Diferenças técnicas de aumento estético de coroa clínica / Different techniques of aesthetic clinical crown lengthening: cases report

A crescente demanda de pacientes que procuram tratamento dentário por razões estéticas vem crescendo, tendo como queixa principal o sorriso gengival e a aparência de dentes curtos. O aumento estético de coroa clínica é de suma importância para se alcançar um sorriso harmônico, principalmente quando a etiologia é a erupção passiva alterada. Tradicionalmente, o procedimento é realizado com a elevação de um retalho para a exposição da crista óssea e subsequente osteotomia/osteoplastia. Entretanto, a osteotomia via sulco gengival sem levantamento de retalho, utilizando microcinzéis, tem sido uma opção para casos de biotipos periodontais intermediários ou finos. Os benefícios da técnica incluem a finalização do procedimento sem a necessidade de suturas, a diminuição do desconforto pós-operatório e a otimização da reparação tecidual. O presente trabalho teve como objetivo exemplificar as diferentes técnicas de osteotomia em aumento estético de coroa clínica, por meio do relato de dois casos clínicos, nos quais os pacientes foram diagnosticados com sorriso gengival devido à erupção passiva alterada. No primeiro caso clínico, a osteotomia foi realizada com elevação de retalho e, no segundo, sem retalho. Ambos os casos obtiveram resultados esteticamente favoráveis, sem intercorrências no pós-operatório.

The growing demand of patients seeking dental treatment for aesthetic reasons has been growing, with the main complaint the gummy smile and appearance of short teeth. The aesthetic clinical crown lengthening is of paramount importance to achieve a harmonious smile, especially when the cause is altered passive eruption. Traditionally, this procedure is performed using flap elevation to fully expose the underlying bone and allow subsequent osteotomy/osteoplasty. However, the osteotomy through gingival sulcus, without flap elevation, using microchisels, has been an option for cases of intermediate or thin periodontal biotypes. The benefits of the technique include the ability to finalize the procedure without the need for sutures, less postoperative discomfort and improved tissue repair. This paper aims to illustrate the different techniques of osteotomy in aesthetic clinical crown lengthening by the report of two clinical cases in which patients were diagnosed with gummy smile due to altered passive eruption. In the first clinical case, osteotomy was performed with elevation flap and in the second case, it was performed without elevation flap. Both cases achieved aesthetically favorable and results without complications postoperatively.

Contagem e prevalência de microrganismos patogênicos e benéficos em indivíduos tabagistas com doença periodontal crônica / Counts and prevalence of pathogenic and benefic microorganisms in smokers with chronic periodontal disease

O objetivo deste estudo foi comparar a contagem e a prevalência dos microrganismos do complexo vermelho (Treponema denticola, Porphyromonas gingivalis e Tannerella forsythia) e do complexo azul (Actinomyces gerencseriae, Actinomyces israelli e Actinomyces naeslundii) na microbiota subgengival em indivíduos tabagistas e não-tabagistas com doença periodontal crônica. Foram selecionados 50 voluntários com periodontite crônica (25 tabagistas – T e 25 não-tabagistas – NT). Os indivíduos foram submetidos a exame clínico periodontal e microbiológico. Os parâmetros clínicos avaliados foram profundidade de sondagem, nível clínico de inserção, placa supragengival visível, sangramento gengival, sangramento à sondagem e supuração. De cada indivíduo foram coletadas entre 6 e 12 amostras de biofilme subgengival, avaliadas para seis espécies bacterianas por meio da técnica Checkerboard DNA-DNA Hybridization. Os resultados clínicos foram semelhantes entre os grupos (T e NT). A exceção foi o percentual de sítios com sangramento gengival, sendo que o grupo T apresentou uma média inferior (9,54 ± 15,31) comparada ao grupo NT (39,44 ± 25,13 – p < 0,001). A única diferença microbiológica foi a contagem de A. gerencseriae diminuída no grupo de tabagistas (p < 0,05). Em conclusão, os perfis clínico-microbiológicos de indivíduos tabagistas e não-tabagistas com periodontite crônica podem ser considerados semelhantes.

The aim of the present study was to compare the levels and the prevalence of bacterial red complex (Treponema denticola, Porphyromonas gingivalis and Tannerella forsythia) and blue complex (Actinomyces gerencseriae, Actinomyces israelli and Actinomyces naeslundii) in the subgingival microbiota of smokers and non-smokers with chronic periodontitis. Fifty subjects wiyh chronic periodontitis were enrolled (25 smokers - S and 25 non smokers - NS). Subjects received clinical and microbiological examination. The clinical parameters evaluated were probing depth, clinical attachment level, visible plaque index, gingival bleeding index, bleeding on probing and suppuration. Six to twelve subgingival biofilm samples were collected per subject, and evaluated for six bacterial species using the Checkerboard DNA-DNA hybridization technique. The clinical results were similar between the groups (S and NS). The exception was the percent of sites with gingival bleeding. The S group showed a lower mean (9.54 ± 15.31) compared with the NS group (39.44 ± 25.13 - p <0.001). The only microbiological difference was the reduced level of A. gerencseriae in smoking group (p < 0,05). In conclusion, the clinical- microbiological profiles of non-smoking and smoking subjects with chronic periodontitis were similar.

Clinical and microbiological benefits of systemic metronidazole and amoxicillin in the treatment of smokers with chronic periodontitis: a randomized placebo-controlled study.

AIM: The aim of this study was to evaluate the clinical and microbiological effects of scaling and root planing (SRP) alone or combined with metronidazole (MTZ) or with MTZ and amoxicillin (AMX) in the treatment of smokers with chronic periodontitis. METHODS: A double-blind, placebo-controlled, randomized clinical trial was conducted in 43 subjects who received SRP alone (n=15) or combined with MTZ (400 mg 3 x per day, n=14) or with MTZ+AMX (500 mg 3 x per day, n=14) for 14 days. Clinical and microbiological examinations were performed at baseline and 3 months post-therapy. Subgingival samples were analysed by checkerboard DNA-DNA hybridization. RESULTS: Subjects receiving MTZ+AMX showed the greatest improvements in mean probing depth and clinical attachment level. Both antibiotic therapies led to additional clinical benefits over SRP alone in initially shallow, intermediate, and deep sites. The SRP+MTZ+AMX therapy led to the most beneficial changes in the subgingival microbial profile. These subjects showed significant reductions in the mean counts and proportions of periodontal pathogens such as Tannerella forsythia, Porphyromonas gingivalis and Treponema denticola, and the greatest increase in proportions of host-compatible species. CONCLUSION: Significant advantages are observed when systemic antibiotics are combined with SRP in the treatment of smokers with chronic periodontitis. The greatest benefits in clinical and microbiological parameters are achieved with the use of SRP+MTZ+AMX.

Clinical and laboratory evaluations of non-surgical periodontal treatment in subjects with diabetes mellitus.

BACKGROUND: The aim of this study was to evaluate the clinical and laboratory changes 3 months after full-mouth scaling and root planing in subjects with and without diabetes mellitus. METHODS: This study was performed using 10 subjects with type 2 diabetes mellitus who required insulin therapy (DM) and 10 healthy adult control subjects (NDM) with generalized chronic periodontal disease. Both groups were treated with full-mouth scaling and root planing and given oral hygiene instructions. Clinical parameters, including plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL), were measured at four sites per tooth. Subgingival plaque samples were obtained from sites with the deepest PD (> or =5 mm) and with furcations in each subject. Samples were also tested for the presence of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia (previously T. forsythensis) by polymerase chain reaction. Glycemic control (glycosylated hemoglobin [HbA1c] and fasting glucose levels) and clinical and microbiologic assessments were recorded at baseline and 3 months after periodontal treatment. RESULTS: Data revealed statistical changes (P < or =0.05; analysis of variance [ANOVA]) in clinical variables (PI, GI, PD, GR, and CAL) between baseline and 3 months in both groups. Conversely, no improvement in the fasting glucose level or glycosylated hemoglobin (P < or =0.05; ANOVA) was found after treatment. Besides some reduction in the bacterial frequency 3 months after treatment, no statistically significant difference was found between the groups. CONCLUSION: Clinical and laboratory responses were similar in DM and NDM groups 3 months after full-mouth scaling and root planing.