Gingival Esthetics Research Articles

Modified semilunar coronally advanced flap: A case series

Dentists traditionally think of periodontal treatment as a means of saving the teeth while leaving the patient with an esthetic problem. The goal of gingival esthetics is to maintain normal healthy gingival appearance around teeth that must be restored. Gingival recession represents a significant concern for patients and a therapeutic problem for the clinician. Root coverage is the goal of periodontal plastic surgery when treating gingival recessions in the esthetic zone. Correction of mucogingival recession deformities with a variety of periodontal plastic surgical procedures have been described each demonstrating a variable degree of success. This case report presents to you the treatment outcomes and predictability of modified semilunar coronally advanced flap (Kamran Haghighat) techniques described for the treatment of recession defects on single and multiple adjacent teeth, respectively.

Additive Solution to Diastema Closure by a Combination of Direct and Indirect Techniques

Smile design in restorative dentistry embraces facial esthetics, gingival esthetics, the relationship between soft and hard tissues and dental asthetics [1,2]. Smile design requires assessment of facial soft tissues and skeleton, followed by intraoral examination of the teeth and their relationship with lips and soft tissues [3]. A facial analysis is performed to determine how lips and soft tissue frame the smile in different positions of speech and laughter and establishes the localization of the facial midline and its position with respect to the dental midline. Smile parameters include: gingival marginal levels tooth size, including tooth-tooth proportion and tooth width: length ratio; tooth position; tooth shape; incisal embrasures; connector spaces, where adjacent teeth appear to touch; axial inclinations; and the shade of maxillary teeth [2].

Gingival depigmentation by surgical treatment

In dentistry, esthetics is a great concern both for the patient and operator. The aim of this clinical article is to review the methods of depigmentation of melanin pigmentation of gingiva and explain scalpel surgical technique for depigmentation of gingiva. Gingival pigmentation occurs in all races of mankind. The degree of melanin pigmentation may vary from person to person. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with a challenge of achieving gingival esthetics. This article presents a simple surgical technique of de-epithelization which has been successfully used to treat gingival hyperpigmentation caused by excessive melanin deposition.

Treatment of traumatized maxillary central incisors

Traumatic injury to the upper anterior teeth is not uncommon in young children. Dental ankylosis frequently occurs when teeth are traumatically luxated or replanted after being avulsed. Orthodontic movement of a traumatized tooth is difficult, especially when treating an ankylosed tooth without surgical luxation and distraction osteogenesis. This report describes a case of a patient with class I crowded malocclusion and labially displaced and intruded traumatized maxillary incisors. The protruded traumatized incisors were successfully brought to an acceptable position with acceptable gingival esthetics through the use of simple orthodontic traction combined with first-premolar extraction. An acceptable overbite and overjet were achieved within 14 months after completion of orthodontic treatment.

Gingival Conditioning in an Implant-Supported Prosthesis: A Clinical Report

The loss of gingival volume is a major challenge for dental surgeons with implant-supported fixed prosthesis manufactures, particularly from an aesthetics perspective in patients with a high smile line. Gingival tissue remodeling can help in papillae formation to avoid soft tissue surgery by reestablishing the appropriate shape and gingival contour of the tissues. This improves not only the aesthetics, but also the phonetics of the patient. This paper describes a clinical case of gingival conditioning obtained with interim implant-supported fixed partial dentures via incremental addition and adjustment of acrylic resin. The purpose of the gingival conditioning was to obtain improved aesthetics. Gingival conditioning by gradual pressure application is presented as an easy, non-traumatic technique that improves gingival aesthetics.

Evaluation of Soft Tissues Around Single Tooth Implants in the Anterior Maxilla Restored With Cemented and Screw-Retained Crowns

Implant-supported restorations can be attached as screw-retained or cemented prostheses. In both situations, the characteristics of the soft tissues around the implants are crucial for oral rehabilitation and patient satisfaction. Therefore, this study uses the Pink Esthetic Score (PES), which allows evaluation of gingival esthetics around implants, to evaluate the soft tissues around implants in the anterior maxilla rehabilitated with cemented prostheses (CP) and screw-retained prostheses (SP). Forty implants placed in the anterior maxilla were evaluated, and these had been rehabilitated with prosthetic crowns for a minimum of 1 year. Periodontal examination was performed to evaluate probing depth (PD) and bleeding on probing (BOP) of the implant and the corresponding natural tooth. The total mean (±SD) PES for SP was 10.73 (±1.98) and 10.41 (±2.67) for CP, which was not statistically significant (P ≥ .05). Periodontal examination revealed that CP and SP showed no difference for BOP (P ≥ .05). Differences were only detected in PD when comparing the reference teeth of both groups to CP and SP (P ≤ .05). The present study demonstrates that the PES proved to be an efficient index to assess peri-implant tissues, and that the type of crown retention does not influence the health and quality of the soft tissues around implants.

Treatment of traumatized maxillary central incisors

Traumatic injury to the upper anterior teeth is not uncommon in young children. Dental ankylosis frequently occurs when teeth are traumatically luxated or replanted after being avulsed. It is commonly recognized that orthodontic movement of a traumatized tooth is difficult, especially when treating an ankylosed tooth without surgical luxation and distraction osteogenesis. This report describes a case of a patient with Class I crowded malocclusion and labially displaced and intruded traumatized maxillary incisors. The protruded traumatized incisors were successfully brought to an acceptable position with acceptable gingival esthetics through the use of simple orthodontic traction combined with first-premolar extraction. An acceptable overbite and overjet were achieved within 14 months after completion of orthodontic treatment.

Depigmentation: A cornerstone in gingival esthetics (case series)

Depigmentation: A cornerstone in gingival esthetics (case series)

The prosthetic management of gingival aesthetics

Periodontal disease, trauma, and congenital defects can result in both soft tissue and hard tissue defects that can present with aesthetic problems. The management of these problems may be limited to prevention or surgical management which can result in significant morbidity especially if a second surgical site for grafting is utilised. This article describes the various prosthodontic techniques to improve gingival aesthetics using contemporary materials such as gingivally coloured composite and gingivally coloured porcelain in addition to more traditional materials such as standard prosthetic acrylic.

Gingival Esthetics by Depigmentation

Gingival Esthetics by Depigmentation

Sorriso Gengival: Cirurgia Ressectiva Coadjuvante à Estética Dental

Aim: report a case of the patient who presented relationship disharmonic between gingival smiles - also caused by presence of the high line lip - and discrepancy between the short lengths of the anterior superior teeth clinical crowns. Case description: the advantages, disadvantages, benefits, indications, contraindications, description of the gingivectomy technique and the harmony relationship between dental and gingival esthetics were discussed. Conclusion: gingival resective surgery (gingivectomy) is a co adjuvant effective procedure at the gingival conditioning reference to the dental esthetic, with purpose not only satisfactory esthetic results, how also the periodontal healthy maintenance.

Duration of reappearance of gingival melanin pigmentation after surgical removal - A clinical study.

Background:In dentistry, esthetics has a special place. Although gingival melanin pigmentation does not present a medical problem, clinicians are often faced with a challenge of achieving gingival esthetics.Materials and Methods:A method of de-epithelialization of the pigmented gingiva using Kirkland’s gingivectomy knife is described. Twenty patients who were conscious about their gingival melanin pigmentation were selected. The gingiva of the whole of the arch was abraded until the entire visible pigmentation was removed. Clinical observations for intensity of pigmentation were recorded at baseline and then after surgery at monthly intervals over a period of 9 months according to Dummett-Gupta Oral Pigmentation Index scoring criteria proposed by Dummett C. O. in 1964.Results:The mean gingival melanin pigmentation score came down to 0.407 after 9 months as compared to preoperative score, which was 2.24. No repigmentation occurred in fair-complexioned persons. In persons with wheatish complexion, repigmentation was seen in 85.71% of the cases, but scores came down to 0.38 postoperatively as compared to 2.27 preoperatively. In dark-complexioned persons, repigmentation occurred in all cases, but the mean scores were 0.93 as compared to 2.40 preoperatively. The difference between preoperative and postoperative mean scores for each segment was put to statistical analysis by applying paired t test and was found to be significant.Conclusion:As this method has shown statistically significant results, it can be used in patients who are conscious of pigmented gingiva and want an esthetically satisfactory color.

A miniature tooth-borne distractor for the alignment of ankylosed teeth.

The ankylosis of a tooth is one of the most difficult clinical problems that an orthodontist faces. In the literature, the treatment protocols for ankylosed teeth are still insufficient and questionable when considering gingival esthetics and conservation of bone health. The purpose of this report is to evaluate and discuss the effects of a newly designed miniature tooth distractor (MTD), which can be used with infrapositioned ankylosed teeth. Two cases with vertically malpositioned incisors were treated using the MTD, and this device was evaluated and compared with the distraction appliances used before in the literature. In conclusion, it was found to be efficient with its small dimensions, ease of application and removal, ease of activation, buccolingual control, and patient tolerance.

Immediate implants placed into infected sockets: a case report with 3-year follow-up

The esthetics and functional integrity of the periodontal tissue may be compromised by dental loss. Immediate implants became a viable option to maintain the periodontal architecture because of their anatomic compatibility with the dental socket and the possibility of eliminating local contamination. This article describes the procedure of immediate implant placement in the anterior maxilla replacing teeth with chronic periapical lesions, which were condemned due to endodontic lesions persisting after failed endodontic treatment and endodontic surgery, and discusses the relationship between the procedure and periapical lesions. Surgical removal of hopeless teeth 11, 12 and 21 was performed conservatively in such a way to preserve the anatomy and gingival esthetics. A second surgical access was gained at the apical level, allowing the debridement of the surgical chamber for elimination of the periapical lesion, visual orientation for setting of the implants and filling of the surgical chamber with xenogenous bovine bone graft. After this procedure, the bone chamber was covered with an absorbent membrane and the healing screws were positioned on the implants. Later, a provisional partial removable denture was installed and the implants were inserted after 6 months. After 3 years of rehabilitation, the implants present satisfactory functional and esthetic conditions, suggesting that immediate implant placement combined with guided bone regeneration may be indicated for replacing teeth lost due to chronic periapical lesions with endodontic failure history in the anterior maxilla.

Isolated Vertical Infrabony Defects Treated by Orthodontic Tooth Extrusion

It has been reported that periodontal disease and traumatic occlusion may cause an isolated vertical infrabony defect. In such cases, the improvement of both inflammation and the occlusion are necessary to ameliorate the defect. We discuss the successful orthodontic treatment of an adult patient with isolated vertical infrabony defects of the maxillary right lateral incisor, left canine, and mandibular left incisor regions. The patient showed an anterior crossbite and one- and two-wall wide isolated vertical infrabony defects. The inflammation was improved by a periodontist; however, the vertical infrabony defects remained. In order to improve the defects, the pulps of the maxillary right lateral incisor, left canine, and mandibular left incisor were extirpated, and temporary crowns were put on those teeth. Next, an edgewise appliance was applied to the maxillary and mandibular teeth. After the anterior crossbite was improved, the incisor edge regions of the temporary crowns were ground, and the maxillary right lateral incisor, left canine, and mandibular left incisor were extruded until they touched antagonistic teeth. The patient's anterior crossbite, traumatic occlusion and gingival esthetics were improved by this treatment. Panoramic and dental radiographs after treatment also showed improvement of the vertical infrabony defects. Thus, tooth extrusion might be effective to improve one- and two-wall wide isolated vertical infrabony defects.

Surgical and Prosthetic Management of Interproximal Region With Single‐Implant Restorations: 1‐Year Prospective Study

Gingival esthetics around dental implants have become a main focus for clinicians. This study analyzed the surgical, prosthetic, and anatomic factors involved in the management of peri-implant tissues. Forty-eight subjects with one tooth scheduled for tooth extraction and immediate implant placement were included in the study. After healing, the implants were restored with single-crown fixed prostheses. The following parameters were assessed after 12 months: presence/absence of the interproximal papilla, interimplant-tooth distance (ITD), distance from the base of the contact point to the interdental bone (CPB), and soft tissue biotype. ITD and CPB values were derived from computer analysis of periapical radiographs. A statistical analysis determined the effect of ITD and CPB on the presence of the interproximal papilla. Papilla was significantly present (P <0.05) for ITD of 2.5 to 4 mm in anterior and posterior areas and for CPB < or =7 mm in posterior areas. Thick biotype was significantly associated (P <0.05) with the presence of the papilla. The combination of surgical and prosthetic plans represents the key factor to optimize predictability in single-implant esthetics. The recommended interproximal distance between the implant and the adjacent tooth is 2.5 to 4 mm. The distance from the contact point to the interdental bone is recommended to be <7 mm. Papilla presence is also correlated with a thick gingival biotype.

The Myth of Instant Orthodontics: An Ethical Quandary

There is a clinical trend of using porcelain veneer restorations (PVRs) for the correction of malaligned anterior teeth. Use of PVRs for this purpose raises clinical and ethical dilemmas.A literature review of four different topics (PVR preparation, enamel thickness of anterior teeth, dentinal bonding adhesive effectiveness and PVR long-term success) was conducted to determine the optimal preparation for a successful PVR. The amount of tooth malalignment that may be corrected with a PVR without adversely affecting its success was calculated.The optimal preparation for a successful PVR may have dentin exposed in the body of the preparation. However, most of the preparation must be in enamel, and all the margins must end in enamel. The strength of a dentin bond varies greatly owing to a multistep, technique-sensitive cementation process and is weaker than an enamel bond. It is not possible to correct atypical gingival esthetics (uneven gingival margins, uneven papillae, short papillae and bulbous gingivae) resulting from malaligned teeth through use of PVRs.andAligning a healthy tooth with a PVR is not a conservative procedure and more conservative treatment options (such as orthodontics, bleaching, direct bonding and enamelplasty) should be offered to the patient. In addition, the inability to restoratively improve gingival relationships with PVRs may result in achieving less-than-optimal esthetics. A clinician should present only treatment options that involve predictable, conservative restorations or that preserve healthy tooth structure. Aligning teeth with PVRs may create ethical dilemmas that can be resolved with the help of the American Dental Association Principles of Ethics and Code of Professional Conduct.

Optical phenomenon of peri‐implant soft tissue. Part II. preferred implant neck color to improve soft tissue esthetics

The purpose of this study was to investigate an optical solution to eliminate the undesirable shine-through effect of implants on peri-implant mucosa by selecting an optimized implant neck color based on an objective and quantifiable method. The optical effect of color strips on 15 peri-implant mucosal sites of 14 patients with Straumann single-tooth implant replacements in the maxillary anterior region was analyzed. The color differences between the peri-implant mucosa with insertion of each of eight different color strips (white, black, light pink, pink, light orange, orange, gold, violet) and the gingiva of an adjacent or contralateral tooth without any color strips were compared for the selection of optimal color of implant neck. Spectrophotometric color measurements were performed to compare the color difference index (DeltaE) and color coordinates (DeltaL*, Deltaa*, Deltab* and DeltaC*). The colors of the peri-implant mucosa with color strips and the gingiva of natural tooth demonstrated that the test site soft tissue with color strips of light pink, pink, light orange and orange showed a significantly smaller DeltaE value (P<0.05). Moreover, light pink exhibited the lowest mean DeltaE value of 2.6+/-0.6, indicating a clinically indistinguishable color difference. The results suggest that it is possible to improve gingival esthetics by coloring the implant neck, most effectively with light pink, to mask the impact of the underlying titanium implant. The use of implants with optimized neck colors to correct an esthetic deficiency may be a feasible approach to establish improved peri-implant soft tissue esthetics.

The Esthetic Challenge of Adjacent Implants

Reformation of natural-appearing sulcular and papilla anatomy between adjacent implants in the esthetic zone presents a complex challenge for the implant team. Guidelines for implant placement of adjacent implants and soft tissue development are introduced that optimize esthetic results. The rule of 3x3x3 PIE is a mnemonic, based on biologically and prosthetically driven implant placement, which maximizes the potential for optimal esthetics between adjacent implants. The 4 interdependent principles of the 3x3x3 PIE rule are as follows: 1) the platforms of the implants should be located 3 mm apical to the zeniths of the predetermined facial-gingival margins of the planned restorations, 2) the centers of the implants should be placed at a distance at least 3 mm palatal to the anticipated facial margins, 3) interimplant spacing of 3 mm is required between adjacent implant platforms, and 4) the implants should emerge through the palatal incisal edge of the ensuing crown positions. After placement of adjacent implants by the surgeon according to the rule of 3x3x3 PIE, the restorative dentist must then develop the remaining soft tissue beginning with a provisional restoration. The reformed peri-implant gingiva is then supported by the subgingival contours of the definitive abutments and crowns. If ideal gingival esthetics are not achievable, pontics or gingival-colored porcelain can be acceptable alternatives. New technologies, including platform switching, are enhancing clinicians' abilities to deliver consistent esthetic results with adjacent implants.

Smile Aesthetics

The aim of this article is to outline some of the factors practitioners should take into consideration when planning optimal smile aesthetics. The components of the smile that will be discussed include the smile arc, incisor/gingival display, smile width, gingival aesthetics, tooth proportionality/symmetry, contacts/connectors/embrasures and the dental midlines. A systematic evaluation of the components of the smile when planning treatment will help to improve smile aesthetics and produce greater patient and dentist satisfaction.