The complete oral rehabilitation of patients demanding a beautiful and attractive smile involves a multidisciplinary approach that includes the change of both the morphological aspect of the teeth and the architecture of gum tissues. This clinical report describes a successful interdisciplinary approach for the treatment of an esthetically compromised dentition. In a first phase, the periodontal plastic surgery was performed for root coverage and, in particular, it was decided for the execution of a coronally advanced flap for the treatment of multiple recession defects. Once complete healing of soft tissues was obtained, six lithium disilicate veneers were placed over the anterior maxillary teeth. Lithium disilicate is a glass-based ceramic which presents excellent aesthetics and allows the passage of light without creating unnatural reflections. This feature has made it possible to recreate a natural aspect of teeth that in combination with the harmonic architecture of soft tissue has permitted obtaining a beautiful and pleasant smile. 1. Introduction From antiquity to modern times, the face and its expressions have always played a crucial role because they can greatly affect interpersonal relationships [1]. According to several studies, it is especially the smile that influences the appearance of the face as a beautiful smile seems to convey serenity, safety, and success in the beholder [2]. Therefore, patients who turn to dentists require, in addition to the functional aspect, an outcome that meets their esthetic needs in order to obtain a natural smile and beautiful teeth [3]. The professional, in consideration of these demands, can improve the patient’s smile in a comprehensive manner, changing both the morphological characteristics of the teeth (shape, color, position, and size) and the architecture of the soft gum tissue [4]. To do this, different techniques of periodontal surgery have been developed for the correction of soft tissue and many changes have been done in the discovery of methods and materials for the construction of direct and indirect restorations. In this work, we present a clinical case of a patient who required, for cosmetic reasons, the replacement of the previous restoration and the correction of the soft tissue profile at the level of the anterior region of the maxilla. The gingival recessions were treated with a coronally advanced flap, and once healing was complete, prosthetic veneers made of lithium disilicate were placed over the teeth. 2. Clinical Case The patient, C. C., female, aged 45, came to our attention requiring
References
[1]
K. Schmidt, R. Levenstein, and Z. Ambadar, “Intensity of smiling and attractiveness as facial signals of trustworthiness in women,” Perceptual and Motor Skills, vol. 113, pp. 964–978, 2012.
[2]
S. Malkinsons, T. C. Waldrop, J. C. Gunsolley, S. K. Lanning, and R. Sabatini, “The effect of esthetic crown lengthening on perceptions of a patient's attractiveness, friendliness, trustworthiness, intelligence and self-confidence,” Journal of Periodontology, vol. 84, no. 8, pp. 1126–1133, 2013.
[3]
N. Sharma, S. F. Rosenstiel, H. W. Fields, and F. M. Beck, “Smile characterization by U.S. white, U.S. Asian Indian, and Indian populations,” Journal of Prosthetic Dentistry, vol. 107, no. 5, pp. 327–335, 2012.
[4]
M. K. Goyal, S. Goyal, V. Hegde, D. Balkrishana, and A. I. Narayana, “Recreating an esthetically and functionally acceptable dentition: a multidisciplinary approach,” The International Journal of Periodontics and Restorative Dentistry, vol. 33, no. 4, pp. 527–532, 2013.
[5]
G. Zucchelli and M. De Sanctis, “Treatment of multiple recession-type defects in patients with esthetic demands,” Journal of Periodontology, vol. 71, no. 9, pp. 1506–1514, 2000.
[6]
M. M. Kassab and R. E. Cohen, “The etiology and prevalence of gingival recession,” Journal of the American Dental Association, vol. 134, no. 2, pp. 220–225, 2003.
[7]
D. L. Baker and G. J. Seymour, “The possible pathogenesis of gingival recession. A histological study of induced recession in the rat,” Journal of Clinical Periodontology, vol. 3, no. 4, pp. 208–210, 1976.
[8]
J. L. Wennstrom, “Mucogingival surgery,” in Proceedings of the 1st European Workshop on Periodontology, N. P. Lang and T. Karring, Eds., Quintessence Publishing, Berlin, Germany, 1994.
[9]
P. D. Miller Jr., “A classification of marginal tissue recession,” The International Journal of Periodontics and Restorative Dentistry, vol. 5, no. 2, pp. 9–13, 1985.
[10]
M. Paolantonio, C. di Murro, A. Cattabriga, and M. Cattabriga, “Subpedicle connective tissue graft versus free gingival graft in the coverage of exposed root surfaces. A 5-year clinical study,” Journal of Clinical Periodontology, vol. 24, no. 1, pp. 51–56, 1997.
[11]
R. J. Harris, “A comparative study of root coverage obtained with an acellular dermal matrix versus a connective tissue graft: results of 107 recession defects in 50 consecutively treated patients,” International Journal of Periodontics and Restorative Dentistry, vol. 20, no. 1, pp. 51–59, 2000.
[12]
D. Brustein, “Cosmetic periodontics-coronally repositioned pedicle graft,” Dental Survey, vol. 46, no. 7, pp. 22–25, 1970.
[13]
E. P. Allen and P. D. Miller Jr., “Coronal positioning of existing gingiva: short term results in the treatment of shallow marginal tissue recession,” Journal of Periodontology, vol. 60, no. 6, pp. 316–319, 1989.
[14]
J. Lindhe and K. Lang, Clinical Periodontology and Implant Dentistry, Wiley-Blackwell, Oxford, UK, 5th edition, 2008.
[15]
J. P. Bernimoulin, B. Lüscher, and H. R. Mühlemann, “Coronally repositioned periodontal flap. Clinical evaluation after one year,” Journal of Clinical Periodontology, vol. 2, no. 1, pp. 1–13, 1975.
[16]
J. R. Calamia, “Etched porcelain veneers: the current state of the art,” Quintessence International, vol. 16, no. 1, pp. 5–12, 1985.
[17]
S. D. Campbell, “A comparative strength study of metal ceramic and all-ceramic esthetic materials: modulus of rupture,” The Journal of Prosthetic Dentistry, vol. 62, no. 4, pp. 476–479, 1989.
[18]
F. Spear and J. Holloway, “Which all-ceramic system is optimal for anterior esthetics?” Journal of the American Dental Association, vol. 139, pp. 19–24, 2008.
[19]
M. J. Heffernan, S. A. Aquilino, A. M. Diaz-Arnold, D. R. Haselton, C. M. Stanford, and M. A. Vargas, “Relative translucency of six all-ceramic systems. Part I. Core materials,” Journal of Prosthetic Dentistry, vol. 88, no. 1, pp. 4–9, 2002.
[20]
M. J. Heffernan, S. A. Aquilino, A. M. Diaz-Arnold, D. R. Haselton, C. M. Stanford, and M. A. Vargas, “Relative translucency of six all-ceramic systems. Part II. Core and veneer materials,” Journal of Prosthetic Dentistry, vol. 88, no. 1, pp. 10–15, 2002.
[21]
R. R. Seghi, J. A. Sorensen, M. J. Engelman, et al., “Flexural strength of new ceramic materials,” Journal of Dental Research, vol. 69, pp. 229–302, 1990.
[22]
R. R. Seghi and J. A. Sorensen, “Relative flexural strength of six new ceramic materials,” The International Journal of Prosthodontics, vol. 8, no. 3, pp. 239–246, 1995.
[23]
M. J. Friedman, “A 15-year review of porcelain veneer failure: a clinician's observations,” Compendium of Continuing Education in Dentistry, vol. 19, pp. 625–632, 1998.
