20) mm], amongst 21 thin gingival biotype teeth [periodontal probe: (1.49±0.19) mm; CBCT: (1.57±0.12) mm] and amongst 19 thick gingival biotype teeth [periodontal probe: (1.80±0.21) mm; CBCT: (1.87±0.18) mm] (P>0.05). There were no significant differences of the biological widths [anterior teeth: (1.59±0.15) mm, posterior teeth: (1.67±0.29) mm, P=0.42] and of the sulcus depths [anterior teeth: (2.00±0.28) mm, posterior teeth: (2.11±0.43) mm, P=0.44] between anterior teeth and posterior teeth. The difference of biological widths, measured by two methods respectively, between thin and thick gingival biotype groups was statistically significant (P<0.01). There were significant differences of the sulcus depths, measured by the periodontal probes, between the thin [(1.93±0.28) mm] and thick [(2.24±0.41) mm] gingival biotype groups (P<0.01).@*Conclusions@#The biological widths measured by CBCT is consistent with those measured by using periodontal probes. The biological widths and the depths of the sulcus of thin and thick gingival biotypes are different.

Tratamento reabilitador cirúrgico restaurador: relato de caso / Surgical-restoring rehabilitator treatment: a case report

Tendo em vista a abundância de procedimentos realizados envolvendo a inter-relação entre a Dentística Restauradora e Periodontia na Odontologia contemporânea, é preciso salientar a importância da realização de técnicas cirúrgica e restauradora corretas por parte dos cirurgiões-dentistas, assim como na conceitualização de que os tecidos periodontais podem reagir de forma positiva à presença de materiais restauradores adesivos posicionados apicalmente à gengiva, sem a necessidade da recuperação do espaço biológico. O presente estudo teve como objetivo demonstrar a técnica da realização de uma restauração transcirúrgica através de um relato de um caso clínico realizado no Complexo Odontológico do Centro Universitário da Serra Gaúcha (FSG). A paciente foi diagnosticada com uma cavidade subgengival no elemento 16 e submetida à procedimento restaurador transcirúrgico, sendo o ionômero de vidro fotopolimerizável o material restaurador de eleição. Este trabalho evidenciou como os tecidos periodontais podem reagir de maneira positiva à presença de materiais biocompatíveis resultando, inclusive, em um remodelamento ósseo favorável. (AU)

Considering the abundance of procedures performed involving the Restorative Dentistry and Periodontics relationship in contemporary dentistry, it is necessary to emphasize the importance of performing a correct surgical and restorative technique by dental surgeons, as well as in the conceptualization that periodontal tissues can react positively in the presence of adhesive restorative materials positioned apically to the gingiva, without the need of the recovery of the biological width. The present study aims to demonstrate the technique of performing a trans-surgical restoration through a clinical case report performed at the Odontological Complex of Centro Universitário da Serra Gaúcha (FSG). The patient was diagnosed with a subgingival cavity in element 16, underwent a trans-surgical procedure, the light-curing glass ionomer being the restorative material of choice. This work evidenced how the periodontal tissues can react in a positive way in the presence of biocompatible materials, resulting also in a favorable bone remodeling.(AU)

Lesiones cervicales no cariosas / Non-carious cervical lesions

El objetivo de este trabajo consiste en describir las distintas lesiones cervicales no cariosas, la abrasión, la erosión y la abfracción. Se desarrollarán en detalle su etiología, localización y características clínicas. Se mencionarán los diferentes procedimientos a realizar para su prevención y los materiales a utilizar para su restauración.

This article describes the different types of non-cariouscervical lesions, for example abrasion, erosionand abfraction. We will discuss their etiology, location and clinical features in detail. We will describe the procedures to prevent them, aswell as the materials used for their restoration.

Tooth fragment re-attachment in fracture with biological width violation: case

ABSTRACT: Dento-alveolar traumas are one of the most frequent injuries to teeth, mainly affecting the upper incisors due to their exposed position in the dental arch. In such cases, esthetics, function and phonetics of anterior teeth may be compromised. Furthermore, when there is involvement of the biological width, there is often a poor prognosis. This case report describes the multidisciplinary approach to tooth fragment re-attachment in a fracture with biological width violation. The patient presented with an oblique crown fracture in the maxillary right lateral incisor, extending from the buccal to palatal side, as well as a biological width invasion. The re-establishment of the biological width was obtained by periodontal surgery to achieve clinical-crown lengthening and tooth fragment re-attachment with a glass fiber post to increase retention. After 3 years of follow-up, the rehabilitated lateral incisor remains in good condition, with satisfactory esthetic and periodontal health.

Application of root angioplasty in crown lengthening surgery / 局解手术学杂志

Objective To analyze the application of root angioplasty in the crown lengthening surgery. Methods A total of 80 patients that corresponding to criteria from January 2013 to December 2015 in repair outpatients of our hospital were selected and received retrospec-tive study,and they were randomly divided into the observation group and the control group according to different surgical methods with 40 ca-ses in each group. The observation group was given root angioplasty and crown lengthening surgery,while the control group was only given crown lengthening surgery. Check-up was performed at 6 weeks postoperatively and 3 weeks after restoration,the condition of root surface cov-ered by the gum,the condition of gingival recession of the restoration and the subjective satisfaction of the patients were observed. Results The average coverage of the observation group was 91. 3%,which was significantly more than 55. 3% of the control group (P<0. 05). The a-mount of the gum covering of the observation group was (3.1 ±1.3)mm,which was significantly larger than (1.9 ±1.0)mm of the control group(P<0. 05). Conclusion Root angioplasty can guarantee blood supply,reduce the damage,but the indication range is small,and it is influenced by many factors,and needs to incorporate the ideas of all sides when used in clinic.

Aumento de coroa clínica – relato de casos clínicos / Crown lengthening – Case reports

As cirurgias pré-protéticas são realizadas como rotina na terapia periodontal com a finalidade principal de reconstituição do espaço biológico, que, caso seja invadido pode levar a alterações periodontais como recessão, edema e sangramento, condições que comprometem a qualidade dos trabalhos restauradores. A utilização de retalhos é quase imperativa pela necessidade de correções ósseas e a preservação ou aumento do tecido ceratinizado que contribui para a maior estabilidade da margem gengival. O objetivo deste relato foi descrever os aspectos clínicos de dois casos de aumento de coroa clínica para a reconstituição do espaço biológico.

Pre-prosthetic surgeries are made routinely in periodontal therapy with the main purpose of reconstituting the biological width, which, if invaded can lead to periodontal changes as recession, edema and bleeding, compromising the quality of restorative work. The use of flaps is almost imperative need for bone correction and to preserve or increase keratinized tissue which contributes to greater stability of the gingival margin. The aim of this report was to describe the clinical features of two crown lengthening - cases reports for reconstitution of the biological width.

Orthodontic extrusion of subgingivally fractured tooth using a removable appliance: An alternative treatment to reestablish biological width.

Restoration of a traumatically injured tooth presents a clinical challenge for a predictable aesthetic outcome. This case report describes a multidisciplinary approach of a subgingivally fractured permanent maxillary central incisor. A removable orthodontic appliance was used for orthodontic extrusion of root, and surgical gingival recontouring was done with electrocautery to reestablish the biological width. Form and function were restored establishing biological width and esthetics was repaired with porcelain fused to metal crown.

Evaluación clínica de los tejidos periodontales después del aumento de corona clínica / Clinical evaluation of periodontal tissue after crown lengthening surgery

INTRODUCCIÓN: La cirugía de aumento de corona clínica es un medio para facilitar los procedimientos de restauración con el objetivo de restablecer el ancho biológico periodontal. OBJETIVO: Registrar la evolución clínica de los tejidos periodontales de dientes sometidos a cirugía de aumento de corona clínica durante un período de cicatrización de 6 meses. Material y métodos: Se realizó un estudio observacional prospectivo, en el cual se evaluaron 25 pacientes; todos cumplieron con los criterios de inclusión y exclusión. Para evaluar la evolución de los dientes, se registró el índice gingival, índice de placa, índice PMA, recesión gingival, profundidad de sondaje y después de la cirugía, presencia de movilidad y lesión de área de furcación. Para medir la migración del margen gingival libre, se utilizó un dispositivo de acrílico. Se realizó el análisis estadístico de análisis de la varianza de un factor, margen de error del 5%, intervalo de confianza de 95%. RESULTADOS: El 84% de los pacientes fueron de género femenino, concentrándose el mayor porcentaje de pacientes entre los rangos de edad de 30 a 40 años (60%). Con respecto a los dientes intervenidos, el 76% fueron dientes posteriores, el diagnóstico más prevalente fue la categoría de diente con eliminación de caries subgingival (48%). A los 6 meses, existió ausencia total de inflamación gingival tanto en diente tratado como diente adyacente. Con respecto a la exposición coronal, medida a través de la distancia dispositivo-margen gingival libre, existió variación con la medición inicial de 4,26 mm en diente tratado y 3,90 mm en diente adyacente en relación con los 3 meses, 5,10 mm en diente tratado y 4,40 mm en diente adyacente, manteniéndose casi de forma similar a los 6 meses. CONCLUSIÓN: La evolución clínica de los tejidos periodontales posterior a la cirugía de aumento de corona clínica de nuestros pacientes demostró que a los 3 meses existe ausencia de inflamación gingival y en todos los casos se produjo retracción gingival de la encía comparada con los datos iniciales, consideración que debe tenerse presente en el momento de la rehabilitación final del diente

INTRODUCTION: Crown lengthening is a surgical procedure performed to re-establish the periodontal biological width of the tooth for its subsequent restoration. OBJECTIVE: To record the clinical outcomes of the periodontal tissues subjected to crown lengthening surgery, for a period of 6 months. Materials and methods: A prospective observational descriptive study was conducted on 25 patients who fulfilled the inclusion and exclusion criteria. The parameters evaluated were: gingival index, plaque index, Papillary-Marginal-Attachment (PMA) index, classification for gingival recessions probing depth and after surgery, classes of mobility and furcation classification. An acrylic device was used to measure the gingival margin migration. Statistical analysis was performed using one-way ANOVA, margin of error of 5%, and confidence level of 95%. RESULTS: Of the 25 patients, 84% were female, with the highest percentage of patients between the age ranges of 30 to 40 years (60%). As regards the teeth, 76% were back teeth, and the most prevalent diagnostic category was the removal of subgingival tooth decay (48%). At six months there was complete absence of gingival inflammation in the treated (TT) tooth, as well as in the adjacent (AD) tooth. With respect to the coronal exposure measured by the free gingival margin distance device, there was a difference between the initial measurement of 4.26 mm for the TT tooth and 3.90 mm for the AD tooth, and at three months, 5.10 mm for the TT tooth and 4.40 mm for the AD tooth, remaining almost the same at 6 months. CONCLUSION: The clinical outcome of periodontal tissues after crown lengthening surgery on our patients showed that there is absence of gingival inflammation after 3 months, and in all cases gingival gum recession, compared to the initial data. This should be taken into account when the final restoration of the tooth is considered

Platform switching: uma realidade na preservação da crista óssea ao redor de implantes: revisão de literatura / Platform switching: a reality on crestal bone preservation around dental implants: literature review

A Implantologia atual admite como padrão de normalidade a perda de tecido ósseo marginal ao nível da primeira rosca de implantes osseointegráveis (Brãnemark System®). Em áreas estéticas e/ou de pequena disponibilidade óssea, esse fenômeno traz prejuízos no posicionamento cervical do tecido mole, na conformação da papila interproximal e na diminuição da superfície do implante para osseointegração. O conceito de Platform Switching, utilização de plataformas expandidas e componentes protéticos de menor diâmetro que medialisam a junção implante-abutment, minimiza ou elimina essa perda óssea. O objetivo desse artigo é expor essa ferramenta para preservação da crista óssea ao redor de implantes osseointegráveis.

The current implant dentistry considers the loss of marginal bone tissue at the level of the first thread of osseointegrated implants ("ad modum" Branemark) as normal. In aesthetic areas and/or areas of small bone availability, such phenomenon impedes the cervical positioning of the soft tissue, the interproximal papilla contour, and reduces the surface of the implants for osseointegration. The concept of Platform Switching uses expanded platforms and narrower diameter prosthetic components that medialize the implant-abutment junction (IAJ). Thus, minimizing or eliminating bone loss. The purpose of this article is to expose this tool for preservation of the crestal bone of osseointegrated implants in a literature review.

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.