PREDICTABLE INTERPROXIMAL TISSUE REMOVAL WITH A SURGICAL STENT

The correction of diastemas in the anterior region with composite resin is considered to be practical and conservative. Harmony between the restorative material and the periodontium is necessary to achieve satisfactory functional and esthetic results. Whenever excessive gingiva occurs in the interproximal region, removal is necessary to avoid excessively contoured restorations. A predictable technique is described to conservatively remove interproximal tissue in situations in which crown lengthening is required to treat bilateral diastemas. A surgical template based on the diagnostically waxed cast was produced to serve as a reference during periodontal surgery.

Uma opção terapêutica para o aumento da faixa de gengiva inserida: o enxerto de tecido conjuntivo livre

Several periodontal procedures have been described in the literature to correct mucogingival alterations or to achieve root coverage. The epithelized free gingival graft is a well established periodontal surgery to increase the width of keratinized gingiva with good stability in the long term follow up. However, this procedure is not commonly used in aesthetic areas since the grafted tissue presents differences of color and contrast. The free connective tissue graft emerges as a viable option to increase attached gingiva in areas where aesthetics results are required. The removal of an epithelized free gingival graft from the hard palate region creates a sore and raw surgical wound that slowly repairs, while the connective tissue graft produces only a line of incision that can be easily sutured promoting a more confortable outcome for the patient. This paper aims to report a case where a free connective tissue graft was used to increase the width of attached gingiva in a tooth with gingival recession. This technique presented satisfactory esthetics results, with a better contrast and color matching with the surrounding tissues.

Dificuldades relatadas por estudantes de odontologia diante de procedimentos relacionados à periodontia

Objective: This study aimed at evaluating the difficulties reported by last-year dentistry course students regarding basic and surgical periodontal procedures. Methods: A proposed questionnaire with 24 questions, 14 related to basic periodontal procedures and 10 to surgical procedures, was applied to 45 undergraduate students with jobs involving these procedures, during the practical activities of the Integrated Clinic Discipline, a compulsory subject in the curriculum of the course, taught to last-year students. Students were asked about their own perceptions of the difficulties in implementing the various steps related to the treatments. The degree of individual difficulty was determined according to the Likert scale: 0 = none, 1 = mild, 2 = moderate, 3 = high, 4 = very high. Exploratory analysis of data was applied, and the difficulty level was also dichotomized into none to mild (scores 0 and 1) and moderate to very high (scores 2–4). Results: Regarding the basic periodontal treatment, bone level probing was the procedure with the highest number of student difficulties (57.5%). As for the difficulties reported by students regarding the stages of periodontal surgery, only the procedures related to anesthesia and suture removal had no report of doubts. Conclusion: Periodontal surgery was the procedure involving the most prevalent questions reported as moderate to very high, and the indication for the most suitable surgical technique was the stage with the highest percentage of questions (66.6%) among the undergraduates.

Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comparação de dois tipos de retalho para enxerto de tecido conjuntivo no tratamento de recessões gengivais: estudo clínico controlado randomizado

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Multidisciplinary approach for crown-root fracture treatment after trauma: case report

The development of an accurate diagnosis and appropriate treatment plan can be a complex task, especially in cases of dentoalveolar trauma. The authors present a case report of crown-root fracture caused by trauma and highlight the importance of a multidisciplinary approach for the treatment. An eighteen year-old boy had a bicycle accident resulting in dental trauma. The upper right first molar showed a complicated crownroot fracture and the lower left second pre-molar showed an uncomplicated crown-root fracture. Endodontic treatment, controlled tooth extrusion, periodontal surgery for recovery of biological width, and porcelain crown and onlay restorations were performed. Esthetic and functional results were achieved. At the two-year follow-up it was observed that the tooth/onlay interface of the upper right first molar was stained and the onlay of the left lower second pre-molar was fractured. Therefore, the interface stained was repaired and a porcelain crown was made for the lower second premolar. The clinical case presented herein leads to the conclusion that a multidisciplinary treatment plan is extremely important for a proper resolution in cases of dentoalveolar trauma.

Periodontal plastic surgery associated with treatment for the removal of gingival overgrowth

Background: Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of hindering oral hygiene. Methods: Two clinical cases are reported in which gingival overgrowths were removed by excisional biopsy, resulting in unsightly defects. The first clinical case presents an invasive approach for the treatment of a recurrent pyogenic granuloma in the anterior maxilla, and the second depicts a complete removal of a peripheral odontogenic fibroma in the posterior maxilla. In both situations, the soft-tissue defects were repaired by periodontal plastic surgery, including a laterally positioned flap and a coronally positioned flap, respectively. Results: Periodontal plastic surgery successfully restored the defects that resulted from biopsies, and no recurrence has been noticed in the 5-year postoperative follow-up period. Conclusions: The combination of biopsy and periodontal plastic surgery in a one-step procedure seems to be suitable to remove gingival overgrowths in most areas of the mouth, regardless of esthetic significance. Such procedures seem to restore gingival health, encourage healing, and create both esthetics and function in the excised area.

Periodontal tissue response to coverage of root cavities restored with resin materials: A histomorphometric study in dogs

Background: the purpose of this study was to histomorphometrically evaluate the response of periodontal tissues covering Class V resin restorations in dogs.Methods: After raising a mucoperiosteal flap, bony defects measuring 5 x 5 mm were created on the buccal aspect of the canines of five dogs followed by cavity preparations on the root surface measuring 3 x 3 x 1 mm. Before repositioning the flap to cover the bone defect, the cavities were restored with composite resin (CR) or resin-modified glass ionomer cement (RMGIC) or were left unrestored as control (C). The dogs were euthanized 90 days after surgery. Specimens comprising the tooth and periodontal tissues were removed, processed routinely, cut into longitudinal serial sections in the bucco-lingual direction, and stained with hematoxylin and eosin (H&E) or Masson's trichrome. The most central sections were selected for histomorphometric analysis.Results: Histomorphometric analysis revealed apical migration of epithelial tissue onto the restorative materials (RMGIC and CR). The C group presented significantly longer connective tissue attachment (P < 0.05) than the RMGIC and CR groups and significantly higher bone regeneration (P < 0.05) compared to the RMGIC group. Histologically, the cervical third (CT) of all groups had the most marked chronic inflammatory infiltrate.Conclusions: Within the limits of this study, it can be concluded that the restorative materials used exhibit biocompatibility; however, both materials interfered with the development of new bone and the connective tissue attachment process.

Periodontal and Prosthetic Biologic Considerations to Restore Biological Width in Posterior Teeth

\ The biologic width is an essential dental space that always needs to be maintained to ensure periodontal health in any dental prosthetic restorations. An iatrogenic partial fixed prosthesis constructed in lower posterior teeth predisposed the development of subgingival caries, which induced violation of the biologic width in involved teeth, resulting in an uncontrolled inflammatory process and periodontal tissue destruction. This clinical report describes a periodontal surgical technique to recover a violated biologic width in lower posterior teeth, by crown lengthening procedure associated with free gingival graft procedure, to ensure the possibility to place a modified partial fixed prosthesis in treated area. The procedure applied to recover the biologic width was crown lengthening with some modifications, associated with modified partial fixed prosthesis to achieve health in treated area. The modified techniques in both surgical and prosthetic procedures were applied to compensate the contraindications to recover biologic width by osteotomy in lower posterior teeth. The result, after 4 years under periodic control, seems to achieve the projected goal. Treating a dental diseased area is necessary to diagnose, eliminate, or control all etiologic factors involved in the process. When the traditional methods are not effective to recover destructed tissues, an alternative, compensatory, and adaptive procedure may be applied to restore the sequelae of the disease, applying a restorative method that respects the biology of involved tissues.

The influence of loss of bone mass on induced periodontal disease: A radiographic and densitometric study of female rats

Background: Changes in mineral density in the mandibular and femoral bones (BMD) after estrogen deficiency caused by ovariectomy (OVX) and the influence of these changes on induced periodontal disease were evaluated in female rats.Methods: Forty-eight female Holtzman rats (90 days old) were randomly divided into five groups: 0: control (N = 9); 1: SHAM without induced periodontal disease (N = 11); 2: SHAM with induced disease (N = 10); 3: OVX without induced disease (N = 9); and 4: OVX with induced disease (N = 9). In groups 2 and 4, the first lower molars were tied with ligatures for 30 days 120 days after surgery. After 5 months the animals were sacrificed to measure global mineral density (BMD) and that of the sub-regions of the mandible and femur by dual energy x-ray absorptiometry (DXA). The extent of vertical bone loss was evaluated with digital radiography by measuring the distance from the bone crest to the cemento-enamel junction at the mesial of the first lower molar.Results: Results of the femur (Kruskal-Wallis test) showed a significant difference (P < 0.001) between the groups SHAM and OVX in bone density values for all regions. Comparison between the groups in relation to the BMD of the mandible, both in the sub-regions and global revealed no differences (P < 0.05). The vertical bone loss measured for the groups with induced disease was similar (P= 0.713).Conclusions: Differences between the groups were found in the bone mineral density BMD of the femur but not of the mandible. OVX had no influence on induced periodontal disease.

Influence of the period after ovariectomy on femoral and mandibular bone density and on induced periodontal disease

Background: This study investigated the influence of the period after ovariectomy on femoral and mandibular bone mineral density (BMD) and on induced periodontal disease.Methods: One hundred and twenty-six female Holtzman rats were divided into nine groups: control, sham surgery (SHAM) with and without induction of periodontal disease for 51 and 150 days, and ovariectomy (OVX) with and without induction of periodontal disease for 51 and 150 days. Periodontal disease was induced by placing ligatures on the first lower molars during the last 30 days of each period. BMD was measured by dual-energy x-ray absorptiometry. Vertical bone loss was determined by measuring the distance from the alveolar bone crest to the cemento-enamel junction on the mesial side of the first lower molar.Results: Statistical analyses (Kruskal-Wallis test) revealed a significant difference between the OVX and SHAM groups' global and femoral proximal epiphysis BMD (P < 0.001) for 150 days and in the global evaluation for 51 days. For mandibular BMD, no difference was found between the groups of each period. Influence of the period on femoral BMD was found only for the SHAM groups, with lower BMD for the 51-day period compared to the 150-day period (P < 0.05). In the global evaluation of the mandible, a lower BMD was found after 51 days. The period was a contributing factor for the vertical bone loss, and it resulted in higher values for the 51-day period (P < 0.05).Conclusion: the period influenced the femoral BMD and the vertical bone loss in induced periodontal disease.

CPITN: time and cost estimates for periodontal prevention and treatment procedures.

The aim of this study was to estimate the necessary time and cost for periodontal prevention and treatment in a working population from sugar and alcohol refineries in Araraquara, SP, Brazil. A stratified sample of 528 employees aged 18-64 from administrative, industrial and agricultural staffs was examined by one examiner, previously trained, according to the community periodontal index of treatment needs (CPITN). The time required for procedures and the cost was extrapolated to the total worker population. The results showed that the estimated time required for periodontal prevention/treatment was 4527 hours. Of this time, 1783 hours were required for oral hygiene instruction, 2531 for scaling, 151 for surgery and 62 for maintenance. The cost would be US $17,655 for hiring a dentist for 8 hours/day to provide oral hygiene instruction, scaling, surgery and maintenance. However, the cost would be US $9,028 for hiring a dentist for 4 hours/day to provide surgery and maintenance and a dental hygienist for 8 hours/day to provide scaling and oral hygiene instruction. Taking into account epidemiologic, technical and economic aspects, the decision relating to manpower should be this second option.

Immediate replantation of maxillary incisors in rats: effects of tooth immersion in sodium fluoride and subsequent removal of the periodontal ligament.

The advantages and disadvantages of maintaining the periodontal ligament (PDL) in immediate replantation as well as chemical treatment of the root surface have been a matter of discussion because the vitality of such tissue in surgery is always questioned. This study evaluated the effects of conserving the tooth in sodium fluoride and the removal of the PDL before replantation of incisors in rats. There was more cementum-dentin resorption in the group with the PDL. The group without the PDL showed more discreet resorption, repair occurred through the newly formed bone tissue in the PDL space and ankylosis was more extensive than in the group with the PDL.

Gingival recession associated with noncarious cervical lesions: Combined periodontal-restorative approach and the treatment of long-term esthetic complications

The combined periodontalrestorative approach (that is, a connective tissue graft for root coverage and NCCL restoration with RMGI cement) has demonstrated significant root coverage and a good esthetic outcome. In some cases, though, the color of an RMGI restoration can change over time, compromising esthetics. In this situation, applying composite resin over an RMGI restoration can be a conservative approach to satisfy the patient's esthetic complaint. Long-term observation is necessary to evaluate the stability of the results and establish the success of this approach over time.

Estudo dos mecanismos envolvidos na resposta tecidual de camundongos diabéticos com doença periodontal: papel dos mastócitos

Pós-graduação em Ciência Odontólogica - FOA