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.

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.

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

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

Phenytoin-Induced Gingival Overgrowth Management with Periodontal Treatment

Phenytoin-induced gingival overgrowth (PIGO) is a common complication of the continuous use of medications. This paper presents a case of PIGO hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. A 39-year-old male patient was referred for dental treatment with several complaints, especially upper and lower gingival overgrowth that hindered speech and swallowing. Generalized deep probing pockets and bone loss were detected. Diagnosis of gingival overgrowth associated with phenytoin and chronic periodontitis was established. The treatment plan consisted of conservative therapy with education on oral health, motivation and meticulous oral hygiene instruction in combination with scaling and root planing. During the revaluation period, a marked reduction in the clinical parameters was noted, particularly probing pocket depth reduction. Surgical therapy for removal of gingival overgrowth was also performed to achieve pocket reduction. Supportive periodontal therapy was proposed and the patient is currently under follow-up for 4 years. Management of PIGO may be obtained by the use of periodontal procedures combined with good oral hygiene and periodontal supportive care.

O crescimento gengival induzido pela fenitoína é uma complicação comum do uso contínuo da medicacão. Este artigo apresenta um caso de crescimento gengival excessivo que dificultava a função oral e comprometia a higiene oral e a estética, o qual foi tratado com uma combinação de terapias periodontais não-cirúrgicas e cirúrgicas. Paciente masculino de 39 anos de idade foi encaminhado para tratamento odontológico com várias queixas, especialmente do crescimento gengival superior e inferior que prejudicava a fala e deglutição. Profundidades de sondagens severas generalizadas e perda óssea foram detectadas. Diagnóstico de crescimento gengival induzido pela fenitoína e periodontite crônica foi estabelecido. O plano de tratamento consistiu de terapia conservadora com educação, motivação e meticulosa instrução de higiene oral em associação com raspagem e alisamento corono-radicular. Durante o período de reavaliação, uma acentuada redução nos parâmentros clínicos foi observada, principalmente uma redução das profundidades de sondagem. Terapia cirúrgica para remoção do excesso de tecido gengival também foi realizada para conseguir redução das bolsas. Terapia periodontal de suporte foi proposta e o paciente está atualmente sob acompanhamento por um período de 4 anos. O manejo do crescimento gengival induzido pela fenitoína pode ser obtido pelo uso de procedimentos periodontais combinados com uma boa higiene oral e cuidados periodontais de suporte.

Gingival overgrowth and drug association: A review.

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

Correção da estética gengival e dentária: interação entre Periodontia e Prótese / Correction of the dental and gingival aesthetic: Periodontology and Prosthodontics interaction

A estética do sorriso representa motivo de grande interesse durante o planejamento reabilitador. Nas situações clínicas de sorriso gengival, onde as coroas clínicas dos dentes anteriores apresentam-se encurtadas, torna-se imprescindível a correção do contorno gengival previamente à reabilitação. Portanto, um tratamento integrado, onde uma cirurgia plástica periodontal seja realizada em uma primeira etapa clínica, pode ser indicado quando da abordagem reabilitadora do paciente com sorriso gengival. Este artigo descreve a transformação estética de um sorriso gengival, com presença de diastemas e alterações de coloração dentária, por meio da associação interdisciplinar entre as especialidades de Periodontia e Prótese Dental.