Gingival cascade/ cosmetic dentistry training

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  • 1. GINGIVAL CASCADE (FACADE) : ANGINGIVAL CASCADE (FACADE) : AN ESTHETIC SOLUTION IN DENTALESTHETIC SOLUTION IN DENTAL PRACTICEPRACTICE - A CLINICAL REPORT- A CLINICAL REPORT INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. INTRODUCTIOINTRODUCTIO NN  ““Beauty lies in the eyes of the beholder”.Beauty lies in the eyes of the beholder”.  Dental esthetics is based on the “white component”Dental esthetics is based on the “white component” (teeth ) and the “pink component” (the gingiva).(teeth ) and the “pink component” (the gingiva).  Loss of alveolar ridge with several anterior teeth -Loss of alveolar ridge with several anterior teeth - through surgery or periodontal bone loss.through surgery or periodontal bone loss.  Poor esthetics and phonetics.Poor esthetics and phonetics. www.indiandentalacademy.com
  • 3. There are three approachesThere are three approaches to this problem:to this problem: 1) Anterior Fixed Partial Denture.1) Anterior Fixed Partial Denture. 2) A tooth borne Removable2) A tooth borne Removable Partial Denture.Partial Denture. 3) “Andrews Bridge” - A3) “Andrews Bridge” - A combination of abutmentcombination of abutment retainers with bar suspendedretainers with bar suspended between them and thebetween them and the corresponding sleeve overlaidcorresponding sleeve overlaid with acrylic resin denturewith acrylic resin denture teeth and the gingiva.teeth and the gingiva. Introduction… www.indiandentalacademy.com
  • 4.  This clinical report describes the fabrication of aThis clinical report describes the fabrication of a Gingival Cascade, by using a simple two stageGingival Cascade, by using a simple two stage impression technique (buccal approach).impression technique (buccal approach). Introduction… www.indiandentalacademy.com
  • 5. CASE REPORTCASE REPORT HistoryHistory:-Trauma that resulted in:-Trauma that resulted in the loss of upper central andthe loss of upper central and lateral incisors 3 years ago.lateral incisors 3 years ago. ExaminationExamination :-:- MissingMissing - 11, 12, 21 and 22.- 11, 12, 21 and 22. PreparedPrepared - 13 and 23- 13 and 23 Deficient maxilla in the anteriorDeficient maxilla in the anterior region.region. A 53 years old male patient was referred to Dept. of Prosthodontics, for prosthetic rehabilitation of missing upper anterior teeth. www.indiandentalacademy.com
  • 6. TREATMENT PLANTREATMENT PLAN  Placement of twoPlacement of two implants in 12 and 22implants in 12 and 22 region with four unit F.P.Dregion with four unit F.P.D  Individual crowns for 13Individual crowns for 13 and 23and 23  Gingival Cascade - fromGingival Cascade - from heat cure acrylic material.heat cure acrylic material. Case Report… www.indiandentalacademy.com
  • 7. PROCEDUREPROCEDURE A labial acrylic custom trayA labial acrylic custom tray was fabricated on thiswas fabricated on this diagnostic cast extending uptodiagnostic cast extending upto the distal embrasure of the firstthe distal embrasure of the first premolar, located on thepremolar, located on the buccal cusp tips and thebuccal cusp tips and the incisal edges only.incisal edges only. Primary impression of the upper arch was made using irreversible hydrocolloid impression material and a diagnostic cast obtained. www.indiandentalacademy.com
  • 8.  Palatal barrier : A silicone puttyPalatal barrier : A silicone putty was mixed and molded on thewas mixed and molded on the palatal aspect of teeth to bepalatal aspect of teeth to be treated. After setting , this barriertreated. After setting , this barrier was trimmed so that it preventswas trimmed so that it prevents the final impression material fromthe final impression material from escaping palatally withoutescaping palatally without encroaching the interdentalencroaching the interdental space.space.  Final Impression was made byFinal Impression was made by using a polyvinyl siloxaneusing a polyvinyl siloxane impression material and poured inimpression material and poured in artificial stone to get the workingartificial stone to get the working model.model. Procedure… www.indiandentalacademy.com
  • 9.  Wax Pattern : The cascade wasWax Pattern : The cascade was waxed up exactly as it has towaxed up exactly as it has to appear and tried in the patientsappear and tried in the patients mouth for its adaptation.mouth for its adaptation.  The pattern was then flaskedThe pattern was then flasked  Colors and stains were added atColors and stains were added at the packing stage so as to get thethe packing stage so as to get the desired characterizationdesired characterization  It was processed in theIt was processed in the conventional manner.conventional manner. Procedure… www.indiandentalacademy.com
  • 10.  The prosthesis was finished,The prosthesis was finished, polished, and inserted in thepolished, and inserted in the patient’s mouth.patient’s mouth.  Instructions were givenInstructions were given regarding the insertion andregarding the insertion and removal of the prosthesis.removal of the prosthesis.  No direct retention was requiredNo direct retention was required as the musculature of the lipas the musculature of the lip holds the prosthesis firmly inholds the prosthesis firmly in place. The patient must manuallyplace. The patient must manually raise the lip to remove theraise the lip to remove the cascade.cascade. Procedure… www.indiandentalacademy.com
  • 11. BEFOREBEFORE AFTERAFTER www.indiandentalacademy.com
  • 12. DISCUSSIONDISCUSSION  Gingival defects - surgical or prosthetic approaches.Gingival defects - surgical or prosthetic approaches.  SURGICAL TREATMENTSURGICAL TREATMENT - Successful only when small- Successful only when small volumes of tissues are being reconstructed.volumes of tissues are being reconstructed. Not popular because of cost, healing time, discomfort andNot popular because of cost, healing time, discomfort and unpredictability.unpredictability.  PROSTHETIC APPROACHPROSTHETIC APPROACH - removable or fixed- removable or fixed prosthesis.prosthesis. Different materials - Cold cure and heat cure acrylicDifferent materials - Cold cure and heat cure acrylic materials, porcelain, as well as silicone based softmaterials, porcelain, as well as silicone based soft materials.materials. www.indiandentalacademy.com
  • 13. A FIXED PROSTHESISA FIXED PROSTHESIS – comfort, peace of mind and– comfort, peace of mind and self confidence. Its use is limited to areas only whereself confidence. Its use is limited to areas only where oral hygiene can be maintained.oral hygiene can be maintained. SILICONE –SILICONE – Flexible Prosthesis:Flexible Prosthesis: Limitations:-Limitations:- 1. Expensive.1. Expensive. 2. Accumulation of stains and plaque because of2. Accumulation of stains and plaque because of inherent porosity of silicone material.inherent porosity of silicone material. 3.Possibility of ingestion of the prosthesis during3.Possibility of ingestion of the prosthesis during function.function. Discussion… www.indiandentalacademy.com
  • 14. The described technique i.e. fabrication ofThe described technique i.e. fabrication of Gingival Cascade by using heat cure acrylic resinGingival Cascade by using heat cure acrylic resin material has several advantages:material has several advantages: 1. It is simple and inexpensive1. It is simple and inexpensive 2. It uses only conventional laboratory procedures2. It uses only conventional laboratory procedures 3. No complex attachments or bars involved3. No complex attachments or bars involved 4. Allows try in of the prosthesis at the wax pattern4. Allows try in of the prosthesis at the wax pattern stage.stage. Discussion… www.indiandentalacademy.com
  • 15. CONCLUSIONCONCLUSION A technique for restoring an anterior edentulousA technique for restoring an anterior edentulous space accompanying severe alveolar bone loss hasspace accompanying severe alveolar bone loss has been describedbeen described This technique combines fixed and removableThis technique combines fixed and removable restorations to achieve an acceptable esthetic andrestorations to achieve an acceptable esthetic and functional results.functional results. The technique described is relatively simple,The technique described is relatively simple, inexpensive and hygienic.inexpensive and hygienic. The cosmetic results achieved from this prosthesisThe cosmetic results achieved from this prosthesis has enabled many patients to smile with confidence.has enabled many patients to smile with confidence. www.indiandentalacademy.com
  • 16. Thank you… For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com