[Downloaded free from http://www.jorr.org on Monday, February 06, 2017, IP: 181.215.97.

118]

CASE REPORT
Gingival mask: A case report on enhancing smiles
Aashritha Shenava

Department of Prosthodontics and Implantology, A. B. Shetty Memorial Institute of Dental Sciences, Mangaluru, Karnataka, India

ABSTRACT
Periodontal attachment loss in the maxillary anterior region can often lead to esthetic and functional clinical problems including
disproportional and elongated clinical crowns and visible interdental embrasures. Gingival replacement prosthesis has historically
been used to replace lost tissue. A gingival mask is an easily constructed and practical device to optimize the esthetic and
functional outcome in these special situations while permitting cleansibility of the prosthesis and supporting tissues. This is
a case report of a young female patient treated using silicon gingival veneer with a 2-year follow-up. The silicon gingival mask
has enabled the patient to regain her lost smile and face people with newly found confidence also enhancing the esthetic
appearance. Virtually, no problem was encountered during the 2 years of usage of the veneer and the patient continues to use
it comfortably.

Key words: Esthetic, gingival mask, gingival replacement, periodontal attachment

Introduction Case Report

Gingival recession is the most common clinical manifestation A 32-year-old female presented with esthetic and phonetic problems.
of all the oral diseases, as it has a relatively high incidence rate.[1] The patient had recently undergone periodontal surgery with respect
Gingival replacement prostheses have historically been used to to 11 and 21, which eventually resulted in the loss of interdental
replace lost tissue when other methods (e.g., surgery or regenerative papillae between maxillary central incisors after 2 months [Figure 1].
procedures) were considered unpredictable or impossible. With
this method, large tissue volumes are easily replaced. Gingival The first option is mucogingival surgery or gingival plastic
prostheses take several forms, and various authors have described surgery, with gingival augmentation coronal to the recession. This
their uses and methods of construction.[2-10] A gratifying smile is suitable for class I and class II type of gingival recessions.[11]
is an assembly of various components. Marginal gingiva and In severe gingival recession conditions, as in class III and class
interdental papilla, having high esthetic value, are mulled over as IV recessions (Millers classification of gingival recession) as seen
the chief components of a smile. Gingival recession can cause in this patient, mucogingival surgeries may give less predictable
loss of inter-dental papilla and lead to open embrasures, which
esthetic results or might cause a recurrence.
project in the form of black triangles. The black triangles that
appear as a result of gingival recession will distort an amiable The second option, gingival replacement with artificial
smile. The condition can be corrected or managed by two substitutes, is more helpful in managing severe gingival recession
approaches. situations. The synonyms of gingival mask are flange prosthesis,

Access this article online

Quick Response Code:
Website:
www.jorr.org

DOI:
10.4103/2249-4987.152913

Address for correspondence:

Dr. Aashritha Shenava,
Department of Prosthodontics and Implantology,
A. B. Shetty Memorial Institute of Dental Sciences,
Mangaluru, Karnataka, India.
E-mail: keepthefaith999@yahoo.com Figure 1: Preoperative view

Journal of Oral Research and Review Vol. 6, Issue 2, | July-December 2014 68

[Downloaded free from http://www.jorr.org on Monday, February 06, 2017, IP: 181.215.97.118]

Shenava: Gingival mask

gingival veneer, gingival veneer prosthesis, gingival replacement impression using polyether impression material. After the casts
unit, and artificial gingiva. were made, it was followed by construction of wax-up try-in
on this model [Figure 2]. This wax-up was then duplicated to
This case report describes the use of a silicon gingival veneer to form removable silicon prosthesis with Cosmesil M511 silicone
hide the deformities in a young female patient with a successful (Cosmedica Ltd., Cardiff UK) [Figures 3 and 4].
follow-up of 2 years. The gingival replacement unit should be
fabricated 2-3 months following initial periodontal treatment to The prosthesis was extended up to the mesial aspects of first
allow the gingiva to stabilize. But in certain situations, the mask premolars bilaterally. This seemed to be necessary considering
can be used as an interim measure to improve the esthetics of the patient’s smile window. The distal most portions of the
anterior crowns after initial periodontal therapy to allow time prosthesis were thinned out in order to be blended with
for healing and the establishment of periodontal stability and
prognosis. In this way, the patient’s smile can be maintained
while the final treatment planning decisions are delayed until the
periodontal prognosis is established.[7,12,13]

The removable gingival mask is indicated:

1. To cover-exposed crown margins, exposed implant components
and root surfaces and reduce the length of the clinical crown.
2. To block out the black triangles between teeth in which
gingival recession has occurred.
3. To fill in the space between the crown and the soft tissue.
4. To prevent airflow through or beneath maxillary fixed
restorations or through the spaces between the teeth and
thus improving phonetics.
5. To provide increased lip and cheek support for those patients Figure 2: Wax-up of the gingival mask
who require it.
6. It is also beneficial for patients with high lip lines and a gummy
smile who have been treated with osseointegrated dental implants.
7. To hide the dark lines around old crowns that are often seen
with patients who have experienced gingival recession.
8. It also aids the prosthodontist to design implant supported
prosthesis with optimal configurations permitting easy
access for oral hygiene maintenance.

The gingival mask is contra-indicated in patients with poor plaque

control, unstable periodontal health, high caries activity, smoking,
and known allergy to acrylic or silicone.[14]

The gingival mask is retained mechanically with tiny extensions Figure 3: Fabricated gingival mask
of the mask material slightly projecting between the roots of the
natural teeth or the implants just above the gum line. Part of the
retention also comes from the natural capillary action created
by the saliva and lastly part of the retention is dependent on the
pressure of the lips against the gingival prosthesis.

A treatment plan was established involving the following steps:

1. The topography of the soft tissue defect was evaluated.
2. The color of the soft tissue was determined to achieve the
acceptable esthetics.
3. Photographs were taken to replicate the similar color in the
silicon mask.

For gingival veneer, master impression with a complete

interproximal detail was made. The lingual embrasures were
blocked using utility wax. A custom tray was used to make a final Figure 4: Postoperative view

69 Journal of Oral Research and Review Vol. 6, Issue 2, | July-December 2014

[Downloaded free from http://www.jorr.org on Monday, February 06, 2017, IP: 181.215.97.118]

Shenava: Gingival mask

natural gingival tissues. Instructions were given to clean it References

every time after having food and to remove the prosthesis
at night. This would also ensure adequate rest to the gingival 1. Studer S, Naef R, Schärer P. Adjustment of localized alveolar ridge
defects by soft tissue transplantation to improve mucogingival
tissues. The importance of persistent plaque control in the esthetics: A proposal for clinical classification and an evaluation of
ongoing prevention of both caries and periodontal disease procedures. Quintessence Int 1997;28:785-805.
2. Tallents RH. Artificial gingival replacements. Oral Health
was emphasized. 1983;73:37-40.
3. Botha PJ, Gluckman HL. The gingival prosthesis: A literature review.
Discussion SADJ 1999;54:288-90.
4. Friedman MJ. Gingival masks: A simple prosthesis to
Gingival defects may be treated with surgical or prosthetic improve the appearance of teeth. Compend Contin Educ Dent
2000;21:1008-10, 1012.
approaches. With successful surgical treatment, the result mimics
5. Blair FM, Thomason JM, Smith DG. The flange prosthesis. Dent
the original tissue contours. But the surgical costs, healing time, Update 1996;23:196-9.
discomfort and unpredictability make this choice unpopular. 6. Mekayarajjananonth T, Kiat-amnuay S, Sooksuntisakoonchai N,
Salinas TJ. The functional and esthetic deficit replaced with an acrylic
Prosthetic replacement, with acrylics, composite resins, porcelains resin gingival veneer. Quintessence Int 2002;33:91-4.
and silicones, is a more predictable approach to replacing lost 7. Greene PR. The flexible gingival mask: An aesthetic solution in
tissue architecture. It is especially useful when a larger amount periodontal practice. Br Dent J 1998;184:536-40.
8. Priest GF, Lindke L. Gingival-colored porcelain for implant-supported
of tissue needs replacement. Ideal tissue contours can be waxed, prostheses in the aesthetic zone. Pract Periodontics Aesthet Dent
processed and then colored to match the surrounding tissue. 1998;10:1231-40.
The patient need not undergo any additional surgical procedures 9. Hannon SM, Colvin CJ, Zurek DJ. Selective use of gingival-toned
ceramics: Case reports. Quintessence Int 1994;25:233-8.
and receives an esthetically pleasing, functional restoration. It 10. Brygider RM. Precision attachment-retained gingival veneers for fixed
is possible to show the patient a waxed-up result or even take implant prostheses. J Prosthet Dent 1991;65:118-22.
a try-in prosthesis directly to the mouth for evaluation before 11. Cairo F, Rotundo R, Miller PD, Pini Prato GP. Root coverage esthetic
score: A system to evaluate the esthetic outcome of the treatment of
significant treatment is initiated. gingival recession through evaluation of clinical cases. J Periodontol
2009;80:705-10.
Several materials are available for the fabrication of gingival 12. Ellis SG, Sharma P, Harris IR. Case report: Aesthetic management of
veneer among all these materials, Cosmesil M511 silicon gives a localised periodontal defect with a gingival veneer prosthesis. Eur J
Prosthodont Restor Dent 2000;8:23-6.
a lifelike finish. Hence, in the present case, this material was 13. Nair C, Dange SP. Aesthetic management of gingival recession: A
chosen to construct gingival veneer as mentioned by Green flexible gingival mask. J Indian Prosthodont Soc 2003;3:34-5.
14. Shah A. A case report gingival veneer: Non-invasive approach in
et al. Loss of interdental papillae in maxillary anterior region can
the management of lost interdental papilla. Int J Dent Case Rep
often lead to esthetic and functional clinical problems. In such 2012;2:54-8.
cases, it becomes a challenge for the dentist to provide optimum
esthetic solution for the missing gingival tissues and at the same
How to cite this article: Shenava A. Gingival mask: A case report
time preserve periodontal health.[14] Gingival veneers are easy on enhancing smiles. J Oral Res Rev 2014;6:68-70.
to fabricate and offer predictable and satisfactory results in the
Source of Support: Nil, Conflict of Interest: None declared.
management of lost interdental papillae.

Journal of Oral Research and Review Vol. 6, Issue 2, | July-December 2014 70