ABSTRACT
BACKGROUND: Junctional epidermolysis bullosa (JEB) is one of the four major types of EB caused by genetic variants in the genes coding the proteins of the lamina lucida. All patients with this major type of EB present syndromic hypoplastic amelogenesis imperfecta (AI), with either a pits and fissures or generalized hypoplastic phenotype. Severe forms of AI are associated with compromised oral health-related quality of life (QoL) mostly due to poor dental aesthetics, dentofacial anomalies, and oral pain. AIM: To present the comprehensive dental treatment of a patient with JEB and AI from the age of 20 months until the age of 18 years, including complex orthodontics and digital oral rehabilitation. MATERIALS AND METHODS: A male patient with intermediate JEB (homozygous c.3228+1G>A LAMB3 variant) has been under the care of the special care dentistry clinic of the University of Chile since the age of 20 months. His complex dental needs include structural enamel abnormalities in primary and permanent dentition (hypoplastic generalized AI), severe dental crowding with maxillary compression, Class III skeletal pattern, agenesia (#45), and gingivitis. RESULTS: Pediatric dental care included oral hygiene education and preventive strategies (prophylaxis and fluoride applications), maintaining the dentition free of caries. Due to AI, severe tooth sensitivity hindered proper oral hygiene and required early rehabilitation with temporary polycarbonate and metallic crowns. At the age of 16, the patient began orthodontic treatment. A maxillary expansion was performed with two consecutive mini-implant assisted rapid palate expansion (MARPE) bonded to four mini-implants in the palate. After finishing orthodontic treatment metallic multibrackets (duration 19 months), a definitive oral rehabilitation based on digital smile design with feldspathic crowns of all anterior teeth and premolars was performed. CONCLUSION: Patients with severe generalized hypoplastic syndromic AI associated with JEB benefit from long-term preventive oral care. Complex orthodontic techniques, such as MARPE, and multibrackets can be successfully. Digital smile design provides a definitive oral rehabilitation technique improving oral function, aesthetics, and QoL.
ABSTRACT
Com os avanços tecnológicos na odontologia o planejamento digital se tornou algo mais presente na prática clinica. O objetivo desse trabalho é relatar uma experiência vivida em clínica sobre harmonização do sorriso através de uma gengivoplastia e remodelação óssea em paciente com displasia cemento óssea florida. Paciente 42 anos, autodeclarada do sexo feminino, não relatou nenhuma alteração sistêmica, uso de medicamento ou tabagismo, entretanto relatou ter displasia cemento óssea florida com diagnóstico de periodonto saudável. Compareceu a clínica escola de uma instituição de Ensino Superior para realização de tratamento odontológico queixando-se da aparência de seus dentes. Neste caso, foi utilizado escaneamento digital, tomografia computadorizada para tecidos moles, Digital Smile Design (DSD) e Perioguide (guia cirúrgico) para a realização do procedimento de harmonização do sorriso através da cirurgia periodontal. Em suma, apesar da displasia óssea ser um fator limitante ao sucesso ideal do procedimento, o resultado final alcançado foi satisfatório sob ótica do paciente e profissional não havendo recidiva(AU)
With technological advances in dentistry, digital planning has become something more present in clinical practice. The objective of this work is to report a clinical experience on smile harmonization through gingivoplasty and bone remodeling in a patient with florid cemento-osseous dysplasia. Patient 42 years old, self-reported female, did not report any systemic changes, use of medication or smoking, however she reported having florid cemento-osseous dysplasia with a diagnosis of healthy periodontium. He attended the school clinic of a Higher Education institution for dental treatment, complaining about the appearance of his teeth. In this case, digital scanning, soft tissue computed tomography, Digital Smile Design (DSD) and Perioguide (surgical guide) were used to perform the smile harmonization procedure through periodontal surgery. In short, despite bone dysplasia being a limiting factor for the ideal success of the procedure, the final result achieved was satisfactory from the perspective of the patient and professional, with no recurrence(AU)
Subject(s)
Humans , Female , Adult , Cone-Beam Computed Tomography , Fibrous Dysplasia of Bone , Bone Diseases, Developmental , Cementoma , Tomography, X-Ray Computed , Photography, Dental , Gingival HyperplasiaABSTRACT
Nowadays, a lot of people need in reconstruction of the teeth in connection with their loss. Before prosthetics or any other manipulations, a person wants to quickly see the aesthetic appearance of his future tooth. At the moment, many dentists use the option of verbal explanation to the patient, what will look like a smile or a front row of teeth after treatment, but the visual representation of the person remains aside. But now this can be achieved with the help of "Digital smile design", which shows the person the final result of the dentition. This technology has a number of advantages. Some of them are the rapid creation of a prototype model and high accuracy in the manufacture of work. Thanks to these technologies, communication between the specialist and the patient has been facilitated. The digital smile design has simplified the doctor's work process and reduced patient data processing time. From now on, achieving aesthetic results in the reconstruction of teeth for the dentist is not a problem.
Subject(s)
Humans , Decision Making, Computer-Assisted , Tooth Loss/therapy , Denture Design/methods , Dental Prosthesis Design/methods , Computer-Aided Design , Proof of Concept StudyABSTRACT
This technique report describes a fully digital workflow in which two surgical guides (i.e. one for alveolar bone reduction and the other for implant placement) are magnetically connected to ensure stability during full-arch implant surgery following guided bone reduction. Digital prosthesis design as well as virtual bone reduction and implant planning are developed from the superimposition of facial, intraoral and CBCT scans. With this technique, different surgical guides and interim poly(methylmethacrylate) (PMMA) fixed prosthesis are precisely connected with magnets after being digitally designed and 3D-printed. As a result, such magnetic connection allows for satisfactory stability of the implant surgical guide, as well as of the interim fixed PMMA fixed prosthesis during capture of screw-retained abutments.
Subject(s)
Dental Implants , Surgery, Computer-Assisted , Alveolar Process , Computer-Aided Design , Dental Implantation, Endosseous , Dental Prosthesis, Implant-Supported , Printing, Three-Dimensional , WorkflowABSTRACT
Com a evolução da odontologia digital, muitos programas de planejamento virtual, scanners intraorais e métodos CAD-CAM têm sido desenvolvidos com o intuito de auxiliar o desenvolvimento e a confecção de guias cirúrgicos prototipados, tanto para a implantodontia quanto para a periodontia, visando permitir que as terapias de reabilitação dental sejam realizadas com maior segurança e previsibilidade. Uma reabilitação estética de sucesso dos pacientes com excesso de exibição gengival e coroas clínicas curtas requer uma abordagem interdisciplinar e sintonia entre o periodontista e o protesista, pois devolver simetria gengival e harmonia ao sorriso é uma tarefa árdua e minuciosa. Dessa forma, o objetivo deste trabalho é relatar um caso clínico de aumento de coroa, utilizando o fluxo de trabalho digital com o uso do guia duplo periodontal. (AU).
The evolution of digital dentistry, many virtual planning programs, intraoral scanners and CAD-CAM methods have been developed with the purpose of assisting the development and production of prototyped surgical guides for both implantology and periodontics, in order to allow that dental rehabilitation therapies are performed with greater safety and predictability. Successful aesthetic rehabilitation of patients with excessive gingival display and short clinical crowns requires an interdisciplinary approach and attunement between the periodontist and the prosthodontist, as returning gingival symmetry and harmony to the smile is an arduous and meticulous task. Thus, the objective of this work is to report a clinical case of Crow increase, using digital workflow with Double periodontal guide.
Subject(s)
Humans , Male , Adult , Technology, Dental , Surgery, Computer-Assisted , Dental Informatics , Esthetics, DentalABSTRACT
Resumen Los pacientes acuden cada vez más, al consultorio odontológico a fin de mejorar el aspecto de su sonrisa, ampliando la demanda de procedimientos estéticos, y es responsabilidad del odontólogo ofrecer distintas técnicas para que el paciente acoja un tratamiento óptimo, orientado a la conservación de los tejidos dentales en este aspecto; las carillas de cerámica sin preparación, o lentes de contacto, constituyen una opción conservadora de recubrimiento parcial, que mejora la estética del sector anterior, el siguiente caso describe una posibilidad restauradora estética mínimamente invasiva para la rehabilitación del sector anterior, con el uso de porcelana IPS e. max® Press, resaltando el proceso de planificación por medio del diseño digital en dos dimensiones.
Abstract Patients increasingly come to the dental office to improve the appearance of their smile, expanding the demand for aesthetic procedures, and it is the dentist´s responsibility to offer different techniques for the patient to receive an optimal treatment, aimed at preserving the dental tissues in this aspect, unprepared ceramic veneers, or contact lenses, are a conservative alternative, which improves the aesthetics of the front sector, the following case describes a minimally invasive aesthetic restorative alternative for the rehabilitation of the anterior sector, with the use of IPS e. max® Press porcelain, highlighting the planning process through digital design in two dimensions.
Subject(s)
Humans , Male , Adult , Dental Porcelain/therapeutic use , Dental Veneers , Esthetics, Dental , Contact LensesABSTRACT
Com a evolução da odontologia digital, muitos programas de planejamento virtual, scanners intraorais e métodos CAD-CAM têm sido desenvolvidos com o intuito de auxiliar o desenvolvimento e a confecção de guias cirúrgicos prototipados, tanto para a Implantodontia quanto para a eriodontia, visando permitir que as terapias de reabilitação dental sejam realizadas com maior segurança e previsibilidade. Uma reabilitação estética de sucesso dos pacientes com excesso de exibição gengival e coroas clínicas curtas requer uma abordagem interdisciplinar e sintonia entre o periodontista e o protesista, pois devolver simetria gengival e harmonia ao sorriso é uma tarefa árdua e minuciosa. Dessa forma, o objetivo deste trabalho é relatar um caso clínico de aumento de coroa, utilizando o fluxo de trabalho digital com o uso do guia duplo periodontal (AU).
The evolution of digital Dentistry, many virtual planning programs, intraoral scanners and CAD-CAM methods have been developed with the purpose of assisting the development and production of prototyped surgical guides for both Implantology and Periodontics, in order to allow that dental rehabilitation therapies are performed with greater safety and predictability. Successful aesthetic rehabilitation of patients with excessive gingival display and short clinical crowns requires an interdisciplinary approach and attunement between the periodontist and the prosthodontist, as returning gingival symmetry and harmony to the smile is an arduous and meticulous task. Thus, the objective of this work is to report a clinical case of crown increase, using digital workflow with double periodontal guide (AU).
Subject(s)
Periodontics , Software Validation , Surgery, Computer-Assisted , Cone-Beam Computed Tomography/instrumentation , BrazilABSTRACT
The use of digital tools offers a new perspective to daily clinical activities. The digital information serves as a starting point for a wax-up and intraoral mock-up, which is widely reported in literature as an objective and efficient communication tool among dentist, patient, and technician. This case report of a maxillary anterior rehabilitation demonstrates esthetic planning with the digital smile design (DSD) system and a direct mock-up technique. After preoperative photographs were obtained, digital planning was created using DSD. However, due to differences in virtual simulation, a direct mock-up with composite resin was performed. Porcelain laminate veneers using feldspathic ceramics were used to restore the anterior teeth. Many times, the DSD simulation is not enough for the patient to understand and observe the changes that will be performed on the anterior teeth. This combination of techniques can offer predictability to results as well increasing the patient expectation satisfaction.
ABSTRACT
Atualmente, o DSD (digital smile design) tem sido utilizado como um recurso de grande destaque para a Odontologia Estética. O uso de um software pode facilitar e implementar através de simulações o tratamento reabilitador estético, fazendo com que haja maior entendimento do paciente sobre o procedimento e seus resultados, bem como evitando equívocos que possam ocorrer durante o tratamento. A técnica consiste em analisar as proporções faciais e dentárias de cada paciente e suas relações com dentes, lábios e gengivas por meio de fotografias digitais e vídeos. Com isso, são realizados desenhos seguindo métodos específicos que podem ser apresentados de maneira simples, compreensível e cativante para o paciente(AU)
Nowadays, the DSD (digital smile design) has been used as a great resource for aesthetic restorative dentistry. Through simulations, the use of a software can facilitate and implement aesthetics rehabilitation treatment, helping the patient to have a better understanding of the procedure and its outcomes, and also avoiding misunderstandings that may occur during the treatment. This technique consists in analyzing facial and dental proportions of each patient and the relations with their teeth, lips and gum through digital photograph and movies. Therefore, designs are made following specific methods that can be presented in a simple way, understandable and engaging for the patient(AU)
Subject(s)
Humans , Female , Adult , Smiling , Dental Restoration, Temporary , Esthetics, Dental , Software DesignABSTRACT
A busca pela estética tem acentuado a procura dos pacientes pela transformação do sorriso. Com o auxílio da fotografia e da tecnologia computacional, é possível a realização do DSD (digital smile design planejamento digital do sorriso), que nos dá maior previsibilidade do tratamento. A confirmação deste planejamento digital se dá na prova do mock-up, a partir do qual o paciente tem a real sensação do seu sorriso planejado. Este artigo apresentou um caso clínico no qual se destaca a adesão do paciente ao tratamento e a realização de cirurgia periodontal para aumento de coroa clínica, seguida de restaurações diretas com resinas compostas, posterior ao enceramento diagnóstico. Com o planejamento integrando a terapia cirúrgica periodontal e o protocolo restaurador adesivo direto guiado por planejamento digital (DSD), foi possível estabelecer um excelente resultado com uma elevada satisfação do paciente.
The seek for esthetics has increased patient´s demand for the smile makeover. With the help of computational technology, it is possible to perform the DSD (digital smile design) with greater treatment predictability treatment. Confirmation of this digital planning occurs in the mock-up test, from which the patient has a physical sensation of his/her planned smile. This article presents a clinical case which highlights the patient cooperation and periodontal surgery for crown lengthening, followed by direct composite resin restorations after the diagnostic wax-up procedure. With an integrated treatment planning guided by the DSD protocol, it was possible to establish an excellent outcome with high patient satisfaction.
Subject(s)
Humans , Female , Adult , Composite Resins/therapeutic use , Esthetics, Dental , Gingivoplasty/methods , Photography, Dental , Smiling , Technology, DentalABSTRACT
Este caso clínico foi realizado com as técnicas e os conceitos mais modernos da Odontologia na atualidade, iniciado pela análise multidisciplinar do conceito Digital Smile Design, do Dr. Coachman e grande equipe, com a qual conseguimos uma análise prévia e uma previsibilidade estética com medidas exatas para o procedimento técnico. Utilizou-se o sistema sem ajuste da AmannGirbach, que combina modelos precisos, com o articulador ARTEX e o sistema CAD/CAM CERAMILL completo. O trabalho foi realizado com ZIRCÔNIA ZOLID FX, monolítica e maquiada, material de última geração que tem uma altíssima translucidez. Esse conjunto de técnicas juntas diminuem o tempo de ajuste nas peças definitivas que chegam à clínica glazeadas e prontas para serem colocadas em boca.
This case was carried out with the most modern techniques and concepts of dentistry. The multidisciplinary analysis of the concept Digital Smile Design, Dr. Coachman and great team, has provided a previous analysis and an aesthetic predictability with precise measures for the technical procedure. We used the system without adjusting the Amann-Girbach,that combines accurate models with ARTEX articulator and complete CAD CAM Ceramill system. The work was made with monolithic ZOLID FX Zirconia, super high-translucent materal. This set of techniques decreases the time of adjustment of definitive pieces that reach the clinic glazed and ready to be placed in the mouth.
Subject(s)
Humans , Female , Middle Aged , Ceramics , Computer-Aided Design , Crowns , Esthetics, Dental , Technology, Dental , ZirconiumABSTRACT
O objetivo dessa revisão foi buscar na literatura o que há de mais relevante e atual sobre o tema Excessiva Mostra Gengival (EMG). Foram incluídos os aspectos de como identificar a condição do que é a EMG, de como avaliar cada paciente portador da EMG e suas características e manifestações, como classificar cada caso e como essa classificação vai influenciar no desenrolar do tratamento. Para esse estudo, foi realizada uma pesquisa bibliográfica no Banco de dados PUBMED, utilizando as palavras-chave: excessive gingival display, lip reposition, smile line, smile design, gummy smile, smile, aesthetic factors in a smile, aesthetic smile. Foram pesquisados 90 trabalhos relacionados a esse tema e também 4 livros foram envolvidos na busca. Destes 90 Artigos, 40 foram utilizados, tendo maior relevância para essa obra. Também foi feita uma busca utilizando palavras em Língua Portuguesa, com as palavras-chave: reposicionamento do lábio superior, excessiva mostra gengival, sorriso gengival, linha do sorriso. Após esse estudo, as conclusões foram: as EMG são classificadas em cinco tipos, com diferentes etiologias. Para cada tipo de EMG existe um tratamento indicado, sendo na maioria das vezes cirúrgico. A EMG quando associada a alterações periodontais são tratadas com cirurgias de menor complexidade e com alta previsibilidade de sucesso. A técnica de mudança de posicionamento do lábio superior (LipStat) mostra ser uma forma bastante promissora para o tratamento de EMG complexa e, finalmente, pesquisas futuras são necessárias para avaliar resultados a longo prazo.(AU)
The objective of this review is to search in the literature the most relevant and updated regarding to the theme Excessive Gingival Display ( EGD ). This search has dealt with the aspects regarding the identification of this condition , what exactly it is that condition , how to evaluate each patient who portrait this situation and identify all relevant characters of the condition EGD . And how this character will influence upon the treatment. For this piece, a search was performed through the database PUBMED, utilizing the key-words: excessive gingival display, lip repositioning, smile line, smile design , gummy smile, smile, aesthetic factors in a smile , aesthetic smile. Searches gathered 90 Articles which were related to the matter and 4 books were involved, too. From these 90 Articles, 40 Articles were utilized, having more relevance. Some words in Portuguese Language were used to perform a search, too. After this search in the literature, conclusions were made: the EDG is classified in five different types, with different etiologies. For every kind of EDG, there is a different kind of treatment, most of them through surgery. The EDG, when associated to periodontal problems are treated by minor complex surgeries, having highly visibility of success. The technique of upper lip repositioning (lipStat) has shown to be a good way to solve the EGD complex cases and finally, future researches are necessary to evaluate long term outcomes.(AU)
Subject(s)
Esthetics, Dental , Gingiva , Gingival Overgrowth , Oral Health , Smiling , ReviewABSTRACT
El diseño, la planificación, la ejecución y la obtención de una sonrisa armónica trajo consigo el avance de materiales odontológicos, tanto para el uso clínico como laboratorial, y modificaciones en las técnicas restauradoras estéticas. Los diastemas son espacios entre dientes adyacentes que causan generalmente incomodidad estética al paciente. Los laminados cerámicos constituyen una buena alternativa para ofrecer al paciente una sonrisa funcional y armónica por sus propiedades ópticas excelentes, además de su biocompatibilidad con la estructura dentaria y gingival, estabilidad de color y durabilidad a largo plazo, sin embargo la ejecución del tratamiento con estos materiales implica una planificación previa, el análisis estético a través de fotografías digitales y del diseño de la sonrisa, encerado de diagnóstico, ensayos de mock-up, el conocimiento de las características del material, dominio de la técnica clínica en cuanto a la preparación de la estructura dentaria preservando el tejido sano por medio del desgaste selectivo, además de la técnica de provisionales y del protocolo para la cementación. Este trabajo tiene como objetivo presentar una técnica de tratamiento restaurador indirecto con laminados cerámicos para el cierre de diastemas con la finalidad de armonizar la sonrisa.
The design, planning, performance and getting a harmonious smile brought an advance of Dental Materials, of clinical use and laboratory,and changes in esthetic restorative techniques. Diastemas are spaces between adjacent teeth which usually cause an esthetic discomfort of the patient. Ceramic veneers are a good alternative to offer the patient for a functional and harmonious smile with excellent optical properties. In addition to the biocompatibility with the tooth and gingival structure, color stability and durability of a long term, however, the execution of treatment with these material implications prior planning, aesthetic analysis of a through digital photography and smile Design, waxing diagnosis, Mock-up, Testing model, knowledge of material properties, domain the clinical preparation of tooth structure preserving healthy tissue through selective wear, in addition to the temporary restoration technique and protocol for cementation. This clinical report aims to present a technique of indirect restorative treatment with ceramic veneers for diastema closure in order harmonize smile.
Subject(s)
Humans , Female , Young Adult , Dental Veneers , Diastema/therapy , Dental Porcelain/therapeutic use , Esthetics, DentalABSTRACT
The digital smile design is a practical diagnosis method that can assist the clinician to visualize and measure dentogingival discrepancies. This clinical report aims to present the associated steps, from the diagnosis of the alterations diagnosis through to the final aesthetic result. A 37-years-old female patient presented as her main complaint the tooth form and colour discrepancies. Applying the digital smile design principle, the necessary measures for a harmonic smile correction could be accurately determined. The initial diagnosis led to a wax up of the master cast that was duplicated in acrylic resin directly in the mouth. This temporary restoration guided the periodontal surgery and the final pressed ceramic crown restoration. We conclude that the digital smile design concept seems to be a useful tool to achieve a satisfactory aesthetic result.
ABSTRACT
This clinical report describes how to achieve predictable outcomes for anterior teeth esthetic restorations with porcelain laminate veneers by associating the digital planning and design of the restoration with interim restorations. The previous digital smile design of the restoration eliminates the communication barrier with the patient and assists the clinician throughout patient treatment. Interim restorations (diagnostic mock-ups) further enhance communication with the patient and prevent unnecessary tooth reduction for conservative tooth preparation. Adequate communication between patient and clinician contributes to successful definitive restorations and patient satisfaction with the final esthetic outcome.