The crown lengthening double guide and the digital Perio analysis.

OBJECTIVE: This article describes a surgical crown lengthening double guide, which was digitally obtained to improve diagnosis, treatment outcome, and follow-up. CLINICAL CONSIDERATIONS: The rehabilitation of anterior dental esthetics should involve interdisciplinary and facially driven planning for achieving pleasant long-term outcomes. Surgical crown lengthening is one of the most common periodontal surgery, which can be assisted by digital tools to improve surgical planning and follow-up. CONCLUSION: The double guide for surgical crown lengthening allows the proper management of hard and soft tissues for achieving a predefined goal based on biological requirements and facially driven planning. In addition, the digital quality control allows the follow-up compared with the pre-operative condition and planned treatment plan. CLINICAL SIGNIFICANCE: The use of digital tools allow the clinician to develop a facially driven planning with proper communication with the team and patient, leading to a shorter, more predictable, and less invasive surgical technique, reducing postoperative inflammation and increasing patient comfort.

Use of Botulinum Toxin Before Surgical Lip Repositioning: A Randomized Clinical Trial.

This study aimed to determine whether administering botulinum toxin type A (BT) prior to surgery would stabilize surgical lip repositioning. A randomized controlled parallel-group clinical trial was performed. A total of 18 participants with excessive gingival display (EGD) were divided into two groups. For the test group (TG), BT was injected into the smile muscle locations 15 days before the surgical procedure. For the control group (CG), only lip repositioning surgery was performed. Gingival display (GD) and upper lip displacement (LD) were measured 3 and 6 months postoperatively. Data were submitted to ANOVA, Tukey, and t tests. For GD and LD, the changes were statistically significant between the measurements taken at the baseline, 3-month, and 6-month marks. The GD presented a reduction of 5.2 ± 1.1 mm in TG and 3.2 ± 1.4 mm in CG after 6 months. The LD measurements reduced 45% for TG and 26% for CG in 6 months. The injection of BT 15 days before lip repositioning surgery provided more stable results and effectively reduced the GD at 6 months.

Clinical evaluation and biological understanding of the early step-by-step healing after periodontal microsurgery: A case report with PES analysis comparing initial and 31-day result.

Microsurgery has evolved, permitting faster vascularization and healing than macro-interventions, reducing tissue trauma and obtaining precise wound closure. Therefore, this study aimed to detail the initial healing steps after the periodontal microsurgical procedure. A -26 year-old female had a localized recession (anterior lower tooth, recession type1-), with the absence of local keratinized tissue width (KTW) and adjacent gingival thickness (GT)<1 mm. After oral prophylaxis and occlusal adjustments, the pink esthetic score was performed (5 points), followed by the microsurgery procedure. Prior to inserting the subepithelial connective tissue graft (SCTG), the epithelial layer was removed, and the root surface was biomodified. Two days postoperatively, it was possible to observe a white layer from the SCTG in the gingival margin, decreasing after 4 days. In 6 days, the sutures were removed; no graft and volume loss was observed. For 9 days, the volume was the maintenance. Nevertheless, there was a reduction in tissue volume in the facial zone. After 11 and 13 days, an improved healing process was found, whereas, after 16 days, it was possible to report stable tissues, which was confirmed after 31 days, with a significant GR reduction and an increase in KTW and GT. Moreover, the final pink esthetic score (PES) was 9. Microsurgery had a faster healing and predictable outcome, suggesting reduced trauma, which may allow a quicker suture removal without jeopardizing the outcomes.

Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation.

OBJECTIVES: The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2 weeks). MATERIALS AND METHODS: Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6 months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1ß, IL-6, IL-8, FGF, MIP-1α and ß, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14 days after procedures. RESULTS: The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14 days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side. CONCLUSION: The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process. CLINICAL RELEVANCE: EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.

Endodontic and Periodontal Treatment of Complete Buccal Root and Apex Exposition: A Challenging Case Report With 17 Months Follow-Up.

INTRODUCTION: This case report demonstrated a challenging clinical case addressed within a multidisciplinary approach to achieve its maintenance, even though had a poor prognosis. It was associated with the endodontic treatment with mucogingival techniques, including periodontal microsurgery and connective tissue graft. CASE PRESENTATION: A patient presented a deep gingival recession with the apex-exposed non-vital tooth with interproximal bone loss (RT2) and without mobility. The treatment involved an initial endodontic approach and periodontal therapy (scaling and root planing), microsurgical techniques with coronally advanced flap, root preparation with PrefGel (24% EDTA), enamel matrix derivatives (Emdogain), and connective tissue graft. As a clinical result, it was verified an increase of keratinized tissue width and gingival thickness, and root coverage (RC), reaching good esthetics and a stable result after 17 months. CONCLUSION: The correct diagnosis and technique selection may affect directly the outcome, especially in challenging cases. Even though there was a poor prognosis, an adequate treatment plan, patient cooperation, and technique mastery help to achieve a high level of RC, esthetic recovering, and successful outcome.

Histologic and histomorphometric analysis of connective tissue grafts harvested by the parallel incision method: a pilot randomized controlled trial comparing macro- and microsurgical approaches.

OBJECTIVE: The aim of this pilot randomized controlled trial was to assess the efficacy of macro- and microsurgical procedures in removing the epithelial tissue layer of subepithelial connective grafts (SCTGs) harvested by the parallel incision method. METHOD AND MATERIALS: Sixteen patients were randomized to receive macro-SCTG harvesting (n = 10, control group) or micro-SCTG harvesting (n = 10, test group) by the parallel incision technique. Histologic and histomorphometric analysis of the SCTG evaluated the percentage remnant of epithelium and connective tissue. The presence of remnant portions of the epithelium was identified in eight samples (three in the macro- and five in the microsurgery groups). RESULTS: Sixteen participants with 20 sites were included and 20 SCTG were collected and analyzed. SCTG harvested by microsurgical approaches displayed more portions of remnant epithelium compared to the conventional removal (50% versus 30%). There were no significant differences in mean remnant epithelial thickness for test (147.3 ± 89.3 µm) and control (209.0 ± 127.5 µm) groups (P = .57). Likewise, nonsignificant differences were identified in terms of the connective tissue thickness (macrosurgery: 1,511.0 ± 1,160.0 µm; microsurgery: 1,472.0 ± 1,063.0 µm) between groups (P = .96). CONCLUSION: The samples harvested by microsurgery had greater remaining epithelial portions than those harvested by macrosurgery, and similar connective layer thickness.

Deepithelialized Connective Tissue Graft and the Remaining Epithelial Content After Harvesting by the Harris Technique: A Histological and Morphometrical Case Series.

INTRODUCTION: The remaining epithelial layer existent in connective tissue graft (CTG) harvested from the hard palate, which underwent de-epithelization outside the oral cavity, can be histologically detected unless it is completely removed. Its presence may cause adverse esthetics results, affecting thus the color and texture of the receptor site, and an increased risk of presence of scar tissues after surgical procedures. The proposal of this study was to evaluate the CTG (histological and morphometrically) collected from the hard palate using the Harris technique, removing the epithelial layer outside the mouth, assessing the remaining presence of epithelial tissue. CASE SERIES: Fourteen patients (14 CTGs) were included in the present case series study, therefore there were two dropouts. A small part of the tip of the graft was harvested and fixed in formalin solution for histological processing, staining, and then to be morphometrically analyzed. The epithelial tissue and CTGs were assessed by three calibrated and double-blinded professionals. All information was compiled, and the statistical analysis was performed. CTGs obtained had a width average of 1224.26 µm. There was no presence of any residual of the epithelium in three samples, whereas only one had the epithelium tissue covering the entire connective layer. Furthermore, seven samples (approximately 50%) had the presence of epithelium. CONCLUSION: Within the limitation of this study, there was incomplete removal of the epithelial layer after harvesting the CTG using the Harris technique (44.32%), most likely due to its histological persistency, suggesting to be inaccurate the clinical removal.

A doença periodontal materna associada ao nascimento de bebês de baixo peso e parto prematuro / The maternal periodontal disease associated with low birth weight and premature delivery ­ a literature review

Objetivo: revisar a literatura sobre a associação entre o nascimento de bebês de baixo peso e o parto prematuro, e esclarecer sobre os mecanismos que induzem esses acontecimentos em gestantes com doença periodontal. Material e métodos: foi realizada uma busca entre os anos de 1995 a 2015, na base de dados Pubmed, Lilacs e Medline, com as seguintes palavras-chave: periodontitis, pregnancy, periodontal disease, gingival fluid, prostaglandin. Resultados: das 229 referências inicialmente recuperadas, apenas 15 foram utilizadas, sendo dez séries de casos, um estudo coorte e um transversal retrospectivo. Oito artigos mostraram associação entre a doença periodontal materna e o nascimento de bebês de baixo peso e parto prematuro, enquanto quatro artigos não mostraram associação. Conclusão: dentro dos limites desta revisão, pôde-se concluir que a doença periodontal pode se apresentar como fator de risco para o nascimento de bebês de baixo peso e o parto prematuro, e esta associação ocorre através da liberação de mediadores inflamatórios, provenientes da doença periodontal, que alcançam a unidade fetoplacentária através da corrente sanguínea, induzindo o trabalho de parto prematuro e podendo afetar também o desenvolvimento fetal.

Objective: to review the literature on the association between low birth weight and premature delivery, and to clarify the mechanisms that induce these events in case of periodontal disease. Material and methods: a search between the years 1995-2015 was carried out in the Medline and Lilacs databases using the following key words: "periodontitis", "pregnancy", "periodontal disease", "gingival fluid", "prostaglandin". Results: of the 229 references initially recovered, only 15 were used (10 case series, 1 cohort, 1 retrospective). Eight articles demonstrated an association between periodontal disease, low birth weight, and premature delivery, while 4 articles not. Conclusion: within the limits of this review, we conclude that periodontal disease may present a risk factor for low birth weight and premature delivery, and this occurs through the release of infl ammatory mediators, reaching the fetal-placental unit through the bloodstream, leading to premature labor, and also affecting fetal development.

Clinical Considerations on the Root Coverage of Gingival Recessions in Thin or Thick Biotype.

Gingival biotype is a clinical term used to describe the thickness of the gingiva. It has been classified as being thick or thin and may be related to the clinical outcome of root coverage procedures. This study evaluated the impact of gingival biotype on the clinical outcome of root coverage procedures following subepithelial connective tissue graft plus coronally positioned flap. A total of 19 patients, 10 with thin and 9 with thick gingival biotype, were treated for localized Miller Class I or II gingival recessions. After 6 months, 14 patients achieved complete root coverage, 7 from each group. The overall mean pooled root coverage rate was 90.93%. The thin biotype cases yielded a reduced mean root coverage of 88.51% compared with 93.63% for patients who had the thick biotype classification. Although the thin gingival biotype may impair the clinical outcome of root coverage procedures, this limitation does not appear to have a strong influence on the success of the root coverage therapy when subepithelial connective tissue graft was associated with the coronal positioning of the flap.

Fibrina rica em plaquetas para recobrimento radicular no tratamento de recessões gengivais / Platelet-rich fibrin for root coverage on the treatment of gingival recessions

As principais queixas de pacientes com recessões gengivais são: aspecto antiestético e hipersensibilidade radicular. Diversas técnicas surgiram para recobrir raízes expostas, sendo o enxerto de tecido conjuntivo subepitelial (ETCS) considerado o padrão- ouro, devido à sua previsibilidade de resultado e manutenção em longo prazo. Outros biomateriais surgiram como alternativa ao ETCS, a fim de evitar suas principais desvantagens: segundo sítio cirúrgico e desconforto pós-operatório. É o caso da fibrina rica em plaquetas (PRF), biomaterial autógeno derivado do PRP, criado na França em 2001. Objetivo: realizar uma revisão da literatura sobre o uso do PRF para tratamento de recessões gengivais, para avaliar seu desempenho clínico no recobrimento radicular. Material e métodos: foi realizada uma pesquisa no PubMed com quatro palavras-chave, totalizando 819 títulos diferentes de artigos científicos. Através dos critérios de inclusão e exclusão, dez trabalhos foram selecionados. Conclusão: o PRF parece ser um biomaterial promissor no tratamento de recessões gengivais, por ter apresentado resultados satisfatórios de recobrimento radicular, semelhantes aos encontrados com o ETCS. Ele pode ser uma boa alternativa ao padrão-ouro, por evitar o segundo sítio cirúrgico, não gerar morbidade ou desconforto pós-operatórios e proporcionar uma melhor cicatrização inicial. Mais estudos devem ser feitos abordando análises histológicas, maior quantidade de indivíduos testados e maior tempo de acompanhamento.

Low-shrinkage composites: an in vitro evaluation of sealing ability after occlusal loading.

The objective of this in vitro study was to compare the microleakage of a flowable low-shrinkage-stress resin composite--in a Class II fatigue-loading design when used as a 4 mm dentin replacement--to a conventionally layered silorane-based resin composite. Eighty standardized 4 mm deep cavities, divided into 4 subgroups, were restored with the 2 tested materials. Half of the restorations were submitted to mechanical loading, and all of the restorations were prepared for microleakage evaluation. The evaluation of the marginal adaptation to dentin was performed with scanning electron microscopy. The results showed that both silorane-based composite groups had higher rates of microleakage in comparison to the low-shrinkage-stress resin composite groups.

Comparação de medições clínicas e tomográficas da espessura gengival de dentes anteriores / Comparison of clinical and tomografic measurements of gingival thickness in superior anterior teeth

Existem muitos métodos de medição da espessura gengival para determinação do morfotipo periodontal, desde procedimentos não invasivos (tomografia computadorizada por feixe cônico e a transparência da sonda através da margem gengival) a procedimentos invasivos (perfuração gengival através de espaçadores endodônticos, sondas periodontais ou agulhas anestésicas associadas a cursores de silicone). Apesar de a medição clínica ser o padrão-ouro atual, muitos estudos buscam comprovar a eficácia de métodos não invasivos. O objetivo do presente trabalho foi realizar uma comparação entre medição clínica e tomográfica da espessura gengival na região de dentes anteriores superiores. Cinco pacientes foram examinados através de exame tomográfico e por avaliação clínica por perfuração com espaçador endodôntico. Foram avaliados seis dentes de cada paciente, de canino a canino superiores. Os resultados não mostraram uma diferença estatisticamente significativa entre os dois métodos. Apesar das limitações do estudo, concluiu-se que os métodos são equivalentes.

Parâmetros para a definição de morfotipos periodontais / Parameters for the definition of morphotype periodontal

Mediante tantas classificações de biotipos periodontais e métodos de obtenção, esta revisão da literatura teve por objetivo definir os principais parâmetros que podem ser tomados como pontos de referências para contribuir e determinar, com mais precisão, biotipos periodontais e qual método pode ser empregado para essa obtenção, o que poderá facilitar o planejamento, o diagnóstico e plano de tratamento em procedimentos periodontais, ortodônticos e procedimentos estéticos restauradores, facilitando a vida clínica dos profissionais da área de Odontologia. O estudo foi realizado com artigos publicados de 1963 até a atualidade, sendo selecionados 77 artigos relevantes ao tema. Os resultados mostraram que o método mais utilizado para medição de biotipos periodontais é a transparência da sonda, porém, não significa ser o mais preciso, mas o método mais viável e acessível na prática clínica. Os parâmetros mais utilizados pelos pesquisadores foram: espessura gengival, largura gengival, forma do dente, crista óssea alveolar, altura da papila, anatomia óssea e idade. Porém, fazem-se necessários mais estudos para definir com exatidão esses parâmetros, pois, segundo a revisão, essa classificação é muito subjetiva.

Sorriso gengival: uma visão periodontal / Gingival smile: a periodontal point of view

O objetivo do presente trabalho foi apresentar os fatores determinantes para o diagnóstico, plano de tratamento e realização de uma correção de sorriso gengival, do ponto de vista periodontal. Por meio de uma revisão de literatura, foram expostos e discutidos a etiologia e os parâmetros fundamentais para o tratamento do sorriso gengival. Além disso, foram apresentados dois casos clínicos. Concluiu-se que a cirurgia para correção de sorriso gengival é um procedimento previsível, em que se alcança o resultado no ato cirúrgico, sem morbidades para o paciente. No entanto, o profissional deve ter conhecimento dos parâmetros periodontais envolvidos e dos padrões de estética para um resultado favorável e harmonioso.

Periodontal plastic microsurgery in the treatment of deep gingival recession after orthodontic movement.

Gingival recession is a condition that affects a large portion of the young and adult population and negatively affects the aesthetic aspects of the smile. Many factors are related to its development, including orthodontic movement beyond the osseous limits. Many treatment options have been proposed to cover the exposed root surface. The aim of this article was to describe three cases where a subepithelial connective tissue graft was performed, using a microsurgical technique, in the treatment of deep gingival recession after orthodontic treatment. This technique resulted in successful root coverage and keratinized tissue gain, improving the gingival esthetic pattern.

Influence of periodontal biotype on the presence of interdental papillae.

The absence of interdental papillae can be a negative influence in aesthetics. Periodontal biotype (PB) is one of the factors that can possibly influence this relation and has to be considered in periodontal diagnosis and treatment planning. The objective of this study was to evaluate the influence of the periodontal biotype on the presence and absence of interdental papillae. Forty-seven patients were included in this transversal clinical study. The PB, presence and height of interdental papilla, loss of papillary height, and the distance between the base of the contact point and bone crest (CP-BC) were evaluated. The chi-square test was used to verify the significance level of the PB distribution frequency between groups. The Mann-Whitney test was used to compare the CP-BC measures between the different PB groups, and the correlation test was used to verify the relation between the CP-BC distance and the presence of papillae. The thin PB group presented a significantly higher presence of papillae (71.1%) than did the thick PB group (59.6%, P < 0.05). An inverse and proportional correlation between the CP-BC distance and the presence of papillae was found. The authors concluded that the PB influenced the presence and height of interdental papillae.

Influência do biótipo periodontal na Implantodontia e na Ortodontia / Influence of periodontal biotype in Implantology and Orthodontics

O objetivo do presente estudo foi realizar uma revisão de literatura para avaliar a importância da definição do biótipo periodontal nos tratamentos ortodônticos e de implantes. Observou-se que as diferenças das características periodontais são semelhantes tanto para pacientes dentados quanto para portadores de implantes, então essa informação deve ser importante para a definição do tratamento ortodôntico e com implantes para evitar transtornos funcionais e estéticos. A definição do biótipo periodontal é fundamental para a previsibilidade desses tratamentos.

The aim of this study was to conduct a literature review to assess the importance of the definition of the periodontal biotype in orthodontic and implants treatments. It was observed that the differences in periodontal characteristics are similar for both dentate patients and for patients with implants, then this information should be important to the definition of orthodontic and implants treatments to avoid functional and aesthetic inconvenience. And the definition of periodontal biotype is critical to the predictability of these treatments.

Relationship between the width of the zone of keratinized tissue and thickness of gingival tissue in the anterior maxilla.

The aim of this study was to evaluate whether there is a positive correlation between the width of the zone of gingival keratinized tissue and its thickness. Maxillary right canines, lateral incisors, and central incisors of 60 patients (30 men, 30 women) between the ages of 20 and 35 years were examined. Using an endodontic spacer with a rubber cursor and a digital caliper of 0.01-mm resolution, the values of the width of the zone of gingival keratinized tissue and gingival thickness were obtained. It was observed that the lateral incisor has the largest mean zone of gingival keratinized tissue (5.54 ± 1.09 mm), followed by the central incisor (4.62 ± 1.02 mm) and canine (4.32 ± 1.33 mm). The mean gingival thickness was greater in the central incisor (1.17 ± 0.20 mm), followed by the lateral incisor (1.04 ± 0.24 mm) and canine (0.87 ± 0.27 mm). No statistically significant difference was verified for the mean width of the zone of gingival keratinized tissue and gingival thickness between men and women. A positive correlation between gingival thickness and width of the zone of gingival keratinized tissue was observed in the maxillary canine (Pearson r = 0.398, P < .05), lateral incisor (Pearson r = 0.369, P < .05), and central incisor (Pearson r = 0.492, P < .05). In patients 20 to 35 years of age, there was a positive correlation between gingival thickness and width of the zone of gingival keratinized tissue for the maxillary right canine, lateral incisor, and central incisor.

Correlação entre espessura gengival e largura de tecido queratinizado nos dentes anterossuperiores / Correlation betwen gingival thickness and width of keratinized tissue in upper anterior teeth

A definição do morfotipo de periodonto a ser tratado é um fator importante para melhor diagnóstico e prognóstico de tratamentos, principalmente os que envolvem estética. Para isso, a avaliação da espessura gengival e da largura da faixa de gengiva são parâmetros importantes. O objetivo do presente trabalho foi avaliar se existe correlação entre a espessura gengival e a largura da faixa de gengiva inserida. Foram avaliados incisivos centrais, incisivos laterais e caninos de ambos os lados de 50 indivíduos, entre 20 e 35 anos, com saúde periodontal. Foi utilizado um espaçador endodôntico com cursor de borracha e um paquímetro digital para obtenção dessas medidas com resolução de 0,01 mm. Os dentes que apresentaram a maior média de espessura gengival foram os incisivos centrais direito e esquerdo e a menor o canino direito. Em relação à largura da faixa de gengiva, a maior média foi encontrada no incisivo lateral esquerdo e a menor no canino direito. Não foi encontrada correlação entre a espessura gengival e a largura da faixa de gengiva inserida.

O efeito do tratamento periodontal na proteína c-reativa em pacientes com indicação de cirurgia de revascularização: resultados preliminares / The effect of periodontal treatment in c-reactive protein in patients with indications of surgery revascularization: preliminary results

O objetivo do presente estudo foi examinar o efeito do tratamento periodontal não-cirúrgico sobre a proteína C-reativa, em pacientes com indicação de cirurgia de revascularização no Instituto Nacional de Cardiologia. Foram avaliados 22 pacientes portadores de periodontite crônica, com idade acima de 35 anos (média de idade 59,45 anos) separados em 2 grupos. O grupo I, estudo, (n = 11) recebeu tratamento periodontal anterior ao procedimento cirúrgico, e o grupo II, controle, (n = 11) não realizou tratamento periodontal. Os parâmetros periodontais avaliados foram: profundidade de bolsa à sondagem e nível de inserção clínica. Foram coletadas amostras de sangue de todos os pacientes para análise da proteína C-reativa. Os parâmetros foram avaliados no dia 0, ao início do tratamento periodontal e repetida aos 90 dias, junto com a coleta sanguínea. O tratamento periodontal não-cirúrgico foi eficaz no controle da doença periodontal e aumentou os níveis séricos de proteína C-reativa.

The aim of this study was to examine the effect of periodontal treatment on nonsurgical blood components like C-reactive protein in patients referred for bypass surgery at the Instituto Nacional de Cardiologia. We evaluate 22 patients with chronic periodontitis, aged above 35 years (mean age 59.45 years) divided into 2 groups. The group I, study (n=11), received periodontal treatment prior to cardiovascular surgvyery, and group II, control (n=11) did not have periodontal treatment. The periodontal parameters evaluated were: probing depths and clinical attachment level. Blood samples were collected from all patients for analysis of C-reactive protein. The parameters were evaluated at baseline, in the beginning of periodontal treatment and were repeated after 90 days, along with blood collection. The non-surgical periodontal treatment was effective in controlling periodontal disease and increased serum levels of C-reactive protein.