Intérêt de la greffe épithélioconjonctive au cours du traitement orthodontique multiattaches: rapport de 3 cas / Interest of free gingival grafting during multi-attachment orthodontic treatment: a 3-case report

Introduction. La récession gingivale (RG) entraine une exposition de la racine et une hypersensibilité. L'étiologie est multifactorielle. Une incidence plus élevée pourrait être observée au niveau des dents avec des phénotypes parodontaux fins ou si des forces orthodontiques ont été appliquées pour déplacer les dents en dehors de leurs processus alvéolaires. La greffe épithélioconjonctive (GEC) est indiquée pour prévenir ou corriger la RG et améliorer l'esthétique. L'objectif de ce rapport de cas est de montrer l'intérêt de la GEC dans la prise en charge des RG en cours de traitement orthodontique multiattaches. Observation clinique et prise en charge. Trois patientes en cours de traitement orthodontique multiattaches depuis 2 ans ont été référées dans la clinique de parodontie de l'Institut d'Odontologie et de Stomatologie de l'Université Cheikh Anta Diop de Dakar, avec des RG de type 2 (RT2) de Cairo sur la 31 et la 41. Un diagnostic parodontal de gingivite induite par le biofilm a été posé pour la première patiente. Les deux autres patientes présentaient une parodontite localisée de stade II et de grade B. La prise en charge a consisté en une thérapeutique initiale suivie d'une réévaluation à 2 mois. L'indication de la GEC a été posée avec comme objectifs de créer une bande de gencive kératinisée avec un approfondissement du vestibule en regard de la 31 et de la 41 et d'obtenir un recouvrement radiculaire. Des résultats satisfaisants ont pu être obtenus. Conclusion. Les rapports entre parodontie et orthodontie Impliquent un diagnostic initial précis et une planification thérapeutique coordonnée des intervenants.

Introduction. Gingival recession (GR) leads to root exposure and hypersensitivity. The etiology is multifactorial. A higher incidence may be observed in teeth with fine periodontal phenotypes, or if orthodontic forces have been applied to move teeth out of their alveolar processes. Free gingival grafting (FGG) is indicated to prevent or correct GR and improve aesthetics. The aim of this case report is to demonstrate the value of ECG in the management of GR during multiattachment orthodontic treatment. Case description and management. Three patients undergoing multiattachment orthodontic treatment for 2 years were referred to the periodontics clinic of the of the Institut d'Odontologie et de Stomatologie at Cheikh Anta Diop University in Dakar, with Cairo type 2 GR (RT2) on 31 and 41. A periodontal diagnosis of biofilm -induced gingivitis was made for the first patient. The other two patients presented with localized stage II, grade B periodontitis. Management consisted of initial therapy followed by reassessment at 2 months. The indication for FGG was to create a band of keratinized gingiva with deepening of the vestibule opposite 31 and 41, and to achieve root coverage. Satis factory results were obtained. Conclusion. The relationship between periodontics and orthodontics requires accurate initial diagnosis and coordinated treatment planning. .

Research progress on the tunnel technique for root coverage / 口腔疾病防治

@#Gingival recessions (GRs) result in root hypersensitivity, root surface caries, and esthetic problems. Various root coverage surgeries are being developed for periodontal plastic therapy. The tunnel technique (TUN) is one of the most widely applied surgeries due to its features of being minimally invasive, practical, excellent outcomes and long-term stability; however, there are still some limitations of this technique. The history and evolution from the envelope flap to TUN, including its efficiency when compared with coronally advanced flaps with a connective tissue graft (CTG), are reviewed in this paper. The limitations of TUN are discussed in consideration of our clinical experience; for example, there is high technique sensitivity when TUN is applied in GR>5 mm because of the great difficulty in covering the grafts. The advantages of surgical access, including vertical incisions in the vestibule, “W” type and pinhole access, are discussed for different situations. Mattress sutures and sling sutures in a single tooth or multiple teeth are applied in TUN. The different types of grafts, such as CTG, platelet-rich plasma, articular dermal matrix and xenogeneic collagen matrix, are described. Mechanical, chemical and biological conditioning of the root surface are recommended during surgery. Protecting the surgical area and taking antibiotics postoperatively are also very important. Finally, the modifications when TUN is applied with other kinds of techniques are discussed, including lateral closed TUN, laterally positioned flaps, double papilla flaps and frenuloplasty. Minimally invasive, esthetic, long-term stability and simplified techniques are the development trends of TUN in the future.

Cirugía plástica periodontal. Aplicación de la técnica de colgajo semilunar / Periodontal plastic surgery. Application of the semilunar flap technique / Cirurgia plástica periodontal. Aplicação da técnica de retalho semilunar

RESUMEN Introducción: cada día es más frecuente observar la preocupación de los pacientes por la presencia de trastornos mucogingivales, y dentro de estos, uno de los más comunes es la recesión periodontal. Esta puede acompañarse de sensibilidad radicular, mayor prevalencia de caries y abrasiones cervicales. Presentación de caso: el caso que presentamos se trató de un paciente de 25 años de edad del sexo masculino que acudió a nuestra consulta preocupado por su estética y sensibilidad dental a los cambios térmicos. El mismo presentaba una recesión periodontal de 3 mm a nivel del 13. Discusión: decidimos darle solución al problema con la técnica de colgajo semilunar, cumpliéndose el objetivo del trabajo al quedar resueltos los problemas de estéticas y sensibilidad del paciente una vez cubierta la raíz y aumentado el ancho la encía insertada. Conclusiones: al examen clínico los resultados mostraron un recubrimiento radicular, aumento del grosor de encía insertada, disminución de sensibilidad dental y estética aceptada por el paciente.

ABSTRACT Introduction: every day it is more frequent to observe the concern of patients for the presence of mucogingival disorders, and within these, one of the most common is periodontal recession. This can be accompanied by root sensitivity, increased prevalence of caries and cervical abrasions. Case presentation: the case we presented was a 25-year-old male patient who came to our office concerned about his aesthetics and dental sensitivity to thermal changes. It presented a periodontal recession of 3 mm at the level of 13. Discussion: we decided to solve the problem with the semilunar flap technique, fulfilling the objective of the work by solving the problems of aesthetics and sensitivity of the patient once the root is covered and the width of the inserted gum is increased. Conclusions: on clinical examination the results showed a root coating, increase in the thickness of the inserted gum, decrease in dental sensitivity and aesthetics accepted by the patient.

RESUMO Introdução: a cada dia é mais frequente observar a preocupação dos pacientes com a presença de distúrbios mucogingival, e dentro destes, um dos mais comuns é a recessão periodontal. Isso pode ser acompanhado de sensibilidade radicular, aumento da prevalência de cárter e abrasões cervicais. Apresentação do caso: o caso que apresentamos foi um paciente do sexo masculino de 25 anos que veio ao nosso consultório preocupado com sua estética e sensibilidade dentária às mudanças térmicas. Apresentou uma recessão periodontal de 3 mm ao nível de 13. Discussão: decidimos resolver o problema com a técnica de retalho semilunar, cumprindo o objetivo do trabalho resolvendo os problemas da estética e sensibilidade do paciente uma vez que a raiz é coberta e a largura da gengiva inserida é aumentada. Conclusões: no exame clínico os resultados mostraram revestimento radicular, aumento da espessura da gengiva inserida, diminuição da sensibilidade dentária e estética aceita pelo paciente.

Regeneración de tejido blando en una clase 3 mediante un colgajo desplazado lateral e injerto de tejido conjuntivo. Reporte de un caso clínico / Elian class 3 regeneration of soft tissue using a laterally moved flap and connective tissue graft. A clinical case report

RESUMEN: Se describe el caso clínico de una paciente de 60 años, sexo femenino, sana, la cual presentaba en el diente 1.1 una recesión de 6 mm de longitud con extensa pérdida ósea en vestibular correspondiente a una clase 3 de Elian. En el presente reporte se expone los pasos que se siguieron para llegar a una Clase 2 de Elian, mediante un colgajo desplazado lateral con injerto de tejido conjuntivo subepitelial.

ABSTRACT: We describe the clinical case of a 60-year-old female patient, healthy, who presented a 6mm-long recession on tooth 1.1 with extensive vestibular bone loss corresponding to an Elian class 3. In the present report, the steps followed to reach an Elian class 2,by means of a laterally moved flap with subepithelial connective tissue graft, are shown.

A detailed description and 16-year validation of a new suturing method for stabilizing connective tissue grafts at recipient sites for root coverage and gingival augmentation

Background: Which are the different ways of stabilizing connective tissue grafts (CTGs) for root coverage and gingival augmentation by means of placement of sutures? There are various defined and undefined ways of stabilizing CTGs depending on experience and personal preferences. Most of the techniques profess use of absorbable sutures in separate interrupted fashion (sutures at the corners of the graft wherever possible). Aim: This paper describes a new suturing method, “the lingually-tied horizontal mattress contouring suture,” for stabilization of CTGs with or without epithelialized collar at the recipient site, for use with papilla retention and sparing techniques to treat marginal tissue recessions. Methods and Material: The suturing technique is described in detail. It can be indicated for good number of root coverage cases, with additional objectives of gingival augmentation, specifically developed for papilla sparing and papillary buccal de-epithelialization recipient site preparations. Results: Over a period of last 16 years this suturing technique showed promising results in terms of graft stabilization and survival. The main advantage of this technique lies in the use of cost-effective nonabsorbable sutures that usually retain some amount of tension on the soft tissues longer. Conclusion: The primary objective of the suturing technique, per se, is to stabilize the CTG firmly along the contours of the root surface and to expedite a very close adaptation to the interdental soft tissues as well. The secondary objective of the article or publication is to disseminate the knowledge acquired through long periods of performance and observation for the benefit of the periodontal community as whole. Further validation is advocated.

Cirugía plástica periodontal: reporte de un caso clínico / Periodontal plastic surgery: report of a clinical case

El abordaje terapéutico de las recesiones gingivales requiere un plan de tratamiento que involucre terapia básica, la cual tendrá como objetivo la resolución de la/las etiologías de la/las mismas y una terapia de cirugía plástica periodontal adecuada al caso específico. Los procedimientos quirúrgicos con injertos de tejido conjuntivo tomados principalmente del paladar son el gold standard en el tratamiento de las recesiones gingivales. El objetivo de este trabajo es exponer paso a paso el tratamiento de una recesión gingival post-terapia de ortodoncia y su evaluación a largo plazo (AU)

The therapeutic approach to gingival recession requires a treatment plan involving basic therapy, which will focus on its etiologies, and the most suitable periodontal plastic surgery therapy in each specific case. Surgical procedures with connective-tissue grafts, taken mainly from the palate, are the gold standard in gingival recession treatment. The aim of this paper is to present the step-bystep post-orthodontic therapy treatment of a case of gingival recession and its long-term evaluation (AU)

Tratamento de recessões múltiplas bilaterais com matriz colágena (Mucograft) e enxerto de conjuntivo / Treatment of bilateral multiple recessions with connective tissue graft and collagen matrix (Mucograft)

Atualmente, várias abordagens cirúrgicas têm sido propostas para o tratamento das recessões gengivais. Dentre as técnicas descritas, o uso do enxerto de tecido conjuntivo demonstrou ser efi caz e previsível, sendo considerado o padrão-ouro para o recobrimento radicular. No entanto, essa técnica demanda mais tempo operatório devido à necessidade de um segundo sítio cirúrgico para a remoção do enxerto, podendo aumentar a morbidade e o desconforto ao paciente. Visando reduzir essa possibilidade, novos biomateriais têm sido propostos, incluindo as membranas de colágeno de origem suína. O objetivo desse relato de caso foi comparar o recobrimento radicular de recessões múltiplas, utilizando a matriz de colágeno Mucograft e o enxerto de tecido conjuntivo, após 12 meses de acompanhamento.

Currently several surgical approaches have been proposed for the treatment of gingival recessions. Among the techniques described, the use of the connective tissue graft was shown to be effective and predictable, being considered the gold standard for root coverage. However, this technique requires more operative time due to the need for a second surgical site for graft removal, which may increase morbidity and discomfort for the patient. Aiming to reduce discomfort to the patient, new biomaterials have been proposed including porcine collagen membranes. The objective of this clinical case report was to compare the root coverage of multiple recessions using the Mucograft collagen matrix and the connective tissue graft after 12 months of follow-up.

Interdental Papilla Management “Reality or A Myth” - A Review.

Interdental papillary recession has been esthetical as well as an oral hygiene maintenance problem for the patients. Abnormal tooth shape, improper contours of prosthetic restorations, and traumatic oral hygiene procedures may also negatively influence the outline of the interdental soft tissue. There are very fewer surgical techniques to create interdental papilla, which has been very technique sensitive and less predictive in treatment outcome; in this article, a review is attempted to illustrate various causes, classification, and management of interdental papilla.

A Randomized Comparative Study of Two Techniques to Optimize the Root Coverage Using a Porcine Collagen Matrix

Abstract: The aim of this randomized controlled clinical study was to compare the extended flap technique (EFT) with the coronally advanced flap technique (CAF) using a porcine collagen matrix (PCM) for root coverage. Twenty patients with two bilateral gingival recessions, Miller class I or II on non-molar teeth were treated with CAF+PCM (control group) or EFT+PCM (test group). Clinical measurements of probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), keratinized tissue height (KTH), keratinized mucosa thickness (KMT) were determined at baseline, 3 and 6 months post-surgery. At 6 months, the mean root coverage for test group was 81.89%, and for control group it was 62.80% (p<0.01). The change of recession depth from baseline was statistically significant between test and control groups, with an mean of 2.21 mm gained at the control sites and 2.84 mm gained at the test sites (p=0.02). There were no statistically significant differences for KTH, PPD or CAL comparing the two therapies. The extended flap technique presented better root coverage than the coronally advanced flap technique when PCM was used.

Resumo: O objetivo deste estudo randomizado, controlado e clínico foi comparar para recobrimento radicular a técnica de retalho estendido (EFT) com a técnica de retalho avançado coronalmente (CAF) utilizando uma matriz suína colágena (PCM). Vinte pacientes com duas retrações gengivais bilaterais, classe I ou II de Miller em dentes não molares foram tratados com PCM+CAF (grupo controle) ou PCM+EFT (grupo teste). Medidas clínicas de profundidade de sondagem, (PPD), nível clínico de inserção (CAL), altura da retração gengival (RH), altura do tecido queratinizado (KTH), espessura da mucosa queratinizada (KMT) foram determinadas no exame inicial, aos 3 e 6 meses após a realização das cirurgias. Após 6 meses a média de recobrimento radicular para o grupo teste foi de 81,89% e para o grupo controle foi de 62,80% (p<0,01). A mudança na altura das retrações gengivais em relação ao exame inicial foi estatisticamente significante entre os grupos teste e controle, com média de 2,21 mm ganhos nos sítios controle e 2,84 mm ganhos nos sítios teste (p=0,02). Não houve diferenças estatísticas significantes para os parâmetros KTH, PPD ou CAL comparando as duas terapias. A técnica de retalho estendido apresentou melhor recobrimento radicular do que a técnica de retalho avançado coronalmente quando a PCM foi usada.

Manejo quirúrgico periodontal de la erupción pasiva alterada: reporte de casos / Periodontal surgical management of the altered passive eruption: case report

Cuando el tejido blando se posiciona excesivamente sobre las coronas anatómicas de los dientes, frecuentemente visto en adultos y que resulta en coronas clínicas cortas, es una condición que ha sido descrita en la literatura por diversos autores como ®erupción pasiva alterada¼. Se define como una relación dentogingival en la que el margen gingival se posiciona en la corona anatómica y no se aproxima a la unión cemento-esmalte debido a la alteración en los patrones de desarrollo y eruptivos de la unidad dentogingival. En este artículo se describe cómo la cirugía plástica periodontal puede remodelar el aparato de inserción, restablecer el espacio biológico adecuado, eliminar la exposición excesiva de la encía y exponer las dimensiones correctas de los dientes. En este reporte se presentan 3 casos de erupción pasiva alterada, abarcando su diagnóstico, clasificación clínica y tratamiento a través de cirugía periodontal para corregir las alteraciones estructurales y devolver la estética.

When the soft tissue is positioned excessively on anatomical crowns of teeth, frequently seen in adults and resulting in short clinical crowns, a condition has been described in the literature by several authors as "altered passive eruption". It is defined as a dentogingival relationship wherein the gingival margin is positioned coronally on the anatomic crown, and does not attach to the cement-enamel junction due to the disruption in the development and eruptive patterns of the dentogingival unit. This article describes how periodontal plastic surgery can remodel the attachment apparatus, re-establish the correct biological width, eliminate the excessive showing of gingiva, and expose the correct dimensions of teeth. In this report, 3 cases are presented of altered passive eruption, and includes the diagnosis, clinical staging and treatment through periodontal surgery to correct the structural and aesthetic appearance.

Cirugía plástica periodontal, una realidad asistencial: reporte de casos / Periodontal plastic surgery, a care reality: case report

En la actualidad, la periodoncia no solo se encarga de resolver los procesos infecciosos que afectan al periodonto, sino que también es responsable de la preservación de la función, del confort y de la estética de los tejidos periodontales. Es por eso que hoy en día las técnicas de cirugía plástica periodontal son una herramienta esencial para la resolución de defectos mucogingivales en donde el tejido conectivo subepitelial, debido a su biología, se ha convertido en la mejor alternativa para resolver las secuelas derivadas de trauma maxilofacial, tratamientos de ortodoncia en biotipos finos, trauma dentoalveolar, resección de tumores, tratamiento de las secuelas de la periodontitis, en donde al restaurar la pérdida de tejido existente y modificar el biotipo periodontal mejora el pronóstico dentario. En Chile, el tratamiento periodontal realizado en la atención secundaria se ha centrado históricamente en el control de infecciones. Sin embargo, debido a la gran demanda de casos relacionados con los tejidos periodontales sin periodontitis, hoy enfrentamos una nueva realidad clínica asistencial que amerita el empleo de nuevas técnicas y procedimientos quirúrgicos tendentes a la restauración de los tejidos periodontales perdidos o mutilados. En este reporte de casos se expone la labor realizada en el servicio dental del Hospital El Salvador, dependiente del Servicio de Salud Metropolitano Oriente, en donde desde el año 2006 se realizan intervenciones quirúrgicas con técnicas de cirugía plástica periodontal para resolver casos complejos.

Periodontics is not only charged with resolving infectious processes that affect the periodontium, but is also responsible for preservation of function, comfort and aesthetics of the periodontal tissues. For this reason current plastic periodontal surgery techniques are an essential tool for the resolution of mucogingival defects, where the subepithelial connective tissues, due to their biology, have become the best alternative to resolve the sequelae of maxillo-facial trauma (TMF), fine biotype orthodontic treatment, dentoalveolar trauma (TDA), tumor resection, and treatment of the sequelae of periodontitis. In all of these conditions, the restoration of lost tissue and the modification of existing periodontal biotype dental improves their prognosis. In Chile, the periodontal treatment performed in secondary care has historically focused on infection control. However, due to the high demand for cases involving periodontal tissues without periodontitis, there is now a new reality that must focus clinical attention on the use of new techniques and surgical procedures designed to restore lost or mutilated periodontal tissues. This case report presents the work of the El Salvador Hospital Dental Department of East Metropolitan Health Service (SSMO), where periodontal plastic surgery techniques to treat complex cases have been performed since 2006.

Aumento coronario anterior como tratamiento estético periodontal: reporte de caso / Increased anterior coronary as periodontal aesthetic treatment: a case report

El aumento coronario es un procedimiento quirúrgico periodontal que consiste en eliminar encía y hueso para crear una corona clínica más larga y desplazar el margen gingival en sentido apical. Se reporta el caso de un paciente de 16 años de edad con diagnóstico de agrandamiento gingival , al cual se le realiza un aumento coronario anterosuperior. El objetivo de este tipo de cirugía es corregir alteraciones del margen gingival y favorecer la estética en pacientes con exposición incompleta de corona y con una línea de sonrisa alta

Crown lengthening is a periodontal surgical procedure of removing gum and bone to create a longer clinical crown and move the gingival margin apically. We report a patient of 16 years of age diagnosed with gingival enlargement, which underwent an anterior crown lengthening. The aim of this type of surgery is to correct abnormalities of the gingival margin and promote the aesthetics in patients with incomplete crown exposure and a high smile line

Reanatomização cosmética associada à cirurgia plástica periodontal, relato de caso clínico / Cosmetic reanatomization associated to periodontal plastic surgery

A busca pelo sucesso estético aliado a prática clínica de procedimentos que visam otimizar a cosmética dentária têm sido um tema de enfoque particular na odontologia atual. Este artigo tem como objetivo, apresentar o caso clínico de um paciente do gênero masculino, 21 anos, leucoderma, estudante de odontologia, que apresentavasorriso gengival, alterações de simetria e proporção dentárias e hipoplasia de esmalte em região anterior. A opção clínica eleita foi a reanatomização cosmética associada à cirurgia plástica periodontal, onde se observou a importância do planejamento clínico integrado envolvendo a periodontia e a dentística restauradora.

The search for aesthetic success allied to the clinical practice of procedures that aim to optimize the cosmetic dentistry has been a subject of particular focus in dentistry today. This article aims to present a case of a male patient, 21 years old, Caucasian, dentistry students, who had smile gums, changes in symmetry and proportion and dental enamel hypoplasia in the anterior region. The option chosen was the clinical reanatomização associated with cosmetic periodontal plastic surgery, where he noted the importance of integrated planning involving clinical periodontics and restorative dentistry.

Aplicación clínica del aloinjerto de matriz dérmica acelular en cirugía plástica periodontal* / Clinical application of a cellular dermal matrix allograft in periodontal plastic surgery

Se han indicado diferentes procedimientos quirúrgicos para la preservación y aumento del reborde alveolar, así como para el tratamiento de recesiones gingivales e incremento de la amplitud de la encía adherida, alrededor de dientes naturales e implantes. Cuando se utilizan injertos autógenos en estas intervenciones se evidencian algunas desventajas que incluyen la inconformidad asociada con un sitio quirúrgico adicional y la disponibilidad limitada de tejido donante. Recientemente, se utilizan aloinjertos de matriz dérmica acelular como sustitutos de los injertos autógenos en cirugía plástica periodontal. La matriz dérmica es un aloinjerto libre de células obtenido de la piel humana, bioestructuralmente compuesto por membrana basal y matriz extracelular que actúa como una matriz que permite la neovascularización, y proliferación de fibroblastos y células epiteliales En esta serie de casos, se presentan tres aplicaciones quirúrgicas de la matriz dérmica: cubrimiento de recesiones gingivales, manejo de dehiscencias sobre implantes y aumento de reborde alveolar(AU)

Several surgical procedures have been indicated for the preservation and increase of the alveolar ridge, and for the treatment of gingival recessions so to increase the width of attached gingiva around natural teeth or implants. The disadvantages of harvesting autogenous grafts on these procedures lie in the postoperative discomfort associated with an extra surgical site, as well as the limitation of available donor tissues. Recently, an acellular dermal matrix allograft has been approved as substitutes for autogenous grafts in periodontal plastic surgery. Dermal matrix allograft are free cells obtained from human skin, bioestructuraly formed by basement membrane and extracellular matrix that act as a matrix that allow the revascularization and proliferation of fibroblasts and epithelial cells. In this series case, we present three surgical applications of the dermal matrix: coverage of gingival recessions, management of implant dehiscence and alveolar ridge augmentation(AU)

Cirurgia plástica periodontal para correção de sorriso gengival associada à restaurações em resina composta: relato de caso clínico / Periodontal plastic surgery associated with composite resin restorations: case report

O objetivo deste relato de caso clínico é descrever uma cirurgia periodontal para correção de sorriso gengival e ajuste cosmético associado à restaurações estéticas diretas em resina composta. Paciente do gênero feminino insatisfeita com seu sorriso apresentou ao exame clínico irregularidades no contorno gengival, coroas clínicas curtas nos dentes anteriores, presença de restaurações classe III esteticamente insatisfatórias e giroversão no canino. Foi realizada cirurgia de gengivectomia de bisel interno, proporcionando equilíbrio estético entre as estruturas faciais e dento gengivais. Após três meses da cirurgia a terapia cosmética foi realizada para corrigir a giroversão do canino, possibilitando o melhor alinhamento dental, e substituição das restaurações estéticas anteriores em resina composta. A interação entre a Periodontia e a Dentística mostrou-se essencial para viabilizar a previsível reabilitação estética e funcional, possibilitando atender as expectativas da paciente e proporcionar longevidade.

The aim of this case report is to describe a surgical procedure of increasing clinical crowns of anterior teeth and to adequate the smile line associated with direct cosmetic restorations. A female patient presented dissatisfaction with smile, regarding of gum line irregularity, short clinical crowns, unsatisfactory class III restorations and position alterations of canine. A modified Widman surgery with partial-thickness mucoperiosteal flap was done aiming to increase the clinical crowns of anterior teeth and to modify the smile line, providing a better balance between the facial structures and dental-gingival relation. After three months of surgery, cosmetic adjustment was made to correct the position of maxillary canine, improve the alignment and a replacement of the anterior restorations were performed. The interaction between Periodontology and Restorative Dentistry showed is essential for obtaining the favorable aesthetic rehabilitation and maintaining the functionality and periodontal health, which contributes for better longevity.