Pink Aesthetics – Gummy smile

This is a surgical procedure commonly used in the cosmetic zone, before all-ceramic restorations, to achieve harmony between teeth and gums in a new, natural and aesthetic smile. It usually affects the anterior upper 6 teeth, and it is done in a single visit with immediate results. The goal is to correct gums severely discolored or uneven between the teeth, so that the new smile displays the right proportions.

Smile Design creates an ideal smile in relation to the teeth and the aesthetics of pink. With respect to biology, bone measurements are performed on CT scans, resulting in an accurate surgical design that ensures a balance between aesthetics and longevity. After the surgery, there is a slight to no sensitivity, the results are immediate and the healing is usually completed 6 weeks later.

Soft tissue grafts

During the surgical procedure, a piece of soft tissue is transferred to a point where there is a deficiency. It usually affects areas around implants that have lost keratinized gums or cover cervical recessions due to periodontitis, periimplantitis, or trauma (de-epithelialized connective tissue graft). Typical areas are usually the hard palate or the tuberosity. The procedure is demanding, fine sutures and ophthalmology scalpels are used under magnification and requires the full cooperation of the patient during the first period. Soft tissue maturation is observed 4-6 months later, ensuring stable, healthy results around implants or all-ceramic restorations.

Free graft 

A small piece of keratinized gum is removed from the palate and placed in another area to change local biology and increase width of attached gingiva or to cover a small recession. The graft bleeds again into the new site, increasing the thickness and width of keratinized tissues, usually in Miller I and II classification, before orthodontic treatment or before implant placement. The main disadvantage is the difference in the color of the soft tissues, after the procedure which is due to the different DNA of the donor area, while the main advantage seems to be the quite predictable process and the increased survival prognosis.

De-epithelialized connective tissue graft 

It is the most common process of correcting recessions and increasing the thickness of gum tissue. A piece of epithelial tissue is usually removed from the palate and placed after the epithelium is removed under the gums in the new location. It does not have the characteristics of the donor area, therefore it does not alter its color, creating aesthetic problems. It is usually combined with a coronally advanced flap for better perfusion and prognosis of the graft. Healing of the donor area is easier than free grafts.

Coronal advanced flap (CAF/VAF)

Gum tissue from a neighboring or the same area is not removed but is transferred apically to a new location in order to cover an existing one. It is commonly used in combination with a de-epithelialized graft to increase the general thickness of the gum tissue. The main advantage is that the tissue is not removed from the donor area but is repositioned thus maintaining perfusion and the ability to heal with an increased prognosis. Vestibuloplasty or frenectomy are assigned to this procedure as well.

A cellular dermal collagen matrix (Mucoderm)

It is a three-dimensional matrix of collagen I and III that resembles human connective tissue. They are grafts of xenogeneic origin that are used instead of connective tissue grafts. The result is a new, enlarged gum tissue depending on the DNA of the area (biomimetics) with the main advantage being the reduction in discomfort felt by the patient as he does not need a donor area.

Emdogain

Amelogenin – Protein aimed at increasing the regenerative capacity of the periodontal ligament.