Actualización sobre la optimización de la estética en prótesis fija mediante el manejo tisular

Resumen

Restorations in the aesthetic orofacial zone are particularly challenging in presence of intense resorption of the residual ridge. In this paper various treatment options are reviewed focusing on the improvement of the appearance of the soft tissues combined with conventional fixed prostheses. A deep and rigorous selection of national and international scientific papers published in the last ten years has been made. No age limit was set to describe the key concepts. Basically, the findings that emerge from the literature review can be summarized as follows: once made a correct selection of the case, different types of treatments have been shown to provide satisfactory aesthetic of the soft tissues in combination with conventional fixed prostheses. Treatments that intend to modify the aesthetics preserving hard and soft tissues are proposed (i.e., ovoid pontics, orthodontic treatment, alveolar preservation techniques, guided tissue regeneration, monocortical graft). In addition, surgical treatments including hard tissue (osteoplasty / ostectomy) and soft tissue modification (i.e., soft tissue grafts, gingivoplasty/ gingivectomy, various types of flap, etc.) are detailed. Nowadays, both prosthetic and surgical treatments are considered valuable strategies for adequate tissue handling. The connective tissue graft may be considered as the most predictable surgical procedure in the management of recessions, whereas pontics are the first choice for achieving suitable aesthetic results in shaping the gingival margin.