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OBJECTIVE: To compare the color change, the risk and intensity of tooth sensitivity (TS), and gingival irritation (GI) of at-home bleaching applied on the buccal surface only or the buccal and lingual surfaces. MATERIALS AND METHODS: Sixty patients with canines A2 or darker were selected and their superior arches were randomized in two groups: at-home bleaching on the buccal-only or on the buccal and lingual surfaces, with 7.5% hydrogen peroxide, for 1 h daily/2 weeks. The color change was evaluated at baseline, 7, 14 days, and 1 month after bleaching using shade guides scales (ΔSGU) and a spectrophotometer (ΔEAB, ΔE00, and ΔWID). Risk and intensity of TS and GI were recorded daily using visual analogic scale (0-10). Patient satisfaction was evaluated with the orofacial esthetics. Paired t-test, McNemar's, and Wilcoxon signed-rank test were used for data analysis (α = 5%). RESULTS: Neither the color change nor the risk/intensity of TS was statistically different between groups (p > 0.05). Patient satisfaction increased after bleaching for both groups (p < 0.05). CONCLUSION: The addition of one contact surface does not result in an increased whitening degree compared to bleaching applied solely on the buccal surface. CLINICAL SIGNIFICANCE: Understanding the influence of surfaces interacting with the bleaching agent is crucial for comprehending the bleaching mechanism and avoiding unnecessary material expenses. Notably, employing the buccal-only technique is sufficient to achieve the desired efficacy.

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El recontorneo estético es una cirugía plástica periodontal que tiene como objetivo restablecer una sonrisa más armoniosa de acuerdo al aspecto facial del paciente, el principal motivo para realizar este procedimiento es cuando existe un diagnóstico de una erupción pasiva alterada o sonrisa gingival. La sonrisa gingival es una de las principales preocupaciones de acuerdo a la estética cuando existe una exposición gingival de más de 3 mm en lo cual es justificable realizar el recontorneo estético. Paciente femenino de 28 años de edad, con diagnóstico de erupción pasiva alterada 1B con un seguimiento de 4 meses. El tratamiento consistió en realizar el recontorneo estético para corregir la sonrisa gingival. El recontorneo estético es un procedimiento quirúrgico que se realiza con el objetivo de mejorar la estética del paciente cuando existe una exposición gingival excesiva y para facilitar la armonía de acuerdo a su aspecto facial.

Esthetic recontouring is a periodontal plastic surgery that aims to restore a more harmonious smile according to the patient's facial appearance, since the main reason to perform this procedure is when there is a diagnosis of an altered passive eruption or gingival smile. The gingival smile is one of the main concerns according to aesthetics when there is a gingival exposure of more than 3 mm in which it is justifiable to perform the aesthetic recontouring. 28-year-old female patient with a diagnosis of altered passive eruption 1B with a 4-month follow-up. Treatment consisted of esthetic recontouring to correct the gingival smile. Esthetic recontouring is a surgical procedure performed with the aim of improving the patient's esthetics when there is excessive gingival exposure and to facilitate harmony according to facial appearance.

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O anseio por um sorriso harmônico tem se tornado cada vez maior, uma vez que muitos pacientes relatam desconforto ao sorrir, pois correlacionam a estética do sorriso a problemas de baixa autoestima e em alguns casos suscetibilidade a alterações psicossociais decorrente aos padrões estéticos impostos pela sociedade. O sorriso gengival é uma das grandes queixas relatadas por pacientes. A exposição excessiva de gengiva maxilar pode ser decorrente a fatores gengivais, ósseos, dentários e musculares. Dentre os tratamentos disponíveis para diminuir essa exposição, contamos com cirurgias periodontais, aplicação de toxina botulínica, tratamentos ortodônticos, cirurgia ortognática e reposicionamento labial. O tratamento adequado será definido de acordo com o fator etiológico de cada caso. Diante disso o objetivo do trabalho é realizar um relato de caso sobre aumento de coroa clínica estética. A paciente estava descontente com a exibição de uma grande quantidade gengival ao sorrir. Após estudos clínicos e de imagem o diagnóstico foi de erupção passiva alterada, tipo IB. O tratamento de escolha foi a gengivoplastia associada a remodelação óssea osteotomia e osteoplastia. O tratamento estético vai além de uma boa aparência, através deste trabalho, foi possível evidenciar impactos benéficos que o sorriso harmônico pode acarretar na vida do indivíduo, atendendo suas expectativas e a do cirurgião-dentista(AU)

The desire for a harmonic smile has become increasing, since many patients report discomfort when smiling, as they correlate smile aesthetics to problems of low self-esteem and in some cases susceptibility to psychosocial changes due to aesthetic standards imposed by society. Gummy smile is one of the major complaints reported by patients. Excessive exposure of the maxillary gingiva may be due to gingival, bone, dental and muscular factors. Among the treatments available to reduce this exposure, we have periodontal surgeries, botulinum toxin application, orthodontic treatments, orthognathic surgery and lip repositioning. The appropriate treatment will be defined according to the etiological factor of each case. Therefore, the objective of this work is to carry out a case report on aesthetic clinical crown augmentation. Patient discount with the display of a large amount of gingival when smiling. After clinical and imaging studies, the diagnosis was an altered passive eruption, type IB. The treatment of choice was gingivoplasty associated with bone remodeling, osteotomy and osteoplasty. Final comments and conclusions: The aesthetic treatment goes beyond a good appearance, through this work, it was possible to evidence beneficial impacts that the harmonic smile can have on the individual's life, meeting their expectations and that of the dentist(AU)

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Introduction: Excessive gummy smile affects the aesthetics of the patient and can be the result of several factors, including altered passive eruption, which can be surgically corrected by aesthetic crown lengthening. Case report: 22-year-old female patient, who was treated by aesthetic crown lengthening for the correction of type 1B altered passive eruption. Discussion: Considering the patient's age and periodontal phenotype, surgical correction of the gummy smile by aesthetic crown lengthening shows stable long-term results. Conclusion: Surgically correcting excessive gingival exposure through esthetic crown lengthening can help patients improve the appearance of their smile and regain their self-confidence.

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Introducción: El quiste nasolaveolar, conocido también como nasolabial o de Klestadt, se considera un raro quiste del desarrollo, epitelial y no odontogénico. Aparece en la región del ala nasal, produce asimetría facial, afecta la estética y puede conducir a alteraciones psicológicas. Objetivo: Presentar un caso clínico de quiste nasoalveolar unilateral derecho. Caso clínico: Paciente masculino de 30 años de edad, de color de piel negra, procedencia rural y con antecedentes de salud. Acudió a consulta por presentar aumento de volumen en ala nasal derecha, que producía obstrucción nasal y dificultades al respirar. El examen físico y complementarios imagenológicos revelaron diagnóstico presuntivo de quiste nasoalveolar unilateral derecho. Se procedió a la exéresis quirúrgica de la lesión bajo anestesia local sin complicaciones, el examen histopatológico confirmó el presunto diagnóstico. Conclusiones: El quiste nasoalveolar es una entidad clínica poco frecuente en Cuba y el mundo, su tratamiento es quirúrgico y es baja su recurrencia(AU)

Introduction: The nasolaveolar cyst, also known as nasolabial or Klestadt, is considered a rare developmental, epithelial and non-odontogenic cyst. It appears in the region of the nasal wing, produces facial asymmetry, affects aesthetics and can lead to psychological disorders. Objective: To present a clinical case of a right unilateral nasoalveolar cyst. Clinical case: A 30-year-old male patient, black, rural origin and with a history of health. He came to the consultation due to presenting an increase in volume in the right nasal wing, which caused nasal obstruction and difficulties in breathing. The physical and complementary imaging examinations revealed a presumptive diagnosis of a right unilateral nasoalveolar cyst. The lesion was surgically removed under local anesthesia without complications and histopathological examination confirmed the presumed diagnosis. Conclusions: The nasoalveolar cyst is a rare clinical entity in Cuba and the world, its treatment is surgical and its recurrence is low(AU)

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BACKGROUND: This study introduces and assesses the outcomes of a novel rhinoplasty technique, TRICK-TIP (Transcolumellar and Inter Cartilaginous Keystoning with Tip preservation), employing a combined open and closed approach with tip anatomy conservation and structured tip support. METHODS: The procedure involves a low stairstep columellar sectioning, followed by transmembranous and intercartilaginous incisions without skin dissection in the columella or tip. Elevating the entire mobile nose as a three-layered flap provides extensive access to the entire nasal pyramid and septum. Tip modifications, including retrograde cephalic cartilage resection and supratip skin thinning, are performed based on individual cases. A key columellar strut is frequently used, initially sutured in the interdomal space and then turned down for height adjustment and final fixation. Interdomal sutures, supratip sutures, and alar resection are implemented as needed. RESULTS: One hundred twenty patients participated, with high satisfaction and a low frequency of adverse effects reported using four FACE-Q™ questionnaires. One hundred and two independent raters evaluated pre and postoperative photographs, scoring "overall nose result" as 3.6 out of 5, with minimal or absent nostril deformities (1.84), soft triangle deformities (1.73), and columellar external scar deformity/visibility (1.35) where 1 is the absence of the deformity and 5 is disfigurement. Complications were absent, and revisions were infrequent. CONCLUSIONS: The combined benefits of the wide-open approach, shortened surgery duration, and nasal tip preservation contribute to outcome optimization. TRICK-TIP rhinoplasty is characterized by simplicity, enabling targeted modifications, preventing soft triangle and rim complications, and facilitating essential tip support while maintaining favorable results. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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OBJECTIVE: The Journal of Esthetic and Restorative Dentistry (JERD) stands out as one of the most prominent international journals publishing research in esthetic dentistry. This study analyzed articles published by JERD since the year 2000 through bibliometric analysis. METHODOLOGY: The search was conducted in January 2024 using Scopus. The following data were extracted from the articles: citation count, year, language, access type, funding agency, study design, theme (general and specific), country, institution, authors, and keywords. The VOSviewer software was used to generate collaborative network maps among the data. Dimensions were consulted to measure altmetric data. Google Trends was used to investigate the global popularity of JERD research. RESULTS: A total of 1394 articles were included in this analysis. Citation count ranged from 0 to 625 (average: 16.9). Articles were published between 2000 and 2023. Laboratory studies were more prevalent (n = 850), with the most investigated general theme being restorative procedures (n = 882), and the highlighted specific theme being the use of composite resin (n = 327). The United States had the highest number of articles (n = 640), with the diverse distribution among other countries. The most common keyword was "cad/cam" (n = 63). VOSviewer demonstrated high collaboration among countries. Intense mentions were identified primarily on Facebook. According to Google Trends, Egypt was the country that searched for JERD the most. CONCLUSIONS: JERD exhibited significant growth in the number of published articles and their diversity by topics, types, origin (country), number of citations, and impact factor. CLINICAL SIGNIFICANCE: The JERD is a journal that publishes studies influencing clinical practice. Identifying the key characteristics of this journal is essential for charting future paths.

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A Odontologia Estética baseia- se em princípios de estética com condutas e técnicas de procedência lógica, como também intuitiva, para planejar um sorriso harmônico. Com seu atual perfil mais conservador atrelado às inúmeras ferramentas disponíveis no mercado, é possível arquitetar procedimentos priorizando o sucesso do tratamento, restabelecendo a função e harmonia, com maior segurança e previsibilidade. O fluxo digital inclui Softwares e equipamentos automatizados que podem otimizar o tempo clínico, apresentando benefícios tanto para o Cirurgião Dentista como para o paciente. Atualmente, o DSD (digital smile design) tem sido utilizado como um recurso de grande destaque para a Odontologia reabilitadora, pois, possibilita um planejamento mais minucioso em cada estágio do tratamento reabilitador estético com o uso de desenhos e linhas de referência para comparações entre as imagens geradas do antes e depois, avaliando se concordam com o planejamento e anseios do profissional e do paciente, ou se serão necessárias modificações. Com isso, o objetivo do presente trabalho foi realizar uma revisão de literatura sobre os avanços do fluxo de trabalho digital em reabilitação oral estética, analisando-se a influência na qualidade do atendimento atrelado ao conforto dos pacientes. Foi realizada uma revisão de literatura nas bases de dados PubMed, Scielo e Wiley Library, utilizando os descritores "Digital Smile Design", "Dental Esthetic," EstheticTreatment". Foram buscados artigos entre 2009 até 2022. Com base na revisão de literatura, foi possível concluir que a técnica se apresenta como uma ferramenta valiosa para tratamentos restauradores, otimizando a compreensão das dificuldades estéticas e aumentando a aceitação do tratamento pelo paciente. E, por trás destes resultados, existem diversas variáveis influenciando-os, como a maior previsibilidade dos procedimentos, reduzindo o tempo para a finalização, além de trabalhos mais conservadores, com estrutura dental preservada.

Esthetic dentistry is based on aesthetic principles with logical, also intuitive procedures and techniques, in order to plan a harmonic smile. With its more consecutive current profile linked to the numerous tools available on the market, it is possible to design procedures prioritizing the success of the treatment restoring the function and harmony with greater safety and predictability. The digital flow includes software and automated equipment that can optimize clinical time, presenting benefits for both, the dental surgeon and the patient. Currently, the DSD (digital smile design) has been used as a resource of great prominence for Rehabilitative Dentistry, because it allows a more detailed planning in each stage of the aesthetic rehabilitation treatment with the use of drawings and reference lines, in order to compare between the images generated before and after the procedure, assessing whether they are in accordance with the planning and desires of the professional and the patient, or if modifications are necessary. With this, the objective of the present work was to carry out a literature review of the advances in the digital workflow in aesthetic oral rehabilitation. Analyzing the influence on the quality of care linked to the comfort of patients. A literature review was carried out in PubMed, Scielo and Wiley Library databases, using the descriptors "Digital Smile Design", "Dental Esthetic", "Esthetic Treatment". Articles were searched between 2009 and 2022. Based on the literature revie, it was possible to conclude that the technique presents itself as a valuable tool for restorative treatments, optimizing the understanding of aesthetic difficulties and increasing the acceptance of the treatment by the patient. And, behind these results, there are several variables influencing them, such as greater predictability of procedures, reducing the time for completion in addition to more conservative works, with preserved tooth structure.

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BACKGROUND: Rehabilitation in the anterior region requires specific conditions for success, such as the presence of papilla, emergence profile, and balance between pink and white esthetic. OBJECTIVES: This systematic review aimed to evaluate the esthetic risk associated with immediate implant placement with immediate restoration in the anterior superior area, where the facial bone plate may be absent or deficient. MATERIAL AND METHODS: The search was done in PubMed, Embase, Cochrane, Lilacs, Scopus, Scielo, and Google Scholar databases. The investigation involved clinical studies and observational studies published between January 2012 and July 2023. Studies were excluded if there was less than 12-month follow-up, no immediate restoration or facial defect, heavy smokers, or systemic disease. The risk of bias was assessed using the ROBINS-I and Modified-Cochrane RoB tools. RESULTS: Twelve studies were included in this systematic review. The thinner the facial plate, the higher the alveolus's risk of gingival recession or shrinkage. There was an increased interproximal recession when the thin phenotype was associated with flap surgery. An increase in pink esthetic score (PES) was reached when immediate implant placement (IIP) and immediate restoration were done. Soft tissue augmentation achieved more gingival-level stability. Regardless of the initial phenotype, an esthetic outcome was delivered. The risk of bias was high in 1 study and moderate in 3 studies. CONCLUSION: It is possible to conclude that esthetic results and increased final PES or patient satisfaction index in IIP treatments associated with immediate restoration could be obtained even in buccal bone wall defects or gingival recession, regardless of their extension.

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OBJECTIVE: To explore the feasibility of the usage of digital guides in combination with low- and high-power lasers for the treatment of excessive gingival display, also known as "gummy smile". CLINICAL CONSIDERATIONS: Excessive gingival display due to altered passive eruption can affect patient's perception of their own esthetics and consequently have an impact on self-confidence. Therefore, the management of this condition should offer a predictable and stable long-lasting solution. To attain these objectives, digital planning emerges as a tool in optimizing the outcomes of crown lengthening surgery for this condition by enhancing precision through the use of surgical guides. Additionally, the usage of high- and low-powered lasers can provide a safe approach because of their tissue selective removal properties. CONCLUSIONS: The technique described showed satisfactory clinical results in the short- and long-term follow-up, leading to an improvement in patients' self-esteem. This approach integrates digital and laser technologies to deliver a surgical treatment characterized by precision, efficiency, and safety. CLINICAL SIGNIFICANCE: Digital dentistry has contributed to innovative dental procedures, as personalizing surgical guides for patients, assisting and guiding incisions of the gingival margins, as well as the extension of the osteotomy, during the procedures for increasing the clinical crown. Furthermore, smile esthetics are directly related to an individual's improved emotional and social quality of life.

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Objective: To reduce environmental biohazards, technicians should be educated with safe biological waste disposal procedures and dental material recycling. The present study assesses the retentive force, deformation test and XRD analysis of re-injection acetal resin clasps. Material and Methods: specimens were prepared for clasp retention test injection according to the manufacture's instruction for acetal resin. The first group represent control group with (100% New) and other five groups as experimental groups (group II (25% old +75% new), group III (50% old + 50%) new, and group IV (75% old + 25% new) with different percentages between new acetal materials and old acetal materials, while two last groups with several times (group V (100% old) and group VI (re-injection two times)) only used old acetal materials. The X-ray diffraction (XRD) device used to give structural information for the materials to be tested. The study data were analyzed via One-way ANOVA (LSD) at a significant P-value of (p≤0.05) and a confidence level of 95%. Results: After comparing the results, a significant improvement in the retentive force of acetal clasp specimens after re-injection two times there was found high mean value in group re-injection two times and lower mean value recorded in control group. In XRD patterns of there was no diffraction peak refers to crystal structure of acetal resin. Conclusion: the present study findings concluded that the recycling of acetal resin enhanced the retentive force of acetal clasp and not affected on the crystal structures of material(AU)

Objetivo: Para reduzir os riscos biológicos ambientais, os técnicos devem ser educados com procedimentos seguros de eliminação de resíduos biológicos e reciclagem de material dentário. O presente estudo avalia a força de retenção, teste de deformação e análise de DRX de grampos de resina acetal reinjetada. Material e Métodos: as amostras foram preparadas para o teste de retenção dos grampos e a injeção realizada de acordo com as instruções do fabricante para resina de acetal. O primeiro grupo representa o grupo controle com (100% novo) e os outros cinco grupos como grupos experimentais (grupo II (25% antigo + 75% novo), grupo III (50% antigo + 50% novo) e grupo IV (75% antigo + 25% novo) com porcentagens diferentes entre materiais de acetal novos e antigos, enquanto os dois últimos grupos (grupo V (100% antigo) e grupo VI (reinjeção duas vezes)) utilizaram apenas materiais de acetal antigos. O dispositivo de difração de raios X (DRX) foi utilizado para fornecer informações estruturais dos materiais a testados. Os dados do estudo foram analisados por ANOVA um fator (LSD) com um valor P significativo de (p≤0,05) e um nível de confiança de 95%. Resultados: Após a comparação dos resultados, foi encontrada uma melhora significativa na força de retenção das amostras de grampo de acetal após duas reinjeções, além disso, foi registrado um maior valor médio no grupo reinjeção duas vezes e menor valor médio no grupo controle. Nos padrões de DRX não houve pico de difração referente à estrutura cristalina da resina acetal. Conclusão: os resultados do presente estudo concluíram que a reciclagem da resina de acetal aumentou a força retentiva do grampo e não afetou as estruturas cristalinas do material(AU)

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Human musicality exhibits the necessary hallmarks for biological adaptations. Evolutionary explanations focus on recurrent adaptive problems that human musicality possibly solved in ancestral environments, such as mate selection and competition, social bonding/cohesion and social grooming, perceptual and motor skill development, conflict reduction, safe time-passing, transgenerational communication, mood regulation and synchronization, and credible signaling of coalition and territorial/predator defense. Although not mutually exclusive, these different hypotheses are still not conceptually integrated nor clearly derived from independent principles. I propose The Nocturnal Evolution of Human Musicality and Performativity Theory in which the night-time is the missing piece of the adaptationist puzzle of human musicality and performing arts. The expansion of nocturnal activities throughout human evolution, which is tied to tree-to-ground sleep transition and habitual use of fire, might help (i) explain the evolution of musicality from independent principles, (ii) explain various seemingly unrelated music features and functions, and (iii) integrate many ancestral adaptive values proposed. The expansion into the nocturnal niche posed recurrent ancestral adaptive challenges/opportunities: lack of luminosity, regrouping to cook before sleep, imminent dangerousness, low temperatures, peak tiredness, and concealment of identity. These crucial night-time features might have selected evening-oriented individuals who were prone to acoustic communication, more alert and imaginative, gregarious, risk-taking and novelty-seeking, prone to anxiety modulation, hedonistic, promiscuous, and disinhibited. Those night-time selected dispositions may have converged and enhanced protomusicality into human musicality by facilitating it to assume many survival- and reproduction-enhancing roles (social cohesion and coordination, signaling of coalitions, territorial defense, antipredatorial defense, knowledge transference, safe passage of time, children lullabies, and sexual selection) that are correspondent to the co-occurring night-time adaptive challenges/opportunities. The nocturnal dynamic may help explain musical features (sound, loudness, repetitiveness, call and response, song, elaboration/virtuosity, and duetting/chorusing). Across vertebrates, acoustic communication mostly occurs in nocturnal species. The eveningness chronotype is common among musicians and composers. Adolescents, who are the most evening-oriented humans, enjoy more music. Contemporary tribal nocturnal activities around the campfire involve eating, singing/dancing, storytelling, and rituals. I discuss the nocturnal integration of musicality's many roles and conclude that musicality is probably a multifunctional mental adaptation that evolved along with the night-time adaptive landscape.

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About half of the cases of gingival recession are associated with the noncarious cervical lesion (NCCL), resulting in combined defects (CDs). NCCL negatively affects the root coverage outcomes. In addition, considering the morbidity associated with graft harvesting, soft-tissue substitutes (STSs) appeared as a suitable option for connective tissue grafts for surgical root coverage. Currently, the literature addressing the therapy of CDs employing STSs is scarce. Thus, the present review aimed to update the literature and outline the future perspectives about root coverage of CDs using STSs. A detailed literature search was conducted on MEDLINE, Web of Science, EMBASE, LILACS, Scopus, and Google Scholar databases using keywords and Boolean operators. Randomized clinical trials (2) and case reports (6) were included. None of the selected studies reported any adverse effect using STSs. Based on the limited evidence available, we cannot state that STSs may benefit the periodontal clinical and patient-centered outcomes. Randomized controlled trials are needed to assess the long-term outcomes, surgical approaches, and restorative protocols.

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Therapeutic options for incisors affected by Molar Incisor Hypomineralization range from very conservative procedures to those considered to be more invasive. Clinicians must select the appropriate approach, considering the outcomes of the procedures. This case series presents clinical outcomes of five female patients with aesthetic complaints associated with the Molar Incisor Hipomineralization. Macroabrasion, microabrasion and dental vital bleaching were used as combination techniques in three cases. Resin infiltration was indicated for a specific case, considering the oncoming orthodontic treatment. Composite restoration was performed in one patient with posteruptive enamel breakdown. Clinicians must select the appropriate approach according to an individualized evaluation of each case, considering factors such as the patient's expectations, dental age, psychosocial period, the severity of the condition, presence of sensitivity and the presumed aesthetic result of the selected treatment. The advantages and disadvantages of the techniques are presented.

Las opciones terapéuticas para los incisivos afectados por hipomineralización incisivo molar van desde procedimientos muy conservadores hasta los considerados más invasivos. Los clínicos deben seleccionar el enfoque adecuado, teniendo en cuenta los resultados de los procedimientos. Esta serie de casos presenta los resultados clínicos de cinco pacientes femeninas con quejas estéticas asociadas a la Hipomineralización Incisivo Molar. En tres casos se utilizaron la macroabrasión, la microabrasión y el blanqueamiento dental vital como técnicas combinadas. La infiltración de resina fue indicada para un caso específico, considerando el tratamiento de ortodoncia próximo. Se realizó una restauración con composite en un paciente con rotura posteruptiva del esmalte. Los clínicos deben seleccionar el abordaje adecuado de acuerdo con una evaluación individualizada de cada caso, considerando factores como las expectativas del paciente, la edad dental, el período psicosocial, la gravedad de la afección, la presencia de sensibilidad y el resultado estético presumible del tratamiento seleccionado. Se presentan las ventajas e inconvenientes de las técnicas.

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Frontal darkened teeth have shown to be one of the most challenging treatments for esthetic dentistry in recent years. This case report, along with a 30-month follow-up, describes the application of a partial ceramic veneer, restricted to the mid-cervical third region, made in the upper left central incisor darkened by trauma. The procedure consisted of maintenance of the entire incisal face, as well as esthetic and morphological rehabilitation of the smile line with veneers and ultra-thin partial ceramic veneers. The planning process was thoroughly elaborated by photographs, study models, a virtual smile designed, diagnostic waxing, and reproduction in the patient's mouth through mock-up. Following, dental home bleaching, esthetic gingival contouring, and minimally invasive tooth preparation were performed. Two types of glass ceramics (lithium disilicate and feldspathic) were used in different regions due to the peculiar characteristics of resistance, finishing, and polishing. According to the present case report, preparing a cervical partial ceramic veneer is an innovative, viable, and safe approach to maintaining the incisal portion of the tooth preserved and setting a detailed tooth morphology/color. The application of partial ceramic veneer provides incisal edge preservation and simplifies the reproduction of the adjacent tooth characteristics, avoiding multiple esthetic appointments.

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BACKGROUND: Dermal facial fillers are increasingly popular. Published reports on the clinical and histopathologic characteristics related to adverse reactions to dermal fillers in the facial region have been relatively well documented. This study adds to the literature on adverse reactions to injected filler in the oral and maxillofacial region in a South American population. METHODS: A retrospective, descriptive cross-sectional study (2019-2020) was performed. The study population was a dermatology service in Venezuela. Clinical and histopathologic features of patients with adverse effects were documented. RESULTS: A total of 35 cases of adverse reactions associated with cosmetic filler procedures were diagnosed during the analyzed period; of these, six cases (17.1%) involved the oral and maxillofacial region. All cases occurred in women. The mean age at diagnosis was 59.3 years (58-73). In three cases, dermal fillers were used in different locations on the face, while three involved the lips. Five patients exhibited adverse reactions to lip filler. All six cases were histopathologically diagnosed as foreign body reactions to injected material. Four and two cases revealed microscopic features compatible with hyaluronic acid and polymethylmethacrylate, respectively. CONCLUSION: Reflecting the dramatic increase in cosmetic procedures with soft tissue fillers, this study contributed by reporting six cases of foreign body reaction involving the oral and maxillofacial region, confirmed with biopsy and histopathology.

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Introdução:O aprimoramento das resinas compostas nos últimosanos em associação com a difusão de informações nas redes sociais tornou as facetas diretas tratamentos populares na dentística restauradora. No entanto, são procedimentos que exigem ampla destreza manual e conhecimento técnico. O fluxo digital através doescaneamento, enceramento digital e prototipagem 3D para construção de guias tem se tornado uma excelente alternativa para aumentar a previsibilidade e aumentar a longevidade destes trabalhos. Objetivo:Descrever o protocolo de confecção de facetas diretas em resina composta, através de um relato de caso, utilizando como auxílio o planejamento digital para confecção de modelo 3D, guia de silicone e paredes palatinas. Descrição do Caso:Paciente do gênero masculino, 43 anos, queixava-se do formato dos seus dentes. Ao exame clínico percebeu-se desgaste dental nos incisivos centrais e linha do sorriso levemente invertida. Após duas sessões de clareamento de consultório com Peróxido de hidrogênio (35%) e mockup direto com resina composta, foi realizada a moldagem e escaneamento do modelo de gesso no laboratório. O enceramento digital foi aprovado, o modelo 3D foi impresso para confecção da guia de silicone. Com auxílio da guia foram executadas facetas diretas nos elementos 13, 12, 11, 21, 22 e 23. Conclusão:O fluxo digital pode ser uma alternativa viável para minimizar as falhas na confecção de facetas diretas em resina composta (AU).

Introduction:The improvement of composite resins in recent years, together with information disseminated on social media, has made direct veneers popular treatments in restorative dentistry. However, these procedures require significant manual dexterity and technical knowledge. Digital work flow using scanning, digital wax-up and 3D prototyping for the construction of guides has become an excellent alternative to increase predictability and the longevity of these procedures. Objective:Describe the manufacturing protocol for direct composite resin veneers, using a case report and digital to construct the 3D model, silicone guide and palatine walls. Case description:Male patient, 43 years old, complained of the shape of his teeth. Clinical examination revealed tooth wear on the central incisors and a slightly inverted smile line. After two whitening sessions with hydroigen peroxide (35%) and direct mockup with composite resin, the plaster model was molded and scanned in the laboratory. Digital wax-up was approved, and the 3D model was printed to manufacture the silicone guide. With the help of the guide, the direct veneers were applied to elements 13, 12, 11, 21, 22 and 23.Conclusions:Digital flow may be a feasible alternative to minimize manufacturing flaws in direct composite resin veneers (AU).

Introducción: La mejora de las resinas compuestas en los últimos años, y la difusión de información en las redes sociales, ha popularizado las facetas directas en los tratamientos en odontología restauradora. Sin embargo, son procedimientos que requieren demasiado destreza manual y conocimientos técnicos. El flujo digital usando escaneo, encerado digital y prototipado 3D para la construcción de guías se ha convertido en una excelente alternativa para aumentar la previsibilidad y la longevidad de estos procedimientos. Objetivo: Describir el protocolo para la realización de carillas directas en resina compuesta, a través de un reporte de caso, utilizando el planeo digital como ayuda para la realización de un modelo 3D, guía de silicona y paredes palatinas. Descripción del caso: Paciente masculino, 43 años, se quejó de la forma de sus dientes. El examen clínico reveló desgaste dental en los incisivos centrales y una línea de sonrisa levemente invertida. Después de dos sesiones de blanqueamiento en consultorio con peróxido de hidrógeno (35%) y maqueta directa con resina compuesta, el modelo de yeso fue moldeado y escaneado en el laboratorio. El encerado digital fue aprovado, el modelo 3D fue impreso para hacer la guía de silicona. Con la ayuda de la guía se realizaron carillas directas en los elementos 13, 12, 11, 21, 22 y 23. Conclusiones: El fluxo digital puede ser una alternativa viable para minimizar fallas en la fabricación de carillas directas en resina compuesta (AU).

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Background: The objective of this systematic review and meta-analysis was to answer the questions ''Does lip repositioning surgery reduce the amount of gingiva exposed in the smile in individuals with excessive gingival display EGD (excessive gingival display)?'' and ''Is the reduction of the amount of gingiva exposed when smiling obtained with lip repositioning surgery stable over time?'' to evaluate the effectiveness of lip repositioning surgery for correcting EGD on smiling. Materials and Methods: A systematic structured search was carried out in five databases without data restriction. Studies reporting the degree of reduction in gingival ex-posure after lip repositioning surgery were included. Study selection, data extraction, and risk of bias assessment were performed in duplicate Results: One hundred sixty-four references were retrieved and eleven studies met the eligibility criteria. Meta-analysis demonstrated that lip repositioning surgery results in a significant reduction in the amount of exposed gingival tissue (mean difference = -3.03; confidence interval = -3.55; -2.52). In addition, the results remained stable in the evaluated follow-up periods (1, 3, 6 and 12 months). Included studies had a low risk of bias. Conclusions: Lip repositioning surgery is effective for the treatment of EGD on smiling and exhibits stable results in the evaluated periods. The study was registered (CRD42020184866) in the international prospective register of systematic reviews (PROSPERO)

Antecedentes: el objetivo de esta revisión sistemática y metanálisis fue responder a las preguntas "¿La cirugía de reposicionamiento de labios reduce la cantidad de encía expuesta en la sonrisa en personas con exposición gingival excesiva (EGE)?" y "¿La reducción de la cantidad de encía expuesto al sonreír obtenido con cirugía de reposicionamiento de labios estable en el tiempo?" para evaluar la efectividad de la cirugía de reposicionamiento de labios para corregir la EGE al sonreír. Materiales y Métodos: Se realizó una búsqueda sistemática estructurada en cinco bases de datos sin restricción de datos. Se incluyeron los estudios que informaron el grado de reducción de la exposición gingival después de la cirugía de reposición de labios. La selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo se realizaron por duplicado. Resultados: Se recuperaron ciento sesenta y cuatro referencias y once estudios cumplieron con los criterios de elegibilidad. El metanálisis demostró que la cirugía de reposicionamiento de labios da como resultado una reducción significativa en la cantidad de tejido gingival expuesto (diferencia de medias = -3,03; intervalo de confianza = -3,55; -2,52). Además, los resultados se mantuvieron estables en los periodos de seguimiento evaluados (1, 3, 6 y 12 meses). Los estudios incluidos tenían un bajo riesgo de sesgo. Conclusión: La cirugía de reposicionamiento de labios es efectiva para el tratamiento de la EGE al sonreír y presenta resultados estables en los períodos evaluados. El estudio fue registrado (CRD42020184866) en el registro prospectivo internacional de revisiones sistemáticas (PROSPERO).

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Minimally invasive dentistry is a considered process that requires the clinician to be prepared with the ideal sequence and the tools needed. This report describes a well-planned ultraconservative approach using only two ceramic laminate veneers for the maxillary central incisors to significantly improve the patient's overall smile. A 30-year-old female presented with the chief complaints of having diastemas between the central and lateral incisors as well as incisal wear. Diagnostic wax-up and mock-up were performed, and the patient approved the minimally invasive treatment with veneers only for central incisors. A reduction guide aided the conservative tooth preparations, and hand-crafted feldspathic veneers were bonded under total isolation with a rubber dam. The two final conservative veneers significantly improved the smile and fulfilled the patient's expectations. Following proper planning and sequencing, predictable outcomes were obtained and fulfilled the patient's esthetic demands. Minimally invasive restorative dentistry with only two single veneers can impact the entire smile frame. Overtreatment in the esthetic zone is unnecessary to meet a patient's esthetic expectations.

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In this case report, we demonstrate how the correct positioning of implants, associated with optimal gingival conditioning, and the correct choice of biomaterial can yield very predictable and fantastic aesthetic results. OBJECTIVE: We aimed to use dental implants to rehabilitate the area of elements #11 and #21 in a satisfactory surgical and prosthetic manner, using guided surgery, connective tissue, nano-biomaterials, and a porcelain prosthesis. CASE REPORT: A 32-year-old male patient presented with bone loss of elements #11 and #21, which was proven radiographically and clinically. Thus, oral rehabilitation with the use of dental implants was required. It was decided to proceed via digital planning with the DSD program (Digital smile design) and with the software Exoplan, (Smart Dent-Germany) whenever it was possible to plan immediate provisional and accurate dental implant positioning through reverse diagnostics (Software Exoplan, Smart Dent-German). The dental elements were extracted atraumatically; then, a guide was established, the implants were positioned, the prosthetic components were placed, the conjunctive tissue was removed from the palate and redirected to the vestibular wall of the implants, the nano-graft (Blue Bone®) was conditioned in the gaps between the vestibular wall and the implants, and, finally, the cemented provision was installed. RESULTS: After a 5-month accompaniment, an excellent remodeling of the tissues had been achieved by the implants; consequently, the final prosthetic stage could begin, which also achieved a remarkable aesthetic result. CONCLUSIONS: This report demonstrates that the correct planning of dental implants, which is associated with appropriate soft tissue and bone manipulation, allows for the achievement of admirable clinical results.