Diagnóstico e tratamento de erupção passiva e ativa alteradas associado à laserterapia pós-operatória

Erupção passiva: trabalho apresenta caso clínico de uma paciente que se queixava de “dentes curtos” e diferença de tamanho.

AUTORES

Rafael Sponchiado Cavallieri
Mestrando do programa de Ciências Odontológicas, disciplina de Periodontia – FOB-USP; Especialista em Periodontia – HRAC-USP.
Orcid: 0000-0003-3975-6211.

Caique Andrade Santos
Mestrando do programa de Ciências Odontológicas, disciplina de Periodontia – FOB-USP.
Orcid: 0000-0001-5646-3424.

Sebastião Luiz Aguiar Greghi
Professor doutor titular da disciplina de Periodontia – FOB-USP.
Orcid: 0000-0003-2530-3705.

Adriana Campos Passanezi Sant’Ana
Professora doutora associada da disciplina de Periodontia – FOB-USP.
Orcid: 0000-0001-5640-9292.

Carla Andreotti Damante
Professora doutora associada da disciplina de Periodontia – FOB-USP.
Orcid: 0000-0002-6782-8596.

Mariana Schutzer Ragghianti Zangrando
Professora doutora assistente da disciplina de Periodontia – FOB-USP.
Orcid: 0000-0003-0286-7575.

RESUMO

Entre as desarmonias do sorriso, o excesso de exposição gengival pode ser associado a diferentes causas, como o excesso vertical de maxila, extrusão dentoalveolar, lábio superior curto, hipermobilidade labial, erupção passiva e/ou ativa alteradas, ou uma combinação desses fatores. O objetivo deste trabalho foi apresentar o caso clínico de uma paciente com 22 anos que se queixava dos “dentes curtos” de 14 a 24 e da diferença de tamanho entre os elementos 11 e 21. Para diagnóstico e planejamento, foi utilizada tomografia computadorizada de feixe cônico (TCFC), diagnosticando assim erupção passiva alterada (EPA) em todos os dentes e erupção ativa alterada (EAA) nos caninos e pré-molares. Na técnica cirúrgica, foi realizada incisão em bisel interno (45°) e discreta frenectomia labial, retalho total para a osteotomia e osteoplastia com pontas diamantadas, e sutura com fio de nylon 5-0 em colchoeiro vertical. No pós-operatório imediato e durante mais três sessões com intervalo de 48 horas, foi realizada fotobiomodulação com laser vermelho para auxiliar na cicatrização dos tecidos moles. As suturas foram removidas em 14 dias e a paciente acompanhada até o momento (90 dias de pós-operatório). A EPA e EAA não são consideradas patologias, mas variações da normalidade, o correto diagnóstico, conhecimento dos tecidos de inserção supracrestal, princípios periodontais de preservação de mucosa ceratinizada e identificação de fenótipo gengival garantem excelência em resultados a longo prazo. Além disso, ferramentas digitais, como a TCFC, podem auxiliar no planejamento e na previsibilidade do tratamento.

Palavras-chave – Periodontia; Aumento da coroa clínica; Terapia a laser.

ABSTRACT

Among smile disharmonies, excessive gingival exposure can be associated with different causes such as vertical maxillary excess, dentoalveolar extrusion, short upper lip, labial hypermobility, altered passive and active eruption, or a combination of these factors. The aim of this study is to present the clinical case of a 22-year-old patient who complained of “short teeth” from 14 to 24 and the difference between the sizes of 11 and 21. For diagnosis and planning, CBCT was performed, thus diagnosing altered passive eruption (APE) in all teeth and active altered eruption (AAE) at canines and premolars. Regarding the surgical techniques, a bevelled internal incision was placed at 45 degrees with a discrete lip frenectomy, raising a full tissue flap for osteotomy and osteoplasty with diamond burs; then, a vertical mattress 5-0 nylon suture was placed to close the surgical area. After, red laser photobiomodulation was used immediately after and for three sessions (48h intervals each) to help in the soft tissue healing. The sutures were removed 14 days later and the patient followed up to 90 days. APE and AAE are not considered pathologies, but variations from normality, correct diagnosis, knowledge of supracrestal attachment tissues, periodontal principles of preservation of keratinized mucosa and identification of gingival phenotype ensure excellence in long-term results. In addition, digital tools such as CT can help with treatment planning and predictability.

Key words – Periodontics; Crown lengthening; Laser therapy.

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