Inverted Layering Technique as a Biomimetic Procedure in a Multidisciplinary Resolution of Discolored Teeth: A Case Report.

The objective of this work is to report a restorative approach with composite resin applied in reverse in the aesthetic resolution of darkened anterior teeth. A 27-year-old female patient presented with the main complaint of dissatisfaction with the aesthetics of her smile due to dental darkening, a result of childhood trauma, without painful symptoms, pathological clinical signs or change in care. In the intraoral examination, a darkening of teeth 11 and 21 was observed, which radiographically showed thickening of the periodontal ligament, with disharmonious configuration of the marginal gingiva. From the clinical and radiographic characteristics, we opted for periodontal intervention for recovery and gingival levelling, followed by endodontic intervention and aesthetic restorative restoration. The restorative step was carried out sequentially by internal tooth bleaching, removal of dentin still pigmented after bleaching and enamel preservation. Soon after, it was restored in an alternative way and layered using a technique called reverse, using strips of polyethylene fiber over the dentin resin. The technique preserved the remaining enamel with the maintenance of the original remaining guides, proving to be a viable conservative alternative since of the diagnosis to the restorative conclusion in view of the longitudinal confirmation of the restorative efficacy after 1 year.

Transurgical Restoration With Glass-Ionomer Cement as an Option for Root Perforations: Case Report.

Iatrogenic perforation is a procedural incident that may occur in endodontic treatments of primary and/or permanent teeth. Prognosis may be favorable if a complete seal with biomaterial is immediately established. Several materials, including glass-ionomer cement (GIC), have been used to seal different types of perforation defects. GIC is considered to be biocompatible, nontoxic, and non-irritating, and promotes bone healing and cementum regeneration. In the present case, GIC was used to treat an endodontic perforation. The perforation was cleaned with periodontal curettes and sealed with GIC. A reintervention was needed in which sealing was performed with a light-curing GIC, a material that was less rough than the initial material used. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing perforation in the case.

Associação de técnica cirúrgica e toxina botulínica para correção de sorriso gengival / Association of surgical technique and botulinum toxin in gummy smile management ­ case report

O sorriso gengival caracteriza-se pela exposição de 3 mm ou mais de gengiva ao sorrir. Para o paciente, pode gerar incômodo e, com isso, abalar sua autoestima e seu estado emocional. A perfeição de um sorriso não está apenas associada à coloração dos dentes, mas também à harmonia dos dentes, da gengiva e dos lábios. Quando a aplicação de toxina botulínica é associada ao procedimento cirúrgico, torna-se vantajosa, com a redução da exposição gengival sem a necessidade de outra intervenção cirúrgica. O propósito deste artigo foi relatar o caso de uma paciente que foi submetida à gengivoplastia associada à aplicação de toxina botulínica tipo A, para correção do sorriso gengival. A associação das técnicas se mostrou uma alternativa segura e efetiva no tratamento de correção do sorriso gengival.

Gummy smiles are observed when 3 mm or more gingival tissue is exhibited. For patients, it can be considered annoying at smiling, and interfere with his/her self esteem. Perfection of a smile is not just linked to dental color and shape, but to the harmony of teeth, gums and lips. Botulinum toxin associated to gingivoplasty is a promissing approach, once there is no need for a second surgical intervention to reduce gum exhibition. The aim of this paper is to report a case of gingivoplasty associated to botulinum toxin to manage a patient gummy smile. It was observed that the association of both techniques presented as a safe effective approach to treat gummy smile in cases of excessive maxilla.

Characterization of the release profile of doxycycline by PLGA microspheres adjunct to non-surgical periodontal therapy.

The aim of this pilot study was to assess the release of locally delivered doxycycline by poly (l-lactide-co-glycolide) (PLGA) microspheres in the periodontal pocket of patients with chronic periodontitis, treated by non-surgical periodontal therapy. Nineteen sites of non-adjacent teeth of four different patients were evaluated. Five milligram of PLGA microspheres loaded with 16 doxycycline hyclate (DOX) was administered per periodontal site. To quantify DOX released into the periodontal pocket, gingival crevicular fluid (GCF) was collected from the sites on days 2, 5, 7, 10, 15, and 20 after DOX application, and high-performance liquid chromatography was performed. Data were statistically assessed by ANOVA/Tukey test. At days 2, 5, and 7, the DOX concentration was stably sustained (23.33 ± 1.38, 23.4 ± 1.82, and 22.75 ± 1.33 µg/mL, respectively), with no significant differences over these assessment times (p > 0.05). At days 10 and 15, a tendency was observed toward a decrease in DOX concentration (21.74 ± 0.91 and 20.53 ± 4.88 µg/mL, respectively), but a significant decrease in GCF drug concentration (19.69 ± 4.70 µg/mL) was observed only on day 20. The DOX delivery system developed demonstrated a successful sustained release after local administration, as an adjunct to non-surgical periodontal therapy.

Reconstrução estética do sorriso: a necessidade da abordagem multidisciplinar / Esthetic reconstruction of the smile: the need for a multidisciplinary approach

Atualmente a estética tem sido o principal motivo pelo qual diversos pacientes buscam o consultório odontológico. Em muitas situações, as cerâmicas são os materiais de escolha para a restauração dos dentes anteriores, no entanto diversos fatores devem ser avaliados na decisão do melhor protocolo a ser realizado. Uma visão ampla sobre o quadro apresentado também é necessária, observando-se a necessidade de realização não só de procedimentos restauradores, mas também ortodônticos e periodontais. Diante disso, o presente artigo demonstra a abordagem multidisciplinar na obtenção da estética dos dentes anteriores, através de cirurgia plástica periodontal e finalização do caso utilizando resinas compostas diretas. A combinação dessas técnicas permitiu devolver harmonia e naturalidade ao sorriso, restabelecendo as características da região anterior.

Currently, aesthetics has been the main reason why many patients seek the dental office. In many situations, ceramics is the material of choice for the restoration of anterior teeth. However, many factors must be evaluated when deciding the best protocol to be performed. A comprehensive view of the situation presented is also required, observing, not only, the need to perform restorative, but orthodontic and periodontal procedures. In view of this, the present article demonstrates a multidisciplinary approach in obtaining the aesthetics of anterior teeth through periodontal plastic surgery, finalizing the case using direct composite resins. The combination of these techniques made it possible to restore harmony and naturality to the smile, by restoring the characteristics of the anterior region.

Esthetic and functional rehabilitation via reattachment of dental fragments.

Anterior teeth fractures are frequently encountered in clinical practice. The reattachment of dental fragments, if possible, is a conservative and effective technique, which is utilized in this case. This case presentation concerns an 18-year-old male patient with a root-crown fracture of the left maxillary central incisor, which involves the periodontal biologic space. The treatment was the reattachment of the dental fragment with a composite resin and adhesive, in association with periodontal surgery. The reattachment technique described in this case report is simple, but it provides long-lasting esthetics and improved function via a very conservative approach.

Treatment of peri-implantitis using nonsurgical debridement with bioresorbable nanospheres for controlled release of doxycycline: case report.

Peri-implantitis treatment is often surgical; however, in this case report, an alternative approach has been documented using a combination of nonsurgical debridement with the local controlled release of doxycycline by bioresorbable nanospheres in the peri-implant defect. After 15 months, remission on clinical inflammatory parameters of bleeding and suppuration on probing, as well as reduction of probing depths, was observed. This alternative approach may enhance clinical parameter improvements in some cases of peri-implantitis without the need for a surgical approach for implant decontamination.