Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis

Abstract Botulinum toxin type A is effective in reducing excessive gingival display caused by hyperfunctional upper lip elevator muscles; however, this effect is transient. This study aimed to determine the duration of the effectiveness of botulinum toxin type A on a gummy smile. A systematic search was conducted using Medline (PubMed), Scopus, and Web of Science electronic databases, from 1970 to March 2017 with no language restriction; the search included studies evaluating adult patients with excessive gingival display who were treated with botulinum toxin and were followed-up for at least 3 months. OpenGrey and Clinical Trial Registry were also consulted. Quality assessment was applied to determine the level of evidence and bias, and a meta-analysis was performed. Of 2181 full texts, 71 were obtained, with 3 prospective studies meeting the selection criteria. The gingival display was significantly reduced to baseline with 2, 4, and 8 weeks of treatment. The gingival display considerably reduced at the baseline-2-week comparison (-4.44 mm using raw data and-4.05 mm using the standard difference) and increased throughout the weeks of follow-up. There is scant evidence to determine the duration of the effectiveness of toxin type A on a gummy smile. The effect tends to be stable until at least 8 weeks of follow-up, and the gingival exposure may not return to baseline within 12 weeks of follow-up. Well-designed randomized clinical trials with a minimum of 6 months of follow-up are necessary to strengthen the evidence.

Interproximal wear versus incisors extraction to solve anterior lower crowding: A systematic review

OBJECTIVE: To determine by means of a systematic review the best treatment, whether interproximal wear or incisor extraction, to correct anterior lower crowding in Class I patients in permanent dentition. METHODS: A literature review was conducted using MEDLINE, Scopus and Web of Science to retrieve studies published between January 1950 and October 2013. In selecting the sample, the following inclusion criteria were applied: studies involving interproximal wear and/or extraction of mandibular incisors, as well as Class I cases with anterior lower crowding in permanent dentition. RESULTS: Out of a total of 943 articles found after excluding duplicates, 925 were excluded after abstract analysis. After full articles were read, 13 were excluded by the eligibility criteria and one due to methodological quality; therefore, only fours articles remained: two retrospective and two randomized prospective studies. Data were collected, analyzed and organized in tables. CONCLUSION: Both interproximal wear and mandibular incisor extraction are effective in treating Class I malocclusion in permanent dentition with moderate anterior lower crowding and pleasant facial profile. There is scant evidence to determine the best treatment option for each case. Clinical decision should be made on an individual basis by taking into account dental characteristics, crowding, dental and oral health, patient's expectations and the use of set-up models. .

OBJETIVO: determinar, por meio de uma revisão sistemática, o melhor tratamento entre desgastes interproximais e extração de incisivos para a correção de apinhamento anteroinferior em pacientes Classe I com dentição permanente. MÉTODOS: foram feitas buscas nas bases de dados eletrônicas MEDLINE, Scopus e Web of Science por artigos publicados de janeiro de 1950 até outubro de 2013. Os critérios de inclusão foram estudos que abordassem tratamentos com desgastes interproximais e/ou extração de incisivos inferiores, de casos Classe I com apinhamento anteroinferior na dentição permanente. RESULTADOS: dos 943 artigos encontrados após a remoção dos duplicados, 925 foram excluídos após a leitura dos resumos. Após leitura dos artigos completos, 13 foram excluídos pelos critérios de eligibilidade e um pela qualidade metodológica, restando quatro artigos, sendo dois retrospectivos e dois prospectivos randomizados. Os dados foram coletados, analisados e organizados em tabelas. CONCLUSÕES: tanto o desgaste interproximal quanto a extração de incisivo inferior são tratamentos eficazes em Classe I na dentição permanente, com apinhamento anteroinferior moderado e perfil facial agradável. Há fracas evidências para determinar a escolha do melhor tratamento para cada caso. A decisão clínica deve ser tomada em bases individuais, considerando as características anatômicas dentárias, da severidade do apinhamento, condições de saúde dentária e bucal, expectativas dos pacientes e ensaio em modelos (set-up). .

Tratamento não cirúrgico em adulto com overjet acentuado / Nonsurgical approach in adult patient with severe overjet

Este relato de caso clínico apresenta o tratamento de um paciente adulto com maloclusão de Classe II, 1ª divisão e com overjet de 15 mm. O plano de tratamento consistiu na extração dos primeiros pré-molares superiores e ancoragem com mini-implantes durante a retração dos dentes anteriores superiores. Obteve-se melhora significativa na estética facial com expressiva redução do overjet e restabelecimento das funções normais.

This case report describes the orthodontic treatment of an adult patient with severe Class II division 1 with a 15 mm of overjet. Treatment plan included the extraction of maxillary first premolars and use of mini-implant for anchorage during maxillary anterior teeth retraction was performed. There was significant improvement in facial aesthetics with noteworthy reduction in overjet and restoration of normal functions.

Incisivo central superior não erupcionado: alternativa de tratamento / Included upper central incisor: an alternative to the treatment

O objetivo do presente trabalho consistiu no relato do tratamento ortodôntico de um paciente que apresentava o incisivo central superior esquerdo não erupcionado, além de perfil convexo e discrepância de modelo negativa. O plano de tratamento elaborado incluiu extração seriada, montagem do aparelho ortodôntico fixo, exposição cirúrgica da coroa do dente não erupcionado e tracionamento ortodôntico. Obteve-se, ao final do tratamento, uma correta intercuspidação dos dentes, com trespasses horizontal e vertical adequados, além de perfil harmônico.

The purpose of this paper was to relate the orthodontic treatment of a patient that had an included upper central incisor, a convex profile and a negative arch discrepancy. The treatment planning consisted of serial extraction therapy, installation of the fixed appliance, surgical crown exposure of the included tooth and orthodontic traction. At the end of the treatment, a suitable profile and a correct occlusion, with appropriate overbite and overjet, were obtained.