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Distal facial composite

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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.

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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.

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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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