Chameleon qualities

March 21, 2012

We sometimes struggle to match a patient’s tissue color. The tough connective gingiva, which lines the base of the teeth, is part of the lining of the mouth. Not only does it surround the teeth, it also produces a seal. Unlike the soft tissue linings of the lips and cheeks, most of this gingiva is tightly bound to the underlying bone, which aids in resistance of the chafing of food as it’s chewed.

We sometimes struggle to match a patient’s tissue color. The tough connective gingiva, which lines the base of the teeth, is part of the lining of the mouth. Not only does it surround the teeth, it also produces a seal. Unlike the soft tissue linings of the lips and cheeks, most of this gingiva is tightly bound to the underlying bone, which aids in resistance of the chafing of food as it’s chewed.

This tissue color is not always definitive, but if healthy, it is often called “coral pink.” Colors such as red, white or even blue may indicate inflammation due to plaque. However, we must also consider racial pigmentation, because this can make the tissue appear darker. The most significant issue then is color homogeny. Pockets of different colors, lighter or darker, could indicate a concern.

In texture, healthy gingiva is firm, does not move, and often exhibits stippling, or a speckled appearance. Unhealthy gingiva, on the other hand, will often present as puffy and spongy.

Yet if the tissue color does not blend properly, it ruins the effect of the final restoration. Tissue color also affects the size of the teeth and the tint of our combined porcelain colors. When we recreate tissue, we have to keep in mind that a patient’s smile is in large part influenced by that color.

In the past, we could only mimic tissue color by adding or mixing together modified colors with pink porcelain. But the GC Initial™ Zr Gum Shade Set System (GC America) now includes the Zr and MC gum shades with six color choices. Included are Frame Modified Gum, Base Dark, Intensive Red, Intensive Violet, Base Light and Intensive Cream. The individual steps can be divided between different firings, according to the standard layering techniques.

Case Study

Refer to the slideshow for figures.

As mentioned above, from the different skin types people exhibit, we can safely assume their tissue color also will be unique. When I am assigned a restoration such as the one we see in Fig. A, I will match tissue color by overlaying the solid porcelain color with a pink tone.

In my newly updated Chairside Shade Guide™ System (LSK121 Oral Prosthetics), there are nine total tissue colors all created, categorized and photographed. With the three possible soft-tissue colors we see here, I am attempting to match this patient’s shade, which appears to be a light pink with slightly darker tones at the gingival. Ultimately, that dark color will be covered when the restoration is completed.

The temporary implant crown on tooth No. 8, demonstrated in Fig. B, is long compared with tooth No. 9. The two will need to be matched at the gingival area (Fig. C), which is the reason for the pencil line I drew-to mimic what is adjacent. GC Initial™ created five different pink tissue color possibilities (Fig. D). Shown here are numbers GM 23, 24, 34, 35 and 36-tissue-colored, light-curable micro-composites-Gradia Gum Shades that allow the technologist to naturalize the existing restoration to give it the color, texture, translucency and veining of natural gum tissue. The line of gum shades is offered in three composite viscosities: a liquid, a gel and a paste. These alternatives afford the user almost unlimited combination of colors and textures and even allow the anatomy of the restoration to be enhanced in terms of root structure, tissue connectors and rugae. Gum fibers are even available to imitate the natural blood vessels in the oral cavity.

In Fig. E, we are given a view of the implant titanium abutment in the mouth, post-operatively. I decided to use GC Initial™ 23, 24 and MC – C-LF for this particular restoration to match the patient’s gum color (Fig. F). Fig. G demonstrates the process of applying each shading layer to the restoration to accomplish the color goal I had set out to complete. Over the top of this, I then applied the GC C-LF (clear fluorescent) (Fig. H).

There are five possible powder colors for the gum area, with shade tabs and opaque (Fig. I) available for the technician, opening up multiple possibilities when it comes to creating a beautiful and life-like restoration. On a mirror, the shade tabs are given a more detailed appearance (Fig. J). Post-operatively, the patient’s retracted view provides us a good view of the gum area (Fig. K).

Conclusion

The technician will find this product to be especially beneficial for use with restorations such as the implant crown we demonstrated, or for denture work as well. There is no mixing involved, which makes it easy to use. Maximum results can be achieved with very little effort necessary. And, as we can see from the photos, the end result is pleasing to the eye.