Periodontal Approach To Esthetic Dentistry: February 2015
Periodontal Approach To Esthetic Dentistry: February 2015
Periodontal Approach To Esthetic Dentistry: February 2015
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Pakistan Oral & Dental Journal Vol 35, No. 1 (March 2015) 91
Periodontal approach to esthetic dentistry
The lips: The lip form frames the smile and defines PERIO-AESTHETIC PROCEDURES
the aesthetic zone.7 Lip lines can be classified as high, SURGICAL CROWN LENGTHENING FOR
medium or low, depending on relation of inferior border FUNCTION AND AESTHETICS
of lip with gingiva and teeth.8
Crown lengthening involves the surgical removal of
1 High lipline – shows a large exposure of the gingiva hard and soft periodontal tissues to gain supracrestal
extending from the inferior border of the upper lip tooth length, allowing for clinical crowns and reestab-
to the free gingival margin. lishment of the biological width.12 Crown lengthening
2 Medium lipline – when the patient smiles, a nominal has been described as a procedure similar to an apically
exposure of 1-3 mm of the gingiva from the apical repositioned flap with ostectomy/osteoplasty.13 The
extent of the free gingival margin to the inferior lengthening procedure is indicated to provide tooth
border of the upper lip is exposed. length for caries removal, restoration of the tooth with-
out violating the biologic width, restoration retention
3 Low lipline – only a portion of the teeth are exposed and aesthetics.14
below the inferior border of the upper lip.
The biologic width
The teeth are exposed in their entirety as well as
the interdental gingival tissue and the border of the In 1961 Gargiulo et al studied human cadavers
free gingiva around the cervical area of the tooth.8 to study the dimensions of the normal dentogingival
unit.15 The dentogingival complex comprises of the
Horizontal and vertical reference lines of the face: connective tissue fibrous attachment, the junctional
Most clinicians have the tendency to focus on the epithelium/ epithelial attachment and the gingival
defect, but when evaluating aesthetic problems, the
clinician needs to widen the focus, studying first the
proportions of the face9, how these proportions relate
to the smile and how the lip line relates to the teeth
and the mucogingival complex.7 The “perioaesthetic”10
defect should then be evaluated. In an aesthetic analysis
of the dentogingival complex, the midline of the face,
the position of the incisal edges and the gingival line
are important landmarks. The gingival line is defined
as the tangent running through the height of contours
of the maxillary central incisors and canines, ideally
should be parallel to the bipupillary line and the incisal
• Vertical lines can be drawn from the pupil of the
edges. Additionally, the papilla between the maxillary
eye to the corners of the mouth
central incisors should coincide with the midline of the
face.9 • The face can also be horizontally divided into thirds
as can be seen by line.11
Root coverage techniques
Currently numerous surgical techniques are proposed for root coverage
1 Pedicle soft tissue grafts 2 Free soft tissue grafts 3 Additive treatments
A) Rotational flaps A) Non-submerged graft A) Root surface modification agents
- Laterally positioned flaps - One stage (free gingival graft) A) Enamel matrix proteins
- Double papilla flaps - Two stage (free gingival graft + cor- B) Guided tissue regeneration
onally positioned graft)
B) Advanced flaps B) Submerged graft -Non-resorbable membrane barriers
- Coronally repositioned flap - Connective tissue graft + laterally - Resorbable membrane barriers
positioned flap
- Semilunar flap - Connective tissue graft + double
papilla flap
- Connective tissue graft + coronally
positioned graft (Subepithelial con-
nective tissue graft)
- Envelope techniques
Pakistan Oral & Dental Journal Vol 35, No. 1 (March 2015) 92
Periodontal approach to esthetic dentistry
Pakistan Oral & Dental Journal Vol 35, No. 1 (March 2015) 93
Periodontal approach to esthetic dentistry
procedure involves not exactly the manipulation of Any treatment intended for ablation of melanin
the papilla but it also involves orthodontic forces or should be non-scarring, safe and easy to handle, leave
prosthesis placement so as to move the contact point no melanin remnants and carry a low risk of repigmen-
more apically to close the gingival black hole. tation.47
Pakistan Oral & Dental Journal Vol 35, No. 1 (March 2015) 94
Periodontal approach to esthetic dentistry
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