When patients lose teeth, they also lose the supporting alveolar bone and gingival architecture. Surgical procedures are available today to rebuild these deficits and to provide an esthetic framework for tooth replacement. However, when surgical procedures are contraindicated, or when it is impossible to adequately replace the amount of lost gingival architecture, prosthetic replacement is indicated.
Removable dentures routinely incorporate the lost gingival tissue in the flanges using shades of pink-colored acrylic resin. Porcelain fused to gold bridges, either supported by natural teeth or implants, may include pink-colored porcelain to achieve the same result. This allows replacement of the soft- and hard-tissue deficits without leaving dark spaces between the teeth and soft tissue or having large clinical crowns.
A technique is available for crown and bridge restorations to replace the missing soft-tissue contours independent of a fixed prosthesis. This is accomplished by means of a removable gingival replacement unit, sometimes referred to as a gingival mask.
Patients should be instructed on proper care of the prosthesis, ie, to handle with care, clean with a brush and denture toothpaste, and soak in water in a denture cup at night.
Applications for a removable gingival replacement unit, or a gingival mask, are as follows:
(1) to cover exposed crown margins
(2) to cover exposed implant components
(3) to cover root surfaces and reduce the length of the clinical crown
(4) to block out the black triangles between teeth in which gingival recession has occurred
(5) to fill in the space between the crown and the soft tissue
(6) prevent air flow through or beneath maxillary fixed restoration, improving phonetics; (7) to provide increased lip and cheek support for those patients who require it.
The advantage of this technique is that it allows for easy replacement of the soft tissue for improved esthetics while permitting easy access for oral hygiene procedures.
Aside from being a removable prosthesis, the only apparent disadvantage is the potential for fracture because of its delicate nature. However, considering the large population who use ocular prostheses or a similar design and retention concept (contact lenses), patients seem to readily adapt to their use and have been known to wear them for years, even after they fracture.
In summary, the advantages of the gingival replacement unit are numerous, including improved esthetics and phonetics while maintaining the opportunity for open embrasures and easy access for oral hygiene.
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