Pink Esthetics Research Articles

РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ КОЛЛАГЕНОВОГО МАТРИКСА ПРИ МЕНЕДЖМЕНТЕ МЯГКИХ ТКАНЕЙ В ОБЛАСТИ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ ВО ФРОНТАЛЬНОМ ОТДЕЛЕ ВЕРХНЕЙ ЧЕЛЮСТИ

The aim is to comparatively analyze the using of collagen matrix and free connective tissue graft in soft tissue thickness increase in the area of dental implants in the anterior region of the upper jaw.
 Materials and methods. 30 patients with partial absence of teeth and soft tissue thickness deficit in the anterior part of the upper jaw took part in the study. In the 1st group (n = 15) a free connective tissue graft (CTG) from the hard palate was transplanted, in the 2nd group (n = 15) a collagen matrix (CM) was used. The primary endpoint was the amount of soft tissue thickness gain 3 months after surgery. Secondary endpoints were: duration of surgery, severity of collateral edema and pain, amount of analgesic medication consumed, quality of life assessment, width of keratinized attached gingiva, and soft tissue aesthetics.
 Results. 3 months after augmentation the increase in soft tissue thickness from the vestibular surface was 0.86 ± 0.25 mm and 0.77 ± 0.26 mm (p = 0.34), from the occlusal surface - 0.46 ± 0.14 mm and 0.37 ± 0.18 mm (p = 0.137) in patients of the 1st and 2nd groups, respectively. The use of CM was characterized by less prolonged surgery (p = 0.002), less pronounced postoperative pain on the 1st and 3rd day (p = 0.007; p = 0.023), less consumption of analgesic drugs on the 1st, 3rd and 5th day (p = 0.014; p = 0.033; p = 0.002) and less reduction of patients' quality of life in the first 7 days after surgery (p = 0.023). When analyzing the "Pink Esthetics Scale" (PES) in patients, group 2 showed more pronounced inconsistencies in the assessment of the zenith level (p < 0.001), less natural soft tissue contour (p < 0.001) and more significant deficit of the alveolar ridge (p < 0.001).
 Conclusion. Collagen matrixes make it possible to obtain soft tissue augmentation comparable with the use of CTG, to reduce the time of surgical intervention and to provide a more comfortable postoperative period. The use of autogenous grafts provides better results in terms of soft tissue aesthetics.

Evaluation of esthetic outcome of delayed implants with de-epithelialized free gingival graft in thin gingival phenotype with or without immediate temporization: a randomized clinical trial

AimThe current study investigates the effect of immediate temporization on the pink esthetics of delayed implants in patients with thin gingival phenotype in combination with a De-epithelialized Free Gingival Graft in the maxillary premolar area.MethodologyThe study population was randomly assigned into two groups. The two groups were treated with delayed implants with simultaneous placement of a de-epithelialized free gingiva graft. The test group was immediately temporized while the control group had no temporization. The pink esthetic score was assessed as the primary outcome. Additional secondary outcomes were assessed such as the keratinized tissue width and the soft tissue thickness.ResultsTwenty implants were placed in the current study, split into 10 implants per group. The results showed that the Pink Esthetic Score of the IT group was 11.88 ± (1.13) and 11.33 ± (1.25) for the CTG group, which showed no statistical difference between the groups after 1 year of follow-up. There was also no significant difference between the two groups at 12 months regarding the keratinized tissue width and the soft tissue thickness.ConclusionsImmediate and delayed temporizations have no effect on the Pink Esthetics of the delayed implants; however, immediate temporization allowed earlier provisional crown delivery. Soft tissue augmentation of the thin gingival phenotype improved esthetics for both groups.Trial registration Name of the registry: clinicaltrials.gov; trial registration number: NCT03792425. Date of registration: January 3, 2019. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03792425?term=NCT03792425&draw=2&rank=1Graphical

Esthetic and clinical outcomes after immediate placement and restoration: Comparison of two implant systems in the anterior maxilla-A cross-sectional study.

To assess the esthetic and clinical performance of a novel self-tapping implant system for single-tooth restorations in the esthetic zone after immediate placement and provisionalization. This cross-sectional study included 52 patients contributing a total of 52 immediately placed and restored implants with ≥12 months after functional loading, comparing two different implant systems: Straumann® BLX (Institut Straumann AG, Basel, Switzerland; 25 patients) and Ankylos® (Dentsply Sirona, Hanau, Germany; 27 patients). As the primary outcome measure, peri-implant tissue esthetics were assessed by means of pink esthetics score (PES) rated by three independent clinicians. Moreover, as secondary outcome measures, the peri-implant tissue health was assessed by means of bleeding on probing, probing depth, and suppuration. Apart from that, the modified plaque index, keratinized mucosa width, and the presence of mucosal recessions were also assessed. When clinical signs suggested the possibility of peri-implantitis, radiographs were indicated to assess progressive bone loss. The mean PES ratings were 12.10± 1.10 for Ankylos versus 11.2± 1.86 for BLX, both achieving good esthetic results without significant differences (p= 0.143). There were no differences among most clinical parameters (plaque, bleeding on probing, probing depth, peri-implant mucosal recession), although peri-implant mucositis was present in one-third of the cases. The inter-rater agreement on esthetics was not significant (p < 0.250). Within the limitations of the present study, it was concluded that the use of either BLX or Ankylos implant systems was associated to comparable peri-implant health and good pink esthetic outcomes during immediate implantation and restoration protocols, for at least 12 months.

The Cortical Shield for Facial Bone Reconstruction of Severely Damaged Sockets with Simultaneous Implant Placement: A Feasibility Clinical Trial.

To evaluate a novel proof-of-principle technique of simultaneous bone regeneration and implant placement in severely damaged sockets. This study consisted of patients who required a single implant and presented with severe facial bone loss. Individuals were randomly assigned to either the immediate or delayed implant placement protocol. Socket reconstruction and simultaneous implant placement were performed through periosteal-guided bone regeneration. Implants were encased in a customized shield of autogenous cortical bone harvested from an adjacent site. Re-entry surgery was performed at 12 to 18 weeks. Peri-implant tissues and pink esthetics were assessed following established success criteria. Of the 34 patients treated, 28 patients-consisting of 15 women and 13 men with an average age of 50.8 ± 4.5 years-continued to the final follow-up. All individuals showed new facial cortical bone regeneration at second-stage implant surgery after an average healing time of 14.9 ± 2.2 weeks (range: 12 to 18 weeks). Implants remained stable after loading. Success rates were 100% at 12 months. Mean pink esthetic score (PES) was 7.8 ± 1.2 (range: 6 to 9 on a scale of 0 to 10). Linear regression analysis showed that provisionalization and attachment loss are independent risk factors affecting pink esthetics (P < .01). Mild and moderate/severe attachment loss decrease pink esthetic scores by 0.9 and 1.7 points, respectively (95% CI: 0.2-1.5; P < .01). The use of provisional restorations improves pink esthetic scores by 1.6 points (95% CI: 0.8-2.4; P < .001). A PES > 7 was four and five times more likely to be expected for delay and immediate implants, respectively, if the implant had a provisional restoration delivered post-second-stage (RR = 4 to 5; 95% CI: 1-31; P = .07; P = .02). Cramér's V test showed a strong association between lack of implant provisionals and low pink esthetic scores (≤ 7, value = 0.7; P = .02). Facial implant transparency at follow-up was absent, and all implants had a band of keratinized tissue > 2 mm. Facial bone regeneration and simultaneous implant placement is feasible in severely damaged sockets through periosteal-guided bone regeneration after a short healing period following immediate or delayed protocols. The assisted regenerated intrasocket bone allows for functional implant stability. Adjacent tooth attachment loss and lack of implant provisionalization negatively impacts pink esthetics. The proposed approach decreases costs, morbidity, and treatment duration and eliminates the need for multi-stage approaches.

Immunologically Neutral Dental Implants Ceramic (Zirconia) Implants

Since their introduction in the 1960s, titanium implants have dominated the field of dental implants. As a result, titanium implant systems are largely the foundation for the goods and solutions, scientific and clinical research, as well as the development and effectiveness of this treatment.The subject of when and why to substitute titanium implants with ceramics is evident for practitioners thinking about adding ceramic implants to their portfolios. Of course, every situation and patient are different, but there are a few things to take into account if ceramic and Titanium implants are an option based on the signs.The patient's resistance to having metallic medical devices inside their body, which might manifest as mucosal recession and the visibility of gray Titanium is one of the problems with titanium implants. The emotional feel of a more 'natural' alternative may be of preference.From a clinical perspective, recent developments in zirconia solutions now mean that the restorative flexibility of a two-piece, cemented, and/or screw-retained options are available, along with proven osseointegration and soft tissue adhesion, [1] generally lower plaque accumulation, [2] and less bacterial adhesion than titanium implants [3]. Titanium implants are narrower at the implant-abutment transition; however, ceramic implants should be wider, and which is what SDS has done since the wide tulip stabilizes the gingiva allowing it to attach. To preserve soft tissue and pink esthetics, Ceramic implants should be placed tissue-level. This will also prevent the disturbance of the valuable bond between implant and the tissue.In various range of cases, Ceramic implants are used as the substitute of the titanium implants as they are given esthetic white appearance and are 100% metal-free.

The Assessment of Different Gingival Management Materials for Immediate Implant Treatment in the Esthetic Zone: A Clinical and Biochemical Study.

To observe the effect of different prosthetic materials (polymethyl methacrylate [PMMA] and flowable composite [FC]) on marginal bone loss, pink esthetic score (PES), and cytokine levels (receptor activator of nuclear factor kappa-Β ligand [RANKL] and osteoprotegerin [OPG]). A total of 46 patients (31 women, 15 men) were treated with immediate implant therapy after tooth extraction. For standardization, only the maxillary premolar tooth of each patient was restored, and also, both of the adjacent teeth were present in the dental arch. Provisional crowns were prepared before the surgery on patient models with two different materials (24 PMMA, 22 FC). Following the surgical procedure, provisional crowns were adjusted on polyetheretherketone (PEEK) abutments as nonfunctional in centric and eccentric movements. After the surgery, patients were evaluated monthly for 3 months. At each follow-up, periapical radiography was obtained by the parallel technique, and peri-implant crevicular fluid (PICF) was collected. Pink esthetic scoring was done. MBL was calculated for the mesial and distal sides separately. Cytokine levels were analyzed from PICF. Statistical analyses (Shapiro-Wilk, Mann-Whitney U, independent-samples t test, Wilcoxon t test, paired-samples t test, and Friedman two-way analysis of variance with Bonferroni correction) were completed (α = .05). PES was increased significantly within groups (P < .01). However, there was no statistically significant difference between groups. According to the Mann-Whitney U test, no significant difference was found for the MBL (P > .05). When the RANKL/OPG values were evaluated within the group by using the Friedmann two-way analysis of variance test, no significant difference was found (P > .05). Similar pink esthetics, cytokine levels, and bone loss can be achieved using a protocol including immediate implants, particle grafts, soft tissue graft, PEEK abutments, and provisional restorations fabricated using PMMA and FC.

Periodontal Approaches to Esthetic Dentistry: A Review on Current Trends

Thepresent review is to discuss the current trends in periodontal approaches for improving the esthetics in dentistry. Esthetics is an essential component of today's dental care. A growing awareness of esthetics has fueled an increase in esthetic demand in dentistry in recent years. The ultimate goal in modern dentistry is to attain "white and pink esthetics" in the esthetically important zone Review results: Current evidence-based periodontal approaches for improving esthetic dentistry are discussed. The periodontal management of esthetics is mainly focused on proper assessment of the case scenario including the associated mucogingival deformities and selection of a proper technique for the correction of the same. There is drastic increase in esthetic demand for the dental procedures in recent years. With the evolution of innovative techniques, clinicians can fulfill the patient's esthetic demands. Thus it is important to be updated in this field about the current innovative approaches. Newer procedures are being developed all the time and are gradually being integrated into periodontal practice. The practitioner should be mindful that novel approaches are sometimes presented without appropriate clinical research. Our ongoing progress toward better therapeutic approaches should be guided by critical analysis of freshly offered methodologies.

Socket-shield Technique vs Conventional Immediate Implant Placement for Esthetic Rehabilitation: A Systematic Review and Meta-analysis

The present systematic review and meta-analysis (SR/MA) aimed to test the null hypothesis that there is no difference between socket-shield technique (SST) and conventional immediate implant placement (CIIP) as an esthetic rehabilitation option for permanent human anterior teeth, against the alternative one of a difference. Socket-shield technique is considered as a highly promising procedure that has the potential to prevent resorption of anterior alveolar ridges, maintains white and pink esthetics, and provides a solution for esthetically critical cases. Controlled randomized clinical trials (RCT) and nonrandomized ones had been identified by searching the following databases: Google Scholar, Scopus, and PubMed. Literature search was determined from January 2010 up to June 2020. Hand searches were also accomplished for relevant abstracts, books, and reference lists. The eligibility criteria included prospective observational controlled RCTs and non-RCTs. patients with endodontically treated/nonrestorable permanent mature anterior teeth indicated for extraction. the sockets were subjected to immediate implant placement using SST. implants placed with SST compared with those of CIIP. the pink esthetic score measured for esthetic rehabilitation. To assess article quality, the Cochrane risk-of-bias tool was used by two independent authors. The data across quantitative studies were analyzed using comprehensive MA software. The initial search found out 172 references through the search strategy and three additional ones were recognized through hand searching. After being filtered, 101 references were screened and recorded. After the inclusion and exclusion criteria were applied, only seven unduplicated prospective controlled RCTs and non-RCTs were involved in the quantitative MA. At the 6-month evaluation period, the total standard difference in mean was 1.07 and I 2 test value measuring heterogeneity was 77.182, whereas at the 12-month period, the total standard difference in mean was 1.43 and I 2 test value measuring heterogeneity was 64.914. SST had a positive effect on the esthetic rehabilitation for anterior teeth better than CIIP. However, this conclusion was dependent on a very few well-conducted prospective RCT and non-RCT. Further RCTs with longer observational time, proper methodology, and of larger sample size are still required to adequately answer the question of the present SR. There is limited knowledge about the appropriateness of SST in the field of implant dentistry, specifically for esthetic consideration. This SR/MA confirmed the positive effect of the SST over CIIP for esthetic rehabilitation for anterior teeth. PROSPERO, identifier CRD42020194086.

Comparison between orthodontist, general dentist, and layperson in the perception of pink esthetics on smile: A cross-sectional study

Objectives: Smile designing has become an essential part of dental training and a beautiful smile not only adds to the esthetics of the face but also conveys emotions and augments the self-esteem of an individual. A beautiful smile is achieved by well-balanced pink and white esthetics. This study was designed to evaluate the difference in perceptions of orthodontists, general dentists, and laypersons to alterations in gingival characteristics on smile. Material and Methods: Smile images were modified intentionally to obtain the desired variations in gingival features such as color and contour of free gingival margins, inflammation, pigmentation, gingival margins with or without recession, zenith, and interdental papilla. A total of 51 images were rated by orthodontists, general dentists, and laypersons using Q sort methodology. Results: Variations in the position of free gingival margin with recession was most negatively ranked gingival factor by orthodontists, general dentists, and laypersons followed by variations in the position of interdental papilla. Position of free gingival margin without a recession, color changes due to pigmentation, and inflammation were moderately ranked. Control images and altered gingival zenith images were most positively ranked. Bilateral changes were perceived more readily compared to unilateral in factors such as a black triangle, zenith position, pigmentation, inflammation, and recession. Conclusion: Orthodontists seem to be less tolerant in their evaluations in comparison to general dentists and laypersons. The findings of this study point toward a crucial fact that smile designing should focus on parameters that are perceived readily by the public in general.

Interarch space assessment in edentulous patients rehabilitated with complete removable dentures using open-access software.

BackgroundThe interarch space is defined as the vertical space between the edentulous ridge and the occlusal or incisal aspect of the opposing arch. Measuring the interarch space in a patient requiring an implant-supported fixed prosthesis is crucial for determining the prostheses to be used in each clinical situation. Depending on the measurements and other factors, such as the need for lip support or pink esthetics issues, decisions about the most convenient type of implant-supported prosthesis can be taken. Analogic workflow to measure the interarch space can represent a time-consuming and expensive procedure that may lead to inaccuracies. ObjectiveTo describe a step-by-step protocol to measure the upper and lower interarch space with open-access software, starting from the digital scan of the patient's complete dentures obtained with an intraoral scanner. MethodsAn extraoral scan (using an intraoral scanner) of the existing complete removable prosthesis is required to assess the interarch space for making an implant-supported prosthesis treatment planning. If the existing complete denture does not fulfill the required functional and esthetic parameters, a complete interim denture, a wax trial denture, or a printed denture prototype should be previously fabricated. The antagonist arch and the intermaxillary record scan also need to be obtained. Finally, all STL files are imported into an open-access software for measuring the interarch space. ResultsOpen-source software can be used to measure the upper and lower interarch space from existing complete dentures following the step-by-step protocol outlined in this paper. ConclusionInterarch space of edentulous patients rehabilitated with complete dentures can be measured with a 360 degrees scanning of the existing complete denture and open-access software by applying the protocol outlined in this paper. Clinical relevanceThe clinician can assess and digitally measure the interarch space of edentulous patients requiring an implant-supported fixed prosthesis using an open access software.

Esthetic evaluation of conventional and socket shield technique immediate implant restoration

Objective: To evaluate the pink and white esthetics of conventional and socket shield technique (SST) immediate implant restoration. Methods: Thirty volunteers were recruited according to preset criteria, and were assigned to 3 groups. Natural teeth group (ten undergraduates or postgraduates from Peking University School and Hospital of Stomatology in January 2020, n=10): all volunteers' maxillary anterior teeth were natural teeth with healthy gingiva, and none of the teeth were restored by crowns or composite. Conventional group and SST group (patients had a maxillary central incisor immediate implant placed in Department of Prosthodontics, Peking University School and Hospital of Stomatology during October 2016 to January 2021, n=10 for each group): the volunteer had an unrestored natural maxillary central incisor, and the contralateral maxillary central incisor was restored by conventional or SST immediate implant placement, temporization and all ceramic final restoration, photos were taken 12 months post-surgery. Three groups of evaluators namely layperson (staff from Second Clinical Division of Peking University School and Hospital of Stomatology and 2 family members, n=10), dental students (class 2015 undergraduates from Peking University School and Hospital of Stomatology, n=10) and prosthodontists (from Department of Prosthodontics, Peking University School and Hospital of Stomatology, n=10) were invited to assess the esthetics using pink esthetic score (PES) and white esthetic score (WES). The results were statistically analyzed. Results: PES and WES of natural teeth group [9(8, 10) and 8(7, 10)] were significantly higher than conventional group [7(6,8) and 7(6,9)] (H=287.08, 132.79,P<0.01) and SST group [7(6, 9) and 8(7, 9)] (H=216.01, 101.21, P<0.01). SST group yielded higher PES than the conventional group (H=-71.06, P<0.01), yet had similar WES (H=-31.57, P>0.05). Dental students had significant lower PES and WES than prosthodontists (H=-120.90, -218.86, P<0.01) and layperson (H=-109.55, 134.97, P<0.01). Prosthodontists and layperson got similar PES (H=-11.36, P>0.05), however yielded different WES (H=-83.89, P<0.01). Conclusions: SST immediate implant placement obtained better pink esthetics than conventional protocol 12-month after implant surgery, profession may have significant impact on evaluators during pink and white esthetic evaluation.

Patient Satisfaction and Pink Esthetics of PEEK Versus Zirconium Abutments in the Esthetic Zone (A Randomized Controlled Trial)

Objective: This study was performed to evaluate the use of PEEK abutments versus zirconium abutments with lithium disilicate superstructure on the esthetic acceptance and peri-implant clinical parameters. Zirconium abutments were found to have high surface roughness even after polishing. This causes a remarkable collapse of the soft tissue papilla that is a primary factor in the Pink Esthetic Score(PES), resulting in failed esthetic restoration in the anterior esthetic zone. Material and Methods: Twenty patients who needed a single implant restoration in the esthetic zone were included in this study. Eighteen patients completed screening, baseline, three-month, six-month, and twelve-month follow-up visits. At the screening visit, the patients were randomly allocated into two groups: Zirconia abutments (A) Group, and PEEK abutments (B) Group, both of which were restored with IPS e.max CAD superstructure. Patients Satisfaction was assessed by visual analogue scale (VAS). Pink esthetics score (PES), modified plaque index (mPI) and modified gingval index (mGI) were also assessed. Results: All implants were successfully osseo-integrated with a 100% survival rate over one year. Patient satisfaction was significantly higher for the PEEK group than the zirconium group. The pink esthetic score showed no statistical significance between both groups. The modified plaque index was significantly lower for the PEEK group than the zirconium group. The modified gingival index showed no statistical difference between both groups. Conclusion: PEEK revealed to be a versatile material to replace zirconium for implant abutments, due to its lower plaque affinity and higher patient satisfaction. Keywords Dental implantation; Patient satisfaction; PEEK abutments; Pink esthetic score (PES); Zirconium abutments.

Gingival depigmentation: A therapeutic modality for pink esthetics: A case series

Hyperpigmentation is a condition where melanin is present in excess quantity which can cause significant esthetic problems. Pigmentation of gingiva is considered to be unaesthetic by patients, and it may have a psychological impact on them. This impact is aggravated in patients with “gummy smile” or excessive gingival display while smiling (high smile line). Variety of treatment modalities have been promulgated for depigmentation of gingival such as scraping, bur abrasion, partial thickness flap, cryotherapy, electrosurgery, and laser. In the present case series, techniques such as scalpel and diode laser have been tried for treatment of hyperpigmentation, which are simple, effective, and yielded good results, along with good patient satisfaction.

Analysis of root coverage esthetic score in patients treated for gingival recession: An interexaminer reliability.

Background:Awareness about pink esthetics among dentists in general needs to be assessed as root coverage procedures are the mainstay of treatment for gingival recession. Concordance among the dentists in figuring out the esthetic outcomes after root coverage procedures is inconsistent. Hence, this study aims to evaluate inter- and intra-examiner reliability of root coverage esthetic scores (RES) between periodontists and nonperiodontists.Materials and Methods:The study was conducted using twenty baseline and 6-month posttreatment photographs of Miller's Class I and Class II gingival recessions. The participants that constituted ten periodontists and ten nonperiodontists were assembled in the seminar hall to receive training on protocol and procedures for RES by the investigator. All the participants were shown twenty projections of side-by-side baseline and 6-month outcomes of root coverage procedures. Each projection was shown for 30 s during which the participants were made to use RES system to evaluate the surgical outcomes.Results:Periodontists showed the highest reliability in the scores of marginal tissue contour with an overall intraexaminer reliability to be perfect among periodontists. Intraexaminer reliability among nonperiodontists was fair, and gingival margin was the parameter with the highest reliability among them. Interexaminer reliability between periodontists and nonperiodontists showed slight reliability concerning gingival margin, and fair reliability was found for marginal tissue contour, soft-tissue texture, mucogingival junction, and gingival color.Conclusion:Satisfying the esthetic component of gingiva is the duty of every dentist in general and not only the periodontists. Significant variability was found in esthetic scores between the groups, which can probably be attributed to the lack of sufficient knowledge regarding pink esthetics among the nonperiodontists, which needs to be improved.

Pink esthetic defects of restoration in anterior teeth and the treatment protocol

How to achieve the esthetic results with the restoration in anterior teeth is key aims which both of dentists and patients concern about now. Previously, the shape, color and texture of the teeth, i.e. "white esthetics" , were main objectives that prosthodontists want to achieve. The development of dental materials has played a key role in this field. More and more, the prosthodontist has realized that the healthy soft tissue is also very important for the final esthetic results. The healthy periodontal tissue is not only the basis for the longevity of restoration, but also the basis of esthetic results. The shape, color and texture of soft tissue, the mesial and distal gingival papilla, the margin and symmetry of the gingival, i.e. "pink esthetics" , have ultimate relationship with final esthetic results. The objective of the article is to introduce the common pink esthetic defects for the restorations in anterior teeth, the treatment protocol and methods to improve pink esthetic results.

A Novel Technique of Repositioning Papilla to Create a Balanced Anterior Pink and White Esthetics

The ultimate goal in modern era dentistry is to achieve the balance of “white” and “pink” in esthetically important zones. “White esthetics” is the natural dentition or the restoration of dental hard tissues with suitable materials. “Pink esthetics” refers to the surrounding soft-tissues, which includes the interdental papilla and gingiva that can enhance or diminish the esthetic result. This paper aims to describe a careful diagnosis and multidisciplinary treatment approach to achieve a satisfactory final esthetic outcome in a clinical scenario where there is an abnormal shape, position of tooth and displaced papilla in the anterior esthetic zone.

Impact of altered gingival characteristics on smile esthetics: Laypersons' perspectives by Q sort methodology.

Smile esthetics includes the white esthetics related to the teeth and the pink esthetics related to the mucosa. Many surveys have been conducted to evaluate laypersons' perceptions to altered dental characteristics, but few have focused on the soft tissue factors. This study was designed to determine the perceptions of laypeople to variations in soft tissue esthetics during smile. An ideal smile photograph was intentionally altered to produce variations in gingival inflammation, pigmentation, contour, position of free gingival margins (with and without recession), zeniths, and interdental papilla. Sixty-seven images thus produced were rated for attractiveness by 100 laypersons with the Q sort technique. Variations in interdental papilla (black triangles) were the most negatively ranked gingival factor by laypersons closely followed by color changes of the gingiva due to inflammation and pigmentation. Alteration of gingival contour and gingival zenith had the least impact on smile esthetics, and changes in the free gingival margin with and without recession were moderately perceived. Furthermore, laypersons considered unilateral or asymmetric alterations more unesthetic compared with bilateral or generalized alterations for factors such as free gingival margin without the recession, and color changes caused by inflammation and pigmentation. Laypersons have considerable negative perception to asymmetric gingival alterations and to optical color changes caused due to black triangles, inflammation, and pigmentation of the gingiva. Whereas alteration in gingival contour and zenith have least impact on smile esthetics.

Assessment of gingival zenith position and distance from vertical bisecting midline in the maxillary anterior dentition − An observational study

Background: Esthetics in the maxillary anterior segment is determined by both the hard and soft tissues. Gingival contour plays a vital role in pink esthetics. The most common apical position of the marginal gingiva is referred to as gingival zenith (GZ). This study aimed to assess the position and distance of the GZ from the vertical bisecting midline (VBM) in the anterior maxillary dentition in a sample of South Indian population. Materials and Methods: A total of 105 participants were recruited based on specific inclusion and exclusion criteria. Following recruitment, alginate impressions were made, and dental cast were poured. A total of 630 anterior teeth were evaluated on the cast. The position of the GZ was marked, and a vertical line was drawn through the point. The VBM was drawn on the cast based on the crown width. Using magnification loupes (2.5×) and calibrated digital vernier caliper, the distance between the GZ and VBM was measured twice for each tooth, and the average reading was recorded. The position of GZ was recorded as mesial, distal, or coinciding with the VBM. Results: Majority of the right and left maxillary central incisors and lateral incisors were placed distal to the VBM measuring a mean distance of 0.7 ± 0.4 and 0.76 ± 0.36 mm, respectively, for centrals and 0.59 ± 0.3 and 0.62 ± 0.31 mm, respectively, for laterals. The GZ of both the right and left canines were mesial to the VBM at a mean distance of 0.59 ± 0.4 and 0.61 ± 0.3 mm, respectively. Conclusion: Familiarity with the position and distance of the GZ enables the dentist to plan an appropriate esthetic rehabilitation for the patients based on the population in question.

Association between central papilla recession and gingival and interdental smile line.

Interdental soft tissues play a critical role in pink esthetics. The presence and preservation of the interdental papillae in the esthetic zone is as crucial as the shape and contour of the anterior teeth in achieving an esthetically pleasing smile. The present study determines the association of central papilla recession with gingival and interdental smile line in periodontally healthy patients of different age groups. The present study included 200 patients equally divided into 21 to 40 years and 41 to 60 years age groups. The clinical and photographic evaluation of the central papilla, with midfacial gingiva, and its relationship with the vermilion border was performed. In total, 137 patients exhibited presence of central papilla, whilst 63 patients had central papilla recession with variable extent. The male patients predominantly had presence of central papilla in both the age groups, with 86% and 64%, compared with 74% and 50% in females, respectively. High gingival smile line was seen in the majority of the patients (62%), and this trend was similar to high interdental smile line (82% of the patients). Esthetics is affected in individuals having papilla recession along with high gingival smile line and interdental smile line as compared to individuals with low or cupid bow gingival smile line and interdental smile line.

Pinhole surgical technique for treatment of marginal tissue recession: A case series

The field of periodontal plastic surgery is always a subject of fascination for periodontists, and the importance of pink esthetics is gaining its pace. Preservation of what is existing is more important than its replacement. The same principle also applies to soft-tissue esthetic procedures thereby the concept of minimal surgical invasion came into existence. This article presents a series of five cases with 18 recession sites which were treated with a minimally invasive Pinhole Surgical Technique which resulted in overall root coverage of 96.7% after 6-month follow-up with minimal complications.