Abordagens periodontais na promoção da harmonia do sorriso

Several therapeutic approaches have been proposed in order to achieve an esthetically pleasing and harmony smile. The present study reports a case in which gingivectomy was performed in the region of the upper anterior teeth combined with osteotomy in the region of the upper posterior teeth and removal of the superior labial frenum to promote harmony smile by decreasing the gummy smile and adequacy of buccal corridor. Osteoplasty gingivoplasty, and frenectomy procedures were planned and performed in a single session. The extraction of the maxillary third molars was also performed in order to avoid postoperative complications. Follow-up visits were performed at 7, 15, 30 and 180 days postoperatively. At 7 days, the gingival tissue was in the initial process of healing, demonstrating inflammation still in evidence. At 15 days, the gingival tissue was found in the final healing process, showing characteristics of normal health gum. At 30 days, there was complete healing of gingival tissues without clinical exposure of the root surfaces. After 180 days, tissues remained in healthy, demonstrating the success of the treatment. Patient showed complete satisfaction with the results. It can be concluded that, when properly indicated, the combination of gingivectomy, osteotomy and frenectomy procedures are promising therapeutic approaches for promoting harmony smile.

Enxerto de tecido conjuntivo para correção da margem peri-implantar

Soft tissue recessions frequently cause esthetic disharmony and dissatisfaction. The results of coverage in peri-implant sites, in comparison with soft tissue coverage around a tooth, is less predictable. This clinical report describes the correction of an esthetic problem with a single-tooth implant-supported using a subepithelial connective tissue graft (SCTG) combined with the re-establishment of a new limit of gingival margin, and emergence crown profile. After anamnese and clinical exam it was observed an implant in the region of tooth 22 in vestibular position to alveolar ridge with a recession of 5 mm in its vestibular face. In the first cirurgical procedure the crown and the abutment were removed and a SCTG associated with a coronally positioned flap was performed in order to re-establish the limit of gingival margin. After 90 days, it was observed that the tissue in the implant site showed no adequate volume or thickness. Because of that, another SCTG was performed. The reopening procedure to install the healing cap was performed after 4 weeks. Then the prosthesis was installed. At 180 and 360 days postoperative, the implant adjacent tissue presented regular contour, color compatible with health and absence of bleeding. The patient was satisfied with the esthetic result. According to the clinical results and favorable esthetics it was possible to conclude that the use of ETC to correct an esthetic deficiency may be a feasible approach to establish new and stable peri-implant soft tissue contours.

Recobrimento de múltiplas recessões com enxerto subepitelial: tratamento de descontaminação da superfície radicular com laser de Erbium YAG

Multiple gingival recessions may cause mainly dentinary sensibility and aesthetic alterations. The subepithelial graft is a mucogingival technique which can be used to treat multiple gingival recessions. In this case report the Erbium YAG laser was applied to promote radicular surface decontamination, an important step to reach reinsertion of the gingival tissues on exposed radicular surface.

Reabilitação protética implantossuportada em região anterior maxilar com utilização de gengiva artificial cerâmica: relato de caso

The osseointegrated implants created a progress in oral rehabilitation. But this rehabilitation may be complicated by anatomical conditions, mainly in maxillary anterior region, where a higher aesthetic is required. The aim of study was to report one case which the use of angled abutments were necessary to allow the correct positioning of the prosthesis and also the prosthetic reconstruction with gingival-colored ceramic to provide best aesthetic result for patient. The aesthetic and functional results provided greater patient satisfaction with her smile. The correct planning is essential to provide to patient the best aesthetic and functional results, being necessary the use of abutments and gingival-colored ceramic to reach better results. Uniterms: dental implantacion, esthetics, mouth rehabilitation.

A utilização de abutment de zircônia na reabilitação oral: aspectos protéticos e periodontais

Zirconia abutments are used to obtain satisfactory aesthetic results in implant fixed anterior prostheses when metal abutments promote a grayish mucosal discoloration of the peri-implant soft tissues. However, there is a lack of studies to confirm the clinical performance of the peri-implant soft tissues surrouding zirconia abutments. This study described a case report of a patient treated with implant fixed all-ceramic crown made out on zirconia abutment after 3 years of followup. A 47-year-old female patient was admitted to the dental clinic (Aracatuba Dental School) complaining about the fracture of her implant fixed single crown in the region of the left lateral incisor. The patient chose the replacement of the fractured prosthesis for an allceramic crown. After 3 years of follow-up it was observed that maintenance of the aesthetic results and the peri-implant soft tissue without any inflammation or gingival recessions. Within the limitations of a case report, it can be conclude that zirconia abutments is a effective rehabilitation treatment because it preserves the aesthetics and function through the maintenance of peri-implant tissues.

Plástica gengival associada à laminados cerâmicos para resolução estética

Sometimes we face clinical situations in which the lack of harmony in the smile is caused by a major exhibition of the gingival tissue. In these cases the professional should be able to perform a detailed analysis of the static and dynamic components of the smile, in search of a satisfactory planning and treatment which may include different dental specialties. For these situations, the association of periodontics/prosthesis is a viable alternative that has been used positively in search of an aesthetic and functional condition that benefits the patient, without leaving aside the preservation of periodontal tissues and of the remaining structure of the tooth. Thus, the aim of this study was to describe a case in which the association between these two areas was proposed to correct gummy smile and dental vestibularization. Clinical results and the satisfaction of the patient indicate that this multidisciplinary treatment combining periodontal and prosthetic techniques is favorable to positive results in cases of compromised smile aesthetics due to excessive gum tissue.

A importância da mucosa queratinizada na implantodontia

The purpose of current implantology is to ensure that implants maintain its state of full health, proper function and aesthetics. The aim of this paper is to discuss, through a literature review, the importance of keratinized mucosa in relation to cleaning, gingival maintenance, aesthetics involving dentistry implant and evaluating some options to provide a keratinized mucosa when it is insufficient. For the studies identification, it is included or considered in this review, Pubmed database with the following keywords: implant and mouth mucosa and, according to the criteria for inclusion and exclusion, 27 articles were selected. According to the reviewed articles, it was found that the keratinized tissue does not influence the survival of the implant, but it facilitates the cleaning, decreases the irritation of the peri-implant tissues and promotes aesthetics in anterior regions.

Influência do formato do rebordo alveolar sagital em reabilitações com associação de prótese parcial removível de extremidade livre e implante ósseo integrado

The association of mandibular distal extension removable partial dentures with an osteointegrated implant is a treatment option at hasn't been fully explored by modern rehabilitation dentistry yet. The objective of this study is to evaluate, by means of the bidimensional method of finite elements, the distribution of tension on the structures supporting the distal extension removable partial denture (DERPD), associated to a 10.0 x 3.75 mm osteointegrated implant with an ERA retention system, in alveolar ridges of different shapes. Eight models were created, representing, from a sagittal perspective: Model A (MA) – a half arch with a horizontal ridge without posterior support, with the presence of the lower left canine, and a conventional DERPD, with metallic support in the incisal aspect of this canine, as replacement for the first and second pre-molars and the first and second molars of the lower left half arch; Model B (MB) – similar to MA, but different because of the presence of a 3.75 x 10.00 mm implant with an associated ERA retention system in the posterior region of the DERPD base; Model C (MC) - similar to MA, however with a distally ascending ridge format; Model D (MD) – similar to MC, but different because there is an implant associated to a retention system; Model E (ME) - similar to MA, however with a distally descending ridge format; Model F (MF) – similar to ME, but ditfferent in the sense that there is an implant with an associated ERA retention system; Model G (MG) – similar to MA, however with a distally descending-ascending ridge format; Model H (MH) – similar to MG, but different in the sense that there is an implant with an associated ERA retention system. The finite element program ANSYS 9.0 was used to load the models with vertical forces of 50 N, on each cuspid tip. The format of distal descending edge (ME and MF) was that presented worse results, so in the models with conventional RPD as in the models with RPD associated to the implant and ERA system of retention, for the structures gingival mucosa and tooth support. 1) the distally descending ridge presented the most significant stress in the model with the conventional RPD (ME) or with a prosthesis associated to an implant (MF) and 2) the horizontal ridge (MB) provided more relief to the support structures, such as the tooth and the spongy bone, when there was an implant associated to an ERA retention system. The incorporation of the implants with the ERA system retention, in the posterior area of the toothless edge, it promotes larger stability and retention to PPREL, improving the patient's masticatory acting and, consequently, its comfort and function.

A relevância do periodontista na prevenção da doença periodontal em pacientes ortodônticos: relato de caso clínico

The increase of the retentive areas of bacterial plaque can be observed in patients who use dental braces in the mouth. The difficulty of making hygienic is one of the problems that this particular group of patients faces day by day, and consequently, the establishment of gingival inflammation becomes more frequent. The objective of this case report is to show the importance of the periodontist in preventing and promoting health to the users of dental braces, aimed at education and motivation as one of the priorities of this treatment. The ESA patient, 29 years old, male, attended the dental office of a periodontist, sent by the orthodontist, due to the extensive area of gingival hyperplasia and gingivitis, in both arches. The possibility of taking out the dental braces was considered by the orthodontist, but after the periodontist evaluation, this step was procrastinated. Thus, the periodontist started the adequacy of the oral environment together with the work of education and promotion of health, which lasted until the complete recovery of the healthy gingival condition of the patient. In this way, it is possible to observe the relevance of the work of the periodontist in the application of preventive methods in oral health for orthodontic patients. The motivation of these patients in relation to the orientations of buccal hygienic, maintenance of oral health and diet should not be considered as secondary and should be prioritized, because only in this way it would be possible to reach a good occlusion, without esthetic and functional prejudice.

Pemphigus vulgaris in adolescence: a case report

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Combined therapy with mineral trioxide aggregate, and guided tissue regeneration for a large radicular cyst: a 13-year follow-u

Biomaterials such as membrane barriers and/or bone grafts are often used to enhance periapical new bone formation. A combination of apical surgery and these biomaterials is one of the latest treatment options for avoiding tooth extraction. In case of periapical lesions, guided tissue regeneration (GTR) is attempted to improve the self-regenerative healing process by excluding undesired proliferation of the gingival connective tissue or migration of the oral epithelial cells into osseous defects. In many cases, GTR is necessary for achieving periodontal tissue healing. This report describes the healing process after surgery in a challenging case with a long-term followup. In this case report, endodontic surgery was followed by retrograde sealing with mineral trioxide aggregate (MTA) in the maxillary right central incisor and left lateral incisor. Apicectomy was performed in the maxillary left central incisor and a 1-mm filling was removed. The bone defect was filled with an anorganic bone graft and covered with a decalcified cortical osseous membrane. No intraoperative or postoperative complications were observed. After 13 years of follow-up, the patient showed no clinical signs or symptoms associated with the lesion and radiographic examination showed progressive resolution of radiolucency. In conclusion, the combination of apical surgery and regenerative techniques can successfully help the treatment of periapical lesions of endodontic origin and is suitable for the management of challenging cases

Análise do clareamento dental caseiro realizado com diferentes produtos: relato de caso

Aesthetic dental treatments are very popular nowadays. Among them, dental bleaching occupies a prominent place. Por esse motivo, muitos trabalhos são realizados a fim de avaliar seus efeitos clínicos sobre a estrutura dental. Due to the high demand for bleaching treatments, many studies have been conducted to evaluate its effects on tooth structure. This study aimed to report and discuss the aspects related to color change as well as the side effects caused by dental home bleaching using carbamide peroxide or hydrogen in different concentrations. This case reported and recent literature shows that the available products are similarly effective for vital dental bleaching. However, considering the occurrence of dental sensitivity, the use of hydrogen peroxide-based products promoted higher levels of this symptom when compared to carbamide peroxide. Gingival irritations were also verified during the treatment, regardless the product used. It was concluded that dental bleaching using 10% carbamide peroxide or 6% hydrogen peroxide accomplished with the aid of a tray produces satisfactory results, providing patients a greater selfesteem and pleasure in smiling.

Classe mollicutes na boca de pacientes com dependência química

Drug addiction is one of the biggest public health problems worldwide, not only by the dimensions of the problem, but also by the severity of the damage, creating favorable conditions for opportunistic microorganisms such as class Mollicutes. This study aims to evaluate the presence of the main species and genera of this group in the subgingival biofilm of drug addiction patients, comparing them with non-dependent subjects. For this purpose, data on systemic health conditions, socioeconomic characteristics, drug addiction from 72 patients with drug addiction kept in rehab clinics and 100 non-dependent patients who formed the control group were obtained. Intra and extraoral clinical examinations were performed and samples of subgingival plaque were collected through sterile absorbent paper cones. The presence of different genera and species of the class Mollicutes was evaluated by PCR using the specific primers and conditions for each microorganism. The statistical analysis was performed using the Chi-square test for comparisons of three or more variables and the Mann-Whitney test, with significance level of 5%. Out of species and genera evaluated, Mycoplasma salivarium showed correlation with gingival inflammation in both patient groups and was more frequently detected among drug addiction patients

Ocorrência de microrganismos periodontopatogênicos em pacientes com dependência química

Drug addiction won dramatic aspects in terms of its dimensions and the effects that it imposes. These chemical agents are able to reduce the immune reactivity and tissue repair, and enhance microbial aggression, aggravating the destruction of the periodontium and other side effects. This study aimed to evaluate the presence of key periodontal pathogens in the mouth of drug addiction patients, comparing it with individuals who do not exhibit this dependence, as well as assess the influence of oral conditions on the occurrence of such microorganisms. For this purpose, data on systemic health conditions, socioeconomic, patterns of licit or illicit drug consumption of 100 patients with chemical dependency kept in rehabilitation clinics and an equal number of non-dependent patients, who formed the control group were obtained. Intra and extraoral clinical examinations were performed and samples of supragingival and subgingival biofilm, saliva and mucous membranes were collected. The presence of the targeted microorganism was assessed by polymerase chain reaction (PCR). It was found that Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola showed close correlation with bone loss and gingival bleeding in drug addiction dependents and control group, but the oral mucous membranes and saliva of addicts showed higher occurrence of these pathogens.

Saúde bucal de adolescentes que receberam assistência odontológica na primeira década de vida

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)