Interdental Papilla Research Articles

EFFECTIVENESS OF APPLYING HYALURONIC ACID GEL IN GINGIVAL RETRACTION

The interdental papilla is a small part of the free gingiva that fills the space between the teeth, apical to its contact area. The objective of this study was to analyze the effectiveness of the application of hyaluronic acid gel in gingival retraction. The methodology used was a literature review with an exploratory qualitative approach, using academic platforms and bibliographies: SCIELO, PUB MED and GOOGLE ACADEMICO. The inclusion criteria were articles from the last few years in Portuguese and English. The effectiveness of the use of HA gel in reducing the area of ​​the black triangle was 85.06%. In addition, the length of the papilla increased by 70.256%, while the distance from the contact to the papilla decreased by 83.026%. At the different times, the values ​​of the variables studied at the three levels were significantly different (p < 0.05). We concluded that injection of HA with a concentration of 1.6% at two points of the interdental papilla was effective in reconstructing the interdental papilla in the esthetic zone, especially in long-term follow-ups (especially 6 months).

Analyses of gingival papilla blood flow via color doppler flow imaging and micro-flow imaging in patients with advanced periodontitis: a clinical pilot study

BackgroundResearch investigating the potential link between gingival microvascular blood flow and inflammatory status is scarce. This study aims to assess color doppler flow imaging (CDFI) and micro-flow imaging (MFI) as tools for the assessment of gingival papilla blood flow (GPBF) and to examine their diagnostic utility as a noninvasive means of detecting gingival bleeding.MethodsCDFI and MFI were used to assess the GPBF grade (0–4) of 140 anterior gingival papilla sites in advanced periodontitis patients. Correlations between GPBF grades and periodontal characteristics were examined, and diagnostic performance as a means of predicting bleeding on probing (BOP) was examined using receiver operating characteristic curves.ResultsGPBF grades 0 and 1 assessed by the MFI were 14.29% and 15.71% respectively, lower than the 28.57% and 24.29% assessed by the CDFI. In contrast, MFI detected a higher frequency of GPBF grade 2 sites (40.71%) relative to CDFI (22.14%). The CDFI and MFI provided consistent results in 62.14% of the sites, while the MFI demonstrated higher ratings in rest 37.86% of the sites. A significant positive correlation was detected between GPBF grade and the modified gingival index (MGI), bleeding index (BI), BOP, and probing depth (PD). It showed high accuracy for CDFI or MFI to diagnosing BOP with a sensitivity of 80.51% and 96.43% and a specificity of 77.27% and 57.14%, respectively. Area under the receiver operator characteristic curve values when predicting BOP based on the GPBF grade determined using CDFI and MFI approaches 0.887 (95% CI 0.833–0.942) and 0.917 (95% CI 0.862–0.972), respectively, and there were no significant differences between these values (Z = − 1.502, p = 0.133).ConclusionsBoth MFI and CDFI can be employed for the evaluation of GPBF, and MFI is better suited to detecting mild inflammation.Trial registration ChiCTR2200066021 (Date of registration: 22/11/2022).

THE PARTIAL EXTRACTION THERAPIES:ROOT MEDIATED RIDGE PRESERVATION IN RESTORATIVE AND IMPLANT DENTISTRY

Crestal bone loss, a decrease in the edentulous ridges width, and a decrease in the height of the interdental papillae are all possible outcomes of extraction. It is commonly known that alveolar bone volume decreases following tooth extraction. Following tooth extraction, the bundle bone-periodontal ligament complex [BB-PDL complex] is lost, which results in the loss of alveolar bone and ridge shape. Compared to the palatal and lingual cortical plates, the buccal cortical plate is thinner and has four times as much residual ridge resorption. Numerous methods for preserving ridges have been suggested in the literature. By preserving the buccal bone-periodontal complexs vascular supply, partial extraction procedures have been shown to stop buccal bone loss. Techniques such as root submergence, socket shield, proximal socket shield, and pontic shield are examples of partial extraction therapy. This method maintains the ridge contour and the loss of alveolar bone. To replicate the future pontic, the coronal root is hollowed out and the tooth is decoronated at the level of the bone crest using the root submergence procedure. When planning a pontic location underneath a traditional fixed partial denture, the root submergence approach is recommended. The tooth root is divided into the palatal and facial portions longitudinally in the socket shield procedure. The long-shank dental bur has a little concavity in the facial root. Pontic shielding entails the same preparation as extraction socket grafting using a slow-resorbing bone replacement. By preserving the periodontal ligament and the blood vessels that are connected to it, these procedures highlight the long-term effectiveness of implants and are anticipated to produce better aesthetic results. Thus, by stopping the buccal bones natural bone resorption and the soft tissues that cover it from contracting. The review of several partial extraction therapy approaches is the main focus of this article.

A Contemporary Approach: Presentation of 4 Cases with the Entire Papilla Preservation (EPP) Technique

Regeneration of periodontal tissue is a primary goal of periodontal treatment. Periodontal regeneration approaches are widely used in the treatment of intraosseous defects. However, the success of these techniques depends on many factors, including surgical considerations. Failures in wound closure in the interdental region, which are surgical factors, have led to the development of papilla preservation techniques. The entire papilla preservation technique (EPP) maintains the integrity of the papilla associated with the defect. This technique stabilizes the blood clot with intact gingiva, preventing wound exposure and contamination. EPP is performed in intra-osseous defects through a short buccal vertical incision, without incising the papilla of the involved tooth. A full-thickness buccal flap is lifted from the incision to the relevant papilla and a tunnel extending under the papilla is prepared. The papilla is also lifted to full thickness. The defect is cleaned of granulation tissue and the wound is closed primarily with or without biomaterial application. In this report, we present 4 cases, 3 in the anterior maxilla and 1 in the mandibular premolar region, undergoing periodontal surgery with EPP with biomaterial application with a 3-month follow-up. In all cases, soft tissue healing was uncomplicated and radiographs showed bone filling at 3 months. EPP has a high success rate in periodontal regeneration by providing complete nutrition of the interdental papilla through natural, continuous vascular support in intraosseous defects.

GINGIVAL MARGIN, CORRECTION IN ORTHOPEDIC DENTISTRY

A big problem for obtaining aesthetic and functional results of dental treatment is the condition of the gingival papillae. The effectiveness of orthopedic interventions without high-quality correction of the marginal edge of the gums can lead to an unsatisfactory result and the occurrence of numerous complications Materials and methods. A literature search was conducted in the PubMed and Medline databases for the period 2000-2024, for which the following keywords were used: correction of soft gingival tissues, fixed dentures, effectiveness, front group of teeth. A general search revealed 112 sources regarding gingival margin correction in fixed dentures. The primary exclusion referred to literary sources in which the correction of the gingival margin applied to all types of prosthetics. Literary sources that contained only reference information were included in the secondary exclusion. As a result, only relevant full-text articles in professional journals remained (n=25). The purpose of the research is to analyze the methods of gingival margin correction in orthopedic dentistry at the current stage, to formulate relevant tasks for further research. Research results. Methods of restoration of the aesthetics of the marginal part of the gums during orthopedic treatment are divided into the following groups: plastic of soft and bone tissues; laboratory and technical procedures; use of materials for artificial gums. It has been established that the plastic-surgical method is used for the loss of the gingival papilla, defects of the ridge of the alveolar process, asymmetric contour of the gums, and their unaesthetic shape. Correction of the gums allows to achieve satisfactory aesthetic results both at the final stage of orthopedic treatment (prosthetics with fixed orthopedic prostheses) and at the intermediate stage of temporary prosthetics with plastic fixed prostheses. It was found that the most common methods of gingival margin correction are flap operations on the gums using the technique of lateral movement of the muco-osseous flap. These include the following types of interventions: endothelial modification from the tooth-alveolar ridge; oblique displaced flap; periosteally stimulated flap; partial or complete split flap. The positive effect of hyaluronic acid on the healing of the gingival margin and tissue regeneration has been proven. Several researches have shown the positive effects of hyaluronic acid on gingival margin healing and tissue regeneration due to its properties to stimulate cell adhesion, migration and proliferation, mediate cell signaling. The authors indicate a better effectiveness of hyaluronic acid in relation to periodontal parameters during the correction of the marginal gingival margin. The use of a laser scalpel is characterized by less pronounced traumatization of tissues, lower temporary costs for intervention, reduced blood loss, less pronounced signs of inflammation in the postoperative period, relative simplicity and cost-effectiveness of use. Conclusions. To date, only a combination of various orthopedic and surgical manipulations allows to achieve an optimal aesthetic result during prosthetics with fixed dentures of the front group of teeth.

Exploratory study on a novel minimally invasive tunnel like flap approach for orthodontic movement of dental implants.

To propose a new flap design that utilize a minimally invasive approach to move implants. We also propose a 3D method to track changes in implant position without the need for CBCT. Implants were inserted in two mongrel dogs then a minimally invasive tunnel like flap was made. Bone cutting around implants was done using piezotome device and orthodontic force was applied on the implants. For tracking positional changes of implants, an impression was taken then scanned with an identical implant copy inside. The pre- and post-treatment 3D images were then superimposed over each other to detect changes in implant position. Healing of the flap was rapid with minimal swelling and edema. The position of the interdental papilla was preserved maintaining optimal esthetic outcome. Implant pocket depth was maintained. Our 3D imaging method was able to accurately detect the movement that occurred in the dental implants after their movement with significantly higher resolution than CBCT (6μm for this method versus 76-300μm for the CBCT). This flap can preserve the esthetic soft tissue contour of implants during orthodontic movement allowing rapid healing with minimum swelling and edema. Moreover, our proposed 3D method has many advantages over CBCT in tracking the movement of implants by being non harmful and cheap thus allowing several follow up points. Orthodontic movement of implants can be required in cases of improperly placed implants or to intentionally place the implant in a certain position then altering it to avoid the need for bone grafting.

Papillary Coronal Anchorage Technique for Periodontal Reconstruction of Infrabony Defect and Interdental Papilla: A Case Report.

Esthetic issues and phonetic disturbances frequently occur after periodontal regeneration of the anterior teeth, even if treatment is supposed to be successful. Conventional regenerative techniques are predominantly targeted at infrabony defects and often inadequately address the loss of the interdental papilla. This study introduces the papillary coronal anchorage technique, a novel modified tunnel surgical procedure, to facilitate the reconstruction of the interdental papilla. This method allows for coronal movement of the entire interdental papilla without incisions at the papilla to facilitate primary wound healing. Using a combination of bone grafts and recombinant human fibroblast growth factor 2 and anchoring the tunnel-like flap coronally using sutures, we successfully achieved a reconstruction of the infrabony defects as well as the interdental papilla. The papillary coronal anchorage technique is effective as it enables the simultaneous reconstruction of both the infrabony defect and the interdental papilla.

The Papilla Base CTG: A Novel Approach for Interdental Soft Tissue Reconstruction.

Impairment or loss of interdental papilla is a common issue in patients with periodontal disease, leading to phonetic, functional, and aesthetic concerns. Numerous techniques have been explored to reconstruct and regenerate interdental papillae, but consistent success remains challenging. This article presents a novel surgical approach that applies the principles of the Connective Tissue Graft (CTG) wall technique to enhance papilla volume when interdental clinical attachment loss is present in the aesthetic zone. The case of a 35-year-old woman with an RT3 recession defect associated with loss of interdental hard and soft tissues is discussed. The patient underwent a procedure involving palatal incisions, application of amelogenins, and a trapezoidal shape CTG fixed at the base of the papilla under a coronally advanced flap. This approach aimed to stabilize the blood clot and prevent soft tissue collapse into the defect area, enhancing the position and volume of the interdental papilla. Results at 6- and 12-months follow-up indicated significant improvement in papilla appearance and complete root coverage. This case suggests that the modified CTG wall technique can effectively treat buccal and interdental gingival recessions associated with horizontal or infrabony defects. Further clinical trials are necessary to confirm these findings and establish the most effective approach for interdental papilla reconstruction.

Giant Lobular Fibrous Epulis- A Case Report

The Fibrous epulis, is a tumour like lesion arising from the gingiva, periosteum or periodontal ligament and is commonly involving the interdental papilla. Its etiology is attributed to a reactive mechanism in response to chronic irritation or tissue injury which stimulates excessive tissue response. They are usually asymptomatic and have a very slow rate of growth. The recurrence rate is high and they are commonly treated by a combination of surgical excision, thorough curettage and oral prophylaxis. We report a case of a Giant lobular fibrous epulis in a 62 year old female which was located in the left maxillary canine, first premolar region since 6 months. It was asymptomatic and was pale pink in colour and pedunculated and lobular with no involvement of the underlying bone. It was surgically excised along with thorough curettage and oral prophylaxis. The histopathology report was suggestive of fibrous epulis.

Knowledge And Perception About Dental Implant And Its Complications Among GeneralPractitioners And Post Graduates In Coimbatore – A Cross Sectional Survey

Background: It is necessary for dental students and freshly graduated dentists to apply their education and practice to different clinical and preclinical procedures. The implant success rate and durability are high. Therefore, this study was designed to assess the level of knowledge, awareness and perception of dental practitioners and post graduate students regarding dental implant complications in Coimbatore. Materials and Methods: A prevalence study design using a web-based method was conducted among dental practitioners and postgraduate students in Coimbatore. Data were collected from all (n = 212) general dental practitioners and postgraduate students using a pretested standardized self-administered web-based questionnaire that was prepared and circulated using a template provided by Google Forms (Google, Inc., USA). Results: In a survey of 212 general dental practitioners and postgraduate students in Coimbatore, 69.2% considered dental implants a viable option for tooth replacement, though 38% noted financial constraints affecting patient acceptance. While 38.5% were highly aware of the risks associated with implants, 61.5% emphasized the importance of case selection. Common issues included postoperative infections (53.8%) and screw loosening (46.2%). Aesthetically, 30.8% cited loss of the interdental papilla as a concern. Most participants favored flap surgical methods (61.5%) and recommended considering patient conditions when choosing implant prostheses. Notably, 61.5% were aware of regenerative possibilities related to dental implants. Conclusion: A comprehensive evaluation concluded that undergraduate instruction in basic implantology is essential due to the increasing prevalence of implants. Additionally, postdoctoral training programs should be established to enhance practitioners' skills and knowledge, providing them with the confidence needed to treat patients effectively

Clinical and Radiographic Evaluation of Soft Tissue and Bone Status in Immediate Loaded Implants Placed Following Their Extraction in the Maxillary Anterior Region.

In the maxillary anterior region, teeth extraction leads to significant soft and hard tissue changes. Immediate implant placement following extraction aims to reduce bone loss and overall treatment time. However, it may result in adverse soft tissue changes impacting esthetics. This study evaluates the clinical and radiographic outcomes of immediately loaded implants in the maxillary anterior region, focusing on soft tissue preservation and bone status. This study, conducted from April 2022 to August 2024 at the Department of Oral and Maxillofacial Surgery, Ragas Dental College and Hospital, included 10 immediately loaded implants in seven patients. Following atraumatic extraction, implants were placed and loaded with functional provisional crowns fabricated using three-dimensional (3D) rapid prototyping models. Parameters such as crestal bone loss, buccal and palatal bone width, and interdental papilla thickness were evaluated preoperatively and postoperatively using radiographsand clinical assessments. The study found significant crestal bone loss at both mesial and distal sites over time, with the greatest loss observed at the three-month follow-up. Buccal and palatal bone width showed no significant differences preoperatively and postoperatively. Interdental papilla thickness and overall pink esthetic scores also showed no significant differences between preoperative and postoperative evaluations. Immediate implant placement in the maxillary anterior region, using 3D rapid prototyping for custom splint fabrication, demonstrated effective preservation of soft tissue profile and bone architecture. This approach provides functional and esthetic benefits, although careful monitoring of crestal bone loss is necessary.

HYALURONIC ACID INJECTION MAY BE EFFECTIVE FOR RECONSTRUCTION OF MILD TO MODERATE LOSS OF INTERDENTAL PAPILLA IN ADULT PATIENTS IN THE SHORT TERM

HYALURONIC ACID INJECTION MAY BE EFFECTIVE FOR RECONSTRUCTION OF MILD TO MODERATE LOSS OF INTERDENTAL PAPILLA IN ADULT PATIENTS IN THE SHORT TERM

Dental and microbiological status of COVID-19 convalescent patients with simple marginal gingivitis

The pattern of dental morbidity in the population of the Russian Federation evidences about a high incidence of inflammatory periodontal diseases, which varies based on patient age and comorbidity. The negative age-related dynamics of dental health emphasizes the problem of concomitant pathology and requires constant monitoring of risk factors for inflammatory periodontal diseases. Insufficient attention is paid to endogenous risk factors, such as neurodystrophic disorders, diseases of the cardiovascular system, leukemia, anemia, gastrointestinal tract diseases, infections, etc. At the same time, the growth of “new” infections (HIV-infection, HCV-infection, Ebola fever, new coronavirus infection) is recorded with elevating level of other infectious diseases. The aim of the study is to assess dental and microbiological status of COVID-19 convalescent patients. A survey of 100 patients diagnosed with simple marginal gingivitis (ICD-10 code: K 05.10) was carried out consisting of the following groups: main group — 75 COVID-19 convalescent patients, control group — 25 COVID-19-negative subjects. All individuals underwent microbiological diagnostics for gingival groove contents and an assessed dental status. The index assessment was performed using the simplified Green-Vermillion Oral Hygiene Index (OHI-S), the PMA index (Parma) and the gingival papilla blood flow index (PBI). In the laboratory, the collected material was seeded onto expanded list of dense nutrient media. The identification of isolated microorganisms was carried out using MALDI-ToF mass spectrometry. Our analysis of the index assessment in both groups showed that the average values of the indices 1 month after the diagnosis of new coronavirus infection (ICD-10 code: U07.1) in main group are higher than in control group. Based on the results of a microbiological study, significant differences in the frequency of microbial species isolation were identified for 12 species. Thus, it is important to develop approaches to predicting development of chronic gingivitis and its exacerbation in COVID-19 patients.

Impact of long contact areas for the management of varying levels of interdental papilla loss on the perception of smile esthetics between dentists and laypersons in asymmetric and symmetric situations.

To determine the effect of restorations with long contact areas for the management of interdental papilla deficiencies, in smile attractiveness among laypersons and dentists. A full-portrait image was used to create a set of digitally modified images, simulating the management of various levels of interdental papilla loss. In a total of 48 modified images, single as well as multiple loss of interdental papilla among the anterior teeth, treated with a single or multiple restorations were simulated for unilateral and bilateral situations. Through a digital monitor 160 laypeople and dentists were asked to assess the attractiveness of each displayed image utilizing a visual-analog-scale. Multiple Wilcoxon-signed-rank tests followed by Mann-Whitney U tests were performed considering a significance level of 0.05. The management of an open gingival embrasure due to interdental papilla loss, by simulating the restoration of both central incisors led to a significantly higher mean smile attractiveness compared to the restoration of a single central incisor. Among the investigated regions, the management of open gingival embrasure in the area of central incisors using a restorative approach was perceived as the least esthetic (p<0.05). Despite the restorative management of interdental papilla loss, with the establishment of longer contact areas for the reduction of open gingival embrasures, as the level of the interdental papilla loss is increased, facial esthetics are compromised. When a longer contact area is accomplished through a single restoration, asymmetry among the teeth can be induced, especially in the region of the central incisors.

An esthetic flap design for surgical endodontics in the anterior zone.

To describe an esthetic flap design for surgical endodontics in the anterior zone and to discuss the treatment outcome. Traditional flaps used in apical surgery in the anterior region are created with horizontal and vertical incisions. These incisions do not completely avoid scarring, and may sometimes cause esthetic defects. We describe an envelope flap with no vertical incision for apical surgery in anterior that mainly consists of oblique incision in interproximal papilla. The approach achieve rapid would healing while avoiding scar formation. The present report describes successfully treated cases of surgical endodontics in the esthetic zone using an envelope flap that the author recommend in order to achieve better esthetic results.

Inter-implant Papilla Reconstruction using the Iceberg and 'Garage' Connective Tissue Graft Technique. A Case Report and Technique Illustration.

A 45-year-old female patient presented with a lack of inter-implant papilla after a partially edentulous anterior area was rehabilitated with dental implants. The soft tissue phenotype and inter-implant papilla was augmented using the 'iceberg' connective tissue graft, followed by a second surgical procedure where a strip gingival graft was combined with a connective tissue graft inserted underneath a pouch prepared into the previous 'iceberg' connective tissue graft at the level of the crest ('garage' approach), further enhancing soft tissue volume in that region. This technique aims to improve mucosal thickness and supracrestal tissue height while addressing esthetic concerns associated with multiple implant placements in the anterior region. The final esthetic outcome was excellent, harmonious soft tissue with appropriate thickness, symmetry with adjacent teeth, well-shaped interdental and inter-implant papilla with high patient satisfaction, making this approach a valuable addition to a surgeon's armamentarium. Future clinical studies are needed to evaluate the performance of this novel approach.

Clinical Efficacy of GBR Technique Combined with Temporary Bridgework-Guided Gingival Contouring in Treating Upper Anterior Tooth Loss with Labial Bone Defects

Objective: To investigate the clinical effect of the guided bone regeneration (GBR) technique combined with temporary bridgework-guided gingival contouring in treating upper anterior tooth loss with labial bone defects. Methods: From July 2023 to April 2024, 80 patients with upper anterior tooth loss and labial bone defects were admitted to the hospital and selected as evaluation samples. They were divided into an observation group (n = 40) and a control group (n = 40) using a numerical table lottery scheme. The control group received treatment with the GBR technique, while the observation group received treatment with the GBR technique combined with temporary bridges to guide gingival contouring. The two groups were compared in terms of clinical red aesthetic scores (PES), labial alveolar bone density, labial bone wall thickness, gingival papillae, gingival margin levels, and patient satisfaction. Results: The PES scores of patients in the observation group were higher than those in the control group after surgery (P &lt; 0.05). The bone density of the labial alveolar bone and the thickness of the labial bone wall in the observation group were higher than those in the control group. The levels of gingival papillae and gingival margins were lower in the observation group after surgery (P &lt; 0.05). Additionally, patient satisfaction in the observation group was higher than in the control group (P &lt; 0.05). Conclusion: The GBR technique combined with temporary bridge-guided gingival contouring for treating upper anterior tooth loss with labial bone defects can improve the aesthetic effect of gingival soft tissue, increase alveolar bone density and the thickness of the labial bone wall, and enhance patient satisfaction. This approach is suitable for widespread application in healthcare institutions.

The Impact of Orthodontic Extrusion on Keratinized Gingiva.

Background and Objectives: The key factor that enables osteoblastic activity and the formation of new bone, as well as gingiva, during orthodontic tooth extrusion (OE) is the periodontal ligament. The reaction of periodontal tissues associated with changes in the gingiva is a part of orthodontic tooth displacement. The aim of this study was to examine the effect of OE on the width of the zone of the keratinized and attached gingiva, the position of the mucogingival junction, and the height of the interdental papillae in the region where the OE was performed as well as in the adjacent region. Materials and Methods: This research included 28 adult patients (both orthodontically treated and untreated). The treated group included 15 patients, in whom orthodontic extrusion of the upper or lower frontal teeth was indicated and performed. The untreated group included 13 patients, with no previous or undergoing orthodontic treatment. Patients with periodontal disease and periodontal pockets in the frontal region and patients allergic to iodine were excluded from the study. Gingivomorphometric measurements were performed on two occasions in three groups of teeth (24 extruded and 30 agonist teeth in the treated patients; 66 teeth in the untreated patients). Statistical analysis of the obtained data was performed using the software package SPSS version 26.0. Results: Orthodontic extrusion induced changes in the position of the mucogingival line and an increase in the width of the keratinized gingiva. There were no statistically significant effects on the depth of the gingival sulcus, the attached gingiva width, or the height of the interdental papillae. Conclusions: Orthodontic tooth extrusion has an effect on the periodontium in the observed region. Vertical orthodontic force, directed towards the coronal plane, affects the surrounding soft oral tissues.

An Enigmatic Soft-Tissue Creeping Phenomenon: The Spontaneous Peri-Implant Mucosa Margin and Papilla Growth, Part Two-A Scientifically Supported Hypothesis Article.

In our previous article, we observed and measured a spontaneous growth in the coronal direction of the keratinized tissues present around implants. This growth involved both free margins and interdental papillae, and we indicated our hypothesis on the probable cause of this still-unexplained phenomenon. The growth of oral soft tissues involves several other structures, such as the linea alba and tongue indentation. Our idea holds that growth of these tissues is generated by the negative intraoral pressure created in the oral phase of swallowing and the subsequent resting position, which through the resulting suction causes a shift of these soft structures in the gaps around the dental crowns. Other hypotheses have been suggested in the past to understand this phenomenon of soft tissue growth, which still lacks data supporting etiological evidence. The purpose of this article is to thoroughly analyze and verify our model by comparing the clinical observations with citations and examples from the literature, combined with notions of physiology, biology, and physics that help in clarifying these events. To better explain the mechanisms of oral soft tissue growth, photographs of clinical cases paradigmatic of the phenomenon are shown.

Cosmetic Makeover of Periodontally Compromised Patients using Flexible Gingival Mask and Porcelain Laminate Veneers: Report of Two Cases

Chronic periodontal disease can lead to advanced gingival tissue loss that can result in problems with esthetics, phonetics, food impaction and tooth sensitivity. One of the most difficult problem encountered in the management of periodontal disease is loss of interdental papillae which leaves unsightly “black triangles” between the teeth. The first step in the management of these problems is surgical correction of the defect. In cases where mucogingival surgery is unpredictable due to generalized recession and loss of large volume of gingival tissue, removable gingival prosthesis is an excellent alternative to correct the deformities remaining after the control of destructive periodontal disease specially in the maxillary anterior region. Gingival prostheses may be fixed or removable. It can be made from a range of materials like acrylic, silicones, porcelain- based materials and flexible resin denture material. This report describes two clinical situations in which combined periodontal/prosthodontic rehabilitation was done for patients with advanced periodontal disease. Accurately fitting flexible gingival prostheses and porcelain laminate veneers were fabricated to restore advanced gingival tissue loss in esthetic area following periodontal flap surgery. The flexible gingival masks not only help to achieve excellent cosmetic results but also reinstate the functional and psychological wellbeing of the patient.