Gingival Architecture Research Articles

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.

The importance of red aesthetics in dental implants: a systematic review

Introduction: Aesthetics region should be defined as any area to be restored visible in the patient's smile. The charge or immediate function is a prerequisite for the present implant's primary stability in your installation. Thus, to maintain the gingival architecture, understanding biological principles governing is essential to remodeling, as well as alveolar bone soft tissue. The gingival tissues' health, color, and texture are critical to the long-term success and the aesthetic value of treatment. Objective: It was to review the literature and discuss the major factors supporting the red aesthetic excellence before and after the rehabilitation of former regions, and the use of dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion:128 articles were found, 44 articles were evaluated in full and 32 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 23 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=81.5%>50%. It was concluded RED aesthetics has become a primary factor in the patient's expectations, and the duty of the surgeon's professional knowledge of the fundamental aspects in achieving this aspect. A correct treatment plan to meet the restorative and surgical protocols appropriate, thus being able to achieve satisfactory results is required.

Minimally invasive prosthodontics using the concept of prosthetically guided orthodontics.

This case report aims to present how digital technology can be employed to plan the orthodontic movement of teeth into their final positions for prosthodontic rehabilitation. An interdisciplinary approach to treatment planning and the result of prosthodontic treatment involves the cooperation of an orthodontist and a prosthodontist. When planned to achieve optimal results for a minimally invasive and functional prosthodontic treatment, orthodontic pretreatment provides superior esthetic results and favorable long-term success. The orthodontic movements of the teeth were planned so that the prosthodontist could reconstruct an optimally functional and esthetic occlusion while preserving the hard dental tissues. The orthodontic pretreatment minimized the need to prepare the teeth, avoiding any mucogingival surgery to improve the gingival architecture. In complex clinical cases, it is essential to evaluate the advantages of an orthodontic pretreatment before starting a prosthodontic treatment. This pretreatment can help preserve dental tissues, reduce or eliminate the need for surgical intervention, and achieve long-term stability and esthetic results. This case clearly shows the benefits of orthodontic pretreatment for prosthodontic outcomes. With modern digital tools, such an orthodontic pretreatment should become standard clinical practice when planning a complex clinical case.

A Non-Surgical Approach to enhance Soft Tissue Esthetics in Anterior Fixed Restorations: A Case Report

The sound health of the supporting tissues is critical to the long-term success of Fixed Prosthodontic treatment, especially when it involves the Maxillary Anterior region. This will contribute immensely to a lasting esthetic outcome. The final prosthetic value may be may be compromised by factors such as extend of gingival display, gingival architecture, coronal dimensions clinically, and tooth position. Surgical correction for optimization of soft tissue contour possesses certain drawbacks as it is an invasive procedure which could involve a longer and unpredictable healing period as well as the possible risk of an infection. This article describes a non-surgical approach for the re-contouring of the soft tissue through the sustained application of pressure using a provisional fixed prosthesis, which could avoid potential complications that a surgical approach may invite and provide a reliable option to enhance anterior aesthetic value in the final fixed prosthesis. Keywords: Anterior aesthetics, Non-surgical, Soft tissue re-contouring, Provisional prosthesis, Zirconia

A biologically oriented preparation technique (BOPT) for immediate posterior implant placement, immediate provisionalization, and definitive implant crown fabrication: A complete digital workflow.

Immediate implants and immediate alveolar sealing have been a widely utilized treatment with high predictability and biological advantages. The improvement in technology has made it possible to simplify clinical processes. The aim of the present report was to describe the complete digital workflow of the Biologically oriented preparation technique for immediate posterior implant, immediate provisionalization and fabrication of definitive implant crowns. The surgical process and prosthetic management to preserve the gingival contours of the extracted natural tooth during immediate implant placement and provisionalization are described. Additionally, during the same clinical intervention, the definitive intraoral digital implant scans for capturing the implant position, peri-implant tissue contours, adjacent and antagonist dentition, and profile emergence of the interim implant crown are captured for the fabrication of the definitive crown. Based on the technique described, the immediate implant placement and provisionalization in the posterior area provides biological and clinical advantages, reducing the number of abutment-implant disconnections and the number of clinical appointments, as well as increases patient comfort. The present article describes a technique for an immediate implant placement and provisionalization in the posterior region for maintaining the gingival architecture of the extracted tooth. During the same appointment, the implant position, peri-implant tissue contours, and adjacent and antagonist dentition, and profile emergence of the interim implant crown are captured by using an intraoral scanner and used for the fabrication of the definitive crown. This technique aims to reduce the number of abutment-implant disconnections and clinical appointments.

Maxillary lip dynamics and gingival display revisited: Utilizing standardized metrics.

This study was initiated to validate a predictable system for establishing maximum maxillary lip dynamics and highlight the clinical significance of the findings. Seventy-five subjects, ranging in age from 25 to 71 years old were photographed with lips in maximum and minimum reveal. The images were digitally analyzed using set references. The statistical analysis was performed using Meta. Numerics version 4.1.4. A Pearson correlation coefficient (r) was carried out to identify relationships between age and maxillary lip dynamics. A p-value less than or equal to 0.05 was considered to be significant. A greater percentage of participants have posterior gingival display than anterior gingival display. There is greater movement of the maxillary lip at the cuspid than at the central incisor. There was a tendency for lip dynamics to increase at the right central incisor when there is an increase in lip dynamics at the right cuspid. Lip dynamics does not appear to decrease with age. Accurately recording and considering maximum lip dynamics helps avoid asymmetric, excessive or insufficient gingival architecture, insufficient or excessive tooth length and visible restorative margins.

Relationship between supracrestal soft tissue dimensions and other periodontal phenotypic features: A cross-sectional study.

The purpose of this study was to determine the association between periodontal supracrestal soft tissue dimensions (PSSTDs) and other phenotypic features in non-molar maxillary teeth. Adult subjects in need of comprehensive dental treatment were recruited. Periodontal phenotypic variables (i.e., facial and palatal gingival thickness [GT], alveolar bone thickness [BT], and PSSTDs, namely distance from the gingival margin to the bone crest defined as periodontal supracrestal tissue height [PSTH] and distance from the cementoenamel junction to the bone crest [CEJ-BC]) were recorded using cone-beam computed tomography scans. Standardized intraoral photographs were obtained to assess facial keratinized tissue width (KTW) and other anatomical parameters (i.e., tooth type, gingival architecture, and interproximal papilla height). The study sample was constituted of 87 participants that contributed with a total of 522 maxillary anterior teeth. Differences in mean values of PSSTDs, KTW, GT, and BT were observed between tooth types and gender. Males exhibited a thicker GT and BT, and taller PSTH and KTW compared to females. Shorter CEJ-BC was associated with shorter PSTH, wider KTW, and thicker GT and BT. Shorter PSTH was associated with thicker facial BT. Notably, BT and GT were positively correlated at both facial and palatal sites, meaning that the thicker the gingival phenotype, the thicker the bone morphotype. Facial BT and facial GT were positively correlated with KTW. A flat gingival architecture was associated with the thick periodontal phenotype. Square teeth had shorter CEJ-BC, wider KTW, and thicker GT. Periodontal phenotypic features vary across and within subjects, between facial and palatal sites at different apico-coronal levels, and as a function of gender and tooth type. The shorter the PSSTDs, the wider the KTW and the thicker the GT and BT. PSSTDs, particularly PSTH, should be considered an integral component of the periodontal phenotype.

Management of Root Sensitivity following Socket Shield Technique with Anterior Single Immediate Implant Placement and Provisionalization.

Maintaining facial soft tissue contour and inter-implant papilla are challenging for implants in the esthetic zone. To counteract the inevitable hard and soft tissue changes after tooth extraction, the socket shield technique (SST) has been advocated as means to maintain the facial and/or interproximal osseous and gingival architecture. Because SST is a technique-sensitive procedure, various complications related to SST have been reported. This article presents a unique complication after a socket shield procedure and a novel management of the complication. Int J Periodontics Restorative Dent 2023;43:157-165. doi: 10.11607/prd.5426.

Implant position and guided placement for in-house-produced CAD/CAM restorations with titanium (Ti)-bases.

Digital dentistry has contributed to the evolution and simplification of dental implantology over the last decade. The incorporation of intraoral scanners, CBCT, 3D implant-planning software, and CAD/CAM systems makes prosthetically driven implantology a straightforward process. Such digital resources for treatment planning and execution, following evidence-based concepts, have the ability to improve the long-term esthetics and function of implant-supported restorations as well the long-term survival of dental implants. Dental implants are frequently considered as the first treatment option for replacing failing or missing teeth. However, their use in the esthetic zone remains a challenge for many clinicians. The present article provides clinical guidelines for ideal implant positioning employing computer-guided surgery and chairside CAD/CAM-fabricated provisional and definitive restorations with titanium (Ti)-bases for successful prosthetic outcomes, optimizing gingival architecture, and decreasing overall treatment duration. (Int J Comput Dent 2023;26(1):75-0; doi: 10.3290/j.ijcd.b3818287).

A Comparative Study Evaluating the Effects of Crestal Bone Change Following Immediate and Delayed Implant Placement

For the rehabilitation of the single-tooth space, a number of prosthodontic techniques have been known and are well established. Fixed and removable partial dentures being the easiest are associated with the major drawbacks of loss of tooth structure and vitality. Though replaced by implant supported rehabilitations, crestal bone loss has been reported as the one of the major factor affecting the long term prognosis. Thus the main aim of the study was to assess and compare the reverberations of immediate and delayed placement of implant on crestal bone height. Material and methodology: 30 patients aged between 18-60 years were selected on the basis of inclusion criteria and divided randomly into two groups of 15 each. In Group A immediate implant placement was done while in Group B delayed implant placement was done. In both the groups, Crestal bone height (Buccolingual width + interproximal height), keratinized mucosa index, Jemt papilla fill index, Plaque index, Gingival index and Periodontal attachment levels were analyzed at baseline, after 3, 6 and 12 months. Results: The parameters were recorded and analyzed statistically. Categorical values were analyzed using mean, frequency and percentage while descriptive analysis was done using student t test. It was observed that mean changes in crestal bone height, papilla filled index, periodontal attachment levels, gingival and plaque index was statistically significant in both the groups from baseline to 12 months, while keratinized mucosa index represented no change between the two groups. Conclusion: The study came to the conclusion that placing an immediate implant rather than a delayed should be significantly preferred. Though in immediate implant placement, crestal bone is preserved and gingival architecture is prevented from collapsing along with time of treatment, preservation of aesthetics and patient comfort being the other major advantages. Keywords: Aesthetics, Crestal Bone Height, Delayed Implant, Extraction Socket, Immediate Implant, Periodontal Parameters.

Correlation of Gingival Stippling with Periodontal Phenotypic Features: A Cross-Sectional Study.

This study aimed to determine the correlation between gingival stippling (GS) and other phenotypic characteristics. Adult subjects in need of CBCT scans and comprehensive dental treatment in the anterior maxilla were recruited. Facial gingival thickness (GT) and buccal bone thickness (BT) were assessed utilizing CBCT. Standardized intraoral photographs were obtained to determine keratinized tissue width (KTW), presence of GS in all facial and interproximal areas between the maxillary canines, and other variables of interest, such as gingival architecture (GA), tooth shape, and location. Statistical analyses were conducted to assess different correlations among recorded variables. A total of 100 participants and 600 maxillary anterior teeth constituted the study population and sample, respectively. Facial GS was observed in 56% of men and 44% of women, and it was more frequently associated with flat GA, triangular and square/tapered teeth, central incisors, and men. Greater mean GT, BT, and KTW values were observed in facial areas that exhibited GS. Interdental GS was present in 73% of the sites, and it was more frequently observed in men, in the central incisor region, and when facial GS was present. Multilevel logistic regression revealed a statistically significant association between the presence of GS and KTW, BT measured at 3 mm apical to the bone crest, and tooth type. This information can be used to recognize common periodontal phenotypical patterns associated with specific features of great clinical significance.

Smile in a Day: A Case Report on Compressive Implants

The replacement of missing teeth has become a transition from dentures to dental implants in the present era. Implant placement in anterior regions has the most aesthetic challenges in implant dentistry as tooth loss leads to bone resorption and collapse of gingival architecture, which causes aesthetic compromise and inadequate bone for implant placement. Immediate implant placement and loading have become a popular treatment modality and they are being widely used to reduce the treatment time which is a major disadvantage with conventional implants. Immediate implant placement into fresh extraction socket maintains gingival aesthetics and increases the comfort of the patient. The present case report highlights the placement of two compressive implants into fresh extraction sockets and immediate loading within 72 h or less than that. Immediate placement and early loading of the dental implant provide advantages such as fewer surgical procedures, shorter treatment time and improved aesthetic and psychological confidence.

Prosthodontic Rejuvenation of Oral Esthetics

Abstract A system of esthetic predictions that has been used since antiquity is described. The system’s naturalness is emphasized by displaying nature’s examples of how artists and designers used it. The smile’s esthetics are greatly improved by framing the teeth within the confines of gingival architecture. An uneven gingival contour height can have a dramatic effect on the beauty of a smile. Although the position of the gingival tissue zenith may appear insignificant, it can significantly impact the axial inclination and emergence profile of the teeth. The present article describes a case report that deals with replacing unsatisfactory and extensive metal-ceramic restorations with all ceramic restoration to improve esthetics in the form and shape of the tooth, color, and alignment of the tooth; consequently, the patient’s smile’s esthetics and harmony are established.

Esthetic and Prosthetic Rehabilitation of Maxillary Lateral Incisor: A Case Report

Introduction: The maxillary anterior region poses the highest number of aesthetic challenges in implant dentistryas any tooth loss in the region leads to bone resorption and collapse of gingival architecture leaving inadequatebone for implant placement. However, immediate implant placement and provisionalization has been a viableoption for replacing failing maxillary anterior teeth as it preserves the vertical existing osseous and gingivalarchitecture. A proper case selection guided by an appropriate step-by-step treatment plan can ensure the successof any immediate implant placement.Case Summary: This case report describes atraumatic extraction of a fractured right maxillary lateral incisor,followed by immediate placement of a dental implant in the prepared socket. Implant was successfully loaded andwas functional during 24 months follow up period. The patient exhibited no clinical or radiologic complicationspost operatively. Recall visits exhibited patient’s high-level confidence of smile with optimum satisfaction andsuccessful aesthetic outcome.Conclusion: Immediate implant placement into fresh extraction socket reduces the treatment time, cost, preservesthe gingival aesthetic and increases the comfort of the patient.

Atraumatic extractions-Indications and treatment modalities

This paper seeks to enumerate and explain the instruments used commonly for atraumatic extractions, their method of usage and identify their indications. The methodology includes review of journal articles on approaches, benefits and procedures for atraumatic extraction and their compilation. The methodology also includes a review of websites of manufacturers of atraumatic extraction devices and instruments. These sources help to identify the common means for carrying out atraumatic extractions and also the indications for the same. Implants continue to be an exceedingly accepted means to replace an extracted tooth. This may be done immediately following an extraction or at a later date subsequent to satisfactory wound healing. In both situations the need for an atraumatic extraction seems all the more pertinent. Extractions for orthodontic purposes requiring minimal trauma to the surrounding structures of a tooth, particularly the bone, call for a far more atraumatic procedure than the conventional tooth extraction. With the advent of physics forceps, periotomes, luxators piezoelectric instruments and root traction devices atraumatic extractions by preservation of the alveolar bone, the socket, gingival architecture and without trauma to the periodontium has become a necessary skill in the repertoire of the general dental practitioner. This facilitates better implant outcomes or better orthodontic therapy. Newer methods such as Endoscopically Assisted Root Splitting can be used for extractions without causing trauma to the alveolar bone. This can be done using a Storz-Hopkins support endoscope and enlargement of the canals using Lindemann burs followed by longitudinal root splitting and removal using Bein forceps or fragment removal if an implosion technique is used. However, one needs to keep in mind the duration required for such procedure and the cost of instruments required. These methods prevent unnecessary mucoperiosteal flap elevations, incisions and osteotomies thereby minimizing inflammation. To make dental practitioners embrace these procedures, inadequate literature availability and time limitations remain the biggest constraints.

Tooth preservation of deeply destroyed teeth by forced orthodontic extrusion: A case series.

Maintaining and restoring teeth exhibiting subgingival or even subcrestal defect extensions represent a common problem in daily practice. Such teeth are often deemed "unrestorable" due to a significant hard tissue loss and defect locations violating the biologic width. In order to achieve a sufficient 2-mm-ferrule design and reestablish the biologic width, both surgical crown lengthening and orthodontic extrusion have been suggested. However, surgical crown lengthening has a negative effect on the attachment level of adjacent teeth as well as esthetic disadvantages particularly in the esthetic zone. Therefore, orthodontic extrusion might be considered as a valid therapeutic alternative since gingival architecture is maintained. While most orthodontic appliances are too complex for daily application, forced orthodontic extrusion by means of the Tissue Master Concept might be a cost- and time-effective approach due to advances in adhesive and computer-assisted dentistry. This clinical case series illustrates the methodology of the rather straightforward Tissue Master Concept in specific clinical situations that may occur in clinical routine.

Relationship between smile type and periodontal phenotype: A clinical and tomographic cross-sectional study

ObjectivesTo evaluate the correlation between smile type (ST) and the periodontal phenotype (PP). Material and methodsClinical and photographic examinations of 164 participants (48 men and 116 women, mean age 22.9 ± 4.6 years) were performed, including an evaluation of ST (high, average, and low), gingival phenotype (GP) by transparency of the periodontal probe (TRAN), keratinized tissue width (KTW), gingival architecture (GA), tooth shape (TS), and papilla height (PH). A subgroup of 70 participants underwent soft-tissue cone-beam tomographic examinations (ST-CBCT), in which GP, gingival thickness (GT), buccal bone thickness (BBT), and the distances from the gingival margin and cementoenamel junction to the buccal bone crest (GM-BBC and CEJ-BBC) were evaluated. The data were analyzed using one-way ANOVA, Student's t-test, and chi-square tests, with the level of significance set at 0.05. Results: High, average, and low STs were found in 31.7%, 56.7%, and 11.6% of the participants, respectively. Sex (p=0.001), GP evaluated using TRAN (p=0.021) and ST-CBCT scans (p=0.009), GA (p<0.001), and TS (p=0.001), were associated with STs. The prevalence of thin GP was: 63% in low, 50% in average, and 38% in high smile types. KTW (p=0.004), PH (p<0.001), GT at different landmarks (p<0.05), CEJ-BBC (p=0.017), and GM-BBC (p=0.001) were significantly different among STs. The highest GT and KTW were found in the high-smile group, average-smile presented the higher CEJ-BBC while GM-BBC and PH, were higher in low-smile group. ConclusionPeriodontal phenotype components presented important difference over the smile types. Clinical relevanceA detailed examination of smile types is an essential part of treatment planning, especially when the patient has high esthetic demands. Clinical and tomographic individual analysis of periodontal phenotypes over the smile types may be helpful for a case-by-case approach, and for the development of well-defined treatment protocols.

Assessment of efficiency of arm force only versus arm force plus wrist movement during closed method extractions

Background: Atraumatic dental extraction preserves bone and maintains gingival architecture, thereby ensuring the option of replacement with implant supported prosthesis. The present study was conducted to compare the efficiency of arm force only versus arm force plus wrist movement during closed method extractions. Materials &amp; Methods: 84 patients undergoing mandibular molar extraction of both genders were selected. Patients were divided into 2 groups. Each group comprised of 42 patients. In group I, interns used arm force only while in group II, interns used both arm force and wrist movement in extraction of mandibular molar. Parameters such as time taken for extraction, root fracture, bone plate facture, and adherence of buccal plate to the root were assessed. Results: Group I had 22 males and 20 females and group II had 18 males and 24 females. The mean time taken for extraction was 10.2 minutes in group I and 5.4 minutes in group II. The difference was significant (P&lt; 0.05).

Management of Root Sensitivity following Socket Shield Technique with Anterior Single Immediate Implant Placement and Provisionalization.

It is challenging for implants in the esthetic zone to maintain the facial soft tissue contour and interimplant papillae. To counteract the inevitable hard and soft tissue changes after tooth extraction, the socket shield technique (SST) has been advocated as means to maintain the facial and/or interproximal osseous and gingival architecture. As SST is a technique-sensitive procedure, various complications related to SST have been reported. This article presents a unique complication after a socket shield procedure and a novel management of the complication.

A technique for improved gingival esthetics on complete arch implant-supported acrylic resin prototype prosthesis

An important step during the workflow of complete arch fixed implant-supported prostheses is the fabrication of an acrylic resin prototype prosthesis so that the patient can visualize the definitive treatment outcome or to be used as an interim prosthesis. The prototype prosthesis is typically designed digitally as a single file and is produced by milling from a solid block of white-colored prepolymerized acrylic resin. A common challenge in fabricating a resin-based prototype prosthesis is reproducing the natural appearance of the gingival architecture in gingiva-colored material. Current methods, including multicolored resin blocks, gingiva-colored stain, and layering with gingiva-colored composite resin, can be costly, time-consuming, and labor-intensive. This article describes a straightforward chairside technique that allows clinicians to fabricate an acrylic resin prototype prosthesis with appropriate gingival esthetics.