Removable Gingival Mask-a Non-Invasive Cosmetic Alternate

Abstract

Gingiva plays a very essential role in dental aesthetics. Loss of interdental papilla between the teeth not only leads to spaces in between anterior teeth that can be a major aesthetic concern for patients but also functional problems like food impaction, phonetic problem and hyper sensitivity. Gingival mask can be one such alternative treatment when surgical intervention is not opted by the patients.

INTRODUCTION

A major percentage of inquires in a dental clinic is regarding cosmetic treatment. Growing concern with aesthetics has resulted in greater demand on a practicing dentist to focus his or her practice towards aesthetics dentistry. Gingiva plays a very essential role in dental aesthetics. Loss of interdental papilla between the teeth not only leads to spaces in between anterior teeth that can be a major aesthetic concern for patients but also functional problems like food impaction, phonetic problem and hyper sensitivity.

The interdental papilla acts as a biological barrier in protecting the periodontal structures 1. This clinical case reports presents a restorative option for an esthetically compromised patient with uneven interdental spaces in maxillary anterior region. The patient's esthetic expectations were successfully met through a removable heat-polymerized polymethylmethacrylate resin gingival prosthesis.

CASE REPORT

28 year old female patient reported to the dental clinic with the chief complaint of loss of gums between the upper front teeth. On clinical examination there was presence of generalized bleeding on probing, with deep periodontal pockets in relation to 11, 12, 13,14,21,22 and 23 with loss of papilla between the two maxillary central incisors (Fig1).

The patient’s oral hygiene status was found to be poor. Various treatment options were suggested which included surgical and non-surgical. As the patient did not opt for surgical intervention in reconstructing the papilla as it involved surgical costs, discomfort and healing time, a non-surgical, non-invasive, prosthetic option was selected and patients consent was obtained. The treatment involved removable heat-polymerized polymethylmethacrylate resin gingival prosthesis.

A multidisciplinary treatment plan was developed that included oral hygiene instructions, scaling and root planning. The patient was recalled after 1week and the impression of maxillary arch was recorded using custom tray made of autopolymerizing acrylic resin(DPI) and a putty wash impreesion technique was used.A vinyl polysiloxane putty ( Aquasil) impression was made with light body to register the interproximal dental spaces.(Fig 2a,b,c)

The cast was prepared using type II dental stone (Fig 3). This was followed by construction of wax-up try- in on this model (Fig 4).

The prosthesis was extended up to the mesial aspects of first premolars bilaterally considering the patient’s smile line. The prosthesis was processed with a heat- polymerized polymethylmethacrylate resin. The prosthesis was then polished and carefully adjusted with acrylic resin burs (Fig5). The patient was advised to maintain the prosthesis as well as maintain her oral hygiene. The patient readily adapted to the prosthesis. The treatment improved her lip support,eliminated the escape of air through the space thus resulting in improved speech and food impaction(Fig6).

1. Pre-operative

2. Impression

3. Wax up	4. Gingival mask

5. Post-operative

DISCUSSION

Aesthetics is not only limited to hard tissue like teeth but also the soft tissues in and around the teeth. Loss of interdental papilla results in black triangles. Several reasons contribute to the formation of “black triangles” between teeth because of plaque associated lesions leading to the loss of periodontal support, abnormal tooth shape like the highly tapered triangular tooth form, abnormal location and size of interproximal contact, improper contours of prosthetic restorations, traumatic oral hygiene procedures, previous periodontal surgery, post-orthodontic treatment, iatrogenic surgical removal tissue collapse following extraction etc2.

Replacement, with acrylics, composite resins, porcelains and silicones, is a more predictable approach to replacing lost tissue architecture. The patient need not undergo any additional surgical procedures and yet receive an aesthetically pleasing and functional restoration 3.

CONCLUSION

An increased cosmetic demand from the profession and patients has resulted in more emphasis on the gingival esthetics. Removable gingival mask can be an alternative prosthetic procedure to rebuild the pink gingival esthetics .They are easy to fabricate, inexpensive and the esthetics and functional outcomes are also met with complete patient satisfaction .

REFERENCES