Facial, dental, periodontal, and tomographic characteristics of the etiology of excessive gingival display: a cross-sectional clinical study.

PURPOSE: In this study, we examined the facial, dental, periodontal, and tomographic features associated with excessive gingival display (EGD) when smiling in young adults self-reporting a "gummy smile," categorized by potential etiology. METHODS: The study included 25 healthy adults (18-42 years old; 23 women and 2 men) who self-reported EGD. Participants completed a health questionnaire and underwent a periodontal examination assessing probing depth, clinical attachment level, keratinized gingival width, and gingival thickness (GT). Extraoral and intraoral photographs were taken for smile analysis and to determine facial and dental characteristics. Cone-beam computed tomography (CBCT), performed with a lip retractor in place, was used to measure the distance from the gingival margin (GM) to the cementoenamel junction (CEJ), the distance from the CEJ to the alveolar crest, buccal bone thickness, and GT. The extent of EGD when smiling was quantified as the distance from the GM at the upper central incisor to the upper lip edge when smiling fully. The smile was categorized into 4 types based on gingival exposure characteristics observed during full smile. RESULTS: Most participants were female (92%), with a mean age of 28.77±6.56 years. The average EGD was 4.2±2.44 mm, extending bilaterally from the anterior to the posterior maxilla. Two primary etiological factors were identified, alone or in combination: vertical maxillary excess (VME), predominantly indicated by an anterior maxillary height greater than 29 mm and a large interlabial gap; and altered passive/active eruption (APE), primarily characterized by square teeth (64%), upper central incisor width-to-height ratio (CIW:CIH) exceeding 87.5%, and GM-CEJ distance on CBCT exceeding 2 mm. CONCLUSIONS: These findings suggest a multifactorial etiology of EGD, primarily associated with VME and APE. Clinical periodontal examination, CBCT conducted with a lip retractor, CIW:CIH, and soft tissue facial cephalometric analysis may aid in identifying the etiological factors of EGD.

Effects of polymethyl methacrylate-based bone cement graft for treating excessive gingival display and its dimensional facial changes: 12-Month clinical study.

Objective: to present a 12-month follow-up with photographic and tomographic analyses of the effect of polymethyl methacrylate-based bone cement graft (PMMA) in gingival exposure (GE) in patients with excessive gingival display (EGD). Methods: Twelve patients with EGD were included. The PMMA was surgically placed. A frontal and lateral photograph protocol was performed at baseline (T0), 3 (T3), 6 (T6), and 12 months (T12) post-operatively. Soft tissue cone-beam computed tomography (ST-CBCT) was performed at T0 and T12. Measures included GE, length of the lip vermilion (LLV), lip shape (LS), nose width (NW), filter width (FW), nasolabial angle (NAS) while smiling, and nasolabial angle at rest (NAR). The height, thickness, and volume of the cement graft were also measured in the ST-CBCT. The comparisons were performed by Kruskal-Wallis test at 5 % of significance (p < 0.05). Results: The height, thickness, and volume of the PMMA were respectively 12.84 ± 1.59 mm, 3.83 ± 0.53, and 1532.02 ± 532.52 mm3. PMMA significantly decreased GE from 8.33 ± 1.25 mm (T0) to 6.60 ± 0.93 mm (T12) (p < 0.01). NAR was 98.34 ± 9.28° at T0 and increased to 105.13 ± 7.33° at T12; however, the angle value was not statistically different (p = 0.08). LLV, LS, NW, FW, and NAS did not exhibit statistical differences between the baseline and follow-up periods. Conclusions: PMMA significantly decreased GE in a 12-month follow-up without influencing adjacent soft tissue anatomical structures.

Protocolo Abreviado Guiado Digital: Técnicas de Marcadores Tisulares, Silicona de Registro y CBCT con Sonrisa / Digitally Guided Abbreviated Protocol: Tissue Marker Techniques, Recording Silicone and CBCT with Smile

Establecer un protocolo de cirugía guiada estática con técnicas referenciales para ser realizado de manera predecible, repetible y simple, en todos los tipos de casos. El protocolo abreviado guiado digital para cirugía guiada estática para implantes se centra en diseñar computacionalmente una guía quirúrgica que se apoye en el tejido remanente del paciente, siendo un protocolo digital versátil para la cirugía y rehabilitación implanto protésica, basada en registros clínicos, principalmente la línea de la sonrisa y la captación de ésta en tomografía de haz cónico (CBCT), además de establecer dimensión vertical oclusal (DVO). Logrando así, planificación de implantes hasta la inserción inmediata de la prótesis temporal. Se ejemplifica el trabajo con 2 casos clínicos. Se establece un protocolo con la intención de que pueda ser realizado en pacientes desdentados parciales (Técnica de Registro Silicona) o totales (Técnica de Marcadores Tisulares en prótesis), definiendo un flujo de trabajo tridimensional, digital y optimizado, con un consecuente ahorro de tiempo clínico. Como principio del protocolo de cirugía guiada es lograr el objetivo quirúrgico - protésico deseado con alta precisión. La cirugía y rehabilitación de implantes de manera convencional es altamente dependiente del operador por lo que la alternativa de cirugía guiada de manera estática es una herramienta más para mejorar el pronóstico del paciente. Se establece un protocolo digital simple y efectivo, de cirugía guiada, para la rehabilitación implanto protésica basada en la línea de la sonrisa, tomografía de haz cónico (CBCT), dimensión vertical oclusal (DVO). Protocolo predecible y que optimiza los tiempos clínicos, logrando una rehabilitación protésica inmediata acorde e individualizada para cada paciente.

Establish a static guided surgery protocol with referential techniques to be performed in a predictable, repeatable and simple way, in all types of cases. The abbreviated digital guided protocol for static guided surgery for implants focuses on computationally designing a surgical guide that rests on the patient's remaining tissue, being a versatile digital protocol for prosthetic implant surgery and rehabilitation, based on clinical records, mainly the line of the smile and its uptake in cone beam tomography (CBCT), in addition to establishing occlusal vertical dimension (OVD). Thus achieving implant planning until the immediate insertion of the temporary prosthesis. The work is exemplified with 2 clinical cases. A protocol is established with the intention that it can be carried out in partially edentulous patients (Silicone Registration Technique) or total (Tissue Marker Technique in prostheses), defining a three-dimensional, digital and optimized workflow, with a consequent saving of time. clinical. As a principle of the guided surgery protocol, it is to achieve the desired surgical-prosthetic objective with high precision. Conventional implant surgery and rehabilitation is highly dependent on the operator, so the alternative of statically guided surgery is one more tool to improve the patient's prognosis. A simple and effective digital protocol for guided surgery is established for prosthetic implant rehabilitation based on the smile line, cone beam tomography (CBCT), and occlusal vertical dimension (OVD). Predictable protocol that optimizes clinical times, achieving an immediate and individualized prosthetic rehabilitation for each patient.

Effectiveness of lip repositioning in the treatment of excessive gingival display: systematic review and meta-analysis / Eficacia del reposicionamiento de labios en el tratamiento de la exposición gingival excesiva: revisión sistemática y metanálisis

Background: The objective of this systematic review and meta-analysis was to answer the questions ''Does lip repositioning surgery reduce the amount of gingiva exposed in the smile in individuals with excessive gingival display EGD (excessive gingival display)?'' and ''Is the reduction of the amount of gingiva exposed when smiling obtained with lip repositioning surgery stable over time?'' to evaluate the effectiveness of lip repositioning surgery for correcting EGD on smiling. Materials and Methods: A systematic structured search was carried out in five databases without data restriction. Studies reporting the degree of reduction in gingival ex-posure after lip repositioning surgery were included. Study selection, data extraction, and risk of bias assessment were performed in duplicate Results: One hundred sixty-four references were retrieved and eleven studies met the eligibility criteria. Meta-analysis demonstrated that lip repositioning surgery results in a significant reduction in the amount of exposed gingival tissue (mean difference = -3.03; confidence interval = -3.55; -2.52). In addition, the results remained stable in the evaluated follow-up periods (1, 3, 6 and 12 months). Included studies had a low risk of bias. Conclusions: Lip repositioning surgery is effective for the treatment of EGD on smiling and exhibits stable results in the evaluated periods. The study was registered (CRD42020184866) in the international prospective register of systematic reviews (PROSPERO)

Antecedentes: el objetivo de esta revisión sistemática y metanálisis fue responder a las preguntas "¿La cirugía de reposicionamiento de labios reduce la cantidad de encía expuesta en la sonrisa en personas con exposición gingival excesiva (EGE)?" y "¿La reducción de la cantidad de encía expuesto al sonreír obtenido con cirugía de reposicionamiento de labios estable en el tiempo?" para evaluar la efectividad de la cirugía de reposicionamiento de labios para corregir la EGE al sonreír. Materiales y Métodos: Se realizó una búsqueda sistemática estructurada en cinco bases de datos sin restricción de datos. Se incluyeron los estudios que informaron el grado de reducción de la exposición gingival después de la cirugía de reposición de labios. La selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo se realizaron por duplicado. Resultados: Se recuperaron ciento sesenta y cuatro referencias y once estudios cumplieron con los criterios de elegibilidad. El metanálisis demostró que la cirugía de reposicionamiento de labios da como resultado una reducción significativa en la cantidad de tejido gingival expuesto (diferencia de medias = -3,03; intervalo de confianza = -3,55; -2,52). Además, los resultados se mantuvieron estables en los periodos de seguimiento evaluados (1, 3, 6 y 12 meses). Los estudios incluidos tenían un bajo riesgo de sesgo. Conclusión: La cirugía de reposicionamiento de labios es efectiva para el tratamiento de la EGE al sonreír y presenta resultados estables en los períodos evaluados. El estudio fue registrado (CRD42020184866) en el registro prospectivo internacional de revisiones sistemáticas (PROSPERO).

Tratamiento estético de la sonrisa gingival / Aesthetic treatment of the gummy smile

La exposición gingival excesiva es una condición conocida como sonrisa gingival. Esta alteración genera en muchos casos insatisfacción y solicitud de tratamiento por parte de los pacientes. Este exceso de exposición gingival podría obedecer a diferentes etiologías como un exceso maxilar en sentido vertical, un labio superior corto e hipermóvil, la erupción pasiva alterada, la extrusión dentoalveolar en el sector anterior o la combinación de estas causas. El enfoque de tratamiento va a depender del diagnóstico, de la complejidad del caso y de las expectativas de cada paciente. Por lo tanto, las rutas terapéuticas principales son el alargamiento de corona clínica, el reposicionamiento labial, la cirugía ortognática o la aplicación de toxina botulínica. Para ello, se debe considerar las ventajas y limitaciones de cada tratamiento estético, para garantizar predictibilidad y éxito.

Excessive gingival exposure is a condition known as a gummy smile. This generates in many cases dissatisfaction and request for treatment by patients. This excess of gingival exposure could be due to different etiologies such as vertical maxillary excess, a short and mobile upper lip, altered passive eruption, dentoalveolar extrusion in the anterior sector or a combination of these causes. The treatment approach will depend on the diagnosis, the complexity of the case and the expectations of each patient. Therefore, the main therapeutic routes are clinical crown lengthening, lip repositioning, orthognathic surgery, or the application of botulinum toxin. For this, the advantages and limitations of each aesthetic treatment must be considered, to guarantee predictability and success.

3D-printed PMMA implant for gingival smile treatment through the VISTA technique: A report of a new approach.

BACKGROUND: A gingival display higher than 3 mm is considered a characteristic of a gingival smile (GS). Several etiological factors have been associated to GS and for this reason various treatments have been proposed according to its etiology. The aim of this study is to present a case with an alternative technique to treat GS with minimally invasive vestibular incision subperiosteal tunnel access (VISTA) and polymethyl methacrylate (PMMA) implants for lip repositioning. METHODS AND RESULTS: The patient, a 25-year-old woman diagnosed with excessive gingival exposure, had previously done botulinum toxin (BoNT) injections and did not like the result. She had a major subnasal depression and the upper lip would lodge in there during spontaneous smile. She was informed about all options of treatment and agreed to a lip repositioning installing a customized PMMA implant. CONCLUSION: This is the first study to our knowledge to present a case with use of a PMMA implant associated with the VISTA approach for lip repositioning and gingival smile correction. The results are encouraging, and the patient was satisfied with results accomplished by this technique. KEY POINTS: Why is this case new information? This is a new and innovative surgical approach for gingival smile with PMMA implants through a minimally invasive technique (VISTA). What are the keys to successful management of this case? Well-defined presurgical planning and the presence of the upper lip lodging in the subnasal depression during spontaneous smile. What are the primary limitations to success in this case? Cases with vertical maxillary excess and those in which osteotomy/osteoplasty is indicated. It is a technique-sensitive treatment dependent on the clinician's experience.

Os (des) caminhos da saúde bucal coletiva: perspectivas atuais / The (mis)paths of collective oral health: current perspectives / Los (des)caminos de la salud bucal colectiva: perspectivas actuales

Objetivo: Analisar as perspectivas atuais acerca (des) caminhos da saúde bucal coletiva no Brasil. Método:Trata-se de um estudo bibliográfico de abordagem quantitativa. A pesquisa abrange a busca de artigos publicados nos últimos dez anos, na Scientific Electronic Library Online ­Scielo. Resultados:Ao realizar a triagem desses artigos, utilizando os critérios de inclusão, têm-se para o estudo um total de dez artigos, sendo (30%) em 2015, (40%) em (2016, 2019) e 30% em (2017, 2021, 2023). Conclusão:a PNSB vem apresentando grandes avanços conforme sua sériehistórica e o programa Brasil Sorridente tem como compromisso qualificar a atenção básica, garantindo universalidade, equidade, integralidade da assistência e resolutividade, conforme os princípios doutrinários do SUS.

Objective: To analyze the current perspectives on the (mis)paths of collective oral health in Brazil. Method:This is a bibliographic study with a quantitative approach. The search includes the search for articles published in the last ten years in the Scientific Electronic Library Online ­Scielo. Results:When screening these articles, using the inclusion criteria, a total of ten articles were included in the study, (30%) in 2015, (40%) in (2016, 2019) and 30% in (2017, 2021, 2023). Conclusion:the PNSB has been showing great advances according to its historical series and the Smiling Brazil program is committed to qualifying primary care, ensuring universality, equity, comprehensiveness of care and problem-solving, according to the doctrinal principles of the SUS.

Objetivo: Analizar las perspectivas actuales sobre los (des)caminos de la salud bucal colectiva en Brasil.Método: Se trata de un estudio bibliográfico con enfoque cuantitativo. La búsqueda incluye la búsqueda de artículos publicados en los últimos diez años en la Scientific Electronic Library Online ­Scielo. Resultados:Al cribar estos artículos, utilizando los criterios de inclusión, se incluyeron en el estudio un total de diez artículos, (30%) en 2015, (40%) en (2016, 2019) y 30% en (2017, 2021, 2023).Conclusión: el PNSB viene mostrando grandes avances de acuerdo con su serie histórica y el programa Brasil Sonriente está comprometido con la calificación de la atención básica, garantizando la universalidad, la equidad, la integralidad de la atención y la resolución de problemas, de acuerdo con los principios doctrinarios del SUS.

Smile esthetic: comparison of perception amongst orthodontists, dental students, orthodontic patients and surgical orthodontic patients

Most patients require orthodontic treatment to improve the esthetics of their smile. Orthodontists must consider how some parameters of mini-esthetics can influence the patient's esthetic perception. Methods: A photograph of the smile of a young female was taken and some modifications were made to the buccal corridor, gingival exposure, smile arc and midline position to assess the influence of these variables on smile attractiveness. Two hundred examiners were selected from four groups: orthodontists (O), dental students (DS), orthodontic patients (OP) and surgical-orthodontic patients (SOP). Each examiner was asked to complete the questionnaire with an approval rating from 1 to 10. Significant level was set at P ≤ 0.05. Results: Only orthodontists considered buccal corridors of 4mm and midline deviation of 1mm as non-esthetic; all other examiners considered gingival exposures ≥3 mm and midline angulation as non-esthetic. All examiners assigned higher satisfaction values to the photo with the concordant smile arc and defined as non-esthetic the covered smile and the reverse smile arc. Patients perceived as non-esthetic only midline deviations of 4mm. The surgical orthodontic patients assigned lower values to the photos and showed greater attention to evaluating the esthetics of the smile than the orthodontic patients. Conclusion: Smile arc, gingival exposure and midline angulation influence smile esthetics; the role of buccal corridors and midline deviation is dependent on the type of examiner

Prevalence and factors associated with gummy smile in adolescents: a cross-sectional analysis

Aim: To evaluate the prevalence and factors associated with gummy smiles in adolescents aged between 15 and 18 years attending high school. Methods: The cross-sectional and quantitative study was carried out during the Covid-19 pandemic, with 160 adolescents, from two public (A1) and two private (A2) schools chosen by lottery, divided into two groups: G1 (with gummy smile) and G2 (no gummy smile). A clinical examination was carried out on the adolescents, investigating the presence or absence of a gummy smile (GS), by analyzing the variables (interlabial distance at rest, upper incisor exposure at rest, smile arc, measurement from the subnasal to the upper lip philtrum, upper lip length, upper lip thickness, hypermobility and lower/middle third ratio). Means and dispersion were obtained, and the Chi-square association test was applied, to compare the results between A1 and A2 and between G1 and G2. Results: The prevalence of GS was 33.8% (=54). It was found that no statistically significant associations were found (p > 0.05), regarding the type of school and gender with the presence of GS in adolescents. There was no statistically significant difference (χ² = 1.82; p = 0.07) between the groups and the age of adolescents. There was a significant association between the studied variables and GS (p < 0.05). Conclusion: The prevalence was high with a predominance of females. There were no statistically significant associations regarding the type of school and gender, but there was a significant association between gummy smile and lip dimensions

Analysis of smile photos posted on social networks as an alternative for human identification / Análise de fotos do sorriso postadas em redes sociais como alternativa para a identificação humana

ABSTRACT Photos of smiles posted on social media contain information on individuals' anatomical and oral morphological characteristics, which can be important for ante and post-mortem human identification, during confrontation for forensic purposes. Objective: The study aimed to evaluate the feasibility of using smile photographs on social networks as a source of information for human forensic identification. Methods: The study sample consisted of forty individuals, randomly divided into four equal groups, two groups in Instagram (IG®) and two groups in Facebook (FB®). Standardized oral photographs of the anterior teeth of the participants, from three different angles (post-mortem photos) were taken using a Nikon® EOS 550D camera. Photos of smiles posted in FB and IG by the participants were also collected (ante-mortem photos). The analysis were carried out by 4 forensic experts, 18 dental professors, and 21 dental students. They compared simulated ante and post-mortem photos, to identify the alleged victims. Results: The correct identification score ranged from 28.6% (students) to 100% (forensic experts). The most frequently reported dental characteristics used for the identification were morphology of the anterior teeth, zenith, and gingival recessions. There was no statistically significant association between the rate of correct identification and the degree of difficulty reported during the analysis (p= 0,068), whereas there was also no association between this index and or the duration of the analysis (p=0,884). Conclusions: Therefore, the photographs of the smile posted on social media proved to be a database of dental information, and with potential to assist in identification with dental forensic purposes.

RESUMO Fotos de sorrisos postadas nas redes sociais contêm informações sobre as características anatômicas e morfológicas orais dos indivíduos, que podem ser importantes para a identificação humana ante e post-mortem, durante o confronto para fins forenses. Objetivo: O estudo teve como objetivo avaliar a viabilidade do uso de fotografias de sorrisos em redes sociais como fonte de informação para identificação forense humana. Métodos: A amostra do estudo foi composta por quarenta indivíduos, divididos aleatoriamente em quatro grupos iguais, dois grupos no Instagram (IG®) e dois grupos no Facebook (FB®). Fotografias orais padronizadas dos dentes anteriores dos participantes, de três ângulos diferentes (fotos post-mortem), foram tiradas com uma câmera Nikon® EOS 550D. Também foram coletadas fotos de sorrisos postados no FB e IG pelos participantes (fotos ante-mortem). As análises foram realizadas por 4 peritos forenses, 18 professores de odontologia e 21 alunos de odontologia. Eles compararam fotos simuladas ante e post-mortem, para identificar as supostas vítimas. Resultados: A pontuação correta de identificação variou de 28,6% (alunos) a 100% (especialistas forenses). As características dentais mais frequentemente relatadas e utilizadas para a identificação foram morfologia dos dentes anteriores, zênite e recessões gengivais. Não houve associação estatisticamente significativa entre a taxa de identificação correta e o grau de dificuldade relatado durante a análise (p = 0,068), assim como não houve associação entre esse índice e/ou a duração da análise (p = 0,884). Conclusão: Portanto, as fotografias do sorriso postadas nas redes sociais mostraram-se um banco de dados de informações odontológicas, e com potencial para auxiliar na identificação para fins odontológicos forenses.

Abordagem ortodôntica de má oclusão originada de uma autointervenção ­ relato de caso / Orthodontic approach to malocclusion originating from a self-intervention ­ case report

Resumo A automedicação, uma conduta realizada pelos pacientes com o objetivo de aliviar alguns sintomas de desconforto, é extremamente condenada pelos profissionais da saúde pelas possíveis consequências negativas que este ato pode causar, podendo gerar sequelas graves e irreversíveis. Tal situação não é diferente na Odontologia, quando os pacientes realizam procedimentos domésticos para camuflar um problema odontológico, principalmente quando há um comprometimento importante da estética do sorriso. O objetivo do presente artigo é relatar uma abordagem de tratamento multidisciplinar, a qual o ortodontista teve papel fundamental na correção dos efeitos adversos na oclusão causados pela autointervenção de uma paciente, que utilizou de artifícios domésticos para restabelecer de forma emergencial sua estética do sorriso. (AU)

Abstract Self-medication, a procedure performed by patients to relieve some symptoms of discomfort, is extremely disapproved of by health professionals for the possible negative consequences that this act can cause, which can generate serious and irreversible sequelae. Such a situation is no different in dentistry, when patients perform domestic procedures to camouflage a dental problem, especially when there is an important commitment to the smile's aesthetics. The aim of this article is to report a multidisciplinary treatment approach, one in which the orthodontist played a relevant role in correcting the adverse effects of the occlusion caused by the self-intervention of a patient, who used domestic devices to urgently restore her smile aesthetics (AU)

Laser-Assisted Lip Repositioning Surgery: A Modification to The Conventional Technique.

Introduction: The lip repositioning surgical technique arose with the objective of correcting and harmonizing the act of smiling. Since the conventional technique was published, some modifications of the technique have been proposed in order to counteract postoperative recurrence and to achieve the best esthetic appearance of the smile. The objective of this paper was to describe the laser-assisted lip repositioning technique (laser-assisted LRS) with a 940nm diode laser and 2780nm Er,Cr: YSGG, as a modification to the conventional lip repositioning technique, for the treatment of a gummy smile. Case Report: The proposed technique consists in achieving the descent of the upper lip by removing the intraoral mucosal band through the laser peeling of oral mucosa, preserving the connective tissue intact for healing by secondary intention. The technique was implemented in two patients with a diagnosis of a gummy smile caused by a short and hyperactive upper lip; the healing process was satisfactory, and there was no bleeding or postoperative edema. Postoperative controls were performed at 3 and 10 months, and no recurrence was found. Conclusion: the 940nm Diode laser or 2780nm Er,Cr: YSGG laser-assisted lip repositioning technique described here is less invasive than that performed with a conventional scalpel, offers aesthetic results, lower risk of infection and recurrence of the gummy smile in the long term.

Restabelecimento estético de incisivos laterais conóides e amplas restaurações em resina composta com laminados cerâmicos: relato de caso / Aesthetic recovering of conoid side incisives and wide restoration in composed resin with ceramic laminates: case report

Introdução: As cerâmicas odontológicas são amplamente utilizadas na Odontologia, desfrutando de grande popularidade devido a sua capacidade de mimetizar as características ópticas do esmalte e da dentina. O constante desenvolvimento de pesquisas tem desencadeado o lançamento de novos sistemas cerâmicos com propriedades aprimoradas e melhores resultados clínicos em longo prazo. Objetivo: O relato de caso aqui apresentado descreve uma reabilitação da zona estética do sorriso com laminados cerâmicos por meio de uma abordagem minimamente invasiva. Relato de caso: Paciente do gênero feminino, compareceu à clínica odontológica relatando insatisfação com a aparência do seu sorriso. Durante avaliação foram observadas, na região anterossuperior, restaurações extensas em resina composta deficientes nos incisivos, com proporção, volume, forma e texturização insatisfatórias, que em conjunto comprometia a zona estética do sorriso. Diante disso, após fotografias extra e intraorais, o tratamento proposto foi a reabilitação com laminados cerâmicos nas unidades 1.2 ao 2.2. Assim, foi realizado o enceramento e o mock-up, os quais serviram de orientação para os preparos dentários, a seguir, foram moldados e as restaurações confeccionadas no sistema IPS e.max. Após prova de cor e adaptação, os preparos e a superfície interna dos laminados cerâmicos foram tratados e cimentados com cimento resino fotopolimerizável. Conclusão: Instituindo uma abordagem conservadora, o plano de tratamento realizado através da reabilitação com laminados cerâmicos nas unidades dentárias anterossuperiores, permitiu o restabelecimento da função e estética, com reprodução das características dos dentes naturais e promoção do equilíbrio, da jovialidade e da harmonia no sorriso(AU)

Introduction: Dental ceramics are widely used in dentistry, enjoying great popularity due to the ability to mimic both enamel and dentin optical characteristics. The constant research development has triggered the launch of new ceramic systems with improved properties and better long-term clinical results. Objective: The case report presented here describes the zone rehabilitation of the aesthetic smile with ceramic laminates through a minimally invasive approach. Case report: Female patient, attended the dental clinic reporting dissatisfaction with the appearance of her smile. During the evaluation, extensive restorations in composite resin were observed in the incisors in the anterosuperior region, with unsatisfactory proportion, amount, shape and texturing, which together compromised the aesthetic zone of the smile. Faced with this, after extra and intraoral photographs, the proposed treatment was the restoration with the ceramic laminates in units 1.2 to 2.2. Thus, waxing and mock-up were performed, which served as guidance for the dental preparations, then they were molded and restorations fabricated in the IPS e.max system. After shade and adaptation proof, the preparations and the inner ceramic laminates surface were treated and cemented with light-cured resin cement. Conclusion: Adopting a conservative approach, the treatment plan carried out through restoration with ceramic laminates on the upper anterior teeth allowed the recovering function and aesthetics, reproducing characteristics of natural teeth and promoting balance, joviality and harmony in the smile(AU)

Evaluation of the botulinum toxin effects in the correction of gummy smile 32 weeks after application / Avaliação dos efeitos da toxina botulínica na correção do sorriso gengival 32 semanas pós-aplicação

INTRODUCTION: The use of botulinum toxin type A (BTX-A) to correct gummy smile has become popular in recent years. OBJECTIVE: To evaluate the effects of BTX-A application in the correction of gummy smile 2 and 32 weeks after application. METHODS: The sample comprised 35 patients (30 female, 5 male) at a mean age of 25.51 years (±5.59) with gummy smile due to muscular hyperfunction. In each patient, 2U of botulinum toxin was applied in the levator labii superioris alaeque nasi, 2 mm from the nasolabial fold. Photographs of spontaneous smiles were taken at 3 stages: before, 2 and 32 weeks after BTX application. Measurements of the gingival display were performed with the Radioface Studio 2 Software, and the calibration used the actual size of the right maxillary central incisor. Comparison of the three stages evaluated was performed with repeated measures ANOVA and Tukey tests. RESULTS: Gingival display decreased significantly 2 weeks after BTX-A application and increased after 32 weeks but did not return to the initial value. CONCLUSION: There was a significant improvement in gummy smile 2 weeks after botulinum toxin application, and a significant relapse in the gingival display after 32 weeks, however not returning to baseline values.

INTRODUÇÃO: A toxina botulínica tipo A (BTX-A) tem se tornado popular na correção do sorriso gengival nos últimos anos. OBJETIVO: Avaliar os efeitos da aplicação de BTX-A na correção do sorriso gengival 2 e 32 semanas após a aplicação. MÉTODOS: A amostra compreendeu 35 pacientes (30 mulheres, 5 homens) com uma idade inicial média 25,51 anos (±5,59) portadores de sorriso gengival devido à hiperfunção muscular. Em cada paciente foi aplicado 2U de BTX-A no músculo elevador superior da asa do nariz, 2 mm a partir da dobra nasolabial. Foram feitas fotografias dos sorrisos espontâneos dos pacientes em 3 fases: antes, 2 e 32 semanas após a aplicação de BTX-A. As medidas da exposição gengival foram feitas com o Software Radioface Studio 2, e a calibração utilizou o tamanho real do incisive central superior direito. A comparação das 3 fases foi feita com ANOVA de medidas repetidas e teste de Tukey. RESULTADOS: A exposição gengival diminuiu significantemente 2 semanas após a aplicação e aumentou novamente após 32 semanas, mas não retornando aos valores iniciais. CONCLUSÃO: Houve uma melhora significante no sorriso gengival 2 semanas após a aplicação de toxina Botulínica, e uma recidiva significante após 32 semanas, mas não retornando aos valores iniciais.

Smile Arc Esthetics in Middle-Aged Man from the Layperson's Perspective Via Eye-Tracking

Abstract Objective: To evaluate the perceptions of smile esthetics associated with variations in the vertical plane of the maxillary incisors in the smile arc using eye-tracking software. Material and Methods: An image of a 59-year-old Caucasian male model was adapted and edited to make three changes in the vertical plane, simulating a convex, straight, and reverse smile arc. Four areas of interest were inserted at the right and left eyes, nose, and mouth. Forty laypeople raters between 18 and 45 years of age participated of the study. Eye-tribe hardware and Ogama software were used to perform eye-tracking. Attractiveness and age-perception questions were also incorporated into the study. ANOVA test and Pearson's correlation coefficient, at p < 0.05. Results: The most observed AOI in images with convex, straight, and reverse smiles, as assessed using heatmaps and point maps, was the mouth, followed by the right eye. A significant difference for the eye (p=0.02) was found when comparing convex and reverse smiles, whereas a significant difference for the mouth was observed between the straight and reverse smiles (p=0.03). Conclusion: Convex and straight smile arcs were associated with equal levels of attractiveness; the reverse smile was less attractive. No significant difference was noticed regarding age perception and the smile arcs. However, the reverse smile recorded a more complete fixation time.

Prevalência e fatores associados ao sorriso gengival em adolescentes / Prevalence and factors associated with gummy smiles in adolescents

Objetivo: Avaliar a prevalência e fatores associados ao sorriso gengival em adolescentes entre 15 a 18 anos cursando o ensino médio. Métodos: O estudo transversal e quantitativo foi realizado durante a pandemia de COVID-19, em 160 adolescentes de duas escolas públicas (A1) e duas privadas (A2) escolhidas por sorteio, divididas em dois grupos: G1 (com sorriso gengival) e G2 (sem sorriso gengival). Foi realizado o exame clínico nos adolescentes, investigando a presença ou não de sorriso gengival (SG), ao analisar as variáveis (distância interlabial em repouso, exposição de incisivo superior em repouso, arco do sorriso, medida do subnasal ao filtro labial superior, comprimento do lábio superior, espessura do lábio superior, hipermobilidade e relação do terço inferior/médio). Foram obtidas médias, dispersão e aplicado o teste de associação qui quadrado, com nível de significância estatística de 5% para comparar os resultados entre A1 e A2 e entre G1 e G2. Resultados: Verificou-se que não foram encontradas associações estatisticamente significativas (p> 0,05), quanto ao tipo de escola e gênero com a presença de SG nos adolescentes. Não houve diferença estatisticamente significativa (χ² = 1,82; p = 0,07) entre os grupos e a idade dos adolescentes. Houve correlação significativa entre as variáveis estudadas e o SG (p < 0,05). Conclusão: A prevalência do SG em adolescentes de 15 a 18 anos de idade foi de 33,8%, com predominância do gênero feminino, não houve associações estatisticamente significativas, quanto ao tipo de escola e gênero com a presença de SG, mas houve correlação significativa entre o SG e as variáveis estudadas.

Aim: To evaluate the prevalence and factors associated with gummy smiles in adolescents aged 15 to 18 years who were attending high school. Methods: The cross-sectional and quantitateve study was carried out during the Covid-19 pandemic, with 160 adolescents, from two public (A1) and two private (A2) schools chosen by lottery, divided into two groups: G1 (with gingival smile) and G2 (no gummy smile). A clinical examination was carried out on the adolescents, investigating the presence or absence of a gummy smile (GS), by analyzing the variables (interlabial distance at rest, upper incisor exposure at rest, smile arc, measurement from the subnasal to the upper lip philtrum, upper lip length, upper lip thickness, hypermobility, and lower/middle third ratio). Means and dispersion were obtained, and the Chi-square association test was applied, with a statistical significance level of 5%, to compare the results between A1 and A2 and between G1 and G2. Results: No statistically significant associations were found (p > 0.05) regarding the type of school and gender with the presence of GS in adolescents. There was no statistically significant difference (χ² = 1.82; p = 0.07) between the groups and the age of adolescents. A significant correlation was found between the studied variables and GS (p < 0.05). Conclusion: The prevalence of GS in adolescents aged 15 to 18 years was 33.8%, with a predominance of females. No statistically significant associations were identified regarding the type of school and gender with the presence of GS; however, a significant correlation was found between the GS and the studied variables.

Management of excessive gingival display using botulinum toxin type A: a descriptive study.

Botulinum toxin is a protease used by the bacterium Clostridium botulinum that causes chemical denervation of skeletal muscles, producing a temporary weakening of muscle activity. Despite having a transitory effect, the application of botulinum toxin has been identified as an alternative for correcting an excessive gingival display (EGD). However, studies evaluating the maintenance of long-term results of botulinum toxin remain scarce. This study aimed to evaluate the effectiveness and duration of botulinum toxin type A in the treatment of anterior EGD. Botulinum toxin Type A was applied to 15 patients with EGD. The measurement was performed in triplicate, using a Castro Viejo dry point compass, between the central cervical portion of the upper lateral incisors to the lower portion of the upper lip, bilaterally. The measurements were performed before the application of the toxin and repeated on days 7, 14, 90, 120, and 180 after the procedure. The data were analyzed using repeated-measures ANOVA, followed by a Bonferroni. There was a statistically significant reduction between the measurements performed on the Baseline and seven days after the application of the botulinum toxin. After 180 days, approximately one-quarter of the patients in the sample did not presented EGD. Mild adverse effects were reported by 46.7% of the patients. The use of botulinum toxin type A was effective to treat EGD. After 180 days, it was still possible to observe a significant effect compared to the initial gingival exposure.

Aesthetic crown lengthening and lip repositioning surgery: Pre- and post-operative assessment of smile attractiveness.

AIM: To assess the effect of aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) on perception of smile attractiveness. MATERIALS AND METHODS: Preoperative and 6-month postoperative smile photographs of ACL- or LRS-treated patients were evaluated by 100 raters (five gender-balanced groups of ten per procedure) of diverse background (dental students, general dentists, periodontists and laypersons with and without any aesthetic concerns about their own smile). Smile attractiveness was rated by visual analogue scale (VAS). Multivariate mixed-effect models were applied to determine the effect of procedure, rater (age, gender and group) and case (gingival display and GD) on smile attractiveness rating. RESULTS: Average preoperative and postoperative VAS scores for ACL patients were 3.8 ± 2.0 and 6.2 ± 1.9, respectively. Corresponding LRS patient values were 4.8 ± 2.0 and 6.4 ± 1.9. Treatment, baseline GD and rater age were significant determinants (p < .001) of smile attractiveness for both procedures. Rater gender was not significant. Rater group was significant (p < .032) only for ACL. Procedure (p < .001), baseline VAS (p < .001), change in GD (p ≤ .002) and rater age (p ≤ .017) were significant determinants of smile attractiveness change from preoperative to postoperative. CONCLUSIONS: ACL and LRS are two periodontal plastic surgery procedures that deliver significant smile attractiveness improvements, in the eyes of both laypersons and dental professionals.

Uso de la toxina botulínica en el tratamiento de sonrisa gingival / Use of botulinum toxin in the treatment of gummy smile

El objetivo es abordar la importancia del uso de la toxina botulínica para corregir la sonrisa gingival, demostrando la satisfacción del paciente, aunque el efecto sea temporal y reversible, evitando procedimientos invasivos. Se realizó un levantamiento bibliográfico en las bases de datos PubMed, LILACS y Bireme, los términos utilizados en la investiga- ción fueron: sonrisa gingival y toxina botulínica o sonrisa gingival y estética. Los criterios de inclusión fueron una revisión de literatura de casos clínicos de pacientes con sonrisa gingival publicados entre 2015 y mayo de 2019. Esta revisión aborda la aplicación de la toxina botulínica para devolver una sonrisa armoniosa y hermosa al paciente, ya que es una alternativa viable, eficiente, menos invasiva y segura. La práctica de la aplicación de toxina botulínica puede ser un complemento útil para mejorar la estética y mejorar la satisfacción del paciente en relación a la sonrisa gingival sin realizar procedimientos invasivos, es decir, cuando está debidamente indicado, pudiendo reemplazar o agregar procedimientos quirúrgicos.

The objective was to address the importance of using botulinum toxin to correct gummy smile, showing patient satisfaction even if the effect is temporary and reversible, avoiding invasive procedures. A bibliographic survey was carried out in the databases PubMed, LILACS and Bireme, the terms used in the research were gummy smile and botulinum toxin or gummy smile and aesthetic. The inclusion criteria were a review of the literature of clinical cases of patients with with a gummy smile published between 2015 and May 2019. This review addressed the application of botulinum toxin to give the patient a beautiful and harmonious smile, as it is a viable, efficient, less invasive and safe alterna- tive. The practice of applying botulinum toxin can be a useful complement to improve patient satisfaction with a gummy smile without undergoing invasive procedures, that is, when well indicated, being able to replace or complement surgical procedures.

Effectiveness of lip repositioning surgeries in the treatment of excessive gingival display: A systematic review and meta-analysis.

To synthesize the available evidence regarding lip repositioning surgery (LRS) and quantify the short- and long-term reduction in excessive gingival display (EGD) with the procedure. Additionally, evaluate the effect of myotomy on the results. Seven electronic databases were searched up to May 2020 by two independent reviewers. Studies evaluating the exclusive use of LRS to treat EGD were included. After risk of bias assessment, the data were quantitatively evaluated with random-effects meta-analysis. The initial database search yielded 368 studies, of which 16 were selected for full-text review. Finally, eight studies were included. The random effects model exhibited an EGD reduction of 2.87 mm (95% CI: 1.91-3.82) after 3 months of LRS. These results decreased after 6 months (2.71 mm; 95% CI: 1.95-3.47) and 12 months (2.10 mm; 95% CI: 1.48-2.72). Meta-analysis comparing the performance of myotomy showed greater EGD reduction at 6 months than without myotomy (P < 0.02). LRS is an effective approach for treating EGD, and it has satisfactory results up to 6 months. After this period, the effectiveness appears to progressively decrease over time indicating substantial relapse at 12 months. Myotomy seems a suitable alternative to increase the stability of LRS. Lip repositioning surgery is an effective procedure to improve smile esthetics in the short-term (up to 6 months). After this period, the efficacy of LRS seems to decrease progressively, and an approximately 25% relapse may be expected after 12 months. Clinicians should combine the procedure with other approaches, such as plastic periodontal surgeries, restorative procedures, or botulin toxin injections for more predictable and stable outcomes.