A relevância da odontologia na Síndrome Treacher Collins: relato de caso / The relevance of dentistry in Treacher Collins Syndrome: case report

Treacher Collins também chamada de disostose mandibulofacial, é uma alteração genética dominante rara caracterizada pela má-formação dos ossos e tecidos da face. É uma síndrome crânio-facial que apresenta alterações bilaterais e simétricas de estruturas originadas do primeiro e segundo arcos branquiais. A maioria dos casos possui transmissão autossômica dominante e expressividade variável. O objetivo do presente estudo é realizar um relato de caso sobre o impacto do tratamento odontológico na qualidade de vida do paciente portador de Treacher Collins. Paciente, 39 anos, sexo feminino compareceu a uma clínica odontológica em Belo Horizonte, com a queixa principal de falhas dentárias e sensibilidade. Durante a anamnese a paciente relatou ter a STC, durante o exame clínico extraoral verificou a presença de hipoplasia malar e mandibular, malformação dos pavilhões auriculares com perda auditiva, obliquidade e coloboma palpebral inferior. Ao exame intraoral observou ser classe II de Angle, ausência dos dentes 11, 12, 13, 21 e 22 e extrusão do dente 41 e recessão gengival e periodontite estágio I grau A. Após exames de periodontograma e complementares foi realizado uma raspagem nas áreas com profundidade de sondagem maior que 3mm, frenectomia labial inferior, aplicação de laser para sensibilidade, enxerto gengival e colocação de prótese parcial removível. A paciente ao final do tratamento relatou ter se sentido realizada e contente com a sua conclusão, ela foi encaminhada ao Sistema único de Saúde para realizar as cirurgias para corrigir as alterações crânio-faciais. O tratamento odontológico deve ser adaptado a cada indivíduo de acordo com sua necessidade, tendo uma abordagem multidisciplinar, possibilitando uma melhora na qualidade de vida e estética do paciente(AU)

Treacher Collins syndrome is a rare dominant genetic disorder characterized by malformation of the bones and tissues of the face. It is a craniofacial syndrome that presents bilateral and symmetrical alterations of structures originating from the first and second branchial arches. The aim of the present study is to perform a case report on the impact of dental treatment on the quality of life of a patient with CTS. Patient, 39 years old, female, attended a dental clinic in Belo Horizonte, with the main complaint of dental flaws and sensitivity. During the anamnesis the patient reported having CTS, during the extraoral clinical examination she verified the presence of malar and mandibular hypoplasia, malformation of the pinnae with hearing loss, obliquity and lower eyelid coloboma. Intraoral examination revealed Angle class II, missing teeth 11, 12, 13, 21 and 22, extrusion of tooth 41, gingival recession and stage I periodontitis grade A. After periodontogram and complementary exams it was performed a scaling in areas with a probing depth greater than 3mm, lower lip frenectomy, laser application for sensitivity, gingival graft and placement of partial removable prosthesis. The patient at the end of treatment reported feeling fulfilled and happy with its completion, she was referred to the Unique Health System to undergo surgery to correct the craniofacial changes. The current treatment aims at functional and aesthetic correction and the need for psychosocial support, having the joint participation of a multidisciplinary team to achieve this goal(AU)

Manejo interdisciplinario para una óptima rehabilitación oral / Interdisciplinary management for optimal oral rehabilitation

Las estrategias para el éxito en la rehabilitación bucal requieren de la interrelación de varias disciplinas que en conjunto logren resultados predecibles y duraderos. La visión individualizada de cada área de especialidad puede conllevar a no ofrecer la mejor alternativa de tratamiento, es por ello que la valoración, el diagnóstico y la planificación del caso clínico debe ser realizada por un equipo interdisciplinario para evitar esta situación y crear una sinergia en donde el «todo sea mayor que la suma de sus partes¼. El objetivo de este trabajo es presentar un caso clínico en el cual intervinieron varias áreas de especialidad: periodoncia, prostodoncia, cirugía oral y patología bucal, logrando devolver la función y la estética a través del manejo interdisciplinario (AU)

The strategies for success in oral rehabilitation require the interrelation of several disciplines, which together, achieve predictable and lasting results. The individualized view of each specialty area may lead to not offering the best treatment alternative, which is why the assessment, diagnosis, and planning of the clinical case must be carried out by an interdisciplinary team to avoid this situation and create a synergy in where the «whole is greater than the sum of its parts¼. The objective of this work is to present a clinical case where several areas of specialty intervened: periodontics, prosthodontics, oral surgery, and oral pathology, thus achieving the return of function and aesthetics through interdisciplinary management (AU)

Utilización de láser diodo en tejidos blandos: reporte de 3 casos / Use of diode laser in soft tissue: report of 3 cases

Existen diversas condiciones anatómicas o alteraciones mucogingivales que pueden afectar tanto el normal funcionamiento como la estética gingival de piezas dentarias e implantes dentales. Si bien los tratamientos de estas condiciones se han realizado tradicionalmente con bisturí, el desarrollo tecnológico ha permitido que actualmente se pueden realizar con láser. Existen diferentes tipos de láser, siendo el diodo uno de los más utilizados debido a su menor tamaño, portabilidad, fácil configuración y menor costo. El láser ha adquirido mayor popularidad en cirugías de tejido blando dado sus múltiples beneficios: menor tiempo operatorio, control del sangrado y de la hemostasia, reducción de la cantidad de anestesia, posibilidad de no requerir suturas y minimización del dolor e inflamación postquirúrgica. El propósito de este trabajo es presentar la resolución de tres casos clínicos a los cuales se les realizaron los procedimientos de frenectomía labial, remoción de melanosis gingival y resección de fibroma irritativo mediante el uso de láser diodo. Para desarrollar todos los procedimientos se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia que varió entre 2 y 2.5 W en modo continuo utilizando una pieza quirúrgica con una punta de 300 µm (E 3-4), la que fue activada antes de empezar. Posterior a la cirugía se bioestimuló para disminuir el dolor y edema postoperatorio utilizando la punta de dolor a 4 W por 30 segundos a una distancia de 1 cm directo en la zona intervenida a todos los casos. La conclusión arroja que en todos los casos, el láser de diodo permitió un resultado exitoso. El procedimiento fue seguro, la técnica fue sencilla y de tiempo clínico reducido. El postoperatorio ocurrió con ausencia de dolor o molestias, generando una mayor satisfacción del paciente. Cabe señalar que la técnica depende de la habilidad del profesional que la realiza.

There are various anatomical conditions or mucogingival alterations that can affect the normal functioning and the gingival aesthetics of teeth and dental implants. Although the treatments of these conditions have been traditionally performed with a scalpel, technological development has allowed that they can be now performed with lasers. There are different types of lasers, being the diode one of the most used due to its smaller size, portability, easy configuration, and lower cost. The laser has become more popular in soft tissue surgeries due to its multiple benefits: shorter operating time, control of bleeding and hemostasis, reduction in the amount of anesthesia, possibility of not requiring sutures, and minimization of post-surgical pain and inflammation. The purpose of this work is to present the resolution of three clinical cases which underwent labial frenectomy procedures, removal of gingival melanosis and resection of irritative fibroma using diode laser. To develop all the procedures, a 940 nm diode laser equipment (Biolase®, USA) was used with a power that varied between 2 and 2.5 W in continuous mode, using a 300 µm tip (E 3-4), which was activated before starting. After surgery, biostimulation was carried out to reduce postoperative pain and edema using the pain tip at 4 W for 30 seconds at a distance of 1 cm directly in the operated area in all cases. In all cases, the diode laser allowed a successful result. The procedure was safe, the technique was simple, and the clinical time was short. The postoperative period occurred with the absence of pain or discomfort, generating greater patient satisfaction. It should be noted that the technique depends on the skill of the professional who performs it.

Patologías del área oral en los recién nacidos e infantes: frenillos y las aportaciones de los sistemas láser / Pathologies of the oral area in newborns and infants: frenula and contributions of laser systems

El propósito de este artículo es mejorar nuestro conocimiento sobre las estructuras y función de los diferentes elementos presentes en la boca del recién nacido, ya que en ocasiones los odontólogos no recuerdan la importancia de la boca en el desarrollo general del lactante y la necesidad de una intervención temprana con láseres para ayudarles a obtener un buen estado de su sistema oral. Realizamos una exploración clínica integral del paciente con el fin de realizar un diagnóstico más preciso. Cuando la cirugía sea necesaria, recomendamos utilizar láseres de Erbio siempre que sea posible (láser de 2780nm Er, Cr: YSGG o un Er: YAG de 2940nm), ya que es una opción rápida y eficaz para tratar estas lesiones orales, especialmente los frenillos labiales o linguales que pueden poner en riesgo el acto de amamantar; Asimismo podemos utilizar láseres de diodo (810nm, 940nm, 980 nm o un láser Nd: YAG de 1064nm o de CO2 10.600- 9600 nm) con sus gafas de seguridad específicas. Estos sistemas láser utilizados por un profesional certificado, en colaboración con un personal debidamente entrenado, son un factor muy importante durante la cirugía. Al tener un conocimiento adecuado de las estructuras orales y sus patologías, podemos diagnosticar si esos trastornos deben tratarse quirúrgicamente y, de ser así, cómo proceder con los sistemas láser, ya que son procedimientos mínimamente invasivos; o si debiésemos recomendar a los padres que visiten a un terapeuta miofuncional para ayudar a recuperar la función normal. La comprensión de las estructuras orales de los recién nacidos es muy importante para promover el desarrollo del crecimiento craneofacial y para brindar un servicio importante a las madres, dándoles a sus bebés un buen comienzo en la vida desde una etapa muy temprana. Necesitamos mejorar la colaboración entre profesionales de diferentes disciplinas con el fin de mejorar nuestro conocimiento.

The purpose of this article is to improve our knowledge about the structures and function of the different elements present in the mouth of newborns since dentists sometimes do not remember the importance of the mouth in the general development of infants and the need for an early intervention with lasers to help them obtain a good state of their Oral System. We performed a comprehensive clinical exploration of the patient in order to make a more accurate diagnosis. When surgery is necessary, we recommend to use erbium lasers when possible (2780nm Er, Cr: YSGG laser or a 2940nm Er: YAG), as they are a quick and effective option to treat these oral lesions, especially lip or tongue ties which can risk the act of breastfeeding; moreover, we can also use diode lasers (810nm, 940nm, 980nm or a 1064nm Nd:YAG laser or CO2 10.600-9600 nm.) al lof them with their specifical safety goggles. These laser systems used by a certified professional, in collaboration with a properly trained staff, are a very important factor during the surgery.By having proper knowledge of the oral structures and their pathologies, we are able to diagnose whether those disorders should be surgically treated and if so, how to proceed with laser systems as they are minimally invasive procedures; or if we should recommend parents to visit a myofunctional therapist in order to help recover the normal function.The understanding of oral structures of newborns is very important in order to improve the development of craniofacial growth and provide an important service to mothers by giving their babies a right start in life from a very early stage. We need to improve collaboration between professionals from different disciplines in order to enhance our knowledge.

Resultados clínicos del tratamiento de frenillos labiales; frenectomía y frenotomía / Clinical results of the treatment of labial frenulums; frenectomy and frenotomy

OBJETIVO: El propósito de esta revisión fue evaluar sistemáticamente la literatura científica sobre los resultados clínicos que se obtienen al remover los frenillos aberrantes al utilizar los procedimientos quirúrgicos convencionales y el láser. MATERIALES Y MÉTODOS: Búsqueda detallada en las bases de datos PubMed, ScienceDirect, Cochrane y SciELO para obtener la información más actualizada los resultados clínicos (dolor posoperatorio, dolor al hablar, dolor al masticar y complicaciones posquirúrgicas) entre las técnicas convencionales (uso del escalpelo) y las técnicas de remoción con el láser (búsqueda de ensayos clínicos). RESULTADOS: De los 501 archivos identificados inicialmente, se excluyeron reportes clínicos, revisiones, estudios observacionales, comentarios, estudios con pacientes pediátricos, etc. Se incluyeron cuatro ensayos clínicos que contrastaron las variables entre la técnica convencional y las técnicas con el láser Nd: YAG y láser CO2 CONCLUSIÓN: La percepción del dolor posoperatorio, el dolor al hablar y el disconfort al masticar luego de la frenectomía es menor en las técnicas que utilizan el láser de Nd: YAG y CO2 frente a las técnicas que utilizan el escalpelo. El tiempo quirúrgico con el uso del láser es significativamente menor que al utilizar el escalpelo. La heterogeneidad de los estudios limita la realización de un metanálisis con respecto a los resultados.

OBJECTIVE: The purpose of this review was to evaluate systematically the scientific literature on the clinical results obtained by removing aberrant frenulums using conventional surgical procedures and laser. MATERIALS AND METHODS: A detailed search was performed in the PubMed, ScienceDirect, Cochrane and SciELO databases to obtain the most up-to-date clinical results (postoperative pain, pain when speaking, pain when chewing and postoperative complications) among conventional (scalpel use) and laser removal techniques (search for clinical trials). RESULTS: Of the 501 records initially identified, clinical reports, reviews, observational studies, comments, studies with pediatric patients, etc. were excluded. We included four clinical trials that contrasted the variables between the conventional technique and the techniques with the Nd: YAG laser and CO2 laser. CONCLUSION: The perception of postoperative pain, pain when speaking and chewing discomfort after frenectomy is lower in the techniques using the Nd: YAG and CO2 laser versus the techniques using the scalpel. The surgical time when using of laser is significantly lower than when using the scalpel. The heterogeneity of the studies limits the performance of a meta-analysis with respect to the results.

Surgical Management of Frenula: Laser Therapy Compared with Z-Frenuloplasty Technique

Abstract Objective: To compare intra- and post-operative consequences associated with Z-frenuloplasty and laser therapy for both upper labial and lingual frenulectomies. Material and Methods: Clinical data of 120 consecutive patients with a mean age of 11 years and 2 months (age range from 9 years and 1 month to 14 years and 3 months) with hypertrophic labial and lingual frenula were assembled. Of the 70 labial frenula, 35 were removed through Z-frenuloplasty (Group 1) and 35 with laser (Group 2); of 50 lingual frenula, instead, 25 were extracted through Z-frenuloplasty (Group 1A) and 25 with laser (Group 2A). The cutting device was Laser Diode Handy 10 in continuous mode. Finally, the time of the surgery, pain and swelling were measured 24-48 hours after the removal. VAS scale was used. Results: The time of the surgery, VAS score after the removal and the swelling were lesser in Group 2 and 2A. Conclusion: Both Z-frenuloplasty and Laser therapy are valid instruments to remove frenula. Moreover, laser offers more advantages like less use of anesthesia, no bleeding in the operating phase, no need for suturing, a faster tissue healing and minor limitations in speech and nutrition.

Perceptions of the Use of the Diode Laser in Dental Surgery: A Qualitative Study

Abstract Objective: To discover the perceptions of pediatric patients, their parents and undergraduate Dentistry students of the use of the diode laser in frenectomy surgeries. Material and Methods: A qualitative study was conducted through semi-structured interviews, recorded and transcribed with subsequent content analysis. Twelve healthy children (5-8 years old) who needed a frenectomy were selected and invited, together with their parents, to undergo laser diode surgery. In addition, 28 undergraduate dentistry students were invited to attend the procedures. One week after performing the surgical procedures, the children (Group 1), their parents (Group 2) and the students who attended the procedures (Group 3) were individually interviewed for the thematic analysis. Results: The analysis of the conversations identified three emerging contents: positive thoughts on the use of diode laser; frustrations from the use of diode laser; and aspects related to professional training. Conclusion: The results pointed to the acceptance of surgical laser use in pediatric dentistry; however, the feelings of frustration indicate that its use requires guidance from the child and his/her parents, in addition to careful handling and specific training.

Displasia ectodérmica hipohidrótica tipo 1 ligada al cromosoma X, síndrome de Christ-Siemens-Touraine: caso clínico y revisión de la literatura / Type 1 hypohidrotic ectodermal dysplasia X-linked, the Christ-Siemens-Touraine syndrome: a clinical case and review of the literature

La displasia ectodérmica hipohidrótica tipo 1 ligada al X (DEH1-X) ­síndrome de Christ-Siemens-Touraine­ es una genodermatosis que forma parte de las displasias ectodérmicas, caracterizadas por alteraciones en el desarrollo de una o más estructuras derivadas de ectodermo. Clínicamente presenta hipotricosis, hipohidrosis e hipodontia de severidad variable. Propósito: Describir las características clínicas de la DEH1-X, su manejo odontológico y diferenciarla de otras entidades patológicas. Caso clínico: Paciente masculino de 18 años de edad, con antecedente familiar de displasia ectodérmica hipohidrótica diagnosticada también en un hermano menor. Acude a consulta por prótesis anterior fracturada y mal ajustada. Se trató mediante frenilectomía anterior y rehabilitación bucal protésica. Discusión: En el diagnóstico y tratamiento de las alteraciones congénitas de desarrollo es de particular importancia la identificación temprana y el trabajo en equipo multidisciplinario. El plan de tratamiento y manejo clínico de tejidos orales blandos y duros debe ser adaptado a las necesidades particulares del padecimiento, lo que permitirá establecer un mejor pronóstico. Conclusiones: La DEH1-X es una alteración congénita del desarrollo que afecta estructuras orales, por lo que debe ser identificada por el estomatólogo para atender correctamente las alteraciones dentales y evitar complicaciones posteriores (AU)

Type 1 hypohidrotic ectodermal dysplasia X-linked (DEH1-X) -Christ-Siemens-Touraine syndrome- is a genodermatosis. Ectodermal dysplasias are characterized by development alterations on one or more ectodermal derived structures. IN DEH1-X, patients present hypotrichosis, hypohidrosis and hypodontia of variable severity. Aims: To describe anatomic and clinical characteristics of the DEH1-X, dental treatment, and to differentiate from other clinical conditions. Case report: Male teenager, 18-year-old, was referred for replacement of anterior dental prosthesis. Family history for hypohidrotic ectodermal dysplasia was positive, younger brother with the same condition. Treatment consisted of anterior labial frenectomy and dental prosthetic rehabilitation with acceptable clinical and esthetic's results. Discussion: When diagnosing and treating patients with developmental genetic conditions is particularly important the early detection and the participation of interdisciplinary team work. The clinical treatment of hard and soft tissues of the oral cavity has to be planned and personalized according to the particular needing of each case, in order to achieve better results and long term prognosis. Conclusions: DEH1-X is a congenital developmental disorder, which affects oral structures, should be identified and treated appropriately by the dentist to prevent further dental complications (AU)

Aplicación del Láser de Baja Potencia (LLLT) en Pacientes Pediátricos: Revisión de Literatura a Propósito de una Serie de Casos / Application of Low Power Laser (LLLT) in Pediatric Patients: Review of the Literature in a Series of Cases

RESUMEN: El uso del láser de baja potencia en odontología está siendo cada vez más frecuente y con excelentes resultados, los equipos más modernos traen pre-establecidos la dosimetría de los parámetros para las diferentes acciones clínicas. El objetivo de esta revisión fue encontrar evidencia científica que permita al clínico tener como una alternativa de tratamiento el uso del láser de baja potencia en patologías orales de tejidos blandos y duros en pacientes pediátricos. Se realizó una revisión de la literatura por medio de buscadores como PubMed, LILACS y SciELO. Después de leer a texto completo todos los trabajos es posible señalar que el láser de baja frecuencia es una buena alternativa terapéutica en la resolución de signos y síntomas en patologías orales que aquejan al paciente pediátrico, puesto que, presenta un rápido control del dolor, la inflamación, el sangrado y acelera los procesos de reparación celular.

ABSTRACT: Low Level Laser Therapy in dentistry is becoming more frequent and has had excellent results, with state of the art equipment having pre-established dosimetry parameters for the various clinical actions. The objective of this review was to find scientific evidence that allows the clinician to have the use of low power laser as treatment alternative, in oral soft tissue and hard pathologies in pediatric patients. A review of the literature was performed through search engines such as PubMed, LILACS and SciELO. After reading the texts, it was possible to point out that low frequency laser is a good therapeutic alternative in the resolution of signs and symptoms in oral pathologies of the pediatric patient. This alternative allows for rapid pain control, reduces inflammation and bleeding, and accelerates cellular repair processes.

Vantagens da frenectomia labial por laser de diodo de alta intensidade / Advantages of lip frenectomy with high-intensity diode laser ­ a case report

Existem condições clínicas em Periodontia na qual o freio labial está posicionado de forma penetrante nas papilas gengivais, ficando muito próximo à margem gengival, podendo predispor ao desenvolvimento de recessões gengivais. Também pode ocorrer dificuldade de higienização, infl amação persistente, restrição no movimento labial, interferência fonética e agravos estéticos, além de dificultar o fechamento de diastemas. Muitas vezes, é indicada a remoção cirúrgica de freios labiais utilizando lâminas de bisturi e, mais recentemente, o laser de alta intensidade. O laser, ao ser absorvido pelos tecidos, gera a vaporização e sublimação, resultando em corte e exérese, além de atuar como auxiliar na cicatrização, provavelmente através da bioestimulação. Seu meio ativo promove a vaporização completa e a coagulação nos tecidos, sem gerar propagação do aquecimento. Há maior controle da hemorragia transoperatória, resultando em um procedimento cirúrgico limpo, frequentemente dispensando suturas, facilitando a visibilidade, execução e remoção do freio labial. O objetivo deste trabalho foi demonstrar as vantagens do laser cirúrgico de alta intensidade (Nd:YAG; 808 nm; 1,2 W; 20 pps; 126 J) a partir de um relato de caso clínico de frenectomia realizada em uma paciente do sexo feminino, com 34 anos de idade, que apresenta freio labial persistente associado a diastema interincisal superior. O procedimento cirúrgico com laser de alta intensidade em tecidos moles apresentou algumas vantagens, como a redução do tempo cirúrgico, de morbidade e sintomatologia pós-operatórias.

There are clinical conditions in periodontics where the labia frenulum is deeply positioned into the gingival papillae getting very close to the gingival margins, predisposing the development of recessions, causing difficulties for cleaning, with persistent infl ammation, lip movement restrictions, phonetic interference, esthetic alteration, besides preventing diastema closure. Oftentimes, removal with a surgical blade or high-intensity lasers is recommended. The laser is absorbed by the tissues generating vaporization and sublimation which results in cutting and excision, and increased improved healing possibly due to its bio-stimulatory effect. Its active medium promotes complete tissue vaporization and coagulation, without heat propagation, control of the intraoperative bleeding and a clean surgery that often does not require sutures. This facilitates visibility, execution and removal of the labial frenulum. The aim of this paper was to demonstrate the surgical benefi ts of the high-intensity laser (Nd:YAG; 808 nm; 1.2 W; 20 pps; 126 J) in a case report of frenectomy for a 34 years-old female patient presenting persistent inter-incisal diastema associated with an atypical labial frenulum. The soft tissue laser therapy has the advantage of reduced clinical time and still not promoting edema, with minimal postoperative pain and side effects.

Frenectomia labial pela técnica de reposicionamento cirúrgico proposta por Chelotti / Labial frenum by chirurgic replacement technic proposed by Chelotti

O freio labial superior, localizado entre os incisivos centrais superiores, é uma estrutura anatômica fina e triangular com base voltada para apical e estendendo-se do tubérculo do lábio superior até o processo alveolar. Quando, ao se tracionar o lábio para frente, para baixo e lateralmente com o objetivo de manter o freio tenso, ocorre uma isquemia tecidual, a intervenção cirúrgica está indicada, obedecendo a princípios da necessidade e oportunidade cirúrgica, principalmente no paciente infantil. A proposta deste trabalho foi apresentar um caso clínico de paciente com oito anos de idade, gênero masculino, que apresentou ao exame clínico freio tetolabial persistente que, ao ser tracionado, produzia isquemia na papila palatina, além da presença de diastema interincisal. O tratamento proposto foi o reposicionamento cirúrgico do freio. Concluiu-se que a técnica proposta contribuiu para o fechamento espontâneo do diastema e preservou as características anatômicas, funcionais e estéticas do freio labial superior.(AU)

The upper labial frenum, between maxillary central incisors, is a thin and triangular anatomical structure which base is faced to the apex extending from the upper labial tubercle until the alveolar process. When the upper lip is pulled to keep its tense, and blanches through to the palatal papilla, this seems to be an indication for its removal, regarding the principles of surgery needs and opportunity, mainly in young patient. Patient with eight years old, male, had abnormal frenum that when was pulled, blanched through to the palatal papilla, besides the midline diastema. In the RX no alteration was observed and we confirmed that midline diastema theory it was a result of abnormal frenum. The proposed treatment was a frenum replacement surgery. This technic had cooperated to the diastema naturally closure and had preserved the anatomical, functional and aesthetics characteristics of the upper labial frenum.(AU)

Tratamento cirúrgico de freio labial anormal / Surgical removal of abnormal labial frenulum

O freio labial torna-se um problema se sua inserção está próxima à gengiva marginal, ou quando mantém sua inserção na papila palatina, transformando-se em uma grossa faixa de tecido denominado freio labial anormal. Esta é uma das causas do diastema interincisal. Para solucionar este problema existem cirurgias periodontais como a frenectomia e a frenotomia. O objetivo deste trabalho foi mostrar a remoção cirúrgica de um freio com inserção anormal superior, utilizando a associação das técnicas de frenectomia e de frenotomia labial. Paciente com 21 anos de idade, do sexo masculino, procurou atendimento odontológico com queixa estética, relatando constrangimento ao sorrir por seus dentes anteriores superiores apresentarem diastema. Durante exame clínico foi observado freio labial proeminente inserido na gengiva papilar dos incisivos centrais superiores, que ao ser tracionado, causava isquemia papilar. O exame radiográfico mostrou ausência de lesões patológicas. Considerando a localização da inserção do freio labial, o tratamento eleito foi a frenotomia labial superior associada à frenectomia palatina. No pós-operatório de sete dias não houve relato de dor, o edema era mínimo, não havia sinais de infecção e o tecido apresentava-se com boa condição de reparo tecidual. Após seis meses, houve completa cicatrização tecidual, ausência de inflamação ou sintomatologia dolorosa e condição clínica adequada para a realização do tratamento ortodôntico. Concluiu-se que a cirurgia com associação das técnicas de frenectomia e frenotomia do freio labial pode ser considerada opção de tratamento cirúrgico seguro, com prognóstico favorável em longo prazo.

Labial frenulum becomes a problem if their insertion is near the marginal gingiva, or when you keep their insertion in the palatine papilla, turning into a coarse band of tissue, called abnormal labial frenulum. This is one of the causes of interincisal diastema. To solve this problem there are periodontal surgery as frenectomy and frenotomy. The objective of this study was to demonstrate the surgical removal of a brake with upper abnormal insertion, using the association of frenectomy and frenotomy labial techniques. Patient 21 years of age, male, came for dental care esthetic complaint, reporting constraint to smile for your upper front teeth present diastema. During clinical exam was observed prominent labial frenulum inserted in the papillary gingiva of the maxillary central incisors, that to the being tractioned, was causing papillary ischemia. Radiographic exam present with the absence of pathologic lesions. Considering the location of the insertion of the labial frenulum, treatment was elected the upper labial frenotomy associated with palatine frenectomy. Postoperatively 7 days there was no report of pain, the edema it was minimal, there were no signs of infection and the tissue presented with good condition of tissue repair. After 6 months, there was complete tissue healing, absence of inflammation or painful symptomatology and adequate clinical condition for the completion of orthodontic treatment. It is concluded that surgery with a combination of techniques of frenectomy and frenotomy the labial frenulum can be considered safe surgical treatment option with a favorable prognosis in the long term.

Gingivoplastia y frenillectomía labial con láser de alta intensidad: presentación de caso / Gingivoplasty and labial frenectomy with high intensity laser: presentation of a case

En los últimos años la estética se ha convertido en motivo de consulta odontológica frecuente. Los pacientes creen que la estética de la sonrisa depende de los dientes; sin embargo, al realizar la evaluación clínica, el profesional puede detectar inconformidad estética del paciente condicionada por factores del medio bucal como los tejidos blandos del periodonto de protección, específicamente la encía aumentada o la inserción muy baja de la mucosa de los frenillos labiales, lo que puede ocasionar que los pacientes manifiesten ver sus dientes de tamaño reducido; además al sonreír pueden exponer gran cantidad de encía. A continuación se expone el caso de una paciente mujer que acude a consulta por inconformidad estética en la sonrisa y tamaño dental; tras la valoración intraoral se diagnostica gingivitis localizada asociada a placa bacteriana y presencia de frenillo papilar alargado, provocando apariencia de dientes cortos o pequeños. Se decide realizar procedimiento quirúrgico mínimamente invasivo para reposicionar los tejidos blandos y mejorar la armonía, respetando espacios biológicos, utilizando terapia con láser de alta intensidad considerando las ventajas de su uso como tiempo de intervención menor, no requerir anestesia local, menor sangrado, tiempo de cicatrización más corto y haciendo innecesario el uso de suturas al compararle con la cirugía convencional con bisturí. Al finalizar el procedimiento la paciente manifiesta satisfacción y ausencia de dolor. Tras control posquirúrgico a los 15 días se aprecia ausencia de edema en el tejido gingival, reposicionamiento de la inserción del frenillo labial superior y borde libre de encía marginal en los órganos dentarios anterosuperiores reposicionados en sentido apical.

In recent years, aesthetics has become a common reason for a dental visit. Patients believe that the aesthetics of the smile depends on the teeth. However, when the clinical evaluation is carried out, the professional can also detect aesthetic dissatisfaction of a patient, conditioned by factors of the oral environment, such as periodontium soft tissue, in particular the increased gingiva or low insertion of the mucosa of the labial frenulum. These may cause patients to believe that their teeth are reduced in size, due to much more gum being exposed when they smile. The clinical case is presented of a female patient who made a dental appointment because of aesthetic dissatisfaction with her smile and dental size. After the intraoral assessment was carried out, a diagnosis was made of a localized gingivitis associated with plaque and presence of an elongated papillary frenum, giving the appearance of short or small teeth. It was decided to perform a minimally invasive surgical procedure to generate the reposition of soft tissues and improve harmony, respecting biological spaces. High-power laser therapy was performed, due to the advantages of its use, such as reduced intervention time, no requirement of local anesthesia, less bleeding, shorter healing time, and unnecessary use of sutures, compared with conventional surgery carried out with scalpel. Immediately after the procedure, the patient felt satisfaction and no pain. On day 15 post-surgery it was observed that there was no swelling of gingival tissue, reposition of the insertion of the upper frenum, and free edge of marginal gingiva in anterior-superior teeth in an apical direction.

Surgical Management of Aberrant Labial Frenum Using Modified Z-Frenuloplasty: A Case Report.

Frenum is a mucous membrane fold that attaches lips and cheek to the alveolar mucosa, gingiva, and the underlying periosteum. The maxillary frenum can contribute to esthetic problems and can compromise the orthodontic outcome in cases of midline diastema, thus leading to treatment relapse. In addition to this, it may jeopardize the health of the gingival, when it is attached too tightly to the gingival margin, by interference in the plaque control or owing to the muscle pull. These situations can be managed with the help of frenectomy. The presenting case report demonstrates the frenectomy of an anomalous labial frenum in a 20-year-old male using modified Z-frenuloplasty technique.

Frenillo labial superior doble / Double frenulum of the superior lip

El frenillo labial superior doble no sindrómico es una anomalía del desarrollo que no hemos encontrado reportada en la revisión bibliográfica realizada. Se presenta una niña de 11 años de edad que fue remitida al servicio de Cirugía Maxilofacial del Hospital Eduardo Agramonte Piña , de Camagüey, por presentar un frenillo labial superior doble de baja inserción. Se describen los síntomas clínicos asociados a esta anomalía y el tratamiento quirúrgico utilizado para su solución: una frenectomía y plastia sobre la banda muscular frénica anormal que provocaba exceso de tejido en la mucosa labial. Consideramos muy interesante la descripción de este caso, por no haber encontrado reporte similar en la literatura revisada

Non-syndromic double frenulum of the superior lip is a developmental anomaly that was not found as reported in our literature review. This is the case of an eleven-years old girl who was referred to the maxillofacial surgery service of Eduardo Agramonte Pina hospital in Camaguey, with a diagnosis of double frenulum of the superior lip of low insertion. The clinical symptoms linked to this anomaly and the surgical treatment applied to this case were described in this paper: frenectomy and frenoplasty upon the abnormal muscular band of the frenulum that brought excessive amount of tissue in the lip mucosa. The description of this case was considered to be very interesting since no similar report had been found in the reviewed literature

Opção cirúrgica para remoção de freio labial superior preservando a papila / Surgical option for removing upper labial frenulum preserving the papila

Os freios bucais são considerados formações anatômicas que, em condições normais, não causam consequências patológicas. No entanto, em alguns casos, os freios podem ocasionar problemas clínicos, fundamentalmente de natureza ortodôntica, protética, fonética e/ou periodontal. Estes podem estar relacionados com a presença de diastemas, dificuldade na realização da higiene bucal, acúmulo de biofilme dentário, entre outros problemas. Em todos os casos em que há consequências patológicas ocasionadas pela presença do freio labial, sua remoção pode ser indicada. Nesse contexto, o presente relato de caso teve por objetivo apresentar e explorar uma modalidade de técnica cirúrgica utilizada para remoção de freios labiais em que o principal foco é manutenção da papila interdentária, obtendo-se um resultado estético mais favorável. Paciente leucoderma, sexo feminino, 22 anos, não tabagista e sem alterações sistêmicas significativas, foi encaminhada por um profissional ortodontista para avaliação da possível associação entre o freio labial superior e a presença do diastema entre os elementos 11 e 21 e sua consequente influência no fechamento desse espaço. O plano de tratamento proposto foi a remoção cirúrgica do freio labial superior a partir da técnica de frenoplastia para posterior fechamento do diastema anterior pelo tratamento ortodôntico. A modalidade terapêutica utilizada no presente relato de caso foi efetiva para resolução do problema apresentado pela paciente. Assim, a modalidade cirúrgica utilizada propiciou melhor estética a região anterior, por ter como uma de suas principais vantagens a manutenção da papila interdentária.

Frenillo Lingual: Cuándo es un problema / Lingual Frenum: WhenÆs it problem

La anquiloglosia es una alteración congénita que se caracteriza por presentar un frenillo lingual corto. Se reporta que esta alteración puede presentar dificultades en la succión, deglución, lenguaje, y problemas ortodóncicos ortopédicos. El propósito de esta revisión es conocer estas alteraciones y determinar si son verdaderas repercusiones de la anquiloglosia, además si ameritan un tratamiento quirúrgico o un tratamiento conservador.

Ankyloglossia is a congenital alteration that is characterized for presenting a short lingual frenum. This alteration can present difficulties in the suction, swallowing, speech, and orthodontics-orthopedic problems. The purpose of this review is to know these alterations and to determine if they are true repercussions of ankyloglossia, besides of they deserve a surgical processing or a conservative precessing.

Diagnóstico e tratamento cirúrgico do freio teto labial persistente em pacientes no período intertransitório da dentição mista: relato de caso / Diagnosis and surgical treatment of an abnormal upper labial frenum at inter-transitory period of mixed dentition: a case report

O freio labial superior é uma estrutura dinâmica sujeito a variações na forma, tamanho e posição durante os diferentes estágios de crescimento e desenvolvimento do indivíduo. No nascimento, o freio é geralmente largo e espesso e se estende até a papila palatina. Com a erupção dos incisivos permanentes e à medida que ocorre o desenvolvimento do processo alveolar, há uma tendência à atrofia fisiológica e ao afastamento apical da inserção do freio. Quando o freio permanece com a inserção na papila palatina ou na margem gengival é então chamado de freio teto labial persistente. Este pode causar diastema mediano, interferir na escovação, causar recessão gengival, provocar a formação de bolsas periodontais, restringir o movimento do lábio, interferir na fonação e produzir efeito estético indesejável. O objetivo deste trabalho consistiu em apresentar um relato de uma paciente do gênero feminino, com dez anos de idade, as principais consequências e o tratamento cirúrgico do freio teto labial persistente. Frente ao relato, pode-se concluir que a frenectomia foi o tratamento que propiciou o reposicionamento e uma nova inserção para o freio labial, deixando que, com o desenvolvimento da oclusão, ocorresse o fechamento do diastema.

The upper labial frenum is a dynamic structure and changeable structure and is subject to variations in shape, size and position during the different stages of growth and development. At birth, the frenum is generally wide and thick and extends to the palatal papillae. The eruption of permanent incisors and the vertical growth of the alveolar process make the insertion of frenum move apically. When the frenum insertion remains at the palatal papillae, its called abnormal upper labial frenum. The abnormal labial frenum, besides creating a diastema, is capable of interfering at oral hygiene, limiting labial movement, causes gingival recession and affects esthetics. The purpose of this study was to present a ten years old female patient report, the main consequences and the surgical treatment of an abnormal labial frenum. In front of this report, it is possible to conclude that frenectomy was the treatment which caused the frenum new position and its new insertion, making possible that, by the occlusion development, it occurred the diastema closing.

Técnica de frenectomia associada a enxerto de mucosa mastigatória: relato de caso clínico / Frenectomy tecnique associated with mastigatory mucosa graft: clinical case report

Freios labiais possuem a função de limitar os movimentos dos lábios, promovendo a estabilização da linha média e impedindo a excessiva exposição da gengiva. A colocação de enxerto da mucosa mastigatória após frenectomia parece evitar a recidiva, aumentar a faixa de gengiva queratinizada e melhorar a estética do paciente. Portanto, o objetivo do presente trabalho é apresentar um caso clínico de frenectomia associada a enxerto de mucosa mastigatória.

Labial frenum have the function to limit the lips moviments, promoting the stability of the medium line and limiting gingival excessive exposition. The mastigatory mucosa graft installation after frenectomy seems to avoid relapse, increase keratinized gingival and improve aesthetics. Then, the objective of this study is to present a case report of the frenectomy combined with a mastigatory mucosa graft.

Frenectomia a laser (Nd: YAP) em Odontopediatria / Laser frenectomy (Nd: YAP) in pediatric dentistry

A frenectomia, tratamento realizado na indicação da excisão do freio labial ou lingual, apresenta diversas complicações trans e pós-operatórias, quando utilizados os métodos cirúrgicos convencionais. O laser cirúrgico vem, crescentemente, sendo empregado nas diversas especialidades odontológicas. O propósito deste trabalho foi apresentar um caso de frenectomias labial e lingual, utilizando-se o laser Nd:YAP em paciente com 5 anos de idade, alcançando melhores condições trans e pósoperatórias ao paciente infantil.

The frenectomy, preconized treatment to the excision of lingual or labial frenun, presents several trans or post complications, when conventional surgical methods are used. Surgical laser has been used in several dentistry specialities. The purpose of this article was to present a case of lingual and labial frenectomies by utilizing the Nd:YAP laser in a 5 years-old patient, achieving the best trans and post surgical conditions to the pediatric patient.