O uso da proteína botulínica na correção do sorriso gengival / The use of botulinum protein in the correction of gingival smile

A sociedade está cada vez mais exigente e em busca de excelência quando o assunto é estética facial. O sorriso tem grande impacto na harmonia da face e, atualmente, os pacientes estão mais conscientes sobre a influência da gengiva na beleza do sorriso. A exposição da gengiva em excesso, conhecida como sorriso gengival, afeta a estética, podendo interferir na autoestima e nas relações sociais dos pacientes. Existem diversos procedimentos descritos para solucionar o problema e, para o planejamento do caso e escolha do método, é preciso determinar a etiologia e levar em consideração o desejo do paciente. A injeção da proteína botulínica é uma alternativa minimamente invasiva que está sedo cada vez mais utilizada para a correção do sorriso gengival. Com isso, o objetivo do presente trabalho monográfico foi realizar uma revisão de literatura sobre o uso da toxina botulínica na correção do sorriso gengival, analisando técnicas de injeção, identificando o efeito imediato e a longo prazo da toxina nos músculos elevadores do lábio superior, além de avaliar a relevância desse método na correção do sorriso gengival, sozinho ou em conjunto com outros procedimentos. Foi realizada uma revisão de literatura nas bases de dados PubMed e Scielo, buscando artigos dos anos de 2013 até 2022, utilizando os descritores "botulinum toxin", "botox", "gummy smile", "gingival display" e "gingival exposure". Essa revisão analisa 15 artigos que discorrem sobre o método, durabilidade e eficácia da aplicação de proteína botulínica para correção do sorriso gengival. Algumas variantes diferenciam as técnicas de aplicação, como a marca do produto e recomendações do fabricante, classificação do sorriso e extensão da exposição gengival. Com base na revisão de literatura, pôde-se concluir que, apesar de ser transitório, esse procedimento se mostrou eficaz, tanto ao ser realizado como método principal, quanto como coadjuvante no tratamento. Além de ser comprovadamente seguro, rápido, minimamente invasivo e ser o tratamento de preferência entre os pacientes, com alto índice de satisfação, são raras as complicações relacionadas a aplicação da proteína botulínica para esse fim.

Society is becoming increasingly demanding, seeking excellence in facial aesthetics. The smile greatly impacts facial harmony, and nowadays, patients are more aware of the influence of the gums on smile beauty. Excessive gum exposure, known as gummy smile, affects aesthetics and can interfere with patients' self-esteem and social relationships. There are various procedures described to address this issue, and for case planning and method selection, it is necessary to determine the etiology and take into account the patient's desires. The injection of botulinum protein is a minimally invasive alternative that is increasingly being used for gummy smile correction. Thus, the aim of this monographic work was to conduct a literature review on the use of botulinum toxin in gummy smile correction, analyzing injection techniques, identifying the immediate and long-term effects of the toxin on the upper lip elevator muscles, and evaluating the relevance of this method in gummy smile correction, either alone or in conjunction with other procedures. A literature review was conducted in the PubMed and Scielo databases, seeking articles from 2013 to 2022, using the descriptors "botulinum toxin", "botox", "gummy smile", "gingival display", and "gingival exposure". This review analyzes 15 articles that discuss the method, durability, and effectiveness of botulinum toxin application for gummy smile correction. Some variations differentiate the application techniques, such as the product brand and manufacturer's recommendations, smile classification, and extent of gum exposure. Based on the literature review, it was possible to conclude that, despite being temporary, this procedure proved to be effective, both when performed as the main method and as an adjunct in treatment. In addition to being proven safe, fast, minimally invasive, and the preferred treatment among patients, with a high satisfaction rate, complications related to botulinum toxin application for this purpose are rare.

Comparison of smile attractiveness in cases with gummy smile treated with botulinum toxin and maxillary impaction surgery: A retrospective study.

This study aimed to compare the smile's attractiveness in patients submitted to the treatment of gummy smiles with botulinum toxin or maxillary impaction surgery. The retrospective sample comprised 26 patients divided into two groups: Group 1 (BTX): 13 patients (12 females and 1 male) with a mean age of 28.06 years (s.d. = 6.09) and mean gingival exposure during smile of 5.18 mm (s.d. = 1.51) treated with botulinum toxin; Group 2 (SURGICAL): 13 patients (9 females and 4 males) with a mean age of 30.59 years (s.d. = 5.72) and mean gingival exposure during smile of 5.21 mm (s.d. = 1.55) treated with orthognathic maxillary impaction surgery. The group of evaluators comprised 317 participants, divided into 143 orthodontists (85 females and 58 males) with a mean age of 41.40 (s.d. = 9.30); 62 dentists (47 female and 15 male) with a mean age of 35.44 (s.d. = 10.44), and 112 lay people (74 female and 38 male) with a mean age of 46, 91 (s.d. = 10.11) in a questionnaire on Google Forms. Without knowing the therapy used, the evaluators assigned scores to the photographs of the posed smile taken before (T1) and after (T2) treatment. Intergroup comparison of smile attractiveness was performed using the t-independent, one-way ANOVA, and Tukey tests. There was a significant improvement in smile attractiveness with treatment in both groups; however, the improvement was significantly better in the surgical group than in the BTX group. Orthodontists rated smile attractiveness significantly higher than dentists and laypersons for the final phase of the BTX and surgical groups. There was a significant improvement in the smile attractiveness with botulinum toxin application and orthodontic-surgical treatment. However, orthognathic surgery promoted a greater improvement in smile attractiveness than the application of botulinum toxin.

Esthetic crown lengthening in the treatment of gummy smile associated with altered passive eruption: A case report

Introduction: Excessive gummy smile affects the aesthetics of the patient and can be the result of several factors, including altered passive eruption, which can be surgically corrected by aesthetic crown lengthening. Case report: 22-year-old female patient, who was treated by aesthetic crown lengthening for the correction of type 1B altered passive eruption. Discussion: Considering the patient's age and periodontal phenotype, surgical correction of the gummy smile by aesthetic crown lengthening shows stable long-term results. Conclusion: Surgically correcting excessive gingival exposure through esthetic crown lengthening can help patients improve the appearance of their smile and regain their self-confidence.

Reanatomização estética dos dentes anteriores com resina composta: relato de caso / Reanatomización estética de dientes anteriores com resina compuesta: reporte de caso / Aesthetic reanatomization of front teeths with composite resin: case report

Introdução: A alta busca por tratamentos estéticos levou a indústria odontológica a aprimorar suas técnicas e desenvolver materiais com novas características que possibilitam a mimetização da estrutura dental, associando alta qualidade estética à saúde. Para isso, é necessário uma anamnese detalhada e exame físico intra e extrabucal, análise morfológica dos dentes e da face, para que a reabilitação proposta seja adequada. Objetivo: O objetivo deste estudo é descrever um caso clínico de reanatomização dos elementos dentais anteriores superiores, por meio de restaurações diretas em resina composta, restabelecendo a estética e função da paciente. Relato de caso: Paciente do sexo feminino, 19 anos, procurou a Clínica Escola da Faculdade de Odontologia do Recife -FOR relatando insatisfação com seu sorriso e declarou não estar disposta a se submeter a um tratamento ortodôntico. Ao realizar o exame clínico, observou-se que havia desalinhamento dos elementos dentários ântero-superiores. Após a realização do enceramento diagnóstico e validação da mesma através do mockupcom resina bisacrílica, optou-se por realizar a reanatomização estética com resina composta nanohíbrida, de forma conservadora, ou seja, sem desgastar os dentes em questão. Conclusão: As etapas do planejamento foram fundamentais para maior previsibilidade e obtenção do excelente resultado. Os materiais e técnicas selecionados para realização dos procedimentos aliaram características de resistência e estética, visando maior longevidade (AU).

Introduction: The high demand for aesthetic treatments has led the dental industry to improve its techniques and develop materials with new characteristics that allow mimicking the tooth structure, associating high aesthetic quality with health. This requires a detailed anamnesis,intra-and extraoral physical examination, and morphological analysis of the teeth and faceto allow an adequate proposed rehabilitation. Objective:The objective of this study is to describe a clinical case of reshaping of upper anterior teeth, by direct composite resin restorations, reestablishing the patient's aesthetics and function. Case report:Female patient, 19 years old, sought the Clínica Escola da Faculdade de Odontologia do Recife -FOR, reporting dissatisfaction with her smile and declared that she was unwilling to undergo orthodontic treatment. Clinical examinationrevealed misalignment of the upper anteriorteeth. After diagnostic waxing and validation by mockup with bis-acryl resin, it was decided to perform the aesthetic reshaping with nanohybrid composite resin in a conservative manner, i.e., without tooth wearing . Conclusion:The planning stages were fundamental for greater predictability and obtaining excellent results. The materials and techniques selected for the procedurescombined resistance and aesthetic characteristics, aiming at greater longevity (AU).

Introducción:La gran demanda para tratamientos estéticos ha llevado a la industria dental a mejorarsus técnicas y desarrollar materiales con nuevas características que permitan mimetizar la estructura dental, combinando una alta calidad estética con la salud. Para que esto ocurra, es necesario realizer una anamnesis detallada y un examen físicointra y extraoral, así como un análisis morfológico de los dientes y de la cara, para que la rehabilitación propuesta sea da adecuada. Objetivo:El objetivo de este studio es describir un caso clínico de reanatomización de los elementos dentales de resinacompuesta, restabeleciendo la estética y función de la paciente. Informe de caso:Paciente del sexo feminine, 19 años de edad, que acudió a la Clínica Escuela de La Facultad de Odontología de Recife ­FOR menifestando insatisfaccíon con su sonrisa y declarando no estar dispuesta a someterse a tratamiento de ortodoncia. En el examen clínico se observódesalineación de los elementos dentarios anterosuperiores. Tras realizar un encerado diagnóstico y validarlo con un mock-up de resina bisacrílica, se optó porrealizer una reanatomización estética con resina compuesta nanohíbrida de forma conservadora, es decir, sin desgastarlos dientes implicados. Conclusión:Las etapas de planificacíon han sido fundamentales para una mayor previsibilidad y la obtención de excelentes resultados. Los materiales y técnicas seleccionados para la realización de los procedimentos combinaron características de resistencia y estética, buscando una mayor longevidad (AU).

High depressive symptomatology reduces emotional reactions to pictures of social interaction.

Individuals with severe depressive symptoms present diminished facial expressions compared to healthy individuals. This reduced facial expression, which occurs in most depressive patients could impair social relationships. The current study sought to investigate whether pictures with social interaction cues could elicit different modulations of facial expressions and mood states in individuals with depressive symptoms compared to healthy individuals. A total of 85 individuals were divided into depressive and non-depressive groups based on their beck depression inventory scores. Participants viewed pictures containing neutral (objects), affiliative (people interacting socially), and control (people not interacting) scenes. Electromyographic signals were collected during the entire period of visualization of the blocks, and emotional questionnaires were evaluated after each block to assess sociability and altruism (prosocial states). In non-depressed individuals, affiliative pictures increased the activity of the zygomatic muscle compared to both neutral and control pictures and reduced fear of rejection compared to neutral pictures. During the visualization of the affiliative block, zygomatic major muscle activation was higher and fear of rejection was lower in the non-depressive individuals than in the depressive. These effects reflected the low expressions of smiling and sociability to affiliative pictures in depressive individuals. These findings highlight the importance of smiling and prosocial states in social interactions, especially in these individuals.

Evaluation of the impact of orthodontists' smile with malocclusions on social media and professional credibility.

OBJECTIVES: This study assessed laypeople's perceptions of orthodontist credibility based on malocclusions and whether these views affect their choice to seek treatment. Eye-tracking technology and questionnaires were utilized. MATERIALS AND METHODS: Ninety-five lay raters, through eye tracking and a questionnaire, assessed 12 images of orthodontists with malocclusions. Malocclusions were categorized by the Index Of Treatment Need (IOTN) as grade 1 (near ideal), 3 (anterior crowding), and 5 (with diastemas). Fixation points were recorded, and credibility was gauged via questionnaires. A Mentimeter word cloud was generated. RESULTS: IOTN 1 orthodontists were viewed as more credible than IOTN 3 (p < 0.001) and 5 (p < 0.001). Raters were more willing to receive treatment from IOTN 1 orthodontists. The focus for IOTN 1 was between eyes and mouth, while IOTN 3 and 5 were on the mouth. "Crooked teeth" and "spacing" were predominant in word clouds for IOTN 3 and 5. CONCLUSION: Orthodontists with an IOTN grade 1 rating were perceived as more competent, reliable, and professional, thus making it more likely for laypeople to choose them as their preferred providers. CLINICAL RELEVANCE: The smiles of professionals play a significant role in laypeople's decision to choose them as their orthodontist, and strategic utilization of social media can effectively deliver health information to a larger audience in a faster and more direct manner.

Malocclusion or laterorhinia: Which one impacts aesthetic facial perception the most?

INTRODUCTION: This study aimed to evaluate the perception of facial attractiveness when nose and teeth, together or isolated, present different degrees of disharmony. The secondary objective was to compare the perception of laypersons with that of dentists. MATERIALS AND METHODS: This cross-sectional observational study included 112 individuals (58 laypersons and 54 dentists) that evaluated 6 manipulated images of the face of the same model, scoring their attractiveness using 10 cm Visual Analogue Scales (VAS), with least and most attractive at the left and right anchors, respectively. The images contained manipulations performed only on the nose (laterorhinia) and mouth (misaligned teeth), as follows: (1) standard photograph, with symmetrical nose + aligned teeth; (2) 2 mm nasal deviation + aligned teeth; (3) 4 mm nasal deviation + aligned teeth; (4) symmetrical nose + misaligned teeth; (5) 2 mm nasal deviation + misaligned teeth and (6) 4 mm nasal deviation + misaligned teeth. We used the repeated measures ANOVA test and Tukey's post-test for intra-group comparison of the images. The independent t-test was used for inter-group comparison of each image. RESULTS: In the laypersons' group, the highest grades were given to images with aligned teeth and the lowest to misaligned teeth (smallest mean difference = 2.88 cm). For this group, there was no statistically significant difference (P-values ranged from .988 to 1.000) between scores of the three images in which teeth were aligned (range of 7.70-7.78 cm). In the group of dentists, highest grades were given to images with aligned teeth and the lowest to misaligned teeth. Difference between images 3 and 4 was not statistically significant (P = .204). All other differences between any image of straight teeth and any image with misaligned teeth were significant and the smallest mean difference between the two groups of images was 1.87 (P = .039). However, in the images with aligned teeth, there was also a statistically significant difference with higher scores to the images with symmetrical nose in contrast with those with significant laterorhinia (mean difference = 1.03 cm). CONCLUSION: Teeth disharmonies had a more negative impact on the aesthetic perception of the face than did nose deviations, for both dentists and laypersons.

Aesthetic perception of black spaces between lower incisors by laypeople of different ethnicities and age groups

Objective: To evaluate the degree of perception among lay people of different age groups about black spaces between lower incisors. Methodology: digital changes were performed in a frontal photograph of a smiling 30 year-old patient, simulating different dimensions of black spaces. The images were printed on photographic paper and applied with a questionnaire in order to evaluate the attractiveness using as tool a visual analogue scale (VAS). The participants were divided into 6 groups, considering race (Caucasian and Negroid) and age (15-19 years, 35-44 years and 65-74 years old). The differences between the examiners were checked by the Mann-Whitney test and the significance level was 5% (α = 0.05) for all analyzes. Results: The photographs that did not have black spaces were better graded and the ones that had larger black spaces scored worse. The older age group and the Negroid race group graded better the photograph with the largest black spaces, compared to the younger age groups and the group of Caucasians. Conclusion: black spaces between lower incisors are esthetically unattractive and their perception decreases with aging, besides being less relevant to older and Negroid people.

Triple nerve transfers for the management of early unilateral facial palsy.

BACKGROUND: Early onset facial paralysis is usually managed with cross-face nerve grafts, however the low number of axons that reach the target muscle may result in weakness or failure. Multiple-source innervation, or 'supercharging', seeks to combine the advantages of different donor nerves while minimizing their weaknesses. We propose a combination of cross-face nerve grafts with local extra-facial nerve transfers to achieve earlier facial reanimation in our patients. METHODS: A retrospective cohort including all patients with early unilateral facial palsy (<12 months evolution) who underwent triple nerve transfer between 2019 and 2021 was conducted. We performed single-stage procedure including zygomatic-to-zygomatic and buccal-to-buccal cross-face grafts, a nerve-to-masseter to bucozygomatic trunk transfer, and a mini-hypoglossal to marginal branch transfer. Results were evaluated using the clinician-graded facial function scale (eFACE). RESULTS: Fifteen patients were included (eight females, seven males), mean age at the time of surgery was 48.9 ± 13.3 years. Palsy was right-sided in eight cases. The mean time from palsy onset to surgery was 5.5 ± 2.8 months. Patients showed improvement in static (70.8 ± 21.9 vs. 84.15 ± 6.68, p = 0.002) and dynamic scores (20 ± 16.32 vs. 74.23 ± 7.46, p < 0.001), as well as periocular (57.33 ± 15.23 vs. 74 ± 7.18, p = 0.007), smile (54.73 ± 11.93 vs. 85.62 ± 3.86, p < 0.001), mid-face (46.33 ± 18.04 vs. 95 ± 7.21, p < 0.001) and lower face scores (67.4 ± 1.55 vs. 90.31 ± 7.54, p < 0.001). CONCLUSION: The triple nerve transfer technique using cross-face nerve grafts, the nerve-to-masseter, and the hypoglossal nerve, is an effective and reproducible technique to obtain middle and lower face reanimation in cases of early facial palsy.

Harmonização do sorriso: aliando ortodontia e estética / Smile harmonization: combining orthodontics and aesthetics

Atualmente é evidente a demanda contínua por padrões de beleza, cada vez mais impecáveis, um sorriso alinhado e harmônico com dentes brancos para se sorrir com confiança. O tratamento odontológico interdisciplinar tem como intuito proporcionar uma boa saúde periodontal, restabelecer a estética e a função do sistema estomatognático. Objetivo: apresentar um relato de caso clínico envolvendo harmonização do sorriso como cirurgia plástica periodontal para alinhamento da margem gengival na região anterior e restaurações diretas em resina composta após a finalização do tratamento ortodôntico, evidenciando a importância da abordagem conservadora e multidisciplinar no âmbito do tratamento estético. Relato de caso: Realizamos o tratamento ortodôntico com aparelho autoligado cerâmico para alinhamento do arco dental e intrusão do elemento 13, em sequência executamos um recorte gengival nos elementos 12 e 22, clareamento dental associado após 15 dias, subsequentemente, reanatomização dentária no elemento 44 para que o elemento 13 não voltasse a extruir pela falta de contato oclusal, e por fim, remodelação dental fazendo uso de resina composta nos elementos 12, 21 e 22 devido a manchas de hipocalcificação dental. Conclusão: Contudo, a estética bucal tem a capacidade de possibilitar a melhoria na autoestima, devolvendo à função, proporcionando satisfação e bem-estar ao indivíduo, enaltecendo o sorriso.

Currently, the continuous demand for increasingly impeccable beauty standards is evident, an aligned and harmonic smile with white teeth to smile with confidence. Interdisciplinary dental treatment aims to provide good periodontal health, restore the aesthetics and function of the stomatognathic system. Objective: to present a clinical case report involving smile harmonization as periodontal plastic surgery for aligning the gingival margin in the anterior region and direct composite resin restorations after completion of orthodontic treatment, highlighting the importance of a conservative and multidisciplinary approach in the field of aesthetic treatment . Case report: We performed orthodontic treatment with a self-ligating ceramic appliance for aligning the dental arch and intruding element 13, then performed a gingival cutout on elements 12 and 22, associated tooth whitening after 15 days, subsequently, dental reanatomization on element 44 to that element 13 would not extrude again due to the lack of occlusal contact, and finally, dental remodeling using composite resin in elements 12, 21 and 22 due to dental hypocalcification stains. Conclusion: However, oral aesthetics has the ability to improve self-esteem, returning to function, providing satisfaction and well-being to the individual, enhancing the smile.

Protocolo Abreviado Guiado Digital: Técnicas de Marcadores Tisulares, Silicona de Registro y CBCT con Sonrisa / Digitally Guided Abbreviated Protocol: Tissue Marker Techniques, Recording Silicone and CBCT with Smile

Establecer un protocolo de cirugía guiada estática con técnicas referenciales para ser realizado de manera predecible, repetible y simple, en todos los tipos de casos. El protocolo abreviado guiado digital para cirugía guiada estática para implantes se centra en diseñar computacionalmente una guía quirúrgica que se apoye en el tejido remanente del paciente, siendo un protocolo digital versátil para la cirugía y rehabilitación implanto protésica, basada en registros clínicos, principalmente la línea de la sonrisa y la captación de ésta en tomografía de haz cónico (CBCT), además de establecer dimensión vertical oclusal (DVO). Logrando así, planificación de implantes hasta la inserción inmediata de la prótesis temporal. Se ejemplifica el trabajo con 2 casos clínicos. Se establece un protocolo con la intención de que pueda ser realizado en pacientes desdentados parciales (Técnica de Registro Silicona) o totales (Técnica de Marcadores Tisulares en prótesis), definiendo un flujo de trabajo tridimensional, digital y optimizado, con un consecuente ahorro de tiempo clínico. Como principio del protocolo de cirugía guiada es lograr el objetivo quirúrgico - protésico deseado con alta precisión. La cirugía y rehabilitación de implantes de manera convencional es altamente dependiente del operador por lo que la alternativa de cirugía guiada de manera estática es una herramienta más para mejorar el pronóstico del paciente. Se establece un protocolo digital simple y efectivo, de cirugía guiada, para la rehabilitación implanto protésica basada en la línea de la sonrisa, tomografía de haz cónico (CBCT), dimensión vertical oclusal (DVO). Protocolo predecible y que optimiza los tiempos clínicos, logrando una rehabilitación protésica inmediata acorde e individualizada para cada paciente.

Establish a static guided surgery protocol with referential techniques to be performed in a predictable, repeatable and simple way, in all types of cases. The abbreviated digital guided protocol for static guided surgery for implants focuses on computationally designing a surgical guide that rests on the patient's remaining tissue, being a versatile digital protocol for prosthetic implant surgery and rehabilitation, based on clinical records, mainly the line of the smile and its uptake in cone beam tomography (CBCT), in addition to establishing occlusal vertical dimension (OVD). Thus achieving implant planning until the immediate insertion of the temporary prosthesis. The work is exemplified with 2 clinical cases. A protocol is established with the intention that it can be carried out in partially edentulous patients (Silicone Registration Technique) or total (Tissue Marker Technique in prostheses), defining a three-dimensional, digital and optimized workflow, with a consequent saving of time. clinical. As a principle of the guided surgery protocol, it is to achieve the desired surgical-prosthetic objective with high precision. Conventional implant surgery and rehabilitation is highly dependent on the operator, so the alternative of statically guided surgery is one more tool to improve the patient's prognosis. A simple and effective digital protocol for guided surgery is established for prosthetic implant rehabilitation based on the smile line, cone beam tomography (CBCT), and occlusal vertical dimension (OVD). Predictable protocol that optimizes clinical times, achieving an immediate and individualized prosthetic rehabilitation for each patient.

Soft Tissue Grafting Procedures before Restorations in the Esthetic Zone: A Minimally Invasive Interdisciplinary Case Report.

An esthetically pleasing smile is a valuable aspect of physical appearance and plays a significant role in social interaction. Achieving the perfect balance between extraoral and intraoral tissues is essential for a harmonious and attractive smile. However, certain intraoral deficiencies, such as non-carious cervical lesions and gingival recession, can severely compromise the overall aesthetics, particularly in the anterior zone. Addressing such conditions requires careful planning and meticulous execution of both surgical and restorative procedures. This interdisciplinary clinical report presents a complex case of a patient with esthetic complaints related to asymmetric anterior gingival architecture and severely discolored and eroded maxillary anterior teeth. The patient was treated using a combination of minimally invasive ceramic veneers and plastic mucogingival surgery, resulting in a successful outcome. The report emphasizes the potential of this approach in achieving optimal esthetic results in challenging cases, highlighting the importance of an interdisciplinary team approach in achieving a harmonious balance between dental and soft tissue aesthetics.

Fatores que impactam na estética do sorriso: uma revisão integrativa da literatura / Factors that impact on smile aesthetics an integrative literature review

Ter um sorriso harmônico é uma das prioridades dos pacientes dentro da odontologia, que procuram os profissionais da área para melhorar nos requisitos estéticos, tanto dos dentes, quanto da gengiva. Com os diversos avanços tecnológicos, o cirurgião-dentista pôde ampliar sua capacidade de diagnóstico e prognóstico, podendo realizar um planejamento de intervenção mais criterioso e com maior possibilidade de sucesso. Por meio desta revisão de literatura integrativa propomos elencar de forma minuciosa quais são essas características que podem desarmonizar um sorriso e ainda apresentamos como restabelecer a harmonia do sorriso por meio de procedimentos e elementos odontológicos. Foi realizada uma pesquisa nos portais eletrônicos PubMed, Biblioteca Virtual em Saúde (BVS), Ebsco host e Scielo, utilizando os descritores: "smile", "periodontal plastic", "aesthetics", "black triangles" e "interdental papila", além dos seus termos relacionados em português, incluído publicações de 2019 a 2022. Foi possível observar que por meio de um quadro multifatorial, a estética e harmonia do sorriso pode ser comprometida por fatores gengivais, faciais e dentários. Assim, um planejamento assertivo deve ser realizado por um profissional capacitado, que identifique os pontos que interferem positivamente e negativamente no equilíbrio do sorriso, com o propósito de gerar soluções clínicas. Com uma abordagem multidisciplinar, pode-se ratificar que é possível restabelecer a harmonia do sorriso e conseguir a satisfação do paciente, por meio de procedimentos plásticos cirúrgicos e restauradores.

Having a harmonious smile is one of the priorities of patients in dentistry, who seek professionals in the area to improve the aesthetic requirements of both teeth and gums. With the various technological advances, the dental surgeon was able to expand his diagnostic and prognostic capacity, being able to carry out a more judicious intervention planning and with greater possibility of success. Through this integrative literature review, we propose to list in detail what are these characteristics that can disharmonize a smile and we also present how to restore the harmony of the smile through dental procedures and elements. A search was carried out in the electronic portals PubMed, Biblioteca Virtual em Saúde (BVS), Ebsco host and Scielo, using the descriptors: "smile", "periodontal plastic", "aesthetics", "black triangles" and "interdental papilla", in addition to of its related terms in Portuguese, including publications from 2017 to 2022. It was possible to observe that through a multifactorial framework, the esthetics and harmony of the smile can be compromised by gingival, facial and dental factors. Thus, assertive planning must be carried out by a trained professional, who identifies the points that interfere positively and negatively in the balance of the smile, with the purpose of generating clinical solutions. With a multidisciplinary approach, it can be confirmed that it is possible to restore the harmony of the smile and achieve patient satisfaction, through plastic surgical and restorative procedures.

Effectiveness of lip repositioning in the treatment of excessive gingival display: systematic review and meta-analysis / Eficacia del reposicionamiento de labios en el tratamiento de la exposición gingival excesiva: revisión sistemática y metanálisis

Background: The objective of this systematic review and meta-analysis was to answer the questions ''Does lip repositioning surgery reduce the amount of gingiva exposed in the smile in individuals with excessive gingival display EGD (excessive gingival display)?'' and ''Is the reduction of the amount of gingiva exposed when smiling obtained with lip repositioning surgery stable over time?'' to evaluate the effectiveness of lip repositioning surgery for correcting EGD on smiling. Materials and Methods: A systematic structured search was carried out in five databases without data restriction. Studies reporting the degree of reduction in gingival ex-posure after lip repositioning surgery were included. Study selection, data extraction, and risk of bias assessment were performed in duplicate Results: One hundred sixty-four references were retrieved and eleven studies met the eligibility criteria. Meta-analysis demonstrated that lip repositioning surgery results in a significant reduction in the amount of exposed gingival tissue (mean difference = -3.03; confidence interval = -3.55; -2.52). In addition, the results remained stable in the evaluated follow-up periods (1, 3, 6 and 12 months). Included studies had a low risk of bias. Conclusions: Lip repositioning surgery is effective for the treatment of EGD on smiling and exhibits stable results in the evaluated periods. The study was registered (CRD42020184866) in the international prospective register of systematic reviews (PROSPERO)

Antecedentes: el objetivo de esta revisión sistemática y metanálisis fue responder a las preguntas "¿La cirugía de reposicionamiento de labios reduce la cantidad de encía expuesta en la sonrisa en personas con exposición gingival excesiva (EGE)?" y "¿La reducción de la cantidad de encía expuesto al sonreír obtenido con cirugía de reposicionamiento de labios estable en el tiempo?" para evaluar la efectividad de la cirugía de reposicionamiento de labios para corregir la EGE al sonreír. Materiales y Métodos: Se realizó una búsqueda sistemática estructurada en cinco bases de datos sin restricción de datos. Se incluyeron los estudios que informaron el grado de reducción de la exposición gingival después de la cirugía de reposición de labios. La selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo se realizaron por duplicado. Resultados: Se recuperaron ciento sesenta y cuatro referencias y once estudios cumplieron con los criterios de elegibilidad. El metanálisis demostró que la cirugía de reposicionamiento de labios da como resultado una reducción significativa en la cantidad de tejido gingival expuesto (diferencia de medias = -3,03; intervalo de confianza = -3,55; -2,52). Además, los resultados se mantuvieron estables en los periodos de seguimiento evaluados (1, 3, 6 y 12 meses). Los estudios incluidos tenían un bajo riesgo de sesgo. Conclusión: La cirugía de reposicionamiento de labios es efectiva para el tratamiento de la EGE al sonreír y presenta resultados estables en los períodos evaluados. El estudio fue registrado (CRD42020184866) en el registro prospectivo internacional de revisiones sistemáticas (PROSPERO).

Importance of the Diagnostic Wax-up When Planning a Periodontal Surgical Guide in Esthetic Surgery.

Periodontal plastic surgery may be indicated to re-establish smile harmony. The aim of this case report is to emphasize the importance of the diagnostic wax-up in the fabrication of a periodontal surgical guide to achieve success in esthetic surgery. In the case presented, during the preoperative testing of the guide, it was verified that the laboratory planning was incompatible with the patient's biological measures. Therefore, had crown lengthening been performed based solely on the guide, it would have caused irreparable sequelae, such as the removal of keratinized tissue and root exposure, which, in turn, could result in esthetic and functional consequences. In this case report, the periodontal surgical guide that was based on the previous diagnostic wax-up was an instrumental component in accomplishing an esthetic surgical outcome.

Tratamiento estético de la sonrisa gingival / Aesthetic treatment of the gummy smile

La exposición gingival excesiva es una condición conocida como sonrisa gingival. Esta alteración genera en muchos casos insatisfacción y solicitud de tratamiento por parte de los pacientes. Este exceso de exposición gingival podría obedecer a diferentes etiologías como un exceso maxilar en sentido vertical, un labio superior corto e hipermóvil, la erupción pasiva alterada, la extrusión dentoalveolar en el sector anterior o la combinación de estas causas. El enfoque de tratamiento va a depender del diagnóstico, de la complejidad del caso y de las expectativas de cada paciente. Por lo tanto, las rutas terapéuticas principales son el alargamiento de corona clínica, el reposicionamiento labial, la cirugía ortognática o la aplicación de toxina botulínica. Para ello, se debe considerar las ventajas y limitaciones de cada tratamiento estético, para garantizar predictibilidad y éxito.

Excessive gingival exposure is a condition known as a gummy smile. This generates in many cases dissatisfaction and request for treatment by patients. This excess of gingival exposure could be due to different etiologies such as vertical maxillary excess, a short and mobile upper lip, altered passive eruption, dentoalveolar extrusion in the anterior sector or a combination of these causes. The treatment approach will depend on the diagnosis, the complexity of the case and the expectations of each patient. Therefore, the main therapeutic routes are clinical crown lengthening, lip repositioning, orthognathic surgery, or the application of botulinum toxin. For this, the advantages and limitations of each aesthetic treatment must be considered, to guarantee predictability and success.

Treatment of gummy smile combining crown lengthening, lip repositioning, and the use of polyester threads.

INTRODUCTION: The case report presents a new possibility of treatment for a gummy smile in a patient with multiple etiologies, such as altered passive eruption and hypermobility upper lip. At first, crown lengthening was not sufficient to achieve the desired aesthetic result, being necessary its combination with lip repositioning. CASE PRESENTATION: Crown lengthening surgery (CLS) was performed in a 20-year-old woman, with a gingival display of 7.5 mm, having her gingival exposure reduced to 5.5 mm. Because the patient continued unsatisfied after 6 months, a new procedure was adopted. To reduce even more her gingival exposure, lip repositioning technique was performed associated with myotomy and the insertion of polyester threads as a physical barrier to prevent relapse. CONCLUSION: The result of the gingival display was reduced to 2.5 mm, removing the condition of a gummy smile after the combination of both techniques: crown lengthening, and lip repositioning. KEY POINTS: Why is this case new information? Association of the technique of lip repositioning and myotomy, the insertion of polyester threads that act as a physical barrier against recurrence. What are the keys to successful management of this case? Correct etiological diagnosis. Prior application of botulinum toxin. Respect the period of 1 month for the insertion of the polyester thread, helping to preserve the suture (limitation of movement). What are the primary limitations to success in this case? Make the patient aware not to move the lips with the hands in order to observe the incision.

Prevalence and influence of dental development anomalies in smile esthetics: a cross-sectional analysis

Aim: To determine the prevalence of dental development anomalies and type of influence on the smile of adolescent students. Method: This was a cross-sectional and analytical study carried out in two public (A1) and two private (A2) schools chosen by lot in the city of Parnaíba-Piauí. The sample calculation was based on the target population: number of people enrolled in public and private schools between 15 and 19 years, in the city of Parnaíba-PI, which totaled 6209 students in 2020, according to a survey carried out by the Brazilian Institute of Geography and Statistics ­ IBGE. A questionnaire on epidemiological data and aesthetic self-perception of the smile was applied to 160 adolescents between 15 and 19 years old, from August 2020 to July 2021. The clinical examination was carried out under natural light, to check for the presence of anomaly(s) in the dental development. Students who presented only one pathology would be called group 1 (G1), those who presented two would be called group 2 (G2) and those who presented 3 or more would be called group 3 (G3). On the other hand, adolescents in whom no anomaly was evidenced would participate in the control group (CG), both in A1 and A2. Results: It was observed that 37.5% of the sample had only a type of dental anomaly, corresponding to 60 individuals. The most prevalent were enamel hypoplasia, fusion, transposition, agenesis, ectopic eruption, microdent and dens-in-dent. It was possible to verify a higher prevalence in the maxilla, private schools (76.6%) and females (86.6%). In 45% of adolescents with dental anomalies, embarrassment was observed when smiling. Conclusion: The prevalence was relatively high, highlighting the enamel hypoplasia, influencing the smile esthetics of a reasonable number of adolescents, whether for acquaintances, strangers or even for photographs

Prevalence and factors associated with gummy smile in adolescents: a cross-sectional analysis

Aim: To evaluate the prevalence and factors associated with gummy smiles in adolescents aged between 15 and 18 years attending high school. Methods: The cross-sectional and quantitative study was carried out during the Covid-19 pandemic, with 160 adolescents, from two public (A1) and two private (A2) schools chosen by lottery, divided into two groups: G1 (with gummy smile) and G2 (no gummy smile). A clinical examination was carried out on the adolescents, investigating the presence or absence of a gummy smile (GS), by analyzing the variables (interlabial distance at rest, upper incisor exposure at rest, smile arc, measurement from the subnasal to the upper lip philtrum, upper lip length, upper lip thickness, hypermobility and lower/middle third ratio). Means and dispersion were obtained, and the Chi-square association test was applied, to compare the results between A1 and A2 and between G1 and G2. Results: The prevalence of GS was 33.8% (=54). It was found that no statistically significant associations were found (p > 0.05), regarding the type of school and gender with the presence of GS in adolescents. There was no statistically significant difference (χ² = 1.82; p = 0.07) between the groups and the age of adolescents. There was a significant association between the studied variables and GS (p < 0.05). Conclusion: The prevalence was high with a predominance of females. There were no statistically significant associations regarding the type of school and gender, but there was a significant association between gummy smile and lip dimensions