Correção de sorriso gengival assimétrico e erupção passiva alterada: relato de caso com 10 meses de acompanhamento

Abstract

Excessive gingival display during smiling can compromise facial aesthetics, and treatment planning can be particularly challenging in cases of asymmetry and local anatomical alterations. The aim of this study was to describe the clinical case of a patient with an asymmetric smile, Altered Passive Eruption (APE), and a history of orthodontic traction of tooth 11. The patient, a 37-year-old male, sought care complaining of "exposing too much gum when smiling". The patient underwent a clinical periodontal examination, facial analysis, and tomographic analysis measuring the anatomical periodontal dimensions of the maxilla, and observed APE type 1B with short clinical crowns, uneven gingival margin, incisal wear of the upper anterior teeth, and generalized exostoses. Periodontal surgery with gingivectomy, osteotomy and osteoplasty was performed on teeth 14 to 25. In the postoperative period, questionnaires using the visual analogue scale (0-10) were applied to measure the patient's perception of the result obtained. In the first seven days, the maximum pain and discomfort score was 0.4. At the end of ten months of follow-up, it was found that satisfaction with smile increased from 1.1 at the beginning to 9.8; while self-esteem increased from 4 to 9.9. Samples of gingival tissue were processed for histological analysis, and intact parakeratinized epithelial tissue was observed; connective tissue with chronic inflammatory infiltrate predominantly lymphocytic, with calcifications. In the clinical case presented, periodontal surgery was efficient in increasing the height of clinical crowns and improving the patient's self-perception of aesthetics and selfesteem.