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.

Cirurgia estética para remoção de hiperplasia gengiva: granuloma piogênico

The pyogenic granuloma, a lesion considered hyperplastic regenerative inflammatory reaction is a finding commonly found in the oral cavity, affecting large numbers of individuals, being more prevalent in females. But its pathogenesis is not well defined and may be associated with numerous factors that stimulate tissue proliferation. Correct diagnosis and treatment plan are essential for success in approach, restoring function and aesthetics to the periodontal tissues. In agreement with the literature, the most common treatment and greater predictability is surgical removal, which involves resection of the lesion, together with its base inserted into the underlying tissue, periosteum and bone tissue. However, the excision can promote aesthetic defects, particularly in anterior regions where it is most affected. This article reports on the importance of a correct surgical approach for removal of pyogenic granuloma in the region of the interdental papilla between teeth 42 and 43, resulting in a good anatomical result and aesthetic.

Prótese metalocerâmica associada à prótese metaloplástica implantossuportada em paciente desdentado total

The use of different methods and materials should be considered during the planning of implant-supported prostheses. Complications such as fractures of the acrylic resin base, wear and fracture of teeth can occur frequently, creating the need for careful planning for each patient, which can make the selection of the type of treatment more complex. Thus, this article describes the oral rehabilitation of a completely edentulous patient with bimaxillary fixed implant-supported prosthesis, with complaints on aesthetics, loss of vertical dimension and fracture of acrylic resin teeth of the upper arch. After the restoration of vertical dimension, his dentures were replaced with new bimaxillary implant-supported fixed prostheses, ceramic and acrylic resin were used as veneering material for maxilla and mandible, respectively. At the end of the treatment, the patient received bimaxillary flat occlusal splints to protect the teeth and implants of possible parafunctional habits. The approach for the treatment allowed a quick and effective resolution, with aesthetic and functional outcomes very favorable for the patient.

Correction of malpositioned implants through periodontal surgery and prosthetic rehabilitation using angled abutment

When dental implants are malpositioned in relation to the adjacent teeth and alveolar bone or in an excessive buccal or lingual position, the final prosthesis rehabilitation impairs the peri-implant health of the gingival tissues and the aesthetics of the patient. Thus, the purpose of this case was to report and discuss a multidisciplinary protocol for the treatment of a compromised maxillary tooth in a patient with an abscess in his right central incisor due to an excessive buccal implant position. The patient presented with an implant-supported provisional restoration on his right maxillary central incisor and a traumatic injury in his left central incisor. The treatment protocol consisted in (i) abutment substitution to compensate the incorrect angulation of the implant, (ii) clinical crown lengthening, (iii) atraumatic extraction of the left central incisor, and (iv) immediate implant placement. Finally, (v) a custom abutment was fabricated to obtain a harmonious gingival contour around the prosthetic crown. In conclusion, when implants are incorrectly positioned in relation to the adjacent teeth, associated with soft-tissue defects, the challenge to create a harmonious mucogingival contours may be achieved with an interdisciplinary approach and with the placement of an appropriate custom abutment.

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.

Interação entre odontologia restauradora e periodontia - parte 2: reanatomização dentária

The development of new dental materials has expanded dental therapeutic modalities ensuring excellence in aesthetic restorative treatments. Thus, the direct restorative procedures have been used in cases of dental reconstruction allowing an effective treatment with a low cost, while preserving healthy tooth structure. However, the clinician must be used to the techniques and the material in order to ensure longevity and success in the direct restorative procedure. The aim of this paper is to descrive, after completion of periodontal surgical procedures, the direct restorative step performed for dental reconstruction and diastema closure. The integration between Restorative Dentistry and periodontics enableb the restoration of a harmonious smile in a conservative manner, ensuring aesthetics and patient stisfaction.

Coroas estéticas anteriores em cerâmica metal-free: relato de caso clínico

Society's change of parameters for health and aesthetics has resulted in an increased demand for dental treatments. Nowadays, ceramics systems have shown a substantial development, becoming more reliable and predictable. Dental ceramics, besides being chemically stable, present excellent optical properties when compared to dental structures, thus assuring a special position in the list of aesthetic restorative materials. OBJECTIVE, CASE REPORT AND CONCLUSION: This article describes a successful clinical procedure involving the anterior teeth aesthetics, which were restored with all-ceramic crowns (IPS e.max® Ivoclar Vivadent).

Repercussões endodônticas dos procedimentos clareadores

Tooth bleaching is a treatment modality that raises great interest, due to the important role played by aesthetics in current life style. To perform such procedure, nowadays, there are several bleaching substances at several concentrations, as well as, diverse clinical techniques. When suggesting this procedure, the dentist should take into consideration several factors related to the patient to determine which will be the most appropriate technique/material combination for solving the clinical problem. The procedure indication should not only be based on the expectations exhibited by the patient, but also on respecting the biological principles to maintain the integrity of both the endodontic and periodontal tissues.

Reabilitação estética do sorriso por meio do sistema cerâmico dissilicato de lítio: relato de caso

The reestablishment of a harmonious smile through dental ceramics, when properly conducted and with specific indications, can achieve extremely predictable results. For aesthetic and functional rehabilitation, many ceramic materials can be used such as zirconia, leucite, alumina, feldspar, and lithium disilicate. Among these materials the lithium disilicate stands out due to the following characteristics: its resistance to wear, to chemical attack, high temperatures and oxidation; low electrical conductivity; near zero thermal expansion; good optical properties and biocompatibility with periodontal; excellent esthetics; color stability and reinforcement of tooth structure. The indications for the use of lithium disilicate are not limited to multiple facets of teeth in cases where there was no favorable response to tooth whitening, and also comprehend teeth with multiple restorations, diastema closure, shape alteration, and dental contouring, replacement of missing or fractured teeth, among others. The versatility of lithium disilicate ceramics allows its utilization in several clinical situations. The concomitant use of lithium disilicate for veneers and over metal has satisfactory aesthetic results, as reported in the present studying cases that require both aesthetics and resistance.

Fragment reattachment after atypical crown fracture in maxillary central incisor

Background. Fracture by trauma is one of the most common types of dental injury in the permanent dentition among children and teenagers. Aim. The aim of this study was to report the treatment performed to an atypical dental trauma case in a maxillary central incisor of a young patient by means of reattachment of the tooth fragment. Case Description. A 12-year-old male patient suffered a vertical crown fracture to the maxillary right central incisor. After clinical and radiographic examinations, a conservative restorative treatment which consisted in the reattachment of the tooth fragment with flow resin was performed in order to preserve the dental element and to obtain maximum aesthetics. Conclusion. The reattachment of fractured fragment is a fast and easy technique that can be used successfully as an option to restore dental element which suffered trauma. Clinical Significance. This technique restores the aesthetics and function of the dental element with minimal discomfort to the patient.

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.

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.

Usabilidade, percepção estética e força de preensão manual: influência no design ergonômico de instrumentos manuais : um estudo com tesouras de poda

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

Corpos (con) sentidos: cartografando processos de subjetivação de produto(re)s de corporalidades singulares

Pós-graduação em Psicologia - FCLAS