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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 30-33

An innovative restorative method for management of complex esthetic problems in partially edentulous mouth using the concept of Cu-sil denture


1 Department of Prosthodontics, SRM Dental College, Chennai, Tamil Nadu, India
2 Department of Prosthodontics, Sree Balaji Dental College, Chennai, Tamil Nadu, India

Date of Web Publication30-Mar-2017

Correspondence Address:
P David Charles
29/17, Secretariat Colony, 1st Street, Kilpauk, Chennai - 600 010, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-433X.203484

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  Abstract 

Management of a hard and soft tissue defect with an acrylic prosthesis has been proved to be very successful in the esthetic zone. The gingival prosthesis is provided when surgical management is either difficult or failed. In the present case report is an innovative method of management of Kennedy's Class I maxillary arch with gingival recession in the anterior teeth with a combined prosthesis.

Keywords: Gingival prosthesis, gingival recession, permanent soft liner, removable denture


How to cite this article:
Charles P D, Anandapandian PA. An innovative restorative method for management of complex esthetic problems in partially edentulous mouth using the concept of Cu-sil denture. SRM J Res Dent Sci 2017;8:30-3

How to cite this URL:
Charles P D, Anandapandian PA. An innovative restorative method for management of complex esthetic problems in partially edentulous mouth using the concept of Cu-sil denture. SRM J Res Dent Sci [serial online] 2017 [cited 2022 Jul 5];8:30-3. Available from: https://www.srmjrds.in/text.asp?2017/8/1/30/203484


  Introduction Top


Management of gingival defects has always been a challenging task for any clinician. Rehabilitation of the defect can be done either surgically by grafting or prosthetically by means of gingival replacement prosthesis.[1] Even though surgeries using soft tissue grafts have promising results, in severe conditions, it may not provide the esthetically acceptable results. The only alternative in such cases is gingival veneer prosthesis.[2]

A gingival veneer is defined as a prosthesis worn in the labial aspect of the dental arch, which aims to restore the mucogingival contour and esthetics in areas where periodontal tissue is deficient.[3]

It was first used by Emslie in 1955 for masking the unaesthetic appearance of gingival recession in a patient with postoperative gingivectomy defect. Miller classified gingival recession as Class I: marginal tissue recession not extending to the mucogingival junction (MGJ). No loss of interdental bone or soft tissue, Class II: marginal recession extending to or beyond the MGJ. No loss of interdental bone or soft tissue, Class III: marginal tissue recession extends to or beyond the MGJ. Loss of interdental bone or soft tissue is apical to the cementoenamel junction but coronal to the apical extent of the marginal tissue recession, Class IV: marginal tissue recession extends to or beyond the MGJ. Loss of interdental bone extends to a level apical to the extent of the marginal tissue recession. Among the above, the Class III and IV are better managed using a gingival prosthesis.[1] With proper treatment planning and construction, gingival prosthesis can easily restore the lost structures without altering the labial fullness of the patient. Even very large volumes of soft tissue defect, especially in the esthetic zone.

Materials used for gingival prosthesis include pink auto-cure and heat cure acrylic resin, porcelain, gingival colored composite resins, and thermoplastic acrylics, and other materials inclusive of silicone based maxillofacial materials.[2],[3],[4]

In this case report, a removable acrylic gingival replacement prosthesis combined with removable partial acrylic denture was fabricated to replace the missing gingival portion as well as missing teeth in the posterior region of the maxilla followed by permanent relining.


  Case Report Top


A 45-year-old male patient reported with the chief complaint of missing upper back teeth and black spaces between his anterior teeth. His dental history revealed extraction 8 months ago and followed by periodontal therapy for the remaining natural teeth. Intraoral examination revealed missing 15, 16, 17, 26, and 27. The remaining natural teeth showed traits of failed surgical regenerative procedures with exposure of root surface (Miller's Class III) [Figure 1]a. Following a thorough radiographical examinations, the various treatment options were discussed with the patients who included replacement of missing teeth with dental implants and correction of the esthetic problem with separate gingival prosthesis. The patient chose the option of a removable acrylic partial denture combined with acrylic gum veneer to cover the gingival defect due to economic reasons for the construction of the prosthesis. Impression of maxillary and mandibular arch was made using irreversible hydrocolloid (DPI Algitex Alginate, India), following which the working cast was poured using Type III dental stone [Figure 1]b. Record base with rims was fabricated, and jaw relations were recorded [Figure 2]a and [Figure 2]b. The maxillary cast was surveyed, and the unfavorable undercuts on the labial and palatal surfaces were permanently blocked out with Type II dental plaster [Figure 3]a and [Figure 3]b. The casts were articulated, and teeth arrangements were done. Following the patient approved wax try-in, trial denture was waxed up to cover the exposed root areas to mimic the lost gingival portion [Figure 4]a,[Figure 4]b,[Figure 4]c,[Figure 4]d and processed by conventional compression molding technique heat cure pink acrylic resin (DPI Heat Cure, India). Before denture placement, the prosthesis was prepared for receiving soft liner to aid in better retention of the prosthesis.
Figure 1: (a) Preoperative intraoral view. (b) Partially edentulous maxillary diagnostic cast

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Figure 2: (a and b) Articulated casts following bite registration

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Figure 3: (a and b) Permanent block out on the master cast

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Figure 4: (a) Wax-up following wax try-in - occlusal view. (b) Wax-up following wax try-in - left view. (c) Wax-up following wax try-in - right view. (d) Wax-up following wax try-in - front view

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The denture areas to be relined were trimmed by 1 mm to allow a relining layer of sufficient thickness. Then, the denture was cleaned and air dried. The denture was degreased exclusively with 90% alcohol and air dried. The prepared denture was coated with Ufi Gel P adhesive and loaded with permanent relining material (Ufi Gel P, VOCO America, Inc.) and positioned in the patient mouth. The patient was asked to gently close the mouth in occlusion for 1 min and carry out masticatory and swallowing movements for 5 min. After which, the denture was removed from the mouth. The excess material was removed with fine sharp (cuticle) scissor, and finishing of the transition area was carried out by grinding after 30 min, using Ufi Gel P(REF 2049) polishing disks and abrasive strips under medium to low rotational speed with very light pressure. This prevented heat generation in the relining as well as excessive abrasion of the denture material. Then, the denture was cleaned with alcohol, following which glaze (Ufi Gel P) was applied to seal and smooth the treated surfaces [Figure 5].
Figure 5: Finished and polished denture with permanent relining material in place

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The prosthesis was placed in the patient mouth and evaluated for proper fit [Figure 6], occlusion, and labial fullness [Figure 7]a and [Figure 7]b. Postinsertion instructions included the technique of placement and removal of the prosthesis. To seat the prosthesis, the patient was instructed to engage the prosthesis first in the edentulous space and then to seat the gingival portion in the anterior region and vice versa for removal. Denture cleanser (Efferdent) was advised for hygienic maintenance of the prosthesis.
Figure 6: Intraoral view of the denture

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Figure 7: (a) Preoperative image without the prosthesis. (b) Postoperative image with the prosthesis with no change in labial fullness

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  Discussion Top


Mild to moderate gingival defects in the esthetic zones such as the anterior maxilla can be easily corrected using surgical procedures while larger defect more than 5–6 mm requires camouflage management with artificial substitutes such as gingival prosthesis.[5],[6] The major advantages of gingival prosthesis are its pleasing appearance, restoration of function without any extensive surgical procedure when a large amount of defect is to be covered.[7],[8]

In the present case report, the patient's periodontal condition was compromised in the maxillary arch.[9] Even after the periodontal surgery, there was no desirable outcome with regards to the exposed roots, thereby creating a soft tissue defect which necessitated the need for a gingival prosthesis.

The gingival prosthesis has shown promising esthetic results in patients with gingival defect.[10],[11] When gingival prosthesis was combined with the removable acrylic partial denture, it proved to be an efficient way for restoring function. In the present case report the use of permanent relining material which stays soft permanently has proved to be an better alternative for the existing materials. The permanent relining material acts like a gasket of stable silicone rubber which hugs the natural teeth as that of a Cu-sil denture and also aids in good retention of the prosthesis.

In other techniques, the relining materials were replaced periodically because of the accumulation of the food particles which will lead to fungal and bacterial infection and furthermore deteriorate the oral structures. The replacement involves removal of the old liner, which may trim away the portions of acrylic leading to thinning of the denture base material, causing fracture of the prosthesis. The use of the permanent reline material (Ufi Gel P, VOCO America, Inc.) has been proved to be a top quality relining silicone used for complete relining in one single session (chair side). It remains permanently soft till the life of the denture. Special adhesive provided by the manufacturer for extreme bonding of silicone to denture is an important advantage preventing the material from peeling out. Its biocompatibility (being methacrylate-free) neutral odor and taste and esthetic color with chameleon effect prove to be an added advantage. Its excellent adaptation to the basal tissues ensures a precise fit and resistance against standard denture cleansers.[12],[13]


  Conclusion Top


The restorative dentist faces numerous clinical challenges, especially in the management of partially edentulous arches. The added complexity of the presence of black triangles due to loss of interdental gingival papilla may be an esthetic challenge. At times, simple modification of existing treatment option such as a conventional acrylic removable prosthesis may provide satisfying results to the patients.

The presented case report is a innovative modification for a combined prosthesis with the use of newer dental materials to solve a complex clinical situation with acceptable and durable esthetic and functional treatment outcome.

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.
Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13.  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.
Greene PR. The flexible gingival mask: An aesthetic solution in periodontal practice. Br Dent J 1998;184:536-40.  Back to cited text no. 3
    
4.
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. 4
    
5.
Oates TW, Robinson M, Gunsolley JC. Surgical therapies for the treatment of gingival recession. A systematic review. Ann Periodontol 2003;8:303-20.  Back to cited text no. 5
    
6.
Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: A systematic review. J Clin Periodontol 2002;29 Suppl 3:178-94.  Back to cited text no. 6
    
7.
Barzilay I, Irene T. Gingival prostheses – A review. J Can Dent Assoc 2003;69:74-8.  Back to cited text no. 7
    
8.
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.  Back to cited text no. 8
    
9.
Emslie RD, A case of advanced periodontitis complex. Dental Practitioner 1955;5:432-3.  Back to cited text no. 9
    
10.
L'Estrange PR, Strahan JD. The wearing of acrylic periodontal veneers. Br Dent J 1970;128:193-4.  Back to cited text no. 10
    
11.
Hickey B, Jauhar S. Gingival veneers. Dent Update 2009;36:422-4, 426, 428.  Back to cited text no. 11
    
12.
Pahuja RK, Garg S, Bansal S, Dang RH. Effect of denture cleansers on surface hardness of resilient denture liners at various time intervals- an in vitro study. J Adv Prosthodont 2013;5:270-7.  Back to cited text no. 12
    
13.
Shakir IA, Abraham PA, Vasanthakumar M. A treatment approach restoring esthetics in gingival recession in an anterior implant: A clinical report. SRM J Res Dent Sci 2012;3:82-5  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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