Focused Clinical Question: How should cases of altered passive and active eruption be diagnosed, classified, and treated?Summary: Frequently, a “gummy smile” contributes to esthetic problems and is caused by several factors such as vertical maxillary growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, altered passive eruption (APE), or a combination of these factors. APE is a genetic or developmental condition characterized by coronal positioning of the gingival margin over enamel, resulting in short clinical crowns. Active eruption is defined as tooth movement in the occlusal direction as the tooth erupts from its osseous crypt. Altered active eruption (AAE) occurs when teeth achieve the opposite relationship to the occlusal plane prematurely and the osseous crest is on or very close to the cemento‐enamel junction. Thus, correct understanding of biologic events related to APE and AAE should be considered in the classification of a gummy smile. This article proposes a modification of a previous clinical classification and provides a surgical guide for treatment planning of cases involving APE and/or AAE. Periodontal biotypes are also taken into consideration.Conclusions: This article proposes modification of a previous classification dealing with two eruptive processes known as AAE and APE. Clinical cases and schemes enable understanding and treatment planning of different conditions.
Background
Previous data suggest that bone demineralization may promote bone graft consolidation as well as proliferation and differentiation of pre‐osteoblasts, but the biological mechanisms involved in this process need to be clarified. This study investigated the effects of bone demineralization with citric acid (CA) and tetracycline (TCN) on the repair of onlay bone grafts.
Methods
Onlay bone grafts were performed on the calvaria of 126 Wistar rats. The contacting surfaces between bone graft and receptor bone bed were demineralized for 15, 30, and 60 seconds with TCN (50 mg/mL), or 10% CA, (pH 1), constituting the following test groups (n = 18): TCN15, TCN30, TCN60, CA15, CA30, and CA60. Control grafts (C) were performed without demineralization (n = 18). After 7, 30, and 60 days, biopsies were obtained for quantitative and qualitative histological analysis (a = 6).
Results
Demineralization accelerated the bone repair early from 7 days of healing. Higher percentage area of newly formed bone was observed in CA15 and TCN60 groups when compared to C in all evaluation periods (P = 0.02). At 30 days, C specimens had lower percentage of consolidated surfaces than TCN60, TCN30 and CA15 (P = 0.0015). At 60 days, CA15, CA60, and TCN60 presented bone surfaces almost completely filled by newly formed bone, against about 75% in C specimens (P = 0.0015).
Conclusions
Both CA and TCN were effective in accelerating osteogenesis at the interface between bone grafts and receptor bone beds, especially when applied for 15 seconds and 60 seconds, respectively.
Quando interpretamos imagens, devemos conhecer os diferentes grupos de lesões radiopacas, radiolúcida e mistas.Dentre as imagens radiopacas mais comuns, que podem ser vistas nas radiografias panorâmicas,podemos citar a osteoesclerose. O objetivo deste estudo foi avaliar a presença de osteosclerose em radiografias panorâmicas, classificando-as conforme gênero e localização. É caracterizadacomo áreas de trabeculado ósseo denso, devido, de etiologia variada que inclui maior demanda funcional de uma determinada região. De formato variadoa imagem pode ser oval, elíptica ou irregular, localizadas no ápice radicular, entre as raízes ou em áreas distantes das raízes dentárias, majoritariamente na região de pré-molares e molares. Neste estudo interpretamos 550 imagens panorâmicaspertencentes ao Departamento de Estomatologia (Disciplina de Radiologia) da Faculdade de Odontologia de Bauru FOB -USP, com melhor qualidade de imagem. Encontramos 57 (10,4%) imagens compatíveis com osteoesclerose. Das 57 imagens, 54 (94,7%), eram unilaterais, e apenas 3apresentavam lesões bilaterais, localizadas na mandíbula. Todas as áreas de osteoesclerose foram encontradas na mandíbula e a ocorrência maior na região de molares (54,4%), sendo 20 na região apical, 16 na área interradicular e 21 em área edêntula.Na região de incisivos e caninos (10,5%) e na região de prémolares (35%). Foi possível constatar que é mais frequente em mulheres e estava presente principalmente em radiografas de pacientes com média de idade de 28,8 anos. Palavras chave: Osteoesclerose. Radiografia panorâmica. Diagnóstico.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.