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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 9  |  Issue : 2  |  Page : 123-125

Reconstruction of the red-white boundary with pink composite


1 Department of Conservative Dentistry and Endodontics, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
2 Department of Pedodontics, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Date of Submission07-Dec-2019
Date of Decision09-Jan-2020
Date of Acceptance13-Jan-2020
Date of Web Publication3-Feb-2020

Correspondence Address:
Dr. Balasubramaniam Anuradha
Department of Conservative Dentistry and Endodontics, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Narayanapuram, Pallikaranai, Chennai - 600 100, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_59_19

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  Abstract 


The composition of smile architecture includes pink gingiva and white tooth structure which gives an esthetic appearance. As age advances, gingival recession is seen which contributes to dentinal hypersensitivity and unsightly smile esthetics. Due to this, increasing number of patients are seeking dentists for the absence of pink-colored gingiva. Pink composites are gingival-colored composites that help to create a life-like tooth easily by reconstructing the red-white boundary with superior esthetics. This material provides long-lasting, high esthetic restorations with low abrasive values and high compressive and transverse strength. This shares a case report on how pink composites help in reconstructing the red-white boundary.

Keywords: Gingiva; pink composite; red-white boundary; shades


How to cite this article:
Anuradha B, Devakar R, Aarthi J, Mitthra S. Reconstruction of the red-white boundary with pink composite. Indian J Multidiscip Dent 2019;9:123-5

How to cite this URL:
Anuradha B, Devakar R, Aarthi J, Mitthra S. Reconstruction of the red-white boundary with pink composite. Indian J Multidiscip Dent [serial online] 2019 [cited 2020 Sep 19];9:123-5. Available from: http://www.ijmdent.com/text.asp?2019/9/2/123/277457




  Introduction Top


Tooth wear leading to dentin hypersensitivity (DHS) is a common clinical scenario that clinicians are confronted with in their day-to-day practice, the prevalence of which might probably increase with aging.[1] Patients suffering from orofacial pain or pain due to DHS may feel disturbed physically and emotionally, causing a sense of helplessness and rely on the clinician completely to resolve their problem.[2],[3]

Individuals suffering from periodontal disease frequently have exposed radicular dentin as do the healthy individuals, for example, overzealous tooth brushing and trauma to the gingival marginal tissues, with subsequent wear of dentin.[4] Frequent symptoms of these patients include sensitivity and unesthetic appearance of the affected teeth. This, in turn, can have a negative impact on their quality of life, especially with regards to dietary selection, maintaining optimal dental hygiene and esthetics.[5]

The prevalence rate of DHS ranges between 2%–8% and 74%.[6] As reported by Gillam et al., clinicians observed a prevalence rate of 10%–25% of DHS for their patients, and it is considered a serious problem for 1% of them.[7] The clinical crown lengths of the affected teeth appear longer than the adjacent unaffected teeth, leading to an unesthetic appearance. Full coverage crowns may be an excellent option for such teeth. However, the recent adhesive technologies offer superior direct esthetic restorations.[8] Reconstruction of the “gingival garland line” poses a major challenge in such patients, which can be overcome by the use of pink composites.

The pink composite was introduced by Zalkind and Hochman in 1997, a gingival-colored composite that helps to create a life-like tooth easily by reconstructing the red-white boundary with superior esthetics. This material provides long-lasting, high esthetic restorations with low abrasive values, high compressive, and transverse strength.[9] In this article, we present a case report where pink composite was used to restore multiple teeth with gingival recession.


  Case Report Top


A 32-year-old male reported to the Department of Conservative Dentistry and Endodontics, Sree Balaji Dental College and Hospital with a chief complaint of receding gums in multiple teeth. Intraoral examination revealed gingival recession in relation to tooth numbers - 12, 13, 14, 15, 16, 23, 24, 31, 32, 33, 34, 41, 42, 43, 44, and 45. The routine radiographic investigation of these teeth revealed no periodontal pathologies. The patient desired high esthetic restoration of his teeth. The pink composite was our material of choice for this patient (AMARIS, VOCO, USA). This includes one base shade and three opaquer shades that can be mixed to reproduce desirable gingival color [Figure 1]. These shades of opaquer are available as white, light, and dark. Buccal aspects of the affected teeth were cleaned with the polish brush. Gingiva was healthy and adapted well on root surfaces. A minimal preparation was carried out in the areas with caries. The noncarious and the sclerotic dentin areas were prepared with minimal invasion by rotating burs. A small groove was prepared at the gingivoaxial wall for better retention. Caries-free areas were rinsed with fluoride paste.
Figure 1: Pink composite kit

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Shade matching was done before the placement of magic foam for the better matching with the tissues. It was done with the help of a shade guide that indicates the shade effect of the opaquers in combination with the compomer material. It consists of light gingival, dark gingival, and white. The shade was matched by mixing above light-cured materials with opaquer. The magic foam was applied to prevent blood and saliva contamination and to provide a clear operating field. Dark and yellow cervical areas impaired the shade of the restoration, so they were covered with an enclosed opaque system before the application of the material.

Enamel surface was etched with 35% orthophosphoric acid for 30 s and washed and dried followed by an adhesive system that was applied on both enamel and dentin. The adhesive system was air thinned for 5 s and light-cured for 20 s.

Opaquer was applied as thin layers, and the surface was light-cured for 20 s. Opaquer was applied on the surface to obtain a natural and stable color appearance and gives an opportunity for the color choice. Then, pink composite was applied in incremental layers of 2 mm thickness maximum and light-cured for 30 s per increment. The restorations were finished and polished with ultra-fine yellow flamed diamond burs. [Figure 2]a shows the preoperative image of the patient's dentition with a gingival recession and [Figure 2]b shows the postoperative image of the dentition after correction with pink composite.
Figure 2: (a) Preoperative image of the patient's dentition with gingival recession (b) postoperative image of the dentition after correction with pink composite

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  Discussion Top


The gingival architecture represents the frame for the teeth and if not restored appropriately, will impair its final three-dimensional esthetics.[10],[11],[12] Gingival restorations with pink composite materials can overcome the limitations of grafting and acts as a good alternative for reconstructing tissues with excellent finish lines. The most challenging cases are those involving anterior teeth requiring a more comprehensive approach and deeper understanding of the pink component of the smile, the gingiva. These materials provide high retention and color stability with minimal shrinkage. The procedure of placement of pink composites is minimally invasive, cost-effective, and less time-consuming. In addition, the “black holes” induced by the loss of interdental papillae as a consequence of periodontitis or gingival recession can be easily treated with this gingival-colored material.[12] Long-term success of these restorations depends on proper case selection, following the procedural steps meticulously, and maintaining proper oral hygiene. High occlusal loadings cause a larger disruption of bonds between hydroxyapatite crystals on both enamel and dentin tissue at cervical areas occurring as abfraction in the tooth.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Martens LC. A decision tree for the management of exposed cervical dentin (ECD) and dentin hypersensitivity (DHS). Clin Oral Investig 2013;17 Suppl 1:S77-83.  Back to cited text no. 1
    
2.
Porto IC, Andrade AK, Montes MA. Diagnosis and treatment of dentinal hypersensitivity. J Oral Sci 2009;51:323-32.  Back to cited text no. 2
    
3.
Pau AK, Croucher R, Marcenes W. Perceived inability to cope and care-seeking in patients with toothache: A qualitative study. Br Dent J 2000;189:503-6.  Back to cited text no. 3
    
4.
Addy M. Dentine hypersensitivity: New perspectives on an old problem. Int Dent J 2002;2:367-75.  Back to cited text no. 4
    
5.
Davari A, Ataei E, Assarzadeh H. Dentin hypersensitivity: Etiology, diagnosis and treatment; a literature review. J Dent (Shiraz) 2013;14:136-45.  Back to cited text no. 5
    
6.
Que K, Guo B, Jia Z, Chen Z, Yang J, Gao P. A cross-sectional study: Non-carious cervical lesions, cervical dentine hypersensitivity and related risk factors. J Oral Rehabil 2013;40:24-32.  Back to cited text no. 6
    
7.
Gillam DG, Bulman JS, Eijkman MA, Newman HN. Dentists' perceptions of dentine hypersensitivity and knowledge of its treatment. J Oral Rehabil 2002;29:219-25.  Back to cited text no. 7
    
8.
Tagtekin D, Yanikoglu F, Ozyöney G, Noyan N, Hayran O. Clinical evaluation of a gingiva-coloured material, Comp Natur: A 3-year longitudinal study. Chin J Dent Res 2011;14:59-66.  Back to cited text no. 8
    
9.
Paryag AA, Rafeek RN, Mankee MS, Lowe J. Exploring the versatility of gingiva-colored composite. Clin Cosmet Investig Dent 2016;8:63-9.  Back to cited text no. 9
    
10.
Zalkind M, Hochman N. Alternative method of conservative esthetic treatment for gingival recession. J Prosthet Dent 1997;77:561-3.  Back to cited text no. 10
    
11.
Kass JJ, McCoy R. assignee. Trailer Body. United States Patent Application US 29/063, 557. Reese Products Inc.; 1998.  Back to cited text no. 11
    
12.
Coachman C, Calamita M. The reconstruction of pink and white esthetics. Int Dent SA 2010;12:88-93.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]



 

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