Rehabilitación estética y funcional de una paciente con caninos retenidos / Cosmetic and functional rehabilitation of a patient with retained canine teeth

Se describe el caso clínico de una paciente de 18 años de edad, quien acudió a la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, por presentar persistencia de caninos temporales. Para el diagnóstico y tratamiento exitoso fue necesaria la participación de un equipo multidisciplinario integrado por especialistas en: ortodoncia, imagenología, prótesis y cirugía maxilofacial, quienes corroboraron la retención de caninos superiores. Mediante el tratamiento conjunto de ortodoncia y prótesis, se logró la rehabilitación estética y funcional de la paciente.

The case report of an 18 years patient is described. She went to Mártires del Moncada Teaching Provincial Stomatologic Clinic in Santiago de Cuba, due to persistence of temporary canine teeth. The participation of a multidisciplinary team integrated by specialists in: orthodontics, imaging, prosthesis and maxillofacial surgery was necessary for the successful diagnosis and treatment. They corroborated the retention of upper canine teeth. By means of the combined treatment of orthodontics and prosthesis, the patient cosmetic and functional rehabilitation was achieved.

Diastemas: etiologia, diagnóstico e possíveis formas de reabilitação / Diastemas: etiology, diagnostic and possible forms of rehabilitation

Introdução: Atualmente, o apelo estético pela harmonização do sorriso faz com que os indivíduos motivem-se ao tratamento de diastemas dentais, principalmente em região anterior, tendo diversas opções de intervenção terapêutica para correção do problema. Objetivo: Realizar uma revisão de literatura acerca das possíveis formas terapêuticas para o tratamento de diastemas. Metodologia: Revisão de literatura por meio de busca bibliográfica nas bases de pesquisa online: PubMED, Medline, Lilacs, Scielo e Google Acadêmico, através do rastreio de artigos relevantes publicados entre o período de 2000 a 2019. Resultados: O diastema dental possui etiologia multifatorial, onde as principais causas são, frequentemente, devido à microdontia, má inserção do freio labial, e hábitos parafuncionais. Logo, o correto diagnóstico do fator causal do diastema deve ser investigado para que seja feito o melhor planejamento para seu tratamento, evitando assim recidivas. Diante disso, encontram-se na literatura diversas formas terapêuticas para a reabilitação, sendo a mais utilizada por meio da técnica restauradora direta com resina composta, porém relatam-se casos onde há a presença de grandes diastemas fazendo a associação da técnica restauradora direta com a motivação ortodôntica, e além desses, existem casos em que se necessita fazer a correção do freio labial para iniciar a reabilitação do tratamento para a correção dos diastemas. Conclusão: Com base na literatura, as diversas possibilidades terapêuticas se mostram bastantes eficazes para a solução dos diastemas dentais, entretanto, é necessário que o cirurgião-dentista faça o correto diagnóstico para aplicar a melhor opção terapêutica, garantindo maior segurança no resultado do fechamento do diastema.

Introduction: Currently the aesthetic appeal for harmonizing the smile makes individuals motivate themselves to treat dental diastemas, especially in the anterior region; where there are several options for therapeutic intervention to correct the problem. Objective: To carry out a literature review about the possible therapeutic forms for the treatment of diastemas. Methodology: The literature review through bibliographic search in the online research bases: PubMED, Medline, Lilacs, Scielo and Google Academic, through the screening of relevant articles published between 2000 and 2019. Results: The dental diastema has a multifactorial etiology, where the main causes are often due to microdontia, poor insertion of the lip brake, and parafunctional habits. Therefore, the correct diagnosis of the causal factor of the diastema must be investigated correctly so that the best planning for its treatment is made, thus preventing recurrences. In view of this, there are several therapeutic forms in the literature for rehabilitation, the most used by means of the direct restorative technique with composite resin, however cases are reported where there is the presence of large diastemas making the association of the direct restorative technique with orthodontic motivation, and in addition to these, there are cases in which it is necessary to make the correction of the lip brake to start the rehabilitation of the treatment for the correction of the diastemas. Conclusion: Based on the literature, the various therapeutic possibilities prove to be quite effective for the solution of dental diastemas, however, it is necessary for the dental sugeon make the correct diagnosis to apply the best therapeutic option, ensuring greater safety in the result of closing the diastema.

Multidisciplinary treatment with a customized lingual appliance for an adult patient with severe Class III malocclusion and multiple missing teeth.

A 24-year-old man presented with a severe skeletal class III malocclusion, associated with an anterior and posterior crossbite in the left side, upper and lower lip eversion, skeletal asymmetry, midline discrepancy, diastemas in the maxillary and mandibular dental arches, and agenesis of maxillary lateral incisors and canines with retained deciduous teeth. Treatment was performed with the use of the Win Lingual System. When the 0.016 × 0.022-inch NiTi archiwire was applied, the deciduous teeth were extracted and replaced with temporary crowns connected to the appliance. After the aligning, leveling, and diastema closure phases, a modified Le Fort II osteotomy, a mandibular setback with a bilateral sagittal split osteotomy and a genioplasty were performed. Implants were placed in the canine site through a flapless guided surgery, and cantilevered temporary bridges were delivered. Final prosthetic rehabilitation included veneers for the central incisors and zirconia-ceramic cantilevered bridges for the canine and lateral incisors. After 36 months of active treatment, the patient showed an Angle Class I molar and canine relationship and an ideal overbite and overjet. His profile had improved, lips were competent, and gingival levels were acceptable. The lateral radiograph and cephalometric analysis showed a good balance of the skeletal pattern, a good profile of the soft tissue, and proper inclinations of the maxillary and mandibular incisors in relation to maxilla and mandible. After 2 years of follow-up, the patient had a pleasant smile and no relapse, or joint or muscular pain.

Harmonização estética do sorriso ­ cirurgia periodontal, clareamento dental e fechamento de diastemas ­ relato de caso / Aesthetic harmonization of the smile ­ periodontal surgery, dental whitening, and diastema closure - case report

Este estudo teve por objetivo relatar um caso clínico de harmonização estética do sorriso com abordagem multidisciplinar integrada, envolvendo cirurgia plástica periodontal, clareamento dental associado e fechamento de diastema com resina composta aplicada diretamente pela técnica "mãos livres". Após anamnese, diagnóstico e aceita da proposta terapêutica, foi realizado o procedimento cirúrgico periodontal (gengivectomia, gengivoplastia e frenectomia labial superior). Após o período cicatricial, foi realizado clareamento dental associado com as técnicas de consultório (peróxido de hidrogênio 35% - 02 sessões) e supervisionado (peróxido de carbamida 10% - 08hs/dia - 02 semanas). O tratamento foi finalizado com restaurações adesivas diretas em resina composta à mão livre para o fechamento de diastema. A terapêutica adotada evidenciou a necessidade de conhecimento científico e habilidade técnica profissional para seu emprego; mostrou-se eficaz como alternativa acessível de tratamento; permitiu melhor equilíbrio da harmonia estética do sorriso e a satisfação do paciente (AU).

This study aimed to report a clinical case of aesthetic harmonization of the smile with an integrated multidisciplinary approach, involving periodontal plastic surgery, associated to dental whitening and diastema closure with composite resin applied directly by the "hands free" technique. After anamnesis, diagnosis, and acceptance of the therapeutic proposal, the periodontal surgical procedure was performed (gingivectomy, gingivoplasty, and upper labial frenectomy). After the healing period, dental bleaching associated with the office techniques (35% hydrogen peroxide - 02 sessions) was performed and supervised (carbamide peroxide 10% - 08hs/day - 02 weeks). The treatment was finished with free hands direct adhesive composite resin restorations for diastema closure. The therapy adopted evidenced the need for scientific knowledge and professional technical skills for its use. It proved to be effective as an accessible treatment alternative; allowed better balance of the smile aesthetic harmony and the satisfaction of the patient (AU).

Veneer or Interproximal Enamel Reduction?

BACKGROUND: Clinicians often ask, "Veneer or no to veneer?" Clinicians usually think of porcelain veneers for cases in which patients are dissatisfied with their teeth shape. Interproximal reduction can change teeth's shape and appearance within the enamel to improve gingival contour, eliminate black gingival triangles, and correct the Curve of Spee. AIM: Our aim is to present to clinicians the option of reshaping and interproximal reduction (IPR) as a valid alternative to porcelain veneers. CASE REPORT: A male patient with round bulbous-shaped anterior maxillary teeth sought a better masculine smile. Interproximal reduction with thin bur size was performed to reshape the anterior teeth in order to achieve a proportional teeth width to height and give a more rectangular rather than square shape. Finally, the orthodontist closed the multiple diastemas using round wires in order to reduce anterior teeth proclination. The patient received bleaching treatment and minor composite fillings. CONCLUSION: Not every cosmetic case should be treated with veneers and crowns. Conservative minimal intervention, such as IPR was more than sufficient in treating such cases. It is the right of the patients to be informed and educated about all possible treatment options. CLINICAL SIGNIFICANCE: Minor reshaping and IPR preserving teeth structures can be helpful in achieving esthetic results and patients' confidence.

Management of the Maxillary Diastema by Various Dental Specialties.

PURPOSE: There is considerable controversy in the literature concerning the indications for frenectomy for treating a maxillary diastema and for timing of the procedure. The purpose of this study was to survey pediatric dentists, orthodontists, and oral and maxillofacial surgeons on their opinion of this matter to develop a consensus. MATERIALS AND METHODS: An anonymous 7-item electronic questionnaire was sent to members of the American Academy of Pediatric Dentists, the American Association of Orthodontists, and the American Association of Oral and Maxillofacial Surgeons asking about the etiology of the maxillary diastema, its diagnosis, and treatment. RESULTS: Although there was no agreement among the oral and maxillofacial surgeons for the timing of frenectomy and when the diastema should be closed, the pediatric dentists and orthodontists generally agreed that frenectomy should not be performed before the permanent canines are erupted and that the operation should follow orthodontic closure of the space. CONCLUSION: Although there was no complete consensus among the 3 groups, a logical treatment approach for the maxillary diastema is proposed.

Using CAD/CAM-Modified Correlation Mode to Produce Laminate Veneers: A Six-Month Case Report.

The expectation of an esthetically harmonious smile increases the level of difficulty when treating patients. Laminate veneers stand out as a treatment option for cosmetic rehabilitation in clinical practice, as they are a more conservative procedure and mimic dental structures. These laminate veneers are generally made with different techniques; the most common requires an impression of the prepared tooth, an impression antagonist, fabrication models, and extensive laboratory time. The computer-aided design/computer-aided manufacturing (CAD/CAM) system optimizes the fabrication of prosthetic structures, reducing chairside time and promoting good esthetic results. Thus, the purpose of this case report is to present the esthetic result of multiple CAD/CAM manufactured laminate veneers using a new self-etching glass ceramic primer with a lithium disilicate ceramic, using the modified correlation and biogeneric modes.

Effectiveness of optical illusions applied on a single composite resin veneer for the diastema closure of maxillary central incisors.

OBJECTIVE: To assess the esthetic effectiveness of four illusion techniques applied to a composite resin veneer for diastema closure between maxillary central incisors. MATERIALS AND METHODS: An acrylic model with six natural maxillary anterior teeth was fabricated with a 2-mm diastema between the central incisors. Resin veneers were constructed on the left central incisor and the following cases were derived: V0: no veneer; V1: veneer without optical illusion features; V2: veneer with centralized interproximal ridges; V3: veneer with curved incisal edges; V4: veneer with gray pigment mesially/distally; V5: veneer with gray pigment on the developmental lobes. Digital printed photos of the models (13.2 x 17.8 cm, and 6.1 x 8 cm), with low, medium, and high smile lines and without a smile line (processed by Adobe Photoshop CS6) were shown to three groups of people (faculty members, senior undergraduate students, and patients; n = 25/group) for them to assess the overall size and width of the two central incisors. The results were analyzed by Pearson's and chi-square goodness of fit tests. RESULTS: There was no significant influence in the estimation of the two central incisors as being the same size, according to the technique used (P = 0.869) and group of evaluators (P = 0.209). The estimated probability of assessing the tested incisor as wider was indicatively lower in V2 compared to V1 (adjusted odds ratio = 0.59; P = 0.088). The height of the smile line affected the evaluation of the veneers only in the large-sized photos. CONCLUSIONS: No interference is the best esthetic decision concerning a 2-mm diastema closure when restoring only one central incisor with a laminate veneer. The next best option is to deliver a veneer with centralized interproximal ridges.

Dental care in patients with antiphospholipid syndrome: two case reports.

Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disease that may be classified as primary or secondary. Treatment consists of oral anticoagulant, antiplatelet, and/or immunosuppressant drugs. This report describes the dental treatment of 2 women with APS and multiple dental concerns, including periodontal disease, caries, and missing teeth. The invasive dental procedures were performed in an outpatient setting with hematologic monitoring and use of local hemostatic measures. Neither interruption of anticoagulant medications nor administration of blood products was necessary. All of the procedures were performed without complications. To date, no recommendations for the dental care of patients with APS have been established, demonstrating a need to investigate the risks for bleeding and infection, among other concerns, during dental treatment of these patients.

Repositioning of a pathologically migrated tooth using autologous platelet-rich plasma: a case report with 3-year follow-up.

An intricate balance between the periodontal tissues and the forces of occlusion, tongue, and lips helps to maintain a tooth in its physiologic position within the dental arch. Disturbances in the equilibrium can cause a tooth to migrate pathologically, often requiring multidisciplinary treatment approaches. The present case demonstrates, for the first time, the use of autologous platelet-rich plasma to aid in tooth repositioning after pathologic tooth migration. A 25-year-old woman presented with extrusion and labial migration of the maxillary left central incisor, a diastema of 3 mm, and grade II mobility. Radiographic evaluation showed a deep, angular bone defect, extending to the apical third of the root, on both the mesial and distal aspects of the maxillary left central incisor. Comprehensive treatment consisted of nonsurgical and surgical periodontal therapy with autologous platelet-rich plasma. Without orthodontic intervention, the unesthetic diastema had completely closed by the end of 3 months postoperatively, and the results were stable at a 3-year follow-up examination. This successful, novel approach can be adopted as a conservative and time-efficient modality for management of unesthetic spaces caused by pathologic tooth migration.

Reabilitação funcional e estética do sorriso û relato de caso / Functional and aesthetic rehabilitation of smile û case report

A constante busca por tratamentos odontológicos estéticos e por um sorriso bonito e harmônico é o que a maioria das pessoas almeja, o que contribui para a realização de procedimentos restauradores que possibilitem mimetização do natural para atingir as expectativas e necessidades dos pacientes. A presença de diastemas pode resultar em problemas funcionais e estéticos. Sendo assim, o presente caso clínico relata reabilitação de um extenso diastema entre os incisivos centrais superiores, após intervenção cirúrgica para remoção do freio labial e clareamento dental. Foram realizadas restaurações diretas minimamente invasivas nos dentes anteriores, com resina composta nanoparticulada. O acabamento e polimento foram realizados de forma a evidenciar anatomia e textura de superfície dos dentes. Em conclusão, o tratamento realizado utilizou materiais com comportamento biomecânico favorável, estabelecendo função, harmonia do sorriso e resultado estético satisfatório...

The constant search for dental aesthetic treatments in order to achieve a nice and harmonic smile has contributed to the development of restorative procedures enabling mimicry of natural teeth to meet expectations and needs of patients. The presence of diastemas can result in functional and aesthetic problems. Therefore, the present clinical case reports rehabilitation of a large diastema between the maxillary central incisors, after surgery for removal of labial frenum and tooth bleaching. Minimally invasive direct restorations were performed in anterior teeth with nanofilled composite resin. Finishing and polishing were done in order to demonstrate anatomy and surface texture of the teeth. In conclusion, the treatment used materials with biomechanical behavior, setting function, harmony of the smile and satisfactory aesthetic result...

Prevalence of artificially created maxillary midline diastema and its complications in a selected nigerian population.

BACKGROUND: Maxillary midline diastema (MMD) is generally regarded as a symbol of beauty in Nigeria. The desperation to look beautiful has caused many individuals to seek the creation of artificial midline diastema and that comes often with undesirable side effects. AIM: To determine the prevalence of artificially created maxillary midline diastema (MMD) and its complications in a selected Nigerian population. METHOD: A cross-sectional study using a semi-structured questionnaire as the instrument for data collection was done among patients attending a private clinic in Owerri the capital of Imo state in Nigeria over a period of 18 months. The data were retrieved from the questionnaires and analyzed using the SPSS version 20. RESULTS: There were 141 respondents comprising 58(41.1%) males and 83(58.9%) females, giving a male to female ratio of 1:1.4. The prevalence of artificially created MMD was 34.0% with increased frequency in: the 21-30 years age group; among the females and in respondents with tertiary level of education. Majority of the respondents (69.5%) desire MMD and 20.8% of those without it wanted it created through cosmetic dentistry. Twenty of the 48 respondents with artificial MMD had it done to enhance personal beauty and aesthetics. The commonest complication was tooth sensitivity (44.8%), followed by toothache (41.4%). CONCLUSION: The prevalence of artificially created MMD was 34.0% in this study; and it is commoner in females and younger age group .The commonest complication was tooth sensitivity. Enhancement of personal beauty and aesthetic was the major reason for having it done.

Reabilita‡Æo est‚tica de diastema m£ltiplo anterior com resina composta – controle cl¡nico de sete meses / Aesthetic rehabilitation of multiple anterior diastemas using composite resin – seven months recall

A busca por padrães est‚ticos ideais contribuiu para o advento de procedimentos restauradores que possibilitam a mimetiza‡Æo do natural e a introdu‡Æo do conceito de harmonia do sorriso atendendo …s exigˆncias dos pacientes. A presen‡a de diastemas anteriores m£ltiplos constitui um desafio … Odontologia, tendo em vista o aspecto negativo que agrega a despropor‡Æo do sorriso e a est‚tica facial. Sendo assim, o presente caso objetiva descrever a t‚cnica operat¢ria do fechamento de diastemas em resina composta atrav‚s de embasamento te¢rico cient¡fico para a resolu‡Æo do caso. O caso descrito relata a reabilita‡Æo est‚tica de diastemas anteriores por meio de procedimentos restauradores diretos em resina composta promovendo a preserva‡Æo da estrutura dent ria, mimetiza‡Æo do natural, restabelecimento das corretas propor‡ães dentais e redu‡Æo do tempo cl¡nico necess rio, alcan‡ando resultados est‚ticos de excelˆncia. A realiza‡Æo de uma t‚cnica padronizada e bem fundamentada em resina composta para o fechamento de diastemas proporciona resultados cl¡nicos est‚ticos satisfat¢rios e previs¡veis.

The indreasing serach for aesthetic standards has collaborated for the advent of restorative procedures that allow a natural apearence and has lauched concept of harmonic smile, meeting patients’ expectations. Considered as a negative aspect of smile and facial aesthetics the presence of multiple anterior diastemas is very chalenging. This case report aims to describe the technique of the diastema closure with composite resin considering the scientific literature for the resolution of the case. In this study the is described the aesthetic rehabilitation of anterior distaemas through of direct restorative procedures with composite resin and preservation of tooth structure, mimicking natural teeth, reestablishment of dental proportions and reduced clinical time, achieving excellent aesthetic results. The implementation of a standardized and wellgrounded technique using composite for diastema closure provides clinical and aesthetic satisfactory and predictable results.

Fechamento de diastemas empregando restaurações adesivas diretas / Diastema closure using adhesive composite resins restorations

Na estética do sorriso a arquitetura dos dentes anterossuperiores é determinante, porém alguns fatores podem contribuir para prejudicar esta harmonia. Este trabalho apresenta a descrição de um caso clínico com abordagem estética na região de incisivos laterais superiores que apresentavam severos diastemas. Os incisivos laterais evidenciavam-se dos demais dentes anteriores pela sua posição no arco dentário e também pelo consequente diastema formado, o que motivou a realização da reanatomização dos incisivos laterais com resina composta, possibilitando uma nova arquitetura estética da zona frontal. A abordagem empregada permitiu a realização do procedimento restaurador com adequado contorno e polimento, além de solucionar o problema da papila incisal, sem prejuízos para a estética e para a saúde dos tecidos periodontais.

Maxillary anterior teeth are very important for the smile aesthetics' but there are some factors that may compromise this harmony. This study describes a clinical case with aesthetic approach on the upper lateral incisors that presented severe diastema. Lateral incisors stood out from the other anterior teeth due to their position in the dental arch and consequent diastema. Therefore, an esthetic recontouring of lateral incisors was performed using composite resins, resulting on a harmonic aesthetic of anterior teeth. This approach enabled restoration with proper shape and polishing and solved the problem of incisive papilla without compromising the aesthetic and health of periodontal tissue.

A long-term study on the clinical effects of mechanical widening of cheek teeth diastemata for treatment of periodontitis in 202 horses (2008-2011).

REASON FOR PERFORMING STUDY: Cheek teeth diastemata are a common cause of painful periodontal disease in horses, but there is limited objective information on their treatment. OBJECTIVE: To assess the long-term response to diastema widening in clinically affected horses. STUDY DESIGN: Retrospective study. METHOD: Medical records from cases of cheek teeth diastemata treated by diastema widening referred to the University of Edinburgh Equine Hospital from 2008 to 2011 were analysed. RESULTS: During this period, 302 horses were diagnosed with clinically significant cheek teeth diastemata, of which 202, median age 11 years, with severe associated periodontitis were treated by widening of 674 problematic diastemata; 89.8% between mandibular cheek teeth and 10.2% between maxillary cheek teeth, with a mean of 1.5 treatments performed per case. These 202 cases showed quidding in 76.2%; weight loss in 33.2%; bitting problems in 20.1% and halitosis in 10.9%, with 5.4% being asymptomatic. Follow-up of 92% of treated cases, a mean of 20.8 months after their initial treatment, showed that 72.6% had complete remission of clinical signs that was permanent (for the duration of this study) in 50.5% and temporary in 22%. A partial response was obtained in 17.2%, no response was obtained in 4.3%, and owners were unsure of response in 5.9%. Clinical improvement was sometimes delayed, with 19% taking >4 weeks following treatment for improvement. Inappropriate sites were burred in individual teeth of 6 horses, causing iatrogenic pulpar exposure in 2 cases, but following treatment none developed clinical signs of apical infection. CONCLUSIONS: Diastema widening is an effective but potentially invasive treatment for horses with cheek teeth diastemata with severe periodontitis. POTENTIAL RELEVANCE: Diastema widening by trained personnel is suitable for advanced cases of cheek teeth diastema, but many cases require repeated treatments.

Restauração de fechamento de diastema com resinacomposta: relato de caso / Restoration diastema closure with composite resin: case report

Com a evolução das técnicas e materiais restauradores,os procedimentos adesivos diretos comresinas compostas são uma excelente opção parafechamento de diastema, sendo considerado comoum dos procedimentos restauradores estéticos demaior impacto na aparência do paciente. O corretodiagnóstico e adequado planejamento são elementoscruciais para a obtenção do sucesso clínico elongevidade das restaurações. O propósito destetrabalho foi relatar através de um caso clínico, aimportância do planejamento para o êxito na execuçãodo procedimento de fechamento de diastemacom resina composta

With the development of techniques andrestorative materials, the bonding procedureswith direct composite resins are anexcellent option for closing diastema, beingconsidered as a restorative procedures withthe greatest impact on the aesthetic appearanceof the patient. The correct diagnosisand proper planning are keys to obtainingthe clinical success and longevity of restorations.The purpose of this study was to demonstratethe importance of planning for thesuccessful execution of the diastema closurewith composite resin through a case report

Tratamento multidisciplinar no fechamento de diastemaanterior: relato de caso / Multidisciplinary treatment on diastema’s closure: case report

Os procedimentos estéticos estão sendo cada vezmais procurados nos consultórios odontológicosdevido ao crescente interesse da população por umsorriso com estética favorável. Neste contexto, otratamento de diastemas anteriores deve ser discutidopara fornecer ao clínico as opções de tratamentoe como escolhê-las adequadamente. A presençade diastemas na região ântero-superior em adultoschega a ter uma prevalência de 5,5% em algumaspopulações. Devido à variada etiologia desta máoclusão e também às diferentes formas de tratamentopossíveis e complementares, o tratamentodos diastemas anteriores pode tornar-se um desafiopara o profissional. O presente artigo propõe-sea discutir o tratamento de um diastema medianoanterior de grande extensão com uma abordagemmultidisciplinar, utilizando-se de movimentação ortodôntica,grade de proporção frontal, tabela deproporção entre largura e altura e sistema restauradoradesivo direto.

Cosmetic procedures are increasingly beingsought in dental offices due to the increasinginterest of the population for a smilewith favorable aesthetics. In this context,the treatment of anterior diastema shouldbe discussed in order to provide treatmentoptions to the clinician and how to choosethem properly. The presence of diastema inthe maxillary anterior region in adults hasa prevalence of 5.5% in some populations.Due to the varied etiology of this malocclusionand also to the different possible formsof treatment, the anterior diastema may becomea challenge for the professional. Thispaper aims to discuss the treatment of alarge anterior median diastema with a multidisciplinaryapproach using orthodonticmovement, front proportion frame, table ofwidth/height proportion and direct adhesiverestorative system.

Frenulectomy: proposal of a new surgical approach and case report.

The frenula of the oral cavity represent the insertion of perioral muscles in jaws, consisting of a fold of the triangular fibro-connective tissue covered with mucous membrane and usually inserted at the mucogingival line. The purpose of this work, after a review of literature, was to provide the clinical signs above the median frenum removal order for the orthodontic closure of a interincisor diastema and to present a new surgical technique.