Cutting-Edge Implant Rehabilitation Design and Management: A Tapered Abutment Approach.

Soft-tissue recession around an implant rehabilitation over time has been considered a physiologic phenomenon. The divergent profile of the abutment and the abutment's dis/reconnections are the most critical predisposing and precipitating factors regarding such gingival recession. Recent publications have discussed how tapered and marginless abutments that allow no disconnections and increase soft-tissue thickness could prevent implant rehabilitations from experiencing gingival recession. The objective of this article is to demonstrate the biologic rationale of tissue behavior surrounding tapered abutments and their clinical application.

Retalho reposicionado coronalmente com a finalidade de recobrimento radicular / Coronally advanced flap with the purpose of root coverage

Introdução: a recessão gengival é caracterizada pelo desnudamento parcial da superfície radicular decorrente da migração apical da gengiva marginal e pela degradação do mecanismo de inserção gengival sobre o elemento dentário. Objetivo: descrever um caso clínico de retalho reposicionado coronalmente com a finalidade de recobrimento radicular em paciente que apresentava recessão gengival Classe I de Miller nos elementos dentários 23 e 24. Materiais e Métodos: O presente estudo contou com a participação de um paciente que queixava-se de hipersensibilidade dentinária, quando aplicado o estímulo térmico, e de insatisfação estética devido à exposição radicular visível ao sorrir e durante o ato de conversação. Foi traçado um plano de tratamento para o recobrimento radicular através de cirurgia de retalho reposicionado de forma coronal, seguido de encaminhamento para a realização de tratamento ortodôntico, já que o paciente possuía oclusão traumática na região acometida pela recessão gengival, decorrente da presença de contato prematuro. Resultados e Discussão: com a técnica empregada, foi possível restabelecer a normalidade estética, prevenir o acúmulo de biofilme dental, devido à maior facilidade de higienização da região cervical, permitindo também a redução da hipersensibilidade dentinária, anteriormente relatada pelo paciente. Conclusão: a técnica cirúrgica de retalho coronal, utilizada para a resolução deste caso, mostrou-se uma eficiente forma de tratamento, pois apresentou resultados satisfatórios levando-se em consideração a previsibilidade de recobrimento da superfície radicular para esta técnica, que é de 70 a 99% da área exposta, devolvendo assim, função ao elemento tratado. (AU)

Introduction: the gingival recession is characterized by the partial denudation of the root surface resulting from the apical migration of the marginal gingiva and by the degradation of the gingival insertion mechanism on the dental element. Objective: we present a clinical report of a coronally advanced flap with the purpose of root coverage in a patient who presented gingival recession Miller Class I in the elements 23 and 24. Material and Method: the patient complained of dental hipersensibility when a thermal stimulus was applied and also a aesthetics dissatisfaction due to a visible root exposure to smile and during the act of conservation. A treatment plan was traced for the root coverage by a coronally repositioned flat, followed by a orthodontic treatment due to premature contact. Results: with the technique employed, it was possible to restore aesthetic normality, to prevent the accumulation of dental biofilm due to an ease of cleaning the cervical region, also allowing the reduction of dental hipersensibility, previously reported by the patient. Conclusion: it's possible to claim that the surgical technique of coronal flap used to the resolution of this case is an efficient form of treatment taking into account the root surface coverage for this technique, which is of 70 to 99% of the exposure area, returning to the treated element its function. (AU)

Injerto libre de encía en el tratamiento de la recesión periodontal / Free gingival graft in the treatment of periodontal recession

La recesión periodontal es el resultado del desplazamiento apical del margen gingival, con la consiguiente exposición de la superficie radicular, que conduce a la afectación de la estética, la sensibilidad radicular y el aumento de la susceptibilidad a la caries dental. Siempre que la recesión no esté progresando y se pueda mantener la salud del tejido gingival, la indicación de recubrimiento radicular es una decisión que debe considerar la reparación de las estructuras perdidas y las exigencias estéticas del paciente. El recubrimiento de las superficies radiculares expuestas se ha convertido en uno de los objetivos más importantes del tratamiento periodontal. Se han descrito una variedad de procedimientos quirúrgicos, como los colgajos posicionados lateral y coronalmente, injertos gingivales libres y de tejido conjuntivo, como medios efectivos para el recubrimiento de la recesión periodontal(AU)

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.

Conservative management of gingival recession: the gingival veneer.

UNLABELLED: Gingival recession is apical migration of the gingival tissues resulting in exposure of the underlying root surface. This can cause significant esthetic concerns for the patient, especially when it affects the anterior teeth. The gingival veneer is a prosthesis indicated for challenging clinical situations where there are esthetic concerns because of gingival recession, particularly loss of interdental papillae. Replacement crowns, surgery, or extraction of teeth, and provision of a removable partial denture are other treatment options; however, these have a significant biologic and financial cost compared with gingival veneers. This article aims to revisit the gingival veneer: its uses, advantages, disadvantages, and its fabrication. The cases discussed here highlight two different clinical situations where the gingival veneer prosthesis helped in achieving optimum esthetics and patient satisfaction thus proving to be a feasible and simple treatment modality in certain clinical cases. This may offer a good interim solution for patients who may wish to have time to consider their options of more advanced and complex treatment. Some patients may choose to wear the veneer as a long-term solution when the burden/risk of further advanced treatment may outweigh the benefits, as perceived by the patients. CLINICAL SIGNIFICANCE: The gingival veneer is a viable treatment option for restoring anterior esthetics in clinical situations where there are esthetic concerns caused by significant gingival recession. Case selection is important for a predictable and successful outcome.

Prosthodontic rehabilitation of dental implants with exposed threads: a clinical report.

An unconventional technique was used to address the challenge of exposed dental implant threads. Titanium dental implants were prepared with rotary instruments to eliminate the exposed threads and to receive a fixed cementable prosthesis. The technique required fabrication of a gold casting of 2 copings connected by a round bar to fit the prepared implants and an implant-retained overdenture. This technique may be applied to other situations when multiple implants present with thread exposure and bone resorption. These include single crowns, partial fixed dental prostheses, and attachments for overdentures.

The prosthetic management of gingival aesthetics.

Periodontal disease, trauma, and congenital defects can result in both soft tissue and hard tissue defects that can present with aesthetic problems. The management of these problems may be limited to prevention or surgical management which can result in significant morbidity especially if a second surgical site for grafting is utilised. This article describes the various prosthodontic techniques to improve gingival aesthetics using contemporary materials such as gingivally coloured composite and gingivally coloured porcelain in addition to more traditional materials such as standard prosthetic acrylic.

Prosthetic rehabilitation of an individual papillary unit: a clinical report.

This article is a clinical and technical report to illustrate the prosthetic correction of an individual interdental papilla, which had been lost due to periodontal disease. The patient presented with localised aggressive periodontitis and was successfully treated non-surgically. As a result of the periodontal disease and its management, the interdental papilla between the 11 and 21 were lost and prosthetically replaced. The clinical details of the case and the technical procedures are fully illustrated within this article.

[Does the combination syndrome exist? A case report]. / Existiert das Kombinationssyndrom? Ein Fallbericht.

This case report documents the prosthetic rehabilitation of a patient showing the typical features of combination syndrome. This case documentation gives a general overview of the suspected development and the prevalence of this "syndrome". A treatment option should be shown by the example of a patient from the starting situation until the prosthetic therapy by means of a complete maxillary denture and an implant-supported mandibular overdenture rigidly retained with a milled bar.

An alternative treatment approach to gingival recession: gingiva-colored partial porcelain veneers: a clinical report.

This clinical report describes the treatment of excessive gingival recession involving maxillary right and left central incisors in a 30-year-old woman. The loss of the gingival soft tissue caused an increase in crown length. Gingiva-colored partial porcelain laminate veneers were applied to imitate the lost gingiva and to provide a natural anatomical tooth length. This method may be a minimally invasive alternative treatment method for gingival soft tissue loss, providing esthetic results and patient satisfaction.

Cosmetic rehabilitation following successful treatment of aggressive periodontitis.

UNLABELLED: With advances in periodontal therapy, many sufferers from aggressive periodontitis are retaining their teeth after successful treatment. This presents the practitioner with aesthetic and restorative challenges in these relatively young patients. Lifelong motivation is essential to the supportive therapy for these patients, and the maintenance of good aesthetics, combined with biologically acceptable corrective therapy, may help maintain a high level of motivation. Any treatment provided must naturally be conducive to maintaining long-term dental and periodontal health. This paper aims to demonstrate options for dealing with the aesthetic challenges posed by a number of patients who have undergone initial cause-related therapy for aggressive periodontitis. CLINICAL RELEVANCE: Loss of gingival tissue, tooth positional changes and tooth loss present practitioners with challenges in relation to patient satisfaction with aesthetics following advanced periodontal breakdown. A range of techniques will be required, tailored to the consequences of periodontal attachment loss, in order to satisfy patient demands.

Recobrimento radicular: apresentação de técnica / Radicular overlap: technique presentation

O presente estudo propõe uma associação de métodos cirúrgicos para recobrimento radicular em regiões de incisivos centrais superiores e/ou inferiores. Pelo fato destes dentes estarem próximos aos freios labiais (principalmente aqueles de inserção papilar ou gengival) o recobrimento de raízes desnudas nestes elementos, torna-se duvidoso, quando do uso de outras terapias cirúrgicas isoladas. Com a utilização do enxerto de tecido conjuntivo subepitelial associado a duas técnicas cirúrgicas, ambas de alta previsibilidade, foi obtido bons resultados.

The present study propose a combination of surgical methods for radicular coverage in the upper or lower central insiciors region. Due to the fact that these teeth are dose to the labial frenum (mainly those of insert papilar or gingival), the coverage of the roots in the elements becomes of doubtful, when other therapies are used separately. With the use of subepithelial connective tissue grafts, combined to the two surgical techniques already described, both of high anticipation, good results were achieved.

Closing diastemas and creating artificial gingiva with polymer ceramics.

A 40-year-old male patient elected orthodontic correction of his crowded anterior teeth, leaving multiple root exposures and spacing in the papilla areas. Connective tissue surgery did not satisfy the patient's expectations and led him to seek alternative treatments. An innovative technique was developed to achieve root coverage and fill-in spaces in the papilla areas. This noninvasive technique used a polymer ceramic material that was bonded to the crown and root surface of the individual teeth. The veneer restorations were inserted on the teeth as a solid unit, then separated into individual units. Clinically, the hygiene, which has been monitored since the placement of the restorations 24 months ago, has been satisfactory. This case illustrates an attenuation of a previously described noninvasive laboratory technique to close spaces between teeth. This conservative method can be used to cover denuded root surfaces that may exhibit sensitivity. Although the treatment has been successful for the short-term, the results are promising and deserve further case-controlled clinical assessment.

Maintaining and attenuating periodontal tissues for aesthetic implant placement.

Alveolar ridge resorption and soft tissue recession after tooth extraction inevitably disrupted the harmonious pre-existing periodontal complex, compromising clinicians' ability to recreate successful aesthetic restorations. Although numerous surgical procedures had been advocated for the augmentation of both the alveolar ridge and its soft tissue to ideal contours, questions remain regarding viability and predictability of these procedures. This is especially critical in the maxillary anterior region, where a the condition of the soft tissue complex and its relationship to the implant restoration and its adjacent dentition often determines the implant's success. The described technique of retaining the root remnant and inducing the proliferation of the surrounding tissue in conjunction with immediate implant placement results in the preservation of existing soft and hard tissue, thus minimizing the necessity of grafting procedures and facilitating primary flap closure during implant placement.

The flexible gingival mask: an aesthetic solution in periodontal practice.

Dramatic aesthetic results have been obtained with the flexible silicone gingival mask which can be used to correct deformities remaining after destructive periodontal inflammation has been controlled. The silicone mask may also be used as an interim measure to improve the appearance of anterior crowns after initial periodontal therapy to allow time for healing and the establishment of periodontal stability and prognosis. A simple two-stage impression technique is described, enabling a suitably trained dental technician to produce comfortable and accurately fitting masks, which are very stable during use. Virtually no problems have been encountered.

Gingival-colored porcelain for implant-supported prostheses in the aesthetic zone.

Success in implant dentistry has evolved to include aesthetic excellence as well as functional longevity. Site development for optimal aesthetics is generally accomplished by surgical augmentation of hard and soft tissues. The results of osseous or gingival enhancement procedures are not always ideal, however, and some patients are unwilling to undergo additional surgical treatment. Use of tissue-colored porcelain is a nonsurgical option of hard and soft tissue replacement that provides lip support, restores symmetrical gingival architecture, and replaces lost papillae. The resulting prostheses can achieve or exceed the aesthetic expectations of these patients.