Purpose of esthetic risk assessment in prosthetic rehabilitations with gingiva-shade ceramics

Esthetic predictability and the possibility to reduce the need for more aggressive surgical interventions have been two strong reasons for the growing acceptance of gingiva shade ceramics in dental treatments. However this type of rehabilitation also has several esthetic constraints. The aim of this paper is to present an assessment system that may serve as a clinician's guideline to clearly identify the risk factors influencing the esthetic result of gum-shade ceramics and, in the end, to grade these clinical situations as high, medium or low esthetic risk. Over several years of clinical experience, the authors have identified different factors that influence the achievement of satisfactory esthetic results using gumshade ceramics: smile line, extension of the prosthetic rehabilitation, anatomical area, vertical and horizontal transition between the prosthesis and the natural gingiva, contact surface, framework material, and color. In conclusion, despite the great applicability of gingiva-shade ceramics in the resolution of clinical cases involving complex architecture of the hard and soft tissues, this procedure should not be considered one free of esthetic risk. There are different factors that should be evaluated when considering the esthetic results with gingiva-shade ceramics.