Tratamento do sorriso gengival por meio da cirurgia periodontal: relato de caso / Treatment of gummy smile through periodontal surgery: case report

A busca por um sorriso considerado perfeito tem sido cada vez maior e isso tem se tornado um desafio para o Cirurgião-Dentista, visto que um sorriso harmônico não envolve somente dentes, mas também gengiva. A exposição excessiva da gengiva ao sorrir ou falar é considerada uma característica antiestética, pois gera uma desarmonia entre dentes, gengiva e lábios. Quando o paciente expõe 3 milímetros ou mais de gengiva ao sorrir, chamamos essa exposição de Sorriso Gengival. O presente trabalho tem como objetivo relatar o tratamento de um caso de sorriso gengival, onde foi realizada cirurgia periodontal ressectiva a fim de diminuir a exposição de tecido gengival ao sorrir. Descrição do caso: Paciente adulto 21 anos, sexo masculino, procurou atendimento no curso de graduação em Odontologia do Centro Universitário da Serra Gaúcha ­ FSG, com queixa de insatisfação estética devido ao tamanho de seus dentes e mostrar muito tecido Gengival ao sorrir. Após anamnese, exame clínico e radiográfico, o paciente foi diagnosticado com Sorriso gengival. O plano de tratamento proposto foi de cirurgia periodontal ressectiva. Conclusão: A partir do exposto, podemos concluir que o tratamento do sorriso gengival depende de sua etiologia. Um correto diagnóstico é de extrema importância, pois dependendo do fator etiológico do sorriso gengival, o plano de tratamento pode ser elaborado de acordo com a necessidade do paciente. No caso apresentado, o procedimento escolhido, cirurgia periodontal ressectiva, se mostrou efetivo no tratamento do sorriso gengival, devolvendo estética e satisfação ao paciente(AU)

The search for a smile that is considered perfect has been increasing and this has become a challenge for the Dental Surgeon, since a harmonious smile does not only involve teeth, but also gums. Excessive exposure of the gums when smiling or talking is considered an unsightly feature, as it creates disharmony between teeth, gums and lips. When the patient exposes 3 millimeters or more of gum when smiling, we call this exposure Gummy Smile. The present work aims to report the treatment of a case of gummy smile, where resective periodontal surgery was performed in order to reduce the exposure of gingival tissue when smiling. Case description: A 21-year-old adult patient, male, sought care at the undergraduate course in dentistry at the Centro Universitário da Serra Gaúcha ­ FSG, complaining of aesthetic dissatisfaction due to the size of his teeth and showing a lot of gingival tissue when smiling. After anamnesis, clinical and radiographic examination, the patient was diagnosed with gummy smile. The proposed treatment plan was resective periodontal surgery. Conclusion: From the above, we can conclude that the treatment of gummy smile depends on its etiology. A correct diagnosis is extremely important, because depending on the etiological factor of the gummy smile, the treatment plan can be elaborated according to the patient's needs. In the case presented, the chosen procedure, resective periodontal surgery, proved to be effective in the treatment of gummy smile, restoring aesthetics and patient satisfaction(AU)

Histological artifacts associated with laser and electroscalpel gingivectomy: Case series / Artefactos histológicos asociados a gingivectomía con láser y electrobisturí: serie de casos

Introduction. Over time, efforts have been invested in the design of new instruments that overcome the disadvantages of the gold standard instrument in surgery, the scalpel. As a result, electronic equipment has emerged such as the electric scalpel and laser devices. The available evidence on these instruments suggests that the tissue response is related to each instrument's physical and biological cutting principles. Objective. To compare the histological changes in gingiva samples associated with surgical cutting performed with a 940 nm diode laser, a 2780 nm erbium, chromium: yttriumscandium-gallium-garnet (Er,Cr:YSGG) laser, and an electric scalpel, by presenting a series of cases. Case presentation. We present three cases of healthy patients undergoing cosmetic surgery. The clinical examination revealed exposure of a keratinized gingiva band greater than 4 mm, normal color and texture in gingival tissue, with a firm consistency and no bleeding on periodontal probing. Gingivectomy was indicated with the following protocols: Diode laser of 940 nm at 1 W, in continuous mode; Er,Cr:YSGG laser of 2780 nm at 2.5 W, 75 Hz, H mode, air 20, water 40, gold tip MT4); and electric scalpel in cutting mode at power level four. Gingival tissue samples were taken and stored in 10% formaldehyde for histological analysis. Conclusion. All the evaluated cutting instruments generated histological changes produced by the thermal effect, the main ones being collagen coagulation and carbonization. The depth of thermal damage caused by the 2780 nm Er,Cr:YSGG laser was much lesser than that induced by the electric scalpel and the 940 nm diode laser.

Introducción. Históricamente se ha invertido esfuerzo en el diseño de nuevos instrumentos que superen las desventajas del estándar de referencia en cirugía, el bisturí. Como consecuencia de esto, han surgido equipos electrónicos como el electrobisturí y los diferentes dispositivos de tecnología láser. La información disponible sobre estos instrumentos sugiere que la respuesta del tejido intervenido está influenciada por los principios físicos y biológicos de corte del instrumento. Objetivo. Comparar los cambios histológicos en muestras de encía asociados al corte quirúrgico realizado con láser de diodo de 940 nm, láser de erbio, cromo: itrio-escandio-galio-granate (Er,Cr:YSGG) (2780nm) y electrobisturí mediante una presentación de serie de casos. Presentación de los casos. Se presentan tres casos de pacientes sanos sometidos a cirugía estética. El examen clínico reveló la exposición de una banda gingival queratinizada mayor de 4 mm, tejido gingival de color y textura normales, de consistencia firme y sin sangrado al sondaje periodontal. Se indicó gingivectomía con los siguientes protocolos: láser de diodo de 940 nm a 1 W, en modo continuo; láser de Er,Cr:YSGG de 2780 nm a 2,5 W, 75 Hz, modo H, aire 20, agua 40, punta de oro MT4; y bisturí eléctrico en modo de corte, a nivel de potencia cuatro. Se tomaron muestras de tejido gingival y se almacenaron en formaldehído al 10 % para su análisis histológico. Conclusión. Los tres instrumentos de corte generaron cambios histológicos producidos por el efecto térmico; los principales fueron coagulación del colágeno y carbonización. La profundización del daño térmico causada por el láser de Er,Cr:YSGG de 2780 nm fue mucho menor que la generada por el electrobisturí y por el láser de diodo de 940 nm.

Harmonização do sorriso: aliando ortodontia e estética / Smile harmonization: combining orthodontics and aesthetics

Atualmente é evidente a demanda contínua por padrões de beleza, cada vez mais impecáveis, um sorriso alinhado e harmônico com dentes brancos para se sorrir com confiança. O tratamento odontológico interdisciplinar tem como intuito proporcionar uma boa saúde periodontal, restabelecer a estética e a função do sistema estomatognático. Objetivo: apresentar um relato de caso clínico envolvendo harmonização do sorriso como cirurgia plástica periodontal para alinhamento da margem gengival na região anterior e restaurações diretas em resina composta após a finalização do tratamento ortodôntico, evidenciando a importância da abordagem conservadora e multidisciplinar no âmbito do tratamento estético. Relato de caso: Realizamos o tratamento ortodôntico com aparelho autoligado cerâmico para alinhamento do arco dental e intrusão do elemento 13, em sequência executamos um recorte gengival nos elementos 12 e 22, clareamento dental associado após 15 dias, subsequentemente, reanatomização dentária no elemento 44 para que o elemento 13 não voltasse a extruir pela falta de contato oclusal, e por fim, remodelação dental fazendo uso de resina composta nos elementos 12, 21 e 22 devido a manchas de hipocalcificação dental. Conclusão: Contudo, a estética bucal tem a capacidade de possibilitar a melhoria na autoestima, devolvendo à função, proporcionando satisfação e bem-estar ao indivíduo, enaltecendo o sorriso.

Currently, the continuous demand for increasingly impeccable beauty standards is evident, an aligned and harmonic smile with white teeth to smile with confidence. Interdisciplinary dental treatment aims to provide good periodontal health, restore the aesthetics and function of the stomatognathic system. Objective: to present a clinical case report involving smile harmonization as periodontal plastic surgery for aligning the gingival margin in the anterior region and direct composite resin restorations after completion of orthodontic treatment, highlighting the importance of a conservative and multidisciplinary approach in the field of aesthetic treatment . Case report: We performed orthodontic treatment with a self-ligating ceramic appliance for aligning the dental arch and intruding element 13, then performed a gingival cutout on elements 12 and 22, associated tooth whitening after 15 days, subsequently, dental reanatomization on element 44 to that element 13 would not extrude again due to the lack of occlusal contact, and finally, dental remodeling using composite resin in elements 12, 21 and 22 due to dental hypocalcification stains. Conclusion: However, oral aesthetics has the ability to improve self-esteem, returning to function, providing satisfaction and well-being to the individual, enhancing the smile.

Gingival Enlargement with Marfan Syndrome: A Case Report

@#Marfan syndrome (MFS) is an autosomal dominant and multisystemic disorder affecting the connective tissues. Patients with MFS may exhibit characteristic oral features including maxillary protrusion, high palate, crowded teeth, and fragility of the temporomandibular joint. Periodontal manifestations may include a higher prevalence of gingivitis and/or periodontitis owing to the high concentration of elastic fibres in the periodontal ligament. This case report describes the management of gingival enlargement associated with MFS. The patient was successfully managed with non-surgical and surgical periodontal therapy. In patients with oral manifestations of systemic disorders, patient motivation and effective treatment planning are able to achieve the optimum periodontal and oral health outcomes.

The anatomical limit and strategies for molar movement during orthodontic treatment / 口腔疾病防治

@#In many cases, tooth movement over a considerable distance is needed to meet the major goal of orthodontic treatment, which has always been to correct malocclusion and improve the facial profile in patients with skeletal malocclusion. However, tooth movement over a considerable distance also carries risks of dehiscence, fenestration, root exposure, and so forth. The reason lies in neglecting many limits for tooth movement, especially anatomical characteristics. This review focuses on structural limits for orthodontic molar movement, such as the alveolar cortex, the maxillary sinus floor, and the mandibular canal. In addition, we set the strategy in clinical orthodontics. For the alveolar cortex and the mandibular canal, orthodontists are recommended to move the root away from the cortical bone initially and formulate personalized molar movement plans according to clinical examination and cone-beam computed tomography (CBCT) and other imaging examinations. First, the molar root was controlled by torque away from the bone plate, and then, the molar movement amount and direction were controlled according to the personalized movement path. In regard to the maxillary sinus floor, light and continuous forces and scientific biomechanics are suitable for bodily tooth movement. In summary, better therapeutic efficacy and long-term stabilization could be achieved by circumventing the limits and risks caused by anatomical limitations and characteristics.

Apport de la technique combinée gingivectomie-frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique: à propos d'un cas / contribution of the combined gingivectomy-frenectomy technique in the management of gingival growth associated with a pathological frenulum: about a case

Introduction : La prise en charge de l'accroissement gingival repose sur un entretien médical bien mené, un examen clinique rigoureux, un diagnostic bien posé et une exérèse chirurgicale. Cependant, une récidive de la lésion peut être observée avec un rendu gingival souvent inesthétique. L'objectif de ce travail était d'illustrer, à travers un cas clinique, l'apport de la gingivectomie et de la frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique. Observation : Il s'agissait d'un patient âgé de 27 ans, venu consulter pour un problème esthétique lié à une excroissance gingivale. L'examen exo-buccal a mis en évidence, une asymétrie faciale dans le sens horizontal. La lésion gingivale était visible au sourire et évoluant depuis plus de 5 ans. L'examen endo-buccal a relevé la présence d'une gingivite induite par le biofilm, d'un frein de type 4 de Placek associés à un accroissement gingival pédonculé saignant au contact et siégeant entre la 11 et la 21. Après la thérapeutique initiale et une réévaluation, une gingivectomie à biseau interne (GBI) associée à une frénectomie ont été réalisées. L'examen anatomo-pathologique a mis en évidence un épulis fibreux ou fibrome périphérique avec absence de signes histologiques de malignité. L'évolution après 6 mois est marquée par une muqueuse gingivale cliniquement saine avec absence de récidive. Conclusion : L'apport de la gingivectomie et de la frénectomie est un atout important en termes de résultat clinique et de limitation de récidives dans l'exérèse des excès gingivaux combinés à un frein labial pathologique.

Introduction: Gingival growth is a change in the size and/or multiplication of cells, the gingival vascular system and the extracellular matrix. Management is based on a wellconducted medical interview, a rigorous clinical examination, a well-made diagnosis and surgical excision. However, a recurrence of the lesion can be observed with an often unsightly gingival rendering. The objective of this work was to illustrate, through a clinical case, the contribution of gingivectomy and frenectomy in the management of gingival growth associated with a pathological frenulum. Observation: It was a patient aged 27 who came to consult for an aesthetic problem related to a gingival growth. The exo-oral examination highlighted, a facial asymmetry in the horizontal direction. The gum lesion was visible on the smile and had been evolving for more than 5 years. The endooral examination noted the presence of biofilm-induced gingivitis, a type 4 Placek frenulum associated with pedunculate gingival growth bleeding on contact and sitting between 11 and 21. After initial therapy and reassessment, an internal bevel gingivectomy (IGG) combined with frenectomy was performed. The anatomo-pathological examination revealed fibrous epulis or peripheral fibroid with absence of histological signs of malignancy. The evolution after 6 months is marked by a clinically healthy gingival mucosa with no recurrence. Conclusion: The contribution of gingivectomy and frenectomy is an important asset in terms of clinical outcome and limitation of recurrence in the excision of excess gingival combined with a pathological labial frenulum.

Efeito do cimento cirúrgico sobre o pós-operatório de gengivectomias e gengivoplastias: uma revisão crítica da literatura / Effect of surgical cement on the post-operative following gingivectomy and gingivoplasty: a critical review of the literature

Contexto:O cimento cirúrgico é um material alternativo no pós operatório de gengivoplastia e gengivectomia, que proporciona conforto ao paciente. Porém, existem controvérsias sobre sua utilização, sendo relatado por alguns especialistas o surgimento do processo inflamatório agudo, sendo classificado como desnecessário.Objetivo: Identificar evidências na literatura acerca do efeito do cimento cirúrgico no pós-operatório do tecido gengival após gengivectomia e gengivoplastia. Materiais e métodos: Foi realizada uma revisão crítica de literatura por meio de buscas nas bases de dadosPubmed, Scielo, Lilacs, Cochrane, Scopus e na literatura cinzenta (Periódicos Capes, Google Scholar). Foram incluídos ensaios clínicos randomizados que testaram o cimento cirúrgico em casos de gengivectomias. Os artigos foram selecionados inicialmente pelo título e resumo, seguido de análise do texto na íntegra. Os estudos incluídos tiveram o nível de evidência avaliado por parâmetros do CONSORT. Resultados:Foram levantados 1458 estudos, sendo 16 escolhidos para leitura na íntegra e, destes, 3 foram incluídos na revisão. A amostra teve idade variando de dezessete a setenta e um anos. Foi utilizado cimento cirúrgico sem eugenol comparado com o bochecho de clorexidina 0,2% e a escovação mecânica precoce no pós-cirúrgico. Um estudo relatou menor índice de dor com o uso de cimento cirúrgico. O tempo de acompanhamento dos estudos foi de 30 dias. Dois estudos tiveram nível de evidência III.Conclusão: Os artigos apresentaram baixa evidência científica e quenão há consenso na literatura quanto ao efeito de cimento cirúrgico após gengivectomias.

Aim:To identify evidence in the literature about the effect of periodontal dressing on the healing of gingival tissue after gingivectomy and gingivoplasty. Materials and methods: A critical literature review was carried out through electronic searches in thePubmed, Scielo, Lilacs, Cochrane, Scopus databases and in the gray literature (Periódicos Capes, Google Scholar). Randomized clinical trials evaluating periodontal dressing in gingivectomies were included. The articles were selected by title and abstract,followed by analysis of the full text. The included studies have the level of evidence determined by CONSORT parameters. Results: A total of 1458 studies were surveyed, 16 were selected for full reading and, of these, 3 were included in the review. The age sample ranged from seventeen to seventy-one years old. A periodontal dressing without eugenol was used compared to a 0.2% chlorhexidine mouthwash and an early mechanical brushing after surgery. One study reported less pain with the use of periodontal dressing. The follow-up of the studies was 30 days. Two studies had Level of Evidence III.Conclusion:It was concluded that the articles had low scientific evidence and that there is no consensus in the literature regarding the effect of periodontal dressing after gingivectomies.

Phenytoin Induced Gingival Enlargement

Certain anticonvulsants, cyclosporine, and calcium channel blockers like amlodipine have been shown to produce clinically and histologically similar gingival enlargements in certain susceptible patients in response to local factors. These drugs appear to be similar with respect to their pharmacologic mechanism of action at the cellular level. Therefore, it is tempting to speculate that these agents may act similarly on gingival connective tissue and cause a hyperplastic response. This tissue reaction may involve a disturbance of calcium ion influx into specific cell populations with a resulting alteration in collagen metabolism and other host cell response mechanisms. A connection between ion exchange, folate uptake, collagenase activation, and bacterial inflammation may exist. The management involves Phase I therapy followed by surgical intervention. The purpose of these case reports is to highlight certain modifications in existing surgical techniques like gingivectomy, to have better aesthetic and functional outcome.

Applications of diode laser in periodontal therapy ­ clinical guidelines and tips / Aplicações do laser de diodo na terapia periodontal ­ Orientações e dicas clínicas

Os lasers de diodo tornaram-se ferramentas clínicas populares devido ao seu tamanho compacto, acessibilidade, facilidade de uso e versatilidade. O objetivo deste artigo é apresentar as diversas aplicações de um laser de diodo na prática diária e destacar os aspectos técnicos do uso do laser de diodo para o mesmo. Esta série de casos relata o manejo de seis diferentes situações clínicas com laser de diodo: anquiloglossia, bolsa periodontal, zênites gengivais desiguais, mucocele, hipersensibilidade dentinária e gengiva hiperpigmentada. Os pacientes foram tratados com laser de diodo de 940 nm com potência de 0,5 W a 2 W dependendo do caso. A cicatrização pós-operatória transcorreu sem intercorrências na maioria dos casos e foram observados resultados favoráveis. O laser de diodo ofereceu vantagens cirúrgicas como ­ campo seco, desinfecção do sítio cirúrgico e cirurgia sem sutura. Além disso, os autores observaram melhor satisfação do paciente devido à mínima dor ou edema pós-operatório e alívio imediato em caso de hipersensibilidade dentinária. Este artigo apresenta as aplicações cirúrgicas e não cirúrgicas do laser de diodo juntamente com os aspectos técnicos. Embora a literatura disponível não forneça evidências substanciais para comparação direta do laser de diodo com as técnicas convencionais, é seguro concluir que o laser de diodo é uma ferramenta eficiente para uso rotineiro em odontologia.(AU)

The diode lasers have become popular clinical tools because of their compact size, affordability, ease of use and versatility. The aim of this paper is to put forth the various applications of a diode laser in day to day practice and highlight the technical aspects of diode laser use for the same. This case series reports management of six different clinical situations with diode laser namely ­ ankyloglossia, periodontal pocket, unequal gingival zeniths, mucocele, dentinal hypersensitivity and hyper-pigmented gingiva. The patients were treated with 940 nm diode laser with power settings from 0.5 W to 2 W depending on the case. The post-operative healing was uneventful in most cases and favourable outcomes were observed. The diode laser offered surgical advantages like ­ dry field, disinfection of surgical site and suture-less surgery. In addition, the authors observed better patient satisfaction owing to minimal post-operative pain or swelling and immediate relief in case of dentinal hypersensitivity. This paper presents both surgical and non-surgical applications of diode laser along with the technical aspects. Even though the available literature does not lend substantial evidence for direct comparison of diode laser with conventional techniques, it is safe to conclude that diode laser is an efficient tool for routine use in dentistry.(AU)

Hereditary gingival fibromatosis: a case report / Fibromatosis gingival hereditaria: informe de caso

Introduction: Hereditary gingival fibromatosis is a rare disorder with a genetic component that may appear during tooth replacement. This condition can cause functional and aesthetic problems such as malocclusions, diastemas, pain when chewing, dental caries, periodontal disease, delayed eruption, among others. Objective: To report the multidisciplinary treatment provided to a patient with hereditary gingival fibromatosis. Case Report: This report describes the treatment carried out in a thirteen-year-old male patient presenting generalized increase in gingival volume associated with functional and aesthetic compromise and delayed eruption of permanent teeth. After diagnosis, a multidisciplinary intervention was proposed, involving periodontal and pediatric dentistry procedures, which improved the quality of life of the patient both functionally and aesthetically. Conclusion: Hereditary gingival fibromatosis not only affects the dental eruption process, but also causes aesthetic and emotional alterations in the patient. The periodontal procedures significantly improved the appearance, function, and the psychological state of the patient.

Introducción: La fibromatosis gingival hereditaria es una altera-ción poco común, asociada a un componente genético que en ocasiones se hace evidente en el recambio dentario. Este padecimiento puede generar problemas funcionales y estéticos como maloclusiones, diastemas, dolor al masticar, caries, enfermedad periodontal, erupción tardía, entre otros. Objetivo: Reportar el caso clínico con manejo interdisciplinario en un paciente con fibromatosis gingival hereditaria. Reporte de Caso: Se expone el tratamiento realizado en un paciente de trece años, sexo masculino, con aumento de volumen gingival generalizado con compromiso funcional y estético, conjugado con retraso en la erupción de dientes permanentes. Tras diagnóstico se plantea la intervención multidisciplinaria, integrando áreas como periodoncia y odontopediatría; los procedimientos ejecutados permitieron mejorar la calidad de vida desde el punto de vista funcional y estético. Conclusión: La fibromatosis gingival hereditaria no solo desencadena alteración en proceso eruptivo dental, sino también alteraciones estéticas y emocionales en el paciente que la padece. Los procedimientos perio-dontales realizados permitieron de forma categórica la mejora de la estética, función y estado psicológico del paciente.

Periodontal Surgery for Correction of Gingival Smile: a Case Report Analysis of Periodontal Parameters After 2 Years / Cirurgia Periodontal para Correção de Sorriso Gengival: Relato de Caso e Análise dos Parâmetros Periodontais Após 2 Anos

Gingival smile is a term used to describe an aesthetic condition in which excessive gingival exposure at the jaw level occurs during smile. There are several factors related to its etiology, the most common is the altered passive eruption of anterior superior teeth. To correct this disharmony, a multidisciplinary approach is necessary, and the treatment plan depends on a correct diagnosis and assessment for a better prognosis. The present study aims to describe a clinical case where periodontal surgical techniques were used to correct this condition. Female patient, 25 years old, with aesthetic complaint of the amount of gum exposed when smiling and diagnosed with altered passive eruption. Clinical crown augmentation surgery was performed on the anterior superior teeth. After 1 and 2 years, periodontal clinical parameters (probing bleeding, probing depth, clinical attachment level, crown length, keratinized mucosa width and plaque index) were reassessed, through clinical examination, digital photographic monitoring and measurement tools. In two years, it was possible to note the stability of the results achieved, maintaining values similar to those of the immediate postoperative period. The case report confirmed the success of the clinical crown augmentation surgery and the periodontal parameters stability evaluated after 2 years. (AU)

Sorriso gengival é o termo utilizado para descrever uma condição estética em que ocorre uma exposição gengival excessiva ao nível da maxila, durante o sorriso. Há diversos fatores relacionados a sua etiologia, sendo a mais comum a erupção passiva alterada dos dentes ântero-superiores. Para correção dessa desarmonia é necessária uma abordagem multidisciplinar, sendo o plano de tratamento dependente de um correto diagnóstico e avaliação para um melhor prognóstico. O presente estudo tem objetivo de descrever um caso clínico onde técnicas cirúrgicas periodontais foram utilizadas para correção dessa condição. Paciente gênero feminino, 25 anos de idade, com queixa estética da quantidade de gengiva exposta ao sorrir e com diagnóstico de erupção passiva alterada. Foi submetida a cirurgia de aumento de coroa clínica nos dentes antero-superiores. Após 1 e 2 anos foram reavaliados os parâmetros clínicos periodontais (sangramento a sondagem, profundidade de sondagem, perda de inserção, comprimento da coroa, largura da mucosa queratinizada e índice de placa), através de exame clinico, acompanhamento digital fotográfico e ferramentas de medição de imagem. Em dois anos, foi possível constatar a estabilidade dos resultados alcançados, mantendo valores semelhantes aos do pós-operatório imediato. O relato de caso confirmou o sucesso da cirurgia de aumento de coroa clínica e a estabilidade dos parâmetros periodontais avaliados após 2 anos. (AU)

Tratamiento del agrandamiento gingival inducido por placa bacteriana asociado a factores locales: Reporte de un caso clínico / Treatment of Gingival Enlargement Induced by Dental Plaque Associated with Local Factors: Case Report

Resumen Los agrandamientos gingivales inducidos por placa bacteriana asociados a factores locales como el uso de aparatología ortodóntica, son frecuentemente observados en pacientes jóvenes, con un inadecuado control del biofilm dental. Dentro de la terapéutica recomendada para tratar dicha condición se encuentra la fase higiénica periodontal y el abordaje quirúrgico. Se presenta un caso clínico de un paciente de 16 años con agrandamiento gingival y su respectivo tratamiento.

Absytract Dental plaque-induced gingival enlargements associated with local factors such as the use of orthodontic appliances are frequently observed in young patients, with inadequate dental biofilm control. Among the recommended therapeutics to treat this condition is the Nonsurgical phase and the surgical approach. A clinical case of a 16-year-old patient with a gingival enlargement and its respective treatment is presented.

Hallazgos histológicos asociados a gingivectomía con láser de Er, Cr: YSGG (2780 nm) / Histological Findings' Associated with Gingivectomy with Er, Cr: YSGG (2780 nm) Laser

RESUMEN Introducción: Al realizar una intervención quirúrgica, el instrumento de corte utilizado cobra especial importancia, pues el mismo está vinculado a los signos y síntomas intra- y posoperatorios y al tiempo de reparación de los tejidos. En respuesta a esto, con el tiempo se han propuesto nuevos instrumentos, particularmente la tecnología láser ha venido sufriendo un avance rápido y significativo y en la actualidad se utiliza para un sinnúmero de tratamientos odontológicos. Al láser se le han atribuido diferentes ventajas en la cirugía estética periodontal: desde facilitar el proceso de hemostasia, hasta la estimulación del proceso de reparación tisular. Sin embargo, es pertinente realizar estudios que demuestren a nivel histológico los cambios que generan en la mucosa oral y obtener información que permita conocer de qué manera influye en el proceso de reparación del tejido. Objetivo: Describir los hallazgos histológicos asociados al corte con láser de Er, Cr: YSGG de 2780 nm en muestras de encía obtenidas mediante gingivectomía. Presentación del caso: Paciente femenina, de 21 años, sistémicamente sana. Asistió a la consulta por presentar por inconformidad estética al sonreír. Se diagnosticó con exposición de banda de encía queratinizada mayor que 4 mm. Como parte del plan de tratamiento se indicó gingivectomía con láser de Er, Cr: YSGG (2780 nm) (Waterlase®, BIOLASE®), el procedimiento se realizó solo bajo anestesia tópica. Se tomaron muestras histológicas de tejido gingival para análisis histológico. Conclusiones: El láser Er, Cr: YSGG (2780 nm) preservó la morfología de los fibroblastos después del corte, no hubo evidencia de carbonización, ni profundización de la lesión térmica en el tejido. Este instrumento fue una herramienta de gran utilidad para la ejecución del tratamiento en este caso. Tuvo ventajas importantes como la ausencia de dolor posoperatorio, buena hemostasia y la reparación epitelial casi completa en tan solo 4 días(AU)

ABSTRACT Introduction: When performing a surgical intervention, the cutting instrument used is especially important, since it is associated with intraoperative and postoperative signs and symptoms and to the time of tissue repair. In response to this, new instruments have been proposed over time, particularly laser technology has been undergoing rapid and significant advancement and is currently used for countless dental treatments. Laser has been attributed different advantages in periodontal cosmetic surgery: from facilitating the hemostasis process, to stimulating the tissue repair process. However, it is pertinent to carry out studies that prove, at histological level, the changes in the oral mucosa and obtain information that allows us to know how it influences the tissue repair process. Objective: To describe the histological findings associated with the Er, Cr: YSGG (2780 nm) laser cut in gum samples obtained by gingivectomy. Case presentation: Female patient, 21 years old, systemically healthy. She attended the consultation for presenting aesthetic dissatisfaction when smiling. She was diagnosed with exposure of keratinized gum band greater than 4 mm. As part of the treatment plan, Er, Cr: YSGG (Waterlase®, BIOLASE®, 2780 nm) laser gingivectomy was indicated. The procedure was performed only under topical anesthesia. Histological samples of gingival tissue were taken for histological analysis. Conclusions: The Er, Cr: YSGG (2780 nm) laser preserved the morphology of the fibroblasts after the cut. There was no evidence of carbonization or deepening of the thermal injury in the tissue. In this case, this instrument was a very useful tool for the performance of the treatment. It had important advantages, such as the absence of postoperative pain, good hemostasis, and almost complete epithelial repair in just four days(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.

Generalized hereditary gingival fibromatosis in a child: clinical, histopathological and therapeutic aspects

Hereditary gingival fibromatosis (HGF) is a rare genetic condition characterized by slow and progressive gingival enlargement. The gingival overgrowth often delays teeth eruption and may cause serious functional and aesthetic problems. We reported a case of a 10-year-old female child presenting a generalized gingival enlargement covering almost all the maxillary and mandibular teeth and resulted in problems for swallowing, speaking, and poor aesthetics. An incisional biopsy was performed and revealed a hypocellular and hypovascular dense collagenous tissue covered by squamous epithelium exhibiting acanthosis and elongated rete ridges. The diagnosis was HGF. The treatment instituted was an association of gingivectomy with a rigorous program of oral hygiene and follow-up. Herein, we describe a rare non-syndromic case of generalized HGF, including clinical and microscopical features, as well as highlighting the importance of correct diagnosis of this genetic condition.

Impacto da correção do sorriso gengival na qualidade de vida: relato de um caso clínico com gengivectomnia suficientemente invasiva e guiada / Impact of correction of gengival smiling on quality of life: report of a clinical case with sufficiently invasive and guided gengivectomy

Introduction: The gingival smile is one of the most common complaints related to aesthetics, having a varied etiology, its most common cause being altered passive eruption. To achieve better results, prior planning is required using photographs, plaster models, diagnostic waxing, allowing anticipation of the results without performing surgery. Objective: to report a clinical case of gingival smile correction through gingivectomy and osteotomy without flap displacement, assisted by a surgical guide, to assess the degree of postoperative pain and the impact of this treatment on the quality of life of the patient. Case report: A female patient presented a flat, thick periodontal biotype with a wide range of keratinized mucosa, short and square clinical crowns, a flat cervical line and gingival exposures greater than 3.0 mm, with no loss of insertion, establishing a ratio of 80% in the width / length ratio of crowns to their surgical planning. Results: After 60 days of surgery, the increase of the elements was as planned, and the periodontal tissues presented regular contours, cervical line of the convex smile, zinith of the canines and central incisors positioned more apically and distal to the lateral incisors. Conclusion: The surgical correction of the gingival smile by the gingivectomy technique with osteotomy without flap displacement had a positive impact on the quality of life of the patients in this study, generating a mild discomfort only in the first five hours postoperatively (AU)

Introdução: O sorriso gengival é uma das queixas mais comuns relacionada a estética, possuindo uma etiologia variada, sendo sua causa mais comum a erupção passiva alterada. Para melhor êxito nos resultados, é necessário um planejamento prévio utilizando de fotografias, modelos de gesso, enceramento diagnóstico, possibilitando antecipação dos resultados sem a realização cirurgica. Objetivo: relatar um caso clínico de correção de sorriso gengival por meio de gengivectomia e osteotomia sem deslocamento de retalho, auxiliada por um guia cirúrgico, avaliar o grau de dor no pós-operatória e o impacto deste tratamento na qualidade de vida da paciente. Relato de caso: Paciente do sexo feminino apresentava biótipo periodontal plano e espesso com larga faixa de mucosa ceratinizada, coroas clínicas curtas e quadradas, linha cervical plana e exposição gengival maior que 3,0 mm, com inexistência de perda de inserção, estabelecendo uma proporção de 80% na relação largura/comprimento das coroas para seu planejamento cirúrgico. Resultados: Após 60 dias da cirurgia o aumento dos elementos foi conforme ao planejado, e os tecidos periodontais apresentaram contornos regulares, linha cervical do sorriso convexa, zênites gengivais dos caninos e incisivos centrais posicionados mais apicalmente e para distal em relação aos incisivos laterais. Conclusão: A correção cirúrgica do sorriso gengival pela técnica de gengivectomia com osteotomia sem deslocamento de retalho impactou positivamente na melhora da qualidade vida da paciente deste estudo, gerando um leve desconforto somente nas cinco primeiras horas do pós-operatório. (AU)

Control of pain in patients undergoing gingivectomy and gingivoplasty with low intensity laser / Controle da dor em pacientes submetidos a gengivectomia e gengivoplastia com laser de baixa intensidade

Objective: To evaluate the efficiency of Laser Low Intensity (LLI) in pain control and reduction of analgesic consumption after gingivectomy and gingivoplasty. Methods: Twenty patients with gingival hyperplasia were randomly divided into two groups with 10 subjects each. In the test group it was applied after gingivectomy / gingivaplasty, low intensity laser in the operative wound and prescription only in case of pain, while in the control group only analgesia was performed in case of pain. Results: The laser was applied at 3 points in the region of periodontal surgery. The irradiation was performed in a single session, using diode laser (808 nm, 100nW, 100J / cm², 30 s). Pain was assessed by Visual Analogue Scale, as well as the amount of analgesics ingested by the patient. In the test group, 80% of the individuals did not report postoperative pain, those who reported symptomatology, were identified only as mild discomfort. The analysis of the data showed a statistically significant difference when compared to the higher postoperative pain between the groups (p = 0.026). However, there was no difference in the evaluation of analgesic use. Conclusion: Based on our results, it is suggested that LLI therapy decreases the intensity of postoperative pain in periodontal surgeries (AU)

Surgical and nonsurgical treatment of papillary hyperplasia: A case report / Tratamiento quirúrgico y no quirúrgico de la hiperplasia papilar inflamatoria: Reporte de Caso

Dentures with dental plaque predispose recurrent hyperplasia on the palatal mucosa. Surgical procedures for the treatment of inflammatory papillary hyperplasia involve postsurgical discomfort and morbidity. This repot describes clinical and histologic aspects of a patient with severe akantolitic inflammatory papillary hyperplasia. The palatal mucosa was treated with a surgical bur with a low-speed handpiece. A new removable denture was performed and adapted. A follow-up of 4 years showed staility of health at palatal mucosa. Patient referred low discomfort and morbidity when using bur technique. Control of removable denture was critical for long-term healing and soft tissue stability.

Las prótesis dentales con placa bacteriana predisponen a la hiperplasia recurrente en la mucosa palatina. Los procedimientos quirúrgicos para el tratamiento de la hiperplasia papilar inflamatoria implican molestias y morbilidad posquirúrgicas. Este reporte describe los aspectos clínicos e histológicos de un paciente con hiperplasia papilar inflamatoria acantolítica severa. La mucosa palatina fue tratada con una fresa quirúrgica con una pieza de mano de baja velocidad. Se realizó y adaptó una nueva prótesis parcial removible. Después de un seguimiento de 4 años, se encontró estabilidad de la salud de la mucosa palatina. El paciente se refirió a la baja incomodidad y morbilidad al usar la técnica de la fresa. El control de la prótesis parcial removible fue crítico para la cicatrización a largo plazo y la estabilidad de los tejidos blandos, evitando la recidiva de la hiperplasia papilar inflamatoria.

In vivo optical coherence tomographic imaging to monitor gingival recovery and the adhesive interface in aesthetic oral rehabilitation: A case report

The available methods for veneer evaluation are limited to clinical and radiographic examinations, which may not allow the appropriate identification of failure. In this report, we demonstrate the use of optical coherence tomography (OCT) as a noninvasive diagnostic and follow-up method to evaluate gingival recovery and the adhesive interface in aesthetic oral rehabilitation involving periodontal plastic surgery and ceramic laminate veneers. OCT was efficient for evaluating both soft and hard tissues, as well as the quality of the adhesive interface. In conclusion, OCT was found to be a promising approach for the professional evaluation of aesthetic oral rehabilitation, as it was capable of generating images that enabled the analysis of gingival recovery and the adhesive interface.

Aplicaciones del cianoacrilato en periodoncia: serie de casos / Applications of cyanoacrylate in periodontics: a series of cases

Introducción: Actualmente el uso de adhesivos tisulares como el cianoacrilato ha sido beneficioso en el área odontológica, reduciendo el tiempo del acto quirúrgico, disminuyendo el tiempo de cicatrización y la cicatriz postoperatoria, así también el dolor postoperatorio. Objetivo: El objetivo de este artículo es reportar diversas aplicaciones del cianoacrilato en tratamientos quirúrgicos periodontales, como recontorneo estético, gingivectomía, colgajo posicionado apical y preservación alveolar. Materiales y métodos/Presentación de casos: Los protocolos de tratamiento utilizados fueron los tradicionales para cada caso en particular más la adición de tres capas de cianoacrilato, con lapso de aplicación de 30 segundos entre cada capa. Conclusión: Los resultados clínicos de los casos presentados muestran una eficacia en la cicatrización al utilizar cianoacrilato, sin embargo, no sustituye los métodos tradicionales de los protocolos de cada tratamiento (AU)

Introduction: Currently, the use of tissue adhesives such as cyanoacrylate has been beneficial in the dental area, reducing the time of the surgical act, decreasing the time of healing and the postoperative scar, as well as the postoperative pain. Objective: The objective of this article is to report various applications of cyanoacrylate in periodontal surgical treatments, such as aesthetic crown lengthening, gingivectomy, apically positioned flap, and alveolar preservation. Materials and methods/Case presentation: The treatment protocols were the traditional ones for each particular case plus the addition of three layers of cyanoacrylate, with application time of 30 seconds between each layer. Conclusion: The clinical results of the presented cases show an efficacy in the cicatrization when using cyanoacrylate adhesives, nevertheless it does not substitute the traditional methods of the protocols of each treatment (AU)