Lip Repositioning Technique With Smile Elevator Muscle Containment - A Novel Cosmetic Approach for Gummy Smile: Case Report.

Excessive gingival display (EGD) is a challenge for dentists attempting to provide their patients a pleasant smile. EGD associated with hyperactivity of the smile elevator muscles can be treated with various surgical techniques; regardless of which technique is used, to achieve a predictable result with long-term stability limiting upper lip movement when the patient smiles, a firm muscle containment is imperative. This report describes an innovative suture procedure associated with a lip repositioning technique aimed at maintaining the traction and containment of the smile elevator muscles. This case demonstrates a successful and stable result for excessive gingival exposure, addressing and satisfying a patient's esthetic concerns.

Análise tridimensional de elementos finitos da distribuição de tensões em implantes inclinados: uma revisão de literatura / Three-dimensional finite element analysis of stress distribution in tilted implants: a review of literature

Implantes inclinados atualmente são utilizados como uma alternativa cirúrgica e protética. Por tanto, estudos in vitro demonstram que o seu uso aumenta a concentração de tensão no osso cortical peri-implantar e questionasse se esse fator pode levar ao insucesso da reabilitação oral estética. O objetivo do presente artigo foi avaliar a informação relacionada com a influência de forças funcionais sobre a biomecânica de implantes inclinados nas reabilitações orais implantossuportadas. No intuito de investigar essa hipótese, foi realizada uma revisão da literatura e busca de informações existentes em artigos científicos indexados ao PubMed, que avaliassem o efeito da distribuição das tensões na interface osso-implante de implantes inclinados, através do método de análise dos elementos finitos. Os resultados mostraram que o uso de implantes inclinados aumenta a concentração de tensões no osso cortical peri-implantar sob simulação de cargas parafuncionais. No entanto, análises in-vitro não podem prever de forma precisa o comportamento dos tecidos biológicos. Apesar dessa limitação dos estudos, pode-se concluir que elevados picos de tensões poderiam comprometer os limites de resistência do osso cortical, podendo levar a falhas do conjunto osso-implante. Todavia, quando associados a reabilitações de próteses múltiplas, os implantes inclinados mudam sua biomecânica, favorecendo a distribuição e redução das tensões e o aumento da estabilidade das reabilitações como um todo.

Tilted implants are currently used as a surgical and prosthetic's alternative. Therefore, in-vitro studies demonstrate that their use increases the stress concentration in the peri-implant cortical bone and it wonders whether this can lead to the failure of an aesthetic oral rehabilitation. The aim of this paper was to assess information related to the influence of functional forces on the biomechanics of tilted implants in implant oral rehabilitation. In order to investigate this hypothesis, a literature review was made in scientific articles indexed to PubMed, to assess the effect of the stress distribution in the bone-implant interface of tilted implants, through the analysis of the finite element method. The results showed that the use of tilted implants increases the concentration of stresses in the peri-implant cortical bone under the simulation of parafunctional loads. However, in-vitro tests may not accurately predict the behavior of biological tissues. Despite this limitation of the study, it can be concluded that high peaks of tension could compromise the strength limits of cortical bone, leading to failure of the bone-implant joint. However, when associated with multiple rehabilitations, the titled implants change their biomechanics, favoring the distribution and reduction of tension and the increase of the stability of restorations as a whole.

Modified Double-Papillae Flap Technique With Subepithelial Connective Tissue Graft for Root Coverage in the Esthetic Zone: Case Report.

Gingival recession can compromise the esthetic appearance, leading to functional problems, hypersensitivity, and root caries. Several techniques have been implicated for root coverage, which includes pedicle grafts, free gingival grafts, connective tissue grafts, and guided-tissue regeneration. The double-papillae flap associated with subepithelial connective tissue is a predictable technique to cover isolated areas with insufficient attached gingiva apical to a recession. This case report demonstrates a surgical alternative to the technique using a sling periosteal suture to stabilize the connective tissue and pedicle flap during the initial phase of healing, increasing the potential of this periodontal procedure for gingival recession coverage.