Botulinum Toxin Injections as an Adjunct to Surgical Lip Repositioning For Gummy Smile Treatment.

BACKGROUND: An attractive smile depends on the proper proportion and arrangement of lip, teeth gingiva scaffold. The ideal smile is the exposure of the entire length of maxillary teeth with 1 mm gingiva. A gingival display exceeding 3 mm is unpleasant and termed ''gummy smile (GS).'' Lip repositioning is a simple surgical procedure intended to minimize the gingival display by removing a strip of mucosa and shortening the vestibular depth. Botulinum toxin injecting overactive muscles with measured quantities results in a reduction of muscle activity, relaxing the lip muscles and decreasing upward pull on the lip. There are some contraindications: patients with short lips and gingival exposures less than 3 mm. PURPOSE: This case report describes the successful management of GS of a young man. CASE REPORT: The procedures were performed and these techniques resulted in shortened vestibule and restricted the muscle pull of the elevator muscles of the lip, reducing gingival display when the patient smiles. Surgical lip repositioning can be a minimally invasive alternative to orthognathic surgery. Botulinum Toxin injections can be a useful adjunct to enhance the esthetics and improve patient satisfaction, being a more conservative and immediate nonsurgical treatment modality available. CONCLUSIONS: In this way, the clinical case report demonstrated that lip repositioning surgery combined to botulinum toxin injections promising outcomes in the GS correction. The effect showed a marked reduction in gingival display at the 4-years follow-up.

Is Low-Level Laser Therapy Effective for Pain Control After the Surgical Removal of Unerupted Third Molars? A Randomized Trial.

PURPOSE: One of the main challenges after extraction of unerupted third molars is pain control, and one of the treatments for pain control is low-level laser therapy (LLLT). Thus, this study aimed to assess the effectiveness of LLLT for pain control after extraction of lower third molars. MATERIALS AND METHODS: This randomized, double-blind, split-mouth study included patients who required bilateral extraction of unerupted lower third molars. Patients received LLLT on 1 side (laser group) but not on the opposite side (control group). On the experimental side, each patient received a laser application at 5 intraoral points for 30 seconds per point. This procedure was simulated on the control side. The pain control response was assessed with a modified pain visual analog scale at the following times: immediately after surgery (T0), after laser application (T1), 24 hours after surgery (T2), 48 hours after surgery (T3), and 72 hours after surgery (T4). RESULTS: Thirty-two patients, 56.25% of whom were women, underwent extraction; the average age was 22.2 years. At the times analyzed, the laser group presented better results than the control group. As for the times, there were differences in pain scores between T0 (8.03 ± 14.87) and T3 (2.66 ± 4.23), as well as T4 (3.36 ± 7.83), in the laser group and differences between T0 (19.76 ± 26.66) and T3 (7.11 ± 10.76), as well as T4 (6.26 ± 13.14), in the control group. CONCLUSION: LLLT was effective in reducing pain after surgical removal of unerupted third molars. At T3 and T4, pain reduction in relation to T0 was noted in both groups.

Effects of different pre-operative doses of dexamethasone on alveolar repair in rats.

Dexamethasone has been widly used in oral and maxillofacial surgery for controlling of postoperative surgical inflammation. Despite its clinical effectiveness, several studies have demonstrated the negative impact of this drug on the healing of soft and hard tissues. This study aimed to assess the effects of different pre-operative doses of dexamethasone on alveolar repair. Sixty rats were divided into four groups of 15 animals each. Single pre-operative doses of dexamethasone equivalent to human doses of 4 mg (Group 4 mg), 8 mg (Group 8 mg), and 12 mg (Group 12 mg), calculated by allometric dose extrapolation, were administered; and rats in the Control Group were injected with saline solution. The animals were anesthetized, and their left mandibular first molars (M1) were removed. After three, seven, and 40 days, 5 animals from each group were euthanized, and bone samples of M1 alveolus were collected for radipgraphic, histomorphological and histometric evaluation of the early and late phases of alveolar healing. At three days, Group 12 mg presented reduced radiographic density, percentage of collagen, and connective matrix compared with the Control Group. At 7 days, the percentage of bone was increased in the Control Group compared to Groups 8 mg and 12 mg (P < 0.05). It can be concluded that a single pre-operative dose of 12 mg of dexamethasone affected the early stages of alveolar repair in rats.

Avaliação da estabilidade primária de implantes curtos e convencionais instalados em ossos de diferentes densidades / Evaluation of primary stability of short and conventional implants in bones with different densities

O objetivo deste estudo foi avaliar a estabilidade primária de implantes curtos e convencionais instalados em ossos com densidades tipo I e tipo IV de origem sintética e natural. Implantes nos tamanhos (Diamêtro x Comprimento) 3,75 x 13 mm, 3,75 x 10 mm, 4,3 x 5,5 mm e 5 x 5,5 mm foram instalados em blocos ósseos seguindo uma sequência de fresagens e avaliados o torque de inserção e o coeficiente de estabilidade primária (CE) através da análise da frequência de ressonância (AFR). Os resultados mostraram que implantes de diferentes tamanhos e ossos de diferentes densidades e origens influenciam tanto nos valores de torque de inserção quanto de AFR (p<0.05). Todos os implantes instalados nos ossos tipo IV apresentaram menores torques de inserção e menores CE (p<0.05) comparados aos instalados nos ossos tipo I, e implantes curtos apresentaram maiores torques que os convencionais intalados no osso tipo I. Assim, a utilização de implantes curtos pode ser uma alternativa viável de tratamento, principalmente em sítios ósseos com maiores densidades (AU).

The aim of this study was to assess the primary stability of short and conventional implants placed in bone with type I and type IV densities of synthetic or natural origin. Implants (D x C) of 3.75 x 13 mm, 3.75 x 10 mm, 4.3 x 5.5 mm, and 5 x 5.5 mm were placed in bone blocks following a drilling sequence and assessment of insertion torque and primary stability coefficient (SC) through resonance frequency analysis (RFA). The results showed that implants of different sizes and bones of different densities and origins influence both insertion torque and RFA values (p <0.05). All implants placed in type IV bones presented lower insertion torques and lower SC (p <0.05) compared to those placed in type I bones, and short implants presented higher torques than conventional implants in type I bone. So the use of short implants may be a viable treatment alternative, mainly in bone areas with higher densities (AU).

A utilização do ácido hialurônico para ganho vertical de papila em área estética / The use of hyaluronic acid for vertical papilas formation in the esthetic zone

Defeitos mucogengivais em decorrência do avanço da doença periodontal resultam em perda óssea alveolar e consequente migração apical da papila interdental, levando à formação de triângulos negros que comprometem a estética do paciente. O tratamento de defeitos mucogengivais e peri-implantares vem sendo amplamente estudado no sentido de otimizar os resultados clínicos alcançados e são considerados um grande desafio na prática clínica. Assim, o presente estudo buscou avaliar a eficácia clínica de um novo método para eliminar ou reduzir pequenos defeitos de papila, utilizando-se o gel de ácido hialurônico (AH). A utilização de gel de AH, comercialmente disponível, foi utilizado em dois casos clínicos como um método possível de formação de papila entre implantes, e em áreas de pôntico de prótese fixa sobre implantes em regiões estéticas da maxila. Os pacientes incluídos neste estudo apresentavam- -se com pelo menos um defeito de papila na região anterior. Antes do tratamento, fotografias da condição inicial dos pacientes foram obtidas. O procedimento clínico para aplicação do gel de AH (0,2 mL) foi realizado com anestesia tópica, após profilaxia, utilizando-se um dispositivo apropriado, 2-3 mm apical à borda coronária da papila envolvida. Reavaliações periódicas a cada 3 semanas foram conduzidas, e a aplicação do gel de AH foi repetida por três vezes. Os pacientes foram acompanhados durante um período de seis meses após a aplicação do gel e fotografias foram obtidas para comparação dos resultados alcançados. Os resultados mostraram satisfatório aumento do volume tecidual nos dois casos tratados, os quais resultaram em um maior preenchimento tecidual e consequente melhora das condições estéticas dos pacientes. Em conclusão, os resultados do presente estudo são encorajadores, evidenciando que pequenos defeitos de papila interdentária entre pônticos e entre implantes podem ser solucionados por meio da aplicação clínica do gel de AH, resultando em satisfatório ganho tecidual com baixa morbidade ao paciente (AU)

Mucogingival defects as a consequence of the advancement of periodontal disease result in bone loss and subsequent apical migration of the interdental papilla, leading to the formation of black triangles that compromise the patient aesthetics. The treatment of mucogingival and peri-implant defects is considered a major challenge in clinical practice and has been widely studied in order to optimize clinical results. Thus, the present study sought to evaluate the clinical effectiveness of a new method to eliminate or reduce small papillary defects, using the hyaluronic acid gel (HA). The HA gel, commercially available, was used in two cases as a possible method for the formation of papilla between implants and in pontics region of implant-supported prostheses in the anterior maxillary region. The patients included in this study had at least one papillary defect in the anterior region. Before treatment, photographs of the initial condition of all patients were obtained. The clinical procedure for the application of the HA gel (0.2 mL) was performed under topic anesthesia, after dental prophylaxis, using an appropriate device, 2-3 mm apical to the coronal tip of the involved papilla. Patients were seen every 3 weeks, and the application of the HA gel was repeated three times. Patients were followed for a period of six months after the HA gel application and photographs were taken for results comparison. Satisfactory increased tissue volume was observed in all cases, which resulted in greater tissue filling and consequent improvement of aesthetic conditions. In conclusion, the results of the present study are encouraging, showing that small defects of interdental papilla between implants and prosthetic pontic can be solved through clinical application of HA gel resulting in satisfactory tissue gain with low morbidity to the patient (AU)

Prevalência de alterações sistêmicas em pacientes atendidos na disciplina de Cirurgia e Traumatologia Bucomaxilofacial do curso de Odontologia da UNIARA / Prevalence of systemic diseases in patients evaluated in the discipline of Oral and Maxillo Facial Surgery of Araraquara University Center - UNIARA

Introdução: A avaliação pré-operatória é de fundamental importância para a prevenção de intercorrências transoperatórias e de complicações pós-operatórias. Objetivo: Identificar a prevalência de enfermidades e condições sistêmicas em pacientes submetidos a tratamento cirúrgico na área de Cirurgia e Traumatologia Bucomaxilofacial do Curso de Odontologia, do Centro Universitário de Araraquara - UNIARA, no período de 2004 a 2009. Material e método: Para o desenvolvimento deste trabalho, foi realizado um levantamento nos prontuários desses pacientes, sendo analisados os seguintes fatores: idade, gênero, presença de vícios, principais enfermidades e condições sistêmicas que afetam a população mundial. Os dados obtidos foram analisados quantitativamente e registrados em uma tabela. Resultado: No total de prontuários analisados (693), foram detectadas 340 respostas afirmativas (49,06%) a uma ou mais enfermidades. As doenças cardiovasculares foram as mais prevalentes (22,34%). Considerando-se a prevalência de doenças relacionadas à idade, a faixa etária de menos de 20 anos representou 16,32%; 20-29 anos, 43,06%; 30-39 anos, 45,16%; 40-44 anos, 48,64%; 45-49 anos, 56,25%; 50-54 anos, 58,33%; 55-59 anos, 57,74%; 60-64 anos, 70,37%; 65-69 anos, 66,66%; 70 anos ou mais, 68,75%. Conclusão: As doenças e alterações sistêmicas com maior prevalência foram doenças cardiovasculares, anemia, sinusite e diabetes. A frequência das respostas afirmativas a quadros sistêmicos foi idade-dependente e houve predominância do gênero feminino. Já o vício mais frequente foi o tabaco. Assim, pôde-se observar ser de fundamental importância a realização de avaliação pré-operatória da saúde dos pacientes que irão se submeter a tratamento odontológico/cirúrgico.

Introduction: pre-operative assessment is of fundamental importance for the prevention of transoperative and of postoperative complications. Objective: to identify the prevalence of diseases and systemic conditions in patients undergoing surgical treatment in the discipline of surgery and Traumatology of University Center of Araraquara, in the period of 2004 to 2009. Material and method: for the development of this study, a survey in medical records of patients was performed and the factors considered included: age, sex, presence of vices, and systemic conditions that affect the world?s population. The data obtained were analyzed quantitatively and recorded in atable. Result:  Considering all patient records analyzed (693), 340 affirmative responses were detected (49,06%) to one or more diseases. Cardiovascular diseases were the most prevalent (22,34%). Considering the prevalence of diseases related to age, the age of less than 20 years represented 16,32%; of 20-29 years, 43,06%; 30-39 years, 45,16%; 40-44 years, 48,64%; 45-49 years, 56,25%; 50-54 years, 58,33%; 55-59 years, 57,74%; 60-64 years, 70,37%; 65-69 years, 66,66%; and 70 years or more, 68,75%. Conclusion: diseases and systemic alterations with higher prevalence were cardiovascular diseases, anemia, sinusitis and diabetes. The frequency of affirmative answers to systemic conditions was age-dependent and there was a predominance of females. The tobacco addiction was the most frequent. Thus, it was found that the preoperative assessment of the health of patients who will undergo surgical dental treatment is of fundamental importance.

Tratamento de rânula pela técnica de marsupialização: relato de caso clínico / Ranula treatment by marsupialization technique: clinical case report

As rânulas são fenômenos extensos de retençãode saliva que ocorrem no assoalho bucal, principalmentena região da glândula sublingual. Elaspodem causar a elevação da língua e interferircom a fala e a deglutição. O tratamento é cirúrgicopor meio da marsupialização da rânulaou da remoção definitiva da glândula sublingualenvolvida. A técnica da marsupialização é umaalternativa cirúrgica a ser considerada, visto queé um procedimento simples e pouco traumático,além de apresentar prognóstico favorávelquando bem indicado. O objetivo deste trabalhoé relatar um caso clínico de rânula tratadopela técnica de marsupialização, além de fazerconsiderações sobre as formas de tratamentodessa lesão glandular benigna.

The ranula phenomena are extensive retentionof saliva, which occur in the floor of the mouth,especially in the region of the sublingualgland. They can cause the elevation of the tongueand interfere with speech and swallowing.Treatment is by surgical marsupialization of theranula or permanent removal of the sublingualgland involved. The technique of marsupializationis a surgical alternative to be considered,since it is a simple and less traumatic, and presentsa favorable prognosis when properly indicated.The objective of this study is to reporta clinical case of ranula treated by marsupializationtechnique, in addition, to show considerationson how to treat this benign glandularlesion.