International Journal of Esthetic Dentistry (EN), 04/2019

The aim of this article was to evaluate 1 year after surgery a surgical protocol that included gingivectomy and an apically positioned flap plus osseous resective surgery to correct excessive gingival display (EGD) in patients with altered passive eruption (APE) of the maxillary anterior teeth. Six female patients aged 18 to 22 years were diagnosed with APE type 1B. Surgical crown lengthening with flap surgery and bone recontouring was performed to achieve the biologic width. Photographic images were analyzed to evaluate the stable improvement of crown length before the procedure (baseline), immediately after surgery (immediate postoperative), and at 3 and 12 months postsurgery. Moreover, a lip repositioning procedure was also performed in one case to complement the periodontal therapy. Compared with baseline, an increase of 1.6 mm in the mean tooth crown height was observed in the photographic analysis at 12 months. A minimal difference was observed between the mean tooth crown height immediate postoperative and at 12 months, which indicates stability of the gingival margin. In conclusion, the surgical protocol outlined in this article describing esthetic crown lengthening for the treatment of APE/gummy smile resulted in predictable outcomes and stability of the gingival margin 1 year after surgery.

An excessive gingival display, which commonly influences the appearance of the smile and the social behavior of patients, can be the result of various factors, including vertical maxillary excess, alterated passive eruption (APE), and a short or hyperactive upper lip. Surgical stents and guides have been used more frequently in clinical crown lengthening procedures during recent years to promote a higher level of precision and more predictable results. The aim of this article is to describe a novel approach for treating patients with APE who have high esthetic demands.

With the advancement of computer-aided design/computer-aided manufacturing (CAD/CAM) in dentistry, the use of digital technologies is being increasingly adopted by clinicians and laboratory technicians. Clinicians are using intraoral scanners (IOSs) more and more to perform computer-aided impressions. While these are mainly used to digitize dentate or partially edentulous jaws, it is feasible with a few of the available systems to scan edentulous jaws, with or without implants. To scan edentulous jaws, the registration and articulation of patient-relevant references and planes is difficult without the use of physical casts. The present article introduces simple yet effective methods to integrate individual interocclusal information during the intraoral scan procedure. The techniques described aim to simplify the digital registration procedure of edentulous jaws, with or without implants, and integrate patient-relevant information in the virtual articulator without the need to manufacture and articulate casts after the intraoral scan.

Objectives: The aim of this study was to compare the translucency levels of various composite materials that are positioned by their manufacturers as 'dentin,' 'opaque,' 'body,' and 'enamel' in relation to natural tooth tissues. Methods: Sixteen commercial composite materials and 10 natural tooth tissue samples (enamel and dentin) were studied. The differences in color of dried and hydrated samples were measured on a black-and-white background using CIELab coordinates. Analysis of variance (ANOVA) and Kruskal-Wallis tests were used to compare the translucency parameter (TP) values of the different materials (P < 0.05), and t test was used to compare the TP values for the dried and hydrated samples, with the significance set at P < 0.001. Results: The TP values of opaque shades for the studied composite materials ranged from 1.5 to 3.9, and those of enamel shades from 3.9 to 10.9. According to the obtained results, a body shade sample had a high level of translucency, comparable with some enamel shades of the materials studied (TP = 4.489 ± 0.505 after polymerization, and 3.916 ± 0.566 after 48 h of water storage). The translucency levels of dry composite samples and samples after hydration were not significantly different, while significant changes were observed for dentin and enamel (P < 0.05). Significance: Choosing a composite material that is suitable for different clinical situations is a major challenge in everyday dental practice. Information about the relative translucency of various composites on the market and their compliance with natural tissues can help dentists to choose optimal restorative materials.

Direct freehand veneers with composite resin (CR) require high clinician ability and a long chair time. Although CR restorations remain the most-used technique for meeting high esthetic demands, and new technologies mean that materials are nowadays more similar to tooth structure, layering techniques for natural results are still considered difficult to achieve. Through advances in adhesive dentistry, systems of prefabricated veneers using conventional techniques have been launched onto the market as an option for the clinician. This case report presents complete step-by-step descriptions of two techniques using prefabricated templates for directly built-up veneers. Both maxillary lateral incisors were simultaneously reconstructed with direct CR veneers with different layering techniques to achieve esthetic results in a shorter chair time. Simple stratification techniques using prefabricated templates may allow clinicians to optimize both time and clinical outcome while obtaining predictable results.

Introduction: The nasolabial angle (NLA) plays an important role in evaluating a patient's profile and smile appearance. The purpose of this study was to evaluate the changes of the NLA during smile and to correlate those changes with other photographic and cephalometric parameters. Methods: Fifty young adults ranging from 20 to 30 years of age who had been referred to a private dental clinic for orthodontic treatment for normal maxillary position were enrolled. For the purpose of this study, the angular measurements of the NLA and its compartments as well as changes in the vertical position of the nasal tip were collected from photographs taken at rest and during smile, while other parameters were measured from the lateral cephalograms taken with the head in a natural position. Changes in the NLA were then correlated with the cephalometric parameters in order to observe any potential relationships. Results: The NLA and its upper compartment decreased during smile (with a mean of 5.42 and 0.77 degrees, respectively). The NLA and its lower compartment increased, with a mean of 3.97 degrees. The nasal tip significantly dropped down from rest to smile (mean = 1.6 mm, P = 0.002). Significant correlations were found between changes of the NLA and the maxilla projection as well as between changes of the lower part of the NLA and the upper lip curvature. Conclusions: Decreasing the NLA during smile is mainly related to the inherent properties of the soft tissues of the nasolabial area and not to the dental parameters under the control of the orthodontist. Patients should therefore be made aware of this from the beginning of the treatment.

The stability and health of the periodontal tissues should be a common goal for all dental care providers with regard to natural or restored teeth as well as implant-supported restorations or any other type of prosthesis. The objective of this study was to address the key aspects to be respected when executing adhesive oral rehabilitations involving ceramic restorations, regardless of their thickness, and to reinforce the importance of each step to ensure the success and longevity of the treatment from a periodontal standpoint. This article reviews the fundamentals of the periodontics that relate directly or indirectly to adhesive ceramic dental restorations, and also addresses their clinical relevance.