Tratamento integrado para correção do sorriso gengival: relato de caso / Integrated treatment for correction of gingival smile: case report

O sorriso gengival possui inúmeras causas, podendo acontecer por motivos esqueléticos, musculares ou por alteração no desenvolvimento dos tecidos de suporte. No entanto, na atualidade, a estética vermelha e a branca têm se apresentado completamente passíveis de transformações e com uma gama de procedimentos cirúrgicos ou não cirúrgicos para sanar as queixas dos pacientes. O objetivo geral deste trabalho é mostrar o poder que a odontologia tem frente às questões estéticas, como, por exemplo, a vergonha de sorrir por não se sentir confortável com os dentes curtos e com uma grande faixa de gengiva sendo exposta. O método utilizado foi um relato de caso. Que descreve todos os passos clínicos do tratamento de um paciente de 40 anos, que estava insatisfeita com o seu sorriso por apresentar erupção passiva alterada juntamente com hiperatividade do lábio superior. O plano de tratamento escolhido foi de realizar a cirurgia de aumento de coroa clínica estético, seguido de clareamento dentário e posteriormente um reposicionamento labial, com ajuda da toxina botulínica. Finalizando, para ajudar na cicatrização, o uso de laserterapia. O resultado de todo o processo cirúrgico envolvido neste trabalho, é satisfação do paciente, materializando o sonho deste, devolvendo segurança e espontaneidade ao sorrir. Pôde-se observar que através da combinação de técnicas cirúrgicas periodontais para tratar o sorriso gengival, obtém-se êxito tanto no sentido científico quanto no biológico, alcançando um sorriso esteticamente mais atrativo(AU)

Gummy smile has numerous causes, which can occur for skeletal or muscular reasons or due to changes in the development of supporting tissues. However, nowadays, the red and white aesthetics have been completely capable of transformation and with a range of surgical or non-surgical procedures to resolve patients' complaints. The general objective of this work is to show the power that dentistry has in the face of aesthetic issues, such as, for example, the shame of smiling due to not feeling comfortable with short teeth and a large strip of gum being exposed. The method used was a case report. Which describes all the clinical steps of the treatment of a 40-year-old patient, who was dissatisfied with her smile due to an altered passive eruption together with hyperactivity of the upper lip. The chosen treatment plan was to perform aesthetic clinical crown augmentation surgery, followed by tooth whitening and later lip repositioning, with the help of botulinum toxin. Finally, to help with healing, the use of laser therapy. The result of the entire surgical process involved in this work is patient satisfaction, materializing the patient's dream, restoring security and spontaneity when smiling. It was observed that through the combination of periodontal surgical techniques to treat gummy smile, success is achieved both in the scientific and biological sense, achieving a more aesthetically attractive smile(AU)

Autogenous graft versus collagen matrices for peri-implant soft tissue augmentation. A systematic review and network meta-analysis.

OBJECTIVE: The primary objective of this review is to compare autogenous soft tissue grafts (connective tissue graft - CTG and free gingival graft-FGG) with different type of matrices (acellular dermal matrix-ADM, xenograft collagen matrix-XCM, volume-stable collagen matrix-VCMX) used to increase peri-implant soft tissues. MATERIALS AND METHODS: A search on electronic databases was performed to identify randomized and non-randomized controlled trials (RCTs and CCTs, respectively) with either parallel or split-mouth design, and treating ≥ 10 patients. A network meta-analysis (NMA) was used to compare different matrices. Soft tissue thickness dimensional changes and keratinized width (KMW) changes were the primary outcome measures. The secondary outcomes were to evaluate: a) PROMs; b) volumetric changes; c) surgical operating time; and d) different periodontal measurements. RESULTS: A total of 23 studies were included in the qualitative analysis, and 16 studies (11 RCTs and 5 CCTs) in the quantitative analysis. A total of N = 573 sites were evaluated for NMA. CTG resulted the best material for increasing peri-implant soft tissue thickness, at 180 and 360 days after surgery. The use of an ADM showed good results for buccal thickness increase, primarily in the first three months after surgery. Vestibuloplasty + FGG resulted in the most effective technique for peri-implant KMW augmentation, after 180 days. CONCLUSIONS: While CTG demonstrated better performance in all the comparison and FGG showed to be the best graft to increase keratinized mucosa up to 90 days, ADM and VCMX may be used to increase soft tissue horizontal thickness with lower patients' morbidity. LIMITATIONS: The limits of this NMA are the following: a) limited number of included studies; b) high heterogeneity among them (number of patients, treatment sites, surgical techniques, outcome measures, and follow-ups). CLINICAL RELEVANCE: Many studies compared the efficacy of autogenous and non-autogenous grafts in terms of gingival thickness, volume, and keratinized width increase. However, there is still not clear overall evidence on this topic. This NMA helps clinicians to choose the right material in different peri-implant soft tissue procedures. Recommendations for future studies are mandatory.

Tratamento do sorriso gengival por meio da cirurgia periodontal: relato de caso / Treatment of gummy smile through periodontal surgery: case report

A busca por um sorriso considerado perfeito tem sido cada vez maior e isso tem se tornado um desafio para o Cirurgião-Dentista, visto que um sorriso harmônico não envolve somente dentes, mas também gengiva. A exposição excessiva da gengiva ao sorrir ou falar é considerada uma característica antiestética, pois gera uma desarmonia entre dentes, gengiva e lábios. Quando o paciente expõe 3 milímetros ou mais de gengiva ao sorrir, chamamos essa exposição de Sorriso Gengival. O presente trabalho tem como objetivo relatar o tratamento de um caso de sorriso gengival, onde foi realizada cirurgia periodontal ressectiva a fim de diminuir a exposição de tecido gengival ao sorrir. Descrição do caso: Paciente adulto 21 anos, sexo masculino, procurou atendimento no curso de graduação em Odontologia do Centro Universitário da Serra Gaúcha ­ FSG, com queixa de insatisfação estética devido ao tamanho de seus dentes e mostrar muito tecido Gengival ao sorrir. Após anamnese, exame clínico e radiográfico, o paciente foi diagnosticado com Sorriso gengival. O plano de tratamento proposto foi de cirurgia periodontal ressectiva. Conclusão: A partir do exposto, podemos concluir que o tratamento do sorriso gengival depende de sua etiologia. Um correto diagnóstico é de extrema importância, pois dependendo do fator etiológico do sorriso gengival, o plano de tratamento pode ser elaborado de acordo com a necessidade do paciente. No caso apresentado, o procedimento escolhido, cirurgia periodontal ressectiva, se mostrou efetivo no tratamento do sorriso gengival, devolvendo estética e satisfação ao paciente(AU)

The search for a smile that is considered perfect has been increasing and this has become a challenge for the Dental Surgeon, since a harmonious smile does not only involve teeth, but also gums. Excessive exposure of the gums when smiling or talking is considered an unsightly feature, as it creates disharmony between teeth, gums and lips. When the patient exposes 3 millimeters or more of gum when smiling, we call this exposure Gummy Smile. The present work aims to report the treatment of a case of gummy smile, where resective periodontal surgery was performed in order to reduce the exposure of gingival tissue when smiling. Case description: A 21-year-old adult patient, male, sought care at the undergraduate course in dentistry at the Centro Universitário da Serra Gaúcha ­ FSG, complaining of aesthetic dissatisfaction due to the size of his teeth and showing a lot of gingival tissue when smiling. After anamnesis, clinical and radiographic examination, the patient was diagnosed with gummy smile. The proposed treatment plan was resective periodontal surgery. Conclusion: From the above, we can conclude that the treatment of gummy smile depends on its etiology. A correct diagnosis is extremely important, because depending on the etiological factor of the gummy smile, the treatment plan can be elaborated according to the patient's needs. In the case presented, the chosen procedure, resective periodontal surgery, proved to be effective in the treatment of gummy smile, restoring aesthetics and patient satisfaction(AU)

[Histopathological characteristics of peri-implant soft tissue in reconstructed jaws with vascularized bone flaps].

OBJECTIVE: To analyze the histopathological characteristics of peri-implant soft tissue in reconstructed jaws and the changes after keratinized mucosa augmentation (KMA) with free gingival graft (FGG). METHODS: Twenty patients were enrolled in this study. Five patients of them, who were periodontal and systemic healthy and referred for crown lengthening before restoration with healthy keratinized gingiva collected were enrolled as healthy controls. 15 patients of them were with fibula or iliac bone flaps jaw reconstruction (10 with fibula flap and 5 with iliac flap), who were referred to FGG and implant exposures before restoration. Soft tissue was collected before FGG in reconstructed jaws, and in 5 patients (3 with fibula flap and 2 with iliac flap) 8 weeks after FGG if a second surgery was conducted. Histological analysis with hematoxylin-eosin stain and immunological analysis to interlukin-1 (IL-1), interlukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were performed. RESULTS: Thickness from the bottom of stratum basale to the top of stratum granulosum and thickness of keratinized layer in reconstructed jaws were significantly lower compared with that of natural healthy keratinized gingiva [0.27 (0.20, 0.30) mm vs. 0.36 (0.35, 0.47) mm, P<0.05; 16.49 (14.90, 23.37) µm vs. 26.37 (24.12, 31.53) µm, P<0.05]. In the reconstructed area, thickness from the bottom of stratum basale to the top of stratum granulosum increased after KMA with FGG [0.19 (0.16, 0.25) mm vs. 0.38 (0.25, 0.39) mm, P=0.059] and the thickness of keratinized layer significantly increased after KMA with FGG [16.42 (14.16, 22.35) µm vs. 28.57 (27.16, 29.14) µm, P<0.05], which was similar to that in the control group. Furthermore, the number of positive cells of IL-1, IL-6 and TNF-α significantly increased after KMA [0.67 (0.17, 8.93) vs. 11.00 (9.16, 18.00); 13.00 (8.50, 14.14) vs. 21.89 (15.00, 28.12); 0.22 (0.04, 0.63) vs. 2.83 (1.68, 5.00), respectively, P<0.05] as well as the average optical density value [0.15 (0.14, 0.17) vs. 0.18 (0.17, 0.21); 0.28 (0.26, 0.33) vs. 0.36 (0.33, 0.37); 0.23 (0.22, 0.29) vs. 0.30 (0.28, 0.42), respectively, P<0.05], which was similar to that in the healthy keratinized gingiva. CONCLUSION: The lack of rete pegs and inflammatory factors were common in soft tissue with jaw reconstruction. FGG can improve the quality of the epithelium and may improve the stability of the mucosa around implants.

The effects of injectable platelet-rich fibrin application on wound healing following gingivectomy and gingivoplasty operations: single-blind, randomized controlled, prospective clinical study.

OBJECTIVES: The aim of this study was to evaluate the effects of wound healing using injectable platelet-rich fibrin (IPRF) after gingivectomy and gingivoplasty. MATERIALS AND METHODS: In this clinical study, 46 systemically healthy patients with chronic inflammatory gingival enlargement were randomly treated with gingivectomy-gingivoplasty + I-PRF (n=23) or gingivectomy-gingivoplasty alone (n=23). The primary outcome was to evaluate the effect of I-PRF on wound healing over a 3-week follow-up period. Samples collected from gingival crevicular fluid (GCF) were processed using enzyme-linked immunosorbent assay (ELISA) to measure VEGF and FGF-10 biomarkers. The surgical areas were stained with Mira-2 tone and evaluated in ImageJ. Wound healing was evaluated with Modified Manchester Scar (MMS) scale and Landry, Turnbull, and Howley (LTH) index. RESULTS: VEGF values of the control group at baseline, week 2, and week 3 were significantly higher than the test group. In weeks 2 and 3, FGF-10 values were found to be significantly higher in the control group than the test group. The amount of staining was found to be significantly higher in the control group than in the test group on days 3, 7, and 14. LTH values of the control group were significantly lower than the test group and MMS values were significantly higher than those of the test group. CONCLUSIONS: I-PRF applications revealed positive effects on epithelial wound healing after gingivectomy and gingivoplasty operations. CLINICAL RELEVANCE: Platelet concentrates such as I-PRF accelerate wound healing and contribute to the patient's comfort and quality of life. I-PRF application may have positive effects on wound healing after gingivectomy and gingivoplasty operations.

[Timing and surgery option of keratinized mucosa augmentation around implant site].

In recent years, clinicians have paid more attention to the biological and esthetic effects of the 2 mm keratinized mucosa width (KMW) around dental implant. How to increase the keratinized mucosa is the focus of clinicians. While the free gingival graft (FGG) is still the gold standard of keratinized mucosa augmentation, alveolar ridge preservation (ARP), connective tissue graft (CTG) and apically positioned flap (APF) can also be used to obtain more than 2 mm keratinized mucosa width when they are used before implantation, with implantation, within the implant-healing phase, with second stage of implantation or after rehabilitation according to different indications. This article comprehensively summarizes the influencing factors of timing and surgical procedures for keratinized mucosa augmentation, providing guidance for clinicians to treat peri-implant keratinized mucosa deficiencies.

Reabilitação estética anterior em abordagem multidisciplinar: relato de caso / Aesthetic rehabilitation in a multidisciplinary approach: case report

A estética tem um papel importante na aceitação e autoestima das pessoas e, em virtude disso, os pacientes buscam cada dia mais ter um sorriso harmonioso. As reabilitações estéticas devem envolver um planejamento completo, atrelando função e estética, avaliando tamanho dos dentes, perfil e alturas gengivais, altura do sorriso e corredor bucal. Por conta disso, a odontologia nos permite uma série de abordagens terapêuticas diferentes que chegam a resultados satisfatórios para o paciente. Sendo assim, o presente trabalho tem como objetivo descrever um relato de caso de uma paciente com queixa estética do seu sorriso devido à diferentes tonalidades, formas e tamanhos dos dentes. Após anamnese, exame clínico e radiográfico, o plano de tratamento proposto foi de harmonizações periodontal com aumento de coroa e enxerto gengival, além de coroas em cerâmicas de dissilicato de lítio. Dentro desse contexto, mostra-se que uma abordagem multidisciplinar para reabilitação estética e funcional do sorriso é fundamental, a qual nos proporciona equilíbrio e naturalidade entre estética branca e vermelha no resultado do tratamento reabilitador(AU)

Aesthetics plays an important role in people's acceptance and self-esteem and, as a result, patients increasingly seek to have a harmonious smile. Aesthetic rehabilitations must involve a complete planning, linking function and aesthetics, evaluating tooth size, gingival profile and heights, smile height and buccal corridor. Because of this, dentistry allows us a series of different therapeutic approaches that reach satisfactory results for the patient. Therefore, the present work aims to describe a case report of a patient with an aesthetic complaint of her smile due to different shades, shapes and sizes of teeth. After anamnesis, clinical and radiographic examination, the proposed treatment plan was periodontal harmonization with crown augmentation and gingival graft, in addition to lithium disilicate ceramic crowns. Within this context, it is shown that a multidisciplinary approach to the aesthetic and functional rehabilitation of the smile is fundamental, which provides us with balance and naturalness between white and red aesthetics in the result of the rehabilitation treatment(AU)

Benefícios do planejamento digital para cirurgias periodontais estéticas: relato de caso / Benefits of digital planning for esthetic periodontal surgeries: case report

Sorriso gengival é comumente conhecido pela exposição excessiva das gengivas ao sorrir, acarretando assim na diminuição das coroas dos elementos. No que tange a etiologia dessa condição, ela se apresenta de maneiras diversas e sua identificação é fundamental para o desenvolvimento de um plano de tratamento eficaz. O planejamento clínico pode ser feito usando uma abordagem dinâmica e digital do sorriso, como softwares, exames de imagem, modelos virtuais 3D e guias cirúrgicos, melhorando a qualidade e precisão do tratamento, oferecendo diversos benefícios aos pacientes. Sendo assim esse estudo teve como objetivo demonstrar a importância dos processos digitais no planejamento e correção do sorriso gengival. Paciente queixou-se da desproporção do sorriso, caracterizado por coroas curtas nas regiões de pré-molares e incisivos ligadamente com a exposição excessiva da gengiva ao sorrir. Após estudos clínicos e de imagem, a etiologia foi diagnosticada como erupção passiva alterada, tipo I (fenótipo espesso). O tratamento de escolha foi o remodelamento gengival associado à osteotomia e osteoplastia obtendo assim uma maior precisão no tratamento, sendo confeccionado um guia cirúrgico duplo. Sendo assim, é possível contemplar que o planejamento digital permite uma maior previsibilidade da execução, compatibilidade em relação a expectativa do paciente e profissional, além da total individualização do caso, tornando os resultados mais favoráveis e exatos e minimizando as chances de iatrogenias(AU)

Gummy smile is commonly known for exposing the gums to the smile, thereby increasing the crowns elevation of the elements. Regarding a condition, it presents itself in different ways and its identification is fundamental for the development of a treatment plan. The clinician can be done using a dynamic and digital approach to image treatment, such as software, imaging exams, various 3D virtual models and elaborate guides, improving the quality and precision of treatment, offering benefits to patients. Therefore, this study aimed to demonstrate the importance of digital processes in planning and correcting the gummy smile. Patient complained of disproportion of the smile, facing the regions of premolar crowns and incisors of the smile, facing the exposure of the gingiva when smiling. After clinical and imaging exams, the diagnostic studies were diagnosed as passive eruption, type I (phenotype and specific). The choice of choice was remodeling associated with surgery treatment and surgery treatment, thus providing a greater precision in the treatment, being a double guide elaborated. Therefore, it is possible that the digital is possible a predictability of execution, compatibility in relation to patient and professional care, in addition to the greater possibility of individualization planning than it allows, making the results more planned as possibilities and exactly the iatrogenic(AU)

Three-dimensional changes of a porcine collagen matrix and free gingival grafts for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study.

BACKGROUND: Emerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG. AIM: The present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period. MATERIALS AND METHODS: The study enrolled 32 patients exhibiting deficient KT width (i.e., < 2 mm) at the vestibular aspect who underwent soft tissue augmentation using either CM (15 patients/23 implants) or FGG (17 patients/31 implants). The primary outcome was defined as tissue thickness change (mm) at treated implant sites between 1- (S0), 3- (S1), and 6-months (S2). Secondary outcomes considered changes of KT width over a 6-month follow-up period, surgical treatment time, and patient-reported outcomes. RESULTS: Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of - 0.14 ± 0.27 mm and - 0.04 ± 0.40 mm in the CM group, and - 0.08 ± 0.29 mm and - 0.13 ± 0.23 mm in the FGG group, with no significant differences noted between the groups (3 months: p = 0.542, 6 months: p = 0.659). Likewise, a comparable tissue thickness decrease was observed from S1 to S2 in both groups (CM: - 0.03 ± 0.22 mm, FGG: - 0.06 ± 0.14 mm; p = 0.467). The FGG group exhibited a significantly greater KT gain after 1, 3 and 6 months compared to the CM group (1 month: CM: 3.66 ± 1.67 mm, FGG: 5.90 ± 1.58 mm; p = 0.002; 3 months: CM: 2.22 ± 1.44; FGG: 4.91 ± 1.55; p = 0.0457; 6 months: CM: 1.45 ± 1.13 mm, FGG: 4.52 ± 1.40 mm; p < 0.1). Surgery time (CM: 23.33 ± 7.04 min.; FGG: 39.25 ± 10.64 min.; p = 0.001) and postoperative intake of analgesics were significantly lower in the CM group (CM: 1.2 ± 1.08 tablets; FGG: 5.64 ± 6.39 tablets; p = 0.001). CONCLUSIONS: CM and FGG were associated with comparable three-dimensional thickness changes between 1 and 6 months. While a wider KT band could be established with FGG, the use of CM significantly reduced surgical time and patients´ intake of analgesics.

Evaluation of the effect of 3D-bioprinted gingival fibroblast-encapsulated ADM scaffolds on keratinized gingival augmentation.

BACKGROUND AND OBJECTIVES: The keratinized gingiva plays an important role in maintaining healthy periodontal and peri-implant tissue. Acellular dermal matrix (ADM), as a substitute biomaterial, has a porous structure and good biocompatibility. 3D-bioprinting has the potential for tissue engineering because it enables precise loading of cells layer-by-layer. Herein, we bioprinted ADM scaffold encapsulating gingival fibroblasts (GFs) and evaluated its efficacy in keratinized gingiva augmentation in vivo to assess its potential for clinical periodontal tissue regeneration. METHODS: GFs were extracted from the gingiva of beagles and transfected with a green fluorescent protein (GFP). The ADM scaffold (ADM cell-free group) was constructed using ADM, gelatin, and sodium alginate mixed at an appropriate ratio via 3D-bioprinting. The ADM cell scaffold (ADM cell group) was established by adding extra GFs in the same manner. Six beagles were divided into blank control, ADM cell-free, and ADM cell groups; and implant surgery was performed. The keratinized gingiva was clinically and histologically evaluated at baseline and after 2 months. RESULTS: GFs transfected with GFPs expressed green fluorescence and were present in new tissue in the ADM cell group and not observed in the ADM cell-free group. At 2 months after surgery, the keratinized gingival augmentation in the ADM cell group was significantly more than that in the ADM cell-free group. Attached gingival augmentation was also observed more in the ADM cell group than that in the ADM cell-free group. Histological staining showed that the tissue in the ADM cell group displayed a more integrated structure and higher expression of COL I, COL III, and VEGF-A than those in the ADM cell-free group. CONCLUSION: 3D-bioprinted GF-encapsulated ADM scaffolds increased the amount of keratinized gingiva in vivo, suggesting that 3D-bioprinting has great potential for oral soft tissue regeneration.

Reabilitação estética com facetas e coroas cerâmicas em dissilicato de lítio: relato de caso / Aesthetic rehabilitation with ceramic facets and crowns in lithium disilicate: case report

Introdução: A procura pela estética do sorriso é crescente na Odontologia, pois, muitas vezes um sorriso alinhado e periodonto saudável não são o bastante. A cerâmica odontológica apresenta-se como uma ótima possibilidade restauradora, visto o avanço das técnicas de adesão entre o substrato dentário e as cerâmicas, torna-se mais previsível o resultado com este tipo de reabilitação. Objetivo: O presente artigo tem como objetivo descrever um caso clínico com envolvimento de diversos níveis de desgaste dentário para reabilitação estética com cerâmica de dissilicato de lítio. Relato de caso: Paciente 36 anos, gênero feminino, apresentava insatisfação com seu sorriso devido a forma e a alteração de cor dos seus dentes superiores anteriores e pré-molares. O plano de tratamento consistiu em realizar a troca da coroa metalocerâmica por coroa total cerâmica da unidade 14, coroa total cerâmica nas unidades 11, 21 e 22, facetas cerâmicas nas unidades 15, 13, 12, 23, 24 e 25, osteotomia e gengivoplastia das regiões de 2º prémolar superior esquerdo ao 2º pré-molar superior direito, clareamento dental caseiro da arcada inferior e placa oclusal superior de proteção. O material de escolha para a resolução do caso clínico foi a cerâmica vítrea reforçada à base de dissilicato de lítio, pois, possui um índice de refração de luz semelhante à estrutura dentária, sem interferência significativa da translucidez, além de ser passível de cimentação adesiva por se tratar de uma cerâmica ácido sensível e o tamanho do cristal e a sua disposição favorecem o aumento das propriedades mecânicas da restauração. Conclusão: O plano de tratamento realizado permitiu o restabelecimento da função e estética, com reprodução das características dos dentes naturais e promoção da jovialidade e da harmonia no sorriso(AU)

Introduction:The demand for smile aesthetics is growing in Dentistry, because, often a smile aligned and healthy periodontium are not enough. Dental ceramics, presented as an excellent restorative possibility, since the advancement of adhesion techniques between the dental substrate and the ceramics, becomes more predictable the result with this type of rehabilitation. Objective: This article aims to describe a clinical case involving several levels of dental wear for aesthetic rehabilitation with ceramics. Case Report: A 36-year-old female patient presented dissatisfaction with her smile due to the shape and color alteration of her anterior and premolar upper teeth. The treatment plan consisted of exchanging the metal-ceramic crown for the total ceramic crown of unit 14, total ceramic crown in units 11, 21 and 22, ceramic veneers in units 15, 13, 12, 23, 24 and 25, osteotomy and gingivoplasty of the regions from 2nd left upper premolar to 2nd right upper premolar, home tooth whitening of the lower arch and upper occlusal plate of protection. The material of choice for the resolution of the clinical case was the glass ceramic reinforced on the basis of lithium disilicate because it has a refractive index of light similar to the dental structure, without significant interference of translucency, besides being liable to adhesive cementation because it is a sensitive acid ceramic and the size of the crystal and its disposition favor the increase of the mechanical properties of the restoration. Conclusion: The treatment plan performed allowed the restoration of function and aesthetics, with reproduction of the characteristics of natural teeth and promotion of joviality and harmony in the smile(AU)

Effects of ozone therapy on periodontal and peri-implant surgical wound healing: a systematic review.

OBJECTIVE: To evaluate the effectiveness of the use of adjuvant ozone therapy in the healing process of wounds resulting from periodontal and peri-implant surgical procedures by answering the following focused question: "Can adjuvant ozone therapy improve wound healing outcomes related to periodontal and peri-implant surgical procedures?". METHOD AND MATERIALS: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched, without language restriction, for peer-reviewed articles published until 23 March 2022, in addition to manual search. Only controlled clinical trials (randomized or not) were considered. The risk of bias was evaluated by the Cochrane risk-of-bias tool for RCTs - version 1 (RoB1). Data were pooled into evidence tables and a descriptive summary was presented. RESULTS: Of the 107 potentially eligible records, only seven studies were included. Four addressed free/deepithelialized gingival grafts with a palatal donor area, two evaluated implant sites, and one comprised gingivectomy and gingivoplasty. A total of 225 patients were evaluated in the included studies, considering control and test groups (ozone and other adjuvant therapies for comparison). Ozone therapy had a positive effect on outcomes directly or indirectly related to periodontal/peri-implant surgical wound healing. Furthermore, it could also increase the stability of immediately loaded single implants installed in the posterior mandible. CONCLUSION: In general, ozone therapy seems to both accelerate the healing processes of periodontal/peri-implant wounds and increase the secondary stability of dental implants; however, considering the limited evidence available and the risk of bias in the included studies (none classified as low risk), a definitive conclusion cannot be drawn. (Quintessence Int 2023;54: 100-110; doi: 10.3290/j.qi.b3512007).

Gingival pedicle with split-thickness tunnel technique: A retrospective case series for single mandibular anterior recessions.

INTRODUCTION: Gingival recessions in the mandibular anterior sextant are a common clinical finding, but mucogingival treatment in this location is particularly challenging, due to several anatomical and surgical difficulties. In the present case series, a novel technique, called gingival pedicle with split-thickness tunnel (GPST), was retrospectively evaluated. CASE SERIES: Fifteen patients presenting with a single buccal RT1 or RT2 gingival recession of a depth of ≥3 mm in the mandibular anterior sextant were treated by means of the GPST technique. Clinical periodontal parameters at baseline and at the last follow-up evaluation visit (6-84 months) were compared. Early healing was uneventful in all cases, and no complications such as flap dehiscence or loss of connective tissue graft were observed. Mean root coverage (mRC) was 98.1% ± 7.38%, corresponding to a statistically significant recession reduction (ΔRD) of 4.53 ± 1.19 mm. Complete root coverage was achieved in 14 of 15 cases. The gain in keratinized tissue width amounted to 3.13 ± 0.99 mm and was statistically significant, whereas no significant change in periodontal probing depth was observed after treatment. CONCLUSION: In conclusion, treatment with GPST technique seems to achieve a favorable and predictable clinical improvement in gingival recessions on mandibular anterior teeth. Why are these cases new information? Limited information is available about the management of isolated deep labial recessions in the mandibular anterior teeth. A novel surgical approach, called GPST technique, is described in a case series to specifically address this type of defect. What are the keys to successful management of these cases? Horizontal incision ≥ RECwidth Cut-back preparation helps to mobilize the flap without tension. CTG width ≥ 3 times RECwidth CTG height ≥ RECdepth Proper graft and flap stabilization need to be achieved. What are the primary limitations to success in these cases? Limited mesio-distal dimensions, which do not allow to obtain a pedicle with adequate horizontal width Very thin biotype may not be suitable because of the risk of inadequate flap vascularization.

Modified gingivoplasty for hereditary gingival fibromatosis: two case reports.

BACKGROUND: Hereditary gingival fibromatosis (HGF) is characterized by sub-epithelial fibromatosis of keratinized gingiva resulting in a fibrotic enlargement of keratinized gingiva. The treatment choice is gingivectomy, which can be performed with an internal or external bevel incision conventionally. However, both techniques can hardly resume the natural status of gingiva, and have a certain recurrence rate, especially in the cases which have limited width of attached gingiva. CASE DESCRIPTION: Two cases of HGF with the chief complaint of difficulty in mastication, pronunciation, and poor esthetics were presented. After the initial periodontal therapy, a novel gingivoplasty modified with a crevicular incision was applied. A full thickness flap above the mucogingival junction and a split flap below the junction were raised. Then, fibrotic connective tissue was completely eliminated and keratinized gingival epithelium was preserved. The fibrotic alveolar bone was shaped by handpiece and bur. Finally, the flap was apically repositioned and sutured. Twelve months after surgery, the gingiva recovered with normal color, contour and consistency. CONCLUSIONS: Compared to traditional gingivectomy, modified gingivoplasty which focuses on eliminating pathological fibrotic connective tissue can completely resume the natural appearance of gingiva and demonstrate no tendency of recurrence.

Clinical applications of mucogingival therapies utilizing adjunctive autologous blood products.

BACKGROUND: Mucogingival deformities are prevalent oral conditions and can result in esthetic compromise, dentinal hypersensitivity, and an increase in radicular caries rates. Mucogingival treatments address thin periodontal phenotype and/or gingival recession defects. Although many of these grafting procedures are predictable in improving soft-tissue quality and quantity around teeth and dental implants, patients often complain of discomfort at both the donor and recipient sites. Free gingival grafts and coronally advanced flaps alone or in combination with subepithelial connective tissue graft and/or acellular dermal matrix are among the most common surgical procedures employed to achieve root coverage and enhance periodontal phenotype. Autologous blood products (ABPs) contain platelets, growth factors, leukocytes, and stem cells that contribute to cell mitosis, collagen production, and angiogenesis, leading to the healing and regeneration of hard and soft tissue. Evaluation of the adjunctive role of ABPs in mucogingival surgery and their impacts on clinical and patient-centered data is critical to achieve optimal patient-reported outcome measures based upon the current scientific evidence. METHODS: We present exemplar cases in which adjunctive ABPs were utilized in mucogingival treatment to enhance treatment outcomes. RESULTS: No adverse events were noted. Satisfactory treatment outcomes were achieved in patients with local and/or systemic compromise when mucogingival therapies were used in combination with ABPs. CONCLUSIONS: Adjunctive use of ABPs may enhance outcomes of mucogingival therapy. Utilization of adjunctive ABPs may be particularly advantageous in situations where the predictability of clinical and esthetic outcomes is limited due to anatomical and/or patient factors.

Idiopathic Gingival Fibromatosis in a Pediatric Patient.

Idiopathic gingival fibromatosis (IGF) is a rare, benign, slow-growing proliferation of the gingival tissues involving both maxillary and mandibular gingiva. It is exacerbated during the eruptive phase of both primary and permanent dentitions. The purpose of this article is to report the case of a 10-year-old boy who presented with IGF whose gingival enlargement covered the occlusal surfaces of many teeth and displaced the erupting dentition, compromising the patient's cosmetics, function, speech and development. The treatment involved gingivectomy and gingivoplasty, combining both surgical and laser methods. The case showed remarkable esthetic and functional im provement, without signs of recurrence one year post-treatment.

Esthetic Mucogingival Treatment After Biopsy of Inflammatory Fibroepithelial Hyperplasia.

INTRODUCTION: This case reports a biopsy of a large soft tissue defect with gingival grafting. The therapeutic approach presented here combines a partly de-epithelialized free gingival graft (PDFGG) with an envelope technique, which may be useful for cases needing a large reactive lesion biopsy. CASE PRESENTATION: A patient with an esthetic and functional complaint due to a fibroepithelial hyperplastic lesion was treated by excisional biopsy leaving a 10 mm cervical defect on tooth 23. A palatal PDFGG was harvested and sutured into the defect, using an "envelope technique" to improve the blood supply to the graft. The procedure is aimed at both recession coverage and reduction in root hypersensitivity. Stability of the outcome is demonstrated 9 months post-operative. CONCLUSIONS: Gingival margin biopsies pose a significant challenge due to the need to combine significant tissue removal while providing a predictable esthetic and functional outcome. The case is the first description of a successful grafting of a large residual gingival biopsy defect, resulting from using combined mucogingival surgical approach. This technique may be helpful for similar cases.