This presentation discusses periodontal considerations in esthetic fixed prosthodontics. It covers key elements of a healthy smile including gingival health, interdental embrasures, zenith points, gingival level and harmony, and lip line. It describes the characteristics of a healthy gingiva and importance of interdental papillae. Factors like zenith points, gingival contours and excessive gingival display are discussed. The role of periodontal plastic surgery in creating an esthetic smile is highlighted. Clinical cases demonstrate how periodontal treatment can optimize esthetics. References on the topic are provided.

1. Welcome
TO OUR PRESENTATION
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2. Small INTRO
Important information about the Periodontal Esthetics
The primary elements of beautiful
smile are aligned teeth, related to each
other and to the surrounding soft tissue
that act as their frames.
The esthetic components of the
gingiva that contribute to the beauty of
the smile are:
• Gingival health
• Interdental embrasures
• Zenith points
• Gingival level and harmony
• Lip line
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3. Gingival Health How a healthy gingival looks like?
Elements of a Healthy Gingiva The surface
The Free Gingiva extends from the free gingival The gingiva has a Pale Pink color, firm texture
margin to the gingival groove (keratinized and attached), and stippling
(orange-peel appearance).
The Attached Gingiva extends from the gingival
groove to the mucogingival junction The prosthodontic treatment should be
postponed until the health of the gingiva is
The Alveolar Mucosa extends apical to the restored, to allow us to designs the prosthesis to
mucogingival junction achieve maximum esthetic results.
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4. Interdental Embrasure
Interdental Papilla Clinical Importance
Interdental papilla should be thin, form a It may be possible to compensate for the open
pyramid shape, ends in a knife edge contour, and embrasures by restorative means.
completely fill the interdental embrasure.
If the oral hygiene is neglected, periodontal
disease can result in alteration of the gingival
architecture or complete loss of papilla.
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5. Zenith Points
Definition Clinical Importance
The most apical point of the gingival outline The Zenith point has special importance when
where the gingiva is scalloped most. Usually lies closing diastema: if the Zenith points are not
distal to the center of the tooth, with the moved mesially from the original position, the
exception of the lateral incisors in some cases. finished prosthesis may give the perception of
being mesially tilted.
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6. Gingival Level & Harmony
Gingival Level Clinical Importance
The gingival contour of the lateral incisor ideally In case of deformity, plastic periodontal surgery
should lie 0.5 ~ 1 mm coronal to the level of the can be used to optimize the gingival contours.
central incisor and canine. The tip of the papilla is Removal of excess gingiva, bone and new root
most incisally between the two centrals, and coverage procedures can be used to create the
gradually assumes a more cervical position beautiful smile.
toward the canine.
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7. Lip Line
Tooth Visibility Excessive Gingival Display
Ideally; 75% ~ 100% of upper teeth show when Altered passive eruption can be a cause of
smiling, and 3 ~ 4 mm when talking. Low lip line excessive gingival display and short clinical
will cover more of the upper teeth and show crowns which can be corrected with periodontal
more of the lower teeth, giving an elderly osseous surgery. Other treatment modalities can
appearance. With high lip line we will have: be implemented to treat excessive gingival
display, including orthodontics and orthognathic
surgery.
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8. Clinical Cases
Lost papilla, open embrasures Redistribution of the spaces Final Restoration
Excessive gingival display During surgery After treatment
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9. Our References
Carrranza’s Clinical Periodontology
Gurel, Galip. The Science and art of porcelain
laminate veneers. 2003 Quintessence Publishing.
Magne, Pascal. Bonded porcelain restorations in
the anterior dentition: a biomimetric approach.
2003 Quintessence Publishing.
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10. Show is over
YOU MAY NOW RELAX!
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