Managing Excessive Gingival Display Using a Digital Workflow

The relevance of intraoral scanner (IOS) for periodontal diagnosis: a scoping review

OBJECTIVES

The aim of this scoping review was to map the literature on the application and relevance of intraoral scanners (IOS) in periodontal diagnosis.

DATA

Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, and the protocol was registered on the PROSPERO platform under identification number CRD42024541948.

SOURCES

An electronic search covering the past 10 years was conducted in the PubMed/Medline, Web of Science, and Embase databases in September 2023 and updated on September 30 2024.

STUDY SELECTION

The search identified 524 articles, of which 52 were included in the review. These studies, with varying levels of evidence (6 RCTs, 21 interventional studies, 10 cross-sectional studies, 2 retrospective studies, and 13 case reports) covered various applications of IOS for periodontal diagnosis, including exclusive use in periodontology as well as the transversal application of IOS in other dental disciplines. The TRIOS camera was the most common type of IOS in the studies, featuring in 54% of publications. Intraoral scanners were found to be highly accurate in measuring gingival thickness, when combined with CBCT, and keratinized tissue height. According to the studies, plaque detection and probing depth were evaluated with limited success due to examination bias. Software analysis enhanced the interpretation of IOS data, although limitations related to scanning protocols and the visualization of posterior and proximal areas were noted.

CONCLUSIONS

Within the limitations of this scoping review, IOS represents a promising approach in the field of periodontology. As technological advancements continue, IOS should play an increasingly significant role in diagnostic procedures. Integrating intraoral scanning with traditional clinical methods could enhance diagnostic accuracy and contribute to more effective patient management in the future.

Comparative analysis of the trueness of linear measurements using direct and indirect scanning protocols compared to actual clinical measurements

OBJECTIVES

To assess the trueness of digital measurements using direct and indirect scanning approaches compared to the actual clinical measurements.

MATERIALS AND METHODS

The crown length, width, and width/length ratio were measured in 36 anterior maxillary teeth using three different methods. The first was clinically using a digital caliper, the second was by scanning the teeth using a digital scanner and the third was by making an impression of the teeth, constructing a stone cast in the lab, and scanning it to obtain digital measurements. Bland-Altman test and intraclass correlation were used to assess the data and make comparisons.

RESULTS

Measurements taken using both approaches were highly reliable, with intraclass correlations ranging from 0.934 to 0.977 (p ≤ 0.000). Bland-Altman plot reflected a minimal mean difference between measurements especially in crown width measurements. Crown width/crown length measurement displayed the highest mean difference.

CONCLUSIONS

Both direct and indirect optical surface scans showed similar high trueness in linear measurements of teeth. A higher discrepancy was detected in the crown width/length ratio.

CLINICAL SIGNIFICANCE

Digital dentistry is the new era in patient management. The use of conventional impression techniques and physical dental casts is associated with several disadvantages. Scanning dental casts to convert physical records into digital ones has multiple advantages. Optical surface scans (digital models) of the dentition are currently being more broadly used and advocated in the different dental disciplines including the construction of surgical guides for esthetic crown lengthening procedures. The trueness and reliability of linear measurements are of paramount importance to allow for proper fit and predictable outcomes. In this study, the trueness of these linear measurements obtained using direct and indirect methods was compared to the actual clinical measurements.

Digital Smile Makeover: A Multidisciplinary Team Approach

Aesthetics is a fundamental part of contemporary dental practice. A pleasant smile depends on the gingival tissue architecture and dental characteristics. Excessive gingival display (gummy smile) is considered an unattractive smile and can affect a person's confidence. There are many etiological factors related to a gummy smile. Aesthetic rehabilitation of these cases often requires an interdisciplinary approach and close collaboration between dental specialties. This article describes an approach to excessive gingival display management caused by short teeth and hyperactive lips using a digital workflow for crown lengthening. A digital approach enables predictable planning and decreases the need for postsurgical modifications, thus shortening the treatment duration. Computer software is used for planning and 3D-printed guide for crown lengthening and implant placement. Two months later, lip repositioning was performed to reduce the hyperactive lip. After 4 months, prosthetic treatment and Botox injections were done to restore an aesthetic smile.

Diagnostic Applications of Intraoral Scanners: A Systematic Review

In addition to their recognized value for obtaining 3D digital dental models, intraoral scanners (IOSs) have recently been proven to be promising tools for oral health diagnostics. In this work, the most recent literature on IOSs was reviewed with a focus on their applications as detection systems of oral cavity pathologies. Those applications of IOSs falling in the general area of detection systems for oral health diagnostics (e.g., caries, dental wear, periodontal diseases, oral cancer) were included, while excluding those works mainly focused on 3D dental model reconstruction for implantology, orthodontics, or prosthodontics. Three major scientific databases, namely Scopus, PubMed, and Web of Science, were searched and explored by three independent reviewers. The synthesis and analysis of the studies was carried out by considering the type and technical features of the IOS, the study objectives, and the specific diagnostic applications. From the synthesis of the twenty-five included studies, the main diagnostic fields where IOS technology applies were highlighted, ranging from the detection of tooth wear and caries to the diagnosis of plaques, periodontal defects, and other complications. This shows how additional diagnostic information can be obtained by combining the IOS technology with other radiographic techniques. Despite some promising results, the clinical evidence regarding the use of IOSs as oral health probes is still limited, and further efforts are needed to validate the diagnostic potential of IOSs over conventional tools.

A stereolithographic template for computer-assisted teeth preparation in dental esthetic ceramic veneer treatment

OBJECTIVE

This article describes a digital dental esthetic ceramic veneer treatment workflow using a stereolithographic template for teeth preparation.

CLINICAL CONSIDERATIONS

We have presented the case of a 33-year-old woman with dental fluorosis who wanted an esthetic ceramic veneer treatment. A digital smile design was created on a virtual patient, and a virtual diagnostic wax-up was made. Based on the suggested ceramic material thickness, virtual teeth preparation was performed on the diagnostic wax-up. A special-teeth preparation template was then created digitally and fabricated using a stereolithographic technique. This template guided the teeth preparation using a special bur with a stopper. The veneers were fabricated by CAD/CAM and delivered good esthetics and function.

CONCLUSIONS

The stereolithographic tooth reduction template helps realize digital restorative planning. It provides better control of the reduction depth of the labial and incisal preparation, making the operation simpler.

CLINICAL SIGNIFICANCE

The digital dental esthetic ceramic veneer treatment workflow described here using a stereolithographic template for teeth preparation helped with the accurate control of reduction depth for minimally invasive teeth preparation, making the operation simpler, which is a significant improvement over the previous methods.