Esthetic Zone Research Articles

Soft Tissue Changes at the Pontic Sites of Cantilever Zirconia Ceramic Resin-Bonded Fixed Dental Protheses inthe Esthetic Zone: A Clinical Observational Study.

Data on the stability of soft tissues at pontic sites of resin-bonded fixed dental protheses (RBFDP) are lacking. The purpose of this study was to evaluate soft tissue changes at pontic sites of cantilever zirconia ceramic RBFDPs with and without surgical pretreatment after different follow-up periods in the esthetic zone. Impressions were taken after the insertion of the restorations and an intraoral scan was performed at follow-up examinations. Dental casts were digitalized and superimposed with the follow-up scan. Vertical and horizontal soft tissue changes were measured buccally and lingually at mucosal margin at the central cross-section of each pontic, and for horizontal change at 1 and 2 mm below. One-way ANOVA and Kruskal-Wallis test were performed to analyze the collected data. A total of 36 pontic sites with (n = 7) and without surgical pretreatment (n = 29) were evaluated at a follow-up period of either > 4, > 6, or > 10 years (n = 12). The follow-up period had no significant effect on the tissue change. Surgical pretreatment showed significantly higher tissue loss at 2 mm below the lingual mucosal margin than for sites without surgical pretreatment. Soft tissues at pontic sites remained stable with a tissue gain at the mucosal margin up to 10 years. Based on the findings of this study, cantilever resin-bonded fixed dental protheses provide excellent functional and esthetic outcomes with preservation of soft tissues in the edentulous area of single missing incisors and a gingival sulcus-like tissue growth at the mucosal margin forming an emergence profile at pontic sites similar to that of a natural tooth.

Does Injectable Platelet-Rich Fibrin Combined With Autogenous Demineralized Dentine Enhance Alveolar Ridge Preservation? A Randomized Controlled Trial.

The present trial evaluated the first-time application of autogenous demineralized dentin graft with injectable platelet-rich fibrin (ADDG + i-PRF) versus autogenous demineralized dentin graft (ADDG), in alveolar ridge preservation (ARP) in the maxillary aesthetic zone. Twenty-two maxillary (n = 22) non-molar teeth indicated for extraction were randomized into two groups (n = 11/group). Extracted teeth were prepared into ADDG, implanted into extraction sockets with or without i-PRF amalgamation and covered by collagen sponge. Cone-beam computed tomography scans at baseline and 6 months were compared to assess ridge-dimensional changes. Keratinized tissue width, patient satisfaction, pain score and chair time were recorded. In the course of dental implant placements at 6 months, bone core biopsies of engrafted sites were obtained and analysed histomorphometrically. Reduction in ridge width was 1.71 ± 1.08 and 1.8 ± 1.35 mm, while reduction in ridge height was 1.11 ± 0.76 and 1.8 ± 0.96 mm for ADDG + i-PRF and ADDG, respectively (p > 0.05). Significant differences in keratinized tissue width reduction were notable between ADDG + i-PRF and ADDG (0.12 ± 0.34 and 0.58 ± 0.34 mm respectively; p = 0.008). Postoperative pain scores were significantly lower in ADDG + i-PRF (p = 0.012). All patients in the two groups were satisfied with no differences in chair time (p > 0.05). No differences in total percentage area of newly formed bone, soft tissue or graft particles were observed between the groups (p > 0.05). ADDG alone or in combination with i-PRF yields similar results regarding ARP clinically, quality of the formed osseous tissues, as well as patients' satisfaction. Yet, the addition of i-PRF to ADDG tends to preserve the keratinized tissue and lessen postoperative pain.

Effect of soft tissue volume on midfacial gingival margin alterations following immediate implant placement in the esthetic zone: a 1-year randomized clinical and volumetric trial.

The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm3) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. The midfacial gingival margin changes demonstrated a significant difference (P ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm3) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference (P > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm3) after 1 year and mid-facial gingival margin changes (P ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group (P = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups (P ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant(P > 0.05). This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm3) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023).

Use of Advanced Platelet-Rich Fibrin for the Treatment of Multiple Adjacent Mucogingival Recessions: A Technical Report of the Fibrin-Assisted Soft-Tissue Promotion Protocol.

Platelet-rich fibrin (PRF) has had a marked impact on regenerative medicine due to its widespread ability to promote angiogenesis to defective tissues. Particularly in the dental field, evidence from randomized clinical trials has further shown that PRF facilitates greater soft-tissue regeneration when compared with hard tissues. Recently, the fibrin-assisted soft-tissue promotion (FASTP) technique has been developed as a means to promote soft-tissue regeneration of mucogingival recessions utilizing PRF. Within the present case report, a 28-year-old male presented with multiple adjacent mucogingival recessions in the maxilla ranging in probing depths (1-3 mm) and gingival recessions (1-5 mm). For optimal regenerative outcomes, the use of advanced PRF (A-PRF; 1300 RPM for 8 min) has been utilized to enhance regenerative outcomes by fully taking advantage of the low-speed centrifugation concept (LSCC). This case report highlights the latest surgical concepts, centrifugation protocols, and use of the LSCC to regenerate multiple adjacent mucogingival recessions in the esthetic zone.

Innovative Approach to Severe Esthetic Zone Trauma: Integrating Root Submergence With Guided Bone Regeneration.

Acute traumatic defects in the esthetic zone pose a significant challenge in dental implant rehabilitation, requiring innovative techniques to achieve optimal functional and esthetic outcomes. This article investigates the use of a novel combination of root submergence and guided bone regeneration (GBR) to address these defects. The goal is to evaluate the potential of this integrated approach for achieving predictable bone regeneration and long-term tissue stability. Studies have shown significant improvements in soft-tissue contour, papilla preservation, and emergence profile when root submergence is employed. Despite these benefits, the integration of root submergence with GBR remains underexplored in the literature. This combination shows considerable potential for achieving predictable bone regeneration and sustaining tissue stability in the esthetic zone. The integration of root submergence with GBR offers a promising solution for managing traumatic defects in the esthetic zone by enhancing soft-tissue contours and facilitating predictable bone regeneration. However, additional clinical studies are needed to support the long-term success of this innovative approach in dental implant rehabilitation. The combined use of root submergence and GBR for treating acute traumatic defects in the esthetic zone represents a notable advancement in dental implant rehabilitation. This article presents a detailed analysis of the rationale, technique, and clinical outcomes of this approach, underscoring its importance in achieving optimal esthetic and functional outcomes for patients with complex clinical needs.

3D Printed Dual Reduction Guide: A Feasible Alternative for Conservative Gingivectomy and Minimally Invasive Preparation for Ceramic Veneers.

This case report describes a digital workflow for designing and 3D printing a guide with the dual purpose of gingivectomy and tooth preparation in the esthetic zone, to be followed by cementation of ceramic veneers under rubber dam isolation. The patient's primary concern was to improve her smile. After clinical evaluation, our recommendation was for a minimal gingivectomy to match the gingival zenith for both central incisors, to be followed by ceramic laminate veneers. A digitally designed and 3D printed guide was used for gingivectomy and tooth preparation for the ceramic veneers. Ceramic veneers were cemented under rubber dam isolation to maximize bonding properties. A single guide can be digitally designed and 3D printed to perform controlled gingivectomy and minimally invasive tooth preparations. The outcome of the gingivectomy improved the gingival architecture for central incisors, and the ceramic veneers fulfilled the patient's esthetic demands.

Immediate Loading and Implant Placement With Bone Grafting in Severely Proclined Anterior Mobile Teeth in the Esthetic Zone: A Report of an Intriguing Case

Immediate Loading and Implant Placement With Bone Grafting in Severely Proclined Anterior Mobile Teeth in the Esthetic Zone: A Report of an Intriguing Case

One-Piece Versus Two-Piece Abutments for Single Crowns in the Esthetic Zone: A Clinical Trial.

To evaluate whether a two-piece abutment is equivalent to a one-piece in peri-implant esthetics, patients' satisfaction, and oral health-related quality of life (OHRQOL) for implant-supported anterior single crown placement. Thirty implants were allocated sequentially: 15 in the one-piece abutment group (OP) and 15 in the two-piece abutment group (TP). Peri-implant esthetics were evaluated by the pink esthetic score (PES) at temporary crown insertion (T1), after tissue conditioning (T2), and at 30 days after the final crown insertion (T3). OHRQOL was measured using the OHIP-14 and satisfaction was evaluated using the visual analog scale (VAS) at baseline, T1, and T3. Treatment was considered equivalent if the 95% coefficient interval (CI) for mean difference in PES was between -1.5 and +1.5 points. Statistical analysis was performed using Mann-Whitney, SPANOVA, and Student's t-test, with Sidak's posttest, adopting p < 0.05. No differences were found between the groups for any variable and during follow-up. A significant increase in OHRQOL and satisfaction was observed at T3, when compared to baseline (p < 0.05) for both groups. Significant improvements in peri-implant esthetics were also observed throughout the treatment, particularly after tissue conditioning (p < 0.05). Primary and secondary outcomes were evaluated for equivalence, and both abutment types were considered equivalent following the insertion of the temporary crowns. Two-piece abutment was equivalent to one-piece abutment for peri-implant esthetics, quality of life, or the satisfaction of patients rehabilitated with metal-free single crowns. Tissue conditioning and final crown insertion appear to play a role in improving these outcomes.

Contemporary Rationales for Cemented Implant Restorations in the Esthetic Zone.

This article explores the ongoing relevance of cement-retained implant restorations, focusing on their contemporary rationales for their successful use. Comprehensive considerations include esthetic, positional, and occlusal factors alongside recent technological advancements designed to mitigate previous known challenges. In certain clinical scenarios, cement-retained implant restorations offer distinct advantages such as eliminating access holes for improved esthetics, particularly for malpositioned implants. Modern advancements in materials and techniques have enhanced their predictability, safety, and overall outcomes while minimizing biological risks. When performed within appropriate protocols, cement-retained implant restorations can effectively address diverse clinical challenges. Recent technical advancements further bolster their utility, supporting esthetic, technical, biomechanical, and biological outcomes in implant rehabilitation of the partially edentulous esthetic zone. Understanding the justifications and guidelines for cement-retained implant restorations, along with recent technological advancements, enables clinicians to optimize treatment outcomes with greater flexibility while minimizing common limitations in practice.

Effect of Orthodontic Forced Eruption for Implant Site Development in Maxillary Esthetic Zone: A Systematic Review of Clinical Data

Effect of Orthodontic Forced Eruption for Implant Site Development in Maxillary Esthetic Zone: A Systematic Review of Clinical Data

The Papilla Base CTG: A Novel Approach for Interdental Soft Tissue Reconstruction.

Impairment or loss of interdental papilla is a common issue in patients with periodontal disease, leading to phonetic, functional, and aesthetic concerns. Numerous techniques have been explored to reconstruct and regenerate interdental papillae, but consistent success remains challenging. This article presents a novel surgical approach that applies the principles of the Connective Tissue Graft (CTG) wall technique to enhance papilla volume when interdental clinical attachment loss is present in the aesthetic zone. The case of a 35-year-old woman with an RT3 recession defect associated with loss of interdental hard and soft tissues is discussed. The patient underwent a procedure involving palatal incisions, application of amelogenins, and a trapezoidal shape CTG fixed at the base of the papilla under a coronally advanced flap. This approach aimed to stabilize the blood clot and prevent soft tissue collapse into the defect area, enhancing the position and volume of the interdental papilla. Results at 6- and 12-months follow-up indicated significant improvement in papilla appearance and complete root coverage. This case suggests that the modified CTG wall technique can effectively treat buccal and interdental gingival recessions associated with horizontal or infrabony defects. Further clinical trials are necessary to confirm these findings and establish the most effective approach for interdental papilla reconstruction.

Implant-supported restorations using digital workflow in esthetic zone

Implant-supported restorations using digital workflow in esthetic zone

Pre-prosthetic periodontal preparation in the esthetic zone: case report

Pre-prosthetic periodontal preparation in the esthetic zone: case report

Immediate implantation in esthetic zone:case series 1-8 years follow-up

Immediate implantation in esthetic zone:case series 1-8 years follow-up

A comparative study of the application of three digital imaging techniques to assess the thickness of the palatal mucosa of the maxillary anterior teeth

BackgroundThis study highlights the need for precise and efficient methods to measure palatal mucosal thickness in the maxillary anterior teeth, particularly for soft tissue augmentation in the aesthetic zone. The research evaluates three digital imaging techniques, suggesting that Cone Beam Computed Tomography (CBCT) combined with intraoral scanners (IOS) is a promising approach for reliable clinical assessment.MethodsTen volunteers with healthy periodontium were selected, and three methods were employed: CBCT-based indirect gingival imaging, modified soft tissue CBCT (ST-CBCT), and CBCT combined with IOS. Measurements of palatal mucosal thickness were taken at multiple points along the palatal gingival margin. Statistical analysis included Bland-Altman plots for method agreement and intraclass Correlation Coefficient (ICC) analysis for reliability. All measurements were standardized, repeated for consistency, and accurate to 0.01 mm to ensure reliability.ResultsThe Bland-Altman plots showed that less than 5% of the points for palatal mucosal thickness differences measured by the gingival indirect radiographic method, modified ST-CBCT, and CBCT combined with IOS were located outside the 95% limits of agreement (LoA). The mean value of the differences was within 0.2 mm, indicating good clinical agreement among the three methods. The inter- and intra-study ICC values for palatal mucosal thickness measurements of the maxillary anterior teeth using the three CBCT methods were greater than 0.75 (P < 0.001), demonstrating reproducibility.ConclusionsBased on the evaluation of three digital imaging techniques, this study indicates that the combination of CBCT with IOS is a feasible method for measuring palatal mucosal thickness in the maxillary anterior teeth and demonstrates good reproducibility.

IMMEDIATE IMPLANT PLACEMENT AND LOADING IN THE MAXILLARY ESTHETIC ZONE DEMONSTRATE HIGH SURVIVAL RATES, BUT ESTHETIC AND FUNCTIONAL SUCCESS DATA IS STILL NEEDED

IMMEDIATE IMPLANT PLACEMENT AND LOADING IN THE MAXILLARY ESTHETIC ZONE DEMONSTRATE HIGH SURVIVAL RATES, BUT ESTHETIC AND FUNCTIONAL SUCCESS DATA IS STILL NEEDED

Assessment of ridge preservation with immediate implant placement using socket shield versus guided bone regeneration techniques in aesthetic zone (a randomized clinical trial)

Assessment of ridge preservation with immediate implant placement using socket shield versus guided bone regeneration techniques in aesthetic zone (a randomized clinical trial)

Comparison of the Accuracy and Reliability of Instrumental Shade Selection Devices and Visual Shade Selection: An in Vitro Study.

New shade-matching devices are available for clinical use, but their accuracy and reliability have not been investigated. This in vitro study compared the accuracy and reliability of a shade-matching colorimeter (Optishade), a spectrophotometer (VITA Easyshade V), and visual shade matching in simulated clinical conditions. Shade matching was conducted with two digital devices; (Optishade and Vita Easyshade) and the visual shade selection method, with a new 16-tab Vita Classical shade guide. Shade tabs were placed within a gingival matrix and measurements were taken from the central area of each shade tab enclosed in a black box to simulate the oral cavity. Visual assessments were conducted independently by two examiners. For the reliability assessment, each shade tab was measured 20 times by each examiner. Accuracy was calculated as a percentage of the matching readings with the actual shade per each tab. Data were analyzed with the one-way ANOVA test (α = 0.05) and Pairwise Comparison (Bonferroni Post hoc Test) to assess accuracy. The reliability evaluation was conducted by comparison between both examiners using mean and standard deviation; by a two-tailed t-test for the independent samples for all the three groups included in the study. The shade matching accuracy of Optishade was 97.50%, Vita Easyshade 89.38%, and visual method 62.19%. Statistically, high significant difference in accuracy (p < 0.001) was found when comparing both Optishade and VITA Easyshade with the visual method. Additionally, there was statistically significant difference in accuracy (p < 0.05) when Optishade was compared to Vita Easyshade. The reliability of the Optishade was 99.6% and Vita Easy shade was 99.38%. Statistically, showed no statistically significant difference in the reliability of shade match obtained within the same group when comparing the readings of Examiner 1 and Examiner 2 (p > 0.05). The colorimeter demonstrated the highest accuracy, followed by the spectrophotometer, and the visual shade selection method. Both digital methods investigated in this study showed comparable reliability. The results of this study emphasize the clinical advantage of digital shade-matching devices over visual shade-matching. The colorimeter offers high accuracy for shade matching and should be considered to use for shade matching especially with restorations in the esthetic zone.

Horizontal Augmentation Using Customized Zirconia Membrane: A Case Report

Background Horizontal bone defects are frequently observed after tooth extraction, primarily resulting from the physiological resorption of the alveolar ridge. Reconstruction of horizontal defects is essential before or during dental implant placement, particularly in the esthetic zone. This case report aims to evaluate the effectiveness of horizontal alveolar ridge augmentation utilizing a customized zirconia membrane. Case Presentation A 20-year-old female patient desired to replace the missing right upper central incisor with a dental implant. The radiographic evaluation showed a concave bone defect, which makes it impossible to place a dental implant. The treatment plan was made for localized ridge augmentation using a customized zirconia membrane (CZM) prior to dental implant placement. Conclusion The customized Zirconia membrane is an effective and very satisfactory treatment option in the management of horizontal defects. Customized zirconia membranes reduce surgical time, facilitate the procedure for the patient and the practitioner, reduce the rate of complications, and achieve good horizontal bone gain.

Esthetic Outcomes of Immediately Placed Implants with Convergent Transmucosal Profile: A Retrospective Single-Cohort Study.

Purpose: Immediate implant placement is a reliable solution to replace hopeless teeth, but this procedure may be associated to an increased risk of soft tissue complications in case of thin biotype. The use of tissue-level implants with a convergent transmucosal profile has been advocated to increase space for soft tissue, contributing to improve their stability and esthetics. The aim of this retrospective study was to evaluate the esthetic outcomes and the Patient-Reported Outcome Measures (PROMs) of immediately placed implants with a convergent transmucosal profile. Materials and methods: This single-cohort, monocentric, retrospective clinical study was conducted on patients treated with an immediately placed implant in the esthetic zone (from premolar to premolar). All the eligible patients were recalled for a clinical and radiographic follow-up visit. Results: This study included 20 patients (8 males, 12 females) with an average age of 55.5± 6.8 years, who received 20 implants, with a mean follow-up of 46.5± 15.3 months. At the time of follow-up, immediately placed implants showed a mean Marginal Bone Loss of 0.42± 0.49 mm, and a statistically significant improvement of the esthetic parameters from baseline to the last available follow-up; in particular, Pink and White esthetic scores (p=.001) and Papilla Index at mesial and distal sites (p<.001). All the patients reported a high satisfaction (VAS>9) both from esthetic and functional point of view. Conclusion: Immediately placed implants with convergent transmucosal profile in the esthetic zone showed good clinical and esthetic outcomes, with stable results over time.