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Harmonização cirúrgica da assimetria periodontal em paciente com sorriso gengival decorrente de erupção passiva alterada

RESUMO

O sorriso gengival é causa frequente de insatisfação e desconforto estético por parte de alguns pacientes. Diversos fatores podem estar relacionados a essa condição clínica, sendo a erupção passiva alterada uma das mais frequentes. A consequente aparência de coroas clínicas curtas associadas à posição do zênite e a harmonia do contorno gengival assumem grande relevância no planejamento estético e são consideradas elementos-chaves para um sorriso agradável. Ademais, também pode influenciar e restringir determinados tratamentos restauradores. A principal forma de tratamento da erupção passiva alterada é cirúrgica, através de procedimentos de gengivectomia/gengivoplastia ou com retalhos de espessura total, com ou sem osteotomias, possibilitando o aumento da coroa clínica dos dentes, alteração do posicionamento dos zênites e harmonização da assimetria do sorriso. O objetivo do presente trabalho foi relatar o tratamento em uma paciente com diagnóstico de erupção passiva alterada com resultante sorriso gengival, por meio de cirurgia periodontal para aumento de coroa clínica.

Palavras-chave – Sorriso gengival; Erupção passiva alterada; Tratamento.


ABSTRACT

Gingival smile is a frequent cause of dissatisfaction and aesthetic discomfort for some patients. Several factors may be related to this clinical condition; with passive eruption being altered one of the most frequent. The appearance of short clinical crowns associated with the zenith position and the harmony of the gingival contour assume great relevance in aesthetic planning and are considered key elements for a pleasant smile. Furthermore, it can also influence and restrict certain restorative treatments. The main form of treatment for altered passive eruption is surgical, through gingivectomy/gingivoplasty procedures or with full-thickness flaps with or without osteotomies, allowing for an increase in the clinical crown of the teeth, alteration of the zenith positioning and harmonization of the smile asymmetry. The objective of this study was to report a treatment in a patient diagnosed with altered passive eruption with resulting gingival smile, through periodontal surgery.

Key words – Gingival smile; Altered passive eruption; Treatment.

Referências

  1. Nart J, Carrio N, Valles C, Solis-Moreno C, Nart M, Rene R et al. Prevalence of altered passive eruption in orthodontically treated and untreated patients. J Periodontol 2014;85(11):e348-53.
  2. Gomes GH, da Silveira WG, Bolfe RK, Martos J. Reabilitação estética anterior de paciente com erupção passiva alterada. INPerio 2019;4(6):1178-84.
  3. Kokich Jr. VO, Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent 1999;11(6):311-24.
  4. Ker AJ, Chan R, Fields HW, Beck M, Rosenstiel S. Esthetics and smile characteristics from the layperson’s perspective: a computer-based survey study. J Am Dent Assoc 2008;139(10):1318-27.
  5. Antoniazzi RP, Fischer LS, Balbinot CEA, Antoniazzi SP, Skupien JA. Impact of excessive gingival display on oral health-related quality of life in a Southern Brazilian young population. J Clin Periodontol 2017;44(10):996-1002.
  6. Tjan AH, Miller GD, The JG. Some esthetic factors in a smile. J Prosthet Dent 1984;51(1):24-8.
  7. Levine RA, McGuire M. The diagnosis and treatment of the gummy smile. Compend Contin Educ Dent 1997;18(8):757-62.
  8. Alpiste-Illueca F. Morphology and dimensions of dentogengival unit in the altered passive eruption. Med Oral Patol Oral Cir Bucal 2012;17:e814-20.
  9. Coslet GJ, Vanarsdall R, Weisgold A. Diagnosis and classification of delayed passive eruption of the dentogengival junction in the adult. Alpha Omegan 1977;70(3):24-8.
  10. Wu H, Lin J, Zhou L, Bai D. Classification and craniofacial features of gummy smile in adolescents. J Craniofac Surg 2010;21(5):1474-9.
  11. Dolt AH, Robbins W. Altered passive eruption: an etiology of short clinical crowns. Quintessence Int 1997;28(6):363-71.
  12. Carvalho CV, Pinto RCNC, Souto MLS, Chambrone L, Soares FP, César-Neto JB et al. Espaço biológico: conceito chave para estética e saúde gengival em procedimentos restauradores. Int J Periodontics Rest Dent 2016;1(1):825-32.
  13. Mele M, Felice P, Sharma P, Mazzotti C, Bellone P, Zucchelli G. Esthetic treatment of altered passive eruption. Periodontol 2000 2018;77(1):65-83.
  14. Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontol 2000 1996;11(1):18-28.
  15. Chu SJ. A biometric approach to predictable treatment of clinical crown discrepancies. Pract Proced Aesthet Dent 2007;19(7):401-9.
  16. Zucchelli G. Altered passive eruption. In: Zucchelli G. Mucogingival esthetic surgery. Berlin: Quintessence Publishing, 2013. p.749-93.
  17. Berglundh T, Giannobile WV, Lang NP, Sanz M. Terapia mucogengival: cirurgia plástica periodontal. In: Lindhe J. Tratado de Periodontia Clínica e Implantologia Oral. Rio de Janeiro: Guanabara Koogan, 2024. p.998-1005.
  18. Cavallieri RS, Santos CA, Greghi SLA, Sant’ana ACP, Damante CA, Zangrando MSR. Diagnóstico e tratamento de erupção passiva e ativa alteradas associado à laserterapia pós-operatória. ImplantNews 2023;8(4):542-8.
  19. Gargiulo AW, Wentz FM, Orban B. Dimensions of the dentogingival junction in humans. J Periodontol 1961;32(3):261-7.
  20. Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: consensus report of workgroup 3 of the 2017 world workshop on the classification of periodontal and peri-Implant diseases and conditions. J Periodontol 2018;89(1):S237-48.
  21. Tinoco EMB, Almeida JM, Matheus HR, Novaes Jr. AB, Muglia V. Espaço biológico entre dente e implante. INPerio 2017;2(6):1004-11.
  22. Cairo F, Graziani F, Franchi L, Defraia E, Pini Prato GP. Periodontal plastic surgery to improve aesthetics in patients with altered passive eruption/gummy smile: a case series study. Int J Dent 2012;2012:837658.
  23. Ribeiro FV, Hirata DY, Reis AF, Santos VR, Miranda TS, Faveri M et al. Open-flap versus flapless esthetic crown lengthening: 12-month clinical outcomes of a randomized controlled clinical trial. J Periodontol 2014;85(4):536-44.
  24. Prates RA, Suzuki LC, Kato IT. Terapia laser de baixa potência na periodontia. In: Garcez AS, Ribeiro MS, Núñez SC. Laser de baixa potência: princípios básicos e aplicações clínicas na Odontologia. Rio de Janeiro: Elsevier, 2012. p.168-74.
  25. Nabi S, Amin K, Masoodi A, Farooq R, Purra AR, Ahangar FA. Effect of preoperative ibuprofen in controlling post endodontic pain with and without low-level laser therapy in single visit endodontics: a randomized clinical study. Indian J Dent Res 2018;29(1):46-50.
  26. Abd-Elaal AZ, El-Mekawii HA, Saafan AM, El Gawad LA, El-Hawary YM, Abdelrazik MA. Evaluation of the effect of low-level diode laser therapy applied during the bone consolidation period following mandibular distraction osteogenesis in the human. Int J Oral Maxillofac Surg 2015;44(8):989-97.
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