Uma abordagem microcirúrgica híbrida no tratamento do sorriso gengival e follow up

Abstract

Currently, a natural and harmonious smile are clear goals in dentistry. To correct an excessive exposure of the gingiva there are different techniques indicated according to the predominant etiology. On the other hand, the level of complexity in some procedures and the need for frequent interventions in others can affect the cost-benefit ratio. This case report aims to show the feasibility of joining two different approaches in a single surgical procedure: the enlargement of the tissue band eliminated in the aesthetic clinical crown augmentation and the repositioning of the flap in an ultracoronal position, displacing the mucogingival line. Obtaining clinical data (Index of gingival bleeding, probing depth, dimensions of the clinical crown and keratinized tissue) and imaging (Cone Beam Computed Tomography) were collected to support clinical and aesthetic analyses. Therapeutic options, with a multidisciplinary treatment involving periodontics, orthodontics, orthognathic surgery and restorative dentistry were presented and discussed. Dental correction by orthodontics/orthognathic surgery was rejected by the patient. The patient complied with the periodontal microsurgical modality with extensive removal of a band of keratinized tissue. A periodontal plastic microsurgery was planned to reduce the excessive sample of gingiva caused by altered passive eruption and vertical excess of the maxilla. The procedure was performed using periodontal surgical micro instruments and an OPMI PROERGO Zeiss microscope. The mixing of approaches allowed lip replacement due to excessively coronal displacement of the mucogingival line and the short and medium-term clinical outcome was satisfactory, with an increase in the size of clinical crowns, limited movement of the lips and reduced gingival exposure. The limitation in this case refers to the unsatisfactory final tooth arrangement due to the presence of dental crowding and narrow mesiodistal dimension. However, the periodontal harmonization obtained with the combination of two approaches in a single procedure was stable after a period of 04 years of follow-up.