The smile is a characteristic that expresses emotions and affects interpersonal relationships, significantly impacting self-esteem and influencing personal and professional life. The growing emphasis ...on aesthetics has made patients increasingly well-informed and demanding regarding available procedures. Excessive gingival display (EGD) can result from various factors, such as altered passive eruption, vertical maxillary excess, and short or hyperactive upper lip, among others. In this case report, where EGD was caused by upper lip hypermobility, the proposed treatment involved the modified lip repositioning surgical technique (MLRS) using sutures in the modified horizontal mattress technique, aiming to limit muscle and tissue movement and to approximate the mucosal edges. The outcome was an improved aesthetic harmony of the smile, with a more suitable position of the upper lip during spontaneous smiling, as observed in a six-month follow-up.
We present a case that describes a three-step clinical technique to provide guidelines to replace fractured teeth with immediate implant placement using the same dental structure as a temporary crown ...and a regenerative approach. This approach predictably maintains the interdental papilla and gingiva emergence profile to ensure a favorable cosmetic result. A 3-year follow-up has shown good clinical outcomes and stability in crestal bone levels. Consequently, this is an innovative way to do temporary crown and design restorations in everyday clinical practice.
Interdental papilla, dental implant, inmmediate implant, gingival aesthetics, dental aesthetics.
The gingival zenith (GZ) positions according to a reference line in the premolar (PM) area remain concern, especially for the clinicians in placing the gingival contours during surgery.
The ...objectives of this study are to determine the maxillary PM GZ positions according to GZ line (GZL).
A sample population of 63 patients with healthy gingival tissue was studied. The GZ was determined at the most apical point of the gingival marginal scallop. A horizontal-zenith line (ZL) was drawn connecting the GZ from the ipsilateral canine (C) and central incisor teeth. Reference lines were drawn, and bilateral measurements were taken in the respective stone casts in the PM area.
No statistically significant differences were found between bilateral first premolars (FPM) and second premolars (SPM). When considering ipsilateral FPM and SPM, statistically significant differences were found between them. For all PM teeth, the mean distance value of GZ to GZL was approximately 1.32 mm.
The present study results showed that GZs of FPM and SPM teeth for both left and right sight was coronally located according to ZL.
The aim of this study was to identify a correct clinical, surgical, and prosthetic management of endosseous implants replacing missing teeth in the anterior maxilla, achieving predictable aesthetic ...outcomes. Placement of immediate post-extraction implants without incisions or flap elevation is one of the surgical treatment options able to improve the healing and regenerative potentials of the fresh socket.
Fifty-five patients (33 men, 22 women), ranging in age from 19 to 57 years (mean 29), were selected for this study. All the patients were not smokers, no bruxers, presented stable soft tissue conditions, an acceptable occlusion, and the absence of pathologies that would contraindicate bone healing. Patients were treated with implants made by 2 manufacturers: Institute Straumann, Walderburg, Switzerland and Friadent, Mannheim, Germany. A total of 87 implants were placed immediately after each failing tooth had been removed. The temporary restoration was placed 3 months after implant placement, and the final restoration was placed 4 months from the surgical procedure. The patients were evaluated clinically and radiographically at implant placement, and 2, 4, 18, and 24 months post-insertion.
At 24 months, only 3 implants were lost (2 in male patients;1 in female patient). All of these failed implants did not achieve osseointegration. The overall success rate was 96.6%, with an implant failure rate of 3.4%, all prior to restoration.
The immediate placement in the anterior maxilla fresh extraction sockets without incisions or flaps elevation is a surgical option that can ensure ideal peri-implant tissues healing, preserving the presurgical gingival and bone aspects. For a predictable aesthetic result, the most important aspect seems to be the height and thickness of the buccal bone wall, which remain after immediate placement of the fixture.
In addition to understanding the basic standards of a smile and patient's opinion, dentists should take into account smile aesthetics, an essential factor for optimal outcomes. This study aimed to ...evaluate the factors that affect the perception of an aesthetic smile and determine its morphological characteristics and measure the gingival aesthetic parameters.
In all, 200 Vietnamese aged 18-35 years were recruited to have their spontaneous smiles captured. These smile images were assessed by 50 laypersons and 50 dentists using a visual analogue scale measurement. The images were analysed to evaluate perceptions of evaluators, determine smile attractiveness, and measure gingival aesthetics.
The difference in the judgements of laypersons and dentists, males and females, and laypersons aged 18-25 and 26-35 years were nonsignificant. High or average anterior smile line, parallel smile arc, upward upper lip curvature, second premolars as the posterior-most teeth displayed, smile index of 5.23-5.63, and dynamic smile symmetry of 1 were scored highly on smile attractiveness. The following maxillary gingival aesthetic parameters were preferred: gingival zenith (GZ) of the canine 0.72-0.75 mm apical to the GZ of the central incisor; GZ of the lateral incisor 0.66 mm coronal to the gingival line; gingival line angle of ∼87°; for the central incisor, lateral incisor, and canines, distance from the GZ to the long axis of 1, 0.4, and 0 mm, respectively; interdental papilla height of 4.25, 3.60, and 3.85 mm, respectively; ratio of the distance from the GZ and the interdental papilla tip to the incisal edge of ∼1.74-1.77 mm.
Factors including profession, gender, and age of evaluators had almost no impact on their perception of aesthetics. Smile attractiveness characteristics and gingival aesthetic parameters have clinical applicability for patient care.
Excessive gingival display (EGD), also known as a gummy smile, is characterized by overexposure of the maxillary gingiva on smiling. EGD can cause embarrassment and reduce patient satisfaction. This ...study aimed to evaluate the clinical and psychological effects of lip repositioning surgery on the management of EGD.
This experimental study enrolled 14 patients with EGD who had undergone a modified lip repositioning technique, which comprised moving two strips of mucosa bilaterally to the maxillary labial frenum and repositioning the new mucosal margin coronally. The extent of gingival display (GD), lip mobility (LM), total lip length (TLL), lip length (LL), and internal lip length (ILL) was measured at baseline and 6 months postoperatively. The pre-operative psychological assessment was conducted using the social appearance anxiety scale (SAAS) scores, whereas the postoperative assessment was conducted using SAAS and visual analog scale (VAS) scores at 1 week, 3 months, and 6 months postoperatively.
Among the clinical parameters, TLL increased by 2.0 ± 1.038, LL increased by 2.28 ± 0.99, ILL reduced by 2.78 ± 1.36, LM reduced by 3.21 ± 1.12, and GD reduced by 3.14 ± 0.77 at 6 months postoperatively. Among the psychological parameters, SAAS reduced by 31.42 ± 1.907 from the baseline to 6 months, whereas the VAS score reduced to 3.14 ± 0.27 at 6 months postoperatively.
A significant reduction in GD, which is largely dependent on strict case selection, pain, and social anxiety was observed in this study, indicating that lip repositioning surgery is effective in managing EGD.
This 1-year prospective study evaluated the implant success rate, peri-implant tissue response, and esthetic outcome of immediately placed and provisionalized maxillary anterior single implants.
...Thirty-five patients (8 men, 27 women) with a mean age of 36.5 years (range 18 to 65) were included in this study. Thirty-five threaded, hydroxyapatite-coated implants were placed and provisionalized immediately after each failing tooth had been removed. The definitive restoration was placed 6 months later. The patients were evaluated clinically and radiographically at implant placement and at 3, 6, and 12 months after implant placement.
At 12 months, all implants remained osseointegrated. The mean marginal bone change from the time of implant placement to 12 months was -0.26 +/- 0.40 mm mesially and -0.22 +/- 0.28 mm distally. No significant differences in the Plaque Index scores were noted at different time intervals. The mean midfacial gingival level and mesial and distal papilla level changes from pretreatment to 12 months were -0.55 +/- 0.53 mm, -0.53 +/- 0.39 mm, and -0.39 +/- 0.40 mm, respectively. All patients were very satisfied with the esthetic outcome and none had noticed any changes at the gingival level.
Although marginal bone and gingival level changes were statistically significant from pretreatment to 12 months of follow-up, they were well within clinical expectations.
The results of this study suggest that favorable implant success rates, peri-implant tissue responses, and esthetic outcomes can be achieved with immediately placed and provisionalized maxillary anterior single implants.
The positive psychological effects of improving patients' smile often contribute to an improved self-image and enhanced self-esteem. Periodontal disease may lead to tooth and tissue loss that can ...result in esthetic problems. Combined periodontal/prosthodontic treatment for patients with advanced disease is well documented. This case report illustrates a method of treatment for an advanced tissue loss in an esthetic area using a removable silicone gingival prosthesis/mask.
Rehabilitating anterior edentulous areas can be a challenge for clinicians when there is a loss of hard and soft tissues. The authors present an innovative approach to manage these cases.
Case 1 ...involved a patient with a dental implant placed in the position of tooth no. 7 and a loss of soft tissues in the proximal areas. The authors bonded veneers to teeth nos. 6 and 8 and placed a screw-retained implant crown in the position of tooth no. 7. All of the prosthetic components had gingiva-shade and crown ceramics. Case 2 involved a patient with a dental implant in the position of tooth no. 10 and loss of soft tissues. The authors bonded papillary veneers to teeth nos. 9 and 11 and placed a screw-retained zirconia anatomical abutment prepared for a ceramic veneer with gingiva-shade ceramics in the cervical area.
The prosthetic option of papillary veneers helps in the restoration of lost soft tissue and can mimic natural appearance in a predictable and stable way.
Due to the development of dental materials and the esthetic requirements of patients, conservative restoration and esthetic dentistry is becoming more and more important.....
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