title: Technique to Obtain a Predictable Aesthetic Result through Appropriate Placement of the Prosthesis/Soft Tissue Junction in the Edentulous Patient with a Gingival Smile.
abstract: BACKGROUND
  Treating the edentulous patient with a gingival smile requires securing the prosthesis/soft tissue junction (PSTJ) under the upper lip.
  
  
  OBJECTIVE
  To present a simple method that helps achieve a predictable aesthetic result when alveoplasty of the anterior maxilla is needed to place implants apical to the presurgical position of the alveolar ridge.
  
  
  METHODS
  The maximum smile line of the patient is recorded and carved on a thin silicone bite impression as a soft tissue landmark. During the three-dimensional radiographic examination, the patient wears the silicone guide loaded with radiopaque markers. The NobelClinician® software is then used to bring the hard and soft tissue landmarks together in a single reading. Using the software, a line is drawn 5 mm apical to the smile line; it dictates the position of the crestal ridge to be reached following the alveoplasty. Subsequently, the simulated implant position and the simulated residual bone height following alveoplasty can be simultaneously evaluated on each transverse section.
  
  
  RESULTS
  An alveoplasty of the anterior maxilla was performed as simulated on the software, and implants were placed accordingly. The PSTJ was always under the upper lip, even during maximum smile events. The aesthetic result was, therefore, fully satisfactory.
  
  
  CONCLUSIONS
  This simple method permits the placement of the PSTJ under the upper lip with a predictable outcome; it ensures a reliable aesthetic result for the edentulous patient with a gingival smile.
authors.affiliation: Excellence in Dentistry research group, Paris, France.|Department of Prosthetics, Hôpital Charles Foix, Paris Descartes University, Paris, France.
authors.forename: Georgy
authors.initials: G
authors.lastname: Demurashvili
authors.affiliation: Excellence in Dentistry research group, Paris, France.|Department of Prosthetics, Hôpital Bretonneau, Paris Descartes University, Paris, France.
authors.forename: Keyvan
authors.initials: K
authors.lastname: Davarpanah
authors.affiliation: Excellence in Dentistry research group, Paris, France.|OBL, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: Serge
authors.initials: S
authors.lastname: Szmukler-Moncler
authors.affiliation: Excellence in Dentistry research group, Paris, France.|Oral Rehabilitation Center, American Hospital of Paris, Paris, France.
authors.forename: Mithridade
authors.initials: M
authors.lastname: Davarpanah
authors.affiliation: Laboratoire Didier Raux, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Raux
authors.affiliation: Excellence in Dentistry research group, Paris, France.
authors.forename: Nedjoua
authors.initials: N
authors.lastname: Capelle-Ouadah
authors.affiliation: Excellence in Dentistry research group, Paris, France.|Oral Rehabilitation Center, American Hospital of Paris, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rajzbaum
mesh_terms: D000328:Adult; D000539:Alveolar Process / Q000187:drug effects / Q000601:surgery; D003757:Dental Implantation / Q000379:methods*; D004955:Esthetics, Dental; D005260:Female; D005881:Gingiva / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery*; D009066:Mouth, Edentulous / Q000000981:diagnostic imaging / Q000601:surgery*; D011861:Radiography, Dental; D012904:Smiling
keywords: bone resection; computer assistance; computerized tomography; cone beam CT; edentulous mandible; smile line