RESUMO
Some tools can be used as an aid to the surgical planning for gummy smile correction, such as digital smile design (DSD), which allows to determine patterns of harmony and eventual asymmetries between teeth and gums. This work aims to report a gummy smile correction using DSD as reverse planning. The clinical examination revealed the presence of gummy smile and extensive bone exostosis in the premolar region. DSD was performed in the upper arch, determining the amount of gingiva to be removed, thus providing more safety and precision to the procedure. The surgery was performed by performing using an internal bevel incisions, detachment of a full thickness flap, and osteotomy and osteoplasty. After 6 months of preservation, there was an increase in the clinical crown of the teeth, with smile harmony, less exposure of the gingiva in the smile and a high level of patient aesthetic satisfaction.
RESUMO
Smokers have small root coverage which is associated with bad vascularity of periodontal tissues. This study evaluated a technique that can increase the blood supply to the periodontal tissues compared with a traditional technique. Twenty heavy smokers (10 males and 10 females) with two bilateral Miller class I gingival recessions received coronally positioned flaps in one side (Control group)and extended flap technique in the other side (Test group). Clinical measurements (probing pocket depth, clinical attachment level, bleeding on probing, gingival recession height, gingival recession width, amount of keratinized tissue, and width and height of the papillae adjacent to the recession) were determined at baseline, 3 and 6 months postoperatively. Salivary cotinina samples were taken as an indicator of the nicotine exposure level. No statistically significant differences (p>0.05) were detected for the clinical measurements or smoke exposure. Both techniques promoted low root coverage (Control group: 43.18 percent and Test group: 44.52 percent). In conclusion, no difference was found in root coverage between the techniques. Root coverage is possible and uneventful even, if rather low, in heavy smoker patients with low plaque and bleeding indices.
Fumantes apresentam resultados ruins no recobrimento radicular, o que pode estar relacionado à má vascularização dos tecidos periodontais. O objetivo deste estudo foi avaliar uma técnica que pode aumentar a nutrição do tecido periodontal, comparando com uma técnica tradicional.Vinte fumantes pesados (10 homens e 10 mulheres) apresentando duas retrações bilaterais classe I de Miller receberam recobrimento radicular pela técnica de retalho posicionado coronalmente de um lado e pela técnica do retalho estendido no outro lado. Medidas clínicas (profundidade de sondagem, nível clínico de inserção, sangramento a sondagem, altura e largura da retração gengival, quantidade de tecido queratinizado, altura e largura das papilas dos dentes adjacentes a retração gengival)foram realizadas no início do estudo, 3 e 6 meses de pós-operatório. Amostras salivares foram feitas para detectar cotinina, um indicador do nível de exposição ao fumo. Não foram detectadas diferenças estatisticamente significantes (p>0,05) para os parâmetros clínicos ou exposição ao fumo. Ambas as técnicas tiveram baixo recobrimento radicular (controle: 43,18 por cento e teste: 44,52 por cento). Nenhuma diferença estatisticamente significante foi encontrada para o recobrimento radicular entre as técnicas. Em pacientes fumantes pesados com baixo índice de placa e de sangramento gengival o recobrimento radicular é possível e comum, no entanto, o recobrimento é parcial.