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1. GINGIVAL CASCADE
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. INTRODUCTIO
N

“Beauty lies in the eyes of the beholder”.

Dental esthetics is based on the “white component”
(teeth ) and the “pink component” (the gingiva).

Loss of alveolar ridge with several anterior teeth through surgery or periodontal bone loss.

Poor esthetics and phonetics.
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3. Introduction…
There are three approaches
to this problem:
1) Anterior Fixed Partial Denture.
2) A tooth borne Removable
Partial Denture.
3) “Andrews Bridge” - A
combination of abutment
retainers with bar suspended
between them and the
corresponding sleeve overlaid
with acrylic resin denture
teeth and the gingiva.
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4. Introduction…

This clinical report describes the fabrication of a
Gingival Cascade, by using a simple two stage
impression technique (buccal approach).
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5. CASE REPORT
A 53 years old male patient was referred to Dept. of
Prosthodontics, for prosthetic rehabilitation of missing
upper anterior teeth.
History:-Trauma that resulted in
the loss of upper central and
lateral incisors 3 years ago.
Examination :Missing
- 11, 12, 21 and 22.
Prepared - 13 and 23
Deficient maxilla in the anterior
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region.

6. Case Report…
TREATMENT PLAN

Placement
of
two
implants in 12 and 22
region with four unit F.P.D

Individual crowns for 13
and 23

Gingival Cascade - from
heat cure acrylic material.
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7. PROCEDURE
Primary impression of the upper arch was made
using irreversible hydrocolloid impression material and
a diagnostic cast obtained.
A labial acrylic custom tray
was
fabricated
on
this
diagnostic cast extending upto
the distal embrasure of the first
premolar,
buccal
located
cusp
tips
incisal edges only.
on
the
and
the
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8. Procedure…

Palatal barrier : A silicone putty
was mixed and molded on the
palatal aspect of teeth to be
treated. After setting , this barrier
was trimmed so that it prevents
the final impression material from
escaping
palatally
without
encroaching
the
interdental
space.

Final Impression was made by
using
a
polyvinyl
siloxane
impression material and poured in
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artificial stone to get the working
model.

9. Procedure…

Wax Pattern : The cascade was
waxed up exactly as it has to
appear and tried in the patients
mouth for its adaptation.

The pattern was then flasked

Colors and stains were added at
the packing stage so as to get the
desired characterization

It
was
processed
conventional manner.
in
the
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10. Procedure…

The prosthesis was finished,
polished, and inserted in the
patient’s mouth.

Instructions
were
given
regarding the insertion and
removal of the prosthesis.

No direct retention was required
as the musculature of the lip
holds the prosthesis firmly in
place. The patient must manually
raise the lip to remove the
cascade.
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11. BEFORE
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AFTER

12. DISCUSSION


Gingival defects - surgical or prosthetic approaches.
SURGICAL TREATMENT - Successful only when small
volumes of tissues are being reconstructed.
Not popular because of cost, healing time, discomfort and
unpredictability.

PROSTHETIC
APPROACH
-
removable
or
fixed
prosthesis.
Different materials - Cold cure and heat cure acrylic
materials, porcelain, as well as silicone based soft
materials.
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13. Discussion…
A FIXED PROSTHESIS – comfort, peace of mind and
self confidence. Its use is limited to areas only where
oral hygiene can be maintained.
SILICONE – Flexible Prosthesis:
Limitations:-
1. Expensive.
2. Accumulation of stains and plaque because of
inherent porosity of silicone material.
3.Possibility of ingestion of the prosthesis during
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function.

14. Discussion…
The described technique i.e. fabrication of
Gingival Cascade by using heat cure acrylic resin
material has several advantages:
1. It is simple and inexpensive
2. It uses only conventional laboratory procedures
3. No complex attachments or bars involved
4. Allows try in of the prosthesis at the wax pattern
stage.
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15. CONCLUSION
A technique for restoring an anterior edentulous
space accompanying severe alveolar bone loss has
been described
This technique combines fixed and removable
restorations to achieve an acceptable esthetic and
functional results.
The technique described is relatively simple,
inexpensive and hygienic.
The cosmetic results achieved from this prosthesis
has enabled many patients to smile with confidence.
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16. Thank you…
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