Upper lip characteristics and associated excessive gingival display etiologies in adults: Race and sex differences

BACKGROUND

This cross-sectional study aimed to examine upper lip (UL) and smile characteristics and soft tissue excessive gingival display (EGD) etiologies (hypermobile upper lip [HUL], altered passive eruption [APE], and short upper lip [SUL]) in a nondental adult population and to analyze interracial (Black and White) and intersex differences.

METHODS

Community participants, non-Hispanic Blacks (NHB) and non-Hispanic Whites (NHW), were recruited and examined for UL vertical dimensions at rest and maximum smile and for HUL, APE, and SUL. Associations between gingival display (GD) or EGD and UL anatomical characteristics, HUL, APE, and SUL were analyzed.

RESULTS

Participants included 66 NHB and 65 NHW adults. Ergotrid height (greater among NHW; p = 0.019) averaged 14.0 mm. Upper lip vermilion length (ULVL), total UL length, internal lip length, total UL length during smile, and UL mobility averaged 8.6, 22.5, 23.1, 16.6, and 5.9 mm, respectively (all significantly greater in NHB; p ≤ 0.012). SUL prevalence was 4.6%, found only among NHW. Lip length change from rest to smile (LLC) averaged 26.2% (significantly greater in females; p = 0.003). HUL prevalence was 10.7% (NHB 13.1%, NHW 3.5%; p = 0.024). NHB had significantly greater GD (p ≤ 0.017). EGD and APE prevalence (6.9% for both) showed significant interracial and intersex differences (p ≤ 0.014). Multivariate logistic regression analyses indicated that LLC and HUL were the most consistently significant EGD determinants.

CONCLUSIONS

UL anatomical and functional characteristics and soft tissue-related EGD etiologies exhibit significant interracial and intersex differences, with UL mobility/hypermobility being the most consistently significant determinant of GD.

Colour stability of 3D-Printed orthodontic brackets using filled resins

OBJECTIVE

To determine the effect of common beverages and accelerated aging on the colour stability of filled resins, which could potentially be used for fabrication of 3D-printed orthodontic brackets.

MATERIALS AND METHODS

GR-17.1 (shades A1, A2, and A3), and GR-10 Guide resins (pro3dure medical, Eden Prairie, MN) were printed on an Asiga MAX UV printer into discs 2 mm thick, with a diameter of 10 mm, and then post-print processed as per manufacturer's instructions. Discs were immersed in 5 mL of coffee, tea, red wine, or distilled water for 7 days. Another group was subjected to accelerated aging in accordance with ISO Standard 4892-2. Ten samples were produced per resin, per treatment condition. Colour measurements were taken on the discs before and after treatment using a spectrophotometer against white and black reference tiles to assess colour and translucency differences with the CIEDE2000 colour difference formula.

RESULTS

While initial colour of the printed resin discs was acceptable, all resin groups underwent significant colour change during the experiment. Red wine and coffee produced the greatest colour and translucency change, followed by tea, with accelerated aging producing the least change in colour and translucency.

CONCLUSION

The 3D-printed resins tested underwent significant changes in colour and translucency following exposure to endogenous and exogenous sources of staining, which may affect their acceptability for fabrication of aesthetic orthodontic brackets.

Acellular dermal matrix for the treatment of multiple gingival recession defects associated with carious and previously-restored cervical lesions: a case report with 10 years of follow-up

INTRODUCTION

Limited evidence exists on the outcome of the modified coronally advanced tunnel (MCAT) with acellular dermal matrix (ADM) for the treatment of gingival recession defects (GRD) especially when complicated by restored cervical lesions. Therefore, the aim of this case report was to assess the short- and long-term clinical outcomes of maxillary Type 1 recession defects (RT1) associated with restored cervical lesions treated with MCAT with ADM.

CASE PRESENTATION

A 43-year-old female patient, presented with multiple adjacent RT1 recessions in the left maxilla, previously treated with overhanging cervical resin restorations. The case was approached with a careful evaluation of the diagnostic determinants of root coverage, removal of the aberrant resin restorations, treatment with MCAT with ADM, and periodical evaluation over a follow-up of 10 years. The treatment was followed by complete root coverage, improvement of gingival phenotype and perfect root coverage esthetic score. Outcomes were periodically assessed, and were maintained over 10 years of follow-up.

CONCLUSION

MCAT with ADM is an effective technique for the treatment of multiple GRD complicated by cervical restorations. Complete root coverage and excellent esthetic outcomes were obtained and maintained in the long term. This article is protected by copyright. All rights reserved One-sentence summary: Complete root coverage was obtained and maintained over 10 years with modified coronally advanced tunneling and acellular dermal matrix for treatment of multiple gingival recessions with cervical restorations.

Long-term evaluation (up to 7 years) of the use of a collagen matrix to treat gingival recession associated with noncarious cervical lesion: Report of two cases

INTRODUCTION

Gingival recession (GR) is a relevant clinical condition due to its high prevalence worldwide, which leads to aesthetic demands and dentin hypersensitivity. Collagen matrices have been associated with different designs of coronally advanced flaps (CAFs) to treat GR defects. However, the literature lacks long-term follow-up of this treatment option. The aim of this study is to present the long-term follow-up (up to 7 years) of two GR defects (associated or not with noncarious cervical lesion) treated with a CAF and a collagen matrix (CM).

CASE PRESENTATION

Case 1 underwent a CAF associated with a CM to treat a single GR defect. After 7 years, Case 1 presented with 3 mm of recession reduction, which corresponds with the 85.7% of root coverage. Case 2 presented two GR defects associated with noncarious cervical lesions (NCCLs). The NCCLs were partially restored with resin composite and then underwent a modified CAF for multiple defects and a CM. After 5 years of follow-up, Case 2 presented with 1.5 and 2.5 mm of recession reduction, which corresponds with the average 83.3% defect coverage.

CONCLUSION

These two cases may show that CMs can provide long-term stable outcomes in the treatment of GR defects. Why is this case new information? One of the cases is the first one to describe a 7 years of follow-up after CAF+CM to treat gingival recession defects. What are the keys to successful management of this case? Correct material handling. Adequate restorative protocol and surgical technique. What are the primary limitations to success in this case? Diagnose Patient compliance.

Do non-clinical subjective factors influence the treatment decisionmaking of Brazilian dentists?

The literature contains little information on several non-clinical factors such as the association between graduate residency programs and the application of minimally invasive dentistry, or on dentists' clinical decision-making processes for replacing restorations for esthetic reasons. This study evaluated whether non-clinical subjective factors influence the treatment decisions made by Brazilian dentists regarding technical and esthetic matters. Dentists were invited to participate in a cross-sectional survey by answering an electronic questionnaire containing clinical cases, regarding what treatment they would select for: T1 - a molar tooth with significant crown destruction and spontaneous pain, and T2 - premolar teeth with extensive amalgam restorations and no carious lesion or associated complaint. The survey also included questions about subjective variants (sociodemographic and professional). Chi Square test and Fischer's Exact test were used toanalyzetheanswers to T1, and one-factor analysis of variance and post-hoc Tamhane were applied to T2. The significance level was set at 5% for all analyses. A total 302 professionals participated in the study. For T1, it was found that clinical decision-making was influenced by the Brazilian region of clinical practice (p=0.005). For T2, a significant association was found between increased loss of patient tooth tissues and whether the professional had completed a residency program in Operative Dentistry (p=0.035), worked in a private practice (p=0.033), or if most of his/her patients belonged to a high estimated socioeconomic level (household income above $4350) (p=0.002). In conclusion, the clinical decision-making of Brazilian dentists varies according to professional profile, mainly with relation to the replacement of restorations due to esthetic concerns.

Efficacy of a harvest graft substitute for recession coverage and soft tissue volume augmentation: A randomized controlled trial

BACKGROUND

The autogenous connective tissue graft (CTG) with coronally advanced flap (CTG+CAF) is the "gold standard" for recession defect coverage; however, researchers continue to pursue lower morbidity, more convenient and unlimited supply harvest graft substitutes, including those that could provide soft tissue volume augmentation.

METHODS

A randomized, controlled, double-masked comparison of a volume-stable collagen matrix (VCMX) versus CTG was conducted at four clinical investigation sites. Single, contralateral, within patient matched-pair, RT1 recession defects were treated with VCMX+CAF (test) and CTG+CAF (control). The primary efficacy end point was percent root coverage at 6 months. Secondary efficacy end points included clinical measures such as soft tissue volume, attachment level, and keratinized tissue width. Patient-reported outcomes included measures such as discomfort, esthetics, and overall satisfaction; 6-month end point results were followed for 1 year.

RESULTS

Thirty patients received control and test therapies, and all patients were available for follow-up measures. Average percent root coverage for CTG+CAF was 90.5% ± 14.87% versus 70.7% ± 28.26% for VCMX+CAF, P <0.0001. Both therapies produced significant soft tissue volume increases (84.8 ± 47.43 mm² control versus 48.90 ± 35.58 mm² test, P = 0.0006). The test, harvest graft substitute produced less postoperative pain and was preferred by patients at the 6-month end point. All other end point measures were not significantly different.

CONCLUSIONS

VCMX+CAF root coverage was inferior to CTG+CAF but produced less morbidity and was preferred by patients. Case/patient selection and surgical technique appear key to achieving successful results with the harvest graft alternative.

Randomized clinical trial evaluating single maxillary gingival recession treatment with connective tissue graft and tunnel or trapezoidal flap: 2-year follow-up

BACKGROUND

The literature lacks long-term evidence regarding outcomes of the coronally advanced tunnel flap (TUN) combined with connective tissue graft (CTG) when compared to the trapezoidal coronally advanced flap (CAF) and CTG combination. This study presents 2-year results of a randomized clinical trial comparing CTG combined with either CAF or TUN in the treatment of single maxillary gingival recession (GR) defects.

METHODS

Thirty-nine patients, each contributing a single Miller Class I or II GR defect, were treated by CAF+CTG (control; n = 19) or TUN+CTG (test; n = 20) and completed the 2-year follow up. Clinical, patient centered, and esthetic evaluations were performed and differences among groups were analyzed.

RESULTS

At 2 years, mean root coverage for control and test group was 89.5% ± 14.6% and 87.7% ± 18.4%, respectively (P = 0.5). The corresponding complete root coverage prevalence was 68.4% and 50% (P = 0.4). Dentin hypersensitivity significantly decreased for both groups. The two groups showed improvement in esthetics, as assessed by both professionals and patients, without significant intergroup differences (P > 0.5). TUN+CTG sites were much more likely to present improvement in root coverage between 6 months and 2 years, exhibiting creeping attachment of 0.7 ± 0.6 mm.

CONCLUSIONS

At 2 years of follow up, both CAF+CTG and TUN+CTG resulted in significant clinical and esthetic improvements and provided similar results in the treatment of single maxillary GRs.

Lip repositioning with or without myotomy: A randomized clinical trial

BACKGROUND

Lip repositioning is a conservative surgical method for the correction of excess gingival display (EGD) by limiting the upward retraction of the lips. Lip repositioning presents a simple method for the treatment of gummy smile. The aim of this randomized clinical trial (RCT) was to assess lip repositioning, compared to lip repositioning with muscle severance for efficacy in treatment of EGD and resultant stability.

METHODS

A single-blinded, controlled, parallel-group RCT was performed. Twenty patients with EGD were enrolled in the study, treated with lip repositioning with and without muscle severance. Participants were assessed for EGD reduction, changes in lip length and result stability at 3, 6 and 12 months. Additionally, pain, swelling and satisfaction, were assessed.

RESULTS

Classic lip repositioning was found capable of reducing EGD by 2.73 mm (SD ± 1.281), while lip repositioning with muscle severance offered an improved reduction in EGD with a mean reduction of 3.57mm (SD ± 1.62). Lip length, swelling and pain scores were found comparable between the two techniques.

CONCLUSION

Lip repositioning is an effective method for treating EGD, however, muscle severance provides a more stable result at 12 months when compared to the classical technique. More studies are necessary to fully assess this procedure.

Treatment of Gummy Smile of Multifactorial Etiology: A Case Report

INTRODUCTION

This case report describes the management of a patient diagnosed with excessive gingival display caused by altered passive eruption and hyperactive lip. Treatment for this patient was staged and included esthetic crown lengthening and a subsequent lip repositioning procedure.

CASE PRESENTATION

A 17-year-old female was referred for assessment of a "gummy smile." The patient reported a history of mouth breathing and a sports injury causing a non-vital tooth #9, which had been temporarily restored. After periodontal evaluation, the patient was diagnosed with plaque-induced gingivitis and excessive gingival display due to hyperactive lip and altered passive eruption. After initial therapy, an esthetic crown lengthening procedure was performed on the maxillary anterior sextant, resulting in ideal maxillary anterior crown contours. Six weeks after esthetic crown lengthening, the patient was treated for hyperactive lip by a modified lip repositioning surgery. Subsequently, the patient received a permanent restoration on tooth #9. During the 1.5-year follow-up time the patient repeatedly expressed her satisfaction with the improvement of her smile. Persistent mouth breathing and associated recurrent gingival inflammation remained a challenge.

CONCLUSIONS

The presented case illustrates results of sequentially applied techniques for management of a gummy smile of multifactorial etiology and limitations imposed by unresolved factors. Excessive gingival display can be a significant esthetic concern for patients. Understanding the etiology can be challenging due to multiple factors that may be concomitantly involved. Accurate diagnosis and treatment planning are critical for proper management. When multifactorial etiology is present, multiple treatment modalities, including various surgical approaches, are necessary to obtain positive outcomes in such patients.

Implant Site Development by Orthodontic Forced Eruption for Esthetic Restoration of Adjacent Implants

INTRODUCTION

Despite recent advancements in ridge preservation techniques, complete tissue regeneration remains difficult to achieve when managing multiple tooth loss in the esthetic zone. Guided bone regeneration has been shown to be effective in creating sufficient bone support, but post-surgical complications including soft tissue deficiencies have been reported. Obtaining "natural" esthetic results has proven challenging, especially when restoring adjacent implants in patients with a high smile line. The addition of extrusion and palatal positioning of the implant facilitates ridge preservation surgery as well as the esthetic outcome, but requires an additional treatment phase devoted to orthodontics.

CASE PRESENTATION

A healthy 43-year-old female with a longstanding history of smoking presented with terminal periodontal disease on teeth #7 and #8 together with a wide diastema between teeth #8 and #9. Comprehensive dental treatment included smoking cessation, oral hygiene instruction, full-mouth scaling and root planing, orthodontic realignment, and implant placement to manage those teeth with a hopeless prognosis. Orthodontic therapy included forced eruption of teeth #7 and #8 to create optimum implant receptor sites. One year after prosthetic restoration, interproximal papillae height proved stable and similar to the contralateral side.

CONCLUSION

A multidisciplinary approach proved beneficial in achieving an improved esthetic outcome in a challenging situation in implant therapy.

Immediate Single-Tooth Implant Placement in Bony Defects in the Esthetic Zone: A 1-Year Randomized Controlled Trial

BACKGROUND

This study aims to assess, with regard to marginal bone level (MBL), whether the outcome of immediate implant placement in bony defects in the esthetic zone was non-inferior to delayed implant placement after 1 year.

METHODS

Forty patients with a failing tooth in the esthetic zone and a labial bony defect of ≥5 mm after removal of a tooth were randomly assigned for immediate (n = 20) or delayed (n = 20) implant placement. Second-stage surgery and provisionalization occurred after 3 months of healing. Follow-up was at 1 month and 1 year after definitive crown placement. The study was powered to detect a difference in MBL of >0.9 mm. Buccal bone thickness, soft tissue peri-implant parameters, esthetic indices, and patient satisfaction were also assessed.

RESULTS

One year after definitive crown placement, MBL loss was 0.56 ± 0.39 mm mesially and 0.74 ± 0.51 mm distally for the immediate placement group and 0.51 ± 0.43 mesially and 0.54 ± 0.45 distally mm for the delayed placement group, respectively (not significant). Regarding differences in means, non-inferiority was observed after 1 year (difference in mean for immediate versus delayed: mesially 0.04 mm [95% confidence interval (CI) = -0.22 to 0.30 mm, P = 0.40]; distally 0.21 mm [95% CI = -0.10 to 0.51 mm, P = 0.58]). No significant differences in the other outcome variables were observed.

CONCLUSIONS

Immediate implant placement with delayed provisionalization was non-inferior to delayed implant placement with delayed provisionalization in labial bony defects of ≥5 mm regarding change in MBL. Although not powered for other outcome variables, no clinically relevant differences were observed in these variables.

Rebuilding Anterior Dental Esthetics: Interdisciplinary Treatment of an Iatrogenically Induced Marginal Tissue Recession

INTRODUCTION

Root canal perforation during endodontic therapy is one of the most commonly encountered clinical situations that necessitates interdisciplinary therapy.

CASE PRESENTATION

This case report presents the use of periodontal and prosthodontic teamwork to treat severely deteriorated anterior esthetics caused by an iatrogenically induced marginal tissue recession defect.

CONCLUSION

In the case of deterioration of anterior dental esthetics, an interdisciplinary approach can successfully restore both esthetics and function, as observed in this case report.

A Novel Method to Cover Metal Display in Implants Using a Modified Free Gingival Graft: A Case Report

INTRODUCTION

Correction of an esthetic failure in the anterior esthetic zone is difficult, especially after placement of the final restoration. This case report describes a novel technique to cover metal display with a graft that combines the advantages of the free gingival and the subepithelial connective tissue grafts.

CASE PRESENTATION

A patient presented to the author's private practice with marked metal display leading to compromised esthetics. To cover the metal display, it was decided to increase the amount of soft tissue surrounding the implant. A free gingival graft was obtained from the palate with two de-epithelialized extensions to ensure adequate blood supply and excellent color match. The graft was adapted to the recipient site, which included a previously prepared bed and two pouches. The pouches accommodated the de-epithelialized extensions. The clinical outcome exhibited superior results in both volume and quality of the gained soft tissue.

CONCLUSION

The technique described in this case report could be considered as a method to cover metal display in the esthetic zone to improve the volume and quality of the tissue.