Maxillary Anterior Region Research Articles

Modified lip repositioning for management excessive gingival display: A case report

Introduction: Excessive Gingival Display (EGD), commonly known as “gummy smile” is a condition in which the maxillary gingiva looks excessive (>2 mm) than normal when someone is smiling. This condition is considered aesthetically disturbing, affecting the patient's self-confidence and psychological state. The objective of this case report is to describe the stages of gingivectomy and modified lip repositioning for EGD reconstruction and attachment of the labial mucosa of the maxillary anterior region. Case Report: A 21-year-old male came with the main complaint of wanting to improve his smile which showed less attractive gums. The results of the examination obtained the presence of EGD and hypermobile upper lip so a combined surgical action was planned with gingivectomy and modified lip repositioning for EGD reconstruction and attachment of the labial mucosa of the maxillary anterior region. Case management: The first surgical procedure performed was gingivectomy. One month later, modified lip repositioning was performed. The patient was satisfied with the treatment results and at follow-up after 7 months there was no EGD when the patient smiled. Conclusion: Combined gingivectomy and modified lip repositioning surgery can be an alternative treatment to correct Excessive Gingival Display and provide satisfactory aesthetic results for patients

Clinical analysis of 1,038 cases of odontogenic jawbone cysts

BackgroundThis study aims to analyse the clinical characteristics of different types of odontogenic jawbone cysts (OJCs) and to provide a theoretical basis for prevention and clinical treatment.MethodsData from 1,038 patients with OJCs were collected, and relevant information, such as sex, age, clinical symptoms and signs, imaging data, number of lesions, lesion location, pathological diagnosis, clinical treatment and prognosis, was statistically analysed.ResultsAccording to the World Health Organization (WHO) classification of OJCs in 2022, the highest incidence rate was observed for radicular cysts (RCs), accounting for 58.96% of the total number of cases, followed by dentigerous cysts (DCs), accounting for approximately 23.22% of cases. lateral periodontal cysts (LPCs) and calcifying odontogenic cysts (COCs) comprised the lowest number of cases. The age distribution of patients was between 4 and 89 years, and the high incidence age group was youth and middle age, accounting for 66.67% of the total number of cases. The male-to-female ratio of patients was 1.51:1, and there was a statistically significant difference between the sexes(p < 0.05).In terms of the site of incidence, odontogenic keratocysts (OKCs) were prevalent in the mandibular molar region. In addition, mandibular ramus, inflammatory collateral cysts (ICCs) and dentigerous cysts (DCs) were more common in the mandibular third molar, and radicular cysts (RCs) and calcifying odontogenic cysts (COCs) were prevalent in the maxillary anterior region. On imaging, 955 (92.0%) lesions were solitary, and 83 (8.0%) were multiple. The treatment included four types of surgery, including simple curettage, marsupialization, marsupialization followed by secondary curettage, and partial resection of the jaw, and a total of 921 patients were followed up, with a recurrence rate of 2.82%.ConclusionsOJCs are more common in males than in females, and a statistically significant difference is observed in the most prevalent types of cysts occurring at different ages and in various regions of the jawbone (p < 0.05). Early diagnosis should be made with the help of X-rays, age, location, and clinical symptoms. In addition, appropriate treatment methods should be selected, and long-term follow-up observation is needed.

Blending White and Pink Esthetics: Restoring Central Incisors Using a Complete Digital Workflow- A Case Report

Background/Objectives: Collapse in the anterior maxillary region often follows extractions, posing significant esthetic challenges. Restoring lost central incisors requires a balance of functional and esthetic results, especially in the highly visible anterior region. With advancements in CAD/CAM technology, restorative dentistry has become more precise and efficient. This study aims to explore the use of CAD/CAM technology for restoring two missing central incisors through a fixed ceramic bridge. Methods: The treatment process included the design and fabrication of a fixed ceramic bridge using CAD/CAM technology. An interim bridge with an ovate pontic was placed to shape the soft tissue and prepare the edentulous ridge. Gingivoplasty was performed using a 3D-printed guide to enhance the harmony between gingival and dental structures. The final restoration employed stratified zirconia for its natural esthetic properties. Results: The integration of digital workflows allowed precise planning and execution, resulting in improved predictability of the esthetic outcomes. The interim bridge effectively supported the soft tissue, and the gingivoplasty helped achieve a harmonious gingival contour. The use of CAD/CAM technology contributed to a functional and visually pleasing restoration of the lost central incisors. Conclusions: Digital technology, especially CAD/CAM, significantly enhances the predictability and success of complex dental restorations. It enables the seamless integration of esthetic and functional outcomes, making it an invaluable tool in modern restorative dentistry. This case demonstrates the potential of digital approaches in achieving optimal results in challenging esthetic cases.

Comparing Medium to Long-Term Esthetic, Clinical, and Patient-Reported Outcomes Between Freehand and Computer-Assisted Dental Implant Placement: A Cross-Sectional Study.

The aim of the study was to compare medium to long-term clinical and patient-reported outcomes between implants placed with computer-assisted implant surgery (CAIS) and freehand protocols. Thirty dental implants in the anterior maxillary region with an average of 4 years after loading were assessed by means of Pink Esthetic Scores (PESs), marginal bone level (MBL), and clinical and patient-reported outcomes. CAIS significantly outperformed freehand placement with regard to PES scores (p = 0.011). Likewise, implants placed with CAIS showed significantly higher MBLs (p < 0.001). Bleeding on probing, probing depth, and prevalence of mucositis did not differ between the groups, while no peri-implantitis was diagnosed. The use of CAIS leads to superior outcomes in terms of esthetics and MBLs for implants placed in the esthetic zone as observed in medium to long-term follow-up. No difference was however observed with regard to peri-implant mucosa inflammation. This article highlights the outcome of computer-assisted implant surgery in achieving higher esthetic, MBL, and esthetic satisfaction compared to freehand implant placement. TCTR20240422015.

A Comparative Evaluation of Efficacy of Local Infiltration of Sodium Bicarbonate Buffered Local Anesthesia with Epinephrine Vs Non-Buffered La with Epinephrine: A Clinical Study

Background: The aim of the study was to compare the efficacy of local infiltration of sodium bicarbonate buffered local anaesthesia with epinephrine vs non- buffered local anaesthesia with epinephrine.  Method: Patients having periapical infection in the maxillary anterior and premolar region were selected for the study. A total of 50 patients were included in the study. In group A, 8.4% sodium bicarbonate buffered 2% Lignocaine with 1:80,000 adrenaline was used for local infiltration for extraction. In group B, 2% Lignocaine with 1:80,000 adrenaline (non-buffered) was used for local infiltration for extraction. The onset of anesthesia, was compared between group A and group B. Data was tabulated and statistical analysis was carried out using paired t-test.  Result: The inter-group difference in onset of anesthesia,was assessed using paired t-test and highly significant difference was found between group A and group B (p≤0.05).  Conclusion: Significant improvement seen in onset of anesthesia and duration of anesthesia.

Optimizing Treatment for Severe-Early Childhood Caries: The Role of Groper’s Appliance

Severe-Early Childhood Caries (S-ECC), often leading to serious health issues if left untreated, possesses a great restorative challenge to the pediatric dentist. This case report discusses a comprehensive management of S-ECC in a 5-year-old female patient with high dental caries risk. The patient presented with multiple carious lesions, root stumps, and fenestrated roots, necessitating a staged intervention. Treatment involved restorations with glass ionomer cement, pulpectomy followed by omega loop post build-up on anterior tooth and stainless-steel crowns on posterior teeth. Additionally, extractions were performed and Groper’s appliance was inserted for esthetic rehabilitation and space maintenance on maxillary anterior and posterior regions, respectively. Following completion of the planned treatment, overall risk assessment measured low. This case report emphasizes the importance of rehabilitative interventions in S-ECC, showcasing Groper's appliance as a viable and effective treatment option.

Impact of Two Implant-Abutment Connection Types on Crestal Bone Stability: A 3-Year Comparative Split-Mouth Clinical Trial.

This prospective, preliminary controlled clinical trial investigates the comparative effectiveness of platform-switching (PS) versus traditional butt-joint or platform-matching (PM) implant-abutment connections on peri-implant crestal bone stability. Utilizing a split mouth design, 10 systemically healthy patients (n= 20 implants) had adjacent non-restorable maxillary anterior teeth replaced with two different implants (butt-joint connections and platform-switching interfaces). Patients underwent alveolar ridge preservation, followed by implant placement: platform-matching implants were inserted at crestal bone level, and platform-switching implants were placed 1mm subcrestally. Customized Zirconia crowns were then fabricated for both systems. Outcome measures included bleeding on probing (BOP), probing pocket depth (PPD), and marginal bone loss (MBL), which were evaluated through standardized periapical radiographs over 3-year timeframe. Results showed significantly higher initial MBL in the PM group (0.86 ± 0.13 mm) compared to the PS group (0.34±0.29 mm) [p value: p<0.01]. Moreover, at the three-year follow-up, the crestal bone levels remained above the implant shoulder until the third year of the study for the PS subcrestal group (PS: -0.15±0.39 mm) and slightly below the implant platform in the PM crestal group (PM: 0.55±0.19). After 3 years, the PS group also exhibited lower mean BOP percentages (12%) than the butt-joint group (17%). This study suggests that subcrestal placement with PS and internal connections can provide better long-term peri- implant bone preservation, thereby potentially improving implant success and aesthetic outcomes in the anterior maxillary region.

Evaluation of canalis sinuosus and accessory canal morphology by cone-beam computed tomography.

To evaluate canalis sinuosus (CS) and accessory canalis sinuosus (AC) morphology and their relationship with the impacted canine on cone-beam computed tomography (CBCT) images. The diameter and location of the CS, its distance from the nasal cavity (NC-CS), its distance from the buccal cortical plate (BC-CS), and its distance from the alveolar ridge crest (AR-CS) were evaluated on 1000 CBCT scans. The prevalence and termination of AC and the presence of impacted canines were also evaluated. CS was detected in 89 (8.9%) of 1000 CBCTs. The mean CS diameter was found as 1.34 ± 0.53mm. No statistically significant difference was found between gender, age, direction, and CS presence and diameter. CS was most frequently seen in regions 11 (23.6%) and 13 (23.6%). The average NC-CS, BC-CS, and AR-CS length was 6.14, 6.06 and 4.35mm, respectively. AC was detected in 22 patients (24.71%). There was no statistically significant difference between the presence of AC and gender, age, CS diameter, NC-CS, BC-CS, and AR-CS distance. BC-CS length and AR-CS length were statistically significantly higher in patients with impacted canines. It should be kept in mind that the CS diameter, NC-CS, BC-CS, and AR-CS distance may increase in the presence of an impacted canine and the integrity of the neurovascular structure should be preserved. The fact that the CS is often localized in the palatial region requires a detailed evaluation of the anterior maxillary region with three-dimensional imaging methods.

Measurement of Anterior Maxillary Alveolar Ridge Dimension and Assessment of Sagittal Root Position by Cone Beam Computerized Tomography (CBCT)

Maxillary anterior region is the implant site that may require the most rigorous pre-operative assessment as it will have a direct influence on aesthetic outcome and stability of the dental implant. In the present study, CBCT (cone beam computerized tomography) images were used to evaluate alveolar ridge dimension in the maxillary anterior region. This observational radiographic study was done at Nepal Medical College Teaching Hospital. The width of the alveolar bone was measured from the labial cortex to the palatal cortex of the maxillary anterior teeth in mm at the alveolar crest (L1), mid-root (L2), and apical root region (L3) for each tooth. Alveolar height was also measured from the alveolar crest to the floor of the nasal fossa. The Sagittal Root Position (SRP) of the maxillary anterior teeth was also assessed. Results showed that the maximum width of the alveolar bone was seen at L3 of canine and lateral incisor showed least width of alveolar bone width at L1. Maximum alveolar bone height was seen in canines. Males were seen to have increased width of the alveolar bone as compared to the females in all anterior teeth. The most frequent sagittal root position was class I which was seen in 270 (51.4%) of the total teeth examined, which was followed by class IV observed in 210 (40%) of the teeth examined. It could be concluded that for maxillary anterior region, additional regeneration therapy maybe required since class I is the most frequent SRP observed.

Effect of Needle Insertion Angle on Pain During Labial Infiltration Anesthesia of the Anterior Maxilla: A Randomized Clinical Trial.

This study aimed to assess the effect of needle insertion angle on pain during labial infiltration anesthesia in the anterior maxillary region. In this parallel-design randomized clinical trial, participants were randomly assigned to four groups for labial infiltration anesthesia of the anterior maxilla. Local anesthesia was performed with needle orientation parallel to the longitudinal axis of the tooth using a conventional syringe (Syringe-0), needle at α angle with a conventional syringe (Syringe-α), computer-controlled local anesthetic delivery (CCLAD) device parallel to the longitudinal axis of the tooth (CCLAD-0), and CCLAD at α angle (CCLAD-α). The heart rate (HR), blood pressure (BP), and respiratory rate (RR) of participants were measured before needle insertion, immediately after needle insertion, and immediately after the injection by a vital signs monitor. The level of pain experienced by participants was quantified using a numerical rating scale (NRS). Data were analyzed by repeated-measures ANOVA and regression models (α = 0.05). Thirty-six participants aged from 21 to 60 years, with a mean age of 35.36 years were recruited. The mean pain scores were 7.44, 4.67, 2.89, and 0.67 in groups Syringe-0, Syringe-α, CCLAD-0, and CCLAD-α, respectively (p < 0.001). Age and sex had no significant effect on pain scores (p = 0.914 and p = 0.702, respectively). The four groups had no significant difference in vital signs (p > 0.05). Injection at an α angle and the application of CCLAD can be used in clinical practice to decrease the pain experienced by participants during labial infiltration anesthesia of the anterior maxilla. Iranian Registry of Clinical Trials: IRCT20230719058849N1.

Immediate Implantation with Autologous Mineralized Dentin Graft versus Deproteinized Bovine Bone as Space-Filling Substitute in Maxillary Anterior Zone: Retrospective Radiological and Clinical Study.

Background/Objectives: Various bone substitutes have been recommended to augment the horizontal gap following immediate implantation. The purpose of this study was to compare the effectiveness of an autogenous mineralized dentin graft or a deproteinized bovine bone in horizontal gap augmentation following immediate implant placement in the maxillary anterior region. Methods: A total of 110 patients underwent tooth extraction followed by immediate implant placement. The patients were divided into two groups. The first group received an autogenous mineralized dentin graft (the test group) while the second group received a deproteinized bovine bone (the control group) to augment the horizontal gap. Preoperative (T0), immediate postoperative (T1), and 1-year postoperative (T2) cone beam computed tomography scans were taken from all the patients. Linear measurements were recorded 1 mm (R1) and 5 mm (R2) points apical to the implant platform at both T1 and T2 time intervals. Pink Esthetic Scores and prosthetic complications were evaluated as well. Results: There were 57 patients with a mean age of 45.42 ± 9.86 (range 24-63 years) selected as the test group and 53 patients with a mean age of 40.28 ± 11.69 (range 20-63 years) as the control group. The mean reduction in the buccal bone plate at R1 was 6.39 ± 3.78% in the test group and 6.99 ± 5.01% in the control group (p > 0.05). The mean reduction in the buccal bone plate at R2 was 5.46 ± 4.98% in the test group and 6.77 ± 7.60% in the control group (p < 0.05). The PES and prosthetic-related complications were shown to be negligible between the groups (p > 0.05). Conclusions: The efficiency of using an autogenous mineralized dentin graft for horizontal gap augmentation showed similar results in comparison to using a deproteinized bovine bone in relation to buccolingual socket reduction following immediate implantation.

Reconstruction of Pathology Induced Anterior Maxillary Defect: A Case Report

A cyst is defined as a pathologic cavity lined by epithelium. Nasopalatine duct cysts (NPDC) are of non-odontogenic origin arising from epithelial remnants from two embryonic nasopalatine ducts. These cysts may form anywhere along the ducts’ course, which runs from posterior palatal midline to the soft tissue palatine papilla also known as the incisive papilla. NPDC often develop between the 4th and 5th decades of life with men being affected more than women (2:1 ratio). They are typically asymptomatic but present with palatal swelling in the anterior maxillary region. Larger cysts may create a labial expansion in addition to a midpalate expansion which is usually compressible due to resorption of bone beneath the mucosa. Radiography often shows a well demarcated round or pear-shaped radiolucency superimposed on the incisive canal, tooth displacement or divergence of roots may be observed. This pathology is usually greater than 6mm in size which differentiates it from the incisive canal. Differential diagnoses often include a periapical granuloma or radicular cyst from nonvital central incisors, however a palatal radiolucency and expansion represents a NPDC until proven otherwise. Typical treatment includes enucleation and curettage with low recurrence rates.

Clinical and Radiographic Evaluation of Soft Tissue and Bone Status in Immediate Loaded Implants Placed Following Their Extraction in the Maxillary Anterior Region.

In the maxillary anterior region, teeth extraction leads to significant soft and hard tissue changes. Immediate implant placement following extraction aims to reduce bone loss and overall treatment time. However, it may result in adverse soft tissue changes impacting esthetics. This study evaluates the clinical and radiographic outcomes of immediately loaded implants in the maxillary anterior region, focusing on soft tissue preservation and bone status. This study, conducted from April 2022 to August 2024 at the Department of Oral and Maxillofacial Surgery, Ragas Dental College and Hospital, included 10 immediately loaded implants in seven patients. Following atraumatic extraction, implants were placed and loaded with functional provisional crowns fabricated using three-dimensional (3D) rapid prototyping models. Parameters such as crestal bone loss, buccal and palatal bone width, and interdental papilla thickness were evaluated preoperatively and postoperatively using radiographsand clinical assessments. The study found significant crestal bone loss at both mesial and distal sites over time, with the greatest loss observed at the three-month follow-up. Buccal and palatal bone width showed no significant differences preoperatively and postoperatively. Interdental papilla thickness and overall pink esthetic scores also showed no significant differences between preoperative and postoperative evaluations. Immediate implant placement in the maxillary anterior region, using 3D rapid prototyping for custom splint fabrication, demonstrated effective preservation of soft tissue profile and bone architecture. This approach provides functional and esthetic benefits, although careful monitoring of crestal bone loss is necessary.

Long-Term Assessment (5 to 19-Year Follow-up) of the Incisal Level Changes in Single Implants Placed in the Anterior Maxillary Region. An Observational Clinical Study.

Long-Term Assessment (5 to 19-Year Follow-up) of the Incisal Level Changes in Single Implants Placed in the Anterior Maxillary Region. An Observational Clinical Study.

Primordial odontogenic tumor of the maxilla: A case report

A primordial odontogenic tumor (POT) consists of an ellipsoidal mass of dental papilla-like myxoid connective tissue entirely enveloped in an intricate membrane of the ameloblastic epithelium. This case has been particularly interesting due to its unique identity and rare nature. A 5-year-old boy came to the ENT department of a tertiary care hospital complaining of left facial swelling for the past three months. In contrast with clinical, radiological, and histological investigations and following the WHO definition, it was confirmed as a Primordial odontogenic tumor of the maxilla. The ideology and genetic makeup of this disease are still idiopathic and in the early developing phase. The clinical, radiologic, microscopic, and IHC features in this case suggest POT in an infrequent location of the anterior maxillary region.

Non-Surgical Treatment of Residual Cyst in Maxillary Anterior Region of an 11-year-old Patient: A Case Report

We aim to report a case of residual cyst in an 11-year-old male patient, which was treated by marsupialization as a conservative alternative to surgical enucleation. An 11-year-old male patient reported to our department with a painless swelling of approximately 1.5x1 cm in size intraorally, both in the maxillary right buccal and palatal region for about 1 month. On fine needle aspiration, a yellow-coloured highly viscous fluid was observed which on histopathological examination revealed an infected cyst. This along with the clinical examination and history confirmed the diagnosis of a residual cyst. Marsupialization was chosen as a conservative treatment due to the size of the cyst and the age of the patient. Weekly follow-up and dressing change were carried out for 6 months which lead to a complete resolution of the cyst with continuous normal development of the occlusion. No adverse effects such as fever, infection, or pus discharge were seen at any time during treatment. We have been able to design a treatment protocol which has provided us with a nonsurgical solution for large cystic lesions in growing patients without adverse effects for the complete duration of treatment. Marsupialization should be considered as a treatment option for large residual cysts, especially in pediatric patients. Key Words - Marsupialization, Maxilla, Mixed dentition, Residual cyst

Management of jump space in immediate implants with and without demineralised freeze dried bone allograft: a randomised controlled trial.

The present study aimed to evaluate and compare the management of Jump space (JS) in immediate implants with and without Demineralised freeze-dried bone allograft (DFDBA) with flapless approach. The present study included 40 sites with immediate implant placement in the maxillary anterior region. Group 1 patients were treated without augmentation while Group 2 patients with DFDBA in the JS. Both the groups were further subdivided according to the horizontal dimensions as JS less (G1S1, G2S1) or more than 2mm (G1S2, G2S2). Plaque index (PI), Gingival Index (GI), Probing depth (PD), Testori esthetic score (TS), VAS score, Crestal Bone height (CBH), Ridge width (RW), Vertical distance (VD) and radiolucent area (RA) were evaluated radiographically with CBCT at baseline and 12 months' post therapy. Significant differences were observed in CBH in the midfacial region in G1S1-G2S1 with the mean of 0.34±0.19mm and G1S2 -G2S2 with 0.75±0.26 mm at 12 months. Significant differences in TS were observed in G1S1 and G2S1 with mean value of 0.55±0.53 while G1S2 and G2S2 exhibited value of 1.33±0.82. DFDBA shows better CBH preservation in midfacial region, reduction in RA indicating greater resolution of JS thereby leading to better hard and soft tissue healing.

Management of a Maxillary Radicular Cyst in a Patient with Gilbert Syndrome: A Rare Case Report

Gilbert syndrome is a rare benign autosomal genetic disorder characterized by reduced activity of glucuronyl transferase, leading to decreased clearance of bilirubin and occasional mild jaundice in the absence of hepatic injury or hemolysis. Diagnosis involves clinical and laboratory investigations as part of differential diagnosis, with genetic analysis providing additional confirmation. Oral manifestations of Gilbert syndrome exist but often go unnoticed. Drugs metabolized by this enzyme need to be considered along with stress management in patients undergoing surgical procedures. This case report of a 24-year-old male diagnosed with a radicular cyst in the maxillary anterior teeth region, who incidentally exhibited Gilbert syndrome, also highlights perioperative management considerations for such patients.

Assessment of variations in the nasopalatine canal on CBCT: considerations from an anatomical point of view.

The nasopalatine canal (NPC) is one of the most significant anatomical markers in the anterior maxillary region. Its location is quite important, especially for implant placement. Therefore, the purpose of this study was to use cone-beam computed tomography (CBCT) to evaluate the morphology, size, and anatomic variations of the NPC. A total of 150 individual CBCT images were assessed in various sections to evaluate the dimensions, morphology, and extent of the NPC. Reformatted sagittal images were chosen to classify the shape and course of the canal. The Student's t-test, the χ² test, and Pearson correlation coefficients were used. The NPC was longer in males than in females, and the mediolateral diameter of the canal was greater in older adults. In sagittal sections, the canal predominantly exhibits a cylindrical shape, while a spindle shape is the least common. In coronal sections, a single shape is most frequently observed, with a Y-shape being the least common. Regarding the orientation of the canal, slanted canals are more prevalent, whereas vertically curved canals are rare. Typically, 2 canal openings are observed, with 4 openings being the least common. The current study highlights the challenges associated with identifying the anatomical appearance and variations of the NPC. Consequently, possessing a thorough understanding of this anatomy is essential before undertaking any surgical procedures, such as implant placement. This knowledge helps prevent complications such as nerve injury-related loss of sensation, bleeding due to blood vessel injury, and the development of a nasopalatine duct cyst following trauma to the canal during surgery.

Cosmetic Makeover of Periodontally Compromised Patients using Flexible Gingival Mask and Porcelain Laminate Veneers: Report of Two Cases

Chronic periodontal disease can lead to advanced gingival tissue loss that can result in problems with esthetics, phonetics, food impaction and tooth sensitivity. One of the most difficult problem encountered in the management of periodontal disease is loss of interdental papillae which leaves unsightly “black triangles” between the teeth. The first step in the management of these problems is surgical correction of the defect. In cases where mucogingival surgery is unpredictable due to generalized recession and loss of large volume of gingival tissue, removable gingival prosthesis is an excellent alternative to correct the deformities remaining after the control of destructive periodontal disease specially in the maxillary anterior region. Gingival prostheses may be fixed or removable. It can be made from a range of materials like acrylic, silicones, porcelain- based materials and flexible resin denture material. This report describes two clinical situations in which combined periodontal/prosthodontic rehabilitation was done for patients with advanced periodontal disease. Accurately fitting flexible gingival prostheses and porcelain laminate veneers were fabricated to restore advanced gingival tissue loss in esthetic area following periodontal flap surgery. The flexible gingival masks not only help to achieve excellent cosmetic results but also reinstate the functional and psychological wellbeing of the patient.