Relato de caso de cirurgia periodontal em paciente com Erupção Passiva Alterada tipo 1B e exostose maxilar: aspectos clínicos, tomográficos e histológicos

Abstract

Excessive gingival display can have several causes, one of which is Altered Passive Eruption (APE). Although less discussed, it seems plausible that maxillary vestibular exostoses can also compromise gingival aesthetics during smiling. The aim of this study was to report a clinical case of a patient with excessive gingival display, APE type 1B and maxillary exostosis, who underwent periodontal surgery, addressing clinical, tomographic and histological aspects of his treatment. The 24-year-old male patient sought treatment with an aesthetic complaint. Based on the clinical and tomographic examinations, the diagnoses of APE 1B and maxillary exostosis were confirmed, and the recommended treatment consisted of gingivectomy, osteotomy and osteoplasty of teeth 16 to 26. Samples of gingival and bone tissue were processed for histological analysis, and intact parakeratinized epithelial tissue was observed; connective tissue with chronic inflammatory infiltrate, dense collagen fibers, and areas of sclerosis; and compact and vital bone. To evaluate the effectiveness of the treatment, questionnaires using the Visual Analogue Scale (0-10) were applied addressing pain and discomfort, aesthetics and self-esteem of the patient. The results showed that pain and discomfort in the first three days were less than 4.0, while satisfaction and self-esteem reached scores of 8.8 and 8.7 respectively after 6 months postoperatively. The clinical crowns increased on average 1.5 ± 0.3 mm, while gingival exposure reduced on average 0.8 ± 0.2 mm. It is concluded that in the patient studied, while the gums were inflamed, the bone had normal histological aspects; and periodontal surgery was effective in reducing gingival exposure, increasing the height of the clinical crowns, satisfaction and self-esteem, having generated mild pain and discomfort.