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

doi:10.1016/S0022-3913(07)60040-7

The Journal of Prosthetic Dentistry

Volume 98, Issue 2, August 2007, Pages 82-84

https://doi.org/10.1016/S0022-3913(07)60040-7 Get rights and content

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.

Section snippets

Clinical report

A 30-year-old white woman was referred to the Department of Prosthetic Dentistry of the Yeditepe University dental clinic, Istanbul, Turkey. Her complaint was the unaesthetic appearance of her maxillary right and left central incisors due to gingival recession after periodontal treatment (Fig. 1). The patient occasionally reported hypersensitivity of the involved teeth. Clinical and radiographic examination revealed that the teeth were not cariously involved. The patient had no complaints

Summary

GCP porcelain laminate veneers may be an alternative prosthetic procedure to treat advanced tissue loss, achieving acceptable esthetic results and patient satisfaction. This method preserves the remaining tooth structure with minimal invasive hard tissue loss.

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Cited by (11)

Fifteen ceramic gingival samples: A proposed gingival shade guide
2023, Journal of Dentistry
(1) To put forward a set of valid pink ceramic samples for subjective gingival colour selection in the Caucasian population, and (2) to assess the quality of the shade matches provided by the selected pink samples.
The ceramic gingival shade samples (n = 133) were obtained by mixing pairs of basic colours from a single system. In each mixture, the proportions of the colours were altered in 10% increments, following the numerical order used by the manufacturers of the three colour systems under study (Heraceram, Vita VM9 and IPS Style). The CIELAB colour coordinates were recorded using spectrophotometry in three zones of healthy anterior gingiva (n = 360). The sample was randomly divided into two subsamples, each of which contained 180 participants. Subsample 1 was used to select the ceramic gingival samples that provided the best shade matches, using the k-means clustering method. Subsample 2 was used to assess the chromatic validity of the selected gingival samples, according to the coverage error.
To identify the ceramic gingival samples that best represented participants’ gingival colour, the minimum colour differences (ΔEab∗, ΔE00) between the cluster centroids and the 133 gingival samples were calculated. Fifteen gingival samples were selected: 8 from the Heraceram system, 4 from the VM9 system, and 3 from the IPS Style system. Coverage errors for the 15 gingival samples fell below the gingival clinical acceptability thresholds in the three gingival zones examined.
The 15 ceramic gingival colour samples provide satisfactory coverage of the gingival colour space, with coverage errors below the ΔE00 clinical acceptability threshold of 2.9 units. These pink colour samples have the potential to provide good gingival shade matches in subjective colour selection.
Mixing basic ceramic colours is a viable method for generating a series of pink shades that can be used as a physical gingival shade guide. The resulting guide provides valid results (under the acceptability thresholds) for subjective selection gingival colour selection in clinical practice.
Using Kubelka-Munk reflectance theory to predict optimal pink composite thickness and shade with an opaqued PEEK background for a final gingival color: An in vitro study
2022, Dental Materials
Citation Excerpt :
The importance of gingival color cannot be overemphasized. Majority of the population show some percentage of the gingiva when smiling [31], and color is one of the most important factors on patient acceptance of dental prosthesis [32], as problems related to color reproducibility can lead to treatment failure [33]. Even though, shade selection and esthetic parameters regarding tooth colored dental materials have evolved dramatically in the past years, gingiva-colored dental materials showed little progress [28].
The aims of this study were to demonstrate and evaluate how Kubelka-Munk (K-M) reflectance theory is used to adjust the color of the opaqued PEEK backing and the color and thickness of the resin composite layers in different thicknesses in order to minimize the color difference from a target gingival color.
PEEK specimens were opaqued with either a dark or a light opaquer. Composite resin layers in 3 different colors were fabricated in varying thicknesses. Reflectance of opaqued PEEK and composite layers was determined using a spectroradiometer. Kubelka–Munk (K-M) absorption (K) and scattering (S) coefficients were derived for each material and then K-M reflectance theory was then used to predict the reflectance of each composite disk as layered on each backing. The color of the opaqued PEEK backings alone and the color of 12 pink composite layers on opaqued PEEK backings was calculated for the CIE D65 Illuminant. Composite resins in 3 different color were then bonded to the opaqued PEEK specimens and color differences of these specimens from the theoretical colors were determined.
The ∆E00 values ranged from 0.45 to 1.29 units for the bonded pink specimens and the K-M theory. K-M theory was validated as a viable predictor of gingival color using pink composite bonded to opaqued PEEK background.
Using K-M theory to predict the gingival color of pink composite bonded to opaqued PEEK eliminates the need to make many specimens of different thicknesses that would otherwise be required to find an acceptable color match.
Colour thresholds of the gingival chromatic space
2020, Journal of Dentistry
Citation Excerpt :
Colour in aesthetic dentistry is not only related to teeth (white aesthetics) and gingival colour (pink aesthetics) but must be harmonious if a beautiful and attractive smile is to be achieved [1,2]. In fact, colour is one of the most important factors with respect to how dental prosthetics are accepted by patients [3], and often problems with reproducing the optimal colour of fixed dentogingival prostheses can lead to treatment failure [4,5]. The thresholds of perception (PT) and acceptability (AT) associated with tooth colour are usually studied in vitro [6–10].
To establish the thresholds of chromatic perception and clinical acceptability of gingival colour according to professional category and in accordance with the perceptibility/acceptability threshold of 50:50 (colour differences that can be perceived/accepted by 50 % of the observers).
A total of 21 different coloured samples made of pink gingiva Heraceram porcelain were used. Dentists (n = 54), dental assistants (n = 56), dental students (n = 126) and participants unrelated to dentistry (n = 116) were asked to identify pairs of samples that appeared identical. In addition, they were asked to indicate the pairs of samples whose colour they considered to be acceptable for use in a dental rehabilitation. A least squares regression was adjusted using an S-shaped curve of the equation y = exp (B0 + B1/x). The adjusted model was used to predict a colour difference value for an acceptability percentage of 50 %.
The threshold value for the perception of colour changes in human gingiva varies from ΔEab* 2.3 ± 0.38 units and CIEDE2000 (ΔE00) 1.5 ± 0.28units (dental students) to ΔEab* 2.7 ± 0.43 units and ΔE00 1.8 ± 0.30 units (participants unrelated to dentistry). The threshold of gingival acceptability varies from ΔEab* 2.9 ± 0.43 units and ΔE00 2.0 ± 0.31 units (dental assistants) to ΔEab* 3.6 ± 0.54 units and ΔE00 2.5 ± 0.41 units (dental students).
From the total number of samples, the average threshold of perception for the gingival chromatic space is 3.1 units for ΔEab* and 2.1 units for ΔE00. Moreover, the mean gingival acceptance threshold is 4.1 units for ΔEab* and 2.9 units for ΔE00. These thresholds are similar for all professional categories studied.
The determination of the perception and acceptability thresholds in the gingival chromatic space are of special relevance for designing the physical shade tabs used in gingival colour guides. The results from this work will aid in selecting optimal gingival colour for patients.
Minimally invasive use of coloured composite resin in aesthetic restoration of periodontially involved teeth: Case report
2013, Saudi Dental Journal
Citation Excerpt :
Prosthetic approaches to reproduction of artificial gingival tissue include porcelain, acrylics (denture base material), silicone based soft materials, or co-polyamide and composite resin. Each material has advantages, disadvantages, and specific indications (Barzilay and Irene, 2003; Capa, 2007; Coachman and Calamita, 2010). A removable prosthesis allows a larger volume of tissue to be replaced without disturbing other dental units and proper cleaning is still feasible (Barzilay and Irene, 2003; Patil et al., 2011).
Gingival recession causes not only aesthetic problems, but problems with oral hygiene, plaque accumulation, speech, and tooth sensitivity. Replacing the missing gingival tissue with composite resin, when indicated, can be a time- and cost-effective solution. Here we report the case of a 25-year-old female who presented with generalized gingival recession. Black triangles were present between the maxillary and mandibular anterior teeth due to loss of interdental tissues, caused by recent periodontal surgery. She also had slightly malposed maxillary anterior teeth. The patient elected to replace gingival tissue with pink composite resin and to alter the midline with composite resin veneers. The first treatment phase involved placement of pink gingival composite to restore the appearance of interdental papilla to her upper (16, 15, 14, 13, 12, 11, 21, 22, 23, and 24) and lower (34, 33, 32, 31, 41, 42, 43, and 44) teeth. Phase two was to place direct composite resin bonded veneers on her upper (16, 15, 14, 13, 12, 11, 21, 22, 23, and 24) teeth to alter the midline and achieve desired colour. The third treatment phase was to level the lower incisal edge shape by enameloplasty (31, 32, 41, and 42) to produce a more youthful and attractive smile. This case report and brief review attempt to describe the clinical obstacles and the current treatment options along with a suggested protocol. Use of contemporary materials such as gingival coloured composite to restore lost gingival tissue and improve aesthetics can be a simple and cost-effective way to manage patients affected by generalized aggressive periodontitis (AgP).
Association of fixed partial denture and gingival prosthesis as alternative approach to recover esthetics and function in anterior maxillary region
2012, Journal of Prosthodontic Research
Citation Excerpt :
These is a condition that frequent happens in older populations [3], populations with a high standard of oral hygiene, and in periodontally untreated populations with poor oral hygiene [2]. Hard and soft tissue loss can result in enlarged increased crown length, causing esthetic problems and hypersensitivity of root surfaces [4–6]. Selecting the best esthetic prosthetic treatment for teeth with gingival recession in the anterior region may be challenging [7,8].
Tooth replacement in the maxillary anterior region is especially difficult when the loss includes significant amounts of the residual ridge and the soft tissue. Several techniques are available, such as dental implants or fixed partial denture, and bone and gingival grafts or gingival prostheses, respectively. This article showed a clinical case of an elderly who was treated with a collarless metal–ceramic fixed partial denture and acrylic removable gingival prosthesis to recover the esthetics in the maxillary anterior region. The association of a metal–ceramic fixed denture and gingival prosthesis was an excellent alternative in cases when surgical procedures are contraindicated.
Prosthetic management of partial anodontia with microdontia from 11 to 20 years of age - 10 years of follow up
2022, Journal of Indian Prosthodontic Society

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

Section snippets

Clinical report

Summary

J Prosthet Dent

J Dent

J Prosthet Dent

J Dent

J Prosthet Dent

J Prosthet Dent

J Prosthet Dent