Reabilitação oral em paciente acometido por cárie da primeira infância: relato de caso / Oral rehabilitation in a patient with severe early childhood caries: a case report

Objetivo: Apresentar as abordagens adotadas no tratamento estético reabilitador de paciente pediátrico acometido por cárie da primeira infância respeitando as individualidades e buscando a integralidade do paciente infantil. Relato do caso: O caso clínico descreve a reabilitação bucal realizada em uma criança de 4 anos e 6 meses de idade, diagnosticada com cárie da primeira infância. Após anamnese criteriosa, exames físicos e complementares e de posse do diagnóstico, estabeleceu-se um plano de tratamento obedecendo-se a todas as fases terapêuticas, nas quais a fase preparatória englobou abordagem psicológica, fluorterapia, exodontias e selamento dos dentes com cimento de ionômero de vidro. Posteriormente, procedeu-se à fase estético-re-abilitadora por meio de restaurações diretas e indireta, instalação de mantenedor de espaço estético-funcional e confecção e instalação de uma prótese total superior. Após a conclusão do tratamento odontológico, os responsáveis foram orientados quanto à necessidade e importância do tratamento multidisciplinar com o fonoaudiólogo para completa recuperação da saúde do paciente e de visitas periódicas ao cirurgião-dentista para acompanhamento. Conclusão: A reabilitação bucal da criança propiciou o restabelecimento das funções do sistema estomatognático e promoveu a recuperação da sua saúde bucal.

Aim: To present the approaches adopted in the rehabili-tative aesthetic treatment of pediatric patients affected by early childhood caries, respecting individualities and seeking the integrality of the child patient. Case report: The clinical case describes the oral rehabilitation performed in a child aged 4 years and 6 months, diagnosed with early childhood caries. After careful anamnesis, physical and complementary examinations and in possession of the diagnosis, a treatment plan was established, complying with all therapeutic phases, in which the preparatory phase included a psychological approach, fluortherapy, extractions and teeth sealing with glass ionomer cement. Subsequently, the esthetic-rehabilitation phase was carried out through direct and indirect restorations, installation of an esthetic-functional space maintainer and fabri-cation and installation of an upper total denture. After completion of the dental treatment, those responsible were instructed on the need and importance of multi-disciplinary treatment with the speech therapist for the complete recovery of the patient's health and periodic visits to the dentist for follow-up. Conclusion: The child's oral rehabilitation provided the reestablishment of the functions of the stomatognathic system and promoted the recovery of their oral health.

Antibacterial and Antimicrobial Effects of Xanthorrhizol in the Prevention of Dental Caries: A Systematic Review.

BACKGROUND: Xanthorrhizol is one of the numerous phytochemicals whose pharmacological benefits have been explored for its antibacterial and antimicrobial effects. In light of the role bacteria play for initiating tooth decay, this present systematic review assessed xanthorrhizol's effect against dental caries. METHODS: The electronic databases including Pubmed, Scopus and Embase were searched up to September 2020, Studies examining the antibacterial and antimicrobial effects of xanthorrhizol in the prevention and treatment of dental caries. RESULTS: Eleven studies met the criteria for final inclusion. Findings from these studies showed that xanthorrhizol showed significant inhibition of notable caries causing bacteria including Streptococcus mutans, Streptococcus sanguinis, Enterococcus faecalis and Bacillus cereus. Furthermore, there was no reported toxicity. However, it could not selectively target the growth of cariogenic bacteria. CONCLUSION: So far, studies exploring the use of xanthorrhizol as a potential drug for the prevention and treatment of dental caries have shown promising outcomes. However, more work needs to be done especially in areas such as optimal dose or concentration, in addition, in vitro, in vivo and clinical studies and selective targeting of cariogenic bacteria has been performed.

Caries temprana de la infancia: rehabilitación estética, funcional e integral en paciente preescolar. Caso clínico / Early childhood caries: esthetic, functional and comprehensive rehabilitation in preschool patient. A clinical case

La American Academy of Pediatric Dentistry (2020) define a la caries temprana de la infancia (CTI) como una forma severa de caries de etiología multifactorial que compromete la dentición primaria de niños pre-escolares. Afecta principalmente a los incisivos primarios superiores seguidos de los primeros molares primarios, pudiendo promover el desarrollo de hábitos parafuncionales, reducción de la eficacia masticatoria, pérdida de la dimensión vertical, alteraciones en la fonación y defectos estéticos que causan repercusiones emocionales e impacto psicosocial. La insuficiente cantidad y calidad de estructura coronaria remanente, luego de la eliminación del tejido cariado, puede comprometer la adhesión de los materiales de restauración. El objetivo de este trabajo es presentar la atención y el seguimiento a dos años de un paciente preescolar que presenta CTI, que concurrió para su atención a la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (AU)

Reabilitação estética e funcional em paciente com cárie na primeira infância: relato de caso / Aesthetic and functional rehabilitation in a patient with caries in early childhood: case report

Introdução: Cárie na Primeira Infância (CPI) é o termo utilizado para descrever a cárie dentária em crianças menores de 6 anos de idade. Objetivo: Relatar o tratamento reabilitador estético e funcional de uma criança com CPI. Relato do caso: Paciente do sexo masculino, 5 anos de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia de Araçatuba (FOA/UNESP), acompanhado pela mãe, que relatou como queixa principal dor e presença de cárie. Ao exame clínico intrabucal, constatou-se na arcada superior lesões de cárie em todos os dentes, exceto nos dentes 55, já restaurado, e dente 65, hígido. Na arcada inferior, lesões de cárie foram observadas nos dentes 74 e 84. Após diagnóstico clínico e radiográfico, optou-se por realizar a confecção de coroa de aço para os dentes 74 e 84, exodontia dos dentes 51, 52, 61 e 64, instalação de aparelho mantenedor de espaço funcional removível e restaurações dos demais dentes afetados com compósito resinoso. Conclusão: Foi possível recuperar as funções estéticas, fonéticas e mastigatórias do paciente, colaborando para a melhora da autoestima da criança, o que gerou satisfação dos familiares. A educação em saúde bucal realizada com a criança e os responsáveis foi essencial para o sucesso do tratamento e a manutenção da saúde bucal.

Introduction: Early Childhood Caries (ECC) is the term used to describe dental caries in children under 6 years of age. Objective: Report the aesthetic and functional rehabilitation treatment of a child with ECC. Case report: A 5-year-old male patient was attended at the to the Pediatric Dentistry Clinic of the Araçatuba Dental School (FOA/UNESP), accompanied by his mother, who reported pain and dental caries as the main complaint. On intraoral clinical examination, caries lesions were found in all upper teeth, except for tooth 55, already restored, and tooth 65, healthy. In the lower arch, caries lesions were observed in teeth 74 and 84. After clinical and radiographic diagnosis, it was decided for the manufacture of steel crown for teeth 74 and 84, extraction of teeth 51, 52, 61 and 64, installation of removable functional space maintenance device and restorations of the other affected teeth with composite resin. Conclusion: In view of the treatment performed, it was possible to recover the aesthetic, phonetic and masticatory functions, contributing to the improvement of the child's self-esteem as well assatisfaction of family members. Oral health education carried out with the child and his parents was essential for the success of the treatment and the maintenance of oral health.

The Monitor Practice Program: implications for dentistry and dental education.

The restorative model of care, known colloquially as drilling and filling, has been challenged on the basis of its inappropriateness. The Caries Management System protocol was developed as an evidence-based strategy for non-surgical treatment of caries lesions and the Monitor Practice Program was designed to test the hypothesis that use of the protocol would reduce risk of dental caries experience. After 7 years, patients attending intervention practices, compared with those attending control practices, needed: 30%-50% fewer restorative interventions; 55% fewer first time restorative interventions; 32% fewer repeat restorative interventions; and were only 23% as likely to be classified as high risk. The outcome was cost-effective and patients attending intervention practices highly valued non-invasive care, and intervention dentists derived professional satisfaction from non-surgical caries management. The implications of the program are that the general public will likely embrace the benefits of non-invasive caries management, as will many current and future dental practitioners. This calls for dental practice reform including: the establishment of a clinical discipline in cariology; cariology curriculum development; revised accreditation regulations for cariology programs in dental schools; advanced training in clinical cariology leading to a specialty; support from the dental profession; and public health advocacy.

Impact of different restorative treatments for deep caries lesion in primary teeth (CEPECO 1) - study protocol for a noninferiority randomized clinical trial.

BACKGROUND: Due to the lack of evidence to determine the best treatment for deep cavitated caries lesions in primary molars, the search for an effective restorative technique, which results in a minimal discomfort to patients, and reduce the time needed for the treatment, becomes relevant. The objective of this randomized clinical trial was to evaluate if high-viscosity glass ionomer cement (HVGIC) restorations is noninferior to restoration with calcium hydroxide cement associated with HVGIC for treatment of deep lesions in primary molars, as well as the impact of the treatments on cost and discomfort of the patient. METHODS: A non-inferiority randomized clinical trial with two parallels arms (1:1) will be conducted. Children with 4 to 8 years will be selected at Clinic of Pediatric Dentistry at Ibirapuera University. 108 teeth will be randomized into two groups: (1) Calcium hydroxide cement associated with HVGIC and (2) HVGIC restoration. Primary outcome will be considered the pulp vitality and to be evaluated after 6, 12, 18 and 24 months by two calibrated examiners. Survival of restorations will also be evaluated in the equal intervals. The duration of dentals treatment and the cost of all materials used will be considered for estimating of cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Wong-Baker's Facial Scale. For the primary outcome, Kaplan-Meier survival and the long-rank test will be used to comparison between the groups. Cox regression will be performed to assess the influence of variables on the outcome. For all analyzes, the significance level is set at 5%. DISCUSSION: Based on the philosophy of ART, our hypothesis is that the HVGIC restoration is a possible approach to restore the deep caries lesion with pulp vitality without the use of rubber dam and anesthesia. TRIAL REGISTRATION: Clinicaltrials.gov registration NCT02903979 . Registered on June 9th 2016.

Oral Health Status of 12-year-olds from Regions with and without Coverage of the National Oral Health Comprehensive Intervention Program for Children in China.

OBJECTIVE: To investigate the oral health status and related factors of 12-year-olds from regions with and without coverage of the National Oral Health Comprehensive Intervention Program in China by means of analysing national data from the 4th National Oral Health Survey. METHODS: Data of 12-year-olds participating in the 4th National Oral Health Survey of China were used for statistical analysis. Children who were recruited in the survey completed a dental examination and filled in a questionnaire. Oral health status, pit-and-fissure sealant history, oral hygiene behaviours, sugar consumption habits, status of dental service utilisation, and oral health knowledge were compared between children from regions with and without coverage of the national programme. For the number of decayed, missing and filled permanent teeth (DMFT) and its components, as well as the number of teeth with pit-and-fissure sealants, mean values were statistically tested to see if significance existed between regions covered by the national programme and uncovered regions, whereas caries prevalence and percentage of pit-and-fissure sealants presented were also compared. RESULTS: Data from 27,821 12-year-old children were analysed, among whom 7,726 were from regions covered by the national programme and 20,095 were from uncovered regions. Statistical significance was found in caries experience and activity, pit-and-fissure sealant history, sugar consumption habits, utilisation of dental services and oral health knowledge when compared between the covered and uncovered regions. Prevalence of dental caries and indices for caries experience and activity was lower in regions covered by the national programme than those not covered, while the percentage of pit-and-fissure sealants presented and the number of teeth with pit-and-fissure sealants exhibited higher in the covered regions. This remained the same even if we focused only on the first molars instead of the full dentition. CONCLUSION: The National Oral Health Comprehensive Intervention Program for Children in China potentially contributed to better oral health status, behaviour and knowledge in 12-year-old children. The expansion and extension of coverage of the national programme was expected to be beneficial for improving oral health status in children, as well as constructing teams of oral and dental workforce and working mechanisms in some underdeveloped regions.

Remineralizing potential of CPP-ACP in white spot lesions - A systematic review.

OBJECTIVE: The aim of this systematic review was to assess the long term remineralizing potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) only in paste form compared with fluoride varnish, and or placebo in both naturally occurring and post-orthodontic white spot lesions in vivo. DATA SOURCES: The literature search covered the electronic databases: PubMed and Google scholar from 2005-2016. Only articles published in English were included. Randomized control trials in which CPP-ACP delivered by paste form were included. All studies which met inclusion criteria underwent two independent reviews. STUDY SELECTION: Two ninety five articles were identified from the search after excluding duplications. Abstracts of forty one articles were reviewed independently. Twenty nine articles were excluded after reading abstract. Full text articles were retrieved for fifteen relevant studies. After reviewing articles independently, three articles were excluded after full text reading. Finally twelve studies were selected based on the eligibility criteria. The remineralizing effect of CPP-ACP were compared with placebo and fluoridated toothpaste and fluoride varnish in randomized control trial. CONCLUSION: A high level evidence of remineralizing potential of CPP-ACP on naturally occurring white spot lesion and WSL post orthodontic treatment was found in comparison with placebo/fluoridated toothpaste and fluoride varnish without any statistically significant difference. Well-designed RCTs are, therefore, required to improve the level of evidence in this area.

Salivary antioxidant capacity of children with severe early childhood caries before and after complete dental rehabilitation.

OBJECTIVE: There is a need to determine whether total antioxidant capacity (TAC) in severe early childhood caries (S-ECC) is an indicator of inflammatory response to the lesion or a marker of the disease. This study compared TAC levels in children with ECC before and after dental treatment and compared the results with those of caries-free children. DESIGN: Prospective study. SETTING: A teaching hospital. PATIENT SELECTION: Salivary samples were obtained from 20 children aged 5 years and diagnosed with S-ECC, and 20 age- and sex-matched controls. INTERVENTION DETAILS: Complete dental rehabilitation under general anesthesia was performed on the children with S-ECC, and follow-up salivary samples were obtained one week and three months postoperatively. TAC was measured using a commercially available Oxygen Radical Absorbance Antioxidant Assay measurement kit (Zen-Bio ORAC™, AMS Biotechnology, Abington, UK). OUTCOME MEASURES: Differences between children with and without dental caries were tested using the Mann-Whitney U test; differences before and after dental treatment were analyzed using Friedman test followed by Wilcoxon sign-rank test with Bonferroni correction to compensate for multiple comparisons. RESULTS: Median TAC (1.54 mcg/L, CI 1.15-1.92) of the control group was significantly lower than that of the treated group prior to treatment (p = 0.003). Treatment of the dental lesions significantly reduced TAC of the treated group, and no significant differences were observed between the test and control groups at either one week (p = 0.076) recall or three-month recall (p = 0.096). TAC in children posttreatment was significantly reduced compared to their pretreatment values (p < 0.001). CONCLUSION: Total antioxidant capacity in the saliva of children with severe early childhood caries undergoes significant reduction following treatment of the carious lesions.

Deep Sedation Technique for Dental Rehabilitation of a Patient with Klippel-Feil Syndrome.

Klippel-Feil syndrome (KFS) is a congenital anomaly characterized by a defect in the formation or segmentation of the cervical vertebrae, resulting in their fusion. The clinical triad of the syndrome consists of short neck, low posterior hairline, and limited neck movement, although fewer than 50 percent of patients demonstrate all three clinical features. The short neck and its immobility and instability present a significant challenge for endotracheal intubation. The purpose of this paper is to describe the management of a 13-year-old patient with KFS, extensive dental caries, and restricted mouth opening using a deep sedation technique in the operating room, which allowed successful completion of dental treatment.

Enamel Pit Defects and Taurodontism in a Patient with Ring Chromosome 14 and 47,XXX.

The purpose of this paper is to describe the clinical findings and management of a case involving a patient with co-occurring ring chromosome 14 syndrome and 47,XXX presenting with enamel pit defects and taurodontism. Ring chromosome 14 syndrome is an unusual condition with uncontrolled seizure disorder as its most significant finding; 47,XXX (trisomy X; triple X) is a more common condition and has characteristic physical and behavioral findings. Neither condition has been associated with enamel pit defects.

Effectiveness of a Preventive Recall Strategy for Children After Dental Rehabilitation with General Anesthesia.

PURPOSE: To test a more frequent preventive recall strategy following full-mouth dental rehabilitation (FMDR) in children with early childhood caries (ECC). METHODS: Patients were randomized into two groups: controls, who were scheduled to return at six-month intervals (6-MR); and the intervention group, who were scheduled to return at three-month intervals (3-MR and 6-MR). At baseline and at each recall, a caries risk assessment (CRA) and dental exam were completed. Analyses followed CONSORT recommendations, resulting in three analyses: intent-to-treat; per-protocol; and an actual recall analysis. RESULTS: Intent-to-treat analysis showed no significant difference in CRA at six months (P>0.7); per-protocol analysis showed borderline significance (P>.08); and actual recall analysis showed a statistically significant difference in CRA at six months (P=.021). For patients with both 3-MR and 6-MR, 44 percent were assessed at a high caries risk level; for patients with only a 6-MR, 72 percent were assessed as a high caries risk level (P=.021). No significant differences were found in caries incidence at six months. CONCLUSIONS: Following full-mouth dental rehabilitation, patients who returned for follow-ups at both three- and six-month intervals had a greater decrease in caries risk level compared to patients seen at six-month follow-up intervals.

An Evaluation of Bite Pattern in Children with Severe-Early Childhood Caries Before and After Complete Dental Rehabilitation.

PURPOSE: The purpose of this study was to examine the changes in bite characteristics of children before and after the placement of multiple stainless steel crowns (SSCs) under general anesthesia (GA). METHODS: Twenty children scheduled for treatment under general anesthesia who needed SSCs in three or more posterior quadrants were included in this study. The bite was digitally analyzed and recorded preoperatively and at one and four weeks postoperatively. The occlusion time, number of force outliers, and distribution of force at each visit was recorded and compared. RESULTS: The placement of the SSCs in children significantly improved the bite characteristics of the participants. The placement of the SSC did not alter occlusion time, and there were no significant differences in occlusion time. While there was an increase in the number of outliers in the first week after the placement of the crown, there was a reduction in the total number of outliers at the end of one month. All the patients treated with bilateral placement of an SSC showed a posterior balanced occlusion post-operatively, a finding that was retained over the one-month follow-up period. CONCLUSION: Bilateral placement of SSCs under general anesthesia does not significantly alter the occlusion of the child.

Kooperation von Kieferorthopädie, Kieferchirurgie und Prothetik bei der umfassenden Rehabilitation von DysgnathiepatientInnen. Teil 1: Fallbeispiel Klasse-III-Malokklusion, Unterkiefer-Schaltlücken.

In a case report the stomatognathic rehabilitation of a patient with class III malocclusion and mandibular bilateral interdental gaps from the diagnosis and treatment planning through to the stepwise realization of the orthodontic, surgical and prosthetic treatment is presented. Explicit information about the proposed treatment, risks and the prospective outcome beforehand ensured the patient’s compliance during the extensive procedure.

Rehabilitation of severely worn teeth: A systematic review.

OBJECTIVES: The aim of this systematic review was to evaluate the treatment performance/longevity of dental materials/techniques indicated to restore teeth with severe wear. MATERIALS AND METHODS: A systematic literature search was conducted to select retrospective studies (cohort and case series) and prospective studies that evaluated or compared techniques/materials to restore teeth with severe wear. A search was conducted in Medline (via Pubmed - June 2015) with no limits for publication year or language to identify clinical studies. Two reviewers independently selected studies, extracted data and assessed the risk of bias of randomized controlled trials included. The annual failure rate (AFR%) of restorations was calculated for each study. RESULTS: A total of 511 articles were found and 23 studies were eligible for full-text analysis; hand search included 7 more papers. From the 30 studies, 12 were eligible for the review. Most of these studies presented good performance of the restorations in teeth with severe wear. AFR ranged from 0.4% (microhybrid) to 26.3% (microfilled) for direct resin composite, 0% to 14.9% for indirect resin composite and 2.7% for porcelain veneers. CONCLUSION: There is no strong evidence to suggest that any material is better than another. Direct or indirect materials may be feasible options to restore severely worn teeth.

Perfil de los pacientes rehabilitados por medio de prótesis atendidos en servicio público de salud en Ribeirão Preto, Brasil / Patients profile rehabilitated with dental prosthesis assisted by the health public service in Ribeirão Preto, Brazil

La prevalencia de sexo y el padrón de edad relacionado a los diferentes tipos de rehabilitaciones protésicas son variables importantes que deben ser estudiadas. De esta manera, el objetivo de este estudio fue evaluar el perfil de edad y género en pacientes rehabilitados con prótesis dentales en un curso de Odontología durante un periodo de cinco años. Fueron evaluados 638 fichas de pacientes que recibieron prótesis parcial fija (PPF), prótesis parcial removible (PPR) y prótesis total (PT). Las prótesis de los pacientes rehabilitados con PPR fueron clasificadas en dentomucosoportada (DM) o dentosoportadas (D). Para el análisis de los resultados, los pacientes fueron divididos en 2 grupos: A) >50 años y B) <50 años. Los datos fueron analizados estadísticamente por el test exacto de Fisher o chi-cuadrado (p<0,05). No se observaron diferencias significativas en relación a la edad y tipo de prótesis. Para la PPF 74% fueron <50 años, para la PPR 52%, >50 años y para la PT 92%, >50 años. En todas las prótesis, existió una mayor prevalencia del género femenino. Con relación a la clasificación de las PPRs, 47% fueron D y 53% DM, sin identificar diferencias estadísticamente significativas. De esta manera se puede concluir que la necesidad de rehabilitación de un mayor numero de elementos dentales aumenta con la edad, siendo prevalente en todos los periodos de la vida adulta, principalmente, en mujeres

The prevalence of gender and age related pattern of the different types of prosthetic restorations are important variables to be estimated. The aim of this study was to evaluate the profile of age and gender in patients rehabilitated with dental prostheses on School of Dentistry during five years. Were evaluated 638 records of patients who received fixed prosthesis (FP), removable partial (RP) or total dentures (T). Rehabilitated patients with RP had their prostheses classified into dental-mucous-supported (DM) or tooth-supported (D). To analyze the results, patients were divided into 2 groups: A) >50 years or B) <50 years. Data were statistically analyzed by Fisher's exact test or chi Square (p<0.05). No statistical significance relation to age and types of prostheses was observed. On RP, 47% was D and 53% DM, there was no statistically significant difference. It was possible to conclude that the rehabilitation of greater number of the teeth increases with age and is prevalent in all periods of adulthood, especially in women

Prosthetic Oral Rehabilitation of a Child With S-ECC: A Case Report with Histopathologic Analysis.

The aim of this case report is to describe the treatment planning of a young child with severe early childhood caries (S-ECC) as well as the prosthetic rehabilitation technique. A 3-year-old female child was referred to the pediatric dentistry clinic with the chief complaint of tooth pain, difficulty in eating and recurrent hospitalizations caused by dental infections. The mother reported intermittent episodes of fever and recurrent swelling of child's face. The girl presented angular cheilitis and was referred to a dietitian. The treatment plain consisted on a behavior changes in oral hygiene habits, exodontias of all primary teeth and oral rehabilitation with a prosthesis. The extracted teeth with periapical lesions were submitted to histopathologic analysis (hematoxilin and eosin staining) and revealed an inflammatory infiltrate. The aesthetic requirement of children with S-ECC has been a challenge to pediatric dentists. In the present case, the oral rehabilitation provided for the children better aesthetic, nutrition, phonation, and functional conditions.

[NONSURGICAL RECONSTRUCTION METHOD INTERDENTALLY PAPILLAE IN THE RESTATION OF APROXIMAL CAVITIES AS ONE OF THE STAGES OF REHABILITATION OF PATIENTS WITH GENERALIZAD PERIODONTITIS].

Reconstruction of missing papilla--the basis of modern concepts of objective treatment of dental diseases. Interproximal spaces are important anatomical structures, as are bulky in the mouth and repeated many times. Violation of relations between different structural elements increases the risk of inflammation in periodontitis. Patients with approximal caries posteriors and generalized periodontitis studied anthropometric parameters of the structures of the interdental spaces and their impact on the volume papilla before and after restoration, carried out with move a contact point to the apex. The results showed that the relationship between anthropometric data interdental had certain patterns in all groups surveyed. Important was a clear relationship between anthropometric indicators of basic elements of interdental spaces. In the absence of the interproximal papilla length (IPL) was on average 7.2 mm, the distance from the gingival margin to the proximal contact--3.9 mm and the horizontal distance between the roots at the enamel--cement border (HDR) reached 3.2 mm. Following the restoration with move a contact point to the apex to an average of 4.5 mm IPL, there was a significant increase in the interdental papillae. In the case of patients prior to treatment was determined by a thin biotype, the small width of attached gingival significant HDR--volume papilla week after restorations movement of the contact point to the root apex contact point is not increased. The results obtained require long-term studies for the possibility of forecasting the success of the restoration or preservation of the interdental papillae in the restoration of approximal cavities on the stages of rehabilitation of patients with generalized periodontitis.