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Distal facial composite

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Gingival recession causes not only aesthetic problems, but problems with oral hygiene, plaque accumulation, Distal facial composite, and tooth sensitivity. Replacing the missing gingival tissue with composite resin, when indicated, Distal facial composite be a time- and cost-effective solution. Here we report the case of a 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, Distal facial composite, 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.

Aesthetic dentistry Distal facial composite harmonious integration of smile design, conception, and material selection.

This is accomplished by a comprehensive knowledge of facial aesthetics, tooth morphology, available restoration techniques, and communication skills.

An understanding of smile components, teeth, gingival tissues, and lips, is crucial. The maxillary central incisors are the visual focal point for the smile, Distal facial composite they should be dominant and symmetrical. The ideal gingival levels are determined by establishing the correct width-to-length ratio of the maxillary anterior teeth Marus, ; Wolfart et al.

Generally, gingival tissue runs parallel to the upper lip and its architecture is bilaterally symmetrical.

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The zenith of this tissue on the maxillary central incisors and canines is skewed slightly to the distal side Feigenbaum, ; Magne and Belser, The gingival embrasures should be bilaterally symmetrical and allow for interdental papillary architecture Feigenbaum, ; Magne and Belser, Aggressive periodontitis AgP includes both localized and generalized forms of periodontitis in which there is rapid destruction of the periodontal ligament and the alveolar bone in younger and otherwise systemically healthy individuals Roshna and Nandakumar, Untreated AgP can result Distal facial composite flaring, protrusion, diastema, extrusion, rotation, and drifting of the teeth.

Malocclusion caused by pathologic migration of teeth can be corrected by orthodontics once AgP has been stabilized with periodontal therapy Roshna and Nandakumar, Regeneration of the periodontal supporting structures lost due to periodontal disease and restoration of aesthetic appearance and function of the periodontium is difficult and in most cases requires interdisciplinary approaches Maeda et al.

Techniques for periodontal regeneration include the use of grafts, barrier membranes or guided tissue regeneration, biologic modifiers like growth and differentiation factors, and extracellular matrix proteins such as enamel matrix proteins, or any combination of Distal facial composite above Roshna and Nandakumar, This gingival defect also contributes to retention of food debris, adversely affecting the health of the periodontium Kurth and Kokich, ; Donovan, ; Roshna and Nandakumar, Treatments include surgical or prosthetic approaches.

Surgical treatment can be successful in creating aesthetically pleasing and anatomically correct tissue contours when small volumes of tissue are being reconstructed.

However, long term results are variable due to the complexity of the interdental space and its vascularity Babu et al. Surgical costs, healing time, discomfort, and varying long term results make this choice unpopular Barzilay and Irene, ; Distal facial composite, ; Jacobson and Frank, ; Patil et al.

Prosthetic approaches to reproduction of artificial gingival tissue include porcelain, acrylics denture base materialsilicone based soft materials, or co-polyamide and composite resin. Each material has advantages, disadvantages, and specific indications Barzilay and Irene, ; Capa, ; Coachman and Calamita, 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, ; Patil et al.

For Distal facial composite requesting fixed restoration of soft tissue in the aesthetic zone, the use of gingiva-coloured pink porcelain can help in recreating natural tooth proportions and provide realistic alternatives to surgery Sarver, ; Martegani et al. The use of pink composite resin as an artificial gingival tissue was first described by Zalkind and Hochman in the management of a cervical defect. When used for soft tissue restoration, the cervical contour must be created such that plaque retention is prevented.

This can be achieved using appropriate application instruments, adequate moisture control, and curing. For optimal aesthetics, a pseudo gingival sulcus Distal facial composite be created around the margin of the restoration that coincides with the previous free gingival margin. An advantage of using composite resin over pink porcelain is direct placement.

For proper tooth alignment, a clinician should present only treatment options that involve predictable, conservative restorations that preserve healthy tooth structure Jacobson and Frank, Orthodontic alignment is expensive and time consuming, but usually successful.

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The appearance of tooth alignment can be achieved using porcelain veneer restoration PVRbut this procedure usually requires aggressive removal of tooth structure Christensen, ; Christensen, ; Croll, ; Heymann and Kokich, ; Spear, ; Jacobson and Distal facial composite, and therefore is not a conservative measure. More conservative treatment options such as orthodontics, direct bonding composite resin, and enameloplasty should be offered to the patient.

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Moreover, the inability to restoratively improve gingival relationships with PVRs may result in achieving less-than-optimal aesthetics.

For patients with aesthetic and functional defects from loss of gingival tissue, composite resin material can be a timely and cost-effective alternative Distal facial composite surgical options. This study was approved by the Hospitals Human Ethics Committee.

Written informed consent was obtained from the patient for publication of this case report and accompanying images. The authors report no conflicts of interest in the preparation of Distal facial composite case report. A year-old female patient reported to the Department of Conservative Dentistry, Makkah Dental Center, Makkah, Saudi Arabia with a chief complaint of generalized gingival recession with black triangles present between the maxillary and mandibular anterior teeth Figs.

Facial view of the patient showing open gingival embrasure between the maxillary and mandible central incisors. The patient complained of tooth sensitivity and oral hygiene problems resulting in plaque accumulation on maxillary and mandibular teeth. Air and fluid escaping from between the anterior teeth made her extremely uncomfortable.

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The mandibular lateral incisors 32, 42 were rotated and slightly extruded, partially overlapping the central incisor, which impart softness and youthfulness to smile. Gingival recession with loss of the interdental papilla involved her maxillary 16, 15, 14, 13, 12, 11, 21, 22, 23, and 24 and mandibular 34, 33, 32, 31, 41, 42, 43, and 44 teeth Figs.

The patient also had varying shades of mild Distal facial composite band discolourations of the anterior teeth 11, 12, 13, 21, 22, and The patient was thoroughly informed about the different options for restoration of gingival tissue, alteration of the midline for aesthetic smile symmetry, and improved tooth shading.

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She expressed opposition to an additional surgical procedure to reconstruct open gingival embrasures by grafting and bone augmentation. Instead she opted for restoration of the dentogingival complex using the pink composite resin because this technique allowed satisfactory function and aesthetics at lower cost and could be completed chairside.

She also chose to alter the midline and to block out the underlying tooth colour using composite resin. The teeth were isolated and acid etched with The pink gingival composite anaxGUM Pink Composite, Anaxdent, Stuttgart, Germany was scalloped between the teeth and natural gingiva Distal facial composite preparation.

The gingival base was made in layers to create the proper contours without any overhang of material. Composite was completed on the maxillary teeth 16, 15, 14, 13, 12, 11, 21, 22, 23, and 24 Fig. Final contouring was performed using a composite finishing and polishing system Enhance Dentsply Caulk Dentsply International Inc.

The maxillary pink gingival composite completed first around teeth 16, 15, Distal facial composite, 13, 12, 11, 21, 22, 23, and Facial view of the completed direct pink gingival composite around maxillary teeth 16, 15, 14, 13, 12,11, 21, 22, 23, and 24 and mandibular teeth 34, 33, 32, 31, 41, 42, 43, and After soft tissue restoration with aesthetic gingival papillary levels and scalloping over the central incisors, composite splints were placed palatally from canine Distal facial composite canine to stabilize the teeth and reduce mobility.

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