International Journal of Esthetic Dentistry (EN), 01/2022

Background and aim: The coronally advanced flap (CAF) and the tunnel technique (TUN) are the most performed surgical approaches for treating gingival recessions (GRs). Nonetheless, these two approaches have commonly been regarded as substitutes for one another, and clinicians are often faced with the choice of performing only one during root coverage procedures. The aim of the present article is to describe a surgical design in which the benefits of both the CAF and the TUN are combined for the treatment of isolated type 2 (RT2) GRs with deficient papilla. Materials and methods: Ten patients with isolated RT2 GRs were treated using the tunneled coronally advanced flap (TCAF) + connective tissue graft (CTG) technique. Results: The healing was uneventful, and patients consistently reported minimal discomfort. After 6 months, the TCAF + CTG resulted in an average mean root coverage of 86.5%, with six sites showing complete root coverage (60%). The mean increases in keratinized tissue width and gingival thickness were 1.40 and 0.92 mm, respectively. All the treated GRs showed an increased soft tissue phenotype. No significant changes were observed for midfacial probing depth, while a mean midfacial clinical attachment level gain of 3.05 mm was obtained after 6 months. The professional esthetic evaluation, according to the root coverage esthetic score, was 7.90 ± 1.66. Conclusions: The present article suggests that the TCAF + CTG is a suitable technique for treating isolated RT2 GRs. The newly introduced technique may have the potential to enhance flap blood supply and graft vascularization and improve clinical-, esthetic-, and patient-reported outcomes of RT2 GRs with deficient papilla. Future studies with larger sample sizes and comparative groups are needed to support these preliminary results.

Connective tissue graft (CTG) surgery has been performed since the 1980s with the principal aim of root coverage. Various types of CTG surgery have been reported, not only for root coverage but also as a preprosthetic treatment for the prevention of gingival recession and to alleviate gingival discoloration. Although there have been numerous reports on the prognosis of such treatment, few observational case reports of 10 years or more have been published. The present article reports on five patients who were monitored from between 13 to 23 years after CTG surgery through the use of intraoral findings, CBCT, and histologic evaluation. The hypothesis of the present authors is that growth factors are released gradually from connective tissue placed either above or below the periosteum. Furthermore, stimulated by the optimal occlusion of the natural teeth, osteoblasts present on the periosteum and/or alveolar bone surrounding the teeth are stimulated. Similarly, the connective tissue itself ensures that the soft tissue has a certain biologic width. At the same time, it acts as a scaffold, resulting in the tissue being replaced by bone.

The esthetic success of a case requiring implant therapy mainly depends on both the correct planning and the surgical-prosthetic execution. However, planning and surgical implementation according to prosthetically guided criteria are not always possible due to contingent anatomical limitations. When this is further complicated by the presence of mucogingival deficiencies in a highly visible esthetic area, the management of the case can become very complex. The present case report describes the presurgical and surgical management of a case of maxillary lateral incisor agenesis in the absence of sufficient vertical space. Through orthodontic therapy, the opening of the deep overbite and the alignment of the maxillary and mandibular arches were obtained, allowing for an implant positioning without compromises dictated by anatomical limitations. Finally, through mucogingival surgery and careful management of the provisional prosthetic phase, an optimal esthetic profile was achieved.

The present case series aimed to evaluate the use of a Digital Smile Design (DSD) and mock-up technique for esthetic crown lengthening (ECL) surgery in six clinical cases with a 2-year follow-up. Six nonsmoker patients (five females, one male; aged 22 to 32 years), periodontally and systemically healthy, with inadequate tooth width/height ratio proportions associated with a gingival misalignment in the anterior maxilla were included. The DSDs were created using PowerPoint for all patients to evaluate gingival level and tooth form/contour. A wax-up and mock-up were created based on the DSD measurements. ECL surgeries were performed in all cases using the mock-up technique to determine the final gingival margin position and the amount of bone resection needed. A mock-up to bone crest distance of 3 mm was obtained in all cases. Using patient photographs, comparisons were made between the dental crown length (DCL) measurements obtained before the surgical procedure (baseline; T0), on the DSD template immediately postoperatively (IPO; T1), and at the 2-year follow-up (T2). A DCL augmentation of 1.16 ± 0.68 mm was obtained at T1, with an augmentation of 1.03 ± 0.73 mm at T2. Moreover, a minimal difference of 0.34 ± 0.74 mm between the DCL planned in the DSD template and the DCL obtained IPO was observed. In conclusion, the ECL procedure based on the DSD concept and mock-up technique proposed in this cases series was a predictable protocol for smile disharmony treatment in all the patients.

The biologically oriented preparation technique (BOPT) has revolutionized the execution of fixed prosthetic treatments, ensuring tissue stability and the integration of the gingival tissue with the prosthetic restorations. BOPT follows both a clinical and laboratory sequence; the two must be perfectly integrated and synchronized, with the phase of preparation and temporary restorations in the clinic correlating with a well-founded and protocolized execution of the laboratory steps. In turn, prosthetic work returned to the clinic must show perfect integration between the prosthesis, the preparation, and the periodontal tissue, with a balance between pink and white esthetics. The clinical case in the present article illustrates the close relationship between the clinical and laboratory steps, including the technical laboratory procedures, that make it possible to achieve these objectives. The aim of the article is to introduce the concept of the prosthetic adaptation profile of new restorations, establishing the definition, importance, and direct relationship of this profile with the success of the rehabilitation treatment.

Purpose: The aim of the present study was to evaluate the facial esthetic perception of dental students, non-dental students, and laypersons with respect to digitally altered profile photographs in the vertical and sagittal dimensions. Materials and methods: Colored profile photographs of a male subject and a female subject were digitally altered in the sagittal and vertical dimensions. Preclinical and clinical dental students, clinical medical students, senior art and engineering students, and laypersons with various occupations were invited to rate the profile photographs and their treatment need by means of a questionnaire created on Google Forms. Results: The study involved 574 participants (378 females, 196 males). Male and female straight normal profiles were found to be the most attractive facial profiles by all groups, followed by convex profiles. Concave profiles were rated as the least attractive and in need of more treatment. No significant difference was observed between the ratings of the preclinical and clinical dental students. The ratings of dental students showed significant differences in terms of esthetic perception compared with the engineering students and laypersons. Regarding the gender of the participants, there were significant differences between males and females. Conclusion: The perception of facial esthetics was influenced by education, and students whose study curriculum was esthetic in nature or clinically based were more critical in their judgment. The gender of the participants significantly influenced their esthetic judgment.

Background: Due to controversial results in relation to the influence of desensitizing agents on sensitivity during bleaching, the present study evaluated the degree of tooth bleaching sensitivity, color change, and patient acceptability of desensitizing agents containing potassium nitrate/sodium fluoride (PNF) or nanostructured calcium phosphate (N) associated with in-office bleaching with 35% hydrogen peroxide (HP). Materials and methods: Seventy-five patients were randomly distributed into three groups (n = 25): 1) Group W – in-office bleaching (Whiteness HP Maxx – three sessions of 45 min); 2) Group WD – associated with PNF desensitizing gel (Desensibilize KF 2%) applied for 10 min before each session; 3) Group WDN – associated with N desensitizing paste (Desensibilize Nano P) applied after bleaching for 5 min. The degree of sensitivity and patient acceptability of the desensitizing treatments were evaluated using a visual analog scale. Color change evaluations were made over different time intervals. Results: The three groups showed no significant difference in sensitivity between the time intervals throughout the evaluation, except for the one of 24 h after the second bleaching session, in which group WD showed lower bleaching sensitivity than group W (P < 0.05; Kruskal-Wallis and Dunn tests). The use of PNF gel and N paste did not interfere with the color change during dental bleaching. Conclusions: Although the use of desensitizing agents during bleaching did not interfere with the color change during dental bleaching, it was shown that these agents were not effective in the treatment of tooth bleaching sensitivity, despite being acceptable to the patients.