A relevância dos detalhes técnicos no tratamento cirúrgico da erupção passiva e ativa alteradas

RESUMO

Uma das queixas estéticas de pacientes que buscam harmonia do sorriso é a exposição gengival excessiva, chamada “sorriso gengival”. Existem diferentes etiologias e formas de tratamento do sorriso gengival, sendo algumas situações clínicas resolvidas com abordagem periodontal através do aumento de coroa clínica estética. No entanto, alguns detalhes técnicos são essenciais no planejamento e execução deste procedimento cirúrgico. Sendo assim, o presente trabalho teve como objetivo relatar um caso clínico, evidenciando as etapas cirúrgicas realizadas para obtenção de um resultado harmônico e estético. A queixa principal da paciente era seu sorriso gengival excessivo. Ao exame clínico, foi observada linha de sorriso alta e erupção passiva alterada (EPA), e coroas clínicas curtas. A paciente apresentava biotipo periodontal espesso, com ampla faixa de mucosa ceratinizada. Ela foi classificada como EPA tipo I associada à erupção ativa alterada (EAA), já que apresentava crista óssea coincidente com a junção cemento/esmalte (JCE). Foi planejado o aumento de coroa clínica estética dos dentes 14 ao 24 com incisão em bisel interno (45o em relação ao longo eixo do dente), para remover altura e espessura de tecido gengival. A incisão na região interproximal envolveu as papilas, já que estas se apresentavam volumosas. Foi feito retalho total para possibilitar a osteotomia e osteoplastia, devolvendo melhor contorno ósseo e espaço adequado entre a crista óssea e JCE (aproximadamente 2 mm). A paciente mostrou-se muito satisfeita no pós-operatório, havendo estabilidade dos resultados alcançados graças ao diagnóstico, planejamento e tratamento adequados.

Palavras-chave – Periodontia; Odontologia cosmética; Protocolos clínicos; Retalhos cirúrgicos.

ABSTRACT

One of the aesthetic complaints of patients seeking harmony of the smile is the excessive gingival exposure, called “gummy smile”. There are different etiologies and ways of treatment of the gingival smile, and some clinical situations are solved with periodontal approach through aesthetic crown lengthening. However, some technical details are essential in the planning and execution of this surgical procedure. Thus, the present study aims to report a clinical case, evidencing the surgical steps performed to obtain a harmonic and aesthetic result. The patient’s main complaint was her excessive gummy smile. Clinical examination revealed a high smile line and altered passive eruption (APE) and short clinical crowns. The patient had a thick periodontal biotype with a wide range of keratinized mucosa. It was classified as EPA-type I associated with altered active eruption (AAE), since it had a crestal bone coincident with the cement-enamel junction (CEJ). The aesthetic clinical crown lengthening from teeth 14 to 24 was planned with an internal bevel incision (45o to the long axis of the tooth) to remove height and thickness of gingival tissue. The incision in the interproximal region involved the papillae, since they were bulky. A full-thickness flap was made to allow osteotomy and osteoplasty, giving a better bone contour and adequate space between the bone crest and CEJ (approximately 2 mm). The patient was very satisfied in the postoperative period, with stability of the results achieved, due to adequate diagnosis, planning and treatment.

Key words – Periodontics; Cosmetic dentistry; Treatment protocol; Surgical flaps.

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