Periodontia, Estética Orofacial e o Tratamento Multidisciplinar do Sorriso Gengival: Relato de Caso

REVISTA FIMCA ◽  
2017 ◽  
Vol 4 (1) ◽  
pp. 72-80
Author(s):  
Christiane Mayara Couto Louzada Neves Silva ◽  
Andrea Damas Tedesco ◽  
Davi Silva Barbirato ◽  
Mariana Fampa Fogacci
Keyword(s):  
Computed Tomography ◽  
Botulinum Toxin ◽  
Cone Beam Computed Tomography ◽  
Botulinum Toxin Type A ◽  
Multidisciplinary Treatment ◽  
Botulinum Toxin Type ◽  
Cone Beam ◽  
Patient Reported ◽  
Satisfaction With Treatment ◽  
Gummy Smile

Introdução: O sorriso gengival, ocorre durante a fala ou sorriso espontâneo, quando há aparência de mais de três milímetros de gengiva, tornando-se desarmônica a relação entre a proporção de dentes, lábios e gengivas. Nesses casos, o tratamento seria o aumento de coroa clínica, seguido ou não de aplicação de toxina botulínica do tipo A, dependendo do diagnóstico. Ferramentas como o Planejamento Digital do Sorriso e a Tomografia Computadorizada Cone Beam com afastadores labiais, são recursos atuais que possibilitam um bom e completo planejamento dos casos de sorriso gengival. Associando-se ambas as técnicas para o planejamento, o tratamento de correção do sorriso gengival torna-se mais simples e previsível. Objetivos: A presente pesquisa teve por objetivo reportar um caso clínico de sorriso gengival de etiologia múltipla, em que o planejamento e o tratamento foram multidisciplinares. Relato do Caso: Paciente do sexo feminino, 19 anos de idade, compareceu à Clínica de Odontologia da Faculdades Integradas Aparício Carvalho – FIMCA, com queixa de sorriso gengival, e desproporção de tamanho das coroas dos incisivos centrais superiores. Foram realizados anamnese, exame clínico e exame periodontal, tomografia computadorizada e planejamento digital do sorriso. Após minucioso planejamento foi inidicada a cirurgia de aumento de coroa clínica e a aplicação de toxina botulínica. Paciente, relatou satisfação pelo tratamento e novo sorriso. Conclusão: Quando se trata de estética do sorriso, é essencial um bom planejamento. O Planejamento Digital e a Tomografia Computadorizada Cone Beam com afastadores labiais são ferramentas fundamentais para os casos de sorriso gengival. Optar pelo tratamento multidisciplinar, avaliando a estética orofacial seré sempre mais seguro e com resultados precisos, previsíveis e satisfatórios. Introduction: The gummy smile, occurs during speech or spontaneous smile, when there is appearance of more than three millimeters of gingiva, making disharmonious the relation between the proportion of teeth, lips and gums. In these cases, the treatment would be the clinical crown increase, followed or not by the application of botulinum toxin type A, depending on the diagnosis. Tools such as Digital Smile Design and Cone Beam Computed Tomography with lip retractors are current features that enable good and complete planning of gummy smile cases. By associating both techniques in the planning, gingival smile correction treatment becomes simpler and predictable. Objectives: The present study aimed to report a clinical case of gummy smile of multiple etiology, in which planning and treatment were multidisciplinary. Case Report: A 19-year-old female patient attended the Dental Clinic of Faculdades Integradas Apari?cio Carvalho - FIMCA, with complaint of gummy smile, and disproportion of crown size of the upper central incisors. Anamnesis, clinical examination and periodontal examination, computed tomography and digital smile planning were performed. After careful planning, clinical crown augmentation surgery and the application of botulinum toxin were instituted. Patient reported satisfaction with treatment and new smile. Conclusion: When it comes to smile aesthetics, good planning is essential. Digital Smile Design and Cone Beam Computed Tomography with lip retractors are fundamental tools for gingival smile cases. Opting for multidisciplinary treatment, evaluating orofacial aesthetics will always be safer and will bring accurate, predictable and satisfactory results.

scholarly journals Inferior alveolar nerve paraesthesia after overfilling into the mandibular canal, confirmed by cone-beam computed tomography: a case report

2021 ◽  
Vol 24 (2) ◽  
Author(s):  
Claudemir de Souza Júnior ◽  
Ricardo Machado ◽  
Renee Ashley Batts ◽  
Lucas da Fonseca Roberti Garcia
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Cone Beam Computed Tomography ◽  
Root Canal ◽  
Inferior Alveolar Nerve ◽  
Mandibular Canal ◽  
Cone Beam ◽  
Filling Material ◽  
Mandibular Molar ◽  
Patient Reported

The filling material should be restricted to the root canal, and not extend to the periradicular tissues. Overextension occurs when there is an overflow of gutta-percha and sealer, whereas overfilling refers to the overflow only of sealer beyond the apical foramen. Both may cause several negative clinical consequences. Nevertheless, an accurate diagnosis of where they occurred cannot always be performed by conventional radiographic examination, because of the two-dimensional aspect of the image. This paper describes a clinical case of labiomandibular paraesthesia after overfilling into the mandibular canal (MC), as diagnosed by cone-beam computed tomography (CBCT), later used to perform the treatment planning. A 34-year-old Caucasian female patient sought a private dental clinic complaining of pain in the right mandibular posterior region. After taking the anamnesis and performing clinical and radiographic exams, the patient was diagnosed with pulp necrosis in the second right mandibular molar, and underwent root canal treatment. The final radiography showed overextension or overfilling, probably into the MC. About 2 hours after the procedure, the patient reported paraesthesia of her lower right lip and chin. A CBCT confirmed a small overfilling into the MC. For this reason, vitamin B12 was prescribed as the first treatment option. After 7 days, the patient reported a significant decrease in paraesthesia, and was completely normal after 15 days. This case report shows that CBCT is an effective radiographic diagnostic tool that can be used as an alternative in clinical cases of labiomandibular paraesthesia caused by overextension or overfilling.   Keywords Endodontic treatment; Overfilling; Paraesthesia; Conebeam computed tomography.

scholarly journals Cone-Beam Computed Tomography as a Diagnostic Method for Determination of Gingival Thickness and Distance between Gingival Margin and Bone Crest

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Germana Jayme Borges ◽  
Luis Fernando Naldi Ruiz ◽  
Ana Helena Gonçalves de Alencar ◽  
Olavo César Lyra Porto ◽  
Carlos Estrela
Keyword(s):  
Computed Tomography ◽  
Linear Regression ◽  
Cone Beam Computed Tomography ◽  
Diagnostic Method ◽  
Cone Beam ◽  
Simple Linear Regression ◽  
Gingival Thickness ◽  
Gingival Margin ◽  
Gummy Smile

The objective of the present study was to assess cone-beam computed tomography (CBCT) as a diagnostic method for determination of gingival thickness (GT) and distance between gingival margin and vestibular (GMBC-V) and interproximal bone crests (GMBC-I). GT and GMBC-V were measured in 348 teeth and GMBC-I was measured in 377 tooth regions of 29 patients with gummy smile. GT was assessed using transgingival probing (TP), ultrasound (US), and CBCT, whereas GMBC-V and GMBC-I were assessed by transsurgical clinical evaluation (TCE) and CBCT. Statistical analyses used independentt-test, Pearson’s correlation coefficient, and simple linear regression. Difference was observed for GT: between TP, CBCT, and US considering all teeth; between TP and CBCT and between TP and US in incisors and canines; between TP and US in premolars and first molars. TP presented the highest means for GT. Positive correlation and linear regression were observed between TP and CBCT, TP and US, and CBCT and US. Difference was observed for GMBC-V and GMBC-I using TCE and CBCT, considering all teeth. Correlation and linear regression results were significant for GMBC-V and GMBC-I in incisors, canines, and premolars. CBCT is an effective diagnostic method to visualize and measure GT, GMBC-V, and GMBC-I.

Therapeutic effects of botulinum toxin type A in subjects with gummy smile: A longitudinal sEMG approach

2021 ◽  
Author(s):  
Adilson Tolfo de Oliveira ◽  
Sylvia de Araújo Paes-Souza ◽  
Marco Antonio Cavalcanti Garcia ◽  
Claudia Trindade Mattos ◽  
Matilde da Cunha Gonçalves Nojima
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Therapeutic Effects ◽  
Gummy Smile

Exploring the Psychosocial Impact of Botulinum Toxin Type A Injections for Individuals With Oromandibular Dystonia: A Qualitative Study of Patients' Experiences

2021 ◽  
pp. 1-15
Author(s):  
Allyson D. Page ◽  
Nada Elhayek ◽  
Carolyn Baylor ◽  
Scott Adams ◽  
Mandar Jog ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Speech Production ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Psychosocial Impact ◽  
Interview Data ◽  
Semistructured Interview ◽  
Oromandibular Dystonia ◽  
Satisfaction With Treatment ◽  
Qualitative Phenomenological

Purpose The purpose of this study was to explore the psychosocial impact of botulinum toxin (BoNT) injections for oromandibular dystonia (OMD) and to gain a better understanding of how participants judge the success of this treatment. Method Eight individuals with OMD and dysarthria participated in one face-to-face, semistructured interview. Interviews were audio-recorded and transcribed verbatim. Qualitative, phenomenological methods of coding, immersion, and emergence were used in the analysis of interview data. Results Two major themes and six subthemes emerged from the analysis of interview data. The first theme, Botox has changed me and my experiences , explored the participants' perspective of receiving BoNT injections and its psychosocial impact. The second theme, What communication is like for me , explored the psychosocial impact of BoNT on speech production and participation. Conclusions Our results suggest that BoNT has a variable impact on domains related to quality of life, satisfaction with treatment, speech production, and communicative participation. This study adds novel information related to the psychosocial consequences of BoNT treatment in the management of OMD and builds on a literature that studies the consequences and experiences of living with OMD.

Optimization of diagnosing and treatment of cervical dystonia

2020 ◽  
Vol 18 (5) ◽  
pp. 110-116
Author(s):  
С. М. М. СЕХВЕЙЛ ◽  
◽  
З. А. ГОНЧАРОВА ◽  
И. М. БЛИНОВ ◽  
◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Botulinum Toxin ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Botulinum Toxin Type A ◽  
Pain Syndrome ◽  
Botulinum Toxin Type ◽  
Botulinum Toxin Therapy ◽  
Before And After

The purpose is to optimize diagnostics of cervical dystonia using multispiral computed tomography (MSCT) of the cervical spine to improve the results of botulinum toxin therapy. Material and methods. 27 patients diagnosed with the idiopathic CD (21 females among them) were examined. The age of patients ranged from 25 to 72 years old (the average age was 40 (3,3)). All the patients were scanned with 3D multispiral computed tomography (MSCT) of the cervical spine in order to verify the dystonic muscles and determine the degree of head and neck rotation. MSCT helped to identify the cervical spine deformation, the level of its displacement and the state of dystonic muscles. The Tsui et al. rating scale was used for assessing the severity of CD before and after the treatment. Also the intensity of pain syndrome was assessed according to the visual analogue scale (VAS) before and after the treatment. All the patients had injections of botulinum toxin type A, in the dose 200–300 U. The time period between the injections was 3,5–4 months. Results. The study revealed that women tend to have cervical dystonia more often (77,8%). Late diagnostics of the disease still remains. The duration of the disease lasted from 1 month to 18 years. Before the treatment the pain syndrome intensity amounted to 5,6 (0,8) points, according to VAS, whereas after the treatment it was 1,9 (0,8) points. The 3D MSCT revealed the deformation of the cervical spine. MSCT helped to verify the dystonic muscles (a bigger surface of the dystonic muscle in comparison with the healthy part, a more «round» image of the muscle). MSCT of the cervical spine enabled to verify the form of dystonia (caput, collis or their combination). Conclusions. Late diagnostics of CD remains. Botulinum toxin therapy is a highly effective way of CD treatment. The efficiency of the botulinum toxin therapy in the given category of patients depends on the right choice of target muscles, the verification of the form of CD and adherence to the early treatment principle.

Evidence-Based Review of Patient-Reported Outcomes With Botulinum Toxin Type A

2004 ◽  
Vol 27 (5) ◽  
pp. 234-244 ◽  
Author(s):  
Joseph Jankovic ◽  
Alberto Esquenazi ◽  
Darcy Fehlings ◽  
Fred Freitag ◽  
Amy M Lang ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Patient Reported Outcomes ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Evidence Based ◽  
Patient Reported

scholarly journals Clinical and electromyographic evaluation of botulinum toxin type A in the treatment of gummy smile: A prospective clinical study

2021 ◽  
Vol 15 (2) ◽  
pp. 122-128
Author(s):  
Payal Padmakar Mate ◽  
Kumar Nilesh ◽  
Anand Joshi ◽  
Arun Panda
Keyword(s):  
Botulinum Toxin ◽  
Clinical Study ◽  
Repeated Measures ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Prospective Clinical Study ◽  
Upper Lip ◽  
The Mean ◽  
Gummy Smile

Background. The present study aimed to assess the effect of botulinum toxin type A (BTX-A) for the management of gummy smile and evaluate its stability after administrating BTX-A clinically and using electromyography. Methods. The investigators designed and implemented a prospective clinical study on 10 patients with a gummy smile. Patients with different types of gummy smile were injected with BTX-A in the levator muscles of the upper lip and were followed for six months. The effect of BTX-A was evaluated clinically and using electromyography preoperatively and after two weeks and three and six months. Statistical analyses were carried out using repeated measures ANOVA and post hoc Bonferroni tests for pairwise comparisons. Results. The sample consisted of 10 patients with an anterior gummy smile (n=3), posterior gummy smile (n=2), mixed gummy smile (n=3), and asymmetrical gummy smile (n=2). There were significant differences (P<0.001) between the mean gingival display and compound muscle action potential at two-weeks and three-month follow-ups. The maximum result was obtained at the two-week interval. The mean gingival display and C-MAP values increased slightly at the three-month postoperative interval and gradually increased to the baseline values at six-month follow-up. Conclusion. BTX-A is an effective, minimally invasive, and temporary treatment modality for gummy smiles. The electromyographic study is a convenient method for assessing changes in the upper lip muscle contractility to quantify the effect of BTX-A in the treatment of gummy smile.

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