Effectiveness of local and topical anesthesia during gingival retraction / Eficácia da anestesia local e tópica durante a retração gingival

Objective: To compare the effectiveness of local and topical anesthesia during gingival retraction in prepared abutment teeth. Material and Methods: 72 patients desiring full mouth rehabilitation or bilateral fixed partial denture in the same arch were selected based on the inclusion criteria framed and were randomly allocated into Groups A and B of 36 each. Patients in Group A received gingival retraction with topical anesthesia and Group B received gingival retraction with infiltration anesthesia. All the patients were tested for pain, discomfort and bleeding during gingival retraction. Results: There was no significant difference in pain, discomfort and gingival bleeding (P >.05) during gingival retraction using topical and local anesthetic agents. Conclusion: Topical anesthesia was equally effective as infiltration anesthesia in managing the pain, discomfort and bleeding during gingival retraction by cord packing in prepared abutment teeth. (AU)

Objetivo: Comparar a eficácia da anestesia local e tópica durante a retração gengival previa a moldagem em dentes pilares preparados. Material e Métodos: Foram selecionados 72 pacientes indicados para reabilitação bucal total ou prótese parcial fixa bilateral na mesma arcada com base nos critérios de inclusão formulados e alocados aleatoriamente nos Grupos A e B com 36 pacientes cada. Os pacientes do Grupo A receberam retração gengival com anestesia tópica e no Grupo B receberam retração gengival com anestesia infiltrativa. Todos os pacientes foram testados para dor, desconforto e sangramento durante o procedimento. Resultados: Não houve diferença significativa na dor, desconforto e sangramento gengival (P>. 05) durante a retração gengival com anestésicos tópicos e locais. Conclusão: A anestesia tópica foi tão eficaz quanto a anestesia de infiltração no controle da dor, desconforto e sangramento durante a retração gengival com fio retrator gengival em dentes pilares preparados.(AU)

Una Descripción General y Actualizada de Miniplacas y Minitornillos. Efectos Dentoalveolares y Esqueléticos / A General and Updated Description of Miniplates and Miniscrews. Dentoalveolar and Skeletal Effects

RESUMEN: En ortodoncia, las miniplacas se utilizan como dispositivo de anclaje temporal (TAD) para la realización de movimientos dentales que permiten el uso de fuerzas ortopédicas en ellos. En comparación con los mini tornillos, las miniplacas tienen la ventaja de una tasa de falla muy baja, pero la desventaja es que para la extracción se necesita el mismo acto quirúrgico que se realizó para la instalación. El objetivo de este estudio es realizar una revisión bibliográfica de las indicaciones de miniplacas en pacientes con mordidas abiertas, clase II y anomalías de clase III, y buscar cómo las miniplacas han mejorado los tratamientos de ortodoncia. La información principal se reunió buscando en PubMed con las palabras clave enumeradas a continuación. Afirmamos que las miniplacas están indicadas para la retracción en masa de la arcada, donde se observó que la fuerza de 150 g aplicada en los molares superiores es suficiente no solo para empujar los molares hacia atrás en una clase I corregida, sino también para iniciar la retracción de premolares, caninos e incisivos. En pacientes con mordida abierta, las miniplacas se definen como un método seguro, una alternativa rápida y menos costosa a la cirugía ortognática. Y en pacientes de las clases II y III se utilizan sin producir efectos dentoalveolares que sustituyan a los dispositivos extraorales como máscaras, con dispositivos intraorales y elásticos (BAMP).

ABSTRACT: In orthodontics, miniplates are used as a Temporary Anchoring Device (TAD) for the purpose dental movements, allowing the use of orthopedic forces. In comparison with mini-screws, miniplates have the advantage of a very low rate of failure. Nonetheless, their removal requires the same surgical procedure as during installation, which is an obvious disadvantage. The aim of this study is to review the indications of miniplates in patients with open bite, class II and class III anomalies, and review how miniplates improved orthodontics treatments. Information was obtained by a search in PubMed with the keywords listed below. Miniplates are indicated for retraction in mass of the arcade, where it was seen that the force of 150 g applied on maxillary molars, is sufficient not only to push the molars back into a corrected class I, but also to initiate retraction of premolars, canines, and incisors. In open-bite patients, mini plates, are achieved as a safe method, that is quick and a less expensive alternative to orthognathic surgery. Further, in class II and III patients they are used without producing dentoalveolar effects replacing extraoral devices as facemasks, with intraoral devices and elastics. (BAMP).

Effect of Gingival Retraction Method to Lateral Gingival Displacement Width

Abstract Objective: To analyze the efficacy of retraction cord with a hemostatic agent in comparison with retraction paste on lateral gingival displacement, to achieve the success of fixed dental prostheses (FDP). Material and Methods: Test samples included 32 teeth that required treatment with metal-porcelain FDP at RSKGM FKG Universitas Indonesia. Impressions were taken before the gingival retraction procedure. From the 32 samples, 16 teeth were retracted using a combination of retraction cord and hemostatic agent, whereas the other half were retracted with retraction paste. Impressions were then taken. The sample was made using cutting die. Lateral gingival displacement width was measured on die-cast using an optical microscope Results: The mean value of group A before gingival retraction was 0.1695 mm, and after gingival retraction was 0.4705 mm. The mean value of group B before gingival retraction was 0.1767 mm, and after gingival retraction was 0.3289 mm. Lateral gingival displacement width between a combination of cord retraction and hemostatic agent group in comparison with the retraction paste group showed a significant difference (p<0.001). The combination of cord retraction and hemostatic agent group showed higher mean value Conclusion: Gingival displacement width as a result of cord retraction with the hemostatic agent was larger compared to the retraction paste. Even though both of them are still considered to be effective in providing access for impression material.

Fatores locais relacionados à previsibilidade de sucesso das técnicas cirúrgicas de recobrimento radicular / Local factors related to the predictable success of root coverage surgical techniques

Recessões gengivais podem causar, principalmente, sensibilidade dentinária, alterações estéticas e interferências na qualidade de vida do paciente, fazendo com que ele busque, cada vez mais, um tratamento periodontal estético com o objetivo de recobrimento radicular. Diversas técnicas cirúrgicas podem ser empregadas com esse intuito. O objetivo deste trabalho foi descrever, através de uma revisão da literatura, os principais fatores locais relacionados à previsibilidade de sucesso das técnicas cirúrgicas com o objetivo de recobrimento radicular. A pesquisa mostrou que os fatores locais que podem influenciar positivamente no resultado do recobrimento radicular são: o tratamento adequado da superfície radicular exposta, a vascularização, a espessura favorável do enxerto e do retalho, a estabilidade dos tecidos, o controle de infecção local, as condições técnicas operatórias, o cumprimento das orientações dadas ao paciente pelo cirurgião-dentista e a escolha da técnica cirúrgica em relação à lesão a ser operada.

In special, gingival recessions can cause dentin sensitivity, esthetic changes, and interferences on the patient's quality of life, prompting his/her to seek for surgical treatment for root coverage. For this, several surgical techniques can be used. The aim of this study is to describe, through a literature review, the main local and systemic factors related to the predictability of success of surgical techniques for root coverage. Research has shown that local factors that can positively influence the outcome of root coverage are the appropriate treatment of exposed root surface, vascularization, favorable graft and flap thicknesses, tissue stability, local infection control, local surgical conditions, patient's compliance with postoperative instructions, and the surgical technique chosen.

Coverage of Miller class I and II gingival recessions treated with subepithelial connective tissue graft, acellular dermal matrix, and enamel matrix proteins. Pilot study / Recobrimento de recessões gengival classe I e II de Miller com enxerto de tecido conjuntivo subepitelial, matriz dérmica acelular, e proteína derivada da matriz do esmalte. Estudo piloto

Objective: The aim of this study was to compare clinical findings obtained in the treatment of gingival recessions using subepithelial connective tissue graft (SECT), acellular dermal matrix (ADM), and enamel matrix proteins (EMP). Material and method: Twelve patients with Miller class I and II recession in the canines or upper premolars were randomly divided into groups to receive treatments using SECT, ADM, or EMP. Clinical measurements were performed before and three months after surgical procedures. The data evaluated were as follows: percentage of root coverage, height and width of gingival recession, probe depth, clinical attachment level, and height and thickness of keratinized gingiva. The Kruskal-Wallis test complemented by Dunn's test was used to perform the between-group, analysis and the Wilcoxon test was used to perform the within-groups analysis. The tests were applied at the 95% confidence level. Result: The SECT and ADM groups had a higher percentage of root coverage and greater reduction in the height and width of gingival recessions compared to the EMP group (p< 0.05). Conclusion: The SECT and ADM are more effective in treating gingival recessions than EMP.

Objetivo: O objetivo desse estudo foi de comparar os achados clínicos obtidos no tratamento de recessões gengivais utilizando o enxerto de tecido conjuntivo subepitelial (SECT), a matriz dérmica acelular (ADM) e as proteínas derivadas da matriz do esmalte (EMP). Material e método: Doze pacientes que apresentavam recessões gengival classe I e II de Miller nos caninos e pré-molares superiores foram randomicamente alocados para receber o SECT, ADM ou EMP. Análises clínicas foram executadas antes e 3 meses após os procedimentos cirúrgicos. Foram avaliados os seguintes parâmetros: porcentagem de recobrimento radicular, altura e comprimento da recessão gengival, profundidade de bolsa a sondagem, nível clínico de inserção, altura e espessura da gengiva queratinizada. O teste de Kruskal-Wallis complementado pelo teste de Dunn foram usados para avaliar as diferenças entre os grupos em cada período enquanto que o teste de Wilcoxon foi utilizado para avaliar as diferenças dentro de cada grupo variando-se o período de avaliação. Os teste foram aplicados com nível de confiança de 95%. Resultado: Os grupos SECT e ADM apresentaram maior porcentagem de recobrimento radicular e maior redução da altura e comprimento das recessões do que o grupo EMP (p<0,05). Conclusão: O SECT e a ADM são mais efetivos no tratamento de recessões gengivais que o EMP.

Cirurgia periodontal estética em dentes anteriores / Esthetic periodontal surgery in anterior teeth

As cirurgias pl sticas periodontais vˆm sendo muito valorizadas e cada vez mais procuradas por pessoas que alegam querer corrigir o “sorriso gengival”, que ocorre quando ao sorrir, mostram mais gengiva do que os dentes. Existem diversas causas para o sorriso gengival, e este artigo aborda um caso de erup‡Æo passiva alterada dos dentes com excesso de gengiva ceratinizada. Um comprometimento do sorriso harm“nico ‚ um desconforto est‚tico que incomoda principalmente as mulheres. Diante dos fatos, este trabalho tem como objetivo relatar um caso cl¡nico de cirurgia est‚tica com osteoplastia. Essas t‚cnicas promovem uma exposi‡Æo dent ria mais adequada proporcionando um sorriso mais harm“nico ao paciente. O presente caso ‚ de uma paciente do sexo feminino, 23 anos, que queixava-se da insatisfa‡Æo que o sorriso gengival a proporcionava. Atrav‚s da an lise do sorriso foi indicado o procedimento cir£rgico. Ap¢s o procedimento cir£rgico, p“de-se concluir atrav‚s do grau de satisfa‡Æo da paciente que as t‚cnicas empregadas foram adequadas para se obter um sorriso est‚tico.

Periodontal plastic surgery have been highly valued and increasingly sought by people who want to fix the “gummy smile”. There are several causes for gummy smile, and this article will discuss a case of altered passive eruption of teeth with excessive keratinized gingiva. An aesthetically compromised smile bothers mostly female patients. Given the facts, this paper aims to report a case of clinical cosmetic surgery with osteoplasty. These techniques promote a more adequate dental exhibition providing a more harmonious smile to the patient. This case was a 23 years old female patient, displeased with her gummy smile. After the analysis of the smile, surgical treatment was indicated. After surgery it was concluded that, according to the patient’s satisfaction, the utilized techniques were adequate to obtain an aesthetically harmonious smile.

Effect of a cordless retraction paste on titanium surface: a topographic, chemical and biocompatibility evaluation

Good exposure of the preparation margins and haemostasis in the sulcular gingiva are necessary for accurate impressions to produce precise restorations. The use of cordless retraction paste material in implant dentistry is a relatively novel application. However, few studies have been conducted on the use of retraction pastes and their possible interaction with implant surfaces. Recent literature has described remnants on titanium implant surfaces and expressed the need for an assessment of the biocompatibility of the exposed surface (Chang et al.). This in vitro study evaluated the effect of a cordless gingival retraction paste on sterile titanium disks. Surface chemistry was determined using energy-dispersive X-ray spectroscopy (EDS), and further investigated using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). After exposure to retraction paste, surface chemistry alterations were identified. A fibroblast cell line (L929) was exposed to the disks and the live/dead viability/cytotoxicity assay was used to determine any effects on the proliferation and health of cells. The disks exposed to the retraction paste showed fewer dead cells compared to the unexposed disks. This was statistically significant.

Optimización de la estética a través de acondicionamiento mucogingival: técnica por escarificación / Optimization of beauty through design gingival: technical scarification

Las expectativas de los pacientes en relación con el resultado estético de las prótesis fijas requiere una visión amplia del tratamiento del profesional. Esto incluye los aspectos dentales y de las estructuras que dan armonía a la sonrisa. Este trabajo tiene por objetivo mostrar a través de un caso clínico, el acondicionado mucoso mediante la técnica de escarificación para el restablecimiento satisfactorio de la armonía dento gingival, lo que permite la formación de las papilas interdentales y la conformación del arco cóncavo mucoso para la correcta instalación de los fantomas. La técnica se mostró con mucha previsibilidad cuando está indicada, planeada y ejecutada de la forma correcta, siendo una opción válida de tratamiento para el clínico obtener resultados estéticos satisfactorios

The patients' expectations related to the aesthetic outcome of dental prosthesis requires a broad view of the professional treatment. This includes all aspects of the teeth and the structures that create harmony in the smile. This paper aims to show through a case report utilizing the conditioning of the soft tissue (gingival scarification), a possible way to achieve a satisfactory restoration of the gingival tooth harmony, allowing the formation of the interdental papillae and the gingival concave arc shape for the proper installation of pontics. The technique is very predictable when directed, planned and executed correctly, being a valid treatment option for the clinician to obtain satisfactory aesthetic results

Effects of sulfur-based hemostatic agents and gingival retraction cords handled with latex gloves on the polymerization of polyvinyl siloxane impression materials

OBJECTIVES: This study investigated the possible interactions between three addition silicone materials (Express®, Aquasil Ultra® and Adsil®), three hemostatic agents (ferric sulfate, StatGel FS®; aluminum sulfate, GelCord®; and aluminum chloride, Hemostop®) and gingival retraction cords previously handled with latex gloves to determine whether direct contact with medicaments or indirect contamination by latex in conditions similar to those found in clinical practice inhibit or affect the setting of the impression materials. MATERIAL AND METHODS: A portable device for the simultaneous test of several specimens was specifically developed for this study. Polymerization inhibition was analyzed by examination of the impressions and the molded surface. Ten trials were performed for each addition silicone material used in the study, at a total of 240 study samples. RESULTS: All the samples tested (N=240) were nonreactive regardless of the type of combination used. CONCLUSIONS: Aluminum sulfate, ferric sulfate and aluminum chloride hemostatic solutions did not show any inhibitory potential on the addition silicone samples under study, and there were no changes in polymerization as a result of contact between addition silicone and retraction cords handled with latex gloves.

Effect of a cordless retraction paste material on implant surfaces: an in vitro study

Cordless retraction paste material for gingival retraction in implant dentistry has recently become of interest to the clinician. However, few studies have been conducted on the use of retraction pastes and their possible interaction with implant surfaces. This in vitro study evaluated the effect of a cordless retraction paste material, Expasyl® (Acteon), on TiUnite® (Nobel Biocare) implant surfaces. Three areas of the fixtures were evaluated before and after contact with the retraction paste using scanning electron microscopy to evaluate changes in surface topography and energy-dispersive spectroscopy to identify any surface chemistry modifications. Alteration of the initial surface after exposure to Expasyl® was identified, with the implant collar showing the most changes.

Avaliação de diferentes técnicas de recobrimento radicular para a saúde dos tecidos periodontais / Evaluation of differents techniques of coverage root to health periodontal tissues

Visando a correção das recessões gengivais, várias técnicas foram desenvolvidas, dentre elas, a de posicionamento coronário do retalho semilunar e a técnica de retalho deslocado coronariamente. O objetivo deste estudo foi avaliar a efetividade de duas técnicas cirúrgicas de recobrimento radicular através dos parâmetros clínicos periodontais nos tecidos periodontais de pacientes portadores de recessão gengival Classe I de Miller. Foram selecionados 20 pacientes, com idade entre 20 a 50 anos. Após a realização do tratamento periodontal básico foi determinado: índice de placa, índice gengival, profundidade de sondagem, nível de inserção clínica e altura de gengiva inserida; cada paciente foi incluído em um dos grupos selecionados de acordo com a técnica cirúrgica: grupo 1: técnica de retalho semilunar posicionado coronariamente e grupo 2: técnica de retalho deslocado coronariamente. Os pacientes foram avaliados por um período de 90 dias. Os resultados mostraram uma diminuição significativa dos índices de placa e gengival em ambos os grupos, assim como os resultados do nível de inserção clínica. Com relação à profundidade de sondagem, não houve mudanças ao final dos 90 dias e em relação à altura de gengiva inserida, houve um aumento apenas no grupo que recebeu a técnica do retalho semilunar. Podemos sugerir que ambas as técnicas foram efetivas para a saúde dos tecidos periodontais de pacientes portadores de recessão gengival Classe I de Miller. A técnica do retalho semilunar posicionado coronariamente teve uma pequena vantagem em relação à técnica do retalho deslocado coronariamente, devido ao ganho significativo de altura de gengiva inserida.

Comparación entre dos técnicas de retracción gingival para la toma de impresión definitiva en prótesis fija / Comparison between two gingival retraction techniques for taking a definitive impression in a fixed prosthesis

La retracción gingival consiste en la separación del tejido gingival con el objetivo de dejar expuestos transitoriamente las líneas de terminado talladas en la preparación de piezas dentarias. La cual desde hace algunos años, se ha realizado bajo la técnica de hilo retractor, dando muy buenos resultados, pero el tiempo empleado en ella y la difícil aplicación de esta técnica ha llevado a buscar técnicas alternativas que consigan la retracción deseada, disminuyendo estas complicaciones. Es por eso que se realizó este estudio comparativo entre dos técnicas una que habitualmente se ha usado (hilo retractor) y la otra una pasta elaborada con cloruro de aluminio y Kaolín (Expasyl). El presente trabajo de investigación comprende el análisis de 36 modelos de estudio de 18 pacientes que asistieron a las clínicas de la Facultad de Odontología de la Universidad de El Salvador en los meses de Febrero a Agosto; a los que se les tomó una impresión de control y otra después de haber aplicado las dos técnicas de retracción en estudio; posteriormente se obtuvieron los modelos en yeso extraduro, que se individualizaron y cortaron transversalmente de vestibular a lingual para su análisis. Los resultados reflejaron que en tiempo de trabajo el Expasyl se realizó en un intervalo de 4 a 6 minutos y el hilo retractor en un intervalo de 7 a 8 minutos. El hilo proporcionó un porcentaje promedio mayor de retracción de 1.62mm en comparación al Expasyl que proporcionó un promedio de 1.38mm. También se determinó que la visibilidad de la línea de terminado era mayor en el hilo retractor con un 74% de aprobación en comparación al Expasyl que presento un 56% de aprobación.

Gingival retraction consists of the separation of the gingival tissue in order to temporarily expose the finishing lines carved in the preparation of teeth. Which for some years has been carried out under the retractor wire technique, giving very good results, but the time spent in it and the difficult application of this technique has led to the search for alternative techniques that achieve the desired retraction, reducing these complications. . That is why this comparative study was carried out between two techniques, one that has been commonly used (retractor wire) and the other a paste made with aluminum chloride and Kaolin (Expasyl). The present research work includes the analysis of 36 study models of 18 patients who attended the clinics of the Faculty of Dentistry of the University of El Salvador in the months of February to August; To whom a control impression and another one were taken after having applied the two retraction techniques under study; Afterwards, the extra-hard plaster models were obtained, which were individualized and cut transversely from buccal to lingual for analysis. The results reflected that in working time the Expasyl was performed in an interval of 4 to 6 minutes and the retractor wire in an interval of 7 to 8 minutes. The thread provided a higher average percentage of shrinkage of 1.62mm compared to Expasyl which provided an average of 1.38mm. It was also determined that the visibility of the finishing line was higher in the retractor cord with a 74% approval compared to the Expasyl that presented a 56% approval.