- This type of prosthesis is retained with the help of the capillary action of saliva, support of lips and surrounding soft tissues along with the mechanical retention achieved by the extension of the epithesis in the buccal embrasures.Indications
- To fill the unaesthetic gap between soft tissue and teeth
- To restore the large black triangular spaces
- To improve the length of the clinical crown by concealing the exposed root surface
- As an interim prosthesis after periodontal therapy for healing.
- To provide intra-oral bulk in patients who lack lip and cheek support
- To mask the exposed margins of A crown or implant-supported prosthesis
- Poor periodontal status
- Increased carious activity
- Smoking
- Lack of maintenance of oral hygiene
- Allergy to acrylic or silicone (used to make prosthesis)
- Mold wax sheet and place it on the palatal aspect extending only into the palatal embrasures of the teeth that acts as a barrier thereby preventing the flow of the impression material. Also, ensure that it doesnot cover the entire interdental space but cover enough to provide additional retention and prevent lisping.
- Impression is made using an irreverible hydrocolloid material and carefully retrieved with inter-dental tags (as much as possible) after it is set (as per the manufacturer instructions)
- A cast is obtained and a wax up is done on it which is then cured in an usual manner as a conventional denture followed by finishing and polishing.
- Other materials that can be used for it’s fabrication are – cold cure or heat cure acrylics, thermoplastic or comppsite resins, silicone based materials (Valplast, Cosmesil M51, Gingivamoll), porcelain etc.
- The fit of the final prosthesis is then evaluated in the patient’s mouth and the necessary changes are made before it is delivered.
- Post operative instructions:
- Clean the prosthesis after every meal with a soft brush using a mild detergent.
- Prostheis should be kept in water at night to prevent warpage.
- Smoking excessive consumption of tea or coffee is not recommended.
Regular follow up should done for evaluating the maintenance of the same. - Economical
- Easy fabrication and fit
- Comfortable to the patient
- Discolouration and dimensional changes seen with time
- Requires proper cleaning/maintenance and should be removed during night
With minimum efforts and at no additional cost, this technique can be employed for eliminating “Black Triangles” which in turn provides psychological satisfaction not only to the patient but also to the dentist as a result of an aesthetic outcome and acceptance of the treatment by the patient. - Greene PR. The flexible gingival mask: An esthetic solution in periodontal practice. Br Dent J 1998;184:536-40.
- Botha PJ, Gluckman HL. The gingival prosthesis — A literature review. SADJ 1999;54:288-90.
- Barzilay I, Irene T. Gingival prosthesis — A review. J Can Dent Assoc 2003;69:74-8.
- Antony V , Khan R. Gingival mask-restoring the lost smile. IOSR-JDM) 2013;5(3):20-22.
- Shenava A. Gingival mask: A case report on enhancing smiles. J Oral Res Rev 2014;6:68-70.
- Debnath N, Gupta R, Nongthombam RS, Chandran P. Acrylic gingival veneer prosthesis: A case report. J Med Soc 2016;30:121-3.
- Keyf F. Gingival epithesis in periodontally compromised patient for esthetic solution. SRM J Res Dent Sci 2016;7:255-8.
DISCLAIMER : “Views expressed above are the author's own.”
Prosthetic gingival replacement is most useful when a tissue defect is extensive, surgical correction is unpredictable or the patient prefers a less invasive approach. The design should reproduce tissue volume without creating an uncleanable cervical contour. Colour matching must account for hue, chroma, value, translucency and surface texture under different lighting conditions.
Pink ceramics, laboratory or direct composites, acrylic resins and removable silicone materials may be used. Selection depends on the restoration, defect size, required flexibility, hygiene access, repairability and colour stability.
Surgery may be preferable when predictable tissue augmentation can correct the defect, improve periodontal health or establish a maintainable restorative environment. Large defects, limited donor tissue or high morbidity may favour prosthetic replacement.
How should a pink restoration be maintained?
Contours should permit plaque control and professional review. Patients require individualised instructions for interdental cleaning and maintenance around margins, connectors and implant components.
What is the main aesthetic limitation?
Matching natural gingiva is difficult because colour and texture vary between sites and change with hydration, lighting, tissue thickness and inflammation.
For soft-tissue landmarks used in smile planning, review the clinical significance of the gingival zenith.
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There are two approaches to manage recession of gingiva depending upon the severity.
In class III and IV gingival recession, mucogingival surgery is not usually preferred due to its failure to provide optimal aesthetic outcome and may even cause reoccurrence in some cases. Therefore, the preferred option is to make use of the artificial substitutes. 
Fig. 1 – The marked areas show areas of “Black Triangles”
