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BACKGROUND: Junctional epidermolysis bullosa (JEB) is one of the four major types of EB caused by genetic variants in the genes coding the proteins of the lamina lucida. All patients with this major type of EB present syndromic hypoplastic amelogenesis imperfecta (AI), with either a pits and fissures or generalized hypoplastic phenotype. Severe forms of AI are associated with compromised oral health-related quality of life (QoL) mostly due to poor dental aesthetics, dentofacial anomalies, and oral pain. AIM: To present the comprehensive dental treatment of a patient with JEB and AI from the age of 20 months until the age of 18 years, including complex orthodontics and digital oral rehabilitation. MATERIALS AND METHODS: A male patient with intermediate JEB (homozygous c.3228+1G>A LAMB3 variant) has been under the care of the special care dentistry clinic of the University of Chile since the age of 20 months. His complex dental needs include structural enamel abnormalities in primary and permanent dentition (hypoplastic generalized AI), severe dental crowding with maxillary compression, Class III skeletal pattern, agenesia (#45), and gingivitis. RESULTS: Pediatric dental care included oral hygiene education and preventive strategies (prophylaxis and fluoride applications), maintaining the dentition free of caries. Due to AI, severe tooth sensitivity hindered proper oral hygiene and required early rehabilitation with temporary polycarbonate and metallic crowns. At the age of 16, the patient began orthodontic treatment. A maxillary expansion was performed with two consecutive mini-implant assisted rapid palate expansion (MARPE) bonded to four mini-implants in the palate. After finishing orthodontic treatment metallic multibrackets (duration 19 months), a definitive oral rehabilitation based on digital smile design with feldspathic crowns of all anterior teeth and premolars was performed. CONCLUSION: Patients with severe generalized hypoplastic syndromic AI associated with JEB benefit from long-term preventive oral care. Complex orthodontic techniques, such as MARPE, and multibrackets can be successfully. Digital smile design provides a definitive oral rehabilitation technique improving oral function, aesthetics, and QoL.

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Com os avanços tecnológicos na odontologia o planejamento digital se tornou algo mais presente na prática clinica. O objetivo desse trabalho é relatar uma experiência vivida em clínica sobre harmonização do sorriso através de uma gengivoplastia e remodelação óssea em paciente com displasia cemento óssea florida. Paciente 42 anos, autodeclarada do sexo feminino, não relatou nenhuma alteração sistêmica, uso de medicamento ou tabagismo, entretanto relatou ter displasia cemento óssea florida com diagnóstico de periodonto saudável. Compareceu a clínica escola de uma instituição de Ensino Superior para realização de tratamento odontológico queixando-se da aparência de seus dentes. Neste caso, foi utilizado escaneamento digital, tomografia computadorizada para tecidos moles, Digital Smile Design (DSD) e Perioguide (guia cirúrgico) para a realização do procedimento de harmonização do sorriso através da cirurgia periodontal. Em suma, apesar da displasia óssea ser um fator limitante ao sucesso ideal do procedimento, o resultado final alcançado foi satisfatório sob ótica do paciente e profissional não havendo recidiva(AU)

With technological advances in dentistry, digital planning has become something more present in clinical practice. The objective of this work is to report a clinical experience on smile harmonization through gingivoplasty and bone remodeling in a patient with florid cemento-osseous dysplasia. Patient 42 years old, self-reported female, did not report any systemic changes, use of medication or smoking, however she reported having florid cemento-osseous dysplasia with a diagnosis of healthy periodontium. He attended the school clinic of a Higher Education institution for dental treatment, complaining about the appearance of his teeth. In this case, digital scanning, soft tissue computed tomography, Digital Smile Design (DSD) and Perioguide (surgical guide) were used to perform the smile harmonization procedure through periodontal surgery. In short, despite bone dysplasia being a limiting factor for the ideal success of the procedure, the final result achieved was satisfactory from the perspective of the patient and professional, with no recurrence(AU)

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Nowadays, a lot of people need in reconstruction of the teeth in connection with their loss. Before prosthetics or any other manipulations, a person wants to quickly see the aesthetic appearance of his future tooth. At the moment, many dentists use the option of verbal explanation to the patient, what will look like a smile or a front row of teeth after treatment, but the visual representation of the person remains aside. But now this can be achieved with the help of "Digital smile design", which shows the person the final result of the dentition. This technology has a number of advantages. Some of them are the rapid creation of a prototype model and high accuracy in the manufacture of work. Thanks to these technologies, communication between the specialist and the patient has been facilitated. The digital smile design has simplified the doctor's work process and reduced patient data processing time. From now on, achieving aesthetic results in the reconstruction of teeth for the dentist is not a problem.

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This technique report describes a fully digital workflow in which two surgical guides (i.e. one for alveolar bone reduction and the other for implant placement) are magnetically connected to ensure stability during full-arch implant surgery following guided bone reduction. Digital prosthesis design as well as virtual bone reduction and implant planning are developed from the superimposition of facial, intraoral and CBCT scans. With this technique, different surgical guides and interim poly(methylmethacrylate) (PMMA) fixed prosthesis are precisely connected with magnets after being digitally designed and 3D-printed. As a result, such magnetic connection allows for satisfactory stability of the implant surgical guide, as well as of the interim fixed PMMA fixed prosthesis during capture of screw-retained abutments.

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Com a evolução da odontologia digital, muitos programas de planejamento virtual, scanners intraorais e métodos CAD-CAM têm sido desenvolvidos com o intuito de auxiliar o desenvolvimento e a confecção de guias cirúrgicos prototipados, tanto para a implantodontia quanto para a periodontia, visando permitir que as terapias de reabilitação dental sejam realizadas com maior segurança e previsibilidade. Uma reabilitação estética de sucesso dos pacientes com excesso de exibição gengival e coroas clínicas curtas requer uma abordagem interdisciplinar e sintonia entre o periodontista e o protesista, pois devolver simetria gengival e harmonia ao sorriso é uma tarefa árdua e minuciosa. Dessa forma, o objetivo deste trabalho é relatar um caso clínico de aumento de coroa, utilizando o fluxo de trabalho digital com o uso do guia duplo periodontal. (AU).

The evolution of digital dentistry, many virtual planning programs, intraoral scanners and CAD-CAM methods have been developed with the purpose of assisting the development and production of prototyped surgical guides for both implantology and periodontics, in order to allow that dental rehabilitation therapies are performed with greater safety and predictability. Successful aesthetic rehabilitation of patients with excessive gingival display and short clinical crowns requires an interdisciplinary approach and attunement between the periodontist and the prosthodontist, as returning gingival symmetry and harmony to the smile is an arduous and meticulous task. Thus, the objective of this work is to report a clinical case of Crow increase, using digital workflow with Double periodontal guide.

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Resumen Los pacientes acuden cada vez más, al consultorio odontológico a fin de mejorar el aspecto de su sonrisa, ampliando la demanda de procedimientos estéticos, y es responsabilidad del odontólogo ofrecer distintas técnicas para que el paciente acoja un tratamiento óptimo, orientado a la conservación de los tejidos dentales en este aspecto; las carillas de cerámica sin preparación, o lentes de contacto, constituyen una opción conservadora de recubrimiento parcial, que mejora la estética del sector anterior, el siguiente caso describe una posibilidad restauradora estética mínimamente invasiva para la rehabilitación del sector anterior, con el uso de porcelana IPS e. max® Press, resaltando el proceso de planificación por medio del diseño digital en dos dimensiones.

Abstract Patients increasingly come to the dental office to improve the appearance of their smile, expanding the demand for aesthetic procedures, and it is the dentist´s responsibility to offer different techniques for the patient to receive an optimal treatment, aimed at preserving the dental tissues in this aspect, unprepared ceramic veneers, or contact lenses, are a conservative alternative, which improves the aesthetics of the front sector, the following case describes a minimally invasive aesthetic restorative alternative for the rehabilitation of the anterior sector, with the use of IPS e. max® Press porcelain, highlighting the planning process through digital design in two dimensions.

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Com a evolução da odontologia digital, muitos programas de planejamento virtual, scanners intraorais e métodos CAD-CAM têm sido desenvolvidos com o intuito de auxiliar o desenvolvimento e a confecção de guias cirúrgicos prototipados, tanto para a Implantodontia quanto para a eriodontia, visando permitir que as terapias de reabilitação dental sejam realizadas com maior segurança e previsibilidade. Uma reabilitação estética de sucesso dos pacientes com excesso de exibição gengival e coroas clínicas curtas requer uma abordagem interdisciplinar e sintonia entre o periodontista e o protesista, pois devolver simetria gengival e harmonia ao sorriso é uma tarefa árdua e minuciosa. Dessa forma, o objetivo deste trabalho é relatar um caso clínico de aumento de coroa, utilizando o fluxo de trabalho digital com o uso do guia duplo periodontal (AU).

The evolution of digital Dentistry, many virtual planning programs, intraoral scanners and CAD-CAM methods have been developed with the purpose of assisting the development and production of prototyped surgical guides for both Implantology and Periodontics, in order to allow that dental rehabilitation therapies are performed with greater safety and predictability. Successful aesthetic rehabilitation of patients with excessive gingival display and short clinical crowns requires an interdisciplinary approach and attunement between the periodontist and the prosthodontist, as returning gingival symmetry and harmony to the smile is an arduous and meticulous task. Thus, the objective of this work is to report a clinical case of crown increase, using digital workflow with double periodontal guide (AU).

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The use of digital tools offers a new perspective to daily clinical activities. The digital information serves as a starting point for a wax-up and intraoral mock-up, which is widely reported in literature as an objective and efficient communication tool among dentist, patient, and technician. This case report of a maxillary anterior rehabilitation demonstrates esthetic planning with the digital smile design (DSD) system and a direct mock-up technique. After preoperative photographs were obtained, digital planning was created using DSD. However, due to differences in virtual simulation, a direct mock-up with composite resin was performed. Porcelain laminate veneers using feldspathic ceramics were used to restore the anterior teeth. Many times, the DSD simulation is not enough for the patient to understand and observe the changes that will be performed on the anterior teeth. This combination of techniques can offer predictability to results as well increasing the patient expectation satisfaction.

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A busca pela estética tem acentuado a procura dos pacientes pela transformação do sorriso. Com o auxílio da fotografia e da tecnologia computacional, é possível a realização do DSD (digital smile design ­ planejamento digital do sorriso), que nos dá maior previsibilidade do tratamento. A confirmação deste planejamento digital se dá na prova do mock-up, a partir do qual o paciente tem a real sensação do seu sorriso planejado. Este artigo apresentou um caso clínico no qual se destaca a adesão do paciente ao tratamento e a realização de cirurgia periodontal para aumento de coroa clínica, seguida de restaurações diretas com resinas compostas, posterior ao enceramento diagnóstico. Com o planejamento integrando a terapia cirúrgica periodontal e o protocolo restaurador adesivo direto guiado por planejamento digital (DSD), foi possível estabelecer um excelente resultado com uma elevada satisfação do paciente.

The seek for esthetics has increased patient´s demand for the smile makeover. With the help of computational technology, it is possible to perform the DSD (digital smile design) with greater treatment predictability treatment. Confirmation of this digital planning occurs in the mock-up test, from which the patient has a physical sensation of his/her planned smile. This article presents a clinical case which highlights the patient cooperation and periodontal surgery for crown lengthening, followed by direct composite resin restorations after the diagnostic wax-up procedure. With an integrated treatment planning guided by the DSD protocol, it was possible to establish an excellent outcome with high patient satisfaction.

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Atualmente, o DSD (digital smile design) tem sido utilizado como um recurso de grande destaque para a Odontologia Estética. O uso de um software pode facilitar e implementar através de simulações o tratamento reabilitador estético, fazendo com que haja maior entendimento do paciente sobre o procedimento e seus resultados, bem como evitando equívocos que possam ocorrer durante o tratamento. A técnica consiste em analisar as proporções faciais e dentárias de cada paciente e suas relações com dentes, lábios e gengivas por meio de fotografias digitais e vídeos. Com isso, são realizados desenhos seguindo métodos específicos que podem ser apresentados de maneira simples, compreensível e cativante para o paciente(AU)

Nowadays, the DSD (digital smile design) has been used as a great resource for aesthetic restorative dentistry. Through simulations, the use of a software can facilitate and implement aesthetics rehabilitation treatment, helping the patient to have a better understanding of the procedure and its outcomes, and also avoiding misunderstandings that may occur during the treatment. This technique consists in analyzing facial and dental proportions of each patient and the relations with their teeth, lips and gum through digital photograph and movies. Therefore, designs are made following specific methods that can be presented in a simple way, understandable and engaging for the patient(AU)

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