Protocolo Abreviado Guiado Digital: Técnicas de Marcadores Tisulares, Silicona de Registro y CBCT con Sonrisa / Digitally Guided Abbreviated Protocol: Tissue Marker Techniques, Recording Silicone and CBCT with Smile

Establecer un protocolo de cirugía guiada estática con técnicas referenciales para ser realizado de manera predecible, repetible y simple, en todos los tipos de casos. El protocolo abreviado guiado digital para cirugía guiada estática para implantes se centra en diseñar computacionalmente una guía quirúrgica que se apoye en el tejido remanente del paciente, siendo un protocolo digital versátil para la cirugía y rehabilitación implanto protésica, basada en registros clínicos, principalmente la línea de la sonrisa y la captación de ésta en tomografía de haz cónico (CBCT), además de establecer dimensión vertical oclusal (DVO). Logrando así, planificación de implantes hasta la inserción inmediata de la prótesis temporal. Se ejemplifica el trabajo con 2 casos clínicos. Se establece un protocolo con la intención de que pueda ser realizado en pacientes desdentados parciales (Técnica de Registro Silicona) o totales (Técnica de Marcadores Tisulares en prótesis), definiendo un flujo de trabajo tridimensional, digital y optimizado, con un consecuente ahorro de tiempo clínico. Como principio del protocolo de cirugía guiada es lograr el objetivo quirúrgico - protésico deseado con alta precisión. La cirugía y rehabilitación de implantes de manera convencional es altamente dependiente del operador por lo que la alternativa de cirugía guiada de manera estática es una herramienta más para mejorar el pronóstico del paciente. Se establece un protocolo digital simple y efectivo, de cirugía guiada, para la rehabilitación implanto protésica basada en la línea de la sonrisa, tomografía de haz cónico (CBCT), dimensión vertical oclusal (DVO). Protocolo predecible y que optimiza los tiempos clínicos, logrando una rehabilitación protésica inmediata acorde e individualizada para cada paciente.

Establish a static guided surgery protocol with referential techniques to be performed in a predictable, repeatable and simple way, in all types of cases. The abbreviated digital guided protocol for static guided surgery for implants focuses on computationally designing a surgical guide that rests on the patient's remaining tissue, being a versatile digital protocol for prosthetic implant surgery and rehabilitation, based on clinical records, mainly the line of the smile and its uptake in cone beam tomography (CBCT), in addition to establishing occlusal vertical dimension (OVD). Thus achieving implant planning until the immediate insertion of the temporary prosthesis. The work is exemplified with 2 clinical cases. A protocol is established with the intention that it can be carried out in partially edentulous patients (Silicone Registration Technique) or total (Tissue Marker Technique in prostheses), defining a three-dimensional, digital and optimized workflow, with a consequent saving of time. clinical. As a principle of the guided surgery protocol, it is to achieve the desired surgical-prosthetic objective with high precision. Conventional implant surgery and rehabilitation is highly dependent on the operator, so the alternative of statically guided surgery is one more tool to improve the patient's prognosis. A simple and effective digital protocol for guided surgery is established for prosthetic implant rehabilitation based on the smile line, cone beam tomography (CBCT), and occlusal vertical dimension (OVD). Predictable protocol that optimizes clinical times, achieving an immediate and individualized prosthetic rehabilitation for each patient.

Effectiveness of lip repositioning in the treatment of excessive gingival display: systematic review and meta-analysis / Eficacia del reposicionamiento de labios en el tratamiento de la exposición gingival excesiva: revisión sistemática y metanálisis

Background: The objective of this systematic review and meta-analysis was to answer the questions ''Does lip repositioning surgery reduce the amount of gingiva exposed in the smile in individuals with excessive gingival display EGD (excessive gingival display)?'' and ''Is the reduction of the amount of gingiva exposed when smiling obtained with lip repositioning surgery stable over time?'' to evaluate the effectiveness of lip repositioning surgery for correcting EGD on smiling. Materials and Methods: A systematic structured search was carried out in five databases without data restriction. Studies reporting the degree of reduction in gingival ex-posure after lip repositioning surgery were included. Study selection, data extraction, and risk of bias assessment were performed in duplicate Results: One hundred sixty-four references were retrieved and eleven studies met the eligibility criteria. Meta-analysis demonstrated that lip repositioning surgery results in a significant reduction in the amount of exposed gingival tissue (mean difference = -3.03; confidence interval = -3.55; -2.52). In addition, the results remained stable in the evaluated follow-up periods (1, 3, 6 and 12 months). Included studies had a low risk of bias. Conclusions: Lip repositioning surgery is effective for the treatment of EGD on smiling and exhibits stable results in the evaluated periods. The study was registered (CRD42020184866) in the international prospective register of systematic reviews (PROSPERO)

Antecedentes: el objetivo de esta revisión sistemática y metanálisis fue responder a las preguntas "¿La cirugía de reposicionamiento de labios reduce la cantidad de encía expuesta en la sonrisa en personas con exposición gingival excesiva (EGE)?" y "¿La reducción de la cantidad de encía expuesto al sonreír obtenido con cirugía de reposicionamiento de labios estable en el tiempo?" para evaluar la efectividad de la cirugía de reposicionamiento de labios para corregir la EGE al sonreír. Materiales y Métodos: Se realizó una búsqueda sistemática estructurada en cinco bases de datos sin restricción de datos. Se incluyeron los estudios que informaron el grado de reducción de la exposición gingival después de la cirugía de reposición de labios. La selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo se realizaron por duplicado. Resultados: Se recuperaron ciento sesenta y cuatro referencias y once estudios cumplieron con los criterios de elegibilidad. El metanálisis demostró que la cirugía de reposicionamiento de labios da como resultado una reducción significativa en la cantidad de tejido gingival expuesto (diferencia de medias = -3,03; intervalo de confianza = -3,55; -2,52). Además, los resultados se mantuvieron estables en los periodos de seguimiento evaluados (1, 3, 6 y 12 meses). Los estudios incluidos tenían un bajo riesgo de sesgo. Conclusión: La cirugía de reposicionamiento de labios es efectiva para el tratamiento de la EGE al sonreír y presenta resultados estables en los períodos evaluados. El estudio fue registrado (CRD42020184866) en el registro prospectivo internacional de revisiones sistemáticas (PROSPERO).

Tratamiento estético de la sonrisa gingival / Aesthetic treatment of the gummy smile

La exposición gingival excesiva es una condición conocida como sonrisa gingival. Esta alteración genera en muchos casos insatisfacción y solicitud de tratamiento por parte de los pacientes. Este exceso de exposición gingival podría obedecer a diferentes etiologías como un exceso maxilar en sentido vertical, un labio superior corto e hipermóvil, la erupción pasiva alterada, la extrusión dentoalveolar en el sector anterior o la combinación de estas causas. El enfoque de tratamiento va a depender del diagnóstico, de la complejidad del caso y de las expectativas de cada paciente. Por lo tanto, las rutas terapéuticas principales son el alargamiento de corona clínica, el reposicionamiento labial, la cirugía ortognática o la aplicación de toxina botulínica. Para ello, se debe considerar las ventajas y limitaciones de cada tratamiento estético, para garantizar predictibilidad y éxito.

Excessive gingival exposure is a condition known as a gummy smile. This generates in many cases dissatisfaction and request for treatment by patients. This excess of gingival exposure could be due to different etiologies such as vertical maxillary excess, a short and mobile upper lip, altered passive eruption, dentoalveolar extrusion in the anterior sector or a combination of these causes. The treatment approach will depend on the diagnosis, the complexity of the case and the expectations of each patient. Therefore, the main therapeutic routes are clinical crown lengthening, lip repositioning, orthognathic surgery, or the application of botulinum toxin. For this, the advantages and limitations of each aesthetic treatment must be considered, to guarantee predictability and success.

Smile esthetic: comparison of perception amongst orthodontists, dental students, orthodontic patients and surgical orthodontic patients

Most patients require orthodontic treatment to improve the esthetics of their smile. Orthodontists must consider how some parameters of mini-esthetics can influence the patient's esthetic perception. Methods: A photograph of the smile of a young female was taken and some modifications were made to the buccal corridor, gingival exposure, smile arc and midline position to assess the influence of these variables on smile attractiveness. Two hundred examiners were selected from four groups: orthodontists (O), dental students (DS), orthodontic patients (OP) and surgical-orthodontic patients (SOP). Each examiner was asked to complete the questionnaire with an approval rating from 1 to 10. Significant level was set at P ≤ 0.05. Results: Only orthodontists considered buccal corridors of 4mm and midline deviation of 1mm as non-esthetic; all other examiners considered gingival exposures ≥3 mm and midline angulation as non-esthetic. All examiners assigned higher satisfaction values to the photo with the concordant smile arc and defined as non-esthetic the covered smile and the reverse smile arc. Patients perceived as non-esthetic only midline deviations of 4mm. The surgical orthodontic patients assigned lower values to the photos and showed greater attention to evaluating the esthetics of the smile than the orthodontic patients. Conclusion: Smile arc, gingival exposure and midline angulation influence smile esthetics; the role of buccal corridors and midline deviation is dependent on the type of examiner

Prevalence and factors associated with gummy smile in adolescents: a cross-sectional analysis

Aim: To evaluate the prevalence and factors associated with gummy smiles in adolescents aged between 15 and 18 years attending high school. Methods: The cross-sectional and quantitative study was carried out during the Covid-19 pandemic, with 160 adolescents, from two public (A1) and two private (A2) schools chosen by lottery, divided into two groups: G1 (with gummy smile) and G2 (no gummy smile). A clinical examination was carried out on the adolescents, investigating the presence or absence of a gummy smile (GS), by analyzing the variables (interlabial distance at rest, upper incisor exposure at rest, smile arc, measurement from the subnasal to the upper lip philtrum, upper lip length, upper lip thickness, hypermobility and lower/middle third ratio). Means and dispersion were obtained, and the Chi-square association test was applied, to compare the results between A1 and A2 and between G1 and G2. Results: The prevalence of GS was 33.8% (=54). It was found that no statistically significant associations were found (p > 0.05), regarding the type of school and gender with the presence of GS in adolescents. There was no statistically significant difference (χ² = 1.82; p = 0.07) between the groups and the age of adolescents. There was a significant association between the studied variables and GS (p < 0.05). Conclusion: The prevalence was high with a predominance of females. There were no statistically significant associations regarding the type of school and gender, but there was a significant association between gummy smile and lip dimensions

Analysis of smile photos posted on social networks as an alternative for human identification / Análise de fotos do sorriso postadas em redes sociais como alternativa para a identificação humana

ABSTRACT Photos of smiles posted on social media contain information on individuals' anatomical and oral morphological characteristics, which can be important for ante and post-mortem human identification, during confrontation for forensic purposes. Objective: The study aimed to evaluate the feasibility of using smile photographs on social networks as a source of information for human forensic identification. Methods: The study sample consisted of forty individuals, randomly divided into four equal groups, two groups in Instagram (IG®) and two groups in Facebook (FB®). Standardized oral photographs of the anterior teeth of the participants, from three different angles (post-mortem photos) were taken using a Nikon® EOS 550D camera. Photos of smiles posted in FB and IG by the participants were also collected (ante-mortem photos). The analysis were carried out by 4 forensic experts, 18 dental professors, and 21 dental students. They compared simulated ante and post-mortem photos, to identify the alleged victims. Results: The correct identification score ranged from 28.6% (students) to 100% (forensic experts). The most frequently reported dental characteristics used for the identification were morphology of the anterior teeth, zenith, and gingival recessions. There was no statistically significant association between the rate of correct identification and the degree of difficulty reported during the analysis (p= 0,068), whereas there was also no association between this index and or the duration of the analysis (p=0,884). Conclusions: Therefore, the photographs of the smile posted on social media proved to be a database of dental information, and with potential to assist in identification with dental forensic purposes.

RESUMO Fotos de sorrisos postadas nas redes sociais contêm informações sobre as características anatômicas e morfológicas orais dos indivíduos, que podem ser importantes para a identificação humana ante e post-mortem, durante o confronto para fins forenses. Objetivo: O estudo teve como objetivo avaliar a viabilidade do uso de fotografias de sorrisos em redes sociais como fonte de informação para identificação forense humana. Métodos: A amostra do estudo foi composta por quarenta indivíduos, divididos aleatoriamente em quatro grupos iguais, dois grupos no Instagram (IG®) e dois grupos no Facebook (FB®). Fotografias orais padronizadas dos dentes anteriores dos participantes, de três ângulos diferentes (fotos post-mortem), foram tiradas com uma câmera Nikon® EOS 550D. Também foram coletadas fotos de sorrisos postados no FB e IG pelos participantes (fotos ante-mortem). As análises foram realizadas por 4 peritos forenses, 18 professores de odontologia e 21 alunos de odontologia. Eles compararam fotos simuladas ante e post-mortem, para identificar as supostas vítimas. Resultados: A pontuação correta de identificação variou de 28,6% (alunos) a 100% (especialistas forenses). As características dentais mais frequentemente relatadas e utilizadas para a identificação foram morfologia dos dentes anteriores, zênite e recessões gengivais. Não houve associação estatisticamente significativa entre a taxa de identificação correta e o grau de dificuldade relatado durante a análise (p = 0,068), assim como não houve associação entre esse índice e/ou a duração da análise (p = 0,884). Conclusão: Portanto, as fotografias do sorriso postadas nas redes sociais mostraram-se um banco de dados de informações odontológicas, e com potencial para auxiliar na identificação para fins odontológicos forenses.

Os (des) caminhos da saúde bucal coletiva: perspectivas atuais / The (mis)paths of collective oral health: current perspectives / Los (des)caminos de la salud bucal colectiva: perspectivas actuales

Objetivo: Analisar as perspectivas atuais acerca (des) caminhos da saúde bucal coletiva no Brasil. Método:Trata-se de um estudo bibliográfico de abordagem quantitativa. A pesquisa abrange a busca de artigos publicados nos últimos dez anos, na Scientific Electronic Library Online ­Scielo. Resultados:Ao realizar a triagem desses artigos, utilizando os critérios de inclusão, têm-se para o estudo um total de dez artigos, sendo (30%) em 2015, (40%) em (2016, 2019) e 30% em (2017, 2021, 2023). Conclusão:a PNSB vem apresentando grandes avanços conforme sua sériehistórica e o programa Brasil Sorridente tem como compromisso qualificar a atenção básica, garantindo universalidade, equidade, integralidade da assistência e resolutividade, conforme os princípios doutrinários do SUS.

Objective: To analyze the current perspectives on the (mis)paths of collective oral health in Brazil. Method:This is a bibliographic study with a quantitative approach. The search includes the search for articles published in the last ten years in the Scientific Electronic Library Online ­Scielo. Results:When screening these articles, using the inclusion criteria, a total of ten articles were included in the study, (30%) in 2015, (40%) in (2016, 2019) and 30% in (2017, 2021, 2023). Conclusion:the PNSB has been showing great advances according to its historical series and the Smiling Brazil program is committed to qualifying primary care, ensuring universality, equity, comprehensiveness of care and problem-solving, according to the doctrinal principles of the SUS.

Objetivo: Analizar las perspectivas actuales sobre los (des)caminos de la salud bucal colectiva en Brasil.Método: Se trata de un estudio bibliográfico con enfoque cuantitativo. La búsqueda incluye la búsqueda de artículos publicados en los últimos diez años en la Scientific Electronic Library Online ­Scielo. Resultados:Al cribar estos artículos, utilizando los criterios de inclusión, se incluyeron en el estudio un total de diez artículos, (30%) en 2015, (40%) en (2016, 2019) y 30% en (2017, 2021, 2023).Conclusión: el PNSB viene mostrando grandes avances de acuerdo con su serie histórica y el programa Brasil Sonriente está comprometido con la calificación de la atención básica, garantizando la universalidad, la equidad, la integralidad de la atención y la resolución de problemas, de acuerdo con los principios doctrinarios del SUS.

Restabelecimento estético de incisivos laterais conóides e amplas restaurações em resina composta com laminados cerâmicos: relato de caso / Aesthetic recovering of conoid side incisives and wide restoration in composed resin with ceramic laminates: case report

Introdução: As cerâmicas odontológicas são amplamente utilizadas na Odontologia, desfrutando de grande popularidade devido a sua capacidade de mimetizar as características ópticas do esmalte e da dentina. O constante desenvolvimento de pesquisas tem desencadeado o lançamento de novos sistemas cerâmicos com propriedades aprimoradas e melhores resultados clínicos em longo prazo. Objetivo: O relato de caso aqui apresentado descreve uma reabilitação da zona estética do sorriso com laminados cerâmicos por meio de uma abordagem minimamente invasiva. Relato de caso: Paciente do gênero feminino, compareceu à clínica odontológica relatando insatisfação com a aparência do seu sorriso. Durante avaliação foram observadas, na região anterossuperior, restaurações extensas em resina composta deficientes nos incisivos, com proporção, volume, forma e texturização insatisfatórias, que em conjunto comprometia a zona estética do sorriso. Diante disso, após fotografias extra e intraorais, o tratamento proposto foi a reabilitação com laminados cerâmicos nas unidades 1.2 ao 2.2. Assim, foi realizado o enceramento e o mock-up, os quais serviram de orientação para os preparos dentários, a seguir, foram moldados e as restaurações confeccionadas no sistema IPS e.max. Após prova de cor e adaptação, os preparos e a superfície interna dos laminados cerâmicos foram tratados e cimentados com cimento resino fotopolimerizável. Conclusão: Instituindo uma abordagem conservadora, o plano de tratamento realizado através da reabilitação com laminados cerâmicos nas unidades dentárias anterossuperiores, permitiu o restabelecimento da função e estética, com reprodução das características dos dentes naturais e promoção do equilíbrio, da jovialidade e da harmonia no sorriso(AU)

Introduction: Dental ceramics are widely used in dentistry, enjoying great popularity due to the ability to mimic both enamel and dentin optical characteristics. The constant research development has triggered the launch of new ceramic systems with improved properties and better long-term clinical results. Objective: The case report presented here describes the zone rehabilitation of the aesthetic smile with ceramic laminates through a minimally invasive approach. Case report: Female patient, attended the dental clinic reporting dissatisfaction with the appearance of her smile. During the evaluation, extensive restorations in composite resin were observed in the incisors in the anterosuperior region, with unsatisfactory proportion, amount, shape and texturing, which together compromised the aesthetic zone of the smile. Faced with this, after extra and intraoral photographs, the proposed treatment was the restoration with the ceramic laminates in units 1.2 to 2.2. Thus, waxing and mock-up were performed, which served as guidance for the dental preparations, then they were molded and restorations fabricated in the IPS e.max system. After shade and adaptation proof, the preparations and the inner ceramic laminates surface were treated and cemented with light-cured resin cement. Conclusion: Adopting a conservative approach, the treatment plan carried out through restoration with ceramic laminates on the upper anterior teeth allowed the recovering function and aesthetics, reproducing characteristics of natural teeth and promoting balance, joviality and harmony in the smile(AU)

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.

The Perspective of Dental Aesthetics in Finding a Job as a Dentist: A Cross-Sectional Study

ABSTRACT@#This study aimed to determine the influence of dental aesthetics in finding a job as a dentist and the employer’s willingness to interact in personal and professional setting. Ten dental students’ smiling photographs were taken prior to the correction of their dental aesthetic problems. The images were digitally altered to an ideal smile. Two different questionnaires were prepared (Groups A and B) with the images with or without alteration (ideal and non-ideal smile). The images with an ideal smile and non-ideal smile were randomly allocated in each group and assessed by 84 private dental practitioners who has the authority of hiring another dentist in their practice. Four questions were asked on the likelihood of being hired, friendliness, intelligence, and good clinical skills. In general, the students with ideal smile were more likely to be hired (p < 0.05) except for those presented with buccally erupted canine and mild median diastema. Students with ideal smile scored higher in terms of friendliness and intelligence than the non-ideal smile. Most of them did not correlate a smile to an individual’s clinical skills and manual dexterity (p > 0.05). In conclusion, individuals with an ideal smile was graded more friendly and intelligent thus increases the employer’s willingness to interact personally and is more likely to be hired in contrast to a person with a non-ideal smile. Therefore, an aesthetically pleasing smile is one of the factors affecting the chances of a dentist to be hired and improve their personal interaction with people.

Smile Arc Esthetics in Middle-Aged Man from the Layperson's Perspective Via Eye-Tracking

Abstract Objective: To evaluate the perceptions of smile esthetics associated with variations in the vertical plane of the maxillary incisors in the smile arc using eye-tracking software. Material and Methods: An image of a 59-year-old Caucasian male model was adapted and edited to make three changes in the vertical plane, simulating a convex, straight, and reverse smile arc. Four areas of interest were inserted at the right and left eyes, nose, and mouth. Forty laypeople raters between 18 and 45 years of age participated of the study. Eye-tribe hardware and Ogama software were used to perform eye-tracking. Attractiveness and age-perception questions were also incorporated into the study. ANOVA test and Pearson's correlation coefficient, at p < 0.05. Results: The most observed AOI in images with convex, straight, and reverse smiles, as assessed using heatmaps and point maps, was the mouth, followed by the right eye. A significant difference for the eye (p=0.02) was found when comparing convex and reverse smiles, whereas a significant difference for the mouth was observed between the straight and reverse smiles (p=0.03). Conclusion: Convex and straight smile arcs were associated with equal levels of attractiveness; the reverse smile was less attractive. No significant difference was noticed regarding age perception and the smile arcs. However, the reverse smile recorded a more complete fixation time.

Prevalência e fatores associados ao sorriso gengival em adolescentes / Prevalence and factors associated with gummy smiles in adolescents

Objetivo: Avaliar a prevalência e fatores associados ao sorriso gengival em adolescentes entre 15 a 18 anos cursando o ensino médio. Métodos: O estudo transversal e quantitativo foi realizado durante a pandemia de COVID-19, em 160 adolescentes de duas escolas públicas (A1) e duas privadas (A2) escolhidas por sorteio, divididas em dois grupos: G1 (com sorriso gengival) e G2 (sem sorriso gengival). Foi realizado o exame clínico nos adolescentes, investigando a presença ou não de sorriso gengival (SG), ao analisar as variáveis (distância interlabial em repouso, exposição de incisivo superior em repouso, arco do sorriso, medida do subnasal ao filtro labial superior, comprimento do lábio superior, espessura do lábio superior, hipermobilidade e relação do terço inferior/médio). Foram obtidas médias, dispersão e aplicado o teste de associação qui quadrado, com nível de significância estatística de 5% para comparar os resultados entre A1 e A2 e entre G1 e G2. Resultados: Verificou-se que não foram encontradas associações estatisticamente significativas (p> 0,05), quanto ao tipo de escola e gênero com a presença de SG nos adolescentes. Não houve diferença estatisticamente significativa (χ² = 1,82; p = 0,07) entre os grupos e a idade dos adolescentes. Houve correlação significativa entre as variáveis estudadas e o SG (p < 0,05). Conclusão: A prevalência do SG em adolescentes de 15 a 18 anos de idade foi de 33,8%, com predominância do gênero feminino, não houve associações estatisticamente significativas, quanto ao tipo de escola e gênero com a presença de SG, mas houve correlação significativa entre o SG e as variáveis estudadas.

Aim: To evaluate the prevalence and factors associated with gummy smiles in adolescents aged 15 to 18 years who were attending high school. Methods: The cross-sectional and quantitateve study was carried out during the Covid-19 pandemic, with 160 adolescents, from two public (A1) and two private (A2) schools chosen by lottery, divided into two groups: G1 (with gingival smile) and G2 (no gummy smile). A clinical examination was carried out on the adolescents, investigating the presence or absence of a gummy smile (GS), by analyzing the variables (interlabial distance at rest, upper incisor exposure at rest, smile arc, measurement from the subnasal to the upper lip philtrum, upper lip length, upper lip thickness, hypermobility, and lower/middle third ratio). Means and dispersion were obtained, and the Chi-square association test was applied, with a statistical significance level of 5%, to compare the results between A1 and A2 and between G1 and G2. Results: No statistically significant associations were found (p > 0.05) regarding the type of school and gender with the presence of GS in adolescents. There was no statistically significant difference (χ² = 1.82; p = 0.07) between the groups and the age of adolescents. A significant correlation was found between the studied variables and GS (p < 0.05). Conclusion: The prevalence of GS in adolescents aged 15 to 18 years was 33.8%, with a predominance of females. No statistically significant associations were identified regarding the type of school and gender with the presence of GS; however, a significant correlation was found between the GS and the studied variables.

Uso de la toxina botulínica en el tratamiento de sonrisa gingival / Use of botulinum toxin in the treatment of gummy smile

El objetivo es abordar la importancia del uso de la toxina botulínica para corregir la sonrisa gingival, demostrando la satisfacción del paciente, aunque el efecto sea temporal y reversible, evitando procedimientos invasivos. Se realizó un levantamiento bibliográfico en las bases de datos PubMed, LILACS y Bireme, los términos utilizados en la investiga- ción fueron: sonrisa gingival y toxina botulínica o sonrisa gingival y estética. Los criterios de inclusión fueron una revisión de literatura de casos clínicos de pacientes con sonrisa gingival publicados entre 2015 y mayo de 2019. Esta revisión aborda la aplicación de la toxina botulínica para devolver una sonrisa armoniosa y hermosa al paciente, ya que es una alternativa viable, eficiente, menos invasiva y segura. La práctica de la aplicación de toxina botulínica puede ser un complemento útil para mejorar la estética y mejorar la satisfacción del paciente en relación a la sonrisa gingival sin realizar procedimientos invasivos, es decir, cuando está debidamente indicado, pudiendo reemplazar o agregar procedimientos quirúrgicos.

The objective was to address the importance of using botulinum toxin to correct gummy smile, showing patient satisfaction even if the effect is temporary and reversible, avoiding invasive procedures. A bibliographic survey was carried out in the databases PubMed, LILACS and Bireme, the terms used in the research were gummy smile and botulinum toxin or gummy smile and aesthetic. The inclusion criteria were a review of the literature of clinical cases of patients with with a gummy smile published between 2015 and May 2019. This review addressed the application of botulinum toxin to give the patient a beautiful and harmonious smile, as it is a viable, efficient, less invasive and safe alterna- tive. The practice of applying botulinum toxin can be a useful complement to improve patient satisfaction with a gummy smile without undergoing invasive procedures, that is, when well indicated, being able to replace or complement surgical procedures.

Esthetic harmonization of front upper teeth using composite resin: a clinical case report / Harmonização estética de dentes ântero-superiores com resina composta: relato de caso clínico

ABSTRACT Every day, professionals who work with esthetics are faced with the challenge of meeting patients expectations who longs for a perfect smile, where every detail must show harmony and naturality. In this context, composite resin reanatomization is widely indicated for small corrections of color and shape in one or more dental elements, for diastema closure and sometimes for correction of small dental misalignment. The case report presented here discuss the planning and treatment for the esthetic and functional improvement of the dental units 1.1, 1.2, 2.1 and 2.2, by making direct restorations in composite resin. The patient sought the Faculty of Dentistry of UFBA in search of esthetic treatment, reporting dissatisfaction with the smile. During an evaluation, the thickness and size of the upper back teeth were dissonant, besides of the interincisal diastema and a discrete gyroversion of the lateral incisors, which together compromised the esthetic area of the smile. Therefore, the proposed treatment for solving this clinical situation was direct esthetic rehabilitation with composite resin in units 1.2 to 2.2. After obtaining the study models, it was accomplished diagnostic waxing and silicone guide as auxiliary resources on the planning and restorative stage. Nanoparticulate composite resins were used, making a stratification technique to obtain a harmonic result. The treatment was able to reproduce the esthetic and natural appearance of the teeth, through a conservative alternative, fast and with an excellent cost-benefit relation when compared to the indirect techniques.

RESUMO Profissionais que trabalham com estética se deparam diariamente com o desafio de atender as expectativas dos pacientes que anseiam por um sorriso perfeito, onde cada detalhe deve evidenciar harmonia e naturalidade. Neste contexto, a reanatomização em resina composta é amplamente indicada, para pequenas correções de cor e forma, em um ou mais elementos dentais, para fechamento de diastemas e, por vezes, para correção de pequenos desalinhamentos dentais. O relato de caso aqui apresentado discute o planejamento e tratamento realizado para a melhora estética e funcional das unidades dentais 1.1, 1.2, 2.1 e 2.2, por meio da confecção de restaurações diretas em resina composta. A paciente procurou a Faculdade de Odontologia da UFBA em busca de tratamento estético, relatando insatisfação com o sorriso. Durante a avaliação, foi observada desarmonia de espessura e tamanho em dentes ântero-superiores, além de diastema interincisal e discreta giroversão dos incisivos laterais, que em conjunto comprometia a zona estética do sorriso. O tratamento proposto para solucionar esta situação clínica foi a reabilitação estética direta com resina composta nas unidades 1.2 ao 2.2. Após a obtenção dos modelos de estudo, foi realizado o enceramento diagnóstico e guia de silicona como recursos auxiliares no planejamento e etapa restauradora. Foram utilizadas resinas compostas nanoparticuladas, realizando a técnica de estratificação para a obtenção de um resultado harmônico. O tratamento realizado conseguiu reproduzir a aparência estética e natural dos dentes, através de uma alternativa conservadora, rápida e com ótima relação custo-benefício quando comparada às técnicas indiretas.

Digital smile design as a tool in the planning of porcelain laminate veneers restoration / Desenho digital do sorriso como ferramenta no planejamento de restaurações de facetas laminadas de porcelana

ABSTRACT Digital smile design is an important tool for esthetic planning in dentistry as it facilitates ease of communication between professionals and patients. This clinical report has the objective of describing a clinical procedure involving digital smile design for the placement of porcelain laminate veneer restorations. The digital smile design included dental and facial analyzes. The smile curve was drawn and a dental ruler was used to delimitate the spaces between each tooth. An approximate simulation of the smile was generated using Adobe Photoshop software. For esthetic and functional evaluation of the digital plan was created a diagnostic waxing and mock-up. The laminate veneers were made with feldspathic porcelain. Digital smile design was essential for successful planning because it enabled better patient contact with the end result. This case demonstrates the importance of this tool in esthetic dentistry.

RESUMO O desenho digital do sorriso é uma importante ferramenta para o planejamento estético em odontologia, pois facilita a comunicação entre profissionais e pacientes. Este relato clínico tem o objetivo de descrever um procedimento clínico envolvendo desenho digital do sorriso para a confecção de restaurações de facetas laminadas de porcelana. O desenho digital do sorriso incluiu análises dentais e faciais. A curva do sorriso foi desenhada e uma régua dentária foi utilizada para delimitar os espaços entre cada dente. Uma simulação aproximada do sorriso foi gerada usando o software Adobe Photoshop. Para a avaliação estética e funcional do planejamento digital foi elaborado um enceramento diagnóstico e mock-up. As facetas laminadas foram confeccionadas em porcelana feldspática. O desenho digital do sorriso foi essencial para um planejamento bem-sucedido, pois possibilitou um melhor contato do paciente com o resultado final. Este caso demonstra a importância desta ferramenta na odontologia estética.

Análise da percepção estética do sorriso por professores do curso de odontologia da Universidade do Estado do Amazonas / Aesthetic perception analysis of the smile by professors of the dentistry course of Universidade do Estado do Amazonas

Objetivo: Comparar as opiniões de professores do curso de Odontologia das seguintes especialidades: Dentística, Periodontia, Endodontia, Prótese Dentária, Ortodontia, Cirurgia e Traumatologia Buco-maxilo-facial a respeito da percepção estética do sorriso e o padrão Diagrama de Referências Estéticas Dentárias (DRED). Métodos:A coleta de dados foi realizada dentro da faculdade de Odontologia da Universidade do Estado do Amazonas (UEA), na cidade de Manaus, Amazonas, Brasil, por meio de um questionário. Foram 42 professores avaliados, sendo sete de cada especialidade, que analisaram 12 fotografias coloridas de sorrisos frontais e as pontuaram de 0 a 10, sendo 0 menos estético e 10 mais estético. Foi aplicado o teste de Coeficiente de Correlação Intraclasse (ICC), misto de duas vias e Teste de Kruskal-Wallis. Resultados: Verificou-se que 88,9% dos avaliados, apresentaram concordância de seus resultados em relação ao consenso de seu grupo de especialidade. Todavia, quando comparados individualmente 47,6% dos professores não obtiveram correlação alguma e 23,8% deles apresentaram uma correlação que pode ser atribuída ao acaso. A especialidade que apresentou a maior discrepância entre os examinadores e o gabarito foi a de Ortodontia com 87,5%. Conclusão: Desse modo, foi notável que os professores dentro da mesma especialidade apresentaram relativa concordância, porém, quando analisado a assertividade dos avaliadores individualmente houve uma correlação extremamente baixa. É possível inferir ainda, que após avaliação entre as especialidades, o grupo que apresentou maior discrepância estatística em relação ao padrão DRED de análise foi a especialidade de Ortodontia.

Aim: To compare the opinions of the professors of the Dentistry course regarding the following specialties: Dentistry, Periodontics, Endodontics, Prosthodontics, Orthodontics and Bucco-maxillo-facial Surgery and Traumatology regarding the aesthetic perception of the smile and the standard Diagrams of Dental Aesthetic References (DDAR). Methods: Data collection was carried out within the School of Dentistry of the State University of Amazonas (UEA), in the city of Manaus, Amazonas, Brazil, using a questionnaire. This study evaluated 42 teachers, seven from each specialty, who analyzed 12 color photographs of frontal smiles, and scored them from 0 to 10, where 0 was the least aesthetic and 10 was the most aesthetic. The Intraclass Correlation Coefficient test (ICC), two-way mixed test and Kruskal-Wallis test were applied. Results: It was found that 88.9% of those evaluated showed agreement in the results as regards the consensus of their specialty group. However, when compared individually, 47.6% of the teachers did not obtain any correlation, while 23.8% of them presented a correlation that can be attributed to chance. The specialty that had the greatest discrepancy among the examiners and the template was Orthodontics, at 87.5%. Conclusion:Thus, it is remarkable that professors from the same specialty showed relative agreement, but when the assertiveness of the evaluators was analyzed individually, an extremely low correlation was found. It is also possible to assume that after evaluation among the specialties, the group that showed the highest statistical discrepancy in comparison to the DDAR was the Orthodontic specialty.

The midline from the perspective of the layperson and dental surgeon / A linha média na perspectiva do leigo e do cirurgião-dentista

Aim: The objective of this research was to evaluate the midline from the perspectives of the layperson and the dental surgeon. Methods: The survey was conducted from August to December 2018 in Parnaíba, PI, Brazil. An image of a female smile was used, in which changes were made in the upper dental midline, every 1 mm up to 4 mm, and in the incisal angulation, every 5 degrees up to 15 degrees, to the left side. The images were cut and formed into two groups, one showing a smile with no lip filter (G1) and another with a smile with a lip filter (G2). These were then shown to 334 lay people and 25 dentists for evaluation with scores from 0 to 10, with scores from 0 to 5.9 for an unacceptable smile and from 6 to 10 for an acceptable smile. Results:Dental surgeons were more critical when analyzing the images and detected deviations from 1mm and 5 degrees in both groups G1 and G2. Laypeople noticed deviations from 2mm and 15 degrees on G1 and deviations from 3mm and 10 degrees on G2. Conclusion: Dental surgeons and laypeople are able to assess midline deviations with the minimum deviation present. Dentists were more critical in detecting midline deviation when analyzing photos.

Objetivo: Avaliar a linha média sob a ótica do leigo e do cirurgião-dentista. Métodos: A pesquisa foi realizada de agosto a dezembro de 2018 em Parnaíba, Piauí, Brasil. Foi utilizada uma imagem de sorriso feminino, na qual foram feitas alterações na linha média dentária superior, de 1 em 1 mm, até 4 mm, e na angulação incisal, 5 em 5 graus, até 15 graus, para o lado esquerdo. As imagens foram recortadas e formadas em dois grupos, um com sorriso sem filtro labial (G1) e outro com sorriso com filtro labial (G2). Em seguida, foram apresentados a 334 leigos e 25 dentistas para avaliação, com pontuação de 0 a 10, com pontuação de 0 a 5,9 para sorriso inaceitável e de 6 a 10 para sorriso aceitável. Resultados: Os cirurgiões-dentistas foram mais críticos na análise das imagens e detectaram desvios de 1mm e 5 graus nos dois grupos G1 e G2. Os leigos notaram desvios de 2mm e 15 graus no G1 e desvios de 3mm e 10 graus no G2. Conclusão: O cirurgião-dentista e o leigo são capazes de avaliar o desvio da linha média com o desvio mínimo presente. Os dentistas são mais críticos na detecção do desvio de linha média quando analisaram as fotos.

Reabilitação estética e funcional com facetas pré-fabricadas em resina composta: relato de caso / Aesthetic and functional rehabilitation with prefabricated resin facets: case report

Atualmente é constante a demanda por sorrisos harmoniosos nos procedimentos clínicos odontológicos, resultando em estímulos no desenvolvimento de técnicas minimamente invasivas, sistemas adesivos e materiais que sejam capazes de reproduzir as características naturais dos elementos dentários. Para as reabilitações estéticas, em especial nas unidades anteriores, os laminados cerâmicos apresentam destaque, em virtude das suas características físicas e ópticas. Como procedimento alternativo, as facetas pré-fabricadas em resina composta foram reintroduzidas na Odontologia Restauradora, exibindo versatilidade, facilidade e relação custo/benefício satisfatórias. Objetivo: Relatar um caso, demostrando uma das opções viáveis para solucionar problemas estéticos, como diastemas e desproporções dentárias. Relato de caso: A paciente procurou atendimento odontológico especializado relatando insatisfação com o sorriso. Durante avaliação, foram observados desarmonia nas proporções dentárias, diastemas múltiplos, restaurações deficientes em resina composta e fraturas nas bordas incisais. Diante disso, após o registro fotográfico, foi realizado a seleção do formato e cor das facetas pré-fabricadas, assim como, do agente de cimentação. A seguir, foi feito o isolamento relativo, remoção das restaurações deficientes e os ajustes das facetas ao dente. Para preparação da peça, foi realizado a limpeza e aplicação do adesivo; nos preparos dentários, após asperização da superfície, houve o condicionamento e aplicação do adesivo, a seguir procedeu-se a etapa de cimentação e, acabamento e polimento. Conclusão: O tratamento realizado conseguiu suprir as necessidades estéticas do sorriso da paciente, mostrando que as facetas préfabricadas em resina composta apresentam estética satisfatória, facilidade de instalação, baixo custo em relação as peças em cerâmica e conservação da estrutura dentária(AU)

Introduction: In present days, there is a constant demand for harmonious smiles in the dental clinical procedure, resulting in encouragement on development in minimally invasive techniques, adhesives systems and materials that can be capable to reproduce natural dental elements. For aesthetic rehabilitation in special in the anterior units, the ceramic laminates are highlighted due to their optical and physical features. As an alternative procedure, prefabricated composite resigns have been reintroduced into restorative dentistry, showing satisfactory versatility, ease and cost-effectiveness. Objective: Report a case, showing one of the viable options to solve aesthetical problems as diastemas and dental disproportions. Case Report: The patient sought specialized dental care reporting dissatisfaction with the smile. During evaluation, disharmony in tooth proportions, multiple diastemas, composite deficient resigns restorations and incisal edges fractures were observed. Therefore, after the photographic register, the shape and colour of the prefabricated facets, as well as cementing agent were selected. Hereinafter, relative isolation, removal of the deficient restorations and adjustments of tooth's veneers were then performed. For the piece preparation, cleaning and adhesive application were performed; on dental preparations, after the surface roughening, the adhesive was etched and applied followed by finishing and polishing cementation. Conclusion: The treatment was able to supply the aesthetical needs of the patient's smile, showing that prefabricated composite resigns veneers present satisfactory aesthetics, ease installation, low cost compared to ceramic pieces and conservation of the dental structure(AU)

O uso da toxina botulínica na correção do sorriso gengival: revisão de literatura / The use of botulinal toxin in the correction of gengival smile: literature review

In recent years, the demand for an increasingly aesthetic smile has been increasing in the clinical routine, due to this fact, countless patients look for treatments in order to improve the aesthetic appearance of your smile. It is denominated gingival smile, for individuals who present a gingival exposure with more than 3 mm during the act of smiling. Thus, among the possibilities of treatment for gingival smile, botulinum toxin has been widely used to promote a more harmonic smile. Thus, the objective of this work is to review the literature on the application of botulinum toxin in the treatment of gingival smile. The main advantages of using botulinum toxin as a therapeutic alternative for cases of gingival smile are the high tolerability of the patient, a low rate of complications, the ease of using the technique, and an almost immediate and natural effect. However, due to the disadvantage, it is possible to emphasize mainly in the short time of its effects, being necessary the maintenance. Thus, it is up to the dentist to perform a detailed anamnesis to select the most appropriate technique and promote the best treatment for the patient. (AU)

Nos últimos anos, a demanda por um sorriso cada vez mais estético vêm se tornando comum na rotina clínica. Devido a esse fato, inúmeros pacientes procuram por tratamentos com o intuito de melhorar a aparência estética do seu sorriso. Denomina-se sorriso gengival, indivíduos que apresentam uma exposição gengival com mais de 3 mm durante o ato de sorrir. Desse modo, dentre as possibilidades de tratamento para o sorriso gengival, a toxina botulínica tem sido muito utilizada para promover um sorriso mais harmônico do paciente de forma menos traumática. Assim, o objetivo deste trabalho é revisar a literatura sobre a aplicação da toxina botulínica no tratamento do sorriso gengival. As principais vantagens de se utilizar a toxina botulínica como alternativa terapêutica para os casos de sorriso gengival são a alta tolerância pelo paciente, baixo índice de complicações, facilidade de se empregar a técnica, efeito praticamente imediato e natural. Contudo, por desvantagem pode-se destacar principalmente a curto período de tempo de seus efeitos, sendo necessário a manutenção. Dessa forma, cabe ao cirurgião-dentista realizar uma anamnese minuciosa para selecionar a técnica mais adequada e promover o melhor tratamento para o paciente (AU)

Correção do sorriso gengival por meio de aumento de coroa clínica em região estética: relato de um caso clínico / Gummy smile correction through periodontal plastic surgery in esthetic region: a case report

O sorriso é considerado uma das mais importantes expressões faciais e é indispensável para a manifestação dos sentimentos. Para ser considerado estético, o sorriso deve possuir harmonia e equilíbrio entre a exposição dentária e a gengival. Este trabalho tem como objetivo descrever um caso clínico, em que foi executada uma cirurgia plástica periodontal de aumento de coroa clínica, para a correção do sorriso gengival, e avaliar o grau de sensibilidade pós-operatória, com a técnica utilizada. Com o presente estudo, foi possível concluir que o aumento de coroa clínica em região estética foi uma opção terapêutica valiosa e efetiva para a correção do sorriso gengival. A técnica permitiu restabelecer a harmonia do sorriso da paciente, o que resultou em uma melhora na sua qualidade de vida e na sua autoestima. Em relação à sensibilidade pós-operatória, observou-se que a técnica produziu baixa sensibilidade e baixo consumo de analgésico, nas condições utilizadas neste trabalho (AU)

The smile is considered one of the most important facial expressions and is indispensable for the manifestation of feelings. However, the smile must have harmony and balance between dental and gingival exposure, to be considered aesthetic. This paper intends to describe a clinical case where a periodontal plastic surgery of increase the clinical crown was performed, to correct the gingival smile, and to evaluate the degree of post-operative sensitivity with the technique used. With the present study it was possible to conclude that the increase of aesthetic region clinical crown was a valuable and effective therapeutic option for the correction of the gingival smile. Through this technique it was possible to reestablish the harmony of the patient's smile, which resulted in an improvement in her quality of life and her self-esteem. With respect to post-operative sensitivity, it was observed that this technique produced low sensitivity and low analgesic consumption, under the conditions used in this study. (AU)