Abstract
Objective: This paper presents a rare management of excessive gingival display around dental implants and natural teeth using a minimally invasive approach to reduce peri-implant soft tissue with limited osseous reduction around natural teeth. It highlights esthetic crown lengthening procedure creating symmetrical gingival margins in the maxillary anterior region around dental implants and natural teeth. Clinical considerations: Excessive gingival display or gummy smile may adversely impact patient's appearance leading to esthetic concerns. Careful management of soft tissues around dental implants differs than that around teeth to achieve esthetic results. A technique is presented to esthetically and biologically align the gingival margins in areas of implants and natural teeth. It combines soft tissue reduction for implants with limited osseous and soft tissue reduction around natural teeth to achieve symmetrical results. Conclusion: Based on objectively evaluating the results using PES and WES parameters, esthetic results can be achieved around natural teeth and implants with excessive gingival display, through establishing a natural harmonious smile with stable outcomes at 24 months follow up
Highlights
Excessive gingival display or gummy smile with altered position of the dento-gingival complex gives the appearance of short clinical crowns or undesirable gingival symmetry leading to unaesthetic smile [1]
Esthetic crown lengthening (ECL) aims to reduce excessive soft and hard tissues to establish a natural smile with harmonious proportion between the teeth and the dentogingival complex
Symmetrical gingival margins with esthetically pleasing clinical crown width to length ratios were achieved for the dental implants and natural teeth
Summary
Excessive gingival display or gummy smile with altered position of the dento-gingival complex gives the appearance of short clinical crowns or undesirable gingival symmetry leading to unaesthetic smile [1]. This bears an emotional and psychological impact on patients [2,3,4]. Esthetic crown lengthening (ECL) aims to reduce excessive soft and hard tissues to establish a natural smile with harmonious proportion between the teeth and the dentogingival complex. Violation of the biologic width will result in chronic irritation of periodontal tissues leading to inflammation and bone loss with unpleasant esthetics [10,11,12]
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