Determinación de parámetros estéticos gingivales y dentarios en dientes anterosuperiores / Determination of gingival and dental esthetic parameters in anterosuperior teeth

La odontología estética no es una disciplina especial o área de la odontología en sí misma, pero con consideraciones funcionales y biológicas, representa uno de los objetivos de las intervenciones de tratamiento dental, que abarca todas las áreas de especialidad, desde la odontología preventiva y restaurativa hasta la prostodoncia, ortodoncia, periodoncia, como, así como la cirugía oral y maxilofacial. El cénit gingival es un importante componente de la sonrisa y su estudio sigue siendo muy relevante en la odontoestética internacional. En el presente trabajo se determinaron distancias del cenit al eje longitudinal y se correlacionaron con otros parámetros gingivales, se establecieron diferencias en las alturas de las papilas interdentales y se correlacionaron los datos métricos de las piezas dentarias anteriores de la población estudiada y los datos conocidos con el fin de obtener datos estadísticos relevantes. Los datos mesurables fueron obtenidos de pacientes de ambos sexos, (18 ­ 25) años, con piezas dentarias del grupo anterior y superior a saber: incisivos centrales, incisivos laterales y caninos superiores, normalmente implantados, libres de lesiones o restaruración, ausencia de enfermedad gingivoperiodontal y sin tratamientos ortodoncicos. El trabajo observacional, descriptivo y tranversal arrojó resultados basados en la estadística preponderante. Provee dimensiones y proporciones de dientes maxilares que pueden adaptarse a pacientes individuales en relación con parámetros establecidos en la odontoestética. Estos datos pueden ser pautas útiles para el diagnóstico y la planificación del tratamiento (especialmente cirugía periodontal) en la dentición maxilar (AU)

A esthetic dentistry is not a special discipline or area of dentistry itself, but with functional and biological considerations, it represents one of the objectives of dental treatment interventions, which covers all areas of specialty, from preventive and restorative dentistry up to prosthodontics, orthodontics, periodontics, as well as oral and maxillofacial surgery. The gingival cenith is an important component of the smile and its study remains very relevant in international dentistry. In this work, distances from the cenith to the longitudinal axis were determined and correlated with other gingival parameters, differences in the heights of the interdental papillae were established and the metric data of the anterior teeth of the studied population were correlated and the known data with in order to obtain relevant statistical data. The measurable data were obtained from patients of both sexes, (18 - 25) years, with teeth of the anterior and superior group, namely: central incisors, lateral incisors and upper canines, normally implanted, free of lesions or restoration, absence of disease gingivoperiodontal and without orthodontic treatments. The observational, descriptive and transverse work produced results based on the preponderant statistics. It provides dimensions and proportions of maxillary teeth that can be adapted to individual patients in relation to parameters established in odontoesthetics. These data can be useful guidelines for diagnosis and treatment planning (especially periodontal surgery) in the maxillary dentition (AU)

Assessment of Periodontal Biotype in a Young Chinese Population using Different Measurement Methods.

Periodontal biotype is used to describe the morphological characteristics of periodontal tissues and is closely related to periodontal health and prognosis of many dental treatments. This study was undertaken to explore the periodontal biotype distribution in a young Chinese population and to evaluate the accuracy of different methods for gingival thickness (GT) measurement. A total of 372 teeth from 31 periodontally healthy subjects were included. GT was measured simultaneously by probe transparency, transgingival probing and cone-beam computed tomography (CBCT). Some other anatomic parameters, including crown width/crown length ratio, attached gingival width, labial bone thickness and papilla volume were recorded for periodontal biotype classification. As found by probe transparency, the gingivae of 222 teeth (59.68%) were thick, while those of 150 teeth (40.32%) were thin. The mean GT of included subjects was 1.03 ± 0.31 mm as measured by transgingival probing and 1.03 ± 0.24 mm as measured by CBCT. Four groups were identified by cluster analysis. Thick-flap biotype, average-scalloped biotype, average-flap biotype and thin-scalloped biotype comprised 137 teeth (36.83%), 96 teeth (25.81%), 39 teeth (10.48%) and 100 teeth (26.88%), respectively. These results demonstrate that the most common periodontal biotype in this young Chinese population was the thick-flap type with low aesthetic risk.

Morphometric Variation in Maxillary Central Incisors and Its Influence on Gingival Characteristics: A Preliminary Epidemiologic Study in an Indian Population.

The presence of interdental papilla between the maxillary central incisors has a considerable influence on harmonizing esthetics and biologic functions. Preliminary investigations indicate an association between tooth shapes and periodontal characteristics. This study aimed to evaluate the prevalence of morphologic variation in maxillary central incisors and its influence on gingival characteristics. It was determined that varied crown forms have a definite influence on gingival characteristics, which could act as a valuable guideline in periodontal, restorative, and anterior implant placement procedures.

Papilla height in relation to the distance between bone crest and interproximal contact point at single-tooth implants: A systematic review.

OBJECTIVES: The aim of this systematic review was to investigate the tooth-implant papilla formation in correlation with the distance between the interproximal bone level and the prosthetic contact point. MATERIAL AND METHODS: A comprehensive search of the current literature (01/01/2000-01/01/2017) was performed to identify human trials that included 10 patients or more, with at least 12 months follow-up, in need of the replacement of one single tooth in the anterior maxillary region with an implant-supported single crown. To meet the inclusion criteria, studies had to provide both radiographic and clinical data regarding the distance between the interproximal bone level and the prosthetic contact point. RESULTS: The search yielded 136 records. After evaluation of abstracts and full texts, 12 papers were included in the final review, even though various reference points, for the comparison between the vertical distance and the papilla height, were used. The vertical distance between the interproximal bone level and prosthetic contact point ranged between 2 and 11 mm, and the partial or complete papilla fill (Jemt's score 2-3) ranged between 56.5% and 100% of cases. CONCLUSION: There is limited evidence that the vertical distance from the base of the interproximal contact point to the crestal bone level seems to affect the interproximal papilla height; that is, the lower is the distance the higher is the percentage of papilla fill. Complete embrasure fill between an implant restoration and the adjacent tooth seems to be correlated with the integrity of the periodontal ligament of the tooth. To reduce the risk of aesthetic failures, interproximal probing on the adjacent teeth should be encouraged before implant placement.

Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: Osteology Foundation Consensus Report Part 3-Aesthetics of peri-implant soft tissues.

OBJECTIVES: Working Group 2 at the 2nd Consensus Meeting of the Osteology Foundation had a focus on the influence of vertical implant placement on papilla height at single implants adjacent to teeth and on the inter-implant mucosa fill at two adjacent implants in the anterior maxilla. MATERIALS AND METHODS: Two systematic reviews were prepared in advance of the consensus meeting. Due to the heterogeneity among the studies with regard to study design, study population, method of assessment, meta-analyses were not possible. Consensus statements, clinical recommendations, and implications for future research were based on structured group discussions until consensus was reached among the entire expert group. RESULTS: The systematic review about single-tooth implants included a total of 12 studies demonstrating that the vertical distance from the crestal bone level to the base of the interproximal contact point varied considerably from 2 mm up to 11 mm, and a partial or complete papilla fill was reached in 56.5% to 100% of the cases. For the systematic review regarding two adjacent implants, only four studies reported on horizontal inter-implant distances which ranged between 2.0 and 4.0 mm. More than half of the papilla presence was indicated in 21% to 88.5% of the cases. CONCLUSIONS: It was concluded that for single-tooth implants, the papilla height between an implant and a tooth is predominantly dependent on the clinical attachment level of the tooth. In cases with two adjacent implants, it was concluded that it is not possible to define the optimal horizontal distance between two adjacent implants restored with fixed dental prosthess.

An Evaluation of the Effect of Periodontal Biotype on Inter-Dental Papilla Proportions, Distances Between Facial and Palatal Papillae in the Maxillary Anterior Dentition.

PURPOSE: Gingival esthetics are an essential segment of facial beauty. The aim of the present study was to clinically assess the impact of periodontal biotype (PB), the length between the base of interproximal contact area and the interproximal bone crest (CP-BC), the distance between the facial and palatal papillae (DFPP), and papillary proportions (PP) on the presence of interdental papillae (PIP). MATERIALS AND METHODS: 80 patients aged 18 to 60 years were recruited for study. PB and CP-BC were evaluated clinically. Alginate impressions of maxillary arches were made, and DFPPs were measured using a digital Vernier caliper. The impressions were later poured in dental stone, and PP were calculated. RESULTS: Descriptive statistics and ANOVA were used for statistical analysis for correlation among the variables. A greater proportion of individuals who had a thick PB (77.7%) had significantly higher amounts of PIP than did patients with thin PB (60.7%) (p < 0.01). A strong significant positive correlation was found between PIP in thick PB patients and DFPP (p < 0.01, r = 0.56); DFPP and PP (p < 0.01, r = 0.61). A strong negative correlation was seen between PIP in thin PB and DFPP (p < 0.01, r = -0.67). CONCLUSION: According to the results of this study, PB affected the heights and presence of maxillary interdental papillae by affecting papilla proportion and distances between the facial and palatal papillae.

Evaluation of peri-implant bone levels and soft tissue dimensions around zirconia implants-a three-year follow-up study.

The aim of this study was to measure bone levels around zirconia implants during follow-up of up to 3 years. Additionally, the effect of clinical contact point positions on the papilla deficit was evaluated. Eighty-one patients with 105 zirconia implants were examined at the 3-year follow-up. Bone levels were measured on the date of implant placement and at 3 months, 1year, and 3 years thereafter. Distances between the first bone-implant contact and the contact point of the crowns and between the bone level at the adjacent tooth and the contact point of the crowns were assessed. The effect of the clinical contact point position on the papilla deficit was also assessed. Significant reductions in the distances between the bone-implant contact and the implant shoulder, as well as the contact point of the crowns, and between the bone level at the adjacent tooth and the contact point of the crowns, were found. A significant association was found between the papilla deficit and the height of the contact point. Implant survival was 100% and implant success was 95.4%. While zirconia implants presented little bone loss up to 1year, significant bone apposition was observed up to 3years. Low contact points correlated with full papillae, whereas high contact points were associated with a papilla deficit.

Dimensions of hard and soft tissue around adjacent, compared with single-tooth, zirconia implants.

Preservation or regeneration of the papilla has always been a challenge around consecutive implants or with implants next to teeth, and many studies have evaluated the papilla's behaviour and patterns based on surgical technique and prosthetic design, though evidence about its behaviour around zirconia implants is scarce. The aim of this study was to evaluate papilla behaviour between implants and teeth (tooth-implant group) and between consecutive implants (implant-implant group). Ninety patients with 122 zirconia implants (Straumann® PURE Ceramic Implant) were examined at the one-year follow up. We measured the effect of the distance: first from the base of the contact point of the crowns to the contact with bone at the implant site (D1); secondly, to the contact with the bone at the neighbouring tooth or implant site (D2); and thirdly on the papillary deficit (D3). In both the tooth-implant group and the implant-implant group, D1 and D2 correlated significantly with the papillary deficit (D3), whereas D2 was the major determinant factor (Spearman's rho=0.60). In both groups, when D1 and D2 were <6mm, the papilla was present every time. The papillary deficit was significantly greater in the tooth-implant group than in the implant-implant group (p=0.048). We conclude that the ideal distance from the base of the contact point to the bone contact at the implant and to the bone contact at the adjacent tooth in both groups is <6mm. The height of the bone on the teeth adjacent to implants has a significant impact on that of the papilla.

Influence of horizontal dimensions around single gap and adjacent zirconia implants on the papilla - a cross-sectional survey.

PURPOSE: To evaluate a possible association between the inter-implant distance and the papilla deficit. Additionally, the effect of high or low contact points of the crowns on the papilla deficit was investigated. MATERIALS AND METHODS: Periapical radiographs taken 1 year after loading were used to assess the distance from the shoulder of the implant to the adjacent tooth or implant. On the clinical images, the interdental papilla height, soft tissue deficit and crown length were evaluated. The papilla crown proportion and the proportion of the height of the contact point to the crown length were assessed. RESULTS: Eighty-one patients, with a total of 104 zirconia implants and 208 measurements were involved in this cross-sectional survey. Considering patient means, the correlation between the papilla deficit and the interproximal distance, respectively inter-implant distance, was very low (r = -0.05220; P = 0.6435, N = 81). Logistic regression at implant-level showed that there was no significant difference in the likelihood for a papilla deficit between a high and a low contact point of the crowns with P = 0.8191 (Odds ratio: 1.106 with 95%CI 0.461; 2.654). CONCLUSIONS: Horizontal interproximal dimensions around zirconia implants showed very weak influence on the papilla height. A high or a low contact point position of the crowns did not affect the papilla deficit. Conflict of Interest and sources of funding: All authors reported no conflict of interest. There were no sources of funding for the research.

The relationship between open versus normal contact point and inter-proximal papilla dimensions in periodontally healthy young adults: A controlled clinical trial.

AIM: The gingival architecture is determined by the spatial orientation of the gingival zenith (GZ) and the inter-dental papillae (IP). Among the factors commonly associated with the presence and morphology of the IP, the contact point (CP) and the inter-dental distance relationships have been considered the most important. The objective of the present controlled clinical trial was to evaluate the role of the CP in determining the clinical and morphometric parameters of the inter-dental papilla. MATERIALS AND METHODS: The inter-dental papillae of sixty patients with unilateral diastemas were evaluated by means of periodontal probing, transgingival probing, the papilla presence index and morphometric measurement with a digital calliper and were analysed with a paired t-test, with significance set at alpha value of 0.05 or lower. RESULTS: All the papillae exhibited PPI score = 1. Papillary measurements were significantly increased in the experimental (diastema) group. CONCLUSIONS: In patients with gingival health, the dimensions of the IP are significantly increased in teeth without a contact point in comparison with their contra-lateral controls with a contact point. The contact point does not determine the presence and size of the inter-dental papilla, in patients with a healthy gingiva and without periodontal attachment loss.

Influence of a Laser-Lok Surface on Immediate Functional Loading of Implants in Single-Tooth Replacement: Three-Year Results of a Prospective Randomized Clinical Study on Soft Tissue Response and Esthetics.

The purpose of the present prospective randomized study was to evaluate the influence of Laser-Lok microtextured surface on soft tissue peri-implant parameters and esthetics around immediate, functionally loaded implants for single-tooth replacement in the esthetic zone. This study included 77 patients divided into two groups based on different implants used: the control group had BioHorizons tapered internal non-Laser-Lok-type implants (NLL; n = 39) and the test group had BioHorizons tapered internal Laser-Lok-type implants (LL; n = 39). Outcome measures were survival, radiographic marginal bone-level changes, soft tissue parameters, and esthetics. One implant was lost in the test group and one in the control group, for a total survival rate of 96.1% after 3 years. Radiographically, mean crestal bone loss ± standard deviation was 0.59 ± 0.27 mm in the LL group compared with 1.17 ± 0.31 mm in the NLL group. A mean gain in papilla level of 0.41 ± 0.34 mm and 0.17 ± 0.36 mm was observed in the LL and the NLL groups, respectively, while the level of the midfacial peri-implant mucosa remained stable in both groups with no statistically significant differences (0.08 ± 0.42 mm for the LL group vs 0.06 ± 0.36 mm for the NLL group). The mean probing depth values in the LL and NLL groups were 0.58 ± 0.2 mm and 1.89 ± 0.3 mm, respectively. Within the limitations of this study, it was demonstrated that the clinical and esthetic outcome of immediate functional loading was more favorable for LL implants than for NLL implants.

Morphology of the Lingual and Buccal Papillae in Alpaca (Vicugna pacos) - Light and Scanning Electron Microscopy.

The aim of this study was the description of the lingual and buccal papillae in adult alpaca (Vicugna pacos) by light and scanning electron microscopy (SEM). The tongue consisted of apex, body and root. Four types of lingual papillae (filiform, fungiform, conical and circumvallate) in addition to two types of buccal papillae were observed. The filiform papillae, some with secondary papillae, were distributed on both the corpus and apex of the tongue, with stratified epithelium, and layer of keratin coat were recognized. The short (small) cone papillae had pointed top, while bunoform papillae were wide with smooth apex. The much less numerous circumvallate papillae with pseudopapillae on the each rim of the caudal lingual body were present with weak layer of keratin and intra-epithelial taste buds. The small fungiform papillae were found on the dorsal lingual surface, while the large fungiform papillae were situated on the ventral surface of the tongue, especially, in rostral part and were round in shape with numerous gustatory pores and very thin keratin coat. Pseudopapillae were present on the buccal conical 'bunoform' papillae surface, while 'elongate' buccal papillae surface was rather softly folded with thin coat of keratin. Microridges were observed in the less keratinized parts of each type of papillae. The orientation of either lingual or buccal papillae into the throat side facilitates the emptying of oral cavity from nutrient and swallowing of food. In conclusion, the anatomical features of the alpaca tongue are an adaptation to the feeding habits.

Biotipos periodontales, un resumen actualizado / Periodontal biotypes, an updated review

El interés por los biotipos periodontales se ha acrecentado en el último tiempo, por lo cual en los años recientes el estudio de las dimensiones de los diferentes tejidos periodontales se ha desarrollado desde un punto de vista epidemiológico, estético y terapéutico en varias áreas de la odontología, especialmente en periodoncia. Esta revisión bibliográfica tiene por objetivo mostrar las últimas evidencias relacionadas con esta temática.

Biotipos periodontales, un resumen actualizado / Periodontal biotypes, an updated review

El interés por los biotipos periodontales se ha acrecentado en el último tiempo, por lo cual en los años recientes el estudio de las dimensiones de los diferentes tejidos periodontales se ha desarrollado desde un punto de vista epidemiológico, estético y terapéutico en varias áreas de la odontología, especialmente en periodoncia. Esta revisión bibliográfica tiene por objetivo mostrar las últimas evidencias relacionadas con esta temática.(AU)

Influence of periodontal biotype on the presence of interdental papillae.

The absence of interdental papillae can be a negative influence in aesthetics. Periodontal biotype (PB) is one of the factors that can possibly influence this relation and has to be considered in periodontal diagnosis and treatment planning. The objective of this study was to evaluate the influence of the periodontal biotype on the presence and absence of interdental papillae. Forty-seven patients were included in this transversal clinical study. The PB, presence and height of interdental papilla, loss of papillary height, and the distance between the base of the contact point and bone crest (CP-BC) were evaluated. The chi-square test was used to verify the significance level of the PB distribution frequency between groups. The Mann-Whitney test was used to compare the CP-BC measures between the different PB groups, and the correlation test was used to verify the relation between the CP-BC distance and the presence of papillae. The thin PB group presented a significantly higher presence of papillae (71.1%) than did the thick PB group (59.6%, P < 0.05). An inverse and proportional correlation between the CP-BC distance and the presence of papillae was found. The authors concluded that the PB influenced the presence and height of interdental papillae.

[Measurement and analysis of smile line of 62 Han-Chinese].

OBJECTIVE: To analyze smile features in maximum lip-dynamic in Chinese. METHODS: Sixty-two Han-Chinese, travelling in Germany, with a mean age of 28.5 years were enrolled and photographed. Standardized digital photos were made to measure the height of displayed maxillary gingiva, papilla and tooth during an enjoyment smile. Statistical analysis was performed using Mann-Whitney-U Test and non-parametric analysis. RESULTS: The mean height of tooth display for the central incisors was 10 mm, with no significant difference between the gender (P > 0.05). The mean height of gingival display was 1.3 mm and the mean papilla height was 3.4 mm. There was no significant difference between the genders (P > 0.05). 31% (19/62) of the subjects belonged to high smile line type, 50% (31/62) to medium smile line type and 19% (12/62) to low smile line type. CONCLUSIONS: The red esthetics is a paramount factor for Chinese men and women in the esthetic restoration. 81% of the Chinese studied showed various degree of gingival exposure from central incisor to the premolars, which defined the esthetic area for Chinese people. Papilla is a critical parameter for esthetic evaluation and treatment design. The ratio of high smile line in Chinese may be higher than that in Caucasian.

Genetic analysis of tongue size and taste papillae number and size in recombinant inbred strains of mice.

Quantitative trait loci (QTLs) analysis has been used to examine natural variation of phenotypes in the mouse somatosensory cortex, hippocampus, cerebellum, and amygdala. QTL analysis has also been utilized to map and identify genes underlying anatomical features such as muscle, organ, and body weights. However, this methodology has not been previously applied to identification of anatomical structures related to gustatory phenotypes. In this study, we used QTL analysis to map and characterize genes underlying tongue size, papillae number, and papillae area. In a set of 43 BXD recombinant inbred (RI) mice (n = 111) and 2 parental strains (C57BL/6J and DBA/2J; n = 7), we measured tongue length, width, and weight. In a subset of 23 BXD RI mice and the parental mice, we measured filiform and fungiform papillae number and fungiform papillae area. Using QTL linkage analysis (through WebQTL), we detected 2 significant and noninteracting QTLs influencing tongue length on chromosomes 5 and 7. We also found a significant QTL on chromosome 19 underlying fungiform papillae area and a suggestive QTL on chromosome 2 linked to fungiform papillae number. From these QTLs, we identified a number of candidate genes within the QTL intervals that include SRY-box containing gene, nebulin-related anchoring protein, and actin-binding LIM protein 1. This study is an important first step in identifying genetic factors underlying tongue size, papillae size, and papillae number using QTL analysis.

The association between embrasure morphology and central papilla recession: a noninvasive assessment method.

BACKGROUND: The distance from bone crest to contact point is only the most frequently studied of the many factors that influence whether interdental papilla are present. The purpose of this study was to discover the association between embrasure morphology and central papilla recession. METHODS: The central papilla was visually assessed in 310 adults using paralleling periapical radiographs of the maxillary central incisors. The following vertical distances were measured: the recession distance, i.e., papilla tip (PT) to contact point (PT-CP), bone crest (BC) to contact point (BC-CP), proximal cementoenamel junction (pCEJ) to contact point (pCEJ-CP), papilla height (PH), and bone crest to proximal cementoenamel junction (BC-pCEJ). Interdental width was measured horizontally. Subjects were divided into 4 groups according to interdental width and pCEJ-CP distance: long-narrow, short-narrow, long-wide, and short-wide. RESULTS: Statistical analysis revealed the following for all four study groups: a positive correlation between papilla recession distance and age, a positive correlation between bone crest-contact point distance and age, and a negative correlation between age and papilla height. CONCLUSION: Central papilla recession as a result of aging occurs most frequently in the long-wide group, that is, among people who have both a wide interdental width and a long distance between the proximal cementoenamel junction and the contact point. However, other factors also affect the likelihood of central papilla recession. Thus, there is a need for further study of the interaction among these causal factors.

Influence of interimplant distance on gingival papilla formation and bone resorption: clinical-radiographic study in dogs.

PURPOSE: The purpose of this study was to evaluate in dogs the area between implants after prosthetic restoration within 5 mm distance between the contact point (CP) between crowns and the bone crest (BC). MATERIALS AND METHODS: The mandibular premolars of 6 dogs were extracted bilaterally. After 12 weeks of healing, each dog received 8 implants. On each side, 2 implants were separated by 2 mm (group 1) and 2 by 3 mm (group 2). After a healing period (3 months), the implants were restored with temporary acrylic resin prostheses and after 4 more weeks, with definitive metallic prostheses. After 8 weeks, the distance between the CP and the papilla (P) was measured. The distance between a line extending from the CP and the gingival height at the distal extension of the prosthesis (DE) was also measured. Digital radiographic images were obtained for evaluation of the CP-BC and BC-P distances and the analysis of bone resorption adjacent to the implant surfaces. RESULTS: The median CP-P distances were 1.75 mm and 1.98 mm for groups 1 and 2, respectively; the median CP-DE distances were 2.60 and 2.69, respectively. The mean CP-BC distances were 5.64 mm and 6.45 mm, for groups 1 and 2, respectively; mean BC-P distances were 3.07 mm and 3.55 mm, respectively. DISCUSSION AND CONCLUSIONS: The differences in distances of 2 and 3 mm between implants did not present significant differences in the formation of papillae or in crestal resorption. The CP-BC distances for prostheses should be different from those of natural teeth because in natural teeth, the biologic width is already present, and in the case of implant-supported prostheses, it will develop following second-stage surgery.