|Year : 2014 | Volume
| Issue : 2 | Page : 68-70
Gingival mask: A case report on enhancing smiles
Department of Prosthodontics and Implantology, A. B. Shetty Memorial Institute of Dental Sciences, Mangaluru, Karnataka, India
|Date of Web Publication||10-Mar-2015|
Department of Prosthodontics and Implantology, A. B. Shetty Memorial Institute of Dental Sciences, Mangaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Periodontal attachment loss in the maxillary anterior region can often lead to esthetic and functional clinical problems including disproportional and elongated clinical crowns and visible interdental embrasures. Gingival replacement prosthesis has historically been used to replace lost tissue. A gingival mask is an easily constructed and practical device to optimize the esthetic and functional outcome in these special situations while permitting cleansibility of the prosthesis and supporting tissues. This is a case report of a young female patient treated using silicon gingival veneer with a 2-year follow-up. The silicon gingival mask has enabled the patient to regain her lost smile and face people with newly found confidence also enhancing the esthetic appearance. Virtually, no problem was encountered during the 2 years of usage of the veneer and the patient continues to use it comfortably.
Keywords: Esthetic, gingival mask, gingival replacement, periodontal attachment
|How to cite this article:|
Shenava A. Gingival mask: A case report on enhancing smiles. J Oral Res Rev 2014;6:68-70
| Introduction|| |
Gingival recession is the most common clinical manifestation of all the oral diseases, as it has a relatively high incidence rate.  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. [2, 3, 4, 5, 6, 7, 8, 9, 10] A gratifying smile is an assembly of various components. Marginal gingiva and interdental papilla, having high esthetic value, are mulled over as the chief components of a smile. Gingival recession can cause loss of inter-dental papilla and lead to open embrasures, which project in the form of black triangles. The black triangles that appear as a result of gingival recession will distort an amiable smile. The condition can be corrected or managed by two approaches.
| Case Report|| |
A 32-year-old female presented with esthetic and phonetic problems. The patient had recently undergone periodontal surgery with respect to 11 and 21, which eventually resulted in the loss of interdental papillae between maxillary central incisors after 2 months [Figure 1].
The first option is mucogingival surgery or gingival plastic surgery, with gingival augmentation coronal to the recession. This is suitable for class I and class II type of gingival recessions.  In severe gingival recession conditions, as in class III and class IV recessions (Millers classification of gingival recession) as seen in this patient, mucogingival surgeries may give less predictable esthetic results or might cause a recurrence.
The second option, gingival replacement with artificial substitutes, is more helpful in managing severe gingival recession situations. The synonyms of gingival mask are flange prosthesis, gingival veneer, gingival veneer prosthesis, gingival replacement unit, and artificial gingiva.
This case report describes the use of a silicon gingival veneer to hide the deformities in a young female patient with a successful follow-up of 2 years. The gingival replacement unit should be fabricated 2-3 months following initial periodontal treatment to allow the gingiva to stabilize. But in certain situations, the mask can be used as an interim measure to improve the esthetics of anterior crowns after initial periodontal therapy to allow time for healing and the establishment of periodontal stability and prognosis. In this way, the patient's smile can be maintained while the final treatment planning decisions are delayed until the periodontal prognosis is established. [7, 12, 13]
The removable gingival mask is indicated:
The gingival mask is contra-indicated in patients with poor plaque control, unstable periodontal health, high caries activity, smoking, and known allergy to acrylic or silicone. 
- To cover-exposed crown margins, exposed implant components and root surfaces and reduce the length of the clinical crown.
- To block out the black triangles between teeth in which gingival recession has occurred.
- To fill in the space between the crown and the soft tissue.
- To prevent airflow through or beneath maxillary fixed restorations or through the spaces between the teeth and thus improving phonetics.
- To provide increased lip and cheek support for those patients who require it.
- It is also beneficial for patients with high lip lines and a gummy smile who have been treated with osseointegrated dental implants.
- To hide the dark lines around old crowns that are often seen with patients who have experienced gingival recession.
- It also aids the prosthodontist to design implant supported prosthesis with optimal configurations permitting easy access for oral hygiene maintenance.
The gingival mask is retained mechanically with tiny extensions of the mask material slightly projecting between the roots of the natural teeth or the implants just above the gum line. Part of the retention also comes from the natural capillary action created by the saliva and lastly part of the retention is dependent on the pressure of the lips against the gingival prosthesis.
A treatment plan was established involving the following steps:
For gingival veneer, master impression with a complete interproximal detail was made. The lingual embrasures were blocked using utility wax. A custom tray was used to make a final impression using polyether impression material. After the casts were made, it was followed by construction of wax-up try-in on this model [Figure 2]. This wax-up was then duplicated to form removable silicon prosthesis with Cosmesil M511 silicone (Cosmedica Ltd., Cardiff UK) [Figure 3] and [Figure 4].
- The topography of the soft tissue defect was evaluated.
- The color of the soft tissue was determined to achieve the acceptable esthetics.
- Photographs were taken to replicate the similar color in the silicon mask.
The prosthesis was extended up to 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. Instructions were given to clean it every time after having food and to remove the prosthesis at night. This would also ensure adequate rest to the gingival tissues. The importance of persistent plaque control in the ongoing prevention of both caries and periodontal disease was emphasized.
| Discussion|| |
Gingival defects may be treated with surgical or prosthetic approaches. With successful surgical treatment, the result mimics the original tissue contours. But the surgical costs, healing time, discomfort and unpredictability make this choice unpopular. Prosthetic replacement, with acrylics, composite resins, porcelains and silicones, is a more predictable approach to replacing lost tissue architecture. It is especially useful when a larger amount of tissue needs replacement. Ideal tissue contours can be waxed, processed and then colored to match the surrounding tissue. The patient need not undergo any additional surgical procedures and receives an esthetically pleasing, functional restoration. It is possible to show the patient a waxed-up result or even take a try-in prosthesis directly to the mouth for evaluation before significant treatment is initiated.
Several materials are available for the fabrication of gingival veneer among all these materials, Cosmesil M511 silicon gives a lifelike finish. Hence, in the present case, this material was chosen to construct gingival veneer as mentioned by Green et al. Loss of interdental papillae in maxillary anterior region can often lead to esthetic and functional clinical problems. In such cases, it becomes a challenge for the dentist to provide optimum esthetic solution for the missing gingival tissues and at the same time preserve periodontal health.  Gingival veneers are easy to fabricate and offer predictable and satisfactory results in the management of lost interdental papillae.
| References|| |
Studer S, Naef R, Schärer P. Adjustment of localized alveolar ridge defects by soft tissue transplantation to improve mucogingival esthetics: A proposal for clinical classification and an evaluation of procedures. Quintessence Int 1997;28:785-805.
Tallents RH. Artificial gingival replacements. Oral Health 1983;73:37-40.
Botha PJ, Gluckman HL. The gingival prosthesis: A literature review. SADJ 1999;54:288-90.
Friedman MJ. Gingival masks: A simple prosthesis to improve the appearance of teeth. Compend Contin Educ Dent 2000;21:1008-10, 1012.
Blair FM, Thomason JM, Smith DG. The flange prosthesis. Dent Update 1996;23:196-9.
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.
Greene PR. The flexible gingival mask: An aesthetic solution in periodontal practice. Br Dent J 1998;184:536-40.
Priest GF, Lindke L. Gingival-colored porcelain for implant-supported prostheses in the aesthetic zone. Pract Periodontics Aesthet Dent 1998;10:1231-40.
Hannon SM, Colvin CJ, Zurek DJ. Selective use of gingival-toned ceramics: Case reports. Quintessence Int 1994;25:233-8.
Brygider RM. Precision attachment-retained gingival veneers for fixed implant prostheses. J Prosthet Dent 1991;65:118-22.
Cairo F, Rotundo R, Miller PD, Pini Prato GP. Root coverage esthetic score: A system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases. J Periodontol 2009;80:705-10.
Ellis SG, Sharma P, Harris IR. Case report: Aesthetic management of a localised periodontal defect with a gingival veneer prosthesis. Eur J Prosthodont Restor Dent 2000;8:23-6.
Nair C, Dange SP. Aesthetic management of gingival recession: A flexible gingival mask. J Indian Prosthodont Soc 2003;3:34-5.
Shah A. A case report gingival veneer: Non-invasive approach in the management of lost interdental papilla. Int J Dent Case Rep 2012;2:54-8.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]