Gingival Contour Assessment: Clinical Parameters Useful for Esthetic Diagnosis and Treatment

Effect of prerestorative short-term clear aligner therapy in restorative treatment planning

STATEMENT OF PROBLEM

One of the major challenges in restorative dentistry is to provide optimal esthetics in a minimally invasive way. The optimization of dental esthetics and function is directly related to the position and alignment of the anterior teeth, but whether prerestorative clear aligner therapy will enhance esthetics and minimize restorative needs is unclear.

PURPOSE

The purpose of this clinical study was to evaluate the effect of prerestorative maxillary and mandibular second premolar to second premolar clear aligner therapy in minimizing the need for restorative treatment.

MATERIAL AND METHODS

Fifty adult patients treated with clear aligners (Invisalign Go; Align Technology) were included in this study. Previously generated 3-dimensional orthodontic simulations and clinical photographs in the ClinCheck/6.0 software program were used. Three restorative treatment plans for each participant were generated for initial (no aligners), Express (after using 7 aligners), and Lite Packages (after using 20 aligners) by 2 blinded restorative dentistry instructors. The maxillary and mandibular teeth in the smile-line (to the second premolars) were included. Assessment criteria were the estimated number of restorations, restoration surfaces and preparations and incisal edge inclusion, and the need for gingival leveling. The Friedman test and Cochran Q test were used for statistical analyses (α=.05).

RESULTS

A strong positive correlation was found between the 2 instructors (P<.001). Estimated number of restorations (10 [3 to 16]a) decreased significantly for Express (6 [0 to 14]b) and Lite Packages (4 [0 to 8]c) (P<.001). The estimated number of restoration surfaces (28.5 [9 to 48]a) decreased significantly for Express (15 [0 to 42]b) and Lite Packages (9.5 [0 to 24]c) (P<.001). While the estimated number of teeth to be prepared for recontouring (7 [0 to 16]a) was significantly less for Express (3 [0 to 10]b) and Lite Packages (0 [0 to 4]c) (P<.001), the incisal edge inclusion (10 [3 to 16]a) was significantly less for Express (6 [0 to 14]b) and Lite Packages (4 [0 to 8]c) (P<.001). The need for gingival leveling (26 [52%]a) decreased significantly for Express (20 [40%]a) and Lite Packages (7 [14%]b) (P<.001).

CONCLUSIONS

Prerestorative short-term clear aligner therapy might conserve tooth structure and reduce the number of restorations. The application of the Invisalign Lite Package was more effective than the Invisalign Express Package for second premolar to second premolar alignment.

Orthodontic management of uneven gingival margins in patients with healthy or reduced periodontium to improve smile aesthetics

Uneven gingival margins may cause visible asymmetries during smiling and may reflect alterations in the tooth shape and morphology, particularly in cases requiring restorative procedures. Despite being perceived as a minor health condition, presence of uneven gingival margins usually impacts the smile aesthetics and could affect the individual's appearance, self‐esteem, and overall quality of life, especially in subjects with a high smile line. Uneven gingival margins may result from different causes, which makes an accurate diagnosis fundamental for its treatment planning. Orthodontic treatment often serves as a conservative approach for leveling these margins, by achieving the most appropriate tooth position. This article reviews the rationale, differential diagnosis, and clinical management of uneven gingival margins using orthodontic tooth movements, providing insights for orthodontists, periodontists, and restorative dentists on the interdisciplinary care needed to correct this condition, and hence, to improve the subject's smile aesthetics.

Gingival zenith level, position, and symmetry: A systematic review and meta-analysis

STATEMENT OF PROBLEM

The gingival zenith (GZ) influences the line angle position in the emergence profile and the axial inclination of the crown. Irregularities in GZ symmetry and contour have a negative impact on dental esthetics. GZ location is not consistently distal to the crown's long axis; instead, it tends to be more distal in anterior teeth. The GZ levelling of the lateral incisor is often described as either level with or slightly above the zenith line connecting the central incisor and canine teeth, but there are also reports of GZ being aligned apically to the zenith line. Controversial reports persist regarding GZ positioning, magnitude, and location, potentially leading to inadequate positioning and levelling of the GZ in esthetic restorative therapy.

PURPOSE

The purpose of this systematic review and meta-analysis was to assess the scientific evidence related to GZ level, position, and symmetry in maxillary incisors and canines.

MATERIAL AND METHODS

This study adhered to the population, variable, outcome (PVO) criteria and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Cross-sectional studies involving healthy adults with complete dentition of the maxillary anterior sextant were subjected to prevalence analysis and quantitative measurement to assess the gingival zenith level and position. Data were extracted, and methodological quality was appraised using the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Certainty of evidence was evaluated through the grading of recommendations, assessment, development, and evaluation (GRADE) system.

RESULTS

The GZs were distally positioned, coinciding with the tooth axis or mesially positioned in, respectively, 96%, 3%, and 1% on central incisors; 84%, 14%, and 1% on lateral incisors; and 43%, 44%, and 5% on canines. GZ distal positioning was greater in central incisors, followed by lateral incisors and canines. In lateral incisors, the GZ was levelled coronally in 82% of the population. Contralateral symmetry was observed for GZ levelling and positioning. The certainty of the evidence was very low for all comparisons.

CONCLUSIONS

The frequency and magnitude of the distal position of the GZ increased the more anterior the tooth. Axially, the GZ was frequently levelled coronally to the zenith line. The contralateral positioning and levelling of the GZ was symmetrical.

Compatibility of digital and analog methods in assessment of gingival zeniths

OBJECTIVE

The compatibility of digital and analog methods assessing the positions of gingival zenith (GZ) points has not been evaluated before. Therefore, the aim of this study was to investigate the accuracy of a digital scanner and a three-dimensional (3D) measuring tool in specifying positions of GZs by comparing it to the conventional method, an analog plaster cast and a caliper.

MATERIALS AND METHODS

Both analog and digital impressions were obtained from 32 individuals. Following measurements were conducted in the anterior maxillary region from canine to canine on both the plaster casts and 3D images: (1) The distance from GZ to the corresponding vertical midline in each tooth (GZVM), (2) The distance from GZ of lateral incisor to the corresponding tangent that connects GZs of central incisor and canine (GZLI).

RESULTS

The intraclass correlation coefficients (ICC) of GZVM in each tooth varied between 0.366 and 0.755, demonstrating moderate to good compatibility between the two methods. The ICC of analog and digital GZLI for the right and left lateral incisors was 0.788 and 0.395, respectively.

CONCLUSION

The digital and analog methods used in this study are compatible in determining the positions of GZs. Therefore, within the limitations of the present study, the choice of method can be based on the available equipment, time, comfort, and personal preference of the researcher.

CLINICAL SIGNIFICANCE

Both digital and analog methods have the capability of determining the positions of GZs in compatible way.

Smile Aesthetic Evaluation on Videographs: An Intra-Rater and Inter-Rater Agreement Study

The aim of this study was to assess on videographs the intra- and inter-rater reproducibility of the Smile Esthetic Index (SEI) that has been previously validated on photographs. Smile videographs were obtained using a smartphone associated with the Smile Lite MDP mounted on a tripod. They were then randomized and evaluated twice consecutively at a 1-week interval by three periodontists according to the SEI based on 10 variables. Cohen’s Kappa and Fleiss’ Kappa tests were performed to measure intra- and inter-rater agreement. Sixty-five smile videographs of 24 men and 41 women (mean age 33 ± 11.3 years) were scored. A mean intra-rater agreement of 0.68 (0.64–0.73) was obtained, representing substantial agreement. The inter-rater agreement calculated for each variable ranged from 0.31 for the variable “absence of visible excessive gingiva” to 0.90 for the variable “absence of diastema and/or missing inter-dental papilla.” Within the limits of this study, we have demonstrated that it was possible to use videographs to reproducibly evaluate an aesthetic score (SEI) previously validated on photographs.

Morphological features of smile attractiveness and related factors influence perception and gingival aesthetic parameters

INTRODUCTION

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Visible Portion of Anterior Teeth at Rest and Analysis of Different Smile Characteristics in the Saudi Population of the Jeddah Region

This cross-sectional study aimed to determine the degree of visibility of maxillary and mandibular anterior teeth at rest in different age groups and to evaluate the smile line, smile arc, and number of maxillary teeth displayed during smiling among the Saudi population visiting King Abdulaziz University Dental Hospital, Jeddah, Saudi Arabia. A total of 157 participants (77 males and 80 females) were included in this study with an age range of 19 to 69 years. All participants had maxillary and mandibular anterior teeth without restorations. Crown length and visible portions of anterior teeth at rest were measured using a Fowler Electronic Digital Caliper. Three measurements of each variable were recorded by two independent dental interns and calibrating their measurements was performed. Smile line, smile arc, and number of teeth displayed during smiling were examined. The collected data were statistically analyzed using SPSS software. It was found that the average clinical crown lengths in the maxillary lateral incisor, mandibular central incisor, and canine were significantly higher in males than females. At rest position, females displayed more maxillary central and lateral incisors. The displayed length of maxillary teeth at rest is inversely proportional to increasing age; the reverse occurs in mandibular teeth. The common visibility of maxillary teeth during smiling was from the second bicuspid to its counterpart. Average smile line and consonant smile arc were the most common characteristics. It was concluded that both age and gender affect the characteristics of tooth display at rest and in smiling. These effects should be considered during treatment planning and restoration of anterior teeth to obtain a more predictable esthetic outcome.

Periodontal plastic surgery for the management of an ankylosed permanent maxillary lateral incisor: A clinical report with 5-year follow-up

Anterior maxillary tooth ankylosis disturbs the development of the alveolar bone process, leading to discrepancies between the cervical gingival margin and incisal edge position of the affected tooth, and therefore, the esthetics is compromised. Proposed treatments in adults and growing patients have been used successfully, but they have disadvantages and are contraindicated in some circumstances. This article proposes an alternative treatment for an ankylosed permanent maxillary anterior tooth with a slow replacement resorption rate in an adult patient, for whom a combination of a periodontal plastic surgery procedure and a fixed dental prosthesis was used to correct the esthetics. This treatment has less risk of complications, preserves the ankylosed tooth as long as possible, creates an optimal gingival contour, and maintains the alveolar bone for further treatment should the tooth be lost.

Association of the gingival line angle with the gingival and interdental smile line: A gender based evaluation

OBJECTIVE

Gingival line angle (GLA) has been considered an important attribute of an esthetic smile. The purpose of this study was to evaluate GLA on either sides of maxillary arch and correlate it with the gingival smile line (GSL) and interdental smile line (ISL).

MATERIALS AND METHODS

One hundred twenty periodontally healthy patients with an age range of 20-40 years, equally divided into males and females were included. Standardized digital photographs were taken for assessment of the interdental papillae and smile line. Study models of the participants were used to record the GLA. Gingival thickness (GT) was measured clinically.

RESULTS

Although there was consistent difference between the values, the correlation between GLA and GT on either sides of the arch did not indicate positive association. It was revealed that maximum of patients that is, 76.67% and 75% of males and females respectively possessed low GSL.

CONCLUSIONS

Although there is a difference between GT and GLA, the difference was statistically insignificant. Majority of the study population exhibited low GSL and high ISL, thereby indicating greater importance for interdental papillae in designing an esthetic smile.

CLINICAL SIGNIFICANCE

Considering the likely variations based on gender on gingival line angle and the tooth and gingival display in interdental smile line and gingival smile line, these parameters need to be assessed further. It is believed that appropriate assessment of these parameters would enable the clinician to adopt these relationships as guidelines for interdisciplinary treatment procedures.

Revisiting the Maxillary Teeth in 384 Subjects Reveals A Deviation From the Classical Aesthetic Dimensions

Dental esthetics need to be defined from the scientific perspective in order to obtain predictable treatment outcomes and avoid the effects of subjectivisms on the part of the dental profesional. It can be deduced that the ideal dimensions in the maxillary anterior sector are difficult to establish. Therefore, the primary purpose of this study was to define the dimensions of the maxillary anterior teeth and the relationships between them. In addition, an analysis was made to reinvestigate whether they complied with the Golden proportion, the RED (Recurrent Esthetic Dental) proportion and the Golden percentage. A total of 2304 tooth corresponding to 384 subjects were evaluated. The central incisor presented a mean width of 8.58 mm and a height of 9.35 mm, while the lateral incisor presented a width of 6.69 mm and a height of 7.75 mm. The mean width of the canine was 7.69 mm, with a height of 8.68 mm. The teeth revisited in this study did not comply with the ideal dimensions in the anterior maxillary sector as established by the Golden proportion, Golden percentage and RED. The information obtained from this study can be clinically applied to restore the dimensions during periodontal surgery, restorative dentistry and prosthetic rehabilitation.

Prosthetic Rehabilitation of Edentulous Patients With Implants Based on Facial Profile Assessment: A Case Report

PURPOSE

To introduce a user-friendly protocol for implant-retained prosthetic rehabilitation of fully edentulous patients based on facial profile and the cephalometric intermaxillary relationship.

MATERIALS AND METHODS

The prosthetic rehabilitation of edentulous patients with implants based on facial profile assessment protocol commences with a clinical and cephalometric analysis, followed by a preliminary projection to obtain a harmonious interarch relationship, eventually stabilized by the preplanned prosthesis. The protocol is divided into the following 5 phases: esthetic evaluation; cephalometric-occlusal assessment; surgery; provisionalization; and definitive prosthesis. Evaluation of patient's satisfaction from the treatment provided was performed through a preoperative and postoperative visual analogue scale scores.

RESULTS

The patient was granted immediate function and superior esthetics at day 1 of the treatment. These results were re-evaluated on an interval of 18 months and continued to be stable. The overall treatment time was significantly reduced.

CONCLUSION

Our recommended protocol gives the clinician a chance to grasp results beyond the offered by traditional protocols by using a wider perspective of rehabilitation, involving the patient's facial profile, thus fulfilling the integration of both occlusal and cephalometric parameters in a unified surgical-prosthetic approach.

A quantitative research on clinical parameters of gingival contour for anterior teeth esthetic analysis and design

OBJECTIVES

To provide reference for computer-aided esthetic analysis and design of the maxillary anterior teeth.

MATERIALS AND METHODS

Intraoral scanner was used to obtain the maxillary three-dimensional digital models of subjects with healthy periodontal tissue. In SpaceClaim, the occlusal plane was established as the horizontal reference plane to measure the positional relation between the gingival zenith (GZ) of the maxillary anterior teeth, the angle formed between the gingival line and the maxillary midline (GLA), the distance between the GZ of the lateral incisor and gingival line (LID), and the distance between the GZ and the vertical bisected middle surface along the long axis of the clinical crown (VBMS).

RESULTS

The GLA was 92.7 ± 3.2°. The GZ of the canine, lateral incisor, and left central incisor were located to the GZ of the right central incisor coronally at 0.68 ± 0.91, 0.65 ± 0.66 mm, and apically at 0.12 ± 0.42 mm, respectively. The LID was 0.65 ± 0.92 mm. The GZ of the canine, lateral incisor, and central incisor were located distally to the VBMS at 0.00 ± 0.06, 0.27 ± 0.19, and 0.73 ± 0.21 mm, respectively.

CONCLUSION

The GZ at different tooth position are in different heights. The direction and degree of the GZ deviation from the VBMS are also related to tooth position.

CLINICAL SIGNIFICANCE

The clinical parameters of the gingival contour obtained in this research can be used for patients with unsound contour of periodontal soft tissue to do the anterior teeth esthetic analysis. Besides, it can also be used to determine the proper position between the GZs of the maxillary anterior teeth in anterior teeth esthetic design.

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.

Esthetic evaluation of natural teeth in anterior maxilla using the pink and white esthetic scores

BACKGROUND

Natural teeth in the anterior maxilla are critical in determination the esthetic outcome of single implant prosthesis.

PURPOSE

The present study aimed to explore aesthetics of natural teeth in the anterior maxilla using the Pink Esthetic Score/White Esthetic Score (PES/WES) index. Additionally, inherent weak spots of natural teeth and high-risk parameters of prostheses were also considered.

MATERIAL AND METHODS

This cross-sectional study was performed by photographic analysis.

RESULTS

A total of 102 subjects and 306 teeth (the right incisor, lateral incisor and canine) were included. The grand means of the PES and WES were 12.92 and 8.75, respectively. The score of soft tissue margin, soft tissue contour and outline/volume of the crown were significantly lower than other variables. The PES and WES showed a downward trend with age. Most of the PES/WES values of the females exceeded those of the males.

CONCLUSION

The average level of natural teeth in PES and WES assessment were around 13 and 9, respectively. The soft tissue margin, soft tissue contour and outline/volume of the crown were high-risk parameters for the esthetic outcomes of implant reconstructions. Underlying factors, such as age and gender, contributed to the esthetics of natural teeth change.

Do different vertical positions of maxillary central incisors influence smile esthetics perception?

INTRODUCTION:

The purpose of this study was to determine the perception of smile esthetics among orthodontists and layperson, with respect to different maxillary central incisors vertical positions in full-face and close-up smile analyses.

METHODS:

Frontal photographs of the smiles of two adult women were used. Images were altered to create a symmetrical image with the gingival margin levels of the maxillary canines matching the central incisors and a 1.0-mm central-to-lateral incisal step. Later, the images were altered in order to create six different central incisor vertical positions in 0.5-mm increments. The images were randomly assembled in an album, which was given to 114 judges, 57 orthodontists and 57 laypersons, who were asked to evaluate the attractiveness of the images using the visual analog scale. The data collected were statistically analyzed by means of 1-way analysis of variance with the Tukey post-hoc test and the Student t test.

RESULTS:

The highest rated smiles showed two notable characteristics: a) the central incisor gingival margins matched or were 0.5 mm below the line of the canine gingival margins and; b) the central-to-lateral incisal step was 1.0 to 1.5 mm. The worst smiles showed two notable characteristics: a) the central incisor gingival margins were 1.0 mm above or 1.5 mm below the canine gingival margins and; b) no step between the centrals and laterals or a 2.5-mm step.

CONCLUSION:

The vertical position of the maxillary central incisors significantly affected the perception of the smile esthetics, whereas slightly extruded central incisors were more esthetically preferred than intruded.

[Perfecting smile esthetics: keep it pink!]

INTRODUCTION

Smile aesthetics is based on numerical, physical, physiological and psychological data regarding beauty, while taking into account the desires of the patient. It is determined by the shape, colour and position of the lips, teeth and gingival tissues. Periodontal examination in both the facial and labial settings supports analysis of the gingival display during natural and forced smiling, the health of the periodontium, the gingival contours, the aesthetic gingival line, and the presence of the papillae.

MATERIALS AND METHODS

All these data will help establish a gingival aesthetic score to determine the causes of disharmony and possible treatment.

DISCUSSION

During implementation of the global orthodontic treatment plan, periodontal plastic surgery can change the gingival appearance and morphology in order to restore the harmony of the smile. Subtractive periodontal plastic surgery treats biological space defects and excess tissue during incomplete passive eruption by gingivectomy or apically positioned flap, combined, or not, with osteoplasty or osteoectomy. Finally, injections of hyaluronic acid in the papillae can plump them up and minimize the size of any black holes.

Esthetic Outcomes of Immediately Loaded Locking Taper Implants in the Anterior Maxilla: A Case Series Study

The purpose of this study was to evaluate the esthetic outcome of single-tooth locking taper connection implants placed in the anterior maxilla following a postextractive nonfunctional loading protocol. This preliminary clinical study involving 16 patients evaluated the results of 21 implants placed in areas with high esthetic value. For each implant the pink esthetic score, white esthetic score, cumulative survival rate, and health status of peri-implant tissues were evaluated. The cumulative survival rate was 100% 2 years after prosthetic loading, and the mean total pink esthetic score/white esthetic score was 16.9 ± 1.14 on a maximum value of 20. There was excellent plaque control in all patients, and inflammation indices were within the norm. Within the limits of this study, this immediate nonfunctional loading protocol seems to be a successful procedure esthetically and for the maintenance of peri-implant soft tissues.

Perception of smile esthetics varies between patients and dental professionals when recession defects are present

The aim of this study was to compare the smile esthetic perception of patients, dental students and dentists faced to different situations concerning gingival margin position. A total of 123 individuals (41 patients, 41 dental students and 41 dentists) completed a structured questionnaire and evaluated 6 pictures of the same smile modified in Adobe Photoshop® image-editing software representing: no gingival recession, 2 mm recession in one maxillary lateral incisor, 2 mm recession in both maxillary lateral incisors, 2 mm recession in one maxillary canine, 2 mm recession in both maxillary canines and generalized 2 mm recession. The visual analogue scale (VAS) was used to rate the esthetic perception. Mean VAS values were calculated and compared among gingival situations as well as group of respondents by one-way ANOVA, with an alpha level of 0.05. VAS analysis revealed that mean values ranged from 4.2 (±1.8) to 6.8 (±1.7). Images with no gingival recession received the highest score by all groups, with statistically significant differences among dentists and dental students. However, patients scored images with no recession with significantly lower ranks as compared with dentists and dental students. No significant differences were observed among patients for any of the situations. When dentists and dental students were compared, the worst situation was observed for generalized gingival recession, with scores 4.2 (±1.8) and 4.9 (±1.8), respectively. Patients and dental professionals had different perceptions about esthetics related to gingival margin position.

[Reciprocal relationships between orthodontics and periodontics in esthetic treatments]

The objective of this article is to review various unsightly periodontal defects and the treatments that have previously been used to eliminate them in order to establish guidelines for future therapy. The inter-relationship between orthodontic and periodontal disciplines is well established and needs no defense here. Periodontal tissues change throughout life and the same is true for the smile. The periodontium is an essential component of the appearance of the face as well as the lips. These are dynamic esthetic criteria while the gingiva and the static character of the dentition also contribute to the character of an individual's smile. In order to conduct orthodontic therapy most effectively it is essential that orthodontists and periodontists utilize a coordinated approach. From the beginning, they must establish an etiological diagnosis of any esthetic defects that will insure that their joint therapy is conducted appropriately and at the proper moment.

Rehabilitation of the maxillary arch with implant-supported fixed restorations guided by the most apical buccal bone level in the esthetic zone: a clinical report

This article describes a prosthetically-driven protocol for the rehabilitation of the completely edentulous maxillary arch using immediate implant placement and loading techniques. After the incisal edges of the planned maxillary central incisors are determined, the most apical buccal bone level in the esthetic zone serves to guide complete arch rehabilitation.

Gingival zenith and its role in redefining esthetics: A clinical study

BACKGROUND

The purpose of this study was to quantify some clinical parameters useful as esthetic guidelines when gingival contour is modified and to compare the left and right sides of six maxillary anterior teeth.

MATERIALS AND METHODS

Maxillary casts mounted on an articulator according to the axis orbital plane were photographed from 35 young adults. The angle formed between the gingival line and maxillary midline (GLA) and the distance between the gingival zenith of the lateral incisor and the gingival line were measured (LID) using a flexible protractor and digital vernier caliper, respectively. The asymmetry was evaluated using a paired t test for the left vs right measurements of GLA and LID. The descriptive statistics for GLA and LID were calculated.

RESULTS

The GLA measurements of the left side (86.7°±4.2°) were significantly greater than those of the right side (84.6°±5.4°), and the mean absolute symmetry for GLA was 1.7°±4.4°. The mean LID measurement was 0.92΁0.11.

CONCLUSIONS

The gingival zenith of the canine is apical to the gingival zenith of the incisors (GLA <90°) and the gingival zenith of the lateral incisor is below or on (17%) the gingival line when head is oriented on the axis orbital plane. A directional asymmetry was shown with the right side higher than the left side. Along with the other parameters related to dental esthetics, these clinical parameters may serve as esthetic guidelines and may enable us to obtain a more predictable outcome.

Influence of esthetic dental and facial measurements on the Caucasian patients' satisfaction

PURPOSE

The purpose of the present study was to investigate how some esthetic dental and facial measurements may correlate the variability of patients' ratings of their satisfaction with the maxillary anterior teeth appearance in different gender groups.

MATERIALS AND METHODS

The following measurements were made on 78 Caucasian subjects: width and length of each maxillary anterior tooth, their distal gingival zenith displacements, the upper lip height, intercommisural width, maximum maxillary central incisal, and gingival display at rest and smile. All the patients rated their satisfaction with the dental appearance on the visual-analogue scale (0 meaning absolute dissatisfaction, whereas 4 indicated complete satisfaction). All the parameters have been analyzed with respect to gender.

RESULTS

The majority of the esthetic dental and facial measurements were larger in men (p<0.05). The great majority of the participants were completely satisfied with their dental appearance (75% of men and 89% of women; p>0.05). In the men, the two factors of maximal maxillary incisal display at rest and intercommisural width at smile paralleled the variability of the patients' satisfaction with dental appearance by 99% (p>0.05). In women, the combination of central incisor width/length ratio, intercommisural width at rest, central incisor gingival zenith displacement, intercommisural width at smile, upper lip height, and maximum maxillary incisal display at rest paralleled the variability of the patients' satisfaction with dental appearance by 99% (p>0.05).

CONCLUSIONS

Within the population tested, the results suggest that the use of esthetic dental and facial measurements may serve as an esthetic guideline and should be considered in esthetic anterior oral rehabilitation.

CLINICAL SIGNIFICANCE

The information presented in this article may be useful in helping to create dental restorations with an acceptable esthetic appearance to the patient. Prior to the treatment the dentist should consider not only the size of maxillary anterior teeth but also their gingival architecture and the soft tissue surrounding the teeth.

Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores

BACKGROUND

To validate the concept of early implant placement for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria when assessing outcome parameters.

METHODS

In this cross-sectional, retrospective 2- to 4-year study involving 45 patients treated with maxillary anterior single-tooth implants according to the concept of early implant placement, a novel comprehensive index, comprising pink esthetic score and white esthetic score (PES/WES; the highest possible combined score is 20), was applied for the objective esthetic outcome assessment of anterior single-tooth implants.

RESULTS

All 45 anterior maxillary single-tooth implants fulfilled strict success criteria for dental implants with regard to osseointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 14.7 +/- 1.18 (range: 11 to 18). The mean total PES of 7.8 +/- 0.88 (range: 6 to 9) documents favorable overall peri-implant soft tissue conditions. The two PES variables facial mucosa curvature (1.9 +/- 0.29) and facial mucosa level (1.8 +/- 0.42) had the highest mean values, whereas the combination variable root convexity/soft tissue color and texture (1.2 +/- 0.53) proved to be the most difficult to fully satisfy. Mean scores were 1.6 +/- 0.5 for the mesial papilla and 1.3 +/- 0.5 for the distal papilla. A mean value of 6.9 +/- 1.47 (range: 4 to 10) was calculated for WES.

CONCLUSIONS

This study demonstrated that anterior maxillary single-tooth replacement, according to the concept of early implant placement, is a successful and predictable treatment modality, in general, and from an esthetic point of view, in particular. The suitability of the PES/WES index for the objective outcome assessment of the esthetic dimension of anterior single-tooth implants was confirmed. However, prospective clinical trials are needed to further validate and refine this index.