Gingival Veneers 4l452z

An alternative treatment approach to gingival recession: gingiva-colored partial porcelain veneers: A clinical report Nuray Capa, DDS, MSc, PhDa Yeditepe University, Istanbul, Turkey (J Prosthet Dent 2007; 98: 82-84.)

Presented by Soumya P.G Prosthodontics

• Loss of tooth structure and the surrounding periodontal soft tissues may occur due to abrasion, erosion, caries etc.. . • Hard and soft tissue loss can result in enlarged gingival embrasures and increased crown length causing esthetic problems and hypersensitivity.

• Selecting the best esthetic, prosthetic treatment for teeth with gingival recession in the anterior region may be challenging • Some authors suggest alternative, conservative prosthodontic treatments for lost papillae, such as • a gingival flange retained by precision attachments, • a fixed prosthesis with gingiva-colored ceramics, • restoration with gingiva-colored composite resins, • or a removable gingival prosthesis.

• This clinical report describes treatment for excessive tissue loss around natural teeth using gingiva-colored partial (G) porcelain laminate veneers.

• A 30-year-old white woman was referred to the Department of Prosthetic Dentistry, Istanbul, Turkey. • Her complaint was the unaesthetic appearance of her maxillary right and left central incisors due to gingival recession after periodontal treatment • The patient occasionally reported hypersensitivity of the involved teeth.

• Prior to rendering treatment initial periodontal therapy and periodontal regeneration procedures were performed. Healthy periodontal tissues were achieved • The use of gingiva-colored ceramics in conjunction with a fixed prosthesis has been reported for treatment of gingival recession. • However, this procedure requires extensive preparation of teeth, resulting in significant hard tissue loss

• Direct pink-colored composite resins may also be used to restore unesthetic appearances caused by gingival recession and to decrease dental hypersensitivity. • However, composite resins are susceptible to discoloration, marginal fractures, and wear. • Due to the young age of the patient, an invasive treatment approach such as full crown preparation was not selected

• G porcelain laminate veneers were preferred in this situation because of their biocompatibility, color stabilization, and nonporous surface, which prevents plaque adherence better than composite resin.

• The gingivally recessed region was restored with pink partial laminate veneers to mask the increase in the crown length

• Minimal preparation and restoration with G porcelain laminate veneers was performed only in the area with gingival recession, thus reproducing the anatomic crown.

• A diagnostic waxing was developed by covering the gingival area with pink wax to imitate the gingiva

• Root surfaces were prepared to provide adequate space for the G porcelain laminate veneers. • 0.5- mm labial reduction was performed

A chamfer preparation was used for the gingival margin of the teeth using a medium-grid chamfer diamond rotary cutting instrument –to maximize the esthetics and maintain gingival marginal health

• The impression was made with addition silicone material . • The impression and an intraoral photograph were sent to the dental laboratory technician. • The lack of a scale for selecting proper gingival color made shade selection difficult. • The intraoral photograph helped the technician in selecting the proper gingival color

• The G porcelain laminate veneers were fabricated using IPS Empress Esthetic (Ivoclar Vivadent AG, Schaan, Liechtenstein). • To obtain the natural pink color of the gingiva, basic red color (IPS Empress Universal Stains; Ivoclar Vivadent AG) and Essence terra color (IPS e.max; Ivoclar Vivadent AG) were used during the fabrication of G porcelain laminate veneers.

• The G porcelain laminate veneers were shaped to conform with the anatomic contours of the maxillary incisors. • Laboratory preparations of the porcelain laminate veneers were completed after glazing with universal glazing paste (IPS Empress; Ivoclar Vivadent AG). • The restorations were cemented with an adhesive system (Variolink II; Ivoclar Vivadent AG

• Hydrofluoric acid was used for 60 seconds to etch the G porcelain veneers. • After rinsing and drying the veneers, silane (Monobond-S; Ivoclar Vivadent AG)was applied on the etched surfaces. • Surfaces were air-dried for 60 seconds. • Bonding agent (Heliobond;Ivoclar Vivadent AG) was applied with a brush on the porcelain laminate veneers and thinned with an air syringe for 5 seconds.

• The prepared root surfaces were etched for 15 seconds with 37% phosphoric acid • Rinsed with water for 15 seconds and gently dried with an air syringe. • Primer was applied for 15 seconds • dentinal adhesive was applied for 10 seconds. • Bonding agent was then applied with a brush

• A transparent shade of a dual-polymerizing resin-based luting cement shade was mixed for 10 seconds and placed in the preparation. • Then porcelain laminate veneers were placed. • Excess resin cement was removed and polymerized for 40 seconds. • After 5 minutes excess was removed from marginal areas with polishing discs.

• The patient was recalled after 1 week • and 6 months • The patient reported that tooth hypersensitivity had disappeared

• By restoring the recessed regions with the G porcelain laminate veneers, the esthetic demands of the patient were fulfilled and the hypersensitivity was alleviated. • Increased use of this method may encourage the dental ceramic manufacturers to develop ranges of gingival color to provide optimal results.

SUMMARY • G porcelain laminate veneers may be an alternative prosthetic procedure to treat advanced tissue loss, achieving acceptable esthetic results and patient satisfaction. • This method preserves the remaining tooth structure with minimal invasive hard tissue loss.