Skip to main content

Periodontal Considerations in Esthetic Dentistry

  • Chapter
  • First Online:
Esthetic Oral Rehabilitation with Veneers
  • 1619 Accesses

Abstract

The smile is a basic and universal facial expression that is fundamental for communication and facial attractiveness. As the demand for esthetics increases, smile design must evolve beyond singular considerations of individual elements to a multidisciplinary approach. The position of the lips, the condition of the oral tissues, and gingival outlines are all factors that affect the final esthetics of the smile, along with the traditional dental considerations. The most common periodontal problems found in our restorative cases in addition to several corrective therapies will be discussed in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gargiulo AW, Wentz FM, Orban B. Dimensions and relations of the dento-gingival junction in humans. J Periodontol. 1961;32:261–7.

    Article  Google Scholar 

  2. Cohen DW. Periodontal preparation of the mouth for restorative dentistry. Presented at the Walter Reed Army Medical Center, Washington, DC, 1962.

    Google Scholar 

  3. Kois JO. New paradigms for anterior tooth preparation: rationale and technique. Contemp Esth Dent. 1996;2:1–8.

    Google Scholar 

  4. Smukler H, Chaibi M. Periodontal and dental considerations in clinical crown extension: a rational basis for treatment. Int J Periodont Rest Dent. 1997;17:465–77.

    Google Scholar 

  5. Lang NP, Löe H. The relationship between the width of the keratinized gingiva and gingival health. J Periodontol. 1972;43:623–7.

    Article  PubMed  Google Scholar 

  6. Wennström J, Lindhe J, Nyman S. Role of keratinized gingiva for gingival health. Clinical and histologic study of normal and regenerated gingival tissue in dogs. J Clin Periodontol. 1981;8:311–28.

    Article  PubMed  Google Scholar 

  7. Wennström JL. Mucogingival therapy. Ann Periodontol. 1996;1:671–701.

    Article  PubMed  Google Scholar 

  8. Wilson RD. Marginal tissue recession in general dental practice: a preliminary study. Int J Periodontics Restorative Dent. 1983;3(1):40–53.

    PubMed  Google Scholar 

  9. Agudio G, Nieri M, Rotundo R, Cortellini P, Pini PG. Free gingival grafts to increase keratinized tissue: a retrospective long-term evaluation (10 to 25 years) of outcomes. J Periodontol. 2008;79:587–94.

    Article  PubMed  Google Scholar 

  10. De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol. 2009;36(5):428–33.

    Article  PubMed  Google Scholar 

  11. Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restorative Dent. 2010;30(3):237–43.

    PubMed  Google Scholar 

  12. Weisgold AS. Contours of the full crown restoration. Alpha Omegan. 1977;70(3):77–89.

    PubMed  Google Scholar 

  13. Sanavi F, Weisgold AS, Rose LF. Biologic width and its relation to periodontal biotypes. J Esthet Dent. 1998;10(3):157–63.

    Article  PubMed  Google Scholar 

  14. Pontoriero R, Carnevale G. Surgical crown lengthening: a 12-month clinical wound healing study. J Periodontol. 2001;72(7):841–8.

    Article  PubMed  Google Scholar 

  15. Hwang D, Wang HL. Flap thickness as a predictor of root coverage: a systematic review. J Periodontol. 2006;77(10):1625–34.

    Article  PubMed  Google Scholar 

  16. Zuhr O, Baümer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014;41(Suppl 15):S123–42.

    Article  PubMed  Google Scholar 

  17. Chu S. Gingival zenith positions and levels of the maxillary anterior dentition. J Esthet Restor Dent. 2009;21:113–21.

    Article  PubMed  Google Scholar 

  18. Vig RG, Brundo GO. The kinetics of anterior tooth display. J Prosthet Dent. 1978;39:502–4.

    Article  PubMed  Google Scholar 

  19. Chu S. Papilla proportions in the maxillary anterior dentition. Int J Periodontics Restorative Dent. 2009;29:385–93.

    PubMed  Google Scholar 

  20. Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol. 1992;63(12):995–6.

    Article  PubMed  Google Scholar 

  21. Heins PJ, Wieder SM. A histologic study of the width and nature of interradicular spaces in human adult premolars and molars. J Dent Res. 1986;65:948–51.

    Article  PubMed  Google Scholar 

  22. Dragoo MR, Williams GB. Periodontal tissue reactions to restorative procedures. Part 1. Int J Periodontics Restorative Dent. 1982;2:8–29.

    Google Scholar 

  23. Dragoo MR, Williams GB. Periodontal tissue reactions to restorative procedures. Part 2. Int J Periodontics Restorative Dent. 1982;2:34–42.

    PubMed  Google Scholar 

  24. Martignoni M, Schbnenberger A. Precision fixed prosthodontics: clinical and laboratory aspects. Chicago: Quintessence; 1990. p. 255–8.

    Google Scholar 

  25. Maynard JG, Wilson RD. Physiologic dimensions of the periodontium significant to the restorative dentist. J Periodontol. 1979;50:170–4.

    Article  PubMed  Google Scholar 

  26. Lang NP, Kiel RA, Anderhalden K. Clinical and microbiological effects of subgingival restorations with overhanging or clinically perfect margins. J Clin Periodontol. 1983;10:563–78.

    Article  PubMed  Google Scholar 

  27. Zweers J, Thomas RZ, Slot DE, Weisgold AS, Van der Weijden GA. Characteristics of periodontal biotype, its dimensions, associations and prevalence: a systematic review. J Clin Periodontol. 2014;41(10):958–71.

    Article  PubMed  Google Scholar 

  28. Gurel G. The science and art of porcelain laminate veneers. Chicago: Quintessence Publishing; 2003.

    Google Scholar 

  29. Tjan AHL, Miller GD, The JGP. Some esthetic factors in a smile. J Prosthet Dent. 1984;51:24–8.

    Article  PubMed  Google Scholar 

  30. Kaya B, Uyar R. Influence on smile attractiveness of the smile arc in conjunction with gingival display. Am J Orthod Dentofac Orthop. 2013;144(4):541–7.

    Article  Google Scholar 

  31. Cracel-Nogueira F, Pinho T. Assessment of the perception of smile esthetics by laypersons, dental students and dental practitioners. Int Orthod. 2013;11(4):432–44.

    PubMed  Google Scholar 

  32. Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. Am J Orthod Dentofac Orthop. 2006;130(2):141–51.

    Article  Google Scholar 

  33. Silberberg N, Goldstein M, Smidt A. Excessive gingival display-etiology, diagnosis and treatment modalities. Quintessence Int. 2009;40:809–18.

    PubMed  Google Scholar 

  34. Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontol. 1996;11:18–28.

    Article  Google Scholar 

  35. Mclaren EA, Rifkin R. Macroesthetics: facial and dentofacial analysis. J Calif Dent Assoc. 2002;30(11):839–46.

    PubMed  Google Scholar 

  36. Polo M. Botulinum toxin type a in the treatment of excessive gingival display. Am J Orthod Dentofac Orthop. 2005;127(2):214–8.

    Article  Google Scholar 

  37. Mazzuco R, Hexsel D. Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. J Am Acad Dermatol. 2010;63(6):1042–51.

    Article  PubMed  Google Scholar 

  38. Al-Fouzan AF. Botulinum toxin for the treatment of gummy smile. J Contemp Dent Pract. 2017;18(6):474–8.

    Article  PubMed  Google Scholar 

  39. Rubinstein A, Kostianovsky A. Cosmetic surgery for the malformation of the laugh: original technique. Prensa Med Argent. 1973;60:952.

    Google Scholar 

  40. Rosenblatt A, Simon Z. Lip repositioning for reduction of excessive gingival display: a clinical report. Int J Periodontics Restorative Dent. 2006;26(5):433–7.

    PubMed  Google Scholar 

  41. Tawfik OK, El-Nahass HE, Shipman P, Looney SW, Cutler CW, Brunner M. Lip repositioning for the treatment of excess gingival display: a systematic review. J Esthet Restor Dent. 2018;30(2):101–12.

    Article  PubMed  Google Scholar 

  42. Cairo F, Graziani F, Franchi L, Defraia E, Pini Prato GP. Periodontal plastic surgery to improve aesthetics in patients with altered passive eruption/gummy smile: a case series study. Int J Dent. 2012;2012:837658.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Batista EL Jr, Moreira CC, Batista FC, de Oliveira RR, Pereira KK. Altered passive eruption diagnosis and treatment: a cone beam computed tomography-based reappraisal of the condition. J Clin Periodontol. 2012;39(11):1089–96.

    Article  PubMed  Google Scholar 

  44. Ribeiro FV, Hirata DY, Reis AF, Santos VR, Miranda TS, Faveri M, Duarte PM. Open-flap versus flapless esthetic crown lengthening: 12-month clinical outcomes of a randomized controlled clinical trial. J Periodontol. 2014;85(4):536–44.

    Article  PubMed  Google Scholar 

  45. Coslet JG, Vanarsdall R, Weisgold A. Diagnosis and classification of delayed passive eruption of the dentogingival junction in the adult. Alpha Omegan. 1977;70(3):24–8.

    PubMed  Google Scholar 

  46. McGuire MK, Scheyer ET. Laser-assisted flapless crown lengthening: a case series. J Periodontics Restorative Dent. 2011;31:357–64.

    Google Scholar 

  47. Coachman C, Calamita M. Digital smile design: a tool for treatment planning and communication in Esthetic dentistry. QDT. 2012:1–8.

    Google Scholar 

  48. Trushkowsky R, Montalvo-Arias D, David S. Digital smile design concept delineates the final potential result of crown lengthening and porcelain veneers to correct a gummy smile. Int J Esthet Dent. 2016;11:338–54.

    PubMed  Google Scholar 

  49. Ribeiro-Júnior NV, Campos TV, Rodrigues JG, Martins TM, Silva CO. Treatment of excessive gingival display using a modified lip repositioning technique. Int J Periodontics Restorative Dent. 2013;33(3):309–14.

    Article  PubMed  Google Scholar 

  50. Gabric Panduric D, Blaskovic M, Brozovic J, Susic M. Surgical treatment of excessive gingival display using lip repositioning technique and laser gingivectomy as an alternative to orthognathic surgery. J Oral Maxillofac Surg. 2014;72(2):404.e1-11

    Article  PubMed  Google Scholar 

  51. Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA. Can subepithelial connective tissue grafts be considered the gold standard procedure in the treat- ment of Miller class I and II recession-type defects? J Dent. 2008;36:659–71.

    Article  PubMed  Google Scholar 

  52. Chambrone L, Pannuti CM, Tu YK, Chambrone LA. Evidence-based periodontal plastic surgery. II. An individual data meta-analysis for evaluating factors in achieving complete root coverage. J Periodontol. 2012;83:477–90.

    Article  PubMed  Google Scholar 

  53. Cairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol. 2008;35(Suppl. 8):136–62.

    Article  PubMed  Google Scholar 

  54. Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol. 2015;86(Suppl):S8–S51.

    Article  PubMed  Google Scholar 

  55. Loe H, Anerud A, Boysen H. The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. J Periodontol. 1992;63:489–95.

    Article  PubMed  Google Scholar 

  56. Khocht A, Simon G, Person P, Denepitiya JL. Gingival recession in relation to history of hard toothbrush use. J Periodontol. 1993;64:900–5.

    Article  PubMed  Google Scholar 

  57. Kallestal C, Uhlin S. Buccal attachment loss in Swedish adolescents. J Clin Periodont. 1992;19:485–91.

    Article  Google Scholar 

  58. Lost C. Depth of alveolar bone dehiscences in relation to gingival recessions. J Clin Periodont. 1984;11:583–9.

    Article  Google Scholar 

  59. Mirko P, Miroslav S, Lubor M. Significance of the labial frenum attachment in periodontal disease in man. Part 1. Classification and epidemiology of the labial frenum attachment. J Periodontol. 1974;45:891–4.

    Article  PubMed  Google Scholar 

  60. Stetler KJ, Bissada NF. Significance of the width of keratinized gingiva on the periodontal status of teeth with submarginal restorations. J Periodontol. 1987;58:696–700.

    Article  PubMed  Google Scholar 

  61. Miller PD. A classification of marginal tissue recession. Int J Periodont Rest Dent. 1985;5:8–13.

    Google Scholar 

  62. Miller PD. Root coverage using the free soft tissue autograft following citric acid application. III. A successful and predictable procedure in areas of deep-wide recession. Int J Periodontics Restorative Dent. 1985;5:14–37.

    PubMed  Google Scholar 

  63. Zucchelli G, Amore C, Sforza NM, Montebugnoli L, De Sanctis M. Bilaminar techniques for the treatment of recession-type defects. A comparative clinical study. J Clin Periodontol. 2003;30:862–70.

    Article  PubMed  Google Scholar 

  64. Zucchelli G, Mele M, Mazzotti C, Marzadori M, Montebugnoli L, De Sanctis M. Coronally advanced flap with and without vertical releasing incisions for the treatment of multiple gingival recessions: a comparative controlled randomized clinical trial. J Periodontol. 2009;80:1083–94.

    Article  PubMed  Google Scholar 

  65. Cueva MA, Boltchi FE, Hallmon WW, Nunn ME, Rivera-Hidalgo F, Rees T. A comparative study of coronally advanced flaps with and without the addition of enamel matrix derivative in the treatment of marginal tissue recession. J Periodontol. 2004;75:949–56.

    Article  PubMed  Google Scholar 

  66. Barker TS, Cueva MA, Rivera-Hidalgo F, et al. A comparative study of root coverage using two different acellular dermal matrix products. J Periodontol. 2010;81:1596–603.

    Article  PubMed  Google Scholar 

  67. Aichelmann-Reidy M, Yukna R, Evans G, Nasr H, Mayer E. Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession. J Periodontol. 2001;72:998–1005.

    Article  PubMed  Google Scholar 

  68. Novaes AB Jr, de Barros RR. Acellular dermal matrix allograft. The results of controlled randomized clinical studies. J Int Acad Periodontol. 2008;10(4):123–9.

    PubMed  Google Scholar 

  69. Martiniello N, Stefanini M, Zucchelli G. Full-mouth treatment of gingival recessions and noncarious cervical lesions with coronally advanced flap and xenogeneic collagen matrix: a 2-year case report. Int J Esthet Dent. 2016;11(4):506–18.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Montalvo-Arias, D. (2020). Periodontal Considerations in Esthetic Dentistry. In: Trushkowsky, R. (eds) Esthetic Oral Rehabilitation with Veneers. Springer, Cham. https://doi.org/10.1007/978-3-030-41091-9_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-41091-9_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-41090-2

  • Online ISBN: 978-3-030-41091-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics