Page 18 - Dental Practice South Asia 18-6

multidisciplinary section

THE DIGITAL APPROACH IN THE MANAGEMENT OF

ANTERIOR SURGICAL-PROSTHETIC TREATMENT

ROBERTO MOLINARI, MD

With this article I want to propose a new
approach to digital dentistry, showing new
surgical prosthetic work protocols in terms of
complex aesthetic rehabilitations in the ante-
rior, with particular reference to patients who
exhibit a “Gummy Smile”.
More precisely, I would like to introduce
the digital work protocol I adopt when I need
to preserve the original morphology of soft
tissues (gingival parabolas and papillae) in FIG 1A: Ideal anterior esthetic composition FIG 1: Initial photos of the face
the anterior; it involves the use of matrices of
customizable collagen and temporary pros-
thetics that are digitally fabricated.
It goes without saying that to achieve an
optimal result in aesthetic cases, it is neces-
sary to have a certain harmony between soft
tissues and prosthetics: this means that the
interdental papillae, gingival parabolas, den-
tal axes and the dominance of central incisors
must all be well balanced with each other
(Figure 1a). FIG 2: Initial intraoral photos FIG 3: Initial post-trauma CBCT
The digital management of aesthetic cases
in which it is essential to perform a surgical
intervention in an anterior area such as the
placement of a dental implant requires
greater attention to detail, especially if the
patient has a “gummy smile”.
To keep the position and thickness of the
papillae and gingival parabolas stable it is rec-
ommended to perform a free gingival graft in
the vestibular area of the implant. The place- FIG 4: Emergency solution FIG 5: Digital smile Design
ment of connective tissue in this area is
essential not only from an aesthetic point of valid alternative to the conventional path so it was not possible to perform a reimplan-
view, but also with a view to maintaining the which, to date, represents the gold standard. tation of the tooth 2.1. In order to support
long-term health of the implant. the soft tissues of this area (papillae and gin-
The most widely used method involves CLINICAL CASE gival margin), and as an immediate solution,
the removal of a donor graft from the palate Following a facial trauma, a 24-year-old I excised the root of tooth 2.1 and made a
or near the tuberosity. A conventional patient with a gummy smile, lost tooth 2.1. provisional using only the crown, adapted
approach of this type presents the following tooth 1.1 is palatally displaced and 1.2 suffers and modified with composite on its cervical
risks: slight damage to the incisal edge (Figures 1 side. Subsequently, by means of a braided
1) hemorrhage of the donor area and 2). metal wire and flowable resin, I luted the
2) graft necrosis CBCT shows a fracture of both correspon- detached tooth to the adjacent teeth (Figure
3) neurological damage ding buccal cortical plates of the two upper 4).
4) aesthetic damage central incisors (Figure 3).
5) pain, swelling and paresthesia CASE STUDY AND TREATMENT PLAN
The use of a collagen matrix, as evidenced IMMEDIATE THERAPY In all cases where aesthetics are involved, I
in the clinical case which follows, can be a I first saw the patient 3 days after the trauma always perform the aesthetic study of the

18 Dental Practice // November-December 2022 // Vol 18 No 6