Transconjunctival Surgical Access With Modified Aesthetic Lateral Canthotomy.

ABSTRACT: Displaced fractures of the zygomatic bone that require surgical treatment are accessed transcutaneously but these accesses to the skin can cause a hypertrophy scar in patients with this predisposition. This paper indicates a modification in the lateral canthotomy that aim to minimize the hypertrophic scar in the treatment of zygomatic fracture.

Salivary profile of children with erosive tooth wear: a transversal study.

The aim of the present transversal study was to evaluate the clinical and biochemical salivary parameters of children with and without erosive tooth wear (ETW). The study population was children aged 4 to 9 years. A trained and calibrated examiner (kappa value for intraexaminer reliability = 0.89) classified the children into ETW (n = 24) and control groups (n = 24), and applied the O'Brien index. The salivary flow rate was initially evaluated by stimulated sialometry (paraffin chewing). Afterwards, the collected saliva was submitted to biochemical analyses of pH, uric acid, total buffering capacity, ferric-reducing antioxidant power, reduced glutathione, calcium, and phosphorus. Among the ETW children, 20 (83%) had dental lesions restricted to enamel, and 4 (17%) presented lesions affecting both enamel and dentin. A statistically significant difference between the groups was obtained only for the pH values (t-test; p = 0.004), with averages of 7.31 and 7.56 for the control and the ETW groups, respectively. Considering the parameters evaluated in general, it is suggested that the salivary profile of children with ETW does not differ considerably from that of children without ETW. However, the pH mean value seems to be slightly higher in ETW children, but is still within the normal physiological range.

Salivary profile of children with erosive tooth wear: a transversal study

Abstract The aim of the present transversal study was to evaluate the clinical and biochemical salivary parameters of children with and without erosive tooth wear (ETW). The study population was children aged 4 to 9 years. A trained and calibrated examiner (kappa value for intraexaminer reliability = 0.89) classified the children into ETW (n = 24) and control groups (n = 24), and applied the O'Brien index. The salivary flow rate was initially evaluated by stimulated sialometry (paraffin chewing). Afterwards, the collected saliva was submitted to biochemical analyses of pH, uric acid, total buffering capacity, ferric-reducing antioxidant power, reduced glutathione, calcium, and phosphorus. Among the ETW children, 20 (83%) had dental lesions restricted to enamel, and 4 (17%) presented lesions affecting both enamel and dentin. A statistically significant difference between the groups was obtained only for the pH values (t-test; p = 0.004), with averages of 7.31 and 7.56 for the control and the ETW groups, respectively. Considering the parameters evaluated in general, it is suggested that the salivary profile of children with ETW does not differ considerably from that of children without ETW. However, the pH mean value seems to be slightly higher in ETW children, but is still within the normal physiological range.

Contribuição da tomografia computadorizada de feixe cônico no diagnóstico da rinolitíase assintomática / Contribution of cone beam computed tomography in the diagnosis of asymptomatic rhinolithiasis

Rinolitíase é uma formação calcárea rara situada no interior das fossas nasais. Geralmente apresenta-se acompanhada de rinorréia purulenta e obstrução nasal. Porém, outros sintomas como epistaxe recorrente e cacosmia podem estar presentes. O diagnóstico é realizado por meio de exames nasais endoscópicos e tomografia computadorizada (TC) associados à alta suspeita clínica. O tratamento consiste na sua remoção e antibioticoterapia. Neste artigo os autores descrevem o caso de um rinolito de grandes dimensões, assintomático, em indivíduo do gênero masculino, 17 anos, descoberto em exame de tomografia de feixe cônico realizada após observação de uma radiografia panorâmica.

Rhinolithiasis is a rare calcareous formation located within the nasal fossae. It is usually accompanied by purulent rhinorrhea and nasal obstruction. However, other symptoms such as recurrent epistaxis and cacosmia may be present. The diagnosis is made through endoscopic nasal exams and computed tomography (CT) associated with high clinical suspicion. The treatment consists of its removal and antibiotic therapy. In this paper, the authors describe the case of a large, asymptomatic, rhinolith in a 17-year-old male, discovered on a conical beam tomography scan performed after a routine panoramic radiograph

Comments on "Review of the association between periodontitis and chronic obstructive pulmonary disease in smokers".

Comments on "Review of the association between periodontitis and chronic obstructive pulmonary disease in smokers" by Agathi Spiropoulou and colleagues, published in issue 1 of the 89th volume (2019) of the Monaldi Archives for Chest Disease.

Harmonization of gummy smile by techniques of gingivoplasty and botulinum toxin application / Harmonização do sorriso gengival pelas técnicas de gengivoplastia e aplicação da toxina botulínica

The esthetic excellence has become the main objective in the dental treatment. The gummy smile is one of the complaints from the patients, since this situation may influence their self-esteem, social relationship and quality of life. The development of new techniques search to be therapeutic option more conservative, in the treatment of gummy smile, such as the association between the gingivoplasty and application of botulinum toxin, in comparation with other surgical procedures as the orthognatic surgery. The purpose of this article is to present a case of a patient with dentogingival discrepancy and gummy smile, who was treated with the association of these techniques, in order to optimize the harmony of the smile

A excelência estética tornou-se o principal objetivo no tratamento odontológico. O sorriso gengival é uma das queixas dos pacientes, uma vez que esta situação pode influenciar a sua autoestima, relação social e qualidade de vida. O desenvolvimento de novas técnicas busca ser uma opção terapêutica mais conservadora, no tratamento do sorriso gengival, como a associação entre a gengivoplastia e a aplicação da toxina botulínica, em comparação com outros procedimentos cirúrgicos como a cirurgia ortognática. O objetivo deste artigo é apresentar um caso de uma paciente com discrepância dentogengival e sorriso gengival, que foi tratada com a associação dessas técnicas, a fim de otimizar a harmonia do sorriso.

Comment on "Botulinum toxin type-A as an alternative treatment for gummy smile: a case report".

Currently, the search for esthetic excellence has become the main objective in the facial treatment. The gummy smile is one of the complaints from the patients, since this situation may influence their self-esteem and social relationship. The development of new techniques, such as the application of botulinum toxin, may be a conservative therapeutic option in the treatment of gummy smile. The purpose of this letter is to comment some points about a case report publicated in Dermatology Online Journal, of a patient with dentogingival discrepancy and severe gummy smile, who was treated with application of botulinum toxin in order to optimize the harmony of the smile.

Gummy Smile Correction Using Botulinum Toxin With Respective Gingival Surgery.

The pursuit of esthetic excellence has become a major goal in the dental treatment and orthodontic treatment. The beauty of the smile is not only constituted by the shape, position, and size of the teeth, but also based on the characteristics of the gingival tissue and conformation of the lips, which should be as harmonious as teeth. Gummy smile is one of the complaints of the patients, since such a situation can influence self-esteem and social relationships. The development of new more conservative techniques may provide a better therapeutic option than surgical procedures, such as the application of botulinum toxin, in the treatment of gummy smile. The purpose of this article is to present the case of a patient who presented dentogingival discrepancy and gummy smile, treated by resective gingival surgery and by application of botulinum toxin, optimizing smile harmony, and achieving improved self-esteem and quality of life. The application of botulinum toxin is an alternative less invasive, faster, safer, and more effective. Moreover, it produces harmonics and pleasing results when applied in target muscles, respecting the appropriate dose and type of smile. Therefore, the technique is a useful adjunct in the esthetic improvement of the smile and provides better results when combined with resective gingival surgery.

Temporomandibular joint disorders as the only manifestation of juvenile idiopathic arthritis: a case report.

Juvenile idiopathic arthritis is a term used to include all chronic childhood arthritis of unknown etiology. It is characterized by chronic inflammation persisting for at least 6 weeks, beginning before 16 years of age. The characteristics present are chronic synovitis, arthralgia, impaired joint mobility in at least one joint, and erosion with destruction of cartilage and subchondral bone, that could be associated or not with systemic involvement, according to each subtype of the disease. During the pathologic process, the temporomandibular joint can be involved by the juvenile idiopathic arthritis, resulting in severe mandibular dysfunction, with higher frequency in female patients. Initially, these lesions can show minor alterations like flattening of the condyle, erosions, and evolve to severe lesions, like destruction of the head of the condyle. We report a case of male patient who had destruction of both condyles, as a result from juvenile idiopathic arthritis. Proposed mechanisms to explain the juvenile idiopathic arthritis was reviewed. In this report the patient did not have pain or inflammatory process, and the temporomandibular diseases was the only manifestation.

Temporomandibular joint disorders as the only manifestation of juvenile idiopathic arthritis: a case report / Comprometimento da articulação temporomandibular como única manifestação da artrite idiopática juvenil: um relato de caso

ABSTRACT Juvenile idiopathic arthritis is a term used to include all chronic childhood arthritis of unknown etiology. It is characterized by chronic inflammation persisting for at least 6 weeks, beginning before 16 years of age. The characteristics present are chronic synovitis, arthralgia, impaired joint mobility in at least one joint, and erosion with destruction of cartilage and subchondral bone, that could be associated or not with systemic involvement, according to each subtype of the disease. During the pathologic process, the temporomandibular joint can be involved by the juvenile idiopathic arthritis, resulting in severe mandibular dysfunction, with higher frequency in female patients. Initially, these lesions can show minor alterations like flattening of the condyle, erosions, and evolve to severe lesions, like destruction of the head of the condyle. We report a case of male patient who had destruction of both condyles, as a result from juvenile idiopathic arthritis. Proposed mechanisms to explain the juvenile idiopathic arthritis was reviewed. In this report the patient did not have pain or inflammatory process, and the temporomandibular diseases was the only manifestation.

RESUMO Artrite idiopática juvenil é um termo usado para incluir toda artrite infantil crônica de etiologia desconhecida. É caracterizada por uma inflamação crônica, que persiste por pelo menos 6 semanas, com início antes dos 16 anos de idade. As características presentes são sinovite crônica, artralgia, mobilidade articular diminuída em pelo menos uma articulação, e erosão com destruição da cartilagem e do osso subcondral, podendo ser associada ou não com o envolvimento sistêmico, de acordo com cada subtipo da doença. Durante o processo patológico, a articulação temporomandibular pode ser envolvida pela artrite idiopática juvenil, resultando em disfunção mandibular severa, com maior frequência em pacientes do sexo feminino. Inicialmente, estas lesões podem mostrar pequenas alterações, como achatamento do côndilo e erosões, e evoluir para lesões graves, como a destruição da cabeça do côndilo. Relatou-se o caso de um paciente do sexo masculino, que apresentou destruição de ambos os côndilos, como resultado da artrite idiopática juvenil. Os mecanismos para explicar a artrite idiopática juvenil foram revisados na literatura. Neste relato de caso, o paciente não apresentou dor e nem processo inflamatório, sendo o comprometimento da articulação temporomandibular a única manifestação.

Aplicación de toxina botulínica tipo A para el manejo de la sonrisa gingival / Application of type-A botulinic toxin for the management of gummy smile

La toxina botulínica tipo A puede ser utilizada en diversas situaciones de interés odontológico, entre ellas, los trastornos temporo-mandibulares, hábitos parafuncionales, hipertrofia del músculo masetero, parálisis facial, asimetría de labios y, más recientemente, en los casos de hipermiotonía labial y sonrisa gingival. El objetivo de este trabajo es reportar el caso de un paciente con queja estética de sonrisa gingival. La aplicación de la toxina botulínica promovió la dehiscencia uniforme del labio superior y minimizó la molestia causada por la sonrisa gingival de forma rápida y poco invasiva, mostrando que esta puede convertirse en una alternativa terapéutica eficaz para el tratamiento de la sonrisa gingival, favoreciendo la estética facial y la autoestima del paciente.

Botulinum toxin type A could be used in various situations of dental interest including temporomandibular disorders, parafunctional habits, masseter muscle hypertrophy, facial paralysis, lip asymmetry and more recently in the cases of hyper myotonic lips and gummy smile. The aim of this paper is to report the case of a patient with complaint of gingival aesthetic smile. The application of botulinum toxin promoted the uniform dehiscence of the upper lip and minimized the discomfort caused by the gummy smile in a fast and little invasive way, showing that botulinum toxin can become an effective therapeutic alternative for the treatment of gummy smile, favoring facial aesthetics and patient self-esteem.

Toxina botulínica no sorriso gengival: recurso terapêutico complementar ao tratamento ortodôntico / The use of Botulinum toxin in gingival smile: therapeutic resource complementary to the orthodontic treatment

A toxina botulínica é produzida pela bactéria Clostridium botulinum e produz sete sorotipos, sendo que o tipo A apresenta maior emprego clínico. Este fármaco vem sendo amplamente utilizado com sucesso na área estética e terapêutica na Medicina. Na Odontologia, é indicada para sorriso gengival, disfunções temporomandibulares, hábitos parafuncionais (bruxismo e briquismo), hipertrofia massetérica, distonia oromandibular, sialorreia, paralisia facial, e na prevenção de fraturas e perdas protético-implantares reduzindo forças mastigatórias em pacientes com carga mastigatória excessiva. O escopo desse artigo é apresentar o caso de uma paciente com deformidade dentoesquelética (dentadura mista Classe II de Angle mordida aberta) tratada na infância com técnica conjugada Ortopedia Funcional e Ortodontia. Na fase adulta, após a conclusão do tratamento ortodôntico e persistência do sorriso gengival, foi aplicada a toxina botulínica com o propósito de minimizar a queixa estética da paciente.(AU)

Botulinum toxin is produced by Clostridium botulinum bacterium and it produces seven serotypes, among which type A presents a greater clinical use. This drug has been widely used successfully in area of aesthetics and therapeutic Medicine. In Dentistry, it is indicated for gingival smile, temporomandibular disorders, parafunctional habits (bruxism and clenching), masseteric hypertrophy, oromandibular dystonia, sialorrhea, facial paralysis, and prevention of prosthetic-implant fractures and losses, reducing masticatory forces in patients with excessive masticatory load. The scope of this paper is to present the case of a patient with dental-skeletal deformity (mixed dentition Angle Class II open bite), treated in childhood with Functional Orthopedics and Orthodontics combined technique. In adult hood, after the conclusion of orthodontic treatment and persistence of gingival smile, botulinum toxin was applied in order to minimize the aesthetic complaint of the patient.(AU)

Extensive epidermoid cyst of the submental region.

Epidermoid cysts are malformations that are rarely observed in the submental region. Imaging has an important role in surgical planning according to the size and location of the cyst in relation to geniohyoid and mylohyoid muscles. This article reports the case of a 15-year-old female patient complaining of submental swelling. The differential diagnosis included infection, tumor, ranula, and abnormalities during embryonic development. The lesion was surgically excised using an extra-oral approach. The histopathological examination revealed a cyst wall lined with stratified squamous epithelium with the presence of several horny scales consistent with the diagnosis of an epidermoid cyst. No recurrences were found after 1 year of follow-up.

Harmonização da estética dentogengivofacial / Harmonization of dental, gingival and facial aesthetics

Atualmente a busca pela excelência estética tem-se tornado o objetivo principal no tratamento odontológico. O sorriso gengival é uma das queixas dos pacientes, já que tal situação pode influenciar a autoestima e o relacionamento social. A beleza do sorriso não está apenas na forma, posição e cor dos dentes, mas também nas características do tecido gengival, que devem ser tão harmoniosas quanto os dentes. O desenvolvimento de novas técnicas como a aplicação de toxina botulínica pode ser uma opção terapêutica mais conservadora quando comparada à intervenção cirúrgica no tratamento do sorriso gengival. O propósito deste trabalho é mostrar o caso de um paciente que apresentou discrepância dentogengival e sorriso gengival, tendo sido tratado pela cirurgia gengival ressectiva e aplicação de toxina botulínica, com vistas a otimizar a harmonia do sorriso e a estética facial(AU)

Currently, the search for aesthetic excellence is the main goal of the dental treatment. The gingival smile is a common patients' complaint, because it may influence the self-steem and social relationship. The beauty of the smile is not only related to tooth shape, position and shade, but also to the features of the gingival tissue, which should be as harmonious as the teeth. The development of new techniques, such as the application of botulinum toxin, may be a more conservative therapeutic option when compared to surgical intervention for the treatment of the gingival smile. The aim of this paper is to present a case report of dentogingival discrepancy and gingival smile, which has been treated with gingival resection surgery and application of botulinum toxin, optimizing the harmony of the smile and facial aesthetics(AU)

Sorriso gengival: complementação do tratamento conjugado Ortopedia Funcional e Ortodontia pela associação terapêutica entre toxina botulínica e cirurgia gengival ressectiva / Gingival smile: complementation of Functional Orthopedics and Orthodontics combined treatment by therapeutic association of botulinum toxin and resective gingival surgery

O sorriso é a expressão facial de felicidade, prazer e bom humor. Fisiologicamente e anatomicamente é o resultado da exposição dos dentes e da gengiva durante a contração de grupos musculares do terço médio e inferior da face. Quando a exposição gengival é maior que 3 mm, caracteriza-se a condição esteticamente desagradável, denominada por sorriso gengival, o que pode afetar psicologicamente e socialmente alguns pacientes. O propósito desse trabalho foi relatar o caso de uma paciente de 22 anos, apresentando sorriso gengival, que mesmo após tratamento multidisciplinar (ortopedia funcional, ortodontia, otorrinolaringologia e periodontal), ainda se reportou insatisfeita. Foram realizadas a cirurgia gengival ressectiva para a remoção de crescimento gengival e a aplicação da toxina botulínica, para a deiscência do lábio superior. Apesar de apresentar efeito temporário, a toxina botulínica associada a cirurgia gengival ressectiva, demonstrou ser uma opção terapêutica útil e viável no manejo do sorriso gengival, sendo uma técnica mais conservadora, efetiva e rápida.(AU)

Smile is a facial expression of happiness, pleasure and good mood. Physiologically and anatomically, it is the result of exposure of the teeth and gingiva during contraction of muscle groups of the middle and lower third of the face. When the gingival exposure is larger than 3 mm, an aesthetically displeasing condition known as gingival smile, is characterized, which can affect psychologically and socially some patients. The purpose of this study was to report the case of a 22 year-old patient presenting gingival smile; she reported dissatisfaction even after multidisciplinary treatment (functional orthopedics, orthodontics, otolaryngology and periodontal). Resective gingival surgery for gingival hyperplasia removal and application of botulinum toxin were carried out, for upper lip dehiscence. Despite presenting temporary effect, botulinum toxin associated with resective gingival surgery proved to be a useful and viable therapeutic option in the management of gingival smile, because it is a more conservative, effective and faster technique.

CONSIDERAÇÕES ÉTICO-LEGAIS SOBRE A APLICAÇÃO DE TOXINA BOTULÍNICA PELO CIRURGIÃO-DENTISTA / Ethical and legal considerations on the application of botulinum toxin by the dentist

Recentemente, a toxina botulínica vem angariando papel importante na terapêutica odontológica, após ser amplamente utilizada na Medicina, tanto com finalidades cosméticas quanto terapêuticas. A toxina botulínica é indicada em diversas patologias e condições estomatológicas, dentre elas as disfunções temporomandibulares, hábitos parafuncionais (bruxismo e briquismo), hipertrofia massetérica, paralisia facial, sialorreia, sorriso gengival e, preventivamente na redução de carga mastigatória excessiva após as reabilitações implantodônticas. Perante a elevada oferta de cursos de toxina botulínica em Odontologia no mercado nacional - alguns dos quais equivocadamente focados em estética facial - o propósito deste trabalho é orientar o cirurgião-dentista elucidando possíveis questionamentos referentes à utilização da toxina botulínica na área de atuação da Estomatologia. O presente trabalho também apresenta recomendações e diretrizes para a aplicação da toxina botulínica em nossa atividade profissional, evitando possíveis processos éticos e legais contra o cirurgião-dentista.

Recently, the botulinum toxin has raising important role in dental therapy, after being widely used in medicine, with both cosmetic and therapeutic purposes. Botulinum toxin is indicated in several pathologies and stomatological conditions, among them: temporomandibular disorders, parafunctional habits (bruxism and clenching), masseteric hypertrophy, facial paralysis, drooling, gummy smile and, preventively, in reducing excessive masticatory load after implantodontic rehabilitation. Given the high availability of courses of botulinum toxin in dentistry in the domestic market - some of which mistakenly focused on facial aesthetics - the purpose of this work is to guide the dentist, elucidating possible questions regarding to the use of botulinum toxin in the field of Stomatology . This paper also presents recommendations and guidelines for the application of botulinum toxin in our professional activity, in order to avoid potential ethical and legal litigations against the dentist.

Gingival resection surgery complementation through botulinum toxin application at the management of gummy smile

Introduction:The gummy smile is characterized by a marked gingival exposure on smiling and it has been considered as one of the main complaints of patients, also influencing on self-esteem and social relationship. The development of new techniques such as botulinum toxin application may be a more conservative treatment option than surgical intervention (myectomy and Le Fort I osteotomy) in the treatment of gummy smile. Objective: To present the case of a patient who presented dental-gingival discrepancy and gummy smile, treated by gingival resection surgery and complemented by the application of botulinum toxin. Case report: A female patient, 23 years old, presented dental-gingival discrepancy and gummy smile, treated by gingival resection surgery and complemented by the application of botulinum toxin. Results: The gingival resection surgery promoted improvement of dental relationship, caused by increase of dental zenith and the application of botulinum toxin caused uniform dehiscence of the upper lip, increasing the harmony of the smile and improving self-esteem and quality life. Conclusion: Botulinum toxin is an additional option in the cosmetic improvement of the smile and gives better results when combined with gingival resection surgery.

Estética dentogengivofacial angariada pela cirurgia gengival ressectiva associada à aplicação de toxina botulínica / Dental, gingival and facial aesthetic obtained by resective gingival surgery associated to the application of botulinum toxin

Atualmente, a busca pela excelência estética tem se tornado o objetivo principal no tratamento odontológico. O sorriso gengival é uma das queixas dos pacientes, já que tal situação pode influenciar a autoestima e o relacionamento social. A beleza do sorriso não está apenas na forma, posição e cor dos dentes, mas também nas características do tecido gengival, que devem ser tão harmoniosas quanto os dentes. O desenvolvimento de novas técnicas, como a aplicação de toxina botulínica, pode ser uma opção terapêutica mais conservadora quando comparada à intervenção cirúrgica no tratamento do sorriso gengival. O propósito deste trabalho foi relatar o caso de um paciente que apresentava discrepância dentogengival e sorriso gengival, sendo tratado pela cirurgia gengival ressectiva e aplicação de toxina botulínica, otimizando a harmonia do sorriso e a estética facial.