Abstract When periodontal disease is diagnosed, it is difficult to predict the clinical response of treatment of a tooth over time because the result of treatment is affected by several factors and will depend on the maintenance and support of periodontal treatment. Rehabilitation with removable dental prostheses, fixed prostheses, and dental implants makes it possible to restore the function and esthetics of patients with tooth loss due to periodontal disease. The predictive factors of tooth loss in periodontitis patients should be assessed by dentists to inform their clinical decision-making during dental treatment planning. This will provide detailed individualized information and level of risk of patients considered suitable for dental rehabilitation. Therefore, the aim of this article was to review the subject of “Impact of tooth loss due to periodontal disease on the prognosis of rehabilitation” and the effect of fixed, removable, and implant-supported prostheses in periodontal patients.

Abstract The generalist training planned by Brazilian National Curriculum Guidelines for Dentistry undergraduate courses should provide actions for the development of health promotion in the field of public health, as well as disease prevention, diagnosis, planning, and dental treatment in the clinical field. Considering this complexity, the aim of the present study was to validate dimensions and sub-dimensions in dentistry training, allowing the identification of the main necessary competences and clinical skills for the generalist practice. For this, an evaluation study was carried out through the Delph’s Method with the participation of 19 professors of Dentistry courses in Brazil working in the clinical area, considered “experts” in this theme. It was possible to identify clinical competences and skills in four dimensions and respective sub-dimensions: Transversal skills (biosafety, patient-team communication, humanization, ethical principles, dental documentation); Diagnosis and planning (diagnosis of dental caries, pulp and periapical changes, and periodontal diseases, clinical and imaging exam, and single treatment planning); Preventive activities (oral hygiene guidance and oral cancer prevention); and Dental care (anesthesia, basic oral surgery, drug prescription, subgingival scaling and root planing, dental restoration, minimally and non-invasive restoration treatment, and dental urgencies). The developed model represents a differentiated alternative for the construction of an innovative curriculum in Dentistry, aimed at the training of general practitioners to provide humanized, highly effective, and resolving care. The importance of clinical tutoring by professors on the essential clinical skills and abilities is highlighted in this study.

Abstract The rapid and abrupt transmission pattern of the SARS-CoV-2 unleashed the current COVID-19 pandemic, as recognized by the World Health Organization in March 2020. Considering the high risk of transmission of the virus in dental environments and the specificities in clinical practice, COVID-19 posed immediate challenges for dental care and education. Due to the need to establish infection prevention and control guidance in dental health settings to enable a safe clinical practice, this review aims to list the challenges and perspectives in managing dental care in services and schools. This review employed materials collected from PubMed and the main guidelines and studies on the novel coronavirus to provide an overview of the clinical procedures and decisions made by health care personnel in dental offices and dental schools. We expect the COVID-19 scenario to promote significant changes in clinical practice and dental education; dentists should seek specific and particular regulations for dental practice established by their state or country. Biosafety checklists are strongly recommended for appointments at dental services and face-to-face activities in dental schools.

Resumo Introdução A determinação do fenótipo gengival possibilita compreender melhor as variações e diferenças clínicas intra e interindividuais dos tecidos periodontais saudáveis. Objetivo O objetivo deste estudo foi determinar os perfis do fenótipo gengival e compará-los em diferentes regiões da cavidade oral, levando em consideração parâmetros clínicos relacionados aos tecidos moles circunjacentes nos dentes anteriores superiores e inferiores. Material e método Noventa e um pacientes com saúde periodontal foram examinados e os parâmetros clínicos profundidade de sondagem (PS), largura de mucosa ceratinizada (MC), espessura gengival em ambos incisivos centrais superiores (EG) e fenótipo gengival (FG) foram coletados nos dentes anteriores superiores e inferiores. Os dados foram analisados estatisticamente pelos testes t-Student pareado e independente, Correlação de Pearson e Qui-quadrado, com um nível de significância de 5%. Resultado O fenótipo gengival espesso predominou nos dentes anteriores superiores (60,5%), enquanto o fenótipo fino foi mais prevalente nos dentes anteriores inferiores (84,6%). Diferenças estatisticamente significativas foram encontradas para os parâmetros largura de mucosa ceratinizada e espessura gengival em relação aos fenótipos gengivais superiores e inferiores (p<0,05). Não houve diferença estatística entre profundidade de sondagem e o fenótipo gengival nos dentes superiores e inferiores. Conclusão Concluiu-se que o fenótipo gengival espesso é mais frequente nos dentes anteriores superiores e que o fenótipo fino é mais comum nos dentes anteriores inferiores, sendo mais frequente em indivíduos do sexo masculino. Os parâmetros largura de mucosa ceratinizada e espessura gengival mostraram-se adequados à determinação do fenótipo gengival.

Abstract Introduction Gingival phenotype determination enables a better understanding of intra and interindividual clinical variations in healthy periodontal tissues. Objective The aim of this study was to determine gingival phenotype profiles and compare these in different regions of the oral cavity, considering clinical parameters related to the surrounding soft tissue in the upper and lower front teeth. Material and method Ninety-one periodontally-healthy patients were examined and clinical parameters such as probing depth (PD), keratinized tissue width (KW), gingival thickness at both maxillary central incisors (GT) and gingival phenotype (GP) were determined for the upper and lower front teeth. Data were statistically analyzed by paired and independent t-Student tests, Pearson Correlation and the Chi-square test, using a significance level of 5%. Result The thick gingival phenotype predominated in the upper anterior teeth (60.5%), while the thin phenotype was more prevalent in the lower anterior teeth (84.6%). Statistically significant differences were found for keratinized tissue and gingival thickness parameters, in relation to the upper and lower gingival phenotypes (p<0.05). There were no statistical significances for probing depth and gingival phenotype in the upper and lower teeth. Conclusion It was concluded that the thick phenotype is more frequent in the upper anterior teeth and that the thin phenotype is more common in the lower anterior teeth, and more frequent in males. The keratinized tissue and gingival thickness parameters proved to be suitable for the determination of gingival phenotype.

Resumo Objetivo Caracterizar os Biótipos Periodontais (BP) por meio de fotografias, além de verificar a concordância com o método clínico de determinação, bem como com diferentes profissionais em Odontologia. Material e método A avaliação clínica intra-bucal de 34 pacientes (n=34) e verificação de fotografias padronizadas foram realizadas para caracterização dicotômica do BP em fino e espesso. A avaliação subjetiva, por meio da fotografia, foi comparada ao método clínico da transparência à sondagem. A determinação do BP por meio de fotografias foi realizada através da aplicação de um questionário contendo três categorias (fino, espesso e intermediário), direcionadas a 90 cirurgiões-dentistas divididos igualmente em três grupos: clínicos gerais, periodontistas e protesistas. A concordância em ambas as comparações foi avaliada por meio do Teste Kappa, além dos testes de sensibilidade e especificidade. Resultado Na comparação entre o método clínico e o fotográfico, não houve concordância (K = 0,264, p = 0,113). Na comparação entre os grupos dos profissionais, foi encontrada uma baixa concordância (kappa = 0,160; p<0,05) entre os periodontistas e protesisas, bem como entre protesistas e clínicos gerais (kappa = 0,110; p = 0,142). Houve maior concordância, ainda que fraca, entre periodontistas e clínicos gerais (kappa = 0,291; p = 0,00). O questionário obteve um valor de sensibilidade e especificidade maior para o diagnóstico do BP espesso. Conclusão A avaliação clínica do paciente por meio dos parâmetros clínicos ainda é necessária para caracterizar o BP, visto que a determinação usando-se análise visual por meio do fotografia, independentemente da especialidade, não foi efetiva, embora o BP espesso tenha sido o mais facilmente identificado.

Abstract Objective To characterize the Periodontal Biotypes (PB) through photographs and verify the agreement with the clinical method of determination as well as with different Dental professionals. Material and method Standardized photographs and intraoral clinical evaluation of 34 patients (n = 34) were performed for dichotomous characterization of PB in thin and thick. The subjective assessment, through photography, was compared to clinical method of probing transparency. The PB determination by photographs was performed through the application of a questionnaire containing three categories (thin, thick intermediate) directed to 90 dental professionals. They were equally divided into 3 groups: general practitioners, periodontists and prosthodontists. The concordance in both comparisons was evaluated through the Kappa Test, in addition to the sensitivity and specificity tests. Result In the comparison between the clinical and the photographic method, there was no agreement (K = 0.264, p = 0.113). However, in the comparison between the groups of professionals, a low agreement (kappa = 0.160; p <0.05) was found between periodontists and prothesis, as well as between prosthesis and general practitioners (kappa = 0.110; p = 0.142). Greater agreement, although weak, between periodontists and general practitioners (kappa = 0.291, p = 0.00). The questionnaire obtained a higher sensitivity and specificity value for the diagnosis of thick PB. Conclusion The evaluation of patients through clinical parameters is still necessary to characterize PB, since the determination using visual analysis using photography, regardless of specialty, was not effective, although thick PB was the most easily identified.

Resumo Introdução Recursos de imagem são indispensáveis para o diagnóstico e preparação de um plano de tratamento adequado, sendo imprescindível para o sucesso reabilitador com implantes dentários. Objetivo O objetivo deste estudo seccional foi caracterizar áreas edêntulas de pacientes candidatos à reabilitação com um implante dentário osseointegrado unitário em região estética da maxila por meio das tomografias computadorizadas de feixe cônico (TCFC) e correlacionar parâmetros de interesse. Material e método Catorze TCFC foram avaliadas em um programa de computador de acordo com os seguintes parâmetros: distância da Junção Cemento-Esmalte (JCE) até a crista óssea (CO), distância entre as CO e distância entre as coroas dentárias dos dentes adjacentes ao espaço protético (EP), largura e altura óssea do EP, espessura do palato na região dos segundos pré-molares e molares bem como a espessura horizontal e vertical do tecido mole na região do EP. Resultado e discussão os resultados foram analisados por meio de estatística descritiva e do teste de Correlação de Spearman. Correlações fracas e moderadas e sem diferenças estatísticas significativas foram encontradas na maioria das comparações (≤ 0,29 e ≥ 0,30 ≤ 0,49, respectivamente). Apenas para a correlação espessura da mucosa do EP versus distância entre JCE e CO no dente mesial ao EP foi encontrada diferença estatística significativa (p= 0,03) e correlação moderada (r = 0,56). Conclusão A TCFC é uma ferramenta viável para a região maxilofacial, pois permitiu a mensuração de diversos parâmetros de tecido mole e duro da cavidade bucal úteis para o planejamento e previsibilidade de tratamento reabilitador com implantes dentários.

Abstract Introduction Imaging resources are indispensable to assist the professional dental surgeon in the formulation of the diagnosis and preparation of an adequate treatment plan for the patient, being essential for the successful rehabilitation with dental implants. Objective The purpose of this cross-sectional study was to characterize the edentulous areas of patients who will be rehabilitated with single osseointegrated dental implant in the aesthetic area of the maxilla by means of computerized tomography and correlate parameters of interest. Material and method Fourteen cone beam computerized tomographies were evaluated in a program according to the following parameters: distance from the cementoenamel junction (CEJ) to the bone crest (BC), distance between the BC and distance between the dental crowns of the teeth adjacent to the prosthetic space (PS), bone width and height of PS, thickness of the palate in the region of the second premolars and molars as well as the horizontal and vertical thickness of the soft tissue in the PS region. Result and discussion The results were analyzed by means of descriptive statistics and the Spearman Correlation test. Weak and moderate correlations and no statistically significant differences were found in most comparisons (≤ 0.29 and ≥ 0.30 ≤ 0.49, respectively). Only for the correlation between PS mucosa thickness versus distance between CEJ and BC in the mesial tooth to PS was found significant statistical difference (p = 0.03) and moderate correlation (r = 0.56). Conclusion Cone beam computerized tomography is a viable tool for the maxillofacial region because it allowed the measurement of several parameters of soft and hard tissue of the buccal cavity useful for planning with dental implants, which may increase the predictability of successful rehabilitation treatments.

Abstract: BACKGROUND: Recurrent aphthous ulcerations are common benign ulcerated lesions on the mouth, whose etiology is poorly understood, with controversial treatment and difficult to control in clinical practice. OBJECTIVE: To evaluate the cases of recurrent aphthous ulcerations with a focus on treatment, diagnosis and etiology. METHODS: This is a retrospective study of the cases of the Oral Diagnosis service of the Rio Grande do Norte Federal University in Natal/RN. Data such as sex, age, race, location, smoking habits, types of treatment, relapsing episodes, laboratory test results and clinical characteristics were collected. The associations between the variables were analyzed using the Pearson Chi-square test (p <0.05). RESULTS: A total of 4895 patients were seen in the service over a period of 11 years. Of these, 161 (3.3%) had complaints of oral aphthous ulcerations, of which 76 (47.2%) were diagnosed as suffering from recurrent aphthous ulcerations and 68 (42.2%) with clinical information necessary for evaluation. The tongue was the most affected anatomical region, with 27 individuals (39.7%), followed by the buccal mucosa, with 22 cases (32.3%). STUDY LIMITATIONS: Retrospective study with data from medical records. CONCLUSION: Dental surgeons, dermatologists and otorhinolaryngologists are the main responsible for the first contact with patients with this disease and should be attentive to the clinical aspects and treat each patient in an individualized way, since the therapy is palliative, its diagnosis is by exclusion and its etiology is unknown.

ABSTRACT: In this study, we report the case of a patient presenting a severe atrophic mandible that was treated with short implants and stable internal fixation, without using bone grafts or biomaterials. The patient had a long history of failure of several previous consecutive treatments. Cone-bean tomography revealed a small amount of mandibular bone, suggesting a high risk of fracture of the mandible during drilling and installation of osseointegrated implants. We opted to place 5 implants (4.0 × 7.0 mm) between the mental foramens. Since the mandible presented a high risk of fracture, we inserted a titanium plate (2.3 mm) as bone reinforcement along the entire length of the mandible, including the bilateral mandibular angles. A Branemark type prosthesis was installed 5 days after the procedure. After 24 months, the patient continues to be satisfied and presents good masticatory functions without any complications.

ABSTRACT: Dento-alveolar traumas are one of the most frequent injuries to teeth, mainly affecting the upper incisors due to their exposed position in the dental arch. In such cases, esthetics, function and phonetics of anterior teeth may be compromised. Furthermore, when there is involvement of the biological width, there is often a poor prognosis. This case report describes the multidisciplinary approach to tooth fragment re-attachment in a fracture with biological width violation. The patient presented with an oblique crown fracture in the maxillary right lateral incisor, extending from the buccal to palatal side, as well as a biological width invasion. The re-establishment of the biological width was obtained by periodontal surgery to achieve clinical-crown lengthening and tooth fragment re-attachment with a glass fiber post to increase retention. After 3 years of follow-up, the rehabilitated lateral incisor remains in good condition, with satisfactory esthetic and periodontal health.

Resumo Os efeitos dos fármacos anti-inflamatórios não esteroidais (AINEs) sobre a quantidade e qualidade óssea tem sido investigados ao longo dos anos.Entretanto, há falta de informação sobre o impacto dos AINEs na qualidade do osso alveolar de suporte na ausência de inflamação periodontal. Assim, o objetivo deste estudo foi avaliar, histometricamente, a influência de um AINE seletivo para COX-2 (Meloxicam) na densidade mineral óssea inter-radicular em ratos. Quarenta e nove ratos Wistar, machos e adultos foram divididos aleatoriamente em quatro grupos experimentais: injeções subcutâneas de 0,9% de solução salina estéril por 15 dias (G1, n=12) e 45 dias (G2, n=11); e injeções subcutâneas de Meloxicam por 15 (G3, n=13) e 45 dias (G4, n=13). A densidade mineral foi determinada histometricamente na área inter-radicular dos primeiros molares mandibulares e a análise dos dados realizada por meio de ANOVA (a=5%). Os resultados mostraram nenhuma interação entre tempo e tratamento (p>0,05) e que o meloxicam não afetou a densidade óssea alveolar. Em contraste, foi encontrado que a densidade óssea alveolar inter-radicular aumentou ao longo do tempo (91,88±3,08% e 92,86±2,38% para os grupos 15 e 45 dias, respectivamente) (p<0,05). Dentro dos limites deste estudo, a administração diária de um inibidor seletivo para COX-2 (Meloxicam) não afetou a qualidade do osso alveolar inter-radicular na ausência de infecção periodontal.

Abstract The effects of the non-steroidal anti-inflammatory drugs (NSAIDs) on bone quantity and quality were investigated for years. However, there is lack of information on the impact of NSAIDs on the quality of tooth-supporting alveolar bone in absence of periodontal inflammation. Thus, the aim of this study was to evaluate histometrically the influence of a selective COX-2 NSAID (Meloxicam) on the inter-radicular bone mineral density in rats. Forty-nine adult male Wistar rats were randomly divided into four experimental groups: Subcutaneous injection of 0.9% sterile saline for 15 days (G1; n=12) and 45 days (G2; n=11); and subcutaneous injection of Meloxicam for 15 days (G3; n=13) and 45 days (G4; n=13). Mineral density was histometrically determined in the inter-radicular area of the 1st mandibular molars and data analysis performed by two-way ANOVA (a=5%). Results showed no interaction between time and treatment (p>0.05) and that meloxicam did not affect the alveolar bone density. In contrast, it was found that inter-radicular alveolar bone density increased with time (91.88±3.08% and 92.86±2.38% for groups 15 and 45 days, respectively) (p<0.05). Within the limits of this study, daily administration of a selective COX-2 inhibitor (Meloxicam) did not affect the quality of the inter-radicular alveolar bone in absence of periodontal infection.

Resumo O fator induzível por hipóxia 1 alfa (HIF-1α) e o fator de crescimento endotelial vascular (VEGF) são proteínas que estimulam a proliferação e a migração de células endoteliais. Estas proteínas têm sido descritas em muitas condições patológicas e inflamatórias, mas o envolvimento dessas no desenvolvimento de periodontite não foi completamente investigado. Este estudo comparou a expressão imunohistoquímica destas proteínas, envolvidas na angiogênese e hipóxia, na doença periodontal e em tecidos gengivais saudáveis por meio de contagem de células inflamatórias e endoteliais imunomarcadas. As amostras de tecido gengival foram divididas da seguinte forma: 30 amostras com periodontite crônica, 30 com gengivite crônica e 30 de gengiva saudável. Os resultados foram analisados estatisticamente pelos testes de Kruskal-Wallis e Mann-Whitney (p=0.01). As células inflamatórias e endoteliais foram positivas para estas proteínas. A porcentagem média de células positivas para HIF-1α foi de 39,6% nos casos de periodontite, 22,0% nos casos de gengivite e de 0,9% no grupo de gengiva saudável (p = 0,001). A porcentagem média de células imunopositivas para o VEGF foi de 68,7% nos casos de periodontite, 66,1% nos casos de gengivite, e 19,2% em espécimes gengivais saudáveis (p<0,001). Correlação significativa entre o VEGF e HIF-1α foi observada em gengival. A expressão elevada do HIF-1α e VEGF em periodontite, comparada a gengivite e gengiva saudável, sugere ativação da via do HIF-1α, na doença periodontal avançada. A correlação entre o HIF-1α e expressão de VEGF na gengiva saudável, sugere uma função fisiológica para estas proteínas em condições de homeostase. Na doença periodontal, a expressão de HIF-1α e VEGF pode ser regulada por outros fatores, além da hipóxia, tais como endotoxinas bacterianas e citocinas inflamatórias.

Abstract Hypoxia-inducible factor 1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF) are proteins that stimulate the proliferation and migration of endothelial cells. These proteins have been described in many pathologic and inflammatory conditions, but their involvement in the development of periodontitis has not been thoroughly investigated. This study compared the immunohistochemical expression of these proteins, involved in angiogenesis and hypoxia, by imunnostained inflammatory and endothelial cells in periodontal disease and healthy gingival tissues. Gingival tissue samples were divided as follows: 30 samples with chronic periodontitis, 30 with chronic gingivitis, and 30 of healthy gingiva. Results were analyzed statistically by the Kruskal-Wallis, Mann-Whitney and Spearman correlation tests (p=0.01). Inflammatory and endothelial cells were found to express these proteins. Periodontitis showed median percentage of HIF-1α-positive cells of 39.6%, 22.0% in cases of gingivitis and 0.9% in the healthy gingiva group (p=0.001). For VEGF, median percentage of immunopositive cells was 68.7% for periodontitis, 66.1% in cases for gingivitis, and 19.2% for healthy gingival specimens (p<0.001). Significant correlation between VEGF and HIF-1α was also observed in healthy gingiva (p<0.001).The increased expression of HIF-1αα and VEGF in periodontitis, compared to gingivitis and healthy gingiva, suggests possible activation of the HIF-1α pathway in advanced periodontal disease. The correlation between HIF-1α and VEGF expression in healthy gingiva suggests a physiological function for these proteins in conditions of homeostasis. In periodontal disease, HIF-1 and VEGF expression may be regulated by other factors, in addition to hypoxia, such as bacterial endotoxins and inflammatory cytokines.

O dente invaginado é uma das alterações de desenvolvimento que mais incide sobre os elementos dentários, podendo acometer qualquer dente existente na cavidade oral, inclusive decíduos e supranumerários. Consiste em uma invaginação da superfície da coroa, que ocorre na odontogênese, que penetra no interior da cavidade pulpar dos elementos dentários envolvidos, podendo chegar, em algumas situações, à região apical. O incisivo lateral superior permanente é o que apresenta maior envolvimento. Por apresentar uma anatomia complexa e variável, quando diagnosticado, o dente pode apresentar necrose pulpar e rizogênese incompleta, o que torna a sua manutenção muitas vezes de difícil solução. Em 1957, Oehlers classificou-os, conforme sua complexidade, em tipos I, II e III. Foi realizada uma revisão da literatura e descrito o tratamento de um incisivo medial superior com invaginação tipo II, cuja estrutura invaginada se desprendeu devido às várias instrumentações durante as trocas de curativo, o que facilitou sua obturação. Pudemos concluir com este caso a viabilidade, através de diversos métodos, da remoção da porção invaginada no tratamento de dentes invaginados tipo II.

Dens invaginatus is one of the most frequent malformations in dental elements. It can affect all teeth, even primary and supernumerary ones. It consists of an invagination of the crown surface, which happens during odontogenesis and penetrates the interior of the pulp chamber of the dental elements involved. In some cases, it can reach the apical tooth area. The maxillary lateral incisor is the most common site of occurrence. Due to its complex and variable anatomy, the tooth may present pulp necrosis and open apex, making it difficult to salvage. Oehlers classified them into types I, II, and III according to their complexity. This article reviews the literature and describes the treatment of a maxillary central incisor with type II invagination. The invaginated structure in this case detached due to various instrumentations during the change of dressing phase, facilitating root canal filling. In conclusion, this case shows that many methods are capable of removing the invaginated area of a dens invaginatus type II.

<sec><title>Aim:</title><p> To evaluate the involvement of Th2 cells in different periods of the active phase of experimental periodontal disease and expression of the R1 subunit of the receptor for IFN-γ during the early and advanced progression of the disease.</p></sec><sec><title>Methods:</title><p> Experimental periodontitis was induced in 30 male Wistar rats by placing cotton ligatures around the mandibular first molars. The rats were then randomly assigned into two groups: G1=15 and G2=15, in group G1, ligatures were maintained for 2 days, a period that corresponds to the initial stage of periodontal disease in rats, in G2 ligatures were left for 15 days, a period that corresponds to the advanced stage of periodontal disease. The contra-lateral teeth served as controls (unligated). An immunohistochemical investigation of the gingival tissue was performed to detect the presence of the Th2 specific transcription factor (GATA3).</p></sec><sec><title>Results:</title><p> Light microscopy analysis revealed a decreased expression of GATA-3-positive cells when bone loss progressed. IFN-γ R1 was detected at an early stage during the active phase of disease, but the expression of positive cells remained unaltered during the remaining period of the study.</p></sec><sec><title>Conclusions:</title><p> These results indicate that the Th2 response may have a protective role during the pathogenesis of experimental periodontal disease, and that the IFN-γ R1 subunit may not be associated with periodontal disease progression.</p></sec>

O crescimento gengival induzido pela fenitoína é uma complicação comum do uso contínuo da medicacão. Este artigo apresenta um caso de crescimento gengival excessivo que dificultava a função oral e comprometia a higiene oral e a estética, o qual foi tratado com uma combinação de terapias periodontais não-cirúrgicas e cirúrgicas. Paciente masculino de 39 anos de idade foi encaminhado para tratamento odontológico com várias queixas, especialmente do crescimento gengival superior e inferior que prejudicava a fala e deglutição. Profundidades de sondagens severas generalizadas e perda óssea foram detectadas. Diagnóstico de crescimento gengival induzido pela fenitoína e periodontite crônica foi estabelecido. O plano de tratamento consistiu de terapia conservadora com educação, motivação e meticulosa instrução de higiene oral em associação com raspagem e alisamento corono-radicular. Durante o período de reavaliação, uma acentuada redução nos parâmentros clínicos foi observada, principalmente uma redução das profundidades de sondagem. Terapia cirúrgica para remoção do excesso de tecido gengival também foi realizada para conseguir redução das bolsas. Terapia periodontal de suporte foi proposta e o paciente está atualmente sob acompanhamento por um período de 4 anos. O manejo do crescimento gengival induzido pela fenitoína pode ser obtido pelo uso de procedimentos periodontais combinados com uma boa higiene oral e cuidados periodontais de suporte.

Phenytoin-induced gingival overgrowth (PIGO) is a common complication of the continuous use of medications. This paper presents a case of PIGO hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. A 39-year-old male patient was referred for dental treatment with several complaints, especially upper and lower gingival overgrowth that hindered speech and swallowing. Generalized deep probing pockets and bone loss were detected. Diagnosis of gingival overgrowth associated with phenytoin and chronic periodontitis was established. The treatment plan consisted of conservative therapy with education on oral health, motivation and meticulous oral hygiene instruction in combination with scaling and root planing. During the revaluation period, a marked reduction in the clinical parameters was noted, particularly probing pocket depth reduction. Surgical therapy for removal of gingival overgrowth was also performed to achieve pocket reduction. Supportive periodontal therapy was proposed and the patient is currently under follow-up for 4 years. Management of PIGO may be obtained by the use of periodontal procedures combined with good oral hygiene and periodontal supportive care.

The aim of this observational study was to assess the degree of patient satisfaction toward implant-supported prostheses. A questionnaire was used with two scales (one consisting of detailed adjectival and the other of numerical responses) regarding chewing, esthetics, speaking, comfort and overall satisfaction. The scales were administered to a sample of 147 patients treated with implants and prostheses. The data were submitted to the Kappa statistic and the Chi-square test to analyze the association between dependent and independent variables. High degrees of satisfaction (greater than 91%) were found for all categories evaluated, regardless of gender, age, number of implants or type of prosthesis. “Comfort” was associated significantly with the number of implants (p = 0.038), and “speaking” was associated significantly with the type of prosthesis (p = 0.029). Positive agreement was found between the scales for all categories evaluated, without statistically significant differences regarding respondent preference (p = 0.735). Patients treated with implant-supported prostheses were highly satisfied with the treatment.