Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 2  |  Page : 128-130

Gingival prosthesis: A treatment modality for recession


1 Department of Periodontics, Prosthodontics, Drs. Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Chinaoutpalli, Gannavaram Mandal, Vijayawada, Krishna, Andhra Pradesh, India
2 Department of Periodontics, Prosthodontics, Sree Mookambika Institute of Dental Sciences, Padanilam, Kulashekram, K.K District, Tamil Nadu, India

Date of Web Publication3-Jan-2014

Correspondence Address:
Pallavi Samatha Yalamanchili
Department of Periodontics, Drs. Sudha & Nageswara Rao Siddhartha Institute of Dental Sciences, Chinaoutpalli, Gannavaram Mandal, Vijayawada, Krishna - 521 286, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-8844.124259

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  Abstract 

Gingival recession caused due to periodontal disease disturbs patients because of sensitivity and esthetics. Gingival prosthesis may be fixed or removable and can be made from silicones, acrylics, composite resins or ceramics according to what is best suited for the case. The gingival veneer is esthetically appealing and easy to maintain. This case report describes the use of gingival veneer as a treatment modality for recession.

Keywords: Esthetics, gingival prosthesis, recession


How to cite this article:
Yalamanchili PS, Surapaneni H, Reshmarani AP. Gingival prosthesis: A treatment modality for recession. J Orofac Sci 2013;5:128-30

How to cite this URL:
Yalamanchili PS, Surapaneni H, Reshmarani AP. Gingival prosthesis: A treatment modality for recession. J Orofac Sci [serial online] 2013 [cited 2020 Feb 26];5:128-30. Available from: http://www.jofs.in/text.asp?2013/5/2/128/124259


  Introduction Top


Dental esthetics is just not confined to the tooth as such but also to the gingival component (soft-tissue). Periodontal disease may lead to loss of alveolar bone or apical migration of the gingival margin resulting in unsightly black triangles and sensitivity of teeth. Black triangles were rated as the third most disliked esthetic problem below caries and crown margins. [1] Such interdental spaces may also result in phonetic problems due to escape of air. [2] Isolated gingival recessions can be corrected by various surgical root coverage procedures. Sometimes gingival recession can be generalized and very extensive that it cannot be corrected by surgical root coverage procedures. The alternative for such a clinical situation is gingival prosthesis.

Gingival prosthesis (gingival mask or gingival veneer or gingival epithesis) is a flexible removable periodontal prosthesis used to replace lost gingiva due to periodontal surgery, gingival recession or to hide black triangle spaces between teeth. Materials used for gingival prosthesis include pink auto cure and heat cured acrylics, porcelains, composite resins, and thermoplastic acrylics as well as silicone based soft materials. [3],[4],[5],[6] It can be fabricated in acrylic resin or silicon by conventional processing procedures.

The indications for gingival prosthesis are: [7]

  1. Gingival recession with root exposure and open interdental spaces due to loss of papillae after periodontal disease or post-periodontal treatment therapy.
  2. Provisional coverage prior to definite restorations. Temporary splint.
  3. As a gingival augmentation for implant supported prosthesis.
  4. When there is proclination of teeth along with mild recession.
  5. As an interim measure in cases where final treatment planning is delayed.


Contraindications of gingival prosthesis include: [7]

  1. Poor or unstable periodontal health.
  2. Poor oral hygiene.
  3. High caries activity.
  4. Known allergy to silicone.
  5. Heavy smokers.


This article presents non-surgical management of patients with gingival recession.


  Case Report 1 Top


A 35-years-old male patient reported with a complaint of receding gums, sensitivity and food lodgment in the maxillary anterior region. The patient expressed dissatisfaction with esthetics and phonetics because of spacing between upper front teeth and loss of gums [Figure 1]a. It was planned to fabricate non-flexible gingival prosthesis.
Figure 1: (a) Patient with spacing between upper front teeth and loss of gums. (b) Non-flexible gingival prosthesis delivered to the patient

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For the gingival veneer, a diagnostic impression was made using alginate impression material (Tropicalgin, Zhermack, Italy). The impression was then poured with type III dental stone (Kalrock, Kalabhai, India). A labial custom tray was made using Self cure methyl methacrylate (DPI, Self cure, India) after blocking the interdental spaces from palatal side on the model using utility wax. The tray extended from incisal edges to vestibular sulcus from first premolar of one side to first premolar of contralateral side. The custom tray tried in the mouth and practiced for orientation and a buccal approach was used to create the master impression with a complete interproximal detail. The impression was made using addition silicone impression material (Reprosil, Regular Body, Dentsply, USA). The cast was prepared using type IV die stone (Kalrock, Kalabhai, India), and a gingival prosthesis was waxed up and processed in heat-cured acrylic resin (DPI Heat cure, India). Retention was achieved with minor interproximal undercuts. The prosthesis was made extremely thin and had enough flexibility to engage these undercuts [Figure 1]b.


  Case Report 2 Top


A 45-years-old woman recently underwent periodontal surgery of the maxillary teeth. The surgery improved her periodontal condition, but left the patient with a significant loss of papillae. The patient found the resulting tooth sensitivity extremely uncomfortable, and was also very unhappy with the unesthetic appearance of the elongated teeth [Figure 2]a. The decision was made to fabricate a flexible removable prosthesis to close the spaces between the anterior teeth. For the gingival veneer, a buccal approach was used to create the master impression with complete interproximal detail. The lingual embrasures were blocked using utility wax. A custom tray was used to make a final impression using the polyether impression material (Impregnum, Germany) [Figure 2]b. The cast was prepared using type IV die stone (Kalrock, Kalabhai, India) [Figure 2]c, and a gingival prosthesis was waxed up and the model with wax prosthesis in place was flasked such that it was embedded in plaster and reverse was formed in dental stone [Figure 2]d. The wax was then boiled out and tinfoil substitute applied. In the flask silicone material was packed at a stage as suggested by the manufacturer [gingival moll, [Figure 3]a and b. After recovery of gingival prosthesis from the flask, it was color shaded and a layer of protective lacquer applied before delivery to the patient [Figure 3]c. They are not easy to make and the material will lose color after about 12-24 months, depending on the habits of the patient. Smoking heavily has a deleterious effect as also colored spices. For this reason, the veneers are made in pairs or in some cases as many as four at a time for people with high profile public lives.

Silicone gingival prosthesis was delivered to the patient who was quite happy with the esthetic result and improved phonetics [Figure 3]d.
Figure 2: (a) Patient with anterior gingival recession. (b) Silicone impression made. (c) Master cast for wax up. (d) Flasking of waxed up prosthesis

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Figure 3: (a, b, c) Fabrication of flexible gingival prosthesis. (d) Prosthesis delivered to patient

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  Discussion Top


Chronic Periodontal Disease ("Gum disease") results in the loss of the bone and supporting tissues that hold the teeth in. In many cases, this leads to the formation of deep gum with this tissues can lead to gingival/gum recession, unfortunately the successful treatment of chronic periodontitis will often lead to gum recession. [8] The extent of the recession is directly related to the extent of the disease and amount of underlying bone loss that has resulted. Recession can lead to an unesthetic end result. There is no predictable surgical method for correcting esthetic deformities, which have resulted due to generalized loss of attachment. The only way to improve the esthetics is to try and mask the tissue loss especially in generalized recession situation.

The gingival veneer is a viable treatment option for restoring anterior esthetics in clinical situations where there are esthetic concerns caused by significant gingival recession. Case selection is important for predictable and successful outcome. [9] Gingival prosthesis takes several forms and various authors have described their uses and methods of construction. [2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14] Materials used for prosthesis include pink auto cured and heat cured acrylics, porcelains, composite resins, and thermoplastic acrylics as well as silicone based soft materials. Greene PR in 1998 described two stage impression techniques for construction of two identical masks. Two masks are used on alternate days. [4] Brygider in 1991 described fabrication of precision attachment retained gingival acrylic veneers for fixed implant prosthesis. [14] Barzilay and Irene in 2003 presented different methods of using pink materials to create gingival prosthesis. [3] Lai et al. in 2003 studied the in-vitro color stability, stain resistance, and water sorption of four removable gingival flange materials and concluded that gingival flange made of silicone or coplyamide materials may be more prone to staining with coffee and tea than traditional denture base acrylic resins. [15]

The gingival prosthesis replaces a large volume of tissue in patients with generalized attachment loss due to periodontal disease. The gingival prosthesis can be easily maintained and provides good esthetics.


  Conclusion Top


Gingival recession caused due to periodontal disease frequently disturbs patient's esthetics. Dental esthetics is based not only on the "white component" of the restoration, but also on the "pink component." A clear understanding of color and form that is required is essential to fabricate prosthesis and its acceptance by the patient. Gingival veneer is a good treatment option for patients with generalized/multiple recessions to achieve good esthetics. Prosthetic option of a gingival veneer helps in mimicking natural appearance of the gingiva in a predictable way, which is cost-effective to the patient.

 
  References Top

1.Cunliffe J, Pretty I. Patients' ranking of interdental "black triangles" against other common aesthetic problems. Eur J Prosthodont Restor Dent 2009;17:177-81.  Back to cited text no. 1
    
2.Mekayarajjananonth T, Kiat-amnuay S, Sooksuntisakoonchai N, Salinas TJ. The functional and esthetic deficit replaced with an acrylic resin gingival veneer. Quintessence Int 2002;33:91-4.  Back to cited text no. 2
    
3.Barzilay I, Irene T. Gingival prostheses - A review. J Can Dent Assoc 2003;69:74-8.  Back to cited text no. 3
    
4.Greene PR. The flexible gingival mask: An aesthetic solution in periodontal practice. Br Dent J 1998;184:536-40.  Back to cited text no. 4
    
5.Priest GF, Lindke L. Gingival-colored porcelain for implant-supported prostheses in the aesthetic zone. Pract Periodontics Aesthet Dent 1998;10:1231-40.  Back to cited text no. 5
    
6.Blair FM, Thomason JM, Smith DG. The flange prosthesis. Dent Update 1996;23:196-9.  Back to cited text no. 6
    
7.Hickey B, Jauhar S. Gingival veneers. Dent Update 2009;36:422-4, 426, 428.  Back to cited text no. 7
    
8.Reddy MS. Achieving gingival esthetics. J Am Dent Assoc 2003;134:295-304; quiz 337-8.  Back to cited text no. 8
    
9.Gopakumar A, Sood B. Conservative management of gingival recession: The gingival veneer. J Esthet Restor Dent 2012;24:385-93.  Back to cited text no. 9
    
10.Tallents RH. Artificial gingival replacements. Oral Health 1983;73:37-40.  Back to cited text no. 10
    
11.Botha PJ, Gluckman HL. The gingival prosthesis - A literature review. SADJ 1999;54:288-90.  Back to cited text no. 11
    
12.Friedman MJ. Gingival masks: A simple prosthesis to improve the appearance of teeth. Compend Contin Educ Dent 2000;21:1008-10, 1012-4, 1016.  Back to cited text no. 12
    
13.Hannon SM, Colvin CJ, Zurek DJ. Selective use of gingival-toned ceramics: Case reports. Quintessence Int 1994;25:233-8.  Back to cited text no. 13
    
14.Brygider RM. Precision attachment-retained gingival veneers for fixed implant prostheses. J Prosthet Dent 1991;65:118-22.  Back to cited text no. 14
    
15.Lai YL, Lui HF, Lee SY. In vitro color stability, stain resistance, and water sorption of four removable gingival flange materials. J Prosthet Dent 2003;90:293-300.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Abstract
Introduction
Case Report 1
Case Report 2
Discussion
Conclusion
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