The influence of the soft tissues on the esthetic appearance

Doktori dentalne medicine svakodnevno su izloženi estetskim zahtjevima pacijenta. Napretcima u parodontologiji i implantologiji estetici tvrdih i mekih potpornih tkiva sve se više pridaje pozornost. Na estetiku mekih tkiva oko zuba utječu boja, vidljivost gingive prilikom osmijeha, recesije gingive i crni trokuti. Upaljenu gingivu karakterizira tamnija lividna boja koja se inicijalnom terapijom vraća u bljedoružičastu. Alterirana pasivna erupcija, hipermobilnost gornje usne ili pretjerani vertikalni rast maksile uzroci su gingivnog osmijeha. Terapija je usmjerena na eliminaciju uzročnog čimbenika. Recesija gingive pomicanje je ruba gingive apikalno od caklinsko-cementnog spojišta. Mnogo je različitih tehnika za prekrivanje recesija s različitim uspjesima, od kojih je koronalno pomaknuti režanj u kombinaciji s vezivnotkivnim transplantatom najuspješniji. Crni trokuti prisutni su kada je udaljenost od interproksimalne kontaktne točke do vrha interdentalne alveolarne kosti veći od 5 milimetara. Najučinkovitiji način zatvaranja crnih trokuta jest pomicanje kontaktne točke između zuba apikalno restaurativnim ili protetskim postupcima. Nadomještanje izgubljenih zuba u estetskoj zoni implantatima zahtijeva razumijevanje dimenzionalnih promjena koštanih i mekih tkiva nakon ekstrakcije zuba. Recesija oko implantata čest je estetski problem koji se kirurški može uspješno riješiti. Za prevenciju recesija i crnih trokuta oko implantata naglašena je važnost očuvanja ili rekonstrukcije keratinizirane gingive te pravilno pozicioniranje implantata prilikom njihove ugradnje. Periimplantitis je jedna od najčešćih komplikacija oko dentalnih implantata, što može rezultirati estetskim problemom. U estetskoj zoni poželjno je za kiruršku terapiju periimplantitisa koristiti regenerativne postupke. Za nadomještanje zubi implantatima u prednjoj maksili minimalno invazivni postupci kao socket shield tehnika pokazali su se iznimno korisni s odličnim estetskim rezultatima.Patients nowadays have increasing esthetic demands. Esthetics of the soft tissues have gained more attention because of the advances in periodontology and implantology. Factors affecting soft tissue esthetics are color, appearance of the gingiva while smiling, gingival recessions and black triangles. Inflamed gingiva is characterized by a darker livid color. After initial periodontal therapy, the color returns to pale pink. Altered passive eruption, hypermobility of the upper lip or excessive vertical maxillary growth can cause a gummy smile. The treatment of choice is aimed to remove the cause of the gummy smile. Gingival recessions are described as the apical shift of the gingival margin apical from the cemento-enamel junction. There are many described techniques of covering gingival recessions with varying degrees of success. A coronally advanced flap combined with a connective tissue graft has been proven the most successful. Black triangles are present when the distance from the interproximal contact point to the alveolar bone crest is greater than 5 millimeters. The most effective treatment of black triangles is relocating the interproximal contact point apically in a restorative or prosthetic manner. Tooth extraction results in significant dimensional changes in bone and the surrounding soft tissues. Understanding those dimensional changes is important for the successful replacement of lost teeth with dental implants. Recessions around implants are a common esthetic problem. Some surgical techniques have shown to be effective in covering recessions around implants. Preserving or restoring the keratinized gingiva combined with the correct positioning of the implant are important for the prevention of recessions and black triangles around implants. Peri-implantitis is one of the most common complications regarding dental implants. Severe peri-implant lesions could result in an esthetic problem. Regenerative procedures are preferable for the surgical treatment of peri-implantitis in the esthetic zone. Minimally invasive procedures, such as the socket shield technique, have been proven useful in replacing teeth with implants in the anterior maxilla, with excellent esthetic results