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CASE REPORT
Year : 2016  |  Volume : 30  |  Issue : 2  |  Page : 121-123

Acrylic gingival veneer prosthesis: A case report


1 Department of Prosthetic Dentistry, Dental College, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India
2 Department of Community Dentistry, Nair Hospital and Dental College, Mumbai, Maharashtra, India
3 Department of Prosthetic Dentistry, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication24-May-2016

Correspondence Address:
Nitai Debnath
Dental College, Regional Institute of Medical Sciences (RIMS), Lamphelpat, Imphal West, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.182923

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  Abstract 

Periodontal disease may lead to gingival recession causing elongated clinical crown height and formation of black triangle in the interproximal area. Acrylic gingival prosthesis is a noninvasive, economical restorative procedure to artificially replace the lost gingival tissue. This artificial prosthesis overcomes the pitfall of extensive surgical corrective procedure. This article aims to describe a clinical case with advanced gingival recession with diastema between the upper anterior teeth, which was esthetically rehabilitated with acrylic gingival veneer prosthesis.

Keywords: Black triangle, diastema, gingival veneer prosthesis, rehabilitation


How to cite this article:
Debnath N, Gupta R, Nongthombam RS, Chandran P. Acrylic gingival veneer prosthesis: A case report. J Med Soc 2016;30:121-3

How to cite this URL:
Debnath N, Gupta R, Nongthombam RS, Chandran P. Acrylic gingival veneer prosthesis: A case report. J Med Soc [serial online] 2016 [cited 2021 Apr 12];30:121-3. Available from: https://www.jmedsoc.org/text.asp?2016/30/2/121/182923


  Introduction Top


Advanced loss of periodontal support in the maxillary anterior area presents special challenges to the restorative dentist. The problems encountered in this situation may include open interdental spaces, elongated clinical crowns, and altered labiodental and linguoalveolar consonant production.

Several reasons contribute to the loss of interdental papillae and the establishment of "black triangles" between teeth. The most common reason in the adult population is the loss of periodontal support because of the plaque-associated lesions. However, abnormal tooth shape, inproper contour of prosthetic restorations, and traumatic oral hygiene procedures may also negatively influence the outline of the interdental soft tissues. [1],[2],[3],[4]

In those patients who manifest a prominent maxillary display, it becomes a very difficult challenge to maintain hygiene and yet create a proportional prosthetic replacement that phonetically seals these patents' interdental areas. The use of a removable resin veneer to simulate the missing gingival tissue may provide a solution to these problems.

This prosthesis can be used to cover the exposed root surfaces, to prevent food impaction between the teeth, and to improve the esthetics and speech of the patient. It may be included in complete treatment of a patient or in transitional phases pending treatment with fixed or removable partial dentures. It may be used in combination with a fixed partial denture to mask severe alveolar bone loss or similar situations with fixed implant prosthesis.


  Case report Top


A 34-year-old female patient was reported to the clinic with a chief complaint of elongated upper anterior teeth along with diastema between them [Figure 1]. She also complained about the excessive visibility of upper anterior teeth while smiling and in resting state. The patient had a history of gradually proclined maxillary anterior teeth with mobility since the last 4 years. Periodontal flap surgical procedure was performed 6 months back. After periodontal flap surgery, the teeth became more elongated resulted in more esthetic and phonetic problems.
Figure 1: Intraoral view showing loss of interdental papilla

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Different treatment options were discussed with the patients. Because of her poor economic condition, the patient was not ready for additional surgical or extensive rehabilitation procedures. Obliteration of interdental space with composite resin restoration was not found to be feasible considering the anatomy of the anterior teeth and the diastema between them. Considering all these factors and the patient's wishes, a removable acrylic gingival veneering prosthesis was planned for the patient.

For final impression buccal approach was used to record better interproximal details. Custom tray was used to make a final impression using polyether impression material. In the patient's mouth, the lingual embrasures were blocked using utility wax. The cast was prepared using type IV gypsum product and the lingual gingival embrasure was blocked out with modeling clay material (Jing Jing, China) [Figure 2]. This was followed by the construction of wax-up try-in on this model. This wax-up was then duplicated to form removable prosthesis. The removable prosthesis was fabricated from heat-cured acrylic resin. The prosthesis was extended upto the mesial aspects of first premolars bilaterally. This seemed to be necessary considering the patient's smile window. The distal most portions of the prosthesis were thinned out in order to be blended with natural gingival tissues [Figure 3]. Acrylic gingival veneer was delivered to the patient. The patient was quite happy with the esthetic result and also improved phonetics [Figure 4]. The maintenance care of prosthesis and also oral hygiene guideline was given to the patient.
Figure 2: Palatal gingival embrasure block out on master cast

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Figure 3: Acrylic gingival veneer prosthesis

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Figure 4: Prosthesis in situ

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  Discussion Top


This procedure is a relatively easy, inexpensive, and practical way to allow an esthetic replacement of the gingiva that also permits hygiene procedures for the underlying prosthesis. Advantages of the gingival veneer include improved esthetics, phonetics, and prevention of food impaction. [5],[6] Caution should be used when the interproximal areas are adjusted on delivery, because this step is crucial to the overall success of retention. The patients with poor oral hygiene or dexterity are not candidates for this type of prosthesis.

Several surgical and prosthetic approaches for the management of lost interdental papillae have been described in the literature. [7],[8],[9] Several factors determine the choice of treatment approach. These factors include anatomy of teeth, amount of tissues to be replaced, underlying periodontal bone loss, and patient's compliance and expectations.

Surgical treatments include papilla reconstruction procedures and soft as well as hard tissue grafting. This approach provides esthetically pleasing and morphologically correct tissue contours when small volumes of tissue are being reconstructed and deformity is limited to single tooth. However, factors, such as surgical costs, healing time, discomfort, and unpredictability, make this choice of limited use.

Gingival replacement prostheses have historically been used to replace lost tissue when other methods (e.g., surgery or regenerative procedures) were considered unpredictable or impossible. With this method, large tissue volumes are easily replaced.

Gingival prostheses take several forms, and various authors have described their uses and methods of construction. The restorative approach (composite resin restoration) was also not feasible considering the anatomy of teeth and location of contact points between maxillary central incisors. Hence, we decided to go ahead with noninvasive and inexpensive option, i.e., gingival veneer.

Several materials have been described in the literature for the fabrication of gingival veneer. [10],[11],[12],[13] Among all these materials, acrylic resin is widely available and relatively cheap. It also allows for adequate polishing of final prosthesis and its shade can be matched to adjacent gingival tissues. Hence, in the present case, this material was chosen to construct gingival veneer.


  Conclusion Top


With the aid of the acrylic resin gingival veneer, the esthetic and phonetic characteristics of the anterior maxilla can be improved when the loss of periodontal support is evident. Although such prosthesis is considered auxiliary and is somewhat fragile, it can be made easily, with minimal additional effort and costs, to provide these patients with a greater sense of psychological satisfaction.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/ their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Prato GP, Rotundo R, Cortellini P, Tinti C, Azzi R. Interdental papilla management: A review and classification of the therapeutic approaches. Int J Periodontics Restorative Dent 2004;24:246-55.   Back to cited text no. 1
    
2.
Cunliffe J, Pretty I. Patients′ ranking of interdental "black triangles" against other common esthetic problems. Eur J Prosthodont Restor Dent 2009;17:177-81.  Back to cited text no. 2
    
3.
Barzilay I, Irene T. Gingival prosthesis - A review. J Can Dent Assoc 2003;69:74-8.  Back to cited text no. 3
    
4.
Venkat R, Chander GN, Vasantakumar M. Ersatz gingiva. J Indian Prosthodont Soc 2008;8:126- 30.  Back to cited text no. 4
  Medknow Journal  
5.
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. 5
    
6.
Botha PJ, Gluckman HL. The gingival prosthesis - A literature review. SADJ 1999;54:288-90.  Back to cited text no. 6
    
7.
Blatz MB, Hürzeler MB, Strub JR. Reconstruction of the lost interproximal papilla - Presentation of surgical and nonsurgical approaches. Int J Periodontics Restorative Dent 1999;19:395-406.   Back to cited text no. 7
    
8.
Barzilay I, Tamblyn. Gingival prosthesis - A review. J Can Dent Assoc 2003;69:748.  Back to cited text no. 8
    
9.
Tallents RH. Artificial gingival replacements. Oral Health 1983;73: 37-40.  Back to cited text no. 9
    
10.
Mule SA, Dange SP, Khalikar AN, Vaidya SP. Gingival prosthesis: An aesthetic solution for a periodontally compromised patient - A case report. J Indian Dent Assoc 2011;5:652-3.  Back to cited text no. 10
    
11.
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. 11
    
12.
Greene PR. The flexible gingival mask: An esthetic solution in periodontal practice. Br Dent J 1998;184:536-40.  Back to cited text no. 12
    
13.
Blair FM, Thomason JM, Smith DG. The flange prosthesis. Dent Update 1996;23:196-9.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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