• Journal of the Korean Academy of Esthetic Dentistry
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• v.28 no.2
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• pp.95-115
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• 2019

To be successful in aesthetic prosthetic treatment, the crown part aesthetic (White Esthetic) and the tissue part aesthetic (Pink Esthetic) must be well controlled. Clinically, white esthetics are the area of dental technicians and pink esthetics are the area of dentists, but a deeper understanding of counterparts can produce more successful results. In this paper, I will briefly describe this process.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.23 no.2
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• pp.70-76
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• 2014

After extraction of tooth, alveolar ridge resorption is inevitable in most cases. Clinicians confront with horizontal and vertical resorption of alveolar bone. Without massive amount of bone and soft tissue graft, dental implant will be placed apically to gain stability. In those cases, not only white esthetic part, but also pink esthetic part should be restored with pink porcelain. The margin of prosthesis should be located apically to reproduce natural look with adjacent teeth. However, when the margin is located apically, it is always hard to remove remaining cement, thus complications may arise. In this report, a novel design of implant prosthesis is introduced to solve those issues. The novel design is consisted of zirconia framework with pink porcelain and separate crowns on top of the framework. It eliminates the possibility of cement remnants by bringing the crown margin coronally. Pink esthetic part is incorporated in abutment part instead of crown part and the screw hole is covered with separate crowns.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.26 no.1
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• pp.4-16
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• 2017

In dental esthetics, soft tissue plays an important part, probably very large portion of it. A clear understanding of the periodontal tissues and its management around teeth and implants help us to develop concepts for a modern dental treatment that addresses the needs of demanding patients in regard of esthetics and durability. When we talk about esthetic, we can say that one of the most important element is a harmonization with gingiva (soft tissue) called 'Pink Esthetic' As for the pink esthetics, gingival line(contour) takes most of the influence on esthetic result; it consists of labial gingival level, interproximal papilla height, and a line that connects them. In the gingival recession, labial gingival level and gingival contour move to the apical portion, and the root area is exposed. It leads to the unesthetic result. Root coverage technique is classically used to treat gingival recession (marginal tissue recession) of natural teeth. It is an essential technique on periodontal plastic surgery part. It is also a very useful technique to recover soft tissue problems in implant dentistry. So, root coverage technique must be mastered for a good implant esthetic result. The general overview of root coverage procedures will be discussed with step by step explanation to get more esthetic result.

• The Journal of Korean Academy of Prosthodontics
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• v.59 no.4
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• pp.469-477
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• 2021

For successful restoration of maxillary anterior implants, both pink esthetics and white esthetics must be satisfied. For pink esthetic part, the role of appropriate provisional prosthesis restoration is important, and for white esthetic part, the color and shape of the definitive prosthesis is important. Multilayer zirconia can be used for natural tooth appearance due to the higher transparency of the incisal area compared to the conventional monolithic zirconia. Therefore, in this case, white esthetic part was achieved through multilayer zirconia after recovering function and esthetics through appropriate provisional prosthesis in a patient who lost the maxillary anterior teeth.

• The Journal of Advanced Prosthodontics
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• v.8 no.5
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• pp.345-353
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• 2016

PURPOSE. The aim of this study was to assess the esthetic outcome of maxillary anterior single implants by comparing the esthetic perception of dental professionals and patients. MATERIALS AND METHODS. Twenty-three patients with single implants in the esthetic zone were enrolled in this study. Dentists of four different dental specialties (Three orthodontists, three oral surgeons, three prosthodontists, and three periodontists) evaluated the pink esthetic score (PES)/white esthetic score (WES) for 23 implant-supported single restorations. The satisfactions of the patients on the esthetic outcome of the treatment have been evaluated according to the visual analog scale (VAS). RESULTS. The mean total PES/WES was $12.26{\pm}4.76$. The mean PES was $6.45{\pm}2.78$ and mean WES was $5.80{\pm}2.82$. There was a statistically significant difference among the different specialties for WES (P<.01) and Total PES/WES (P<.01). Prosthodontists were found to have assigned poorer ratings among the other specialties, while oral surgeons gave the higher ratings than periodontists, orthodontists, and prosthodontists. CONCLUSION. Prosthodontists seemed to be stricter when assessing aesthetic outcome among other specialties. Moreover, a clear correlation existed between dentists' and patients' esthetic perception, thereby providing rationales for involving patients in the treatment plan to achieve higher levels of patient satisfaction.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.10 no.1
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• pp.30-45
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• 2001

In recent years, clinicians' and dentists' esthetic demands in dentistry have increased rapidly. The ultimate goal in modern restorative dentistry is to achieve "white" and "pink" esthetics in the esthetically important zones. Therefore, modern esthetic dentistry involves not only the restoration of lost teeth and their associated hard tissues, but increasingly the management and reconstruction of the encasing gingiva with adequate surgical techniques. Interdental space are filled by interdental papilla in the healthy gingiva, preventing plaque deposition and protecting periodontal tissue from infection. This also inhibits impaction of food remnants and whistling through the teeth during speech. These functional aspects are obviously important, but esthetic aspects are important as well. Complete and predictable restoration of lost interdental papillae remains one of the biggest challenges in periodontal reconstructive surgery. One of the most challenging and least predictable problems is the reconstruction of the lost interdental papilla. The interdental papilla, as a structure with minor blood supply, was left more or less untouched by clinicians. Most of the reconstructive techniques to rebuild lost interdental papillae focus on the maxillary anterior region, where esthetic defects appear interproximally as "black triangle". Causes for interdental tissue loss are, for example, commom periodontal diseases, tooth extraction, excessive surgical periodontal treatment, and localized progressive gingiva and periodontal diseases. If an interdental papilla is absent because of a diastema, orthodontic closure is the treatment of choice. "Creeping" papilla formation has been described by closing the interdental space and creating a contact area. In certain cases this formation can also be achieved with appropriate restorative techniques and alteration of the mesial contours of the adjacent teeth. The presence of an interdental papilla depends on the distance between the crest of bone and the interproximal contact point, allowing it to fill interdental spaces with soft tissue by altering the mesial contours of the adjacent teeth and positioning the contact point more apically. The interdental tissue can also be conditioned with the use of provisional crowns prior to the definitive restoration. If all other procedures are contraindicated or fail, prosthetic solutions have to be considered as the last possibility to rebuild lost interdental papillae. Interdental spaces can be filled using pink-colored resin or porcelain, and the use of a removable gingival mask might be the last opportunity to hide severe tissue defects.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.26 no.1
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• pp.17-23
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• 2017

Purpose: This retrospective study is to evaluate whether the timing of implant placement and the result of esthetic outcomes are related. Materials and Methods: Among the patients who had undergone single implant surgery on anterior area from 2010 to 2013 in Veterans Health Service Medical Center, 34 implants in 27 patients (24 male and 3 female) were selected and categorized into 3 groups according to the timing of placement, which are group D (Delay), group E (Early) and group I (Immediate). Aesthetic indices used included the Pink Esthetic Score (PES). It has 7 variables scores, such as mesial papilla, distal papilla, a level of soft-tissue margin, soft-tissue contour, alveolar process, soft-tissue color, and soft-tissue texture. Each variable ranges from 0 to 2, therefore total 14 points are highest. All patients were received by regular follow-up at least 1-year. One examiner measured PES on the intraoral photos. Each patient was considered as a statistical unit for statistical analysis. Statistical analyses were performed using a commercially available statistical software (SPSS Statistics 21.0, IBM Corp., Armonk, NY, USA). Kruskal-Wallis test was used for inter-group comparisons. Statistical significance was set at P<0.05. Result: Mean score in Group D, Group I, and Group E were $11.5{\pm}1.5$, $11.4{\pm}1.8$, and $11.3{\pm}1.8$ respectively. In Kruskal-Wallis test, there are no differences (P=0.989). Conclusion: In this limited study suggests that clinical aesthetic results can be achieved with all treatment protocols. Finally, various factors can be considered to produce the esthetic results.

• Journal of Periodontal and Implant Science
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• v.40 no.4
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• pp.188-193
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• 2010

Purpose: The aim of this study is to assess the influence exerted by the observer's dental specialization and compare patients' opinion with observers' opinion of the esthetics of maxillary single-tooth implants in the esthetic zone. Methods: Forty-one adult patients, who were treated with a single implant in the esthetic zone, were enrolled in this study. Eight observers (2 periodontists, 2 prosthodontists, 2 orthodontists and 2 senior dental students) applied the pink esthetic score (PES)/white esthetic score (WES) to 41 implant-supported single restorations twice with an interval of 4 weeks. We used a visual analog scale (VAS) to assess the patient's satisfaction with the treatment outcome from an esthetic point of view. Results: In the PES/WES, very good and moderate intraobserver agreements were noted between the first and second rating. The mean total PES/WES was $11.19{\pm}3.59$. The mean PES was $5.17{\pm}2.29$ and mean WES was $6.02{\pm}1.96$. In the total PES/WES, the difference between the groups was not significant. However, in the WES, the difference between the groups was significant and prosthodontists were found to have assigned poorer ratings than the other groups. Periodontists gave higher ratings than prosthodontists and senior dental students. Orthodontists were clearly more critical than the other observers. The statistical analysis revealed statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth. However, the correlation between the total PES/WES and the VAS score for the first premolar was not statistically significant. Conclusions: The PES/WES is an objective tool in rating the esthetics of implant supported single crowns and adjacent soft tissues. Orthodontists were the most critical observers, while periodontists were more generous than other observers. The statistical analysis revealed a statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth.

• The Journal of Korean Academy of Prosthodontics
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• v.54 no.4
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• pp.438-444
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• 2016

To enhance the esthetic appearance, the maxillary anterior area is important. It is possible to improve the esthetic appearance through the treatment of maxillary anterior area, which includes altering the color, form, and arrangement of teeth. When planning these treatments, clinicians should individualize personal demands, by using the information obtained from facial, dento-labial, dental, and gingival analysis. It is essential to properly prepare the gingival structure, which includes the height of gingival margin, the location of zenith, reconstruction of the interdental papillae, emergence profile, and symmetry. Clinicians often face unfavorable condition of the gingiva and the edentulous ridge, and appropriate management of the gingival structure is needed. In this case report, the patients were treated to improve the gingival conditions surrounding maxillary anterior teeth. By using conservative treatment without surgical intervention, such as application of pink porcelain, subgingival contour modelling and modification of pontic base, satisfactory esthetic results were gained.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.30 no.2
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• pp.53-58
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• 2021

The attractiveness of the gingiva is determined by its color, shape, and the shape and location of the boundary between the teeth and the gingival tissue. The standards beauty, balance, and health of the gingiva are all different, but the general public would agree that a coral pink gingiva is more beautiful than black or brown gingiva. Hence, one would be able to smile more confidently in public if he or she receives a gingival pigmentation removal surgery that changes the color of black or brown gums to a beautiful pink color with relative simplicity. The color of one's gingiva varies from pale pink to deep bluish purple, depending on many health components. The most prominent among these include the vascular supply, epithelial thickness, the degree of keratinization, and the presence of pigment in the epithelium. Melanin, carotene, reduced hemoglobulin, and oxyhemoglobulin are the main pigments contributing to the normal color of the oral mucosa. The health of one's gingival tissue are essential for an attractive smile. Excessive melanin deposits in the basal and early basal layers of the epithelium stored in the form of melanosomes frequently cause pigmentation. Although there are many different procedures to remove this pigmentation, the it was removed using the Er;YSGG laser. It is my wish that, through this case study, many people