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)

Hiperplasia gingival fibrosa asociada a incisivo central superior retenido / Fibrous gingival hiperplasia associated with upper central incisor retained / Hiperplasia gengival fibrosa associada a incisivo central superior retido

RESUMEN Se describió el caso clínico de un adolescente de 12 años de edad, atendido en el Departamento de Ortodoncia de la Clínica Estomatológica Provincial "Mártires del Moncada" de Santiago de Cuba, al cual se le diagnosticó retención del incisivo central superior derecho hace más de dos años y para la cual recibió tratamiento con aparatología fija previo entorche del diente y seguimiento clínico-radiográfico. Durante el proceder ortodóncico, es remitido al Departamento de Periodoncia por presentar en la zona de dicho diente un aumento de volumen de color rosa coral, de consistencia dura y aspecto fibroso, que imposibilitó la incorporación definitiva del diente en su arco y plano de oclusión. Se realizaron los exámenes complementarios correspondientes, se diagnosticó hiperplasia gingival fibrosa localizada y se realizó tratamiento quirúrgico (gingivectomía), lo que permitió llevar a feliz término el tratamiento ortodóncico sin ninguna implicación psicológica y social para el paciente. La poca frecuencia de aparición de este tipo de lesión asociada a la retención de incisivos centrales superiores motivó el presente informe de caso.

ABSTRACT It was described a clinical case of a 12-year-old adolescent, treated at the Orthodontic Department of the Provincial Stomatological Clinic "Mártires del Moncada" in Santiago de Cuba, who was diagnosed with retention of the upper right central incisor more than two years ago and for which he received treatment with fixed appliances prior to tooth straightening and clinical-radiographic follow-up. During the orthodontic procedure, he was referred to the Department of Periodontics because he had a coral pink increase in volume in the area of that tooth, with a hard consistency and fibrous appearance, which made it impossible to definitively incorporate the tooth into its arch and occlusion plane. The corresponding complementary examinations were carried out, localized fibrous gingival hyperplasia was diagnosed and surgical treatment (gingivectomy) was performed, which allowed the successful completion of orthodontic treatment without any psychological or social implications for the patient. The rare occurrence of this type of injury associated with retention of upper central incisors motivated this case report.

RESUMO O caso clínico de um adolescente de 12 anos de idade, atendido no Departamento de Ortodontia da Clínica Estomatológica Provincial "Mártires del Moncada" de Santiago de Cuba, diagnosticado com retenção do incisivo central superior direito, foi descrito mais de dois anos e para os quais ele recebeu tratamento com aparelhos fixos antes do bloqueio dentário e monitoramento clínico-radiográfico. Durante o procedimento ortodôntico, é encaminhado ao Departamento de Periodontia por apresentar na área do referido dente um aumento no volume rosa coral, de consistência dura e aparência fibrosa, o que impossibilitou a incorporação definitiva do dente em seu arco e plano de oclusão. Foram realizados os exames complementares correspondentes, diagnosticada hiperplasia gengival fibrosa localizada e realizado tratamento cirúrgico (gengivectomia), o que permitiu o tratamento ortodôntico sem envolvimento psicológico e social do paciente. A baixa frequência de ocorrência desse tipo de lesão associada à retenção dos incisivos centrais superiores motivou este relato de caso.

Corrección quirúrgica en una adolescente con hiperplasia gingival hereditaria / Surgical correction in an adolescent with hereditary gingival hyperplasia

Se describe el caso clínico de una adolescente que fue atendida en la consulta de Periodoncia del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, por presentar agrandamiento de las encías desde hacía más de un año, lo que le dificultaba la masticación de los alimentos y, por tanto, le producía trastornos digestivos transitorios, además de afectar su estética. Luego de realizados los exámenes físico y complementarios, se estableció el diagnóstico presuntivo de hiperplasia gingival hereditaria o familiar y se indicó el tratamiento, que incluyó 3 fases: la inicial, la correctiva quirúrgica y la de soporte periodontal. En la fase quirúrgica se tomó una muestra hística cuyo análisis anatomopatológico confirmó el diagnóstico presuntivo inicial

The case report of an adolescent that was assisted in the Periodontics Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba is described. He presented enlargement of the gums for more than a year, which made mastication of foods difficult and therefore, transitory digestive dysfunctions took place, besides affecting her aesthetics. After the physical and complementary tests, the presumptive diagnosis of hereditary or family gingival hyperplasia was established and the treatment was indicated into 3 phases: initial phase, surgical corrective phase and that of periodontal support. In the surgical phase a tissue sample was taken which pathologic analysis confirmed the initial presumptive diagnosis

Gingivoplastia y frenillectomía labial con láser de alta intensidad: presentación de caso / Gingivoplasty and labial frenectomy with high intensity laser: presentation of a case

En los últimos años la estética se ha convertido en motivo de consulta odontológica frecuente. Los pacientes creen que la estética de la sonrisa depende de los dientes; sin embargo, al realizar la evaluación clínica, el profesional puede detectar inconformidad estética del paciente condicionada por factores del medio bucal como los tejidos blandos del periodonto de protección, específicamente la encía aumentada o la inserción muy baja de la mucosa de los frenillos labiales, lo que puede ocasionar que los pacientes manifiesten ver sus dientes de tamaño reducido; además al sonreír pueden exponer gran cantidad de encía. A continuación se expone el caso de una paciente mujer que acude a consulta por inconformidad estética en la sonrisa y tamaño dental; tras la valoración intraoral se diagnostica gingivitis localizada asociada a placa bacteriana y presencia de frenillo papilar alargado, provocando apariencia de dientes cortos o pequeños. Se decide realizar procedimiento quirúrgico mínimamente invasivo para reposicionar los tejidos blandos y mejorar la armonía, respetando espacios biológicos, utilizando terapia con láser de alta intensidad considerando las ventajas de su uso como tiempo de intervención menor, no requerir anestesia local, menor sangrado, tiempo de cicatrización más corto y haciendo innecesario el uso de suturas al compararle con la cirugía convencional con bisturí. Al finalizar el procedimiento la paciente manifiesta satisfacción y ausencia de dolor. Tras control posquirúrgico a los 15 días se aprecia ausencia de edema en el tejido gingival, reposicionamiento de la inserción del frenillo labial superior y borde libre de encía marginal en los órganos dentarios anterosuperiores reposicionados en sentido apical.

In recent years, aesthetics has become a common reason for a dental visit. Patients believe that the aesthetics of the smile depends on the teeth. However, when the clinical evaluation is carried out, the professional can also detect aesthetic dissatisfaction of a patient, conditioned by factors of the oral environment, such as periodontium soft tissue, in particular the increased gingiva or low insertion of the mucosa of the labial frenulum. These may cause patients to believe that their teeth are reduced in size, due to much more gum being exposed when they smile. The clinical case is presented of a female patient who made a dental appointment because of aesthetic dissatisfaction with her smile and dental size. After the intraoral assessment was carried out, a diagnosis was made of a localized gingivitis associated with plaque and presence of an elongated papillary frenum, giving the appearance of short or small teeth. It was decided to perform a minimally invasive surgical procedure to generate the reposition of soft tissues and improve harmony, respecting biological spaces. High-power laser therapy was performed, due to the advantages of its use, such as reduced intervention time, no requirement of local anesthesia, less bleeding, shorter healing time, and unnecessary use of sutures, compared with conventional surgery carried out with scalpel. Immediately after the procedure, the patient felt satisfaction and no pain. On day 15 post-surgery it was observed that there was no swelling of gingival tissue, reposition of the insertion of the upper frenum, and free edge of marginal gingiva in anterior-superior teeth in an apical direction.

Management of Phenytoin-Induced Gingival Enlargement: A Case Report.

Gingival enlargement is frequently observed in patients taking certain drugs such as anticonvulsants, immune suppressants, and calcium channel blockers. The effects of these drugs are not only directed at the primary target tissues, but also on secondary target tissues, such as gingival connective tissue, causing clinical, and histopathological aberrations. These aberrations can adversely affect speech, mastication, tooth eruption, and esthetics. Disfiguring gingival overgrowth triggered by these medications often impairs the nutrition and provides access to oral infection, caries, and periodontal disease. The present case report describes the treatment of a patient with a phenytoin induced gingival enlargement.

Hiperplasia gingival fibrosa en sitio estético: enfoque quirúrgico ante recidiva / Fibrous gingival hyperplasia in esthetic zone: surgical approach on recurrence

Objetivo: aportar evidencia clínica sobre el abordaje de lesiones hiperplásicas en sitios estéticos y enfatizar la importancia de la planificación quirúrgica para reducir al mínimo su recidiva. Caso clínico: una paciente de 65 años de edad se presentó a la consulta con lesión nodular localizada en encía vestibular de pieza 21, con un período de evolución de 18 meses. Se describe el procedimiento quirúrgico inicial llevado a cabo para su tratamiento, el diagnóstico anatomopatológico, su evolución y recidiva, y un nuevo enfoque quirúrgico para su eliminación. Conclusiones: este informe enfatiza la importancia de una completa escisión de la lesión con margen de seguridad para evitar su recidiva, como objetivo primario en el abordaje quirúrgico. En sitios estéticos, la biopsia escisional, junto con la cirugía plástica periodontal, puede ser una opción para restaurar la salud gingival y devolver la estética y función al sitio

Extensive gingival enlargement in siblings. A case report

Gingival fibromatosis is characterised by varying degrees of fibrotic gingival overgrowth that can be caused by a variety of aetiological factors. Hereditary gingival fibromatosis [HGF] is a rare genetic disorder, characterised by a slowly progressive, benign enlargement of keratinised gingiva. The condition may be found in an autosomal dominant or autosomal recessive mode of inheritance, the former being more common. It usually develops as an isolated disorder but can be one feature of a multisystem syndrome. Accordingly, HGF has been divided into two forms: non-syndromic and syndromic. The gingival enlargement can be localised or generalised, but usually involves both arches. The authors describe a case of non-syndromic generalised severe HGF, involving the maxillary and mandibular arches in two brothers. This report focuses on the diagnosis, treatment, and control of the disease. The pattern of inheritance and histopathologic characteristics are also emphasised

Hereditary gingival fibromatosis diagnosis and treatment

Hereditary Gingival Fibromatosis [HGF] also referred to as idiopathic gingival hyperplasia is a rare type of slow growing gingival enlargement with great clinical and genetic heterogeneity inherited usually as Mendelian autosomal dominant fashion. Occurring as an isolated trait [HGF] and/or as a component of a syndrome, the affected gingival is characterized by firms, asymptomatic, non-hemorrhagic enlarged [hyperplastic] tissue with characteristic pale pink colour, covering most of the anatomic crown, involving usually all the quadrants. There is no definitive treatment present but post pubertal surgical intervention and good oral hygiene maintenance can improve the compromised esthetics and function of the patient. This paper presents a case report of a 15 year old male suffering from hereditary gingival fibromatosis with a positive family history. Periodontal management including gingivectomy [external bevel] was being undertaken after biopsy

Gengivectomia para o restabelecimento do arco côncavo regular: relato de caso / Gingivectomy for restoring the regular concave arch: Case report

O objetivo deste trabalho é descrever um tratamento cirúrgico periodontal na região de incisivos superiores, com a finalidade de restabelecer a estética periodontal após tratamento ortodôntico. A gengivectomia associada à plastia gengival viabilizou a estética periodontal do caso clínico apresentado, solucionando a desproporção periodontal.

The aim of this paper is to describe the surgical periodontal treatment in the maxillary incisors area for restoring periodontal esthetics after orthodontic treatment. Gengivectomy associated to gingivoplasty allowed the periodontal esthetic rehabilitation in the clinical case reported, solving the periodontal disproportion.

Hiperplasia gingival idiopática: diagnóstico y tratamiento de un caso clínico y revisión de la literatura (AU) / Idiopathic gingival hyperplasia: diagnosis and treatment of a clinical case and review of the literature

El término hiperplasia se refiere al aumento de tamaño de los tejidos en un órgano, producido por el aumento del número de sus componentes celulares. En este trabajo se presenta un caso clínico de Hiperplasia Gingival Idiopática en un paciente del sexo femenino, de 13 años de edad. El tratamiento consistió en la motivación, enseñanza de higiene bucal y terapia quirúrgica para la eliminación del tejido gingival excesivo. El estudio histopatológico confirmó el diagnóstico presuntivo. Basado en lo expuesto se analizan los diversosagrandamientos gingivales habiendo realizado una revisión del tema, según diversos autores.

Alport syndrome: significance of gingival biopsy in the initial diagnosis and periodontal evaluation after renal transplantation

Alport Syndrome (AS) is an important hereditary disorder affecting the glomerular basement membrane. Diagnosis of AS is based on the presence of hematuric nephropathy, renal failure, hearing loss, ocular abnormalities and changes in the glomerular basement membrane of the lamina densa. The aims of this case report were to show the changes in the gingival tissues in a patient with AS under therapy with cyclosporin-A after renal transplantation and to discuss the possible role of type IV collagen in gingival basal lamina as an alternative approach for the diagnosis of AS. A 20-year-old male patient with AS underwent periodontal therapy including a series of gingivectomy surgeries. Gingival samples obtained during the second surgery were examined histopathologically and by transmission electron microscopy for further pathological examination. Gingivectomy procedures have been performed every 6 months over the last 4 years. The excessive and fibrous gingival enlargements resulted in migration of the anterior teeth, but no alveolar bone loss occurred. This is the first report to demonstrate the possible changes in the gingival tissues caused by AS. It is suggested that gingival biopsy can be an initial diagnostic tool instead of renal or skin biopsies. Proper dental and periodontal care and regular visits to the dentist could provide limited gingival hyperplasia to patients with AS.

Tratamiento de la hiperplasia gingival en una escuela odontológica de Brasil: conceptos generales, diagnóstico y tratamiento / Treatment of gingival hyperplasia in a dental school of Brazil: general concept, diagnosis and treatment

La hiperplasia gingival es una condición patológica benigna en la que aumenta de volumen de tejido gingival de forma lenta y gradual, causando importantes molestias estéticas y funcionales en los pacientes. Se clasifica como idiopática, inflamatoria, hereditaria y asociada a drogas, según su etiología, donde cada una tiene sus peculiaridades que deben ser bien comprendidas por el cirujano-dentista, a fin de lograr el tratamiento adecuado para cada caso. Este artículo revisa la literatura reciente sobre la hiperplasia gingival, abordando su etiología y tratamiento, presentando un caso clínico de fibromatosis gingival hereditaria y su tratamiento quirúrgico.

The gingival hyperplasia is a condition in which increase in volume in benign, slow and gradual development of the gingival tissue, causing significant discomfort and aesthetic function in patients. It is classified as idiopathic, inflammatory, and hereditary drug, according to its etiology, and that each variant has its peculiarities that must be well understood by the Clinical-Dentist, in order to achieve the appropriate treatment for each case. This paper reviews the recent literature on gingival hyperplasia, addressing its etiology and treatment given, and clinical case report of hereditary gingival fibromatosis in the surgical therapy was performed successfully.

Hiperplasia gengival no paciente ortodôntico: conduta clínica / Gingival hyperplasia in the orthodontic patient: clinic conducts

Este relato de caso apresenta as condutas clínicas realizadas em paciente ortodôntico com hiperplasia gengival, história de respiração bucal e higiene bucal deficiente. O tratamento ortodôntico foi interrompido provisoriamente e foram realizados a remoção cirúrgica do excesso de tecido gengival e a aplicação tópica de clorexidina gel 1%. A integração entre Ortodontia e Periodontia mostrou eficácia com respeito à promoção de saúde e maior compatibilidade para aplicação de forças e resposta dos tecidos de suporte dentário.

Hiperplasia gengival anatômica: relato de caso clínico / Anatomic gingival hyperplasia: a case report

A hiperplasia gengival anatômica é uma condição oral benigna que envolve desde aumento gengival ao redor da coroa dentária até deformação do palato. O presente caso clínico refere-se ao paciente A.P.D., 39 anos de idade, gênero masculino. Durante a anamnese, foi relatado que a lesão estaria presente por aproximadamente um ano, de forma assintomática, com crescimento lento e gradual. Ao exame clínico foi detectada significativa massa nodular na região posterior do palato duro, bilateral, mais proemnente no lado esquerdo. Foi realizada biópsia incisional, seguida de exame histopatológico, confirmando-se o diagnóstico clínico de hiperplasia gengival anatômica

Estudio comparativo entre el uso del electrobisturí y del bisturí convencional en la eliminación de la hiperplasia gingival por dilantin / A comparative study on the use of the electroscalpel and conventional scalpel in the elimination of gum hyperplasia due to dilantin

La eliminación quirúrgica del tejido gingival hiperplásico se ha realizado durante mucho tiempo con la técnica convencional de bisel externo provocado un exceso de sangrado y retardo en la cicatrización. Algunos autores recomiendan el uso del electrobisturí como una mejor opción y mencionan no tener problemas en la cicatrización ni complicaciones durante el tratamiento. Se realiza un estudio comparativo con las dos técnicas mencionadas a fin de establecer la diferencia

Utilização da alta rotação como instrumento de corte para tecidos moles / Use of high speed as a cutting instrument for soft tissues

O autor tem utilizado a alta rotação como instrumento de corte - bisturi rotatório para tecidos moles, mais especificamente para ulotomias com resultados satisfatórios, considerando vários aspectos como facilidade de conformar a incisão; maior domínio de corte; menos risco que o bisturi elétrico; campo exangüe; cicatrização mais rápida, pela ausência de calor; diminuição da dor durante os procedimentos; possibilidade de executar a osteotomia concomitante, etc. Durante 11 anos o autor tem utilizado este instrumento como bisturi rotatório, tendo obtido larga experiência e domínio técnico