Aumento de coroa estético associado ao reposicionamento labial com cimento ortopédico / Aesthetic crown lengthening combined with lip repositioned using bone cement

O sorriso gengival é uma das queixas mais comuns dos pacientes em relação à estética. De acordo com as diferentes etiologias diversos tipos de tratamento são propostos. O objetivo deste relato de caso é descrever uma técnica de tratamento desorriso gengival, utilizando o aumento de coroa estético, associado ao reposicionamento do lábio com o uso de cimento ortopédico. Concluiu-se que o aumento de coroa estético associado ao reposicionamento labial com cimento ortopédico é uma técnica inovadora e adequada para tratamento de sorriso gengival por falta de suporte labial.

The gummy smile is one of the most common complaints of patients regarding aesthetics. According to the different etiologies, several treatments are sought to resolve this complaint. This report describes a different technique to increase crown aesthetic associated with the repositioning of the lip with the use of orthopedic cement. It was concluded that is an innovative and suitable technique for treatment of gummy smile due to lack of lip support.

Retalho posicionado lateralmente e enxerto de tecido conjuntivo subeptelial no tratamento das recessões teciduais marginais / Laterally positioned flap and subepithelial connective tissue graft for marginal tissue recession treatment

Introdução: As cirurgias mucogengivais têm sido amplamente utilizadas para o tratamento de problemas periodontais. Nos casos de recobrimento radicular diversas são as técnicas utilizadas, dentre elas, o retalho posicionado lateralmente (RPL) e o enxerto de tecido conjuntivo subepitelial (ETCS). Objetivo: Apresentar um caso clínico de recobrimento radicular no qual foram utilizadas conjuntamente as técnicas de RPL e ETCS. Relato: Paciente procurou tratamento periodontal com queixa principal de sensibilidade dental. Foram observadas recessões classe I de Miller nos dentes 23, 24 e 25 e faixa de tecido queratinizado de 1 mm na região dos dentes em questão. A técnica escolhida para tratamento das recessões foi o enxerto de tecido conjuntivo associado ao retalho posicionado lateralmente. Resultados: Após 35 dias observou-se completa cobertura da superfície radicular e ganho de tecido queratinizado de 4 a 5 mm.

Introduction: Mucogingival surgeries have been widely used for the treatment of periodontal problems. In cases of root coverage many techniques are used, among them, the laterally positioned flap (LPF) and subepithelial connective tissue graft (SCTG). Objective: To present a clinical case of root coverage in which was used together the techniques of LPF and SCTG. Report: The patient sought for periodontal treatment complaining of tooth sensitivity. It was observed Miller Class I recessions on teeth 23, 24 and 25 and 1 mm of keratinized tissue track in the region of these teeth. The technique used for treatment of recessions was the connective tissue graft associated with the laterally positioned flap. Results: After 35 days was observed complete coverage of the root surface and keratinized tissue gain 4 to 5 mm.

The bone formation capabilities of the anorganic bone matrix-synthetic cell-binding peptide 15 grafts in an animal periodontal model: a histologic and histomorphometric study in dogs.

BACKGROUND: The aim of this study is to verify the regenerative potential of particulate anorganic bone matrix-synthetic peptide-15 (ABM-P-15) in class III furcation defects associated or not with expanded polytetrafluoroethylene membranes. METHODS: Class III furcation defects were produced in the mandibular premolars (P2, P3, and P4) of six dogs and filled with impression material. The membranes and the bone grafts were inserted into P3 and P4, which were randomized to form the test and control groups, respectively; P2 was the negative control group. The animals were sacrificed 3 months post-treatment. RESULTS: Histologically, the complete closure of class III furcation defects was not observed in any of the groups. Partial periodontal regeneration with similar morphologic characteristics among the groups was observed, however, through the formation of new cementum, periodontal ligament, and bone above the notch. Histologic analysis showed granules from the bone graft surrounded by immature bone matrix and encircled by newly formed tissue in the test group. The new bone formation area found in the negative control group was 2.28 + or - 2.49 mm(2) and in the test group it was 6.52 + or - 5.69 mm(2), which showed statistically significant differences for these groups considering this parameter (Friedman test P <0.05). There was no statistically significant difference among the negative control, control, and test groups for the other parameters. CONCLUSIONS: The regenerative potential of ABM-P-15 was demonstrated through new bone formation circumscribing and above the graft particles. The new bone also was accompanied by the formation of new cementum and periodontal ligament fibers.

Influence of interimplant distances and placement depth on papilla formation and crestal resorption: a clinical and radiographic study in dogs.

Among the factors that contribute to the papilla formation and crestal bone preservation between contiguous implants, this animal study clinically and radiographically evaluated the interimplant distances (IDs) of 2 and 3 mm and the placement depths of Morse cone connection implants restored with platform switch. Bilateral mandibular premolars of 6 dogs were extracted, and after 12 weeks, the implants were placed. Four experimental groups were constituted: subcrestally with ID of 2 mm (2 SCL) and 3 mm (3 SCL) and crestally with ID of 2 mm (2 CL) and 3 mm (3 CL). Metallic crowns were immediately installed with a distance of 3 mm between the contact point and the bone crest. Eight weeks later, clinical measurements were performed to evaluate papilla formation, and radiographic images were taken to analyze the crestal bone remodeling. The subcrestal groups achieved better levels of papillae formation when compared with the crestal groups, with a significant difference between the 3 SCL and 3 CL groups (P = .026). Radiographically, the crestal bone preservation was also better in the subcrestal groups, with statistically significant differences between the 2SCL and 2CL groups (P = .002) and between the 3SCL and 3CL groups (P = .008). With the present conditions, it could be concluded that subcrestal implant placement had a positive impact on papilla formation and crestal bone preservation, which could favor the esthetic of anterior regions. However, the IDs of 2 and 3 mm did not show significantly different results.

RhDNase I aerosol deposition and related factors in cystic fibrosis.

To identify factors influencing lung dose of aerosolized recombinant human deoxyribonuclease (rhDNase I), we used gamma camera and filter techniques to measure deposition in 15 clinically stable patients with cystic fibrosis (CF) (five males and 10 females, age 6-31 yr, mean 16.9) who were on chronic daily therapy. Total and regional deposition were correlated with breathing pattern, pulmonary function, demographic factors, and disease severity. In addition, the effects of each patient's measured lung dose on pulmonary function was estimated by stopping the drug and observing changes in spirometry over a 2-wk follow-up period. After discontinuance of the drug, all patients reported worsening of dyspnea and difficulty producing sputum. There was a significant decrease in FEV1 (% predicted, mean +/- SE, 86.9% +/- 5.57 to 77.8% +/- 5.73, p < 0.005), but all patients completed the study. In some patients, as much as 48% of the deposited aerosol was found in the pharynx (range 0.0 to 0.30 mg, mean 0.089 mg +/- 0.029), and pharyngeal deposition correlated negatively with tidal volume (r = -0.696, p < 0.006) and age (r = -0.743, p < 0.005). For the lungs, deposition ranged between 0.16 mg and 0.78 mg of the 2.5 mg nebulizer dose (mean 0.47 +/- 0.04 mg) and correlated negatively with FEV1 (% predicted, r = -0.611, p = 0.0152). However, the spirometric decrements following cessation of therapy did not correlate with the lung dose of the drug. Analysis of regional deposition within the lungs indicated a wide range of distribution between central and peripheral zones. In conclusion, the deposition pattern of rhDNase I aerosols in patients with CF is largely influenced by respiratory physiology, which itself depends upon age and severity of lung disease. As the patients grow there is a decrease in upper airway deposition and more particles are presented to the lungs where those patients with more airways disease have enhanced pulmonary deposition. Upper airway deposition of rhDNase I is significant, especially in younger patients, and may be related to laryngeal side effects.

A transactional analysis of biobehavioral systems.

The system of behavior [B] consists of those transactional interrelationships between organism [O] and environment [E] that govern their commerce. The biological significance of such [O]-[E] interrelationships, their truing through learning, as well as those systems involved in the subordinate and superordinate regulation of behavior, are clear when life, itself, is seen as an emergent property of the [O]-[E] complex. In addition, a systems view of these hierarchically organized complexities suggests that they adaptively self-stabilize and self-organize, over time, as they participate in [L], the organism-environment complex. Such a transactional analysis of biobehavioral systems resonates well with the most basic axioms of Pavlov's paradigm.

Brain dynamics, psychophysiological uncertainty and behavioral learning.

The present paper takes a first step toward the integration of recent findings on brain dynamics and learning into established fields of psychophysiological science. Leading-edge studies of brain dynamics have shown that the brain manifests an inherent variability and that, when new stimuli (i.e., "problems") are presented to the organism, brain chaos increases. Similarly, many previous studies using a wide variety of physiological and behavioral measures have shown that "psychophysiological uncertainty" is associated with novel stimuli, novice behavioral performance, and new stimulus-stimulus and response-stimulus contingencies. Such uncertainty may ultimately be resolved through some form of learning. Along with the general changes in physiological and behavioral activity, increases in brain chaos may usher the organism into an exploratory mode which serves as a catalyst for learning.

A systems view of the orienting reflex.

According to Pavlov's observations, the orienting reflex is a specific response to a specific stimulus, bound together in a cause and effect relationship, and having the capacity to specifically inhibit or suppress weaker, conditional reflexes. Contemporary psychophysiological research has added to the definition the well-replicated fact that the total reaction to a novel stimulus is a highly generalized increase in variability that temporarily appears in many basic and vital physiological functions--"organismic uncertainty." A systems view of the orienting reflex may be used to complement Pavlov's understanding.