Esthetic Zone Research Articles

Dynamic monitoring and esthetic evaluation of dimensional changes in the peri-implant soft tissue contour after the immediate implant placement and provisionalization with the modified socket-shield technique in the esthetic zone

Objective: To accurately measure the dynamic changes of peri-implant soft tissue within one year after the immediate implant placement and provisionalization with the modified socket-shield technique (MSST) in the esthetic zone, and to provide a basis for evaluating the effect of the modified socket-shield technique on the maintenance of peri-implant soft tissue. Methods: A total of 22 patients (22 implants) were prospectively included 1 year after completion of immediate implant placement and provisionalization (IIPP) within MSST in the esthetic zone from January 2022 to January 2024 at the Department of Oral Implantology in the Stomatological Hospital of Chongqing Medical University. The intraoral optical models of patients were obtained by an intraoral scanner system preoperatively and at 3, 6, and 12 months postoperatively, respectively. The standard tessellation language files of intraoral optical models at multiple time points were imported to Geomagic Studio 2013 to be superimposed and aligned for analyzing the peri-implant soft tissue contour on the labial side of the implant site at multiple levels. The amount of gingival margin recession, gingival papilla change, and thickness change of the labial side of the soft tissues at each postoperative point in time were measured at each postoperative time point, as well as evaluating the esthetic effect by the pink esthetic score (PES). Results: The patients were (40±13) years old (21-75 years), including 9 males and 13 females. No adverse events occurred in all the implants during the 12-month follow-up period. The recession level of the gingival margin of the implant site (GL) was 0.08 (0.07) mm, the recession level of the mesial papilla (ML) was 0.19 (0.25) mm, and the recession level of the distal papilla (DL) was 0.19 (0.10) mm. The average collapse thickness of the soft tissue contour on the labial side of the implant (ΔD) was (0.39±0.09) mm, mainly occurring within 2 mm of the root of the gingival margin. The height of the alveolar bone was reduced by (0.17±0.08) mm. The thickness of the labial alveolar bone at 1, 3, and 5 mm root side of the implant shoulder was reduced by (0.13±0.08), (0.12±0.10) and 0.04 (0.17) mm, respectively. The postoperative pink esthetic score was 13.00 (2.25) points at 12 months, which suggested that all implant sites achieved ideal esthetic results. Conclusions: The labial soft tissue contour at implant sites shows minimal change following immediate implant placement and provisionalization using the modified socket-shield technique for 1 year in the esthetic zone.

IMMEDIATE RESTORATION CUSTOM-MADE BY ADDITIVE MANUFACTURING ABOUT DENTAL IMPLANTS: PREDICTABLE RESULTS FOR PINK AND WHITE ESTHETICS

The definition of dental implant failure has evolved from focusing solely on lack of osseointegration to encompass broader concerns such as aesthetics. However, the criteria for aesthetic failure in implant dentistry are not well defined. Although several aesthetic indices have been validated to objectively evaluate clinical outcomes, including failure of an implant-supported crown. In this sense, aesthetic flaws in implant dentistry can be categorized into pink and white tissue flaws. This study aims to describe an extensive rehabilitation protocol where implants were placed using printed surgical guides and adaptations for bone and tissue grafts, facilitating restoration in the aesthetic zone. Key clinical stages and aspects are illustrated through the case of a fractured upper left central incisor, where an implant system was used for immediate patient rehabilitation. By highlighting these crucial steps and considerations, this study underscores the effectiveness of immediate implantation and restoration techniques in achieving optimal aesthetic and functional outcomes in dental rehabilitation

Technique for Soft Tissue Modification for Pontic Reception: A Case Report

Background The article discusses a technique for modifying the pontic site when replacing missing maxillary incisors in the anterior esthetic zone. In such cases, patient concern often centres around esthetics, especially considering factors like smile lines and the display of incisors. The esthetic zone may extend to the entire clinical crown and involve the surrounding soft tissue, particularly if the patient has a high smile line.  Case Summary The emergence profile is highlighted as a crucial aspect when dealing with pontics in the esthetic zone. The emergence profile refers to the way the pontic emerges from the gingival tissue, and it significantly influences the overall esthetics of the restoration.  Conclusion The technique described in this case report involves converting a flat gingival contour into a concave receptor site for the desired pontic without soft tissue grafting. This modification aims to enhance the emergence profile, contributing to a more natural and esthetically pleasing outcome when replacing missing maxillary incisors in the anterior esthetic zone.

Digital workflow for prosthetic management of malpositioned implant in an adolescent patient: A 20-year follow-up.

Dental implants placed in adolescent patients pose a challenge to restore and maintain an esthetic outcome over longer period of follow-up. Maxillomandibular changes throughout adulthood may lead to complications such as implant infraocclusion and interproximal contact loss. This case report describes an alternate prosthetic treatment strategy for maxillary single implant placed in an adolescent patient in the esthetic zone with inappropriate implant axis and screw hole placement. With temporary restorations, the gingiva and soft tissues were shaped to imitate the emerging profile of the contralateral side. A zirconia screw-retained abutment was customized as a copy-mirror from the contralateral prepared tooth to mimic the exact shape and to avoid labiolingual over contour by computer-aided design/computer-assisted manufacture (CAD/CAM). The porcelain laminate veneer was bonded to the zirconia abutment. Porcelain adhesive approach was used instead of traditional principles of retention and resistance form of the abutment. A functional and esthetic outcome was achieved and maintained, while a minimally invasive procedure was implemented to use the malplaced implant instead of explanting it. The present report illustrates the prosthetic management of a malpositioned dental implant placed 20 years ago, utilizing a minimally invasive digital protocol.

An Analogy between Two Bio-Membranes (CGF-PRGF) Mixed with Xenogeneic Bone Graft to Achieve Frugal Management of Labial Dehiscence amidst Immediate Implantation in Esthetic Zone: A Randomized Clinical Trial

Background Labial dehiscence is a very prevalent esthetic concern among implantologists during immediate implantation in the esthetic zone since recent implant treatment and patient ambition are not only directed to function reestablishment, but esthetic superbness also holds immense consideration. Objective This study aimed to manage the labial dehiscence at the time of implantation and evaluate and compare the effects of two different autologous biomembranes, Concentrated Growth Factor (CGF) and Plasma Rich Growth Factors (PRGF), in combination with xenogeneic bone around the immediate implants in the esthetic zone. Methods Twenty patients indicated for immediate implant in the esthetic zone were randomly divided into two groups. The first group received CGF with xenograft, and the second group received PRGF mixed with xenograft. Cone Beam Computed Tomography (CBCT) radiographs and clinical periodontal parameters were evaluated, and all the results were tabulated and statistically analyzed. Results The two groups showed a statistically significant increase in bone density and inevitable crestal bone loss after 9 months, even though the CGF group comparably showed a statistically significant reduction in crestal bone loss. Conclusion Platelet concentrate derivatives, such as CGF and PRGF, are beneficial in the management of labial dehiscence around the immediate implants even though CGF offers a considerably and statistically significant decrease in crestal bone loss and more amelioration of bone density alongside its easier and faster preparation than PRGF. Clinical Trial Registration The study is registered at the U.S. National Library of Medicine website of clinical trials (clinicaltrials.gov) under ID: NCT05595772.

Preservation of Socket for Immediate Dental Implants in Aesthetic Zone from Upper Jaw: Aesthetic Approach-Case Report

Ensuring optimal aesthetic outcomes in dental implant cases within the maxillary anterior area requires careful consideration of socket preservation and atraumatic tooth extraction. These factors play a crucial role in achieving successful and aesthetically pleasing treatments. The objective of this study is to present a series of clinical cases involving dental extractions of anterior maxillary teeth with a poor prognosis. This study highlights the importance of socket preservation and atraumatic tooth extraction in ensuring optimal aesthetic results in dental implant cases within the maxillary anterior area. In these cases, a two-armed lever technique was planned for atraumatic alveolar preservation during the extraction process.Following the tooth extraction, the fresh socket was reclassified, and dental implants were subsequently placed using a modified drilling technique in certain cases. The authors assessed the primary stability of the implants, while in other cases, bone regeneration procedures were performed. The presented clinical cases demonstrate the successful implementation of the two-armed lever technique for atraumatic alveolar preservation, leading to favorable outcomes in terms of primary implant stability and bone preservation. Techniques for bone preservation after tooth extraction aim to minimize post-extraction bone resorption. By implementing appropriate protocols, such as the concept of the dual zone and the two-armed lever technique, successful outcomes can be achieved in terms of both aesthetics and preservation of the alveolar bone.

Application of '10 Keys' Checklist and Partial Extraction Techniques to Optimize Esthetic Outcome for Adjacent Implants in the Esthetic Zone.

Placing immediate implants in the esthetic zone area poses significant challenges. Implants should be placed with consideration to hard and soft tissue management to optimize long term implant and cosmetic success. In this case report, two maxillary central incisors were extracted in two different time points, separated by 5 years because of horizontal root fractures. Implants were placed according to immediate single-tooth guidelines, using two different surgical and loading approaches, as risk assessment factors changed in the time between first immediate placement (#8) and second immediate placement (#9). These techniques included Partial Extraction Therapy (PET), the use of allograft and growth factors, connective tissue graft (CTG), platelet rich fibrin (PRF) and immediate and conventional loading. These were grouped as the '10 keys', a checklist used to pursue long term success. After 6-year and 1-year follow-up, radiographic and clinical results were satisfactory.

Validation of the pink esthetic score/white esthetic score at single tooth-supported prostheses in the esthetic zone: A randomized clinical trial.

To validate the reproducibility and inter/intra-observer variability of the Pink Esthetic Score/White Esthetic Score (PES/WES) of single tooth-supported prostheses in the maxillary esthetic zone (13-23). Forty-five patients were randomly assigned to one of the three treatment options (15 patients per group) receiving each one a different crown type: Porcelain fused to metal (PFM), monolithic zirconia, and lithium disilicate. Eight observers from each of four different specialties (Prosthodontists, Orthodontists, Periodontists, and Oral Surgeons) were recruited and assessed twice and four weeks apart (i.e., T1 and T2) 45 photographs of the single tooth-supported prosthesis using PES/WES and compared them with contralateral teeth. According to the ANOVA and post hoc tests, the zirconia crown type obtained the highest mean score by all observers, with a mean value of 16.70 ± 2.94. The prosthodontists and oral surgeons assigned the lowest mean score to PFM crowns, 13.03 ± 3.47 and 13.80 ± 3.17, respectively. Notably, the prosthodontists awarded the highest scores, specifically 17.50 ± 2.81 for the zirconia crowns. Intraobserver agreement was calculated utilizing the paired t-test. Pairwise comparisons between observers of different specialties revealed significant intraobserver agreement. Interclass correlation coefficient (ICC) scores were statistically significant among four specialties. No difference was detected concerning the interobserver agreement. The PES/WES index remains consistent across various observers from different specializations, yielding uniform results in the overall esthetic evaluation. Consequently, in light of the presented preliminary positive results, its use might also be considered for the esthetic assessment of single-tooth-supported prostheses. The PES/WES index may be employed clinically to evaluate single tooth-supported prostheses as it emerged as a reproducible esthetic scoring system.

Micro-needling versus acellular dermal matrix in RT1 gingival recession coverage: A randomized clinical trial.

This randomized trial assessed for the first time the efficacy of coronally advanced flap (CAF) followed by micro-needling (MN) in contrast to CAF with acellular dermal matrix (ADM) on gingival thickness (GT, primary outcome), keratinized tissue width (KTW), clinical attachment level (CAL), probing depth (PD), recession depth (RD), recession width (RW), recession reduction (Rec-Red), complete root coverage (CRC) and percentage of root coverage (all secondary outcomes) in management of RT1 gingival recession in patients with thin gingival phenotype. A total of 24 patients (n = 24) with a thin gingival phenotype and single RT1 gingival recession in the aesthetic zone were randomly allocated to test- (CAF + MN; n = 12) or control group (CAF + ADM; n = 12). All clinical parameters were evaluated at baseline, 3 and 6 months. Both groups independently demonstrated significant gain in GT, RW, RD, CAL, PD, Rec-Red, CRC and percentage of root coverage, with reduced PI and BOP (p < .05) at 3 and 6 months, without intergroup differences (p > .05). At 6 months, KTW gain was significantly higher in CAF + MN (5.08 ± 0.9 mm) than in CAF + ADM-group (4.25 ± 1.06 mm; p < .05). Stepwise linear regression model with GT as dependent variable showed that base-line GT was the only statistically significant predictor for GT with a direct correlation between base-line GT and GT after 6 months. CAF followed by MN could represent a promising graft-less approach for increasing gingival thickness, comparable to CAF with ADM, with superior keratinized tissue width improvement, in the treatment of RT1 recession defects in patients with thin gingival phenotype.

FUNCTIONAL CROWN LENGTHENING AS A PRE-RESTORATIVE PROCEDURE IN THE AESTHETIC ZONE

Introduction: Crown lengthening is a surgical procedure to increase the height of the clinical crown for aesthetic and restorative purposes, or combination. The indications include treatment of subgingival caries and altered passive eruption. Functional crown lengthening for restorative purposes in the esthetic zone should consider the concept of biologic width and the ideal proportion of the dentogingival complex. Case: A 39-year-old male patient was referred from the Department of Conservative Dentistry, RSGM UGM Prof. Soedomo to expose the maxillary anterior teeth crowns for full crown and veneer restorations. Clinical examination showed 11, 12, and 12 post root canal treatment with 3-4 mm remaining crowns. Teeth 13, 21, 22, and 23 appear short, excessive gingival display of 3 mm, with a diagnosis of altered passive eruption type 1B. Treatment: Functional crown lengthening was performed by gingivectomy followed by flap elevation, ostectomy, and osteoplasty. A fenestration was found at the apical of 22 and treated with regenerative procedure. Full crowns and veneers insertion was done 3 months after surgery. Crown lengthening as a pre-restorative procedure is a multidisciplinary treatment that considers the need for restoration by re-establishing the biologic width, to prevent inflammation and bone loss. In addition, adequate post- surgical tissue healing time prior to restoration is necessary to avoid gingival margin rebound and to assure long-term success of the restoration. Conclusionn : Functional crown lengthening as a pre-restorative procedure in the esthetic zone can gives satisfactory and stable results, with careful examination and correct surgical procedure.

Immediate Loading of Single Implant in the Aesthetic Zone: A Case Report

Immediate Loading of Single Implant in the Aesthetic Zone: A Case Report

Outcomes of Connective Tissue (CT) Graft on Periodontal Health in Relation to Dental Implants Placed in Esthetic Zone of Anterior Maxilla

Background: Since 1998, maxillary anterior single immediate implant insertion and provisionalization (IIPP) has been successful and practical. It preserves natural gingival profiles without extending treatment time or needing a removable interim prosthesis. The gingival profile includes a hard tissue zone with bone and a soft tissue zone without bone, extending from the free gingival border to the bony crest's apex. Objective: The purpose of this study was to examine the effect of connective tissue transplant on the thickness and appearance of soft tissue around single implants in the anterior maxilla's aesthetic zone. Study Design: A Prospective cross-sectional study. Settings: A Prospective cross-sectional study was conducted CMH Dental College Multan. Duration: This study was conducted from January 2021 to April 2022. Methods: A total of 64 individuals were included who had criteria for a single cosmetic implant implantation. Detailed demographic information was recorded for enrolled patients once informed written consent was obtained. Patients were equally divided in two groups. Group I (consisting of 32 patients) underwent implant insertion and connective tissue graft implantation (1.50 mm thick) while group II (consisting of 32 patients) simply had implant insertion. Six-month and twelve-month clinical assessments were conducted. Postoperative pain and discomfort were measured. Results: There were 37 (57.8%) males and 27 (42.2%) females among all cases. Buccal tissue thickness in group I significantly increased from 2.45 ±1.80 mm at baseline to 4.0±1.1 mm after 6 months and 3.9±3.46 mm after 12 months (P &lt;0.05), whereas no change was seen in the implant group. After a year, the buccal deficiencies in Group I were significantly less than those in the implant group (∆ -0.46±1.42 mm and ∆ -1.67 ±2.28 mm,). After 12 months, there was a statistically significant difference in proximal bone resorption between the two groups (0.59±0.37 mm and 1.0±0.19 mm), with group I exhibiting less bone resorption than the implant group. Conclusion: In this research, we observed that a single implant placed in the front maxilla in conjunction with a connective tissue graft may enhance peri-implant mucosa thickness and decrease proximal bone resorption.

Volumetric Analysis of Peri-implant Tissue Change Over Time: Validating an Innovative 3D Method.

To validate an innovative 3D volumetric method of evaluating tissue changes proposed by Lee et al in 2020 by comparing the results of this method-in which the scanned peri-implant surfaces were transformed, visualized, and analyzed as 3D objects-to the results reported by an existing method based on calculation of the mean distance between measured surfaces. The null hypothesis was that there was no statistically significant difference between the two methods. Additionally, the present study evaluated peri-implant tissue changes 5 years after single implant placement in the esthetic zone. Both methods were applied to 11 oral implant site casts (6 maxillary central incisor sites, 5 maxillary lateral incisor sites) taken from 11 patients at crown placement and at follow-up examinations 5 years later. The methods are based on digital workflows in which the reference and 5-year casts are scanned and the resulting STL files are superimposed and analyzed for three regions of interest (mesial papilla, central area, and distal papilla). The volumetric changes reported by the Lee et al method and the mean distance method were calculated and compared using the Spearman rank correlation coefficient (P < .01) and the Wilcoxon signed-rank test (P < .05). The correlation between the two sets of measurements was very high (Spearman rank correlation coefficient = 0.885). The new volumetric method indicated a mean volume loss of 2.82 mm3 (SD: 5.06), while the method based on the measurement of mean distance showed a mean volume loss of 2.92 mm3 (SD: 4.43; Wilcoxon signed-rank test result: P = .77). No statistically significant difference was found. The two methods gave equivalent results, and the null hypothesis was accepted. The new volumetric method was validated and can be considered a trustworthy tool.

Autonomous robotic system for the assisted immediate placement of a maxillary anterior implant: A clinical report

Precise reproduction of the preoperatively designed 3-dimensional (3D) implant position is key to seating a prefabricated restoration and restoring esthetics. Static and dynamic computer-aided implant surgery (CAIS) based on the fusion of 3D imaging files have been used to improve implant accuracy. However, both techniques have shortcomings that can be remedied by a robotic system. This clinical report describes the immediate placement of an implant in the anterior esthetic zone by using an autonomous dental implant robotic system (ADIR).

Profilometric, esthetic, and patient-reported outcomes of the L-shape technique combined with delayed connective tissue grafting in the maxillary anterior region: A 3-year case series study.

To evaluate the profilometric, esthetic, and patient-reported outcomes of peri-implant tissues in the maxillary anterior esthetic zone following guided bone regeneration (GBR) using the L-shape technique combined with delayed connective tissue grafting (CTG). Profilometric and pink esthetic score (PES) measurements were performed at the time of implant surgery with GBR (T0) and at the 1- (T1), 2- (T2), and 3-year (T3) follow-up. Patient-reported outcomes were also assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Statistical analysis over 3 years of follow-up assessed changes at time points (T0, T1, T2, and T3) and time periods (T0-T1, T0-T2, and T0-T3) using the Wilcoxon signed-rank test. A total of 12 patients (57.5 ± 12.3 years) were included in this study. The mean profilometric change in peri-implant tissues over the 3-year follow-up period was 3.49 ± 1.11 mm, and the buccal contours were not significantly different between the comparison periods. The PES remained stable, while all OHIP-14 domain scores improved significantly. Simultaneous implant placement and GBR using the L-shape technique combined with delayed CTG in the maxillary anterior region provides stable buccal profiles and consistent esthetics and improves patient-reported quality of life over a 3-year period. This study demonstrated that GBR using the L-shape technique combined with delayed CTG in the maxillary anterior region improved the buccal profile, esthetics, and patient-reported quality of life.

Immediate implant placement in the anterior mandible: a cone beam computed tomography study

BackgroundThe placement of implants into the alveolar socket right after tooth extraction is called immediate implant placement (IIP). This approach has its particularities depending on which region of the jaws is involved. The anterior mandible region is peculiar due to the presence of mandibular incisors, which have the shortest roots among all permanent teeth.PurposeThis study aimed to investigate the factors that could be associated with the risk of either cortical bone wall perforation or invasion of the 2 mm secure distance from the surrounding anatomical structures (defined as unsafe implant placement), with IIP in the maxillary aesthetic zone, in a cone-beam computed tomography (CBCT) virtual study.Materials and methodsCBCT exams from 239 eligible subjects were investigated. Implants were virtually placed in two distinct positions: prosthetically-driven (along the long axis of the existing tooth) and bone-driven position (according to the available bone and with regard to nearby anatomical structures). Correlation between several variables was tested, and binary logistic regression analysis in order to assess of the possible associations between covariates and unsafe placement was performed.ResultsSafe placing implants was significantly higher for the bone-driven in comparison to the prosthetically-driven position (22.2% vs. 3.3%, respectively), and the 2-mm secure distance from anatomical structures was not possible to respect in the majority of cases (77.6% vs. 82.9%, respectively). Covariates associated with a higher risk of unsafe placement were tooth region (CI in relation to IL and CA), decrease of labial concavity angle (LCA), decrease of mandible basal bone height (MBBH), and decrease in mandibular bone thickness at the tooth apex level (MBT0).ConclusionThe possibility of safely placing immediate implants in the anterior mandible is significantly higher for bone-driven than in prosthetically driven position. Presurgical virtual planning with CBCT is a great tool for minimizing the risk of implant unsafe placement with regards to the anatomical conditions in the mandible.

Componeer as an aesthetic treatment option for anterior teeth: a case report

IntroductionStructural abnormalities or anomalies in the anterior teeth, also known as the aesthetic zone, are an important problem for patients and a challenge for dentists. Structural abnormalities or tooth anomalies can change in color, shape, and function. Most dentists prefer minimally invasive aesthetic treatment. One of the aesthetic treatment options for anterior teeth is veneers. Veneer is a restoration that covers the labial part of the tooth with a thin layer of material to correct abnormalities in the color, shape, or function of the tooth. Veneer restoration can be done indirectly with porcelain material made in a laboratory and directly with composite material on the tooth surface or prefabricated which is available from the factory. Componeer is a prefabricated composite veneer that combines the aesthetic properties of ceramic veneers and the adhesive ability of composite veneers to the tooth structure. This case report describes the treatment of two central incisors that had been filled with composite and peg shapes on both lateral incisors using a componeer.Case reportA 32-year-old female patient came to the Dental Conservation Clinic at Dentistry Hospital, Padjadjaran University with the main complaint of her right and left upper front teeth and wanted to repair her old fillings and close the gap between her right and left upper front teeth and her canine teeth. Clinical examination showed that teeth 11 and 21 had been filled with composite which had changed color and had an inharmonious shape as well as a gap between the upper front teeth on the right and left sides and the right and left canine teeth.TreatmentThe maxilla and mandibular teeth are molded for study models and working models. In the working model, a wax-up is carried out, then a mock-up on the patient’s teeth. Next, choose the color and size of the components that match the mock up results. Teeth 11 and 21 had their old composite fillings cleaned and refilled with dentin colored composite, teeth 13, 12, 11, 21, 22, and 23 were prepared with a minimum thickness of 0.3 mm to make room for the componeer material. The teeth was etched and bonded, and bonding was applied to the inner surface of the componeer. The composite is placed on the inner surface of the componeer then placed on the labial surface of the tooth and pressed with a special tool, then light cured. The final step is polishing.Treatment resultsTeeth 13, 12, 11, 21, 22, and 23 which had undergone veneer treatment using componeer, were controlled after 1 week of treatment. The patient did not complain about the results of the treatment and said he was satisfied with the treatment.

Difference in Buccal Gingival Thickness between the Mandible and Maxilla in the Aesthetic Zone: A Systematic Review and Meta-Analysis.

Background: Fragile gingival tissue is a risk factor for the development of gingival recessions. Despite the fact that gingival recessions are more commonly seen around anterior mandibular teeth, previous research has predominantly concentrated on the gingival dimensions in the anterior maxilla. The objective was to systematically compare buccal gingival thicknesses between the upper and lower jaws in individuals with healthy gingival conditions in the aesthetic zone. Methods: A comprehensive search of three databases was carried out until October 2023. Gingival thickness differences between the maxilla and mandible were evaluated by calculating the mean differences along with the corresponding 95% confidence interval (CI). Subgroup analysis was conducted based on the measurement area, measurement method, and tooth category. Results: A total of seventeen studies were included in this systematic review. Eleven studies were included in the quantitative analysis. Quantitative analysis comparing gingival thickness around 2100 teeth in the anterior mandible to 2056 teeth in the anterior maxilla revealed a statistically significant thinner buccal gingiva in the mandible (mean difference: 0.16 mm; 95% CI [-0.24, -0.07]; p = 0.0003). Conclusions: The present systematic review revealed a more delicate buccal gingiva in the anterior mandible. However, further scientific validation is required due to the considerable heterogeneity in study design and the potential presence of confounding variables.

ORTHODONTIC EXTRUSION TECHNIQUE AS A METHOD FOR ALVEOLAR BONE VOLUME INCREASE BEFORE DENTAL IMPLANTATION. CLINICAL CASE

Objectives: Tooth extraction and replacement with dental implant represents a common treatment choice, when teeth are hopeless. We presented a clinical case, the treatment of which was carried out by the method of orthodontic extrusion technique. This technique can increase alveolar bone level and also soft tissue level. The increased amount of alveolar bone can improve primary implant stability and be compared with bone regeneration techniques. The purpose of presenting this clinical case is to emphasize the efficiency of orthodontic extrusion. Methods and materials: A 45-year-old female patient referred by the general dentist regarding cosmetic defect and tooth mobility in the area of the anterior upper teeth. During the examination, her upper right central incisor was found to be mobile, with diastema and slight congestion in the anterior teeth Photographs, CT and X-ray studies of the patient were used. The patient was bonded with .018 slot Roth prescription ceramic brackets (Dentaurum, Germany). After achieving the optimal results of orthodontic treatment and the necessary extrusion of the upper right central incisor, the tooth was removed and replaced with a dental implant. After six months, the patient had a crown with a screw fixation of zirconium dioxide with ceramic application Results: As a result of orthodontic extrusion, clinically significant increase in alveolar bone and gingival tissue was reported. This resulted significant qualitative and quantitative improvements in the implant site. As the clinical case was in aesthetic zone, we could also rehabilitate beautiful smile of patient and increase her self-esteem. Conclusions: Summing up the above and the results of the treatment of this patient, we can definitely say that orthodontic extrusion technique is effective for implant site development. As we have described, this can effectively move the facial gingival margin and allow for esthetic restoration of implant placed in the extruded tooth position without any bone graft.

Restoration of Anterior Teeth Using Minimal Invasive Esthetic Techniques with Opalusture and Composite Restoration: A Clinical Technique

Discoloration is one of the important reasons for restoration of anterior teeth in esthetic zone. Dental fluorosis is among common discoloration. Main reason for fluorosis is that concerned person residing in area with high fluoride content in community drinking water supply. In this case report, a 45year old male patient reported with esthetic concern due to discoloration in anterior teeth which was in turn diagnosed to be fluorosis and eventually treated with minimal invasive techniques including combination of microabrasion ,macroabrasion and direct composite veneers. KEYWORDS: Fluorosis,Tooth discoloration,Enamel microabrasion,Dental veneers