-
Dental Press Journal of Orthodontics 2017In dental practice, low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are mainly used for dental surgery and biostimulation therapy. Within the... (Review)
Review
INTRODUCTION
In dental practice, low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are mainly used for dental surgery and biostimulation therapy. Within the Orthodontic specialty, while LLLT has been widely used to treat pain associated with orthodontic movement, accelerate bone regeneration after rapid maxillary expansion, and enhance orthodontic tooth movement, HILT, in turn, has been seen as an alternative for addressing soft tissue complications associated to orthodontic treatment.
OBJECTIVE
The aim of this study is to discuss HILT applications in orthodontic treatment.
METHODS
This study describes the use of HILT in surgical treatments such as gingivectomy, ulotomy, ulectomy, fiberotomy, labial and lingual frenectomies, as well as hard tissue and other dental restorative materials applications.
CONCLUSION
Despite the many applications for lasers in Orthodontics, they are still underused by Brazilian practitioners. However, it is quite likely that this demand will increase over the next years - following the trend in the USA, where laser therapies are more widely used.
Topics: Animals; Gingivectomy; Humans; Laser Therapy; Lasers, Semiconductor; Low-Level Light Therapy; Orthodontics; Surgery, Oral; Tooth Movement Techniques
PubMed: 29364385
DOI: 10.1590/2177-6709.22.6.099-109.sar -
Journal of Periodontology Apr 2003Previous surgical crown lengthening studies have investigated positional changes of the free gingival margin but not the biological width. Histological studies utilizing... (Clinical Trial)
Clinical Trial
BACKGROUND
Previous surgical crown lengthening studies have investigated positional changes of the free gingival margin but not the biological width. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biological width. However, very little work has been done in humans. Therefore, the purpose of this study was to evaluate the positional changes of the periodontal tissues, particularly the biological width, following surgical crown lengthening in human subjects.
METHODS
Twenty-three (23) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent teeth with adjacent and non-adjacent sites: plaque and gingival indexes, free gingival margin, probing depth, attachment level, bone level, direct bone level, and biological width. During surgery, the bone level was reduced based on the future prosthetic margin and predetermined biological width; flaps were placed at the bony crest. Patients were examined at baseline and at 3 and 6 months postoperatively.
RESULTS
Eighteen patients completed the study. Overall, the amount of bone resected was 1 to 5 mm. At 90% of treated sites, > or = 3 mm of bone was removed. At 3 months, the apical displacement of the free gingival margin at non-adjacent, adjacent, and treated sites was 2.46 +/- 0.25 mm, 2.68 +/- 0.20 mm, and 3.07 +/- 0.16 mm, respectively. There was no significant change in the position of the free gingival margin from 3 to 6 months. The biological width at all sites was smaller at 3 and 6 months compared to baseline (P<0.05) except for the treated sites, which were not significantly different from baseline at 6 months.
CONCLUSIONS
During surgical crown lengthening, the bone level was lowered for placement of the prosthetic margin and reestablishment of the biological width. The biological width, at treated sites, was reestablished to its original vertical dimension by 6 months. In addition, a consistent 3 mm gain of coronal tooth structure was observed at the 3- and 6-month examinations.
Topics: Adult; Aged; Alveolectomy; Analysis of Variance; Crown Lengthening; Epithelial Attachment; Follow-Up Studies; Gingiva; Gingivectomy; Humans; Middle Aged; Oral Surgical Procedures, Preprosthetic; Periodontal Index; Statistics, Nonparametric; Surgical Flaps; Vertical Dimension
PubMed: 12747451
DOI: 10.1902/jop.2003.74.4.468 -
International Journal of Surgery Case... 2018A gummy smile (GS) affects the esthetic and the psychological status as it usually decreases the self-confidence leading to hidden or controlling the smile. A smile with...
INTRODUCTION
A gummy smile (GS) affects the esthetic and the psychological status as it usually decreases the self-confidence leading to hidden or controlling the smile. A smile with more than 2 mm exposed gingiva is called gummy smile. It may be due to one or more of the following etiologies; altered passive eruption of teeth, dentoalveolar extrusion, vertical maxillary excess, and short or hyperactive lip muscles. The treatment of gummy smile should be planned according to its cause/causes. The purpose of this case report was to highlight the ability of combined treatment of gingivectomy and Botox injection technique in managing a severe gummy smile. Also, techniques, advantages, disadvantages, indication and contraindications of Botulinum toxin (BT) are discussed at the literacy.
PRESENTATION OF THE CASE
A 24 year old female patient with a severe gummy smile was refereed to the periodontal clinics of our institution. Clinical examination revealed that she has a GS of an 11-12 mm gingival exposed area that was indicated for orthognathic surgery. The GS was treated by a gingivectomy surgery to increase the clinical crowns of upper anterior teeth and the use of Botox injections. The treatment showed remarkable and satisfactory results instead of doing extensive surgery.
DISCUSSION AND CONCLUSION
It is important to assess the patients' esthetic expectations and show the possible therapeutic solutions that fit him. We revealed that BT is considered as one of the minimally invasive, quick and affordable modalities that can replace extensive surgical procedures for corrections of sever GS.
PubMed: 29248835
DOI: 10.1016/j.ijscr.2017.11.055 -
Journal of Pharmacy & Bioallied Sciences Jun 2013A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the...
INTRODUCTION
A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome.
OBJECTIVE
The aim of this paper is to compare clinically the three different surgical techniques of crown lengthening procedures.
MATERIALS AND METHODS
Fifteen patients who reported to the department of Periodontology, were included in the study. Patients were randomly divided into three groups, which include patients who underwent gingivectomy (Group A), apically repositioned flap (Group B) and surgical extrusion using periotome (Group C). Clinical measurements such as clinical crown length, gingival zenith, interdental papilla height were taken at baseline and at 3(rd) month post-operatively.
RESULTS
Clinical and radiographic evaluation at 3(rd) month suggest that surgical extrusion technique offers several advantages over the other conventional surgical techniques such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss.
CONCLUSIONS
This technique can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.
PubMed: 23946567
DOI: 10.4103/0975-7406.113281 -
Medicina (Kaunas, Lithuania) Sep 2022The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. The patient's primary concern...
The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. The patient's primary concern was improving her smile due to her "gummy smile" and short clinical crowns. After clinical evaluation, surgical crown lengthening accompanied by maxillary central full-coverage single-unit prostheses and lateral incisor veneers was recommended. The diagnostic mock-up was placed in the patient's maxillary anterior region and used as a soft tissue reduction guide for the gingivectomy. Once the planned gingival architecture was achieved, a flap was reflected to proceed with ostectomy in order to obtain an appropriate alveolar bone crest level using the overlay. After six months, all-ceramic crowns and porcelain veneers were provided as permanent restorations. A diagnostic mock-up fabricated with a putty guide directly from the diagnostic wax-up can be an adequate surgical guide for crown-lengthening procedures. The diagnostic wax-up was used to fabricate the diagnostic mock-up. These results suggested that it can be used as a crown-lengthening surgical guide to modify the gingival architecture. Several advantages of the overlay used in the aesthetic complex case include: (1) providing a preview of potential restorative outcomes, (2) allowing for the appropriate positioning of gingival margins and the desired alveolar bone crest level for the crown-lengthening procedure, and (3) serving as a provisional restoration after surgery. The use of a diagnostic mock-up, which was based on a diagnostic wax-up, as the surgical guide resulted in successful crown lengthening and provisional restorations. Thus, a diagnostic overlay can be a viable option as a surgical guide for crown lengthening.
Topics: Humans; Female; Crown Lengthening; Dental Porcelain; Gingivectomy; Crowns; Incisor
PubMed: 36295521
DOI: 10.3390/medicina58101360 -
Journal of Indian Society of... 2021Radiosurgery (RS) has evolved from electrosurgery and uses ultra-high-frequency radio waves at a frequency ranging from 3 to 4 MHz. It is used to address numerous... (Review)
Review
Radiosurgery (RS) has evolved from electrosurgery and uses ultra-high-frequency radio waves at a frequency ranging from 3 to 4 MHz. It is used to address numerous soft-tissue concerns in dentistry and as well as medicine with excellent and predictable results. A review of the indexed literature disclosed that RS has been employed for various periodontal procedures such as gingivectomy, gingivoplasty, crown lengthening, minimally invasive closed osteotomy, frenectomies, operculectomies, depigmentation, gingival curettage, periodontal flap procedures, mucogingival surgeries, harvesting soft-tissue grafts, and also in implantology. Reduced lateral heat production with minimal tissue damage, faster healing, availability of specialized electrodes, increased perception, and cost-effectiveness are some of the notable advantages of RS. The evidence available implies that RS when used appropriately might be a better and economical alternative to a scalpel, electrosurgery, and laser. Inadequate knowledge on the use of this treatment modality due to short of research conducted in this area could be the reason behind it becoming obsolete. This review is an attempt to reminiscence the uses of this versatile tool in periodontal therapy and reinstate its use in present-day clinical practice.
PubMed: 33642734
DOI: 10.4103/jisp.jisp_48_20 -
Turkish Journal of Orthodontics Jun 2020Laser systems have been used in the practice of dentistry for >35 years. Laser systems have so many advantages, such as increase patient cooperation, reduce the duration... (Review)
Review
Laser systems have been used in the practice of dentistry for >35 years. Laser systems have so many advantages, such as increase patient cooperation, reduce the duration of treatment time, and help the orthodontists to enhance the design of a patient's smile to improve treatment efficacy, and the success of orthodontic treatments can also be improved by diminishing the orthodontic pain and the discomfort of the patients. Laser systems also have some disadvantages, such as cost, large space requirements for some types, and high-risk potential for physician and patient if not used at the appropriate wavelength and power density, that is why before incorporating lasers into clinical practice, the physician must fully understand the basic science, safety protocol, and risks associated with them. Lasers have many applications in orthodontics, including accelerating tooth movement, bonding and debonding processes, pain reduction, bone regeneration, etching procedures, increase mini-implant stability, soft tissue procedures (gingivectomy, frenectomy, operculectomy, papilla flattening, uncovering temporary anchorage devices, ablation of aphthous ulcerations, and exposure of impacted teeth), fiberotomy, scanning systems, and welding procedures. In reviewing the literature on the use of laser in orthodontics, many studies have been conducted. The purpose of the present study was to give information about the use of laser in the field of orthodontics, the effects of laser during the postoperative period, and its advantages and disadvantages and to provide general information about the requirements to be considered during the use of laser.
PubMed: 32637195
DOI: 10.5152/TurkJOrthod.2020.18099 -
World Journal of Stem Cells Sep 2018The gingiva, the masticatory portion of the oral mucosa, is excised and discarded frequently during routine dental treatments and following tooth extraction, dental...
The gingiva, the masticatory portion of the oral mucosa, is excised and discarded frequently during routine dental treatments and following tooth extraction, dental crown lengthening, gingivectomy and periodontal surgeries. Subsequent to excision, healing eventually happens in a short time period after gingival surgery. Clinically, the gingival tissue can be collected very easily and, in the laboratory, it is also very easy to isolate gingival-derived mesenchymal stem cells (GMSCs) from this discarded gingival tissue. GMSCs, a stem cell population within the lamina propria of the gingival tissue, can be isolated from attached and free gingiva, inflamed gingival tissues, and from hyperplastic gingiva. Comparatively, they constitute more attractive alternatives to other dental-derived mesenchymal stem cells due to the availability and accessibility of gingival tissues. They have unique immunomodulatory functions and well-documented self-renewal and multipotent differentiation properties. They display positive signals for Stro-1, Oct-4 and SSEA-4 pluripotency-associated markers, with some co-expressing Oct4/Stro-1 or Oct-4/SSEA-4. They should be considered as the best stem cell source for cell-based therapies and regenerative dentistry. The clinical use of GMSCs for regenerative dentistry represents an attractive therapeutic modality. However, numerous biological and technical challenges need to be addressed prior to considering transplantation approaches of GMSCs as clinically realistic therapies for humans.
PubMed: 30310530
DOI: 10.4252/wjsc.v10.i9.116 -
Journal of Indian Society of... 2015Idiopathic gingival fibromatosis (IGF) is a rare hereditary condition characterized by slowly progressive, nonhemorrhagic, fibrous enlargement of maxillary and...
Idiopathic gingival fibromatosis (IGF) is a rare hereditary condition characterized by slowly progressive, nonhemorrhagic, fibrous enlargement of maxillary and mandibular keratinized gingiva caused by increase in submucosal connective tissue elements, mostly associated with some syndrome. This case report describes a case of nonsyndromic generalized IGF in an 18-year-old male patient who presented with generalized gingival enlargement. The enlarged tissue was surgically removed by internal bevel gingivectomy and ledge and wedge procedure. The patient was regularly monitored clinically for improvement in his periodontal condition as well as for any recurrence of gingival overgrowth.
PubMed: 26941525
DOI: 10.4103/0972-124X.162206