International Journal of Esthetic Dentistry (EN), 02/2022

The replacement of a single tooth can be achieved through multiple restorative alternatives. Resin-bonded fixed restorations are the most conservative option if dental implant placement is not possible or is contraindicated. Over the years, an increase in knowledge and the improvement of materials and technologies have enriched many aspects of this technique. According to the literature, single-retainer all-ceramic cantilevered restorations made either from zirconia or lithium disilicate have shown long-term success. The present article describes the updated, scientifically validated protocols of this technique with a particular focus on framework design and adhesive procedures, including a clinical report with a 6-year recall of maxillary lateral incisor agenesia that was managed with a single-retainer lithium disilicate fixed restoration.

There is an ever-increasing patient demand for an esthetic and ultraconservative approach in the restoration of anterior teeth. No-prep veneers are one of the most conservative methods of rehabilitation in esthetic dentistry. To implement the no-prep veneer technique successfully, it is essential to adhere to an analytical treatment concept. In the present case report, despite the fact that some of the veneers were very thin, they could be designed in a nature-identical manner in terms of light dynamics and color. The laboratory technique presented in this article opens up the possibility of modifying and harmonizing tooth shapes and gingival margin contours, and makes it possible to position the prosthetic termination line at different levels without affecting the marginal and interproximal adaptation of the restoration.

Carious lesions with deep margins represent a challenge in daily clinical practice. The following key points are discussed in this article: how to manage a deep margin from a restorative point of view; when and how to perform a surgical procedure; and when it is favorable to carry out definitive restoration work after surgery. The restorative materials and adhesive procedures available today allow minimally invasive techniques to be used on dental tissue with a high preservation of tooth structure. These materials and techniques help to avoid adverse periodontal tissue reactions. Depending on the clinical situation, three treatment options are available when dealing with a subgingival margin. If the depth of the cavity margin is at a maximum distance of 1.5 mm below the gingival margin, isolation with rubber dam allows the performance of interproximal margin relocation, thereby 
facilitating optimal restoration and periodontal tissue integration. If the margin is located deeper than 1.5 mm below the gingival margin, surgery is necessary before any restorative work can take place. When the margin is within 2 mm above the bone crest, a supracrestal tissue esthetic management (STEM) procedure is undertaken, which means that no ostectomy is required and only osteoplasty is necessary to reshape the preexisting supracrestal attachment, thereby allowing the restorative work to proceed. When the margin is less than 2 mm above the bone crest, crown lengthening with minimal ostectomy and subsequent osteoplasty becomes necessary.

Aim: The objective of the present case series was to propose a modified technique for esthetic crown lengthening surgery (ECLS) and a new method for categorizing esthetic parameters in terms of the gingival tissue as well as to assess treatment outcomes after 6 months. Materials and methods: Patients seeking ECLS were enrolled according to inclusion and exclusion criteria that are decribed in the materials and methods criteria. Digital photographs were obtained at baseline and at 6 months postsurgery. Soft tissue cone beam computed tomography (ST-CBCT) was performed at baseline, and the dimensions of the periodontal tissue were digitally measured. All patients were submitted to the modified ECLS. Periodontal esthetic outcomes were evaluated according to the crown lengthening esthetic score (CLES) system. The mean CLES and its subdomains (gingival zenith [GZ], papillae, and gingival recession [GR]) were compared at baseline and 6 months using the paired t test and the Wilcoxon signed-rank test. Results: Fifteen patients were assessed. At 6 months, the mean CLES (15.23 ± 2.49 to 20.30 ± 2.65), GZ (4.80 ± 1.17 to 7.28 ± 1.97), and papillae (4.62 ± 2.30 to 7.30 ± 0.95) presented statistically significant differences compared with baseline. GR did not present significant changes at 6 months. Conclusions: The modified ECLS technique effectively improved esthetic periodontal parameters in the present case series. The CLES system may be a useful tool for assessing ECLS outcomes.

Objective: Advanced peri-implantitis treatment is a clinical challenge. Reconstructive surgery is not suggested in defects with limited bony walls and/or in those with a suprabony defect. All studies of peri-implantitis reconstructive surgery have considered a marginal surgical approach. However, in the present case report, a new apical approach is presented for the reconstruction of an advanced peri-implantitis lesion. Materials and method: First, a non-surgical phase combines prosthetic, mechanical, and chemical strategies. Second, a surgical phase combines the apical nonincised papillae surgical approach (NIPSA) with biomaterials and a connective tissue graft. Conclusion: Successful results have been obtained when using a NIPSA for the treatment of peri-implantitis, despite the unfavorable characteristics of the peri-implant defect.

Objective: Excessive gingival display (‘gummy smile’) is often an esthetic concern for the patient. There is a difference in perception of smile esthetics between dentists and laypersons. Understanding what is acceptable to laypersons is critical to achieve patient satisfaction in terms of smile esthetics. The present study aimed to identify the ideal and acceptable range of excessive gingival display as defined by laypersons. Materials and methods: A systematic English language literature search was carried out in the following electronic bibliographic databases: PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, and EMBASE, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the articles was assessed using the AXIS tool as well as 11 additional criteria that were specifically designed for the study. Results: Out of the 1263 potentially eligible articles selected in the initial search, 34 were included in the final review. A total of 16 articles identified both the ideal values and the range of acceptance of excessive gingival display, 10 only the range of acceptance, and 8 only the ideal values. From the pooled sample, the mean threshold of acceptance was -0.84 ± 1.43 mm, the range of acceptance was +3 to -2.7 mm, and the median was 0.0 mm. Conclusion: The present study concluded that laypersons considered minimal gingival exposure (GE) or minimal tooth coverage (TC) to be the most esthetic. However, a smile falling in the range of 3 mm of GE to 2.7 mm of TC was considered acceptable. Knowledge of laypersons’ threshold of acceptance of excessive gingival display can guide clinicians in evidence-based dental esthetic treatments.