Association between post-orthodontic treatment gingival margin alterations and symphysis dimensions

Orthodontic therapy is known to be associated with the development of gingival recession. Several factors may be involved in the causal chain of this outcome, including anatomical and behavioral aspects. Among the anatomical aspects, the dimensions of the mandibular symphysis could play a predisposing role. This study evaluated the relationship between the mandibular symphysis dimensions prior to orthodontic therapy and the development of gingival recessions on the lower incisors and cuspids. Records from 189 orthodontically treated adolescents were evaluated, including radiographs, casts and intra-oral photographs. Symphysis dimensions were assessed by cephalograms. Gingival margin alterations were determined in photographs and cast models. Association between gingival margin alterations and symphysis dimensions was tested by chi-square (α=0.05). Occurrence of gingival recession increased after orthodontic therapy. No association was observed on average of symphysis dimensions and the occurrence of gingival recessions. It may be concluded that pretreatment symphysis dimensions may not be used as predictors of gingival recession after orthodontic therapy.

Subepithelial connective tissue graft: a case report

Introduction and objective: Marginal tissue recession represents a common condition in Periodontology. Miller's Classes I and II recessions, in which the etiological factors are well diagnosed and eliminated, show great predictability of total coverage when the technique of subepithelial connective tissue graft is used. This technique success has been mainly attributed to the double blood supply for graft's nutrition, originating from the connective tissue of both the periosteum and flap. Case report and conclusion: The authors reported a clinical case in which a Miller's Class I recession was treated by the surgical technique of subepithelial connective tissue graft, obtaining total coverage, eliminating the aesthetic deficiency and the dentin hypersensitivity complained by patient.

Tratamento de recessões gengivais múltiplas: uma abordagem mais conservadora

Periodontal therapy has undergone significant changes in recent decades. While in the past the only goal was to restore gingival health, with no concern about the possible consequences of the disease treatment, currently the procedures are performed in a less invasive manner, to maintain aesthetic periodontal results or even recover them. Gingival recession is an alteration frequently found in patients and may be a complaint for causing various complications. For their treatment, several surgical techniques are reported in the literature. The techniques that are more predictable are those that associate a subepithelial connective tissue graft and a coronally repositioned flap. The original technique consists in performing two vertical incisions for an extensive release of the flap and its stabilization in a coronal position. Although this procedure is extremely widespread in the literature, the search for less invasive surgeries without the use of vertical incisions are the current aim of periodontal plastic surgeries, since they present several advantages. The aim of this paper is to demonstrate a case where adjacent, deep and multiple recessions were present resulting in aesthetic problems, which was resolved by a less invasive approach using a surgical technique in envelope and a subepithelial connective tissue graft.

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.

Importância do tratamento estético periodontal na reabilitação protética

Gingival recession is a common deformity that affects a large number of people. This condition is frequently associated with esthetic complains and may lead to dental hypersensitivity. Thus, various surgical procedures have been proposed to provide root coverage. Since the 1950s, free and pedicle gingival grafts have been greatly used for treating gingival recession. However, after the 1985 Miller gingival recession classification, and with the development of other appropriated techniques that use subepithelial connective tissue grafts, gingival recession treatments have resulted in more predictable outcomes, especially with respect to Class I and II sites, i.e., in the absence of interproximal bone loss. This article reported the importance of aesthetical periodontal treatment in the prosthetic rehabilitation of a patient with a class I gingival recession with 3 mm of vertical extension in the superior canine. The treatment plan consisted of root coverage using subepithelial connective tissue graft (SCTG) associated with construction of new prosthesis.

Hipersensibilidade dentinária cervical: em busca de um tratamento eficaz

The knowledge of the etiology of any disease or condition is paramount to a safe and effective treatment. This literature review aims to show some options to treat dentine hypersensitivity (HSDC). The loss of cervical enamel and cementum exposure of tubules leads to a painful condition and patient discomfort, called HSDC. This loss of tooth structure occurs due to formation of cervical lesions in cases of gingival recession, abrasion, erosion, or abfraction by the association of two or more factors. Some treatments are not effective, but there are effective therapies, such as: application of ferric oxalate, potassium oxalate, potassium nitrate, fluoride varnish, solutions of calcium phosphate, adhesives and Bonding procedures. Therefore, the identification and removal of etiological factors is essential to successful treatment of HSDC normally associated to tubules obliterate and consequent reduction of fluid motion within the dentin.

Tratamento estético periodontal: revisão de literatura sobre alguns tipos de cirurgias

Currently, periodontal aesthetics has been prized for harmony of the smile. The clinical crown lengthening, gingival excess or altered passive eruption, is effectively corrected by periodontal surgery. The purpose of this paper is to show, through a literature review, some types of surgery on clinical crown lengthening and root coverage. Clinical crown lengthening is done to Change the size of the anterior teeth and to optimize the cosmetic result of treatment with new coronal restoration and other cosmetic dental care. In general, the treatment plan and the choice of operative technique begin with careful clinical examination. Recessions tissue can be defined as a displacement of the gingival margin toward the junction mucogingival exposing the root surface. These, when present, impacting on patient comfort by providing the occurrence of cervical dentin hypersensitivity, and the esthetic, the amendment of the gum line. Successful treatment of recessions is based on knowledge of its etiology and assessment of predictability of surgical techniques that aim to root coverage. Through literature review, we can conclude that the types of surgery most often used are: 1) to increase the clinical crown, gingivectomy, flap surgery and gingivoplasty osteotomy, and 2) for root coverage, the use will depend on the amount of gum keratinized and especially the classification of Miller.

Lesão endoperio: apicectomia com abordagem palatina: Relato de caso clínico com 30 meses de acompanhamento

Traditionally, the apicoectomies are carried out with the vestibular approach for visibility and easiness of access. The aim of this study was to present a case report of a patient with extensive injury endo-periodontal opted for the surgical access through a palatal incision. The patient presented with abscess drainage via periodontal ligament. The periodontal probing coincident with the radiographic apex in mesial tooth on dental element 22. Radiographically it was noted that the periapical lesion extended from the distal of the tooth 11 to the mesial of tooth 23. The tooth 22 had undergone endodontic treatment and showed signs of shutter material extravasation. It was decide to carry out an approach by the Palatine of the tooth to prevent gingival. After the flap elevation, the injury was debrided and apicoectomy was performed. The patient reported no pain or discomfort after surgery. Furthermore, as follow-up of 30 months there was total remission of signs and symptoms presented initially and absence of gingival recession. Therefore, according to the results showed in this case report, it is suggested that the Palatine access is an alternative approach that can be successfully employed in cases of apicoectomies in order to avoid the occurrence of gingival recessions.

Associação de prótese fixa, implantes e estética periodontal para reabilitação de pacientes parcialmente edêntulos

Periodontitis is a chronic inflammatory disease that results in the destruction of teeth and their supporting tissues with subsequent tooth loss. The replacement of missing teeth for implant-supported restorations has proven to be a highly predictable treatment method with good long-term prognosis. However, some consequences of tooth loss prevents dental implant placement in an ideal position, where regenerative procedures are necessary for this type of rehabilitation. Less invasive procedures such as conventional prosthesis emerge as a therapeutic option in cases where there is enough bone structure for implants and patient´s non-acceptance for invasive procedures. Thus, this paper aims to present the resolution of rehabilitation through a noninvasive and multidisciplinary treatment. One female patient referred to the clinic presented maladaptive bilateral mandibular fixed prostheses, endodontic lesions, gingival recession, and root sensitivity. For proper resolution of this case, an association among osseointegrated implants, fixed partial prosthesis, tooth extraction, and aesthetic periodontal procedures with the use of subepithelial connective tissue graft was proposed. After two years, the patient shows excellent aesthetics and chewing. Within the limits of this scenario, this paper discusses the various factors that may affect the choice of a particular treatment modality for the rehabilitation of edentulous single spaces.

Importância do tratamento estético periodontal na reabilitação protética

Gingival recession is a common deformity that affects a large number of people. This condition is frequently associated with esthetic complains and may lead to dental hypersensitivity. Thus, various surgical procedures have been proposed to provide root coverage. Since the 1950s, free and pedicle gingival grafts have been greatly used for treating gingival recession. However, after the 1985 Miller gingival recession classification, and with the development of other appropriated techniques that use subepithelial connective tissue grafts, gingival recession treatments have resulted in more predictable outcomes, especially with respect to Class I and II sites, i.e., in the absence of interproximal bone loss. This article reported the importance of aesthetical periodontal treatment in the prosthetic rehabilitation of a patient with a class I gingival recession with 3 mm of vertical extension in the superior canine. The treatment plan consisted of root coverage using subepithelial connective tissue graft (SCTG) associated with construction of new prosthesis.

A new calcium silicate-based material (Biodentine) for filling radicular perforation in an endodontic-periodontal lesion: a case report

This case report presents an apical radicular perforation management using new calcium silicate-based cement (Biodentine) in a combined endodontic-periodontal lesion. The presence of apical radicular perforation may interfere in the endodontic treatment prognosis. Radicular perforation filling with bioactive cement through endodontic surgery is a possible treatment. This study presents an apical radicular perforation with periodontal involvement, due to alveolar bone loss on the buccal radicular surface from an incorrect intracanal preparation for the fiber post placing. The chosen alternative was a periapical surgery, the perforation was filled with a silicate and calcium chloride bioactive cement (Biodentine; Septodont, Saint-Maur-des-Fosses Cedex, France), and the radicular surface was etched with citric acid, because the access from root canal was impossible. The follow-up was for 8 months, through clinical and radiographic analysis. At the end of the follow-up, radiographic analyses showed the bone healing, and no clinical changes in periodontal probing depth, gingival recession, and the height of the interproximal mesial and distal papillae were observed. The root perforation treatment has a difficult management, especially when the dental root has a simultaneous periodontal commitment. The Biodentine proves to be a promising material for use in these situations.

Aplicação do enxerto conjuntivo subepitelial para recobrimento de recessões em dentes inferiores

Some regions of the oral cavity present anatomical conditions that seem to hinder the result of gingival recessions coverage. Thus, the aim of this case report was to present two surgeries for gingival recessions coverage in the mandibular teeth performed on the same patient with the follow-up of 24 months. Patient RP, 35 years old, male, Caucasian, nonsmoker, systemically healthy, sought care at the clinic of specialization course in Periodontics from the Araraquara Dental School (Foar-Unesp). His main complaint was the gingival recessions within the lower teeth 33, 34, 35, 43, 44 and 45. Besides the aesthetic nuisance, the patient reported occasional dentin sensitivity. For resolution of the case was referred to the technique of subepithelial connective tissue graft associated with a coronally advanced flap. After 2 years of surgery, it was observed an excellent root guards with significant aesthetic improvement of the case. It can be concluded that the subepithelial connective tissue graft technique was effective in covering of type class I gingival recessions of Miller, even in a region that provides a difficult procedure.

Recobrimento radicular para o tratamento de hipersensibilidade dentinária cervical persistente

Gingival recession has a high prevalence in the population. This alteration may promote several complications such as cervical dentinal hypersensitivity (HSDC), carious and non-carious cervical lesions, and cosmetic changes due to the increase of the clinical crown length. To treat HSDC there are several therapeutic possibilities that should aim to eliminate pain after external stimulus. Treatment of this alteration can be performed by a conventional or invasive procedure, depending on the clinical condition and patients' desires. In situations where aesthetics is not the main complaint and HSDC persists even after conservative procedures, it is possible to indicate a procedure to achieve root coverage in Miller's Class I and II recessions. The aim of this paper is to report a case where the HSDC was not eliminated by conventional methods, which was resolved only after performing a minimally invasive surgery that promoted total root coverage.

Recobrimento radicular por enxerto de tecido conjuntivo subepitelial

Gingival recession lesions are characterized by apical migration of gingival margin with consequent exposure of the root surface, which constitutes an aesthetic problem for the patient. Several surgical techniques have been used for the root coverage, and the technique of subepithelial connective gingival graft has greater predictability of root coverage and best aesthetic results with fewer postoperative side effects in relation to the epithelial free gingival graft. The goal of this case repot is to describe the technique of subepithelial connective tissue graft and demonstrates its result in a coverage Miller class I root recessions. After two years we can see excellent root coverage with significant aesthetic improvement of the case. The free subepithelial connective tissue graft technique was effective in coverage Miller class I root recession presented in this clinical case.

Dimensional changes in soft tissues around dental implants following free gingival grafting: an experimental study in dogs

ObjectiveTo study the buccal dimensional tissue changes at oral implants following free gingival grafting, with or without including the keratin layer, performed at the time of implant installation into alveolar mucosa.Material and methodsThe mandibular premolars and first molars were extracted bilaterally in six Beagle dogs. In the right side of the mandible (Test), flaps were first elevated, and the buccal as well as part of the lingual masticatory mucosa was removed. An incision of the periosteum at the buccal aspect was performed to allow the flap to be coronally repositioned. Primary wound closure was obtained. In the left side, the masticatory (keratinized) mucosa was left in situ, and no sutures were applied (Control). After 3months of healing, absence of keratinized mucosa was confirmed at the test sites. Two recipient sites were prepared at each side of the mandible in the region of the third and fourth premolars. All implants were installed with the shoulder placed flush with the buccal alveolar bony crest, and abutments were connected to allow a non-submerged healing. Two free gingival mucosal grafts were harvested from the buccal region of the maxillary canines. One graft was left intact (gingival mucosal graft), while for the second, the epithelial layer was removed (gingival connective tissue graft). Subsequently, the grafts were fixed around the test implants in position of the third and fourth premolars, respectively. After 3months, the animals were euthanized and ground sections obtained.ResultsSimilar bony crest resorption and coronal extension of osseointegration were found at test and control sites. Moreover, similar dimensions of the peri-implant soft tissues were obtained at test and control sites.ConclusionsThe increase in the alveolar mucosal thickness by means of a gingival graft affected the peri-implant marginal bone resorption and soft tissue recession around implants. This resulted in outcomes that were similar to those at implants surrounded by masticatory mucosa, indicating that gingival grafting in the absence of keratinized mucosa around implants may reduce the resorption of the marginal crest and soft tissue recession.