Minimally Invasive Cosmetic Restoration of Teeth Associated with Open Gingival Embrasures. Descriptive Case Series

ABSTRACT

The aim of this study is to evaluate the performance of the restorations and soft tissues at 2 years using direct composite resin with injection molding technique to solve open gingival embrasures, also known as black triangles.

Materials and Method

An observational study of a case series was conducted for the treatment of black triangles. The criteria evaluated in each of the restorations were: color stability, polishing, maintenance of surface gloss, staining in the tooth/restoration margins, secondary caries, radiographic appearance of the restored emergence profile, probing depth and bleeding on probing (of the restored proximal surface), presence of plaque (of the restored proximal surface), detachment, delamination, and fracture of the restoration. The following patient satisfaction criteria were evaluated using the visual analog scale (VAS): aesthetic, functional and overall satisfaction.

Results

A total of 36 restorations were performed in the anterior aesthetic area between canines (24 upper and 12 lower). The mechanical and biological survival rate of restorations were both 100% (95%CI: 90.3–100%). Regarding mechanical complications, there were no restorations showing secondary caries, alteration of color, staining in the tooth/restoration interface, detachment, delimitation or fracture during the entire follow-up (0%; 95%CI: 0–9.7%). Regarding biological complications, there were no restorations measuring probing depth higher than 3 mm or showing an unusual radiographic appearance during the entire follow up (0%; 95%CI: 0–9.7%).

Conclusions

The composite injection technique using anatomical matrices is a cost-effective, minimally traumatic, predictable, and reproducible approach to achieve anterior black triangles closure and creation of pseudopapillas.

KEYWORDS:

• Composite resin
• dental marginal adaptation
• cosmetic dentistry
• gingival recession
• matrix band
• dental papilla

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author Contributions

“Conceptualization, A.F.C; A.M.R methodology, R. F.C; formal analysis, R. A-P.; investigation, A.F.C.; A.M.R.; J. A.L.; writing – original draft preparation A.F.C; S. S; writing – review and editing, A. F.C.; D.C. supervision, A. M.R.; D.C. All authors have read and agreed to the published version of the manuscript.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Álvaro Ferrando Cascales

Álvaro Ferrando Cascales, DDS, PhD, is currently adjunct Professor of Adhesive Aesthetic Dentistry subject. Department of Biomaterials Engineering, Faculty of Medicine, Universidad Católica de Murcia UCAM. Member of the research group: Tissue Regeneration and Repair Group, Biomaterials and Tissue Engineering. He is also visiting professor in several postgraduate programs of Aesthethic Oral Rehabilitation at different universities of Spain (Universidad de Granada, IVIO-Universidad Politécnica de Valencia, La Salle and UCAM). He obtained his PhD in “Dental Biomaterials Research Pre-clinical Dentistry” at Universitat de València. He maintains his private practice in Murcia, Spain, working as an Aesthetic Restorative Dentist at Clínica Dental Ferrando.

Rubén Agustín Panadero

Rubén Agustín-Panadero, DDS, PhD, is currently full Professor of Prosthodontic subject, Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, Valencia, Spain.

José Amengual Lorenzo

José Amengual-Lorenzo, DDS, PhD, is currently adjunct Professor of Prosthodontic subject. Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, Valencia, Spain.

Salvatore Sauro

Salvare Sauro, PhD, is currently full professor in dental biomaterials at the Departamento de Odontología, Facultad de Ciencias de la Salud, Universidad CEU-Cardenal Herrera, coordinator of the Dental Research and Director (Principal Investigator) of the research group: In Situ Dental Tissues Engineering and Minimally Invasive Therapeutic Adhesive Rehabilitation. He is also visiting professor, at the Department of Therapeutic Dentistry, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. He obtained his PhD in “Dental Biomaterials Research Pre-clinical Dentistry” at King’s College London Dental Institute London, where he continued his scientific work as post-doctorate and then as research associate in “Adhesive dentistry and dental bioactive materials research.” He, is currently former president of the Dental Materials Group (DMG) at the International Association of Dental Research (IADR).

Antonio Mendoza Rodríguez

Antonio Mendoza Rodriguez. DDS, MSc, Master in Occlusion and Oral Rehabilitation at the University of Barcelona. He is currently adjunct Professor of oral rehabilitation postgraduate. Catalan Society of Odontostomatology (SCOE). He has exclusive private practice in aesthetic restorative dentistry and prosthodontics in Arconclinic odontólegs, Barcelona. Spain.

Raúl Ferrando Cascales

Raúl Ferrando Cascales, DDS, PhD, is currently adjunct Professor of Othodontics subject. Department of Biomaterials Engineering, Faculty of Medicine, Universidad Católica de Murcia. UCAM, member of the research group: Tissue Regeneration and Repair Group, Biomaterials and Tissue Engineering. He is also director of the Master in Orthodontics (Universidad Católica de Murcia. PGO-UCAM). He has the Spanish board in Orthodontics. He maintains his private practice in Murcia, Spain, working as an orthodontist at Clínica Dental Ferrando.

Ronaldo Hirata

Ronaldo Hirata, DDS, MSc. PhD, is assistant professor of Biomaterials and Biomimetics Department at New York University (NYU), working with research on restorative biomaterials, focusing on composites and adhesives. Also, he keeps private practice in Curitiba, Brazil, working with Esthetic Dentistry.

David Clark

David Clark, DDS, founded the Academy of Microscope Enhanced Dentistry, an international association formed to advance the science and practice of microendodontics, microperiodontics, microprosthodontics and microdentistry. He is a course director at the Newport Coast Oral Facial Institute in Newport Beach, California. He is co- director of Precision Aesthetics Northwest in Tacoma, Washington, and an associate member of the American Association of Endodontists. He lectures and gives hands-on seminars internationally on a variety of topics related to microscope enhanced dentistry. He has developed numerous innovations in the fields of micro dental instrumentation, imaging, and dental operatory design. He has authored several landmark articles about microscope dentistry including Aesthetic Dentistry, Sealants, The Role of Ultrasonics in Three Dimensional Shaping and Restoration of Non Vital Teeth, Micro-Imaging and Practice Management, and Crack Diagnosis. Dr. Clark is a 1986 graduate of the University of Washington School of Dentistry. He maintains a microscope centered restorative practice in Tacoma, Washington.