For many years, when fabricating crowns and bridges for edentulous implant patients, we made the units longer in order to compensate for lost periodontal tissue. However, this approach doesn't produce esthetic results and may not give proper lip support. Today, patients' esthetic demands require us to use gingival porcelain to recreate periodontal tissues for a more natural-looking, properly contoured restoration.
I've therefore developed the Oral Stratified Buildup TechniqueTM, a systematic porcelain layering technique for creating lifelike periodontal tissue. I use gingival porcelain and pink opaque along with a combination of other porcelains for the gingival area and to recreate internal oral structures such as the alveolar bone, roots and gingival mucosa. Since natural gingiva is very complex and has different colors, values, translucencies and surface textures, opaceous dentin, dentin and enamel porcelain in different shades are all used to complete the buildup.
The key is to pick the right opaque color to mimic the shade of the natural bone; from there, I choose an opaceous dentin porcelain to build the basic tooth and alveolar bone form. Once the internal oral outline is built, I add detail to the teeth using pink gingival porcelain; in some cases, I also add dentin or enamel porcelain depending on the patient's gingival color. Then I continue incremental layering of porcelain. For a successful result and to achieve a truly lifelike restoration, you must have a good understanding of natural teeth, gingival morphology and oral anatomy. Here's a closer look at the technique:
All cases fabricated using Jensen Dental's Creation CC and Creation New Gingival porcelain kit.