GENGIVECTOMIA: SOLUÇÃO ESTÉTICA E FUNCIONAL DURANTE O TRATAMENTO ORTODÔNTICO

A gengivectomia é um procedimento cirúrgico periodontal. Uma de suas finalidades é recuperar a conformação fisiológica da gengiva. Este trabalho tem como objetivo mostrar os resultados de um caso clínico onde a terapia cirúrgica periodontal foi conciliada ao tratamento ortodôntico por necessidades estéticas e funcionais. Paciente A.A.S., 15 anos, compareceu a Clínica Integrada da UFPR, tendo como queixa principal uma gengiva mole que sangra muito ao escovar. Através da anamnese não foi constatada nenhuma alteração sistêmica. Na história odontológica o paciente relatou usar aparelho ortodôntico fixo há um ano e a partir de então a gengiva cresceu. Por meio de exame clínico, detectou-se higiene oral precária, presença de grande quantidade de placa bacteriana em ambas as arcadas, gengiva avermelhada e edemaciada, com falsas bolsas e sangramento generalizado. Além da realização da terapia periodontal básica, incluindo a orientação de higiene bucal e a raspagem supra e subgengival com aparelho de ultrasom, realizou-se gengivectomia em toda a arcada superior do paciente. Após 1 mês do procedimento cirúrgico, observou-se um resultado estético favorável e a presença de saúde periodontal, além da total satisfação do paciente

Health-related quality of life of patients undergoing rehabilitation with implant-supported prostheses

The success of oral reabilitation treatment depend on the re-establishment of the masticatory function and oral comfort of the patient. Objective: To evaluate the oral health-related quality of life (OHRQoL) of patients undergoing rehabilitation with implant-supported prostheses by Oral Health Impact Profile - short form questionnaire (OHIP-14) and a questionnaire associated to the Visual Analog Scale (VAS). Material and methods: Fourteen patients requiring implant-supported prostheses on anterior region were asked to complete the OHIP-14 before, 1 and 3 months, and the VAS questionnaire, 1 and 3 months after the prosthesis installation (sample group). Moreover, fourteen complete dentate patients were asked to complete the OHIP-14 (control group). For each OHIP-14 category, the sample group’s answers were compared between the evaluation periods by the Kruskal-Wallis test, and to the control group’s answers by the U-test. The answers of the questionnaire associated to VAS were compared between the evaluation periods by t-test ( α=0.05). Results: For OHIP-14, there was no statistical difference between the answers after 1 and 3 months; however, there was difference among the answers of baseline, and 1 and 3 months after the prostheses installation, excepted for functional limitation. Comparing to the control group, before the prostheses installation, there was statistical difference for functional limitation, physical pain, psychological discomfort, physical and psychological disability; and, there was no difference after 3 months of prostheses installation. For the questionnaire associated to the VAS, there was no statistical difference between the responses for both evaluation periods, excepted for the prosthesis’ comfort and stability. Conclusion: The rehabilitated patients showed a significant improvement in function, aesthetics, self-esteem, and the quality of life.The success of oral reabilitation treatment depend on the re-establishment of the masticatory function and oral comfort of the patient. Objective: To evaluate the oral health-related quality of life (OHRQoL) of patients undergoing rehabilitation with implant-supported prostheses by Oral Health Impact Profile - short form questionnaire (OHIP-14) and a questionnaire associated to the Visual Analog Scale (VAS). Material and methods: Fourteen patients requiring implant-supported prostheses on anterior region were asked to complete the OHIP-14 before, 1 and 3 months, and the VAS questionnaire, 1 and 3 months after the prosthesis installation (sample group). Moreover, fourteen complete dentate patients were asked to complete the OHIP-14 (control group). For each OHIP-14 category, the sample group’s answers were compared between the evaluation periods by the Kruskal-Wallis test, and to the control group’s answers by the U-test. The answers of the questionnaire associated to VAS were compared between the evaluation periods by t-test ( α=0.05). Results: For OHIP-14, there was no statistical difference between the answers after 1 and 3 months; however, there was difference among the answers of baseline, and 1 and 3 months after the prostheses installation, excepted for functional limitation. Comparing to the control group, before the prostheses installation, there was statistical difference for functional limitation, physical pain, psychological discomfort, physical and psychological disability; and, there was no difference after 3 months of prostheses installation. For the questionnaire associated to the VAS, there was no statistical difference between the responses for both evaluation periods, excepted for the prosthesis’ comfort and stability. Conclusion: The rehabilitated patients showed a significant improvement in function, aesthetics, self-esteem, and the quality of life

Treatment of class II furcation defects with autogenous bone graft associated with Bichat’s fat pad: case report

The periodontal treatment of teeth with furcation defect is clinically challenging. In cases of class II furcation defects, the regenerative surgery shows low morbidity and good prognosis when correctly indicated. The aim of the presentstudy is to report a treatment option for class II furcation defect through autogenous bone graft associated with the Bichat’s fat pad. Case report: A 59-year-old female patient was diagnosed with class II furcation defect in the left mandibular first molar. The treatment comprised surgical reconstruction of the defect with a combination of maxillary tuberosity bone graft and Bichat’s fat pad. The clinical and radiographic follow-up of 180 days showed bone formation inthe furcation area and absence of probing depth. Conclusion: An association of autogenous graft form the maxillary tuberosity with a Bichat’s fat pad proved to be a safe, low cost, and effective therapy for the regenerative treatment of class II furcation.The periodontal treatment of teeth with furcation defect is clinically challenging. In cases of class II furcation defects, the regenerative surgery shows low morbidity and good prognosis when correctly indicated. The aim of the presentstudy is to report a treatment option for class II furcation defect through autogenous bone graft associated with the Bichat’s fat pad. Case report: A 59-year-old female patient was diagnosed with class II furcation defect in the left mandibular first molar. The treatment comprised surgical reconstruction of the defect with a combination of maxillary tuberosity bone graft and Bichat’s fat pad. The clinical and radiographic follow-up of 180 days showed bone formation inthe furcation area and absence of probing depth. Conclusion: An association of autogenous graft form the maxillary tuberosity with a Bichat’s fat pad proved to be a safe, low cost, and effective therapy for the regenerative treatment of class II furcation

Treatment of peri-implantitis with surface decontamination and particulate bone graft in a smoker patient

Introduction: With the increase of implant-supported rehabilitation, the cases of patients with peri-implantitis become more frequent. Objective: To report the treatment of peri-implantitis by associating techniques of surface decontamination and particulate bone graft. Case report: The treatment was carried through curettage of the granulation tissue, mechanical bone decontamination withbicarbonate jet, chemical decontamination with tetracycline solution, and particulate graft in the place of the bone defect. Conclusion: After 45 postoperative days, the peri-implant tissues were health without inflammation. After 6 postoperative months, the bone defect was repaired.Introduction: With the increase of implant-supported rehabilitation, the cases of patients with peri-implantitis become more frequent. Objective: To report the treatment of peri-implantitis by associating techniques of surface decontamination and particulate bone graft. Case report: The treatment was carried through curettage of the granulation tissue, mechanical bone decontamination withbicarbonate jet, chemical decontamination with tetracycline solution, and particulate graft in the place of the bone defect. Conclusion: After 45 postoperative days, the peri-implant tissues were health without inflammation. After 6 postoperative months, the bone defect was repaired

Periodontal plastic surgery for treatment of gummy smile with cosmetic restauration treatment

Introduction: Today, the appreciation of aesthetic dentistry by society brought to the search for materials and techniques that improve the appearance of smile, which is essential in maintaining physical and mental health of the patient. Objective: This study aimed to report a case of gummy smile involving Periodontics and Restorative Dentistry. Case report: This case, despite other possible alternatives, was solved through periodontal surgery (clinical crown augmentation associated with osteotomy) and indirect restorations with porcelain crowns. Conclusion: In our experience this procedure is safe, predictable, with minimal risks or side effects, and it is a treatment option for these cases.Introduction: Today, the appreciation of aesthetic dentistry by society brought to the search for materials and techniques that improve the appearance of smile, which is essential in maintaining physical and mental health of the patient. Objective: This study aimed to report a case of gummy smile involving Periodontics and Restorative Dentistry. Case report: This case, despite other possible alternatives, was solved through periodontal surgery (clinical crown augmentation associated with osteotomy) and indirect restorations with porcelain crowns. Conclusion: In our experience this procedure is safe, predictable, with minimal risks or side effects, and it is a treatment option for these cases

SOLUÇÃO ESTÉTICA PARA ABRASÕES CERVICAIS PROFUNDAS RESTAURADAS COM MATERIAL RESINOSO ASSOCIADA AO RECOBRIMENTO RADICULAR: RELATO DE CASO CLÍNICO

O uso de materiais restauradores resinosos tem-se mostrado uma alternativa biocompatível na restauração de abrasões cervicais e/ ou cáries profundas previamente ao procedimento cirúrgico de recobrimento radicular. Este trabalho tem como objetivo mostrar os resultados obtidos em um caso clínico onde abrasões cervicais profundas foram previamente restauradas ao procedimento cirúrgico de recobrimento radicular. Paciente do sexo masculino, 56 anos, compareceu à Clínica de Periodontia do Unicenp, queixando-se de falta de estética na região dos elementos dentários 14, 15 e 16. Por meio do exame clínico, detectou-se a presença de recessões gengivais múltiplas, classe II de Miller, associadas com abrasões cervicais profundas. Além da realização da terapia básica periodontal, incluindo a orientação de higiene bucal, realizou-se a restauração das abrasões cervicais, com resina composta microhíbrida, 2 semanas antes da técnica cirúrgica de recobrimento radicular com enxerto de tecido conjuntivo subepitelial. Após 6 meses, observou-se recobrimento parcial das superfícies radiculares anteriormente expostas e saúde periodontal, além da total satisfação do paciente. A associação entre tratamento restaurador e recobrimento radicular para tratar abrasões cervicais profundas pode ser considerada uma técnica de sucesso

Surgical correction of vertical maxillary excess associated with mandibular self-rotation

Introduction: The Class I skeletal deformity associated with vertical maxillary excess is a rare condition reported in the literature. Surgical impaction allows the correction of the long face and gummy smile. Objective: This case report aimed to evaluate the positioning of the condyle after Le Fort I osteotomy associated with mandibular selfrotation. Case report: The patient underwent orthognathic surgery for the correction of maxillary vertical excess. Tomography studies were performed to evaluate the initial and final position of the condyle. The patient improved mastication, breathing and phonetics, with esthetic benefit. Conclusion: After the Le Fort I osteotomy and mandibular self-rotation, the condyle remained stable occupying a new anterior-superior position in the glenoid fossa and patient’s TMJremained asymptomatic after 9 months of postoperative follow-up.Introduction: The Class I skeletal deformity associated with vertical maxillary excess is a rare condition reported in the literature. Surgical impaction allows the correction of the long face and gummy smile. Objective: This case report aimed to evaluate the positioning of the condyle after Le Fort I osteotomy associated with mandibular selfrotation. Case report: The patient underwent orthognathic surgery for the correction of maxillary vertical excess. Tomography studies were performed to evaluate the initial and final position of the condyle. The patient improved mastication, breathing and phonetics, with esthetic benefit. Conclusion: After the Le Fort I osteotomy and mandibular self-rotation, the condyle remained stable occupying a new anterior-superior position in the glenoid fossa and patient’s TMJremained asymptomatic after 9 months of postoperative follow-up

Effect of the use of different periodontal curettes on the topography and roughness of root surface

Periodontal scaling is the treatment approach most used to remove dental calculus, plaque, and altered cementum from root surface. During root decontamination, the instruments used leave the root rougher and more irregular. Objective: To verify the root surface after mechanical scaling with different Gracey curettes steel through SEM and superficial roughness analyses. Material and methods: Twelve teeth were embedded in acrylic resin. The teeth were instrumented with new Gracey curettes Gracey 5/6 from different brands. The groups (n=2) were divided into: control, no instrumentation (GC); carbon steel (CSN); stainless steel Neumar (SSN); stainless steel Millenium (SSM); premium steel Neumar (PSN); Hu-Friedy (HF). An area measuring 3 x 3 mm2was marked on the distal surface of the root to guide the Reading of the root topography on SEM and rugosimeter. The data were analyzed by a single examiner previously calibrated. SEM analysis was based on scores of the root surface smoothness after scaling. We analyzed the parameters of mean roughness (Ra) and mean roughness deepness (Rz). SEM data were submitted to statistical analysis through Fisher’s exact test (p < 0.002) and roughness data by Anova followed by Student t test. Results: The quality of the active surface of the curette demonstrated by SEM and roughness analyses that it can exert difference in the result regarding to the homogeneity produced after the scaling of root surface. Group SSM demonstrated a homogenous root surface (score 0) in SEM and better smoothness in rugosimeter analysis. Conclusion: According to com the methodology used, the group of curettes that provided better smoothness of root surface after scaling was SSM

Mesenchymal stem cells surpass the capacity of bone marrow aspirate concentrate for periodontal regeneration

Regenerative approaches using mesenchymal stem cells (MSCs) have been evaluated to promote the complete formation of all missing periodontal tissues, e.g., new cementum, bone, and functional periodontal ligaments. MSCs derived from bone marrow have been applied to bone and periodontal defects in several forms, including bone marrow aspirate concentrate (BMAC) and cultured and isolated bone marrow mesenchymal stem cells (BM-MSCs). This study aimed to evaluate the periodontal regeneration capacity of BMAC and cultured BM-MSCs in the wound healing of fenestration defects in rats. Methodology: BM-MSCs were obtained after bone marrow aspiration of the isogenic iliac crests of rats, followed by cultivation and isolation. Autogenous BMAC was collected and centrifuged immediately before surgery. In 36 rats, fenestration defects were created and treated with suspended BM-MSCs, BMAC or left to spontaneously heal (control) (N=6). Their regenerative potential was assessed by microcomputed tomography (µCT) and histomorphometry, as well as their cell phenotype and functionality by the Luminex assay at 15 and 30 postoperative days. Results: BMAC achieved higher bone volume in 30 days than spontaneous healing (p&lt;0.0001) by enhancing osteoblastic lineage commitment maturation, with higher levels of osteopontin (p=0.0013). Defects filled with cultured BM-MSCs achieved higher mature bone formation in early stages than spontaneous healing and BMAC (p=0.0241 and p=0.0143, respectively). Moreover, significantly more cementum-like tissue formation (p&lt;0.0001) was observed with new insertion of fibers in specimens treated with BM-MSCs within 30 days. Conclusion: Both forms of cell transport, BMAC and BM-MSCs, promoted bone formation. However, early bone formation and maturation were achieved when cultured BM-MSCs were used. Likewise, only cultured BM-MSCs were capable of achieving complete periodontal regeneration with inserted fibers in the new cementum-like tissue

Split crest technique: a solution for atrophic anterior maxilla – case report

Introduction: The rehabilitation of atrophic anterior maxilla can be done by different techniques. Among the procedures for bone augmentation, we can use block grafting, guided bone regeneration, and split crest technique (SCT). SCT consists in bone crest osteotomy, followed by manual/mechanical expansion up to the splitting of the buccal plate from the lingual/palatal plate through greenstick fracture. SCT advantage is the possibility of simultaneously installing a dental implant. However, SCT planning should consider the remaining bone width and the the flap type to obtain success. Objective: To report a case of implant-supported rehabilitation of an atrophic anterior maxilla using the split crest technique with insertion of 4 immediate implants, showing the effectiveness of the technique.Introduction: The rehabilitation of atrophic anterior maxilla can be done by different techniques. Among the procedures for bone augmentation, we can use block grafting, guided bone regeneration, and split crest technique (SCT). SCT consists in bone crest osteotomy, followed by manual/mechanical expansion up to the splitting of the buccal plate from the lingual/palatal plate through greenstick fracture. SCT advantage is the possibility of simultaneously installing a dental implant. However, SCT planning should consider the remaining bone width and the the flap type to obtain success. Objective: To report a case of implant-supported rehabilitation of an atrophic anterior maxilla using the split crest technique with insertion of 4 immediate implants, showing the effectiveness of the technique