Gingival Display in "Forced" Smile Evaluated by Sex and Age.

The smile is a standard by which individuals often are judged. Gingival display is an important component of the smile. While perceptions vary between the sexes and between laypeople and dental professionals, gingival display of ≥4 mm has been considered excessive and unattractive. The amount of gingiva that an individual displays can vary depending on the type of smile the individual produces. An emotional or forced smile will produce greater upper lip movement and gingival display than a posed smile. Much of the dental literature that discusses gingival display focuses on subjects of a limited age range, has a limited number of subjects, or neglects to determine the gingival display with maximum upper lip movement. The purpose of this prospective observational investigation was to document the smile type, gingival display, and upper lip movement of male and female subjects in different age groups.

Double-Layer Technique Using an Acellular Dermal Matrix and Coronally Advanced Flap to Treat a Mandibular Incisor with a Cairo RT2 Defect: 8.5-Year Results.

INTRODUCTION: The purpose of this case report is to document the 8.5 years result of treatment of a mandibular incisor having a buccal Cairo Recession Type 2 (RT2) gingival recession defect (GRD) using a double-layer technique using an acellular dermal matrix (ADM) with a coronally advanced flap (CAF). To the author's knowledge, no long-term results of this treatment modality in the mandibular incisor area have been reported. CASE PRESENTATION: A 65-year-old non-smoking female presented with an RT2 GRD on the buccal aspect of tooth #25 (International Standards Organization, ISO #41). Her overall periodontal status was healthy. This GRD was treated using a double-layer of an ADM with a CAF. Tension-free flap advancement was permitted by eliminating a frenum pull. Improved root coverage and stable gingival margins were found after 8.5 years. CONCLUSION: This report provides evidence to support the use of a double-layer technique using an ADM with a CAF to treat a mandibular incisor with an RT2 GRD.

Abutment Screw Loosening Due to Dental Laboratory Error.

Abutment screw loosening (ASL) is a fairly common problem that adversely affects the longterm success of a dental implant restoration. Dental laboratory error can play a role in the etiology of ASL. This article presents three cases that demonstrate how laboratory errors in the fabrication of implant restorations and mismanagement of abutment surfaces can result in ASL. It describes a method for examination of the abutment surface.

Modified Tunnel Technique and Double-Layer Acellular Dermal Matrix to Treat Multiple Teeth and Implant: 3.5-Year Results.

Recession defects can affect both tooth and implant sites. The objective of connective tissue grafting is to correct recession defects and develop a soft-tissue architecture that is both stable and natural in appearance. By protecting the integrity of the interdental papillae, tunnel techniques are intended to maximize esthetic results. The use of an acellular dermal matrix (ADM) allows treatment of multiple adjacent recession defects without the need for a palatal donor site. The dental literature is scarce on the use of ADMs to treat recession affecting implant sites. The purpose of this article is to discuss and demonstrate the use of a modified tunnel technique and a double layer of an ADM in the treatment of recession defects affecting multiple teeth and an implant.

Implant Abutment and Restoration Design and Risk Factors for Peri-Implant Disease.

With dental implants continuing to gain in popularity and their usage steadily rising, clinicians must be wary of peri-implant disease in patients with implants. Poorly constructed and inadequately delivered implant restorations can lead to peri-implant bone loss and disease. Implant abutment design plays an important role in minimizing the risk of the development of peri-implant disease. Abutment design elements that may affect the risk for developing peri-implantitis include topography, materials, height, implant-abutment connection, and emergence profile. This article discusses these implant abutment design elements for bone-level implants and the risks they may present for the development of peri-implant disease.

Preservation of Natural Gingival Pigmentation When Treating Multiple Gingival Recession Defects.

Proper surgical techniques can permit treatment of multiple gingival recession defects without altering the visible gingival pigmentation. In this case report, a patient presented with multiple adjacent sites displaying gingival recession. Natural pigmentation was present in the interdental papillae and in the zone of keratinized gingiva. This patient wanted his natural pigmentation to be preserved. A modified tunnel technique was used to avoid traumatizing the pigmented tissues and allow placement of a large graft. A double layer of an acellular dermal matrix (ADM) was implanted and the gingival complex was relocated coronally. Root coverage and preservation of the natural gingival pigmentation were achieved. The use of the modified tunnel technique with a double layer of ADM can preserve natural gingival pigmentation when treating adjacent gingival recession defects.

Lateral Access Pouch Technique to Treat Implants With Gingival Recession.

Connective tissue grafting is a means of developing stable and natural-looking soft-tissue architecture. The use of a subepithelial connective tissue graft (SCTG) has been successful in achieving root coverage and augmenting tissue thickness. Tunnel techniques enable root coverage with results that appear natural. These techniques can be applied to the treatment of dental implants with gingival recession. The purpose of this article is to demonstrate the use of a SCTG and a lateral access pouch in the treatment of multiple gingival recession defects affecting adjacent implants.

Use of Double Layer of Acellular Dermal Matrix and Modified Tunnel Technique to Treat Multiple Adjacent Gingival Recession Defects.

The goal of connective tissue grafting is to cover exposed root surfaces with gingival tissues that are stable and have a natural appearance. The use of an acellular dermal matrix (ADM) has been shown to be a successful alternative to the palatal connective tissue graft. Use of a double layer of an ADM has been shown to have stable results for 1 year. Tunnel grafting techniques can yield root coverage with a natural appearing soft-tissue architecture. The purpose of this case report is to demonstrate the use of a modified tunnel technique and a double layer of ADM in the treatment of multiple adjacent gingival recession defects. Treated teeth were found to have root coverage and natural soft-tissue contours that were stable at 20 months.

Elimination of a "Gummy Smile" With Crown Lengthening and Lip Repositioning.

Excessive gingival display is considered unattractive by many patients. A combination of surgical approaches may be required to correct this problem. Clinical crown lengthening involves recontouring crestal bone levels and moving the gingival margin in an apical direction. Lip repositioning reduces gingival display by limiting upper lip movement when smiling. This article describes a case in which a combination of clinical crown lengthening and lip repositioning was used to correct excessive gingival display when smiling.

Use of an Autogenous Connective Tissue Graft to Treat Peri-Implantitis With Gingival Recession Affecting an Implant Supporting an Overdenture.

INTRODUCTION: Bone loss associated with peri-implantitis can result in exposure of the implant surface. A lack of keratinized mucosa has been associated with increased plaque accumulation, attachment loss, and mucosal recession. This case report describes the benefits of connective tissue (CT) grafting in the treatment of peri-implantitis and gingival recession affecting an implant supporting an overdenture. To the best of the author's knowledge, there are few clinical case reports depicting this treatment for implants supporting overdentures. CASE PRESENTATION: A 75-year-old female was diagnosed with peri-implantitis associated with an implant that supported a mandibular overdenture. The bone loss and gingival recession was on the facial aspect of the implant. The roughened threaded surface of the implant was exposed, and there was an absence of facial keratinized mucosa. Peri-implant therapy included surgical access to debride the area and decontaminate the implant surface using a 3% hydrogen peroxide rinse. This site was then treated with CT grafting using an autogenous CT graft. At the completion of treatment, the implant site was found to be healthy with greatly improved implant coverage and an increased keratinized tissue width. CONCLUSION: The use of an autogenous CT graft can be an important part of treatment of peri-implantitis when there is gingival recession and a lack of keratinized mucosa.

Minimizing shrinkage of interdental papilla height when treating multiple Miller Class III gingival recession defects.

Miller Class III and IV gingival recession defects have interdental bone and soft-tissue loss that limit root coverage. Given the importance of the interdental papilla, protecting the integrity of this structure would seem prudent. Tunnel techniques have been successfully used to protect the interdental papilla. This article discusses the results of two cases in which multiple Miller Class III gingival recession defects were treated using tunnel-grafting techniques and an acellular dermal matrix. In both cases, root coverage was achieved while protecting the interdental papilla height.

A double-layer technique using an acellular dermal matrix for the treatment of Miller Class I and II gingival recession defects: 1-year results of 50 consecutive cases.

The aim of this study was to evaluate the performance of a double-layer technique using an acellular dermal matrix (ADM) in conjunction with a coronally advanced flap (CAF) in treating Miller Class I and II gingival recession defects. A total of 50 patients with isolated Class I and II gingival recession defects were treated. At 52 weeks, the mean recession defect decreased from 3.8 ± 0.9 mm to 0.2 ± 0.5 mm. This represents 94.7% root coverage. Complete root coverage was achieved in 80.0% of the cases. Statistical improvements also were found with probing depths and clinical attachment levels. These results support the use of a double-layer technique using ADM in conjunction with a CAF in treating Class I and II recession defects.

Biotype change for the esthetic rehabilitation of the smile.

UNLABELLED: An esthetic and natural appearing smile is the result of multiple important factors. There must be a harmonious relation between tooth size, shape, proportion, and the periodontium. Successful rehabilitation of a smile often requires an interdisciplinary approach which was applied in the case presented in this article to a patient with multiple esthetic challenges. Treatment included management of canines in the lateral incisor positions, proportionally small teeth, and excessive gingival display. Good communication and coordination of care between the surgical and restorative partners produced a pleasing outcome facilitated by periodontal surgery resulting in a modification of the gingival biotype. CLINICAL SIGNIFICANCE: Smile design including crown lengthening and biotype modification can be used to create an esthetic and natural appearing restorative result.

CAD/CAM implant abutments using coded healing abutments: a detailed description of the restorative process.

Computer-aided design/computer-aided manufacturing (CAD/CAM) represents a leap forward in the fabrication of implant restorations. Coded healing abutments can be digitally read, and they eliminate the steps needed to make implant impressions using traditional impression copings. This article provides a detailed description of the restorative process using CAD/CAM technology and coded healing abutments.

Use of the tunnel technique and an acellular dermal matrix in the treatment of multiple adjacent teeth with gingival recession in the esthetic zone.

The proper management of gingival recession is critical to the establishment of a natural-appearing soft tissue architecture. Subepithelial connective tissue grafts have been considered the "gold standard" but are limited by the availability of palatal donor tissue. Tunnel techniques have improved the esthetic results of connective tissue grafting. Acellular dermal matrices have been successful in the treatment of gingival recession and are not limited by the palatal anatomy. The aim of this report is to describe the application of the tunnel technique, with use of an acellular dermal matrix, in the correction of gingival recession affecting multiple adjacent teeth in the esthetic zone.