Gingival recession causes not only aesthetic problems, but problems with oral hygiene, plaque accumulation, speech, and tooth sensitivity. Replacing the missing gingival tissue with composite resin, when indicated, can be a time- and cost-effective solution. Here we report the case of a year-old female who presented with generalized gingival recession. Distal facial composite triangles were present between the maxillary and mandibular anterior teeth due to loss of interdental tissues, caused by recent periodontal surgery.
She also had slightly malposed maxillary anterior teeth. The patient elected to replace gingival tissue with pink composite resin and to alter the midline with composite resin veneers. The first treatment phase involved placement of pink gingival composite to restore the appearance of interdental papilla to her upper 16, 15, 14, 13, 12, 11, 21, 22, 23, and 24 and Distal facial composite 34, 33, 32, 31, 41, 42, 43, and 44 teeth.
Phase two was to place direct composite Distal facial composite bonded veneers on her upper 16, 15, 14, 13, 12, 11, 21, 22, 23, and 24 teeth to alter the midline and achieve desired colour. The third treatment phase was to level the lower incisal edge shape by enameloplasty 31, 32, 41, and 42 to produce a more youthful and attractive smile.
This case report and brief review attempt to describe the clinical obstacles and the current treatment options along with a suggested protocol. Use of contemporary materials such as gingival coloured composite to restore lost gingival tissue and improve aesthetics can be a simple and cost-effective way to manage patients affected by Distal facial composite aggressive periodontitis AgP. Aesthetic dentistry involves harmonious integration of smile design, conception, and material Distal facial composite.
This is accomplished by a comprehensive knowledge of facial aesthetics, tooth morphology, available restoration techniques, and communication skills. An understanding of smile components, teeth, gingival tissues, and lips, is crucial. The maxillary central incisors are the visual focal point for the smile, and they should be dominant and symmetrical. The ideal gingival levels are determined by establishing the correct width-to-length ratio of the maxillary anterior teeth Marus, ; Wolfart et al.
Generally, gingival tissue runs parallel to the upper lip and its architecture is bilaterally symmetrical.
The zenith of this tissue on the maxillary central incisors and canines is skewed slightly to the distal side Feigenbaum, ; Magne and Belser, The gingival embrasures should be bilaterally symmetrical and allow for interdental papillary architecture Feigenbaum, ; Magne and Belser, Aggressive periodontitis AgP includes both localized and generalized forms of periodontitis in which there is rapid destruction of the periodontal ligament and the alveolar bone in younger and otherwise systemically healthy individuals Roshna and Nandakumar, Untreated AgP can result in flaring, protrusion, diastema, extrusion, rotation, and drifting of the teeth.
Malocclusion caused by pathologic migration of teeth can be corrected by orthodontics once AgP has been stabilized with periodontal therapy Roshna and Nandakumar, Regeneration Distal facial composite the periodontal supporting structures lost due to periodontal disease and restoration of aesthetic appearance and function of the periodontium Distal facial composite difficult and in most cases requires interdisciplinary approaches Maeda et al.
Techniques for periodontal regeneration include the use of grafts, barrier membranes or guided tissue regeneration, biologic modifiers like growth and differentiation factors, and extracellular matrix proteins such as enamel matrix proteins, or any combination of the above Roshna and Nandakumar, This gingival defect also contributes to retention of food debris, adversely affecting the health of the periodontium Kurth and Kokich, ; Donovan, ; Roshna and Nandakumar, Treatments include surgical or prosthetic approaches.
Surgical treatment can be successful in creating aesthetically pleasing and anatomically correct tissue contours when small volumes of tissue are being reconstructed. However, long term results are variable due to the complexity of the interdental space and its vascularity Babu et al.
Surgical costs, healing time, discomfort, and varying long term results make this choice unpopular Barzilay and Irene, ; Clark, ; Jacobson and Frank, ; Patil et al. Prosthetic approaches to reproduction of Distal facial composite gingival tissue include porcelain, acrylics denture base materialsilicone based soft materials, Distal facial composite co-polyamide and composite resin.
Each material has advantages, disadvantages, and specific indications Barzilay and Irene, ; Capa, ; Coachman and Calamita, A removable prosthesis allows a larger volume of tissue to be replaced without disturbing other dental units Distal facial composite proper cleaning is still feasible Barzilay and Irene, ; Patil et al.
For patients requesting fixed restoration of soft tissue in the aesthetic zone, the use of gingiva-coloured pink porcelain can help in recreating natural tooth proportions and provide realistic alternatives to surgery Sarver, ; Martegani et al. The use of pink composite resin as an artificial gingival tissue was first described by Zalkind and Hochman in the management of a cervical defect.
When used for soft tissue restoration, the cervical contour must be created such that plaque retention is prevented. This can be Distal facial composite using appropriate application instruments, adequate moisture control, and curing. For optimal aesthetics, a pseudo gingival sulcus can be created around the margin of the restoration that coincides with the previous free gingival margin. An advantage of using composite resin over pink porcelain is direct placement.
For proper tooth alignment, a clinician should present only treatment options that involve predictable, conservative restorations that preserve healthy tooth structure Jacobson and Frank, Distal facial composite Orthodontic alignment is expensive and time consuming, but usually successful.
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The appearance of tooth alignment can be achieved using porcelain veneer restoration PVRbut this procedure usually requires aggressive removal of tooth structure Christensen, ; Christensen, ; Croll, ; Heymann and Kokich, ; Spear, Distal facial composite Jacobson and Frank, and therefore is not a conservative measure. More conservative treatment options such as orthodontics, direct bonding composite resin, and enameloplasty should be offered to the patient.
Moreover, the inability to restoratively improve gingival relationships with PVRs may result in achieving less-than-optimal aesthetics. For patients with aesthetic and functional defects Distal facial composite loss of gingival tissue, composite resin material can be a timely and cost-effective alternative to surgical options.
This study was approved by the Hospitals Human Ethics Committee. Written informed consent was obtained from the patient for publication of this case Distal facial composite and accompanying images. The authors report no conflicts of interest in the preparation of this case report. A year-old female patient reported to the Department of Conservative Dentistry, Makkah Dental Center, Makkah, Saudi Arabia with a chief complaint of generalized gingival recession with black triangles present between the maxillary and mandibular anterior teeth Figs.
Facial view of the patient showing open gingival embrasure between the maxillary and mandible central incisors. The patient complained of tooth sensitivity and oral hygiene problems resulting in plaque accumulation on maxillary and mandibular teeth. Air and fluid escaping from between the anterior teeth made her extremely uncomfortable.
The mandibular lateral incisors 32, 42 were rotated and slightly extruded, partially overlapping the central incisor, which impart softness and youthfulness to smile. Gingival recession with loss of the interdental papilla involved her maxillary 16, 15, Distal facial composite, 13, 12, 11, 21, 22, 23, and 24 and mandibular 34, 33, 32, 31, 41, 42, 43, and 44 teeth Figs.
The patient also had varying shades of mild brown band discolourations of the Distal facial composite teeth 11, 12, 13, 21, 22, and The patient was thoroughly informed about the different options for restoration of gingival tissue, alteration of the midline for aesthetic smile symmetry, and improved tooth shading.
She expressed opposition to an additional surgical Distal facial composite to reconstruct open gingival embrasures by grafting and bone augmentation. Instead she opted for restoration of the dentogingival complex using the pink composite resin because this technique allowed satisfactory function and aesthetics at lower cost and could be completed chairside. She also chose to alter the midline and to block out the underlying tooth colour using composite resin.
The teeth were isolated and acid etched with The pink gingival composite anaxGUM Pink Composite, Anaxdent, Stuttgart, Germany was scalloped between the teeth and natural gingiva without preparation.
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The gingival base was made in layers to create the proper contours without any overhang of material. Composite was completed on the maxillary teeth 16, 15, 14, 13, 12, 11, 21, 22, 23, and 24 Fig.
Final contouring was performed using a composite finishing and polishing system Enhance Dentsply Caulk Dentsply International Inc. The maxillary pink gingival composite completed first around teeth 16, 15, 14, 13, 12, 11, 21, 22, 23, and Facial view of the completed direct pink gingival composite around maxillary teeth 16, 15, 14, 13, 12,11, 21, 22, 23, and 24 and mandibular teeth 34, 33, 32, 31, 41, 42, 43, and After soft tissue restoration Distal facial composite aesthetic gingival papillary levels and scalloping over the central incisors, composite splints were placed palatally from canine to canine to stabilize the teeth and reduce mobility.
After two months, both patient and clinician were satisfied with the shade and contour of the pink gingival composite, and the composite splints were nicked off the Distal facial composite structure. Alteration of the midline and shading of maxillary anterior teeth using composite resin veneers. Composite resin veneers were placed on maxillary teeth 16, 15, 14, 13, 11, 12, 21, 22, 23, and Minimally invasive preparation techniques were used, with gross labial Distal facial composite from 0.
The gingival margin consisted of a shallow chamfer about 0.
Colour matching of the composite...
The preparations extended sufficiently interproximally to conceal the margins. The incisal preparation was very minimal. The prepared surfaces were acid etched with The composite resin veneer was placed using an incremental layering technique to create a polychromatic effect.
Because of the minimal preparation design and Distal facial composite tooth discolouration, no dentin shade A2D was necessary. Placement of each layer was closely monitored from the incisal view to prevent over bulking, which would negatively impact the health of the soft tissue.
Cervically Distal facial composite composite veneer finished at the gingival pink composite, while the veneer blended incisally.
Finally, the mandibular incisal edge shape was altered by enameloplasty 31, 32, 41, and 42producing a more youthful and aesthetically pleasing smile Fig. Facial view of the Distal facial composite direct composite resin veneers for maxillary teeth 16, 15, 14, 13, 12, 11, 21, 22, 23, and 24 before finishing and polishing. Altering the incisal shape and leveling mandibular 32, 31, 41, and 42 anterior incisal edge by enameloplasty. The definitive restorations exhibited a harmonious, natural form and achieved the aesthetic expectations of the patient.
Pre and postoperative aesthetic appearance of the completed direct resin veneers. Distal facial composite that define a desirable smile have been refined while retaining consideration and respect for individual variations Tanaka et al.
Challenging cases involving the anterior area require a more comprehensive approach and a deeper understanding of the pink component of the smile, the gingiva.
The gingival architecture represents the frame for the teeth. If it is not restored correctly, either surgically or prosthetically, it will impair the final three dimensional aesthetic Zalkind and Hochman, ; McCoy et al.
Surgical treatment for the aesthetic and functional problems caused by open gingival embrasures are often insufficient to re-establish ideal aesthetics. Therefore, composite resin should be a consideration in the initial treatment plan. The application must be carefully assessed to prevent undue thickness which could cause plaque retention, compression of the papilla, Distal facial composite inflammation, leading Distal facial composite subsequent aesthetic problems Burke et al.
The greatest challenge in using restorations to alter interproximal embrasure form is for the clinician to carry the restoration subgingivally to gradualize the contour change.
Keywords: Minimally invasive aesthetics coloured...
Attempting to leave the margin at gingival levels Distal facial composite leave ledges of restorative material and will negatively impact the papillary form Spear, In the case presented here, the patient had gingival and ridge recession leading to open embrasures that caused functional and aesthetic problems Figs.
A major consideration in alveolar ridge recession is the vertical aspect of the defect, including papillae and gingival margin levels. The use of pink composite resin was indicated in this case to restore the gingival architecture and to guide the shape of the interdental papilla Figs.
Problems with midline and Distal facial composite discolouration can both be improved with veneers. Newer dental adhesive materials do not require as much mechanical retention, allowing minimally invasive preparations and conservation of tooth structure Murdoch-Kinch and McLean, Most manufacturers of dental adhesives offer Distal facial composite a total-etch adhesive and a self-etch adhesive. Research shows the highest mean bond strengths to enamel were obtained with total-etch adhesives Bagis et al.
show typical damage on the impact and distal faces for two reinforced wall panels, one with single face and another with double face reinforcement.
DF Distal-Facial Incisal . DFI Distal- Facial Incisal Lingual Distal-Occlusal Facial. Distal-Occlusal Lingual Facial. Occlusal Composite. Decay/Caries. Needs to be done. Page 3. MOD Amalgam Filling. Distal. Mesial.
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Page 4. Cervical/Facial Bonding.
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Gingival recession causes not just aesthetic headaches, but worriments with vocal hygiene, pin accumulation, sales pitch, and tooth sensitivity. Replacing the missing gingival pack with composite resin, when indicated, can be a time- and cost-effective result. Here we report the case of a year-old female who presented with generalized gingival recession. Felonious triangles were present among the maxillary and mandibular anterior teeth due to loss of interdental tissues, caused next to recent periodontal surgery.
She also had slightly malposed maxillary anterior teeth. The patient elected to substitute for gingival web with pink composite resin and to alter the midline with composite resin veneers.
The first treatment phase intricate placement of pink gingival composite to restore the appearance of interdental papilla to her upper 16, 15, 14, 13, 12, 11, 21, 22, 23, and 24 and lessen 34, 33, 32, 31, 41, 42, 43, and 44 teeth.
Phase two was to place manage composite resin bonded veneers on her upper 16, 15, 14, 13, 12, 11, 21, 22, 23, and 24 teeth to alter the midline and achieve appropriate colour. The third treatment phase was to constant the take down incisal perimeter shape nearby enameloplasty 31, 32, 41, and 42 to construct a more youthful and attractive grin.
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Incidence and size of pretreatment overlap and posttreatment gingival embrasure space between maxillary central incisors. The patient also had varying shades of mild brown band discolourations of the anterior teeth 11, 12, 13, 21, 22, and Abstract Gingival recession causes not only aesthetic problems, but problems with oral hygiene, plaque accumulation, speech, and tooth sensitivity.
Clinical management of root caries. Replacing the missing gingival tissue with composite resin, when indicated, can be a time- and cost-effective solution. Malocclusion caused by pathologic migration of teeth can be corrected by orthodontics once AgP has been stabilized with periodontal therapy Roshna and Nandakumar, The appearance of tooth alignment can be achieved using porcelain veneer restoration PVR , but this procedure usually requires aggressive removal of tooth structure Christensen, ; Christensen, ; Croll, ; Heymann and Kokich, ; Spear, ; Jacobson and Frank, and therefore is not a conservative measure.
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Do women really play hard to get? show typical damage on the impact and distal faces for two reinforced wall panels, one with single face and another with double face reinforcement. DF Distal-Facial Incisal .. DFI Distal- Facial Incisal Lingual Distal-Occlusal Facial. Distal-Occlusal Lingual Facial ..
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