The effects of injectable platelet-rich fibrin application on wound healing following gingivectomy and gingivoplasty operations: single-blind, randomized controlled, prospective clinical study.

OBJECTIVES: The aim of this study was to evaluate the effects of wound healing using injectable platelet-rich fibrin (IPRF) after gingivectomy and gingivoplasty. MATERIALS AND METHODS: In this clinical study, 46 systemically healthy patients with chronic inflammatory gingival enlargement were randomly treated with gingivectomy-gingivoplasty + I-PRF (n=23) or gingivectomy-gingivoplasty alone (n=23). The primary outcome was to evaluate the effect of I-PRF on wound healing over a 3-week follow-up period. Samples collected from gingival crevicular fluid (GCF) were processed using enzyme-linked immunosorbent assay (ELISA) to measure VEGF and FGF-10 biomarkers. The surgical areas were stained with Mira-2 tone and evaluated in ImageJ. Wound healing was evaluated with Modified Manchester Scar (MMS) scale and Landry, Turnbull, and Howley (LTH) index. RESULTS: VEGF values of the control group at baseline, week 2, and week 3 were significantly higher than the test group. In weeks 2 and 3, FGF-10 values were found to be significantly higher in the control group than the test group. The amount of staining was found to be significantly higher in the control group than in the test group on days 3, 7, and 14. LTH values of the control group were significantly lower than the test group and MMS values were significantly higher than those of the test group. CONCLUSIONS: I-PRF applications revealed positive effects on epithelial wound healing after gingivectomy and gingivoplasty operations. CLINICAL RELEVANCE: Platelet concentrates such as I-PRF accelerate wound healing and contribute to the patient's comfort and quality of life. I-PRF application may have positive effects on wound healing after gingivectomy and gingivoplasty operations.

Effects of the GingivalStat approach on early gingival margin remodeling following esthetic clinical crown lengthening: A case series.

OBJECTIVES: The aim of this case series is to present the potential applications of the GingivalStat approach, that is, the use of temporary gingival stabilizers, to favor early gingival margin remodeling and prevent the occurrence of gingival rebound following esthetic clinical crown lengthening. CLINICAL CONSIDERATIONS: Four patients requiring clinical crown lengthening were treated for esthetical and functional reasons. The surgical approach included: (a) gingival margin recontouring; (b) full-thickness flap elevation; (c) osteotomy (to achieve an adequate dimension between the alveolar bone crest and the CEJ) and osteoplasty (to reduce the bone thickness and improve the buccal bone anatomic profile, where indicated); (d) temporary gingival stabilizer placement using a block-out resin or a composite (the GingivalStat approach); and (e) flap repositioning, adaptation, and suture. One- to five-year follow-ups, reported in the different case scenarios, show evidence of clinically stable gingival margins around the treated teeth. CONCLUSIONS: Within the limits of this case series, it can be concluded that the GingivalStat approach appears as a further maneuver to cope with clinical crown lengthening procedures at esthetic sites. GingivalStat seems to favor gingival margin contour remodeling during the early phase of healing as well as prevent the occurrence of gingival rebound. CLINICAL SIGNIFICANCE: GingivalStat approach may guide gingival margin remodeling and prevent gingival rebound after wound healing of sites submitted to esthetic clinical crown lengthening.

A Minimally Invasive Osseous Resective Surgical Protocol for Pocket Elimination at Maxillary and Mandibular Posterior Sextants: MI-PES.

The purpose of the present study was to describe a novel protocol for a minimally invasive pocket elimination surgery (MI-PES) in the posterior maxilla and mandible, which consists of the combined use of (1) an access flap based on an internally beveled gingivectomy with minimal to no papilla mobilization at the buccal aspect, and (2) a resective procedure with an apically positioned flap on the lingual aspect. The interproximal bone defects were accessed with a single (lingual) flap, and the bone architecture was modified by the adoption of piezoelectric inserts for controlled bone recontouring associated with fiber retention. Mean probing depth (PD) was 5.5 ± 0.8 mm before surgery and 2.7 ± 0.6 mm at the 6-month reevaluation. All treated pockets showed a postsurgical PD < 4 mm. Gingival recession (REC) was 0.3 ± 0.5 mm at baseline and increased to 1.6 ± 0.8 mm at 6 months. When buccal and lingual pockets were analyzed separately, a trend toward a similar PD reduction, less REC increase, and greater clinical attachment level gain was recorded for buccal pockets. These preliminary observations seem to support the use of MI-PES as a valuable option for pocket elimination, at least when residual pockets are associated with a shallow interproximal osseous crater in the posterior maxilla or mandible.

Efficacy of hyaluronic acid gel and photobiomodulation therapy on wound healing after surgical gingivectomy: a randomized controlled clinical trial.

BACKGROUND: Surgical gingivectomy can be considered the gold standard treatment for gingival enlargement. The healing of wound site after gingivectomy occurs slowly by secondary intention. To accelerate the wound healing process, several studies have been conducted evaluating the effect of various treatment modalities. Photobiomodulation therapy (PBMT) was proposed to provide minimally invasive and painless treatment as well as to decrease discomfort of the patient following the surgical process. Another factor that is expected to improve the healing after surgery is topical application of chemotherapeutic agents such as Hyaluronic acid (HA). This study aims to assess the effect of topically applied HA gel after PBMT on the healing of wound site after surgical gingivectomy. METHODS: This randomized controlled clinical trial included twenty-six surgical gingivectomy wound sites, equally divided into two groups, Group-I (test group): the surgical sites after gingivectomy were irradiated with a diode laser (980 nm, 0.2 W) then covered by 2% HA gel loaded in a special custom-made soft transparent tissue guard appliance for each patient. Group II (control group): the surgical sites were irradiated with a diode laser (980 nm, 0.2 W) only. Wound healing was assessed subjectively by Landry healing index on the 3rd, 7th, 14th and 21st days after surgery, and pain perception was assessed by the patients using visual analog scale (VAS) throughout the 21 days of the follow up period. Comparisons between the two study groups were performed using Mann-Whitney U test, while comparisons between different time points were performed using Friedman test. Significance was inferred at p value < 0.05. RESULTS: By the end of the follow-up period, surgical sites of the test group showed excellent healing compared to the control group. There were no significant differences in VAS scores between both groups (p > 0.05). CONCLUSIONS: Application of 2% HA gel as an adjunctive to PBMT was found to have significant clinical effects and higher power of repair among test group when compared to that achieved by PBMT alone in control group. TRIAL REGISTRATION: This study was retrospectively registered on ClinicalTrials.gov and first posted on 28th of March 2023 with an identifier number: NCT05787912.

Histological artifacts associated with laser and electroscalpel gingivectomy: Case series / Artefactos histológicos asociados a gingivectomía con láser y electrobisturí: serie de casos.

Introduction. Over time, efforts have been invested in the design of new instruments that overcome the disadvantages of the gold standard instrument in surgery, the scalpel. As a result, electronic equipment has emerged such as the electric scalpel and laser devices. The available evidence on these instruments suggests that the tissue response is related to each instrument's physical and biological cutting principles. Objective. To compare the histological changes in gingiva samples associated with surgical cutting performed with a 940 nm diode laser, a 2780 nm erbium, chromium: yttriumscandium-gallium-garnet (Er,Cr:YSGG) laser, and an electric scalpel, by presenting a series of cases. Case presentation. We present three cases of healthy patients undergoing cosmetic surgery. The clinical examination revealed exposure of a keratinized gingiva band greater than 4 mm, normal color and texture in gingival tissue, with a firm consistency and no bleeding on periodontal probing. Gingivectomy was indicated with the following protocols: Diode laser of 940 nm at 1 W, in continuous mode; Er,Cr:YSGG laser of 2780 nm at 2.5 W, 75 Hz, H mode, air 20, water 40, gold tip MT4); and electric scalpel in cutting mode at power level four. Gingival tissue samples were taken and stored in 10% formaldehyde for histological analysis. Conclusion. All the evaluated cutting instruments generated histological changes produced by the thermal effect, the main ones being collagen coagulation and carbonization. The depth of thermal damage caused by the 2780 nm Er,Cr:YSGG laser was much lesser than that induced by the electric scalpel and the 940 nm diode laser.

Introducción. Históricamente se ha invertido esfuerzo en el diseño de nuevos instrumentos que superen las desventajas del estándar de referencia en cirugía, el bisturí. Como consecuencia de esto, han surgido equipos electrónicos como el electrobisturí y los diferentes dispositivos de tecnología láser. La información disponible sobre estos instrumentos sugiere que la respuesta del tejido intervenido está influenciada por los principios físicos y biológicos de corte del instrumento. Objetivo. Comparar los cambios histológicos en muestras de encía asociados al corte quirúrgico realizado con láser de diodo de 940 nm, láser de erbio, cromo: itrio-escandiogalio-granate (Er,Cr:YSGG) (2780nm) y electrobisturí mediante una presentación de serie de casos. Presentación de los casos. Se presentan tres casos de pacientes sanos sometidos a cirugía estética. El examen clínico reveló la exposición de una banda gingival queratinizada mayor de 4 mm, tejido gingival de color y textura normales, de consistencia firme y sin sangrado al sondaje periodontal. Se indicó gingivectomía con los siguientes protocolos: láser de diodo de 940 nm a 1 W, en modo continuo; láser de Er,Cr:YSGG de 2780 nm a 2,5 W, 75 Hz, modo H, aire 20, agua 40, punta de oro MT4; y bisturí eléctrico en modo de corte, a nivel de potencia cuatro. Se tomaron muestras de tejido gingival y se almacenaron en formaldehído al 10 % para su análisis histológico. Conclusión. Los tres instrumentos de corte generaron cambios histológicos producidos por el efecto térmico; los principales fueron coagulación del colágeno y carbonización.

Gingivectomy with Diode Laser Versus the Conventional Scalpel Surgery and Nonsurgical Periodontal Therapy in Treatment of Orthodontic Treatment-Induced Gingival Enlargement: A Systematic Review.

Background and objective: Some studies support the superiority of diode laser gingivectomy to scalpel surgery and nonsurgical treatments. However, a systematic review on this topic is lacking. This study aimed to compare gingivectomy with diode laser versus the conventional scalpel surgery and nonsurgical periodontal therapy (NSPT) in the treatment of orthodontic treatment-induced gingival enlargement (GE). Materials and methods: In this systematic review, an electronic search of the relevant literature was conducted in Web of Science, Medline/PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ProQuest with no language restriction. Randomized clinical trials published between 1985 and 2020 on comparative treatment of orthodontic treatment-induced GE by diode laser gingivectomy and scalpel surgery or NSPT regarding intraoperative and postoperative bleeding and/or pain were included. Risk of bias was assessed by the Cochrane 1 tool. Results: Of the initially retrieved 288 articles, 40 were duplicates and excluded; 236 articles were excluded following title and abstract screening, and 5 others were excluded following full-text assessment. Finally, 7 studies underwent systematic review. In the risk-of-bias assessment, 5 studies scored 2, and 2 studies scored 3 out of 6. Intraoperative and postoperative bleeding and pain were found to be significantly lower in the laser group. Conclusions: Within the limitations of this systematic review and with respect to the quality of evidence, the present results revealed lower level of pain and bleeding in diode laser gingivectomy compared with the conventional scalpel surgery and NSPT for treatment of orthodontic treatment-induced GE.

Histological artifacts associated with laser and electroscalpel gingivectomy: Case series / Artefactos histológicos asociados a gingivectomía con láser y electrobisturí: serie de casos

Introduction. Over time, efforts have been invested in the design of new instruments that overcome the disadvantages of the gold standard instrument in surgery, the scalpel. As a result, electronic equipment has emerged such as the electric scalpel and laser devices. The available evidence on these instruments suggests that the tissue response is related to each instrument's physical and biological cutting principles. Objective. To compare the histological changes in gingiva samples associated with surgical cutting performed with a 940 nm diode laser, a 2780 nm erbium, chromium: yttriumscandium-gallium-garnet (Er,Cr:YSGG) laser, and an electric scalpel, by presenting a series of cases. Case presentation. We present three cases of healthy patients undergoing cosmetic surgery. The clinical examination revealed exposure of a keratinized gingiva band greater than 4 mm, normal color and texture in gingival tissue, with a firm consistency and no bleeding on periodontal probing. Gingivectomy was indicated with the following protocols: Diode laser of 940 nm at 1 W, in continuous mode; Er,Cr:YSGG laser of 2780 nm at 2.5 W, 75 Hz, H mode, air 20, water 40, gold tip MT4); and electric scalpel in cutting mode at power level four. Gingival tissue samples were taken and stored in 10% formaldehyde for histological analysis. Conclusion. All the evaluated cutting instruments generated histological changes produced by the thermal effect, the main ones being collagen coagulation and carbonization. The depth of thermal damage caused by the 2780 nm Er,Cr:YSGG laser was much lesser than that induced by the electric scalpel and the 940 nm diode laser.

Introducción. Históricamente se ha invertido esfuerzo en el diseño de nuevos instrumentos que superen las desventajas del estándar de referencia en cirugía, el bisturí. Como consecuencia de esto, han surgido equipos electrónicos como el electrobisturí y los diferentes dispositivos de tecnología láser. La información disponible sobre estos instrumentos sugiere que la respuesta del tejido intervenido está influenciada por los principios físicos y biológicos de corte del instrumento. Objetivo. Comparar los cambios histológicos en muestras de encía asociados al corte quirúrgico realizado con láser de diodo de 940 nm, láser de erbio, cromo: itrio-escandio-galio-granate (Er,Cr:YSGG) (2780nm) y electrobisturí mediante una presentación de serie de casos. Presentación de los casos. Se presentan tres casos de pacientes sanos sometidos a cirugía estética. El examen clínico reveló la exposición de una banda gingival queratinizada mayor de 4 mm, tejido gingival de color y textura normales, de consistencia firme y sin sangrado al sondaje periodontal. Se indicó gingivectomía con los siguientes protocolos: láser de diodo de 940 nm a 1 W, en modo continuo; láser de Er,Cr:YSGG de 2780 nm a 2,5 W, 75 Hz, modo H, aire 20, agua 40, punta de oro MT4; y bisturí eléctrico en modo de corte, a nivel de potencia cuatro. Se tomaron muestras de tejido gingival y se almacenaron en formaldehído al 10 % para su análisis histológico. Conclusión. Los tres instrumentos de corte generaron cambios histológicos producidos por el efecto térmico; los principales fueron coagulación del colágeno y carbonización. La profundización del daño térmico causada por el láser de Er,Cr:YSGG de 2780 nm fue mucho menor que la generada por el electrobisturí y por el láser de diodo de 940 nm.

Harmonização do sorriso: aliando ortodontia e estética / Smile harmonization: combining orthodontics and aesthetics

Atualmente é evidente a demanda contínua por padrões de beleza, cada vez mais impecáveis, um sorriso alinhado e harmônico com dentes brancos para se sorrir com confiança. O tratamento odontológico interdisciplinar tem como intuito proporcionar uma boa saúde periodontal, restabelecer a estética e a função do sistema estomatognático. Objetivo: apresentar um relato de caso clínico envolvendo harmonização do sorriso como cirurgia plástica periodontal para alinhamento da margem gengival na região anterior e restaurações diretas em resina composta após a finalização do tratamento ortodôntico, evidenciando a importância da abordagem conservadora e multidisciplinar no âmbito do tratamento estético. Relato de caso: Realizamos o tratamento ortodôntico com aparelho autoligado cerâmico para alinhamento do arco dental e intrusão do elemento 13, em sequência executamos um recorte gengival nos elementos 12 e 22, clareamento dental associado após 15 dias, subsequentemente, reanatomização dentária no elemento 44 para que o elemento 13 não voltasse a extruir pela falta de contato oclusal, e por fim, remodelação dental fazendo uso de resina composta nos elementos 12, 21 e 22 devido a manchas de hipocalcificação dental. Conclusão: Contudo, a estética bucal tem a capacidade de possibilitar a melhoria na autoestima, devolvendo à função, proporcionando satisfação e bem-estar ao indivíduo, enaltecendo o sorriso.

Currently, the continuous demand for increasingly impeccable beauty standards is evident, an aligned and harmonic smile with white teeth to smile with confidence. Interdisciplinary dental treatment aims to provide good periodontal health, restore the aesthetics and function of the stomatognathic system. Objective: to present a clinical case report involving smile harmonization as periodontal plastic surgery for aligning the gingival margin in the anterior region and direct composite resin restorations after completion of orthodontic treatment, highlighting the importance of a conservative and multidisciplinary approach in the field of aesthetic treatment . Case report: We performed orthodontic treatment with a self-ligating ceramic appliance for aligning the dental arch and intruding element 13, then performed a gingival cutout on elements 12 and 22, associated tooth whitening after 15 days, subsequently, dental reanatomization on element 44 to that element 13 would not extrude again due to the lack of occlusal contact, and finally, dental remodeling using composite resin in elements 12, 21 and 22 due to dental hypocalcification stains. Conclusion: However, oral aesthetics has the ability to improve self-esteem, returning to function, providing satisfaction and well-being to the individual, enhancing the smile.

Multifunctional anatomical prototypes (MAPs): Treatment of excessive gingival display due to altered passive eruption.

OBJECTIVE: To describe a strategy using digital technologies for improving the diagnosis, treatment planning, and surgical execution of patients with excessive gingival display (EGD) due to altered passive eruption (APE). CLINICAL CONSIDERATIONS: An important component for successful patient's management is to fulfill their esthetic expectations whilst delivering predictable and long-term therapeutic outcomes. To achieve this goal in patients with excessive gingival display due to altered passive eruption, it is essential to perform an accurate diagnosis and to communicate to the patient the expected customized results using digital technologies. Computer-aided designed and manufactured multifunctional anatomical prototypes (MAPs) may contribute to these purposes. Additionally, they can guide the surgical crown lengthening procedure or serve as a reference during the surgical guide fabrication providing information of the required anatomical landmarks. CONCLUSIONS: This novel strategy protocol for diagnosis, communication, and treatment management of patients with excessive gingival display follows functional and biological principles within the frame of a digital workflow, which improves the diagnostic capabilities, enhances communication, and guides the surgical treatment as shown in the 12 months follow-up of the reported case. CLINICAL SIGNIFICANCE: Developing a virtual patient by combining multiple digital data sets including cone-beam computed tomography (CBCT), intra-oral scans and digital photography, supports the clinician and the patient to achieve a comprehensive diagnosis and to better communicate the expected results to the patient. Furthermore, this digital treatment exercise based on anatomical and biological principles will facilitate the surgical precision and the achievement of successful outcomes, thus fulfilling the patient needs and expectations.

Effectiveness of lip repositioning in the treatment of excessive gingival display: systematic review and meta-analysis / Eficacia del reposicionamiento de labios en el tratamiento de la exposición gingival excesiva: revisión sistemática y metanálisis

Background: The objective of this systematic review and meta-analysis was to answer the questions ''Does lip repositioning surgery reduce the amount of gingiva exposed in the smile in individuals with excessive gingival display EGD (excessive gingival display)?'' and ''Is the reduction of the amount of gingiva exposed when smiling obtained with lip repositioning surgery stable over time?'' to evaluate the effectiveness of lip repositioning surgery for correcting EGD on smiling. Materials and Methods: A systematic structured search was carried out in five databases without data restriction. Studies reporting the degree of reduction in gingival ex-posure after lip repositioning surgery were included. Study selection, data extraction, and risk of bias assessment were performed in duplicate Results: One hundred sixty-four references were retrieved and eleven studies met the eligibility criteria. Meta-analysis demonstrated that lip repositioning surgery results in a significant reduction in the amount of exposed gingival tissue (mean difference = -3.03; confidence interval = -3.55; -2.52). In addition, the results remained stable in the evaluated follow-up periods (1, 3, 6 and 12 months). Included studies had a low risk of bias. Conclusions: Lip repositioning surgery is effective for the treatment of EGD on smiling and exhibits stable results in the evaluated periods. The study was registered (CRD42020184866) in the international prospective register of systematic reviews (PROSPERO)

Antecedentes: el objetivo de esta revisión sistemática y metanálisis fue responder a las preguntas "¿La cirugía de reposicionamiento de labios reduce la cantidad de encía expuesta en la sonrisa en personas con exposición gingival excesiva (EGE)?" y "¿La reducción de la cantidad de encía expuesto al sonreír obtenido con cirugía de reposicionamiento de labios estable en el tiempo?" para evaluar la efectividad de la cirugía de reposicionamiento de labios para corregir la EGE al sonreír. Materiales y Métodos: Se realizó una búsqueda sistemática estructurada en cinco bases de datos sin restricción de datos. Se incluyeron los estudios que informaron el grado de reducción de la exposición gingival después de la cirugía de reposición de labios. La selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo se realizaron por duplicado. Resultados: Se recuperaron ciento sesenta y cuatro referencias y once estudios cumplieron con los criterios de elegibilidad. El metanálisis demostró que la cirugía de reposicionamiento de labios da como resultado una reducción significativa en la cantidad de tejido gingival expuesto (diferencia de medias = -3,03; intervalo de confianza = -3,55; -2,52). Además, los resultados se mantuvieron estables en los periodos de seguimiento evaluados (1, 3, 6 y 12 meses). Los estudios incluidos tenían un bajo riesgo de sesgo. Conclusión: La cirugía de reposicionamiento de labios es efectiva para el tratamiento de la EGE al sonreír y presenta resultados estables en los períodos evaluados. El estudio fue registrado (CRD42020184866) en el registro prospectivo internacional de revisiones sistemáticas (PROSPERO).

3D-printed PMMA implant for gingival smile treatment through the VISTA technique: A report of a new approach.

BACKGROUND: A gingival display higher than 3 mm is considered a characteristic of a gingival smile (GS). Several etiological factors have been associated to GS and for this reason various treatments have been proposed according to its etiology. The aim of this study is to present a case with an alternative technique to treat GS with minimally invasive vestibular incision subperiosteal tunnel access (VISTA) and polymethyl methacrylate (PMMA) implants for lip repositioning. METHODS AND RESULTS: The patient, a 25-year-old woman diagnosed with excessive gingival exposure, had previously done botulinum toxin (BoNT) injections and did not like the result. She had a major subnasal depression and the upper lip would lodge in there during spontaneous smile. She was informed about all options of treatment and agreed to a lip repositioning installing a customized PMMA implant. CONCLUSION: This is the first study to our knowledge to present a case with use of a PMMA implant associated with the VISTA approach for lip repositioning and gingival smile correction. The results are encouraging, and the patient was satisfied with results accomplished by this technique. KEY POINTS: Why is this case new information? This is a new and innovative surgical approach for gingival smile with PMMA implants through a minimally invasive technique (VISTA). What are the keys to successful management of this case? Well-defined presurgical planning and the presence of the upper lip lodging in the subnasal depression during spontaneous smile. What are the primary limitations to success in this case? Cases with vertical maxillary excess and those in which osteotomy/osteoplasty is indicated. It is a technique-sensitive treatment dependent on the clinician's experience.

Gingival fenestration defect treated with gingivectomy and gingivoplasty: A case report with an 8-year follow-up.

INTRODUCTION: Gingival fenestration (GF) is scarcely reported in the literature. We present a unique case of GF defect combined with gingivitis and altered passive eruption (APE). CASE PRESENTATION: An 18-year-old female patient with gingivitis, APE, and GF in the mandibular left central incisor presented for periodontal treatment. The gingival lesion was successfully treated with basic periodontal therapy gingivectomy, and gingivoplasty and resulted in an excellent aesthetic long-term outcome. This case report shows its 8-year clinical follow-up. CONCLUSION: There are no earlier reports dealing with the use of gingivoplasty for the treatment of GF, as it is not the usual therapeutic intervention for these defects. Gingivoplasty proved to be effective in treating GF. Why is this case new information? Available literature on gingival fenestration defects does not describe gingivectomy and gingivoplasty as a treatment of choice. Gingivectomy and gingivoplasty proved to be effective in treating gingival fenestration defects. What are the keys to successful management of this case? Proper diagnosis. What are the primary limitations to success in this case? Gingival fenestration has been defined when the overlying gingiva is denuded, exposing the root to the oral cavity. However, in this case report, only the crown was exposed because the patient had altered passive eruption.

Treatment of gummy smile combining crown lengthening, lip repositioning, and the use of polyester threads.

INTRODUCTION: The case report presents a new possibility of treatment for a gummy smile in a patient with multiple etiologies, such as altered passive eruption and hypermobility upper lip. At first, crown lengthening was not sufficient to achieve the desired aesthetic result, being necessary its combination with lip repositioning. CASE PRESENTATION: Crown lengthening surgery (CLS) was performed in a 20-year-old woman, with a gingival display of 7.5 mm, having her gingival exposure reduced to 5.5 mm. Because the patient continued unsatisfied after 6 months, a new procedure was adopted. To reduce even more her gingival exposure, lip repositioning technique was performed associated with myotomy and the insertion of polyester threads as a physical barrier to prevent relapse. CONCLUSION: The result of the gingival display was reduced to 2.5 mm, removing the condition of a gummy smile after the combination of both techniques: crown lengthening, and lip repositioning. KEY POINTS: Why is this case new information? Association of the technique of lip repositioning and myotomy, the insertion of polyester threads that act as a physical barrier against recurrence. What are the keys to successful management of this case? Correct etiological diagnosis. Prior application of botulinum toxin. Respect the period of 1 month for the insertion of the polyester thread, helping to preserve the suture (limitation of movement). What are the primary limitations to success in this case? Make the patient aware not to move the lips with the hands in order to observe the incision.

Apport de la technique combinée gingivectomie-frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique: à propos d'un cas / contribution of the combined gingivectomy-frenectomy technique in the management of gingival growth associated with a pathological frenulum: about a case

Introduction : La prise en charge de l'accroissement gingival repose sur un entretien médical bien mené, un examen clinique rigoureux, un diagnostic bien posé et une exérèse chirurgicale. Cependant, une récidive de la lésion peut être observée avec un rendu gingival souvent inesthétique. L'objectif de ce travail était d'illustrer, à travers un cas clinique, l'apport de la gingivectomie et de la frénectomie dans la prise en charge d'un accroissement gingival associé à un frein pathologique. Observation : Il s'agissait d'un patient âgé de 27 ans, venu consulter pour un problème esthétique lié à une excroissance gingivale. L'examen exo-buccal a mis en évidence, une asymétrie faciale dans le sens horizontal. La lésion gingivale était visible au sourire et évoluant depuis plus de 5 ans. L'examen endo-buccal a relevé la présence d'une gingivite induite par le biofilm, d'un frein de type 4 de Placek associés à un accroissement gingival pédonculé saignant au contact et siégeant entre la 11 et la 21. Après la thérapeutique initiale et une réévaluation, une gingivectomie à biseau interne (GBI) associée à une frénectomie ont été réalisées. L'examen anatomo-pathologique a mis en évidence un épulis fibreux ou fibrome périphérique avec absence de signes histologiques de malignité. L'évolution après 6 mois est marquée par une muqueuse gingivale cliniquement saine avec absence de récidive. Conclusion : L'apport de la gingivectomie et de la frénectomie est un atout important en termes de résultat clinique et de limitation de récidives dans l'exérèse des excès gingivaux combinés à un frein labial pathologique.

Introduction: Gingival growth is a change in the size and/or multiplication of cells, the gingival vascular system and the extracellular matrix. Management is based on a wellconducted medical interview, a rigorous clinical examination, a well-made diagnosis and surgical excision. However, a recurrence of the lesion can be observed with an often unsightly gingival rendering. The objective of this work was to illustrate, through a clinical case, the contribution of gingivectomy and frenectomy in the management of gingival growth associated with a pathological frenulum. Observation: It was a patient aged 27 who came to consult for an aesthetic problem related to a gingival growth. The exo-oral examination highlighted, a facial asymmetry in the horizontal direction. The gum lesion was visible on the smile and had been evolving for more than 5 years. The endooral examination noted the presence of biofilm-induced gingivitis, a type 4 Placek frenulum associated with pedunculate gingival growth bleeding on contact and sitting between 11 and 21. After initial therapy and reassessment, an internal bevel gingivectomy (IGG) combined with frenectomy was performed. The anatomo-pathological examination revealed fibrous epulis or peripheral fibroid with absence of histological signs of malignancy. The evolution after 6 months is marked by a clinically healthy gingival mucosa with no recurrence. Conclusion: The contribution of gingivectomy and frenectomy is an important asset in terms of clinical outcome and limitation of recurrence in the excision of excess gingival combined with a pathological labial frenulum.

Modified gingivoplasty for hereditary gingival fibromatosis: two case reports.

BACKGROUND: Hereditary gingival fibromatosis (HGF) is characterized by sub-epithelial fibromatosis of keratinized gingiva resulting in a fibrotic enlargement of keratinized gingiva. The treatment choice is gingivectomy, which can be performed with an internal or external bevel incision conventionally. However, both techniques can hardly resume the natural status of gingiva, and have a certain recurrence rate, especially in the cases which have limited width of attached gingiva. CASE DESCRIPTION: Two cases of HGF with the chief complaint of difficulty in mastication, pronunciation, and poor esthetics were presented. After the initial periodontal therapy, a novel gingivoplasty modified with a crevicular incision was applied. A full thickness flap above the mucogingival junction and a split flap below the junction were raised. Then, fibrotic connective tissue was completely eliminated and keratinized gingival epithelium was preserved. The fibrotic alveolar bone was shaped by handpiece and bur. Finally, the flap was apically repositioned and sutured. Twelve months after surgery, the gingiva recovered with normal color, contour and consistency. CONCLUSIONS: Compared to traditional gingivectomy, modified gingivoplasty which focuses on eliminating pathological fibrotic connective tissue can completely resume the natural appearance of gingiva and demonstrate no tendency of recurrence.

Diagnostic Mock-Up as a Surgical Reduction Guide for Crown Lengthening: Technique Description and Case Report.

Background and Objectives: The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. Materials and Methods: The patient's primary concern was improving her smile due to her "gummy smile" and short clinical crowns. After clinical evaluation, surgical crown lengthening accompanied by maxillary central full-coverage single-unit prostheses and lateral incisor veneers was recommended. The diagnostic mock-up was placed in the patient's maxillary anterior region and used as a soft tissue reduction guide for the gingivectomy. Once the planned gingival architecture was achieved, a flap was reflected to proceed with ostectomy in order to obtain an appropriate alveolar bone crest level using the overlay. After six months, all-ceramic crowns and porcelain veneers were provided as permanent restorations. Results: A diagnostic mock-up fabricated with a putty guide directly from the diagnostic wax-up can be an adequate surgical guide for crown-lengthening procedures. The diagnostic wax-up was used to fabricate the diagnostic mock-up. These results suggested that it can be used as a crown-lengthening surgical guide to modify the gingival architecture. Several advantages of the overlay used in the aesthetic complex case include: (1) providing a preview of potential restorative outcomes, (2) allowing for the appropriate positioning of gingival margins and the desired alveolar bone crest level for the crown-lengthening procedure, and (3) serving as a provisional restoration after surgery. Conclusions: The use of a diagnostic mock-up, which was based on a diagnostic wax-up, as the surgical guide resulted in successful crown lengthening and provisional restorations. Thus, a diagnostic overlay can be a viable option as a surgical guide for crown lengthening.

Use of Botulinum Toxin Before Surgical Lip Repositioning: A Randomized Clinical Trial.

This study aimed to determine whether administering botulinum toxin type A (BT) prior to surgery would stabilize surgical lip repositioning. A randomized controlled parallel-group clinical trial was performed. A total of 18 participants with excessive gingival display (EGD) were divided into two groups. For the test group (TG), BT was injected into the smile muscle locations 15 days before the surgical procedure. For the control group (CG), only lip repositioning surgery was performed. Gingival display (GD) and upper lip displacement (LD) were measured 3 and 6 months postoperatively. Data were submitted to ANOVA, Tukey, and t tests. For GD and LD, the changes were statistically significant between the measurements taken at the baseline, 3-month, and 6-month marks. The GD presented a reduction of 5.2 ± 1.1 mm in TG and 3.2 ± 1.4 mm in CG after 6 months. The LD measurements reduced 45% for TG and 26% for CG in 6 months. The injection of BT 15 days before lip repositioning surgery provided more stable results and effectively reduced the GD at 6 months.

Double guide concept: A new digital paradigm for the treatment of altered passive eruption in patients with high esthetic expectations.

Digital guides (also known as stents) have become commonly used in daily dental practice. CBCT, digital impressions, and stereolithographic models are considered extremely helpful to create guides for the planning and resolution of surgical cases. In recent years, in periodontal surgery and in particular for the treatment of altered passive eruption (APE), there has been an increasing use of digitally designed guides to improve esthetic outcomes and achieve more predictable results. Digital custom-made guides can be used to improve safety and precision in crown lengthening procedures in patients with APE who have high esthetic expectations. Although most approaches described in the literature show guides used for primary flap or gingivectomy design, the precision of bone recontouring and ostectomy plays a key role in soft tissue rebound and in the final esthetic outcome. The present article describes a new approach using two different guides for soft tissue design in patients with APE.

Colágeno tipo I en el agrandamiento gingival inducido por tratamiento ortodóntico: un estudio inmunohistoquímico piloto / Type I Collagen in Gingival Overgrowth Induced by Orthodontic Treatment: A Pilot Immunohistochemical Study / Colágeno do tipo I no aumento gengival induzido por tratamento ortodôntico: um estudo imuno-histoquímico piloto

el tratamiento ortodóntico es responsable del agrandamiento gingival (ag), una condición clínica caracterizada por el crecimiento patológico, difuso o localizado del tejido gingival. La acumulación excesiva de la matriz extracelular (mec), incluyendo el colágeno tipo I, parece contribuir a las manifestaciones patológicas del ag. El objetivo del artículo es identificar y describir la distribución del colágeno tipo I en el tejido gingival de pacientes con ag por ortodoncia fija. Materiales y métodos: estudio de tipo descriptivo que analizó los tejidos gingivales de sujetos diagnosticados con ag portadores de ortodoncia (test, n = 5) e individuos periodontalmente sanos (control, n = 5). Las muestras se obtuvieron mediante gingivectomía. Todas las biopsias fueron fijadas, incluidas en parafina, cortadas y analizadas por medio de la coloración rojo picrosirius/verde rápido, con el propósito de distinguir las fibras de colágeno. Mediante una reacción inmunohistoquímica, el colágeno tipo I fue identificado con anticuerpo monoclonal. Resultados: en los pacientes con ag por tratamiento ortodóntico, se identificó un tejido epitelial hiperplásico con aumento evidente de las prolongaciones epiteliales y un tejido conectivo con abundantes haces de fibras de colágenos, principalmente en la lámina basal y la zona subyacente. Las fibras de colágeno tipo I en los tejidos de pacientes con ag por ortodoncia fueron gruesas de aspecto desorganizado, con una tinción inmunohistoquímica intensa, en comparación con las fibras del grupo control. Conclusiones: el aumento de fibras de colágenos, en especial de colágeno de tipo I, es un hallazgo histológico que caracteriza a los pacientes con ag por ortodoncia fija.

Orthodontic treatment is responsible for gingival overgrowth (go), a clinical condition charac-terized by pathological, diffuse, or localized growth of gingival tissue. Excessive accumulation of the extra-cellular matrix, including type I collagen, contributes to the pathological manifestations of go. The objective of this study is to identify and describe the distribution of type I collagen in the gingival tissue of patients with go because of fixed orthodontics. Materials and Methods: A descriptive study that analyzed the gingival tissues of subjects diagnosed with go with orthodontic (test, n = 5) and periodontally healthy individuals (control, n = 5). The samples were obtained by gingivectomy. All the biopsies were fixed, embedded in paraf-fin, and cut and analyzed using picrosirius red/fast green staining, in order to distinguish the collagen fiber. By means of an immunohistochemical reaction, type I collagen was identified with a monoclonal antibody. Results: A hyperplastic epithelial tissue was identified with an evident increase in epithelial processes and connective tissue with abundant bundles of collagen fiber, mainly in the basal lamina and the underlying area in patients with go because of orthodontic treatment. Type I collagen fiber in the tissues of patients with orthodontic go were thick and disorganized in appearance with intense immunohistochemical stain-ing, compared to the fibers of the control group. Conclusions:The increase in collagen fibers, particularly type I collagen, is a histological finding that characterizes patients with go because of fixed orthodontics.

• tratamento ortodôntico é responsável pelo aumento gengival (ag), uma condição clínica caracterizada pelo crescimento patológico difuso ou localizado do tecido gengival. O acúmulo excessivo de matriz extracelular (mec), incluindo colágeno tipo I, parece contribuir para as manifestações patoló-gicas do ag. O objetivo deste trabalho é identificar e descrever a distribuição do colágeno do tipo I no tecido gengival de pacientes com AG devido à ortodontia fixa. Materiais e métodos: estudo descritivo que analisou os tecidos gengivais de indivíduos diagnosticados com ag em uso de ortodontia (teste, n = 5) e indivíduos periodontalmente saudáveis (controle, n = 5). As amostras foram obtidas por gengivectomia. Todas as biópsias foram fixadas, embebidas em parafina, cortadas e analisadas com coloração picrosirius vermelho/verde rápido, a fim de distinguir as fibras colágenas. Usando uma reação imuno-histoquímica, o colágeno tipo I foi identificado com anticorpo monoclonal. Resultados: em pacientes com ag devido ao tratamento ortodôntico, foi identificado tecido epitelial hiperplásico com evidente aumento das exten-sões epiteliais e tecido conjuntivo com abundantes feixes de fibras colágenas, principalmente na lâmina basal e região subjacente. As fibras de colágeno tipo I em tecidos de pacientes com ag ortodôntico eram espessas com aspecto desorganizado e intensa coloração imuno-histoquímica, em comparação com as fibras do grupo controle. Conclusões: o aumento das fibras colágenas, principalmente do colágeno do tipo I, é um achado histológico que caracteriza os pacientes com ag devido à ortodontia fixa.