There is the need at times to simulate soft tissue with artificial materials because of ridge or papillae deficiencies. One of the goals of the restorative clinician is to create a long-term outcome for patients that require minimal or no professional maintenance of the prosthesis. The three restorative choices to simulate soft tissue with a fixed prosthesis are:
- Pink ceramic.
- Pink composite - alone or laminated onto a ceramic base.
- Pink heated processed acrylics or injected acrylic/composite. These are generally only used for removable prosthesis such as complete and partial dentures, or hybrid implant support prosthesis, which may be removable or screw retained, so they will not be further addressed.
There are pros and cons for virtually every technique and material. The key is to assess which option is the most predictable in a given clinical situation. The advantages of pink ceramic are:
- It is non-porous.
- It is biologically compatible to soft tissue.
- It can create a smooth, highly glazed or polished surface.
- It is a stable material - it does not change over time in color, surface, or overall integrity.
The disadvantages of pink ceramic are:
- The color match to soft tissue can be challenging because of its tendency to be too violet or orange.
- The prosthesis is fabricated in a laboratory rather than directly in the patient's mouth.
The advantages of pink composite are:
- The color choices and match to natural tissue are generally better than ceramic.
- It can be applied or layered intraorally to achieve the best color match.
The disadvantages of pink composite are:
- It is more porous than ceramic, and therefore will change color over time.
- The surface appearance will change over time, typically losing its luster.
- If the composite extends over the soft tissue in a thin layer to help hide the transition line between the prosthesis and the soft tissue, this composite overlay will need to be maintained periodically (possibly as often as yearly). Remember that using this technique compromises patient oral hygiene.
- It may need to be removed and replaced to maintain its original appearance and integrity.
- There is additional clinical time and expense for the initial procedure and for maintenance.
After weighing the risks and benefits, my general recommendation is to use pink ceramic as the restorative material. Unfortunately at times this may result in slightly compromised esthetic outcome. If the clinician chooses to use pink composite alone or laminated onto a pink ceramic base, I recommend that the prosthesis be screw retained or removable in the case of an implant restoration. This allows for it to be removed from the mouth for maintenance, both for prophylaxis and refinishing the composite.