Gummy smile constitutes a relatively frequent aesthetic alteration characterized by excessive exhibition of the gums during smiling movements of the upper lip. It is the result of an inadequate relation between the lower edge of the upper lip, the positioning of the anterosuperior teeth, the location of the upper jaw, and the gingival margin position with respect to the dental crown. Altered Passive Eruption (APE) is a clinical situation produced by excessive gum overlapping over the enamel limits, resulting in a short clinical crown appearance, that gives the sensation of hidden teeth. The term itself suggests the causal mechanism, i.e., failure in the passive phase of dental eruption, though there is no scientific evidence to support this. While there are some authors who consider APE to be a risk situation for periodontal health, its clearest clinical implication refers to oral esthetics. APE is a factor that frequently contributes to the presence of a gummy or gingival smile, and it can easily be corrected by periodontal surgery. Nevertheless, it is essential to establish a correct differential diagnosis and good treatment plan. A literature review is presented of the dental eruption process, etiological hypotheses of APE, its morphologic classification, and its clinical relevance.
BackgroundThe study and identification of new biomarkers for periodontal disease, such as microRNAs (miRNAs), may give us more information about the location and severity of the disease and will serve as a basis for treatment planning and disease-monitoring. miRNAs are a group of small RNAs which are involved in gene regulation by binding to their messenger RNA target (mRNA). In this pilot study, the procedure for purifying miRNAs from gingival crevicular fluid (GCF) was, for the first time, described. In addition, the concentration of miRNAs in GCF was analyzed and compared between patients with moderate or severe chronic periodontitis (CP) and healthy controls.Material and MethodsGCF samples were collected from single-rooted teeth of patients with moderate or severe CP (n=9) and of healthy individuals (n=9). miRNAs were isolated from GCF using miRNeasy Serum/Plasma kit (Qiagen, CA. USA). Reverse transcription polymerase chain reaction (qRT-PCR) was used to determine the expression of a series of miRNAs candidates that are related to bone metabolism. The significance of differences in miRNA levels between both groups was determined using Mann-Whitney U test.ResultsThe results from this pilot study indicate that miRNAs can be isolated from GCF. Six different miRNAs were analyzed (miR-671, miR-122, miR-1306, miR-27a, miR-223, miR-1226), but only miR-1226 showed statically significant differences between the CP group and healthy controls (p<0.05). This miRNA was downregulated in patients with CP.ConclusionsWithin the limitations of the present study, it may be concluded that miR-1226 can be a promising biomarker for periodontal disease, adding relevant information to common clinical parameters used for diagnosis and prognosis of periodontitis. Key words:Small interfering RNA, biomarkers, periodontal diseases, reverse transcriptase polymerase chain reaction.
Except for a significant decrease in the pathogenic burden of A. actinomycetemcomitans, coadjuvant PDT resulted in no additional improvement compared with SRP alone in patients diagnosed with moderate-to-advanced chronic periodontitis.
Objetives: This study define altered passive eruption (APE) and evaluate the morphology of the dentogingival unit. Material and Methods: 123 individuals subjected to clinical examination and parallel profile radiography of the upper central incisor. An evaluation was made of the correlation between the clinical diagnosis of APE and the degree of gingival overlap; by using a 19% overlap to define APE (Kappa concordance index = 0.7). The Mann-Whitney / Wilcoxon test was used to identify the variables influencing APE. Results: Statistically significant differences were observed between the teeth with and without APE: gingival width (p = 0.0073), clinical crown length (p = 0.0000), smiling exposed gums (p = 0.0000), bone crest thickness (p = 0.0030), connective tissue attachment thickness (p = 0.0003) and biological width (p = 0.0015). Conclusions: The APE is characterized by: a gingival overlapping of over 19% of the length of the anatomical crown, increased gingival width and gingival smile; furthermore is associated to a thick bone crest and connective tissue attachment. Statistical analysis confirms two morphological patterns of APE. Key words:Altered passive eruption (ape), radiographic exploration, dentogingival unit (dgu), gingival thickness, plastic periodontal surgery, surgical crown lengthening.
Hereditary gingival fibromatosis (HGF) is a rare disorder characterized by a benign, non-hemorrhagic, fibrous gingival overgrowth that can appear in isolation or as part of a syndrome. Clinically, a pink gingiva with marked stippling can be seen to cover almost all the tooth, in many cases preventing eruption. HGF usually begins during the transition from primary to permanent teeth, giving rise to a condition that can have negative psychological effects at that age. As it does not resolve spontaneously, the treatment of choice is gingivectomy, which can be performed with an internal or external bevel incision, depending on each case and bearing in mind the changes that will take place at the dentogingival junction (DGJ). This paper describes clinical aspects and treatment in two eight-year-old boys with HGF, considering different facets of the surgical approach with conscious sedation in young children.
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