Gingival Esthetics Research Articles

Validation of a New Questionnaire for Assessing the Psychosocial Impact of Gingival Aesthetics (PIGAQ).

While the importance of gingival aesthetics is increasingly recognized, a questionnaire quantifying its psychosocial impact is still lacking. We have adapted the validated Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) for the gingival context. This study's aim was to develop a new Psychosocial Impact of Gingival Aesthetics Questionnaire (PIGAQ) and test its validity for the general population in Spain, exploring the underlying dimensions of the construct assessed. The PIDAQ was adapted to address gingival aesthetics. PIGAQ (23 items) was completed by 200 patients aged from 18 to 85 years, and socio-demographic variables were recorded. The four-dimensional structure of the PIDAQ was respected, adapting the subscales to focus on the gingiva. Descriptive analysis, assessments of reliability and validity and an exploratory factor analysis were performed. The revised PIGAQ (now containing 20 items) has a Cronbach's alpha coefficient of 0.88 with four underlying factors explaining 61.5% of the total variance. Three items (SI-1, PI-2 and PI-5) were eliminated because of unacceptable fit indices. The Cronbach's alpha coefficients for the subscales are as follows: Gingival Self-Confidence, 0.85; Social Impact, 0.84; Psychological Impact, 0.79; and Aesthetic Concern, 0.76. PIGAQ is a reliable and potentially valid instrument for assessing psychosocial perceptions of gingival aesthetics. The scale was shown to have a satisfactory factor structure and level of internal consistency.

TÉCNICAS CIRÚRGICAS PARA ESTÉTICA GENGIVAL E PERFIL EMERGENTE EM IMPLANTODONTIA

Introduction: Implant dentistry seeks to improve the similarity of implants with natural teeth, focusing on soft tissue quality, authentic gingival shape and adequate crown. The emergence profile plays a vital role in implant esthetics, guiding the soft tissues and preventing food accumulation. Direct and indirect techniques manipulate tissue to create the emergence profile using grafts and temporary abutments. Connective grafts and PRF are options to improve the gingival phenotype, with standard CTG and PRF promising to treat peri-implant diseases. Choosing the right techniques is crucial to restoring the patient’s anatomical profile. This study explores the main surgical techniques for gingival aesthetics and the emerging profile in implant dentistry. Objectives: To address the main surgical techniques for gingival aesthetics and the emerging profile in implant dentistry. Results: 27 articles were obtained, 2 (by duplicity), 20 (by abstract) and 1 (by not meeting the eligibility criteria) were excluded. Finally, 4 articles were included in this review. Discussion: the appropriate surgical technique promotes an adequate emergency aesthetic profile that reduces the time of the clinical procedure and obtains the best osseointegration associated with a peri-implant tissue, stable, healthy, with ideal and safe extensions. Thus achieving longevity in protection and gingival health. Conclusion: The choice of surgical technique depends on the individual characteristics of each patient, and the anatomical and aesthetic aspects of the patient must be considered in order to create an emerging profile that is aesthetically healthy and functionally healthy.

The "Smile Design and Space" Concept for Altering Vertical Dimension of Occlusion and Esthetic Restorative Material Selection.

This article introduces the smile design and space (SDS) concept for managing the vertical dimension of occlusion (VDO) in full-mouth reconstructions and its influence on the selection of esthetic restorative materials. Limitations of traditional VDO adjustment methods are being addressed through a facially driven treatment approach that enhances esthetics improves function and minimizes invasiveness. The SDS concept involves detailed evaluations of the incisal edges of the maxillary central incisors in relation to the upper lip at rest and at full smile. This includes analyzing variations in incisal exposure due to differing lip mobility, which can significantly impact gingival esthetics, particularly in cases with gingival exposure during smiling. The concept employs a strategic formula to determine the necessary alterations in VDO based on specific dental relationships and wear patterns. The SDS concept provides guidelines for full-mouth reconstructions, emphasizing minimal invasiveness and the integration of esthetics with functional dynamics to enhance the predictability of clinical outcomes and reduce complications associated with traditional restoration techniques. The SDS concept enhances the precision of full-mouth reconstructions through individualized adjustment of the VDO, tailored to the esthetic and functional requirements of each patient.

A STUDY ON THE INFLUENCE OF GINGIVAL ESTHETICS ON THE ESTHETIC PERCEPTION OF WIDE SMILE

Aim: To examine the influence of gingival esthetics on the esthetic perception of wide smile; as when the subject smiles more openly exposing the gingiva and how it is esthetically appreciated by the common people and to correlate the gold standard criteria (Gingival zenith alignment is considered gold standard here) with the manipulated gingival esthetics. Materials & Methods: 50 clinical and 50 nonclinical students, a total of 100 students were involved in the study to score the esthetics of the smile photographs shown to them. Results: clinical and non clinical students were not able to find all the manipulated smiles as unesthetic smile. Conclusion: Gold standard factors like Gingival zenith doesn’t always play an important role in determining esthetic smile.

Observation of the clinical effect of immediate implantation and delayed implantation in the maxillary and maxillary molars.

To study the clinical application effect of two kinds of implants in the upper and lower molars. A selection of 120 patients (134 teeth) who underwent implant treatment in the upper and lower molars in the army hospital of the Chinese people's liberation army from January 2018 to June 2019 were divided into an immediate group (using immediate implantation) and a delayed group (using delayed implantation) using a random number table 60 cases (60 teeth) in each group; differences in implant success rate, buccal keratinized gingival width before and after treatment, alveolar bone absorption, periodontal pocket depth, and gingival aesthetic indicators were compared between the two groups. The gingival aesthetics effect of the immediate group was better than that of the delayed group on the whole and the difference was statistically significant (P<0.05); after 12 months of restoration, the implantation success rate of the immediate group was 96.67%. The deferred group was 93.33%, and the difference between the two groups was not statistically significant (P>0.05). Both delayed restoration and immediate implant restoration can achieve good results in implant restoration treatment in the maxillary and maxillary molars. However, immediate implantation has certain advantages in reducing the amount of alveolar bone absorption and maintaining the aesthetic effect of the gums.

Reliability of the novel cleft lip and palate smile esthetic index (CLP-SEI).

The aim of this research was to determine the reliability of a novel index for the assessment of smile esthetics in patients with cleft lip and/or palate (CL ± P) at the end of their multidisciplinary treatment, for use in clinical and academic settings. Five orthodontists, five periodontologists, five general practitioners, five dental students, and five laypeople rated the smiles of 10 patients with CL ± P twice at a 2 weeks interval. The rating scale consisted of four main categories: 1. nasolabial esthetics, 2. gingival esthetics, 3. dental esthetics, and 4. overall esthetics. A total of 15 parameters were rated. Intra- and inter-rater agreements were calculated using SPSS. The inter-rater agreement varied between good and excellent whereby the orthodontists, periodontists, general practitioners, dental students, and laypeople obtained agreement scores of 0.86, 0.92, 0.84, 0.90, and 0.89, respectively. The intra-rater agreement was good with agreement scores of 0.78, 0.84, 0.84, 0.80, and 0.79, respectively. Smile esthetics were rated on static pictures, not in real life or by video recordings in a young adult population. The cleft lip and palate smile esthetic index is a reliable tool for the assessment of smile esthetics in patients with CL ± P.

CLINICAL FEATURES OF GINGIVAL HYPERPIGMENTATION IN VIETNAMESE OUTPATIENTS

Background: Gingival esthetics was considered one of the most significant aspects of aesthetic smiles, especially in those with gingival hyperpigmentation. Understanding the features, distribution, and causes impacting gingival pigmentation was critical for developing an effective treatment plan. Objectives: The prevalence of gingival hyperpigmentation in outpatients at Can Tho University of Medicine and Pharmacy Hospital; the association between gingival hyperpigmentation and age, gender, smoking status, and skin color. Material and Methods: Descriptive cross-sectional method; convenience sampling. Results: In a total of 100 outpatients, the rate of gingival hyperpigmentation was 53%, of which 40% had mild gingival hyperpigmentation according to DOPI (grade 1), 13% had moderate gingival hyperpigmentation (grade 2), and 13% had heavy gingival hyperpigmentation disease (grade 3). The study collected 3/6 groups of gingival melanin hyperpigmentation according to Ponnaiyan's classification. Of all the hyperpigmentation groups according to Hedin's classification, the hyperpigmentation group forming a long continuous ribbon accounted for a high proportion (45% in the maxilla, 40% in the mandible). The rates of gingival hyperpigmentation in the group of 40-year-old patients and the others were 48.8% and 75%, respectively. Conclusion: There was a statistically significant relationship between gingival melanin pigmentation and skin color. The percentage of melanin pigmentation was higher in those with dark skin. There were no differences in the ratios for age, gender, or smoking status.

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.

Combined Effect of Platelet-Rich Fibrin Matrix (PRFM) and Demineralized Freeze-Dried Bone Allograft (DFDBA) in Immediate Implant Placement: A Single-Arm Clinical Trial

Introduction Placement of immediate implants in contrast to delayed implant placement may be favorable. The factors contributing to this are shortened overall treatment time, aid in ideal orientation andfixture placement, bone preservation following extraction, and achieving optimal aesthetics involving soft tissue. However,the gap distance between the surface of the implant and the buccal bony wall during implant placement is critical for subsequent bone healing in a fresh extraction socket. Considering that as the gap broadens, the amount of bone-to-implant contact (BIC) decreases, causing an apical shift of the highest bone-implant contact. Incorporating a bone substitute material (BSM) within the fixture-socket gap preserves alveolar ridge volume by minimizing socket remodeling and encouraging de-novo bone formation. Aim and objectives To evaluate the efficacy of platelet-rich fibrin matrix (PRFM) and demineralized freeze-dried bone allograft (DFDBA) in fresh extraction socket with simultaneous implant placement. Methods Implants were immediately placed in 12 patients following a two-stage submerged protocol. The combination of PRFM and DFDBA was used to fill the gap between the implant body and the surrounding socket wall. The final restoration was placed after 3 months following implant placement. The full mouth plaque, gingival bleeding index, and gingival esthetics scores were assessed at baseline, 3, and 6 months. The crestal changes were evaluated using intraoral periapical radiographs (IOPA) at baseline, 3, and 6 months. Cone beam computed tomography (CBCT) images were obtained at baseline and 6 months after implant loading to analyze the buccolingual changes. Results At 6 months follow-up, the coronal bone remodeling detected on CBCT revealed a minimal (0.1 mm) narrowing of the alveolar ridge in a buccolingual direction, with a mean bone loss of 0.10+0.09, which was statistically non-significant (p > 0.05). Implant success was 100% at 6 months after loading as determined by Akbrektsson's criteria for implant success. Conclusions The adjunctive use of PRFM with DFDBA following immediate implant placement yielded a significant reduction in bone resorption and maintenance of buccolingual dimensions.

Study protocol for the management of impacted maxillary central incisors: a multicentre randomised clinical trial: the iMAC Trial

BackgroundFailure of eruption of the maxillary permanent incisor teeth usually presents in the mixed dentition between the ages of 7 and 9 years. Missing and unerupted maxillary incisors can be regarded as unattractive and have a potentially negative impact on facial and dental aesthetics. The presence of a supernumerary tooth (or odontoma) is commonly responsible for failed eruption or impaction of the permanent maxillary incisors. The primary objective of this trial is to investigate the success of eruption associated with maxillary incisor teeth that have failed to erupt because of a supernumerary tooth in the anterior maxilla.MethodsThis protocol describes an interventional multicentre two-arm randomised clinical trial. Participants meeting the eligibility criteria will be randomised (unrestricted equal participant allocation [1:1]) to either space creation with an orthodontic appliance, removal of the supernumerary tooth and application of direct orthodontic traction or space creation with an orthodontic appliance, removal of the supernumerary tooth and monitoring. The primary outcome of this trial is to determine the prevalence of successfully erupted maxillary central permanent incisors at 6 months following removal of the supernumerary tooth. Secondary outcome measures include (1) the effect of initial tooth position (assessed radiographically) on time taken for the tooth to erupt, (2) time taken to align the unerupted tooth to the correct occlusal position, (3) gingival aesthetics and (4) changes in the self-reported Oral Health Related-Quality of Life (OHRQoL) (pre-and post-treatment).DiscussionThere is a lack of high-quality robust prospective studies comparing the effectiveness of interventions to manage this condition. Furthermore, the UK national clinical guidelines have highlighted a lack of definitive treatment protocols for the management of children who present with an unerupted maxillary incisor due to the presence of a supernumerary tooth. The results of this trial will inform future treatment guidelines for the management of this condition in young children.Trial registrationISRCTN Registry ISRCTN12709966. Registered on 16 June 2022.

GINGIVAL DEPIGMENTATION USING SIMPLE DE-EPITHELIZATION BY BUR ABRASION TECHNIQUE - A CASE REPORT

Dentofacial esthetics demands have increased tremendously in the past decade. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with the challenge of achieving gingival esthetics. Melanin pigmentation of the gingiva occurs in all races. Gingival hyper-pigmentation is seen as a genetic trait in some populations and is more appropriately termed physiologic or racial gingival pigmentation. Pigmentation of gingiva not just has an impact on esthetics but also creates psychological negativity.Treatment of gingival melanin pigmentation can be done using scalpel, chemical agents, abrasion, grafts, electro surgery, cryosurgery or lasers. Recent reports on treatment of gingival melanin pigmentation using bur abrasion method which shows results in terms of ease of use, acceptance and patient comfort to be far superior to other techniques.

Crown Lengthening Surgery for Treating Asymmetric Gingiva: A Case Report

Background: The aesthetic appearance of gingiva is influenced by color, contour, interdental papilla and location of gingival margin. Crown lengthening is one of the surgical procedures performed to improve aesthetic problems. It can be performed by gingivectomy, with or without alveolar bone removal (osteotomy) to obtain a good crown and root ratios.&#x0D; Objective: To obtain better crown and root ratios, resulting in more aesthetic smile.&#x0D; Case Report: A 24-year-old woman presented with a complaint that the length of her anterior maxilla teeth was different. Extraoral examination showed a symmetric face with no abnormalities and the patient did not have a systemic disease. Intraoral examination showed that the gingival margins between teeth 11 and 21 was asymmetric, consistency of the gingiva was normal, there was no sign of inflammation and the pocket depth was 2–3 mm. The patient was given scaling in the first phase, and then the alignment of gingival margins of teeth 11–13 with teeth 21–23 was measured. Gingivectomy was performed on teeth 21–23 using scalpel no. 11, gingival contour was formed and the periodontal pack was applied.&#x0D; Results: The patient reported no complaints at the one-week follow-up and the gingival margin looked symmetrical one-month post-surgery.&#x0D; Conclusion: Crown-lengthening surgery with a gingivectomy procedure gives a good aesthetic result, in this case, characterized by a symmetrical gingival margin.&#x0D; Keywords: crown lengthening, gingivectomy, gingival aesthetics

Management of gingival hyperpigmentation using three different techniques: A case series

Although the colour of the gingiva plays a vital part in overall aesthetics, the ideas and strategies for treating problems caused by gingival melanin pigmentation are still being worked out. Clinicians are confronted with obtaining acceptable gingival aesthetics as well as resolving biologic and functional difficulties as aesthetics has become an important element of dentistry. This case report discusses three different de-epithelization treatments that have been effectively utilised to treat gingival hyperpigmentation caused by excessive melanin deposition, as well as the importance of having an aesthetically pleasant smile, especially for smile aware people. Creating esthetic awareness among dental practitioners about various treatment modalitites for the management of gingival hyperpigmentation.

The soft tissue esthetic outcome with and without immediate provisionalization in immediate implants: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed at checking influences of immediate provisionalization on the primary esthetic outcome by Pink Esthetic Score (PES) as well as other secondary soft tissue outcomes such as bleeding on probing, probing depth, plaque index, mesial papillary recession, distal papillary recession, and midfacial mucosal recession of the peri-implant mucosa around immediately placed implants in the anterior maxilla. This systematic review and meta-analysis was evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The relevant studies were found in the databases such as MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials, Science Direct, and Google Scholar. The search was restricted to studies published in English only, with no time constraints. A second hand search was conducted on individual journals and study reference lists. The Evidence Project risk-of-bias tool was used to assess the risk of bias in included studies. The level of evidence was determined using the GRADEpro GDT: GRADEpro Guideline Development Tool (software). McMaster University, 2020 (developed by Evidence Prime, Inc.,). The statistical meta-analysis was conducted by using Review Manager (RevMan) (Computer Program). Version 5.4. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2020. Nine studies were finalized. Seven studies were selected out of nine in the meta-analysis for PES. The results of the current meta-analysis for primary outcome observed that immediate implant placement (IIP) followed by immediate provisionalization improves the esthetic outcome, with forest plot favoring immediate provisionalization and demonstrating a statistically significant difference (mean difference [MD] =1.54, [95% confidence interval (CI): 0.82-2.27], P < 0.0001). Statistically insignificant result was observed for secondary outcomes; bleeding on probing (MD = 4.00, [95% CI: -1.15-9.15], P = 0.13), probing depth (MD = 0.17, [95% CI: -0.13-0.48], P = 0.26), plaque index (MD = -1.00, [95% CI: -7.56-5.56], P = 0.77), mesial papillary recession (MD = -0.10, [95% CI: -0.31-0.10], P = 0.33), midfacial mucosal recession (MD = -0.47, [95% CI: -1.01-0.07], P = 0.09). However, for distal papillary recession (MD = -0.32, [95% CI: -0.50--0.13], P = 0.0007), the result was statistically significant with forest plot favoring immediate provisionalization. When the implant is placed in the esthetic zone, IIP with immediate provisionalization provides the best gingival (pink) esthetics.

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.

A case report on gingival depigmentation by scraping method by scalpel

Smile is the most wonderful gesture of the human being. A Person who is genuinally happy shows his or her pleasure in the form of smile. A beautiful smile for sure enhances individual self confidence. A beautiful smile lies in a harmonial balance between competent lips, size, color, and proper alighnment of teeth and the color of gingival tissues. The normal color of gingival is coral pink as in accordance to British population, and pale pink as in accordance to Indian population. However this gingival pigmentation varies among each and every individual in accordance with the color of the skin, various pigments present in human body like melanin, haemoglobin, carotene. However this melanin when secreted in excess, can lead to brownish, blackish, or bluish discoloration of gingiva, and this discoloration is denoted by the term hyperpigmentation, and the procedure to overcome this hyperpigmentation is called as depigmentation. Present case report is on a 21 years old female whose chief complaint was visual blackish display of gums while smiling. So the procedure depigmentation was done by surgical scalpel by scraping method, and the patient showed better results following two weeks after procedure. Esthetic dentistry is a recently emerging branch. People now a days are much more concern about the gingival esthetics and smile design, as they want their smile to be beautiful in order to boost up their confidence. . One of the gingival esthetic for which the people are concerned are the hyperpigmented gingiva. Gingival depigmentation is the process to remove this abnormal pigmented gingiva. The clinician must have a knowledge as for which condition, which type of gingival depigmentation technique can be applie so as in order to make the treatment successful.

Maxillary anterior implant restorations fabricated with digital workflow in Dental Clinic : Case Report

For anterior implant prostheses, both teeth and gingival esthetics must be considered. It is true that one mis-take during analog implant surgery and prosthesis manufacturing can cause failure of the final results, making it difficult to access easily. Recently, digital devices such as CT, intraoral scanners, CAD programs, milling ma-chines, and 3D printers are spreading to dental clinics. By utilizing this, digital workflow can minimize mistakesin each process and complete successful anterior implant prostheses within the clinics. If we accurately recog-nize the possibilities and limitations of digital clinical practice and effectively apply them to clinical practice, standardized results can be obtained and various applications will be possible in the future.

Evaluation of the peri-implant tissues in the esthetic zone with prefabricated titanium or zirconia abutments: A randomized controlled clinical trial with a minimum follow-up of 7 years

Statement of problemLong-term clinical studies are lacking on the influence of the type of abutment, titanium or zirconia, on peri-implant tissues. PurposeThe purpose of this randomized clinical trial was to evaluate peri-implant tissues with titanium or zirconia abutments. Material and methodsA total of 26 single-tooth implant-supported prostheses in 14 participants were analyzed. They received either a titanium abutment with a metal-ceramic crown (TAG) or a zirconia abutment with a ceramic crown (ZAG). Data were collected immediately, at 5 months, and at a minimum of 7 years after crown delivery. The success rate, plaque and bleeding indexes, bleeding on probing, white and pink esthetic scores, and the relationships of the gingival phenotype with the pink esthetic score were analyzed. Statistical analyses were conducted with the t test for paired and independent data (α=.05). ResultsThe mean follow-up time was 95.2 ±2.6 months, showing an implant success rate of 96.7%. No statistically significant differences were found between TAG and ZAG among the time intervals evaluated for plaque or bleeding indexes (P>.05). A statistically significant difference was found for peri-implant probing depths in the mid-buccal sites between the groups at all the time intervals evaluated (TAG, P=.008; ZAG, P=.021): TAG showed an increase between 5 months (3.65 ±0.93 mm) and over 7 years (4.47 ±1.32 mm); and ZAG showed a reduction (5 months=5.22 ±1.71 mm; over 7 years=4.25 ±1.28 mm) in values. For the pink (PES) and white esthetic score (WES), ZAG (PES: immediately=6.33 ±1.41; 5 months=7.44 ±1.81; over 7 years=8.25 ±1.03; WES: immediately=7.67 ±1.50; over 7 years=8.38 ±0.74) showed higher mean values than TAG (PES: immediately=5.94 ±2.35; 5 months=6.53 ±2.15; over 7 years=7.44 ±1.81; WES: immediately=7.00 ±1.17; over 7 years=8.35 ±1.27) (P<.05). Statistically significant differences were found for gingival phenotype and for PES in TAG (P=.031), and the participants with thick phenotype showed higher PES in the 3 time intervals studied. ConclusionsZirconia abutments exhibited better results than titanium abutments in terms of the peri-implant tissues. Moreover, in those with a thin phenotype, zirconia provided improved gingival esthetics.

Morphological features of smile attractiveness and related factors influence perception and gingival aesthetic parameters

IntroductionIn addition to understanding the basic standards of a smile and patient's opinion, dentists should take into account smile aesthetics, an essential factor for optimal outcomes. This study aimed to evaluate the factors that affect the perception of an aesthetic smile and determine its morphological characteristics and measure the gingival aesthetic parameters. MethodsIn all, 200 Vietnamese aged 18-35 years were recruited to have their spontaneous smiles captured. These smile images were assessed by 50 laypersons and 50 dentists using a visual analogue scale measurement. The images were analysed to evaluate perceptions of evaluators, determine smile attractiveness, and measure gingival aesthetics. ResultsThe difference in the judgements of laypersons and dentists, males and females, and laypersons aged 18-25 and 26-35 years were nonsignificant. High or average anterior smile line, parallel smile arc, upward upper lip curvature, second premolars as the posterior-most teeth displayed, smile index of 5.23-5.63, and dynamic smile symmetry of 1 were scored highly on smile attractiveness. The following maxillary gingival aesthetic parameters were preferred: gingival zenith (GZ) of the canine 0.72-0.75 mm apical to the GZ of the central incisor; GZ of the lateral incisor 0.66 mm coronal to the gingival line; gingival line angle of ∼87°; for the central incisor, lateral incisor, and canines, distance from the GZ to the long axis of 1, 0.4, and 0 mm, respectively; interdental papilla height of 4.25, 3.60, and 3.85 mm, respectively; ratio of the distance from the GZ and the interdental papilla tip to the incisal edge of ∼1.74-1.77 mm. ConclusionsFactors including profession, gender, and age of evaluators had almost no impact on their perception of aesthetics. Smile attractiveness characteristics and gingival aesthetic parameters have clinical applicability for patient care.

A novel minimally-invasive approach for metal tattoo removal with Er:YAG laser.

Few effective and established treatment methods can remove gingival metal or amalgam tattoos. With this case series, we aimed to demonstrate the use of a novel minimally invasive technique to remove metal tattoos using an erbium-doped yttrium aluminum garnet (Er:YAG) laser. We retrospectively collected clinical data from 18 patients who had undergone Er:YAG laser treatment to remove metal tattoos. Minimal gingival ablation using an Er:YAG laser directed towards the pigmented area was performed, which exposed metal debris within the connective tissue that was carefully removed. A dental microscope was employed to identify the metal debris, for accurate irradiation, and to minimize wounding by reducing invasion. Postoperative gingival color and morphology, and visual analog scale as a patient-reported outcome assessing postoperative pain were evaluated. All patients' metal tattoos were removed completely and safely during short procedures. Considerable esthetic improvements and favorable wound healing were achieved with almost no postoperative pain or complications. The findings from this case series suggest that this novel minimally invasive therapy for metal tattoo removal that involved the Er:YAG laser is effective and safe, is associated with successful outcomes, and contributes greatly to patients' esthetic satisfaction. Metal tattoo removal using an Er:YAG laser safely and successfully improved gingival esthetics. This novel technique is much simpler and less invasive than conventional periodontal plastic surgery, and it may be more reliable regarding esthetic gingival improvements as it is associated with favorable wound healing, and it could offer significant benefits to patients by alleviating physical and mental stresses via reduced chair time and postoperative pain.