Contemporary treatment techniques for excessive gingival display caused by altered passive eruption or lip hypermobility.

OBJECTIVES: Excessive gingival display (EGD), also known as gummy smile, has various causes, including altered passive eruption (APE) and hypermobile upper lip (HUL). This state-of-the art narrative review explores current concepts regarding soft tissue EGD etiologies and the contemporary modalities available for APE or HUL treatment. DATA, SOURCES, STUDY SELECTION: Literature search was conducted for a narrative review on the etiology, diagnosis, and treatment of EGD caused by APE and HUL. Searching for articles was carried out in PubMed and Google Scholar. Published articles, including case reports, case series, observational and interventional clinical trials, and critical appraisals of the literature (e.g., systematic reviews) on the etiology, diagnosis, and treatment of EGD caused by APE and HUL were retrieved and reviewed. Particular focus was placed on novel treatment modalities introduced in the last five years. CONCLUSIONS: Recent research evidence indicates that APE and HUL are the two major soft tissue-based EGD etiologies. Aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) are the established surgical treatment modalities for APE and HUL, respectively. The last few years have seen the introduction of new techniques for APE and HUL management, an expansion of the available ACL and LRS technique variations, and additional evidence further supporting the effectiveness of these two procedures. Several of the recently introduced approaches offer unique, innovative, and potentially impactful concepts. However, for many of these newly described treatments the available evidence is limited to case reports and the exact indications remain to be adequately defined. CLINICAL SIGNIFICANCE: Altered passive eruption and hypermobile upper lip are the common soft tissue causes of gummy smile and can be successfully managed through aesthetic crown lengthening and lip repositioning surgery, respectively. A wide range of newly introduced approaches promises to further facilitate gummy smile treatment and improve outcomes.

Antineoplastic therapy in childhood cancer patients presents a negative impact in the periodontal tissues: a cohort study.

OBJECTIVES: To investigate the effect of antineoplastic therapy (AT) in the periodontal tissues of childhood cancer (CC) patients. MATERIALS AND METHODS: Seventy-two individuals were divided into CC (n=36) and healthy individuals (control group-CG, n=36). Demographics, hygiene habits, CC type, and AT were collected. Salivary flow and the presence and concentration of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Fusobacterium nucleatum were analyzed. Clinical evaluation included plaque (PI) and gingival indexes (GI), periodontal probing depth (PPD), and clinical attachment level (CAL). Patients were classified into periodontal health, gingivitis, or periodontitis. Descriptive statistics, T test, Mann-Whitney test, chi-square, Fisher's exact test, and two-way analysis of variance were used (p<0.05). RESULTS: The mean age of the patients was similar (CC 12.0±3.9 years and CG 12.0±4.0 years). In the CC group, all patients underwent chemotherapy and nine radiotherapy. Color/race, income, and family education showed significant differences between groups. There was no difference between groups in salivary flow. Higher levels of Fusobacterium nucleatum were seen in CC (p=0.02). Significant difference between groups was found for PI (CC: 30.5%, CG: 22.6%), GI (CC: 28.8%, CG: 17.3%), PPD (CC: 1.77 mm, CG: 1.61 mm), and CAL (CC: 1.77 mm, CG: 1.57 mm), periodontal health (CC: 3, CG: 7), gingivitis (CC: 16, CG: 24), or periodontitis (CC: 17, CG: 5). CONCLUSION: AT in CC patients presents a negative impact in the periodontal and microbiological parameters. CLINICAL RELEVANCE: Childhood cancer individuals showed worse periodontal parameters and higher levels of Fusobacterium nucleatum in the saliva when compared to healthy individuals.

Gingival pigmentation: Concurrent assessment of distribution, intensity, and extent in a black population.

OBJECTIVE: To evaluate prevalence, distribution, intensity and extent of physiologic gingival melanin pigmentation (GMP) in black individuals. MATERIALS AND METHODS: For this cross-sectional study, GMP was evaluated on digital images by three calibrated examiners, according to de Krom (distribution), DOPI (intensity) and Melanin Index (extent) classifications. Descriptive statistics, Wilcoxon, Mann-Whitney, Kruskal-Wallis, Two-way ANOVA, chi square, and K-means cluster analysis were used. RESULTS: Seventy participants were recruited. The most prevalent GMP categories were: de Krom category 2 (34.3%), DOPI heavy intensity (57.2%), and Melanin index Degree IV (50%). Significant inter-group differences were found for age (p < 0.05) but not gender (p > 0.05). Significant correspondence/overlap was observed between classifications (p > 0.05). Three GMP clusters were identified: Cluster 1 (27%; n = 19) had mild asymmetric and interspersed pigmentation; Cluster 2 (46%; n = 32) had heavy pigmentation in one long continuous ribbon, with pink marginal gingiva; and Cluster 3 (27%; n = 19) had heavy pigmentation in one long continuous ribbon, symmetric, and uniform. CONCLUSIONS: There may be overlap among GMP classification systems. In black individuals, the predominant GMP presentation is one of a broad zone of heavily pigmented attached gingiva, in a continuous strip from central incisors to canines, symmetrical across the midline, and with pink free marginal gingiva. CLINICAL RELEVANCE: This is the first study to analyze distribution, intensity, and extent of gingival melanin pigmentation in the same population and to integrate the various classification systems through cluster analysis. The novel findings provide a foundation for patient assessment and counseling and for future studies.

Aesthetic crown lengthening and lip repositioning surgery: Pre- and post-operative assessment of smile attractiveness.

AIM: To assess the effect of aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) on perception of smile attractiveness. MATERIALS AND METHODS: Preoperative and 6-month postoperative smile photographs of ACL- or LRS-treated patients were evaluated by 100 raters (five gender-balanced groups of ten per procedure) of diverse background (dental students, general dentists, periodontists and laypersons with and without any aesthetic concerns about their own smile). Smile attractiveness was rated by visual analogue scale (VAS). Multivariate mixed-effect models were applied to determine the effect of procedure, rater (age, gender and group) and case (gingival display and GD) on smile attractiveness rating. RESULTS: Average preoperative and postoperative VAS scores for ACL patients were 3.8 ± 2.0 and 6.2 ± 1.9, respectively. Corresponding LRS patient values were 4.8 ± 2.0 and 6.4 ± 1.9. Treatment, baseline GD and rater age were significant determinants (p < .001) of smile attractiveness for both procedures. Rater gender was not significant. Rater group was significant (p < .032) only for ACL. Procedure (p < .001), baseline VAS (p < .001), change in GD (p ≤ .002) and rater age (p ≤ .017) were significant determinants of smile attractiveness change from preoperative to postoperative. CONCLUSIONS: ACL and LRS are two periodontal plastic surgery procedures that deliver significant smile attractiveness improvements, in the eyes of both laypersons and dental professionals.

The Influence of TLR4, CD14, OPG, and RANKL Polymorphisms in Periodontitis: A Case-Control Study.

The pathogenesis of periodontitis involves a complex interaction between the microbial challenge and the host immune response. The individual immunoinflammatory response has a great contribution in the pathogenesis of the disease and becomes a trigger in the process of bone remodeling which is a characteristic of the disease. Thus, the aim of this study was to evaluate the influence of the TLR4 A896G (rs4986790), TLR4 C1196T (rs4986791), CD14 C-260T (rs2569190), RANKL (TNFSF11, rs2277438), and OPG (TNFSF11B C163T, rs3102735) polymorphisms in periodontitis. A case-control study was conducted on patients with periodontitis (N = 203) and controls (N = 213) over 30 years of age, without diabetes mellitus, acute infections, and osteoarthritis, and patients without aggressive periodontitis, i.e., stage IV and C degree of periodontitis, and any periodontal treatment performed in the last 6 months. Genotypes were determined by the PCR-RFLP and sequencing method. The frequency comparisons between case and controls were performed using the chi-square test and logistic regression (OpenEpi and SNPStats software). The risk (OR) was evaluated for values of P < 0.05. Differences in TLR4, CD14, RANKL, and OPG genotype and allele frequency distributions were not observed between patients and controls. However, some variants were a risk factor for the development of periodontitis when considering gender and smoking habits. The TLR4 896 A/G genotype was a risk factor for periodontitis in males (OR = 2.86), and the TLR4 1196C/C genotype was a risk factor for nonsmoking males (OR = 1.85) when compared to women. The RANKL A/A and the OPG T/C genotype was associated with the risk of the disease in nonsmoking men compared to nonsmoking women with the same genotype (OR = 1.96 and OR = 2.9, respectively). In conclusion, TLR4, CD14, RANKL, and OPG variants were not associated with periodontitis. However, TLR4, RANKL, and OPG polymorphisms could be a risk for periodontitis in males regardless of smoking habits.

IL18 Polymorphism and Periodontitis Susceptibility, Regardless of IL12B, MMP9, and Smoking Habits.

Genetic variations contribute to the susceptibility in the development of periodontitis. The aim of this study was to investigate the influence of IL18, IL12, and MMP9 polymorphisms in the chronic periodontitis. This case-control study involved 381 individuals matched by gender and age. Genotyping of IL18 (rs187238 and rs1946518) and IL12B (rs3212227) was performed by PCR-SSP and PCR-RFLP was used for MMP9 (rs3918242). IL-18 and MMP-9 were quantified in the serum by ELISA. SNPStats and OpenEpi software were used for statistical analysis and, in order to eliminate smoking as a confounding factor, the analyses were also performed in nonsmoking subjects. The IL18-137G/C genotype was associated with the risk of chronic periodontitis in nonsmokers (P c = 0.03; OR = 1.99; overdominant inherence model). In the multivariate analyses, homozygous IL18-137G/G and IL18-607C/C were more frequent in males compared to women with these same genotypes (OR = 2.51 and OR = 3.30, respectively). The serum levels of the IL-18 in patients were higher than those in healthy controls (P = 0.005). IL12B and MMP9 polymorphisms and MMP-9 serum concentration were similar in patients and controls. In this study, IL18 was associated with chronic periodontitis susceptibility. Men had greater risk than women for developing the disease when IL18 polymorphism was considered and the susceptibility was independent of the smoking status.

Socket healing with and without immediate implant placement.

The aim of the present review was to describe the studies produced in Latin America that contributed to the elucidation of the effect of tooth extraction with and without immediate implant installation. An electronic search was conducted in MEDLINE (PubMed), Scopus, Scielo, Lilacs, and Embase to include clinical and experimental (animal) studies on immediate implants. The studies selected had to fulfill the following inclusion criteria: (i) to present clinical and/or histological data on socket healing with or without immediate implant installation; (ii) to be approved by a Latin American Ethic Committee or comparable; and (iii) to include at least one author from a Latin American institution or to be conducted in a Latin America institution. Latin American studies that fulfilled these criteria demonstrated that immediate implant installation was conducive for predictable osseointegration and high survival rates but failed to prevent bone modeling and dimensional reduction of the alveolar ridge. In addition, it was also shown that regenerative approaches, including hard and soft tissue grafts at the time of immediate implant placement, may be beneficial to compensate for the alveolar ridge reduction. Regenerative approaches immediately after tooth extraction may decrease the amount of dimension reduction of the alveolar ridge.

Plaque-induced gingivitis: Case definition and diagnostic considerations.

OBJECTIVE: Clinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC. IMPORTANCE: A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance. FINDINGS: Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.

Plaque-induced gingivitis: Case definition and diagnostic considerations.

OBJECTIVE: Clinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC. IMPORTANCE: A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance. FINDINGS: Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.

Short-term changes on C-reactive protein (CRP) levels after non-surgical periodontal treatment in systemically healthy individuals.

OBJECTIVES: The aim of the present study was to evaluate serum C-reactive protein (CRP) levels in chronic periodontitis patients and periodontally healthy individuals and to assess the effect of non-surgical periodontal treatment on the CRP levels. MATERIALS AND METHODS: Twenty-two patients with chronic periodontitis (test group) and 22 periodontally healthy individuals (control group), both groups without any systemic disorder or potential confounding factors, were included in the study. At baseline, periodontal clinical variables and CRP levels were obtained in both groups. In the test group, oral hygiene instruction and scaling and root planning were carried out; then, after 60 days, periodontal clinical variables and CRP levels were reevaluated. RESULTS: The baseline CRP level in the test group was significantly higher than the corresponding value in the control group (1.98 ± 1.55 vs. 1.26 ± 1.05 mg/L; p < 0.05). After periodontal treatment in the test group, there were improvements in all periodontal clinical variables (p < 0.05). The CRP level decreased significantly in those patients with higher baseline levels of CRP (>3 mg/L). CONCLUSIONS: Chronic periodontitis seemed to promote elevated levels of CRP. Furthermore, non-surgical periodontal treatment significantly decreased the levels of CRP only in patients with high baseline levels of such pro-inflammatory cytokine. CLINICAL RELEVANCE: Periodontitis may be a potential factor to change the risk of CVD. Thus, the control of periodontal infection performed by health professionals may improve cardiovascular health.

Avaliação retrospectiva das características dos implantes instalados na faculdade Ingá entre 2005 e 2014 / Retrospective evaluation of the characteristics of dental implants installed in the University Inga between 2005 and 2014

Objetivo: avaliar retrospectivamente as características dos implantes colocados no curso de especialização do Centro Universitário Ingá (Uningá). Material e métodos: os prontuários dos pacientes que realizaram tratamento entre 2005 e 2014 na Uningá foram analisados quanto à saúde sistêmica, sexo, idade, local de colocação, uso de enxertos, diâmetro e comprimento dos implantes, e complicações. Resultados: neste centro, 108 pacientes receberam 307 implantes de quatro marcas comerciais diferentes (154 na maxila e 160 na mandíbula). Os implantes foram instalados mais em mulheres (67,6%), principalmente na região posterior (76,7%), tanto de maxila (49%) quanto de mandíbula (51%), com o uso de enxertos ósseos em cerca de 20% dos casos da maxila e somente 1% dos casos de mandíbula. Além disso, ainda são realizados muitos implantes longos (38,6% > 13 mm), de diâmetro regular (83,6% entre 3,75 mm e 4 mm) e com plataforma do tipo hexágono externo (97,7%). Conclusão: no local pesquisado, ainda são instalados muitos implantes na região posterior, longos e de diâmetro regular, com plataforma do tipo hexágono externo. Além disso, os enxertos ósseos são usados em um em cada dez casos de implantes, principalmente na maxila.

Objective: to retrospectively evaluate the characteristics of implants placed in the specialization course of the Inga University Center (Uningá). Material and methods: the medical records of patients who underwent treatment between 2005 and 2014 at Uningá were analyzed for systemic health, gender, age, area of installation, use of grafts, diameter and length of the implants and complications. Results: in this center, 108 patients received 307 implants (four different brands, 154 in maxilla and 160 in mandible). The implants were installed more frequently in women (67.6%), mainly in the posterior region (76.7%), in both maxilla (49%) and mandible (51%), with the use of bone grafts in 20% of maxillary cases and only 1% of cases in mandible. The prevalence of long (38.6%, 13 mm), regular diameter (83.6% between 3.75 mm and 4 mm), and external hex implants (97.7%) was great. Conclusion: at the Uningá, many implants in the posterior region, long and of regular diameter with external hexagonal platform are still installed. Moreover, bone grafts are used in 1 of each 10 cases of implants, mainly in th e maxilla.

Aesthetic crown lengthening: periodontal and patient-centred outcomes.

AIM: The objective of this prospective study was to assess clinical and patient-centred outcomes of aesthetic crown lengthening surgery for the treatment of altered passive eruption. MATERIALS AND METHODS: Twenty-two patients were treated and followed up for 6 months. The evaluated clinical parameters included, among others, probing depth, clinical attachment level, clinical crown length (CLc ), cemento-enamel junction to alveolar bone crest distance, gingival width (GW) and gingival display (GD). Subjects completed surveys to evaluate satisfaction with smile, gingiva and tooth features and experience with the procedure. RESULTS: Average CLc was 8.5 ± 0.5 mm at baseline and significantly increased (9.9 ± 0.5 mm; p < 0.0001) at 6 months. Concomitantly, GW significantly decreased from baseline (5.8 ± 1.2 mm) to 6 months (4.9 ± 1.1 mm; p < 0.008), as did GD (from 2.6 ± 2.0 mm to 1.1 ± 1.9 mm; p < 0.0001). In contrast to their pre-operative satisfaction level, the majority (≥73%) of patients were very satisfied post-operatively with gingival and tooth display, when smiling or talking, and with maxillary anterior tooth size and shape. All patients would undergo the procedure again and would recommend it to someone with a similar problem. CONCLUSION: Aesthetic crown lengthening surgery results in high levels of patient satisfaction and predictable and stable outcomes in the short term.

Alveolar socket healing: what can we learn?

Tooth extraction induces a series of complex and integrated local changes within the investing hard and soft tissues. These local alterations arise in order to close the socket wound and to restore tissue homeostasis, and are referred to as '"socket healing". The aims of the present report were twofold: first, to describe the socket-healing process; and, second, to discuss what can be learned from the temporal sequence of healing events, in order to improve treatment outcomes. The socket-healing process may be divided into three sequential, and frequently overlapping, phases: inflammatory; proliferative; and modeling/remodeling. Several clinical and experimental studies have demonstrated that the socket-healing process promotes up to 50% reduction of the original ridge width, greater bone resorption at the buccal aspect than at the lingual/palatal counterpart and a larger amount of alveolar bone reduction in the molar region. In conclusion, tooth extraction, once a simple and straightforward surgical procedure, should be performed in the knowledge that ridge reduction will follow and that further clinical steps should be considered to compensate for this, when considering future options for tooth replacement.

Soft Tissues Changes After Immediate and Delayed Single Implant Placement in Esthetic Area: A Systematic Review.

The aim of the present study was to conduct a systematic review of the literature to compare soft tissue aspects of immediate and delayed implant placement in esthetic areas. This review of literature was conducted in the following databases: MEDLINE (PubMed), Lilacs, Scielo, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). For those studies that met the inclusion/exclusion criteria, the results were analyzed and summarized according to the treatment protocol used for implant placement. The primary parameters taken into consideration were papilla level (PL) and marginal mucosa level (MML) around implants. Four randomized controlled trials (RCT) were selected for analysis, but all were deemed as being of poor quality according to quality assessment. No studies reported any statistically significant differences concerning the soft tissue esthetic parameters analyzed around immediate or delayed implants at any follow-up periods reported. However, PL results seemed to be more reliable than were MML results, due to the PL standardization of the method of analysis, which showed a tendency for poorer results around immediately placed implants. In conclusion, although the results are based on only a few poor quality RCTs, both treatment options for implant placement demonstrated similar outcomes in the esthetic area, especially when PL was considered.

Correção de sorriso gengival pela técnica de reposicionamento labial / Correction of gummy smile by lip repositioning technique

O sorriso gengival é uma condição que acomete uma proporção considerável da população causando, muitas vezes, um problema estético para o indivíduo. Dentre as diversas causas de sorriso gengival, a hiperfunção do músculo levantador do lábio superior é uma das mais significativas. Esse relato de caso teve por objetivo demonstrar uma forma alternativa, menos invasiva, de tratamento do sorriso gengival causado pela hiperfunção do músculo levantador do lábio superior. Paciente, gênero feminino, 22 anos, buscou a clínica com queixa de excesso de exposição gengival ao sorrir. Após anamnese e exame clínico, ficou caracterizado o sorriso gengival, com 4 mm de gengiva aparecendo durante o sorriso, causado por hiperfunção do músculo levantador do lábio superior. A paciente foi tratada pela técnica de reposição labial, em que duas faixas de mucosa de cerca de 10 mm de altura são removidas do fundo de vestíbulo, com preservação do freio. A mucosa foi reposicionada coronalmente e suturada. A paciente foi acompanhada por seis meses e, ao final deste período, demonstrava um sorriso mais harmônico com 1 mm de exposição gengival. Pôde-se concluir que a técnica utilizada é capaz de tratar adequadamente, promovendo uma diminuição na quantidade de exposição gengival, e de forma mais conservadora casos de sorriso gengival cuja causa é a hiperfunção do músculo levantador do lábio superior...

The gummy smile is a condition that affects a considerable proportion of the population, often causing a cosmetic problem for the individual. Among the various causes of gummy smile, the hyperfunctional upper lip elevator muscle is one of the most significant. This case report aims to demonstrate an alternative, less invasive, treatment for gummy smile caused by hyperfunctional upper lip elevator muscle. Female patient, 22 years old, sought the clinic complaining of excessive gingival display when smiling. After anamnesis and clinical evaluation the gummy smile was characterized, with 4 mm of gingiva appearing during smile, caused by hyperfunction of upper lip elevator muscle. The patient was treated by the lip repositioning technique, in which two strips of mucosa of about 10 mm height are removed from the bottom of the vestibule, with frenum preservation. The mucosa was coronally repositioned and sutured. The patient was followed up for six months and at the end of this period she showed a more harmonious smile with 1 mm of gingival exposure. It can be concluded that the technique is able to adequately, decreasing the amount of exposed gingiva, and conservatively treat cases of gummy smile caused by hyperfunction of upper lip elevator muscle...

Evaluation of the effects of periodontal treatment on levels of ascorbic acid in smokers.

Smokers consistently have lower levels of vitamin C, which is important for optimal healing, especially following invasive procedures. Some studies demonstrated that patients undergoing surgery experience significant reductions in systemic vitamin C levels, presumably due to higher metabolic utilization of existing vitamin pools. However, there appear to be no studies evaluating the effect of non-surgical periodontal therapy on plasma levels of vitamin C. The aim of this study was to evaluate if non-surgical periodontal therapy is able to reduce the plasmatic level of ascorbic acid (AA) in smokers. Twenty-six systemically healthy adult (> 40 years) smokers (10 cigarettes/day for > 5 years) who needed scaling and root planing (SRP) for chronic periodontitis were recruited. The sessions of SRP (per quadrant) were scheduled 7 days apart from each other. Blood was collected by venipuncture before the first session of SRP and at the end of the periodontal treatment. The ascorbate concentrations in plasma were assessed according to a published protocol. A paired t-test (p < 0.05) evaluated the statistical significance of differences between the mean values obtained pre- and post-treatment. In general, there was no significant change in levels of AA; however, in 38% of patients, increased levels of AA in plasma were observed after SRP. In 15% of the patients, no change was noted, while 47% of patients showed a reduction in levels of AA after SRP. It can be concluded that although almost half of individuals presented with reduced levels of ascorbic acid after treatment, SRP did not significantly change the levels of AA in smokers.

Restaurações em dentes posteriores com incremento único referente à dentina / Restorations in posterior teeth with single increase referred at the dentin

Introdução: recentemente foi lançada uma nova categoria de resinas para restaurações posteriores (Bulk Fill). Essa categoria tem a vantagem de mínima tensão pela contração durante o processo de polimerização, sendo um substituto da dentina. Caso clínico: este trabalho demonstra a resolução de restauração classe II no dente 35 utilizando esta nova técnica. O elemento dental apresentava restauração de amálgama onde foi constatada uma recidiva por cárie pela face distal, a qual foi removida e assim se obteve acesso direto a lesão cariosa. Após remoção e proteção pulpar foi adaptada a matriz e realizados os procedimentos adesivos. A parte da dentina foi substituída pela resina de autonivelamento para base em dentes posteriores (SDR) adaptada nas paredes de fundo e gengival, seguindo a inserção da resina referente ao esmalte IPS Empress Direct até sua conclusão. Conclusão: a técnica diminui o tempo clínico e facilita a adaptação da resina composta a parede gengival durante o procedimento restaurador

Treatment of excessive gingival display using a modified lip repositioning technique.

Excessive gingival display during smiling ("gummy smile") is an esthetic issue that affects a considerable part of the population. The hyperactivity of the elevator muscle of the upper lip is one of the main causes of a gummy smile, and several techniques have been proposed for its treatment. The aim of this report is to describe a modification of the lip repositioning technique to achieve stable and significant outcomes through a more conservative procedure. Two patients complaining about a gummy smile were treated with the proposed technique and presented, after a 6-month follow-up, significant improvement in the amount of gingival exposure and esthetic satisfaction.

Avaliação subjetiva da função do nervo alveolar inferior após cirurgia de lateralização / Subjective assessment of inferior alveolar nerve function after lateralization surgery

Introdução: a lateralização do nervo alveolar inferior é uma opção de tratamento para mandíbulas atróficas em que a reabilitação protética fica limitada pela reabsorção vertical na região posterior que resulta na proximidade entre o canal mandibular e o rebordo alveolar. Essa manobra cirúrgica pode resultar em dormência e alteração sensorial ao longo do trajeto do nervo. Objetivo: avaliar a função do nervo alveolar inferior e a satisfação do paciente após cirurgia de lateralização. Métodos: foram realizadas 20 cirurgias de lateralização com instalação imediata de 52 implantes. Todos os pacientes foram operados pelo mesmo cirurgião, seguindo um protocolo cirúrgico padronizado. Após 6 meses do procedimento, os pacientes responderam um questionário sobre a presença de alteração sensorial após a cirurgia e a satisfação com o resultado do procedimento. Resultados: todos os indivíduos relataram perturbação sensorial transitória inicial, com relatos de melhora a partir do terceiro dia, ocorrendo, em média, 45 dias após a cirurgia. Em um caso não houve melhora por completo em 6 meses. Mesmo com as alterações sensoriais, todos os pacientes fariam novamente ou indicariam a realização da cirurgia. Conclusões: a lateralização do nervo alveolar inferior pode ser segura e previsível, resultando em alteração sensorial mínima e reversível, sem danos significativos ao paciente, desde que realizada com protocolo cirúrgico padronizado.

Utilização de implante curto como opção de tratamento em região de maxila com altura óssea reduzida / Use of short implant as a treatment option in maxilla with reduced bone height

Os implantes dentários têm sido uma opção segura na reabilitação bucal. Os curtos, menores que 10mm, são usados em situações clínicas com grandes reabsorções ósseas após perda dentária, ao invés de um processo de enxertia óssea. Esse trabalho consiste no relato de um caso de perda do elemento dentário 15 há mais de 17 anos, e da consequente deficiência de volume ósseo remanescente. Entre as possíveis opções de tratamento com implantes dentários, foram apresentados os enxertos ósseos e instalação de implantes de tamanho convencional e implantes curtos. Como forma mais conservadora, de menor morbidade, de menor custo e com diminuição de tempo de tratamento, os implantes curtos tornaram-se a opção de escolha da paciente. Muitos trabalhos têm relatado altos índices de sucesso dos implantes curtos, considerando a importância da qualidade óssea, diâmetro, geometria, desenho e tratamento de superfície. Essa escolha de técnica pode ser uma boa alternativa de tratamento para áreas onde o volume ósseo é reduzido. Entretanto, o sucesso desse tipo de tratamento está relacionado à execução de um planejamento criterioso.