Cirurgia periodontal sem elevação de retalho para tratamento de sorriso gengival

RESUMO

O objetivo deste relato de caso foi apresentar o manejo clínico de uma paciente com sorriso gengival por erupção passiva alterada (EPA), associando técnicas cirúrgicas periodontais com o aumento dental por meio de facetas diretas em resina composta. A paciente compareceu ao Centro de Ensino e Pesquisa em Implantes Dentários (Cepid), no departamento de Odontologia da Universidade Federal de Santa Catarina (UFSC), mostrando insatisfação com a aparência do seu sorriso, por este mostrar demais a gengiva e os dentes parecerem pequenos. Após o diagnóstico de EPA, o caso foi planejado e a paciente foi submetida a procedimento cirúrgico para aumento da exposição das coroas dentais, por meio de gengivectomia e osteoplastia sem elevação de retalho. Aproximadamente oito meses depois da cirurgia, a paciente modificou o tamanho e forma dos dentes por meio de facetas. No controle pós-cirúrgico de 18 meses, os tecidos moles mostravam-se adequadamente cicatrizados e a paciente declarava-se satisfeita com o resultado. Concluiu-se que a cirurgia plástica periodontal associada ao uso de facetas diretas em resina pode ser uma opção de tratamento eficaz para minimizar a exposição gengival e alcançar resultados estéticos harmoniosos.

Palavras-chave – Periodontia; Periodonto; Erupção dentária; Cirurgia odontológica; Sorriso.

ABSTRACT

The aim of this case report was to present the clinical management of a patient with excessive gingival display associated with altered passive eruption (APS). A periodontal surgical approach together with direct composite resin veneers to increase the length of the teeth was proposed. The patient attended the Center for Education and Research on Dental Implants (Cepid), at the Department of Dentistry of the Federal University of Santa Catarina (UFSC), reporting dissatisfaction with the appearance of her smile due to excessive gingival display and small size of her teeth. After APS diagnosis, the case was planned and the patient was submitted to a surgical procedure to increase dental exposure by means of gingivectomy and osteoplasty. Approximately eight months after surgery, the patient modified size and shape of her teeth with resin restorations. In the postoperative control of 18 months, the soft tissues were adequately healed and the patient was satisfied with the result. It can be conclued that periodontal plastic surgery associated with dental restorations may be an eff ective treatment to minimize gummy smile and achieve harmonious aesthetic results.

Key words – Periodontics; Periodontium; Dental eruption; Oral surgical procedures; Smile.

Referências

Tin-Oo MM, Saddki N, Hassan N. Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics. BMC Oral Health 2011;23(11):6.

Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontol 2000 1996;11(1):18-28.

Allen EP. Use of mucogingival surgical procedures to enhance esthetics. Dent Clin North Am 1998;32(2):307-30.

Gabric Panduric D, Blaskovic M, Brozovic J, Susic M. Surgical treatment of excessive gingival display using lip repositioning technique and laser gingivectomy as an alternative to orthognatic surgery. J Oral Maxillofac Surg 2014;72(2):404-11.

Robbins JW. Differential diagnosis and treatment of excess gengival display. Pract Periodontics Aesthet Dent 1999;11(2):265-72.

Silberberg N, Goldstein M, Smidt A. Excessive gingival display-etiology, diagnosis, and treatment modalities. Quintessence Int 2009;40(10):809-18.

K D, Yadalam U, Ranjan R, Narayan SJ. Lip repositioning, an alternative treatment of gummy smile – a case report. J Oral Biol Craniofac Res 2018;8(3):231-3.

Rosenblatt A, Simon Z. Lip repositioning for reduction of excessive gingival display: a clinical report. Int J Periodontics Restorative Dent 2006;26(5):433-7.

Khan MN, Akbar Z, Shah I. Rapid and promising technique to treat gummy smile – lip repositioning. J Coll Physicians Surg Pak 2017;27(7):447-9.

Manfredi GGP, Carvalho EBS, Zangrando MSR, Greghi SLA, Damante CA, Sant’Ana ACP et al. Reabilitação estética cirúrgica com preservação de papilas. ImplantNewsPerio 2016;1(6):1153-8.

Rossi R, Benedetti R, Santos-Morales RI. Treatment of altered passive eruption: periodontal plastic surgery of the dentogingival junction. Eur J Esthet Dent 2008;3(3):212-23.

Mostafa D. A sucessful management of sever gummy smile using gingivectomy and botulinium toxin injection: a case report. Int J Surg Case Rep 2018;42:169-74.

Ishida Y, Ono T. Nonsurgical treatment of an adult with a skeletal Class II gummy smile using zygomatic temporary anchorage devices and improved superelastic nickel-titanium alloy wires. Am J Orthod Dentofacial Orthop 2017;152(2):693-705.

Sonick M. Esthetic crown lenghtening for maxillary anterior teeth. Compend Contin Educ Dent 1997;18(8):807-19.

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 2012:837658

Batista Jr. EL, Moreira CC, Batista FC, de Oliveira RR, Pereira KKY. Altered passive eruption diagnosis and treatment: a cone beam computed tomography-based reappraisal of the condition. J Clin Periodontol 2012;39(11):1089-96.

Gargiulo AW, Wents FM, Orban B. Dimensions and relations of the dentogingival junction in human. J Periodont 1961;32(3):261-7.

Fradeani M. Evaluation of dentolabial parameters as part of a comprehensive esthetic analisys. Eur J Esthet Dent 2006;1(1):62-9.

Martins AT et al. A modified technique that decreases the height of the upper lip in the treatment of gummy smile patients: a case series study. J Dent Oral Hyg 2012;4(3):21-8.

Rosenblatt A, Simon Z. Lip repositioning for reduction of excessive gingival display: a clinical report. Int J Periodontics Restorative Dent 2006;26(5):433-7.

Storrer CLM, Deliberador TM, Villabona CA, Zago A, Teixeira-Neto A, Oliveira ND et al. Recontorno gengival e reposicionamento labial cirúrgico para tratamento do sorriso gengival: resultados após um ano. ImplantNewsPerio 2016;1(5):973-80.

da Cunha LF, Pedroche LO, Gonzaga CC, Furuse AY. Esthetic, occlusal, and periodontal rehabilitation of anterior teeth with minimum thickness porcelain laminate veneers. J Prosthet Dent 2014;112(6):1315-8.

Abduo J, Tennant M, McGeachie J. Lateral occlusion schemes in natural and minimally restored permanent dentition: a systematic review. J Oral Rehabil 2013;40(10):788-802