Study Results
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Basic Information
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UNKNOWN
NA
18 participants
INTERVENTIONAL
2023-10-01
2024-11-30
Brief Summary
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The main question it aims to answer is:
Does the fully digital guided gingivectomy approach able to introduce a more precise, accuracy and reliability technique with more patient satisfaction compared to the conventional guided method?
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Detailed Description
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The term "pink aesthetics" refers to the aesthetics of gingival tissues, which play a significant influence in smile aesthetics.
Excessive gingival display while smiling, also usually known as a "gummy smile," is a common esthetic concern among dental patients and, being largely viewed as unesthetic, leads many patients to seek some form of treatment to address the issue.
Gummy smile (Excessive gingival display) is recognized by the American Academy of Periodontology (AAP) as a deformity and mucogingival condition that affects the area around the teeth.
This condition could be caused by many etiological factors: short lip, hypermobile/hyperactive lip, short clinical crowns, dentoalveolar extrusion, altered passive eruption (APE), gingival hyperplasia, and vertical maxillary excess.
Altered passive eruption defined as "the gingival margin in the adult is located incisal to the cervical convexity of the crown and removed from the cementoenamel junction of the tooth".
Altered passive eruption classified into two main classes according to the relationship of the gingiva to the anatomic crown and furthermore subdivided those classes according to the position of the osseous crest. The two types are subdivided into four categories: 1A, 1B and 2A, 2B.
The diagnosis of APE is made on a collective clinical and radiographic examination, it begins with analyzing the repose during a natural smile followed by analyzing the gingival display, the alveolar crest level, as well as the lip line of the patient.
Determination can be made whether a gingivectomy alone will suffice or a gingival flap will be needed with or without ostectomy will depend of the diagnosis of APE and classification of each case.
The selection of one technique over another depends on several patient related factors such as esthetics, clinical crown to root ratio, root proximity, root morphology, furcation location, individual tooth position, collective tooth position and ability to restore the teeth.
The gingivectomy approach alone is used when 3 mm gingival tissue or greater exists from bone to gingival crest, and an adequate attached gingiva will remain after surgery (APE type IA).
A diagnostic wax-up then an intraoral fabricated mock-up representing the desired outcome can assist in the selection of proper planning of the need for periodontal surgical approach.
Diagnostic mock-up fabricated using a temporary bis-acrylic resin with a putty guide directly from the wax-up can be used to provide the patient and clinician with an evaluation of the future outcome and can be used as a surgical guide for gingivectomy procedures.
The major limitations with conventional guided gingivectomy procedure would be the time consumed during making and modifying conventional wax-ups as well as the unpredictable estimate of where the gingival margin should be.
Utilization of digital workflows allowed the enhancement of communication and might improve the predictability of contemporary gingivectomy approach.
The introduction of computer-aided design and computer-aided manufacturing (CAD-CAM) techniques has helped surgeons perform more precise and predictable surgery and contributed to improved esthetics.
By combining the use of Digital Smile Design and CAD/CAM technology with (3D) printing, a surgical guide for Gingivectomy procedure could be produced.
The aim of the present study will be to evaluate accuracy and reliability of digital guided method of gingivectomy procedure using CAD CAM technology versus conventional method using resin Mock-up as gingivectomy surgical guide.
Research Question "Does the fully digital guided gingivectomy approach able to introduce a more precise, accuracy and reliability technique with more patient satisfaction compared to the conventional guided method?"
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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Digital workflow-based Protocol
Fully digital guided gingivectomy procedure
Fully digital guided gingivectomy procedure
1. Full history with clinical and radiographic examination (CBCT) to aid in patient's selection.
2. Supra- and sub-gingival debridement.
3. Oral hygiene instructions (OHI)
4. Presurgical intraoral scanning using an intraoral scanner (IOS)
5. Fabrication of the Gingivectomy guide:
* Convert (DICOM) file to STL file then merged to STL file corresponding oral soft tissues 3D data obtained by IOS using software of surgical planning.
* Digital waxing up with new desired positions of gingival margins and zenith points performed.
* Designing Gingivectomy guide then exported to a 3D printer and mill a transparent resin gingivectomy guide.
6. Surgical Procedure: anesthetized the patient using local anesthesia, Surgical incision using 15c blade following CEJ anatomy will be made at each tooth using the Gingivectomy guide as reference to new gingival level and being careful to preserve the gingival papillae without involving the palatal surfaces.
7. Postoperative care
Mock-up workflow-based Protocol
Convectional guided gingivectomy procedure
Convectional guided gingivectomy procedure
1. Full history with clinical and radiographic examination (CBCT) to aid in patient's selection.
2. Supra- and sub-gingival debridement with OHI
3. Gingivectomy guide fabrication:
* Impressions and casts obtained.
* Waxing-up included new positions of gingival margins and zenith points.
* Silicone index with condensation silicone impression materials made with pressure on the cast to reproduce the details of the wax, then filled after setting with resin material and placed in the patient's mouth.
* Resin mock-up trimmed with blade to define the correct new gingival level.
* After the patient accept the mock-up design will used as Gingivectomy guide.
4. Surgical Procedure: anesthetized the patient using local anesthesia, Surgical incision using 15c blade following CEJ anatomy will be made at each tooth using the Gingivectomy guide as reference to new gingival level and being careful to preserve the gingival papillae without involving the palatal surfaces.
5. Postoperative care
Interventions
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Fully digital guided gingivectomy procedure
1. Full history with clinical and radiographic examination (CBCT) to aid in patient's selection.
2. Supra- and sub-gingival debridement.
3. Oral hygiene instructions (OHI)
4. Presurgical intraoral scanning using an intraoral scanner (IOS)
5. Fabrication of the Gingivectomy guide:
* Convert (DICOM) file to STL file then merged to STL file corresponding oral soft tissues 3D data obtained by IOS using software of surgical planning.
* Digital waxing up with new desired positions of gingival margins and zenith points performed.
* Designing Gingivectomy guide then exported to a 3D printer and mill a transparent resin gingivectomy guide.
6. Surgical Procedure: anesthetized the patient using local anesthesia, Surgical incision using 15c blade following CEJ anatomy will be made at each tooth using the Gingivectomy guide as reference to new gingival level and being careful to preserve the gingival papillae without involving the palatal surfaces.
7. Postoperative care
Convectional guided gingivectomy procedure
1. Full history with clinical and radiographic examination (CBCT) to aid in patient's selection.
2. Supra- and sub-gingival debridement with OHI
3. Gingivectomy guide fabrication:
* Impressions and casts obtained.
* Waxing-up included new positions of gingival margins and zenith points.
* Silicone index with condensation silicone impression materials made with pressure on the cast to reproduce the details of the wax, then filled after setting with resin material and placed in the patient's mouth.
* Resin mock-up trimmed with blade to define the correct new gingival level.
* After the patient accept the mock-up design will used as Gingivectomy guide.
4. Surgical Procedure: anesthetized the patient using local anesthesia, Surgical incision using 15c blade following CEJ anatomy will be made at each tooth using the Gingivectomy guide as reference to new gingival level and being careful to preserve the gingival papillae without involving the palatal surfaces.
5. Postoperative care
Eligibility Criteria
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Inclusion Criteria
* Patients classified as Altered Passive Eruption Type 1A
Exclusion Criteria
* Pregnant and lactating females.
* Heavy smoker ≥ 10 cigarettes/day.
* Poor oral hygiene.
* Patients with systemic diseases which could influence the outcome of the therapy e.g.
(Diabetic patients).
* Heavy smoker ≥ 10 cigarettes/day.
* Vulnerable groups of patients e.g. (prisoners, handicapped patients and decisionally impaired individuals)
20 Years
40 Years
ALL
Yes
Sponsors
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Ain Shams University
OTHER
Responsible Party
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Eslam Hashim
Master Student
Principal Investigators
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Ahmed E. Amr, Ass. Prof.
Role: STUDY_DIRECTOR
Faculty of dentistry Ain Shams University
Locations
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Faculty of Fentistry Ain Shams university
Cairo, , Egypt
Countries
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Central Contacts
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References
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Ahmed WM, Hans A, Verhaeghe TV, Nguyen C. Managing Excessive Gingival Display Using a Digital Workflow. J Prosthodont. 2020 Jun;29(5):443-447. doi: 10.1111/jopr.13181. Epub 2020 May 6.
Arias DM, Trushkowsky RD, Brea LM, David SB. Treatment of the Patient with Gummy Smile in Conjunction with Digital Smile Approach. Dent Clin North Am. 2015 Jul;59(3):703-16. doi: 10.1016/j.cden.2015.03.007.
Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999 Dec;4(1):1-6. doi: 10.1902/annals.1999.4.1.1.
Bensimon GC. Surgical crown-lengthening procedure to enhance esthetics. Int J Periodontics Restorative Dent. 1999 Aug;19(4):332-41.
Coslet JG, Vanarsdall R, Weisgold A. Diagnosis and classification of delayed passive eruption of the dentogingival junction in the adult. Alpha Omegan. 1977 Dec;70(3):24-8. No abstract available.
Davarpanah M, Jansen CE, Vidjak FM, Etienne D, Kebir M, Martinez H. Restorative and periodontal considerations of short clinical crowns. Int J Periodontics Restorative Dent. 1998 Oct;18(5):424-33.
De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol. 2009 May;36(5):428-33. doi: 10.1111/j.1600-051X.2009.01398.x.
Dolt AH 3rd, Robbins JW. Altered passive eruption: an etiology of short clinical crowns. Quintessence Int. 1997 Jun;28(6):363-72.
Dym H, Pierre R 2nd. Diagnosis and Treatment Approaches to a "Gummy Smile". Dent Clin North Am. 2020 Apr;64(2):341-349. doi: 10.1016/j.cden.2019.12.003. Epub 2020 Jan 24.
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Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontol 2000. 1996 Jun;11:18-28. doi: 10.1111/j.1600-0757.1996.tb00179.x. No abstract available.
Garcia B, Larrazabal C, Penarrocha M, Penarrocha M. Pain and swelling in periapical surgery. A literature update. Med Oral Patol Oral Cir Bucal. 2008 Nov 1;13(11):E726-9.
Geevarghese A, Baskaradoss JK, Alsalem M, Aldahash A, Alfayez W, Alduhaimi T, Alehaideb A, Alsammahi O. Perception of general dentists and laypersons towards altered smile aesthetics. J Orthod Sci. 2019 Aug 8;8:14. doi: 10.4103/jos.JOS_103_18. eCollection 2019.
Goldman, H.M. & Cohen, D.W. (1968). Periodontal Therapy. 4ed. St. Louis: C.V. Mosby Company.
Gurrea J, Bruguera A. Wax-up and mock-up. A guide for anterior periodontal and restorative treatments. Int J Esthet Dent. 2014 Summer;9(2):146-62.
Herrero F, Scott JB, Maropis PS, Yukna RA. Clinical comparison of desired versus actual amount of surgical crown lengthening. J Periodontol. 1995 Jul;66(7):568-71. doi: 10.1902/jop.1995.66.7.568.
Hejazin, N., Wehbe, C., Wierup, M., Montilla, D.E. & Al-Mashni, L. (2020). Diagnosis and treatment modalities of altered passive eruption: Review and a case report of gummy smile. J Case Rep Images Dent, 6:100034Z07NH2020.
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Levine RA. Forced eruption in the esthetic zone. Compend Contin Educ Dent. 1997 Aug;18(8):795-803; quiz 804.
Liu X, Yu J, Zhou J, Tan J. A digitally guided dual technique for both gingival and bone resection during crown lengthening surgery. J Prosthet Dent. 2018 Mar;119(3):345-349. doi: 10.1016/j.prosdent.2017.04.018. Epub 2017 Jul 8.
Patil AS, Ranganath V, Yerawadekar SA, Kumar CN, Sarode GS. Pink Esthetics: A Study on Significant Gingival Parameters. J Contemp Dent Pract. 2020 Feb 1;21(2):207-210.
Pavone AF, Ghassemian M, Verardi S. Gummy Smile and Short Tooth Syndrome--Part 1: Etiopathogenesis, Classification, and Diagnostic Guidelines. Compend Contin Educ Dent. 2016 Feb;37(2):102-7; quiz 108-10.
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Ruhmann, N.L., Borrasca, C., Araújo, C, A., & Pfau, E.A. (2014). Aesthetic rehabilitation of the "gummy smile" associated to virtual planning with "digital smile design"-DSD. J Surg Clin Dent, 1(1):5-9
Simon H, Magne P. Clinically based diagnostic wax-up for optimal esthetics: the diagnostic mock-up. J Calif Dent Assoc. 2008 May;36(5):355-62.
Trushkowsky R, Arias DM, David S. Digital Smile Design concept delineates the final potential result of crown lengthening and porcelain veneers to correct a gummy smile. Int J Esthet Dent. 2016 Autumn;11(3):338-54.
Vercruyssen M, Cox C, Coucke W, Naert I, Jacobs R, Quirynen M. A randomized clinical trial comparing guided implant surgery (bone- or mucosa-supported) with mental navigation or the use of a pilot-drill template. J Clin Periodontol. 2014 Jul;41(7):717-23. doi: 10.1111/jcpe.12231. Epub 2014 Apr 10.
Wessel JR, Tatakis DN. Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol. 2008 Mar;79(3):425-30. doi: 10.1902/jop.2008.070325.
Other Identifiers
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FDASU-RecIM122209
Identifier Type: -
Identifier Source: org_study_id
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