Manifestaciones gingivales de sífilis secundaria: serie de casos / Gingival manifestations of secondary syphilis: case series

Objetivo: La sífilis es una enfermedad de transmisión sexual con una incidencia creciente a nivel mundial. En la sí- filis secundaria, las lesiones orales son frecuentes, siendo a veces la única manifestación. El objetivo de este artículo es presentar una serie de casos clínicos de sífilis con localización predominante o exclusivamente gingival, destacando las ca- racterísticas clínicas más relevantes para su diagnóstico. Casos clínicos: Esta serie de casos clínicos incluyó nueve casos de sífilis secundaria con manifestaciones gingi- vales. El diagnóstico se realizó mediante pruebas serológicas (VDRL, TPPA, FTA-ABS y MHA-TP), y se describieron le- siones tanto gingivales como extragingivales. En la encía se observó sífilis secundaria afectando principalmente la región anterior ­tanto superior como inferior­, presentándose pla- cas rojas o blancas. Algunos casos también presentaban le- siones en otros sitios intraorales, tenían síntomas como dolor o sensación de ardor, o presentaban enfermedad periodontal dependiente de placa. El diagnóstico diferencial de sífilis se- cundaria gingival con condiciones periodontales inespecíficas es fundamental para un diagnóstico adecuado. Por lo tanto, se debe considerar el diagnóstico de sífilis secundaria cuando se enfrentan casos gíngivo-periodontales atípicos en la práctica diaria (AU)

Aim: Syphilis is a sexually transmitted disease with growing incidence worldwide. In secondary syphilis, oral le- sions are common, sometimes being the only manifestation. Gingival features of syphilis are rare and usually present mul- tiple oral lesions. The aim of this article is to present a series of clinical cases of syphilis with predominantly or exclusively gingival localization, highlighting the most relevant clinical characteristics for its diagnosis. Clinical cases: This clinical case series included nine cases of secondary syphilis with gingival manifestations. The diagnosis was made using serological tests (VDRL, TPPA, FTA-ABS, and MHA-TP), and both gingival and extragingi- val lesions were described. Secondary syphilis was observed in the gum, mainly affecting the anterior region ­both up- per and lower­, depicting red or white plaques. Some cases also presented lesions in other intraoral sites, had symptoms such as pain or burning sensation, or showed plaque induced periodontal disease. The differential diagnosis of second- ary syphilis considering non-specific periodontal conditions with gingival involvement is essential for a proper diagnosis. Thus, the diagnosis of secondary syphilis should be consid- ered when dealing with atypical gingivo-periodontal cases in everyday practice (AU)

Aggressive localized juvenile spongiotic gingival hyperplasia (LJSGS) in a 33-year-old patient: a case report

The aim of this study is to report a case of an extensive and aggressive gingival lesion, compatible with localized juvenile spongiotic gingival hyperplasia (LJSGH), demonstrating the difficulties of diagnosis and management. A 33 years-old male patient was referred to Department of Oral and Maxillofacial Surgery at the Erasto Gaertner Hospital with a lesion on anterior maxillary gingiva, with 3-months evolution period. The patient had complete permanent dentition and good oral hygiene. The gingival hyperplasia involved the gums of teeth 11 and 12, and was solitary, asymptomatic, red, flaccid and bleeding on palpation. No palpable lymph nodes were found. An incisional biopsy was performed, with anatomopathological result of "squamous mucosa with pseudoepitheliomatous hyperplasia and lymphoplasmocytic infiltrate with neutrophils". The lesion was fully excised and the anatomopathological report confirmed the biopsy showing no malignancy in the sample and negative for the investigation of fungus. Biofilm control, mouth rinses with hydrogen peroxide, Chlorhexidine Digluconate 0.12% and Amoxicilin 500mg+Potassium Clavulanate 125mg have not demonstrated efficacy, and the patient kept showing recurrence of the lesion in short time even after the complete excision. Against this situation, the patient was referred to an infectologist, by the suspicion of a resistant microorganism. He started antibacterial therapy with Sulfamethoxazole 800mg+Trimethoprim 160mg that showed good results after 3 months. Currently, the patient remains in follow-up without signs of recurrence. LJSGH is a clinicopathological benign entity that appears in young patients as a soft, bleeding and reddish mass, mainly in the buccal gingiva of the upper anterior maxilla and lonely in most cases. The management of this condition is very difficult because of the few cases described in literature, and establishing the correct diagnosis is essential to ensure that the appropriate treatment is followed. (AU)

A comparative study to evaluate the effects of antibiotics, plant extracts and fluoride-based toothpaste on the oral pathogens isolated from patients with gum diseases in Pakistan / Um estudo comparativo para avaliar os efeitos de antibióticos, extratos vegetais e creme dental à base de flúor sobre os patógenos orais isolados de pacientes com doenças gengivais no Paquistão

Oral diseases caused by various microorganisms are common around the world. Scientific research has now been focusing on novel medicines to overcome bacterial resistance and antibiotics side effects; therefore, the current study was designed to assess the efficacy of certain antibiotics, toothpaste, and medicinal plant extracts (Ajuga bracteosa and Curcuma longa) versus the bacterial pathogens isolated from the human oral cavity. A total of 130 samples were collected from Khyber Teaching Hospital Peshawar, Pakistan, among those 27 species isolated, and eight bacterial species were identified from the samples. Among all the bacterial species, Staphylococcus aureus (29.62%) and Proteus mirabilis (22.2%) were found to be more prevalent oral pathogens. In comparison, the least pervasive microbes were Proteus vulgaris, Shigella sonnei, Escherichia coli and Aeromonas hydrophila. The study also suggested that dental problems were more prevalent in males (41-50 years of age) than females. Among the eight antibiotics used in the study, the most promising results were shown by Foxicillin against A. hydrophila. The survey of TP1 revealed that it showed more potent antagonist activity against Proteus vulgaris as compared TP2 and TP3 that might be due to the high content of fluoride. The Curcuma longa showed more significant activity than Ajuga bracteosa (Stem, leaves and root) extracts. The data obtained through this study revealed that antibiotics were more effective for oral bacterial pathogens than toothpaste and plant extracts which showed moderate and low activity, respectively. Therefore, it is suggested that the active compounds in individual medicinal plants like Curcuma longa and Ajuga bracteosa could replace the antibiotics when used in daily routine as tooth cleansers or mouth rinses.

As doenças bucais causadas por vários microrganismos são comuns em todo o mundo. A pesquisa científica agora tem se concentrado em novos medicamentos para superar a resistência bacteriana e os efeitos colaterais dos antibióticos; portanto, o presente estudo foi desenhado para avaliar a eficácia de certos antibióticos, pasta de dente e extratos de plantas medicinais (Ajuga bracteosa e Curcuma longa) contra os patógenos bacterianos isolados da cavidade oral humana. No total, 130 amostras foram coletadas do Khyber Teaching Hospital Peshawar, Paquistão, entre essas, 27 espécies foram isoladas e oito espécies bacterianas foram identificadas a partir das amostras. Entre todas as espécies bacterianas, Staphylococcus aureus (29.62%) e Proteus mirabilis (22.2%) foram os patógenos orais mais prevalentes. Em comparação, os micróbios menos difundidos foram Proteus vulgaris, Shigella sonnei, Escherichia coli e Aeromonas hydrophila. O estudo também sugeriu que os problemas dentários eram mais prevalentes em homens (41-50 anos de idade) do que em mulheres. Entre os oito antibióticos usados no estudo, os resultados mais promissores foram mostrados pelo Foxicillin contra A. hydrophila. A pesquisa de TP1 revelou que ele mostrou atividade antagonista mais potente contra Proteus vulgaris em comparação a TP2 e TP3, o que pode ser devido ao alto teor de flúor. A Curcuma longa apresentou atividade mais significativa em relação aos extratos de Ajuga bracteosa (caule, folhas e raiz). Os dados obtidos neste estudo revelaram que os antibióticos foram mais eficazes para os patógenos bacterianos orais do que os dentifrícios e os extratos vegetais que apresentaram atividade moderada e baixa, respectivamente. Portanto, sugere-se que os compostos ativos em plantas medicinais individuais como Curcuma longa e Ajuga bracteosa possam substituir os antibióticos quando usados na rotina diária como limpadores de dentes ou enxaguatórios bucais.

Comparative Evaluation of Clinical Efficacy of Diode LASER and Cryosurgery for Gingival Pigmentation: A Split-Mouth Randomized Clinical Study

ABSTRACT Objective: To compare and evaluate the clinical efficacy of diode laser and cryosurgery for treating melanin pigmentation of gingiva. Material and Methods: A total of twenty-five subjects with physiological gingival pigmentation on the facial aspect of both maxillary and mandibular anterior arches (50 sites), both male and female, with an average age ranging from 18-35 years, participated in the study. The sites were randomly divided into Group I: depigmentation by Laser and Group II: depigmentation by Cryosurgery. The following parameters were assessed for the evaluation of treatment results: Melanin Oral Pigmentation Index (PI), Visual Analogue Scale (VAS) for pain evaluation and Healing index (HI). The data collected was statistically evaluated. Results: On intergroup comparison, there was no statistical difference in the score from baseline (p>0.05); however, a statistically significant difference was seen at the end of 1 year (p<0.05). Moreover, 57-60% of arches showed recurrence of pigmentation in the laser group whereas; only 12.7-17% recurrence was seen in the cryosurgery group at the end of the first year. Conclusion: Treatment of gingival hyperpigmentation with laser and cryosurgery shows a marked improvement of gingival pigmentation in both groups, but the cryosurgery depigmentation sites showed more sustainability.

Gingival state and presence of red complex bacteria in 12-Year-Old schoolchildren / Estado gingival y presencia de bacterias del complejo rojo en escolares de 12 años

Abstract The objective of this study was to determine the gingival state and presence of red complex bacteria in saliva samples of 12-year-old schoolchildren. A calibrated periodontist evaluated biofilm index (BI) (Silness and Löe, 1964), presence of calculus, and gingival index (GI) (Silness and Löe, 1967) in sixty two 12-year-old students of Carmen Lyra School. Saliva samples were collected from each student. The DNA of each sample was extracted and amplified by the polymerase chain reaction (PCR) technique, using specific primers. The BI was 1.18. Calculus was present in 40.40% of the schoolchildren examined; 19.4% was supragingival calculus and 21% both supragingival and subgingival calculus. The GI was 0.97, which according to Silness and Löe is mild gingivitis. Gingivitis was present in 96.8% of the children examined. Regarding the PCR tests: 18 of the samples (31.58%) did not present any of the bacteria analyzed and the remaining 39 samples (68.42%) were positive for at least the presence of red complex bacteria. Within the limitations of this study, it is concluded that the prevalence of gingivitis and calculus is high in the sample examined, and the gingival state observed in the study population, may be related to the presence of red complex bacteria.

Resumen El objetivo de este estudio era determinar el estado gingival y la presencia de bacterias del complejo rojo en muestras de saliva de niños de 12 años de la Escuela Carmen Lyra. Una periodoncista calibrada evaluó en 62 estudiantes de 12 años de la Escuela Carmen Lyra, el índice de biofilme (IB) (Silness y Löe, 1964), la presencia de cálculo y el índice gingival (IG) (Silness y Löe, 1967). Se recolectaron muestras de saliva de cada estudiante. El ADN de cada muestra fue extraído y amplificado por medio de la prueba PCR, empleando primers específicos, para determinar la presencia de bacterias del complejo rojo. El IB fue de 1.18. El cálculo estuvo presente en el 40.40% de la muestra, se encontró 19.4% de cálculo en supragingival y 21% tanto en supragingival como en subgingival. El IG fue de 0.97, que de acuerdo con Silness y Löe es una gingivitis leve. La gingivitis estuvo presente en el 96.8 % de los niños examinados. Con respecto a las pruebas PCR: 18 de las muestras (31.58 %) no presentaron ninguna de las bacterias analizadas y las 39 muestras restantes (68.42%) fueron positivas por lo menos a la presencia de las bacterias del complejo rojo. Dentro de las limitaciones de este estudio, se concluye que la prevalencia de gingivitis y cálculo es alta en la muestra examinada y el estado gingival observado puede estar relacionado con la presencia de bacterias del complejo rojo.

Tratamiento de recesiones gingivales tipo I y II de cairo: Reporte de caso / Treatment of cairo type I and II gingival recessions: Case report

Introducción: Las recesiones gingivales, son defectos mucogingivales que ocurren con mayor frecuencia en adultos y pueden aumentar con la edad. Existe una exposición parcial de la superficie radicular y puede causar problemas estéticos, funcionales y periodontales. Reporte de caso: Paciente femenino de 51 años de edad, sistémicamente sana, diagnosticada con recesiones tipo I y II de Cairo, las cuales se trataron con técnicas de colgajo posicionado coronal, túnel y con uso de biomateriales como matriz dérmica acelular y proteínas derivadas del esmalte. Conclusión: La importancia de tomar en cuenta el diagnóstico de la recesión, así como las características del defecto y tejidos adyacentes determinarán el éxito en el tratamiento.

Introduction: Gingival recessions are mucogingival defects that occur more often in adults and may increase with age. There is a partial exposure of the tooth root which can create aesthetic, functional and periodontal problems. Case Report: 51 year-old female patient, systematically healthy, was diagnosed with Cairo type I and II recessions, which were treated with techniques such as: coronally advanced flap, tunnel and with the use of biomaterials like acellular dermal matrix and enamel matrix derivatives. Conclusion: The importance of taking into account the diagnosis of the recession, as well as the characteristics of the defect and adjacent tissues, will determine the success of the treatment.

Granuloma piógeno oral. Serie de casos / Oral pyogenic granuloma. Case series

RESUMEN El granuloma piógeno es una lesión que se manifiesta en la piel y en la cavidad oral, relacionado con diversas causas, como irritación crónica, trauma y cambios hormonales. Clínicamente se muestra como una lesión hiperplásica altamente vascularizada, con un tamaño de 1-3 cm, de base pedunculada o sésil y de crecimiento lento. Predomina en el sexo femenino y tiende a aparecer, sobre todo, en la encía, con muy pocos casos reportados en zonas edentes, motivo por el que se realizó el reporte de tres casos de granuloma piógeno oral en pacientes femeninas, comprendidas entre 30 y 40 años de edad. Se presentaron lesiones que diferían en cuanto a su localización y apariencia clínica (AU).

ABSTRACT Pyogenic granuloma is a lesion that arises in the skin and oral cavity, related to various causes, such as chronic irritation, trauma and hormonal changes. Clinically it looks like a highly vascularized hyperplastic lesion, sized 1-3 cm, with a pedunculated or sessile base and slow growing. It predominates in the female sex and tends to appear, above all, in the gum, with very few cases reported in edentulous areas; that is why the authors reported three cases of oral pyogenic granuloma in female patients, aged between 30 and 40 years. The lesions differed in their location and clinical appearance (AU).

The Prosthetic Management of a Case of Epulis Fissuratum by a Novel Technique / El manejo protésico de un caso de épulis fisurado con una técnica novedosa

ABSTRACT: The clinical management of the epulis involves the elimination of causal factors, excision of fibrous tissue excess accompanied by an appropriate prosthetic rehabilitation. The confection of interim prosthesis or the rectification of old prosthesis for the setting up of a tissue conditioner if necessary, to improve the healing and prevent the decrease of the vestibule depth after the surgical exeresis. Throughout this paper, we are going to present a new technique for the correction of old prostheses poorly adapted for the management of a case of the epulis fissuratum.

RESUMEN: El manejo clínico de un épulis comprende la eliminación de los agentes causales y la eliminación del tejido fibroso, acompañado de una adecuada rehabilitación protésica. Es necesaria la confección de una prótesis provisional o la rectificación de la prótesis vieja, para la colocación del acondicionador de tejidos si fuera necesario para mejorar el sanado y prevenir la disminución de la profundidad del vestíbulo después de la exéresis quirúrgica. En este artículo, presentaremos una nueva técnica para la corrección de la prótesis desajustada en el manejo de un caso de épulis fisurado.

Melanosis gingival: diagnóstico y terapéutica de su implicación estética. Revisión de la literatura / Gingival Melanosis: Diagnosis and Therapy of Its Aesthetic Involvement. Literature Review

ABSTRACT: Gingival hyperpigmentation is produced by excessive melanin deposit, generating a dark gum coloring. Although it does not constitute a health issue, in some cases it usually represents an aesthetic problem that can affect psychologically, for which there are currently several treatment alternatives such as: surgery with scalpel, laser therapy, abrasion, cryosurgery, electrosurgery, among others. The aim of this literature review was to analyze the available information about gingival melanosis and the therapeutics that can be applied to improve the appearance of patients with this condition. Articles in English and Spanish, published during the period 2000-2020 in the PubMed, Medline, Scielo, Cochrane and Lilacs databases, were reviewed. It was concluded that the selection of the technique will depend on each particular case, however, the laser is the most relevant.

RESUMEN: La hiperpigmentación gingival se produce por el depósito excesivo de melanina, generando una coloración oscura de la encía. Aunque no constituye un inconveniente para la salud, en algunos casos suele representar un problema estético que puede afectar psicológicamente, por lo cual, en la actualidad existen diversas alternativas de tratamiento como: cirugía con bisturí, terapia láser, abrasión, criocirugía, electrocirugía, entre otros. El objetivo de esta revisión de la literatura fue analizar la información disponible acerca de la melanosis gingival y la terapéutica que puede ser aplicada para mejorar el aspecto de los pacientes con esta condición. Se revisaron artículos en inglés y español, publicados durante el período 2000-2020 en las bases de datos PubMed, Medline, Scielo, Cochrane y Lilacs. Se concluyó que la elección de la técnica dependerá de cada caso en particular, sin embargo, el láser es el más destacado.

Cepillos interdentales, de la teoría a la práctica. Revisión de literatura e indicaciones clínicas / Interdental toothbrushes, from theory to practice: a review of the literature and clinical indications

Los cepillos interproximales son una herramienta de higiene interdental que tiene variadas indicaciones y múltiples beneficios. Pacientes con enfermedad periodontal, con papilas que no llenan el espacio interdentario, portadores de aparatología ortodóncica, prótesis fija o de implantes entre otros casos, pueden beneficiarse con su utilización. El presente artículo tiene como objetivo dar una orientación de su uso clínico basado en la evidencia científica disponible. Los resultados apoyan su utilización en combinación con el hilo dental para la prevención y tratamiento de las enfermedades bucales más prevalentes, con un efecto marcado sobre el control del biofilm y la inflamación gingival (AU)

Interproximal brushes are an interdental hygiene tool with diverse indications that have, multiple benefits. Among other uses, they are indicated in patients with periodontal disease, with papillae that do not fill the interdental space, patients with orthodontic appliances, fixed prosthesis or implant-supported prosthesis. The aim of this article is provide guidance on their clinical use based on the available evidence. The results support their use in combination with dental floss for preventing and treating the most prevalent oral diseases, with a significant effect on biofilm control and gingival inflammation (AU)

Utilización de láser diodo en tejidos blandos: reporte de 3 casos / Use of diode laser in soft tissue: report of 3 cases

Existen diversas condiciones anatómicas o alteraciones mucogingivales que pueden afectar tanto el normal funcionamiento como la estética gingival de piezas dentarias e implantes dentales. Si bien los tratamientos de estas condiciones se han realizado tradicionalmente con bisturí, el desarrollo tecnológico ha permitido que actualmente se pueden realizar con láser. Existen diferentes tipos de láser, siendo el diodo uno de los más utilizados debido a su menor tamaño, portabilidad, fácil configuración y menor costo. El láser ha adquirido mayor popularidad en cirugías de tejido blando dado sus múltiples beneficios: menor tiempo operatorio, control del sangrado y de la hemostasia, reducción de la cantidad de anestesia, posibilidad de no requerir suturas y minimización del dolor e inflamación postquirúrgica. El propósito de este trabajo es presentar la resolución de tres casos clínicos a los cuales se les realizaron los procedimientos de frenectomía labial, remoción de melanosis gingival y resección de fibroma irritativo mediante el uso de láser diodo. Para desarrollar todos los procedimientos se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia que varió entre 2 y 2.5 W en modo continuo utilizando una pieza quirúrgica con una punta de 300 µm (E 3-4), la que fue activada antes de empezar. Posterior a la cirugía se bioestimuló para disminuir el dolor y edema postoperatorio utilizando la punta de dolor a 4 W por 30 segundos a una distancia de 1 cm directo en la zona intervenida a todos los casos. La conclusión arroja que en todos los casos, el láser de diodo permitió un resultado exitoso. El procedimiento fue seguro, la técnica fue sencilla y de tiempo clínico reducido. El postoperatorio ocurrió con ausencia de dolor o molestias, generando una mayor satisfacción del paciente. Cabe señalar que la técnica depende de la habilidad del profesional que la realiza.

There are various anatomical conditions or mucogingival alterations that can affect the normal functioning and the gingival aesthetics of teeth and dental implants. Although the treatments of these conditions have been traditionally performed with a scalpel, technological development has allowed that they can be now performed with lasers. There are different types of lasers, being the diode one of the most used due to its smaller size, portability, easy configuration, and lower cost. The laser has become more popular in soft tissue surgeries due to its multiple benefits: shorter operating time, control of bleeding and hemostasis, reduction in the amount of anesthesia, possibility of not requiring sutures, and minimization of post-surgical pain and inflammation. The purpose of this work is to present the resolution of three clinical cases which underwent labial frenectomy procedures, removal of gingival melanosis and resection of irritative fibroma using diode laser. To develop all the procedures, a 940 nm diode laser equipment (Biolase®, USA) was used with a power that varied between 2 and 2.5 W in continuous mode, using a 300 µm tip (E 3-4), which was activated before starting. After surgery, biostimulation was carried out to reduce postoperative pain and edema using the pain tip at 4 W for 30 seconds at a distance of 1 cm directly in the operated area in all cases. In all cases, the diode laser allowed a successful result. The procedure was safe, the technique was simple, and the clinical time was short. The postoperative period occurred with the absence of pain or discomfort, generating greater patient satisfaction. It should be noted that the technique depends on the skill of the professional who performs it.

Treatment strategy for pregnancy epulis / 华西口腔医学杂志

Pregnancy epulis is a tumor-like lesion with high prevalence in China. The local lesion, the general condition of the pregnant patient, and the complications during treatment should be taken into consideration when making a treatment plan for pregnancy epulis. In this study, three representative pregnancy epulis cases were presented, and related studies at home and aboard were reviewed to summarize the etiology, differential diagnosis, treatment, and prevention of pregnancy epulis and share the clinical experience in the treatment of pregnancy epulis.

LipStaT® Surgery, A Novel Technique for the Treatment of Gummy Smile: Case Report / LipStaT®, Una novedosa técnica quirúrgica para el tratamiento de la sonrisa gingival, reporte de casos Gummy Smile and LipStat® Technique

Background: The lip stabilization technique (LipStaT®) is a novel surgical approach for the management of gummy smile. It is an outpatient technique, minimally invasive, with low risk of morbidity and low incidence of complications. The goal of the technique is to reduce the excessive gingival display during smile. Objective: to describe the LipStaT® technique including its indications, preoperative evaluation, surgical approach and patient post procedure care instructions. Clinical Cases: the authors present two female patients, aged 20 and 31 years, with excessive gingival display (over 3mm) and with experiences of failures with other procedures. The LipStaT® technique allowed to achieve aesthetic, harmonic and functional results. Conclusion: The LipStaT® technique is a safe outpatient procedure that allows to obtain predictable results, which are well accepted by patients.

Introducción: La técnica de estabilización labial (LipStaT®), es un novedoso abordaje quirúrgico para el manejo de la sonrisa gingival. Es una técnica ambulatoria, mínima-mente invasiva, con baja morbilidad e incidencia de complicaciones. La meta de la técni-ca es reducir la excesiva cantidad de encía que se visualiza durante la sonrisa. Objetivo:Describir la técnica LipStaT® incluyendo sus indicaciones, evaluación preoperatoria, abordaje quirúrgico y las indicaciones posteriores a la intervención. Presentación del caso: Los autores presentan dos pacientes, mujeres, entre 20 y 31 años, con visuali-zación excesiva de la encía de más de 3mm al sonreír y con experiencias de fracasos con otros procedimientos. La técnica LipStaT® permitió lograr un resultado estético, armónico y funcional. Conclusión: Este es un procedimiento seguro, ambulatorio, que permite obtener resultados predecibles y bien aceptados por los pacientes.

Criterios Clínicos para el Manejo de las Complicaciones del Tejido Blando Periimplantar / Clinical Criteria for the Management of Peri-implant Soft Tissue Complications

Las complicaciones del tejido blando periimplantar condicionan la apariencia estética y el pronóstico clínico de los implantes y son, en la actualidad, cada vez más diagnosticadas. Los defectos gingivales asociados a implantes dentales incluyen recesiones, fenestraciones o dehiscencias en la superficie mucosa vestibular, inflamación gingival, ausencia de encía insertada/queratinizada, falta de volumen y presencia de concavidades gingivales que generan sombras y oscuridad en la mucosa. La detección de éstas en forma temprana permite establecer un plan de tratamiento en busca de soluciones eficaces. Mediante la presentación de una serie de casos, abordaremos distintos procedimientos para aumento de los tejidos blandos periimplantarios y la corrección de defectos. La ganancia de encía queratinizada ha demostrado tener un impacto positivo en la estabilidad a largo plazo de todos los tejidos implantarios (AU)

Perceptions of the Use of the Diode Laser in Dental Surgery: A Qualitative Study

Abstract Objective: To discover the perceptions of pediatric patients, their parents and undergraduate Dentistry students of the use of the diode laser in frenectomy surgeries. Material and Methods: A qualitative study was conducted through semi-structured interviews, recorded and transcribed with subsequent content analysis. Twelve healthy children (5-8 years old) who needed a frenectomy were selected and invited, together with their parents, to undergo laser diode surgery. In addition, 28 undergraduate dentistry students were invited to attend the procedures. One week after performing the surgical procedures, the children (Group 1), their parents (Group 2) and the students who attended the procedures (Group 3) were individually interviewed for the thematic analysis. Results: The analysis of the conversations identified three emerging contents: positive thoughts on the use of diode laser; frustrations from the use of diode laser; and aspects related to professional training. Conclusion: The results pointed to the acceptance of surgical laser use in pediatric dentistry; however, the feelings of frustration indicate that its use requires guidance from the child and his/her parents, in addition to careful handling and specific training.

Gingival Melanin Depigmentation With Diode Laser - Case Report / Despigmentación Melánica Gingival con Láser de Diodo - Relato de Caso

ABSTRACT: The pigmented lesions of the oral cavity may be endogenous or exogenous. Endogenous lesions are benign and usually caused by melanin, and they are called gingival melanin pigmentations. Among the options for depigmenting these areas, laser therapy stands out for being a minimally invasive procedure. This study aims to report a clinical case of the gingival depigmentation technique using a high-power diode laser in the anterior maxillary region, for the ablation of the pigmented tissue to improve gingival aesthetics. The patient had an aesthetic complaint of the darkened aspect of the gingiva in the anterior maxillary and mandibular portions. After local anesthesia, we started depigmentation with high-power diode laser and performed ablation from the attached gingiva toward the free marginal gingiva. The patient returned after 30 and 180 days presenting healthy gingiva and absence of melanin repigmentation. Thus, we concluded that the diode laser was a good alternative for melanin depigmentation because it is a procedure with lower morbidity and satisfactory postoperative results.

RESUMEN: Las lesiones pigmentadas de la cavidad oral pueden ser endógenas o exógenas. Las endógenas son benignas y generalmente causadas por la melanina, denominándose pigmentaciones melánicas gingivales. Entre las opciones para la despigmentación de estas regiones, se destaca la laserterapia, por ser un procedimiento poco invasivo. Este trabajo tuvo como objetivo relatar un caso clínico de la técnica de despigmentación gingival utilizando láser de diodo de alta intensidad en la región anterior de los maxilares para ablación del tejido pigmentado con la finalidad de mejorar la estética gingival. El paciente presentaba como queja estética el aspecto oscurecido de la encía en la región anterior de la maxila y de la mandíbula. Tras aplicar anestesia local, se inició la despigmentación con láser de diodo de alta intensidad, siendo que la ablación se realizó a partir de la encía insertada hacia la encía marginal libre. El paciente regresó tras 30 y 180 días, presentando encía saludable y con ausencia de repigmentación melánica. Así fue posible concluir que el láser de diodo mostró ser una buena alternativa para la despigmentación melánica, ya que se presentó como un procedimiento con menor morbidad y buen resultado postoperatorio.

Complicaciones y cicatrización del injerto libre de encía y el colgajo de reposición coronal / Complications and healing of the free gingival graft and the coronally repositioned flap

RESUMEN La recesión periodontal se define como un trastorno de instalación lenta, progresiva y destructiva, en la cual, la encía adherida de uno o varios dientes se encuentra apical a la unión cemento-esmalte. Se realizó un estudio descriptivo y transversal desde enero 2014 a diciembre 2016, en la Facultad de Estomatología de Villa Clara, con el objetivo de describir las principales complicaciones y la cicatrización del injerto libre de encía y el colgajo de reposición coronal asociado a injerto de tejido conectivo subepitelial. La muestra fue de 45 pacientes y 54 zonas de injerto. Las complicaciones postoperatorias más frecuentes fueron: el dolor, seguido de la gingivorragia postoperatoria y el edema, en los casos donde se empleó el injerto libre de encía. La cicatrización de la zona donante y receptora, evaluada de buena, fue superior con el empleo del colgajo de reposición coronal asociado al tejido conectivo subepitelial.

ABSTRACT Periodontal recession is defined as a destructive and slowly progressive disorder, in which the attached gingiva of one or several teeth is apical to the cement-enamel junction. A descriptive and cross-sectional study was carried out from January 2014 to December 2016, in the Faculty of Dentistry of Villa Clara, with the aim of describing the main complications and healing of the free gingival graft and the coronally repositioned flap associated with subepithelial connective tissue graft. The sample consisted of 45 patients and 54 graft areas. The most common postoperative complications were pain, followed by postoperative gingival bleeding and edema, in cases where free gingival graft was used. The healing of the donor and recipient area, evaluated as good, was superior with the use of the coronally repositioned flap associated with subepithelial connective tissue.

Granuloma Periférico de Células Gigantes e Hiperparatiroidismo. Presentación de un Caso / Peripheral Giant Cell Granuloma and Hyperparathyroidism. Case Report

RESUMEN: Se presenta el caso de un paciente sexo femenino 31 años, insuficienciente renal crónica en hemodiálisis, hipertensa secundaria, consulta por aumento de volumen oral en relación a encía marginal vestibular izquierda, 6 meses de evolución. Al examen se observa aumento de volumen de 15 mm en relación a piezas. 3.6 y 3.7. Radiografía muestra compromiso periodontal pieza 3.7. Se realiza biopsia excisional y exodoncia pieza 3.7. Histopatología informa granuloma periférico de células gigantes. Se solicitan exámenes de laboratorio para estudio de hiperparatiroidismo (PTH elevada, calcemia fosfatemia normales). Evoluciona favorablemente. Sin signos de recidiva a los 3 meses. El diagnóstico histopatológico de lesión de células gigantes debe ser complementado con la clínica, exámenes de laboratorio e imagenología, el objetivo final es definir si tal diagnóstico corresponde a un tumor pardo, a un granuloma central de células gigantes o a un granuloma periférico de células gigantes. En la literatura los reportes de asociación entre granuloma periférico de células gigantes e hiperparatiroidismo son escasos. Este caso corresponde a granuloma periférico células gigantes, asociado a hipersecreción de paratohormona.

ABSTRACT: A 31-year-old female patient with chronic renal insufficiency in hemodialysis and secondary hypertension consulted due to an enlarging intraoral lesion in relation to the left marginal vestibular gingival, with 6 months of evolution. A 15mm mass in relation to mandibular left molars was noted. Radiograph showed periodontal involvement of mandibular left second molar. Excisional biopsy and tooth 3.7 extraction were performed. Histopathology reported a peripheral giant cell granuloma. Laboratory tests were requested for suspected hyperparathyroidism (aiding in the diagnosis) (high PTH, normal phosphatemia and calcemia). Evolution was favorable, without signs of reappearance after 3 months. The histopathological diagnosis of giant cell lesions should be complemented with clinical, laboratory and imaging tests. The final objective is to make the differential diagnosis between brown tumor, central giant cell granuloma and peripheral giant cell granuloma because the treatment varies considerably. There are few reports in the literature about the association between peripheral giant cell granuloma and hyperparathyroidism. This case corresponds to peripheral giant cell granuloma, possibly associated with parathormone hypersecretion.

Hallazgos Histopatológicos del Tejido Pericoronario de Terceros Molares Incluidos Sanos / Histopathological Findings of Pericoronary Tissue in Healthy Third Molars

RESUMEN: Este estudio se realizó para evaluar la presentación de cambios histopatológicos tempranos en sacos pericoronarios de terceros molares incluidos sanos. Sesenta y un tejidos pericoronarios de terceros molares incluidos, clínicamente asintomáticos y sin evidencia radiográfica de anomalía del saco pericoronario, se extrajeron por diferentes razones. Las muestras se fijaron y procesaron de forma rutinaria y se tiñeron con hematoxilina-eosina antes de la evaluación. Se estandarizaron los diagnósticos concluyendo que toda muestra que presente metaplasia escamosa del epitelio reducido del órgano del esmalte (EEE) se considerará cambio quístico temprano. De las muestras presentadas, el 28 % mostró metaplasia escamosa sugerente de cambio quístico temprano. Esta variación histológica del tejido pericoronario fue significativamente mayor en los pacientes menores de 20 años de edad, sexo femenino, terceros molares mandibulares, en inclusión ósea y en pacientes que no informaron sintomatología local previa (P = 0,05). Estos hallazgos sugieren que la ausencia de semiología clínica y radiográfica en terceros molares incluidos no necesariamente indica ausencia de alteraciones en el tejido pericoronario de los mismos.

ABSTRACT: This study was performed to evaluate the presentation of early histopathological changes in pericoronal healthy third molars. Sixty-one pericororonitis tissues third molars, without radiographic evidence of abnormality in pericoronary sack, extracted for various reasons. The samples were fixed and processed routinely and stained with hematoxylin-eosin before evaluation. Diagnostic standardized concluding that all this shows that squamous metaplasia of the reduced enamel organ (EEE) is considered cystic epithelium were early change. Of the samples submitted, 28 % showed squamous metaplasia early suggestive of cystic change. This histological tissue pericoronary variation was significantly higher in patients under 20 years of age, female gender, mandibular third molars, including in bone and in patients who reported no previous local symptoms (P = 0.05). These findings suggest that the absence of clinical and radiographic semiology third molars does not necessarily indicate the absence of alterations in tissue pericoronary thereof.