Vestibuloplastia con láser de Er Cr:YSGG y nanotransportador biomolécula EPX: un nuevo cicatrizante periodontal / Vestibuloplasty with Er Cr:YSGG laser and EPX biomolecule nanocarrier: a new periodontal healing agent

La resorción ósea alveolar suele dar lugar a que las inserciones de la mucosa interfieran para la construcción, estabilidad y retención de una prótesis removible, una opción que permite modificar este tejido se obtiene por medio de una vestibuloplastia. Actualmente se puede favorecer la cicatrización de heridas utilizando láser de alta potencia aplicado a procedimientos quirúrgicos orales. Se realiza reporte de caso en paciente femenino a la que se realizó procedimiento de vestibuloplastia con láser de Er,Cr:YSGG, utilizando de forma postoperatoria gel de quitosano en nanotransportador biomolécula EPX. Se observa una cicatrización rápida y favorable al combinar ambas terapéuticas, además al utilizar productos con quitosano se disminuye el riesgo de la necrosis de fibroblastos gingivales humanos como recientemente se reportó en el uso de colutorios de clorhexidina (AU)

Alveolar bone resorption often results in mucosal insertions interfering with the construction, stability and retention of a removable prosthesis, an option to modify this tissue is obtained by means of vestibuloplasty. Currently, wound healing can be promoted by using high power laser applied to oral surgical procedures. A case report of a female patient who underwent a vestibuloplasty procedure with laser Er,Cr:YSGG, using chitosan gel with EPX biomolecule nanocarriers postoperatively. A fast and favorable healing is observed when combining both therapeutics, besides, when using products with chitosan, the risk of necrosis of human gingival fibroblasts is reduced, as recently reported in the use of chlorhexidine mouthwashes (AU)

Aprofundamento de Vestíbulo para Adaptação de Prótese Total / Vestibular Deepening for Total Prosthesis Adaptation

Introdução: Rebordos alveolares com extensa reabsorção e com inserções musculares próximas à crista dificultam a adequada adaptação e estabilidade de próteses totais. A cirurgia pré-protética de aumento de vestíbulo, também conhecida como vestibuloplastia, é uma alternativa, que busca melhorar a retenção desses aparelhos protéticos, pois proporciona um aumento do rebordo residual. Relato de caso: O presente trabalho tem como objetivo relatar um caso clínico de aprofundamento de vestíbulo maxilar, realizado para melhorar a adaptação da prótese total. Paciente do sexo feminino, 68 anos de idade, com a queixa de instabilidade da prótese total superior. Ao exame clínico, observou-se um rebordo maxilar bastante reabsorvido e com inserções musculares baixas. Após a certificação de nenhum atestado mórbido clínico, o tratamento proposto foi a realização de vestibuloplastia, a fim de melhorar a estabilidade para uma nova prótese. Considerações finais: O ganho cirúrgico foi bastante satisfatório, e a paciente apresentou um resultado significativo de fundo de vestíbulo. O aprofundamento vestibular é uma opção para aumentar a área chapeável e melhorar a retenção de próteses totais. Mesmo que essa cirurgia se encontre em parcial desuso com o avanço da implantodontia, é possível a sua indicação na impossibilidade do uso de implantes osteointegrados... (AU)

Introduction: The Alveolar ridges with extensive reabsorption and muscular insertions closer to the bone crest make difficult the total prosthesis' adaptation and stability. The pre-prosthetic vestibular depth surgery, also known as vestibuloplasty is an alternative to increase the prosthetic retention devices because it provides an increase on the residual ridge. Case report: The aim of this work is to report a clinical test of maxillary vestibule deepening surgery, which was performed to improve the adaptation of the total prosthesis. A 68-year-old female patient complaining about the instability of her upper total prosthesis. At the clinical examination has shown a severe resorbed symptom on the maxillary ridge with shallow muscle insertions. After the analysis presents none clinical morbidity attested, the proposed treatment to improve the stability for a new prosthesis was the vestibuloplasty. Final considerations: The surgery achievement has been completely satisfactory, also the patient has presented a significant result for the vestibular deepening . The Vestibular deepening procedure is an option to increase the prosthetic area and retention of the total prosthesis. Even though this surgery is partially disused based on the progress of the implantology, it is possible its indication in cases that presents the impossibility of use osteointegrated implants... (AU)

Injerto de Piel en Territorio Oral: Presentación de un Caso / Skin Graft in Oral Cavity. Case Report

RESUMEN: Los injertos de piel consisten en la toma de un segmento de epidermis y dermis logrando una separación completa del sitio dador y del aporte vascular, transfiriéndolos a un sitio receptor. Existen dos tipos de injertos de piel: de espesor parcial y de espesor total. En cavidad oral se utilizan en reconstrucción de lengua, piso de boca, mucosa bucal y defectos producto de maxilectomías. Se presenta el caso de un paciente sexo masculino 26 años que acudió por secuela de tejidos duros y blandos secundarios a trauma facial hace 7 años. Al examen se observó pérdida de fondo de vestíbulo en sector mandibular anteroinferior y pérdida de piezas anteroinferiores. Bajo anestesia general, se realizó vestibuloplastía más injerto de piel de espesor parcial abordando el antebrazo izquierdo de donde se tomó el injerto de piel con el dermatomo. Se llevó el injerto a boca posicionándolo con la dermis hacia la zona cruenta del sitio receptor, cubriendo la cara interna de labio denudada y fijándolo con sutura continua. Se instaló splint de acrílico en el área para mantener colgajos en posición fijándolo con 3 tornillos de 15 mm. Debemos considerar todos los requisitos funcionales de la cavidad oral al momento de planificar una reconstrucción. El injerto de piel de espesor parcial permite tener una buena resistencia, movilidad adecuada y menor contracción por cicatrización. El paciente evoluciona de manera satisfactoria con una clara mejoría en la función labial, en la morfología del vestíbulo oral y en su estética.

ABSTRACT: Skin grafts consist in taking a segment of dermis and epidermis, achieving a complete separation of the donor site and vascular supply, and transferring them to a receptor site. There are two types of skin grafts: split-thickness and full-thickness. In the oral cavity, they are used in tongue reconstruction, oral mucosa reconstruction, floor of mouth reconstruction and in defects product of maxillectomies. We present a case of a 26-year-old male patient who presented sequelae of hard and soft tissues secondary to facial trauma. Clinical examination showed a compromised vestibule and loss of anterior mandibular teeth. Under general anesthesia, soft tissue management consisting of vestibuloplasty and a split-thickness skin graft was performed. The skin graft was taken from the forearm with a dermatome. The graft was then taken to the mouth with the dermis towards the wounded area of the recipient site, covering the inner face of the denuded lip and fixing it with sutures. An acrylic splint was installed in the area to keep the flaps and skin graft in position, fixing it with three 15 mm screws. We must consider all functional requirements of the oral cavity when planning a reconstruction. The split-thickness skin graft allows for good resistance, adequate mobility and less contraction due to scars. The patient evolves with definite improvement in labial function, the morphology of the oral vestibule and in its aesthetic.

Técnica de Alemán y Pico para la profundización del surco vestibular inferior / Alemán and Pico technique for deepening the inferior vestibular edge

A pesar de los avances en la tecnología para preservar la dentición, aún se requiere la rehabilitación del sistema masticatorio en pacientes desdentados parcial o totalmente, lo que resulta difícil y frustrante -- tanto para los afectados como para los protesistas -- si existe atrofia grave del hueso alveolar. Este problema se puede solucionar mediante una intervención quirúrgica denominada profundización del vestíbulo, dirigida a lograr el aumento de la cresta alveolar y, con ello, el soporte de las prótesis dentales. A tal efecto, en el presente trabajo se propone y describe una nueva opción terapéutica: la técnica de Alemán y Pico, para la profundización del surco vestibular inferior, la cual no es tan invasiva y resulta factible cuando no se cuenta con las condiciones necesarias para colocar implantes, ya sea por escasez de recursos materiales o por situaciones propias del paciente(AU)

In spite of the advances in technology to preserve the eruption of teeth, the rehabilitation of the masticatory system is still required in partial or totally toothless patients, what is difficult and frustrating -- either for those affected patients or for the prosthesists -- if serious atrophy of the alveolar bone exists. This problem can be solved by means of a surgical procedure denominated deepening of the vestibule directed to achieve the increase of the alveolar crest and, with it, the support of the dental prosthesis. To such an effect, this work intends and describes a new therapeutic option: the Alemán and Pico technique, for deepening of the inferior vestibular edge, which is not so invasive and it is feasible when the necessary conditions to place an implant are not available, either due to shortage of material resources or due to situations of the patients themselves(AU)

Técnica de Alemán y Pico para la profundización del surco vestibular inferior / Alemán and Pico technique for deepening the inferior vestibular edge

A pesar de los avances en la tecnología para preservar la dentición, aún se requiere la rehabilitación del sistema masticatorio en pacientes desdentados parcial o totalmente, lo que resulta difícil y frustrante -- tanto para los afectados como para los protesistas -- si existe atrofia grave del hueso alveolar. Este problema se puede solucionar mediante una intervención quirúrgica denominada profundización del vestíbulo, dirigida a lograr el aumento de la cresta alveolar y, con ello, el soporte de las prótesis dentales. A tal efecto, en el presente trabajo se propone y describe una nueva opción terapéutica: la técnica de Alemán y Pico, para la profundización del surco vestibular inferior, la cual no es tan invasiva y resulta factible cuando no se cuenta con las condiciones necesarias para colocar implantes, ya sea por escasez de recursos materiales o por situaciones propias del paciente

In spite of the advances in technology to preserve the eruption of teeth, the rehabilitation of the masticatory system is still required in partial or totally toothless patients, what is difficult and frustrating -- either for those affected patients or for the prosthesists -- if serious atrophy of the alveolar bone exists. This problem can be solved by means of a surgical procedure denominated deepening of the vestibule directed to achieve the increase of the alveolar crest and, with it, the support of the dental prosthesis. To such an effect, this work intends and describes a new therapeutic option: the Alemán and Pico technique, for deepening of the inferior vestibular edge, which is not so invasive and it is feasible when the necessary conditions to place an implant are not available, either due to shortage of material resources or due to situations of the patients themselves

Vestibuloplastia con la técnica de Edlan Mejchar: descripción de cuatro casos clínicos / Vestibuloplasty with Edlan Mejchar technique: description of four clinical cases

Antecedentes: En ocasiones, las retracciones gingivales se asocian a altas fuerzas tensionales de los músculos y a vestíbulos poco profundos. Dichas retracciones generan problemas periodontales a los pacientes por la dificultad de limpiar estas zonas. La vestibuloplastia por medio de la técnica de Edlan Mejchar permite, en una sola intervención y un solo campo quirúrgico, controlar los factores etiológicos y una inserción trepadora de la encía al eliminar las fuerzas tensionales. Objetivo: Describir la efectividad de la técnica de Edlan Mejchar empleada para solucionar retracciones gingivales producidas por fuerzas tensionales en cuatro casos clínicos. Descripción de los casos: Se presentaron cuatro pacientes con retracciones gingivales en dientes incisivos inferiores con poca encía adherida debida a fuerzas tensionales del frenillo labial inferior. Como tratamiento se usó la técnica de Edlan Mejchar que incluyó una incisión supraperióstica y relajantes internas en el tejido conjuntivo. Resultados: El porcentaje de cobertura radicular logrado después del procedimiento fue de aproximadamente el 60 % y se eliminaron inserciones anómalas del frenillo. Conclusiones: La técnica de Edlan Mejchar de vestibuloplastia mostró resultados favorables en los casos descritos en los cuales el frenillo labial ejercía fuerzas tensionales sobre el periodonto de dientes anteriores inferiores.

Background: Sometimes gingival retractions are associated with high muscular tensional forces and shallow vestibules. Such retractions cause periodontal problems to patients due to the cleaning access limitations. Edlan Mejchar vestibuloplasty technique allows controlling, in one intervention and a single surgical field, etiological factors and a creeping gingival attachment by eliminating tensional forces. Purpose: To describe the effectiveness of Edlan Mejchar technique to solve gum retractions caused by tensional forces in four clinical cases. Description of cases: Four patients with gingival retractions in lower incisors and little adhered gingiva due to lower lip frenulum tension seek dental treatment. Edlan Mejchar vestibuloplasty was the surgical treatment chosen, which consisted of supraperiosteal incisions and internal dissections in connective tissue. Results: The percentage of root coverage achieved was close to 60 % and abnormal frenulum insertions were eliminated. Conclusion: Vestibuloplasty through Edlan Mejchar technique showed favorable results in the cases described in which the labial frenum exerted tensional forces on the periodontium of lower anterior teeth.

Vestibuloplastia peri-implantar associada à regeneração tecidual guiada no tratamento da peri-implantite / Peri-implant vestibuloplasty and guided tissue regeneration in the peri-implantitis treatment

Levando em consideração que a peri-implantite é de etiologia multifatorial, embora o fator determinante seja o biofilme dentário, é interessante buscar formas de minimizar as perdas ósseas ocorridas. Desta maneira, ainda que ressalvas possam ser feitas à possibilidade concreta de se obter uma regeneração tecidual guiada, pode-se entender como uma alternativa válida para buscar, pelo menos, estabilizar o processo de progressão desta perda. Concomitantemente a este procedimento, e tendo em vista a indicação de vestibuloplastia para melhor prevenção da recidiva de peri-implantite, foi possível obter um resultado favorável dentro do objetivo proposto, em uma única intervenção cirúrgica. Material e métodos: paciente do sexo feminino, com 68 anos de idade, fumante moderada (8-10 cigarros/dia), se apresentou com exsudato purulento na face mesiovestibular do implante 46. Debelada a fase aguda por meio de fisioterapia local, a paciente foi submetida à cirurgia peri-implantar visando à interceptação da perda óssea por meio de "regeneração tecidual guiada" associada à vestibuloplastia, com a utilização de enxerto gengival subepitelial. Resultados: foi possível obter estabilização da perda óssea, bem como diminuição na profundidade de sondagem, além da redução de exsudato no implante em discussão. Conclusão: além disso, a vestibuloplastia criou melhores condições anatômicas estruturais devido ao tecido ceratinizado obtido e, sobretudo, criou um favorável acesso à escovação em toda a extensão dos quatro implantes, antevendo- -se melhor possibilidade de preservação do resultado.

Taking into account that the peri-implantitis is of multifactorial etiology, although the determining factor is the dental biofilm, it is interesting to look for ways to minimize the bone losses that have occurred. Thus, although safeguards can be made to the concrete possibility of obtaining a guided tissue regeneration, it can be understood as a valid alternative to seek to at least stabilize the process of progression of this loss. Concomitantly to this procedure and in view of the indication of vestibuloplasty for better prevention of recurrence of peri-implantitis, it was possible in a single surgical intervention to obtain a favorable result within the proposed objective. Material and methods: a 68-year-old female patient, moderate smoker (8-10 cigarettes/day) presented with purulent exudate on the mesiobuccal surface of the implant in the region of the 46. After the acute phase, through local physiotherapy, the patient underwent to peri-implant surgery aiming the interception of bone loss by means of "guided tissue regeneration" associated with vestibuloplasty with the use of subepithelial gingival graft. Results: it was possible to obtain a stabilization of the bone loss, as well as a decrease in the depth of probing, besides the reduction of exudate in the implant under discussion. Conclusion: the vestibuloplasty created better anatomical structural conditions due to the keratinized tissue obtained, and above all, the favorable access to brushing throughout the four implants, predicting a better possibility of preservation of the result.

Vestibuloplastia con láser: Reporte de caso / Laser vestibuloplasty: Case report

En pacientes edéntulos totales, uno de los desafíos para rehabilitación bucal es la confección de prótesis en un reborde alveolar con avanzada resorción ósea, lo que hace necesario realizar cirugías preprotésicas que preparen las bases óseas y los tejidos blandos circundantes para recibir la prótesis mucosoportada, brindando retención y adecuado soporte; además de generar menor cantidad de trauma posible, permitiendo la pronta cicatrización tisular. Se presenta el caso de mujer de 56 años, sin antecedentes médicos relevantes. Refiere portar prótesis totales desde hace 14 años, las cuales se encuentran desadaptadas. Al examen clínico intraoral se observan rebordes colapsados y reabsorbidos. Debido a la falta de retención en los rebordes inferiores, se realizó cirugía de profundización del vestíbulo con láser. Se obtiene a los 18 días tejido completamente cicatrizado, con una recuperación en profundidad del vestíbulo de 6 mm en sector anterior y 4 mm en posterior. Finalmente se rehabilita con prótesis total bimaxilar. Se concluye que la vestibuloplastia láser permite profundizar el vestíbulo y ofrece las ventajas de la incisión láser que disminuye la hemorragia, brinda mejor campo operatorio, disminuye la inflamación y el dolor postoperatorio.

One of the greatest challenges when rehabilitating fully edentulous patients, is to manufacture a denture to be placed on an alveolar ridge with advanced bone resorption. This requires performing pre-prosthetic surgery and prepare groundwork bone and surrounding soft tissues to receive a tissue-borne prosthesis, as well as providing suitable retention and support. This will elicit lesser trauma and thus allow prompt tissue healing. The case here presented is that of a 56 year old female, with non-contributory medical history. The patient had been wearing dentures for the last 14 years; her dentures were ill-adapted. Intra-oral clinical examination revealed collapsed and re-absorbed ridges. Due to a lack of retention in the lower ridges, a laser surgery was performed to deepen the vestibule. 18 days after surgery tissues were completely healed, the vestibule had recovered 6 mm depth in the anterior section and 4 mm in the posterior section. Rehabilitation was completed with the manufacture of full bi-maxillary dentures. It was thus concluded that laser vestibuloplasty confers depth to the vestibule and offers the advantages of laser incision, which decreases hemorrhage, provides better operating field and reduces post-operative inflammation and pain.

Manejo quirúrgico de frenillos labiales sobreinsertados: reporte de caso / Surgical management of upper inserted labial frenums: a case report

Los frenillos labiales patológicos son comúnmente observados en la práctica clínica en grupos etarios no especificados. La presencia de frenillos sobreinsertados ocasiona no sólo alteraciones estéticas, sino también, alteraciones de tipo periodontal, protésicas, ortodónticas, e inclusive fonéticas, por lo cual es importante analizar el cuadro clínico, efectuar un apropiado examen radiográfico, establecer el diagnóstico correcto y aplicar el tratamiento más adecuado entre los distintos que hoy en día se utilizan. Se reporta el caso de una paciente de 21 años de edad de sexo femenino que asistió a consulta manifestando insatisfacción estética por presencia de frenillo labial superior e inferior sobreinsertados. Se practicó frenectomía y vestibuloplastia cuya finalidad principal era la eliminación de las fibras de inserción del frenillo, causantes del diastema entre los dientes incisivos y patología periodontal. En el control postoperatorio, se observaron resultados estéticos y funcionales satisfactorios.

Pathological labial frenula are commonly observed in clinical practice in age groups not specified. The presence of inserted upper frenula brings not only an esthetic change, but also periodontal, prosthetic, orthodontic, and even phonetic alterations, hence the importance of analyzing the clinical case, obtaining an appropriate radiographic examination, establishing the correct diagnosis and implementing the most appropriate treatment from those used nowadays. We present a case of a 21 years old female patient that attended consultation expressing esthetical dissatisfaction due to the presence of inserted upper and lower labial frenula. Vestibuloplasty frenectomy was performed whose main purpose was to eliminate frenum attachment fibers causing incisive teeth diastema and periodontal disease. In the postoperative control, satisfactory aesthetic and functional results were observed.

The use of latex biomembrane in mandible vestibuloplasty: a case report / O uso de biomembrana de látex natural em vestibuloplastia de mandíbula: relato de caso clínico

Introduction: the latex biomembrane BiomembranaTM has been used in several medical specialties with promising results in promoting wound healing, including surgical, traumatic, isquemic and pressure-induced, as well as ulceration of varied etiology. However, in dentistry its use is not currently well established. Objective: the aim of this study was to describe a treatment for vestibuloplasty using a latex membrane. Case report: due to the inherent characteristics of the latex biomembrane (BiomembranaTM), a vestibuloplasty of the anterior sextant of the mandible was performed using Arruda?s technique of second intention healing modified by the use of a latex biomembrane, in order to assess its applicability and ability to maintain the depth of the vestibule in this type of surgery. Final considerations: latex membrane is an easy to use material which proved useful for vestibuloplasty, since it provided gain of attached gingiva, which remained stable during the 9-month follow-up period.

Estreitamento da base nasal no nariz caucasiano através da técnica de cerclagem / Nasal base narrowing of the caucasian nose through the cerclage technique

Introdução: Diversas técnicas podem ser realizadas para diminuir a base nasal (estreitamento), como ressecção de pele vestibular, ressecção de pele columelar, ressecção de pele em elipse do bordo narinário, descolamentos e avançamentos de pele (técnica V-Y de Berstein) e o uso de suturas na cerclagem da base nasal. Objetivo: Avaliar a técnica de cerclagem realizada na base nasal, através de rinosseptoplastia endonasal por técnica básica sem delivery, no nariz caucasiano, diminuindo a distância inter-alar e corrigindo o alar flare com consequente melhora da harmonia nasal no conjunto facial. Método: Realizado estudo retrospectivo através da análise das fotos e documentos clínicos de 43 pacientes, nos quais foi confeccionada a cerclagem da base nasal, através da ressecção de pele em elipse da região do vestíbulo e base nasal (técnica de Weir modificada), utilizando-se fio mononylon® incolor 4"0" com agulha reta cortante. O estudo foi realizado nos anos de 2008 e 2009 no Hospital Instituto Paranaense de Otorrinolaringologia - IPO em Curitiba-Paraná, Brasil. Os pacientes tiveram um follow up que variou de 7 a 12 meses. Resultados: Em 100% dos casos foi atingida uma melhora na harmonia nasal, através da diminuição da distância inter-alar. Conclusão: A cerclagem associada a ressecção mínima de pele vestibular e da base nasal é um método eficaz para o estreitamento da base nasal no nariz caucasiano, com resultados previsíveis e de fácil realização.

Introduction: Several techniques can be performed to reduce the nasal base (narrowing), as skin resection vestibular columellar skin resection, resection of skin in elliptical lip narinary, sloughing of skin and advancements (VY technique of Bernstein) and the use of cerclage sutures in the nasal base. Objective: To evaluate the technique of cerclage performed in the nasal base, through endonasal rhinoplasty without delivery of basic technique, in the Caucasian nose, reducing the distance inter-alar flare and correcting the wing with consequent improvement in nasal harmony in the whole face. Methods: A retrospective analysis by analysis of clinical documents and photos of 43 patients in whom cerclage was made of the nasal base by resecting skin ellipse in the region of the vestibule and the nasal base (modified technique of Weir) using colorless mononylon® 4 "0" with a straight cutting needle. The study was conducted in 2008 and 2009 at Hospital of Paraná Institute of Otolaryngology - IPO in Curitiba, Parana - Brazil. Patients had a follow up ranging 7-12 months. Results: In 100% of cases was achieved an improvement in nasal harmony, by decreasing the inter-alar distance. Conclusion: The encircling with minimal resection of vestibular skin and the nasal base is an effective method for the narrowing of the nasal base in the Caucasian nose, with predictable results and easy to perform.