Oral Health and Dental Management

Gingival hyperplasia, impact on smile aesthetics: Clinical case report

4^th International Conference on Orthodontics

October 09, 2023 | Prague, Czech Republic

Vinicius Correa Dalbom

Unisul Institution Florianopolis, Brazil

Scientific Tracks Abstracts: OHDM

Abstract:

Case report: A 22-year-old female patient was using an orthodontic appliance and during clinical examination, gingival tissue enlargement and extension with the periodontal probe were observed, in addition to the presence of biofilm on the brackets and gingival margin. The choice of treatment was gingivoplasty. Gingivoplasty is the periodontal surgical technique used to achieve adequate gingival contour, without bone involvement, establishing harmony with the smile. (SANCHES; MEZA; MIRANDA, 2019). Through this technique, it is possible to promote the remodeling, anatomy and physiological contour of the gingiva (SOUZA, 2018). In the anamnesis, the patient reported being asthmatic and allergic to Amoxicillin. In the clinical examination, probing was carried out, with a millimeter probe, of all teeth and gingival excess was found that varied from 2 to 3 mm in depth between dental units 16 to 24 in the upper region. The irregular outline was the main cause of dissatisfaction. The patient had indication for removal of the orthodontic appliance, by the specialist, and was informed about the possibility of recurrence of the hyperplasia if she continued to use the appliance and neglected oral hygiene. Procedure: Dexamethasone 4mg was administered as preoperative medication, 1 hour before the procedure, orally, in a single dose, as an anti-inflammatory agent. Then, mouthwash was performed with 0.12% chlorhexidine digluconate and extra-oral antisepsis with 2% chlorhexidine. Use of topical anesthetic benzotop® 200mg/g. Anterior and middle superior alveolar nerve block with 2% lidocaine with epinephrine 1.100.00. After anesthetic technique and waiting time for the anesthetic to diffuse, probing was performed with a millimeter probe and bleeding point was marked, then an incision was made in an internal bevel with a 15C scalpel blade and the edematous tissue was removed with a McCall curette. Soon after, the distance of the biological space was verified, through bone probing, 3mm from the gingival margin to the bone crest was indicated. There was no need for an osteotomy. Postoperative medication of choice was Ibuprofen 600mg, 01 tablet every 08 hours for 03 days and mouthwash with 0.12% chlorhexidine digluconate, 24 hours after surgery and 30 minutes after brushing, with the aim of reducing post-operative bacteremia. operations, where effective oral hygiene becomes difficult and uncomfortable. In addition, post-operative instructions were provided, as well as instructions regarding recurrence of hyperplasia if the appliance was not removed. The patient returned to the clinic for evaluation after 7 days of surgery, in which she had removed the appliance with her orthodontist, and reported satisfaction with the result obtained. It was clear that there was a decrease in swollen gums in the lower anterior teeth, a result after controlling bacterial plaque and removing the orthodontic appliance. It is worth mentioning that the patient was already at the end of the orthodontic treatment and for this reason the appliance was removed. Discussion: The brackets have a format that facilitates the retention of biofilm, and when not properly cleaned with the aid of interdental brushes and floss, it becomes a bias for the stomatognathic system, as it facilitates the appearance of gingival inflammation (SANTOS; XAVIER; RIBEIRO, 2014; DA MATA et al., 2021). The main way to induce the regression of gingival inflammation caused by orthodontic appliances is to eliminate the cause, with correct brushing, with the aid of an interdental brush and the use of dental floss with floss, to control the biofilm (DA MATA et al., 2021). Gingival excess can trigger adverse actions not only in aesthetics, but also in periodontal health, affecting the masticatory function where the protective barrier against trauma decreases as a consequence, in addition to the formation of false periodontal pockets that serve as a focus of bacteria proliferation (SOUZA, 2019). Therefore, before the surgical procedure, it is imperative that basic periodontal therapy be carried out in a session prior to the day of surgery (SOUZA, 2019). The choice of treatment was based on the patient’s history, she reported that the gingival growth appeared after the use of orthodontic appliances. Thus, gingivoplasty consists of surgical excision by demarcating a marginal contour, modeling the gingiva and removing excess, promoting the proper anatomical contour of the interdental papillary and attached gingiva. (CARRANZA et al., 2012). The drug choice was Ibuprofen 600mg, as it has an anti-inflammatory and analgesic action. Drug therapy associated with mouthwashes with 0.12% chlorhexidine digluconate led to good healing, avoiding infectious foci (DIAS et al., 2020). The postoperative period was satisfactory and there was a quick and good healing, without any intercurrence during surgery or after surgery. Conclusion: The literature shows that patients with orthodontic appliances have a high chance of developing gingival hyperplasia. This condition can worsen when it is associated with poor hygiene. It is concluded that basic periodontal therapy, correct oral hygiene instructions and the surgical technique of gingivoplasty promote good prognosis, esthetics and periodontal function, bringing patient satisfaction.

Biography :

Vinícius Correa Dalbom is a dental surgeon (CRO/SC 22531) with a degree from the Unisul institution in Florianopolis, Brazil. During his final semester at Unisul, Vinícius collaborated with colleagues to publish many articles featured in the Brazilian Journal of Health Review, and he will be presenting it during the event. Vinicius’s dedication to dental research and his contributions to the field showcase his commitment to advancing oral healthcare.