Gingival Recontouring Research Articles

Tratamento conservador de sorriso: um relato de caso e breve revisão sobre abordagem multidiscplinar na odontologia estética

ABSTRACT The gingival contour, the color of the teeth and the presence of interincisal diastema are seen as unsightly factors, being highly harmful from a social point of view. The present study aimed to report a comprehensive and conservative esthetic treatment executed with a multidisciplinary approach in a 20-year-old female patient that presented darkened teeth with poor spacing and excessive gingival display while smiling, as well as present a brief literature review on multidisciplinary approach in esthetic dentistry. After clinical examination and diagnosis, a treatment plan was elaborated to meet the patient’s expectations with a conservative approach. After patient consent, therapy began with supervised home-based tooth whitening with 22% carbamide peroxide applied one hour/daily for 14 days, followed with gingival recontouring surgery and, after a healing period of 30 days, diastemas closure with direct composite resin technique, occlusal adjustment, finishing, and polishing. The multidisciplinary approach was fundamental for the accomplishment of the proposed treatment, achieving satisfactory esthetic and functional results.

One Piece Dental Implants in Esthetic Zone

Objectives: In recent years, one-piece dental implants are widely used to replace missing teeth as the technique is minimally invasive, and its special design offers to be used in an atrophied and narrow bone. Few pieces of literature were found regarding the use of these dental implants in the esthetic zone. This study aimed to evaluate the esthetic satisfaction of patients treated with one-piece dental implants in the esthetic zone using a special technique to enhance gingival recontouring and provide an optimum emergence profile. 
 Methods: Twenty patients with single missing maxillary or mandibular teeth were enrolled in the study (25-50 year age group). They were treated by one-piece dental implants performing the flapless technique; a flame-shaped bur was used to create a sulcus around the implant abutment; the sulcus was then filled with flowable composite resin and allowed for seven days to recontour the gingival tissue. Esthetic satisfactions of the patients were evaluated two weeks and six months after the placement of the permanent crown using subjective and objective methods. 
 Results: The esthetic assessment after 14 days and after six months using the objective method Pink Esthetic Score / White Esthetic Score (PES / WES) index showed that 85% to 90% of the cases received PES and WES mean values of 6 or more, which is the threshold of clinical acceptability. Regarding the subjective method using the Visual Analogue Scale (VAS) index. After 14 days, the total means value for all the questions was (7.19), and the results after six months were (7.25). There was a statistically non-significant difference between the two-time intervals in both objective and subjective methods (P< 0.05). 
 Conclusions: It has been concluded that one-piece dental implants can be successfully used in the esthetic zone after the special gingival recontouring technique.

BIOLOGIC WIDTH CONCEPT IN GINGIVECTOMY

Background: Relationship between periodontal tissue and aesthetic considerations is an important thing to determine the form, function and aesthetics of periodontal tissue itself. For orthodontic cases with gingival enlargement, using the biological width concept in gingivectomy to facilitate an optimal oral hygiene maintenance, function and aesthetic. Bone sounding before gingival recontouring is dictated by the distance from the gingiva crest to alveolar crest. Recommended distance between margins restoration and alveolar bone crest is 3 mm to avoid breaching the biologic width.Case and Case Management: Case 1: A 21 years old female patient whom referred from orthodontist with gingival enlargement in upper front teeth after treated with fixed orthodontic for 1.5 years. PBI: 1,6. After clinical examination, bone sounding was performed = 7mm and gingivectomy without ostectomy was determined. Case 2: A male patient, 24 years old, with gingival enlargement in upper front teeth while treated with fixed orthodontic. After determined the problem, bone sounding (6 mm) was performed along with gingivectomy without ostectomy also for anterior upper right site.Conclusion: The purpose of this report is to provide a diagnostic rationale for gingival recontouring. When gingivectomy is determined, the concept of biological width must be applied achieve a harmonious gingival contour with an optimal oral hygiene maintenance.

Minimally invasive (flapless) crown lengthening by erbium:YAG laser in aesthetic zone

Crown lengthening is a surgical procedure aimed at exposure of a larger tooth surface by gingivectomy alone or with cortical bone remodelling for aesthetic purposes in the anterior zone of the maxilla or for reconstruction of teeth affected by subgingival caries. We report two cases of crown lengthening in the anterior maxilla for aesthetic purposes by gingival and bone re-contouring performed by erbium-doped yttrium aluminium garnet (erbium:YAG) laser. As highlighted in this report, the erbium:YAG laser-assisted crown lengthening is less invasive and also leads to faster clinical outcomes in contrast to the conventional surgical technique by scalpel incision, flap elevation and osteoplastic.

Laser Applications in Oral Surgery

Oral surgery can be assisted by surgical lasers: diode, erbium, CO2, Nd:YAG. The surgical lasers are used in various procedures on oral soft and bone tissues: aesthetic procedures (gingival recontouring, gingival depigmentation); operculectomy; pro-prosthetic surgical procedures (remodeling of mucosa on edentulous sites, dental crown lengthening, frenectomies, vestibuloplasty); excision of gingival or mucosa hyperplasia; peri-implantitis treatment; the removal of small exophytic lesions; the removal of oral benign lesions (ranula, mucocele, pyogenic granuloma, fibrous hyperplasia, epulis fissuratum, hemangioma). For optimum effects at the level of the target oral tissues, the laser energy parameters should be set in relation to the wavelength, the type of intervention, the nature of the inflammatory process (acutechronic), the tissue penetration depth, tissue pigmentation, and systemic status. The oral surgical procedures performed by surgical lasers are recommended in modern dentistry due to lower risk of soft and hard tissues necrosis, decreased rate of complications, higher patients’ compliance (decreased postoperative pain and discomfort) and the acceleration of the healing processes.

Abstracts from the 7th Congress of the World Federation for Laser in Dentistry European Division June 20–22, 2019 Parma, Italy

Abstracts from the 7th Congress of the World Federation for Laser in Dentistry European Division June 20–22, 2019 Parma, Italy

Management of Sub-gingival Fracture of Tooth by Multi-disciplinary Approach

Dental trauma is commonly occur in children and may involve adult person also. In permanent dentition crown fracture is common and it may be uncomplicated or complicated. Complicated crown-root fractures require a multidisciplinary treatment modality for longterm success. Here we presented multidisciplinary treatment of a traumatized permanent maxillary incisor of a young male patient where oblique tooth fracture involved coronal pulp. As more than 50% of the crown and palatal coronal part of the root had been fractured and the tooth could not be properly isolated during endodontic procedure which is essential for success of root canal treatment. An intra-canal wire hook was cemented in the root canal and attached to another wire fixed to the adjacent teeth. With the help of elastic band attached with hook the fractured tooth fragment was extruded to create clinical crown. Finally, gingival re-contouring was performed to establish optimum biological width. At last, porcelain fused to metal crown was placed and the patient was comfortable both esthetically and functionally.International Journal of Human and Health Sciences Vol. 03 No. 03 July’19. Page: 165-168

Low Level Laser Therapy in Orthodontics

Lasers are widely used in most of the fields in dentistry for many years and they have recently gained popularity in orthodontic practice. Most common procedures with laser applications in orthodontics could be summarized as acceleration of tooth movement, pain reduction after force application, bone regeneration in the median palatal suture area during maxillary expansion or consolidation phase after distraction osteogenesis, enamel etching during bonding procedure, reduction of enamel decalcification, debonding of ceramic brackets, soft tissue applications such as gingival recontouring and attachment placement for impacted teeth. In this review, biostimulation effect or low level laser therapy in orthodontics will be exclusively evaluated.

Esthetic rehabilitation of anterior teeth through gingival recontouring and ceramic veneers: a case report

Esthetic rehabilitations require a broad and thorough evaluation of all the elements that make up the smile such as lips, dental, and periodontal structures to plan the treatment to provide harmony to the whole set. Objective: To demonstrate through a case the association of Periodontics and Restorative Dentistry in the esthetic rehabilitation of anterior teeth replacing resin restorations by modifying the gingival architecture conservatively and harmonically. Case report: It is essential for a multidisciplinary approach to succeed in treatment. The replacement of previous restorations is an increasing demand in currently clinical practice, for many reasons, mainly due to dissatisfaction with the esthetics. It is observed that many of these patients involve not only dissatisfaction with the dental structure but also with the periodontal health, for this reason, it is necessary a previous adaptation of the gingival tissues for proper restorative rehabilitation. Conclusion: Ceramic laminates have proved to be a great choice for anterior teeth restorations, but they must be indicated in specific situations, to obtain excellent results as most conservative as possible.

Esthetic rehabilitation of anterior teeth through gingival recontouring and ceramic veneers: a case report

Esthetic rehabilitations require a broad and thorough evaluation of all the elements that make up the smile such as lips, dental, and periodontal structures to plan the treatment to provide harmony to the whole set. Objective: To demonstrate through a case the association of Periodontics and Restorative Dentistry in the esthetic rehabilitation of anterior teeth replacing resin restorations by modifying the gingival architecture conservatively and harmonically. Case report: It is essential for a multidisciplinary approach to succeed in treatment. The replacement of previous restorations is an increasing demand in currently clinical practice, for many reasons, mainly due to dissatisfaction with the esthetics. It is observed that many of these patients involve not only dissatisfaction with the dental structure but also with the periodontal health, for this reason, it is necessary a previous adaptation of the gingival tissues for proper restorative rehabilitation. Conclusion: Ceramic laminates have proved to be a great choice for anterior teeth restorations, but they must be indicated in specific situations, to obtain excellent results as most conservative as possible.

Laser Therapy for Soft Tissue Management in Orthodontics

Context: In recent years, lasers have numerous applications in orthodontics as an important field of dentistry. The purpose of this article is to review some of the major applications of laser in the field of soft tissue management in orthodontics. Evidence Acquisition: No single laser wavelength can be used to optimally treat all dental diseases. However, the needs of the orthodontic clinician are unique and selection of the most appropriate laser for orthodontic applications is essential to achieve optimal results. Results: Light emitted from diode lasers is poorly absorbed by dental hard tissues, these lasers can be safely used for soft tissue surgery applications, including gingival recontouring, crown lengthening, removal of hypertrophic tissue and frenectomies close to the enamel, dentine and cement. Considering beam safety, most of the lasers used for medical and dental purposes are in the Class IV category, so it is necessary to take appropriate safety measures. Conclusions: In the near future, with the clarification of laser exposure protocols and a decrease in device cost and, Dental lasers may play an increasingly important role in soft tissue management during orthodontic treatment.

Multidisciplinary esthetic approach for multiple anterior diastema: 36-month clinical performance

The presence of diastema, between anterior teeth, distorts a pleasing smile by concentrating the observer’s attention on the spaces. The patient’s needs and expectations must be considered in the process of treatment planning to ensure satisfaction with the treatment outcomes. There are many forms of therapy that can be used for diastema closure. A carefully developed diagnosis, which includes a determination of the causal elements and advanced treatment planning, allows the most appropriate treatment to be selected for each case. The aim of this paper is present a multidisciplinary approach as a solution to multiple diastemas in the anterior region using gingival tissue recontouring and direct adhesive restorations, with minimum wear of the dental structure, after the orthodontic intervention discussing the minimal intervention to obtain imperceptive and aesthetic final restoration. Thirty-six months after the treatment was carried out, the final aesthetic was maintained with all dental element details and gingival tissue harmony, without recurrence of periodontal pockets and the preservation of the tooth color and shape.

Digital Smile Design for Computer-assisted Esthetic Rehabilitation: Two-year Follow-up.

The esthetics of the smile are related to the color, shape, texture, dental alignment, gingival contour, and the relationship of these with the face. To present a two-year follow-up for an esthetic rehabilitation clinical case in which the method of digital smile design (DSD) was used to assist and improve diagnosis, communication, and predictability of treatment through an esthetic analysis of the assembly: face, smile, periodontal tissue, and teeth. The smile's esthetics were improved through gingival recontouring, dental home bleaching, and a restorative procedure with thin porcelain laminate veneers using lithium disilicate glass-ceramic (e.max Ceram, Ivoclar-Vivadent) laminates on teeth 4 through 13. The proposed technique had an acceptable clinical performance at the end of a two-year follow-up. DSD can be used to increase professional/patient communication and to provide greater predictability for the smile's esthetic rehabilitation.

An innovative approach for gingival re-contouring using a provisional restoration and positive pressure – A case report

Increase in awareness among patients about the cosmetic options in dentistry make the clinician to be competent enough to meet the needs of the patients. The appearance of the gingival tissues surrounding the teeth plays a critical role in anterior aesthetics and also gingival perspective is concerned with the soft tissue envelope surrounding the teeth. The gingival texture, shape, tooth to tooth progression and its relation to the extra oral tissues are interdependent on many factors. To improve the contour of gingiva we can have either surgical or nonsurgical approaches like application of pressure. In this case positive pressure was applied on soft tissue in an attempt to create the illusion of the restoration emerging from the tissue and the formation of “pseudo” interdental papillae. This article describes a technique of using a uniquely designed provisional restoration for the application of circumferential pressure for contouring gingiva.

Perception of laypersons and dental professionals and students as regards the aesthetic impact of gingival plastic surgery

To evaluate the degree of perception of laypersons, professionals, and dental students, regarding the aesthetic appearance of the smile in cases of gingival plastic surgery of the maxilla for correction of a gingival smile, by examining alterations in photographs. Alterations were made to an extraoral front-view-photograph of a gingival smile in normal occlusion, by gingival recontouring of the maxilla, simulating a gingival plastic surgery procedure to diminish gingival exposure. For this purpose, specific image-manipulation program (Adobe-Photoshop-Software-CS3) was used. Images were printed on photographic-paper, attached to questionnaire, distributed among laypersons, professionals, and dental students to evaluate degree of aesthetics (n = 150). To evaluate degree of aesthetics, an attractiveness scale was used, with 0 representing hardly attractive, 5 for attractive, and 10 for very attractive. Differences between examiners were examined by Mann-Whitney test. All the statistics were performed with a confidence level of 95 per cent. Both dental professionals and students and laypersons were capable of identifying alterations resulting from gingival plastic surgery. In all evaluated groups, they demonstrated that large gingival extension does not always affect aesthetic appearance of the smile, and maxillary incisors not being much visualized is characterized as hardly attractive, with statistically lower scores being attributed (P < 0.05). According to aesthetic parameters, the presence of the gingiva is important in the composition of the smile, however, only when exposed to small extent.

Moving an incisor across the midline: A treatment alternative in an adolescent patient

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement.

Diastema closure with direct composite: architectural gingival contouring

One of the most challenging task in closing anterior diastema is avoiding “black triangle”between the teeth. This paper reports a case that the closure of diastema in anterior teeth could be successfully accomplished using direct adhesive restorations and gingival recontouring. The traditional technique using Mylar strip was modified to increase the emergence profile with natural contours at the gingival-tooth interface. Mylar strip was extended out of the sulcus by approximately 1 mm high from the gingival margin, and a small cotton pellet was used to provide the emergence contour. This modified approach is acceptable for the clinical situation. [J Kor Acad Cons Dent 2011;36(6):515-520.]

Gingival recontouring by provisional implant restoration for optimal emergence profile: report of two cases

PurposeThe emergence profile concept of an implant restoration is one of the most important factors for the esthetics and health of peri-implant soft tissue. This paper reports on two cases of gingival recontouring by the fabrication of a provisional implant restoration to produce an optimal emergence profile of a definitive implant restoration.MethodsAfter the second surgery, a preliminary impression was taken to make a soft tissue working cast. A provisional crown was fabricated on the model. The soft tissue around the implant fixture on the model was trimmed with a laboratory scalpel to produce the scalloped gingival form. Light curing composite resin was added to fill the space between the provisional crown base and trimmed gingiva. After 4 to 6 weeks, the final impression was taken to make a definitive implant restoration, where the soft tissue and tooth form were in harmony with the adjacent tooth.ResultsAt the first insertion of the provisional restoration, gum bleaching revealed gingival pressure. Four to six weeks after placing the provisional restoration, the gum reformed with harmony between the peri-implant gingiva and adjacent dentition.ConclusionsGingival recontouring with a provisional implant restoration is a non-surgical and non-procedure-sensitive method. The implant restoration with the optimal emergence profile is expected to provide superior esthetic and functional results.

The Use of a Diagnostic Wax Set-up in Aesthetic Cases involving Crown Lengthening – A Case Report

Crown-lengthening surgery (CLS) consists of recontouring and repositioning the gingival margin as well as the alveolar crest. This technique results in the increase of the clinical crown height of teeth, which can consequently be advantageous in terms of improving retention and resistance, as well as aesthetics.The aim of this article is to demonstrate the uses of the diagnostic wax set-up and the subsequent production of surgical stents and templates to provide the patient with an initial intra-oral diagnostic mock-up for the process of obtaining consent, as well as acting as a useful guide for gingival and osseous recontouring in order to achieve a predictable, healthy and stable dento-gingival complex with pleasing aesthetics. The use of a well made diagnostic wax-up can provide valuable information to the dentist, laboratory, and patient which can be otherwise difficult to communicate.

Closure of Diastema and Gingival Recontouring Using Direct Adhesive Restorations: A Case Report

One of the challenges in clinical esthetic dentistry is closing anterior diastemas without creating "black triangles" between the teeth. The success of a restorative treatment in anterior teeth depends on the esthetic integration between soft tissues and hard tissues. The conditioning of the interdental papilla is a simple, direct, predictable, and low-cost alternative. This paper reports a case on diastema closure in anterior teeth that was successfully treated using gingival recontouring and composite resin restorations. The closure of diastemas in anterior teeth using direct adhesive restorations and gingival recontouring is a viable option for the clinician because it restores esthetic harmony between soft and hard tissues.