Anterior dental aesthetics: Gingival perspective

A Cross-Sectional Observational Study of Gingival Color Patterns in the South Indian Population

BACKGROUND

Gingival aesthetics or pink aesthetics requires a prosthodontic approach to ensure an appealing smile with an optimal muco-gingival appearance by the use of colored materials with gingival shades to match adjacent soft tissues. However, the selection of this adhesive gingival-colored material becomes complex owing to the wide range of gingival color guides and shade tabs currently available on the market.

AIM

The study aims to assess the variation in gingival color between two specific regions on the anterior gingival surface through the use of a digital color assessment method. Furthermore, the study seeks to investigate the potential requirements for an innovative soft tissue dual shade guide system.

METHODOLOGY

Fifteen participants were examined with an external light source set up in a 45-degree optical configuration. The Frontal view intraoral photographs were taken with a digital Canon 70D camera using a cheek retractor. The photo was white balanced using the color sorter tool in the software (Adobe Photoshop CS6®), and the second quadrant was cropped, two regions were selected (free gingival margin and marginal gingiva) and used for all samples for standardization. The color data were represented in terms of L*, a*, and b* coordinate axes values following the CIELAB color system. The recorded color coordinates were then examined using SPSS software, version 24 (IBM Corp., Armonk, NY).

RESULTS

The mean and standard deviation of the coordinate axes were as follows: for L1, 52.33 ± 12.92; for a1, 30.06 ± 4.81; for b1, 18.00 ± 3.89; for L2, 44.53 ± 11.01; for a2, 36.13 ± 7.92; and for b2, 18.26 ± 6.70. Statistically significant differences were found between the L*, a*, and b* color coordinates with a color difference (ΔE) beyond the clinical acceptance (ΔE > 3.7) threshold of ΔE = 4.88, mainly for a* values.

CONCLUSIONS

Within the limitations of this study, significant color differences were observed between the selected regions. The a* coordinate was found to be statistically significant (+6.07), indicating a shift towards a lighter shade of redness (+a) in the color-opponent dimensions of redness-greenness within the CIELAB color space system.

Gingival phenotype determination: Cutoff values, relationship between gingival and alveolar crest bone thickness at different landmarks

Background/purpose

Gingival phenotype (GP) has been reported to influence the treatment planning and clinical outcomes in several dental specialties. This study aimed to investigate optimal cutoff values for gingival thickness (GT) measurement at different landmarks to determine GP. The correlations between GT and bone thickness (BT) of buccal alveolar crest were also analyzed.

Materials and methods

A total of 600 teeth were included. GP was clinically determined by the transparency of a periodontal probe through the gingival margin (TRAN). Measurements for free gingival thickness (GT1), cementoenamel junction gingival thickness (GT2), supracrestal gingival thickness (GT3), subcrestal 1 mm gingival thickness (GT4) and BT at 1, 3 mm apical from the alveolar crest edge (BT1 and BT2) were assessed on cone-beam computed tomography (CBCT) images. Spearman's correlation coefficient was used to evaluate correlations between GT and BT.

Results

The optimal cutoff values of GT using CBCT method to discriminate GP were 0.75 mm for GT1, 0.85 mm for GT2, 1.15 mm for GT3 and 0.45 mm for GT4. There was significantly positive correlation between GT and BT at all levels (r: 0.375-0.903). The correlations between GT3 and BT (r: 0.789-0.903) were strong, while correlations between GT4 and BT were weak (r: 0.375-0.467).

Conclusion

The optimal cutoff values of gingival thickness using CBCT method to discriminate gingival phenotype at each gingival landmark were determined. The supracrestal gingival thickness might be an indicator of buccal alveolar crest bone thickness, which could provide valuable perspectives on clinical diagnosis, treatment planning and decision-making.

Periodontal Healing with Fixed Restorations Using the Biologically Oriented Preparation Technique Combined with a Full Digital Workflow: A Clinical Case Report

(1) Gingival inflammation is an ongoing challenge in tooth-supported fixed restorations, especially when the prosthetic margin does not consider the supracrestal tissues of patients. This case report aimed to present the case of a patient who was periodontally compromised due to a previous invasion of the supracrestal tissue attachment with fixed restorations and evaluate the healing response of periodontal tissues to a vertical edgeless preparation technique: bleeding upon probing (BOP), periodontal probing depth (PPD) and clinical attachment level (CAL). (2) After tooth preparation, the new restorations were adapted, this time without invading the supracrestal space of the patient, and CAD/CAM monolithic zirconia crowns were fabricated. (3) Optimal maturation of the soft tissue was observed, achieving correction of the marginal contour of periodontal tissues and improvement of periodontal indexes. (4) It can be concluded that the BOPT technique combined with a full digital workflow is a valid option for the correction and remodeling of gingival architecture.

The Interference of Age and Gender on Smile Characterization Analyzed on Six Parameters: A Clinical-Photographic Pilot Study

Background and Objective: This study aimed to evaluate six smile-esthetic parameters (deviation of the upper dental midline from the facial midline, upper lip curvature, smile line, smile arch, smile width, and shape of the maxillary central incisors), correlating them with age and gender. Materials and methods: Caucasian individuals (N = 114) were grouped by gender (male and female) and age (group I—18 to 30 years old; group II—31 to 50 years old; and group III—over 50 years old). Using a digital camera, extra and intraoral pictures were taken to analyze the variables above-mentioned. The data were statistically evaluated, considering a significance level of p < 0.05. Results: Most participants found deviations of the upper dental midline, straight upper lip curvature, and the medium smile line coincided with the facial midline. The parallel smile arch exposing 9 to 11 upper teeth, the absence of exposure of lower teeth when smiling, and oval upper incisors were prevalent parameters. Regarding gender, significant results were found for the curvature of the upper lip (p = 0.049), the smile arch (p = 0.001), and the shape of the upper central incisors (p = 0.004). For age, the association with the curvature of the upper lip (p = 0.032), the smile line (p = 0.001), the smile arch (p = 0.007), the width of the smile exposing lower teeth (p = 0.002), and the shape of the upper central incisors (0.012) were significant. Conclusions: Within this study’s limitations, gender and age affect the anterior teeth shape and upper lip curves; gender and age did not influence the coincidence between dental and facial midlines.

Interdental Papillary Reconstruction by Microtunnelling Technique Using Autologous Biomatrices-A Randomised Controlled Clinical Trial

Background and objectives: The study aimed to evaluate and compare the amount of papillary gain and black triangle height reduction after intervention with a microtunnelling technique with either Connective tissue graft (CTG) or Platelet-rich fibrin (PRF) as a biomatrix at 6 months using a microsurgical approach. Materials and Methods: Twenty-six patients with interdental papillary loss were included in the study. The patients were selected randomly for the study groups with thirteen patients in each group: a control group where CTG was utilised as a matrix, and a test group where PRF was utilised as a matrix, for interdental papillary reconstruction. A microtunnelling technique was performed for both the study groups under a surgical microscope. The primary parameters assessed were interdental Papillary height (PH) and Black triangle height (BTH) at baseline, with secondary parameters Visual analogue score by dentist (VAS-D) and patient (VAS-P) assessed at 6 months. Results: Both the control and test groups showed a significant reduction in BTH within their respective group at six months (p < 0.05). The gain in papillary height significantly improved only in the CTG group at 6 months. However, significant differences could not be demonstrated for any of the variables such as BTH (p value = 0.582) and PH (p-value = 0.892) between the study groups at 6 months. Conclusions: IDP reconstruction utilising a microtunnelling approach with CTG or PRF was successful without any significant differences between the groups for the parameters assessed at 6 months.

Orthognathic Surgery for Management of Gummy Smile

Excessive gingival show is mainly caused by hypermobility of the upper lip, altered passive eruption, gingival hyperplasia, and bony maxillary vertical excess. Orthognathic surgery is the optimal treatment option for patients with moderate and severe vertical maxillary excess. Surrounding anatomic structures and soft tissue changes such as alternation in the nasal morphology confine the amount of impaction. Therefore, Le Fort 1 may be performed in conjunction with horseshoe osteotomy or partial turbinectomy. The possible necessity of further mandibular orthognathic surgeries and chin repositioning has to be considered. No common major complication and long-term relapse have been reported for maxillary impaction.

Gender- and age-related differences in the width of attached gingiva and clinical crown length in anterior teeth

Background

The anatomical features of the gingiva and the clinical crowns and their interrelation, especially in aesthetically and functionally demanding areas, are important in complex dental or implant-retained prosthetic rehabilitations. This observational cross-sectional study was designed to evaluate gender- and age-related differences in the width of attached gingiva (WAG), the clinical crown length (CCL), and their interrelation in the anterior teeth to determine the relationship between the pink and white aesthetics.

Methods

Eighty (54 females, 26 males) fully dentate Caucasian participants between the ages of 20 and 25 years and 36 probands (23 females, 13 males) between the ages of 45 and 55 years were included in the present study. The CCL of the maxillary and mandibular canines, as well as the central incisors of the maxilla and mandible, were determined with a dental sliding caliper measuring from the middle margin of the gingiva at its deepest point to the incisal edge. The clinical investigation of the WAG was performed by inserting a periodontal probe into the gingival sulcus in the middle of the buccal surface to firstly measure the probing pocket depth. The distance between the gingival margin and mucogingival junction (MGJ) was then measured with a Beerendonk sliding caliper in the middle of the labial curvature, and the clinical WAG was determined by subtraction of the measured probing depth. For the statistical analysis, the Mann–Whitney U test, the Wilcoxon-Test, the Spearman’s rank correlation, and a two-factorial non-parametric analysis were used.

Results

There was no correlation between the CCL and the WAG in a healthy periodontium. Gender influenced the CCL, with men having significantly longer teeth than women in both maxilla (P ≤ 0.01) and mandible (P ≤ 0.05). Age did not influence the CCL significantly neither in the upper (P = 0.06) nor in the lower jaw (P = 0.33). Gender did not show to have a significant influence on the WAG of maxilla (P = 0.69) and mandible (P = 0.26). But differences in the WAG between young and old participants were observed in both upper (P ≤ 0.01) and lower jaw (P ≤ 0.05).

Conclusion

The present observational study demonstrated that the mean values of cohorts with mixed age groups and genders should not be considered when attempting to determine the ideal relationships between the pink and white aesthetics since the statistical analyses showed significant differences between different age groups and genders.

Surgical Correction of the "Gummy Smile"

The delineation of excessive gingival display and review of current treatment options. Discussion over periodontal and prosthetic treatments, mucosal stripping procedures, myotomies, Botox therapy, and orthognathic procedures for correction of the "gummy smile."

The Influence of Varying Gingival Display of Maxillary Anterior Teeth on the Perceptions of Smile Aesthetics

OBJECTIVES

The aim of the study was to investigate the influence of gingival display on perceived smile aesthetics and to compare aesthetic gingival display preference amongst dental professionals and lay people.

METHODS

This cross-sectional study was based on the analysis of quantitative data collected via questionnaires. Two sets of digitally altered smile images with variations of gingival amount and architecture displays were produced. Ranking order scale was used to record aesthetic preferences, from the most attractive to the least attractive.

RESULTS

There were 124 respondents (60 lay people, 32 general dentists [GDPs] and 32 orthodontists). Average smile line, tangent to the zeniths of maxillary anterior teeth, was found to be the most attractive gingival amount (53.2%, χ² = 144.15, p < 0.045) amongst lay people, GDPs and orthodontists. High smile line was ranked as the least attractive amount amongst all respondents (88.7%, χ² = 359.37 p < 0.002). Class III gingival outline, where all gingival levels are symmetrical and in line, was found as the most attractive gingival architecture (65.3%, χ² = 10.87 p < 0.001).

CONCLUSION

No particular amount of gingival display is universally perceived as attractive although high smile lines are generally disliked. Class III gingival architecture is the most preferred gingival archetype when excessive amount of maxillary gingiva is exposed.

CLINICAL SIGNIFICANCE

A general acceptance to smile line variations demonstrates that the harmony amongst all smile components is more important than merely focusing on a single ideal smile constituent. However, when designing the smile with an inherent high lip line, a Class III gingival architecture might be more preferable since it reduces the negative impact of excessive gingival display.

Association between Gingival Biotype and Facial Typology through Cephalometric Evaluation and Three-Dimensional Facial Scanning

In dentistry, the assessment of periodontal biotype is considered one of the most important parameters with which to plan treatment, and craniofacial morphology might affect it. The aim of this study was to investigate the association between facial typology and gingival biotype in patients by means of two-dimensional and three-dimensional evaluations of facial typology. This study included 121 participants searching for orthodontic treatment (43 M, 78 F; 20.4 ± 10.4). Gingival biotype was evaluated based on the transparency of the periodontal probe through the gingival margin of the mid-buccal sulcus for both upper (UGB) and lower (LGB) anterior teeth. SellionNasion^GonionGnation (SN^GoGn) and CondylionGonionMenton (CoGoMe^) angles were measured on two-dimensional cephalograms. Three-dimensional face scans were acquired by means of a three-dimensional facial scanner (3dMD system) and successively analyzed to assess the facial typology using the ratio between lower facial height (SNMe) and total facial height (NMe). A chi-squared test and regression analysis were used to evaluate the associations between gingival biotype and facial morphology (p < 0.05). The chi-squared test showed that there was no statistically significant association between facial typology and gingival biotype (UGB p = 0.83; LGB p = 0.75). The logistic regression showed an association between SNMe/NMe and the UGB (p = 0.036), and SNMe/NMe and LGB (p = 0.049). The decreased ratio of SNMe/NMe might be a protective factor for a thin gingival biotype.

Interim restoration technique for gingival displacement with a feather-edge preparation design and digital scan

A straightforward and time-efficient technique is presented for recording digital scans in single- and multiple-unit tooth abutments with feather-edge finish lines. The margins of the interim restoration should be precise and sufficiently deep in the sulcus so that the tissues can be properly displaced. Definitive intraoral scans should be made approximately 3 to 4 weeks after the tooth (or teeth) has been prepared to allow healing of the soft tissues. The interim restoration is first removed and then reseated after removing cement residue. First, a scan is made with the interim restoration in place. The abutment tooth or teeth are then erased from the original digital file, the interim restoration is removed again, and a new scan enclosing only the abutment tooth is made.

Use of different concentrations of hyaluronic acid in interdental papillary deficiency treatment: A clinical study

Background:

In the present era, demand of beauty and esthetics has increased rapidly. Interdental papilla construction, especially in the esthetic zone, is one of the most challenging tasks. Interdental papilla loss might occur due to several reasons as a consequence of periodontal surgery, trauma, and others.

Aim and Objective:

The present study was aimed to prepare economically feasible injectable form of hyaluronic acid (HA) gel in three different concentrations – 1%, 2%, and 5% HA to evaluate its efficacy in the enhancement of deficient interdental papilla (IDP).

Materials and Methods:

A total of 42 sites (mean age range was 29.6–30.6 years) was categorized into three groups; 1% HA group (16 sites), 2% HA group (14 sites), and 5% HA group (12 sites). Total 35 sites were followed up out of 42 in which 2% HA group included only 7 sites. Both maxillary (17 sites) and mandibular (18 sites) sites were included in this study. HA was injected at 2 mm apical to papillary tip at weekly interval for 3 weeks. The IDP augmentation was measured using UNC-15 probe and modified stent at 1, 3, and 6 months. The photographic analysis was done using Image J software.

Results:

On clinical measurement, 5% of HA showed highly significant enhancement (P = 0.001) of 19.2%, 20.6% 18.2% at 1, 3, and 6 months, respectively. On photographic analysis, 5% of HA showed 41%, 42.9%, and 39.8% at 1, 3, and 6 months, respectively. However, intergroup comparison showed nonsignificant improvement.

Conclusion:

This study results suggest that the use of 5% of HA is effective for interdental deficiency treatment with minimal rebound at the end of 6 months. The modified stent for IDP measurement used in this study for the first time in the literature is highly recommended. The photographic analysis using image J Analyzer serves a useful and dependable tool. Further, long-term clinical studies would throw more insight in this regard.

Periodontal biotype modification using a volume-stable collagen matrix and autogenous subepithelial connective tissue graft for the treatment of gingival recession: a case series

Purpose

The purpose of this study was to propose a technique for periodontal biotype modification through thickening of the entire facial aspect using a volume-stable collagen matrix and autogenous subepithelial connective tissue graft (CTG) for the treatment of gingival recession.

Methods

Four systemically healthy patients showing Miller class I or class II gingival recession in the mandibular incisor area were included in this study. Full-mouth scaling and root planing procedures were performed at least 4 weeks prior to periodontal plastic surgery. A split-thickness flap with a horizontal intrasulcular incision and 2 vertical incisions was used in cases 1–3, and the modified tunnel technique was used in case 4 for coronal advancement of the mucogingival complex. After the exposed root surfaces were debrided thoroughly, double-layered volume-stable collagen matrix was placed on the apical part of the recession and a subepithelial CTG harvested from the palatal area was placed on the coronal part. The amount of root coverage at 3 months postoperatively was evaluated in cases 1–3, and facio-lingual volumetric changes were analyzed in cases 1 and 2.

Results

Healing was uneventful in all 4 cases and complete root coverage was shown in cases 1–3. In case 4, reduction of gingival recession was observed at 3 months after surgery. In cases 1 and 2, a comparison of stereolithographic files from the preoperative and postoperative time points demonstrated that the entire facio-lingual volume had increased.

Conclusions

The surgical technique suggested herein, using a volume-stable collagen matrix and autogenous subepithelial CTG, may be an effective method for periodontal biotype modification through thickening of the entire facial aspect for the treatment of gingival recession.

[Treat or prevent the loss of inter-dental papillae]

INTRODUCTION

Contemporary literature agrees that orthodontic results can no longer be limited to occluso-functional success. The integration of the teeth into a healthy periodontium is essential to good treatment finish and durability.

MATERIALS AND METHODS

This article proposes to describe the orthodontic physiopathological and iatrogenic lesions leading to the opening of black triangles in place of the inter-dental papillae. It goes on to discuss different periodontal, prosthetic as well as orthodontic reconstruction protocols.

RESULTS

This last point, supported by a biological rationale well-known to periodontologists, is described using clinical cases.

Facial profile based evaluation of gingival zenith position in maxillary central incisors among Saudi, Indian & Bangladeshi population

Background

Recently quantitative evaluation of gingival zenith position was evaluated in different facial forms suggesting clinicians may need to evaluate patients facial form and then decide to distalise the Gingival Zenith position in relation to Vertical Bisected Midline (VBM). The aim of the study was to quantitatively evaluate the gingival zenith width in convex, concave and straight facial profiles for Saudi, Indian and Bangladeshi nationals.

Materials/methods

114 subjects of each Saudi, Indian & Bangladeshi nationality were grouped into convex, concave and straight profile based on angle of convexity. Gingival zenith position (GZP) on #11 and #21 was evaluated on the scanned dental plaster model using CBCT. Inter and Intra group comparison was done using one-way ANOVA test.

Results

Mean GZP values ranged from 0.84 mm to 1.10 mm, 0.75 mm to 1.02 mm and 0.87 mm to 1.14 mm for Saudi, Indian and Bangladeshi subjects respectively. Statistically significant (p < 0.05) difference was observed in convex, concave and straight profile subjects of these nationalities.

Conclusion

GZP variation does exist in different facial profiles of Saudi, Indian & Bangladeshi nationalities with respect to central incisors.

Clinical significance

These findings help clinician to consider facial profile as important entity in designing the smile following restorative and prosthetic procedures such as crown lengthening, teeth selection, implant esthetics and laminates.

An evaluation of the influence of teeth and the labial soft tissues on the perceived aesthetics of a smile

Objective The aim of this study was to investigate how the lips and teeth may affect the perceived aesthetics of a given smile. Lips and teeth were collectively assessed in different fields of view to see how they may contribute to smile aesthetics. The perception of 'beauty' was assessed to determine whether differences existed between; dentists, non-dentists, males and females.Methods Five subjects were photographed to produce the following views: 1) retracted anterior teeth; 2) lips at rest; 3) zoomed smile; and 4) smile showing the lower face. Images were compiled in a survey questionnaire and shown to respondents who ranked the subjects in order of aesthetic appeal. Kendall's coefficient of concordance (W) and median rank scores were used to determine the statistical significance.Results All groups demonstrated statistically significant agreement in the perception of beauty. Both the teeth and lips seemed to contribute similarly to the attractiveness of a smile. Dentists seemed to be more influenced by teeth in a zoomed smile view, however, this was negated when viewing a broader field of view. All other groups showed no difference in perception of aesthetics with changing field of view.Conclusion Both lips and teeth seem to contribute to the aesthetic appeal of a smile. Dentists may have a tendency to place a disproportionate weight to teeth when assessing a smile close up.

A guide to minimally invasive crown lengthening and tooth preparation for rehabilitating pink and white aesthetics

The rehabilitation of anterior dental aesthetics involves a multitude of disciplines, each with its own methodologies for achieving a predefined goal. The literature is awash with different techniques for a given predicament, based on both scientific credence, as well as empirical clinical judgements. An example is crown lengthening for correcting uneven gingival zeniths, increasing clinical crown lengths, and therefore, reducing the amount of maxillary gingival display that detracts from pleasing pink aesthetics. Many procedures have been advocated for rectifying gingival anomalies depending on prevailing clinical scenarios and aetiology. This paper presents a minimally invasive technique for crown lengthening for short clinical crowns concurrent with excessive maxillary gingival display, which is expedient, maintaining the inter-proximal papilla, mitigating morbidity, reducing post-operative inflammation, and increasing patient comfort. In addition, with a similar ethos, a minimally invasive tooth preparation approach is presented for achieving optimal white aesthetics.

CAD/CAM techniques help in the rebuilding of ideal marginal gingiva contours of anterior maxillary teeth: A case report

BACKGROUND AND OVERVIEW

"Pink esthetics," which are considered to be as important as "white esthetics," have attracted increasing attention. To date, clinicians rarely have applied computer-aided design and computer-aided manufacturing (CAD/CAM) techniques in the rebuilding of the contour of the marginal gingiva in the esthetic zone.

CASE DESCRIPTION

In this case report, the authors describe a female patient who had gingival inflammation and an asymmetrical contour of the marginal gingiva of the anterior maxillary teeth because previously placed ceramic crowns violated the biological width. The authors used a 3-dimensional-printing surgery template to guide precise crown-lengthening surgery to expose subgingival shoulders and to obtain an ideal marginal gingival contour. Then the authors used interim CAD/CAM crowns to induce the growth of the interdental papilla by 0.5 to 1.5 millimeters. Finally, the patient had a symmetrical and well-balanced contour of the marginal gingiva. In addition, the authors reduced the patient's "black triangle" areas to the greatest possible extent.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

This case report illustrates that CAD/CAM products, including 3-dimensional-printing surgery templates and CAD/CAM interim crowns, are helpful in shaping and rebuilding the ideal contour of the marginal gingiva in the esthetic zone, such as the anterior maxillary teeth.

Perception of smile esthetics by laypeople of different ages

BACKGROUND

Age is a factor affecting smile esthetics. Three variables of smile esthetics associated with the maxillary anterior teeth and age-related changes have recently received considerable attention: (i) the incisal edge position of the maxillary central incisors, (ii) the maxillary gingival display, and (iii) the presence of a black triangle between the maxillary central incisors. The aim of this study was to evaluate the influence of age on smile esthetic perception based on these three variables in a group of Thai laypeople.

METHODS

The smiles were constructed from a photograph of a female smile. Smile photographs were altered in various increments using three variables: the incisal edge position of the maxillary incisors, gingival display, and a black triangle between the maxillary central incisors. The photographs were shown to a group of 240 Thai laypeople. The subjects were divided into two groups: a younger group, 15-29 years old (n = 120) and an older group, 36-52 years old (n = 120). Each subject was asked to score the attractiveness of each smile separately using a visual analog scale.

RESULTS

Smile attractiveness scores concerning the incisal edge positions of the maxillary central incisors were similar between the two groups. However, upper lip coverage was rated as unattractive by the younger group. A gingival display of 0 and 2 mm was rated as most attractive by the younger group. Upper lip coverage and gingival display of 0 and 2 mm were considered attractive by the older group. Excessive gingival display (6 mm) was scored as unattractive by both groups. A black triangle ranging from 1 to 2.5 mm between the maxillary central incisors was scored differently between the two groups. The older group was more tolerant of the black triangle size.

CONCLUSIONS

Age impacts smile perception based on maxillary gingival display and the presence of a black triangle between the maxillary central incisors, but not of the incisal edge position of the maxillary central incisors. Due to the variation in esthetic perception of each individual, participation between orthodontists and patients for decision-making and treatment planning is a crucial process to provide successful results.

Prevalence of Gingival Biotypes among Young Dentate North Indian Population: A Biometric Approach

AIM

To evaluate the prevalence of various gingival biotypes and to corroborate gingival thickness and gingival biotypes across tooth type, site, and gender.

MATERIALS AND METHODS

A cross-sectional study was conducted across systemically healthy subjects. A systematic clinical evaluation for gingival biotypes and gingival thicknesses was recorded by modified Iwanson's gauge, to the nearest 0.1 mm, probing the gingival sulcus at the midfacial aspect of maxillary and mandibular central incisors and first molars. All measurements were made across a total of 920 sites in 115 subjects (69 female and 46 male) based on gingival transparency and were statistically analyzed.

RESULTS

A significant agreement on the reproducibility of the measurements was noted. The median overall gingival thickness was recorded at 0.75 mm with interquantile difference of 0.39 mm. The thin biotype variant showed across the ranges of 0.3 to 0.6 mm of gingival thicknesses and thick biotype variant across the ranges of 1.0 to 1.2 mm, with more prevalence in anterior and posterior site respectively. Moreover, for gingi-val thickness of 0.7 mm, the probe visibility showed tendency toward both thin/thick biotype variant in both anterior and posterior segments. The disposition of male participants toward thick biotype and female participants toward the thin biotype variant has been noted.

CONCLUSION

Within the limitations of the current study, our data support the traditional hypothesis of two main gingival biotypes as distinguishable by gingival transparency. In addition, we provide evidence of existence of intermediate biotypes with respect to gingival thickness. These findings can be utilized as objective guidelines for determination of biotype and can be implicated in many dental operative procedures. How to cite this article: Rathee M, Rao PL, Bhoria M. Prevalence of Gingival Biotypes among Young Dentate North Indian Population: A Biometric Approach. Int J Clin Pediatr Dent 2016;9(2):104-108.

Aesthetic Treatment Related to Clinical Need--An Illustrated Case Report

Aesthetic treatment may be patient driven and usually by a 'want', rather than a 'need'. This paper describes the management of a patient who presented with aesthetic wants and clinical needs, both of which were caused as a result of unsuccessful aesthetic treatment which the patient had received previously. The diagnostic process, discussion of the treatment plan and clinical procedures, which produced a satisfactory result, are described and illustrated. Clinical Relevance: This case demonstrates that aesthetic treatment may commit the patient to future dental treatment needs, particularly if treatment provided is poorly planned and carried out to an unsatisfactory standard.

Management of gingival black triangles

Gingival black triangles (GBTs) are generally considered to be aesthetically unacceptable, have a multifactorial aetiology and a range of treatment options. This review covers the surgical and non-surgical management of GBTs. Surgical methods address recontouring, preserving or reconstructing the soft tissue including the interdental papilla as well as the alveolar bone. Non-surgical approaches include restorative techniques (including the use of prostheses and gingival-coloured materials), orthodontic movement, tissue engineering and tissue volumisers. This review covers the aetiology and management of GBTs, highlighting the importance of considering the options currently available when treating a lost dental papilla. A lack of longitudinal studies investigating the long-term outcomes of the options in management of GBTs presence is identified.

Factors to consider when treatment planning for patients seeking comprehensive aesthetic dental treatment

Co-operation between specialties, improvements in dental materials, bonding technology, increase in public awareness of 'cosmetic dentistry' and patients' desires to improve their appearance, mean that, increasingly, dental practitioners are being asked how elective treatment may be used to improve their patients' smiles. Traditionally, a dentist's role has been to treat disease and promote oral health. Elective, invasive dental treatment needs careful consideration and, often, interdisciplinary planning. The issues dentists may need to consider and discuss with their patients are outlined with reference to dental literature.

CLINICAL RELEVANCE

Requests to dentists to embark upon complex elective treatments to improve their patients' dental appearance are on the increase. It is important that clinicians appropriately assess cases prior to committing to a treatment plan. Considerations to be taken when assessing these patients are discussed.

An Exploratory Study on Assessment of Gingival Biotype and Crown Dimensions as Predictors for Implant Esthetics Comparing Caucasian and Indian Subjects

Gingival biotype and crown dimensions may be important predictors for the esthetic outcome of surgical procedures. However, the visual distinction between “thick” and “thin” biotype may not be a suitable predictive parameter of surgical outcome. Intraoral photographs of 73 Indian and Dutch subjects were matched with respect to age and gender and were used to determine the gingival biotype (subjective assessment) and crown dimensions (objective assessment). Intraobserver and interobserver agreement was determined for subjective measurements (Cohen's kappa), and the error of the method was calculated for the objective measurements (Dahlberg formula). Intraobserver agreement for the subjective assessment of gingival biotype was adequate (κ = 0.49–0.60), but interobserver agreement was poor (κ = 0.10), whereas the error of the method for objective assessment of crown dimensions was small. The mean crown width-length angle is smaller in Dutch as compared to Indian subjects in this sample (P &lt; .05). Crown dimensions may be a more quantitative approach and could become a future norm to predict outcomes of implant restorative and surgical procedures, bearing in mind that cross-cultural differences may be present.

A restorative approach to the clinical and aesthetic management of adult patients with Class II division 2 incisor malocclusions

A Class II division 2 incisor malocclusion may be a cause of aesthetic and/or functional concern for some affected patients. Their particular concerns may include dark spaces around the misaligned teeth or uneven gingival contours. Orthodontic and/or orthognathic treatment can address some of these problems but frequently involves lengthy and expensive treatment in the adult dentition. Sadly, such treatment often produces an unstable result, with significant drawbacks such as the requirement for long-term retention. This article aims to describe alternative strategies for managing patients with this incisor malocclusion.

CLINICAL RELEVANCE

This paper outlines a quicker, pragmatic and minimally destructive restorative treatment alternative to conventional orthodontic treatment and the associated long-term retention.

The papillary veneers concept: an option for solving compromised dental situations

BACKGROUND

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 DESCRIPTION

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.

CLINICAL IMPLICATIONS

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.

Aesthetic smile evaluation--a non-invasive solution

Enhancement of the aesthetic zone is a common reason for patients to seek dental care. This article describes a protocol for the examination, assessment and treatment planning for a patient seeking a solution to an aesthetic concern. The technique of undertaking an intra-oral'mock-up' using resin composite as a diagnostic approach can be particularly helpful when planning for future prosthodontic rehabilitation. The latter can allow the operator and patient to visualize crudely what is aesthetically and functionally possible, given the constraints imposed by that patient. The patient has ultimately managed in a minimally invasive manner.

CLINICAL RELEVANCE

It can be very tempting for a dental operator to impose his/her concepts of the'artistic ideal' when planning for care in the smile zone. Such ideals are largely based on established universal aesthetic principles of tooth colour, size, shape, form, position, symmetry and proportion. However, beauty is a very subjective matter. It is essential for the operator to listen attentively to his/her patient's concerns. Meticulous patient examination and assessment are absolutely critical factors in attempting to attain a successful outcome. The use of reversible, chairside intra-oral mock-up techniques can not only help with the transference of essential information to the dental technician when planning for restorative intervention in the smile zone, but can also allow the patient to gain an insight and indeed contribute his/her views to the possible restorative endpoint, respectively.

Biologic perspectives in restorative treatment

One of the primary goals of a long term successful restorative therapy is to establish a physiologic periodontal climate that facilitates the maintenance of periodontal health. The contemporary clinician has a host of alternatives for the restoration of teeth. It is now possible to mimic nature and provide restorations that defy detection but the most challenging procedure in clinical dentistry is fabricating a restoration in gingival harmony. Periodontal health is the basis of all restorative dentistry. Because periodontal disease is a major cause of tooth loss in adults, the clinician must be aware of the biological variables relevant to restorative therapy, basic concepts and clinical modes of therapy available, to be able to develop an appropriate diagnosis and treatment plan. A natural looking prosthesis within a healthy periodontium should represent the ultimate goal. This article addresses the interactions between periodontal tissues and restorative procedures. It reviews the essentials of soft tissue management inherent in restorative dentistry that will increase the probability of a successful restoration.

Gingival biotype - Prosthodontic perspective

During treatment planning it is important to recognize different gingival biotypes and forms, because they can affect the esthetic outcome of the treatment. This review provides an insight into the different gingival biotypes, their response to inflammation and trauma; significance in different prosthodontic modalities like esthetic rehabilitation and implant therapy.

Gingival retraction techniques for implants versus teeth: current status

BACKGROUND

The authors reviewed and compared gingival retraction techniques used for implants and teeth.

TYPES OF STUDIES REVIEWED

The authors searched the literature using article databases Ovid MEDLINE up to May 2008, PubMED and Google Scholar (advanced search) and the following search terms: gingival retraction, implant abutment, impressions, cement-retained implant restoration, impression coping, peri-implant tissue, emergence profile and tissue conditioning.

RESULTS

The authors found insufficient evidence relating to gingival displacement techniques for impression making for implant dentistry. Gingival retraction techniques and materials are designed primarily for peridental applications; the authors considered their relevance to peri-implant applications and determined that further research and new product development are needed.

CLINICAL IMPLICATIONS

The use of injectable materials that form an expanding matrix to provide gingival retraction offers effective exposure of preparation finish lines and is suitable for conventional impression-making methods or computer-aided design/computer-aided manufacturing digital impressions in many situations. There are, however, limitations with any retraction technique, including injectable matrices, for situations in which clinicians place deep implants.