The concepts of evidence-based periodontal plastic surgery: Application of the principles of evidence-based dentistry for the treatment of recession-type defects.

The decision-making process for the treatment of recession-type defects is based on translation of the outcomes from randomized controlled trials and systematic reviews to clinical practice. Such an approach is capable of assisting researchers, clinicians, and patients to understand the mechanisms and effects of the treatment of different root-coverage procedures, as well as turning treatment options into usable and predictable tools to be applied in dental practice. This review explores: (a) the aspects related to the etiology of gingival recession; (b) the history of periodontal plastic surgery procedures used to achieve root coverage; (c) the main findings, implications of research, and practice of root-coverage procedures described from the current base of systematic reviews; (d) the role of the evidence produced in Latin American research centers; and (e) the outcomes of an individual patient data meta-analysis of randomized controlled trials evaluating the role of root coverage and restorative procedures in achieving complete root coverage of noncarious cervical lesions. The findings of the current base of evidence clearly indicate that all of the main periodontal plastic surgery procedures lead to improvements in initial clinical parameters, but subepithelial connective tissue grafts, either alone or associated with coronally advanced flaps, result in superior complete root coverage, long-term stability, and greater increase of keratinized tissue. Nonetheless, coronally advanced flaps, either associated with biomaterials (acellular dermal matrix grafts, enamel derivative proteins and xenogeneic collagen matrix) or used alone, provide satisfactory results and are suitable for use as secondary/alternative procedures to subepithelial connective tissue grafts.

Wound Healing of the Laterally Positioned Flap: A Histomorphometric Assessment.

The aim of this study was to histomorphometrically assess the soft tissue anatomy in single gingival recessions (GR) treated with a laterally positioned flap (LPF). Five patients presenting maxillary first molars with GR to the apex of the buccal surface of the mesial-buccal root were invited to take part. The LPF-treated roots were removed en bloc (the root and the soft tissue covering the treated GR) 3 to 4 months postoperatively. Photomicrographs of Mallory trichrome stain sections were taken to allow reassessment of the specimens regarding the longitudinal dimensions of the crevicular/sulcular and junctional epithelia. The use of LPF resulted in new attachment with formation of crevicular epithelium, long junctional epithelium, and some connective tissue, re-establishing the normal anatomical characteristics of the soft tissues covering the previously exposed root.

Evidence-based periodontal plastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage.

BACKGROUND: The aim of this review is to conduct an individual patient data meta-analysis of randomized controlled clinical trials (RCTs) to evaluate whether baseline recession-, patient-, and procedure-related factors can influence the achievement of complete root coverage (CRC). METHODS: A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE (for Medical Literature Analysis and Retrieval System Online), EMBASE (for Excerpta Medica Database), CENTRAL (for Cochrane Central Register of Controlled Trials), and the Cochrane Oral Health Group's Specialized Register databases up to and including March 2011. Only RCTs, with a duration of ≥6 months evaluating recession areas (Miller Class I or II) that were treated by means of root coverage procedures were included. Mixed-effects logistic regression analyses were conducted to evaluate associations between five baseline variables and CRC. RESULTS: Of the 70 potentially eligible trials, 22 were included in the meta-analyses. In total, the data from 320 patients and 16 procedures were evaluated. None of the RCTs were classified as low risk of bias. Of the 602 recessions treated, 310 (51.5%) achieved CRC. Subepithelial connective tissue grafts (SCTGs), matrix grafts, and enamel matrix derivative protein (EMD) procedures were superior in achieving CRC when compared to coronally advanced flap (CAF) alone. For the adjusted covariates, the greater the baseline recession depth, the smaller the chance of achieving CRC (individual procedure analysis [odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.44, 0.70] and grouped procedure analysis [OR = 0.56; 95% CI = 0.45, 0.71]), as well as studies with conflict of interest were more likely to achieve CRC than those without conflict of interest (individual procedure analysis [OR = 6.78; 95% CI = 1.78, 25.86]). CONCLUSIONS: SCTGs, matrix grafts, and EMD were superior to CAF in achieving CRC, but SCTGs showed the best predictability. The impossibility of inclusion of all identified RCTs should be taken into consideration when interpreting the present findings.

Evidence grade associating periodontitis with preterm birth and/or low birth weight: II: a systematic review of randomized trials evaluating the effects of periodontal treatment.

AIM: The aim of this systematic review was to evaluate whether maternal periodontal disease treatment (MPDT) can reduce the incidence of preterm birth (PB) and/or low birth weight (LBW). METHODS: The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched for entries up to October 2010 without restrictions regarding the language of publication. Only randomized-controlled clinical trials (RCTs) that evaluated the effect of MPDT on birth term and birth weight were included. The search was conducted by two independent reviewers and random-effects meta-analyses were conducted methodically. RESULTS: Thirteen RCTs provided data, but only five trials were considered to be at a low risk of bias. The results of eight studies (61.5%) showed that MPDT may reduce the incidence of PB and/or LBW. However, the results of all meta-analyses showed contrasting results for PB [RR: 0.88 (95% CI: 0.72, 1.09)], LBW [RR: 0.78 (95% CI: 0.53, 1.17)] and PB/LBW [RR: 0.52 (95% CI: 0.08, 3.31)]. CONCLUSION: The results of this review show that MPDT did not decrease the risk of PB and/or LBW; however, the influence of specific aspects that were not investigated (disease diagnosis, extension and severity and the success of MPDT) should be evaluated by future RCTs.

Evidence grade associating periodontitis to preterm birth and/or low birth weight: I. A systematic review of prospective cohort studies.

AIM: The aims of this systematic review (SR) were to evaluate the association between maternal periodontitis and preterm birth (PB) and/or low birth weight (LBW), and the methodological quality of prospective cohort studies conducted for such a purpose. METHODS: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to and including October 2010 to identify prospective studies on the association of periodontitis with PB and/or LBW. Search was conducted by two independent reviewers. The methodological quality of the observational studies was assessed using a specially designed methodological tool. Random effects meta-analyses were conducted thoroughly. RESULTS: Search strategy identified 1680 potentially eligible articles, of which 12 prospective studies were included. One cohort study had their data reported in two articles. Of the 11 studies, 10 showed a high methodological quality and one a medium methodological quality. Nine studies (81.8%) found an association between periodontitis and PB and/or LBW. Meta-analysis showed a significant risk of preterm delivery for pregnant women with periodontitis [risk ratio (RR): 1.70 (95% confidence interval (CI): 1.03, 2.81)] and a significant risk for LBW [RR: 2.11 (95% CI: 1.05, 4.23)] or PB/LBW [RR: 3.57 (95% CI: 1.87, 6.84)], as well as a high and unexplained degree of heterogeneity between studies. CONCLUSION: Although this SR found a consistent association between periodontitis and PB and/or LBW, this finding should be treated with great caution until the sources of heterogeneity can be explained.

Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review.

BACKGROUND: The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects. METHODS: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration > or = 6 months that evaluated recession areas (Miller Class I or II > or = 3 mm) that were treated by means of periodontal plastic surgery procedures were included. RESULTS: Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific procedures. CONCLUSIONS: SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized recession-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate.

[Prevalence and severity of gingivitis among scholars (7-14 years): local conditions associated to bleeding on probing]. / Prevalência e severidade de gengivite em escolares de 7 a 14 anos: condições locais associadas ao sangramento à sondagem.

The objective of this study was to collect data about the prevalence and severity of gingivitis in a sample of scholars, as well as its relationship with possible local risk factors. Two hundred and six subjects were examined, 107 male and 99 female, with age ranging from 7 to 14 years, where data from their Plaque Index (IP), Gingival Index (IG), and Clinical Probing Depth (PCS) were collected. Among all the clinical parameters observed, the mean values found referent to PCS, IP and IG were 1.58 + 0.46, 1.12 + 0.49 and 0.89 + 0.32, respectively. Ninety five subjects (46.1%) presented a diagnostic of slight gingivitis and 111 (53.9%) of moderate gingivitis. Overall, male subjects presented statistically more dental plaque and more gingival inflammation than female subjects. Clinical signs of gingival inflammation were found in all the examined subjects. Gingivitis severity around permanent teeth was directly linked to the amount of dental plaque deposits and to the presence of bleeding on probing.

Prevalência e severidade de gengivite em escolares de 7 a 14 anos: condições locais associadas ao sangramento à sondagem / Prevalence and severity of gingivitis among scholars (7-14 years): local conditions associated to bleeding on probing

O objetivo deste estudo foi coletar dados sobre a prevalência e severidade de gengivite em uma amostra de crianças em idade escolar, bem como sua relação com possíveis fatores de risco locais. Duzentos e seis indivíduos foram examinados, sendo 107 meninos e 99 meninas, com idades entre 7 e 14 anos; foram coletados dados referentes ao índice de placa (IP), índice gengival (IG) e profundidade clínica de sondagem (PCS). Entre os parâmetros clínicos observados, as médias referentes a PCS, IP e IG encontradas foram de 1,58 + 0,46, 1,12 + 0,49 e 0,89 + 0,32, respectivamente. Noventa e cinco indivíduos (46,1 por cento) apresentaram um quadro de gengivite leve e 111 (53,9 por cento), de gengivite moderada. No geral, os indivíduos do sexo masculino apresentaram estatisticamente maior quantidade de placa bacteriana e maior inflamação do tecido gengival que indivíduos do sexo feminino. A presença de inflamação gengival foi encontrada em todos os indivíduos examinados. A severidade de inflamação nos dentes permanentes esteve diretamente relacionada à quantidade de placa e ao sangramento à sondagem.

The objective of this study was to collect data about the prevalence and severity of gingivitis in a sample of scholars, as well as its relationship with possible local risk factors. Two hundred and six subjects were examined, 107 male and 99 female, with age ranging from 7 to 14 years, where data from their Plaque Index (IP), Gingival Index (IG), and Clinical Probing Depth (PCS) were collected. Among all the clinical parameters observed, the mean values found referent to PCS, IP and IG were 1.58 + 0.46, 1.12 + 0.49 and 0.89 + 0.32, respectively. Ninety five subjects (46.1 percent) presented a diagnostic of slight gingivitis and 111 (53.9 percent) of moderate gingivitis. Overall, male subjects presented statistically more dental plaque and more gingival inflammation than female subjects. Clinical signs of gingival inflammation were found in all the examined subjects. Gingivitis severity around permanent teeth was directly linked to the amount of dental plaque deposits and to the presence of bleeding on probing.

Systematic review of periodontal plastic surgery in the treatment of multiple recession-type defects.

OBJECTIVES: The objectives of this systematic review were (1) to evaluate results obtained with different periodontal plastic surgery procedures in the treatment of multiple recession-type defects and (2) to assess differences in results from randomized controlled trials and other types of studies (i.e., controlled clinical trials and case series). MATERIALS AND METHODS: The MEDLINE, EMBASE and CENTRAL databases were searched up to June 2008 to identify randomized controlled trials, controlled clinical trials and case series with a follow-up period of at least 6 months for patients with multiple recession-type defects who were treated with periodontal plastic surgery. RESULTS: Of 632 articles initially retrieved, only 16 were deemed suitable for more detailed analysis. Of these, only 4 case series met the inclusion criteria. Mean recession and clinical attachment level decreased substantially from baseline to final examination, and probing depth also declined. Mean width of keratinized tissue increased. Mean root coverage ranged from 94% to 98% over the 4 studies, and complete root coverage was achieved for 68% to 90% of patients in the 3 trials for which this variable was reported. CONCLUSIONS: Analysis of the limited information available in the dental literature showed improvements in clinical parameters with all of the periodontal plastic surgery procedures. Randomized controlled trials are needed to identify the indications for each surgical technique and any prognostic factors.

Root coverage procedures for the treatment of localised recession-type defects.

BACKGROUND: Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable periodontal plastic surgery (PPS) procedures. OBJECTIVES: To evaluate the effectiveness of different root coverage procedures in the treatment of recession-type defects. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched up to October 2008. The main international periodontal journals were handsearched. There were no restrictions with regard to publication status or language of publication. SELECTION CRITERIA: Only randomised controlled clinical trials (RCTs) of at least 6 months' duration evaluating recession areas (Miller's Class I or II > 3 mm) and that were treated by means of PPS procedures were included. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. MAIN RESULTS: Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significant greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTG) compared to guided tissue regeneration with resorbable membranes (GTR rm). A significant greater gain in the keratinized tissue was found for enamel matrix protein when compared to coronally advanced flap (0.40 mm) and for SCTG when compared to GTR rm plus bone substitutes. Limited data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure. AUTHORS' CONCLUSIONS: Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for the treatment of localised recession-type defects. In cases where both root coverage and gain in the keratinized tissue are expected, the use of subepithelial connective tissue grafts seems to be more adequate. Randomised controlled clinical trials are necessary to identify possible factors associated with the prognosis of each PPS procedure. The potential impact of bias on these outcomes is unclear.

The influence of tobacco smoking on the outcomes achieved by root-coverage procedures: a systematic review.

BACKGROUND: The authors conducted a systematic review to evaluate the effect of smoking on the clinical outcomes achieved by periodontal plastic surgery procedures in the treatment of recession-type defects. TYPES OF STUDIES REVIEWED: The authors performed an electronic search on MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled clinical trials, controlled clinical trials and case series that involved at least six months' follow-up. They looked for studies published through June 2008 that compared the outcome measures achieved by smokers and nonsmokers after they underwent periodontal plastic surgery procedures for treatment of gingival recession. RESULTS: From a total of 632 references, the authors considered seven studies to be relevant. The meta-analysis indicated a statistically significant greater reduction in gingival recession (P < .001) and gain in clinical attachment level (P < .001) for nonsmokers when compared with smokers whose gingival recession was treated with subepithelial connective-tissue grafts. Additionally, nonsmokers exhibited significantly more sites with complete root coverage than did smokers (P = .001). For coronally advanced flaps, differences between the groups were not significant. CLINICAL IMPLICATIONS: The results of this review show that smoking may negatively influence gingival recession reduction and clinical attachment level gain. Additionally, smokers may exhibit fewer sites with complete root coverage.

Treatment of Miller Class I and II localized recession defects using laterally positioned flaps: a 24-month study.

PURPOSE: To assess the clinical results obtained with laterally positioned flap (LPF) for the treatment of localized gingival recessions (GR). METHODS: 32 systemically healthy, non-smoking patients, with one Miller Class I or II buccal GR of > or = 3 mm, were treated with a LPF. At baseline the following measurements were recorded: (1) recession depth; (2) probing depth; (3) clinical attachment level; and (4) width of keratinized tissue. At 24 months post-surgery, all clinical measurements were repeated. RESULTS: Mean root coverage obtained with the laterally positioned flaps was 93.8%. Complete root coverage was obtained in 62.5% of the recipient sites. The mean recession depth decreased from 4.71 +/- 1.30 mm to 0.28 +/- 0.42 mm. Statistically significant improvements were found for all clinical parameters from baseline to 24 months (P < 0.05). Patients with maxillary recessions recorded statistically superior gains in the width of keratinized tissue than patients with mandibular recessions. The results of the present study demonstrated that the LPF is an effective procedure to cover localized gingival recession. Moreover, both groups (i.e., patients with maxillary or mandibular recessions) recorded similar significant improvements from baseline to 24-month examination, except for the width of keratinized tissue which was statistically higher for maxillary recessions.

Prevalência das doenças periodontais no Brasil: parte II: 1993-2003 / Prevalence of periodontal diseases in Brazil: part II: 1993-2003

Em 1993, através de uma revisão da literatura dos levantamentos epidemiológicos até então realizados evidenciou que 86,7% do total de indivíduos examinados apresentavam atividade de doença periodontal. O propósito deste artigo foi avaliar a prevalência de doença periodontal através de uma revisão crítica da literatura odontológica referente a diversos estudos epidemiológicos independentes realizados e publicados no Brasil entre 1993 e 2003. Diferenças na metodologia empregada não permitiram muitas comparações entre os dados coletados. Entretanto, concluiu-se que a prevalência geral de doença periodontal encontrada foi de 92,92%. Esta revisão também revelou uma carência de dados sobre a epidemiologia das doenças periodontais em todas as regiões geográficas brasileiras. Todos os levantamentos epidemiológicos estudados apontam a placa dental como único agente etiológico das doenças gengivais e periodontais.

In 1993 a review of epidemiological surveys of the prevalence of periodontal diseases in Brazil has shown that 86.7% of the total of examined individuals had evidence of marginal gingivitis or periodontal damage. The aim of this paper was to evaluate the prevalence of periodontal disease through a critical review of the dental literature of several independent epidemiologic studies that have been conducted during the last 10 years in Brazil (1993-2003). Differences in epidemiological methodology and clinical differential diagnosis made comparative evaluation of surveys data difficult and subjective. However, it can be concluded that the general prevalence rate of periodontal diseases was 92.92%. This review also revealed a lack of data on the epidemiology of periodontal disease in all Brazilian geographic regions. All the epidemiological data reviewed pointed to dental plaque as the primary aetiological agent in gingivitis and periodontitis.

Abordagem estética em casos extremos: um tratamento multidisciplinar / Aestethics approach in advanced cases: a multidisciplinary treatment

Durante os últimos anos, diversos procedimentos cirúrgicos, técnicas restauradoras e materiais dentários vêm sendo estudados, de forma a preencher as expectativas dos pacientes por estética. Dentes amplamente restaurados ou fraturados, apresentando retrações gengivais extensas, podem causar uma deterioração no aspecto estético. O tratamento destes casos sempre requer uma abordagem multidisciplinar. Normalmente, uma combinação entre a cirurgia plástica periodontal e Odontologia Restauradora pode ser empregada no re-estabelecimento da estética, mimetizando a natureza. Os principais objetivos desta modalidade de tratamento são melhorar a saúde periodontal e manter os resultados obtidos ao longo do tempo.

Over the last years several surgical procedures, restorative techniques and dental materials have been studied in an attempt to fulfill patients' aesthetic expectations. Extensive wide gingival recessions involving heavily restored or fractured teeth can deteriorate the esthetic appearance. Usually, the treatment of these cases needs a multidisciplinary approach. The main goals of this treatment modality are to improve periodontal health and to maintain long-term results. Often a combination of periodontal plastic surgery and restorative dentistry can be employed to reestablish aesthetics and mimic nature.

Subepithelial connective tissue grafts in the treatment of multiple recession-type defects.

BACKGROUND: There is little documentation regarding the treatment of multiple recession-type defects. The objective of this study was to evaluate the results obtained with a connective tissue graft placed under a coronally advanced flap for the treatment of multiple gingival recessions. METHODS: Twenty-eight patients, with at least two recession defects affecting adjacent teeth, were treated with a combination of a connective tissue graft and a coronally advanced flap. At baseline, the following measurements were recorded: 1) recession depth; 2) probing depth; 3) clinical attachment level; and 4) width of keratinized tissue. At 6 months post-surgery, all clinical measurements were repeated. RESULTS: The mean root coverage from baseline to 6 months post-surgery results was 96%. Complete root coverage was achieved in 20 (71%) of the 28 defects. The mean recession depth decreased from 3.84 +/- 1.50 mm to 0.14 +/- 0.23 mm. Statistically significant improvements were found for all clinical parameters from baseline to 6 months (P <0.01). Patients with maxillary recessions recorded statistically superior outcomes than patients with mandibular recessions. CONCLUSIONS: The results of the present study demonstrated that the connective tissue graft associated with a coronally advance flap is an effective procedure to cover multiple gingival recessions, especially in defects localized in the maxillary arch. However, further investigation focusing on the effects of this root coverage procedure in mandibular sites is necessary.

Root coverage in a class IV recession defect achieved by creeping attachment: a case report.

BACKGROUND AND OBJECTIVES: The amount of root coverage obtained after a graft procedure may be improved after the early phase of healing by a coronal displacement of the gingival attachment. The aim of this report is to present a clinical case of complete root coverage of a Miller's class IV recession achieved by creeping attachment subsequent to a laterally repositioned flap. METHODS: In 1995, a 44-year-old male patient was referred for a root coverage graft on the upper right central incisor. Clinical examination revealed that the upper right central incisor had a recession of 7 mm. The defect was classified as class IV according to Miller's classification of marginal tissue recession. It was decided that root coverage would be attempted using a laterally repositioned flap from the upper right lateral incisor and upper right canine. Sutures were removed ten days after surgery. RESULTS: Four months after grafting, the amount of root coverage obtained was 4 mm. After an 8-year period, the previously denuded root surfaces were entirely covered by soft tissue. The marginal position of the gingiva appeared stable, the gingival tissue became firmly attached to the root surface and probing showed a shallow sulcular depth. CONCLUSION: Several interesting observations were made after 8 years. In conclusion, the most significant and interesting finding of this report is that the amount of interdental papilla and marginal gingival tissue covering donor and recipient areas improved with time, providing an excellent aesthetic appearance.

Aspectos clínicos associados ao uso de piercing oral / Clinical aspects associated to the wearing of oral piercing

O body piercing vem se tomando freqüente e de maior aceitação entre os jovens, apesar de ser uma prática há tempos conhecida e tradicional para determinados povos antigos. Confeccionados em diferentes materiais, se apresentam como possíveis agentes etiológicos responsáveis pelo desenvolvimento de trauma sobre os tecidos orais. Com o intuito de alertar os cirurgiões-dentistas quanto às possíveis alterações decorrentes do uso deste artefato, cinco casos clínicos foram apresentados, discutidos e relacionados com outros artigos publicados. Dentre os cinco casos apresentados, em apenas um houve a remoção do artefato, motivada pelo trauma visível e pela sensibilidade dentinária que incomodavam a paciente. Para os outros quatro casos, os indivíduos optaram por permanecer com os piercings, sendo orientados quanto à necessidade de manutenção adequada e controle periódico com visitas ao consultório com o intuito de se evitar danos maiores aos tecidos.

Estudo clínico e radiográfico da técnica de erupção ortodôntica forçada em elementos dentários portadores de doença periodontal avançada com finalidade de colocação de implantes / Clinical and radiographic study of the ortodonthic forced eruption technique in dental elements carriers of advanced periodontal disease with implant placement purpose

Erupção Forçada de dentes para colocação de implantes, é uma técnica não cirúrgica para melhorar a topografia tridimensional do sítio receptor de implante antes da extração. Um dente comprometido por doença periodontal grave pode ser movido por meios ortodônticos, e as mudanças clínicas na arquitetura dos tecidos gengivais e ósseos, revelam a presença de uma mancha vermelha indicando o trajeto da Erupção Ortodôntica. Com a previsibilidade da osseointegração na colocação de implantes de titânio comercialmente puro, melhorados com as superfícies tratadas, as reabilitações de pacientes total ou parcialmente edêntulos, se tornaram factíveis. Dezoito elementos dentários foram selecionados em 7 pacientes para o presente estudo, 05 do sexo feminino, e dois masculinos, leucodermas, com idade variando de 35,1 a 50,0 anos, média ± desvio padrão 42,3 ± 5,5.. Quatro pacientes eram tabagistas e nenhum fazia uso de bebidas alcoólicas, e todos gozavam de boa saúde.Dentes com doença periodontal avançada e com extração indicada, submetidos à Erupção Ortodôntica Forçada com forças leves e contínuas, parecem melhorar os aspectos gengivais e ósseos, para a colocação de implantes osseointegráveis imediatamente após as extrações. Os resultados obtidos com a técnica de Erupção Ortodôntica Forçada por meio de radiografias panorâmicas inicial e final, com interposição de gabaritos computadorizados, indicaram uma variação de 0mm a 4,5mm, com media de 1,7mm e Desvio Padrão 1,08mm de neoformação óssea.

Forced eruption of teeth for placement of implant, it is a non surgical technique to improve the three-dimensional topography of the receiving site of implants before the extraction. Where a tooth committed by advanced periodontal disease can be moved by orthodontics means, and the clinical changes in the architecture of the gingivals and bony tissues, they reveal the presence of a red patch indicating the trajectory of the Forced Eruption. With the previsibility of the osseointegration in the placement of implant commercially pure titanium, improved with the treated surfaces, the total rehabilitations or partially of patients edentulus, became feasible. Eighteen dental elements were selected in 07 patient for the present study, 05 of the female, and two male, leucodermas, with age varying of 35,1 to 50,0 years, medium ± standard deviation 42,3 ± 5,5.. Four patients were smokers and none made use of alcoholic drinks, and everybody enjoyed good health. Teeth with advanced periodontal disease and with indicate extraction, submitted to the Forced Orthodontic Eruption with light and continuous forces, seem to improve the gingivals and bony aspects, for the immediately placement of osseointegratable implant after the extractions. The results obtained with the technique of Forced Orthodontic Eruption through initial and final panoramic x-rays, with interference of computerized templates, indicated a varying from 0mm to 4,5mm, with it measured of 1,7mm and Deviate Pattern 1,08mm of neoformed bony.

Efeitos adversos do tratamento ortodôntico sobre os tecidos mucogengivais / Adverse effects of orthodontic treatment on the mucogingival tissues

O efeito movimento dentário ortodôntico sobre os tecidos periodontais é considerado controverso dentro da literatura odontológica. Apesar das alterações mucogengivais serem consideradas também como um componente importante na resposta global dos tecidos periodontais, o efeito da ortodontia na gengiva inserida e na mucosa alveolar vem sendo pouco investigado. À luz desta discussão, o propósito deste artigo foi reunir e revisar publicações relacionadas aos efeitos adversos do tratamento ortodôntico sobre os tecidos mucogengivais. Os seguintes aspectos foram examinados: (a) resposta clínica da gengiva aos aparelhos ortodônticos e (b) os efeitos clínicos e histológicos dos tecidos gengivais após o movimento dentário. As vantagens e desvantagens do tratamento são discutidas pelos autores.

Gingival recessions caused by lip piercing: case report.

Fear of losing the teeth is common among patients presenting with gingival recession. This report describes a case in which unusual gingival recessions were caused by lip piercing. Periodontal treatment involved removal of the causative agent, hygiene instruction, scaling and root planing, and coverage of the root with a subepithelial connective tissue graft. The therapeutic measures applied in this case yielded satisfactory root coverage, an increase in the width of the keratinized gingiva, improvement in hygiene status and absence of dental hypersensitivity.